FIGURE IT OUT… in Martinique, recipients of the Personalized Autonomy Allowance often use the “direct employment” option, given the high cost of dedicated in-home care services.

Myrtille FERNÉ, a sociologist, examines public and family-based care systems for older people in need of assistance in Martinique. This territory is experiencing very rapid population aging, along with high levels of unemployment and poverty. The in-home care services sector (SAAD) is emerging under the impetus of national in-home care reforms. However, care provided by a family member has remained central. Myrtille FERNÉ explores how this family-centered structure of care - both ideological and organizational - interacts with public support.

Her analysis draws on interviews and observations conducted with 13 older adults, 43 family caregivers, 12 SAAD employees, and 40 staff members of the Territorial Collectivity of Martinique. 

In this territory, most recipients of the Personalized Autonomy Allowance (APA) opt for the direct employment scheme, which allows them to use the benefit to hire an in-home caregiver outside of a SAAD; this worker is often a relative. In 2018, the scheme accounted for 57% of APA expenditure, a share five times higher than the national average. Interviews with the Collectivity staff suggest that this rate reflect family preferences rather than an explicit policy choice. Indeed, direct employment provides a form of recognition, through payment, for the work of a family caregiver, who may face economic and employment difficulties. But the caregivers interviewed also point to a lack of alternatives: limited public funding for the SAAD sector in Martinique restricts its development and makes it too expensive for many families.

Overall, the prevalence of direct employment reflects both practices rooted in family solidarity and limited access to SAAD services in the territory, within a difficult economic context.