Hiring and Retaining Professional Caregivers

by Rowan Report | Jul 31, 2026 | Admin, Recruitment & Retention

by Roger McManus, MBA

Hiring and Retaining Professional Caregivers

What Really Keeps People in This Work

People who work in home‑based care, whether licensed home health clinicians or trained home care aides, do something unusual in the healthcare world. They walk into a stranger’s home and step into the middle of that person’s daily life. Their role is to try to help them stay, or get, healthy, stable, safe, and dignified. All this happens in someone else’s environment. That fact impacts the hiring and retention challenge for agencies.

While somewhat overlapping, home health and home care are different fields. Home health visits are shorter, clinically focused, and built around medical goals. Home care shifts are longer, non‑medical by law, and often revolve around companionship, safety, and daily living support. But the shared denominator, the home environment, creates a common reality. Agencies must find and keep people who can handle the emotional, practical, and interpersonal demands of working inside a client’s private world.

Long-term retention depends significantly on the caregiver’s ability to adapt with a chameleon-like mindset.

The Home Environment Changes Everything

A hospital or clinic has structure; a home does not. Workers deal with cluttered living rooms, anxious adult children, and unpredictable pets. They see clients who may be having a good day, a bad day, or something in between. They have to be able to read the situation, adjust their tone, and figure out how to help without dominating.

This is not a skill you can measure with a résumé alone. Agencies that hire well look beyond credentials. They look for temperament — calmness, respect, patience, and the ability to stay professional even when the environment may be anything but.

Retention starts with hiring people who can work in this setting.

Why Turnover Hits Home Based Care Harder

Turnover in this field isn’t just inconvenient. It’s disruptive in ways that office‑based healthcare rarely experiences.

When a home health clinician leaves, cases get reshuffled, documentation gets delayed, and continuity of care suffers. When a home care aide leaves, long‑standing client relationships can collapse overnight. The Patient is most aware. Families notice. Referral partners notice.

Workers leave for predictable reasons:

Home health clinicians may feel isolated or overwhelmed by documentation and case complexity.
Home care aides may feel undervalued or stuck in roles with no visible progression.
Both groups may struggle with inconsistent schedules, long drive times, or emotionally draining cases.

Retention improves when agencies acknowledge these realities instead of treating turnover as “just part of the industry.”

Creating a Support System That Actually Works

The best retention strategies aren’t flashy. They’re consistent, practical, and rooted in what workers experience every day.

Home health clinicians need clinical leadership that is reachable. Not a voicemail box. Not a once‑a‑week check‑in. They need someone who answers the phone when a wound looks worse, when a medication list doesn’t match the chart, or when a family is spiraling. Caregivers knowing they have that backup reduces burnout more than any bonus ever will.

Home care aides need respect and inclusion. They may not have medical licenses, but they are the ones who see the client’s real daily life. Agencies that treat aides as essential contributors, not interchangeable labor, see stronger loyalty and longer tenure.

Across both groups, communication is the glue. Workers stay when they feel connected to a team that listens and responds.

Logical Rewards

Incentives That Make Sense in the Field

Many agencies try bonuses, gift cards, or occasional “thank you” events. Those gestures are fine, but they rarely change long‑term behavior. Logical rewards do.

These incentives tie directly to the realities of home‑based work:

Readiness bonuses for workers who reliably take short‑notice visits.
Incentives for on‑time arrival, complete documentation, or strong client feedback.
Skill‑tier pay ladders that reward additional certifications or specialized training.
Continuity bonuses for maintaining long‑term client relationships without disruption.

These rewards reinforce the behaviors that stabilize the agency. They’re not random. They’re strategic.

Onboarding and Training:

The First Impression That Never Goes Away

Retention begins the moment a new worker walks through your door. A chaotic onboarding process sends a message that “this agency is disorganized.” A clear, supportive onboarding process sends the opposite message that “we know what we’re doing, and we want you to succeed.”

Home health clinicians need onboarding that covers real‑world clinical scenarios, documentation expectations, and the unpredictable nature of home visits. Home care aides need onboarding that prepares them for communication challenges, safety issues, and the emotional realities of working with seniors.

Ongoing training matters just as much. Workers stay when they see a path forward, something to grow into, not just a job to survive.

Retention Is Not HR, It is Strategy

Agencies that retain their workers don’t just solve staffing problems. They build a competitive advantage. Families trust agencies whose workers stay. Referral partners prefer agencies that don’t constantly reshuffle cases. Regulators appreciate agencies with consistent documentation and stable clinical outcomes.

