On the Japanese island of Okinawa, renowned for the longevity of its residents, there is a tradition known as *moai*. From childhood, groups of neighbors or friends come together and commit to supporting one another throughout their lives. When one member faces hardship, they can rely on the support of the group. This system is based neither on government intervention nor on specialized institutions, but on strong community ties. This community-based approach is not unique to Japan. In many parts of the world, support for vulnerable individuals relies primarily on family members and close friends.
In France, this role is fulfilled by millions of people: family caregivers. According to the French Directorate for Research, Studies, Evaluation and Statistics (Direction de la recherche, des études, de l’évaluation et des statistiques, DREES), 9.3 million people in France report providing regular support to a loved one because of age, disability, or illness (DREES, *Études et Résultats*, 2023).
These caregivers are a cornerstone of the support system. Understanding their role, identifying them more effectively, and providing them with appropriate support have become critical priorities for the future of long-term personal autonomy.
In this article, Alcimed explores the increasingly central role of family caregivers in supporting people experiencing a loss of independence and the challenges this reality presents for the future of public long-term care policies.
A family caregiver is someone who regularly provides support to a loved one experiencing a loss of independence, living with a chronic illness, or having a disability. This support can take many forms, including financial assistance, transportation to medical appointments, help with administrative tasks, meal preparation, emotional support, and more. Unlike healthcare or social care professionals, family caregivers provide this support without professional status and, in most cases, without formal training.
In France, one in six adults and one in twenty minors (DREES) are caregivers. Although they come from a wide range of backgrounds, several trends stand out: women account for 58% of caregivers, and nearly 70% are employed (DREES). For them, this often means adding to already demanding lives that include work, raising children, and other family responsibilities.
While ubiquitous, caregivers often are often not named as such. Many people who regularly support a loved one do not naturally identify themselves as “family caregivers.” Instead, they simply see themselves as fulfilling their role as a parent, child, or spouse.
The growing recognition of family caregivers and their role in society must be viewed in light of the profound demographic and epidemiological changes taking place in France today. Population aging and the rising prevalence of chronic diseases are steadily reshaping long-term care needs.
According to the French National Institute of Statistics and Economic Studies (Institut national de la statistique et des études économiques, INSEE), more than one in five people in France are now aged 65 or older, compared with approximately 16% in the early 2000s. This demographic shift has led to a growing number of people experiencing a loss of independence. In 2021, France had just over 2 million older adults living with as dependent, and that number could reach nearly 2.8 million by 2050 (INSEE).
At the same time, the increasing prevalence of chronic diseases is changing the very nature of the support provided to vulnerable individuals. Neurodegenerative diseases such as Alzheimer’s and Parkinson’s disease, as well as chronic conditions including cardiovascular disease and diabetes, often require long-term support over many years.
In this context, family caregivers are playing an increasingly central role. For example, aging in place relies heavily on their involvement.
In other words, family caregivers are no longer simply providing informal family support. They have become essential contributors to the organization of care pathways and long-term care services.
However, this level of involvement comes at a cost. Research from DREES shows that caregivers are more likely than the general population to experience physical and psychological exhaustion, social isolation, and difficulties balancing work, family life, and care giving responsibilities.
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In response to these developments, family caregivers have become an increasingly important focus of France’s long-term care policies. In recent years, several initiatives have been introduced to better recognize and support them.
Among these initiatives, Caregiver Support and Respite Platforms (Plateformes d’accompagnement et de répit, PFRs) play a central role. Available throughout the country, their mission is to provide caregivers with information, connect them with available resources, and offer solutions tailored to their individual needs. According to the French National Solidarity Fund for Autonomy (Caisse nationale de solidarité pour l’autonomie, CNSA), more than 300 local platforms are currently operating across France. They serve as a gateway for caregivers, helping them identify their needs and better understand the services available to them, including psychological support, information about their rights, assistance with administrative procedures, and referrals to local organizations.
These initiatives reflect growing recognition of the essential role family caregivers play in supporting vulnerable individuals. Nevertheless, several challenges remain.
The first challenge is identifying caregivers. Many people do not recognize themselves as caregivers and are therefore unaware of the resources available to them. In this context, healthcare professionals, social care professionals, local authorities, employers, and educational institutions all have an important role to play in identifying and connecting caregivers with existing support services.
The second challenge is ensuring caregivers can access the most appropriate support services. Today, caregiver support involves a wide range of organizations, including nonprofit organizations, public institutions, and private providers. This diversity can make it difficult to identify the right point of contact or the most appropriate service for a specific situation. For many caregivers, the challenge is not the lack of available support, but rather the complexity of navigating the system.
Finally, another major challenge is ensuring caregivers receive sustained support over time, particularly through the expansion of caregiver support and respite services.
Respite care refers to the range of services and programs that allow caregivers to take a temporary break from their care giving responsibilities so they can rest or maintain their personal and professional lives. These services may include adult day care, temporary residential care for the person receiving support, in-home replacement care provided by professionals, activities specifically designed for caregivers, psychological support, and more.
Today, family caregivers play an essential role in supporting people living with dependency, disabilities, or chronic illnesses. In France alone, more than 9 million people assume this responsibility, often behind the scenes and with little recognition.
As the population continues to age and chronic diseases become more common, their contribution will become even more critical in the years ahead.
Recognizing, identifying, and supporting family caregivers has therefore become a key priority for the future of long-term care policy. Beyond existing programs, this challenge also calls for broader reflection on the organization of care pathways, coordination among stakeholders, and the adaptation of public policies to local needs.
Behind every person experiencing a loss of independence, there is often a loved one who organizes, supports, and cares for them. Supporting family caregivers also means strengthening the long-term sustainability of care delivery and the broader long-term care system.
Alcimed can support your projects related to care pathways for people experiencing a loss of independence. Do not hesitate to contact our team.
About the author,
Romane, Consultant in Alcimed’s Innovation and Public Policy team in France
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