Skilled nursing at home (private duty nurse) costs in Missouri
Here is the middle of the price range in Missouri, and then — because it is the question that actually follows — who pays for it. The short answer on that second one surprises most people: Medicare does not.
The Missouri median
$95.00 an hour
- Works out to, monthly
- $18,113
- Works out to, yearly
- $217,360
Our arithmetic, not the survey's. The survey reports this one by the hour, so the monthly and yearly figures assume a schedule: $95.00 an hour × 44 hours a week × 52 weeks ÷ 12 months. Fewer hours, smaller bill — the schedule is the biggest lever you have.
That is about 6% higher than the national median of $90.00 an hour. Within Missouri the spread is usually wider still: a city costs more than a rural county, often by a great deal.
A licensed practical nurse or registered nurse who comes to the house for medical care such as wound care, injections, IV therapy, catheters, feeding tubes and medication management.
What this number is, and what it is not.
It comes from an industry cost-of-care survey — providers reporting their prices — not from a government rate table. There is no federal agency that publishes what assisted living costs, which is why the survey is the source of record here and why we label it plainly rather than dressing it up as official.
A median means half charged more and half charged less. It is not a quote for any particular home, agency or facility, and no provider is bound by it. Prices collected for the 2025 survey.
Where Missouri sits
$95.00 an hour ranks Missouri 23rd of the 46 states priced for skilled nursing at home (private duty nurse): 22 charge more, 23 charge less.
Georgia is the next state up, at $98.00; South Dakota the next down, at $92.00.
The national median is $90.00, so Missouri runs $5.00 above it — 6% more, or $11,440 a year ($5.00 × 44 hours a week × 52 weeks).
The column runs $43.00 (Mississippi) to $207.00 (Wyoming). Missouri sits 32% up it, 2.21× the lowest, with 8 other within a tenth of it.
Of the 6 kinds of care Missouri was priced for, this is its 1st dearest standing: at best 23rd of 46 for skilled nursing at home (private duty nurse), at worst 49th of 50 for nursing home, semi-private room.
What $18,113 a month becomes
Our multiplication, holding the Missouri median flat — no real bill does — with the same span of the state's least costly priced care beside it:
Six months
$108,680
$12,350 of adult day health care
One year
$217,360
$24,700 of adult day health care
Two years
$434,720
$49,400 of adult day health care
Three years
$652,080
$74,100 of adult day health care
Five years
$1,086,800
$123,500 of adult day health care
Care is bought in years, not months, and $18,113 a month is $217,360 a year.
Five years at the national median would be $1,029,600: $57,200 less than five years in Missouri.
Inside Missouri, five years of adult day health care runs $123,500 and five of nursing home, private room $456,240; this page's $1,086,800 sits 100% between them. Most families pay for more than one of these in sequence.
Against other care in Missouri
Converted to a month on our schedule, set beside this page's $18,113:
Nursing home, private room
$7,604 a month
$10,509 a month less, $126,112 a year, 0.42× this page. Missouri places 48th of 49 for it, 25 below its 23rd here.
Nursing home, semi-private room
$6,741 a month
$11,372 a month less, $136,468 a year, 0.37× this page. Missouri places 49th of 50 for it, 26 below its 23rd here.
In-home care (non-medical caregiver)
$6,292 a month
$11,821 a month less, $141,856 a year, 0.35× this page. Missouri places 36th of 50 for it, 13 below its 23rd here.
Assisted living community
$5,400 a month
$12,713 a month less, $152,560 a year, 0.30× this page. Missouri places 39th of 50 for it, 16 below its 23rd here.
Adult day health care
$2,058 a month
$16,055 a month less, $192,660 a year, 0.11× this page. Missouri places 23rd of 45 for it, the same rung as here.
On the same monthly footing, skilled nursing at home (private duty nurse) is the 1st costliest of the 6 kinds of care priced in Missouri, at $18,113. The conversions are ours; the medians are the survey's.
44 hours a week of in-home care in Missouri is $6,292 a month against $5,400 for assisted living — 14% less. The first buys 44 hours and nothing else; the second includes the room, the meals, and someone awake overnight.
