Nova Scotia letter of agreement to amend bilateral agreements for home and community care and mental health and addiction services

December 15, 2021

The Honourable Jean-Yves Duclos
Minister of Health
House of Commons
Ottawa, ON K1A 0A6

Dear Minister Duclos,

The COVID-19 pandemic has created significant challenges for Canadians and has disproportionately affected those residing in long-term care facilities. Outbreaks in these facilities have taken the lives of some of Canada’s most vulnerable citizens, and forever changed the lives of families and caregivers. To address this crisis Nova Scotia has been working to improve the safety of care for those living in long-term care settings, and those who care for them, through a broad range of measures for enhanced infection prevention and control. These measures have been supported by federal investments and resources, including the September 2020 Safe Restart Agreement funding.

Further to the Government of Canada’s commitment on November 30, 2020 to support provinces and territories through a new Safe Long-term Care Fund, Canada and Nova Scotia agree through this Letter of Agreement to amend the Canada-Nova Scotia Home and Community Care and Mental Health and Addiction Services Agreement (the Bilateral Agreement), in accordance with appendices A and B to this letter, with the aim of further protecting Canadians who reside in these settings through increased infection prevention and control measures.

The amendments in Appendix A establish the terms and conditions that apply to the Safe Long-term Care funding and include the following:

• The Government of Canada will provide Nova Scotia with total funding of up to $27,264,311, in fiscal year 2021-22 under the Safe Long-term Care Fund for eligible expenditures incurred between December 1, 2020 to March 31, 2022.
• The federal funding through the Safe Long-term Care Fund will support Nova Scotia to increase infection prevention and control in long-term care facilities, which includes licensed and funded nursing homes and residential care facilities in Nova Scotia where residents receive continuing care services. Priorities for initiatives supported by this funding will include increased staff support through the hiring of long-term care assistants, infrastructure changes to support isolation and/or single room configurations, enhanced environmental supplies to support infection prevention and control, and the creation of an Infection Control (IC) designate role to work with the Nova Scotia Health Authority (NSHA) clinicians to create robust Infection Prevention and Control (IPAC) programs to significantly reduce the impact of healthcare-associated infections.
• The funding will also support other infection protection and control efforts, including:
  • funding a team of 5 IC practitioners at the NSHA with formal accreditation to provide active participation and coordinated response in outbreak management, education, and ongoing support to work directly with the IC designates in long-term care and build capacity to develop the culture of IPAC in long-term care; and
  • other infection prevention and control efforts, including the coordination of access to personal protective equipment (PPE) to ensure all sites have readiness supplies on hand to support day to day IPAC requirements, as well as emergency supply in the event of an outbreak with increased isolation requirements.
• Nova Scotia has attached an amended action plan (Appendix B) which includes: background on long-term care in Nova Scotia; efforts undertaken since spring 2020 to mitigate the impact of COVID-19 in long-term care settings (including efforts to enhance infection prevention and control and activities supported by the Safe Restart Agreement funding); details on the initiatives that will be supported by the Safe Long-term Care Fund in the priority areas, along with a breakdown of planned expenditures and performance measures to track progress.
• Nova Scotia uses cost share methodology to fund all facilities for a portion of total expenses. To ensure Safe Long-term Care funding does not displace existing investments made by for-profit operators, Nova Scotia will  seek to identify how this funding and financial and in-kind measures made by facilities enhance overall COVID response and continue to promote and support infection prevention and control measures with any for-profit facilities that benefit from the funding under the Safe Long-term Care Fund by February 2022 to ensure that federal investments are used to further enhance the protection of residents and staff and to ensure transparency in the use of funds. Nova Scotia will amend its action plan by February 2022 to provide information with respect to those privately-owned for-profit facilities benefiting from the federal investments.
• Nova Scotia will amend its performance measurement section of the action plan by February 2022 and will further update this section by October 1, 2022 to provide information on results, with a view to showcasing to Canadians the progress achieved to protect vulnerable Canadians in long-term care settings through increased infection prevention and control.

Except as set out in the appendices to this Letter of Agreement, the terms of the Bilateral Agreement will remain in effect.

This Letter of Agreement to amend the Bilateral Agreement will be effective upon respective signature and, as per the Agreement, will remain in effect until March 31, 2022, unless otherwise terminated by the parties to the Agreement.  It, along with the updated Agreement and annexes, will be made public online by Health Canada.

The Honourable Michelle Thompson,
Department of Health and Wellness

The Honourable Barbara Adams,
Department of Seniors and Long-Term Care

The Honourable Jean-Yves Duclos, Federal
Minister of Health