Dr. Geneviève Dechêne loves her work and is always on the go. The family physician retired from her office practice and now devotes her time visiting patients in the comfort of their own home.
On Friday morning, after a stop at the local CLSC health clinic in Montreal’s Verdun neighbourhood, Dechêne headed out to see her first patient — a woman with terminal cancer who was recently coughing up blood.
The patient, a senior, sat on her couch as Dechêne took her blood pressure, asked questions and provided reassurances.
She could have sought help in hospital — potentially waiting hours in an overcrowded emergency room — but chose instead to call Dr. Dechêne and the care team at the Verdun CLSC.
Dechêne is part of a specialized team of 15 doctors and nurses who provide intensive palliative care to patients.
“We’re following in their home, terminal patients in their last year of life, either from cancer or heart disease or dementia,” Dechêne explained.
The program, called SIAD, has been running since 2008 and offers services 24/7.
Dechêne noted the benefits of such a system are numerous. For vulnerable patients and their families, repeated hospital visits can be taxing both emotionally and physically.
“If you’re in your last year of cancer with pains… and shortness of breath and bleeding, you will go back and forth, sometimes every week,” Dechêne said.
By receiving care at home, patients avoid long wait times and the risk of being exposed to infections like influenza and COVID, said Melissa Leboeuf, a nurse on the SIAD team.
“It’s rewarding,” she said of being able to provide such services.
Alternative to overpacked emergency departments
The care provided by SIAD also lessens the burden on overcrowded ERs.
“Sixty-five per cent of all our patients avoid emergency rooms and hospitalizations,” Dechêne said.
“We follow here, our team, 1,500 patients. Can you imagine the number of patients not going to the hospital?”
In the last week, several Montreal-area emergency departments have been operating at 200-per cent capacity. But the problem extends beyond Montreal.
With a proven track record, Dechêne believes the SIAD program could play a crucial role in alleviating the province’s ER crisis and wants to see more teams put in place.
Patient advocate Paul Brunet agrees.
“We should apply this to everyone,” he said.
Hurdles to expanding project
Dechêne says the model is common in the rest of Canada and in Europe.
While Quebec says expanding home care is a priority, Dechêne claims the government is blocking the project’s growth.
“They don’t consider of any value the work of family physicians at home. But if they do the same work in the hospital, it’s very much valued,” she said.
In a statement, Quebec’s health ministry said it is “very favourable” to the development of SIAD.
“The Ministry of Health and Social Services has increased its support for health establishments in order to facilitate the implementation of the SIAD across Quebec,” wrote health ministry spokesperson Marie-Pierre Blier.
She added that the program developed in Verdun is an excellent model.
“Words are cheap. Actions are gold. If they wanted to implement the medical teams in the CLSCs they would have done it since 2018. They have not done it,” Dechêne said.
In May 2023, however, the government announced a new hospital-at-home initiative in which patients are hospitalized at home and monitored remotely 24/7. Dechêne said the program differs from what she does because physicians don’t do home visits, although nurses do and patient files are closed after seven days.
For terminal patients, seven days isn’t enough.
“The patients who we are following here, we will follow them until the end, with an average of eight months of follow up,” Dechêne said.
Whereas the patients in the hospital-at-home program “are healthy patients who are going to be cured in a week.”
Dechêne and Brunet also claim that SIAD is facing hurdles from the Quebec federation of general practitioners (FMOQ).
“FMOQ General Practitioners Union does not want that,” Brunet said. “They diminished as much as they could the salary of doctors visiting patients at home and they raise the salary for family doctors becoming emergency doctors.”
The federation’s president told Global News it fully supports the idea of SIAD.
“It’s totally false that we are against it,” said Marc-André Amyot.
Amyot explained that it isn’t always feasible to implement a SIAD team depending on location and that staffing shortages are a barrier.
Meanwhile, Dechêne said she’ll continue to advocate for terminal patients provincewide to get the critical care they need in a home setting.
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