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Autonomy Regimes in Long-Term Care Arrangements: Instrumentation and Territories (AURELIA)

Autonomy Regimes in Long-Term Care Arrangements: Instrumentation and Territories (AURELIA)

Project website
Project status
Olivier Lipari Giraud
Host institution
Ined (Institut National d'Etudes Démographiques)
Institution web page
Team members
VALDES Béatrice, EHESP, France LEFORT Marc, CHU Nantes, France LEROUX Guillaume, INED, France LELIEVRE Eva, INED, France TRABUT Loïc, INED, France BOUQUET Marie-Victoire, INED, France PENNEC Sophie, INED, France TRENTA Arnaud, IRES, France SOPADZHIYAN Alis, EHESP, France EYDOUX Anne, LISE - CNAM, France GARNIER Bénédicte, INED, France MORAND Elisabeth, INED, France OUMEDDOUR Leïla, IRTS, France LECHEVALIER Sébastien, EHESS, France GUILLEMARD Anne-Marie, EHESS, France TAMAKI WELPLY Yuko, EHESS, France TRIFFEAU Vincent, CHRU Lille, France LEDUC Ophélie, CHU Nantes, France THREHOREL - PINOT Marie-Lyne, CHU Nantes, France MARIER Patrick Concordia, Canada VAN PEVENAGE Isabelle CREGES, Canada DUSSUET Annie CENS, France MIYAZAWA Kazutoshi Doshisha University, Japan NIIMI Yoko Doshisha University, Japan SAKODA Sayaka Doshisha University, Japan TAKANAMI Chiyoko Doshisha University, Japan YAGI Tadashi Doshisha University, Japan YAMAMORI Toru, Doshisha University, Japan YOSHIDA Toru, Doshisha University, Japan LEDOUX Clémence, Univ. Nantes, France CAMPEON Arnaud, EHESP, France GIRAUD Olivier, LISE - CNAM, France PETIAU Anne, BUC Ressources, France DARMON Linda, HIA Percy, France CAILLAUD Pascal, Univ Nantes, France LE BIHAN Blanche, EHESP, France MEILLAND Christelle, IRES, France NIZZOLI Cristina, IRES, France COMAS HERRERA Adelina, LSE, UK PFAU-EFFINGER Birgit, U. Hamburg, Germany LEBORGNE Françoise, U. Brest, France REBOURG Murie, U. Brest, France BENOIT Maud , UQAM, Canada OCH Ralf, Germany
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Project Summary



The Aurelia project aims at analysing autonomy regimes, defined as the organisational modalities of autonomy support. They result from social discourses, institutionalised norms and concrete aid measures, but also from the daily practices of carrying out support tasks for frail older people and for people with disability (objective 1 & 2). This project combines a comparative analysis of the policy instruments design, in relation to specialized debates and social discourses, but also with the implementation procedures, and the concrete practices of support for autonomy, as well as the different dimensions of their reception by the public concerned and informal carers. This project will capture these regimes at the territorial level, in articulation with national systems, territories and individual situations.

The Aurelia project develops three articulated objectives:

  • Analysis of the tensions between norms and practices of long term care;
  • Analysis of the tensions between national, territorial and individual policy scales of regulation long term care provision;
  • A reading of the autonomy regimes through the analytical lens of instrumentation, as the instruments deploy concrete provision and organise power relations in a given policy domain and between them (capacities, financial resources, obligations, information, etc.). Concretely, the project focuses on the instruments assessing autonomy loss, the doctrines of rehabilitation, but also the tools for compensating autonomy loss. In the case of those instruments, autonomy is simultaneously constructed by representations, scientific knowledge, and especially medical and professional knowledge. These instruments also give rise to acts of implementation, appropriation – or circumvention – by the public. The project analyses public discourses insofar as they contribute to defining the content of the notion of autonomy in policy making, contribute to forging policy instruments, but also to structure professional or lay knowledge corpuses that guides both the practices of implementing measures and the informal acts of autonomy support that take place at home. Finally, the Aurelia project produces analyses of autonomy as a norm, located at the intersection between differentiated social orders, driven by actors anchored at various scales and individual expectations.


The project is based on a pluralistic research methodology. It is based on qualitative analyses of discourses, public policies – and specifically of instruments -, interviews of actors involved in the decision or implementation of instruments, as well as of informal actors and recipients of the various measures and practices of autonomy support. The quantitative analyses will capture the disparities of territories and characterise the autonomy regimes of specific context: equipment, policy implementation and take up, varieties in the modes of care, socio-economic indicators, but also the configurations of actors and care around the beneficiaries.

Outputs / expected Outputs

The Aurelia project aims to have impacts and to launch both direct and indirect spin-offs in various social areas. In particular, linking distinct social spheres to autonomy is one of the key objectives of the project.

