“It is essential to develop a real public service for the management of the loss of autonomy”

Tribune. After the formal creation of the fifth branch of Social Security (Law of December 14, 2020), it is high time to provide it with content. For years, even decades, each new government has announced a major plan to deal with the loss of autonomy linked to the aging of the population, and we are still waiting.

It is no longer useful to recall that this is a growing need, essential for an ever increasing number of elderly people, but also for family carers. The aging of the population is also a major determinant of the growth in the use of hospital services, which are struggling to meet needs.

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Almost twenty years ago, the 1er January 2002, the personalized autonomy allowance (APA) came into effect, partial reimbursement of the care prescribed by a medico-social team, on the model of the health insurance. But the level of out-of-pocket expenses continues to lead to the renunciation of care.

Since then, public policies have focused on expanding tax credits, combining care with comfort services for the able-bodied, such as cleaning and gardening. The hope was that the need would be such that a little subsidy oil in the cogs would suffice to get the machine going. A 2008 report from the General Inspectorate of Finance even announced that we would be able to settle at the same time the issue of taking charge of the loss of autonomy and that of mass unemployment, at no cost to the finances. public!

Inegalitarian policies

It has to be said that this did not work: public spending is far from negligible, but these extensions have had very little or no effect on job creation (” Effectiveness and equity of aid for the employment of an employee at home, Clement Carbonnier, Work and employment n ° 143, 2015). However, if jobs – and therefore activity – have not been created, this means that many people with loss of autonomy have not been able to benefit from the services they nevertheless need …

In addition, these policies are very unequal. The wealthiest, including the elderly, are much more likely to consume personal services and benefit from subsidies. This explains the low impact of the tax measures: the better-off would have consumed these services even without tax credit, and their price remains out of reach of the most modest, even after reduction by tax measures.

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