A local and cultural reality Home and Community Care Program & Assisted Living Harmonisation Project A local and cultural reality

Context In Quebec, 2 Federal Department are directly involved with the funding of home care services for First Nations communities : Health Canada (HC) with the Home and Community Care Program(HCCP) Indiginous and Northern Affairs Canada (INAC) with the In-home Care component of the Assisted Living Program (ALP)

Context Even though the provincial health and social services authority generally does not offer in-community services, the Health and social department (MSSS) remains nonetheless a critical partner in the reinforcement of some elements of the continuum of care for persons with decreasing independence.

Brief description of the HCCP The HCCP aims to provide members of First Nations living in a community with access to basic home and community care services that are comprehensive, culturally sensitive, accessible, effective, equitable to that of other Canadians, and responsive to the unique health and social needs of FNI; It is comprised of essential service elements to which supportive services may be added. When alternate resources provide some the Program’s essential elements, the Program will not duplicate these services, but the funding remains unchanged; The Program may coordinate additional programs and services destined to persons with decreasing independence.

Brief description of ALP The Assisted Living Program provides funding for non-medical, social support services to seniors, adults with chronic illness, and children and adults with disabilities (mental and physical) to help them maintain their independence. The Assisted Living Program provides services to any individual residing on-reserve, or ordinarily resident on-reserve, who has been formally assessed by a health care provider (in the provinces or Yukon) as requiring social support services, and who cannot obtain these services otherwise.

Brief description of the FNQLHSSC The FNQLHSSC is a non-profit organisation that is responsible for supporting the efforts of the First Nations of Quebec in order to, among other things, plan and deliver culturally-appropriate and preventive health and social services programs. To promote and monitor the physical, mental, emotional and spiritual well-being of First Nations and Inuit people, families and communities while improving access to comprehensive and culturally-sensitive health and social services programs designed by First Nations organisations that are recognized and sanctioned by local authorities, all the while respecting their respective cultures and local autonomy. The FNQLHSSC also assists communities that so desire, to set up, develop and promote global health and social services and programs that are adapted and conceived by First Nations organisations.

Context (followed) There is a known issue pertaining to each Program’s authorities and the respective eligibility of certain expenses. Implementing coordinated service delivery is sometimes an operational and financial headache; Work on the integration of the two programs has already been done, but was inconclusive; The current momentum has led to the creation of this tripartite working group, which relies more on the harmonization of the HCC and AL Programs rather than on their integration.

Background 1981 : INAC Adult Support Program to provide adult care and services; 1984 : Memorandum of Understanding between the Department of Indian and Northern Affairs Canada (INAC) and Health Canada (HC); 1987 : INAC analyses services offered to adults and develops, with HC, the First Nations Continuing Care Services Model; 1997 : Joint National Summary on the First Nations Continuing Care Services identifies gaps in personal care, respite and in other services to promote client autonomy;

Background (followed) 1998-2008 : Joint Working Group on Continuing Care (FNIHB, INAC, FN&I)- Objectives- phase 1: to develop the HCC Program; phase 2: analysis of issues related to institutional care and other community services; 1999 : Announcement of the funding of Health Canada's Home and Community Care Program and implementation over 2 years; 2006 : For Quebec, publication by the FNQLHSSC of Phase 2: Assessing Continuing Care Requirements in FN and Inuit Communities : http://www.cssspnql.com/docs/centre-de-documentation/assessing_continuing_care.pdf?sfvrsn=2 2016 : Creation of tripartite working group on Harmonisation of HCC and AL Programs (regional approach).

Working Group Regional collaboration between INAC, the FNQLHSSC and Health Canada to facilitate the management and delivery of the two programs, thereby fostering an improved continuum of services : Clarification of the roles, responsibilities and authorities of each program; Mapping the current situation: funding agreements, service delivery, etc. Findings; How to respond to local needs for harmonisation?

Service Planning Eligibility criteria (HCCP vs ALP) OEMC (both) Service Delivery Plan (HCCP) Policies and Procedures Manual (HCCP)

Line of services Essential Elements (HCCP) Supportive Elements (HCCP) Auxiliairy Support Services (both)

Service Delivery Human Resources Registered Nurses, Licensed Practical Nurses, family and social support workers / beneficiary attendants, other health professionals Social workers, domestic support workers, family and social support workers / beneficiary attendants (AVA)

Service Delivery (followed) Service delivery environment In-home setting Adult and Elder Care Facilities Adult Day Centers Health Center/Nursing Stations?? Social Services??

Service Delivery (followed) Cost of Service Delivery Salaries Staff travel costs (rental / purchase of vehicle, reimbursement of km, etc.) Supplies and equipement Staff training Etc.

Specific Activity Reports e-SDRT e-SHR INAC model for ALP (FR & EN) http://www.aadnc-aandc.gc.ca/DAM/DAM-INTER-HQ-AI/STAGING/texte-text/dci2017-18_455937_1479827361943_fra.pdf http://www.aadnc-aandc.gc.ca/DAM/DAM-INTER-HQ-AI/STAGING/texte-text/dci2017-18_455937_1479827361943_eng.pdf

Financial Reports ALP : Reports or data collection instruments (DCI) are used to evaluate program costs as financial data are reported. In addition, each program funding recipient (band council, tribal council or organisation) produces annually audited financial statements that report the expenditures of the AL Program.

Financial Reports (followed) HCCP : Each program funding recipient (band council, other beneficiary) produces annually audited financial statements that report the expenditures under the HCC Program. Financial reports and activity reports are analyzed together for a better understanding of the services offered.

Findings and issues For the same beneficiary, the funding model for the two programs is not necessarily the same (global vs set). Also, joint vs. non-joint agreements; ALP funding is integrated with 3 other program components; The beneficiaries are sometimes different (Band Council vs. Youth Center vs. Tribal Council); Method funding agreement follow-up is different; Duplication in reporting; Health and social services are not integrated in every community; Gray area in terms of personal support and respite/support to caregivers; Variability in provincial involvement and access to supportive elements across the region; A single harmonisation model is not realistic.

Our objectives To support communities towards optimal operationalization of their services for persons with decreasing autonomy (adapted service delivery model); To simplify reporting process; Submit recommendations at the National level.

How to respond to local needs for harmonisation? Do you wish to harmonise your programs? If yes : How can we help? What are your specific needs?

Your contact persons FNQLHSSC : Health Canada : INAC : Kathleen Jourdain (418-842-1540) Kathleen.Jourdain@cssspnql.com Health Canada : Marie-Josée Lévesque (514-496-7873) marie-josee.levesque@hc-sc.gc.ca Michèle Béchard (514-283-7742) michele.bechard@hc-sc.gc.ca INAC : Élaine Bouchard (418) 951-2542 Elaine.bouchard@aadnc-aandc.gc.ca