2023-09-05 09:00:00
(Quebec) Scanning prescriptions, transcribing notes, conducting assessments that last for hours and traveling dozens of kilometres: administrative tasks and travel take up approximately 70% of the time of caregivers assigned to home care.
This is one of the troublesome findings of the Legault government, which undertook in its second term to operate a “real revolution” in home care.
A working document obtained by The Press – and which reveals the aims of the Minister for Health and Seniors, Sonia Bélanger, to improve access to home care (see other tab) – indeed places the government of the Coalition avenir Québec (CAQ) in front of colossal challenges.
Despite significant investments since 2018, more than 70% of waiting users receive home support services outside the prescribed time limits. At the heart of the problem: health professionals spend most of their time doing something other than treating.
“At the nurses’ level, administrative tasks can easily take up 75% of the time and the little that remains, and once more, I am generous, it is with the patient”, illustrates Linda Gingras, nursing assistant at CLSC Mercier-Est– Anjou in Montreal.
Office work which is also weighed down by “computer troubles” while the systems “are not up to date”, continues the one who is also a union delegate for the Fédération interprofessionnelle de la santé du Québec (FIQ) at the CIUSSS de l East of the Island of Montreal.
INFOGRAPHIC THE PRESS
It is in terms of psychosocial services that the situation is most dramatic, according to the working document prepared by the Ministry of Health and Social Services (MSSS). We learn that the proportion of “indirect hours” of social workers reaches 76%.
What are “indirect hours”? This is the time when the health network employee is not in direct contact with a user.
It is also in the psychosocial services where there is the highest proportion of users waiting, with home occupational therapy and nutrition services.
INFOGRAPHIC THE PRESS
By Minister Bélanger’s own admission, however, psychosocial services are the user’s “gateway” to home support. It has decided to prioritize this sector as part of its new approach, which should serve “to build the shift towards home care”.
INFOGRAPHIC THE PRESS
His project, called “valorization of SAD clinical activities”, aims to increase the volume of home visits while increasing the number of hours spent with the user, in “a context of unprecedented shortage of staff”, writes -on in the working document.
“Nothing to do with clinical duties”
According to Linda Gingras, the nursing staff, following their tour in the field, must do a lot of “paperwork” such as transcribing handwritten notes, filling out forms and other evaluation documents.
She cites the example where a nurse who notices that a user is no longer able to stay at home must take steps to find him a place in a residential environment. “It can take, depending on the patient, half a day to three days,” explains Ms.me Gingras.
“The nurse must collect information […]repatriate the documents, make contact with the residences, meet the family, do the research to find a place […]. There are things that have nothing to do with clinical tasks,” she lists.
These tasks should be shared with social workers and administrative officers, she stresses.
Another “scourge”, in the eyes of the caregiver: the displacement of health workers in the metropolis.
The workers assigned to home support must accomplish what is called in their jargon “a road”. It is in fact a list of patients to be visited. The duration of the journey is calculated in “hours-of-care”, that is to say according to the time allocated for each procedure.
The girl who leaves with her car to realize [une route] 4-hour treatment, that does not take traffic jams into account, [de la recherche] parking lots, traffic cones everywhere. All this time is not counted.
Linda Gingras, licensed practical nurse at CLSC Mercier-Est–Anjou
She also notes that the order of visits is established according to the state of health of the user without regard to his location, which makes them waste precious time on the road.
A “completely backward system”
According to Philippe Voyer, expert in geriatric nursing and director of bachelor’s degree programs in nursing at Université Laval, these findings are not surprising. It should be remembered that various reports – from the Auditor General and the Ombudsperson, in particular – have shown in recent years significant shortcomings in the supply of home support services.
PHOTO YAN DOUBLET, LE SOLEIL ARCHIVES
Philippe Voyer, expert in geriatric nursing and director of baccalaureate nursing programs at Laval University
I did home care at the CLSC de l’Estuaire in 1995 and that was how it was. We were going to make five, six visits in the morning and we spent the followingnoon doing paperwork. I can tell you that there are several circles where it’s still like that. […] It’s completely backward as a system.
Philippe Voyer, director of baccalaureate nursing programs at Université Laval
According to him, the solution lies in improving work practices and organization, and implementing technologies. “It goes through smaller teams of professionals who talk to each other, with electronic files, and smaller territories to move around,” he says.
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