Hospice Hope

by Rowan Report | Jul 10, 2025 | Admin, CMS, Hospice, Outcomes, Regulatory

by Peggy Rattarree, Principle Product Manager, Curantis Solutions

Hospice HOPE

The importance of documenting symptom impact for patient-centered care

In hospice care, the focus isn’t just on treating symptoms; it’s on improving the quality of life for patients and their families. This is where Hospice HOPE takes center stage, emphasizing the importance of documenting symptom impact to deliver truly patient-centered care. By understanding how symptoms affect each patient’s physical, emotional, and psychosocial well-being, hospice teams can provide care that aligns with their unique needs and goals.

What is hospice HOPE?

Hospice HOPE stands for Hospice Outcomes and Patient Evaluation. It’s a philosophy that places the patient’s comfort, dignity, and goals at the forefront of care delivery. Documenting symptom impact is a critical part of this approach because it provides a detailed understanding of how symptoms affect the patient’s overall quality of life.

In hospice care, every patient’s journey is unique. By actively tracking and documenting symptom impact, care providers can move beyond generic treatments and embrace a truly individualized approach that prioritizes what matters most to the patient.

Why documenting symptom impact matters?

Moves us to patient-centered care

Documenting symptom impact allows hospice teams to focus on what truly matters to the patient. Instead of simply addressing symptoms like pain, nausea, or fatigue in isolation, it provides a holistic view of how these symptoms affect the patient’s daily life. For example:

Pain
- How does it limit mobility or the ability to participate in meaningful activities?
Fatigue
- Is it preventing patients from spending time with loved ones?
Nausea
- Is it reducing their ability to eat or enjoy meals?

By asking these questions and recording the answers, hospice providers can better tailor interventions to manage not just symptom management but the overall patient experience.

Improves communication across the care team

In hospice care, communication is everything. Documenting symptom impact ensures that every member of the interdisciplinary team (IDT), from nurses and physicians to social workers and chaplains, has access to the same comprehensive information.

This documentation:

Creates a shared understanding of the patient’s condition
Helps align the team’s goals with the patient’s priorities
Reduces duplication of efforts and enhances care coordination

When everyone is on the same page, patients and families receive more seamless, cohesive care.

Supports compliance and quality standards

Regulatory bodies like CMS (Centers for Medicare & Medicaid Services) require hospices to document and monitor patient symptoms to ensure care quality. But beyond compliance, tracking symptom impact demonstrates a commitment to continuous improvement.

Documenting symptom impact allows hospices to:

Identify trends and gaps in care
Measure the effectiveness of interventions
Use data to advocate for better resources or innovations in care delivery

Empowers families and caregivers

When symptom impact is documented, families and caregivers gain a clearer understanding of their loved one’s condition. This transparency fosters trust and collaboration between the hospice team and the family, ensuring everyone is working toward the same goals.

For example, a caregiver might better understand why a loved one sleeps more during the day or avoids certain foods. These insights can help families feel more prepared and supported during a challenging time.

Final Thoughts

With CMS rolling out Hospice HOPE, documenting symptom impact is no longer optional. It’s the standard for compassionate, high-quality care. This shift helps hospice organizations go beyond symptom control and into whole-person care that honors each patient’s life journey.

This is part one in a two-part series on Hospice HOPE. Check back next week for part two.

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Peggy Rattarree Curantis Solutions Hospice HOPE

Peggy is an IT professional with over 30 years’ experience. She has defined and developed software products in industries such as grocery management, financial services, and reporting and analytics. In her 2.5 years with Curantis, Peggy has helped to shape the definition and delivery of the application. She brings a passion for agility and has been integral in transitioning Curantis to an environment of delivery on cadence, release on demand.

Peggy has a Bachelor of Music degree from University of North Texas.

©2025 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in the Curantis Solutions blog and is reprinted here with permission. For more information or to request permission to print, please contact Curantis Solutions.

