Canada-Nova Scotia Aging with Dignity Funding Agreement (2023-24 to 2027-28)

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 -

HIS MAJESTY THE KING IN RIGHT OF THE PROVINCE OF NOVA SCOTIA (hereinafter referred to as "Nova Scotia" or "Government of Nova Scotia") as represented by the Minister of Seniors and Long-Term Care (herein referred to as "the provincial Minister")

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

PREAMBLE

WHEREAS, on February 23, 2023, Canada and Nova Scotia 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 Nova Scotia 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 Nova Scotia 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, Nova Scotia has the primary responsibility for delivering health care services to its residents and supports diversity, equity, and the needs of underserved and/or disadvantaged populations, including, but not limited to First Nations, Inuit and Métis, official language minority communities, rural and remote communities, children, racialized communities (including Black Canadians), and LGBTIQA2S+;

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

WHEREAS, the provincial Minister is authorized to enter into Agreement; and

WHEREAS, Nova Scotians' personal information is protected by the Nova Scotia Personal Health Information Act and the Nova Scotia Freedom of Information and Protection of Privacy Act;

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

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

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 Nova Scotia, 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 Nova Scotia, 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, Nova Scotia estimated share of the amounts will be:

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

Fiscal Year	Budget 2017 Home and Community Care Estimated amount to be paid to Nova ScotiaFootnote * (subject to annual adjustment)	Budget 2021 Long-Term Care Estimated amount to be paid to Nova ScotiaFootnote * (subject to annual adjustment)
2023-2024	$15,720,000	$16,510,000
2024-2025	$15,720,000	$16,510,000
2025-2026	$15,720,000	$16,510,000
2026-2027	$15,720,000	$16,510,000
2027-2028	n/a	$16,510,000
* Amount represent annual estimates based on Statistics Canada's July 1st, 2022, 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:

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 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 Nova Scotia 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 Nova Scotia of the amount of the second installment as determined under sections 5.2.3 and 5.2.4.
6. Canada shall withhold payments if Nova Scotia has failed to provide reporting in accordance with 8.1.
7. Canada shall withhold the second payment in 2023-24 if Nova Scotia has failed to satisfy all reporting requirements associated with the preceding Canada – Nova Scotia 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 province's Financial Officer, of funding received the preceding Fiscal Year from Canada for home and community care under the Canada – Nova Scotia 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 Nova Scotia will use cost-recovery agreements with one or more privately-owned for-profit facilities as an accountability measure and Nova Scotia 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 Nova Scotia 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, Nova Scotia 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 expenditures 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, Nova Scotia 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 Nova Scotia 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 Nova Scotia 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, Nova Scotia 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 Nova Scotia 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 Nova Scotia 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, Nova Scotia agrees to put in place the accountability mechanisms outlined in Annex 4.

6.2 Where Nova Scotia has cost-recovery agreements in place with one or more privately-owned for-profit facilities pursuant to subsection 6.1, Nova Scotia 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 Nova Scotia 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, Nova Scotia 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 Nova Scotia 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 province's Financial Officer, of funding received the preceding Fiscal Year from Canada under this Agreement or the Previous Agreement compared against the Action Plan, and noting any variances, between actual expenditures and the Action Plan:
   1. The revenue section of the statement shall show the amount received from Canada under this Agreement during the Fiscal Year;
   2. The total amount of funding used for home and community care and long-term care;
   3. If applicable, the amount of any funding carried forward under section 5.4;
   4. If applicable, the amount of overpayment that is to be repaid to Canada under section 5.5; and
   5. With respect to the long-term care funding under this Agreement, where cost-recovery is used, the annual financial statement will also set out:
      1. The amount of the federal funding flowing to private, for-profit facilities; and
      2. The estimated amount of funds to be recovered under cost-recovery agreements, where applicable, and the priority areas where those funds will be reinvested.

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

8.3 Evaluation

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

9.5 Canada, with prior notice to Nova Scotia, 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 Nova Scotia 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 Nova Scotia 10 days advance notice, including advance copies of public communications related to the Common Statement, this Agreement, and results of the investments of this Agreement.

9.7 Nova Scotia reserves the right to conduct public communications, announcements, events, outreach and promotional activities about the Common Statement and this Agreement. Nova Scotia 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 Nova Scotia agree to participate in a mutually agreeable joint announcement upon signing of this Agreement.

9.9 Canada and Nova Scotia 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 Nova Scotia responsible for health, and if it cannot be resolved by them, then the federal Minister(s) and the provincial Minister(s) shall endeavour to resolve the dispute.

11.0 Amendments to the agreement

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

Tracey Barbrick
1741 Brunswick Street
Halifax NS B3J 3X8
Email: seniors@novascotia.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 Nova Scotia.

14.3 No member of the House of Commons or of the Senate of Canada or of the Legislature of Nova Scotia 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 Nova Scotia by the Minister of Seniors and Long-Term Care

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

Annex 1 – Common Statement of Principles on Shared Health Priorities

Common Statement of Principles on Shared Health Priorities

Annex 2 – Shared pan-Canadian interoperability roadmap

Figure 1 - Text description

5-Year Shared Pan-Canadian Interoperability Roadmap

The Roadmap outlines 8 categories of activities planned for fiscal years 2023 to 2027, followed by anticipated outcomes enabled. Notes are also included throughout to highlight a "milestone", where "vendor input is required", and/or when an activity is "continued" across multiple fiscal years.

