How home nursing works in France
Written by Julie Martin, State-registered nurse · · 3 min read
Reviewed on · Reviewed by Rabah Slimani
Who prescribes, who treats, who pays, who coordinates: the full chain between patient, doctor, nursing practice, health insurance, laboratory and hospital, explained without jargon.
Key points
- Home nursing care nearly always rests on a prescription setting the procedure, frequency and duration.
- A self-employed nurse works under agreement with health insurance and bills the fund, not the patient, where direct billing applies.
- Coordination is not paperwork: it is what prevents avoidable readmissions.
- Four different schemes can operate at home — private practice, SSIAD, HAD, PRADO — and they do not replace one another.
The principle: the home becomes the place of care
Home nursing is not a downgraded hospital: it is technical care delivered where the person lives, by a state-registered professional who is personally accountable at every visit.
That shift changes three things: the person stays in their environment, the nurse sees what a ward never sees (the stairs, the fridge, the isolation), and the family becomes part of the care rather than a visitor.
In exchange, everything a hospital supplies by default — equipment, pharmacy, an immediate second opinion — must be organised in advance. That is exactly what a practice is for.
A prescription's path, from the doctor's office to your home
Five handovers. Until all five are done, no nursing visit can be scheduled or billed.
Prescription
The doctor writes down the care required, its rhythm and its duration.
Receipt
You send us the prescription: a photograph, a drop-off, or a transfer from the hospital ward.
Reading
We check what is asked, what equipment it implies, and whether the address is inside our sector.
Scheduling
The visit enters the morning or the evening round, depending on what the care requires.
Handover
Every visit is recorded and reported to the doctor; renewal is requested before the prescription ends.
The six actors and what each one decides
Each actor holds a decision no one else can take for them. Knowing who decides what removes most blockages.
| Actor | Decides | Does not decide |
|---|---|---|
| Patient | Consent, preferred times, choice of practice | The nature of the prescribed care |
| Doctor | Diagnosis, procedure, frequency, duration | How the round is organised |
| Nursing practice | Feasibility, the actual time slot, care technique | The prescription |
| Health insurance | Reimbursement and prior-agreement rules | The clinical content of care |
| Pharmacy and supplier | Dispensing the prescribed supplies | The care protocol |
| Laboratory | Analysis and result reporting | What to do about the result |
What decides your visit time
A round is not a diary of appointments: it is an itinerary. The order of visits follows four constraints, in this order.
The care first
An injection tied to a meal, or a morning dressing, sets its own moment; the rest is built around it.
Geography
Nearby homes follow one another: that is what makes the number of visits possible without rushing.
The unexpected
A wound that has changed takes the time it takes; the following visits shift accordingly.
Your preference
It is recorded and honoured whenever the three constraints above allow it.
The pathway, step by step
From prescription to first visit, here is what actually happens.
The prescription is written
By the GP, a specialist or the hospital ward at discharge. It states the procedure, frequency and duration.
The patient chooses a practice
Free choice of professional is a right: no one can impose a practice, not the hospital, not the fund.
The practice checks feasibility
Address within the area, slot compatible with the round, supplies available, protocol clear.
The first visit sets the frame
Prescription and medicines checked, home assessed, times agreed, contact details exchanged.
Visits are documented
Every visit produces written handover notes, kept and shareable with the prescriber.
Billing is transmitted electronically
The Vitale and CPS cards sign the electronic claim: with direct billing the patient pays nothing upfront.
Private practice, SSIAD, HAD, PRADO: do not confuse them
These four schemes coexist and answer different needs. Wrong routing costs days.
| Scheme | What it provides | When it fits |
|---|---|---|
| Self-employed nursing practice | Prescribed technical care, agreed times, seven-day continuity | The vast majority of situations |
| SSIAD | Care and hygiene support by salaried staff, on prescription and subject to places | Established dependency, daily washing support |
| HAD | Hospital-level care with its own medical coordination | Heavy situations: complex chemotherapy, unstable end of life |
| PRADO | Administrative support at hospital discharge | Arranging first appointments before leaving hospital |
Who pays what, concretely
Prescribed nursing procedures are reimbursed under the national schedule, usually at 60 %, with the top-up insurer covering the rest.
