War-game a caregiver backup rule by proving each coverage lane has a named owner, a measured age-out, and a reverse path before draft clocks start governing every home care visit plan.
Caregiver backup rules fail when "covered" means a status without a decision artifact, when teams dual-count a draft roster as both aspirational and live, and when high-acuity visit families still pin to one thin coordinator because the lane inventory is incomplete. The review needs one written inventory of backup lanes, one owner who can deny a risky shortcut, and a documented consequence when a failed cover ages past the deadline.
Freeze one backup family first
State which visit families the rule covers, the effective date, which coverage lanes change, how versions are stored, and what happens to patients already in flight. Name the agencies that feel it first and the care promises that depend on coherent backup handling. If the memo mixes a caregiver backup rule with a visit frequency cut and a home health hand-off, split them.
Write the decision you will make if the war game finds nothing new. Also write the reverse criteria: the missed lane, agency gap, or patient deadline that would force a caregiver backup rollback within a stated window.
| Lane | Owner | Age-out | Reverse path |
|---|---|---|---|
| Primary caregiver absence | Named coordinator | Measured hours | Documented reassign |
| Secondary agency fill | Home care ops | Measured hours | Documented escalate |
| High-acuity dual cover | Care management | Measured hours | Documented restore |
Fill the table from stored exports, not from memory. Empty cells are blockers, not notes for later.
Failures to surface before go-live
- A high-acuity visit class stays soft while the aggregate backup dashboard stays green.
- Two teams claim the same lane ownership and neither can force a freeze at week end.
- A restore has already left a case without a trusted coverage state.
- The primary backup export lags beyond the planned observation window.
- An operator skips a coverage gate because a payer cutoff is near.
For each failure, require detection time, agency impact, containment, and the authority to force a caregiver backup rule rollback. Commands and export links belong in the runbook.
Hostile chairs on the coverage
Feed Pingpong the rule memo, the lane exhibits, and seating briefs for home care ops, care management, nursing, and utilization review. First pass steelmans the rule. Later passes attack from those seats. Final pass turns surviving objections into phased lane rules, mitigations, or a changed recommendation. Agreement across passes is not proof. Keep the objections that still have evidence gaps.
Pair with the home care ops lead seat, an after-hours call spike stress test, a visit frequency cut, and the care management lead seat. More operating decisions live in the war-game decisions hub.
Ship the rule only when approved and blocked coverage labels can be reproduced from stored backup exports without a verbal override.