Canada-Manitoba Aging with Dignity funding agreement (2023-24 to 2027-28)

Table of contents

• Funding agreement
• Annex 1 – Common statement of principles on shared health priorities
• Annex 2 – Shared pan-Canadian interoperability roadmap
• Annex 3 – Indicators: Access to home and community care
• Annex 4 – Action plan

Funding agreement

(the "Agreement")

BETWEEN:

- and -

REFERRED to collectively as the "Parties", and individually as a "Party"

PREAMBLE

WHEREAS, on February 24, 2023, Canada and Manitoba announced an overarching agreement in principle on Working Together to Improve Health Care for Canadians, supported by almost $200 billion over ten years in federal funding, including $46.2 billion in new funding to provinces and territories, Canada and Manitoba acknowledged the importance of helping Canadians age closer to home;

WHEREAS, Canada has also announced a 5 per cent Canada Health Transfer (CHT) guarantee for the next five years, starting in 2023-24, which will be provided through annual top-up payments as required. This is projected to provide approximately an additional $17 billion over 10 years in new support. The last top-up payment will be rolled into the CHT base at the end of the five years to ensure a permanent funding increase, providing certainty and sustainability to provinces and territories;

WHEREAS, in the area of home and community care, Working Together to Improve Health Care for Canadians also includes a commitment by Canada and Manitoba to continue to work to support collaboration on the Common Statement of Principles on Shared Health Priorities (hereinafter referred to as the "Common Statement", attached hereto as Annex 1), supported by the federal Budget 2017 investment of $6 billion over ten years;

WHEREAS, this Agreement also provides financial support for long-term care as it relates to the Government of Canada's Budget 2021 investment of $3 billion over 5 years to support provinces and territories in keeping long-term care residents safe and improve their quality of life;

WHEREAS, Manitoba has the primary responsibility for delivering health care services to its residents and supports diversity, equity, and the needs of underserved and/or disadvantaged populations, including, but not limited to First Nations, Inuit and Métis, official language minority communities, rural and remote communities, children, racialized communities (including Black Canadians), and LGBTIQA2S+;

WHEREAS, Canada authorized the federal Minister to enter into agreements with the provinces and territories, for the purpose of identifying activities that provinces and territories will undertake in respect of long-term care, and for funding in this Agreement associated with the federal investment for home and community care consistent with the Common Statement (and menu of actions outlined in Annex 1);

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 associated with the federal investment for long-term care, and home and community care consistent with the Common Statement; and

NOW THEREFORE, this Agreement sets out the terms between Canada and Manitoba as follows:

1.0 Key principles and collaboration

The key principles and commitment to collaboration agreed to in Working Together to Improve Health Care for Canadians are outlined below.

1.1 Canada and Manitoba acknowledge that this Agreement will mutually respect each government's jurisdiction, and be underpinned by key principles, including:

• A shared responsibility to uphold the Canada Health Act that strengthens our public health care system;
• Principles agreed to in the Common Statement (outlined in Annex 1);
• Reconciliation with Indigenous Peoples, recognizing their right to fair and equal access to quality and culturally safe health services free from racism and discrimination anywhere in Canada, including through seamless service delivery across jurisdictions and meaningful engagement and work with Indigenous organizations and governments; and
• Equity of access for under-served groups and individuals, including those in official language minority communities.

1.2 Canada and Manitoba acknowledge the importance of supporting health data infrastructure, data collection and public reporting, and will work together to improve the collection, sharing and use of de-identified health information, respecting federal/provincial/territorial privacy legislation, to improve transparency on results and to help manage public health emergencies, and to ensure Canadians can access their own health information and benefit from it being shared between health workers across health settings. This includes:

• collecting and securely sharing high-quality, comparable information needed to improve services to Canadians, including disaggregated data on key common health indicators with the Canadian Institute for Health Information (CIHI);
• adopting common interoperability standards (both technical exchange and content of data), including the Shared pan-Canadian Interoperability Roadmap (outlined in Annex 2), to improve Canadians' access to their health information in a usable digital format and support the exchange and analysis of health data within and across Canada's health systems in a way that protects Canadians' privacy and ensures the ethical use of data to improve the health and lives of people;
• work to align provincial and territorial policies and legislative frameworks where necessary and appropriate to support secure patient access to health information, and stewardship of health information to support the public good, including improving care quality, patient safety, privacy protection, system governance and oversight, planning and research;
• promoting health information as a public good by working with federal-provincial-territorial Ministers of Health to review and confirm overarching principles, which would affirm Canadians' ability to access their health information and have it follow them across all points of care. The existing Health Data Charter, as outlined in the Pan-Canadian Health Data Strategy would serve as the starting point for the discussion of these principles; and
• collecting and sharing available public health data (e.g., vaccination data, testing data) with the Public Health Agency of Canada to support Canada's preparedness and response to public health events, building on commitments made as part of the Safe Restart Agreements.

