Home In France Research Articles

Asymptomatic SARS COV-2 carriers among nursing home staff: A source of contamination for residents?

ObjectivesTo show that circulation of SARS-COV-2 in nursing homes in France can come from staff as well as residents’ families, whether they are known or not to have had COVID-19. MethodsThis study reports a screening campaign of asymptomatic staff working in elderly nursing homes in Paris where the virus had been circulating actively in March and April 2020. ResultsBefore the screening campaign, the rate of symptomatic COVID-19 was 23.3% among the residents and 12.1% among their home employees. Within a 72h screening period, all employees not known to have the virus were screened by RT-PCR in nasopharyngeal swabs. Among the 241 screened employees, 32 (13.3%) tested positive for SARS-CoV-2 on RT-PCR. SARS-CoV-2 carriers and non-carriers did not differ in term of gender, age or type of staff. Staff carrying SARS-CoV-2 were strictly asymptomatic in 75% of cases while during the days following or before the test, 25% presented mild symptoms of COVID-19. Considering both symptomatic and asymptomatic cases, 66 out of 281 (23.5%) of the home employees had been carriers for COVID-19. ConclusionScreening for viral carriage of asymptomatic staff in nursing homes can avoid contact and transmission to frequently severely vulnerable residents.

Acceptability of a Novel Telemedication Review for Older Adults in Nursing Homes in France: A Qualitative Study

PurposeIn France, polypharmacy among older people living in nursing homes (NH) is a major public health concern. In this context, the randomized controlled trial TEM-EHPAD was recently launched in various NH in southern France to evaluate the impact of implementing a novel telemedication review (TMR) on hospital admission rates of NH residents at high risk of iatrogenic disease. A qualitative study was integrated into the main trial study to assess general practitioners’ (GP) and other NH healthcare professionals’ (HP) acceptability of the proposed TMR before its implementation.Material and MethodsA qualitative study using face-to-face semi-structured interviews was conducted with 16 HP before the beginning of the intervention. A manual thematic analysis was performed on the transcribed interviews.ResultsFour main themes emerged from the thematic analysis: HP perceptions of the TMR, difficulties related to medication management for NH residents, HP perceptions of the roles of different professionals, and facilitators of good practices. Most participants were favorable to the TMR, but some GP expressed fears about loss of control over their prescription writing.ConclusionThis study fulfilled its objective to assess pre-intervention acceptability by GP and other HP. Results provided important information about how to adapt the TMR intervention to make it more acceptable to HP who will be involved in TEM-EHPAD. One of the main recommendations is the importance of providing participating GP with the opportunity to take part in the process of reviewing prescriptions.

COVID-19: Association Between Increase of Behavioral and Psychological Symptoms of Dementia During Lockdown and Caregivers’ Poor Mental Health

From March 2020, the support and care systems for caregivers and people with dementia (PWD) were suspended or dramatically changed due to the lockdown during the world pandemic of COVID-19. Thus, these changes in living conditions have had deleterious consequences on the behavior of PWD and subsequently on their caregivers' mental health, the two being linked. Our study aimed to examine changes in behavior among PWD and to look for associations between the evolution of behavioral and psychological symptoms of dementia (BPSD) and caregivers' mental health in the context of COVID-19. The study was conducted among caregivers of PWD living at home in France. Caregivers were interviewed via an anonymous cross-sectional online survey during the first lockdown between April 15 and June 15, 2020. Three hundred and eighty-nine caregivers accompanying a relative living at home participated in the study; 43.3%of the PWD presented a worsening of BPSD during the lockdown. With multivariate logistic regressions, a significant association was observed between "more BPSD" and burden, anxiety and depression, between "BPSD equivalent" and anxiety and depression, and between "emerging BPSD" and only depression. The lockdown seems to have an impact on behavioral disorders in PWD and these disorders are associated with poorer mental health of caregivers. Our findings suggest attention should be given to caregivers of PWD who have BPSD before lockdown and the need for continued consultations and professional help in case of new lockdowns.

