The Blanket Waivers Aren't Forever. One Word From The Federal Government And You Have 60 Days To Comply. You Ready?
June 9, 2023
The COVID-19 public health emergency gave our industry a break from increased administrative burden and some increased flexibility in regards to home health aide supervision and initial assessments. Although the waivers are still in place as of this post, the time is coming for that to end. The question is whether you are prepared to comply if the switch is flipped tomorrow?
The Current PHE Waivers:
The full list of healthcare waivers can be found on the CMS website under COVID-19 emergency declaration waivers. For the purposes of this article, we won’t focus on the entire list, but certain bullet points and how your agency would be able to comply if the Federal Government changed it today. The bullet pointed items are directly pulled from the COVID-19 emergency declaration waivers pdf.
- Initial Assessments: CMS is waiving the requirements at 42 CFR §484.55(a) to allow HHAs to perform Medicare-covered initial assessments and determine patients’ homebound status remotely or by record review. This will allow patients to be cared for in the best environment for them while supporting infection control and reducing impact on acute care and long- term care facilities. This will allow for maximizing coverage by already scarce physician, and advanced practice clinicians, and allow those clinicians to focus on caring for patients with the greatest acuity.
- Waive Onsite Visits for HHA Aide Supervision: CMS is waiving the requirements at 42 CFR §484.80(h), which require a nurse to conduct an onsite visit every two weeks. This would include waiving the requirements for a nurse or other professional to conduct an onsite visit every two weeks to evaluate if aides are providing care consistent with the care plan, as this may not be physically possible for a period of time. This waiver is also temporarily suspending the 2-week aide supervision by a registered nurse for home health agencies requirement at §484.80(h)(1), but virtual supervision is encouraged during the period of the waiver.
- 12-hour Annual In-service Training Requirement for Home Health Aides: CMS is modifying the requirement at 42 CFR §484.80(d) that home health agencies must assure that each home health aide receives 12 hours of in-service training in a 12-month period. In accordance with section 1135(b)(5) of the Act, we are postponing the deadline for completing this requirement throughout the COVID-19 PHE until the end of the first full quarter after the declaration of the PHE concludes. This will allow aides and the registered nurses (RNs) who teach in-service training to spend more time delivering direct patient care and additional time for staff to complete this requirement.
- Detailed Information Sharing for Discharge Planning for Home Health Agencies: CMS is waiving the requirements of 42 CFR §484.58(a) to provide detailed information regarding discharge planning, to patients and their caregivers, or the patient’s representative in selecting a post-acute care provider by using and sharing data that includes, but is not limited to, (another) home health agency (HHA), skilled nursing facility (SNF), inpatient rehabilitation facility (IRF), and long-term care hospital (LTCH) quality measures and resource use measures. This temporary waiver provides facilities the ability to expedite discharge and movement of residents among care settings. CMS is maintaining all other discharge planning requirements.
- Training and Assessment of Aides: CMS is waiving the requirement at 42 CFR §418.76(h)(2) for Hospice and 42 CFR §484.80(h)(1)(iii) for HHAs, which require a registered nurse, or in the case of an HHA a registered nurse or other appropriate skilled professional (physical therapist/occupational therapist, speech language pathologist) to make an annual onsite supervisory visit (direct observation) for each aide that provides services on behalf of the agency. In accordance with section 1135(b)(5) of the Act, we are postponing completion of these visits. All postponed onsite assessments must be completed by these professionals no later than 60 days after the expiration of the PHE.
- Quality Assurance and Performance Improvement (QAPI): CMS is modifying the requirement at 42 CFR §418.58 for Hospice and §484.65 for HHAs, which requires these providers to develop, implement, evaluate, and maintain an effective, ongoing, hospice/HHA-wide, data driven QAPI program. Specifically, CMS is modifying the requirements at §418.58(a)–(d) and §484.65(a)–(d) to narrow the scope of the QAPI program to concentrate on infection control issues, while retaining the requirement that remaining activities should continue to focus on adverse events. This modification decreases burden associated with the development and maintenance of a broad-based QAPI program, allowing the providers to focus efforts on aspects of care delivery most closely associated with COVID-19, and tracking adverse events during the PHE. The requirement that HHAs and hospices maintain an effective, ongoing, agency-wide, data-driven quality assessment and performance improvement program will remain.
