Home and Community Program Care
Program Criteria
Overview
Program Description and Criteria
Appendices
- Appendix A - History and Background
- Vision
- Background
- Home and Community Care - Building a Common Understanding
- How Can the Home and Community Care Program Help First
Nations and Inuit
Overview
Program Description
The First Nations and Inuit Home and Community Care Program will
provide basic home and community care services that are:
- comprehensive
- culturally sensitive
- accessible
- effective
- equitable to that of other Canadians, and
- responsive to the unique health and social needs of First Nations
and Inuit.
The Program will be delivered primarily by trained and certified
personal care/home health aide workers1 at the community
level supported and supervised by registered nurses.
The Home and Community Care Program will be comprised of essential
service elements and may be expanded to include supportive service
elements provided the essential service elements are
met. When communities already have all essential services through
alternate sources, the program will not duplicate these services,
but will allow communities to augment, through the supportive service
components, the current services.
The Program will coordinate and link with existing
programs and services at the community and/or provincial/territorial
level.
1 See Glossary of Terms for definition
Program Requirements
The First Nations and Inuit Home and Community Care Program initially
will be driven by plans submitted by communities
or by organizations on behalf of communities. This phase, commonly
referred to as Program Planning, will ensure that
a solid foundation for the Program is established.
The Program Planning phase will provide the opportunity
for:
- community consultation about the home and community care needs
of the community,
- community development and awareness,
- planning and delivery model development,
- staffing and training activities, and
- infrastructure and capacity development.
The community sets its own schedule for completing the program
planning activities and decides how it will carry out the necessary
work.
Once the community leadership has made the decision to proceed
with Home and Community Care, the community should contact the
region of its intent to start planning.
Note: For reasons of sustainability, specific regional processes
for planning will be developed for communities with a population
of 500 or less who are not affiliated with a Tribal Council or
regional Inuit association. Please contact your region for further
detail.
Program Planning Guide
- Getting Started
- Community Needs Assessment
- Planning
- Service Delivery Plan
- Capital Plan
- Training Plan
- Preparation Activites for Program Service Delivery
- Program Service Delivery
Each community will address how it will provide basic home and
community care services by undertaking a Community Needs
Assessment to determine:
- (1) the home and community care service needs/priorities for
the community,
- (2) the training needs required for the service priorities
identified, and
- (3) capital needs.
Each community will then be required to prepare a Service
Delivery Plan, a Training Plan, and
a Capital Plan.
All plans will be reviewed by a review process established by
the region for adherence to regional criteria, if established,
complementing the national program criteria.
Once the plans have been approved, communities will develop a Workplan or
Implementation Schedule outlining all the Preparation Activities
for Program Service Delivery and the associated timelines.
The workplan will serve as the principal document for entering
into a contribution agreement with the funding agency.
The Evaluation Framework and Reporting Requirements for
the Program will be developed by fiscal year 2000-2001. In the
meantime, consideration of how the community will review and evaluate
its Home and Community Care Program should begin during the development
of the plans in the form of Community Evaluation Questions for
the ongoing monitoring of the Program.
Program Linkages
The First Nations and Inuit Home and Community Care Program is
one that builds onto existing investments in health and social
community based services. Service Delivery Plans must demonstrate
how the new program will build on and link with other related services
and opportunities within and external to the community. An example
of this would be the Health Canada Building Healthy Communities
Home Nursing Program and the Department of Indian Affairs and Northern
Development (DIAND) Adult Care Program (In-Home Component). The
goal is for clients to have access to services in a manner that
is holistic and comprehensive in its approach and maximizes resource
utilization, both human and financial.
Program Funding
All funding for the First Nations and Inuit Home and Community
Care Program will be allocated according to the Home and Community
Care funding formula. Each community will be informed of its notional
amount of ongoing funding before planning activities begin.
Funding for Planning
Communities wishing to undertake home and community care planning
activities will be eligible for funding to support the planning
activities. Contact your region to initiate this process.
