· Executive Brief
National Home Care & Hospice Month 2026
A practical executive framework for access, ownership, handoffs, measurement, and improvement.
Leadership signal
National Home Care & Hospice Month can serve as an executive operating checkpoint.
Awareness can generate questions and requests for help. Executive teams can prepare by clarifying the first point of contact, the qualified team that accepts the request, the handoff standard, and the method used to verify completion without assuming that one route fits every person.
Start by distinguishing what is known from what the organization still needs to learn. A campaign plan, communication volume, or meeting count does not establish that a route is usable. Leaders need direct listening, clear ownership, locally defined measures, and a method for keeping exceptions visible.
Executive opening
Home care at a turning point: the handoff into the home
Home health and hospice sit at the end of many hospital pathways, yet they are often managed as someone else’s service. A discharge planner selects a setting, a referral leaves the building, and the health system assumes the next team has accepted the work. National Home Care & Hospice Month is a useful moment to test that assumption. The evidence suggests that the handoff into care at home is where access, cost and equity begin to diverge.
The stakes are visible in Medicare data. Among stroke and heart failure patients, skilled nursing facility care was associated with approximately $4700 more in Medicare spending per post-acute episode than home health care.[1] The same study found no significant average differences in 30-day mortality or rehospitalization between the two settings.[1] In North Carolina, 38% of cancer decedents still had no hospice use in the last 30 days of life in 2019.[5] Live discharge occurs for 20% of hospice enrollees, a disruptive transition that removes support from patients and families.[7] Patients with dementia face higher risk of live discharge, and their families carry a heavier care burden.[7]
These are not isolated clinical events. They reflect how referrals are triggered, how settings are matched to needs, how agencies are staffed and how quality is measured. Discharge recommendations among acute care physical therapists showed poor national agreement, particularly across adjacent post-acute options.[3] Home care aides, who deliver much of the hands-on work, report high levels of material hardship.[6]
The sections below summarize current peer-reviewed evidence on post-acute outcomes, hospice timing and disenrollment, equity, the home care workforce and measurement. They sit beside the executive guidance already on this page. Together they give boards and operating leaders a shared factual base for deciding which home-based handoff to strengthen first.
Current evidence
What research shows about setting choice, hospice timing and live discharge
The choice of post-acute setting carries large financial consequences, while clinical differences remain uncertain. Using 2013–2017 Medicare claims and an instrumental variable design, one study compared skilled nursing and home health care for stroke and heart failure patients.[1] It found no significant average differences in 30-day mortality or rehospitalization.[1] The authors noted that the confidence intervals did not exclude clinically meaningful mortality reductions, so the result supports careful matching rather than a blanket preference.[1]
Setting still matters for some conditions. When 55 U.S. hospitals closed inpatient rehabilitation units between 2009 and 2017, patients with stroke or hip fracture were redirected to skilled nursing and home health.[12] Relative to inpatient rehabilitation, skilled nursing discharge was associated with higher 90-day mortality for stroke (+6.5%) and hip fracture (+5.8%).[12] Stroke patients redirected to home health had significantly higher rates of successful community discharge (+6.8%).[12] The authors cautioned that unmeasured confounding is possible and called careful referral protocols critical.[12]
Hospice timing remains a persistent quality gap. Among 150,412 North Carolina decedents with cancer from 2003 to 2019, the most frequent end-of-life care practice was hospital admission in the last 30 days, at 54%.[5] No hospice use, intensive care admissions, hospital admissions and in-hospital deaths decreased over time.[5] Even so, in 2019 hospital admissions and no hospice use remained high, at 52% and 38%.[5]
Live discharge is the other end of the hospice pathway. Among 1,436,018 older adults admitted to hospice with dementia, overall disenrollment moved only slightly, from 24.0% in 2012 to 23.2% in 2019.[8] Disenrollment for extended prognosis fell from 10.9% to 9.7% after federal policy changes.[8] Over the same period, transfers rose from 2.6% to 4.0% and moves out of the service area from 0.7% to 1.5%.[8] For-profit hospices had consistently higher overall disenrollment than nonprofits.[8] A separate hospice study also noted that live discharge carries higher risk for patients with Alzheimer’s disease and related dementias.[7]
For executives, the pattern is consistent. Placement decisions, hospice entry and hospice exit are each frequent decisions with uneven reliability and real consequences for patients and spending. The most useful local evidence is therefore how patients move between settings, how quickly and for what reasons, rather than referral counts alone.[1][8]
Figure 1
Hospice and home care pathways leave many patients outside the expected route
Percent of patients or hospitals affected by a pathway gap, as reported in each study. Values are copied from the cited studies [5], [7], [8], [13]; none is estimated.
Data note. These values come from different studies, populations, years and denominators, so this is an indirect comparison; the bars show where pathways leak, not how one gap compares with another.
Limitation. The hospice-use and disenrollment figures are patient-level rates from different cohorts, while the measure-agreement figure is a share of hospitals.
