Canada-Northwest Territories Aging with Dignity Funding Agreement (2023-24 to 2028-29)

Tables 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:

His Majesty the King in right of Canada (hereinafter referred to as "Canada" or "Government of Canada") as represented by the Minister of Health (herein referred to as "the federal Minister")

- and -

Government of the Northwest Territories (hereinafter referred to as "Northwest Territories" or "Government of the Northwest Territories") as represented by the Minister of Health and Social Services (herein referred to as "the territorial Minister")

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

Preamble

Whereas, on July 6, 2023, Canada and the Northwest Territories 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 the Northwest Territories 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 the Northwest Territories 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, the Working Together to Improve Health Care for Canadians plan also includes a commitment of $1.7 billion over 5 years to support provinces and territories to increase the wages of personal support workers and related professions (hereinafter collectively referred to as "PSW"), and support other recruitment and retention measures;

Whereas, the Northwest Territories 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, 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), and PSWs;

Whereas, the Hospital Insurance and Health and Social Services Administration Act authorized the territorial Minister to enter into agreements with the Government of Canada under which Canada undertakes to provide funding toward costs incurred by the Government of the Northwest Territories associated with the federal investment for long-term care, home and community care consistent with the Common Statement, and PSWs; and

Now therefore, this Agreement sets out the terms between Canada and the Northwest Territories 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 the Northwest Territories 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 the Northwest Territories 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 draft 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 the Northwest Territories 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 the Northwest Territories acknowledge a mutual intent to engage in a two-phased formal review process:

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

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

3.0 Action plan

3.1 The Northwest Territories 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 The Northwest Territories 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 The Northwest Territories 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 The Northwest Territories will invest the federal PSW funding provided under this Agreement to support incremental activities to raise wages for PSWs.

3.5 With a plan (outlined in Annex 4) to make a meaningful difference to raise the wages of the lowest-paid PSWs by 20% or to reach $25/hour over the 5 years of funding, the Northwest Territories may use the remaining federal funds to support additional non-wage related recruitment and retention measures.

3.6 In developing initiatives under this Agreement, the Northwest Territories 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+.

3.7 The Northwest Territories' approach to achieving home and community care, long-term care, and PSW objectives is set out in their 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, 2029, unless terminated in accordance with section 12 of this Agreement. Funding provided under this Agreement will be for six years and will cover the period April 1, 2023 to March 31, 2029 ("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 territory.

5.2 Allocation to the Northwest Territories

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

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

Budget 2021 Long-Term Care

$600 million for the Fiscal Year beginning on April 1, 2023
$600 million for the Fiscal Year beginning on April 1, 2024
$600 million for the Fiscal Year beginning on April 1, 2025
$600 million for the Fiscal Year beginning on April 1, 2026
$600 million for the Fiscal Year beginning on April 1, 2027

Budget 2023 PSW

$325 million for the Fiscal Year beginning on April 1, 2024 
$333 million for the Fiscal Year beginning on April 1, 2025 
$342 million for the Fiscal Year beginning on April 1, 2026 
$350 million for the Fiscal Year beginning on April 1, 2027 
$359 million for the Fiscal Year beginning on April 1, 2028

5.2.3 Allocation Method

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 the Northwest Territories, 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.
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 the Northwest Territories, 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.
For funds associated with Budget 2023 committed by the federal government in 2023 on PSWs, annual funding will be allocated to provinces and territories with a base amount of $680,000, 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: $680,000+(F- (N x 680,000)) x (K/L), where:
F is the annual total funding amount available under this program;

N is the number of jurisdictions (all 13) that will be provided the base funding of $680,000;

K is the total population of the Northwest Territories, 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, the Northwest Territories estimated share of the amounts will be:

Fiscal Year	Budget 2017 Home and Community Care Estimated amount to be paid to the Northwest Territories^{Footnote *} (subject to annual adjustment)	Budget 2021 Long-Term Care Estimated amount to be paid to the Northwest Territories^{Footnote *} (subject to annual adjustment)	Budget 2023 PSW Estimated amount to be paid to the Northwest Territories ^{Footnote **}(subject to annual adjustment)
2023-2024	$700,000	$1,880,000	n/a
2024-2025	$700,000	$1,880,000	$1,030,000
2025-2026	$700,000	$1,880,000	$1,040,000
2026-2027	$700,000	$1,880,000	$1,050,000
2027-2028	n/a	$1,880,000	$1,060,000
2028-2029	n/a	n/a	$1,070,000
Footnotes Footnote * Amounts represent annual estimates based on Statistics Canada's July 1^st, 2022, population estimates. Return to footnote * referrer Footnote Amounts represent annual estimates based on Statistics Canada's July 1^st, 2023, population estimates. Return to footnote referrer