1.3 Canada and Manitoba acknowledge they will work with other provinces and territories to streamline foreign credential recognition for internationally-educated health professionals, and to advance labour mobility, starting with multi-jurisdictional recognition of health professional licences.

1.4 Canada and Manitoba acknowledge a mutual intent to engage in a two-phased formal review process:

1. Phase 1: This review will be done in 2026 by a joint committee of Federal, Provincial, and Territorial health and finance officials to assess results and determine next steps for bilateral agreements related to improvements to home and community care, mental health, substance use, and addiction services associated with the Common Statement and long-term care; and
2. Phase 2: A formal five-year review of the healthcare plan outlined on February 7, 2023, recognizing the importance of long-term sustainability for provincial-territorial health systems. This review would consist of an assessment of both the bilateral agreements (herein) and the CHT investments (not included as part of this bilateral agreement). The review will be done by a joint committee of Federal, Provincial, and Territorial health and finance officials, commencing by March 31, 2027, and concluded by December 31, 2027, to consider results achieved thus far in the four shared health priority areas and will include:
   1. an assessment of progress-to-date on public reporting to Canadians using the common indicators;
   2. sharing of de-identified health information, and other health data commitments; and
   3. current and forward-looking Federal, Provincial, and Territorial investments to support this plan.

2.0 Objectives

2.1 Canada and Manitoba agree that, with financial support from Canada, Manitoba will continue to build and enhance health care systems towards achieving some or all of the objectives of:

• Improving access to home and community care services (listed in the Common Statement, attached as Annex 1); and
• Supporting workforce improvements for long-term care and standards, to keep long-term care residents safe and to improve their quality of life.

3.0 Action plan

3.1 Manitoba will set out in their Action Plan (attached as Annex 4) how the federal investment under this Agreement will be used, as well as details on targets and timeframes for each of the initiatives supported under the Agreement.

3.2 Manitoba will invest federal funding as part of the 2017 commitment for home and community care provided through this Agreement in alignment with the menu of actions listed in the Common Statement.

3.3 Manitoba will invest federal funding for long-term care provided through this Agreement to bolster efforts to support workforce improvements and standards by:

• Supporting activities/initiatives to achieve stability in the long-term care workforce, including through hiring and wage top-ups and/or improvements to workplace conditions (e.g., staff to patient ratios, hours of work); and
• Applying long-term care standards, with an emphasis on strengthened enforcement (e.g., enhanced inspection and enforcement capacity, quality and safety improvements to meet standards).

3.4 In developing initiatives under this Agreement, Manitoba agrees to implement measures that also respond to the needs of underserved and/or disadvantaged populations, including, but not limited to First Nations, Inuit and Métis, official language minority communities, rural and remote communities, children, racialized communities (including Black Canadians), and LGBTIQA2S+.

3.5 Manitoba's approach to achieving home and community care and long-term care objectives is set out in their five-year Action Plan, as set out in Annex 4.

4.0 Term of Agreement

4.1 This Agreement comes into effect upon the date of the last signature of the Parties and will remain in effect until March 31, 2028, unless terminated in accordance with section 12 of this Agreement. Funding provided under this Agreement will be for five years and will cover the period April 1, 2023 to March 31, 2028 ("the Term").

5.0 Financial provisions

5.1 The funding provided under this Agreement is in addition to and not in lieu of those that Canada currently provides under the CHT to support delivering health care services within the province.

5.2 Allocation to Manitoba

5.2.1 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.

5.2.2 Canada has designated the following maximum amounts to be transferred in total to all provinces and territories under this initiative based on the allocation method outlined in subsection 5.2.3 for the Term of this Agreement.