Retention is not a side project. It is a core business function.

# # #

Roger McManus is the author of several books on entrepreneurship, including “Entrepreneurial Insanity in the Home Care Business,” which he co-wrote with Tim Rowan. He advises Home Care owners and HR professionals on techniques for recruiting, retaining, and rewarding caregivers.

Healthcare Workers May be Deported

by Tim Rowan | Jul 31, 2026 | Home Care, Home Health, Regulatory

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

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.

# # #

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

Formal NGS Complaint Submitted to OIG

by Tim Rowan | Jul 31, 2026 | CMS, Hospice, Medicare, Waste Fraud and Abuse

by Tim Rowan, Editor Emeritus

Formal NGS Complaint Submitted to OIG

Hospice Wrongly Subjected to PPEO Fights Back

Two weeks ago, we reported on an Arizona hospice that found itself in the middle of a revalidation survey when its Medicare Administration Contractor incorrectly classified it as a new provider. NGS placed the hospice under Provisional Period of Enhanced Oversight (PPEO) and promptly terminated its owners following a separate, 10-claim audit. (See “NGS Shutters Valid Hospice” – July 17)

According to this hospice’s PECOS file, no change of ownership — or any other triggering event that would justify reclassification — ever occurred. The error led to a clinical review of a handful of claims, a determination of fraudulent billing, and a 10-year ban against the owners.

On Monday, July 27, the hospice submitted a formal complaint to the Office of the Inspector General at HHS regarding NGS practices. According to the Medicare consultant retained by the hospice, the formal referral became necessary after a letter to CMS Administrator Dr. Mehmet Oz, describing multiple missteps by NGS, went unanswered. A subsequent video meeting with low-level CMS staff resulted only in a defense of the contractor.

Executive Summary

The hospice allowed us to publish a general summary of the complaint, provided we do not share its name at this stage. The OIG referral documents specific instances that the complainant asserts are representative of a “systemic pattern of misconduct by Medicare contractors.”

The complaint says that such misconduct “enriches contractors at the expense of providers and the Medicare Trust Fund.” It further notes that offending contractors continue to operate with CMS trust while the Center’s leadership remains focused only on a limited number of fraudulent providers.

Demand for Restitution and Reform

Dr. Mehmet Oz shifted uncomfortably in his chair, a look that signaled something between frustration and distress clouding his famous face. The new CMS Administrator removed his reading glasses, laid the Medicare consultant’s letter on his desk, thanked his aide for handing it to him, and asked her to close the door behind her as she left. Who he may have called next is anyone’s guess, but he did have a staffer tell the letter-writer, “We called the MAC; they said they didn’t do it.”

The complaint calls for meaningful reform that restores fairness to providers whose practices have been terminated. It demands restitution for owners who have been placed on the Preclusion List for ten years, often based on improper classifications.

The OIG referral specifically requests that:

CMS take immediate investigative action
All affected providers receive restitution with interest, and
CMS subject the entire contractor model to a thorough audit, similar in rigor to prior OIG reviews that uncovered widespread errors in contractor processes, some going back decades.

The complaint emphasizes that, while effective detection and elimination of actual fraud is essential, it must not come at the expense of compliant providers.

Strength in Numbers: Protect Your Agency

As we did in our first report of this series, we are opening our doors, well, our contact information anyway, to all Home Health and Hospice providers in the Medicare program. CMS may be able to ignore evidence from one or two providers, but a larger volume of consistent reports is harder to ignore. Write to us at editor@therowanreport.com, or Tim@RowanResources.com. If putting your story in writing makes you nervous, call me at 719-499-8902. You have seen how I protect the identity of the two providers outlined in this story. I will do the same for you.

We also have ways to help you find assistance to write your own OIG complaint. Once we get 100 or more complaints submitted, we will have status to demand Congressional hearings. You can be part of the solution.

# # #

The Caregiver’s Mindset

by Rowan Report | Jul 24, 2026 | Partner News

by Roger McManus, MBA

This chapter is part of the upcoming book, The Intuitive Caregiver. It is designed to strengthen in-home caregiving skills with clear, practical, real‑world guidance.

