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.
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.
Whether in small, medium or large RPAs, there are difficulties obtaining care and services in the homes of these establishments. “But where there are more problems is that at the level of small RPAs, we are often in the presence of residents who have less significant degrees of autonomy compared to residents in large RPAs. . Necessarily, this means that we need more home care and services, explains M.me Bourassa Forcier. […] This is where there is a disparity in terms of services that residents can receive depending on where they have chosen to reside. »
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.
“To the extent that the CLSC or health establishment is not able to offer the home care and services that must be offered, there should be some compensation [financière] to ensure the survival of RPAs. It is important that we maintain the different types of RPA, both small and large, because people do not all want the same type of residence,” argued M.me Bourassa Forcier.
The Regroupement québécois des Résidences pour Agieux (RQRA) says that it has been repeating for years that RPAs must provide care to their residents who are losing their autonomy without being sufficiently compensated by the CISSS / CIUSSS.
“Rather than being partners and being complementary to the public network by delaying the transfer of seniors to housing resources, RPAs are being overused. Due to a lack of places in the public network, they are forced to keep clients whose care need profile is too high, which drains their resources and causes closures,” deplores the president and CEO of the RQRA in a press release, Marc Fortin.
Requests to the Santé Québec agency
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.
Mme Bourassa Forcier and his team indicated that it would be relevant for an evaluation 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. “And there, if there is indeed an overrun of services, there are delays to be able to transfer the person”, indicates Mme Bourassa Forcier.
In addition, there are not always units available in higher category RPAs intended for people losing their autonomy or in CHSLDs. “This ensures that the person remains in the residence, where initially, we did not anticipate these needs. Either this implies an overload for the employees, or it implies unmet needs for the resident. These situations are quite a headache for RPAs,” underlines the researcher.
Furthermore, the new Santé Québec agency should be responsible for the RPA file once it is well established. Mme Bourassa Forcier believes that the most urgent thing for the state-owned company will be to find a way to relax the regulations which are too heavy at the moment, which is leading to RPA closures. “Among the residents we spoke to and surveyed, there is not one person who wants to go to an RPA if we have the impression of being in an institution, they want to feel at home” , specifies the researcher.
She also believes that Santé Québec has a duty to ensure healthy collaboration between health establishments and RPAs. The agency should ensure that it is possible to “raise the red flag” when there are problems.
Mr. Fortin, president of the RQRA, hopes that government authorities will take note of the CIRANO study and that they will relax current standards to avoid closures.
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%.
Since 2019, at least 432 RPAs have gone 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.
“It is the financial pressure that arises from over-regulation, but also from the tensions that are sometimes present with health establishments. […] This is really the inability of small RPAs which operate with a smaller volume, so necessarily there are higher costs to operate in a context where there are more and more standards that we must meet, underlines Mme Bourassa Forcier. There is considerable pressure on these RPAs which explains these closures. »
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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