“Who’s going to take care of my elderly parents?” »

This is the story of a huge disappointment. Everywhere, in hospitals, nursing homes, in home care, the same words come back from the staff. “We don’t have time”, “it’s too hard”, “we lose the meaning of our work”. With the consequence “a serious crisis in the recruitment and retention of health professionals”, was already alarmed, in a column published by Le Monde on November 9, 2021, a hundred representatives of the AP-HP and hospital centers of ‘Ile-de-France. Everywhere, the same words, for the same evils: lack of resources, insufficient patient-caregiver ratios, salaries too low for responsibilities, but also a “mental load” which continues to increase.

Especially since, since the Covid crisis, a vicious circle has set in: “The positions left vacant by those who leave force those who are still in place to work in degraded conditions (…), encourage them[ant] in turn to leave”, underlined the authors of the forum, specifying that, “on average, a nurse exercises her profession only seven or eight years, three years in the emergency room”. According to a survey by the Order of Nurses carried out in the spring of 2021, 40% of them confide that the Covid crisis made them want to change jobs. To the point of wondering: who, tomorrow, will treat us? Who will take care of our elderly parents? Because the field of old age is also under tension: according to the 2019 El Khomri report, nearly 93,000 jobs will have to be created by 2024 to meet the challenges of ageing. However, as in the hospital, the candidates do not wait behind the door.

Vocation crisis? Not so sure. On the contrary, assures a number of professionals in these sectors. With, again, the same words: “We love our job! At the Constance-Mazier nursing home in Aubervilliers, near Paris, Julien Horel bears witness to this. “Our nurses have been there for more than ten years, they have chosen to take care of the elderly and invest a lot”, assures this nursing executive who, too, is not there by chance. “I’m proud when I get small victories like a return home, because we’ve put a patient back on track. Or when the end of life happens as the deceased wished, surrounded by his family, in serenity, ”he confides.

“Home helpers are very attached to the elderly people they care for,” adds Nathalie Canieux, author of a report by the Economic, Social and Environmental Council (Cese) on this sector (1). The problem comes from the working conditions: they are so difficult that it ends up destroying the foundation of their profession”, discouraging the most seasoned, according to this CFDT representative. When the staff throws in the towel, or when younger people hesitate to get started, it is therefore neither out of casualness, nor out of lack of interest – even less out of “laziness”. But because we ask too much of them, affecting the deep meaning of care and the relationship with the patient.

Charlotte, a midwife in Malakoff, in the Paris region, does not say anything else. “I settled as a liberal so as not to suffer the stress of the hospital”, explains the 30-year-old who, too, chose this profession “to support patients, for the social dimension, empathy. Not to dispatch the consultations in ten or twenty minutes on a corner of the table. In this period of time, we are in the pure medical field, the rest falls by the wayside, ”she regrets. Not to mention the delivery rooms, where “a midwife on call has to take care of three to five mothers at a time”.

At Cese, Nathalie Canieux protests against the fact that “we cut the intervention time of home helpers into half-hours. Imagine having to wash an old lady who has trouble walking. It already takes thirty minutes to go to the bathroom and undress the person. And when the auxiliaries point it out, you know what they get back? “Clean the toilet in the kitchen!” It’s hellish. »

Admittedly, the Ségur de la santé has improved things. 12 billion additional euros must be invested in health and 9 billion in the revaluation of wages (2). However, according to Éric Heyer, an economist at the OFCE, the answer “is not at all up to the challenges”. “€2,000 net for a nurse is better than before. But given the responsibilities to assume, it’s not that much, ”also nuance Julien Horel.

A picture ? His establishment has only two nurses for a hundred residents, including 26 suffering from degenerative diseases. And no coordinating doctor. “Would you? We do not realize the mental load that this entails. Especially, he continues, that some families are very hard on us, especially since the Covid and the Orpea scandal. We devote ourselves to our loved ones and we reap reproaches and threats. »

What, again, discourage candidates. In Ehpad as in hospitals, a “shock of attractiveness” is therefore needed, to use the expression of the professionals of the AP-HP, who listed concrete ideas in their forum: better pay for night guards, weekends and public holidays; set ambitious staff ratios – they mentioned, at the hospital, the target of one nurse “for six to eight patients in the acute pathology departments”; finally, bet on the valorization of the acquired experience to give real prospects of evolution to caregivers. The ball is now in the government’s court.

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