Among people aged 60 or over, who live at home and who live in care homes?

The youngest care home residents are more isolated and socially disadvantaged

Among all older people aged 75 or over, nearly one in ten lives in a care home. Care home residents are 86 years old on average, and three-quarters are women. One in four older people in care homes has no living children, compared with one in ten living at home, and one in three has no grandchildren, compared with one in five living at home. These findings are consistent with previous research (Abdoul-Carime, 2021): people in care homes, particularly the younger ones, are more isolated from their families than those living at home.

They are also more socially disadvantaged. The differences are much more pronounced among those under 80. Former manual workers are heavily over-represented in care homes among men, and among men under 80 living in care homes, 11 per cent had no occupation before retirement, compared with 0.2 per cent of those living at home. This very high percentage may indicate that these are people who had a disability before entering a care home, or who faced difficulties in entering the labour market that kept them out of work, and once again highlights the greater social vulnerability of these younger residents. These disparities are reflected in the distribution of income and living standards. In care homes, the youngest residents have the lowest living standards; these then stabilise from the age of 75 onwards, at which point living standards become more similar between those living at home and those in care homes.

In care homes, significant motor and cognitive limitations are present at all ages

The prevalence of sensory difficulties at each age does not differ significantly depending on where people live: hearing impairments increase with age at the same rate whether living at home or in care homes, and the majority of older people can hear without difficulty in a quiet room up to the age of 90, regardless of where they live.

Significant mobility difficulties, at all ages, are characteristic of people in care homes: at all ages, and from the age of 60 onwards, the majority of residents have great difficulty bending over or kneeling, climbing stairs or carrying 5 kilos for 10 metres.Finally, cognitive limitations increase with age for people living at home, but their prevalence remains moderate at all ages. In care homes, however, memory lapses, difficulties in understanding and making oneself understood, in solving everyday problems, and difficulties in forming relationships are common at all ages.

People under 75 living in care homes therefore have particularly significant limitations for their age, whilst the oldest residents have sensory and physical limitations similar to those of people living at home, but far more cognitive limitations. This partly explains the particularly high proportion of people under legal guardianship in care homes, which exceeds two-thirds among residents under the age of 75.

Two distinct groups under one roof

These findings highlight the differences between older people living at home and those in care homes, at comparable ages (notably the high prevalence of cognitive limitations in care homes, across all age groups), but also certain similarities, particularly among the very elderly, such as sensory and physical limitations or socio-economic characteristics.
They also demonstrate the dual nature of the residents in care homes, both under and over the age of approximately 75. This duality was already recognised, but this study is the first to document it in all its dimensions: functional limitations, demographic characteristics, educational qualifications, income, legal protection… It raises questions about public policy regarding the home, in the same setting and under the same conditions, for several groups with such different characteristics. Among the youngest residents of nursing homes, for example, are ageing people with disabilities who require a considerable level of support, or people with mental health conditions. The needs of these groups differ; caring for them does not involve the same tasks and does not necessarily entail the same workload, which has implications for the organisation of the care homes and their staff.

Findings that raise questions about the conditions for a ‘shift towards home-based care’

Finally, a comparison of the characteristics of older people living in care homes and at home helps to clarify the practical conditions under which a significant, or even complete, shift towards home care for current care home residents might be feasible. The economic and social conditions required to support their independence must therefore be anticipated, in light of the characteristics described above: the relative social isolation and low incomes of the youngest residents, the fact that a quarter of them are under legal guardianship, and the very high prevalence of cognitive disorders and motor impairments…
In particular, these imply the existence and economic viability of a substantial home-care sector, understood in the broadest sense: help with housework, meals, personal hygiene, etc.but also medical and paramedical care at home, which would correspond to the tasks currently carried out by healthcare staff in residential care homes: these range from assistance with taking medication to numerous nursing or physiotherapy procedures, for example, right through to end-of-life care (palliative care).