private duty nursing?? - page 3

by ArwenEvenstar

35,194 Views | 29 Comments

I have been a hospital staff nurse (RN) for 14 years and I am VERY burned out. I need to get into a new area of nursing and i am considering several options. (such as home health, utilization review/case management, mobile field... Read More


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    As a private contractor couldn't you slightly undercut the agencies and still make a huge profit? If taking care of an elderly person, can I bill medicare and the family? Where can I find a complete list of medicare laws regarding something like this?

    Thanks.
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    Quote from oldiegoldie
    As a private contractor couldn't you slightly undercut the agencies and still make a huge profit? If taking care of an elderly person, can I bill medicare and the family? Where can I find a complete list of medicare laws regarding something like this?

    Thanks.
    Private duty RN (or LPN) level cases tend to be pediatric medicaid cases. I know that in some states a RN can be approved as an independent medicaid provider for these cases, but I don't know the details of it. I think that RN (or LPN) level elderly cases (and thus medicare) are going to be rare. Most elderly cases would be more likely to be nurse's aid/home care assistant level cases. Although there are exceptions...for instance I know about an elderly ventilator dependent client in my area that requires RN/LPN level care. But I think those cases are not too frequent. Well..I have not really answered your question. Sorry! Maybe someone else can.
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    Around here you will see more adults with PDNs than peds. The reason is most agencies have in-house hospital reps to start the private cases before the families have a chance to explore the private (without agency) options. Here you will make $22.XX for low tech adults and $25.93 for high tech. Medically fragile peds get the same base reimbursement rates plus a 30% add on. Therefore, it's easier to get adult cases because there is significantly less money to be made and because as a rule the agencies aren't out actively recruiting adult patients as they are pediatric. I see Craigslist ads for adults but very rarely for peds, and when a peds case is posted it's normally filled very quickly and will experience minimal turnover.
    Jenn55e likes this.
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    Hey Bob, thank you for sharing your experience with becoming a private duty provider. I myself have just been approved by medicaid, I currently have one patient, and will begin my own billiong this week. So I am desperate for your help. I have no clue what type of procedure codes to use, I know the diagnosis coding, but are so confused as to whether there is one specific code for LPN private provider, or if it's billed as per procedure as in a medical office. Also please share more regarding how you became a comrporation, and fees associated with all you have accomplished. Thank you. Reann
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    Quote from ArwenEvenstar
    Hi! I noticed that my original post from 2005 got revived and was posted on just recently in 2007. I have been doing private duty for almost 3 years now and I feel like I have found a real nitch. I've worked two different cases now and thought I'd make some comments.

    Private duty is not for everyone. Yes, you are essentially a high-tech babysitter. Some may find it boring. But that is exactly why I like it! I love the non-chaotic, casual, boring, low-stress (comparatively speaking - there are some stressors which I'll comment on below) atmosphere. I had to deal with a lot of "issues" on my first case that were partially created by nurses who lacked a professional boundary.
    Reading this thread with high interest...thanks for posting your story and following up with it I have been in PDN for over a year now and really enjoying my two cases.

    Can you elaborate a little more on the nurses who lacked professional boundaries? Just recently I encountered an RN who crossed that line and the family let her go. It was a really ugly scene. Just wondered what your exact experience was.
    DianeDon likes this.
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    [color=#1a1a1a]what i find to be outrageous is that the agencies who hire home care workers are getting rich as their employees are getting poorer. on average, the agencies pay their workers less than 1/3 of what the agencies are getting reimbursed by medicaid (for the employee who does all the actual work).

    [color=#1a1a1a]home care workers generally get zero paid holidays, zero mileage, zero medical insurance, etc.

