Quebec must take action, launch an ambitious project and reinvest massively in home support, concludes the Commissioner for Health and Well-being (CSBE) Joanne Castonguay in a new report. But it will also have to ask users to contribute financially, according to her.
“If nothing changes, ensuring that citizens who wish to do so remain safe at home for as long as possible will be an impossible challenge,” says volume 4 of his analysis of home care in Quebec.
And to meet this challenge, the government must “impose a contribution from users”, according to the commissioner, who does not comment on the amount of such a contribution, but indicates that it must be “according to their means”.
Remember that the home care provided by the network includes nursing care but also domestic help and personal assistance such as meal preparation or hygiene care, for example.
“The Ministry of Health and Social Services cannot bear sole responsibility for developing the ecosystem for maintaining autonomy,” argues Mme Castonguay in his report. She also points out that the majority of people would be in favor since a total of 78.3% of people say they are ready to pay more, according to a web survey carried out as part of the mandate among a group of 55 to 69 year olds.
In 2023, the Quebec government spent $2.155 billion on home services. However, this only corresponds to a third of the total of what we call long-term care, which is monopolized by the financing of CHSLDs.
According to the commissioner, this trend must be reversed. Quebec, she writes, currently meets only 10.7% of the needs for home support hours, or 25.4 million hours out of the 234.7 million that should be offered.
Meanwhile, more than 17,000 people were waiting for a first home support service in 2022.
Restrict access to CHSLDs
On the other side of the spectrum, the network manages to meet 98% of the demand for places in CHSLDs, a much more expensive system.
Thus, CHLSDs monopolize 62% of long-term care funds, but only take care of 16% of users, while with only 38% of the budget, home support takes care of 84% of people.
In this context, CHLSDs should be reserved for people with serious loss of autonomy who are not able to move around (an ISO-SMAF profile of 10 to 14), judges Mme Castonguay. This is the case for the majority of residents currently (at least 85%).
The commissioner also believes that the contribution of CHSLD residents is also increasing. Currently, a single room in a CHSLD costs a maximum of $2,142.30 per month, an amount that can be reduced depending on people’s ability to pay.
This rent is imposed out of “concern for fairness between accommodated adults and those living at home,” indicates the Régie de l’assurance santé du Québec (RAMQ).
Because if health services are free for everyone in Quebec, “when you are accommodated, you must assume the expenses related to your lodging and your food”.
This is a crucial question, underlines the commissioner, because a vast majority of Quebecers want to age in their home for as long as possible (83% when surveying the general population; 91% among those over 55). ).
“Aging is not a disease. Long-term care and services should be integrated into a perspective,” she also writes.
More details will follow.