Canada-New Brunswick 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 23, 2023, Canada and New Brunswick 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 New Brunswick 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 New Brunswick 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, New Brunswick has the primary responsibility for delivering health care services and long-term care 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 Financial Administration Act authorized the provincial Minister, as a member of the Executive Council, to enter into a funding agreement with the Government of Canada under which Canada undertakes to provide funding toward costs incurred by the Government of New Brunswick associated with the federal investment for long-term care, and home and community care consistent with the Common Statement;

NOW THEREFORE, this Agreement sets out the terms between Canada and New Brunswick 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 New Brunswick 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 New Brunswick 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 New Brunswick 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 New Brunswick 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 New Brunswick agree that, with financial support from Canada, New Brunswick 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 New Brunswick 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 New Brunswick 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 New Brunswick 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, New Brunswick 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 New Brunswick'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 New Brunswick

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 New Brunswick, as determined using the annual population estimates on July 1st from Statistics Canada; and

   L is the total population of Canada, as determined using the annual population estimates on July 1st 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 New Brunswick, as determined using the annual population estimates on July 1st from Statistics Canada; and

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

5.2.4 Subject to annual adjustment based on the formulas described in section 5.2.3, New Brunswick 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 New Brunswick 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 New Brunswick of the amount of the second installment as determined under sections 5.2.3 and 5.2.4.
6. Canada shall withhold payments if New Brunswick has failed to provide reporting in accordance with 8.1.
7. Canada shall withhold the second payment in 2023-24 if New Brunswick has failed to satisfy all reporting requirements associated with the preceding Canada – New Brunswick 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 Department of Health's Executive Director, Financial Services, of funding received the preceding Fiscal Year from Canada for home and community care under the Canada – New Brunswick 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 New Brunswick will use cost-recovery agreements with one or more privately-owned for-profit facilities as an accountability measure and New Brunswick 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 New Brunswick 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, New Brunswick 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, New Brunswick 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 New Brunswick 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 New Brunswick 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, New Brunswick 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 New Brunswick 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 New Brunswick 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, New Brunswick agrees to put in place the accountability mechanisms outlined in Annex 4.

6.2 Where New Brunswick has cost-recovery agreements in place with one or more privately-owned for-profit facilities pursuant to subsection 6.1, New Brunswick 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 New Brunswick 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, New Brunswick 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 New Brunswick 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 Department of Social Development's Director, Finance and Administration, 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 New Brunswick 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 New Brunswick will ensure that expenditure information presented in the annual financial statement is, in accordance with New Brunswick's standard accounting practices, complete and accurate.

8.3 Evaluation

8.3.1 Responsibility for evaluation of programs rests with New Brunswick 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 New Brunswick will make publicly available, clearly identified on a Government of New Brunswick website, this agreement, including any amendments.

9.5 Canada, with prior notice to New Brunswick, 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 New Brunswick 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 New Brunswick 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 New Brunswick reserves the right to conduct public communications, announcements, events, outreach and promotional activities about the Common Statement and this Agreement. New Brunswick 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 New Brunswick agree to participate in a joint announcement upon signing of this Agreement.

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

10. 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 responsible for health and Deputy Minister of New Brunswick, responsible for long-term care, 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 New Brunswick, 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 New Brunswick shall be:

New Brunswick Department of Social Development
Sartain MacDonald Building
P.O. Box 6000
Fredericton, NB
E3B 5H1

Email: Ben.Mersereau@gnb.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 New Brunswick.

14.3 No member of the House of Commons or of the Senate of Canada or of the Legislature of New Brunswick 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 New Brunswick by the Minister of Social Development

The Honourable Jill Green, Minister of Social Development

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

Introduction

According to the 2021 Census, out of the total population of 775,610 citizens of New Brunswick (NB), 177,160 are adults aged 65 years and over, contributing to a significant 22.8% of the total population. The province is also witnessing an explosive growth in the population of baby boomers who were born between 1946 and 1965 and are now starting to turn 75 years and over. Over the next 20 years, this cohort of older seniors is projected to increase from 75,900 to 145,700, (92% growth). The rapid growth in seniors' population is putting pressure on the province's long-term care system.

