If you run a home health or hospice agency, you probably know the feeling: survey season keeps you up at night, ADR rejections eat into your margins, and staff are constantly frustrated by conflicting forms and policies. Even worse, patients can suffer when important details get lost between your software, policies, and care plans.
These problems don’t usually happen because your team doesn’t care or isn’t working hard enough. These problems happen because most agencies are operating with a patchwork system; meaning forms from one vendor, policies from another, training from somewhere else that simply don’t line up. That hidden lack of continuity is what creates confusion, survey deficiencies, failed ADR’s and even compliance risks that put your agency’s future on the line.
*This article was written in consultation with Mariam Treystman.
At The Home Health Consultant, we’ve spent decades helping Medicare-certified home health and hospice agencies navigate compliance. We’ve seen firsthand how continuity, or lack of it, can make or break an agency. As our co-founder Mariam Treystman explains:
“Over the last 20 years, I’ve rarely seen a system that’s truly consistent. Most agencies are piecing together policies from one place, forms from another, inservices from somewhere else. Individually, they may be compliant, but together they create contradictions that set agencies up for failure.”
In other words, continuity is the “glue” that holds your systems together.
By the time you finish this article, you’ll know:
- Exactly how to spot gaps in your system
- Why those gaps cause survey and ADR headaches
- Simple steps you can take to align your policies, forms, & teaching so your agency runs smoother and safer
What Does Continuity Mean in Home Health & Hospice Care?
Before we dive into why agencies lose continuity, let’s define it. Continuity means that all components of your agency’s system fit together seamlessly to reflect the same processes and expectations.
The components of your agency’s system include:
- Programs (infection control, falls, emergency preparedness, etc.)
- Policies & Procedures (step-by-step instructions for tasks)
- Forms (admission, charting, HR, audits, etc.)
- Staff Inservices (training and education materials)
- Patient-Facing Information (brochures, admission booklets, teaching guides)
When each of these is pulled from different sources, they often conflict with one another.
A policy might say one thing, but your form doesn’t capture it. A patient booklet might promise something your staff training never covers. And when surveyors connect those dots, the agency, not the vendor, is the one at risk.
With this in mind, let’s look at how agencies end up with systems that don’t match.
Why Do Agencies End Up with Mismatched Systems?
If continuity is so important, why do so many agencies end up with mismatched systems? The short answer: because they’re doing their best with what’s available.
Agencies often:
- Get forms from their EMR software
- Buy policies from national vendors like Corridor
- Purchase OASIS/Comprehensive Assessment tools from Briggs or MedPass
- Download patient teaching sheets from the internet
- Pull inservices from various healthcare organizations
This patchwork approach isn’t wrong, but it creates cracks in the system. As Mariam Treystman explains:
“It’s not that agencies are doing anything bad. They’re doing what everyone does: grabbing the resources they can find. But the problem is when your patient packet says one thing, your policy says another, and your forms don’t match either, you’re essentially sabotaging yourself.”
When resources don’t come from the same place, they don’t naturally “speak” to each other, and that’s when continuity breaks down. Next, let’s talk about the real-world consequences of that breakdown.
What Problems Does Lack of Continuity Create for Agencies?
The biggest danger of mismatched systems is that the problems multiply. What looks like a simple oversight on one form actually cascades into bigger issues across your entire agency.
- Survey Deficiencies Multiply Quickly: Surveyors don’t just note an error. They immediately ask for the policy behind it. If your form didn’t capture what the policy required, you get cited twice: once for the error, once for not following your policy.
- Critical Care Errors: Misaligned forms and policies often mean critical patient information never makes it to the care plan. For example, medications listed in an assessment may not flow into the care plan, creating dangerous gaps in treatment.
- ADR Rejections: Medicare contractors deny claims when documentation doesn’t present a “continuous picture” of eligibility and medical necessity. If homebound status is documented on one form but not consistently across the record, an ADR denial is almost guaranteed.
- Legal Risks: If mismatched systems lead to a missed step that harms a patient, agencies face liability. Families may sue if care errors, injury or death are linked to inconsistent documentation.
- Inability to Grow: The problems above create non stop issues that require leadership time, effort and input. When everyone is busy putting out fires, they can’t focus on growth.
Lack of continuity turns everyday operations into compliance landmines. The good news is there are warning signs you can spot early.
How Do You Know If Your Agency Has a Continuity Problem?
Recognizing continuity issues is half the battle. Many agencies don’t realize they have a problem until surveyors or auditors point it out.
Ask yourself these questions:
- Do our patient brochures match the policies we train staff on?
- Do our software forms capture all the data our policies say we must collect?
- Do our inservices align with our programs and patient teaching?
- Are ADRs being denied for vague reasons like “lack of medical necessity”?
If the answer is “yes” to any of these, you likely have a continuity problem. The sooner you address it, the safer your agency will be. So how do you actually fix these gaps?
How Can Agencies Fix Continuity Gaps Before They Lead to Deficiencies?
The key to solving continuity problems is alignment. Every piece of your system should be designed to support the others, not contradict them.
Here’s where to start:
- Standardize Your Sources: Use one integrated system wherever possible. The more you mix vendors, the greater your risk of contradictions.
- Cross-Check Patient Materials: Make sure admission packets and patient brochures reflect the exact policies your staff follow.
- Audit for Alignment: Regularly compare your policies, forms, and programs to confirm they’re consistent.
- Train Staff with Matching Materials: Staff education must reflect the same processes your forms, programs and policies require.
- Invest in Unified Systems: Programs like The Home Health Consultant’s Administrative Compliance Program are built intentionally so that policies, forms, and programs align with each other and with accreditor requirements.
As Mariam puts it:
“The agencies that grow to the next level are the ones that solve continuity. Without it, you’re always patching holes with mismatched resources instead of building a strong, consistent foundation.”
By taking proactive steps to unify your systems, you can avoid many of the costly problems we’ve covered.
What’s the Bottom Line on Continuity in Home Health & Hospice?
At the end of the day, continuity isn’t just a “nice-to-have.” Continuity is the difference between agencies that are constantly putting out fires and those that run smoothly.
Audit your systems, consolidate your resources, and ensure your patient-facing, staff-facing, and compliance documents all match.
If you need help preventing deficiencies and aligning your systems, you may be a good fit for our Administrative Compliance Program (ACP).
You can learn more about ACP and how we help agencies like yours improve their continuity and compliance below.
*Disclaimer: The content provided in this article is not intended to be, nor should it be construed as, legal, financial, or professional advice. No consultant-client relationship is established by engaging with this content. You should seek the advice of a qualified attorney, financial advisor, or other professional regarding any legal or business matters. The consultant assumes no liability for any actions taken based on the information provided.
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