August 28, 2026
4:28 am

What Is Private Duty Nursing?

Private duty nursing is skilled nursing care delivered in a person’s home by a licensed nurse — a registered nurse or a licensed practical nurse — on an hourly or shift basis, for continuous stretches of time. The defining feature is duration. A nurse is present for a block of hours, sometimes around the clock, rather than dropping in for a task and leaving.

The numbers explain the entire subject, so they come first.

$33 an hour. Roughly the recent national median for a home health aide, per the Genworth Cost of Care Survey, which at 44 hours a week works out to about $6,300 a month and $75,000 a year. An aide is not a nurse, and this figure is the floor, not the price of private duty nursing.

$50 to $95 an hour. The range market surveys have reported for licensed private duty nursing, with LPN care at the lower end and RN care, ventilator care or complex wound management at the upper end. Confirm current local rates with two agencies in your own county, because regional variation is enormous.

$200,000 to $400,000 a year. What continuous 24-hour private duty nursing costs at those rates. This is more than a private room in almost any nursing home in the country, and it is the number families do not see coming.

In This Article

What Medicare Pays, Which Is Not This
What Medicaid Pays, Which Depends Enormously on Age and State
What Long-Term Care Insurance Pays
The Terms It Is Confused With
The Honest Arithmetic on Funding It With a Policy
What to Do in the First Two Weeks
Frequently Asked Questions

What Medicare Pays, Which Is Not This

The single most common and most expensive misunderstanding: Medicare does not cover private duty nursing. Not Part A, not Part B, not under any ordinary circumstance.

What Medicare does cover is a different service with a similar name. Medicare’s home health benefit pays for intermittent skilled nursing, along with therapy, a home health aide in connection with skilled care, and medical social services, for a beneficiary who is homebound and under a plan of care established and periodically reviewed by a physician or allowed practitioner. The plan of care requirement is explained at what a plan of care is.

The word intermittent carries the whole restriction. Medicare’s rules define skilled nursing as intermittent when it is needed fewer than seven days a week, or daily for a limited period, and the combined skilled nursing and aide services are generally capped at fewer than eight hours a day and fewer than 28 hours a week, with limited exceptions permitting somewhat more on a short-term basis. Continuous hourly nursing falls outside that definition by design.

So a family calling Medicare to ask about eight hours a day of nursing at home is asking about a service the benefit does not contain. That is not a coverage denial to appeal. It is a different product.

What Medicaid Pays, Which Depends Enormously on Age and State

Medicaid is where private duty nursing is actually funded, and the rules split sharply by age.

For children under 21, private duty nursing is generally available through the Early and Periodic Screening, Diagnostic and Treatment benefit, which requires states to cover medically necessary services for eligible children regardless of whether the service is covered for adults in that state. Coverage for a medically fragile child is often extensive.

For adults, private duty nursing is an optional benefit. Some state Medicaid programs cover it; some cover it only through a home and community-based waiver; some cap the weekly hours; and some do not cover it for adults at all. There is no national answer, and a general article cannot give you one. Call the state Medicaid agency and ask two specific questions: does this state cover private duty nursing for adults, and if so, under the state plan or through a waiver, and what is the hour limit.

If it runs through a waiver, ask a third question: is there an interest list or waiting list, and how long is it currently? In several states that answer is measured in years, which changes the planning problem entirely. The waiver route and its alternatives are worth understanding alongside consumer-directed care, where a participant hires and supervises their own workers, sometimes including family members.

What Long-Term Care Insurance Pays

A long-term care policy is the third funding source, and its structure matters more than its existence.

Four features determine what a policy actually delivers. The daily or monthly benefit amount, which is a cap, not a reimbursement of whatever care costs. The elimination period, commonly 90 days, during which the household pays out of pocket — and on some policies those days must be days on which care was actually received and paid for. The benefit period, commonly two to five years or a total dollar pool. And the benefit trigger, which on tax-qualified policies generally requires either an inability to perform two of six activities of daily living without substantial assistance, expected to last at least 90 days, or a severe cognitive impairment.

Two practical cautions. Many older policies require care from a licensed agency and will not reimburse an independently hired nurse. And some policies pay less for home care than for facility care, or pay home care only as a percentage of the facility benefit. Read the schedule page before assuming.

If no long-term care policy exists, that is the common case rather than the exception, and the options are covered at paying for care without long-term care insurance.

Service	Who Provides It	Typical Recent Rate	Usual Payer
Private duty nursing, RN	Registered nurse	Roughly $65 to $95 an hour	Private pay, some Medicaid, LTC insurance
Private duty nursing, LPN	Licensed practical nurse	Roughly $50 to $70 an hour	Private pay, some Medicaid, LTC insurance
Home health aide	Certified aide	About $33 an hour, recent national median	Private pay, waivers, LTC insurance
Homemaker or companion	Unlicensed worker	Slightly below aide rates	Private pay, some waiver programs
Medicare home health	Certified agency	No cost sharing for covered visits	Medicare, intermittent care only
Skilled nursing facility	Licensed facility	Above $100,000 a year, semi-private median	Medicare short term, then private pay or Medicaid

The Terms It Is Confused With

The vocabulary in home care is imprecise, and the imprecision costs money because different services carry different licensure, different prices and different coverage.

Private duty nursing versus home health aide. An aide assists with bathing, dressing, toileting, transfers and mobility. An aide is not licensed to administer medications, manage a ventilator, provide tube feeding or perform sterile procedures. The price gap between the two is roughly two to three times.

