GIR 1 to GIR 6: the complete guide to the 6 levels of dependence for families
When you start taking care of an elderly parent who is losing autonomy, the term "GIR" appears everywhere — without anyone really explaining what it encompasses. Here is the clear guide to understanding the 6 levels and navigating the procedures.
Where this classification comes from
The AGGIR grid (Geriatric Autonomy Iso-Resource Groups) was designed in the 1990s to provide an objective and reproducible measure of the degree of dependence of elderly people. It has been progressively adopted as a reference tool by departmental councils to allocate the APA, by Nursing homes to assess their residents, and by home care services to calibrate their interventions.
Its principle is simple: to evaluate a person's ability to perform ten essential daily activities, called "discriminating variables," and seven more complex activities called "illustrative variables." Depending on the combination of observed dependencies, an algorithm assigns a GIR from 1 to 6. The lower the number, the greater the dependence.
The evaluation is carried out by a medico-social team from the departmental council, usually a nurse or a specialized social worker, during a home visit. In an institution, it is the coordinating physician who takes care of it. Family members can be present, and this is even recommended: they provide concrete elements about the daily life that the elderly person sometimes tends to minimize or embellish.
The six GIR levels in detail
People confined to bed or a chair, severely impaired mental functions
GIR 1 corresponds to situations of total dependence. The person is confined to bed or a chair and has lost their mental, social, and physical autonomy. They require indispensable and continuous presence from others, day and night. This includes people at the end of life, those at a very advanced stage of Alzheimer's disease or related conditions, and those severely disabled by the aftereffects of Stroke or other neurological pathologies.
Typical profile: completely dependent person for all actions — bathing, dressing, eating, moving — often bedridden, communicating very little or not at all, requiring constant supervision. Care in a Nursing home or long-term care unit is often indicated. At home, it requires a very extensive support system, both financially and humanly burdensome.
Two main profiles: lucid bedridden individuals or "wandering demented"
GIR 2 encompasses two very different types of situations. On one side, people confined to bed or a chair but whose mental functions remain relatively preserved: they are dependent for all daily actions but maintain a social life. On the other side, people whose mental functions are impaired — often at a moderate to severe stage of Alzheimer's disease — but who retain their motor skills, what was called the "wandering demented" profile: they walk, go on adventures, lose their sense of direction, and require constant supervision to prevent wandering, falls, and domestic accidents.
Typical profile: dependence for bathing, dressing, sometimes eating, severe cognitive disorders or significant immobility, need for continuous presence. A Nursing home is very often indicated, but remaining at home is possible with a significant support system — caregiver several hours a day, nurse, day care to relieve the caregiver.
Preserved mental autonomy but need for daily help for the body
GIR 3 corresponds to people who have retained their mental autonomy and partially their locomotor autonomy, but who require daily and multiple times a day assistance for their physical autonomy. These individuals can generally move around their home with technical assistance but can no longer manage their bathing, dressing, and sometimes even eating or elimination independently.
Typical profile: person who still walks with a walker, who speaks and understands, but needs help getting dressed in the morning, bathing, and eating their meals. Remaining at home is entirely possible with a daily support system — one to three visits from a caregiver per day, housekeeping help, meal delivery, emergency alarm. Entry into a Nursing home is an option but not a necessity.
Help for getting up, bathing, or meals, but autonomy for the rest
GIR 4 encompasses two profiles. Either individuals who cannot manage their transfers alone — moving from bed to chair — but who, once up, can move around inside their home and need help with bathing and dressing. Or individuals without locomotor problems but who need assistance with personal care and meal preparation.
Typical profile: person autonomous during the day for movements within their home, but who needs help with morning bathing, meal preparation, and sometimes some household tasks. Remaining at home is the norm, with a moderate support system: one visit per day, sometimes two. This is the most common level of dependence among APA beneficiaries.
Occasional help for bathing, meal preparation, and housekeeping
People in GIR 5 manage their movements inside their home independently, eat and dress themselves. They occasionally need help with bathing, meal preparation, and housekeeping. This level does not qualify for the APA, but may grant access to other more modest aids — retirement funds, departmental social action.
Typical profile: elderly person still very autonomous in their daily life, who simply wants a helping hand with housekeeping or shopping, and who may benefit from housekeeping assistance partially funded by their retirement fund or by departmental social aid.
Person autonomous for essential daily acts
GIR 6 corresponds to people who have not lost their autonomy for the essential and discriminating acts of daily life. They do not need help with bathing, dressing, eating, or moving. This level does not qualify for any specific aid related to dependence, but the person may benefit from standard aids — retirement fund, mutual insurance, occasional assistance.
Typical profile: elderly person autonomous who leads their daily life without assistance, sometimes with a few very occasional aids like a housekeeping assistant for two hours a week funded by the retirement fund. This is the level at which the majority of people over 65 in France are situated.
