Canada-Manitoba Home and Community Care and Mental Health and Addictions Services Funding Agreement

Funding Agreement
Annex I - Common Statement of Principles on Shared Health Priorities
Annex II - Action Plans
- Manitoba Action Plan on Home and Community Care and Mental Health and Addictions Services
- Manitoba Action Plan for Increased Infection Prevention and Control

Funding Agreement

BETWEEN:

HER MAJESTY THE QUEEN IN RIGHT OF CANADA (hereinafter referred to as "Canada" or "Government of Canada") as represented by the Minister of Health (herein referred to as "the federal Minister")

- and -

HER MAJESTY THE QUEEN IN RIGHT OF THE PROVINCE OF MANITOBA (hereinafter referred to as "Manitoba" or "Government of Manitoba") as represented by the Minister of Health, and the Minister of Seniors and Long-Term Care (herein referred to as "the provincial Ministers")

REFERRED to collectively as the "Parties"

PREAMBLE

WHEREAS, on August 21, 2017 Canada and Manitoba agreed to targeted federal funding over 10 years, beginning in 2017-18, for investments in home and community care and mental health and addictions, in addition to the existing legislated commitments through the Canada Health Transfer;

WHEREAS, Canada and Manitoba agreed to a Common Statement of Principles on Shared Health Priorities (hereinafter referred to as the Common Statement, attached hereto as Annex 1) on August 21, 2017, which articulated their shared vision to improve access to home and community care as well as mental health and addictions services in Canada;

WHEREAS, Canada authorizes the federal Minister to enter into agreements with the provinces and territories, for the purpose of identifying activities provinces and territories will undertake in home and community care and mental health and addictions services, based on a menu of common areas of action and in keeping with the performance measurement and reporting commitments, consistent with the Common Statement;

WHEREAS, Canada and Manitoba agree that data collection and public reporting of outcomes is key to reporting results to Canadians on these health system priorities, and that the performance measurement approach taken will recognize and seek to address differences in access to data and health information infrastructure;

WHEREAS, the Executive Government Organization Act authorizes the provincial Minister to enter into agreements with the Government of Canada under which Canada undertakes to provide funding toward costs incurred by the Government of Manitoba for the provision of health services which includes home and community care and mental health and addictions initiatives;

WHEREAS, Manitoba makes ongoing investments in home and community care and mental health and addictions services, consistent with its broader responsibilities for delivering health care services to its residents;

WHEREAS, the Government of Canada makes ongoing investments in home and community care and mental health and addictions services for Indigenous communities and other federal populations.

WHEREAS, since March 2020, Canada has been in the midst of the COVID-19 global pandemic, which has disproportionately affected Canadians living in supportive care settings in the community, namely long-term care facilities, assisted living facilities, and seniors’ residences where they receive continuing care services (hereinafter referred to as long-term care settings), and which is requiring provinces and territories to put in place stronger measures to reduce the risk of harm to residents of these facilities;

WHEREAS, the Government of Canada announced an investment of $19 billion to help provinces and territories to safely restart their economies and make Canada more resilient to possible future surges in cases of COVID-19, of which $740M is to support provinces and territories through 2020-21 with one-time investments for infection prevention and control, including in long-term care settings;

WHEREAS, on November 30, 2020, the Government of Canada committed to a further investment of $1 billion to support provinces and territories to protect residents in long-term care settings, given the continued serious risk to health of these vulnerable Canadians;

WHEREAS, Manitoba has taken substantial action to support COVID-19 response in long-term care facilities, and makes ongoing investments and improvements to the sector to support an integrated system of care that meets the needs of residents and their families;

WHEREAS, Canada authorizes the federal Minister to enter into agreements with the provinces and territories, for the purpose of identifying activities provinces and territories will undertake to protect residents in long-term care settings through increased infection prevention and control measures and in keeping with performance measurements and reporting commitments;

AND WHEREAS, the Executive Government Organization Act authorizes the provincial Ministers to enter into agreements with the Government of Canada under which Canada undertakes to provide Safe Long-term Care Funding toward expenditures incurred by Manitoba for activities to protect residents in long-term care settings through increased infection prevention and control measures;

NOW THEREFORE, Canada and Manitoba agree as follows:

1.0 Objectives

1.1 Building on Manitoba's existing investments and initiatives, Canada and Manitoba commit to work together to improve access to home and community care and strengthen access to mental health and addictions services (listed in the Common Statement, attached as Annex 1).

1.2 Further, Canada and Manitoba commit to work together to improve access to safe care through increased infection prevention and control in long-term care settings.

2.0 Action Plan

2.1 Manitoba will invest federal funding for Home and Community Care and Mental Health and Addictions Services provided through this Agreement in alignment with the selected action(s) from each menu of actions listed under home and community care and mental health and addictions in the Common Statement.

2.2 Manitoba's approach to achieving home and community care and mental health and addictions services objectives is set out in their five-year Action Plan (2017-18 to 2021-22), as set out in Annex 2.

2.3 Manitoba will invest the federal Safe Long-term Care Funding provided under this Agreement on infection prevention and control activities in long-term care settings in the following three areas:

Retention measures for existing staff, including wage top-ups, and/or hiring of additional human resources (e.g. personal support workers, licensed practical nurses, cleaners);
new infrastructure and renovations to existing infrastructure, such as ventilation of self-isolation rooms and single rooms; and,
readiness assessments conducted in long-term care settings to prevent COVID infections and spread.

2.4 In addition, Manitoba may also invest the federal Safe Long-term Care Funding through this Agreement on infection prevention and control activities in long-term care settings in one or more of the following areas;

Strengthened infection prevention and control measures and training for existing staff;
adequate supply of personal protective equipment for staff and visitors;
rapid training programs to increase the number of supportive care workers, including training for students and workers from other sectors;
enhanced screening and regular testing of staff and visitors to quickly detect, prevent or limit spread; and,
additional inspectors and infection prevention and control specialists to support in-person inspections of all facilities, as well as accreditation costs associated with meeting long-term care standards.

2.5 Manitoba’s approach to achieving the objective of the Safe Long-term Care Funding, as set out in section 1.2, in the areas identified above, is set out in Annex 2, as amended.

3.0 Term of Agreement

3.1 The term of this agreement is four years, from April 1, 2018 to March 31, 2022 (the Term).

3.2 Subject to sections 4.4 and 4.5, the Safe Long-term Care Funding provided under this Agreement may be used by Manitoba for expenditures that are incurred from December 1, 2020, to March 31, 2022.

3.3 Renewal of Bilateral Agreement

3.3.1 Manitoba's share of the federal funding for 2022-23 to 2026-27, based on the federal commitment in Budget 2017 of $11 billion over ten years, will be provided upon the renewal of bilateral agreements, subject to appropriation by Parliament, and Manitoba and Canada's agreement on a new five-year action plan.

3.3.2 The renewal will provide Manitoba and Canada the opportunity to review and course correct, if required, and realign new priorities in future bilateral agreements based on progress made to date.

4.0 Financial Provisions

4.1 The contributions made under this Agreement are in addition and not in lieu of those that Canada currently provides to Manitoba under the Canada Health Transfer to support delivering health care services within their jurisdiction.

4.2 Allocation to Manitoba

4.2.1 In this Agreement, "Fiscal Year" means the period commencing on April 1 of any calendar year and terminating on March 31 of the immediately following calendar year. Furthermore, this funding is in addition to, and not in lieu of, those funds that Canada has already provided or already provides towards home and community care and mental health and addictions services.

4.2.2 Canada has designated the following maximum amounts to be transferred in total to all provinces and territories under this initiative on a per capita basis for the Term starting on April 1, 2018 and ending on March 31, 2022.

Home and Community Care

$600 million for the Fiscal Year beginning on April 1, 2018
$650 million for the Fiscal Year beginning on April 1, 2019
$650 million for the Fiscal Year beginning on April 1, 2020
$900 million for the Fiscal Year beginning on April 1, 2021

Mental Health and Addictions Services

$250 million for the Fiscal Year beginning on April 1, 2018
$450 million for the Fiscal Year beginning on April 1, 2019
$600 million for the Fiscal Year beginning on April 1, 2020
$600 million for the Fiscal Year beginning on April 1, 2021

Safe Long-term Care

$1 billion for the Fiscal Year beginning on April 1, 2021

4.2.3 For Home and Community Care and Mental Health and Addictions Services, annual funding will be allocated to provinces and territories on a per capita basis, for each Fiscal Year that an agreement is in place. The per capita funding for each Fiscal Year, are calculated using the following formula: F x K/L, where:

F is the annual total funding amount available under this program (funding amount will change depending on Fiscal Year);
K is the total population of the particular province or territory, as determined using annual population estimates from Statistics Canada; and
L is the total population of Canada, as determined using annual population estimates from Statistics Canada.

For Safe Long-term Care, annual funding will be allocated to provinces and territories with a base amount of $2,000,000 for each province and territory, and the remainder of the fund allocated on a per capita basis, for each Fiscal Year that an agreement is in place. The total amount to be paid to Manitoba will be calculated using the following formula: $2,000,000+(F- (N x 2,000,000)) x (K/L), where:

F is the total one-time funding amount available under this initiative;
N is the number of jurisdictions (all 13) that will be provided the base funding of $2,000,000;
K is the total population of a particular province or territory, as determined using the annual population estimates from Statistics Canada; and,
L is the total population of Canada, as determined using annual population estimates from Statistics Canada.

4.2.4 For the purposes of the formula in section 4.2.3, the population of Manitoba for each fiscal year and the total population of all provinces and territories for that Fiscal Year are the respective populations as determined on the basis of the quarterly preliminary estimates of the respective populations on July 1 of that Fiscal Year. These estimates are released by Statistics Canada in September of each Fiscal Year.

