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Home Health Registered Nurse Salary in the United States

How much does a Home Health Registered Nurse make in the United States? The average Home Health Registered Nurse salary in the United States is $87,271 as of July 29, 2024, but the salary range typically falls between $78,578 and $99,824 . Salary ranges can vary widely depending on many important factors, including education , certifications, additional skills, the number of years you have spent in your profession. With more online, real-time compensation data than any other website, Salary.com helps you determine your exact pay target. 

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Skills associated with Home Health Registered Nurse: Regulatory Compliance , Patient Care

Recently searched related titles: Home Care Consultant , Home Health Care Rn , Home Health Nurse

Learn more about: Compensation Packages , Employee Flight Risk , Gender Pay Gap , Job Openings for This Role

Jobs with a similar salary range to Home Health Registered Nurse : Rn Private Duty , Home Visiting Nurse , Homecare Nurse

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Study: home health rn salaries & turnover increase.

WASHINGTON, D.C. (November 9, 2021)—The average hourly rate for registered nurses (RNs) in home health agencies increased 2.98% in 2021, according to the 2021-2022 Home Care Salary & Benefits Report, just released by Hospital & Healthcare Compensation Service (HCS). The report is published in cooperation with the National Association for Home Care & Hospice (NAHC).

In a comparison of rates by agency type, RNs in hospital-based home health agencies received the highest in pay with an average hourly rate of $40.10. The average hourly rate for RNs in visiting nurse associations was $37.67; for-profit agency RN hourly pay was $34.43; and not-for-profit agency pay was $36.17/hour. (All rates above represent the national average hourly rate.)

The national average hourly rate for RNs in any setting was $35.20. In a comparison of rates by state, RNs in Connecticut received $41.19/hour; RNs in Massachusetts received $41.98/hour; and California RNs ranked the highest in pay at $48.83/hour. On the lower spectrum, RNs in Mississippi received $28.53/hour; while RNs in Kentucky received $31.32/hour; and RNs in Alabama received $31.68/hour. 

The national average turnover rate for RNs has risen 11.70% since 2019. The average turnover rate for RNs in 2019 was 20.55%; 25.85% in 2020; and 32.25% in 2021. The average turnover rate for homecare aides rose from 36.53% in 2020 to 38.05% in this year’s study.

1,011 home health agencies participated in the study. The complete 190+ page report contains 58 jobs and covers salaries, bonuses, and hourly and per visit rates. Data include the 10th, 25th, 50th, 75th, 90th average, total number of employees and total number of agencies. Data is reported by state, CBSA, region, agency type and revenue size. Also included are 20 fringe benefits, planned percent increases, productivity, and personnel policies.

The report price is $375. A separate Hospice Salary & Benefits Report will be published in late November. Both studies are published in cooperation with the National Association for Home Care & Hospice (NAHC). 

To order, visit the HCS website at hhcsinc.com .

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Home Health Nurse: Salary, Duties, and How To Become One

• Last Updated: August 14, 2024

If you’re looking for a nursing specialty outside of traditional healthcare environments, becoming a Home Health Nurse could be the right career choice for you.

These types of nurses provide care to patients in patients’ homes. Additionally, they provide care with very little supervision, allowing them a great level of autonomy and independence.

However, there’s a lot to consider before pursuing a career as a Home Health Nurse. What exactly do they do? How much do they make? How do you become one?

In this article, we’ll answer all these questions and cover everything you need to know about Home Health Nursing to help you decide if this nursing specialty may be a good fit for you.

Table of Contents

What is a home health nurse, types of home health nurses, what are a home health nurse’s responsibilities, what skills does a home health nurse need, how to become a home health nurse, home health nurse certification, home health nurse salary, home health nurse career outlook, is home health nursing stressful, should you become a home health nurse, home health nurse faqs.

Home Health Nurses provide direct, one-on-one care to patients in their homes. Unlike most nurses, they work outside of traditional healthcare facilities like hospitals. However, home health nurses do often report to a healthcare facility to receive their daily assignments.

They typically provide care to:

• Elderly patients
• Critically ill patients
• Disabled patients
• Patients recovering from surgery and injury
• Pregnant women who need assistance
• New mothers

One of the best benefits of pursuing this nursing speciality is that it offers a lot of flexibility and autonomy. Often, Home Health Nurses are able to set their own schedule and choose how many patients they’d like to take on.

Another potential advantage of becoming this type of nurse is that you have the opportunity to develop a deeper relationship with your patients, as you’ll spend a lot of one-on-one time with them in a more personal setting.

Finally, this nursing role is open to nurses with varying levels of training and educational qualifications , which we discuss in more detail below.

There are three different types of Home Health Nurses. The type of Home Health Nurse you can become depends upon your level of nursing education and credentials. 

The responsibilities differ for each type, and we discuss them below. However, keep in mind that most home healthcare agencies prefer to hire Registered Nurses, because RNs have the highest level of training and education of the three.

1. Certified Nurse Assistant (CNA)

The lowest-level type of Home Health Nurse is a Certified Nursing Assistant, or CNA. Since CNAs require the least amount of education and training of the three types of Home Health Nurses, they have the most limited autonomy and duties. These responsibilities typically include:

• Communicating patient concerns to a supervising LPN or RN
• Assisting patients with mobility and the everyday tasks necessary to care for oneself
• Completing a list of specific tasks dictated by a supervisor

While this is the most limited Home Health Nurse role, the good news is that you can become a CNA via a training program which can typically be completed in less than 15 weeks. From there, you’ll need to pass a certification exam.

