Home support | A "complex ecosystem" that does not reach the intended targets

Despite significant investments, the Legault government’s major shift towards home care is long overdue. The “successive reforms” in health have left in their wake a “complex ecosystem” which does not allow Quebec to reach its own targets, notes the commissioner for health and well-being.

Posted at 5:00 a.m.

Joanne Castonguay will unveil this Tuesday the first volume of a vast survey carried out at the request of the Legault government to examine the performance of home care and services (SAD), the effectiveness and equity of funding programs across the province.

The commissioner points to the “absence” of a plan, costing and planning of the main government home support policy, At home: the first choicewhich remains 20 years after its filing “the foundation of the Quebec model”.

His work shows that successive governments have not rolled out an “implementation plan” for the different dimensions of this policy, adopted in 2003. Nor has the legislation evolved in line with the achievement of the objectives, writes -She.

“There has been no evaluation of the related costs and planning of the sources of financing, nor any public debate as to the coverage of the services that are offered”, can we read in the report.

So much so that over the years and through “successive reforms” in health, “a complex ecosystem” of services offered in SAD has been built which “does not achieve the governmental objective” of the policy, despite “the increased funding.

“Better results could be obtained if resources were better structured and allocated and if local communities were given more opportunities to develop adequate situations given the resources they have at their disposal,” said Mr.^meCastonguay in interview.

OBSERVATIONS IN BRIEF

Doctors are generally little involved in SAD.
Services are developed in silos.
Different modes of payment create distortions and inequities.
The regulations governing financial envelopes and procurement are restrictive and hinder innovation.
The public, private and community networks are in competition to attract an increasingly scarce workforce.

She also concludes that establishments “focus mainly on the volumes of services sometimes, to the detriment of their relevance”.

Indeed, in recent years, bonuses have been given according to the number of hours and patients followed at home.

“Sometimes, we will therefore provide services that are not necessarily what the person needs. With these premiums, we could decide to provide domestic care, when the person would need respite for caregivers,” she says.

Insufficient mechanisms

At the start of his second term, François Legault promised to operate “a real revolution” in home care.

“We have invested a lot in care, then in home services, but there are still too many people who tell us: it’s complicated to have access,” argued the Prime Minister in his speech. opening of the first session after the elections in November.

M^meCastonguay also notes 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 Ministry of Health and Social Services is showing its desire to improve the population’s ability to age in place, but it has not yet put in place all the mechanisms that will allow it to guide and support the activities of institutions. [de santé en ce sens].

Excerpt from the first volume of the report by Health and Welfare Commissioner Joanne Castonguay

The recommendations of M.^meCastonguay will arrive in its final report (4^e volume) which will be submitted in December 2023.

Quebec lagging behind

Despite an increase in investments, the share of the long-term care budget that is invested in home care in Quebec remains “low” compared to other OECD countries, at 20%.

Spending has also increased by 35% since 2015. In 2019-2020, the Ministry of Health spent nearly $2 billion on home care.

“In Quebec, only about one-fifth of long-term care spending is devoted to home care, unlike about half in countries such as Denmark, Norway or Belgium,” notes the Commissioner in his report.

PHOTO MARTIN CHAMBERLAND, ARCHIVES LA PRESSE

The Canadian Institute for Health Information has established that for 2021-2022, Quebec was ranked 11th in the country for per capita investment in home care services.

The Canadian Institute for Health Information has established that Quebec invests $259 per capita in home and community care services, in 2021-2022, compared to $293 per capita for Canada as a whole, which places it 11^e in the country.

M^meCastonguay nevertheless underlines the increase in Quebec in recent years of investments in home care. ” [Cela] will have to continue in the future to make up for the shortfall compared to the provinces and territories,” she wrote.

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 as of this year for 963.5 million in new money within 5 years.