How to Choose a Home Health Agency

Start with two things you can look up before you talk to anyone: the CMS star rating for quality of patient care, and the patient survey results. Those two numbers tell you more about what it is actually like to be a patient there than any brochure. Then find out which services the agency offers, because not every agency provides every discipline, and if your parent needs physical therapy from an agency that does not have it, you are looking at a second agency or a switch mid-episode.

The choice belongs to the patient, not to the hospital. Discharge planners often hand over a short list of agencies they work with regularly, and there is nothing wrong with that list as a starting point, but it is not the limit of what you can pick. Any Medicare-certified agency serving the area is available to you. That single fact changes how you shop.

One more thing before the details: home health under Medicare requires a doctor's order and a determination that the patient is homebound. Without both, the benefit does not start, no matter how good the agency is. If you are early in this process, that is the gate everything else sits behind.

What the star rating actually measures, and what it leaves out

CMS publishes a quality-of-patient-care star rating for home health agencies. It is built from measures like how often patients improved in walking or moving around, how often they got better at bathing, and how often their breathing improved. The patient survey results are separate and come straight from patients themselves. Read them together. An agency can score well on clinical measures and poorly on the survey, which usually means the care is technically adequate but the experience of receiving it is not.

What the star rating does not tell you: whether the same nurse will show up each visit, how the agency handles a Saturday night problem, or whether the aide who bathes your mother speaks her language. Those are operational facts, and you get them by asking, not by reading a score. Think of the rating as a filter, not a verdict. It tells you who to call first and who to skip. It does not tell you who to hire.

If you are comparing this decision to a nursing home decision, some of the same logic applies. Our page on how we grade explains why we weight certain federal measures the way we do, and the reasoning carries over here: published data narrows the field, and human questions close it.

Check the service list before anything else

Agencies differ in which disciplines they staff. Skilled nursing, physical therapy, occupational therapy, speech-language pathology, medical social work, and home health aide services are each a separate line, and an agency may offer some and not others.

Here is a scenario that plays out constantly, and it is illustrative rather than a real case. Say a patient is discharged after a hip fracture. The doctor's order calls for skilled nursing to manage the wound and physical therapy to rebuild strength and gait. You call the agency with the best star rating in your zip code, and it turns out they have nursing but contract out therapy to a partner agency. Now two agencies are in the house, two sets of notes go to the doctor, and coordination is on you. That is not automatically a dealbreaker. It is a fact you want to know before the first visit, not three weeks in.

Ask for the full service list in writing. Then match it against the doctor's order line by line. If there is a gap, either find an agency that covers everything or plan deliberately for the handoff between two agencies and ask who owns the coordination.

Ownership type is published, and it is worth reading

CMS publishes whether an agency is for-profit, non-profit, or government-operated. Ownership type is not a quality score by itself, and you should not treat it as one. What it does tell you is something about incentives and about how decisions get made when money is tight. A for-profit agency answers to owners or investors. A non-profit answers to a board and a mission. Both can be excellent. Both can be poor. But if you have two agencies with similar ratings and you are trying to understand why one staffs more generously on weekends, ownership is part of the answer.

If ownership structure matters to you in this decision, you can see how we track it across the long-term care sector on our ownership tracker. The patterns there are worth understanding even though home health and nursing home ownership are separate systems.

The questions that separate a good agency from a bad one

Ratings get you a shortlist. These questions get you an answer. Ask them of every agency you are seriously considering, and write down what you are told so you can compare.

• How quickly can visits start after a hospital discharge? Some agencies can be in the home the next day. Others take several days to open a case. If your parent is coming home with a wound that needs checking, a gap of days matters.
• Who covers evenings and weekends? Ask specifically whether there is a nurse on call, whether that person is employed by the agency or an answering service, and what the after-hours nurse is authorized to do. A call center that takes a message is not the same as a nurse who can act.
• Will the same nurse or aide come each time? Consistency is not guaranteed anywhere, but some agencies assign a primary clinician and some rotate whoever is available. Ask how they handle it when your regular nurse is out.
• How are missed visits handled? A missed visit should be documented, explained, and made up if the order still calls for it. Ask what their process is and whether you will be told when a visit does not happen.
• How does the agency communicate with the doctor? Ask who contacts the physician, how often, and whether you will be told what was reported. You want to know before a problem, not after one.

