Reports commissioned from eminent figures, the Senate’s (upper house) own inquiry and reports from public bodies: the growing loss of independence is fortunate to have so many collective and individual expert gazes cast on it. We have picked out the essentials for you.
1. The Gisserot report
Top public law officer Hélène Gisserot, tasked with looking into a specific branch of social security to address loss of autonomy and what part supplementary insurance might play in it, unveiled her report at the end of the first quarter 2007. It projects three possible scenarios.
The first is no new increase in compulsory deductions from earnings other than that linked to GDP growth! Which puts paid to the responsible choice voted for by the rank-and-file activists at the UCR congress in Saint-Etienne! Worse, because it actually means a long-term reduction in the scope of what will be paid for by personalized independence benefit (APA) and a development of “long-term care insurance”…
The second is to improve care provision while cutting the family self-pay amount. This would be a costly measure, involving an increase of around 4.7% a year in compulsory deductions from earnings…
The third and final scenario is for a sharper reduction in the self-pay amount by introducing a high insurance co-payment charge (about 15%) except for people on low incomes, or by freezing it at the current level: in this case, public spending would grow at rates well in excess of 5%…
2. The Economic and Social Council report
The Economic and Social Council also considered the issue of growing dependency in a report published in September 2007. It stresses both the benefits and consequences of longer life expectancy, and argues that the costs, especially spending for the benefit of carers, should be paid for by society as a whole. It also calls for firmer management of the CNSA
3. The CNSA report
The national solidarity for autonomy fund (CNSA) is more than happy to side with the ESC’s call to strengthen its role. Its report was handed in to Xavier Bertrand on 5 November 2007 following a unanimous vote by its board on 16 October (47 members for and just one abstention - by the CGT!).
The report’s main aim is to point to possible ways forward, clarify the different approaches that prevail within the board, and spell out future points for consultation and negotiation. But what is the bottom line?
Improved governance, confirming the CNSA’s national operator role. That means expanding the board to include other players involved in long-term care and possibly increasing the influence of county councils.
A new universal right which would take the form of a universal personalized “disability adjustment and help with independent living” benefit. That will mean drawing up a detailed catalogue of essential goods and services.
Opting for financing by collective solidarity, which does not rule out looking at what place supplementary insurance may play in the system, which would have to work on the basis of a partnership based on a common set of rules and costs accepted by the participants.
On top of that, Xavier Bertrand and Ministry officials have said that they expect this report to form the basis for the future consultations!
4. Proposals from individual senators
What this foreshadows might have been accepted except that unfortunately, December saw various senators reviving the disgraceful principle of clawback from the individual’s estate: ill people pay even more because they are ill...
After this scheme was thrown out, one of these senators - Philippe Marini (UMP) - promoted the setting up of a senatorial board of inquiry into the issue and the initial feedback from its work - unveiled at a conference on 30 January 2008 - is far from encouraging for the exchange and consultation phase meant to follow the exploratory thought phase.
We shall know the actual terms of what it says when it is officially published in mid-May (not in time for this issue - Ed.).
A few figures
Being human is not about age, but about dignity! This phrase must be written into all the thinking and debates that are apt to come out of this vexed issue of dependency that is likely to affect one in ten pensioners in 2010, and double that number by 2019. The pensioner population is set to increase from 13.5 million in 2010 (1/6th of whom will be over 85!) to 17 million in 2019/2020, rising to 21.5 million in 2040 - an estimated one-third of the total population.
The steadily lengthening lifespan of this growing pensioner population will bring with it an increase in the number of dependent persons. The prevalence of dependency, which is 2% among 60-69-year-olds, will rise to over 10% at age 80 and 30% at 90 years of age.
These statistical prevalence scenarios are already borne out by the steady rise in APA payments to GIR categories (Iso resource groups) 1 and 4[[GIR 1: bedridden elderly people with seriously impaired intellectual functions, requiring constant attendance by health care personnel
GIR 4: two main groups of elderly people: those who are unable to get up on their own, but once up can move around indoors; and those who have no problem moving around but need help with bodily functions and meals.
At 30 June 2007, there were 1 048 000 recipients - up 6.8% on 30 June 2006 and 8.8% up from between June 2005 and June 2006, including an unchanged 44% in GIR category 4.
The same sources (Drees No. 615) report that 60% of APA claimants live at home and 40% in residential care - unchanged from previous years.
Finally, as regards the question of whether growing dependency always equals greater disability, it bears pointing out that disability-related expenditure - taken in its widest sense - is more than three times that on dependency (34.2 billion euros in 2006).
Extract from the UCR-CFDT’s “Retraité Militant” magazine, Issue No. 08-06, June 2008
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