Long Term Care in Quebec

Government-Subsidized Nursing Homes

How Nursing Homes are organized and administered

Nursing homes or centres d'hébergement et de soins de longue durée (CHSLD), as they are called in Quebec, are residential facilities that provide 24-hour professional nursing care and supervision in a protective, supportive environment for people who have complex care needs and can no longer be cared for in their own homes.

Admissions to subsidized nursing homes or beds (subsidized beds within a private nursing home) are managed by Local Community Service Centres called Centres locaux de service communautaire (CLSC) in Quebec. If a client currently living at home wants to apply for admission into a CHSLD, he/she must contact their local CLSC. Alternatively a relative or friend of the client can make the request for admission on his/her behalf. In the case of a client who is hospitalized, the hospital will undertake the request of admission into a CHSLD on the client's behalf. In both cases, a social worker or nurse from the CLSC will conduct an assessment of the client's physical & mental capacities. A medical evaluation is also undertaken by the client's doctor.

Eligibility/Requirements for Admission

To be eligible for admission into a CHSLD, an individual must:

• be aged 18 years or older,
• be a resident of Quebec,
• be a Canadian citizen or have permanent resident status,
• have diminished autonomy due to aging or because of physical or mental handicap(s).

Income/Asset Test

An income/asset test is not a standard element of the assessment conducted by the CLSC. However, if a client cannot afford the costs of a nursing home, he/she must duly fill out the Demande d'exonération ou de réévaluation (Request for exoneration or re-evaluation) form that can be obtained from the CHSLD where the client is residing and send it to the Régie de l'assurance maladie du Quebec (Health Insurance Board of Quebec) or the RAMQ. The RAMQ then analyzes the request taking into account the client's and his spouse's liquidity (bank statements, guaranteed investment accounts, shares, savings, RRSP etc.), assets (principle residence, other properties such as cottages, buildings, land etc.) and revenues (income from Old Age Security, Canada's Pension Plan, the Régie des rentes du Québec (Revenue Board of Quebec), employment, employment insurance, American social security or pension from other countries etc.). The RAMQ will also take into account family obligations. Based on this evaluation the RAMQ will inform the client what he/she has to pay the CHSLD.

The following family deductions from maximum room rates may apply:

• $342.00 per month for the client's personal expenses
• $1,482.00 per month if the client has a non-accommodated spouse

Costs

Fees are set on the 1st of January of every year by the ministère de Santé et des Services Sociaux (Ministry of Health and Social Services).

These fees paid by the client to the CHSLD are a co-payment that covers part of the cost towards:

• services related to room and board such as food, housekeeping, heating etc.
• articles and services necessary for personal hygiene such as incontinence products, soap, shampoo, deodorant, baths and laundry
• all other equipment necessary for therapeutic purposes

Medical care, nursing (when it is provided by the CHSLD) and medicines are free and covered under the provincial health plan.

Private Nursing Homes

All unsubsidized private nursing homes are in charge of their own admissions procedure, wait lists and fees. Following pandemic-related deaths in long term care facilities, and in order to standardize and improve the quality of care and services, the Quebec government had committed to subsidizing all private nursing homes in Quebec by the end of 2025. As of the fall of 2024, only a few private nursing homes remain unsubsidized.

Costs for Private Nursing Homes

Retirement Homes/ Residences

How Retirement Homes are Organized and Administered

A retirement home in Quebec is a multi-residence housing facility that provides accommodation and services such as meals and cleaning services for older people. Retirement homes in the province are privately owned and operated and not administered by the provincial government. Each facility usually provides a private or semi-private room or complete living suite and then also provides common living quarters, including a lounge area, a common dining room, recreation rooms, cleaning services, social and/or religious programs and some basic health care services. The unit can be paid for on a monthly fee basis, like an apartment, or can in some instances be bought the same way as a condominium.

Admission, fees and waiting lists for retirement homes are controlled by the homes themselves, not by the government. Admission usually depends on the ability to pay and absence of serious medical conditions that require professional nursing care. Residents are responsible for paying their own fees and government subsidies are not available for accommodation in a retirement residence.

Approximate Monthly Cost for Functionally Dependent Residents

Government-Subsidized Home Care

How Government-subsidized home care is organized and administered

Subsidized Home support services are designed to help clients remain independent and in their own home for as long as possible. Home support provides personal assistance with daily activities, such as bathing, dressing, grooming and light household tasks that help to maintain a safe and supportive home. They also provide medical care such as skilled nursing and occupational therapy in the home.

To apply for subsidized home care a client must contact his/her Local Community Service Centres called Centres locals de service communautaire (CLSC) in Quebec. The CLSC will conduct an assessment to determine the needs of the client. If home support assistance is recommended, the CLSC will help the client determine the assistance that will best suit their needs and will make the necessary arrangements. The maximum number of home care hours per week provided by the CLSC is usually 15 hours, following assessment of needs by the CLSC.

Eligibility/Requirements for Admission

To be eligible for home care, a client must be:

• a resident of Quebec,
• a Canadian citizen or have permanent resident status,
• physically handicapped, chronically ill or otherwise require in-home assistance.

