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At-Home Support - CISSS de la Montérégie-Centre

Home care and services are available to anyone:

  • with a loss of autonomy, with an end-stage disease, or with a temporary or permanent disability;
  • who cannot travel to receive the care they need;
  • who requires an assessment in their living environment.

In some situations, they can also be provided to the person’s caregivers.

Intellectual disability, physical disability, and autism spectrum disorder services are available to the user or their caregivers to help them cope with the disability.

Requests can be made by the user themselves, a loved one, a doctor, another healthcare professional, or any person involved in the user’s care. A medical prescription is required for certain services.


Home care services

  • Help with activities of daily living: dressing, hygiene, etc.
  • Help with exercises and transfers, according to the physiotherapist’s recommendations.
  • Equipment loans: Depending on the home care worker’s assessment, you may be loaned certain pieces of equipment to help the attendants provide hygiene services safely (certain criteria may apply).
  • Assessment of sitting or respite needs for caregivers and help finding services.


Social services

  • Psychosocial assessment, reassessment and follow-up.
  • Interventions:
    • in a crisis situation;
    • in anticipation of a move;
    • in a situation of social protection or abuse;
    • adaptation to the announcement of a diagnosis;
    • to prevent burnout;
    • to address bereavement related to a loss of autonomy or a disability;
    • related to social integration/reintegration and adjusting to changes;
    • during complex social problems;
    • in the context of palliative care.


At-home nursing care

  • Assessment and monitoring of health condition and needs.
  • Treatments, e.g., post-operative care, dressings, blood draws, injections, etc.
  • Follow-up of chronic diseases, e.g., high blood pressure, diabetes, etc.
  • Support and teaching, e.g., on how to use a medical device.
  • Palliative and end-of-life care.


Occupational therapy

  • Assessment of functional skills before any occupational therapy services.
  • Maintenance or optimization of functional capacities related to activities of daily and domestic living, recreational activities, and social roles that have an impact on staying at home.
  • Safe transfers and fall prevention; recommendations and teaching.
  • Treatments for wounds, pain and discomfort.
  • Alternatives to control measures.
  • Recommendations on equipment and home modifications.
  • Teaching of energy conservation and pain management principles.



  • Assessment of physical function related to neurological, musculoskeletal, cardiac and respiratory systems.
  • Treatment plan and exercise program, teaching, compensation for disabilities.
  • Interventions aimed at improving functional performance, e.g., transfers, movements, stairs, etc.
  • Assessment/reassessment of progress and effectiveness of chosen treatments, with adjustments to the plan as needed.


Clinical nutrition

Determination of the nutrition therapy plan in the context of:

  • wound care;
  • gastrointestinal disorders;
  • chronic diseases;
  • malnutrition;
  • swallowing disorder and dysphagia;
  • enteral nutrition;
  • palliative and end-of-life care;
  • monitoring of nutritional status.


Respiratory therapy

  • Assessment of cardiorespiratory function.
  • Assessment of eligibility criteria for at-home oxygen therapy.
  • Tracheotomy care, aspiration, instillation, airway clearance.
  • Follow-up related to assisted ventilation and oxygen therapy.
  • Teaching related to taking medications: role, side effects, techniques.
  • With a prescription: assisted ventilation; specimens; respiratory function tests; administration and adjustment of medications; adjustment of equipment settings.
  • Oncology and palliative care follow-ups.


Respite for caregivers

Various services are provided to support the people who take care of a loved one with a loss of autonomy. The goal of these services is to give them a break from their responsibilities. Following an assessment, the home care worker may recommend various support options for the caregiver.


Respite and sitting services

To reduce the risk of burnout in loved ones, in collaboration with local community organizations, we provide periods of respite/support at home or at one of several local organizations. Some partners also run support groups.


Day centres

Day centres also offer respite to caregivers by taking in the person under their care for the day. Different group activities are organized to stimulate the memory and develop the motor skills of people with a loss of autonomy.


Home care

After an assessment by one of our professionals, services can also be provided by a home care worker.


Respite beds

Some respite beds are also available to give caregivers a 24-hour rest period (for a total of a few days).


Other resources

Collaboration with community partners is important, and the team may also refer caregivers to community resources.

Call the psychosocial intake department at your local CLSC for more information.