Patient Summary

• Fiscal Year 2023
  • Alberta & Ontario Trial Implementation & onboard 2-3 Jurisdictions
  • Update based on Trial Implementations
  • Update and publish the Canadian Health Data Exchange (CA:FeX) Specification
• Fiscal Year 2024
  • Update specification to fully align to IPS/CA Core+ and reflect implementation feedback
  • Onboard remaining jurisdictions
  • Publish vendor conformance requirements and represent in national procurements [vendor input required]
• Fiscal Year 2025
  • Advance implementation and adoption
  • Pan-Canadian vendor compliance service *(Pan-Canadian interoperability compliance testing service in place, vendors conform to pan-Canadian standards in stages.) [vendor input required]
• Fiscal Year 2026
  • Advance implementation and adoption [continued]
  • Conduct performance evaluation
  • Update specification to reflect updated CA Core+ [milestone]
• Fiscal Year 2027
  • Advance implementation and adoption [continued]
  • Conduct performance evaluation [continued]

Data Portability

• Fiscal Year 2023
  • Develop Primary Care Dataset V1 & EMR Extract Specification V1 [milestone]
  • Represent Data Portability components in the Canadian Health Data Exchange (CA:FeX) Specification
• Fiscal Year 2024
  • Trial Implementation of specifications
  • Extend CA Core+ to include other settings (e.g. Acute Care, Mental Health)
• Fiscal Year 2025
  • Expand adoption and refinement to include LTC, Community Care and implementation feedback
  • Include requirements in national procurements (e.g. Acute Care, LTC, Mental Health, Community Care)
• Fiscal Year 2026
  • Expand adoption of Specifications
  • Complete specifications [milestone]
  • Pan-Canadian vendor compliance service *(Pan-Canadian interoperability compliance testing service in place, vendors conform to pan-Canadian standards in stages.) [vendor input required]
  • Conduct performance evaluation
• Fiscal Year 2027
  • Expand adoption of Specifications [continued]
  • Conduct performance evaluation [continued]

Patient Access

• Fiscal Year 2023
  • Assess patient data and access needs across jurisdictions
  • Assess the feasibility of IPA standard and decide on Canadian adoption of same
• Fiscal Year 2024
  • Co-design patient data access design/Blueprint to represent policy and consent in alignment with IPA
  • Implementation and refinement of the Canadian Health Data Exchange Specification to include Patient Access components [milestone]
• Fiscal Year 2025
  • Update data exchange specification to support patient Digital Identities
  • Expand adoption of Canadian Health Data Exchange Specification
• Fiscal Year 2026
  • Develop pan-Canadian guidance documentation for basic digital consent
  • Expand adoption of Canadian Health Data Exchange Specification [continued]
  • Conduct performance evaluation
• Fiscal Year 2027
  • Develop advanced guidance documentation to integrate policy and consent into data access
  • Expand adoption of Canadian Health Data Exchange Specification [continued]
  • Conduct performance evaluation [continued]

eReferral & eConsult

• Fiscal Year 2023
  • Consolidate existing specifications and publish pan-Canadian specification with procurement requirements [milestone]
• Fiscal Year 2024
  • Publish conformance requirements for vendors [vendor input required]
  • Implementation of pan-Canadian specifications
• Fiscal Year 2025
  • Evolve specification to integrate other services (e.g. PS-CA. Provider Directories and Digital Identities)
  • Pan-Canadian vendor compliance service *(Pan-Canadian interoperability compliance testing service in place, vendors conform to pan-Canadian standards in stages.) [vendor input required]
• Fiscal Year 2026
  • Complete Specification [milestone]
  • Conduct performance evaluation [continued]
• Fiscal Year 2027
  • Conduct performance evaluation [continued]

Enablers

• Fiscal Years 2023 to 2027
  • Governance
  • Change Management
  • Vendor Mobilization

Data

• Fiscal Year 2023
  • p-CHDCF, CA Core+ and Consistent Data Semantics
  • Data Matching
• Fiscal Year 2024
  • p-CHDCF, CA Core+ and Consistent Data Semantics [continued]
  • Data Matching [continued]
• Fiscal Year 2025
  • p-CHDCF, CA Core+ and Consistent Data Semantics [continued]
  • Data Matching [continued]
• Fiscal Year 2026
  • p-CHDCF, CA Core+ and Consistent Data Semantics [continued]
• Fiscal Year 2027
  • N/A

Access & Exchange

• Fiscal Year 2023
  • Consistent, Secure, HIE Exchange
  • Healthcare Directories and Resource Locations
• Fiscal Year 2024
  • Consistent, Secure, HIE Exchange [continued]
  • Provider Directories
  • Digital Identities & Identity Proofing
  • Healthcare Directories and Resource Locations [continued]
• Fiscal Year 2025
  • Consistent, Secure, HIE Exchange [continued]
  • Provider Directories [continued]
  • Digital Identities & Identity Proofing [continued]
  • Healthcare Directories and Resource Locations [continued]
• Fiscal Year 2026
  • Consistent, Secure, HIE Exchange [continued]
  • Provider Directories [continued]
  • Digital Identities & Identity Proofing [continued]
  • Consistent Patient Access
  • Healthcare Directories and Resource Locations [continued]
• Fiscal Year 2027
  • Consistent, Secure, HIE Exchange [continued]
  • Consistent Patient Access [continued]

