Waiting
Dear Réjean,
It’s your old woman, your old Louise who writes to you after a scorching summer to say the least, it reminded me of the 38 °C he was doing in my father’s room at the CHSLD on the day of his death in 2003. There was no air conditioning in the rooms, I wonder: is there any today? I have the impression that nothing has changed since.
Réjean, did you know that it will cost me about $ 10,675 to keep clean (five showers per week) and my person and my accommodation. I learned that by reading the excellent paper by Marie-Hélène Proulx in The news. Come on, citizens, you have to read it, it’s scary, but a good slap on the buttocks at any age, it “helps” as we say in the new language!
In this article, you reveal to us that Quebecers are among the least well served in the world in terms of home support!
When should you put your name on the CLSC home care list or something like that?
Louise
* * *
“Making” CHSLD residents
Hello Louise,
Quebec is in fact in last place among industrialized countries in terms of public funding of home services for the elderly (and the rest of Canada is no better). Sad record. How did we get here ?
It dates back to the creation of our public health system 50 years ago. We were then a young country with baby boomers in their prime: we had to cover medical services and hospital care. This is what Canadian law instituted by urging the provinces to establish public funding for doctors and hospitals, with the promise of paying half the bill. Quebec followed suit, with the creation of health insurance and even wanted to go further and cover front-line services outside the hospital. We even created an establishment with this mandate, the CLSC. It was a fairly revolutionary innovation: an organization focused on local services with a board of directors made up of citizens. Citizen participation was at the heart of the planning and delivery of services to the population.
Among the mandates of the CLSCs, we find home services, in particular for the elderly with loss of autonomy. A home care policy even confirmed and supervised this vocation in 2003.
But now, the budgets never followed. Worse, the ambulatory shift in 1995, which shortened the length of stay in hospitals, transferred responsibility for post-hospitalization to the CLSCs. However, the funding of post-hospital services has eroded that of home care for the elderly and the disabled.
Then, the successive reforms of 2003 and 2015 abolished the autonomy of the CLSCs. This is now only one of the missions of the new establishments dominated by the hospital. However, the hospital vocation drains a large part of the funding and human resources. Home care for the elderly has therefore shrunk and is no longer the priority. An example: a person who leaves the hospital will have his care at home the next day; an elderly person with a loss of autonomy must wait weeks and months to expect to receive less than 2 hours of care per week (the average is 1.7 hours per week). So you will have to do it early, my dear Louise.
During the first wave of the COVID-19 pandemic, people receiving home care saw their services drastically reduced. CLSC workers have been transferred to CHSLDs; social economy enterprises and community organizations have been forced to reduce or cease their services. The elderly have been left to fend for themselves with loved ones who have exhausted themselves in making up for the lack of services. Consequences: deterioration of the state of health, resignation of relatives, hospitalization, transfer to a CHSLD. A usually slow stunt that precipitated during the pandemic.
This is how we “make” CHSLD residents: through insufficient home care. It is sad and it is also very expensive for society. To change that, we need to invest more, but above all differently in home services. Even by increasing budgets under current conditions, the hospital ogre is watching: the money invested for home care rather feeds the hospital and does not necessarily translate into more services.
To answer your question, my dear Louise, you cannot put your name on a waiting list for home care if you do not already have a loss of autonomy and need for services. If this happens, you will need to be patient and have a caregiver to support you while you wait. Or, use your savings to pay for services.
Réjean
* * *
And in France ?
Dear Réjean,
Your text enlightens me. It is disturbing to note the ideological and economic diversion that this organization has taken up to the level of old and old who only want to live their life, on their real street, with the differences in ages, colors of skin. , accents, languages, music, cooking smells that it entails and especially who want to age at home.
Far from us, in the suburbs close to Paris, this is what Thérèse, the mother of my Franco-Italian friend, chose to live, but I must admit my dear Réjean that barely ten years ago I ” asked Patricia if she had visited EHPAD (accommodation establishment for dependent elderly people) around her mother’s pavilion, because you had to plan ahead to find a place!
It seemed to me that the EHPAD worked much better there than our CHSLDs here. But all the same Thérèse, aged 82, still kept a house with her cat Mélodie and above all did not want to age anywhere other than in her house. My friend respected her mother’s wish. She spends every other weekend with her and little by little has been able to install around her mother an adequate assistance service provided by the City in addition to the neighbors who cast a benevolent eye on Thérèse.
All that to ask you if what Thérèse is going through is exceptional or if in France “aging at home” is almost a stay in the desert of solitude.
Louise
* * *
Wayne Gretzky on the bench
Dear Louise,
I am following the situation in France very closely. I did my training there in geriatrics and social gerontology at the beginning of 1980 in Grenoble. I spent a year in Paris at the National Solidarity Fund for Autonomy (CNSA) in 2011 and I’m there again, in Nice this time, for a sabbatical year. France suffered an electric shock in 2003 during the heatwave which killed nearly 20,000 old men and women. They then followed suit in several neighboring countries by establishing the Personalized Autonomy Allowance (APA). It is public insurance for long-term care. The needs of the elderly are assessed and a defined sum is allocated according to the importance of the need. With this sum, people can receive their care in a residential establishment for dependent elderly people (EHPAD) or at home.
And guess what ? Like Thérèse, people prefer home. With the allowance, they can finance the services they need. Not all the services, of course, but a significant portion that allows home support. APA amounts were even increased a few years ago.
I was able to see for myself how this allowance worked during my stay in France and I took the opportunity to go and see similar insurance policies in place in Germany, Luxembourg and the Netherlands. I went to Japan and South Korea where this system was also implemented. That works. The allowance makes it possible to finance public or private services and it is the person and his family who decide what has priority. Budgetary decisions are not taken by the public establishment, but by individuals.
It is this system that I wanted to implement in Quebec with the autonomy insurance project. In addition, Quebec has many advantages: we have a standardized assessment carried out by a case manager who establishes a service plan with the person, this assessment is translated into categories of needs which can correspond to an amount of allowance, a computer system is already in place to facilitate all of this. All that remains is to create a fund or fund and have the process managed by the Régie de l’assurance maladie et bingo … Unfortunately, I ran out of time for the bill to be adopted and that autonomy insurance be implemented.
We will have to come back to it. All the more so with colleagues from HEC, we have clearly shown that this would cost less than the current situation which favors the institutional placement solution: CHSLDs, intermediate resources and other senior centers. The government has announced that it will examine the issue of home care. I hope to participate in this exercise. A colleague recently compared me to a Wayne Gretzky who is kept on the bench as the team is losing the playoffs. I can’t wait, Louise, to jump on the ice and “score” some goals for the old men and women who like you want to live at home as long as possible.
Réjean