Choosing a home health agency starts with understanding exactly what kind of care you need, then verifying that any agency you consider is properly licensed, certified, and staffed to deliver it. The difference between a good agency and a mediocre one shows up in measurable outcomes: how often patients improve at walking, bathing, and managing medications, and how often they end up back in the hospital. These numbers are publicly available, and knowing where to find them gives you a real advantage.
Medical Home Health vs. Non-Medical Home Care
Before you start comparing agencies, clarify which type of service you actually need. These are two different industries with different regulations, staffing, and payment structures.
Medical home health care is provided by licensed professionals like nurses and physical therapists. It must be ordered by a physician. Services include skilled nursing, wound care, pain management, physical and occupational therapy, and mobility training. Insurance, including Medicare and Medicaid, typically covers at least some of these costs when a doctor prescribes them.
Non-medical home care focuses on daily living: bathing, getting dressed, meal preparation, housekeeping, companionship, medication reminders, and transportation. The caregivers performing these tasks don’t need medical licenses. Insurance generally does not cover non-medical home care. The national median cost for this type of care runs about $33 per hour in 2025, with state-level costs ranging from $24 to $43 per hour. A helpful way to think about the distinction: a home health nurse can change your prescription, while a home care aide helps you remember to take it every day. A physical therapist can modify your therapy plan, while a caregiver encourages you to do your exercises and watches for problems.
Check Certification and Licensing First
Any agency you’re considering should be licensed in your state and, for medical home health, certified by Medicare. Medicare certification isn’t just a billing designation. It means the agency has met federal health and safety requirements: it must be primarily engaged in skilled nursing and therapeutic services, have policies governed by a group that includes at least one physician and one registered nurse, maintain clinical records on all patients, and operate under physician or nurse supervision. These requirements exist to protect you.
Beyond Medicare certification, look for voluntary accreditation from organizations like the Joint Commission or the Community Health Accreditation Partner (CHAP). Accreditation requires an on-site survey where evaluators assess the agency’s compliance with quality and safety standards. It’s not required by law, but agencies that pursue it are signaling a commitment to higher accountability. Not every good agency is accredited, but it’s a meaningful positive indicator.
Use Medicare’s Star Ratings
The most useful free tool for comparing agencies is Medicare’s Care Compare website. Every Medicare-certified home health agency receives a quality rating from 1 to 5 stars based on seven specific measures. These include how often the agency started care in a timely manner, and how often patients improved at taking medications correctly, walking or moving around, getting in and out of bed, and bathing. The ratings also track how often patients experienced less shortness of breath and how often they were hospitalized for a potentially preventable condition while receiving home health services.
These aren’t subjective reviews. They’re calculated from patient assessments and Medicare claims data. An agency with a 4- or 5-star rating is demonstrably producing better outcomes for its patients. If two agencies in your area seem comparable, the star rating is a reliable tiebreaker. You can search by zip code and compare agencies side by side.
Ask About Staffing and Background Checks
The quality of care you receive depends almost entirely on the people who walk through your door. States require home health workers who have direct contact with vulnerable adults to undergo criminal history and background checks, typically fingerprint-based. Disqualifying findings include convictions for certain crimes, records on sex offender registries, listings on the nurse aide registry for abuse or neglect, and exclusion from Medicare or Medicaid programs. Ask any agency you’re considering how they screen their employees and whether they go beyond the minimum legal requirements.
The National Institute on Aging recommends asking these specific questions when interviewing an agency:
- Consistency: Will it be the same caregiver each time?
- Training: How do you train your care providers?
- References: Can you provide references from current or past clients?
- Supervision: Who do I contact if there’s a problem?
- Emergency availability: Are you available for emergencies around the clock, and what types of emergency care can you provide?
Caregiver consistency matters more than people expect. When the same nurse or aide shows up regularly, they notice subtle changes in your condition that a rotating cast of strangers would miss. If an agency can’t commit to consistent staffing, that’s worth weighing heavily in your decision.
Understand the Plan of Care Process
For medical home health, care doesn’t begin randomly. A registered nurse conducts an initial assessment within 48 hours of your referral or discharge from the hospital, followed by a comprehensive assessment within five calendar days of the start of care. These assessments form the basis of your plan of care, which outlines the type, amount, and duration of services you’ll receive.
The plan is reviewed at least every 60 days to evaluate your progress, adjust strategies, and confirm the services are still appropriate. Your physician is involved in establishing and updating this plan. When you’re evaluating agencies, ask how they communicate with your doctor, how quickly they respond to changes in your condition, and how involved you and your family will be in care planning decisions. An agency that treats the plan of care as a living document, not paperwork filed and forgotten, will deliver noticeably better results.
Evaluate After-Hours and Emergency Response
Federal regulations require that the agency’s administrator and clinical manager be available during all operating hours, but there is no federal mandate for 24/7 on-call nursing. This means after-hours coverage varies significantly from one agency to the next. Some agencies staff a nurse on call around the clock. Others rely on answering services that route messages to on-call staff. A few offer little beyond voicemail after business hours.
Ask explicitly what happens if you have a problem at 2 a.m. on a Saturday. Will you reach a nurse who knows your case, or a general call center? How quickly will someone respond? If the agency hedges on this question, consider it a red flag. Health needs don’t follow office hours, and you need to know what support exists when the unexpected happens.
Know Your Rights as a Patient
Home health patients have specific legal protections. You have the right to know who is providing your care and who is responsible for it. You have the right to be informed about your diagnosis, treatment plan, alternatives, risks, and prognosis. You can refuse any treatment. You can request a reasonable estimate of charges before treatment begins and receive an itemized, understandable bill afterward. You have the right to access care regardless of race, national origin, religion, disability, or payment source.
If you’re eligible for Medicare, you can ask in advance whether the agency accepts the Medicare assignment rate. And if something goes wrong, you have the right to file a grievance through the agency’s own process and through your state licensing authority. A reputable agency will present these rights to you clearly at the start of care, not bury them in a stack of paperwork.
Compare at Least Three Agencies
Once you’ve narrowed your options to agencies that are properly certified, well-rated, and transparent about their staffing and policies, request an in-home consultation from at least three. This visit lets you assess something data can’t capture: how the agency’s representative communicates with you. Do they listen to your concerns? Do they explain things clearly? Do they seem rushed, or do they take time to understand your situation?
Pay attention to how quickly each agency responds to your initial inquiry. An agency that takes days to return your call before you’re even a client is unlikely to become more responsive once you are one. The consultation is also your chance to ask about scheduling flexibility, how they handle caregiver substitutions when your regular provider is unavailable, and what their process looks like if you’re unhappy with a specific caregiver. The best agencies make it easy to raise concerns and act on them quickly.