Why do we place our elders in nursing homes?

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If in the West, the elderly considered as dependent are often placed in retirement homes, this choice to rhyme old age with Ehpad says a lot about our relationship to old age and death.

With the lengthening of the lifespan of individuals and the announced aging of baby boomers, caring for the elderly has become a central issue in our societies. Today, France would have 1.5 million people over the age of 85, and among them, over 600,000 would live in medicalized accommodation facilities. A figure that should see a marked increase in less than ten years: after a study published in 2020 by the DREES, 108,000 more seniors would be expected in nursing homes by 2030.

The supply of these structures, which have undergone a profound change over the past thirty years, has therefore not stopped accelerating. But at a time when the care given to individuals within these establishments is called into questionquestioning in passing the economic model on which they were built, the social status of dependent elderly people raises questions.

Why do retirement homes exist and what vision of old age do they convey? What future for these establishments that many French people will have to integrate when they enter the age of dependency?

A not-so-old hosting model

As of the Middle Ages, the hospices, dedicated to the reception of all the evils of the company (indigent, poor, orphans, vagabonds and “old people”) appear, in the bosom of the religious institutions. Poor and familyless elderly people are welcomed there, at a time when the care of old age remains confined to the private sphere. Until the turn of the XX^and century, elderly people considered to be capable of disturbing public order were taken care of by relegating them to asylum structures.

In 1905, a law in favor of compulsory assistance for the elderlywhich at the time was about 450,000 people, is adopted. The fate of the elderly becomes the responsibility of the State and the structures aimed at welcoming them specialize in order to better take care of them.

“The legal status of Ehpad, created in 1997, immediately suggests an idea of ​​old age inseparable from a loss of autonomy.”

Another pivotal moment was the publication in 1962 of the “Laroque Report”, at the origin of real policies to fight against the precariousness of old age and to stay at home. At the same time, while the Trente Glorieuses are in full swing, the indicators show a visible increase in the life expectancy of individuals, attributed to progress in medicine and the democratization of hygiene. The figure of the retired-active, fully integrated into the society of leisure and consumption, made his appearance.

As the perception of old age evolves, the question of the end of life arises again. The hospices were definitively repealed at the turn of the 1970s and the State, supported by actors in the field, invested in public structures to make “aging well” accessible to as many people as possible, by focusing on new forms of housing. located halfway between the home and the specialized establishment.

“From there, the public authorities invested more in reception structures than in effective support for the development of home support systems”explains Marion Villez, teacher-researcher in sociology at the University of Paris-Est Créteil and educational co-responsible for training courses intended for executives in establishments for the elderly. “Today, we realize that the policies put in place do not allow a dependent individual to live at home and in good conditions, which pushes a good number of elderly people to turn to accommodation structures. collective.”

A reality that feeds perceptions making addiction an inseparable factor of old age: “The legal status of Ehpad, created in 1997, immediately suggests an idea of ​​old age inseparable from a loss of autonomy: the name “accommodation establishment” indeed suggests that we are not there. not really at home and that we rely on the nursing staff.

A biomedical vision of old age

Since antiquity, old age has been subject to ambivalent representations. Sometimes a figure of wisdom, sometimes synonymous with decrepitude, she embodies the last stage of an existence perceived as linear and arouses concern.

The collective accommodation for the elderly that we know today are moreover the symptom of this cultural vision of ageing. “The public authorities, like society, persist in seeing old age through the prism of its losses, its difficulties and its pathologies, which is reflected in the hegemonic model of medicalized collective accommodation”, says Marion Villez.

“Retirement homes reflect our difficulty in making room for old age in the public space.”

This homogenization of the complex process that aging represents has, in recent years, taken the form of a biomedicalization of old age, based on a technicization of care and a strengthening of therapeutic approaches favoring rational management of the body.

A reality not always adapted to the needs of the elderly, as demonstrated by the health crisis: “The treatment of the elderly during the pandemic has revealed this prevalence of the medical over the social bond, a tendency to overprotect the elderly which leads them to respond to their problems only through the therapeutic route”adds Marion Villez.

A perception of age which, according to the sociologist, embodies our inability to think about aging and the notion of finitude, and to apprehend death: “Retirement homes reflect our difficulty in making room for old age in the public space, a difficulty that is embodied in the fact of relegating the elderly and therefore death to dedicated places.” A recent evolution which contrasts with older times, but not so distant, when one grew old and died in family or at home.

The end of generational cohabitation?

In 1962, 15% of people over 65 lived under the same roof as their children and/or parents. In 1999, they were only 5%. A discohabitation which is explained in particular by the rural exodus, industrialization and urbanizationwhich have significantly contributed to redefining family units.

Should we see in this a rise in individualism and an erosion of family ties? Not according to Alain Villez, president of the association The little brothers of the poorwhich underlines the significant change in the relationship to housing of individuals since the Second World War:

“Baby-boom generations have always wanted to access independent housing as soon as possible after coming of age. Those reaching the age of 65 were no longer in a hurry, after their cessation of activity, to give up their place in their dwelling to their children, or to return to their children’s dwelling, two scenarios among the most frequent in pre-colonial society. war”, he writes in “The crisis of models”article published in 2007 in the journal Gerontology and Society.

“We must overcome the divide between home and accommodation structure, and set up a real gerontological culture.”

While staying at home remains the most enviable situation for the majority of seniors, the proportion of elderly people integrating collective medicalized housing increases with their age. Today, entry into a retirement home generally takes place after the age of 85. “We are very far from the profile of the people received in the retirement homes of the 1960s, which the elderly integrated quite quickly after their cessation of professional activity or their widowhood for periods often exceeding ten years”explains Alain Villez.

The current accommodation model thus embodies the desire to find intermediate places between family culture and independence. “But it’s not because we no longer live together that there is no more family solidarity, emphasizes the sociologist. Many caregivers continue to take care of their elderly parents who live in nursing homes.

Towards a real social project on old age?

For better care of old age, Marion Villez stresses that priority must be given to diversifying the places of aging: “We must go beyond the divide between home and accommodation structure, and set up a real gerontological culture, from which would flow a social project capable of thinking and welcoming the aging of the population.”

Diversify the places of aging therefore, and think of intermediate forms that would not automatically assimilate old age to therapeutic care. “The main challenge is to recognize that behind nursing homes hide a great diversity of elderly people. There are also a multitude of practices and professionals, concerned with providing the best possible support to residents and their families, but also to make these medical establishments living spaces where everyone’s needs are taken into account. We must support these initiatives, but also the birth of alternative places, despite the current context, which is very constrained and standardized.”

Places where the emphasis would be on life, rather than the end of life.