Faced with a population that is aging at a rate second only to that of Japan, Quebec is proposing to create an innovative insurance plan to offer the elderly less expensive long-term care services at home.
The long-term care insurance would, according to the government, keep tighter control on the spiralling health costs for older people by offering more services at home as an alternative to costly long-term care facilities.
Under the proposed policy, health care specialists would evaluate people's degree of autonomy and determine with family members what services are required for them to stay at home if they so desire.
"This will allow people to live in their own homes and receive the required services…while being funded and managed by the public," Quebec Health Minister Réjean Hébert said. "We have to move in that direction otherwise it will be unsustainable for the health care system."
As a medical doctor, Mr. Hébert specialized in geriatric care and the impact on society of an aging population. The plan unveiled on Thursday was the result of his more than 20 years of work comparing long-term care programs in other countries and how they could apply to Quebec.
"It is a question of allowing the elderly the freedom to choose if they want to live at home," Mr. Hébert said. "Examples elsewhere have shown that they prefer to be at home than in an institution."
The long-term care insurance would cover professional services such as nursing, rehabilitation, psychological services or nutritional evaluations, as well long-term daily and domestic assistance such as preparing meals, helping take a bath or housecleaning.
Each person's yearly allocation would be based on needs and annual income. Poorer people would pay the least.
The government would set the rates and pay private companies or non-profit groups such as Meals On Wheels and community organizations to deliver the services. However, seniors still could choose to go to a nursing home.
The elderly currently pay about 85 per cent of the cost of receiving services at home. The government said that under the proposed plan, the individual cost would be slashed to 40 or 45 per cent.
The government said the plan would be cost-neutral, meaning that funding would come from the more than $4.3-billion a year currently being spent on long-term care services. The money would be placed into a special fund and augmented each year through yet to be determined taxpayer contributions or premiums.
"I am aware that this will be a delicate debate, but it is one that we need to have," Premier Pauline Marois said. "We need to put aside partisanship, because let's be clear … we will be paying more. So we have to decide how do we pay? Do we leave things as they are or do we anticipate … and control costs."
If nothing changes, the burden on taxpayers will be even greater within five years, she said. Government estimates indicate that, by 2017-2018 it will cost Quebec taxpayers an additional $150-million to $200-million a year to serve the health needs of older residents. That is partly because it cost about $90,000 a year to care for elderly patients in a nursing home or other type of facility, twice as much as receiving services at home.
"We cannot hide our head in the sand. There will be an aging population and an increase in funding for long-term care service," Mr. Hébert said. "The major issue is how we are going to manage this gap between what is now budgeted and the needs of the long-term care insurance after 2017."
A National Assembly committee will hold public hearings on the policy paper next fall. Ms. Marois hopes legislation can be adopted by the end of the year.
Claude Quentin, who represents a coalition of regional groups for seniors in the province, applauded the initiative to promote home care, but will seek to make sure that the services are delivered by competent people and the quality strictly controlled by the government.
"We don't need to create new groups and a new bureaucracy. Many of the services are already in place. We just need to give them better resources so that they can do a better job," Mr. Quentin said.
The group representing private homes for the elderly was also in favour of the proposal. However, its president, Yves Desjardins, was concerned that it could lead to more bureaucracy.
"Governments are always tempted to create more bureaucracy. We hope they can avoid it this time," Mr. Desjardins said.