HCAOA: Past, Present, Future

Advocacy

by Kristin Rowan, Editor

HCAOA: Past, Present, Future

An Interview with Jason Lee and Aaron Stapleton

During this year’s HCAOA annual meeting, The Rowan Report sat down with association CEO Jason Lee and outgoing board president Aaron Stapleton. We talked about the accomplishments during Stapleton’s tenure, this year’s annual meeting, and what’s in store for HCAOA in the coming years.

Stapleton set priorities for his term

As HCAOA board president, Aaron Stapleton set three priorities: raise the association’s visibility, strengthen membership and build strategic partnerships. Stapleton said the work is beginning to change how policymakers and the broader health care community understand home care.

CEO Jason Lee Board President Aaron Stapleton HCAOA

Visibility

Stapleton said greater recognition matters because home care remains less understood outside its own professional community. Advocates, patients, families and lawmakers need a clearer picture of what home care providers do and how their services fit into the wider health care system.

“We’re actually having conversations, not introducing who we are and what we do, but building off of previous years. I went into a legislator’s office this year and she said she remembered our conversation from last year. To me, that said these people are getting it; they’re understanding what we do.”

Aaron Stapleton

Board President, Home Care Association of America

Lee's focus on growth

Membership growth is another measure of progress. Lee said HCAOA had grown to more than 5,300 members, up from about 4,600 the previous year. He credited the association’s staff and board, as well as the value members find in advocacy, education and professional connections.

Partnership efforts

Lee and Stapleton pointed to partnerships as another way to amplify the sector’s voice. HCAOA has been building relationships with organizations including the Alzheimer’s Association and other national and state-level groups. Stapleton said the goal is not simply to announce partnerships before his term ends, but to open doors that can develop into lasting relationships.

“The more you co-brand things, the stronger the voice is,” Stapleton said.

Advocating for the caregiver profession

Another priority for both leaders is changing how the work is described. They objected to the term “unskilled” when applied to home care, saying it diminishes the training, judgment and oversight involved in supporting older adults and other people who need assistance. Stapleton said he would like the industry to use “care professional” more consistently to distinguish trained, employed caregivers from the broader category of family caregiving.

That distinction is about more than terminology, they said. Home care workers can help identify safety risks, support medication routines and reduce the likelihood that vulnerable people will need hospital care. Stapleton described home care as a proactive part of the health care continuum—one that can help people remain safely at home while easing pressure on families and the wider system.

The leaders acknowledged that training and licensing requirements vary by state. Lee said HCAOA has model legislation and regulations that can help states develop home care licensure frameworks, and that the association is considering a gradual approach to credentials and broader accreditation. The aim, he said, is to establish a meaningful baseline without creating unnecessary burdens for agencies that are already operating responsibly.

2027 and beyond

As Stapleton’s term approaches its end, he said his focus is on finishing strong: continuing to support Lee and the association, sustaining membership and partnership growth, and preparing incoming president Sarah Wilson for a smooth transition. He said the next leader should be able to build on existing work while bringing her own strengths and perspective.

For both leaders, the larger goal is to make home care more visible and better understood—not only by policymakers, but by health care partners and the public. They see stronger membership, broader partnerships and more personal stories from families and caregivers as ways to make that case.

Final Thoughts

I want to thank Jason and Aaron for sitting down with me during this year’s annual meeting for HCAOA. I also want to thank HCAOA for their continued support of The Rowan Report. The annual meeting is always educational and I enjoy reconnecting with members, vendors, and staff. Until next year. 

# # #

Kristin Rowan Editor The Rowan Report
Kristin Rowan Editor The Rowan Report

Kristin Rowan is the owner and Editor-in-chief of The Rowan Report, the industry’s most trusted source for care at home news. She is also a sought-after speaker on Artificial Intelligence, Technology Adoption and Lone Worker Safety. She is available to speak at state and national conferences as well as software user-group meetings.

