VA in NM: An Interview from a Provider

by Kristin Rowan | Jun 19, 2026 | Advocacy, Veterans Affairs

by Kristin Rowan, Editor

VA in NM

An Inside Look from an Anonymous Provider

Effective January 1, 2026, the U.S. Department of Veterans Affairs made substantial rate cuts that impacted hundreds of veterans. None moreso than in rural areas of Texas and New Mexico. Reports from national and local news and associations reported a 43% rate cut in rural Texas and a 20% rate cut in rural New Mexico. On paper, those numbers are accurate. In practice, the situation looks much different. The Rowan Report spoke with a provider in New Mexico who asked to remain anonymous to preserve their relationship with both the U.S. VA and their local VA office.

Background and Experience

This anonymous source has worked in the home care space for 10 years. They opened the agency they now own about 3 years ago. The provider agency is strictly non-medical home care, operates in seven states, including their largest location in New Mexico, and has a patient population that is 90% VA.

What's Really Happening with VA in NM

Prior to the rate change, the home health aide (HHA) in New Mexico was $67 per hour. The new HHA rate for 2026 is $54 per hour. The source says if it were just the rate change, they could survive. But, the rate change is only one change impacting the agency.

HHA vs Homemaker

Prior to 2026, the average veteran received set hours of care almost exclusively at the HHA rate of $67 per hour. The rate change in New Mexico also include a split authorization requirement, capping the HHA hours at 60% of the total hours of care provided. The remaining 40% is now billed at the homemaker rate of $36.20 per hour.

Breaking Down the Math

In 2025, agencies billed 100% of care at HHA rates. In 2026, they are billing 60/40 homemaker to HHA rates. For an agency providing 10 hours of care per week, that is a difference of more than $200. The actual rate reduction is just over 30%.

More Hurdles

In addition to the rate cut and the HHA/Homemaker change, this agency and countless others are struggling to find caregivers for remote areas. Hours of drive time for one visit doesn’t pay enough to entice caregivers.

In most agencies, this one included, drive time and mileage are reimbursed between visits but not for the time to the first visit and after the last visit. This model doesn’t work for rural visits when the drive time is as long or longer than the visit and takes the whole day. Especially with the rate cut forcing lower hourly rates for caregivers, reimbursement for rural visits are necessary.

The Reality of VA in NM

My source described the grim reality over the last six months. What it means for agencies in New Mexico, what it means for caregivers, and especially what it means for veterans is disturbing and infuriating. Agencies in New Mexico, especially those whose client base is primarily veterans have few choices. They can stop serving veterans or they can operate at a loss. This agency knew the catastrophic consequences of no longer serving the veteran population and chose to operate at a loss. They are spending more on caregivers in rural areas than they make. The agency has onboarded more clients, more caregivers, and more staff in the last six months because so many agencies weren’t able to continue providing VA services.

Personal Plea

My source asked me to convey this personal message to agency owners in New Mexico and Texas, and to the industry:

“The Albuquerque VA team is exceptional. They are playing the cards that were dealt to them. These decisions were made above their heads. Support and be kind to your local VA offices. They’re not happy about this; they’re fighting this fight with us.”

When asked what agencies can do to support veterans and agencies, he said:

“The important thing for all of us to remember is what we do is important; we make a difference in the lives of veterans every day. It is important to advocate on behalf of providers and veterans.

Get in front of people who can influence. U.S. Reps, U.S. Senators. If enough people talk, they will have to listen. If they reach a threshold of calls, they have to answer.”

Final Thoughts

The thought of veterans, especially rural veterans, losing their in home care is devastating, as I hope it is for you. For some, this is the only human contact they have. For others, it is the only contact they can have. The consistency and familiarity that comes from having the same caregiver visit at the same time in a familiar setting is vital for veterans with PTSD or dementia. Disturbing that care and then claiming the rate change will not impact veteran care is ignorant and irresponsible. Whether you are operating in Texas and New Mexico or not, please consider writing to Secretary Collins and your local officials to ensure someone with decision-making authority is looking at the reality they have created.

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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

Fight Loss of Rural Veteran Care: An Interview with Angelo Spinola

by Kristin Rowan | May 29, 2026 | Advocacy, Regulatory

by Kristin Rowan, Editor

Fight Against the Loss of Rural Veteran Care

Deep Cuts Impact All

Last November, the U.S. Department of Veterans Affairs (VA) announced the 2026 VA Fee schedule, which became effective January 1st. There were significant changes to the fee schedule compared with previous years. By far the most concerning, though, was the “rate restructuring” for Home Health Aide and Homemaker codes in Texas and New Mexico.