Figure data (4 rows)
| Measure | Value | Population, setting and year as reported | Source |
|---|---|---|---|
| Cancer decedents with no hospice use in the last 30 days | 38% | North Carolina decedents with cancer, 2019 | [5] |
| Hospitals where aggregate hospice measures matched timing patterns | 39.2% | 217 hospitals treating Medicare decedents with advanced cancer, 2016 | [13] |
| Hospice enrollees with dementia who were disenrolled | 23.2% | Medicare hospice enrollees aged 65 and older with dementia, 2019 | [8] |
| Hospice enrollees discharged alive | 20% | Live discharge rate for hospice enrollees, as reported in the background of a study of U.S. hospices | [7] |
Continuum of care
Where transitions into home-based care break down
Transitions into home health depend on many small steps that cross organizational lines. Timely attention by home health and outpatient providers within one week after discharge is associated with lower readmission rates among sepsis survivors.[9] Yet few patients nationwide receive this pattern of care.[9] Reported barriers included sepsis identification, information transfer, care coordination, timely access to care and patient engagement.[9]
One multi-site implementation study shows what closing those gaps requires. Five health systems with 16 hospitals partnered with affiliated home health agencies to deliver timely post-acute care for sepsis survivors.[9] Implementation teams deployed strategies spanning 62% of the 73 categories in a standard implementation taxonomy, totaling more than 450 distinct strategies.[9] They included record adjustments, centralized scheduling, telemedicine workflows, tailored home health pathways, staff education and quality monitoring.[9] Cross-cutting strategies reinforced coordination and education across the full continuum of care.[9]
The placement decision itself is variable. In a national vignette survey of 109 acute care physical therapists, overall agreement on discharge recommendations was poor (kappa 0.20), and mean pairwise agreement was 36.6%.[3] Agreement on home health recommendations was lower (kappa 0.17), and variability was not explained by training or experience.[3] The authors pointed to calibration and a shared understanding of post-acute settings as the response.[3] The rehabilitation closure study adds urgency, because the protective effect of inpatient rehabilitation was concentrated within 20 days after discharge.[12] The first weeks after discharge are where a placement decision shows its consequences.[12] The receiving team therefore needs complete information on day one.
Hospice live discharge is also a transition that needs ownership. In interviews with 20 hospice leaders at seven nonprofit U.S. hospices, participants described challenges in supporting patients after live discharge at the individual and family, organizational, community and system levels.[7] Families dealing with dementia faced a heavier care burden but could also access dementia-specific programs.[7] That mix of risk and resource argues for discharge planning that names who supports the family next.[7] Rising transfers between hospices and moves out of service areas are transitions too, and each hands a family to a new team.[8]
Each finding points to the same operating gap. The receiving setting is often chosen, informed and scheduled through steps that no single team owns from end to end. When a hospital and a home health agency share the work, both need to see whether the first visit happened.[9][3]
Figure 3
Why the pathway breaks
People
- Home care aides facing material hardship and income volatility
- Discharge recommendations that vary across clinicians
- Limited aide training and professional development
Process
- No owner for the first home health visit after discharge
- Late hospice referral in the last days of life
- Live discharge without a named next source of support
Technology
- Information not transferred to post-acute providers
- Predictive tools not integrated into clinical workflow
- Weak data quality and privacy protections in home care tools
Environment
- Constrained skilled nursing capacity in rural and low-income markets
- Limited home health access in some U.S. jurisdictions
- Heavier care burden for families of patients with dementia
Policy
- Payment rules that shape setting choice and spending
- Insurance expansion that did not change palliative care trends
- Lower hospice use among Medicaid and low-wealth older adults
Measurement
- Aggregate hospice measures that hide timing inequality
- Disenrollment not reported by type
- Nonspecific race and ethnicity categories
Unranked qualitative cause-and-effect diagram for the outcome in the box: Patients do not reach the right home-based setting, or enter hospice late, or leave hospice without a supported transition Causes are assembled from the cited literature [1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [13], [14], [15]; categories are not weighted and their order carries no meaning.
Data note. Qualitative; no frequencies are implied.
Limitation. Causes drawn from published studies may not all apply locally; validate them with frontline teams.
