A nurse or an attendant can only be as good as the room, the chart and the plan you hand them. A bed at the wrong height, medicines in a plastic bag and no written instructions produce the same bad outcome whoever is at the bedside. Before the first shift, set up the room, decide what to rent and what to buy, get the chart right, and write the care plan.
The room
Choose the room before the patient comes home, if there is a choice. Ground floor if stairs are a problem, close to a bathroom, with a window and a door that closes.
- The bed. For a mobile patient, their own bed at a height where their feet touch the floor when sitting. For anyone bedridden or who needs help to sit up, a hospital bed on rent at ₹3,500 a month: adjustable back and knee, side rails, and height that saves the attendant's back. A manual bed with hand cranks is fine; an electric one is for a patient who adjusts it themselves.
- The mattress. An air mattress at ₹1,500 a month, from day one, for any patient who cannot turn themselves. It alternates pressure under the body and is the single most effective thing against bed sores. It does not replace turning every two hours; it makes the turning enough.
- Space on both sides of the bed. The attendant needs to reach from either side to turn the patient. A bed against the wall is a back injury waiting.
- A chair for the patient to sit out in, with arms, and a chair for the attendant.
- A bedside table with the chart, the medicines, water and the phone, and a bin with a lid.
- Light and a fan, and a night light so the attendant can check without switching on the main light.
- The bathroom. A commode chair if the patient can be moved to it; a grab rail by the toilet; a non-slip mat; a shower chair or a stool. Falls in the bathroom are the second-commonest reason for a readmission.
Rent or buy
| Item | Rent | Buy |
|---|---|---|
| Hospital bed | ₹3,500 a month; under six months or uncertain | Long-term bedridden, after the first months |
| Air mattress | ₹1,500 a month; any immobile patient | Long-term, once you know the type that works |
| Wheelchair | ₹1,200 a month; recovery, a few months | Permanent mobility need |
| Oxygen concentrator | ₹4,500 a month; always rent first, on prescription | Only on a doctor's long-term order |
| Walker, commode chair, shower chair | Usually bought; cheap | Yes |
| BP monitor, thermometer, glucometer, pulse oximeter | Bought; small | Yes |
Rental companies deliver, set up and take back; ask who services the concentrator and the mattress pump if they fail, and how fast. A concentrator that stops at 2 am needs a number that answers at 2 am, and a backup cylinder in the house if the patient depends on it.
The medicines and the chart
Nearly every medicine error at home comes from the chart, not the medicine: a dose given twice, a dose missed on a shift change, a tablet the doctor stopped that the family kept giving.
One chart, by the bed. Every medicine, the dose, the time, the route, and who ordered it. The discharge summary is the source; the chart is the working copy. Nobody but the doctor changes it. When the doctor changes a medicine, the chart is rewritten the same day and the old strips are removed.
Tick every dose. The nurse or attendant ticks the box and initials it. A missed tick at shift change is the question the family asks at 8 pm, not the next week.
One person fills the pill organiser. Weekly, from the chart, with the strips checked against it. The attendant gives from the organiser. This removes the "which white tablet" problem.
Keep the strips. In a box, labelled, with the expiry visible. Insulin and some injections in the fridge, on a shelf the children cannot reach.
Know which medicines matter most. Blood thinners, insulin, heart and blood pressure medicines, seizure medicines. A missed or doubled dose of these is a call to the doctor, not a shrug.
The supplies the household stocks
For an attendant on shift, the household keeps the daily supplies. A month's worth, topped up weekly:
- Disposable gloves, hand sanitiser, liquid soap and a hand towel for the carer only.
- Adult diapers if needed, underpads, wet wipes, barrier cream for the skin.
- A bedpan or urinal, a commode chair, a basin and a jug for bed baths, two sets of towels.
- A thermometer, a BP monitor, a glucometer with strips if diabetic, a pulse oximeter if there is any breathing or heart trouble.
- Dressing materials exactly as the doctor listed, for the nurse's visits: gauze, saline, the ointment, tape. The nurse brings the sterile items for the procedure at ₹400 a visit; the household keeps the consumables between visits.
- Catheter bags and the stand, if there is a catheter; feed and the syringe, if there is a Ryles tube.
- A notebook for the chart, a pen that works, and a clock the patient can see.
The one-page care plan
Write it with the doctor's discharge instructions in front of you, read it with the nurse or attendant on day one, and keep it by the bed. It should say:
- The patient. Name, age, the diagnosis in one line, allergies, and the doctor's name and number.
- The level of care and why: attendant, nurse, or ICU-trained; the shift hours; who covers the night.
- The routine. Wake, wash, meals, medicines, turning every two hours, sitting out, exercises, sleep. Times, not "morning".
- Diet. What the doctor said: soft, diabetic, low salt, thickened fluids, nothing by mouth. The cook needs this page too.
- Procedures and who does them. Dressing on which days, catheter change due when, injections at what time, by the nurse at ₹500 a visit or on shift.
- The vitals to record and the numbers that mean "call": the BP above or below which, the sugar above or below which, the oxygen saturation below which, a temperature above which. The doctor gives these; write them down.
- When to call the doctor and when to call an ambulance. Two lists, separate. Chest pain, breathlessness at rest, a fall with pain, a seizure, confusion that is new, bleeding that does not stop, a blocked catheter with pain: ambulance, not a call.
- The family contact, one number that answers, and the hospital the patient goes to.
- The arrangement. Shift times, the monthly rate, ₹26,000 for a 12-hour attendant or ₹42,000 for a nurse, pay date, weekly off, who covers it, notice.
A care plan that says "call the doctor if the sugar goes above the number on this line" is what turns an attendant into a safe pair of hands. Without it, every judgement is a guess.
What not to buy
- A fancy electric bed for a patient who will be up in six weeks. Rent the manual one.
- Medicines "to keep in case". The chart is the chart; extra strips are the doubled dose.
- A concentrator without a prescription. Oxygen is a medicine with a dose; a doctor sets the flow and the target saturation.
- Supplements and tonics the attendant suggests. Nothing goes in that is not on the chart.
- A cheap pulse oximeter you cannot trust. Check it against the one at the clinic; a wrong reading in either direction is dangerous.
The rules to agree on day one
Shift hours and the handover: fifteen minutes with the chart, every shift. Hand washing at the door and before and after every contact. Nothing given that is not on the chart. The chart shown to the family every evening. The numbers that mean "call". The weekly off and who covers it. The pay date. Notice, two weeks for a shift attendant, a month for live-in.
The how-it-works guide covers the shifts, the handover and the step-down from nurse to attendant; the essentials guide covers bed sores, falls, medication safety and when hospital care is non-negotiable.