5.3 Payment

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

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 be paid on or about November 15.
In 2024-25, the first installment of Budget 2023 PSW funding will be paid within approximately 30 business days following the execution of the amendment to the Agreement by the Parties. The second installment will be paid on or about November 15.
Starting in 2024-25, and 2025-26 for Budget 2023 PSW funding, 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.
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.
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.
Canada will notify the Northwest Territories 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 the Northwest Territories of the amount of the second installment as determined under sections 5.2.3 and 5.2.4.
Canada shall withhold payments if the Northwest Territories has failed to provide reporting in accordance with 8.1.
Canada shall withhold the second payment in 2023-24 if the Northwest Territories has failed to satisfy all reporting requirements associated with the preceding Canada – the Northwest Territories 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 and Social Services' Financial Officer, of funding received the preceding Fiscal Year from Canada for home and community care under the Canada – the Northwest Territories 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.
The sum of both installments constitutes a final payment and is not subject to any further payment once the second installment has been paid.
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 the Northwest Territories will use cost-recovery agreements with one or more privately-owned for-profit facilities as an accountability measure and the Northwest Territories 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(c) an amount equivalent to the amount of funding noted in Annex 4 to be provided by the Northwest Territories 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 2027-28, upon request, the Northwest Territories 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, the Northwest Territories is not entitled to retain any amounts beyond March 31, 2029. 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 the Northwest Territories 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 the Northwest Territories 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, the Northwest Territories 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 the Northwest Territories 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 the Northwest Territories 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 and PSW funding may be provided to:

publicly-owned settings;
privately-owned not-for-profit settings; and
subject to section 6.0, privately-owned for-profit 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, the Northwest Territories agrees to put in place the accountability mechanisms outlined in Annex 4.

6.2 Where the Northwest Territories has cost-recovery agreements in place with one or more privately-owned for-profit facilities pursuant to subsection 6.1, the Northwest Territories 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 The Northwest Territories 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:

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;
Develop new common indicators for long-term care and PSWs; and
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, the Northwest Territories agrees to:

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 and PSWs.
Beginning in Fiscal Year 2024-25, report annually and publicly in an integrated manner to residents of the Northwest Territories on progress made on targets outlined in Annex 4 (Action Plan).
Beginning in Fiscal Year 2024-25, provide to Canada an annual financial statement, with attestation from the Department of Health and Social Services' 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, long-term care and PSWs;
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 The Northwest Territories 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 The Northwest Territories will ensure that expenditure information presented in the annual financial statement is, in accordance with the Northwest Territories' standard accounting practices, complete and accurate.

8.3 Evaluation

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

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

9.9 Canada and the Northwest Territories 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 the Northwest Territories responsible for health, and if it cannot be resolved by them, then the federal Minister(s) and the territorial 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 the Northwest Territories, by the territorial 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 the Northwest Territories shall be:

Assistant Deputy Minister, Finance, Policy and Planning Branch
Tatsaotı̨̀ne Building, 7th Floor
5015 - 49th Street
P.O. Box 1320
Yellowknife, NWT
X1A 2L9
Email: Jeannie_Mathison@gov.nt.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 the Northwest Territories.

14.3 No member of the House of Commons or of the Senate of Canada or of the Legislature of the Northwest Territories 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 counterparts together shall constitute one agreement, and (ii) communication of execution by fax transmission or emailed in PDF shall constitute good delivery. 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

Signed on behalf of the Northwest Territories by the Minister of Health and Social Services

The Honourable Lesa Semmler, Minister of Health and Social Services

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

**Figure 1: 5-Year 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

Northwest Territories Aging with Dignity action plan

Introduction

The Northwest Territories (NWT) population is 45,493 people spread over 33 communities on a land mass of 1,144,000 km², with many communities without year-round access to larger centres ("fly-in communities") ^{Footnote 1}. NWT communities range in size from the capital city of Yellowknife with a population of 21,720 to the community of Kakisa with under 50 people^{Footnote 1}. The number and proportion of seniors in the NWT has steadily been increasing since 2016 and is anticipated to continue increasing from 2022 to 2035. Accordingly, the seniors (65+) population is forecasted to increase 59% by the year 2035 for a total of 7,250 seniors (65+) and represent 16% of the NWT population.^{Footnote 2} Just over two thirds of the current senior population is concentrated in and around the four largest communities of the NWT while the remaining third is spread out over more than 25 communities. NWT communities also vary in living experiences and conditions; culture; and access to services and programs.

The NWT has a large and diverse Indigenous population, who represent approximately 51% of the current population. The legacy of colonization and residential schools and the associated intergenerational traumas continue to affect the wellness of residents and communities. Despite the challenges experienced by NWT residents, there are many committed people in our communities who are working hard to keep communities healthy and support the people around them. Communities know what they need to achieve increased wellness. Therefore, in developing initiatives to improve access to health and social services, community participation needs to be fostered, and demographic and infrastructure differences need to be reflected in our planning to ensure services are culturally safe and meet the diverse needs of each community services.

The mandate of the 19th Legislative Assembly of the Government of the Northwest Territories (GNWT), released in February 2020, included a priority to enable seniors to age in place with dignity. To support this mandate, the GNWT Department of Health and Social Services (Department) has been focused on ensuring a continuum of service options are available to support the needs of our growing population of seniors.

The Department is mandated to provide a broad range of health and social programs and services; and to support the Minister of Health and Social Services in carrying out this mandate by:

Setting the strategic direction for the system;
Developing legislation, regulations, policy and standards;
Establishing approved programs and services;
Establishing and monitoring of system budgets and expenditures; and
Evaluating, monitoring, and reporting on system outcomes and accountabilities.

The Health and Social Services Authorities (HSSAs) are responsible for the delivery of health and social services, and are funded by the Department to:

deliver health services, social services, and health and wellness promotional activities within the NWT;
manage, control and operate each health and social service facility for which they are responsible; and
manage the financial, human and other resources necessary to perform these duties.

