Lifestyles and need for help after age 75, data compared in 1989 and 1999
En August 2003, the heatwave experienced by France put the spotlight on living conditions in old age. How could a climatic episode, even an exceptional one, have involved the death of nearly 15,000 people, most of them elderly (Hémon, Jougla, 2003) [1] ? Without delay, certain voices rushed to explain this human catastrophe by the failure of family solidarity, the triumph of individualism and the disengagement of families from their oldest, most fragile members [2]. . Thus, the quality of life of the elderly would have deteriorated significantly compared to that experienced by previous generations. So what is the reality of this development? What can we say about the living conditions of elderly people at the end of the 20th century in France? The spectrum of questions relating to this question is very broad. The way of living in old age refers to the story of a life, particularly in its marital and family aspect: the constitution of the family and its transformations, the place of the individual in the family group. It also refers to the obligations of each person towards each other, those of the individual and the family group but also to the social contract. Social policies, which have undergone in-depth changes since the middle of the 20th century , have largely contributed to improving the living conditions of the population. More than ever, young retirees have today reached, on average, a level of comfort never equaled, but what about the oldest members of French society?
2Based on the two quantitative surveys carried out ten years apart, we propose to compare the data observed for people aged 75 and over, living at home and in institutions in 1988/1989 and in 1998/1999 (see box). Firstly, it involves analyzing marital, family and residential situations, then confronting them with the need for help with daily activities and how to cope with them by relying on those around them. and/or on specialized services. Finally, the discussion will address the aspects on which the situation is expected to evolve, particularly in the context of the arrival of retirement of the large post-war generations, that is to say the children of the youngest respondents analyzed. .
The analytical framework: two quantitative surveys
The second, “Handicaps, incapacities, dependence” (HID), is a survey conducted in 1998/1999 (2nd longitudinal part in 2000/2001) whose project is to estimate the consequences of health problems on daily life and social welfare of disabled or dependent people, whatever their age and their situation with regard to aid systems or their place of residence. The sample, representative of the population of mainland France, allowed us to interview 9,448 people aged 75 and over (Goillot, Mormiche, 2003) [3] .
3The people we study have all reached their seventy-fifth birthday and were born in 1913 or before for the first survey of 1988/1989 and in 1923 or before for the second survey of 1998/1999 [4] . Without mentioning the increase in life expectancy, taking into account the years of birth, we can already anticipate a distortion of the structure of the population ten years later since in the 1989 sample, the people were all born before the First World War, while that of 1999 includes the birth deficit resulting from the loss of young men during the same war.
? Contrasting lifestyles
? Live older, together longer
4The major events that individuals experience reverberate throughout their lives and mark generations differently depending on the moment in the life cycle when they experience a particular episode. The consequences of the First World War are found three-quarters of a century later, both in age configuration, descent and marital status. The mechanical effect of the birth deficit, to which are added the gains in life expectancy, result in a massive increase between 1989 and 1999 in the weight of those aged 85 and over, which went from 25% to 30% of the population ( see table 1). The lack of young men old enough to start families left large numbers of women from the turn-of-the-century generations single and childless. A quarter to a fifth of these women born at the beginning of the 20th century did not have children while another quarter had only one child (Desplanques, 1993). Even in the 1920-1924 generations, in other words for women aged 75 to 79 in 1999, up to 15% of them did not have children and almost a fifth only had 'only one child. Beyond fertility, the fertility observed at the time of the survey only accounts for surviving children. However, one of the notable facts of the 20th century is the spectacular increase in life expectancy at birth, first at the youngest ages with the reduction in infant mortality, then at older ages.
5Mortality gains at older ages lead to living together much longer at the time of retirement and increasingly beyond the age of 75. Over the period observed, men even experienced slightly faster gains in life expectancy than women, thus allowing a slight catch-up [5] . Marital status clearly reflects this development, with a higher rate of married people in 1999 compared to 1989 (45% compared to 41%). Symmetrically, the greater longevity of life as a couple reduces the rate of widowed people, a situation which combines with the fact that the rate of never married people is lower in the youngest generations. From the point of view of marital and family isolation, that is to say for a person without a spouse or descendants, from the age of 85, there were more than one person in four isolated in 1989 (27%), compared to less than one in five ten years later (19%).
