Home healthcare interview questions

A competing agency in a neighboring county is for sale. How do you decide whether to buy it?

Situational · Acquisitions

Strong answer

Checks survey history, billing and referral compliance, payer mix, census, staff stability and star ratings, models the deal with the CFO, and is ready to walk away from compliance risk.

Red flags

Buys for the census without checking compliance.

A top-referring physician group asks us to pay for a coordinator who would work in their office. What do you do?

Situational · Referral compliance

Strong answer

Recognizes the anti-kickback risk, declines, involves the compliance officer or counsel, documents it, and keeps the relationship focused on quality of care.

Red flags

Agrees to protect the referrals.

A Medicare Advantage plan that sends us many patients cuts its rates below our cost per visit. What do you do?

Situational · Payer contracts

Strong answer

Models the cost, negotiates with outcome data, considers limiting volume or exiting, tells referral sources, and protects current patients during any change.

Red flags

Accepts the cut to keep volume, or drops the plan without a transition.

Tell me about a time you had to choose between growth and quality. What did you choose, and why?

Behavioral · Growth and quality

Strong answer

A specific tradeoff, the data behind it, and a choice that protected patients and the license.

Red flags

Always chose growth and dealt with problems later.

Tell me about a senior leader you hired or let go. What drove the decision?

Behavioral · Leading leaders

Strong answer

Names the standard the leader met or missed, the evidence they used, how they gave the person a fair chance or a fair exit, and what improved after.

Red flags

Decided on loyalty or gut feel.

Explain how Medicare pays for home health under PDGM, and what that means for how we run the agency.

Technical · Medicare payment

Strong answer

Payment per period depends on clinical grouping, functional level, comorbidities, admission source and timing, with low-visit adjustments. Accurate OASIS and coding, appropriate visit use and referral mix matter, not therapy volume.

Red flags

Thinks more therapy visits mean more pay.

Missed visits in one branch doubled this month. How do you find out why and fix it?

Situational · Missed visits

Strong answer

Breaks missed visits down by staff, area, day and reason, finds the cause such as call-offs, routes or understaffing, fixes it, and checks that physicians were notified per policy.

Red flags

Tells the branch to do better without data.

The state offers us [10] new Medicaid personal care clients in a rural county where we have no caregivers. How do you decide how many to accept, and how fast?

Situational · Growing into a new area

Strong answer

Checks whether the rate covers drive time and mileage, how long hiring and training will take there, and whether visits can be grouped into routes, then accepts only what can be staffed and sets honest start dates.

Red flags

Accepts every client to grow census and hopes to staff them.

Walk me through how you'd cut EVV exceptions across branches.

Technical · EVV compliance

Strong answer

Sorts exceptions by type and staff, fixes phone or GPS issues, trains caregivers, has schedulers review daily, and tracks it on a branch dashboard.

Red flags

Has office staff edit exceptions without fixing the cause.

Tell me about a time you reduced overtime without hurting service.

Behavioral · Overtime

Strong answer

Found the drivers, rebuilt schedules or routes, added part-time staff, and showed overtime fell while visits held.

Red flags

Banned overtime and visits were missed.

Tell me about a branch or team you turned around. What did you change first?

Behavioral · Turnarounds

Strong answer

Names the diagnosis, the first changes in people or process, and results such as fewer missed visits or lower turnover.

Red flags

Can't say what they changed, or credits luck.

How do you decide how many aides and caregivers to hire next month?

Technical · Hiring plans

Strong answer

Uses the referral forecast, open hours, expected turnover, availability by area and shift, and how long training and onboarding take.

Red flags

Hires whoever applies, with no forecast.

Walk me through forecasting cash when Medicare, Medicaid, Medicare Advantage and private pay all pay on different timelines.

Technical · Cash forecasting

Strong answer

Builds collections by payer using actual payment lag, adds billing holds and denials, lines up payroll dates, and plans a credit line for gaps.

Red flags

Uses one average collection rate for all payers.

Payroll is in [3] days, and a state Medicaid system outage has delayed payments. What do you do?

Situational · Payroll under pressure

Strong answer

Updates the cash forecast, draws on the credit line if needed, tells the owners or lender early, makes payroll first, and follows up with the state.

Red flags

Delays or shorts caregiver paychecks.

How should caregiver pay handle travel time between clients and overtime?

Technical · Wage and hour

Strong answer

Pays travel between clients during the workday as work time. Checks the current federal overtime rule for agency caregivers, which the Labor Department has moved to change, and follows state law where it's stricter.

Red flags

Pays only time in the client's home, or calls caregivers exempt without checking federal and state rules.

Leadership wants to open a new county. How do you model the cost?

Situational · New territories

Strong answer

Licensing timeline, start-up costs, staffing and recruiting, census ramp, payer mix, cash needed before breakeven, and the downside case.

Red flags

Assumes the new county will look like an existing one.

Tell me about a time you found money leaking in a process others thought was fine.

Behavioral · Finding leaks

Strong answer

Names the leak, such as unbilled visits or mileage errors, how the data showed it, the fix, and the money recovered.

Red flags

Describes across-the-board cuts instead of a specific leak.

Tell me about a time you presented bad results to owners or lenders.

