Elders | Home care must become “a national priority”

(Montreal) The Réseau FADOQ and the Council for the protection of the sick are asking the various political parties to make clear commitments to quickly establish a home care system for all seniors who need it, a solution to relieve emergency room congestion, according to them.

The pandemic has shown that the Quebec “hospital-centred system” “no longer holds water” and home care must become “a national priority”, said the president of the Réseau FADOQ, Gisèle Tassé-Goodman, during a press conference Wednesday morning in Montreal.

The two organizations argue that home medical and nursing care has proven itself in the majority of Western health systems and is the solution to freeing up beds and reducing pressure on hospitals.

“Working illegally” to care for the elderly

In 2018, an agreement between the Government of Quebec and the Federation of General Practitioners of Quebec aimed to allow the deployment of palliative and intensive care teams at home throughout Quebec.

These 24-hour intensive care medical teams at home are called SIAD.

However, a change to the agreement between the doctors’ union and the government in 2019 meant that this network never developed, lamented the D^D Geneviève Dechêne, head of the SIAD program at CLSC de Verdun.

“We had dozens of teams that were establishing themselves quickly. Young family physicians loved the project. But when Danielle McCann (the Minister of Health at the time) and the union reopened the agreement, they set, I call it the horror, a seven-day limit on medical follow-up, “said the one who took part in the press conference organized by the FADOQ and the Council for the protection of the sick.

According to these two organizations, the SIADs represent a solution to emergency room overcrowding, but the limit of seven days of home care is clearly insufficient for the system to work.

“We, at home, our patients are very sick and die within eight months on average, not seven days”, lamented the D^D Dechêne, indicating that she had decided not to respect this rule and to “work illegally”.

“I continue to follow my patients until death at home, so on average eight months, but I am not allowed to do so, so you will understand why the SIAD network has not developed”, specified the D^D Dechêne, adding that “most family doctors don’t want to be outlaw cowboys.”

The president of the FADOQ maintains that “during their evaluation, it was shown that the SIADs are responsible for a 65% reduction in hospitalizations”, in addition to allowing the State to save money.

“For 60 to 65% of deceased patients who were followed at home, the costs were reduced by 50%,” said Gisèle Tassé-Goodman.

The D^D Dechêne believes that “political powers have blocked” the establishment of SIADs in all CLSCs as planned.

She accuses the Federation of General Practitioners of Quebec (FMOQ) of having a “hospital-centric orientation” which influences the decisions of the Ministry of Health.

“More than 40% of the hours worked by our family doctors are in hospital”, whereas “elsewhere in Canada, it is 20%”.

She is of the opinion that the various agreements signed between the FMOQ and the Ministry of Health since 2008 “prioritize hospital family care to the detriment of office and home care”.

She added “that in Europe and in English Canada, it is the medical specialists who work weekends, nights, with the pager, but here, it is the family doctors” and that if we dwell on this situation, “we put our finger on the sore”.

Discouraged from repeating the same requests

Almost three decades after “the ambulatory turn”, which was intended in particular to relieve hospitals by providing home care, the president of the Council for the protection of the sick, Paul Brunet, is discouraged to have to repeat the same requests.

“Despite all the promises and assertions from successive governments in the 25 years that I have been spokesperson, there are 4,000 people and more waiting for a bed in long-term care. Many of these people occupy hospital beds that they would not need to occupy if they were cared for at home”, indicated Paul Brunet who maintains that “it is between 10 and 25% of the beds which are currently occupied by elderly people who could be released”.

For Paul Brunet, there is no doubt that “treating people at home will solve the problem at the source”.

“And that’s without taking into account the feeling of comfort of people who are in their homes rather than in a hospital room,” added Gisèle Tassé-Goodman.

A new health agency

Last week, the Coalition avenir Québec promised a new health agency “to coordinate the operations of the system” and make the network “more efficient and more human”.

According to the Minister of Health, Christian Dubé, the “Santé Québec” agency will allow the CEOs of CIUSSSs and CISSSs to have more autonomy and “the legitimacy to act according to the realities specific to each region and establishment”. .

The D^D Dechêne sees positive in the promise of the Minister of Health, but according to her, time is running out.

“Currently, the problem for the SIADs is that the ministry is blocking the operational aspect”, so what Minister Dubé promised, “it’s not bad”, indicated the head of the SIAD program to the CLSC de Verdun, adding: “But can we wait another two or three years? Me, I do not believe so. »

For the president of the Council for the protection of the sick, Paul Brunet, the creation of the Health Quebec agency “would only be another unfortunate stage in the great organization chart which will not be of much use and even less to make anyone be accountable”.

The Réseau FADOQ and the Council for the Protection of Patients are asking that the next government of Quebec renegotiate the agreement with the FMOQ “in order to no longer limit the number of days of medical follow-up and to ensure adequate funding for the SIAD teams in all Province “.