Start of Care (SOC)
The longest and highest-stakes visit in the episode — what has to be confirmed before you start, what happens in the home, and the deadlines that follow.
The start of care sets everything: eligibility, coding, case-mix, the plan of care, the outcome baseline you will be measured against, and whether the episode is payable at all. Every other visit in the episode inherits the decisions you make here.
Budget for it. A first SOC takes a new clinician two to three hours in the home, and that is normal.
Before you go
Confirm these on the referral. If any is missing, raise it with intake before the visit, not after.
- Order for skilled services — a separate order for each discipline being asked to evaluate
- Face-to-face encounter that is compliant and documents new or changed needs — see The Face-to-Face Encounter
- The encounter is related to the primary reason for home health, and the condition is acute
- A physician is willing to oversee the plan of care
- Contact details that work, and directions that make sense
- Insurance verified and authorisation obtained if the payer requires it
- Hospital discharge summary and medication list, if there was an inpatient stay
Also check what you are walking into: infection precautions, oxygen in the home, pets, anyone else living there, and whether the neighbourhood needs a daylight visit.
What the SOC date is
The SOC date is the date of the first billable visit — normally this one. It starts the 60-day certification period and every clock attached to it.
Do not open a start of care you cannot finish. If you arrive and the patient is not appropriate, see Missed Visits and Non-Admits.
In the home
Consent and admission paperwork
Before any assessment: consent to treat, patient rights and responsibilities, notice of privacy practices, advance directive information, the agency's emergency and on-call instructions, and the complaint process including the state hotline. Leave a copy of everything.
The assessment
A full head-to-toe assessment plus the OASIS. The OASIS is not a separate task you do afterwards — you gather it as you assess.
- Vital signs including pulse oximetry — see Vital Sign Parameters — When to Call
- Complete systems assessment
- Wounds: measure, describe, photograph if policy allows — see Wound Etiology and Pressure Injury Staging
- Full medication reconciliation against every bottle in the house, not the discharge list
- Functional status, actually observed
- Cognition, mood, and pain
- Caregiver: who, how often, and what they are genuinely able to do
- Home safety and fall risk
Establish homebound status, in the patient's own circumstances
Both criteria, with different reasons. This is the foundation every subsequent visit rests on — get the language right here and the rest of the episode is easier. See Homebound Status — What Actually Qualifies.
Build the plan of care
- The disciplines needed, and why each one
- Frequency and duration for each — see Frequency and Duration — How to Write It
- Measurable goals with target dates
- Interventions tied to the goals
- Parameters for notifying the physician
Start discharge planning
Today. Not in week five. Name what has to be true for this patient to no longer need us, and tell them what it is.
Teach before you leave
- When the next visit is, and who is coming
- How to reach the agency, including nights and weekends
- What would make them call us, and what would make them call 911
- The one thing that matters most for their condition — the daily weight, the glucometer, the wound signs
After the visit
| Deadline | What |
|---|---|
| Same day | Submit the visit note per agency timeliness policy |
| Within 5 days of the SOC date | Complete the OASIS SOC assessment |
| Within 5 calendar days of the SOC date | The Notice of Admission (NOA) must be submitted — the agency does this, but it depends on your documentation being in. Late submission reduces payment for every day it is late. |
| Promptly | Plan of care to the physician for signature |
| Within the first week | An RN should be in the home — see Plotting Visits |
Where start of care goes wrong
- The face-to-face doesn't cover the reason for home health. Found at SOC, it is fixable. Found at billing, it is not.
- Homebound language is generic. "Weak, uses walker" will not survive review. Describe the effort.
- Medications reconciled from the discharge paperwork instead of from the bottles in the kitchen. The discrepancy is the clinical finding.
- Goals that cannot be measured. "Patient will improve mobility" cannot be met or failed.
- No RN in the first week on a therapy-first case, when the patient had a medication change on discharge.
- The OASIS and the visit note describe different patients. Read them side by side before you submit. See What OASIS Is, and Why Every Answer Matters.