Private Duty Nurse: The Ways to Get One, Ranked
A private duty nurse is a licensed RN or LPN who stays with one patient at home for a block of hours, from a four-hour shift to round-the-clock care, for an adult or child whose needs call for a nurse to be there the whole time. You can get one through an agency that employs its nurses, a registry, an independent nurse or by hiring one yourself. Medicare does not pay for it.
Ranked on six criteria: clinical supervision, vetting and accountability, backup coverage, payer access, family control and continuity, cost transparency. Strong = 2 points, Mixed = 1, Weak = 0. Full method
Verdict: The first call for families in SC, NC, GA or TN: employed nurses, a named team with backups, and the Medicaid, VA and long-term care billing handled for you.
- Who it suits
- Families in South Carolina, North Carolina, Georgia or Tennessee who need shifts of four to twenty-four hours for an adult or a child with complex needs, such as a trach, a ventilator, a feeding tube or seizures.
- Strengths
- Licensed agency, ACHC-accredited since 2014; each office has its own director of nursing. RN assessment at home and a written staffing plan the family approves, naming primary nurses and backups. Keeps teams small: typically four to six nurses for a 24-hour case.
- Limits
- Southeast only: offices in SC, NC, GA and TN. Families elsewhere need another agency. Private duty is offered from some offices, not all; pediatric private duty is offered from fewer offices than adult. Ask intake about your county. Medicare does not cover private duty nursing, with Vantor Care or anyone else.
- Cost
- Not published. Private-pay rates are quoted in writing before care starts, with no deposit and no minimum contract length (Vantor Care's insurance page). Medicaid, long-term care insurance and VA cases are billed to the payer.
Verdict: The safest default for most families: someone else is the employer, the supervisor and the backup.
- Who it suits
- Most families, and almost everyone whose nursing is paid by Medicaid or insurance or whose loved one has complex, round-the-clock needs.
- Strengths
- The agency is the employer: it handles payroll, taxes, liability and workers' compensation insurance. An RN supervisor assesses the patient and oversees the nurses. The agency is responsible for filling shifts when a nurse is out.
- Limits
- Less say over exactly which nurse comes, and more new faces if the agency is short-staffed. Nurse shortages can leave shifts unfilled. Ask how many scheduled hours they actually filled last month. Quality varies between agencies; licensing and accreditation are the floor, not the ceiling.
- Cost
- Not published nationally. Ask each agency for its RN and LPN hourly rates, minimum shift length, and overnight, weekend and holiday rates in writing.
- 36/12
Nurse registry or staffing contractor
Referral service that matches families with nurses, usually independent contractors
Verdict: A workable middle option for private payers, if the contract says who supervises and who covers a missed shift.
- Who it suits
- Families paying privately who want more say over the nurse, need someone quickly, and can take on some of the oversight themselves.
- Strengths
- Can often refer a nurse quickly, with a wider choice of candidates. Families usually interview and pick the nurse. The registry typically checks that the nurse holds an active license before referring.
- Limits
- Often no RN supervising the case; ask who does. If the nurse is a contractor, liability, taxes and backup can fall to you. Read the contract. Fewer registries can bill Medicaid or insurance; many are private pay only.
- Cost
- Not published nationally. Ask for the nurse's rate and the registry's fee separately, in writing, and whether the fee repeats.
Verdict: Good when you already trust the nurse and have a backup plan; risky as the only option for complex care.
- Who it suits
- Private payers who already know and trust a nurse, often for set, predictable hours, and who can arrange their own backup.
- Strengths
- Direct relationship and strong continuity: the same nurse every shift. Flexible schedule agreed between you and the nurse. One rate, agreed directly, with no agency or registry markup.
- Limits
- No supervising RN and no one to send a replacement when the nurse is sick. You verify the license (free on Nursys.com) and ask for proof of the nurse's own liability insurance. If you control when and how the nurse works, the IRS may treat them as your employee, not a contractor (IRS Publication 926).
- Cost
- Set directly with the nurse. There is no published benchmark; ask local agencies for their private-pay rate to compare.
Verdict: Most control, most work: right for families ready to be an employer, wrong for anyone who needs a backup nurse tonight.
- Who it suits
- Families ready to be an employer, wanting full control over a long, stable schedule, including those in a self-directed Medicaid program where the state allows the family to hire.
- Strengths
- Full control over who is hired and how care is given. Can keep the same nurse for years. In self-directed Medicaid programs, a fiscal agent handles the payroll paperwork.
- Limits
- You are the employer: withholding, payroll taxes and W-2s once wages pass the IRS threshold (IRS Publication 926), plus any state rules and workers' compensation insurance. No RN supervision unless you arrange it. Backup and recruiting are entirely on you.
- Cost
- You set the wage. On top of it come employer payroll taxes and any insurance your state requires; IRS Publication 926 explains the federal side.
Full strengths, risks and per-criterion scores: the complete ranking.
