DRADs, Dispositifs renforcés de soutien à domicile (Enhanced Home Support Arrangements), improve coordination between professionals and encourage cooperation between EHPADs and home care providers. This seems to be working in the fight against the isolation of elderly people. Louis Braverman, PhD in sociology and a researcher at IRIS, explains.
Your study focuses on Enhanced Home Support Arrangements (DRADs).Can you explain what these are?
DRADs are innovative and experimental schemes aimed at improving support for the elderly at home. The objective is to ensure the continuity of care, to avoid sudden breaks in life pathways and to implement coordination between professionals. DRADs can give rise to quite varied initiatives, but it is often the EHPADs who take a central position in the scheme and ensure coordination with doctors, physiotherapists, night-shift workers, nursing services, carers…
Originally, these schemes were designed to promote home support with a view to responding to the challenges of old age and the loss of autonomy. The purpose of my study is rather to analyse the extent to which these schemes can combat isolation and loneliness amongst elderly people.
What observations did you make during your study? And above all, do these schemes make it possible to fight effectively against isolation?
DRADs enable us to transcend the home/EHPAD dichotomy. Traditionally, home care reaches its limits when the loss of autonomy is too great or when the family is unable to ensure the continuity of care. Too often, care abruptly shifts from home to an EHPAD following an incident or hospitalisation. The elderly person leaves their world, where they could receive visits from neighbours, friends, family and professionals.
Above all, DRADs help to combat loneliness and isolation, inasmuch as they effectively support people’s attachment to their environment. How? By strengthening support services, if necessary, by focusing on prevention and by making it possible to go back and forth easily between the home and the host institutions. In themselves, the additional visits by professionals have a strong relational dimension, and are often experienced by the elderly as moments of social life. Finally, in some cases, DRADs provide additional opportunities to get out of the home, through mobility assistance services, to take part in activities with volunteers or as part of day care in EHPADs.
Concretely, what are the main advantages of DRADs in home support and the fight against isolation?
Perhaps the most important point is the coordination between professionals. This coordination time is usually implemented by an EHPAD nurse coordinator. This makes it possible to organise a regular presence of assistants, and to ensure a global consideration of the individual, combining accompaniment in everyday life, more technical medical care, health promotion and preventive actions. This often leads to additional benefits – remote support, accommodation arrangements, nightly care, assistance with medication.
Families greatly appreciate the presence of this single point of contact. Especially since the bridges between home and EHPAD can be particularly beneficial, notably to prevent the exhaustion of caregivers. I discovered the example of an elderly person who was able to benefit from temporary accommodation in an EHPAD so that his daughter could join her family on vacation for a few days. Carers remain relays who must be taken into account in the scheme in order to successfully support people at home.
Have you identified any limitations to these innovative schemes, or any difficulties in their implementation?
Cooperation between EHPADs and home care providers can sometimes be a source of friction. First of all, a collaboration must be built up between professionals who do not work in the same way. The computer systems are not necessarily compatible. But above all, we sometimes witness a clash of cultures between the home and the host institution. Hygiene standards, respect for habits, the nature of relationships, prevention, rhythms… The priorities do not always align. But this exchange about practices is one of the noteworthy aspects of this cooperation. For the EHPADs, which are often the driving force behind the collaboration, it is also an opportunity to open up to the outside and to restore a highly degraded or even repulsive image. The main threats to DRADs, however, are located at a more structural level. In order to stabilise models and reap all the benefits of their cooperation, professionals must have a certain visibility with regard to the sustainability of the system and funding. In addition, the whole sector is affected by problems of training, recruitment and employee retention. Although DRADs contribute, indirectly but effectively, to the fight against isolation, their current means will not allow them to maintain a model that is under pressure in a context of ageing populations.
Top photo: @Christophe Hargoues