There are currently three HSSAs in the NWT:

Northwest Territories Health and Social Services Authority (NTHSSA)
Hay River Health and Social Services Authority (HRHSSA)
Tłı̨cho Community Services Agency (TCSA)

Home and Community Care (HCC) services and Long Term Care (LTC) services are administered under the larger NWT Continuing Care Services program, which also includes Supported Living (SL) services for adults with disabilities. Continuing Care services in the NWT are largely delivered by the HSSAs and are intended to maintain or improve the physical, social, and psychological health of individuals who are not able to fully care for themselves. While available to all residents of the NWT, most services are provided to seniors and elders; growth in the NWT seniors population and prevalence of chronic health conditions resulting in disability are the largest driver of future need for these services. The Department is committed to delivering culturally respectful and safe HCC services, within the context of a whole of government mandate commitment to enable seniors to age in place with dignity. The Department is also committed to ensuring culturally safe LTC services are available to those whose health and personal care needs can no longer be met in the community. This includes our commitment to hiring local and Indigenous staff where possible (GNWT Indigenous Recruitment and Retention Framework), hiring interpreter services to serve Indigenous clients where local staff may not speak the client's Indigenous language; and implementation of Guidelines for Serving Traditional Foods in NWT Health and Social Services Facilities.

HCC and LTC services are integrated with other core health and social services delivered by the HSSAs such as Primary Care Services, Rehabilitation Services and Mental Health and Addictions Services. This integration ensures that NWT residents have access to a multidisciplinary team to support assessment and intervention and facilitates access to specialist services and medical equipment and supplies.

Recruitment and retention of health human resources is essential to ensure the availability of Continuing Care service, however, as in many Canadian jurisdictions, it is a challenge to recruit workers to fill vacant positions. Additionally, the GNWT has made a commitment to increase the number of resident health care professionals by at least 20%; this will ensure a more sustainable workforce with knowledge of the NWT context to ensure we are able to provide culturally safe services. The primary health human resources required to deliver HCC and LTC services are Practical Nurses (PNs) and Personal Support Workers (PSWs), that are hired within the health and social services system under the job titles of Licensed Practical Nurses (LPNs), Home Support Workers (HSWs) in HCC, and Resident Care Aides (RCAs) in LTC. The GNWT has made incremental investments in the last several years to contract Aurora College to expand the PSW program in the NWT, including a distance delivery option, and to deliver a PN program. Distance delivery has increased options for individuals from remote and Indigenous communities to complete training through a blended approach of online classes and in-person practicums. This will increase our system capacity to provide culturally safe services in Continuing Care programs by training a workforce that has the necessary language/cultural skills to meet diverse client needs.

Home and community care

Context

HCC services are a suite of services delivered by the HSSAs to NWT residents of all ages in their homes, or other places of residence such as group homes or independent seniors housing units. HCC services include nursing and personal care services which are delivered based on an assessment of the individual's needs. Also offered through HCC are adult day services and respite services which focus specifically on supporting both the individual and their family caregivers to ensure this caregiving relationship can continue. Home-based palliative care services and acute care nursing services related to early discharge from the hospital are also provided as part of the suite of HCC services. Some HCC service elements, such as advanced foot care services and intravenous therapy (IV-therapy), may be offered within HSSA infrastructure, such as primary care clinics.

The Department has committed to addressing access to appropriate health services and supports in home and community to meet the needs of the growing population of seniors in a manner that supports aging in place. The Department priorities were articulated within the Continuing Care Services Action Plan (CCSAP) 2017/18 to 2021/22 under the following objectives:

Optimize healthy aging,
Improve home and community care services and caregiver supports,
Provide equitable access and high-quality long-term care,
Enhance palliative care services, and
Employ sustainable best practices.

The CCSAP objectives and activities aim to reduce some of the gaps in the GNWT health and social services system for seniors and other adults who require supportive services to remain living at home.

The Department completed a comprehensive review of HCC services in September 2019. It contained 22 recommendations related to scope of services, projected resource requirements, standards for the program and other recommendations. These recommendations are focused on positioning the HCC program to provide consistent, effective client centered services and will assist the Department with decisions related to program scope, future investments and allocation of resources in HCC. The Report recommended the Department focus on defining the scope of services, develop updated HCC Standards, increase oversight for services in small communities, expand hours of services, continue to implement interRAI and pilot the Paid Family/Community Caregiver option within HCC, improve communications about HCC services to clients and with other organizations to improve the coordination of services; improve data collection, ensure home support workers are certified and receive training, and plan for an 80% increase in service requirements by 2035.

In addition to these strategic and HCC program priorities, the COVID-19 pandemic highlighted the importance of rigorous infection prevention and control (IPAC) policies and practices in the delivery of health care programs. As HCC clients tend to have multiple chronic health conditions or frailty that makes them more vulnerable to severe outcomes from COVID-19, developing and implementing IPAC policies and training within HCC is of importance to ensure the safety of health care workers and clients.

HCC federal funding over the last six years has been invested in projects to advance activities identified in the CCSAP and recommendations of the Review, and address IPAC challenges highlighted through the COVID -19 pandemic response, namely:

InterRAI project
Funding has been used over the past 6 years to advance a project to introduce International Resident Assessment Instrument (interRAI) tools across continuing care programs to address the lack of a consistent, evidence-based assessment tool across the Continuing Care program. Introducing the interRAI tools will give us a standardized and evidenced-based way to assess the care and service needs of clients and align resources to support them. interRAI will allow us to monitor and report on patient outcomes and system performance, which will better support more efficient and effective delivery of Continuing Care Services, more effective planning, and will allow us to meet our commitment to report on Canadian Institute for Health Information (CIHI) pan-Canadian indicators for HCC that rely on interRAI data.

