Physical and psychological abuse, lack of manpower and material resources, “questionable” management of public money… In his book The Gravediggers, Victor Castanet makes a startling observation on the living conditions in certain nursing homes and private clinics of the Orpéa group, the world leader in the sector. In a staggering investigation, the journalist denounces in particular the serious failures and shortcomings in various structures of the group, despite high rent for residents and their families. However, this warning is far from being the first: regularly, scandals of abuse in these structures, public or private, are revealed by the media, certain whistleblowers, or by the testimonies of residents, families or caregivers. .
“A certain number of reports appear regularly on the subject, there have been political impulses each time, but we are still a little unsatisfied”, deciphers Valentine Trépied, sociologist at EHESS and specialist in aging. “The fact that we are on a type of aging that is very devalued in our society, very taboo, carrying very negative social representations, is discouraging,” she believes. An analysis confirmed by the psychologist Marie-Frédérique Bacqué, author of the book Tame Death (Odile Jacob, 2018) and professor of psychopathology at the University of Strasbourg. “The reality reflected by the dependent elderly person is frightening. […] It’s easier to ignore, obviously,” she tells Interview.
L’Express: Even though many scandals about living conditions in nursing homes have already been revealed, why did Victor Castanet’s investigation cause such a shock, in your opinion?
Valentine Tripod: It is indeed necessary to remember that this is not the first book published on the question of the dehumanizing living conditions of the elderly in nursing homes. Regularly, caregivers, families, or residents themselves alert on the subject. At the level of academic research, many works carried out by sociologists have, for example, warned about the demotivation of caregivers and their difficult working conditions. If this subject resonates so much today, it is primarily because it is about us. Our aging, and that of our loved ones: this is a question that concerns us all.
Marie-Frederique Bacque: Many scenes recounted by Victor Castanet in his book, such as the description of the martyrdom of Françoise Dorin, the wife of Jean Piat, are indeed very touching, we feel very involved in the subject. But I also think that if the book has had such a success, it’s because it touches on the money issue : the French were shocked by the discrepancy between the enormous costs invested by the residents or their families, and the care offered, which was more than mediocre.
Since the publication of the book, many families and residents have begun to testify on the subject. Why was there previously such silence around the subject of nursing homes?
MF.B: I will rather use the term “repression” of our future situation. In fact, the very old send the same message as the dead: we were what you are, you will be what we are. The reality reflected by the dependent elderly person is frightening. When we talk about old intellectuals, we talk about them like a library, witnesses of the past, of history, of politics… But when we talk about nursing home residents, we talk about the “old dependent”, the “old passive”, or even worse. And it is precisely this that we absolutely repress: this image that we have of these elderly people slumped on armchairs, staring into space.
TV: Addiction is simply scary. And society designates these elderly people as dependent people who, in the collective imagination, are in a state of submission in relation to other members of society. It is an extremely pejorative label, associated with a category of people who would no longer have needs, no longer desires, and who would be subject to the decisions of others. In a society marked by incessant injunctions to autonomy, to individual responsibility, to the promotion of youth, this is frightening.
“It is precisely this that we absolutely repress: this image that we have of these elderly people slumped on armchairs, staring into space”
Where exactly does this fear come from?
MF.B: First, it comes from numbers. In the past, if the elderly were recognized and sometimes admired, it was because they were rare. Today, life expectancy has increased overall, for everyone. This number of elderly people therefore refers to an inevitable fate, which frightens us, and which leads us to repress the idea that we too will one day be these elderly people. Especially since medicine can now treat them and keep them alive. Previously, it was possible not to think about this great aging, to avoid it. This is no longer the case. In other words, the fear of death has literally been replaced by the fear of the beginnings of death, represented in particular by great aging. This displacement is observable in all Western civilizations: previously we waited for the advice of the “old man” because he had this status of patriarch, symbol of memory. This is less true today.
TV: The establishments themselves are also scary. In the collective imagination, they suffer from a very pejorative image, and are associated with places of death and hospices. We can therefore understand the difficulty families have in bringing their parents into this type of structure, and in imagining themselves entering these establishments. On the other hand, the elderly entering nursing homes are now imagined as a homogeneous group, whose members would all be placed in the structure for the same reasons. However, this is not true: some have chosen to enter nursing homes themselves, have anticipated their aging process, and then found ways to enhance themselves in the collective life of the establishment. Others are sent to structures by their families, and will then be much more critical of their support and the caregivers. Finally, others have great difficulty understanding what they do in these establishments, and it is this last case that is widely taken up in collective discourse. We tend to think that all the elderly living in these nursing homes are subject to this, which is false.
“In the collective imagination, nursing homes suffer from a very pejorative image, and are associated with death homes and hospices”
Why is it easier to repress reality, rather than accepting it and working on it, in order, perhaps, to soften it?
MF.B: Because repression is above all unconscious. We may not realize it. Then, our pace accelerated: we see it in dozens of everyday examples, such as people’s verbal flow, the days that pass extremely quickly, the decline in the transition to retirement… We didn’t the time to dwell on the problem of ageing.
Does this taboo about nursing homes also come from the guilt that some families feel at the idea of placing their loved ones in these structures?
MF.B: That’s part of it, yes. There is already a big problem with the word ‘Ehpad’ as such: why don’t we say retirement home, or nursing home? This term, ‘Ehpad’, is hated by the residents and their families, because it refers to the purest administration. It amounts to admitting that the loved one who was supposed to fulfill the unconscious mission of caring for his parents has failed, asking the administration and society to take his charge. The placement of his parents leads to this famous guilt: that of not having helped enough, and of course not having loved his parents enough – here, love would have involved a form of sacrifice. This feeling can even go as far as shame. At dinners, we don’t like to broach this subject at all, because some may consider it ‘shameful’ to have been able to get rid of what we are supposed to owe to our parents.
“The placement of his parents leads to this famous guilt: that of not having helped enough, and of course not having loved his parents enough”
Why isn’t the subject of aging more debated in your opinion?
MF.B: Because it is a very political question. For this, it would be necessary to make a complete inventory, to communicate, and this can only be done locally, by city or by region. However, we are a terribly centralizing country. The great aging is a problem of human ecology: what to do to keep our elderly as long as possible and in good shape? Can we look the issues of aging and death in the face? This is not so sure. Studying death is fundamental work. We see problematic blocks emerging, as during the Covid crisis or after the publication of this investigation by Victor Castanet, but not really any work on the substance. Since The Gravediggers, I am happy that the State immediately decided to open several investigations, but it must be emphasized that these are investigations into the financial aspect of the case. Isn’t it the tree that hides the forest?
TV: A certain number of reports appear regularly on the subject, there were impulses given by politicians after the heat wave of 2003, after the Covid… But we are still a little hungry. As a sociologist, I notice once again that these reports and book publications feed a very negative social representation of the elderly: the fact that we are on a type of aging that is very devalued, very taboo, and bears representations very negative social, discourages. We don’t really want to know how this old age lives. Observations are made, there is not a total disinterest, but there are no actions strictly speaking to change the way we look at great ageing.
Do you think there is a will, unconscious or not, to ignore the subject?
MF.B: It’s easier to ignore, of course. And yet, the human species has an awareness of temporality, and of its own death. But as Freud says, it always puts it aside! In France, progress should be made on the question of “education in death”, as is already the case in Anglo-Saxon countries for example. My hope is that death, nursing homes, and the end of life in nursing homes will not remain taboo.