Behavioral · Reporting bad news

Strong answer

Was early and plain, explained causes, brought a plan, and followed through.

Red flags

Delayed or dressed up the numbers.

State surveyors arrive unannounced and ask for personnel files, aide supervision records and signed orders. What do you do in the first hour?

Situational · Survey readiness

Strong answer

Welcomes them, gets the clinical manager, produces the records promptly and honestly, keeps notes on requests, and debriefs daily. Explains that readiness comes from monthly self-audits, not a scramble.

Red flags

Stalls for time, or tries to fix records before handing them over.

A family reports that an aide was rough and left bruises on a patient. Walk me through what you do.

Situational · Complaint investigation

Strong answer

Makes sure the patient is assessed and safe, removes the aide from the case pending review, reports to the state or adult protective services as required, investigates and documents, takes corrective action, and informs the governing body.

Red flags

Asks the aide for their side and closes the complaint.

Walk me through writing a plan of correction for a deficiency on late aide supervisory visits.

Technical · Plans of correction

Strong answer

How affected patients get the visits now, how other cases were checked, what system changes prevent repeats, who is responsible, completion dates, and how audits will show it stays fixed.

Red flags

A promise to retrain staff, with no monitoring or dates.

Tell me about a policy you rewrote because staff weren't following it. What changed?

Behavioral · Policy that works

Strong answer

Found out why staff weren't following it, made it simpler, trained on it, and checked that practice changed.

Red flags

Re-sent the same policy with a warning.

Tell me about a time you held a clinical leader accountable for a compliance gap.

Behavioral · Holding leaders accountable

Strong answer

Clear facts, a direct conversation, a corrective plan with dates, and follow-up until fixed.

Red flags

Avoided it because the leader was hard to replace.

Walk me through how the agency should handle a winter storm that will close roads for two days.

Technical · Emergency preparedness

Strong answer

Uses the emergency plan: ranks patients by risk, contacts them ahead, plans who must be seen and how, keeps staff safe, uses backup communication, coordinates with local emergency management, and documents.

Red flags

Cancels visits and waits for the roads to clear.

A hospital refers a patient who needs daily insulin injections and has no caregiver, in a county where we have one nurse. What do you do?

Situational · Accepting referrals safely

Strong answer

Weighs whether we can safely meet the need, looks for options like teaching the patient or a family member, and if we can't, declines quickly and tells the referral source.

Red flags

Accepts it and hopes staffing works out.

Hospitalizations among our patients have risen for two quarters. What do you do?

Situational · Reducing hospitalizations

Strong answer

Reviews each case for patterns, such as heart failure or falls, adds early visits and calls, strengthens teaching and emergency plans, and tracks the rate.

Red flags

Tells nurses to watch patients more closely.

Walk me through how you make sure aide supervision meets federal rules.

Technical · Aide supervision

Strong answer

Tracks supervisory visits for each patient on the required schedule, includes on-site visits with the aide present as required, re-evaluates competency when a problem is found, and documents every visit.

Red flags

Leaves supervision to each nurse with no tracking.

Tell me about a clinician whose documentation kept falling behind. What did you do?

Behavioral · Documentation timeliness

Strong answer

Found the cause, such as caseload or EMR skills, set clear expectations, gave support, followed up, and escalated if needed.

Red flags

Did the documentation for them or ignored it.

Tell me about a nurse you helped become a stronger case manager.

Behavioral · Developing nurses

Strong answer

Specific skills worked on, the method such as joint visits or chart reviews, and the result.

Red flags

Expects nurses to learn case management on their own.

An aide reports that a family member seems to be taking the patient's pain pills. What do you do?

Situational · Suspected abuse

Strong answer

Makes sure the patient is safe and assessed, notifies the physician, documents, reports to adult protective services as the state requires, and involves the social worker on safe medication storage.

Red flags

Asks the family member about it and closes the matter.

The credential report shows [6] aides with expired CPR cards, and they're on this week's schedule. What do you do?

Situational · Lapsed credentials

Strong answer

Takes them off the schedule per policy until renewed, books a class quickly, works with the Scheduler to cover visits, and fixes the alert timing.

Red flags

Lets them work while they renew.

An aide is bitten by a client's dog during a visit. Walk me through what you do.

Situational · Field injuries

Strong answer

Makes sure the aide gets care, documents the incident, files the workers' compensation claim, reviews it with the coordinator, and updates the care plan so pets are secured before visits.

Red flags

Tells the aide to be more careful.

Walk me through what has to happen before a new aide can be scheduled for a first visit.

Technical · Clearing new hires

Strong answer

Background and registry checks, exclusion checks, I-9, state-required health screenings, verified training and competency, orientation, and any certification your state requires.

Red flags

Schedules them while checks are pending.

Tell me about a retention effort you led for frontline workers. What changed?

Behavioral · Retention

Strong answer

Used exit or stay interview data, made specific changes such as scheduling or recognition, and measured turnover.

Red flags

Ran a pizza party and stopped.

Tell me about an investigation you ran into an employee accused of misconduct, such as falsifying visit times or harassing a coworker.

Behavioral · Investigations

Strong answer

Interviewed people promptly, pulled records such as EVV data, documented, protected against retaliation, reached a conclusion consistent with past cases, and reported when required.

