Private Nurse Home Care

Understanding Private Duty Nursing

Private duty nursing offers a unique and personalized healthcare experience for individuals who require continuous care beyond what standard home health services can provide. This type of care is ideal for those with chronic illnesses, rehabilitation needs, or continuous medical supervision, making it a valuable option for many patients and their families.

What is Private Duty Nursing?

Definition of private duty nursing

Private duty nursing (PDN) refers to specialized nursing services provided to patients in their homes. This service is particularly aimed at Medicaid members who require individual and continuous nursing care exceeding what a certified home health agency (CHHA) can offer. In typical scenarios, CHHAs provide care for less than two hours per service, making PDN essential for those needing more extensive assistance.

Differences from other home care services

Unlike other home care services that may include non-medical assistance, such as bathing and household chores, PDN focuses exclusively on skilled nursing tasks. Here are some key distinctions:

Feature	Private Duty Nursing (PDN)	Certified Home Health Agency (CHHA)
Type of care	Skilled nursing tasks	Limited nursing, often non-skilled tasks
Duration of service	Continuous and extensive care	Typically under 2 hours per visit
Providers	Licensed Home Care Agencies (LCHSAs), independent RNs, and LPNs	Varies, often includes unlicensed aides
Medicaid eligibility	Requires prior approval from an enrolled physician	May not need prior approval for basic services

All nurses providing PDN must hold valid RN or LPN registrations in New York State and work under physician oversight if an independent LPN. Thus, PDN encapsulates a more intensive approach to home health care, emphasizing patient-centered, skilled nursing support.

Scope of Services in Private Duty Nursing

Types of Services Provided

Private duty nursing (PDN) focuses on personalized, one-on-one care tailored to each patient's specific health challenges. Unlike services offered by certified home health agencies (CHHAs), which typically provide less than two hours of nursing care per visit, PDN involves continuous skilled nursing tasks.

Common services provided include:

• Medication Administration: Ensuring the patient receives their medications safely and on schedule.
• Ventilator and Tracheostomy Care: Specialized care for patients who require assistance with their breathing apparatus.
• G-tube Feeding: Nutritional care for individuals who are unable to consume food orally.
• Seizure Monitoring: Maintaining oversight for patients with seizure disorders.
• Wound Care: Managing and treating wounds to promote healing.

How Care Plans Are Developed

Care plans in private duty nursing are developed collaboratively, involving the patient's physician, registered nurses (RNs), or licensed practical nurses (LPNs). Prior to accessing PDN services, a Medicaid member must secure approval from a Medicaid enrolled physician or nurse practitioner.

The process typically includes:

• Initial Assessment: Evaluating the patient's health needs and requirements.
• Customization: Creating a care plan that addresses the patient's specific medical conditions and preferences.
• Regular Reassessment: Continuously adjusting the care plan based on changing health conditions and needs.

All nurses providing PDN services must hold a current RN or LPN registration with the New York State Department of Education, ensuring a high level of care and compliance with state regulations.

Service Type	Description	Requirement
Medication Administration	Administering prescribed medications	RN or LPN required
Ventilator & Tracheostomy Care	Managing respiratory equipment for patients	RN or LPN required
G-tube Feeding	Providing nutrition via a gastric tube	RN or LPN required
Seizure Monitoring	Observing and responding to seizures	RN or LPN required
Wound Care	Treating and caring for wounds	RN or LPN required

This framework ensures that patients receive tailored, effective nursing care right in the comfort of their own homes while promoting independence and enhancing their quality of life.

How to Access and Fund Private Duty Nursing

Payment options and insurance coverage

Accessing private duty nursing services can be financially demanding. Individuals may consider various payment methods to cover costs effectively.

• Personal Funds: Many families opt to use personal savings to pay for nursing services.
• Long-Term Care Insurance: This type of insurance often provides coverage for private duty nursing, helping to alleviate financial burdens.
• Veterans Benefits: Eligible veterans can access specific benefits that may help with the costs of nursing care.
• Home Equity: Homeowners can explore options such as reverse mortgages or selling property to secure funds for nursing services.

