Despite one of the highest long-term care needs in Canada, Quebec is the province with the fewest beds allocated to this clientele in proportion to its population.
Last June, 4,160 people in Quebec were waiting for a place in a CHSLD, according to data from the Ministry of Health.
“A higher level of financial resources does not x27;is not associated with better performance”, reveals the health and well-being commissioner, Joanne Castonguay, in a report she has just published on the evolution of performance in CHSLDs between 2015-2016. and the onset of the COVID-19 pandemic, i.e. 2020-2021.
This unpublished information on performance in CHSLDs is drawn from a study of 71 indicators and data provided by the Régie de l'assurance maladie du Québec (RAMQ) and by the Ministry of Health and Social Services ( MSSS).
The Commissioner and her team established a value-based assessment framework that led to the following observation: There are large disparities in the performance observed between the different territories – some succeed in positioning themselves well against the established benchmarks , but a large majority do not succeed.
And these disparities have an impact on the people who spend their last days in residential and long-term care centers duration (CHSLD). In 2019-20, there were 58,000; more than half of them were aged 85 and over.
Among other examples, the commissioner looked at:
- < li>matching to needs (providing care and offering appropriate services);
- accessibility (offering a place in a CHSLD at the right place and time);
- productivity (optimizing care based on resources);
- the quality of care and services (offering a quality living environment).
No establishment is targeted: It was really to paint a portrait of Quebec, then to find out if it varied a lot, explains Geneviève Ste-Marie, responsible for scientific coordination in the commissioner's office. It's a state of affairs, with data.
By consulting this state of affairs, we conclude that it is better to be in a CHSLD in certain regions rather than in others.
Especially at mealtimes: according to ministry evaluations, only 36% of CHSLDs offer structured meals. This means standardized meal times, an alternate menu for mashed potato-weary patrons, and adequate vigilance and assistance from staff.< p class="sc-v64krj-0 knjbxw">According to a survey made public in November 2021 and which was conducted at the request of the users' committee of the Integrated University Health and Social Services Center (CIUSSS) of the East-of-the-Island-of-Montreal, 40% of respondents say that their tastes are not taken into account when preparing their meals.
In this category – people-centred care and services – CHSLDs in regions such as Côte-Nord, the Laurentians or Laval obtain a passable mark. In the West-Island of Montreal, it is low.
This is just an example. More generally, only 10 of the 22 regions that make up this portrait are still doing quite well in terms of performance, says Ms. Ste-Marie, given their financial, human and material resources. The other 12 regions are aligned.
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In the table above, we see for example that only Estrie stands out in terms of safety or that two sectors of Montreal are among those that stand out for the care and services offered to users.
The best student is Mauricie-et-Centre-du-Québec. In three of the four [categories], they are doing better than the level of resources they have, says Ste-Marie.
This is one of the main findings of this report: money does not necessarily guarantee quality.
More financial resources do not translate through better care and services centered on people, writes Commissioner Castonguay.
Clearly, to improve the quality of life of seniors in CHSLDs, money only, that will not change anything, summarizes Geneviève Ste-Marie.
Moreover, during the coronavirus pandemic, notes the commissioner, Quebec has considerably increased financial resources in CHSLDs, for all establishments, regardless of how they have been affected by COVID-19. .
Except that all this money has not translated into an increase of the same magnitude in terms of human resources, the quality of life at work and the accessibility of care and services.
For things to improve, you have to train people, you have to recruit people to train people, insists Geneviève Ste-Marie. You have to adopt good practices. You have to measure yourself to know that you have good practices, that you have to readjust.
A beneficiary attendant serves a snack to a patient at the CHSLD Éloria-Lepage in Montreal in April 2020, during the first wave of the COVID-19 pandemic.
Last June, 4,160 people in Quebec were waiting for a place in a CHSLD, according to the most recent MSSS data compiled by Radio-Canada. This is a 50% increase from when the Coalition Avenir Québec (CAQ) came to power in October 2018. There were then 2,766 people waiting.
In fact, the report of the Health and Welfare Commissioner illustrates the fact that the accessibility of the CHSLD network is a systemic problem in Quebec. Only three regions – with Saguenay–Lac-Saint-Jean in the lead – show good or excellent accessibility.
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Accessibility issues are not surprising […], writes the Commissioner.
