What future for our elders? If for years, exhausted staff and whistleblowers have regularly challenged public opinion on the sometimes lackluster reality of establishments for dependent elderly people, the scandal of Ehpad Orpea, revealed at the start of the year by journalist Victor Castanet in his work The gravediggers, shined an unprecedented light on this issue. Piece of cheese removed from the menu to save money, fewer nappies for the change for the same reason, toilet accomplished in a few minutes for lack of manpower… In question, a logic of rationalization of costs where cynicism disputes it with accounting objectives.
So, a few days before the first round of the presidential election, have the twelve candidates for the Elysée taken up the question sufficiently? What measures are they considering to ensure a serene, happy and decent daily life for our seniors in nursing homes? What working conditions do they imagine to solve the chronic lack of personnel? And what do they plan to avoid abuses within these establishments? 20 minutes summarizes their proposals for you.
Massive recruitments
The idea that puts all the candidates (or almost) in agreement is the need to recruit massively. And on this point, it is the candidates on the left who are the most forceful. Jean-Luc Mélenchon (LFI), who supports his proposal on that of LFI MP Caroline Fiat, co-signatory of the report of the flash mission on “the nursing home of tomorrow”, pleads for the creation of “210,000 minimum jobs”. The communist Fabien Roussel goes further, and proposes the creation “from 2022, and over three years, of 300,000 jobs” in these establishments, with “a ratio of one carer per resident”. For his part, the leader of the NPA, Philippe Poutou, considers “urgent to set up a public service for the elderly, with trained personnel and in sufficient numbers”, accompanied by “an employment-training plan for 200,000 positions”. The ecologist Yannick Jadot, aligning himself with the “recommendations formulated by the defender of rights in 2021”, promises to ensure “the application of a minimum ratio of 0.8 FTE [équivalent taux plein] staff per resident. And if she does not give a figure, the socialist Anne Hidalgo pleads for “a greater human presence in nursing homes, with more nurses and caregivers”.
“The obvious need to recruit more is a point that has emerged in recent years from various works, in particular those carried out by the Social Affairs Commission of the Assembly. Because even before Victor Castanet’s book, there have already been several scandals alerting to the reality of what is happening in certain nursing homes, ”recalls Ilona Delouette, economist, specialist in the financing system for dependency care in France.
So, a little more to the right on the chessboard, the measure is consensus, even if it panics the figures less. Regarding the LREM candidate for his succession, Emmanuel Macron proposes to “recruit 50,000 additional nurses and caregivers by 2027”. To his right, the candidate LR Valérie Pécresse, not very loquacious on the subject, plans “more staff with residents and indicators of quality of care which will be made public”, without further details. To the right of the right, no figures either for Nicolas Dupont-Aignan, who wants to “increase the number of caregivers and psychological medical aids”. Nor for Eric Zemmour, who promises “a major recruitment plan” and the creation of “400,000 new places in nursing homes by 2030”, without quantifying the personnel to support them. No figures either at the RN for Marine Le Pen, who wants to “significantly increase the presence of medical personnel”.
Better staff compensation
“The problem is that although we want to employ more people, we must at the same time improve training, working conditions and raise salaries, underlines the economist. We saw it during the Covid-19 crisis, nursing homes tried to recruit without success. For the past few years, we have been facing what the directors call “Ehpad bashing”. To fight against this major crisis of attractiveness, better working conditions should be guaranteed”.
Jean-Luc Mélenchon believes that “salaries, status and working conditions must be upgraded”. To this end, Anne Hidalgo provides “a training and recruitment plan for old age professions, built around the triptych professionalization, salary enhancement, recognition”. Like them, Yannick Jadot and Fabien Roussel plead for an increase in salaries and careers for staff.
A point absent from the program of the other candidates, but nevertheless essential in order to encourage vocations in a sector where the needs – already significant and unmet – will only increase with the aging of the population. “What could change the situation is the way in which we think of financing according to the tasks to be accomplished within nursing homes, advances economist Ilona Delouette. Since 2009, the challenge has focused on the rationalization of tasks. A strategy of extreme cost control that goes against care and the caregiver-resident relationship, very badly experienced by workers in the sector, who have the impression of dealing with objects and not people. To re-enchant this sector, which recruits enormously but does not appeal, we must give staff the means to do their job correctly, humanely”.
Private nursing homes in the sights
However, to date, the indicators on which the costs of each act of care are calculated “do not take into account the relational side, deplores Ilona Delouette. Funding is thought of as if it were only a question of technical tasks, whereas the loss of autonomy relies heavily on relationships, and this is at the heart of the vocation of the staff. It is with this logic that we arrived at a system which institutionalized the mistreatment, fortunately not generalized, tempers the economist ”. In practice, “the fact of having opened up the sector to the lucrative private sector has led to an objectification of care, to its rationalization, which is harmful”.
Would going back to this openness to the private sector change the situation? “It could be a solution, says the economist. These private nursing homes receive public funding, which they use visibly less effectively, since they have lower supervision rates for higher daily costs”. Clearly, they cost more while they have fewer staff. However, “there are checks carried out by the regional health agencies (ARS), insists Ilona Delouette. But for lack of human resources, they only inspect the budgets granted according to indicators. They therefore control tables of data rather than establishments with staff and residents.
For Philippe Poutou, the solution has been found: “The shareholders who fill their pockets with ‘grey gold’ (Orpea, Korian, etc.) must be expropriated”. Yannick Jadot, for his part, wishes to “prohibit new for-profit Ehpad facilities”. But “that would not be enough, fears the economist, recalling that in the public, similar problems of understaffing and degraded working conditions are also present”.
The financing in question
So, how to avoid drifts? “This raises a political and moral question: is it normal to profit from the vulnerability of elderly people? asks Ilona Delouette. And “how are nursing homes financed according to human and social needs? “. For the anti-capitalist candidate, “society must support the last years of our elders, with funding provided by Social Security”. The environmental candidate plans to “reform the entire nursing home sector, whether public, mutual, associative or private non-profit”, by reviewing “financing, management and organization”. When their communist comrade promises “an investment plan for the realization and modernization of nursing homes”.
It remains to be seen whether the next tenant of the Elysée will really take up the question of old age, and whether substantial resources will be allocated to him. “Financing this sector means raising new resources,” says Ilona Delouette. However, if we can no longer increase social contributions, nor increase the financing of Social Security, it is complicated”.