For Jennifer, home health nurses hold her family together. Nurses come to her home and care for her 11-year-old child’s medical needs. They help ensure that her child’s tracheostomy (a surgically created hole in his neck) and ventilator are both working so he can breathe. Because of this care, her child can experience his childhood at home—riding his bike, going to school, and playing with friends.

Around the country, thousands of people with disabilities and families like Jennifer’s rely on private duty nursing to help their family members live at home and stay financially stable.

Private duty nursing is care provided by a registered nurse or licensed practical nurse to someone who has complex medical needs. A private duty nurse performs skilled care in a person’s home that is typically provided in a hospital or nursing home. Nurses may help monitor and ensure that ventilators and tracheostomies are working, change and monitor feeding tubes, provide IV therapy, and more.

Children and adults with disabilities who need these services rely on private duty nurses in order to live at home in their communities. Otherwise, they may be forced into an institution or nursing home—away from their families—and often have a lower quality of life and social inclusion.

For parents and family members, private duty nurses help the family stay intact. For Pamela from New Jersey, “The home health care nurses change our lives every shift they show up. I get the chance to just be mom, not nurse or therapist, and I can be more present for my older son.”

Private duty nurses also help families remain financially stable and parents remain employed. When their third child, Josh, was born and had significant medical needs, Debbi and Victor struggled to hold onto their jobs. Victor was often called away for active military duty. Debbi worked through the night to meet her deadlines and keep the health insurance they relied on for Josh’s care. “That insurance, it was always in the back of my mind, was what was keeping Josh alive.” The challenges of balancing work and family caregiving responsibilities began to mount. Debbi struggled to get approved for unpaid leave and as Josh’s care needs increased, Debbi had to reduce her working hours substantially. This was a financial burden for the entire family and increased her worry about losing her job altogether.

For many families nationwide, parents are forced to leave work to care for their family members who are medically complex. Pamela concedes, “Our son’s medical needs are left for us to manage; often at the cost of one parent having to leave behind their career.” It doesn’t help that there is still a lack of state paid family leave programs across the country.

Right now, 50 to 70% of private duty nursing shifts nationwide are going unfilled. This is causing additional pressure and stress for the families who need it.

The home skilled nursing workforce is experiencing a shortage similar to that of the general nursing and direct care worker communities, and Medicaid is often unable to pay nurses at the wages they could get in a hospital.

The result is that people with medical complexities are being hospitalized with avoidable complications, and parents and caregivers are being forced to leave their careers behind to care for their loved ones or to make the difficult decision to put their family members into an institution.

How You Can Help

Protect Medicaid from any cuts so that people eligible for private duty nursing receive their services.

Any potential Medicaid cuts could make access to private duty nurses even more difficult. The stability of families and quality of life for children and adults with medical complexities is at stake. Support proposals at the state and federal levels that would improve pay and benefits for private duty nurses and other members of the direct care workforce. Two major federal bills are the Better Care Better Jobs Act and the HCBS Access Act.

Support universal paid family leave that includes siblings and other family members.

The Paid Family Leave Act would help parents and family members stay employed while they balance work and provide the needed care to their family members with medical complexities when they cannot find a nurse. Some states nationwide are working to pass legislation to provide different variations of paid family leave. Contact your local legislators or state chapters of The Arc to support those bills.