ASSOCIATIONS OF INFECTION PREVENTION AND CONTROL MEASURES WITH COVID-19 CASES AND DEATHS IN NURSING HOMES

Background/Objectives: To identify which infection prevention and control (IPC) precautions in long-term care facilities (LTCF) were associated with reduced COVID-19 incidence and mortality among residents and reduced COVID-19 incidence in health care professionals (HCP). Design: Retrospective data on self-assessment of adherence to 101 IPC measures collected via an online questionnaire sent to 825 nursing homes in France in December 2020. Setting and participants: Medical and administrative staff jointly reported data on IPC measures, characteristics of LTCF, counts of residents’ COVID-19 deaths and cases, and counts of HCP cases. Measurements: Random forest models were used to identify the most important IPC measures associated with reduced number of COVID-19 deaths and cases in residents and cases in HCP. The identified variables were then included in linear regression models to estimate the association between levels of adherence to each selected IPC measure and COVID-19 deaths and cases. No data on time of IPC measures implementation were collected. Results: Data from 307 LTCF (37.2%) were collected, accounting for 22,214 residents. A higher number of COVID-19 deaths in residents was associated with a better adherence to physical distancing in group activity rooms. A better adherence by HCP to physical distancing during their mealtimes and break times was associated with fewer COVID-19 cases among residents and HCP. Other IPC measures were not significantly associated with COVID-19 cases or deaths. Conclusion: Physical distancing between residents was more implemented when LTCF had been confronted with COVID-19 deaths. Physical distancing between HCP was associated with fewer COVID-19 cases in residents and HCP, suggesting it may prevent significantly COVID-19 spreading in LTCF. HCP should particularly adhere to physical distancing measures during their mealtimes and break times. A higher adherence to such preventive measures does not require extra material or human resources and may be easily achievable.

Frailty Index, Hospital Admission and Number of Days Spent in Hospital in Nursing Home Residents: Results from the Incur Study.

To investigate the predictive capacity of an age-related deficit accumulation index (the so-called Frailty Index [FI] proposed by Rockwood) for hospital admission (HA) and number of days spent in hospital (DSH) among nursing home residents. Data are from a longitudinal cohort study, the Incidence of pNeumonia and related ConseqUences in nursing home Residents (INCUR), of 768 elder people (75.4% women) living in 13 nursing homes in France. The FI was computed taking into account 30 possible deficits at the baseline visit. Hospital admissions were defined as all urgent and involuntary admissions including unplanned readmissions. The length of stay was the total number of days spent by the resident in the hospital. Cox proportional hazard models in the presence of competing risks (death) were performed to study the relationship between the FI and HA over a 12-month follow-up. A Zero-inflated negative binomial regression was performed to study the association between the FI and DSH. Mean age of participants was 86.7 (standard deviation [SD] 6.9) years, with a mean FI of 0.37 (SD 0.11). At the end of the follow-up, 238 (30.9%) HA events were recorded. Positive associations of the FI with DSH and HA were reported (per 0.01 FI increment: age- and gender-adjusted hazard ratio 1.15, 95% confidence interval 1.020-1.297, p=0.02 and OR 1.209 (1.075 - 1.359, p<0.001, respectively). The FI is a strong predictor of negative health-related outcomes as HA and DSH events, even with very old and complex nursing home residents.

