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Family Guide · Updated May 2026

How to choose a home health agency in Central Florida (and what CMS star ratings actually mean)

Nine questions to ask before you sign, a plain-English read on Care Compare star ratings, and the green flags and red flags families say they wish they had known — written for Central Florida families.

Medically reviewed by Kassy Health Medical Team Last reviewed: May 2026 Re-review: May 2027 Written for families · Reading time ~12 min

Choosing a Medicare home health agency comes down to five questions and three numbers. Ask: (1) Is the agency Medicare-certified and Florida-licensed? (2) Will the same visiting nurse case-manage my parent? (3) How often do aides change? (4) How are no-shows handled? (5) Who calls the physician? On Medicare Care Compare, look at the Quality of Patient Care star rating, the Patient Survey star rating, and the recommendation rate.

Plain-English Definitions

Five terms you will see while comparing agencies

Care Compare uses specific words for specific measurements. Knowing them out loud makes every star rating and every agency sales call clearer.

CMS star rating
A 1- to 5-star score Medicare publishes for every certified home health agency. There are actually two ratings — the Quality of Patient Care star rating (clinical outcomes) and the Patient Survey star rating (family experience). They are not the same and an agency can score differently on each.
Medicare Care Compare
The official Medicare.gov tool at medicare.gov/care-compare where you can look up any Medicare-certified home health agency by ZIP code and read both star ratings side by side. Data refreshes quarterly (January, April, July, October).
CHAP accreditation
An optional, voluntary accreditation from the Community Health Accreditation Partner. CHAP surveys agencies every three years against standards above the federal minimum. Not every Medicare-certified agency is CHAP-accredited. Kassy Health is.
Quality of Patient Care score
The clinical half of the Care Compare rating. CMS calculates it from nine OASIS-based measures — improvement in mobility, bathing, transferring, pain management, dyspnea, medication management, hospitalization risk, and timely initiation of care. National median is 3 stars.
HHCAHPS patient experience score
The family-survey half of the rating, built from the federal Home Health Consumer Assessment of Healthcare Providers and Systems (HHCAHPS) survey. It captures communication, professionalism, discharge information, and whether families would recommend the agency to friends and family.
A Kassy Health visiting nurse consulting with a patient in their Central Florida home.
What Good Care Looks Like

The right agency feels like a partner, not a vendor

A Kassy Health visiting nurse doesn’t just complete a checklist. She knows the patient by name, calls the physician directly when something changes, and stays on the case from admission through discharge — the same person, every visit. The nine interview questions below are designed to surface exactly that.

Talk to an Intake Nurse
The Interview

The 9 questions to ask before you sign

These are the questions Central Florida families tell us they wish they had asked. Each one has a version of a "good answer" and a "bad answer." When the answers are vague, that is its own answer.

  1. Are you Medicare-certified and Florida-licensed — and what is your CMS Quality of Patient Care star rating?

    What a good answer sounds like: the agency gives you the CMS Certification Number (CCN), points you to its profile on Medicare Care Compare, gives the current star rating without rounding it up, and tells you its Florida AHCA license number for cross-check on FloridaHealthFinder. What a bad answer sounds like: "Oh, we're highly rated" without a number, or insisting Florida licensure alone is enough. Many agencies in Florida are licensed but not Medicare-certified — those agencies cannot bill Medicare for the visits a home health episode requires.

  2. Will the same visiting nurse case-manage my parent, or does it rotate?

    What a good answer sounds like: "Your case manager is one named RN who opens the case and stays on through discharge. She or he is your single phone number when something feels off." What a bad answer sounds like: "We have a great team." Care continuity is the single biggest predictor of family satisfaction in HHCAHPS survey data, and the absence of a named case manager is the most common upstream cause of the "nobody is in charge" feeling families describe. Ask for the case manager's name in writing on Day 1.

  3. How often do home health aides change — and can the same aide be assigned to our case?

    What a good answer sounds like: the agency tells you its aide turnover rate, names the aide who is most likely to be assigned, and explains how substitutions are handled. What a bad answer sounds like: "It depends on availability." Aide turnover is the single loudest live complaint families post about home health agencies — titles like "I have switched companies 20 times" and "Why does the agency send different personal care aides without advance notice?" are common in caregiver forums. If aide consistency matters to your family, name it in the first call. The agency's answer tells you how the rest of the relationship will go.