In fact, although comparisons between Canadian provinces must be made with caution, it can be argued that Quebec is the province with the fewest long-term care beds relative to its population, despite health care needs. among the highest in Canada.
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Another problem is the lack of continuity and coordination of the nursing staff. Continuity is the proportion of staff who work full time.
In CHSLDs, says Geneviève Ste-Marie, there are a lot of part-time positions. You can imagine how many different people a patient sees per day when their entire care team is part-time.
“In CHSLDs, 44% of the hours worked by nurses are performed by full-time employees; this proportion is 40% among beneficiary attendants. »
— Excerpt from the report entitled The performance of the care and services system for the elderly in CHSLDs, published by the Commissioner for Health and Welfare of Quebec
In a damning report published less than a year ago on the governance of CHSLDs, Commissioner Castonguay concluded that the crisis that arose during the first wave of COVID-19 was partly due to generalized disorganization and faulty transmission of information.
According to data obtained by Radio-Canada, there have been more than 15,000 deaths associated with COVID-19 in Quebec since the start of the pandemic. Over 40% of these deaths occurred in CHSLDs.
The health and well-being commissioner recommends that the government of François Legault establish an information system that will adequately measure quality in all CHSLDs, recalls Geneviève Ste-Marie.
The problem is that the data is missing.
What is a good result in a CHSLD? asks Mrs. Ste-Marie. There is the quality of life to be improved, there would be the state of controlled health, a death with appropriate palliative care… A whole series of elements which could be real results of the results. a good CHSLD system. But we have nothing to measure that, we have no information on that. So we are not able to know that.
Of course, this recent performance report illustrates the gaps between the current situation and what would be desirable. But it does not allow us to understand what explains these discrepancies.
“Commissioner [Joanne Castonguay] really wants to fuel the public debate, put the data forward and then start the conversation. But if we hide it because it's not perfect, it won't improve. »
— Geneviève Ste-Marie, Scientific Coordinator at the Office of the Commissioner for Health and Welfare of Quebec
Quebec's health and well-being commissioner, Joanne Castonguay, released a report on July 20, 2022 that contains “unpublished information” on performance in CHSLDs and “which highlights the significant variations that exist between different territories”.
I find that the Health and Welfare Commissioner, Ms. Castonguay, has done “a great job”, comments Me Paul Brunet, spokesperson for the Council for the Protection of the Sick. However, Mr. Brunet totally disagrees with the Commissioner when she asserts that before the pandemic, the performance of CHSLDs was adequate in terms of the intensity of care and clinical relevance. /p>
In a class action of 500 million dollars brought in 2018 against the Quebec government, the Council for the protection of the sick alleges that degrading living conditions prevail in the CHSLD network. We have a hundred allegations about the fact that there is a lack of people, there is a lack of services, there is a lack of care, summarizes Me Brunet. The case will be heard in Superior Court.
The fact remains that the analysis conducted by Joanne Castonguay paints a very good portrait of what the field is experiencing […], approves Me Brunet. This confirms our concerns and our allegations […].
A rehabilitation unit in a CHSLD in Abitibi. Across Quebec, 58,000 people lived in residential and long-term care centers in 2019-2020. More than half of them were aged 85 and over.
The statistical data analyzed by the commissioner has value, adds Me Patrick Martin-Ménard, from the firm of the same name, who has expertise in defending victims of the health system. This is a positive step.
But more must be done: There are several elements of the reality of patients in CHSLDs that are not reflected in this report and for which we must ask more questions, he warns.
Among other glaring problems, he cites the air conditioning of rooms in CHSLDs. We've known about the problem for years and nothing seems to change. Is there really a political will to change anything?
“What has been done since the carnage of the first wave in CHSLDs? Basically, the system remains the same. The philosophy remains the same, the approach we have with these patients remains the same. »
— Me Patrick Martin-Ménard
For Me Brunet, of the Council for the Protection of Patients, the highlights of Commissioner Castonguay's report are the introduction of an accountability system, with clear terms of reference and sample performance indicators.
“Now is- is this going to lead to an accountability system? I am not sure. ”
— Me Paul Brunet, spokesperson for the Council for the Protection of Patients
The Commissioner's work must lead to concrete changes, concludes Me Martin-Ménard. We must stop considering CHSLD patients as numbers.
With the collaboration of Mélanie Meloche-Holubowski and Daniel Boily