75 years and over in 1989 and 1999: characteristics by age group
? Independence at home, increasingly later in an institution
6Preconceived ideas die hard, in particular the idea that elderly people are mainly housed in specialized establishments. However, this place of life is far from being the most widespread, any more today than yesterday. At every age and whatever the marital and family situations, even for the most isolated, home remains the dominant mode of accommodation [6] . And, despite aging, this trend became even more accentuated between the two observation periods: among those aged 75 and over, the rate of people in collective accommodation was lower in 1999 than it was ten years earlier ( 9% versus 12%). The proportion of people living alone at home is unchanged before age 85 (around 40%), as are situations of cohabitation with children (around 10%). On the other hand, from the age of 85, we observe a crossed effect at both dates: the proportion of people living alone increased in 1999 compared to 1989, while intergenerational cohabitation decreased in equivalent proportions. Maintaining independence at home is a real concern. This well-known phenomenon, which sees residential isolation increase and cohabitation decrease, reflects the improvement in retirement conditions which allow older people to find housing and live more decently without depending on their children. This desire for independence of generations from one another has been attested since the 1960s in a major study carried out in Austria and from which we began to speak of "remote intimacy" to illustrate the feeling of elderly people towards -towards their children (Rosenmayr, Kockeis, 1963). Autonomy preserved on a daily basis is an essential element of the quality of life claimed by everyone. Faced with the decline in family cohabitation, sometimes erected as a symbol of a decline in solidarity, we must remember the increase in the rate of people living in single couples beyond the age of 75, including for the oldest among them. them: in 1999, nearly one in five people who have reached or exceeded the age of 85 lived alone at home with their spouse (19% compared to 13% in 1989).
7The structure of the sheltered population is changing to focus on old age: residents aged 85 and over represent almost two thirds of the sheltered people aged 75 and over in 1999 (65%), compared to less than half (43 %) ten years earlier (see table 2, p. 128). This result is the conjunction of several effects: the demographic deficit of the youngest and the gains in life expectancy without disability faster than the gains in average life expectancy which make it possible to delay the time of leaving home, but also a potential demand strongly constrained by supply. Overall, over the years, the number of residents has increased but, at a given age, the proportion of people living in communities has decreased, except at the highest ages. At the end of 2003, people aged 90 and over represented a third of the clientele of accommodation establishments for the elderly (EHPA) compared to a fifth at the end of 1994 (Dutheil, Roth, 2005). Between 1996 and 2001, the number of places in EHPA (in mainland France), relative to the population aged 75 and over, decreased by around 8%. In other words, the increase in the number of places was on average 1% per year between 1996 and 2002, while the population aged 75 and over grew by around 3% per year in mainland France (Mesrine, 2003). Over the years, the social accommodation vocation of the establishments changes: the hospice sections disappear, the institutions adapt to meet the criteria of medicalization [7] . Waiting lists are the expression of the deficit in creating places in the face of the increase and evolution of demand which concerns an older, more disabled population. Depending on the marital status of residents, widowhood affects 70% of the population accommodated on both dates but from the point of view of marital and family isolation, we observe that being single, without children, is less discriminatory in 1999 compared to 1989 [8] . This means that other individual characteristics are increasingly involved in residing in an establishment, compared to people living in their private home, and we are thinking in particular of the state of health.
8Taking inspiration from the mobility grid, known as “Colvez”, adapted according to the elements available in the two surveys, we constructed an activity restriction indicator in four groups, from the most disabled to the least disabled [9] . The most severely disabled people do not eat alone, or cannot move around the home. In a second group, there are people who cannot wash themselves and, in a third group, those who cannot go out alone. Finally, the last group is made up of so-called autonomous people, in the sense of this indicator, that is to say they have the capacity to leave their homes alone (even if they experience difficulties) and to do their own thing. toilet, without resorting to the help of a third person.