Rate Restructure

Prior to 2026, Texas VA had a tiered fee structure. The tiered structure applied different rates for geographical areas based on _____. The restructure for 2026 applied a single statewide rate. This gave a slight increase in rate for some urban and suburban areas. However, the change created a drastic drop in rates for rural areas. For most Texas rural areas, it is a 43% reduction for Home Health Aides. The restructing results in a 19% decrease in New Mexico.

Tiered Rates

2025 VAFS rates were as high as $67 per hour in some rural areas. The hourly rate covered the time spent in the home, greatly increased travel time compared to urban visits, and differential incentives to entice caregivers to take these shifts that are often short and spread apart. The new statewide rate is $38 per hour. For the highest paying rural areas, this is a 43% rate cut.

Hours per Veteran

In addition to the rate cut, the number of hours per veteran has also dropped to an average 3.4 hours per shift. Some veterans are seeing their monthly hours cut by more than 30%.

Advocating for Change

State and national associations and advocacy groups reached out to the VA. Six senators and congresspeople reached out Doug Collins, secretary of the VA, to express their concerns. The VA has largely not responded to inquiries about the validity of the rate reduction and has not provided the analysis used to decide the new rate.

Notice and Comment Period

Most rate changes like this require advanced notice for agencies to adjust as well as a comment period when interested and impacted parties can contact lawmakers to provide feedback and ask questions. The announcement about these rate changes came in December and went into effect in January. The VA provided almost no notice and did not entertain comments or questions.

Fight Against VA Rate Cuts Texas New Mexico

Collins Responds

“[The rate reductions] reflect our assessment that prior rates for these areas significantly exceeded prevailing market rates. Aligning these rates with market conditions is not expected to affect veteran care.”

Doug Collins

Secretary, U.S. Department of Veterans Affairs

Defying His Objective

When Collins accepted the role of Secretary of the VA, he thanked President Trump for the assignment and asked him, “What would you like me to do?” The President answered, “Take care of my Veterans.” In a statement to the press, Collins outlined how he would accomplish that mission. Second on his list is to “put Veterans as the center of everything VA does, focusing relentlessly on customer service and convenience.”

Fail

Creating care deserts in rural areas and forcing veterans to travel up to an hour to get care is not convenient. Reducing home care hours and raising the probability of veterans having to move to care facilities is not service. Secretary Collins is failing in his objective and failing his directive from the President. More importantly, he is failing our veterans.

Coalition with Polsinelli

The Rowan Report spoke with Angelo Spinola and Heather Looby of Polsinelli. Polsinelli has been actively working on getting the rate changes reversed. Spinola, an employment litigator with a special interest in home care, explained the situation in more detail. According to Spinola there has been little information from the VA and what communication exists has been inconsistent. Many of the letters sent to the VA get no response at all. Spinola says there are legal remedies available, but they are challenging and expensive. In a letter to the VA, Polsinelli outlined the risks and consequences of these actions and gave the VA 30 days to respond.

Join the Fight

Next week, we will bring you real stories of agencies and veterans impacted by the changes in Texas and New Mexico. Their stories are powerful and moving. Even still, you may think this isn’t your fight because

A small enough percentage of your business is impacted
You have agencies in other states making up the difference
You don’t operate in Texas or New Mexico

Angelo cautions:

If they can do it in TX and NM, they can do it anywhere

“They” might be the VA changing rates that are unsubstantiated and contrary to the Administrative Procedure Act.

“They” might be CMS following suit and arbitrarily changing rates without analysis, notice, or comment.

“[Whether you are currently impacted by these changes or not,] the industry needs to get together to address this and join the fight before it’s too late; before it becomes the norm. “

Angelo Spinola

Home Health, Home Care & Hospice Chair, Polsinelli

How You Can Help

Write to your congressperson and senator and urge them to push Collins and the VA to reverse this change

Write to Collins and the VA directly with impact statements and concerns

Join the coalition with Polsinelli – PolsinelliHomeCare@polsinelli.com

Final Thoughts

We have interviews scheduled with providers and veterans to bring you real stories of how this is impacting our industry. We will also continue our discussions with Polsinelli to get additional information and keep you updated on the progress of the 30-day deadline and additional action the coalition will take.

