7 Tableau de bord sur l’emploi et le chômage des personnes handicapées, source: DARES-Ministère du Travail.
Two national agencies in charge of monitoring risk reduction at work – INSR (Institut national de recherche et de sécurité pour la prévention des accidents du travail et des maladies professionnelles – National Research Institute for Preventing Work Accidents and Occupational Diseases) and ANACT (Agence Nationale pour l’Amélioration des Conditions de Travail – National Agency for the Improvement of Working Conditions) – agreed on the major risks faced in the home-care sectors. Workers suffer from musculoskeletal disorders that particularly affect their hands, shoulders and backbone due to repetitive gestures and lifting people with disabilities. Because they often have to travel from home to home, visiting several households in a work day, they are more likely to be involved in a road accident. They also are at risk of suffering from stress. See http://www.anact.fr/web/dossiers/mutations-changements- organisationnels/services-a-la-personne?p_thingIdToShow=22719582 and
One study inFrance stated that 60% of individuals who have depression seek medical treatment .
In this study, a small difference in newsqol was observed between Luxembourgers and other nationalities (for pain and vision domains only) while low-level education, lower income and becoming inactive (retired or unemployed) were associated with mobility, self-careand a number of domains concerning depressive symptoms. This may be attributed to possible more severe stroke and to more mental difficulties due to health and socioeconomic prob- lems. These findings identify the subjects most at risk and to whom particular attention should be paid in terms of prevention and intervention. The financial and psycho- logical instability that accompanies negative life events may reveal or revive latent weaknesses that otherwise would not appear and would not affect health. The effects of stroke would be amplified among subjects with socio- economic disadvantages . Our results are in accord with those of another study, which reported that most stroke-survivors had low QoL, a greater prevalence of stress and depression, more economic burden, andmore change in social relationships than the general population . Our findings have to be put into the socioeconomic context of Luxembourg, which is one of the smallest European countries (502,500 inhabitants, area 2600 km 2 ) and has a high gross domestic product per inhabitant . In our study, most stroke-survivors were Luxembourgers, inactive (retired or unemployed) and had over 3000€/per month. Luxembourgers have public or private resources, andservices are principally professional. The distances be- tween the population andservices are short, and health- care is geographically accessible to the whole population. The indicator of the quality of the National Health Service is 7.4/10 for Luxembourg vs. 6.2/10 for the EU-15 and 6.1/10 for the EU-27 (2007) .
Moreover, we only consider single living persons because informal caregivers living with the care recipient often have problems to declare the exact amount of time they spend on caring their cohabitant. This leads to a high proportion of missing values for this particular group of caregivers. The amounts of care declared are also not as robust as the one given by informal caregivers living somewhere else. The distinction between careand regular household duties is sometimes very difficult to make. Many spouses seem to consider any caring tasks as marital duties and report then a very small number of care hours, even if they actually help a lot more. Eventually, information about the health status of the spouse is not available in our data. Assuming that there is a significant proportion of spouses in need of care themselves, we cannot distinguish them from those able to help their partner. We have thus decided to only look at single-living care dependent people.
4.3. Architecture of the platform
We chose a process oriented development approach which cor- responded to the process modeling we used to model activities. The development itself was organized around a relational database and involved the MYSQL, JPA, VAADIN technologies. Subsequently, we tested, still using a process oriented approach, a development organized around a NoSQL database with the MongoDB system [ 55 ]. MongoDB is a document oriented system. We have associ- ated it with Web Services to take processes into account. A NoSQL document oriented system has advantages and disadvantages that are related to the types of applications. Designing the logical data model and implementing the physical model is generally simpler andmore direct than with a relational system. The format of doc- uments can easily be changed. But references between documents must be managed by the developer and a NoSQL system must only be used for applications with fairly simple reference schemes. In addition, transactional operations are not supported by MongoDB and, if necessary, a transaction management must be implemented. Fortunately, our application only involves simple cases for both ref- erences and transactions and it has appeared that a system such as MongoDB could bring greater ease of development and offer greater agility than a relational system. For some processes, andin particular scheduling, it appeared that users wish to define their own rules. In this perspective, a development paradigm associat- ing processes and rules could be a direction to explore.
the object or target of measurement, the initial level of application (local, national, international) and the degree of novelty in the method.
