Benefits in kind for persons living at home or in an assisted living facility
For the purposes of long-term care insurance, the care and/or assistance provided by a professional care and assistance service provider – i.e. a care and assistance establishment or network, or a semi-inpatient facility – is referred to as 'benefits in kind'.
If the dependent person lives at home
If the assistance or care is provided only through a care and assistance network (Réseau d’aides et de soins – RAS), the lump-sum coverage for benefits in kind in connection with activities of daily living (ADLs) is paid directly to the RAS by the National Health Fund (Caisse nationale de santé – CNS). Where applicable, the costs in connection with the various approved activities are also paid directly to the RAS.
If the care and/or assistance is provided by both a RAS and caregiver, the allotment of the required care and assistance – i.e. how the care and/or assistance is allotted between the RAS and the caregiver – will be shown in the summary of care and assistance. Based on the allotment appearing in the summary, the CNS will pay the lump-sum benefits in kind directly to the RAS, and the cash benefits directly to the dependent person.
If the dependent person lives in an elderly home or an establishment for the disabled
The long-term care insurance provider will cover the costs of the care and assistance required for the dependent person to perform their activities of daily living (ADLs): the CNS will pay the lump-sum coverage for benefits in kind in connection with ADLs directly to the establishment. There are 15 categories of lump-sum payments, which vary depending on the amount of care and assistance required. Where applicable, the costs in connection with the various approved activities will be paid directly to the establishment.
However, the cost of board and lodging (which includes the cost of renting a room, meals and supervision) – which varies depending on the establishment – is always borne by the person living in the establishment, whether dependent or otherwise.
The different forms of aid covered by long-term care insurance
Care and assistance to perform activities of daily living (home and long-term care facility)
This applies to care or assistance for the following:
- personal hygiene: bodily and oral hygiene, shaving and facial hair removal, menstrual hygiene;
- elimination: eliminating bodily waste; changing colostomy bags or emptying urinary drainage bags;
- nutrition: eating and drinking, enteral feeding;
- dressing: putting on and taking off clothes, installing and removing corrective and compensatory equipment;
- mobility: getting up and sitting/lying down, getting from one place to the next, entering and leaving home, going up and down stairs.
Activities to support independence and autonomy (home and long-term care facility)
This section applies to specialised individual or group activities carried out at home or in an inpatient setting.
Activities to support independence and autonomy entail teaching a dependent person the skills required to perform activities of daily living (ADLs), in order to:
- prevent a loss of motor, cognitive and mental capacity;
- maintain motor, cognitive and mental capacity;
- improve motor, cognitive and mental capacity.
These activities, undertaken individually or in groups, are planned and structured as mutually agreed by the beneficiary and their provider, based on the dependent person's status and specific needs.
The activities are covered at a set allowance of 5 hours a week when undertaken on a one-to-one basis, or 20 hours a week when undertaken in groups. Activities to support independence and autonomy may be combined with home-care support activities (activités de maintien à domicile – AMD), or with inpatient support activities, within the limits provided for by the long-term care insurance provider.
Home care support activities
Individual care/supervision (AMD-GI)
The purpose of individual supervision is to ensure the physical and mental integrity of a dependent person who needs constant supervision and support. It also makes allowance for scheduled rest periods for the caregiver.
Individual supervision consists of providing the dependent person with home supervision and support for a short period during the day when their caregiver is absent.
Where appropriate, individual supervision also includes occupational activities, if the person's general condition allows them to engage in such activities.
Individual supervision is covered at a set allowance of 7 hours a week. If the caregiver is demonstrably overstretched, the allowance may be increased to 14 hours a week.
Group care/supervision (AMD-GG)
The purpose of group supervision is to ensure the physical and mental integrity of a dependent person who needs long-term support. It may also make allowance for scheduled rest periods for the caregiver.
Group supervision consists of providing a dependent person, who cannot remain on their own for an extended period of time, with daytime support outside their usual residence.
Where appropriate, group supervision also includes occupational activities, if the patients' general condition allows them to engage in such activities.
Group supervision sessions may be replaced by individual care/supervision sessions, or outside activities, within the limits provided for by the long-term care insurance provider.
Group supervision is covered at a set allowance of 40 hours a week. For persons requiring specific, personalised support and ongoing supervision, the group-supervision allowance can be increased to 56 hours a week .
Night-time supervision
Night-time supervision consists of providing a dependent person who requires the full-time presence of another person with home supervision throughout the night.
This form of supervision provides a replacement for the caregiver if they are temporarily absent, if they need some time off to rest, if they are hospitalised, or if they are permanently unavailable.
Coverage for night-time supervision is based on an allocation of 10 nights a year.
Caregiver training
The purpose of caregiver training is to provide caregivers with advice on, and training in, assisting dependent persons to perform activities of daily living (ADLs) by teaching them the required techniques and knowhow.
Caregiver training, provided individually or in groups, is planned and structured based on the caregiver's specific needs.
Coverage for caregiver training is based on an allocation of 6 hours a year.
Assistive technology training
The purpose of assistive technology training is to provide dependent persons or their caregivers with advice on, and training in, home use of the assistive technology provided by the long-term care insurance provider, by teaching them the required techniques and knowhow.
The training is delivered individually, and is not equivalent to the information given by the assistive technology supplier at the time of delivery and installation.
Coverage for assistive technology training is based on an allocation of 2 hours a year.
Assistance with household chores
Coverage is based on an allocation of 3 hours a week for each dependent person living at home.
The coverage is meant to finance tasks to ensure the cleanliness of the dependent person's living spaces – bathroom, toilets, kitchen, bedroom, sitting room, dining room – or to ensure their basic sustenance:
- cleaning and tidying living spaces;
- washing dishes and cleaning kitchen appliances;
- ensuring that food is edible;
- purchasing food and other staple items for the dependent person;
- changing bedclothes;
- washing and ironing laundry.
Support activities in long-term care facility
Inpatient support care and assistance activities consist of providing a dependent person with daytime support.
The purpose of these activities is to ensure the safety of a dependent person who cannot remain on their own for an extended period of time, or to prevent social isolation. They help to structure the dependent person's day by providing them with opportunities to take part in social activities or activities to occupy their time. These activities are undertaken in groups.
For persons requiring specific, personalised support and ongoing supervision, there is an extended allowance for inpatient support activities.
The basic allowance is 4 hours a week for each dependent person living in an inpatient setting. The extended allowance is 10 hours a week. In practice, these hour allowances correspond to a monetary amount and not the actual hours of support provided to the beneficiary individually. The monetary amount is allocated to establishments to so they can cover the costs of providing support to the dependent persons.
These activities may be combined with activities to support independence and autonomy (activités d’appui à l’indépendance – AAI), within the limits provided for by the long-term care insurance provider.
Lump-sum allowance for incontinence products (home)
The lump-sum allowance for incontinence products (forfait pour matériel d’incontinence – FMI) is meant to be a contribution towards the cost of incontinence products for dependent persons living at home. "Incontinence products" means the absorbent pads and pull-ups required by persons with daily episodes of urinary and/or faecal incontinence. The FMI is paid out once a month. The amount is indexed.
For persons who require incontinence products and live in a care and assistance facility or in a semi-inpatient facility, the cost of the products is covered through monetary allowances paid to the establishments.