France: in nursing homes, "a constant fight" against the coronavirus

Text by: Romain Philips Follow

884 deaths from Covid-19 and 14,638 confirmed cases have been recorded in accommodation establishments for dependent elderly people (Ehpad) since the start of the epidemic in France, according to figures still partial published on April 2.

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For several weeks now, accommodation establishments for dependent elderly people (Ehpad) have been operating behind closed doors. No one comes in or out except the nursing staff. Impossible for the residents to see their family or go out for a walk, they are confined to their room. " In nursing homes, it is confinement within confinement, " comments Jean-Pierre Riso, the president of Fnadepa (National Federation of associations of directors of establishments and services for the elderly).

The fight against the Covid-19, which has led to the confinement of all of France since March 17, “ is a constant battle in the Ehpad. We are experiencing the crisis on a daily basis, ”adds the president. All " people aged 70 and over " have an increased risk of developing a severe form of Covid-19, according to the High Council of Public Health. Since the beginning of March, cases of coronavirus and the number of deaths, despite the measures put in place, have continued to increase.

According to figures still " very partial " disclosed on April 2, 2020 by the Director General of Health, Jérome Salomon, 884 deaths from Covid-19 and 14,638 confirmed cases have been recorded in Ehpad since the start of the epidemic in France .

" It's like being in a ghost hospital "

Thursday, April 2, the epidemic is present in several hundred establishments out of the more than 7,500 in France. " The challenge is to ensure that the virus does not enter unaffected establishments ," said the president of Fnadepa. For this, the caregivers are extra careful. “ We remain confined to our service from 7 am to 8 pm. Whether to eat or take a break, we don't go out. And when you get there in the morning, taking the temperature is compulsory, as is putting on the mask and disinfecting the hands, ”says Marina, a nursing assistant in Vendée. In some nursing homes, the nursing staff even go as far as confining themselves 24 hours a day with the residents.

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As evidenced by the results of the epidemic in establishments that welcome the elderly, not everyone is spared. In a nursing home in Hauts-de-Seine, east of Paris, " two people died, three are Covid + and we are awaiting the result of 10 tests, " says Marie, a nurse. In this establishment, the staff did not wait until March 28 and the announcements of the Minister of Health, Olivier Véran, to confine the residents to the rooms. This measure was put in place several weeks ago in order to prevent the virus from spreading. " It makes us feel bad, " she says, " the usual nursing home is a place to live, today, when I look at the corridors without noise and without anyone, it's like being in a ghost hospital "

As in hospitals, it is the nursing staff who are on the front line in this " war " declared by the President of the Republic, Emmanuel Macron. " In my establishment, it is a massacre, adds Marie, out of 11 nurses, seven are affected by Covid-19 and have been arrested ". The caregiver therefore continues her work in an understaffed team. Reinforcements were called to compensate for the lack of arms in the establishment but it is insufficient, according to the nurse. " We should normally have five caregivers and a hotelkeeper per floor, this morning there were only 3 caregivers and no hotelkeeper ."

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The anxiety of not " holding the shock " in the face of the coronavirus epidemic is spreading in nursing homes. “ People are afraid, there is fear in the teams and a very heavy workload. The colleagues are very worried for the next few days, ”says Christian, a nursing assistant in a nursing home in Lyon. Cloistered at home for a week because of the appearance of symptoms linked to the coronavirus, he was confirmed positive on March 31. In the nursing home where he has been practicing for 21 years, several patients are contaminated and the equipment is lacking. " It takes soldiers to put out the fire, but we were not protected quickly enough ," he said.

" We also lack body bags "

In the deserted corridors of Ehpad, the question of protective equipment keeps coming up. If the masks have been less and less of a problem for several days, the nursing staff reports numerous shortages of over-gowns and protective glasses. “ Finally, we have weekly deliveries of surgical masks (...) but the first people infected date from the beginning of March. And a month is a long time, ”notes Jean-Pierre Riso.

Before these deliveries, " we were not adequately equipped ," says Marion, a nursing assistant in a nursing home in Maine-et-Loire. But thanks to a call for donations launched by the city on social networks, surgical masks and hydroalcoholic gel poured in. She now hopes that deliveries from the state will be regular. " The donations will stop and the first delivery of 500 masks will quickly run out because we need almost a hundred a day, " she worries.

The concern isn't just about protective gear. " We also lack body bags," regrets the president of Fnadepa. As the number of coronavirus deaths adds up to “ non-covid ” deaths , nursing homes are not prepared to have “ 10, 15 or 20 deaths ” in a single establishment in such a short time. " It is a real pain for everyone ," he concludes.

Caregivers, the last link with families

Families and residents also suffer from confinement. Matéo, a nursing student, can no longer visit his 75-year-old grandfather who has Alzheimer's. " It pains me to know that he is going through this. He is worried because he knows that we are experiencing a health crisis and the elderly know that they are the first affected. When you have a loved one in a nursing home, it's very difficult, ”he testified.

Video calls, parcel deliveries, etc. The healthcare teams are mobilized to maintain a minimum of connection between patients and their families. The host of the establishments, who can no longer take care of collective activities, has seen his profession completely changed. At the time of the coronavirus, it is now responsible for organizing long-distance relationships with residents. In some establishments, Facebook pages have been opened to share the life of the nursing home with patients' relatives.

" It is very complicated confinement in Ehpad "

However, confinement must be " temporary " and " allow the possibility, even limited, to circulate ", according to an opinion from the National Consultative Ethics Committee (CCNE) published on April 1. For example, it proposes to establishments welcoming elderly people to set up “ separate areas ” for contaminated people and others.

A measure already implemented in some nursing homes which endeavor to isolate infected patients as quickly as possible. This alternative would limit the loneliness of patients, which can prove to be “ fragile ” for an elderly person. “ It is very complicated confinement in Ehpad. Some residents get depressed and start to cry. There is a real fear about cases of depression that could start with confinement, ”says Marie.

Regarding the visits, the CCNE suggests that they can be authorized " under strict conditions of health security " if and only if screening tests were offered on a large scale. That is to say only for residents and their loved ones tested negative. For Jean-Pierre Riso, the question of tests is essential. " We have to be able to test regularly, I was even going to say systematic " to be sure that no one in the nursing homes is a healthy carrier, he believes. A plea that echoes that of the WHO (World Health Organization): " test, test, test ". For his part, the Minister of Health, Olivier Véran, announced on Saturday March 28 " test as a priority for the virus the staff who work within the Ehpad ".

We will have to " take stock of the situation "

Faced with an unprecedented situation, institutions are trying to find the best solution to protect the elderly of the Covid-19 to the point of exceeding their limits. " You would have asked me three months ago, I would never have said that an Ehpad was a place where we could do isolation but we must protect our seniors, " says the president of Fnadepa.

However, he believes that it will be necessary to " take stock of the situation ". Ehpad staff have been sounding the alarm for a long time on the healthcare system for the elderly who " must be considered differently " in France. " The Minister of Health said he could not remember the effort made by the professional at home and for the elderly. In any case, we will remember it, ”concludes Jean-Pierre Riso. " The day after will not be a return to the day before, " said Emmanuel Macron on March 16 in a presidential address , promising to " draw all the consequences " from this crisis.

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