Fain's Private Duty
Fain's Private Duty Home Care is a nationwide private duty operator built on 17 years of New Jersey home care operating experience. New Jersey is our first launch market.
SERVICE TIER

Skilled nursing (LPN and RN)

Skilled nursing is the clinical tier of private duty home care. FAINS delivers it through New Jersey licensed LPNs and RNs, verified against the Board of Nursing registry, working under a Registered Nurse Supervisor of record and inside the published cadence of The Fain Standard.

Minimum credential: NJ-licensed LPN or RN
Starting rate: $78 per hour LPN, $95 per hour RN
Shift minimum: Four hours (per The Fain Standard pillar 3)

What skilled nursing covers in the home

Skilled nursing at FAINS is a licensed clinical service delivered inside the client's home by an LPN or RN under the direction of the FAINS Registered Nurse Supervisor's plan of care. The tier exists for cases where the clinical work exceeds the CHHA scope of practice and where a hospital admission, a rehab stay, or a facility placement would be the alternative if in-home nursing were not available.

The specific tasks that place a case at the skilled nursing tier are defined by New Jersey nursing scope of practice and by the plan of care. Common examples include medication administration for regimens that require nursing judgment, insulin administration and diabetic management, complex wound care and wound vac management, central line and PICC line care, indwelling catheter management beyond routine CHHA care, G-tube feedings and site care, tracheostomy care and suctioning, ostomy management for complex sites, IV therapy in the home when the plan of care and physician orders allow it, and clinical assessment of a client whose condition is unstable enough to require nursing observation and documented judgment on the shift itself.

The tier is not a marker of client severity in an absolute sense. It is a marker of what the shift itself requires. A client with stable, well-managed complex needs may be a CHHA case with an RN Supervisor visit cadence. A client whose acute wound care regimen is not yet stable may be a skilled nursing case for the arc of the wound and then step down. The RN Supervisor makes that call and revisits it monthly.

What a typical case looks like

Deborah, 68, lives with her adult son David in a townhouse in Westfield, Union County. Deborah has type 1 diabetes managed with an insulin pump, moderate diabetic peripheral neuropathy, and a slow-healing surgical wound on her right lower leg following a debridement six weeks ago. The wound is dressed with a specific antimicrobial dressing that requires nursing judgment on frequency of change, on drainage assessment, and on when to escalate to the vascular surgeon. Deborah's endocrinologist and her vascular surgeon are both in a Livingston medical office. Her PCP is in Westfield.

David has a full-time job and cannot manage the wound care regimen himself, and Deborah has enough vision impairment from her diabetic retinopathy that she cannot see the wound bed reliably enough to dress it. The family had been coping with a mix of visiting nurse appointments and a family friend who was a retired RN doing occasional wound changes, and the arrangement was fraying. Deborah called FAINS on a pre-license waitlist inquiry.

The FAINS RN Supervisor did the in-home assessment. The plan of care named the LPN tier for daily wound care visits, four-hour shifts to allow for the dressing change, the diabetic foot assessment, the pump site rotation on the two days a week that rotation was due, the medication administration for the antibiotics still on board, and a mid-day meal that supported Deborah's glycemic management. The RN Supervisor would visit every 60 days and be available by phone for the vascular surgeon's escalation protocol. When the license issues, Deborah's case will run at the LPN tier at the published rate, billed weekly, with an LPN who has been chemistry-matched to Deborah's temperament and interviewed in Deborah's own living room before the first shift.

What FAINS commits to for skilled nursing

Every skilled nursing case at FAINS is governed by all seven pillars of The Fain Standard. The skilled nursing tier is where the framework's clinical layer does its most visible work.

Every case has a Registered Nurse Supervisor of record. For skilled nursing cases the Supervisor's involvement is denser than for CHHA cases: the plan of care is more detailed, the coordination with physicians and specialists is more active, and the monthly supervisory visit is a full clinical review rather than a check-in.

Every LPN and RN on the FAINS roster is license-verified against the NJ Board of Nursing registry before the first shift and re-verified monthly. Certifications for specific clinical skills (wound care, IV therapy, complex catheter care) are documented in the personnel file and checked against the case at assignment time.

The four-hour minimum shift applies at the skilled nursing tier the same way it applies at every other tier. If a case genuinely needs a 30-minute daily visit, that is a different service category and we refer to a visit-based provider. Private duty skilled nursing is time-based and continuous.

Weekly transparent invoicing runs Monday through Sunday. LPN and RN tier rates are published on the pricing page in dollars. When a case mixes tiers within a week (some LPN shifts, some CHHA shifts, one RN supervisory visit) the invoice line items itemize each tier at the correct rate. Nothing is bundled into an obscure line.

The chemistry-matched commitment applies to nursing staff as much as to CHHAs. A nurse who is technically excellent but a poor personality fit for the client is not the right assignment. The FAINS matcher proposes candidates, the family interviews before the first shift, and swaps happen without penalty inside the first week.

The 24-hour cancellation window applies both ways. When a scheduled nurse cannot make a shift, the FAINS RN Supervisor calls the family personally and dispatches a covering nurse from the on-call clinical roster. That coverage is easier at the CHHA tier than at the RN tier for scarcity reasons; the Supervisor makes coverage decisions with the family, not for the family.

