Routine Home Care Days in Nursing Facilities SSVI Measure

9.2% of scored hospices nationally tripped this measure in FY2025.

What CMS measures

This measure looks at what share of your Routine Home Care days are delivered inside a nursing facility or skilled nursing facility, as opposed to a private home, assisted living, or other community setting. When that share reaches 40% or more of all your RHC days, CMS flags it as a facility-heavy census pattern — the kind associated with recruitment-driven admission models rather than community-based referral growth.

The flag threshold

• FY2025: Flagged when 40% or more of Routine Home Care days are delivered in a nursing facility or skilled nursing facility (≥40%).
• FY2024: Same threshold — flagged at 40% or more (≥40%).

Percentile-based thresholds are recalculated by CMS every fiscal year, so the line moves as the industry moves.

Why hospices trip it

• Referral mix concentrated in a small number of facility partners rather than a broad base of community sources.
• Marketing and business development built primarily around facility relationships because they are easier to scale quickly.
• Visit routing that treats all facility patients the same way instead of individualizing frequency to acuity.

How to move it — changes you can start today

1. Pull your facility-RHC share this week from billing data using revenue location codes — know your number before you plan anything else.
2. Redirect one marketing or liaison hour per day this week toward community referral sources — physician practices, hospital discharge planners, ALFs — instead of facility rounds.
3. Review visit frequency orders for facility patients this week and correct any that default to a one-size-fits-all facility schedule.
4. Audit your last 10 facility patient charts for documentation that shows what hospice specifically added beyond the custodial care the nursing home already provides.

Common questions

Is caring for patients in nursing facilities itself a problem?

No — the flag is about concentration, not the setting itself. It only trips when 40% or more of ALL your RHC days are delivered in a nursing facility or SNF.

Do assisted living facility (ALF) days count toward this measure?

No. Assisted living is not classified as a nursing facility or SNF for this measure — only nursing facility and skilled nursing facility days count.

Where does your hospice stand?

Look up your score free — the breakdown shows your raw value on this exact measure next to the CMS threshold. Or browse scores by state.

All nine SSVI measures

• Non-hospice spending
• No CHC or GIP days
• Facility-based RHC days (this page)
• Last 2 days skilled visits
• Long length of stay
• Live discharge rate
• SN minutes per RHC day
• Weekend skilled visits
• 7-day return rate