Long-term Care and Autonomy Insurance

Your long-term care and autonomy insurance

A dependency contract for your home support

Long-term care insurance with financial and human support that adapts to all life paths and allows, depending on your situation, to stay at home for the desired time.

Scalable insurance for your dependency guarantee

Your long-term care insurance contract allows you, in the event of loss of autonomy, to benefit from an annuity that varies depending on where you live: at home or in an establishment. You can also plan to receive a dependency pension only if you live in an establishment.

Long-term care insurance with accessible contributions

The earlier you subscribe, the lower your contributions. Your contributions no longer change once your contract is taken out (excluding revaluation). In addition, you benefit from a 10% reduction on your contribution and that of your spouse if you subscribe to two.

Extended loss of autonomy assistance

Numerous services are available to support you as soon as you take out your long-term care insurance to preserve your health, in the event of temporary fragility, when entering dependency at home or when entering an establishment. Specific services are also provided for caregivers.

Dependence and loss of autonomy: differences?

There is no difference between loss of autonomy and dependence, even if, in everyday language, we talk more about addiction to alcohol, drugs, games, etc. Physical or psychological dependence, among young and old, let's take stock of the different forms of loss of autonomy.

Dependence: definition of a dependent person

Dependence refers to the inability of a person to perform certain daily acts independently. It can be a physical dependence or a psychological dependence. Dependence can thus take the form of an inability to wash, to feed oneself or to take care of oneself due to psychological disorders. In the latter case, the person can sometimes represent a danger to himself or to others.

Two situations can be encountered: total dependence or partial dependence.

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What is loss of autonomy?

Loss of autonomy describes an evolving situation that can be caused by age, by an accident or even an illness. But it is also possible to be reached by a total and irreversible loss of autonomy which occurs following an accident or an illness, and which prevents a person from meeting his needs. As part of a loan insurance, there is also a total and irreversible loss of autonomy guarantee (PTIA).

While some refer to the 4 forms of autonomy, the WHO definition of loss of autonomy has 5 functions:

locomotion
the locution
sensory (hearing and vision)
the psychosocial
vitality (reserves, nutrition)

The loss of autonomy can be reflected in various ways:

difficulty moving;
difficulty in bathing;
difficulty in eating;
psychological confusion that complicates the performance of daily acts;
etc.

Definition of dependency in the elderly

While addiction can occur as a result of an accident in life, it is sometimes linked to aging and loss of motor and mental functions.

A charter of rights and freedoms for the dependent elderly person was drawn up by the National Foundation of Gerontology with the Ministry of Social Affairs in 1987 and revised several times, with a view to allowing the rights of the persons concerned to be recognized, but also to leave them a freedom of choice as to their care.

The dependent elderly person can thus freely choose his place of life. She must be able to benefit from access to care and support to carry out daily activities. This charter of rights and freedoms for the elderly with a disability or loss of autonomy aims to propose rules to be observed in the event of loss of autonomy of people.

Why are loss of autonomy and dependence linked?

Although both terms are used, there are no differences between loss of autonomy and dependence in this context. The loss of autonomy generally leads to dependence, and therefore a need for daily assistance. The loss of autonomy of the elderly is a major issue at a time when they want to stay at home as long as possible.

This is why there is assistance in the event of loss of autonomy (or age-related dependence) which allows care tailored to the needs of each senior.

How to estimate the loss of autonomy and dependence?

It is necessary to estimate the loss of autonomy in order to define the rights of people in a situation of dependency.

There are three solutions for this: the Gir grid, the MMS test and the AVQ grid.

The Gir grid

If we talk about the Gir grid, in reality, the Gir (iso-resource group) is the level of loss of autonomy of an individual. Thus, the grid for calculating the Gir is the AGGIR grid.

It has three functions:

measure the person's ability to perform certain activities and their degree of loss of autonomy;
determine the amount of the personalized autonomy allowance (APA);
determine the level of assistance needed.

There are 6 Gir. Gir 1 concerns the most dependent people. They cannot move and their intellectual functions are impaired.

