Economic valuation of formal and informal care for French disabled elderly living at home

1. 19th Alzheimer Europe Conference - Session “ Assistance and support (Home and respite care) ” 28-30 May 2009 - Brussels Economic valuation of formal and informal care for French disabled elderly living at home Bérengère DAVIN – Alain PARAPONARIS

2. Introduction Methods Results Discussion Context • Demographic trends in France • Persons aged 60 and over (Insee, 2008) • 2006: 13 million (20.7% of the total population) • 2035: 21 million (30.6%) • Disabled elderly (Duée & Rebillard, 2006) • 2006: 1 million • 2035: about 1.4 million • Long-term care costs • Public costs • 19 billion euro / year (Sénat, 2008) • 1.1% of the GDP in 2005  between 2 and 2.8% in 2050 (OECD, 2005) • Private costs • Out-of-pocket payments??? • Informal care?

3. Introduction Methods Results Discussion Objective • Sharing between formal care and informal care • Informal care represents ¾ of care provided to the French elderly • (Breuil-Genier, 1999; Petite & Weber, 2006; Davin et al, 2008) Objective of the study: Assessing cost of care provided to French disabled elderly living at home

4. Introduction Methods Results Discussion Data • French representative survey on health and disability (HID survey) • Carried out in 1999 among people living at home • Information on • Sociodemographic characteristics: household composition, education level, income • Living conditions: care received, home modifications, use of assistive devices • Health: impairments, disability, need for care • Daily activities • 6 ADL: bathing, dressing, using the toilet, eating, getting in and out of bed, going out • 3 IADL: shopping, preparing meals, doing housework Sample restricted to disabled people aged 60 and over who receive assistance with daily activities (n = 2,686)

5. Introduction Methods Results Discussion Economicvaluation • First step: assessing hours of care • Use of a methodology developed by French social experts that defines the number of hours required to perform each activity (Pampalon et al., 1991) • Application to HID data • Distinction between formal and informal care • Second step: assessing cost of care • Use of the proxy good method that applies to a non-market activity the labour market wage of a close substitute (van den Berg et al., 2004) • Wage rate used • French minimum gross hourly wage in 1999 : 11.05 euro / hour

6. Introduction Methods Results Discussion Cost of care • Persons with dementia in the HID survey • Criteria used in a report for the Fondation Médéric Alzheimer (Colvez & Royer, 2008) • Reported or assessed impairment of intellectual functions • Disorientation to time and place • Disability with managing paperwork, taking medication and using phone

7. Introduction Methods Results Discussion Cost of care • Annual cost of informal care per person • with dementia: 12,840 euro • with other disabilities: 12,745 euro • Informal care represents about • 57% of cost of care provided to persons with dementia • 67% of cost of care provided to persons with other disabilities • Comparison with other results (EuroCode working group - Wimo et al, 2008) • Total cost of dementia in EU27: 130 billion euro • Annual cost of informal care per person with dementia: 11,773 euro • Informal care represents 56% of the total cost

8. Introduction Methods Results Discussion Discussion • Limits: • Underestimation of cost • 9 activities only • Supervision / surveillance not considered • Hypothesis: provided care meets the whole needs • Cost assessment method (proxy good method) (McDaid, 2001; Van den Berg et al, 2004, Koopmanschap et al, 2008) • No distinction between the different care tasks provided • Formal and informal care are assumed to be perfect substitute, with no difference in efficiency and quality • Which value for care provided by people who don’t work? • How distinguish between normal household tasks and informal care tasks for people living together? • Exclusion of people living in institutions

9. Introduction Methods Results Discussion Discussion • Consequences of providing care • On economic and financial resources of informal caregivers • Decrease of working time, career break, early retirement • (Carmichael & Charles, 1998, 2003; Fast et al., 1999; Heitmueller & Inglis, 2007; Stone & Short, 1990) • Out-of-pocket payments for care • (Rice et al., 1993) • On caregiver’s life • Isolation from family and social network • (McDaid, 2008) • On caregiver’s health • Either physical, mental or psychological health • (Joël et al., 2000; Navaie-Waliser et al., 2002; Schulz & Beach, 1999)

10. 19th Alzheimer Europe Conference - Session “ Assistance and support (Home and respite care) ” 28-30 May 2009 - Brussels Economic valuation of formal and informal care for French disabled elderly living at home berengere.davin@inserm.fr