Private Duty Nursing provides one-on-one skilled nursing care in the home, delivered by an RN or LVN, for patients who require ongoing medical support beyond what can be provided through intermittent home health visits.
Eligibility is based on medical necessity and is determined by your physician and insurance plan. Children on Medicaid STAR Kids and adults on Medicaid STAR+PLUS may qualify if they require continuous skilled care. Many commercial insurance plans also offer PDN benefits.
PDN can support a wide range of diagnoses, including:
• Prematurity and complex neonatal conditions
• Genetic and metabolic disorders
• Developmental disabilities
• Neurological disorders
• Respiratory conditions requiring trachs or ventilators
• Feeding tube dependence
• Chronic illnesses requiring continuous monitoring
Hours are determined by the patient’s medical needs and insurance authorization. Care can range from 8-hour nursing shifts up to 24-hour continuous care, depending on what is approved for your loved one.
Home health typically provides short, intermittent visits (30–60 minutes).
PDN delivers extended, hourly, one-on-one nursing care, often several hours a day, and is designed for medically fragile individuals requiring continuous monitoring and intervention.
Care is delivered by licensed RNs and LVNs who undergo specialized training. At Strive, all nurses receive ongoing competency training in our in-office labs to ensure skills match the patient’s specific needs.
Yes. Depending on insurance approval and the patient’s needs, PDN may be provided at home, school, daycare, or other approved locations.
Our clinical team reviews your loved one’s medical needs, care plan, equipment, and daily routines. We then match nurses based on their training, experience, and comfort level with the required skills.
Strive works to provide coverage whenever possible. If your primary nurse is unavailable, we may offer a qualified substitute nurse who has completed required competencies for your child or loved one.
All nurses go through hands-on skills training and ongoing competency checks in Strive’s dedicated training labs. This includes ventilator management, trach care, feeding tubes, seizure protocols, emergency response, and more.
A referral is typically initiated by your physician. Our team will contact you, review the clinical documentation, submit requests to insurance, and guide you step-by-step until services are approved and staffed.
Strive is in network with most Medicaid Managed Care Organizations and multiple commercial insurance plans. You can review our full list of accepted plans on our Insurance & Coverage page. Our team can also help review your benefits and determine eligibility for PDN.
Your nurse will follow your physician’s orders and care plan, support daily routines, monitor health status, and communicate closely with your family and Strive’s clinical team. You can expect consistent updates and collaborative care.
Yes. Strive provides PDN for pediatric and adult patients, each with age-appropriate goals, considerations, and care plans.
Pediatric in-home therapy provides Occupational Therapy (OT), Physical Therapy (PT), and Speech Therapy (ST) directly in the child’s home or another approved location. Therapists work one-on-one with the child to support development, communication, mobility, and functional skills.
Strive provides pediatric therapy for children from newborns to 21 years of age, in accordance with insurance guidelines and medical necessity.
A child may benefit from therapy if you, your pediatrician, or another provider notices concerns with:
• Communication or speech
• Feeding or swallowing
• Sensory processing
• Delays in motor development
• Walking, balance, or coordination
• Fine motor or self-help skills
• Behavior related to sensory or communication challenges
Your pediatrician can submit a referral for an evaluation, and our team can guide you through the process.
Strive provides:
• Occupational Therapy (OT) – sensory, fine motor, self-care, visual–motor, daily routines
• Physical Therapy (PT) – mobility, strength, coordination, gait, motor development
• Speech Therapy (ST) – communication, language, articulation, feeding, AAC
Therapy is provided in your home or at a designated and approved location such as a daycare, caregiver’s home, or community setting, depending on insurance requirements and clinical need.
Therapy can support a wide range of conditions, including:
• Developmental delays
• Autism spectrum disorder
• Down syndrome and genetic conditions
• Cerebral palsy and neurological disorders
• Prematurity-related delays
• Muscle weakness or orthopedic concerns
• Sensory processing challenges
• Feeding disorders or swallowing difficulties
• Speech, language, and communication delays
Session length varies based on clinical need and insurance approval. Most sessions are 30 to 60 minutes, typically scheduled weekly or as ordered by the physician.
