Contenu du sommaire : Handicap, âge, dépendance : quelles populations ?

Disability as an administrative category
The law of 11 February 2005 modifying public policy for people with disabilities has been described as introducing significant disruption in defining disability. This article demonstrates that legislators strengthened administrative control in defining the population concerned by this government policy by applying the same label and a scattering of identical measures to a set of individuals, as well as by their inclusion in the same “local world of production of rights.” This sector, like many others, has deeper roots in the instruments structuring relationships between actors than it has in an explicit, objective, and commonly accepted definition of the limits to the sphere of activity and the principles to be applied. This instrumentalist construction of the sector has led to a lack of clarity in defining the boundaries of the population concerned, a lack of clarity affecting both the individuals declared to be eligible for these rights, as well as the internal arrangements of structuring relations between these actors.

Disability: a dominated position
This article analyses the recent transformations of disability insurance [assurance invalidité] (AI) in Switzerland. Drawing on the theoretical framework of Critical Disability Studies, it first demonstrates how disability has been established as a different, lower level standard compared to an able-bodied standard as defined by one's earning capacity. It then examines the transformation of the concepts of disabled or able-bodied as linked to the three revisions of AI between 2004 and 2012. These reforms—legitimised by the financial deficits and supported by an evolution of the “ableist” orthodoxy—were designed to limit disability and reduce the number of pensions. Not only do they deepen the focus on rehabilitation and activation measures at the expense of granting pensions, but they also introduce early detection of able-bodied persons and reviews of the potential for rehabilitation of persons receiving a disability insurance pension. Presumed ability has become a new organising principle of insurance while disability, downgraded and excluded, has become a moral issue.

When the “fragility” of the elderly becomes a motive for public policy
This article takes a sociological look at the concept of the “fragility of the elderly”, which has been playing an increasingly important role in France in the debate on autonomy. Starting with a review of the relevant literature, complemented by analysis of scientific and institutional events, we first analyse the different connotations of this category (biomedical, vulnerability, and demographic approaches), as well as its more transversal ambitions such as preventing the loss of autonomy and the integration of services. We then look at actual actions on fragility in light of interviews and observations by professionals in both areas. Fragility of the elderly emerges as a motive for public policy, the success of which is due as much to the malleability of its contents—facilitating the action of a wide range of actors in organisations in the autonomy field—as it is to its normative implications. However, the actions concerning fragility are severely challenged by the fragmentation of this area of public policy, in which there is a particular lack of clarity in the interrelations linking the various types of actions.

The age 60 barrier in French long-term care schemes : the effects on home care utilization by disabled and dependent individuals
In France, long-term care policies are organized into two distinct fields. Disability schemes are offered to individuals whose disabilities were recognized before age 60, while so-called ‘elderly' may access dependence schemes. Although the ‘age 60 barrier' is debated, there is little empirical evidence about how it affects the way activity restrictions are being compensated for. This article makes use of the economists' concepts and tools to inform the debate. Firstly, it shows how the concept of disability compensation may be understood, and why the age 60 barrier may seem arbitrary within this framework. Secondly, we assess the effects of the institutional discontinuity on home care utilization by community-dwelling individuals with activity restrictions. We use the Disability and Health Survey on Households [Handicap-Santé Ménages] (2008) to document the disabilities, benefits and home care services received on both sides of the age 60 barrier. For given socio-demographic characteristics and family structure, the probabilities of benefitting from an allowance and receiving formal home care appear to be higher for individuals aged 60 and over.

Profiles of autonomy and dependence of nursing home residents. Multidimensional approach—HSI Survey 2009
Elderly persons have made up a sharply increasing percentage of the overall population during the second half of the twentieth century. This transformation in the age pyramid in France has stimulated studies of living conditions for the elderly. The article re-examines the measures produced by conventionally used dependency indicators.
Multivariate analysis describes different personal profiles according to their degree of autonomy in carrying out daily activities and compares them to the usual indicators measuring dependency (Colvez, Katz, AGGIR). While these indicators are able to clearly identify states of great dependency, they fail to identify situations of more or less moderate dependency involving a population whose disability characteristics are very heterogeneous. The article then examines the characteristics of “relatively” autonomous persons living in institutions.
The field of study is that of individuals aged 50 or older in institutions for the elderly and for disabled adults, and the data source is the Institutions component of the Disability-Health Survey by the DREES and INSEE in 2009.

The disability sector, a market in gestation? Competitive strategies and market stabilisation (1944–2010)
This article examines government influence on competition between management associations in the social-health sector since World War II. It exploits a statistical database drawing on two longitudinal case studies (43 semi-structured interviews and the archives of two large management associations in the Rhone and Isere departments) and 50 additional semi-structured interviews in the former name Rhône-Alpes region. We demonstrate that public actors promote the reproduction of the position of dominant associations from one period to the next by playing on the competition between operators. Their action aims to stabilise the structure of relations between actors : the organisational scope of the disability sector is a stable market as described by Fligstein (2001).

