What each one actually is
A home health agency sends skilled professionals — nurses, physical or occupational therapists, speech pathologists, medical social workers, home health aides — into the patient's home for visits. The person lives at home; care comes to them intermittently. Nobody is present between visits.
A nursing home, which CMS also calls a skilled nursing facility, provides care in a facility with staff present around the clock. It covers both short-term rehabilitation after a hospital stay and longer-term residential care, which is why the same building can serve two quite different populations.
The practical dividing line is usually whether someone is safe at home between visits — overnight, and in an emergency. That is a clinical judgement, not a preference, and it is the question a discharge planner is actually answering.
They are often stages, not alternatives
A common path after a hospitalisation is a period of rehabilitation in a skilled nursing facility, followed by discharge home with home health support during recovery. Families comparing the two as competing options are sometimes really looking at consecutive stages.
That matters for how you research. If a skilled nursing stay is expected to be temporary, the questions worth asking are about rehabilitation and discharge planning — how therapy is delivered, what the goal is, what happens next. If home health follows, the agency question arrives weeks later and is a separate piece of work.
Why the star ratings cannot be compared
CMS builds the two ratings from entirely different measurements. A nursing home's overall star is anchored on state health inspections and adjusted by staffing and quality measures. A home health agency's quality-of-patient-care star comes from patient-outcome and process measures drawn from assessments and claims — there are no inspections in it at all.
The scales differ too: nursing-home stars are whole numbers, home-health stars come in half-steps. And the nursing-home inspection component is graded on a curve within each state, while the home-health measures are not. A four-star agency and a four-star facility have nothing meaningful in common, and this site never combines them into one score or ranking.
How much data exists differs sharply
This asymmetry surprises people and changes the research. Nearly every certified nursing home carries a CMS overall rating. For home health, about a quarter of Medicare-certified agencies have no star and no reported quality measure at all, and in some states the share is far higher.
So the same research approach does not transfer. Choosing a nursing home is usually an exercise in reading a rich record carefully; choosing a home health agency frequently means working out what to do when the record is thin. Our research on home-health data availability by state measures how uneven that is.
What to ask, and who decides
Which setting is appropriate is a clinical decision made with the discharge planner, physician, and therapy team — not something a data site can determine, and not something this site attempts to advise on.
What you can usefully bring to that conversation is specificity: whether the person is safe alone overnight, what help is available at home and from whom, what the recovery goal is, and what happens if it is not met. Once the setting is settled, the public record does real work in choosing among providers within it.