None of these questions have a single correct answer. What you are listening for is whether the person answering actually knows, or whether they are giving you the sales version. An agency that cannot tell you who covers Saturday night has told you something.

Who pays, and why it shapes the choice

Medicare home health requires a doctor's order and a homebound determination. Homebound does not mean bedbound. It means leaving the home takes considerable effort or is medically inadvisable, and the rule has specific criteria your doctor applies. If your parent does not meet it, Medicare will not cover the visits, and no agency can change that.

Medicare covers skilled nursing and therapy on an intermittent basis, not long-term custodial care. If what your parent actually needs is help with bathing, dressing, and meals on an ongoing basis, that is a different benefit with different rules, and often a different payer. Getting this wrong is expensive. If you are not sure which category your parent falls into, our guide on who pays for care walks through the boundaries between skilled care and custodial care.

If Medicare does not apply, Medicaid rules vary by state, and so do the home and community-based waiver programs that fund care at home. There is no national answer here. You can see how your state handles it on our Medicaid by state page, and you can get a sense of what different settings cost on our costs page. For anything specific to your parent's finances, ask the state Medicaid office or a benefits counselor, not the agency.

When the hospital hands you a list

Discharge planners are busy, and they tend to work with agencies they know will pick up the phone and take the referral. That is not a conspiracy. It is a workflow. But the list you are handed is usually short, and it is not a complete inventory of certified agencies serving your area.

You are allowed to ask for more options. You are allowed to call an agency that is not on the list and ask whether they serve your parent's address and can start in time. Some will say no. Some will say yes, and that agency might be the better fit.

Two practical points. First, timing matters more than perfection. If discharge is tomorrow, an agency that can start tomorrow with good ratings beats a slightly better-rated agency that cannot start for a week. Second, you can switch later. If the first agency is not working out, you can ask the doctor to change the order to a different agency. It is a hassle, but it is not a lock-in.

The mistake people make most often

The most common mistake is choosing on the star rating alone and skipping the service and scheduling questions, because the rating feels like the whole answer. It is not, and the cost of that mistake is concrete.

Here is what it looks like, again illustrative. A family picks the highest-rated agency in their area. The rating is genuinely good. But the agency does not have a physical therapist on staff in that territory, so therapy gets contracted out. The contracted therapist comes twice in the first week and then the schedule slips because the therapist's caseload is full. The patient's mobility, which was the whole point of the therapy order, does not improve. Six weeks later the family is back at square one, the doctor is asking why there has been no progress, and the patient has lost ground that is harder to regain the second time.

None of that shows up in a star rating. All of it was discoverable with two phone calls before the first visit: does your agency provide physical therapy directly, and what is your current wait for a PT evaluation. Ask those before you sign anything.

What to ask, in order, when you call

You will be on the phone more than once. Here is a sequence that keeps you from getting lost in the conversation.

1. Confirm they are Medicare-certified and serve your parent's address.
2. Ask for the full list of services they provide directly, and which they contract out.
3. Ask how soon a nurse can be in the home after discharge, and whether a therapy evaluation can be scheduled in the same window.
4. Ask who covers nights, weekends, and holidays, and whether that person is a nurse.
5. Ask whether patients typically see the same clinician each visit, and what happens when that person is unavailable.
6. Ask how they notify the doctor of changes, and how they notify you.
7. Ask what happens when a visit is missed, and whether you will be told.
8. Ask for the patient survey results if you have not already found them.

