Elise Denjean and AFP 11:33 a.m., February 17, 2022

In the midst of a storm in the Ehpad sector after the publication of a book-investigation on abuse in these structures, the Court of Auditors points the finger at their calamitous management.

It calls on the government to initiate a reform to rethink the system in place in accommodation establishments for dependent elderly people.

The Covid crisis has highlighted the "structural weaknesses" of nursing homes, and the need for a reform that the government has "delayed for too long", estimates the Court of Auditors, in the midst of a storm in the sector after the publication of a book-investigation on mistreatment in these structures.

The heavy toll of the epidemic in accommodation establishments for dependent elderly people – nearly 34,000 deaths between March 2020 and March 2021, out of a total population of just over 600,000 people – cannot be explained “not only by the fragility of the residents", but also by the "structural difficulties of nursing homes", analyze the Elders.

"Notable weaknesses" in the care

"The level of dependence of the people concerned is increasing, as are their medical needs", but their health care has "significant weaknesses", notes the report: many establishments do not have a coordinating doctor, while suffering from a shortage of city doctors nearby, and most are struggling to recruit and retain a sufficient number of caregivers and nurses.

This shortage "can cause real problems of quality of care, outside of a crisis situation", according to the Court of Auditors.

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During the Covid-19 epidemic, the State and Health Insurance provided massive financial support to the sector, including through permanent measures, such as the salary increases decided within the framework of the "Ségur de la Santé" - but which also benefit non-medical staff, notes the Court.

This financial effort "could have been an opportunity for the State to initiate structural reforms that had been delayed for too long. "That was not the case", deplores the Court, without specifically mentioning the government's refusal to present a law specific on this subject before the end of the five-year term.

An overhaul of the Ehpad system

To improve the care of the elderly, the report recommends taking action on the working conditions of staff (particularly with regard to training, career development and the prevention of accidents at work), but also better articulate Ehpad and care sectors.

The nursing homes must not remain "isolated" but "fit into a larger functional whole, either by backing up with a health establishment, or by belonging to a group, or even by the pooling of certain functions", proposes again the Court of Auditors.

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This report is published at a time when the sector is being shaken up, after the publication in January of "Les Fossoyeurs", an investigative book which reveals mistreatment within nursing homes of the Orpea group.

Responding to these criticisms, a press release from the Minister Delegate for Autonomy, Brigitte Bourguignon, recalls that "the government mobilized in the summer of 2020 in a structural reform of nursing homes in order to put an end to the dilapidation and low medicalization The establishments".

The government also points out that it "launched a vast plan in September 2020 to promote the attractiveness of old age professions", in particular through salary increases, and that the latest social security budget provides for "10,000 nursing staff positions additional" in addition to the "10,000 already recruited since 2017".