Trusted Framework

• Fiscal Year 2023
  • Jurisdictional Needs Assessment [milestone]
  • Scalable Data Sharing Governance Framework
  • Industry-wide, Testing and Conformance
• Fiscal Year 2024
  • TEF development (contingent on PT support)
  • Scalable Data Sharing Governance Framework [continued]
  • Industry-wide, Testing and Conformance [continued]
• Fiscal Year 2025
  • Consistent Representation of Policy & Consent
  • Scalable Data Sharing Governance Framework [continued]
  • Industry-wide, Testing and Conformance [continued]
• Fiscal Year 2026
  • Consistent Representation of Policy & Consent [continued]
  • Scalable Data Sharing Governance Framework [continued]
  • Industry-wide, Testing and Conformance [continued]
• Fiscal Year 2027
  • Consistent Representation of Policy & Consent [continued]
  • Scalable Data Sharing Governance Framework [continued]
  • Industry-wide, Testing and Conformance [continued]

Outcomes

• Ability to import/export primary care data to, from and between EMRs
• Clinicians able to change EMRs
• Governance model established
• Vendor support services available to all jurisdictions
• National procurement framework established
• Change management program in place
• 50% of Canadians enabled to directly access their longitudinal record
• 60% of primary care physicians reporting ability to exchange patient summary record
• 70% of clinicians with EMRs enabled to send clinical summaries through a vendor conformed solution
• 75% of Canadians enabled to access their patient summary record
• Benefits realized:
  • Health System – $500M in improved interactions, effective use of ED, in-patient services, an reduction in duplicate tests
  • Canadians – over $500M in saved patient time
  • Clinicians – over $350M in saved time

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

Action for Health

Since 2022, all health care planning in Nova Scotia has been guided by Action for Health: A Strategic Plan 2022-2026. Action for Health is government's roadmap for a health system where Nova Scotians can access world-class healthcare in a timely manner.

Action for Health is comprised of six core solutions, each including its own objective for creating an efficient, modern, equitable, and respectful health ecosystem. The work, actions, and investments generated by these solutions will make an impact in the short and the long term.

Solution One: Become a magnet for healthcare providers

Solution Two: Provide the care Nova Scotians need and deserve

Solution Three: Cultivate excellence on the frontlines

Solution Four: Build in accountability at every level

Solution Five: Be responsive and resilient

Solution Six: Address the factors affecting health and well-being

As part of the Action for Health plan, the province has committed to ensuring that Nova Scotians have access to important, regularly updated healthcare data. The Action for Health website now includes measures so Nova Scotians can understand how the Province is tracking and measuring progress on improving the system for patients and healthcare professionals.

The work of implementing the actions outlined in Action for Health are well underway. As Nova Scotia continues to make significant progress on health transformation, the province welcomes federal support and partnership towards implementing actions that support Action for Health. The Shared Health Priorities outlined by Health Canada, and agreed to by all jurisdictions, complement and align with Nova Scotia's Action for Health plan and each of the six solutions.

A Commitment to Health Equity in Nova Scotia

In July 2023, Nova Scotia released the Health Equity Framework to guide Nova Scotia's health providers and partners in identifying, reducing, and eliminating all forms of racism and discrimination within the health system. The framework was informed by extensive consultation sessions with Indigenous and equity communities, healthcare providers and partners across the province.

When the province was engaging with partners to develop the Dismantling Racism and Hate Act (passed in April 2022), the health care system was identified as a major concern related to racism and discrimination. As a result of what was heard in these engagement sessions, the Dismantling Racism and Hate Act required government, in collaboration with all health partners and in consultation with underrepresented and underserved communities, to develop the Health Equity Framework.

The framework:

• considers all EDIRA^{Footnote 1} and ARAO^{Footnote 2} elements when making improvements to the health system.
• guides the incorporation of ARAO principles across the health system.
• focuses on addressing how the health system creates health inequities, anchored by the social and structural determinants of health.
• provides clear, measurable outcomes with indicators/metrics to assess progress.

The Health Equity Framework is also an important initiative under Solution Six of Nova Scotia's Action for Health plan, which says government must address the factors affecting health and well-being. The priority actions in this framework are at the core of the work laid out in Action for Health and are necessary to transform the health system in the province. The approach detailed in the framework is also in line with Nova Scotia's Equity and Anti-Racism Strategy, which calls for coordinated action, community engagement, and accountability to Nova Scotians.

Continuing Care in Nova Scotia

The proportion of adults over the age of 65 in Canada is 18.5%, with most residing in the Atlantic provinces. In Nova Scotia, 21.8% of the population is 65 years and older (Statistics Canada, 2021).

Nova Scotia established the Department of Seniors and Long-term Care (SLTC) in August 2021 by combining the Continuing Care Branch of the Department of Health and Wellness with the Department of Seniors. SLTC supports the social and economic well-being of older adults across the ageing continuum and is mandated with improving the quality of care for those accessing Continuing Care Services.

