Private residences for seniors (RPA) are increasingly finding themselves with elderly people who are seriously losing their autonomy, while these environments are often not adapted to meet their needs, reveals a study published Monday by the Interuniversity Center for research in organizational analysis (CIRANO).
In particular, it is argued that the improvement of home services delays the arrival of elderly people in RPA at a time when their autonomy is declining. The average age of new tenants is higher than a few years ago, according to establishment managers.
The latter have the feeling of being left to their own devices in the face of the needs of seniors which exceed their range of services. They say they adapt their services in the interest of kindness, which causes financial losses and an overload of work.
“The loss of autonomy of seniors is accompanied not only by an increased need for services, but also by more aggressive behavior on the part of certain residents as well as cognitive disorders,” indicated managers of private residences. Like the staff, they see that the needs of seniors are increasing.
Home care and services, for example changing compression stockings or treating wounds, must be offered by CLSCs in RPAs. However, they are often deficient, indicates the study, which has repercussions on all residents. “RPAs must provide care and services for which there is not necessarily dedicated staff. Some RPAs absorb the financial costs arising from these services,” we can read in the document which is more than 200 pages long.
An RPA may proceed or request that the loss of autonomy of a resident person be identified, according to the Regulation respecting the certification of an RPA. The evaluation must be carried out using the Research Program on the Integration of Services for Maintaining Autonomy, but this tool is not always used by certain residences which prefer to equip themselves with an in-house tool. Furthermore, the study concludes that this tool as well as the Functional Autonomy Measurement System are not adequate to determine the needs of residents.
Mélanie Bourassa Forcier is the researcher who conducted the study entitled Private residences for seniors (RPA) in Quebec: issues and opportunities. Its methodology includes a literature review and the grouping of statistical data, a portion including interviews with RPA managers and employees as well as surveys addressed to residents.
Ms. Bourassa Forcier and her team also made several recommendations to remedy the problems raised in the research. On the aspect of identifying loss of autonomy, they indicated that it would be relevant for an assessment tool to be developed by a clinical team of an RPA and to make training available on the use of the tools. currently available.
When it is assessed that the RPA no longer meets the health needs of a senior, the transfer times to the appropriate establishment are too long, the study notes. There are also communication gaps between the RPAs and the CISSS / CIUSSS, which accentuates this issue.
As a solution, we suggest “financially compensating an RPA that adapts its service offering to the needs of a resident, because the transfer times are too long.”
The RPA landscape is changing
RPAs constitute the largest offer of places in living environments for seniors in Quebec, but their number has been declining for several years
“As of March 31, 2024, the number of RPAs, as well as the number of places available, have both decreased, falling to 1,393 RPAs and 136,525 units respectively,” the study indicates.
Generally speaking, in recent years, smaller private residences have tended to close their doors while larger establishments take up more space in the landscape. It is estimated that the total number of RPAs decreased by 23% in Quebec between 2015 and 2023. During this period, the number of large RPAs (100 units or more) increased by 24%.
Between 2019-2020 and 2022-2023, at least 432 RPAs went out of business. Of this number, nearly 90% were residences with 30 units or less and at least 11 were non-profit organization type RPAs. For 2023 alone, 77 additional private residences have ceased operations or changed purpose.
The vast majority of RPAs are intended for seniors with a more pronounced loss of autonomy, what we call categories 3 and 4. Category 1 and 2 RPAs are those intended for independent seniors and they represented 15 % of RPA in 2023.
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