Aging is not an illness; however, aging can be associated with greater complexities in health status and care needs. The long-term care system in New Brunswick fulfills the needs of the senior's population whose functional needs require long term supports to help them carry out activities of daily living by providing appropriate long term care services at the appropriate time and in the appropriate place within the overall continuum of care.

Home and community care

The Government of New Brunswick recognizes that older adults want to age at home in their communities. The government also knows that older adults are frequent users of our health care system, meaning that enhancing home- and community-based health care options for New Brunswickers is a key priority for government. By shifting more care to the community and allowing older adults to receive care at home, we can lessen the burden on our acute care resources and long-term care facilities as our population gets older.

New Brunswick's provincial health plan

In November 2021, the Government of New Brunswick released a Provincial Health Plan entitled, "Stabilizing Health Care: An Urgent Call to Action". The Provincial Health Plan acknowledged that health care in our province is in crisis and set forward a series of action items over the course of a two-year timeline to "build a health care system that is citizen-focused, accessible, accountable, inclusive, and service-oriented for all New Brunswickers".

Deliverables within the Provincial Health Plan are organized according to five Action Areas:

• Access to Primary Health Care
• Access to Surgery
• Create a Connected System
• Access to Addictions and Mental Health Services
• Support Seniors to Age in Place

New Brunswick Extra-Mural Program (EMP) overview

The EMP provides inclusive home health care services to New Brunswickers in their homes (personal residence, special care home, nursing home) and/or communities for the purpose of promoting, maintaining, and restoring health and supporting quality of life for individuals with progressive life-threatening illnesses.

Since 1981, the Extra-Mural Program has evolved into a publicly funded program providing comprehensive home health care services to New Brunswickers of all ages. The program has a mandate to: provide an alternative to hospital admissions; facilitate early discharge from hospitals; and provide an alternative to, or postponement of, admissions to long-term care facilities. The program anticipates and responds to changes in home health care needs, and consistently provides services in the best possible way to achieve the desired outcomes for patients with the most cost-effective use of resources. EMP also promotes the integration of health care services in order to ensure the sustainability of the New Brunswick health care system.

EMP nursing services are provided 24 hours per day, 7 days per week. Other EMP professional services are available seven days a week as required to meet the patient's home health care needs.

EMP interdisciplinary health care professionals are specialists in the delivery of home health care services. The interdisciplinary team includes:

• Licensed Practical Nurses;
• Nurse Practitioners;
• Occupational Therapists;
• Physiotherapists;
• Registered Dietitians;
• Registered Nurses;
• Rehabilitation Assistants;
• Respiratory Therapists;
• Speech-Language Pathologists;
• Social Workers; and
• Diagnostic Imaging Technologists.

The New Brunswick Department of Health is responsible to set the provincial EMP policies in consultation with the Regional Health Authorities, the New Brunswick EMP Medical Advisory Committee and other stakeholders.

Ambulance New Brunswick (ANB) overview

ANB is responsible for providing land and air ambulance services for all of New Brunswick. The team consists of more than 1,000 health care professionals, including primary care paramedics, advanced care paramedics, emergency medical dispatchers and critical care flight nurses.

Ambulance New Brunswick's paramedics practice at the primary care paramedic (PCP) and advanced care paramedic (ACP) scopes. ANB's primary care paramedics are some of the most skilled in the country. In delivering medical care, ANB's paramedics follow national guidelines called the National Occupational Competency Profile, and they practice at the highest level of the PCP guidelines. Their scope of practice includes advanced airway techniques, intravenous (IV) therapy and other interventions, as well as the administration of various medications.

ANB's advanced care paramedics complement the excellent care provided by the PCPs by responding alongside them to the highest acuity calls in Fredericton, Saint John, Moncton and Bathurst. Through their education and certification, ACPs are able to provide a host of additional interventions including advanced airway management, additional options for vascular access, needle thoracotomy, and advanced electrical therapy. ACPs are equipped with an additional 15 medications crucial for treating conditions such as seizures, cardiac arrhythmias, post-partum hemorrhage, trauma and pain. ACPs have been practicing in New Brunswick since April of 2017.

ANB's clinical care guidelines, protocols, policies and procedures are under the purview of the Department of Health and its Provincial Medical Director (PMD), and continue to be created, maintained and updated through ongoing collaborative work between the PMD and the Clinical Oversight Committee as well as the Training and Quality Assurance Department.

