Changes in the family resources and environment of France’s old people have slowed a rise in the use of institutional long-term care
Projections for France’s needs in the way of institutional long-term care (LTC) facilities for older people are based primarily on the hypothesis that the probability of using LTC by age and sex will remain stable. Degree or type of dependency may also be considered. However, the recent increase in the proportion of very old people in the French population has not led to as great an increase in institutional LTC as was anticipated on the basis of those criteria. From 2008 to 2015, the proportion of persons aged 75 or over living in LTCs institution rose very moderately, from 8.4% to 9.2%. Drawing on two surveys—Handicap-Santé (2008-2009) and CARE or Capacités, Aides, et Ressources des Séniors (2015-1016)—the researchers identified additional characteristics that explain the use of LTC facilities among people of those ages in metropolitan France, and assessed the mechanisms driving this development over the period.
What characteristics are linked to older persons remaining at home rather than using LTC?
To better understand what explains the use of LTC institutions in France (called EHPA for Établissement d’Hébergement pour Personnes Âgées), and given the literature on the subject, the researchers considered not just older person’s age and degree or type of dependency but also their socioeconomic status and their family environment. Introducing these characteristics into the equation explains the moderate rise in recourse to LTC over the period.
First, the analyses confirm the impact of demographic aging (effect of the age composition of the population) and a rise in certain types of dependency, which together account for the rising trend of LTC institutionalization. The study then shows that the higher educational level found for the oldest people in France increased LTC use: people with relatively high educational attainment are slightly more likely to turn to LTC than those with intermediate educational attainment. What has worked to offset the factors driving LTC use higher is family structure and environment: an increase in the proportion of older people in couples or who have a least one child helps reduce the probability of their living in an LTC institution. In addition to the effects of social network, these family characteristics indirectly affect the probability of a senior continuing to live at home because they represent potential sources of in-home help for older persons who can no longer carry out basic daily activities.
Does propensity to keep older persons at home change with characteristics kept equal?
Another interesting conclusion: the analysis allows for measuring whether the propensity to institutionalize seniors associated with each family characteristic changed over the period. For example, did living with a spouse or intimate partner increase the probability of remaining and being assisted at home in 2015 to the same degree as in 2010? Overall during the period, no real change was found in the propensities to use institutional LTC associated with the factors studied.
The mechanisms of change over the period were induced by changes in the French population structure. These findings suggest the relevance of considering family and socioeconomic resources as well as age and dependency to fully apprehend developments in institutional LTC use. It is useful to keep track of both structural change in these noteworthy characteristics and change linked to potential future changes in the propensities to remain at home associated with those characteristics.
Source: Amélie Carrère, Emmanuelle Cambois and Romain Fontaine, 2023, Institutional Long-Term Care Use in France (2008-2015): The Role of Family Resources [Fr]. Economie et Statistique/Economics and Statistics 538: 31–48.
Contact: Amélie Carrère, Emmanuelle Cambois and Roméo Fontaine
Online: December 2023