Kristin also runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in content creation, social media management, and event marketing. She works with care at home software providers to create dynamic content that increases conversions for direct e-mail, social media, and websites.  Connect with Kristin directly at kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

©2026 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in The Rowan Report. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com

 

New Technology Buyer’s Guide Announced

Admin

Sponsored Content

by Tim Rowan, Owner, Homecare & Hospice Buyer’s Guide

New Technology Buyer's Guide Announced

Free Online System Streamlines Tech Selection

Finding the right EMR, AMS, Telehealth System, OASIS Analyst, or Consultant can be a daunting task. And that’s before you consider the expense in both staff time and finances.

In the best-case scenario, Home Health, Home Care, or Hospice leadership selects the right match and is happy with that vendor for years. In the opposite case, the agency realizes too late that it made a bad choice and has to repeat the process a year later, or sooner.

I have seen the latter happen all too often in my 30 years as a technology selection consultant. That is why I updated and am relaunching my popular Home Care Technology Buyer’s Guide.

How it Works

Getting the full benefit from The Guide is easy

  • Create a profile so we know your business lines
  • Tell us the tech category you are ready to buy
  • Identify your healthcare category
    • Home Health
    • Hospice
    • Home Care
  • Tell us your size
    • One location
    • Multiple locations
  • Include or exclude
    • Name your current vendor in this category
    • Select whether it should be included in the results we give you
  • Review our recommendations
    • Click on each vendor’s name to read product details
    • Keep all or remove vendors from your final list
    • Advance to the RFP we have written for you; we will send it via email to each of your chosen vendors
  • Go to your desk and wait for the phone to ring

 

Beta Test Available Now

Truth be told, we are still in the process of finalizing vendor and product descriptions. Our official launch is November 1, but you can give it a look-see today.

Please be aware that the recommendations we give you are preliminary, and some may be wrong. Every day between now and November 1, our results will improve as more vendors are added.

We are giving you the link now so you can see how easy and pleasant The Guide will be to use every time you are in the market for software or services.

https://healthcareathome.news

# # #

Tim Rowan The Rowan Report

Tim Rowan is a 33-year home care technology consultant who co-founded and served as Editor and principal writer of this publication for 25 years. He continues to occasionally contribute news and analysis articles under The Rowan Report’s new ownership. He also continues to work part-time as a Home Care recruiting and retention consultant. More information: RowanResources.com
Tim@RowanResources.com

©2026 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in The Rowan Report. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com

HCAOA Annual Event Preview

Advocacy

by Kristin Rowan, Editor

HCAOA Annual Event Preview

Woah!

Orlando, Florida is known for its warm weather and sunny days. But, next week, Orlando will be “cool!” The opening keynote speaker at the HCAOA National Home Care Conference is Mr. Cool himself, Arthur Fonzarelli. Henry Winkler, aka “The Fonz”, is an Emmy Award-winning actor, director, producer, and best-selling author. He is also an advocate for people who learn differently. This year’s keynote address will certainly kick things off with humor and inspiration, but “Ayyy” that’s just the beginning.

Headliners

Joining Winkler in this year’s lineup are Disney executive Louie Gravance talking about service excellence and comedian turned motivational speaker Jeff Civillico. Gravance is the featured speaker for the opening session on day 2 of the event. Civillico is the emcee on the main stage throughout the conference.

HCAOA Annual Event Headliners

Education

If you’re heading to HCAOA next week, expect a busy schedule. The hardest part will be deciding which sessions to attend when some of the best minds in the industry have overlapping time slots. 

Home Care CEOs and software solutions providers will present real-world applications and use cases for AI in home care, workforce solutions for developing caregivers and preparing for the future, operations guidance on benchmarking, cultivating cultural connections, recruitment, employment law, and finance and marketing. 

For Floridians, HCAOA has a state-focused session track including regulatory and compliance updates a Florida Advocacy Forum. 

