Quebec home care policy: expectations of seniors and staff

The Legault government plans to adopt a provincial home support policy this year, among other things to improve access to care for seniors. In addition to investing the necessary sums, the main parties concerned want a reorganization of care and to have better fluidity.

The Minister responsible for Seniors, Sonia Bélanger, announced that she wants to present a province-wide home support policy by December 2025. Consultations with organizations and professional orders have already begun.

“We made ourselves heard as part of the national policy project on home care and services last week,” Luc Mathieu, president of the Ordre des infirmières et infirmiers du Québec (OIIQ), said in an interview. “The elements that we insisted on and that are difficult, there are three things: first, access to home care; the fluidity in the process to access it; third, the training of health professionals in relation to the care of the elderly and home care.”

Access to front-line services remains an issue, something that Minister Bélanger has already acknowledged in the past. “That’s why she announced that CLSCs would become the gateway for all care for seniors, including home care. We support this because it promotes access,” said Mathieu.

The Association of Retirees from Education and Other Public Services of Quebec (AREQ-CSQ) is of the same opinion. Integrating CLSCs as hubs for home care is part of the proposals in their brief submitted to the General Directorate for Seniors and Caregivers of the Ministry of Health and Social Services.

“All categories of personnel involved in home care and services will need to have synergy, a sharing of expertise, and be able to talk to each other. I know people who have been assessed four or five times by different levels. When you repeat the same service with a person, you multiply. We could achieve the same goal by doing better,” laments AREQ President Micheline Germain.

She believes that the government is funding a “dysfunctional system” with its approach focused on residences and long-term care centres (CHSLDs). “People are forced to leave their current place of residence, whether it’s a house or an apartment, to go to a RPA (private residence for seniors). They feel forced to leave because they don’t receive the services they need at their house or residence to be able to stay in their own home,” explains Germain.

An investment

By 2031, seniors aged 65 and over will represent a quarter of the Quebec population, or more than two million people. The demand for health care is therefore expected to increase in addition to the complexity of cases.

It is estimated that 73 per cent of people aged 65 and over suffer from a chronic illness, and this rises to 81 per cent among those aged 75 and over. Home care is a solution in several respects, starting with respecting the wishes of a majority of Quebecers who want to age in their own homes. In addition, staying at home is significantly less expensive than accommodation and hospital care.

“It is the population’s wish to stay at home as much as possible, and unfortunately this is not yet the case. The last governments all say that they have invested a lot in home care, but it is nothing compared to what has been invested in hospital structures,” argued Mathieu.

Germain criticized the exorbitant cost of seniors’ homes put forward by the Legault government. “With the increase in the number of people who will be over 65 in a few years, we would have to build a lot of seniors’ homes. And that costs a lot more than helping someone stay at home. So, there is a better use of money that is important. And yes, the government needs to invest more, but the status quo is going to cost more anyway,” she explained.

Health and Wellness Commissioner Joanne Castonguay estimated in 2023 that the health system was meeting only 10.7 per cent of home support needs. The AREQ president believes it is crucial to increase this rate.

Use existing solutions

The OIIQ was working with other partners in the health network to develop a new specialty in senior care for specialized clinical nurses. “This would help promote access, and we know that Minister Bélanger is very open to this given the demographic curve that is increasing significantly and the more complex care for seniors,” said Mathieu.

One of the roles of clinical nurse specialists is to ensure that good practices are integrated into care, including home care. Mathieu gives the example of neurocognitive disorders where the clinical nurse specialist should put in place appropriate intervention plans.

“Currently, in many respects, when people have neurocognitive disorders, among others in the long-term care environment which is the home of many of these people, instead of putting behavioral plans in place, we are going to medicate these people when that is not at all what would be appropriate to do,” describes Mathieu.

He said that a committee of ministerial experts in nursing is working to develop this new specialty of specialized clinical nurses.

Home care is not efficient at present, as reported by the Commissioner of Health and Well-being. “So we need to increase coordination and continuity of care, and we say that there are already known models. For example, case manager or pivot worker models,” maintains Mr. Mathieu.

He deplores the fact that some health reforms have been abandoned over the years. This is the case of the adapted approach for seniors that was deployed in the network in the 2010s. “It would be something to update this approach,” says the president of the OIIQ.

He also believes that training needs to be improved in home care for the elderly, both continuing education, which is handled by the Order of Nurses, and training provided in CEGEPs and universities. “It’s really important, we’re way behind on that. People aren’t ready to deal with what’s coming, with what’s already here,” worries Mathieu.

He welcomes the future national policy on home support, but he wonders whether the government will give itself the means to put it forward to successfully make the shift to home care.

–This report by La Presse Canadienne was translated by CityNews