After the revelations of the investigative book by journalist Victor Castanet, The Gravediggerson the living conditions of residents of certain nursing homes of the Orpea group, the Minister Delegate for the Autonomy of the Elderly announced on Tuesday February 1 on France Inter the triggering of a “dual investigation”, entrusted to the General Inspectorates of Social Affairs (Igas) and Finance (IGF). Brigitte Bourguignon also promised “random checks”carried out by State services, in Orpea establishments.
But the “serious and intolerable practices and dysfunctions” denounced by the minister also raise the question of the effectiveness of ordinary controls, decided by the public authorities, in nursing homes.
1Who inspects nursing homes?
Controls in Ehpads can be decided by three different authorities, in accordance with the Code of Social Action and Families: the prefect, who represents the State in the department where the establishment is located, the departmental council or the agency regional health authority (ARS).
These checks may concern the reception conditions of residents, hygiene, the quality of medical care as well as the upkeep of rooms, compliance with health rules in catering or the employment of qualified personnel. . Inspections can also target economic aspects, such as compliance with contracts, tariffs or account compliance.
2In which cases are checks carried out?
Controls can be triggered following reports or by internal referral. For example, they “are possible on adverse events such as running away, suicide attempts or a security deficiency”explains the Aisne departmental council to France 3 Hauts-de-France.
Tours can also be arranged “to check the conformity of the equipment with a view to the approval of the establishment” and control “respect for the rights of users, the proper implementation of activities and social links”.
3What happens when a failure is detected?
After a check, “a provisional inspection report is drawn up by the ARS in which recommendations are sent to the establishment, which has a response time to explain how it will act and what it will modify to carry out the recommendations”explains the Ministry of Health to the Figaro.
The Ehpad must determine an action plan with the ARS, which then ensures its implementation, assures the ministry to the Figaro. When the checks are carried out on behalf of the departmental councils, the procedure is comparable.
In a report published in April 2021 (PDF)the Defender of Rights considers that in the event of default, “the safety of residents must be able to lead to the closure of the establishment or service”. But, he laments, “whether it is the withdrawal or non-renewal of the authorization, or even the withdrawal of the security clearance, these measures remain rare”.
4Are these checks frequent?
According to the Defender of Rights quoted in Le Figaro, over the years 2017, 2018 and 2019, there were only 3 to 50 annual checks, depending on the region. In Hauts-de-France, a region with 568 nursing homes, the ARS has received 1,230 reports and carried out 90 inspections since 2018.
This low number of checks is confirmed by the testimony of the former medical director of Clinéa, a subsidiary of the Orpea group, interviewed by Victor Castanet. The former executive of the group says that during the eight years he spent at Orpea, he “only had to manage a dozen checks at most for the fifty clinics he supervised”.
“The last time we had a check-up was a few years ago”also testifies on franceinfo Siham Touazi who has worked for 12 years in the Ehpad du Château de Neuville (Val-d’Oise).
5 Are these inspections unannounced?
In addition to being infrequent, controls are rarely carried out by surprise. “There are still too few spot checks”acknowledged Monday Florence Arnaiz-Maumé, general delegate of Synerpa, union of private nursing homes. “This crisis highlights the need to urgently review the quality control and evaluation systems in nursing homes”said the union leader. “The establishments themselves pay an audit firm to evaluate them, and the results are transmitted to the regional health agency and the departmentsshe explained. Rather, there should be a real certification procedure, carried out directly by the High Authority for Health, as for clinics.
“In general, we are warned months before. Everything is bricked, cleaned and organized to properly receive said control”, abounds on franceinfo Siham Touazi. In his book, Victor Castanet notes that even after a complaint from a family or a boarder, the director of the establishment inspected was “generally, notified by the control authorities a month and a half or two months in advance, and the group therefore had plenty of time to prepare for the upcoming control.” Which allowed him, on D-Day, to change “plans” and of “redo” contracts so as not to be worried, specifies the author on the set of “C Politique”, Sunday January 30.
6 Do the health authorities have the means to control nursing homes more?
In his report, the Defender of Rights also points out “the lack of resources within these entities”. “The staff of the regional health agencies and the departmental councils are too weak to carry out very many checks”, confirms Luc Broussy, director of the Monthly for retirement homeson BFTMTV.
In his book, Victor Castanet recounts his meeting with a former director of the Regional Hospitalization Agency (ARH) in the Midi-Pyrénées region. The latter refers to only “two inspectors” for the department of Tarn-et-Garonne.