Continuing Care Services are authorized by the provincial health authority, Nova Scotia Health (NSH). The provincial health authority employs care coordinators who: provide assessments and case management; determine the type and level of care needed; and authorize Nova Scotians to receive those services. Services are then delivered by NSH, contracted nursing and home care agencies and long-term care facilities and other equipment/home oxygen providers.

Home Care

Home Care is available to all Nova Scotians who need help with care in their homes and communities. Clients access home care services through Nova Scotia Health by calling a centralized intake number. To receive home care services, clients are required to meet with a Care Coordinator and complete an assessment to determine service eligibility based on needs.

Home Care Services include Home Support, such as personal care, meal preparation, respite and essential housekeeping, and Home Nursing, such as dressing changes, catheter care, intravenous therapy and palliative care.

There are currently 18 home care agencies across the province, supporting over 30,000 clients a year through approximately 4.5M hours of authorized home support services and approximately 1.1M home nursing visits.

The province also provides Direct funding programs which support individuals to purchase home support services privately. Direct funding programs flourished during COVID and have continued to expand. For those who choose these programs, benefits include providing the client with the ability to hire someone they know, to determine their schedule, and to make changes and have direct control of their care. The programs have become a valued part of the home support services continuum and support close to 3,000 Nova Scotians each year.

Community Care

SLTC Community Care includes programs and services that support Nova Scotians to have access to resources, equipment, and devices to foster independence. The range of programs and services offered include:

• The Seniors Care Grant (SCG): The SCG helps low-income seniors with the cost of household services (like lawn care, snow removal, grocery delivery, transportation, small home repairs and phone service) and healthcare services (like physiotherapy and mental health support). In 2022-23, over 40,621 Seniors Care Grants were approved.
• Equipment Loan Programs: A number of programs which provide access to equipment and devices including home lifts, hospital beds, home oxygen devices, wheelchairs, and other home safety equipment as well as Personal Alert devices and medication dispensers are available to eligible Nova Scotians.
• The Caregiver Benefit Program: This program recognizes the important role of caregivers in their efforts to assist loved ones and friends by providing $400 per month to caregivers of low-income adults who have a high level of disability or impairment.
• Adult Day programs: These programs provide personal assistance, supervision, and health, social, and recreational activities in a supportive group setting to help seniors live in their community as independently as possible, while also offering respite care, training, and informal support to family caregivers. Nova Scotia is currently funding four pilot medical high needs adult day programs. These programs, located across the province, are offered at no fee to clients.
• Community organization supports: Funding to community organizations to create age-friendly environments, promote healthy aging and support initiatives that help lead to positive impacts in the lives of older adults in Nova Scotia, such as Age-Friendly Community Grant, CORAH (Centre of Rural Aging and Health), the Seniors' Safety Program, etc.
• Seniors focused pilots and demonstration projects: These projects are aimed at helping the Province understand how best to support Nova Scotians as they age. Examples of this work include testing new models of care, such as providing services in a "cluster' centered around public housing units, and the Capable pilot program which pairs a nurse, occupational therapist, and a tradesperson with a senior in order to achieve greater independence to allow them to remain longer in their homes.

Home and Community Care and Mental Health and Addiction Services Bilateral Agreement

The Canada - Nova Scotia Home and Community Care and Mental Health and Addiction (HCCMHA) Services Funding Agreement was signed in 2017/18. Funding from the HCCMHA bilateral agreement has been used to support many programs and services in Nova Scotia, in alignment with the shared priorities of the federal government, and provinces and territories.

The following table outlines key investments made from 2017/18-2022/23.