Red flags

Decided before investigating, or kept no records.

How do you decide whether caregivers can be paid as independent contractors?

Technical · Worker classification

Strong answer

Explains that when the agency sets schedules, training and care plans, caregivers are generally employees, and names the legal risk of misclassification.

Red flags

Thinks it's the agency's choice.

Unsigned orders past policy have piled up, and one physician office is most of the problem. What do you do?

Situational · Unsigned orders

Strong answer

Meets with that office to find a better way, such as a portal or e-signature, sets a follow-up schedule, escalates through the Director of Nursing if needed, and tracks it weekly.

Red flags

Keeps faxing the same orders.

Payroll closes tomorrow, and [8] timesheets don't match visit records. What do you do?

Situational · Payroll accuracy

Strong answer

Compares each one with EVV and visit notes, contacts the staff, fixes what's confirmed before close, and documents the corrections.

Red flags

Pays the timesheets as submitted.

Walk me through what you do when a fax with patient records goes to the wrong number.

Technical · Privacy incidents

Strong answer

Contacts the recipient to destroy or return it, documents it, tells the privacy officer, and supports the breach risk assessment HIPAA requires.

Red flags

Ignores it because it was an accident.

Tell me about a time you covered for a missing team member and kept things running.

Behavioral · Covering gaps

Strong answer

Set priorities, did the critical work, told people about delays, and caught up after.

Red flags

Let important work wait until the person came back.

Tell me about an office process you improved, such as orders, payroll or filing.

Behavioral · Process improvement

Strong answer

Names the problem, the change, and a measurable result such as fewer late orders or payroll errors.

Red flags

Can't point to a process they changed.

How do you run the after-hours on-call schedule so no call goes unanswered?

Technical · On-call coverage

Strong answer

Publishes the rotation, names a backup, tests the answering service, and keeps a log that's reviewed each morning.

Red flags

Assumes the answering service handles it.

A caregiver's mileage log shows the same trip twice in one week. What do you do?

Situational · Mileage review

Strong answer

Checks it against the schedule and visit records, asks the caregiver politely, corrects it, and tells the manager if there's a pattern.

Red flags

Pays it without checking, or accuses the caregiver of fraud.

A Medicaid deposit arrives with no matching remittance. How do you record it?

Situational · Unmatched deposits

Strong answer

Looks for the electronic remittance or portal detail with billing, holds the money in an unapplied account until matched, and doesn't guess at accounts.

Red flags

Applies it to whatever accounts look close.

Walk me through a bank reconciliation that's off by a small amount.

Technical · Bank reconciliation

Strong answer

Checks outstanding checks, deposits in transit, bank fees and transposed numbers, finds the cause, and never plugs the difference.

Red flags

Plugs it because it's small.

Tell me about a time you caught a small error before it reached a financial report.

Behavioral · Accuracy

Strong answer

A specific check habit that caught it, the fix, and a change to prevent repeats.

Red flags

Can't describe any regular check on their own work.

Tell me about a time an employee was upset about a late or wrong reimbursement.

Behavioral · Staff questions

Strong answer

Listened, checked the record, fixed or explained it quickly, and followed up.

Red flags

Sent them to someone else.

How do you set up the payroll accrual when a pay period crosses month-end?

Technical · Month-end accruals

Strong answer

Calculates wages and payroll taxes earned in the month but not yet paid, records the accrual, and reverses it the next month.

Red flags

Records payroll only when paid.

Payroll is Friday, and a large batch of visits can't bill because of unsigned orders and EVV gaps. What do you do?

Situational · Clearing billing holds

Strong answer

Sorts holds by payer, dollar value and deadline, sends unsigned orders to the Office Manager, fixes EVV gaps with the Scheduler, escalates what won't clear, and tells the CFO what's at risk.

Red flags

Waits for others to fix the holds, or bills visits without what's needed.

Walk me through what happens when a Medicare Notice of Admission is filed late, and how you prevent it.

Technical · Notices of Admission

Strong answer

Medicare cuts the payment for each day from the start of care until the notice is filed, unless an exception is approved. Prevents it with a daily check of new admissions against filed notices.

Red flags

Doesn't know there's a penalty or a deadline.

You find a Medicare Advantage patient's authorized visits ran out two weeks ago, but visits kept happening. What do you do?

Situational · Authorizations

Strong answer

Requests a retro authorization or appeals if the plan allows, tells Intake and the Scheduler, fixes the tracking, and doesn't shift the cost to the patient improperly.

Red flags

Bills the patient or writes it off without trying.

Walk me through responding to an additional documentation request from Medicare.

Technical · Documentation requests

Strong answer

Notes the deadline, pulls the face-to-face encounter, signed plan of care and orders, OASIS and visit notes that show homebound status and skilled need, reviews it for gaps, sends it, and tracks the result.

Red flags

Sends whatever is in the chart without reviewing it.

Tell me about a denial pattern you found and fixed.

Behavioral · Fixing denial patterns

Strong answer

Names the payer and reason, found the source, worked with the right team, and denials dropped.

Red flags

Kept appealing one by one.

Tell me about a time you needed something from coworkers who were slow to respond.

Behavioral · Getting answers from coworkers

Strong answer

Made the request clear and specific, explained what was at stake, followed up, and escalated politely when needed.

