Here is what the organizational structure of a home health agency typically looks like:
Administrator
│
├── Director of Patient Care Services (DON/DPCS)
│ │
│ ├── Clinical Manager
│ │ │
│ │ ├── RN Case Managers
│ │ ├── Field RNs
│ │ ├── LVNs
│ │ ├── Home Health Aides
│ │ ├── PT / PTA
│ │ ├── OT / COTA
│ │ ├── Speech Therapist
│ │ └── Medical Social Worker
│ │
│ ├── Clinical Care Coordinator
│ ├── QA / OASIS Reviewer
│ ├── Coding Specialist
│ └── Infection Prevention Coordinator
│
├── Intake Department
├── Scheduling Department
├── Billing Department
├── Medical Records (HIM)
├── Human Resources
└── Business Development / Marketing
Home Health Administrator
The home health administrator oversees the entire agency and makes sure everything runs smoothly behind the scenes. Although they typically don’t provide direct patient care, they play a vital role in ensuring patients receive safe, high-quality home health services. They manage the agency’s daily operations, staffing, budgeting, contracts, Medicare certification, accreditation, and overall business functions.
The administrator is also ultimately responsible for ensuring the agency complies with all Centers for Medicare & Medicaid Services (CMS) and state regulations. They work closely with the clinical team, office staff, and leadership to keep the agency running efficiently so nurses, therapists, and other clinicians can focus on providing excellent care to their patients.
Director of Patient Care Services (DPCS) / Director of Nursing (DON)
The Director of Patient Care Services (DPCS), also known as the Director of Nursing (DON) at many agencies, oversees all of the clinical care provided to patients. Their primary responsibility is to make sure every patient receives safe, appropriate, and high-quality care while supporting the nurses, therapists, and other clinicians in the field.
The DPCS supervises the clinical staff, reviews and updates clinical policies, monitors quality improvement efforts, and helps ensure the agency meets Medicare’s Conditions of Participation and other regulatory requirements. They also serve as a valuable resource for clinicians when complex patient situations arise, helping guide clinical decisions and maintain the highest standards of patient care.
Clinical Manager / Clinical Supervisor
The Clinical Manager or Clinical Supervisor is the person who keeps the clinical side of the agency running smoothly. They oversee the day-to-day operations of the nursing and therapy teams, making sure patients are assigned to the right clinicians, documentation is completed correctly, physician orders are processed, and patient care stays on track. If you’ve ever had a difficult patient situation, a documentation question, or needed guidance on a clinical issue, the Clinical Manager is often the person you’ll turn to for support.
In many agencies, the Clinical Manager also supervises the RN case managers and serves as a bridge between the field staff and the Director of Patient Care Services (DPCS) or Director of Nursing (DON). They review documentation for quality, help resolve complex patient cases, monitor clinician workloads, ensure regulatory compliance, and work closely with scheduling, intake, and other office staff to keep patient care running efficiently. While they may occasionally see patients in smaller agencies or during staffing shortages, their primary role is to support the clinical team and ensure every patient receives safe, high-quality care.
RN Clinical/Case Manager
The RN Case Manager is often considered the “quarterback” of a home health patient’s care. While many different clinicians may visit the patient throughout their episode of care, the RN Case Manager is responsible for coordinating those services and making sure everyone is working toward the same goals. They serve as the primary point of contact for the patient, caregivers, physicians, therapists, and other members of the home health team.
An RN Case Manager typically performs the Start of Care (SOC), Resumption of Care (ROC), Recertification, and Discharge assessments while developing and updating the patient’s individualized plan of care. They monitor the patient’s progress, identify changes in condition, communicate with physicians to obtain new orders, coordinate services with physical therapy, occupational therapy, speech therapy, medical social work, and home health aides, and ensure the patient receives the right care at the right time. In many agencies, they also order wound care and medical supplies needed to safely care for the patient at home.
Beyond clinical visits, RN Case Managers spend a significant amount of time coordinating care behind the scenes. They review medications, educate patients and caregivers, update visit frequencies when appropriate, complete Medicare-required documentation, and help prevent unnecessary hospitalizations by identifying potential problems early. From admission to discharge, the RN Case Manager oversees the patient’s entire home health journey, ensuring their goals are met and that they receive safe, high-quality care every step of the way.
