The Future of Long-Term Care in Quebec: What Are the Cost Savings from a Realistic Shift toward More Home Care?

In this article, we aim to estimate future long-term care needs and expenditures in Quebec while proposing and evaluating a reform package that could deliver increased coverage and be more financially sustainable than current policy. This reform package consists of a shift toward more intensive use of home care while increasing public coverage of care needs. A key feature of the proposed reform is to improve users' ability to choose their provider with the creation of a senior's care account, an account that allows individuals in need to purchase services from several providers, including both home and institutional care. To improve the neutrality of public support across care arrangements, we also propose an increase in the resident contribution in nursing homes while favouring the continued use of existing tax credits to help seniors with lower care needs. Using detailed dynamic modelling of care needs, living arrangements, and expenditures, we estimate that long-term care needs will grow rapidly in the next two decades, and the costs will quickly become prohibitive under current policy. We show that substantial cost savings may exist.