9The need for help indicator highlights that institutions must cope with an increasingly disabled population. In 1999, nearly a third of residents suffered from very severe disabilities to the point of being unable to eat alone or move around alone, compared to a quarter ten years earlier. This is also true for the second group which concerns 28% of people accommodated in 1999, compared to 21% in 1989. In establishments, the drop in the rate of independent people from 29% to 18% in ten years suggests the extent of the difficulties faced with the aging and disability of the accommodated population.
10On the other hand, at home, the indicator of need for help does not show any change: the rate of independent people (79%), versus that of people needing help, is equivalent for the two surveys. However, this stability should not mask the fact that the number of very elderly people has increased and that there are still more disabled people at home than in establishments. In 1989, 69% of non-autonomous people lived at home, compared to 71% in 1999, a situation that must be confronted with the evolution of the mode of care.
75 years and over in 1989 and 1999: characteristics according to place of life
? Need help, answers that evolve
11The 1980s and 1990s saw a profusion of reports, working groups and discussions on the management of dependency [10] . In 1989, home nursing services (SSIAD) and housekeepers were the main providers at home. There are around 38,000 places for nursing care and 400,000 beneficiaries of household help, 300,000 under social action from pension funds and 110,000 under departmental social assistance. The compensatory allowance for third parties (ACTP), which is a cash benefit, unequally benefits people over 60, with certain departments refusing to grant it, on the pretext that it is intended for “disabled adults” and not to “elderly people”. Moreover, it was only from 1992 that departmental social assistance statistics broke down ACTP beneficiaries according to age: 166,000 beneficiaries over 60 were then recorded. In 1994, twelve departments participated in the implementation of the experimental dependency benefit (Ped) before the specific dependency benefit (PSD) saw the light of day in 1997. For the first time, with the PSD, the law ratified a criterion of age which discriminates between “dependent elderly people aged 60 and over” and “disabled adults under 60”. The PSD, which must replace the compensatory allowance for third parties, is a social assistance benefit, allocated by the general council, paid at home and in establishments, according to the need for assistance calibrated according to the Aggir grid [ 11] . Subject to resource conditions and without maintenance obligations, unlike the ACTP, it is subject to recovery from inheritance. Just before the implementation of the PSD, the ACTP was paid in 1996 to more than 200,000 people aged 60 and over. As of 1999, the ACTP only had 60,000 beneficiaries while PSD coverage did not reach 120,000 people [12] . Over the period, the number of beneficiaries of home nursing care reached 56,000 in 1996 while that of household help tends to decrease, particularly in terms of social assistance: household help provided by pension funds represents 72% beneficiaries in 1989 and 80% in 1996.
? Lay help and professional services
12Individual aging becomes a concern when the help of a third person is required for daily activities. What respective commitments from those around them and the community can older people count on? As soon as the community mobilizes specialized services, either on the basis of home help services, or through the staff of establishments for the people who reside there, we consider the existence of professional services. In this sense, these are commercial, paid services, the responsibility of the person or their entourage, in which the public community possibly participates through operating subsidies, equipment loans, the provision of personnel. , financing of hours. With regard to these professional services, lay help corresponds to informal, non-market services, provided by voluntary, unpaid people, who are generally part of the close entourage of the person being helped [13] .
13From this point of view, market or non-market services, whether professional or lay, have, proportionately, slightly fewer beneficiaries in 1999 than ten years earlier (see Table 3, p. 132). In 1989, 40% of people aged 75 and over, at home or in an institution, benefited from professional services, compared to 37% ten years later. But the difference mainly plays out on the side of non-market services for which there were almost half of the beneficiaries in 1989, compared to barely more than a third in 1999. The concomitant decrease in the two forms of aid concerns the youngest and autonomous. For each modality, age or sex, marital or family situation, help from those around them has decreased, except in situations of activity restriction for which the level of lay help remains strictly at the same level. : 60% of people helped in 1999, as in 1989. Moreover, for disabled people, the intervention rate of professional services increased slightly, from 66% to 71%. The most unfavorable development, from the point of view of secular help, first affects people in situations of marital and family isolation, particularly single people: from 51% in 1989, the rate of secular help is 17% in 1999. To what extent can this observation be the consequence of a breakdown in social ties and the population's disinterest in their elderly isolated neighbors, or that of a double generation effect, the youngest being in better health at the same age and having gained autonomy compared to older generations? Thus, for example, we observe a clear decline in the rate of single men housed in institutions: 82% lived in ordinary households in 1999 compared to only 62% ten years earlier.
