CHSLD: a foreseeable catastrophe

CHSLD: une catastrophe prévisible

The auditor general has severely criticised the management of accommodation centres for seniors in 2012, calling for changes to ensure a safe environment and quality care. But few things have changed.

The pandemic of COVID-19, which falls in NURSING homes has raised awareness in Quebec of the poor conditions in which are our seniors.

The shocking testimonies multiply : lack of staff, monitoring of schools inadequate, obsolete infrastructure, services to the users dysfunctional, criminal records for certain owners of CHSLD-private, etc

However, the elected members of the national Assembly and the leaders of the health system were aware of these numerous shortcomings.

The alarm had been turned in a report of the auditor general of Québec, Michel Samson, 2012, while Marguerite Blais was liberal minister responsible for Seniors, and Yves Bolduc, minister of Health.

Unsatisfactory

No less than four governments have succeeded one another since the filing of the report pointing the finger at the negligence that reigns in the management of accommodation services for the elderly in loss of autonomy.

In total, the auditor general had issued 15 recommendations. Of this number, only 67 % have given place to progress rated ” satisfactory “.

The deputy minister of Health who was in office at the time, James Cotton, had nevertheless assured that there was ” a plan of action developed in response to each of the recommendations. ”

Further efforts

Contacted by our Bureau of investigation, the ex-auditor general, Michel Samson, has not wanted to comment on the record until eight years later.

In 2013, Mr. Samson, however, had mentioned, before the Commission of the public administration, there’s still significant efforts to be done to give effect to all its recommendations.

“We’ll obviously monitor it closely, to see the actions that will be posed to improve the situation,” he said.

The current minister of Health, Danielle McCann, who was at the time CEO of the Agency of health and social services of Montreal, had then defended the management of his organization.

“A lot of things have been done. And we can be proud of. However, we are at a crucial stage and we must, with all of the institutions, continue the work to complete this transformation of our services “, she stated.

Which was wrong, according to the VG

Michel Samson

In the management of residential resources

  • The average time for daily care per user varied significantly, from 7 to 29 minutes per user, and the service differed;
  • In NURSING homes, one-quarter of the assessments were dated more than 5 years. For other types of resources, the information was not recorded;
  • The residential resources available not always match the needs of the elderly in loss of autonomy. Sometimes, the use of resources was inadequate;
  • The level of services offered to users and the rate of response to the needs lacked detail. No information on the qualification of the employees;
  • The institutions audited did not have all the information needed to perform an effective management of the resources of the accommodation;
  • Absence of a portrait of the whole people, including their profile, independence and their needs, the services provided by institutions and access to resources accommodation;
  • The assessment tool users adopted by the MSSS in 2003 was not always used;
  • Waiting lists and gaps.

In the quality control

  • No assurance that all of the measures of quality control allowed for adequate supervision and adequate of all types of residential resources;
  • The shortcomings observed for ministerial visits in NURSING homes and intermediate resources : control uncommon with only 10% of facilities per year at the time;
  • Approval from the CSSS, but not to visit in some CHSLD CSSS verified;
  • No visit to intermediate resources had been made since 2009;
  • 85 % of homes were certified;
  • Non-compliance with the certification criteria observed;
  • Visits are planned;
  • Several private residences for seniors did not have the required permissions;
  • Purchases places from private residences not having a permit;
  • There is no integration of the results of the various controls;
  • Lack of overall picture of the quality of the resources as a whole, and no comparison between them.

In the funding of accommodation services

  • The funding of accommodation services were the differences and did not take sufficient account of the needs of the customer and the services required;
  • The full cost of each type of accommodation was not calculated by the department in order to guide the choices made;
  • CHSLD : the contribution of the user and the rules used to establish it had not been reviewed for over 15 years.

They return the ball

Yves Bolduc

Minister of Health, 2008 to 2012

He assured that measures had been put in place before his departure. “The reports are always taken seriously. The auditor had made an objective assessment. The one who had to respond to the recommendations is Réjean Hébert, and after that, Gaétan Barrette, ” says Mr. Bolduc. “It took more tools to measure. There were a lot of patients who were not in the right place, mainly in Montreal. It lacked resources, intermediate. The profile of the customer has increased in NURSING homes. ”

Marguerite Blais

Minister responsible for Seniors, 2007 to 2012 and current

The minister declined our request for an interview. Ms. Blais, when she was the minister of Seniors in 2012, was not the responsibility of the accommodation, and for the first time the responsibility of living environments for elders in the ministry, says the firm. “We do not wish to comment on the reform passed or to review decisions that have been taken by previous governments. ”

Réjean Hébert

Minister of Health, 2012 to 2014

He inherited the report of the VG. He claims to have put in place several measures. He has worked on the creation of an insurance policy autonomy of the elderly. “I asked for a picture of the supply of beds in CHSLDS, public and private, to plan for the future needs of the population in the context of the implementation of the insurance autonomy, which would have put a lot more emphasis on home care. We had also put in place a process of assessment visits of the ministerial quality. ”

Gaétan Barrette

Minister of Health, 2014 to 2018

“In 2012, I was not there. I arrived at a time when people like Réjean Hébert had decreased the number of places in NURSING homes for the benefit of the home support. Me, my philosophy was to do both “. He assured that he was going in the right direction, according to the allocated budgets. He is said to have stopped the decline and put in place best practices. And then to be attacked at the issue of ratios and wages. “Except that to complete the whole thing, it asked for a suite in the mandate after that. ”

What they said, a year after the filing of the report…

“An important measure is to carry out assessment visits in a CHSLD. The department has increased the number of reviewers to six. “

– Jacques Cotton, deputy minister for Health of the time

“Actions are underway to promote the attraction and retention of staff in accommodation centres. “

– Danielle McCann, then CEO of the Agency of health and social services of Montreal

“When Mrs McCann speaks of retention of staff, it is also the wages which it offers to the staff. The staff moves because it is a difficult environment. “

– Marguerite Blais, who sat in the opposition

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