The project has encountered delays due COVID-19 pandemic response, staff turnover and availability, and the need to involve and coordinate the work of many stakeholders. The project is currently fully staffed and the implementation of interRAI continues to be a priority, with work progressing despite the delays. Key work that has progressed includes establishing a contract with a vendor for 3 interRAI tools within a Continuing Care Information System (CCIS), along with training, testing, support, and maintenance services; purchasing servers and configuring the CCIS on the servers; progressing integration work with other Department systems; establishing future state workflows to support use of the interRAI tools and CCIS; and purchasing computer hardware to support use of the interRAI tools at point of client care. The Department is working towards a phased roll-out of the interRAI tools and CCIS across regions of the NWT beginning in 2023-24, to all 33 communities in the NWT.
Paid family/community caregiver pilot project
Funding has been used to design, launch and evaluate a service option within HCC that gives clients and caregivers an option for accessing support services according to their assessed needs while reducing pressure on the public Home Care system. The Pilot included client assessment, care planning, and monitoring of outcomes for clients through the hiring of a Coordinator. Participants for the Pilot were chosen based on an assessment of their care needs by the HCC program. The Pilot focused on providing supports, such as assistance with home maintenance, laundry, meal preparation, grocery shopping, wood cutting/snow shoveling, and getting to and from appointments and community events. Professional services, including nursing and palliative care, remain exclusively delivered through HCC. The Pilot evaluation was completed, and Department funding has been leveraged to continue the Pilot in the current communities in 2023-24. In addition to the evaluation findings of the Pilot, the Department will consider findings of other planning work recently completed in 2022-23 and 2023-24, including a Supported Living Review and a Seniors Strategic Framework, to determine how to continue service options.
Reporting – RL6
RL6 is an incident reporting system used across the HSS system in the Northwest Territories. Federal funding allowed for the addition of two new modules: Feedback and RootCause. The Feedback Module will capture and organize feedback from staff, patients and families to assist the existing Home Care program in responding to concerns in a timely and efficient manner. The RootCause module will allow the quality and risk team to support Home Care program staff to look at the root cause of incidents within the home care delivery system so that resources and policies can be aligned to deliver safe, effective care. This incident reporting system is already in use to report on two key Accreditation Canada indicators in Home Care:
- Number or % of clients sustaining injuries due to falls
- Number or % of clients with new pressure ulcer stage 2
IPAC (Infection, Prevention and Control) continuing care services
Due to heightened IPAC measures brought on by COVID-19, the NWT has been using federal funding to hire an additional IPAC professional to assist in Continuing Care program. This is crucial to the HCC services team, as they interface with many clients and may have minimal ability to change and control the client's home. HCC clients are also supported in other health care settings e.g., primary care for service elements relating to wound care, foot care, an intravenous therapy; and long term care for respite services. Ensuring IPAC training and practices are integrated into Continuing Care service will ensure that IPAC risks are reviewed and mitigated, ensuring the delivery of safe services to clients and workplace safety for staff.

While progress has been made through each of these projects, the Department recognizes the need to continue to support implementation of infrastructure and safe work practices to ensure HCC services are delivered effectively.

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

1. Implementation of InterRAI CCIS

Aging with Dignity funding from 2023-24 to 2026-27 will be used to advance the implementation and support ongoing operational needs of the interRAI CCIS. These activities are a continuation of current activities funded under the HCC bilateral agreement, in alignment with the 2017 Common Statement of Principles on Shared Health Priorities action "Enhancing home care infrastructure". Funding will be used for 3 FTE on the interRAI CCIS Project team, contract costs, and training activities for implementation of the interRAI tools and CCIS.

InterRAI is a key activity to improve Continuing Care services, and support NWT seniors to age in place with dignity. InterRAI assessment tools will allow health care providers to complete effective client assessments to identify client care needs, which is foundational to ensuring services are put in place to meets client's needs. The interRAI tools will also provide an effective mechanism to monitor change in Continuing Care client's health status and the needs of family caregivers; this will allow Continuing Care services to engage other services, such as respite, social worker or rehabilitation services, to ensure clients' and caregivers outcomes are improved and they receive optimal care. The interRAI CCIS will give the Department a standardized and evidenced-based way to assess the care and service needs of clients and align resources to support them. InterRAI will allow the Department to monitor and report on client outcomes and system performance, which will better support more efficient and effective planning for and delivery of Continuing Care Services.

The Report of the Auditor General of Canada Report to the Northwest Territories Legislative Assembly (2011); the Continuing Care Review (2013);NWT Home Community Care Review Report(2019) and the NWT Long Term Care Program Review (2015) present the case for implementing use of interRAI assessments in the NWT. The LTC and HCC review reports both specifically recommended implementing interRAI to support analysis and evidence-informed decisions on clinical practice, planning and resource allocation. The Department completed a comprehensive HCC Review resulting in the recommendation to implement interRAI assessment tools and a Continuing Care Information System (CCIS) to improve program and service data capture and to ensure investments are aligned with needs across the system, which requires an information system capable of reporting on service data in addition to interRAI data.

interRAI CCIS is a critical tool to ensure the GNWT can support the needs of seniors, and enable them to age in place, in an evidence informed manner. Final preparations of the CCIS are underway and implementation of the interRAI CCIS will begin in 2023-24.

The NWT has a large and diverse Indigenous population, who represent approximately 51% of the current population. The interRAI CCIS will provide the Department with data on Continuing Care client demographics (age, ethnicity, language, gender), service utilization data (e.g. number of new referrals and discharges), as well as interRAI data on client outcomes and quality indicators, such as cognitive function, medication, incontinence, nutrition, physical function and pain. Together, the various data available through the interRAI tools and the CCIS will assist the Department to better understand the needs of clients by community and regions of the NWT. This will support the Department to ensure adequate resources are in place to meet the diverse needs of residents of the NWT, including inequities in access to Continuing Care services for Indigenous people of the NWT.

