Future law on long-term care: the main thrusts

The report on the national consultation on “Old Age and Autonomy” was submitted by Dominique Libault to the Minister for Solidarities and Health, Agnès Buzyn, at the end of March. This report is the result of a vast national consultation carried out in late 2018 and early 2019. It is based on proposals formulated in association with people and stakeholders involved in the old-age sector and aims to improve the autonomy of elderly people requiring long-term care. The report makes 175 proposals, some of which will form the basis for the Government Bill on Long-Term Care, which is expected to be presented next autumn. Here is a general outline of these proposals.

1. Implement a national plan to develop careers in the old-age sector:

• increase the supervision ratio in nursing homes for dependent elderly people (EHPADs) (80,000 additional professionals)
• transform management methods to enhance the status of professionals working in the old-age sector
• implement an occupational risk prevention plan
• develop career prospects (facilitate access to training, changes in pay scales, cross-functional structuring of the sector).

2. Support home care services

• introduce a minimum rate for all home help and support services (minimum rate of €21 per hour, plus a subsidy of €3)
• replace the Personalised Autonomy Allowance (allocation personnalisée d’autonomie – APA) with a new "Home-Based Autonomy Allowance” (prestation autonomie à domicile), featuring three components: human assistance; technical assistance; respite and temporary care solutions. A specific upper limit would be set for each component
• generalise additional care solutions: develop a diversified range of temporary care services in institutions for short stays and day-time or night-time stays
• simplify formalities by introducing a single national application form for the "Home-Based Autonomy Allowance”, by enabling online applications for entitlement to allowances and by generalising remote management or "all-in-one" solutions for the payment of allowances.

3. Improve the quality of service in institutions

• launch a ten-year renovation plan for EHPADs and residences for autonomous seniors (résidences autonomie), costing €3 billion
• create a “Quality Fund” for institutions and home support & care structures
• promote the quality-labelling of institutions by financing staff training as part of an institutional plan.

4. Improve support for elderly people who are starting to lose their autonomy:

• reate a “one-stop shop” for elderly people and carers in each department (“Centres for the elderly and carers”) in order to support the efforts of elderly people and carers, and coordinate social and medical interventions
• generalise the creation of mobile hospital teams
• generalise personalised health plans (common action plans used by the different professionals working with the elderly).

5. Reorganise care provision to break down the barriers between EHPADs and home care

• create a support fund to reorganise provision
• create a new type of social and medico-social institution (known as a “territorial institution”)
• increase the reception capacities of residences for autonomous seniors
• develop family care and increase the safeguards for it (by associating family carers with a medico-social service or institution).

6. Reduce the out-of-pocket payments to institutions:

• reduce out-of-pocket payments (reste à charge) by €300 per month for people on incomes of between €1,000 and €1,600 per month
• introduce financial support averaging €740 per month on average, called the “autonomy shield” (bouclier autonomie), for long-term residents in EHPADs
• reduce out-of-pocket payments for all EHPAD residents by merging the prices of medical treatment and long-term care.

7. Combat the isolation of elderly people and caregivers: 

• reimburse family caregivers for leaves of absence
• introduce mandatory negotiation in professional sectors to strike a better balance between professional life and helping a dependent relative
• carry out more activities with elderly people as part of “citizenship service” (service civique) and the future national universal service (service national universel)

8. Increase healthy life expectancy through prevention:

• launch a national mobilisation on preventing loss of autonomy, including awareness-raising activities for all professionals and the introduction of prevention meetings for vulnerable groups.