Safer Patients, Stronger Agencies: Managing the Six Biggest Home Health Care and Hospice Risks

Every agency knows the feeling. The phone rings after hours, and it's a clinician reporting that a patient went down during a transfer. In that moment, your team isn't thinking about liability exposure or quality scores, they're thinking about the person on the floor. But in the days that follow, that single event can ripple into an injury, a hospitalization, a family's heartbreak, and yes, a claim.

Falls are the reality your teams manage every single day. They're also one of the most preventable risks in the care you provide. But the home is full of hazards a hospital's controlled environment simply doesn't have, medications on the kitchen counter, an oxygen tank next to a lit cigarette, a fragile patient who hasn't been repositioned in hours. At VGM Insurance, we work alongside home health and hospice agencies to protect both the patients you serve and the organizations you've built. So let's talk honestly about the full range of safety risks your teams face, what's changing in 2026, and the practical steps that make a measurable difference across every one of them.

Part 1: Falls — The Leading Threat

The scope of the problem

Falls are the leading cause of both fatal and nonfatal injuries for adults 65 and older. More than one in four older adults reports falling each year—over 14 million people—and about 37% of those falls result in an injury that requires medical care or restricts activity. Each year, older adult falls drive roughly 3 million emergency department visits and 1 million hospitalizations.

The financial weight is just as sobering. Total medical costs tied to older adult falls now exceed $70 billion annually, and fall-related death rates among seniors have climbed sharply over the past decade. For your agency, falls aren't only a clinical concern, they're one of the most frequent sources of liability claims in home health, and that risk rises specifically when your personnel are present, assisting with a transfer, or using equipment to move a patient.

Why hospice and home health patients are especially vulnerable

Standard fall-risk tools were largely built for hospitals and nursing homes, where the environment is controlled and staff are steps away. The home is a different world—unpredictable layouts, throw rugs, narrow hallways, poor lighting, and a caregiver who may be a spouse in their 80s.

Hospice patients carry even greater risk. The combination of terminal illness, the effects of treatment, and medications used to manage pain and symptoms can dramatically increase fall likelihood. And the goal of care adds a layer of complexity: comfort, dignity, and independence sometimes sit in tension with the safest possible intervention. Your clinicians walk that line thoughtfully every day.

What's changing in 2026: the new CMS Falls with Major Injury measure

Here's a development every administrator needs on their radar. Effective January 1, 2026, CMS updated the Falls with Major Injury (FMI) measure, and it changes how falls are counted and how your agency's performance is judged.

Previously, FMI relied on OASIS assessment data alone. The Office of Inspector General found significant underreporting—in 2023, fewer than half of claims-identified major-injury falls in home health patients were actually reported in OASIS assessments. Even more striking, some agencies with the best Care Compare fall scores had the worst actual fall rates.

To close that gap, CMS now combines multiple data sources:

• OASIS assessment items (J1800 and J1900)

• Medicare fee-for-service claims for injuries

• Medicare Advantage encounter data

• Medicaid claims and encounter data

• External cause codes from hospital, ER, and observation stays

The takeaway is direct: even if a fall isn't documented in your OASIS assessment, it can still be identified through claims data and factored into your score. Underreporting is no longer a viable strategy, accurate documentation is your best defense. The definition also expanded to include coming to rest on the next lower surface (a bed, chair, or mat), and even an intercepted fall—where a patient catches themselves or a staff member catches them—now counts.

A practical fall-prevention framework

The good news is real: as many as two-thirds of falls can be prevented through evidence-based interventions. The Joint Commission recognized fall prevention as a National Patient Safety Goal for home care programs, built around four elements: assess risk, intervene based on that risk, educate staff, and educate the patient and family.

1. Assess every patient thoroughly—and repeatedly. A strong assessment includes a full medical history (with every prior fall event), a medication review, and a physical exam checking gait and balance. Reassess after any medication change, change in condition, or fall. Ask the hard questions directly, caregivers often hold details the patient won't volunteer.

2. Scrutinize the medication list. Taking more than five routine or PRN medications measurably increases fall risk, and the danger climbs with sedatives, antidepressants, and certain blood pressure medications. One program found that adjusting CNS-altering and hypertension medications—paired with caregiver education—kept 72% of previously-fallen patients from falling again.

3. Modify the home environment. Roughly 75% of falls happen in the home. Remove throw rugs and clutter, install grab bars, improve lighting, check for uneven steps, and evaluate footwear and walking aids.

4. Educate patients, families, and caregivers. Increased caregiver confidence shows up again and again as a protective factor. Teach safe transfer techniques and make sure families know what to do if a fall occurs.

5. Document with discipline. Detailed, accurate records of assessments, care plans, interventions, and incidents serve as both compliance evidence and your strongest shield if a claim arises.

Part 2: The Other Risks That Deserve Equal Attention

Risk #2: Medication errors and adverse drug events

Medication management is central to home health and hospice and a leading source of preventable harm. Adverse drug events cause more than 1.5 million emergency department visits every year, and older adults are especially vulnerable. The unstructured home environment magnifies the danger; unlike a facility, there's no pharmacy double-check down the hall, and errors can be more pronounced.