4.2.5 Subject to annual adjustment based on the formulas described in section 4.2.3, Manitoba's estimated share of the amounts will be:

Fiscal Year	Home and community care Estimated amount to be paid to Manitoba ^{Footnote *} (subject to annual adjustment)	Mental health and addictions services Estimated amount to be paid to Manitoba^{Footnote *} (subject to annual adjustment)
2018-2019	$21,870,000	$9,110,000
2019-2020	$23,690,000	$16,400,000
2020-2021	$23,690,000	$21,870,000
2021-2022	$32,810,000	$21,870,000
Footnote * Amounts represent annual estimates based on StatCan 2017 population Return to footnote * referrer

4.2.6 Subject to annual adjustment based on the formulas described in subsection 4.2.3, Manitoba’s estimated share of the amounts will be:

Fiscal Year	Safe Long-Term Care Estimated amount to be paid to Manitoba^{Table 2 Footnote *}
2021-2022	$37,239,850
Table 2 Footnote * For Home and Community Care and Mental Health and Addictions Services, amounts represent annual estimates based on StatCan 2017 population. For Safe Long-term Care Funding, amounts represent annual estimates based on StatCan 2021 population. Table 2 Return to footnote * referrer

4.3 Payment

4.3.1 Canada's contribution for Home and Community Care and Mental Health and Addiction Services will be paid in approximately equal semi-annual installments as follows:

The first installment will be paid on or about April 15 of each Fiscal Year. The second installment will be paid on or about November 15 of each Fiscal Year.
The amount of the first installment will be equal to 50% of the notional amount set out in Article 4.2.5 as adjusted by Article 4.2.3.
The amount of the second installment will be equal to the balance of Canada's contribution to Manitoba for the Fiscal Year as determined under sections 4.2.5 and 4.2.3.
Canada will notify Manitoba at the beginning of the Fiscal Year of their notional amount. The notional amount will be based on the Statistics Canada quarterly preliminary population estimates on July 1 of the preceding Fiscal Year. Canada will notify Manitoba of the actual amount of the second installment in each Fiscal year as determined under the formula set out in sections 4.2.5 and 4.2.3.
Canada shall withhold payment of the second installment for the Fiscal Year if Manitoba has failed to provide its annual financial statement for the previous Fiscal Year or the quarterly reporting form referred to in 4.4.1 and agreed to by Manitoba and Canada or has failed to provide data and information related to home and community care and mental health and addictions to CIHI for the previous Fiscal Year in accordance with section 5.1.2.
The sum of both semi-annual installments constitutes a final payment and is not subject to any further adjustment once the second installment of that Fiscal Year has been paid.
Payment of Canada's funding for each Fiscal Year of this Agreement is subject to an annual appropriation by Parliament of Canada for this purpose.

4.3.2 Canada’s contribution for Safe Long-term Care will be paid in approximately equal semi-annual installments as follows:

The first installment will be paid within 30 days of Canada’s acceptance of Manitoba’s proposed approach and initiatives for the use of the Safe Long-term Care Funding, as set out in Annex 2.
The second installment will be paid, following Manitoba’s fulfillment of the obligations identified in subsection 5.1.2, and amendment of Annex 2 in accordance with subsection 5.1.3.

4.3.3 Where Manitoba fails to put in place a cost-recovery agreement as required pursuant to section 4.8, Canada shall deduct from the payment referred to in subsection 4.3.2(b) an amount equivalent to the amount of funding provided by Manitoba to those facilities with whom they do not have the required cost-recovery agreements in place.

4.4 Carry Over

4.4.1 At the request of Manitoba, Manitoba may retain and carry forward to the next Fiscal Year the amount of up to 10 percent of the contribution paid to Manitoba for a Fiscal Year under subsection 4.2.5 and 4.2.6 that is in excess of the amount of the eligible expenditures actually incurred by Manitoba in that Fiscal Year, and use the amount carried forward for expenditures on eligible areas of investment incurred in that Fiscal Year. Any request by Manitoba to retain and carry forward an amount exceeding 10 percent will be subject to discussion and mutual agreement in writing by the Parties via an exchange of letters. Manitoba may retain and carry forward an amount exceeding 10 percent of the contributions for the Fiscal Years 2018-19, 2019-20, and 2020-21, which funds will be subject to monitoring and reporting to Canada on the management and spending of the funds carried forward on a quarterly basis, in accordance with the quarterly reporting form provided by Canada.

4.4.2 For greater certainty, any amount carried forward from one Fiscal Year to the next under this subsection is supplementary to the maximum amount payable to Manitoba under subsection 4.2.5 and 4.2.6 of this Agreement in the next Fiscal Year.

4.4.3 In the event this bilateral agreement is renewed in accordance with the terms of section 3.2.1, and at the request of Manitoba, Manitoba may retain and carry forward up to 10 percent of funding provided in the last Fiscal Year of this Agreement for eligible areas of investment in the renewed 5-year agreement (2022-23 to 2026-27), subject to the terms and conditions of that renewed agreement. The new Action Plan (2022-23 to 2026-27) will provide details on how any retained funds carried forward will be expended. Any request by Manitoba to retain and carry forward an amount exceeding 10 percent will be subject to discussion and mutual agreement in writing by the Parties via an exchange of letters.

4.5 Repayment of overpayment

4.5.1 In the event payments made to Manitoba exceed the amount to which Manitoba is entitled under this Agreement, the amount of the excess is a debt due to Canada and, unless otherwise agreed to in writing by the Parties, Manitoba shall repay the amount within sixty (60) calendar days of written notice from Canada.

4.6 Use of Funds

4.6.1 Canada and Manitoba agree that funds provided under this Agreement will only be used by Manitoba in accordance with the areas of action outlined in Annex 2.

4.7 Eligible Expenditures

4.7.1 Eligible expenditures for funds provided under this Agreement are the following:

capital and operating funding;
salaries and benefits;
training, professional development;
information and communications material related to programs;
data development and collection to support reporting; and,
information technology and infrastructure.

4.7.2 Canada and Manitoba agree that amounts paid to Manitoba under the Safe Long-term Care Fund may be provided by Manitoba to:

Publicly-owned long-term care settings;
privately-owned not-for-profit long-term care settings; and,
subject to section 4.8, privately-owned for-profit long-term care settings.

4.8 Cost Recovery

4.8.1 Where Manitoba provides Safe Long-term Care Funding to privately-owned, for-profit facilities in accordance with this Agreement, Manitoba agrees to put in place cost-recovery agreements with these facilities and report on these agreements through amendments to Annex 2 by no later than March 31, 2022 in accordance with the requirements set out in subsection 5.1.3

4.8.2 Where Manitoba has cost-recovery agreements in place with one or more privately-owned for-profit facilities pursuant to subsection 4.8.1, Manitoba agrees to invest all funds recovered through those agreements in accordance with the terms of this Agreement and the initiatives outlined in Annex 2.

5.0 Performance Measurement and Reporting to Canadians

5.1 Funding conditions and reporting

5.1.1 As a condition of receiving annual federal funding, Manitoba agrees to participate in a federal-provincial-territorial process, including working with stakeholders and experts, through the Canadian Institute for Health Information (CIHI), to develop common indicators and to share relevant data in order to permit CIHI to produce annual public reports that will measure pan-Canadian progress on home and community care and mental health and addictions services.

Manitoba will designate an official or official(s), for the duration of this agreement, to work with CIHI and represent the interests of Manitoba related to performance measurement and reporting for home and community care, as well as mental health and addictions services.

5.1.2 As a condition of receiving annual federal funding, by no later than October 1 of each Fiscal Year during the Term of this Agreement, Manitoba agrees to:

Provide data and information (based on existing and new indicators) related to home and community care and mental health and addictions services to the Canadian Institute for Health Information annually. This will support the Canadian Institute for Health Information to measure progress on the shared commitments outlined in the Common Statement and report to the public.
Beginning in 2019-2020, provide to Canada an annual financial statement, with attestation from the Manitoba Health, Seniors and Active Living's Chief Financial Officer, of funding received from Canada under this Agreement during the Fiscal Year compared against the action plan, and noting any variances, between actual expenditures and Manitoba's Action Plan (Annex 2):
1. The revenue section of the statement shall show the amount received from Canada under this Agreement during the Fiscal Year;
2. The total amount of funding used for home and community care and mental health and addictions programs and services;
3. If applicable, the amount of any amount carried forward by Manitoba under section 4.4; and
4. If applicable, the amount of any surplus funds that is to be repaid to Canada under section 4.5.
For the Safe Long-term Care Funding, the annual financial statement will also set out, for the previous fiscal year:
1. The amount of the federal funding flowing to each facility, and the type of facility (as set out in 4.7.2);
2. The estimated amount of funds to be recovered under cost-recovery agreements, where applicable, and the priority areas where those funds will be reinvested;

5.1.3 As a condition of receiving the second payment installment of the Safe Long-term Care Funding, Manitoba agrees to, by no later than March 31, 2022, amend Annex 2 to:

Provide up-to-date information on performance measures, targets and intended outcomes for the three areas identified in section 2.3, and for any other areas in which Manitoba has used Safe Long-term Care Funding to support infection prevention and control, and interim results for each initiative.
Provide a breakdown of the facilities receiving funding under this Agreement, and specifically, identifying those privately-owned, for-profit facilities receiving funding pursuant to this Agreement and whether or not cost-recovery agreements are in place with them with respect to this funding;
Indicate the amount paid to each recipient operating a privately-owned, for-profit facility and describe the incremental impact that will be achieved through these investments;
Provide information on the estimated amount of funding to be recovered pursuant to the cost-recovery agreements; and,
Indicate how Manitoba will use recovered funding to increase infection prevention and control pursuant to the terms of this Agreement.

5.1.4 Manitoba also agrees to amend Annex 2, by October 1, 2022, to report, in accordance with the performance measures set out in Annex 2, on the outcomes and results achieved using the Safe Long-term Care Funding.