  4. What is your missed-visit rate, and what happens when an aide or nurse does not show up?

    What a good answer sounds like: the agency tracks missed visits, has a written backfill policy, and a 24-hour phone line that picks up live. They tell you within how many minutes a no-show is escalated. What a bad answer sounds like: "That doesn't happen." It does — the AgingCare title "My home health aide hasn't been showing up lately. The agency doesn't do anything about it" represents a recurring family experience. Agencies that won't name a backfill protocol typically don't have one.

  5. Who handles communication with my parent's physician?

    What a good answer sounds like: "The case manager sends the plan of care to the physician for signature, calls the physician's office with any significant change, and updates you when the physician changes orders." What a bad answer sounds like: "We let the family know what to tell the doctor." Coordination with the certifying physician is a federal Condition of Participation under 42 CFR Part 484. It is not optional and not the family's job. If the agency does not have a clear physician-communication workflow, you will spend the next 60 days as the unpaid messenger.

  6. Is anyone on the team bilingual — and is your written material available in Spanish?

    What a good answer sounds like: the agency tells you which clinicians are bilingual, whether Spanish-language patient education is available, and whether interpreter services are arranged when needed. What a bad answer sounds like: "We use Google Translate." Central Florida is a bilingual market — Census QuickFacts (vintage 2024) put the Hispanic population at about 55% in Osceola County and 32% in Orange County. For families navigating discharge instructions, medications, and OASIS questions, language access is a clinical-safety issue, not a marketing preference.

  7. What does discharge planning look like — how will I know when home health is ending?

    What a good answer sounds like: the agency tells you the certification period is 60 days, explains that recertification is a clinical re-evaluation (not an automatic renewal or a benefit cliff), and walks through what happens at discharge — a final HHCAHPS survey, a written discharge summary, and a handoff back to the primary care physician. What a bad answer sounds like: the staff suggest Medicare will stop paying as soon as the patient "plateaus" or "no longer needs PT." That is the so-called plateau myth — it has been contradicted by the federal Jimmo v. Sebelius settlement (2013), which clarified that Medicare covers skilled care to maintain a patient's condition or prevent further decline, not just to improve it. An agency that repeats the plateau myth on the intake call is an agency that may push for premature discharge later.

  8. How do you handle the face-to-face encounter and the physician's signed orders?

    What a good answer sounds like: the agency explains that the certifying physician must document a face-to-face encounter 90 days before or 30 days after the start of care, that the agency tracks this paperwork on the family's behalf, and that the agency — not the family — chases the signed plan of care if anything is missing. What a bad answer sounds like: "We need you to get that from the doctor." The face-to-face requirement is one of the four eligibility pillars under CMS Benefit Policy Manual Chapter 7. Agencies that have a clean F2F workflow do not punt that work to families.

  9. What is your 30-day hospital readmission rate, and what do you do to prevent readmissions in the first week?

    What a good answer sounds like: the agency cites its own rate, names front-loaded visits in the first seven days (medication reconciliation, red-flag-symptom teaching, telehealth check-ins), and explains how the case manager escalates a worsening patient before an emergency-department visit. What a bad answer sounds like: "We do everything we can." Roughly one in five Medicare patients discharged from the hospital is readmitted within 30 days, and the first week of home health is the structural window where most preventable readmissions are prevented (AHRQ Patient Safety Network, "Readmissions and Adverse Events After Discharge," 2024). An agency that cannot quantify its own work probably is not doing it.

If the agency uses any of these phrases — "Medicare will only pay if…", "she has plateaued so we need to discharge," "the doctor already did the face-to-face so we don't need anything from you," "we don't really track that" — treat them as soft red flags and ask a follow-up question. None of those statements is necessarily wrong, but each one has a precise version that a well-run agency can give you without hedging.

Take these nine questions to the intake call. The printable PDF is the same questions on one page, with space for notes — usable with any agency, not just Kassy.

Download the PDF (1 page)
What Good Looks Like

Green flags vs. red flags when choosing an agency

This is the shorthand pattern. If most of an agency's answers fall in the left column, you have found a partner. If most fall in the right column, keep looking.

