"Twenty years already," say without consulting each other the government advisor and Minister of Social Affairs and Health Christophe Robino and Doctor Pascale Gelormini , who heads the center with Philippe Migliasso. Twenty years that the Monaco Gerontological Coordination Center (CCGM) has welcomed, guided and supported people over 60 in their desire to maintain independence, at home, despite their fragility.
Philippe Migliasso, who has led the CCGM since its creation, remembers when it opened its doors in 2005. "It was quite innovative and pioneering at the time. It was designed to address this demographic shift that we even call gerontogrowth, with a shift in the oldest segment of the population. Monaco is also following this trend."
Preserve autonomy, maintain security
To address this phenomenon of population aging, the center has focused its scope on supporting vulnerable people while preserving a certain degree of autonomy for those affected. "We only serve people who live at home. We are not a residential center. Here, we respond to the needs of people who ask to remain in their own homes as long as possible. Our team, made up of Dr. Gelormini, nurses, and social workers, visits the home to conduct a gerontological assessment. This is a big word to say that it involves a battery of internationally recognized tests that will allow us to assess the person's autonomy in their living environment. On a physical and cognitive level, but also on an environmental and social level."
The interview lasts about an hour, and at its end, Philippe Migliasso's teams establish a "support plan" to provide a tailored response to the patient's problem. "With the perspectives of our different professions, each of us will analyze the situation through our own lens. We look at what measures can be implemented to respond to the individual."
So, whether for washing, medical assistance or a simple mission, the CCGM teams go to the patient's home to provide the necessary support.
Support for the elderly... and caregivers
While we often talk about helping seniors, their loved ones are also concerned. "Taking care of someone who is losing their independence also means taking care of the family caregiver," says Philippe Migliasso. "It's not the primary intention, but for us to have peaceful support, we must of course work with the family caregiver."
This help sometimes takes the form of a simple listening session. "From time to time, the person arrives with many, many questions. They panic. Often, we have crisis episodes. We even talk about caregiver burnout."
The organization therefore organizes individualized, one-on-one interviews. " The person is encouraged to express their difficulties. Sometimes, it's up to us to allow them to take a step back to analyze the situation and defuse it, to let them know that they are not alone in this situation, that there are solutions."
An evolution proportional to that of civil society
Over time, practices evolve. And thanks to twenty years of experience, Philippe Migliasso has the perspective to observe some of these changes. Starting with the desire to remain at home at all costs. "We see a difference and a shift in mentalities. Today, we support the first-generation caregivers we supported. Their wishes are different. Now, the people we care for want to be active participants in their life projects, to be decision-makers. They are truly partners in the support plans we offer."
And when he tries to motivate the reasons that push people to act this way, Philippe Migliasso has several ideas. "Home is more than just the place where we live, it's memories, it's the whole history we carry. Homes are a bit like a self-portrait of the people who live there. And then entering an institution means accepting new habits, it's accepting community life, it's accepting to be guided by a rhythm, the rhythm of the institution. Home is still the freedom to choose. And autonomy is also the freedom to say no. And when you're at home, you can say no."
However, these developments have consequences for institutions. "Today, people entering institutions are much more dependent than the population we initially supported. This means they no longer have any other options and this is a last-ditch solution. That is to say, we've tried everything before."
Implemented at the beginning of the year, the mobile care services have been a resounding success, says Philippe Migliasso. This service is provided by a personal services company, with two visits per night to maintain a connection with seniors outside of the hours of intervention of the care workers. "The missions are mainly for late bedtimes or physiological needs. This allows us to maintain a social connection and interaction for the person being cared for, who often had difficulty participating in family meals because they had to go to bed at times that were not necessarily suitable." The center manager is pleased with the positive reception of this system, which still requires meeting eligibility criteria. "We still need to continue to evolve and communicate about it. We observe a fear in the acceptance of these mobile night care services since it still means accepting the intervention of people at night in one's home."
Towards recognition of caregiver status? In addition to this project already underway, Philippe Migliasso hopes to have the status of family caregiver recognized. "There is a lot of thought being given to this subject because it is a central pillar. It is an invisible force that is there 24 hours a day, 365 days a year. We are also thinking about relaying care to allow the caregiver to take a stay, to go to the family, knowing that there will be a presence in the home 24 hours a day. The reflection is well advanced and is underway, but it requires small legislative adjustments, particularly in terms of labor law."
Finally, still with the aim of relieving the caregiver and supporting the person who is losing their autonomy, the head of the CCGM wishes to set up a reception center for patients whose caregiver needs to be temporarily hospitalized. "If the senior cannot stay at home while the caregiver is hospitalized, the idea is that they can go to a temporary reception center with care."
