Home care | “We’re blocking the way for the people who are there”

(Quebec) In the midst of a shortage, caregivers who provide home support services can almost no longer work due to new administrative rules. These employees are now required to own a car.

Around thirty employees of the Progressive Services company saw their working hours melt like snow in the sun with the entry into force, in October, of a procedure which modifies the way in which contracts are given to employment agencies in Home Care.

“It’s not my competence that is in question,” argues Marie-Suzie Paul, a 69-year-old beneficiary attendant.

“I have always worked without a car and it has never been an issue […]. We are in Montreal, in 2023, we have a public transport network that works, really, I don’t understand,” laments the woman who lives in Saint-Léonard. “It’s a luxury to have a car today. »

M^me Paul, an employee of Progressive Services since 2008, worked an average of 25 hours per week. She could visit three or four users per day – some of whom she has been treating for two years – traveling entirely by public transport, she explains.

However, the employer, which serves around 2,600 users in eastern Montreal, had to withdraw its list of users. The reason ? CLSCs require that agency workers assigned to home care have a car.

The beneficiary attendant has therefore only worked three hours over the last two weeks.

At her age, there is no question of her joining the public network.

His boss also deplores the situation: “It’s such a classic case where we see that the machine reforms by completely ejecting the human aspect,” says the general director Patrice Lapointe, who is also the president of the Association private healthcare personnel companies in Quebec (EPPSQ).

The Legault government adopted a law last spring to get rid of independent workers in the health network. We want to achieve this by 2026, and starting next year in large urban centers like Laval and Montreal.

In the wake of the transition, a first contract for the hiring of agency staff changed the usual rules in home care.

Until now, a health establishment entrusted a volume of users to be served to the private company, which was responsible for organizing the services. With the changes, the company must instead “lend” its staff to the CLSC, which gives workers the instructions to follow.

The Press reported at the beginning of the month the concerns of user committees and the industry who fear service disruptions.

As of September 9, 21,000 Quebecers were waiting for a first home support service.

Public transport

In the case of Progressive Services, the company was able to develop lists of users to be served based on public transportation since a large number of its employees do not have a car. When resuming the service, the CIUSSS did not keep these lists.

“We realized that the routes that were sent to the agencies were often reorganized to meet the availability of their staff,” wrote the spokesperson for the CIUSSS de l’Est-de-l’Île-de-Montréal in an email. , Carl Boisvert.

“This had an impact on the stability of schedules and [main-d’œuvre indépendante] which served our users,” we add. In addition, “almost all” of home network workers also have “a vehicle requirement required in their position,” explains the establishment.

The CIUSSS maintains that, “as provided for in the current contract”, it is “entitled to request assignments with vehicle use while reimbursing the mileage traveled”. We also recall that the private companies “bid knowingly”.

The establishment ensures that “issues related to travel in the new contract” have never been raised by the agencies.

“Organized in disaster”

Mr. Lapointe, on the other hand, sees the effects of a transition “organized as a disaster” and a “hypercentralization where we will standardize” the provision of care rather than according to “the reality specific to each person”.

“We take services in an area where we were able to do so by public transport. Now we can no longer because it was too complicated from an administrative point of view,” he denounces, affirming that it is “the patients who pay the price”.

He reports that in the first weeks of October, calls increased while users and their families had difficulty explaining the arrival of new caregivers. Some said they did not have the service or tried in vain to contact the CLSC, he lists.

“One of my patients told me that she is not receiving the services she is used to. They are new people or no services at all, they are in nothingness too,” relates Marie-Suzie Paul. The Press was unable to contact this user in question.

The CIUSSS ensures that “100% of requests for assignment with vehicle are accepted by contracted agencies, which has not and does not cause any service breakdown or particular problem.”

According to the establishment, the new contract on the contrary results in “added value in the quality of services to users” while the CIUSSS itself manages “the schedule of workers, by welcoming them, and offering them the clinical support necessary,” we write.

In November, the office of the Minister for Health, Sonia Bélanger, indicated that there was no “way to ensure the quality of the services offered and the qualification of the staff” by awarding contracts by outsourcing.

It was then stated that the “priority” is to ensure that the “transition goes well”. A meeting between the cabinet of M^me Bélanger and the EPPSQ took place in September.

Labor shortage

One of the objectives of the Legault government with its law is to bring agency workers back into the fold of the public and, above all, to slow down their exodus towards the private sector.

Minister Sonia Bélanger also launched a project to reduce the administrative burden on employees assigned to home care. The CIUSSS de l’Est-de-l’Île-de-Montréal is also participating in the pilot project to improve the provision of care.

In a study published in January 2022, the Institute for Socioeconomic Research and Information (IRIS) concluded that home care is one of the sectors where “structural dependence” on placement agencies is the strongest.

The EPPSQ calls for better supervision of the use of health placement agencies, but is opposed to their abolition.