Tribune. The doctrine of inclusion has everything to seduce. Not only is it a promise of equality through access to school for all, disabled or not, but it is also a promise of care, well-being and work adapted to everyone. The reality on the ground is quite different. The implementation of this policy is accompanied by a radical questioning of medico-social institutions, accused of being segregative and of obstructing human rights.
This is why the authorities are starting to shut down these facilities to replace them with “service platforms” delivering indications of care with regard to identified needs, without an institution, without a collective, without employees. This is to forget that the medico-social institutions for disabled children, young people and adults, very often created on the initiative of parents, were from the outset conceived as essential places of life to allow support and personalized care.
They therefore work, as much as possible, to promote access to school for the child, to social autonomy for young people and adults, while respecting and within the limits of individual capacities. But then, why reduce or even eliminate this institutional offer which has proved its worth, without taking into account the human tragedies for the people received and their families when an establishment closes? No doubt because these places which were recognized as a progress of general interest are perceived today as a costly weakness, especially in terms of payroll.
45,000 places missing in institutions
The “service platforms” offer “pathways”, the funding of which is based on Sérafin-ph (Services and establishments: reform to match funding to the pathways of people with disabilities): a diagnosis of the “needs” of the disabled person is carried out, to which we match a prescription of services, to be provided by professionals most often under the status of self-employed.
Insofar as many essential needs, such as the stability of a living environment among peers or comprehensive care, are not taken into account in the initial assessments, this device is much less expensive. Sérafin-ph is just a variant of activity-based pricing (T2A), the effects of which in hospitals have been denounced from all sides, and even more so since the pandemic.
While the number of places missing in institutions is estimated at 45,000, offering above-ground “routes”, of which the family will ultimately be the sole guarantor, is nothing more than a regression of the policy of solidarity with disability. a hoax. Inclusion works like a mantra, without any debate on the ongoing evolution of the healthcare sector.
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