Re-Imagining
Decentralization
Since 1992, the ministry of health and social services (MSSS) is in charge of long-term residential care in Quebec (AEPC, n.d.) In 2015, health institutions in Montreal regrouped in five different district named Centre intégré universitaire de santé et de services sociaux (CIUSSS, 2020). Since this merger, institutions find themselves in a situation where they lose agency over what the organization and the staff can achieve, thus contributing to the dehumanization of the system (Rad, 2022). Massive shortages of frontline workers are one example proving that over-controlling these spaces affect the whole living and working environment. Decentralizing should be considered as it brings back agency at a local level, where people can directly act on their environment and be more resilient toward their immediate needs (La Converse, 2021).
Since 1992, the ministry of health and social services (MSSS) is in charge of long-term residential care in Quebec (AEPC, n.d.) In 2015, health institutions in Montreal regrouped in five different district named Centre intégré universitaire de santé et de services sociaux (CIUSSS, 2020). Since this merger, institutions find themselves in a situation where they lose agency over what the organization and the staff can achieve, thus contributing to the dehumanization of the system (Rad, 2022). Massive shortages of frontline workers are one example proving that over-controlling these spaces affect the whole living and working environment. Decentralizing should be considered as it brings back agency at a local level, where people can directly act on their environment and be more resilient toward their immediate needs (La Converse, 2021).
No future in
for-profit
There are three types of LTRC: public, privately funded, and private. The Health Insurance plan that we benefit from setting a monthly price of 2019.30$ for an individual room, which includes the medical care, in public long-term care when it costs 10 242.00$ to the state (Girard, 2020). Privately funded and private LTRCs can set their own rules regarding housing prices which vary from 5 000$ and 8 000$ per month. Regrettably, for-profit homes proved to be the least resilient during the pandemic: higher mortality rates, scandals, low staffing, and low wages (Armstrong & al., 2020). We have the chance of having a public system, which has flaws but still contributes to 76% of all the places in Quebec (CSBE, 2021).
Caring Community
Re-imagining Long-term residential Care necessitates changes at multiple scales, from the system of governance to urban planning, architecture, ideologies about living and sharing together, and spaces themselves. With the rising demographic of old people, there’s a crucial need to stop isolating them and make them active members of society. In his book Lost in Space: Architecture and Dementia, the architect Eckhard Feddersen describes seven characteristics of an age-friendly culture that can serve as a basis for future design around the theme of caring communities (Feddersen, 2014) :
▫ Inclusion of older people in social, political and cultural discourse
▫ Intergenerational perspective
▫ Potential in old age
▫ Social spaces that promote independence, accountability and participation
▫ Respect of individual uniqueness
▫ Break down social inequalities among old people
▫ Recognize and acknowledge the rights, entitlements and needs of all
Re-imagining Long-term residential Care necessitates changes at multiple scales, from the system of governance to urban planning, architecture, ideologies about living and sharing together, and spaces themselves. With the rising demographic of old people, there’s a crucial need to stop isolating them and make them active members of society. In his book Lost in Space: Architecture and Dementia, the architect Eckhard Feddersen describes seven characteristics of an age-friendly culture that can serve as a basis for future design around the theme of caring communities (Feddersen, 2014) :
▫ Inclusion of older people in social, political and cultural discourse
▫ Intergenerational perspective
▫ Potential in old age
▫ Social spaces that promote independence, accountability and participation
▫ Respect of individual uniqueness
▫ Break down social inequalities among old people
▫ Recognize and acknowledge the rights, entitlements and needs of all
Collaboration between Actors
The complexity of re-imagining a system comes in part from interdisciplinarity, since a decentralization requires actors and/or stakeholders, that do not necessarily talked to each other, to work together. The inclusion of a cooperative approach within the health care system would be complex, but extremely beneficial. So how do we juggle between the government, the municipality or the boroughs, and the co-operative at the administrative level?
We asked this complex question to the Professor Emeritus André-Pierre Contandriopoulos from the School of Public Health, at the University of Montréal.
‘’ Nowadays, we realize that neither the state nor the private sector alone can respond to health care issues. It is clear that the private sector just doesn't work, and public/private partnerships generally don't work either while the state alone doesn't always have the means or the capacity to do so... So we need the huge space of cooperative, social economy, voluntary, semi-voluntary groups working for a public good ... and it’s the regulation of that common space, between the state, the municipality and the social field, like a not-for-profit organization that would enable us to tackle this issue sustainably. ‘’
The complexity of re-imagining a system comes in part from interdisciplinarity, since a decentralization requires actors and/or stakeholders, that do not necessarily talked to each other, to work together. The inclusion of a cooperative approach within the health care system would be complex, but extremely beneficial. So how do we juggle between the government, the municipality or the boroughs, and the co-operative at the administrative level?
We asked this complex question to the Professor Emeritus André-Pierre Contandriopoulos from the School of Public Health, at the University of Montréal.
‘’ Nowadays, we realize that neither the state nor the private sector alone can respond to health care issues. It is clear that the private sector just doesn't work, and public/private partnerships generally don't work either while the state alone doesn't always have the means or the capacity to do so... So we need the huge space of cooperative, social economy, voluntary, semi-voluntary groups working for a public good ... and it’s the regulation of that common space, between the state, the municipality and the social field, like a not-for-profit organization that would enable us to tackle this issue sustainably. ‘’
- André-Pierre Contandriopoulos