Aging with dignity is a fundamental right. However, for many people who have experienced precariousness, accessing suitable accommodation becomes a real obstacle course. What should you do when an elderly loved one, after years of wandering or living a difficult life, finds himself without a solution for his old age? How can we ensure that he will benefit from support that respects his history and his needs?
In Île-de-France, nursing homes are seeing a growing number of residents arriving who have lived on the streets or in very precarious circumstances. Their integration poses complex challenges, both for establishments and for caregivers. Faced with this new reality, initiatives are emerging to adapt care and offer these vulnerable seniors a secure living environment. This article explores this problem and highlights the solutions put in place to respond to it.
Aging precariousness increasingly visible in nursing homes
The aging of people who have experienced precariousness is a reality which is gradually imposing itself on accommodation establishments for dependent elderly people (Ehpad). Unlike previous generations, these new residents often have a past marked by difficult living conditions, limited access to care and great social instability.
Deprived of a solid environment and sufficient resources, they today find themselves faced with a double difficulty: finding a place to live peacefully and adapting to a collective environment sometimes far removed from their way of life. This situation raises fundamental questions about the specific support they need.
Why do nursing homes welcome more and more precarious people in Île-de-France?
In Île-de-France, a study carried out by the Regional Health Agency (ARS) between 2022 and 2023 reveals that 43% of nursing homes[1] welcome at least one resident in a precarious situation. This population represents 8% of all residentswith a majority of men (61%). Their average age is 75 ansalthough some are admitted from 52 answhile others exceed 85 ans.
This development can be explained by several factors. On the one hand, the life expectancy of people living on the streets is particularly low, around 49 years on average. However, those who reach an advanced age often require specific care and increased medical support. In the absence of suitable solutions upstream, nursing homes often become the only way out for these vulnerable seniors.
Complex support for establishments and professionals
Welcoming residents from very precarious situations constitutes a real challenge for nursing homes. These establishments are traditionally designed for elderly people who have followed a more stable life path. However, residents who have experienced the street or social exclusion often have very specific profiles, making their integration more difficult.
Psychiatric disorders, addictions, poorly treated chronic pathologies or even difficulty living in a community: all realities that nursing homes must now face. For caregivers and supervisory teams, this involves adapting their practices and increasing their skills on issues that they had not necessarily anticipated.
What are the challenges of welcoming vulnerable people into nursing homes?
Precarious elderly people arriving in nursing homes often experience several difficulties: unstabilized psychiatric disorders, persistent addictions, severe chronic pathologies and deep social isolation. This combination of factors complicates their support and requires an adapted approach.
One of the major challenges lies in their ability to adapt to life in nursing homes. Unlike traditional residents, who are often surrounded by family and accustomed to life in institutions, formerly homeless people may have difficulty integrating into a collective setting, with its strict rules and schedules.
-Staff insufficiently prepared for these new resident profiles
Nursing home caregivers are not always trained to support these residents with chaotic life paths. While structures specializing in homelessness have teams accustomed to managing complex psychiatric disorders or behaviors linked to addictions, nursing homes must urgently adapt to these new challenges.
This adaptation involves a professional developmentbut also through better cooperation between nursing homes and emergency reception structures. Sharing knowledge and good practices could enable more effective care that is better adapted to the specific needs of these residents.
Initiatives to better support these vulnerable people
Faced with these challenges, solutions are beginning to emerge. Health authorities and players in the medical-social sector are becoming aware of the need to adapt existing systems to ensure dignified and respectful support for these atypical residents.
A regional roadmap to structure support for precarious residents
The ARS Île-de-France has set up a regional roadmap as part of its 2023-2028 health plan. This program aims to structure the care of precarious residents through four key axes:
- Create a common culture among professionalsby raising teams' awareness of the specific needs of residents from precarious situations.
- Structuring care pathways to avoid breakdowns in support and guarantee appropriate medical and social follow-up.
- Supporting caregivers and supervisory teamsby strengthening training on issues related to addictions and psychiatric disorders.
- Support the coordinating doctorsin order to better assess the medical and social needs of these residents with atypical life paths.
The role of mobile psychiatric teams in supporting formerly homeless people
Alongside this regional strategy, mobile precarious psychiatry teams (EMPP) play a key role in supporting vulnerable residents in nursing homes. These specialized teams work directly with the people concerned to facilitate their access to care and help them integrate into their new environment.
In 2023, the EMPPs of Île-de-France achieved more than 26 000 interventionstestifying to the extent of the needs. Their work not only supports residents in their transition to nursing homes, but also supports professionals who must adapt their practices to these new profiles.
What solutions for more adapted care in the future?
Welcoming vulnerable elderly people in nursing homes is a challenge that will only grow in the years to come. Although progress has been made, much remains to be done to provide care that is truly adapted to these residents with specific needs.
The development of structures alternativeslike independent residences, could constitute a more appropriate intermediate solution. Likewise, a better cooperation between nursing homes and homelessness stakeholders would make it possible to optimize care and support pathways.
To guarantee dignified and secure aging for these vulnerable seniors, it is essential that all stakeholders in the medical-social sector continue their efforts and engage in a process of innovation and adaptation.
