How to Find the Best Home Health Care Services for You or a Loved One

“Home health care” is a broad term that gets used to describe very different things. Before comparing providers, it helps to understand the major categories of home health services.

• Skilled nursing care involves licensed nurses providing medical services in your own home, such as wound care, medication management, injections, or monitoring of a chronic condition. This is typically ordered by a physician following a hospitalization or medical event.
• Personal care and home health aide services cover non-medical support with activities of daily living, including bathing, dressing, grooming, meal preparation, light housekeeping, and mobility assistance. Home health aides do not provide clinical care, but the support they offer is essential for older adults and people with disabilities who need help maintaining their routines safely at home.
• Therapy services include physical, occupational, and speech therapy provided at home, most often as part of a recovery plan after surgery, illness, or injury.
• Community-based services extend care beyond the home, connecting people with day programs, transportation, social support, and other resources that help them stay engaged in their communities and maintain independence.

Understanding which category fits your situation is the first step toward finding the right home care provider. Someone recovering from a hospitalization has different needs than someone managing a chronic condition long-term.

Cost is one of the most pressing concerns families face during a difficult time, and how care is funded affects which providers are available to you.

• Medicare covers skilled home health services for people who meet specific eligibility criteria, including being homebound and having a physician-ordered care plan. Medicare does not cover ongoing personal care or custodial services unless skilled care is also being provided.
• Medicaid covers a broader range of home and community-based services, including long-term personal care, for people who meet income and functional eligibility requirements. Because Medicaid is jointly administered by federal and state governments, covered services, eligibility rules, and program names vary significantly by state.
• Private pay and long-term care insurance are options for people who do not qualify for Medicaid or whose needs go beyond what Medicare covers.

Knowing how care will be paid for shapes your entire search. Medicare-certified home health agencies must meet federal standards and are subject to regular oversight. Medicaid programs open up a different set of options, including some that give participants a meaningful say in how care is structured and who provides it.

Whether you are evaluating a home care agency, a Medicare-certified provider, or another type of home care provider, there are consistent factors worth examining before making any decision.

• Licensing and certification should be your starting point. Home health agencies in most states are required to hold a state license. Agencies that provide skilled nursing or therapy and bill Medicare must also be Medicare-certified and are subject to federal oversight. You can look up Medicare-certified agencies using Medicare’s Care Compare tool, which publishes quality ratings and patient experience scores for home health agencies across the country.
• Quality measures on Care Compare include data on how often patients improved in their ability to walk, manage daily activities, or control pain. These measures are not a complete picture of quality care, but they provide a data-backed starting point when comparing home health agencies in your area.
• Patient experience scores reflect how people rate their care experience, including communication, professionalism, and responsiveness. Reading reviews from other families alongside patient experience data gives you a more complete view than either one alone.
• Staffing consistency matters more than most people realize. High turnover disrupts routines, especially for older adults or people with cognitive conditions who rely on familiarity. Ask any agency how they handle scheduling continuity and what happens when a regular caregiver is unavailable.
• Specialization is worth considering when care needs are more complex. Some providers focus on senior care and aging. Others specialize in chronic condition management, rehabilitation, or support for people with intellectual or developmental disabilities. A generalist agency may not be the right fit if your situation calls for specific expertise.
• Costs and payment options should be laid out clearly before any agreement is signed. Ask for a written breakdown of what is included, what is billed separately, and what is covered by Medicare, Medicaid, or private insurance. Pricing transparency is a reasonable expectation from any reputable provider.

When you read reviews of home care services, look for patterns rather than isolated incidents. Consistently strong feedback across multiple sources over time is a more meaningful signal than a handful of perfect scores or a single complaint.

When speaking directly with a provider, some questions worth asking include:

• Are your caregivers employees or independent contractors?
• How are caregivers screened, trained, and supervised?
• What happens if my regular caregiver is unavailable?
• How do you keep family members informed about changes in care?
• How do you handle evolving care needs over time?

The answers tell you a lot about how an organization actually operates, not just how it presents itself.

Agency-based home care is not the only option available to people who qualify for Medicaid. There is another model, called self-directed care, that works very differently from a traditional home care agency and is worth understanding before you make any decisions about long-term care.

In an agency model, the agency assigns caregivers, controls the schedule, and determines how services are delivered. The person receiving care has limited input into who comes into their home or when. For many families, that lack of control is one of the most frustrating parts of the experience.

Self-directed care works the other way around. The participant, or their authorized representative, takes on the role of employer. They choose who provides their care, set the schedule that works for their life, and direct how services are delivered in their own home.

In many states, self-direction allows participants to hire someone they already know and trust, including a family member or close friend who may already be providing informal support. That family member can become an official, paid caregiver. This is one of the most significant differences from a traditional home care agency model, and for many families, it is the deciding factor.

The rules about who can be hired, which services can be self-directed, and how budgets are structured vary by state. Program names differ as well. What matters is that this option exists in many states and is funded through Medicaid.

Common supports available through self-direction include personal care, assistance with daily activities, meal preparation, and community-based services, depending on the state and program. Self-direction serves older adults, people with physical disabilities, people with intellectual or developmental disabilities, and individuals managing chronic conditions, among others.

Self-direction does require more active involvement from the participant or their representative. Managing a caregiver means handling scheduling, supervision, and the employment relationship. The administrative side, including payroll, taxes, and enrollment paperwork, is typically handled by a Financial Management Services (FMS) provider, so participants can focus on care rather than paperwork.

For people who value consistency, relationship, and control, self-directed care offers something a traditional home care agency often cannot: the caregiver who shows up is someone you chose, who knows you, and who is not limited by agency restrictions on scheduling or service delivery. For many older adults and people with disabilities, that peace of mind makes a real difference in daily life.

There is no single best home health care provider for every situation. The right fit depends on the complexity of care needs, how care is funded, how much control the person receiving care wants to have, and what home health services are available in your area.

For short-term skilled nursing following a hospital stay, a Medicare-certified agency with strong quality ratings and patient experience scores is often a reasonable starting point. For ongoing personal care and daily living support, especially for people who qualify for Medicaid, it is worth comparing the home care agency model and the self-directed model before committing.

Talk with more than one provider. Write down your questions before those conversations. And look into whether self-directed care is available in your state, because many families do not learn it exists until they are already well into the process.

If Medicaid covers your care or that of a loved one, self-direction may be an option worth exploring. Every state’s program is different, and eligibility depends on where you live and the nature of your needs.

Our questionnaire can help you find out if self-directed care is available in your state. 

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Public Partnerships LLC (PPL) is a Financial Management Services provider that supports self-directed care across approximately 50 programs in the United States. PPL has supported more than 700,000 participant and caregiver relationships and has processed over $10 billion in goods and services payments.

PPL handles the administrative side of self-direction, including payroll processing, tax compliance, and enrollment paperwork, so participants can focus on what matters most: getting quality care from people they know and trust.