Fun & Games

Some of the best networking opportunities are often accompanied by a glass of wine, a coffee, or an award. Don’t miss the vendor networking breakfast and lunch, the networking reception on Monday night, and the presentation of the Caregiver of the Year Award on Tuesday morning. And, of course, if you stick around after the reception on Monday, you’re bound to find most of us at the hotel bar. 

Worth the Trip

The Home Care Association of America hosts a stellar event every year and this year is shaping up to be no different. I look forward to seeing many of you in Orlando next week. Plan your schedule here.

# # #

Kristin Rowan Editor The Rowan Report
Kristin Rowan Editor The Rowan Report

Kristin Rowan is the owner and Editor-in-chief of The Rowan Report, the industry’s most trusted source for care at home news. She is also a sought-after speaker on Artificial Intelligence, Technology Adoption and Lone Worker Safety. She is available to speak at state and national conferences as well as software user-group meetings.

Kristin also runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in content creation, social media management, and event marketing. She works with care at home software providers to create dynamic content that increases conversions for direct e-mail, social media, and websites.  Connect with Kristin directly at kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

©2026 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in The Rowan Report. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com

 

The Alliance Hosts Second Annual Advocacy Week

Advocacy

FOR IMMEDIATE RELEASE

Contact:                                                            Hannah Kristan
communications@allianceforcareathome.org
202-355-1647

Over 150 Advocates Convene on Capitol Hill to Champion Care at Home

National Alliance for Care at Home Hosts Second Annual Advocacy Week on Capitol Hill    

Alexandria, VA and Washington, DC, Sept. 16, 2026. – This week, more than 150 care at home advocates from across the country met with 285 congressional offices to discuss key legislative and regulatory priorities for expanding and protecting access to care at home. The meetings were part of the 2026 National Alliance for Care at Home Advocacy Week, an important opportunity to unite the entire care at home continuum under one voice.

Alliance Advocacy Week, now in its second year, offers a unique opportunity to bring together leaders, advocates, and supporters to amplify that home is where care happens, driving positive change and shaping the future of care to ensure that access to these essential services is protected and expanded.

"Our strength has always been our unity..." Jennifer Sheets

“This is a defining moment for care at home. When more than 150 advocates walk the halls of Congress together, speaking with one voice on behalf of patients, families, and providers, we send an unmistakable message. Care at home already has bipartisan support and recognition as a cost-effective, patient-preferred solution. As demand continues to grow, we are committed to being a strong partner with Congress to help federal policy grow with it,” said Jennifer Sheets, CEO of the Alliance. “Our strength has always been our unity, and Advocacy Week proves what we can accomplish when the entire continuum stands together to protect and expand access to the care people need, where they want to receive it most.”

Alliance Hosts Second Annual Advocacy Week

Key Issues

Advocates focused on five key issues during their congressional meetings:

End the home health and hospice provider moratoria and instead focus on implementing existing mechanisms to apply targeted, risk-based enforcement that roots out bad actors while protecting patients and legitimate providers.

Ensure that Medicare and Medicaid program integrity strategies are targeted and data-driven, focused on stopping fraudsters without harming legitimate providers or access to care, and supporting the Protecting Seniors and Stopping Fraudsters Act.

Stabilize Medicare home health payment rates by supporting the Medicare Home Health Payment Integrity and Protection Act to reverse an access crisis that has already left more than one-third of patients referred for home health without the care they need.

Protect and strengthen access to Medicaid HCBS by supporting policies and funding that let people receive care in their homes and communities, and that strengthen the direct care workforce making that possible.

Expand access to home care services by supporting the Credit for Caring Act to provide a federal tax credit of up to $5,000 to support family caregivers who provide 49 billion hours of unpaid care to relatives.

Alliance Hosts Second Annual Advocacy Week

Advocacy Week Activities

In addition to congressional meetings, Alliance Advocacy Week featured in-depth policy briefings, a training for first-time advocates, and a panel discussion with seasoned government affairs professionals. The Alliance celebrates another successful Advocacy Week on behalf of care at home providers across the country and looks forward to continuing its work with policymakers and key stakeholders.