Green flags — what good looks like
Red flags — what to walk away from
Names a CMS star rating with a specific number and a link to its Care Compare profile.
Refuses to name a star rating or rounds 3 stars up to “highly rated.”
Gives you its Florida AHCA license number without being asked and invites you to look it up on FloridaHealthFinder.
Treats AHCA licensure as a synonym for Medicare certification. They are different. Both should be active.
Names a single RN case manager on Day 1 with a direct phone number.
Tells you “the team will call you” without committing to a single point of contact.
Explains aide assignment and substitution policy in writing, including how the agency handles aide call-outs.
“Different aides every visit” without an apology or a backfill protocol.
Tracks and shares a missed-visit rate and explains the 24-hour line escalation path.
“That doesn’t happen here.” Every agency has missed visits. The question is what the agency does about them.
Handles the face-to-face paperwork with the physician without involving you.
Asks the family to chase the F2F note from the certifying physician.
Talks about maintenance therapy as a covered benefit when a skilled clinician is needed to prevent decline.
Repeats the “plateau” myth (“she no longer needs PT so Medicare will stop”) — contradicted by Jimmo v. Sebelius.
Offers bilingual clinicians and Spanish-language materials if a Spanish-speaking family member is involved.
“We’ll use a translation app” when written discharge instructions and OASIS questions are at stake.
Cites its 30-day readmission rate and describes a front-loaded first week.
Cannot describe what the first seven days actually look like beyond “the nurse will come.”
How To

How to use Medicare Care Compare in five steps

This is the five-minute version. Do it before the first agency phone call — the questions in Section 3 are sharper when you already know the star ratings.

  1. Open Medicare Care Compare and select Home Health

    Go to medicare.gov/care-compare, choose "Home Health" as the provider type, and enter the patient's ZIP code. This pulls every federally-certified agency that serves that address — not just the ones the hospital named.

  2. Read the Quality of Patient Care star rating

    This is the clinical-outcomes half of the score, calculated from nine OASIS-derived measures including timely initiation of care, improvement in walking and bathing, medication management, and acute-care hospitalization risk. National median is 3 stars; 4 stars and 5 stars are above average. CMS publishes the full methodology.

  3. Read the Patient Survey (HHCAHPS) star rating

    This is the family-experience half of the score, from the HHCAHPS survey families receive after discharge. It captures whether the team communicated well, whether discharge information was clear, and whether the family would recommend the agency. An agency can score high on Quality of Patient Care and lower on Patient Survey — or the reverse. Read both.

  4. Compare three or four agencies side by side

    Use the comparison feature to view three or four agencies together. Look at both star ratings, the underlying measure percentages, and the services each agency offers — nursing, physical therapy, occupational therapy, speech therapy, medical social work, and home health aide. An agency missing one of these disciplines may not be the right fit for a parent who needs all of them.

  5. Cross-check Florida licensure on FloridaHealthFinder

    Open FloridaHealthFinder's HHA compare tool and look up the same agency name. Confirm the Florida AHCA license is active, and read any recent inspection findings or complaint history. This is the licensure-and-enforcement layer Care Compare does not show.

Evidence & Local Context

What the data actually says — and what Central Florida families should know

The Medicare Quality of Patient Care star rating is not an opinion poll. CMS builds it from nine OASIS-based measures (timely initiation of care, improvement in ambulation, transferring, bathing, dyspnea, pain management, medication education, and two measures of acute hospitalization and emergency-department use). The methodology is published in full in the CMS Home Health Star Ratings methodology (updated 2025), with a consumer-facing explanation on the Care Compare resources page. The Patient Survey star rating is built from HHCAHPS, the federal home health patient-experience survey developed by AHRQ and administered by CMS.

National medians and distributions matter when you read a star rating. In the April 2024 quarterly refresh, the median Quality of Patient Care rating across roughly 8,000 Medicare-certified home health agencies was 3 stars, with roughly a quarter of agencies earning 4 stars and a small share earning 5 (CMS Home Health Star Ratings, public refresh tables). That is why a 4-star or 5-star score is a meaningful trust signal — it is above the population median, not a marketing claim. The rating refreshes quarterly; the date on the Care Compare profile tells you which refresh you are reading.

Families in Florida have a second public layer: licensure. Florida's Agency for Health Care Administration (AHCA) licenses every home health agency under Chapter 400, Part IV of the Florida Statutes. Public licensure status, inspection findings, and complaint history are searchable at quality.healthfinder.fl.gov — the state's renamed FloridaHealthFinder portal (migrated 2024–2025). The site also offers an HHA compare tool that pairs neatly with Medicare Care Compare.

