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Ageing at home: regional disparities, challenges and prospects

Delphine Roy, Amélie Carrère, Léa Toulemon
March 2023
This study aims to help document the current conditions of care for older people with loss of autonomy: at home and in care homes, by professionals and Caregivers, and across different regions, in order to discuss the feasibility of a ‘Shift towards home-based care’ in this context.
Reference IPP Report No. 41

Quote this publication

Roy, Delphine, Carrère, Amélie, Toulemon, Léa (March 2023). ‘Ageing at home: regional disparities, challenges and prospects’, IPP Reports, No. 41. The Institut des politiques publiques.
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Presentation

Public policy on independent living is increasingly prioritising home-based care for older people. This is known as the ‘shift towards home-based care’, by analogy with the ‘shift towards outpatient care’ initiated by hospitals, and in contrast to institutionalisation, which relies on care in residential care homes. In recent months, the Orpéa scandal has heightened questions about the economic model and day-to-day running of residential care homes (Ehpad), and has once again highlighted the preference of individuals themselves for remaining in their own homes.
But what are the implications of this shift towards home-based care, at a time when the first generations of the baby-boom cohort are reaching an age where loss of autonomy is more common?

This publication is the result of a three-year research project carried out by the IPP’s Health and Independence Division with the support of the National Solidarity Fund for Independence (CNSA). This project analysed three aspects of enabling older people to remain in their own homes, which have been little explored to date:
1/ the trajectories of older people experiencing a loss of autonomy
2/ the support provided by their social circle
3/ regional disparities

Key Results

The report confirms and sets out in detail, for each of the three dimensions mentioned above, the conditions that must be met to successfully achieve the shift towards home-based care

1/ People living in care homes are a very diverse group. Among them, the youngest are more often socially isolated and economically vulnerable. How can people age at home without a support network or the financial means to pay for home help? For those with a high degree of loss of autonomy, ageing at home rather than in a care home would require far greater and more varied support than that currently provided to people living at home.

2/ Support from family and friends – known as ‘Informal care’ – is neither a given, nor free, nor inexhaustible. Projections of the number of older people and potential caregivers show that this resource could run out as early as the 2030s, particularly for older men, an increasing number of whom will have neither a spouse nor children, mainly due to the decline in the number of descendants.

3/ The budgets of departmental councils, which provide funding for the Personalised Autonomy Allowance (APA), are uneven and constrained. This reduces their room for manoeuvre in funding the APA and leads them to prioritise the most unavoidable cases: those of people in care homes, the most economically disadvantaged or those who are socially isolated. There is a risk that, without an increase in their budgetary allocation, the departments facing the greatest financial constraints will intensify these prioritisation measures, to the detriment of meeting all needs.

Method and Data

This study is based on an analysis of data from the ‘CARE’ survey programme produced by the Drees (Directorate for Research, Studies, Evaluation and Statistics)

Last modified: July 21, 2026