Ten days after being submitted to the government, the report of the General Inspectorate of Finance (IGF) and that of Social Affairs (Igas) on Orpea is finally made public.
The government had commissioned the IGF and the IGAS on February 1, the day after the publication of the investigation by Victor Castanet, Les Fossoyeurs, which denounces an "
Orpea system
" made of "
rationing
" of protections and meals, and fraudulent financial practices.
A book that triggered a real shock wave in public opinion and the political class, especially on the eve of the presidential elections.
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The publication of the double report of Igas and IGF had been the subject of controversy in recent weeks.
The Minister Delegate for Autonomy Brigitte Bourguignon first invoked “
business secrecy
” to justify its confidentiality before accusing Orpea of opposing its publication.
The political class and many players in the sector were moved.
The government had finally decided to publish it in the name of “
transparency
”.
14,000 employees and 228 nursing homes
The report of the “
mission on the management of EHPADs of the Orpea group
”, which has 524 pages, was finally published this Tuesday morning in its entirety, with the exception of certain quantified elements for reasons related to competition.
It was written in five weeks by nine members of the IGF and six of Igas.
These inspectors relied on investigations carried out at the group's headquarters, "
unannounced
" visits of one to two days to ten establishments in six regions, past reports from the Regional Health Agencies on several establishments, external evaluation reports as well as accounting elements provided by the company.
Orpea has around 14,000 employees and 228 nursing homes in France, which last year housed 27,392 residents.
Overall, the final report – which has six chapters – takes up most of the conclusions of the pre-report.
But it seems that the answers provided by Orpea during the contradictory phase have made it possible to put certain accusations into perspective.
Starting with the use of life auxiliaries acting as nursing assistants.
The inspectors refer to a "
widespread
" practice in many nursing homes and "
poorly apprehended by the State
".
Without exculpating Orpea, they point to “
the difficulties in recruiting and retaining nursing staff
” in France.
Same thing for the management rate (61.6 employees for 100 beds at Orpea, against 62.1 on average in private nursing homes) which does not seem "
exceptional within the sector
“, according to the inspectors.
The final report clears the company of low diaper usage.
"
In particular, the mission did not find any rationing of protections
", indicate the authors.
This was one of the main accusations against Orpea in Victor Castanet's book.
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On the other hand, the “
very centralized
” organization of Orpea, which the group has undertaken to change as quickly as possible, is denounced by the inspectors.
They describe in detail the functioning of the group, in particular the “
limited autonomy
” of the directors of establishments.
All recruitment must therefore be validated by the regional management.
The head of the establishment is also subject to "
daily budget reporting
" to "
respect the objectives set for him in terms of payroll, net income or even occupancy rate
".
A pressure which would explain the high turnover among the directors of establishments: 10 to 15% leave the group each year, and a third of them are subject to dismissal for incapacity.
Moderate or severe malnutrition
The question of food appears as one of the most striking elements of the report.
More than 52% of residents are moderately or severely malnourished, he says.
By way of comparison, this rate would amount to 30% of residents on average in all nursing homes in France.
The weights used by the cooks of Orpea are “
significantly below
” the references of health professionals for foods containing proteins.
“
Up to 42% for meat
,” note the inspectors.
Snacks between meals, which are important for promoting adequate nutrition in the elderly, are not offered systematically, in particular the "
night snack
".
Shortcomings that echo the rationing described by Victor Castanet as the "
two rusks and not three
" served at breakfast.
"
These points of vulnerability linked to nutrition are all the less trivial as the population of residents in EHPADs is very exposed to the risk of undernutrition
", recalls the report.
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Another recurring flaw denounced in the report, the management of the group's payroll is part of an
"optimization strategy"
which leads to management levels
"which are not always able to guarantee the well-being and the well-treatment of residents”
.
With 61.6 employees per 100 beds compared to 62.1 on average, the Orpea management rate in 2019 is slightly lower than that observed on average in the private nursing home sector.
A practice that leads to a reduction in the time spent caring for the elderly.
In five Orpea establishments, the inspectors calculated that a nursing assistant spent between 50 minutes and 1 hour 20 minutes caring for a resident.
While getting up and going to bed, toilets, changing or meals take a lot of time, the supervision rate is “
incompatible with the overall performance of these tasks
”.
Toilet time was between 15 and 24 minutes.
During the day, and especially at night, calls from residents sometimes go unanswered.
Their alarm bells don't always ring.
Falls, false routes during a meal, even risk of violence from disoriented residents...: this incomplete monitoring "
therefore increases the risk of adverse events
", note the inspectors.
The organization of care has
"indisputable weaknesses"
: lack of transmission between teams, problems with the traceability of drugs, insufficient oral care...
Use of fixed-term contracts
Like the Gravediggers, the mission notes that fixed-term contracts have been concluded "
to replace non-existent employees
" with false names and others pending the arrival of employees who have never entered service.
Social life auxiliaries (AV) have been recruited to replace nursing auxiliaries (AS).
Even more worrying, people without qualifications have even been able to be directly recruited on fixed-term contracts to take care of the residents.
From 2019 to 2021, Orpea's staff turnover is "
almost twice as high as the sector average
", the use of short-term fixed-term contracts is significant and non-economic layoffs are more numerous than elsewhere.
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As expected, the final report scrutinizes certain financial practices of Orpea, even if the amounts complained of seem relatively low in view of the annual public allocations received.
"
The group's internal budgetary process organizes the setting aside of part of the care packages received by nursing homes
", accuse the authors, and the "
constitution of surpluses at the end of the financial year
".
They point to "
the failures of the group's analytical accounting
" and the difficult "
sincerity of restitution to the supervisory authorities
".
Between 2017 and 2021, no trace of the surpluses of the care and dependency sections has thus been found.
Which makes "
impossible to verify whether these surpluses are actually and correctly allocated
”.
As for the commissions received by Orpea on the purchases of medical equipment, they are presented by the group as royalties following “
services
” on behalf of its suppliers.
But the mission considers that they are “
imprecise
” and that “it
has not been demonstrated that these services constituted a real consideration
”.
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Brigitte Bourguignon announced last month additional means of control of nursing homes.
A reinforcement that the authors of the report consider necessary given the limited control capacities of the ARS as of the departments, and their restricted field which “
does not therefore allow to exercise a more global control of groups of Ehpad like Orpea
”.
They believe that the “
skills of the ARS would benefit from being supplemented by those of the labor inspectorate
”.
They deplore the lack of “
joint inspection missions between ARS and departmental councils
”.