The effects of system characteristics on policy implementation and functioning of care for the elderly in France.

In the early 1960s, old age in France was replaced by the notion of "troisième âge," a new definition stressing the possibility of pursuing social and leisure activities and greater independence. Old age itself was postponed to a later age, and acquired a purely negative image and one confused with that of incurable illness. As a result, a living-at-home policy was elaborated, and also a program of adapting institutions to the problems of those now defined as being in the "quatrième âge." This dual-faceted medicosocial policy was originally intended to be comprehensive and coordinated. Analysis of the structural characteristics of the care providers and of the agencies responsible for organization and financing of services shows fragmentation at the levels of service delivery and policy development. This prevents the coordination of service provision, gives rise to a mismatch between people and provision, and leads to a lack of coherent regulation and of adequate financing, in particular with regard to domiciliary care and social services. External factors, such as scarcity of funds related to the economic crisis, reinforce system dysfunctions.