Residential or In-home Care for Disabled Older Adults: The Role of Geographical Context

Population ageing raises the question of long-term care arrangements for disabled older adults, be it in their own homes or in a residential facility. Analysis of trade-offs in the long-term care market is especially interesting for France, where old-age policy is managed at the département level. This decentralized system may give rise to geographical inequality in access to care because not all departments are equally endowed with resources to offer the desired levels of care provision. This article analyses the determinants of residential care access by combining data from two surveys and from administrative sources on long-term care. To identify the constraints that weigh upon individual choices, multilevel models are used to examine how needs, income, and informal and formal care shape geographical inequalities in care arrangement. This study reveals substantial differences in the probability of living in a care home, due partly to geographical disparities in the availability of formal care, further accentuated by disparities in out-of-pocket costs.