2025 Caregiver Survey: An Interview with Stephen Vaccaro

by Kristin Rowan | Dec 18, 2025 | Caring for the Caregiver, Clinical, Vendor Watch

by Kristin Rowan, Editor

2025 Caregiver Survey

An Interview with Stephen Vaccaro

The end of the year seems like a good time to see where caregivers fall on questions about technology, training, management support, career motivations, and other relevant and pressing topics. Some of the results of the HHAeXchange caregiver survey are not surprising. Others, you may not expect.

The Rowan Report spoke with HHAeXchange President Stephen Vaccaro this week to discuss the survey.

Key Takeaways

Here are a few of the key takeaways from the 2025 Caregiver Survey:

Just over 65% of respondents said they are comfortable with technology, up from 55.65% just two years ago
Caregivers find technology supports them most with managing shifts and schedules
70% said they would spend an extra 3-5 minutes documenting client observations if it improves care
Higher pay is still the #1 complaint of caregivers
A desire for additional training and flexibility increased to 21.7% and 28.2%, respectively

Read theHHAeXchange survey press release.

In His Own Words

The Rowan Report:

Stephen, thank you for talking with me today. It’s good to see you again. It’s been quite a year or so of changes for HHAeXchange.

Stephen Vaccaro:

Thanks, Kristin. 2025 has been truly transformational for HHAeXchange. State Medicaid and Medicaid managed care plans have been very positive with the change. We’re now in a position to invest at scale.

RR:

It’s been fascinating watching. I can’t wait for what’s next. The answers you received in the 2025 Caregiver Survey had some significant changes to the answers this year. What can you tell me about this year’s survey?

HHAeXchange 2025 Caregiver Survey Vaccaro

Stephen:

We are connected to close to 3 million caregivers on the personal side. The past couple of years, we’ve done the caregiver survey. 2025 is the third year. It’s interesting to see the evolution of it. In the beginning there was a lot of fear around EVV technology. Now, the level of adoption is increasing and they’re starting to see that it’s a value add to their job. This year, 65% had positive feedback on technology in the home.

RR:

To what do you attribute this change in response?

Stephen:

It’s a very meaningful change. The first round of technology was different. There were promises, delays, and a lot of pepople who didn’t think it would ever happen. It has gone from “We’d like to see you use it” to “you have to use it.” There’s a certain level of expectation. And now, it’s pushing down to managed care plans. Providers are cooperating now because it’s not okay not to. Sometimes it’s the consumers that are convincing the caregiver to use the technology.

RR:

Do you think there’s any tie in to the average age of the caregiver?

Stephen:

I think that helps, certainly. I think when new caregivers come in, they are starting mobile first. It’s part of the orientation. It’s how the job is done. But it’s also the impact the technology makes.

More than 61% ranked the positive impact on the client as the most important thing that they do. Having the app is bringing them in to the care team. Nurses and NPs are collaborating with caregivers and seeing that the observations of the caregiver are important, even when they seem small.

So, as we start to look at different care needs, we have to design programs accordingly, and that also has impacted the the change. Caregivers want support to get the training they need to do their job the best they can. They want resources, tools, and information. Advanced training is important, but the technology to be able to see the patient records, notes, and observations is key and that necessitates the technology.

RR:

What are the top reasons a caregiver leaves an agency?

Stephen:

Well, salary of course is the number one challenge. But more training and more flexibility rank pretty high on the list.

2025 Caregiver Survey Vaccaro HHAexchange

RR:

What do you see coming in 2026 and beyond?

Stephen:

I think there will be a big focus on technology. It will be the year we truly step into mobile first as a standard.

I also think we will continue to see the evolution of the caregiver as part of the care team. We will start leveraging the caregiver as the untapped asset that they are. We will see increased continuity of care, especially for integrated dual eligible patients.

RR:

And, what’s next for HHAeXchange?

Stephen:

We will continue looking for ways to innovate and bring value to the industry and the ecosystem. In the home care economy, all the players are involved. The patient, the caregiver, the doctor, and the payor. But, also the training vendors, food suppliers, transportation providers, and so many more. We will be looking at ways to involve all of the players from a patient’s home ecosystem into the care plan.

RR:

Stephen, it’s always a pleasure talking with you. Thank you, again for sharing your 2025 Caregiver Survey with us and for your always valuable insights. Happy Holidays.

Stephen:

Thank you for having me. Happy Holidays

Final Thoughts

Caregivers are embracing technology not for themselves, but for their clients. The desire to help and make a positive impact on their clients’ health and well-being is the core drive for caregivers, so it’s not surprise that they want better access to information and training. Non-medical supportive care at home has more contact hours and indiidual time with clients and are an invaluable untapped resource for home health and hospice. With the technology finally catching up to the motivation, we can tune in to that resource and provide better care across the board.