Clinical features and medical care factors associated with mortality in French nursing homes during the COVID-19 outbreak

ObjectivesThis study aimed to identify demographic, clinical and medical care factors associated with mortality in three nursing homes in France. MethodsTwo nursing homes were hospital-dependent, had connections with infection prevention and control departments, and had permanent physicians. A third nursing home had no direct connection with a general hospital, no infection control practitioner, and no permanent physician. The main outcome was death. ResultsDuring the first 3 months of the outbreak, 224 of 375 (59.7%) residents were classified as COVID-19 cases and 57 of 375 (15.2%) died. The hospital-dependent nursing homes had lower COVID-19 case fatality rates in comparison with the non-hospital-dependent nursing home (15 [6.6%] vs 38 [25.8%], OR 0.20 [0.11–0.38], p = 0.001). During the first 3 weeks of the outbreak, mortality in COVID-19 patients decreased if they had a daily clinical examination (OR: 0.09 [0.03–0.35], p = 0.01), three vital signs measurement per day (OR: 0.06 [0.01–0.30], p = 0.001) and prophylactic anticoagulation (OR: 0 [0.00–0.24], p = 0.001). ConclusionsThis study suggested that high mortality rates in some nursing homes during the COVID-19 outbreak might have been contributed by a lack of medical care management. Increasing human and material resources, encouraging presence of nursing home physicians and establishing a connection with general hospitals should be considered to deal with present and future health disasters in nursing homes.

From the forerunners of document collection to the trial of Klaus Barbie and beyond: the transitional justice journey of the Izieu telegram

ABSTRACT This article analyses the journey of the so-called Izieu telegram – a telegram sent by Nazi perpetrator Klaus Barbie to report the raid of a Jewish children’s home in France to his superiors – from its creation to its use in multiple transitional justice mechanisms, including an international military tribunal, domestic trials in France, and various memorialisation projects. In doing so we apply the concepts of activation and the records continuum approach, both borrowed from archival studies scholarship, to analyse how an individual record becomes continuously recontextualised through its use in transitional justice processes and in the process contributes to those same processes. We conclude by highlighting both the benefits of bringing archival concepts into dialogue with transitional justice scholarship and practice, and the tensions inherent in that endeavour.

Which Factors Are Associated with Body Mass Index Among Elderly People Living at Home in France?

Obesity is a complex and multifactorial chronic disease. Body weight can be affected by environmental and socio-economic conditions, genetic factors, lifestyle, etc. The aim of this study was to investigate the links between body mass index (BMI) categories and socio-demographic, health and life style variables among people aged 60 years or over who live at home. Data were collected from the 2008 cross-sectional national survey on health and disability (Handicap Santé Ménages) and are representative of the elderly population in France living at home (N = 9,867). We have performed multinomial logistic regressions with weight status as the outcome variable. Compared to individuals aged 75 to 79, people aged 80 and over were more likely to be overweight than obese, and of normal weight rather than overweight. Having at least one chronic disease increased the probability of being obese as opposed to overweight. Women with severe physical limitations were also more likely to be obese than overweight. Doing physical exercise decreased the probability of being obese as opposed to overweight and overweight vs. normal weight. Time spent watching TV increased the probability of being overweight vs. normal weight. There is an urgent need for public health measures to prevent obesity among the elderly, such as those that promote good nutrition, exercise and social relationships, in order to help old people to maintain their capacities and autonomy.

High depression and anxiety in people with Alzheimer's disease living in retirement homes during the covid-19 crisis

To cope with Covid-19 and limits its spread among residents, retirement homes have prohibited physical contact between residents and families and friend and, in some cases, even between residents or between residents and caregivers. We investigated the effects of measures against Covid-19 on the mental health of participants with Alzheimer's disease (AD) who live in retirement homes in France. We instructed on-site caregivers to assess depression and anxiety in participants with mild AD who live in retirement homes. Fifty-eight participants consented to participate in the study. The participants rated their depression and anxiety during and before the Covid-19 crisis. Participants reported higher depression (p = .005) and anxiety (p = .004) during than before the Covid-19 crisis. These increases can be attributed to the isolation of the residents and/or to the drastic changes in their daily life and care they receive. While, in their effort to prevent infections, retirement homes are forced to physically separate residents from the outside world and to drastically reduce residents’ activities, these decisions are likely to come at a cost to residents with AD and their mental health.

