Ten days from now, a nationwide freeze on new home health and hospice enrollment in Medicare is set to expire. CMS announced the freeze on May 13. It blocks new agencies from enrolling, along with new branch locations and certain changes in majority ownership. It does not affect agencies already enrolled, and care for current patients continues as usual. As of October 30, CMS had not said whether it will extend the freeze, let it lapse, or narrow it to specific high-risk mark

It's early November 2026, and agency owners are watching two dates. The first is November 13, when CMS's nationwide freeze on new home health and hospice Medicare enrollment is set to expire unless CMS extends it. As of late October, CMS hadn't said which way it would go. The second is January 1, when the 2027 Medicare payment rule is expected to take effect. Behind both dates is the same question owners keep asking: how do we grow when oversight is tighter, margins are thinn

An agency tries an AI tool. The first few weeks are busy: setup, training, a few early wins. Three months later, the owner asks a simple question: is it working? Nobody is quite sure. The team likes it, mostly. Things feel a little smoother. But no one wrote down where things stood before, so no one can say what has changed or what it's worth. This is one of the quiet reasons agencies hesitate on AI: not fear of the technology, but fear of spending money and time on something

The demo goes well. The tool looks useful, the price is reasonable, and your team could see themselves using it. Then a quieter thought shows up: where does our clients' information actually go? For a lot of agency owners, that question is the real reason AI stays on the "next quarter" list. It isn't the technology. It's trust. Why the Hesitation Makes Sense In an AxisCare-commissioned survey of more than 400 U.S. home care agency leaders, 41% cited ethics concerns as a barri

Take a look at your inbox this week. An AI scheduler. An AI recruiter. AI documentation. AI call handling. AI reporting. Each one promises to fix a single problem, and each one comes with a demo, a price, and a login. The question for most agency owners isn't "Should we use AI?" It's "Which of these is actually worth the effort, and what happens to my team if I say yes to five of them?" The Results Are Real. So Is the Overload. An AxisCare-commissioned survey of more than 400

You've heard it at every conference and read it in every newsletter: AI is coming to home care. Then you go back to the office. There are a dozen vendor emails in your inbox, a team that's a little uneasy, and no clear idea where to begin. So nothing changes. The same calls go to voicemail, the same coordinator covers every evening, and AI stays a topic for next quarter. If that sounds familiar, you're in good company. The Gap Between Interest and Action An AxisCare-commissio

The Greatest Gift Automation Can Give Isn't Speed—It's Time. When people hear the word automation, they often think about technology replacing people. I think about something completely different. I think about a caregiver who doesn't have to interrupt a meaningful conversation with a patient to answer another phone call. I think about an office coordinator who can finally focus on helping a worried family instead of juggling five administrative tasks at once. I think about a

The Best Use of AI Isn't Replacing Caregivers—It's Giving Them More Time to Care. Whenever people ask me about artificial intelligence in home health, I always come back to one simple question: What if AI could give your caregivers back an extra hour every day? Not by asking them to work faster. Not by expecting them to do more. But by taking repetitive, time-consuming administrative tasks off their plates so they can spend more time where they're needed most—with patients. B

The phone rings. Most agencies hear another incoming call. I hear a decision being made. That decision isn't always about choosing a home care provider. Sometimes it's about whether a frightened daughter feels someone truly understands what her family is facing. Sometimes it's a hospital discharge planner deciding whether your agency is dependable enough to recommend. Other times it's a caregiver needing immediate guidance before a small concern becomes a major issue. Every i

What happens when the living room becomes the center of care? I want to ask every home care agency owner, administrator, care coordinator, and operations leader a question: What happens when the living room becomes the center of care? A few years ago, that question may have sounded futuristic. Today, it feels like reality. The healthcare campus is changing right in front of us. Care is no longer defined by hospital walls, medical buildings, waiting rooms, or centralized facil

Trust Isn't Built When Things Go Right I want to ask you something: What actually makes a family trust your home care agency? Is it your years of experience? Your caregivers? Your care plans? Your reputation in the community? Those things matter. But I've learned that trust often isn't built when everything is running perfectly. Trust is built when something unexpected happens. When a caregiver calls out. When schedules suddenly change. When families feel uncertain. When anxi

The Smallest Messages Often Create the Biggest Moments I want to ask you something: When was the last time a client remembered your agency because of a simple text message? Not because of a care plan. Not because of paperwork. Not because of an invoice. But because someone on your team reached out at exactly the right moment. In home care, we often think relationships are built through major milestones: the first assessment, onboarding, care plan discussions, family meetings,

I Think We Might Be Asking the Wrong Question When families contact a home care agency, we often assume they’re shopping for care services. They ask about caregiver availability. They ask about schedules. They ask about costs. They ask about hours. And on the surface, it sounds like they're purchasing care. But over time, I’ve started asking a different question: Are families really buying care—or are they buying peace of mind? Because I’ve noticed something. Most families ar

There’s a phrase I hear often in healthcare and home care operations: "We’ll call you back." On the surface, it sounds harmless. Professional, even. But I want to ask you something: Have you ever stopped to think about what those four words actually feel like to the person hearing them? Because while we hear process... Families often hear uncertainty. While we hear workflow... Families hear waiting. While we hear operational necessity... Families hear: "You're not our priorit

At 2:13 AM tonight, a phone rings. On the other side is a daughter whose voice is shaking. "My dad just fell trying to get to the bathroom." Or maybe it is a husband saying: "Our caregiver didn't show up. I don't know what to do." Or a son whispering because he doesn't want his mother to hear the panic in his voice: "Can someone help us right now?" Now here is the question I want every home care agency owner, administrator, and operations leader to think about: What would hap

It wouldn't be revenue. It wouldn't be recruiting. It wouldn't even be compliance. If I were handed the keys to a home care agency today and asked where I would begin, my answer might surprise some people. I wouldn't start by reviewing financial statements. I wouldn't immediately focus on marketing. I wouldn't even begin with caregiver recruitment. The very first thing I would audit is communication. Why? Because communication sits at the center of virtually every operational

Many agencies grow. Far fewer successfully scale. For a long time, I thought growth and scaling were the same thing. More clients meant growth. More caregivers meant growth. More revenue meant growth. And while all of those things are true, I eventually realized something important: Growth and scaling are not the same. In fact, some agencies grow themselves into operational chaos. They add more clients. They hire more caregivers. They increase revenue. Yet somehow, everything

What if the key to improving scheduling, caregiver retention, client satisfaction, and profitability isn't a new hire—but a metric you're not measuring? As home care agency owners, we live in a world of metrics. We track revenue. We monitor referrals. We watch caregiver turnover. We measure client growth. We review overtime costs. And yet, despite having access to more data than ever before, I believe many agencies are overlooking one of the most valuable performance indicato

It's not always payroll. It's not always recruiting. And it's probably not what you think. As home care agency owners, we're constantly watching the numbers. We monitor revenue. We track caregiver retention. We review overtime. We analyze client growth. We keep a close eye on expenses. But over the years, I've come to realize that some of the biggest threats to profitability don't show up as a line item on a financial report. They're hidden inside our daily operations. They'r

Sometimes the biggest lessons in home care come from the systems we wish we had built differently from the beginning. If I could go back and rebuild one process in a home care agency from scratch, it wouldn't be marketing. It wouldn't be billing. It wouldn't even be recruiting. It would be communication. And I'm willing to bet many agency owners feel the same way. When most of us start or grow a home care agency, we're focused on serving clients, supporting caregivers, fillin