Aging in place has become a central objective of health and social care policies in aging societies, framed as a means of reconciling individual autonomy with system sustainability. In both France and Quebec, the domiciliary shift is strongly endorsed through legislative, regulatory, and programmatic instruments. Yet, despite sustained legal and political commitment, the effective delivery of home-based services remains highly uneven. This article examines the operationalization of the domiciliary shift through a comparative analysis of France and Quebec. Drawing on statutory law, regulatory frameworks, and institutional arrangements governing home support services, it argues that the gap between policy objectives and effective implementation does not primarily result from insufficient legal recognition. Rather, it reflects structural constraints inherent to health and social care systems historically organized around institutional provision, fragmented governance, and persistent workforce limitations. The analysis shows that legal and policy instruments contribute to legitimizing aging in place and organizing coordination, but do not determine the material conditions required for its realization. Access to home-based care remains contingent upon organizational capacity and territorial resources, resulting in structural inequalities. By focusing on the operational limits of the domiciliary shift, this article contributes to law and health scholarship by clarifying the conditions under which legal and policy frameworks can meaningfully support aging in place. This version is shared to facilitate early dissemination and feedback prior to submission to a peer-reviewed journal.
ERIC BERNIER (Wed,) studied this question.
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