France

The share of people aged 65+ in the French population is expected to grow from 20.8% to 30.3% during the period 2021-2100 (compared with the EU: 20.9 % to 31.3%).

The ageing of the aged ratio, which is the share of people aged 80 and above relative to the population aged 65 and above, is projected to increase from 28.5% in 2022 to 42.8% in 2070. The old-age dependency ratio, which is the share of older people (aged 65 and above) relative to the working-age population (aged 20 to 64) is projected to increase from 38.2% in 2022 to 57.8% in 2070.

Life expectancy at 65 is projected to continuously increase over the 2022-2070 period, from 19.7 to 24.1 years for men and from 23.8 to 27.7 years for women, which would represent an increase of +4.4 years for men and +3.9 years for women between 2022 and 2070 respectively.

Sustainability challenge

Assuming there are no policy changes, public expenditure as share of GDP could rise from 1.9% in 2022 to 2.6% by 2070 (EU-27: 1.7%-2.6%).

The impact of a progressive shift from the informal to the formal care sector in France would entail an estimated increase by 85% in the share of GDP devoted to public expenditure on LTC in 2070 compared to 2019 (109% on average for the EU27).

 

Organisation of LTC

 

The French public provision of LTC for dependent older people and persons with disabilities is based on a two-pronged system:

 

1. Health Insurance Coverage

The health insurance scheme covers healthcare costs provided in institutional settings to dependent older people and persons with disabilities. It also finances LTC units in hospitals, as well as nursing care delivered at home. These services are paid for directly through health insurance, meaning that patients do not need to advance the costs themselves.

2. Social Support Schemes

In parallel, two main schemes—primarily financed by the State and local authorities—provide social benefits to dependent older people and persons with disabilities. These schemes help cover care-related expenses not included in health insurance coverage, whether care is delivered in institutions or at home.

 

Structure of the LTC Sector

 

LTC services are organised around two main pillars: institutional care and home-based care:

1. Institutional LTC

More than 600,000 people currently receive care in medico-social establishments (EHPAD – Établissement d’Hébergement pour Personnes Âgées Dépendantes) what is commonly referred to in English as a nursing home or a residential care home for dependent older people. Unlike a standard retirement home (maison de retraite), an EHPAD is specifically “medicalised,” meaning it has a staff of nurses and doctors on-site to provide constant care. In some cases, they can also be accommodated in hospital LTC units.

Within EHPADs, highly dependent older people receive medical and nursing care, as well as social support and activities. Medical care costs are fully covered by health insurance through the Regional Health Agencies (ARS), while dependency-related expenses are generally covered by departmental councils, with some remaining out-of-pocket costs.

Residents must cover accommodation and meal costs, which average just under €2,000 per month. Several financial support mechanisms exist to reduce these costs. In particular, social housing assistance (ASH) enables departmental councils to cover all or part of accommodation costs in EHPADs, assisted living residences, LTC units, or family care settings. ASH covers the difference between the total accommodation cost and the amount the older person can afford to pay.

 

Home-Based LTC

In response to the strong preference of the vast majority of French people to remain at home for as long as possible, France has implemented a “home-based shift” in LTC policy. This approach aims to support people experiencing a loss of autonomy while ensuring that remaining at home does not compromise their health or safety.

Home care services, which underwent significant reform in 2023, provide both daily support services (such as meal preparation and housekeeping) and medical care at home. These services are largely financed through individual allowances, notably the personalised autonomy allowance (APA) and the disability compensation benefit (PCH).

Public support has also been developed to finance housing adaptations linked to loss of autonomy, such as bathroom modifications or stairlifts.

 

Intermediate Care and Housing Solutions

For individuals whose loss of autonomy is too significant for standard home care, intermediate solutions exist between home-based care and institutionalisation. These include assisted living residences and inclusive housing arrangements. In these settings, older people live independently while benefiting from shared services, communal spaces, and organised social activities. These options provide an alternative residential pathway tailored to individual needs.

 

Addressing Demographic Transition and Systemic Challenges

Beyond general health protection, France has established specific measures aimed at ensuring affordable and high-quality LTC, particularly at home. Territorial resource centres were launched in 2023 to provide enhanced support for older people at home, with the objective of delaying entry into medico-social institutions. A total of 500 centre openings are planned for 2028.