Budget 2017 home and community care

1. $600 million for the Fiscal Year beginning on April 1, 2023
2. $600 million for the Fiscal Year beginning on April 1, 2024
3. $600 million for the Fiscal Year beginning on April 1, 2025
4. $600 million for the Fiscal Year beginning on April 1, 2026

Budget 2021 long-term care

1. $600 million for the Fiscal Year beginning on April 1, 2023
2. $600 million for the Fiscal Year beginning on April 1, 2024
3. $600 million for the Fiscal Year beginning on April 1, 2025
4. $600 million for the Fiscal Year beginning on April 1, 2026
5. $600 million for the Fiscal Year beginning on April 1, 2027

5.2.3 Allocation method

1. For funds associated with Budget 2017 Home and Community Care committed by the federal government in 2017, annual funding will be allocated to provinces and territories on a per capita basis. The per capita funding for each Fiscal Year is calculated using the following formula: F x K/L, where:

   F is the annual total funding amount available under this program;

   K is the total population of Manitoba, as determined using the annual population estimates on July 1^st from Statistics Canada; and

   L is the total population of Canada, as determined using the annual population estimates on July 1^st from Statistics Canada.

2. For funds associated with Budget 2021 Long-Term Care committed by the federal government in 2021, annual funding will be allocated to provinces and territories with a base amount of $1,200,000 and the remainder of the funding allocated on a per capita basis. The total amount to be paid will be calculated using the following formula: $1,200,000+(F-(N x 1,200,000)) x (K/L), where:

   F is the annual total funding amount available under this program;

   N is the number of jurisdictions (13) that will be provided the base funding of $1,200,000;

   K is the total population of Manitoba, as determined using the annual population estimates on July 1^st from Statistics Canada; and

   L is the total population of Canada, as determined using the annual population estimates on July 1^st from Statistics Canada.

5.2.4 Subject to annual adjustment based on the formulas described in section 5.2.3, Manitoba estimated share of the amounts will be:

5.3 Payment

5.3.1 Funding provided by Canada will be paid in semi-annual installments as follows:

1. In 2023-24, the first installment will be paid within approximately 30 business days of execution of this Agreement by the Parties. The second installment will also be paid within approximately 30 business days of execution of this Agreement by the Parties, subject to 5.3.1.g.
2. Starting in 2024-25, the first installment will be paid on or about April 15 of each Fiscal Year and the second installment will be paid on or about November 15 of each Fiscal Year.
3. The first installment will be equal to 50% of the notional amount set out in section 5.2.4 as adjusted by section 5.2.3.
4. The second installment will be equal to the balance of funding provided by Canada for the Fiscal Year as determined under sections 5.2.3 and 5.2.4.
5. Canada will notify Manitoba prior to the first payment of each 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. Prior to the second payment, Canada will notify Manitoba of the amount of the second installment as determined under sections 5.2.3 and 5.2.4.
6. Canada shall withhold payments if Manitoba has failed to provide reporting in accordance with 8.1.
7. Canada shall withhold the second payment in 2023-24 if Manitoba has failed to satisfy all reporting requirements associated with the preceding Canada – Manitoba Home and Community Care and Mental Health and Addictions Services Funding Agreement 2022-23, specifically to:
   1. continue to participate in a Federal-Provincial-Territorial process to improve reporting on and provide data to CIHI for the 6 common indicators (listed in Annex 3) to measure pan-Canadian progress on improving access to home and community care; and
   2. submit an annual financial statement, with attestation from the Manitoba Health Financial Officer, of funding received the preceding Fiscal Year from Canada for home and community care under the Canada – Manitoba Home and Community Care and Mental Health and Addictions Services Funding Agreement 2022-23 compared against the Expenditure Plan, and noting any variances, between actual expenditures and the Expenditure Plan.
8. The sum of both installments constitutes a final payment and is not subject to any further payment once the second installment has been paid.
9. Payment of Canada's funding for this Agreement is subject to an annual appropriation by the Parliament of Canada for this purpose.

5.3.2 Where Manitoba will use cost-recovery agreements with one or more privately-owned for-profit facilities as an accountability measure and Manitoba has failed to put in place a cost-recovery agreement by April 1, 2024, Canada shall deduct from the payment referred to in subsection 5.3.1(b) an amount equivalent to the amount of funding noted in Annex 4 to be provided by Manitoba to those facilities with whom they do not have the required cost-recovery agreements in place.

5.4 Retaining funds

5.4.1 For Fiscal Years 2023-24 through 2026-27, upon request, Manitoba may retain and carry forward to the next Fiscal Year up to 10 percent of funding that is in excess of the amount of the eligible costs actually incurred in a Fiscal Year and use the amount carried forward for expenditures on eligible areas of investment. Any request to retain and carry forward an amount exceeding 10 percent will be subject to discussion and mutual agreement in writing by their designated officials, at the Assistant Deputy Minister level (herein referred to as "Designated Officials"), and is subject to monitoring and reporting to Canada on the management and spending of the funds carried forward on a quarterly basis.

