Aides aux personnes âgées dépendantes : La famille intervient plus que les professionnels (version anglaise)

Pascale Breuil-Genier

Description

Une personne de plus de 65 ans sur dix vivant en domicile ordinaire ne peut sortir sans aide. À incapacité comparable, les aides dont bénéficient les personnes dépendantes restent très inégales : si 55 % des personnes sévèrement dépendantes reçoivent plus de trois heures d'aide par jour, 20 % en reçoivent moins d'une heure. Certes, cette variabilité traduit, en partie, la difficile quantification des aides informelles fournies par les proches. Elle montre, cependant, qu'il serait délicat d'établir un barème associant un volume d'aide à un niveau de dépendance. La durée d'aide totale d'aide augmente avec la dépendance et l'isolement, mais ne semble pas liée au niveau d'éducation ou au revenu. Cependant, les facteurs économiques influencent fortement le prix horaire moyen et donc la dépense totale : les personnes les plus aisées ne bénéficient pas, à autres caractéristiques comparables, d'aides plus importantes mais les paient plus cher. L'aide informelle reste beaucoup plus développée que l'aide professionnelle : à tous niveaux de dépendance, la moitié des personnes âgées ne reçoit que ce type d'aide. Aux niveaux de dépendance modérée, le temps d'aide informelle représente 2 à 3 fois celui d'aide professionnelle. L'isolement, le niveau d'éducation et une résidence dans l'Ouest, le Centre-Ouest ou le Bassin parisien favorisent le recours à l'aide formelle. Le temps d'aide formelle reçu est alors d'autant plus important que son prix horaire moyen est faible. Il est également plus élevé lorsque les dépenses associées ouvrent droit à des réductions d'impôts. Toutefois, les volumes d'aides formelle et informelle sont trop variables d'une personne dépendante à l'autre, pour que l'on puisse déterminer dans quelle mesure ces deux types d'aides peuvent se substituer.

