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Reports (Technical Report) Year : 2018

ESPN Thematic Report on Challenges in long-term care. France


Traditionally characterised by a familialist approach to elderly care, France has evolvedtowards a mixed model, combining public and family care. Long-term care (LTC) is afragmented policy field associating different levels of governance and severalinstitutional, organisational and professional actors. It is based on a cash-for-carescheme, the personal autonomy allowance (allocation personnalisée d’autonomie – APA).Managed at the local level by the département (French local authority in charge of socialpolicies), the APA is paid, at home or in institutions, to any person aged 60 or over whoneeds assistance to accomplish daily living activities. At home, it finances a specific ‘careplan’ elaborated with a multidisciplinary team of professionals, and covers the needswhich are not taken into account by the health insurance system.Different in-kind services have been introduced since the 1970s (home-based careservices, residential care, day care centres) to organise the care of elderly people. Yet,considering demographic trends – by 2060 one third of French citizens will be over 60,including almost 5 million people over 85 compared with 1.4 million in 2015 – thesemeasures are insufficient. In a spending cuts context the sustainability of the publicfinances is a major challenge. The overall cost of public expenditure on policies aimed atolder people represents EUR 21 billion – i.e. 1.05% of GDP. Different solutions have beenadopted in recent decades to face the current difficulties and anticipate the comingdemographic situation.• Since the 2010s greater emphasis has been placed on the role of informal carers.Home-based care, which is considered as the least-cost option, cannot developwithout an informal carer acting as the coordinator of the care arrangement set-up. Policy measures to support informal carers have been introduced with theobjective of facilitating investment in informal carers: care leave, respite solutions,training and education.• The priority given to home-based care also implies a restructuring of the care worksector, based on a complex price system and offering precarious work conditions.• Better coordination of the different schemes and actors, belonging to different –health or social care – policy sectors, involving different territorial levels and amultiplicity of professionals, is another solution which has been put forward atboth national and local levels. A variety of schemes have been created such asnetworks, pathways, coordination or integration schemes, with the objective offacilitating continuity of care for elderly people and rationalising the elderly carefield.• Prevention is also a pillar of recent policy proposals.All these orientations inform the main objectives of the 2015 Act on adapting society toan ageing population, which proposes a move away from the medico-social perspectiveon old age (focused on elderly people and dating back to the 1990s) towards a morecomprehensive approach, integrating all the different dimensions of ageing. The objectiveis not only to meet the needs of frail elderly people but also to anticipate their difficultiesand incapacities by developing prevention and by adapting society to ageing. The 2015Act also emphasises the role of local actors and the development of measures at theterritorial level.However, the measures above are considered insufficient to meet the needs of elderlypeople and of their families. The EUR 700 million annual budget to finance the differentmeasures is without doubt highly insufficient. In the medium term, given the predicteddemographic changes, the question of the financial operation of the LTC sector thereforeremains open. The possibility of creating a fifth social security branch, which first arose inthe 1990s, has come up again. The government, aware of the difficulties of creating anew user contribution, is putting a greater accent on prevention, thus anticipating andreducing the costs of dependency.
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Dates and versions

hal-02613339 , version 1 (20-05-2020)


  • HAL Id : hal-02613339 , version 1


Blanche Le Bihan. ESPN Thematic Report on Challenges in long-term care. France. [Technical Report] European Commission. European Social Policy Network (ESPN). 2018, 18p. ⟨hal-02613339⟩
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