Central Florida is also large and getting older. Census QuickFacts (vintage 2024) report adults age 65 and over make up 16.4% of Orange County, 19.4% of Seminole County, 16.7% of Osceola County, and 28.0% of Brevard County — Brevard is one of the oldest county populations in Florida (U.S. Census Bureau QuickFacts, four-county comparison). Chronic-disease prevalence by county is published on the FLHealthCHARTS County Health Dashboard (Florida Department of Health) — the same data set that shapes hospital discharge volumes back to home health.

One more thing families should know up front. AHRQ's Patient Safety Network primer on "Readmissions and Adverse Events After Discharge" (updated 2024) describes the period immediately after hospital discharge as the highest-risk window for the patient. Roughly one in five Medicare beneficiaries is readmitted within 30 days, with medication errors, missed follow-ups, and unaddressed red-flag symptoms as the most common preventable drivers. The agency you choose in the first 48 hours is the one running that window. The interview questions in Section 3 are designed to surface whether the agency runs it on autopilot or actually staffs it — the most common version of the question, in plain language, is "will a visiting nurse actually show up on Day 1, and will the same one come back on Day 3."

A note on the home bound (two-word) spelling. Some discharge planners and physician offices use the two-word spelling "home bound" interchangeably with "homebound." Medicare itself uses one word, but the underlying definition is the same: the patient must require a considerable and taxing effort to leave the home and leaves only infrequently or for medical care. If an agency seems unsure how that test applies to your parent — for example, a parent who still drives to a single weekly grocery trip or church service — that is itself a clue. A good agency will walk you through the two-part test before quoting a coverage decision.

Frequently Asked Questions

Questions families actually ask while comparing agencies

These are the eight questions we hear most often on Central Florida intake calls. Each answer is short, practical, and what we would tell our own family.

CMS calculates the Quality of Patient Care star rating from nine OASIS-based clinical outcome measures — things like improvement in walking, bathing, pain management, medication management, and the rate at which the agency's patients return to the hospital. 3 stars is the national median (average performance). 4 stars is above average; 5 stars is in the top tier nationally. Roughly 1 in 4 Medicare-certified agencies earns 4 stars; only a small share earn 5. The methodology is published on the CMS Home Health Star Ratings page.

No. Federal law requires that the hospital give you a list of every Medicare-certified agency in your area that serves your address — not just one. Hospitals frequently steer to a single preferred partner, but you have the right to choose any certified agency. The patient-choice rule lives in the Home Health Conditions of Participation (42 CFR Part 484). Compare two or three agencies on Medicare Care Compare and ask the nine interview questions above before you sign.

Yes. You can change agencies during an open episode of care. The new agency will coordinate the transfer, contact the certifying physician, and pick up the plan of care. There is no Medicare penalty and your benefit is not interrupted. The transfer right is part of the patient-rights provisions in 42 CFR Part 484. Tell the current agency in writing (a text or email is fine), then call the new agency — they handle the rest.

Call the agency listed on the discharge paperwork directly. If you cannot reach them, call the hospital case manager who set up the referral. If the agency continues to no-show or you cannot get a visit scheduled, any other Medicare-certified agency that serves your ZIP code can pick up the case — you do not have to wait. You can also file a complaint with Florida AHCA through quality.healthfinder.fl.gov and a separate complaint with the Medicare Beneficiary Ombudsman.

Not always. Original Medicare covers home health from any Medicare-certified agency. Medicare Advantage plans typically require the agency to be in network and may require prior authorization. Ask the agency directly which Medicare Advantage plans they contract with, and ask the plan whether your agency of choice is in network — both answers should match. The April 2024 CMS interoperability and prior-authorization rule has tightened MA timelines: 7 calendar days for a standard prior-authorization decision and 72 hours for an expedited one. Agencies that handle MA in volume should know these timelines without checking.

Aide assignment is an agency-level scheduling choice, not a Medicare rule. Aide turnover and last-minute substitutions are the single most common complaint families report — AgingCare titles such as "I have switched companies 20 times" and "my home health aide hasn't been showing up" show how common this is. Before you sign, ask how many home health aides have left in the last six months, whether the same aide can be assigned to your case, and what happens when an aide calls out. You have the right to ask and the right to switch agencies if the answers do not work for your family.

