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 street-level 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.

Keywords

• implementation
• long-term care
• frames
• gender
• professional cultures