Question 13400 — dependency

Summary

Mr. Christophe Marion draws the attention of the Minister Delegate to the Minister of Health, Families, Autonomy and People with Disabilities, responsible for autonomy and people with disabilities, to the absence of extension or generalization of the experiment relating to the improvement of the visual health of elderly people losing their autonomy residing in EHPADs, implemented in application of Decree No. 2020-110 of February 11 2020. Conducted over a period of four years and ending on December 31, 2025, this experiment aimed to respond to an insufficiently addressed public health problem: the high prevalence of uncorrected visual problems among residents in EHPADs. The findings established over these four years are worrying. A significant proportion of residents - close to 40% - have a poor visual defect or not corrected. The consequences are not only functional: accelerated loss of autonomy, increased risk of falls, social isolation, alteration of nutritional status and overload for healthcare teams. Furthermore, there are twice as many people losing their autonomy at home than in EHPADs. The experimentation made it possible to provide an operational response to these needs. It demonstrated the possibility of organizing interventions in residents' living spaces in secure conditions, respectful of health and ethical requirements, with concrete results in terms of improving visual comfort and maintaining autonomy. More than one in three residents were able to benefit from corrective equipment adapted to their vision after visiting an optician. It also validated the relevance of a “go-to” approach, consistent with government guidelines regarding access to care for vulnerable groups. However, since the end of the system on December 31, 2025, no transitional framework or prospect of generalization has been officially announced. This situation creates a break in continuity detrimental to establishments and residents, even though the identified needs remain. In the hypothesis of a generalization, the initial limitation of the deployment only to opticians with commercial premises open to the public does not appear to meet a public health objective. On the contrary, a more open approach seems likely to facilitate access to care, while guaranteeing healthy competition that is beneficial for patients. Such an orientation would be difficult to reconcile with the logic of accessibility and “going towards” promoted by the public authorities. Indeed, the quality of the service provided in a patient's place of life has no direct link with the optician's mode of practice (100% roaming or mixed mobility/store activity). The quality and safety of the care of dependent elderly people is not based solely on the professional's mode of practice, but on objective guarantees: regular and rigorous travel to the patients' living areas and monitoring of the After-sales service, organization agreed with establishments, compliance with hygiene and confidentiality standards, provision of miniaturized and transportable professional equipment to carry out examinations and take measurements, coordination with healthcare teams and doctors and traceability of procedures and transmission of indicators to the supervisory authorities. In this context, he asks him if the Government intends to publish an official report of experimentation and whether a national generalization is envisaged. Also, he asks what would be the timetable and eligibility criteria for professionals, in order to guarantee both the quality of care and the continuation of the dynamic of access to care in the places where vulnerable people live in establishments but also at home. Finally, he asks what orientations are envisaged to ensure the continuity of access to visual care in EHPADs, in ESMS and at home.

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