A home health agency is a licensed organization that sends medical professionals to your home to deliver skilled care, such as nursing, physical therapy, and wound treatment. These agencies are regulated at both the federal and state level, and most are certified by Medicare, meaning they meet specific safety and quality standards. If you or a family member has been discharged from the hospital, is recovering from surgery, or is managing a chronic condition, a home health agency is often how that care continues without requiring repeated trips to a clinic.
Services a Home Health Agency Provides
The core of home health is skilled care, meaning services that require a trained, licensed professional. The most common is nursing care. A registered nurse develops a plan of care with your doctor, then visits your home to handle tasks like wound dressing, IV therapy, medication administration, pain management, ostomy care, and general health monitoring.
Physical therapy is the next most common service. A physical therapist designs a program to help you regain strength, improve joint mobility, or relearn how to walk safely after an injury or surgery. Occupational therapists focus on a different set of goals: helping you perform daily activities like bathing, dressing, eating, and getting around your home when a physical, developmental, or emotional disability makes those tasks difficult.
Speech therapy is available for patients who need help recovering the ability to communicate clearly, often after a stroke or neurological event. Medical social workers round out the clinical team by connecting patients to community resources, providing counseling, and coordinating complex care plans when multiple services are involved. Some agencies also employ respiratory therapists for patients on home oxygen or ventilator equipment.
Home health aides work under the supervision of a nurse and assist with basic personal needs: getting out of bed, walking, bathing, and dressing. Some aides receive specialized training that allows them to help with more involved care tasks.
Home Health vs. Home Care
These two terms sound interchangeable, but they describe very different levels of service. A home health agency provides medical care through licensed professionals like nurses and therapists. A home care agency provides non-medical support through caregivers who help with daily living tasks such as bathing, grooming, meal preparation, and companionship. Home care workers may or may not be licensed.
The distinction matters for insurance. Home health care is typically covered by Medicare and Medicaid because it involves skilled medical services ordered by a doctor. Home care often is not covered, though some Medicaid programs and long-term care insurance policies may help with costs. The timeline also differs: home health is usually short-term, lasting weeks to a few months until you recover or transition to another level of care. Home care can continue indefinitely.
Who Qualifies for Home Health Services
To receive home health services covered by Medicare, you need to meet three requirements. First, a health care provider must order your care. Second, a Medicare-certified home health agency must provide it. Third, you must be considered “homebound.”
Homebound does not mean you can never leave your house. It means leaving home is a major effort because of your condition. You might need a cane, wheelchair, walker, or special transportation. You might need another person’s help to get out the door. Or your doctor may have determined that leaving home is simply not recommended given your health status. Occasional trips to a religious service, a barber, or a medical appointment don’t disqualify you.
There is one important limitation: Medicare covers part-time or intermittent skilled care only. If you need around-the-clock nursing, home health under Medicare won’t cover it, and a different care arrangement would be necessary.
How Care Gets Started
Before a home health agency can begin treating you, a face-to-face encounter with a physician or nurse practitioner is required. This visit must happen within 90 days before home health services begin or within 30 days after your admission. If a new condition arises that wasn’t apparent during an earlier visit, the certifying provider must see you within 30 days of your admission date.
During that encounter, the provider documents your clinical condition, explains why you’re homebound, and confirms you need skilled services. This documentation becomes the foundation for your plan of care. Without it, Medicare will not authorize payment, and the agency cannot proceed.
In practice, most referrals happen at hospital discharge. A discharge planner or case manager identifies that you’ll need continued care at home and connects you with a certified agency. Your doctor can also refer you directly from an office visit if your condition warrants it.
How Agencies Are Regulated
Home health agencies must meet federal conditions of participation established under the Social Security Act in order to bill Medicare. These rules cover patient safety, care quality, staffing, and organizational transparency. If state or local law also requires a license, the agency must hold one.
Every person working for the agency, whether a nurse, therapist, or aide, must be licensed, certified, or registered according to state requirements. The agency itself must disclose detailed information to the state survey agency, including the names and addresses of all owners, officers, directors, and managing employees. Branch locations must be reported at the time of initial certification and whenever they change.
State survey agencies conduct inspections to verify that an agency is meeting federal standards. These surveys can happen at initial certification, during routine reviews, or in response to complaints.
How Agencies Are Paid
Since January 2020, Medicare has paid home health agencies through the Patient-Driven Groupings Model. Rather than paying a flat rate per visit, this system groups each 30-day period of care into one of 432 possible payment categories based on clinical and patient characteristics.
Five factors determine which group a patient falls into: whether the patient was admitted from the community or an institution, whether it’s early or late in the course of care, which of 12 clinical categories best describes the primary reason for services (ranging from musculoskeletal rehabilitation to wound care to cardiac management), the patient’s level of functional impairment (low, medium, or high), and whether secondary diagnoses warrant a comorbidity adjustment. This design ties payment more closely to each patient’s actual clinical needs rather than the volume of visits provided.
How to Compare Agencies
Not all home health agencies perform equally. The federal government tracks quality through the Home Health Quality Reporting Program, which collects data on how well agencies help patients regain function, how consistently they follow evidence-based care processes, and how patients rate their experience through standardized satisfaction surveys.
This data is publicly available on CMS’s Care Compare website, where you can search for agencies in your area and review their quality scores side by side. Outcome measures show results like whether patients improved in their ability to walk or manage daily activities. Process measures show whether the agency consistently followed best practices. Patient experience scores reflect how real patients felt about communication, professionalism, and overall care. Checking these ratings before choosing an agency gives you a much clearer picture than relying on word of mouth alone.