France Guidance

How the system is structured

Care and support for older or vulnerable adults in France involves several parts of the system.

This may include the Conseil départemental, local information points, doctors, hospitals, home care providers, EHPADs, the Agence régionale de santé — often called the ARS — and, in some cases, the courts.

The system is structured, but responsibility is not always easy to understand in practice.

The département is especially important because it is responsible for many social support and autonomy-related services for older people, including the Allocation personnalisée d’autonomie, known as APA. APA is for people aged 60 or over who are losing autonomy, and is managed through the departmental council.

Local information points

France has local information points for older people and their families.

These are designed to provide free, local and personalised information. They can help people understand available services, care options, financial support, local contacts and possible routes for assistance.

Depending on the area, these may be known as local information points, CLICs, autonomy points, or other local names.

These services are not always identical across France, so it is important to check what exists in the relevant département.

The role of the département

The Conseil départemental plays a central role in support for older adults.

It may be involved in assessing needs, managing APA applications, supporting care at home, contributing to care planning, and responding to some concerns about vulnerability or mistreatment.

For people living at home, APA à domicile can help pay for support linked to loss of autonomy. A professional from the département’s medico-social team may assess the person’s situation and propose a support plan.

APA is not strictly means-tested in the same way as some benefits, but the amount the person contributes towards their support can depend on their income. Official guidance explains that the person’s financial participation varies according to resources and the amount of the care plan.

In practice, this means the département is often one of the main places to contact where an older person needs support, assessment, or help to remain at home.

Healthcare involvement

Healthcare services are separate from social support, but they often work alongside it.

This may include the person’s médecin traitant — their regular doctor — hospitals, nurses, specialists, home nursing services and community health providers.

Where the person lives in an EHPAD or other care setting, healthcare and daily support may overlap.

Coordination between healthcare and social care is important, but it may not always be clear. If responsibility is unclear, families and carers can ask who is coordinating the situation, what decisions have been made, and which service is responsible for the next step.

APA and care planning

The Allocation personnalisée d’autonomie — APA — is one of the main forms of support for older people losing autonomy in France.

There are two main forms:

• APA à domicile, for people living at home
• APA en établissement, for people living in an EHPAD or long-term care setting

APA à domicile is intended to help pay for certain expenses linked to remaining at home. APA en établissement helps pay part of the dependency-related cost charged in an EHPAD or other eligible medico-social establishment.

A care or support plan should reflect the person’s needs and circumstances. In practice, carers may still need to check whether the plan matches what is happening day to day.

EHPADs and residential care

An EHPAD is a medico-social residential care home for older people, generally aged 60 or over, who need daily support and care.

People may live there permanently, temporarily, full-time or part-time, depending on the circumstances.

Where there are concerns about care in an EHPAD, it is important to keep records and raise concerns clearly. Depending on the nature of the concern, this may involve the establishment itself, the Conseil départemental, the ARS, or national reporting routes for mistreatment.

Safeguarding, abuse and mistreatment

In France, concerns about abuse, neglect or mistreatment of older or vulnerable adults may be described using the term maltraitance.

Maltraitance can include physical, psychological, financial, medical, institutional or neglect-related concerns.

France has national routes for reporting mistreatment. The newer official national number is 3133, introduced for reports of mistreatment involving vulnerable adults. The historically established helpline 3977 is also widely recognised for concerns involving older people and adults with disabilities.

These routes can be used by victims or witnesses, including family members, carers, professionals or anyone worried about a vulnerable adult.

If there is immediate danger, emergency services should be contacted: 17 for police, 18 for fire and rescue services, or 114 for people who have difficulty hearing or speaking.

Reporting concerns

If mistreatment is suspected, concerns may be reported through national, administrative or judicial routes.