Gaslighting Patients and Caregivers

by Elizabeth E. Hogue, Esq. | Mar 31, 2025 | Admin, Caring for the Caregiver, Clinical

by Elizabeth E. Hogue, Esq.

Gaslighting

Gaslighting, According to:

Nurse Professional Liability Exposure Claim Report: 4th Edition issued by Nurses Service Organization and CNA, for the period from 2016 to 2019 nurses who prvided services to patients in their homes; including those providing home health and hospice, and palliative care; were the most vulnerable of all nursing specialities to professional liability claims.

A Dubious Distinction

This is the first time that nurses in home care topped the list since the reports were first compiled in 2008. Home care nurses accounted for 20.7% of claims, which represents an increase of 12.4% over the previous number reported in 2015. Adult medical/surgical nurses topped the list in past reports.

Tell me Why

These factors may contribute to increases in claims against home care nurses:

Lack of institutional support for home care nurses that is routinely received by nurses in hospitals and other facilities
Growing popularity of home care
Rising acuity of home care patients
Lack of 24-hour oversight of patients
Absence of equipment in patients’ homes that is readily available in institutional settings to help identify patients at high risk for negative outcomes

According to the Experts

However, the nonprofit organization Emergency Care Research Institute (ECRI) says that eroding trust is a major threat to patient safety in 2025. ECRI ranks “gaslighting,” or dismissing concerns of patients and caregivers, as the top issue. In other words, nurses aren’t listening to patients and their caregivers! There is an old adage that says that if practitioners would just listen to their patients, patients will tell them what is wrong (i.e., the diagnosis). Perhaps, then, the best way to avoid negligence and resulting lawsuits is to listen to patients and caregivers.

Gaslighting Safeguards

Other strategies that nurses can use to protect themselves from malpractice claims include:

Stay up to date on education and training
Document assessments of patients in a timely and objective manner
Go up the chain of command when concerned about the well-being of patients
Maintain files that demonstrate character; such as letters of recommendation, notes from patients, and performance evaluations

Of course, complete, accurate and contemporaneous documentation may provide the best defense of all!

Final Thoughts

An increase in malpractice claims against home health and hospice nurses is a significant new industry development. It’s time to move risk management, with a focus on listening to patients and caregivers, higher up the list!

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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.

No portion of this material may be reproduced in any form without the advance written permission of the author.

©2025 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

Perfect Storm

by Rowan Report | Feb 20, 2025 | Admin, Clinical, CMS, Regulatory

by Hannah Vale, CMO HealthRev Partners

Care at Home Industry Faces Perfect Storm

Industry Challenges in 2025

The care at home industry is grappling with an unprecedented crisis as staffing shortages, technological hurdles, and complex reimbursement models converge to create significant operational challenges. Industry experts warn that without immediate intervention, patient care could be severely impacted.

Staffing Crisis Reaches Critical Levels

The staffing shortage in home health care has intensified dramatically since the COVID-19 pandemic. Carole Carlson, Registered Nurse (RN), Administrator at Avant Home Care, is a veteran with 36 years of experience in the field. She reports unprecedented difficulty in recruiting registered nurses.

“We’re seeing a mass exodus of healthcare workers who have found remote work alternatives. This exodus has also led to a significant caregiver shortage, causing a decline in non-skilled care services.”

Carole Carlson

Administrator, Avant Home Care

RN Shortage

“The other issue is the RN shortage. This is our first time ever experiencing an RN shortage. We are not even getting applicants, whereas in the past we have always had nurses apply and were able to hire within a relatively short period of time,” Carlson added.

Michael Greenlee, Founder and CEO of HealthRev Partners, notes that the shortage is systemic, with insufficient new workers entering the field to meet growing demand. The situation is particularly dire in rural areas, where agencies face additional challenges in attracting and retaining staff.

Connectivity Issues on Top of Documentation Burden

The documentation requirements for home health care are proving to be a major source of burnout among nurses. Pointedly, in rural areas, the problem is exacerbated by poor connectivity:

Many patients still rely solely on landlines
Large areas lack cell coverage
Limited or no WiFi access is common

These issues often force nurses to complete documentation after hours, significantly impacting their work-life balance. Greenlee suggests that emerging satellite connectivity solutions could potentially address these issues in the future.

