In 2020 and 2021, a multidisciplinary research team* conducted a vast qualitative study on 21 local experiments with EHPADs, hospitals, home nursing services, etc. as well as a national experiment “Watch over my parents “. In total, 22 innovative devices, throughout the national territory, were screened. The study required on-site observation work: a particular challenge in times of health crisis. 43 qualitative interviews were conducted with facility directors, health managers, coordinating doctors and nurses, beneficiaries, families, etc.
The research team notably analyzed the “Passerelle” scheme in Nord-Isère: an off-site EHPAD scheme aimed at keeping the elderly at home for as long as possible. “The Passerelle device adds, to the range of classic services of an EHPAD, a platform for connecting people and caregivers. Thus, the role of coordinating home care complements the traditional missions of accommodation, care and animation specific to EHPADs”, underlines Claire Le Breton, post-doctoral researcher in the Department Man, Organizations and Society at GEM .
Social issues
“The interest of this study is to be able to adjust supply and demand for dependency care – particularly during the more or less long period of transition to dependency. On the ground, alternative solutions, such as shared accommodation between elderly people, are intended to fit the right public, in the right place. Indeed, according to a given territory, and according to the socio-economic categories of the populations, certain EHPADs remain little frequented, or prove to be ill-suited to impoverished territories, for example”, notes Claire Le Breton.
some EHPADs remain infrequent, or prove to be ill-suited to impoverished areas
A number of measures have therefore already been deployed at national level aimed, on the one hand, at reducing the costs of taking charge of dependency and, on the other hand, at curbing the reluctance of old people vis-à-vis of the EHPAD, as it is currently designed. “Some experiments focus on developing daytime services (animation, coordination), while others develop nighttime services. The important thing is not the care as such, but the services that will facilitate care (ergotherapy), coordinated and facilitated at home. Additional services are also offered. One of the most popular being the emergency room, or transport. »
A key dimension: coordination
The survey reveals a few key characteristics specific to these initiatives outside the walls. Thus, all the innovative devices are articulated and supported by the coordinating nurse (IDEC), who federates all the associated actors: EHPAD management, coordinating doctors, nursing staff, elderly people, families… “IDEC does this an integral part of the medical staff of the EHPAD as a person recruited specifically for this experiment. The same applies to occupational therapists, nursing assistants, day or night nurses, psychomotricians who are specifically dedicated to experimentation and are not recruited for other tasks in the EHPAD. It was observed that these positions were occupied by professionals who had another activity – either within the EHPAD or elsewhere. »
Among the points of vigilance, the research team noted: “Often, the workload is greater than expected for the actors involved in the structure that carries the experimentation, and those who are internalized must assume more responsibilities and tasks than before. Moreover, there is not one, but two potential beneficiaries: the beneficiary and his carer. Similarly, transmissions are sometimes complex between the night and day shifts. » Beyond that, decentralized coordination requires the use of physical tools (electronic cameras, emergency call systems, etc.) and digital tools (PCs, tablets, etc.) which are often little used by liberal professionals and by beneficiaries of the system.
For illustration, the cost of the system deployed by the AESIO solidarity fund varies between 12,000 and 14,000 euros per year on average per beneficiary, compared to 24,000 euros on average in nursing homes.
*Territories in Transition research team: Thibault Daudigeos, Frédéric Bally, Helen Picard, Albane Grandazzi et Claire LeBreton.
A national symposium on aging well, at GEM
What is “aging well”? How are old age and dependency covered in France? And how to allow the elderly to continue to live with dignity at home, by integrating the specificities of each territory…?
On June 16, the Territories in Transition chair is organizing a national symposium on the theme of “ageing well”, at Grenoble Ecole de Management, alongside regional health players. The ambition of this national symposium is to allow a collective reflection of health actors around the territorial management of old age. On this occasion, the research chair will present the results of its unprecedented study on innovative EHPAD devices outside the walls, in France. Also on the program, the afternoon of June 16: an introduction to the issues related to the territorial management of old age with Yann Lasnier, General Delegate of the Little Brothers of the Poor; reflection workshops and round tables, led by public actors in social action, housing and medico-social from the Department of Isère and the City of Grenoble and the Mutualité Française Isère.
More information and registrations
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