5.4.2 For Fiscal Year 2027-28, Manitoba is not entitled to retain any amounts beyond March 31, 2028. Any amounts that remain unexpended at the end of that Fiscal Year are considered debts due to Canada and shall be repaid in accordance with section 5.5.2.

5.4.3 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 5.2.4 of this Agreement in the next Fiscal Year.

5.5 Repayment of overpayment

5.5.1 In the event payments made 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.

5.5.2 Funds not spent within the Term of the Agreement will be considered a debt due to Canada and Manitoba shall repay the amount within sixty (60) calendar days of written notice from Canada.

5.6 Use of funds

5.6.1 The Parties agree that funds provided under this Agreement will only be used by Manitoba in accordance with the initiatives outlined in Annex 4.

5.7 Eligible Expenditures

5.7.1 Eligible expenditures under this Agreement are the following:

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

5.7.2 The Parties agree that the long-term care funding may be provided to:

• publicly-owned long-term care settings;
• privately-owned not-for-profit long-term care settings; and
• subject to section 6.0, privately-owned for-profit long-term care settings.

6.0 Accountability mechanisms for long-term care

6.1 Where federal funding is provided to privately-owned, for-profit facilities in accordance with this Agreement, Manitoba agrees to put in place the accountability mechanisms outlined in Annex 4.

6.2 Where Manitoba has cost-recovery agreements in place with one or more privately-owned for-profit facilities pursuant to subsection 6.1, Manitoba agrees to report on these in accordance with the requirements set out in subsection 8.1.1 and invest all funds recovered through those agreements in accordance with the terms of this Agreement and the initiatives outlined in Annex 4.

7.0 Performance measurement

7.1 Manitoba agrees to designate an official or official(s), for the duration of this Agreement to participate in a CIHI led Federal-Provincial-Territorial indicator process to:

1. Improve reporting on common indicators to measure pan-Canadian progress on improving access to home and community care, associated with the commitment in the Common Statement;
2. Develop new common indicators for long-term care; and
3. Share available disaggregated data with CIHI and work with CIHI to improve availability of disaggregated data for existing and new common indicators to enable reporting on progress for underserved and/or disadvantaged populations including, but not limited to, Indigenous peoples, First Nations, Inuit, Métis, official language minority communities, rural and remote communities, children, racialized communities (including Black Canadians), and LGBTIQA2S+.

8.0 Reporting to Canadians

8.1 Funding conditions and reporting

8.1.1 By no later than October 1, in each fiscal year, with respect of the previous Fiscal Year, Manitoba agrees to:

1. Provide data and information annually to CIHI related to the home and community care common indicators (listed in Annex 3) identified as part of the commitment made in the Common Statement, and, new common indicators on long-term care.
2. Beginning in Fiscal Year 2024-25, report annually and publicly in an integrated manner to residents of Manitoba on progress made on targets outlined in Annex 4 (Action Plan).
3. Beginning in Fiscal Year 2024-25, provide to Canada an annual financial statement, with attestation from the Manitoba Health, Seniors and Long-Term Care Financial Officer, of funding received the preceding Fiscal Year from Canada under this Agreement or the Previous Agreement compared against the Action Plan, and noting any variances, between actual expenditures and the Action Plan:
   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 long-term care;
   3. If applicable, the amount of any funding carried forward under section 5.4;
   4. If applicable, the amount of overpayment that is to be repaid to Canada under section 5.5; and
   5. With respect to the long-term care funding under this Agreement, where cost-recovery is used, the annual financial statement will also set out:
      1. The amount of the federal funding flowing to private, for-profit facilities; and
      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.

8.1.2 Manitoba will provide quarterly reporting to Canada on the management and spending of the funds retained to the next Fiscal Year.

8.2 Audit

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

8.3 Evaluation

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

9.0 Communications

9.1 The Parties 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.

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

9.3 In the spirit of transparency and open government, Canada will make this Agreement, including any amendments, publicly available on a Government of Canada website.

9.4 Manitoba will make publicly available, clearly identified on a Government of Manitoba website, this Agreement, including any amendments.

9.5 Canada, with prior notice to Manitoba, may incorporate all or any part of the data and information in 8.1, or any part 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.

9.6 Canada reserves the right to conduct public communications, announcements, events, outreach and promotional activities about the Common Statement and this Agreement. Canada agrees to give Manitoba 10 days advance notice and advance copies of public communications related to the Common Statement, this Agreement, and results of the investments of this Agreement.

