In our previous article, we discussed five important questions families should ask when choosing a Private Duty Nursing (PDN) agency.

One of those questions was:

“Can the agency consistently provide the nursing hours authorized for my loved one?”

In reality, scheduled nursing shifts may sometimes go unfilled because of unexpected call-outs, staffing challenges, or difficulty finding a nurse with the right experience.

When this happens repeatedly, it can create significant stress for families.

So, what should you do if your loved one’s PDN hours are not being consistently filled?

1. Understand the Difference Between Authorized and Actual Hours

First, make sure you understand how many PDN hours have been authorized and how many hours are actually being provided.

Ask the agency:

• How many hours are currently authorized?

• How many hours are actually being provided?

• Which shifts are going unfilled?

• Is this a temporary staffing issue or an ongoing problem?

Knowing the difference between authorized hours and actual coverage is an important first step.

2. Ask Why the Shifts Are Not Being Filled

There can be several reasons for staffing challenges.

A nurse may call out unexpectedly, or the agency may be having difficulty finding a nurse with the appropriate experience for your loved one’s specific medical needs.

Instead of simply asking, “Why don’t you have a nurse?” consider asking:

“What is preventing these authorized hours from being consistently staffed?”

Understanding the reason can help you and the agency discuss possible solutions.

3. Keep Track of Unfilled Shifts

If missed shifts become a recurring issue, consider keeping a simple record.

You may want to document:

• Date and scheduled hours

• Hours actually provided

• Reason the shift was not covered

• Whether a replacement nurse was offered

• When the family was notified

• Important communication with the agency

Keeping a record can help you determine whether the problem is occasional or part of an ongoing staffing issue.

It can also make conversations with the agency more productive.

4. Ask About the Agency’s Backup Plan

Unexpected nurse call-outs can happen.

That is why it is helpful to understand the agency’s backup plan before a problem occurs.

Ask:

• What happens if the regular nurse calls out?

• Are backup nurses available?

• What happens if a replacement cannot be found?

• How will the family be notified?

• Who should we contact after regular business hours?

No agency can guarantee that every shift will always be covered. However, families should understand how the agency responds when unexpected staffing problems occur.

5. Make Sure the Nurse Matches Your Loved One’s Needs

Every patient has different care needs.

Some patients may require experience with tracheostomy care, ventilator care, feeding tubes, seizure management, medication administration, or other complex medical needs.

Having a nurse available is important, but it is equally important that the nurse has the appropriate experience and training for your loved one’s care needs.

6. Consider Your Options if the Problem Continues

Occasional staffing challenges can happen. However, if the same problem continues over time, it may be helpful to have a more detailed conversation with the agency.

Ask whether additional nurses are being recruited, whether scheduling options can be adjusted, and whether backup staffing is available.

If the problem continues, families may also consider exploring other PDN agencies. Before making a change, however, families may have questions about whether the new agency can provide the authorized hours, whether enough nurses are available, and how the transition will be handled.

Families may want to ask:

• Will the new agency be able to provide the same level of coverage?

• Does the agency have enough nurses available to consistently staff my loved one’s authorized hours?

• If the agency is smaller, does it have backup nurses available when the regular nurse is unavailable?

• Can multiple agencies provide care for different shifts for the same child?

• Can the MCO help locate additional PDN providers if the current agency cannot fill all authorized hours?

• What is the formal complaint process if authorized services are not being consistently delivered?

Understanding Your Options Through the MCO

For families enrolled in Texas Medicaid managed care, it may also be helpful to contact the MCO or the appropriate Texas Medicaid program representative when authorized services are not being consistently provided.

Families can ask whether a plan change is an option and what steps are required. According to the Texas STAR Program guidance, families can request an MCO plan change by calling the STAR Program Helpline at 1-800-964-2777. The effective date of a plan change may depend on when the request is made.

Families should also ask whether the MCO can help identify additional providers, whether multiple agencies can cover different shifts for the same child, and what formal complaint or escalation options are available when authorized services are not being delivered.

For children enrolled in programs such as MDCP or DBMD, families can also ask whether the appropriate program escalation or helpline can assist with unresolved service issues. The MDCP/DBMD escalation helpline is 1-844-999-9543.

Before changing an agency or MCO plan, families should confirm how the change could affect their current services and whether any steps are required to prevent an interruption in care. Requirements and procedures can vary depending on the child’s Medicaid program, MCO, authorization, and individual circumstances.

The goal is not simply to find another agency. The goal is to find a workable care arrangement that can consistently meet the child’s authorized services and medical needs.

The Goal Is Continuity of Care

When PDN hours are not being consistently filled, the first step is to understand the situation and ask questions.

Know how many hours are authorized, how many are actually being provided, why shifts are going unfilled, and what the agency is doing to improve coverage.

Private Duty Nursing is about more than filling a nursing shift. It is about providing skilled care that meets the patient’s needs while helping families maintain a safe and consistent care environment at home.

When staffing problems occur, open communication and asking the right questions can be an important first step toward finding a workable solution.

Disclaimer: This article is for general informational purposes only and does not constitute medical, legal, or Medicaid advice. PDN services, authorization, staffing, and program requirements may vary depending on the patient’s individual circumstances, state, and Medicaid plan. Families should confirm applicable requirements with their Medicaid plan, program representatives, healthcare professionals, or appropriate agency representatives.