Money alone will not improve the care of CHSLDs, warns the health commissioner

CHSLD“,”text”:”Ces informations inédites sur la performance en CHSLD”}}”>This unprecedented information about the performance in CHSLD come from the study of 71 indicators and data provided by the Régie de l’assurance maladie du Québec (RAMQ) and the Ministry of Health and Social Services (MSSS).

The Commissioner and her team have established themselves a value-based assessment framework which led to the following conclusion: certains réussissent à bien se positionner par rapport aux balises établies, mais une grande majorité n’y arrive pas.”,”text”:”Il existe de grandes disparités dans la performance observée entre les différents territoires –certains réussissent à bien se positionner par rapport aux balises établies, mais une grande majorité n’y arrive pas.”}}”>Large differences in performance can be observed between the various territories – some manage to position themselves well in relation to the established benchmarks, but a large majority do not.

And these differences are affecting people spending their final days in residential and long-term care centers (CHSLDs). In 2019-20 it was 58,000; more than half of them were 85 years or older.

Among other things, the Commissioner considered the following:

  • Needs orientation (support and offering of suitable services);
  • accessibility (offering a place in a CHSLD at the right place and time);
  • productivity (optimization of supply based on resources);
  • the quality of care and services (offering a quality living environment).

No facility is targeted: It was really about drawing a portrait of Quebec and then finding out if it’s very differentexplains Geneviève Ste-Marie, responsible for scientific coordination in the Commissioner’s office. It’s a statement of fact with dates.

When we consult this state of affairs, we conclude that it is better to be in a CHSLD in certain regions than in others.

Especially at mealtimes: According to the Ministry, only 36% of CHSLD offer structured meals. That means standardized meal times, an alternative menu for users who are tired of mashed potatoesalertness and appropriate assistance from the staff.

According to a survey published in November 2021, conducted at the request of the East-of-the-Island-of-Montreal’s Integrated University Health and Social Services Center (CIUSSS) Users Committee, 40% of respondents say their taste not taken into account when preparing their meals.

Photo: Radio Canada

In this category – Human-centred care and services -, She CHSLD Regions such as the Côte-Nord, the Laurentians or Laval receive the note Industrial fair. It’s like that on Montreal’s West Island weak.

This is only an example. More generally, only 10 of the 22 regions that make up this portrait still quite good on the performance side, says Ms. Ste-Marie, given her financial, human and material resources. The other 12 regions will be readjusted.

For example, in the table above we see that only Estrie excels in terms of security or that two sectors of Montreal are among those that stand out for the care and services offered to users.

The best student is Mauricie-et-Centre-du-Québec. At three of the four [catégories]do better than the level of resources you haveexplains Mrs. Ste-Marie.

This is one of the key takeaways of this report: money is not necessarily a guarantee of quality.

Richer financial resources do not translate into better person-centred care and serviceswrites Commissioner Castonguay.

In other words, to improve the quality of life of seniors CHSLD, Just money, it doesn’t change anythingsummarizes Geneviève Ste-Marie.

Additionally, Quebec has increased significantly during the coronavirus pandemic, the commissioner notes considerably funding CHSLDfor all companies regardless of how they are affected by COVID-19.

Except all the money has not resulted in increases in human resources, quality of life at work, and accessibility of care and services on the same scale.

To make it better You have to train people, you have to recruit people to train peopleemphasizes Geneviève Ste-Marie. You must adopt good practices. You have to measure yourself to know you have the best practices to tweak.

A favored companion who helps a patient at CHSLD Éloria-Lepage in Montreal.

A beneficiary attendant serves a snack to a patient at CHSLD Éloria-Lepage in Montreal in April 2020 during the first wave of the COVID-19 pandemic.

Photo: Radio Canada / Ivanoh Demers

Widespread lack of accessibility

Last June, 4,160 people in Quebec were waiting for a seat CHSLDaccording to the latest data from the MSSS compiled by Radio Canada. That’s an increase of 50% compared to when the Coalition avenir Québec (CAQ) took office in October 2018, when 2,766 people were waiting.

In fact, the Health and Welfare Commissioner’s report highlights the fact that the accessibility of the network of CHSLD is a systemic problem in Quebec. Only three regions – above all Saguenay-Lac-Saint-Jean – have good or excellent accessibility.

Accessibility issues are not surprising […]writes the commissioner.

Although comparisons between Canadian provinces should be made with caution, it can actually be argued that this is the case Quebec is the province with the fewest long-term care beds relative to its populationAnd the, despite some of the highest long-term care needs in Canada.

Another problem: the lack of continuity and coordination of the nursing staff. Continuity is the proportion of employees working full-time.

CHSLD“,”text”:”En CHSLD”}}”>in the CHSLDsays Genevieve Ste-Marie, Many of these are part-time positions. You can imagine how many different people a patient sees every day when their entire care team is part-time.

In CHSLDs, 44% of hours worked by nurses are performed by full-time employees; this proportion is 40% among the beneficiary accompanying persons. »

A quote from Excerpt from the report entitled The performance of the care and service system for the elderly in CHSLDs, published by the Commissioner for Health and Welfare of Quebec

What is a good result in CHSLD?

