Vilavi’s services are set as essential services but the pressure is increasing on the intervention teams.
Like a over eighty addiction treatment centers in Quebec *, the Vilavi center, located in the Terrebonne area, must face complex questions regarding the Covid-19 pandemic: should services be maintained? If so, under what conditions? Is it possible to offer quality treatment while ensuring the safety of teams and users? What is the most critical breach, the employees who drive everyday between the shelter and their homes or the new residents who are admitted?
These questions are asked in each center of Quebec with variable answers depending on the conditions from one organization to another: financial reality, effective support of the public network, number of beds, duration of treatment, contractual conditions, physical capacities of buildings , technological integration etc… All these considerations lead to a decision which is valid only the time to see appearing new restrictions.
The Vilavi team tried to design a dynamic “decision kit” which aims to respond to existing challenges based on information made available by its various networks: addictions and mental health, homelessness, social housing and intellectual disability.
For the treatment center, the decision was to maintain its services and admissions because the people who call on us cannot access alternative solutions and therefore risk appearing quickly in the hospital network. The CISSS de Lanaudière (CISSS-L) had itself decided on March 16 to suspend admissions to Multifunctional Bed Units (ULM) operated in collaboration with Vilavi and the Pavilion du Nouveau Point de vue, before to revert the same day to this directive. The following day we were confirmed with its intention to “maintain our partnership and collaboration for the referral, placement and admission of ULM customers north and south of Lanaudière”.
What are the implications of maintaining services?
The fallout is above all human, because the pandemic generates a large number of fears among employees and beneficiaries. Measures have therefore been implemented to prevent exposure to the virus (set of measures defined by the Ministry of Health) and everything has been widely communicated to employees and residents to obtain their buy-in and commitment to the implementation of these measures. However, repeated requests for protective equipment and disinfection products have still not been answered by the government.
The effects are also economic: the concern led to the discontinuation of treatment by several residents, the pre-admission control measures slowed down the flow of admissions to the center and the result was a net drop in occupancy, passing in 2 weeks from 34 to 26, then 23 people on March 23. A drop of over 30% which has an instantaneous effect on revenues when the organization has to support new expenses, in particular the purchase of protective equipment and hygiene products, consultation costs and the replacement of employees in segregation.
The crisis highlights the fragility of the funding model
However, this 30% drop in income cannot result on the layoff of 30% of employees, because anxiety and pressure in times of crisis must be offset, on the contrary, by expressing our recognition and admiration for the commitment shown by our stakeholders. In addition, the implementation of preventive measures and the anxiety experienced by beneficiaries and their entourage increase the workload which must be ensured by qualified and teams aware of the constraints of our workplaces.
The truth is, the current model is essentially based on the social commitment of all addiction treatment centers and their employees, which makes no sense from a public health point of view. If our organizations provide essential services in times of crisis, the funding model shouldn’t be based on the fragile capacity of each center to maintain itself!
A cycle of consultation meetings proposed by the national addiction treatment centers association (AQCID) has highlighted the disparity in decisions. More than half of the centers have suspended admissions, a few centers have temporarily or permanently closed, and distancing measures at the very least have resulted in a reduction in intake capacity. In addition, public centers have also reportedly closed their accommodation services and reduced their outpatient services. But can unserved people suspend their need for treatment or will they appear in a health network already saturated with crisis management? To this question, AQCID brings the following point of view: “The pandemic context exacerbates the needs of people who use drugs. Stress and anxiety, financial insecurity, more difficult access to services are all risk factors that justify the availability and proper functioning of community treatment centers.”
* There are 85 centers and 2,600 treatment places with accommodation in Quebec.
Information: Bruno Ferrari, Managing Director | firstname.lastname@example.org | 514-875-7013