Red flags

Waited, or complained without following up.

A family calls upset that the caregiver was on their phone most of the shift. How do you handle it?

Situational · Family concerns

Strong answer

Listens, checks visit records and notes, talks with the caregiver, coaches or reassigns, updates the family, and follows up.

Red flags

Defends the caregiver, or removes them without hearing their side.

During a check-in, you see a client has a new open sore on their heel. What do you do?

Situational · Spotting skilled needs

Strong answer

Doesn't treat it, tells the family and suggests they contact the physician or our home health team, documents it, updates the care plan, and tells the caregivers what to watch for.

Red flags

Puts a bandage on it and moves on.

Walk me through an in-home assessment for a new client.

Technical · In-home assessment

Strong answer

Daily tasks the client needs help with, routines and preferences, home safety, emergency contacts, who makes decisions, the payer and authorized hours, then a care plan with tasks and hours and a caregiver match.

Red flags

Collects hours and an address and leaves the rest to the caregiver.

Tell me about a hard conversation you had with a family about declining health or the cost of care.

Behavioral · Hard conversations

Strong answer

Prepared, used plain and kind words, gave the family real options and costs, and followed up afterward.

Red flags

Avoided the topic or buried the family in information.

Tell me about a time you fixed a poor match between a caregiver and a client.

Behavioral · Matching people

Strong answer

Noticed early, asked both sides, made a better match with the Scheduler, and checked in after.

Red flags

Waited until the client quit.

A new client starts tomorrow, and the caregiver you matched just quit. What do you do?

Situational · First-shift readiness

Strong answer

Works with the Scheduler to find a good replacement, briefs them on the care plan, tells the family honestly, and introduces the new caregiver if possible.

Red flags

Sends whoever is free without telling the family.

A discharge planner hints that referrals would come faster if you brought lunch for the whole department every week. What do you do?

Situational · Referral source rules

Strong answer

Stays within the gift policy based on anti-kickback law, explains kindly what's allowed, and keeps the relationship focused on service and fast starts.

Red flags

Starts bringing weekly lunches to win referrals.

A hospital sent us a referral we couldn't staff, and the case manager is annoyed. What do you do?

Situational · Repairing trust

Strong answer

Calls back, explains honestly, shares what we can staff and where, and fixes the response process with Intake.

Red flags

Avoids the case manager or blames the office.

A hospital nurse says you can go talk to patients being discharged about choosing us. What do you do?

Situational · Patient choice

Strong answer

Doesn't approach patients unless the patient has asked to meet us, respects the patient's right to choose an agency and their privacy, and works through the case manager.

Red flags

Visits patient rooms to sign them up.

Tell me about a referral relationship you built from nothing.

Behavioral · Building relationships

Strong answer

How they got in the door, the value they offered, steady follow-up, and referrals that resulted.

Red flags

Credits gifts or meals for the referrals.

Tell me about a month you missed your referral goal. What did you change?

Behavioral · Learning from a miss

Strong answer

Looked at the data, found the gap, changed targets or approach, and improved.

Red flags

Blames the market or the office.

Walk me through how you plan a week of visits.

Technical · Planning a territory

Strong answer

Uses CRM data to rank accounts by potential, plans routes, sets a purpose for each visit, and schedules follow-ups.

Red flags

Drives to familiar places with no plan.

Eligibility shows the patient is already in an open home health period with another agency. What do you do?

Situational · Eligibility checks

Strong answer

Contacts the patient, referral source and other agency to confirm discharge or transfer, coordinates the transfer before starting care, and documents.

Red flags

Starts care without sorting out the other agency's open period.

Walk me through what a Medicare home health referral needs before start of care.

Technical · Referral requirements

Strong answer

Orders from a physician or allowed practitioner, face-to-face encounter documentation tied to the reason for home health, support for homebound status, history and medication list, and verified insurance.

Red flags

Only needs a name and insurance.

At [4] p.m. Friday, a hospital calls with a discharge today that needs wound care tomorrow. What do you do?

Situational · Late referrals

Strong answer

Gets the documents, verifies insurance, confirms with the Director of Nursing that we can staff it, and if not, tells the hospital right away.

Red flags

Accepts it without checking staffing.

Tell me about a time you explained confusing insurance to a worried family.

Behavioral · Explaining insurance

Strong answer

Used plain words, compared the options simply, checked the family understood, and followed up in writing.

Red flags

Used jargon, or rushed the family off the phone.

Tell me about a time you got missing paperwork from busy offices.

Behavioral · Chasing paperwork

Strong answer

Made it easy to respond, followed up on a schedule, and escalated politely.

Red flags

Sent one fax and waited.

A family member asks whether the patient's long-term care insurance will pay from the first day of care. How do you answer?

Situational · Long-term care insurance

Strong answer

Explains the elimination period, claim forms and care notes, and offers to check the policy details rather than guessing.

Red flags

Promises it will pay right away.

Walk me through reviewing an OASIS before submission.

Technical · OASIS review

Strong answer

Checks consistency across items and with the visit narrative and therapy notes, checks diagnosis support, follows CMS guidance, sends specific questions to the clinician, and doesn't change answers without the clinician's agreement.

Red flags

Changes answers to raise the payment.

