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									                    HOMECARE and Hospice Salary & Benefits Questionnaire


     Save this spreadsheet to your computer, before
                    entering any data.
Email the Excel questionnaire to:

                            rzabka@hhcsinc.com
We will email a confirmation of receipt for your file.
If you do not receive an email confirmation within 24 hours, please contact HCS.

Questions? Call Rosanne Zabka, (201) 405-0075, ext. 11.
                                                                               Final Deadline
                                                                               to Participate
                                                                                  August 6


Dear Home Health Executive:

HCS invites you to participate in the 20th annual HOMECARE Salary & Benefits Report. Published in
cooperation with the National Association for Home Care & Hospice, the Report is recognized as the
standard for reliable and comprehensive home health compensation data.

Last year’s Report included 1,709 home health agencies submitting data on more than 68,277
employees. The 2010-2011 HOME CARE Salary & Benefits Report, which features a brand new
design, will again provide data according to auspice, revenue size and profit status. Data will be
broken down from national figures to nine geographic regions, and by state and county. In response
to changes in the industry, we have expanded data collection regarding pay structures for visit rates.
This questionnaire is designed for both home health agencies and hospices. Please submit data
effective July 2010, using your current rates unless you are anticipating increases in July. As always,
your individual data will be kept confidential.
The due date for return of completed questionnaires is August 6. Please submit your data on or
before this date to be included in the 2010-2011 HOME CARE Salary & Benefits Report. Publication
is scheduled for October 2010.

The findings will be published both in hard copy and PDF. The prepaid participant rate remains $135
for either format, while the nonparticipant rate is $295. In addition, HCS will offer the Report results in
Excel. The Excel files include the salary/hourly/visit sections of the Report, and show each data
grouping of the published results. For pricing, please refer to the order form.
If you have questions, call (201) 405-0075 ext. 11 or email me at rzabka@hhcsinc.com. We look
forward to your participation and thank you for your continued support.


Sincerely yours,                           Supported by:
Rosanne Zabka
Director of Reports
        770721fc-851a-4b50-8ccd-09ab4768b8b7.xls                                                                                        Participant Order Form

    HCS Use Only
 M           D        INC                         HOMECARE and Hospice Salary & Benefits Questionnaire
 SD          FB                                                            Conducted in Cooperation with                                         Deadline to
                                                                                                                                                 Participate
                                                         The National Association for Home Care & Hospice
                                                              and The Hospice Association of America
                                                                                                                                                  August 6
                                                        Published by: Hospital & Healthcare Compensation Service
                                                PO Box 376 Oakland, NJ 07436-0376 (201) 405-0075 Fax (201) 405-2110
                                                           www.hhcsinc.com        email: rzabka@hhcsinc.com

                                                                        HOMECARE Report                                        Hospice Report
             Effective Date of Data July 2010
                                                                  Publication Date October 2010                      Publication Date November 2010
                                                                       ORDER FORM

                                           Please reserve              copies of the                           Please reserve               copies of the
                                        2010-2011 HOMECARE Salary & Benefits Report                          2010-2011 HOSPICE Salary & Benefits Report

                                                            HOMECARE                                                             Hospice

                                                   Hard Copy &                          PDF &                           Hard Copy &                          PDF &
                                  Hard Copy                        PDF CD (2)                          Hard Copy                        PDF CD (2)
                                                   Excel CD (4)                      Excel CD (4)                       Excel CD (4)                      Excel CD (4)

Pre-paid Participant (1) (3)          $135.00         $435.00         $135.00           $435.00            $115.00        $435.00          $115.00           $435.00

Billed Participant (1)                $155.00         $455.00         $155.00           $455.00            $135.00        $435.00          $135.00           $435.00

Non-Participant (1)                   $295.00         $595.00         $295.00           $595.00            $250.00        $550.00          $250.00           $550.00
Shipping $15 per
Report/PDF (1)
NJ Tax 7% - NJ Locations
Only

Total(s)
    (1) Add $15.00 Shipping per Report (UPS Ground) Shipping charges apply for UPS Ground (Contiguous United States). Additional charges applied for
    shipping to AK, HI, and APO. UPS will not deliver to a PO Box.

    (2) PDF CD must be shipped. Files are too large to email.

    (3) Payment must be received by August 31 to qualify for pre-paid rate. Make checks payable to: Hospital & Healthcare Compensation Service. Send
    check with survey or copy of order form to ensure proper credit to your account.

    (4) The Excel CD contains the salary/hourly/visit data tables from the published Report. It does not contain fringe benefits or Report summary. CD must be
    purchased in conjunction with the hard copy/PDF.

    Due to the sensitve nature of the data, there are no returns.

    Please mail completed order form along with checks payable to: Hospital & Healthcare Compensation Service - PO Box 376 - Oakland, NJ 07436

           Name, Title:

           Company:


           Street Shipping Address:        (Reports are shipped UPS Ground. UPS does not deliver to a Post Office Box.)

           City, State, Zip:


           Method of Payment:
              Check: Made payable to Hospital & Healthcare Compensation Service                     Purchase Order (please attach):

              American Express              MasterCard              Visa



                                 Credit Card Number                                        Expiration Date
        Card Holder's Name:


        Credit Card Billing Address:




           2010-2011 HOMECARE Hospice Survey
                                                                                                                                           Facility Info & Svcs

          HCS Use Only
    M             D           INC               HOMECARE and Hospice Salary & Benefits Questionnaire
   SD            FB                                                       Conducted in Cooperation with                                      Deadline to
                                                                                                                                             Participate
                                                    The National Association for Home Care & Hospice                                          August 6
                                                         and The Hospice Association of America
                                                         Published by: Hospital & Healthcare Compensation Service
                                              PO Box 376 Oakland, NJ 07436-0376 (201) 405-0075 Fax (201) 405-2110
                                                                          www.hhcsinc.com

Agency Name:


Name of Multi-Chain System:                                                                                                               Number of Offices:


Contact Name, Title:


Agency Street Address:


City, State, Zip:


Telephone:                                                                                  Fax:


Email:



 May we publish the name of your organization as a participant in this survey:                     Yes        No
 All data received from participants will remain confidential. No data which will identify a specific facility will be released. A blank response shall be
 considered "No."

Would you like to receive updates/information on this HCS Report?                     Yes          No    A blank response shall be considered a “Yes.”

