Its publication had caused a shock wave. Nine months ago, independent journalist Victor Castanet published his book The gravediggerswhich denounces the excesses of Orpea, world leader in retirement homes.
The author points the finger, in particular, on the “failures” in the control of nursing homes, partly financed with public funds. And Eure-et-Loir? Instructions for using department inspections.
After the scandal, nothing really changed in the nursing homes: the special editorial dossier
Are the controls unannounced?
Eure-et-Loir has forty-three nursing homes for a total of 4,186 beds. The checks of these establishments are carried out jointly by the ARS (Regional Health Agency) of the Center-Val de Loire and the Departmental Council of Eure-et-Loir, who are the two public financiers of the retirement homes.
Gérald Naulet, Deputy Director of the ARS of Eure-et-Loir, explains:
“When we perform an inspection in an Ehpad, we arrive at 8 am and the management is never informed of our arrival. We check the factory as it is, as part of its daily business. “
Gerald Naulet (Deputy Head of Department of ARS in Eure-et-Loir)
The inspectors verify that the conditions for the reception of residents comply with the texts in force. “Our goal is to start a dialogue with the structure, on what is good and what is not. We check if the funds allocated are well implemented. The first financiers of an Ehpad are often the users “, emphasizes Gérald Naulet.
How is an inspection carried out?
A surprise check in an Ehpad is divided into three phases: the visit of the plant, followed by the verification of administrative documents, then a moment of exchange between inspectors and members of the management, staff and residents. Gerald Naulet insists:
We are constantly vigilant not to be exploited, neither by management, nor by staff, nor by users.
Management, personnel, equipment, entertainment, or even pain management – it all needs to be sifted through by investigators.
Denis Gelez, departmental director of the ARS in Eure-et-Loir, decrypts:
“The duration of the checks is longer than before, because the requirements are increasingly stringent, in particular on the quality of care. “
Denis Gelez (Director of the ARS department in Eure-et-Loir)
To evaluate the catering in a retirement home, the investigators cross different data. “Sometimes we weigh certain portions. We also look at the weight curves of a sample of residents to make sure there are no problems with malnutrition, ”says Gérald Naulet.
What are the main dysfunctions observed in Eure-et-Loir?
In Eure-et-Loir, Between the end of 2021 and the first half of 2022, 9 nursing homes were inspected. These checks have resulted 96 recommendations, 60 prescriptions and 26 injunctionsaccording to the ARS.
“The recommendations correspond to areas for improvement identified by the inspection mission and for which either the risk is lower or there is no legal reference”, explains Gérald Naulet. “This may relate to an unsuitable hospitalization procedure that delays a resident’s entry to the nursing home, the continuing education policy or insufficient collaboration with some partners. “
Prescriptions are non-compliance measures for which “the risk is proven without being critical”. The Eurelian inspectors noted, in particular, a malfunction of the air conditioning of a nursing home – which must have at least one refrigerated room, an insufficient number of specific beds for people at risk of fallingthe use of jewelry by the nursing staff or even poorly maintained floors.
The injunctions correspond to “a critical risk”. In Eure-et-Loir, during the checks, malfunctions in the drug distribution circuit have been observed. The insufficient presence of nurses it was also noted. The management of the nursing homes affected by such violations must comply. “We will go back to the nursing homes to see what has changed,” says Gérald Naulet.
In 2016, an inspection resulted in a fine. The director of the Gallardon Nursing Home had been fired from her position. “There was a strong absenteeism on the staff level and we felt that the manager was not making the right decisions in the organization of her restaurant”, explains Denis Gelez.
What has changed since the book came out The gravediggers ?
Thomas Bourdet, Director of Solidarity at the Departmental Council of Eure-et-Loir, explains:
“The president of the county council wanted more checks to be carried out in the medical and social institutions. We already had this desire in mind, but the Orpea affair has certainly accelerated things. “
Thomas Bourdet (Director of Solidarity at the Departmental Council of Eure-et-Loir)
The Eure-et-Loir County Council has chosen to entrust this mission to an external company specializing in auditing. The SPQR company was selected this summer. “A program has been set. All nursing homes will be checked by the end of 2024. We need to make sure things are going well. It is also a support for working on improvement or renovation projects in the factories ”, continues Thomas Bourdet.
In addition to the rest homes, all Eurelian medical-social institutions (in the sectors of disability and child protection) will be inspected, for a total of one hundred institutions.
The Departmental Council of Eure-et-Loir has allocated an annual budget of € 500,000 to finance these inspections.
Elena Bonnet
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