PRESENTATION BY ACADÉMIE DE CRÉTEIL

1. PRESENTATION BY ACADÉMIE DE CRÉTEIL Marie-José Côme Nadine Mundinger Véronique Ponchaux Claire Vivant Le Calonnec

2. DEPENDENCY AND DISABILITY

3. ALZHEIMER AND UNDER 60-YEAR-OLD PEOPLE • In France more than 8000 people under 60 years suffer from Alzheimer’s disease. The person can ask the Committee for the rights and autonomy of handicapped people ( Commission des droits et de l’autonomie des personnes handicapées – CDAPH) Actually the clause « l’article L.241-6 » of social action and family law considers that « CDAPH » has the authority • to decide on the placement of a handicapped person • To say in which establishments of rehabilitationor personalized retraining the adult disabled should be sent.

4. OBLIGATION TO GIVE WORK TO DISABLED PEOPLE : A RIGHT TO WORK AND HAVE AN OCCUPATION

5. References Employment law :   the 5th part is devoted to employment / Book 2 « Measures concerning certain categories of workers / Title 1 : Handicapped workers Law n°2005-102 11 February 2005 : equal rights and chances, the participation and citizenship of handicapped people • Principal concept Every employer who has employed at least 20 full-time workers for 3 years should employ 6 % of handicapped people of the total number of staff.

6. The organizations which don’t employ disabled people or not as many as they should have to pay AGEFIPH (private companies) or to FIPHFP (public organizations), to finance the funds of professional integration of the disabled. • The obligation to employ disabled people concerns all workers, in private or public sectors, those who have a permanent or temporary contract, who work full-time or part-time, who are doing an apprenticeship or a professional training. • Some aids can be given to employers who employ handicapped workers.

7. Payments to public funds of integration of disabled workers (AGEFIPH or FIPHFP) if the quota of 6% is not respected • According to number of employees and missing handicapped employee • From 20 to 199 employees: 400 times the minimum hourly salary (3676€) • From 200 to 749 employees: 500 times minimum hourly salary (4595€) • Over 750 employees: 500 times minimum hourly salary (5514€)

8. THE ORGANISATIONS WHICH DEAL WITH DISABLED PEOPLE AND THEIR INTEGRATION

10. FINANCIAL AID FOR DEPENDENCY OF PEOPLE UNDER 60 IN FRANCE Autonomybenefits (APA)

11. THE LAWS CONCERNING DISABLED PEOPLE ARE COVERED BY ALL TRAINING COURSES • 10 years of existence • The objective is to reinforce aid to old people who are losing their autonomy, by having the necessary help in their daily routines

12. TERMS OF AWARDING • To be 60 years old or older, • to miss or to be losing one’s autonomy due to physical or mental conditions , • To be in need help to accomplish essential tasks in every day life or to be in need of surveying • To be French and live in France , or to be a foreigner legally living in France. • For information : APA benefits don’t depend on revenue.

13. ASSESMENT TOOL TO ANALYSE THE LOSS OF AUTONOMY • National grid AGGIR (Autonomie Gérontologie Groupes Iso-Ressources) It serves to evaluate the degree of autonomy lossor the degree of physical or psychological dependency • Assessment is done according to 17 criterias (variables): • Ten variables called "distinguishing criterias" which define the loss of physical and psycholocal autonomy and which are used to calculate GIR (groupe iso-ressources) : coherence – sense of direction - washing – getting dressed - eating – going to toilet- transfers (getting up, going to bed, sitting) – moving around inside a house- moving around outside – communicating at distance ; • Seven variables called "illustratives", concerning the loss of household and social skills, they are not included in the calculation GIR but they give useful information for the care plan : handling of one’s budget and goods- cooking - cleaning - transports -shopping – following the treatment – leisure activities.

14. THE SIX GROUPS OF THE GRID AND THEIR INFLUENCE ON FINANCIAL AID

15. The group iso-ressources 1 includes people in bed care or in a wheel chair, whose mental functions are badly damaged and who need permanent assistance ; • The groupe iso-ressources 2 , includes people in bed care or in a wheel chair whose mental functions are not completely damaged but whose condition obliges them to have assistance in most everyday activities. This group also includes those elderly people whose mental capacities are diminished but who can move independently; • The groupe iso-ressources 3 gathers the elderly who have mental independence, are capable of moving up to some point, but who need daily assistance and need to be helped several times a day; • The groupe iso-ressources 4 consists of people who can’t get up alone but who, once up, can move around their apartment. They sometimes need help for washing and getting dressed. This group also includes those elderly people who don’t have problems moving about but need help in physical activities and meals ; • The groupe iso-ressources 5 is formed by elderly people who only need help in specific situations such as preparing meals or cleaning, or washing ; • The groupe iso-ressources 6 is composed of elderly people who have not lost autonomy in their everyday activities. • Only the first 4 groups of the national grid give rights to APA. The benefactors can be at home or in an institution. They can get help if their age and residency correspond to criterias. • The elderly people of groups GIR 5 et 6 can ask for financial assistance to help with cleaning corresponding to their social health insurance category.

16. THE ADVANTAGES • A measure based on universal and objective means to standardize fees and national scales. • This measure favours diversified payment. • It aims to improve the quality of services. • It garanties a double solidarity in its financing: local solidarity by local organisations and the general council (Conseil Général)

17. DIFFERENT CATEGORIES OF PROFESSIONALS IN CHARGE OF DEPENDANT PEOPLE Home aide Family care assistant Home family assistant Home assistant in rural areas Social family assistant Nursing assistant Medico-psychological assistant Gerontology assistant Social and family technical assistant

18. ACADEMIE DE CRETEIL OFFERS CERTIFICATES which specialize in knowledge of dependency • Nursing assistant • Social family assistant • Home care assistant • Medico-psychological assistant • Gerontology assistant

19. THE TRAINING COURSE CONTENTS • Each training course has an objective to: - Give the necessary knowledge of the disease and the ability to help the patient and family in need . - Give the assistants the information and means to better help the family and handle its needs, but also know the structure and functioning of the health network in order to help the family to deal with it.

22. EXAMPLES OF TRAINING COURSES PURCHASED BY PROFESSIONALS • Assisting dependent people • Supporting a person who is at the end of his/her life • Taking good care of a person/ dealing with cases of bad treatment • Ergonomy , gestures and postures professionals • The aging process • Alzheimer's disease • Stimulating physical or intellectual capacities which favor the autonomy of dependent people

23. HUMANITUDE , TO TAKE CARE OF ALZHEIMER PATIENTS IN A NEW WAY:A PHILOSOPHY SERVING ELDERLY PEOPLE • Objective: rehabilitating a person in taking into consideration one’s dignity and improvement of relationships between the patient and the assistants • THE FOUR PILLARS OF HUMANITUDE • This method relies on a global changement of caretakers’ behaviour • Eye contact: the caretaker should talk to the patient face to face on the same level • Speech : one should explain every gesture and announce it beforehand • Touch : one should touch the patient with « tenderness » instead of « practicality » • Verticality : no more washing patients in the bed which they never leave. Elderly person is adequately taken care of, she /he can or should function standing up. Verticality is one of characteristics which distinguishes us from animals , therefore it’s very important for us.