Hiring a nurse for home care involves choosing the right level of nursing skill, deciding whether to go through an agency or hire independently, vetting candidates thoroughly, and handling the legal and financial details that come with bringing a healthcare professional into your home. The process has more moving parts than most people expect, but breaking it into clear steps makes it manageable.
Decide What Level of Care You Need
The first decision is whether you need a Registered Nurse (RN) or a Licensed Practical Nurse (LPN), because their scope of practice differs significantly. An RN works independently: they can perform comprehensive health assessments, create and modify care plans, formulate nursing diagnoses, manage complex medication regimens, and supervise other caregivers. An LPN works under the direction of an RN or physician, carrying out care plans rather than creating them. LPNs collect health data and recognize changes, but they cannot independently interpret clinical findings or adjust the plan of care on their own. Certain tasks, including some types of IV therapy, fall outside an LPN’s scope entirely.
If your family member needs wound care after surgery, management of a ventilator, or complex medication adjustments, you likely need an RN. If the need is more routine, such as help with daily medications, blood pressure monitoring, basic wound dressing changes, or catheter care following an established plan, an LPN can handle it at a lower cost. For non-medical help like bathing, dressing, and meal preparation, a home health aide may be sufficient, and no nursing license is required.
Agency vs. Independent Hire
You can hire a nurse through a home health agency or bring someone on directly as a private hire. Each path has real trade-offs.
A home health agency handles credentialing, background checks, scheduling, payroll taxes, liability insurance, and backup coverage if your nurse calls in sick. You pay a higher hourly rate for that convenience, but you avoid the paperwork and legal exposure of being an employer. Agencies also carry their own malpractice and liability insurance, which protects you if something goes wrong.
Hiring independently gives you more control over who enters your home, often costs less per hour, and lets you build a direct relationship with the nurse. The downside is significant: you become a household employer in the eyes of the IRS, responsible for taxes, insurance verification, and finding your own backup when the nurse is unavailable. Many families start with an agency and shift to a private arrangement once they find a nurse they trust and feel comfortable managing the logistics.
What Independent Hiring Costs
Private duty nurses typically charge $20 to $30 per hour for an LPN and $30 to $45 per hour for an RN. Rates vary by location, shift length, and the complexity of care involved. Overnight shifts and weekend hours usually command a premium. A full-time RN working 40 hours a week at $35 per hour would cost roughly $1,400 per week before taxes, or about $73,000 annually.
If you hire through an agency, expect to pay 20% to 40% more than the nurse’s base rate, since the agency’s fee covers overhead, insurance, and administrative costs.
Check Whether Insurance Covers It
Medicare covers home health nursing under specific conditions. You must be “homebound,” meaning leaving the house is a major effort due to illness or injury and requires help like a wheelchair, cane, or another person. A healthcare provider must assess you face-to-face and certify that you need skilled nursing care, and a Medicare-certified home health agency must deliver the services.
Even when Medicare does cover home nursing, the hours are limited. Coverage typically caps at 8 hours per day of combined skilled nursing and aide services, with a maximum of 28 hours per week. In some cases, a provider can authorize up to 35 hours per week for a short period. If you need more than part-time or intermittent skilled care, Medicare will not cover home health services at all, and you’ll need to look at private pay or long-term care insurance.
Medicaid coverage varies by state and often provides more generous home care benefits than Medicare, particularly for children and adults with disabilities. Private long-term care insurance policies frequently include home nursing benefits, but the terms differ widely. Review your specific policy or call the insurer to confirm what’s covered before you hire.
Verify Credentials Before Anything Else
Before interviewing anyone, verify their nursing license. Nursys, the national nurse license verification database, offers a free QuickConfirm lookup where you can check any nurse’s license status and disciplinary history. Go to nursys.com, enter the nurse’s name and state, and you’ll get a downloadable report showing whether the license is active and whether any disciplinary actions are on file. Not every state participates in QuickConfirm, so if the nurse is licensed in a non-participating state, contact that state’s board of nursing directly.
