Photo: Alex Raths Getty Images iStockphoto In 2023, Quebec spent $2.155 billion on home services. This only corresponds to a third of the total of what we call long-term care, which is monopolized by the financing of CHSLDs.
Isabelle Porter in Quebec
Quebec must take action, launch an ambitious project and reinvest massively in home support, concludes the Commissioner for Health and Well-being (CSBE), Joanne Castonguay, in a new report. But he will also have to ask users to contribute financially, according to her.
“If nothing changes, ensuring that citizens who wish to do so remain safe at home for as long as possible will be an impossible challenge to meet,” she says in volume 4 of her analysis of home care in Quebec.
And to meet this challenge, the government must “impose a contribution from users”, according to the commissioner, who does not comment on the amount of such a contribution, but indicates that this must be “in according to their means.
At a press conference on Tuesday, Ms. Castonguay stressed that the home support system had become “unsustainable” financially.
Remember that home care provided by the network includes nursing care, but also domestic help and personal assistance, such as meal preparation or hygiene care, for example.
Health care delivered at home must remain free and universal, stressed the commissioner, but other services could be priced.
“The Ministry of Health and Social Services cannot bear sole responsibility for developing the ecosystem for maintaining autonomy,” she argues in her report. She also reports that the majority of people would be in favor of it, since a total of 78.3% of people say they are ready to pay more, according to a web survey carried out as part of the mandate among a group of 55 to 69 year olds .
In 2023, the Quebec government spent $2.155 billion on home services, a financial commitment among the lowest in Canada.
This only corresponds to a third of the total of what we call long-term care, which is monopolized by the financing of CHSLDs.
According to the commissioner, this trend must be reversed. Quebec, she writes, currently meets only 10.7% of the needs for home support hours, or 25.4 million hours out of the 234.7 million that should be offered.
Meanwhile, more than 17,000 people were waiting for a first home support service in 2022.
Restrict access to CHSLDs
On the other side of the spectrum, the network manages to meet 98% of the demand for places in CHSLDs, a much more expensive system.
Thus, CHLSDs monopolize 62% of long-term care funds, but only take care of 16% of users, while with only 38% of the budget, home support takes care of by 84% of people.
In this context, CHLSDs should be reserved for people with serious loss of autonomy who are not able to move around (an ISO-SMAF profile of 10 to 14 according to the autonomy measurement system functional used by the network), judges Ms. Castonguay. This is the case for the majority of residents currently (at least 85%).
The commissioner also believes that the contribution of CHSLD residents is also increasing. Currently, a single room in a CHSLD costs a maximum of $2,142.30 per month, an amount that can be reduced depending on people's ability to pay.
This rent is imposed out of “concern for fairness between accommodated adults and those living at home”, indicates the Régie de l’assurance santé du Québec (RAMQ).
Because if health services are free for everyone in Quebec, “when you are accommodated, you must assume the expenses related to your lodging and your food”.
The CSBE further notes that the current system of tax credits for home care disadvantages seniors who stay at home compared to those who live in residence. An inequity that must be corrected, she recommends.
Improving home support is a key issue, underlines the commissioner, because a vast majority of Quebecers want to age at home for as long as possible (83% when surveying the general population; 91% among those over 55 years old).
“Aging is not a disease. Long-term care and services should be integrated into a lifelong well-being perspective,” she also writes.
The commissioner also recommends the creation of “regional offices” of home support which would act as a “gateway” to services. She also recommends improving the support given to caregivers. She also suggests that Quebec draw more inspiration from “innovative” practices and “good moves” made in Quebec as elsewhere.
The report caused a strong reaction from the Parti Québécois. “Before asking for a financial contribution for home support, let's stop sinking billions of dollars into the bottomless hole of seniors' homes,” wrote MP Joël Arseneau in a comment on the X network.
The Minister responsible for Seniors, Sonia Bélanger, said she “agreed with the major findings raised” without specifying what her government intended to do to rectify the situation.