In the scientific field, the project aims to create a significant impact in three ways.

Firstly, the project will have a significant impact on the different disciplines mobilised for the project. The Aurelia project will produce new knowledge in the fields of sociology, political science, geography, institutional economics, demography, and law, because it will connect diversified areas of knowledge pertaining to LTC research. This ambitious research will be innovative because it analyses the transformations of policy and policy instruments in the domain of LTC, the cultures and representations of social groups, national and territorial traditions, and the social practices of autonomy captured at the individual level in a multiscalar and comparative perspective both within and between countries.

Secondly, this ambition will be achieved by using a research strategy based on mixed methods (Giraud, Maggetti, 2015). Qualitative analysis of cultural productions (novels and films, in particular), in-depth interviews with those responsible for policy making (institutions, associations, and service providers), and people specifically involved in LTC work (professionals and lay people) will be combined with qualitative analyses of social discourses in the field. These qualitative methodologies will be combined with quantitative analyses that are notably centred on the territories and their diversity (notably: needs, services, equipment, and methods of recourse). Furthermore, taking into account the socio-historical trajectories of the territories will constitute an additional methodological dimension of the intrinsically multiscalar approach taken by the Aurelia project. Finally, the international comparison will also specifically be of a multiscalar nature and combine studies on both EU and non-EU European countries with non-European countries. The diversity of the membership of these national configurations makes it possible to construct a large number of explanatory hypotheses through these national configurations, which are diverse in terms of their welfare state regimes (Esping-Andersen, 1990), social service provisions, cultural traditions, and their public authorities being either centralized or decentralized.

Thirdly and finally, this work is especially ambitious because it goes beyond the field of human and social sciences, especially by mobilizing medical specialists, notably in the field of functional rehabilitation, and allows for interdisciplinary work. In addition to the fact that this interdisciplinarity will provide crucial knowledge to the program, scientific impacts are expected from the cooperation between different disciplines within the humanities, social sciences, and medicine. New knowledge about LTC will be provided by an international comparison of various analyses on medical expertise in the governance of public actions for supporting autonomy loss and on the more individual context of the relationships between medical experts, other professionals (particularly in the field of social support), and laypersons.

These scientific impacts will be promoted in the scientific community through the publication of numerous communications and articles in scientific journals, with citations in French, English, and in the national languages of the countries analysed. The first results will be presented in the form of working papers (posted on the project partners’ websites and on a website dedicated to the project) and in thematic communications at scientific events (in connection with the various tasks). The seminars organized by the consortium will aim in particular to collectively discuss the work and publications in progress. The final results of the research will be presented at the project’s closing day and will be the subject of coordinated and varied scientific production in scientific journals specialized in various disciplines.

In order to promote dialogue between science, research, and society, the Aurelia project will develop partnerships with civil society actors (associations, where appropriate, as well as public and private companies) and local authorities, particularly in the territories that will give rise to in-depth analyses.

Preliminary contacts will be expanded upon and developed, specifically those based on this call for tenders, on following previous research (notably research conducted by APF-France handicap), and those initiated with hospital and university practitioners who are members of learned societies in the medical sciences, such as the French Society of Physical Medicine and Rehabilitation. A large number of researchers who are specialists in the field of LTC and involved in the Aurelia consortium already have links with specialist associations in the field. In the case of France, in addition to APF-France Handicap, these are Spina Bifida, France Alzheimer, and Unafam, among others. In the same way, we will build partnerships with local authorities in France, above all with departmental councils, due to their key role in implementing LTC policies. Others will be municipalities, due to the traditional role they play in support policies for the elderly and people with disabilities. This will facilitate access to field and make it possible to initiate scientific research and social exchanges, which are often productive. The partnerships built between private organizations from civil society and local authorities will enable the Aurelia research to have a strictly social impact.

The project’s spin-offs will be diverse. The medium-term scientific aspects are important and linked both to the international nature and to the interdisciplinary character of the Aurelia project. The creation of long-term links between researchers from different countries working in a large number of social science disciplines and the medical sciences will constitute an active contribution to the constitution of a vast research community focused on the issues of autonomy and LTC. The existence of strong and long-lasting links between researchers who are above all inserted in their disciplinary and national space will eventually make it possible to formulate research questions and to develop and carry out investigation methodologies, which will take into account the various disciplinary contributions. The contribution of such expertise that extends greatly beyond disciplinary boundaries – particularly those between the humanities, social sciences, and medicine – will also form the basis of a strong societal contribution.

Beyond the scientific spin-offs, however, the comparative analysis of national, territorial and individual autonomy support configurations will enable the dissemination and stimulation of good practices for institutions, organisations, territorial players, the people concerned, and their families.


Output 1

Output 2

Output 3