Private duty nursing versus homemaker or companion care. Housekeeping, meals, errands and supervision. No clinical component, and the lowest cost of the three.

Private duty nursing versus custodial care. Custodial care is non-skilled assistance with daily living, which Medicare does not cover regardless of who provides it — see what custodial care is. The distinction between skilled and custodial is the hinge on which most home care coverage decisions turn.

Private duty nursing versus skilled nursing facility care. Same clinical category, different location and payment system. A facility bundles nursing, room, board and therapy at an institutional rate; see what a skilled nursing facility is. On a per-hour basis, facility nursing is far cheaper, which is why round-the-clock home nursing costs more than a nursing home.

Private duty nursing versus respite care. Respite is short-term relief for a family caregiver, measured in days rather than as an ongoing arrangement.

The Honest Arithmetic on Funding It With a Policy

This site exists to talk about life insurance, so here is the honest version rather than the flattering one.

Run the math before anything else. At $60 an hour, twelve hours a day, seven days a week, private duty nursing costs about $262,000 a year. A $500,000 life insurance policy sold in the secondary market might produce somewhere in the range of 10 to 35 percent of face value — the range the federal Government Accountability Office found in its study of the market, GAO-10-775. Call it $50,000 to $175,000. That is roughly two and a half to eight months of care.

Say that out loud before making a decision, because families routinely assume a policy sale solves a care problem when it actually postpones it by a season. Compare that to a nursing facility at a national median above $100,000 a year for a semi-private room, where the same proceeds might buy six months to a year and a half.

Where selling genuinely makes sense: the coverage is no longer needed by anyone, the premium is itself a strain on the household budget, the face amount is meaningful, and the cash creates a bridge to something — a Medicaid approval, a waiver slot, a sale of the house, a move to a different care setting. A bridge to a defined destination is a plan. A bridge to nothing is a delay.

Where selling is the wrong answer: the policy is small, the insured is in good health for their age so offers will be modest, a surviving spouse still depends on the death benefit, or the household is close enough to Medicaid eligibility that a lump sum would break it. That last one is not hypothetical — proceeds count as a resource and can end eligibility, which is why the timing question belongs to an elder law attorney before any transaction. See how a life settlement affects Medicaid, and for the counterargument stated plainly, when keeping the policy is the right answer.

What to Do in the First Two Weeks

A sequence that works.

First, get the clinical question settled. What exactly does this person need — licensed nursing, or an aide, or supervision? Ask the discharging physician or the home health agency to be specific, because the answer moves the hourly rate by a factor of two or three.

Second, call two or three licensed agencies in the county and get written hourly rates for RN, LPN and aide services, including any minimum shift length. Four-hour minimums are common and change the math.

Third, call the state Medicaid agency and ask the three questions above: adult coverage, state plan or waiver, and interest list length.

Fourth, call the Area Agency on Aging serving the county. They administer Older Americans Act programs, know the local landscape, and their help is free.

Fifth, if there is a long-term care policy, request the policy schedule page and a written claim procedure, and start the elimination period clock as early as the policy permits.

Sixth, only after all of that, look at household assets. Pine Lake Legacy provides education and a free, no-obligation policy review — send the policy cover page or call (732) 978-9575. We do not give legal, tax or Medicaid eligibility advice, and if the arithmetic says a policy sale would buy three months and cost you a death benefit your spouse needs, that is what you will hear.

Frequently Asked Questions

Does Medicare cover private duty nursing at home?

No. Medicare’s home health benefit covers intermittent skilled nursing for a homebound beneficiary under a physician-established plan of care, generally fewer than eight hours a day and fewer than 28 hours a week combined with aide services. Continuous hourly nursing falls outside that definition, so it is not a denial to appeal but a different service.

How much does 24-hour nursing at home actually cost?

At recent market rates of roughly $50 to $95 an hour for licensed nursing, around-the-clock care runs somewhere between $200,000 and $400,000 a year. That exceeds the cost of a private room in almost every nursing home in the country. Get written rates from two local agencies, since regional variation is very large.

Will Medicaid pay for it?

For children under 21, generally yes through the EPSDT benefit. For adults it is an optional benefit that varies enormously: some states cover it under the state plan, some only through a waiver with hour caps, and some not at all. Call the state Medicaid agency and ask specifically about adult coverage and waiting lists.

What is the difference between a nurse and a home health aide?

A licensed nurse can administer medications, manage ventilators and feeding tubes, perform sterile procedures and assess clinical status. An aide assists with bathing, dressing, transfers and mobility but is not licensed for clinical tasks. The price difference is roughly two to three times, so getting the clinical requirement right matters financially.

Can we fund this by selling a life insurance policy?

Run the arithmetic first. Proceeds in the range federal research has reported, roughly 10 to 35 percent of face value, mean a $500,000 policy might fund two to eight months of full-time private duty nursing. That can be a useful bridge to a defined destination, but it rarely solves an open-ended care need on its own.

What should I ask a home care agency before hiring?

Ask for written hourly rates by discipline, the minimum shift length, whether nurses are employees or contractors, how they cover a call-out, whether they carry liability and workers compensation coverage, and whether they are licensed by the state. Ask a long-term care insurer separately whether that agency’s services qualify for reimbursement.

Find out what your policy is worth — free, confidential, no obligation.

A 15-minute educational review covers your eligibility, every alternative, and a realistic view of what each path would net you.

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