9.7 Manitoba reserves the right to conduct public communications, announcements, events, outreach and promotional activities about the Common Statement and this Agreement. Manitoba agrees to give Canada 10 days advance notice and advance copies of public communications related to the Common Statement, this Agreement, and results of the investments of this Agreement.

9.8 Canada and Manitoba agree to participate in a joint announcement upon signing of this Agreement.

9.9 Canada and Manitoba agree to work together to identify mutually agreeable opportunities for joint announcements relating to programs funded under this Agreement.

10.0 Dispute resolution

10.1 The Parties 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.

10.2 If at any time a Party 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, that Party may notify the other Party in writing of the failure or breach. Upon such notice, the Parties will endeavour to resolve the issue in dispute bilaterally through their Designated Officials.

10.3 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 federal Minister(s) and the provincial Minister(s) shall endeavour to resolve the dispute.

11.0 Amendments to the Agreement

11.1 The main text of this Agreement may be amended at any time by mutual consent of the Parties. Any amendments shall be in writing and signed, in the case of Canada, by the federal Minister(s), and in the case of Manitoba, by the provincial Minister(s).

11.2 Annex 4 may be amended at any time by mutual consent of the Parties. Any amendments to Annex 4 shall be in writing and signed by each Party's Designated Official.

12.0 Termination

12.1 Either Party may terminate this Agreement at any time if the terms are not respected by giving at least 6 months written notice of intention to terminate.

12.2 As of the effective date of termination of this Agreement, Canada shall have no obligation to make any further payments.

12.3 Sections 1.0 and 9.0 of this Agreement survive for the period of the 10-year Working Together to Improve Health Care for Canadians plan.

12.4 Sections 5.4 and 8.0 of this Agreement survive the termination or expiration of this Agreement until reporting obligations are completed.

13.0 Notice

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

The address of the Designated Official for Canada shall be:

Assistant Deputy Minister, Strategic Policy Branch
Health Canada
70 Colombine Driveway
Brooke Claxton Building
Ottawa, Ontario
K1A 0K9

Email: jocelyne.voisin@hc-sc.gc.ca

The address of the Designated Official for Manitoba shall be:

Associate Deputy Minister - Health, Seniors and Long-Term Care
Manitoba Health, Seniors and Long-Term Care
300 Carlton Street
Winnipeg, Manitoba

Email: Suzanne.Gervais@gov.mb.ca

14.0 General

14.1 This Agreement, including Annexes, comprises the entire Agreement entered into by the Parties.

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

14.3 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.

14.4 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 severed and deleted from this Agreement, but all the other provisions of this Agreement will continue to be valid and enforceable.

14.5 This Agreement may be executed in counterparts, in which case (i) the Parties have caused this Agreement to be duly signed by the undersigned authorized representatives in separate signature pages in accordance with the following signature process, which together shall constitute one agreement, and (ii) the Parties agree that facsimile signature(s) and signature(s) transmitted by PDF shall be treated as original signature(s). Electronic signature(s) may be accepted as originals so long as the source of the transmission can be reasonably connected to the signatory.

IN WITNESS WHEREOF the Parties have executed this Agreement through duly authorized representatives.

SIGNED on behalf of Canada by the Minister of Health

The Honourable Mark Holland, Minister of Health

IN WITNESS WHEREOF the Parties have executed this Agreement through duly authorized representatives.

SIGNED on behalf of Manitoba by the Minister of Health, Seniors and Long-Term Care

The Honourable Uzoma Asagwara, Deputy Premier and Minister of Health, Seniors and Long-Term Care

Annex 1 – Common Statement of Principles on Shared Health Priorities

Common Statement of Principles on Shared Health Priorities

Annex 2 – Shared pan-Canadian interoperability roadmap

Annex 3 – Indicators: Access to home and community care

Indicator

• Death at home or in community (Percentage)
• Home care services helped the recipient stay at home (Percentage)
• Wait times for home care services (Median, in days)
• Caregiver distress (Percentage)
• New long-term care residents who potentially could have been cared for at home (Percentage)
• Hospital stay extended until home care services or supports ready (Median, in days)

Annex 4 – Action plan

1.0 Introduction

All seniors should be able to age with dignity and respect. The Government of Manitoba is committed to taking better care of seniors to support their ability to stay safe in their own homes and communities as long as they choose.

Manitoba offers a range of supports and continuing care options for seniors including home care, supportive housing and long-term care through personal care homes (PCH). The seniors population in Manitoba is expected to increase by almost 60% by 2050, further highlighting the importance of ensuring a continuum 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.