Thus there are a multitude of international assessment scales (Borrel, 1996 ; Dubuisson and Gardeur, 2000 ; Le Bihan, 2002 ; Bontout et al. 2002): the ADL (Activities of Daily Living) scale, the Mini-Mental State Examination, the Clinical Dementia Rating, the Geriatric Index of Comorbidity (these scales all emphasise the medical dimension, that is the identification of mental or physical pathologies), the Barthel scale (which relates to daily activities such as washing, dressing etc.), the Lawton and Brody scale (which relates to the „ability to perform instrumental activities: telephone, shopping, medication, etc.) and the Feifer scale (used to assess cognitive capacities). However, there is also a large number of national assessment scales. Confining ourselves to France, we can mention the following: the AGGIR scale (autonomie gérontologique groupes iso- ressources), the Colvez scale, the EHPA indicator (survey of residential care homes for the elderly) and ANGELIQUE (national application providing guidance for internal quality assessments for users of establishments). Finally, there are local scales, specific to a region, a local authority or even an individual institution. An innovation may involve the introduction of new assessment systems directed at new targets (or even a combination of several new and/or old targets). Equally, it may involve the adaptation of existing tools to new contexts, for example by simplifying them or making them more generally applicable.
User privacy The SHG is a point for aggregation and management of user data in the home. As sensors in the home become more common (e. g., smart power meters, per- sonal health monitoring), the SHG can store and control access to personal data collected from these sensors. This same model could be applied to other types of personal data or user credentials, e. g., for information stored on social net- works today or user profiles that inform targeted advertise- ment. In this context, protecting users privacy becomes an important priority. In that sense the SHG offers an oppor- tunity to better preserve and control user privacy at home. In particular, users can control access to sensitive informa- tion at a single, in-home location potentially offering better privacy protection than when personal data is scattered over multiple cloud services. We acknowledge, however, that ad- ditional research is necessary to develop appropriate mech- anisms to protect user’s privacy and give users more control over their own data.
[Insert Figure 3 here]
In further analyses, our article turns to specific health problems, and explore whether they are more prevalent among children from low-income families. We find that children from low-income families are significantly more likely to get digestive problems. However, the correlation between income and most specific health problems is insignificant. A potential explanation for this result, that future research could focus on, is that the income gradient in these specific health problems is underestimated due to differences in doctor consultation and screening between children from low- and high-income families. These differences may in particular explain the absence of income gradient in (1) certain infectious and parasitic diseases, (2) endocrine, nutritional and metabolic diseases and (12) injury, poisoning and certain other consequences of external causes. Similarly, our findings indicate that children from high-income families are significantly more likely to have skin problems. Again, these differences may simply be due to the greater probability to visit a doctor and to be diagnosed with skin conditions in high-income families.
3.2. Specificities of the French case
InFrance, formal homecare can be provided to elderly dependents in several ways, in- cluding using service providers of formal homecare that hire and pay employees to care for elderly dependents. As service providers engage in a regulated activity, they are subject to agreements provided by French public agencies. We can distinguish service providers agreed to by the French District Councils from those agreed to by the French Regional Offices for Labor. The former cannot choose their prices, while the latter have more flexibility as long as their prices do not vary dramatically from one year to another. An elderly dependent can also pay the care provider directly by recruiting over the counter. The spectrum of formal homecare providers is thus very different from one French district to another. Moreover, visiting nurses and housekeepers can practice anywhere inFrance. As a result, there is a significant imbalance between districts in terms of supply. In addition, inFrance as in many European countries, the out-of-pocket expenses for an elderly dependent receiving formal homecare are reduced thanks to the “Allocation Personnalis´ ee d’Autonomie” (APA). Since 2002, this benefit has been allotted by the French District Councils. To benefit from the APA, an application must be completed. Each district has its own application, with varying levels of complexity and numbers of supporting documents. Out-of-pocket expenses for the formal homecare of elderly dependents can vary widely from one district to another.