# # #

About the National Alliance for Care at Home

The National Alliance for Care at Home (the Alliance) is the leading authority in advancing care in the home. We envision an America where everyone has access to the highest quality, person-centered healthcare wherever they call home. Through advocacy, education, and convening, we connect providers and stakeholders to strengthen care delivery across the home-based care continuum — spanning home care, home health, hospice, palliative care, and Medicaid home and community-based services. Learn more at www.AllianceForCareAtHome.org.

©2026 The National Alliance for Care at Home. This press release was issued by The National Alliance for Care at Home and is reprinted here with permission. For more information, please see contact information above.

Private Duty Fraud Enforcement

Admin

by Elizabeth E. Hogue, Esq.

The Future of Private Duty/Home Care

It Begins with Fraud Enforcement

Use of private duty/home care services continues to increase. It has become increasingly clear, however, that companies will not be permitted to care for patients who need these services without considerable additional oversight.

The proverbial “bottom line” is that private duty/home care companies will be under greater scrutiny and regulation. The instances of gross mistreatment of patients, some of which we have described in previous articles, are too shocking and lurid. And caregivers about whom lip service is given about their need for support have been mistreated by private duty companies.

And Then There's This:

The feds are convinced that there is rampant fraud in state Medicaid Programs to the tune of millions, if not billions, of dollars that has not been addressed. The number of fraud strike forces, task forces, etc. targeting companies that provide services to Medicaid recipients are now too numerous to count.

Fraud enforcement is definitely “in fashion” and enforcers are eager to put private duty/home care companies in the color orange! If this a fashion statement you want to make?

To Illustrate:

The National Fraud Enforcement Division of the U.S. Department of Justice (DOJ) recently announced that it has prosecuted 6200 defendants who collectively billed federal health care programs, including Medicaid, TriCare, the VA and others, $45 billion.

In a press release issued on August 4, 2026, the Division stated:

“Home care fraud is everywhere, and the victim is all of us taxpayers. Medicaid claims date and the experience of veteran prosecutors all point to the systematic exploitation of reimbursable home care programs….Today. we sound the alarm on the scale of this fraud by announcing some truly egregious cases, in which numerous people are charged with filing fraudulent claims for caregivers who were not actually providing home care services, but in fact were dead, in prison, or trafficking drugs. This racket ends today.”

And There's More!

“Let today’s announcement be a warning to those engaging in similar activity: if you seek to exploit our health care systems for personal profit, you should expect the FBI and our partners to uncover your scheme and bring it to an end. Every dollar stolen through fraud is a dollar diverted from patient care, and the FBI will continue its work to safeguard the public’s trust and hold accountable those who abuse these vital programs.”

Finally the press release promises that enforcers “…will pursue anybody who seeks to profit at the expenses of American taxpayers, regardless of whether the wrong doing is in the boardroom or in the sickroom.”

In other words, it’s not just the perpetrators who will be punished. The companies, owners and managers will also face punishment.

So, what are some of the offenses pursued so far?

Private Duty Fraud Enforcement

One of the defendants was captured on tape:

”This home health care is the best kept secret…I made a buck plus (each of) the last five years. That’s a half million dollars… ain’t checking on nobody.”

It may be tempting for owners and managers to say: “That’s on them.” Not so! Companies and management will be held accountable for the actions of their employers and contractors.

Private duty/home care companies will see a tsunami of regulation. Use of fraud and abuse prohibitions is just the beginning.

# # #

Elizabeth E. Hogue, Esq The Rowan Report
Elizabeth E. Hogue, Esq The Rowan Report

Elizabeth Hogue is an attorney in private practice with extensive experience in health care. She represents clients across the U.S., including professional associations, managed care providers, hospitals, long-term care facilities, home health agencies, durable medical equipment companies, and hospices.

©2026 Elizabeth E. Hogue, Esq. All rights reserved.
No portion of this material may be reproduced in any form without the advance written permission of the author.

©2026 by The Rowan Report, Peoria, AZ. All rights reserved. 