EMR Limitations

Electronic Medical Record (EMR) systems, while essential, present their own set of challenges. Agencies find that basic systems require multiple costly add-ons for full functionality.

Carlson identifies several gaps in current EMR systems:

Lack of built-in HIPAA-compliant dictation capabilities
Limited care plan template libraries requiring extensive manual input
Need for multiple add-ons to achieve full functionality

These limitations are forcing agencies to invest in additional software solutions, further straining already tight budgets.

Medicare Advantage Complicates Operations

The growing prevalence of Medicare Advantage plans is adding another layer of complexity to home health care operations. In one agency’s case, Medicare Advantage patients now represent 30% of their 160-patient census, equal to traditional Medicare patients. Each Medicare Advantage plan comes with different requirements, creating a significant administrative burden for agencies.

“Keeping up with the varying billing requirements across plans is a constant challenge for our small staff,” Carlson notes. “The need to maintain efficient workflows with clearinghouse and software updates for different payers is putting additional strain on already stretched resources”

Final Thoughts

As the care at home industry navigates these multifaceted challenges, experts stress the urgent need for comprehensive solutions to ensure the continued delivery of quality care to an aging population increasingly preferring to receive treatment at home.

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Hannah Vale, M.Ed. is a dynamic leader bringing a wealth of experience and marketing innovation to her role at HealthRev Partners. Hannah is dedicated to helping post acute agencies streamline processes, optimize reimbursement, and embrace tech-driven solutions. She is recognized as an advocate for empowering agencies with the tools and knowledge they need to drive successful growth. A lifelong learner and former educator turned entrepreneur with a proven track record in launching and scaling businesses, passionate about creating impactful strategies that unite purpose and business. Hannah is also the co-host of the Home Health Revealed podcast, where she discusses industry insights and shares stories from experts in all things pertaining to home health, hospice, and palliative care. Hannah holds a Bachelors Degree in Education from Cleveland State University and a Masters in Educational Leadership from Evangel University.

©2024 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in Healthcare at Home: The Rowan Report. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com

Product Review: Plan-of-Care Documentation

by Kristin Rowan | Jan 23, 2025 | Admin, Clinical, Product Review

by Kristin Rowan, Editor

OASIS Assessment is a Time Suck

Regulatory requirements for home health quality assurance are designed to monitor and improve quality of care. QA focuses on ensuring that patients get safe, effective, compassionate care that meets their individual needs. QA also improves patient outcomes and reduces adverse events like ER visits and rehospitalizations. OASIS includes 79 standardized medical, nursing, and rehab data elements for a comprehensive assessment. Typical OASIS assessments take 1-2 hours to complete, depending on the patient’s complexity and the assessment type.

Artificial Intelligence in OASIS coding

The Rowan Report recently came across a tool that addresses the complexities of OASIS coding. We sat down with Zach Newman (CEO) and Dan Conger (Founder) at Enzo Health to learn more about their AI powered QA tool with customizable workflows.

Co-pilot for Your Agency

Enzo Health is a documentation tool that automates workflows, acting as a co-pilot for your agency. Some of the workflows that Enzo Health supports include intake, OASIS, and QA reviews. Automating these processes can reduce errors and clawbacks, save your clinicians hours of paperwork, and offer cost savings to your agency.

QA Process

With the Enzo health QA tool, users upload all documents related to an episode. This will include the referral, initial visit notes, patient information, medical history, and form 485. Enzo calls out any issues it finds in the documentation.

In Face-to-Face encounters, Enzo looks for dates, signatures from qualifying clinicians, a valid primary diagnosis, and other qualifying information.

For ICD-10 Coding, Enzo assesses primary and secondary diagnoses, and adds notes with links to where the information can be found in the uploaded documentation.

