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“Analyze the mechanisms that led to the perverse effects of nursing homes”

RRevealed to the general public by the recent news around the Orpea group, the dysfunctions of accommodation establishments for dependent elderly people (Ehpad) have actually existed for a very long time. In a few days, the new minister in charge of the subject will have to rethink the accommodation policy for dependent people. But, before even considering “new” solutions, it would be useful to identify the factors that have led to today’s situation.

In the 1980s, dependent people who could no longer live in a “retirement home” were redirected to the hospital, in so-called “long-term” services, following a hospital-type model, sometimes even still in a common room. In 1983, Alain Gille, director of facilities at the Assistance Publique-Hôpitaux de Paris (AP-HP), particularly visionary on the scale of dependency to come, launched a call for ideas from architects in order to open the leads to suitable accommodation. The responses were numerous, varied and innovative, consecrating the success of this call. This was the starting point for a series of innovative projects particularly suited to aging and dependency.

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The Sepia program, launched in 1989 by the Ministry of Health, took over and an important movement of gerontologists, sociologists and other researchers contributed to these pilot operations. The exemplary achievements that followed are reported in the specialized press (Architectures of old age. Architectural variations on end of lifeLe Moniteur, 1988) and highlight, among other things, the openness to the city, the mix of programs, the space with variable geometry, the anchoring in the territories.

Although welcomed by professionals, healthcare teams and the families of residents, these advances were brutally halted by the creation of nursing homes in 2002. therefore endeavored to supervise, standardize and govern the accommodation of dependent elderly people throughout the territory, while delaying their entry into the institution as much as possible, home support then appears to be less expensive than nursing homes. The system thus put in place became a standard from which it was then forbidden to derogate, if one wished to benefit from the financing and authorizations to open, both for the creation of a new establishment and for its operation. It was becoming impossible to pursue the advances made in the 1990s, which quickly fell into oblivion.

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