The government does not offer enough care to seniors with a great loss of autonomy and underestimates the costs that will be associated with this care over the next few years, revealed on Wednesday the report of the Auditor General of Quebec (VG), Guylaine Leclerc.
In a context where the population is aging, the shortfall to cover the needs of seniors with a great loss of autonomy will be, at the very least, 1.9 billion dollars in 2028, writes the VG in its report.
“So, the ministry must immediately think about how we are going to serve them, but not only that, how we are going to finance it,” she told the National Assembly.
Already, the intensity of care — ie the number of hours allocated to a person with a great loss of autonomy — is insufficient in Quebec, both in home care and in CHSLDs.
At home, the average number of hours of service was established annually at 1,962 hours. However, in fact, it varied between 325 and 692 hours between 2015 and 2021. In CHSLDs, this threshold is also 1962 hours per year. Between 2015 and 2020, it was rather 1157 to 1249, notes the report.
In 59% of home care users aged 70 or over and with a great loss of autonomy, “less than 5% [des] needs were met in terms of home help and nursing care received at home” in 2020-2021.
In front of the media, the Minister responsible for Seniors, Marguerite Blais, recalled that she had recently tabled a policy and an action plan for long-term accommodation. ” We are on the right path. I don’t know of any government that has invested, in three and a half years, $1.9 billion to provide home care,” she added. “Now, it also takes staff to provide home care,” she added, pleading for better working conditions for these professionals.
No projection for 15 years
The AG’s report also shows that the Government of Quebec has ignored the fate of seniors for years. “For more than 20 years, the [ministère de la Santé] is aware that the demand for long-term accommodation will continue to increase. Yet for nearly 15 years it did not make projections of this demand,” the report read.
At the same time, “from 2005 to 2019, the ministry chose not to increase the number of places in CHSLDs. In reality, this number has decreased by around 15%”, observes the VG in its audit.
The Ministry of Health finally built in 2018 new projections over ten years in 2018, for seniors aged 70 and over. “The expected average annual increase is 2,026 seniors in CHSLDs from 2019 to 2028,” the report notes.
The projections are however made “over too short a period” according to the VG, who believes that “projections over a more distant horizon would make it possible to have a fairer vision of the challenges to come”. “Furthermore, the [ministère de la Santé] did not include certain important variables in its calculations, including the number of seniors waiting for a place in permanent long-term accommodation, when these represent part of the real demand”.
Among these seniors, some occupy a short-term bed in the hospital while waiting for a transfer to a residential resource more suited to their long-term needs. The mere fact of keeping these people in a hospital center costs the Quebec state 65% more than their accommodation in a CHSLD, notes Ms. Leclerc.
As of March 31, 2020, a total of 2,352 seniors were waiting for a permanent place in long-term accommodation in Quebec. The 2,600 places promised by the government in seniors’ homes by the fall of 2022 should therefore just “cover the people who are waiting,” said Ms. Leclerc.
On-sight navigation for home care
Regarding home care, which the government is seeking to promote, the VG notes that the Ministry of Health “has no precise description of the planned evolution of the model for providing services to seniors at great loss of autonomy in a context of accentuation of the shift towards home support, nor of an action plan that would make it possible to implement it”.
Clearly, the government “does not know the costs associated with maintaining a senior with a great loss of autonomy at home according to his personal situation and the desired service organization model. Consequently, it is not in a position to compare these costs with those of the various long-term accommodations,” adds Ms. Leclerc.
In general, the ministerial planning document produced in 2020 by the Ministry of Health contains scenarios that “do not provide for any catch-up aimed at reducing the current deficit of home support services”. Nor do these scenarios make it possible to meet the needs of seniors who will need long-term care by 2028-2029 and are based on a supply of care that is much lower than that required for a senior in great loss of autonomy, underlines the VG.
Ms. Leclerc’s report also reveals that the “average total annual cost” for a bed in a seniors’ home is estimated at $150,000 by the government. This cost is higher than all other types of hosting. At $118,019, the “average total annual cost per bed equivalent” of public CHSLDs is the closest to the estimated cost of seniors’ homes.
The government’s latest budget allocates $1.5 billion over five years to seniors’ homes. From 75 million in 2022-2023, operating costs will increase to 501 million in 2026-2027. Quebec plans to open 2,640 places in 33 seniors’ homes by September 2022, and a total of 3,480 places in 46 homes by 2023.