Kelly Duranti and Denise Giovanniello founded Milestones in Home Care,...

Kelly Duranti and Denise Giovanniello founded Milestones in Home Care, a nursing service for handicapped children, and now face challenges as Medicaid and insurance companies cut benefits for their clients. (Sept. 20, 2011) Credit: Newsday/Alejandra Villa

Kelly Duranti is a sixth-generation nurse. As a teenager, Denise Giovanniello biked to her grandfather's house in Marine Park, Brooklyn, from the Midwood section a few miles away, after school to care for her ailing grandfather.

So Duranti and Giovanniello never thought of being anything other than registered nurses.

But after more than two decades in the field, they have become something else: businesswomen working out of an office in a small, tidy home in Farmingdale where Duranti once lived when she first married. They are owners of an uncommon business -- experts say there are only a handful of others on Long Island -- that provides pediatric nursing services for the handicapped who range in age from infancy to early 20s.

But the business, Milestones in Home Care Inc., now faces challenges from sharp cuts to Medicaid and reductions in the amount of money insurance companies will pay for such services. Said Giovanniello, "Insurance companies don't realize that keeping these children at home is a fraction of what hospitalization would cost."

The reimbursement situation is unlikely to ease up soon, said Irina Mitzner, vice president of clinical services for North Shore-LIJ's home care network. "It's going to be tough going," Mitzner said. The women say they battle on.

Milestones, which the two women started in 2003 by putting up about $75,000 each -- their families' life savings at the time -- has grown into a business with revenue of about $4 million annually. The company now has on payroll 100 nurses who are dispatched to care for about 40 patients.

Giovanniello, 45, of Rockville Centre, and Duranti, 44, of Farmingdale, who met while working at Winthrop-University Hospital in Mineola in the early to mid-1990s and now are so close they finish each other's sentences, went through a laborious and highly bureaucratic process for two years in the early 2000s before being licensed by the state health department.

Giovanniello was pregnant at the time. "We had babies," said Duranti. Their husbands -- Stephen Duranti, a Suffolk police officer, and Anthony Giovanniello, a psychiatrist, went along with the project.

On the day they sent off their licensing application to the state, Giovanniello recalls standing in front of a postal box holding a package with one hand and thinking, "This will change our lives."