By 2030, 25 percent of the Quebec population will be 65 or over. Today, this proportion is 21 percent, and the pressure on public residences for long-term care (CHSLD) in Quebec is already becoming too much to manage.
This reality hit us during the first wave of the pandemic when deaths from COVID-19 were overrepresented in these facilities. However, even before the pandemic, an assessment by health authorities between 2015 and 2017 found that living conditions in 11.5 percent of public CHSLDs were “worrying,” while only 17.6 percent were deemed “completely adequate”. The rest (71 percent) were simply “acceptable”. But whether worrisome, acceptable or entirely appropriate, aging in an institution is simply not what most seniors in the province hope for. On the contrary, 71 percent of Quebecers want to stay at home at age 75 and over.
The province should therefore build a home care system that corresponds to the population’s wishes and meets the needs of the elderly of Quebec. For this to be done in an efficient and fiscally responsible manner, the province must rethink its historical dependence on CHSLDs, particularly in terms of the allocation of financial resources. In other words, a greater proportion of the total budget for the care of the elderly must be devoted to home care rather than to institutions.
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In 2019-2020, only 22 percent of the Quebec Seniors Autonomy Support Program (SAPA) budget was devoted to home support services, while seniors living in CHSLDs monopolized 63.6 percent of the funds. This distribution is almost exactly inversely proportional to the distribution of elderly people cared for: approximately 20 percent in CHSLDs and 75 percent at home.
Part of the funds freed up by transitioning to a system favouring home care should then be redirected to a training program for family caregivers. This is all the more important since natural caregivers, whose number is estimated at 1.5 million in Quebec, provide up to 75 percent of the care required at home for their elderly loved ones.
Given the time they devote to helping people in need, it is imperative that caregivers have access to adequate training in order to provide safe and effective care to their loved ones. A range of services could be offered through the training program, including assistance in navigating the many existing tax credits in Quebec, ensuring that caregivers and the people they care for receive the available financial resources. The program, to be comprehensive, should also include an attendant or nurse showing a caregiver how to safely perform tasks such as changing dressings, changing bed sheets with minimal physical effort, etc.
To have the best chance of success, the government must leave it to existing organizations to design, administer and implement the program. The government’s role would be limited to financial support and awareness raising. The ultimate goal would be to delay or avoid having to institutionalize the elderly due to the lack of know-how of the caregivers.
In addition, entrepreneurs in the province must have the opportunity to develop new technologies to facilitate the independence of seniors in their homes. The current situation is characterized by regulatory barriers and heavy bureaucracy, so new products do not reach the people who need them in a timely manner. Likewise, the home care network itself needs to adopt today’s technologies more rapidly and catch up with the rest of the industrialized world.
By creating a training program for caregivers and facilitating innovation within the home care network, more seniors will be able to experience the benefits of staying in their own homes as they age. For people with dementia, for example, living in a familiar environment and preserving their independence can contribute to their sense of well-being and quality of life. Additionally, home care costs are generally billed by the hour, allowing for greater flexibility in payment plans.
Quebec must renounce its dependence on institutionalization. With some significant adjustments, it can instead offer many seniors the opportunity to age in place with the help of their caregivers, who will have been equipped with the tools necessary to care for their loved ones.
Maria Lily Shaw is an Associate Researcher at the Montreal Economic Institute and the author of Spending Your Golden Years at Home: Developing Home Care Services in Quebec.
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