Supporting seniors and improving long-term care are important priorities for the Government of Manitoba. Manitoba will be creating a Seniors Advocate to act as a strong independent voice for seniors and their families and improve care for seniors. The province is committed to help seniors live independently through expanded home care hours and hiring 100 more home care workers. This will mean more support to age at home and more options for seniors who need higher levels of care as they age.

Manitoba is also taking action to improve care in PCHs and address staffing shortages. This includes a commitment to increasing the hours of direct care for seniors in PCH, and increasing the overall number of PCH beds available.

2.0 Home and Community Care

2.1 Context

Established in 1974 and the first of its kind, Manitoba has the oldest comprehensive, province-wide, universal home care 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. This includes work to better address the needs of underserved populations, such as Indigenous people, 2SLGBTQ+ seniors, Francophones and French-speaking Manitobans, and members of different ethno-cultural communities by fostering equitable, culturally safe, and high-quality care where these individuals may experience stigma and discrimination in the health care system. Home care services are provided to all qualifying Manitobans, at no cost to the individual.

However, demands for home care services continue to increase significantly. Moreover, 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 have necessitated ongoing service expansions and implementation of evolving models of care to appropriately meet demands through Manitoba's universal, non-income tested home care services. Federal funding through the Canada-Manitoba Home and Community Care and Mental Health and Addictions Services Funding Agreements (2018-19 to 2021-22 and 2022-23) has helped to support ongoing service delivery expansions required to meet the ever-changing needs of home care recipients in Manitoba.

Between 2016-17 and 2017-18 the number of Manitoba home care clients grew by 3.7% from 25,573 to 26,531 clients at a given time respectively, and as of March 31, 2022, 30,150 clients served at a given time through home care in 2021/22 (total number serviced in a year grew by almost 10,000 clients).

Seniors want to live and age in their homes and communities and innovative actions and initiatives will be needed to meet the needs of individuals and families into the future. Seniors advocacy, prevention and wellness, community health, home care, congregate settings with health services, personal care homes, and end of life care are foundational in supporting seniors to age successfully in their homes and communities.

2.2 Initiatives to be supported by federal funding over the next four years

Manitoba is making significant investments to meet the needs of seniors and support home and community care options. Federal funding through the Aging with Dignity agreement will help to support a portion of new measures the province is implementing to support home and community care on the continuum of care and the menu of actions outlined in the Common Statement of Principles on Shared Health Priorities (2017).

2.2.a Increasing safety, wellness, and prevention for seniors in the community

Seniors should expect the opportunity to remain a part of our communities as long as they choose and it is safe to do so. This will require communities to be safe, inclusive and appropriate for all. Funding through this agreement will be directed to initiatives that support safety and wellness for seniors and their caregivers in the community. Federal funding will support the expansion of the number of seniors supported by elder abuse services, and the expansion of the Age Friendly Communities initiative. Funds will also be directed to the launch of a new grant program for hearing aids as outlined below.

• Expansion of Elder Abuse Services - The abuse of seniors is an ongoing concern in Manitoba and is one of the most unreported crimes in Canada with an estimate of 10% of seniors experiencing one or more forms of abuse. Manitoba provides support through A&O: Support Services for Older Adults to deliver elder abuse prevention and support services. Federal funding will be directed to the expansion of these services to support home safety planning, community awareness, and support for victims of crime. A total of 290 clients are estimated to be serviced each year. Funds will be used to increase the number of vulnerable seniors served and support the development of online services.
• Expansion of Age Friendly Communities - Age-Friendly Manitoba supports seniors in leading active, socially engaged, independent lives that contribute to healthy aging and enhanced quality of life. Age Friendly Communities yield benefits for all community members, particularly seniors and their caregivers. Federal funding will be directed to the expansion of Age Friendly Communities in Manitoba beginning in 2023/24, which will support new and developing age-friendly communities, including Indigenous, northern and ethno-cultural communities. Funding will also support providing increased resources and tools to better meet the needs of seniors, including adding dementia-friendly concepts into resources and broadening focus on wellness through social inclusion.
• New Hearing Aid Program - The introduction of a Hearing Aid Program in 2023/24 will assist moderate to low-income seniors in purchasing hearing aids. The cost of hearing aids is a barrier for many seniors, resulting in increased social isolation, increased dependency on others to meet care needs and deceased independence. With the support of federal funding for this new program, approximately 4000 seniors are expected to be served each year through these new grants. Hearing loss is associated with increased social isolation, increased dependency on others to meet care needs and deceased independence. This program will help to increase the safety and quality of life for grant recipients, and increase their ability to age-in-place and remain in their homes independently.