2. Infection Prevention and Control (IPAC) coordinator

Aging with Dignity funding from 2023-24 to 2026-27 will be used to continue to support a dedicated professional for IPAC Coordinator for continuing care programs to ensure IPAC training and practices are integrated and embedded in programming across the system. The position will support caregivers within the continuing care program areas by establishing, implementing and monitoring standardized IPAC policies and procedures that are aligned with established best practice. This is achieved by working collaboratively with continuing care services to assess and audit Continuing Care settings, and providing input on policies, resources and training to meet specific needs of caregivers. This will help to mitigate IPAC risks which could impact on staff safety, service delivery and availability, including the spread of communicable diseases in home and facility settings. The NWT will use Aging with Dignity funding to support the Coordinator, ongoing operational costs and compliance audits across the NWT. These activities are a continuation of current activities funded under the HCC bilateral agreement, in alignment with the 2017 Common Statement of Principles on Shared Health Priorities action "Increasing support for caregivers". These activities also align with the shared priority under the Working Together to Improve Health Care for Canadians focused on enabling Canadians to age with dignity closer to home with access to home care or care in safe long term care facilities.

The COVID-19 pandemic highlighted the importance of rigorous infection prevention and control (IPAC) policies and practices in the delivery of health care programs. As HCC and LTC clients tend to have multiple chronic health conditions or frailty that makes them more vulnerable to severe outcomes from COVID-19 and other communicable diseases. The nature of the delivery of HCC services involves the movement of service providers and equipment between multiple service settings, therefore developing and implementing IPAC policies and training within HCC is critical to ensuring the safety of health care workers and clients.

The NWT has a large and diverse Indigenous population, who represent approximately 51% of the current population. The IPAC Coordinator will use a cultural safety lens in addition to IPAC best practices to ensure that Continuing Care services are delivered in a client centred, safe and effective manner.

Summary of funding and planned expenditures
Home and Community Care	2023-24	2024-25	2025-26	2026-27	Total
Total funding available	$839,000^{Footnote 3}	$700,000	$700,000	$700,000	N/A
Initiative 1 – Enhancing Home Care and infrastructure -interRAI Project
InterRAI CCIS Project	$628,000	$470,000	$471,000	$473,000	$2,042,000
Initiative 2 – Increasing Support for Caregivers – Territorial IPAC Coordinator
Territorial IPAC Coordinator	$211,000	$230,000	$229,000	$227,000	$897,000
Total planned expenditure	$839,000	$700,000	$700,000	$700,000	$2,939,000

Measuring and reporting on results

The NWT will continue to report Wait Times for Home Care Services to CIHI. Over the next few years with the implementation of InterRAI across the NWT, there will be opportunity for the NWT to support new and existing data capacity, collection, and management.

In addition to reporting through established annual and business planning processes, a reporting on indicators presented in this Action Plan will occur through the public website of the Department of Health and Social Services.

Summary of jurisdiction-specific indicators and targets
Indicator	Baseline	Target	Timeframe
Initiative 1- Enhancing Home Care Infrastructure – InterRAI Project
Number of communities that have transitioned to InterRAI and CCIS	0 (2022-23)	33	2025-2026^{Footnote 4}
Initiative 2- Increasing Support for Caregivers – Territorial IPAC Coordinator
Number of IPAC site visits completed each year	0	7	2026-2027

Long-term care

Context

LTC facilities in the NWT provide nursing and personal care services to individuals who have complex health conditions that require monitoring and who need personal care throughout the day and night which can no longer be met in the community with support from HCC. LTC primarily serves seniors and elders, however, persons admitted to these facilities may be of any age.

There are currently 9 GNWT funded LTC facilities operating in the NWT in 7 regional centres, providing a combined total of 200 beds. These 200 beds include 183 long-stay beds for permanent residents, and 17 palliative and respite care beds intended for shorter-term stays for community dwelling clients with continuing care needs and their family and community caregivers. Seven of the existing LTC facilities are operated by the GNWT, while two are operated by a Yellowknife based non-government organization (NGO). All NWT LTC facilities are accredited through the Accreditation Canada process.

The Department will use Aging with Dignity funding to support 2 activities. Flexibility in using the funding across the 5 years of the agreement is critical to ensuring project success.

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

Priority Area 1 – Workforce stability

1. LTC staffing standard

The Department's draft revised LTC Standards (not yet implemented) require a minimum of 3.6 hours of direct care per resident per day within LTC facilities for clinical staffing requirements. Some NWT LTC facilities already meet this standard while some do not. These facilities will require new resources to enable the adoption of the direct care hours standard when implemented in Fall 2023. Aging with Dignity funding from 2023-24 to 2027-28 will be used to support this transition including adopting a staffing ratio of 30% nursing to 70% Resident Care Aide (RCA), and the requirement for RN coverage 24/7.

The primary health human resources required to deliver HCC and LTC services are Practical Nurses (PNs) and Personal Support Workers (PSWs), that are hired within the health and social services system under the job titles of Licensed Practical Nurses (LPNs), Home Support Workers (HSWs) in HCC, and Resident Care Aides (RCAs) in LTC. The GNWT has made incremental investments in the last several years to contract Aurora College to expand the PSW program in the NWT, including a distance delivery option, and to deliver a PN program. The distance delivery option has increased options for individuals from remote and Indigenous communities to complete training through a blended approach of online classes and in-person practicums. This will increase our system capacity to provide culturally safe services in Continuing Care programs by training a workforce that has the necessary language/cultural skills to meet diverse client needs.

