Warning from a doctor | “One minute to midnight of the collapse of the elder care system”

(Quebec) A coalition of organizations is calling for CLSCs open 24 hours a day, 7 days a week, as the main gateway for seniors requiring home services.

This is one of the proposals that emerged from a national meeting on home support which was held in Quebec on Wednesday.

Home support services range from domestic help services to babysitting, troubleshooting, nutrition, family tasks, personal care, etc.

Currently, only a minority of seniors have full access to all the home services they require and the Commissioner of Health and Welfare concluded that the results of the current system are “worrying”: it only responds at 10.7% of support hour needs.

However, the Coalition for the Dignity of Seniors, which organized Wednesday’s Meeting, is calling for the adoption of a framework law that recognizes the right to affordable and adapted housing, as well as the right to access home services. -which would oblige the State to provide services to all.

However, the coalition abandoned one of the recommendations proposed due to dissension, namely the payment of an “autonomy allowance” to people aged 65 and over so that they can obtain all kinds of services to ensure they remain at home.

This resembled the assurance of autonomy that the PQ government of Pauline Marois wanted to put in place in 2013.

In her morning speech to the participants, the Minister responsible for Seniors, Sonia Bélanger, indicated that fewer seniors are now waiting to obtain home support services, but that it will be impossible to eliminate the waiting list .

“The minister is giving up,” lamented PQ MP Joël Arseneau, who attended the deliberations at the end of the day, in an interview with La Presse Canadienne.

Liberal MP Linda Caron, who represented her party at the Rendez-vous, for her part said that she had to consult her colleagues to find out if the PLQ would endorse a law that would recognize the right to home services.

She questioned the feasibility of CLSCs open 24/7.

Waiting list

In her speech, Sonia Bélanger indicated that the waiting list which was 21,000 people last year was reduced to 16,500 people as of March 31.

But we are still above the figures before the pandemic. The number of people waiting for a first service increased from 13,250 on March 31, 2019 to 17,226 on March 31, 2022.

We are therefore still far from a universal service offered to all elderly people, as recommended by the Commissioner for Health and Welfare.

“It will not be to reduce (the waiting list) to zero within a year, it is impossible to do that,” said the minister in an interview with The Canadian Press.

“There will always be a waiting list because there are always people registering every day. »

“Collapse of the system”

During a morning presentation, a doctor with 40 years of practice in home care sounded the alarm. By 2030, Quebec will move from 15^e at 6^e world rank for the proportion of people aged 85 and over, she noted.

“It’s time to say the real things, we are one minute to midnight of a collapse of the elder care system,” notes Dr. Geneviève Dechêne, a pioneer in home care.

Dr. Dechêne concluded that Quebec is heading straight into the wall because it is at the “back of the pack” in the OECD in terms of investment in home care and home support.

This is particularly because the doctors’ unions and the Order of Nurses have “too much power” and impose a vision centered on “the hospital”, a “magic word” for politicians, she lamented.

And there is also the “magical thinking” of baby boomers who are too afraid to think about the loss of autonomy which occurs on average 6 to 8 years before death.

According to her, there are no real health services in living environments, private seniors’ residences, or intermediate resources, to ensure the autonomy and maintenance of seniors at home.

“Don’t be surprised that our emergency rooms are overflowing with these patients,” she noted, while in other countries, doctors and nurses provide services at home.

No less than 90% of Quebecers do not have access to home medical services, and “that’s where the problem lies,” she continues.

A “universal” character

The Commissioner for Health and Well-being, Joanne Castonguay, who gave a worrying assessment of the home support system in Quebec at the beginning of the year, nevertheless believes that everyone should have access to services if they require them- like health care, which is universal.

“The universal nature (of home support) is non-negotiable in our society, so yes, it is a principle which is important because it is important for our population, I think that is very clear,” said argued the deputy commissioner for evaluation and principal scientist of the organization, Georges-Charles Thiebaut, in an interview with The Canadian Press.

On Tuesday, the Liberal Party called for a public debate on the universality of home support.

“For loss of autonomy, the universal system is more vague,” recognized Philippe Voyer, full professor at the Faculty of Nursing at Laval University.

“While we’re talking about it, there are people waiting for services,” lamented the general director of the Network for Cooperation of Social Economy Enterprises in Home Help, J. Benoît Caron.

“I’m in an emergency!” » he said.

In 2023, the system only met 10.7% of home support needs, stated the Commissioner of Health and Welfare: it provided 25.4 million hours of services, while 234 million hours were required.

M^me Bélanger, however, indicated that 37 million hours of services were provided in the last year.

“Worrying situation”

In her report, the Commissioner for Health and Wellbeing stated that “the current situation is worrying” and that this “endangers the viability of services for the future”.

The minister had questioned the commissioner’s methodology.

“The Quebec home support ecosystem was developed in another era. Today, it no longer meets the needs of the population and it is unsuitable for future needs,” we could read.

“Accessibility is the most problematic dimension of home support services,” noted the commissioner.

The system currently costs 7.6 billion per year, but in 2040 it will cost 16.5 billion, or 8.9 billion more per year.

However, it costs much less to provide home support services than to provide accommodation for reasons of loss of autonomy.

In the report, we can read that for the year 2023, “the average annual operating cost for a person receiving home support services (home itself or seniors’ residence) is estimated at $13,900. This cost varies from $67,400 to $96,800 for a person in accommodation, depending on the type of accommodation (intermediate resources-family type resources and CHSLD).”