Funding for Program Delivery
Communities who have already conducted all program planning activities,
including the needs assessment and program service delivery plan
will be able to use their portion of planning dollars to support
program delivery activities or develop plans for expanding the
continuum of services.
Funding for Training
The development of quality home and community care service delivery,
staff qualifications and occupational health practices will require
extensive training and upgrading in the majority of First Nations
and Inuit communities. For this reason, a separate funding allocation
has been identified within the overall Home and Community Care
Program budget for training during the three year developmental
period. Each region/territory will be required to develop a comprehensive
training plan addressing the training needs of home care nurses,
personal care workers and others who will be involved in the Home
and Community Care Program. The plans will need to be developed
in collaboration with First Nations, Inuit and other federal departments
including DIAND and Human Resources Development Canada to enhance
and maximize the efficient use of available training resources.
All plans will be reviewed against established criteria.
Funding for Capital
Essential to the development and implementation of effective home
and community care programs is the need to build a physical infrastructure
to support program delivery. Capital requirements may include modifications
to office space for staff or program delivery; staff accommodation
may need to be obtained for more northern communities; medical
equipment and supplies may be required to support the delivery
of therapeutic programs, e.g. bath facility with hydraulic lift.
For this reason, a separate funding allocation has been identified
within the overall Home and Community Care Program budget for capital
construction and capital equipment during the three year developmental
period. Each region/territory will be required to develop a capital
plan based on established criteria. The capital allocation is not
intended to support renovations of homes or build institutions
or health centres.
Program Description and Criteria
Principles and Objectives
The First Nations and Inuit Home and Community Care guiding principles
and objectives have been developed to provide the basic fundamentals
for the program. They are based on universally accepted home care
precepts with adaptations for First Nations and Inuit cultural
values. They have been designed so that Home and Community Care
Programs will strive to achieve excellence and to ensure program
quality and consistency. They are intended to contribute to program
development and management throughout the life of the program.
They should be a key resource that is reviewed for strategic planning
and the development of policies and procedures. They are:
- Respect traditional and contemporary First Nations and Inuit
approaches to healing and wellness.
- Planning will be community-based and community-paced.
- Programs will be available to individuals of all ages with
an assessed need.
- Services provided will be at least equitable, effective and
equivalent to those received by the general population and supported
by quality assurance measures.
- Supportive to family and community involvement.
The objectives for the First Nations and Inuit Home and Community
Care Program are:
- To build the capacity within First Nations and Inuit to develop
and deliver comprehensive, culturally sensitive, accessible and
effective home care services at a pace acceptable to the community.
- To assist First Nations and Inuit living with chronic and acute
illness in maintaining optimum health, well-being and independence
in their homes and communities.
- To facilitate the effective use of home care resources through
a structured, culturally defined and sensitive assessment process
to determine service needs of clients and the development of
a care plan.
- To ensure that all clients with an assessed need for home care
services have access to a comprehensive continuum of services
within the community, where possible.
- To assist clients and their families in participating in the
development and implementation of the client's care plan to the
fullest extent and to utilize available community support services
where available and appropriate in the care of clients.
- To build the capacity within First Nations and Inuit to deliver
home care services through training, evolving technology, information
systems to monitor care and services and to develop measurable
objectives and indicators.
Eligible Recipients
The eligible recipients for this program are:
- First Nations and Inuit of any age; and
- Who live on a First Nations reserve, Inuit settlement or First
Nations community North of 60; and
- Who have undergone a formal assessment of their continuing
care service needs and have been assessed to require one or more
of the essential services; and
- Who have access to services which can be provided with reasonable
safety to the client and caregiver, within established standards,
policies and regulations for service practice.
Funding Guidelines
and Principles
All program planning and service delivery funding will be allocated
according to the Home and Community Care funding formula. This
funding framework respects the resolution of the Assembly of First
Nations (AFN) Annual General Assembly indicating the funding should
be based on the health needs of First Nations. The funding formula
model is based on delivery of essential service elements, a set
of funding principles and care requirements.
