If you’re a home health or hospice DPCS in California, the phrase “home visit observation” probably makes your chest tight. You’ve built your agency around excellent patient care. But, when a surveyor steps into your patient’s home with a clipboard and a checklist, it can feel like every move, glove, and policy is under a microscope.
We hear from agency leaders all the time that they thought they were ready for their next ACHC, TJC, or CHAP survey. But then the home visit begins. Suddenly, small details like where a nurse places her bag or how a medication list is verified can turn into deficiencies. Deficiencies that ripple through your agency’s entire survey.
At The Home Health Consultant, we help agencies move from “hoping we pass” to knowing they’re ready, every single day of the year.
This article will help you:
- Understand what actually happens during a survey home visit
- What surveyors are looking for during a survey home visit
- How to make sure your clinicians can demonstrate excellence (not just compliance) when it matters most
*This article was written in consultation with Mariam Treystman.
Why Is the Home Visit Such a Big Deal During a Home Health or Hospice Survey?
For both home health and hospice agencies, the survey home visit isn’t just another step in the process. The home visit typically makes up about 20–25% of your total survey score, and it’s the only time surveyors directly observe care being delivered.
Whether it’s your initial Medicare certification or Medicare renewal survey, this visit allows surveyors to see if the policies in your binder are being followed in the field. That’s why how your clinicians perform in a real home setting says more about your agency’s systems than any document ever could.
What Do Surveyors Actually Look for During a Home Health or Hospice Home Visit?
Every home visit looks different depending on the patient’s condition and discipline. But, surveyors consistently focus on a few critical areas that reveal whether your agency’s care delivery aligns with your written procedures and regulatory standards.
Let’s unpack what those elements look like in practice.
How Should Clinicians Identify Home Health & Hospice Patients?
If your agency is accredited by The Joint Commission (TJC), you’re required to use a double-verification process before any clinical activity begins. That means confirming two identifiers. This could be full name and date of birth, or full name and address.
*Important Note: Whatever two identifiers your agency chooses to use, must be standardized and used across the board. For example one clinician can’t ask for full name and date of birth, when another is asking for full name and address.
Even a small deviation, like using the wrong pair of identifiers, can result in non-compliance for agencies accredited through TJC. For agencies accredited through ACHC, this specific TJC rule won’t cause a deficiency. But, it’s still a best practice worth adopting across all settings for a field staff’s first encounter with a patient. It sets the tone of professionalism surveyors expect from the start.
What Infection Control Practices Matter Most?
No matter your discipline, hand hygiene and bag technique are two of the most heavily observed elements in any home visit.
Surveyors expect clinicians to demonstrate proper hand hygiene including but not limited to:
- before patient interaction,
- during patient interaction,
- and after patient interaction
*This is the rule for all roles, even social workers who may not physically touch the patient. It’s a visible indicator of your agency’s infection control culture.
Similarly, bag technique shows how well your team prevents contamination between visits. Clinicians should always follow proper bag technique, including but not limited to:
- place their bag on a clean barrier (like a disposable paper towel),
- and clearly separate clean and dirty sections inside their bags
Surveyors will note not only if the technique is correct, but if it’s performed consistently and confidently.
How Does Medication Reconciliation Factor Into Survey Home Visits for Home Health & Hospice?
When a nurse is present, medication reconciliation becomes a focal point of the observation.
Your nurse must verify that every medication in the home matches the patient’s care plan and the office medication list: bottle by bottle, detail by detail.
As this happens, the surveyor will often review the home chart to confirm that all documentation is complete, accurate, and aligned. Any discrepancies here can escalate quickly into deeper investigations of your agency’s medication management and documentation practices. This deeper investigation can then escalate, even further, into conditional deficiencies and patient safety issues.
*Pro Tip: As we always say in this industry, if it wasn’t documented, it wasn’t done. If your nurse is conducting medication reconciliation but not documenting it, you’ll get a deficiency.
Will the Surveyor Stay for an Entire Home Health or Hospice Clinical Visit?
Whether or not your surveyor will stay for the entire home health or hospice home visit depends. In many cases, once the surveyor has observed the key components (including but not limited to)…
- Patient identification
- Hand hygiene
- Bag technique
- Medication reconciliation
- Home chart review
…they’ll step out and allow the clinician to complete the rest of the visit privately.
However, if the visit involves more technical or hands-on procedures (like wound care or IV therapy), the surveyor may stay longer to observe how treatment is delivered.
The key takeaway? Always assume you’re being observed for the entire visit until the surveyor leaves the property.
What Happens If a Surveyor Finds an Issue During a Home Health or Hospice Home Visit?
Deficiencies during the home visit don’t just affect that portion of your survey. Surveyors often see these deficiencies as signals of systemic weaknesses.
For example:
- A lapse in hand hygiene could lead to an expanded infection control review
- Medication discrepancies might trigger a deep dive into your medication management policies
- Missing chart elements can prompt a full audit of your clinical documentation.
In short, one weak link in the home visit can pull the entire chain of compliance under review. That’s why consistent training, observation, and real-world practice are essential parts of staying ready.
How Can Agencies Prepare for Home Visit Success?
The most survey-ready agencies we work with don’t “cram” before a visit, they build readiness into their routine.
That means regularly reviewing and practicing these core policies:
- Hand Hygiene
- Bag Technique
- Medication Reconciliation
- Patient Identification (if your home health or hospice is accredited through The Joint Commission)
Supervisory visits, direct observations, and inservices help keep these skills second nature. As our co-founder, Mariam Treystman, puts it:
“Get these elements right every time, not just for survey. It’s how you prove your agency runs safely and professionally, day in and day out.”
What’s the Need to Know About Survey Home Visits for Home Health & Hospice Agencies?
The survey home visit is your agency’s moment to show, not tell. The home visit is where you demonstrate that your systems aren’t just compliant, but consistent.
When every clinician knows exactly what to do and why, surveyors see what you already know: that your agency is built on safe, defensible, high-quality care.
Want to strengthen your understanding of how regulations that feel bureaucratic actually connect to patient care? At The Home Health Consultant, we don’t believe in gatekeeping industry knowledge. The more educated agencies and their teams are, the better, more compliant care patients receive.
Read our next article: How Admin Compliance Affects Patient Care in Home Health & Hospice.
*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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