Ecole des hautes études en santé publique (School of Public Health), Paris and Rennes, France.
Health Soc Care Community. 2012 May;20(3):238-46. doi: 10.1111/j.1365-2524.2011.01051.x. Epub 2012 Jan 7.
This article investigates the impact of policy measures on the organisation of home-based care for older people in France, by examining the balance between formal and informal care and the redefinition of the initial familialist model. It focuses on the specific cash for care scheme (the Allocation personnalisée d'autonomie - Personalised allowance for autonomy) which is at the core of the French home-based care policy. The author argues that in a redefined context of 'welfare mix', the French public strategy for supporting home-based care in France is articulated around two major objectives, which can appear contradictory. It aims to formalise a professional care sector, with respect to the employment policy while allowing the development of new forms of informal care, which cannot be considered to be formal employment. The data collection is two-fold. Firstly, a detailed analysis was made of different policy documents and public reports, together with a systematic review of existing studies. Secondly, statistical analysis on home-based care resources were collected, which was not easy, as home-care services for older people in France are part of a larger sector of activity, 'personal services' (services à la personne). The article exposes three main findings. First, it highlights the complexity of the formalisation process related to the introduction of the French care allowance and demonstrates that formalisation, which facilitates the recognition of care as work, does not necessarily mean professionalisation. Second, it outlines the diversity of the resources available: heterogeneous professional care, semi-formal forms of care work with the possibility to employ a relative and informal family care. Finally, the analysis outlines the importance of the regulation of cash payments on the reshaping of formal and informal care and comments on its impact on the redefinition of informal caring activities.
本文通过考察法国家庭护理中正式和非正式护理之间的平衡以及初始家庭主义模式的重新定义，研究了政策措施对老年人家庭护理组织的影响。它关注的是特定的现金护理计划（个性化自主津贴——Personalised allowance for autonomy），该计划是法国家庭护理政策的核心。作者认为，在重新定义的“福利组合”背景下，法国支持家庭护理的公共战略围绕着两个主要目标展开，这两个目标可能看起来相互矛盾。它旨在为专业护理部门制定就业政策，同时允许新形式的非正式护理发展，这些护理不能被视为正式就业。数据收集有两个方面。首先，对不同的政策文件和公共报告进行了详细分析，并对现有研究进行了系统回顾。其次，对家庭护理资源进行了统计分析，这并不容易，因为法国老年人的家庭护理服务是更大的“个人服务”（services à la personne）活动部门的一部分。文章揭示了三个主要发现。首先，它强调了引入法国护理津贴相关的正式化过程的复杂性，并表明，正式化虽然促进了将护理视为工作的认可，但并不一定意味着专业化。其次，它概述了可用资源的多样性：异质的专业护理、半正式的护理工作形式，有可能雇用亲属和非正式的家庭护理。最后，分析还概述了现金支付对正式和非正式护理的重塑的重要性，并评论了其对非正式护理活动重新定义的影响。