HHAeXchange Launches RCM Services

Admin

by Kristin Rowan, Editor

HHAeXchange Announces RCM Services

An Interview with Phil Feldman

In April of 2026, HHAeXchange unveiled their new end-to-end Revenue Cycle Management (RCM) service. HHAeXchange is a leading provider of homecare program management designed for Medicaid Home and Community-Based Services. (HCBS).

Addressing Top Concerns

HHAeXchange’s 2025 Provider Voice Survey asks homecare agencies about the pain points facing the industry. Administrative workload and cost are significant areas of concern for homecare agencies, cited by 41% of providers. RCM services address these concerns by removing administrative tasks from agencies, freeing up personnel to focus on growth, community outreach, referrals, and caregiver training. 

“Homecare providers are navigating diverse payers, rising costs, growing administrative demands, and an increasingly complex financial and regulatory environment. RCM Services relieves agencies of the operational burden of billing and collections while improving cash flow and business performance. By offloading revenue cycle management to experts who deeply understand homecare and the HHAeXchange platform, agencies gain clarity, efficiency, and more time to focus on care.”

Paul Joiner

CEO, HHAeXchange

From Submission to Resolution

End-to-end RCM services handle the full revenue cycle. The RCM Services team at HHAeXchange handles everything from the initial claim submission to handling discrepancies, resolving rejections, appealing denials, and shortening the cycle of aging receivables.

Improved Cash Flow

RCM services go beyond billing and collections. HHAeXchange uses operational intelligence to track denial trends, authorization issues, and payer challenges. With these issues addressed at the beginning, claims are cleaner, denials are reduced, and agencies stay in compliance. These are issues cited by 70% of homecare agencies. 

With improved cashflow, agencies have the resources to grow, to invest in their staff, to scale operations, and to create a more stable work environment.

HHAeXchange RCM Services

Phil Feldman, National Director of RCM

The Rowan Report sat down with Phil Feldman, the National Director of RCM for HHAeXchange. Feldman, and the RCM service platform, came from Sandata and joined HHAeXchange in the acquisition in 2024. We asked Feldman about RCM services: 

The Rowan Report:

What makes HHAeXchange’s RCM different?

Phil Feldman:

The RCM service platform is specific. It is specific to home care, specific to Medicaid, and specific to HHAeXchange. Agencies are connected to resources within the organization. We have existing relationships with payors that we can resolve directly. And the customer-facing team, the experts handling your revenue cycle, are employees of HHAeXchange, not a partner or a 3rd party.

RR:

What is the agency experience with HHAeXchange’s RCM service?

Feldman:

We are currently only offering the RCM services within the HHAeXchange platform. You have one vendor and one platform. When there’s a finger to point, it points right back at us. 

Every account has at least one RCM advisor who serves as the primary point of contact, working with the agency on their billing schedule, their time-keeping week, and the whole process from close to claim.

The intelligence in the platform goes beyond mechanically processing claims and takes a holistic approach. The system checks for demographic descrepancies from intake like member IDs, gender alignment, ID updates from new payors, overservicing on claims, providing services past the end date or outside allotted days. We look directly at the agency’s denial trends and go upstream in the revenue cycle to fix the whole process, not just one claim.

Results

With just under five months since the full launch, and nearly a year of data from beta test agencies, Feldman says their agency claims are in the 90% collection rate. Claim denials, clawbacks, and remit time are trending down. A full data set is forthcoming, but for now, Feldman is relying on anectodal evidence: Their customers are referring agencies that are looking for RCM solutions.

“You’re the best thing ever. I have a lot of friends that I consult with and help them run their business. I want to introduce them to you.”

– An Indiana Agency Owner

Final Thoughts

Hiring and retention issues, reimbursement rates, administrative workload, operational costs, denials, payor compliance, authorizations…these issues are universal across home care and aren’t going away any time soon. If you’re looking for ways to optimize your current workforce, reduce overhead costs and tasks, and create a steady cash flow for your agency, outsourcing RCM is one way to do it. If you’re already an HHAeXchange customer, well, it just makes good sense to work within the system you know, with advisors who take time to understand your agency, and the backing of decades of experience.

