Tomorrow, a third of the French population will be over 60 years old. The subjects are numerous and the stakes colossal. Home care, the future of EHPADs, financing of the old age sector, the attractiveness of professions and the revaluation of remuneration, societal involvement… so many key subjects on the table, to which rapid solutions must be provided. . What method to finally move from observation to the implementation of solutions? What should we expect from the National Council for Refoundation (CNR) and its section on aging well? Jean-Christophe Combe, Minister of Solidarity, Autonomy and People with Disabilities, was, on October 26, the guest of the Counterpoints of Health, of which we are partners. Extracts.
Pascal Maurel: On the occasion of launch of the CNR “Ageing well”, on October 11, you recalled that “since 2018, 18 reports and 372 proposals have been produced on the subject; the time is no longer for observations but for the implementation of solutions”. How ? What method do you intend to apply?
Jean-Christophe Combe: When I launched the CNR of aging wellthe objective, in accordance with the request of the President of the Republic, was to set up a new method which would allowinvolving citizens much more broadlythe company, the persons concerned to these questions.
Indeed, these questions have already been the subject of many reports. Everything is on the table, proposals as observations. Moreover, I am often criticized for having launched yet another consultation. I simply think that it is important, given the challenges of demographic transitionthat today this debate is truly at the heart of public debate.
Because the question that arises today is not just a medico-social question; it’s not knowing how we’re going to grow old in nursing homes or at home… It’s really the place that our society gives to the elderly, the way we age, the way we look at aging.
Philippe Leduc : Celwe have been trying for 20 years to make real progress in terms of autonomy and care for the elderly. How will you succeed where many have failed?
Jean-Christophe Combe: Precisely because we have material. Many things have been done. I remind you that there was creation of the 5th branch of Social Security. There are also a certain number of measures, in particular within the framework of the PLFSS 2022, which have been introduced to, here too, take the home turn, strengthen and transform our nursing homes.
But really, the difference is to say that this debate can only be a debate of experts: it must be a debate of society as a whole.
My objective in the months to come with the National Council for Refoundation is to close this period of observations and drafting of proposals, and to come out with a plan d’actionsand agenda et financing to implement this vision in the years to come. It’s really concrete.
Philippe Leduc: Should we expect a big law on autonomy, as many professionals in the sector want, or small laws?
Jean-Christophe Combe: I said, on this subject, ni tabou ni totem, I prefer to talk about the content before talking about the container. The law is a vehicle, a support. If, at the end of the CNR “Ageing well”, in May 2023, we consider that there are legislative measures to be taken, well, we will take them. If we consider that the law can be a real lever for transforming society, well, we will make a big law or a small law, we will continue to enrich our PLFSS.
But really, here, I want, in the coming months with all the citizens, to concentrate on the content before deciding how it will be carried.
Renaud Degas: What links are there between the “Aging Well” CNR and the “Health” CNR, led by Mr. Braun and Mrs. Firmin le Bodo?
Jean-Christophe Combe: There are walkways. We will organize joint workshops. The first axis of the CNR that I manage is that of prevention and of theadaptation of society ; there will therefore necessarily be work with the “Health” CNR. In the same way, theadaptation of buildingshousing, transports… will be subjects on which we will work with the CNR “Climate and biodiversity”led by Christophe Béchu, Minister of Ecological Transition.
Pascal Maurel: How will this societal vision that you mention be put in place?
Jean-Christophe Combe: I often say that aging well starts at an early age. My ministerial portfolio goes from childhood to old age.
It is important that, at every moment of life, we can support all of our fellow citizens, fight against health inequalities and put in place mechanisms that allow us to age well, to delay a certain number of chronic diseases and identify as early as possible the progressive neuro diseasesfor example.
The challenge is therefore really to systematize a comprehensive prevention approach which, it is often said, is not necessarily the strong point of the French health system. The creation of prevention consultations at different key ages of lifeis part of this approach.
(…) It will also be necessary to draw inspiration from good ideas, experience and the field. (…) It will no doubt be necessary to invent new professions.
