PRESS RELEASE

28 February 2022

Communication to the Senate Social Affairs Committee

MEDICAL CARE OF THE ELDERLY

IN NURSING HOMES (Ehpads)

A need for a new model

Estimated at 2.5 million in 2015, the population of dependent older people could reach 4

million by 2050. Despite the desire of French authorities to promote a “shift towards home”,

établissements d’hébergement pour personnes âgées dépendantes

(EHPADs, “residential

establishments for dependent elderly people”) play a central role in the provision of care,

as they now accommodate around 600,000 residents, i.e., 15% of the over-80 population

living in France. The overall volume of public expenditure allocated to care and dependency

in EHPADs increased by 30% between 2011 and 2019

–

almost three times faster than GDP

–

reaching €11.24 billion in 2019. However, this significant increase in expenditure was not

sufficient to meet the needs of an increasingly fragile segment of society. When considering

the challenges of adjusting services accordingly, there seems to be a need for a better

understanding of the development of conditions linked to dependency in the population, in

order to anticipate future needs and to design plans able to meet the challenges. With this

in mind, the Court suggests better integration of EHPADs into the territories, and

strengthening medical care within them, as well as the quality approach.

Chronic shortages of qualified personnel

Although the ratio of staff per resident has increased in recent years, the number of caregivers

remains insufficient to ensure high-quality support. In addition to changing the staff-to-staff

ratio, improving the quality of care involves improving the organisational structure of work and

the distribution of tasks, as well as improving the qualifications and training of personnel, in

particular nursing auxiliaries. It also takes the form of better professional recognition, which

can be a means of attracting and stabilising personnel, whose difficult working conditions result

in high rates of absenteeism and turnover. Moreover, medical services appear to be in

particular difficulty: in half of all EHPADs, there is either no coordinating doctor, or the number

of hours worked is insufficient. And lastly, in terms of prevention, the programmes carried out

are limited in scope, and certain major issues are not given sufficient consideration, such as the

overuse of drugs.