Meet the Team: Crystal Flynt, RN, BSN
For four decades, Crystal Flynt has focused on home health and hospice. She joined ACHC in 2011 as a full-time surveyor and traveled to almost every state for 13 years. Now Crystal shares her hospice accreditation expertise as a clinical review specialist for our community-based programs.
Crystal sat down with us to discuss frequent survey deficiencies and what it takes to work in hospice care.
Posted: December 15, 2025
INTERVIEWER: Crystal, how did you come to ACHC?
CRYSTAL: Well, I started out as a visiting nurse in home health 40 years ago. I transitioned into management, then worked for 25 years in home health and hospice administration.
In the early 2000s, I was working with an organization that was accredited by ACHC. I was so pleased with the standards, the process, and the overall survey experience. ACHC’s philosophy made a huge impression on me. So, when I was offered a role, it was an easy decision.
INTERVIEWER: As a clinical review specialist, what’s a typical day for you?
CRYSTAL: No two days are the same with questions from the agencies we serve and from the surveyors while onsite… Every day has at least one surprise. I love my job; it keeps me on my toes!
I spend most of my day problem-solving and providing education. I answer a wide range of questions, because that’s just the nature of providing care in someone’s home.
INTERVIEWER: How so?
CRYSTAL: When you’re providing care in the home, nothing’s controlled. No two patients are the same. Every family is different. Everybody’s caregiving ability is different. Some people live upstairs, some live downstairs. Some have mobility issues, cognitive issues… We could go over the various and sundry scenarios for the rest of the day and into tomorrow.
Generally speaking, I help people understand our standards, survey processes, and CoPs. But some of the questions I receive can be very situation-specific.
INTERVIEWER: Are some questions more common than others?
CRYSTAL: One of the most common questions I hear is, “How do we prepare for survey? How do we reach compliance?” Agencies are always interested in resources, tools, education… And I love being able to say that ACHC has education for everyone. If you like to learn by watching videos, we have webinars and workshops. If you prefer in-person learning, we have ACHCU Academy. And if you’re ready to get started, we have customizable checklists, audit templates, and mock survey interview questions. You can download those forms and start using them right away.
When agencies use our resources, they start digging in and really thinking through compliance. And this almost always leads to more specific questions, especially about ACHC Standards.
Hospice care is complex. Keeping patients comfortable requires constant change. It doesn’t come with an agenda, and it’s not a cookie cutter, one-size-fits-all process.
INTERVIEWER: Do any particular standards stand out to you?
CRYSTAL: I’ve noticed that agencies tend to come up deficient for ACHC Standard HSP5-4A.
The standard deals with the individualized plan of care, and it has several components. Agencies are usually in compliance with the majority of the standard, but they’re missing part of it. Specifically, L tags 545 and 549.
L-545 requires the plan of care to reflect patient/family goals and interventions based on the problems identified in the initial, comprehensive, and updated comprehensive assessments.
The plan of care and assessments are partners, in a sense. What happens in one affects the other, ongoing, as problems appear and resolve.
For example, a patient is complaining about nausea. The nausea is first identified as a problem in the assessment. Then the plan of care addresses the nausea in terms of goals and interventions. Then after a few days, the updated assessment notes that the nausea symptoms have improved. So, the care plan is adjusted. Nausea comes back… okay, let’s reassess. It’s a moving target.
Then there’s L-549. This tag requires the plan of care to be specific for all medications and treatments. I think “specific” really says it all.
Medication orders include dose, frequency, and route. If a medication is ordered “as needed,” that isn’t enough information on its own. When and what is “as needed?” The plan of care explains the specific indication/symptom that prompts the need for that medication. Or let’s say a patient has three medications ordered for pain. What are the specific pain levels that define when each medication should be chosen for administration?
Hospice care is complex. Keeping patients comfortable requires constant change. It doesn’t come with an agenda, and it’s not a cookie cutter, one-size-fits-all process. There’s a high level of documentation and communication between every member of the care team.
INTERVIEWER: I’m sure our readers would agree that it takes a special kind of person to work in hospice care. Help me define what those “special” traits are.
CRYSTAL: Well, I do think providing hospice care does have to be a “calling,” because it might be too hard otherwise.
On a more tangible level, if you work in hospice you absolutely must enjoy working with a group. The IDG (interdisciplinary group) is foundational. There’s a high level of care planning. It’s very cohesive. The meetings aren’t fragmented. You’ve got a medical director, nurse, counselor, social worker, chaplain… The whole team is there. And patients participate in their care, plus the families. The goal is to ensure the patients are comfortable, but also to make sure all domains of their life are being addressed… The physical, psychosocial, spiritual, you know, the whole pie.
I’m really proud of hospice care and how the care team works as a unit. It’s so beneficial for patients and families.
INTERVIEWER: Let’s talk about that “calling.” I know that may be hard to pin down.
CRYSTAL: It’s different for everyone. But in my opinion, very few people start out saying, “I want to be a hospice nurse.” I think a lot of providers are introduced to hospice through personal experiences. And it means so much to them, they decide to pay it forward.
When I was a surveyor, providers would often say to me, “We can teach hospice. We cannot teach the caring heart.” So, while all healthcare providers need to have empathy and compassion, those who work in hospice really understand that this is going to be the family’s and the patient’s last memory. They know that you never get a second chance to make it right. They make very deep, personal commitments.
INTERVIEWER: Crystal, thanks so much for chatting with me today. Any parting words?
CRYSTAL: I’d love to remind hospice agencies that there’s always room to improve, and that’s not a bad thing. You’re delivering quality patient care, handling staffing issues, conducting daily operations, and adhering to complex regulations—which are subject to change. It is impossible to know everything without ongoing support and assistance. At ACHC, we truly want you to succeed. We’re in it together!
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Read more articles about Hospice Accreditation here.