The estimates of the bivariate Tobit model can be found in Table 4 . Our instrumental variable, the density of self-employed midwives by district, is positively correlated with the hours of formal homecare received and is significant at a 1% level. The more attractive the area, the more formal homecare the elderly dependent uses. We try to include our instrument in the informal-care equation, even if the model is then identified only by the censor of both dependent variables. As expected, the coefficient is not significant at a 10% level, indicating that our instrument is not correlated with informal care. Formal and informal care are both positively influenced by the level of dependence. Parameters associated with the dependence score, Alzheimer’s disease status and the age group are significant at the 5% level, even if Alzheimer’s disease has a significant impact only on informal care. People suffering from early-stage Alzheimer’s disease must be over-represented in our sample of Alzheimer’s patients living alone at home. These people may not need help beyond family support, or their family may believe that to be so. People suffering from Alzheimer’s disease find it difficult to collect the necessary paperwork to benefit from formal homecare. The fact of having a diploma has a positive impact on formal home-care use: educated individuals may find information about the formal home-care market more easily and have easier access to it. Moreover, the fact of having a diploma can be considered a proxy variable for social class. Individual belonging to high social classes have more chance to hire an housekeeper to do domestic tasks. This effect is consistent with estimates from several studies, such as that by Van Houtven and Norton (2004)  . Use of informal care increases with the number of children, consistent with intuition and the literature on the subject ( Bolin et al. (2008)  , Charles and Sevak (2005)  ) because children are the main informal-care providers for elderly dependents living without a partner.
Despite the clear interest of all three countries in preventive care as evidenced by the large number of recommendations, the recommendation methodology, grading system, means of expression, clinical categories, as well as the populations targeted, were all highly variable, which complicated any comparison of the preventive services recommended by each country (Hayward et al., 1991). The divergence in topics addressed by the three different countries, which made it impossible to compare around ten percent of the global recommendations, could be explained in several ways: a difference in the perception of certain preventive services as essential priorities; differences in the epidemiology of certain illnesses; or differences in health delivery systems and medical coverage (Organisation for Economic Co-operation and Development, 2011; Starfield, Shi and Macinko, 2005; USPSTF, 2010b; USPSTF, 2010c). This impossibility of comparing recommendations existed despite our deliberate choice of three countries with well-developed health care systems whose means allow them the luxury of focusing on prevention rather than exclusively on priorities that are more basic. Surprisingly, some of the recommendations that could not be compared related to prevailing issues: chronic obstructive pulmonary disease, high blood pressure, illicit drug use, peripheral arterial disease, and unintended pregnancy [Figure 1]. This cannot be due to variations in access to scientific information, as these recommendations were founded on the analysis of evidence-based medical data that are available to the experts in all three countries (McAlister et al., 2007). The discrepancies between recommendations on preventive care could also be explained by political willingness, or socioeconomic and cultural contexts (Atkins et al., 2004). Considering the lack of consideration on patient characteristics too, this may affect the applicability and the transferability of recommendations in clinical practice (Ahmad et al., 2010; Herland et al., 2005).
Access to technologies (mainly computer and Internet) may become a factor of conflict in terms of family rules and practices when the young ones use these. The need for business-dedicated space and work time may call for sensitive family trade-offs. For example, conflicts may arise when the self-employed worker wishes to continue a work assignment later in the day or in the evening while children insist on having access to the computer or Internet. Women who participate in their husband’s self-employed activities may find themselves locked-in some type of work for which they are not qualified; they have no time to maintain or develop their own skills for use in the job market outside the home. Young ones are offered learning opportunities while contributing to the “family business”. This contribution is particularly significant in matters concerning information technologies when the parents lack the appropriate knowledge or know-how. The offspring of self-employed workers is provided daily opportunities to observe work for pay and to participate in the effort in ways that are not within reach of other children. Our research intends to examine whether self-employment in the Canadian context accounts for a benefit or a disadvantage in work-family balance. The availability of quality day care facilities and the frequent holidays afforded to most parents in Québec may well make wage-earning more attractive in Québec even though work schedule arrangements are not readily accessible in the employment context (Tremblay 2004b). Let us now examine the results of our survey.
however, the APA is far from being a solution to gender inequalities, which are perpetuated by the methods of service delivery. These especially concern relatives andcare workers.
Relatives are still ‘care managers’
When deciding the structure of the help plans, the frames and practices of street-level organisations and bureaucrats impact the relatives of elderly people. The ‘évaluateurs’ who have an administrative background are more likely to draw up plans including what people already have as services, or what they say they would like to have, while those who have a social work background are more attentive to social ways of functioning and unexpressed needs. This can bring them to reinforce gender norms by allocating a limited number of care hours when female relatives already do the major part of the care work. But their ways of studying cases can also bring them to detect more easily elderly people ’s individual situations and/or their caregivers’ refusal to recognize the decline in their own capacities. In this sense, some frontline social workers tend to propose help plans that give more paid care hours than would be claimed by the beneﬁciaries, and try to convince families to accept these hours. The issue is then for them ﬁnd a way to encourage the families to accept the intervention of a paid care worker in the home, and to progressively increase the number of paid hours of care given. Sensitive to the possibility of ‘caregiver burnout’, they seek in this way to forestall exhaustion in unpaid family members carrying out care work. From this viewpoint, burnout prevention is often presented as being in the interest of the elderly person, and designed to maintain the care function of the existing family carer as long as possible; the interests of the informal care providers themselves do not seem to be taken into account.
