Build an inclusive care model rooted in people centric with integrated services

This model embodies addressing diverse needs by surpassing institutional barriers and prioritising collaboration. By transcending these silos and emphasising collaboration, it holds the potential to cultivate more efficient, equitable, and compassionate systems, designed to authentically meet society’s multifaceted needs. However, its successful implementation demands a joint commitment from policymakers, service providers, and communities, requiring fundamental restructuring and a collaborative culture for ongoing responsiveness to evolving needs

The NOTRe (New Territorial Organisation of the Republic) Act of 7 August 2015 (art. 98) mandates the Prefect and the President of the County Council (Département) to develop collaboratively a plan for each county council (Département) aimed at enhancing public service accessibility, encompassing social services. This stands as a guiding principle for both local and national public administrations, although it is not enforceable as a legal right.

Although there is no published social services strategic plan, the law of 2002-2 establishes the organisational principles and regulatory framework for social services. This law specifically regulates reception and accommodation establishments, mandating joint authorisation from both the State and the Department for the legal operation of housing intended for individuals in need.

The six-year departmental plan enhances service provisions in under-served and inaccessible areas, outlining the involvement, operations, distribution, and targets of social and medical-social services. The professionals responsible for this assessment are integrated into social services.

Furthermore, the law of November 23, 2018 incorporates so-called inclusive housing (similar to community-based services) into the category of social and medical-social establishments. Local community-based services are part of the long-term care system.

In France, combating violence against women is one of the first pillars of the Interministerial Plan for Equality between Women and Men 2023-2027. This plan provides for the creation of 460 social worker posts in the police and gendarmerie services. The law of 28 February 2023 introduced emergency assistance for victims of domestic violence, which provides financial support to help victims meet immediate costs until lasting solutions can be found.

Finally, the French social protection system covers a range of social risks: sickness, invalidity (which also includes disability), accidents at work/occupational illnesses, old age, survivors, family, employment, housing, poverty, and social exclusion.

Main Agencies

Social protection is primarily overseen by the National Social Security System, while the responsibility for social policy and welfare falls under the jurisdiction of the County Councils (Départements).

The responsibility for social services, which is decentralised, rests within the individual County Council.

The County Councils provide social assistance to older people and disabled people, facilitate professional and social integration for job seekers, and oversee child protection.

The County Councils are responsible for assessing the loss of autonomy of older persons and their eligibility for home support services. The departments hold the responsibility of evaluating the decline in independence among older people and determining eligibility for home support services. Additionally, they provide subsidies, like the loss-of-autonomy allowance, to assist older people facing decreased autonomy.

Unless the County Councils delegate certain responsibilities to them, municipalities are not responsible for social assistance. However, municipalities carry specific obligations in terms of social actions, including participating in the examination of applications for social assistance (except for applications for social assistance for children) and forwarding them to the appropriate body, providing housing for social assistance applicants, conducting a social needs analysis (ABS) for the population of the municipality, and maintaining an updated register of people receiving statutory or optional social assistance who live in the municipality.

In addition, social protection bodies like the Caisse nationale d’assurance vieillesse (CNAV), the Caisse nationale des allocations familiales (CNAF), the Caisse centrale de la Mutualité sociale agricole (MSA), the Caisse nationale d’assurance maladie des travailleurs salariés (CNAMTS), and Unédic, can also carry out social actions, by providing financial support to older people and people with disabilities. In addition to providing social insurances, they can also carry out social welfare.

Expenditure on social and medical-social services by the departments amounted to €40.4 billion in 2021. This amount increased by 3.1% compared to 2019, following an average annual growth of 1.9% between 2016 and 2019. Part of French health insurance expenditure goes towards the care of dependent older people and people with disabilities in medical and social establishments or services.

In 2021, the County Councils along with sickness insurance companies, significantly drove the implementation of social assistance and social welfare, culminating in an substantial allocation of €78 billion, constituting 9.6% of the total expenditure on social protection.

In 2021, 121,500 professionals were employed by French local authorities in charge of social and medical-social services in the departments, including 38,100 administrative and technical staff, 36,200 family assistants and 31,900 social and educational workers. In addition, the voluntary sector managing medical-social residential and home facilities and services employed 852,700 professionals in 2021.

Long-term Care

Residential Care

Accommodation provision varies across the country. Without considering any territorial prevalence of dependency situations, the number of places per 1,000 inhabitants aged 75 or over varies from 1 (La Réunion, Corsica) to almost 5 (Lozère). Between 2007 and 2019, there was a 12% increase in the number of places designated for the care of frail older people.

There are two primary types of residential facilities for older people: residential facilities known as ‘EHPAD’ establishments, with medical staff, and sheltered care homes or ‘independent living’, without medical staff. In 2021, ‘EHPAD’ residential facilities for dependent older people accounted for 70% of all accommodation options. Additionally, as of December 31, 2019, there were 10,600 social-health institutions or shelters for older people, collectively offering a total of 760,000 available places.

In 2021, approximately 1.3 million individuals aged 60 or over were expected to receive the personalised loss-of-autonomy allowance. 7.3% of the total population within this age group in France receives the loss-of-autonomy allowance. This percentage fluctuates across departments, ranging from 3.3% to 11.7%.

Day Centres

In 2021, there were 19,842 day-care places available nationwide, constituting 2.7% of the total residential places for older people.

Home Care

Home support is provided by home help services, some of which are integrated with nursing services (SPASAD: multi-purpose home help and care services). This model is currently being deployed.

44% of the beneficiaries receiving the allowance for people losing their independence (APA) live in an establishment, while the remaining 56% receive home help.

The number of hours of help per beneficiary increases with the degree of dependency. It is 0.7 hours per day for the least dependent beneficiaries and 2.1 hours for the most dependent.

Technology and Telecare Services

In 2015, 10% of older people in France subscribed to a tele-assistance programme, i.e., 500,000 persons.

Support Services for People with Disabilities

Within the population of those under 60 living at home, 2.9 million individuals claim to have an officially recognised disability, representing 6.8% of this age group.

In 2021, there were a total of 533,038 places available in residential facilities and services supporting people with disabilities, comprising 174,630 places dedicated to children and 358,408 places for adults.

Also in 2021, home care services were provided to a total of 140,000 people aged 16 and above, living with disabilities.

There were 6,483 publicly-financed day centre places for people with disabilities representing 1.2% of the total number of accommodation places for people with disabilities.

A total of 125,650 individuals with disabilities received support through ESATs (sheltered workshops to support in employment and social integration).

Minimum Income Schemes

In 2021, 4.09 million people were covered by the Active Solidarity Income, equal to 6.0% of the French population. The poverty rate among ASI recipients is 75%. The average payment per beneficiary is €860 per month.

Child Protection Services

In 2022, 377,000 children and young people under 21 were in the child protection system. Foster families provided care for 40% of children in child protection, while 39% were living in residential care.

Services for Female Victims of Violence

Since the implementation of the Caisse Nationale d’Allocation Familiale law in 2023, a social security body, provides financial assistance to any victim of domestic violence, regardless of their beneficiary status, living arrangements with the perpetrator, marital status, or dependent children.

This aid is not contingent on the couple’s separation. Based on the victim’s monthly resources and the number of dependents, it is designed for individuals with permanent legal residence in France. Offered as an interest-free grant or loan, the assistance is disbursed in a single payment within 3 to 5 working days.

Currently France has 11,000 accommodation places for female victims of violence.

Services for Homeless People

As of 2021, there were 145,000 emergency accommodation places. There are no separate housing support allowances.