Prevention tips:

• Reconcile the full medication list at every visit, flagging recent additions, discontinuations, and dose changes.

• Keep a current, written list of all medicines, vitamins, and supplements accessible to the care team and family.

• Use reminder tools, clear labeling, and good lighting to help patients take the right dose at the right time.

• Ensure tight communication between clinicians and caregivers on dosages and any change in the patient's condition, with thorough documentation.

Risk #3: Infection control breaches

Home care clinicians carry their equipment into an uncontrolled, non-sterile environment which makes infection prevention both critical and challenging. Depending on severity, breaches may be reportable to state public health authorities and are among the most commonly cited survey deficiencies.

Prevention tips:

• Hand hygiene before and after every patient contact avoid shortcuts like using a patient's bar soap and cloth towel instead of proper supplies.

• PPE: wear gloves for wound care, masks for respiratory procedures, and train staff on correct donning and doffing.

• Bag technique: proper bag placement, barriers, and disinfection of multi-use items like BP cuffs, stethoscopes, and thermometers.

• Wound care and sharps: follow correct dressing-change technique, check for expired supplies, and dispose of sharps in approved containers.

• Keep policies aligned with CDC, APIC, and SHEA standard precautions, and confirm staff can demonstrate them in the field.

Risk #4: Home oxygen and fire safety

This one is often overlooked, and it's deadly. Roughly 1.5 million people in the U.S. use home oxygen, and up to 750,000 of them continue to smoke while on therapy. A home oxygen-related fire death occurs, on average, every four days. Fires burn hotter and faster in oxygen-enriched air, and smoking is by far the leading cause. Oxygen safety is also a Joint Commission National Patient Safety Goal (NPSG.15.02.01), requiring formal risk assessment and monitoring.

Prevention tips:

• Perform a home fire-risk assessment at setup, watching for smoking history, cognitive impairment, patients living alone, and missing or non-functional smoke detectors.

• No smoking—including e-cigarettes—in any room where oxygen is used or stored; post "No Smoking" and "Oxygen in Use" signs at all entrances.

• Keep oxygen away from open flames like stoves, candles, and gas appliances, and never leave it on when not in use.

• Avoid petroleum-based products (like Vaseline®); use water-based alternatives instead.

• Consider FDA-approved thermal fuses. They cost under $5 each and automatically shut off the oxygen supply during excessive heat, preventing catastrophic fires.

Risk #5: Pressure injuries and skin breakdown

Pressure injuries are one of the most common complications in home hospice care. A large multicenter study found that more than one in three hospice patients (34.1%) already had a pressure injury at admission, and 17.3% developed a new one during their stay. Declining nutrition, cachexia, reduced mobility, and fragile skin all compound the risk—malnourished patients have roughly 3.66 times the odds of developing a pressure injury. These wounds cause pain, raise infection risk, and can become a documentation and liability concern if prevention isn't consistent.

Prevention tips:

• Reposition patients every 2 hours in bed and every hour when sitting, using pillows to offload the tailbone, hips, and heels.

• Inspect skin regularly, especially bony areas: the tailbone, hips, heels, elbows, and back of the head.

• Catch Stage 1 signs early: redness that doesn't fade when pressed, warmth, or firmness. At this stage, damage is often reversible.

• Keep skin clean and dry, use barrier creams (like zinc oxide), and standardize documentation including formal protocols for recording when a patient refuses care.

Risk #6: Preventing abuse, neglect, and exploitation

Hospice patients are among the most vulnerable in the entire healthcare system, and families rightly worry about protection from abuse and neglect. Abuse, whether physical, emotional, or financial, is a recognized source of liability for home health providers, often stemming from gaps in training, supervision, or screening.

Prevention tips:

• Conduct thorough background screening and provide regular training on workplace conduct and patient dignity.

• Maintain detailed, accurate records of assessments, care plans, and any incidents. Documentation is both a quality tool and your strongest defense against a claim.

• Foster a supportive environment and clear reporting channels so concerns surface early.

The Common Thread: Protecting Patients Protects Your Agency

Here's the framework we always come back to with our agency partners: the same work that keeps a patient safe, on the floor, on their medications, in an oxygen-equipped home, or in bed, keeps your organization safe from a claim. Rigorous assessment, disciplined documentation, staff training, and patient and caregiver education aren't separate tasks. They're one integrated strategy for better outcomes and lower risk across every category above.

You carry an enormous responsibility, often with lean teams and impossible days. You shouldn't have to carry the risk side of it alone.

Let's Build Your Safety Net Together

At VGM Insurance, we understand home health and hospice because it's who we serve. Beyond coverage tailored to your world, we help you strengthen the risk-management practices that keep patients safe and claims at bay. If you'd like a review of your current safety protocols—or your coverage in light of the new 2026 CMS requirements—our team is ready to help.

Reach out to VGM Insurance today—because the best claim is the one that never happens.