Community Care in England and France

Like other countries, England and France have been reforming community and long-term care. Comparison is fruitful because these two societies with much in common contrast in cultures, policy and politics in general, and policy for the care of frail, elderly persons in particular. The comparisons suggest important systemic choices for each country, which can be greatly illuminated by analysis of policy outcomes of the other's systems. The book's opening chapters describe these and the fascinating and chequered history of the development of services, policy critiques, and policies themselves. What can be learned from comparative analysis is too often limited by inadequate evidence about impacts on disabled persons and their families. This study collected similar information in England and France for users of community social services and their caregivers. The need-related circumstances, patterns of service use are compared across areas within and between countries. Analyses estimate how service use and informal care are interrelated over time, and investigate whether these are the short-term substitutions feared by policy-makers. They show the degree to which British and French community services and cash benefits reduce admissions to institutions. One focus of the last chapter is the effect of incorporating features developed in each other of the countries' systems: for instance, mixing social insurance with social assistance financing; combining direct cash payments with brokerage help; focusing more on the performance of core care management tasks. Another is the long-run effects of the current reform attempts.