These initiatives align with the Common Statement of Principles by spreading and scaling evidence-based models of home and community care, and by providing increased support to caregivers.

2.2.b Improving access to community supports for seniors that alleviate pressures from other health system services (e.g. home care).

Community supports are vital in supporting more formalized health services such as home care. Investments of federal funding through the agreement will help to enable seniors to stay engaged and as part of our communities as their needs and capabilities change. This includes expanded capacity for community-based services and dementia supports, and launch of a new program supporting home modifications as outlined below.

• Safe and Healthy at Home for Seniors – Federal funding will help support the launch of a new program that will assist low to moderate income senior homeowners across Manitoba with activities of daily living home modifications. Grant supports to seniors will be provided to modify their homes to remain safe and age in their communities, and with their family members. Typical modifications may include widening of doorways or installing ramps, grab bars or safety rails. An estimated 100-150 clients per year will receive grants.
• Expansion of Seniors Support Services – The Support Services to Seniors (SSS) Program promotes a range of coordinated, accessible and affordable community-based services that focus on promoting health, independence, social engagement, and the well-being for seniors. SSS assists communities in creating and developing resources that maintain and/or enhance the physical, psychological, and social well-being of older persons in order to support their ability to remain independent and alleviating pressure from home care and other health services. SSS programing is community-based and dependent on the needs of the local community and may include supports such as congregate community meal programs, seniors centres, and seniors resource coordinators. This includes specific programming for 2SLGBTQ+ seniors. Many 2SLGBTQ+ seniors experience social isolation and are choosing to go back into the closet due to fears of discrimination they may face in the health system. Federal funding will be directed to supporting expanded SSS programming and navigation supports. Federal funding will also support expansion of services aimed specifically at reducing social isolation among 2SLGBTQ+ seniors, and training to improve inclusive 2SLGBTQ+ supports to seniors in long-term care and other health settings.
• Expansion of Dementia supports – The Alzheimer Society of Manitoba (ASM) First Link program connects people with Alzheimer's disease and other dementias, and their families, to necessary supports throughout the progression of the disease. Federal funding will be used to increase the number of clients served and reduce wait-times for clients in the First Link Program and other community-based dementia supports. This includes increased access to community resources, support and information, education, and access to dementia-specific expertise. Client contact time is expected to be reduced from the current three week wait to 48 hours.

These initiatives align with the Common Statement of Principles by spreading and scaling evidence-based models of home and community care, and by providing increased support to caregivers.

2.2.c Improving health services through home care in the community

Supporting and stabilizing health services in home care will improve patient access and flow, and reduce avoidable emergency department utilization. These services need to be accessible, equitable, high quality, affordable, connected to each other, and delivered by expert and experienced service providers. To ensure that programs and services are meeting people's needs, there needs to be a mechanism to guide them towards the best-fit services for the public. Federal funding through this agreement will be directed to the expansion of home care service options in the community, including palliative care services.

• Expansion of Homecare – Manitoba is committed to rebuilding public home care services in Manitoba. The Self and Family Managed Care (SFMC) is a home care program option under which funding equivalent to the cost of home care non-professional services is provided to assist eligible home care clients in taking full responsibility for arranging, coordinating and managing those non-professional services (e.g. housekeeping, laundry, meal preparation, and personal care) required to meet their assessed home care needs. Federal funds will be used to increase program funding to help clients recruit and retain workers and the number of clients served through the SFMC program in order to strengthen and support traditional home care services in Manitoba. An estimated 1700 clients are expected to be served through SFMC per year, an increase of more than 20%.
• Expansion of Palliative Care Services – Palliative and end-of-life care is an approach to care that improves the quality of living and dying for patients and their families. Federal funding will support strengthened and enhanced access for people affected by life-limiting illness at home, including in First Nations communities. Funding will also be used to increase the number of clients receiving palliative care services. The expansion will also increase support for caregivers through consultations with palliative care teams, improve after hours and on-call care, and enhance training and awareness of palliative care for health providers. There will also be improved coordination of home care services for palliative clients. With the expansion an estimated 600 clients are expected to be served through the palliative care program per year.

These initiatives align with the Common Statement of Principles by spreading and scaling evidence-based models of home and community care, enhancing access to palliative care, and by providing increased support to caregivers.