Income/Asset Test

An income/asset test is not a standard element of the assessment conducted by the CLSC as most services provided by the CLSC are free. However some services, such as housekeeping, are priced according to income (as per annual income tax returns).

Costs

All services are free except for housekeeping, meal delivery, home repairs and required equipment, such as assistive bathtub bars.

Persons using domestic help services provided by a domestic help social economy business that has been accredited for program purposes may receive financial assistance applicable towards the hourly rate the business charges. There are 2 types of financial assistance - basic and variable.

Basic financial assistance of $4 for each hour of service rendered is granted to any eligible person, regardless of family income.

Variable financial assistance  which ranges between $2.70 to $21.60 for each hour of service rendered, may be granted over and above the basic financial assistance, and is determined on the basis of an eligible person's age, situation and family income.

Private Home Care

CLSC resources are limited and go to the neediest. As a result many clients get inadequate amounts of CLSC services and have to rely on private home care services to receive the appropriate amount of care.

Costs of Private Home Care

Scenario 1: Low level of care (early in the crisis management stage of care)

Mrs. Williams is an 85 year old widow living in her own home. She has osteoarthritis and leg edema. She must wear support stockings to relieve her edema and because her fingers and back are arthritic, she needs help getting dressed. To get around her home, she uses a walking support device or rollator. Both of Mrs. Williams' daughters help her out regularly on weekends and evenings while her son-in-law helps maintain the house and takes care of the lawn.

After fracturing her femur in a significant fall 9 months ago, Mrs. Williams' mobility has been severely decreased and she lost 9 kg or almost 20 lbs as a result. She tells her daughters that she forgets to eat and the food in her refrigerator is spoiled. During their visits, her daughters notice she eats very little and sometimes chokes on her food.

To help her eat safely and address her other needs, Mrs. Williams and her daughters agree it's time for some formal care. She needs her meals delivered to her home, someone to supervise her meals and assistance with dressing and bathing. She would also benefit from a home safety assessment.

Care plan to assist family caregivers part-time

• Meal preparation - 2 hours a day on weekdays
• Meal supervision - 1 hour a day on weekdays (to include a record of food intake and assistance if patient chokes)
• Personal Care (bathing, dressing) - 1 hour a day on weekdays
• Occupational therapist: to provide initial home safety assessment and recommendations

In addition, depending on whether the senior chooses to go with a CLSC or a private provider, there may be expenses for two visits of an occupational therapist including a 1 hour initial assessment and a 45 minute follow up after the equipment has been installed. The two visits will cost $262.50 altogether. If the senior decides to go with the CLSC, the CLSC may provide these services for free.

Scenario 2: Intermediate Level of Care (late in the crisis management stage of care)

Mr. Leung is a 72 year old widower. He lives with his daughter and her husband in a small community outside the city. Mr. Leung has cataracts in both eyes. He also has dementia which has progressed to the point where he requires continual supervision. He forgets to take his medication, does not eat properly and cannot safely prepare meals. He needs cues for dressing and bathing.

Mr. Leung's daughter and her husband assist him mornings, evenings and weekends but aren't available on weekdays. For weekdays, they enrolled him in an adult day program 2 days per week and hired someone to accompany him to and from the program. For the remaining 3 days of the week they've hired someone to supervise him and keep him company. They've also arranged help for laundry and house cleaning.

Care Plan to assist family caregiver full days, during the week

• Companionship/Supervision: 3 times a week, 8 hrs a day
• Adult Day Program: 2 days a week
• Safety Supervision: to and from the Adult Day Program - 2 times a week, 30 minutes each way
• Laundry/House cleaning: 3 hrs a week

Scenario 3: High level of care (in the dependence stage of care)

Mr. and Mrs. Jensen live in a two-bedroom condominium. Mr. Jensen is 93 years old, alert and aware but physically frail. Mrs. Jensen is 88 years old, diabetic and recently had a stroke. Her balance is poor and she's at high risk for falling. She can only walk short distances and needs help to get around. She also has heel ulcers that make walking even more difficult. For longer distances, she uses a wheelchair.

Her family doctor recommends Mrs. Jensen move to a nursing home. But because Mr. and Mrs. Jensen's daughter promised she wouldn't send her parents to a nursing home, she needs to make alternate arrangements. Options include a caregiver to assist Mrs. Jensen with bathing, dressing, toileting, walking, meal preparation, household chores and transportation to and from appointments. A nurse could monitor and chart her medicine use and blood sugar levels, clean her heel ulcers and change her bandages. Mr. and Mrs. Jensen would also benefit from a home safety assessment by an occupational therapist who may recommend safety bars, raised toilet seats, better lighting, removing clutter and securing loose rugs.

Care plan to assist family caregivers full-time, every day

• In-home meal preparation - 7 days a week, 2 hours daily
• Private caregiver - 7 days a week, 8 hours daily to assist with bathing, dressing, toileting and walking and relieve spouse of caregiver duties
• Private Registered Nurse - 4 times a week for 30 minutes to monitor and chart medicine use and blood sugar levels and monitor and change dressing on heel ulcers
• Laundry - 2 hours every other week
• House cleaning - once a week for 90 minutes
• Occupational therapist: to provide initial home safety assessment, recommendations and a 45 minute follow-up after equipment installation