Incidence, criticality and typology of care-related adverse events in nursing homes based on initial epidemiological characteristics and possible prevention measures in France.

Knowledge of care-related adverse events in nursing homes in France is limited. An observational descriptive study was conducted in 25 nursing homes over a period of two weeks between 2016 and 2017. This study aimed to describe types of care-related adverse events and to assess their severity, the frequency with which they occurred, and their criticality. Eighty-six types of care-related adverse events, associated with 13 risk areas, were identified (31 of which were identified by an investigating physician). Of these types of events, 11 corresponded to an unacceptable level of criticality, and 13 were categorised as warranting surveillance. Efforts in nursing homes should focus on the different types of care-related adverse event: loss of or damage to a medical device, failure to administer medication, failure to coordinate between different establishments, shortfalls in planning and continuity of care, shortfalls in the information system, loss of or damage to laundry items, and unauthorised exit from the premises. Broad recommendations on preventing adverse events and improving nursing homes should be the subject of future study.

Fragility fractures in France: epidemiology, characteristics and quality of life (the EPIFRACT study).

To estimate the incidence of fragility fractures in France and to describe the characteristics of individuals with such fractures and of their fractures. In April-May 2018, a postal survey was performed in France targeting a representative panel of 15,000 individuals aged ≥ 50years, who were invited to complete a questionnaire. If they reported experiencing a fracture in the previous 3years, they were asked to provide information on demographics, fracture type, risk factors for fractures and osteoporosis diagnosis. Only fragility fractures were considered, and these were classified as major (associated with increased mortality) or minor, based on the fracture site. Around 13,914 panellists returned an exploitable questionnaire (92.8%). About 425 participants reported ≥ 1 fragility fracture (453 fractures), corresponding to a 12-month incidence rate of 1.4% [95%CI: 1.2, 1.6]. Incidence was higher in women (1.99% [1.87, 2.05]) than in men (0.69% [0.38, 0.86]) and increased with age. Around 157 fractures (34.6%) were classified as major. Participants reporting major fractures were older than those reporting minor fractures (mean age: 72.6 ± 11.3 vs 67.1 ± 10.6) and more likely to report previous corticosteroid use (odds ratio: 1.90 [95%CI: 1.13, 3.18]). No other patient characteristic was associated with fracture severity. About 117 participants with fractures (27.5%) had undergone bone densitometry, and 97 (22.8%) declared having received a diagnosis of osteoporosis. Around 340,000 people aged ≥ 50years living at home in France are estimated to experience osteoporotic fractures each year. However, > 75% of panellists reporting fractures were never diagnosed with osteoporosis and thus did not have the opportunity to receive appropriate care.

