Ages et Vie: Personalised care and a richer social life for the elderly in rural France

In rural France, the elderly who can’t live independently at home any more must, in most cases, go into an institution that specialises in care of the elderly. This solution is often traumatic for them – in many cases, having spent their entire life in the countryside, it means moving to a town a long way off and far from their relatives and friends. In France, 6000 local authorities have between 100-3000 inhabitants and they generally lack adequate facilities for taking care of elderly persons.

In order to deal with this issue, the architect and urban planner Nicolas Perrette developed the housing concept Ages&Vie (‘Age and Life’). The first Ages&Vie house was opened in the administrative district Creuse in 2009, the département with the highest number of elderly people in France.

The concept Ages&Vie is based on the idea that elderly people have the right to live in their own village, close to their family and friends, while maintaining a maximum degree of autonomy in an environment which does not feel institutionalised. Furthermore, the project aims at providing jobs and professional qualifications for people who take care of the elderly in rural areas. Last but not least, the Ages&Vie homes aim at providing elderly people with an environment where they have company and social interaction.

The Ages&Vie homes are built in the centre of the village, so that elderly people can keep in touch with their family, friends and neighbours, can continue to play a role in the life of the local community and are close to professional support staff.  They also support inter-generational mixing to end the artificial separation of young and old people, which means that both miss out on the benefits that can come when the generations mix freely.

The architecture of the Ages&Vie homes allows several generations to live together. On the ground floor, there is a big communal area where the residents can take their meals together, share daily activities and have fun. Leading from this communal area, the  residents have their own room, which they  can furnish as they like. These rooms are also respected as the private space of the residents - for example, when staff or other people want to enter this room they must knock at the door. On the first floor are three flats for the three professional support workers and their families (typically, 80 m2  large), with a private entrance, so that the staff and families can keep their independence, too.

The presence of three professionals in the homes means that they can take turns to look after the residents, so that they are not obliged to be available 24/7 on 365 days of the year, which would lead to overwork and continuous pressure.

Most importantly, all support staff (in most cases women) are required to take part in a professional training programme which emphasises caring for the elderly in a way which allows them to keep a maximum of autonomy in their daily lives.

Nicolas Perrette and Simon Vdouillot developed the innovative Ages&Vie concept with the support of the mayors of a number of small villages in the East of France. One key feature of Ages&Vie homes is the tailored architecture to balance personal autonomy with communal social life. Each home typically accomodates six elderly residents and three support staff. The design of the projects also ensures the financial viability of the concept and ensures that the rent is no higher than the average rent in institutionalised care homes. The project sponsors, particularly the mayors, were also keen to create full-time posts for support staff. The Ages&Vie homes are based on the philosophy of living together rather than joint living – so there are no spaces in the homes that are meant for joint use by the residents and the support staff (a feature built into an earlier version of the concept but which proved to be unsustainable).

All residents of an Ages&Vie house – the elderly, the professional support staff and their families – have the same status as tenants. In addition to the rent, the elderly residents also pay a salary to the professional support staff. With the creation of an Ages&Vie house, an association is set up which includes the mayor, the GP of the village, the professional support staff and their families and the elderly residents or their families. In this governance structure, the elderly residents are regarded as the employers of the professional staff members. The mayor has the power to nominate the President of the assocation (who in most cases will be himself or the GP of the village). The secretary is always one of the elderly residents representing his/her peers. The presence of the secretary at the meetings of the association gives the elderly residents decison-making powers in staffing and building issues.

The professional staff are female in 95% of cases. Typically, they have a state diploma as a social support worker (called AVS in French). Alternatively, they may demonstrate professional experience in gerontology as a nursing auxiliary, either in medical institutions or in homes for the elderly. Many of the support staff prefer to work in an Ages&Vie house because it allows them to combine a highly responsible job at an attractive salary (typically €1700 per month, 25% over the average salary in this field). Moreover, their flat and living space in the house is big enough to suit a young couple with children, and both the children and the elderly benefit from being in touch with other generations. Consequently, there are lots of applicants for these jobs.

The professional support staff in Ages&Vie homes also get extra training which helps them to focus on the overall quality of life of the residents, so that they can help and support them much more effectively. Their role is to allow the elderly residents to continue to live their life with a maximum of autonomy. As Nicolas Perrette emphasises, traditional training of care staff in France focuses on how to help dependent persons. However, in Ages&Vie homes the professionals have to work WITH the elderly residents and not just simply provide a service FOR them. For example, they try to help elderly residents to eat their meals without any external help. The training also helps the professionals to deal with bereavement issues – the death of elderly residents affects staff and other residents strongly, as they live close to each other and often develop very close relationships. The financing of this training comes from contributions by the elderly residents. Other specific training programmes, e.g. on pain management, is often subsidised by the regional government.

As far as social issues are concerned, the professional support staff are monitored and regulated by the public sector. Three public authorities are involved: central government, the département, and the local authority. Central government fixes salary levels of support care staff, and the level of allowances for food and daily care. The staff are registered and monitored by the respective département, which checks their level of competence and the suitability of their household, and also provides training courses. The local authority plays the role of a mediator through its role in the association – but the association only intervenes in cases of a conflict, it does not otherwise interfere in the management of the Ages&Vie homes. For instance, when an elderly person becoms so severely ill that they are themselves in danger or become a danger to the others, the association is entitled to decide to transfer them to an appropriate specialised institution. Furthermore, through this association, other members of the community – and, of course, relatives of the elderly – can be kept in touch of what is going on in the house.

