Care for the Elderly in France
- By Alexander Anichkin
- Jun. 18 2015 00:00
Huelgoat: retirement home Mont-Leroux. Main building.
Traditionally, it is considered natural among the French for senior relatives to be cared for by the family. In accordance with the law, children are required to provide for their aging parents.
This, in particular, explains why old people's homes and retirement homes (essentially boarding houses with additional equipment, and health care facilities) are less common in France than in other Western countries. Recently, however, this has gradually begun to change.
A survey conducted by one of the country's leading sociological research centers, IPSOS, confirms that 90 percent of people aged 50 or older would prefer to live in their own homes as long as possible. A quarter of those over 85, though, are already in some form of assisted living, which amounts to around 450,000 people. In reality, it is not rare to see 85+ people in France: it has always been on the list of countries with the longest life expectancies. France invests more than most other European countries in health care, and the country's senior population benefits from this. The WHO ranked France's health care system as the best in the world. The French agree to "pay more to get more." "Most often people come to us when they need constant care," explains Thierry Morosolli, general director for real estate at GDP Vendome, a leading French provider of services to elderly pensioners.
Yet today, the population of France is 65.3 million, and over a quarter is aged 60 or older. By 2030, it is estimated those over 60 will number some 20 million. The sharpest growth will be in the group aged 75 and above, which is expected to increase threefold. The 85+ group will be four times larger.
These demographic changes will increase demand for elderly care facilities.
In France currently, there are several different types of senior assisted living.
This could be a standard old people's home, maison de retraite or maison de repos, which is either state or privately run. These are divided into homes with specialized care facilities and those without them. Expenses for their activities fall into three categories: accommodation, general care, and medical treatment. "In an EHPAD, accommodation and care are paid for by the [resident]," says Thierry. "In some cases, they can be supported by the regional department to which the resident is legally registered. If the senior resident qualifies, the Social Development Council for the department will send funds to serve as a form of reimbursement or compensation. The costs of medical care, in turn, are covered by health insurance.
The other forms of senior assisted living differ according to the type, volume, and intensity of services provided, and the extent of involvement in a resident's life.
Apartments for low-income seniors are located on campuses. Foyer logement usually refers to a building or complex entirely occupied by seniors. Foyer soleil is a mixed housing situation with people of different ages. The apartment itself and the organization of household activities can be left to their senior residents to maintain, if they desire a degree of autonomy. This can be coupled and complemented by some supervision and involvement of social services, if there is a wish or need for it. Apartments are rented separately and are furnished by their residents, but services such as laundry and meals are shared.
Another type of assisted living is an apartment with additional services, (résidence avec services pour personnes âgées, abbreviated to résidence services). They differ from the low-income apartments above for the condition: they can either be bought or rented by their inhabitants. There is an option for the apartments to come furnished or not.
Separate communities for seniors, village retraite, are quite rare in France, and exist mainly in the south of the country. These are specially designed communities for seniors with purpose-built homes or apartments, with security, utilities and amenities. There is a communal swimming pool, lounge room, library, exercise room and music, and a restaurant or cafe. Services for residents may include special care, cleaning, assistance in administrative matters, caring for pets, food service, hairdressing, physiotherapy, and even guided tours, lectures, games, presentations or movie clubs.
A community of this kind usually consists of 50 individual one- to two-room homes, or pavilions. They can be rented for around 300–600 euros per month or they can be bought outright. The cost of a two-room home is about 120,000 euros. In addition, residents must pay for heating and air conditioning, water supply, including hot water, a subscription to satellite TV, and other similar expenses.
Since 2002, benefits for seniors needing care have been provided through the so-called APA system (Allocation personnalisée à l'autonomie). The funds for these benefits originate from local councils and the newly created agency CNSA (Caisse nationale de solidarité pour l'autonomie). The CNSA does not finance itself via tax credits. Rather it gathers funds from an extra working day of employees and by taking an additional 0.3 percent tax from employers, also claiming assistance from the existing healthcare budgeting system. The benefits are primarily intended for care for the elderly, but they also aim to give seniors a chance to maintain their independence for as long as possible.
More than a million people receive APA benefits. Sixty-one percent of benefit recipients continue to live in their own homes, receiving regular assistance from professional aid services, and visits from friends, relatives, and loved ones. APA care provides home alarm and emergency systems, clubs for the elderly, recreation centers, and, of course, volunteer associations. Often, the social and communal services are combined with visits to see nurses, physiotherapists and psychologists. Therefore, even a physically weak senior is surrounded by a support system, which is run by professional and semi-professional social and volunteer organizations.
Despite all these efforts, the majority of seniors still prefer to live at home until the moment institutional care is absolutely necessary. Losing the ability to live an autonomous existence is always there. It increasingly happens that family members are unable to look after aging relatives. "Children now often cannot care for their parents under the same roof," says Thierry Morosolli from GDP Vendome. "It is just too costly for them. In these cases, the EHPAD system is a possible solution. Our organization is not a hospital where people come for treatment. We are both a medical and a social institution. Our goal is not to treat illness, but to provide shelter, quality living conditions and medical care when age becomes a potential vulnerability. We care for people on a regularized, daily basis. This is something that a hospital cannot provide."
