How to Choose a Home Health Agency: A Family Guide

Someone you love is coming home from the hospital, or their doctor has said they need care at home. Then a discharge planner hands you a list of agencies and asks which one you want. It usually happens on a busy afternoon, with little time to think.

I'm an occupational therapist, and I've been the clinician walking into those homes. The families who end up happiest knew they had a choice, checked a few numbers, and asked good questions before they said yes. This guide walks through that, in the order you will do it.

You Get to Choose

Under Medicare, the choice of agency is yours.

The law. Medicare's basic freedom-of-choice rule says a person on Medicare "may obtain health services from any institution, agency, or person qualified to participate" if that agency agrees to provide the care (42 U.S.C. §1395a(a)).
The hospital's job. When a hospital refers a patient to home health, CMS rules say it must give a list of Medicare agencies that serve the patient's area, tell the patient about their "freedom to choose," and not limit the choice. If the hospital has a financial interest in the agency it refers you to, the discharge plan must say so (42 CFR §482.43(d)).
The limits. Medicare's own home health booklet says your doctor, hospital discharge planner or referring agency "should honor your choice," but that choices can be limited by which agencies have staff available and by your insurance. A Medicare Advantage plan may require you to use agencies it contracts with. If you have one, call the plan first.

So if a hospital says "we use this agency," you can still ask for the list and pick another one.

Step 1: Make a Short List

Start with the agencies that actually serve the home. Agencies cover set areas, and an agency across town may not come to your parent's street.

Our free Find an Agency tool lists the Medicare-certified agencies that serve a ZIP code. Use the ZIP where care will happen, not the hospital's. You can narrow the list to agencies that offer nursing, physical therapy or a home health aide, and to agencies with 4 or more stars. Each listing has the agency's phone number.

Everything in it is Medicare's own Care Compare data. It is not a Logicly rating.

Step 2: Read the Two Star Ratings

Medicare gives home health agencies two different star ratings. They measure different things, so look at both.

The quality of patient care star

This star runs from 1 to 5 in half stars. CMS builds it from seven measures taken from the assessments clinicians complete at the start and end of care, plus Medicare claims:

Starting care on time
Getting better at walking or moving around
Getting better at getting in and out of bed
Getting better at bathing
Less shortness of breath
Getting better at taking medicines by mouth
Preventable hospital stays during care

A measure counts only if the agency had at least 20 completed patient stays for it (CMS calls them episodes), and an agency needs at least 5 of the 7 to get a star at all. CMS updates it every three months.

The patient survey star

This one comes from a standard Medicare survey of the agency's own patients, called HHCAHPS. Patients answer questions about whether the team gave care in a professional way, communicated well, and talked with them about medicines, pain and home safety. They also rate the agency from 0 to 10 and say whether they would recommend it.

An agency needs 40 completed surveys over a year to get a survey star. Medicare's data also flags results based on fewer than 70 surveys, with a note to use them with caution.

When there is no star

A blank is not a bad grade. It usually means the agency has not had enough patients on enough measures, too few surveys came back, or the agency was certified less than six months ago. I would not rule out an agency for that alone. I would ask them why, and lean harder on the questions in Step 4.

If you want to know how CMS turns seven scores into one star, our article on the October 2026 star ratings explains the method. It is written for agencies, but the method section reads fine for anyone.

Step 3: Look Past the Stars

A star is a summary. Underneath it are the numbers I would look at first as a clinician, because they are the ones a family feels:

Started care on time. A late first visit means days at home without a plan, often right after a hospital stay.
Got better at walking. In my experience, walking is often what decides whether someone can stay home safely.
Preventable hospital stays. How often patients went back to the hospital for something good home care might have prevented.

Find an Agency shows those three on every listing. Next to the first two, it says whether the agency is better than, about the same as, or below its state's average. That comparison is ours, made from the state average CMS publishes. For hospital stays, it shows Medicare's own label instead: better than, the same as, or worse than the national rate.

