Residential settings and support for older adults with loss of autonomy: the challenges of aging-in-place policies feeling at home, wherever you are
Publié le |
Dr Julien Emmanuelli, Jean-Baptiste Frossard, Bruno Vincent (Igas)
With the participation of Charlotte Carsin (Igas), Tom Durepaire (apprentice)
and the data division of the Igas : Juliette Berthe, Léo Zabrocki
With the post-war generations reaching advanced age, the number of older adults experiencing loss of autonomy in France could increase by nearly one million between 2020 and 2040. As many French citizens express the desire to age at home, the public authorities aim to strengthen home care capacity under quality conditions and reduce the proportion of admissions to nursing homes for dependent elderly people (Ehpad).
Through its findings, analysis, and recommendations, the report by the General Inspectorate of Social Affairs challenges several common assumptions about aging and the loss of autonomy. The authors assess how housing and care options should be structured for individuals who, under current circumstances, would move into institutions, but who—under similar conditions in the future—could continue to receive support at home, whether in standard or alternative settings (e.g., senior residences, shared Alzheimer’s housing, etc.).
What is the context?
Currently, it is estimated that more than three-quarters of older adults with loss of autonomy live at home rather than in an Ehpad. Among those with severe dependency levels (GIR 1–2), more than half remain at home—made possible largely by substantial involvement from informal caregivers (36 hours per week versus under 9 hours from professionals).
What are the key findings?
Yet, while informal caregivers are a cornerstone of at-home care in regular housing, their numbers are expected to decline. In addition, standard home care is highly labor-intensive, at a time when France is already facing a shortage of health and care workers. It is also relatively expensive—and potentially more costly than institutional care—due to factors such as travel time for staff and the absence of economies of scale. As a result, while aging in place remains the priority, there are cases where institutional or intermediate care may be in the person’s best interest.
Alternative housing models currently represent only a very small share of living arrangements for dependent elderly individuals (around 2%), though a quarter of seniors in independent living residences fall within dependency levels GIR 1 to 4. More broadly, alternative housing raises concerns about how well the intended target populations match the actual needs of residents.
Finally, among elderly residents in institutions, despite the rising age of admission to Ehpad, the average length of stay remains fairly stable at just under two years.
Despite significant progress since the 2015 law on adapting society to aging, the resources currently in place are still insufficient to successfully implement a strong home-based care policy over the next 20 years for elderly individuals with loss of autonomy, regardless of where they live.
What are the recommendations?
Meeting this objective requires a major public investment in both regular and alternative home settings, as well as in Ehpad facilities. Without such efforts, several negative consequences—already visible in some areas—are likely to worsen: deteriorating living and care conditions for dependent elderly people, overcrowded Ehpad, increased burden on families, growing strain on the eldercare workforce, expansion of poorly regulated care practices, rising risks of neglect or abuse (even at home), and added pressure on the health care system.
Beyond expanding home care support, the report calls for the construction of 100,000 new units in independent senior residences by 2030, alongside the renovation of existing housing stock. It also recommends securing the development and operation of alternative housing models to accommodate older adults with greater needs, launching a national plan to transition Ehpads toward more home-like environments, organizing the governance of care offerings by housing type, and strengthening prevention strategies to ensure long-term quality of life for older adults.