Under what conditions should we entrust the most vulnerable among us to the market? This is the question that immediately comes to mind when we read the investigations by journalist Victor Castanet revealing repeated scandals in private nurseries and nursing homes. To what extent are profit maximization and the quest for low cost by certain actors compatible with the attention due to people who are inherently fragile? Obviously, the limit has been reached.
To enable a start, neither nationalization nor the invisible hand of the market, but simple common sense: let’s condition public aid paid to these sectors on quality criteria. This is a civilizational issue: the level of collective negligence reached is unprecedented. A budgetary issue too – public money is too precious to be spent without compensation – and even a competitive one: without restoring confidence there will ultimately be no customers, no employees, no profitability of nurseries and nursing homes private.
Started at the turn of the century in the face of growing societal demand, the opening of these sectors to companies has led to around a third of the country’s crèches and nursing homes being private today, i.e. more than 250,000 places overall. total. This is in no way to say that this led to widespread mistreatment. This would mean misunderstanding the diversity of structures, the sense of responsibility of many managers and the commitment of employees who care much more about the fate of the people in their charge than the legal form of their employer.
But to say that this system has failed to prevent the destructive practices of a few unscrupulous actors is an understatement. Food rationing, reduction of care, compression of recruitment and salaries, managerial pressure, even, in the worst situations, mistreatment and embezzlement of public funds: the law of margin could lead to the worst, to the detriment of children’s health, seniors and employees.
Neither nationalization nor self-regulation
What to do then? Certainly not engage in immense nationalization. “Status does not equal virtue” : it is not enough to have the “right” structure to have good practices. The demand is also too strong to be handled by a single type of player. In the same vein, the rescue (by a consortium formed by the Caisse des Dépôts, the MAIF, the CNP, the MACSF) at the last minute of Orpea and its transformation into Emeis, if it makes it possible to change practices in depth through the increase in salaries and the supervision rate or even the reduction of workplace accidents, cannot be reproduced infinitely. Conversely, betting on the self-regulation of the market would be risky on two counts: we are not betting on the lives of the most vulnerable, and the breach in confidence is now too big to close on its own.
Let us choose a third path: the conditionality of public funding for private crèches and nursing homes. Indeed, each year these structures legitimately receive public money to carry out their missions, whether for example the reimbursement of healthcare expenses in nursing homes or the care of children in crèches. To avoid any deviation from now on, let’s modulate this funding as quickly as possible based on compliance with objective quality criteria determined together by the State, economic players, unions and user associations.
What could these criteria be? If some seem obvious and transversal – sufficient supervision rate, reduced number of workplace accidents, appropriate annual training rate -, others deserve to be refined according to the particularities of the establishments so that the greatest efficiency of the program is guaranteed. device.
The whole question is to succeed in refounding around three pillars: the long term of the strategy, the quality of the service and consideration towards professionals. It is time to give their full place, all their importance, all their value to childhood and old age within our societies. On this depends the dignity of all of us. Let us therefore accelerate the transformation of these sectors by setting higher standards and responding to an obligation that is as practical as it is ethical. A universal and useful project for any government.
*Pascal Demurger is general director of the Maif group and co-president of the Mouvement Impact France.
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