A tragedy behind closed doors. While the circulation of the coronavirus is accelerating in France, the balance sheet is increasing in retirement homes with already 16 deaths in an establishment in Saint-Dizier (Haute-Marne), 7 in an Ehpad in Haute-Savoie, 20 in Vosges and at least 13 in the retirement home of the Rothschild group in Paris, which also lists 84 other residents positive for Covid-19. According to the Ile-de-France Regional Health Agency (ARS), 148 Ile-de-France nursing homes have cases of infection. It is in this region and in the Grand Est that retirement homes are the most affected.
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However, it is impossible to obtain a national assessment: the daily update from the Director General of Health, Jérôme Salomon, only takes into account deaths that have occurred in hospitals. Surprising, since he himself admits that "the two main places of death are the hospital and the nursing homes" . To dispel this gray area, Jérôme Salomon announced Tuesday the establishment in the coming days of a "daily monitoring of mortality" in institutions for the elderly. "An application is under development" with the ARS to allow this monitoring, confirms the Directorate General of Health (DGS).
We request the creation of an Ehpad emergency cell for critical situations. The hospital has to come to us in one way or another
Florence Arnaiz-Maumé, general delegate of Synerpa (National Union of establishments and private residences for the elderly)If the deaths in Ehpad are not counted, it is also that "there is no place in the hospital" for their residents, underlines Gaël Durel, president of the National Association of coordinating physicians in Ehpad and of medico-social. Most residents suffer from multiple pathologies and would not have the strength to endure weeks of resuscitation, "but many could benefit from hospitalization for continuing care. The problem is that today, when we call 15, we are told more and more often: '' There are not enough beds, find a way to keep them at home ''. The more our colleagues are overwhelmed with the Covid, the more complicated the hospitalization becomes. ” A situation that revolts Florence Arnaiz-Maumé, general delegate of Synerpa (National Syndicate of private establishments and residences for the elderly): “We are asking for the creation of an Ehpad emergency cell for critical situations. The hospital has to come to us in one way or another. We are working with the State on a new protocol in order to unlock availability ” for the Ehpad where the situation is critical.
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How did the virus get so involved in Ehpad? The 850,000 residents of retirement homes had however been the first to be subject to isolation measures. Visits were banned on March 11 because we know from the start that the oldest are vulnerable to this virus: 86% of the 1331 deaths recorded Wednesday evening at the hospital concern people over 70 years of age.
Some regional health agencies have not given instructions to facility managers, who are still waiting to know what to do!
Gaël Durel, President of the National Association of Coordinating Physicians in Ehpad and Medico-SocialThese precautions were not enough, and many retirement homes still do not impose strict confinement, explains Gaël Durel, leaving the residents to eat at the same table or come and go in the corridors. "This is often the case in nursing homes without a coordinating doctor," he notes . You should also be aware that some regional health agencies have not given instructions to facility directors, who are still waiting to know what to do! ”
Another aggravating factor: the lack of tests, for both nursing staff and residents. Currently, the national strategy is to test the first three suspected cases of the same Ehpad. But once the presence of the Covid-19 is confirmed, no more tests are done; the clinical examination is sufficient, we indicate to the DGS. And there is no question at the moment of proceeding otherwise. Hubert Blain, head of the gerontology center of the Montpellier CHU, pleads for systematic screening in case of doubts, especially among caregivers, to avoid letting the virus spread. “A message that applies to nursing homes, independent residences but also to caregivers - family or professionals - who take care of elderly people living alone: they must be able to wear a mask systematically and be tested at the first symptoms . "
