Two years after the Orpéa scandal, “the situation has not improved”: the Ehpad conference opens in a sector in crisis

The financial situation of the establishments is tense. Midi Libre – Midi Libre

The national conference of Ehpad opens this Tuesday, September 10, for two days, in Paris, in a context of crisis marked by the deficit of two thirds of the establishments. Pierre Roux, director of four establishments in Aveyon, and national president of the AD-PA, calls for a complete overhaul of the model of support for the elderly.

The national conference of nursing homes opens this Monday, September 9, for two days, in Paris, in a context of crisis marked by the deficit of two thirds of the establishments. In Occitanie, nine out of ten establishments are in the red, warned already, in June, the public actors. Two years after the Orpéa scandal, what has changed? ? “I don't think the situation has improved”, warns Pierre Roux, director of four nursing homes in Aveyron, national president of the AD-PA (Association of directors serving the elderly).

For Aveyronnais Pierre Roux, “we are led to close the house or give up on projects”. DR AD-PA – Sebastien Bach

Two out of three nursing homes are in serious financial difficulty, does the state of affairs surprise you??

No, it's not surprising. When you take into account the average change in revenue, +2% each year, and the increase in expenditure, of the order of +3% to +4%, at a given moment, you find yourself in a deficit situation.

When you have equity, you can absorb some of these deficits. But every year, your equity melts like snow in the sun.

And it's not a question of margin?

No, by constantly running deficits, those who no longer have equity will close their doors, and those who have equity will lose it and draw a line under their projects. This is why many directors want to abandon the sector because in the medium term they are forced to either close the house or abandon projects. Nothing that could make you dream.

We have a job where we have to focus on the well-being of our residents, our elders, and our employees. The conditions in which we are developing the sector do not present any encouraging or motivating prospects. Neither for the people who are welcomed, nor for the managers, nor for the employees. Today, there is no “Grand âge” law, no prospects given. Under these conditions, I am not surprised that we have deficits, that people are leaving, that some nursing homes are not filling up, since we have no answers on the means, no prospects outlined. These are different symptoms of the same problem.

Isn't this also the consequence of the Orpea scandal two years ago??

The Covid crisis, then the Orpea crisis, then the war in Ukraine and the inflationary crisis that followed accelerated an inexorable process in which we were already engaged. Simply, what happened in three years should have happened in ten years. We let our sector fall into disrepair because we didn't know how to tackle the problem, because people weren't interested… except that this triple crisis is plunging us into a particular crisis. When you leave things unfinished for thirty years, there is a lot to do.

Today, everyone is caught off guard. If there had been a “Grand âge” law, would the situation have been different? ? I don't believe it very much. Already, Villepin's “Grand âge Solidarity” plan from 2006, which was due to expire in 2011, was never implemented on staff ratios, whether at home or in institutions. The State itself has failed to keep its word.

“I don't think there are any places that have been spared by the crisis”

And the earthquake caused by Victor Castanet's book had no impact ?

Promises only bind those who listen to them.

The situation has not changed, the problems are identical to those observed two years ago. years ?

It's more serious. I don't think the situation has improved. What happened? ? The State has carried out checks in all the establishments, at the same time casting opprobrium on our establishments, the vast majority of which are honestly managed, and which for the most part were not abusive as in some Orpéa nursing homes.

The Orpéa crisis has reinforced the distrust of our fellow citizens towards the elderly sector. With the inflation linked to the Ukrainian crisis, we were caught up in another tidal wave: the increase in the daily rate and the loss of attractiveness for professionals for our sectors.

Today, many nursing homes have free places, and vacant positions ?

I take the example of one of the four establishments that I manage in Aveyron: in 2022, we ended up with 52 residents instead of 66, because I did not have the number of staff to not put the residents in a situation of insecurity. residents.

In a rural area that one might think has been spared by the crisis…

I don't think there are places that have been spared by the crisis. Not all nursing homes have faced the same difficulties. But over the last five years, most of them have experienced problems. When it's not a difficulty in recruiting, it's budgetary difficulties. And when it's neither one nor the other, it's the perspectives that are lacking.

“We see the nursing home as a scarecrow, that's a mistake”

What is your daily life like today, do you feel like you're mistreating your residents ?

The term abuse covers so many realities… if you ask me if in my establishments, residents are slapped, no. If you ask me if they all have the possibility of being up and going to bed at the time they want, of having activities adapted to their situation, of having their essential needs respected in a reasonable time frame, no. Because where we have one caregiver, there is almost no other. This is a situation that we have been denouncing for years. We are finding it increasingly difficult to meet the needs and expectations of residents. People are not supported well enough, and families are suffering. We are challenged daily. 

And all the reports, from the Court of Auditors, the Defender of Rights, the Senior Citizens' Solidarity Plan, the El Khomri Plan, all point in the same direction. We know that we don't have enough staff, that working conditions are deteriorating, that we're not attractive, that we have to use temporary workers, and thus add costs and increase the deficit. We call that a vicious circle that only gets worse and faster. However, in the vast majority of establishments, there are competent and committed people, thanks to whom it works. It's the employees who make the system work. As for political decisions, we are still waiting.

There has been nothing?

There are always half-measures… Announcing the arrival of 650 million, which barely covers the increase in expenditure, is not going to create jobs. Yes, there are announcements, but we are waiting for the next government to give very strong signals to the sector to support the longevity of our fellow citizens with dignity and to finally provide the necessary resources.

With France's current deficit…

They will not necessarily be added to the State's deficit: many of the hospital's difficulties are also linked to the problems encountered by the medico-social sector, upstream and downstream of hospitalization. Before spending more, we must start spending better. And spending better may mean spending more on nursing homes and the sector for elderly people at home.

We, on the ground, see that when we run out of answers for our elders, the consequences are dramatic humanly, socially and financially. And families are completely destitute. Today, we see the nursing home as a scarecrow, it is a mistake. We must transform nursing homes, support them, and think about the overall system of supporting longevity in our country, on an economic model to be reviewed, taking into account territorial specificities. The situation is not the same in Aveyron and Montpellier.

If tomorrow, we close, who will take care of the million elderly and disabled French people ? Since two thirds of the establishments are in deficit, there will be closures. We are waiting for awareness, we are going to face situations that are very worrying from a human and social point of view. 

Several unions in the elderly sector are calling for a protest movement for more resources and more support on September 24. I subscribe to read the rest