While you’ll probably need to gain some traditional CNA experience before working in-home, this is the quickest route to providing care to patients.

Finally, it’s worth noting that a Certified Nursing Assistant is not the same as a Home Health Aide (HHA). The three biggest differences between the two roles are:

• A CNA can perform all the duties of an HHA in addition to medically-oriented tasks, which HHA’s are not permitted to perform
• A CNA requires certification and a license to perform their duties, whereas an HHA does not need any state-issued license of certification
• A CNA typically earns a higher salary than an HHA

2. Licensed Practical Nurse (LPN)

The mid-tier type of Home Health Nurse is the Licensed Practical Nurse, or LPN. LPNs can perform all the duties of a CNA in addition to:

• Assigning task-based care to CNAs
• Administering medication
• Taking vital signs
• Managing wounds

While becoming a Licensed Practical Nurse requires a higher level of education and training than a CNA, it is a quicker option when compared to becoming a Registered Nurse. In fact, an LPN program can be completed in as little as a year. Once you complete the program, you’ll need to pass the NCLEX-PN and gain some experience in a healthcare facility before working in-home.

Unlike CNAs, LPNs can perform more advanced duties with more autonomy. Additionally, they earn a higher salary than CNAs because of their ability to complete more complex tasks and take on more responsibilities.

If you choose the LPN pathway, don’t forget that you can always advance your career by enrolling in an LPN to RN program down the road, which will allow you to take on more duties and earn a higher salary.

3. Registered Nurse (RN)

Finally, the highest-level type of Home Health Nurse is the Registered Nurse. RNs can carry out all the responsibilities of CNAs and LPNs in addition to:

• Developing patient care plans with physicians
• Coordinating care between patients, families, and other members of the healthcare team
• Evaluating patients’ progress and responses to treatments

Becoming a Registered Nurse requires, at minimum, the successful completion of an Associate Degree in Nursing program, which can be completed in as little as two years.

However, many aspiring RNs opt to earn their Bachelor’s of Science in Nursing degree , which provides graduates with more in-depth education and training. Home Healthcare agencies typically prefer BSN nurses because of their more advanced knowledge and skillset, which allows them to work more autonomously and deliver more complex care.

A BSN program can typically be completed in as little as four years. However, if you do opt to earn your ADN instead, you can always choose to enroll in an RN to BSN program down the road, which allows you to earn your Bachelor’s degree in as little as a year. You can also enroll in flexible online BSN programs .

After earning your ADN or BSN, you’ll need to pass the NCLEX-RN to become a licensed Registered Nurse. From there, you’ll want to gain some experience in a traditional healthcare setting before looking for employment as a Home Health Nurse.

To become the most desirable candidate possible for Home Health Nursing positions, we recommend you go straight for your BSN and become an RN. They perform the most complex duties of the three types of Home Health Nurses, and they also earn the highest salary.

Above, we broke down some of the specific responsibilities for each type of Home Health Nurse. However, here is a high-level overview of Home Health Nurse responsibilities:

• Traveling to patients’ homes to deliver care based on specific treatment plans
• Educating patients and their families
• Monitoring patient symptoms to provide medical intervention before a hospital visit becomes necessary
• Assisting patients with everyday activities, like grooming and hygiene
• Monitoring wounds and conditions
• Documenting vital signs
• Collaborating with physicians to development treatment plans
• Performing physical assessments

It’s important to note that the typical workday for a Home Health Nurse can vary a lot from day to day. In general, however, you’ll be delivering care in a manner similar to how you would in a traditional healthcare facility, only you’ll be doing so in patients’ homes.

Since Home Health Nurses work in a different environment than most other types of nurses, they require a unique skillset. We discuss some of these essential skills below.

1. Time Management Skills

One critical skill that Home Health Nurses require is time management. Since Home Health Nurses work in patients’ homes without the supervision of other members of the healthcare team, they need to be good at managing their time.

Additionally, most Home Health Care Nurses need to visit multiple patients in a single day. In order to get to every patients’ home, these nurses need to be quick and efficient at completing their required tasks.

Finally, one more reason time management skills are key is that patients will be expecting their nurse to arrive at their home within a specific time frame. To ensure every patient receives their care around the time they expect, completing tasks in an appropriate amount of time is critical to being good at the job.

2. Communication Skills

Another important skill all Home Health Nurses should have is good communication . These nurses not only need to be able to communicate information clearly to patients, but also other care providers.

For example, Home Health Nurses need to communicate with patients, build rapport with them, and earn their trust. They also may need to articulate important information to patients’ families to ensure family members can safely look after patients when the nurse isn’t around.

These nurses also need to tell physicians and other workers involved in developing and delivering care plans about any concerns the patient may have. Additionally, since these nurses are responsible for monitoring the conditions of patients, they need to be able to effectively communicate changes in patients’ conditions to other healthcare team members.

3. Self-Sufficiency

As we mentioned above, Home Health Nurses work in patients’ homes with a great level of autonomy. This means it’s critical that these nurses are able to work independently.