Figure data (6 rows)
| Category | Causes drawn from the cited literature |
|---|---|
| People | Home care aides facing material hardship and income volatility; Discharge recommendations that vary across clinicians; Limited aide training and professional development |
| Process | No owner for the first home health visit after discharge; Late hospice referral in the last days of life; Live discharge without a named next source of support |
| Technology | Information not transferred to post-acute providers; Predictive tools not integrated into clinical workflow; Weak data quality and privacy protections in home care tools |
| Environment | Constrained skilled nursing capacity in rural and low-income markets; Limited home health access in some U.S. jurisdictions; Heavier care burden for families of patients with dementia |
| Policy | Payment rules that shape setting choice and spending; Insurance expansion that did not change palliative care trends; Lower hospice use among Medicaid and low-wealth older adults |
| Measurement | Aggregate hospice measures that hide timing inequality; Disenrollment not reported by type; Nonspecific race and ethnicity categories |
Access
Reaching home health, palliative care and hospice in time
Access to home health is not uniform across U.S. jurisdictions. The comparison involved matched traditional Medicare patients undergoing elective knee replacement.[2] Surgery in Puerto Rico was associated with a lower likelihood of timely home health services than surgery on the mainland (risk ratio 0.33).[2] The same patients were more likely to be discharged to institutional post-acute care (risk ratio 1.35).[2] In sensitivity analyses, surgery in Puerto Rico was also associated with higher 30-day and 90-day readmission.[2] The authors linked these patterns to financial constraints on hospital resources and limited access to home health services.[2]
Local capacity shapes setting choice as well. The spending gap between skilled nursing and home health was larger in markets with constrained skilled nursing capacity.[1] Those markets included states with Certificate of Need regulations, rural areas and low-income neighborhoods.[1] The authors urged aligning discharge decisions with both clinical needs and local capacity, particularly under value-based payment models.[1] Supply changes redirect patients quickly: after rehabilitation units closed, discharge to inpatient rehabilitation declined sharply, offset by increases to skilled nursing and home health.[12]
Insurance expansion alone has not closed access gaps for palliative and hospice services. Among 26,227 Medicare beneficiaries with stage IV gastrointestinal cancer, 80.5% used palliative care before death.[15] Utilization rose from 54.3% in 2007 to 84% in 2013, and from 84.5% in early 2014 to 89.7% in late 2019.[15] An interrupted time series showed that Affordable Care Act implementation did not change that trend.[15] Palliative care use was associated with $2,633 lower total expenditure.[15]
Late entry is a second access failure. In the North Carolina cancer cohort, Medicaid decedents had the best end-of-life care quality, including hospice initiation in the last 3 days of life of only 6%.[5] Medicaid decedents also had lower rates of emergency department visits (9%) and hospital admissions (45%) than decedents with other insurance.[5] The authors suggested that interventions such as end-of-life patient navigation could improve care for patients with cancer.[5] For leaders, the timing of entry deserves the same attention as whether hospice was used at all.
Taken together, access depends on referral timing, agency availability and local capacity. Each can be examined by geography, payer and condition, which turns a general concern about access into specific gaps that can be assigned and tracked.[2][1]
Executive guidance · System route
Build one visible operating route for National Home Care & Hospice Month.
Use this route as a discussion framework. Replace each stage with the organization’s approved process, qualified roles, current service capacity, and applicable requirements. Do not infer a clinical protocol from the observance title.
The route at a glance
- Listen
- Clarify entry
- Coordinate the partner route
- Protect transitions
- Verify and learn
Reliability rule: Every stage needs a named owner, an observable status, an approved escalation path, and a defined signal that shows whether responsibility moved or remained unresolved.
Listen
Gather questions and friction points from people using the route, frontline teams, and community-facing staff. Separate observed barriers from assumptions.
Clarify entry
Publish a plain-language first step and identify who receives requests through each approved channel.
Coordinate the partner route
Align internal teams and external partners around one current message, real entry point, receiving owner, escalation path, and follow-through signal.
Protect transitions
Use acknowledgment and status visibility when responsibility moves between services, locations, or organizations.
Verify and learn
Review unresolved work, repeat contacts, and avoidable handoffs. Use the findings to improve the route rather than blame individuals.
Figure 2
The system route as one flow
The five stages of the system route described in this brief, drawn as one flow with a learning loop back to the start. The stages are the page’s original executive guidance, not a clinical protocol.
Data note. Shows sequence and handoffs only; it carries no counts or rates.
Limitation. Local processes may add, merge or reorder stages under organizational policy.
Figure data (5 rows)
| Stage | What the stage requires |
|---|---|
| Listen | Gather questions and friction points from people using the route, frontline teams, and community-facing staff. Separate observed barriers from assumptions. |
| Clarify entry | Publish a plain-language first step and identify who receives requests through each approved channel. |
| Coordinate the partner route | Align internal teams and external partners around one current message, real entry point, receiving owner, escalation path, and follow-through signal. |
| Protect transitions | Use acknowledgment and status visibility when responsibility moves between services, locations, or organizations. |
| Verify and learn | Review unresolved work, repeat contacts, and avoidable handoffs. Use the findings to improve the route rather than blame individuals. |
Equity and trust
Equity gaps in hospice and home-based care
Hospice use differs by race, ethnicity and wealth. A cross-sectional study examined 6,800 deceased U.S. older adults.[4] Non-Hispanic Black and Hispanic adults were significantly less likely than non-Hispanic White peers to use hospice in the final month of life.[4] After adjustment for socioeconomic and health factors, the gap for Black adults was no longer significant.[4] The gap for Hispanic adults persisted (odds ratio 0.76).[4] The author called for interventions that address structural barriers to end-of-life care.[4]