After receiving a referral, your therapist completes an evaluation and collaborates with you to establish individualized goals. Treatment plans are updated regularly based on progress, medical needs, and insurance guidelines.
Absolutely. Caregiver involvement is encouraged. Therapists provide education, home exercises, and strategies to support development between sessions.
Depending on the therapy type and your child’s goals, a session may include:
• Strengthening or mobility exercises
• Play-based activities for sensory or motor development
• Communication practice or AAC training
• Feeding or swallowing interventions
• Fine motor skill activities
• Daily routine skill-building (dressing, eating, hygiene, etc.)
Therapy is always individualized and developmentally appropriate.
Most sessions use everyday items already in the home. If specialized equipment is needed, your therapist will guide you on what to obtain, or will coordinate recommendations with your provider or DME vendor.
Strive is in network with most Medicaid Managed Care Organizations and many commercial insurance plans. Coverage varies by policy, age, and medical necessity.
You can review accepted plans on our Insurance & Coverage page or contact us to verify your benefits.
A referral from your child’s physician is typically required. Once we receive the referral, our team will:
Begin services once approved
Yes. If clinically appropriate and authorized by insurance, children can receive multiple therapy disciplines simultaneously.
Personal Care includes hands-on assistance with activities of daily living, such as bathing, dressing, toileting, mobility, and meal preparation. Companion Care focuses on social interaction, supervision, light housekeeping, and household support. Personal Care is provided by a CNA or HHA, while Companion Care is provided by trained caregivers.
Personal Care Services are ideal for adults or seniors who need help with day-to-day tasks due to aging, illness, injury, disability, or recovery. Eligibility depends on the individual’s needs and, in some cases, insurance coverage or state program qualification.
Yes. Every client receives an individualized plan tailored to their unique needs, preferences, and daily routines. Care can range from a few hours a week to daily assistance.
While Companion and Personal Care services are typically scheduled in shifts, extended hours and around-the-clock support may be available based on need and staffing availability.
Personal Care is delivered by Certified Nursing Assistants (CNAs) or Home Health Aides (HHAs) who have completed state-approved training and competency evaluations. Companion Care is provided by trained caregivers who receive ongoing oversight, support, and supervision from our nursing and leadership teams.
Absolutely. Every caregiver undergoes comprehensive background checks, reference verification, and ongoing compliance screenings to ensure client safety.
Caregivers can provide medication reminders and help maintain a consistent routine. They cannot administer medication unless they hold specific advanced credentials required by the state.
Yes. Transportation to appointments, errands, and community activities is available with our Personal Care and Companion Care services, depending on the caregiver’s training and assignment.
Yes. Personal Care clients have access to nurse oversight and support. A Registered Nurse is available 24/7 for guidance, questions, or concerns.
Coverage may depend on insurance, Medicaid waiver programs, private pay, or other funding sources. Our team will walk you through your options and help determine eligibility.
Timelines vary based on the level of care needed and caregiver availability. Once an assessment is completed, services can often begin within a few days.
That’s perfectly fine! We can schedule care in as little as a few hours per visit, or as frequently as daily support. Services are flexible and built around your needs.
Yes. As needs change, we can update the care plan at any time. Our goal is to support independence and safety—no matter how needs evolve.
We accept most insurance plans, including Texas Medicaid Managed Care Organizations (MCOs), Marketplace plans, and employer-sponsored Commercial plans.
Private Duty Nursing, Physical, Occupational, and Speech therapy are benefits of most military-sponsored health plans through TriWest and Tricare. Specific benefits will be determined by the sponsor’s enrollment status and eligibility. Veterans may also receive services through the VA Community Care Network, subject to specific eligibility requirements, the availability of VA care, and the needs and circumstances of individual Veterans.
Our intake team will verify your benefits and explain your specific coverage before services begin.
