We are on the verge of rupture, "warns Jacques Doury, director of several medico-social institutions that welcome people with disabilities in the Val d'Oise. The reason? Insufficient investment by the State and the lack of health and educational personnel in the medico-social sector. This includes all trades whose vocation is to welcome and support people with disabilities, such as special educators, workshop monitors, nurses or nursing assistants.
On Wednesday, the Minister Delegate for People with Disabilities, Geneviève Darrieussecq, announced the release of 2 billion euros dedicated to the implementation of the "50,000 solutions" plan. This project includes both the creation of places in specialized childcare facilities and the deployment of new home support.
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However, this new commitment of the government does not calm the anger of the medico-social sector which has been growing for several years. "Before creating new devices, we should first allocate all the current vacancies," criticizes Jacques Doury, also a representative of the CFTC union. To date, "50,000 positions are to be filled" and "150,000 retirements are expected by 2025 within the 35,000 establishments and services in the sector," says Alain Raoul, president of Nexem, the main private professional organization representing employers in the sector.
Why so many unfilled positions? For all the players in the sector interviewed, the lack of attractiveness of the medico-social professions is in question. For example, fifteen positions have been vacant in specialized institutions run by Jacques Doury in the Val d'Oise since the Covid-19 crisis. "A year ago, when we posted a job offer, we received zero resumes. Today we receive one or two, but often they are people who do not fit the profile, "says the director. The same goes for Rouen, where 5% of positions are not filled in the structures led by Emmanuel Afonso, director general of the association Papillons Blancs 76 which brings together a dozen establishments. "No one is applying," he laments.
Low salaries don't help. A professional in the medico-social sector who "works in boarding school, including Sundays, earnson average at the beginning of his career around 1600 and 1700 net per month," details Jacques Doury. For a person who does not work on Sundays, his salary is rather "around 1500 net per month". In 2021, the Ségur de la santé provided for a salary increase of these professionals up to 183 euros net per month. However, "a third of professionals have not been able to benefit from it," says Alain Raoul. The government has not included people in management, logistics and maintenance positions.»
More generally, medico-social staff deplore the lack of "recognition of the profession in the eyes of the State". "We are tired of waiting for answers from the regional health agency," says Angélique Dubuc, head of department of a medico-pedagogical institute (IMP), a reception center for children and adolescents with intellectual disabilities, in Canteleu, west of Rouen.
This fatigue is felt by a large majority of professionals, overworked by a heavy workload. "The problem of understaffing wears out the staff who work twice as much," says Jacques Doury. I notice a lot of exhaustion and, for some, burnout." "We are told that there are needs for support but we have fewer and fewer people to work," he said.
Staff shortages inevitably have a direct impact on the quality of care provided to people with disabilities. "We are more in a small group operation, we lose individual relationships, yet essential," explains Jacques Doury.
We are close to institutional abuse," he said. "Just this morning I met a person in a down jacket in the corridors of the establishment when it was already very hot. And no one saw it. Staff overworked, so they couldn't find time to tell residents how to dress with rising temperatures. We are not immune to disaster," he warns. The heat waves that are coming up this summer only increase the risk, he adds.
Not all children can be taken care of for their rehabilitation, "says Angélique Dubuc. "We have children aged 12 in our IMP which is initially reserved for 3 to 6 year olds," because of the lack of staff and places, she denounces. "I understand that these working conditions are pushing some to resign."
Faced with an increasingly alarming situation, the various players in the sector are calling for "concrete actions". Alain Raoul estimates at "3 to 3.5 billion euros" the amount needed to meet needs, including recruitment. "We are asking for a real Marshall Plan, a global reform of the sector that involves a revaluation of average wages, working conditions and governance," he said.
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For Jacques Doury, it is time to act, before a possible scandal breaks out. "After the publication of the book The Gravediggers who reveal the system of mistreatment of the elderly in Ehpad and the various reports of abuse in nurseries, we will be next, "he prophesied.