The National Association for Home Care & Hospice (NAHC) warned members Thursday to remain on top of laws and regulations as more care moves into homes.

NAHC President William Dombi told members during a webinar to brush up their knowledge on everything from the Americans with Disabilities Act, to Medicare antidiscrimination rules, to state civil rights laws and malpractice laws.

He also advised providers to make sure they understand patients’ conditions, potential lengths of service and source of payment before accepting clients.

William Dombi headhot
William Dombi

“You don’t want to find yourself in a position or facing an abandonment lawsuit where the claim presented and the primary allegation is that you discharged a patient because they weren’t profitable enough,” he stated. “That is not going to put you in great standing before the court.”

Ability to meet clients’ needs 

While most home care providers are not reimbursed by Medicare, Dombi said Medicare’s conditions-of-participation guidelines provide good guidance on quality-of-care standards that might be applied under common law or by state licensing agencies. Medicare guidelines state that there is a reasonable expectation that the provider can meet a client’s needs.

“You have to ask yourself, can you really meet their needs safely and effectively in their home settings? The answer to that may be no. You don’t have the resources to do that. Or no, that person is outside the practice area where you can get to them in a reasonable or timely basis. Or no, their needs are greater than what you can meet,” he explained.

Cope with staffing gaps

As the COVID-19 pandemic has increasingly moved care away from institutional settings and into homes, some agencies don’t have adequate staff to meet the demand. Dombi warned agencies to budget and draw up a plan of action to avoid possible allegations of discrimination. He said agencies might be able to fill a staffing gap with telehealth or assistance from the patients’ family members.

“Can we work with families on care oversight, rather than hands-on care? You might be able to teach them to do some things,” Dombi noted.

Providers might need to make difficult strategic decisions, including confining business to a smaller geographic area, to ensure they can adequately service clients, Dombi said.