How to choose a home health agency after a hospital stay
Your right to choose, what to compare, the questions to ask on the phone, and the red flags.
When a hospital discharge planner says "we've arranged home health," it can sound like the decision is made. It isn't. If Medicare is paying, you can choose any Medicare-certified agency that serves your area and can meet your needs.
Your right to choose
Federal hospital rules (42 CFR 482.43, discharge planning) require hospitals to tell patients they are free to choose among participating home health agencies, respect the patient's and family's preferences where possible, give a list of agencies that serve the patient's area, and disclose any agency the hospital has a financial interest in. Ask for that list — then compare it against the scores here.
What to compare
- Quality star rating. CMS's Quality of Patient Care rating summarises how the agency's patients fared on measures like improvement in walking, bathing and breathing. About 3 stars is typical; a difference of a full star or more is worth noticing. How the stars work.
- Starting care on time. Shown on each profile as "started care on time." After a discharge, a delay of even a few days matters.
- Services offered. Make sure the agency provides everything in the doctor's orders — for example speech therapy after a stroke, or occupational therapy after a hip replacement.
- Coverage area. Agencies are listed at their office address; many serve several counties. Always confirm they serve your ZIP code.
Questions to ask on the phone
- Do you serve my ZIP code, and can you start within 48 hours of discharge?
- Can you cover every service on the doctor's orders?
- Are you in network with my Medicare Advantage plan (if I have one)?
- How often will the nurse and therapist visit in the first week?
- Who do I call at night or on weekends with a problem?
- Will the same nurse and therapist usually come each visit?
Red flags
- An agency that can't say when the first visit will happen.
- Pressure to sign up for services the doctor didn't order.
- Door-to-door or cold-call offers of "free" home health — Medicare warns this can be fraud. Report it to 1-800-MEDICARE.
If it isn't working
You can change agencies. Tell your doctor, choose a new certified agency, and the new agency coordinates the transfer. Concerns about quality of care can be raised with your state survey agency or your Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO), listed on Medicare.gov.