Faced with the demographic challenge of the aging of the population, numerous consultations and reports have concluded on the need to considerably strengthen the resources allocated to old age and have called for a profound change in the structures that accompany it. However, their recommendations remained a dead letter. The budgetary procrastination of public authorities demonstrates that the well-being of the elderly is not their priority.
The majority of people in vulnerable situations prefer to stay at home. The architecture of accommodation establishments for dependent elderly people (Ehpad), their internal organization and also the professional culture of their staff, all combine to make them health structures and not places to live. Funding shortfalls contribute to resident abuse. The ratio of dedicated staff per resident is lower than the European average. Despite the efforts made, the difficulties of professionals have increased, job creations remaining far below the needs and unattractive professions.
The establishments and services dedicated to the elderly are very unevenly distributed according to the territories. The most economically fragile departments are particularly penalized, with aging populations that are often isolated and problematic access to care. The Orpea scandal raises the question of the relevance of the economic model of nursing homes commercially run but publicly funded. In addition, the financial optimization practices of groups sometimes result in the spoliation of savers who have invested in nursing homes.
A paradigm shift
The promotion of the autonomy and well-being of the elderly requires a paradigm shift in the policies devoted to them. First of all, we must banish the term “dependency”, which does not respect the dignity of the elderly. They must be stakeholders in the decisions that concern them. A coordinated pathway between care facilities and living spaces calling on the expertise of all those involved is a determining factor in maintaining the autonomy of the elderly. This is the guarantee of quality geriatric care as close as possible to their living environment by avoiding hospitalizations as much as possible. The most effective existing coordination mechanisms must be generalized.
The Ehpad must become authentic places of life. Residents’ accommodation must include properly sized private spaces that preserve their right to privacy. It is also necessary to strengthen the integration of establishments in the city, the mix of activities and services offered with other populations.
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