Enhancing Continuing Care Services for Clients
Initiative	Description
Provincial Acquired Brain Injury Action Plan	Facilitated the expansion of eligibility criteria for existing programs and services to allow individuals with an ABI to access targeted supports. Supported the operation of an intensive 12-week rehabilitation day program. The customizable program allows individuals to remain in their home and stay active within their community while focusing on achieving specific rehabilitation goals to maximize their capabilities.
Address Gaps in Palliative Care	Added new palliative care clinicians who work in typically underserved areas. Clinicians are integrated into collaborative primary health care teams which helps ensure integration and linkage to available palliative services. Supported palliative care volunteers through the establishment of a coordinator position that manages volunteer services. Implementation of appropriate training for volunteers to enable them to function at an optimal level in their very important role.
Supporting Caregivers
Alzheimer's/Dementia Supports	Expanded existing Alzheimer's Society of Nova Scotia programs and services for continued collaboration with community stakeholders. Supported the delivery of the U-First! Education Series to health care providers in Long Term Care and Home Care.
Acquired Brain Injury Supports	Introduced early intervention virtual care options to caregivers of ABI survivors, which allows Nova Scotians to access supports from their own homes, on their own schedule, without travelling or taking time off work.
Caregiver Benefit Program Expansion	Expansion of the Caregiver Benefit Program eligibility criteria to acknowledge the support provided by more caregivers of those with mild cognitive impairment who often require assistance to manage daily activities.
ALS Society	Purchased new equipment such as hospital bed mattresses, wheelchairs, and bedside tables. Invested in a software program to manage client services and inventory data.
Caregivers Nova Scotia	Increased the reach of Caregiver NS programs, support groups, advocacy, and services focused on the unique needs of friends and family giving care.
Continuing Care Assistant Training	Supported workforce investments in free tuition. In 2022-23, Nova Scotia exceeded their target of 1,000 students enrolled in free tuition Continuing Care Assistant training programs.
Support Integrated Care
Tajikeimɨk Supports	Tajikeimɨk is the new and developing health and wellness organization created to lead health transformation for Mi'kmaw communities in Nova Scotia. Tajikeimɨk works with health system partners to support efforts to provide improved access to culturally informed and culturally safe home and community care and long-term care services that meet the needs of Mi'kmaw communities. HCCMHA bilateral funding was provided to Tajikeimɨk and used for: Expenses associated with equipment, supplies, etc. to enable community members to stay in home or close to home by addressing immediate continuing care needs. Supports for Mi'kmaw community health planning processes in home and community care that integrates Mi'kmaw language, culture, worldview, teachings, wellness and healing practices. Planning will inform efforts to address current gaps in home and community care services/programs. Project supports to expand home nursing services in Mi'Kmaq communities, including coordination and alignment of processes between the health authority and communities (represented by their health directors).
Mi'kmaw Chair in L'nu Healthy Communities	Introduction of the Mi'kmaw Chair in L'nu Healthy Communities at Cape Breton University - a unique, community-based research and practice initiative aimed at improving health outcomes in Mi'kmaw communities.
Exercise Physiology Program at Acadia University	Supported community exercise programs and one-on-one physical activity counseling through weekly exercise management sessions to older adults in a safe environment with knowledgeable instructors. The model offers a continuum of support across the ability spectrum of frailty to encourage long-term health and wellness to even the least fit.
Acquired Brain Injury (ABI) Supports	Supported the operations of the ABI Provincial Network, which connects over 370 practitioners across the province to provide education, mentorship, and support on the care of individuals with Acquired Brain Injury in Nova Scotia. Development of the NeuroCommons, a physical space and a concept that was purpose built to support the needs of acquired brain injury clients. NeuroCommons provides a common space for clinicians, learners, community partners and researchers and also houses Nova Scotia Health's community-based ABI Day Program, ABI Outreach, Social Work Services, a Nurse Practitioner Clinic, and the Provincial Acquired Brain Injury Network.
Emergency Health Services	Implemented Community Based Programs to enhance patient care and help alleviate stress on the health care system. Community Based Programs consist of such initiatives as Extended Care Paramedicine and Supportive Discharge, non-emergency clinical services which are provided in collaboration with communities and other health stakeholders and offer more flexibility and choice with new patient care pathways. Introduced a Medical Transport Service Program using specialized vans and a non-paramedic driver for transport of low-acuity patients in selected areas of the province. The primary objective is to reduce the use of ambulances and paramedics from performing non-clinical and non-urgent transports.
Youth Health Centres	Funded School Health Promoter and Youth Health Centre Coordinator positions in four regions across the province. These positions work closely with the school administration, other health supports, Schools Plus and community partners to deliver health promotion, youth engagement, navigation and referral services.
Enhancing Sustainability, Accountability and System Performance
interRAI Long-Term Care Facilities Assessment Tool	Implemented the interRAI Long-Term Care Facilities Assessment Tool in LTC homes to improve the accountability and performance monitoring for the continuing care system. The implementation of this tool enables comprehensive, standardized evaluation of all LTC clients and will allow for the development of more appropriate client centred care plans and will help ensure appropriate use of LTC beds.

Aging with Dignity: Description of Home and Community Care Initiatives

Investment for Remaining Four Years of the 2017 Common Statement of Principles on Shared Health Priorities

Estimated Investment per Year (Previous Bilateral Agreement): $15,700,000 per year

With the remaining 4 years of funding for HCC services associated with the 2017 Common Statement of Principles on Shared Health Priorities, Nova Scotia plans to continue to fund the following HCC initiatives that were originally included in the Nova Scotia Action Plan on Home and Community Care and Mental Health and Addictions Services:

1. Enhanced Home and Community Care Services

Approx. $920,000 annually

Funding will be used to continue activities implemented under the previous HCCMHA that offer more flexibility and choice, align resources that support health outcomes, promote efficiencies, and leverage community-based resources.

All activities identified below are continuations of supports implemented through the previous HCCMHA bilateral agreement:

• Acquired Brain Injury (ABI) Supports:
  • Brain Injury Association of Nova Scotia Awareness and Training – Funding is used to maintain a directory of ABI services in NS, maintaining the Chapter Network and providing evidence-based training to build the brain injury support and peer support skills of chapter leads, and delivering community-based, evidence-informed ABI information, education, and resources for Nova Scotians.
  • Community Rehab Program - A customizable 12-week program allows individuals to remain in their home and stay active within their community while focusing on achieving specific rehabilitation goals to maximize their capabilities.
  • IWK Home First – Continued funding support for the IWK Home First program to meet the needs of children with an ABI to transition from hospital to their community.
• Home Oxygen – Continued funding to support the increase in Home Oxygen budget due to the rate increase approved in the 2019 Service Agreements with service providers.

Alignment with Common Statement on Principles

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

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

2. Supporting Caregivers

Approximately $2,365,700 annually

Family/friend caregivers are essential partners of continuing care services. Caregiver's situations are shaped by the condition and circumstances of the person they support and likely require different or changing supports at different times through their journey. Nova Scotia acknowledges that caregivers need to be supported in their efforts to support their loved one as long as possible. We know that caregivers are diverse and require flexible supports.

