“We want to rethink the system of care for our seniors from home to the medical establishment” says Arnaud Viala

Arnaud Viala, président du Département de l’Aveyron, est porteur d’un projet expérimental pour la prise en charge des personnes âgées. MIDI LIBRE – F.MAYET

INFO MIDI LIBRE: the president of the Aveyron Department who “doesn't think it's very honest to use the finance bill as a pretext to announce drastic cuts” is aiming for an experimental plan, supported by the ARS, for the care of seniors.

Are you worried about the financial uncertainties linked to the national political situation ?

I am concerned, worried, by the political, economic and social situation. I think that today France is in a bit of a doldrums. The country needs to find stability, serenity. Budgetarily, the outgoing government had drawn up a finance law that aimed to stop the increase in the deficit, in the debt. Local authorities were called upon to contribute. I said, from the outset, that I found Bruno Lemaire's expression quite unfair when he said, basically, that local public actors were responsible for the country's budgetary situation. It is really a bad trial, a false statement.

On the other hand, everyone must roll up their sleeves. The Department, through me, said that, whatever happens, it would honour its commitments. This with two red lines for our 2025 budget: not reducing spending on solidarity missions and preserving our level of investment so as not to suffocate the local economy. We debated this on Friday, December 13.

So you are relatively confident?

I do not want to join the chorus of local executive presidents who hold the State responsible for everything. In Aveyron, we wanted, and my predecessors before me, to ensure that the Department had multi-year, prudential, and very ambitious management. We want to continue these efforts. I do not think it is very honest to use the draft finance bill as a pretext to announce drastic cuts.

Concerning, precisely, the Department's financial margins, is the share devoted to nursing homes protected? ?

The financing of nursing homes is complex and multi-party. The Department is involved alongside the ARS (Regional Health Agency) and each establishment. Today, many nursing homes are reporting their difficulties to us. I am very aware of this. I met with their collective again last week to listen to them carefully. I think that we are faced with the need for structural reforms. That is to say, we could pour all the money imaginable into the budgets of the establishments but it would not solve the underlying problem. This is linked to three things.

First, the demographic evolution of a department like Aveyron where people are aging longer with specific needs for the very old: 95 years and beyond. We know that this trend will strengthen. The second element concerns societal change. The people of Aveyron, like other French people, want to move into a nursing home as late as possible. The third element concerns the median income of Aveyron retirees, which is lower than elsewhere. Our offer must therefore be adapted to these three realities.

What does this mean in concrete terms?

In Aveyron we have a very strong ambition. We want to rethink the entire system of care for our seniors from home to the medical establishment with perfect waiting with the ARS and a very constructive dialogue conducted with the directors of nursing homes. This involves maintaining proximity and a continuum of care, from home help to intergenerational grouped housing. We want to make Aveyron an experimental department, a demonstrator of an innovative solution.

This ambition will also have to involve attention to medical staff…

Of course. As part of the experiment, we want to address the attractiveness of professions, which we know can, in part, depend on remuneration. There is also a weariness linked to isolation in missions that makes people burn out. We must therefore look at the entire chain and create bridges between the medical establishment and the public hospital, between the medical establishment and non-medical grouped housing and between grouped housing and the home. All this to secure these professions and ensure that they are more attractive. A gerontologist from the Montpellier University Hospital is supporting us with his analyses. We want to propose a complete plan to revise our care model to the future government.

This plan may be scrutinized by other departments ?

I like that Aveyron is the first. We have the ambition to be experimenters with the support of the ARS. Then it will be the responsibility of the Minister of Health to deploy the system if it works well in our area.

The department is planning to redeploy the Brusque nursing home by 2025-2026. What about it ?

The Brusque nursing home has been the subject of our attention for years. This establishment with around thirty beds has not, for many reasons, had the capacity to modernize in time and now finds itself in a difficult situation. The building is unsuitable for the residents' dependency needs. This has led to exhaustion of the teams and many staff departures. Four or five years ago, in an effort to find a solution, we ensured that the neighboring nursing home in Saint-Sernin-sur-Rance became involved in daily management with a joint management. We also set up a study for a possible reconstruction or property redevelopment.

But this study concluded that the building, owned by a religious congregation, is very dilapidated. Since 2020, the municipality of Brusque has shown a surprising form of indifference on this subject. As things stand, economic balance is not achievable unless the daily rate is increased insanely. The choice is to focus on the offer of the territory of the Monts Rance and Rougier community of communes with, in addition to the Saint-Sernin establishment which is doing very well, the Camarès-Belmont establishment which has two sites. We want to see how to increase the capacity of these establishments to compensate for the shutdown of the Brusque establishment. This is causing resistance and incomprehension that I understand but we are facing a wall.

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