Enzo then provides functional limitations and improvements that can be made. Using a team of clinicians that are trained as home health coders, Enzo provides a proxy for internal teams. These coders review charts and finalize diagnosis coding and OASIS answers.

Episode of Care

Qualification for an episode of care is required before anything else happens with a referral. Enzo’s intake automation tool reviews the referral package in advance of the initial F2F. Mirroring the agency’s internal intake process, Enzo determines whether the patient will be admitted to care, whether their insurance will cover the episode, and whether the patient’s psych history may impact the plan of care.

Clinical Assistance

The Rowan Report has often stated, and will continue to stand by this fact, that there is no substitute for face-to-face care and the expertise of the nurses and clinicians in the home. We have also seen the advancement of artificial intelligence that provides assistance and guidance at the point-of-care that can be useful. Enzo health includes a chat tool that pulls evidence-based information to provide guidance, coding instructions, and other help to nurses.

QA Tool Integration with Scribe Tool

Enzo Health has developed a talk-to-text scribe tool that integrates directly with the QA tool. The use of both products together would likely save more time as well as reduce errors. The Rowan Report will provide a thorough product review of the scribe tool at a later date. Enzo Health charges a flat fee determined by volume and offers bundle pricing for using both the QA and Scribe tools.

Final Thoughts

Costs are increasing, the workforce shortage is ongoing, nurses are suffering from burnout, and employees are stretched about as thin as they can go. Any tool that alleviates paperwork, stress, unpaid work at home to finish documentation, and the need for additional back-office staff is worth looking into. Enzo differentiates its tool from other QA software with their team of clinicians trained in home health coding to review the documentation. This end-to-end tool boasts a 95% accuracy rate and do date has no clawbacks or ADRs.

In my conversation with Zach and Dan, their coding expertise and knowledge of the home health industry were evident. They are excited about the tools they are creating and passionate about helping agencies to provide patient care, a task they referred to as “very noble.” They continue to improve upon their software and conceive of innovative additions. If they continue as they started, Enzo Health will be one to watch.

Year of the Caregiver

by Kristin Rowan | Dec 19, 2024 | Admin, Caring for the Caregiver, Clinical, Editorial

by Kristin Rowan, Editor

Year of the Caregiver

Medical and non-medical caregivers in home health, hospice, palliative, and home care are the life-blood of the industry, without whom Care at Home would not exist.

Agency owners are limited in their capacity to compensate caregivers, working with CMS reimbursement rates, PDGM, and VBPM. However, Agency owners also know that caregivers are selfless, caring, empathetic, and dedicated. They also spend hours upon hours on documentation, drive billions of miles per year (literally), and adapt to changing industry regulations regularly.

So, how do you, as an agency owner, executive, or manager, care for your caregivers in a meaningful way to express your appreciation for all that they do? How can you impact the high turnover rate? Pay raises are limited by CMS and insurance companies. Benefits are expensive for an already low-margin industry. Extended vacations limit the care you can provide your clients.

The Advantages of Employee Recognition

When your employees are engaged and feel appreciated, they are more loyal. Loyal employees are less likely to leave for another job, even if the pay rate is slightly higher. Employee recognition helps retain your best employees, increases their engagement, encourages best practices, and can be used as a recruitment tool when you need more staff.

A 2023 study highlights the importance of employee recognition. Employees who are likely to be recognized are more than twice as likely to go above and beyond their regular duties. Hearing a sincere “thank you” from the boss yields a 69% increase in extra effort. Personal recognition would encourage 37% of respondents to do better work more often.

Simple Start

Employee recognition programs don’t have to overhaul your organization, take a lot of time, or cost a lot of money. Start simple and see where it takes you.

Celebrate Major Achievements and Small Wins

It’s important to recognize major achievements like gaining a new licensure, getting a referral for a new client, a positive online review, or a great star rating. How long an employee is with the company is an easy milestone to celebrate. Accolades for 30, 60, & 90 days, one year, five years, 10 years go a long way.

