How to care for those who are dependent and disabled, whether because of age or sickness, is a recurring theme in today’s world. As a result, most countries throughout the world are introducing programmes to provide home-based care for those with reduced autonomy.

The stakes are high: life expectancy and consequently the proportion of old people within the population are steadily increasing. The result is increased dependency, often combined with fundamental changes in traditional care structures and in particular the family, foremost among them.

Last but not least, it represents an economic issue which all countries are obliged to resolve.

Hence the need to ask what the role of social security, taken in its broadest sense, should be in the provision of home-based care.

The problem is identical everywhere, but responses vary depending on whether the national traditions are based on Beveridge or Bismarck, or are closer to those of Southern Europe. It is true that all of them seem to be in favour of home-based care; the main differences lie in their understanding of what it involves.

One fact is obvious: social security is involved everywhere. However, its degree of involvement varies from one country to another and this has a major influence on the provision of such care, and in particular on its financing.

A further element is the multifarious nature of social security activities. It may at one and the same time, be involved in promoting home-based care (supplying benefits, training professionals to meet this new type of need), assessing the degree of dependence (involvement in the design of assistance programmes), coordinating the various actors involved (particularly in networking), monitoring the quality of the care provided and providing support for families (family benefits in kind or in cash to assist families to take care of those with reduced autonomy).

Social security, however, in spite of its praiseworthy efforts, cannot manage without the other actors involved in providing social protection; the responsibility for dependency, in particular, must be global in order to be effective. In other words, it is essential that such care must include not only medical treatment (where the role of social security is vital) but also social factors (where the role of social security is, at best, passive).

Most countries are now introducing reforms to keep dependents with reduced autonomy, at home. Some are more advanced than others, for cultural and/or structural reasons, but the fact remains that all of them share the same philosophy. Finally, it is worth emphasizing that in spite of the remaining divergences, there is consensus on the key role of social security organizations; as the cornerstone of this system, they constitute the essential interface between all those involved in providing home-based care.