LPN and LVN home health jobs are what a lot of nurses are searching for right now. I'm an occupational therapist, not a nurse. But I have worked beside LPNs in home health, and in my experience new ones often start without anyone spelling out where the lines are.
This article is for a licensed practical or vocational nurse who is thinking about home health, or who just started. It covers what the federal rules say about your role, what they hold back for the RN, what the work looks like day to day, and what agencies spend per visit on LPN pay.
Three kinds of statements show up below, and I'll label them. A rule is a federal regulation, and I'll cite the paragraph. Surveyor guidance is the manual that inspectors use when they survey an agency. Anything labeled my experience or my suggestion is just that. For the longer version of who does what on a home health team, see who does what on a home health care team.
Where the Federal Rules Name the LPN
The home health personnel rule defines you in one sentence. Here is 42 CFR §484.115(e):
A person who has completed a practical (vocational) nursing program, is licensed in the state where practicing, and who furnishes services under the supervision of a qualified registered nurse.
Medicare's coverage rule for skilled nursing says who may furnish it. Under 42 CFR §409.44(b)(1):
Skilled nursing care consists of those services that must, under State law, be performed by a registered nurse, or practical (vocational) nurse, as defined in § 484.115 of this chapter
So an LPN visit can be a skilled nursing visit. The same paragraph also says the service has to meet the skilled nursing criteria in §409.32 and the coverage qualifications in §409.42(c). It is not skilled because an LPN does it. It is skilled because of the service. And notice the words "under State law." The federal rule hands part of the question to your state. Our article on which order an assistant works under shows how an LPN visit counts against the skilled nursing order.
The skilled professionals rule, 42 CFR §484.75, says this about you in paragraph (c)(1): "Nursing services are provided under the supervision of a registered nurse that meets the requirements of § 484.115(k)." That RN is "a graduate of an approved school of professional nursing who is licensed in the state where practicing" (§484.115(k)).
Surveyor guidance on that paragraph (tag G726 of the State Operations Manual) is more specific about the working relationship:
The identified RN must in turn monitor and evaluate LPN/LVN performance in the provision of services, provision of treatments, patient education, communication with the RN, and data collection regarding the patient’s status and health needs (as delegated by the RN).
That is guidance, not the wording of the rule. But it tells you what an inspector expects the RN to be doing with your work.
What the Rules Hold Back for the RN
The first visit and the comprehensive assessment
The rule on the first visit, 42 CFR §484.55(a)(1), is blunt:
A registered nurse must conduct an initial assessment visit to determine the immediate care and support needs of the patient
Paragraph (a)(2) lets a therapist make that visit when therapy is the only service ordered. Neither paragraph names the LPN.
The longer comprehensive assessment is the same. Under §484.55(b)(2): "Except as provided in paragraph (b)(3) of this section, a registered nurse must complete the comprehensive assessment." Paragraph (b)(3) is the exception for cases where only physical therapy, speech-language pathology or occupational therapy is ordered. There, a therapist may do it. It does not add the LPN to the list.
The OASIS-E2 Guidance Manual says it for the OASIS itself (section 1.5.6, "Who Completes OASIS?"):
A licensed practical nurse or licensed vocational nurse (LPN/LVN), physical therapist assistant (PTA), occupational therapy assistant (OTA), medical social worker (MSW), or home health aide may not be responsible for completing the comprehensive assessment and OASIS.
The sentence is not limited to one time point. A Coding Tip in the manual repeats it: "LPNs, PTAs, COTAs, MSWs, and home health aides are not disciplines authorized to complete the comprehensive assessment or collect OASIS data." Our OASIS schedule guide walks through each time point.
The manual also leaves you a way in. It says the assessing clinician "may collaborate to collect data for all OASIS items, if agency policy allows," and that collaborators "should have had direct in-person contact with the patient or have had some other means of gathering information." The assessing clinician still signs it and answers for it. In my experience, if you see a patient between assessments and notice a new wound or a change in how they walk, that goes to the RN or therapist who owns the assessment. The State Operations Manual's guidance on the comprehensive assessment gives one example: an agency may have "RNs or practical (vocational) nurses" review the medication lists.
Care planning and discharge planning
The surveyor guidance quoted above ends with a sentence you should know: "Only a registered nurse may perform comprehensive assessment, evaluations, care planning and discharge planning." That is guidance on the supervision rule, and it is a good summary of the line. The RN builds the plan. You carry out your part of it and report back.
Supervising aides
The aide supervision rule, 42 CFR §484.80(h)(1)(i)(A), says that when an aide works with a patient who gets skilled services:
A registered nurse or other appropriate skilled professional who is familiar with the patient, the patient's plan of care, and the written patient care instructions described in paragraph (g) of this section, must complete a supervisory assessment of the aide services being provided no less frequently than every 14 days
The rule does not say an LPN may or may not be the "other appropriate skilled professional," and I did not find LPNs named in the surveyor guidance for it. Do not assume either way. If an agency wants you to do aide supervisory visits, ask them which rule or policy they rely on. Our supervisory visit guide covers the 14-day clock.
State scope of practice can be narrower
Everything above is federal. Medicare's rules set the floor for who can furnish a covered service. Your state's nurse practice act and board decide what an LPN or LVN may actually do in that state, and they can be narrower. I have not looked up any state for this article, so I won't tell you what yours says. Before you take a job, read your board's rules or call the board. Do not rely on an agency's recruiter to know.
