Retirement Homes in France

A lot of our readers have been asking us about retirement homes in France—with their sights on moving to France, and ensuring they will be taken care of as they age and become disabled. By coincidence to their inquiries, I had the “misfortune” of visiting a dear friend who was recently moved to a nursing/retirement home in Paris—the first time for me seeing one of these facilities.

I must admit, that this has never entered my mind, even at the age of 71, because living in an urban setting without a car, makes the possibility of living at home for the rest of my life, a pretty strong reality…even if living alone. Still, one likes to be prepared for such a situation, especially if for some reason I were to become disabled, and couldn’t climb the 70 steps to my apartment, or became mentally encumbered.

My friend’s illness started with Parkinson’s disease. She is 10 years older than me and was one of the toughest, most vibrant women I have ever known. Now, she is bedridden, on painkillers, and a shadow of her former self. It was very upsetting to see her like this, but it hit me as a harsh reality.

I’ve always lived by the expectation that I would be like my mother, who lived by herself until almost 98, with all her wits about her, and was never sick for even a day. She just sat down on her bed one day and died, quietly and peacefully, without any need for home care. Yes, I intend on following in her footsteps, like my oldest sister who is 85 and no less spry than myself.

Get ready to remember a lot of acronyms when discussing this subject. In France, the term for a retirement home is an “EHPAD.” This is an accommodation facility for dependent elderly people. It is a medicalized retirement home that can accommodate elderly people who are losing their independence and need daily support (doctor, nurse, etc…) depending on their level of dependency.

After World War II, residential care homes for senior citizens were called hospices. A French law of June 3, 1975 changed the designation to “maison de retraite” (retirement home), partly because the old terminology had become derogatory. Another reform in 1999 created the new term Établissement d’Hébergement pour Personnes Agées Dépendantes…or EHPAD.

In 2021, nearly 27% of the French population, or 17.7 million individuals, were aged 60 or older. INSEE projections indicate that by 2050, this proportion will rise to 35%, encompassing 24.4 million people. To accommodate the increasing number of seniors, the number of facilities has grown significantly in recent years. In 2021, France had 7,503 EHPADs with a capacity of over 600,000 places. Projections for 2050 suggest that an additional 319,000 places will be needed to meet the anticipated demand.

To determine the level of dependency, the doctor will need to assess the elderly person’s autonomy using the “AGGIR grid.” The AGGIR grid is the standardized national instrument for determining the dependency of elderly people in France living in institutions or in the community. The allocation of the Allocation Personnalisée d’Autonomie (APA) depends essentially on the classification of frail elderly people into 6 degrees of dependence (GIR1 to GIR6).

Some EHPADs have an Alzheimer’s unit or Unité de Soins Longue Durée (USLD) within the residence, so that each pathology can be treated with appropriate care. Elderly people may be eligible for various forms of financial assistance, such as the APA. EHPAD tariffs can vary from one region to another, depending on the establishment and the level of dependency (GIR 1 to GIR 6). The higher the level of dependency, the higher the daily supplement.

An EHPADs mission is to support fragile and vulnerable people and to preserve their autonomy through comprehensive support including accommodation, catering, entertainment and care. They are intended for people over the age of 60 who need help and care on a daily basis. These people require more or less significant help from a third party in the activities of daily living for physical or mental reasons. People under 60 years of age may be admitted to an EHPAD with an exemption.

There are also independent living residences which are non-medicalized accommodations. They are intended for people over 60 years old who are independent or who have slightly impaired autonomy without needing permanent help and care. These accommodations offer collective services.

EHPADs accommodate on average between 50 and 120 residents. Residents and their loved ones are therefore relieved of all daily management. They offer accommodations, entertainment and activities, support for loss of autonomy, and daily medical and paramedical care. Small living units are small EHPADs with fewer than 25 places that have signed an agreement with the departmental council and the ARS (regional health agency). Their operation and the aid they provide are the same as those of a traditional EHPAD. Some small living units have chosen not to sign an agreement, but to use liberal professionals or home care services. In this context, residents benefit from APA at home and not from APA in an establishment.

The EHPAD offers its residents a program of entertainment and activities organized within the establishment. Outdoor activities are also offered. Each resident is free to participate. These activities allow residents to share friendly times, to participate in prevention actions linked to health, loss of autonomy, to practice physical activity, etc.

 

Since the “Aging Well” law of April 8, 2024 , the EHPAD guarantees that: Residents have the right to receive visitors every day without having to inform the establishment in advance; and residents have the right to welcome their pets, under certain conditions. The resident must be able to provide for the needs of these animals and respect hygiene and safety conditions. A decree will specify these conditions. My friend had her cat living with her in her room and it was very comforting to her.