Summary table of the 6 GIR
| GIR | Level | Main characteristic | Daily aid | APA? |
|---|---|---|---|---|
| GIR 1 | Total dependence | Bed/chair confinement + severe mental impairment | Continuous day and night | Yes, highest ceiling |
| GIR 2 | Severe dependence | Bed/chair confinement or severe cognitive disorders | Several times a day | Yes |
| GIR 3 | Significant dependence | Mental autonomy, but daily physical help | Several times a day | Yes |
| GIR 4 | Moderate dependence | Help for transfer, bathing or meal preparation | One to two visits per day | Yes |
| GIR 5 | Partial autonomy | Occasional help for housekeeping, meals, bathing | A few times a week | No, other aids possible |
| GIR 6 | Complete autonomy | No loss of autonomy for essential acts | None or very occasional | No |
How the evaluation takes place
Who evaluates
For a request for APA at home, the evaluation is done by a medico-social team from the departmental council. A member of this team, often a nurse or a social worker specialized in gerontology, visits the home. For an evaluation in a Nursing home, it is the coordinating physician of the establishment who carries out the evaluation, upon admission and then periodically.
How the visit proceeds
The visit lasts between one hour and one and a half hours. The evaluator observes the person in their environment, asks questions about living habits, difficulties encountered, and current aids received. They may ask to see certain actions — getting up from a chair, walking, picking up an object — and discuss with the present family caregivers. Several areas are evaluated: coherence, orientation, bathing, dressing, eating, elimination, transfers, movements inside, movements outside, communication at a distance.
Do not let them minimize
For each area, the evaluation rates the person on three levels: A (does it alone, totally, usually, and correctly), B (does it partially or not usually or not correctly), C (does not do it). This is one of the most important moments for families: it is crucial not to let the elderly person minimize their difficulties out of pride or fear of appearing diminished. Many seniors say "I'm fine, I manage" while they are actually struggling, and the GIR assigned then underestimates their needs.
🎯 Prepare for the assessment visit: 4 tips
First tip, be present as a caregiver. Your presence helps to contextualize what the person is saying and to signal the difficulties they downplay. Second, prepare a written list of concrete daily difficulties — “takes thirty minutes to get dressed,” “no longer prepares real meals alone.” Third, ask the evaluator what they rated A, B, or C — you have the right to know these elements. Fourth, keep a copy of the assessment report, it's an important document for the future.
The aids associated with each GIR
The APA for GIR 1 to 4
The Personalized Autonomy Allowance is the main aid linked to the GIR. It is paid by the departmental council for people in GIR 1, 2, 3, or 4. The amount depends on the GIR — higher ceiling for GIR 1 and 2 — and the person's income, with a progressive financial contribution beyond a certain threshold. The APA finances home help hours, meal delivery, telealarm, certain technical aids, day care, and temporary accommodation.
The APA in institutions (Nursing home) takes the form of assistance that covers part of the “dependency rate” of the institution, again depending on the GIR and income.
The aids for GIR 5 and 6
People in GIR 5 or 6 cannot benefit from the APA, but other schemes exist. Pension funds — CARSAT, MSA, special schemes — offer home help and personalized action plans subject to resource conditions. The departmental councils can allocate optional social aids. Some complementary mutuals also have services dedicated to maintaining at home.
The aids that can be combined with the APA
Several schemes can complement the APA: the disability compensation benefit (PCH) for people with a RQTH prior to age 60 that they can retain, housing aids (APL, ALS), tax credits on home services (50% of expenses, capped), exemptions from employer contributions for the direct employment of a home employee, and certain one-off aids through the MDPH or Action Logement for housing adaptations.
When the GIR changes: the revision
The GIR is not fixed. The condition of an elderly person can worsen — illness, Stroke, fall — or improve — rehabilitation, treatment of depression. Any significant change justifies a request for revision to the departmental council. The new assessment is conducted according to the same protocol as the initial assessment.
This revision is particularly important after an acute event — prolonged hospitalization, surgical intervention, cognitive decline — or conversely after a recovery period. It entitles one to an adjustment of the APA and the aids in place. Many families are unaware of this possibility and remain on an outdated GIR that no longer corresponds to real needs.
💡 Self-assess to anticipate
Before the official visit, having your loved one complete a self-assessment questionnaire can give you an idea of the likely GIR and prepare the discussion. On DYNSEO, you can complete an online self-assessment questionnaire that covers the main items of the official assessment. The result has no official value — only the departmental team decides — but it gives you a reference point and structures your preparation.
Cognitive stimulation and preservation of autonomy
The autonomy of an elderly person is never a fixed state. It depends on physical factors, but also cognitive and psychological ones. Maintaining regular cognitive stimulation — without performance pressure, with adapted exercises — protects against decline and can, in some cases, allow one to gain or regain autonomy. This applies as much to people in GIR 5 or 6 who want to stay at home as long as possible as to those in GIR 3 or 4 for whom every preserved ability reduces the necessary help.
