Homecare: insurers are expected to be on the ball

With the demographic transition, French society is changing its face

A sharp acceleration in the aging of the population to come

Although France already has more than 13 million people aged 65 and over, the aging of the population is expected to accelerate between now and 2040 with the arrival of the baby-boom generations in old age.

Indeed, INSEE estimates that the number of dependent persons will increase by 1.5 million by 2050 and that the number of Protected Adults will double to reach 2 million by 2040.

New, evolving and complex needs that will increase in the coming decades  

While it is accepted that the dependent population will be older and longer, it is difficult to predict the future needs of the elderly population. On the one hand, this acceleration of the aging of the population is unprecedented in French demographic history, and on the other hand, it is complex and evolving because it depends on the social, financial and medical situation of the person. Finally, a study by the former General Commission for Territorial Equality emphasized that territorial dynamics can be very disparate.

This observation underlines the need to act at the root to better prevent situations of loss of autonomy and their subsequent deterioration, which we believe the current system does not do well.

Moreover, this should reinforce the need for all actors to act on the determinants of health and autonomy (adaptation of housing, mobility, access to culture, physical activity, leisure, etc.) as well as on avoidable factors of loss of autonomy (prevention of falls, malnutrition, sedentary lifestyle, etc.) and to prevent situations of incapacity from deteriorating further (adequate level of care and assistance, at home or in an institution, etc.). These needs are still not covered in our opinion by the current health system.

Today, the market is highly concentrated on the dependent elderly and is expected to grow especially among the elderly population at home

Today, public and private actors are focusing their efforts on only part of the challenge

For the moment, the public authorities are focusing mainly on dependency, as shown by the €34 billion devoted to the 605,000 residents of EHPAD and the 200,000 people losing their autonomy, compared to €28 billion devoted to the 25.6 million elderly people at home. This concentration comes at the expense of a very important "informal economy" made up of 11.5 million close caregivers, a quarter of whom declare that they devote at least 20 hours a week to the person being cared for.

In the future, the home should be a major driver of the aging support market

First and foremost, 85% of French people want to age at home^[1]. This aspiration is already confirmed by the fact that 90% of people over 75 years of age live at home, as well as by the decline in the average age of entry into EHPAD (86 years and 8 months at the end of 2019). This trend is expected to continue with the arrival of the baby boomers, who are very attached to their autonomy and well-being.

Finally, estimates by the DRESS^[2] tend to indicate that the number of existing places in EHPAD could be sufficient in 2030 with an additional need for 110,000 beds if the policy of home care is strengthened.

On the other hand, support in the home is far from optimal at the moment, mainly due to the overlapping of competences between all the players involved, which means that the elderly person's progressive loss of autonomy is followed in a disjointed manner.

But there are still major obstacles to be overcome

The development of support for ageing at home must remove several obstacles. First of all, all of the resources dedicated to support are very difficult for the population to understand. This is exacerbated by the fact that the population is not sufficiently aware of the challenges of aging. Finally, the services offered are still too expensive and the French population is generally not convinced of their quality.

Initiatives in some European countries are inspiring, such as the care manager (a single local contact person) who is responsible for the personalized follow-up of beneficiaries to help them with their procedures and coordinate the various services mobilized.

Milestones for reflection and action around an updated services strategy

Although the challenges of aging well are major, the demand is for the moment timid and fragmented according to the numerous needs. Despite unsuccessful attempts for the moment, no BtoC offer exists to try to gather these needs.

In the absence of a strong public policy that could concentrate demand, the question arises of how to respond to the many needs in a realistic and relevant way.

A more targeted approach by type of population, actors and key moments of evolution seems to us more relevant:

• Caregivers, especially the half who do not consider themselves as such, who have a strong need for reassurance and who buy certain services "on prescription";
• Players in the dependency market, who are interested in the home care market as a potential growth driver, but who are not venturing into this market for the moment due to a lack of resources;
• The local authorities most strongly impacted by the aging of the population, which must review their local support services;
• The period when the loss of autonomy is the greatest, with the absence of coordination mechanisms between actors accompanying the elderly person, which often leads to a traumatic experience and therefore a further deterioration of the person's condition.

We believe that banks, and in particular bancassurance companies, are well placed to support their customers, both those being cared for and those providing care, in these complex and intimate issues, by capitalizing on their proximity to them, particularly in the following areas

• Contribute to bringing creativity to their potential insured clients while the 5th branch of social security dedicated to loss of autonomy has just been created (but without any real means) and no compulsory financing by private insurance is planned for the moment.
• Integrate prevention issues, with a strong promise to be able to delay or even limit the loss of autonomy, including the financing of home improvement work, or relying on existing services such as remote monitoring;
• Adjusting and developing offers dedicated to Protected Persons, while capitalizing on proximity and digital technology to strengthen their attractiveness and performance
• Playing their role of advice more widely, whether on the issues of transferring assets, or on the procedures and assistance related to the status of each person
• Play the role of "orchestrating" the more global offer related to "Aging well", associating the necessary partners, and possibly also targeting other players (players in the dependency market, local authorities)

Laure Lemaignen (associate director) and Olivier Milcamps (senior manager)

^[1] FESP Study / Sociovision and IFOP in 2019

^[2] DREES Study: Stuy and results 1172, Décember 2020

Read the article published on April 26 in La Tribune de l'Assurance.