# # #

Kristin Rowan Editor The Rowan Report
Kristin Rowan Editor The Rowan Report

Kristin Rowan is the owner and Editor-in-chief of The Rowan Report, the industry’s most trusted source for care at home news. She is also a sought-after speaker on Artificial Intelligence, Technology Adoption and Lone Worker Safety. She is available to speak at state and national conferences as well as software user-group meetings.

Kristin also runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in content creation, social media management, and event marketing. She works with care at home software providers to create dynamic content that increases conversions for direct e-mail, social media, and websites.  Connect with Kristin directly at kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

©2026 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in The Rowan Report. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com

 

The Broadway Secret

Admin

by Aaron Marcum

The Home Care Back Stage

The Broadway secret every home care owner needs to know

A few years ago, I took my daughter to see “Wicked” in London’s West End.

From the moment the lights dimmed, we were transported. The performances were flawless, the choreography mesmerizing, and the vocals spine-tingling. For two and a half hours, we sat captivated by what appeared to be theatrical magic.

It looks like magic

But here’s what struck me as I watched: what we were experiencing wasn’t magic at all. It was the result of an incredibly sophisticated operation happening behind that curtain—an operation most audience members never think about.

Dan Sullivan, founder of Strategic Coach, calls this the “Front Stage” and “Back Stage” of your business. And it’s a framework that every home care owner needs to understand.

The Home Care Back Stage

What Makes Broadway, Broadway?

When you pay for a West End ticket, you’re not just paying for talented actors. You’re paying for a lighting crew coordinating hundreds of cues per show, costume designers managing dozens of quick changes, sound engineers balancing multiple wireless microphones in real-time, stage managers calling hundreds of technical cues with split-second precision, and a production team that rehearsed for months before opening night.

The Front Stage—what the audience sees—only shines because of an exceptional Back Stage.

Your home care business has the same dynamic

Front and Center

In our industry, the Front Stage is your care professional arriving at Mrs. Johnson’s home at 9 AM. It’s the smile, the gentle assistance with morning medication, the conversation during breakfast, and the compassionate help with bathing and dressing.

That’s what your clients see. That’s what their families remember. That’s how your business gets judged.

But we all know that caregiver showing up prepared, on time, and trained isn’t an accident.

Behind the Scenes

Your Back Stage makes it possible: 

  • Care Coordination ensures the right caregiver with the right skills is scheduled for the right client. When this system fails, clients feel it immediately.
  • Billing Systems that work seamlessly mean caregivers get paid accurately and on time—because nothing destroys Back Stage morale faster than payroll errors.
  • Compliance Infrastructure keeps you operating legally and safely, protecting both your clients and your business.
  • Recruitment and Hiring processes that attract quality candidates. With projections showing a national shortage of 151,000 caregivers by 2030 and 355,000 by 2040, your Back Stage recruiting determines whether you have anyone to put on the Front Stage. As a side note, I personally believe the shortages are greater than this.
  • Training Programs that don’t just check boxes but actually prepare caregivers for real situations. The 2025 Activated Insights Benchmarking Report found that agencies offering 8+ hours of orientation training had median revenue of $2.4 million compared to $2.03 million for those with 3 or fewer hours.
  • Retention Strategies because the average caregiver costs $2,600 to replace Activated Insights. Your Back Stage culture determines whether caregivers stay or leave.
Home Care Broadway Back stage
Home Care Broadway back stage

The Numbers Tell a Sobering Story

Here’s the reality: the home care industry’s turnover rate reached 79.2% in 2023 Home Health Care News—the highest it’s been in five years. Think about that. In an agency with 100 caregivers, you’re replacing nearly 80 of them every single year.

But it gets worse. Nearly four out of five caregivers leave their job within the first 100 days of employment. That means the caregivers you just spent weeks recruiting, screening, and training? Most of them won’t even make it through their first three months.

