Most agencies don’t realize how quickly a missing medication list, an outdated care plan, or a disorganized patient folder can snowball into a conditional deficiency during survey. Surveyors spend up to a quarter of the home visit reviewing the documentation left by your agency at the patient’s home. Because of this, home chart compliance becomes a source of stress for administrators, clinical directors, and field staff alike.
At The Home Health Consultant, our team supports home health & hospice agencies with Medicare compliance. We’re writing this article because home chart errors are one of the most preventable causes of survey failure. Agencies deserve clarity, not guesswork, when it comes to what should (and must) be left in a patient’s home.
This article breaks down the Medicare Conditions of Participation around your home health or hospice home charts. In this article, we’ll explain:
- How surveyors evaluate home charts
- What must be included in a home chart
- Why accuracy matters more now than ever
*This article was written in consultation with Mariam Treystman.
What Is a Home Chart and Why Does Survey Depend So Heavily on It?
A home chart is the set of documents clinicians leave in a patient’s residence. The home chart serves as both a patient resource and a clinical reference when staff arrive for visits.
During survey, this folder is a major focal point. Home chart review accounts for 20–25% of the entire survey home visit. Deficiencies tied to missing or inaccurate materials can immediately escalate to conditional deficiencies.
Agencies often underestimate how tightly linked the home chart is to the office chart. Any mismatch between the two automatically raises questions about accuracy, safety, and compliance. And the last thing you want is a surveyor doubting your agency’s accuracy, safety, and compliance. So let’s talk about how to prevent that.
What is Required in a Medicare Home Chart for Home Health & Hospice?
While a home chart can sometimes be viewed as another generic folder, that could not be further from the truth. The home chart is intended to be a complete patient information resource (emphasis on the ‘complete’ part). What’s included is not arbitrary.
The “Patient Book” and Required Notices
Agencies commonly place a comprehensive “patient book” in this folder. This patient book can be anywhere from 50 to 200 pages. It commonly contains but is not limited to:
- Contact information
- Patient rights
- Privacy notices
- Emergency instructions
- Program details
- (In some cases) Financial information
Whether the agency uses a printed book or loose documents doesn't matter. What matters is that it’s all there.
Signed Consent Copies
Every legal form the patient signs, including but not limited to:
- general consent to treat
- hospice election forms
- medical record releases
- arbitration agreements
- consent to photograph
- similar documents
…must have a copy stored in the patient’s home chart.
Admission Forms That Guide Care
Your patient’s home chart will also need to include any forms and documents that help guide care. This could be but is not limited to:
- Evacuation plans
- Important phone number or contact information
- Advance directives
- The POLST (Physician Orders for Life-Saving Treatment) form. This must be present so caregivers and clinicians know how to respond in emergencies, and is especially important for hospice agencies.
Frequency-of-Visit Schedule
One of the most important requirements for a patient home chart is the frequency form. Surveyors expect to see a clear, visual explanation of how ordered visit frequencies translate into a calendar. This is so patients understand what “2wk2” or “1wk7” actually means for their care. This is a conditional requirement.
Current Care Plans
All current care plans, not just the general plan of care, must be present. Some agencies produce a single consolidated plan; others generate discipline-specific versions. The home chart must reflect whatever actually exists in the office chart.
Up-to-Date Medication List
The medication list is another one of the most critical components. An agency will not pass survey if the medication list is missing. Any discrepancy between the home and office versions is a major deficiency risk.
Patient Teaching Materials
If clinicians provide printed educational handouts, those materials should also be kept in the home folder. Though less central in survey than care plans or med lists, they are still part of the expected documentation.
Why Does Accuracy Between the Home Chart and Office Chart Matter So Much?
Surveyors treat the home chart as a real-time reflection of your records. If a clinician or patient sees outdated or incorrect information, that suggests the agency may not be safely coordinating care.
But beyond compliance, accuracy matters for daily operations. Here’s why.
1. Clinicians Cannot Rely on Memory
Most field clinicians see four to eight patients per day. Expecting them to remember ordered interventions, visit frequencies, or complex medication regimens isn’t realistic or safe.
While some EMRs (Electronic Medical Records, aka charting software) offer mobile apps, technology still hasn’t fully caught up. Clinicians often can’t pull up the kind of detailed care plan information they need directly from a phone while in a patient’s home. They also don’t have access to a reliable internet connection in the field. That’s why the home chart remains the most accessible, reliable source of truth.
2. Patients and Caregivers Need Clarity
Many home health and hospice patients take dozens of medications, sometimes upward of 30.
Without an updated list, families would be trying to navigate multiple pill bottles several times a day, which is a recipe for medication errors. The home chart exists to reduce that risk.
Further, each clinical visit comes with education and training for patients and caregivers. The home chart is where patients and the people that take care of them can reference detailed clinical instruction.
What Problems Do Agencies Experience When Home Charts Are Missing or Incorrect?
Our co-founder Mariam Treystman explains it clearly and simply:
“You will fail the survey if you have issues with your home chart.”
Surveyors regularly cite agencies for:
- Missing or outdated medication lists
- Missing or mismatched care plans
- Missing consent forms
- Missing POLST forms in hospice
- Missing or incorrect frequencies
- Incomplete patient books or required notices
These deficiencies often lead to more surveyor scrutiny. Home chart errors can trigger deeper record reviews, policy reviews, and cross-checks with EMR data.
While agencies vary in structure and EMR setup, the home chart must function as an accurate mirror of the office record. Completeness, clarity, and alignment across all documents are non-negotiable.
Home chart compliance is a clinical safety requirement. It’s also one of the first areas surveyors evaluate to understand how well an agency is managing care.
What Steps Should Home Health & Hospice Agencies Take to Be Ready for Their Survey Home Visit?
Strengthening home chart practices is only one part of preparing for survey. A deeper understanding of the entire home visit process helps agency leaders anticipate surveyor expectations long before the door knock happens.
If you want support beyond an article, our team provides a complete, federally compliant home chart through our Admin Compliance Program (one that passes survey every day).
But if you’re looking to read more, your next step should be reviewing What Really Happens During a Home Visit. This article breaks down the entire survey experience inside the patient’s home and how surveyors evaluate clinicians in real time.
*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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