Aging at home is the wish of the French but remains an inaccessible dream for many due to the lack of sufficient home care services adapted to severe dependency, notes the Court of Auditors in a report made public on Monday 24 January. Despite the commitments of successive governments since 2005, “the oft-heralded home turn” is “still not very successful”, underline the financial magistrates, who investigated home care at the request of the Senate Social Affairs Committee.
France has only 2,125 home nursing care structures that can take care of 126,600 potential beneficiaries. That is 20 places for 1,000 people aged 75 and over, compared to 102 places in nursing homes for 1,000.
If only to maintain this care offer at the same level as today, the Court estimates the need for 25,000 new places by 2030, to cope with the demographic shock. The report also reviews facilities for people with disabilities.
No data study
To create places, a home nursing service (Ssiad) must have the green light from a regional health agency (ARS). Until 2015, “major national plans have significantly increased supply”, which has been followed by “clear slowdown in the creation of places”. So that the rate of institutionalization of the elderly, that is to say the proportion of people residing in nursing homes in the population, has remained the same. More than 80% of places in the medico-social sector are in nursing homes.
This “waiting” singled out by the report is due to an “old age” reform that is always postponed. And stems from the delay on several sites. The first concerns the deepening of data on “unknown services”, the report points out: “To date, there is no analysis of needs that makes it possible to plan an adjusted offer” home care.
The reproach is addressed to the National Health Insurance Fund (CNAM), which has still not used the information on the health expenditure of the elderly in institutions, in hospitals or followed at home, which it has since 2019. This data would make it possible to “measuring the performance of medico-social support” and D’“direct care more efficiently”, regrets the Court, which recommends the dissemination of this information from the CNAM to the directorates of the central administrations responsible for developing the programming, to the ARS and to all the financial managers of the Ssiad.
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