The following principles provide the foundation for the funding
allocation model:
- flexibility
- sustainability and longevity
- integration and linkages
- accountable
- accessible
- needs based
- plan based, and
- does not penalize First Nations and Inuit who currently have
programs and services in place through other funding arrangements,
nor will it duplicate existing programs such as DIAND's Adult
Care Program (In-Home Component).
Allocation parameters of the funding formula include:
- on-reserve population, Inuit settlement, North of 60 First
Nation communities
- care requirements of the population
- program support requirements
- program management and client assessment requirements
- operating and remoteness.
Community Needs Assessment
Each community will undertake a community needs assessment to
identify:
- (1) the home and community care service needs and priorities,
- (2) training needs required for the service priorities identified,
and
- (3) capital needs.
Assessing community needs involves surveying community members
and health providers to find out which home and community care
problems are most prevalent and need most attention. The community
can then use this information and base line data to set its priorities
in designing the Home and Community Care Program that will best
meet its needs and to measure the impact of home care services
for long term program planning and evaluation.
The community needs assessment is the key basis of the service
delivery plan, training plan and capital plan. It will provide
the foundation for all home and community care planning and as
such must be completed carefully to ensure that it is representative
of the community (appropriate sample size), addresses the real
needs of community members (the right questions and most current
data), addresses the essential services elements of the program,
and involves proper and accurate analysis and summary (report).
For more information on carrying out the assessment, refer to Handbook
2 - Community Needs Assessment.
Planning
Service Delivery Plan
Each community will be required to prepare a service delivery
plan describing how the program will be managed (management structure
for the program), how the essential services will be delivered
and how service and funding linkages will be made.
For more information on preparing a service delivery plan, refer
to Handbook 3A
- Service Delivery Plan.
Management Structure
This component of the service delivery plan includes:
- a brief description of the roles and responsibilities of the
management structure;
- detailed work descriptions including roles, responsibilities,
qualifications, experience required, and lines of supervision
of all health services personnel to be involved in providing
home and community care services;
- an organization chart showing the reporting requirements of
each of the home and community care positions to the proposed
management structure outlined above;
- the program policies to be implemented including policies on:
- salary levels and benefits
- professional registration and licensing
- professional supervision
- liability and malpractice insurance
- confidentiality of medical records
Essential Service Elements
The Home and Community Care Program will be comprised of essential
service elements. They may be expanded to include supportive service
elements as long as the essential services are provided. The latter,
however, is contingent on the availability of resources and identified
needs determined in the program planning phase.
Where communities already have some or all essential services
through alternate sources, the program will not duplicate these
services. It will, however, allow communities to augment, through
the supportive services components, the current services and "Reach
For The Top" levels of home and community care.
The service delivery plan will identify how the essential service
elements will be established. Essential service elements include:
- A structured client assessment process that
includes on-going reassessment and determines client needs, family
supports and service allocation. It is recommended that client
assessments be performed by an appropriately trained registered
nurse.
- A managed care process that incorporates case
management, referrals and service linkages to existing services
provided both on and off reserve/settlement.
- Home care nursing services that includes direct
service delivery as well as supervision and teaching of personnel
providing personal care services.
- The delivery of home support services that
are determined by the community needs assessment plan and that
do not duplicate, but enhance existing Department of Indian Affairs
and Northern Development (DIAND) Adult Care Program In-Home services.
Home support covers a range of services such as personal care
services (e.g. assistance with Activities of Daily Living such
as bathing, grooming, dressing, care of bed bound clients including
turning, back rubs and routine skin care, etc.) and home management
(e.g. light housekeeping, laundry, meal preparation).
- Provision of in-home respite care.
- Established linkages with other professional
and social services that may include coordinated assessment processes,
referral protocols and service links with such providers as hospitals,
physicians, respite and therapeutic services.
- Provision of and access to specialized medical equipment,
supplies and specialized pharmaceuticals to provide home and
community care.
- A system of record keeping and data collection to
carry out program monitoring, ongoing planning, reporting and
evaluation activities.
