Aging in Place: How Dependable Are Family Members?

Since the 1960s, the priority of public policies has been to encourage people to stay at home. In 2015, the law on the adaptation of society to aging reinforced this orientation, now called the “home shift”. It responds to the wish of a majority of French people to age at home, but also to budgetary logic: staying at home would be less expensive than a stay in an EHPAD.

However, this comparison forgets an essential factor: family help. This does not appear in the public accounts even though it represents a considerable part of home support. A share which will increase in the years to come, due to the aging of the population.

Today, eight out of ten elderly people losing their autonomy are helped by those around them, according to the DREES. However, from 2023, a report from the Public Policy Institute indicated that this support could become rarer, particularly for single and childless men. And this, even though the number of dependent people will increase in the years to come. Basing home support on family solidarity therefore appears fragile.

As part of the Aging UP! from Paris Cité University, we analyzed, as researchers, the preferences of elderly people and their loved ones regarding support for loss of autonomy. 36 interviews with elderly people and their relatives were conducted, followed by a national survey deployed in 2024 among 6,000 people over 60 and relatives (carers or not) (representative of the French population on the usual socio-demographic criteria). Here are the first lessons learned from these surveys.

A desire not to become a burden on those around you

Data analysis reveals that 6.7% of older people want total delegation of all help and would like not to have to rely on those around them at all. However, this is not always possible. Indeed, in some cases, people do not have available relatives who could provide help: either the spouse is in poor health, or there are no children or children who live far away or lack time (because they are employed and/or with parental responsibilities). Furthermore, even if relatives are available, the majority of elderly people want the intervention of those around them to be limited, preferring the intervention of professionals.

The desire not to become a burden for loved ones and particularly for children is very present among the elderly people interviewed, who consider that “children have their own lives” and that it is not up to them to help them on a daily basis. As this elderly person puts it: “ If I ever had an addiction that requires presence, I would prefer to manage to find assistance and not weigh on [la] life [de mes] children, their life as a couple, their professional life. »

The help of spouses, on the other hand, seems less questioned and more “natural”, with all the same the desire to preserve the couple's relationship, as these two other testimonies indicate: “It's too demanding for the partner, so obviously it's good for her to be there and do things, but outside help is absolutely necessary otherwise it completely changes the relationship. I don't want to become my partner's patient. »

“Within the limits of feasibility, yes, but a little helping hand. I don't want to be a burden on them and make everything feel like a chore. »

Loved ones who would agree to help even more

For their part, relatives are ready to provide more help than the elderly would accept from them. In fact, they provide more help than they would have liked, due to lack of an alternative solution.

Part of this aid provided is therefore “constrained”. Children often say they help to the detriment of the best years of their lives, no longer having enough time for their families, their friends and no longer being able to go on vacation. A heavy situation, as evidenced by some interviewees: “I have worked all my life, I am also entitled to my share of calm. […] These might be the best years I have. It's a bit heavy to still carry this. […] I had gotten to a point where I didn't want to see them anymore. Because it was synonymous with too much constraint. »

Faced with this situation, the spouses of dependent people will seek to assume the greatest share of responsibility, in order to minimize the role of caregivers for their children: “This is not the place for children [d’être aidants]. Children, they have to live their lives. We have already lived. »

Personal care, a limit for the elderly and caregivers

Older people generally refuse to involve their children in personal care, such as washing, hygiene, feeding, getting out of bed, etc. 30% of them prefer to involve loved ones for only a small part of this type of help (around 25% of the overall time), while 29% prefer to delegate all help for personal care to professionals and not involve their loved ones. So this person, who asserts: “I don't want it to be [mes enfants] who come to wash my butt. We're not used to that, it's embarrassing. »

Relatives themselves also do not want to carry out personal care, or only agree to do it when their involvement is low. This is particularly the case for children, who consider this helping activity too intimate, as highlighted by these caregivers interviewed during the survey: “I had to change the diaper [de mon père] once, I'll tell you, I still remember it. Really, it was complicated. For an opposite sex, it's even harder. »

“I wouldn't [la toilette de ma mère] for her, to the extent that it is her privacy. Because I'm his child, anyway, no matter how old I am. »

Furthermore, relatives who have already had experience of helping are even less inclined than others to carry out personal care: more than 50% only want to be involved in at most 25% of the help, and say they want to delegate the rest.