In a scathing report on governance released less than a year ago CHSLDCommissioner Castonguay concluded that the crisis during the first wave of COVID-19 was partly due to widespread disorganization and poor information delivery.

According to Radio-Canada, there have been more than 15,000 COVID-19-related deaths in Quebec since the pandemic began. More than 40% of these deaths occurred in CHSLD.

The Commissioner for Health and Welfare recommends installing the government of François Legault CHSLD“,”text”:”un système d’information qui va mesurer la qualité de façon adéquate dans tous les CHSLD”}}”>an information system that adequately measures overall quality CHSLDremembers Geneviève Ste-Marie.

The problem is that the data is missing.

CHSLD?”,”text”:”C’est quoi, un bon résultat en CHSLD?”}}”>What is a good result in CHSLD? asks Mrs. Ste-Marie. CHSLD. Mais on n’a rien pour mesurer ça, on n’a aucune information sur ça. Donc on n’est pas capables de savoir ça.”,”text”:”Il y a la qualité de vie à améliorer, il y aurait l’état de santé contrôlé, un décès avec des soins palliatifs appropriés… Toute une série d’éléments qui pourraient être de vrais résultats d’un bon système de CHSLD. Mais on n’a rien pour mesurer ça, on n’a aucune information sur ça. Donc on n’est pas capables de savoir ça.”}}”>There would be quality of life to improve, health to be controlled, dying with appropriate palliative care… A whole series of elements that could be real results of a good system CHSLD. But we don’t have anything to measure that, we don’t have any information about it. So we can’t know.

Certainly this latest performance report shows the gaps between the current situation and what would be desirable. But it doesn’t allow us to understand what explains these discrepancies.

The commissioner [Joanne Castonguay] really want to fuel the public debate, present the data and then start the conversation. But if we hide it because it’s not perfect, it won’t improve. »

A quote from Geneviève Ste-Marie, Scientific Coordinator at the Office of the Quebec Commissioner for Health and Welfare
Interview with Joanne Castonguay.

Quebec Health and Well-Being Commissioner Joanne Castonguay released a report on July 20, 2022 that contains “unpublished information” about performance in CHSLDs and “highlights the significant variability that exists between different areas.”

Photo: Radio Canada

A positive step

Castonguay, a fait \”une belle job\””,”text”:”Je trouve que la commissaire à la santé et au bien-être, MmeCastonguay, a fait \”une belle job\””}}”>I think the Health and Wellbeing Officer, Ms Castonguay, has done a “great job”., comments Me Paul Brunet, spokesman for the Council for the Protection of the Sick. However, Mr. Brunet is have a completely different opinion with the commissioner when she says that before the pandemic, the performance of CHSLD was appropriate in terms of care intensity and clinical relevance.

In a $500 million class action lawsuit filed against the Quebec government in 2018, the Council for the Protection of the Sick alleges that living conditions humiliating dominance in the network of CHSLD. We have a hundred allegations that there is a lack of people, a lack of services, a lack of care, sums up Me Brunet. The case will be heard in the Supreme Court.

The fact remains that the analysis conducted by Joanne Castonguay pulls a very good portrait of what the field is going through […]approved Me Brunet. This confirms our concerns and our claims […].

A corridor with a lot of medical equipment.

A rehabilitation unit in a CHSLD in Abitibi. Across Quebec, 58,000 people were living in residential and long-term care centers in 2019-2020. More than half of them were 85 years or older.

Photo: Radio Canada / Melanie Picard

The statistical data evaluated by the client have valueadds Me Patrick Martin-Ménard of the eponymous law firm, which has expertise in defending victims of the healthcare system. It’s a positive step.

But more needs to be done: CHSLD qui ne sont pas reflétés dans ce rapport-là et pour lesquels on doit se poser davantage de questions”,”text”:”Il y a plusieurs éléments de la réalité des patients en CHSLD qui ne sont pas reflétés dans ce rapport-là et pour lesquels on doit se poser davantage de questions”}}”>There are several elements in the reality of patients CHSLD which are not reflected in this report and for which we must ask ourselves further questionshe warns.

He names the air conditioning in the bedrooms in the house as another glaring problem CHSLD. We’ve known about the problem for years and nothing seems to have changed. Is there really a political will to change something?

What has been done since the slaughter of the first CHSLD wave? Basically, the system remains the same. The philosophy remains the same, the approach to these patients remains the same. »

A quote from I Patrick Martin Menard

For Me Brunet of the Council for the Protection of Patients, the highlights of the report are Commissioner Castonguay the introduction of an accountability system with a clear mandate and examples of performance indicators.

Will this now lead to an accountability system? I am not sure. »

A quote from I Paul Brunet, spokesman for the Council for the Protection of the Sick

The commissioner’s work must lead to specific changesconcludes Mr Martin-Ménard. CHSLD comme des numéros.”,”text”:”On doit cesser de considérer les patients de CHSLD comme des numéros.”}}”>We need to stop considering patients of CHSLD like numbers.

With the collaboration of Mélanie Meloche-Holubowski and Daniel Boily

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