Home nursing service, hospital-at-home or private nurse: who does what
Written by Rabah Slimani, State-registered nurse · · 3 min read
Reviewed on · Reviewed by Julie Martin
Three French schemes deliver care at home, with different prescribers, delays and funding. Here is how they genuinely differ, how to move from one to another, and what changes in practice for the patient.
Key points
- The choice between the three schemes depends on how heavy and how technical the care is, never on administrative preference.
- A private nurse can start on a simple prescription, with no admission file and no processing delay.
- Hospital-at-home is a hospital admission: a hospital doctor prescribes it and it frames the whole of the care.
- The schemes do not freely stack: entering hospital-at-home usually suspends private nursing for the same acts.
Three schemes, three logics
They get confused because they share the same setting: a home, a clinician, a bag of supplies. Their logic differs. A private nurse is an independent professional the patient chooses and a prescription activates. A home nursing service is an organisation caring for older or disabled people, with a place to be granted. Hospital-at-home is a full hospital admission, simply moved to your address.
The difference is not theoretical: it determines who prescribes, who coordinates, who pays, and above all how long before somebody rings the doorbell.
A well-matched scheme avoids two classic failures: care too light that ends in the emergency department, and care too heavy that strips a person of their ordinary day.
Hospital discharge: who does what, on which side
A break in care almost never comes from a missed procedure, but from a box nobody ticked between two organisations.
The hospital ward
Discharge prescription
The ward writes down the care to continue and the date of the first expected visit.
Equipment
The ward states what it supplies and what must be ordered from a pharmacy.
Discharge report
The ward sends its report to the family doctor, who remains in charge of follow-up.
The home-care practice
First contact
We confirm that the sector, the rhythm and the equipment are covered before discharge.
First visit
We come on the agreed date, with the prescription and the discharge report at hand.
Field feedback
We write down what we observe at home and send it to the family doctor.
Compared on what actually matters
The criteria below are the ones that change a patient's life: the delay, the contact person, the scope of care, the bill.
| Criterion | Private nurse | Home nursing service | Hospital at home |
|---|---|---|---|
| Trigger | Doctor's prescription, free choice of practice | Admission request, assessment, available place | Medical prescription, usually from hospital |
| Usual delay | A few hours to a few days | Several days to several weeks | Arranged before or during hospital discharge |
| Scope | Prescribed acts, monitoring, education | Hygiene and nursing care, long-term follow-up | Complex care, continuous medical coordination |
| Coordination | The practice with the GP | The service team | The scheme's coordinating physician |
| Billing | Direct billing of the statutory share | Global cover by statutory health insurance | Hospital cover |
Signs the scheme should change
Today's right scheme is not necessarily the right one in three months. These situations justify reviewing it with the GP.
- The visits needed exceed what a private round can absorb without compromise
- Care becomes technical: pumps, nutrition, complex pain relief
- Daily hygiene support is required and nobody is providing it
- Hospital admissions repeat for avoidable reasons
- The situation stabilises and heavy supervision is no longer justified
Switching without a gap in care
The risk is not the change itself: it is a switchover day nobody prepared.
Set a date, not an intention
A transfer is decided with a date and a time for the incoming service's first visit. Without that, each side assumes the other has already been.
Hand over the prescription and the current protocol
The incoming service needs up-to-date prescriptions, the dressing or infusion protocol and the latest observations, not an approximate verbal summary.
Name one contact for the transition week
A single person answers questions during the seven days of switchover. That is what prevents duplicate visits and forgotten slots.
Confirm the handover after the first visit
The outgoing service confirms the first care visit actually happened before closing the file. Closing early is the commonest cause of a day without care.
What it changes for you, in practice
With a private nurse you choose the practice and keep the same contact; timings are negotiated within the constraints of the round.
With a service or hospital-at-home you gain a team and stronger coordination, but you lose part of the choice over who comes and when.
No scheme is superior: there is the one that matches today's care, and it gets reassessed.
Three schemes, three decision logics
The three schemes are not chosen according to perceived severity, but according to who prescribes, who coordinates and how care is funded.
| Scheme | Who decides admission | What it provides |
|---|---|---|
| Private nurse | The patient chooses, the doctor prescribes | Prescribed care, flexible timing, free choice |
| Home nursing service (SSIAD) | Admission by the service, on prescription | Hygiene care and monitoring, limited places |
| Hospital at home (HAD) | Medical prescription and medical admission | Complex hospital-level care, continuous medical coordination |
Which combinations are possible, and which are not
A patient under hospital-at-home does not also receive private billing for the same care: the structure organises and pays for the whole, sometimes by calling on private nurses contracted with it.
By contrast, a patient followed by a home nursing service for hygiene may have a private nurse for prescribed procedures the service does not perform. This is common, and it requires written coordination to avoid duplication.
Moving from one scheme to another is prepared: handover notes, supplies, information for the patient. We take part in that handover when it concerns us, in both directions.
When to call
An announced admission to hospital-at-home or a nursing service, discharge from either, overlapping carers on the same procedure, doubt about who should visit today: call. These are settled in one exchange.
Two carers on the same procedure is a risk; nobody is another. Coordination exists to avoid both.
What changes for the patient, day to day
With a private nurse, the patient chooses the practice and keeps the same team; timing is discussed and billing goes through health insurance. With a nursing service, the team is the service's and places are limited. With hospital-at-home, the organisation is hospital-grade: equipment, coordination and sometimes night visits.
None of the three is better in itself. The right question is not "which is best" but "which matches the prescribed care and today's situation at home".
What we do when a situation exceeds private practice
We say so. When complexity, frequency or required monitoring exceed what a practice can provide at home, we inform the GP and document why.
The handover is then prepared with notes, equipment and information for the patient — in this direction and the other, because returning from hospital-at-home to private care demands the same rigour.
Frequently asked questions on this page
Can I keep my usual nurse if I enter hospital-at-home?
Is a new prescription needed when the scheme changes?
How long is the wait for a place in a home nursing service?
Who ultimately decides which scheme applies?
Can you choose your nursing practice while under a home nursing service?
Who decides when hospital-at-home ends?
Terms explained
- SSIAD
- A home nursing service providing prescribed care and personal hygiene support for older or disabled people.
- Home hospitalisation (HAD)
- A structure delivering hospital-level care at the patient's home, with its own medical coordination.
- IDEL (self-employed nurse)
- A state-registered nurse working independently under agreement with the French health insurance system, providing care at patients' homes.
- Prescription
- A doctor's written order stating the procedure, frequency and duration. Without it, nursing care cannot be delivered or reimbursed, apart from procedures allowed in direct access.
- Direct billing
- You do not pay upfront: the professional is paid directly by health insurance and, where applicable, by the top-up insurer.
Official sources
What we write is based on public references you can check for yourself.
This page is informational and replaces neither a medical consultation nor a prescription.