Uber-like Nurse… Really?
Considering the Uber or DoorDash trends - convenience and customer orientation - could concierge nursing fill a gap for both nurses and caregivers needs?
With nurse shortages, burnout and a desire to work remote, many nurses are turning to alternative employment arrangements. Nurse informatics and remote roles in coding and case management are just a few.
But what if you want to stay in direct patient care?
Concierge nurses typically provide personalized one-on-one care in a patient’s home. Services include specific clinical interventions, patient monitoring and health education. Although these services vary by state and legal business structure, private duty nursing has been around for a long time. With a focus on overall well-being and a high level of attention to the patient, it seems like a perfect fit for a nurse who wishes to continue direct patient care but needs a change from hospital or clinic-based care. There is also a great deal of flexibility for the patient and the nurse in scheduling and time spent on a visit.
So, is there a demand for private nurse roles?
While a search for “concierge nurse” on LinkedIn brings up almost 200 companies, many of these are staffing agencies that provide travel nurses to health systems or offer traditional home health care. They usually bill insurance companies for the services but also offer concierge nurses for cash pay or out-of-pocket pay. These options broaden the traditional staffing company’s reach. It allows an alternative to continue services when a patient has a health plan that limits home health or the caregiver feels they need more professional healthcare support.
But how else is a concierge nurse different from a traditional home health care nurse?
Besides the insurance coverage aspect, another main difference is independence. The private business structures or self-employed entities that a nurse can choose to launch, based on their legal scope of practice and state laws, allows a level of entrepreneurship. The types of entities and focus areas are expanding from med spa services to nutritional therapies to post-surgical care, to name a few. And while not defining the registered nurse (RN) vs nurse practitioners (NP) scope of practices and business structure differences in this article, it is accurate to say private duty nursing has evolved to concierge nurse to “nursepreneur”.
So, from the companies that employ concierge services to nursepreneurs, will we cover the needs of our growing patient populations?
Doubtful.
NCOA research shows 94.9% percent of adults age 60 and older have at least one condition, while 78.7% have two or more (Tavares et al., 2022). With our growing aging population trying to manage these chronic conditions, regardless of financial model (insurance coverage or cash-pay), covering the lives that need care in the home will be a huge challenge. Even as cash pay services grow and nurses shift to the more flexible and independent structures, insurance companies will likely continue to offer home health care as a benefit. Often these services lower cost of care and may reduce emergency room visits and hospital readmissions.
So back to our original question in the introduction. Could concierge nursing fill a gap for both nurses and caregivers needs?
A resounding YES!
With the emergence of Uber and Door Dash, a trend for convenience, flexibility and innovation is here to stay. As the public becomes less tolerant of traditional services in ANY industry, there is a demand for the “next greatest thing”. The benefits for nurses and patients may continue to drive a demand for concierge roles. However, the aspect that is challenging for many to accept, is the fact that some patients may not be able to afford an out-of-pocket option. Many older Americans on fixed incomes spend a significant amount of money on insurance and out-of-pocket costs already to have “the basics” covered. Additional cash spend may not be feasible or seem fair. Some believe concierge nursing is for the rich, but like any industry, demand will drive cost and opportunity over time.
As a registered nurse and an advocate for women in healthcare, I am not advocating for or against concierge nursing. I recognize the challenges and the opportunity. If you are just getting started down this career path, I recommend you proceed with eyes wide open, lots of research and legal advice when considering these roles. Be open to how innovation will change this industry significantly in the coming years. And like anything in a rewarding healthcare career, a singular role is not permanent, so consider what will create the lifestyle you will love, then pivot if it is not what you want.
Thank you for the time to read this blog.
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“POM-style disclaimer” - I would never assume there are not amazing nurses in home health care providing services covered by patient’s insurance. I know many! Nor would I propose patients and their caregivers do not receive great 1:1 care that meets all their needs from covered benefits. I am also not judgmental of nurses who successfully fill the gap with concierge services. I always believe there is a place for all of us, especially as coverage models and services change and evolve year over year. But, I am 100% in favor of the best care we can provide patients and supporting caregivers where they are in terms of their comfort level with their loved ones. Look forward to my blog on “Unreasonable Caregiver Asks.”
In addition, as I stated a few times, this article is not addressing the complexities of business structure, ownership laws or scope of practice, which vary by state. All of which are essential to understand from a legal perspective if considering this career path. This article does not speak to nurse practitioner scope, which is often broader than registered nurses as described above.
References
National Council on Aging. Chronic Inequities: Measuring Disease Cost Burden Among Older Adults in the U.S. A Health and Retirement Study Analysis. Page 5, Figure 2. April 2022. https://ncoa.org/article/the-inequities-in-the-cost-of-chronic-disease-why-it-matters-for-older-adults
Uber. (2024). https://www.uber.com/