                                                                      Facility Information
 Are you reporting for:              HOMECARE              Hospice                 Is your agency Medicare Certified?               Yes        No

                                       As of 12/31/2009                                     HOMECARE          HOSPICE
        Annual Gross Revenue ($)

        Number of FTEs

         Number of Annual Visits

         # of Unduplicated Patients (Patient Census)

         Number of HOSPICE Patient Days

                              Please see definitions page of this questionnaire for terms used.

1. Type of Ownership of Home Care/Hospice Organization
          VNA/VNS(21)               Private         Government (12)             Hospital-Based(50)            Publicly Held (33)

2. Profit Status
          Not-for-profit (23)             Proprietary [For-Profit] (33)

3. Type of Home Care Programs
          Home Health (45)              Hospice (51)          Support Care             Personal Care               Home Infusion Therapy

4. Type of Hospice [Answer No. 4 Only if your Agency is a Hospice or has Hospice Programs .]
          Free Standing (F)             Home Health-Based (A)                 Hospital-Based (H)           Skilled Nursing Facility (S)




         2010-2011 HOMECARE Hospice Survey
                                                                                                                                               Facility Info & Svcs


5. Services
       Adult Day Services            Medicaid                                Pediatric Home Care                   Private Duty
       Dietitian Services            Medicare                                Pediatric Hospice                     Respiratory
       DME                           Nursing (RN, LPN)                       Pharmacy                              Social Services
       Home Care Aide                Occupational Therapy                    Physical Therapy                      Speech Pathology
       Infusion Services             Pastoral Care                           Physician Care                        Volunteer

6. Salary Increases
                                                       Management            Nonmanagement             RNs         Therapists         Social Workers       HCAs

     ACTUAL % INCREASE GRANTED
     between 8/2009 and 7/2010
     PLANNED % INCREASE between
     8/2010 and 7/2011

7. Does the agency grant retention bonuses for the following?
                                                           Management                          Clinician - Hourly                     Clinician - Per Visit
                                                           Yes               No                  Yes               No                    Yes              No
     Length of Service                                                   Years                                 Years                                    Years
     Average Retention Bonus                      $                                      $                                        $


8. What is your estimated annual turnover rate in percents (%) for the following jobs?
     [Turnover rate is the number of times, on average, a facility replaced a position in one year (12 months). Turnover does not include hiring
     for new or increased positions. Excludes employees terminated during their probationary period. Turnover rate = Total number of
     resignations, terminations, and vacancies divided by the number of actual positions, multiplied by 100. ]

            Management               % Turnover              Professional               % Turnover                  Therapy                    % Turnover

     All Employees                                    Clinical/Client Svcs.                              HCA

     Top Level Execs (CEO,
                                                      Social Worker                                      OT
     COO, CFO, etc.)

     Finance                                          RN                                                 PT

     Human Resources                                  LPN                                                Speech Pathologist



9. What is the average caseload for the following jobs?
    Average caseload represents the average number of patients assigned to a particular employee at any given time.
                                                                                   Physical            Occupational
                             RN                 LPN                HCA             Therapist            Therapist                 Chaplain         Social Worker
     HOMECARE
        Hospice

10. What is the average number of actual patient visits per day performed for the following jobs?
     Actual patient visits are the average number of face-to-face patient visits, including travel and paperwork time. All visits (including
     admission and complex) count as one (1) visit to compute average patient visits per employee, within a job, per eight (8) hour day.


                                                                 Physical         Occupational         Therapy
                            RN        LPN         HCA            Therapist         Therapist           Assistant          Chaplin          Social Worker
     HOMECARE
        Hospice




      2010-2011 HOMECARE Hospice Survey
                                                                                                                                 Facility Info & Svcs

11. What is the number of phone calls to patients/families related to plan of care logged per week for the following jobs?
                                                                            Physical              Occupational
                            RN              LPN              HCA            Therapist              Therapist          Chaplain       Social Worker
      HOMECARE
        Hospice

12. Please report additional pay rate in dollars ($) for on-call duty or working 2nd, 3rd, or weekend shift.
                                                                                      Hourly                               Routine Visit

                                                    On-Call Hourly                   3rd                                    3rd
                                                                   2nd Shift                     Weekend      2nd Shift                    Weekend
                                                        Rate                        Shift                                  Shift

       31. OCCUPATIONAL THERAPIST
       32. PHYSICAL THERAPIST
       33. THERAPY ASSISTANT
       35. SPEECH/LANGUAGE PATHOLOGIST
       36. REGISTERED NURSE (RN)
       37. HI TECH NURSE
       38. PRACTICAL NURSE (LPN)
       44. HOME CARE AIDE I (HCA I)
       45. HOME CARE AIDE II (HCA II)
       46. HOME CARE AIDE III (HCA III)
       47. MEDICAL SOCIAL WORKER



                                                                    Hospice Only

13. What is the average length of stay?                      days              What is the median length of stay?                           days

14. What is the percentage of patients discharged?                                    % Alive                             % Dead

15. Please indicate the following: (must total 100%)
         % Days of General          % Days of        % of Days    % Home Care Day
               Inpatient        Continuous Care Inpatient Respite      Rate                                 TOTAL

                                                                                                            = 100%

16. What percent of your caseload resides in a SNF or LTC Facility?                                     %

17. Does the Hospice have its own Inpatient Unit?                Yes         No                Number of inpatient beds:

18. Does the hospice have its own Residence?                     Yes         No                Number of residential beds:

     A. How is the Residence funded?
             Private Pay              Fundraising             Medicaid              Other

     B. How is the Residence staffed?
             RN            LPN            HCA           Social Worker               Other



                                                                    Per Visit Data

19. What is the minimum number of visits per week that must be performed to be considered a full-time employee?

20. What is the pay differential for type of visit?     (Example: Routine=1x pay or straight time, Admission= 2x pay, and Complex=1.5x pay)
                                          Routine                       Admission                     Complex

             Times Pay




21. What is the average length of visit?
       2010-2011 HOMECARE Hospice Survey
                                                                                                                                   Facility Info & Svcs

                                            Routine                      Admission                      Complex

             Minutes

22. How is documentation time paid for per visit employees:
       A. Documentation time is considered part of the per visit rate.                 B. Documentation time is separately paid.

