Caregivers are widely criticizing the scaling back of Quebec’s home-care services, which support vulnerable people in accomplishing daily tasks.
As part of the service employment paycheque program, the government helps pay for caregivers outside the health network to provide home-care services. About 22,000 Quebecers used the program last year.
While people who rely on it are worried they’re facing cuts, government bodies say services are being reduced for users on a case-by-case basis.
Concerns about the program’s future come as Quebec Health Minister Christian Dubé promised to limit the impact of $1.5 billion in cuts to the province’s health-care services.
Teri-Lee Walters has been a caregiver for her disabled friend in Montreal for the past three years, often helping him get in and out of bed, cooking for him and doing his laundry seven days a week.
“There’s nothing I can’t do unless it’s something that’s really high up,” said Walters, who uses a wheelchair.
She and her friend had hired another caregiver for reinforcement thanks to the service employment paycheque program. But after eight weeks of the program not sending payments, the person quit.
Soon after, her friend’s occupational therapist informed them that new limits had been put on the program.
“The hours I’m already doing I can keep, but I can’t take over any of the other hours if I want to because they’re just not going to pay,” Walters said. “At this point we’re stuck.”
While provincial health authorities say no cuts to the chèque emploi-service program have been made, advocates for people with disabilities say many members are expressing concerns about difficulties getting approval.
Rose-Marie Wakil, co-ordinator of Exaequo — a Montreal-based advocacy group for people with disabilities — said she’s been fielding calls about the program from concerned members for three weeks.
She said reducing home-care services would force members to rely on their local CLSCs whose limited services can be unpredictable.
“You never know when the [préposé au bénéficiaire] will come,” she said. “Will they be unkind to the person? It’s hard to have someone different everyday.”
The benefit of having a caregiver who isn’t sent by a CLSC is that people seeking home-care services can request — at their own convenience — help with activities, such as eating, bathing and dressing, she said.
“With CLSC services, times can vary. Schedules can vary. The people coming and going — it’s always somebody different,” Walters said. “Lying in bed for 15 hours because you don’t know whether somebody is coming is very uncomfortable.”
A Health Ministry spokesperson denied that the ministry ordered cuts to the program, noting that regional health authorities (CISSS and CIUSSS) are responsible for assessing and meeting the needs of their clientele.
The spokesperson said the government has invested over $8 billion in home-care services.
In an email sent on Wednesday, a spokesperson for Santé Québec said the Crown corporation managing health care delivery had not issued directives related to the service employment paycheque.
“We are working jointly with each institution to analyze measures to be adopted in the current budgetary context,” the email reads. “These decisions are made by the institutions, based on their local realities, always with the aim of minimizing the impact on care and services offered, especially to the most vulnerable people.”
In total, 22,158 users benefited from the service employment paycheque in 2023-24, up from 18,585 people for the same period two years earlier, according to the Health Ministry.
Changes to services depend on urgency
Montreal regional health authorities say that changes to home-care services depend on whether health network professionals consider that support essential to the safety of patients.
Services “may be suspended or put on hold in order to meet our obligations to all members of our community who have priority needs,” a CIUSSS de l’Est-de-l’Île-de-Montréal spokesperson said in an email sent on Thursday.
“It is not a budgetary issue but rather a question of fairness between the members of our community who need services.”
Liberal MNA Elisabeth Prass, the opposition critic for persons living with a disability, said in an interview the service is not only essential for people with disabilities but also family members who may serve as caregivers.
“It’s not up to institutions to make those decisions,” Prass said, adding that Santé Québec remains “an enigma to many of us, even in government.”
Santé Québec will manage all health-care establishments in the province but workers and community groups are worried the change in hierarchy will cause concerns and confusion.