Palliative care in New Brunswick

Palliative care services are currently provided in a variety of settings, including patient homes, residential facilities, hospices, special care homes and nursing homes, by primary care providers with minimal access to a designated palliative care team outside of hospitals. As the burden of disease increases, due to the aging population and a continuing shift toward more in-home and community-based services, the need for access to consultation and/or care from a palliative care team in the community will continue to increase.

Building on the objectives and achievements of government strategies and priorities, New Brunswick has made strides in advancing the initiatives set out in 2017 under the Home and Community Care priority areas, all the while continuing to innovate and advance these priorities in the face of unprecedented challenges and opportunities brought on by the COVID-19 pandemic. A summary of the achievements to date and the outstanding initiatives to be undertaken in the remaining four years of the funding agreement can be found for each priority area below.

1. Integration of Community Care Systems ($6.0 million per year)

As of January 1, 2018, Ambulance New Brunswick and the Extra-Mural program were integrated into a new entity, EM/ANB Inc., to build capacity and optimize the delivery of these primary healthcare services so that patients can be better supported in their homes and communities. Medavie Health Services New Brunswick manages these services on behalf of EM/ANB Inc. through a performance-based contract.

This was done to eliminate silos among these services and create additional capacity to care for citizens in the community, by avoiding hospital admissions and decreasing existing hospital length of stays.

The integration of Ambulance New Brunswick and the Extra-Mural program aims to:

• Improve access to community-based primary health care services;
• Improve patient satisfaction;
• Reduce hospitalizations;
• Reduce visits to emergency departments and episodic care services;
• Reduce alternate level of care (ALC) days; and
• Reduce variations in previous service delivery models, increasing the effectiveness of the continuum of care.

The following initiatives have been undertaken under this priority area since 2017-18 and will continue to be improved and expanded by investing approximately $1.0M in federal funding annually between 2023-24 and 2026-27:

• Introduction of Advanced Care Paramedics
• Introduction of a Dedicated Patient Transfer Unit System
• Implementation of EMP Clinical Practice Leadership Structure
• Adoption of EM/ANB Quality and Safety Framework
• Establishment of EMP Liaison Program
• Launch of EM/ANB Paramedics Providing Palliative Care at Home
• Vaccinations provided in home and adult residential facilities by EM/ANB staff
• Launch of the Pre-Hospital Alternative Low-Risk Triage (Pre-ALRT) protocol
• Launch of the Model of Care for Vulnerable Patients with Complex Needs
• Implementation of nurse practitioners within the Extra-Mural Program interdisciplinary team
• Transition beds/ ALC initiatives

New Brunswick will invest approximately $5.0M in federal funding annually to initiate the following new initiatives under this priority area by 2026-2027:

• Enhancements of Rapid Rehabilitation and Reablement (R&R) Service. The objective of R&R is to provide seniors with intensive short-term care and services to help them restore their independence and remain at home following a hospital admission or a health event in the community. This model of interdisciplinary health care is integrated with social services to support patients who are at home and at risk of hospital admission or in hospital but no longer in need of acute medical care. Building on the experience of the R&R Services implementation in 2017/18, there is an opportunity to further enhance the positive impact of the services by addressing a current gap – timely access to personal support workers (PSW) with the appropriate level of training as well as introduce nurse practitioners into the R&R to able to see these patients in their homes or special care homes for assessment and management and support and advise the EMP interdisciplinary team.
• Enhance Clinical Services in Adult Special Care Homes. The Departments of Health and Social Development in collaboration with EM/ANB have introduced enhanced clinical services in Special Care Homes across NB, with the overall goal of enhancing collaboration around the health care needs of all residents, so that the care is provided in the right place, at the right time, by the right provider. EMP has the care coordination role in close collaboration with the Special Care Home and other care providers, to provide timely and appropriate access to health care services as required. This model ensures that all residents in Special Care Homes are assessed to determine if they require additional health and social supports to live as independently as possible for as long as possible, thus delaying earlier transitions to a higher level of care.
• Enhanced Community Pathway to decrease hospitalization rates for seniors. This is an integrated, rapid access for non-emergency community health and social assessment for seniors. This pathway involves the Extra-Mural Program (EMP), Department of Health (DH), and the Department of Social Development (SD). The goal of the pathway is to create an alternate community-based option for seniors at risk of hospitalization by working with existing resources, building on the knowledge and expertise of EMP and SD. It will provide a rapid integrated assessment process to access short-term integrated health and social supports to stabilize a crisis. This will allow for the development of a joint ongoing health and social care plan focused on keeping seniors in their homes and communities.

