Quebec is still too “modest” when it comes to loosening the purse strings to fund home care services. The low budget devoted to this portfolio weakens the chances of Quebec seniors staying at home at the end of their life.
These are two of the main conclusions drawn by the Health and Welfare Commissioner (CSBE), Joanne Castonguay, in her latest report on home care and support services. The document of a hundred pages, of which The duty got copy, raises performance ‘worrying[es] of the health network when the time comes to assist and care for people with a loss of autonomy in their homes.
“Despite an increase in financial resources in recent years, few users receive the care and services they really need,” notes Commissioner Castonguay. “Increasing budgets without reviewing the organization of services therefore seems to have a limited impact. »
According to the analysis carried out by the CSBE — this is the second volume of this report, after the publication of the first part in March — the share of the cake granted to home support (SAD) in the colossal Health portfolio slow to expand.
“Over the years, the share of SAD spending in the [ministère de la Santé] relative to overall health expenditure has remained modest, rising from 4.0% in 2003 to 4.8% in 2021-2022. It should be noted that this places Quebec among the Canadian provinces whose financial resources granted to SAD services are the weakest”, is it written in the report.
More money, not better services
Although the situation may have “slightly” improved since 2015-2016, the home care performance indicators place Quebec among the dunces, notes the commissioner.
“A greater financial effort in SAD has not translated into more results for home care at the end of life”, even if this option “represents the first choice of 71% of Quebecers”, can we read in The report. What are the reasons for this phenomenon? The lack of financial and human resources, in particular.
“The current level of resources in SAD programs [ne permet] not to ensure home support for the majority of the population aged 65 and over,” the commissioner said.
According to the teams of Mme Castonguay, the new funds devoted to home care in recent years have not made it possible to replenish the labor pool either. From 2019-20 to 2021-2022, the number of professionals working in ADS services has stagnated. For example, the number of home care nurses (full-time equivalent) per 100,000 population has increased from 44 to 46, and the number of non-home care professionals from 53 to 57.
Yet, the report notes, “the net direct costs of DAS services increased from $16.9 million to $21.7 million per 100,000 population” for this same period.
Joanne Castonguay deplores the “low” rate of response to home support needs. “This weak response to needs significantly increases the risk of being admitted to a CHSLD for people with a greater loss of autonomy,” reads its report.
Not better after the pandemic
When mandating Commissioner Castonguay to make her diagnosis, in March 2022, Health Minister Christian Dubé had made known his intentions to initiate a “big shift” towards home care, in the context of the COVID-19 pandemic, which had already caused thousands of deaths in CHSLDs.
According to the Commissioner’s observations, Quebecers are quietly turning to this solution. “The number of SAD users has increased by approximately 4% in Quebec,” the report illustrates.
However, according to the document, “many issues that existed before the pandemic still persist in 2021-2022”.
“Before the onset of the pandemic, accessibility [des] SAD services was already an issue, and the situation has deteriorated overall in Quebec,” we can read. Or again: “The issues related to the viability of the SAD, largely present in Quebec before the pandemic, have remained important. »
A final report on home care is due on the health minister’s desk in December this year. This is where Commissioner Castonguay will make her recommendations in this regard.