Skilled nursing at FAINS is private pay and private insurance only, the same brand rule that governs every other tier. Families needing Medicare-covered intermittent skilled nursing are referred to a Medicare-certified home health agency with the specifics named.

What FAINS skilled nursing does NOT do

FAINS skilled nursing does not replace the primary care physician. The PCP remains the medical home. FAINS does not write prescriptions, order imaging, or make specialist referrals independent of the physician relationship. The FAINS RN Supervisor coordinates with the PCP and with specialists, but the medical home stays with the physician.

FAINS skilled nursing does not do post-surgical rehabilitation therapies. Physical therapy, occupational therapy, and speech therapy in the home are delivered by licensed therapists through home health agencies operating under Medicare or through private-pay therapy practices. The FAINS RN Supervisor coordinates the therapy schedule around the private duty shift schedule when both are running concurrently.

FAINS skilled nursing does not run intermittent Medicare-covered nursing visits. Those are visit-based, task-based, physician-order-directed, and belong to the Medicare-certified home health category. Some cases run concurrent Medicare intermittent visits and private-pay private duty from FAINS; the RN Supervisor coordinates the overlap.

FAINS skilled nursing does not provide emergency services. If a clinical situation on shift requires 911, the nurse calls 911. Private duty nursing is a continuous-care model, not an emergency response service.

How the intake works for a skilled nursing case

Three steps, deeper than a CHHA intake because the clinical complexity is higher.

Step one is the initial call. The FAINS intake line hears the situation, names the LPN or RN tier rate and the four-hour minimum before any payment information changes hands, and schedules the RN Supervisor's in-home assessment window.

Step two is the RN Supervisor's in-home assessment. For a skilled nursing case the assessment typically runs 120 minutes and produces a detailed plan of care. The RN reviews the discharge paperwork if the case is post-hospital, contacts the PCP and any relevant specialists to confirm the clinical picture, documents the medication list, defines the clinical skills the shift nurse will need, identifies the escalation triggers, and confirms the shift structure and coverage plan with the family.

Step three is the chemistry match. The matcher reviews the plan of care and the RN's notes, proposes one to three nursing candidates whose credentials and experience fit the case, and coordinates the pre-shift interview in the client's home. Twenty to thirty minutes. If the fit is right, the nurse arrives for the first shift with the plan of care already in hand and any specific clinical skill training already documented. If the fit is not right, the matcher proposes another candidate. The family holds the veto on the match, always.

Common questions

When does a case need LPN or RN rather than CHHA?
The line is drawn at nursing scope. If the plan of care requires medication administration beyond reminded self-administration, injectable medications including insulin, complex wound care, wound vac management, central line care, PICC or port access, indwelling catheter management beyond routine care, G-tube feeding administration, tracheostomy care, or ongoing clinical assessment with judgment, the case belongs to the skilled nursing tier. The FAINS RN Supervisor makes that determination at the in-home assessment and revisits it every 60 days.
Is it always an RN, or can an LPN cover the case?
New Jersey scope of practice governs the answer, and every LPN case has RN oversight in the plan of care. LPNs handle a substantial portion of ongoing skilled nursing work in the home, including insulin administration, wound care, catheter care, and G-tube feedings, under the direction of the RN Supervisor's care plan. Complex assessment, plan of care modification, and higher-acuity clinical situations belong to the RN. The rate tier reflects the credential on shift. The pricing page publishes both.
How is the LPN or RN license verified?
New Jersey publishes a live registry of every LPN and RN authorized to practice in the state. FAINS runs every nursing hire through that registry before the first shift, then re-verifies monthly, per Pillar 2 of The Fain Standard. Compact-state licensure is handled at hire; a nurse practicing in NJ under a compact license is verified against the compact authority. If any license lapses, the nurse comes off the roster the same day.
What is the shift minimum for skilled nursing?
Four hours per shift at the published tier rate, the same shift minimum that governs every FAINS tier. If a case genuinely needs a shorter visit (a daily insulin check that runs 30 minutes, for example), we say so honestly at intake and refer to a visit-based skilled nursing provider whose model fits the shorter visit. Private duty is time-based and continuous by design. Visit-based skilled nursing is a different service category.
Does the FAINS RN Supervisor also work shifts on the case?
In some cases yes, particularly at the opening of a complex case or during a transition, but the RN Supervisor role is structurally separate from the shift RN role. The RN Supervisor writes the plan of care, credentials the shift staff, conducts the monthly supervisory visit, and is the family's clinical point of contact through the case. Shift RNs are staff nurses assigned to the case. In smaller cases and at case opening, the two roles can overlap, and the family sees the same face.
Can skilled nursing coordinate with our physician and specialists?
Yes. The FAINS RN Supervisor is the clinical point of contact who reaches the PCP, the specialists, the discharging hospitalist during the post-hospital window, and any home health agency that may be running concurrent Medicare intermittent visits. That coordination is bundled into the tier rate, not billed separately.
What if we need to step down from skilled nursing to CHHA?
The RN Supervisor manages the step-down the same way she manages the step-up. When the clinical picture stabilizes to the point that the CHHA scope is the correct tier, the case moves to CHHA at the published CHHA rate, with the plan of care carried forward, the chemistry-matched CHHA introduced through the same interview process, and no re-assessment fee. The family's experience continues. Only the credential on shift and the rate change.