Que faire de nos vieux ? Une histoire de la protection sociale de 1880 à nos jours by Capuano Christophe (review)

Christophe Capuano's book retracing the history of French social protections for older people no longer able to carry out fundamental daily activities without assistance arrives just as the question of how to deal with the problem of dependency in old age moves centre stage. The book actually covers public policy on both disability and old age, as French policymakers throughout the period remained undecided about which principles should shape policies targeting dependent older people.

The first part examines the period 1880 to 1945, presenting the development of the "invalidité ordinaire" assistance system (that is, for disabilities not caused by work accidents) and the creation of a social benefit designed specifically to meet home care needs. During the second period, 1945 to the late 1960s, two distinct policies were developed, one targeting people with major disabilities and the other, the elderly. Capuano is careful to show that disabled older people could benefit from both policies, though they were not the priority target of either. In the third and last section, covering the period from the early 1970s to the present, he emphasizes the sector-specific approach characteristic of the period: disability, old age, and employment policies were strictly distinguished from each other, meaning that responses to disabled older people were not coordinated. He also discusses the radical change of 1997, when dependent persons were differentiated by age, causing older people to lose disability policy benefits. And he works to explain the various failed attempts to reform how the national insurance system handles dependency, referring here to France's current debate on the "fifth risk" (the other four areas–health, family, work accidents, and pensions–are already covered by that system).

The history of public policies targeting the needs of dependent older persons appears at first sight like a chaotic, relatively incoherent one marked by policymaker hesitation about the right direction to take. But by bringing into the picture the ideological and political issues of the periods as well as the perceptions of the various institutional and individual actors, Capuano manages to produce an extremely useful reading of how the French social protection system evolved and what its current characteristics are.

Across all periods, French public administrations were constantly concerned to limit social welfare spending. Budget concerns come through as an extremely strong structuring principle of public policy and a strong determinant of its underlying principles. And at the turn of the century, budget concerns led public policymakers to interpret compensation for "invalidité ordinaire" as a matter of social assistance rather than risk insurance.

Likewise, it has been the concern about spending that has led public decision-makers past and present to favour the policy of "home care". As early as 1930, the disabled received cash benefits to pay for home assistance from an outside (non-family) caregiver. The aim was clear: to keep such people, particularly those over 70, out of hospices and other institutions, which local governments considered too expensive. Throughout the twentieth century, reforms and revaluations of benefits never went far enough to support an effective home care policy, one that actually would reduce admissions to institutions.

It was once again the authorities' concern to contain social spending that led them to decide that age should be taken into account in policies targeting dependent persons. Initially, the answer was no: "infirm" persons and older persons with the same level of "infirmity" were to receive the same benefits. For many years, the authorities chose to consider "dependent" older people as "disabled" persons. The author points out that the refusal to differentiate was based primarily on economic concerns; once again, the aim was to keep dependent older people at home, a less costly solution than institutional care. But it was economic arguments–arrangements perceived as too comfortable for...