Social and medico-social sectors: the evaluation of establishments under criticism
When the French National Authority for Health (HAS) published the quality assessment framework for social and medico-social establishments and services in March 2022, the nursing home sector was in the throes of a profound crisis. A few weeks earlier, the investigative book Les Fossoyeurs (Fayard), by journalist Victor Castanet, revealed cases of elder abuse in certain structures of the Orpea group (since renamed Emeis). In this context, the HAS framework "emphasizes respect for the fundamental rights of the people being supported, as well as ethical reflection and a strategy of good treatment in support practices," recalls sociologist Laurent Fraisse.
Three years later, Mr. Fraisse, accompanied by sociologists Jean-Louis Laville and Anne Salmon, and the director of the Cose comune association, Marie-Catherine Henry, published Enquête sur l'évaluation dans les établissements sociaux et médico-socialaux (Erès, 216 p., €14), which offers a critical analysis of the tool provided by the HAS. To do this, they relied on field feedback, through various surveys giving a voice to professionals in the sector as well as users.
Does the evaluation procedure allow for an in-depth study of the work carried out by the teams of an Ehpad, a social accommodation and rehabilitation center or a medical-educational institute? Does it provide effective support to help the teams progress? Above all, does it allow for the identification of situations of user mistreatment? On all these points, the authors' findings are negative. The work describes a framework that is far too rigid and standardized, "indifferent to the types and specificities of the establishments" , which only allows for a superficial and biased approach to their daily reality.
Invisible “small innovations”Because of the priority given to formalized and written professional practices, the evaluation procedure does not focus on the many adaptations made by social workers when unforeseen situations arise. " [The] initiatives, [the] ability of establishments to build specific paths to find appropriate responses for people who do not fit into the boxes, these do not appear in the framework," notes one of these social workers. "Our small innovations, we cannot talk about them because they are not part of the grid," laments the director of a mandatory service.
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