Why Are We Talking About This?
Things can change any day. Some of the current waivers have already been removed for other health care facilities. Let’s consider the home health aides. Many agencies have not resumed the routine 2 week supervisions of aides. It is clear that CMS recognizes virtual supervisions may be necessary at times, but it was intended to be an exception and not normal business operation. If your agency has not resumed in person home health aide supervision, what does this do to scheduling tomorrow if you have to make it happen?
The same holds true for the annual onsite supervisory visit for direct observation. If the federal government removes this waiver tomorrow, you have 60 days to complete the onsite for all your aides. If you are a small agency, this may not be a problem. If you are well-staffed, then it may not be a problem. For a lot of agencies, it will be tough. The same rings true for the 12 hours of aide in-service. You will have through the first full quarter after the end of the public health emergency. You need to consider the time you will have to devote back to QAPI, discharge planning, and timing of initial assessments and Oasis submissions. It will change the availability of staff for other things and you may have push back and requests to add more employees. Implement these things back to your normal day-to day operations so staff is accustomed when the waivers are removed. Do it methodically and with certain pieces added one or two at a time.
If your agency needs assistance with a mock survey, operations management, ICD 10 coding, Oasis, or interim management, call Kenyon Homecare Consulting at 206-721-5091 or contact us online to see how we can help you today!
Results Based Consulting
Did you find value in this blog post? Imagine what we can do for your home care or hospice agency. Fill out the form below to see how we're leading the industry with innovation, affordability, and experience.
Contact Us
The OASIS assessment and ICD-10 coding are not mere administrative paperwork—they form the financial baseline of the entire agency. And, the clinical must match.
Home health is a vital bridge between acute hospital intervention and long-term wellness which requires shifting focus from crisis management to patient empowerment.
An interim manager offers immediate stability, proven expertise, and a fresh perspective while the organization searches for a permanent leader in administration
Product features can be copied, and prices undercut, but a highly trained field team that consistently delivers stronger clinical outcomes is difficult to beat.
A policy manual is only as good as its last update. Agencies should establish a routine—at least annually, and following regulatory shifts—to review and revise.
Chronic disease education is more than clinical compliance; it is business strategy. Staff becoming chronic care experts increases revenue and improves retention.
In an era of rising healthcare costs and widespread clinician burnout, healthcare organizations are facing a critical challenge: how to deliver superior patient care while maintaining a stable, motivated workforce and a thriving business model.
When a patient returns home after a stroke, the clinical landscape changes instantly. Survival is just the first hurdle; the real challenge lies in navigating the complex, often unpredictable journey of rehabilitation and long-term care. For home health and home care agencies and senior care facilities, caring for a stroke survivor requires more than help with Activities of Daily Living (ADLs). Stroke can affect a patient’s neurological, physical, and emotional functioning simultaneously. That’s why specialized, stroke-specific clinical training for caregivers is essential to improving patient outcomes, supporting staff retention, and strengthening the agency’s overall performance. The Multidimensional Complexity of Post-Stroke Care A stroke is not a singular event with a linear recovery path. Depending on the location and severity of the brain injury, caregivers may confront a baffling array of concurrent deficits: Physical and Motor Deficits: Hemiparesis (one-sided weakness) or hemiplegia (one-sided paralysis) completely alters transfer techniques. Improperly moving a patient can cause severe shoulder subluxation or skin tears. Cognitive and Communication Barriers: Aphasia (difficulty speaking or understanding speech) and dysphagia (swallowing difficulties) require immense patience and highly specific intervention techniques to prevent profound frustration or life-threatening aspiration pneumonia. Neurobehavioral Changes: Sudden emotional lability, post-stroke depression, or structural personality changes can easily overwhelm an untrained caregiver, leading to burnout or adversarial dynamics in the home. Without structured education, caregivers are left to rely on intuition. In complex neurological care, intuition is rarely enough to prevent adverse events. 