Honor our Veterans

It was just a few days ago that our nation celebrated Memorial Day in honor of the ultimate sacrifice made by so many. There are too many service men and women who never came home. The ones who did risked everything for you, for me, for this country, and for the ideals that make the United States what it is. They deserve to come home after that service and age with dignity and grace in their homes for as long as they can. We owe them at least that. We all have our own stories and paths that led us to care at home, but at the core of each of those stories is care. Our veterans need that care now. Reach out, write, advocate, join. Whatever you are able to do, now is the time for action.

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Are Nurses Independent Contractors?

by Kristin Rowan | Feb 26, 2026 | Admin, Caring for the Caregiver, Clinical, Legal

by Kristin Rowan, Editor

Are Nurses Independent Contractors?

Jury will decide intent

After investigation, the U.S. Department of Labor (DOL) sued Amazing Care Home Healthcare Services over misclassification of workers, recordkeeping violations, damages, and unpaid overtime. The court decided the workers were misclassified.

Classification as Employee

According to the decision, the workers were employees because the company had control over the work, set wages, required workers to report absences, and evaluated their performance. The DOL provides guidance on what constitutes an employee. Prior regulations use a “totality-of-the-circumstances” approach to classification, looking at the whole picture rather than a single determining factor. Other documents rely on an “economic reality” test that examines two core factors: the nature and degree of control a worker has over the work and the worker’s opportunity for profit or loss.

Summary Judgment

The DOL called for summary judgement, in which the judge would decide the case without a trial or jury due to “overwhelming” evidence. The judge partially agreed and granted summary judgement in favor of the DOL on worker classification, recordkeeping, and damages. The court declined summary judgement on the issue of overtime and intent. There is some question as to whether the workers were paid some overtime wages during the period in question and whether the misclassification was willful. These questions will be decided by a jury at trial.

Economic Reality

The totality framework to determine worker classification came into use during the Biden administration. The DOL has recently proposed a return to the economic reality framework from 2020. Two core and three additional factors comprise the economic reality test. These two core factors are the primary determinants:

The nature of and degree of a worker’s control over their work
- does the employer control scheduling, pay rates, and prices;
- does the employer supervise performance and discipline workers
Opportunity for profit or loss
- does the worker advertise services independently, negotiate contracts, decide when and where to work, have the ability to hire helpers to perform the work

These three additional factors are considered in classification analysis, but carry less weight than the two primary considerations:

The amount of skill required for the work
- does the worker use their own specialized skills rather than relying on the company for training

–and–

- does the worker use that skill to grow the business

The degree of permanence of the working relationship between company and worker
- is the work sporadic, as needed, or project-based

–and–

- is the company engaging in seasonal or temporary work or industry

Whether the work is part of an integrated unit of production
- can the business operate without the work performed

Clear Answer

Using the economic reality test, can we classify home health nurses as independent contractors or employees without question?

Employee

Agency sets pay rate for the nurse
Supervised performance
Clients belong to the agency
Nurses do not hire and pay helpers
Nurses do not automatically make more when the agency grows
The business cannot operate without nurses

Independent Contractor

An agency could allow the worker to set their own schedule
Nurses use their own skills, degrees, and certifications
Work could be created as project-based where 1 client=1 project for 30 days

Final Thoughts

Without very careful planning and disruption of practice, it is pretty clear that home health workers are not independent contractors, but are employees. There may be significant differences in the operation of non-medical supportive care at home, but pay rates are still determined by the agency, performance is supervised, clients belong to the agency, and the business cannot operate without healthcare workers. The DOL sued for unpaid overtime amounting to $5.9 million on behalf of both LPNs and Home Health Aides.

If you do now or plan to in the future engage any worker as an independent contractor, review all current FLSA and DOL requirements to ensure you are not misclassifying your workers.

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Home Care Patient Dies in Care: Aide Arrested

by Kristin Rowan | Oct 10, 2024 | Clinical, Regulatory

by Kristin Rowan, Editor

Elderly Patient Needs 24-hour Care

In Polk County, FL, an 86-year old man, identified only as Mr. Anderson, was hopsitalized and diagnosed with congestive heart failure. In addition to receiving care from Good Shepherd Hospice, his family hired round-the-clock care through Assisting Hands. The home health aides were caring for Mr. Anderson in 12-hour shifts.

