What it Would Take for the Demographic Transition to Succeed

Secondly, ineffective spending and waste in the French long-term care system remain important issues, and there is a need to tackle the issue of low-value long-term care. France spends almost 75% of its total long-term care expenditure on medical care, but does not always ensure the valueof the services that are being funded. For outpatient care alone, frail (but non-dependent) people spend €1,500 more each year than robust people. Is all this medical expenditure necessary? Does it really improve their quality of life? Shouldn’t a larger portion of the budget be dedicated to social spending, which better meets the needs of frail people?
 
Finally, there is still much more to be done to improve the way care for the frail older people is organized. In France, as in most OECD countries, the provision of care remains very fragmented. The work of the many professionals involved with frail people (domestic help, home delivery of meals, nurses, doctors, etc.) is often poorly coordinated and not well integrated. As a result, it is a complex exercise for families to manage an individual’s loss of autonomy, which sometimes leads to suboptimal decisions, such as requiring them to leave home too early. Several other countries, the Nordic countries and the Netherlands among them, have successfully deployed platforms for sharing information between professionals and families, as well as between independent professionals and those in institutions or hospitals. Systems like this can help avoid redundant, inappropriate, or unnecessary expenditure, as well as costly events that may lead to dependency, such as emergency hospitalizations.

Healthy aging: an urgent priority for all OECD countries

International comparisons show that when it comes to implementing healthy aging policies, the most advanced countries (Japan, Canada, the Netherlands, Norway) have significantly developed their human and technological resources.

Like most OECD countries, France needs to increase its long-term care workforce. The population’s aging is creating new needs, and requires the development of more comprehensive home care options that are better coordinated around older persons and better integrated into a comprehensive management of their needs. It is essential to increase the availability of care services through massive recruitments in the sector. In fact, it is an absolute priority, given that needs directly linked to the aging of the French population are expected to increase, as is the risk of a shortage of family assistance. France is lagging far behind in this area: the number of workers in the sector is half the OECD average. The most effective way to attract new workers and retain the existing workforce would be to increase wages. Improving working conditions is critical too, as care work is difficult and often has a detrimental impact on professionals’ health. There is also a need to improve worker training and create new jobs, in order to strengthen capacity in the sector.

The use of these algorithms could help care providers to prevent emergency hospitalization risks, and consequently reduce the risks of iatrogenic disability. Digital platforms could also be used to assess the quality of care individuals are receiving, where currently the choice of services is usually made based on word of mouth, raising sometimes quality and safety issues.

It’s not too late for a successful demographic transition

Effectively meeting the needs associated with loss of autonomy and making a success of the demographic transition that is upon us is still possible. But this requires a strong and certain awareness of the situation’s urgency on the part of decision-makers, as well as the implementation of a clear strategy. In recent years we have seen French governments take the measure of these challenges. Compared to other OECD countries, we have been able to provide significant resources to finance the older people’s needs, notably through the 2004 creation of the Caisse nationale de solidarité pour l’autonomie, and the financing of concrete prevention and support initiatives, such as the 2008-2012 Alzheimer’s plan. France is also one of the more recent countries to have initiated a long-term care reform, with the "Loi relative à l’adaptation de la société au vieillissement" in 2016.

It seems that the time has come to synchronize these initiatives by bringing together the various elements linked to the demographic transition in a Ministry for healthy aging, endowed with enough political weight to impose vast reform on the sector. The Covid-19 crisis has shown that our society is capable of making significant sacrifices in the interest of older populations. For over a year, their interests have been at the heart of public policy and government action. There is a risk that at the end of this crisis, these issues will fade out of government priorities, at exactly the moment when it is most necessary to implement reform. Several OECD countries have already seized the opportunity to do so. This is the case in the United States, for example, where the Biden Administration has announced massive investment in the sector ($400 billion over eight years). 

Copyright: JOE RAEDLE / GETTY IMAGES NORTH AMERICA / Getty Images via AFP