Private duty nursing is nursing care at home in longer shifts, provided by a registered nurse or licensed practical nurse under the direction of the person's doctor. It is for people whose medical needs call for more continuous attention than a nurse who visits for an hour can give. Original Medicare does not pay for 24-hour-a-day care at home, so it is paid for by Medicaid in states that cover it, other insurance, VA benefits or the family.
This guide explains what private duty nursing is, how it differs from Medicare home health and from non-medical home care, how it is paid for and how to choose an agency. It describes services in plain terms. It is not medical advice. What nursing care a person needs is for their doctor and care team to decide. Carevo is a directory. It does not provide care or vouch for any agency.
What private duty nursing is
The federal Medicaid definition, at 42 CFR 440.80, describes private duty nursing services as nursing services for people who need more individual and continuous care than is available from a visiting nurse, or than the nursing staff of a hospital or skilled nursing facility routinely provide. The services are provided by a registered nurse or a licensed practical nurse, under the direction of the person's physician. The rule allows them to be provided at home, in a hospital or in a skilled nursing facility, at the state's option.
In everyday use, private duty nursing means a nurse spends a longer block of time with one person at home, often a full shift. The nurse carries out the medical tasks the doctor has ordered and watches for changes. It can be for a limited period, such as after a serious illness, or ongoing.
Who uses private duty nursing
It is used by people whose doctors say they need skilled nursing care at home for longer stretches than visits can cover. What counts as a need for continuous nursing is for the doctor to decide and, if a program is paying, for the program to approve. Common reasons families ask about it:
- A person coming home from hospital with medical needs that cannot be covered by short visits.
- A person with a long-term medical condition who needs a nurse present for part of the day or night.
- A family that is providing complex care and needs trained cover so it can sleep or work.
If you are not sure whether nursing is needed or whether non-medical help would do, ask the doctor or the hospital discharge planner. For daily help without nursing, see home care.
What a private duty nurse does and does not do
A nurse commonly:
- Carries out medical tasks ordered by the doctor, such as the skilled tasks Medicare.gov lists under home health: wound care, injections, IV or nutrition therapy and monitoring of serious illness or unstable health
- Observes the person and reports changes to the doctor and family
- Teaches family members how to manage care at home
- Documents what was done and what was seen
A nurse does not decide treatment on their own. The doctor directs the care. Ask what the nurse will and will not do on a shift, and who the nurse calls if the person's condition changes. For emergencies, call 911.
Private duty nursing compared with similar services
- Home health care is part-time or intermittent skilled care. A nurse or therapist visits, then leaves. Medicare can pay when its rules are met.
- Home care and personal care are non-medical help with daily life. An aide is not a nurse.
- 24-hour home care and live-in care describe round-the-clock non-medical care. They can be combined with nursing.
- Hospice is comfort care for a terminal illness with a team that includes nurses.
- Nursing homes provide nursing care in a facility.
- Dementia care is non-medical help that may sit alongside nursing.
How private duty nursing is paid for
Medicare. Medicare.gov says Medicare pays for part-time or intermittent skilled nursing as part of home health when you are homebound, a provider orders it and a Medicare-certified agency provides it. It lists 24-hour-a-day care at home as not covered, and says skilled nursing and aide services combined typically total up to 8 hours a day and 28 hours a week, with up to 35 hours a week allowed for a short time if your provider decides it is necessary. See the Medicare guide and the Medicare home health checker.
Medicaid. Medicaid defines private duty nursing at the federal level, but states decide whether and how they cover it. The federal home health rule at 42 CFR 440.70 separately requires home health nursing, aide services and supplies, and does not limit them to people who are homebound. Medicaid.gov says home and community-based waivers must follow an individualized, person-centered plan of care, and that states choose how many people a waiver serves. Call your state Medicaid agency and ask whether private duty nursing is covered and how to apply. Some states let participants self-direct services, hiring and supervising their own workers. See Medicaid and long-term care and the state programs.
VA. VA lists Skilled Home Health Care, home-based primary care, and telehealth, among others. For the home-based services on VA's long-term care page, you must be enrolled in VA health care, VA must determine you need the service, and it must be available near you. A copay may apply. Ask a VA social worker. See VA benefits.