Socioeconomic position compounds those differences. Lower education, low household wealth and Medicaid enrollment were associated with reduced odds of hospice use.[4] Hispanic individuals in the lowest socioeconomic group had the lowest predicted probability of hospice enrollment, at 40%.[4] Similar patterns appear for palliative care. Patients from minority racial groups (odds ratio 0.79) and those in high Social Vulnerability Index counties (odds ratio 0.68) were less likely to use it.[15] The Affordable Care Act did not improve palliative care use for these groups.[15]
Standard quality measures can hide these gaps. Among 30,319 Medicare decedents with advanced cancer across 217 hospitals, 7,852 (25.9%) were people of color.[13] The median hospital-level difference was 3.66% for hospice care, indicating that more White decedents received any hospice care.[13] Inequality patterns based on daily timing matched aggregate measures in only 39.2% of hospitals for hospice and 46.5% for palliative care.[13]
The research base has its own gaps. In a review of 88 influential hospice and palliative care research articles, 60.2% combined minoritized groups into a nonspecific category.[14] Only 3.4% had a minority health or health disparity focus, and 19.3% included over 90% White participants.[14] The authors raised concerns about whether findings generalize to populations that experience disparities in palliative care outcomes.[14]
Place is an equity dimension too. The Puerto Rico comparison matched each patient with up to two Hispanic patients on the mainland, so the home health gap reflected location rather than ethnicity alone.[2] The authors called for research into structural factors that contribute to health disparities.[2] Trust is earned when an organization can show that the people least likely to reach hospice are reaching it, and reaching it in time. That requires specific race and ethnicity categories, socioeconomic and payer stratification, and timing measures that look beyond any use.[13][14]
Human infrastructure
The people who deliver care at home
Home care depends on a workforce that is financially vulnerable. Aides are often undervalued and work in challenging conditions that contribute to high turnover.[11] A 2023 financial health survey of Washington State home care aides came from a nonprofit that administers benefits and training to over 50,000 unionized caregivers.[6] It found that 75% of aides experienced at least one material hardship, such as food or housing insecurity.[6] That rate was significantly higher than among Washingtonians with similar incomes, and income volatility appeared to worsen hardship.[6] The authors recommended raising wages and emergency savings programs to support retention and care quality.[6] For health systems that depend on partner agencies, aide stability is part of their own discharge capacity.
Hospital staff are part of the home care pathway as well. In the sepsis transition study, hospital teams educated staff to improve sepsis recognition, documentation and referral to home health.[9] Providing timely visits also required staff and patient education and tailored home health pathways.[9] The therapists whose discharge recommendations varied did not differ by degree level or years of experience.[3] Calibration is therefore a shared training need rather than an individual performance issue.
Professional development is one lever with early evidence. In a pilot randomized trial of 102 home health aides who received virtual heart failure training, turnover intention fell from 21% to 14% at 90-day follow-up.[11] Baseline job satisfaction was high (77–86%), with modest improvements.[11] Interviews with 66 aides described greater motivation for learning, increased self-efficacy and perceived improvements in patient care.[11]
Technology is arriving in home care with workforce consequences. A qualitative study of 43 participants across five stakeholder groups included aides, agency leaders, worker advocates, clinicians and technology company staff.[10] Participants saw potential for artificial intelligence to enhance patient care and efficiency, but also risks to relationships and working conditions.[10] They called for early, inclusive governance frameworks and labor protections.[10]
Hospice leaders voiced similar conditions for data-driven tools. Leaders at seven hospices expressed strong interest in predictive tools to identify patients at increased risk for live discharge.[7] They emphasized careful tool specification and clinical workflow integration as conditions for usefulness.[7] Workforce plans for home-based care should therefore address pay stability, training and the role of staff in new tools, not only headcount.[6][11]
Executive guidance · Operating dashboard
Use a small dashboard to expose friction and ownership.
Do not publish a number until the organization defines its numerator, denominator where relevant, owner, source system, exclusions, review cadence, and limits. The candidates below are management prompts, not benchmarks or reported results.
Four operating signals
Each signal pairs an executive question with one candidate local measure, set out below.
Executive guidance · Signal
Entry-point clarity
Can people and staff identify the approved first step without searching across conflicting instructions?
- Candidate local measure
- Locally defined contact, routing, and repeat-contact signals by channel and service.
Executive guidance · Signal
Ownership reliability
Does a specific team accept each request and make its status visible?
- Candidate local measure
- Requests without an owner, aged work, transfers, and escalations using locally approved definitions.
Executive guidance · Signal
Partner-route reliability
Do participating teams share one current route and understand who owns each dependency?
- Candidate local measure
- Locally defined conflicting instructions, unaccepted handoffs, unresolved dependencies, repeat contacts, and partner feedback.
Executive guidance · Signal
Improvement closure
Does the organization correct recurring friction and report what changed?
- Candidate local measure
- Selected barriers, assigned actions, completion status, and post-change review.
Figure 4
The operating system behind the dashboard
The four operating signals from this brief’s dashboard, each tied to the candidate owner named in the executive scorecard, around one accountable route. Drawn from the page’s original executive guidance.
Data note. Structural diagram; no measured values.
Limitation. Owners are candidates to be confirmed locally.
Figure data (4 rows)
| Operating signal | Candidate owner |
|---|---|
| Entry-point clarity | Executive sponsor and operational lead |
| Ownership reliability | Operational owner and participating teams |
| Partner-route reliability | Sending and receiving owners |
| Improvement closure | Improvement owner and executive sponsor |
Executive guidance · Handoff workflow
Close the loop across teams, settings, and partners.