23. How is office/training/orientation/meeting time paid for per visit employees?
       A. Routine visit rate.                                 C. Rate higher than routine visit rate.

       B. Rate lower than routine visit rate.                 D. Flat position rate.

24. How are per visit rates set? (Check all that apply.)
       A. Flat rate                       B. Years of experience                       C. Education

25. What is your ratio of hourly versus per visit mode of pay?
     (Example: 25 employees; 15 per visit, 10 hourly. 15 divided by 25=60%; 10 divided by 25=40%)

                % hourly clinicians                                        % per visit clinicians

26. Does the Agency anticipate increasing any of the following in the next 12 months?
       A. Increase the number of hourly mode employees.

       B. Increase the number of per visit mode employees.

       C. Maintain current pay mode.




      2010-2011 HOMECARE Hospice Survey
                                                                                                               Job Data

                                                             Salaries as of 7/1 to nearest $100
                                                                          Formal Salary Range

                                              Number of     Average                                Average
HCS Job                                      FTEs in Each   Annual                                  Annual
Number                                         Position     Salary*     Minimum       Maximum     Bonus Paid
       1 EXECUTIVE DIRECTOR/CEO
      2 DIRECTOR OF HOSPICE
      3 CHIEF OPERATING OFFICER/PROGRAM
        DIRECTOR
      4 TOP LEVEL FINANCIAL EXECUTIVE
      5 SECOND LEVEL FINANCIAL EXECUTIVE
      6 ACCOUNTANT
      7 TOP LEVEL INFORMATION SYSTEMS
        EXECUTIVE
      8 TOP LEVEL MARKETING EXECUTIVE
      9 TOP LEVEL DEVELOPMENT EXECUTIVE
     10 TOP LEVEL HUMAN RESOURCE EXECUTIVE
     11 SECOND LEVEL HUMAN RESOURCE
        EXECUTIVE
     12 RECRUITER
     13 DIRECTOR OF CLINICAL SERVICES
     14 DIRECTOR OF SOCIAL WORK AND
        COUNSELING
     15 DIRECTOR OF DME
     16 DME TECHNICIAN
     17 DIRECTOR OF REIMBURSEMENT/BILLING
     18 BUSINESS OFFICE MANAGER
     19 ACCOUNT EXECUTIVE
     20 CASE MANAGER/TEAM LEADER
     21 CLINICAL SUPERVISOR
     22 QUALITY IMPROVEMENT/UTILIZATION
        REVIEW MANAGER
     23 SUPERVISOR OF HOME CARE AIDES
     24 SUPERVISOR OF REHABILITATION
        SERVICES
     25 CLINICAL NURSE SPECIALIST
     26 ORIENTATION NURSE / INSTRUCTOR /
        EDUCATOR




      2010-2011 HOMECARE Hospice Survey
                                                                                                                                                   Job Data

                                                                                   Contract
HCS Job                                                              # of Hours    Position
   #                                         # FTEs    Hourly Rate   per Week       (Y/N)
     27 MEDICAL DIRECTOR
     28 PHYSICIAN
                                                                         Formal Range                              Routine                    Admission
                                                                                                                    Visit     Visit             Visit    Visit
HCS Job                                    # of Hourly Average      Hourly     Hourly         # of Visit   Visit   Range     Range    Visit    Range    Range
   #                                          FTEs    Hourly Rate Range Min. Range Max.         FTEs       Rate     Min.      Max.    Rate      Min.     Max.
     31 OCCUPATIONAL THERAPIST
     32 PHYSICAL THERAPIST
     33 THERAPY ASSISTANT
     34 RESPIRATORY THERAPIST
     35 SPEECH/LANGUAGE PATHOLOGIST
     36 REGISTERED NURSE (RN)
     37 HI TECH NURSE
     38 PRACTICAL NURSE (LPN)
     39 NURSE PRACTITIONER
     40 PSYCHIATRIC NURSE
     41 PEDIATRIC NURSE
     42 PHARMACIST
     43 REGISTERED CLINICAL DIETITIAN
     44 HOME CARE AIDE I (HCA I)
     45 HOME CARE AIDE II (HCA II)
     46 HOME CARE AIDE III (HCA III)
     47 MEDICAL SOCIAL WORKER
                                                               Hourly Rate as of 7/1
                                                                         Formal Range
                                                        Average
 HCS                                       Number of     Hourly
 Job #                                       FTEs        Rate*       Minimum      Maximum
     48 CASE WORKER
        INTAKE/CUSTOMER SERVICE
     49
        REPRESENTATIVE
     50 DISCHARGE PLANNER
     51 BILLING CLERK
     52 ACCOUNTING CLERK
     53 COMPLIANCE COORDINATOR
     54 HOME CARE AIDE COORDINATOR
     55 DIRECTOR OF VOLUNTEER SERVICES
     56 DIRECTOR OF BEREAVEMENT SERVICES


      2010-2011 HOMECARE Hospice Survey
                                                                                                                                             Job Data

                                                                   Formal Range                              Routine                    Admission
                                                                                                              Visit     Visit             Visit    Visit
HCS Job                                  # of Hourly Average      Hourly     Hourly     # of Visit   Visit   Range     Range    Visit    Range    Range
   #                                        FTEs    Hourly Rate Range Min. Range Max.     FTEs       Rate     Min.      Max.    Rate      Min.     Max.
     57 CHAPLAIN
     58 PAYROLL CLERK
     59 SECRETARY/CLERK II
     60 SECRETARY/CLERK I
     61 COMPUTER OPERATOR
     62 PURCHASING/SUPPLY CLERK
     63 MEDICAL RECORDS CLERK
     64 EXECUTIVE ASSISTANT II
     65 EXECUTIVE ASSISTANT I
     66 RECEPTIONIST




     2010-2011 HOMECARE Hospice Survey
                                                                                                                                   Fringe Benefits

        Please answer the following questions pertaining to Fringe Benefits provided to your full-time employees.
What is the actual cost of all Nonstatutory* Fringe Benefits provided to your employees as % of base compensation?
(*Nonstatutory benefits are those not required by law such as benefits surveyed below. Statutory benefits are: Social Security, Medicare,
Unemployment Insurance, and other federal or state mandated benefits as, workers compensation and FMLA.)