The EHPAD System originated 15-20 years ago. "What we began with 20 years ago is fundamentally different from what we have today. Now we accept people with neurological diseases, cognitive conditions, Alzheimer's disease — this is of particular importance: 63 percent have these diseases. As you see, the things we deal with are complicated. By applying French experience, Russia will benefit by 20 years, because all this time we have been learning from our mistakes." According to Mr. Morosolli, in particular this experience relates to the system of financing, facilities, supplies and equipment for staff, and purchasing statistics for medicine and personal care.
In France, more than 680,000 seniors live in one of the types of care facilities, where additional equipment and support make it easier to provide long-term medical care. Mentioned above, these institutions are public or private, but they can also be a private-social partnership. Places at these institutions are financed from three sources: general expenses are covered by the APA, medicines and care are covered by the health care system and medical insurance, and food and accommodation are paid for by the client, relatives and family members.
To establish an average care cost for seniors is difficult, because it can vary greatly depending on the needs of the resident. With more essential services, both the relative cost and the list of additional services grow at the same time (food, TV, hygiene, etc…). Cost also relates to the quality of services, which differ between institutions. However, estimates from the Inspectorate General of Social Affairs, l'Inspection générale des affaires sociales, set the average sum at 2,200 euros per month. Seniors receive an average pension of 1,200 euros. The difference that relatives and family cover is substantially less than the cost for private caregiving or the true cost of the services provided at these homes.
A Look to the Future
The French public is, in general, skeptical of the idea of old people's homes. The majority of senior citizens wish to remain independent for as long as possible. For this reason, the system continues to develop. Tests are ongoing for new innovative models to provide housing for senior citizens.
Among the approaches being tested is an "intergenerational model." Senior citizens and young people make a cohabitation agreement, which formally outlines how all parties involved will help one another. This innovative solution has its roots in the Middle Ages. At that time, monasteries (situated in present-day Belgium and northern France) ran a system of béguinages where older monks lived together with the young, and they cared for one another.
The agreements are still experimental in nature. There are a host of everyday issues yet to be formalized, for example, how domestic chores are done and who is responsible, and what way responsibilities and privileges should be shared. It is not always possible to transfer all of these obligations and specifics onto paper.
In June 2002, the Generations Program was launched in the town of Saint-Apollinaire. It works toward the establishment of mutually beneficial relations between people of different ages. In practice, the program covers half of a young family's rent ("young family" defined as a couple with children under 5 years old), and then half the expenses for a senior citizen with a deteriorating physical or diagnosed condition. Experiment participants agree to an arrangement where the senior resident minds the children during the day, and in return the young couples help in providing care related services.
People are living longer, and it is all the more important to search for new solutions.
Senior Citizens Need to Have a Choice
Maria Morozova spoke about alternative practices of caring for the elderly.
General Director of the Elena and Gennady Timchenko Foundation
What stereotypes of the older generation exist in Russia?
The main stereotype is to view seniors as dependents, no use to society. We want to show that life at a later age is not over, that any age can bring benefit and be sought-after. But on the other hand, in old age there will always be those in need of care and compassion, and they too deserve respect. This belief defines the underlying principle of the Timchenko Foundation's "The Older Generation" initiative — the right to self-realization, a decent life, and the care and respect of the community at any age. Demographic and economic realities also need to serve as reminders that the older generation can be an important resource for social development by providing a healthy continuation of traditions, professional skills and values.
A themed public event we help facilitate is the annual conference "From Old Age to a Society for All Ages," which will be held in Moscow this year for the third time, from 8–9 October. Participants discuss opportunities to support seniors and to change society's attitudes toward age.
We are working with the professional community to attract the best experts in the field of social work, sociology and gerontology, and we continue to support professional projects and research. We are actively working on involving seniors in social processes by developing volunteering opportunities. For five years running, the foundation has conducted the Active Generation contest, which aims to develop initiatives for seniors in the Northwestern Federal District. For the third year in a row, we have sponsored the All-Russia Help Hotline for Seniors. The hotline's operation has resulted in a base of volunteers across the entire country.
How developed is the system of retirement homes? What innovations in practical care for seniors are being developed by the Timchenko Foundation?
This topic is currently much discussed. On the one hand, the state system of social security has become oriented toward home-based and hospital-replacing forms of care for seniors. After all, even the most comfortable care home is an unfamiliar environment. We are actively voicing the need to support family-based care, to develop daycare centers, and to create mobile home care services, and so on.
But it is absolutely clear that there will always be those in need of institutional care. Of course, these institutions must provide quality and professional services, while ensuing decent living standards and personalized care. It is important, then, to further develop the interpersonal and people-oriented segments of such institutions by increasing the role of the private sector.
Currently, we are actively studying the best care practices from around the world, such as across Western Europe and in Israel. We also support pilot projects in Russia, which we consider vital in the effort to transfer experience to the state authorities, so that they might adjust and improve their services. Often state officials fear that any change will lead to increased costs. Our task is to show the opposite is the case, that adjustments will bring more efficient use of existing assets. The big problem, of course, remains the disunity among departments and the lack of coordination between social and medical services.
The foundation tirelessly supports the development of national strategies of joint actions in the interests of seniors, which should start to take shape in 2015. We are glad that in Russia now an official policy (white paper) is being developed, which will reflect the social consensus to improve the lives of our senior citizens. |