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

Regional Overview

Manitoba

Manitoba Region Profile

Population: 67,556
Average Population per Community: 1,090
Number of Communities Eligible for Funding: 62
Number of Communities Funded: 61
% of Needs Assessments Completed: 100 %
% of Communities with Submitted Plans: 97 %
% of Communities in Planning Implementation: 82 %
% of Communities with Access to Service Delivery: 55 %
2001/02

Manitoba is home to the second largest First Nation on-reserve population in Canada, with only the province of Ontario having a greater on-reserve population. By the end of 2001/02, all of the community needs assessments had been completed and most communities had submitted service delivery plans for the peer review process. Just over one-half of these communities were in full service delivery, representing approximately two-thirds of the on-reserve population in the province.

In terms of size, six communities have a population less than 500, 21 communities with a population between 500 and 1000, and 25 communities with a population greater than 1000. In terms of types of communities Manitoba Region has 1 Type 1, 23 Type 2, 10 Type 3, and 24 Type 4 communities.

Structure

In February 2000, a Nurse in Charge from Community Health was hired as assistant regional coordinator for the First Nations and Inuit Home and Community Care (FNIHCC) Program. In addition to this position and the existing FNIHCC regional coordinator, a full-time administrative support position was also hired in June 2000.

There were seven full time nurse coordinator positions funded at the Tribal Council levels (Tribal Council home and community coordinators). For example, the Keewatin Tribal Council nurse coordinator worked with the 11 affiliated communities. The Four Arrows regional Health Authority has 4 communities serviced by the coordinator. Of the 62 First Nations communities in the province, 51 communities are affiliated with one of the seven Tribal Councils, with the remaining 11 communities independent. Regional staff serviced the independent communities.

Program Overview: 2000/01 and 2001/02

As mandated by the Chiefs' Health Committee with the Assembly of Manitoba Chiefs, a Planning and Implementation Committee for the program was established with quarterly meetings held.

Representation included Tribal Councils, independent communities and Regional coordinators within the province.

There was a significant amount of planning in 1999/00, with needs assessments a key focus of 2000/01. Training for the peer review process and the establishment of a peer review committee was also carried out in 2000/01. The peer review process included representation from Tribal Councils, Independent First Nations, First Nations members, and Health Canada's First Nations and Inuit Health Branch (FNIHB). A booklet was developed that included information on roles, terms of references, goals and objectives, assessment criteria, checklist, and appeal process.

Three workshops were held on service delivery planning, one each in the south, west, and north. Numerous health forums were attended and presentations were made across the province to communities about the Home and Community Care program. A key component of the service delivery plans was to incorporate the Indian and Northern Affairs Canada (INAC) adult care programming already in place. Communities were required to demonstrate how the Home and Community Care (HCC) program would adapt to their communities INAC services.

In 2001/02, additional workshops were held across the Region. For example, a workshop on standards and policies was conducted by St. Elizabeth - one each in the north, south and west regions of the province. Program staff also attended and conducted a variety of presentations and workshops both within and outside the Region.

Having the seven Regional coordinators, as well as the FNIHB Regional coordinating team, developed a significant amount of capacity to assist communities in all aspects of the program including training and capital planning and implementation, nursing services, and recruitment and retention of services.

Training

Based on community needs assessments, the focus of training for 2000/01 was to train health care aides. Over 300 health care aides were trained and capacity correspondingly increased. Training efforts were enhanced through the access of other funders such as Human Resources Development ( HRDC), although the training exceeded the preliminary budget estimate. Much of the training took place within the communities with some trainees having to fly into Regional centres to attend. According to program tracking data, the number of personal care workers (health care aides) was 73 prior to the program. Training plans indicate that this figure would increase to 398 through program funding.

In addition to health care aides, Licensed Practical Nurse (LPN) training programs were developed in the different Regions of the province. In the north, for example, funding provided for LPN training with 31 individuals during this period. According to tracking data, there were no LPNs or Registered Nurses (RNs) for home care in communities prior to the FNIHCC Program. Training plans indicate that these numbers would increase to 18 and 85 respectively through funding.

Program coordinators attended case management symposiums held at the University of Manitoba. Program representatives also attended the Palliative Care conference and Assembly of Manitoba Chiefs' Social Development conference. The latter focused on capacity building within First Nations communities for employment and training to help at the community level to access different sources of funds available through different agencies.

The Yellowquill College is a First Nation college and training institute based in Winnipeg. The college developed a Home and Community Care Management Program tailored to the needs of communities in such areas as management, finance, and data analysis.

Training was also provided to community representatives in the area of contribution agreements, an area identified by communities as one that required better understanding.

Partnerships

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

St. Elizabeth Health Care (Ontario)

• Provided training on policies and procedures based on expertise in home care

Kahnawake First Nation

• Provided peer review training and orientation to facilitate First Nations involvement in peer review process

Victoria Order of Nurses (VON)

• Provided client assessment processes and care planning

Program Linkages

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

Within Health Canada

• Integration with Indian and Northern Affairs Canada (INAC) at the Regional and Local level was initiated, as applicable, to maximize the provision of services efficiently. Linkages were also strengthened with the Aboriginal Diabetes Initiative (ADI) to communicate program information and resources and to explore Regional and Local opportunities for collaboration.

Resources Developed/Distributed

A sub-working group was struck among the Home and Community Care Coordinators in the Region to develop Program and Clinical Policies and Procedures to coincide with the Standards templates that St. Elizabeth had provided. Driven by Tribal Councils, policies and procedures manuals were developed for professionals, para professionals, as well as the development of a clinical procedures manual and programs policies manuals. A consultant coordinated the project, resulting in four binders of manuals for communities.

The Peer Review Process Guidebook was developed in conjunction with Kahnawake (Quebec)

The Data Tracking Tool was utilized to meet National reporting requirements. Communities submit both electronic and manual data.