The Legault government says it wants to take a “massive shift” towards home support so that Quebec seniors can live at home for as long as possible. As needs explode, what role can the private sector play, especially since Quebec already wants to give it more space?
laudette Cyr, 75, has lived in a small apartment in Laval for 12 years. Since her hips and knees hurt, she is not able to do the housekeeping herself. She therefore appealed to the financial exemption program for domestic help services (PEFSAD), which allows her to hire an attendant who comes to clean her home once a month. ” It’s not sufficient. I would need it at least twice a month,” says Ms.me Cyr.
She would also be happy to have a hand with grocery shopping, but her limited budget does not allow it. Since she has income of less than $20,000 per year, she is entitled to a subsidy of $18.24 per hour of service from the Coopérative de soutien à domicile de Laval, whose rates are $31.50. per hour. “$26 a month, I can’t pay more than that,” says the septuagenarian, who wants to avoid ending up in a residential center for seniors as long as possible.
A large number of elderly people deprive themselves of the services they need, estimates the Cooperation Network of Social Economy Enterprises in Home Help (EESAD). According to the organization, about a hundred EESADs offer approximately 25% of home support services in Quebec, such as housekeeping, meal preparation, laundry, hygiene care or assistance with taking medications.
“If citizens had the means to pay, we would double [les heures de services données] “says the general manager of the network, J. Benoit Caron.
His group is delighted that the health action plan presented on Tuesday by the government promises “a massive shift” towards home support. But Mr. Caron is disappointed that the Legault government’s latest budget does not provide for an improvement in the assistance provided to PFESAD beneficiaries, contrary to what his network had recommended.
According to him, we must also immediately establish a concerted action plan between the EESADs — non-profit companies, it should be remembered — and the government, which simply does not exist at the moment.
A cocktail of suppliers
EESADs are not the only organizations managed outside the public network to provide home care, far from it. This type of assistance also includes professional services, such as those of nurses.
The sector is made up of a complex cocktail of service providers: social economy enterprises, community organizations, private companies (employment agencies, for example) and individuals paid through service employment cheques, among others. Private residences for seniors also offer similar services.
In fact, in 2020-2021, only 15% of long-term home care service hours in Quebec were provided by CISSS and CIUSSS staff, according to data from the Ministry of Health obtained by researcher Anne Plourde, from the Institute for Socio-economic Research and Information (IRIS).
Some 100 home-help social economy enterprises provide approximately 25% of home-support services in Quebec, such as housekeeping, meal preparation, laundry, hygiene care or medication.
For Alain Dubuc, professor at HEC Montréal and advisor to the Institut du Québec, this mixture has the advantage of offering users a wide variety of choices. “There are so many needs, we can’t say that we don’t want this or that type of partner,” says the author of the report. Home care: the status quo will no longer be possiblepublished in August 2021.
According to Mr. Dubuc, home support is also distinguished by the fact that a large part of the services provided are not of a medical nature. “There’s no reason floorwashing should be public rather than private,” he says.
Mr. Dubuc also believes that part of the fees should continue to be paid by users according to their means. But it is above all necessary to better integrate, coordinate and supervise the different forms of services, believes the professor.
The private wants a place
Private companies want to play an active role in the shift towards home support, says the Council of private companies in health and well-being (CEPSEM).
“They would like to imitate the path taken in surgeries, that is to say that when there were waiting lists, we agreed on certain types of operations that we could do in private , while maintaining universality. These are companies that have formed teams, that have trained personnel, mechanisms for continuous quality improvement, that offer continuity of care and rapid support,” said the CEO of CEPSEM, Luc Lepage, citing in particular the company Bien chez soi, which has about thirty franchise locations in Quebec.
Mr. Lepage regrets that, for the moment, private home support companies are confined to a troubleshooting role. The health network should instead develop a relationship of trust and partnership with them, he believes.
Researcher Anne Plourde, from IRIS, is less optimistic about such recourse to the private sector. “The problem is that they are not integrated into the multidisciplinary team, the global approach, the services that are consistent with each other… We should rather move towards reintegration into the public sector, with well-trained employees”, indicates the person who is particularly concerned about the quality of the services received.
She also points out that part of the money injected into the private sector will necessarily be used to generate profits rather than being reinvested in the services themselves.