The aging of the population in Quebec was long overdue, but nothing has been done to prepare for it. The tendency to resort to housing for our seniors is also indicative of a society unable to provide the home services necessary for people with loss of autonomy (Hébert, 2020). By betting on hospitals, the liberal health reforms will have missed the turning point and, consequently, will have participated in the killing of the front line.
Home support services are bankrupt in Quebec. Apart from the evaluations that our seniors (and any person with a disability) undergo, they wait months before obtaining the slightest service. Due to a lack of access to public, social economy and community resources, seniors are now clearly encouraged to go and live in a private residence.
Three elements contribute to complicate access to home care services. First, there is the technocratic treatment of requests for home help and the very programmatic way of trying to respond to them. Then there is this lack of transparency regarding the resources available, which explains the gap between the expectations of our seniors who want to live at home and the possibility of carrying out their project. Finally, there is the lack of doctors who are accessible and who agree to support their patients who are losing their autonomy at home.
Private social intelligence assessments
There is a cumbersome tool that no longer has its place in home care services in Quebec. The computerized clinical pathway tool (OCCI) used by the professionals involved in making an initial assessment with the person in need is inadequate. Fifty pages to fill in, to revise every year! In fact, this questionnaire, in addition to monopolizing professional resources, skews the perspective of intervention. By decontextualizing the singular demand arising from the experience of loss of autonomy, professionals, stuck in this rigid tool of analysis, no longer have the freedom to formulate a clear judgment that can be extracted from an offer of deficient services.
In fact, this heavy techno-bureaucratic tool prevents opening dialogue with the person with a disability. Instead of favoring the encounter with the user in crisis (rupture of balance) and participating in social development, the OCCI digs into the intimacy of the person, prepares for care opening up to a perspective of services that are … unavailable! Absorbed by the tool and for lack of time, many social workers give up using their skills, their know-how, in exchange for silence and a job in the public network.
A lack of resources
What to think of a social worker, engaged in the public network, who informs his client that he will have to wait more than a month before getting a little help, that he will have to pay for services, if not consider a moving to a private residence? What to say, except that our home services are bankrupt? Without health and social services auxiliaries or help from employees of social economy organizations, it is impossible for a person experiencing a loss of autonomy to continue living at home.
Consider an 86-year-old man living in his house with his wife. Until recently, the man was able to do his transfers alone, to move around with his walker and to wash himself. But then he contracts COVID-19 and is suddenly unable to get out of bed. In a panic, the wife calls us: “What do we do? The man refuses to go to the hospital. He categorically refuses accommodation.
As navigators, we understand the magnitude of the challenges posed by the situation. Without the immediate help of a loved one, a CLSC auxiliary or a community organization, or even a person subsidized by the service employment paycheque program, the man will not be able to stay at home.
Moreover, unable to move, the man will need a doctor who will visit him at home, if only to establish with him his level of care. Because it is possible that the man is content with comfort care. Besides, what is the use of all these convocations from the outpatient clinics of the hospital that he receives for follow-ups in specialties?
For better access to home services
The elderly I meet in the exercise of my profession want to stay in their homes… and die there if possible. Unfortunately, our health network does not allow us to consider such a prospect with them. No sooner will they have been assessed by home support services than people with disabilities will be led to consider accommodation in a private residence, for lack of money to pay for private services. It does not mean anything !
We must think differently about home services. Our social service professionals do not have to restrict their activities or use all their time to use a techno-bureaucratic tool that suggests support by a network that has nothing more to offer. Even less do they have to feel pressured to get people to consider private accommodation as the ultimate option. If the Quebec state no longer has the means to fulfill its ambitions (At home: The first choice2003), it is responsible for informing its population.
Our healthcare companies give the image of being omnipresent, but they have in fact become bloated and disconnected from the needs of their populations. As one expert points out, “health care management has become too distant and opaque,” when it should be more engaging and collaborative. Currently, there is too much management at the top to escape management on the ground, when we need more fortified care, more connected remedies, more nuanced controls and more engaged communities (Mintzberg, 2022). In Quebec, it is really time to decentralize and review the management of health and social services. But what government will have the courage to act by appealing to reason?