Would you allow me a question?
What did you remember from the most recent emergency rankings? The Press ?
Except of course the fact that the situation is improving so little that the Minister of Health, Christian Dubé, must sometimes feel like curling up in a ball under his desk and spending the day there!
After reading my colleague Ariane Lacoursière’s file on the subject of the rankings, I for my part wanted to discuss it with the Commissioner for Health and Well-being, Joanne Castonguay, who published the last of the rankings in January. four reports of a study entitled Aging well at home.
Because one of the most significant findings from this list, in my opinion, is that the portrait of people who find themselves in emergency rooms is changing.
Both Minister Dubé and the president of the Association of Emergency Medicine Specialists of Quebec, Gilbert Boucher, stressed that the number of elderly patients who present themselves to the emergency room is increasing.
Not only that, but nearly 12% of hospital beds are occupied by patients waiting for “a place in a CHSLD or home care”. They prevent other patients in the emergency room from having access to the floors.
We already knew that our collective failure, when it comes to taking good care of all our seniors, has an impact on the state of health of our hospitals. We realize that the effect is more and more pronounced.
“It’s not so much the problems of emergencies, but the problems of: how we take care of people who are seriously losing their autonomy. Anything that does not work in the continuum of care has impacts in the emergency room,” summarizes Joanne Castonguay in an interview.
PHOTO OLIVIER JEAN, LA PRESSE ARCHIVES
Joanne Castonguay in 2017
She is also “not at all surprised” by the findings of the prize list of The Press.
The commissioner has now been studying, with her team, home care and support services in Quebec for two years. His diagnosis is precise and relevant.
“There are not enough places in long-term accommodation in CHSLDs, so people are accommodated in residences or stay there longer. Which means that as soon as there is a complication, we send them to the hospital,” explains Joanne Castonguay.
“And there are not enough doctors who go to homes” on a regular basis. Among other things because financial incentives do not favor this practice.
“We must therefore change the financing mechanisms and think differently. ” Because right now, “there is not enough attention being given to preventing complications and identifying what could lead to complications.”
And if the trend continues, the situation will not improve.
The commissioner’s most recent report shows that if Quebec does not change the way in which home care and support services for our seniors are managed, we are heading straight towards a wall.
“The first section of our report says it: if we continue to work like this, the challenge is impossible to meet,” emphasizes Joanne Castonguay.
There are some terrifying figures in his report. Starting with the fact that the number of people with long-term care needs, which was 324,400 last year, will jump to 547,900 in 2040!
Aging is not a disease. We have to stop treating it like a disease, because as long as we treat it like a disease, that’s what we’re going to get.
Joanne Castonguay, Commissioner of Health and Well-being
Despite everything, Joanne Castonguay seems more optimistic than pessimistic during the interview.
“I have been analyzing health systems macroeconomically for 25 years and I have never seen so much desire to change things,” she explains.
She cites, among other things, Bill 15, which led to the creation of Santé Québec, the state corporation which will be headed by Geneviève Biron.
“The big finding from our first report was that the Ministry is very concerned about operations, but it is not putting enough emphasis on how to reorganize the system to be able to see the big problems coming, to work – precisely – on new financing mechanisms, to develop policies, etc. »
Following the creation of Santé Québec, that should change. If of course the new CEO obtains “the leeway” she will need from the ministry.
Joanne Castonguay also seems encouraged by “the creativity” and the “beautiful projects” set up in the network to allow each senior to be independent for as long as possible.
She cites, for example, a project called “regulatory paramedicine” set up in Montérégie a few years ago.
The name is opaque, but the system is simple. When 911 receives non-emergency calls from seniors, “rather than taking them to the emergency room, they will send paramedics to the person, who will assess their situation and ensure that they receive appropriate follow-up.”
The problem currently is that this culture of innovation is not yet sufficiently stimulated by the system. In fact, sometimes it’s even the opposite.
“The big difficulty we have is that when we have great innovations like that, which work, we are not able to integrate their financing into the regular system. This is what I want to work on in the coming months,” specifies the commissioner.
But she also pleads, in the long term, for a change in culture: we must show more kindness towards our elders. We realized this during the pandemic, she emphasizes. All we have to do is “integrate it into our ways of living”.
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