Clinical Intelligence in Home Care, Hospice, and Home Health

In the home, no one is watching between visits.

A nurse comes twice a week. An aide stays for four hours. A hospice team answers the phone at night. In between, a daughter, a spouse, or a private caregiver fills the hours. When something goes wrong, the record that follows is written in pieces, by different people, often later and away from the patient. Each source holds part of the story. None holds all of it.

Claims arising from private-duty home care, skilled home health, and hospice are among the hardest to evaluate and among the most preventable. In Clinical Intelligence in Home Care, Hospice, and Home Health, Michelle Carroll, Founder and Chief Clinical Strategist of Lexcura Summit, applies the seven pillars of the Lexcura Clinical Intelligence Model to care delivered in the home: Record Integrity, Baseline Profiling, Imaging Analysis, Timeline Reconstruction, Standard of Care Review, Regulatory and Compliance Overlay, and Causation Mapping. Applied in order, the pillars separate what the record can establish from what remains disputed, and show where qualified expert opinion is required.

The same seven questions serve two purposes. After harm, they give attorneys a disciplined way to evaluate a claim without hindsight, for plaintiff and defense alike. Before harm, they give agency leaders a clear view of what their own records and systems would reveal if a claim arose tomorrow, and where documentation, escalation, supervision, and coordination can be strengthened now. Every chapter closes with a Litigation Lens for counsel and a Prevention Lens for agencies.

Inside, readers will find:

• The three care models side by side: their rules, payers, duties, records, and how responsibility is divided when they share one home
• The legal framework of home-based care claims, including negligence, negligent hiring and supervision, vicarious liability and the registry model, abandonment, wrongful death, and elder abuse statutes
• EVV, GPS, telephony, scheduling, on-call logs, OASIS, and hospice records read as evidence, with their limits
• Timeline reconstruction across the gaps between visits, and the many clocks that govern a home record
• The federal home health and hospice Conditions of Participation, state licensure, and Medicaid home and community-based services, applied as of the dates of care
• Falls, pressure injuries, medication errors and controlled substances, missed visits and delayed escalation, and abuse, neglect, and exploitation
• Hospice claims: eligibility and certification, symptom management, levels of care, live discharge and revocation, and False Claims Act exposure
• Causation when decline is expected, competing explanations, and damages tied to baseline and life expectancy
• A prevention framework built on QAPI, documentation and escalation standards, hiring, training, and supervision, event review and preservation, and a structured agency self-audit
• Intake, records and data requests, expert selection, depositions, and damages
• A complete case following one patient from private-duty care to skilled home health to hospice, through all seven pillars

Composite case studies, timelines, trend charts, and more than fifty figures make the reasoning visible. Eight appendices provide an intake worksheet, a records and data request matrix by care model, a regulatory quick reference current through 2026, an agency self-audit checklist, documentation and escalation standards, deposition topic outlines, a glossary, and a table of authorities.

For plaintiff and defense attorneys, legal nurse consultants, expert witnesses, and the owners, administrators, clinical managers, and compliance leaders of home care agencies, home health agencies, and hospices.