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The shortcomings of public oversight in the face of Orpea’s cover-ups

An Ehpad of the Orpea group, in Nice, on February 6, 2022.

How could the serious dysfunctions within the accommodation establishments for dependent elderly people (Ehpad) of the Orpea group escape the vigilance of the French health authorities for years? The report of the General Inspectorate of Social Affairs (IGAS) and the General Inspectorate of Finance (IGF), made public on Tuesday April 5 by the government, provides a series of answers to this question, which could be summed up in two points : a desire for concealment on the part of the group; but also a certain lack of zeal in applying the authorities’ recommendations.

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For the purposes of the report, the IGAS and IGF inspectors went through 42 reports of previous inspections carried out in Orpea establishments. These are few. The regional health agencies (ARS) carried out 64 inspection missions in group establishments between 2018 and 2021, i.e. 2.3% of the total checks carried out by the ARS in nursing homes. A figure which more or less corresponds to the share of Orpea establishments in the landscape of retirement homes, explains the report, which also ensures that the Covid-19 crisis has reduced inspections by almost half in 2020 and 2021. Of the 64 checks carried out within the Orpea group, only 11% were carried out in a “unexpected”, therefore without informing the establishment in advance, a proportion deemed ” too low “ by the reporters.

” Corrective actions “

The report also underlines the general lack of controls by the departmental councils, yet the privileged interlocutors of nursing homes, of which they finance part of the activity: “Their means of control are, with some exceptions, very limited and their investment in them often ad hoc, and embedded in routine relations, the same agents sometimes carrying out visits for verification purposes and managing general relations with establishments. » The report is just as severe with the internal controls carried out by the group, deemed insufficient, as is its “quality action plan”, an internal tool intended in theory to respond to observed shortcomings, but which is little used in practice.

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When external controls take place, they come up against a ” lack of transparency “ of the group, which has put in place a global strategy to respond to them. She goes through “reflex cards” issued by headquarters, “indicating the actions to be taken” in case of control, for “immediately mobilize the hierarchical chain” and “ensure his presence on site during the investigations”, but also, notes the report, to prohibit the dissemination of certain elements, such as the internal budget, at least the time to put in place ” corrective actions ” of ” last minute ” – such as the arrival of additional employees for the time of the control –, which make it possible to “minimize the risk of negative findings”.

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