The dream unfinished des CHSLD

Le rêve inachevé des CHSLD

Illustration: Tiffet
Approximately 1200 places in CHSLDS have been open for 2017 or are in the process of being, according to Québec. To date there are 37 534 beds in this accommodation type.

Albert Doyon no longer has its head. At the age of 86, suffering from dementia, he is unable to stand by himself, feed himself, shave. He has lost 36 kilos in three years. And it is even more frail since he had three falls at the beginning of the year.

This former employee of the Canadian National, however, has not the “score” required for a place in a CHSLD (centre d’hébergement and long-term care). He is too independent : he poops in the toilet — even if it takes help to get there — and therefore did not need to layer. And he holds his own spoon to eat her yogurt, one of the few foods that he continues to swallow.


This is the number of persons waiting for a place in a CHSLD, according to the most recent data available. The waiting list decreases. It consisted of 4392 people in 2010-2011.

His daughter Dominique is out of breath. She fights for 2015 for his father to be hosted in a CHSLD, the only place, according to it, adapted to the condition of the old man. It has moved five times since a year, between his old apartment, the psychiatric hospital and two accommodation centres.

“Every time he moves, he loses his faculties. It is almost unrecognizable. He has the air of a dog who has been hit on the side of the road. And I am trying to leave my health to me also strength to beat me, ” says Dominique Doyon, a teacher in a primary school in Montreal.

“You always said to me that my father does not have the rating required to be admitted to a CHSLD, but he does nothing of his day and has more autonomy. I do not understand. Is it that it must be agonizing to have a place in a CHSLD ? “

Obstacle course


Le rêve inachevé des CHSLD

Photo: Dominique Doyon
Albert Doyon and his daughter Dominique in August 2017. The state of health of the 86 year old man has deteriorated since.

There has been much talk this week of the bad care given in homes for the elderly. A collective action was launched on behalf of patients abused in NURSING homes. The horror stories multiply : patients left in their soiled diapers, fed incorrectly or badly washed by employees exhausted.

The flip side of the coin is that, for many people in loss of autonomy, a place in a CHSLD is a dream. An unattainable dream. The older people must go through the way of the cross to be admitted. The québec ombudsman has denounced for years the time of admission into these shelters of last resort, created for older people are the most depressed.

To force to insist and complain, Dominique Doyon ended up finding a place in a CHSLD for her father (even if he does not have the rating to qualify). But it is not the end of his sentences. Albert Doyon. The accommodation centre is located in the west of the island, around an hour from the home of her daughter (a resident of Rosemont), who can only visit his father once a week.

The man was placed in a special unit for people with problems of behaviour. The floor is locked, to prevent it from running away.

“During my last visit, I realized that residents were in his room. Some had come to steal her yogurt in front of my partner and me. I must confess to you that I am concerned for his safety. If other residents come in his room when we are there, what are they doing when we are not there ? In addition, it is supposed to be a floor safe, but the toilet is shared. My dad is out of breath and could not defend themselves if attacked, ” says Dominique Doyon.

298 days

This is the average time of waiting — a time that the place has been given — according to the ministry of Health and social Services.

The leaders of the CHSLD are considering moving Albert Doyon in another wing of the same accommodation centre or in a private residence, because 25 new patients have arrived recently. Dominique Doyon anguish at the idea that his father is once again moved. The ” intermediate resources “, these private residences that cater to the people waiting for a place in a CHSLD, are ill-equipped for heavy as his father.

The ombudsperson, Mary Rinfret, highlighted the issue in its report tabled in September 2017 : “While the accommodation needs for the elderly increase, there has been this year a tightening of eligibility criteria, increased waiting times and a recourse to increasingly frequent in private residences for seniors not equipped to take care of people in heavy loss of autonomy,” she wrote.

“These situations generate a sense of helplessness among seniors and their families in the face of rigid rules and little-known “, warned the protector into another memory, this one filed by a parliamentary committee in 2014.

“The imperative of decongesting the hospital setting appears to take precedence. Taking into account the fact that the ageing of the population increases, that there was already a substantial wait to gain access to a CHSLD, that the number of seats is stagnant, or even declining, the public Protector can only wonder about the accessibility of the actual places in CHSLDS for the next generation. “

New places

Approximately 1200 places in CHSLDS have been open for 2017 or are in the process of being, said in Quebec city (see box). To date there are 37 534 beds in this accommodation type.

