Background information about dementia and home care services
Home help is intended to provide assistance with everyday tasks to people aged 60 or more to enable them to carry on living in their own homes. The aim of home nursing care services is to prevent, postpone or shorten stays in hospital or residential care institutions.
Legislation relating to the provision of home care services
The Elderly Dependency Act of 20 July 2001 introduced the “allocation personalisée d’autonomie” (individual attendance allowance) known as APA. This allowance, paid to dependent people over the age of 60, is intended to cover the costs of any assistance they need due to the loss of their ability to care for themselves. They must also have their main residence in France and be dependent according to the AGGIR scale (Autonomie Gérontologique – Groupes Iso-Ressources).
According to article L113-1 of the “Code de l’Action Sociale et des Familles”, any person over 65 without sufficient resources may benefit either from home help or a place in a private home or establishment. This home help may take the form of a payment or actual assistance with household tasks (art. L 231-1 of the above-mentioned code).
It is stated in article 205 of the French Civil Code that adult children have a legal obligation to provide maintenance to their parents and other ascendants if in need. This obligation extends to daughters-in-law and sons-in-law in certain circumstances with regard to their parents-in-law (article 206).
Organisation and financing of home care services
Home help is partly financed by retirement schemes (depending on the income of the person receiving the service) and partly by social welfare benefits provided by the “département”. Certain services, such as meals-on-wheels and house alarm systems are often financed by regional governments and recipients may have to contribute towards costs. Home nursing care services and other paramedical services, on the other hand, are fully financed by the healthcare system. There is a growing number of freelance nurses. Home care services for elderly people are mainly provided by private non-profit making associations and by municipalities. Many services are provided by volunteers and are therefore cost free.
People who need assistance (but to a lesser extent than that needed by people who are entitled to the individual attendance allowance) receive special allowances or increased benefits to pay for services from third parties (European Commission, 2002).
The Law 2005-841 of 26 July 2005 on Personal Services and Social Cohesion introduced the “cheque emploi service universel” (CESU) which came into force on 1 January 2006. This replaces the “cheque emploi service” and the “titre emploi service”. CESUs can be purchased by individuals and used to pay directly for services required by an individual, including home help for elderly or disabled people, ironing, gardening and general housework. They can be for a predetermined amount or for an amount to be decided by the purchaser. They can also be co-financed by employers much in the same way as luncheon vouchers or holiday vouchers. Employers are entitled to a tax deduction (credit d’impôt) of 25% of their costs. It is also possible for other organisations to finance the CESU such as pension funds and insurance companies (webpublic.ac-dijon, 2005).
The cheques can be purchased from any bank in collaboration with the national office for the collection of social contributions. People or organisations providing the services simply deposit the cheques into a bank account.
The APA can take the form of services or cash and is paid irrespective of whether the person lives at home or in an institution. The allowance is for human and technical assistance, not the provision of care which would be covered by health insurances. People in receipt of the APA can choose whether to pay for a service or to pay for a private person to provide the service (with the exception of spouses). A private person who is paid to provide a service must declare this as a salary. As of 1 January 2006, people with a monthly income of less than EUR 658.4 are not obliged to contribute towards the costs of the APA. People with an income higher than EUR 2,622.34 have to make a contribution of 90% of the costs. Those with incomes between these two amounts have to contribute progressively towards costs.
On Monday 13 September 2004, the Minister of Health, Mr Philippe Douste Blazy, announced his new plan for Alzheimer’s disease for the period 2004 - 2007.
A major feature of the new plan is the recognition of Alzheimer’s disease as a disease in its own right which means that medication will henceforth be 100% refunded. Douste Blazy also plans to integrate a cognitive evaluation into the “preventative consultations” foreseen for people at the age of 70 according to the Law on Public Health. The aim of these consultations, which will be carried out by a geriatrician, a neuropsychologist and a neurologist, will be to establish a diagnosis of the disease and propose the appropriate care.
100 new memory clinics will be created (in addition to the 238 already existing) and by 2007, 13,000 extra places will be made available in therapeutic day care centres and respite centres, which represents a fourfold increase in available places.
Kinds of home care services available
Home nursing care services provide people with the necessary assistance to carry out essential activities of daily life. Jani-Le-Bris (2004) provides a list of the kinds of home care services offered to older people:
- Accompanying the person for a walk, for medical visits and shopping etc.
- Adaptation of flat/house
- Administrative help
- Day or night care at home
- Delivery of medication (especially in rural areas)
- Taking the person to eat in a centre
- Granny sitting
- Hospitalisation at home (HAD)
- Home alarm service
- Household help (cleaning, cooking, shopping, washing, ironing, cleaning windows etc.)
- Keeping the person company (talking, reading etc.)
- Mobile library
- Night and day care at home or in an institution
- Paramedical service (nursing, personal hygiene, physiotherapy etc.)
- Repair service for small repairs (i.e. where a craftsperson would be too expensive)
- Respite care
- Social nocturnal emergency services (e.g. buying medication or food)
- Technical assistance (hospital beds, crutches etc.)
- Transportation (special mini-buses from the local authority, informal transportation)
Meals-on-wheels is not as popular in France as in other countries. According to Jani-Le-Bris (2004), the service is considered as leading to or reinforcing social isolation. There is a preference for preparing food together with home-helpers or alternatively, eating out in an institution, home for the elderly or sheltered housing restaurant as many open their doors to older people living at home. The social aspect of meals is highly valued. In cities, take-away restaurants (e.g. Asian and Italian) provide a delivery service, which in areas with a high migrant population, have the advantage of offering older people the kind of food that they are used to.
- Agevillage (2006), APA 2006: revalorizations au 1er janvier 2006, http://www.agevillage.com/Article/index.jsp?ARTICLE_ID=671&SECTION_ID=3
- Anonymous (2002), Questionnaire on health and long-term care for the elderly; France’s contribution, European Commission, ( http://europa.eu.int/comm/employment_social/social_protection/docs/fr_healthreply_en.pdf )
- European Commission (2002), France, http://europa.eu.int/comm/employment_social/missoc/2002/03/france_en.pdf#search='care%20insurance%20AND%20france' (accessed on 31 May 2005)
- Jani-Le-Bris, H. (2004), National Background Report for France, EUROFAMCARE, http://www.uke.uni-hamburg.de/extern/eurofamcare/documents/nabare_france_rc1_a4.pdf
- « L’enseignement professionnel tertiaire » website (2005), Le chèque emploi service universel, http://webpublic.ac-dijon.fr/pedago/ecogestpro/Professeurs/Documentation/Economique/PagesEconomiques/cheque_emploi_service_universel.htm
- Prieur, C. (2004), Dix mesures contre l’implacable avancée de la maladie d’Alzheimer, Le Monde (13/9/2004)
Last Updated: mercredi 15 juillet 2009