First Nations and Inuit Home and Community Care Program - Biannual Report 2000-2002

Regional Overview

Atlantic

Atlantic Region Profile

While the Atlantic Region is comparatively smaller than most Regions in terms of total First Nations and Inuit population, the Region covers four provinces with many of the communities small and isolated. Half of the communities in the Region have populations under 500. Among the remainder, eight have more than 1,000 people and twelve with populations between 500 and 1000.

About The Labrador Inuit and Innu Communities

The Inuit are the descendants of the Thule people who migrated to Labrador from the Canadian arctic 700 to 800 years ago. The primary Inuit settlements are Nain, Hopedale, Postville, Makkovik and Rigolet on the north coast of Labrador, but Inuit people are also found in a number of other Labrador communities. They are represented by the Labrador Inuit Association.

The Innu, formerly known as the Naskapi-Montagnais, are descended from Algonkian-speaking hunter-gatherers who were one of two Aboriginal peoples inhabiting Labrador at the time of European arrival. The major Innu communities in Labrador are Sheshatshiu and Utshimassit (Davis Inlet), with respective populations of approximately 1,000 and 500. The word “Innu” means “human being” and the Innu language is called “Innuaimun.” Today there are over 16,000 Innu who live in eleven communities in Québec and two in Labrador.

 Source: http://www.heritage.nf.ca/aboriginal/

Structure

A steering committee for the program was struck early in the process with representatives from First Nations organizations. Community information sessions were held throughout the Region to create awareness of the program. The Mi'kmaq Maliseet Health Board, for example, played an integral role in planning and communications.

Two coordinators were hired and employed by a First Nations organization. One coordinator covered New Brunswick and Prince Edward Island and the other for Nova Scotia and part of Newfoundland and Labrador. Regional coordination initially was the responsibility of the Regional Chief Nursing Officer until the First Nations and Inuit Home and Community Care (FNIHCC) regional coordinator was hired at Health Canada's First Nations and Inuit Health Branch (FNIHB) in late 2001.

Program Overview: 2000/01 and 2001/02

As money flowed to communities, they conducted needs assessments that included training, capital needs, and community home care needs. Following needs assessments, each community moved on to develop policies, programs, and procedures. While larger communities had the capacity to carry out this part of the program, smaller communities typically had significantly less capacity. In retrospect, a Regional policy and procedure that could be modified and adapted by the communities could have helped communities and improved the process. Despite challenges, by the end of 2001/02 80% of communities had completed the planning implementation stage and almost half were in service delivery.

Except for the Regional coordination funding, most program funding for the Region went directly to the communities, the main exception being the Inuit and Innu communities. For these seven communities, the funding flowed through the Labrador Inuit Health Commission.

As communities moved through the process, program workers increased their knowledge and began establishing policies and procedures and then moving into service delivery to enable people to begin to access services. Larger communities tended to move through to this phase faster than smaller communities did. One New Brunswick community, Eell River Bar First Nation, was part of an original home and community pilot project. Information from their experience and relevant information was provided to other communities as a sample.

By the end of 2001/02, communities were able to keep people at home, do dressing changes, and provide services to residents requiring home care.

Training

While home care worker training standards vary between Regions, in the Atlantic Region they varied considerably within the Region. In other words, some jurisdictions require a higher standard of training than other jurisdictions. Additional training challenges included the lack of financial incentive to attend training because other financial assistance was correspondingly eliminated. While some trained workers stayed within their community, some went to work in other non-First Nation communities.

According to program tracking data, the number of personal care workers in communities was 63 prior to the FNIHCC Program. According to training plans, the number of positions would increase to 116 through funding. For home care Licensed Practical Nurses (LPNs), these figures would increase from zero to 14 while the number of home care Registered Nurses (RNs) would increase from 2 to 29.

The Canadian Red Cross and St. John's ambulance provided training directly to many of the larger communities in the Region and, where possible, workers from smaller communities came to participate as well.

Partnerships

Following are examples of partnerships fostered during the first two years of the program.

Provincial

• The provinces and individual hospitals saw the opportunity to send people home earlier through the work of the FNIHCC Program. Communications improved with these facilities as work continued on enhancing this. In New Brunswick, some basic home care services were already being provided when patients were discharged, enabling communities to focus on augmenting services already provided by the province.

• Regional Health Authorities provided physiotherapy and foot care services in some locations. They contracted with local Victoria Order of Nurses (VON) to provide services as needed, such as when there is not a full time nurse in a small community.

Education and Training

• Partnerships were developed with regional colleges and agencies that provide home support services training to make training more culturally applicable.

Program Linkages

Across the country, Regions linked with other federal agencies and programs, where possible. In Atlantic Region, this included:

Indian and Northern Affairs Canada (INAC)

• Communities linked with the adult care program funded through Indian and Northern Affairs Canada (INAC) to prevent duplication of services. A few communities have brought the programs in together.

Human Resources Development Canada (HRDC)

• Training dollars were accessed by communities as applicable.

Within Health Canada

• Communications and human resources linkages were made with Community Health and with the Aboriginal Diabetes Initiative
  (ADI). The Non-Insured Health Benefits (NIHB) program also played a key role in the identification and supply of medical supplies and equipment.

Resources Developed/Distributed

The Atlantic Region distributed to all communities the planning resource kit developed by the National office. In addition, samples of home care policies, a template manual by St. Elizabeth and a video were distributed. A Regional newsletter was produced semi-annually and distributed to communities.