Residents who need support in the essential acts of life (getting up, going to bed, washing, eating, etc.) are helped by EHPAD staff. Daily care (dressings, blood sugar measurement, medication distribution, etc.) is carried out by the EHPAD care team. This care is carried out under the responsibility of the coordination team (coordinating doctor and coordinating nurse). The coordination team also takes care of coordinating the interventions of the attending physician and appointments with specialists.

All EHPADs are normally able to accommodate a person with Alzheimer’s disease or a related disease, subject to the reception possibilities of the establishment. Some EHPADs offer adapted solutions.

Residents have a private bedroom and bathroom in most nursing homes. Some nursing homes offer double rooms for couples or for people who agree to share their room. Connecting single rooms can also sometimes be offered to couples.

There is aid that can help pay for accommodation costs and dependency rate costs. The ASH is used to pay all or part of the accommodation costs that the establishment charges or family reception for the elderly person. The ASH pays the difference between the amount of accommodation and what the elderly person can pay, or even what their family can pay (children, sons-in-law, daughters-in-law). The department can recover the ASH paid, both during the lifetime and at the death of the elderly person.

These aids can add up. They depend on the resources for APA, housing assistance and ASH, and the level of loss of autonomy for the APA. A tax reduction is possible for taxable residents.

Energy checks are accepted in EHPADs. The energy check must be sent to the establishment manager. The amount of the check is then deducted from the accommodation rate which includes energy costs.

In the directory space, by consulting the file of each EHPAD, a tab “Calculation of remaining charge” allows to calculate an estimate of the amount remaining to be paid by the resident for one month of permanent accommodation, after deduction of two public aids: the APA (personalized autonomy allowance) in an establishment and the housing assistance (APL). It is also possible to compare the estimates of monthly remaining charges between several EHPADs.

In many departments, it is possible to make one or more requests for admission to an EHPAD online using the ViaTrajectoire website. The online request allows you to complete the file once and send it to several establishments in a single click.

Nursing home prices have wide regional disparities…the average monthly cost of care in a nursing home can vary by as much as double. The average across France is €2,214, but some French people have to pay much more to finance their accommodation:

In the Rhône:             €2,521
Bouches-du-Rhône:  €2,525
In Corse-du-Sud:      €2,623
In Alpes-Maritimes: €2,679
And in Paris:              €3,698

You have to live in the Meuse to expect to pay a lower cost, €1,749 per month on average. To finance their room in an EHPAD, residents have to dip into their savings by an average of €426 a month, compared with the median standard of living for this age group. Once again, this figure rises sharply depending on location. The Paris region once again stands out, forcing its residents to make major financial efforts: in Seine-Saint-Denis, this rate rises to €1,118, in Hauts-de-Seine to €1,120 and in Paris to €1,380.

The south of France is not spared: in the Alpes-Maritimes, residents have to fork out €836 a month from their savings. Only Finistère offers prices that are more or less equivalent to the median standard of living, with residents theoretically able to save €8/month despite this outlay.

My friend’s facility was in the 18th arrondissement of Paris and was new, spotless and friendly. She had her own room with a bathroom and constant care, much like in a hospital. She was brought her meals at dinner, and at lunch she was taken to the dining room to mingle with the other residents. A flyer was circulated promoting the week’s menus and they looked great! The day I was there, they were serving up “Houmous, Boulettes de boeuf à l’Italienne, Semoule aux petits légumes, Plateau de fromages and a Corbeille de fruits” (Hummus, Italian Beef Meatballs, Semolina with Vegetables, Cheese Platter and a Fruit Basket). Not bad, right? There was also a flyer promoting events or “animations” during the week—fitting with Fête de la Musique, there had been a piano concert on Friday.

From what I could discern, the care was good, and all-in-all, she was satisfied with her health care, even if not with her health. And I felt she was in good hands.

Acronyms to remember:

EHPAD = Établissement d’Hébergement pour Personnes Agées Dépendantes
APA = Personalized Autonomy Allowance
APL = Custom Housing Assistance
AGGIR = Gerontological Autonomy and Iso Resources Group
USLD = Unité de Soins Longue Durée
ASH = Social Assistance for Accommodation

The information above was found in the following sites, which may be of interest to you:

• ehpad.fr
• pour-les-personnes-agees.gouv.fr
• capretraite.fr
• parella.fr

A bientôt,