While many Home Health Nurses arrive at patients’ homes with a set list of tasks to complete, they may also need to be able to fulfill unexpected patient needs when they come up. Since there’s nobody else there to supervise, these nurses need to have a good understanding of how to provide care on their own.

If you’re not comfortable working without supervision or another healthcare team member to back you up, Home Health Nursing may not be the best career path for you.

4. Interpersonal Skills

One more critical skill Home Health Nurses need is interpersonal skills. While most traditional nurses work alongside other healthcare team members and constantly bounce from patient to patient, this type of nursing mostly consists of one-on-one care.

Not only do these nurses work one-on-one with patients, but spending an hour or more with a patient at a time is the norm. This means they need to be good at developing rapport and trust with patients.

Home Health Nurses also frequently interact with patients’ families during home visits. This means they also need to be adept at talking with, answering the questions of, and getting to know families.

Finally, it’s important to note that your interactions with patients and families will be in a more relaxed and personal environment, so developing real connections with them is very important. After all, you’ll be visiting their personal spaces where they spend the majority of their time.

If you consider yourself a “people person” and enjoy getting to know others, Home Health Nursing could be the right nursing speciality for you.

As we mentioned above, there are three different routes you can take to become a Home Health Nurse.

The most basic type of Home Health Nurse is a Certified Nurse Assistant, or CNA. This pathway requires that you complete a CNA training program and earn certification. Training programs can typically be completed in just a few weeks, and this the quickest way to work as a Home Health Nurse.

The mid-level type of Home Health Nurse is a Licensed Practical Nurse, or LPN. This route requires that you complete an LPN education program at a community college, which can usually be completed in as little as a year. From there, you’ll need to pass the NCLEX-PN to become licensed and begin working.

The final type of Home Health Nurse is a Registered Nurse, or RN. This pathway can be carried out in one of two ways.

First, you can earn your Associate Degree in Nursing, which typically takes about two years. 

Second, and the track we recommend, you can earn your Bachelor’s of Science in Nursing degree, which typically takes about four years. The BSN provides you with more advanced training and education, which Home Healthcare agencies prefer when assessing candidates.

Whether you get your ADN or BSN, you’ll then need to pass the NCLEX-RN to become a licensed Registered Nurse. From there, you’ll probably want to get some experience in a traditional healthcare setting, preferably a critical care environment, to make yourself the most attractive candidate possible.

While the American Nurses Credentialing Center does list a Home Health Nursing Certification on their website, it is currently available by renewal only. This means you cannot obtain the certification if you don’t already hold it.

However, there are other certifications you can obtain that may help you stand out as a candidate when applying to Home Health Nursing roles.

For example, if you hope to work with elderly patients, you may consider going for your Gerontological Nurse Certification . Additionally, a Pain Management Nursing Certification could help you stand out if you want to work with patients recovering from injury or illness. The right certification for you depends on the type of care you’re interested in delivering.

Remember, these certifications are not a prerequisite for working as a Home Health Nurse, but they do add a layer of professionalism to your nursing practice. The best decision will differ based on every nurse’s unique interests and goals.

While there is no nursing salary data specific to Home Health Certified Nursing Assistants available, the Bureau of Labor Statistics reports that the average annual salary for all types of CNAs is $30,290 per year. However, the average Home Health CNA salary is likely higher than this figure given that Home Health is a more specific CNA speciality.

Fortunately, Salary.com provides salary data regarding Home Health Licensed Practical Nurses. According to their data, the average annual Home Health LPN salary is $54,183 per year. Note that this is significantly higher than the figure for all types of LPNs listed by BLS , which sits at $48,070 per year.

Finally, Salary.com also provides salary data regarding Home Health Registered Nurses. According to their data, the average annual Home Health RN salary is $82,200 per year. Like the LPN salary listed above, this figure is also significantly higher than the average annual salary for all types of RNs, which BLS lists as $77,600 per year.

As you can see, both Home Health LPNs and RNs earn a higher salary than general LPNs and RNs. Because Home Health Nurses provide specialty care, they’re able to make more money than their more generalist counterparts.

Home Health Registered Nurse Salary By State

The following table presents the average annual salary for Home Health Registered Nurses in each state according to Salary.com . To see an interactive version of the map above, click here .

Home Health Licensed Practical Nurse Salary By State

The following table presents the average annual salary for Home Health Licensed Practical Nurses in each state according to Salary.com . To see an interactive version of the map above, click here .

While the demand for Registered Nurses and other types of healthcare providers is expected to grow in the coming years, the job outlook for Home Health Nurses looks especially promising.

In fact, according to Business Insider :

“The US home healthcare market is projected to grow about 7% annually from $103 billion in 2018 to $173 billion by 2026 — outpacing growth in all other care types, including hospital care (+5.3% annually) and physician services (+5.6% annually).”

The growth in this particular sector of healthcare is largely being driven by the increasing senior population, as well as the expansion of telehealth services. So, if you’re looking for a nursing role with fantastic job stability and future market demand, Home Health Nursing makes a great option.

While Home Health Nursing can certainly be stressful, some nurses may find it less stressful than the typical hospital environment. 

Unlike the traditional hospital environment where nurses may have to provide care to various patients and constantly bounce around, Home Health Nurses visit one patient at a time in patients’ homes. Better yet, these patients are usually in pretty stable condition.