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Kristin Rowan has been working at The Rowan Report since 2008. She is the owner and Editor-in-chief of The Rowan Report, the industry’s most trusted source for care at home news, and speaker on Artificial Intelligence and Lone Worker Safety and state and national conferences.

She also runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in content creation, social media management, and event marketing. Connect with Kristin directly kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

©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

AI in Hospice: 3 Questions Before Adopting

by Rowan Report | Sep 18, 2025 | Artificial Intelligence, Hospice

by Curantis Solutions

AI in Hospice

3 question to ask before adoption

AI in healthcare

Artificial intelligence (AI) is transforming healthcare. From voice-to-text documentation to predictive analytics, AI promises to streamline operations, reduce clinician burden, and improve outcomes. However, in hospice and palliative care, where care is deeply personal and the margin for error is razor thin, adopting AI cannot be treated as just another trend. It must be thoughtful, mission-aligned, and clinically appropriate.

AI in hospice

Hospice leaders are under pressure. Staff shortages are real. Regulatory demands like Hospice HOPE are intensifying. Vendor inboxes are flooded with promises of automation, optimization, and return on investment (ROI). It is easy to feel like you must adopt AI quickly just to keep up.

But the truth is, not all AI is ready for hospice and palliative care. And not all hospice organizations are ready to implement it effectively. The stakes are too high to rush.

If your hospice or palliative care organization is exploring AI, here are three critical questions to ask before making a decision:

1. Is the AI built for the way hospice and palliative care work?

Hospice and palliative care are fundamentally different from other healthcare environments. The workflows are interdisciplinary. Much of the documentation relies on narrative detail. Clinicians manage complex emotional, spiritual, and medical needs at the same time. Care is not episodic or transactional. It is longitudinal, values-driven, and highly individualized.

Many AI tools on the market today were built for hospitals or outpatient clinics. They may offer efficiencies in acute care but fail in hospice because they do not understand the subtleties of team-based care, psychosocial documentation, or end-of-life symptom management.

Ask the vendor: Has your AI been developed specifically for hospice or palliative care? Or are you expecting our team to adapt to your tool?

Healthcare isn't hospice

Some hospices have tried generic AI dictation tools and found them inadequate. They could not capture the nuance of hospice documentation, especially when it comes to describing spiritual distress, family dynamics, or legacy work. Other teams tried predictive tools that produced frequent, non-actionable alerts that distracted the clinical team and created more work, not less.

Hospice AI must be purpose-built. It needs to support interdisciplinary team meetings, comply with documentation standards like HOPE, and align with Medicare Conditions of Participation. If the tool does not understand your workflow, it will only add friction.

2. Will this AI solution actually save time, or will it create more work?

AI should make your clinicians’ lives easier, not harder. Unfortunately, many solutions promise time savings but fail to deliver because they are poorly implemented or require too much manual oversight.

Here is where hidden costs show up. If your team needs to log into separate platforms, copy and paste information, or manually verify AI-generated content line by line, the benefits quickly disappear. Add in the time it takes to train staff, troubleshoot bugs, and manage updates, and you might find you are investing more time than you are saving.

Ask the vendor: What does your implementation and training process look like? What kind of support do you provide after go-live?

Responsible AI vendors should provide more than software. They should offer a clear rollout plan with defined milestones, retraining sessions for staff turnover, and a roadmap for future enhancements. Without this, even the most impressive AI tool will fail to achieve meaningful ROI.

You also want to ensure that your team can trust the AI. If it produces content that needs to be heavily edited or raises questions about accuracy, clinicians will disengage. The best AI makes documentation feel intuitive, not burdensome.

Ultimately, the right solution should reduce charting time, improve documentation quality, and give your clinicians more time for direct patient care. Do not just ask

what the AI can do. Ask what the experience of using it will be like for your team on day one, day 30, and day 365.

3. Does the AI preserve your mission and center the patient?

This is perhaps the most important question of all. Hospice care is defined by its human connection. Patients and families count on your team to be present, compassionate, and attentive during the most vulnerable moments of life. Any technology you introduce must uphold that standard.

Ask yourself: Does this tool enhance our ability to serve patients meaningfully? Or does it get in the way?

AI should never replace the clinician’s presence. It should support that presence by taking on administrative tasks, summarizing clinical notes, or preparing IDG summaries. It should make care feel more personal, not less.

There is a real risk in adopting tools that do not align with your mission. Some AI solutions are focused solely on efficiency. Others may depersonalize care by reducing complex human experiences into checkboxes or canned phrases. If the technology distances your team from the bedside, it is not the right fit.