It is expected that the essential elements of the Home and Community
Care Program will be developed initially in each First Nations
and Inuit community. Based on community needs and priorities, the
existing infrastructure and availability of resources, the Home
and Community Care Program may expand to include supportive
service elements. These supportive elements that may be
provided within a continuum of home and community care might include
but not be limited to:
- facilitation and linkages for rehabilitation and therapy services;
- institutional based respite care;
- adult day programs;
- meal programs;
- mental health home-based services for long-term psychiatric
clients and clients experiencing mental or emotional illness.
These services might include traditional counseling and healing
services, medication monitoring;
- support services to maintain independent living which may include
assistance with special transportation needs, grocery shopping,
accessing specialized services and interpretative services;
- home-based palliative care;
- social services directly related to continuing care issues;
and
- specialized health promotion, wellness and fitness.
First Nations and Inuit Home and Community Care will not:
- fund the construction and/or delivery of long term care
- institutional services; and
- will not duplicate funding for existing on reserve adult care
services.
Service and Funding Linkages
The program model for the new First Nations and Inuit Home and
Community Care Program is one that builds onto existing investments
in health and social community based services. Service delivery
plans will demonstrate how the new program will build on and link
with other related services and opportunities provided within and
external to the community. An example is the Home Nursing Program
through Building Healthy Communities and the Department of Indian
Affairs and Northern Development's Adult Care Program (In-Home
Component). Other service and funding linkages may include community
health nursing and the Non-Insured Health Benefits Program.
The goal is for clients to have access to services in a manner
that is holistic and comprehensive in its approach and maximizes
resource utilization, both human and financial. A structured client
assessment, coordinated care and a case managed approach are just
some of the tools that will assist communities in realizing more
effective, appropriate and timely access to care. Each community
or collation of communities will achieve this goal of seamless
access over a period of time and in a manner that supports the
delivery of the program as developed by the community(ies).
In addition, some provinces and territories have made investments
to providing home care services on reserve and in Inuit settlements.
It is important to incorporate these program supports in client
assessment, case management and service delivery.
Training
Criteria and guidelines for the development of training plans
refer to Handbook
3c - Training Plan.
Capital
Criteria and guidelines for the development of capital plans Handbook
3b - Capital Plan.
Preparation
Activities for Program Delivery
Each community will be required to develop a Workplan or
Implementation Schedule outlining all the preparation activities
for program delivery. The workplan should set realistic
timelines against which progress can be monitored.
During this developmental period, it is recognized that communities
may be providing some service delivery but that the majority of
time and resources will be on training and putting in place the
necessary structures and processes to establishing a solid program
foundation.
Regional Review Process
A collaborative review process will be established in every region
and will play an important role to ensure that available resources
are distributed according to the funding formula and that priority
home and community care needs are treated on a priority basis.
All plans will be assessed for eligibility, completeness and adherence
to the national criteria outlined above.
Home and Community Care Service Delivery, Training and Capital
Plans will be reviewed by regional review processes for:
- adherence to regional criteria, if established, complementing
the national criteria;
- the presence of a program model that demonstrates the delivery
of essential service elements, including the supportive service
elements that may be introduced to the program;
- demonstration of coordination and/or linkages with existing
and proposed home and community care programming and infrastructure
such as adding components to existing services provided in the
community in order to maximize outcomes;
- demonstration of economic feasibility and sustainability;
- demonstration that duplication of services will not occur;
- evidence of strong community involvement in the design, planning,
operation and evaluation of all aspects of the program; and
- identification of capacity building requirements from a capital,
human resource and management infrastructure development perspective.
As a result of the regional process, recommendations will be made:
- for the approval of the plans by the appropriate regional authority;
or
- for revisions prior to reconsideration of the plans and approval
by the appropriate regional authority.
Organizations will be able to appeal recommendations to the appropriate
regional authority.
Program
Evaluation and Reporting Requirements
The Evaluation Framework and Reporting Requirements for the program
will be developed by the end of fiscal year 2000-2001.