However, Home Care Nursing does come with additional stresses that other types of nurses don’t have to deal with. For example, driving from home to home could be particularly stressful if you don’t enjoy driving or commuting to multiple places in a single day.

Additionally, while many Home Care Nurses enjoy working with a great level of autonomy and independence, not having other healthcare staff around to back you up could add another level of stress to the job. Patients and their families will likely have a lot of questions and concerns, and they will rely on you to address them.

Like most nursing positions, you’ll definitely have to deal with stress . However, how stressful you find this particular specialty will depend on your own interests, personality, and skillset.

While Home Health Nursing comes with its unique challenges that many traditional nurses don’t have to deal with, becoming a Home Health Nurse can certainly make a good career choice depending on your interests.

If you enjoy working with a great level of independence, providing one-on-one care to patients, and traveling from home to home, you should definitely consider a career as a Home Health Nurse.

Additionally, the position allows you to earn a higher salary than traditional nurses, and, depending on your interests and personality, you may find it less stressful than working in your typical healthcare environment.

To really make the most of your career as a Home Health Nurse, we recommend earning your Bachelor’s of Science in Nursing and becoming an RN, which allows you to carry out the most advanced duties and earn the highest nursing salary possible.

The following are frequently asked questions regarding Home Health Nurses.

Where Do Home Health Nurses Work?

Home Health Nurses mostly work in patients’ homes. However, it’s worth noting that some nurses have a central office where they keep patient records and perform administrative tasks. They also often report to a healthcare facility to receive their assignments.

Do Home Health Nurses Live With Patients?

No. While Home Health Nurses provide care for patients in patients’ homes, they do not live with them. Once they complete their duties, they leave the patients’ home and only return when they are scheduled to.

How Long Is A Home Health Care Visit?

Most Home Health Care visits last no longer than one hour. While some visits can take longer, Home Health Nurses will not typically provide care for more than eight hours in a single day.

What Degree Do Home Health Nurses Need?

While both Certified Nurse Assistants and Licensed Practical Nurses can work as Home Health Nurses with certification from an accredited training program, their duties are limited.

Meanwhile, Registered Nurses have a wider scope of practice, and becoming an RN requires that you obtain either your ADN or BSN degree.

How Long Does It Take To Become A Home Health Nurse?

The amount of time it takes to become a Home Health Nurse depends on what type you become.

For example, you can become a Certified Nurse Assistant in just a few months, a Licensed Practical Nurse in about a year, or a Registered Nurse in two to four years.

Keep in mind, however, that you’ll likely need to gain at least a year of experience in a more traditional healthcare environment before working in Home Healthcare due to the added level of autonomy and independence involved in providing care in patients’ homes.

Nurse Luke is a CRNA who specializes in Nursing content and still enjoys a very busy career with Locum, Per Diem and Travel nursing in the greater midwest. He has over 25 years of experience in the healthcare field and received his CRNA masters degree from the Mayo Clinic School of Healthcare. He is passionate about helping nurses explore the options of becoming a travel nurse as well as spending time with his Family. 

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How Much Do Home Healthcare Nurses Make?

• Average Salary
• Highest-Paying States
• Ways to Increase Pay

Are you ready to earn your online nursing degree?

Demand for home healthcare nurses has increased due to better remote medical technology, the drive to reduce healthcare costs, and research indicating that patients who recover at home do better than inpatients.

This guide outlines home healthcare nurse salary ranges and offers advice on how to increase your pay. Keep reading for the information you need to negotiate the best salary.

Average Salary for Home Healthcare Nurses

According to Payscale data from June 2022, the average home healthcare nurse salary is $66,280, which amounts to an average hourly salary of $28.74. This rate is lower than the average $68,660 salary for all registered nurses but higher than the $60,680 salary for pediatric nurses .

Many factors can affect home healthcare nurse salaries, including local demand, cost of living, education level, and responsibilities.

$66,280 Average Annual Salary Source: Payscale , June 2022

$28.74 Average Hourly Salary Source: Payscale , June 2022

The Highest-Paying States for Home Healthcare Nurses

The U.S Bureau of Labor Statistics (BLS) does not track home healthcare nurse salaries separately from all registered nurse (RN) income. RN salary figures still reflect the demand and cost of living in different states to provide a general sense of typical pay for all nurses.

California is the highest-paying state for RNs, with an average salary of $124,000. Hawaii is next, paying an average of $106,530, followed by Oregon at $98,630 and Washington, D.C., at $98,540. Alaska is the fifth-highest for average salary, paying $97,230. However, the cost of living in these states is also significantly above average. Be sure to compare state salaries to local cost-of-living figures.

3 Ways to Increase Pay As a Home Healthcare Nurse

Demand for home healthcare nurses is high, so you may be in a good position to negotiate a higher home healthcare nurse salary than before COVID-19. Home healthcare nurses may be able to further increase their bargaining power in the following ways.

Obtain Specialty Certifications

Certification demonstrates your knowledge of a nursing specialty and your commitment to the field. Some relevant specialties to help you negotiate a higher home healthcare nurse salary include geriatric nursing , hospice/palliative nursing , oncology nursing , and pain management nursing .