Depending on the nature of the concern and the setting, this may involve:

• 3133 or 3977 for national mistreatment reporting and guidance
• the Conseil départemental, especially where social support, autonomy, home care or APA-related concerns are involved
• the ARS, especially where healthcare, medico-social services, EHPADs or institutional care are involved
• police or gendarmerie where there is immediate danger, violence, theft, coercion, exploitation or another possible criminal matter
• judicial authorities where legal protection or court involvement may be needed

Decision-making and legal protection

France has several legal protection measures for adults who are unable to protect their own interests because of an alteration of their mental or physical faculties.

These may include:

• Sauvegarde de justice
• Curatelle
• Tutelle
• Habilitation familiale
• Mandat de protection future

These measures are not the same. Some are lighter and preserve more autonomy; others are more restrictive.

The juge des contentieux de la protection, formerly known as the juge des tutelles, decides whether a protection measure is needed and may appoint someone to assist, accompany or represent the adult.

Protection should be proportionate to the person’s situation. Official guidance describes the principle that the protection should be the least restrictive possible.

Mandat de protection future

A mandat de protection future allows someone to plan ahead and appoint one or more people to protect their interests if they can no longer do so themselves because of a change in their physical or mental capacity.

It is not identical to a UK Lasting Power of Attorney, but it has a similar forward-planning purpose.

Because these measures can affect rights, finances, care and family responsibilities, legal advice may be needed where there is disagreement, uncertainty or concern about pressure or misuse.

The role of carers — proches aidants

In France, a family member or close person who supports someone losing autonomy may be described as a proche aidant.

There are specific rights and forms of support for some carers, including congé de proche aidant, which may allow an employee to temporarily stop work or reduce working time to care for a disabled person, an older person, or someone losing autonomy.

This does not mean every carer will automatically qualify for every form of support. Eligibility depends on the relationship, the person’s situation, residence, employment status and the relevant legal conditions.

Financial support and family responsibility

Some forms of help in France are linked to age, residence, income, assessed need or level of autonomy.

Support may include APA, pension-related support, social assistance, or help with care home costs.

For residential care, Aide sociale à l’hébergement — ASH — may help pay part of the cost of accommodation in an EHPAD, résidence autonomie, USLD or approved family care setting.

However, ASH can involve financial assessment and may involve contributions from family members under the obligation alimentaire. It may also be recoverable by the département during life or after death in certain circumstances.

French law can require children to help a parent who cannot meet basic needs. In some cases, sons-in-law and daughters-in-law may also be affected. Because these rules can affect family finances, it is important to seek local advice before making assumptions.

Where the system breaks down

In practice, systems do not always operate clearly or consistently.

This can include:

• delays
• unclear responsibility
• poor communication between services
• confusion between health and social care roles
• disagreement between family members
• concerns not being properly recorded
• care plans not matching reality
• difficulty knowing where to escalate

These situations are not unusual.

Keeping a clear record can help establish what has happened and what still needs to be addressed.

Escalation

If concerns are not addressed, escalation may involve:

• following up in writing
• asking who is responsible for the case
• asking for decisions or assessments to be explained
• contacting the Conseil départemental
• contacting the ARS
• using 3133 or 3977 for concerns about maltraitance
• contacting police or gendarmerie in urgent or serious situations
• seeking legal advice where legal protection, finances, coercion, exploitation or family conflict are involved

Escalation is not about being difficult. It is about making sure concerns are seen, recorded and responded to.

A simple way to think about the routes is:

• Home situation: département, APA team, local information point, GP, 3133 or 3977 if mistreatment is suspected
• Care home or EHPAD: establishment manager, ARS, Conseil départemental, 3133 or 3977
• Immediate danger: 17, 18 or 114
• Legal protection or capacity concerns: legal advice, court routes, juge des contentieux de la protection

Record-keeping

Keeping a record is one of the most important steps a carer can take.

This may include:

• dates
• names
• phone calls
• appointments
• what was said
• what was agreed
• what changed
• symptoms or incidents
• missed care
• financial concerns
• copies of letters, emails or reports

Records help establish patterns and support concerns if they need to be reviewed later.

What comes next

This connects with:

• Safeguarding
• When Nobody Will Listen
• Your Diary
• Care Records
• Family Pressure & Boundaries