    [color=#1a1a1a]at most agencies, medical insurance is denied unless the worker commits to working 4 weekend days monthly....even if that employee is already scheduled to already work 40 hours during the week each week. the agencies get away with that by saying, '...we will always schedule someone else for one of your 'scheduled' days during the week when you work weekends (never happens)...". that phrase doesn't even make sense!!!! why? because they [color=#1a1a1a]make out your schedules 4-6 weeks in advance and it would be at that point that the agency should be deleting two of your days during the week if they are going to schedule you for a weekend. this is fine for those who relish overtime....but for others, a big fat no!

    i find this to be extortion and an immoral way for agencies to provide their employees with medical insurance. oh, by the way.....the agencies do not pay the employee a higher wage differential for weekend work (when you are scheduled for weekdays) , so it is no wonder the agencies must use the leverage of denying medical insurance to the employee if they do not work 2 weekends a month.....no one wants to work weekends if they do not get a higher wage for sacrificing family time.

    agencies are receiving $68 hrly from medicaid for services for a rn and paying that same rn anywhere from $18-$22 hourly depending on their rn experience. medicaid is paying agencies $57 hourly and paying the lpn anywhere from $14-$18 hourly. these nurses have college degrees and most have student loans to repay.

    i would assume that agency caregivers (who are not nurses) mentioned in the star's letter-to-the-editor are being abused even more.

    by the way, the agency office employees, managers, and agency owners get paid holidays and vacation/sick days while their field nurses and aides get none. they do give them a week pto annually, but that is always used up when their patients get ill and must be hospitalized for days and the employee needs a full paycheck that week, which happens several times annually...so the workers do not generally get to take vacations with their families unless they want to go a week without any pay.

    solution: have medicaid pay home care workers directly and they will save 66% of the bill for the disabled, terminal, and senior citizens. while the state will have to hire a few more office personnel to do this, i doubt it would be the 66% the agencies are pocketing.

    Quote from arwenevenstar
    i have been a hospital staff nurse (rn) for 14 years and i am very burned out. i need to get into a new area of nursing and i am considering several options. (such as home health, utilization review/case management, mobile field examiner for a life insurance company, etc.)

    regarding home health...i am not sure i like the idea of driving all over creation! so i have been thinking about private duty home nursing. atleast you are just driving to one house and stay there an entire shift doing one-on-one care.

    a local home care company (pedriatic services of america) has recently been advertsing in my area for private duty nursing positions. i called and got some
    basic information. they do mostly 8 hour shifts.

    anyone out there with private duty nursing experience? pros?? cons?? advice?? how does the stress level compare to hospital staff nursing? atleast you are just dealing with one patient...not 6 to 10. right?

    i am interested in night shift...which is 12 mn to 8 am for pediatric services of america. i am a natural night owl and have worked night shift for years. so this would be a way for me to get away from the hospital but still work at night. can't do regular home health visits at night (or other non-hospital jobs for that matter)!!

    thanks in advance. please do share your private duty nursing experiences and thoughts with me. it will be much appreciated.
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    Pros- You have one pt. Cons- you have one patient. If the patient turns out to be good and you enjoy caring for the patient, you got it made but if the patient turns out to be a monster you are in hell for 8 hours. If no one shows up to relieve you you are stuck there for another shift. You can become too close to the patient. The last patient that I had was an idiot. He watch NASCAR 8 hours a day. He would watch the cars go around and around. He was so dumb that if he was a race car driver, he would be the one that would take pit stop just to ask for directions.
    Next you are it. your help and supervisor is a phone call away but very rarely if ever they will come out. Most of the time you will work alone.
    I couldn't take the NASCAR freak so I went back to LTC
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    I believe you deal with dysfunctional in families whether you are working in private duty, or a hospital setting or any setting in nursing! You might as well only have one family to deal with. I enjoyed reading your post. You are absolutely right about keeping firm boundaries, and if you fail at that, things can get WAY too out of hand! I've seen it throughout my entire nursing career.

    I am wanting to become an independent contractor, and work on private duty cases as an LPN, does anybody know if I am able to do this in MN?

    I am new to this site, if I'm not able to ask Q's on someone else's thread, I can delete this!
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    Does anybody know if LPN's are allowed to do this in the state of MN??
    Last edit by sirI on Aug 11, '12 : Reason: referred to deleted post
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    Quote from Ellie S.
    Does anybody know if LPN's are allowed to do this in the state of MN??
    Try googling Minnesota private duty nurse. A site connected to the dhs.state.mn.us popped up:

    MHCP Provider Manual - Home Care Services - Private Duty Nursing (PDN) Services

    If you scroll down to where it says "Eligible Providers," you can find the answer to your question.


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