In the present study, IDU were more likely to renounce care. Previous research identified discrimination of HIV-infected IDU by healthcare workers as a risk factor for negative health behaviors inFrance , and as a barrier to healthcare worldwide [35–37]. Being an IDU and experiencing discrimination in healthcare services were independent risk factors for renunciation of healthcare in our study, which might indicate riskier individual health behaviors among IDU, as well as among tobacco smokers. In many settings, discrimination and stigma of PHLIV is gender-based as women are more frequently blamed for supposed promiscuity. Accordingly, women with HIV may be more discouraged from seeking healthcare [38,39]. This situation may be aggravated by the use of narcotics in HIV-infected women, especially in relation to pregnancy and motherhood . These elements may explain why female gender was a risk factor for renunciation of healthcare in our univariate model, but unlike IDU and discrimination, disappeared in the multivariate analysis.
We address the following question: how sensitive to price are the disabled elderly when consuming professional homecare? Besides concerns regarding the financial accessibility of long-term careservices, OOP payments raise ef- ficiency issues. As in the health care context, generous homecare subsidies may induce over-consumption and a welfare loss, while insufficient coverage could have adverse health effects ( Stabile et al. , 2006 ; Rapp et al. , 2015 ; Bar- nay and Juin , 2016 ) or induce beneficiaries to substitute homecare for more expensive institutional care ( Ettner , 1994 ; Guo et al. , 2015 ). Uncovering the impact of OOP price on homecare consumption is crucial to design an optimal subsidy policy that would achieve ex ante insurance of uncertain LTC costs while limiting ex post demand-side moral hazard ( Zeckhauser , 1970 ; Cutler and Zeckhauser , 2000 ; Bakx et al. , 2015 ). Our paper brings evidence on this empirical question by estimating the price elasticity of the demand for non- medical homecareservices of the disabled elderly, at the intensive margin.
Older patients are more likely to use health care than younger people ( Ackroyd-Stolarz ,
2014 ; Moons et al. , 2003 ). Hospital and emergency departments are not the right places to receive all seniors needs ( Jones et al. , 2018 ). Better access to home could reduce unnecessary admission to the emergency department ( Truman , 2005 ) and hospital. Homecare can be a good substitution in many cases for hospital use. Increasing expenditure on homecare gene- rate a reduction in demand for hospital services ( Forder , 2009 ) or reduction hospital length of stay ( Holmas et al. , 2013 ). In the same way, the availability of homecare could reduce the hospital length of stay ( Picone et al. , 2003 ). Increasing availability of homecareservices implies shorter waiting times to have homecareservices after hospital discharge, which in- crease the probability of earlier discharge, then reduce the length of stay. Inversely, patients in areas with less homecareservices are more likely to stay longer in hospital and emer- gency department ( Fernandez & Forder , 2008 ; Gaughan et al. , 2015 ). Hospital readmissions are also higher in area with lower homecare or home help supply. Using homecare ser- vices can thus prevent some hospital admission through supporting people with long-term conditions. Homecare can also facilitate the timely discharge from hospital and convales- cent home, and hence can reduce unplanned readmission rates ( Victor et al. , 2000 ; Thomas et al. , 2005 ; Vetter , 2003 ).
• Specification of the short-term management: HHC coordination problems have been addressed by many
different mathematical formulations. The relevant decision-making problems search for the value of many variables that will represent formally what to do, when to do it and how to perform it. In fact, many authors have studied sub problems of coordination separately, such as the scheduling of the careservices, the routing of the caregivers, or the assignment of the caregivers to the HHC’s requests of the patients on time scales that cover different periods (day, week, month). Such works show explicitly many facets of what has to be more or less formally decided by whom is willing to coordinate. We will conceive a decision frame to capture all these configurations of problems from objective functions to constraints to be satisfied. • Architecture of a decision support solution: In this part, we focus on a decision support subsystem embedded in an HHC coordination system. In the literature, optimization methods are often applied to solve the formulated problems. Globally, the valuable judgment of an organization in charge of the control goes through a criticism about the quality of its decisions considering an estimation of the expected properties of the system in operation. The consideration of random variation, for example, is an important factor in the HHC due to the nature of some of the more lavish care activities.
