Private Duty Nursing bridges the homecare gap by allowing private home health care the client chooses, even if strict Medicare home health conditions of participation cannot be met.
Doctor’s orders are still needed, and a quality private duty nursing agency will follow a service plan and plan of care, but the client will not need to be homebound and visit types are not limited by health insurance or Medicare payment requirements.
The types of circumstances that may call for private duty nursing include clients who have a G-tube or J-tube, feeding tubes that go through the stomach and are considered out of the scope of a typical caregiver or personal care attendant. A private duty nursing client may prefer to stay in his or her own home rather than go to a skilled nursing facility even if they have medical issues that go beyond what a caregiver can handle.
Shift care needed is the most common reason for private duty nursing. This involves hourly care needs that go beyond the typical 45 minute visits allowed by Medicare. Someone who needs a nurse to monitor health conditions, administer medications, IV’s or tube feedings on a shift basis, such as three to twelve to 24 hours a day, would hire a private duty nursing agency.
Some private duty nursing clients have sliding scale diabetes, and need multiple assessments daily to adjust insulin amounts and timing. This would be done by an RN or an LVN, not a caregiver. Other private duty nursing clients have ventilators that must be monitored by a skilled nurse throughout a shift. This may be funded privately, although some lower income or developmentally disabled individuals may quality for help through Medi-Cal or Regional Center programs.
Another circumstance where private duty nursing may be helpful is after a client has been receiving Medicare Certified home health, but is discharged due to the fact that the client is no longer home bound. A private duty nursing agency can continue visits to the home so the client can avoid visiting a clinic, as long as the client’s physician agrees and signs the order for care. Some clients ask for a private duty nurse after a cosmetic medical procedure, to have someone monitor them the first 24-48 hours after surgery at home or a hotel room.
Private duty nursing is paid for out of pocket by the client or family members or funded with long term care insurance. Medicare cannot be billed for private duty nursing and will not cover it. As mentioned earlier, some individuals with limited income or who are developmentally disabled may quality through Medi-Cal waiver programs or the Regional Center.
If you wonder whether private duty nursing is appropriate for you or someone you love, feel free to call At Home Nursing Care at 888-634-8004.