Private Duty Nurse
A private duty nurse is a licensed nurse hired to provide one-on-one medical care to a patient in their home or hospital outside of standard public healthcare services. This specialized care is typically required for individuals recovering from surgery, managing chronic illness, or living with a serious medical condition that requires close monitoring or skilled nursing services. The nurse may perform duties such as administering medication, wound care, post-operative support, or palliative care under a physician’s supervision.
How It Works
In Canadian extended health care insurance, private duty nursing is often an eligible expense, subject to medical necessity and pre-authorization by the insurer. Coverage usually applies only to care provided by a registered nurse (RN) or licensed practical nurse (LPN) who is not a relative of the patient, and it excludes services provided by family members or unlicensed caregivers. Under the federal Public Service Health Care Plan, for example, nursing services must be medically necessary and provided by a licensed nurse in the member's personal residence to be eligible. Before a Canadian group insurer such as Canada Life will determine private duty nursing coverage, the plan member must apply for a pre-care assessment, ideally before nursing care begins. Insurers also coordinate private duty nursing benefits with provincial home care, so the member must apply for provincial home care services and authorize the provincial program to exchange information with the insurer, which treats the private health benefit as supplemental to provincial coverage.
Example:
For a private duty nursing predetermination, the insurer requires a prescribing physician's letter stating the diagnosis necessitating care, the estimated duration, and the number of hours or shifts recommended per day, plus confirmation of whether services will be rendered by an RN, RPN, or LPN. Submitting this required predetermination information does not guarantee coverage; the insurer applies the terms of the patient's group benefits policy to decide eligibility for private duty nursing.
What to Watch For:
Remember that coverage usually applies only to care provided by a registered nurse or licensed practical nurse who is not a relative of the patient, and that services provided by family members or unlicensed caregivers are excluded. Apply for the insurer's pre-care assessment before nursing care begins, and apply for provincial home care as well, since the private health benefit is treated as supplemental to provincial coverage. Keep in mind the tax treatment too: under Canadian GST/HST rules, nursing services rendered by a registered nurse can be tax-exempt while equivalent care rendered by a personal care worker may be taxable, and private duty nursing not covered by a provincial health plan can be an eligible expense under a private health insurance policy.