The Caregiver's Mindset

Professional care begins long before knocking on the door

Caregiving does not start with a task list, nor does it begin when you help someone stand, prepare a meal, or assist with bathing. It begins the moment you walk through the door — with your attitude, your awareness, and the way you choose to show up.

A caregiver’s mindset is the foundation of every caregiving activity that follows. Yes, skills matter. Sure, training matters. But the mindset you bring into someone’s home determines whether your presence feels calming or stressful, respectful or intrusive, steady or unpredictable.

This chapter helps you understand what it means to “show up” as a professional caregiver — not just in what you do, but in how you think, how you observe, and how you treat the person and their home.

Enter with Humility and Respect

Professional caregivers enter with humility by:

looking before touching
asking before moving anything
treating every object as meaningful
remembering that routines exist for reasons you may not yet understand

Even something as simple as moving a chair or adjusting a blanket can feel like an intrusion if you do it without asking. Respect for the home is the first sign of respect for the client.

Your Job is Stability, Not Control

Many older adults feel vulnerable when someone new enters their home. They may worry about losing independence, privacy, or dignity. They may fear being judged. They may feel embarrassed about needing help.

Your role is not to take over.
Your role is to create stability.

Stability comes from:

predictable routines
calm communication
steady follow‑through
respecting the client’s pace and preferences

Caregiving is not about being fast. It’s about being reliable. When you move calmly and consistently, the client feels safer — and safety leads to cooperation.

Entering Someone Else’s World

A client’s home is not your workplace.
It is their private space — the place where they feel most themselves.

When you enter that space, you are stepping into someone’s history, habits, routines, and memories. You may see clutter, unusual décor, or ways of doing things that don’t match your own. None of that is your business (though it may suggest you send your agency’s Occupational Therapist to professionally assess safety issues). Your job is not to judge the home. Your job is to respect it.

You Are A Guest, Not A Manager

Even when a client needs significant help, the home remains theirs. You are there to support, not to run the household.

Professional caregivers avoid the trap of “fixing” everything. Instead, they:

collaborate rather than dictate
offer choices rather than instructions
adapt to the client’s rhythms rather than imposing their own

For example:
Instead of saying,
“Let’s get you dressed now.”
You might say,
“Would you like to get dressed before breakfast or after?”
Choices restore control.
Control restores dignity.
Dignity builds trust.

Your Work is Emotional First, Before Physical

Caregiving is not just a list of tasks. It is a relationship.

Many clients are grieving — not always the loss of a person, but the loss of abilities, independence, or identity. They be frustrated by what their body can no longer do. They may be embarrassed to need help. They may be afraid of what comes next.

Your presence can either increase that fear or reduce it.

Emotional safety is the foundation of physical care. Caregivers support emotional safety by:

listening without judgment
acknowledging feelings without trying to “fix” them
offering reassurance through tone and patience
giving people time to process and respond

You are not just helping with daily activities.
You are helping someone navigate a changing life.

Professionalism is A Daily Practice

Professional caregivers represent their agency, their training, and the caregiving profession itself. Clients notice everything — and they should. They are trusting you with their home, their health, and their dignity.

Professionalism shows up in:

punctuality
appearance
communication
boundaries
documentation
confidentiality

It also shows up in the small things:

put your phone away
stay focused on the client
avoid prying, personal conversations
maintain a calm presence even when the day is difficult

Professionalism is not about being perfect. It is about being consistent.

Understanding the Client's Reality

Before you ever walk through the door, the client is already living with pressures, fears, and adjustments to dependence that you may not see.

Loss of Control Is the Central Theme

Most clients do not ask for help because they want it. They ask because they no longer have a choice. That loss of control can feel humiliating, frightening, or deeply unfair.

Even small tasks — tying shoes, opening containers, getting out of a chair — may require assistance for the first time since childhood. Every request for help carries some emotional weight. Feeling like a helpless child carries more.

The Home Is Their Last Stronghold

For many clients, the home represents independence, identity, and safety. When a caregiver enters that space, the client may worry that:

their privacy will disappear
their routines will be disrupted
their preferences will be ignored
their home will no longer feel like their own

Respect for a person’s home environment is not optional — it is foundational.

Judge Not...

A caregiver may simply be observing the environment to understand needs, but the client may interpret that as criticism.

They may think:

“My home is a mess.”
“I’m not doing enough.”
“They must think I’m failing.”

Neutral language and gentle pacing reduce this fear.

