Following his visit to France from 8 to 16 June, the Council of Europe Commissioner for Human Rights, Michael O’Flaherty, sets out his findings on the human rights situation of older people living in long-term care facilities (‘EHPADs’). This visit forms part of a wider initiative by the Commissioner across Council of Europe member states.
A shared assessment
The Commissioner welcomes the remarkable commitment and professionalism of all those working in the sector whom he met, as well as the open and constructive attitude of the French authorities. He notes with satisfaction the efforts made since the shockwaves caused by the Orpéa scandal, which marked a turning point in collective awareness. This crisis prompted a re-evaluation by those working in the sector and the adoption of measures by the public authorities, notably the strengthening of inspections and checks in EHPADs.
He considers that the situation in these long-term care facilities remains a cause for concern. He notes that this general assessment is widely shared by residents and their families, carers, staff and their professional organisations, national human rights bodies, departmental councils and the state authorities themselves. This situation is reflected in several warning signs, of which the Commissioner highlights the following:
- Commonly, care home residents appear to be regarded as objects of care rather than as full rights holders.
- Staff shortages: due to a lack of recognition, the elderly care sector faces major difficulties in recruitment and staff retention, which has led to chronic understaffing and a rate of workplace accidents higher than that of the construction sector.
- A lack of investment: the budgets allocated to ensuring the proper functioning of facilities, adapting them to residents’ needs and addressing climate change, as well as funding for independent living, remain insufficient.
- Ageism persists in society.
The combination of these factors has significant consequences, including instances of abuse, undue restrictions on older people’s human rights, staff burnout and a crisis of public confidence in the sector.
Five key areas for improving the respect for human rights of older people
The Commissioner has identified five priority areas to improve the respect for human rights of older people living in long-term care facilities:
Firstly, it is important to regard older people as individuals in their own right, placing their freedom of choice and their rights (including the ‘right’ to take risks) at the heart of the care they receive. This involves, in particular, decoupling the care provided to people in residential settings from a purely medical and hospital-inspired approach.
Secondly, enhancing the status of professions in the sector appears necessary, by improving staff pay, training and social recognition in order to tackle recruitment and staff retention challenges in the face of pressing demographic pressures.
Furthermore, the development of care home inspections must continue. These should be carried out on the basis of documentation and through on-site visits, unannounced where necessary, in the public sector as well as in the private for-profit and not-for-profit sectors.
Furthermore, the welcome emphasis placed on support for home care and community-based care should go hand in hand with a guarantee that the necessary resources are allocated to residential care homes so that they can provide conditions that respect the rights and dignity of older people.
Finally, it is important to clarify the governance of the sector. The division of responsibilities at all levels should be simplified and all stakeholders, including those at local and departmental levels, should be equipped with the means to act effectively to improve living and working conditions in EHPADs.
An event not to be missed
The National Conference on Independence, for which preparatory work has just begun, offers an opportunity to accelerate the process already underway. In addition to a change in terminology, concrete measures and the allocation of human and financial resources to enable their implementation are expected. To this end, the Commissioner calls on the French authorities to draw on the support of professional organisations, trade unions, associations, national human rights bodies and consultative bodies, whose commitment he commends. The objective is clear: working together to build a more inclusive society in which older people can fully exercise their rights and see their place in society recognised at its true value.
During his visit, the Commissioner met with Camille Galliard-Minier, Minister of Delegate for Autonomy and People with Disabilities, the Defender of Rights, representatives of the Economic, Social and Environmental Council, the National Consultative Commission on Human Rights, the French National Advisory Ethics Council for Health and Life Sciences, the Council on Aging and the Assembly of French Departments, representatives of professional organisations and associations of older people and carers, as well as a journalist who had carried out an investigation into the sector. He also visited two care homes in Alsace, where he met residents and staff, which deepened his understanding of the challenges on the ground.