A year ago, the fees imposed on patients who no longer require acute care in the hospital, but refuse a place in a transitional residential environment that they consider incompatible with their daily life or that of their loved ones, went from $282 to $429 per day. This leap has rightly been described as “scandalous” by the Council for the Protection of the Sick. But beyond the indecency of imposing such amounts on vulnerable people, we must think lucidly and calmly about hospital beds that the latter mobilize in spite of themselves.
As of April 7, the rate of hospitalized users no longer requiring hospital care was up slightly, at 12.12%. That’s a lot of blocked beds. Too much. For the ballet of beds to work and throw enough ballast on our overrun emergencies, the Ministry of Health and Social Services calculates that this rate should not exceed 8%. That he seeks to liberate these places has therefore nothing of caprice, but everything of necessity.
This practice is perfectly legal, that is not the question. Health establishments are required to demand compensatory sums in accordance with an implementing regulation of the Act respecting health services and social services. It is even fully justified if we want to offer the right care, at the right time, in the right place, by the right professional to all Quebecers. But is the way in which it is applied moral? The question is valid.
Highlighted in these pages by reporter Marie-Eve Cousineau, this practice has allowed aberrations that speak volumes about the path that remains to be traveled in Quebec to face our reality of an aging society in a health network in full refoundation. Already, the enormity of his daily rate has drawn unanimous opposition among opposition parties, with some calling it “excessive” while others criticized his blatant “lack of humanity”.
How, indeed, not to find unreasonable the more than $27,000 billed to a 90-year-old man for having refused to allow his 83-year-old wife, who no longer required hospital care, to be transferred to a transitional environment located in her forties miles from their residence? According to their son, this heartbreaking sum exceeds the frugal savings of the couple, together for six decades.
The amount in question is determined by Quebec. At $429 per day, it far exceeds the $41.89 to $67.31 claimed on average per day for equivalent out-of-hospital services. The government deserved the volley of green wood it received. The Minister for Health and Seniors, Sonia Bélanger, was quick to rally to the critics by committing to quickly carry out an analysis “in order to reduce the amount” of $429 per day. We congratulate him.
But this penalty, which aims to discourage unnecessarily long hospital stays, does not affect Quebecers in the same way. The Minister must not stop on such a good path in her thinking. Reducing the bill is good, but providing more flexible and better targeted pricing structures to take into account everyone’s needs and limits would be much better.
We must also make transitional environments more accessible and welcoming. All the specialists agree in saying that between the hospital and these, even imperfect ones, it is the latter which are best suited to these waiting users, and by far. Safer, they are in fact better suited to support and stimulate these clienteles with significant needs.
We will also have to take a more frontal interest in the elephant in the room. If these people and their relatives refuse temporary places that do not suit them within a radius of less than 70 km, it is firstly because our public network is no longer sufficient to stem and organize the flood of requests for help, rehabilitation and accommodation he receives. No less than 4,067 people were waiting for a place in a CHSLD last February. In February 2019, this number was 2477.
The number of people waiting for a first home support service has not stopped growing either during the same period. It was close to 19,000 last December. The network is far from idle, however. While the number of users who benefit from this type of support has not changed much (350,838 in 2019-2020, compared to 365,796 in 2022-2023), the cumulative number of hours of services given has really jumped , from 20 to 28 million. However, much more is needed.
To simply soften the penalties would be to ignore a deleterious dynamic that harms these clienteles, but also all those waiting for care, first and foremost all those patients who wait in the emergency room waiting for a bed on the floors. It is imperative to break this dynamic, which begins with an urgent and robust enhancement of our transition, rehabilitation and accommodation environments.