“There must be regulation by the public authorities” on Ehpad, pleaded Tuesday January 25 on franceinfo Frédéric Bizard, professor of economics at ESCP Business School, founding president of the Health Institute, while a book-investigation “Les Fossoyeurs” – to be published Wednesday by Fayard – signed Victor Castanet, delivers a disturbing dive into the secrets of the Orpéa group, world leader in nursing homes and private clinics. The system “is not regulated”, denounces Frédéric Bizard. So there is “a risk of drift” when “a globalized group” must have “returns on investment”. According to the economics professor, “we must decentralize authorizations” given to nursing homes. He is in favor of “reinventing the model” currently in place.
franceinfo: How do you perceive the revelations of the investigation?
Frederic Bizard: Unfortunately, that’s not a big surprise. There is a real disintegration in this sector of the elderly. I remind you that there was a law on old age which was expected to try to remedy this. And unfortunately, it could not be set up. I won’t comment on this company in particular. But we know that there are deviations which are linked to the economic model and the absence of regulation. When you are a private for-profit group, you have three components of the economic model which are care, dependency services and accommodation. You only have one component on which you can have a margin, and that is accommodation, with a free price per day for newcomers and complete freedom to organize all these services. So inevitably, we are in a system that is hardly regulated. We are in a risk of drift, because of the system, which increases when you have a globalized, ultra-financialized group, with funds which require significant returns on investment. So we are totally moving away from a public service logic which, in my opinion, must still take precedence in this type of service, even if it is delivered by a private sector. There must be regulation by the public authorities to avoid this type of abuse.
The book points to the powers of health ministers. It is a problem ?
These authorizations must be decentralized, either to the departmental council or to another structure. But we must distance the politician, the minister, from this type of decision. It is necessary to clarify the roles between the State, the departmental councils and the Social security, which pay largely. This sector must be linked to health. We made a mistake in creating a fifth branch of Social Security dedicated to old age. Because old age is health. It is a prevention policy. The nursing homes brought an improvement in the early 2000s. We went from hospices to nursing homes. Ehpads were seen as a real innovation. But the model has been completely reinvented for ten years. Intermediate residences must be created. It must be the elderly person who has the choice between several models. Today, it is either the home or the Ehpad. So inevitably, you have a balance of power that is very favorable to nursing homes, because we have the impression that we have no choice. Many developed countries have developed other structures that give the nursing home the role it should have, that is to say the role of last resort. There, you have more than a third of the people who are in nursing homes who have nothing to do there.
Do we need an independent authority to control all nursing homes, public and private?
I think we need to rethink governance. Who gives permissions? And that there are not a lot of conflicts of interest or risks of pressure. The State must define clear specifications on the conditions of supervision, the conditions of development, the regulation of tariffs. And then, there have to be public operators. Health insurance, which is largely paying in this case, must play a role, in particular with the Primary Health Insurance Fund, to ensure that it has good compliance with the specifications. The departments play the role of guides. It is the social pivot. When you have a dependency problem, you need to have a panel of services that integrates nursing homes, and which allows you to have a certain freedom of choice for the person where they feel best to stay.
Are there inspections in these establishments?
Not enough anyway. It is rather on scandalous revelations that the regional health agencies [ARS] will try to put things in order. We need to return to a system with sufficient inspections, but also sufficient specifications. Because we knew that some groups have a daily budget for food of 5 to 6 euros. So you don’t have to do a lot of inspection to realize that when you’re an older person who has given strong importance, at those times of the day, when you have such restrictions, the quality of life in these establishments do not live up to expectations.