Quebec needs more investments in the home care support sector: IRIS

Massive investment and more funding will be needed by the Quebec government if it wants to succeed with the national home support strategy.

According to a new IRIS study published on Thursday, this shift will require annual funding ranging between $7 billion and $11 billion, compared to the current $3 billion.

According to the Institut de recherche et d’informations socioéconomiques (IRIS), the current model should be decentralized and no longer dependent on the private sector. The study indicates that less than 13 per cent of home help hours are provided by staff from public institutions. 

The Minister responsible for Seniors, Sonia Bélanger, shifted her focus to address the issues related to the aging population. She is leading the 2024-2029 government action plan “La Fierté de vieillir,” which was announced last spring.

The status report presented in this plan indicates that 20,490 people are waiting for a first home support service in Quebec, even though the hours of home support service have increased by 63.9 per cent in four years.

Investments per person in home support increased from $199 in 2012-2013 to $423 in 2022-2023.

However, more money is needed to properly support seniors who want live at home, said IRIS study author Anne Plourde.

“If we announce a national home support strategy without significant amounts being invested, if we remain in a model where services are highly privatized and highly centralized, entrusted to the management of Santé Québec, we will continue to have difficulty successfully making the shift to home support,” she said in an interview.

Plourde said that currently only 10 per cent of home support needs are met.

“If we don’t make this shift towards home support, it will be very expensive. Long-term care needs, if they are not met at home, will be met in accommodation and in the hospitals,” she said.

In the long run, the return on this investment will pay off for Quebec, said Plourde. She predicts that the aging population will be healthier since their needs will be taken care of at home.

“We won’t need to build tens of thousands of housing units for these people,” she said.

The researcher analyzed Scandinavian countries, including Denmark, Norway and Sweden, where, based on the proportion of their GDP, these countries invest four times more than Quebec in home support. “But their total health expenditures are much lower than ours in comparison to the weight of their economy,” she added.

In Canada and Quebec, little data is available on household out-of-pocket spending on home support services. However, data from the Organisation for Economic Co-operation and Development (OECD) shows that Canada is one of the countries where households spend the highest proportion of their health care expenditures on long-term care, which includes residential and home support services.

“In Quebec, we have one of the fastest aging populations in the world and despite this, we are below the OECD average for the proportion of our GDP devoted to long-term care spending. There is a lot of catching up to do,” said Plourde.

But even if the government invests massively, how can the shift towards home support be successful in the context of staff shortages? According to Plourde, with adequate amounts in the public network, the workforce that has migrated to the private sector will be tempted to return to the public sector since the establishments will be able to offer attractive working conditions.

However, IRIS believes that home services should not be entrusted to Santé Québec.

“Already, with the CISSS and CIUSSS there has been a strong centralization and bureaucratization of services, particularly in home support. And that has resulted in a deterioration in the quality of services, and a deterioration in access to services as well,” said Plourde.

She added that “this centralization came with the imposition of very hierarchical management methods, very focused on accountability statistics.” According to Plourde, these methods have reduced the autonomy of professionals, deteriorated working conditions and dehumanized services.

“We believe that with the creation of Santé Québec we are going even further in this direction, with an even greater centralization of services.”

She pointed out that countries that are considered models in terms of home support have set up decentralized services and are managed by local environments.

IRIS said that Quebec should move in this direction by entrusting these services to new local authorities with local management to be able to properly adapt the services to the needs of the population.

“We are proposing to entrust the provision of services to CLSCs, so that CLSC employees are responsible for providing the services because currently, these services are subcontracted to private providers. We recommend entrusting the management of these services to social hubs, therefore local democratic bodies that would be distributed throughout Quebec,” explained Plourde.

For the management aspect, new roles would have to be democratically elected. According to the IRIS, representatives of the population, professionals and managers would be part of these management groups. The CLSCs would also have to be accountable to these bodies.

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–This report by La Presse Canadienne was translated by CityNews