Long-term care insurance. Oregon's insurance regulator says policies usually pay a fixed amount per day, week or month, and most set a lifetime maximum. Whether your policy pays for a nurse at home, and for how many hours, depends on the policy. See long-term care insurance.
Private pay. Many families pay directly. See private pay, and use the care cost comparison to compare with other settings.
What drives the cost
Carevo does not publish a price for private duty nursing. What moves the bill:
- Nurse type. An agency's rates can differ for a registered nurse and a licensed practical nurse.
- Hours. The longer and more continuous the coverage, the higher the bill. Ask about nights, weekends and holidays.
- Skill level. Complex tasks and special training may be priced differently.
- Agency or independent. An agency's rate covers the nurse's pay, insurance, scheduling, supervision and back-up cover.
- Funding rules. A program that pays may approve a set number of hours, pay only certain providers and require prior approval.
For comparison, the Bureau of Labor Statistics reports a national median wage of $17.21 an hour for home health and personal care aides in May 2025. That is what aides are paid, not what an agency charges, and it is not a guide to what a nurse costs.
Getting ready for a nurse at home
Nursing care at home works best when the home and the paperwork are ready. Ask the doctor or discharge planner what equipment and supplies are needed, and who orders them. Medicare.gov says home health covers durable medical equipment and medical supplies for use at home, so if equipment is involved, check which program pays. Keep an up-to-date list of medications, allergies, diagnoses and the contact details for every doctor in one place where a nurse can find it. Agree who the nurse should call first in an emergency, and who should be told of any change. Make a space for the nurse to rest during the shift, and agree breaks and meals in advance. Tell the agency about any other caregivers in the home so they can coordinate with each other.
It also helps to set up a regular update, such as a short call or shared notes after each shift, so the family and the doctor see the same picture. If the family is providing care too, ask the nurse to show you the tasks you are expected to do, and ask the doctor to confirm them.
How to choose a private duty nursing agency
- Start with the doctor. Ask what nursing tasks are needed, for how many hours and at what times. Ask for the orders in writing.
- Ask the payer first. If Medicaid, the VA or an insurer will pay, ask which agencies it will pay and what approval it needs before you call.
- Shortlist agencies. Ask the doctor, hospital discharge planner and the payer. Browse private duty nursing agencies on Carevo by state and city. We have not confirmed that every agency listed provides private duty nursing, so ask each one directly.
- Verify the nurses. Ask whether nurses are licensed in your state and for how that can be checked, and check licenses with your state board of nursing.
- Meet the team. Ask to meet the nurse who will come, and ask who supervises and what training the nurse has for your relative's condition. Alzheimer's Association guidance on in-home care notes that skilled care is carried out by licensed professionals, often coordinated by a home health agency after a physician orders it.
- Get the plan in writing. Orders, hours, tasks, who to call and what happens if a nurse cannot come.
Questions to ask
- Do you employ RNs and LPNs? Who would care for my relative?
- Are your nurses licensed in this state? Can I see proof?
- Do you have nurses with experience of this person's condition and equipment?
- Who supervises the nurses, and how often?
- What happens if the nurse calls in sick? How much notice will we get?
- Will the same nurses come regularly?
- How do you communicate with the doctor and with the family?
- How do you handle an emergency during a shift?
- Which payers do you bill? Do you help with prior approvals?
- What are your rates by shift, and do they change at night or on weekends?
Red flags
- No answer on nurse licensing or who supervises.
- Promises that Medicare will pay for continuous or 24-hour nursing at home.
- Nursing tasks done without a doctor's order.
- Unexplained gaps in coverage, with no back-up plan.
- No written plan, or unclear billing.
- Nurses who rotate constantly, so no one knows the person.
Next steps
- Ask the doctor or discharge planner what nursing care is needed and for how long.
- Ask the payer, if there is one, which agencies and approvals apply.
- Weigh options in the care cost comparison.
- Tell us what you need and we will show agencies that serve your area. You decide who to call.