ORIGINAL FRENCH ARTICLE: Le grand âge a besoin de moyens
by Alexandra Chaignon
Translated Wednesday 24 June 2009, by
Geriatrics. Since the long hot summer of 2003, promises have rained down but the means to implement them have not. At the Paul-Brousse Hospital in Villejuif, the teams refuse to think in terms of costs.
In the service for after-care and rehabilitation  at the Paul-Brousse Hospital in Villejuif (Val-de-Marne), they talked almost with pride about what happened during the heat wave of 2003. Nursing manager Martine Desmarest explains ‘We only had two deaths’, then confides mischievously ‘We have ‘a trick’. We moisten the nightclothes of the residents and then sprinkle them. Efficient and easy’.
But to the question ‘Have the supplementary grants been allocated in the interim?’: Silence. With a slight smile she turns to look towards the middle of the dining room, where a mobile air-conditioner sits in solitary state and adds ’We’ve also got electric fans in the bedrooms’.
Dr Christophe Trivalle, deputy manager of the centre for aging, rehabilitation and support and responsible for the long term care (SLD - soins de longue durée) and the after-care and re-education of patients with Alzheimer’s disease (SSR - soins de suite et de rééducation) continues ‘Since the summer of 2003, nothing much has happened. The proposals perhaps outlined some stop-gap measures but they were so diluted that you never saw anything real come from them, not to mention those measures of economy that take back the little we do receive’.
Borderlines that must not be crossed
Latifa Scheirlinck, executive assistant to the centre agrees. ‘There is a time-lag between these offers of additional help and the actual day-to-day care we give’. What they are talking about is additional staffing. In the mornings there should be four care-workers for every 35 patients. But this is hardly ever the case.
A young care assistant uses the daily briefing to talk about changes in the working conditions, saying that they are becoming more and more difficult to handle. Literally and figuratively. She continues ‘We hardly have patients any more that are not bed-ridden. Each of them needs two people to care for them. We don’t even have time to breathe’.
Marie-Françoise, voluntary helper for the organisation ‘Vieillir ensemble’ (Growing Old Together) agrees ‘Ever since I started visiting the patients I have seen how much pressure has increased on the staff’. The approaching summer months and the spectre of under-staffing are once again raising their heads and reviving all the former worries. A nurse says.‘It’s already horrible during the rest of the year... ‘... and then comes the month of August’. Christophe Trivalle admits that the staff are always worn out so the work is not as good as it should be, adding ’Minimum manpower necessary for safety has become the norm nowadays’.
At the moment the geriatric centre has managed to escape the therapy of austerity initiated by Public Assistance. Certainly, 75 beds have been removed from the long stay in-patient unit in anticipation of a Retirement Home (EHPAD : Etablissement d’Hébergement pour Personnes Agées Dépendantes) being built - but this has not yet seen the light of day. And these beds have already been converted into short-stay units for patients with medium care requirements such as Alzheimer’s, palliative care, onco-haematology etc. Dr Trivalle continues ’We manage our budget by emphasizing more medically intensive activities. But even so, in 2009 we risk losing 10 nursing posts and 14 care-assistants from the centre’.
There is additional pressure for the geriatrician. He has to keep a sharp eye on the occupation of the beds in the geriatric unit. ‘We are threatened with the loss of personnel if we don’t keep the beds full all the time’. Although opposed to this ‘system’ and this ‘financial logic’, Christophe Trivalle and Latifa Scheirlinck are obliged to ‘follow the rules’ at the risk of ‘losing everything’. ‘We are constantly on the look-out for ways of economising. It’s something we do every day,’ says the young assistant. But there are limits beyond which the team will not go. ‘We try to meet our obligations. But our priority is to care for the sick as humanely as possible’.
Considerate and caring work.
For example, when a patient dies, the room remains empty for several days. Dr Trivalle explain that this was to allow carers and patients time to mourn. Not every care assistant wants to put the first patient who arrives into the empty bed in a double room. We have to see if two patients will agree to share.
If any two values are present in the geriatric department at the Paul-Brousse Hospital, they are certainly consideration and caring. One example is the daily meeting between staff and doctors. Each patient is carefully discussed. ‘Mrs C. is being admitted today. She is 98 years old and has cognitive difficulties. We have to review her social care services if the family is in agreement’. Another patient, another case to deal with.
‘Mrs Z. is coming back in for a few weeks. We have been treating her for some years so that she can stay in her own home’, explains one of the doctors. Dr Trivalle gently chides an astonished intern who comments that the welcome is ‘just like the Club Med’, by saying that not everything has to be dealt with in terms of money. A similar meeting follows, but this time in the Alzheimer’s after-care and rehabilitation unit. The format is the same.
After this everyone returns to their posts in double quick time. In the corridor a man in large carpet slippers paces up and down, head lowered, hands clinging to the wall. Dr Trivalle takes the time to ‘join’ him in his walk, then passes the time of day with Mrs N. who is looking at photographs of Marcel Cerdan and Edith Piaf tacked to the wall, icons of a by-gone age.
 SSR - le service de soins de suite et de réadaptation