Seniors repeat it: they prefer to age at home and receive their care there. The expansion of this home care, however, comes with an imposing bill for the State. What to do ?
Good news, a team of experienced researchers has made interesting findings on the issue. And she discovered that Quebec could quadruple home support for seniors in need for a public bill which, within a few years, promises to be equivalent to the projection of the current status quo.
The study published Monday was carried out by the team of Pierre-Karl Michaud, from HEC Montréal, with Dr Réjean Hébert1. It has the great advantage of being based on a series of detailed data which makes it possible to clearly quantify the costs and direct benefits of the different options.
The researchers started from an inevitable observation: with the significant aging of the population, it will be necessary to double the number of places in CHSLDs or seniors’ homes (from 38,000 to 75,700) by 2040, i.e. in around fifteen of years. Without this doubling, we are heading towards major social problems.
However, places in such establishments cost the State so much (up to $153,000 per year) that it would be more profitable to restrict access by encouraging seniors to stay at home through significantly improved care.
By care, we mean those required for daily and domestic activities (feeding, washing, managing one’s budget, etc.), as well as nursing care.
To achieve this, significant changes would be necessary. First, places in CHSLDs and seniors’ homes would be strictly reserved for very serious cases only (rated 10 or more on the scale of 14 of the Iso-SMAF model). These are often people with advanced Alzheimer’s.2.
On the other hand, seniors at home with a significant loss of autonomy would see the care provided at home increase fourfold, which would avoid transferring them to an institution. For example, the number of hours of publicly funded services would increase from an average of 2 hours 25 minutes per week currently to 9 hours 40 minutes. And it would be 9:30 p.m. for certain heavy cases.
With their model, the researchers wanted to deploy a service offering different from that of the current model but with, essentially, the same budget.
In the case of the status quo, the state bill would increase from 7.3 billion today to 16.2 billion in 2040 (constant 2023 dollars). Taking into account aging, the status quo implies a 99% increase in places in CHSLDs (i.e. double). Home care would be capped at the current level, meeting 11% of needs.
With their proposal, the system would hardly cost less (15.7 billion), but it would serve a much larger part of the population.
Thus, instead of meeting 11% of home support needs, this proportion financed by the State would increase to 40%. And the overall volume of services would increase from 11.7 million hours to 90.6 million hours per year.
As for the number of places in CHSLDs and others, it would no longer increase by 99%, but by 33% by 2040.
The researchers pose two other hypotheses for the success of their proposal. First, they would increase by 30% the contribution of users in CHSLDs or intermediate resources. The current contribution is the lowest in Canada and does not take into account the cost of accommodation.
Another hypothesis: a large part of the new home care would be entrusted half and half to the community sector and the private sector – as we see elsewhere in the world – rather than to the public sector alone.
This migration would make it possible to provide better services at a lower cost, they judge. Already, Quebec has around a hundred social economy home assistance companies (EESAD), which are very active. The project involves multiplying by six the importance they would have in 15 years compared to the status quo projection (they would go from 5,600 to 32,000 full-time equivalent employees).
2.8 billion per year
To achieve such a change, the authors propose quickly increasing the home care budget. Each year, Quebec should add the equivalent of 400 million new home care services, reaching 2.8 billion in seven years.
These funds would be financed by the relative reduction in the number of places expected in institutions, which essentially implies significantly reducing the development of seniors’ homes and rationalizing their costs.
“Quebec does not have the financial means, the workforce, nor the resources to build and operate residential centers that would meet the needs of an aging population, most of which prefers to receive care at home. when possible. Decisions informed by evidence are required of our leaders,” the authors write.
Some might say that the savings would not be as significant, knowing that currently, it is caregivers who often provide this care at home, rather than the State.
Pierre-Karl Michaud replies, on the one hand, that the time loved ones spend for this care reduces that for their paid work, which our economy greatly needs. And, on the other hand, that there remains a 60% share of care which will not be provided by the State (instead of the current 90%), and which will have to be provided by other sources.
The idea deserves serious consideration. Let’s hope that it makes its way into the minds of the Minister responsible for Seniors, Sonia Bélanger, and Prime Minister François Legault.
1. Consult the document “Horizon 2040: concrete measures for a shift towards home support”
2. SMAF is the acronym for Functional Autonomy Measurement System. The Iso-SMAF scale classifies groups into 14 profiles according to their characteristics. Profiles from the same group require similar services at similar costs depending on the living environment considered.
reference: www.lapresse.ca