         MANAGEMENT                  %                          CLINICIANS                %

 I.       CAFETERIA PLAN

          Does the Agency offer a Cafeteria Plan for funding employee benefits?                  Yes      No


 II.     VACATION TIME or PAID TIME OFF (PTO) BANK SYSTEM
         (Paid Time Off is the combined compensated time for ALL Paid Holidays, Excused Paid Absences, Personal Days, Vacation Time
         and Sick Leave.)
        1. Which of the following does the Agency offer?              PTO              Vacation Time

        2. How many days off are given after the number of years shown are worked?

                                   After 1 Year            After 5 Years          After 10 Years        After 15 Years      After 20 Years

         MANAGEMENT                               Days                 Days                      Days                Days                   Days

         CLINICIANS                               Days                 Days                      Days                Days                   Days

        3. When are employees eligible to take Vacation Time or PTO?

                Upon Employment                     After 60 Days                 After 6 Months

                After 30 Days                        After 90 Days                After 1 Year


 III.      PAID HOLIDAYS (If included in PTO, skip to question IV.)

        1. How many holidays (including Christmas and excluding other religious holidays) are paid though not worked?

             MANAGEMENT                                         CLINICIANS

        2. How many religious holidays (excluding Christmas) are paid though not worked?

        3. What is the rate of pay for holidays worked?

                                                           MANAGEMENT                    CLINICIANS

            A. No additional pay

            B. 1 1/2 x base pay

            C. 2 x base pay

            D. 2 1/2 x base pay

            E. 3 x base pay

            F. Equal time off (no additional pay)

         4. When are employees eligible for Paid Holidays?

                Upon Employment                     After 60 Days

                After 30 Days                       After 90 Days




        2010-2011 HOMECARE Hospice Survey
                                                                                                                                           Fringe Benefits

IV.       EXCUSED PAID ABSENCES (If included in PTO, skip to question V.)

        1. How many days with pay are granted annually for personal leave? (Exclude death in family/FMLA)                                   Days

        2. How many days with pay are granted annually for sick leave?                                                                      Days

        3. How many days with pay are granted for death-in-family leave per occurrence ?                                                    Days

        4. What is the maximum number of days of excused paid absences which can be used or banked?                                         Days

        5. After what period of employment may an employee use Paid Days off?

               Upon Employment                           After 60 Days            After 6 Months

               After 30 Days                             After 90 Days            After 1 Years


V.        BREAKS (Not including lunch.)
        1. How many breaks are permitted for each shift (not including lunch)?             None           1              2          3

        2. What is the time allowed for each break? (Answer in minutes.)                                  10             15         20


VI.       JURY DUTY PAY

        What salary payments do employees on jury duty receive?

             Full pay.

            Difference between regular salary and juror's fees.

            No salary paid.


VII.      EDUCATIONAL ASSISTANCE
                                                                                               MANAGEMENT                         CLINICIANS
        1. Does your Agency have an Educational Assistance Program for                            Yes          No                 Yes          No
           COLLEGE LEVEL courses for its employees?
           If YES, then answer question 2.
        2. What reimbursements to employees are made for COLLEGE LEVEL courses?
               A. Full amount of tuition. (100%)

               B. Part of tuition. (Indicate percent.)                                                              %                               %

               C. Up to a fixed dollar amount. (Indicate amount per year.)                 $                                  $

        3. Does your Agency have an Educational Assistance Program for                            Yes          No                 Yes          No
           NONCOLLEGE LEVEL courses for its employees?
           If YES, then answer question 4.
        4. What reimbursements to employees are made for NONCOLLEGE LEVEL
           courses such as nursing personnel training and education, technical
           training, or computer training?
               A. Full amount of tuition. (100%)

               B. Part of tuition. (Indicate percent.)                                                              %                               %

               C. Up to a fixed dollar amount. (Indicate amount per year.)                 $                                  $


VIII.     GROUP LIFE INSURANCE
                                                                                               MANAGEMENT                         CLINICIANS
        1. Does the Agency carry Life Insurance for its employees?                                  Yes             No               Yes            No
            If YES, then answer next question.

           Average Annual Premium per Employee:               $                  or        $                        /$1,000




       2010-2011 HOMECARE Hospice Survey
                                                                                                                                       Fringe Benefits

VIII.     GROUP LIFE INSURANCE (continued)                                                      MANAGEMENT                       CLINICIANS

        2. How much insurance is provided for:

            A. Fixed amount (Indicate $ amount.)                                            $                                $
            B. 1 x salary

            C. 2 x salary

            D. 3 x salary

            E. Other (Indicate.)

        3. Agency pays entire cost.

        4. Employee pays entire cost.

        5. Agency and employee share cost.

                                                                              Agency Pays                          %                               %

        6. What is the waiting period for enrollment?

               Upon Employment                           After 60 Days                      After 6 Months

               After 30 Days                             After 90 Days                    After 1 Years


IX.       ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE                                          MANAGEMENT                       CLINICIANS

         1. Does the Agency carry AD&D coverage for its employees?                                Yes              No            Yes               No
            If YES, then answer next question.

            Average Annual Premium per Employee                $                   or $                            /$1,000

         2. How much AD&D is provided for:
             A. Fixed amount (Indicate $ amount.)                                           $                                $

             B. 1 x salary

             C. 1.5 x salary

             D. 2 x salary

             E. Other (Indicate.)

         3. Agency pays entire cost.

         4. Employee pays entire cost.

         5. Agency and employee share cost.                                 Agency Pays                        %                                   %


X.        LONG-TERM NONOCCUPATIONAL SICKNESS AND ACCIDENT DISABILITY INSURANCE

                                                                                                MANAGEMENT                       CLINICIANS
        1. Does the Agency have a Long-Term Nonoccupational Sickness
                                                                                                  Yes         No                 Yes          No
           and Accident Disability Insurance Program?
           If YES, then answer next question.
        2. Agency pays entire cost.

         3. Employee pays entire cost.

         4. Agency and employee share cost.                              Agency Pays                      %                                        %

         5. What is the waiting period for enrollment?

               Upon Employment                     After 60 days              After 6 months

               After 30 days                       After 90 Days             After 1 year




      2010-2011 HOMECARE Hospice Survey
                                                                                                                  Fringe Benefits

XI.      HEALTH INSURANCE

        1. Does the Agency have a Health Insurance Program?                           Yes            No
            If YES, then answer next question.
            Average Annual Premium per Employee (single) $                          per Year

        2. Employee Coverage
            A. Agency pays entire cost.

            B. Employee pays entire cost

            C. Agency and employee share cost.                                              Agency Pays       %

        3. Dependent Coverage
            A. Are dependents covered under the Health Insurance Plan?                Yes           No
               If YES, then answer next question.
            B. Agency pays entire cost of dependent coverage.

