In 17 years we will say those were the good old days.
I correct myself: “If nothing is done in 17 years,” the current disastrous situation of home support will make us nostalgic. This is the observation that HEC Montreal researchers have just made by making predictions about what the system will look like in 2040.
It will be very difficult.
The researchers’ verdict is clear. “If Quebec does not change the way it supports autonomy, its costs will skyrocket, it will face a difficult-to-achieve housing construction backlog and it will face historic staffing needs. However, with a response rate of less than 11%, the company will continue to provide home support services that are well below need. »
If we think things are going badly, we haven’t seen anything. By 2040, “the new need for autonomy support represents 236.2 million additional hours per year, an increase of 70%,” including 20.8 million in nursing care, 83 million for nursing activities in daily life and 132.4 million for food and household support services.
The bill? “Total annual costs increase from $7.6 billion in 2023 to $10.8 billion in 2030 and $16.5 billion in 2040. This represents growth of 120% over the entire forecast period . »
The total health budget today is around 53 billion, which is almost half of Quebec’s total budget.
In June, Health and Wellness Commissioner Johanne Castonguay sounded the alarm about deteriorating home support and expanding waiting lists.
The complete opposite of what we should strive for. She was the one who commissioned the Jacques Parizeau Research Chair in Economic Policy at HEC Montréal to model the needs to support the autonomy of older people in 2040.
The research report, titled “Horizon 2040: Projecting the Impact of Support for Autonomy in Quebec,” also finds that Quebec’s population clearly prefers to be cared for at home rather than being placed in CHSLDs or intermediate facilities, as long as the cases are not severe acts.
From this point on, people no longer want to stay at home. “Given the results obtained, we believe that the status quo is not a viable option and that it would lead to a deterioration in meeting the needs of an aging population, with costs that will quickly become a burden for taxpayers.” »
According to demographic forecasts, the number of people aged 75 and over requiring autonomy support will increase by 69% by 2040. “From 324,400 people with needs in 2023, an increase of 223,400 people is expected by 2040, including 33,700 additional people with severe disabilities,” the report says.
Chaudière-Appalaches and the state capital are among the regions of the province that will have the most of them.
In an interview, head of research Pierre Carl Michaud doesn’t pull any punches.
“We are at a dead end. If we continue with the current approach, costs will explode, labor needs will explode, construction costs will explode, and we are still in a situation where we are meeting very little of the population’s needs. It’s the worst of both worlds. It’s expensive, it’s very demanding and we can’t improve our service capacity. »
Doing more of what we do will lead to disaster.
He warns the government against the temptation to rely exclusively on home support to relieve the burden on the health network. Firstly, it is not true that people necessarily want to stay at home when they need a lot of care and secondly, we need to stop sightseeing.
“It’s certainly interesting to have an approach that focuses more on home care. However, it’s a bit too big of an apple pie solution. We really need to define what we mean by a shift to home care.”
This report is a first phase of observation. Researchers are currently working on alternative scenarios and solutions to avoid getting stuck in the wall. Regardless of the direction taken, one must “focus on people with moderate needs, because with people with severe disabilities it is not the case that it is cheaper and it is easier to care for them at home,” he says Mr. Michaud.
This is, among other things, a high demand for nursing staff.
The most ironic thing is that by maintaining this good old inefficient model, we will need twice as many places in CHSLDs, which is a deficit of about 42,500. At $795,000 per place in retirement homes, hello the math, researchers calculate that $2.6 billion will have to be gobbled up in 2040.
It will also need people to care for all these wonderful people. “Due to population aging, the proportion of CHSLDs is increasing: it will rise to 62.8% in 2030 and 64.4% in 2040,” the report predicts. The number of teaching hours is forecast to increase from 69.8 million in 2023 to 151.2 million in 2040, a growth of 116%. »
Of course, it will also be necessary to tackle waiting lists, just waiting. People are even willing to put their hands in their pockets, researchers say. “Respondents don’t like to wait. They are willing to pay $75 to $161 out of pocket to receive services a month faster,” the report concludes.
So what do we do?
Patience, the HEC research team is working on solutions, but would like to clarify the matter first. “In this report we wanted to avoid dwelling on alternative scenarios to give everyone time to sit down. We strongly believe in the ability of tools to bring parties together in debates. »
Let’s hope it doesn’t take 17 years.
* In collaboration with Juliette Nadeau-Besse
To respond to this column, write to us [email protected]. Some answers may be published in our Opinions section.