Sonia Whitebird: Texas Legislature should boost private duty nursing rates

(Sonia Whitebird, RN, is the Area Vice President for Clinical Services with Maxim Healthcare Services, a home health care, personal care and behavioral care provider serving families with eight locations across Texas.) At least 10 Texas families won’t be spending the holidays at home this year. Instead, loved ones will gather in hospitals across the state to be with their medically fragile children – a sad scenario that could be avoided. These children are typically born with an acute medical condition or disability that requires around-the-clock medical care provided in a sterile hospital room, or with the help of specialized nurses in the comfort of their homes. Private duty nurses, or PDNs, are specially trained to manage a patient’s condition and keep them safe in their homes. For families who can benefit from this service, the pathway to care is littered with obstacles. Private duty nursing must be deemed medically necessary for the children who receive it to improve, maintain or slow the deterioration of their health. Unfortunately, many Texas children with complex conditions who would benefit from PDN are either not receiving enough care in the home or are unable to access services due to the lack of nurses.

This is forcing children and their families to wait for a PDN nurse in a costly hospital bed – even over the holidays. The link between complex medical needs and financial constraints is notable. PDNs are a critical component of the medical care provided to these children who require long-term services and supports. Yet there are not enough PDN nurses to cover the needs of patients throughout the state. This is likely because, in part, Texas has not increased pay rates for the profession in nearly two decades. Medicaid pay rates for licensed practical nurses serving as PDNs in Texas is roughly $33 an hour compared to $48 to $66 in neighboring states, according to the rate schedules in Texas, Arizona, Nevada and New Mexico. The gaps are similar for registered nurses. For nurses in other settings, however, wages have increased nearly 12% since 2019, and wages have exploded for contract nurses – increasing more than 106%, according to a May 2022 report, The Financial Effects of Hospital Workforce Dislocation, published by industry analyst Kaufman Hall. According to the Data Resource Center for Child and Adolescent Health, Texas performs lower than other states in meeting the needs of children with special health care needs.