5.2 Audit

5.2.1 Manitoba will ensure that expenditure information presented in the annual financial statement is, in accordance with Manitoba's standard accounting practices, complete and accurate.

5.3 Evaluation

5.3.1 Responsibility for evaluation of programs rests with Manitoba in accordance with its own evaluation policies and practices.

6.0 Communications

6.1 Canada and Manitoba agree on the importance of communicating with citizens about the objectives of this Agreement in an open, transparent, effective and proactive manner through appropriate public information activities.

6.2 Each Party will receive the appropriate credit and visibility when investments financed through funds granted under this Agreement are announced to the public.

6.3 In the spirit of transparency and open government, Canada will make this Agreement, including any amendments, publicly available on a Government of Canada website and Manitoba shall make the results under this Agreement related to the Safe Long-term Care Funding, as set out in Annex 2, publicly available on its Government of Manitoba website.

6.4 Canada, with prior notice to Manitoba, may incorporate all or any part or parts of the data and information in 5.1.2 and 5.1.3, or any parts of evaluation and audit reports made public by Manitoba into any report that Canada may prepare for its own purposes, including any reports to the Parliament of Canada or reports that may be made public.

6.5 Canada reserves the right to conduct public communications, announcements, events, outreach and promotional activities about the Common Statement, Safe Long-term Care Funding and bilateral agreements. Canada agrees to give Manitoba 10 days advance notice and advance copies of public communications related to the Common Statement, Safe Long-term Care Funding, bilateral agreements, and results of the investments of this Agreement.

6.6 Manitoba reserves the right to conduct public communications, announcements, events, outreach and promotional activities about the Common Statement, Safe Long-term Care Funding and bilateral agreements. Manitoba agrees to give Canada 10 days advance notice and advance copies of public communications related to the Common Statement, Safe Long-term Care Funding, bilateral agreements, and results of the investments of this Agreement.

7.0 Dispute Resolution

7.1 Canada and Manitoba are committed to working together and avoiding disputes through government-to-government information exchange, advance notice, early consultation, and discussion, clarification, and resolution of issues, as they arise.

7.2 If at any time either Canada or Manitoba is of the opinion that the other Party has failed to comply with any of its obligations or undertakings under this Agreement or is in breach of any term or condition of the Agreement, Canada or Manitoba, as the case may be, may notify the other party in writing of the failure or breach. Upon such notice, Canada and Manitoba will endeavour to resolve the issue in dispute bilaterally through their designated officials, at the Assistant Deputy Minister level (hereinafter the "Designated Officials").

7.3 If a dispute cannot be resolved by Designated Officials, then the dispute will be referred to the Deputy Ministers of Canada and Manitoba responsible for health, and if it cannot be resolved by them, then the respective Ministers of Canada and Manitoba most responsible for Health shall endeavour to resolve the dispute.

8.0 Amendments to the Agreement

8.1 The main text of this Agreement (not including attached annexes) may be amended at any time by mutual consent of the Parties. To be valid, any amendments shall be in writing and signed, in the case of Canada, by Canada's Minister of Health, and in the case of Manitoba, by Manitoba’s Minister of Health and Manitoba’s Minister of Seniors and Long-Term Care.

8.2 Annex 2 may be amended at any time by mutual consent of the Parties. To be valid, any amendments to Annex 2 shall be in writing and signed, in the case of Canada, by their Designated Official, and in the case of Manitoba, by their Designated Official.

9.0 Equality of Treatment

9.1 During the term of this Agreement, if another province or territory, except the province of Quebec, negotiates and enters into a Home and Community Care and Mental Health and Addictions Services Agreement with Canada, or negotiates and enters into an amendment to such an agreement and if, in the reasonable opinion of Manitoba, any provision of that agreement or amended agreement is more favourable to that province or territory than the terms set forth in this Agreement, Canada agrees to amend this Agreement in order to afford similar treatment to Manitoba, if requested by Manitoba. This includes any provision of the bilateral agreement except for the Financial Provisions set out under section 4.0. This amendment shall be retroactive to the date on which the Home and Community Care and Mental Health and Addictions Services Agreement or the amendment to such an agreement with the other province or territory, as the case may be, comes into force. Manitoba's request must be in writing and provided by the representative identified in clause 11.1.

10.0 Termination

10.1 Canada may terminate this Agreement at any time if the terms of this Agreement are not respected by Manitoba by giving at least 12 months written notice of its intention to terminate. Manitoba may terminate this Agreement at any time if the terms of this Agreement are not respected by Canada by giving at least 12 months written notice of its intention to terminate.

10.2 As of the effective date of termination of this Agreement under section 10.1, Canada shall have no obligation to make any further payments to Manitoba after the date of effective termination.

11.0 Notice

11.1 Any notice, information, or document provided for under this Agreement will be effectively given if delivered or sent by letter or email, postage or other charges prepaid. Except in periods of postal disruption, any notice mailed by post will be deemed to have been received eight calendar days after being mailed.

The address for notice or communication to Canada shall be:

Health Canada
70 Colombine Driveway
Brooke Claxton Building
Ottawa, Ontario
K1A 0K9
Attention: Marcel Saulnier

Email: marcel.saulnier@canada.ca

The address for notice or communication to Manitoba shall be:

Manitoba Health, Seniors and Active Living
300 Carlton Street
Winnipeg, Manitoba
R3B 3M9
Attention: Avis Gray

Email: avis.gray@gov.mb.ca

12.0 General

12.1 This Agreement, including Annexes 1 and 2, comprise the entire agreement entered into by the Parties with respect to the subject matter hereof.

12.2 This Agreement is based on the Common Statement of Principles on Shared Health Priorities, Annex 1, finalized on August 21, 2017.

12.3 This Agreement shall be governed by and interpreted in accordance with the laws of Canada and Manitoba.

12.4 No member of the House of Commons or of the Senate of Canada or of the Legislature of Manitoba shall be admitted to any share or part of this Agreement, or to any benefit arising therefrom that is not otherwise available to the general public.

12.5 If for any reason a provision of this Agreement that is not a fundamental term is found by a court of competent jurisdiction to be or to have become invalid or unenforceable, in whole or in part, it will be deemed to be severable and will be deleted from this Agreement, but all the other provisions of this Agreement will continue to be valid and enforceable.

SIGNED on behalf of Canada by the Minister of Health at Ottawa this 28^th day of March, 2019.

The Honourable Ginette Petitpas Taylor, Minister of Health

SIGNED on behalf of Manitoba by the Minister of Health, Seniors and Active Living at Morden, MB this 26^th day of March, 2019.

The Honourable Cameron Friesen, Minister of Health, Seniors and Active Living

Annex 1 to the Agreement

A Common Statement of Principles on Shared Health Priorities

Annex 2 to the Agreement

Manitoba Action Plan on Home and Community Care and Mental Health and Addictions Services

Introduction

Health care is among the most important services provided by the Manitoba government. Manitoba Health, Seniors and Active Living (MHSAL) strives to meet the health needs of individuals, families and their communities by leading a sustainable, publicly administered health system that promotes well-being and provides the right care, in the right place, at the right time.

Every Manitoban deserves continued improvement in health care services to better support their health. The Manitoba government is confident that better health care is within reach and is making bold changes to the health system that will make it more patient-focused, operate more efficiently and ensure it is safe, affordable and sustainable in the long term. This significant health system transformation includes the creation of a provincial health organization, Shared Health, which will enable provincial planning and integration of services, improve patient care and provide coordinated support to regional health authorities across the province. More information on Manitoba's health system transformation plan can be found at: https://www.gov.mb.ca/healthcaresooner/hst/index.html.

On August 21, 2017, the Government of Canada and the Government of Manitoba publicly agreed to new federal funding for investments in home and community care, including palliative care, and mental health and addictions. Over the 10-year period (2017-18 to 2026-27), the Government of Canada will provide Manitoba with an estimated $400 million. In addition, the Government of Canada and the Government of Manitoba agreed to work together with Indigenous organizations to pursue improvements in health care service delivery for remote Indigenous communities which remains an ongoing priority.

The agenda laid out in this annex to the bilateral agreement between Manitoba and Health Canada will support and align with the Manitoba health system transformation and strengthen and sustain programming and services for Manitobans. Ensuring the long-term sustainability of the health care system presents opportunities and challenges to meet the needs of rural and remote communities, Indigenous communities, and immigrant and newcomer communities with particular emphasis on children and youth as well as the rapidly aging population in Manitoba. While long-term funding sustainability challenges persist, these targeted federal investments will help to sustain services and support the delivery of more and better home and community care services and high quality mental health and addictions services. The funding builds upon the very significant investments Manitoba is already making in these priority areas.

Home, community and palliative care overview

In home and community care, Manitoba will build upon current initiatives for those who receive their care at home and those who experience complex care needs, as well as support transformative changes in the delivery of services to individuals to extend their wellbeing in their homes and community. Manitobans will benefit from federal funding to support movement of patients out of hospital and into community including the expansion of the Priority Home home care pilot project, creation of patient pathways to home through placement in community for restoration and recovery, and expansion of palliative care options and care in Manitoba.

Seniors represent 14.3% of Manitoba's total population^{Footnote 1}. The growing proportion of seniors in the population emphasizes the need to continue to address issues surrounding the aging of the population in Manitoba.

The total number of Manitobans who received home care in 2016-2017 was 41,639. On March 31, 2017, there were 25,573 clients remaining in home care. Of these, 57.4% of clients resided in the Winnipeg Health Region^{Footnote 2}. The majority of Manitobans in need of care have confirmed their desire to receive necessary supports at home, and there is also growing evidence that community-based care is often the most appropriate and cost-effective approach.

