# Long term care and associated insurance in France



## papaia

In a recent analysis conducted in the US, under the existing system, long term care (which is not supported by Medicare, except for some niche "rehab" situations post-hospitalization) is estimated to be in the ~$100K/year range, and ever increasing, with a 50% chance for those turning 65 to need it, during their lifetime. Insurance for long term care is thus considered crucial. What programs and costs exist for such, in France?


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## ko12

papaia said:


> In a recent analysis conducted in the US, under the existing system, long term care (which is not supported by Medicare, except for some niche "rehab" situations post-hospitalization) is estimated to be in the ~$100K/year range, and ever increasing, with a 50% chance for those turning 65 to need it, during their lifetime. Insurance for long term care is thus considered crucial. What programs and costs exist for such, in France?


I suppose I really ought to have looked further into this, but I do know it is expensive. For an EHPAD, the cost ranges €1500-€4000 per month (! I think the €4000 is for 'specials', e.g. Paris, Côte d'Azur), paid for by the individual/family; +€300-400 for 'soins' (covered by l'Assurance Maladie; +'forfait dépendance' (not sure exactly what that is, but it adds a bit more) €160-600. So, it's not easy to find an EHPAD that will leave any change out of even an above average retraite. For 'the middle of nowhere' (i.e. Cantal), the monthly cost seems to be about €1700-2500).


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## Bevdeforges

Such programs probably exist in France (i.e. for "long term care insurance") but I haven't really stumbled onto them. However, a couple of hopeful signs:
Long term care facilities (what you would call a "nursing home" in the US) cost quite a bit less in France than they do in the US. And yes, some of the cost (for actual care, rather than the residence portion) does fall under the Sécu (national insurance). It may also be possible to take out some additional cover for residential type care through a mutuelle or a prévoyance policy.

And you are starting to see private "senior residence" facilities opening up - more like what in the US are "assisted care" or "senior living" housing. These aren't generally covered by insurance, but then again they include far less medicalized services, too. For financing these types of facilities, you're pretty much on your own. Google "residences seniors" with the name of a town or area you're interested in and you'll find ads for many of the private options. Most post their fee schedules online so you can see what you're dealing with.

But one saving grace here is that there is a more serious movement toward keeping seniors in their own homes whenever possible. And much of that assistance you can find out about through the local mairie, starting with the delivery of meals to home-bound folks. Our town also organizes a bus for monthly shopping trips for seniors - once a month to the local grocery store and another monthly run to a large shopping center about 15 or 20 km away. There are also social activities for the "third agers" and some programs through other agencies - like the one where your postman or woman stops by every few days to check in on you and for a short visit. These sorts of services are normally arranged by family members, but there's no reason you couldn't set this stuff up for yourself if you needed and wanted to.


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## BackinFrance

The whole issue of social insurance (and believe me that would include state run retirement homes - eg; EHPADs) is currently under discussion in France. François Bayrou, who is responsible for the long term Plan de relace, has raised it and the need to attract workers who will contribute to the system to France, which he says will otherwise collapse (and that view is widely supported across the political spectrum.. Others have raised the issue of the significant number of retirees who have or will move to France and the consequent burden on the French system. As for over 65s, there is a massive cohort that will come through the system in coming years. I would say that you would need to consider private aged care, the cost of which will also likely rise, even more so if wages rise for staff (a big issue in France).


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## Crabtree

It is a problem the world over-not enough young people to pay for us oldies Italy for example has just created tax breaks for young people and families to move there either as employees or self employed Norway took the sensible option of setting up a Soveriegn Wealth fund from the North Sea oil revenues whereas the UK created a loads of money culture with the same windfall


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## BackinFrance

Expats need to be aware that it is not just about pensions, but also the French health care system to which a significant amount of France's Covid debt has been charged.


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## paul couch

Bevdeforges said:


> Such programs probably exist in France (i.e. for "long term care insurance") but I haven't really stumbled onto them. However, a couple of hopeful signs:
> Long term care facilities (what you would call a "nursing home" in the US) cost quite a bit less in France than they do in the US. And yes, some of the cost (for actual care, rather than the residence portion) does fall under the Sécu (national insurance). It may also be possible to take out some additional cover for residential type care through a mutuelle or a prévoyance policy.
> 
> And you are starting to see private "senior residence" facilities opening up - more like what in the US are "assisted care" or "senior living" housing. These aren't generally covered by insurance, but then again they include far less medicalized services, too. For financing these types of facilities, you're pretty much on your own. Google "residences seniors" with the name of a town or area you're interested in and you'll find ads for many of the private options. Most post their fee schedules online so you can see what you're dealing with.
> 
> But one saving grace here is that there is a more serious movement toward keeping seniors in their own homes whenever possible. And much of that assistance you can find out about through the local mairie, starting with the delivery of meals to home-bound folks. Our town also organizes a bus for monthly shopping trips for seniors - once a month to the local grocery store and another monthly run to a large shopping center about 15 or 20 km away. There are also social activities for the "third agers" and some programs through other agencies - like the one where your postman or woman stops by every few days to check in on you and for a short visit. These sorts of services are normally arranged by family members, but there's no reason you couldn't set this stuff up for yourself if you needed and wanted to.


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## paul couch

in uk if a relative over 60 lives in the same house as someone who needs to go into a nursing home the charge on the house to pay the nursing costs are disregarded .is this the same in france?


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## tardigrade

BackinFrance said:


> The whole issue of social insurance (and believe me that would include state run retirement homes - eg; EHPADs) is currently under discussion in France. François Bayrou, who is responsible for the long term Plan de relace, has raised it and the need to attract workers who will contribute to the system to France, which he says will otherwise collapse (and that view is widely supported across the political spectrum.. Others have raised the issue of the significant number of retirees who have or will move to France and the consequent burden on the French system. As for over 65s, there is a massive cohort that will come through the system in coming years. I would say that you would need to consider private aged care, the cost of which will also likely rise, even more so if wages rise for staff (a big issue in France).


Is part of the discussion include assisted suicide? A lot of the oldies would not like to see their children's savings eaten up by having to care for them.


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## Nunthewiser

papaia said:


> Insurance for long term care is thus considered crucial.


I disagree that insurance is crucial. One certainly needs to plan and prepare for it. My dear mother spent about $70k on such insurance when it was more reasonable (~2003-15). She did need it, but only about $6K for about 3 months. Like any insurance, some win, some lose. The insurance company either wins, or jacks up the rates.


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## BackinFrance

tardigrade said:


> Is part of the discussion include assisted suicide? A lot of the oldies would not like to see their children's savings eaten up by having to care for them.


Assisted suicide is a serious crime in France. You have to travel to another country, which can be expensive, plus you have to be of sound mind. French citizens often avoid being admitted to an EHPAD and prefer to die at home, but getting real assistance at home still unfortunately requires that you can pay for it, despite government promises to the contrary.


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## tardigrade

BackinFrance said:


> Assisted suicide is a serious crime in France. You have to travel to another country, which can be expensive, plus you have to be of sound mind. French citizens often avoid being admitted to an EHPAD and prefer to die at home, but getting real assistance at home still unfortunately requires that you can pay for it, despite government promises to the contrary.


That is just wrong.. You can kill at the start of life but not the end...


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## BackinFrance

I would say it's not a good idea to grow old or have a serious long-term illness in France. Getting into an aged care home at any price is difficult and UFC Que Choisir has issued a damning report about private care homes and the disparities across the country with regard to availability and cost of public aged care.

Not only that, but ADMD (the right to die with dignity) seems to be a topic that is politically too hot to handle, plus the current President is really not in favour of voluntary euthanasia.


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