Twenty years after the “At home, the first choice” policy, is it normal that our parents, our grandparents and our loved ones have to wait until they are very sick to receive appropriate home care? Can we accept that the elderly, those who have contributed all their life to our society, are accommodated in CHSLDs prematurely, when the services offered upstream could have avoided it?
The Commissioner for Health and Welfare (CSBE) has just published the second volume of her reports on the assessment of the performance of care and home support services (SAD). Once again, this report underlines that Quebec does very poorly compared to the rest of Canada and to other OECD countries. Very little importance is given to preventive care before the person becomes very dependent in their daily care.
For example, the Commissioner’s work highlights a very worrying statistic, namely that 10% of home care users share almost 70% of the services. These very sick people absolutely need it to avoid ending up in a CHSLD. But what about those less ill who could benefit from home help to preserve their health? There is very little left of the budget for them, unfortunately! “We’re sorry, sir, you’re not sick enough.” Here is what some of my patients tell me they got as a response.
The Commissioner also reports that only 13.5% of patients with a loss of autonomy or with a physical impairment felt that they had received enough hours of SAD to meet their needs.
Thus, almost 9 out of 10 patients do not receive adequate services from the public health network.
We should also remember that 19,000 people are currently waiting for their first service in Quebec and that these people are at risk of seeing their health continue to deteriorate. In addition, their caregivers, if they have any, exhaust themselves to make up for the non-existent services. In the near future, these people and their loved ones will require even more care and will clog up an already precarious healthcare system.
Prevention is key
As a specialized nurse practitioner, I am very concerned that with the aging of the population, the situation will only deteriorate at “high speed” if the government does not improve the funding of the DAS and does not is not intended to provide services to all those who could benefit from them.
Home care should not be offered only to very ill people, but should aim as much for psychological well-being as for physical well-being and the maintenance of existing capacities.
For example, a person with Parkinson’s disease should receive preventive care from a kinesiologist at home for adapted physical activity, so that they can preserve their ability to walk. In the same way that an exhausted caregiver must receive respite to avoid developing physical or mental health problems, without being told that the services are refused to him, because his spouse does not suffer from severe enough cognitive disorders. . Health promotion and disease prevention are not an expense, but an investment in the future by preventing a greater need for services.
While the development of the 2024-2029 action plan stemming from the “Aging and living together” policy is underway, we encourage the entire population to respond to a short survey aimed at presenting your ideas for solutions to the challenges of aging. The survey is available until July 21, 2023 and will only take a few minutes.
In order for caregivers, the elderly and ourselves to receive appropriate care and services, the current mentality must be changed. We must stop worrying only about people who are very sick and in hospital and also opt for a more preventive approach for our future. The population must make it known that they want home care that is adapted and accessible to all and that they are heard now! It is the small individual gestures that translate into big changes.
* Co-signatories: Anne Bourbonnais, nurse, full professor, Faculty of Nursing (FSI), University of Montreal, Research Chair in Nursing Care for the Elderly and the Family, and her students Vincent Thériault, nurse, doctoral student ( FSI), Paoula Pijeaud-Paul, nurse, master’s student (FSI), Justine Wu, nurse, master’s student (FSI) and Adriana K. Ferreira, master’s student (public health); Maude Dessureault, nurse, associate professor in the Department of Nursing Sciences, UQTR; Nicole Dubuc, nurse, full professor and Didier Mailhot-Bisson, nurse, assistant professor, School of Nursing, University of Sherbrooke; Stéphanie Daneau, nurse, assistant professor, FSI, University of Montreal