Informal support for dependent older persons in France: understanding individual and family caregiving behaviors in order to adapt the welfare system

This support, estimated at a monetary value of between 7 and 11 billion euros, affects public health and labor market participation and impacts on the balance between public and family solidarity. And in the future, informal support will be affected by demographic and socioeconomic changes specific to families. INED researcher Roméo Fontaine has studied the economic impact of informal support, analyzed caregiving behaviors, and clarified the position of family support in the French welfare system.

Informal support is the term used for non-professional assistance—i.e., assistance from a more or less distant family member or member of the person’s close social circle—provided to older people who can no longer carry out certain daily activities. All statistical studies conducted in France over the last ten years show that informal help of this sort is more frequent, more intensive in terms of hours, and more extensive in terms of tasks performed than professional support. Of the 700,000 persons in France aged 60 or over, living at home, and dependent to some degree, 80% receive informal support while 50% receive professional assistance (Soullier and Weber 2011). The median time spent on informal support is one hour and 40 minutes a day, as against 35 minutes a day for formal assistance (ibid.). And on average, dependent older persons receive informal assistance in four daily activities—including washing-bathing, meal preparation, housework, shopping, administrative paperwork, and budget management—as against two from professional caregivers (INSEE’s 2008 Disability-health survey, Households section). Informal assistance is therefore an essential resource in French welfare policies targeting older dependent persons.

In the near future, however, demographic and socioeconomic developments will upset the status quo for this kind of help. On the one hand, population aging will cause a rise in the number of dependent older persons. On the other, demographic and socioeconomic trends specific to families (less stable couples having fewer children, women’s increasing participation in the labor market, children living at greater geographical distances from their parents) suggest that family support will not be able to continue as it has been. These trends cause considerable concern, as they threaten the equilibrium of the French welfare protection system over the middle and long term.

Family members account for more than 80% of informal caregivers (Caregiving for dependent persons and its impact on quality of life among older persons and their caregivers, Chapter 3 of a report by the French High Council for families, childhood and old age, adopted December 1, 2017). Family caregiving behaviors exhibit two characteristics. First, children’s involvement in caring for a parent varies by whether or not that parent has a reliable partner: the children partially compensate for the absence of such a partner. Second, the social norm calling for children to care for dependent parents applies to the entire sibling group. As average sibling group size is falling in most European countries, a fewer number of offspring will be called upon more often to provide care.

Only exceptionally does informal support entail financial transfers or monetary exchange, and yet France’s Economic analysis council estimates its value at between 7 and 11 billion euros. Informal support does cost family caregivers: eligibility for fewer jobs, loss of occupational opportunities, salary cuts, adverse health effects, etc. Deciding not to work or to work fewer hours is costly not only for the individual caregiver but for society at large: smaller social contributions, less labor market flexibility among caregivers, reduced skill acquisition, deeper labor market-related gender inequalities, earlier retirement.

Informal support is also costly for companies. A range of studies (see in particular those by the Employers for Carers group) suggest that the cost entailed in assisting working carers (granting flexible hours, financial aid, etc.) would be much lower for companies (in terms of poor employee health, lower productivity, etc.) than taking into account their specific needs.

Future demographic and socioeconomic developments are likely to call into question the current balance between individual, family, and collective or public responsibility in caring for dependent persons. Greater public support for home care could reduce or delay entry into residential care facilities while relieving informal caregivers to some extent. Lesser family involvement would not mean family disengagement; family members could concentrate on the most personal care, and heavily engaged members would be most impacted by public support. But it is also important to note that having greater informal caregiving resources diminishes individuals’ propensity to insure themselves against the later risk of dependency.

Source: Roméo Fontaine, “Approche économique de l’aide informelle, Analyse des comportements de prise en charge et de la place du soutien familial dans notre système de protection sociale” [Economic Analysis of Informal Care Behaviours and the Role of Family Support in our (French) Welfare System], Dialogue Familles et Couples 216, 2017(2), pp. 67-80

Contact: Roméo Fontaine

Online: September 2018