Name your hourly wages! / 1:1 private duty pay

Nurses Career Support


Specializes in Med/Surg , home care.


 I'm been doing home health 1:1 ( one patient for the entire shift ) for a few years now. I feel that nobody shares their salary. There's a big gap in pay . Some agencies are only paying their nurses 32 an hour and never give raises even 5 years later . Other agencies are paying 45 an hour.  One nurse was an LPN, she was making 36 an hour as an LPN for the same case with a different agency where I was making 35 an hour, same case , with my agency as an RN. RN's were being paid 45-50 an hour . 
This is suburbia NY near NYC. 

   If you have any friends/ acquaintances  or heard anything  in home health 1:1 nursing, how much do they make hourly ?  People need to share their salaries or else if we don't chat, nobody knows they should be demanding more , asking for wage increases , or expecting 1-2% salary jump like you see in other professions besides nursing . It's only here they hope we sit quiet and stay earning the same hourly wage we earned 10 years ago. I'm getting older , it's time to save some money . 
 me: Suburban NY area 

 started :32 an hour several years ago. 
finally got bumped up after asking for the first time in years . It's still a meager salary. I should go agency shopping to make more money. 

  Anyone have any suggestions on how to   Ask for salary increase ?  I feel like I'm getting short -changed. I have read some agencies are billing 90 dollars an hour to a family, but the nurse gets only 35 an hour. How is it the agency gets more than 50.% for their overhead ?! 

Specializes in Vents, Telemetry, Home Care, Home infusion.

How is it the agency gets more than 50.% for their overhead ?! 

I've been involved in startup of a for profit home health care and home care agency along with a large multistate established home health agency.

Most private duty 1:1 home health care , especially pediatrics is covered by Medicaid plans who negotiate with an agency a set hourly rate, getting an increase in hourly payment is extremely difficult often taking several years as each states legislature determines payment for Medicaid services --often with budget cuts requested.

Starting a Home Care Agency can cost $80K and Home Health $350K


Much of the cost is incurred around licensing issues and regulations requiring licensed personnel, computer software and hardware, patient care costs that are paid out of the owner's pocket and are not recoverable, commercial space for the office and the length of time the state is out until initial review or survey. Additionally, many states now require that all Medicare start up agencies go through an Accreditation organization, which also adds cost, and time to the start up phase.

The day to day costs  include software subscriptions, disposable materials like gloves and masks, utilities, rent, bonding office employees, business liability + fire insurance, office equipment + supplies: desks, phone and answering service, billing forms + envelopes, pens, binders, copier paper, stamps; marketing and advertising, mileage payment, performing license and sanction checks,   management staff salaries, etc --costs not billable to insurance like visits are billed but added to field staff salaries in calculating  hourly/per visit pay contracted with each insurance company  that they will pay to an agency ---along with denials of payment (where agency still has to pay staff for care already provided).

Medicare requires 10 patients to be admitted and care provided  prior to revieing agency for compliance with Medicare regulations and granting a Medicare provider number -- with no payment for services rendered. 

These are reasons private duty home health nurses have lower salaries and infrequent raises.

In PA, RN hourly rate $32-36 noted in employment ads.

How to a ask for a raise?   Quality home health agencies provide a yearly evaluation,  often near  anniversary date of hire or on yearly prior to end of budget year  (as former HH Manager, I had to complete 32 staff evals by May 31st yearly).  Staff were notified prior month evals being performed so they could discuss during meeting their accomplishments and goals for following year.   Employees having perormance issues would be counseled at time of occurence/throughout year with improvement plans developed so no one surprised during eval.    

So gather one's thoughts about your work performance for eval and use as justification for a raise:

  •   Time and attendence:  % arrived on time;  # call outs, # shifts missed along with # extra shifts picked-up/ stayed late to cover care
  • Nursing care provided:  Did you serve as team lead, responsible for Q60-90 day plan of care orders review and incorporating verbal orders into chart?    Do you perform Quality Assurance(QA) chart review + # charts reviewed?      Great communication / conflict resolution skills - smooth out miscommunication between  providers/staff/client/parents?   Hospitalization prevented due to prompt action?   New skills learned:  trach/vent care
  • Nursing Career investment:  in-services or conference attended outside work requirements, nursing certifications, additional education/degrees,  articles written/published online or for nursing journals, involvement in nursing organizations: ANA, NLN, Academy of Medical-Surgical Nurses (AMSN) , Society of Pediatric Nurses, etc.  Journals read like Home Healthcare Now, Nursing2023, American Nurse Today and CE courses beyond work/license requirements.

 Amount $$ raise to request: look at employment ads to gain idea of salary offers in your area;  Zip Recruiter and often has 1:1 home health LPN/RN postion's posted.   What's the economy like -- job glut or scarcity/ability of your agency to staff private duty case? Use prior year raise to gauge % to request for raise.   Historically 3% used as base for increase in my Philly area. Underpaid --request $1.00 + more.  

Stand up for yourself:  nothing ventured, nothing gained.

Take advantage of any 401K or 403b plans  saving MAX amount *especially if work matches $$ invested ( often as high as .50 cents/ every dollar you save) as comes out PRETAXED and will need for retirement in years ahead.  One can learn to live on lower initial take home  WHEN you consider will have monies later in life.

Hope these ides help!


Specializes in Med/Surg , home care.

Thanks for your input. 


  Yes I get that there is overhead that the home health agencies have to pay for. But if one agency on the same case pays let's say 34 an hour, and another agency sharing the case paid the nurse 47 an hour, using the same insurance from the patient, then clearly there is some money being pocketed by the agency offering poorer rates .  They want us to believe it's all about poor government reimbursement rates , but I'd say follow the money .... places always have a desire to maximize profits .... it's human nature . 


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