Our elders déconfinement conditional
In the name of the protection of the health, the motto of the Republic ” Liberty, Equality, Fraternity has been particularly felt in the institutions for the elderly : confined well in advance of the other citizens, déconfinés long after, the elderly have been affected most severely by the restriction of their freedoms, but also deprived of a brotherhood which is elementary, that of family ties. The right of exit is not yet acquired. Return on 3 months of a crisis situation for the seniors.
The president of the Republic and the minister of Health announced the déconfinement in retirement homes, summarized in a plan of framing issued last June 17. It is a relief to a large number of families. But this measure is restricted to institutions which do not present a case of coronavirus.
Another uncertainty in the déconfinement : a possible return back without notice at the slightest suspicion of a case of coronavirus. The freedom to go and come for our seniors remains quite fragile or problematic for 600 000 residents and their loved ones.
Currently, many families were unable to see their loved one only once, given the very low number of slots reserved for visits. After the announcements of the déconfinement progressive of the French population in the 11 may and 2 June, without distinction of age or frailty, the 7,000 long-term care facilities have in fact not benefited from the same treatment. The right of visitation had been granted at the rate of half-an-hour, at the end of April, subject to certain conditions : social distancing, limited number of visitors, perspex pane…. Many now hope to finally revisit soon to their loved one in better conditions, and more importantly to organize an exit to the outside !
A balance between security and freedom to find
The Directors ‘ Association at the service of the Elderly (AD–PA) had filed an appeal before the State council for trips (not just visits) are allowed, it comes to remove it. A reading of the plan of framing issued on 17 June, it is thought to have been heard by the government. “According to our interpretation of the document, the outputs are available from the 22 June “, explains Pascal Champvert, the president of the AD-PA. How many exactly are still confined ? This number is unknown because the data are not disclosed currently. In early June, the ministry of Health had indicated that nearly 45 % of long-term care facilities reported at least one case of Covid-19. “The majority of long-term care FACILITY no longer presents a case of coronavirus today, writes Pascal Champvert. For others, the easing should be out soon “
“We understand that it may be necessary to revert back in case of coronavirus but any suspicion will involve a test routine. Even if it is true that the reliability of the test is not 100%, we do with what we have. We insist especially on the necessity to find a balance between security and freedom, but also between the physical safety and emotional security of the residents. Optimum security, in the face of coronavirus, it is the confinement… however, it also involves the death of people because of loneliness, grief or depression. “
Blatant disparities between long-term care facilities
All long-term care facilities will not have the same protocols for the next few weeks. For those free of the case of coronavirus, the new operation including the drafting is under the responsibility of the directors, will soon be communicated to the families during the week of June 22. After having missed the mother’s day, father’s day June 21, will be another missed appointment. For many residents, the mood is more unsteady, despite the daily calls to their family.
“It is necessary to wait until it is too late ? They need to see their loved ones, go out to forget their condition. They are aware of see spend their days without enjoy it, ” said the daughter of a resident at log Mountain. “Three months, for a person of 95 years is a long time,” says a leader of a retirement home. I understand the families, we also want to be free, but our management following a directive of the ARS who asked to keep still until 15 July “. This is surprising, because it goes against the framework document of the government.
If some establishments allow well already outputs or as soon as Tuesday, June 23, next, others ask the families to wait three weeks, even in institutions spared by the epidemic. Another long-term care facilities allow residents to bring to vote in the municipal elections on 28 June, but does not allow the output in families that the next day… We read also, in some of the protocols : “The volunteers and the services of the ICSW will resume at the end of the summer.” In short, a return to normal case-by-case, at the discretion of the management teams.
In the long-term care facilities where the confinement in the room was still, the output of three months of near-seclusion nevertheless seems to be gained in facilities without a coronavirus. The situation was hardly sustainable… What a citizen would have been able to accept this constraint without experiencing severe impact on his morale and his health ? The psychological support or the reinforcement of human he was at the height of what has been requested by seniors, families and personal ? It is a question that will undoubtedly be raised in the context of the two parliamentary committees of inquiry in the course. Comedian Xavier Delarue comes to lodge a complaint to get an explanation on the death of his father, including ” the fact that we had no minutes, no follow-up crisis cells and host for the bereaved families “.
A denial of abuse ?
“I’m not an animal, I’m not in prison “, denounces Denise in an article dedicated to the words of residents on France 3. The fear of dying does not concern. She wants to see her grandchildren and great-grandchildren. “They light up my days. It will last how long to be locked up ? “
In a press release dated 15 June, on the occasion of the world day of fight against abuse of older persons, the association of the Little brothers of the poor dare to raise burning issues :
“The brutality of the breaking of all ties (family, social) of individuals residing in long-term care can be experienced as violence, and this, more especially as the long-term care facilities have banned the visits even before the confinement of the general population,” explain Sylvie Lattanzi and Magali Assor, the cell, Fight against the abuse of the Little Brothers of the Poor. ” From one day to the next day, the elderly no longer have reviewed their entourage, and some died alone, without their loved ones. This violence is child abuse “.
