Loss of autonomy among older people: what are the needs and costs involved in supporting the shift towards home-based care?

Mendras, Pauline

Home » Publications » Policy Brief » Loss of autonomy among older people: what are the needs and costs involved in supporting the shift towards home-based care?

Loss of autonomy among older people: what are the needs and costs involved in supporting the shift towards home-based care?

Pauline Mendras

November 2023

This paper sets out several scenarios for the future trend in public expenditure on care / support for people with loss of autonomy and estimates the number of care workers required to support older people between now and 2040, across three different living environments.

Reference IPP Policy Brief No. 96

Quote this publication

Mendras, Pauline (November 2023). ‘Loss of autonomy among older people: what are the needs and costs involved in supporting the shift towards home-based care?’, IPP Policy Brief, No. 96. Institut des politiques publiques (IPP).

Download

Presentation

In 2021, nearly 2 million people aged 60 or over reported being limited in their activities of daily living (11 per cent), and 1.3 million were recipients of the Personalised Autonomy Allowance (APA, 7.5 per cent). As life expectancy increases, taking people into ages where the likelihood of losing their independence rises, the number of dependent older people and APA recipients is expected to rise in the coming years. The DREES estimates that this will result in more than 350,000 additional APA recipients by 2040, representing a 29 per cent increase compared with 2020.

In light of these trends, the question arises as to the support needs these older people will require and the public funding that will need to be set aside to cover the costs associated with care / support for loss of autonomy.

Key Results

In light of forecasts regarding the trend in the number of elderly people requiring care, and with a view to a ‘shift towards home-based care’, the number of professional carers required to provide care / support for those with loss of autonomy at home and in care homes is expected to increase by 42 per cent and 14 per cent respectively by 2040 compared with 2020.
Assuming public policy on care remains unchanged, the increase in the number of APA recipients would lead to a 30 per cent rise in total APA expenditure between 2020 and 2040.
However, the ‘shift towards home-based care’ means that people with greater needs than at present will be living at home: this will require pay rises to enable the recruitment of care professionals. Taking these changes into account, total APA expenditure would increase by €4.8 billion by 2040, representing an 80 per cent rise compared with 2020 (in real terms).
These new needs could also lead to a reduction in the under-spending of notified APA support plans. Assuming that the notified care plans are implemented in full, APA expenditure could almost double between 2020 and 2040, reaching €12.4 billion.
By 2040, a policy supporting this type of shift towards home-based care would cost an additional 4.6 billion euros compared with one based on unchanged care provision, representing a 60 per cent increase.

Method and Data

Population projections

The simulations presented in this note are based on projections from the DREES’s LIVIA model and are intended to provide quantitative data on the conditions for a successful ‘Shift towards home-based care’.

They are available on the IPP website in two formats: a calculation tool and an RShiny application, both of which allow users to simulate changes in expenditure and the number of Caregivers based on a range of adjustable assumptions.

These projections are based solely on aggregated data at departmental level from the LIVIA model, which will be updated by the DREES in 2024, using new projections of Loss of autonomy at departmental level produced by INSEE. The DREES will then publish new projections of care needs and costs, this time based on individual data.