Evaluating the Evolution of the Ways of Taking Care of the Elderly: An Approach Based on the Trajectories of the Territories

Dependency, or the management of the loss of autonomy of the elderly is today a major issue for the public policies in Western countries and in particular European countries. In France, one of the main trends is home care rather than institutional care. However, beyond this national trend, it can be observed that at the subnational levels, forms of support for the elderly are very heterogeneous (public, associative, family). In this paper, we try to understand the explanatory factors of these territorial disparities.

This paper argues that the history and trajectories of local environments, taking into account both population structures and the socio-economic contexts of the territories, help to structure the supply of services and explain current disparities in the forms of help (family/professional/ mixed).

To demonstrate this, this paper is based on varied material. First of all, we will analyze a series of contextual data from the large databases available in order to characterize the territories. Then, we propose a monographic analysis of 4 contrasting territories (in two French departments) chosen because can be assigned to different types of public policies. This study is based on interviews with the different actors of public policies (about ten in each territory) in relation to the elderly people losing their autonomy, the strengths and weaknesses of the provisions put in place, their capacity to meet the needs of the elderly and more generally on their flexibility, their logics of action and their capacity for innovation. They will help to trace the decision-making processes at the origin of policies or specific instruments linked or not with local demographic and socio-economic changes.