If a parent needs a nurse at home, you will probably hear two terms: home health and private duty nursing. They are easy to mix up. Choosing the wrong one can mean waiting for a service that was never going to fit, or paying for hours you did not need. Gateway is not a home health agency, and we do not provide private duty nursing. We explain the differences here because families ask us.
Private duty nursing
Private duty nursing is longer, continuous nursing care at home, often for several hours at a time. It is typically for people with complex, ongoing medical needs who need a nurse nearby, such as someone with a ventilator, a feeding tube or frequent medical monitoring.
- Length of visit: Shifts of hours, sometimes overnight.
- Who provides it: A licensed nurse employed by a private duty or staffing agency.
- Who orders it: Usually a physician, though some private arrangements are set up by the family.
- Goal: Ongoing support for a stable but demanding condition, not a short recovery.
Home health
Home health is skilled care from an agency, delivered in periodic visits under a physician’s or allowed practitioner’s plan of care. A nurse might visit for an hour a few times a week, with therapists as needed. It is meant to be intermittent and tied to a goal such as recovery after surgery. Our guide to home health in St. Louis goes deeper.
House calls
A house call is a visit by a clinician, such as a physician, podiatrist (DPM) or nurse practitioner, to examine a patient, make medical decisions and update orders. It is not nursing hours. Gateway arranges house calls in St. Louis through partner clinicians, and the treating clinician makes the clinical decisions.
Side by side
- How much nursing time: Private duty nursing means long blocks. Home health means short, periodic visits. A house call is a clinical visit, not a nursing shift.
- Why you would use it: Private duty fits ongoing complex needs. Home health fits recovery with skilled needs. A house call fits medical follow-up when getting to an office is hard.
- Orders: Home health needs a plan of care from a physician or allowed practitioner. Private duty and house calls have their own requirements.
Who pays
Payment varies by person and plan, so ask before you commit.
- Private pay: Many families pay for private duty nursing directly.
- Long-term care insurance: Some policies may help with private duty hours. Read the policy or call the insurer.
- Medicaid waiver programs: Some state programs for people with certain disabilities or needs may include nursing hours. Missouri and Illinois each set their own rules.
- Medicare: Medicare generally does not pay for ongoing private duty nursing or custodial care. It may help with home health when its conditions are met. See our guide on whether Medicare covers home health in Missouri.
For house calls, payment depends on the treating provider, the plan and the care needed. Never assume a service is paid for before you ask.
How to choose
Start with the question your family is trying to solve. If the need is a short recovery with skilled tasks, home health is the usual route. If the need is round-the-clock or long-block nursing, ask about private duty. If the need is a clinician to examine a problem and adjust the plan, ask about a house call. For non-medical help with bathing, meals and company, look at home care, described in our guide to home health, home care and house calls.
Many families use a mix, and each service tells the others what it is doing.
Questions to ask any agency
- Are your nurses employed by you, or by another company?
- What is the minimum shift or visit length?
- What can the nurse do, and what needs a physician’s order?
- How are rates set, and what is billed to whom?
- Who do I call if the scheduled nurse cannot come?
If you are not sure which fits, request care or call 314-325-0126 and tell us what is going on. We will explain what we can arrange. For an emergency, call 911.
Common questions
Can I have private duty nursing and home health at the same time?
Yes, some people do, because they do different jobs. The home health agency follows its plan of care, and the private duty nurse provides longer coverage. Tell both teams about each other.
Does Medicare pay for private duty nursing?
Medicare generally does not pay for ongoing private duty nursing. It may pay for home health when the conditions are met. Confirm with your plan, since Medicare Advantage and other plans can differ.
Is a private duty nurse the same as a home care aide?
No. A private duty nurse is licensed and can perform nursing tasks ordered by a clinician. A home care aide helps with daily activities such as bathing, meals and company, and does not provide nursing. Ask any agency which kind of worker it is sending.
Do I need a doctor’s order?
For home health, generally yes, from a physician or another allowed practitioner who signs the plan of care. For private duty nursing, requirements depend on the agency and the payer, so ask them what paperwork they need before the first shift.
Where do house calls fit?
They fit when someone needs a clinician to examine a problem, review medications or follow a wound. A house call can happen alongside either kind of nursing, and Gateway coordinates with the nurses and agencies already involved so updates reach the physician.
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