Home Health Training
Admin
5.7 The Visit Types

Missed Visits and Non-Admits

What to do when a visit does not happen, when a no-answer becomes a welfare concern, and how to handle a referral that should not be admitted.

Updated Sep 18, 2026

Two situations that feel like non-events and are not. A missed visit is a gap in an ordered frequency. A non-admit is a decision that the benefit does not apply. Both need documentation, and both are where patients get lost.

Missed visits

A visit in the ordered frequency that does not happen. It always needs a note.

Document

  • Why — patient refused, not home, hospitalized, weather, clinician illness
  • What you did about it — attempts to contact, rescheduled date
  • Who you notified — physician, if the pattern affects the plan of care
  • Whether the frequency can still be met, or needs changing

A missed visit with a clear note is a managed event. A gap with no note is a survey finding. See Frequency and Duration — How to Write It.

When the frequency cannot be met

Do not simply leave the gap. Either make the visit up within the week, or get the frequency changed by order — see Verbal Orders and Clarifications.

Patterns matter

One missed visit is logistics. Three in a month is clinical information:

  • A patient who is repeatedly not home may no longer be homebound
  • A patient who repeatedly refuses may be telling you they are done
  • A patient who keeps forgetting may have a cognitive change nobody has assessed

Raise it at case conference rather than rescheduling around it indefinitely.

What counts as a reason

The agency's own list of reasons a visit may legitimately be missed:

  • No response when trying to make an appointment, and a drive-by performed with no success
  • A last-minute cancellation, after a time had already been agreed, that you could not move without creating back-to-back visits
  • Hospitalization, including an admission that results in observation

Any time a patient is admitted to hospital, notify the RN Case Manager and the office. The patient will need a new resumption of care by the RN admit nurse before returning to service — see Resumption of Care (ROC).

Neither you nor the company is paid for a missed visit. If you drove out, carry the mileage onto your next visit or your last one of the day — see Productivity, Time Cards, and Mileage.

No answer at the door

Even if your patient does not answer — go and check on them.

Patients have been left on the floor for days, and have been found deceased, because they could not reach a phone after a fall or a cardiac event.

That is the agency's instruction, and it is the reason the steps below exist. A no-answer is not an administrative outcome to record; it is an unknown to resolve.

This is the one to have a plan for before it happens.

  1. Knock and ring properly. Wait. Try again.
  2. Call the patient's phone from outside the door.
  3. Look and listen — car in the drive, lights, television, a dog reacting. Look through a window if you can do so without entering.
  4. Call the emergency contact.
  5. Call the office and tell them where you are.

When it becomes a welfare concern

Escalate to 911 for a welfare check — do not force entry yourself — if any of:

  • You can see or hear the patient and they are not responding
  • The patient is high-risk and reliably home, and nobody can reach them
  • There are signs something is wrong: door open, a fall you can see, a medical alarm sounding
  • The emergency contact is also worried

Stay until help arrives if it is safe to do so.

Afterwards: document times, everything you observed, everyone you called, and the outcome. Notify the physician.

When it is not

If there is reason to believe the patient is simply out — a neighbour says they went to an appointment, the family confirms it — leave a notice per agency policy, document the attempt, and reschedule. Then follow up: a patient who was "out" may in fact be in hospital, which starts the transfer clock. See Transfer.

Non-admits

A referral that never becomes an episode. Sometimes that is obvious before anyone visits; sometimes you find it in the home.

Reasons a referral should not be admitted

  • The patient is not homebound
  • There is no skilled need — the need is real but unskilled
  • No compliant face-to-face and none can be obtained — see The Face-to-Face Encounter
  • No physician willing to oversee the plan of care
  • The patient declines services
  • The need is continuous, not intermittent
  • The patient is already on service with another agency
  • The environment is unsafe for staff and cannot be made safe

If you are already in the home

Do not start a start of care you should not finish.

  1. Stop before you begin the assessment if it is clear at the door
  2. Call your Field Supervisor from the home or the car. This is not a decision to make alone — a wrong non-admit denies someone care they qualify for
  3. Do not open the SOC in the EMR if the decision is made before the visit becomes billable
  4. Explain it to the patient kindly and clearly, including what they do qualify for — private duty, outpatient therapy, community services
  5. Tell the referring physician the same day, and why

Document

  • The date and time you were there
  • What you observed that led to the decision
  • Who you consulted, and what was decided
  • What you told the patient and family
  • What alternatives you offered
  • That the referral source was notified

The commonest reason a patient is wrongly non-admitted is that the clinician decided alone at the door. The commonest reason one is wrongly admitted is that nobody wanted to have the conversation. Both are fixed by calling your supervisor before you decide.