Quelques dilemmes, quelques valeurs pour une politique de services de longue durée

Abstract

ABSTRACTLong-term care is available for individuals with functional incapacities. Long-term care includes medical, social, and personal hygiene services, which help to maintain the autonomy of the elderly and allows them to live with dignity in spite of loss of autonomy. This definition provides long-term care services with a goal and a clientele. However, are individuals with functional incapacities first and foremost chronically ill? Should long-term care services be conceptualized as independent from medical care? Provincial government policy documents promote a social model of long-term care which privileges community services as opposed to institutional services. What in fact does this choice imply? To what extent have resources been allocated in accordance with these objectives? A study of these questions based on Canadian data on the relationship between illnesses, disabilities and functional incapacity and data from a historical survey of expenditures in Quebec for hospital care, medical care, institutional long-term care and community services indicates that illnesses, disabilities, and functional incapacity, although strongly correlated in an elderly population, cannot be collapsed into one big category for planning services; co-ordinated services in a multidisciplinary approach are needed, not dominance from one professional group. As to costs, an examination of the data shows that in relative terms costs for community care tended to increase significantly in the recent past. Yet it is not clear that there has been a transfer from short-term medical and hospital services to long-term care. However, there has been an important internal change in hospital costs, with the elderly representing the only group whose costs are rising. In short, despite the political rhetoric on long-term care for the elderly promoting a community approach, these services' main function is still the surveillance of the vulnerable elderly in both short- and long-term care facilities; adapting the elderly to their environment and the environment to the elderly play a growing, though minor, role in the overall picture of medical and social services.