Is Home Support Always the Option of Choice? Investigation Report on the Accessibility of Long-term Home Support Services
Québec City, March 30, 2012
A Québec Ombudsman investigation report released today underscores the gap between the principles and thrusts of the home support policy titled Chez soi : le premier choix (Home Support: Always the Option of Choice), adopted in 2003, and the daily lives of people with significant and persistent disabilities who receiveor should receivethese services.
The policy provides that the domestic help and personal assistance services specified in an intervention plan or individualized service plan are offered free of charge to:
- people with a temporary disability;
- people receiving palliative care;
- people with a significant and persistent disability.
The Québec Ombudsmans investigation focused on the third item, the one that involves long-term home support. Further to the sizable increase in substantiated complaints on this subject in the past year, the Ombudsperson wanted to conduct this investigation to determine whether recommendations on overall measures were called for to prevent the situation from worsening.
The investigation therefore looked into the accessibility of personal assistance services (help with hygiene, eating or moving about), domestic help services and services to support civic participation (particularly in managing a budget) for people with disabilities and people with a loss of independence (seniors in particular). The investigation did not cover home healthcare (such as nursing care) or short-term home support for people with temporary disabilities (for example, after surgery), for which there were very few substantiated complaints and reports.
The policy establishes that in respecting the choices of individuals, helping them remain in their home environment should always be the first option, but the cases documented by the Québec Ombudsman clearly show that in the real world this is far from true and access to long-term home support services is lacking. This gap causes natural caregivers to burn out and puts stress on the healthcare system (poor use of places in hospitals, rehabilitation centres, and residential resources).
In recent years, most agencies and health and social services centres (CSSSs) have reviewed their reference guides for home support services used to make decisions on service level and length. The Québec Ombudsman has found that all these documents are based on the policy, but there are differences that can have a direct adverse effect on the services provided to healthcare users.
The following are some of the elements the Québec Ombudsman has noted that stray from the policy:
- new exclusion criteria (in particular if people with disabilities or age-related loss of independence eligible for assistance who have a natural caregiver or access to billable à la carte services offered by private nursing homes);
- ceilings on the number of service hours that are very frequently below the level required for the needs determined;
- disparities in access to the services laid out in the policy and its application from one agency or CSSS to another (depending on the region, the same number of service hours are not given to people with the same determined needs);
- a decrease in service hours (often within a very short period of time and without adequately informing service users);
- longer wait times (more than one year and even more in some cases).
The Québec Ombudsman has noticed that the biggest problems have to do with the insufficient number of services hours allocated given needs, and the time it takes before services are delivered. More generally, it sees inflexibility in applying the criteria and a distinct trend towards a decrease in the number of allocated hours.
On the strength of the findings from the investigation, the Québec Ombudsman has made the following recommendations to the Ministère de la Santé et des Services sociaux, the government department responsible for implementing the policy:
- that it determine the level of funding needed for home support services by:
- analyzing the waiting lists for every region in Québec;
- producing a projection of needs for the next few years;
- benchmarking with other governments.
- that it plan budget allocation so that the funding target is achieved;
- that it allocate resources by differentiating between the various components of home support services (for people with a temporary disability, for people receiving palliative care, and for people with a significant and persistent disability);
- that it establish guidelines clearly setting out the slate of services available under the policy, according to public needs.
The Québec Ombudsman recommends that health and social services agencies and CSSSs:
- apply these guidelines and adequately inform the people in their region about the services offered and their availability.
To be consulted:
- Investigation Report by the Québec Ombudsman: Is home support always the option of choice? Accessibility of home support services for people with significant and persistent disabilities.
Source: Québec Ombudsman
Information and requests for interviews:
Joanne Trudel, Director of Communications,
Carole-Anne Huot, Communications Adviser,