Florida-licensed means the agency holds an AHCA license to operate in Florida — required for any home health agency in the state. Medicare-certified means that same agency has also been surveyed and approved to bill Medicare. Many Florida agencies are state-licensed but not Medicare-certified; those agencies cannot provide the visits Medicare pays for. Verify both: AHCA license on FloridaHealthFinder, Medicare certification on Medicare Care Compare.

CHAP (Community Health Accreditation Partner) is one of three federally-recognized accrediting bodies for home health agencies. CHAP-accredited agencies are surveyed every three years against standards that exceed the minimum Conditions of Participation. CHAP is voluntary — only a portion of Medicare-certified agencies pursue it. Pairing CHAP accreditation with a 4-star or 5-star CMS rating is a stronger trust signal than either alone, because the two are independent assessments.

Sources

Sources cited on this page

Every statistic, regulation, and methodology claim above is linked inline and listed in full here. URLs were click-tested on 2026-05-13.

  1. Centers for Medicare & Medicaid Services. Home Health Star Ratings — Methodology and Public Refresh Tables. Updated 2025. Accessed May 2026. https://www.cms.gov/medicare/quality/home-health/home-health-star-ratings
  2. Medicare.gov. Care Compare — Home Health (Quality of Patient Care consumer methodology). Accessed May 2026. https://www.medicare.gov/care-compare/resources/home-health/quality-of-patient-care/
  3. Medicare.gov. Care Compare — Home Health Provider Search. Accessed May 2026. https://www.medicare.gov/care-compare/?guidedSearch=HomeHealth
  4. Centers for Medicare & Medicaid Services. Home Health Conditions of Participation (42 CFR Part 484). eCFR, current edition. Accessed May 2026. https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-G/part-484
  5. Centers for Medicare & Medicaid Services. Medicare Benefit Policy Manual, Chapter 7 — Home Health Services. Pub. 100-02. Accessed May 2026. https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/bp102c07.pdf
  6. Centers for Medicare & Medicaid Services. Jimmo v. Sebelius Settlement Agreement Fact Sheet. Accessed May 2026. https://www.cms.gov/Center/Special-Topic/Jimmo-Center
  7. Home Health CAHPS (HHCAHPS) Survey. HHCAHPS Program Overview — Patient-Experience Methodology. Accessed May 2026. https://homehealthcahps.org/
  8. Agency for Healthcare Research and Quality. Patient Safety Network: Readmissions and Adverse Events After Discharge. Updated 2024. https://psnet.ahrq.gov/primer/readmissions-and-adverse-events-after-discharge
  9. Florida Agency for Health Care Administration. Home Health Agencies — Laboratory and In-Home Services Unit. Accessed May 2026. https://ahca.myflorida.com/health-quality-assurance/bureau-of-health-facility-regulation/laboratory-and-in-home-services/home-health-agencies
  10. Florida Agency for Health Care Administration. FloridaHealthFinder — Home Health Agency Compare Tool. Accessed May 2026. https://quality.healthfinder.fl.gov/compare-tools/HHA
  11. U.S. Census Bureau. QuickFacts: Orange, Seminole, Osceola, and Brevard counties, Florida (four-county comparison; vintage 2024 ACS 5-year estimates). Accessed May 2026. https://www.census.gov/quickfacts/fact/table/orangecountyflorida,seminolecountyflorida,osceolacountyflorida,brevardcountyflorida
  12. Florida Department of Health. FLHealthCHARTS County Health Dashboard — Leading Causes of Death & Chronic Diseases. Accessed May 2026. https://www.flhealthcharts.gov/ChartsDashboards/rdPage.aspx?rdReport=CountyHealth.LCDAndChronicDiseases&tabid=LCDAndChronicDiseases

For related reading, see our pages on resources for families, what happens in the first week of home health, our home health services, conditions we treat, and the printable interview questions PDF.

Central Florida Home Health

Take the nine questions to a real intake call

If you are comparing agencies, a Kassy Health intake nurse will walk through the same nine questions with you on the phone — with our answers in plain language — so you can use them on whichever agency you end up choosing. No paperwork, no commitment.

Kassy Health — Maitland, FL
Serving Orange, Seminole, Osceola, and Brevard counties since 2006.

  • Medicare-certified home health agency
  • CHAP-accredited
  • 4-star CMS Quality of Patient Care rating
  • Florida AHCA License #299993031
Orange County Seminole County Osceola County Brevard County
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