The nursing care assessment: what actually happens at home

Who it is for

The nursing care assessment applies to dependent people receiving hygiene and monitoring care at home. For them, the health insurance system reasons in terms of needs covered rather than acts counted.

It follows a medical prescription. Without a prescription there is no assessment and no cover: the doctor opens the door, the nurse organises what follows.

What we look at during the assessment visit

Actual autonomy, not reported autonomy: getting up, washing, dressing, moving around the home, preparing and taking medication.

The environment: bathroom access, a suitable bed, lighting, steps, and whether a family carer is present and how heavy their load really is.

Priority risks: falls, undernutrition, pressure sores, confusion, isolation. These determine how often we come.

What it changes for the person and the family

Visit frequency follows the assessed needs, not a negotiation. A deterioration justifies a new assessment: nothing is fixed for a year.

The GP receives the assessment, so it becomes shared ground: the family no longer tells the same story twice to two professionals.

Out-of-pocket costs follow the usual health insurance and top-up rules; we tell you plainly, before starting, what will be billed.

How it is reviewed over time

An assessment is not a fixed document: it is reviewed whenever the person's condition changes — after a hospital stay, a fall, a loss of independence or, conversely, a recovery.

Between reviews, every visit feeds the observations: that continuity is what lets us demonstrate a change rather than assume one.

A review can be requested by us, by the doctor, by the person or by their family. None of those requests is treated as a challenge: they are how the system is meant to work.

What the assessment does not do

It does not open social entitlements: allowances, home help and meal delivery are handled by the département and home-help services, which we can point you to.

It does not replace medical advice. If health deteriorates, the rule stays the same: we call the GP, and 15 in a life-threatening emergency.

What the assessment actually looks at, area by area

A nursing care assessment does not measure a disease: it describes a life situation, and the care and monitoring it requires. It is an organisational instrument, not a diagnosis.

Before, during, after: the real timeline

A well-run assessment is prepared and concluded. Time spent in the home is only part of the work.

1. 01

   Before

   Reading the prescription, the available reports and the history known to the practice.

2. 02

   During

   Observation, open questions, checking what is said against what is seen — a drawer, a step, a box of tablets.

3. 03

   After

   Writing the care plan, sending it to the GP, and explaining it to the person and their relatives.

4. 04

   Then

   Review at term, or sooner if the situation changes: hospital stay, fall, new treatment.

What the family can prepare

Nothing is compulsory, but a prepared visit is shorter and produces a more accurate plan.

• Current prescriptions, including those from specialists.
• Latest hospital or consultation reports.
• The real list of medicines taken, including over-the-counter ones.
• Contact details for the GP and other professionals involved.
• Everyday difficulties noticed, simply written down.

Preparing the assessment: what saves half an hour

The assessment takes longer than an ordinary visit because it looks at the whole situation, not one procedure. Gathering these items before we arrive avoids a second visit.

• All current prescriptions, including those from specialists.
• Hospital discharge reports from the last twelve months.
• The real list of what is being taken, including anything stopped independently.
• Contact details for the GP, the pharmacist and other home carers.
• Support already in place: meal delivery, home help, telecare.
• The name of the designated trusted person, if one exists.

What the assessment looks at, beyond the procedure

Independence is measured on concrete actions: getting up, washing, dressing, preparing a meal, managing medication, going out. Those actions, not an abstract score, shape the care plan.

The environment counts as much: bed height, night lighting, rugs, grab rails, shower access, a relative nearby. Many situations stabilise through a simple material change rather than an extra procedure.

The assessment also records what is outside our remit and must be referred: memory clinic, occupational therapy, benefit applications, dietary advice. We decide none of these; we propose them to the GP.

When to call

A fall, unusual confusion, visible weight loss, lasting refusal to eat, a new wound, exhaustion of the family carer: these change the care plan and should not wait for the next assessment.

A care plan is revised when the situation changes, not only on its anniversary date.

What the assessment becomes, once written

The assessment is not an archive document: it becomes the care plan, that is, the dated list of what will be done, how often, and by whom. It goes to the prescriber, who validates or corrects it.

It is revised at every notable change — hospital stay, fall, treatment change, a carer arriving or leaving. A care plan unchanged for a year, in a situation that has changed, is simply a wrong care plan.

Frequently asked questions on this page

Terms explained

Nursing care assessment (BSI)

A structured assessment of autonomy and needs for dependent people aged 90 and over, which replaces the former care plan and sets the daily care package.

NGAP

The official list of nursing procedures and their billing codes, which determines what can be invoiced to French health insurance.

Long-term condition (ALD)

A chronic condition recognised by French health insurance, granting 100 % cover for care related to that condition.

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.