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Lessons Learned in 2023 and How They Impact 2024

lessons learned in 2023

As the care at home industry settles into the new year, experts are reflecting on key takeaways from 2023 and exploring how these insights can be leveraged to inform best practices in 2024.

Axxess experts Arlene Maxim, RN, HCS-C, Senior Vice President of Clinical Services, Zaundra Ellis, Vice President of Hospice Professional Services, and Tammy Ross, RN, BSN, MHA, Executive Vice President of Professional Services, convened to discuss the following takeaways from last year.

Caregiver Safety

The murder of a visiting nurse in Connecticut in October 2023, just 11 months after the murder of another visiting nurse in Washington, sent a shockwave through the care at home industry, prompting calls to action for better safety measures amid increasing violence toward nurses.

In Washington, the patient’s grandson was charged with the second-degree murder of visiting nurse Douglas Brant. In Connecticut, the patient is the main suspect in the killing of visiting nurse Joyce Grayson and is scheduled to appear in court this month.

“This is a high-level concern that came to light in 2023,” said Maxim. “We need to do more at intake to screen patients and their families.”

Organizations should consider running background checks on patients and their family members and even vetting their social media accounts to look for clues of violence before sending caregivers to their homes, Maxim says. She also encourages organizations to send caregivers in pairs when performing high-risk visits.

“The clinician who was murdered in Connecticut was absolutely performing a high-risk visit,” said Maxim. “We need to consider sending two people when conducting visits with high-risk patients or in high-risk areas, which should be identified through the patient screening process.”

She urges organizations with volunteer programs to tap into that resource. Volunteers who are retired law enforcement officers or military veterans are ideal candidates to accompany caregivers performing high-risk visits.

Mergers and Acquisitions

The Centers for Medicare and Medicaid Services (CMS) continues to move toward provider consolidation, meaning mergers and acquisitions are sweeping the care at home industry.

“The bottom line is Medicare wants to have as few providers as possible,” said Maxim. “The fewer provider numbers, the less oversight they have to maintain. Therefore, Medicare saves money and time with these larger insurance companies that are entering the care at home space.”

Maxim asserts the focus for private insurance companies, including Medicare Advantage Organizations (MAOs), is numbers. “Any time you have these types of non-clinical organizations, their focus is going to be the bottom line,” said Maxim. “They almost always have case managers who are not necessarily clinical people and aren’t looking at things from a clinical perspective. They’re looking at dollars and numbers.”

To survive among the increasing number of mergers and acquisitions, Ellis and Maxim say care at home providers should focus on demonstrating quality through numbers and networking.

“Care at home organizations – no matter what their service line is – should make sure their policies and procedures, their QA, and all their operations are in alignment,” said Ellis. “They need to have data to report their successes and work hard to create relationships with those entities that are buying them. That’s the only possible way they’re going to turn the tide. They need to gain the confidence of the organization that’s purchasing them to continue to provide the care that they provide.”

Artificial Intelligence

As artificial intelligence (AI) continues to grow and evolve, care at home providers are leveraging these solutions to reduce administrative burden.

“As we look at the gap between the acceleration of the aging population and the decline of clinicians entering the workforce, there’s a huge divide,” said Ross. “To bridge that gap, we’re going to have to use technology.”

Ross encourages organizations to investigate AI and interoperability solutions that can ease documentation burden for things like care plan generation and medication reconciliation, so clinical staff can focus on tasks that only clinical staff can perform. She emphasizes the importance of establishing oversight procedures so staff can verify the accuracy of AI-generated documentation.

“I don’t think we’re at a point where we can remove the human element from creating a care plan for instance, but we certainly are at the point where AI can start generating those based on diagnoses,” said Ross.

Axxess’ cloud-based software solutions include built-in AI elements and interoperability add-ons, such as nVoq and Axxess Connect, that leverage the power of technology to streamline documentation and data sharing.


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