The entourage more present for administrative and domestic tasks

If relatives and the elderly do not want family help for personal care, other forms of help are preferred. This is particularly the case for assistance with administrative procedures, the organization of medical appointments and the coordination of professionals.

On these points, older people are ready to accept more help from their loved ones, in particular from their children, who may be required by their professional activities to have to deal with it elsewhere (tax declarations, requests for assistance plans, coordination of professionals, etc.). These tasks not only seem more punctual, but can be carried out for a remote game.

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Thus, 60% of elderly people are in favor of those close to them providing the majority of administrative tasks and coordination of professionals and more than 73% of relatives are ready to carry out the majority of this help themselves.

Next on the list of help in which caregivers are most willing to get involved is help with domestic tasks, such as cleaning or preparing meals. 57% of relatives who are not caregivers themselves and 43% of caregivers are ready to help accomplish the majority of domestic tasks (75% or more). For their part, older people rely less on those around them for domestic tasks: less than 25% would like loved ones to help with the majority of domestic tasks.

Furthermore, the interviews also reveal that children (and sometimes grandchildren) are also expected for small repairs, as well as to help in the event of a fall or occasional needs, as evidenced by this interviewee: “To do the paperwork, my daughter takes care of it […]she does this every day. […] If I needed anything around the house, [mes enfants] would be there. »

The survey also highlights the role of loved ones in supporting social life (being present to keep company, taking people to restaurants, etc.): “I love helping him sing as much as changing the diaper, that’s for sure.” »

Strengthen access to professional caregivers and the quality of assistance

For home care to meet the aspirations of elderly people and their loved ones, it is necessary to increase the use of professionals, considered insufficient and failing in certain situations.

The lack of competent and reliable professionals leads loved ones to have to coordinate assistance, to “monitor” that everything is done well, and to manage the absences of available professionals.

In addition, even if professionals come to the home, the visits are short and fragmented into specific tasks. For example, the average duration of home help and support services (SAAD) is estimated at 12 minutes for help with going to bed, 20 minutes for washing in bed, 8 minutes for help with changing or even 4 minutes for taking medication. This does not allow sufficient social interactions to be developed for the individual being cared for, nor does it allow the caregiver sufficient respite time.

According to the people interviewed, the most important dimensions for ensuring the quality of professional interventions are firstly the existence of a relationship of trust, then the empathy and good manners of professionals as well as the time spent providing care, as illustrated by the following testimonies: “I found a person who takes her two afternoons a week, who takes her for a walk, […] it allows him to be with someone other than us, […] it does him good. I still have this help. »

“The big problem was that occasionally, especially on weekends, I had people from a home help company who didn't come or came late, or were sick. […] So I found myself every other weekend making breakfasts or dinners for my mom. »

“They change my caregivers all the time. I'm the one who educates them every time. »

Aging with, but not to the detriment of those close to you

Ultimately, we see that home support cannot rely too heavily on families. Such a political choice would indeed be to the detriment of loved ones. To make the “home shift” a success, several changes will be necessary.

First of all, it will be necessary to strengthen the professional offer and its quality. Today, there are half as many professionals in France compared to the number of people over 65 as in the average of OECD countries. According to the recent report from the Public Policy Institute, there is a shortage of several hundred thousand full-time equivalents in the home support sector for the elderly.

Support for carers also needs to be improved. This includes providing respite time, improving their recognition, as well as providing support. Not to mention that the main way to help caregivers is to make it easier to delegate certain tasks to professionals.

Finally, and above all, it is necessary to open a social debate on the subject of the respective place of public and family solidarity. This is particularly the purpose of National Carers’ Day, every October 6.