Gir 6 concerns people capable of carrying out all the acts of everyday life. APA is granted to people from Gir 1 to Gir 4.

The MMS test or Folstein test

Do you have the feeling that a loved one is losing their cognitive and brain skills?

MMS test can be indicated. The Alzheimer MMS test can be used to determine whether a patient is suffering from this degenerative disease or, at the very least, from dementia.

This test, also known as the Folstein test, has 30 questions that assess different functions, such as:

language
the calculation
identification
attention
orientation
memorization etc.

Anyone who scores less than 24 points on the MMS test is considered to have dementia. New, more advanced tests are then carried out to find out if it is Alzheimer's disease.

The AVQ grid

The AVQ grid is the grid of activities of daily living. This grid lists 6 ADLs, namely:

the toilet
the dressing
food
continence
the transfers
move

According to the AVQ evaluation grid, generally used by insurers, 4 levels of dependency are determined according to the number of acts of daily living that can no longer be performed:

level 1: 2 ADL
level 2: 3 ADL
level 3: 4 ADL
level 4: 5 or 6 ADL

The issue of home support for the elderly

Today, many elderly people express the wish not to go to a nursing home or, if possible, to delay entering such a facility.

This is explained by a desire to stay in a familiar environment, but also because of the high prices charged by nursing homes.

Home care for the elderly is therefore a real social issue. Various solutions must be considered to combat the loss of autonomy.

While the intervention of family caregivers may be one, they are not always sufficiently available. This is one of the limitations of home support for the elderly.

To remedy this, there is therefore an allowance for home support for an elderly parent: the APA (personalized autonomy allowance) which can be used to pay all or part of the expenses necessary to stay at home, but also to contribute to the payment of part of the dependency tariff of an establishment such as an Ephad, in which the person is accommodated.

In deciding on home support for the elderly, the pros and cons should be considered. The main advantage is the well-being of the person who does not feel uprooted and therefore does not face the loss of his bearings. On the other hand, there is a risk that, despite the intervention of caregivers and caregivers, the person will feel isolated. The price can also be a brake in the event of strong dependence.

Dependence, loss of autonomy: what solutions?

People with loss of autonomy need support. They can be based on the compensatory allowance for a third party intended for the family caregiver (or any other worker), which in 2006 became the PCH (disability compensation benefit), as well as the personalized autonomy allowance and long-term care insurance.

How much is the APA?

The personalized autonomy allowance, the APA, is assistance subject to conditions of age, level of loss of autonomy and residence.

The request for a personalized autonomy allowance is made to the CCAS (or to the social action center of the city of Paris for residents of the capital).

To benefit from this assistance for the loss of autonomy, you must be over 60 years of age and have GIR 1, 2, 3 or 4. On the other hand, you must live:

at his home ;
at the home of a relative who accommodates the elderly person;
with a welcoming family;
in an independent residence.

The amount of APA, in 2020, when you stay at home, is at most:

Gir 1: € 1,742.34
Gir 2: € 1,399.03
Gir 3: € 1,010.85
Gir 4: € 674.27

The amount is revalued each year.

The family carer's allowance

The family caregiver for an elderly person is a loved one who gives time to the dependent senior to improve their daily life. The caregiver's field of action is vast. He can do a partial toilet in bed, take care of administrative procedures, prepare meals, do grocery shopping, housekeeping, etc.

Strictly speaking, there is no allowance for family carers. However, under certain conditions, the dependent person can pay their loved one through APA. On the other hand, it is possible to take family caregiver leave, which allows you to reduce or temporarily suspend your professional activity in order to devote yourself to your loved one.

Long-term care insurance

Beyond the APA, it is possible to take out long-term care insurance. This makes it possible to anticipate the loss of autonomy and thus obtain financial and human support to promote home care. This insurance also makes it possible to pay the cost inherent in an nursing home placement.

Finally, this loss of autonomy insurance can also provide support to the informal caregiver depending on the nature of the cover taken out.

The tariff for long-term care insurance varies according to the subscription age and the level of the desired pension.