Become a Bilingual Home Healthcare Nurse

Bilingual home healthcare nurses have an opportunity to earn some of the highest wages in this speciality.

Complete Your ADN or BSN

You can dramatically increase your home healthcare nurse salary potential with more education. If you are a licensed practical nurse/licensed vocational nurse, you can become an RN , and if you have an associate degree in nursing, you can earn a bachelor of science in nursing (BSN) degree. Similarly, nurses with BSNs can pursue master of science in nursing degrees.

Frequently Asked Questions About Home Healthcare Nurse Salaries

Are home healthcare nurses compensated for travel.

Some home healthcare nurse salaries include travel allowances, while others reimburse travel expenses. The local cost of gas and how often allowances are set will play a part in determining your best option.

How are home healthcare nurses paid?

Home healthcare nurses work for hospitals, health systems, and independent nursing agencies. You may be paid per patient, per hour, or, less commonly, based on a salary. If you are paid by the patient or by the hour, make sure that the rate reflects or includes reasonable travel time.

Is now a good time to become a home healthcare nurse?

Demand is high, and home healthcare nurse salaries are likely to rise in response. Demand for all nurses continues to grow, along with the need for home healthcare. However, fluctuations in gas prices may make your income less predictable if you are not reimbursed for travel costs.

Are home healthcare nurses paid hourly?

Home healthcare nurse salaries are paid hourly, per patient, or annually. The best approach for you depends on the type of work, travel time between patients, and your personal preferences.

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Home Health Nurse

What is a home health nurse home health nurses coordinate and deliver care to a broad range of patients in the home environment. patients are often concerned about how they will manage once they leave the safety of the hospital. it is the job of the home health nurse to organize, support, and provide care to assure them that life outside is safe and achievable.    home health nurses deliver care to both adults and children. a patient could be recovering from surgery, an injury, a stroke, cancer, or other chronic illness. some patients are pregnant mothers unable to eat and need iv nutritional support. others are children who are ventilator dependent and need family teaching to learn how to manage their care at home.  home health nurses can fill a variety of opportunities, giving them more flexibility and autonomy. they can choose to work with one patient for the entire day or visit multiple patients. home health nurses can deliver care to a single patient population such as gerontology, pediatrics, medical, surgical, or home iv patients. there are plenty of part-time or full-time positions, making home care nursing attractive in balancing with one’s lifestyle. home health nurses spend much time teaching patients and families what to expect and how to manage their illness during their daily lives. therefore, these nurses must be skilled, empathetic communicators to gently introduce the changes people must make and allow time for patients to learn.   home health nurses often receive advanced training to improve their skills. some become advanced practice nurses (apns) who specialize in an area relevant to home care, clinical nurse specialists (cnss), or as nursing administrators. { "@context": "https://schema.org", "@type": "faqpage", "mainentity": [{ "@type": "question", "name": "what is a home health nurse", "acceptedanswer": { "@type": "answer", "text": "home health nurses coordinate and deliver care to a broad range of patients in the home environment. patients are often concerned about how they will manage once they leave the safety of the hospital. it is the job of the home health nurse to organize, support, and provide care to assure them that life outside is safe and achievable. home health nurses deliver care to both adults and children. a patient could be recovering from surgery, an injury, a stroke, cancer, or other chronic illness. some patients are pregnant mothers unable to eat and need iv nutritional support. others are children who are ventilator dependent and need family teaching to learn how to manage their care at home." } },{ "@type": "question", "name": "what does a home health nurse do", "acceptedanswer": { "@type": "answer", "text": "home health nurses perform some of the same activities as hospital nurses, but they provide them in a person’s residence. home health nurses coordinate and manage the plan of care since physicians will not see patients as frequently as they would in the hospital." } },{ "@type": "question", "name": "what skills does a home health nurse need", "acceptedanswer": { "@type": "answer", "text": "home health nurses must have sharp assessment skills to anticipate patient risks and monitor changes between visits. they need strong leadership skills to delegate to lvns and cnas how to carry out their care. home health nurses function as the physician's eyes and ears, so they are responsible for communicating the patient’s status. in addition, home health nurses need strong communication and teaching skills to instruct families and patients on delivering medications and treatments at home and how to reduce complications." } }] } what does a home health nurse do home health nurses perform some of the same activities as hospital nurses, but they provide them in a person’s residence. home health nurses coordinate and manage the plan of care since physicians will not see patients as frequently as they would in the hospital.   general activities may include: taking patient histories recording vital signs and blood sugars administering medications or teaching patients how to self-administer providing wound care, iv therapy, and ordering of supplies doing physical exams and monitoring for skin breakdown monitoring lab results and response to therapy alerting the physician to any significant changes that need attention home health nurses offer recommendations to the physician since they see the patient more often. for example, they recommend and arrange for ancillary health visits such as physical or respiratory therapy, home x-rays, and lvn or cna visits. what skills does a home health nurse need.

Home health nurses must have sharp assessment skills to anticipate patient risks and monitor changes between visits. They need strong leadership skills to delegate to LVNs and CNAs how to carry out their care. 

Home health nurses function as the physician's eyes and ears, so they are responsible for communicating the patient’s status. 

In addition, home health nurses need strong communication and teaching skills to instruct families and patients on delivering medications and treatments at home and how to reduce complications. 

