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Suspicions of abuse at Orpéa: six questions about the operation of nursing homes in France

The time for explanations a week after the shock wave caused by the release of the investigative book Les gravediggers. The leaders of Orpea, in turmoil since the publication of an investigation against the reception conditions in the group’s Ehpad, are summoned on Tuesday February 1 by the Minister for the Autonomy of the Elderly, Brigitte Bourguignon, who awaits explanations in the face of accusations of “exceptional gravity”.

In The gravediggers, the independent journalist Victor Castanet denounces rationing, deprivation of care, hygiene in certain establishments of the group to improve the profitability of the company. The private group continues to reject these accusations as a whole.

Faced with this scandal which is shaking the sector, several questions arise and in particular, how do nursing homes work in France? franceInfo explains.

How many nursing homes are there in France?

There are a total of 7,500 accommodation establishments for dependent elderly people (Ehpad) in France, with around 600,000 residents, who will enter them on average at the age of 85. They usually stay there for two and a half years. These residents have an average of eight pathologies and half suffer from dementia, many of them due to Alzheimer’s disease. Among the French nursing homes, 50% are public, 30% are associative-private (non-profit), 20% are private for profit.

How much does a room in an nursing home cost each month?

The median price today stands at 1,800 euros in a public nursing home, nearly 2,000 euros in an associative establishment, between 2,500 and 3,000 in the private sector, with peaks that can go up to 12,000 euros. These last rents concern only five to ten places in France.

The regions where the prices are the highest are Ile-de-France, Corsica and Provence-Alpe-Cote-d’Azur, while the least expensive are in Pays de la Loire, Brittany or New Aquitaine, where you have to count on about 1700 euros per month.

How many people are mobilized to take care of residents in nursing homes?

In France, the staff of nursing homes represents an average of sixty employees per hundred residents if we count everyone. So, really, only thirty people out of a hundred are “at the bedside of the residents”.

With this, you have to work nights, weekends, not to mention holidays and absenteeism which is high in the sector. Result: it appears that the average time devoted to each resident is less than one hour per day. Note, moreover, that there are on average a quarter fewer supervisors in the private sector than in the public sector, according to a parliamentary report.

Are there any controls?

There are many controls, but too few, by the very admission of the union of private nursing homes. Apart from the checks carried out by the establishments themselves, there are rare checks carried out by the ARS, the regional health agencies.

According to the work of the Defender of Rights, over the years 2017, 2018 and 2019, there were only 3 to 50 annual checks depending on the region. You should know that this is a regulated market: before opening an establishment, you need the authorization of the ARS and the departmental council.

Who owns the private nursing homes?

The French sector is divided between different groups, including Orpea, Korian, DomusVi and Domidep, each of which has between 300 and 100 establishments in the country. They are also present in Europe.

In the capital of French Orpea, the largest shareholder is a Canadian pension fund. There is also the Peugeot group. Similarly, at Korian, the largest shareholder is a subsidiary of Crédit Agricole, as well as a Canadian pension fund, in 3rd position this time.

Are these groups profitable?

This is a question that is regularly addressed, particularly when it comes to the resources allocated in the establishments. For Orpea, for example, turnover increased over one year by almost 9% in the first half of 2021, when net profit rose by 40%. Orpéa’s margin is therefore 25%.

For the Korian group, it was even better: net profit climbed 120% in the first half of 2021.

Brigitte Bourguignon, the Minister Delegate in charge of Autonomy, thus announced on February 1 on France Inter that an administrative investigation by the General Inspectorate of Social Affairs (Igas) and a financial investigation into the Orpea group had been opened.

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