2. Community and Home Care Support System ($4.0M per year)

The province has made strides in responding to the EMP's need for the integration of technology and innovative business processes into the daily delivery of home care services. Following the integration of the Extra-Mural Program and Ambulance New Brunswick in 2018, a plan was put in place to identify the components, the approach to implementation, and the technology solution to fulfill this need.

The plan aims to integrate the new system with eHealth, allowing care providers to benefit from a more holistic understanding of a patient's health history and, where appropriate, allowing EMP care providers to contribute their information to client records. It also includes the implementation of a point-of-care clinical information system to replace the current paper-based system.

These technological enhancements to the delivery of home care services, aim to:

• Improve clinical workflows across multiple delivery organizations;
• Enhance timely communication with physicians and other providers thereby helping individuals achieve better self-management of chronic conditions and health outcomes;
• Better coordinate care plans;
• Consolidate functions (e.g. client demographic registration);
• Introduce e-referrals and wait time management;
• Provide access to integrated, clinically-relevant information;
• Deliver services at a location accessible to the patient/client;
• Incorporate immunization registry, community health profiles, access to information on population health determinants; and
• Improve operational, management and strategic reporting provincially.

The following initiatives have been undertaken under this priority area since 2017-18 and will continue to be improved and expanded by investing approximately $0.5M in federal funding annually between 2023-24 and 2026-27:

• Launch of EMP Care Coordination Centre
• Implementation of Shared Care Plan tool
• Launch of a new transfer booking software system
• Ongoing work on Community e-Health Platform
• EMP tablet rollout

New Brunswick will invest approximately $3.5M in federal funding annually to initiate the following new initiatives under this priority area by 2026-2027:

• Implementation of Community Care New Brunswick including the expansion to provide e-charting for paramedics. Community Care NB is an electronic charting solution that will enhance multidisciplinary communication, care delivery and reporting. The enhanced capture of information will support better provision of care in the community, and inform the ability to assess and treat people in their homes - without necessarily having to transport to an Emergency Department.
• Enhancements to remote patient monitoring and virtual care. Virtual care (including remote monitoring technologies) is increasingly becoming an important part of the solution as it has the potential to act as a disruptive force that could bring transformative change, including supporting people to "age in place." EMP implemented Telehomecare RPM services in 2007 and expanded provincially in 2017/18, as a disease management approach to care of patients with a chronic disease, primarily focused on Chronic Obstructive Pulmonary Disease and Congestive Heart Failure. This technology provides precise patient health information between in-person visits to improve outcomes, increase patient engagement, streamline clinical/administrative efficiency, increase clinical capacity, reduce patient travel costs, and reduces infection risk. Accurate data saves time, improves documentation accuracy, and can lead to more effective health management and improved patient outcomes. Expanding RPM to include other chronic conditions and well as upgrades to this technology to support this service are required.

3. Palliative Care Strategy ($2.5M per year)

In 2018, the Government of New Brunswick unveiled a person-centred care and integrated services framework for palliative care in New Brunswick. The framework sets out a vision of a system where all New Brunswick residents in need of palliative care have access to responsive palliative care services that are based on common goals and evolve as required to address the changing needs, regardless of the time of day and location, from diagnosis to death and including bereavement care for significant others.

The framework is centred upon strategic pillars developed under five themes:

• person-centred care;
• family support network inclusion;
• professional capacity;
• community capacity; and
• regional health authority, Extra-Mural/Ambulance New-Brunswick and provincial leadership.