Night Shift

Beatrice Taylor arrived for her night shift at 9 p.m. She noted that Mr. Anderson and his wife were already in bed, but not sleeping. Shortly after the day aide left, Taylor fell asleep on the couch in the living room of the patient’s home. Company policy states she was responsible for the patient’s care and should not have been sleeping.

An Avoidable Tragedy

Taylor was awakened by a “thump” coming from the bedroom. She entered the bedroom to investigate and found Mr. Anderson lying on his side, on the floor, with his head wedged between the nightstand and the bed. Taylor told investigators that she tried to help him back into the bed. He told her not to touch him, so she left him there and went back to sleep on the couch. She did not call 911, as was the policy of Assisting Hands in the event of an emergency. Nor did she call her agency or anyone else to assist.

Four Hours Later

Taylor woke up somewhere between 3:45 a.m. and 4:53 a.m. that morning. At some point, she called her parents and had a 36 minute conversation. During that conversation, she decided to check on the patient and found him still on the floor, but now unresponsive. It was her parents who suggested she call 911.

Contrary to both her parents’ urging and her employer’s policy, Taylor still did not call 911. Instead, she called Assisting Hands and left a message through the company portal. Taylor finally called 911 at 5:37 a.m., more than four and a half hours after Mr. Anderson fell.

The implanted pacemaker found during autopsy showed that Mr. Anderson was still allive at 1:oo a.m. when Taylor initially found him. The autopsy also concluded that he would have survived if Taylor had called 911 right away. His official cause of death was positional asphyxia with pre-existing health conditions listed as contributory causes.

Not actual image from story

Company Policies Broken

During the course of their investigation, detectives reviewed the Assisting Hands employee policies. That investigation uncovered several policies that Taylor violated:

If a patient falls, home aides are required to seek help which may entail calling 9-1-1. Home aides must notify the company as soon as the patient is safe
Home aides are not permitted to sleep during their assigned shift unless it is a “live in” shift
Home aides are required to submit care notes using the company portal throughout their shift to ensure assigned services are being followed appropriately.

The 911 call that Taylor placed at 5:37 a.m. should have been placed at 1:00 a.m.
Assisting Hands confirmed to detectives that this was not a “live in” shift
No information was provided as to whether Taylor submitted care notes during the shift.

Arrested Development

Taylor worked for Assisting Hands for eight months, but did not show up for her shift following the incident with Mr. Anderson. Assisting Hands has since terminated her employment. She was a licensed home health aide, but does not have a medical license, nor is she a nurse.

Taylor was arrested by detectives and made several statements about her innocence. She insisted she had done nothing wrong saying she, “didn’t kill that man.” A paramedic who responded to her 911 call overheard Taylor on the phone say, “he was old anyway so what does it matter.” Taylor remains in custody at the Polk County Jail and is being held without bond.

Polk County Sheriff

“The complete disregard for Mr. Anderson’s life by the person who was employed by his family is completely outrageous, and egregious. I believe someone who was not even being paid to look after this elderly man would have immediately dialed 9-1-1 under these circumstances. Her behavior and attitude are simply deplorable. Mr. Anderson’s family members are in our prayers.”

Grady Judd

Sheriff, Polk County Sheriff's Office

Risk Fall

In 2021, more than 38,000 older adults died from falls. This is the leading cause of injury death for adults aged 65 and older. The death rate increased 41% between 2012 and 2021. You can read more about the risk of falling and what one company is doing to help prevent falls in our accompanying article this week, an interview with Dr. Ann Wells of InnovAge.

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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

Connecticut Senate and House Pass Home Care Worker Safety Bill

by Kristin Rowan | May 10, 2024 | Admin, Caring for the Caregiver, Clinical, Regulatory

by Kristin Rowan, Editor

Last week, we reported on the proposed Bill in the Connecticut Senate and House to provide additional precautions for home care worker safety. In wake of the Elara Caring at Fault Joyce Grayson Home Care Worker Safety Joyce Grayson murder during a home health visit, leadership in Connecticut aimed to safeguard home health and home health aide workers and collect risk assessment data on the same.

On May 6, 2024, CT legislature passed bills in both the Senate and House of Representatives. Instead of the proposed bills that we reported on previously, both branches added amendments to previous bills. The bills include provisions for cyberattack readiness, child safety, and other items not related to care in the home.

First Stage of Home Care Worker Safety

Some of the provisions in the final bill are effective July 1, 2024. As we previously reported, hospice agencies are currently exempt from these provisions and the CT legislature will address hospice agencies in their next session.