Who actually pays for this
This is the part most cost pages leave out, and it is the part that changes what a family does next.
Medicare does not pay for long-term care
Medicare pays for short stretches of skilled care — a limited stay in a skilled nursing facility after a qualifying hospital admission, or skilled home health under specific conditions. It does not pay for custodial care: help with bathing, dressing, meals, medication reminders and supervision. That is what most people need, and for years at a time.
Medicare's own page on long-term care ↗ says the same thing in its own words. It is worth reading once, because almost everyone assumes the opposite.
Medicaid may pay — after a spend-down
Medicaid is the largest payer of long-term care in the country, but it is needs-based: it begins once income and countable savings are inside the limits Missouri sets. Getting there by spending savings on care is what people mean by a spend-down. There is also a look-back period, so gifts and transfers made in the years beforehand matter.
Veterans: Aid and Attendance may help
A wartime veteran, or a surviving spouse, who needs help with daily activities may qualify for an addition to the VA pension called Aid and Attendance. It is an income-and-net-worth benefit, it is paid monthly, and a great many families who qualify have never heard of it. Accredited veterans service organizations help with the claim for free.
Otherwise: savings, family, and long-term care insurance
Most families pay out of pocket first — from savings, a pension, the sale of a house, or several relatives contributing. A long-term care insurance policy bought years ago pays a daily or monthly amount if the policy's conditions are met; if there is a policy in the family, find it and read what triggers it before you need it.
Working out which of these applies to one particular family is exactly what a free Missouri counselor does all day. They are paid by a federal grant, not by commission, and they have nothing to sell you. The Eldercare Locator (ACL): 1-800-677-1116 ↗ will connect you to the area agency on aging for your county.
Who to ask in Missouri
Missouri's free counseling program is Missouri State Health Insurance Assistance Program (SHIP), on 1-800-390-3330. It is grant-funded and sells nothing.
the Missouri Family Support Division decides Medicaid long-term care here — not a facility, and not us. Missouri runs it as Nursing facility (institutional) MO HealthNet — vendor care, Home and community based services and MO HealthNet for the aged, blind and disabled (spend-down), with a 60-month look-back on gifts and transfers.
Beside $18,113 a month — our comparison, its limits — that is what "spend-down" means: countable assets may not top $6,221, or about 10 days of skilled nursing at home (private duty nurse) at this rate and an at-home spouse may keep up to $162,660, or about 9 months of it.
Verified 2026-08-02 against CareScout (formerly Genworth) Cost of Care Survey 2025, fielded July-November 2025 (effective 2026-01-01)— an industry survey, not a government figure. Why we use it.
Verified 2026-08-02 against SHIP National Technical Assistance Center (effective 2026-01-01)— an industry survey, not a government figure. Why we use it.
Verified 2026-08-02 against Missouri Family Support Division, Appendix J — Eligibility Standards for Non-MAGI Programs (07/2026) (effective 2026-01-01)
Common questions
- Does Medicare pay for skilled nursing at home (private duty nurse) in Missouri?
- No. Medicare pays for short stretches of skilled care after a qualifying hospital stay, and for skilled home health in limited circumstances. It does not pay for long-term custodial care — help with bathing, dressing, meals and supervision — which is what most families are actually paying for.
- Is skilled nursing at home (private duty nurse) dearer in Missouri than in other states?
- $95.00 an hour places Missouri 23rd of the 46 states the survey priced for it: 22 charge more and 23 charge less. The national median is $90.00. That ranking is our arithmetic on the survey's published medians, not a ranking the survey itself publishes.
- Is this the price I will be quoted in Missouri?
- No. It is the middle of a range from an industry cost-of-care survey: half of the providers surveyed charged more, half charged less. Prices vary a great deal between a city and a rural county in the same state, and no facility is bound by this figure.
- Who can help me work out how to pay for it?
- Missouri runs its free counseling program as Missouri State Health Insurance Assistance Program (SHIP), on 1-800-390-3330. It is paid for by a federal grant, sells nothing, and the Eldercare Locator (1-800-677-1116) will connect you to the area agency on aging that covers your county.