I just wanted to thank everyone for their responses. Just to clear some things up- the aide we hired is working independently for our family (no agency involved and not affiliated with the hospital), after several nurses on the floor recommended that we might consider extra care for our grandmother. All the nurses highly recommended this aide, and she was *wonderful* to my grandmother today, their first day together. Apparently this aide needs the work, so we were wondering if we should pay her above the fee she stated ($15 an hour, which seems very low) for her hard work. Hence the "tip" question- we don't assume her to be a "servant" as someone implied upthread. We just want to make sure she is well compensated for the work she is doing. We appreciate her and want to show it, and sometimes (especially in this economy and in this part of the country) people can use money more than they can a card or an award, especially if they are unaffiliated with an agency or hospital. Thank you again for taking the time to answer my question. I really appreciate the answers as well as all the hard work you do. As someone with Spina Bifida who has been in and out of the hospital throughout her life, I do appreciate nurses. Several have touched my life and helped me more than anyone else. Thank you.