The priority actions under these strategic pillars aim to:

• Enhance integrated, standardized person and family centered palliative care service delivery across settings, an interdisciplinary team that includes the family physician/nurse practitioner, and palliative care teams in the community;
• Provide compassionate care for patients and families in the community (home, residential facilities, special care homes, nursing homes and inclusive of First Nations communities);
• Support informed choices by patients and families;
• Enhance knowledge for health care and home support providers;
• Enhance communication with patient/family and providers while supporting more timely interventions through the use of standardized assessment and monitoring tools;
• Ensure more efficient use of hospital resources through alternative care delivery models;
• Increase access to hospice services, both volunteer and residential, including alternate residential hospice options for rural communities; and
• Enhance palliative care performance measurement, as palliative care indicators will be defined and used for on-going monitoring.

The following initiatives have been undertaken under this priority area since 2017-18 and will continue to be improved and expanded by investing approximately $1.0 million in federal funding annually between 2023-24 and 2026-27:

• The development of an Integrated Palliative Care Provider Model
• The identification of Standardized Palliative Care Assessment and Monitoring Tools
• The provision of Palliative Care Education for health care professionals and community care providers
• Grief and Bereavement Support Assessment
• The development of evidence based provincial palliative care resources for primary health care and integrated community-based palliative care services
• Supports for more palliative and end of life care in the home
• Establishment of regional palliative care leads in the Regional Health Authorities to assist in coordinating operationalizing initiatives under the palliative care strategy's action plan

Unfortunately, some actions related to the implementation of Strategy had to be postponed due to the Covid-19 pandemic response, recovery efforts and redeployment of staff. The focus is now actioning remaining and continuous initiatives under the strategy through a coordinated implementation approach in partnership with New Brunswick health care partners.

New Brunswick will invest approximately $1.5 M in federal funding annually to initiate the following new initiatives under this priority area by 2026-2027:

• Integrated Residential Hospice; new location in Miramichi in collaboration with EMP. Under this integrated model, Hospice Miramichi Inc. Residential Hospice provides an alternative for patients whose care plan cannot be met at home but who do not require hospital level care, optimizing the skills and resources of the Extra-Mural Program (EMP) and the hospice organization. This integrated model will enhance continuity of care for end-of-life patients and their families, allowing seamless transitions as patients move between home and HMI residential hospice. Primary care providers will be supported to continue to follow their patients after admission to hospice.
• The development and implementation, of provincial palliative care monitoring framework, including palliative care indicators. The framework will identify palliative and end of life care indicators to be used for ongoing monitoring of palliative care in NB. This will allow the Department of Health to streamline data collection and reporting across many services involved in provision of palliative care.
• Promotion, evaluation and monitoring of Standardized Palliative Care Assessment and Monitoring Tools use, Palliative Care Education and Training, and Grief and Bereavement supports.

These three priority areas are consistent with those outlined in the 2018 to 2022 Canada - New Brunswick Home and Community Care and Mental Health and Addictions Services Funding Agreement. More information regarding the specific initiatives supported with this funding can be found at this link: 2018 to 2022 Canada-New Brunswick Home and Community Care and Mental Health and Addictions Services Funding Agreement

Measuring and reporting on results

Long-Term Care

Context

As defined in the HSO Long-Term Care Services Standard, "LTC homes, also referred to as residential, continuing care, personal care, or nursing homes, are residential settings where the majority of residents often live with complex health care needs. LTC homes are formally recognized by jurisdictions (i.e., are licensed and/or permitted) and are partially funded or subsidized to provide a range of professional health services, lodging, food, and personal care (e.g., assistance with everyday activities) for their residents 24 hours/day, 7 days a week. LTC services are provided in a variety of settings. While this standard focuses on those delivered in LTC homes including preventive, responsive, and palliative care, many of the requirements in this standard can be applied to the provision of LTC services in any setting."

Despite the broad definition above, many jurisdictions use LTC homes specifically for those providing 24-hour nursing care in facility only. However, in NB, the LTC continuum philosophically and structurally includes support and care in a home setting or in a facility-based setting. Facility-based care includes Adult Residential Facilities (ARFs) and Nursing Homes (NHs); congregate settings with a broad ranges of size and levels of care. In addition, the Adult Protection program is a mandated program for the protection of all adults, whether living at home or in facility. As such, this action plan will cover initiatives not only for the benefit of facility-based care, but for home support programs and adult protection programs as well.