Eligibility depends on medical needs and physician recommendations. Typically, PDN is approved for children and adults who require ventilator management, tracheostomy care, G-tube feeding, seizure monitoring, or other continuous skilled care.
Most plans cover physical, occupational, and speech therapy when prescribed by a physician and deemed medically necessary based on the documented medical or developmental need. Our clinical team will help coordinate the assessment and authorization with your health plan.
STAR Kids is a Texas Medicaid program for children and young adults ages 20 and younger who have disabilities or complex medical needs. It provides care coordination and covers services such as Private Duty Nursing, Physical Therapy, Occupational Therapy and Speech Therapy.
STAR+PLUS is a Texas Medicaid managed care program for adults aged 21 and older with disabilities or chronic illnesses. The STAR+PLUS nursing waiver allows medically fragile adults who previously received Private Duty Nursing under STAR Kids to continue receiving private duty nursing care in their home. The STAR+PLUS waiver helps individuals who would otherwise need nursing facility care live in the community. To be eligible, you must be at least 21 years old, meet specific financial requirements, and require a nursing facility level of care due to a medical condition.
While therapy and PDN are clearly defined as benefits for qualifying Medicaid STAR and STAR Kids beneficiaries, determining commercial benefit coverage is a little more complex. Commercial payers (e.g., Blue Cross Blue Shield, UnitedHealthcare, Cigna, Aetna) often cover therapy services within plan benefit limitations.
Continuous skilled nursing or Private Duty Nursing coverage varies by payer and plan. In some cases, a commercial payer may entirely exclude these benefits from its plan, which is often easy to determine. If your plan includes benefits for home health care, skilled nursing, or private duty nursing, the number of hours per week and the approved duration of care will be determined by the plan’s specific benefit details.
Our team is experienced in interpreting benefit details, understands the terminology, and knows how to navigate critical conversations during this process to identify benefits and, if available, obtain authorization for medically necessary services.
Yes. Many families have commercial insurance as their primary payer and Medicaid as their secondary payer.
Commercial insurance is billed first, and Medicaid covers the remaining eligible costs.
Our team can help you appeal insurance denials. We are experienced in the internal appeal process and in appealing to independent review organizations. We have successfully overturned authorization denials from various commercial payers and take great pride in advocating on your behalf in this process. We also help families explore waiver programs, Medicaid, or private-pay options when needed.
Yes. Texas Medicaid typically covers PDN and pediatric therapy services (OT, PT, ST) when they are medically necessary and approved by the child’s physician and the insurance authorization department. Coverage may vary by plan.
Yes. Most insurance plans require authorization before starting Private Duty Nursing or therapy services.
Strive handles the entire authorization process, including collecting documentation and submitting it to the insurance company.
Insurance companies usually require:
Strive works directly with physicians to gather required documents.
Authorization timelines vary by insurance. Some plans approve within a few days; others may take several weeks.
Our team keeps families updated throughout the process and communicates as soon as approval is received.
Most families receiving Medicaid services have no out-of-pocket expense.
Commercial insurance may require deductibles, copays, or coinsurance.
We review all potential costs with families before services begin.
If your insurance changes, notify us immediately.
We will:
Make sure care continues without interruption
Yes. Many medically fragile children qualify for both services.
Insurance authorizations for each service type are handled independently.
Most Medicaid and commercial plans cover the initial therapy evaluation and re-evaluations when medically necessary.
We will confirm coverage before scheduling.
Yes. Insurance plans require a physician referral or order for PDN and for Occupational, Physical, and Speech Therapy.
Strive communicates directly with your child’s physician to obtain the required orders.
If nursing hours or therapy frequency need to be adjusted, Strive will:
Absolutely. Our intake and authorization team can walk families through coverage, authorizations, and what to expect during the approval process.
Yes. Families may pay privately for services not covered by insurance. We provide transparent pricing and flexible payment options.
Contact your local office or submit a referral form online. We’ll verify your benefits, obtain necessary authorizations, and create a personalized care plan for your loved one’s nursing and therapy needs.
Our team will guide you step-by-step through the process.
