Home care offers seniors the opportunity to continue living in their homes and to maintain a quality of life that is as fulfilling as possible. Moreover, it allows seniors to receive assistance in the activities of daily living (ADLs), such as personal hygiene, eating and mobility, with a caregiver who is a familiar figure and an important link between the senior and his or her family.
In addition to providing care and services, a home care worker can act as a liaison between the senior, his or her caregiver and the health system. He or she can also be a contact point for social services and family members.
Currently, aging populations in Canada are putting considerable pressure on the long-term care residence system. This means that the provinces must develop their home care network to ensure that seniors have the support they need to remain in their own homes.
The current Montreal home care system has a limited capacity to respond to growing needs. Nevertheless, the majority of seniors want to stay at home for as long as possible. Hence, it is imperative that the government develops the network in a way that benefits seniors and is fiscally sound.
This paper presents a new policy reform package that could offer increased coverage and be more financially sustainable than the status quo. It consists of a shift toward more intensive use of home care while increasing public coverage of care needs and improving users’ ability to choose their providers.
A key feature of the policy is a new model for public support rates. This is the share of total per capita costs covered by the public system for nursing homes and residential care, including accommodation and meal expenses. Compared with other Canadian provinces, Quebec’s public support rate is quite low.
As shown in Table 4, the share of these expenses that are covered by the public system varies significantly between provinces, with the average being around 5 percentage points lower than in Quebec. The difference is particularly pronounced in Quebec, where the daily standard fee for a basic shared room in a nursing home is $36. This is almost twice as much as the lowest daily standard fee observed in Ontario, which is $56.
However, the Quebec government already pays a substantial portion of these expenses to seniors in residential care and nursing homes. This is because the public system is based on the concept of a CR, whereby the total amount of funding for each person covered by the system is equal to the annual cost.
The CR in this case is determined by the individual’s Iso-SMAF profile, which is established by a health professional. For a senior with an Iso-SMAF profile of 70, the CR would be equal to 3.5 times the annual amount of the public funding that the senior currently receives in order to cover his or her costs.
A CR of 30 percent would be a cost-effective option for the Quebec government and would result in significant expenditure reductions compared to the status quo scenario. A CR of 50 percent would also be beneficial. It would reduce the overall spending by 6.0 percent in 2025 compared to the status quo, and it would save the government $1.2 billion in 2025.