First Nations and Inuit Home and Community Care Program - Annual
Report 2002-2003
Challenges
As the focus in most Regions for 2002/03 continued the shift
from planning and implementation to service delivery, approximately
three in four communities across the country were providing home
and community care services by the end of the year. While those
involved in the Program from the community/Tribal Council, region,
and national level were able to overcome a wide range of issues
during the year, following are some common challenges experienced.
Reporting Requirements
As more communities moved into service delivery, the national
team released the Service Delivery Reporting Template (SDRT). The
SDRT was designed to assist communities in meeting the reporting
requirements in an efficient, comprehensive manner. Unfortunately,
it required significant training of regional and community staff
and, ultimately, there were issues of system compatibility and
the tool was perceived as onerous by many in the Program. In some
regions, communities did the reporting requirements manually and
then the region had the task of transposing the information online.
In a few regions, locally developed templates were used to collect
data. While opinions appear mixed as to whether requirements themselves
are becoming easier or more complex, the challenges of the SDRT
have probably created a perception among some that they are more
onerous. It also requires significant training and ongoing support.
A few concerns have also been expressed that the SDRT does not
capture all information required (e.g. trending data). There is
significant interest in integrating Indian and Northern Affairs
Canada (INAC) and First Nations and Inuit Health Branch (FNIHB)
reporting requirements.
Nursing Consultation
In several regions, the provision of nursing consultation was
a significant issue during the year. For example, in Brithish-Columbia
(BC), the Home and Community Care nursing team was required to
provide some home care nursing supervision and program review as
some communities did not have an option to obtain this elsewhere.
Another province cites issues relating to quality assurance, home
care records, and associated supervision. Saskatchewan Region addressed
the issue of nursing consultation for smaller communities by developing
a system whereby smaller communities could use part of their respective
funding to purchase this service as required.
While regions worked with workers to address the provision of
nursing consultation, committees on both a regional and national
level are looking at the issue.
Funding
As with most programs of this nature, there were a number of
challenges reported surrounding funding. The rollout of the funding
based on stages continued to receive mixed reviews with some program
workers feeling that the "community-based, community-paced" philosophy
contradicted the actual funding that was based on the stage the
community was in.
Small, remote communities often are even more challenged as costs
are higher, human resources more scarce, yet essentially the same
type of work and levels of service are required.
Second and third level funding is reportedly an ongoing challenge
within the regions. While some regions choose to augment the third
level funding provided by the national office or to provide some
funding for second level services via other budgets, there is a
flat amount for third level funding for the program and no funding
earmarked directly for second level support.
Different provinces have different levels of partnership, support
and service for First Nations for home care, differences which
are not taken into consideration with funding.
Recruitment and Retention
Nursing recruitment and retention issues varied in scope and
magnitude both between regions and within regions. While recruitment
is an ongoing issue even outside of First Nations and Inuit communities,
some areas successfully attracted the requisite staff for the Program
at the community level.
Retention became an increasing issue in some areas. Wage differentials
between First Nations/Inuit communities and non-First Nations/Inuit
communities were blamed as part of the reason. A lack of ongoing
training support for workers was also cited as a reason workers
were leaving.
At the regional and national level, turnover was also a challenge
as changes affected momentum, communication, and continuity as
new staff was recruited, hired, and trained.
Training and Capital Budgets
Without a specific budget for training and capital projects in
2002/03, regions and communities faced the challenge of providing
ongoing training for current workers and for training new workers,
specifically as home health care aides. Similarly, replacement
of capital or provision of new capital projects proved challenging.
Some regions were able to earmark budget variance to some training
and/or capital projects but many regions, particularly those with
most or all communities in service delivery, were not able to access
alternate funding.
Communications & Support
Communications continued to present a challenge to all those
involved at a local, regional, and national level. In addition
to ad hoc written, verbal, and in-person communications, a number
of other ongoing vehicles were devised to enhance the flow of information.
Regular meetings were held in some regions among community and
regional workers, either in person or via telephone. Regional staff
and First Nations and Inuit partners held regular conference calls
and typically semi-annual meetings to learn, brainstorm challenges
and opportunities, and provide support and guidance to one another.
Despite ongoing efforts with communications, most involved felt
that even more communications and information could only improve
knowledge, support and services.
As many regions felt challenged and stretched in providing support
to communities with relatively limited resources, despite many
successes, the national team also experienced ongoing challenges
in supporting regions and communities given the scope and nature
of the Program. Many communities, in turn, were challenged to deliver
a relatively complex program, particularly smaller and/or isolated
communities. While support included working at the three levels,
there is also a keen desire for support from other programs and
offices (e.g. Office of Nursing, Non-Insured Health Benefits (NIHB),
Indian and Northern Affairs Canada (INAC), etc.)
Despite the challenges faced in communications and support with
this program, the achievements and successes at all levels across
the country cannot be underestimated, as Program workers moved
communities through planning, developing, launching and sustaining
Home and Community Care (HCC) Programs.
Linkages and Partnerships
While the level of linkage and partnerships between the Program
and other government programs and non-government organizations
varied significantly at the community, regional, and national level,
some great successes were realized during the year as these collaborations
developed or intensified.
Despite many successes, integration and linkages with other organizations
and federal programs is challenging. Depending on the organization
and issue, discussions and networking can be limited on a national,
regional, and/or local level.
Non-Insured Health Benefits Issues
An exciting First Nations and Inuit Home and Community Care -
Non-Insured Health Benefits (FNIHCC-NIHB) pilot project was developed
for early 2003/04 in three communities in Alberta and one in Nova
Scotia. The project aims to improve timely and efficient access
to certain medical supplies and equipment at the community level.
However, the issue of consent and coverage for Non-Insured Health
Benefits (NIHB) is viewed by some as a significant program issue
and challenge for the future.
Partnerships: First Nations and Inuit Partners and Health Canada
The FNIHCC Program is premised on a partnership between the Federal
Government (Health Canada) and First Nations and Inuit partners.
First Nations and Inuit representatives were instrumental in providing
input into the Treasury Board Submission for the Program. A National
Steering Committee with equal representation from both government
and First Nations and Inuit remained instrumental during the 2002/03
fiscal year. Within the regions, partnership and collaborative
activities were also conducted. In each region and nationally,
these partnerships operate differently, based, in part, on the
organizations and individuals involved, their designated roles,
and the history of past partnerships.
First Nations and Inuit Partners and government employees alike
recognized the importance of collaboration to deliver the outcomes
expected for the program. There is not always agreement on the
way to achieve these objectives. It has been emphasized that it
is important that First Nations and Inuit partners be involved
from planning through to implementation, service delivery and evaluation.
Challenges also go directly to the community level where it is
sometimes difficult reconciling the roles and perspectives of the
different bodies and individuals involved (i.e. disagreements between
Government and First Nations and Inuit Partner representatives).
When disputes do occur, it is difficult for either party to resolve
formally issues with no formal dispute resolution system in place.
Despite these challenges, there were countless reports from a
local, regional and national perspective where the partnerships
between government, health care, and First Nations and Inuit partners
worked well not only amongst themselves but also with other partners
from other organizations and interest groups.
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