A handoff is reliable only when the sending party knows who is expected to receive the work, the receiving party acknowledges responsibility, and any unresolved exception remains visible. Local policy and qualified judgment control the actual process.
How responsibility moves
Lane A
From message to accepted ownership
- Confirm the approved message and intended audience.
- Publish the actual entry point and receiving role.
- Acknowledge receipt using the locally approved method.
- Escalate when ownership or response remains unclear.
Lane B
From accepted ownership to verified follow-through
- Record the next accountable owner and visible status.
- Name the sending and receiving owners, shared information, current status, and unresolved dependency.
- Keep unresolved work visible across boundaries.
- Confirm closure or document the continuing exception.
Executive guidance · Executive scorecard
Give leaders one view of route reliability and improvement.
The scorecard keeps review focused on decisions. Leaders should set definitions locally, examine variation without overclaiming cause, and pair quantitative signals with the experience of people who use and operate the route.
Who reviews what
- Executive sponsor and operational lead
- Operational owner and participating teams
- Sending and receiving owners
- Improvement owner and executive sponsor
Candidate owners named in the scorecard, confirmed locally.
| Operating signal | Executive question | Candidate owner | Suggested review point |
|---|---|---|---|
| Entry-point clarity | Can people and staff identify the approved first step without searching across conflicting instructions? | Executive sponsor and operational lead | At campaign launch and close |
| Ownership reliability | Does a specific team accept each request and make its status visible? | Operational owner and participating teams | At a locally defined cadence |
| Partner-route reliability | Do participating teams share one current route and understand who owns each dependency? | Sending and receiving owners | At a locally defined cadence |
| Improvement closure | Does the organization correct recurring friction and report what changed? | Improvement owner and executive sponsor | Until action is verified |
Figure 5
Control points for reliable home health and hospice handoffs
| Control point | Risk if missing | Owner | Evidence of control |
|---|---|---|---|
| Shared criteria for post-acute setting recommendations | Patients are matched to settings inconsistently and at higher cost | Chief medical officer with case management and rehabilitation leads | Periodic calibration review of discharge recommendations by setting |
| Confirmed first home health visit after discharge | Referrals leave the hospital without timely follow-up | Care transitions director with partner agency leaders | Share of home health referrals with a first visit within one week |
| Hospice referral timing review | Patients enter hospice only in the last days of life | Palliative care medical director | Hospice entry in the last 3 days of life, by service line and payer |
| Live discharge reported by type with a support plan | Families lose support after disenrollment | Hospice partner leadership and care management | Disenrollment by agency-reported reason with documented follow-up |
| Stratified access and timing measures | Aggregate measures hide inequality in hospice timing | Chief quality officer and board quality committee | Hospice and palliative care use and timing by race, ethnicity, payer and geography |
| Partner agency workforce review | Agencies cannot accept referrals because aide capacity is unstable | Chief operating officer and post-acute network lead | Partner capacity, turnover and training reviewed with referral volume |
| Governance for predictive and AI tools in home-based care | Tools disrupt workflows or worsen working conditions | Chief information officer with clinical and workforce leaders | Approved tool specification, workflow integration plan and staff input |
Control points derived from the cited evidence [2], [3], [5], [6], [7], [8], [9], [10], [11], [13] and this brief’s executive guidance.
Data note. Each row is a control to verify, not a measured result.
Limitation. Owners and evidence of control must follow local policy and applicable requirements.
Public communication
Communicating about home care and hospice with accuracy and trust
Public messages about hospice and home care should match the services an organization can deliver and the timing patients actually experience. Aggregate measures and daily timing patterns told different stories about hospice inequality in most hospitals studied.[13] Agreement occurred in only 39.2% of hospitals for hospice, so reporting based only on any use may miss late or uneven entry.[13] A message that hospice is available can therefore overstate what some patients experience. Leaders can use this observance to describe concrete next steps rather than general availability.
Communication about live discharge needs particular care. Disaggregating disenrollment by type showed that declines in extended-prognosis discharges were offset by increases in transfers and moves.[8] The authors called for research into how agency-reported reasons reflect underlying circumstances.[8] Live discharge brings loss of support and disruptive care transitions for patients.[7] Leaders interviewed saw predictive tools as a way either to support patients to remain in hospice or to facilitate robust discharge planning.[7] Either path makes the family conversation earlier and more deliberate.
Communication among clinicians shapes what patients hear. Because discharge recommendations varied widely across physical therapists, patients and families may receive different advice about home health depending on who evaluates them.[3] Shared definitions of post-acute settings support more consistent conversations about where recovery will happen.[3] The setting comparison evidence adds that clinical needs and local capacity both belong in that conversation.[1]
Information transfer is itself a communication task. The sepsis transition study relied on record-based tools, telemedicine workflows and centralized scheduling so that information reached post-acute providers and outpatient appointments were made.[9] Staff and patient education were also part of providing timely home health and outpatient visits.[9] Aides also carry information into the home. They assist patients with heart failure with daily activities, symptom monitoring and medication management, and trained aides reported perceived improvements in patient care.[11]
Trust in new tools and in research also depends on transparency. Home care stakeholders raised data quality, privacy protections and artificial intelligence literacy among aides as challenges.[10] Reporting race and ethnicity with standard categories helps communities judge whether evidence applies to them.[14] Public communication during National Home Care & Hospice Month can build that trust by naming the entry point, describing the handoff and reporting what is measured.