The demand for home care services is projected to rise. For example, according to the 2016 Government of Manitoba report, The Future of Home Care Services in Manitoba^{Footnote 3}, the number of Manitobans age 65 and older will nearly double by the year 2038. The greatest increase will be found among the 75 to 84 age cohort, who, based on a 5-year average of home care admissions, have the greatest utilization of home care, with over half of the provincial home care admissions coming from this age group. Also, seventy-two percent of home care admissions were 65+ years of age, with increasingly complex client needs, including cognitive impairment which is projected to grow by 50% over the next ten years, increased frailty of the aging home care population including patients that are challenged with activities of daily living, and multi-morbidity of chronic illnesses, among others. If projections hold true, home care services in Manitoba will essentially have to double their efforts within 20 years to provide the required service needs of clients.

Home care and supportive housing services are currently available to support those needing assistance to remain safely in the community, however those requiring supports beyond these services often have fewer care options and find themselves entering a personal care home (PCH) on a premature basis. Transformation and innovation are required to permit Manitoba residents to stay longer in their homes, and reduce PCH wait times. Manitoba will use the federal funding to reduce the number of Manitobans entering a PCH on a premature basis.

Manitobans' experience with palliative care reveals that there are opportunities for enhancement to the range of palliative care options, particularly for rural Manitobans. A palliative approach to care focuses on comfort and quality of life for people of all ages affected by life-limiting illness and uses a team approach to address the needs of patients and their families. Current best practice models indicate that individuals with access to integrated palliative care services report fewer symptoms, better quality of life, and greater satisfaction with their care.

Manitoba health system and palliative care experts note that many more individuals with life-limiting illnesses living in rural areas could receive care in their community/ home if the correct provisions were in place to support the individual, their family members and their primary care provider. Enhancing access to ongoing psychosocial supports, health system navigation, pain management and respite care will allow rural Manitobans to receive the care they need at home in their community.

Priority areas for cost-shared investment

Investment through the federal funding will be used to respond to the growing needs for home and community care, and increasing supports for these services through the development of a multifaceted array of transformative system enhancements. These investments will offer intensive community focused care for those at risk of hospitalization, those who remain in hospital for prolonged periods pending PCH placement, or, in some cases, premature PCH placement.

It is often preferable from the patient's perspective to be appropriately treated in the home or community. These priorities will focus on providing safe, seamless care for Manitobans as they move from one care setting to another to ensure that individuals receive a collaborative team-based care approach in the setting that best meets their needs.

A shift in investment away from hospital towards home and community-based care supports a corresponding shift towards more proactive approaches to health. The investments identified align with the agreed-to Common Statement of Principles on Shared Health Priorities by:

Spreading and scaling evidence-based models of home and community care that are more integrated and connected with primary health care;
Enhancing access to palliative and end-of-life care at home or in hospices;
Increasing support for caregivers.

1. Expanding Manitoba's proven model of home care

Established in 1974 and the first of its kind, home care in Manitoba is the oldest comprehensive, province-wide, universal service in Canada. Home care is provided to Manitobans of all ages based on assessed need and provides a proven client and family-centred approach to care. Home care allows clients to remain in their homes longer, promotes independence, facilitates client choice and decision-making, and improves the quality of life of clients and their families. Manitoba's home care program is able to respond to a wide-range of client needs based on individualized care plans integrated with other services.

However, as outlined in The Future of Home Care Services in Manitoba, demands for home care services are increasing significantly. Between 2016-17 and 2017-18 the number of Manitoba home care clients grew by 3.7% from 25,573 to 26,531 clients respectively^{Footnote 4}. Moreover, home care clients are becoming more complex with increases in cognitive impairment, psychiatric diagnosis, and multi-morbidity of chronic illnesses, among others. Such clients contribute to a growing cohort of individuals receiving home care, with admissions greatly exceeding discharges to the program. The increasing care needs of the aging population of Manitoba will necessitate ongoing service expansions and implementation of evolving models of care to appropriately meet demands through Manitoba's universal, non-income tested home care services. These services are provided to all qualifying Manitobans, at no cost to the individual.

Manitoba will use federal funding to support the ongoing service delivery expansion required to meet the ever-changing needs of home care recipients in Manitoba. This includes increases in hours for nursing services, home care attendant services and home care dialysis. Federal funding directed to this initiative will be used to support increased service provision of home and community care services to meet the needs of Manitoba's residents in the coming years. This includes increases in the number of hours of nursing home care and home care attendant services to support service provision for approximately 1,000 additional Manitoba clients per year, as well as targeted services to meet specific population needs, such as home dialysis. In 2018-19, home care service hours increased by more than 80,000 compared to 2017-18, which amounts to a 3% increase. Service hours are expected to continue to rise at a similar rate over the course of this agreement. Expanding services and meeting the changing needs of clients means more Manitobans will be able to stay at home longer and caregivers will receive more support in looking after their loved ones.

The initiative aligns with the agreed-to Common Statement of Principles on Shared Health Priorities by:

Spreading and scaling evidence-based models of home and community care that are more integrated and connected with primary health care.

2. Intensive community focused care: Developing a community and home care support system

Manitoba plans to use federal funding to expand existing evidence-based programs in Winnipeg and to rural Manitoba to shorten hospital stays by providing clients with intensive at-home care and supports within the familiar surroundings of their home and local caregivers. The programs, Priority Home (PH) and Pathways to Home (PTH), are in the early stages of implementation in the Winnipeg Regional Health Authority (WRHA) and are showing initial transformation in the range of service alternatives for seniors requiring care.

PH and PTH are programs that provide intensive, but time limited support, to individuals being considered for PCH placement. By using a more restorative approach, individuals can avoid premature or unnecessary time spent in hospitals and long term care environments.

PH identifies individuals from the hospital or the community who are at high risk for PCH placement and focuses on providing them intensive home care services. PH uses a person-centered, collaborative philosophy of care. The program has been successful with 80% of clients (134 out of 168 clients) referred and screened being transitioned to PH or regular homecare services. Since the program's inception, the number of clients moved to long-term care (PCH) from hospital has been reduced by 88% and community PCH waitlists have been reduced by 47%. Manitoba plans to use federal funding to expand PH in Winnipeg and establish similar services for rural areas of the province.

PTH provides a restorative approach in a transitional environment for a maximum of 90 days and provides a community housing environment for rehabilitation with the expectation that a return to home will ensue. This initiative enhances the continuum of care for elderly people living in the community and increases connection with primary health care providers and support systems, including caregivers in the community. Federal funding will support the creation of a PTH option which will allow patients to safely transition back to home with time for healing and recovery, specifically, expansion of the number of placements in Winnipeg and up to another 40 PTH placements in a rural Manitoba setting. It will be used for service delivery and for monitoring and evaluating the programs through tools such as interRAI.

Through the adoption of these initiatives, Manitoba expects a cultural shift across the continuum of care. These innovative enhancements will empower individuals to participate in their care resulting in improved health outcomes.

This initiative aligns with the agreed-to Common Statement of Principles on Shared Health Priorities by:

Spreading and scaling evidence-based models of home and community care that are more integrated and connected with primary health care;
Increasing support for caregivers.

3. Supports for rural palliative care

Manitoba has only 16 hospice beds for a population of 1,278,365 people^{Footnote 5}. Furthermore, all hospice beds are located in Winnipeg. As the number of older adults in Manitoba continues to rise, demand for hospice care is expected to rise significantly.

Federal funding will be used to expand end-of-life care service delivery for rural Manitobans, including increasing access to hospice services and after-hour's access to resources for palliative care clients and their families.

Funding will support enhanced end-of-life care initiatives identified through an expression of interest process. Rural Manitobans will benefit from new services modelled on the range of end-of-life care services delivered in a hospice environment. Hospice facilities provide patient-centered care in a home-like environment for individuals at end-of-life. Care delivered in a hospice environment includes the provision of physical, emotional and spiritual support with a focus on pain and symptom management and quality of life. Patients receiving end-of-life care in a hospice environment report significantly higher levels of satisfaction with their care than those in acute care settings. Patients will receive care catered to the local context of the community and needs of unique populations, including cultural considerations.

In addition, recognizing access to after-hours palliative care support is currently limited in rural Manitoba, federal funding will be used to enhance after-hours palliative care resources for rural clients and their families. Specific initiatives will be identified through an expression of interest process with a focus on resources to support families in the home. Supports will include the provision of clinical guidance and advice to address the entire burden of illness, including physical, emotional, cultural and psychosocial aspects. Supports are to be delivered in coordination with other resources and developed with consideration of the local context of the community and needs of unique populations, including cultural considerations.

This initiative aligns with the agreed-to Common Statement of Principles on Shared Health Priorities by:

Enhancing access to palliative and end-of-life care at home or in hospices; and
Increasing support for caregivers.

Performance measurement for home and community and palliative care

Expected outcomes and results from implementing these initiatives

Manitoba will participate in the collection of data through CIHI. It is important to note that there are currently limitations across Manitoba in data collection for some of the measures selected.

These initiatives are expected to prevent unnecessary hospital admission, prevent unnecessary/premature long term care admission, support earlier discharge to home, and increase access to end-of-life care, using additional and existing home and community-based services. This approach will empower clients to be more actively involved in their plan of care, assist in achieving better outcomes, improve quality of life and create a more effective and efficient health service delivery system.