In summary, the concept of Ages&Vie is based on the idea of multiple actors working with each other, all using their own capabilities and personal assets to contribute to the overall functioning of the home.

The project has created significant win-wins for all those involved. As Pierre Contoz, Mayor of the village of Montfaucon, summarises it : "Our two new Ages&Vie homes are accomodating 18 elderly residents in the village without having any impact on our budget. Furthermore, they have created six jobs which have not cost the local council anything".

Most importantly, residents benefit from a higher quality of life than in a traditional care home, as they are not treated as dependent service users. Moreover, living in an Ages&Vie home allows them to make significant savings. On top of that, their status as co-employers of the staff gives them more self-esteem and ensures that ‘their’ staff are responsive to their needs.

For the professional support staff, these jobs are well paid and carried out in an attractive rural environment, less stressful than in a big city.

Last but not least, the founders Nicolas Perrette and Simon Vouillot (2003) emphasize : "The lifestyle of tomorrow must not isolate generations – rather, it must bring them together. Standardised solutions are no longer suitable for the increasing diversity of individual needs".

Today, there are eight Ages&Vie homes within a radius of 100 km of the city of Besançon in Eastern France. Given the favourable results, one may wonder why this kind of initiative is not spreading faster – some of the barriers and perceived risks of this care concept are discussed in the ‘Learning points’ section.

At the beginning of 2012 the company Ages&Vie conducted the third satisfaction survey among the residents of Ages&Vie homes. The survey showed that more than 65% of residents are very or quite satisfied with the services they get in the Ages&Vie homes, including the menus and preparation of meals, support with household tasks and personal hygiene, and the respect for their privacy shown by staff.

The majority of tenants are also satisfied with their membership in the association (30% very satisfied, 55% satisfied).

These results are similar to those in previous years, although some interesting positive developments have occurred – e.g. satisfaction with alarm systems in the homes has increased from 54% to 73% (due to a new product being used). The proportion of residents who are satisfied with the quality-price ratio has increased from 73% in 2010 to 85%.

The concept of Ages&Vie is basically a public-private partnership. The local authorities wishing to take part in the project donate the plot of land on which the Ages&Vie houses will be built for the symbolic price €1. They also guarantee the return to the investors in the building for a duration of 40 years. The private investors finance the construction of the Ages&Vie homes, in return for the rent which they collect. The investor has no right to intervene in the construction of the houses, which is the responsibility of Ages&Vie.

The rent is fixed in line with the rent charged by other care homes in France. For the elderly residents, it is typically €300 per month and for the professional support staff €500 per month for their flat. As the land is donated by the local authority, the rent is affordable for most people. Ages&Vie makes sure that local people of the village have priority in being allocated to the local Ages&Vie home.

This means that living in an Ages&Vie home costs less than living in a conventional care home. Perhaps more importantly, though, the key pillar in this concept is the employment contract between the professional support staff and the elderly residents. This set-up means that the elderly residents can expect the professionals to be responsive to them – and, if not, the contract allows residents to end their employment. As a result, the elderly people have the opportunity to influence the environment and atmosphere in their home, independent of their age and any disabilities they have. Of course, they also need to respect their responsibilities as employers.

So far, only the mayors of small villages have been supportive in endorsing the concept of Ages&Vie. Decision-makers at the higher district level have tended to perceive Ages&Vie homes as competition, given that they are responsible for the provision of traditional institutionalised care homes. At regional level, there is also little interest in new approaches for improving the well-being of elderly people, given that French regions have few responsibilities for social care. Due to the weak engagement of local levels of government, the Ages&Vie concept has not found major resonance within the French state.

Given that French administrative culture is still not very managerialist, no public agency has commissioned an external evaluation of the Ages&Vie projects so far. However, the annual satisfaction surveys of the residents in Ages&Vie homes demonstrate its success as a concept, and this has also found a very positive echo in the press.

The benefits of a housing concept which allows elderly residents to maintain a maximum of autonomy, supported by personalised care from professionals, while being integrated in the local community are evident. The inter-generational benefits of the Ages&Vie projects have been strengthened in a number of villages such as Montfaucon, where two new Ages&Vie houses were built close to the local school.

The key lesson to be learnt from the Ages&Vie projects in the East of France is that it is not sufficient to improve the services offered to the elderly – it is necessary also to focus on improving the overall quality of life of the elderly. This means rethinking how generations live together. According to Nicolas Perrette and Simon Vouillot (2004), it is also necessary to strengthen volunteering in France and to think of wider changes in the way the public sector works in France.  The Ages&Vie projects show that small-scale local authorities cannot bring about these changes by themselves but need to work in partnership with other public agencies, the private and third sectors as well as local communities.

Perrette, Nicolas et Vouillot, Simon (2004), Bâtir la Ville pour tous les âges, DOC ‘animation en gérontologie N°2,  pages 59 à 64 (janvier/mars 2004). (in French)

Article on the concept- http://www.famidac.fr/article1253.html (in French)