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

National Overview

Program Status

Based on program tracking data, following is a synopsis of the program status as of March 31, 2003. Figures are based on Program implementation and monitoring tracking data and supplementary figures provided by regional staff.

• 686 communities have been funded, up from 667 in 2001/02
• 95% of the communities have completed the home care needs assessments, up from 87% in the previous year
• Over 91% have submitted home care service delivery plans, up from 80% in 2001/02
• Almost 3 in 4 communities (72%) had access to service delivery at the end of 2002/03, up from 51% at the end of 2001/02. These communities represent more than 82% of the First Nations and Inuit population.

First Nations and Inuit Home and Community Care (FNIHCC) Program: Canada-wide Figures

Population: 441,736
Average Population per Community: 634
Number of Communities Eligible for Funding: 698
Number of Communities Funded: 686
% of Needs Assessments Completed: 95%
% of Communities with Submitted Plans: 91%
% of Communities in Planning Implementation: 88%
% of Communities with Access to Service Delivery: 72%
2002/03

National Workplan: 2002/03

For 2002/03, the National Team developed the National Workplan around three key goals:

1. to work collaboratively at the national/regional/territorial levels to identify and address developmental and implementation issues;

2. to enhance existing linkages and establishing additional linkages that are supportive to the delivery of home and community care services within a primary health care framework; and

3. to achieve accountability requirements and generate knowledge for future program planning and/or policy development inclusive of evaluation related activities.

Key Issues

Following are highlights relating to some of the key issues addressed by the National Team in 2002/03.

Continuing Care and Adult Care

Linkages between the First Nations and Inuit Home and Community Care (FNIHCC), Assembly of First Nations (AFN), Inuit Tapiriit Kanatami (ITK), and Indian and Northern Affairs Canada (INAC) continued during 2002/03 on continuing care issues, including joint strategic planning. First Nations and Inuit Home and Community Care (FNIHCC) Program representatives attended monthly liaison meetings with INAC social policy officials in continuing care.

Other examples of collaboration at the national level included:

• INAC formulated a joint working group to provide input into their adult care policy framework;

• integration between Home and Community Care (HCC) and INAC adult care program was explored;

• a joint meeting with INAC, HCC and some community health programs was conducted in February 2003 to help promote integration of HCC and INAC adult care;

• a joint paper was initiated with emphasis on facility care and the gap in policy on the responsibility of providing institutional care. Neither Health Canada nor INAC has a mandate for institutional care;

• a background paper was created and a focus group was held with Health Canada, INAC, and a number of Aboriginal health programs to determine best practices and examples of successful integration at the community level;

• an option paper was researched and prepared, addressing Long Term Care on residency-issues, with particular emphasis on facility care in the context of Continuing Care; and

• program representatives participated in INAC meetings to discuss development of an evaluation of the adult care policy.

Medical Supplies and Equipment Access

Considerable work was accomplished through collaboration with the Non-Insured Health Benefits (NIHB) office of Health Canada's First Nations and Inuit Health Branch (FNIHB). Efforts focused on exploring changes to policy that would improve access to certain NIHB medical supplies and equipment by allowing nursing authorization to those supplies and equipment. The goal was to make the process more efficient and provide more timely access to supplies and equipment, as an essential element of the FNIHCC Program is access to medical supplies and equipment. Planning focused on gearing up for pilot projects in one Nova Scotia and three Alberta First Nation communities to commence early in the 2003/04 fiscal year.

The collaboration through the pilot projects is intended to:

• test a new approach for the access to NIHB medical supplies and equipment for FNIHCC clients;

• identify a potential national process for ordering approved NIHB medical supplies and equipment through authorized Home and Community Nurse providers;

• test the use of wound management protocols in the selection of NIHB medical supplies and equipment benefits; and

• assess cost-effectiveness and appropriateness of supplies toward the health outcomes for the participating clients.

Palliative Care

Meetings were held with Health Canada's Palliative Care Secretariat to participate in the development of a national strategy and establish a model for funding allocation.

A contract for a Palliative Care Costing Model was awarded and Phase 1 on Home and Community Care was initiated. The first phase focused on HCC programs while Phase 2 focuses on community-based and institutional care. Health Canada collaborated with INAC and conducted surveys and focus groups, producing a paper on the issue.

Work also included engaging representation from First Nations communities, tribal councils and Inuit communities on task specific working groups in the area of Palliative Care, Human Resources development, and identification of small community issues. Five different working groups addressed areas and all had Aboriginal participation. In June 2002 Senator Carstairs, Minister with Special Responsibilities for Palliative Care, presented a strategy to Cabinet.

Nursing

The FNIHCC National Team collaborated with the FNIHB Nursing Working Group to publish a nursing handbook for First Nations and Inuit communities. The handbook was designed to be a resource for nurses and health directors alike. A draft manual was completed by the end of 2002/03 for final editing and publishing in 2003/04.

The Nursing Working Group also tackled issues surrounding HCC nursing, with the group having representation from the FNIHB Office of Nursing, HCC regional coordinators, First Nations and Inuit nursing partners, and national team staff.

The HCC planning resource kit had specific requirements for issues such as nursing supervision and the group revised appropriate sections and provided updates to communities.

A separate working group was exploring issues related to nursing recruitment and retention and the Nursing Working Group addressed relevant issues with this other group. As well, another group was working on ongoing second and third level support issues.

Representatives from the national team also participated as observers in national strategic work in FNIHB's Office of Nursing Leadership Committee.

Disabilities

The HCC national team coordinated FNIHB input into a Federal Disability Report, which was released in December 2002. The HCC team had initiated work on an environmental scan in fall 2002, including strategic initiatives and options in the area of disabilities. Human Resources Development Canada (HRDC) represents the federal lead on the issue of disabilities. Health Canada collaborated with HRDC in producing a terms of reference and HRDC produced the federal disability report.

Health System Renewal

Renewal activities included a joint committee with representatives from AFN, ITK, and FNIHB. The committee looked at the key issues with First Nations and Inuit health, the direction it is taking, and strategy development.

Risk Management

The issue of risk management has been a long-standing, complex issue within the FNIHCC Program. Discussions were held with the HCC regional coordinators to explore ways of addressing this issue, more specifically clinical practice in the home and quality care and risk management. Work was initiated on developing best practices on quality care and self-assessment in January 2003. The working group is also exploring legal opinions on the federal role in quality care.

Human Resources

Human Resources Development Canada (HRDC) was planning a research study on Health Human Resources in the Home Care Sector. There was preliminary consultation with FNIHB, AFN and ITK and on how to proceed with the study. However, funding for the First Nations and Inuit component of the study did not materialize and that portion of the study was discontinued.

As a result, the National Steering Committee directed that the Program HR/Training Working Group should address the home care human resource issues as part of the scope of activities undertaken. A request for proposals to carry out a small project to further clarify human resources and training issues for the FNIHCC was prepared. Only two proposals were obtained which were subsequently deemed unsuitable to research fully both First Nations and Inuit needs. The HRDC Labour Sector Study was completed and included several recommendations addressing the home care industry's labour sector needs.