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Find Home Health Care the Smart Way

May 13, 2016 (Updated: August 16, 2018)
Lily Moran

Suppose you have a loved one—let’s say a husband—who’s been hospitalized for, say, a heart attack.

Thankfully, he gets well fixed up and discharged—with orders for recovering at home, under the care of Medicare-covered nurses, aides, physical and occupational therapists.

So how do you know who the best home caretakers are?

Medicare Home Health Compare—a good start

From Medicare’s web site, Home Health Compare:

“This is the first national standard for collecting information on patient experiences that would enable valid comparisons among all home health agencies.”

Kudos to Medicare. Home Health Care Compare is a stupendous collection of data, comparing, as the name suggests, home health care providers and the quality of the care they provide. Here, you can drill all the way down to your local providers to see how they’re ranked, side by side, on a system of 1–5 stars.

As I said, it’s a good start.

But there’s a catch.

How good was the home care delivered?

This has always been a difficult call to make—so many factors are involved, and so many are different from place to place.

Let’s say your husband recovers and resumes his normal life, but with lifestyle changes recommended by his care team to reduce the risk of future heart attacks.

Medicare wants to know this outcome, so they collect data from two main sources.

In the case of your husband, one source gives the care he received 5 stars, the highest ranking.

But the other data source gives the same care just 2 stars.

Why the difference?

Apples and oranges

One of Medicare’s two key measures of successful care delivery (of 22 total) is whether the patient returned to their normal life. If yes, that earns the care agency stars. If no—if the patient had to be re-hospitalized, that loses stars.

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Medicare’s other key measure is the patient’s and family’s own assessment of the care. Were the caregivers informative, helpful, considerate, prompt, courteous…?

In an ideal world, the “hard” clinical data—how well the patient recovered—and the “soft” data—about positive interpersonal engagement—would track together.

But often, as in this case, they don’t.

So Medicare ends up with results like these, after studying thousands of home health care providers:

  • Based on patients’ opinion scores, Medicare awarded 4 or 5 stars to 74 percent of the agencies it rated. Of those, 2,152 agencies got 5 stars.
  • But for clinical quality, only 27 percent of agencies received 4 or 5 stars, and just 286 agencies received the maximum five stars.
  • Only 30 agencies got 5 stars from both ratings systems.

To their credit, Medicare recognizes there’s a source of confusion here, and is working to fix it.

And I get it. Listen to a geriatric physician at a nonprofit consulting firm, who says “If you’re in an area that doesn’t have a lot of advanced care planning, has a year-long waiting list for Meals on Wheels, and no doctors who are able to visit people at home, you’re going to be stuck with sending sick people back to the hospital,” she said.

And though it’s not the provider’s fault…down goes its ranking.

Fair enough. I’m sure there are hundreds of similar explanatory insights.

So use what you’ve got

It’s about teamwork and homework.

We certainly can’t dismiss the rankings Medicare makes available. The Home Health Compare site is awesome. It includes in their rankings whether an agency provides a specific test, item, or service you need, and whether it’s covered or not. It gives you good advice on diet, on lifestyle, and on nearly any aspect of any medical condition.

So dig in and see what you can learn about your local providers. But don’t stop there.

Your doctor and local hospital surely know your local care agencies. It’s very likely your family, friends, and neighbors do as well. And many communities have resource centers that help people locate the care they need.

Get all of their opinions. And visit any and all local care agencies personally. If you find something in Medicare’s rankings that raises questions … ask the agencies those questions.

Combining teamwork and homework is your best bet. It’s essential that you learn as much as you can, however you can—so you’re prepared if and when you need the best possible home health care providers.


  • gov. Medicare Health Compare.
  • Rau, J. July 16, 2015. “Home Health Agencies Get Medicare’s Star Treatment.” Kaiser Health News Analysis of Federal Home Health Compare Data from January 2016.
  • Rau, J. February 23, 2016. “Conflicting Ratings For Home Health Agencies Can Be Puzzling.”

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