Living conditions of adults housed in CHSLDs: the Québec Ombudsman calls for tighter quality control
Québec City, February 19, 2014 – Based on investigations conducted over the past five years in 128 CHSLDs (63% of Québec CHSLDs), the Québec Ombudsman today presented its brief to the Committee on Health and Social Services on the living conditions of adults accommodated in these institutions.
The Ombudsperson, Raymonde Saint-Germain, commented on each of the nine challenges raised by the Committee. She focused on accessibility of CHSLDs, services and care, and monitoring their quality. On this last point, she reminded the Committee that it is imperative for public institutions to monitor the quality of the private resources with which they have service agreements. According to the Ombudsperson: "Users have the same needs and rights, regardless of whether they are directed to a public CHSLD or to a temporary private residential care resource. The public network is responsible for ensuring that its partners offer quality care and services. "
Accessibility of CHSLDs
Over the course of its investigations, the Québec Ombudsman found that resorting to temporary residential care resources with the goal of countering problems of accessibility of CHSLDs could cause prejudice to the users. It recommends a review of the conditions of access to residential care, including the wait times and the consequences of resorting systematically to temporary residential care. It also draws the Committee's attention to the importance of communication with seniors and their families. Finally, it proposes an analysis of the foreseeable increase in the demand for public residential care to measure its effects on the supply of services.
Services and care
Assistance in activities of daily living is the greatest source of dissatisfaction for residents accommodated in CHSLDs. The Québec Ombudsman's investigations reveal that the patient attendants' daily work plan leaves little leeway to respect the conditions of a quality living environment, regardless of whether this involves communication with the residence, assistance with meals, or hygiene care. To support the implementation of a living environment adapted to the residents' special needs, it is not possible to skimp on a better organization of work.
Monitoring the quality of care and services
The Québec Ombudsman has no inherent reservations regarding the principle of agreements between the public network and private partners for the purchase of residential care places. However, it is concerned about the insufficient control of quality monitoring recognized during its investigations. Indeed, several CSSS and agencies do not adopt adequate procedures to favour an informed and sound choice of private partners. The Québec Ombudsman considers that the following factors should be given better consideration: the private partners' staff evaluation and hiring criteria, the skills and competencies of this staff based on the profile of the clientele, the staff ratios in relation to the number of residents in this specific environment, and the clinical supervision tools. In its brief, the Québec Ombudsman makes suggestions in this matter.
In conclusion, the Ombudsperson pointed out to the Committee that it is now time for action. "Several solutions were raised in the context of the mandate for this initiative. They are added to the recommendations made by the Québec Ombudsman in its annual reports. It is now time to implement these recommendations consistently within a comprehensive perspective that includes home support services, access to hospitals, and temporary residential care."
- Québec Ombudsman's Brief presented to the Commission de la santé et des services sociaux on the living conditions of adults accommodated in long-term and residential care centres — initiative mandate (PDF, 221 KB)