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 of health and well-being.

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 plan, costing and planning of the government’s main home support policy, At Home: The First Choice, which remains 20 years after its tabling “the bedrock of the Quebec model”.

His work shows that successive governments have not deployed 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 funding, nor public debate as to the coverage of the services that are offered,” reads the report.

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

“We could obtain better results if resources were better structured and allocated and if local communities were given more opportunities to develop appropriate situations given the resources they have at their disposal,” Ms. Castonguay said in an interview.

She also concludes that institutions “focus mostly on service volumes sometimes at the expense of 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 bonuses, we could decide to offer domestic care, when the person would need respite for caregivers, ”she says.

At the start of his second term, François Legault promised to bring about “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.

Ms. Castonguay 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.

Ms. Castonguay’s recommendations will appear in her final report (the 4th volume) which will be tabled in December 2023.

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%.

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

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 11th in the country.

Ms. Castonguay nevertheless underlines the increase in Quebec in recent years of investments in home care. “[This] will need to continue into the future to make up for the shortfall to 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 this year for 963.5 million in new money within 5 years.