“The home support is considered as the first option to meet the needs of the user in his or her course of care and services regardless of the magnitude of the needs,” says Marie-Claude Lacasse, a spokesperson for the ministry of Health.

“The accommodation will be considered only if the retention in the community is no longer possible in safe conditions, in spite of the services intensified and the support of loved ones, in order to avoid an admission of premature resource of institutional accommodation. “

Contrary to what has been written by the ombudsperson in her report of 2017, the criteria for admission have not been tightened, ” says Quebec. The current method, the ISO-SMAF (see box), was implemented in 2009, ” said Ms. Lacasse.

The real drama

Dr. Réjean Hébert, former minister of Health in the government Marois, has created the standard ISO-SMAF with his team when he was a professor at the University of Sherbrooke. He recalls that this tool, though imperfect (perfection is not of this domain), has been validated by the international scientific community.

“NURSING homes should be reserved for people who have the greatest needs, which are in heavy loss of autonomy,” he said. This is not funny, living in a CHSLD. There are people who are in NURSING homes and who should not be there ! “

According to him, the greatest tragedy is not difficult access to NURSING homes, but the inadequate services before arriving in the residences of last resort. “The services are not adequate in RI (intermediate), and home care settings. From my point of view, it is dramatic, ” he says bluntly.

Developed countries, such as Denmark, for example, are investing heavily in home care — three-quarters of public funds for the old are destined to the care of the house. In Quebec, the reverse is true : more than 80 % of the budgets for the elderly go to NURSING homes. “We give money to the schools and told them to fill their beds,” said Réjean Hébert.

Review the system

He wanted to reverse the trend by creating an insurance policy autonomy during his short stay as minister of Health, between the years 2012 and 2014 (the project died when the Parti québécois lost power). This fund would have given the opportunity for people to invest in their care at home. “With the aging of the population, we will not have the choice to create an insurance policy autonomy, as has been done in Japan,” said Réjean Hébert.

Mélanie Bourassa Forcier, a professor of health law at the University of Sherbrooke, believes also that a great deal of reflection is needed in the care of the elderly. “Our health system is stuck on the 1970’s, when the population was relatively young, she said. In 2018, the population is aging and suffering from chronic diseases. We also care a lot more at home and with medications. It is difficult to conceive that the only guarantees of care that we have derived primarily from the medical act. The other services seem to be offered so variable, non-transparent, at the option of the decisions of the managers and according to the budgets available. “

The ISO-SMAF, or how to get a place

Since 2009, Quebec has adopted the ISO-SMAF, which provides 14 profiles of patients — the so-called “ratings” — according to their degree of incapacity. Tags to admission to a CHSLD have been published in 2013. A rating of 1, 2, or 3 indicates difficulty completing domestic tasks. The more the rating increases, more mental problems, or motor skill are important. Between 11 and 14, the violations are ” mixed and serious “. “The vast majority of admissions to NURSING homes should be reserved for people who are profiles of ISO-SMAF ranging from 10 to 14,” says Marie-Claude Lacasse, a spokesperson for the ministry of Health. Before 2009, the people hosted in NURSING would require three more hours of care per day.

New places in CHSLDS

Current projects

  • 72 beds in Rivière-du-Loup (in progress) — CHSLD de la rue of Chauffailles (phase 1)
  • 75 beds in Rivière-du-Loup (in progress) — CHSLD de la rue of Chauffailles (phase 2) on the site of the hospital du Grand-Portage
  • 64 beds in Quebec — hôpital Sainte-Monique
  • 99 beds in Lac-Mégantic
  • 100 beds to Maniwaki
  • 32 beds in Chibougamau
  • 55 beds in the Outaouais — Vallée-de-la-Lièvre
  • 176 beds in Granby

To be delivered in 2017

  • 100 beds in the vicinity of the hospital in Baie-Saint-Paul
  • 212 beds in Saint-Jérôme (delivered in 2017) — Centre d’hébergement de Saint-Jérôme
  • 96 beds in Saint-Jérôme (delivered in 2017) — CHSLD Louise Faubert
  • 36 beds in Sept-Îles
  • 64 beds to East-Angus

Ce text is part of our “Outlook” section.