The Actors in the Reform of Provisions for the Elderly in France: Difficulties to Generalise a Global Service.

of provisions and benefits, on a categorical approach of people and on a sectorial approach of social interventions (poverty, unemployment, early childhood, old age, etc.). From the 1980s, decentralisation laws have strengthened their territorial implantation, in the name of proximity, while at the same time leading to a proliferation of scales of social action and their monitoring, generating tension, duplication and competition on both horizontal and vertical levels.

Discourses on and public measures to support dependent elderly now emphasize the need for a better coordination between care and cure sectors in supporting dependent people. This is particularly the case of the experimental “care and cure at home multi-service” (Spasad), included in the Law on the adaptation of society to aging (2014), which promotes its consolidation and generalization with a constant budget. The purpose of this paper is to analyse how this local initiative, which is today valued on the national level, is put in place in the territories and to identify the favourable factors and obstacles to this sectorial rapprochement. Indeed, there is a delay in the implementation of these provisions, termed as global support, which illustrate – this is the hypothesis that we will test – the difficulties in strengthening coordination between those fields (family caregivers, social/care professionals and health professionals) unequally present on territories, but also between institutional actors at different territorial levels (regional health agencies, pension funds for health and work who finance and organise various services) whose objective may be distinct.

Our interviews focus on the main institutional actors working at different territorial levels in the field of social and health (professional associations, territorial and national authorities, unions) and will allow us to think about the dissemination conditions of these social innovations.