A cardinality-constrained robust model for the assignment problem in Home Care services

Home Care includes medical, paramedical and social services which are delivered to patients at their domicile rather than in hospital. Managing human and material resources in Home Care services is a difficult task, as the provider has to deal with peculiar constraints (e.g., the continuity of care, which imposes that a patient is always cared for by the same nurse) and to manage the high variability of patients' demands. One of the main issues encountered in planning Home Care services under continuity of care requirement is the nurse-to-patient assignment. Despite the importance of this topic, the problem is only marginally addressed in the literature, where continuity of care is usually treated as a soft-constraint rather than as a hard one. Uncertainty is another relevant feature of nurse-to-patient assignment problem, and it is usually managed adopting stochastic programming or analytical policies. However, both these approaches proved to be limited, even if they improve the quality of the assignments upon those actually provided in practice. In this paper, we develop a cardinality-constrained robust assignment model, which allows exploiting the potentialities of a mathematical programming model without the necessity of generating scenarios. The developed model is tested on real-life instances related to a relevant Home Care provider operating in Italy, in order to evaluate its capability of reducing the costs related to nurses' overtimes.