2.3 Measuring and reporting on results

Manitoba will continue to work with the Canadian Institute for Health Information (CIHI) on pan-Canadian indicators and commits to working towards reporting data related to home and community care. Manitoba will also report annually on the following jurisdiction-specific indicators on the Government of Manitoba website:

3.0 Long-Term Care

3.1 Context

There are 124 licensed PCH operating in Manitoba with approximately 9600 beds (over 75% are non-profit). PCHs are designed for individuals who require 24 hour daily care and are experiencing care needs that cannot be met in the community. PCHs primarily serve adults 75 years of age and older that may have a chronic condition, disability, or can no longer live independently. 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 licensed 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 licenses and monitors all PCHs in Manitoba. A regular standards review is conducted at each PCH 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.

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.

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. Underlying this work is a commitment to better serving the needs of all Manitobans. This includes increasing the representation of Indigenous health care providers, and increasing the provision of culturally-safe and informed care models. Manitoba is also committed to improving access to services in French.

The COVID-19 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. Gaps were identified in facilities ability to operationalize outbreak plans, staffing levels and appropriate services, and licensing standards. Provincial efforts to date have supported enhancements of infection prevention and control within the long-term care sector, strengthening capacity for quality and standards officers and direct care and allied health staffing.

Manitoba is committed to building public trust in PCHs, addressing staffing challenges, and prioritizing quality and safety.

3.2 Initiatives to be supported by federal funding over the next five years

Quality and Safety in Personal Care Home

Manitoba is investing heavily in increased staffing and operational supports to long-term care facilities across the province. Federal funding through the Aging with Dignity agreement will support a portion of new investments to support improvements for PCH residents, families and staff, with a focus on quality and safety.

These initiatives will support both workforce stability, and compliance and enforcement of quality and safety in both publicly-owned and private not-for-profit PCHs.

3.2.a Resident Safety and Standards Modernization

New federal funding will be directed at a number of initiatives to support resident safety and standards modernization as outlined below.

Federal funds will be used to support implementation of an infection prevention and control (IPAC) provincial program to improve integration, coordination and safety in IPAC practices in PCHs. Investments will help to increase resident safety with the application of consistent practices and standards in PCHs and integrated with the broader health system. Funding will increase the number of IPAC-trained staff at the provincial, regional and PCH site levels, and provide a standardized program with requirements for audits and monitoring.

Federal funding will support improvements to increase medical oversight and ensure medical on-site visitation within PCHs. A medical long-term care leadership structure will provide consistent medical guidance and communication between provincial medical leads, regional medical leaders and medical leads in PCHs. These medical leads will also have responsibilities to support IPAC activities, and to ensure that on-site visits occur. The Medical Bylaw Rules and Regulations will guide medical oversight.

Additionally, as outlined below, federal funds are supporting the addition of new housekeeping positions in PCHs to ensure sites are able to meet IPAC standards of cleanliness at all times, including during an outbreak or pandemic, and improve residents experience and quality of life care. Federal funds will also be used to support increases in FTE capacity targeted at resident safety and standards, including staff associated with IPAC and disaster management, as well as physicians, nurses and housekeeping.

Manitoba will be investing over $20 million annually to support these new resident safety initiatives. Federal funding will support $5 million per year of these increased investments.

3.2.b Workforce Stability

To support a strong PCH workforce, an overall plan to increase staffing for PCHs has been developed, recommending incremental increases for direct care nursing, health care aides, and allied health staff. Federal funding will support significant staffing expansions in PCHs in line with this plan with the overall goals of increasing quality of care for residents and improving safety. Over 400 additional FTEs across the areas of housekeeping, IPAC, direct care and allied health have been added in 2022/23, and further expansions will continue annually.

Health staffing increases will help to bring all PCHs up to a common standard of care and Manitoba is working towards a 4.1 HPRD (hours per resident day) benchmark standard (CAN/HSO 21001:2023) over time. Timelines and progress in achieving this goal will be dependent on availability of health human resources. An increased baseline standard will ensure that residents experience improvements in quality of life care. Alignments with broad health human resource planning are underway to advance and action staffing increases for PCHs and to ensure that plans for training and recruitment support staffing requirements.

Federal funding will be used to help advance accelerated increases in FTE capacity, including targeted HPRD direct care, and allied health care staffing increases.

Manitoba will be investing over $37 million per year in the ongoing salary costs for substantial PCH staffing expansions. Federal funding will support $17.4 million of these increased staffing investments during the duration of this agreement.

Note: Federal funding will only be applied to non-profit PCHs.

3.3 Measuring and reporting on results

Manitoba will work with the Canadian Institute for Health Information (CIHI) on indicators and commits to working towards reporting data related to long-term care. Manitoba will also report annually on the following jurisdiction-specific indicators on the Government of Manitoba website: