More than 600 days of waiting | The Press

Suffering from Alzheimer’s disease, Montrealer Jean Bossé was placed on a waiting list to obtain a place in Quebec’s public accommodation network in 2021. It was only more than 600 days later that the 68-year-old man was finally allocated a room in a CHSLD.

“The system is insane. There is a serious change to be made on the part of the health and social services authorities,” said Mr. Bossé’s partner, Monique Hébert.

Daughter of Mr. Bossé, actress Anne-Élisabeth Bossé deplores the fact that throughout the process, it was impossible to obtain information on her father’s rank in the waiting list. “We don’t know anything. It’s very opaque,” ​​she says.

“Very aware” that solutions must be found to increase the supply of accommodation for seniors in a context of an aging population, the Minister responsible for Seniors, Sonia Bélanger, nevertheless believes that we “cannot paper the Quebec CHSLD”. “We want to change the model of aging in Quebec in relation to accommodation,” she said.

Mr. Bossé’s case is not unique, as revealed by stories collected by The Press (see the tab “Caregivers “trapped””). A former businesswoman from the west of Montreal, Marguerite (fictitious first name*) has, for example, been waiting for more than a year for a place in a CHSLD. “We don’t know where we are waiting. We are just told to be patient and that a year is not that long,” says her daughter, who fears that her mother will die before obtaining a place in a CHSLD.

And his fears are not entirely unfounded: The Press discovered by going through the 700 coroner’s reports produced in 2021 and 2022 following the deaths of elderly people in private seniors’ residences that 25 of them died… on a waiting list for an accommodation place to the public.

This is how, on 1^er November 2021, a 76-year-old man, L. B., died while waiting for three months for a place in a CHSLD in the west of Montreal. The intermediate resource (often the stage preceding accommodation in a CHSLD) where he lived had nevertheless stressed to the authorities of the health network that LB’s case had become “too heavy for the capacities of the environment”, it is written in the coroner’s report produced following his death.

As of May 20, 2023, the CIUSSS de l’Ouest-de-l’Île-de-Montréal had 286 people on its waiting list for a place in a CHSLD. The average wait time was 232 days. The spokesperson, Hélène Bergeron-Gamache, emphasizes that urgent cases are taken care of “immediately”. For others, a “private service” including close monitoring, hygiene care and feeding assistance can “be offered 24 hours a day, 7 days a week, until the user moves to a CHSLD,” she says.

Among the other coroner’s files consulted by The Press, a 79-year-old person, Mr. B., died on January 21, 2021 following a fall down a staircase in the seniors’ residence where she lived in Marieville. Suffering from Alzheimer’s, this lady had been waiting for a place in a CHSLD for 17 months.

The spokesperson for the CISSS de la Montérégie-Centre, Martine Lesage, affirms that places in CHSLDs are allocated according to the level of precariousness of the users. The most urgent cases can obtain a place within a few weeks. The longest period is normally one year. M^me Lesage recognizes, however, that places in units for clients with cognitive disorders, such as Alzheimer’s, are rarer and that obtaining one of these places takes longer.

President of the Coalition for the Dignity of Seniors, Pierre Lynch emphasizes that the problem has been going on for years in Quebec. But with the aging of the population, access is becoming more and more difficult. Mr. Lynch notes that elderly people whose profile would nevertheless require CHSLD care are sometimes not accepted quickly in these establishments “because of the lack of places”.

An obstacle course

In a special report published in October 2021 on access to public accommodation for seniors in Quebec, the Québec Ombudsman considered “unacceptable” the fact that some people wait several years to obtain a place in a CHSLD. He spoke of a “complex administrative structure” which left “little room for human considerations”. Then, in a new report published on September 21, the Québec Ombudsman indicates that access to accommodation in CHSLDs is still “an obstacle course” in Quebec. While waiting to obtain a place, some people “are taken care of by environments which do not meet their particular needs, resulting in a real risk for their safety”.

Vice-president of the Federation of Health and Social Services (FSSS-CSN), which represents 3,000 workers in private residences for seniors (RPA), Lucie Longchamp notes that the clientele has increased considerably in RPAs in recent years .

For me^me Longchamp, private residences for seniors “are clearly not all equipped to take care of this growing clientele”.

Director of public affairs for the Regroupement québécois des Résidences Privés pour Agieux (RQRA), Hans Brouillette affirms that this increase creates immense pressure on RPAs. When a resident loses autonomy, an assessment is requested from the CLSC so that home care can be provided. “But often it can take months. Who is responsible for the shortfall during this period? RPA,” he says. And when a request to travel to a CHSLD is made, again, delays can be long, notes Mr. Brouillette.

“What do those who have no one do? »

Jean Bossé had been enjoying his retirement for barely two years after a career as a police investigator with the Sûreté du Québec when he was diagnosed with Alzheimer’s disease in April 2019. He was 64 years old. “It’s a very, very early form,” says Anne-Élisabeth Bossé, who is spokesperson for the Quebec Federation of Alzheimer Societies.

As his loss of autonomy progressed, Mr. Bossé obtained some home care from his CLSC. His partner, Monique Hébert, hired private workers, used day centers and help from relatives. In October 2021, Mr. Bossé qualified to obtain a place as an intermediate resource.

“I wasn’t there yet, finding a place for him. But I was told that I shouldn’t wait too long to put him on a waiting list, because there were delays and the disease progresses quickly,” says M.^me Hébert, who therefore accepted.

In November 2022, Mr. Bossé moves to a private seniors’ residence.

As the weeks passed, Mr. Bossé’s state of health deteriorated. To the point that the private residence he lives in issues a “notice of excess care”. “That’s when we had to consider the CHSLD,” notes M^me Hébert. But when she inquires, she learns that her partner is still considered priority 4, i.e. a non-urgent case, on the waiting list. The problem: the RPA where Mr. Bossé lives and the CHSLDs where he is waiting are all in Montreal, but in two different territories.

After the publication in August of an article by The Press on the problems of access to CHSLDs between health territories, the Minister for Health and Seniors, Sonia Bélanger, recalled having modified the protocol for access to accommodation in the spring to be precisely “more flexible”.

M^me Hébert asked several questions and demanded meetings with decision-makers. Her partner finally moved on September 20 to a CHSLD in Montreal where he receives excellent care.

M^me Hébert and Anne-Élisabeth Bossé wonder what happens to people who have no one to fight for them and navigate the system. “I am relatively young. I am educated. I know how to take care of myself. I’m not afraid to speak […] What do those who have no one do? », asks M^me Hébert.

Multiple solutions

In an interview, Minister Bélanger assures that she wants to increase accommodation places for people with serious loss of autonomy in Quebec, in particular by opening 46 seniors’ homes (3,500 places). A “needs assessment” is also underway to add CHSLD beds in certain regions by renovating existing buildings. The Laurentians, Lanaudière, Montérégie and Outaouais are among others targeted. But^me Bélanger does not just want to focus on CHSLDs. “Our goal is really to overhaul the entire lodging ecosystem,” she says.

The minister wants to “continue to support RPAs” and also “continue the development of home care”. When it is pointed out to her that the home care clientele is not the same as that of CHSLDs, the minister replies that “the more we invest in home care, the less people need to go to CHSLDs”.

Professor at the Faculty of Nursing at Laval University, Philippe Voyer adheres to this vision of diversifying models of care for seniors. But according to him, the pressure of aging will be “so immense that we will still need many more accommodation places for people with cognitive disorders”.

The minister recognizes that the challenge remains great. Among other things, because the staff shortage is significant. “But we have to move. We have no choice,” she said.

* The family wanted to remain anonymous so as not to harm their case.