Senior Care | Instead of rearranging the chairs on the deck of the Titanic

It is not by rearranging the chairs on the deck of Titanic that Quebec will overcome the wave of care for seniors which is approaching dangerously quickly.

Rest assured, it’s not too late to take a step back. A fresh study from the Jacques-Parizeau Research Chair in Economic Policies at HEC Montréal also outlines the direction to follow.¹. And the Minister responsible for Seniors, Sonia Bélanger, intends to act.

Twenty years after the “At Home: The First Choice” policy, it is “clear that we must look at the structure of our home care in Quebec,” she said last week, giving hope for major announcements Soon.

Let’s hope she doesn’t give birth to a mouse, because hopes are high. The issues too.

By 2040, the number of Quebecers aged 80 to 89 will double. These elders are our parents or grandparents who we want to take the greatest care of. But right now, we are far from ready. Very far.

The most recent report from the Commissioner of Health and Well-being² sounded the alarm: by continuing on the current trajectory, we would have to build 2,500 places in seniors’ homes each year by 2040. We will never get there! The Coalition Avenir Québec (CAQ) has not succeeded in building as many… in six years.

Due to a lack of accommodation, these people losing their independence will occupy beds on hospital floors, which will prevent patients stuck on stretchers from being transferred to the emergency room, where the wait is even worse (17 h 26 min in average) than before the pandemic, as demonstrated by our annual ranking published last Monday³.

Instead of investing a fortune to build seniors’ homes, it is time to make a big move towards home care. It costs a lot less. And it corresponds more to the aspirations of seniors whose health deteriorates less quickly by remaining in their living environment.

Currently, 20 to 30% of CHSLD clients have moderate needs and could be cared for differently (we are talking about profiles 8 to 10, on a scale of up to 14). It is the growth of this cohort which means that we must build a huge number of places.

To give you an idea, a person with profile 8 needs help with domestic tasks (meals, cleaning), has mobility problems (getting up, washing, dressing) and has moderate cognitive disorders. …while still being able to live at home with appropriate assistance.

“The philosophy in Quebec means that we are no longer even able to imagine sufficient services to keep them at home, as we do in Europe or Japan,” laments the D^r Réjean Hébert, co-author of the study.

Currently, barely 10% of home support needs are met. Quebec finances two hours of care per week, on average. Don’t ask yourself why people are lining up for the CHSLD.

As a society, are we getting value for our money? No. Is it possible to obtain better care without increasing costs? Absolutely. This is the exercise that the Chair’s researchers undertook by activating different levers. An interactive tool also allows Internet users to create their own scenarios⁴.

By increasing the level of service to 10 or 24 hours per week, depending on needs, experts estimate that it would cost approximately $50,000 to support a senior at home. This is much less than in a CHSLD (around $125,000) or in a senior center (around $150,000).

The beauty of the operation is that it can be carried out at zero cost compared to the current trajectory, since the increase in home care would reduce the number of places to be built.

To optimize the system, the researchers also propose other actions that deserve careful analysis:

• Increase the user contribution in CHSLDs (currently at $2,142.30 per month for a single room, for those who have the means) so that it at least covers accommodation (accommodation, meals, leisure activities, etc.) . But be careful not to exacerbate the inequities that the Public Protector has already denounced.
• Make greater use of the private sector and non-profit organizations whose home care interventions cost approximately 65% ​​less than the public. That said, the State should foot the bill and ensure that the services received meet standards. A one-stop shop to help people find their way is also required.
• Reduce construction costs for seniors’ homes, which cost almost $1 million per room. Do we really need a dining room and a living room where it is good to play chess if we are focusing on a clientele with a serious loss of autonomy?

Let’s think about it quickly, otherwise we will all feel the weight of the glaring lack of services, seniors and caregivers, most often women.

“If our children see us acting like this with our parents, we wonder how they will treat us when it is our turn,” says Pierre-Carl Michaud, co-author of the study.

The boat will sink if we don’t do anything. The time has come to change course. For real.

1. Check out the study Horizon 2040: projection of the impacts of support for autonomy in Quebec

2. Read the Health and Welfare Commissioner’s report Aging well at home – volume 4: a necessary transformation

3. Read the file “Fifteenth emergency rankings of The Press : worse than before the pandemic »

4. Consult the interactive toolHorizon 2040