Despite these efforts, several challenges remain. Recent reforms require full implementation to assess their impact and ensure appropriate calibration. The system also faces structural challenges, including workforce shortages in the LTC sector, underutilisation of individual benefits (APA and PCH), and the need for improved coordination among stakeholders to prevent gaps in care pathways and avoid unnecessary hospitalisations.

 

Stakeholder Participation and Consultative Governance

As beneficiaries of LTC are recognised as rights holders, public policies emphasise their participation in decisions and projects that affect them, both individually and collectively.

National Consultative Bodies

Several national bodies contribute to the design and monitoring of policies pertaining to autonomy and ageing:

• The Economic, Social and Environmental Council (Le Conseil Économique, Social et Environnemental – CESE) advises the Government and Parliament on legislation and public policies. Since 2021, it has also been responsible for strengthening citizen participation. In the field of ageing, the CESE recently published an opinion entitled: “Supporting Autonomy: Needs and Their Financing”. This entailed recommendations, among other measures, for a multi-year programming law on loss of autonomy, improved working conditions and training for professionals, reduced out-of-pocket costs, and increased funding for the autonomy branch of France’s Social Security.
• The High Council for Family, Children and Ageing (Le Haut Conseil de la famille, de l’enfance et de l’âge – HCFEA), reporting to the Prime Minister, provides prospective and cross-cutting expertise on family, ageing, societal adaptation to ageing, and the prevention of abuse. It issues opinions and recommendations on priority objectives related to policies for older people and autonomy.

 

National Refoundation Council on “Ageing Well”

Launched in October 2022, the National Refoundation Council (Conseil National de la Refondation – CNR) is a national consultative body that brings together stakeholders to inform and shape policy reform across a range of thematic areas, including “Ageing Well”.

Its work on ageing is structured around three main themes:

• Adapting society and territories to ageing;
• Strengthening citizenship, participation, and social connections;
• Improving the attractiveness, training, and working conditions of LTC professions.

Eleven citizen workshops held across France in 2022–2023 brought together professionals, associations, caregivers, and older people, including specific sessions focused on overseas territories and ageing with disabilities. Their conclusions contributed directly to the national “Ageing Well” strategy.

 

Objectives and Measures of the “Ageing Well” Strategy

Adopted in November 2023, the “Ageing Well” Strategy sets out an interministerial framework comprising 50 measures across four priority areas:

1. Adapting Society to Ageing

The strategy seeks to better recognise the role of older people in society by adapting territories and infrastructure, supporting local authorities, and fostering innovation. It includes investments in prevention and research, notably through France’s participation in the WHO’s Integrated care for older people approach (ICOPE) programme, which aims to delay dependency through early detection of frailty.

2. Enabling Choice in Ageing Pathways

A central objective is to allow individuals to choose where and how they age. Measures include housing adaptation through the Ma Prime Adapt’ programme, adaptation of social housing, strengthened home care services, and development of intermediate housing solutions. Inclusive housing has expanded, with around 7,000 residents in 2023. Workforce development is also prioritised, including recruitment targets for EHPADs and improved qualifications for care professionals.

3. Preventing Social Isolation and Promoting Solidarity

The strategy promotes senior engagement through volunteering, mentoring, and intergenerational initiatives, recognising their importance for social cohesion and well-being.

4. Ensuring Rights, Participation, and Prevention

Finally, the strategy reinforces the rights and participation of older citizens and prioritises prevention. Measures include promoting physical activity and nutrition, as well as preventive health assessments at key life stages (ages 60–65 and 70–75), with the aim of extending disability-free life expectancy and preserving autonomy.

Number of carers 

In France, 24.9% provide informal care or assistance at least once per week on average (EU: 17.0%); with 26.9% of the female population and 23% of the male population performing this care. This is higher than the EU average, with 19% of women and 14.8% of men providing care at least once a week.

The share of informal carers aged 45-64 providing high-intensity informal care (20h+ per week) is 6.9% (lower than the EU average of 17.1%), with a proportion of the female population in this age category amounting to 8% (EU: 19.9%) and 5.4% of the male population in the same age category. Although the percentages are not that far apart between the proportion of females and males aged 45-64 who are providing high-intensity informal care, it nevertheless confirms the gender gap in care intensity in France. This is reflective of the situation in most EU Member States, where the share of women providing high-intensity informal care is higher than that of men.