Your audits show one branch's OASIS answers rate patients as more impaired than the therapy notes describe. What do you do?

Situational · Coding and OASIS integrity

Strong answer

Pulls a larger sample, compares OASIS answers with notes and observations, meets the clinicians and branch leader, retrains, corrects records under policy, and tells the compliance officer if it looks deliberate.

Red flags

Ignores it because the higher scores help payment.

HHCAHPS scores on how well staff explained medications have dropped. What do you do?

Situational · Patient experience

Strong answer

Reads the comments, looks by branch and clinician, adds a teaching tool and teach-back, and monitors the score.

Red flags

Blames the survey or the patients.

Tell me about an improvement project you led. How did you measure whether it worked?

Behavioral · Improvement projects

Strong answer

A baseline, a clear change, data tracked over time, and a result that lasted.

Red flags

Ran a project with no measurement.

Tell me about a time a clinician pushed back on your audit finding.

Behavioral · Handling pushback

Strong answer

Listened, showed the guidance, stayed respectful, and reached agreement or escalated.

Red flags

Gave in or got into a power struggle.

How does the Home Health Value-Based Purchasing Model affect us, and what do you watch?

Technical · Value-based purchasing

Strong answer

Medicare adjusts our payments up or down based on quality measures compared with peers, including OASIS-based, claims-based and HHCAHPS measures, so it tracks those monthly and acts early.

Red flags

Doesn't know it affects payment.

An experienced aide applies on a Sunday, and competitors usually call within hours. What do you do?

Situational · Speed to contact

Strong answer

Reaches out quickly by text and phone per policy, books an interview, and keeps in touch until orientation.

Red flags

Calls back later in the week.

The Scheduler needs aides in a rural county where you've had no applicants. What do you do?

Situational · Rural sourcing

Strong answer

Uses local workforce centers, aide and CNA training programs, community boards and employee referrals, and suggests a pay or mileage differential if needed.

Red flags

Posts the same ad again.

Walk me through confirming an aide's certification before an offer.

Technical · Credential verification

Strong answer

Checks the state registry, confirms active status and no findings, matches the name, saves the record, and checks training records where the role requires them.

Red flags

Accepts a photo of a card.

Tell me about a time you got more new hires to actually show up for orientation.

Behavioral · Orientation show rate

Strong answer

Reminders, removing barriers like transportation or paperwork, and a measured improvement.

Red flags

Accepted no-shows as normal.

Tell me about a time you told a hiring manager no candidate met the bar.

Behavioral · Holding the bar

Strong answer

Explained with specifics why candidates fell short and proposed a new sourcing plan.

Red flags

Sent weak candidates anyway to fill the seat.

During a call, an applicant mentions they have young kids. How do you keep the conversation on track?

Situational · Lawful conversations

Strong answer

Doesn't follow up on it, and asks every applicant the same question about the job's shifts and travel.

Red flags

Asks follow-up questions about the applicant's family.

At [6] a.m., three caregivers call off, including one for a client who can't be left alone. What do you do?

Situational · Covering call-offs

Strong answer

Covers the highest-risk client first, calls regular and on-call staff, tells clients and families about changes, logs any missed visits and tells the case manager.

Red flags

Works in order of the call-offs.

A nurse can't make a wound care visit ordered for today. What do you do?

Situational · Missed skilled visits

Strong answer

Finds another nurse, and if no one can go, tells the case manager the same day so the physician is notified, reschedules and documents.

Red flags

Moves it to tomorrow without telling anyone.

Walk me through fixing an EVV exception where a caregiver forgot to clock out.

Technical · EVV exceptions

Strong answer

Confirms the time with the caregiver and client, edits it with the reason code your state requires, and coaches the caregiver.

Red flags

Enters a guessed time.

Tell me about a time you had to tell someone their plans were changing at the last minute.

Behavioral · Delivering changes

Strong answer

Told them quickly and honestly, gave options, and followed up.

Red flags

Let them find out on their own.

Tell me about a schedule or route you built that saved drive time or overtime.

Behavioral · Efficient schedules

Strong answer

Names the change and the result, such as fewer miles or overtime hours, without missing visits.

Red flags

Can't point to a change they made.

How do you build a route that keeps drive time down without missing the ordered visit frequency?

Technical · Route planning

Strong answer

Groups visits by area, protects ordered frequencies and time windows, plans around start-of-care visits, and watches overtime.

Red flags

Builds routes by staff preference only.

You arrive for a bath visit, and the patient is more confused than usual and their ankles are much more swollen than last week. What do you do?

Situational · Reporting changes

Strong answer

Doesn't just start the bath, takes vital signs if the care plan calls for it, calls the RN Case Manager right away, calls 911 for trouble breathing or chest pain, and documents.

Red flags

Does the bath and mentions it at the end of the week.

You find the patient on the floor when you arrive. They say they're fine and ask you to help them up. What do you do?

Situational · Falls

Strong answer

Doesn't lift alone, checks for injury, keeps them comfortable, calls 911 if hurt or unable to get up safely, calls the nurse for direction, and documents.

Red flags

Pulls the patient up alone without checking for injury.

The patient asks you to take their pills out of the bottles and hand them over because their hands shake. What do you do?