            C. Employee pays entire cost of dependent coverage.

            D. Agency and employee share cost of dependent coverage.                        Agency Pays       %

        4. What is the waiting period for enrollment?

              Upon Employment                    After 60 days           After 6 months

              After 30 days                      After 90 days           After 1 year


XII.     DENTAL INSURANCE PLAN

        1. Does the Agency have a Dental Insurance Plan?                              Yes            No
            If YES, then answer next question.
            Average Annual Premium per Employee (single) $                          per Year

        2. Employee Coverage
            A. Agency pays entire cost.

            B. Employee pays entire cost.

            C. Agency and employee share cost.                                              Agency Pays       %

        3. Dependent Coverage
            A. Are dependents covered under the Dental Insurance Plan?                Yes            No
               If YES, then answer next question.
            B. Agency pays entire cost of dependent coverage.

            C. Employee pays entire cost of dependent coverage.
            D. Agency and employee share cost of dependent coverage.                        Agency Pays       %

        4. What is the waiting period for enrollment?
              Upon Employment                    After 60 days           After 6 months

              After 30 days                      After 90 days           After 1 year

XIII.    VISION INSURANCE PLAN

        1. Does the Agency have a Vision Insurance Plan?                      Yes              No
            If YES, then answer next question.
            Average Annual Premium per Employee (single) $                          per Year

        2. Employee Coverage
            A. Agency pays entire cost.

            B. Employee pays entire cost.

            C. Facility Agency and employee share cost.                              Agency Pays          %




       2010-2011 HOMECARE Hospice Survey
                                                                                                                                                     Fringe Benefits

XIII.    VISION INSURANCE PLAN (continued)
                                                                                             Yes             No
        3. Dependent Coverage
            A. Are dependents covered under the Vision Insurance Plan?                       Yes             No
               If YES, then answer next question.
            B. Agency pays entire cost of dependent coverage.

            C. Employee pays entire cost of dependent coverage.

            D. Agency and employee share cost of dependent coverage.                               Agency Pays                            %

        4. What is the waiting period for enrollment?

                 Upon Employment                       After 60 days                   After 6 months

                 After 30 days                         After 90 days                   After 1 year


XIV.     LONG TERM CARE INSURANCE

        1. Does the Agency have a Long Term Care Insurance program?                                 Yes              No

        2. Employee Coverage

            A. Agency pays entire cost.
            B. Employee pays entire cost.

            C. Agency and employee share cost.                                                               Agency Pays                       % of premium


XV.      401(k)/403(b) PLAN

        1. Does the Agency have a 401(k) or 403(b) Plan?                               Yes          No

        2. Employee contributes what average percent of salary?                   Avg.                   %
        3. Does the Agency match employees’ contributions?                             Yes          No
            If yes, the employer matches, what is the amount?

                                 % of salary.

            $                    cents per $1.00 of employee contribution, up to                               % of salary, or $

        4. What is the eligibility period for enrollment?                 Upon employment             or                             months/                      hours

        5. Vesting - number of months until fully vested.                 Immediate vesting           or                             months


XVI.     SEVERANCE

        1. Does the Agency provide Severance Pay?                         Yes             No

        2. Indicate number of weeks pay given for years in service.

                Number of Weeks:                            Number of Years:                             Maximum Number of Weeks Allowed:

        3. Is pay contingent upon years in service?                       Yes             No


XVII.    MILEAGE

        1. Does the Agency provide mileage expense reimbursement?

                Management           Yes          No             Hourly          Yes           No                     Visit        Yes         No

        2. What is the rate per mile/visit allowed?

                Management                                       Hourly                                               Visit

                     $0.50 (2010 Fed. Rate) eff. 01/10                 $0.50 (2010 Fed. Rate) eff. 01/10                      $0.50 (2010 Fed. Rate) eff. 01/10

                 $               per mile                         $                      per mile                         $               per mile




      2010-2011 HOMECARE Hospice Survey
                                                                                                                        Fringe Benefits

XVIII. CELL PHONE                                                                           MANAGEMENT                 CLINICIANS

       1. Does the Agency provide cell phone reimbursement?                                   Yes        No            Yes          No

       2. What is the monthly rate allowed?                                             $                          $


XIX.    PROFESSIONAL ASSOCIATION FEES                                                       MANAGEMENT                 CLINICIANS

       1. Does the Agency pay the cost of professional association membership fees?           Yes             No       Yes               No



XX.     EDUCATIONAL AND PROFESSIONAL MEETINGS                                               MANAGEMENT                 CLINICIANS

       1. Does the Agency pay for time off for educational and professional meetings?         Yes             No       Yes               No




      2010-2011 HOMECARE Hospice Survey
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2010-2011 HOMECARE/Hospice Survey
                                                                                                                                    Job Descriptions


                              Job Descriptions

                                    1    EXECUTIVE DIRECTOR/CEO - Top level position in the agency. Is owner or reports to
                                         Board of Directors. Responsible for profitability, planning and overall administration.
                                         Accountable for all activities and departments. Administers, directs, and coordin

                                    2    DIRECTOR OF HOSPICE - Top level position in the Hospice agency. Is responsible
                                         for the direction and overall functions of the hospice or hospice program.


                                    3    CHIEF OPERATING OFFICER/PROGRAM DIRECTOR - Reports to CEO or parent
                                         organization. Responsible for assisting and coordination of agency activities for all
                                         departments. Plans, directs, and coordinates all activities. May work for a free
                                         standing agency or operate a multi chain branch.
                                    4    TOP LEVEL FINANCIAL EXECUTIVE - Top level position in Finance Department.
                                         Responsible for direction and coordination of activities concerned with financial
                                         administration, treasury functions, budgets, general accounting, client business
                                         services, computer systems, physical plant, and financial and statistical reporting.


                                    5    SECOND LEVEL FINANCIAL EXECUTIVE - Second level position in the Finance
                                         Department. Reports to and takes on some of the responsibilities of the Top Level
                                         Financial Executive. Provides assistance, as may be delegated, in areas of financial
                                         administration, budgets, general accounting, financial, and statistical reporting.


