Weakened by inflation, nursing homes are hoping for a gesture from the government in the next budget, but in the meantime, a new decree is making it easier for some residents to increase their rates, a breath of fresh air for their finances.
"The budgetary situation of the establishments is catastrophic," Annabelle Vêques, director of the Federation of Directors of Establishments for the Elderly (Fnadepa), told AFP. "Despite the political instability and the public deficit," it is necessary to invest in the elderly sector so that the structures can continue to "pay salaries" and to "avoid any risk of bankruptcy."
A survey conducted in September among 1,600 members of this federation showed that 71 % expected to close the year 2024 in the red, an increase of six points compared to the previous year. The average loss is estimated at 156,600 euros. However, half of the establishments no longer have sufficient cash reserves to compensate.
"We have no room for maneuver," Pierre Roux, president of the Association of Directors of Services for the Elderly (AD-PA), also assured AFP.
Reducing the number of carers, turning down the heating or spacing out cleaning of premises: saving on expenses would amount to "reducing the quality of life and care of residents", an unthinkable option for him.
– Revaluation –
These expenditure items have increased significantly over the last two years, mainly due to inflation. But the revenues of the approximately 7,000 public, associative and private commercial nursing homes in France have not increased at the same rate.
Nursing homes benefit from three sources of funding: a State grant for care, funding from the department to deal with dependency issues and payment from the resident to cover accommodation costs (meals, maintenance of premises, etc.).
The public authorities have increased their funding too limitedly in recent years, the institutions believe.
"The allocations linked to care and dependency have probably not been revalued to sufficient levels," Olivier Richefou, vice-president of the association Départements de France (DF), acknowledged to AFP.
"The establishments need to get their breath back and be able to invest to modernise themselves, everyone must participate [in the effort], including the residents, without putting the most modest people in difficulty," he believes.
To get some breathing room, the sector hopes above all to benefit from a "significant revaluation" of the amount granted by the State for care. This will be determined during the next parliamentary discussions on the Social Security budget (PLFSS 2025).
"We are waiting for a strong signal from the government," confirms Jean-Christophe Amarantinis, president of Synerpa, the main union of private nursing homes. He is hoping for "at least 5-6%" of increase.
– Differentiated rates –
Until now, nursing homes could not freely increase their accommodation rates, as the increases were governed by different rules.
Pending discussions on the budget, the government published a decree on January 1st - in application of the law on "aging well" adopted in 2024 - which facilitates increases in accommodation rates for the most well-off residents, those who do not receive social assistance for accommodation (ASH).
This measure mainly concerns public and associative establishments, which accommodate around 20% of modest residents, but had until now been in the habit of charging the same price to all. The decree specifies that the most well-off will be able to pay up to 35% more for an identical service.
For Marc Bourquin, strategy advisor to the French Hospital Federation (FHF), which represents public nursing homes, this is a welcome measure: "it is not a miracle solution, but it should help establishments to get their heads above water."
On the other hand, for the residents' families, it's a cold shower: "a lot of residents already have difficulty paying for their place and this risks becoming a barrier to entry," reacted to AFP Françoise Gobled, president of the Federation of Friends of the Elderly (Fnapaef), who said she was "shocked" by this measure.
Its effects will be felt in the accounts of nursing homes gradually because it will only apply to new arrivals.
English 
French