What the Job Usually Looks Like
This section is my experience from working beside LPNs, not a rule, and agencies differ.
Routine visits on a plan the RN built. Most of an LPN's day is follow-up visits on patients the RN has already assessed. You go to the house, check what the plan of care asks you to check, do the treatments, and teach.
Wound care and medication teaching. In my experience, wound care and medication teaching make up a big share of nursing visits, and LPNs do a lot of them. Teaching matters here. A patient who understands why a pill changed is the patient who doesn't land back in the hospital.
Documentation. Every visit needs a note, and the note has to match the plan of care. The agency that has a good template for this saves you an hour a night. Ask to see it before you accept.
The RN relationship. This is the part that makes or breaks the job for me. Good agencies make it easy to reach the RN who supervises you when something changes, and the RN calls back fast. When I have seen LPNs struggle, it was usually because the RN was stretched too thin to answer.
Driving. You spend a lot of the day in your car. If you are an employee, federal wage rules count the drive from one patient to the next as hours worked, whether you are paid hourly or per visit. Mileage reimbursement is a separate question that federal law leaves to the agency. Read what federal law says about mileage and drive time before you compare offers.
What Agencies Spend Per Visit on LPN Pay
These numbers come from the yearly cost reports that Medicare-certified home health agencies file with CMS. They are not a wage survey, and they are not what any one agency will offer you. For each agency we add up what it reported spending on LPN pay, including contracted services, and divide by its number of LPN visits. Benefits are left out. We use each agency's latest report in the 2024 file. The full method is in our article on pay per visit by state.
| Low end (25th percentile) | Middle (median) | High end (75th percentile) | Agencies | |
|---|---|---|---|---|
| LPN/LVN | $39 | $50 | $68 | 4,568 |
| Registered nurse (RN) | $68 | $95 | $130 | 6,587 |
"Middle" means half the agencies spent more per visit and half spent less. Half of all agencies fall between the low end and the high end. The middle LPN figure is about half the middle RN figure. The LPN range is also narrower than the RN range, which runs from $68 to $130.
Two cautions. These are national numbers, and pay varies a lot by state. A rate that looks low nationally can be normal where you live, and the other way around. And a per-visit figure means little until you know how many visits you can do in a week. Pick LPN in the clinician pay calculator, enter your ZIP code and your own per-visit range, and it shows what agencies near you spent, then turns a per-visit rate into weekly and yearly pay.
Questions to Ask in the Interview
This is my suggestion, drawn from what I've seen new LPNs run into. None of it is a rule.
- Who is my supervising RN, and how do I reach that person during the day? Ask what happens when the RN is in the field.
- What do you pay for, besides the visit? Mileage, drive time, a visit the patient cancels, orientation days.
- Is the rate the same for every visit type? Ask how a discharge visit pays versus a routine one.
- What will I do on my own, and what goes to the RN? Ask specifically about wound care orders, med changes and new symptoms.
- Will you ask me to do anything my state board's rules don't allow LPNs to do? If the answer sounds vague, that tells you something.
- How many visits a day does a typical LPN schedule have, and who builds the route?
- Do I get a template for notes, and how long after the visit do notes have to be done?
Frequently asked questions
Can an LPN or LVN work in home health?
Yes. Medicare's coverage rule defines skilled nursing care as services that must be performed by a registered nurse or a practical (vocational) nurse, as defined in the home health personnel rule. That rule says the LPN must be licensed in the state where practicing and furnish services under the supervision of a qualified registered nurse. Your state's nurse practice act can limit what you do further.
Can an LPN do the home health start of care assessment or OASIS?
No. The federal rule requires a registered nurse to conduct the initial assessment visit and to complete the comprehensive assessment, except on therapy-only cases, where a therapist may. The OASIS guidance manual says an LPN/LVN may not be responsible for completing the comprehensive assessment and OASIS. You can still collaborate and share what you see with the assessing clinician, if your agency's policy allows it.
Who supervises an LPN in home health?
A registered nurse. The rule says nursing services are provided under the supervision of a registered nurse. Surveyor guidance says the agency should identify an RN to supervise LPNs and monitor their work. I did not find a federal visit-interval clock for that supervision, so your state's nurse practice act and your agency's policy set the details.
How much do LPNs make per visit in home health?
In 2024 Medicare cost reports, the middle home health agency spent $50 per LPN visit on LPN pay, with the middle half of agencies between $39 and $68. That is what agencies reported spending, not a wage survey and not an offer. Registered nurse visits came to $95 in the middle.
Sources
- 42 CFR §484.115, Personnel qualifications (Cornell LII)
- 42 CFR §484.75, Skilled professional services (Cornell LII)
- 42 CFR §484.55, Comprehensive assessment of patients (Cornell LII)
- 42 CFR §484.80, Home health aide services (Cornell LII)
- 42 CFR §409.44, Skilled services requirements (Cornell LII)
- State Operations Manual, Appendix B, Home Health Agencies (CMS)
- OASIS-E2 Guidance Manual (CMS)
- Home health pay per visit by state, from 2024 Medicare cost reports (HCRIS, Form CMS-1728-20)
What do agencies near you spend per LPN visit?
Pick LPN, enter your ZIP code and your own per-visit range, and see what agencies in your county or state spent per visit in 2024, then turn a rate into weekly and yearly pay.