Patient companions: the informal workers keeping Iran’s hospitals running

A chronic shortage of nurses and auxiliary staff in Iran’s hospitals has quietly given rise to a new and largely unregulated job: the “patient companion.”

Across Tehran and other major cities, advertising websites, job boards and even the walls outside hospitals are plastered with notices offering such services.

The role is not filled by relatives. Instead, patient companions are hired—often informally—to care for hospitalized patients, helping with eating, hygiene and mobility.

According to the head of Iran’s Nursing Organization, the country faces a shortfall of at least 100,000 nurses. The deficit appears to have created a parallel, low-wage labor market with little oversight and frequent abuse.

A nurse working at a hospital in Tehran told Iran International that the tasks assigned to patient companions often go far beyond what their wages suggest.

“They do work that no one would normally accept for this pay,” she said, requesting anonymity. “They care for patients who cannot go to the toilet or bathe on their own.”

Exploited

A search for “patient companion” (hamrah-e bimār) on Iran’s largest classifieds website, Divar, produces dozens of listings from across the country. The companies share a familiar pitch: assurances of experience, professionalism and official registration.

One company advertises an eight-hour shift for a mobile patient who does not require personal hygiene care at 800,000 tomans (about $6 at December 16 exchange rates). Many others list prices as “negotiable.”

Alongside these firms, individuals also advertise their services directly. Many claim to have first-aid training or nursing experience and say they are willing to travel nationwide.

Yet trust remains a major barrier.

“People don’t feel comfortable hiring individuals directly,” said another nurse in Tehran, who also asked not to be named. “So they turn to companies, even though the companies take most of the money.”

According to this nurse, nursing service firms often keep close to two-thirds of what families pay, leaving companions with little compensation despite the physical and emotional demands of the work.

No better option

To avoid company fees, some companions eventually try to secure work through hospital staff. After being introduced repeatedly by agencies, they ask nurses or aides to connect them directly with families in need.

The practice is most common in public hospitals, where staff shortages are most acute.

A doctor at a Tehran hospital told Iran International that families struggling to pay medical bills sometimes plead with doctors or nurses to help a relative find work as a patient companion. “It becomes a way to cover treatment costs,” he said.

A male nurse in Tehran described hiring a companion through an agency several years ago to care for his grandmother, who had cancer.

“She was a nursing student, working to support herself while studying,” he said. “She told us the companies demand large promissory notes from workers and then take two-thirds of the family’s payment.”

For many companions, the job is a temporary lifeline rather than a chosen profession.

Home-care assignments can carry additional risks, especially for women. Reports of assault or sexual harassment are not rare, the nurse added, but few are willing to come forward, fearing that agencies may move to cash promissory notes at the first sign of dispute—effectively blacklisting workers from future employment.

That lack of regulation cuts both ways. Families often prefer companies, believing them to be safer. But, as nurses acknowledge, the skills of agency-provided companions are far from guaranteed.

“Most companions are women, many of them heads of household,” one nurse in Tehran said. “Few have formal training. Most learn on the job from hospital staff. They do this because they have no other option.”