Situational · Medication limits

Strong answer

Does only what the care plan and state rules allow, explains kindly if it's not allowed, and calls the RN to arrange help.

Red flags

Hands out the pills because the patient asked.

When you arrive, a relative in the home is shouting and seems intoxicated. What do you do?

Situational · Personal safety

Strong answer

Doesn't go in or leaves calmly, moves to a safe place, calls the office as the safety policy says, and calls 911 if anyone is in danger.

Red flags

Goes in anyway to finish the visit.

Walk me through helping a patient move from the bed to a wheelchair with a gait belt.

Technical · Safe transfers

Strong answer

Explains the move, locks the brakes, angles the chair on the patient's stronger side, fastens the belt snugly, bends at the knees, counts together, pivots, and stops and calls the nurse if the patient can't help.

Red flags

Lifts by the arms or skips the brakes.

Tell me about a time at work, school or volunteering when you had to finish important tasks on your own, with no one checking.

Behavioral · Working independently

Strong answer

Names the tasks, a way they kept track such as a checklist or notes, and how they checked the work was done right before leaving.

Red flags

Needs someone checking in to stay on task.

Tell me about a time you helped someone who was embarrassed to accept help.

Behavioral · Respect and dignity

Strong answer

Was patient, explained each step, let the person do what they could, and kept them covered.

Red flags

Rushed, or took over tasks the person could do.

At a visit, a patient who takes insulin is shaky and sweaty, and their fingerstick blood sugar is below the low limit in the orders. What do you do?

Situational · Low blood sugar

Strong answer

Treats it right away with fast-acting sugar per the orders or agency protocol if the patient can swallow, rechecks on schedule, calls 911 if they can't swallow or don't improve, then calls the RN Case Manager and documents.

Red flags

Gives juice and leaves without rechecking, or doesn't report it.

Walk me through how you keep your nursing bag and supplies clean in a patient's home.

Technical · Infection control in the home

Strong answer

Places the bag on a clean barrier away from pets and clutter, cleans hands before opening it, takes out only what's needed, and cleans reusable equipment before it goes back in.

Red flags

Sets the bag on the floor and reaches in with used gloves.

The RN Case Manager is behind and asks you to do a patient's recertification assessment and OASIS this week because you know the patient well. What do you do?

Situational · Scope of practice

Strong answer

Explains that Medicare rules leave the comprehensive assessment and OASIS to an RN or therapist, offers to cover the skilled visit and share what they've observed, and tells the RN or Director of Nursing if the deadline is at risk.

Red flags

Completes the OASIS because they know the patient.

How do you document a wound so the next nurse can tell whether it's improving?

Technical · Wound documentation

Strong answer

Location, length, width and depth measured the same way each time, tissue type, drainage, odor, edges, surrounding skin, pain, treatment given and the patient's response.

Red flags

Writes 'wound care done' with no measurements or description.

Tell me about a time you worked alone and had to make a careful judgment call. How did you decide?

Behavioral · Judgment while alone

Strong answer

A specific situation, who they called, the policy they followed, and the outcome.

Red flags

Acted outside scope or didn't call anyone.

Tell me about a time you taught a patient or family member a skill. How did you check they got it?

Behavioral · Patient teaching

Strong answer

Demonstrated, had them show it back, corrected, and checked again at the next visit.

Red flags

Explained once and left without checking understanding.

During a visit, the patient looks underweight, there's little food in the house, and the relative who manages their money avoids your questions. What do you do?

Situational · Suspected exploitation

Strong answer

Talks with the patient privately, documents what they see, tells the RN and physician, reports to adult protective services as the state requires, and connects the patient to food help.

Red flags

Waits for more proof before reporting.

A patient tells you everyone would be better off without them. What do you do?

Situational · Suicide risk

Strong answer

Asks directly about thoughts of suicide, a plan and means, stays with the patient, follows the agency's crisis protocol, uses the crisis line or emergency services if needed, and tells the physician and RN.

Red flags

Changes the subject or reassures them and leaves.

Walk me through helping a family figure out how to pay for long-term nursing home care.

Technical · Long-term care funding

Strong answer

Explains that Medicare doesn't pay for long-term custodial care, covers Medicaid eligibility and the application, waiver options for care at home, private pay and long-term care insurance, and refers to an elder law attorney for asset questions.

Red flags

Says Medicare will cover it.

Tell me about a family conversation about end-of-life choices that you helped guide.

Behavioral · End-of-life conversations

Strong answer

Prepared, asked about values, explained options plainly, kept the patient's wishes central, and documented.

Red flags

Pushed a choice or avoided the topic.

Tell me about a time you found help for a patient when the usual programs were full or closed.

Behavioral · Resourcefulness

Strong answer

Names the alternative found, such as a local food pantry or a utility hardship fund, how they followed through, and the outcome.

Red flags

Gave a list of phone numbers and stopped.

How do you help a patient complete an advance directive and make sure the team knows their wishes?

Technical · Advance directives

Strong answer

Explains the options in plain words, uses the state's forms, confirms who will decide for the patient, shares the documents with the care team and physician, and records them in the chart.

Red flags

Hands over a form with no explanation.

A patient insists on stepping over the tub wall to shower, even though they nearly fell last week. What do you do?

