Three services, one confusing phrase
“In-home nursing” can mean very different things. A hospital discharge nurse may say it and mean home health. A neighbor may say it and mean a private nurse who stays for a shift. A doctor’s office may say “we can send someone” and mean a house call. Starting with the right label saves phone calls and disappointment.
This guide is general education. Definitions, rules and payment vary by plan, agency and clinician, so use it to shape your questions rather than as a promise about any one service.
Home health nursing
Home health is care delivered by an agency under a plan of care that a physician or other authorized clinician orders. A nurse visits, and the agency may add physical, occupational or speech therapy. Agencies that take part in Medicare must follow set rules, and Medicare Care Compare is a tool families can use to look up agencies.
- Best for: Recovery after a hospital stay or surgery, or a new need for skilled nursing or therapy.
- Order needed: Yes, from a physician or other authorized clinician.
- Length: Usually intermittent and time-limited.
- Payment: Often a plan or Medicare, if the rules are met. Ask the agency and your plan.
Our page on home health in St. Louis goes into more detail on this option.
Private duty nursing
Private duty nursing is a nurse hired for longer blocks of time at home, such as a shift. It suits people with ongoing, complex needs who need someone watching and giving care, not just visiting.
- Best for: Long-term, hands-on nursing needs that last hours at a time.
- Order needed: Often arranged directly by the family, though some plans want a physician’s order.
- Length: Shift-based and ongoing.
- Payment: Frequently private pay or through a policy or program that allows it.
For how it differs from agency care, see private duty nursing vs home health.
Medical house calls
A house call is a medical visit. A clinician comes to the home to examine the patient, make decisions and write orders, much as in an office. Gateway arranges house calls with partner clinicians, who may include physicians, podiatrists, nurse practitioners and nurses, depending on what the patient needs.
- Best for: Primary care follow-up, wound checks and diabetic foot care when getting to an office is hard.
- Order needed: No. Patients and families can ask directly.
- Length: Visits follow a schedule that the treating clinician sets.
- Payment: Depends on the practice, the plan and the care. Ask before the first visit.
Gateway is not a home health agency, and it does not send private duty nurses. Our page on nurse practitioner and nurse visits explains what the visits cover.
How to choose
Match the need to the service:
- A new medical problem, a check-in on a long-term condition or a wound that is slow to change: ask about a house call.
- Skilled nursing or therapy after a hospital stay, under a physician’s plan: ask about home health.
- A nurse who stays for hours to give ongoing care: ask about private duty nursing.
- Help with bathing, meals and daily tasks: that is home care, a non-medical service. A separate guide, home health, home care and house calls, covers it.
Many families use two. For example, an agency nurse visits during recovery while a house call clinician follows a wound that is not progressing.
Questions to ask before you agree
- Who exactly will come, and what training do they have?
- Who orders the service, and is a referral needed?
- Does my plan limit this service, for example by homebound status?
- What will I pay, and who answers billing questions?
- How will you tell my physician what you find?
- What should we do if something changes between visits?
When to call 911
None of these services is an emergency service. Call 911 for chest pain, trouble breathing, sudden confusion, a serious fall or bleeding that will not stop. For other concerns, call the clinician or agency who is following the patient.
If you are unsure which service fits, request care or call 314-325-0126. We can explain what Gateway arranges in Greater St. Louis and the Metro East, and what belongs elsewhere.
Common questions
Is in-home nursing the same as a house call?
No. In-home nursing usually means an agency nurse or a private nurse. A house call is a medical visit by a clinician, such as a physician, podiatrist or nurse practitioner, who assesses the patient and sets the plan. They can be used together.
Can a house call replace home health?
Not usually. Home health provides ongoing nursing or therapy under a plan of care, while a house call is a medical visit to assess and plan. If a patient needs both, they can run side by side, and each should know about the other.
Does Gateway provide home health or private duty nursing?
No. Gateway does not provide home health services, and it does not staff private nurses. We arrange medical house calls with partner clinicians and work with the agency you already use.
Do I need a doctor’s order for each one?
Home health needs an order. Private duty nursing is sometimes arranged without one, though plans may ask for it. A house call can be requested by the patient or family. Always ask each provider what it needs.
Which one is right for a wound?
It depends on the wound and who is already involved. A house call can add a clinician who assesses and follows the wound. Home health may also change dressings under orders. Tell every provider who else visits, and see our page on mobile wound care.
Related pages
General information to help you talk with your own clinician. It is not medical advice, and the treating clinician makes every clinical decision. For a medical emergency, call 911.
Updated October 2026