Mini-hospitals focused on the needs of the elderly to relieve overcrowding in emergency departments

Halfway between a family medicine group (FMG) and a hospital, the Quebec government on Wednesday clarified its model for private mini-hospitals that will focus on the needs of the elderly.

Two mini-hospitals, which will resemble specialist geriatric clinics, will be set up in the Montreal and Quebec City regions.

The office of Health Minister Christian Dubé confirmed on Wednesday that a budget of $35 million in public funds will be allocated annually for each mini-hospital. All care and services will be free for patients, who will be covered by the Régie de l’assurance maladie du Québec.

These facilities, which the Coalition Avenir Québec (CAQ) hopes to deliver by 2025, will have an emergency room, but no operating theatre.

They will be equipped to meet the needs that most often affect the elderly, but people of all ages could be referred there if the mini-hospital is the best place for their needs.

In an e-mail to The Canadian Press, Jacques Morin, president of the Association des médecins gériatres du Québec (AMGQ), expressed scepticism about the CAQ’s mini-hospital concept.

“The geriatric outpatient clinic model as presented is vague and it is difficult to assess its added value in terms of the target clientele and real benefits. A number of less costly and scientifically proven alternatives exist to achieve their objectives of reducing emergency room visits, including optimising geriatric outpatient clinics that already exist but are underfunded and understaffed,” said Morin.

He indicated that the AMGQ would be commenting on the project in greater detail over the next few days.”For the time being, what we know for sure is that geriatricians are not part of the project in its current version, even though they are called ‘ambulatory geriatric clinics’,” said Morin.

The mini-hospitals will be open 24/7, but new patients will be admitted from 7 a.m. to 10 p.m.

The teams will have diagnostic tests on-site and will be able to keep patients under observation for short stays.

Nurse Philippe Voyer, who is also a professor, researcher, and vice-dean of the Faculty of Nursing at Université Laval, welcomes the government’s concept, describing it as a first step in adapting care for the elderly.

“I’d certainly like to see geriatric hospitals with all the specialties, like Sainte-Justine Hospital for children. In my opinion, this is the best way to meet the needs of geriatric patients, but we’re not there yet. The decision that has just been taken is, for me, a step in the right direction,” said Voyer in an interview.

Since the mini-hospitals will specialise in geriatrics, Voyer is hopeful that the needs of the elderly will never be lost sight of, whatever their health problem.

Patients admitted to the mini-hospitals will first be referred by a healthcare professional from another healthcare establishment. This could be a referral via the Guichet d’accès à la première ligne, 811, 911 or ambulance staff.

The government’s aim is to relieve hospital overcrowding of less urgent cases, more specifically P4 and P5 cases as they are known in medical jargon.

The president of the AMGQ pointed out that among patients classified as P3, P4, and P5, elderly patients are the most likely to have a condition requiring hospitalisation. According to Morin, “Directing them straight to an outpatient clinic is a care offer that runs the risk of failing to meet the needs of these patients.”

The mini-hospitals will also have access for ambulances and paratransit.

The government could repeat the mini-hospital project elsewhere in Quebec.

“We have always said that the private network should complement the public network, and it is by joining forces as we are doing today that Quebecers will have better access to their healthcare network,” said Minister Dubé in a press release.

The health minister’s office said it was aware of situations where elderly people who go to emergency departments can spend several hours there when they are sorted out at the bottom of the priority list, even though we know that this is often not an appropriate environment for the elderly, or even a hostile one. The mini-hospitals concept is designed to alleviate such situations.

“Waiting in an emergency room, not getting the fluids you’re used to, not sleeping properly, not eating the way you’re used to, not being able to move around (…) all these things have a negative impact on this clientele. We want to help them, but emergency departments are not a helpful environment for the elderly, and it’s detrimental to their health,” explains Voyer.

He would like to see Quebec develop a network of care and services that take account of the vulnerability of the elderly, including geriatric hospitals.

Not everyone in the healthcare sector is welcoming with open arms the concept of mini-hospitals presented on Wednesday. The Fédération de la santé et des services sociaux (FSSS-CSN) voiced its dissatisfaction on the X social network.

“The CAQ wants to reserve its future private hospitals for seniors. Minister Dubé just doesn’t get it. We need to invest in the public sector. Studies show that the private sector is not good for health”, writes the federation.

The Montreal Economic Institute (MEI) pointed out on X that although 73 per cent of Quebecers support the concept of mini-hospitals, “the CAQ is backtracking on its project and distorting it by creating large GMFs and minor emergencies for seniors instead. By visiting Quebec’s emergency rooms, the CAQ would realise that waiting times in emergency rooms affect all age groups.”

-This article was translated from French by CityNews