On and after July 1, 2024

The Commissioner shall increase the fee payable to a home health care or home health aide agency that provides escorts for safety purposes to staff conducting a home visit to cover the costs of providing such escorts.

The Commission of Public Health will establish and administer a home care staff safety grant program to provide grants to home health and home health aide agencies for staff safety technology, including, but not limited to :

A mobile application for staff to access safety information about a client
A method for staff to communicate with either local police or other staff in the event of an emergency
A global positioning system-enabled, wearable device that allows staff to contact local police

Effective July 1, 2024

The sum of one million dollars is appropriated to the Department of Public Health for the the fiscal year ending June 30, 2025, to establish and administer the aforementioned grant program.

The Commissioner of Public Health and the Commission on Community Gun Violence Intervention and Prevention, will develop or find educational material about gun safety practices and provide such to primary care providers to give to patients who are 18 years of age or older.

Second Stage of Home Care Worker Safety

Some of the provisions in the final bill are effective October 1, 2024. Home health and home health aide agencies have five months to comply with these measures.

Effective October 1, 2024, home health and home health aide agency must collect and provide to assigned workers information about:

The client, including as applicable;

psychiatric history
history of violence
history of substance use
history of domestic abuse
current infections, if any, and treatment received
whether diagnoses or symptoms have remained stable over time

Other persons present or anticipated to be present at the location of care including, if known to the agency:

name and relationship to client
psychiatric history
history of violence or domestic abuse
criminal record
history of substance use

Location where employee will provide services including, if know to the agency:

the crime rate for the municipality in which employee will provide services
the presence of any hazardous materials, including, but not limited to used syringes
the presence of firearms or other weapons
the status and of the fire alarm system
the presence of any safety hazards, including, but not limited to, electrical hazards

By October 1, 2024, each home health and home health aide agency must:

Provide staff training consistent with the health and safety training curriculum for home care workers, including but not limited to:

Training to recognize hazards commonly encountered in home care workplaces
Applying practical solutions to manage risks and improve safety

Conduct monthly safety assessments with each staff member and

Provide staff with a mechanism to perform safety checks, which may include, but need not be limited to:

A mobile application that allows staff to access safety information about the client
A means of communicating with local police or other staff in the event of an emergency
A global positioning system-enabled, wearable device that allows staff to contact local police by pressing a button or through another mechanism

Effective October 1, 2024

Each home health and home health aide agency shall, in a manner prescribed by the Commissioner of Public Health:

Report each instance of verbal abuse that is perceived as a threat or danger to the staff
Report each instance of physical, sexual, or any other abuse by a client against a staff member

Third Stage of Home Care Worker Safety

No later than January 1, 2025

Beginning January 1, 2025 and annually therafter, the commissioner shall report to the joint standing committee:

The number of reports of violence and abuse received
The actions taken to ensure the safety of the staff member about whom the report was made

Effective January 1, 2025

Each individual health insurance policy shall provide coverage for escorts for the safety of home health care agency or home health aide agency staff

The joint standing committee of the General Assembly will convene a working group to study staff safety issues affecting home health and home health aide agencies, including but not limited to the following members:

Three employees of a home health care or home health aide agency
Two representatives of a home health care or home health aide agency
One representative of a collective bargaining unit representing home health care or home health aide agency employees
One representative of a mobile crisis response services provider
One representative of an assertive community treatment team
One representative of a police department; and
One representative of an association of hospitals in the state

Implications

As we mentioned before, these regulations will become mandates across the country soon. OSHA has found the home care agency in Connecticut at fault for failing to implement safety procedures and precautions in the death of Joyce Grayson. The nurse’s family is suing the home health agency for wrongful death. Connecticut has established a protocol for safety measures, committees, reporting, and grant programs to implement immediate safety procedures across home health and home health aide agencies in the state. Before these provisions are passed on a national level, and before you have to tell the family of one of your staff that they aren’t coming home…

We urge you to:

Create a safety committee within your agency
Invest in training on de-escalation, workplace violence prevention, and self-defense
Research and invest in a GPS-enabled emergency alert system for your staff. We recommend POM Safe and Katana Safety
Insist on background information on all clients and others living in the home upon intake and BEFORE the first home visit
Create a safe and comfortable way for your staff to report verbal abuse, violence, or uneasiness from any in-home visit
Invest in escort and/or paired visits for high-risk clients, first-time clients, or any other situation that warrants it

We will continue to follow this story and provide updates as we receive them.

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