What skills does a Home Health Nurse need? Home health nurses must have sharp assessment skills to anticipate patient risks and monitor changes between visits. They need strong leadership skills to delegate to LVNs and CNAs how to carry out their care.  Home health nurses function as the physician's eyes and ears, so they are responsible for communicating the patient’s status.  In addition, home health nurses need strong communication and teaching skills to instruct families and patients on delivering medications and treatments at home and how to reduce complications.  Learn More About Home Health Nurses Work settings for Home Health Nurses Home health nurses often work in patients’ or their family’s homes or assisted living places. Others work for insurance companies or a government public health service. Common Cases Home Health Nurses Encounter Home health nurses care for Dementia/Alzheimer’s disease‍ Stroke, hypertension, and cardiac disease‍ Traumatic brain injury (TBI)‍ Spinal cord injury (SCI)‍ Diabetes‍ COPD or other respiratory complications‍ Cancer and other chronic conditions‍ Neurological conditions: Multiple sclerosis (MS), Muscular dystrophy (MD)‍ Home IV therapy How to Become A Home Health Nurse Complete an Associate Degree in Nursing (ADN) or Bachelor of Science in Nursing (BSN) degree: takes two-to-four-years based on the program  Pass the NCLEX-RN exam and apply for your RN license after graduation Work for one to two years in the hospital or skilled nursing facility to gain experience. Apply to your county Visiting Nurse Service (VNS) or contact a local home health nursing agency. How to Advance Your Career As A Home Health Nurse You can advance your career by getting a master’s or doctoral degree focusing on an area relevant to home care, such as gerontology, pediatrics, or nursing administration. Alternatively, you can become an Adult-Gerontology Primary Care Nurse Practitioner (AG-PCNP), Pediatric Primary Care Nurse Practitioner (PPCNP), Clinical Nurse Specialist (CNS), or become an educator or manager.   Education Requirements & Helpful Certification Home health nurses must be BCLS certified. The Home Health Nurse certification was retired by the ANCC. Other certifications you might consider are:  Wound, Ostomy, and Continence Certification Board has four options with differing CE/CME requirements. Gerontological Nursing Certification (GERO-BC) Pediatric Nursing Certification (PED-BC) Average Salary For Home Health Nurses Home health nurses typically make between $65,137 - $102,290, with a median salary of $80,302, according to Salary.com . The May 2021 Bureau of Labor and Statistics report shows which states have the highest and lowest wages for nurses. They do not list by nurse specialty, but home health nurse salaries would likely follow suit. The highest-paid states are California, Hawaii, and Oregon. The lowest-paid states are South Dakota, Alabama, and Mississippi. Specialty Organizations & Communities National Association for Home Care & Hospice Visiting Nurse Association of America Association of Public Health Nurses Ideal Personality Traits Confident nursing skills Strong patient advocate Independent  Enjoys teaching patients and families Patient and flexible Excellent communicator  Empathetic Browse Jobs Let's start building the life you want.

Home health nurses provide care to patients in their homes who need on-going support with their medical conditions. Home health nurses may provide wound care, administer medications, manage catheters, draw lab work, educate family members, and decide when to call the physician or send a patient to the hospital. Patients may be elderly or young and have straight forward needs or complicated ones. Home Health nurses must maintain meticulous notes to get reimbursement from Medicare/Medicaid or insurance.

Education Requirements

Home health nurses must be BCLS certified. The Home Health Nurse certification was retired by the ANCC. Other certifications you might consider are: 

Wound, Ostomy, and Continence Certification Board has four options with differing CE/CME requirements.

Gerontological Nursing Certification (GERO-BC)

Pediatric Nursing Certification (PED-BC)

How to advance/career pathway

You can advance your career by getting a master’s or doctoral degree focusing on an area relevant to home care, such as gerontology, pediatrics, or nursing administration.

Alternatively, you can become an Adult-Gerontology Primary Care Nurse Practitioner (AG-PCNP), Pediatric Primary Care Nurse Practitioner (PPCNP), Clinical Nurse Specialist (CNS), or become an educator or manager.  

RESPONSIBILITIES

• Patient assessments: vital signs, physical exams, and home safety
• Wound care: dressing changes and preventive skin care to prevent breakdown
• Medication administration: IV, IM, oral, nebulizer 
• Ensure all equipment operates safely to prevent falls
• Supervise and coordinate other home care staff: CNAs, Physical Therapy and Speech Therapy
• Patient and family education

MOST COMMON CASES

Home health nurses care for

• Dementia/Alzheimer’s disease‍
• Stroke, hypertension, and cardiac disease‍
• Traumatic brain injury (TBI)‍
• Spinal cord injury (SCI)‍
• COPD or other respiratory complications‍
• Cancer and other chronic conditions‍
• Neurological conditions: Multiple sclerosis (MS), Muscular dystrophy (MD)‍
• Home IV therapy

How to become a

• Complete an Associate Degree in Nursing (ADN) or Bachelor of Science in Nursing (BSN) degree: takes two-to-four-years based on the program 
• Pass the NCLEX-RN exam and apply for your RN license after graduation
• Work for one to two years in the hospital or skilled nursing facility to gain experience.
• Apply to your county Visiting Nurse Service (VNS) or contact a local home health nursing agency.

