First Nations and Inuit Home and Community Care Program - Annual Report 2002-2003

The Regions

Atlantic

Fast Facts

Population: 24,707
Average Population per Community: 618
Number of Communities Eligible for Funding: 40
Number of Communities Funded: 40
% of Needs Assessments Completed: 100%
% of Communities with Submitted Plans: 100%
% of Communities in Planning Implementation: 100%
% of Communities with Access to Service Delivery: 80%
% of Population with Access to Service Delivery: 79%
2002/03

The Region

Spread across four provinces, communities in the Atlantic Region include First Nations, Inuit, and Innu populations. Communities tend to be relatively small, with approximately half with populations under 500.

In addition to a program manager (regional coordinator) staffed through the First Nations and Inuit Health Branch (FNIHB) Regional Office, there was also an administrative support position at FNIHB. Two area coordinators, employed by First Nations organizations, remained integral to the program in the region.

One area coordinator position is based in Nova Scotia and coordinates the program for the 21 communities in Nova Scotia and Newfoundland and Labrador. The total population served is approximately 15,000. The other position is based in New Brunswick and services the 17 communities in that province ands the two communities on Prince Edward Island, a combined population of approximately 10,000.

Overview: 2002/03

2002/03 was a highly successful year in the Atlantic Region, with approximately 80% of communities in service delivery by year-end. A corresponding increase in calls for referrals and increased awareness of the Program ensued. Despite the 40 communities spread across four provinces, the smaller number of communities enabled regional workers to conduct visits in person, develop working groups, and help in building capacity. As the Program matured, so did the confidence of workers in communities who began to feel less isolated and had a greater understanding of the Program.

Prior to the First Nations and Inuit Home and Community Care Program (FNIHCC) Program, there were very few home care services for people in the region. Since service delivery began, clients were receiving services based on assessment instead of having to be treated in a hospital. In fact, in some cases expectations were higher than the Program delivery capabilities in terms of type and scope of services.

Most communities now had the staff, including nurses and home support workers. They also had clients now assessed through established guidelines.

Pilot Projects

Several pilot projects were conducted in the region during 2002/03 including the following:

Palm Pilot "Pilot"

The national team contracted a company to test palm pilot usage at the community level in home care. Home care workers in one New Brunswick community and Registered Nurses and Licensed Practical Nurses in Home and Community Care (HCC) in one Nova Scotia community participated. The pilot was completed in June 2002.

Hospital Discharge Pilot

Five Mi'kmaq bands on Cape Breton participated in this evidence-based evaluated pilot. The province of Nova Scotia was reluctant to participate initially and provide assistance from hospital staff, in part, due to the perceived increase in workload. Prior to the pilot there were gaps in service between discharge and people returning to the communities partially due to communication. The community coordinators in Cape Breton approached the province to see if home care staff would do an assessment on the First Nations clients and the coordinators developed a tool to collect information. Although there were a few issues, the province was very supportive and all involved are looking at rolling it out province wide in 2003/04.

The pilot also demonstrated the value of having the framework for the program in place, as it showed the provincial representatives the deliverables and outcomes desired of the program and the need for partnerships.

Working Groups

Working groups met each month, either in-person or via teleconference, and a primary benefit was sharing information among communities, offering support, and minimizing feelings of isolation. Guest speakers and specialized training was also provided to the community coordinators, most of whom had a nursing background. Most of the other community coordinators were health directors.

A Regional FNIHCC Steering Committee had representation from the following:

• each of the four political First Nations and Inuit organizations
• an Innu representative
• FNIHB representation
• a representative from the original FNIHCC pilot project conducted in a Nova Scotia community

Training

As in all regions, the funding formula changed in 2002/03 with all money earmarked to communities and no funding specifically earmarked for capital or training. This created a challenge to address these needs, particularly among smaller communities. All training in the region in 2002/03 was at the community level.

Home Support Worker Training

• Home Support Worker training was provided throughout the region, as funding would allow. In the fall of 2002 in the community of Escasoni, Nova Scotia, a community college trained 10 First Nations persons. Training was conducted within the community and was designed to be both convenient and culturally appropriate. Based on the success, plans are for the project to be replicated in 2003/04. In contrast, Davis Inlet in Labrador could not secure having someone come to the community so investigations began into distance learning options. In Prince Edward Island, workers took training of home support workers online, as these small communities could not afford the cost of sending workers to training off the island. Some small communities may not have any trained workers while larger communities could have ten personal support workers. These smaller communities would sometimes contract out the services of trained workers from other communities as needed.

Community Coordinator Training

• A successful training program was conducted for community trainers including a "train the trainer" approach on various aspects of home and community care.

Advanced Wound Care Training

• Advanced Wound Care Training for Registered Nurses (RNs) and Licensed Practical Nurses (LPNs) was provided in July 2002 through a partnership with Convatec, a Montreal based pharmaceutical corporation. The company contracted individuals to come to the region and teach advanced wound care so workers could be up on the latest techniques and best practices. Plans are for the training to be replicated in 2003/04. Convatec paid for consultants, meeting room and lunch/breaks. Communities paid for their workers' travel and accommodations. Over 75% of communities had at least one community person attend.

Case Management Training

• Case Management Training was offered through utilization of part of the regional budget variance. One person from each community was sent to the week-long case management course at McMaster University in Hamilton, Ontario.

Computer Training

• Basic training for computers was provided for community coordinators so they could learn to complete the Service Delivery Reporting Template. One central session was conducted with all coordinators through Health Canada's eHealth team.

Retention Issues

• Across the regions, a common issue was that people were being trained yet often they ultimately left for non-First Nations communities for a variety of reasons. The result was that the turnover of staff in all facets of the program, including RNs and personal support workers, was becoming an issue.

Partnerships and Linkages

Provincial

A significant accomplishment was the willingness of the Nova Scotia provincial home care program to partner with First Nations to help with assessments at hospitals. Through a tripartite organization that included First Nations, the province, and the federal government, the province began investigating ways of helping to build First Nation capacity.

International Social Worker Conference

Although this conference was held in Halifax in May 2003, a significant amount of planning occurred in the final quarter of 2002/03. In addition to the area coordinator for Nova Scotia and Newfoundland and Labrador, two other presenters included a community coordinator and the Provincial Director of Home Care in Cape Breton. Presentations focused on partnerships, successes and challenges. The conference was indicative of the program becoming better known and recognized outside of First Nations communities and organizations.

ADI (Aboriginal Diabetes Initiative)

Linkages with ADI were conducted on both a regional and local level wherever feasible. This included collaborating at workshops, providing referrals, and developing programs benefiting both programs such as walking clubs. Presentations were also made at conferences and through training initiatives.

eHealth

Representatives from eHealth provided assistance in areas of training such as the Service Delivery Reporting Template training and support.

Indian and Northern Affairs Canada (INAC)

In several communities, Home and Community Care (HCC) and Indian and Northern Affairs Canada (INAC) Adult Care funding were combined to avoid duplication of services and maximize efficiencies.

Resources Developed and Distributed

Evaluation Guide

The Evaluation Guide developed by the National Evaluation Team was distributed in February 2002. The guide offers evaluation options for communities that may or may not have experience in evaluation. A New Brunswick community began developing a standard evaluation form using the booklet.

Newsletters

Area coordinators developed a newsletter for community staff, which was distributed semi-annually.

Fact Sheets

Several fact sheets were developed and distributed as part of the policy and procedures manuals and shared with communities. These sheets were used for a variety of program purposes such as conducting assessments, dealing with personnel, etc.

Textbooks

Textbooks were sourced and distributed to nurses.