Pediatric Private Duty Nursing and Home Care

How the hours actually work

This is the part nobody explains properly, and it causes more confusion than anything else.

You do not buy private duty nursing hours by the hour the way you would buy home care for an adult. A physician documents the child's medical need, the request goes to Florida Medicaid or the child's managed care plan, and a set number of nursing hours per week is authorized based on medical necessity.

• The number is not negotiable in the ordinary sense: It is a clinical determination, and it changes when the child's condition changes. If the authorized hours do not match what the household actually needs, the route is a documented reassessment, not an argument with the agency.
• Children are treated differently from adults: Federal Medicaid rules require states to cover medically necessary services for people under twenty-one more broadly than for adults. That is the reason pediatric nursing hours exist at the level they do, and it is also why turning twenty-one is such a difficult transition.

The gap between authorized and staffed

Here is the thing families discover second, and it is the one that matters most day to day.

Authorized hours are permission. They are not a nurse. An agency has to actually fill them, with a nurse qualified for your child's specific needs, on your schedule, week after week.

Nursing shortages hit pediatric private duty harder than almost any other setting, because the work requires pediatric competence, often trach or ventilator experience, and a willingness to work nights alone in someone's house. Families routinely hold authorizations for hours that go partly unstaffed, and the shortfall is absorbed by a parent who is already doing this without sleep.

So when you speak to any agency, the question is not whether they accept your authorization. It is:

• What percentage of authorized hours did you actually staff last month?: Ask for a number.
• How many nurses would be assigned to my child?: And who covers when one of them is unavailable?
• Have your nurses worked with a child on a ventilator, with a trach, with a G-tube, with seizures?: Ask about your child's specific needs, not general pediatric experience.
• What happens to overnight shifts when someone calls out?: Nights are the hardest to fill and the most consequential to miss.
• How long does onboarding take?: Ask how long before a new nurse can work independently with your child.

What we can tell you

An agency that answers those clearly is telling you something real. An agency that changes the subject to how much they care is telling you something too.

Fifty Focus Family Care nurses are trained in tracheostomy and ventilator care. Last quarter Focus Family Care staffed more than 3,000 authorized nursing hours.

A registered nurse writes and supervises every pediatric plan of care. We match nurses to families by the child's clinical needs, the family's schedule, and the household's language.

Nursing at school

A child with authorized nursing hours often needs a nurse present during the school day, and this catches families out because it involves a second set of arrangements.

Where a nurse accompanies a child to school, it has to be coordinated with the school district as well as with the care plan, and the hours come out of the same authorization. The practical effect is that school-day coverage and home coverage compete for the same total, which is worth planning for before term starts rather than during the first week.

Turning twenty-one

Every family in pediatric private duty nursing eventually meets this, and almost nobody is warned early enough.

Because federal rules cover under-twenty-ones more broadly, a young adult who has had substantial nursing hours for years can face a sharp reduction when those pediatric protections end. The services do not disappear, but they are authorized under different rules and often at a different level.

In Florida the route for many young adults with developmental disabilities runs through the Agency for Persons with Disabilities and its waiver program, and the waiting list means starting early matters enormously.

If your child is fifteen or older, start reading about this now. See how to qualify for APD home care services in Florida.

Conditions we support

Respiratory conditions, including tracheostomy and ventilator dependence. Feeding-tube dependence. Seizure disorders. Cerebral palsy. Genetic and metabolic conditions. Autism, where nursing or one-to-one support is clinically indicated. Complex medical diagnoses following prematurity. Post-surgical recovery at home.

Paying for pediatric home health care

Most pediatric private duty nursing is funded through Florida Medicaid or a Medicaid managed care plan rather than through Medicare, which does not generally apply to children.

Florida's Medicaid regions were restructured in February 2025. Focus Family Care serves Region G, covering Palm Beach, Martin, St. Lucie, Indian River and Okeechobee; Region H, which is Broward alone; and Region I, which is Miami-Dade and Monroe. Focus Family Care verifies coverage at no charge before care begins.

Areas Focus Family Care Serves for Pediatric Home Care

Focus Family Care provides pediatric home care across seven South Florida and Treasure Coast counties. Focus Family Care serves Palm Beach County, including West Palm Beach and Boca Raton. Focus Family Care serves Broward County, including Fort Lauderdale and Hollywood. Focus Family Care serves Miami-Dade County, including Miami and Hialeah. Focus Family Care also serves Martin, St. Lucie, Indian River, and Okeechobee counties across the Treasure Coast.