Home nursing service, hospital-at-home or private nurse: who does what
Written by Rabah Slimani, State-registered nurse · · 1 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.
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.
01
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.
02
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.
03
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.
04
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.
Frequently asked questions on this page
- Can I keep my usual nurse if I enter hospital-at-home?
- Sometimes yes, because some providers contract private nurses to act on their behalf. It depends on the provider and the care involved, so the question belongs before admission rather than after it.
- Is a new prescription needed when the scheme changes?
- As a rule yes, because both the prescriber and the legal framework change. Existing prescriptions remain useful to the incoming team as history, but they do not cover it legally.
- How long is the wait for a place in a home nursing service?
- It depends on available places in the sector and can run to several weeks. In the meantime, private nursing prevents the person being left without care while the file is being processed.
- Who ultimately decides which scheme applies?
- The prescribing doctor, together with the patient. Providers assess eligibility and the practice gives a technical view on feasibility, but the decision belongs to the patient and their doctor.
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.
- Hospital at home: scope and conditionsMinistère de la Santé
- Care pathways: questions and answersHaute Autorité de santé
- Reimbursement of care: rules for insured patientsAssurance Maladie (ameli.fr)
This page is informational and replaces neither a medical consultation nor a prescription.