How to Hire a Private In-Home Nurse (RN/LPN) vs. Home Health Aide (HHA)
1. Defining the Roles: Scope of Practice and Training
A Registered Nurse (RN) holds an associate or bachelor degree in nursing, passed the NCLEX-RN, and is licensed to administer IV medications, manage complex tube feedings, assess acute health declines, and coordinate with attending physicians. A Licensed Practical Nurse (LPN) works under RN or MD supervision, handling medication administration, wound dressings, and catheter care. In contrast, Home Health Aides (HHAs) and Certified Nursing Assistants (CNAs) focus on activities of daily living (ADLs)—transferring, bathing, dressing, and gentle nutrition assistance.
2. Hourly Cost Comparison: Agency Markups vs. Direct Hire
Traditional home health agencies typically charge $85–$120/hour for private duty RNs and $36–$48/hour for HHAs, keeping 40% to 50% as administrative gross margin. On where.care, transparent direct pricing lets families hire independent verified RNs at $45–$70/hour and experienced HHAs/CNAs at $22–$32/hour with 0% platform fee markups. Caregivers keep 100% of their bill rate, resulting in higher caregiver retention and more dependable care.
3. Legal and State Nurse Practice Act Boundaries
By law in all 50 states, HHAs and uncertified companions cannot administer prescription medications, draw blood, or dress open surgical wounds. Attempting to assign medical procedures to an aide exposes families to severe liability and patient risk. If your loved one has a tracheostomy, insulin injections, surgical incisions, or IV therapy, hiring a licensed RN or LPN is legally and clinically mandatory.
4. Checklist Before Hiring an In-Home Nurse
Always confirm: (a) Primary Source State Board of Nursing license verification, (b) active CPR/BLS certification, (c) a 10-year criminal background check through Checkr, and (d) verifiable GPS door-to-door timestamps for Medicaid, VA, or private insurance claims.
Frequently Asked Questions
Can a Home Health Aide administer oral medications?
In most states, an aide may only provide "medication reminders"—prompting the senior to open pre-poured pill organizer boxes. An aide cannot pour, measure, or administer prescription drugs unless they hold a specific State Medication Aide certification under RN delegation.
Is private duty nursing covered by Medicare?
Original Medicare only covers intermittent, short-term skilled nursing for acute rehabilitation following a qualifying hospital stay. Long-term, continuous private duty nursing is paid out-of-pocket, via Long-Term Care Insurance (LTCI), or through Medicaid Home and Community-Based Services (HCBS) waivers.
How does where.care verify an RN or LPN license?
where.care connects directly with State Licensing Boards and the Nursys national database to verify license numbers, disciplinary actions, and active standing before any healthcare professional can offer skilled nursing services.
Hire Verified Eldercare Without Agency Markups
Find vetted RNs, LPNs, CNAs, and senior companions with zero platform markups and 100% direct escrow protection.
Find Caregivers Near You →