health authorities unable to measure abuse
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Poorly cared for, malnourished, isolated pensioners… The revelations about the ill-treatment inflicted on residents of accommodation establishments for dependent elderly people (Ehpad) have multiplied since the publication in January from the investigation book The Gravediggers (Fayard) on the excesses of the Orpéa group. But how widespread is abuse? How many of the approximately 700,000 nursing home residents have been victims? To date, the French health authorities are unable to say.
Asked in February, the government said it did not have reliable national statistics on the subject. However, a “annual national statistical report” situations of mistreatment in the medico-social sector is established every year by the Ministry of Health since 2010.
These reports have so far been kept secret by the government, which at first refused to release them to the World. However, nothing opposes their publication, estimated the Commission for access to administrative documents (CADA), which we requested. Following the opinion issued by the CADA on July 7, the Ministry of Health finally sent us the last four editions of this national report, dated from 2018 to 2021.
Reports that go back to the dropper
In these annual reports, the monitoring alert mission of the General Directorate for Social Cohesion (DGCS), which depends on the Ministry of Health, is supposed to document the nature of the “exceptional and/or dramatic events threatening or compromising the health or safety of users” medico-social establishments. This includes nursing homes, but also establishments welcoming disabled adults and those of child protection.
However, far from producing an X-ray of reports of mistreatment or violence, these reports actually reveal that the ministry is almost blind to these phenomena, due to major shortcomings in the monitoring system and the feedback of information from the field.
In principle, medico-social establishments must report any serious malfunction to the regional health agencies (ARS), which must then report the most serious cases to the national level.. However, the DGCS regrets not receiving “only a very low number of reports” from the ARS: barely ten cases of mistreatment each year, all types of establishments combined. In 2019, more than a third of the ARS (seven out of eighteen) did not report any reports. Year after year, the reports deplore that the central administration has only “very little data”thus distorting their analysis.
For comparison, 3977 – national listening number to report elder abuse – in 2019 handled more than 1,380 cases of mistreatment of elderly people and adults with disabilities in institutions.
In one of its reports, the DGCS acknowledges that the shortcomings of the information feedback system prevent it from providing a “overall assessment of the phenomena of mistreatment”. “Today, the share of alerts that we know via 3977 or other channels is derisoryabounds Pierre Czernichow, president of the federal office of 3977. The problem of mistreatment is not identified as a priority by the public authorities. » According to him, the methods of collecting alerts could be standardized in order to allow a pooling of the files entered by the establishments with those which go up by other channels, such as the listening number.
A blockage that persists, despite the Orpea scandal
The absence of reliable national statistics is not just an arithmetic problem. In December 2021the defender of rights deplored this situation, believing that such a dashboard would allow “evaluate, objectify and compare the different situations of mistreatment”.
The reasons for reporting are sometimes unclear and not well known to the establishments and the responses provided are not always in line with the seriousness of the facts: they may not result in any criminal action, or may be late.“at the request of the ARS” and “after several events” serious. What “allows the repetition of facts against several victims, even in several structures and over several years for the same individual”regrets the DGCS in its 2019 report.
Each year, the authors of the DGCS reports highlight the complexity and failures of the system for reporting abuse and call for “optimize this process” by reviewing the dedicated IT systems. “It seems necessary to review the functioning and objectives of the alert mission”the authors still concluded in 2021.
These findings and these warnings were, it seems, not heard before the Orpea scandal. And almost eight months after this one, the long-awaited overhaul of the computer systems is still pending. Contacted by The worldthe Ministry of Solidarity, Autonomy and People with Disabilities argues that the definition of mistreatment by the law of February 7, 2022 constitutes real progress, which should facilitate the creation of an information system in the long term.
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