Your Rights as a Home Health Patient, and How to Complain When Something Is Wrong

Something feels off. A visit was skipped and nobody called. The aide was rough with your dad. A bill came that nobody mentioned. You're not sure who to call, or whether speaking up will make things harder for the person you're trying to protect.

I'm an occupational therapist, and I've worked inside home health agencies. Every Medicare-certified agency works under a written list of patient rights, and the same rule says what it must do with a complaint. Here are those rights in plain words, and who to call.

When You Get the List of Rights

The rights are in Medicare's Conditions of Participation, the rules every Medicare-certified home health agency must meet, at 42 CFR §484.50. It opens with this line: "The patient and representative (if any), have the right to be informed of the patient's rights in a language and manner the individual understands."

The agency must give the patient, and the legal representative if there is one, the following "during the initial evaluation visit, in advance of furnishing care to the patient" (§484.50(a)(1)):

• Written notice of the patient's rights and responsibilities, plus the agency's transfer and discharge policies.
• The administrator's name, business address and business phone number, "in order to receive complaints" (§484.50(a)(1)(ii)).
• A privacy notice about the assessment data Medicare collects, called OASIS (§484.50(a)(1)(iii)).

The agency must get a signature confirming the notice was received (§484.50(a)(2)). If your parent chose someone to represent them, that person gets the written notice within 4 business days of the initial evaluation visit (§484.50(a)(4)). Our guide to the first home health visit covers the rest of that day.

My suggestion, not a rule: find that packet now. The two numbers you'll want later, the administrator's and the state hotline's, are supposed to be in it.

The Rights, in Plain Words

The table follows the rule, §484.50(c). The middle column is my plain-English version.

In my experience, the right families lean on most is (c)(5): visits in the plan that don't happen. If a cost caught you off guard, start with our guide to what home health does not cover.

When the Agency Can Discharge or Transfer

The rule lists the only reasons an agency may transfer or discharge a patient (§484.50(d)):

1. The agency and the doctor or allowed practitioner agree the agency can no longer meet the patient's needs. The agency must arrange a safe transfer.
2. The patient or the payer will no longer pay.
3. The goals in the plan of care are met, and the agency and the doctor or allowed practitioner agree the services are no longer needed.
4. The patient refuses services, or chooses to be transferred or discharged.
5. Discharge for cause: the behavior of the patient, or of someone else in the home, is disruptive, abusive or uncooperative to the point that care is seriously impaired.
6. The patient dies.
7. The agency stops operating.

Before a discharge for cause, the agency must tell the patient, the representative and the doctors involved that it is being considered, try to fix the problem, give contact information for other agencies, and document it (§484.50(d)(5)(i) through (iv)). The rule lists steps, not a number of days.

A complaint is not on that list. And CMS's guidance to surveyors says "A patient who occasionally declines a service is distinguished from a patient who refuses services altogether, or who habitually declines skilled care visits." Saying no to one visit is not the same as refusing care.

When Medicare-covered home health is ending, there is also a formal notice and, as Medicare's booklet puts it, "a fast appeal if you think these services are ending too soon". Medicare's booklet says the agency should give that notice, called the "Notice of Medicare Non-Coverage" (NOMNC), "at least 2 days before they end your services." The appeal itself is a separate topic.

What the Agency Must Do With a Complaint

The agency must investigate complaints "made by a patient, the patient's representative (if any), and the patient's caregivers and family" (§484.50(e)(1)(i)). That covers care not given, given inconsistently or given badly, and any mistreatment, neglect, abuse or theft of property. So yes, you can complain, not just your parent.

The agency must "Document both the existence of the complaint and the resolution of the complaint" and act to prevent further problems, "including retaliation," while it investigates (§484.50(e)(1)(ii) and (iii)). Staff who see signs of abuse or neglect must report it immediately (§484.50(e)(2)).

Surveyors check this. Their manual tells them to look at the agency's complaint log "to verify that the HHA is tracking complaints received from receipt of complaint through resolution." It also defines reprisal as "treating a patient differently from other patients after receipt by the HHA of a patient complaint, without a medical justification for such different treatment." Its examples include cutting services or discharging the patient (State Operations Manual, Appendix B, tags G484 and G448).

Who to Call

Medicare.gov sets the first two steps. The rest of the order is my suggestion. You don't have to go in order: the rule protects voicing grievances "to the HHA or an outside entity" (§484.50(c)(11)). For abuse, neglect or a safety problem, you can call the state hotline the same day.

1. The agency's administrator

Medicare.gov's advice is direct: "Call the home health agency and ask to speak to the administrator." The agency must give you that number at the first evaluation visit (§484.50(a)(1)(ii)).

In my experience, a scheduling slip is often fixed fastest by the clinical manager, whose name and contact information must be on the written instructions the agency gives you (42 CFR §484.60(e)(5)). Our guide to who does what on the home health team explains that role. For safety, or how your parent is treated, go to the administrator.

