Home and Community Care Digest

Home and Community Care Digest 6(2) May 2007 : 0-0

Home care services in Quebec do not adequately meet user needs


This study sought to determine the adequacy of public provision of home care services in the Montérégie region of Quebec. Using a standardized measurement of functional autonomy, researchers assessed individual service requirements of home care recipients. These scores were then used to assign predetermined levels of nursing care, personal care, and support services. The total number of hours deemed necessary was then compared to the actual hours of service provided to home care recipients. Findings indicated that public provision of home care services in the region of Montérégie may not meet the actual service requirements. Further study to assess the adequacy of the measurement tools used is recommended.
Background: In recent years, increasing numbers of Canadians are receiving health care at home, rather than in hospital. Consequently, many provinces have expanded and modified their home care policies and programs. However, little research exists to demonstrate the extent to which home care funding (supply) is adequately meeting the needs of care recipients (demand). This study compares the service requirements of home care recipients to the publicly-funded services provided in the province of Quebec.

Methods: The administrative region of Montérégie (offering health care services via 19 CLSCs [Centre Local de Services Communautaires, or local community service centres]) was selected for analysis. All adults in the region aged 65 and older with disabilities who received at least one long-term home care service during a three month period in 2002 were included. Each adult requiring services was assessed for functional ability using the Functional Autonomy Measurement System (SMAF). The level of services required by each individual as determined by the SMAF was matched to one of 14 profiles, each of which offers a recommended number of hours of nursing care, personal care, and support services. (For example, an individual with minimal service requirements (profile 1) would require 6 minutes of nursing care, 15 minutes of personal care, and 27 minutes of support services daily. In contrast, a highly dependent individual (profile 14) would require almost an hour of nursing care, three hours of personal care, and two hours of support services daily). These time requirements were then multiplied by the number of days in the care episode for each person. The hours of service actually provided to individuals through the CLSCs were then compared to these pre-determined service requirements to create an adequacy of care measure.

Findings: 8434 individuals received services during the study period: 68% were women, and the median age was 80. The average level of disability was considered moderate: 46% of individuals mainly experienced problems with Instrumental Activities of Daily Living (IADLs); 50% had predominantly motor and mental disabilities; and only 4% had severe disabilities. The average level of needs that were met for all types of care was 8%. When service types were considered independently, 13% of needed nursing services were provided, versus 8% of personal care and support services. The highest functioning individuals had the lowest levels of needs met at 5%, while the most dependent individuals had average scores of 15%. The extent to which this gap can be attributed to inadequate service provision, assignment of service provision to health and community care system actors other than the CLSCs (unpaid caregivers, community agencies, etc), client refusal, or other reasons was not discussed.

Conclusions: This study suggests that public funding for home care to older individuals in Quebec falls far short of ideal service requirements. However, the average score of 8% is limited by the assumptions of the original measurement scale, suggesting further research is necessary. Nevertheless, given that all care recipients throughout the province of Quebec receive SMAF assessments, this scale could be useful in comparing various administrative regions' adequacy scores to assess regional variation in service provision.

Reference: Tousignant M, Dubuc N, Hebert R, Coulombe C. "Home-care programmes for older adults with disabilities in Canada: How can we assess the adequacy of services provided compared with the needs of users?" Health & Social Care in the Community. 2007;15(1):1-7.


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