Nursing homes: the three rates and the financial assistance available (APA, housing allowance, ASH)

A nursing home (EHPAD) charges three rates: accommodation and dependency care are the responsibility of the elderly person, while medical care is covered by national health insurance. Three forms of assistance can reduce the cost: the APA (Personalized Autonomy Allowance) for dependency care, housing assistance for accommodation, and social assistance for accommodation (ASH) in certain nursing homes only. These forms of assistance can be combined.

This page covers the pricing structure, available assistance, the security deposit required from relatives, and the rules of the residency agreement. It does not provide any average cost for a nursing home, the amount of housing assistance, or the eligibility criteria for the ASH (Social Housing Allowance): the official source consulted does not provide these figures.

The three rates for a nursing home

Two useful points to clarify:

• The accommodation rate is the same for all residents of the same nursing home with the same level of comfort. It is stated in the residency contract.
• The level of dependency is assessed by the coordinating physician of the nursing home., using the Aggir scale. The dependency rate varies according to the person's level of dependency, and only people classified in GIR 1 to 4 can obtain the APA.

Aid: what each one finances

The APA (Personalized Autonomy Allowance) covers the dependency care rate. For accommodation costs, other forms of assistance exist: housing allowance and, in some nursing homes, the ASH (Social Housing Allowance). The remaining cost corresponds to the nursing home fee, after deduction of the APA and housing allowance.

It is possible to find out whether a nursing home (EHPAD) qualifies for the ASH (Social Housing Allowance). This is important because the security deposit and residency agreement follow different rules depending on the situation (see below). It is advisable to check this before choosing a facility.

The APA in a care facility: conditions and calculation

Terms

You must be at least 60 years old, classified as GIR 1, 2, 3, or 4, and reside in a facility in France that houses at least 25 dependent elderly people. If the facility houses fewer, the APA (Personalized Autonomy Allowance) is applied for at home.

How is the out-of-pocket cost for dependency calculated?

It depends on the care home's dependency care rate and your monthly income. For a single person:

For couples (married, in a civil partnership, or cohabiting), the total monthly income of the couple is divided by 2 before these thresholds are applied. The same thresholds and percentages then apply.

These amounts are those published on service-public.gouv.fr. The page does not specify the year the thresholds were applied. The page does not detail the exact formula for the intermediate bracket.

Procedures and deadlines

• Who to contact: to the management of the chosen institution, which can help in preparing the application. In case of emergency, to the departmental services.
• Decision : The department will decide within 2 months of receiving the complete application.
• Departure date: The APA is due from the date of submission of the complete file.
• Payment: The first payment is made the month following the decision, and then every month thereafter, no later than the 10th of the month in question. The APA is paid to the institution, or upon request to the beneficiary.
• Medical or social emergency: A provisional allocation is possible for a maximum of two months from the date of application. An advance payment equal to half the dependency care rate for a resident classified as GIR 1 or 2 is then paid.

Numerical example (fictitious profile)

Situation. Hélène, 84 years old and classified as GIR 2 (a French dependency level), enters a nursing home in France. She lives with her partner, Paul. Their total monthly income is €5,400 (based on a hypothetical situation). The nursing home's dependency care rate is not specified here; it varies from one facility to another.

Issue. In which APA bracket do they fall? A total of €5,400 appears to exceed the final threshold of €4,379.64.

Strategy. Apply the pair rule: resources are divided by 2 before comparing to thresholds.

Result. €5,400 ÷ 2 = €2,700 per month. This amount is €146.77 less than the first threshold of €2,846.77. Hélène's out-of-pocket expenses for dependency care are therefore limited to the dependency care rate for GIR 5 and 6 at the nursing home. Without dividing by 2, the same total of €5,400 would exceed the threshold of €4,379.64 by €1,020.36, and the difference between the rates would be added.

These profiles are fictitious. The total of €5,400 is an assumption. The calculation only considers the individual's position within the income brackets; it does not indicate the remaining amount in euros, which depends on the nursing home's rate. The department remains solely responsible for setting the APA (Personalized Autonomy Allowance).

The deposit requested from relatives

The nursing home may ask those legally obligated to provide support (children, grandchildren, sons-in-law or daughters-in-law) to sign a joint guarantee to pay the accommodation costs when the elderly person can no longer do so.

If the person receives ASH, the deposit can only cover the part of the cost that remains their responsibility.

The reference page does not detail the consequences of this commitment for the person signing. These are verified in the document itself, before signing.

Security deposit and accommodation agreement

• Security deposit: It must not exceed the monthly accommodation fee, which remains the responsibility of the individual. It is refunded within 30 days of departure, less any outstanding balance.
• Residency contract: It is mandatory as soon as the accommodation period may exceed 2 months. It specifies, in particular, the conditions of stay, the calculation of rates and the right of withdrawal.
• Contract handover: In a nursing home that qualifies for social assistance (ASH), the contract is provided within 15 days of admission and must be signed within one month. In other cases, it is signed before admission.
• Withdrawal: in writing, within 15 days of signing the contract. If admission occurs after signing, the notice period begins from the date of admission. No notice period can be imposed, but the person must pay for the entire stay.
• Cancellation after this period: It must be done in writing, at any time. A 48-hour reflection period allows for reconsidering the decision; this is included in any notice period, which must be specified in the residency contract.

What changes depending on your situation

• The selected GIR: Only people classified in GIR 1 to 4 can obtain the APA, and the dependency rate varies according to the state of dependency.
• Household resources: They place the person in one of the three APA brackets, with the division by 2 for a couple.
• The chosen nursing home: its accommodation rate, its dependency rate, and whether or not it qualifies for ASH.
• The tax situation: The tax reduction of up to €2,500 only applies to taxable persons.
• The family: the presence of those legally obligated to provide support and the guarantee required from them.

No results are promised. The rules are examined on a case-by-case basis.