The shortage of personnel has reached such proportions in the private CHSLDs not under agreement that owners fear having to “dump seniors in the emergency room” for lack of manpower. Some establishments have lost dozens of caregivers to the public network in two years, increasing their use of placement agencies by up to 700%, according to figures obtained by The Press.
If the situation is not resolved by the summer, establishments will close their doors, others will change their vocation or experience major service disruptions, warn several owners. And the elderly? “Incessantly, there will start to be people in the emergency room who are overwhelmed because we are no longer able to replace [les employés] fears the president of the Association of long-term private establishments of Quebec (AELDPQ), Paul Arbec, whose company owns six CHSLDs.
The staff, it is made that the garroche on the floors. I am no longer proud of what I do.
Paul Arbec, President of the Association of Private Long-Term Institutions of Quebec
As we know, the COVID-19 pandemic has greatly exacerbated the lack of staff in the health network, particularly in living environments for seniors. But while the health crisis subsides, the bleeding continues for non-contracted private establishments. In fact, the situation is worse now than it has ever been. “It got considerably worse,” says Jean-François Blanchard, general manager of the CHSLD Manoir Harwood in Vaudreuil-Dorion and vice-president of the AELDPQ.
A data collection carried out in the spring by the association targeted 17 establishments where the use of placement agencies has completely exploded, increasing, depending on the location, from 80% to 711% between 2019 and 2021. This is revealed by a letter sent by Paul Arbec in February to the Minister of Health and Social Services, Christian Dubé, and obtained by The Press. The missive asks the government in particular to contract as soon as possible the non-contracted establishments of the province, as promised by Quebec, so that they can, among other things, receive the same funding for salaries.
As far as costs are concerned, some establishments [privés non conventionnés] recorded an increase of more than $2 million, without having benefited from an increase in their funding.
Extract from the letter sent to Minister Christian Dubé
In the office of the Minister responsible for Seniors and Caregivers, Marguerite Blais, we reiterate “the firm will” to contract private CHSLDs. “We have also started a major shift in this direction,” said the minister’s press attaché, Jean-Charles Del Duchetto. A pilot project to contract three private CHSLDs is underway (see next tab). The problem? It’s too long, insists Paul Arbec. “We can no longer be the victims of this slowness. There are residents who will begin to be affected. »
In the 17 “most affected” establishments named by the AELDPQ, 505 positions are currently vacant, including 127 nursing positions. “In terms of recruitment and retention, that’s where the shoe pinches. How do we fill in these missing numbers? It’s through the agencies, at two or three times the price [par rapport au salaire d’un employé régulier]plus taxes,” said Paul Arbec in an interview.
Three types of CHSLDs
There are just over 300 of these state-run and funded institutions.
Private CHSLDs under agreement
About sixty establishments are managed by individuals, but financed by the State.
Private CHSLDs not under agreement
There are about 40 of these essentially self-contained establishments, although they must be licensed by the Department of Health and Human Services and meet certain standards to operate.
The price to pay
The example of the CHSLD Boisé Sainte-Thérèse, in the north crown of Montreal, is striking. The establishment of 166 beds, of which nearly 140 are purchased by the CISSS for lack of places in its own establishments, did not use agencies before the pandemic. Then, the CHSLD lost a dozen caregivers to the public, where salaries are better. Two nurses have also been on long-term sick leave since the pandemic. Result: 70% of shifts for nurses and 57% of shifts for licensed practical nurses are now filled by independent workers. Some agencies are charging nearly $300 an hour when there are COVID-19 cases, three times the usual $90 an hour wage for a nurse. The establishment now pays $250,000 per month in agency fees, compared to zero two years ago.
The situation is “precarious”, admits Valérie Villeneuve, director of nursing.
First, the impact of constant personnel changes weighs heavily on seniors. “At the family level, at the resident level, that’s what’s most difficult,” says Ms.me Villeneuve. They ask to have a follow-up, but when I don’t have the same nurse overnight, the follow-up doesn’t happen. It is us, the executives, who have to be on the floor to ensure that the follow-up is done. To ensure families have the right answers. Because the agency nurses answer: I don’t know, I wasn’t there yesterday. »
This is without taking into account the financial pressure which is approaching unbearable.
We draw on what we had, which was already very little. […] We have to do something in the short term, we have no choice. We are in reflection. Are we going to change missions? We have a lot to discuss internally.
