Many EHPADs have already created dedicated units. The Plan provides for the creation of specific units to be generalised, distinguishing between two types of units according to the degree of behavioural problem of the people concerned.
The objective is to achieve 30,000 places in EHPADs with specific projects, adapted to the seriousness of the behavioural problems.
12,000 places to be created,
18,000 places to be reinforced.
These units will be reinforced in terms of staffing, with a high level of supervision, the intervention of professionals specially trained in the disease, and training for all staff in these establishments in the specific nature of the care required. They will also be adapted with regard to their architecture and internal layout.

Context

As Alzheimer’s disease evolves, psychological and behavioural symptoms or behavioural problems often appear. These may include apathy or aggressiveness, wandering behaviour or agitation. These are very important issues in Alzheimer’s disease, as they have a considerable impact on patients and on patients’ families. They also constitute the main difficulty encountered by EHPAD professionals.
For example, 80% of residents with Alzheimer’s or a related disease present behavioural problems at some stage in the evolution of the disease. Of these 80%, 25% have moderate behavioural problems (measured on an internationally validated scale) and 10% have major problems (aggressiveness etc.). These problems must be measured more effectively and the diagnosis of the disease must be made clearly for EHPAD residents affected by it.

Measures

(1) Specially adapted treatment and activity units will be created to offer residents with productive behavioural problems, social and therapeutic activities during the day in a specially adapted living area in a calm environment with space to walk around.

They will be led by specially trained professionals, which requires that the professional skills made available to patients be widened. This will include creating the role of "gerontological assistant", a new skills profile described in measure 20.
It will also be necessary to reinforce teams with new skills in this area, such as psychomotor and occupational therapy. Speech therapists may also intervene on the basis of a medical prescription.

Finally, psychiatrists will be involved with the operation of these units, either working with the psychiatric team or in a partnership with independent psychiatrists. Daily care for the disease regularly requires recourse to psychiatrists: EHPAD staff acknowledge that they are sometimes helpless to deal with certain facets of the disease.

The creation of these specific units will require extra staffing, enabling the establishments to be more medicalised. Pricing for these units must also be re-evaluated, in order to incorporate these professionals, such as gerontological assistants, psychomotor therapists and occupational therapists, into the establishments’ teams. In addition, all the institutions’ staff must be trained to deal with the specific nature of care for Alzheimer’s patients.

The presence of a living unit of this type within an EHPAD, occupying people with behavioural problems during the day, will enable other residents to benefit from more traditional social activities, offering all residents times apart and times together without having to move residents experiencing behavioural problems at a particular point in the history of their disease from one bedroom to another.
These activities and care are very important because they can reduce behavioural problems by 20% and cut down on use of sedative psychotropic drugs and restraint. They may involve structured activities (physical activity, sensory activity, nutritional aspects) designed specifically to improve behavioural problems. Similarly, spatial orientation rehabilitation, cognitive validation groups, behavioural approaches and psychosocial treatment in general can improve quality of life and reduce the incidence of behavioural problems, even if such interventions still need to be better evaluated.

2) For patients with very considerable behavioural problems, reinforced structures will be developed in the form of small units able to house about a dozen people day and night, providing both accommodation and activities and satisfying all the criteria for a suitable care and activity unit.

3) These specialist units must also be adapted in their layout and even architecture to host Alzheimer’s patients.
The Plan thus provides for the launch of a major investment programme, subsidised through modernisation credits from the CNSA, in order to avoid the development work undertaken for specific Alzheimer’s units weighing too heavily on the price for accommodation paid by patients and their families.
Initially, the modernisation plan will enable 15,000 places to be adapted or constructed in 2008.
This work will be carried out according to specifications established by the Ministry for Social Affairs, the ANESM, the HAS and the CNSA together with foundations such as the Fondation Médéric Alzheimer and professionals who have worked on these architectural issues.
Adherence to these specifications will be a decisive factor in the CNSA’s allocation of support, and expertise in this area must be continuously available to establishments.

An "Alzheimer’s architecture prize" will be created to reward the most innovative EHPADs. The prize will emphasise the advantages of thinking about architectural quality in caring for Alzheimer’s patients.