Loss of autonomy

For several years now, multiple laws have been passed in the area of independence and old age.

In 2015, the law on the adaptation of society to aging translated the ambition to age well by promoting home care for the elderly, the prevention of loss of autonomy, and the recognition and support of family caregivers through the right to respite and family support leave.

In 2018, an “old age and independence consultation” formulated 175 proposals for an ambitious reform of the policy for the elderly, integrating all of these challenges in preparation for a dedicated bill, which could not be completed. The law of August 7, 2020 on social debt and independence established the fifth branch of the Social Security system dedicated to the independence of the elderly and people with disabilities, managed by the Caisse Nationale de Solidarité pour l’Autonomie (CNSA).

If autonomy and the elderly sector are now part of the pillars of our social protection model, structural and organizational transformations are now necessary to support the restructuring of the offer and the evolution of the practices and positions of professionals.

How can we support the restructuring of the autonomy and old age offer? How can we change practices and help professionals in the sector to rethink their practices?

The prevention of loss of autonomy and healthy aging are now at the heart of public policies, whether it be the fight against isolation, the evaluation of the degree of dependence of the elderly (state of health, analysis of the first signs of age-related loss of autonomy, etc.), the adaptation of the home of seniors, home help, or the promotion of physical activity.

In order to identify, as early as possible, the first signs of loss of autonomy, the World Health Organization has developed the ICOPE approach (integrated care for older people) based on the identification of fragility among the five intrinsic capacities (mobility, memory, sensory, nutritional status, mood) through a five-step methodology: screening with the assessment tool, deeper assessment of loss of function, compilation and design of a care plan, follow-up of the care plan and implementation of all necessary resources in the territory to prevent dependency.

How can professionals be trained to identify frailties to prevent dependency? What innovations or personalized home care solutions should be implemented to prevent loss of autonomy? How can we experiment with tools to assess the loss of autonomy and adapt the homes of the elderly?

In recent years, emphasis has been placed on the notion of a personalized life pathway to emphasize the need to take into account the requirements and desires of the person being cared for, to give the person free rights and to provide support to caregivers. The search for simplification of support and greater clarity of offers has led to the development of several mechanisms, including the ‘CLICs’ (Local Information and Coordination Centers), supported by Departmental Councils, aimed at guaranteeing greater accessibility to information for the elderly and the people around them. Another mechanism, the MAIA (methods of action for the integration of assistance and care services in the field of independence), created in 2008, seeks to make the pathway more fluid, coherent and, above all, to ensure continuity, in order to avoid any rupture, by coordinating all players. This pathway logic is based on the challenge of decompartmentalizing the interventions of professionals, teaching them to work together and to speak the same language. As part of the 2019 law on the organization and transformation of the healthcare system, the MAIAs in all territories must integrate the Coordination Support Systems (DAC) in order to strengthen the organization and territorial coordination of healthcare, social and medical-social professionals facing complex situations related in particular to loss of autonomy.

How can we coordinate those involved in elder care to combine their actions into a pathway-based logic? How to set up territorial pathway coordinators and case managers for all territorial coordination mechanisms (PTA, MAIA, DAC, PAERPA, etc.)?

Since the publication of Victor Castanet’s book Les Fossoyeurs and the 2022 annual report of the Cour des Comptes, the issue of quality of life for residents and professionals in EHPADs (assisted living residences) has received major attention. Although the public authorities are seeking to promote home care, 15% of people over 80 years of age live in an assisted living facility (EHPAD) in France, i.e. 600,000 residents. It is therefore essential to ensure quality of life in these facilities and to cultivate healthy aging. To this end, numerous initiatives have been launched, notably to combat isolation, with “out-of-home” EHPADs — allowing the elderly to benefit from the services and technologies available in EHPADs directly at home —, establishments adapted to different pathologies, and the creation of inclusive and intergenerational housing. Another major challenge is the quality of life at work and the training of professionals working with the elderly, as the medical-social sector suffers from a lack of attractiveness that penalizes the recruitment of qualified personnel.

How can we rethink the EHPAD by opening it up to the outside world (Third Place logic, transition to the home, integration of technological innovations, etc.)? How can we support EHPAD professionals in order to reposition them in a logic of healthy aging, while restoring meaning to their commitment?