According to a recent survey, in France, 7.1 million people, or 11% of the population aged 5 and over, are informal caregivers, providing regular “informal” support to 5 million people living in ordinary housing in metropolitan France. Among these caregivers, they most often assist a parent (35%), a spouse (24%), or a child (19%). The majority of caregivers are women (58%) and the average age is nearly 53. Half of the people receiving care at home from a relative are under 65 years of age (17% are aged between 5 and 29). Indeed, informal care concerns not only seniors experiencing a loss of autonomy but also children and adults with disabilities or chronic illnesses.

Regular support provided by caregivers can take several forms: emotional support, assistance with daily living, and financial or material aid. Emotional support is the most common form of assistance (95% of caregivers), followed by help with daily living (83%), such as accomplishing household tasks, personal care, or mobility assistance. 42% of caregivers provide financial or material support. One-third of caregivers provide all three types of support. The time devoted to daily living assistance varies greatly: from less than one hour per day (44%) to 35 hours or more per week (11%).

Three out of ten caregivers support their relative without any co-caregiver, meaning neither family members nor professionals or volunteers are providing care support. This situation is particularly common when the care recipient is a spouse. The absence of support can increase the negative impact on the caregiver’s health or social life. Nevertheless, sharing the caregiving duties does not always mean relief.

In 2022, 58% of informal caregivers were employed, seeking work, or were students, representing 78% of caregivers of working age. Among these, almost half also had a child in their care who was not the primary care recipient but also requiring care duties. In these cases, they are forced to balance their caregiving role with their family responsibilities and other activities.

Strategy for informal carers

The second strategy for mobilisation and support, “Agir pour les aidants” (Acting for Caregivers) 2023-2027, introduced new measures to assist caregivers, including the deployment of 5,000 new respite care solutions and the creation of a single point of contact for caregivers in every department. The goal of these respite care platforms is to ensure that all caregivers across the country have access to services, including orientation and a variety of support options (respite, psychological support, etc.). This platform is an integral component of the Departmental Public Autonomy Service (SPDA), established in collaboration with the departments.

The strategy also includes the strengthening of new rights for caregivers, particularly through the introduction of the caregiver leave (Congé Proche Aidant – CPA) and the daily caregiver allowance (Allocation Journalière Proche Aidant – AJPA). These measures are part of both the implementation of the Council recommendation and the continuity of the implementation of the 2019 Directive on work-life balance for parents and carers. Additionally, the recent pension reform has established the Caregiver Retirement Insurance (Assurance Vieillesse des Aidants – AVA). Recipients of the AJPA will thus automatically accumulate pension credits with the general social security system. Finally, a key initiative of the strategy is the extension of the Recognition of Prior Learning (Validation des Acquis de l’Expérience – VAE) to family caregivers. This aims to acknowledge the informal carers’ experience with a view to employment and is fully aligned with the implementation of the recommendation (see point 9.b) on the identification of carers and the assessment of their needs.

Support for carers

Recognition and definition of carers

There is no formal status for informal caregivers in France.

Several definitions coexist in the Social Action and Families Code. According to article L.113-1-3, informal caregivers are referred to as follows: “their spouse, the partner with whom they have entered into a civil solidarity pact or their cohabitant; a relative or a person in-law, defined as family caregivers; or a person residing with them or maintaining close and stable ties with them, who help them, regularly and frequently, in a non-professional capacity, to carry out all or part of the acts or activities of daily life and as such, is considered to be a close caregiver of an elderly person.” Family caregivers are also defined in the section relating to disability compensation benefits: “a family caregiver is considered to be the spouse, cohabitant, person with whom the disabled person has entered into a civil partnership, ascendant, descendant or collateral up to the fourth degree of the disabled person, or the ascendant, descendant or collateral up to the fourth degree of the other member of the couple who provides human assistance and who is not employed for this assistance” (article R.245-7).