Fear of Decline Is Always Present

Even when clients don’t say it, they are often thinking:

“What happens when I get worse?”
“Will I lose my home?”
“Will I become a burden?”

You cannot remove these fears, but you can avoid triggering them. Predictability and calmness go a long way.

The First Visit Sets the Tone

A caregiver’s first visit is more than an introduction — it defines the entire relationship. Clients quickly determine whether you will make them feel safe, respected, and understood.

Arrive Calm, Prepared, and Unhurried

Your arrival should feel like relief, not disruption.

Introduce Yourself Clearly

Clients should never have to guess who you are or why you’re there.

Observe Before You Act

The first visit is not the time to reorganize or “improve” anything. It is the time to learn.

Ask Permission for Everything

Even small actions require permission. Asking restores control.

Match the Client’s Pace

Your pace should never exceed theirs.

Keep the First Visit Simple

The goal is rapport, understanding, and emotional safety — not efficiency.

Heart of the Chapter

Caregiving begins with a mindset, not a task.
Caregiving begins with humility, awareness, and respect.
Caregiving begins with the attitude that you are entering someone else’s world — and your presence can either bring calm or create stress.

When you show up with steadiness, patience, and professionalism, you create the foundation for everything that follows.

# # #

AI Scribe

by Elizabeth E. Hogue, Esq. | Jul 24, 2026 | Artificial Intelligence, Clinical, New Tech

by Elizabeth E. Hogue, Esq.

Ai Scribes Enticing

But...

Use of AI (artificial intelligence) scribes or generative AI is very enticing to many clinicians. The “scribe” listens in the background to the interchange between clinicians and patients and then produces comprehensive documentation in a matter of minutes.

No more staring at a computer screen and punching away at keyboards while talking with patients!

No more struggling to complete documentation on a timely basis after visits with patients!

The use of this technology is spreading rapidly. In fact, it may be the fastest-adopted medical technology of all time!

From clinicians’ point of view, what could go wrong?

Clinicians are discovering, however, that writing clinical notes is a vital step to arrive at an accurate diagnoses and/or appropriate plans of care.

Here is what Helen Ouyang says in The New York Times Magazine, July 12, 2026:

“For a while, after I started using the scribe, my role in creating the …note seemed simple: read the draft, correct what was wrong, sign it. So fast, so easy.”

But then...

“…the process began to discomfit me, as a I slowly realized that editing a note I did not create does not demand the same of me as writing a note. I was no longer thinking through the interaction with a patient and the meaning of the information I had gathered from the visit…

This distinction seemed small at first. Over time, though, I have come to see how much of my own thinking had been bound up in the writing process itself.”

Ms. Ouyang goes on to say:

“The process of note-writing helps me formulate decision-making and then check whether it really holds up. If I find myself trying too hard to explain away a patients’ symptoms, trying to hard to dismiss a worrisome vital sign, trying too hard to fit an abnormal result into a reassuring narrative, then maybe I need to revise my conclusions….”

Unsettling changes

According to Ms. Ouyang, there’s something else, too. What also unsettles her is that the interaction no longer feels quite like what healthcare, at its heart, is supposed to be i.e. an intimate exchange between two humans. The sick room should be able to hold fear, shame and guilt, to shelter things people say in the depths of illness.

“But when every word is being recorded, no matter that the recording stays confined to a machine something feels diminished. There is, or ought to be, something close to sacred in such moments.”

Helen Ouyang, MD MPH

Emergency Medicine, Columbia University Irving Medical Center

Final Thoughts

The provision of care also depends on exchanges between clinicians. Documentation generated by AI makes it more difficult to tell what colleagues really think.

And clinicians should always bear in mind that AI is not foolproof. AI may, for example, introduce new diagnoses, for example.

Like many other things, AI may prove to be a mixed bag rather than the answer to the never-ending story of complete, accurate timely documentation.

# # #

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.

VA Cuts Harm Another Provider

by Kristin Rowan | Jul 24, 2026 | Advocacy, Veterans Affairs

by Kristin Rowan, Editor

Veterans Losing Access to Care

The 90-year-old veteran clutched tightly to his medal, a Purple Heart, as he made his way to a VA health center to apply for care. That was nine months ago.

He is still waiting.

Franchise Executive Speaks Out

We spoke with Heidi Maddocks, VP of Health Care Strategies and National Alliance for Amada Senior Care, a national franchise system with franchisees in Texas and New Mexico. She describes herself as a “self-appointed veteran advocate.”

