Bestsellers come and go. They stay at the top of the list for a few weeks, sometimes a few months, and then fade away. In January 2022, Les Fossoyeurs, The Gravediggers, by Victor Castanet, started climbing the charts. A title like that suggests crime and horror. In fact, the book is about both and since January, has sold more copies than either its editor, Fayard, or its author would have ever imagined.
Have the movie rights been sold? Will it be turned into a series on Netflix? Neither because it is not that kind of book. Les Fossoyeurs is the fruit of three years of investigative journalism into how the elderly are cared for in private for-profit nursing homes in France, a story of crime and horror from beginning to end.
Victor Castanet, an independent journalist, conducted 250 interviews, benefited from the help of courageous whistle-blowers, and delved through thousands of pages of sensitive documents, gathering evidence of misuse of government funds, systemized rationing, and understaffing in the nursing homes of the Orpea group, a European leader in for-profit elder care. He also brought to light conflicts of interest and connivance between public officials and the management of Orpea nursing homes, “high-end” establishments, where costs for residents are 2 or 3 times higher—or more—than those of the public sector.
Six months later, the book is still making waves. In March, Castanet was called to testify about the Orpea scandal before a special Senate committee. This month, more than 30 complaints, including one for involuntary manslaughter, have been filed against France’s second largest private operator of for-profit nursing homes, Korian. Meanwhile, public-sector nursing homes have also come under closer scrutiny.
For the moment, Castanet’s book, the eye-witness accounts of nursing home employees and residents, the guilt-ridden sorrow of the children who have placed their parents in ehpads, as nursing homes are called in France, a complex acronym I’ll translate as “establishments dedicated to the care of the dependent elderly,” all feed the current “buzz” of indignation and call for change.
Yet, except for the misuse of public funds on a grand scale, not much is new in Castanet’s book and in the testimonies of those concerned. There are some surprises: in the most expensive private nursing homes, in locations considered highly desirable, residents benefit from less care and fewer caregivers than in a public-sector home. They are also subject to a strict system of rationing, where the bottom line is shareholder value. Examples in Castanet’s book include the rationing of adult diapers (Orpea allots at most 3 per day) and that of food.
As he was wrapping up his book, Castanet received an offer of 15 million euros (15.6 million dollars) to abandon publication. Orpea represents big money and this exposé could do the company serious harm. Castanet turned down the offer and since then, the company and the for-profit nursing home “industry” have been under fire.
At this time, French social media abounds with testimonies from nursing home employees, children with elderly parents in nursing homes, and residents themselves. A former employee talks about the rationing of bed sheets, the careful inventory of the quantity of bedding used, and the extra costs this adds to a resident’s monthly bill. Another speaks of dependent residents who never eat a meal because there are not enough personnel to feed them. They are placed in front of a tray with hot food and often a cold untouched meal is taken away because overworked and underpaid caregivers do not have the time to do their job.
A bereft daughter laments that her mother is allotted one diaper per day and never gets more than a sponge bath because there’s simply not enough staff to go around in the public nursing home where she resides. Other residents, though not suffering from incontinence, are forced to wear diapers because there’s no one to help them to the bathroom. This demoralizing pressure on employees may in part explain why workplace accidents are higher in nursing homes than in any other healthcare structure in France. Absenteeism is also much higher, as is employee turnover.
Residents complain of abuse and scorn, even violence, but are powerless to do much about it. One victim, a former French teacher, silently recites poetry by Victor Hugo whenever an episode of abuse occurs.
In 2018, the French parliament published a report attesting to the lack of means to take care of dependent residents in ehpads (nursing homes). At that time, there was an in-depth investigative report on “Envoyé spécial,” France’s equivalent of “60 Minutes.” Then as now, social media exploded with the testimonies of nurses and directors of nursing homes, with the children of residents, with stories of abuse and negligence.
And then people’s minds wandered and they forgot about it. There were other scandals, other “buzz.”
This time round, the financial scandal, particularly well documented in Castanet’s book, has placed the nursing home industry under legal scrutiny. Though Orpea threatened to drag Castanet into court for slander, the company knows it does not have a case. It should be more worried about being charged with the embezzlement of millions of taxpayer euros!
In 2022, the French have had their first in-depth look into for-profit nursing care (though Orpea has been around since 1989). In the United States, anyone who works in a for-profit nursing home is surely familiar with the sad examples presented here. The very concept of for-profit care for the most dependent of the elderly, where profits take precedence over human dignity, can only lead to abuse. Understaffing is the rule and the most dedicated members of staff are the first to take the blame when things go wrong. That’s why they so often give up and leave. As in France, in US nursing homes, turnover is high.
Six months from now, will anyone in France be talking about “ehpads” and the abuse of the dependent elderly? War in Ukraine, threats from China, global warming, economic collapse. Are the old really so important after all?
Mahatma Gandhi said, and Harry Truman repeated, “the true measure of any society can be found in how it treats its most vulnerable members.”
What does that say about us?