14In all cases, the data show an adaptation of both forms of market and non-market aid to the changing needs of individuals, with a refocusing on those who need it most. Professional services seem to concentrate their intervention on potentially the most isolated people: the rate of assistance has increased for those aged 85 and over, in particular women, widowers and more generally for people without a spouse. However, to the extent that lay help is not collected in establishments, it is appropriate to strictly compare the same intervention situations at home, between professional services and lay help.
75 years and over in 1989 and 1999: professional services and lay help
? Need help and configure home services
15In 1999 as in 1989, 80% of people aged 75 and over at home who are faced with a loss of autonomy (groups 1 to 3 of the indicator) mobilized lay help for daily activities (see table 4 ). Over the same period, professional services progressed: 52% beneficiaries in 1989, 60% in 1999. As we have seen, between the two surveys, the diffusion of professional services is concentrated on the most isolated people (without a spouse, without children), the oldest (after 85 years), the most disabled (groups 1 and 2 of indicator). The family situation is particularly illuminating about the mode of intervention. In 1999, among people without children, 70% mobilized those around them and 88% professional help; ten years earlier, these figures were 88% and 57% respectively. As for people who can “potentially” count on their children, 86% benefited from secular help in 1999, compared to 81% in 1989 and, for professional help, there were 56% beneficiaries in 1999, compared to 51%. in 1989. These results are already giving rise to reflection on the mobilization of loved ones: in the presence of children, the increase in professional intervention does not reduce that of those around them; when there are no children, the community is more mobilized, the surroundings less solicited. In this particular situation, the underlying question refers to the hypothesis of a substitution of public and private aid. However, in the absence of longitudinal data, there is nothing to confirm or refute this interpretation. However, the method of organizing aid, between professionals and volunteers, should be able to provide additional insight.
Need for help at home: professional services and lay help
16The confrontation of professional or lay intervention cannot free itself from the mode of organization specific to situations where the two forms of market and non-market services combine, situations of exclusivity when the professionals or the entourage are alone to intervene. From one survey to another, there is always a minority of people (5%) who, despite a clear need for help, declare that they do not receive any assistance, neither professional nor lay (see table 5). . It is quite significant to observe that men are more concerned, as are people living with a spouse. These characteristics suggest that a caregiver is potentially available, precisely in the person of the spouse. Help is perceived and reported differently depending on the couple and the sex of the respondent. In certain cases, the man may have to mention – or omit – the help of his partner who usually “assumes” all the daily tasks. In the same way, in 1989 as in 1999, there were 10% of people who could only count on the intervention of professional services to help them on a daily basis [14] . In this case, men are less frequently found in this configuration of exclusively professional help. Rather than the ability of men to mobilize those around them, this could reflect the propensity of those around them to mobilize for men left alone. In all cases, these rates of exclusively professional or lay help, identical to both periods, confirm the inescapable nature of lay help. They also confirm that market services alone are rarely sufficient to meet the need for help. In all situations where, without necessarily being intensive, the help may need to be renewed several times a day, it is really by creating a synergy between the two forms of intervention that the need for help can be covered. Between the two observation periods, the diffusion of collective services in association with lay help is increasing. In 1999, almost half of the people needing home help benefited from the services of professionals and those around them: 48% compared to 40% ten years earlier. By symmetry, this also means that the situations where those around them take responsibility alone are, proportionally, rather decreasing, from 43% in 1989 to 35% in 1999.
