WP2 : Territorial regimes

Territorial regimes of autonomy (A. Sopadziyan, L. Trabut)

At the territorial scale, autonomy regimes refer above all to the capacities that institutional and organized actors, families, and relatives have for implementing specific support for persons in need. The territorial scale is above all concerned with locally available resources. As levers of implementation, the contingency of these resources then redefine national regulations, thus leading to an appropriation of the definition of autonomy. To this end, Aurelia proposes to analyse the local level evolution of resources and actor configurations in space and time.

Characterization of territories and their relationships with local definitions of LTC policies on autonomy

Significant differences between countries have been highlighted in their decisions on LTC policies and schemes, which are particularly a result of different traditions, laws, and geopolitical contexts (Lavoie and Clément, 2005; Gérontologie et société, 2003; Ishii, 2013). The social support systems for autonomy that coexist in the territories today are the result of a combination of systems anchored in different policy scales. In order to test the hypothesis that the deployment of national schemes is partly contingent on the resources available in a given territory, we first propose to identify the resources specific to the different territories studied. This approach is based on a diachronic and synchronic analysis of the mechanisms involved in the autonomy schemes. 

Subtask 1.a Inventory of the schemes and services:

A survey of the LTC schemes and services relating to support for autonomy will be carried out in three territories per country. The focus will be on the support systems for populations targeted by the project, in particular those in the health and medico-social fields, as well as on support systems for carers. In order to identify these systems, we will rely on the systematic analysis of administrative and public policy documents and we will carry out an  analysis of configurations of local actors/local actors’ in the domain of frail older persons and persons with disability. The territories, selected in consultation with the partner teams identified in each country, will present contrasting economic and social characteristics (urban/rural, level of socio-economic development) and different procedures for supporting autonomy (establishment/home, involvement of families, importance of the market, etc.). This will allow studying a variety of devices and structures involved in the implementation of the schemes. In France, we will select a rural territory in the département Loire-Atlantique, in consultation with the Nantes team involved in the project; an urban area in the Île-de-France; and a third area in the more familial south-west of France (Trabut, Gaymu, 2016). The choice of international areas will respect the contrasts relevant to each national space: for example, in Germany between the eastern and western parts of the country, and in Canada between the French- and English-speaking provinces.  
The document analysis will enable us to understand the local dynamics of LTC policies and scheme implementations. The aim will be to formulate hypotheses on the conditions of their emergence and implementation by observing the administrative sources over a long period of time (about twenty years). 
The inventory carried out on administrative documents will be completed and objectified by a quantitative census of the facilities in all the sub-national territories together with an evaluation of the needs of the populations. We will try to characterize the territories according to their facilities, taking into account the characteristics of the latter when possible. To this end, we will mobilise survey and administrative data in order to draw up standardized territorial portraits that will allow an objective comparative analysis of the schemes. With an exhaustive ambition in France, this work will be carried out according to the availability of administrative data in each country.

Subtask 1.b Sequence analyses: 

As a second step, in order to understand the conjunction of schemes leading to the current situation, their historical trajectories will be analysed based on the implementation of the schemes from a territorial and longitudinal perspective. We hypothesize that a reconstruction of the history is necessary for understanding the conjunction between demographic and socio-economic evolutions, on the one hand, and the multiple dimensions of policies on the other. 
In order to reconstitute the "territorial histories", we will rely on indicators defined on the basis of the data identified in subtask 1.a. and the sources specific to each country. We will rely on methods of sequence analysis. Our aim is to identify sequences of welfare state development at the territorial level in order to compare them with national development sequences and to draw up a typology following the example of A. Abbott and S. Deviney (1992). By selecting the instruments and measures to be analysed according mostly to their sector (medico-social or health) rather than to the recipients (carers, people with disabilities, and elderly people), it is possible to observe the combinations of measures and understand how they become segmented over time. By establishing an order of the appearance, development, and even disappearance of certain systems or actors over time, we can try to reconstruct sequences specific to each territory and compare them.

Autonomy in context and the implementation of instruments

 Following the inventory drawn up in task 1, task 2 proposes to analyse the implementation of LTC provision in the selected territories based on the organizational and professional interactions between the structures involved in supporting individuals in the three selected territories.
It is based on a monographic qualitative survey. We will interview both the public actors who manage and finance these structures when they are territorialized as well as the managers and persons in charge of the services involved in support. The interviews will aim to understand the manner, the issues, and the effects of maintaining autonomy. It will be a question of going back over the genesis and dynamics of the systems studied without overlooking their functions and possible dysfunctions in relation to the established objectives of autonomy. The interviews will enable us to analyse the locally specified definition of autonomy by highlighting both the advances and the possible organizational, institutional, and professional obstacles to realizing the different dimensions of autonomy. These interviews will be complemented by observation, particularly in terms of accommodation and collective support.
The more specific report on instrumentation will be devoted to analysing the implementation of the selected instruments. It will first of all establish who are the actors involved in the implementation and their knowledge of it, which namely concerns the professionals and family carers. In the different countries, a wide variety of reference frameworks (technical, functional, self-evaluative, psychological, multi-disciplinary, etc.) guide the implementation of the selected instruments.
For each family of selected instruments (assessment of autonomy loss; standard of autonomy to be restored and rehabilitation rationale; and tool for compensating autonomy loss), we will characterize:

  • The actors involved in the implementation (status, sectors, administrative structure, professions, rationale for interacting with the public, supervision, and control over implementation etc.);
  • Professional and technical knowledge (for example, in the case of France, the poor development of nursing and care sciences);
  • The legal framework for care procedures (responsibilities, obligations, derogations, etc.);
  • The corpus of values and references that guide the actions of laypeople (especially family carers).