Q&A: The Quebec Election and Long-Term Care

The NIA’s Dr. Samir Sinha shares his top takeaways from the parties’ campaign promises

Quebec is heading toward a provincial election on Oct. 3. The province was one of the hardest hit by the COVID-19 crisis in long-term care, so it’s no surprise that each of the five major parties is promising changes to better care for older Quebeckers. The NIA’s Director of Health Policy Research, Dr. Samir Sinha, shares some thoughts on the parties’ campaign platforms.

Q: What are your overall impressions of what the parties are promising on long-term care?

A: Overall, there seems to be a much more thoughtful dialogue happening in Quebec. In this year’s Ontario election, the parties were mostly focused on building new long-term care (LTC) beds. What we see in Quebec is much more conversation around investing in a more comprehensive approach to the provision of LTC — including in people’s homes — and better ways to support family caregivers and enable things like home adaptations that could enable more people to age in place.

Q: What’s an example of that?

Many parties are looking at making significant improvements to the portion of LTC spending directed to home- and community-based care: Québec Solidaire is promising $750 million annually to guarantee access to at-home care; the Parti Québécois is promising to invest $1.5 billion annually for home care and triple the amount of home-care service hours; the Quebec Liberal Party is offering $2,000 a year to people aged 70 and older who stay at home, which could be spent on in-home care or making adaptations to their houses. Quebec is currently one of the provinces in Canada that spends the least on at-home care compared to institutional care. Perhaps the pandemic raised the ire of people in Quebec about the state of institutional LTC so they’re looking at more home- and community-care options they can also pursue.

Another really key thing is that all the political parties recognize the role of unpaid caregivers. Quebec is one of the only provinces that offers a non-refundable tax credit to caregivers, regardless of whether they earn an income. The Parti Québécois and Conservative Party of Quebec would expand that tax credit; Québec Solidaire would spend $380 million to support caregivers. It looks like the parties recognize the indispensable role of unpaid caregivers and also the financial disadvantages of being a caregiver, and they’re looking to better support them financially.

Q: What do you think about the current government’s approach to LTC?

The incumbent Coalition Avenir Québec (CAQ) first announced in 2019 their new model of LTC known as maisons des aînés — homes that provide care in a more home-like setting, with a maximum of 12 residents living in individual units making up each home. My main criticism of this model has come to life — while they’re building almost 50 of these homes, they haven’t necessarily made a clear commitment to staffing homes more appropriately to ensure they can deliver the high-quality care that small-home models like Green Houses in the United States can enable. So we might be seeing more of the same inadequate ratios that we do in traditional LTC settings. The question is, will the quality of care be much better in maisons des aînés when we know we need more staffing to get the positive results we’ve seen in other jurisdictions?

Q: Are there any unique proposals that jumped out at you?

The Conservative Party of Quebec is proposing making Quebec the first jurisdiction in Canada to offer long-term care insurance. The idea is that, just like how we make contributions to the Canadian Pension Plan, this is another form of insurance that would cover your potential future costs of LTC. Other countries around the world have already implemented this, as well as Washington State. This is an idea we’ve talked a lot about at the NIA.

Q: For the party that wins this election, what is the most important thing to keep in mind?

Long-term care is not just about building more beds: it fundamentally needs to be about providing the appropriate supports, along with the right health workforce resources, to provide the care that an ageing population needs to age in the right place. It should also specifically include appropriate supports for unpaid caregivers, and support that allows people to age at home for as long as possible.