Accessing services through Medicaid

Medicaid members needing more intensive care than what a certified home health agency (CHHA) can provide may qualify for private duty nursing (PDN) services.

To access PDN:

1. Obtain a Prior Approval: A physician or nurse practitioner enrolled in Medicaid must authorize the need for PDN services.
2. Service Oversight: Services provided by Licensed Practical Nurses (LPNs) must be supervised by a licensed physician.
3. Claim Submission: After exhausting other insurance options, claims can be submitted to Medicaid for reimbursement.

By understanding these pathways, families can better navigate funding for essential private duty nursing services.

Qualifications and Standards of Care

Qualifications for Nurses

To provide Private Duty Nursing (PDN) services under New York State Medicaid, nurses must meet specific qualifications. Both Registered Nurses (RNs) and Licensed Practical Nurses (LPNs) are required to:

• Hold a current registration with the New York State Department of Education.
• Be enrolled in the Medicaid program to ensure they can bill for their services.

These regulations help maintain a high standard of care for Medicaid members who need continuous nursing assistance.

Oversight and Regulation

PDN services are strictly regulated to ensure the safety and efficacy of care provided. Here are the key oversight points:

• Medical Oversight: For services administered by independent LPNs, the care must be overseen by a licensed physician. This ensures that skilled nursing tasks are carried out under professional scrutiny.
• Approval Process: Prior approval from a Medicaid-enrolled physician or nurse practitioner is necessary for members to access PDN services. This step is crucial as it validates the need for more intensive nursing care.

Requirement	Details	Importance
RN/LPN Registration	Must be current and valid	Ensures qualified practitioners
Medicaid Enrollment	Required for billing	Validates service eligibility
Physician Oversight	Mandatory for independent LPN services	Guarantees patient safety
Prior Approval	Needs to be obtained for PDN access	Confirms necessity of services

These standards are vital for ensuring that individuals receive the level of care they need and deserve.

Understanding Coverage Options

Is in-home nursing care covered by Medicare?

Yes, in-home nursing care is covered by Medicare under specific conditions. Medicare Part A and Part B offer coverage for eligible home health services when individuals require part-time or intermittent skilled care and are homebound due to an illness or injury.

Covered services include skilled nursing care, physical therapy, occupational therapy, and home health aide services. These must be part of a care plan established by a physician. It's important to note that custodial care, such as non-skilled activities like bathing or household chores, is not covered under Medicare.

Typically, beneficiaries face minimal costs; however, they may need to cover 20% of the expenses for durable medical equipment, depending on the service.

Medicaid approval process

To access Private Duty Nursing (PDN) services through Medicaid, several steps must be followed. First, prior approval is necessary from a Medicaid-enrolled physician or nurse practitioner. This mandates that any nursing needs must exceed what is provided by a Certified Home Health Agency (CHHA).

Private duty nursing services are specifically for skilled nursing tasks. Independent Registered Nurses (RNs) or Licensed Practical Nurses (LPNs) enrolled in New York State Medicaid can provide these services. Moreover, all participating nurses must maintain current registrations with the New York State Department of Education, ensuring adherence to professional standards.

After approval, claims for PDN services must be submitted to Medicaid after all other insurance sources are exhausted, indicating a comprehensive coverage planning process for those in need.

Making Informed Decisions About Home Care

Choosing the right private home nursing care is a significant decision for many families. It involves weighing the available services, costs, and qualifications of the care providers. With the right information and support, families can ensure that their loved ones receive the personalized care they need to maintain their quality of life, all while remaining in the comfort and familiarity of their home.

References

• Guide to Accessing Medicaid Private Duty Nursing Services in the ...
• What is Private Duty Nursing Care? | Care Indeed
• The Different Types of Nurses, Customizing Care
• Nursing - LeTourneau University
• Home Health Services Coverage - Medicare
• What Home Health Is Covered by Medicare?
• Does Medicare Cover Home Care and Home Health Care?
• Does Medicare Cover Home Healthcare? - GoodRx