The NWT Long Term Care Program Review (2015) recommended the implementation of 3.6 hours of direct care in LTC facilities. Through a review of research and a jurisdictional scan completed by the Department in 2019, it was concluded that many jurisdictions have legislated that there must be an RN on site 24/7 to provide clinical oversight, and the trend towards a higher percentage of nursing care to respond to the growing complexity of LTC residents. The importance of quality and safety in LTC services was highlighted during the COVID-19 pandemic. As a result, the federal government initiated the development of national LTC standards.

The recently published Health Standards Organization (HSO) LTC Standards has set a LTC staffing standard of 4.1 hours of direct care per day to improve quality of care, especially as residents' care needs become more complex. The NWT needs to take steps to move towards this standard; this will occur by initially ensuring all NWT LTC facilities provide 3.6 hours of direct care with funding for a higher ratio of nursing/care aides to ensure adequate clinical oversight to services. Additional funding will be required by 2026-27 to ensure NWT LTC facilities meet the new Health Standard Organization (HSO) Standard of 4.1 hours of direct care.

The NWT has a large and diverse Indigenous population, who represent approximately 51% of the current population. The percentage of LTC residents who are Indigenous is currently over 60%, which is reflective of differences in social determinants of health in Indigenous people, which have been noted in the NWT and elsewhere in Canada. Ensuring LTC residents receive culturally and clinically safe LTC services is paramount to addressing the health and social needs of LTC residents, in particular those who are Indigenous and may experience barriers to receiving health services.

Priority Area 2 – Long-term care standards

1. Territorial housekeeping specialist and furniture and equipment replacement

IPAC assessments conducted in NWT LTC facilities have identified deficiencies including lack of standardized training in cleaning practices, and equipment and furniture that requires replacement due to wear. Aging with Dignity funding from 2023-24 to 2024-25 will be used to establish a Territorial Housekeeping Specialist to address deficiencies through the development and implementation of housekeeping policies and standardized training, and funding to replace LTC equipment and furnishings to ensure IPAC standards are met. These activities will contribute to meeting LTC standards for quality and safety, and assist NWT facilities to address deficiencies in their audit. LTC standards will provide the mechanism for accountability and oversight for housekeeping policies and training, once implemented. LTC furnishings and equipment replacement will be completed by the Health and Social Services Authorities, with input from the Department and through engagement with elders and LTC residents to ensure it is appropriate and resident informed.

The COVID-19 pandemic highlighted the importance of rigorous infection prevention and control policies and practices in the delivery of health care programs. To improve quality and safety in LTC, federal Safe Long Term Care funding was used in 2021-22 and 2022-23 to complete IPAC audits of each NWT LTC facility. These audits revealed deficiencies in several LTC facilities. Addressing the deficiencies will improve resident care and safety.

The NWT has a large and diverse Indigenous population, who represent approximately 51% of the current population. The percentage of LTC residents who are Indigenous is currently over 60%, which is reflective of differences in social determinants of health in Indigenous people, which have been noted in the NWT and elsewhere in Canada. Ensuring IPAC standards are being met will ensure LTC residents receive culturally and clinically safe LTC services, which is paramount to addressing the health and social needs of LTC residents, in particular those who are Indigenous and may experience barriers to receiving health services.

Summary of funding and planned expenditures
Long-Term Care	2023-24	2024-25	2025-26	2026-27	2027-28	Total
Funding available	$1,880,000	$1,880,000^{Footnote 1}	$1,880,000	$1,880,000	$1,880,000	N/A
Carryover	-	$1,299,000	$727,000	$533,000	$291,000	N/A
Total	$1,880,000	$3,179,000	$2,607,000	$2,413,000	$2,171,000	N/A
Priority Area 1 – Workforce Stability
Direct Care Staffing Standard	$543,000	$2,028,000	$2,074,000	$2,122,000	$2,171,000	$8,938,000
Priority Area 2 – Long-Term Care Standards
Territorial Housekeeping Specialist	$38,000	$174,000	-	-	-	$212,000
Furniture and equipment replacement	-	$250,000	-	-	-	$250,000
Total planned expenditure	$581,000	$2,452,000	$2,074,000	$2,122,000	$2,171,000	$9,400,000
Carryover Available	$1,299,000	$727,000	$533,000	$291,000	-	-

Measuring and reporting on results

Currently the NWT does not report LTC data to CIHI. Over the next few years with the implementation of InterRAI across the NWT, there will be opportunity for the NWT to support new and existing data capacity, collection and management.

Summary of jurisdiction-specific indicators and targets
Indicator^{Footnote 5}	Baseline	Target	Timeframe
Priority Area 1- Workforce Stability
Percent of facilities that meet Standards for Direct Care Staffing	22% (2/9) facilities meet the staffing standard	56% (5/9)	2027-2028
Priority Area 2- Long-Term Care Standards
Number of IPAC site visits completed each fiscal year	0	9 facilities	2024-2025
Number of Compliance Audits of cleaning practices completed each fiscal year	0	9 facilities	2024-2025

Northwest Territories Personal Support Workers and Related Professions

Personal Support Workers and Related Professions

In the Northwest Territories (NWT), personal support workers (PSWs) are considered professional care providers with the training and expertise to collaborate with nurses and other health care providers to ensure their clients and residents have quality and safe care. They have an important role in the NWT health and social services system helping clients and residents manage chronic conditions and remain safely in their homes and communities for as long as possible and/or provide services and programs to participate fully in community.

