Entrance to the Ehpad: the thorny query of consent | EUROtoday

LOrsque her mom, who lives alone, begins to current evolutionary reminiscence losses, Jacques shortly realizes that at some point she will now not keep at house. “The symptoms progressing, I started to get used to the idea that term reception in nursing homes was the only option. “If her mother, still often lucid, does not reject the idea, she prefers to consider this big jump in the future” as distant as possible “. During the two years when the subject is regularly mentioned with his son, the prospect of a move to EHPAD inspires him alternately fatalism and fears. “She didn’t want to go. But the idea made its way. I will speak of default acceptance, ”says Jacques.

Until the second when the illness turns into too superior and inconceivable wait -and -see. Things rush. Jacques is organizing the go to together with his mom of a number of potential institutions and enrolled it on the ready listing of one in every of them. Three months later, the information arrives: a spot has been launched. Jacques then cuts quick to any procrastination. “I told her that I would come at the end of the week and that she had time to prepare her suitcase,” he continues. This is the place the difficulties began. She known as me every single day to ask me what she had to remove. At no time does she clearly oppose her departure, however when her son involves get her, the suitcase isn’t made. “Certainly an effect of the disease,” he mentioned.

Once there, it is the shock. “I think she had accepted the idea as long as it was theoretical. When things materialized and she understood that she was entering the last establishment of her life, there was no more consent. She wanted to go out physically. “After a brief return of his mom to his house, Jacques warns the psychologist and the director of the Ehpad: he’ll carry her again and, this time, it is the correct one, she is going to keep. The feeling of guilt within the pincer, however what different selection does it have?

“We don’t” place “a mother, a father in nursing homes”

The circumstances just like that of Jacques are extraordinarily widespread. “We are in a paradoxical situation which wants that it is now often children who decide in place of parents,” emphasizes Prois François Vialla, director of the college of well being regulation (Chair Epione) on the Faculty of Law and Political Science on the University of Montpellier. Families are usually not responsible. But the very first thing to do is to stop language variations in any respect prices. In specific the terrifying terminological drift “place”. We do not “place” a mom, a father in nursing houses. »»

The scenario of individuals admitted to Ehpad has advanced enormously over the previous ten years. They are older: in the present day, they’re typically 85 and over when they’re welcomed, they usually current way more pronounced dependence. The fault of persistent illnesses whose prevalence will increase with age, on the forefront of which neuroEvolutive illnesses, and specifically Alzheimer’s illness: greater than two thirds of residents thus current neurocognitive problems in relation to those circumstances.

This medical actuality makes the query of consent, presupposed to be free and enlightened, “very simple in theory and extremely complicated in practice”, as François Vialla explains. The regulation is evident: if they aren’t positioned beneath a safety regime, individuals have their complete resolution -making energy. “Rather than dependent dependent people, it would first be necessary to speak of inhabitants,” continues the director of the well being regulation college. People are at house. As such, they’re anticipated to conclude a keep contract within the lodging institution that’s the EHPAD. »»

For this, the particular person will need to have the capability to consent, inside the which means of contract regulation. This is the place, fairly often, the rub. If this capability is altered, the Code of Social Action and Families supplies for the substitution of this contract with a person doc of care. Without dupe enjoying. “The content is the same, but we don’t pretend. We are not trying to make believe that the person we welcome is able to conclude a contract. And we associate it, of course, with this individual document. We can do without consent, not assent. »»

Read too Loss of autonomy: when to take out a dependence contract? Delphine Langlet, Director General of the Share and Life Foundation – recognized as a public utility and non -profit, which acts for the support and care of people weakened by age, illness or disability – shares this concern for transparency. “The ideal is of course to be able to attest to the consent of the new resident in writing. In view of the audiences we welcome, it is not always possible, she confirms. The collection of this consent must remain the common thread of our actions. On the other hand, it should not be a lure, something that we are looking for in an artificial way. It would not take into account the people who are facing us. »»

At the EHPAD, the resident expropriated by himself

The question is all the more complex since consent, far from being binary, can largely fluctuate. And “works” on long time. Out of the question of putting the person concerned at the foot of the wall. “It is very important, upstream, to organize a visit to the establishment and a meeting with the coordinating doctor and the whole team of professionals, who will already seek to collect consent. It is, in fact, quite rare to be confronted with frontal refusals, “explains Gwenaëlle Le Bourdonnec, psychologist in Dinard, particularly in Ehpad.

And when residents, as soon as admitted, appear refractory, they’re significantly adopted by workers throughout the first weeks. “We are attentive to try to make up for this initial consent defect, knowing that it is always said to the person that she will be able to return home,” says Delphine Langlet.

To uncover



The kangaroo of the day

Answer

Consent shouldn’t be thought-about as acquired anyway, however consistently sought. “We follow in particular, in our care software, the verbalized elements of residents but also unpertified. For example, if the person eats well, if they participate in the entertainment, ”she continues. Focusing on the time of admission could be far too simplistic.

Once the step has taken, it’s a new life that begins, the place all of the on a regular basis is ruled by the collective group. “The person is like a little expropriated by himself,” says François Vialla. Obviously individuals should give their consent for bogs, meals or leisure. We are now not, right here, inside the framework of a technique of regulation of obligations and contracts. Another type of consent is required, which protects the integrity of the particular person. An assent simply as basic as shut and professionals should endeavor to hunt to keep away from “small daily dramas”.

Share and life summer season

LA 6^e version of sharing and life summer season, in partnership with The levelwill happen on June 25 from 4:30 p.m. to eight p.m. on the Maison de la Chimie (Paris 7^e). Almost 4 hours of change across the theme “Enting into nursing homes: how to adapt to the change of life?” With philosophers, docs, comedians, public officers and professionals from medico-social institutions. We invite you to participate within the debate by responding to our flash investigation on the theme of this 12 months.

Free participation and registration obligatory on Foundation PartageetVe.org