Comparative study of institutional reforms on the integration of gerontological services in France and Quebec – ERIIG

The ageing of the population has led many countries to move towards the integration of gerontological services along various trajectories according to national contexts. France and Quebec have relied on the same model, called PRISMA (Program of Research on Integration Services for the Maintenance of Autonomy), to construct the gerontological services integration. Institutional and organizational fragmentation induced by different characteristics of health and social services in France and Quebec have been identified as obstacles to organizing integrated services for the elderly.

Nevertheless, in these two countries, two major reforms have been launched and constitute an opportunity to limit the fragmentation that impedes gerontological services integration. These reforms led to health regional agencies (ARS) in France and health and social services agencies (ARSSS) in Quebec. These agencies are mandated to implement services integration notably through territorial organizations: Homes for the Integration and Autonomy for people suffering from Alzheimer’s or associated disorders (MAIA) in France, and the Networks of Integrated Services for Older Persons (RSIPA) in Quebec.

The objective of this qualitative and comparative research project, which relies on the paradigm of the public action sociology, is to analyze, using a comprehensive approach, policies of gerontological integration. It will allow understanding how and why the ARS and ARSSS act in favour of integration or not. More specifically, the questions are how these agencies support the national deployment of organizational integrated innovations and how leaders and managers of ARS and ARSS, as well as the managers and stakeholders of territorial integrated networks, undertake to achieve this integration of services.

Considering these questions require three interdependent levels of analysis: institutional, organizational and clinical. Thus, the framework of socio-politics of "path dependency” at the institutional level will articulate with the "readiness to change" at the organizational level, and the "cognitive ergonomics" at the clinical level. This multidimensional and comparative analysis will allow a better understanding of the structural conditions supporting or hindering the integration of services, as well as the identification and transfer to France or Quebec of successful practices for the deployment of services integration.

A documentary and discursive analysis will be conducted over a period of three years in three territories with ARSSS and ARS
This innovative research will be conducted from an interdisciplinary perspective involving social scientists, anthropologists, political scientists, economists and doctors in two teams in France and Quebec who have previously worked together.