                                    6    ACCOUNTANT - Assists in the day-to-day operations of the Accounting Department.
                                         Assists in the preparation of financial reports, budgets, and payroll. Analyzes general
                                         ledger accounts and prepares monthly journal entries.

                                    7    TOP LEVEL INFORMATION SYSTEMS EXECUTIVE - Maintains computer systems
                                         and provides assistance in the development and implemen-tation of new systems
                                         including network administration. Creates information applications to support business
                                         functions. Evaluates systems capabilities and makes recommenda-tions to
                                         management to promote optimal utilization.

                                    8    TOP LEVEL MARKETING EXECUTIVE - Responsible for marketing/selling product
                                         lines to viable markets. Fulfills marketing goals by generating new business and
                                         maintaining existing business. Explores new business opportunities through referral
                                         sources as well as promoting existing business. Responsible for preparation and
                                         implementation of a yearly marketing plan.

                                    9    TOP LEVEL DEVELOPMENT EXECUTIVE - Responsible for the design,
                                         development, and implementation of fund raising and in-novative marketing programs,
                                         special events, capital campaigns, deferred giving programs, and other community
                                         relations activities essential to business development.

                                    10   TOP LEVEL HUMAN RESOURCE EXECUTIVE - - Plans, develops, and administers
                                         personnel and labor relations programs within the healthcare facil-ity. Formulates,
                                         implements, and supervises programs relative to selection, orientation, training,
                                         promotion, and welfare of all person-nel and all employer-employee relationships.
                                         Evaluates manpower requirements. Initiates policies and procedures to achieve
                                         objectives of the facility and to ensure maximum utilization of personnel.


                                    11 SECOND LEVEL HUMAN RESOURCE EXECUTIVE - Second level position in
                                         personnel and human resource management. Position takes on some responsibilities
                                         of Top Level Human Resource Executive and provides assistance, as may be
                                         delegated, in areas of employment, recruitment, training, policies and procedures,
                                         compensation, benefits, labor relations, health and safety, and security.


                                    12 RECRUITER - Responsible for reviewing qualified applicants for hire. Conducts
                                         interviews and recommends candidates to management.

                                    13 DIRECTOR OF CLINICAL SERVICES - Responsible for adminis-tration of client care
                                         services. Plans, implements, and directs nurses/clinical services to assure quality care
                                         and appropriate quantity of services. Has authority and responsibility for operation of
                                         programs. Interprets policies and regulations to all nursing personnel and ensures
                                         compliance. Analyzes and evaluates nursing and related services rendered to im-prove
                                         quality of care and to better utilize staff time and abilities.


                                    14 DIRECTOR OF SOCIAL WORK AND COUNSELING - Responsible for planning and
                                         administering social work and counseling programs in identifying and analyzing social
                                         and emotional factors underlying client's condition. May include supervision of Director
                                         of Bereavement Services and Chaplain. May do home visits.


                                    15 DIRECTOR OF DME - Responsible for the management, planning and coordination of
                                         all services related to the procurement, distribution and servicing of all medical
                                         equipment and DME personnel.

                                    16 DME TECHNICIAN - Responsible for the delivery, training, and maintenance of all
                                         DME equipment.


2009-2010 HOMECARE Hospice Survey
                                                                                                                                       Job Descriptions


                                    17 DIRECTOR OF REIMBURSEMENT/BILLING - Manages the agency billing func-tion by
                                         planning, organizing and supervising all reimbursement to promote the optimum benefit
                                         coverage for clients and reimburse-ment of all services. Manages the coordination of
                                         documentation necessary for reimbursement, Medicare Compliance, and control of
                                         receivables.

                                    18 BUSINESS OFFICE MANAGER - - Manages the collection and processing of data for
                                         billing, statistics, and medical orders. Directly super-vises such positions as office
                                         clerks, secretaries, receptionist, data entry operators, admission/discharge clerks, and
                                         volunteer staff.

                                    19 ACCOUNT EXECUTIVE - - Responsible for developing a specific territory for
                                         marketing and selling home healthcare services in the private pay sector. Participates
                                         in the development of the overall marketing program.

                                    20 CASE MANAGER/TEAM LEADER - Responsible for assignment and coordination of
                                         activities for a multidisciplinary team (nurses, therapists, home care aides, specialists).
                                         Communicates with referral sources, patients, payors, physicians and field staff.
                                         Provides continuity of essential clinical and financial information to ensure effective
                                         patient care management by professional staff members of the team. Monitors
                                         productivity and patient outcomes.

                                    21 CLINICAL SUPERVISOR - Provides direct supervision and clinical oversight of visiting
                                         staff. Responsible for case assignments, follow-up with interdisciplinary staff,
                                         communication with patients, physicians, and referral sources. Serves as a clinical
                                         resource and educator for field staff.

                                    22 QUALITY IMPROVEMENT/UTILIZATION REVIEW MANAGER - Responsible for
                                         coordination of interdepartmental quality improvement activities such as staff education,
                                         utilization review, clinical risk management, and patient satisfaction. Serves as
                                         resource to quality improvement committees and work groups. Analyzes outcome
                                         reports, including OASIS reports, determines areas for improvement, assists tracks
                                         trends and compiles report for professional advisory committee. May be responsible for
                                         oversight of agency regulatory and accreditation compliance.


                                    23 SUPERVISOR OF HOME CARE AIDES - Responsible for the quality and quantity of
                                         services rendered by the Home Care Aides. Develops and implements new programs
                                         and services.

                                    24 SUPERVISOR OF REHABILITATION SERVICES - Responsible for plan-ning,
                                         developing, and facilitating the implementation and the evalua-tion of occupational
                                         therapy, physical therapy, and speech/language pathology programs. Provides clinical
                                         consultation. Responsible for monitoring the performance of the therapists. License in
                                         area of specialization required.

                                    25 CLINICAL NURSE SPECIALIST - Assumes primary responsibility for nursing practice
                                         and its effect on healthcare. Provides clinical direc-tion to personnel and client
                                         programs. Develops and implements pro-grams of the facility. Acts as consultant to
                                         nursing supervisors in maintaining clinical competency of their staff. May serve as
                                         clinical expert, consultant, and in specific specialty such as oncology, infusion therapy,
                                         wound and skin care or rehabilitation. Provides direct patient care, develops programs
                                         and monitors outcomes of care.