“Some may point out that these measures were vital, and were taken only for the safety of the elderly, not in a purpose intentional to harm them, says the association. However, the national advisory board of ethics has stated that the respect of dignity includes the maintenance of a social link. “
“Some long-term care facilities have applied the containment room to all residents, without distinction, without paying attention to the state of health, ability and discernment of the people,” explains Magali Assor, project manager, ethics in of the Little Brothers of the Poor. All this could be put in place very quickly because there was a sort of social acceptance to the idea of closing the long-term care facilities “.
Staff and families at the end
In general, the situation of personal home, pension approach of the exhaustion generalized : “there are a lot of things that families were naturally in support of and that they have not been able to do. All this work falls on the nurses, the orderlies, the facilitators. It is noted that the staff is stretched, ” said Bernadette Gauthier, one of the representatives incumbents of the families on the Board of Living Social (CVS) of a long-term care Facility of a small municipality in the Dordogne. On the ground, one notes that some institutions have in fact turned under-staffed dangerous (see this article from the South West).
“We regret the lack of communication with families during this period of containment. This is the case in many long-term care facilities that have been overworked, but in the future it is necessary that the CVS is more closely associated with decisions and communication. We can not be satisfied today with a simple advisory opinion. This is a point on which we need to be vigilant in the future law that will concern the long-term care facilities. Moreover, it would be wise for the families and the residents organize themselves into an association and can make their voice heard. Families and residents have rights that are not limited in respect of the services for which they are paying for benefits which have been undermined during this period.”
Management more or less human
Beyond the application of the instructions of the State and of the regional Agencies of health, residents and their families have not always enjoyed the same attention.
The testimonials are so very contrasting in the national territory. Some returns on social media are very positive : “We had a flexible management and human. For me, this means : follow the national guidelines, but to also distance themselves from depending on a particular case, in one direction or the other, mobilize the medical teams for follow-up care and caring, close to residents, regularly inform families of the situation and answer their questions, explain, create trust, create conditions to promote the best contacts at a distance… To be honest, we also had moments of impatience, of frustration and questioning, but in the end, a great respect and a great appreciation for the team “. Other testimonies show that this was not the case everywhere, far from it…
Risk of overprotection
The déconfinement in the long-term care FACILITY is particularly complex. This is due initially to the configuration of a community life where, in the case of a contagious disease, the health of one can impact the health of others. This responsibility of the security is based on the principals caught between the need of freedom claimed by many families and residents, and guidelines security of the government. Some families also prefer to see their loved one confined to do not risk their death. “There is a risk of overprotection on the part of the families of some people who advise the government, focused on security. This is why we have insisted from the beginning on the need to find a balance, ” says Pascal Champvert, president of the Association of Managers in the service of the Elderly (AD–PA).
We understand the delicate position of the directors likely to be attacked criminally for allowing too fast a relaxation and in addition subjected to the pressure of families or residents who wish to see respected, the right to live, and die, in dignity, that is to say, surrounded by their loved ones. A true puzzle. “The model long-term care FACILITY has been constructed more with a view of safety and of freedom. It is necessary to revisit this model, which displeased the entire world “, explains Pascal Champvert, the AD-PA.
The crisis of the sars coronavirus has demonstrated the fragilities of the model long-term care FACILITY. Some of them have become, despite the considerable efforts of the staff, as they do not should, above all, not to become in this difficult period : prisons for people at the end of life. The future law on the great age, which must be presented at the end of the year 2020, should be taken into account.
The reconfinement, a sword of Damocles
What will happen to the sporadic cases of coronavirus in retirement homes ? How will be managed the next outbreak of seasonal flu ? At the slightest sign of coronavirus, influenza, or pneumonia, it is very likely that seniors will once again be the first to be reconfinés. By precautionary principle, for the sake of protection.
Our seniors residing in retirement homes should they become accustomed to confinement in a yo-yo ? The ethical problem remains, that of the deprivation of liberty in a public said to be “at risk” and not in the other. This undermines the equality of all citizens. Added to this is a form of age discrimination : “This” ageism ” is extremely present in our society. It is important to ensure that the institutions for the elderly do not have to pay a higher price than the rest of the population in terms of restriction of liberties under the pretext of the fear of some experts “, believes Pascal Champvert.
Finally, there is the problem of the tests : their reliability is not optimal and may lead to a containment required on the basis of an incorrect diagnosis (false positive). On the other hand, the availability of the tests may not be at the rendezvous and lead, as this was the case, in a containment on the basis of a simple suspicion, the famous “possible cases” and not confirmed.
There is no doubt that the experience of containment 2020 is currently to think of the families and residents prior to the arrival of winter : “There is no question that I revive this again. It will be necessary to find another solution for me, ” said a resident. At the same time, some families feel guilty of having their parents in the institution and are considering to host their close, as the are already 11 million family caregivers in France, with all the organizational difficulties that this entails.
Author(s): Pryska Ducoeurjoly for FranceSoir