Part of the federal funding for this program will be used to develop performance measurement frameworks for each program. The evaluation will include the following indicators and targets:

Performance indicators
Initiative	Output/Outcome	Indicators
Expanding Manitoba's proven model of care	Manitoba seniors receive the care they require in their home rather than moving into personal care home or other institutional settings before they truly need to leave their homes.	Increase in hours of nursing care Increase number of hours of home care attendant services Increase in number of home dialysis services/clients Increase in number of home care clients served (i.e. monthly clients admitted and discharged from home care)
Developing a Community and Home Care Support System	Enhance the continuum of care for elderly people living in the community and increases connection with primary health care.	% reduction in waitlist for PCHs % reduction in number of Alternate Level of Care (ALC) days related to waiting for HC or PCH. Number of patients awaiting PCH staying in Winnipeg hospitals
Supports for Rural Palliative Care	Providing greater training and awareness opportunity to health care providers across the province, and providing after hours palliative care resources for clients and families and staff throughout rural Manitoba will result in more options for end of life care outside of hospital. Enhance the range of palliative service in Manitoba outside of Winnipeg. Enhance after hours palliative care resources for clients, families outside of Winnipeg.	Reduced % of palliative deaths in-hospital in Manitoba Increased number of individuals in rural Manitoba who receive palliative care supports and resources

Funding requirements – Home and Community and Palliative Care
Funding Breakdown by Initiative ($millions)	2017-18^{Footnote *}	2018-19	2019-20	2020-21	2021-22	Total
Federal Funding Received n Home and Community Care^{Footnote }**	7.265	21.89	23.68	23.59	32.56	108.985
Expanding Manitoba's Proven Model of Home Care	-	11.325	17.40	19.105	17.170	65.0
Priority Home and Pathways to Home	7.265	10.565	6.28	3.815	3.85	31.775
Hospice and Palliative Care Services	-	-	-	-	0.275	0.275
Total Expenditure	7.265	21.89	23.68	22.92	21.295	97.05
Total Carry Forward to be Spent the Next Fiscal Year^{Footnote ***}	-	-	-	0.67	11.935	-
Footnote * Funding was provided through legislative transfer. Return to footnote * referrer Footnote Allocations are rounded. Initial funding allocations were subject to annual adjustment based on the formula described in section 4.2.3 of the Agreement. Return to footnote referrer Footnote * Funds were carried forward to the next fiscal year of this bilateral agreement to better reflect the needs of the initiatives. Any carry forward funds from 2021-22 will be noted in next agreement to be spent in 2022-23. Return to footnote * referrer

Mental health and substance use and addictions overview

In the area of mental health and addictions, the results of a recent external report (March 31, 2018) by VIRGO Planning and Evaluation Consultants Incorporated entitled Improving Access and Coordination of Mental Health and Addiction Services: A Provincial Strategy for all Manitobans^{Footnote 6} will guide Manitoba's policy and service delivery priorities to inform a provincial mental health and addictions strategy that will enhance access to and coordination of mental health and addictions services. In addition to developing plans to address the strategic priorities, Manitoba will also use the federal funding to support the integration of peer and family support workers in key primary sites such as emergency departments (EDs) and crisis services, and to support early intervention for vulnerable families accompanying the loss of a pregnancy or infant.

Substance use and addictions (SUA), and mental health (MH) treatment and support services in Manitoba are delivered by a diverse array of organizations, including psychiatric facilities, non-profit agencies, and hospitals. Bed-based services in hospitals and psychiatric facilities incorporate a range of programs including acute care inpatient and outpatient programs, and longer-term rehabilitation.

Manitoba offers an array of both SUA and MH programs, and building on that existing suite of services, a recent external review by VIRGO Planning and Evaluation Inc. has identified a number of potential reforms to improve system coordination and accessibility for Manitobans.

Manitoba has the highest prevalence of certain mental health and substance use disorders. The 2012 Canadian Community Health Survey – Mental Health (CCHS-MH)^{Footnote 7} indicated that, in comparison to the national average, Manitoba has the highest lifetime prevalence of major depressive disorder; the second highest lifetime prevalence of alcohol use disorder; and the third highest lifetime prevalence of generalized anxiety disorder.

The use of crystal methamphetamine and its impacts on the lives of individuals, families, and communities has reached a point of deep concern in Manitoba. This situation is leading to an increase in challenging presentations to EDs, to first responders and to crisis response services. Increasingly, health care and allied service providers are identifying significant resource demand and limited capacity to appropriately support and respond to individuals affected by crystal methamphetamine.

Alcohol-related harms continue to be one of the largest issues related to substance use in Manitoba and across Canada. The 2012 CCHS-MH indicated that about 27% of Manitobans aged 15 and older report having misused or been dependent on alcohol in their lifetime, which is much higher than the Canadian average of 18.1%. A new report from the Manitoba Centre for Health Policy (MCHP) indicates that, in Manitoba, 15.1% of females and 20.6% of males, aged 15 years and over, exceed the recommended daily limits for alcohol consumption^{Footnote 8}.

Opioid use and misuse related consequences are also placing significant pressure across multiple sectors. In Manitoba, the proportion of apparent opioid-related deaths where an opioid was dispensed within six months prior to death increased from 57% in 2014 to 72% in 2017 (January to September). Between January 1st and September 30th, 2017 in Manitoba, compared to the same time in 2016, apparent opioid-related deaths increased by 50%. The largest increase was noted for apparent fentanyl-related deaths, where 86% of these deaths had the fentanyl analog carfentanil present^{Footnote 9}.

Recent work by the MCHP^{Footnote 10} (2018) found that the overall prevalence of diagnosed mood and anxiety disorders was 23.2% in Manitoba. Individuals affected by mental illness, including substance use disorders, used more health care services even when controlled for age, gender, income and medical conditions.

Another recent MCHP study^{Footnote 11} of the mental health of Manitoba's children ages 6-19 found that 14% received a diagnosis of a mental disorder by a physician between 2009 and 2013 – a rate almost double that of the national average. Many of these children face a multitude of interconnected challenges which require an interdisciplinary, multi-sectoral response. However, the new CIHI report on Child and Youth Mental Health in Canada indicated that in 2016-17, Manitoba had the lowest rates of children and youth hospitalizations for mental disorders^{Footnote 12}.

Over the last two years, Manitoba has made investments to address identified challenges. These include:

The addition of a third Program for Assertive Community Treatment (PACT) team in Winnipeg which provides long-term, intensive community based treatment
Proclamation of The Advocate for Children and Youth Act, which enhances the abilities of the Office of the Children and Youth Advocate to support and advocate for children and youth who have come in contact with MHA services
A $3 million investment in Siloam Mission, a community agency which provides housing for persons struggling with homelessness, physical and cognitive disabilities, MHA issues, and trauma
Investment of $8.4 million with Fountain Springs Housing, to provide supported housing to individuals with MHA related support needs
Opening of Hope North Recovery Centre for Youth in Thompson, Manitoba, a crisis and addictions stabilization unit for youth in the region, including a youth mobile crisis unit
Enhanced supports for Manitobans recovering from opiate addictions through the Manitoba Opioid Support and Treatment Program, including coverage of suboxone in the Manitoba Pharmacare Program

While these investments have enhanced Manitoba's SUA/MH system, VIRGO's report indicates that improvements remain for an integrated, comprehensive provincial plan.

Priority areas for cost-shared investment

Federal funding will be used to improve access to and coordination of mental health and addictions services through implementation of several new initiatives. The largest portion of funding will be used to implement Manitoba's Mental Health and Addictions (MHA) Strategy that supports children, youth, emerging adults, adults and older adults.

These investments align with the Common Statement of Principles on Shared Health priorities by:

Expanding access to community-based mental health and addiction services for children and youth (age 10-25), recognizing the effectiveness of early interventions to treat mild to moderate mental health disorders;
Spreading evidence-based models of community mental health care and culturally appropriate interventions that are integrated with primary care services; and,
Expanding availability of integrated community-based mental health and addictions services for people with complex health needs.

The federal funding will also support the integration of peer and family peer support in formal health settings, and the initiation of a provincial pregnancy and infant loss program.

Specifically, the peer support initiative will develop an evidence-based program to support individuals accessing primary and crisis care, to ensure that they receive support and appropriate follow up post-discharge to maximize their recovery. This approach recognizes the significant benefit of having peers and family members with lived experience make meaningful connections to individuals seeking help. This includes providing information and encouraging important skill building; both are integral to recovery and the ability to thrive in the community.

The pregnancy and infant loss program will provide an array of community and primary care resources to assist individuals and families who are dealing with the complex grief and mental health issues associated with pregnancy and infant loss.

These investments align with the Common Statement of Principles on Shared Health priorities by:

Expanding access to community-based mental health and addiction services for children and youth (age 10-25), recognizing the effectiveness of early interventions to treat mild to moderate mental health disorders; and
Spreading evidence-based models of community mental health care and culturally appropriate interventions that are integrated with primary care services

1. Increasing timely access to coordinated care for mental health and addictions services for Manitobans

Implementation of Manitoba's Mental Health and Addictions Strategy will be guided by the VIRGO report, Improving Access and Coordination of Mental Health and Addiction Services: A Provincial Strategy for all Manitobans. The implementation will focus on more timely access to and coordinated care for all age groups, including priority populations such as Children and Youth and Indigenous peoples.

The VIRGO strategy report contained more than 100 recommendations in the areas of service enhancements and system re-alignment. The implementation of the strategy will focus on access and coordination using a whole-of-government approach to prioritize recommendations and guide investment in mental health and addictions.

Concurrently, clinical aspects of mental health and addictions care are being addressed through Provincial Clinical and Preventive Services Planning, which is currently underway by Shared Health, in conjunction with clinicians across the province, regional health authorities and other service delivery organizations. Service enhancements are being designed with focus on care that is patient-centric, equitable, accessible, integrated and effective.

Federal funding will be used to augment this significant provincial focus and corollary provincial investment in these areas. A number of specific programs will be rolled out during this four year Agreement to create a seamless continuum of integrated services that are person- and family-focused. This includes culturally relevant treatment options by staff cross-trained in mental health and addictions supports, more services focused on early intervention and greater access and emphasis on collaborative care models, building upon the successful model of My Health Teams. In addition, Manitoba clients will have more timely access to psychiatric consultation including tele-psychiatry.