Aging with Dignity bilateral funding will be used to continue activities implemented under the HCCMHA intended to support caregivers by ensuring they are aware of and have access to services and supports that address their distinct needs.

• Caregiver Benefit – Continue to fund the Caregiver Benefit Program, which provides $400 per month to caregivers caring for low-income adults living with a high level of disability and impairment.
• Alzheimer's Society of Nova Scotia (ASNS):
  • Continue funding the expansion of programs and services due to increased service demand, such as public awareness and First Link programs that increase access to education and information dementia resources about dementia in communities across Nova Scotia.
  • Continue the delivery of the U-First! Education Series to health care providers in Long Term Care and Home Care to provide hands on training, key skills, and best practices for providing care to persons presenting with cognitive impairment and responsive behaviour. Approximately 320 participants per year receive U-First! For Healthcare training.
  • ASNS is currently in the process of developing key performance indicators related to inclusion, diversity, engagement, and accessibility, such as the number of education sessions and displays in diverse communities, including African Nova Scotian Communities, Indigenous Peoples and other equity-seeking groups.
• Self-Managed Care – Self-Managed Care is a direct funding programs that allows people with physical disabilities to hire their own care providers and develop their own care plans, which gives them control over the services they need and the providers they choose. Federal funding will continue to be utilized to support increased costs related to care.
• Caregivers NS – Caregivers Nova Scotia offers referral services, counseling, education, and peer support programs. By addressing the immediate needs of caregivers, they are helping alleviate the burden on families and contribute to the overall well-being of both caregivers and care recipients. The work of Caregivers Nova Scotia and their partners are contributing to improved support systems for caregivers, enhanced well-being of families, and the overall advancement of government priorities in the caregiving sector. Access to federal funding increases the reach of Caregivers Nova Scotia programs, support groups, advocacy, and services to more communities, including recent caregiver engagement in African Nova Scotian and newcomer communities.
• Workforce – Bilateral funding will continue to support the province's ongoing workforce investments. Through Action for Health, Nova Scotia has a target of 2,000 free tuition and books for continuing care assistants. AWD funding will augment the province's substantial investment in Continuing Care Assistant (CCA) training.

Alignment with Common Statement on Principles

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

• Increasing support for caregivers.

3. Integrated Care

Approximately $6,774,000 annually

AWD funding will be used to continue to support investments in the integration and coordination of care in the community and across the entire care continuum. This includes:

• Acquired Brain Injury Supports:
  • Continue funding the Acquired Brain Injury (ABI) Provincial Network, which connects over 370 NSHA and IWK practitioners across the province to provide education, mentorship, and support on the care of individuals with Acquired Brain Injury in Nova Scotia.
  • Continue funding the NeuroCommons, which supports the needs of acquired brain injury clients by providing a commons space for clinicians, learners, community partners and researchers – a neurosciences hub for collaboration and innovation.
• Clinical Exercise Physiologists – Continue funding Clinical Exercise Physiologists through the Centre for Lifestyle Studies at Acadia University to offer community exercise programs and one-on-one physical activity counseling to older adults. Through the delivery of community exercise programs and one-on-one physical activity counseling, this initiative provides 2-3 hours of exercise management to ~100 older adults each week in a safe environment with knowledgeable instructors.
• Indigenous home care – Continue to support the work of Tajikeimɨk, the new and developing health and wellness organization created to lead health transformation for Mi'kmaw communities in Nova Scotia. NS funds Tajikeimɨk directly to determine most appropriate use of funding that will support efforts to provide improved access to culturally informed and culturally safe home and community care and long-term care services that meet the needs of Mi'kmaw communities. Funding has been used to purchase supports not otherwise funded to enable people to return home from hospital with equipment and supports in place. It has also been used for committee working sessions to support home care policy review and integration of provincial and community supports, as well as funded training to support culturally cafe care.
• Continue funding the Mi'kmaw Chair in L'nu Healthy Communities at Cape Breton University to bring together Mi'kmaw health professionals and leaders with academic partners to deepen understanding related to the incorporation of Mi'kmaw ways of knowing in health promotion and to design and test interventions aimed at improving health outcomes.
• Continue funding the ALS Society to provide support to those with ALS that delays the need for long-term care, reduces hospital stays, and lessens financial strain on families living with ALS and the health care system.
• Continuing funding EHS Community Based Programs to enhance patient care and help alleviate stress on the health care system by providing non-emergency clinical services that will offer more flexibility and choice with new patient care pathways.
• Continue funding EHS Medical Transport Service Program to transport low-acuity patients in selected areas of the province, reducing the use of ambulances and paramedics from performing non-clinical and non-urgent transports of people within Nova Scotia's health system.
• Continuing funding of four School Health Promoter positions and five Youth Health Centre Coordinator positions to enhance mental health and addictions supports and health promotion activities through youth health centres in schools. As well, funding supports the continued implementation and enhancement of a school based youth health centre model throughout Nova Scotia.

Alignment with Common Statement on Principles

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

• Spreading and scaling evidence-based models that are integrated and connected with primary health care; and
• Enhancing community-based service delivery.