For a recognised long-term condition, related care is covered at 100 %. A travel supplement applies to care delivered at home.
With direct billing the patient pays nothing upfront: the claim goes straight to the fund. Any remaining cost is known before the first visit, not discovered afterwards.
Coordination: where quality is decided
A practice sees the patient several times a week, sometimes twice a day. It is the health professional who observes most often — so the one who can detect deterioration earliest.
That information only matters if it travels: written handover to the GP, secure health messaging rather than ordinary email, an immediate phone call when a sign demands it.
The reverse holds too: a treatment change decided in consultation must reach us. A modified prescription nobody forwards is an incident waiting to happen.
What digital tools actually change
Electronic claims remove paper and shorten reimbursement delays; they do not improve care by themselves, they free up time.
Secure health messaging lets us send a report or a wound photograph to the doctor without exposing the data. An ordinary text message cannot.
Mon espace santé gives the patient control of their record: they decide who sees what. We add what serves continuity, never more.
From need to first visit: the real chain
The path is shorter than people assume, provided each piece arrives at the right moment.
A prescription is issued
By the GP, a specialist or the hospital ward at discharge. It names the procedure, the frequency and the duration.
The practice checks feasibility
Address within the area, procedure within our scope, supplies available, room in the round.
A first visit is scheduled
It serves the care and the set-up alike: access, work surface, storage, liaison sheet.
The rhythm settles
Later visits are organised as a round, within a time window rather than at an exact minute.
Follow-up circulates
Notes to the doctor, alerts when something changes, prescription renewal anticipated.
What home changes, compared with hospital
In hospital the patient comes to the care. At home the care comes to the patient: the environment is no longer neutral, it is part of the treatment. A clear table, accessible water and decent lighting matter as much as the supplies.
The other difference is time: between visits, nobody is watching. That is why we always spend a few minutes explaining what to look for and when to call. An informed patient is the first safety net at home.
When to call
Deterioration between visits, unexplained fever, missing supplies, an expiring prescription, a hospital admission, a move outside the area: each of these changes the plan and should be reported without waiting for the next visit.
We would rather take an unnecessary call than receive information too late.
Why a time is a window, not a minute
A round is a series of homes linked by real journeys. A procedure that takes ten minutes longer, a broken lift, a door that does not open: everything shifts what follows. Promising exactly 8:15 would be promising what no practice can keep.
So we announce a window, we respect clinical priorities — insulin before a meal, antibiotics at fixed intervals — and we warn when a delay exceeds what was announced. Less flattering than a to-the-minute time, but true.
Frequently asked questions on this page
Can I freely choose my nursing practice?
Is a prescription always required?
What is the difference between a private practice and an SSIAD?
What happens when my nurse is on holiday?
Can you choose your private nurse?
What happens during the practice's holidays?
Terms explained
- 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.
- NGAP
- The official list of nursing procedures and their billing codes, which determines what can be invoiced to French health insurance.
- SESAM-Vitale
- The electronic claims system: the patient's Vitale card and the professional's CPS card jointly sign an invoice sent to the health fund with no paperwork.
- CPS card
- The health professional's personal electronic identity card, required to submit electronic claims and to access national digital health services.
- Direct billing
- You do not pay upfront: the professional is paid directly by health insurance and, where applicable, by the top-up insurer.
- Long-term condition (ALD)
- A chronic condition recognised by French health insurance, granting 100 % cover for care related to that condition.
- PRADO
- The health insurance discharge support programme: an adviser arranges the first community appointments from the hospital before discharge.
- Home hospitalisation (HAD)
- A structure delivering hospital-level care at the patient's home, with its own medical coordination.
- SSIAD
- A home nursing service providing prescribed care and personal hygiene support for older or disabled people.
- MSSanté
- The French secure health messaging system, used to exchange health data between professionals, and with patients, outside ordinary email.
- Mon espace santé
- The patient's national digital health record, including a shared medical file and secure messaging. The patient controls who can access it.
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.