Private Duty Nursing vs Home Health
Home health sends a nurse or therapist for a short visit, usually under an hour, to do a skilled task and leave, on a plan of care a doctor signs. Private duty nursing puts a nurse in the home for a shift, from four to twenty-four hours, for someone who needs nursing the whole time. Medicare covers home health for homebound patients; it does not cover private duty nursing.
| Home health | Private duty nursing | |
|---|---|---|
| What happens | Visits: a nurse, therapist or aide comes, does a task, leaves | Shifts: a nurse stays with the patient for a block of hours |
| Typical length | A visit, a few times a week, for weeks | 4 to 24 hours a day, for weeks to years |
| Who it is for | Recovery after a hospital stay, a new diagnosis, wound care, therapy | Complex needs that need a nurse present: ventilators, trachs, feeding tubes, seizures, unstable conditions |
| Ordered by | A physician, with a plan of care | A physician when insurance or Medicaid pays; private-pay families can arrange it directly, though agencies still need orders for skilled tasks |
| Medicare | Covered for homebound patients needing part-time skilled care | Not covered |
| Medicaid | Covered in every state | Covered for children under 21 when medically necessary (EPSDT); for adults, depends on the state plan or a waiver |
| How it ends | When goals are met or the patient is no longer homebound | When the need for continuous nursing ends or coverage runs out |
What home health is
Medicare-certified home health is built around intermittent skilled care. Medicare's definition of "part-time or intermittent" is fewer than 8 hours a day and 28 or fewer hours a week (up to 35 in some limited cases), and the patient must be homebound, under a doctor's care and seen face to face. A nurse might come twice a week to change a dressing and check vital signs; a physical therapist might come three times a week after a hip replacement. You can check the rules on Medicare.gov's home health page and compare certified agencies on Medicare Care Compare.
What private duty nursing is
Private duty nursing is continuous: the nurse is there for the shift, watching the patient, giving medications and feeds, suctioning a trach, managing a ventilator, and responding when something changes. It is typically arranged in shifts of four, eight, twelve or twenty-four hours. Care Compare does not list private duty providers, because Medicare does not pay for the service; your state's health department licenses them.
Where they overlap
- The same agency can do both. Many licensed agencies run a home health line and a private duty line. Ask which one you are being offered.
- A patient can have both at once. A child on a ventilator might have private duty nurses for most of the day and a home health therapist visiting twice a week.
- The nurses hold the same licenses. RNs and LPNs work in both. What differs is the hours, who orders the care and who pays.
How to decide which one a patient needs
- Does someone with nursing skills need to be present the whole time? If the patient could not safely be left with a family member or an aide for a few hours, that points to private duty nursing.
- Is the need a task or a presence? A task (a wound, an injection, therapy) fits home health visits. A presence (watching breathing, responding to seizures) fits private duty.
- Is it short-term recovery or ongoing? Home health usually ends when recovery goals are met. Private duty can last years.
- Who will pay? If the patient has only Medicare, home health is covered and private duty is not. See who pays for a private duty nurse.
- Ask the discharge planner or doctor directly: "Does this patient need intermittent skilled visits, or continuous nursing?" Their answer usually shapes what a payer will approve.