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Private nurses for common folks

If you or your parents need medical care, consider bringing the services of a hospital to your home.

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By Patricia B. Gray, Money Magazine contributing writer

Match nurse to need
What you'll pay for home health care largely depends on how much medical expertise you require.
Registered nurses
Change surgical dressings, set up I.V.s, draw blood: $40 to $90
Home health aides
Help you bathe, dress and eat: $13 to $24

(Money Magazine) -- You may think of private nurses as a luxury for the ultra-rich, like a butler or personal chauffeur. But hiring in-house medical care has become an increasingly viable option for regular folks too.

You can use a nurse to ease the transition from hospital to home after surgery or a major illness, or even to administer chemotherapy if you want to stay out of a clinic or hospital. Visits from a private nurse can help your elderly parent remain in his or her own house safely.

Care at home can be a less expensive option than an extended stay in a nursing facility, says Kathleen Kelly, executive director of the Family Caregiver Alliance, a San Francisco nonprofit. Still, the cost can add up quickly, and you may have to cover most of it yourself. So it pays to know whether you need a nurse and how to pick one.

Know who is footing the bill

If you're under 65, chances are you're on your own; for the most part, group health insurance offers little if any coverage for private nursing care. If you are tending to an elderly relative, you will get help from Medicare, which generally pays for up to eight hours a day or 24 hours a week of care within a 60-day period.

Your relative's long-term-care insurance may also provide some coverage, usually $150 to $200 a day (which buys two to four hours of nursing care or about 10 hours of an aide's time). Review the policy before you bring someone onboard.

Make sure a nurse is necessary

You'll pay three times as much for a nurse as for an aide (see table), so consider what care you need. If you're recovering at home from major surgery, you will likely need the services of a registered nurse (R.N.), who can do everything that a nurse in a hospital might do, from monitoring vital signs such as pulse and blood pressure to dressing wounds and setting up an intravenous catheter for drug treatments.

Plus, an R.N. will be able to alert you to complications in your condition. "An experienced nurse has almost a sixth sense for trouble," says Mary Jean Schumann, director of policy and practice for the American Nurses Association.

If your situation is more practical than medical - you need help eating or dressing because you're woozy or weak, for example - a health aide, who may have little formal training, should suffice. The most cost-effective strategy may be to combine the two options; if, say, you're recovering from surgery, have a nurse visit for an hour or two a day to change bandages and administer medications, but let an aide provide around-the-clock care.

Tally the cost

According to a 2007 MetLife survey, agencies charge $13 to $24 an hour for a home health aide, depending on where you live. A registered nurse will cost about three times that much, or $40 to $90 an hour. For agency recommendations, ask another nurse at your hospital or a discharge planner, and find out whether the agency monitors its workers' performance and covers liability insurance and workers' compensation.

You can lower the bill by about a third by hiring - and screening -candidates yourself, but if you hire an aide on your own and she throws out her back while helping Grandpa into the bath, you could end up paying for her medical bills. Even if you can take the risk, you'll almost certainly want to use an agency if the patient is too sick or old to voice any complaints about a caregiver or the quality of care, says Schumann.

Patricia B. Gray is a medical writer and former editor-in-chief of Dartmouth Medical School's Internet venture. E-mail her at health_wealth@moneymail.com.

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