Need for help at home: absence of support or combination of professional services and lay help
17Women have a very special place in the organization of secular aid. When they need to be helped, men are almost exclusively helped by a woman, almost 90% in 1999 and, for women, the helper is also a woman in 60% of situations. However, beyond this well-known dimension of the omnipresence of women in the production of aid, it is more interesting to observe the clear progression of aid provided by men to women. In 1989, less than one in four women could count on the support of a man, and in 1999, four in ten. In ten years, the role and place of men in the provision of care have changed, particularly on the side of spouses and to a lesser extent on the side of sons. Faced with activity restrictions, the overall intervention rate of spouses was twice as high in 1999 compared to 1989: 12% compared to 25% (see table 6, p. 136). It is first of all women, and more precisely daughters or daughters-in-law, who are truly concerned by these developments in the direction of disengagement. In half of the situations, it was a daughter, sometimes a daughter-in-law, who provided help in 1989, the rate reaching 60% for only people who actually had children. Ten years later, these rates increased to 37% and 43% respectively. Between the spouse and the children who provide most of the lay help at home, ten years were enough to see a reversal in the rates for these two types of caregivers. In other words, within couples, help from a spouse, which was less frequent (37%) than that from a child (45%) during the first survey, became more frequent in 1999: 72% of men or women provide help to their spouse who needs help, while help from children is documented in 33% of these situations.
Need help at home: family caregivers, spouse, child
18These results on the involvement of spouses which would allow the disengagement of children were not necessarily expected. The hypothesis of a geographical distance between generations which would limit the availability of children is not borne out by the data: in 1989, 60% of people had a child living nearby (the same municipality or the same canton); in 1999, 60% had a child living nearby (the same town or its surroundings). In reality, a range of factors contribute to the emergence of the evolution identified: the less availability of children due to their more frequent presence on the labor market, the increase in the length of life as a couple, the autonomy family generations and the desire for independence claimed by the oldest to meet their needs. Indeed, it should be noted that this new role of the spouse does not only result from the longer survival of couples but from a real change within older couples, who are more autonomous in relation to their descendants.
? Discussion
19Comparing lifestyles after age 75 and ways of responding to the need for help at the end of the 20th century in France allows us to identify certain developments over ten years. Mirroring the introductory paragraph recalling the heatwave of the summer of 2003, the data do not confirm a decline in social bonds necessarily leading the oldest members of our society to live in solitude and isolation or in dehumanized establishments. We are not living in retirement homes more and more often, the increase in the number of places offered is far below the increase in the number of very elderly people. Entry into an establishment is happening later and later, almost exclusively for health reasons, in place where previously collective structures were intended to accommodate the most socially deprived and without family ties. Furthermore, the data show a decline in isolation linked to the decline in single people and people without children and the increase in the duration of companionship as a couple. Finally, lay help for people with home activity restrictions does not appear to be in decline. The spouse becomes much more visible in the organization of help, and the daughters, while remaining the strong link in home help, are called upon a little less. The results also confirm the interdependence of the two forms of intervention, professional and lay. The strengthening of professional services is only made possible by the existence of resource people near the person being helped: the rate of professional intervention alone has not varied over the period, unlike the accumulation of aid which has increased.
20Following these results, many questions arise about what future developments could be. With a majority of people relying on their close entourage at home and a minority of people housed in establishments, what can we observe both in terms of the commitments of the community and those around them in the face of aging and disability?
