Implementing the French elderly care allowance for home-based care: bureaucratic work, professional cultures and gender frames

Abstract

Care realities are characterised by important differences between men and women. At the end of the 1990s, women were overrepresented among the oldest sections of the French population, as well as among their unpaid and paid helpers. Nevertheless, when the current national benefit scheme for elderly people needing long-term care (the APA (Allocation Personnalisée d'Autonomie)) was adopted in France, it was not explicitly framed with gender issues in mind. French subnational governments (the départements) were charged with implementing the new scheme, but also have the capacity to transform it. How has this policy been applied on the ground and with which gender-related effects? In order to answer this question, this article draws on 33 interviews and several observations conducted with street-level bureaucrats in charge of implementing the APA in a French département. Through streetlevel organisation analysis, frame analysis and discursive institutionalism, it analyses how subnational governments and street-level bureaucrats use their room for manoeuvre in policy implementation, and the frames they use to take decisions. Special attention is given to the implications of these frames from a gender perspective. This article explores three different dimensions of this issue: (1) the discursive frames attached to the APA at national and subnational organisational levels; (2) the way street-level bureaucrats perceive institutional constraints and resources, and interpret their work, and how the gender implications of these frames influence the decisions they make in practice; and (3) the consequences of administrative decisions for the public affected by them.

Care policies in practice: how discourse matters for policy implementation

“…Bureaucrats, in turn, use administrativealso, gender-blindframings to try to fit the specific situation of the individual into standard institutional schemes with the aim of fast-processing applications. By contrast, social workers adopt sociological frames which, although also gender-blind, are more responsive to the story told by the applicant and their families, and make decisions also considering the needs and the socio-economic inequalities involved (Dussuet & Ledoux, 2019). In sum, the conflicting interpretations and genderblind practices of the different groups of professionals engaged in the implementation process have important gender+ effects on the beneficiaries of the measures.…”

“…Implementing actors interpret these policy frames according to their own conscious or unconscious gender, race, and class biases, which express particular norms and values about what care is, what gender is and who should take care of children and frail adults. For instance, common policy frames show that care is interpreted as a problem related to employment (Scala et al, 2019), to family well-being (Plomien, 2019), a private responsibility (Ranci & Arlotti, 2019) or as 'real work' but only if carried out by someone other than the spouse of the person needing care (Dussuet & Ledoux, 2019). The frames used by implementing actors differ in their underlying gender+ norms because of the differential emphasis they place on women as the main actors attributed caring responsibilities, on the goal of achieving greater equality between women and men, and the need to address other inequalities that intersect with gender in the social organization of care (Ciccia & Sainsbury, 2018).…”

“…The professional frames adopted by different categories of street-level bureaucrats in charge of implementing care policies affect the decisions they make in practice by influencing their interpretation of institutional resources and policy instruments. Dussuet and Ledoux (2019) show that in assessing the level of dependency of applicants for the elderly care benefit, doctors rely on a biomedical, gender-blind frame. Doctors' framings, thus, tends to overlook the wider social context of the applicant such as the existence of an informal carer at home, usually the spouse.…”