                                    26 ORIENTATION NURSE / INSTRUCTOR / EDUCATOR - Implements the orientation
                                         and continuing education program of all employees (pro-fessional and
                                         paraprofessional). Provides individualized instruction and guidance as may be
                                         required.

                                    27 MEDICAL DIRECTOR - Directs, plans, coordinates client care in establishing and
                                         implementing standards of medical service, and advises Executive Director/CEO on
                                         medical questions and policies.

                                    28 PHYSICIAN
                                    31   OCCUPATIONAL THERAPIST - - Plans and provides occupational therapy program
                                         for the treatment of physical and psychological dysfunctions. Involves such activities as
                                         arts and crafts, practice in functional prevocational and vocational skills, and activities
                                         of daily living. Adapts programs according to needs of individual clients. Studies
                                         clients' reactions and prepares reports reflecting clients’ pro-gress. Meets state
                                         educational and licensure requirements to practice


                                    32   PHYSICAL THERAPIST - - Organizes and conducts medically prescrib- ed therapy
                                         program for clients involving exercise, massage, heat, water, light, and electricity.
                                         Applies diagnostic and prognostic mus-cle, nerve, joint, and functional ability tests.
                                         Directs and aids clients in active and passive exercises. Evaluates, records, and
                                         reports client progress. Meets state educational and licensure requirements to practice.


                                    33   THERAPY ASSISTANT - Under general supervision of Physical Therapist or
                                         Occupational Therapist, exercises client as instructed. Special training required for this
                                         position. Meets state educational and licensure requirements to practice.




2009-2010 HOMECARE Hospice Survey
                                                                                                                                       Job Descriptions


                                    34   RESPIRATORY THERAPIST - Performs respiratory modalities such as pressure
                                         breathing, mechanical ventilation, positive pressure breathing, humidity/medicated
                                         aerosol therapy, medical gas administration, pulmonary drainage procedures, and
                                         cardiopulmonary resuscitation. Sets up and operates various types of oxygen and other
                                         therapeutic gas and mist equipment. Meets state educational and licensure
                                         requirements to practice.

                                    35   SPEECH/LANGUAGE PATHOLOGIST - Examines and provides remedial services for
                                         clients with speech and language disorders. Speech disorders treated include
                                         stuttering, voice disorders, articulation, and speech problems associated with speech
                                         impairments. Devises vocal exercises and teaches proper breath control to improve
                                         speech. Prepares client progress reports describing therapy and progress made.
                                         Meets state educational and licensure requirements to practice.


                                    36   REGISTERED NURSE (RN) - Provides services for clients consistent with the agency’s
                                         philosophy, policies, and standards of care. Meets state educational and licensure
                                         requirements to practice.
                                    37   HI TECH NURSE - Provides clients with specialized services. Provides services such
                                         as I.V. therapy, ventilator care, and any other service that requires specialized training
                                         of technical skills. Meets state educational and licensure requirements to practice.


                                    38   PRACTICAL NURSE (LPN) - Provides services under the direction of a Registered
                                         Nurse, for clients consistent with the agency’s philosophy, policies, and standards of
                                         care. Meets state educational and licensure requirements to practice.


                                    39   NURSE PRACTITIONER - Serves as liaison between the clinical staff and the
                                         administrative operational staff. Plans and evaluates the clinical management of
                                         clients. Evaluates treatment plans, medications, and other necessary care. Provides
                                         clinical recommendations to nursing staff to address the medical needs of the clients.
                                         Can also provide comprehensive client care.

                                    40   PSYCHIATRIC NURSE - Responsible for the care and needs of psychiatric clients.
                                         Administers medications and maintains clients' medical records. Meets state
                                         educational and licensure requirements to practice.
                                    41   PEDIATRIC NURSE - Provides nursing services to infants, children, and adolescents
                                         by monitoring and recording vital signs such as temperature, blood pressure, and
                                         respiratory rate. Administers medications as prescribed by the Physician. Assesses
                                         significant behavior in relation to the child's illness through understanding of children's
                                         growth and development patterns.

                                    42   PHARMACIST - Provides professional pharmaceutical services in compounding and
                                         dispensing medications and other pharmaceutical supplies. Uses standard physical
                                         and chemical procedures in the filling of written prescriptions. Meets state educational
                                         and licensure requirements to practice.
                                    43   REGISTERED CLINICAL DIETITIAN - Responsible for the assessment of clients'
                                         nutritional needs relative to medical diagnosis and patient/caregiver education to
                                         facilitate achievement of defined nutritional goals and clients' nutritional needs. Meets
                                         state educational and licensure requirements to practice.
                                    44   HOME CARE AIDE I (HCA I) - Assists with environmental services such as
                                         housekeeping and homemaking services in order to preserve a safe, sanitary home
                                         and enhance family life. The Home Care Aide I does NOT provide personal care. May
                                         also be called chore worker or homemaker.
                                    45   HOME CARE AIDE II (HCA II) - Provides non-medically directed personal care. May
                                         also be called personal care attendant.
                                    46   HOME CARE AIDE III (HCA III) - Provides personal care services under a medically
                                         supervised plan of care. Meets federal and/or state training and licensure
                                         requirements. May also be called home health aide.

                                    47   MEDICAL SOCIAL WORKER - Identifies and analyzes the social and emotional
                                         factors underlying client illness and communicates these factors to the health team.
                                         Assists clients and their families in understanding and accepting treatment to
                                         permanent and temporary effects of illness. Master’s Degree required. Provides direct
                                         and indirect social work services.

                                    48   CASE WORKER - Provides direct or indirect social/environmental work services based
                                         on staff and client needs. Assists with the development of the social work assessment
                                         of clients and families. Bachelor's Degree in social work, sociology, psychology, or
                                         related field required.

                                    49   INTAKE/CUSTOMER SERVICE REPRESENTATIVE - Provides centralized intake,
                                         takes client information and refers to appropriate individuals within the agency.
                                         Coordinates the staffing assignments as instructed.
                                    50   DISCHARGE PLANNER - Manages and facilitates the safe and timely transfer of
                                         clients from a hospital or skilled nursing facility to the care of the home care
                                         agency/hospice program. Evaluates the clients referred to determine ap-propriateness
                                         for admission.