Specialty Groups and Communities

National Association for Home Care & Hospice

Visiting Nurse Association of America

Association of Public Health Nurses

• Develop close relationships with home care patients and their families
• Able to focus on one patient at a time
• Less physically demanding than hospital care
• Make independent but collaborative decisions with the primary care physician
• Can feel isolated from hospital nursing
• Patients or family may see visits as an intrusion
• Stressful if having difficulty performing interventions in the home
• Safety issues if visits are in low-income areas

Personality Traits

• Confident nursing skills
• Strong patient advocate
• Independent 
• Enjoys teaching patients and families
• Patient and flexible
• Excellent communicator 

Average Salary

Home health nurses typically make between $65,137 - $102,290, with a median salary of $80,302, according to Salary.com .

The May 2021 Bureau of Labor and Statistics report shows which states have the highest and lowest wages for nurses. They do not list by nurse specialty, but home health nurse salaries would likely follow suit. The highest-paid states are California, Hawaii, and Oregon. The lowest-paid states are South Dakota, Alabama, and Mississippi.

Certifications

There is no requirement that home health nurses obtain certifications though it may help with advancement. The Home Health Nursing Certification (RN-BC) was phased out so cannot be pursued. 

An alternative option is: Wound, Ostomy and Continence Care Certification

Work Setting

Home health nurses often work in patients’ or their family’s homes or assisted living places. Others work for insurance companies or a government public health service.

Image by pasja1000 from Pixabay | CC0

Finding the Right Employee Compensation Model Under PDGM

Mapping out a clear pay structure and expectations for field staff is imperative for success in home-based care, particularly as margins become slimmer and the Patient-Driven Groupings Model (PDGM) takes hold.

Compensation structure is one of the biggest influences on providers’ margins — if not the biggest. With that in mind, providers need to find one model that works for both employees and their bottom line.

“What agencies want is a pay structure that will support reasonable margins on care,” Sharon Harder, president at C3 Advisors, said Wednesday at the National Association for Home Care & Hospice (NAHC) 2020 virtual Financial Management Conference. “This is really important under PDGM — we no longer have those therapy thresholds that are going to pay us for volume. And so we’re going to have to be really careful about managing our margins.”

C3 Advisors is a consulting firm focused on post-acute health care compliance.

At the end of the day, a pay structure should address four things, Harder explained.

On a basic level, a pay structure should reward outcomes and efficiency rather than visit volume. It should additionally reward the best employees and foster retention, while also creating incentives for good documentation practices.

Pay structures also need to be compliant with applicable wage-and-hour laws.

“We have to remember here, the compensation program is going to create financial incentive for employees, and they’re going to work to meet those incentives,” Harder said. “So when we wanted them to do a lot of visits, that’s what they did. Now, what we’re really looking for is far more efficiency. So [that’s] what we want to focus on [with those four things].”

But if providers are not cognizant of the fourth aspect — labor law compliance — the other three may not end up mattering at all.

“The goal is to find a structure that everyone likes, but then you also have to find a structure the government likes,” Robert Markette Jr., an attorney for Hall, Render, Killian, Health & Lyman, said in a presentation alongside Harder at the Financial Management Conference. “Because everything we do, we have to please the government and follow those various state and federal rules.”

Hall, Render, Killian, Health & Lyman is one of the largest health care law firms in the country.

Otherwise, non-compliance could result in very expensive costs on its own.

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The different pay options.

There are various ways to pay staff — and each has its own perks and pitfalls.

For starters, there’s a pay-per-visit rate, an hourly rate and a salary. 

In 2020, pay per visit can be a compensation model fraught with challenges, Home Healthcare Solutions President J’non Griffin said Wednesday on the same panel.

Home Healthcare Solutions works with home health agencies on coding, compliance and maximizing reimbursement, among other areas.

“It’s almost like administrators think that [pay per visit] is an easy way to pay,” Griffin said. “But if you really think about what pay per visit is, it is paying for a task, and we have moved past paying for a task in PDGM. We’re actually looking for quality, patient-centered visits — so that may not be our best option.”

If a pay-per-visit model is adopted, it’s also worth considering travel. One clinician could make six visits in a relatively short amount of time, while another may have to travel hundreds of miles to get to six different visits, Griffin explained.

That means an agency has to work out how they’re going to pay an employee for that traveled time.

An additional hurdle is telehealth visits, particularly during the COVID-19 crisis, as they’ve grown exponentially. Home health providers still don’t get paid for telehealth visits, but clinicians are still putting in that time, which means that those providers need to develop a strategy for how to pay for telehealth and in-person visits.

“For [pay per visit], the focus is on expediting the visit and not necessarily on what the patient needs,” Griffin said. “A lot of times, you have nurses or therapists that just go in and do the bare minimum and really don’t delve into what else may be happening with the patient. So pay per visit, a lot of times, is convenient for payroll purposes — but it does have a lot of unintended consequences.”

Hourly rates are the easiest to set up from a payroll perspective on the administrative end. There are usually a different set of rates based on experience and also for things like working holidays.

The difference in an hourly rate in home health, however, is that it relies on an honor system of sorts. Because clinicians are not working in an office environment, providers need to rely on a trust between the administrators and clinicians in order for the hourly rate to be effective.