Although the evaluation framework is not prepared, consideration
of how the community will review and evaluate its Home and Community
Care Program should begin during the planning phase in the form
of Community Evaluation Questionsto ensure community
and regional evaluation questions are developed as part of the
national framework. Communities will also need to identify data
sources to collect and carry out the evaluation that responds to
community questions, health outcomes, program value and effectiveness.
Communities will be required to develop information management
processes. Data collection will most probably be paper based initially
until development work occurs with a number of stakeholders and
can build on the developments which have occurred around the First
Nations Health Information System and the Regional Health Survey.
Program Accountability
The purpose of this section is to describe the accountability
requirements for the program.
Accountability of the First Nations/Inuit Structure
to its Members...
The structure is accountable to its members for the provision
and management of the First Nations and Inuit Home and Community
Care Program to achieve the objectives and outcomes established
and mandated by its members.
The structure will ensure that it communicates to its members
any changes which may arise as a result of or subsequent to their
delivery of the First Nations and Inuit Home and Community Care
Program.
The structure will ensure fair and equitable access to services
for its members provided in a respectful manner. This will be supported
by a formal process for assessing service delivery needs.
The structure will ensure that information concerning its members
and the services they individually receive will be kept confidential
in line with a code of ethics and privacy legislation related to
health information.
The structure shall make available to its members an annual report
on the management and delivery of the First Nations and Inuit Home
and Community Care Program.
2 For purposes of this document, First Nations/Inuit
Structures are defined as: First Nations Band, Tribal Councils,
First Nations/Inuit Health Authorities, First Nation/Inuit Service
Delivery Organizations, First Nation Provincial/Territorial Organizations,
Regional Inuit Associations.
The First Nation/Inuit Structure to the Minister of
Health...
The structure will engage an independent auditor to perform a
financial audit to examine the adequacy of financial controls and
certify that sound accounting principles and practices are followed.
The structure will ensure that essential program elements and
program standards are maintained.
The structure will uphold the First Nations and Inuit Home and
Community Care Program principles and objectives.
The structure will collect and maintain data in accordance with
the performance reporting requirements.
The structure will evaluate the First Nations and Inuit Home and
Community Care Program to ensure effective management and delivery
of the program.
The structure will provide the Minister with a copy of the annual
report and the statistical information referred to in the reporting
requirements.
The Minister of Health to the First Nation/Inuit Structure
and its Members...
The Minister will respect the need for program planning and development
to occur at a time and pace determined by First Nations and Inuit.
The Minister will ensure that the structure has an appropriate
mandate to deliver the First Nations and Inuit Home and Community
Care Program for its members.
The Minister will provide funding in accordance with the terms
and conditions of agreements.
The Minister will evaluate the First Nations and Inuit Home and
Community Care Program to ensure effective management and delivery
of the program.
The Minister will uphold the First Nations and Inuit Home and
Community Care Program principles and objectives.
The Minister will respect existing Treaty and Aboriginal rights
and fiduciary relationships and negotiated self-government agreements.
The Minister of Health to Parliament...
The Minister will remain accountable to Parliament for the overall
program.
The Minister will present an annual report on the program to Treasury
Board.
Appendices
Appendix A - History and Background
Vision
First Nations and Inuit have a long tradition of caring for the
health and well-being of their members within their families and
communities. In the Health Canada report "National Consultation
on Continuing Care Needs in First Nations Communities (1994:76)",
prepared as part of the National Strategy for the Integration of
Persons with Disabilities, the following summary on directions
for continuing care programs in First Nations communities was provided:
First Nations and Inuit societies have different
traditions and approaches to health and healing that must be respected.
Aboriginal healing is a way of life rather than a segregated or
specialized activity. These traditions, which emphasize the multi-dimensional
nature of people as physical, mental, emotional and spiritual beings,
must be recognized in addressing the continuing care needs of First
Nations peoples. As Inuit and First Nations move toward self-government
and jurisdiction over the development and delivery of health programs
and services...the further development of health services, such
as continuing care, which are managed and provided by First Nations
and Inuit, is critical.