Financial Support

There is no remuneration for informal carers in France. However, family carers can benefit from a family carer leave and a daily caregiver allowance for a limited period and under certain conditions, particularly if they stop working to care for their loved one.  Departmental councils are responsible for paying salaries or compensation related to the Personalised Autonomy Allowance (APA) and the Disability Compensation Benefit (PCH).  With the Personalised Autonomy Allowance (APA), a dependent older person (aged 60 and over) is allowed to employ a carer, except if they are a spouse, cohabiting partner, or civil partner. With the Disability Compensation Benefit (PCH), people with disabilities are allowed to employ a carer (non-retired, without fulltime employment) or to pay them compensation if salaried employment is not possible. The carers Old-Age Insurance (AVA) allows retirement quarters to be credited for periods of informal care, via contributions paid by the Family Allowance Fund (CAF). The National Solidarity Fund for Autonomy (CNSA) portal, My Disability Journey, and the public service website are accessible for more information.[1]

 Psychological support

Informal carers can also benefit from training and support workshops.

 Respite services

Informal carers can access various respite solutions to take a breath and prevent burnout. As needs vary depending on the situation, several complementary programmes exist throughout the country: Support and Respite Platforms (PFR) provide services and support for caregivers, can set up respite care, refer the person receiving care to a caregiving solution, and can contribute to preventing the risk of burnout. Home-based care involves a professional who provides in-home care to support or temporarily replace an informal carer. The Personalised Autonomy Allowance (APA) can fund certain respite solutions, including temporary care. The Disability Compensation Benefit (PCH) also funds temporary stays in foster care or respite vacations.[2]

 Training and education

The National Solidarity Fund for Autonomy (CNSA) funds training, psychosocial support, and family mediation initiatives for informal carers. At the local level, numerous initiatives exist, notably through respite and support platforms or other community organisations.

 Work Care balance

Carer leave allows any employee, civil servant, or public official, regardless of seniority, to take time off to care for a loved one who is losing their independence or is disabled. This leave can be compensated by the daily informal carer allowance (AJPA) and be increased to the minimum wage. The AJPA is renewable, allowing informal carers to renew their entitlements if they support several relatives throughout their career. Employees who are also supporting a loved one at the end of life are entitled to a family solidarity leave. Parental leave allows parents to care for a seriously ill, injured, or disabled child for a maximum of 310 working days (approximately 14 months), renewable once up to 620 days. During this leave, parents receive the daily parental leave allowance (AJPP), also aligned with the minimum wage.

A paradox: despite the growing range of support for carers, uptake remains low.

According to a recent study by AGIRR ARCCO while an increasing number of support measures are available to informal carers in France, they remain largely underused. 76% of carers surveyed reported having accessed no carer-specific support at all. A key reason is limited awareness of existing schemes. One in two carers say they experience significant difficulty in knowing where to turn for advice and support. In addition, 62% report a strong or very strong difficulty in understanding their own rights and those of the person they care for.

 The AGIRR ARCCO study sheds light on the many layers of complexity that continue to shape the carer’s journey. While carers’ needs — for information, support, respite and recognition — are well understood, a persistent gap remains between the proliferation of available schemes and carers’ ability to access and make use of them. This indicates the need for much greater attention on the side of the policy makers to ensure France’s citizens are both informed of their rights and benefit from a clear process for accessing and benefitting from them.

[1] More information on existing benefits and assistance can be found at: https://www.service-public.gouv.fr/ while the CNSA Portal (https://www.cnsa.fr/) provides directories and respite solutions for the elderly and their loved ones. My Disability Journey (https://www.monparcourshandicap.gouv.fr/) provides an overview of rights, assistance, and services for people with disabilities and their caregivers and my Caregiver Compass (https://maboussoleaidants.fr/) lists local solutions for caregivers and those they support.

[2] Idem.

• The 2021 Ageing Report Economic and Budgetary Projections for the EU Member States (2019-2070), EC, 2021
• The 2024 Ageing Report, Economic and Budgetary Projections for the EU Member States (2022-2070), EC, 2024
• Ageing Europe, Eurostat
• The EU Monitoring Framework on the Council Recommendation on access to affordable high-quality long-term care, EC, 2025
• Report from France on the implementation of the Council Recommendation on access to affordable and high-quality long-term care, 2024
• WHO Training Academy, Course ‘Care and self-care competences for informal caregivers’, Country fiches, France This content is shared under a Creative Commons Attribution-Non-Commercial-Share Alike 4.0 International License (CC BY-NC-SA 4.0).
• Etude 2025 DREES Aidants
• Prévenir, Accompagner, Soulager : trois leviers pour faciliter le parcours des aidants, Agirc-Arrco, Emicité, May 2025 [synthesis accessible here]