Editorial: Tribute to Dr. Elinore L. Barber

Editorial:Tribute to Dr. Elinore L. Barber Christina Fuhrmann The present volume marks the fiftieth anniversary of BACH: Journal of the Riemenschneider Bach Institute. Both this issue and the next celebrate this milestone with articles by many of the best Bach scholars today. These issues also celebrate, in memoriam, the remarkable woman who founded the journal: Dr. Elinore L. Barber (1919–2013). Although I never had the honor to meet Barber, poring over past issues of BACH and archival material in the Riemenschneider Bach Institute (RBI) at Baldwin Wallace University in Berea, Ohio, brings one word to mind to describe her: indefatigable. In 1969, Barber became the director of the newly founded RBI. Dr. Warren Scharf, director of the Baldwin Wallace Conservatory of Music, wanted to increase visibility for the collection of rare items related to Bach and his circle that Dr. Albert and Mrs. Selma Riemenschneider had lovingly acquired over many years and donated to Baldwin Wallace. And increase visibility Barber did. In 1969–1970 alone, she gave two public lectures at Baldwin Wallace on topics as diverse as "Reactions to the New in Music from the Fourteenth Century to the Twentieth" and "Composing Machines and Chance Music"; lectured on "Bach and the Moon" for the Fortnightly Musical Club in Cleveland; wrote program notes for Baldwin Wallace's annual Bach Festival; assisted in the purchase of her mentor Hans T. David's collection for the RBI; and founded and published four issues of BACH, to which she contributed four articles as well as numerous announcements and an "ask the editor" column.1 Barber's pace did not lessen in succeeding years. She founded a Symposium Concert Series that featured guest and faculty performers and for which she lectured on a range of topics. These symposia [End Page 1] included an ambitious set of anniversary celebrations. She coordinated, gave lectures, and wrote program notes for celebrations of the 400th anniversary of Heinrich Schütz's birth in 1985, the 350th anniversary of Dieterich Buxtehude's birth in 1987, and the 200th anniversary of Carl Phillip Emanuel's death in 1988.2 Barber also celebrated the twenty-fifth anniversary of the RBI and BACH in 1994 with a concert featuring a newly commissioned work by Baldwin Wallace faculty member Loris Chobanian and a special issue reprinting the best articles from the journal's history.3 The latter included an article by Walter Schenkman, "Portrait of Mattheson, the Editor, Together with his Correspondents," that initially appeared in 1978 and that won the ASCAP-Deems Taylor Award for Excellence in Publication in 1980.4 Barber continued to garner awards and accomplishments. The year 1982 brought her greatest highlight. She, the Riemenschneider family, and the Huenefeld family collaborated to purchase a Bach autograph manuscript for the RBI from the Walter Hinrichsen family. The manuscript comprises thirteen parts for the cantata Ich liebe den Höchsten von ganzem Gemüte BWV 174, five pages of which contain important material in Bach's hand.5 As with many of the RBI's most valuable items, Barber published a facsimile in BACH to maximize access for Bach scholars around the world.6 Barber also collaborated with many prominent scholars and performers. Her mentor for her PhD at the University of Michigan, Hans T. David, admired Barber greatly, and David's friend Max Rudolf became her [End Page 2] Click for larger view View full resolution Figure 1. Elinore L. Barber and Alfred Dürr at the Riemenschneider Bach Institute, 1982 supporter as well.7 A chance meeting on a train in 1949 with Albert Schweitzer led to a lifelong friendship and several years of study spent at Schweitzer's home in France.8 Barber recalled: "He was a very great influence, not only musically, but as a person because he treated me just like a granddaughter. It was just an incredible experience."9 Many renowned scholars pursued research at the RBI, including Alfred Dürr, who published numerous articles in BACH and in 1982 visited Baldwin Wallace to lecture at the fiftieth anniversary of the Bach Festival, receive an honorary doctorate, and conduct research in the RBI. Figure 1 shows Dürr and Barber poring over the...

Acceptability of oral liquid pharmaceutical products in older adults: palatability and swallowability issues

BackgroundIn institutional care, oral liquid pharmaceutical products are widely prescribed for older patients, especially for those with swallowing disorders. As medicines acceptability is a key factor for compliance in the older population, this study investigated the acceptability of oral liquid pharmaceutical products in this targeted population.MethodsAn observational, multicenter, prospective study was conducted in eight geriatric hospitals and eight nursing homes in France. Observers reported several behaviours/events describing the many aspects of acceptability for various pharmaceutical products’ uses in patients aged 65 and older. Acceptability scores of oral liquid pharmaceutical products were obtained using an acceptability reference framework (CAST - ClinSearch Acceptability Score Test®): a 3D-map summarizing the different users’ behaviors, with two clusters defining the positively and negatively accepted profiles materialized by the green and red zones, respectively.ResultsAmong 1288 patients included in the core study and supporting the acceptability reference framework, 340 assessments were related to the administration of an oral liquid pharmaceutical product. The mean age of these patients was 87 (Range [66-104y]; SD = 6.7), 68% were women and 16% had swallowing disorders. Globally, the oral liquid pharmaceutical products were classified as “positively accepted,” the barycenter of the 340 assessments, along with the entire confidence ellipses surrounding it, were positioned on the green zone of the map. Sub-populations presenting a different acceptability profile have also been identified. For patients with swallowing disorders, the oral liquid pharmaceutical products were classified as “negatively accepted,” the barycenter of the 53 assessments along with 87% of its confidence ellipses were associated with this profile. A gender difference was observed for unflavored oral liquids. In women, they were classified “negatively accepted,” the barycenter of the 68 assessments with 75% of its confidence ellipses were located in the red zone, while they were classified “positively accepted” in men.ConclusionThis study showed that oral liquid pharmaceutical products are a suboptimal alternative to solid oral dosage forms in patients with swallowing disorders. To ensure an optimal acceptability, prescribers should also consider the presence of a taste-masker in these oral liquids. As highlighted herein, palatability remains crucial in older populations, especially for women.

