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Grand Âge, Le Temps D 'Agir

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Grand Âge, Le Temps D 'Agir CONCERTATION Grand âge et autonomie Dominique Libault Mars 2019 Grand âge, le temps d ’agir © Romain Bourguinon CONCERTATION Grand âge et autonomie SOMMAIRE INTRODUCTION UNE CONCERTATION NATIONALE DE GRANDE AMPLEUR QUI SONT LES PERSONNES ÂGEES EN PERTE D’AUTONOMIE ? COMMENT LES DÉPENSES SONT-ELLES PRISES EN CHARGE ? SYNTHÈSE PARTIE 1 – CONSTATS ET ENJEUX 21 1 - Une demande forte de transformation en profondeur 22 une priorité affirmée au maintien à domicile une attente forte d’amélioration de la qualité de la prise en charge en établissement le besoin d’« être chez soi », quel que soit son lieu de vie une demande de simplification du parcours de la personne âgée l’attente d’une plus grande égalité de traitement entre les territoires 2 - Un système complexe et peu lisible, en dépit d’un effort public croissant et de nombreuses initiatives innovantes 26 un effort en hausse constante depuis le début des années 2000 de nombreuses initiatives témoignant de la capacité d’innovation du secteur une offre en établissement comme à domicile, segmentée et fragile sur le plan économique des prestations peu lisibles des réponses professionnelles trop cloisonnées et peu coordonnées un pilotage local particulièrement complexe un débat parlementaire peu organisé une connaissance statistique et une recherche insuffisamment développées 3 - Un investissement fort et urgent dans l’attractivité des métiers et les compétences 39 un emploi en croissance forte depuis une décennie une pénurie de personnel aggravée par de fortes difficultés de recrutement dans la décennie à venir un temps professionnel auprès de la personne âgée insuffisant 1 CONCERTATION Grand âge et autonomie des tensions sur les effectifs aggravées par la dégradation des conditions de travail un manque d’attractivité lié aux insuffisances de la formation et des perspectives de carrière 4 - L’attente d’une meilleure prise en compte des ressources dans l’attribution des aides et le choix d’une couverture publique 47 un reste à charge maîtrisé à domicile mais élevé en établissement un attachement à la modulation de l’aide financière selon les revenus malgré des disparités, un niveau de vie relatif des plus de 65 ans le plus élevé de l’OCDE les français privilégient une couverture publique du risque 5 - Un manque de coordination autour de la personne source de ruptures de parcours, de défaut de prévention et d’isolement 51 la prévention, enjeu mal reconnu et peu soutenu des interventions insuffisamment pensées dans une logique de continuité des parcours un appui aux proches aidants insatisfaisant des solidarités du quotidien et un cadre de vie ne parvenant pas à rompre l’isolement PARTIE 2 - LES PROPOSITIONS POUR CHANGER DE MODÈLE 61 1. Un nouveau regard sur le grand âge 62 a. Donner du sens au grand âge en réaffirmant la citoyenneté, la dignité et le droit au libre choix de la personne âgée 62 Objectif : Sensibiliser pour inclure la personne âgée dans la vie de la cité Objectif : Renforcer l’intégration de la politique du grand âge et des politiques du cadre de vie de la personne âgée Objectif : Faciliter l’accès des personnes âgées à des solutions innovantes de mobilité, d’adaptation du logement et d’amélioration du quotidien Objectif : Affirmer en tout lieu la dignité de la personne âgée en prévenant la maltraitance b. Aider les proches aidants et lutter contre l’isolement de la personne âgée : pour un modèle d’accompagnement et de soin intégré associant démarches citoyennes et démarches professionnelles pour et avec les personnes 69 Objectif : Simplifier la vie des proches aidants, faciliter leurs démarches et rendre leurs droits plus effectifs Objectif : Améliorer l’accompagnement financier des proches aidants Objectif : Mieux concilier le rôle de proche aidant et la vie professionnelle 2 CONCERTATION Grand âge et autonomie Objectif : Innover sur les territoires en faveur des proches aidants Objectif : Lutter contre l’isolement de la personne âgée en mobilisant les bénévoles de tous les âges 2. L’autonomie de la personne âgée au cœur de la stratégie 74 a. Garantir le libre choix de la personne âgée en construisant une nouvelle offre d’accompagnement et de soin recentrée sur le domicile 74 Objectif : Assurer la viabilité, l’attractivité et la qualité de l’accompagnement et des soins à domicile Objectif : Développer des modes d’habitats intermédiaires pour les personnes âgées plus autonomes Objectif : Décloisonner les structures pour améliorer la qualité de service et réaliser des gains d’efficience Objectif : Piloter par la qualité Objectif : Rééquilibrer l’offre sur le territoire Objectif : Changer le regard sur les structures pour personnes âgées et valoriser les bonnes pratiques Objectif : Mettre la personne âgée au cœur de l’accompagnement et partir de ses attentes, dans une logique de « chez soi » b. Prévenir la perte d’autonomie pour augmenter l’espérance de vie sans incapacité 86 Objectif : Matérialiser une forte ambition en matière de prévention de la perte d’autonomie en fixant un objectif ambitieux d’augmentation de l’espérance de vie sans incapacité