“The rate cuts for Texas and New Mexico don’t make any sense,” she told us. “The community care network was created for veterans to access care outside of VA facilities. The parts they cut hit hardest where it is already hard to get care, such as rural areas in both states.”

She added...

“This is only one of many issues we have with the VA, but that is a story for another day.”

“Who decided this? What data did they use? Why did they keep rates steady in every other state?” She has a lot of questions, but found that the VA does not answer such questions. Perhaps that would change if more agency owners spoke up.

Veterans Experience Office

Maddocks works closely with the Veterans Experience Office in DC but is disappointed to find that most veterans do not know it exists. “Personnel in their regional offices are trying to do better,” she said. “They are not responsible for the cuts but must try to increase awareness and enrollment in spite of them. 48% of veterans are not enrolled in VA healthcare, often because they are elderly do don’t know it is available to them.”

A mission of awareness

Enrolling veterans is one of her missions. “It is one of three pain points for veterans,” she continued. “Suicide and homelessness are the other two. All three accompany loneliness.” Even veterans who receive other benefits don’t know about healthcare benefits they may be entitled to because the VA Health Administration and the benefits side are siloed. “They don’t talk to each other,” she asserted.

Veterans' Needs Come First

Ms. Maddocks understands that the VA Administration is trying to manage their budget. She does not know why Secretary Doug Collins can not understand that cutting home care will not achieve that goal. Limiting in-home services has always led to higher total expenditures when patients and clients are forced into institutional care.

“We have to put the veterans first,” she emphasized. “That is why we have kept our Waco office open, for example, even though it is operating at a loss. We have to have caregivers drive in from Dallas, which means higher hourly rates and drive time reimbursement.

Peer Advocates

She has also compiled a list of zip codes where veterans are impacted, in order to facilitate planning for resource allocation.

Final Thoughts

As we quoted in the first of these reports, VA Secretary Doug Collins believes his cuts will merely bring these two states in line with national market rates. He said they will not impact veteran care. The experience of Amada and other agencies to which we have spoken proves him wrong.

The thought of veterans, especially rural veterans, losing their in home care is devastating. 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.

# # #

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

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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Stark Law

by Elizabeth E. Hogue, Esq. | Jun 19, 2026 | Legal

by Elizabeth E. Hogue, Esq

Stark Law

History

The Stark law is more than 30 years old! It was enacted in 1989 and took effect on January 1, 1992. As many providers already know, the so-called “Stark law” prohibits physicians from making referrals to providers who render “designated health services” (DHS) if referring physicians have an ownership or investment interest in or compensation arrangement with the provider.

What's Included

Designated health services generally include home health, home medical equipment (HME), infusion services, and outpatient hospital services. Hospices, however, are not DHS. Likewise, providers of DHS generally cannot bill for services provided to patients referred by physicians who have ownership or investment interests in or compensation arrangements with them that violate the Stark law.

Enforcement

Enforcement is currently extremely aggressive. In 2024, there were 979 qui tam or whistleblower lawsuits with settlements and judgments amounting to a record-breaking $2.92 billion. In the same year, CMS resolved 314 Stark law self-disclosure settlements totaling more than $24.7 million, which is almost twice the previous annual record. An additional 232 disclosures were withdrawn, closed without settlement, or closed without settlement by law enforcement partners of CMS.

Bumper Crop

Here are some possible reasons for this “bumper crop:”

Whistleblowers are more knowledgeable and sophisticated
The U.S. Department of Justice is more willing to litigate cases
Court decisions provide new guidance about physician compensation, referral arrangements, and ownership.

Recent Illustrations

Five recent cases illustrate these trends:

Community Health Network paid a total of $480 million to settle violations related to the Stark law. This settlement was based on a complaint by a whistleblower filed by the former CFO and COO. They complained that doctors were paid more than fair market value (FMV) and received bonuses that were tied to the number of referrals. This case shows that if compensation arrangements are structured based on the volume of referrals, they likely violate the Stark law even if consultants claim that compensation is at fair market value.
Covenant HealthCare and two physicians paid a combined $69 million to settle civil suits based on contracts that did not meet requirements of any exception to the Stark law. Providers who use medical directors were reminded by this case that physicians who make referrals must be paid at FMV.St. Francis Health paid $36.5 million because it allegedly made payments to physician specialists tied to the volume or value of referrals.
Massachusetts Eye and Ear paid more than $5.7 million based on compensation paid to physicians that violated the Stark law. Physicians were paid a percentage of operating margins from facility fees. These fees were, in turn, distributed as bonuses to employed physicians based on services performed and hours worked. Returning revenue back to physicians through bonus structures even if treated as compensation based on productivity is clearly a “non-starter.”
Erlanger Health System is currently defending itself in two lawsuits that claim it compensated employed physicians in violation of Stark. In response to these suits, Erlanger says that physician compensation is based on FMV as determined by outside consultants, but cases described above call this conclusion into question.