Pain and symptoms of depression: international comparative study on selected factors affecting the quality of life of elderly people residing in institutions in Europe

BackgroundAs the number of elderly people is on the rise in societies throughout the world, providing them with optimal care is becoming a major demand, especially in the context of rising interest in institutional care. Quality of life is multidimensional notion and its perception depends highly on pain and mood levels. The aim of this study was to perform a comparative analysis of pain and depression symptoms in elderly people living in nursing homes in France, Germany, and Poland.MethodsThe research carried out in years 2014–2016 involved female residents of nursing homes in France, Germany, and Poland: 190 women from each country, aged over 65 years and not previously diagnosed with advanced dementia, were included. Collection of medical, demographic, and anthropomorphic data from medical documentation was followed by interviews with each senior and her caregiver. A questionnaire of authors’ own devising was used, along with the Beck Depression Inventory (BDI) and the scale of Behavioral Pain Assessment in the Elderly (DOLOPLUS). The results were subjected to statistical analysis, p < 0.05 was accepted as threshold of statistical significance.ResultsThe main health complaints of nursing homes’ residents were constipation, diarrhea, back pain and dizziness. 44,38% of the residents self-assessed their health status as bad and complained of suffering pain (83,33%) and sleeping problems (72,98%) within the last month. According to BDI the average score was 17.01 points and 44,38% of seniors were free from depression or depressed mood. The average DOLOPLUS result was 8.86 points.ConclusionThere are no significant differences, neither in prevalence of pain and symptoms of depression nor in average levels of quality of life, in elderly residents in institutions in the three studied European countries. The decrease in quality of life is mainly due to various complaints and pain and there is a close relationship between health status and quality of life. Further research should be performed in order to study interdependencies between the occurrence of pain and depression, including primary reasons leading to both phenomena. The recognition of factors that induce pain complaints and mood depression in elderly people will contribute to improving their comfort.

Analysis of energy consumption profiles in residential buildings and impact assessment of a serious game on occupants’ behavior

The paper has a focus on energy consumption habits, trends and intervention strategies in residential buildings, mainly through the serious game approach with a combination of direct consumer feedback through smart metering. More than 150 homes in France and Spain have been involved in the research experiment and the consumption habits of approximately 50 homes were deeply analyzed. The applied methods, processes, results and findings of the monitoring data analysis are presented in the paper with two aims. First, consumption profiles and trends were determined for apartment homes with regard to heating, domestic hot water and electric consumption. Second, the impact of a serious game experiment was assessed comparing energy consumption, indoor air temperature and users’ habits (based on questionnaires) before and after launching the experiment.

Validation of the French version of the LEIPAD in community-dwelling people aged 80 years and above.

