(Québec) The private geriatric mini-hospitals promised by the Legault government worry the Association of Geriatric Physicians of Quebec (AMGQ), which deplores the addition of a “new access route” which will “exacerbate the problems” and “vampirize” network resources.
Geriatric doctors have reservations about the new model that Quebec wants to develop.
The Coalition Avenir Québec promised two private mini-hospitals during the election campaign to relieve congestion on the front line. It was revealed this spring that future facilities will instead take the “more nested” form of geriatric outpatient centers1. One will be located in Lévis and the other in eastern Montreal.
“Although we welcome your desire to invest significant sums in improving care for the elderly, we believe that this approach will accentuate the problems by allocating resources to the wrong place,” writes the AMGQ in a letter addressed to the health Minister.
The Quebec Geriatric Society, full professor at the School of Nursing at the University of Victoria Damien Contandriopoulos and Mylaine Breton, from the Canada Research Chair in the clinical governance of primary care services, co-sign the missive published this Monday in The Press.
According to the signatories, these “mini-hospitals will only be a new access route in a network that is congested and complex to navigate”. They are particularly concerned about the “safety of care and patients” as illnesses “often present in an atypical manner” in the elderly.
“Take for example the fall. It can be the consequence of a trivial accident, but can also hide a medical problem. How can we ensure that patients referred to these “mini-hospitals” will be sent safely? Will they have access to the technical platform and consultations in specialized medicine if necessary? What will happen to the patient who was initially misdirected or who presents with medical deterioration? Will we transfer him to the emergency room? », they write.
Furthermore, they emphasize that older people who present for minor emergencies “are more likely to require hospitalization”.
According to them, “directing this clientele to an outpatient clinic risks not meeting needs, and even potentially harming patients by extending delays and increasing the number of transfers.”
“Finally, let us note the apparent absence of conclusive data supporting this project and the risk of draining the already largely insufficient human resources of the public system,” add the signatories, who are asking to meet Minister Christian Dubé. “We want to be part of the solution,” they assure.
A revised project
During its electoral commitment, the Legault government said it wanted the private mini-hospital in Montreal to include an outpatient clinic in geriatrics and that in Quebec, in pediatrics. However, after consulting the community and interested promoters (there were two calls for interest), Quebec revised its concept.
PHOTO EDOUARD PLANTE-FRÉCHETTE, LA PRESSE ARCHIVES
The Minister of Health, Christian Dubé
“The issue is the increase in the volume of the population in emergency rooms”, an aging population, explained the Minister of Health during the study of budgetary appropriations in April. Christian Dubé then mentioned the “more niche” scenario of “mini-emergencies” which would be “much more oriented towards the needs of an aging clientele”.
It is also because geriatric services are well organized in the Capitale-Nationale that the project was moved to Chaudière-Appalaches, said last Wednesday MP Youri Chassin, who is leading the file.2. The call for tenders was published last week. The one in Montreal should be there soon.
“What we currently have is not a well-defined project,” laments the president of the AMGQ, Dr.r Jacques Morin.
Elderly people, who have nevertheless contributed to society, are told: “you take up a lot of space in the emergency room, you prevent fluidity, we would find alternatives, perhaps send you to a service route not organized”. That worries me.
The Dr Jacques Morin, president of the AMGQ
According to the association, which represents some 100 geriatric doctors, it would be better to integrate new services into the public health network in the context of the aging population.
Solutions proposed by the AMGQ
- Provide emergency services in Quebec with the necessary tools to apply the measures of the ministerial reference framework “Towards an emergency service adapted for the elderly”, the objective of which is to reduce complications linked to emergency room stays.
- Strengthen the application of the approach adapted to the elderly in a hospital environment to prevent complications and reduce length of stay and the use of accommodation.
- Improve access, funding and operation of public geriatric outpatient clinics.
- Reduce emergency room congestion by tackling extended stays of patients waiting for an accommodation bed, home support or rehabilitation.
“Wouldn’t the integration of this population into our services be more relevant? […] rather than creating something in parallel? It will always remain that our elderly people will find themselves in the hospital, on the front line, in hospitalization”, illustrates the vice-president of the AMGQ, the DD Julia Chabot.
The two mini-hospitals are to be operational in 2025. The estimated cost for each facility is 35 million, which will be privately financed. Services will be covered by health insurance.
Read the AMGQ letter
1. Read “CAQ promise: private mini-hospitals converted into geriatric clinics”
2. Read “Mini-private hospital in Lévis: Quebec will announce another project for the National Capital”