This study provides an overview of the volume of care provision available in mainland France to support older people who have experienced a loss of autonomy, whether at home or in care homes, and is based on a dedicated indicator – developed by the author for this project – known as ‘localised potential accessibility’.
Potential local access to care / support for older people with loss of autonomy: a regional approach
This study aims to assess the geographical accessibility of medical, social and healthcare services for older people, both at home and in care homes.
Reference IPP Report No. 45
Presentation
Key Results
- Based on these figures, the total volume of care / support provision dedicated to addressing the loss of autonomy is estimated at 515,000 FTE, of which 262,440 FTE are in care homes and 252,740 FTE provide care in people’s own homes.
- The median geographical accessibility to care provision in FTE terms is 3,178. This means that half of those aged 60 or over have fewer than 3,178 care professionals (expressed in FTE) within 60 minutes’ reach per 100,000 people aged 60 or over (the other half having more than 3,178 FTE per 100,000 people aged 60 or over).
- Accessibility is poor in the departments surrounding the Île-de-France region (Oise, Seine-Maritime, Eure, Orne, Eure-et-Loir, Sarthe, Loir-et-Cher), as well as in mountainous regions (the Alps, the Pyrenees, the Vosges, the Jura) and the Grand-Est region. The rest of France appears to benefit from a relatively accessible provision. Areas with low accessibility are scattered and small in size.
- A clear distinction between ‘home-based’ and ‘care home-based’ provision is evident. Whilst inland municipalities in Brittany and the Pays-de-la-Loire have high levels of access to care home provision, those in the Nord and Corsica have high levels of access to home-based provision.
- As regards the distinction between ‘medical-social care’ and ‘healthcare’ provision at home, healthcare provision is more accessible in the southern half of France, the North-East and Brittany, whilst medical-social care provision is particularly high on the Channel coast and in the North.
- The Mediterranean, Île-de-France, Corsica, and the Alps, Pyrenees and North-East regions are predominantly served by private, for-profit providers, whilst the regions of Brittany, Pays-de-la-Loire, Normandy and Central France are predominantly served by public providers. However, some departments do not follow the pattern seen in their neighbouring areas (Landes, Haut-Rhin, Somme, Loire-Atlantique, Calvados, Vienne and Indre-et-Loire).
Method and Data
This report proposes a composite indicator of geographical accessibility for professionals providing care / support (for loss of autonomy) in mainland France, regardless of the organisation to which they are affiliated (care home, SAAD, home nursing services (SSIAD), private practice, etc.).
This indicator is based on the following three elements: care provision, potential demand, and catchment area. It is broken down into several sub-indicators for each type of care and legal status of the care provider. For each, the indicator measures density: the number of care professionals, expressed in FTE, accessible within 60 minutes (with a decreasing time threshold) per 100,000 people aged 60 or over.
It is based on the Kernel density two-step floating catchment area (KD2SFCA) method (Dai and Wang, 2011).
The measure of provision is expressed in terms of the number of FTEs. As far as possible, the scope is restricted to activities carried out with older people and within the health and medico-social sectors (we exclude the medical sector and administrative staff). The data used are:
● the dashboard from the Technical Agency for Hospitalisation Information (ATIH), which covers permanent, temporary and day care provision in residential care homes for the elderly (Ehpad) and home care services (SSIAD) in 2020
● the National Register of Health and Social Care Establishments (Finess), supplemented by the 2019 EHPA survey, which covers permanent, temporary and day care provision in non-Ehpad residential care homes (EHPA), long-term care units (USLD), day centres and independent living facilities
● the 2019 SAE survey for places in home healthcare (HAD) and rehabilitation (SSR) services catering for
older people with loss of autonomy
● the 2019 Nova database to identify staff working on a service-provider basis within SAADs and Spasads for the provision of care for older people
● the National Health Data System (SNDS) to identify AIS records for self-employed nurses and those in health centres
● the 2019 Annual Social Data Declarations (DADS) to identify home help activity, whether through direct employment or an agency
Amélie Carrère
