(Here is an open letter from Réseau FADOQ and Conseil pour la Protection des Malades)
The last two years, and particularly the last few months, have made it glaringly obvious that Quebec’s hospital-centric system is no longer coping.
For decades now we have known about a way to free up beds and reduce the pressure on hospitals: home medical and nursing care. Many countries have adopted this model and its effectiveness is proven.
Quebec must begin this essential shift right away. Seniors have been saying they want to age at home for a long time now.
Réseau FADOQ and the Conseil pour la Protection des Malades (CPM) are calling on the Quebec government to make home medical and nursing care a priority across Québec.
While we realize that a reform of the health care system takes time, a first step to increase medical care in the home already exists. Intensive home care teams (known by the French acronym SIAD) provide visits with physicians and nurses, prioritizing patients with severe loss of mobility and at the end of life.
SIADs are a proven effective solution for reducing hospitalizations for patients who no longer need the clinical facilities of a hospital, such as those whose diagnoses are known or whose magnetic resonance imaging has been done or can be done by appointment. SIADSs also apply to people requiring palliative care.
An agreement that must be revisited
Unfortunately, the agreement between the Fédération des médecins omnipraticiens du Québec (FMOQ) and the Quebec government, which implemented the SIADs, was modified in 2019 to insert a maximum of seven days to the medical follow-up and limit remuneration to less than 50% of the CLSCs in each region.
These changes to the original agreement mean that Quebec has not implemented any new intensive home care teams in the province, with some exceptions, since 2018.
With an accelerating population aging rate and pressure on hospitals, there is an urgent need for action on this front. The Quebec government and the FMOQ must quickly agree to abolish the maximum number of days for home medical monitoring of SIAD teams, which considerably limits their use.
A concrete example of the problem: a person at the end of life who has been discharged from the hospital and is being followed by a SIAD team, but requires a doctor’s visit after seven days, must return to a health care facility to see a doctor.
In addition, SIADs must be available throughout Quebec with adequate and recurring funding based on needs and resources.
The advantages of SIADs are numerous on the human, hospital and financial levels. Studies show that they are reducing the number of patients in emergency departments. There are 65% fewer hospitalizations, 60–65% of patients followed die at home, and costs for the last year of life are reduced by 50%. This, in addition to the comfort people feel when in their homes instead of a hospital room.
The government and the professional orders must find common ground in order to respond to the wishes of Quebecers. The health of our population and the health of our health care system are at stake.