Communication breakdowns between the office employees to nurses in the field, to caregivers of patients are too frequently happening. Nurse Case Managers are overworked and uncompensated. No communication to nurses happens when office staff changes occur. Office employees are shown public favoritism by upper management. Field nurse appreciation is severely lacking. Nurses do not receive annual merit raises. Mileage reimbursement (if you are fortunate to receive it) is loosely based on base pay, favoritism and ability to barter. High turnover of staff in the North Texas office, leaving caregivers questioning stability of company. Authoritative, unreasonable "upper" management in the office. Zero chance at internal promotions if you're not "in good" with office manager. Expensive insurance options.