It’s a habit that has punctuated Muriel’s life for more than five years. From 2015 to March 2020, this dynamic fifties ended each of her days with a visit to her mother Ginette, hospitalized in an associative Ehpad in Dordogne. Every evening, she supplemented the caregivers’ work by encouraging the resident to walk a few steps in the hallway, to brush her teeth alone in front of the sink in her room, or by accompanying her to the bathroom one last time before nightfall. “I was present on a daily basis, I could visit him until 9 p.m. if I wanted to… Until the Covid pandemic turned everything upside down”, summarizes Muriel. During the various periods of confinement, she assists, helpless, to the isolation of her mother and the other residents within their Ehpad. Then rejoices, when the vaccine arrives, to finally be able to find Ginette, the daily brushing of teeth and the walks at the end of the day in the corridors. “But I quickly became disillusioned. We were never able to resume this little ritual, because despite the masks and the vaccine, certain restrictions have not stopped for three years.”
Previously open to the public all day, the establishment has decided, since the Covid, to only welcome families from 2 p.m. to 6 p.m. maximum. “There were no additional justifications, we simply had to manage with this announcement”, regrets Muriel. At the same time, she denounces isolations considered “abusive” of certain patients, sometimes by “pure precautionary principle”. While a handful of caregivers and residents tested positive for Covid last July, Ginette would have been confined for “more than ten days” in her room… “Even though she was not sick”, despairs his daughter.
Almost three years after the start of the health crisis, Ginette’s case is far from isolated. In a report published Monday, January 16, the Defender of Rights Claire Hédon denounces “the attacks on the fundamental rights” of the elderly in Ehpad, and the mistreatment of which they are sometimes victims. The finding is clear: of the 181 complaints received over the past eighteen months, 46% concerned restrictions on visits to residents, their “freedom to come and go” and their right to privacy. The health measures decided at the heart of the crisis to manage the organization of nursing homes in an exceptional context “continue to be enacted in the form of ‘protocols’, ‘recommendations’, ‘plans’, without legal basis and without that they are always strictly necessary and proportionate”, notes Claire Hédon, who believes that residents “continue to be victims of discrimination” and do not always benefit from the general relief of health measures.
“Inadmissible” Restrictions
Prohibition for relatives to attend meals, to create physical contact – such as simply taking hands -, to touch the cupboards or personal effects of residents, obligation to keep the doors of the rooms open in order to check compliance with barrier gestures… In a jumble, the Defender of Rights cites the cases of “measures prejudicial” to the rights of residents which have been reported to her since May 2021, and which would continue almost everywhere in France. In March 2022, for example, it was seized by the children of a resident whose establishment was closed for seven days, despite the low number of positive cases for Covid and the triple vaccination of patients. “The management has decided to confine all residents to rooms or upstairs, depending on their mobility; close the collective restaurant; cancel collective entertainment; cancel appointments, in particular medical, outside; ban showers for residents for fear of a spread of the virus by water vapour”, she is indignant, calling for an end, “without delay”, to this type of measure.
“For us, these restrictions are inadmissible,” comments Laurence Tcheng, co-founder of the Circle of Caregivers in Ehpad (CPAE), a citizen collective created in October 2020. Before the holiday season at the end of 2022, she testifies “many very worrying feedback” from its members, with “suspensions of visits with a vengeance”, residents “who no longer had the right to receive in the room”, or even “bans on aid at lunch”.
To the point that, in a letter dated December 6, 2022 and addressed to the directors of establishments in order to call on them to accelerate vaccination campaigns in nursing homes, the Minister of Solidarity Jean-Christophe Combe insisted on recalling that all of the barrier gestures and these vaccination measures were to “make it possible to ensure the protection of residents without restricting their right to receive visits and to visit their families”. “We remind you that these freedoms of residents must be preserved and cannot be suspended”, he hammered in this letter co-signed with the Minister of Health François Braun, which L’Express was able to consult.
A necessary reminder, while the restrictions in force in certain establishments “sometimes make no sense”, considers Sylvie *. In the Alzheimer unit of the Rhône-Alpes nursing home where his mother resides, all of the residents are thus regularly isolated in the event of a positive test for only one of the residents. Since the pandemic, families are still not allowed to take their loved ones outside, nor to visit them in the morning. Same story on the side of Léna *, who is surprised that all the seniors of the Ehpad de la Loire where her mother resided were confined to their rooms for eight days in November, “sick or not”. While her relative was indeed infected with the disease, Léna was forbidden to visit her. “However, she needed to see her family… With the masks, the vaccines and the barrier measures, we absolutely did not understand this measure.” A few weeks later, very tired, the resident died. “She was weak, of course, but I have deep down the certainty that she started a slip syndrome during this period of isolation”, breathes Léna.
“Sometimes the best is the enemy of the good”
Disconcerted by these restrictions, families are beginning to doubt the validity of certain measures. While the Var nursing home in which her father is staying has still not fully reopened since the pandemic, Danielle expresses her dismay. “I can only visit him from 2 p.m. to 6 p.m., and I feel like it’s a way to keep loved ones at a distance,” she says. In the morning, families can no longer check that residents have been properly washed, dressed or changed. And during her visits, Danielle would have noticed a certain “laxity”, especially on hygiene measures. “I wonder. Why are we forbidden access to the Ehpad for half the day? During the toilet and meals, in particular? Receiving families at any time is to guarantee a certain ethic in the work caregivers. This is no longer the case.” Same questioning on the side of Sylvie, who recently offered new pajamas to her mother. At 6:30 p.m. that same evening, she received a photo from a caregiver, telling her that the pajamas “fit very well” on the resident. “It wasn’t even 7 p.m., and they had already changed her and put her to bed… Since no more family was there to check on her.”
Caught between the instructions of the directions, the anger of the families and the anxieties of the patients, the caregivers are, too, more than perplexed in the face of certain decisions. In the Ehpad d’Eure-et-Loire where Laura works, all the patients are confined when a quarter of their unit is affected by the Covid. “Those who are not sick pay the consequences for others… Quite simply because it is easier to isolate everyone than to do it on a case-by-case basis,” laments this caregiver. Result ? “Residents live in fear. Sometimes they don’t understand what is happening to them.” “Sometimes the best is the enemy of the good. Starting from a good intention, we have improperly deprived people of their fundamental freedoms,” said Yann Le Baron, national secretary of Unsa Santé. For months, the man has been managing the returns of caregivers who entrust him with “their cases of conscience”. “The worst is when the patient is at his worst, on the verge of death, and the families are still not allowed to visit him… Or when a resident lets himself slip because of the isolation imposed on him.
Asked about the subject, the president of the Association of directors serving the elderly Pascal Champvert regrets a “double discourse” on the part of the health authorities. “On the one hand, we are invited to suspend visits as soon as there are cases of contamination, with ARS who send us very safe messages. And on the other, we are called for more flexibility… All the responsibility cannot rest with the directors”, he pleads. Contacted, the National Federation of Associations of Directors of Establishments and Services for the Elderly and the National Union of Establishments, Residences and Private Home Help Services for the Elderly did not respond to requests from L’Express.
For her part, the Defender of Rights recalls that the elderly in nursing homes “cannot suffer from imperative restrictions on their fundamental rights that are greater than the rest of the population without a legal or regulatory basis”. It emphasizes that the infringements of rights and freedoms must be temporary and supervised, strictly limited and proportionate to the objective pursued.
*Names have been changed.