Final Thoughts

Many trade associations and providers have called for changes to the Stark law or even doing away with it altogether. As the above cases demonstrate, however, Stark is alive and well!

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Justice Department’s Next Target

by Kristin Rowan | Jun 19, 2026 | Medicaid, Waste Fraud and Abuse

By Kristin Rowan, Editor

Justice Department's Next Target

New York Sued for Fraud

The past several months, Vice President JD Vance, Dr. Oz, and the anti-fraud task force have investigated home health and hospice agencies suspected of fraud. Much of the focus has been in Minnesota, Georgia, and California. Now, New York joins the list of targeted states, as the Justice Department suis the New York State Department of Health, the state’s Medicaid director, Public Partnerhsips, LLC (PPL), the company operating the $10 billion Consumer Directed Personal Assistance Program (CDPAP) for the state.

CDPAP Management

Prior to the fall of 2024, CDPAP was managed by hundreds of individual agencies. The state opted to consolidate management into one firm and selected PPL. At the time, CDPAP was one of the largest public health benefits programs in the state with more than 250,000 patients.

Justice Department Allegations

Skimming

In the lawsuit, the Justice Department alleges unauthorized profits going to PPL. These profits allegedly come from PPL skimming a percentage of each hour of care billed to Medicaid. The skimmed percentage, according to the suit, amounts to millions of dollars.

Favored Vendor

The Justice Department further alleges PPL was untruthful in its bid regarding its staffing plan, its financial readiness to handle the contract, and the quality of its software, among other aspects of the plan.

The Department of Justice is blaming New York Governor Kathy Hochul and her administration for allowing the fraud. The DOJ alleges PPL was “preselected” as the winner of the contract in a fixed bid process.

Misrepresentation

The lawsuit further alleges that PPL won the contract after a “sham bid” process. The Justice Department claims PPL intended to stray from the representations made in their bid, that the New York Department of Health learned of the deceit, and failed to hold PPL accountable.

JD Vance Speaks

At a recent campaign event, Vice President JD Vance spoke about the lawsuit.

“You do not want your government facilitating fraud; you want your government fighting against fraud. You know what these fraudsters are doing? They’re taking advantage of American generosity to enrich themselves.”

JD Vance

Vice President of the United States

Response

New York State Department of Health spokesperson Cadence Acquaviva called the lawsuit a “baseless complaint” and an attempt by Republicans to “score political points at the expense of vulnerable New Yorkers.” Acquaviva called the lawsuit “inexcusable and completely lacking in merit.”

The Rowan Report reached out to PPL for comment, but did not hear back as of the publication of this article. We will provide updated information as it becomes available.

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Response to HHS Reports

by Rowan Report | Jun 19, 2026 | Advocacy, Medicare Advantage

FOR IMMEDIATE RELEASE

Contact: Colleen Knudsen
cknudsen@leadingage.org
202-508-1215

Post-Acute Care Medicare Advantage Coalition Statement on OIG Reports Confirming Barriers to Post-Acute Care in Medicare Advantage

Washington, D.C, June 16, 2026. The Post-Acute Care Medicare Advantage (PAC MA) Coalition issued the following statement in response to the U.S. Department of Health and Human Services (HHS) Office of Inspector General’s (OIG) two new reports, The Three Largest Medicare Advantage Organizations Denied Requests for Long-Term Acute Care and Inpatient Rehabilitation at Some of the Highest Rates and Medicare Advantage Organizations Overturned Nearly All Appealed Prior Authorization Denials for Skilled Nursing Facility Admission, Raising Concerns About Initial Denials:

Coalition Statement

The PAC MA Coalition has long championed critical yet commonsense and necessary reforms to ensure Medicare beneficiaries’ access to medically necessary care across all post-acute settings. These June 2026 OIG reports provide important, independent confirmation of what providers and Medicare beneficiaries have experienced for years: Medicare Advantage (MA) plans are using prior authorization (PA) and similar tactics to restrict beneficiaries from receiving the services that Medicare Advantage Organizations (MAO) are legally required to provide.