That includes reporting hours on the road, hours at the home and hours doing documentation.

That can make things dicey when it comes time to pay overtime. If there is a no overtime policy but a clinician claims they’ve worked 40 hours per week in three days, an agency needs to decide if that means that the employee is done for the week.

On the other hand, if there is overtime — and a clinician racks up a lot of hours on their timesheet and continues to work — that could end up being harmfully expensive for the agency.

“There is no built-in efficiency at all on the hourly rate — it’s usually the opposite,” Griffin said. “It’s usually the clinicians that do less that get more money, and the clinicians that are efficient get less money. You have to look at that when you’re setting [this all up].”

Some states and hospital systems may require hourly rates. In that case, there’s no way around some of these issues.

For salaries, agencies have obviously set the price they’re going to pay a clinician, no matter how efficient they are. But if an agency has some salaried employees and some that aren’t, it’s important that they’re using their salaried ones first.

“If they’re on salary, I need to use them first because they’re not being productive to meet their salary if I don’t,” Griffin said. “So then you have to start looking at how you move those chess pieces around to get everybody what they need.”

While salary is a more simple payment system, it does not create incentives for efficiency or better quality.

The mix-and-match, hybrid-type arrangements include “visits plus an hourly rate” and “salary plus an incentive bonus,” but those types of agreements can lead to compliance concerns.

“These can result in great wage and hour compliance complications for agencies,” Griffin said. “Agencies have [certainly] been penalized for not paying properly [with these models].”

Companies featured in this article:

C3 Advisors , Home Health Solutions LLC , NAHC

Andrew Donlan

Before becoming a reporter, and then editor, for HHCN, Andrew received journalism degrees from the University of Iowa and Northwestern University. When he's not writing about health care, he makes himself miserable by indulging in Chicago sports.

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Pay per Visit

Specialties Home Health

Published Mar 25, 2009

ittybittybabynurse

I'm talking with a HH agency about possibly working there. They are going to pay per visit. 32 hrs/week = 16-21 visits per week depending if you have some admissions vs. regular visits. This includes travel time and documentation. OK, that would typically be 4-5 visits per day. Does that seem about right for an nurse working 32 hrs/week? Approx what time of the time should I expect to be done for the day?

• + Add a Comment

chenoaspirit, ASN, RN

1,010 Posts

I start homehealth in a couple weeks and they pay by visit too. Hourly, they dont care how many hours I put in, as long as I see all my patients. I can either do the paperwork in the patients' home or take it home with me. just curious, what is your pay per visit? Mine is 34/visit, 52 if its a start of care, 75 if I go out on an oncall visit. Is that a good pay?

I'm still interviewing. I believe it is $60 for a regular visit/$90 for admission. This includes travel tiem & time for documentation.

wow! Thats good money. I also get .46 cents per mile, which adds more income. But yours sounds better! I start April 20, and Im so nervous. Ive only done med/surg and Ive been there for 4 years. With homehealth, I have to do 28 visits/week to be considered fulltime. I shadowed a nurse the other day and I also have a friend who works for this same company. Some visits only take 15 minutes (filling pill boxes) and that pays 34.00. We did a Start of Care and it took an hour, it paid $52.00. Either way, to me it is great money compared to what Im doing now. Let us know if you get the job/take the job. Good luck!

GrumpyRN63, ADN, RN

We get $65 for a revisit, $95 for an admission, plus extra comp for charting-- '' administration time''

WOW!!!! that's excellent pay compared to our per visit rate of regular visit anywhere in the 32-35 range, add $50 to that for admission! what area of the country are you in, was wondering it that makes a difference.

I'm in the Northeast, i'm sure there is much regional variation.(from what I see posted here)

I'm in the Los Angeles area and am interviewing Monday for my first HH position. I am an OR nurse wanting more patient interaction/flexibility. The agency told me $75.00 new admit, $45.00 pervisit and $55.00 for IV. Does that sound pretty competitive? It is the first agency I have talked to about pay.

38,333 Posts

Sounds decent to me.

I am in the Bay area and get 63 per visit. Extra 35 for an admit. If I were you I would talke to another diff agency in LA to compare because that 45 per visit sounds kind of low.

Caliotter3 and Ladyboyd,

Thank you both for responding to my post.

I have applied to two other agencies and will be talking to them about $ next week.

Can you give me anyother advice?

Do you enjoy HH, it just seems like it is flexible and gives you the freedom that you can't (obviously) have working in the hospital. How many patients do you see in a day? Do you think that you can make as much money as working in a hosp? It almost sounds too good to be true.

I responded that I thought the rates were ok because one of my agencies only offers me $25 for a visit; but I don't do visits. I work shifts and not visits, because it is easier all the way around and that has been the type of employment offered to me when I go to agencies for work. I only have to worry about one patient, one family, one trip to and from work, one visit note per day. So much easier and less strain, all the way around. I always suggest shift work, rather than intermittent visits, for these reasons, particularly to nurses who are going into hh to lower their stress levels. The amount of money earned may not be as good as in a hospital, but the advantages of only having one patient at a time and all the flexibility and autonomy make up for it. I would just be cautious about the rates offered because if you are looking in the LA area versus the Bay area, you will see a definite trend of lower salaries, no matter where you work. Good luck with your interviews next week.