Private Duty Nursing for Children and Adults
Private duty nursing is for anyone, child or adult, whose care at home needs a licensed nurse present, not just visiting. Hours range from a four-hour shift so a parent can sleep or work to 24-hour care for someone on a ventilator. Children and adults use it for different reasons, are paid for differently, and need nurses with different skills.
| Hours | What it often looks like |
|---|---|
| 4 to 8 hours | Overnight so family caregivers can sleep; a block of time so a parent can work; a few weeks after surgery |
| 8 to 12 hours | School-day nursing for a child; day or night coverage for an adult while family covers the rest |
| 16 to 24 hours | Ventilator dependence, frequent suctioning, unstable seizures or other needs where the patient cannot safely be without a nurse |
Children with complex medical needs
Children usually come home on private duty nursing from a NICU or PICU, or after a new diagnosis. Common reasons:
- A tracheostomy or home ventilator, which needs suctioning, equipment checks and fast response to a blocked or dislodged tube.
- A G-tube or J-tube with continuous feeds, medications and site care.
- A seizure disorder that needs monitoring and rescue medication.
- Complex genetic, neuromuscular or heart conditions with several of the above.
What to know:
- Parents are still the primary caregivers. Nursing hours are usually approved to cover part of the day, and families are trained to cover the rest.
- Many families start with nights. Overnight shifts let parents sleep; daytime hours are added as parents return to work.
- Nurses can go to school. When a child starts school, the nurse may go along. Under federal disability law the school has duties too, so ask the school district and your payer who covers school hours.
- Pediatric skills are specific. Ask how the nurse was trained in pediatric trach and vent care and when their skills were last checked.
- Medicaid is the main payer. Children under 21 are covered for medically necessary care under EPSDT, and many states offer programs based on the child's income, not the parents'. See who pays.
Adults with complex or round-the-clock needs
Adults use private duty nursing for:
- Ventilator and tracheostomy care after an illness, injury or with conditions like ALS.
- Short stretches after surgery or a hospital stay, often a few overnight shifts.
- Complex medication, infusion or feeding schedules a family member can't safely manage alone.
- Advanced dementia with medical needs beyond what an aide can do.
- End-of-life care alongside hospice, adding nursing hours hospice does not provide around the clock.
What to know:
- Adults pay differently. Long-term care insurance, Medicaid waivers where the state offers them, the VA, workers' compensation for work injuries, and private pay are the usual routes. Medicare does not cover private duty nursing.
- Aide or nurse? Many adults need help with bathing, dressing and meals rather than skilled nursing. That is home care from an aide, and it costs less. A nurse is needed when the tasks are nursing tasks under your state's rules.
- Continuity matters for dementia. Ask how many different nurses will be on the case and how new nurses are introduced.
For both: questions to settle first
- What tasks need a nurse, and which could an aide or family member do? Ask the doctor to list them.
- How many hours, and which hours? Payers approve hours, not a person, so be specific about the hours that are unsafe without a nurse.
- RN or LPN? Your state's rules and the payer decide; many cases are staffed by LPNs under RN supervision.
- Who covers the gap when a nurse cancels? For a ventilator-dependent patient, a family member must be trained and ready.
Ask Vantor Care about nursing hours
For families in South Carolina, North Carolina, Georgia or Tennessee. Tell us a little about the patient and an intake coordinator will call you back.