Les Amis, France: Redeployment, training and development
Les Amis is a non-profit organisation in the health and social services sector. Activities mainly consist of domiciliary care services, for which the association benefits from both public and non-governmental funding. Since 1997, the association has also managed home help staff on behalf of private individuals employing them directly. The association looks after 1,200 clients, mainly older people, in one district in Paris.
Les Amis employs 312 staff: 236 home helps and 40 government-registered nurses or nursing auxiliaries. Employees are mostly women (96%) aged over 40 years and less than 60 years (71%). Contrary to the prevailing characteristics of this sector, 62.5% of employees work full time and 90% are on permanent contracts. The activity of managing home helps concerns 24 employees (18 full-time equivalents).
Over the years, the area of home help has evolved. Nowadays, tasks consist not only of housework but also of body care, administrative help, intermediary work between children and parents and care of very different needs and pathologies, such as persons with disabilities, AIDS sufferers or the elderly. However, less time is spent with clients. Work is physically and psychologically demanding. Psychological demands have increased, for instance, due to the greater frequency of Alzheimer’s disease and this has been compounded by the increasing age of the persons cared for in recent years. A decline in physical and psychological well-being is often experienced from the age of 45 years, and worsening from 55 years onwards, with repeated sick leave.
Since its foundation in 1978, the association has had the same director. Discussions with employee representatives are regular and often informal.
The original initiative
The development of public policies to care for older people in their own homes has increased skill requirements in the home help sector. However, the proportion of graduates in the home help sector is still low, as is reflected in the case of Les Amis. Moreover, Les Amis does not have the financial means to support the development of a large team of highly qualified home helps. Thus, there has not been significant competition from younger graduate workers.
In relation to recruitment at Les Amis, there is no maximum age threshold. Young workers are not systematically favoured and recruitment may occur among older age groups, as long as the person is physically able for the work. In fact, age is a positive characteristic from a management point of view and employees aged 40–45 years are often viewed more preferably than younger employees. Early exit schemes are not used by the organisation and any person wishing to work beyond 60 years of age is allowed to do so. In certain circumstances, flexible working time options are allowed, e.g. reduced working time or part-time employment for medical reasons.
Good practice today
Skill requirements in the home-help sector have increased in recent years. In 2002, a new diploma was introduced, i.e. the State Social Auxiliary Diploma (Diplôme d'etat d'auxiliaire de vie sociale, DEAVS). It replaces the CAFAD, introduced in 1987. The DEAVS diploma requires 1,000 hours of training (compared with 600 hours for the CAFAD). Validation of prior experience is possible, although it requires the putting together of an application portfolio and its presentation to a board of examiners. Preparation training, which aims to help people in making a presentation to a panel (how to express themselves orally, how to sell themselves), is supported by the continuous training body of the home help associations’ federation.
By the end 2004, some 42 (18%) of Les Amis’ 236 home helps acquired the DEAVS. The association has encountered two difficulties, however, in relation to the diploma. First, it has insufficient financial resources to provide development opportunities to the large number of experienced home helps. Second, the DEAVS does not properly meet the needs of experienced workers. The way validation of prior learning is carried out (on the basis of a portfolio of work experience and an oral exam, and not on the basis of a real working situation) does not favour persons with low educational attainment and those who have difficulties expressing themselves in French (many home helps are immigrants). Therefore, some home helps over 50 years do not want to partake in this process. Moreover, the DEAVS is split into units, which are scheduled over a three-year period.
Even if priority is given to the most senior employee, a home help aged 40 years or older is unlikely to pass the DEAVS before leaving (due to retirement or otherwise). However, the 2002 sectoral collective agreement forbids the classification of a C grade to a person who does not hold the DEAVS. As salaries are calculated on the basis of employees’ grade classification, wages paid to an experienced home help who does not hold the DEAVS often do not reflect their skills and years of experience. Career progression thus remains at a standstill for many senior home helps.
Despite the importance of the diploma, experience is still an important criterion for recruitment. The social dimension of the tasks involved is considered crucial, even if the person is a graduate. Non-graduate but experienced persons, e.g. those employed in a similar organisation or caring for an elderly person in a family setting, are not excluded. Moreover, there is a shortage of graduates in the sector, evident in the fact that they account for no more than one in five applicants at most. During periods of high activity or staff shortages (particularly during holidays), the association continues to recruit unskilled persons.
Although there is no age threshold, and workers are encouraged to continue working at Les Amis even after 60 years of age, a lack of fitness to work is frequent, resulting in four to five lay-offs a year. Possibilities for more flexible work practices are still limited, except for a reduction in working time and allowing home helps to ‘negotiate’ with clients the tasks to perform. Given the high proportion of severe cases, it is difficult to improve working conditions and at the same time provide a full-time service. To help reduce difficulties, 20 to 25 persons are required to attend a training course in handling every year. Currently, home helps only work during the week; weekends are operated by students.
An experimental agreement was signed for 2002–2005 between the city of Paris, the home help associations’ federation and the government, allocating funding from the home help modernisation fund (set by the 2001 Act on personalised independence allowance – allocation personnalisée d’autonomie, APA). Under this arrangement, a psychologist visits the home helps every month to help them deal with the psychological difficulties they may experience as part of their job. In addition, an occupational therapist may visit the home of the person being cared for in order to suggest adjustments, e.g. a medical bed or patient lifting device. This allows for an improvement in the working conditions of the home helps, although the client first has to agree to the proposed changes. Occupational therapists also give advice to home helps on their positions at work.
For five years, all the senior home helps (unless they refused to take part) have benefited from training courses in handling or advice from occupational therapists. Overall, the impact of the experimental agreement is positive as far as physical and psychological distress is concerned. However, this support is still not sufficient and there is no certainty of renewal or extension of the agreement after 2005.
Working conditions and management of employees are highly dependent on levels of funding. Under the 2005 Borloo law on social cohesion, it is proposed that personal services should be developed along the same lines as services in the private sector. This might encourage Les Amis to strengthen its working conditions for home helps, in particular, through the implementation of on-call and generalised weekend work.
Contact: Bernard Ennuyer, Director