16

Institutional changes and managerial practices are not sparing living environments, such as residential establishments for dependent elderly people (EHPAD). This contribution aims to shed light on what needs to be “managed” and adapted in these institutions. It questions the presence and effects of dementia processes on caregivers, on their daily work, and on the failures in this work. Paradoxes and mises en abîme abound in a place where professional investments are confronted with psychic disorganization, degradation, and death. The counter-investments are massive: there is no downtime for the caregivers and the institution. Everyone feels exhausted by the task, trying to save time, while the time that passes is obviously a time that leads the residents to death. Doing and acting therefore replace thinking. Task completion, organization, and scheduling take center stage. The symbolic dimensions of the frameworks and devices, the purpose of what is implemented, the meaning of the work, are lost. The breakdown of the thinking apparatus of the demented elderly person is matched by the breakdown of the thinking apparatus of the professionals and the institution. The resumption of professionalism requires the support of the group, the devices, and the frameworks that block arbitrariness and the return of childlike omnipotence. In the end, the authors emphasize the importance of structuring teamwork, holding management meetings, building common representations, and interpreting institutional movements. This is where management and the clinic must find a way to bond. This means new ways of thinking and working.