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Measure 1Version française

Developing and diversifying respite structures

The aim is to offer a diverse range of respite facilities in each area corresponding to the needs of patients and carers, and to guarantee their accessibility.
In order to ensure a free choice for as long as possible between care at home and institutionalisation, it is essential for carers to have access to flexible solutions that suit their needs for periods of respite which are also an opportunity for treatment and evaluation for the patient and the people involved. In this way we can prevent the crisis situations that often result in permanent institutionalisation. The objective is thus threefold: to provide high-quality care for the patient, while guaranteeing a period of respite for the carer suited to his or her needs and enabling access to these structures with appropriate financial measures.

Context

The greatly accelerated creation of new places

In order to support carers better and widen the diversity of options available to both patients and their families, the public authorities have developed a range of respite structures that are now receiving sustained attention.

  • In 2008, 2,125 day places and 1,125 temporary accommodation places were created.
    Another possibility that will be provided is the financing of transport for Alzheimer’s patients to day care centres. This measure is a response to a pressing need on the part of families, but its effects need to be evaluated.
  • A very ambitious rate of creation of new places will be maintained throughout the duration of the plan. 11,000 day care places or equivalent and 5,600 temporary accommodation places. In view of the existing facilities (7,000 and 3,600 places respectively), this represents unprecedented increase.

Beyond the objective of creating new places, which remains central, four requirements emerge.

Measures

Evaluation of existing facilities

We need to know more about the factors that make the installation and use of day care facilities a success or a failure. A study will be launched by the National solidarity funds for autonomy CNSA, which will explain the differences between structures and give the impact of new measures such as reimbursing transport costs. If the latter initiative proves flawed, it will be reformed in 2009 to make sure families’ needs are fully met. The study will also be a chance to check that good use is being made of temporary accommodation, and otherwise to recommend ways of guaranteeing the availability of places.

Experimenting with innovative respite solutions and then making them more widely available

We need to offer carers new solutions that are more flexible and better suited to their needs. In a given area (covered by a "single point of contact"), a variety of structures corresponding to carers’ needs must be available. To achieve this, several different innovative respite arrangements will be tested as part of the experimentation in progress, located in areas with varied profiles: day accommodation, night accommodation, mobile day and night care, care at home, psychological support and various types of temporary accommodation etc. The use of these facilities will be evaluated, as will their medico-economic benefit, and the obstacles, including legal barriers, in the way of their implementation. After these trials, the innovative respite packages will be developed so that each area can benefit from a range of respite structures corresponding to the needs of patients and carers.

Drafting a set of specifications to give all respite structures a therapeutic dimension

In parallel with these experiments, the National Social and Medico-Social Evaluation Agency (Agence nationale de l’évaluation sociale et médico-sociale, ANESM), in partnership with the National Health Authority (Haute Autorité de Santé, HAS), will establish specifications for the various reception and accommodation facilities that emphasise the quality of care and the intervention of professionals specifically trained to deal with cognitive disabilities, in order to guarantee high-quality care and a real benefit for the patient. No distinction should be made between respite structures for the carer and temporary care structures for the patient: all respite structures should have a strong therapeutic dimension, a real care project for patients.

Drafting a guide for creating day care centres and opening respite places, to remove certain brakes on initiatives

This guide will be drafted in partnership with associations and foundations.

Actors

Lead supervision : The national Independent-Living Support Fund(Caisse nationale de solidarité pour l’autonomie des personnes âgées et des personnes handicapées, CNSA) Supervision : the Directorate General for Social Action (Direction générale de l’action sociale, DGAS), the National Social and Medico-Social Evaluation Agency (Agence nationale de l’évaluation sociale et médico-sociale, ANESM) Partners : the Directorate General for Health (Direction générale de la santé, DGS), Médéric Alzheimer, France Alzheimer, Lions club

Schedule

2008: study of day care by the CNSA (part of its 2008 study programme) 2008: widening the range of care solutions, establishing a new typology of structures in which trials can be carried out and drafting specifications (ANESM, HAS) for each one.
2008: experimenting with different types of temporary reception and accommodation facilities, to be developed across the country from 2009.

Funding

The trials represent a cost of €2.5 million per year (duration: 2 years), corresponding to the launch of ten trials of different packages in areas with different profiles.

The additional funding for these day care centres added to the new places already planned, and the funding for transport, represents a total of €169.5 million over the period of the plan.

Evaluation

Process indicators
The availability in 2009 of a study of the requirements expressed, the relevance of the flexible and innovative solutions proposed and the satisfaction of users according to several archetypal district profiles
Establishment of specifications for the therapeutic dimension of day care
Result indicators
Adherence to the specifications by all day care units by 2012
Number of platforms created/number of Alzheimer’s patients registered
Availability in 2012 of a range of respite services in each district


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