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

About the First Nations and Inuit Home and Community Care (FNIHCC) Program

Program Background

The First Nations and Inuit Home and Community Care (FNIHCC) Program provides basic Home and Community Care services designed to be comprehensive, culturally sensitive, accessible, effective and equitable to that of other Canadians and which respond to the unique health and social needs of First Nations and Inuit communities. The Program is a coordinated system of home and community based health-related services that enable people with disabilities, persistent or acute illnesses and the elderly to receive the care they need in their home communities.

In 1998, a Continuing Care Working Group was formed and included representation from Assembly of First Nations (AFN), Inuit Tapiriit Kanatami (ITK), Health Canada's First Nations and Inuit Health Branch (FNIHB), and the Department of Indian Affairs and Northern Development (DIAND). This group laid the foundation for the FNIHCC Program and the first phase the working group addressed was home care. The FNIHCC Program was announced in the federal budget of February 1999.

The planning and implementation of this initiative is carried out in partnership between the Federal Government (via FNIHB), AFN and ITK. The FNIHCC Program is intended to be built upon and/or enhance other existing federal programs such as Adult Care (In-home component) funded by Indian and Northern Affairs Canada (formerly DIAND) and the Home Nursing component of the Building Healthy Communities initiative.

Funding

A total of $152M was made available for the first three years of the program with an ongoing funding level of $90M per annum at the end of the three-year developmental period.

Funding for Years 2 and 3 included significant resources to begin to address capital and training requirements for the program. Year 4 did not include resources dedicated to training and capital although the funding for the program remained at $90 million for the year.

Program Objectives

The primary objectives of the FNIHCC Program are:

• to build the capacity within First Nations and Inuit to develop and deliver comprehensive, culturally sensitive, accessible and effective home care services;

• to assist First Nations and Inuit living with persistent 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 array 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 community support services where available and appropriate in the care of clients; and

• to build the capacity within First Nations and Inuit to deliver home care services through training and evolving technology and information systems to monitor care and services and to develop measurable objectives and indicators.

Eligibility

The eligible recipients for this program are:

• First Nations and Inuit of any age;
• who live on an Inuit settlement, First Nations reserve or First Nation community North of 60;
• 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 that can be provided with reasonable safety to the client and caregiver, within established standards, policies and regulation for service practice.

Program Elements

Essential Service Elements

Essential service elements provide the foundation upon which future program enhancements can build. They include:

• a structured client assessment process that includes on-going reassessments and determines client needs and service allocation. Assessment is a structured dynamic process of continuous information gathering and knowledgeable judgements that attach meaning to the information being gathered. Assessment and reassessment processes can involve the client, family and other care givers and /or service providers;

• 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 include direct service delivery as well as supervision and teaching of personnel providing personal care services;

• the delivery of home support personal care 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 services (e.g. bathing, grooming, dressing, transferring, care of bed-bound clients including turning, back rubs and routine skin care, etc.);

• 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 hospital service providers, physicians, nurse practitioners, advanced practice nurses, respite and therapeutic services;

• provision of and access to specialized medical equipment, supplies and specialized pharmaceuticals to provide home and community care;

• the capacity to manage the delivery of the home and community care program that is delivered in a safe and effective manner, if existing community infrastructure exists; and

• a system of record keeping and data collection to carry out program monitoring, ongoing planning, reporting and evaluation activities.

Supportive Service Elements

The essential service elements of the Home and Community Care Program are expected to be developed initially in each First Nation or Inuit community. The Program may expand to include supportive service elements based on community needs and priorities, existing infrastructure and availability of resources.

Supportive elements that may be provided within a continuum of home and community care might include, but are not limited, to:

• facilitation and linkages for rehabilitation and therapy services;
• respite care;
• adult day care;
• meal programs;
• mental health home-based services for long-term psychiatric clients and clients experiencing mental or emotional illness. These services might include traditional counselling and healing services, and 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.

The FNIHCC Program:

• will not fund the construction and/or delivery of long term care institutional services nor duplicate funding for existing on-reserve adult care services.