Executive guidance · 90-day plan
Turn the observance into one sustained operating change.
The time boxes below are a management framework, not a clinical timeline. Adjust them to risk, scope, governance, resources, stakeholder participation, and applicable review requirements.
Ninety days, three moves
- Days 1–30See the current route
- Days 31–60Build the reliable path
- Days 61–90Make the change visible
Days 1–30 · Listen and map
See the current route
- Name an executive sponsor and an operational owner.
- Listen to people using the route and representative frontline teams.
- Map how National Home Care & Hospice Month communications connect to real entry points, owners, transitions, and escalation.
- Select one recurring barrier that the organization can responsibly address.
Days 31–60 · Design and test
Build the reliable path
- Define the trigger, receiving owner, required information, acknowledgment, escalation, and closure signal.
- Validate the design with every sending and receiving team involved.
- Test one internal or partner handoff and correct a verified communication, dependency, or ownership gap.
- Test the route in more than one representative setting or operating period where practical.
Days 61–90 · Implement and verify
Make the change visible
- Launch the redesigned route with a small set of locally defined measures.
- Review unresolved work and recurring friction using a learning approach.
- Correct implementation barriers and record who owns each remaining dependency.
- Report what changed, what evidence was reviewed, and what still requires live oversight.
Figure 6
The 90-day plan on one timeline
The 90-day plan from this brief drawn as a timeline: each action sits in the 30-day window the plan assigns it. The full wording of each action is in the figure data and in the plan above.
Data note. Time boxes are a management framework, not a clinical timeline.
Limitation. Durations are uniform 30-day windows; real tasks may span windows.
Figure data (12 rows)
| Window | Action |
|---|---|
| Days 1–30 · Listen and map | Name an executive sponsor and an operational owner. |
| Days 1–30 · Listen and map | Listen to people using the route and representative frontline teams. |
| Days 1–30 · Listen and map | Map how National Home Care & Hospice Month communications connect to real entry points, owners, transitions, and escalation. |
| Days 1–30 · Listen and map | Select one recurring barrier that the organization can responsibly address. |
| Days 31–60 · Design and test | Define the trigger, receiving owner, required information, acknowledgment, escalation, and closure signal. |
| Days 31–60 · Design and test | Validate the design with every sending and receiving team involved. |
| Days 31–60 · Design and test | Test one internal or partner handoff and correct a verified communication, dependency, or ownership gap. |
| Days 31–60 · Design and test | Test the route in more than one representative setting or operating period where practical. |
| Days 61–90 · Implement and verify | Launch the redesigned route with a small set of locally defined measures. |
| Days 61–90 · Implement and verify | Review unresolved work and recurring friction using a learning approach. |
| Days 61–90 · Implement and verify | Correct implementation barriers and record who owns each remaining dependency. |
| Days 61–90 · Implement and verify | Report what changed, what evidence was reviewed, and what still requires live oversight. |
Executive guidance · Leadership close
Make National Home Care & Hospice Month a starting point, not an endpoint.
Recognition matters. It becomes durable when leaders also listen, clarify the route, support the people operating it, close an identified gap, and report the result without claiming more than the evidence supports.
Leadership commitment
Make ownership visible, test the route, and report what improved.
Executive action kit · Month observance
Turn National Home Care & Hospice Month into accountable action.
A practical executive framework for access, ownership, handoffs, measurement, and improvement.
Leadership focus
Use this observance to examine trustworthy information, prevention access, and community connection. Select one verified barrier, assign an accountable owner, and carry the improvement beyond the campaign window.
Workforce lens
Ask whether staffing, role clarity, training, tools, workload, and escalation support the people operating the information, access, coordination, and follow-through pathway.
Patient and community lens
Make the approved first step clear. Test whether a person can move from information to an acknowledged next action without navigating conflicting instructions.
Equity and access lens
Review language, disability, transportation, digital access, geography, trust, and other barriers using protected feedback and locally appropriate data.
Five-minute briefing
Inspect the operating sequence
Listen with people using the pathway, frontline teams, operational leaders, and community partners. Find one a message, request, referral, or handoff that does not reach an accountable owner, then test the locally approved route from entry through acknowledged follow-through.
- Listen
- Clarify entry
- Coordinate the partner route
- Protect transitions
- Verify and learn
Leadership actions for this week
- Name an executive sponsor and frontline operating owner.
- Ask people using and operating the pathway where ownership becomes unclear.
- Test one representative route from first question to acknowledged next step.
- Select one barrier that can be corrected without overstating the evidence.
- Set a review date and define how completion will be verified.
Candidate measures
Define every numerator, denominator where relevant, owner, data source, exclusions, cadence, and limitation locally. These are management prompts, not external benchmarks.
- Locally defined contact, routing, and repeat-contact signals by channel and service.