(…) My role, moreover, is to respond to a need and an expectation today. Nearly 90% of French people want to age at home and therefore, the minister that I am must legitimately meet this expectation: the residential shift will therefore become a reality.
Philippe Leduc: All of this requires funding. The Libault report recommended providing 9 billion euros by 2030 for old age. And in a interview with Echoesyou announce that these additional 9 billion will be reached from 2026, thus increasing from 32.6 billion in 2021 to 42 billion in 2026. How are you doing?
Jean-Christophe Combe: Parliament will determine how to allocate these resources. But I do hope that the CNR will give us indications. From 2024, you will already have almost 2.5 billion euros additional and a fraction de CSG, of 0.15 points, transferred from the fallwhich will go to branch autonomy.
The question of funding will inevitably be raised in the coming months and if we consider that there is not enough money to meet the needs, well, we will have to put things on the table.
The issue of financing of our social protection model debated today. This is why the government wants to be able to balance the pension funding. You’re going to say “what’s the connection?” The idea is not to finance autonomy with pension contributions, but to ensure that the pension system is balanced so that behind it, we do not have to find additional funding when ‘we know that we are going to have funding needs for autonomy.
(…) Especially since if we are sure of having 9 billion in 2026, (…) on the other hand, the question arises for the future, because we know that the demographic transition will accelerate. (…) The insurance issue and the mobilization of private financing will return to the debate.
Pascal Maurel: On the subject of nursing homes, new data from the CNSA, the National Solidarity and Autonomy Fund, show that the prices of establishments are increasing quite moderately, driven by the commercial private sector. A comment ?
Jean-Christophe Combe: The increase in Ehpad rates is supervised, even in the commercial private sector. My own goal is to ensure that the Ehpad offer is as accessible as possible. 75% of places today are eligible for social assistance. So it’s quite substantial. Nevertheless, there will be a debate on the question of remains dependent and funding for residents and families.
Pascal Maurel: One establishment out of two would be at the origin of rate fraud and many territorial disparities remain…
Jean-Christophe Combe: Fraud is obviously a permanent fight for the State. The figure you are referring to comes from a 2020-2021 report drawn up by the fraud prevention department. Since then, I can confirm that the situation has improved and both the State and the State services are intractable vis-à-vis fraudsters.
Philippe Leduc: The State is committed to controlling all of the country’s EHPADs. Where are you on this point?
Jean-Christophe Combe: This is a commitment made by my predecessor at the start of 2022, following theORPEA affairthat is to say control within two years them 7500 nursing homes in our country. It is a commitment that I took up when I was appointed, which mobilized the ARS in particular.
Since, approximately 600 EHPADs have already been checked. More than 500 agents are mobilized. We are going to recruit 120 more to be able to carry out control inspections.
Philippe Leduc: And concerning the attractiveness and upgrading of professions. Will you be able to afford it?
Jean-Christophe Combe: The attractiveness of professions is a whole host of subjects. First of all, it’s the way we talk about these professions, the representation that society has of these professions. And that is extremely important.
It is also, of course, the wage issue at the heart, moreover, of the Health Segur : we have engaged 4 billion euros in a full year for the social and medico-social sector. This is considerable, even if it is insufficient and it is no doubt necessary to go further, including on the quality of life at work, career paths, training…
There is a lack of doctors, nurses, caregivers… all these professions of accompaniment, care and connection. You have to inspire. We need to recruit massively. But it takes time: when I say that I will recruit 3,000 nurses in nursing homes next yearwe say it’s not enough but we have to find them, train them…
- 20% of French people have suffered from ageism and this, in the professional environment for half of them
- only 36% of French people think that the elderly are well taken care of in France
- To age well, you need: of lien social (34% of French people), a good health (32 %) et of the sufficient financial means (28 %).
Source : barometer of received ideas about the elderlysponsored by the MUTAC Foundation and presented by Odile Peixotodirector BVA Health during this debate on Counterpoints.
The Health Counterpoints are monthly debates proposed by journalists Pascal Maurel, Philippe Leduc et Renaud Degasalso director of Health Actors Watch.
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