30 Years in Home Health — What Actually Changed
with Kathy Duckett, RN · Clinical Advisor, Copper Digital · 30-year home health nurse
Kathy started in home health when documentation was paper and the OASIS was four pages. She walks through what the job felt like in 1995, what changed when CMS layered in PDGM, and why the documentation tail finally got longer than the visit itself.
Key takeaways
- OASIS started as a 4-page form. It's now 23 pages of skip-logic and validation.
- PDGM didn't make documentation worse, but it made the cost of bad documentation much higher.
- The biggest predictor of nurse retention is whether the nurse finishes documentation before bedtime.
- Agencies that solved documentation 10 years ago by hiring more QA are now solving it again with AI.
Transcript (excerpt)
Kathy, you've been in home health for 30 years. When you started, what did the documentation actually look like?
Paper. Carbon copies. The OASIS was about four pages. I'd finish a visit, sit in my car, write the note out longhand, and drop it at the office on the way home.
When did that change?
Slowly through the early 2000s with the first electronic systems. But the real shift was PDGM. Once the payment was tied to the case-mix coming out of the OASIS, every field on the form became a risk.
And the time on the form went up.
Way up. The form went from four pages to 23. And then visit notes went to 33 pages in Kinnser. The job didn't get harder clinically — but the paper job became the job.
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