Beyond the license check, ask for proof of current CPR and Basic Life Support certification. Request at least two professional references from previous home care families or supervisors. Run a criminal background check, which you can do through commercial screening services for a modest fee. If you’re hiring independently rather than through an agency, no one else is doing this vetting for you.
Interview With the Right Questions
A good interview for a home care nurse goes beyond credentials and into how the person handles real situations. You want to understand their clinical judgment, communication style, and temperament, since this person will be in your home and interacting closely with your family.
- “Describe a time you were under a lot of pressure. How did you handle it?” This reveals how they respond in emergencies and whether they stay calm or freeze.
- “Tell me about a time you dealt with a difficult or unhappy patient or family member.” Home care involves navigating family dynamics. You want someone with patience and diplomacy.
- “How do you explain medications, treatments, or healthcare situations without using medical jargon?” A home nurse needs to communicate clearly with family members who aren’t clinicians.
- “Describe a time a patient was really happy with your care.” This tells you what the nurse values and how they go above and beyond.
- “What would you do if my family member’s condition changed suddenly at 2 a.m.?” You need to hear a specific, confident answer about calling 911, notifying the physician, and what steps they’d take while waiting.
Pay attention to how the nurse interacts with the person who will be receiving care. If possible, arrange a brief trial visit so you can observe bedside manner in practice rather than just hearing about it.
Handle the Tax and Legal Requirements
If you hire a nurse directly rather than through an agency, you are a household employer. The IRS is clear on this: if you control not only what work is done but how it’s done, the worker is your employee, not an independent contractor. Most private duty nurses in a home setting meet this definition.
Once you pay a household employee $3,000 or more in cash wages in a calendar year, you owe Social Security and Medicare taxes. The Social Security tax is 6.2% from the employee’s wages and a matching 6.2% from you. Medicare tax is 1.45% each. You can either withhold the employee’s share from their paycheck or pay it out of your own pocket. If you pay total cash wages of $1,000 or more in any calendar quarter, you also owe federal unemployment (FUTA) tax at 6% on the first $7,000 of wages per employee.
You’ll need an Employer Identification Number (EIN) from the IRS, which you can apply for online. At tax time, you file Schedule H with your federal return and issue a W-2 to the nurse. Many families use a payroll service that specializes in household employees to handle these filings, typically for $50 to $100 per month.
Confirm Insurance Coverage
Any nurse you hire independently should carry their own professional liability (malpractice) insurance. The standard policy in nursing provides up to $1 million per claim and $3 million to $6 million in total claims per policy period. Ask to see a copy of the policy and confirm it’s current.
There are two types of liability policies to be aware of. An occurrence-based policy covers any incident that happens during the policy period, even if the claim is filed years later. A claims-made policy only covers incidents if both the event and the claim happen while the policy is active. Occurrence-based policies offer stronger protection. If a nurse has a claims-made policy and it lapses, there’s a gap in coverage unless they purchase “tail insurance” to extend it, which can cost 1.5 to 2 times the final year’s premium.
You should also check your own homeowner’s insurance to confirm it covers injuries to a worker in your home. Some policies exclude household employees, and you may need to add workers’ compensation coverage, which is required by law in many states once you employ someone in your home.
Put Everything in a Written Agreement
A written care agreement protects both you and the nurse. It doesn’t need to be drafted by a lawyer, but it should cover several key areas clearly:
- Scope of care: Spell out exactly what tasks the nurse will perform, the level of care required (RN or LPN), and any specific medical procedures involved. Reference the physician’s care plan if one exists.
- Schedule and hours: Define the days, shift times, and whether overnight or weekend coverage is included.
- Pay rate and payment schedule: State the hourly rate, overtime policy, and when paychecks are issued.
- Emergency protocols: Describe what the nurse should do in a medical emergency, including who to call and in what order.
- Cancellation and termination: A 30-day written notice period is standard for either party to end the arrangement.
- Confidentiality: The nurse should agree to keep all medical and personal information about your family private.
Both parties should sign the agreement and keep a copy. If your family member’s care needs change over time, update the agreement to reflect the new scope of services rather than relying on informal conversations.