The ageing of the population (linked in particular to the "papy-boom") and longer life expectancy have had a major impact on the economy and on the personal services sector.
In France today, dependency affects 2% of people up to the age of 79, 17% between 80 and 89, and more than 50% of the population over 90. On January 1, 2024, the over-75s represented 10.4% of the French population; by 2040, they are expected to account for over 14%, necessitating the creation of more than 250,000 jobs.
However, staff costs are a heavy burden on budgets, and the arduous nature and lack of recognition of these services make recruitment difficult. All the more so as the inflationary context is not conducive to improving salaries, and temporary employment remains too costly.
A regulation passed in 2023 requires home help to be financed at a rate of 23 euros per hour. This amount is not sufficient to cover expenses, and is too costly for some beneficiaries who do not have the means, thus forgoing these much-needed services.
As for family carers, they are often still active and therefore unavailable during the day. What's more, their homes are often unsuitable for people losing their independence.
In 2024, a survey by the Fédération hospitalière de France (FHF) and the Conférence nationale des directeurs d'établissements pour personnes âgées, warned of accelerating deficits in not-for-profit structures dedicated to dependent people. By 2023, 85% of public EHPADs would have recorded losses, almost double the figure for 2019.
Major difficulties are also being experienced by private groups, such as Emeis (formerly Orpéa). This is the group behind the scandal that shook the sector in 2022, following the exposure of chronic understaffing, and consequently care shortages, in its 300-plus establishments. The group's restructuring is based, in particular, on the sale of assets. However, the real estate crisis has lengthened the timetable.
In addition, the drive to improve the quality of its services, precisely by increasing headcount, has led to stagnation in gross operating income in the first half of 2024, despite the increase in sales.
The same applies to Clariane (formerly Korian), France's number-one provider of EHPAD (around 600 establishments), which is also facing financing problems. At the end of 2023, the group launched a debt reduction plan through asset sales, and in May 2024 announced the sale of its French home hospitalization and nursing care business to Fondation Santé Service for 130 million euros (2023 sales of 46.5 million euros; 8 establishments and over 300 employees). Last but not least, Médicharme, a privately-owned group of nursing homes, is to be wound up in February 2024, and has found a buyer for only 42 of its 43 establishments.
On the legislative front, the "old age" law announced during Emmanuel Macron's first five years in office has been repeatedly postponed. A section of this law was nevertheless validated at the end of March 2024 under the name "bien vieillir" (ageing well); measures should be put in place in 2025 to consolidate the steps giving access to different care for people losing their autonomy.
On the budget side, in April 2024, an additional envelope of 650 million euros was granted by the government, +5% for public EHPADs and +3% for the private sector. These funds are intended in particular to finance new nursing positions, leaving a small share for covering deficits or making investments.
The current political uncertainty, the state's excessive indebtedness and the general increase in charges weighing on local authorities are unlikely to improve the situation of these institutions in the short term. In this highly restrictive context, it will probably be necessary to accelerate the development of more supportive solutions, such as foster care or shared accommodation for senior citizens.