Families in Greater St. Louis often learn they need home health with only a day or two to pick an agency. A little structure helps. The steps below work whether you are leaving a hospital in the city, a rehabilitation center in St. Charles County or a home in the Metro East.
Gateway is not a home health agency. We do not rank agencies, but we can explain how the process works. Our overview of home health in St. Louis covers what home health is and what it is not.
Who starts the process
Home health generally begins with an order from a physician or another allowed practitioner. That clinician certifies the need and signs a plan of care once the agency has assessed you. Under Medicare, there is also a face-to-face encounter tied to the reason for care.
If you are in the hospital, a discharge planner or case manager usually sends the referral. If you are at home, call your physician’s office and say you are asking about home health.
Know your choices
You are allowed to pick the agency. Hospitals commonly share a list of agencies that serve your ZIP code and are expected to respect your preference. If you feel rushed, ask for the list and a few hours to look at it.
Check your plan first. Original Medicare, Medicare Advantage, Medicaid and commercial plans each have their own rules, and some plans only work with certain agencies. Call the number on your insurance card and ask which agencies take part.
Use Medicare Care Compare
Medicare Care Compare is a search tool on Medicare’s website. Search for it by name, enter your ZIP code and you can see home health agencies that serve your area, along with quality information published by Medicare. It lists agencies that take part in Medicare, so it is a sensible place to begin even if you have a Medicare Advantage plan.
Use it to build a short list of three or four agencies instead of calling every name you find. Ratings and measures are one input. They do not tell you how an agency will communicate with your family.
What to compare
- Whether the agency serves your address and which days its staff visit.
- Which services it offers: nursing, physical therapy, occupational therapy, speech therapy, social work, aides.
- Whether it takes part in Medicare and works with your plan.
- How it handles wound care, medications and equipment.
- How the agency contacts you and your physician.
- How quickly it can typically do the first assessment, which you should ask about rather than assume.
Questions to ask each agency
- Do you take part in Medicare, and do you work with my plan?
- Who will visit, how often, and what will each visit include?
- Who do I call after hours or when something changes?
- How do you communicate with my physician and with family members?
- What will I be asked to pay, if anything, and how will I know in advance?
- What happens if I am no longer eligible for visits?
Write the answers down. Our guide to the questions to ask about Medicare and home health can help with the cost and eligibility side.
What happens at the start of care
After you choose, the agency usually schedules an assessment visit. A nurse or therapist looks at your health, your home, your medications and your goals. The agency then works with your physician to finalize a plan of care. You should be told what to expect, who will visit and what the plan says.
Homebound status is an important part of the Medicare rule. If you are unsure whether it applies, read about what homebound means.
When a wound or medical problem needs more attention
Agency nurses follow the orders in the plan of care. If a wound is not changing, or you need a clinician to examine a problem and update orders, a house call can work alongside the agency. Gateway coordinates that through wound care for home health patients, with the treating clinician making the clinical decisions. To ask about it, request care or call 314-325-0126.
For an emergency, call 911.
Common questions
Is Medicare Care Compare the only way to find an agency?
No, but it is a useful starting point. Your physician’s office, the hospital discharge team and your plan can also supply names. Compare more than one source, then call a few agencies yourself.
Can I switch agencies if I am unhappy?
Generally yes. Tell the agency and your physician, and ask how a transfer works so there is no gap in orders. Your plan may have steps to follow, so call it as well.
Does the agency I pick have to be close to my home?
It has to serve your address, not necessarily sit nearby. Agencies in the St. Louis area cover specific ZIP codes and counties, and staff travel to you, so confirm your ZIP code and county on the first call and ask which days they visit.
Do I need a new agency if I move between Missouri and Illinois?
Possibly. Agencies are licensed by state, and Medicaid rules differ between Missouri and Illinois. Ask your current agency and the new one what to do before you move, so orders and visits do not lapse during the transition.
Can a house call replace home health?
They are different services. Home health sends agency staff under a plan of care. A house call is a clinician visit for medical care. Some people use both, and the right mix depends on your orders and plan.
Related pages
General information to help you talk with your own clinician. It is not medical advice, and the treating clinician makes every clinical decision. For a medical emergency, call 911.
Updated October 2026