Sujets

• INSEE
• Santé
• Politique
• Vieillesse
• Famille

Informations

• Publié par: insee
• Nombre de lectures: 48
• Langue: English

Extrait

Caring for the Dependent
Elderly: More Informal
than Formal*
One in ten people over 65 years old and living at home cannot get out without
help. For comparable disability levels, there are still major imbalances in carePascale
given to dependent individuals. Whereas 55% of highly dependent individualsBreuil Genier**
receive more than three hours of care per day, 20% receive less than one hour.
Although this disparity partially reflects the problems with quantifying informal
care from the family, it also shows that it would be hard to establish a scale
associating volumes of care with levels of dependency.
Total hours of care increase with dependency and isolation, but do not appear to
be linked to the level of education or income. However, economic factors strongly
influence the average price per hour and thus total expenditure. Other
characteristics being comparable, the wealthiest individuals do not receive more
care, but pay more for it.
Informal care is still a lot more developed than formal care. For all levels of
dependency, half of the elderly only receive informal care. For moderate levels of, two to three times more informal care than formal care is received in
terms of time. Isolation, level of education and residence in the West, Central West
and the Paris basin favour receiving formal care. The lower the average hourly
price of formal care, the longer the hours received. Hours of care also lengthen
when the associated outlays are tax deductible. Nevertheless, formal and informal
care volumes vary too much from one dependent person to the next to be able to
determine the extent to which these two types of care are substitutable.
* Originally published as
“Aides aux personnes
âgées dépendantes : la
famille intervient plus
que les professionnels,”
Économie et Statistique,
no. 316 317, 1998. n France, there are still fairly few statistics grids have been developed (see box 1). Above
** Pascale Breuil Genier I available on the dependency of senior and beyond the problem of defining a situationis head of the Health
Economics Bureau in citizens (Join Lambert et al , 1997). of dependency is the question of how to
the Social Security Dependency and the needs it creates are hard to respond to it. There is no easy standard way of
Department.
quantify. First of all, the very notion of dealing with it. The attractive idea of a standard
The names and dates in
dependency is quite vague. Dependency, i.e. type of care for each level of dependency is
brackets refer to the
the need for assistance from a third person, is borne out neither by Joël and a Martin’sreferences at the end of
the article. subjective notion for which many evaluationsociological analyses (1996) nor by the
INSEE Studies, no. 39, September 1999 1Box 1
DEFINITION AND MEASUREMENT
OF DEPENDENCY
Objective and subjective definitions This research posits that two main elements can
be used to identify disadvantaged individuals:
The international classification of impairments, being homebound and dependency on a third party
disabilities and handicaps developed by the World to wash and dress. The 8,350,000 individuals over
Health Organisation helps clarify the concepts 65 years old living at home (94%) and in
generally associated with the notion of institutions (6%) are divided into four categories
dependency (CTNERHI, 1988): using the Colvez classification: bedridden and
chairridden (230,000) (level 1), not bed or
– Impairment denotes any loss or abnormality of a chairridden but helped to wash and dress
psychological, physiological or anatomical struc- (320,000) (level 2), neither bed/chairridden nor
ture or function. It is evaluated with reference to a helped to wash and dress but helped to get out of
biomedical norm and cannot be perceived by the the house (940,000) (level 3), independent (level
impaired individual. 4) (Kerjosse and Lebeaupin, 1993). Three
additional categories (bearings in time and space,
– Disability corresponds to a restriction or lack (re behaviour, and help with bearings and behaviour)
sulting from an impairment) of ability to perform are used to refine this classification by dividing
any activity in the manner or within the range con each of the first four categories into two
sidered normal for a human being such as getting sub categories according to level of psychological
up, getting around, etc. The important factor here dependency.
is not the deviation from an ideal (and theoretical)
state, but solely the objective manifestations of The Isoresources Group Gerontological
this deviation. Independence grid (AGGIR or GIR) is designed to
evaluate the work load associated with the
– Handicap denotes a disadvantage for a given indi- dependency of seniors living at home and in
vidual, resulting from an impairment or disability, institutions. It is based on ten discriminating
that limits or prevents the fulfillment of a role that elements concerning coherence, bearings,
is normal for that individual (according to the cultu washing the top and bottom half of the body,
ral norms of their environment). For example, dressing (top, middle and bottom), eating, urinary
individuals who are relatively homebound (disabili and faecal elimination, transfers, getting around
ty) could consequently find their social network indoors and outdoors, and communicating over
reduced (handicap). distances. Depending on what the senior does,
does not do or partially does in these ten areas, he
Dependency in the strict sense of the term is or she is classed by a complex algorithm in one of
therefore defined as the need for a third party in the six isoresources groups representative of a
activities of daily living. Along with the diversity of mobilisation of caregiver means. The six groups
the data used, the many different concepts have obtained can be described in outline as follows.
produced a huge number of measurement scales. Group 1 denotes individuals who have lost their
Users each need a measurement perfectly suited mental, bodily, motor and social independence and
to the use that they want to make of it, even if thisabsolutely need caregivers to be present all the
undermines the comparability of the results. time. Group 2 is made up mainly of “lucid invalids”
and the “ambulant demented”. Group 3 generally
Assessing the needs of the elderly covers individuals who still have their mental
independence and partially their motor
The purpose of the dependency measurement independence, but who need help with their bodily
obtained from Kuntzmann’s score is to assess the independence several times a day. Group 4 covers
human resources requirements of the individuals individuals who need to be helped or stimulated to
studied. Nine indicators describe five fields (human wash and dress and cannot get up alone but, once
resources requirements, getting around, up, can get around their dwelling. It also covers
continence, psychological state and care needs). individuals who have no motor problems, but need
These are used to ascribe a dependency score of help for bodily activities including eating. The
0 to 10. This method was applied to the 1987 1988individuals in group 5 need ad hoc care (usually
CREDES Seniors in Institutions survey (Mizrahi home help) and those in group 6 are considered to
and Sermet, 1989). be independent (Vetel, 1994a and b).
The French Ministry of Social Affairs’ Department The definitions used by private insurers vary from
of Statistics, Studies and Information Systems one contract to the next. Most of the contracts
(SESI) also has a dependency evaluation grid require the permanent impo ssibility of
(Kerjosse, 1992). Five categories of ph ysical independently carrying out one of the activities of
dependency (eating, washing, dre ssing, daily living (washing, getting around, eating and
incontinence and getting around) are used to class dressing). Some contracts are also based on
the elderly into four groups. INSERM research social security payments (lump sum payments for
helps define these physical dependency groups. home or institutional care). Others include the
2 INSEE Studies, no. 39, September 1999statistical analyses presented in this article.
Box 1 (end) Care needs are highly diverse (care, help with
activities of daily living, special
accommodation, moral support, supervision,
longest length of independence in the day or etc.). A number of combinations of care could
the cumulative length of care over 24 hours. satisfy them. The optimal care plan would
The 1996 Household Living Conditions panel
therefore seem to be closely linked to the
survey on local services included a variable
preferences of the senior citizen and his or hermeasuring the maximum length of time that the
person could stay alone. This question was family. Lastly, the usual statistical surveys are
used in particular to identify psychological not really suited to collecting data on
dependency. dependency and consequently do not provide
much information on this subject. On the one
Estimating the state of health
hand, dependency only affects a small
The CREDES eight class invalidity indicator proportion of the elderly population (Kerjosse
provides objective information on the population and Lebeaupin, 1993). This means using a huge
studied. The consequences in terms of the