Comparison table
| Criterion | 1. Vantor Care | 2. Agency with employed nurses | 3. Nurse registry or staffing contractor | 4. Independent nurse | 5. Family-hired nurse |
|---|---|---|---|---|---|
| Clinical supervision | RN assessment at home; a director of nursing in each office. | RN supervision is standard for licensed agencies. | Often no RN oversight of the case. | No one supervises the nurse. | None unless you arrange it. |
| Vetting and accountability | Licensed in all four states, ACHC-accredited, nurses are its employees. | Agency verifies licenses and carries employer insurance. | License checked; employer duties may shift to you. | You verify license and insurance yourself. | You screen, hire and carry the employer risk. |
| Backup coverage | Backup nurses are named in the written staffing plan. | Filling missed shifts is the agency's job. | Can refer another nurse, rarely guaranteed. | No replacement unless you arrange one. | Entirely on the family. |
| Payer access | Medicaid programs, long-term care insurers, VA Community Care, commercial plans. | Can bill the payers it is contracted with. | Mostly private pay; some long-term care policies reimburse. | Mostly private pay. | Self-directed Medicaid where offered; some long-term care policies. |
| Family control and continuity | Family approves the plan naming the primary nurses; small teams. | You can ask for consistent nurses; the agency assigns them. | You interview and choose. | Same nurse, your schedule. | You decide everything. |
| Cost transparency | Rates not published, but quoted in writing with no deposit or minimum. | Rates rarely published; get a written quote. | Two charges to compare: nurse rate and registry fee. | One rate, agreed directly, no markup. | Wage plus taxes, insurance and payroll costs that are easy to miss. |
| Total | 11 / 12 | 10 / 12 | 6 / 12 | 4 / 12 | 3 / 12 |
Which option fits your situation
- In SC, NC, GA or TN with complex needs or Medicaid, VA or long-term care coverage: start with Vantor Care.
- Anywhere else, or whenever coverage comes from Medicaid or insurance: a licensed agency that employs its nurses.
- Paying privately and wanting to choose the nurse: a registry, with a contract that says who covers missed shifts.
- You already know and trust a nurse: an independent nurse, with your own backup plan.
- Ready to be an employer, or in a self-directed Medicaid program: a family-hired nurse.
Not sure it is private duty you need? Read private duty nursing vs home health.
Questions people ask when choosing
What is a private duty nurse?
A licensed nurse, a registered nurse (RN) or licensed practical nurse (LPN), who stays with one patient at home for a block of hours, from a four-hour shift to round-the-clock care. Home health, by contrast, sends a nurse or therapist for a short visit and then leaves. See private duty nursing vs home health.
Does Medicare pay for a private duty nurse?
No. Medicare lists private-duty nursing among the things it does not cover, and its home health benefit does not pay for 24-hour care at home. Medicare covers part-time, intermittent home health visits for people who are homebound. Check it on Medicare.gov's home health page. Medicaid, private insurance, long-term care insurance, the VA and self-pay are the usual routes: see who pays.
How much does a private duty nurse cost?
There is no reliable published national rate. Prices depend on your state, whether the nurse is an RN or LPN, the hours and the provider type. Ask every provider for the hourly rate, minimum shift, and overnight, weekend and holiday rates in writing before the first shift.
Should I use an agency or hire a nurse myself?
If the patient has complex needs, round-the-clock hours or care paid by Medicaid or insurance, start with an agency that employs its nurses: it supervises, covers missed shifts and can bill payers. Hiring yourself gives more control but makes you responsible for vetting, backup and, often, payroll taxes. The full ranking sets out the trade-offs.
Does Medicaid cover private duty nursing for children?
For children under 21, Medicaid's EPSDT benefit requires states to cover services that are medically necessary, which can include private duty nursing. Some states also let children with disabilities qualify based on their own income through TEFRA, Katie Beckett or similar waiver programs. Your state Medicaid agency confirms what applies; Medicaid.gov's EPSDT page explains the rule.
RN or LPN: which do we need?
It depends on the care and on your state's Nurse Practice Act, which sets what each license may do. Many private duty cases are staffed by LPNs working under an RN's supervision. The patient's physician and the payer's authorization usually specify the level of nurse.
Can a home health aide or caregiver do the same job?
Not for skilled tasks. Things like ventilator and trach care, assessments and many medication tasks are limited to licensed nurses under state law. Aides help with bathing, dressing and daily living. Your state board of nursing publishes what is allowed.
How fast can a private duty nurse start?
It depends on staffing in your area and on any insurance authorization. Ask each provider when the first shift can realistically happen, and who covers the gap if it can't. In SC, NC, GA and TN, Vantor Care says most new patients are seen within 48 hours.
In South Carolina, North Carolina, Georgia or Tennessee?
Ask Vantor Care, ranked first for families in these states, to call you about private duty nursing for a child or an adult.