The nursing home for dependent elderly people (Ehpad) in France, the last place of residence and a space for living until the very end

Abstract

This second interview conducted by Professor Jean-Pierre Bouchard forms part of a four-part series devoted to Établissements d'Hébergement pour Personnes Âgées Dépendantes (EHPAD, French long-term care facilities for dependent older adults). After the first paper traced the institutional and historical trajectory of EHPADs and highlighted the contemporary paradoxes of the “living-care space”, this second contribution focuses on the psychic and existential experience of residents and their relatives. It examines EHPADs as spaces where dependence, aging, and end of life are experienced in their most acute form. Adopting both a clinical and institutional perspective, the transition into residential care is understood as a biographical rupture that necessitates a reconfiguration of one's relationship to self, others, and the world. The move from home to EHPAD often activates defensive mechanisms that are mistakenly interpreted as “behavioral disorders”, whereas they more accurately express psychic survival efforts in the face of loss of autonomy and social detachment. The analysis highlights the tension between safety and freedom, between managerial control and presence, and underlines the desubjectivizing effects of organizational standardization when the resident's voice and shared decision-making are absent. The palliative approach is presented here as a transversal culture of care, refocusing practice on continuity of being, dignity, personal temporality, and the recognition of vulnerability as a fundamental mode of existence. The psychologist's role is described through three complementary registers: the resident's clinical care, mediation between families and teams, and institutional containment, contributing to the prevention of professional exhaustion, moral distress, and the banalization of suffering. Finally, the paper calls for greater investment in staffing, training, and clinical supervision, as essential conditions for an ethics of care capable of integrating technical competence, humanity, and symbolization. Transforming EHPADs into genuine living spaces, rather than places of waiting, means recognizing, even within dependency, a subject who remains alive, thinking, and desiring, and supporting the possibility of inhabiting the end of life within the collective.