PSWs in the NWT work in a variety of settings including Home and Community Care (HCC), Long Term Care (LTC), Extended Care (EC), hospital and Supported Living (SL). The majority of the PSWs are employees of the three Health and Social Services Authorities (HSSA's), however some are employed by private agencies. There is one private LTC facility located in Yellowknife, two private SL facilities located in Inuvik and two private care providers in Yellowknife. These private facilities and care providers are funded and overseen by the HSSA's and must maintain compliance with established standards and policies specific to their program area.

Currently, PSWs in the NWT are consistently compensated at rates ranging from $34.20 - $40.85 per hour. PSWs in the NWT are members of the Union of Northern Workers and receive regular wage increments as per the collective agreement with a starting wage of $34.20 per hour.

Table 1: NWT PSWs
PSW Category	Full Time Equivalents (FTEs)^{Footnote 1}1	Current Wage per hour	Target wage (raise by 20% or to reach $25/hour over 5 years)	Time frame
All PSWs	189.4	$34.20 to $40.85	$25	2024-25 (Completed)
Footnotes Footnote 1 Table 1 provides FTEs, subsequent figures provided are based on total positions which include part-time employees. Return to footnote 1 referrer

Given this, the NWT has already met the first threshold to invest the federal PSW funding provided to support incremental wage increases of the lowest-paid PSWs by 20% or to reach $25/hour over the 5 years of funding. Therefore, federal funds will be used to support additional non-wage related recruitment and retention measures.

There are currently (2024-25) 161 PSWs positions across all three HSSA's (this number does not include the PSWs working at the private LTC facility, which is estimated around 42 PSW positions, and 2 SL facilities). 76% of the PSW workforce works at the largest NWT HSSA, the Northwest Territories Health and Social Services Authority (NTHSSA). See table below for age, ethnicity and gender for this HSSA.

Age	Ratio
<25	1%
25-34	14%
35-44	23%
45-54	35%
55-64	24%
65+	4%
Total	100%

Gender	Ratio
Female	86%
Male	14%
Total	100%

Ethnicity	Ratio
Indigenous	86%
Non-Indigenous	14%
Total	100%

Transformative change within NWT HCC and LTC services has been initiated in response to a looming demographic shift in the population aged 60+ both at a national and territorial level and growth in the number of persons with disabilities. These changes are intended to refocus services to support a philosophy of "aging in place" by becoming more responsive to the needs of seniors, individuals with reoccurring chronic and palliative health conditions and disabilities and their caregivers. This allows individuals to be supported in their own homes and communities with less reliance on institutional care. Individuals receiving these services often have other health and social care needs, including chronic health conditions and mental health and addictions issues, which requires coordination across HSS and Government of NWT (GNWT) programs.

The NWT is well positioned to implement measures that respond to the needs of the underserved/disadvantaged populations including, but not limited to First Nations, Inuit and Métis, official language minority communities, rural and remote communities, children, racialized communities (including people of colour), and LGBTIQA2S+ through a variety of methods that include: anti-racism training, resources for employees to support the commitment to provide a diverse and inclusive workplace, Diversity and Inclusion Framework to foster a public service that is welcoming, culturally competent and free of discrimination, Indigenous Cultural Awareness and Sensitivity Training that will help GNWT employees further develop cultural competencies and play a more active role in reconciliation.

HCC, LTC, ECU and SL services are funded as core healthcare programs by the GNWT and delivered by the 3 HSSA's. HCC is provided in all 33 communities and LTC in all the regional centers. There is one ECU in Yellowknife to support individuals with medically complex diagnoses, physical frailty and or cognitive deficit who require 24/7 professional nursing and or other professional supports on a permanent basis. SL helps adults with disabilities live as independently and safe as possible and participate fully in community. Supports with daily living tasks can be provided in a person's own home, or in SL accommodations. A range of services can be provided based on individual assessed needs which can range from a minimal support to 24-hour support.
The NWT has a large and diverse Indigenous population, who represent approximately 51% of the current population. With the commitments made to enhance HCC and SL services (recommendations from the 2019 HCC Review and 2022 SL Review) and reduce the need for LTC facility placement, there is an urgent and anticipated increased need for PSW education, supports and expertise in these areas. The NWT will allocate the federal funding to the following initiatives aimed at increasing NWTs capacity and supply of qualified and skilled PSWs. The following initiatives will also support enhanced understanding of the needs of NWT residents and ensure that there are adequate resources in place to meet the diverse needs including supporting Indigenous resident access to HCC, LTC and SL programs.

