The Quebec model of seniors’ residences (RPA) is “unsustainable” in its current form, estimates a new study carried out by a group of researchers on behalf of the Interuniversity Research Center for Organizational Analysis (CIRANO), and that The Press obtained.
A team of five researchers, under the direction of Mélanie Bourassa-Forcier, professor at the faculty of law at the University of Sherbrooke, compiled a large number of data on the 1,800 RPAs in Quebec and carried out more than thirty interviews with RPA managers. Surveys were also conducted with RPA staff and residents. “This is what makes this study original,” says M.me Bourassa-Forcier. We enter into the internal workings of the residences. » Several issues emerge.
1. The number of RPAs is decreasing, but the number of places has increased
The number of RPAs has decreased by a quarter since 2015, but the total number of places has increased by 18% until 2023. There is therefore a “concentration of places in large RPAs”, the researchers conclude.
It is especially small RPAs with fewer than 30 places that are affected by the most recent wave of closures. The number of RPAs in this category decreased by 52% between 2015 and 2023.
The burden of certification requirements places a significant burden on RPAs. “We are in a phenomenon of densification of standards. Institutions that protect themselves by saying they want to protect people. And, one thing leading to another, we arrive at specifications that are increasingly voluminous. We absolutely must stop this over-regulation,” said M.me Bourassa-Forcier.
The labor shortage also seriously complicates the lives of RPAs: the report cites the example of an RPA which has hired 86 people in recent years, even though its residence only has 34 places.
2. Private residences are overloaded by the health network
Private seniors’ residences are used well beyond their capacity by the health network, and find themselves housing elderly people whose loss of autonomy is such that they would have to find themselves in other resources. “For example, a woman requires intervention every two hours, day and night, it has been a year and a half since the notice was submitted to the CLSC and there is still no place for her,” relates a manager.
Some CLSCs, when contacted by RPAs, also tend to minimize their requests. “ They take us for a people landing stage. I am a private RPA and not a hospital center. They overuse their rights,” says a manager. In general, estimate the staff members surveyed, the cases have increased over the years: 81% of them believe that the needs have increased.
When the public network does not offer the required services, RPAs tend to take it on, even if they do not necessarily have the staff to do so.
The CIUSSS assumes that from the moment they are in RPA, they are taken care of and as they do not have places in the network, it is “come what may,” keep them.
An RPA manager who testified as part of the study
Likewise, the number of RPA places “purchased” by the health network has jumped since 2015. The number of RPAs having at least a “108 agreement” with the health network, which then assumes the costs of the accommodation, went from 217 establishments to 422. This is almost a 100% increase.
3. Moving residents poses a lot of challenges for RPAs
When an RPA considers that a resident is no longer able to live there because he or she is losing too much autonomy, it must send a notice of excess to the health network. Except that families are often opposed, fearing that their parent will have to move. “The RPA manager therefore finds himself in a position where he knows that this person’s needs are not being met and that he is no longer safe,” note the researchers. Added to this are financial considerations: some seniors, due to a limited budget, have difficulty finding a place.
The prospect of moving is a significant source of anxiety for seniors living in RPA, noted Mme Bourassa-Forcier during his visits. “The ideal would be to make sure to create a link with other RPAs, so that people know that this is where they are going to go when the level of autonomy decreases. »
4. Rents and fees have increased significantly in recent years
Even though Quebec has on average the lowest RPA rent prices, the monthly amounts requested from RPA clients have increased because the operating costs of establishments have also increased.
A third of the residents surveyed also believe that their rent is too expensive, even though the government offers a generous tax credit to RPA residents.
Government spending linked to this tax credit has increased by 40% in the space of 5 years.
As the ability to pay of a good proportion of seniors is still limited, researchers suggest encouraging the population to acquire insurance for long-term care. Like prescription drug insurance, researchers suggest a hybrid formula, a mix of private insurance for long-term care and a public autonomy insurance plan for more disadvantaged clients. “Everyone should have insurance for their old age,” says Mélanie Bourassa-Forcier.
The researchers also highlight the need to create more non-profit RPAs, to allow seniors who have less income to access the RPA network. “We must increase the number of these establishments, in particular through municipalities and the community,” concludes the researcher.