In New Brunswick, the clients served under the long-term care system are generally responsible for the cost of services. However, government provides assistance with the cost of services when the client is financially unable to pay the full cost of these services. The Standard Family Contribution Policy sets out the terms for determining whether a client is eligible for government subsidization of those non-insured long-term care services.

Home support is provided by contracted home support agencies, private home support workers and self-managed care programs. This is an integral part of the long term care continuum and a focus of the province's senior care plan, specifically intended to ensure aging in place with dignity. Improving home support service delivery supports facility-based care by aiming to keep individuals at home who are currently on a trajectory for facility-based care thus reducing the pressures in nursing homes and adult residential facilities. Per the Canadian Institute for Health Information (CIHI), 14% of new Long-Term Care residents could have been cared for at home. Nationally, this number is approximately 10% (CIHI, 2021).

All long-term care facilities in New Brunswick are privately owned. They are operated by either for-profit or not-for profit entities. Although these long-term care facilities are not owned and operated directly by the Government of New Brunswick (GNB), they must be licensed and inspected by the province. The owners and operators of the long-term care facilities are required to operate in accordance with legislative and regulatory requirements and comply with standards and policies established by the Department of Social Development. GNB also provides funding to the operators in the form of a per diem across the facility-based continuum. In addition, non-profit nursing homes receive capital funding through the province's capital budget process.

Presently, there are 511 long-term care facilities in New Brunswick, including Adult Residential Facilities and Nursing Homes which provides care and support to adults who are limited in their ability to live at home safely and carry out normal daily activities on a long-term basis.

As all ARFs and NHs are private entities in NB, their employees are not employees of the Department, but of the individual organizations who own and operate the facilities.

Adult residential facilities

Currently, there are 437 ARFs established as community placement residential facilities under the provincial legislation- The Family Services Act. There are different levels of ARFs. These levels depend on the type of services and care required/provided, which includes:

• Special Care Homes,
• Community Residences,
• Generalist Care Homes, and
• Memory Care Homes.

These ARFs provide 24-hour supervision and various levels of care to approximately 7000 individuals who are above 19 years of age. However, some homes focus on a specific client group (for example seniors). There are approximately 6400 Special Care, 400 Memory Care, and 280 Generalist Care beds, and 635 Community Residence beds in the province and approximately 5000 human service workers are working in these homes throughout the province including Personal Support Workers (PSWs) and Human Service Counsellors (HSCs).

Nursing homes

Currently, there are 74 nursing homes licensed by the Department for a total of 5133 licensed beds. These homes are established under the provincial legislation - The Nursing Homes Act and provide care services including 24-hour nursing on the premises. The population in nursing homes is predominantly seniors however, a there are residents under 65 years of age due to complex care needs requiring access to 24-hour nursing.

Recent investments have been made to improve Safe Long-Term Care including several wage increases for care staff and increases to operational funding in order to support the sector in caring for its adults and seniors in long-term care whether at home or in a facility. In addition, significant financial and human resource supports have been provided to support COVID readiness and outbreak management in our nursing homes and adult residential facilities. The Department continues to provide all personal protective equipment for homes as well as guidance for infection prevention and control and outbreak management to meet Public Health protocols.

Under the federal Safe Long-term Care Fund, in 2021-22, approximately $10.5M was provided in the form of COVID per diems ($4.10 per bed/per day for NHs and $2.56 per bed/per day for ARFs) to the Province's licensed nursing homes and adult residential facilities in 2021/22 applied towards the Safe Long-Term Care Fund's priority area (Staff retention measures and hiring additional human resources) and also additional initiative areas (other infection prevention measures/training, PPE, rapid training programs, screening, inspection).

In 2022/23, over $11M from the Safe Long-Term Care Fund helped to support a strategy to improve air quality in its licensed long term care homes and ensure a healthy environment for some of our most vulnerable New Brunswickers.

For nursing homes, a multi-year plan to upgrade the ventilation in 23 older nursing homes was developed including shorter- and longer-term projects. In 2022-23, all 23 homes received shorter-term improvements including a combination of High Efficiency Particulate Air (HEPA) purification units as well as the completion of maintenance and minor modifications to ventilation systems as necessary. Engineering work began under this fund for the longer-term renewal of ventilation systems for 21 of the 23 homes, which is anticipated to be complete in 2023 with tendering and construction to follow. For adult residential facilities, 1817 HEPA air purification units were provided to all ARFs in 2022-23 as an enhanced measure to reduce the spread of COVID and other communicable diseases.

