Soon “resource-based” pricing in public nursing homes

Change in prices in sight in public and associative accommodation establishments for dependent elderly people (Ehpad). This is one of the flagship measures of the “Aging well” bill relating to old age and autonomy, which was adopted in the National Assembly last week and which must be definitively voted on this Wednesday in the Senate. . The principle is simple: it would involve modulating “the average daily rate relating to accommodation” in establishments fully or partially authorized for social assistance, “according to the resources of residents under conditions set by decree in the Council of State. And this, only “for residents not covered by departmental social assistance”.

A concrete measure in a context where “many nursing homes are in great financial difficulty” and “are already implementing a modulation of prices according to residents”, underlines MP Laurence Cristol, rapporteur of the bill, who explains that she wants “ supervise the practice”. Before launching: “To the extent that the practice already exists, we might as well regulate it so that it is as ethical as possible”, whereas this applied until today in total legal vagueness. The challenge, according to the elected official, is to ensure that Ephads can “continue to offer the same quality services”, even if it means increasing prices, but without putting “residents and their loved ones in financial difficulty”. ".

For Annie Vidal, who is pushing the “Aging Well” bill alongside her colleague Laurence Cristol, it is far too strong to talk about “taxing the rich”. “There will be just two rates,” explains the MP, with a rate “for people eligible for social assistance for accommodation”, who – as she is keen to point out – “have very few resources” and “ are not at all able to finance a place in a nursing home” and another which will certainly be increased but will remain “lower than elsewhere” for unauthorized people. “The difference between these two prices will be regulated and cannot go beyond a limit set by decree (...) under the responsibility and control of the department,” adds the elected official. In addition, according to her, it is very important to remember that these “new” prices “will only apply to new residents”, and not to residents currently in nursing homes for whom “the price conditions will remain those applied to their entry”.

“The current law was absolutely not structured. And if it indeed allowed the existence of agreements between the departments and the Ephad (therefore free to apply a price increase for certain residents), there was no land register at the national level,” confirms the cabinet for its part. from Fadila Khattabi, the Minister Delegate in charge of Elderly People, who emphasizes that it was “a request from many professionals in the sector”. For what ? Quite simply because from the moment a nursing home is approved by social assistance, one and the same price - very low - applies for everyone, including the most well-off residents and non-beneficiaries of social assistance. 'welfare. Except that - as the ministry points out - “the majority of public nursing homes are authorized” for social assistance and therefore offer prices “which have not increased in recent years”, despite the inflationary context.

The whole challenge for the ministry was to ensure “not to further weaken public nursing homes”, so as not to “have them disappear for lack of having been too “social””, while guaranteeing “protection of resources of the elderly and more particularly of the beneficiaries of social assistance. A “balance” now found by the establishment of these two rates, one for beneficiaries and the other for non-beneficiaries, thus allowing financial catch-up for establishments whose rates had not increased at the same rate. level than inflation. Knowing that the second rate for non-beneficiaries will be discussed and decided at the departmental level, and cannot exceed a certain difference with that applied to beneficiaries, so that one resident will never pay three times more than another. “They are free to apply an even smaller gap,” the ministry emphasizes.

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This new measure “responds to a need for an overall balanced budget for public establishments” which have been suffering terribly for several years “given their low daily rates applied”, continues Annie Vidal. The latter believes in fact that these prices, “much lower” in public establishments “than elsewhere”, are partly responsible for the difficulty of these structures in maintaining their “financial balance”.

A system also welcomed by the French Hospital Federation (FHF) representing public establishments, which welcomes this possibility offered to authorized nursing homes “to adjust their prices for users not covered by social assistance”, “in proportions reasonable and resource-based. And if this measure “does not in itself constitute a response to the financial difficulties encountered by nursing homes”, it “will provide the concrete possibility of ultimately creating new room for maneuver”, continues the FHF, before recalling that the conditions of The application of this still remains to be defined “by decree”.

However, many experts explain that it will be necessary to go even further and completely overhaul this system which is based on rules decided at a time when the issues were not the same, particularly given the fact that elderly people didn't live that long. “We must anticipate and review the entire Old Age policy,” warns Arnaud Robinet, president of the FHF, calling for “emergency measures to unlock new resources” for nursing homes to be put in place. “It is crucial to adopt a landmark law to finally build a society of longevity. This transformation will notably involve indexing revenues in the public sector to changes in expenditure and, in the long term, through a new financing model,” he concludes.