4. Sustainability, Accountability and System Performance

Approximately $5,390,300 annually

Nova Scotia will continue to invest federal funding in the ongoing operational costs to maintain the interRAI Long-Term Care Facilities Assessment Tool in long term care facilities (LTCFs). InterRAI-LTCF will enable comprehensive, standardized evaluation of all LTC clients. This assessment tool informs system wide analyses of client care goals and allows the province to track client needs and care outcomes (such as care coordination between home care and long-term care) and better share information with other health care system partners, i.e., primary health care.

Nova Scotia is currently exploring the use of expanding the implementation of InterRAI tools through a provincial technology platform to support accountability, quality/consistency of care, and system efficiencies in the home care system.

Alignment with Common Statement on Principles

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

• Spreading and scaling evidence-based models of home and community care that are more integrated and connected with primary health care; and
• Enhancing home care infrastructure, such as digital connectivity, remote monitoring technology and facilities for community-based service delivery.

Estimated HCC Funding Allocation

The following table represents an estimated projection of spending across each priority area. Please note that this will be subject to change as planning for fiscal years 2024/25 and 2025/26 continues.

Home and Community Care Initiative	2023-24	2024-25	2025-26	2026-27	Total
Enhanced Continuing Care Services	$920,000	$920,000	$920,000	$920,000	$3,680,000
Supporting Caregivers	$2,635,700	$2,635,700	$2,635,700	$2,635,700	$10,542,800
Supporting Integrated Care	$6,774,000	$6,774,000	$6,774,000	$6,774,000	$27,096,000
Sustainability/Accountability/ System Performance	$5,390,300	$5,390,300	$5,390,300	$5,390,300	$21,561,200
Total	$15,720,000	$15,720,000	$15,720,000	$15,720,000	$62,880,000

Measuring and reporting on results

Nova Scotia reports on indicators related to home and community care through the Action for Health plan. Interactive data dashboards are updated daily to provide information on the health services Nova Scotians use, and quarterly updates highlight meaningful accomplishments and significant data points from the previous quarter.

Nova Scotia data is included in the following Canadian Institute for Health Information (CIHI) Canadian indicators for home and community care to support measuring progress to improve access:

• Death at Home or in Community;
• Home Care Services Helped the Recipient Stay at Home;
• Caregiver Distress;
• Hospital Stay Extended Until Home Care Services or Supports Ready.

Nova Scotia data is not currently available for the following CIHI indicators:

• New LTC Residents Who Potentially Could Have Been Cared for at Home
• Wait Times for Home Care Services

In recent years, Nova Scotia has made significant progress in the ability to gather, monitor, and share data, particularly in relation to long-term care through the implementation of interRAI-LTCF. As progress continues, both in LTC and elsewhere in the health system, NS commits to ongoing review of potential indicators related to home and community care to determine if additional data can be shared. Nova Scotia currently lacks a home care technology and data sharing platform (including interRAI HC) that would allow the province to report to CIHI on home care measures.

Nova Scotia has identified the following AWD home and community care initiative indicators that will be reported upon annually.

Indicators – Home and Community Care

Indicator	Baseline	Target	Timeframe
Initiative 1 - Enhanced Home and Community Care Services
Total attendance of Brain Injury Association Programs and Training*	0	3,465	Annual target beginning 2024-
Initiative 2 – Supporting Caregivers
Total participants in U-First! For Healthcare delivered by the Alzheimer Society of Nova Scotia*	0	320	Annual target beginning 2024-
Initiative 3 – Integrated Care
Number of clients participating in the ABI Day Program and Outreach teams*	0	3,051	Annual target beginning 2024-
Initiative 4 - Sustainability, Accountability and System Performance
Percentage of long-term care facilities that have implemented interRAI-LTCF	100%	100%	Baseline to be sustained

* These targets represent annual service delivery targets that are reset to a baseline of 0 at the beginning of each year.

Long-Term Care in Nova Scotia

In Nova Scotia, long-term care facilities licensed and funded by the Department of Seniors and Long-Term Care provide services for people who need ongoing care; either on a long-term basis (permanent placement) or short-term basis (respite care). There are two types of long-term care facilities available, nursing homes and residential care facilities.

Nursing homes provide nursing and personal care on a 24-hour basis including care given under the supervision of a nurse, administration of medication and assistance with daily living. Other services may include physiotherapy, occupational therapy, and recreation, and those provided by a Social Worker. Residential care facilities provide assistance with personal care such as, bathing and dressing, and reminders about daily routines. Personal care and supervision are provided by Continuing Care Assistants (CCAs).

To apply for residency in a nursing home or a residential care facility, individuals or their families would contact Continuing Care via a toll-free 1-800 number to arrange for an assessment to determine care needs and eligibility for long-term care.

As of September 2023, there are 138 long-term care facilities in the province, including 82 nursing home (NH) facilities, 40 Residential Care facilities (RCF), and 16 combined NH/RCFs. Of the 138 long-term care facilities, 81 are for-profit and 30 are not-for-profit, 13 are municipally owned, and 14 are hospital-owned. There are approximately 8,000 long-term care beds in the province. Nova Scotia is on track to create 3,500 single-bed rooms within 34 long-term care facilities across the province by 2027, as part of Government's Mandate to renovate and build 2,500 new single-bed rooms over three years. Of the 3,500 rooms, 1,200 will be new rooms and approximately 2,300 will be replacement rooms, increasing the province's long-term capacity from 8,000 people to 9,200.

