A committee promoting home support at the CISSS de Lanaudière is causing serious concern and frustration among employees of the organization. Many denounce the fact that patients are sent home, despite the contrary recommendations of health professionals.
The “Home First” committee was gradually set up starting in 2018. It is made up of about twenty managers and a few health professionals, who meet daily to encourage patients to return home.
“When the committee was set up, we thought it was a good idea,” says Julien*, health professional at the CISSS de Lanaudière. He quickly became disillusioned. In about 10% of cases, its recommendations were overturned by committee members. And this, without obtaining an explanation.
“We are not against the fact that people can benefit from rehabilitation at home, that they can live as long as possible at home. What we denounce is the early return home which is not centered on the needs of the users and which contravenes the clinical opinions of the professionals”, launches Steve Garceau, national representative for the Alliance of professional and technical personnel. health and social services (APTS).
“It’s getting very heavy”
Julien recently cared for an elderly person who had fractured his hip. “He is an independent gentleman who wanted to recover quickly and did not want to return home,” he recalls.
After analyzing his file, the professional suggested that his patient be sent to rehabilitation. The “Home First” committee opted instead for a return home with support services. “In the long term, he probably would have benefited more from a two or three week rehab before going home without any services,” he said.
If he wishes to contest the decision, Julien must engage in a cumbersome administrative process. “We have to take steps over the head. It becomes very heavy, ”he testifies.
Two other health professionals told The Press having had similar problems with the committee. When these employees suggest referring a patient to rehabilitation or public accommodation, the committee regularly asks them to carry out new assessments to confirm their decision.
“We find it ridiculous. Even if we manage to prove a second time that a return home is not possible, the committee will come up with solutions to be sure that the patient returns there. If a return home with the CLSC is really not possible, they may bend and talk about relocation,” said one of them, who preferred not to mention her name for fear of reprisals.
A promising committee, says management
The Deputy President and CEO of the CISSS Lanaudière, Philippe Éthier, admits that “a few people remain dissatisfied” with the committee, but maintains that the majority of the clinical teams participate in the project.
He is not concerned about the reversal of recommendations by committee members. “Nine times out of ten, we trust enough [aux professionnels de la santé] so as not to question what they suggested. It’s still good, ”he says.
Mr. Éthier also asserts that the committee has led to a significant reduction in the number of patients waiting for a rehabilitation or residential center. In 2015, the CISSS de Lanaudière had about 70 patients waiting. Today, this figure is between 15 and 20 users, he argues.
“It’s very promising. There is a lot of gain for the users. They wait less, spend less time in the hospital and experience fewer deleterious effects of the hospital, but it is sure that it requires a transformation, ”says the CEO.
As for the senior advisor for clinical trajectories and special projects, Marylène Ricard, she maintains that the benefits of home recovery have been demonstrated in research. “The person recovers faster if they are in their environment,” she explains.
Multiple reports
According to the union, however, the committee is still a big waste of employees’ time. “When a medical team agrees that it is unfortunately no longer possible for a patient to return home, we must still absolutely go to the Home First Committee”, illustrates the vice-president at the local office of the APTS of the CISSS de Lanaudière, Valérie Lepage.
The situation creates frustration and a feeling of helplessness for the staff, who see their skills and expertise called into question, according to her.
In recent years, the union says it has repeatedly raised these issues with managers, with no significant change. “We were conciliatory, we made committees, working tables with the employer, the problems were named many times,” insists union representative Steve Garceau.
Asked about this, the deputy CEO of the CISSS maintains that improvements have indeed been made in recent weeks following meetings with staff. Among other things, he mentions a considerable reduction in administrative procedures and forms to be completed.
*Name has been changed to maintain confidentiality.