Establishments for the elderly are facing an unprecedented crisis, between a drop in occupancy rates, a crisis of confidence following the Covid-19 pandemic and the Orpéa scandal, and difficulties in attracting professionals.
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The diagnosis is clear: the nursing home model must be thoroughly reviewed. Establishments providing care for dependent elderly people, both public and private, are facing “economic difficulties of an unprecedented scale” and must reinvent themselves, warn senators in a report published on Wednesday, September 25.
The nursing homes, which remain “by far the first category of structures welcoming elderly people”face “a financial situation (…) seriously deteriorated”. In 2023, according to senators, 66% of them were in deficit (compared to 27% in 2020). Among the establishments falling under the public hospital service, 84% are in the red. The private, lucrative nursing homes, for their part, have seen their net results “practically halved between 2017 and 2023”.
Why such a decline? The authors of the report point to several recent and simultaneous crises. First, the average occupancy rate of nursing homes “at half-mast”which remains at 88.7% in the first quarter of 2023. The authors attribute this to several factors, including the Covid-19 health crisis, which caused “a high number of deaths” in some establishments, and also fueled distrust towards nursing homes because of the containment measures imposed at the time.
This “crisis of confidence” in nursing homes was also fueled by the Orpéa scandal and the revelations of journalist Victor Castanet in his book The Gravediggerswho have “aggravated the fall in occupancy rates, particularly (but not exclusively) in the private commercial sector” And “established in public opinion a suspicion of widespread mistreatment concerning nursing homes”.
While revenues were falling, nursing homes also had to cope with an increase in expenses. The causes: general inflation and salary increases.
“The nursing home model appears to be running out of steam.”
“The organization of the financing of nursing homes into three tariff sections [soins, hébergement et dépendance] is a source of complexities and costs which appear less and less justified, particularly in view of the changing profiles of residents, who are increasingly older and more dependent”judge the senators. They specify that“a reform of this organization has been considered for a long time and supported by the federations of the sector” and that an experiment to merge the care and dependency sections has been initiated in around twenty departments.
The way in which nursing homes determine their care and dependency packages is also being judged “dysfunctional”because representing “an excessive administrative burden” which pushes towards medicalization to the detriment of prevention. The sector must also deal with “a lasting lack of attractiveness” which amplifies the arduousness of the job and occupational diseases in a vicious circle, according to the report.
Finally, the senators recommend adapting the supply of nursing homes to “long term challenges”The report mentions “places of care” which are not designed as living spaces (the authors cite bedrooms as examples) “too small” And “poorly arranged” and collective spaces “too big, dull and inhospitable”) and which are accompanied by a geographical isolation perceived as synonymous with “social death”It also highlights the challenges posed by climate change, with an increase in mortality in cases of extreme heat.
Furthermore, public interventions in support of the sector are judged “insufficient” by the authors, despite the creation of an emergency fund for medico-social establishments and services in difficulty, endowed with 100 million euros at the end of 2023.
“The envelope proved insufficient in view of the generalisation of the difficulties and the scale of the needs.”
The report makes several recommendations to improve the state of nursing homes. Among them, the creation of a “second day of solidarity, which could result in the elimination of a public holiday” and would generate 2.4 to 3.3 billion euros in additional revenue. The authors also propose to better take inflation into account in the evolution of aid, to thoroughly review the pricing by section, or to open public services or businesses near rural nursing homes to open them up.
The senators who produced this report finally recommend: “an effective strategy to promote the attractiveness of professions”involving “remuneration, training and qualification as well as the improvement of working conditions”. An essential effort, according to them, given that “The dependent elderly population will increase significantly over the next 25 years”.