Tuesday, May 28, 2024

aging at home | Journalism

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Maria Gill
Maria Gill
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The pandemic and many unanswered questions about the future of older adults have prompted artist and author Louise Forester to join geriatrician Reagan Heber. “Regin, we have to talk about seniors! What’s waiting for me? What’s in store for us? I heard a cry from the heart. And share it. They give their thoughts in a lively email exchange we’re posting part four of today.”


Dear Regine,

It’s your old woman, old Louise writing to you after a hot summer to say the least, it reminded me of 38 °He was doing this in my father’s room at CHSLD the day he died in 2003. There was no air conditioning in the rooms, I wonder: is there any today? I get the impression that nothing has changed since then.

Réjean, did you know it would cost me about $10,675 to keep my hygiene (five bathrooms per week), my person and my accommodations. I learned this by reading the excellent paper by Marie-Helen Proulx in news. Come on, fellow citizens, read it, it’s scary, but it’s a good slap on the buttock at any age, it “helps” as we say in the new language!

In this article, she reveals to us that Quebecers are among the least served people in the world in terms of domestic support!

When should you put your name on the CLSC Home Care List or something?


* * *

‘Make’ CHSLD residents

hello louise

In fact, Quebec ranks last among the industrialized countries in terms of public funding of home services for seniors (and the rest of Canada is no better). sad record. How did we get here?

It dates back to the establishment of our public health system 50 years ago. At that time we were a young country with baby boomers in its heyday: we had to cover medical services and hospital care. That’s what Canadian law set by urging provinces to create public funding for doctors and hospitals, with a promise to pay half the bill. Quebec followed suit, with the creation of health insurance and wanted to go even further and cover front-line services outside the hospital. We even set up an institution with this mandate, CLSC. It was a rather revolutionary innovation: an organization focused on local services with a board of directors made up of citizens. Citizen participation was at the heart of planning and delivering services to the population.

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Among the prerogatives of the Social Welfare Services Centers, we find home services, especially for the elderly who have lost their independence. This profession was confirmed and overseen by the Home Care Policy in 2003.

But now, budgets are not followed. Even worse, the 1995 ambulatory shift, which shortened hospital stays, shifted post-hospital responsibility to HCS. However, funding for post-hospital services has eroded funding for home care for the elderly and disabled.

Subsequently, successive reforms of 2003 and 2015 abolished the autonomy of social services centres. This is now only one of the tasks of the new institutions that the hospital has taken over. However, the hospital profession drains a large portion of funding and human resources. Therefore, home care for the elderly has diminished and is no longer a priority. Example: a person who leaves the hospital will receive their care at home the next day; An elderly person who has lost their independence must wait weeks and months to expect to receive less than two hours of care per week (average 1.7 hours per week). So you have to do it early, dear Louise.

During the first wave of the COVID-19 pandemic, people receiving home care saw a significant reduction in their services. CLSC workers transferred to CHSLDs; Socioeconomic institutions and community-based organizations have had to reduce or stop their services. Older people were left to live with loved ones who had exhausted themselves to make up for the lack of services. Consequences: deterioration of health, resignation of relatives, hospitalization, transfer to CHSLD. A slow stunt that usually speeds up during a pandemic.

This is how we “make” CHSLD residents: through inadequate home care. It’s sad and it’s also very expensive for society. To change that, we need to invest more, but above all differently in home services. Even with increased budgets under current circumstances, the hospital ghoul is watching: Money invested for home care is feeding the hospital and not necessarily translating into more services.

To answer your question, dear Louise, you cannot put your name on the home care waiting list if you are not already experiencing a loss of independence and a need for services. If this happens, you will need to be patient and hire a caregiver to support you while you wait. Or use your savings to pay for services.

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* * *

And what about France?

Dear Regine,

Your text enlightens me. It is disturbing to note the ideological and economic perversion that this organization has taken to the level of old and old people who just want to live their lives, in their real streets, with differences in ages, skin colours, dialects, and languages. , the music, and the aroma of cooking involved, especially those who wish to grow old at home.

Far from us, in the suburbs near Paris, that’s what Therese, the mother of my French-Italian friend, chose to live, but I must admit that ten years ago I hardly asked Patricia if she had ever been to an EHPAD (a residence institution for dependent seniors) About her mother’s suite, because you had to plan in advance to find a place!

It seemed to me that EHPAD works better there than the CHSLDs here. But all the same Therese, 82, still keeps a home with her cat Melody and above all doesn’t want to get old anywhere other than her own. My friend respected her mother’s wish. She spends with her every other weekend, and little by little she manages to provide enough help around her mother as well as the neighbors who have taken a benevolent look at Therese.

All this to ask you whether what Thérèse is going through is exceptional or that “old age at home” in France is almost a stay in the desert of solitude.


* * *

Wayne Gretzky on the bench

Dear Louise,

I am closely following the situation in France. I received my training there in geriatrics and social gerontology at the beginning of 1980 in Grenoble. I spent a year in Paris at the CNSA in 2011 and I’m there again, this time in Nice, for a year off. France was electrocuted in 2003 during a heat wave that killed nearly 20,000 elderly people and women. He then followed suit in several neighboring countries by creating a Personal Autonomy Allowance (APA). It is a general long-term care insurance. The needs of the elderly are assessed and a specific amount is allocated according to the importance of the need. With this amount, people can receive their care in a residential facility for Dependent Seniors (EHPAD) or at home.

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And guess what? People like Therese, prefer home. With this allowance, they can fund the services they need. Not all services, of course, but a large part of them allow home support. APA amounts were increased a few years ago.

I was able to see how this allowance works for myself during my stay in France and took the opportunity to go see similar insurance policies in place in Germany, Luxembourg and the Netherlands. I went to Japan and South Korea where this system was also implemented. It works it works. The allowance allows the financing of public or private services, and it is the person and his or her family who decide what takes priority. Budget decisions are not made by the public institution, but by individuals.

This is the system I wanted to implement in Quebec through the Independent Insurance Project. In addition, Quebec has many advantages: we have a standardized assessment that is done by a case manager who develops a service plan with the person, this assessment is translated into categories of needs that can correspond to the amount of the allowance, and a computer system is already in place to facilitate all this. All that remains is to create a fund or fund and manage the process by Régie de l’assurance maladie et bingo … Unfortunately, time has run out for the adoption of the bill and the implementation of the autonomy insurance.

We will have to return to it. Furthermore, with colleagues from HEC, we have clearly shown that this will cost less than the current situation that favors an institutional staffing solution: CHSLDs, intermediate resources and other top centers. The government has announced that it will study the topic of home care. I hope to participate in this exercise. A colleague recently compared me to Wayne Gretzky who has been on the bench because the team is losing playoffs. I can’t wait, Louise, to jump on the ice and “score” some goals for old men and women who love you who want to live at home as long as possible.


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