At the Social and Cure Border : Redefining the Balance of Power in the Field of Elderly Care

The field of dependent elderly care has changed over the last 20 years in France around a double direction. On the one hand, at home professional care has been structured and professionalized (extension of the scope of legal competences, professionalisation through training) but faces financing problems. On the other hand, the public authorities are pushing for a rapprochement between the cure and social sectors in order to promote a comprehensive approach for dependent elderly care. This is particularly the case with the setting up of a system on "care pathways for the elderly at risk of loss of autonomy", which aims to improve coordination between these two sectors and reinforces the role of medical doctors.

In this paper, we examine the effects of these changes on the division of work in the system of care/cure for elderly. We will show that if the role of the health sector is strengthened, they are struggling to engage in a logic of cooperation with social actors and remain driven by a medical logic. At the same time, at home professional carers are obliged to carry out activities outside their field of competence in the area of health care. This shift of tasks may be interpreted as sign of the difficulty in having their profession recognized and the predominance of the medical sector over the social sector. These transformations are a source of tension between social and health actors, which show the difficulty of agreeing with each other on the place of care and cure in the relationship of assistance to the elderly.

This paper is based on two field surveys carried out in France over the last four years with policy makers, health and social actors at different territorial levels, as well as home helpers and trade union representatives.