A novel approach to integrated care using mobile technology within home services. The ADMR pilot study
Introduction
The demographic changes and the rapid increase of the old age population represent major challenges in the economy, the society and medical care. A major goal for old age care is to enable older persons to live in their homes under good circumstances [1]. The care model for supporting the old age people in living independently at home relies on the informal and formal assistance of caregivers and social workers. There is a growing global recognition of the role of informal carers of older people [2]. However, the role of social workers is less well approached. Information and Communication Technology (ICT) offers new approaches for informal care services in old age people [3]. Informal carers and social workers of non-medical home services are gaining importance and may be able to participate in care pathways by detecting health deterioration and sounding an alert.
The ADMR (Aide à domicile en milieu rural, https://www.admr.org) is France’s leading personal care non-profit network. Dedicated ADMR volunteers (over 100,000 people) and staff (93,700 workers) work together to deliver high-quality local services and enable families and vulnerable people, particularly seniors, to live well in their own home, meeting their wants and needs whilst maintaining their independence.
As a proof-of-concept, a longitudinal observational pilot study was carried out in the ADMR section of one of the French states (Gard). Employees of the ADMR home services followed 130 old age people living at home and who were no more than moderately impaired. A single visual analogue scale (VAS) was used on a smartphone of the home service employee to assess the global health status of the seniors every time they were visited. An alert system was devised to inform the old age person and/or a responsible person of any deterioration in health status. All medical and social events were recorded throughout the study. The study was funded by the CARSAT (Caisse d’Assurance Retraite et Santé au Travail, Regional retirement and occupational health insurance agency), a member of the French national Social Security organization [4].
Section snippets
Setting
ADMR of the Gard state.
The ADMR is a national non-profit network that has been active throughout France for over seventy years. The organization helps families and vulnerable people to live well in their own home, throughout their life, by providing bespoke, reliable and professional day-to-day home services. They include housekeeping, shopping, meal preparation or delivery, nursing care, remote assistance, minor DIY/gardening and even childcare, nurseries and micro-nurseries. There are 2700
Demographic characteristics
130 people were screened ranging in age from 69 to 97 years of age. Eight did not accept the study and 106 were evaluated (Fig. 2). Only 2/122 decided to stop the study. There were 8402 evaluations.
Alerts
37 alerts were observed. 21 were confirmed and 16 were false positive. Only the untrained employees reported false positive alerts.
Severe medical alerts
Six severe medical alerts were observed (Table 1) including one cancer undetected by the physician, one diabetes which was worsening and which led to hospitalization, one
Discussion
We attempted to determine whether social workers could participate in the health system with all deontological criteria of medicine. To our knowledge, this is the first ICT-based alert system that has shown that employees of home services can provide alerts that are subsequently found of medical interest by health care professionals.
This study surprisingly showed that social workers can detect severe medical alerts that have not been identified by health care professionals. Social workers spend
Conclusions
A new vision for ageing at home may be considered since social workers have been shown to be able to identify overall health care status and to send an alert of medical relevance. This study is now deployed to other ADMR federations in France in order to confirm it and to refine the alert system. The benefits of this pilot study are for the old age people, the employees and the medical system.
Contributors
Jean Bousquet conceptualized the paper, drafted the manuscript.
Marc Meissonnier conceptualized the paper.
Véronique Michalet was responsible for the administration of the ADMR Gard project and the investigation.
Anne Toupnot was responsible for the administration of the ADMR Gard project and the investigation.
Delphine Paccard reviewed the project as the funding source.
Michel Noguès reviewed the project as the funding source.
Josep M Anto proposed the methodology.
Jean Pierre Riso is the director of
Funding
Funding for this study was received from Caisse d’Assurance Retraite et Santé au travail, Languedoc-Roussillon (CARSAT-LR) and Aide à domicile en milieu rural (ADMR).
Ethical approval
This is an observational study for which approval from an ethical committee was not necessary. However, written informed consent was obtained for each participant.
Provenance and peer review
This article has undergone peer review.
Research data (data sharing and collaboration)
There are no linked research data sets for this paper. Data will be made available on request.
Declaration of Competing Interest
The authors declare that they have no conflict of interest.
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