Field Registered Nurse (RN)
A Field Registered Nurse (RN) is the clinician who travels to patients’ homes to provide skilled nursing care. Depending on the patient’s needs, they may perform wound care, IV medication administration, PICC or midline dressing changes, catheter changes, injections, medication management, disease education, post-surgical assessments, and other skilled nursing services ordered by the physician. They also monitor the patient’s condition, identify changes that need medical attention, and educate patients and caregivers on how to safely manage care between visits.
Not every Field RN is a case manager. In many home health agencies, Field RNs see patients assigned by an RN Case Manager and focus on completing the skilled nursing visit ordered in the patient’s plan of care. In other agencies, especially smaller ones, the Field RN may also serve as the patient’s case manager and be responsible for coordinating the patient’s entire episode of care.
Whether serving as a case manager or not, Field RNs play a vital role in helping patients remain safely at home. They are often the eyes and ears of the healthcare team, recognizing changes in a patient’s condition early, communicating concerns to the physician and case manager, and helping prevent unnecessary emergency room visits and hospitalizations through timely assessment, education, and intervention.
Licensed Vocational Nurse (LVN/LPN)
Licensed Vocational Nurses (LVNs), known as Licensed Practical Nurses (LPNs) in many states outside of California, are an important part of the home health team. They provide skilled nursing care under the supervision of a Registered Nurse (RN) and often develop long-term relationships with their patients through routine follow-up visits.
LVNs commonly perform wound care, catheter changes, medication administration and education, injections, dressing changes, blood glucose monitoring, and other skilled nursing tasks ordered by the physician. They carefully monitor the patient’s condition and report any significant changes to the RN Case Manager or physician so the plan of care can be updated if needed.
In most situations, LVNs cannot independently perform the comprehensive OASIS assessment required for a Start of Care (SOC). However, they play a valuable role in helping patients remain stable at home by providing consistent, high-quality nursing care throughout the home health episode.
Home Health Aide (HHA/CHHA)
A Home Health Aide (HHA), also called a Certified Home Health Aide (CHHA) in California, provides hands-on personal care to help patients safely remain in their own homes. While they do not perform skilled nursing procedures, they play an important role in supporting a patient’s comfort, hygiene, dignity, and overall well-being.
Home Health Aides commonly assist with bathing, grooming, dressing, oral hygiene, shampooing hair, toileting, changing bed linens while the patient is in bed, and other personal care tasks that patients may no longer be able to perform safely on their own. During each visit, they also observe the patient’s skin for redness, irritation, pressure injuries, or other changes and report any concerns to the supervising Registered Nurse. They may also notify the nurse if they notice changes in the patient’s mobility, appetite, mental status, or overall condition.
Home Health Aides work under the supervision of an RN and follow a personalized care plan developed for each patient. Although they don’t perform wound care, administer medications, or provide other skilled nursing services, they are often the clinicians who spend the most one-on-one time with patients. Their observations and communication with the nursing team can help identify problems early and contribute to safer, more effective patient care.
Physical Therapist (PT)
A Physical Therapist (PT) helps patients regain strength, improve mobility, and safely return to their highest level of independence. After an illness, injury, surgery, or hospitalization, many patients experience weakness, poor balance, or difficulty walking. The PT evaluates these challenges and develops an individualized treatment plan to improve function.
During the evaluation, the PT assesses strength, gait, balance, transfers, endurance, range of motion, and fall risk. Based on these findings, they create a therapy program designed to help patients move safely throughout their home and perform everyday activities with greater confidence.
Physical therapists also educate patients and caregivers on proper use of walkers, canes, wheelchairs, and other assistive devices while helping reduce the risk of falls and prevent future injuries.
Physical Therapist Assistant (PTA)
A Physical Therapist Assistant (PTA) works closely with the supervising Physical Therapist to carry out the patient’s therapy plan. After the PT completes the initial evaluation and establishes treatment goals, the PTA provides many of the follow-up therapy visits.