The SCARLETT application designed for seniors offers short and fun exercises, calibrated to the person's level, accessible from a tablet. Integrated into daily life — fifteen to twenty minutes a day — it usefully complements human support by working on memory, attention, language, and logic. It is a valuable resource for family caregivers as well as for professionals in Nursing homes or day care.
The role of professionals and training
Home helpers, nursing assistants, nurses, home companions: these professionals often spend more time with the elderly person than the family. Their ability to finely observe daily changes, to signal significant changes, and to participate in the preparation of GIR assessments makes a real difference in the quality of support.
Understanding the AGGIR grid, knowing how to identify changes that justify a revision, assisting families in the processes: these skills can be learned. The DYNSEO online training, certified Qualiopi, addresses these issues in several courses dedicated to supporting seniors, preventing loss of autonomy, and gerontology. They are accessible remotely, at one's own pace, and can be funded by most OPCOs and continuing education agreements.
Home or Nursing home: what the GIR says — and what it doesn't say
A recurring question is: at what GIR should one consider the Nursing home? The honest answer is that there is no automatic threshold. A person in GIR 2 can very well stay at home with a comprehensive support system and an available caregiver. A person in GIR 4 can conversely enter a Nursing home because loneliness, anxiety, or isolation become unbearable. The GIR measures physical and cognitive dependence, not overall quality of life or environmental resources.
Three elements are as important as the GIR in this decision. First, the availability of family caregivers: a living spouse or present children can allow for home maintenance at high levels of dependence. Next, the adaptation of the housing: an apartment with an elevator, on one level, with an accessible bathroom makes things easier. Finally, the financial situation: home and Nursing home have different costs that do not mechanically compare.
The ideal is to anticipate the decision rather than to endure it in an emergency after a fall or hospitalization. Visiting Nursing homes, inquiring about day care or temporary accommodations, exchanging with a local information point — CLIC, Departmental House of Autonomy — allows time for reflection.
What to remember
The GIR grid is an essential tool for anyone supporting an elderly loved one experiencing loss of autonomy. It provides a common language between families, professionals, and administrations, conditions access to essential aids, and structures the care pathway. Its six levels describe very different realities, from fully dependent old age to full autonomy, and each calls for specific responses. Not confusing administrative evaluation with human decision — entering or staying at home, organizing aids, preparing for the future — is undoubtedly the key to transforming a sometimes rigid system into a tool that serves your loved one.
Frequently asked questions
How to request a GIR assessment for an elderly parent?
The request is made to the departmental council, via the APA request form. The Local Information and Coordination Centers (CLIC) and the Departmental Houses of Autonomy help to compile the file. The time between the request and the assessment visit varies from a few weeks to a few months depending on the departments.
Can the assigned GIR be contested?
Yes. If you believe that the assigned GIR does not reflect the actual situation, you can request an amicable appeal to the president of the departmental council within two months of notification. In case of refusal, a contentious appeal is possible before the administrative court. Requesting a new assessment after a deterioration is also a right.
How much does an hour of home helper funded by the APA cost?
The hourly rate depends on the mode of intervention. In direct employment (helper employed by the elderly person): about €13 to €15 per hour. Through a mandating service: €18 to €22. Through a service provider: €22 to €28. The APA finances all or part according to the validated aid plan and income.
Can a person in GIR 4 enter a Nursing home?
Yes, unconditionally. The GIR does not condition entry but influences the part financed by the APA in the dependency rate of the Nursing home. A person in GIR 4 pays a more moderate dependency rate than a person in GIR 1 or 2, and benefits from a lower APA.
Is the APA recoverable from the estate?
No. Unlike social housing assistance, the APA is not recovered from the beneficiary's estate, their donations, or a return to better fortune. It is aid that does not have to be “repaid” by the heirs.
How long before receiving the APA after the request?
The legal processing time is two months from the complete file. In practice, expect two to four months between the initial request and the first payment. The APA is paid from the date of submission of the complete file, thus retroactively.
What happens if my parent's condition changes suddenly?
A new assessment can be requested at any time from the departmental council. In case of emergency (hospital discharge, rapid deterioration), an emergency APA can be paid while waiting for the new assessment to be carried out. The file must be supported by a medical certificate.
Can one refuse an assessment visit?
The elderly person can refuse, but then they lose the benefit of the APA. If the person cannot express informed consent (advanced cognitive disorders), it is their legal representative — guardian, curator — or close family who makes the decision. The visit is a right, not an obligation, but it conditions access to aids.
From administrative diagnosis to human support
Understanding the GIR is not just an administrative issue: it is putting words to what your loved one is experiencing, anticipating what may come, and preparing the right decisions at the right time. No level of dependence is a fixed fate — autonomy evolves, aids adjust, choices are discussed. With a bit of information, time to prepare assessments, and the support of professionals in the field, these processes can become a framework that protects rather than a constraint that weighs. Your loved one is not just a number between 1 and 6, but that number, when well used, can open essential doors.