On substance abuse disorders, federal funding under this Agreement will support Manitoba initiatives aimed at improving opportunities for prescribers to enhance their competencies in addiction medicine; and increasing access for Manitoba residents across the province to timely treatment through Rapid Access to Addictions Medicine (RAAM) clinics. This is in addition to provincial commitments in this area made under the Canada-Manitoba Emergency Treatment Fund Bilateral Agreement.

As a result of significant provincial focus and investment on the important issue of mental health and substance use disorders, supported by federal funding under this Agreement, Manitobans will benefit from new services, better access and improved service coordination of mental health and addictions supports as this new integrated approach is implemented.

This aligns with the Common Statement of Principles on Shared Health Priorities by:

Expanding access to community-based mental health and addiction services for children and youth (age 10-25), recognizing the effectiveness of early interventions to treat mild to moderate mental health disorders;
Spreading evidence-based models of community mental health care and culturally-appropriate interventions that are integrated with primary health services; and
Expanding availability of integrated community-based mental health and addiction services for people with complex health needs.

2. Implementation of Peer Support in Formal Health Settings

In addition and further to the recommendations from the VIRGO report, federal funding will also support the regional health authorities to contract with a community-based agency to deliver formal peer and family support services in EDs and crisis/urgent care centres, and to evaluate these services, basing implementation on successful peer support models such as the Ottawa Hospital.

Peer support is an evidence-based service that leverages the expertise of people with lived experience to support the recovery of a person with mental health problems and illnesses, and addictions issues. Peer support workers embody hope that recovery is possible and impart important information, links to ongoing services, and life skills for successful recovery in their community of choice.

Jurisdictions across Canada have had great success in reducing inpatient admissions and re-admissions; reducing length of inpatient stays; improving patient and family experiences in crisis situations; reducing hospital visits and improving health outcomes for the person experiencing acute mental illness and addictions issues by introducing peer support into their mental health crisis response system, EDs and inpatient units.

Some studies have found that the use of a transitional discharge model (which incorporates peer follow up) drastically reduces the number of days spent in hospital. Evidence shows that providing peer support for the first two weeks post-discharge reduces the rate of readmission to hospital.

a. Peer Support in the Crisis Response Centre/Emergency Departments

Peer support workers will be employed by a non-profit organization with experience in providing peer support. Peer support workers will be based in ED/Crisis Response Centre (CRC) settings for part of their working time, with the balance of their time providing follow up with individuals who have been discharged from an ED/CRC.

Federal funding will be used for both start up and operating costs of the program, as well as evaluation. Primary activities of the peer support workers will be to: ensure that individuals are accessing the right programs; provide comfort, support and motivation; provide clear information about what to expect in the ED/CRC; offer personal experience; and provide support to the family. Follow up activities will focus on transitioning and connecting individuals to supports and resources in the community. This will include referrals to mental health and addictions agencies that offer community peer support.

The peer support programs in the CRC and ED will target to serve at least 5000 clients in year one, and up to 15,000 clients in year two onward.

b. Emergency Department Violence Intervention and Community Access Program (EDVICAP)

In 2013, a wraparound program for youth (ages 14-24) injured by violence, named the Emergency Department Violence Intervention Program (EDVIP) was launched at the Health Sciences Centre (HSC) in Winnipeg. It was initially supported through the Canadian Institutes for Health Research (CIHR) as a pilot study. The results have demonstrated an impressive effect in decreasing return visits for subsequent injuries due to violence, substance misuse and mental health. The three-year CIHR grant ended in spring, 2016. More information about EDVIP can be found at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4442171/.

Analysis of the pilot study also indicated that Canada's Indigenous population is disproportionately affected by violent injury. It found that the risk of severe violent injury or homicide is 2.9 times higher for First Nations youth than non-First Nations youth. It is essential to acknowledge the historical trauma and intergenerational grief that permeates through the Indigenous community and its role in leading youth to violent injury.

Federal funding will be used to redesign and enhance EDVIP, through a collaboration between HSC and the WRHA (Downtown-Point Douglas Access Centre). The redesigned program will provide significant community follow up (post ED discharge) and wraparound care for EDVICAP clients, with a focus on Indigenous youth. This will include ongoing mentorship with a peer support worker and enhanced access to mental health/addictions support, employment and income assistance, and educational engagement. These services will be provided in the community to maximize recovery and quality of life of EDVICAP clients.

The investments identified align with the agreed-to Common Statement of Principles on Shared Health Priorities by:

Expanding access to community-based mental health and addiction services for children and youth (age 10-25), recognizing the effectiveness of early interventions to treat mild to moderate mental health disorders; and
Spreading evidence-based models of community mental health care and culturally-appropriate interventions that are integrated with primary health services.

3. Implementation of a Pregnancy and Infant Loss Program

Federal funding will also be used to contract a community-based program for families dealing with the loss of a child during pregnancy and infancy (first year of life), delivered through collaborative partnerships.

It is estimated that approximately 15% of women experience some sort of perinatal mental health issue^{Footnote 13}. A Manitoba program that provides support to assist women and families experiencing postpartum depression identified that many of these families had also experienced a previous pregnancy or infant loss.

Major depression and other psychiatric disorders are common during pregnancy and the postpartum period, yet these disorders remain largely under diagnosed and under treated. Developing programs that are uniquely tailored to meet the needs of perinatal mental health clients can improve both the quality and acceptability of care, prevent family breakdown, child welfare involvement, and injury and death.

The complexity of grief that can be associated with pregnancy and infant loss presents additional risk for worsening of mental health issues. Outreach and early intervention is integral to ensuring optimal mental health and well-being for individuals and families impacted by this form of loss.

The Pregnancy and Infant Loss Program will include support groups and outreach services, group therapy, one-on-one therapy for complex cases, a network to share knowledge and best practice, and an evaluation to assess the program.

Group therapy and support groups will be facilitated building on current work in Winnipeg and expanding to communities throughout the province. This will provide an opportunity for individuals to gain support from peers and reduce the isolation experienced by many individuals impacted by pregnancy and infant loss.

Individual counselling and support will be available in the most complex cases (expected to be approximately 20% of participants) to ensure appropriate supports are provided to promote optimal mental well-being and prevent further risk. A training model will also be developed for service providers to ensure that pregnancy and infant loss counselling and support are culturally-appropriate and available in communities throughout the province.

The Pregnancy and Infant Loss Program target will be to serve a minimum of 200 clients per year.

The investment identified aligns with the agreed-to Common Statement of Principles on Shared Health Priorities by:

Spreading evidence-based models of community mental health care and culturally-appropriate interventions that are integrated with primary health services.

Performance measurement for mental health and addictions:

Manitoba will participate in the collection of data through CIHI. It is important to note that there are limitations across Manitoba in data collection for some of the measures selected. The VIRGO report identified significant gaps in information and information systems in Manitoba. In undertaking the development of the strategy in Manitoba, consideration will be given to measures to address the gaps.

Part of the federal funding for this program will be used to develop performance measurement frameworks for each program. The evaluation will include the following indicators and targets:

Performance indicators
Initiative	Output/Outcome	Indicators
Increasing access to coordinated care for mental health and addictions services for Manitobans	Mental Health patients in Winnipeg no longer need to be moved between hospitals for psychiatric assessments.	Increased # of tele-psychiatry assessments (psychiatrists via telehealth) Reduced # of patient transfers in Winnipeg to access psychiatric assessment
	Improved access to services for children and youth and their families with mild to moderate mental health needs through use of technology. This will help prevent needs from becoming more acute and address needs earlier than in the current system where wait lists exist for more acute services.	# of families accessing e-mental health services # of children and youth accessing mental health and addictions services
	Better integration of addictions treatment services with health services, especially those seeking addictions services by presenting at emergency departments. Ensure that pathways to addictions care exist for those presenting at emergency departments	Increased number of clients served through Rapid Access to Addictions Medicine clinics Referral patterns - # of Referrals to Rapid Access to Addictions Medicine clinics from emergency departments
Implementation of peer support in formal healthcare settings (includes EDVICAP)	Manitobans have increased access to peer support services.	Increase in the number clients served by peer support workers in the Crisis Response Centre and Emergency Department
	Improve the mental health of youth in EDVICAP	% change in repeat emergency department visits by youth in EDVICAP
Implementation of pregnancy and infant loss program	Improving support to assist women and families experiencing post-partum depression	Number of individuals and families accessing pregnancy and infant loss supports

Funding requirements – Mental health and addictions
Funding breakdown by initiative ($millions)	2017-18^{Footnote *}	2018-19	2019-20	2020-21	2021-22	Total
Federal Funding Received in Mental Health and Addictions^{Footnote }**	3.63	9.12	16.395	21.775	21.71	72.63
Increasing timely access to coordinated care for mental health and addictions services for Manitobans	3.63	4.0	19.045	19.15	22.77	68.595
Implementation of peer support in formal healthcare settings (includes EDVICAP)	-	-	0.55	2.025	1.0	3.575
Implementation of pregnancy and infant loss program	-	-	0.02	0.05	0.20	0.27
Total Expenditure	3.63	4.0	19.615	21.225	23.97	72.44
Total Carry Forward to be Spent the Next Fiscal Year^{Footnote ***}	-	5.12	1.90	2.45	0.19	-
Footnote * Funding was provided through legislative transfer. Return to footnote * referrer Footnote Allocations are rounded. Initial funding allocations were subject to annual adjustment based on the formula described in section 4.2.3 of the Agreement. Return to footnote referrer Footnote * Funds were carried forward to the next fiscal year of this bilateral agreement to better reflect the needs of the initiatives. Any carry forward funds from 2021-22 will be noted in next agreement to be spent in 2022-23. Return to footnote * referrer

Manitoba - Action Plan for Increased Infection Prevention and Control

Overview

Manitoba offers a range of supports and continuing care options for seniors to support their ability to stay safe in their own homes and communities as long as they choose. This includes home care, supportive housing and long-term care through personal care homes (PCH).

