La qualité des services d’aide à domicile dispensés aux personnes âgées dépendantes : les perspectives des différents acteurs

The number of elderly in needs of personal assistance services in Activities of daily living and Instrumental activities of daily living keeps on increasing. The home- and community-based support for that population is becoming a major societal challenge and requires delivering quality home support services. The organization of these services is often faced with financial problems, increasing service demands, health care system fragmentation and lack of health care professionals qualified in home care services for the elderly. Such situation does not facilitate quality service improvement; moreover, definition and measurement of quality remain difficult. Indeed, in France, research and evaluation of personal assistance services’ quality are underdeveloped. According to different authors, most of the existing studies, including those conducted in other contexts, have faced methodological and conceptual problems. These authors note in particular the lack of clarification of the concepts used in these studies, the use of research methods and evaluation tools which are less appropriate according to the nature of the concerned services, as well as not considering the stakeholders’ perspectives. For those reasons, they recommend further research in this field in order to produce scientific knowledge that will allow a better understanding of the quality of personal assistance services, its definition and measurement. To address this concern, we conducted a qualitative study based on stakeholder’s perspectives, of both the elderly person and the service providers (formal carers and organization managers). This research was aimed at understanding the quality of home care services from a stakeholder’s perspective, to describe its attributes and to identify the factors facilitating or hindering the provision of a quality support service. Taking into account the point of view of all these actors, considering the elderly person as the key actor and not only as the beneficiary of services, as well as emphasizing the real experience of the concerned actors, are among the elements making the relevancy of this thesis. The results of the study show that the quality of personal assistance services is multidimensional. It consists of seven dimensions categorized into three fields. The relationship field composed of interpersonal relationship, attitude of providers, personal qualities, the procedural field composed of appropriateness and relevance of services, and the transversal field composed of competence and ethical values. In addition, three main findings of this study must be emphasized. Firstly, all participants agreed on the importance of essential dimensions of the quality of personal assistance services, namely interpersonal relationship, appropriateness and relevance of services according to the elderly needs, and personal qualities. Secondarily, socio-affective support was firmly asserted more than instrumental support, in acknowledgment of the necessity of meeting the main need of older persons to maintain social contact. Lastly, several quality attributes are interrelated and form a system of relations requiring the involvement of each actor. Thus, quality personal assistance service falls under a comprehensive and personalized approach in order to meet both the functional and socio-affective needs for the elderly person. It requires individual and collective competences. A such, the quality of personal assistance becomes the result of an organizational and clinical process, aimed at addressing the needs of the elderly person in a personalized approach enabling him to be in relationship and maintain social links, to have a functional assistance specific to his disabilities all while considering his remaining capacities. This study contributes to both the development of knowledge and the improvement of home personal assistance practices. The attributes and dimensions of quality identified constitute the premises of a specific conceptual framework of the quality of home care services. In addition, they may contribute to the development of relevant indicators of quality and the implementation of quality assurance for home care services.

Keyphrases: Evaluation, Elderly, Functional disability, Home care services, Home help services, Quality, Personal assistance services, Perspectives of stakeholders, Quality assessment, Quality assurance