Equally important is celebrating smaller victories like completing a training, submitting accurate documentation, picking up an open visit, and birthdays.

Peer-to-Peer Recognition

Giving your employees the opportunity to recognize and celebrate each other creates a culture of appreciation within your agency, even when your employees are rarely together. Picking up a shift, trading a day off, helping answer a question, or simply encouraging a new employee during training are things you might not see, but your employees will. Give them an outlet to celebrate each other.

Peer-to-peer recognition can be done with group text messages or an internal IM system like Slack or Microsoft Teams. For employees who are in the office, you can create a message board for notes, encouragement, and thanks. Create a monthly gift and let employees nominate someone for an act of kindness or helpfulness.

Organizational Change

Once you’ve established a Culture of Caring, ask your employees what they want and need. If recognition isn’t meaningful, it may not have the desired effect.

Scheduling

A study out of the Leonard Davis Institute of Health Economics, 30% of registered nurses and 25% of licensed practical nurses left their positions in a home care agency in the course of one year. Part of the reason for the high turnover rate is schedule volatility. Another study concluded that high schedule variability in just 30 days increased the risk of turnover by 20%.

No change will eliminate client cancellations or immediate starts-of-care under the acceptance-to-service policy. But, that doesn’t mean you can’t minimize the volatility of a schedule.

Automating the scheduling process using existing technology now allows home care agencies to offer open appointments in a “gig economy” style. Caregivers are notified by AI of a visit that needs to be covered, giving them the option to change their schedule. That autonomy reduces the feeling of stress caregivers have over schedule changes.

Stand-alone software options for automated scheduling and reduced schedule changes include Axle Health and Caring on Demand for home health and CareSmartz360 for non-medical supportive care. AI powered scheduling inside EMRs and agency management software include AlayaCare, HomeCare Homebase, CareVoyant, Axxess, Careswitch, and AxisCare, among others.

Documentation

Some sources suggest that home health workers spend up to three hours per shift at home finishing documentation. Visit times increase when employees are documenting on paper or on a device during the visit.

One of the latest innovations in care at home software is AI powered talk-to-text scribe tools. Mobile applications using artificial intelligence record visits and transcribe conversations. The documentation tool scans the transcript as well as all patient data from the EMR and creates the needed documentation. Once a visit is over, the AI tool can finish documentation sometimes within minutes, requiring just a quick review by the visiting caregiver before submitting for QA.

Talk-to-text scribe tools are both stand-alone voice capture and integrated documentation tools. Some of the best talk-to-text scribe tools we’ve found are Athelas Scribe, Ybot, Andy, and Nvoq. OASIS and documentation automation reduces the burden on caregivers even more, almost eliminating the additional time spent at home reviewing charts and documentation. Some of the best OASIS and documentation automated software we’ve reviewed are Andy, Enzo, and Brellium. The Rowan Report will have reviews of these products in 2025.

Communication and Connection

Care at home workers are a disparate group, rarely being in the same place at the same time, missing out on company culture, office parties, trading stories around the water cooler, and engaging with fellow employees, managers, and executives. Access to colleagues and management is an integral part of employee engagement and satisfaction.

Before you share the personal cell phone numbers of your entire agency, remember that all communication between employees, management, and clients should be secure and HIPAA compliant. Agencies have already seen the consequences both to their bottom line and with government agencies for failure to comply with secure messaging requirements.

Luckily, there are plenty of secure messaging platforms available for agencies to use. Employing messaging technology not only increases employee engagement, but also provides a level of security between caregivers and their patients and families. If you’ve now realized that you’ve been communicating on insecure platforms, check out Buzz, Qliqsoft, and Zingage.

Final Thoughts

Whether you start with a simple calendar to remind yourself which employees have been with you the longest, or invest in every AI tool available, the key here is to recognize that your caregivers are giving their all every day for their primary purpose of excellent patient-centered care.

No matter how you decide to do it, make 2025 the Year of the Caregiver and show your appreciation for all that they do for you. We couldn’t do what we do without them.