During these visits, the PTA guides patients through strengthening exercises, gait training, balance activities, transfer training, and mobility exercises while monitoring their progress and reporting improvements or concerns back to the supervising PT.
Although PTAs provide much of the hands-on therapy, they cannot perform the initial evaluation, establish the plan of care, or complete reassessments. Those responsibilities remain with the supervising Physical Therapist.
Occupational Therapist (OT)
Occupational Therapists (OTs) help patients safely perform the everyday activities that many people take for granted. Their goal is to help patients become as independent as possible while reducing the risk of injury at home.
An OT evaluates activities of daily living (ADLs) such as bathing, dressing, grooming, toileting, meal preparation, and other daily tasks. They also assess the patient’s home environment for safety concerns and may recommend adaptive equipment such as shower chairs, grab bars, raised toilet seats, reachers, or other devices that make daily activities easier and safer.
Occupational therapists focus on helping patients regain the skills needed to live independently while improving safety, confidence, and quality of life.
Certified Occupational Therapy Assistant (COTA)
A Certified Occupational Therapy Assistant (COTA) works under the supervision of the Occupational Therapist to carry out the patient’s treatment plan. Once the OT completes the initial evaluation and develops therapy goals, the COTA provides many of the follow-up treatment visits.
During these visits, the COTA helps patients practice daily living skills, improve upper body strength and coordination, learn energy conservation techniques, and safely use adaptive equipment. They closely monitor the patient’s progress and communicate updates to the supervising Occupational Therapist.
Like PTAs, COTAs cannot perform the initial evaluation or establish the patient’s plan of care, but they play an essential role in helping patients achieve their therapy goals.
Speech-Language Pathologist (SLP)
Many people think Speech-Language Pathologists only help patients who have trouble speaking, but their role in home health goes far beyond speech. SLPs evaluate and treat communication disorders, cognitive impairment, memory problems, swallowing disorders (dysphagia), and difficulties related to strokes, neurological diseases, and other medical conditions.
An SLP may work with patients recovering from a stroke, living with Parkinson’s disease, dementia, traumatic brain injuries, or other conditions that affect speech, thinking, memory, or swallowing. They help patients improve communication skills, strengthen memory and problem-solving abilities, and reduce the risk of choking or aspiration during meals.
By improving communication, cognition, and swallowing, Speech-Language Pathologists help patients remain safer and more independent at home.
Medical Social Worker (MSW)
A Medical Social Worker (MSW) focuses on the emotional, social, and practical challenges that can affect a patient’s health and well-being. Serious illness doesn’t just impact the patient—it often affects the entire family. The MSW helps patients and caregivers navigate these challenges by connecting them with valuable resources and support services.
Medical Social Workers assist with advance care planning, counseling, caregiver support, financial assistance programs, transportation resources, community services, long-term care planning, housing concerns, and other non-medical needs that may affect a patient’s ability to remain safely at home.
They also provide emotional support during difficult times, helping patients and families cope with chronic illness, declining health, or major life changes. Their goal is to ensure patients have the resources, support, and guidance they need to achieve the best possible quality of life.
Quality Assurance (QA) / OASIS Reviewer
The Quality Assurance (QA) team, often called OASIS Reviewers, helps ensure the agency’s documentation is accurate, complete, and meets Medicare requirements before claims are submitted for payment. Although patients rarely interact with them directly, they play a major role in helping the agency maintain high-quality care and remain compliant with CMS regulations.
QA reviewers carefully review OASIS assessments, Plans of Care, physician orders, and nursing and therapy documentation. They look for missing information, inconsistencies, coding issues, and documentation that may lead to payment delays or Medicare denials. If something needs to be corrected, they work with the clinician to make sure the documentation accurately reflects the patient’s condition and skilled need.
In addition to reviewing documentation, QA staff educate clinicians on Medicare documentation requirements, identify trends that can improve quality outcomes, and help ensure the agency remains survey-ready at all times.
Coding Specialist
A Coding Specialist reviews the patient’s medical history, physician documentation, and clinical assessments to assign the correct ICD-10-CM diagnosis codes. Accurate coding is essential because it helps demonstrate medical necessity, supports proper reimbursement, and ensures the agency complies with Medicare guidelines.
