Editorial of the “World”. The publication of the survey The Gravediggers (Fayard, 400 pages, 22.90 euros), in which the journalist Victor Castanet denounces major malfunctions in the accommodation establishments for dependent elderly people (Ehpad) of the Orpea group has caused a great stir. Is right. The accusations are serious and the facts reported particularly sordid.
The book describes an implacable system in which the hygiene care, the medical care, even the meals of the residents would be “rationed” to boost the profitability of Orpea, a leading company in its sector and listed on the Paris Stock Exchange. Are the shortcomings revealed by the journalist limited to a “organizational concerns”, as management suggests, or are they an integral part of a misguided economic model to the detriment of the well-being, health and even the lives of residents, as the book suggests? It is still too early to decide.
At this stage, we must be wary of generalities: many nursing homes, despite insufficient means, continue to fulfill a difficult but essential mission for society. Still, the number of families who have been or who are confronted with the subject of abuse in retirement homes should alert us to the dysfunctions of the system.
Legislative procrastination
One of them concerns the role played by the private sector. For lack of sufficient public funding, the activity had to open up to a certain number of companies. They have certainly made it possible to develop reception capacities to accompany the aging of the population, but many investments have been made in a purely financial logic. Today in full expansion, the lucrative private sector offers on average 40% higher prices than the public, with 10% to 15% less staff. However, it is obvious that the well-being of residents is proportional to the density of supervision.
Then, each establishment, whatever its status, receives the same amount of public funding from the regional health agencies (ARS) and the departments, with accommodation being the responsibility of the residents. It is on this item that the private sector ensures its profitability, without offering better services. The economic model remains focused on real estate, less on the needs of the elderly. Public funding theoretically has a counterpart: the regular monitoring of establishments by the ARS. In practice, according to the book, these checks are too lax and random to prevent abuse.
For years, dependency has been waiting for its financing law. Despite some advances such as salary increases, job creations and new investments, the current power has not derogated from this procrastination on the legislative level. However, demographic projections show that the need for opening places in nursing homes will accelerate.
Two choices are possible. Either collective care which will make it possible to lighten the financial burden for families while guaranteeing better services – the political limit of this solution is that it involves an increase in social contributions – or continue to delegate the mission to a lucrative private sector, more expensive than the public but incapable of guaranteeing better services, all financed largely by public funds which remain poorly controlled. It’s not too late for the issue of old age to enter the presidential campaign.