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Kristin Rowan has been working at Healthcare at Home: The Rowan Report since 2008. She has a master’s degree in business administration and marketing and runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in event planning, sales, and marketing strategy. She has recently taken on the role of Editor of The Rowan Report and will add her voice to current Home Care topics as well as marketing tips for home care agencies. Connect with Kristin directly kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

©2024 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in Healthcare at Home: The Rowan Report. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com

2024 Homecare Survey

by Rowan Report | Aug 9, 2024 | Partner News

FOR IMMEDIATE RELEASE

Contact: Hollie Barnidge
912-272-8651
hollie.barnidge@alloycrew.com

HHAeXchange 2024 Homecare Survey: 91% of Caregivers View Patient Relationships as Critical to Job Satisfaction

New data shines a spotlight on the motivations of caregivers and their dedication to improving health and wellness for the thousands of members receiving care in the home

New York, August 7, 2024 – HHAeXchange, a leader in homecare management solutions for providers, managed care organizations (MCOs), and state Medicaid agencies, today announced the results of the HHAeXchange Homecare Insights Survey, which surveyed more than 3,900 caregivers across the company’s homecare agency clients. The survey was designed to understand the motivations of today’s caregivers and find ways to enhance caregiver satisfaction to ultimately improve health outcomes.

The need for quality caregivers in the homecare industry continues to grow, as new data has found that many individuals are rejecting institutional care options due to a lack of quality care. Therefore, attracting and rewarding high-quality caregivers is crucial to meet today’s demand.

Patient Observations

Correlated to this, 60% of the caregivers surveyed said making a positive impact on their patients’ health and well-being is the biggest motivator for their work. Additionally, 57% of caregivers reported that they would take extra time to record patient observations after each visit, motivated by the knowledge that it could improve their patients’ care.

In addition to understanding the importance of their role in improving patients’ quality of life, caregivers are attracted to, and choose to remain in, the homecare industry because of the relationships they form with patients. In a 17% increase from last year’s survey, ninety-one percent of caregivers surveyed revealed that the relationships they form with the patients they care for increase their job satisfaction.

HHAeXchange President Stephen Vaccaro

“While the challenges and demands of being a caregiver still remain – low compensation, feelings of stress and exhaustion, and risk of catching infectious diseases – this survey shows that caregivers remain committed to their work to improve the lives of their patients,” said Stephen Vaccaro, President of HHAeXchange. “As more individuals seek homecare options, the homecare industry must continue to evolve to ensure caregivers are given the resources and recognition they need to remain motivated and focused on patient care.”

Training

Another important finding from the survey was caregivers’ interest in receiving professional training as an additional resource to improve their career satisfaction and longevity. Specifically, the caregivers surveyed said they would be interested in receiving training related to reducing stress (24%), understanding how to treat patients with specific illnesses (18%), and how to use additional medical equipment (14%).

“Training is a critical component of caregiving that improves caregiver job satisfaction, confidence, and improves care outcomes,” said Glen Persaud, Vice President at New York Health Care Inc. “Our agency offers training opportunities and ensures our caregivers receive the help and support they need to ensure we are providing the best care possible.”

To learn more about HHAeXchange, and how it can help both homecare providers and caregivers through its solutions, visit hhaexchange.com/solutions/providers.

Survey Methodology

This survey was conducted by HHAeXchange from April 8 to July 31, 2024, among more than 3,900 caregivers across a variety of the company’s homecare agency clients. For complete survey methodology, please contact michelle.rand@alloycrew.com.

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About HHAeXchange

Founded in 2008, HHAeXchange is a leading technology platform for homecare and self-direction program management. Developed specifically for Medicaid Home and Community-Based Services (HCBS), HHAeXchange connects state agencies, managed care organizations, providers, and caregivers through its intuitive web-based platform, enabling unparalleled communication, transparency, efficiency, and compliance. For more information, visit hhaexchange.com or follow the company on X, LinkedIn and Facebook.