21Since the 1989 and 1999 surveys, the personalized autonomy allowance (Apa) implemented on January 1, 2002 , has replaced the specific dependency benefit (PSD) and part of the managed household help benefits by pension funds as part of their social action [15] . Less restrictive than the PSD, the Apa, which is not subject to recovery on inheritance, nor resource conditions [16] , is allocated to many more beneficiaries: 971,000 people as of June 30, 2006, or around 60% at home , 40% in establishments. At home, by relying on a resource person from the entourage who becomes the referent in the organization of help, the Apa system more or less implicitly endorses the preference for professionals to intervene in a context where the environment is already mobilized. In establishments, the introduction of a dependency rate that can be financed by the Apa does not resolve the difficult equation between the level of personal resources of residents and that of the amount of accommodation. As part of social assistance, the departments can provide accommodation assistance but this is accompanied by recovery from inheritance and the maintenance obligation. However, we observe today that the use of compulsory maintenance is mainly implemented to cover the costs of accommodation in establishments. Most often, families spontaneously organize themselves to provide financial support for elderly parents who cannot do so alone, initially at home. Then, when the situation becomes too difficult, particularly in the face of intellectual deterioration, they take care of the accommodation costs. But how far will families go?
22In the immediate future, as long as we are in the presence of the parents of the large cohorts born after 1945, the situation is still relatively favorable. After a youth marked by deprivation, these generations experienced a significant improvement in the conditions of access to care and their professional lives took place mainly in the favorable context of the “thirty glorious years”. With a high marriage rate, numerous descendants, and low divorce rates, these are truly the first generations to benefit from full careers and to be able to approach their retirement with honorable pension levels. This is true at least for men, because women have not yet entered the labor market on a massive and sustained basis. However, gains in life expectancy should allow more people to enjoy life together for longer. In this first period, on the very near horizon, the large siblings of baby boomers increase the potential for help, the effectiveness depending on their propensity to reproduce what previous generations possibly did for their own parents. However, a notable difference should be taken into account: if the disability appears later, people today live significantly longer and, consequently, help for an elderly parent could last much longer than for previous generations.
23A quick and necessarily reductive portrait, it is intended to highlight the differences that could arise for subsequent generations, when the first generations of the baby boom arrive at the threshold of old age around 2020 (or even 2030). The main difference, with their parents' generation, is probably due to the sharp reduction in the number of potential caregivers in the form of spouses and children. Initiators of new lifestyles, the cohorts born after 1945 had fewer children, experienced marital breakdowns more often and were able to experience periods of unemployment and, above all, more difficult, more chaotic ends to their careers than previous generations. Under these conditions, will baby boomers have to experience the effects of more frequent marital isolation, faced with a smaller number of descendants, themselves confronted with an ancestry potentially amplified by marital recompositions? By 2040, based solely on demographic projections, the work of the Drees shows the existence of a growing gap between the evolution of the number of people aged 50 to 79 in a potential situation of assistance (children and spouses) and the number of elderly people potentially in need of help (Bontout et al. , 2002).
24We can see how the temptation to limit collective aid to older people in order to rely on family resources would be formidable. Faced with the interests of age groups which would necessarily diverge, the idea of a generational war reappears very regularly. Obviously, the younger generations have the greatest difficulty in asserting their skills on the job market and the debate is based on this generational divide between young adults and their elders who concentrate economic resources and political powers. The reasoning is truly worrying, because it directly refers to the risk of seeing the mechanisms of collective solidarity organized by social protection, retirement and care, and which constituted an alternative to the old systems of family obligation, called into question. Because finally, if aid and services within families remain active and if elderly parents are beneficiaries of time transfers, the capacities and needs for aid remain highly unequal between families (Renaut, 2003). As much as the role of social protection, and that of pensions in particular, cannot be to ensure intergenerational redistribution in families, its role is to ensure the independence of individuals and generations. This is an unavoidable fact, transcending age groups, and widely expressed by the desire for independence of parents vis-à-vis their children, as well as adult children vis-à-vis their elderly parents. Rather than anticipating a hypothetical generational war, and beyond developments in the social protection system, we should undoubtedly, all and throughout life, achieve better consideration of our environment. Regardless of age issues, it is the dynamic interaction with other environmental factors that ensures the independence of the individual or, on the contrary, limits his autonomy and his ability to cope with the activities of daily life without external assistance. . From this point of view, the question of care goes far beyond the field of disability in old age to reach that of housing, city, transport or environmental policy.
