## 5 Conclusions and Openings  
In this paper, we first created a use case close to reality, which was available to the scientific community working on the HHCRSP. This use case was the result of several interviews with staff at different home health care centers in France. Then, we modeled two different resilient approaches to counter the high-impact disruptions encountered by caregivers on their routes. Hence, we analyzed and compared the existing solution to a baseline approach and a proposal for the centralization and sharing of information to improve local decision-making.  
By using discrete event simulation, we showed that the centralized collaborative approach enabled both a reduction in the number of late arrivals and the total time of late arrival, but above, it led to all the number of routes ending before the work end time to be halved (contrary to the distributed collaborative approach). These results hold true, regardless of the number and duration of disruptions we tested, as well as the initial schedule solution (handmade or optimized).  
With regard to managerial insights, we recommend that home health care centers:  
* Promote the centralization and sharing of information between caregivers to improve mutual aid. The three resilient \"2-X\" sub-approaches outperform the \"1-X\" ones according to both the total number of late arrivals, the total time of late arrival, and especially the number of routes finishing before the target end time;
* In cases of mutual assistance between two caregivers, the helper must take the care visit closest to them. Among the three resilient sub-approaches studied, those whose rule is to take the next care visit closest to the helper (the \"X-1\" sub-approaches) are those that reduce the number of delays and the total time of delay.  
To take this line of research further, other resilient approaches are considered, in particular, to improve the response times to disruptions and, thus, reduce recovery time  
Figure 8: Distribution of route end times (on the **left**) and cumulative distribution (on the **right**) for the handmade schedule—Scenario with a single one-hour disruption.  
(which we do not discuss in this paper). The coupling of optimization and simulation seems to be a powerful and appropriate tool. Moreover, the simulation plays a double role: firstly, to compare resilient approaches with each other, as is the case here, and secondly, to find a better initial or intermediate schedule solution. Finally, it is also possible to no longer plan the routes but to monitor them in real-time by assigning the care visits on an ongoing basis and taking variations and disruptions in the environment into consideration. However, online scheduling would raise the question of the reliability of real-time communication between the HHC center and the caregivers, which today remains an obstacle to the use of these digital tools in practice.  
The following supporting information can be downloaded at: [[http://dx.doi.org/10.13140/RG.2.2.28201.98402](http://dx.doi.org/10.13140/RG.2.2.28201.98402)]([http://dx.doi.org/10.13140/RG.2.2.28201.98402](http://dx.doi.org/10.13140/RG.2.2.28201.98402)), (Use_Case.zip).  
Literature research, G.D., C.M. and L.Z.; study design, G.D.; data collection, G.D.; data analysis, G.D.; data interpretation, G.D.; writing, G.D., C.M. and L.Z.; supervision, C.B. and F.F.; validation, F.F. All authors have read and agreed to the published version of the manuscript.  
This research was funded by Plan France Relance and Berger-Levrault.  
Informed Consent Statement: Informed consent was obtained from all subjects involved in the study.  
The authors declare no conflict of interest.