Institutional accessibility for disability and dependence: differentiations, territorial consequences, and residential pathway
Studying the accessibility of nursing homes for the elderly and for disabled adults sheds light on their respective freedom of choice in the selection of a place of residence. The article studies financial and geographic accessibility as well as access in terms of rights. Nursing homes for the disabled and for elderly persons are both part of the medical-social sector. They are partially governed by a common body of regulations and are funded by the same institutions: department councils and the National Solidarity Fund for Autonomy [Caisse nationale de solidarité pour l'autonomie (CNSA)], via regional health agencies (ARS). However, the methods of financing the systems are different, particularly in reference to an individual's participation. The institutions also have separate administrative methods and have historically differentiated geographic foundations. There is a much denser geographical coverage of accommodation facilities for dependant elderly persons than for the corresponding accommodation for disabled persons, the latter being much less widely distributed. The specificities of each sector have consequences on individuals in terms of their residential pathway.

Living in residential care homes for the elderly (EHPAD [Établissement d'hébergement pour personnes âgées dépendantes]): testing the boundaries between spatial transitions and limited singularities
As an observer using a multi-method case study, we propose to analyse life in residential care homes for the elderly (EHPAD) and in their environments through an outline of the experiences of residents. Our approach to the subjective and social phenomenon of living in residential care homes for the elderly derives from “inter-world sociology” [sociologie de l'intermonde] (Martuccelli, 2006; 2010). Shaping the contours and experiences that are formed here focuses our attention on two issues: that of spaces (such as physically differentiated places of institutional residence ; such as a home, between social relations and subjective investments) and that of identities. The double issue of spatial transitions and identity negotiations, crystallising the test of living in residential care homes, is thus approached from both angles. This circulation in a socio-spatial diversity reveals relational dynamics marked by the omnipresence of limits and the preoccupation for personalisation.

Résidence Services Seniors [Senior Service Residences] (RSS), what role do they play in the management of ageing?
Dependency management is a major concern of public policy. In a period of increasingly restricted budgets, the law of 28 December 2015 (Society's Adaptation to Ageing), points to the importance of the domestic residence in dependency management, including limiting the use of residential care homes for the elderly or EHPAD (établissement d'hébergement pour personnes âgées dépendantes). In this context, the law grants legal recognition to Senior Service Residences (RSS), without however specifying their role or the scope of their involvement. Our aim here is to clarify the role and place of the RSS in the gerontology field but also in the representations of the elderly and their families. We will therefore compare the viewpoints of the various actors involved : public authorities, home developers, operators and managers, and the elderly.
The development of RSSs did not wait for this law before putting forth its claim to be an actor in the gerontology field helping to limit the loss of autonomy. This self-proclaimed definition nevertheless represents a concern which differs from that of those who use this service. The latter, like the public authorities, consider the RSS as a tool for limiting the usage of residential care homes for the elderly. Committed to the sustainable alternative to institutionalisation represented by the RSS, residents do not plan to leave this type of residence, including when they lose their autonomy. It is up to the directors of residences to limit the scope of their activity. Thus opens a negotiating process regarding staying in the residence for persons with accentuated dependency.

Directors of Residential Care Homes for the Elderly : constraints, flexibility, and diversity of practices
In France, the leading provider of long-term institutional care is the residential care home for the elderly or EHPAD [établissement d'hébergement pour personnes âgées dépendantes]. In recent years the business model of these institutions has been called into question. However, knowledge about their method of functioning is incomplete. This article aims to study the management decisions of EHPAD directors and their determinants. A qualitative survey of 26 directors identified four defining lines in terms of care home organisation, staff composition, the fight against absenteeism, and the extent of modern management. Statistical analysis of an original survey of 460 managers was then used to study the determinants of directors' practices in human resource management. This study shows that, for the three decision nodes studied, the strategies adopted by directors are highly correlated to their initial training. This result opens new perspectives in the tools that can be mobilised to adapt EHPADs to the future challenges of the sector.

Employment of disabled persons in the French civil service: quantitative analysis of available national survey data
The French state is committed to policies whose purpose is to enable social roles and to encourage social participation of people with disabilities. Thus, the law of 11 February 2005 extended the obligation of employing people with disabilities and making up at least 6% of the work force to the public sector. However, an analysis of national survey data reveals that the public sector in France has failed to comply with this employment quota for disabled workers, as has also been the case in the private sector. This article examines the measurement of this rate of employment of disabled people and highlights certain characteristics of disabled workers compared to workers without disabilities, more specifically distinguishing those who work in the public sector. For example, workers with disabilities in the public sector are much older than workers without disabilities. In addition, the legal employment rate is lower in the state civil service than in the territorial and hospital civil services. Thus, the state, as an employer, has experienced difficulties in implementing the social policy of occupational integration of people with disabilities that it itself established with the 2005 law.

Employing the disabled: from the principle of non-discrimination to skills management by local authorities
This article examines how employment policies for disabled persons are perceived by local authorities. Despite the strengthening of national policies encouraging employment of this category of the population, local authorities have not applied these measures in a major way. They challenge the fact that the State directs them in their internal recruitment policies, especially as they have been called on, in parallel, to reduce their payroll. On the other hand, the employment policies adopted do not focus on the fight against discrimination but on increasing the skill level of disabled workers, which continues to heavily penalise this group in the labour market. This article contributes to an analysis of the obstacles, always multiple, faced by people with disabilities in working in ordinary employment, eleven years after the 2005 law.