25In any case, between now and 2009, we can hope to repeat this comparison experience and compare developments on the basis of a new “disability and health” survey. We will then see what happens to the evolution of lifestyles between home and institution, the organization of professional and secular help, the involvement of the family and life as a couple. .
Notes
- [1]
The excess mortality observed from the age of 45 is significant, increasing with age: + 2% in subjects aged 45 to 54, + 40% in subjects aged 55 to 74, + 70% in subjects aged 75. at 94 years and over 120% in subjects aged 95 and over.
- [2]
See, for example, the press release from the Secretary of State for the Elderly, Hubert Falco, to the Council of Ministers of August 21, 2003: “The consequences of the heatwave on the care of the elderly”: “The deterioration of social ties , changing lifestyles are, in large part, the cause of a rise in individualism and loneliness among elderly people. These findings reveal difficulties linked to a profound evolution in our society. The heatwave which hit our country very heavily and cost the lives of several thousand elderly people occurred in this context. » www. the elderly. govt. fr/ point_presse/ c_presse/ 030821. htm.
- [3]
It is possible to refer to the site which hosts the HID surveys: http://rfr-handicap.inserm.fr.
- [4]
For the fluency of reading, thereafter, we refer to 1989 for 1988/1989 and 1999 for 1998/1999.
- [5]
For men, life expectancy at birth increased from 72.8 years in 1990 to 75 years in 1999, and at age 60 it increased from 19 years in 1990 to 20.2 years in 1999; for women, we observe respectively 81 years and 82.5 years at birth, for 24.2 years and 25.3 years, at age 60.
- [6]
Housing in hostels which are considered by INSEE to be ordinary housing was aggregated to the home for the two observation periods, 1989 and 1999.
- [7]
The eighties were marked by this idea that there was a strong mismatch between people and structures; in reality, data on “The price of dependency” showed as early as 1989 that the most disabled people were well accommodated in the most medicalized care structures, long stays now renamed long-term care units.
- [8]
In 1999, residents of institutions entered at an average age of 78.5 for those without children, compared to 82.7 for others (Renaut, 2001).
- [9]
The constraint of having perfectly comparable questions at the two dates limits the comparison of disability to the physical aspect of inabilities; behavioral disorders and spatio-temporal disorientation which pose the most acute treatment problems are not treated here.
- [10]
Reports Théo Braun in 1986, Laroque in 1989, Boulard in 1991, Shopflin in 1989 and several legislative proposals between 1990 and 1996. See in particular the work of simulations and projections of a dependency allowance based on the results of the survey 1989 (Tartarin, Bouget, 1994).
- [11]
The “Aggir” grid (Autonomy gerontology iso-resource groups) is established as the national dependency assessment grid with the law of January 24, 1997 establishing the PSD; 10 axes make up the Aggir grid: consistency, orientation, toileting, clothing, food, elimination, transfer, movement inside, movement outside, communication. In reality, outside travel and communication are not included in the calculation of the algorithm published in Official Journal No. 101 of April 30, 1997 (decree No. 97-427).
- [12]
At its peak in 2001, the PSD covered up to 136,000 people, before declining rapidly following the application of the personalized autonomy allowance in 2002 (see below ). In 2004, the ACTP was paid to less than 20,000 people, the PSD had almost disappeared, household assistance from pension funds was around 250,000 people, that from the departments, a little over 30,000 and the SSIADs had exceeded the threshold of 80,000 places.
- [13]
Comparing the two forms of service neglects lay help for residents in establishments because the information collected in the 1989 survey was not collected in the 1999 survey. In other words, we consider that all residents are beneficiaries of professional services, that only non-residents can benefit from non-professional help, or that an “autonomous” person at home can benefit from professional help for household maintenance.
- [14]
When professionals, or those around them, intervene alone, the rates can be deduced from tables 4 (p.133) and 5 (p.135).
- [15]
Law No. 2001-647 of July 20, 2001. Entry into force in January 2002.
- [16]
However, a financial contribution remains the responsibility of the beneficiaries when their resources exceed a certain amount.
No comments:
Post a Comment