"We can no longer recruit!" : in Ile-de-France, home care is severely understaffed

"I received a desperate call yesterday, from a woman who does not know what to do with her 86-year-old aunt, whose hospital announced her release, after hospitalization for Covid", explains Emmanuelle, one of the five coordinating nurses of Apssad.

This Parisian association, located rue du Faubourg-Saint-Antoine (11th-12th centuries), provides home care, covered by health insurance, for more than 400 Parisians over the age of 60, disabled or chronically ill.

Just the day before, seven new requests for care arrived, mainly for people leaving the hospital.

It is almost 7.15 a.m. on a freezing April morning and uncertainty still hangs over the tours which are due to start at 8 a.m.

"We've been juggling understaffing for a year now, depending on absences, we have to reorganize the tours, we have 40% of temporary workers, we no longer manage to recruit", laments Didier Giraud, head of care. , swallowing his second coffee.

"We are limited in our ability to respond to requests"

Excluded from the salary increases of Ségur, the associative nursing care services at home, or the "Ssiad" as they are called in the jargon, are at bay.

"We are limited in our capacity to respond to requests, whether they come from the hospital or the home, and the situation worsens from week to week", alert about twenty Parisian structures which have just come together as a collective.

With them, there are 800 caregivers for the follow-up of 4000 patients, that is to say nearly a quarter of the coverage in Ile-de-France.

They sent at the end of last week an open letter Thursday to the ministers of Health Olivier Véran and his delegate, Brigitte Bourguignon, as well as to the regional health agency (ARS) and to elected officials.

If they received the bonus of 1,500 euros for the fight against Covid, on the other hand the increase of 183 euros planned by the Ségur de la Santé, in July, was only for their counterparts in hospitals and nursing homes.

As for the new increases announced Monday, they are not for them either.

"There is an urgent need for recognition," insists Marie-Sophie Desaulle, president of Fehap (the Federation of non-profit private hospitals and personal assistance establishments).

Not only do these professions suffer from a problem of attractiveness, but this non-upgrading is a lack of recognition, while these professionals were as committed to the Covid front as the professionals of the establishments.

"

Professionals on the front line in the face of Covid

At Apssad too, nursing assistants and nurses speak of the "front".

“We were at the front, we went through everything,” assures Marie-Françoise, 63, a nursing assistant, recounting the memories of a tiring year, whether they were 20 or 60 years old.

At home, the alarm clock rings most often at 5:30 a.m. to board the first train or RER, from Essonne or Seine-et-Marne, including during confinement.

They tell of the ghost streets to walk "rain, snow or wind".

Anne, 60, remembers this granddaughter telling her once there that “the grandmother had just been tested positive for Covid”.

Another colleague discovered a centenarian who died of Covid.

The virus has also entered the ranks of these invisible caregivers.

“I still haven't recovered,” says a 40-year-old nurse and mother of three.

Paris (XIth), to the Apssad home care association.

Emmanuelle, one of the five coordinating nurses, readjusts the rounds to ensure the care of 70 to 80 patients, each morning, according to new requests and staff absences.

Carole STERLE

This lack of increase is seen as a deep injustice.

"While the work of a nursing assistant is the same as in nursing homes or in hospitals", attests Adeline, 26, who has held all these positions previously.

If she stays at Apssad, despite everything, it is "for the fixed schedule", more compatible with her life as a young mother.

"Remember also that without the pandemic, some patients would have remained in the hospital," say Valentine and Sophie, nurses graduated for eight years, who receive a little less than 1,800 euros after tax.

They leave for a ten-hour day, probably without a lunch break.

There are more and more resignations.

On a base salary of 1200 euros net, 183 euros per month makes the difference.

In an internal survey of its members, Fehap estimates the number of unfilled positions at nearly 20% "due to salary non-alignment".

Out of 21 Ile-de-France structures surveyed, or 966 jobs, 102 resignations were recorded in one year, 162 recruitments could not be completed, and 182 positions were still vacant in March 2021. Applications, Didier Giraud receives from Apssad: " I even had mechanics or restaurateurs who thought that diplomas were not compulsory!

"

40% more beneficiaries in 2040

What will happen to the 17,000 Ile-de-France residents receiving home care if the Ssiads, at the end of the chain, are no longer able to provide staff?

"The retirement home, I can only see that", thinks Inès, who called Apssad for help when her aunt, Annick was discharged from the hospital.

“A precious relay,” she says.

Will there be enough affordable places in retirement homes or hospitals?

The subject is all the more sensitive, as according to the projections of the regional health observatory (ORS) and the Paris Region Institute, the number of beneficiaries of the allowance for the elderly (APA) will increase by around 40% in 2040.

Many expected the Laforcade mission, launched in November 2020 by Prime Minister Jean Castex, to implement measures intended to improve the attractiveness of professions in the private non-profit sector.

According to our information, progress could materialize for implementation in 2022. Asked several times for ten days, the Ministry of Health did not respond to our questions.

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Holding until 2022 is going to be difficult.

Careers are in tension.

In Ile-de-France alone, Adecco listed 530 positions to be filled, including 250 permanent contracts, in the health professions.

"It's difficult to compete", moved the head of a Parisian structure which also knows that the vaccination centers are recruiting.

One of his nurses was canvassed on a social network, at 300 euros per half-day.