2009-2010 HOMECARE Hospice Survey
                                                                                                                                    Job Descriptions


                                    51   BILLING CLERK - Processes, verifies, bills and coordinates billing matters including
                                         Medicare or Medicaid, if applicable. Records payments and reconciles remittance
                                         advices. Follow-up on claims denials, pending and aged claims. Performs various
                                         functions in the preparation of Medicare/Medicaid billing.

                                    52   ACCOUNTING CLERK - Responsible for the accounts payable/purchase order system
                                         and reconciling vendors' monthly statements against the facility's listing of accounts
                                         payable. Responsible for purchase orders, invoices, packing slips and processes for
                                         payment. Logs vendor purchases and processes orders through purchase order
                                         system.

                                    53   COMPLIANCE COORDINATOR - Performs a full range of clerical functions related to
                                         employee record compliance to assure compliance with contractual requirements and
                                         regulations.

                                    54   HOME CARE AIDE COORDINATOR - Responsible for scheduling of Home Care
                                         Aides. Submits staffing reports on Aide activities. Maintains record of Home Care Aide
                                         reports and checks time sheets.

                                    55   DIRECTOR OF VOLUNTEER SERVICES - Organizes and directs a program for
                                         recruiting, screening, training, retaining, and utilization of volunteer workers who
                                         con-tribute their services to supplement work of regular staff.
                                    56   DIRECTOR OF BEREAVEMENT SERVICES - Responsible for the hospice
                                         bereavement program including organizing and training of bereavement counselors and
                                         ensuring that the services reflect family needs and follow the hospice plan of care.


                                    57   CHAPLAIN - Provides patients and members of the family with pastoral care and
                                         religious counseling by making routine visits. Performs church rites or makes
                                         provisions with an appropriate religious leader to do so.

                                    58   PAYROLL CLERK - Performs various calculations of payroll including withholding and
                                         deductions and other payroll functions. Job duties may be coordinated with automated
                                         payroll computer service. Job requires coding payroll data for computer processing.


                                    59   SECRETARY/CLERK II - Performs a variety of complicated clerical tasks and
                                         computer entry in the processing of non-routine transactions. Functions may include
                                         typing reports, formatting computer documents, memoranda, etc., and filing of various
                                         documents.

                                    60   SECRETARY/CLERK I - Performs simple, routine, clerical tasks, and computer entry in
                                         the processing of various transactions. Functions may include some typing, copying
                                         and filing of various documents.

                                    61   COMPUTER OPERATOR - Operates computer and related equipment, such as
                                         printers, backup tapes and disk drives. Performs data entry for the processing of
                                         various accounting and statistical data including admission and discharge forms,
                                         employee daily reports, fee changes, and financial data.

                                    62   PURCHASING/SUPPLY CLERK - Orders, stocks and maintains office, medical, and
                                         other supplies. Keeps office machines, such as photocopier and fax in working order
                                         through simple maintenance and cleaning.
                                    63   MEDICAL RECORDS CLERK - Performs a variety of clerical tasks related to client
                                         admission/discharge process and records. Assigns new codes to the admission
                                         process. Verifies discharge information as reported on discharge form. Processes and
                                         verifies fees.

                                    64   EXECUTIVE ASSISTANT II - Performs administrative/secretarial duties for president
                                         and/or other key executives requiring extensive knowledge of organization, policies,
                                         and procedures. Types a variety of correspondences and documents of a confidential
                                         and sensitive nature. Position requires the use of word processing. Screens and
                                         places phone calls, arranges meetings, and analyzes reports and correspondence as
                                         assigned.

                                    65   EXECUTIVE ASSISTANT I - Types letters, memorandum, reports, and administrative
                                         forms requiring knowledge of organizational policies and procedures. Position requires
                                         the use of word processing. Screens calls for executives, arranges meetings, and
                                         analyzes reports and correspondence as assigned. See also Secretary/Clerk I/II.


                                    66   RECEPTIONIST - Greets and directs visitors entering the premises. Operates console
                                         to take and relay incoming calls. May perform simple, routine clerical and typing tasks.




2009-2010 HOMECARE Hospice Survey
                           Definitions of Terms Used In Questionnaire:

FTE: The sum of annual paid hours for all employees divided by 2,080 hours. This sets the standard for
reporting FTEs. For per-visit employees, divide their number of visits by the average number of visits made by a
full-time employee.

Government (public, official): Operated by a government entity (state, city, county, federal).

Gross Revenue: Income generated by all of the agency’s operations, before deductions for expenses.

Home Health Care: Professional services provided in the place of residence on either a part-time, intermittent,
hourly, or shift basis.

Hospice: Organized program of interdisciplinary services for terminally ill patients and their families to provide
palliative medical care and supportive social, emotional, and spiritual services in the place of residence.



Hospital-based: Organized as a department/division of a hospital.

Hourly: Compensation paid by the number of hours worked.

Management: Supervisory employees who are compensated by salary and are exempt from overtime pay.


Personal Care: Personal care related to assistance with Activities of Daily Living (ADL) provided on a part-time,
intermittent, hourly, or shift basis in the place of residence.


Personal Leave: Personal Leave is all paid days granted which do not include Sick Leave, Death-in Family,
Holidays, and Vacation Pay.


Private: Non-profit or proprietary; privately owned and controlled by an individual, partnership, or corporation.


Profit Status: Not-for-profit--excess revenue retained by the corporation; exempt from Federal income taxation
under Section 501 of the IRC.

Proprietary/For-profit: Excess revenue distributed to owners or shareholders or held as retained earnings
subject to federal taxation.

PTO: Paid Time Off is the combined compensated time for all Holidays, Excused Paid Absences, Personal
Days, Vacation Time & Sick Leave.

Publicly Held Company: Company that issues stocks that are traded on a stock exchange.

Salary: Fixed base compensation paid regularly.

Support Care: Supportive services related to assistance with Instrumental Activities of Daily Living (IADL)
provided on a part-time, intermittent, shift, or hourly basis in the place of residence.

Unduplicated Patient/Client Census: Number of individuals receiving service from an organization during a
given period of time counted only once regardless of the number of services, frequency of admission, or payor
source.


VNA/VNS: Visiting Nurse Association, Visiting Nurse Service. Governed by a community-based, voluntary
board of directors.

								
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