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Early childhood and old age, Marine Tondelier

Old age and long-term care: Public long-term care service, public care homes (Ehpad) with regulated pricing

Direction of change: creation of a scheme, compared with current law.

The lever. Care for dependent older people: care homes (EHPAD), home help, staff, and funding (autonomy branch of social security, out-of-pocket costs). Direction rule: ↑ more public resources for old age.

« Construire un service public de la dépendance à destination des personnes en perte d’autonomie. Développer des établissements publics pour l’accueil de personnes âgées (type EHPAD) soit en gestion publique ou via des entreprises de l’économie sociale et solidaire. Imposer une tarification encadrée et progressive. »1

Translation by the editorsBuild a public long-term care service for people losing their autonomy. Develop public establishments for the accommodation of older people (EHPAD type), either under public management or via social and solidarity economy enterprises. Impose regulated and progressive pricing.

Encoding

No cost-schedule parameter for this position: see the costing for the reason.

Costing

Announced by the candidate

not announced

The programme does not cost this measure.

Published costings

none

No external costing of this position recorded to date.

Our calculation

not costed

Public service for long-term care and public care homes (Ehpad) with no volume or amount: nothing to cost.

Current law, sources and limits of the cost schedule

Current law. Autonomy branch of social security, personalised autonomy allowance (APA), three-part pricing of care homes (EHPAD) (care, dependency, accommodation). Tax credit for employing a home worker: €6,856m forecast for 2025 (CGI (General Tax Code), Art. 199 sexdecies), partly for old age.

Horizon. €bn per year in 2018 GDP-point equivalent, compared with 2018; not restated for the 2032 horizon

Limits. Parameter “Ehpad places” (18 October 2026): annual public operating cost of a place, calculation by the editors: €13,359m of recurrent care funding from the autonomy branch to nursing homes (Ehpad) in 2024 (PLFSS 2026, annex 6) ÷ 609,970 places installed at the end of 2023 (Drees), i.e. about €21,900 (€0.22bn for 10,000 places, lower bound), plus the APA (personalised autonomy allowance) in establishments, €4,940 per beneficiary in 2023 (Drees; €0.05bn for 10,000 places), hence €0.27bn. Relating 2024 funding to 2023 places slightly overstates the cost per place; conversely, residents' community healthcare, non-recurrent funding and the increase in allocations since 2024 are not counted. Not counted: accommodation (paid by residents or by departmental social assistance), housing benefits and investment (construction, aides à la pierre), which is one-off. Residents of new places could have been helped at home (APA at home): this substitution is not deducted (static costing). The Libault report dates from 2019: part of it has been implemented since (Ségur, creation of the autonomy branch in 2021), so the extra cost compared with current policies is below €9.2bn. The figure includes demographics, to be removed if the reference scenario already incorporates them. The 25% increase in the staffing ratio in care homes (EHPAD) (13 FTE per 100 residents) is not isolated in euros in the passages read. No official costing later than 2023 has been read. Annual public cost of an additional place in a care home (Ehpad) (health insurance care package, dependency) not found in a recent official source: commitments expressed in numbers of places remain not costed.

How to read these amounts. These are static costs and revenues, with no feedback effect, over a full year: nothing on growth, employment or the revenue that economic activity would gain or lose. A higher net cost does not on its own make a worse policy, nor net savings a better one: each programme rests on an economic model (demand-led stimulus, lower compulsory levies, consolidation of the public accounts…) that the cost schedule does not settle. GDP itself measures a volume of activity, not well-being or the usefulness of what is produced. Economic models and feedback effects.

This lever in the method · Costing for Marine Tondelier

  1. Pour une prospérité écologique, programme des Écologistes, p. 128. Open the document at this page.

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