On the eve of the presentation of the State and Social Security budget, scheduled for Thursday October 10, and while the government is preparing minds for considerable efforts to restore public accounts, concern is growing is alive and well in certain sectors, notably personal services and nursing homes.
Our guest, Jean-Christophe Amarantinis, is the president of Synerpa, the first confederation of private actors in the elderly. Synerpa represents the players in nursing homes and home care. There are 300,000 people accommodated and helped, and 150,000 employees in total.
According to a working document of the Social Security budget, which franceinfo was able to consult, the Social Security deficit will be of the order of 18 billion euros this year, much more than initially expected.
franceinfo : Jean-Christophe Amarantinis, the old age branch alone represents more than 6 billion euros. What does this inspire you? Are you afraid of cost-saving measures?
Jean-Christophe Amarantinis: Indeed, we fear significant savings measures and we are extremely worried, since we have been calling on the public authorities for several months, with our colleagues from other federations. Because the nursing home sector has been in great financial and economic difficulty for several months.
Was there a long-awaited old age plan by your federations and promised by Emmanuel Macron?
Yes, unfortunately, the information we have at the moment suggests a certain budgetary austerity which, once again, seriously worries us.
How can this budgetary austerity be translated into practice for nursing homes in particular?
Nursing homes are in difficulty, in particular because of what we call administered rates, which are revenues that are set by health insurance and by the departments, therefore the local authorities. These prices, these revenues are insufficient and have not kept up with inflation and the increase in costs over the last two years. So the effect today is that these establishments are out of sync between their revenues and their expenses.
“It would take a significant injection of capital into these establishments to get them back afloat. So the fact that a downturn has been announced worries us greatly.”
Jean-Christophe Amarantinis, president of Synerpaon franceinfo
And do you have information that lets you say that this planing move is going to be a reality?
We do not have information on the figures as they will be implemented at the level of this PLFSS (social security financing bill) 2025. But as we do not have concrete information which let us know that we will be taken into consideration in terms of our requests, we are extremely worried about the treatment of our demands and complaints.
In the meantime, in nursing homes, are working conditions deteriorating? We know that you have enormous recruitment needs.
Yes, and so we try to implement loyalty and attractiveness policies for employees. These are stressful jobs, difficult jobs, and so we try to organize the work so that it is less painful and more rewarding, therefore trying to be more attractive in terms of remuneration.
How much do nursing home staff earn today?
I don’t have in mind the salaries that are paid at the level of nursing staff, but these are conventional salaries, with a whole series of incentives, a series of specific bonuses. Moreover, our commercial sector has not benefited in recent months from what we call suggestion bonuses – measures which were granted by the former Prime Minister in July 2023 – to the public sectors and the sector associative. And therefore commercial nursing homes who do the same job, and in particular nursing staff who have the same responsibilities as their colleagues in public associative establishments, have not been able to benefit from these measures. So it’s extremely painful and worrying there too, because it creates a kind of flight of healthcare personnel, from the commercial sector towards other establishments of different status.
You therefore do not have good hope of filling all the outstanding positions… Especially since the figures are very impressive: the number of elderly people will only increase until 2030 to reach more than six million people. There is a demographic emergency to be addressed.
Quite. There is what we call a “demographic tsunami” that France will face. With more than 50% additional elderly people between 75 and 85 years old, by 2030 and 2040. So to support this increase in life expectancy and this need for care and dependency support, we will need 400,000 additional people to recruit, train and retain. So it’s going to be complicated.
“We are going to need 400,000 additional people to recruit, train and retain.”
Jean-Christophe Amarantinis, president of Synerpaon franceinfo
Prime Minister Michel Barnier did not have a word for old age during his general policy declaration. Is this an oversight or a sign that it is not part of his current political priorities?
I think it was an oversight, certainly. His advisors certainly did not make him aware of this subject. But we rushed the next day to send out messages and various press releases to raise awareness among both the Prime Minister and all his teams. There are other priorities that have been announced, such as mental health. We have in our organization, in our priorities, issues of support for disoriented elderly people, who suffer from Alzheimer’s pathologies and mental pathologies. So, we are also in this dynamic of priority of support for people suffering from Alzheimer’s pathologies.
If you had concrete things to ask today of the new government or new Prime Minister, what would they be?
The first priority is to massively inject what we call funding into healthcare allocations to get these establishments back afloat, all sectors combined, public, associative, private. In order to be able to put them back in balance and so that they do their job correctly and so that they are not financially threatened. And then treat the staff of the different establishments fairly, as when I mentioned it for the Borne measures. And also focus on increases in staff numbers, so that healthcare establishments offer less arduous working conditions, by increasing the number of employees attached to these structures, and in particular healthcare staff.
So, among the avenues contained in the Social Security bill that we were able to consult, there is the extension of the experimentation of a single package, and no longer divided between part of the financing coming from the ‘ARS and another from the department. Is this a good lead?
This is called the merger of care and dependency packages. We are in favor of it. A one-stop shop, a single contact, in this case the Regional Health Agency, which would be the contact for the establishments, would price them and deliver a single recipe. This would have the merit of having a single contact and above all of being able to discuss with a single authority, this would make it possible to anticipate and finance in a multi-year manner and in anticipation, a whole series of commitments and investments for the establishments. So we are 200% in favor of it.