Abolition of private employment agencies | Serious concern for home care

(Quebec) It is not only in hospitals and CHSLDs that independent labor will soon be banned. Quebec also wants us to stop using it for home care, a sector where demand is exploding. While the network welcomes this, user committees fear service disruptions.

The measure went under the radar during the adoption last spring of the law aimed at weaning the health network from private employment agencies. The goal is to completely stop using their services by 2026, and from next year for large urban centers.

In the wake of the transition, a first contract for the hiring of health and social service assistants – employees who travel to their homes – in Montreal and Laval is already creating a stir, according to the Home Care Association of Quebec (ASDQ).

“Since 1^er October, there are horror stories of people who have no service, or to whom three attendants show up at the same time,” says ASDQ vice-president, Alison Green. His company, Bien chez soi, alone offers services to 4,500 users per year.

“It is not true that the network will be able to accommodate these 4,500 more people,” adds the woman who is also an administrator at the Council of Private Enterprises in Health and Well-Being (CEPSEM).

The Provincial Regroupment of Users’ Committees affirms that the decision causes “a lot of concern” among more vulnerable clienteles, such as those suffering from physical disabilities, who are often “at the end of the line” of the service offering.

Until now, the health establishment entrusted a volume of users to the private company, which was responsible for offering them the services. It was the company that drew up the lists, brought together the worker and the user and was responsible for follow-ups.

With the changes, the company must instead “lend” its staff to the CISSS or CIUSSS. The worker of the private company then contacts the CLSC which gives him the instructions to follow.

M^me Green believes that this will have the effect of discouraging his staff, made up largely of retirees from the network, in addition to destabilizing users and reducing the service offering.

“We are experts in optimizing home care. We also really help families because it is always the same people who go [chez le patient] “, she pleads.

Last August, CEPSEM expressed its concerns to the Ministry of Health and Social Services after the publication of the draft regulation specifying several provisions of the law. It was not followed up on.

Control of “quality of services”

The office of Sonia Bélanger, Minister for Health and Minister responsible for Seniors, confirmed to The Press that services were until now “outsourced, that is to say that establishments asked agencies to offer services to patients directly”.

M’s office^me Bélanger emphasizes that there was “therefore no way to ensure the quality of the services offered and the qualification of the staff”, which the new contract allows.

The CISSS de Laval is one of the establishments that have renewed their contract and is delighted with the new ways of doing things. “It saves us an intermediary because we have direct contact with the employee [de l’entreprise privée]. Does the employee show up this morning? Is he well trained? », Explains Annie Fortier, director of support for the autonomy of elderly people.

“ [Cela] facilitates communications and, through the band, the quality of services offered to users,” believes M^me Fortin, who affirms that it sometimes happened that services were not provided. “It could take a few hours before we found out,” she illustrates.

A “very rapid” transition

According to Alison Green, whose association represents around ten home care companies, the transition in Montreal and Laval is already experiencing hiccups. Members reported to him that employees had received, for example, the work schedule for the previous week.

Communication with the CLSC would also not be optimal, particularly in the evenings and weekends.

A worker would only have learned upon arriving at a user’s home that the user had COVID-19. Another was allegedly not informed of an update regarding a user’s medication.

The CISSS de Laval indicates for its part that the “change happened very quickly” and that several “mitigation means” were put in place to avoid problems and service interruptions.

M’s office^me Bélanger also assures that his “priority” is to ensure that the “transition goes well both for the staff and for those at home”.

Even if it pleads for an end to recourse to the private sector, the Provincial Grouping of Users’ Committees is not reassured for the future: “ [Le Ministère] never thinks about implementation,” laments the organization’s general director, Sylvie Tremblay, in an interview.

Labor: a major challenge

The Legault government is betting that abolishing the use of employment agencies will encourage workers to return to the public sector and, above all, will put an end to the exodus of employees to the private sector.

Sonia Bélanger also deployed a vast pilot project to ease the work of home care workers.¹.

In a study published in January 2022, the Institute for Socioeconomic Research and Information revealed that home care was one of the sectors of the network where “structural dependence” on placement agencies was the strongest. . In fact, more than a quarter (27%) of hours worked by independent workers were in home care in 2019-2020.

According to the Ministry’s dashboard, 4.6% of hours worked in the health network (all sectors combined) are carried out by independent workers. It was not possible to know the proportion for home care, since the Ministry does not compile this data “in real time”.

It should be noted that social economy businesses providing home help, which notably offer housekeeping or meal preparation services, are not covered by the law.