Objectif : Proposer une nouvelle offre de prévention et sensibiliser le grand public Objectif : Former massivement les intervenants professionnels auprès des personnes âgées aux réflexes de prévention de la perte d’autonomie Objectif : Diffuser les démarches de prévention dans l’ensemble des structures de prise en charge de la personne âgée Objectif : Renforcer le pilotage et l’évaluation de la politique de prévention de la perte d’autonomie 3. Améliorer les conditions de vie de la personne âgée par la revalorisation des métiers, à travers un plan national pour les métiers du grand âge 93 Objectif : Accroître le temps de présence humaine en proximité de la personne Objectif : Améliorer les conditions de travail des professionnels et la qualité de l’accompagnement des personnes par l’innovation organisationnelle Objectif : Avancer vers des hausses de rémunération ciblées pour les métiers du grand âge, en particulier à domicile Objectif : Engager une montée en compétence de l’ensemble des professionnels du grand âge dans une perspective d’amélioration de la justesse relationnelle de l’intervention Objectif : Ouvrir des perspectives de carrière pour les métiers du grand âge, faciliter les reconversions professionnelles et mobiliser des compétences variées auprès des personnes âgées Objectif : Piloter une politique transversale de valorisation des métiers du grand âge 3 CONCERTATION Grand âge et autonomie 4. Mieux accompagner 105 a. Rénover les prestations pour simplifier la vie des personnes âgées et agir sur l’accessibilité financière, garantie du libre choix 105 Objectif : Simplifier la vie des personnes âgées et des proches aidants et faciliter leurs démarches Objectif : Rénover les prestations à domicile et mieux les articuler avec celles qui relèvent du handicap pour assurer l’effectivité des droits Objectif : Matérialiser l’affirmation de la perte d’autonomie des personnes âgées comme risque de protection sociale en simplifiant le pilotage des établissements, en assumant la part du financement national et en socialisant le risque long de perte d’autonomie lourde en établissement Objectif : Mieux prendre en compte la capacité des personnes à assumer financièrement leur perte d’autonomie dans un triple objectif d’équité intergénérationnelle, intragénérationnelle et territoriale Objectif : Recentrer les dispositifs d’exonération de cotisations sociales ou de crédit d’impôt sur les publics fragiles. b. Assurer une continuité de prise en charge pour chacun et mettre un terme aux réponses en silos 115 Objectif : Eviter toute rupture de parcours pour les personnes âgées et engager l’ensemble des acteurs sanitaires, sociaux et médico-sociaux dans un décloisonnement de leurs interventions Objectif : Prévenir les hospitalisations et les passages aux urgences évitables Objectif : Organiser le séjour de la personne âgée en établissement de santé de manière à éviter les ruptures de parcours Objectif : Promouvoir un établissement de santé bienveillant pour la personne âgée 5. Un risque national à part entière avec un partenariat territorial renouvelé 123 a. Reconnaître la perte d’autonomie comme un risque de protection sociale à part entière 123 b. Améliorer les connaissances statistiques et économiques et soutenir la recherche pour étayer la politique du grand âge 127 Objectif : Faciliter les remontées d’informations et les traitements statistiques ainsi que l’observation économique pour mieux piloter le risque de protection sociale de perte d’autonomie des personnes âgées Objectif : Accélérer et encourager les travaux de recherche liés au vieillissement afin d’éclairer la prise de décision dans le champ du grand âge c. Accroître l’effort financier en assurant un financement juste de la perte d’autonomie liée a l’âge par la solidarité nationale 130 Objectif : Affecter des ressources publiques au financement de la perte d’autonomie de la personne âgée, sans hausse de prélèvement obligatoire Objectif : En complément du financement public du nouveau risque de protection sociale, favoriser la mobilisation des patrimoines financiers et immobiliers 4 CONCERTATION Grand âge et autonomie d. Piloter l’offre sur les territoires, au plus près des personnes, tout en garantissant mieux des réponses homogènes et équitables 136 Objectif : Repositionner le Conseil départemental en proximité de la personne âgée et renforcer la conduite partenariale de la politique du grand âge au niveau départemental Objectif : Simplifier le pilotage de l’offre médico-sociale Objectif : Renforcer les compétences de la CNSA, notamment en matière de pilotage financier et de garanties d’équité entre les territoires Objectif : Evaluer la réforme, notamment sur les aspects de gouvernance et de pilotage CONCLUSION 144 LISTE DES PROPOSITIONS 145 ANNEXES 155 1. Lettre de mission de Dominique Libault 2. Les attentes exprimées par les Français 3. Recommandations du Comité scientifique 4. Enjeux financiers relatifs aux propositions 5. Grand âge et plaisir de la table 6. L’organisation de la concertation 7. La concertation dans les territoires : 500 personnes réunies lors des forums régionaux 8. Les personnes âgées et leur prise en charge 9. L’expérience allemande 10.
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