(Quebec) Despite the shift promised by the Legault government towards home support, the response of the health network to the needs of Quebecers remains “weak”, which “significantly increases the risk” for people with loss of autonomy of to be admitted to a CHSLD, notes the health and well-being commissioner.
Home support services present “worrying results” throughout Quebec and most territories, concludes Commissioner Johanne Castonguay in the second part of her survey on the performance of government home care programs.
Despite significant investments by the Legault government, the Commissioner notes that the level of resources granted for home support services in Quebec nevertheless remains “among the lowest in Canada”. The share of home care expenditures in relation to all health expenditures “has remained modest” in recent years, going from 4% in 2003 to 4.8% in 2021-2022.
PHOTO OLIVIER JEAN, LA PRESSE ARCHIVES
Joanne Castonguay
“Quebec stands out unfavorably in the link to the care of users and caregivers,” said Ms.me Castonguay in his report of some 130 pages. Positive point: “Quebec is doing better in terms of timely accessibility to services, in their coordination, in their effectiveness in contributing to home care and in user satisfaction,” she writes.
The most vulnerable
The Commissioner’s investigation revealed that the system’s response rate to the home care needs of seniors with a loss of autonomy or with physical disabilities is “very low”, while 13.5% of the hours required to meet the needs were provided to these clienteles.
“From then on, the risks of deterioration of the physical and mental health of users increase and the probability of being admitted to a CHSLD increases,” writes M.me Castonguay.
The report also states that in Quebec, people aged 65 and over, who died in 2019-2020, spent 66% of their last six months of life at home. “They therefore spent an average of 62 days in institutions,” notes the commissioner. Of these same people, only 17% died at home.
“The percentage of days lived at home during the last six months of life is not associated with the expenses and tax measures” of the services offered, underlines Ms.me Castonguay.
This suggests that the current financial effort is not able to ensure home support when it counts for people.
Joanne Castonguay, Health and Welfare Commissioner
Moreover, these statistics are even less encouraging among people over 85, among women and among people who are “very materially and socially disadvantaged”. Still at this level, other comparable jurisdictions in Quebec achieve better results.
“A clear finding emerges from our analyses: home support services in Quebec must be improved to enable people who wish to do so to stay at home for as long as possible,” said the Commissioner in a statement.
Despite an increase in financial resources in recent years, few users receive the care and services they really need. Increasing budgets without reviewing the organization of services therefore seems to have a limited impact.
Joanne Castonguay, Health and Welfare Commissioner
Mme Castonguay received in March 2022 the mandate from the Legault government to scrutinize the supply of home care in Quebec. A first volume was presented in March in which the commissioner identified a “complex ecosystem” of programs that does not allow the targets set by Quebec to be reached.
In this first part, she indicated that the government is “aware” of the shortcomings of the system and that it has demonstrated its desire to remedy them by having entrusted it with this special mandate. The recommendations to the government will arrive in its final report (the fourth volume) which will be tabled in December 2023.
Growing needs
The number of people waiting for a first home support service has been increasing since the pandemic. As of March 31, more than 20,000 Quebecers were on a waiting list, according to the dashboard of the Ministry of Health and Social Services.
After analyzing the available data, the commissioner estimates that the number of Quebecers who need home help to perform activities of daily living is between 400,000 and 530,000.
These needs vary from one region to another and would be lower in Montreal and higher in Bas-Saint-Laurent and Gaspésie-Île-de-la-Madeleine.
Moreover, given the limited data available, the Commissioner’s research team will develop a new “regional scope” model for 18-year-old populations, which will make it possible to estimate “more precisely” support needs at home for the whole population.
At the start of his second term, François Legault promised to operate “a real revolution” in home care. In its first mandate, the Legault government invested an additional 2 billion in its shift towards home care. The latest Girard budget provides for new sums of 103 million this year for 963.5 million in fresh money within five years.