Home nursing is not one service. It is a level of care, a shift pattern, and a plan, and the families who get it right understand each before anyone arrives. Here is how the arrangement works, from the first call to the last day.
The sequence
- The doctor says the level. Attendant, nurse, or ICU-trained, and for how long. Ask at discharge; it decides everything.
- The post or the call. The level, the shift, the duration, the diagnosis in one line, and the equipment in the house.
- The first shift, paid at the day rate. This is the trial.
- The week, with the chart and the handover settling into a routine.
- The month, paid on a date, with weekly offs covered.
- The step-down, when the doctor agrees: nurse to attendant, 24 hours to 12, shifts to visits.
- Notice, two weeks for a shift attendant, a month for live-in.
The levels, and the line between them
An attendant is trained in patient handling and hygiene. Bathing, toilet, diapers, feeding, turning, moving to a chair, keeping the chart, company. ₹1,100 for a 12-hour shift, ₹26,000 a month. Not a nurse: no injections, no tubes, no wound care beyond a plaster, no decisions about medicines.
A GNM or ANM nurse holds a nursing qualification. Injections and IV, catheter and Ryles tube care and changes, dressings, vitals, medicines on the chart, and the judgement to call the doctor. ₹1,800 for 12 hours, ₹42,000 a month, ₹500 for a visit of up to an hour.
An ICU-trained nurse at ₹2,500 for 12 hours has worked in intensive care: tracheostomy and suction, oxygen management, a ventilator at home, drains after surgery.
The line matters in both directions. An attendant asked to change a catheter is an infection. A nurse paid ₹42,000 a month to do what an attendant does at ₹26,000 is the commonest overspend in home care.
Shifts: 8, 12, 24 and live-in
8 hours at ₹750: daytime help for a patient who is fine at night, or a companion for an elderly parent at ₹700.
12 hours at ₹1,100: the standard shift, day or night. Two 12-hour shifts is round-the-clock awake care, two people, two rates.
24 hours, stays, at ₹1,500: one attendant in the house, sleeping at night, woken for turning and the toilet. Right for a patient who needs help through the night but not someone awake.
Live-in at ₹30,000 a month, or ₹28,000 for elderly care: the attendant lives in, with food and a room on you, agreed daytime hours, a rest in the afternoon, a full weekly off out of the house, and a month's notice. Live-in is not 24-hour awake care either.
The weekly off is the thing families forget. A 12-hour attendant six days a week needs a seventh person or a family member on the seventh day. Agree it on day one; "we'll manage" is how the attendant leaves.
The handover
Every shift change is fifteen minutes with the chart, and it is where mistakes happen or do not.
- What was given, and when: every medicine ticked.
- Vitals, and anything outside the numbers on the care plan.
- Intake and output: what was eaten and drunk, urine, stools, vomiting.
- Turns, and the skin: any redness over the hips, tailbone, heels or shoulders.
- Sleep, pain, mood, confusion.
- Anything the doctor said on the phone.
The family reads the chart every evening. A handover that happens in the doorway with no chart is a missed dose by Thursday.
Visits versus shifts
A nurse visit at ₹500 is for a procedure: an injection at ₹350, a dressing at ₹400, a catheter or Ryles tube change at ₹700, a blood sample at ₹200, vitals at ₹250. The nurse comes, does it, charts it, and leaves.
A shift is for a patient who needs watching. The right arrangement for most families after the first weeks is an attendant on shift plus a nurse visit on the days the procedure is due. Physiotherapy at ₹600 a session, or ₹500 in a package of ten, is a visit too, on its own schedule.
Agency or direct
| Direct, through TheHire | Through an agency | |
|---|---|---|
| Finding | Post the level and the shift; verified attendants and nurses call back | Agency assigns someone |
| Fee | None; the day or the month at the card rate | A margin on the rate, or a placement fee |
| Replacement for the weekly off or illness | You post again or arrange it | Agency sends cover, if the contract says so |
| Verification | ID and phone verified, public reviews, certificates you ask to see | Varies; ask what is actually checked |
| Who the person answers to | You, with the doctor's plan | The agency's supervisor |
Direct gives you the person's own rate and a direct relationship. An agency is worth it for round-the-clock care, where the weekly-off cover and a replacement during illness matter and you cannot run two rosters yourself, and for ICU-level care where a supervisor who can be called is a real thing. If you use an agency, ask whether the nurse sees the whole rate, and read the replacement clause.
Stepping down
Care should get lighter as the patient improves, and the doctor decides when.
- ICU-trained nurse to GNM nurse when the airway, the oxygen and the drains are stable.
- Nurse on shift to attendant plus nurse visits when the only nursing need is a scheduled procedure.
- Two 12-hour shifts to one 24-hour when the nights settle.
- 12 hours to 8, or to a companion at ₹700 when the patient is up and about.
- Attendant to physio only when the need is exercise, not care.
Review weekly, with the chart in hand, and ask the doctor at each visit: "What can we step down?" The families who do this spend half of what the families who do not do, and the patient does better for it.
Notice and leaving
Two weeks either side for a shift attendant, a month for live-in. An attendant who gives notice is doing you a favour; ask whether they know someone. If you are ending it, pay to the end of the notice and say why. When the patient recovers or passes, the arrangement ends on the day, with the week paid.
What a nurse can and cannot do at home
Can, on the doctor's orders: give oral and injected medicines on the chart; manage IV lines the doctor has set up; care for and change catheters and Ryles tubes; dress wounds; manage oxygen at the prescribed flow; suction a tracheostomy; record vitals and act on the numbers in the plan; call the doctor.
Cannot, at any price: prescribe, change or stop a medicine; start a treatment the doctor has not ordered; give a medicine a family member bought on a hunch; decide that a hospital admission is not needed when the plan says it is; sign anything medical; certify a death.
And an attendant cannot do any of the nursing list. A home where this line is clear is a safe home.
The rule: the doctor sets the level and the plan, the nurse or attendant works the plan and the chart, and the family reads the chart every evening and asks the doctor what to step down. Nobody at home decides medicines.
The hiring guide covers what to ask and which certificates to see; the essentials guide covers bed sores, falls and when hospital care is non-negotiable.