If you've been researching adult family homes for a loved one with high medical needs, you've likely hit a wall: the home you like "can't take vent patients" or "doesn't do trach care." Often, what's missing isn't willingness — it's a private duty nursing (PDN) contract. This explainer breaks down what PDN is, who pays for it, and why it's the key that unlocks 24/7 skilled nursing inside an adult family home.
What Is a PDN Contract?
A private duty nursing (PDN) contract is an agreement between an adult family home and a licensed nursing agency to deliver skilled nursing hours to a resident on-site. It's how a home that is licensed for residential care extends into skilled care without its own nursing license.
Think of it this way: the AFH provides the room, the meals, the daily care, and the watchful staff. The PDN agency brings the nurse — the RN or LPN who handles the vent settings, the trach suctioning, the medication infusions, and the clinical monitoring. Both are needed; neither can do it alone.
Why PDN Matters for High-Acuity Care
PDN contracts are the mechanism that enables an adult family home to care for:
- Ventilator-dependent residents — 24/7 respiratory monitoring and airway management
- Tracheostomy residents — regular suctioning, stoma care, and emergency response
- Residents with complex medication or infusion needs
- Residents needing frequent clinical assessment
Without a PDN contract, an AFH is limited to the care its own staff can provide. With one, the same home can accept the high-acuity residents that most facilities turn away — in a home-like setting, at a fraction of the cost. For more on the kinds of care PDN makes possible, browse our High-Acuity Care articles or read our complete guide to ventilator care in an adult family home.
Who Pays for PDN Hours?
Funding depends on the resident's coverage:
- Medicaid (DSHS): PDN hours can be authorized as part of the resident's care plan for medically necessary skilled care. This is the most common funding path in Washington.
- Medicare: limited to short-term skilled needs under specific conditions.
- Private pay: families pay the nursing agency directly for the contracted hours.
For a family, the key number is the authorized PDN hours per day — 8 hours of nursing covers a day shift; a vent patient typically needs more. Understanding what's authorized changes which homes can say yes. Our placement help for families walks through what to verify before touring a home.
What Families Should Ask
- Does the home have an active PDN contract? Which agency, and how long have they worked together?
- How many nursing hours is my loved one authorized for? Verify this with DSHS before the tour.
- Who covers the night shift? Ask specifically who responds to ventilator alarms at 3 AM.
- What happens if a nurse calls out sick? Coverage plans reveal a lot about reliability.
Why We Work Only With PDN-Capable Homes
At Seattle Assisted Living Network, our high-acuity placements depend on PDN-capable homes. We verify the contract, confirm the nursing hours match the resident's needs, and coordinate the paperwork so the placement doesn't fall apart at the last minute. For families and discharge planners, that means a vent or trach patient can move in days — not weeks. Discharge planners can use our high-acuity discharge planning toolkit, and families can learn more about nursing-led care in our guide to RN-operated adult family homes.
Have a patient who needs PDN care? Call us — we work only with PDN-capable homes.
Call (425) 400-3202 — Free Consultation
Frequently Asked Questions
What is a private duty nursing (PDN) contract?
A private duty nursing (PDN) contract is an agreement between an adult family home and a licensed nursing agency to deliver skilled nursing hours to a resident on-site. It's how a home that is licensed for residential care extends into skilled care without its own nursing license. The AFH provides the room, meals, daily care, and staff, while the PDN agency brings the nurse who handles the vent settings, trach suctioning, medication infusions, and clinical monitoring.
Who pays for PDN hours in an adult family home?
Funding depends on the resident's coverage. Under Medicaid (DSHS), PDN hours can be authorized as part of the care plan for medically necessary skilled care — the most common funding path in Washington. Medicare is limited to short-term skilled needs under specific conditions, and families can also private pay, paying the nursing agency directly for the contracted hours.
How does a PDN contract let a home accept ventilator or trach patients?
A PDN contract brings a licensed nurse — an RN or LPN — into the home to handle the vent settings, the trach suctioning, the medication infusions, and the clinical monitoring. Without one, an AFH is limited to the care its own staff can provide. With one, the same home can accept high-acuity residents that most facilities turn away.
How many PDN hours does my loved one need?
The key number is the authorized PDN hours per day — 8 hours of nursing covers a day shift, and a vent patient typically needs more. Understanding what's authorized changes which homes can say yes. Verify the authorized hours with DSHS before the tour.
What should families ask about a home's PDN contract?
Ask whether the home has an active PDN contract and which agency it works with, how many nursing hours your loved one is authorized for, who covers the night shift, and what happens if a nurse calls out sick. Coverage plans reveal a lot about a home's reliability.