Elderly care | Four times more services for the same bill

Seniors repeat it: they prefer to age at home and receive their care there. However, the expansion of this home care also entails a formidable bill for the state. What to do ?

Good news, a team of experienced researchers has come to some interesting findings on this issue. And it found that Quebec could quadruple home support for seniors in need for a public bill that promises to be equivalent to a projection of the current status quo within a few years.

The study, published Monday, was conducted by a team of Pierre-Karl Michaud of HEC Montréal with D.year Réjean Hébert1. It has the great advantage of being based on a range of detailed data that allows the costs and direct benefits of different options to be clearly quantified.

The researchers were based on an inevitable observation: with the significant aging of the population, it will be necessary to double the number of places in CHSLD or in homes for the elderly (from 38,000 to 75,700) by 2040, i.e. in about fifteen years. Without this doubling, we are headed for major social problems.

But places in such facilities cost the state so much (up to $153,000 a year) that it would be more cost-effective to limit access by making seniors much better at staying at home.

By care we mean that which is necessary for daily and domestic activities (feeding, washing, managing the budget, etc.) as well as nursing care.

To achieve this, significant changes would be necessary. First, places in CHSLDs and nursing homes would be strictly reserved for very serious cases only (rating 10 and above on the 14 scale of the Iso-SMAF ​​model​​​​). These are often people with advanced Alzheimer’s.2.

On the other hand, for elderly people at home with a significant loss of autonomy, the care provided at home would increase fourfold, which would prevent them from being transferred to an institution. For example, the number of hours of publicly funded services would increase from the current average of 2 hours 25 minutes per week to 9 hours 40 minutes. And for certain severe cases it would be 9.30pm.

With their model, the researchers wanted to deploy a service offering different from the existing model, but with essentially the same budget.

In the case of the status quo, the state bill would increase from 7.3 billion today to 16.2 billion in 2040 (constant 2023 dollars). Taking aging into account, the status quo implies a 99% increase in CHSLD places (i.e. double). Home care would be limited to the current level, covering 11% of needs.

With their proposal, the system would hardly cost less (15.7 billion), but would serve a much larger part of the population.

Instead of covering 11% of domestic support needs, this share financed by the state would therefore increase to 40%. And total service volume would increase from 11.7 million hours to 90.6 million hours per year.

As for the number of places in CHSLD and others, it would no longer increase by 99%, but by 33% by 2040.

The researchers present two additional hypotheses for the success of their proposal. First, they would increase by 30% the contribution of users in CHSLD or intermediate resources. The current allowance is the lowest in Canada and does not take housing costs into account.

Another hypothesis: much of the new home care would be entrusted half-and-half to the community sector and the private sector – as we see elsewhere in the world – rather than the public sector alone.

According to them, this migration would make it possible to provide better services at lower costs. Quebec already has around a hundred Social Economy Home Assistance Services (EESAD) companies that are very active. The project involves multiplying the importance they would have in 15 years compared to the status quo projection (from 5,600 to 32,000 full-time employees) by six times.

2.8 billion per year

To achieve such a change, the authors suggest a rapid increase in the home care budget. Every year, Quebec should add the equivalent of 400 million new home care services, reaching 2.8 billion in seven years.

These funds would be financed from a relative reduction in the expected number of places in institutions, which basically means a significant reduction in the development of homes for the elderly and the rationalization of their costs.

“Quebec does not have the funding, manpower or resources to build and operate residential centers to meet the needs of an aging population, most of whom prefer home care when possible. Our leaders are required to make evidence-based decisions,” the authors write.

One might say that the saving would not be that significant, knowing that at present this care is often provided by carers at home, not by the state.

Pierre-Karl Michaud, on the one hand, answers that the time that relatives devote to this care reduces the time for their paid work, which our economy badly needs. And on the other hand, there remains a 60% share of care that will not be provided by the state (instead of the current 90%) and that will have to be provided from other sources.

The idea deserves serious consideration. Let’s hope it gets into the minds of Minister responsible for the elderly Sonia Bélanger and Prime Minister François Legault.

1. Read the document “Horizon 2040: concrete measures to shift to domestic support”

2. SMAF stands for Functional Autonomy Measurement System. The Iso-SMAF ​​scale classifies groups into 14 profiles according to their characteristics. Profiles from the same group require similar services at similar costs depending on the environment considered.

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