France: What care model do we want for the elderly?

In France, EHPADs are residential establishments for elderly dependent people, sometimes known as a retirement home. EHPADs house elderly people over the age of 60 who have lost some physical and/or mental faculties and are no longer able to live at home. There are 7,200 EHPADs and 10,000 home care services in France. They house or provide support for 1.4 million elderly people and employ more than 700,000 workers.

Unfortunately, the elderly persons sector in France faces structural problems that pose a threat to quality care provision. The CFDT Health and Social Care sector is campaigning against serious understaffing and deteriorating working conditions. A survey on staffing levels conducted in September 2017 was repeated in June 2018 and the results were just as damning. Of the 1,723 responses, 35% felt that staffing levels on the day of their response to the survey did not ensure safe and quality care or dignity for patients.

All trade unions agree that care provision for the elderly has deteriorated to an unacceptable level and that the human and financial resources currently allocated to the sector are not enough to provide the elderly with adequate care and dignity. Recruitment problems and high turnover are exacerbating the staffing situation. The sector no longer attracts people who feel they have a vocation for this kind of work.

Staff working with elderly dependent people speak of the “lack of dignity”, “institutionalised abuse”, “staff burnout” and of staff “feeling responsible for poor quality provision”. The sector’s employers and EHPAD managers make the same kind of observations. Everybody is agreed on the urgent need to ensure more dignified housing, support and care for the elderly.

On 30 January and 15 March 2018, tens of thousands of workers from retirement homes, EHPADs, long-term care and home support throughout France came out in support of national strikes backed by the entire trade union movement. The strikes were well-supported because workers are at the end of their tether. All categories of workers have reached breaking point, and many took to the streets to express their frustration.

CFDT Health and Social Care activists chanted slogans saying "Nous sommes une richesse" (We are valuable), stressing the unquantifiable value of care workers for quality elderly care delivery, in response to the politicians who only see health workers as a cost. Families, the elderly, managers and local councillors all joined the movement, with slogans like: “I am here because my grandfather lives at an EHPAD and I agree with your demands.”

The series of social movements that have been taking place since last summer prompted a response from the government, which proposes an increased budget allocation for the sector as part of a “grand plan to meet the challenge of growing old”. But the funds are not enough to meet the needs. The CFDT criticises the government’s tendency to make regular but very small increases in spending, while the unions deplore government announcements that "completely ignore the urgency of responding to the sector’s demands," namely an increase in staffing levels, better pay and career structure, improved working conditions and permanent funding for home support.

President Emmanuel Macron conceded that low staffing levels is “a real problem” and “a key issue for today and even more so for tomorrow”. The French government has committed to dealing with the mess that currently characterises care for the elderly and says it will respond to the demographic challenge posed by an ageing population.

CFDT Health and Social Care believes it is urgent to have a comprehensive understanding of the question of care for the elderly and not just an increase in the budget. The CFDT supports the recommendations made by the Economic Social and Environmental Council (CESE) in its report “Vieillir dans la dignité” (Growing Old with Dignity) published on 24 April 2018:

  • Prevent, anticipate and fund the loss of autonomy;
  • Adapt residential and service provision to meet needs and expectations;
  • Find new ways of working together to respond to the challenge of providing comprehensive and dignified support and immediately introduce minimum “bedside” healthcare worker staffing levels at all EHPADs.

We hope that the French government will adopt a long-term strategy that provides the public with a genuine way forward. The CFDT is ready to put the necessary work in to ensure the emergence of a new model for the care of the elderly. Everyone has a right to health!