1. 19 th 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. 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? Introduction Methods Results Discussion

3. 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) Introduction Methods Results Discussion Objective of the study: Assessing cost of care provided to French disabled elderly living at home

4. 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 Introduction Methods Results Discussion Sample restricted to disabled people aged 60 and over who receive assistance with daily activities (n = 2,686)

5. Economic valuation  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 Introduction Methods Results Discussion

6. Cost of care Introduction Methods Results Discussion Informal careFormal careTotal Persons with dementia3.0 [2.5 ; 3.5]2.2 [1.8 ; 2.7]5.2 [4.3 ; 6.2] Other disabled persons3.6 [3.1 ; 4.0]1.8 [1.4 ; 2.1]5.4 [4.6 ; 6.2] Total6.6 [5.9 ; 7.2]4.0 [3.4 ; 4.6]10.6 [9.4 ; 11.9] Billion euro per year [95% confidence interval]  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. Cost of care Introduction Methods Results Discussion  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. 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 Introduction Methods Results Discussion

9.  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) Introduction Methods Results Discussion

10. 19 th 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