Given Quebec’s extremely high CHSLD death count, the strong criticisms levelled at this practice are perfectly understandable—and justified. It is nonetheless worth looking at the matter in a little more detail.
First, we need to appreciate the size of the phenomenon. As of March 1st of this year, 75% of COVID-19 deaths in Quebec had occurred in long-term care centres. In contrast, these accounted for just 43% of COVID-19 deaths in France, 34% in the UK, and 28% in Germany. If Quebec had suffered similar ratios of LTC deaths as these countries, between 5,800 and 6,700 senior lives could have been saved. Even if Quebec’s ratio of LTC deaths had simply been comparable to the average for the rest of Canada (59%), some 4,000 senior lives could have been saved in the province.
But what did these countries do differently? First and foremost, they substantially increased their capacity to take on cases, notably by adding medical personnel. Of course, this is more difficult in Quebec given the constant staff shortages and chronic overcrowding in our hospitals even in normal times. It is worth noting that the waiting times to which Quebecers have sadly become accustomed would seem unbelievable in European countries.
Because of this interconnecting of two systems, namely hospitals and CHSLDs, both of which were overburdened, the planets were perfectly aligned for the resounding failure we all witnessed. This tragic episode was unfortunately difficult to avoid given the structural weaknesses of our health care system and the way in which we care for our seniors.
Indeed, a much higher proportion of Canadian seniors, and especially Quebec seniors, live in group settings rather than living at home. Across Canada, 7% of seniors live in formal LTC facilities, with that number rising to 9.5% in Quebec, the highest of all the provinces. In contrast, fewer than 2% of seniors in Italy live in nursing homes, while in the UK, approximately 3.5% live either in nursing homes or hospitals. For Quebec, or even Canada, to be more comparable to these countries in this regard would certainly require a considerable expansion of home care services.
Contrary to what some keep repeating in the public debate, shovelling more and more millions at the problem is not the answer. Indeed, the Canadian health care system is unfortunately among the most expensive universal systems on earth, with spending nearly 30% higher than the OECD average. And Canada’s and Quebec’s health care spending have increased far faster than either population or economic growth. This consistent failure to translate ever-more-generous budgets into concrete results that benefit the population suggests that what is needed is systemic reform on a deeper level.
What does this mean concretely? For starters, such reform of health care could include more flexible decision-making and resource allocation; funding that follows the patient; expanded use of existing resources like nurses, pharmacists, and telemedicine; and a reduction in barriers to the entrepreneurial provision of new capacity. Similar principles can be applied to senior care, and recent studies suggest that such reforms can improve service while actually reducing costs, by trimming the enormous waste in our current senior care system.
Many Canadians think health care has become a bureaucratic monster that struggles to meet our needs, and nowhere is this clearer than in Quebec. The true disaster in CHSLDs will forever be a glaring illustration of the limitations of the province’s health care and senior care models. Let’s hope that this leads us to reflect on more flexible, rapid, and efficient ways of providing care to the population, and in particular to the most vulnerable among us. It’s quite simply a question of life and death.
Peter St. Onge est chercheur associé senior à l’IEDM, Maria Lily Shaw est économiste à l’IEDM. Ils sont les auteurs de « COVID-19 et le désastre des SLD au Québec: près de 6700 vies auraient pu être épargnées » et signent ce texte à titre personnel.