While I would not comment on medical care as it seems pretty good, the hospital and nursing staff per se are not.
First, you can't leave a person on his own. Room doors must be kept closed. There is no bell or button on the bed to call for help. If you need help you need to be able to get to the phone (in a table behind the bed) and dial the nurse station phone number. I kept on moving the table closer to the bed but the nurse will push it back any chance she got. Similarly, no emergency call button in the bathroom.
Second, in one of our several visits for my husband, we arrived through the emergency room at about 9:30pm. My husband was extremely cold (in part due to his condition) and had been covered with lots of blankets in the ER. We get to his room, I ask for a blanket for him and another for me, only to be told that they don't have blankets after 9pm. I insisted to get one for my husband at the very least. Nothing, the nurses simply don't have access to blankets or bottled water after 9pm when the "Guest services" person leaves for the day. I ended up asking for lots of sheets and covering my husband with those.
Third, you don't get food or the diet the doctor put you in, unless you ask and check what it is that they are giving you. Just ask and insist, and they get you what you want or what's in your doctor prescribed diet. Don't expect them to check this for you.
I also had elective surgery there a few years ago. After surgery (with local and a sedative) I remember to my astonishment that I was rolled into an OR where I could a slit of light coming in from an unsealed door to a hallway. After surgery I stayed for one night. The nurse pulled in an uncovered used (maybe disinfected but I don't know) thermometer from the breast pocket of her outfit and pushed it into my mouth. I found out later on checking out that there was a covered thermometer in the drawer of my night table just for my personal use.
In talking with one of my husband's doctors, he said HOMS spent a ton of money bringing a team of nurses from Puerto Rico to train the nursing staff but that didn't help much.
HOMS is, however, the best alternative for anyone leaving in the North Coast -- although if it were an emergency situation and something neurological I would go to CMC in Sosua.