Quebec needs to invest 4 times as much to change direction in home support, says IRIS

Quebec Seniors Minister Sonia Belanger. (Karoline Boucher / The Canadian Press)

The Quebec research institute says massive investment, and even a quadrupling of current funding, will be required if the government is to succeed with the national home support strategy it intends to put in place in the future.

According to a new study by IRIS (Institut de recherche et d'informations socioéconomiques), the shift will require annual funding of between $7 billion and $11 billion, compared with the current $3 billion.

According to the IRIS, the current model should be decentralized and no longer dependent on the private sector. The study unveiled on Thursday shows that less than 13 per cent of home help hours are provided by staff in public establishments.

Seniors Minister Sonia Bélanger decided to make the shift towards home support her key priority in order to meet the challenges posed by an ageing population. She is leading the government's 2024-2029 action plan, “The Pride of Ageing” (La Fierté de age), which was announced last spring.

The state of play presented in this plan indicates that 20,490 people are waiting for their first home support service in Quebec, even though the number of hours of home support service has increased by 63.9 per cent in four years.

Investment per person in home support has risen from $199 in 2012-2013 to $423 in 2022-2023. But more money is still needed to properly support seniors who want to age at home, argues the author of the IRIS study, Anne Plourde.

“If we announce a national strategy for home support without any substantial investment, if we remain with a model where services are highly privatized and highly centralized, entrusted to the management of Santé Québec, we will continue to have difficulty making a success of the shift towards home support,” she said in an interview.

She points out that barely 10 per cent of home support needs are currently being met: “If we don't make this shift towards home support, it's going to be very expensive. If long-term care needs are not met at home, they will be met in residential care and in hospital,” she added.

The Coalition pour la dignité des aînés, which brings together six Quebec associations representing more than 150,000 seniors across the province, said that the IRIS study was “another demonstration of the scale of the needs to be met if the shift towards home care promised by the government on numerous occasions is to become a reality.”

“When we're talking about a billion dollars to be cut from the health care system when barely 10 per cent of home support needs are currently being met, seniors have every right to be concerned that the major shift will in fact be a shift in slow motion,” said Coalition for the Dignity of Seniors spokesperson Solange Tremblay in a news release.

In the long term, the return on this investment will pay off for Quebec, Plourde believes. She predicts that the ageing population will be healthier because 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.

Drawing inspiration from Scandinavian models

The researcher analyzed Scandinavian countries, in particular Denmark, Norway and Sweden, where, as a proportion of their GDP, they invest four times as much as Quebec in home support.

“But their total health spending is much lower than ours in relation to the weight of their economies,” she said.

In Canada and Quebec, little data is available on personal household spending on home support services. Nevertheless, data from the Organisation for Economic Co-operation and Development (OECD) show that Canada is one of the countries where households devote the highest proportion of their health-care expenditure to long-term care, which includes accommodation and home support services.

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

But even if the government invests massively, how can it make the shift to home care a success, given the shortage of staff?

According to the researcher, with adequate funding in the public network, the workforce that has migrated to the private sector will be tempted to return to the public sector because the establishments will be able to offer attractive working conditions.

Not under the Santé Québec umbrella, says IRIS

IRIS believes that the management of homecare services should not be entrusted to Santé Québec: “With the CISSS and CIUSSS, there has already been a great deal of centralization and bureaucratization of services, particularly in homecare. The result has been a deterioration in the quality of services, and a deterioration in access to services too,” said Plourde.

She goes on to say that “this centralization came with the imposition of very hierarchical management methods, very focused on accountability statistics.”

According to the health policy expert, these methods have had the effect of reducing the autonomy of professionals, worsening working conditions and dehumanizing services.

“We feel that the creation of Santé Québec takes us even further in this direction, with an even greater centralisation of services,” said Plourde. She points out that countries that are regarded as models in terms of home support have set up decentralized services, managed more by local communities.

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

“We're proposing that service delivery be entrusted to CLSCs, so that CLSC employees are responsible for providing the services, which are currently outsourced to private providers, and we recommend entrusting the management of these services to social hubs, in other words local democratic bodies spread across the whole of Quebec,” said Plourde.

The management aspect would involve the creation of new bodies that would be democratically elected. In IRIS's vision, these management groups would include representatives of the public, professionals and managers.

CLSCs would be accountable to these bodies.

The Coalition for the Dignity of Seniors welcomes the proposal that home care services be provided by CLSC staff, pointing out that a number of organizations have been calling for this for years.

“Our CLSCs must be more than information desks. They must be equipped with the right specialist resources to assess seniors’ needs, provide the care required if it is more effective to do so directly, or refer the senior to the right professional or homecare provider,” said Tremblay.

This report by The Canadian Press was first published in French on Nov. 14, 2024.

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