Then pick up to four agencies and compare them side by side. The comparison adds bathing, shortness of breath and falls with major injury, puts each agency next to the state and U.S. averages, and marks which agency did best on each line.

One caution. A small agency's numbers swing more from year to year, because a few patients move the percentage a lot. If two agencies are within a few points, treat them as even and let the phone call decide.

Step 4: Call and Ask

Numbers can't tell you whether the agency answers the phone, or whether the same nurse will come each week. For that, you have to call.

We built a checklist of 22 questions to ask before you choose, with what a good answer sounds like and what should worry you. You can tick them off on screen or print the one-page PDF and take notes on it.

Some of those answers are set by Medicare rules. Others are just good practice. Know which is which, because an agency can't opt out of the first kind.

Medicare rules (the agency must do these):

The first visit. The first assessment visit must happen within 48 hours of the referral or of the patient's return home, or on the start date the doctor ordered (42 CFR §484.55(a)(1)).
A written schedule. The agency must give you written instructions with the visit schedule, the medication schedule, and the name and contact information of the clinical manager (42 CFR §484.60(e)).
Money in writing. The agency must tell the patient, out loud and in writing, how much Medicare is expected to pay, the charges for anything it may not cover, and what the patient may have to pay before care starts (42 CFR §484.50(c)(7)).
Aide supervision. If a home health aide comes while nursing or therapy is also going on, a nurse or other skilled clinician who knows the patient must assess the aide's care at least every 14 days (42 CFR §484.80(h)).
A say in the plan. The patient has the right to take part in the plan of care, including which disciplines come and how often (42 CFR §484.50(c)(4)).

Good practice (worth asking, but not required):

Will it be the same nurse or therapist most visits?
Can we reach a clinician after hours and on weekends?
How will you tell us if a visit is late or cancelled?
Are your staff employees or contractors?

Medicare's booklet also suggests calling your State Survey Agency, which inspects home health agencies for Medicare, and asking for the survey report on any agency you are considering.

If It Isn't Working

You can change agencies. Medicare's home health booklet says you "may decide to end your relationship with one agency and choose another at any time." Medicare pays only one agency at a time, so ask the doctor for a referral to the new agency and tell both agencies you are switching.

If you have a complaint, the agency must give you the administrator's name and phone number for complaints (42 CFR §484.50(a)(1)(ii)), and must tell you about your state's toll-free home health hotline (42 CFR §484.50(c)(9)).

What It Costs and Who Qualifies

Under Original Medicare, a patient pays nothing for covered home health services. Medical equipment is separate. Our guide to what home health costs with Medicare goes through the details, and who qualifies for home health care explains the homebound rule and the other requirements in plain language.

Frequently Asked Questions

Can I choose my own home health agency?

Yes. Under Medicare you can get care from any agency that is certified to participate and agrees to take you. When a hospital refers someone to home health, it must give a list of Medicare agencies that serve the area and tell the patient they are free to choose. A Medicare Advantage plan may limit you to the agencies it contracts with.

What do the home health star ratings mean?

Medicare shows two. The quality of patient care star, from 1 to 5 in half stars, is built from seven measures such as starting care on time, getting better at walking and avoiding preventable hospital stays. The patient survey star, from 1 to 5, comes from a standard survey of the agency's own patients. Both are updated every three months.

Why does a home health agency have no star rating?

Usually because there is not enough data yet. An agency needs enough patients on at least 5 of the 7 quality measures to get a quality star, and 40 completed patient surveys over a year to get a survey star. A recently certified agency will also show no rating. A missing star is not a bad mark on its own.

Can we switch home health agencies if it is not working?

Yes. Medicare's own guide says you can end care with one agency and choose another at any time. Medicare pays only one agency at a time, so ask the doctor for a referral to the new agency and tell both agencies you are changing.

Sources

See which agencies serve your ZIP code

From Medicare's own Care Compare data: star ratings, on-time starts and hospital stays for every agency that serves the ZIP code, and a side-by-side view of up to four.

Find an agency

How to Choose a Home Health Agency: A Family's Guide to Star Ratings and the Questions to Ask