When I chose to become a nurse, at 18, I already knew that I wanted to work in home support. For palliative care, first of all, but over the years, I developed a love for all patients. I will have practiced there for 18 years.
At the time, the subject was less talked about. Today, home support is often presented as a miracle solution to the aging population. It’s not that I don’t want to understand. But the arguments don’t manage to convince me completely.
It is said that Quebec does not have the means to build new CHSLD places, that we must replace them with home support. Okay, but we must understand that “home” does not mean “house”. That this word includes private residences for seniors (RPA).
The lack of places in CHSLDs increasingly forces RPAs to accommodate users with advanced losses of autonomy. People who require assistance 24 hours a day, due to significant cognitive losses and mobility assistance needs. People who, very often, lived alone.
Replacing CHSLDs with home support also means replacing the public with the private sector. And not only fulfilling the wish of seniors to remain at home. Moreover, the idea that people prefer to age at home is often repeated, but deserves to be qualified. A study by HEC Montréal showed the opposite: when they plan for the future, seniors prefer accommodation in CHSLDs in the event of advanced loss of autonomy.
Currently, almost a third of home help hours are provided by RPA workers, through agreements service. The statistics on home support hours – the ones we are bombarded with – include both the 30 hours of help per week that the person losing their autonomy receives at home and the 30 hours per week for which the private residence agrees to provide care to an elderly person is paid.
Turn
When political parties promise to shift the CHSLD budget towards home support, while presenting staying at home as an objective and without taking this reality into account, I admit that it leaves me perplexed.
Over the years, I have observed a shift toward home care, although obviously imperfect. More services are being provided, and much more quickly. Stories of seniors being housed in CHSLDs when they could have remained at home are becoming increasingly rare. Mechanisms are being put in place to ensure that everything has been tried before authorizing this option.
What has always bothered me the most for my patients and their caregivers is not the service offering, but the waiting times and service interruptions. And by far. It is really annoying to have to call — once again — exhausted children to tell them that they will have to go give their parents their medication and change their incontinence pants, because we do not have enough health and social services assistants that evening. To direct a user to the social economy enterprise for domestic tasks, knowing that the waiting list is over a year long. We are talking about increasing the service offering when we are struggling to meet current commitments due to a lack of staff. Even if these jobs are very far from being limited to these tasks, would you be prepared to provide hygiene care or clean in sometimes unsanitary environments? If so, the health system needs you…
Lessons
I have sometimes read and heard people propose home care as a solution to prevent the massacre in CHSLDs during the pandemic from happening again. And yet. While all eyes were on CHSLDs, some home support workers spent their entire weeks in RPAs, where they provided… home care. In some residences, it was also chaos, elderly people died abandoned, without adequate care. Personally, I have a reserve of scenes that are not forgotten.
Will the response to the aging of the population involve privatizing senior housing, under the guise of home support? Will the quality of care be taken into account, or only the economic aspect and the desire to relieve congestion in the system? However, I thought that this was one of the lessons of the pandemic.