4 Strategic Benefits of Specialized Stroke Education Investing in robust stroke-specific training programs transforms an agency's frontline staff from general monitors into clinical assets. 1. Drastic Reduction in Hospital Readmissions The first 30 to 90 days post-discharge are high-risk windows for stroke survivors. Educated caregivers act as the eyes and ears of the clinical team. They are trained to look past basic symptoms and identify subtle warning signs early: Recognizing micro-signs of silent aspiration during meals. Monitoring for deep vein thrombosis (DVT) in affected limbs. Identifying skin breakdown early on the hemiplegic side. Spotting the warning signs of a secondary stroke using the B.E. F.A.S.T. protocol (Balance, Eyes, Face, Arms, Speech, Time). Early identification allows for timely home health or physician interventions, keeping the patient safe at home and protecting the agency's rehospitalization metrics. 2. Safeguarding Staff and Patients (Risk Mitigation) The process of transferring a patient with dense hemiparesis requires precise biomechanical knowledge. Specialized education teaches caregivers how to support the affected side without pulling on weakened joints, how to properly utilize assistive devices (gait belts, sit-to-stand lifts), and how to manage one-sided neglect (where a patient completely forgets one side of their body exists). Proper training mitigates the risk of catastrophic falls and shields caregivers from debilitating musculoskeletal injuries, directly lowering workers' compensation claims and liability exposure. 3. Boosting Staff Retention and Professional Empowerment High turnover in caregiving is often caused by burnout and feeling unprepared for challenging cases. When an agency provides specialized clinical training, helping staff understand stroke-related behaviors and advanced transfer methods, it strengthens the caregiver’s role. Staff members feel empowered, confident, and valued as professionals rather than viewed as standard domestic labor. This professional dignity translates directly into higher job satisfaction and improved staff retention. 4. A Powerful Market Differentiator In a crowded marketplace, families and hospital discharge planners look for specialized expertise. An agency that can explicitly state, "Our caregiving staff undergoes advanced, competency-verified training in post-stroke neurological care, dysphagia management, and transfer safety," holds a massive competitive advantage. It builds immediate trust with families and establishes preferred provider relationships with local health systems and stroke centers. Building a Competency-Based Training Framework Effective stroke education cannot be a passive, check-the-box exercise. To truly impact care quality, an agency's training framework should combine foundational knowledge with hands-on validation: Neurological Fundamentals Core Focus Areas: Types of strokes, one-sided neglect, emotional lability, and aphasia communication strategies. Competency Verification: Written scenario analysis and communication roleplay. Mobility & Safety Core Focus Areas: Safe transfers (bed to chair), handling the flaccid or spastic limb, fall prevention, and skin integrity. Competency Verification: Hands-on return demonstration with a mechanical lift/gait belt. Nutritional Security Core Focus Areas: Dysphagia precautions, recognizing pocketed food, fluid thickening consistency, and aspiration prevention. Competency Verification: Direct observation of meal prep and feeding techniques. Conclusion: An Investment in Excellence The care of a stroke survivor is inherently complex, demanding, and volatile. Expecting caregivers to navigate these intricacies without targeted clinical education places an unfair burden on the employee and exposes the patient and the agency to significant risk. By prioritizing advanced stroke education, agencies and facilities do more than just improve compliance; they foster a culture of clinical excellence. The results are undeniable: safer patients, more confident and loyal caregivers, and a highly respected agency brand that stands out as a leader in complex home-based care. For in-depth education on caring for a person with a stroke, contact Kenyon HomeCare Consulting, which offers an 8-hour DSHS-certified continuing education course . Each chronic disease course includes a certification with a red-and-yellow flag guide that can be laminated for caregiving staff. To learn more, call 206-721-5091 or email gkenyon@kenyonhcc.com .
MS is notorious for its volatility. Understanding nuances like the MS Hug or Uthoff's phenomenon are crucial to providing the quality of care these patient's need.
Arthritis can cause daily pain taking a massive toll on patients, often leading to depression and anxiety. Education bridges the gap between frustration and empathy.