One statement of a First Nations vision for home care was put
forward by Elders and persons living with disabilities and chronic
illnesses in the Federation of Saskatchewan Indian Nations report "Home
Care On Reserve: A Framework" (1990:7).
"The vision of the Elders, handicapped and
chronically and acutely ill is to continue to live productive,
useful lives in their homes, close to their families, in their
communities...and (to) help maintain their culture, language and
traditions...Their vision for home care on-reserve is a guarantee
that (First) Nations will have the authority and finances to help
them live and contribute always to their communities."
Background
The lack of home and community care in First Nations and Inuit
communities has been recognized as an issue for over 15 years with
a growing need for services being identified. The indicators of
this need include:
- the burden of ill health in Aboriginal communities with disability
rates twice the national average, 50% of respondents over 65
years of age in the First Nations and Inuit Regional Health Survey
had arthritis/rheumatism and high blood pressure and approximately
30% were affected by diabetes, heart and lung conditions; injury
rates three times the national rate, and 37% of those over 75
years need assistance with personal care and hygiene;
- demographic trends indicate that adult First Nations population
will approximately double in the next 2 decades; and
- provincial health reform with the resulting changes in health
care organization, closure of hospitals, introduction of early
discharge programs, technological developments supporting home
based therapies, and enhancement of community based programs.
These health status, demographic and health reform changes have
meant that on-reserve a higher proportion of people at all ages
are in need of home care, the cohort requiring home care services
is increasing, and First Nations do not have the same access as
other Canadians to re-investments in more complex and comprehensive
home care services. Current programs and resources available to
First Nations and Inuit cannot absorb the increased demands for
home care services.
In response to this need, a joint Health Canada/DIAND/First Nations/Inuit
Working Group was formed to develop a framework for a comprehensive
home care program. This work has initially guided the development
of the new Home and Community Care Program.
Throughout the summer of 1999, regional information sharing and
feedback sessions were held with First Nations and Inuit in all
provinces and territories. These sessions have further refined
the program design, delivery, funding and accountability principles,
and roles and responsibilities for the program.
Home and Community Care B Building a Common Understanding
A Home and Community Care Program is "a coordinated system
of home and community health services which enables people to live
in their home environment and to achieve their optimal functional
ability and includes both health and social based services that
are holistic in nature" (National Framework on Continuing
Care Phase 1 B First Nations and Inuit Home Care).
The philosophy of care is to help people maintain their independence
in the home. The home and community care vision recognizes that
each person is different and unique and approaches their care in
a holistic manner that looks at the person=s physical, social,
spiritual and emotional needs. Home and community care is designed
to support and enhance the care provided by family and community,
but not to replace it. A foundational belief is that "Home
Care must only do things for people that they cannot do for themselves
in order to preserve their self-worth. When people feel good about
themselves, they are more likely to be strong resources in their
families and communities." (Paraphrase: Saskatchewan First
Nations Home Care Program Guidelines, 1995).
Home and community care is more than housekeeping and homemaking
services provided through the Department of Indian Affairs and
Northern Development=s (DIAND) Adult Care Program (In-Home Component).
Homemaking is just one of several services of a home care program
linked through a coordinated assessment and managed care process.
Other services of a home and community care program can include
personal care, home nursing, and in-home respite care.
How Can the Home and Community Care Program Help First Nations
and Inuit?
The First Nations and Inuit Home and Community Care Program aims
to address the negative health effects experienced by First Nations
and Inuit due to high rates of chronic and acute illnesses, disabilities
and the changing health delivery mechanisms associated with provincial/territorial
health reform. The First Nations and Inuit Home and Community Care
Program can:
- assist First Nations and Inuit living with chronic and acute
illness and disabilities in maintaining optimum health, well-being
and independence while remaining in their homes and communities;
- ensure that all clients with an assessed need for home and
community care services have access to a comprehensive continuum
of services within the community, where possible;
- build the capacity within First Nations and Inuit to develop
and deliver comprehensive, culturally sensitive, accessible and
effective home and community care services; and
- home and community care will continuously seek new and innovative
ways and means of responding to the identified needs in each
First Nations and Inuit community.
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