France’s care homes have come under renewed scrutiny in recent months following a government decision in April to rename them Maisons France Autonomie.
Previously known as Etablissements d’hébergement pour personnes âgées dépendantes (Ehpads) – and before that maisons de retraite – the name change is intended to distance the sector from various scandals, and shift the way we view ageing.
The transition will take place by 2027, the minister-delegate for autonomy and people with disabilities, Camille Galliard-Minier, told journalists.
Care homes will evolve into “places where people want to live and work”, she said. They will be subject to a certification scheme and offer temporary care in addition to full-time residential facilities.
France’s care homes consist of both private and public institutions, with differences often most visible in cost, though standards and facilities can also vary.
Residential homes for people who are not dépendant (ie. they can live relatively independently and do not require constant medical care) are known as Ehpas (Etablissements d’hébergement pour personnes âgées) – or, increasingly, résidences autonomie – and account for approximately 30% of all offerings, although their number is declining as state resources have increasingly focused on Ehpads.
Retired living complexes
Confusingly, some maisons de retraite still exist, but they now mainly take the form of social housing schemes, sometimes linked to particular industrial sectors, such as agriculture.
All Ehpads are classified as medico-social institutions and provide medical support. This comprises nursing staff and a coordinating doctor (médecin coordonnateur), although not all have doctors permanently on site. Those that do not generally contract services from local doctors.
Ehpads are also becoming more accepted in French culture. Traditionally, older people moved in with family when they were no longer able to live independently. However, the pace of modern life means that often such arrangements can no longer be maintained.
Ehpads are home to around 600,000 people, roughly 20% of the population aged over 85.
The facilities are not free, with costs typically from around €65 per day. The sector has attracted significant investment due to its profit potential.
Cost of care homes in France
The cost of Ehpad care is usually broken down into three parts: accommodation, medical care, and a variable charge depending on the level of dependency.
Medical care is funded by the national health insurance system (Assurance Maladie), administered locally by the departmental CPAM (Caisse primaire d’assurance maladie).
Residents are responsible for accommodation and dependency costs.
There are a variety of ways to cover these costs.
If the person has children and they have good jobs or comfortable pensions, they often take on some or all of the cost so that the family home does not have to be sold.
If this is not an option, selling a property using the viager system guarantees a “rent” for life, but it does mean that the house will pass out of the family upon death.
Selling the home outright provides a lump sum, but carries the risk that if you live longer than the money lasts, you could be in difficulty.
Where residents do not have income or savings to cover the costs, state help is usually available, often managed and provided by departmental social services.
In many cases, social services will have already been involved in helping people live in their own homes before the decision to move to an Ehpad is made.
Typically, private Ehpads are more expensive than public equivalents, often by as much as 50%, but have shorter waiting lists.
Care home scandals
The growth of corporate interest and profit-driven values has not been without problems. There was a national scandal in 2022 following the publication of a book by an investigative journalist called Les Fossoyeurs (The Gravediggers), which detailed abuse in care homes operated by the Orpea group, now renamed Emeis.
Strict corporate controls that prioritised cost-cutting over patient care led to a number of distressing cases being detailed in the book, as well as prosecutions, fines, and the near collapse of the group, which owned 200 Ehpads in France and had been valued at billions of euros.
Controls have since tightened, though concerns persist.
In January, the government closed a 55-resident Ehpad near Bayonne, also owned by a large firm, over safety concerns. Regular inspections since 2019 had uncovered weak management, poor building and equipment maintenance, and staffing problems.
As is often the case, word of mouth is a good guide when choosing an Ehpad.
Care homes with English-speaking staff do exist, if the language barrier is a cause for concern. Many change hands, making internet searches unreliable: new owners may not always appoint English-speaking staff as previous ones did. Generally, your chances of finding one are better near major cities such as Paris, Nice or Bordeaux. It is worth visiting first to see whether you will be comfortable in the language environment.
The government website pour-les-personnes-agees.gouv.fr and regional health sites such as trajectoire.sante-ra.fr show registered Ehpads near you.
Typically, each department has one or two large public Ehpads linked to hospitals – both at the main departmental hospital and, increasingly, at smaller rural hospitals – where many services have been centralised while the number of beds in the associated Ehpad has grown.
An example is the hospital in Barbezieux (Charente), which now has 92 Ehpad beds and 80 beds for people with conditions requiring long-term hospital stays.
It also reflects the typical structure of public services: alongside the Ehpad, its long-term care wards include a specialised unit for people with Alzheimer’s-related dementia, with five beds reserved for respite care, as well as a day unit able to accommodate up to eight patients.
Regulation and oversight of public Ehpads are carried out jointly by the state’s regional health authorities (Agences régionales de santé, ARS) and local departmental councils.
The ARS is responsible for healthcare oversight, quality of care, and the allocation of medical funding. Departmental councils oversee the social care aspects, including funding related to dependency and accommodation.
There are also typically strong links with local mairies and communautés de communes structures, which often draw on their funds to provide additional facilities for residents and staff.