Write the answers down next to each agency's name. Patterns will emerge fast. If two agencies give you vague answers to questions four and seven, that is a signal about how the agency runs, not a coincidence.

Reading the survey results like an adult child, not an analyst

The patient survey asks people who received care whether the agency communicated well, whether they were treated with respect, and whether they would recommend it. The scores are percentages, and a few points of difference between agencies is usually noise. Large gaps are not.

Look at the individual questions rather than the summary star. An agency that scores well overall but poorly on "how often the home health team discussed medicines, pain, and home safety with the patient" is telling you something specific about what visits are like. That question matters more than most, especially if your parent takes several medications.

One caution about survey data: response rates vary, and people who had a bad experience are sometimes more motivated to answer. Treat the survey as one input. It is a better input than a testimonial on a website, and a weaker input than your own questions on the phone.

When your parent needs both home health and something else

Home health is often one piece of a larger arrangement. If your parent is also receiving hospice care, the two benefits can interact in ways that surprise families, and the coordination question becomes the central one. We maintain a separate directory of hospice providers because those decisions are usually made on different criteria than home health. If both are in play, ask each provider directly who is responsible for what, and get it in writing.

If the plan is for your parent to move into a nursing home later, the home health episode is not wasted time. It is a chance to see how your parent responds to care at home, and to learn what they actually need. That information makes the next decision better. When you get there, you can search all nursing homes in our database of 14,696 Medicare-certified facilities and compare them on federal data rather than on impressions.

For families who are already managing a nursing home stay rather than home health, our watchlist of flagged homes is worth checking before a move, and our best-graded homes list is a reasonable place to start a search. Neither replaces a visit. Both save you from wasting a visit on a home that federal data already flags.

Questions to ask before you sign anything

Every agency will ask you to sign paperwork at the start. Read it, or ask someone to read it with you. These are the questions that matter at that moment.

• Does the plan of care list every service the doctor ordered, and is each one something this agency provides directly?
• Who is the supervising clinician, and how do I reach that person if something goes wrong?
• What is the process for changing the plan if my parent's condition changes?
• What are my parent's rights as a patient, and how do I file a complaint if a visit does not happen or care falls short?
• Is there anything I am being asked to agree to that goes beyond the doctor's order?

Patient rights in home health are real and enforceable, not decorative. Our guide on residents' rights covers the nursing home side of this, and the home health version is similar in spirit: you are entitled to be informed, to participate in the plan of care, and to raise a problem without retaliation.

How to compare two finalists without overthinking it

Most families end up with two or three realistic options, not ten. At that point, stop optimizing on ratings and decide on fit.

If both agencies are certified and both can start on time, the deciding factors are almost always operational: which one has the discipline your parent needs on staff, which one gave you a straight answer about weekend coverage, which one described a real process for missed visits rather than a promise that they never happen. An agency that tells you missed visits are rare and here is how we handle them is more trustworthy than one that tells you they do not happen.

One more consideration that families underestimate: distance and territory. An agency that covers a wide region may have a nurse who lives an hour away from your parent. That affects response time on a bad night. Ask which territory your parent's address falls into and how far the assigned clinician travels.

The bottom line

Look up the CMS quality-of-patient-care star rating and the patient survey results first, then make the decision on the questions those numbers cannot answer: which services the agency provides directly, how fast it can start, who covers Saturday night, and whether the same nurse will walk through the door. The choice is your parent's, not the discharge planner's, and any certified agency serving the area is fair game. Get the doctor's order and the homebound determination settled before you fall in love with any agency, and if the first one is not working, switch. The rating narrows the field. You close it.

Where these figures come from

Every number in this article that describes American nursing homes comes from the CMS Provider Data Catalog, the same public federal files behind Medicare's Care Compare. You can see exactly which datasets we use, and how current they are, on our data sources page. Nothing here is medical, legal or financial advice, rules differ by state and change over time, so verify anything that affects a decision with the facility, your state survey agency, your Long-Term Care Ombudsman, or a qualified professional.