Ethical, mission-aligned AI empowers your team. It helps clinicians spend less time documenting and more time connecting. For chaplins, it supports spiritual care providers in crafting better notes. It assists social workers in capturing family dynamics. Finally, it helps the entire team stay informed without increasing their cognitive load.

Final Thoughts

Thoughtful evaluation and the right questions make all the difference

The conversation about AI in hospice and palliative care is just beginning. There is enormous potential to reduce burnout, improve quality, and strengthen compliance. But realizing that potential requires more than excitement. It requires asking the right questions, involving the right stakeholders, and choosing tools that are built for this environment.

Before you adopt AI, pause and evaluate:

Is this solution designed for how we deliver care?
Will this save time or increase workload?
Does this align with our mission and center the patient?

If you can answer yes to all three, then you are on the path to responsible, effective AI adoption.
Hospice and palliative care deserve nothing less.

Reduce Insurance Claim Denials

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

by Lynn Labarta, SimiTree

Reduce Insurance Claim Denials

2025 Guide for Home Health and Hospice Agencies

Is your home health or hospice agency struggling with insurance claim denials? You’re in good company. As we move into 2025, claim denials remain the #1 challenge affecting revenue cycles across the industry. But there’s hope – we’ve compiled the latest strategies and insights to help you overcome this persistent challenge.

The Current State of Home Health & Hospice Billing

The healthcare landscape continues to evolve, and with it, so do the complexities of billing and reimbursement. Home health and hospice agencies face unique challenges, from managing PDGM requirements on the home health side to navigating multiple payer systems on the hospice side. Recent data shows that denied claims significantly impact not just revenue but also patient care delivery and operational efficiency.

Understanding Home Health & Hospice-Specific Denial Triggers

Let’s examine the primary causes of claim denials in our sector:

Home Health Eligibility Challenges

Medicare homebound status verification issues
Face-to-face documentation gaps
PDGM period confusion
Medicare Advantage plan authorization complexities

Hospice-Specific Documentation Issues

Terminal illness certification problems
Level of care documentation gaps
Missing physician narratives
Notice of Election timing issues

Strategic Solutions to Reduce Insurance Claim Denials in 2025

Optimize Your Intake Process

Implement robust homebound status verification- Home health
Establish face-to-face documentation protocols
Create PDGM period tracking systems- Home health
Develop payer-specific authorization workflows

Leverage Technology Effectively

Use specialized home health & hospice billing software
Implement automated eligibility verification systems
Set up PDGM period alerts- Home health
Utilize NOE and NOA tracking tools

Build a Specialized Denial Management Approach

Create dedicated teams for Medicare vs. non-Medicare appeals
Develop PDGM-specific denial protocols- Home Health
Establish hospice-specific documentation review processes
Implement specialty-focused staff training programs

Pro Tips for Implementation

Focus on specialty-specific staff training in home health and hospice billing requirements
Create separate workflows for different payer types (Medicare, Medicare Advantage (home health), private insurance)
Implement weekly PDGM period reviews- Home Health
Establish clear communication channels between clinical and billing staff

Looking Ahead in 2025

The home health and hospice landscape continues to evolve, but with proper strategies in place, your agency can thrive. Focus on building robust processes that address the unique challenges of our industry while maintaining compliance and optimization.

Action Steps to Reduce Insurance Claim Denials for Your Agency

Evaluate your current denial rates by payer type
Assess your PDGM period management effectiveness- Home Health
Review your hospice documentation protocols
Implement targeted improvements based on your findings

Remember, reducing claim denials isn’t just about better processes – it’s about ensuring your agency’s financial health so you can continue providing essential care to your community.

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Lynn Labarta reduce insurance claim denials

Lynn Labarta, VP of Post Acute RCM and the founder of Imark Billing (now SimiTree) has a wealth of experience in the healthcare industry. Lynn provides comprehensive billing services for home health and hospice agencies, streamlining their revenue cycle management process while supporting and managing billing challenges and compliance with evolving healthcare regulations and managing billing challenges; essentially acting as a key partner to ensure accurate and timely claim submissions and optimal revenue collection for agencies.

©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

HHAeXchange: An Interview with Paul Joiner

by Kristin Rowan | Jul 26, 2024 | Caring for the Caregiver, Clinical, M&A, Vendor Watch

by Kristin Rowan, Editor

Paul Joiner Talks to The Rowan Report

The care at home industry changes seemingly daily with new regulations, HH agencies opening and closing, more people qualifying for Medicare, technological advances like artificial intelligence, and the list goes on. Since 2008, HHAeXchange has been part of the change and growth of the industry. This week, The Rowan Report sat down with CEO Paul Joiner to discuss HHAeXchange’s recent changes, upcoming changes, and acquisitions.

