Reader question: How does the care home industry in France work? Are they private or state-run? How much can one expect to pay for a place? What level of care can be expected?
How does the retirement home system work in France?
Retirement homes in France are commonly known as Ehpads, which stands for établissements d'hébergement pour personnes âgées dépendantes (residential establishments for dependent elderly people).
There are four types of Ehpad in France, with some running as for-profit businesses and others as not-for-profit.
Etablissement privé à but lucratif: Private profit-making homes, usually part of a national group
Etablissement privé à but non-lucratif: Non-profit-making home, usually managed by an association, and often cheaper
Etablissement hospitalier public: State-run homes, attached to a local hospital for administration purposes
Etablissement public territorial: State-owned homes run by the mairie or intercommunal body.
There are also “Ehpas” in France, which are care homes for elderly people who do not require as much care or medical attention as those in Ehpads. At the other end of the spectrum, there are Unités de soins de longue durée (USLD), for those who need constant care. These are often attached to a hospital.
Overall, elderly care homes of all kinds may be termed “maison de retraite” as an umbrella term.
We outline these models further in our article here: A guide to retirement homes in France
How many Ehpads are there in France?
There are around 7,500, and around 600,000 residents. The average age of entry into a home is 85. Most stay for two-and-a-half years.
On average, residents are suffering from eight health issues when they enter an Ehpad home, and half have dementia, often caused by Alzheimer's.
What is the public-private split in France?
Around 50% are public; 30% are run by private, non-profit associations; and 20% are run by for-profit private groups.
How much does an Ehpad cost per month in France?
The median cost is around €1,800 for a public home, and up to €2,000 for a non-profit private space. Private fees average around €2,000-€3,000 per month, but can reach as high as €12,000 or more, depending on location, luxury, and level of care.
The highest fees are found in Ile-de-France, Corsica and Provence-Alpes-Côte-d'Azur. The lowest fees are found in Pays de la Loire, Brittany, and Nouvelle Aquitaine, where the average is around €1,700 per month.
Is there assistance available for care home funding in France?
The local ARS (Agence Régionale de Santé) and DGAS ( Direction Générale de l'Action Sociale) share certain responsibilities for the financing of homes, with the costs faced by residents being for their own accommodation plus their care needs, depending on their level of dependency (graded from 1 to 6).
Medical costs are covered directly by the state under the Assurance Maladie.
How many staff carers per resident in Ehpads in France?
The average number of staff in a nursing home is sixty employees for every hundred residents, including all staff. However, only around 30 people per 100 actually take care of the residents “at their bedside”.
However, due to nights and weekends, as well as holidays and a high level of staff absenteeism in the sector, in some homes, it is estimated that staff only spend one hour or less per day with residents.
What checks and inspections are carried out at care homes in France?
Before opening an establishment, homes require authorisation from the local ARS and the departmental council.
Care homes are supposed to have regular checks and inspections, but these are judged to be too few and insufficient, even by the union of private nursing homes, Synerpa.
Who do private Ehpads belong to in France?
The French sector is divided between different groups, including the groups Orpéa, Korian, DomusVi and Domidep, each of which has between 80 and 350 establishments in the country. They also have a presence in Europe.
The largest shareholder in French group Orpéa is a Canadian pension fund, while the Peugeot group also has part-ownership.
Korian’s largest shareholder is a subsidiary of the bank, Crédit Agricole, and is also part-owned by a Canadian pension fund.
Do private care home firms make a large profit in France?
It depends on the company, but overall, yes.
For example, Orpéa saw its turnover increase by almost 9% in the first half of 2021, while net profit rose by 40%. Orpea's margin is therefore 25%.
The Korian group had even better results: net profit rose by 120% in the first half of 2021.
What is the Orpéa scandal?
France’s retirement homes have been under the spotlight since the publication of a book in late January, 2022, detailing abuses in ones owned by the group Orpéa.
The book, called ‘Les Fossoyeurs’, includes claims that residents’ food and nappies were “rationed”, that patients were poorly cared for, and that staff were untrained and uncaring, with practices allegedly designed to boost the firm’s bottom line to the detriment of patients, on whom it continued to impose high charges.
Orpéa has disputed the claims, and described them as “untrue, outrageous, and damaging”.
Two administrative inquiries into the allegations have been launched.
If you have experienced how care homes in France work, either personally or through a relative or friend, and you want to share your story, get in touch at firstname.lastname@example.org