Le book by Victor Castanet, The Gravediggers [Fayard, 400 p., 22,90 euros], should provoke, at least we hope, a necessary debate concerning the care of our elders. In any case, it has already given rise to various proposals to prevent situations comparable to those reported in this book from continuing. Even if they call for urgent answers, let’s try to calmly lay down a few principles to avoid getting into sterile debates.
Let us avoid, first of all, falling into simplification. Financialization to the detriment of the service provided to the elderly is unacceptable, but the quality of this service and respect for people’s rights does not depend on the legal status of establishments. In its report published in May 2021 on “The fundamental rights of the elderly in nursing homes”the Defender of Rights indicated that 45% of the complaints received by its services concerned a nursing home with public status, 30% a private associative nursing home and 25% a private commercial nursing home. [en 2020, les structures publiques représentaient 51 % des places, le privé 29 %, et les établissements privés commerciaux 20 %].
The question of the care of old age is not reduced to the question of nursing homes either. Let’s say clearly that the choices of our society are not made primarily in favor of taking care of the dependency of the elderly. This is reflected in particular by the decision, constantly postponed, of the establishment of a recognition of the loss of autonomy as being a risk of social protection in its own right, whether it is called “fifth risk” or otherwise. . Such a subject requires financial choices.
The report that Dominique Libault [directeur de la Sécurité sociale de 2002-2012] had submitted to the government in March 2019, after broad consultation, assessed the need for additional public financing compared to 2018 at 6.2 billion euros in 2024 and 9.2 billion euros by 2030. Public finances have since been put to the test by the health crisis and the current situation may explain the postponement of the choices to be made when the question of the financing of pensions also arises. And this last subject concerns the social body much more. Have we seen large-scale social movements take to the streets to demand means to compensate for the loss of autonomy of the elderly?
Coherent steering
Entering an institution is rarely the expression of a choice. It is more often the consequence of poor coordination of the various stakeholders in the home, when loved ones cannot fulfill this role. Although the term is inappropriate, the few “Ehpad at home” that have emerged in recent years effectively perform this function of operator, organizing both the layout of the home, its monitoring, and the coordination of care services with the support services. It is the coherent management of home services that needs to be strengthened. The Ehpad of tomorrow will not only be a place of accommodation but a service platform: temporary reception, day care, support and respite platform for caregivers.
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