French Government Defaults on the Advanced Age and Autonomy Act

Successive promises for reforming the “Advanced Age and Autonomy Act”, have been interspersed with repeated postponements, but now the government has officially defaulted. Regrettably, the French Prime Minister, Jean Castex, did not mention the reform in his official speech announcing the upcoming parliamentary agenda to the Council of Ministers. Instead, he declared that the draft law for financing Social Security (known as “PLFSS”) would include “new measures to reinforce the fifth branch of Social Security” (the branch devoted to autonomy) and will be presented to the Council of Ministers on October 6th. These declarations are extremely disappointing for professionals who worry about the healthcare conditions for the elderly.

Only three months ago, at the beginning of June, the Health Minister, Olivier Véran, declared that the “Advanced Age and Autonomy Act” announced in 2019, could be “presented (during) the summer” so that it could “potentially be examined at the beginning of the school year”. This bill aimed to: “develop longer at-home care for the elderly”, “improve residential care in nursing homes” and include new measures for caregivers.

During the National Conference for the “EHPADs” (Nursing Homes) held on September 7th-8th, the deputy minister in charge of Autonomy, Brigitte Bourguignon, reassured attendees that the “PLFSS” will contain “new and strong provisions” for autonomy in the medico-social sector. But, professionals and industry representatives have expressed disappointment at the bill’s abandonment. The director of “FNADEPA”, a national professional federation that includes directors from over 1,300 establishments serving the elderly, Annabelle Vêques, laments that “a PLFSS doesn’t look nor smell like a real law” considering the urgent need for profound changes in the domain of advanced aging. Jean-Pierre Riso, the federation’s president concurs that “the PLFSS” “will not be able to solve all the problems we have been facing for years caring the elderly, which were accentuated by the pandemic. Unfortunately, it will not address crucial reform challenges, such as governance, social assistance and the role of the elderly in our society”  (press release, 09/09/21). The Association of Directors for Serving the Elderly (“AD-PA”) deplores: “once again the government has defaulted on this important issue. The elderly, the professionals and the families who have suffered the full impact of these postponements, exacerbated by the Covid pandemic, are now being abandoned in midstream”. (press release, September 8th ).

Today’s challenges for advanced age are immense. Already, in March 2019, the Libault report estimated that the number of dependent seniors is expected to increase to 2,235,000 by 2050 (1 million more than the 1,265,000 reported in 2015). They also anticipate a significant increase between 2030 and 2040 when the first Baby Boomers reach an advanced age. By the year 2050, the number of people aged 85 and over is projected to increase 3.2 times compared to 2017, and to reach 4.8 million. Currently, one in five French citizens over the age of 85 lives in a nursing home. Each year 608,000 new residents are housed in nursing homes. Due to deep-seated organizational problems, there are widespread staffing difficulties with 63% that admit to having at least one vacant position that has not been filled for 6 months or more.

Half-measures such as recently approved wage increases are insufficient. Provided by the “Ségur de la Santé” provision, nursing home staff received an extra 183 € per month, while the July 2nd amendment (n° 43), revaluated the salaries for in-home services. As the president of the “FNADEPA” concludes: “beyond public funding, the ageing issue needs a thorough societal reform; that impetus must come from the highest level of the government”.

At this point, it remains to be seen how extensive the new “PLFSS” measures will be.

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