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

Priority Areas for Investment

The province's senior population is in a period of explosive growth. As the large baby boomer cohort starts to turn 75 years of age, they will enter the years where individuals typically have the highest care needs. Over the next 20 years, this cohort of older seniors (aged 75 years and over) is projected to increase from 75,900 individuals to 145,700 (92% growth). This will put extraordinary demands on the province's long-term care system.

The initiatives described below under the two priority areas – Workforce Stability and Long-Term Care Standards – will help address these challenges through new, incremental spending in New Brunswick's long-term care sector. The full suite of initiatives being proposed - including improved coordination and communication across the continuum of care; upgrades to critical infrastructure; training to develop LTC staff; and the introduction of a new bed model for community care – will lead to better care and supports for New Brunswick's seniors by addressing known gaps in the LTC sector. Results will be monitored using the jurisdiction-specific indicators shown in the table at the end.

Priority Area 1 – Workforce Stability

1.1 Home Support Partner Portal w/EMP and Providers

• Development and maintenance of partner portal for all partners that provide services to clients of Social Development. Partners include home support agencies, special care home operators, nursing home administrators, and Extra Mural Program health professionals.
• It will be used for communication on clients' case plans as well as how we will request and pay for services. The first service provider enabled in the portal will be Home Support Agencies.
• Will improve time for service delivery and improve communications between Social Development and services providers.
• Clients will receive more coordinated and timely access to care and services.
• This initiative will initially support 47 home support agencies delivering services to 5,500 clients in year one. Expansion to other partners in remaining out years will include approximately 508 long term care facilities serving approximately 11,600 clients
• Improving home support program delivery will also take pressures off the facility-based care

1.2 Care Coordination

• Trial a new type of role to facilitate care coordination across the system.
• This will alleviate workload pressures and improve client experience.
• Care Coordination will enable clients to have more timely access to services, experience improved navigation and coordination of care and services.
• Social Workers will be able to align their responsibilities more closely to their scope of practice. Care coordinators will focus on implementing the case plan, and Social Workers will focus on assessment and monitoring clients with high or complex case plans.
• Partners, such as in long term care facilities will experience improved communication from the department and coordination of supports for clients to help achieve assessed care goals.
• Cost estimates are based on an initial pilot, then a phased scale up across the province to a resulting 16 front line coordinators in the service deliver zones and 1 employee for central coordination (total of 17 staff).
• This role can exist within the Department or within a partner organization, based on the design of the role.

1.3 Recruitment and Settlement Support for LTC Staffing (formerly vacant bed initiatives)

Workforce recruitment, settlement and retention initiatives to support increasing staffing requirements to care for seniors. Includes items under the department's broader recruitment strategies that are under development including initiatives under the People Pillar of the Provincial Health Plan. This can include funding to support personal support workers or licensed practical nurses who are receiving training under the Step Up to Nursing program. While recruitment remains a top pressure, retention must also be addressed. The department is enhancing its supports to nursing home Boards to improve management and workplace culture transformation resulting in greater retention of workforce and therefore, the reduction of vacant beds across the sector. As work continues, new initiatives can be implemented with this funding to support the end goal of sustaining full utilization of available long term care beds in the system. Such things as settlement services and housing supports may be some of the additional initiatives considered to be supported.

1.4 Training for Long Term Care staff (sector and departmental)

• Training programs will be developed based on need for home support, special care homes, nursing homes and social development staff including but not limited to such topics as: dementia care, workplace safety, care and clinical services, adult protection and infection prevention and control.
• Will enable improved care and care compliance across entire LTC continuum (home support, special care homes, nursing homes and departmental staff)
• A needs assessment will be completed in order to build the training programs with a goal to improve the system as a whole, including the access to and the delivery of quality services and care.
• Based on needs assessment, partnerships will be developed to deliver training depending on expertise needed and best practices identified.
• Cultural safety training will be delivered to all nursing homes to help improve the quality of care available to Indigenous populations.

