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“The State, like Orpea, relies on the actors in the field to manage its rationing policy”

Lout of the book The Gravediggers (Fayard), by Victor Castanet, highlighted the catastrophic effect that a mainly financial management could have on the care of residents of residential establishments for dependent elderly people (Ehpad). We suddenly became aware of the direct link that existed between the restriction of resources and institutional mistreatment.

Many were moved by the cynicism of a private sector ready to make profits to the detriment of people’s health, and the idea was even put forward of reserving this type of establishment for solely public management.

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However, it is not certain that the State is much more virtuous than the private sector. If he is ready to mobilize his troops to assess, certify, inspect, verify that the procedures and circulars are well respected, he is suddenly much less present when it comes to respecting his financial commitments.

Totally constrained funding

Where one would expect him to give establishments the means for respectful management of both fragile residents and dedicated and tired staff, he is content with announcements that are imposed on establishments, without giving them the means to implement them.

Today, nursing homes are on the edge of the abyss.

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The State, through the Ségur de la santé, announced entirely legitimate salary increases in view of the arduous nature of old age professions and the considerable commitment of staff during the crisis due to Covid-19, but forgot to finance them in full.

Inflation, which affects all sectors of the economy, weighs heavily on establishments.

The lack of personnel forces us to resort to temporary work, which is very expensive, and when temporary work can no longer meet the needs, the State services direct us to pharmacies with “mercenary staff”, ready to come and work the days that suits it, at times that suits it, for 100 euros per hour, while our nurses, constrained by their schedule, receive 15 euros per hour. And, of course, this good advice does not correspond to any financing.

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However, the financing of nursing homes today is totally constrained: the revenues are set by the State – for care – and by the departments – for dependency and pricing -, the evolution of which is kept well below needs. current institutions.

Reduced expenses

The only lever not to put the key under the door is therefore based on the reduction of expenses, which would correspond, for establishments which are very often on the bone, to what has been reproached to Orpea: elimination of the posts of animators , replaced by mind-numbing afternoon TV programs; lowering the cost of meals, when it is one of the rare moments of pleasure for the residents and when the undernutrition of the elderly person is a factor of deterioration; rationing of health care supplies; and, of course, downsizing, which is bound to happen anyway, because you can’t keep dedicated officers when they increasingly feel that lack of resources is forcing them to become abusive.

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