Getting a nurse to your home typically starts in one of two ways: through a doctor’s order covered by insurance, or by hiring one privately through an agency or registry. The path that makes sense depends on whether you need medical care after a hospitalization, ongoing help with a chronic condition, or simply extra support during recovery. Here’s how each option works.
Home Health Through Your Doctor
The most common route is a physician-ordered home health referral. If you or a family member needs skilled nursing care, such as wound care, injections, IV medications, or monitoring after surgery, your doctor can order a home health agency to send a nurse to your home. The process requires a face-to-face visit with your doctor (or a qualifying practitioner) who then certifies that home nursing is medically necessary and creates a plan of care specifying what services you need, how often, and for how long.
Once certified, a home health agency assigns a nurse and schedules visits. These typically begin within a day or two of the referral for urgent needs, or within a week for routine care. You don’t choose the specific nurse, but you can request a different one if the fit isn’t right. If you’re being discharged from a hospital, the discharge planner usually arranges the referral before you leave, so a nurse is already lined up for your first days home.
What Medicare and Insurance Cover
Medicare covers home health nursing with no copay if you meet three conditions: you’re homebound, you need skilled care, and a doctor certifies the need. “Homebound” doesn’t mean bedridden. It means leaving your home is a major effort, whether because you need a walker, wheelchair, special transportation, or help from another person. You can still attend medical appointments, religious services, or adult day care and keep your homebound status.
“Skilled care” means tasks that require a licensed nurse or therapist, not just general help around the house. Examples include changing surgical dressings, managing a catheter, administering medications through an IV, adjusting insulin doses, or teaching you how to manage a new condition. If all you need is help bathing or getting dressed, that alone won’t qualify.
Coverage is limited to part-time or intermittent care: up to 8 hours per day of combined skilled nursing and aide services, capped at 28 hours per week. In some cases, your doctor can authorize up to 35 hours weekly for a short period. If you need round-the-clock nursing, Medicare won’t cover it through the home health benefit. Most private insurance plans and Medicaid have similar home health benefits, though the specifics vary by plan and state.
Hiring a Nurse Privately
If you don’t qualify for insurance-covered home health, or you need more hours than insurance allows, you can hire a nurse on your own. There are three main ways to do this.
Home care agencies are the simplest option. They’re licensed and regulated by the state, and they handle everything: recruiting, screening, hiring, training, and supervising the nurse or aide. The caregiver is an employee of the agency, which means the agency carries liability insurance and workers’ compensation, handles payroll taxes, and sends a replacement if your regular nurse is sick. You pay the agency directly.
Registries (sometimes called staffing services) work differently. They give you a list of available nurses or aides, but they don’t employ them. The caregiver works as an independent contractor, and you’re responsible for managing the relationship. This can be cheaper than an agency, but it comes with risk. If the caregiver is injured in your home, you could be liable for their medical bills, and most homeowner’s insurance policies don’t cover employees working in your home.
Direct private hire means finding a nurse on your own through word of mouth, online job boards, or professional networks. This gives you the most control over who you hire, but you take on all employer responsibilities: background checks, verifying licenses, withholding taxes, and carrying appropriate insurance. Many families underestimate the administrative burden here.
What It Costs Out of Pocket
The national median rate for a home health aide in 2024 is $34 per hour, based on the CareScout Cost of Care Survey. That covers hands-on personal care like bathing, dressing, and mobility assistance. If you need a licensed practical nurse or registered nurse for skilled medical tasks, expect to pay more, often $50 to $75 or higher per hour depending on your location and the complexity of care.
For someone needing 4 hours of aide care five days a week, the cost runs roughly $680 per week, or about $2,700 per month at the national median. Rates vary significantly by region. Metropolitan areas and states with higher costs of living can run 30 to 50 percent above the national median.
Types of Nurses and What They Can Do
Not every home care visit requires the same level of training, and the type of professional who shows up determines what care you can receive.
- Certified nursing assistants (CNAs) help with daily activities like bathing, dressing, grooming, eating, and moving around. They monitor vital signs, keep the environment clean and safe, and provide companionship. They cannot administer medications or perform medical procedures.
- Licensed practical nurses (LPNs) can do everything a CNA does, plus administer medications (including some IV medications), change wound dressings, start and maintain IV lines, and educate you about your condition and treatment plan. They work under the supervision of a registered nurse or physician.
- Registered nurses (RNs) handle the most complex care. They perform comprehensive assessments, develop care plans, manage wound vacuums, administer all types of medications, coordinate with your physician, and supervise LPNs and CNAs. For specialized needs like home infusion therapy, an RN is typically required.
When you contact an agency, describe the specific care tasks you need. The agency will match you with the appropriate level of provider, which also affects cost.
Specialized Home Nursing Services
Some medical needs go well beyond basic home visits. If you require IV antibiotics, chemotherapy, or other infused medications at home, a home infusion therapy supplier coordinates these services. Federal regulations require that a physician prescribe the type, amount, and duration of infusion therapy, and a qualified supplier must provide nursing services, patient training, and remote monitoring on a 24/7 basis. Your doctor or hospital can refer you to a certified home infusion provider.
Complex wound care is another common reason for home nursing. Nurses who visit your home can manage negative pressure wound therapy (wound vacs), perform dressing changes on surgical sites or chronic wounds, and monitor for signs of infection. Infected wounds or those producing heavy drainage may need daily nurse visits, while cleaner wounds are typically checked two to three times per week.
How to Start the Process
If you think you qualify for insurance-covered home health, call your doctor’s office and ask for a home health referral. Be specific about what you need help with: wound care, medication management, physical therapy, or daily personal care. Your doctor will evaluate whether skilled nursing is appropriate and, if so, complete the certification paperwork.
If you’re paying privately, search for licensed home care agencies in your area through your state’s health department website, which maintains lists of licensed providers. Medicare’s Home Health Compare tool at medicare.gov also rates agencies on quality measures, even if you’re not using Medicare. Call at least two or three agencies to compare rates, minimum hour requirements, and the types of care they provide. Ask whether their staff are employees (not contractors), whether they carry liability insurance, and how they handle scheduling changes or emergencies.
For urgent needs, such as care needed within 24 to 48 hours, agencies can often accommodate quick starts. Hospital discharge planners are particularly effective at arranging rapid home health services, so if you’re being released from a hospital, ask the discharge team to set everything up before you leave.