In Occitania, 9 out of 10 public nursing homes are in deficit: “We are out of breath”, warn the establishments

L’Ehpad Jean Peridier (ici en 2023) traverse des difficultés, comme la grande majorité des Ehpad publics. Midi Libre – Midi Libre

La Fédération de l’hospitalisation publique (FHF) alerte. Malgré une activité en hausse, et des taux d’occupation à plus de 96 %, la situation financière des Ehpad publics se dégrade inexorablement.

"In December, I didn't know how I was going to pay my employees…" A few days before Christmas 2023, Cyril Bride, director of the Ehpad La Castellane, in Port Vendres (Pyrénées-Orientales), was "saved" by the emergency fund released by the State and supplemented by the Occitanie Regional Health Agency, 12.7 million euros for 63 nursing homes and home services < em>"in great financial difficulty", including 450 000 euros for its establishment.

Six months later, the financial difficulties of public nursing homes, revealed by a report by MP Christine Pires-Beaune, in July  2023, then a study by the French hospital federation (FHF), in October, remain unresolved. rsquo;news.

At the national and regional level, Emilie Bérard, general delegate, and Xavier Morel, deputy regional director, alerted directors of nursing homes and managers of the FHF Occitanie, in a conference of press organized this Tuesday, June 11.

The FHF press conference: from left to right, Emilie Berard, general delegate of the FHF Occitanie, Eric Ponce (Ehpad Jean Péridier), Xavier Morel, deputy regional director and Cyril Bride (Ehpad La Castellane de Port Vendres). PHOTO S.G.

"Despite activity which continues to progress, public nursing homes are facing a massive, rapid and profound deterioration in their budgetary balances. A situation which requires strong and lasting responses", insists the FHF Occitanie.

A deficit of 2400 euros per place

With nearly 9 out of 10 nursing homes in deficit despite an occupancy rate that has returned to almost normal after the Covid crisis, 94.3% of places are filled, nursing homes are facing a problem that is "structural", explains Emilie Bérard.

In Occitanie, 40% of public nursing homes had cash flow difficulties in 2023.

To understand the situation, we need to go back to the financing method. Schematically, it is divided into three, in all Ehpad, public as well as private: care, like health in general, is paid by Health Insurance. The management of dependency is covered by the Departmental Councils.

This is based on accommodation, i.e. the "day rate" payable by residents or their families, or "social assistance for accommodation", ASH, financed by the Departmental Councils in the event of insufficient income, than the current financing of nursing homes public bute : "We have greater constraints as we face an explosion in our expenses, due to the increase in salaries, inflation in energy and food prices, +18% between 2020 and 2023. dit Emilie Bérard.

An explosive situation

85 % of public nursing homes are in deficit, alert, in April 2024, the FHF, which reports a worsening of the deficit of + 60  nbsp;% in one year. In 2022, 77.5% of establishments were in this situation, and 42% in 2019.

The survey was conducted in March 2024. It is based on the responses of 730 nursing homes, including 80 in Occitanie, totaling 100,000 places, or 40% of the stakeholders concerned.

The 80 nursing homes in the region account for "nearly 9,000 accommodation beds in a landscape which is composed as follows: 379 nursing homes in Occitanie have a public status (46.4% of places), 275 (33.6% of places) are in the non-profit private sector, 163 (21%) are in the lucrative private sector. They total 58,000 accommodation places.

In the region, 88.75% of public nursing homes were in deficit in 2023, compared to 40.98% in 2019.

When the report was published, Arnaud Chiche, founder of the Santé en danger collective, called for "a shock of conscience" on Franceinfo, and asked "to bring money’ to public nursing homes,< em>"because it’is not possible to leave nursing home directors in the lurch, with a quality of patient care that is non-negotiable".

Since then, nothing.

In detail, in addition to inflation, professionals mention the "deindexation of prices applied by the Departmental Councils" (63.25 euros per day compared to 83.99 euros in the private for-profit sector, as an example), and "levels of socio-fiscal charges" higher, "with fewer allowances and compensation" than in the private sector. An example : "A public nursing home of 100 beds with 70 SSIAD places (nursing care service at home) pays 377,000 euros in payroll taxes.

If we dig deeper, we will find inequalities in the situations of nursing homes inherent to their geographical location: the price difference can vary from 14 euros from one department to the next. ;rsquo;other.

Result: "We have a deficit level of around 2750 euros per month, per place". The resident pays on average "600 euros less than in the private sector in Occitanie", the average difference is 1000 euros at the national level. 

At the Jean Péridier Ehpad, families pay 2,200 euros per month. 2000 in La Castellane, in Port Vendres.

An experiment in Aude, Lot, Haute-Garonne, Pyrénées-Orientales

"These results take into account exceptional credits" already released by the State, and "are uncorrelated with our level of activity", specify the directors of Ehpad.

If we had to remember one salient fact: "In 2017, the State committed to recruiting 50’ ;nbsp;000 additional professionals in nursing homes by 2030. More than 10,000 positions have already been funded, but we have not seen them on the ground. These means are used to compensate for our deficit", specifies Eric Ponce, director of the Ehpad Jean Péridier.

"We are at a crossroads, the scale of the deficit questions us, we are working at a loss. We're out of breath, he notes.

Provisions of the Aging Well law, such as the experimentation of the "care and dependency" sections, which will start in 2025 in 23 departments including Aude, Haute-Garonne, Lot and the Pyrénées-Orientales open trails "which go in the right direction".

"The refoundation site is to be built", insists Cyril Bride, while the general campaign  control of nursing homes, launched after the electroshock of the book "The Gravediggers" by Victor Castanet, will end in 2024 in Occitanie.

In the meantime Eric Ponce explains his daily life: "I pay my suppliers in three or six months, I negotiate with Urssaf deferrals of charge".

Cyril Bride, director of La Castellane, considers himself happy to have received oxygen from the emergency fund: " I think of the colleagues who have not had this chance, and who are in a dramatic situation.

The time bomb of the “baby boomers”

The question of financing nursing homes comes up against another problem, demographic, this one: "We come up against   a wall, knowing that 20% of those over 85 are housed in a structure, specify the Ehpad.

In Occitanie, "the number of people over 85 will "explode", announces Eric Ponce: it was 230,000 inhabitants in 2019, or 3.9% of the population, it will be 407,000 in 2040 (6.3% ;% of population).

It's in 2032 that "the baby boomer generation will celebrate its 85th birthday", he recalls .

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