A story of one hundred and twenty years is about to end in Cabannes, in the Bouches-du-Rhône. At the end of November, this town of 4,700 inhabitants in the south-east of France learned that its Ehpad should close its doors at the beginning of next year. “This news is an atomic bomb for our village. It has been more than a century since this former hospice opened, laments Gilles Mourgues, mayor of Cabannes since 2020. No one understands why they want to take this local establishment away from us. The reason put forward by the health authorities is ringing and stumbling: the retirement home, a member of an inter-municipal public structure, does not fit into its finances. The number of beds in the establishment – 31 occupied out of 38 available – is not enough to ensure its profitability. The case of Cabannes, although presenting particularities specific to the territory, is a more general symptom of the difficulties encountered by public nursing homes, particularly in terms of the budget.
The finances of the retirement home in this village, burdened by the health crisis, are indeed not brilliant. In October, the establishment posted a record deficit of 380,000 euros. The 600,000 euros in aid released by the county council were not enough to allow him to extend his activity. “We were able to rebalance our accounts until 2020, and the Covid made us dive, says the mayor. But there are many small nursing homes in a similar situation. So why go after Cabannes?” A feeling of injustice runs through the village, as the families of the residents worry about the future of their loved ones. “We were recently confronted with the critical situation of a very fragile establishment. The Cabannes nursing home was struggling to recruit staff. It was also in serious financial difficulties: suppliers were refusing to deliver establishment, especially in food. We were at an impasse, “explains Caroline Ageron, director of the Bouches-du-Rhône delegation of ARS Paca.
The risk of a lack of proximity
“We have been hearing rumors about a possible closure for several months. On November 21, we received a letter to let us know. It was really very brutal, says Alain Defrasnes, a resident of the village, whose daughter-in-law mother lives at the Ehpad. We were told that the residents would be transferred to other establishments after the holidays. But at the moment, we still do not know what will happen to them. Five elderly people should be moved to the Ehpad de Noves, the neighboring village, an establishment which is part of the inter-municipal public structure on which the Cabannes retirement home depends. The rest of them should be distributed in several establishments in the region.
“We hear every day that we must limit travel, avoid polluting by using gasoline, and today we are making decisions that will mean that we will have to use the car more, regrets Alain Defrasnes. And above all, we will not be able to visit our loved ones as often as today. The inhabitants of Cabannes benefit from an appreciated comfort to see their relatives: the wife of Mr. Dufrasnes can for example visit his 88-year-old mother “at least three times a week”. An elderly lady, whose husband was recently hospitalized, can walk to see him every day. “Without a car and without public transport, this will no longer be possible”, regrets the mayor.
“Do they realize the brutality for the families?”
A lack of proximity to which is added the fear of the loss of bearings of the residents. “The Cabannes retirement home is an establishment on a human scale, notes Christelle Fermy, caregiver and staff representative of the Ehpad. It is a cocoon, where residents benefit from a facilitator and a center of activity and appropriate care.” About a hundred employees work in the intermunicipal structure bringing together the establishments of Noves and Cabannes. “But caregivers cannot practice in Noves as we do in the village, continues the caregiver. Their nursing home is already large, not to mention the additional elderly people who should be added with the announced closure. Like the families of the residents, the staff of the establishment remains partly in uncertainty: if the incumbents will go to work at Noves, the contract workers are still waiting to know more about their fate. Asked by France 3 Regions, Dominique Charlier, acting director of the Cabannes nursing home, said “ensure human support, whether for employees or for residents”. Contacted by us, Mr. Charlier did not respond to our requests.
Despite management’s assurance, the families continue to express their dismay. “A meeting took place on Monday, where the director advised us to get closer to the establishment’s psychologist to organize the travel of our loved ones, explains Alain Defrasnes. But do they realize the brutality of the situation for families? People cried yesterday. It’s all so fast!” The Bouche-du-Rhône regional health agency wants to be reassuring explaining “to do everything possible to ensure that individualized support is applied for each family”. “The closure of the Ehpad is scheduled, but there is no deadline: we are taking the situation as it happens, and we will not close it until each person has been replaced. establishment will close its doors in January, or in February, or even in March if the need arises”, assures Caroline Ageron. Insufficient guarantees for residents, staff and local elected officials, who are mobilizing against the closure of the Ehpad. “We wrote several letters, which our deputy, Romain Baubry, hand-delivered to the Minister of Health on Tuesday, November 29,” explains the mayor of Cabannes.
Weakened structures
The city councilor still hopes to be able to keep this health establishment open, a few months after the Orpea scandal, which shook the world of private nursing homes. “The families of our residents are very happy to be in a public Ehpad, adds Christelle Fermy. This retirement home is an extension of the village, a real social place, which perpetuates the link. We have denounced the private sector a lot. But in In this case, why close the places that are the counter-example, even if everything is not perfect there?
The reason, financial, is all the more painful as it is not an exception in the world of retirement homes. Beyond the particular case of Cabannes, many public establishments, isolated or associative, are struggling to stay in balance. “We note that more and more establishments and home help services are weakened on the territory”, observes Eric Fregona, deputy director of the association of Directors serving the elderly. In July 2021, the Pays-de-la-Loire regional health agency announced to the inhabitants of Juvigné, in Mayenne, the closure of the village nursing home a few months later. As in the Bouches-du-Rhône, the establishment welcomed around thirty residents. By the end of December, the public nursing home Saint-Louis Champtoceaux (Maine-et-Loire), will also close its doors in Pays-de-Loire. “The increase in expenses linked to inflation and the health crisis have greatly affected our structures”, continues Eric Fregona.
A limited margin to be profitable
Benefiting from a median tariff of around 2,000 euros per month – against 2,700 for the private sector – on the one hand, and financed by the departments on the other, public nursing homes have only limited room for maneuver to be profitable. “These establishments are often either reduced to making economies of scale to stay afloat, or to close”, notes Ilona Delouette, post-doctoral researcher in economics at IMT Nord Europe, author of a thesis on the funding for the management of loss of autonomy. In Cabannes, for example, the cost of meals per resident is around 5 euros per day, according to Christelle Fremy.
At the beginning of the year, in the wake of the revelations of Victor Castanet’s book The Gravediggers, recent winner of the Albert-Londres Prize, a “flash” parliamentary mission on the financial management of these establishments had also underlined the “strong constraints weighing on the public financing of nursing homes”. At the same time, the parliamentarians pointed out that “the financial management of nursing homes cannot be done to the detriment of the services offered to residents”.