For the millions of older Americans discharged from hospitals each year and sent home to recover, choosing the right home health agency has long been a stressful, confusing and time-pressured decision. A new set of ratings from U.S. News & World Report evaluates which agencies exceed expectations and which warrant further scrutiny.
This is the first “Best Home Health” ratings from U.S. News, which analyzed more than 12,000 Medicare-certified home health agencies nationally. Of these, 1,319 agencies earned the top designation of “high performing,” or a “best home health distinction.” Another 5,288 met baseline standards and were rated “as expected.” An additional 4,233 agencies were not rated due to insufficient data.
Why this matters
Demand for post-acute care is surging as the U.S. population ages, and home health has become an increasingly vital part of the care continuum. Many patients and families struggle to make discharge decisions, often under time and financial pressures, without a reliable resource to compare agency quality.
Journalists can use new ratings to highlight details that make some agencies stand out or fall below average. Factors such as pay rates, mix of payor sources and reimbursement, worker recruitment and retention, market demand, transportation and the current immigration crackdown can all impact agency quality and worker availability.
The methodology report includes full ratings and underlying data for each agency. These can be cross-referenced with Medicare’s Care Compare tool for Medicare-certified home health agencies. However, it’s important to note that not all agencies have complete data for both CMS star rating programs. Smaller agencies and those serving specialized patient populations may be missing a patient survey rating, which could affect their placement in the ratings tiers.
“Families often must make crucial post-acute care decisions during stressful times and on very short notice,” said Ben Harder, chief of health analysis and managing editor at U.S. News. “These new ratings are intended to serve as a helpful starting point, offering a clear view of agencies that have demonstrated a track record of positive patient outcomes and satisfied consumers.”
What ratings reveal
The overall rating draws on two datasets from the Centers for Medicare & Medicaid Services: clinical quality measures, including timely initiation of care and rates of potentially preventable hospitalizations and patient experience surveys. Each eligible agency receives a score on a 1.0 to 5.0 scale and is placed into one of three tiers: high-performing, as expected or evaluated.
The performance gap between top-rated agencies and the national average is significant in some cases.
- Best home health agencies started care on time for 99% of patients, compared with a national average of 94%.
- On mobility outcomes, 93% of patients at top-rated agencies improved their ability to walk and move, compared with 83% nationally.
- High performers also outpaced average agencies on patients’ ability to get out of bed, bathe independently and manage their medications.
Maintaining independence in daily activities is often the difference between older adults staying home and moving to a facility.
Overview of home-based services
It’s important to remember that there is a difference between home care and home health care. Understanding that distinction impacts what services are provided, for how long and who pays.
Home health care is just one layer of the support older adults may need to remain safely at home. Home care also serves people who are chronically ill, recovering from illness or injury and often encompasses a range of non-medical services not covered by Medicare.
Loved ones may require a range of skilled and unskilled care or services. Understanding which needs require medically certified care and which require other community-based support is an important step before choosing a home care provider.
As we previously reported, further compounding this challenge are the extensive budget cuts under the OBBBA that will likely affect Medicaid home- and community- based services. Immigration crackdowns are impacting the direct care workforce and low Medicare and Medicaid reimbursement rate adjustments will affect which agencies can afford to stay in business.
Geographic variation is significant
The distribution of top-rated agencies varies widely by state. California leads the nation with 151 best home health agencies, followed by Texas (133) and Florida (105). Louisiana (77) and Alabama (73) round out the top five areas that have had mixed performance on health care quality metrics over the years.
Several states have very few high-performing agencies. Connecticut, Nebraska and Washington each have five. Oregon has four, Wyoming has three and North Dakota has two. Alaska, the District of Columbia, Montana and Vermont have none.
Geographic variation could reflect differences in how agencies in those states report data, the size of local agencies, or genuine differences in care quality, according to the report.
Experts advise that the search for home care should occur before a hospital stay whenever possible, not during the stress-filled hours following a discharge. Reporters can help guide their audience by explaining how families can discuss home care options with their primary care physician or specialist ahead of time and by highlighting which agencies serve a particular ZIP code. This information can help families make more informed decisions about care for their loved ones.
Resources
- Home care vs. home health care–what’s the difference?, U.S. News
- CMS Star rating programs, Centers for Medicare and Medicaid
- Home health care agencies registered with Medicare, Centers for Medicare and Medicaid
- How the Big Beautiful Bill hurts the care economy, Brookings Institution
