January 20, 2022

While the government says it wants to keep the elderly at home as long as possible and reduce the use of independent labour in the health network, a new study by the Institut de recherche et d’informations socioéconomique (IRIS) has turned the spotlight on home care. Over a quarter of home care hours are worked by staff from private employment agencies. Once again, it would appear that the Health Ministry does not have the means to achieve its ambitions and that we need to do a 180 degree turn to stop the privatization of home care.

The study entitled Les agences de placement comme vecteurs centraux de la privatisation des services de soutien à domicile (employment agencies as key catalysts in the privatization of home care) by researcher Anne Plourde, published on January 19, shows that the use of independent labour has grown twice as fast in the home care sector than in the rest of the network, all job titles combined (+159% between 2015-2016 and 2019-2020 in home care, compared to 82% for all other sectors combined).

The cost of independent labour per hour increases much faster than that of network employees in home care services. This means that, for workers who have a college or university education, there’s no real advantage to turning to agency staff. The argument that it’s economical simply doesn’t hold water, the same goes for the argument about the labour shortage.

According to the IRIS, this “supposed shortage” can be explained, at least in part, by the significant deterioration in professionals’ working conditions, since those who work in agencies are looking, among other things, for decent working conditions and better family-work balance. It is therefore clear that political and managerial decisions are the reasons for the “shortage,” especially in the highly difficult context of the COVID-19 pandemic.

The study also sheds light on the casualization and devaluation of agency workers in home care, of which there is a much higher number in Montreal. Vulnerable labour is overrepresented here, especially within the immigrant and racialized population. In half of Quebec’s institutions, the rate of independent labour for home care was less than 3.5% in 2019-2020, whereas in four out of the five CIUSSSs in Montreal, the rates were above 50%. However, some CISSSs and CIUSSSs in the Montreal region have vastly different statistics, which proves that it is possible to do things differently.

This study confirms what the FIQ and FIQP have been saying for years: investments in home care must be made in the public network. Hiring independent labour, whether in home care or other services, finances at a high cost the exodus of healthcare professionals from the public network.

What needs to be done now is to massively reinvest in home care to increase the number of providers, as well as better organize services and plan the workforce needed to properly meet the needs of the elderly. The government should also explore accompanying informal caregivers by offering them a break, instruction, and financial support.

Highlights of the study

• Between 2019 and 2020, the health and social services network’s spending on independent labour accounted for 15% to 28.9% of employment agencies’ total revenue.

• The hourly cost of independent labour has skyrocketed since the pandemic began. On average, the services of an agency home care nurse cost $2.20 less an hour than that of a nurse from the public network before the pandemic. Now they cost $11.57 more per hour. For respiratory therapists, the difference in cost rose from $8.50 to $21.37 per hour.

• In 2019-2020, the amounts spent on services from private agencies neared $500 million dollars. Independent labour accumulated 10.7 million hours worked in the public network.

• Multinational job placement corporations are starting to invest in Quebec’s healthcare market when they had never been subject to calls for tenders before the pandemic.