When your Back Stage is weak, these statistics become your reality.

The "Community Theater" Problem

We’ve all attended shows where you could tell the Back Stage was struggling.
Maybe you’ve seen a local production where an actor missed their entrance, the lighting was off, a scene change took too long, or the sound cut out.

You couldn’t see the Back Stage problems, but you absolutely felt them.
The same thing happens in home care.

A weak back stage

When your Back Stage is weak:

  • Caregivers show up late (or not at all) because scheduling is chaotic
  • Families receive incorrect bills because systems are disconnected
  • Care quality suffers because training is inconsistent
  • Your reputation erodes one Front Stage failure at a time

Your clients might not know your payroll system crashed or that your care coordinator called in sick for the 4th time this month, but they experience the consequences.

The Broadway Standard Question

So here’s the question every home care owner must ask:

Is your business operating at Broadway standards, or community theater? Be honest.

When you look at your Back Stage operations:

  • Can your care coordinators instantly access complete client information?
  • Do your caregivers have clear protocols for every situation they might encounter?
  • Is your billing accurate enough that families rarely question an invoice?
  • Do you have documented processes, or is everything “in someone’s head”?
  • Could your business run smoothly if your top coordinator was suddenly unavailable?

The best home care agencies—the ones with waiting lists and stellar reputations—aren’t just lucky. They’ve built Broadway-quality Back Stage operations.

They’ve invested in systems, training, and processes. They’ve documented their playbook. They’ve made the Back Stage so strong that the Front Stage can shine consistently, every single day.

Because here’s what I learned watching “Wicked”: excellence isn’t about one amazing moment. It’s about a thousand excellent decisions that happen when no one is watching. 

The question is: what's happening in your Back Stage?

Want to build your Broadway-worthy Back Stage?

Stay in the know with strategies, insights, and practical resources designed specifically for home care owners. Subscribe to receive updates, newsletters like this, and tools that will help you elevate both your Front Stage performance and Back Stage excellence. Because your caregivers—and your clients—deserve a five-star experience every single time.

# # #

Aaron Marcum Home care and Broadway
Aaron Marcum Home care and Broadway

Aaron Marcum is an entrepreneur and thought leader who has dedicated his career to transforming the home care industry and nurturing business leaders.

As the founder of Home Care Pulse (now Activated Insights), he pioneered the Best of Home Care® program, revolutionizing quality standards in senior care across North America. His expertise as a Certified Blue Ocean Strategy practitioner and former Certified EOS Implementer has helped shape some of home care’s most respected brands.

© 2026 This article originally appeared in Aaron Marcum’s newsletter and is reprinted here with permission. For more information or for permission to use this material, please contact Aaron Marcum.

Healthcare Workers May be Deported

Home Care

by Tim Rowan, Editor Emeritus
Author’s note: This analysis does not address the right and wrong of  legal asylum status, but will focus only on the impact of deporting tens of thousands of healthcare workers.

Thousands of Healthcare Workers Could be Deported

Florida Will Be Hit Hardest

Denise Bellville is alarmed by looming unintended consequences of this administration’s border protection policy. The Executive Director of the Home Care Association of Florida has good reason. She estimates that 35,000 Haitians work in healthcare in her state, a full third of the U.S. total. Some are in-home caregivers; a few are home care agency owners.

As of last week, all are at risk of being sent back. Temporary Protected Status, given to asylum applicants from dangerous countries, has been canceled for immigrants from specific countries. Among them are 353,000 Haitians, along with applicants from eight other countries. The Supreme Court is yet to rule on four more nations named in the DHS removal request.

“Broward County is one of about six counties that will be hit especially hard and have already begun to feel the effects of the July 24 SCOTUS decision,” she told us. “Two [agencies] there have already closed. One determined that 85 of its 86 caregivers are vulnerable for deportation. The other said that Creole-speaking clients made up 80 percent of its business.”