Valérie Villeneuve, director of nursing care at the CHSLD Boisé Sainte-Thérèse
In his CHSLD in Saint-Hubert, Paul Arbec has lost eight nurses to the public since March 2020. “There were 9 out of 13 who were our employees and there, we only have one left. I have the same thing in Terrebonne. I have the same thing in Rawdon,” says Mr. Arbec, whose agency budget has increased from $400,000 per month to $1 million in his six CHSLDs. Like the Boisé Sainte-Thérèse, he too must sometimes pay double or even triple the base salary. “They tell us: at a single rate in the red zone, we don’t come. They hold us hostage. »
Gaps to fill
At Jean-François Blanchard, at Manoir Harwood, three beneficiary attendants left recently, attracted by the new accelerated training program for nursing assistants launched by Quebec.
Mr. Blanchard would have gladly kept them with their new job title. The problem: the candidates are obligatorily paired with a public health establishment for two years. ” We [les établissements privés non conventionnés] is not included in this. And I am losing my staff. All of Mr. Blanchard’s beds are however purchased by the public network.
On this subject, another letter sent in February, this time to Minister Marguerite Blais, asks that private CHSLDs not under agreement “be included in all your measures, projects and programs”. “This recognition would make it possible, in particular, to eliminate the gaps that continue to widen between establishments and which have a direct impact on the care and services provided to residents. »
“We are network partners. We host clients [du réseau]. The customer has the right to the same service, whether he lives in a public, private contracted or non-contracted establishment. It’s time to fix things,” rages Frédéric Asselin, CEO of CHSLD Angus and administrator of the AELDPQ.
In Quebec, the blame for the current crisis is blamed on previous governments. “We are in a major catch-up mode to compensate for the inaction and disengagement of former governments,” said Minister Blais’ office. Remember that our government is ending a 30-year moratorium on the funding and agreement of private CHSLDs. Previous governments had literally abandoned non-contracted private CHSLDs. They did not have a clear vision of housing and the aging of the population. »
The private CHSLDs not under agreement deplore the fact that they do not benefit from the same measures and advantages as the public and the private under agreement. Several financial aids have however been granted or announced since the start of the crisis, specifies the Ministry of Health and Social Services. In particular: support to increase the hourly rate of nurse technicians and nursing assistants; another sum for raising the salary of salaried staff and a third for attendants; the inclusion of non-conventioned private establishments for certain bonuses in order to attract and retain nursing staff. According to Paul Arbec, of the AELDPQ, many of these sums have not yet been received by the CHSLDs.
A pilot project conducted behind closed doors
Kept away from talks on the agreement of private CHSLDs, the Association of private institutions under agreement (AEPC) fears a “leveling down” in the network of care for the elderly.
For several months, Quebec has been negotiating with three private CHSLDs the terms of their possible agreement as part of a pilot project. These agreements could then be extended to some of the 37 other private CHSLDs in the province.
For AEPC, the file must progress more quickly. But above all, Quebec must stop excluding him from the discussions. “We have 65 years of experience in the field. We are talking about a reform in our community. And we’re not consulted,” says PEAC Board Chair Jean Nadon.
The latter regrets that the three private CHSLDs that are part of the pilot project have been invited to sign confidentiality agreements, so that no details are leaking out in this file. Mr. Nadon nevertheless says he supports the project.
But we have questions. There is a great lack of transparency.
Jean Nadon, President of the Board of Directors of PEAC
Mr. Nadon explains that the private CHSLDs under agreement already have contracts, which are renewed each year. “Why not take the recipe that exists and improve it? Why are we reinventing? This is where we do not agree not to be consulted,” adds PEAC Executive Director Annick Lavoie.
PEAC fears that the new agreements concluded with private CHSLDs will eventually be extended to their members. “Are we going to be imposed a formula that we don’t know? asks Mr. Nadon. For him, the fact that Quebec “does not consult its base” potentially risks “putting residents at risk”.
“Particularities” in question
In the office of the Minister responsible for Seniors and Caregivers, Marguerite Blais, it is said that the pilot project aims to “establish a mechanism to then extend the agreement to other CHSLDs”. M’s press officerme Blais, Jean-Charles Del Duchetto, ensures that the objective of this approach is “to level up” the services offered to residents, in particular by offering “more stable financing and stability of the workforce” to Private CHSLDs which will become contracted.
Mr. Del Duchetto notes that “each private CHSLD is different and has its particularities”. Hence the fact that the pilot project is currently progressing slowly.
Everyone’s goal is to ensure the well-being of seniors.
Jean-Charles Del Duchetto, press officer for Minister Marguerite Blais
President of the Association of Long-Term Private Institutions of Quebec (AELDPQ), Paul Arbec also regrets that the discussions around the pilot project in three private institutions are under confidentiality embargo. “We are two associations. We, the non-contracted private establishments, and the AEPC. The AEPC are specialists in the conventional approach and they are not involved in the process in any way. That, we regret. It’s a problem, the whole kind of embargo on the convention approach or the notion of confidentiality, ”he says.