It is a known fact that front-line health care and social services were hit hard by the passage of the Barrette reform in 2015. By merging health and social services centers (2015) with hospitals and rehabilitation centers in Quebec, and by giving the Minister of Health the power to appoint the new CEOs of these gigantic companies, the Minister of Health at the time, Gaétan Barrette, gave the final push to to take away from front-line services what was left of their autonomy to meet the needs of the population.
Moreover, if the difficulties of access for a visit or care by a family doctor are well known, what do we really know about the inaccessibility of front-line social services in Quebec? Services about which little is said, because they are in the shadow of medical care, but without which home support for thousands of people with functional limitations is impossible.
Woe to the unfortunate! Unless they can afford private services, they will have to be patient and sometimes wait up to three years before obtaining support for their situation. But this endless wait will result in as many failures as the number of elderly people with disabilities trying to stay at home.
Because the waiting lists add up to each other. For example, after the analysis of an initial request for home support, there will be a delay before obtaining a standardized evaluation, which alone opens the door to public services. A year may pass before obtaining this evaluation!
But that’s not all, because the person’s name will be put on other waiting lists, in particular for obtaining professional services (occupational therapy, physiotherapy, social work). However, at each stage of the process, there is reassessment, prioritization and waiting to obtain professional service, human assistance or financial assistance.
The problem is that many of these bottlenecks form in this long technobureaucratic process. In fact, all of these mechanisms, which are commonly called “access windows”, have a very specific unofficial function, that of delaying demand by reducing the pressure a little, to guarantee the survival of the socio-health system, by leading people to believe the person she is about to get the “right” service. However, the person with a disability who knocks at the door of his health center needs immediate help.
too much bureaucracy
In home care, there is far too much time spent on reassessment, too little time on follow-up. The hours spent filling out forms, reading e-mails, entering statistics, going before a committee to obtain the slightest service, are considerable.
Entangled in the procedures, the social workers see every day the failure of the mission they defend. Because in the end, since the public network is no longer capable of meeting the needs of the population, of providing services and care in a timely manner, the system turns to the private sector, often with decline in quality and reliability. However, when the tinkering no longer holds and a professional judges that there is a risk of serious harm, it is to the hospital that the vulnerable elderly person is sent.
The hospital has become the high decision-making place, and the last bastion where one will find a range of public services that one can obtain quickly! The problem is that this institution can never replace people’s homes. They will have to go home and wait. They will have to wait for the call from their social worker, who plays the role of navigator or case manager.
It is through it that the elderly person with a disability can hope to obtain an intensification of their home services or the release of a financial program. Unfortunately, the social worker risks being in the hospital at the request of the medical teams, seeking their expertise to facilitate the discharges.
The image of healthcare companies
Health and social services centers are businesses that have a CEO who is accountable only to the minister. Detached from the communities, the CEOs of these huge companies, which often employ more than 10,000 employees, are now more concerned about overflowing hospitals than people with disabilities at home waiting for services. The problem is the lack of transparency of our large organizations. When there are several hundred people waiting for an assessment to have their situation taken care of, is it honest to let the population believe that they can count on public home support services, as required by the “At home: the first choice” policy developed by the Ministry of Health in 2003?
We believe in public services, the only ones that can promote equal rights in the face of illness and functional limitations leading to handicap situations. But our system must be completely redesigned, based on the communities it is supposed to serve. To do this, it is urgent to invest and restore power to the front line, as well as to prune this bureaucracy! We need a decentralization of services, because nothing is going on the front line at the moment. But which political party will have the courage to properly pose the problem before the elections scheduled for this fall, in order to propose a reform in the interest of the common good?