2. The state home health hotline, or the State Survey Agency

Medicare.gov's next line: "If you don’t believe your complaint has been resolved, call your state home health hotline." Medicare.gov says the agency "should give you this number when you start getting home health services." It's one of your rights (§484.50(c)(9)). If it's missing from the packet, ask for it.

If you can't find the hotline number, Medicare.gov says you "can call 1-800-MEDICARE (1-800-633-4227) to get the contact information for your State Survey Agency." Medicare's booklet describes it as the agency that "inspects and certifies home health agencies" for Medicare.

3. The BFCC-QIO, for quality of care

The Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) is a Medicare reviewer. If your parent has Medicare, the BFCC-QIO is another route. Medicare.gov says "The BFCC-QIO reviews Medicare complaints and monitors your quality of care", lists drug errors among its examples, and says it is run by Commence Health or Acentra, depending on your state. The booklet says to call 1-800-MEDICARE "to get the phone number for your BFCC-QIO." The agency's own packet should list a Quality Improvement Organization too (§484.50(c)(10)(v)). If it isn't labeled BFCC-QIO, get the number from 1-800-MEDICARE.

4. The HHS Office for Civil Rights, for privacy

If your parent's records were shared or lost, that's a privacy question. CMS's surveyor manual says "CMS does not interpret or enforce the HIPAA Privacy and Security Rules, which fall under the jurisdiction of the Office for Civil Rights (OCR)." OCR, part of the U.S. Department of Health and Human Services, takes HIPAA complaints through HHS.gov.

5. If your parent has Medicare Advantage

A problem with the plan itself goes to the plan. Medicare.gov says to "follow the instructions in your plan membership materials to submit a complaint about your Medicare health or drug plan." If the plan refused to cover a service, that is an appeal, not a complaint. Our guide to Medicare Advantage prior authorization for home health explains how plan approval works.

Help along the way

Medicare.gov says "Yes, you can file a complaint anonymously." It also points to your State Health Insurance Assistance Program (SHIP), at shiphelp.org, for free counseling.

What Surveyors Check

CMS's surveyor manual says a complaint investigation "is conducted to investigate specific allegations of noncompliance." During a survey, if a patient or family says they complained, surveyors are told to "review the complaint log to investigate how the HHA addressed the issue." Surveyors also ask patients whether they know the state hotline, and whether their care was "negatively affected" after they complained to the agency (tag G444). When you call the hotline, ask what happens next and how long it usually takes.

How to Make a Complaint Land

None of this is a rule. It's what I've seen work from the agency side of the phone.

• Write it down first. Dates, times, who came or didn't, and what happened. One page.
• Use facts, not adjectives. "No nurse on Tuesday or Thursday, no call either day" gets action. "The care is terrible" gets an apology.
• Say what you want. A missed visit made up this week. A different aide. A call back by Friday. An agency can act on a request.
• Ask what happens next, and by when. The rule says they must document your complaint.
• Follow up in writing. A short email after the call gives you a record if you need step 2. Keep a call log, like the one in our guide to the first 48 hours home.

If your parent is in danger right now, call 911.

Frequently Asked Questions

What rights does a home health patient have?

Medicare's rule for home health agencies lists them. They include being treated with respect, being free from abuse and neglect, taking part in the plan of care, being told what Medicare pays and what you may owe, a confidential record, the state hotline number, and complaining without being treated worse for it. The agency must give them in writing during the first evaluation visit, before care starts.

How do I file a complaint against a home health agency?

Medicare.gov says to call the agency and ask to speak to the administrator. If you don't believe the complaint has been resolved, call your state home health hotline, which the agency should give you when services start. If your parent has Medicare, you can also contact the BFCC-QIO about the quality of care. 1-800-MEDICARE can give you its phone number.

Can the agency drop my parent for complaining?

Not as payback. The rule gives every patient the right to be free from discrimination or reprisal for voicing grievances to the agency or to an outside entity. CMS's guidance to surveyors names cutting services, stopping them, or discharging the patient after a complaint, without a medical reason, as examples of reprisal.

Can a family member complain, or does it have to be the patient?

A family member can. The rule tells the agency to investigate complaints made by the patient, the patient's representative, and the patient's caregivers and family. Medicare.gov also says you can file a complaint anonymously.

Sources

• 42 CFR §484.50, Home health patient rights (Cornell LII)
• 42 CFR §484.60, Care planning, coordination of services, and quality of care (Cornell LII)
• State Operations Manual, Appendix B, Guidance to Surveyors: Home Health Agencies (CMS)
• Medicare & Home Health Care, CMS Product No. 10969, July 2025 (Medicare.gov)
• Filing a complaint (Medicare.gov)