Manitoba has recently created a new standalone department of Seniors and Long-Term Care focused on improving care quality in long-term care facilities, and supporting aging in place and appropriate supports for seniors across the continuum of care.

The seniors population in Manitoba is expected to increase by almost 60% by 2050, further highlighting the importance of ensuring a range of supports are available for seniors, when and where they are needed. This includes examining options for enhanced supports for caregivers, expanding self- and family-managed care options, building supportive housing capacity, modernizing PCHs and working to address staffing challenges.

The new Ministry of Seniors and Long-Term care is working to develop a renewed Seniors Strategy to support aging in place and appropriate supports across all regions. Manitoba will be conducting extensive engagement and consultation to inform a strategy that will be a broad-based whole of government policy and program approach, working with seniors, communities and stakeholder groups.

Long-term care (LTC) in Manitoba

There are 125 licensed personal care homes (PCH) operating in Manitoba with approximately 10,000 beds. PCHs are a mix of privately and publicly owned facilities: 57% are publicly owned, 14% are owned by private for-profit organizations and 29% are owned by private not-for-profit organizations.

PCHs are designed for individuals who require 24 hour daily care and are experiencing care needs that cannot be met in the community. The insured personal care services provided in licensed PCHs include the following:

meals (including meals for special diets)
assistance with daily living activities such as bathing, getting dressed and using the bathroom
necessary nursing care
routine medical and surgical supplies
prescription drugs eligible under Manitoba's Personal Care Home Program
physiotherapy and occupational therapy, if the facility is approved to provide these services
routine laundry, linen and housekeeping services

Special care environments (such as secure units) are also available within some PCHs throughout the province.

PCHs primarily serve adults 75 years of age and older that may have a chronic condition, disability, or can no longer live independently. Approximately 2.8% of the population age 75 and older is admitted to a PCH annually in Manitoba, or approximately 2,500 individuals. The median length of stay of individuals is approximately two years. Over time, there has been a significant trend toward residents having more complex health needs and requiring higher levels of care at the time of admission.

All licenced PCHs in the province must meet standards to ensure safe and appropriate care to residents as set out in The Personal Care Home Standards and Licensing Regulation under The Health Services Insurance Act. Under this legislation, Manitoba licences and monitors all personal care homes in Manitoba.

A regular standards review is conducted at each personal care homes at least once every two years. In addition to these regular standards reviews, unannounced reviews are completed at approximately 20 per cent of PCHs each year. In 2020, the department also conducted modified reviews at all 125 sites, which considered care and resident safety associated with COVID-19.

Personal care homes are directly responsible to the regional health authority (RHA) where they are located.

Licenced personal care homes by regional health authority

Prairie Mountain Health

Baldur Manor
Bayside Personal Care Home
Benito Health Centre
Birch Lodge Personal Care Home
Bren-Del-Win Lodge
Carberry Personal Care Home
Country Meadows Personal Care Home
Crocus Court Personal Care Home
Dauphin Personal Care Home
Delwynda Court Personal Care Home
Dinsdale Personal Care Home
Dr Gendreau Personal Care Home
Elkwood Manor
Erickson & District Health Centre
Evergreen Place Personal Care Home
Fairview Home
Gilbert Plains Health Centre
Glenboro Personal Care Home
Grandview Personal Care Home
Hartney Community Health Centre
Hillcrest Place Inc.
McCreary/Alonsa Personal Care Home
Melita Personal Care Home
Minnedosa Personal Care Home
Morley House Personal Care Home
Rideau Park Personal Care Home
Riverdale Personal Care Home
Rossburn Personal Care Home
Russell Personal Care Home
Sandy Lake Personal Care Home
Sherwood Nursing Home
Souris Personal Care Home
St Paul's Home
Sunnyside Manor
Swan Valley Lodge (1991) Inc.
Swan Valley Personal Care Home Inc.
Tiger Hills Manor
Valleyview Care Centre
Wawanesa Health Centre
West-man Nursing Home
Westview Lodge
Willowview Personal Care Home
Winnipegosis & District Personal Care Home Inc.

Northern RHA

Flin Flon Personal Care Home
Nisichawayasihk Personal Care Home
Northern Lights Manor
Pinaow Wachi Personal Care Home
St. Paul's Residence
Northern Spirit Manor

Interlake-Eastern RHA

Ashern Personal Care Home
Betel Home Gimli
Betel Home Selkirk
East-Gate Lodge
Eriksdale Personal Care Home
Fisher Personal Care Home
Goodwin Lodge
Kin Place Personal Care Home
Lac du Bonnet Personal Care Home
Lundar Personal Care Home
Pioneer Health Services
Red River Place
Rosewood Lodge
Sunnywood Manor
Tudor House
Whitemouth District Health Centre Personal Care Home

Winnipeg Regional Health Authority

Actionmarguerite (Saint-Boniface) Inc.
Actionmarguerite (Saint-Vital) Inc.
Actionmarguerite (St. Joseph) Inc
Beacon Hill Lodge
Bethania Mennonite Personal Care Home, Inc.
Calvary Place Personal Care Home
Charleswood Care Centre
Concordia Place
Deer Lodge Centre
Donwood Manor Personal Care Home Inc.
Extendicare Oakview Place
Extendicare Tuxedo Villa
Fred Douglas Lodge
Golden Door Geriatric Centre
Golden Links Lodge
Golden West Centennial Lodge
Heritage Lodge
Holy Family Nursing Home
Kildonan Personal Care Centre
Lions Personal Care Centre
Luther Home
Maples Personal Care Home
Meadowood Manor
Misericordia Place
Park Manor
Parkview Place Care Centre
Pembina Place Mennonite Personal Care Home
Poseidon Care Centre
River East Personal Care Home Ltd.
River Park Gardens
Riverview Health Centre Inc
Southeast Personal Care Home
St. Norbert Personal Care Home
The Convalescent Home of Winnipeg
The Middlechurch Home of Winnipeg Inc
The Saul and Claribel Simkin Centre
Vista Park Lodge
West Park Manor Personal Care Home

Southern Health-Santé SUD

Bethesda Place
Boyne Lodge Personal Care Home
Douglas Campbell Lodge
Eastview Place
Emerson Health Centre
Foyer Notre Dame
Heritage Life Personal Care Home
Lions Prairie Manor
MacGregor Personal Care Home
Menno Home for the Aged
Pembina-Manitou Health Centre
Prairie View Lodge
Red River Valley Lodge
Repos Jolys
Rest Haven Nursing Home
Rock Lake Health District Personal Care Home
Salem Home Inc.
St. Claude Pavilion
Tabor Home Inc.
Third Crossing Manor
Villa Youville
Vita and District Health Centre

Pre-pandemic challenges

Similar to other jurisdictions, Manitoba faces long-standing challenges in meeting the growing and evolving care needs of the aging population. Exponential increases in demand coupled with the increasing number of older Manitobans with chronic disease requires innovation and a range of supports to best meet seniors’ needs.

Quality health care depends on accessing the right care in the right place at the right time. Coordinated facility-based care and home-based care are important elements of the health care continuum and can help to maximize both quality of life for clients and the sustainability of service.

Demographic changes also mean increased diversity among older Manitobans, necessitating innovative approaches and a strong focus on cultural sensitivity. Similarly, Manitoba recognizes the needs of Indigenous seniors who may live in remote communities, and who may experience multiple barriers to accessing supports and services. Providing equitable and accessible programs and services in rural and remote communities remains an ongoing area of focus.

Health human resources is another key challenge. Recruitment, retention and access to a stable, consistent, appropriately trained workforce are among the most critical issues facing the continuing care sector. Human resource management will become even more challenging as the population ages, service needs increase and the labour pool shrinks.

COVID-19 response

From the beginning of the pandemic, Manitoba has placed a priority focus on protecting vulnerable populations, including those in PCHs and other supportive care facilities. Nonetheless, the pandemic exposed gaps in long-term care systems in Manitoba and across Canada, and brought focus on the central importance of ensuring safe and dignified care for all seniors.

In early 2020, broad precautions were put in place to protect vulnerable residents, including strict visitor restrictions, enhanced screening for staff, and increased cleaning and janitorial services. The safety of residents and staff in PCHs was also supported through focused procurement on personal protective equipment and creation of a distribution protocol for the health-care system.

Additionally, in May 2020, the Manitoba government issued an emergency order for personal care homes to limit the number of employees who work at multiple sites. This order required health-care staff to work in a single personal care home, with limited exceptions. The emergency order was put in place to reduce the risk of transmission of COVID-19 in long-term care facilities.

Manitoba also developed all-season shelters that allow residents to safely visit with loved ones. Initial investments in the construction of the all-season safe visitation shelters and creation and early implementation of the one-site PCH staffing model were supported, in part, by federal funding through the Safe Restart Agreement.

Between October 20, 2020 and January 12, 2021, a serious outbreak of COVID-19 occurred at the Maples Long Term Care Home. Seventy-three staff and 157 residents tested positive, and 54 residents died. The government commissioned an external review, led by Dr. Lynn Stevenson, and accepted all of the report’s 17 recommendations for action.

Implementation of the Stevenson Review recommendations remains a central focus to support a stronger foundation for seniors care in Manitoba. Significant improvements have been implemented in the areas of resident safety; staffing complements; pandemic preparedness; and communication with families and staff. This includes creation of a Provincial Long-term Care/Personal Care Home Pandemic Plan that establishes a standardized approach for service delivery organizations (RHAs), operators and personal care home facilities to plan, prepare and respond to outbreaks and pandemics. The department of Seniors and Long-term Care is committed to continued progress and sustained action following this report.

Initiatives that will be supported by SLTC Funding

Personal care home visitation shelter operating costs

In March 2020, in-person visits to PCH were suspended as a part of a series of infection prevention and control measures to lower the risk of COVID-19 infection to residents. In-person visits were replaced by online visits, window visits and outside visits during warmer months.