Hire a PSW Educator in each HSSA to provide support to PSWs in HCC and LTC
The spending plan considers a PSW Educator at a salary level 13 (e.g. LPN salary level).
- PSW Educators will:
  - Provide support to PSWs and ensure continuing competency amongst HCC and LTC programs in the HSSA's.
  - Assist in the planning, development, implementation, maintenance and evaluation of clinical education programs for PSWs.
  - Work with other clinical educators and quality assurance teams in the HSSAs to ensure that PSWs complete mandatory training and help facilitate successful HCC and LTC program delivery.
  - Review materials to ensure best practices and standards are followed.
  - Determine certification needs for PSWs and provides education to meet them.
  - Participate in the review and development of clinical practice guidelines, policies and procedures that facilitate patent care in HCC and LTC programs.
An educator specific to PSWs will ensure that education and training is targeted to the scope of PSWs and will support tracking and tailoring of the educational and training opportunities to the specific scope of the PSW. Through Indigenous and HSSA engagements, it is understood that there is a continued need for improvement and implementation in the delivery of culturally safe dementia care, palliative care, end of life care and care for those with mental health and addictions needs. These training activities will support person-centered communication to increase comfort in the provision of care and the implementation of evidenced-based practice knowledge, standardized education and monitoring tools.
Supporting Existing PSW Training
- Increase PSW education available to NWT residents for upcoming health care system labour market needs specifically in the areas of HCC and LTC services.
- Provision of quality care to individuals accessing HCC and LTC.
- Increase employment opportunities to NWT residents and create economic and social benefits for various communities.
PSWs play in integral role in helping individuals remain safe in their home and communities for as long as possible. If LTC is required, PSWs provide 24-hour supervision and supports in a home-like facility. PSWs work closely with people to promote and maintain physical, psychological, and social well-being. They work as part of the health care team providing basic care, assistance and support with activities of daily living in a variety of community health settings. Providing ongoing mentorship and tailored education/on the job training for PSWs supported by PSW educators will ensure safe and quality care is being provided to residents of the NWT who need HCC, LTC and SL services.
Enhanced funding for the Aurora College PSW Program
The investment in the Aurora College PSW program builds northern human resource capacity for PSW in continuing care services.
- The program aims to recruit northern residents into the PSW Program by providing a flexible learning structure and offering upgrading programs to existing PSWs already working within NWT health and social services.
- Increase in the number of PSW graduates with the requisite requirements to gain employment in positions.
Aurora College is the only provider of a standardized and structured PSW certificate program in the NWT. Due to an aging population and increase in complexity of health needs of individuals, there is a need to ensure continuation of PSW education and make available to NWT residents for upcoming health care system labor market needs, specifically targeted in the areas of HCC, LTC and SL. The Aurora College program is focused on meeting the needs of individuals, keeping people in their own communities and providing quality programming to ensure clients and residents are safe and that services are delivered according to established best practice. Graduates of the program will have the requisite requirements to gain employment in positions with HCC, LTC and SL in the NWT.

In keeping with the usual processes and practices followed in the territory, where funding is provided to for-profit operators to support the wages of PSWs, and/or recruitment and retention initiatives outlined above, the Northwest Territories will use practices to ensure that funding benefits PSWs through increased wages, and retention and recruitment initiatives without using the federal funding to contribute to operator profitability. Where cost-recovery is used, federal funds recovered will be used in accordance with the initiatives outlined above.

Measuring and Reporting on Results

The NWT will work with the Canadian Institute for Health Information (CIHI) on a pan-Canadian indicator related to PSWs and provide relevant data. The NWT will also report annually and publicly to residents on the progress to increase access to and training for PSWs in an integrated manner with other Aging with Dignity agreement reporting.

See Table below for measuring and reporting.

ACTIVITY	OBJECTIVE	EXPECTED OUTCOME (at the end of this agreement)
Aurora College program attendees in each cohort PSW Yellowknife PSW Blended Distance PSW Outreach	# PSWs who completed each cohort	75% students enrolled will graduate
Hiring of PSW educator in each region	A PSW educator will be hired in each HSSA	100% hired
PSWs will receive education in Palliative Care	# PSWs who received palliative education and training	70% will receive education and training in palliative care
PSWs will receive education in mental health and addictions	# PSWs who received mental health and addictions education and training	70% will receive education and training in mental health and addictions
PSWs will receive education in behavior supports (i.e. dementia and positive training for those with complex behavior)	# PSWs who received behavioral support education and training	70% will receive education and training in behavior supports

PSW Spending Plan
(based on notional allocation outlined in the Agreement)
($)	2024-25	2025-26	2026-27	2027-28	2028-29	Total
Notional funding allocation	1,030,000.00	1,040,000.00	1,050,000.00	1,060,000.00	1,070,000.00	5,250,000.00
PSW Educators	202,618.00	393,500.00	402,500.00	411,500.00	420,500.00	1,830,618.00
Training	-	45,845.50	45,845.50	45,845.50	45,845.50	183,382.00
Aurora College	115,000.00	836,500.00	761,500.00	761,500.00	761,500.00	3,236,000.00
Total Planned Expenditures	317,618.00	1,275,845.50	1,209,845.50	1,218,845.50	1,227,845.50	5,250,000.00
Carryover	712,382.00	476,536.50	316,691.00	157,845.50	-

Footnotes

Footnote 1

NWT Bureau of Statistics. (2023). Population Estimates by Community. Retrieved from: www.statsnwt.ca/population/population-estimates/bycommunity.php

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Footnote 2

Statistics Canada (2022) Population Projections.

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Footnote 3

Total federal funding available for 2023-2024 includes the estimated $139,000 carry-forward from the Canada-NWT Home and Community Care and Mental Health and Substance Use 2022-2023 Agreement

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Footnote 4

The target of 33 communities will be maintained to the end of the funding period.

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Footnote 5

All indicator targets were chosen to reflect the current capacity for data collection and reporting, and the introduction of new, time limited activities. There is limited capacity for outcomes-based reporting at this time, so many of the indicators were selected to demonstrate the output of the work being completed. However, the indicators and targets may need to be revisited at a later point in this Action Plan period to reassess whether a results/outcome-based measure can be established.

Timeframes were based on anticipated timelines for activities to be initiated and occurring, including the completion of staffing processes for new positions, where applicable.

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Date modified:: 2025-02-04