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The explosive revelations of the book Les Fossoyeurs by Victor Castanet about nursing homes raise questions about the way in which these establishments are controlled. Who takes care of inspecting nursing homes? What are the results of these inspections? How can we ensure that this abuse of our elders does not happen again?
After the stupor of the revelations comes the time for questions. The living conditions of the residents of the Ehpad of the Orpéa group denounced in the book Les Fossoyeurs by Victor Castanet prompted the Minister of Health Olivier Véran to react. He commissioned the Minister Delegate in charge of the Autonomy of the Elderly on the question of the control of nursing homes. Brigitte Bourguignon thus announced on February 1 the launch of a double investigation entrusted to the General Inspectorate of Social Affairs (Igas) and the General Inspectorate of Finance (IGF). Brigitte Bourguignon also announced “unannounced checks”, carried out by state services, in Orpea establishments.
Checks on different criteria
At present, three different authorities have the power to trigger an inspection in an Ehpad: the regional health agency, the departmental council or the prefect. These checks can be initiated for different reasons, after reporting for the checks carried out by the authorities but also by the establishment itself (self-seisine).
They are generally engaged on different criteria: compliance with catering rules, hygiene, medical care, maintenance of the establishment and the residents’ rooms, employment of qualified staff, but also more administrative aspects (prices, compliance with contracts, etc.) ).
Controls “not unexpected and too infrequent”
Indeed, according to the Defender of Rights quoted by our colleagues from 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.. Inspectors would be lacking to carry them out.
In addition to being infrequent, these inspections are rarely carried out by surprise. Indeed, according to Florence Arnaiz-Maumé, general delegate of the union of private nursing homes, Synerpa, “it is the institutions themselves that pay an audit firm to assess them, and the results are sent to the regional health agency and the departments. Rather, there should be a real certification procedure, carried out directly by the High Authority for Health, as for clinics..
“Rare” penalties
“This crisis highlights the need to urgently review the quality control and evaluation systems in nursing homes. according to Florence Arnaiz-Maumé. For the time being, 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, still in the columns of Figaro.
It is up to the Regional Health Agency to ensure the implementation of the modifications that the nursing home undertakes to make, following an action plan that the establishment will have proposed to the health authority. Sanctions, going as far as the closure of the establishment are also possible, but according to the Defender of Rights they remain “rare”.
A “real certification procedure”
The general manager of Synerpa also announces that in the coming weeks it will set up a commission to draw up an “ethical charter”, which will involve external stakeholders. “We understand the emotion of the French and we are aware that we must restore confidence through transparency and ethics.” she explained.
She also pleads for a real certification procedure for nursing homes. “The results of all these checks must be pooled in a single database, managed by a single player“, she indicated, and “we must also review the quality evaluation processes for nursing homes“.