Anaïs Henneguelle, Benjamin Monnery, Annie Kensey
Many countries have recently adopted electronic monitoring (EM) as an alternative sentence in order to reduce incarceration while maintaining public safety. However, the empirical evidence on the effects of EM on recidivism (relative to prison) is very scarce worldwide. In this paper, we adress this debated question using quasi-experimental data from France. Our empirical strategy exploits the incremental roll-in of electronic monitoring inFrance, which started as a local experiment in four courts in 2000- 2001, and was later adopted by moreandmore courts (2002-2003). Our IV estimates show that fully converting prison sentences into electronic monitoring has long-lasting beneficial effects on recidivism, with estimated reductions in probability of reconviction of 6-7 percentage points (9-11%) after five years. There is also evidence that, in case of recidivism, EM leads to less serious offenses compared to prison. These beneficial effects are particularly strong on electronically monitored offenders who received control visits at home from correctional officers, were obliged to work while under EM, and had already experienced prison before. This pattern suggests that both rehabilitation and deterrence are important factors in reducing long-term recidivism, and that electronic monitoring can be a very cost- effective alternative to short prison sentences. However, the massive development of EM inFrancein recent years, with shorter and less intensive supervision, may reduce its effectiveness.
METHODS: An online survey was sent to active members of the Ordre des optométristes du Québec (Quebec regulatory board of optometry). Recruitment was performed by email and social media. For descriptive variables, frequencies and percentages were calculated, and analyses were conducted using chi-square tests. RESULTS: The participation rate was 13.3% (n = 186). Forty-two percent of the participants were at least 40 years old and 67% were women. Only 8.5% of the participants performed at least one home-based eye examination in the last 12 months, but 23.7% showed an interest in providing that type of services. Several barriers to home-based services were identified; the three most important being unavailability of portable instrumentation (91% of participants), complex logistics (89%) and insufficient remuneration (88%). Lack of self-confidence (p < 0.05) and lack of knowledge inhome-based eye care (p < 0.05) were more a barrier for women than for men. In the presence of a facilitator, such as a third-party organization providing logistic support (coordination with nursing homes, providing portable ophthalmic instrumentation, etc.), the level of interest to perform home-based eye care increased to 60%. In general, young optometrists (< 40 years old) showed more interest in providing home-based eye careservices than their older colleagues (p < 0.05).
Classical building automation has generally focused on tasks like the control of lighting and heating, aiming to increase energy efficiency and comfort of the occupants. Today, applications are shifting from these quite simple control tasks to more complex requirements such as the autonomous surveillance of buildings . It is attempted to monitor what is going in a building without the need for a human supervisor who has to take over this – often repetitive – observation task. By such measures the ‘external’ security and safety can be increased in private and public buildings. Similarly, certain kinds of ‘internal’ monitoring in hospitals or homes can be beneficial for the ambient assisted living of elderly or handicapped people. In particular, aspects of the health and well-being of occupants can be observed automatically thus supporting medical and nursing staff. Furthermore, elderly and handicapped persons could be enabled to live longer independently in their own homes. To achieve these new possibilities, buildings have to be equipped with different sensors. As argued in , there is a tendency to use an immense number of simple, inexpensive and diverse sensors for such purposes.
INSERT FIGURE 2 HERE
The stability of the proportions of this occupational status is confirmed by official data from the national unemployment insurance system, although the data presents different proportions. If we restrict the universe of workers in the Casen data from 2006 to formal wage earners (open ended + atypical contracts), 77.1% of these workers have open- ended contracts, while 22.9% have atypical ones. 9 However, Table 2 below illustrates the contradictions between survey and administrative data. According to information from the unemployment insurance system the proportion of short-term contracts fluctuates between 36-39% of the formal labour force, while open-ended contracts conversely represent between 61-64% of the labour force. 10 Unfortunately, the insurance system was only implemented in 2002, so the first five years of the time series presented in Table 2 reflect its gradual implementation, which is why atypical contracts at first constituted a higher proportion of contracts than open-ended ones. However, by 2008, the insurance already covered 74.6% of the formal labour force, which in itself is an indicator of the level of flexibility and job rotation in the Chilean labour market. Since the distribution of open ended and atypical contracts has stabilised in recent years, we can now consider that the data genuinely reflects contractual conditions in Chile.