Recognizing the critical importance of safe, in-person visits to both the mental and physical health of residents and their families, Manitoba announced plans to develop all-season temporary visitation shelters at PCHs across the province in June 2020, with tender and construction following through the remainder of 2020. This initiative provides a balance between protecting public health and supporting quality of life by ensuing meaningful connections continue between PCH residents and their friends and family.

A total of 105 external visitation shelters (EVS) and 57 internal visitation shelters (IVS) have been constructed to enable accessible and appropriate environments for visitation with a focus on features to support infection prevention and control. This includes appropriate air flow, separate entrances for residents and their visitors, germicidal UVC lighting to kill bacteria, and installation of easy to clean surfaces and fixtures.

EVS units are built from shipping containers repurposed and fitted-out for a completely finished visiting facility. Each unit has a visiting room with space for one resident and up to five visitors. Electrical and mechanical systems have been designed to ensure each shelter is functional all year round.

Operating costs required for both EVS and IVS include visitation scheduling software, furnishings, cleaning supply costs and human resources to schedule resident visits, screen visitors, ensure safe transportation of residents to and from the EVS/IVS, facilitate resident safety and security during visits, undertake necessary cleaning and disinfection between visits, and overall EVS/IVS maintenance.

Total estimated operating costs for OVS and IVS, excluding operating costs for private for-profit facilities, are expected to be $18 million in 2021/2022.

Increased staffing and operational costs to support pandemic response

As identified above, PCHs have put in place a broad range of measures to protect residents and staff and support increased infection prevention and control measures. This includes enhanced screening protocols for staff, and significantly increased cleaning and janitorial services. Implementation of these measures has resulted in significant incremental staffing and operational costs in LTC facilities throughout the pandemic over and above their original budgets.

Additionally, facilities have incurred significant additional human resource expenditures to operate the one-site staffing model, implemented in May 2020 for nurses and support staff to limit the risk of COVID-19 exposure and transmission across multiple health care sites. Incremental staffing costs have also been incurred as a result of additional staff sick time, and to support social distancing within a shared facility.

Total estimates operating costs for the aforementioned items, excluding operating costs for private for-profit facilities are expected to be $19.2 million in 2021/2022.

Funding breakdown by initiative

Initiative	2021/22	Total
Visitation Shelter Operating costs	18.0	18.0
Increased PCH staffing and operation costs	19.2	19.2
Total	37.2	37.2

Performance Measurement and Expected Results
Initiative	Performance Measure	Target / Outcomes	Reporting and Results
Personal Care Home Visitation Shelters	PCHs with safe visitation shelter sites in operation	Majority of PCHs in the province have indoor or outdoor visitation shelter space available	Reporting to date (March 2022) To date, 105 external and 57 internal visitation sites have been built at facilities across the province. This funding has helped improve the safety and quality of life of residents and their loved ones by supporting an option for in-person visitation. Final Results (Fall 2022) Visitation shelters continue to be in use and the department continues to collect quarterly utilization numbers from the HAs. Majority of the PCHs in the province have indoor or outdoor visitation shelter space available. As of October 1, 162 visitation shelters (105 external/57 internal) are operational across the five HAs.
Increased PCH Staffing and Operating Costs	Support increased infection prevention and controlSupport increased pandemic staffing demand from factors like enhanced screening protocols, the one-site staffing model, and additional paid sick leave	Implementation of hand hygiene audits and high performance complianceAdequate staffing at PCHs supported in part by increased overtime	Reporting to date (March 2022) Hand hygiene performance is being monitored at PCHs across the province. Over 52,000 opportunities for hand hygiene were monitored over this period, both before (moment 1) and after (moment 2) patient or patient environment contact. 2021/22: Q1: 83% (Moment 1 Compliance) 88% (Moment 2 Compliance) Q2: 82% (Moment 1 Compliance) 87% (Moment 2 Compliance) Q1: 83% (Moment 1 Compliance) 86% (Moment 2 Compliance) Final Reporting (Fall 2022) During the 3 quarters reported on below, over 53,000 opportunities for hand hygiene were monitored, both before (moment 1) and after (moment 2) patient or patient environment contact. 2021/22: Q3: 83% (Moment 1 Compliance) 86% (Moment 4 Compliance) Q4: 88% (Moment 1 Compliance) 91% (Moment 4 Compliance) 2022/23: Q1: 84% (Moment 1 Compliance) 88% (Moment 4 Compliance) Reporting to date (March 2022) Additional staffing demands related to pandemic response and associated pressures have resulted in increased overtime in PCHs compared to the pre-pandemic baseline. Overtime as % of hours worked: 2021/22 (to Jan 31, 2022): 5.06% 2019/20 (baseline): 2.73% Final Reporting (Fall 2022) Overtime as % of hours worked: 2021/22 (final): 5.13%

Footnote 1

Manitoba Health, Seniors and Active Living 2016-17 Annual Statistics, https://www.gov.mb.ca/health/annstats/as1617.pdf

Return to footnote 1 referrer

Footnote 2

Manitoba Health, Seniors and Active Living 2016-17 Annual Statistics, https://www.gov.mb.ca/health/annstats/as1617.pdf

Return to footnote 2 referrer

Footnote 3

The Future of Home Care Services in Manitoba, 2016, https://www.gov.mb.ca/health/homecare/future_homecare.pdf

Return to footnote 3 referrer

Footnote 4

Manitoba Home Care Reporting System

Return to footnote 4 referrer

Footnote 5

Statistics Canada Census, 2016, http://www12.statcan.gc.ca/census-recensement/2016/dp-pd/prof/details/Page.cfm?Lang=E&Geo1=PR&Code1=46&Geo2=&Code2=&Data=Count&SearchText=Manitoba&SearchType=Begins&SearchPR=01&B1=All&GeoLevel=PR&GeoCode=46

Return to footnote 5 referrer

Footnote 6

Improving Access and Coordination of Mental Health and Addiction Services: A Provincial Strategy for all Manitobans, 2018 https://www.gov.mb.ca/health/mha/docs/mha_strategic_plan.pdf

Return to footnote 6 referrer

Footnote 7

Canadian Community Health Survey – Mental Health (CCHS-MH), 2012, http://www23.statcan.gc.ca/imdb/p2SV.pl?Function=getSurvey&SDDS=5015

Return to footnote 7 referrer

Footnote 8

Nathan C Nickel, James Bolton, Leonard MacWilliam, Okechukwu Ekuma, Heather Prior, Jeff Valdivia, Christine Leong, Geoffrey Konrad, Greg Finlayson, Josh Nepon, Deepa Singal, Susan Burchill, Randy Walld, Leanne Rajotte, Michael Paille. Health and Social Outcomes Associated with High-Risk Alcohol Use. Winnipeg, MB. Manitoba Centre for Health Policy, Summer 2018. http://mchp-appserv.cpe.umanitoba.ca/reference//alcohol_Report_web.pdf

Return to footnote 8 referrer

Footnote 9

Surveillance of Opioid Misuse and Overdose in Manitoba, 2017, https://www.gov.mb.ca/health/publichealth/surveillance/docs/q1_summary.pdf

Return to footnote 9 referrer

Footnote 10

Improving Access and Coordination of Mental Health and Addiction Services: A Provincial Strategy for all Manitobans, 2018. https://www.gov.mb.ca/health/mha/docs/mha_strategic_plan.pdf

Return to footnote 10 referrer

Footnote 11

Chartier M, Brownell M, MacWilliam L, Valdivia J, Nie Y, Ekuma O, Burchill C, Hu M, Rajotte L, Kulbaba C. The Mental Health of Manitoba's Children. Winnipeg, MB. Manitoba Centre for Health Policy, Fall 2016. http://mchp-appserv.cpe.umanitoba.ca/reference/MHKids_web_report.pdf

Return to footnote 11 referrer

Footnote 12

Canadian Institute for health Information, Care for Children and Youth With Mental Disorders, Updated May 2018 https://secure.cihi.ca/estore/productFamily.htm?locale=en&pf=PFC2866

Return to footnote 12 referrer

Footnote 13

Postpartum Depression Association of Manitoba, The Facts, http://www.ppdmanitoba.ca/the-facts/ Retrieved June 27, 2018

Return to footnote 13 referrer

Page details

Date modified:: 2024-04-15

Canada-Manitoba Home and Community Care and Mental Health and Addictions Services Funding Agreement

Table of Contents

Funding Agreement

1.0 Objectives

2.0 Action Plan

3.0 Term of Agreement

3.3 Renewal of Bilateral Agreement

4.0 Financial Provisions

4.2 Allocation to Manitoba

4.3 Payment

4.4 Carry Over

4.5 Repayment of overpayment

4.6 Use of Funds

4.7 Eligible Expenditures

4.8 Cost Recovery

5.0 Performance Measurement and Reporting to Canadians

5.1 Funding conditions and reporting

5.2 Audit

5.3 Evaluation

6.0 Communications

7.0 Dispute Resolution

8.0 Amendments to the Agreement

9.0 Equality of Treatment

10.0 Termination

11.0 Notice

12.0 General

Annex 1 to the Agreement

Annex 2 to the Agreement

Manitoba Action Plan on Home and Community Care and Mental Health and Addictions Services

Introduction

Home, community and palliative care overview

Priority areas for cost-shared investment

Performance measurement for home and community and palliative care

Mental health and substance use and addictions overview

Priority areas for cost-shared investment

Performance measurement for mental health and addictions:

Manitoba - Action Plan for Increased Infection Prevention and Control

Overview

Long-term care (LTC) in Manitoba

Licenced personal care homes by regional health authority

Pre-pandemic challenges

COVID-19 response

Initiatives that will be supported by SLTC Funding

Personal care home visitation shelter operating costs

Increased staffing and operational costs to support pandemic response

Funding breakdown by initiative

Page details