Across the post-acute care (PAC) continuum, OIG found concerning denial patterns, wide variation of the rate of denials among MA organizations, and high rates of successful appeals. Even when a denial is later overturned, the patient may still have faced unnecessary care delays, a prolonged hospital stay, an interruption in recovery, or placement in a less appropriate care setting. Given each PAC setting’s distinct role and value in the rehabilitation continuum, these outcomes can cause significant disruptions in patients’ recovery trajectory and place patients at higher risk for complications and readmissions – all of which produce poorer outcomes and increase costs for the Medicare program.

For Medicare beneficiaries recovering from serious illness, injury, surgery, stroke, or other complex medical events, timely access to the right post-acute care setting is essential. These decisions are not simply administrative; care in the appropriate setting can affect whether a patient regains function, avoids complications, returns home safely, or receives the services needed to recover altogether.

The Coalition is also concerned by OIG’s findings regarding third-party contractors and vendors involved in PA decisions. MAOs remain responsible for ensuring that their contractors, which may deploy algorithmic or artificial intelligence-supported tools in PA decision-making, comply with Medicare coverage rules. High denial overturn rates should prompt closer CMS oversight of whether these entities are applying Medicare standards accurately and enforcement with meaningful penalties when there are patterns of non-compliance.

The OIG reports underscore the need for better data, transparency, and stronger accountability. The Coalition urges the Centers for Medicare and Medicaid Services (CMS) to implement OIG’s recommendations to collect detailed, request-level PA data–including standardized service type, contractor involvement, denial rationales, decision timelines, appeal outcomes, and information on continued-stay requests. CMS should make these data publicly available and also examine why denial and overturn rates vary so widely across plans and contractors and take corrective action, where appropriate.

The Coalition further urges OIG and CMS to conduct a similar review of MA practices affecting home health services. Home health providers report that even when care is approved, MA plans frequently authorize fewer visits than clinically appropriate and reimburse at rates significantly below traditional fee-for-service (FFS) Medicare. As a result, patients may be left without the full scope of services they need to recover safely at home.

MA plans are required to provide access to Medicare Part A and Part B services in a manner comparable to traditional FFS Medicare. The OIG reports make clear that stronger oversight, greater transparency, and more consistent enforcement are needed to ensure MA beneficiaries receive the post-acute care they are entitled to under Medicare, in the most clinically appropriate setting. Our groups collectively applaud the OIG’s observation that, “as enrollment in Medicare Advantage continues to grow, so does the urgency and importance of ensuring that MAOs are delivering on the value that the Federal Government pays them to provide.”

The PAC MA Coalition therefore stands ready to work with CMS, Congress, OIG, MA organizations, and other stakeholders to address PA, reduce unnecessary administrative burden to providers, ensure adequate payment, and protect timely access to medically necessary post-acute care.

The PAC MA Coalition renews its request for CMS to standardize post-acute care prior authorization procedures across MA plans. Greater consistency, compliance, and accountability are needed to ensure decisions reflect traditional Medicare FFS standards. Expedited PA is essential so beneficiaries receive timely, medically necessary services and avoid unnecessary delays in recovery.”

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About the PAC MA Coalition

Post-Acute Care (PAC) is made up of approximately 15,000 skilled nursing facilities (SNFs), 11,500 home health agencies (HHAs), 1,200 inpatient rehabilitation facilities (IRFs), and 370 long-term acute care hospitals (LTCHs), among other provider types.

The Post Acute Care Medicare Advantage (PAC MA) Coalition is comprised of LeadingAge, the American Health Care Association and National Center for Assisted Living (AHCA/NCAL), the American Medical Rehabilitation Providers Association (AMRPA), the National Alliance for Care at Home (the Alliance), the National Association of Long Term Hospitals (NALTH), and the Center for Medicare Advocacy. Together, the Coalition represents the interests of PAC providers and the Medicare beneficiaries who require their services.

The Coalition’s objective is to ensure Medicare beneficiaries enrolled in MA and Special Needs Plans (SNPs) receive comparable and timely access to Medicare Part A and B services as their Traditional Medicare counterparts, while also ensuring the financial viability of providers who participate in MA networks through adequate payment and reduced administrative burden.