Situational · Bathroom safety

Strong answer

Assesses the transfer, trials a tub transfer bench, a handheld shower and grab bars, practices in the real bathroom, trains the caregiver, respects the patient's choice, and documents the risk.

Red flags

Forbids it, or doesn't address it.

The family caregiver of a patient with dementia is exhausted and does everything for the patient. How do you help?

Situational · Caregiver coaching

Strong answer

Simplifies tasks with cues and routines, teaches the caregiver to let the patient do what they can, and connects them with the social worker for respite.

Red flags

Adds more tasks for the caregiver.

Walk me through an OT evaluation at home for a patient just discharged after a hip replacement.

Technical · Home evaluation

Strong answer

Follows the surgeon's precautions, observes dressing, toileting and bathing, checks adaptive equipment like a reacher and sock aid, assesses the home setup and thinking skills, and sets measurable goals.

Red flags

Hands out equipment without observing tasks.

Tell me about a patient whose goals you set together. How did you find out what mattered to them?

Behavioral · Patient-centered goals

Strong answer

Asked about their daily life and priorities, built goals around them, and saw better effort and results.

Red flags

Used standard goals for everyone.

Tell me about a time you worked with a physical therapist or nurse to fix a problem in a patient's plan.

Behavioral · Team coordination

Strong answer

Called or met the colleague, shared what they saw, agreed on one plan such as the same transfer method, and checked at the next visit that everyone followed it.

Red flags

Worked in parallel without talking to the colleague.

How do you teach energy-saving methods to a patient with COPD?

Technical · Energy conservation

Strong answer

Plans and paces tasks, sits for tasks when possible, coordinates breathing with effort, keeps items within reach, schedules rest, and uses teach-back.

Red flags

Tells them to rest more.

You're due at a client's home at [8] a.m., and your car won't start. What do you do?

Situational · Reliability

Strong answer

Calls the office right away, not just the client, works out a ride or a replacement, and gives an honest arrival time.

Red flags

Doesn't call until after the visit time.

A client offers you cash for being so helpful and asks you not to tell anyone. What do you do?

Situational · Boundaries

Strong answer

Thanks them, politely declines, explains the agency's rule, and tells the coordinator.

Red flags

Accepts it and keeps quiet.

A client with diabetes asks you to trim their toenails. What do you do?

Situational · Staying within the care plan

Strong answer

Explains kindly that it's outside what caregivers do under the care plan and agency policy, and tells the coordinator so a nurse or podiatrist can handle it.

Red flags

Trims them to be helpful.

Over two visits, your client has stopped eating most meals and seems withdrawn. What do you do?

Situational · Noticing changes

Strong answer

Tells the coordinator the same day, writes it in the visit notes, and keeps offering food and company.

Red flags

Assumes it's a bad week and says nothing.

Walk me through helping a client take a shower safely.

Technical · Bathing safety

Strong answer

Sets out a nonslip mat and shower chair, checks water temperature, gets everything within reach, keeps the client covered and close, uses grab bars, dries well, and checks skin for anything to report.

Red flags

Leaves the client alone in the shower.

Tell me about a time at work, school or volunteering when someone depended on you to show up. How did you make sure you did?

Behavioral · Dependability

Strong answer

A specific example and the habits they used, like backup plans and leaving early.

Red flags

Describes missed commitments with no plan to prevent them.

Tell me about a time you kept someone company who was lonely or having a hard day.

Behavioral · Companionship

Strong answer

Listened, found shared interests or old routines, and was patient.

Red flags

Treated company as a chore, or stayed on their phone.

On your first visit, the patient's walker won't fit through the bathroom door, and throw rugs are everywhere. What do you do?

Situational · Home fall hazards

Strong answer

Asks to remove or secure the rugs, rearranges furniture with the patient's consent, plans another device or a bedside commode for the bathroom, and documents.

Red flags

Notes it and leaves the setup unchanged.

Walk me through how you assess fall risk in the home.

Technical · Fall risk assessment

Strong answer

Fall history, standard measures such as the Timed Up and Go, medications to flag for the RN, vision, footwear, lighting, night routines and home hazards, then a plan.

Red flags

Uses only a quick look around.

Your PTA reports a patient isn't progressing and keeps skipping the home exercises. What do you do?

Situational · Lack of progress

Strong answer

Does a joint visit or reassessment, finds the barrier (pain, fear, thinking or mood), adjusts the plan and goals, involves the team, and discharges if skilled care is no longer needed.

Red flags

Keeps the same plan and goals.

Tell me about a time you noticed a medical problem during a therapy visit.

Behavioral · Spotting medical problems

Strong answer

Specific signs, such as a red, swollen calf or new shortness of breath, and a fast call to the RN or physician.

Red flags

Continued the session without telling anyone.

Tell me about a time you had to tell a patient or family that therapy should end.

Behavioral · Ending therapy

Strong answer

Explained progress and reasons plainly, gave a home program, and arranged next steps.

Red flags

Kept visits going to avoid the conversation.

How do you keep therapy reassessments on time, and what goes into one?

Technical · Reassessments

Strong answer

Tracks the dates Medicare and policy require, repeats functional measures, compares progress with goals, updates the plan and orders, and does it personally, not the PTA.

Red flags

Lets the PTA do it.

