2023-09-14 10:03:54
In a report devoted to supporting aging disabled people, the Court of Auditors notes that the responses provided are far from covering all needs. To deal with this observation, it notably recommends the opening of 120,000 places at home, for an annual cost estimated at 1.2 billion euros.
The increase in the number of people with disabilities aged over 50 is a large-scale phenomenon. The number of beneficiaries of the allowance for disabled adults (AAH) over 50 increased by 55% between 2011 and 2019. These figures result from the combination of the advancing age of generations born in the post-war period and the significant improvement in the life expectancy of people with disabilities. However, This demographic development was not anticipated by the public authorities and its consequences on the needs for establishments and specific services were not taken into account. The report published today aims to study the consequences of this major demographic phenomenon, which is insufficiently understood by public authorities.
Different profiles depending on the disabilities
According to IRDES data, In France there are 9.7 million people with motor limitations and 3.5 million with psychological, intellectual or cognitive disorders. Among those who are over 60 years old, at the crossroads of the disability and old age sectors, it is not possible to distinguish aging people with disabilities. The work that the Court carried out on the data from the departmental PH centers made it possible to identify two main profiles of applicants with significantly different needs:
– people with motor, visceral and sensory deficiencies who represent a majority of disability situations acquired during life, after the age of 50. These people are more often able to work and more often request recognition as a disabled worker.
– people with psychological, intellectual or cognitive disorders, who are further removed from the world of work and will have a greater need for an allowance for disabled adults (AAH) or referral to an establishment or medico-social service.
Partially met needs in terms of access to care and social and medico-social support
Aging people with disabilities have significantly less access to care than the general population and although the disability compensation benefit (PCH) plays an important role, it does not cover all support needs. The Court notes that the home support services, which only 41% of applicants actually access, are under severe pressure. The situation is also tense for access to establishments for people with disabilities. The probability of applicants being admitted is only 65%, all ages combined. This insufficient support combined with difficulties in accessing care explains why the aging of people with disabilities is degraded. compared to the general population. Nuances must nevertheless be brought to this observation, as the paths appear to be varied.
Frequent course interruptions
Nearly 90% of aging people with disabilities live in an independent home and are mostly unaccompanied. Their needs relate both to the adaptation of their housing, but also to access to human help. To limit crisis situations, the home support offer must be expanded, diversified, coordinated and associated with systematic identification procedures. With the exception of people living in residential homes, people in establishments for disabled people benefit, in principle, from more stability. The path of people with a psychological deficiency or a severe neurological handicap is particularly hampered by the very clear insufficiency of adapted medico-social services, leading to situations of social exclusion, inappropriate long-term hospitalizations and discharges to unsuitable establishments. Tensions in the medico-social sector find at least partial resolution in accommodation establishments for dependent elderly people (Ehpad), which are the main structure for welcoming aging people with disabilities, with 40,000 people accommodated.
Improving the management of disability policy
The disruptions in the career paths of aging people with disabilities are symptomatic of the difficulties that all people with disabilities encounter. Their aging has a strong effect on the entire medico-social offer through the increase in demand for medical establishments, thus reducing the access of younger adults to an offer adapted to their needs. This situation calls for a determined global response. It involves improving public management of the medico-social offer.
Guarantee respect for the right to support by significantly increasing the provision of home support
Law No. 2005-102 of February 11, 2005, for equal rights and opportunities, participation and citizenship of people with disabilities, creates a right for people with disabilities to benefit from support in accordance with the guidelines pronounced by the MDPH. However, too often, this right is not respected, which has already given rise to several condemnations of the State for failure. Faced with this observation, the graduated response to the needs of aging people with disabilities must be reinforced by identifying their needs, so as to encourage support at home, and by the creation of 120,000 places for home services.
Summary of recommendations
Home support
- Deliver service authorizations covering the needs of a living area, giving priority to operators who offer graduated and diversified solutions (departmental councils, ARS).
- Entrust the MDPH with the mission of identifying people with disabilities living at home to offer them, from the age of 50, an assessment of the medico-social needs linked to aging (DGCS, CNSA).
- Entrust the Esat with the mission of preparing for the end of activity and ensuring support upon leaving the establishment when professional activity ceases (DGCS, CNSA).
In a medico-social establishment for people with disabilities or the elderly
- For establishments and services welcoming aging people with disabilities, include in the establishment project and the multi-year objectives and means contracts (Cpom) the terms of their support and evaluate them within the quality approach (advice departments, regional health agencies).
- Ensure continuity of support in establishments for the elderly for people from an establishment in the disability sector, by guaranteeing funding adapted to their needs and by retaining the resources allocated to them in the original establishment ( DGCS, CNSA, departmental councils).
- Develop a recommendation for good professional practices for the reception of aging people with disabilities in nursing homes (HAS, DGCS, CNSA).
- Use, for people with disabilities aging in nursing homes, an evaluation grid taking into account their specific needs and allowing establishments to benefit from adapted financial resources (DGCS, CNSA).
- Condition the payment of a fraction of the resources allocated to operators to compliance with the obligation to provide information on information systems (ARS, departmental councils).
- Create a national disability observatory responsible for regularly analyzing, in a multi-partner manner, sector data, in order to inform the management of national authorities and ensure public information (SGMAS, CNSA, departmental councils).
Support
Support for aging people with disabilities, Court of Auditors, public thematic report, September 2023.
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