If you run a home health or hospice agency, you’ve probably heard the term "designee" — but what exactly does it mean? When can you use one? Does a designee have to work at your agency full-time, or can they just step in as needed? Understanding the role of a designee is critical for maintaining compliance and ensuring your operations stay stable when key staff are unavailable.
At The Home Health Consultant, we specialize in helping home health and hospice agencies build strong operations — including getting designees set up the right way. With our experience preparing agencies for surveys, accreditation, and compliance success, we’re here to walk you through everything you need to know.
In this article you’ll learn:
- Exactly what a designee is
- Which positions require designees
- How to keep and ensure designees are qualified
- How you can use designees to safeguard your agency
By the time you finish reading, you'll be able to confidently meet designee requirements and ensure the protection of your agency.
What Does “Designee” Mean in Home Health & Hospice?
In short: A designee is a backup.
It’s the person you officially designate to step in and cover an important role when the regular person can’t be there. This could be if they're on vacation, sick, hospitalized, or otherwise unavailable.
Think of it this way: If someone in a critical role suddenly disappears for a few weeks, who would make sure operations don’t fall apart? That person is the designee.
Which Positions in Home Health & Hospice Must Have a Designee?
Not every role in your agency requires a designee. However, some roles are required, by law, to have one. Not having a designee for any of these required positions means you’re out of compliance.
If you're Medicare-certified, CMS expects you to have designees for these roles:
- Administrator (Home Health and Hospice)
- Director of Patient Care Services (DPCS) (Home Health and Hospice)
- Medical Director (Hospice only)
If you're in California, the Department of Public Health (CDPH) also requires and reviews designees for approval. As of this writing (April 2025) CDPH is not processing home health designee applications. So, agencies are advised to update CDPH via email at cab@vdph.ca.gov for any reportable designee changes for home health. Below you’ll find an example of how to format a reportable home health designee change email to CDPH while they’re not processing applications.
Hospice designee applications are still being processed as usual.
Pro Tip: Even though it’s only legally required for these positions, we strongly recommend creating designees for other critical roles too. (More on that below.)
When Can You Use a Designee?
You don’t need to call in your designee for every sick day. But you should activate them when:
- The primary person will be unreachable for an extended period (vacation, surgery, hospitalization, etc.)
- The absence is unplanned, and the role’s responsibilities still need urgent attention
It’s a judgment call. But when in doubt, it’s better to activate the designee than to risk falling into noncompliance by having a gap in your essential staff and operations.
Does a Designee Have to Be a Full-Time Employee?
No, a designee does not have to be a full-time employee at your home health or hospice agency. It’s perfectly acceptable for a designee to be an outside person who just jumps in when needed, as long as they’re qualified.
While a designee doesn’t have to be someone who already works for you, some agencies find it easier to designate a person who already works at their agency. Using someone internal can streamline the process to keeping your designee prepared, educated and qualified.
Whether you designee actively works at your agency or not, they must be properly trained and prepared to do the job.
How To Keep a Designee Trained, Educated, & Compliant?
Here's the easiest way to keep your home health or hospice designees ready: Treat them like the real thing.
To qualify as a designee, the individual must meet all of the same requirements and qualifications as the position they’re the backup for. For example, your administrator designee must have the same qualifications as your active administrator.
Remember, the whole point of a designee is to have someone ready to step into critical staff roles at any time. So, maintaining their qualifications, education, and knowledge of your agency’s internal processes is crucial. Now let’s dive into the specifics.
You must:
- Fully onboard the designee (company mission, policies, compliance expectations) as you would any other employee
- Train them on the specific duties of the role they’re backing up
- Provide and sign job descriptions for both their regular position (if applicable) and the backup position
- Competency-check them (if it’s a clinical role)
- Include them in ongoing training and company-wide inservices (emergency plans, infection control, critical policy changes)
- Conduct performance evaluations based on any duties they actually performed and the duties they’re a back up for. Even if the designee didn’t get a chance to perform those duties in a given year, they should be aware of what they’re responsible for.
This preparation ensures that if a sudden emergency hits, the designee is ready to step in without needing an extended crash course.
How Long Can You Use a Designee?
How long you can use a designee depends on the situation surrounding the primary staff member’s absence.
In California, if the main person resigns or is fired (creating an official vacancy), you can use a designee to fill the gap for up to 30 days. After 30 days, you must officially replace the vacancy with a new hire.
But if someone’s just temporarily absent (like on leave or vacation), there's no hard time limit. You can use your designee as needed.
Should Other Positions Have Designees Too?
While there are only three positions required by law to have designees, you can (and probably should) absolutely appoint others — if you can manage it.
After two decades consulting in the home health and hospice industry, we recommend appointing a designee for anyone essential to your operations, even if it’s not required by law.
To help determine which other staff members may need a designee, ask yourself:
If [this person] disappeared for two weeks, would my agency be in trouble?
If the answer is yes, that role should probably have a designee.
Examples can include:
- Intake Coordinators
- QA/QI Coordinators
- Field Clinicians (especially your only HHA or RN opener)
You don’t necessarily need to hire more people. You should just make sure someone else in your agency is cross-trained enough to step in if needed.
That being said, we understand some agencies have limited resources. If you find yourself unable appoint extra designees, that’s perfectly fine. Just make sure you have the essential, required-by-law designees in place to remain compliant and avoid penalties.
Why Having a Designee Is Critical for Agency Stability
Emergencies don't wait for a convenient time. That’s why being prepared and staying ready makes all the difference.
If you don't have designees lined up and trained, a single unexpected absence can cause chaos. This can look like:
- missed visits
- failed surveys
- compliance violations
- patient care breakdowns
- referral rejection
Again, having designees for your administrator, DPCS, and medical director (hospice only) is required by law.
How Designees Safeguard Your Home Health or Hospice Agency
At the end of the day, running a compliant, stable, and survey-ready home health or hospice agency means being prepared for anything, especially unexpected absences. A designee isn’t just a box to check; it’s a critical safety net that ensures your operations continue smoothly when key staff are unavailable.
Throughout this article, we’ve unpacked:
- Exactly what a designee is
- Which roles require a designee by law
- How to properly appoint and train designees
- Why going beyond the minimum designee standards strengthens your agency's resilience.
If you’re feeling unsure about how to get started, explore our articles on...
...to ensure your designees are meeting the mark.
If you want expert support in setting up designees that work when you need them most, our team at The Home Health Consultant is here to help. We specialize in building agency structures that pass surveys and survive surprises.
Ready to protect your agency’s future? Schedule a call with us today to start building a compliance program you can count on.
*This article was written in consultation with Mariam Treystman.
*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.