Before exercise, the patient's heart rate is above the ordered parameter, but they say they feel fine. What do you do?

Situational · Vital sign parameters

Strong answer

Rests and rechecks, doesn't exercise if it stays out of range, calls the supervising PT or RN, and documents.

Red flags

Exercises anyway because the patient feels fine.

The family asks you to add new exercises and change the goals because they want faster progress. What do you do?

Situational · Scope of practice

Strong answer

Explains that goals and plan changes come from the PT, calls the supervising PT, and progresses only within the current plan.

Red flags

Rewrites the goals on their own.

Walk me through teaching a patient to go up and down stairs with a cane.

Technical · Stair training

Strong answer

Up with the stronger leg first, down with the cane and weaker leg first, uses the handrail, and guards from below on the weaker side: behind going up, in front going down.

Red flags

Can't describe the sequence or guarding.

Tell me about a time you told a supervising therapist that a patient wasn't progressing.

Behavioral · Reporting to the PT

Strong answer

Reported promptly with specifics, such as measures that had stalled, and asked the PT to reassess.

Red flags

Kept treating without telling the PT.

Tell me about a patient you motivated who didn't want to exercise.

Behavioral · Motivating patients

Strong answer

Tied exercise to the patient's own goals, made it doable, and celebrated small wins.

Red flags

Lectured the patient or gave up.

Halfway through gait training, the patient's knees buckle. What do you do?

Situational · Fall during treatment

Strong answer

Uses the gait belt to lower them to the floor safely, checks for injury, calls for help or 911 if needed, notifies the PT and RN, and documents.

Red flags

Grabs the patient's arm to hold them up.

Walk me through the drug regimen review at a start of care visit.

Technical · Medication review

Strong answer

Gathers every medication in the home, including over-the-counter drugs and supplements, compares them with the discharge list, checks for duplicates, interactions, side effects and missed doses, reports problems to the physician, teaches, and documents.

Red flags

Copies the hospital discharge list.

A heart failure patient's weight is up [3] pounds since yesterday, and their ankles are more swollen. What do you do?

Situational · Heart failure warning signs

Strong answer

Assesses breathing, lung sounds and vital signs, reviews medications and diet, calls the physician with SBAR for orders, teaches, plans follow-up, and sends to the ER if in distress.

Red flags

Tells the patient to cut back on salt and checks next week.

A patient who lives alone keeps refusing to use the walker and has fallen twice. What do you do?

Situational · Patient refusal

Strong answer

Finds out why, respects the patient's choice, brings in PT and OT, offers safety options like an alert device, involves family if the patient agrees, and documents.

Red flags

Threatens discharge or ignores the falls.

How do you make sure your OASIS answers reflect what the patient actually does, not just what they say?

Technical · OASIS accuracy

Strong answer

Watches the patient do the tasks, follows CMS OASIS guidance, combines observation with interview, and makes sure notes support each answer, never scoring for payment.

Red flags

Scores from the patient's report alone.

Tell me about a time you supervised an aide whose care wasn't following the plan.

Behavioral · Aide supervision

Strong answer

Observed a visit, gave specific feedback, retrained, documented, and checked again at the next supervisory visit.

Red flags

Avoided addressing it.

Tell me about a patient you helped stay out of the hospital. What did you notice, and what did you do?

Behavioral · Preventing hospitalizations

Strong answer

Names the early signs they caught, such as weight gain or new confusion, the quick call to the physician, the teaching, and the follow-up.

Red flags

Can't recall acting on an early warning sign.

A stroke patient on thin liquids coughs after every sip, and the family says they had a fever last week. What do you do?

Situational · Aspiration signs

Strong answer

Recognizes possible aspiration and pneumonia, tells the RN and physician the same day, recommends an instrumental study, gives interim strategies based on the evaluation, and updates the team.

Red flags

Thickens the drinks without telling the physician.

When would you recommend an instrumental swallow study instead of relying on your bedside exam?

Technical · Instrumental studies

Strong answer

When silent aspiration can't be ruled out, findings don't fit, there's repeat pneumonia, or the throat phase is unclear. Knows the tradeoffs of a modified barium swallow and FEES, and that it needs an order.

Red flags

Relies on the bedside exam for everything.

The family keeps giving thin liquids because the patient hates thickened ones. What do you do?

Situational · Diet adherence

Strong answer

Learns the patient's wishes, explains the risks, offers options, involves the physician, documents an informed choice, and respects quality of life.

Red flags

Lectures the family or ignores it.

Tell me about a patient with aphasia you helped communicate their needs. What tools did you use?

Behavioral · Communication tools

Strong answer

Names tools such as picture boards, yes-no cards or written choices, how they matched them to the patient's abilities, and how the family used them between visits.

Red flags

Can't name a tool or strategy they used.

Tell me about a time you trained caregivers who were skeptical.

Behavioral · Caregiver training

Strong answer

Showed why it mattered, demonstrated, had them practice, and followed up.

Red flags

Gave a handout and left.

How do you teach a family caregiver to mix drinks to the right thickness?

Technical · Liquid thickness

Strong answer

Uses the product directions and a simple check such as the IDDSI flow test, demonstrates, has the caregiver do it back, and leaves a written guide.

Red flags

Tells the family to 'make it thick.'