The bomb that constituted the revelations of the journalist Victor Castanet, in his book-investigation “Les Fossoyeurs” on the excesses of the Orpea group, will leave a trace in the legislation. On November 10, the Senate adopted, as part of the Social Security financing bill (PLFSS) for 2023, a significant strengthening of the financial transparency obligations of nursing homes but also of the powers of control and sanctions of the supervisory authorities. .
The hemicycle even expanded the article, by integrating provisions proposed by the information mission on the control of nursing homes, led at the start of the year by Bernard Bonne (LR) and Michelle Meunier (PS).
An article that tackles the blind spots of control over nursing homes
According to the Social Affairs Committee, the legislative development is “consequent”. It corrects several blind spots, documented by parliamentarians and inspections. The article plans to extend the control mechanisms to the level of the groups, whereas they could apply until now only to the level of the establishments. The signature by a group of a multi-year contract of objectives and resources, in place of an establishment, will be subject to the prior agreement of the pricing and control authorities.
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The Regional Health Agencies (ARS) will be able to organize checks on all the activities of a group, whether or not the establishments are located on its territory. The General Inspectorate of Social Affairs (Igas) and the General Inspectorate of Finance (IGF) are also seeing their scope for controls extended to the level of group headquarters.
The article also secures the procedures for recovering undue funding, at the national level. The use over time of the surpluses realized on public funding is also limited. A system of penalties, via daily fines, has also been instituted for groups that do not transmit the accounting documents requested in the event of an inspection.
Senators call for regular checks
During the debates, Jean-Christophe Combe, Minister of Solidarity, Autonomy and People with Disabilities, defended the need to bring “a shock of transparency to restore confidence in the sector”. “This reinforcement has only one goal: to ensure that the fruits of contributions and public funds are used wisely, in the service of support and care for elderly people with loss of autonomy, and that he will not serve shareholders of the majors in the nursing home sector, ”also recalled Michelle Meunier.
The senators went beyond the text transmitted by the National Assembly, by requiring that the control of the authorities be done at a “regular periodicity”. In doing so, they incorporated recommendation number 1 of the former fact-finding mission. “While the government has launched an ambitious control program aimed at establishments, it is unfortunate that no control of lucrative private groups operating in the sector, other than Orpea, is planned. There should be no need for journalistic revelations to carry out such an operation, ”said Senator Bernard Bonne.
The High Assembly also asks for a cap on the amount of credits that can be put in reserve. The modalities will be defined by a decree in Council of State. On the initiative of Nathalie Goulet (Centrist Union), the senators prohibited the signing of agreements with establishments before a preliminary verification of their tax situation. The senator from Orne notably denounced cases of tax evasion or optimization, citing for example the DomusVi group, the third player in the sector.
Concerns about the means of the supervisory authorities
These new weapons will now have to be given the means to the competent authorities to seize them, recalled the Committee on Social Affairs. “The public bodies in charge of control are under-resourced compared to the groups they assess,” warned Senator Laurence Cohen (Communist). “What we lack is above all funding,” also worried Senator Daniel Chasseing (Les Indépendants).
Minister Jean-Christophe Combe recalled the government’s commitment to strengthening the means of the control authorities. The finance bill, under debate in the Senate from next week, includes the opening of 120 additional positions in the ARS to be able to carry out checks. These reinforcements will probably not be too much to overcome the government’s promise made in March: to control all 7,500 medicalized retirement homes in the country within two years.
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