- Requests without an owner, aged work, transfers, and escalations using locally approved definitions.
- Locally defined conflicting instructions, unaccepted handoffs, unresolved dependencies, repeat contacts, and partner feedback.
Department readiness checklist
- The public and staff entry points match the actual approved process.
- A specific role accepts each request, referral, or escalation.
- Handoffs include acknowledgment and a visible unresolved state.
- Language, disability, digital, transportation, and trust barriers receive explicit review.
- Communications do not introduce unsupported themes, statistics, or clinical advice.
- A named leader will review what changed after the observance.
Intended audiences
- Executive and Operational Leaders
- Public Health and Community Partners
Staff communication template
During National Home Care & Hospice Month, our organization will connect awareness with a practical review of the information, access, coordination, and follow-through pathway. Use approved information, identify the correct entry point, confirm ownership when work moves, protect privacy, and escalate unresolved barriers through local channels.
Community communication template
National Home Care & Hospice Month is an opportunity to share trustworthy information and make the next step easier to find. Use our approved channels for information and support. If a request changes hands, our goal is to keep ownership and follow-through visible.
Measurement worksheet
- Signal
- What observable condition will show whether the route works?
- Definition
- What is included, excluded, and counted?
- Owner
- Who reviews the signal and acts on exceptions?
- Cadence
- When will leaders review it?
- Equity check
- Which differences require protected, locally appropriate review?
- Closure
- What evidence will confirm the improvement was completed?
- Editorial review
- Completed
- Source records
- 2 listed under Authoritative resources
- Review standard
- Sourced facts remain separated from original executive guidance
- Clinical boundary
- No new statistical or clinical claim was added by this action kit
Sources and content boundary
Authoritative resources
Use note: All operating models, measures, scorecard questions, and action steps are original executive guidance. This article supports leadership planning and education. It does not replace clinical judgment, emergency procedures, legal advice, professional standards, organizational policy, or applicable federal, state, and local requirements.
Peer-reviewed references
References
Fifteen peer-reviewed sources, newest first. Each was individually verified through authenticated academic research databases. Bracketed numbers in the text link here; the original executive guidance on this page carries no citations because it is guidance, not a sourced claim. Sources last checked in those databases on .
- 1.Geng F, Gong J, Gozalo PL, Grabowski DC. Do Higher-Cost Settings Deliver Better Outcomes? Post-Acute Care Efficiency in Medicare Skilled Nursing Facilities and Home Health Agencies. Journal of Health Economics. 2026;110:103177. https://doi.org/10.1016/j.jhealeco.2026.103177
- 2.Busigó Torres R, Hong J, Moucha CS, Hayden BL, García Vélez DA, Stern BZ. Disparities in Total Knee Arthroplasty Outcomes: A Comparison Between Traditional Medicare Beneficiaries in Puerto Rico and the U.S. Mainland. Journal of Racial and Ethnic Health Disparities. 2026. https://doi.org/10.1007/s40615-026-02941-z
- 3.Crick JP, Almonroeder TG, Widenhoefer T. Consistency of post-acute care discharge recommendations among acute care physical therapists: a national vignette survey study. Physiotherapy Theory and Practice. 2026:1-9. https://doi.org/10.1080/09593985.2026.2672019
- 4.Folorunsho S. Racial and Socioeconomic Disparities in Hospice Utilization Among Older Adults in the United States. American Journal of Hospice and Palliative Medicine. 2026:10499091261417318. https://doi.org/10.1177/10499091261417318
- 5.Caston NE, Jackson BE, Baggett CD, Wheeler SB, Roberson ML, Thompson T, et al. Trends in End-of-Life Care Quality Among Patients With Cancer, 2003 to 2019. American Journal of Hospice and Palliative Medicine. 2026:10499091261422595. https://doi.org/10.1177/10499091261422595
- 6.Nguyen-Kearns E, Ahler D. Disproportionate Experience of Material Hardships Among Washington State Home Care Aides: A Case for Boosting Wages and Building Savings. Journal of Aging & Social Policy. 2026:1-16. https://doi.org/10.1080/08959420.2026.2627886
- 7.Luth EA, Brennan C, Hurley S, Sheldon KG, Zhang Y. Hospice Care in the Era of AI : Hospices’ Views on Data‐Driven Tools to Support Live Discharge Decisions. Journal of the American Geriatrics Society. 2026;74(9):2659-2668. https://doi.org/10.1111/jgs.70621
- 8.Hunt LJ, Gan S, Harrison KL, Aldridge MD, Ankuda C, Boscardin WJ, et al. National Trends in Types of Hospice Disenrollment Among Older Adults With Dementia, 2012–2019. Journal of the American Geriatrics Society. 2026:jgs.70707. https://doi.org/10.1111/jgs.70707