BackgroundFew studies have addressed health-related quality of life in community-dwelling individuals aged 80 years and above and very few self-assessment quality of life questionnaires have been formally validated in these populations. This study aimed to validate a French version of the LEIPAD, a self-administered questionnaire assessing the health-related quality of life of people aged 80 years and over.MethodA cross-sectional study of people aged 80 years and over living at home in France was conducted. All subjects recruited were sent a letter explaining the study and requesting their consent to take part. Those who accepted then received the questionnaires, including the LEIPAD, which assesses health-related quality of life in the subjects aged 65 years and above. We assessed its psychometric properties: data completeness, score distribution, floor and ceiling effects, internal consistency, item-total correlations, inter-scale correlations, reliability and convergent validity with the Medical Outcome Study Short-Form 36 (SF-36).ResultsThe results obtained from 184 older people (mean age of 83.9 years, standard deviation 3.3) showed very good acceptability (missing data between 1.1% and 11.4% for LEIPAD scales) Factor analysis of the instrument confirmed the multi-dimensional structure in seven independent scales similar to the original version. Good internal consistency (Cronbach’s alpha ranging from 0.68 to 0.87) and strong test-retest reliability of the LEIPAD scales (intraclass correlation coefficients ranging from 0.77 to 0.95) were found. Convergent validity with the SF-36 showed moderate to strong correlations, consistent with the hypotheses stated.ConclusionsThe validation of this specific questionnaire will make it possible to investigate individually the health-related quality of life of French older people living at home and will enable French-speaking investigators to contribute to national and international research projects.

There is No Texting at James Baldwin’s Table

Clearly there is a unique hunger for Baldwin’s wisdom in this historical moment, as illustrated by Raoul Peck’s film, reprints of several Baldwin books, exhibits, and other events. This essay describes the genesis of two five-part public discussions on the works of James Baldwin that were co-facilitated by African-American Studies scholar Dr. Lindsey R. Swindall and actor Grant Cooper at two schools in New York City in the 2016–17 academic year. These discussion series led to numerous Baldwin discussion events being scheduled for the winter and spring of 2018. The surprising popularity of these programs prompted Swindall to wonder: Why do people want to discuss Baldwin now? The first of two parts, this essay speculates that many people in the digital age long for a conversational space like the one Baldwin created at the “welcome table” in his last home in France. The second essay—which is forthcoming—will confirm whether discussion events held in 2018 harmonize with the welcome table thesis.

The spiritual care in nursing homes: A qualitative exploratory study

ABSTRACTSpirituality is a key concept that plays a role in people’s daily lives. This qualitative study aimed to explore representations and experiences of spirituality in nursing homes. This research included eight residents, three family members, seven caregivers and ten psychologists (N = 28). Semi-structured interviews were conducted in several nursing homes in France over three months. Concepts of beliefs, transcendence, and connection were mainly related to spirituality. Participants defined essential spiritual values and needs, and also described their spiritual experience in their nursing homes. In conclusion, spiritual care is desired, or even expected in nursing homes.

Including multiple clients’ requests through singular organizational development strategies.

Old dependent person’s nursing homes in France develop real response strategies to the often conflicting and very demanding requests of their external and non-coordinated stakeholders. Such diversi...

Devising the consumer of the competitive electricity market: the mundane meter, the unbundling doctrine, and the re-bundling of choice

ABSTRACTThis paper follows the sinuous trajectory of the joint design of an electricity meter and the technical architecture of the smart home in France. The analysis points to the articulation between the mundane work of material and market design and the profound, pervasive, and political issue of ‘agencing’ consumption. Three figures of the consumer appeared along with the evolving design of the smart home and meter: a behavioural energy saver; a market offer chooser, and an attached consumer. The ‘unbundling’ doctrine, which states that competition must be sorted out from monopoly in order for the electricity market to function, was often invoked to justify changes in the smart meter and smart home designs. The role of the doctrine was, however, ambiguous. As a rather abstract perspective on the working of markets, unbundling seems to be exceeded by concrete and mundane marketing attempts at re-bundling choice. And yet consumer figures doctrinally compatible with classical/neoliberal economics, which considers the consumer to be an autonomous self, leave open the ground for an attached consumer to emerge, suggesting that the consumer is in fact always ‘attached’ rather than detached.