When the Department of Homeland Security announced “Termination of Temporary Protected Status for Haiti,” the order included a little more than 353,000 Haitian asylum applicants, more than 112,000 of whom work in the U.S. healthcare system. Industry estimates indicate one-third of these healthcare workers, roughly 35,000 Haitians, live and work in Florida.

Why So Many in Florida?

There is a large population of Haiti-born U.S. citizens in Florida. Some have been there for generations. They still speak a unique version of French and hold onto ancient Creole culture. “Caregivers from their own country, who understand both the language and the traditions of these now-elderly citizens are the only ones who can effectively care for them in all settings: home, hospital, and skilled nursing facility,” Bellville said. “When these 35,000 healthcare workers are gone, there are no others who can provide that level of care,” she asserted. “The problem will exacerbate what was already our critical in-home caregiver shortage.” She referred to a disturbing Florida reality:

  • Florida’s population is over 23.5 million
  • 22.8 percent are over 65 years of age, roughly 5.35 million residents
  • The national average is 18.9 percent
  • The state has 16 caregivers per thousand residents
  • The national average is 65 caregivers per thousand

When asked what recourse is available, Ms. Bellville said an association cannot do much. “We even talked with Hospital and LTC associations about working together,” she said. “All of them responded that, sadly, even if we work together, we do not have sufficient clout to make a difference.”

Legal Battle Background

How Asylum Became Expulsion

Thousands face deportation

The U.S. welcomed Haitians when life became dangerous in their home country. Gang violence, a problem for decades, led to the assassination of President Jovenel Moïse in 2021. In the absence of leadership, street gangs took over. Life became cheap. Good people, even if unrelated to any gang, were murdered at random. Due to the rampant violence, the U.S. State Department maintains a Level 4 “Do Not Travel” warning for Haiti. Unemployment is 15 percent; among youth, it is more 37 percent.

The Biden administration processed asylum applications by the thousands. Border Patrol accepted most claims of danger back home. For four years, hopeful applicants, including Haitians, waited for their court asylum hearings. While they were waiting, they legally sought jobs in various sectors, more than a third of them in healthcare. 

Decades into a seemingly unsolvable, unending caregiver shortage, Home Care agency owners welcomed these new arrivals, trained them, and sent them out to care for the elderly in their homes, skilled nursing facilities, and rehab hospitals. Their fluency in Creole French and familiarity with Haitian culture made them invaluable in those communities.

On June 24, 2026, the Supreme Court issued a 6-3 ruling in Mullin v. Doe, denying a challenge to the terminations of TPS for Haiti and Syria. The decision granted DHS permission to move forward with implementing the terminations of TPS for those countries and eight others. Four more countries on the DHS list are expected to follow. 

Epilogue

The $tats

The eventual loss of 112,000 healthcare workers will create a gaping hole in the availability of services. It will also have an impact on the U.S. Treasury and the overall economy. According to a report from Fwd.us, Haitian TPS holders contribute $5.9 billion to the U.S. economy annually. In Springfield, Ohio, where Haitian refugees were invited by the city to live and work, they added $91 million to that town’s economy. They pay over $1.5 billion per year in federal, payroll, state, and local taxes.

Based on DHS published estimates of the cost of deportation ($17,121 per person), sending 353,000 Haitians back to their island will require an expenditure of $6.04 billion. Some of that cost may be reduced by voluntary deportations that do not involve the cost of law enforcement.

Anyone choosing to self deport may have to hurry. Enforcement has already begun. HCAF Director Denise Bellville told us that some of her member agencies have reported ICE agents have started knocking on their doors unannounced, demanding to conduct I-9 audits.

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Tim Rowan The Rowan Report
Tim Rowan is a 33-year home care technology consultant who co-founded and served as Editor and principal writer of this publication for 25 years. He continues to occasionally contribute news and analysis articles under The Rowan Report’s new ownership. He also continues to work part-time as a Home Care recruiting and retention consultant. More information: RowanResources.com
Tim@RowanResources.com

©2026 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in The Rowan Report. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com