- 9.Bowles KH, Hirschman KB, Stawnychy MA, O’Connor M, Mikkelsen ME, You SB, et al. Strategies to address implementation barriers in sepsis survivors’ care transitions to home health and outpatient care: a multi-site, type 1 hybrid implementation study. BMC Health Services Research. 2026;26(1):1406. https://doi.org/10.1186/s12913-026-15118-5
- 10.Solano-Kamaiko IR, Dicpinigaitis M, Tan M, Avgar A, Vashistha A, Dell N, et al. Understanding Key Stakeholders’ Perspectives Towards Artificial Intelligence in Home Care Work. Journal of General Internal Medicine. 2026. https://doi.org/10.1007/s11606-026-10782-z
- 11.Vergez SM, Mitlak HW, Espinosa CG, Bryan Ringel J, McDonald MV, Sterling MR. Impact of an Educational Intervention on Job Satisfaction Among Home Health Aides: Findings from a Mixed-Methods Analysis of a Pilot Randomized Controlled Trial. Home Health Care Management & Practice. 2026:10848223261443495. https://doi.org/10.1177/10848223261443495
- 12.Lake D, Kumar S, Geng F, Gozalo P. Comparative Effectiveness of Inpatient Rehabilitation Versus Skilled Nursing Facilities for Stroke and Hip Fracture Patients. Journal of the American Geriatrics Society. 2025;74(1):64-73. https://doi.org/10.1111/jgs.70164
- 13.Khayal IS, Shin JJ, Brooks GA, Barnato AE, Akré ER, Lewinson T, et al. Hidden figures underlying quality measures: revealing hidden racial inequalities in end-of-life cancer care delivery: a cohort study. The Lancet Regional Health – Americas. 2025;47:101135. https://doi.org/10.1016/j.lana.2025.101135
- 14.Johnson KS, Bullock K, Smith CB, Ejem DB, Barrett NJ, Preston A, et al. Evaluation of Reporting of Race and Ethnicity in Hospice and Palliative Care Research. Journal of Palliative Medicine. 2025;28(6):708-715. https://doi.org/10.1089/jpm.2023.0694
- 15.Worku E, Woldesenbet S, Khalil M, Pawlik TM. Impact of the Affordable Care Act on Palliative and Hospice Care Utilization Among Patients with Gastrointestinal Cancers: An Interrupted Time Series Analysis. Journal of Palliative Medicine. 2025:10966218251377179. https://doi.org/10.1177/10966218251377179
Claim-to-source matrix
What each source supports
Every sourced claim in the new sections maps to the references that support it, the section where it is used, and the limitation a reader should keep in mind. Original executive guidance carries no sources because it is guidance, not a finding.
| Claim group | Sources | Years | Used in | Limitation |
|---|---|---|---|---|
| Post-acute setting, Medicare spending and short-term outcomes | [1] | 2026 | Current evidence | Stroke and heart failure patients, 2013–2017 Medicare claims; instrumental variable estimates are local and confidence intervals were wide. |
| Inpatient rehabilitation versus skilled nursing and home health after unit closures | [12] | 2025 | Current evidence | Quasi-experimental design in 55 hospitals; unmeasured confounding possible. |
| End-of-life care quality and late hospice among cancer decedents | [5] | 2026 | Current evidence | Single state, descriptive analysis; differences not adjusted for case mix. |
| Hospice disenrollment trends among older adults with dementia | [8] | 2026 | Current evidence | Agency-reported reasons may not reflect underlying circumstances; data end in 2019. |
| Hospital to home health transitions for sepsis survivors | [9] | 2026 | Continuum of care | Implementation strategy inventory; does not report outcome effects. |
| Consistency of physical therapist discharge recommendations | [3] | 2026 | Continuum of care | Vignette survey of 109 therapists; stated choices may differ from practice. |
| Supporting patients after hospice live discharge and predictive tools | [7] | 2026 | Continuum of care | Interviews with 20 leaders at seven nonprofit hospices. |
| Timely home health access in Puerto Rico versus the mainland | [2] | 2026 | Access | Elective knee replacement patients in traditional Medicare; matched observational cohort. |
| Palliative care uptake, costs and the Affordable Care Act | [15] | 2025 | Access | Stage IV gastrointestinal cancer in Medicare; observational time series. |
| Racial, ethnic and socioeconomic disparities in hospice use | [4] | 2026 | Equity and trust | Cross-sectional exit interview data; hospice use in the final month only. |
| Timing signatures versus aggregate measures of end-of-life inequality | [13] | 2025 | Equity and trust | Advanced cancer decedents in 2016; hospitals with at least 11 decedents in each group. |
| Race and ethnicity reporting in hospice and palliative care research | [14] | 2025 | Equity and trust | Plenary articles from 2004 to 2019; pre-pandemic research. |
| Material hardship among home care aides | [6] | 2026 | Human infrastructure | Unionized aides in one state; survey data from 2023. |
| Training, job satisfaction and turnover intention among home health aides | [11] | 2026 | Human infrastructure | Pilot trial of 102 aides; turnover intention, not actual turnover. |
| Stakeholder views on artificial intelligence in home care | [10] | 2026 | Human infrastructure | Qualitative study of 43 English-speaking participants. |
About the author
Greg Wahlstrom
MBAHCM
President and Chief Executive Officer, The Healthcare Executive
View Greg’s profile©2014 – 2026 The Healthcare Executive. All rights reserved.