Coding specialists work closely with nurses, therapists, physicians, and the QA team to clarify diagnoses when documentation is unclear or incomplete. They also help ensure the patient’s primary diagnosis accurately reflects the reason for home health services.
Although patients may never meet a Coding Specialist, their work has a direct impact on whether the agency is paid correctly and whether the patient’s episode of care is coded accurately under Medicare’s Patient-Driven Groupings Model (PDGM).
Infection Prevention Coordinator
The Infection Prevention Coordinator helps protect both patients and healthcare workers by overseeing the agency’s infection prevention and control program. Their goal is to reduce the spread of infections and ensure everyone follows current safety guidelines.
This role includes monitoring infection trends, investigating possible exposures, educating staff on hand hygiene, standard precautions, personal protective equipment (PPE), and other infection control practices. They also help develop agency policies and update procedures based on the latest recommendations from CMS, OSHA, and public health organizations.
By promoting safe practices and educating staff, the Infection Prevention Coordinator helps create a safer environment for patients receiving care at home.
Intake Department
The Intake Department is often the first stop for every new home health patient. When a hospital, physician, skilled nursing facility, or another healthcare provider sends a referral, the intake team begins gathering the information needed to determine whether the patient qualifies for home health services.
The intake staff verifies insurance coverage, collects medical records, confirms physician orders, enters patient information into the electronic medical record (EMR), and coordinates with the clinical team to schedule the patient’s Start of Care (SOC).
Without a strong intake team, patients could experience delays in receiving the care they need after leaving the hospital or another healthcare facility.
Scheduling Department
The Scheduling Department helps ensure every patient receives visits when they’re supposed to. They coordinate daily schedules for nurses, therapists, home health aides, and other clinicians while balancing patient needs, clinician availability, travel distance, and physician orders.
Schedulers frequently adjust the schedule throughout the day due to hospitalizations, cancellations, emergencies, or changes in patient condition. Their job is to make sure required visit frequencies are met while helping clinicians travel as efficiently as possible.
Although patients may only know them as the person calling to arrange appointments, schedulers play a huge role in keeping the agency running smoothly.
Billing Department
The Billing Department is responsible for making sure the agency gets paid for the care it provides. Before submitting claims, the billing team verifies that all required documentation has been completed and that Medicare, Medicaid, or the patient’s insurance requirements have been met.
They submit claims, monitor payment status, post payments, follow up on denied claims, and work with other departments to resolve documentation issues that could delay reimbursement.
Accurate documentation from clinicians is essential because the billing department can only bill for services that are properly documented and supported by the patient’s medical record.
Medical Records (Health Information Management – HIM)
The Medical Records Department, also known as Health Information Management (HIM), is responsible for maintaining the patient’s official medical record throughout their home health episode.
This team ensures documentation is complete, signed, and properly filed. They process physician orders, scan documents into the electronic medical record, respond to requests for medical records, and help ensure the agency complies with HIPAA privacy rules and record retention requirements.
Although much of their work happens behind the scenes, maintaining accurate medical records is essential for patient care, regulatory compliance, and legal protection.
Human Resources (HR)
The Human Resources (HR) Department manages the people who make the agency successful. They recruit, hire, and onboard new employees while ensuring clinicians meet all licensing, certification, and employment requirements before seeing patients.
HR also manages payroll, employee benefits, background checks, mandatory education, annual competencies, and license renewals. They help ensure employees remain compliant with agency policies and state and federal regulations throughout their employment.
In short, HR helps build and support the team that provides care to patients every day.
Business Development / Marketing
The Business Development or Marketing team focuses on helping the agency grow by building relationships with referral sources throughout the community. They regularly visit hospitals, physician offices, rehabilitation centers, skilled nursing facilities, hospice agencies, and other healthcare providers to educate them about the services the agency offers.
They monitor referral trends, develop marketing strategies, attend community events, and work to expand the agency’s presence within its service area. Their efforts help ensure that patients who need home health services know where to turn for care.
While they don’t provide direct patient care, the Business Development team plays an important role in helping patients connect with the agency and receive the skilled services they need after leaving the hospital or another healthcare setting.