French Facilities Treat Elderly like Guests

The French do many things so well – cuisine, monuments, castles, daily family life – I wondered, how do they handle elder care?

The French are like us in many ways. Some 80 percent of frail seniors choose home care over institutional care. And institutional care has a history of poor quality. In the past, institutions were seen as a place for the very ill to die.

The facilities I visited were innovative and represent France’s response to an increasing elderly population – 15 percent are over age 65 (compared to 13 percent in this country). In visiting, I discovered two concepts that stand out: Facilities strive for a hotel-like atmosphere and are designed to integrate into daily town or city life.

“We must strive to treat the older person like a client in a hotel requiring all the same exactness of services, rather than a sick person in an institution,” explains Pascal Champvert, director of three facilities and president of an association of facility directors. He emphasized the need to combine medical care, the philosophy of a hotel industry and the dynamism of activities programs found in the tourist industry.

Champvert’s facilities, just outside Paris, are nonprofits. They cost around $72 a day and attract private pay and government-subsidized clients. Shared rooms, so common in U.S. facilities, are nonexistent.

Here, facility life is an integral part of the surrounding community. Buildings are structured in a “U” shape, open to the countryside or the village. Residents who have lived in the town their whole lives contunue to use their favorite baker, meat market or bank. And people living in the community use the facility’s beauty salon and residents’ dining room, called a “restaurant.” During my visit, the town mayor popped in to have her hair done. Community officials, the police and, of course, residents’ families are invited to dine in the facility restaurant.

Finally, I noticed the facility tolerated a higher level of illness than U.S. assisted living facilities. The average age is 87, and many are as ill as residents in U.S. nursing homes.

Hotelia, centered in Paris, is private pay only. Hotelia also has a hotel atmosphere and a sense of being part of its neighborhood. It was around 4 PM when I visited and interviewed director Elizabeth Rank, who pointed out Hotelia’s solution to avoiding the agitated behaviors that often afflict frail elderly people at this time of day: Everyone takes a break for tea, coffee, a beer or glass of wine, much as they might when living on their own.

Hotelia has an actual bar with a waiter, in uniform, who takes orders from residents and visiting family. Those who want coffee or beer sit at small tables, in private corners, contentedly sipping their drinks, as if at a Paris bar or cafe. Outside, on a garden patio, under sun-dappled umbrellas, I chatted with a 100-year-old resident and her family taking afternoon tea. At home, Maman had been Reine, or “queen,” and she continued to feel like a queen at Hotelia. The family had dreaded moving her to a facility and were now completely pleased with their choce.

The French appraoch to institutional care is innovative and clearly strives to normalize aging. The French are well on their way to realizing their belief that “Aging is a state and not an illness.” This country could take notice and follow their lead.