Entering a Care Home in France: What Families Face

Entering a care home in France means applying to an EHPAD, a medically supervised residential establishment, rather than to a retirement residence or to a home care service. The choice is made on the basis of dependency, location and cost, and it is formalised by a contract of residence. The first days are an adaptation period, and part of the cost can be covered by the allocation personnalisée d'autonomie or by social assistance for accommodation.

What is an EHPAD, and how does it differ from other options?

An EHPAD, établissement d'hébergement pour personnes âgées dépendantes, is a residential establishment with a medical presence, a care team and a coordinating physician. It differs from a résidence senior, which offers services but no medical supervision, and from home care, which keeps the person in their own dwelling. The distinction matters because admission procedures, staffing and funding rules are not the same.

The subject is set out in French on the information site of one establishment in Ardèche, which describes daily life, admission steps and costs for families preparing entry into a care home. Its pages cover meals, activities, animal-assisted mediation, room personalisation, fall prevention, care organisation and the personalised support plan, as well as the difference between an EHPAD, a retirement residence and staying at home.

In the United Kingdom, the equivalent decision is regulated differently, and readers comparing systems should note that French establishments are subject to national rules on dependency assessment and on the contract signed with the resident.

How is a place in an EHPAD chosen?

The choice usually starts with a geographical constraint: proximity to family, to a hospital or to a previous home. Visits follow, and the establishment provides information on its organisation, its staffing and its internal rules. A file is then assembled, containing identity documents, proof of resources and a medical assessment.

Admission depends on the establishment's capacity and on the level of dependency of the applicant, assessed through the grille AGGIR, the national grid that classifies autonomy. The grid produces a GIR level, from 1 for the most dependent to 6 for the most autonomous. Establishments with a care agreement generally admit people whose GIR level falls within the range they are funded to accommodate.

In some departments, a coordinating body handles requests and directs families towards available places. Waiting lists are common, and a request may be lodged with several establishments at once.

What happens in the first days after admission?

The first days are an adaptation period. The resident is received by the team, the room is arranged, and the personalised support plan is drawn up or updated with the resident and the family. This plan records needs, preferences and the practical arrangements for daily life.

Two roles are defined at this stage. The personne de confiance is a person designated by the resident to accompany them in their dealings with the establishment, and the directives anticipées record the resident's wishes about end-of-life care. Both are provided for by French law.

The conseil de la vie sociale, a residents' council, meets within the establishment and gives residents and families a channel for questions about daily life. Meals, activities and outings are organised according to the establishment's own programme.

What does the contract of residence contain?

The contract of residence, contrat de séjour, is the agreement between the resident and the establishment. It sets out the services included, the services charged separately, the internal rules, the conditions for temporary absence and the terms for ending the stay.

It must be given to the resident, and where applicable to the family or guardian, before or at the time of admission, with a delay for reflection. A list of charges is attached. The contract also states the arrangements for the personalised support plan and for the residents' council.

French law on the rights of residents in medico-social establishments, consolidated in the Code de l'action sociale et des familles, governs these documents. The relevant provisions have been amended several times, most recently by texts published on legislation.gov.uk's French counterpart, Legifrance, and by ministerial orders issued between 2016 and 2022.

Which financial help can families claim?

Two main schemes exist. The allocation personnalisée d'autonomie, APA, is a departmental benefit for people aged 60 or over who need help with daily activities, assessed through the GIR level. It is paid by the department and can be used towards the cost of care in an establishment.

The aide sociale à l'hébergement, ASH, is a form of social assistance for accommodation costs, granted by the department when resources are insufficient. Where the resident's children have resources, the department may examine the obligation alimentaire, the legal duty of certain relatives to contribute to the support of a person in need.

Tariffs in Ardèche, as elsewhere, vary by establishment and by the level of dependency of the resident. The establishment's own documentation lists the components of the daily rate.

What do families most often confuse?

The most frequent confusion concerns the difference between an EHPAD and a résidence senior. The first is a medico-social establishment with a care team and a dependency assessment; the second is a residential service with no medical supervision and no GIR assessment. A second confusion concerns the APA and the ASH: the APA funds part of the care and dependency cost, while the ASH addresses the accommodation cost when resources fall short.

Families weighing a move into a French EHPAD often find that practical questions about the GIR grid and the contract of residence sit alongside older, less visible family tensions. That wider question of inherited patterns is the subject of a separate page on constellation seminars and their critics, which sets out what happens at a seminar, what the method claims, what evidence and professional criticism say, and where to turn if it unsettles. The two pages meet at the same point: decisions about care are rarely made by paperwork alone.