Aging at home, how much does it cost?
In Quebec, home care services are quite complicated to obtain, and the process sometimes resembles an obstacle course.
Michèle Charpentier, a specialist in social gerontology at UQAM, noted in an interview with L'actualité that obtaining assistance for a senior with loss of autonomy requires diving into a world of paperwork and struggling through exasperating voicemail systems.
On paper, the programs exist and seem both simple and attractive, but when you ask those who have tried to access the services, it's often a completely different story!
According to Dr. Réjean Hébert, a geriatrician who spoke in an interview with Radio-Canada, it would be advantageous for both citizens and the government to restore a better balance between home support and long-term care facility offerings (CHSLD). He claims that too many individuals with mild or moderate loss of autonomy end up in residential care centers due to a lack of access to the assistance that would allow them to remain at home. Of course, such a situation is far from ideal, as the cost of residential care is much higher than the necessary support for someone who is still sufficiently independent to remain at home.
Quebec therefore needs to rethink its elder care offerings, and several groups are advocating for this change. However, it may take some time for the ship to change course, and many aging individuals want to increase their chances of staying in their homes for as long as possible. This is where the advice of a professional and long-term planning that takes into account the client's specific needs becomes crucial.
Among the resources aimed at helping individuals who want to age at home, the following can be mentioned:
1. Paid services offered by social economy enterprises for home support
Nursing care, meal assistance, various tasks, companionship, etc. These services are provided at a cost ranging around thirty dollars per hour, and on average, a person uses about fifteen hours per week. It should be noted that the Financial Exemption Program for Domestic Help Services (PEFSAD) offered by the Régie de l'assurance maladie du Québec (RAMQ) provides financial assistance ranging from $4 to $18.64 for each hour of service provided. This assistance is calculated based on the age, family situation, and family income of the person receiving the services.
2. Home Adaptation Program (PAD)
This is a subsidy from the Société d'habitation du Québec targeting individuals with permanent functional limitations. Unfortunately, there is a long wait time (up to 24 months!) to receive a visit from an occupational therapist to initiate the assistance request.
3. Home Support Tax Credit
Revenu Québec grants a refundable tax credit to seniors aged 70 and over who incur expenses to remain in their homes. Eligible expenses may include housekeeping or other home maintenance work, assistance with bathing, nursing care, or prepared meals, for example. Depending on their income, a single and self-sufficient individual can receive up to $7,020 per year (36% of the maximum eligible expenses of $19,500). For a non-self-sufficient person, the credit can reach $9,435. It should be noted that the credit can be claimed in advance.
4. Personal Financial Strategy
This option, of course, provides the greatest flexibility as the individual uses their own resources to make choices that suit them. However, to be able to take advantage of this option, long-term planning is necessary. For example, it will be necessary to have established a savings plan, optimization of investment tools and tax benefits, a disbursement strategy, accelerated mortgage payment, etc.
5. Insurance for Serious Illness/Loss of Autonomy
Another tool that can prove to be a valuable aid. Depending on the offered contract, this insurance can include a monthly annuity, reimbursement for better treatments, and assistance services in housing, convalescence, or psychological support, for example.
"Planning the financial resources that will be available in the event of loss of autonomy is an aspect of integrated and comprehensive planning that is of increasing interest and concern to advisors and their clients, with the latter attaching greater importance to being able to live at home for as long as possible."
- Yvan Morin
Furthermore, according to Yvan Morin, Vice President of Legal Affairs at MICA Financial Services, "planning the financial resources that will be available in the event of loss of autonomy is an aspect of integrated and comprehensive planning that is of increasing interest and concern to advisors and their clients, with the latter attaching greater importance to being able to live at home for as long as possible."
Example: Pauline's Case
Pauline is 72 years old, lives alone, and is starting to experience some difficulties in performing all her daily tasks. She wants to stay at home for as long as possible. She has an income of just over $30,000 per year and has approximately $200,000 in investments. She owns a fully paid-off house and drives her own car.
Pauline does not suffer from any serious illness, but her arthritis is a cause for concern, she is particularly afraid that losing her balance or falling could greatly reduce her autonomy. In the short term, she would like to have a non-slip floor installed in the bathroom (around $3,500), a raised toilet ($500-$600), and grab bars ($300-$400). She could therefore take advantage of the provincial tax credit for these expenses. However, she would not be able to benefit from the Home Adaptation Program (PAD) as she has not received a diagnosis for a serious illness.
She still believes that in a few years, she may need external assistance for meals and housekeeping. If Pauline needs about ten hours per week, costs could reach $300 per week through the social economy enterprise for domestic assistance in her neighborhood. However, they could be reduced by about half thanks to the government assistance (RAMQ and Revenu Québec) available for her income category.
And if Pauline's health deteriorated to the point where she became non-autonomous, could she still stay home? Her savings ($200,000) would not be sufficient for full-time care for very long. That is why it is essential to establish a comprehensive strategy to maximize the money available for her golden years.
In Pauline's case, if it is a priority for her to remain in her home despite a possible significant loss of autonomy, she may need to consider private insurance.
Private insurance products for home care, however, are very limited in Quebec. They are more commonly in the form of insurance for serious illness, and premiums can be quite high depending on age, health condition, chosen coverage, etc. Nevertheless, they remain a factor to consider within the framework of holistic and integrated financial planning.