Cashé Software

On June 18, 2024, HHAeXchange announced the acquisition of Cashé Software, a Minnesota-based solution for homecare operations and billing. The merging of these two companies yields expanded ability to help homecare providers and billers with compliance, streamlined billing, and optimized workforce management.

Generations Homecare System

Just three weeks later, on July 8, 2024, HHAeXchange announced the acquisition of Generations Homecare System, an all-in-one homecare agency management software solution that connects care teams, simplifies daily tasks, and maintains compliance. This pairing aims to drive innovation and excellence in homecare.

Minnesota Office and Call Center

Ten days after the acquisition of Generations, HHAeXchange announced the opening of a new office and call center in Bloomington, MN. The office will offer localized, skilled agents to provide timely, efficient, and responsive customer support. This location will also be a home base for HHAeXchange employees who work remotely in the area and will provide job opportunities and growth in Bloomington.

Paul Joiner: On the Record

Paul Joiner became the CEO of HHAeXchange in March of 2023. Joiner came to HHAeXchange after serving as CEO in the substance abuse and mental health space. We sat down with Paul this week to talk about his position, the recent acquisitions, and future plans for HHAeXchange.

The Rowan Report:

HHAeXchange has gone through significant change and growth just in the last couple of months. Can you tell us about some of the plans you made for HHAeXchange?

Paul Joiner:

A lot of the growth was keyed up when I came on board. I just took it to the finish line. Implementing growth effectively required some changes. There is some pressure in this industry to evolve quickly.

RR:

What are some of the challenges you faced?

Joiner:

The current issues of recruiting, onboarding, retention, and training put a lot of pressure on technology solutions. And the pace of that change makes it harder for tech solutions to keep up.

Paul Joiner, CEO, HHAeXchange

XRR:

Did that drive the strategy behind your recent acquisitions?

Joiner:

Looking at strategy in the context of current challenges: finding people who understand the space and finding knowledge applied in technology is not easy to find or to develop organically. Then we find businesses like Cashé where we like the people, their position, their geography, and they have pieces that will help us build toward our vision of being the leader in Medicaid homecare and driving value and efficiency.

RR:

What does acquiring Cashé do for HHAeXchange?

Joiner:

Well…I can’t tell you, because it’s part of a strategy that comes with a bigger reveal. But I can tell you that acquiring Cashé is part of our technology lift. They have built a new technology with modern architecture. We will use that as a starting point to provide an additional offering in the marketplace. Cashé enables us to build faster, and innovate faster. While we continue to invest in HHAeXchange, Cashé gives us a head start on modern tech that can be added to our current offerings, or sold as a stand-alone solution.

RR:

And what about Generations?

Joiner:

Generations is a great business that has put business logic and rules into their technology. They also have a geographical presence where HHAeXchange does not.

RR:

How did this rapid growth of two acquisitions and a new call center impact HHAeXchange?

Joiner:

Taking on this much change created the need for improved communication across three organizations. That communication helped us provide a better narrative for Cashé and Generations employees who may have been a little nervous about the change.

RR:

You must have some really great teams in those three organizations to navigate these changes.

Joiner:

We have a great team. There are a lot of people we’ve brought on board in the last two years as we continue to grow along with the incredible team of people who have been at HHAeXchange much longer. We’re comfortable dealing with scale, size, and complexity, so the changes didn’t overwhelm us.

RR:

What does future growth look like for HHAeXchange?

Joiner:

We will probably continue to acquire companies. Maybe not multiple companies in a matter of weeks, but we will continue when the opportunity arises. The spirit behind our strategy is to focus on what our customers need. We are in a position in the market to have a big responsibility to be good stewards, help our customers, caregivers, and agencies, and improve the quality of life for patients.

HHAeXchange is focused on getting the right technology into the hands of caregivers. We’ve already done EVV and point-of-care well. Can we make a difference now in how they are onboarded and scheduled? Can we make a difference in billing and how they’re getting paid? That requires acquisitions and investing organically.

RR:

Any final remarks on what the future holds for HHAeXchange?

Joiner:

Part of our vision board is building a community of caregivers through technology. The good agencies are trying to figure out how to think as much about the caregiver as they do for the people receiving care. Turnover and training is so hard, so we need to invest in our caregivers.

We also need to be a better supplier of data to arm agencies and health plans with the data they need so they can have useful discussion around the date and how they’re supporting caregivers. I’m sad sometimes because agencies don’t get enough financial support for their effort. The industry can be doing more for their caregivers.

We take our responsibility to do the right thing seriously. Because of this, we are investing in the space and we want more options so we can be better for the industry. Our intention is to make a difference.

RR:

Thank you, Paul for talking with us today.

About HHAeXchange

Founded in 2008, HHAeXchange is the 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 Twitter, LinkedIn and Facebook.

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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