Note: all initiatives under this section will benefit populations of predominantly seniors but also adults requiring long term care services from home support to facility-based care. New Brunswick, as the only officially bilingual province with much of its French-speaking population located in rural areas, has unique service delivery requirements, like the need to train, recruit and retain long-term care staff with the language skills needed to deliver programs and services in a clients official language of choice. Consideration of these requirements will be part of the planning and implementation of the various initiatives outlined in the Action Plan. Disaggregated data on the population served by New Brunswick's LTC sector is limited; however, the department aims to maintain a person-centered approach in all of its service delivery and build more inclusive environments for minorities or racialized communities or LGBTIQA2S+ individuals.

Priority Area 2 – Long-Term Care Standards

2.1 Ventilation Upgrades in Nursing Homes

• Complete the installation of ventilation equipment in 21 nursing homes that require major renovation to meet current ventilation standards (per CSA Z8004:22 and CSA Z317.2).
• Will increase air quality and infection prevention and control in older nursing homes.

2.2 Call Bell System Upgrades in Nursing Homes

• Upgrade outdated and unreliable call bell systems in 13 nursing homes - a significant issue for nursing homes as the systems age and can no longer be maintained.
• Will increase reliability of critical systems for resident safety and care.
• Referenced Standards (CSA Z8004:22 and CSA Z32).

2.3 Replacement of Nursing Home Beds

• Replace aging and at-risk nursing home beds and mattresses.
• Will increase safety and comfort for nursing home residents with beds meeting current standards including the prevention of bed entrapment and bariatric resident needs.

2.4 Nursing Home Facility Condition Assessments

• Complete facility condition assessments of 61 non-profit nursing home to inform updated capital, renovation, or replacement plan.
• Will enable proactive capital planning for aging infrastructure with a focus on infection prevention and control and current standards.
• Referenced Standards: DSD Design Standards for Nursing Homes, CSA Z8004:22

2.5 Life Safety and Essential Equipment Upgrade Program for Special Care Homes

• Create funding program to support special care homes in the purchase of essential equipment including generators, sprinklers, lifts, or call bells.
• Increase number of special care homes with essential life safety systems and resident safety equipment meeting current standards.
• Provide equipment for homes to support higher care needs to prevent premature entry into nursing home or avoid unnecessary hospital admission.

2.6 Community Care Bed Model Pilot

• Implementation of new flexible community care bed model at two special care home test sites.
• Will introduce and test a new flexible and sustainable model for special care homes to support aging in place and relieve hospital pressures.
• The new model will aim to replace the current special care home and generalist care models with increased care needs being met while the resident remains in one location and relieve pressures on the nursing home system.
• The pilot sites allow for the development of the care, financial and assessment models to develop a business case for a system-wide expansion.
• A full program evaluation will be undertaken after three years to assess the pilot's results. This will be used to inform a decision on whether the pilot should be expanded or stopped.

Funding allocation

Accountability Measures in Place for Funds Directed to Private For-Profit Facilities

Of the initiatives listed above, the following 3 are identified as those that would impact a Private For-Profit Facility and their respective accountability measures. No federal funding will be disbursed directly to private, for-profit facilities, for the other listed initiatives. It is noted that while all licensed long term care facilities are private, most nursing homes operate as a non-profit with 11 that fall under a for-profit entity.

1. The Home Support Partner Portal project (Initiative # 1.1) does not increase profits for private agencies, but rather is a mechanism for improved communication and services.
2. The Life Safety Equipment Upgrade Program for Special Care Homes (Initiative # 2.5) will be implemented with a rigorous application-based system that will ensure that funds are provided expressly for specific provision of life safety and essential equipment. Appropriate controls will be put in place to ensure funds are directed as intended and not to increase profit margins.
3. The Community Care Bed Model pilot (Initiative # 2.6) would be implemented with a private special care home, which is a private for-profit business. The funding model would aim to cover care and operational costs to provide basic services to residents and not to increase profit margins.

Measuring and reporting on results

The table below outlines New Brunswick's proposed indicators and targets, along with timeframes, for the various Long-Term Care initiatives under the Aging with Dignity Bi-Lateral Agreement.

Summary of jurisdiction-specific indicators and targets: New Brunswick