In addition to increasing the number of long-term care beds, Nova Scotia is also taking steps to enhance the care received by residents. As such, the province has committed to increasing hands-on care for each resident to an average of 4.1 hours of care each day.

Efforts to establish this standard are well underway, with most facilities implementing or ready to implement an average of 4.1 hours of care each day. Facilities receiving 4.1 funding are required to submit quarterly accountability reports outlining implementation progress. Throughout implementation, SLTC is continuing to assess the need for additional funding to implement 4.1, including cases where additional beds are added to facilities.

Ensuring that there are enough providers to deliver care, both in long-term care and in home care, is a key priority within the Province. As such, in February 2022, CCAs in the publicly funded sector received a well-deserved pay increase of about 23 per cent. For most full-time CCAs, this represented an annual increase of close to $9,000. The Nova Scotia government is providing about $65 million in funding to health authorities, long-term care and home care service providers for this increase.

The Province has also been focused on attracting and retaining continuing care workers. This includes an investment of $22 million over two years to cover 100 percent of tuition costs for over 2,000 students in CCA programs. In addition, there have been a number of other human resources investments over the last three years, including:

• Funding long-term care homes to offer their casual and part-time employees full-time positions or to hire more staff to provide direct care;
• Tuition rebates for current continuing care assistant students;
• National and international continuing care assistant recruitment campaigns; and
• Increase in professional development opportunities for staff.

Aging with Dignity: Description of Long-Term Care Initiatives

Estimated Investment per Year: $16,500,00

Action for Health is the Nova Scotia government's roadmap for a health system where Nova Scotians can access world-class healthcare in a timely manner and service agreement renewal for long-term care is included under the Action for Health plan. The Department of Seniors and Long-Term Care is working with long-term care service providers to renew service agreements. As part of service agreement renewal, NS will make investments in staffing and will support improved accountability and quality within the sector. Nova Scotia will use Aging with Dignity funding to support the implementation of new staffing and support enhanced accountability and quality for the LTC sector to meet Nova Scotia's commitments set out under Action for Health to:

• support Nova Scotians to get the care they need and deserve;
• make the province a magnet for health providers;
• ensure service providers can be responsive and resilient; and
• build in accountability at every level.

Funding from the Aging with Dignity agreement will be used to augment current staffing and add new positions to address long-standing issues and historic underfunding in some areas within the LTC sector, support a resident-centered interprofessional team-based approach to care, and lay the foundation needed to support the LTC workforce to work toward expanded/advanced scopes of practice.

The proposed staffing enhancements will result in additional funded positions in nursing homes across the province in both clinical positions and non-clinical positions in cases where facilities have experienced a lower number of funded positions due to historical variations in staffing approaches. This approach to investing in clinical positions and non-clinical positions demonstrates a commitment from the Nova Scotia Government to support all roles in nursing homes needed to ensure the safe and high-quality care that residents deserve.

LTC service providers in Nova Scotia must comply with reporting and accountability requirements set out in multiple accountability tools across program areas, including service and funding agreements, Department of Seniors and Long-term Care policy, annual budget and grant funding, and LTC facility licensing requirements under the Homes for Special Care Act and LTC Program Requirements. The Long-Term Care Funding Envelope Policy includes protected envelopes to ensure that health care dollars intended for program support and resident care remain with residents. All provincially funded long-term care facilities are required to submit annual audited financial statements, including an Accountability Review Appendix, a copy of the auditor's management letter and a special purpose audit report detailing the protected funding envelope.

Nova Scotia will use Aging with Dignity funding to support the implementation of enhanced monitoring and follow-up to ensure compliance with service delivery and accountability mechanisms and that areas of non-compliance are identified and compliance measures enforced. Licensing, reporting and accountability requirements apply to all facilities (for-profit and not-for-profit) licensed by the Department.

System performance and quality improvement in LTC are key priorities for Nova Scotia. Aging With Dignity funding will be used to support work with the sector to enhance quality improvement activities and leverage information technology/data collection to develop Key Performance Indicators to support the development of a provincial quality improvement plan for the sector.

One-time Initiatives

The 2023-24 Aging with Dignity funding will support several one-time initiatives that will allow SLTC to explore enhancements related workforce/training opportunities, quality / data initiatives, and programs to defer LTC placement. These one-time initiatives will allow SLTC to explore / demonstrate opportunities to better support the long-term care sector and ensure that we are optimally positioned for success with the implementation of enhanced staffing and accountability. The one-time initiatives are as follows:

• Workforce Supports aimed at achieving stability in the long-term workforce and support improved quality of LTC:
  • Palliative Care Training Program (endorsed by Nursing Home Association) $710,000 to deliver the McMaster Strengthening a Palliative Approach in Long-Term Care (SPA-LTC) program though facilitated training, implementation and testing/evaluation of palliative and end-of-life educational interventions for staff in Nova Scotia Long-Term Care facilities.
  • Clinical Practice Units – $1,400,000 to develop a shared services model to support continuing care facilities and agencies to ensure clinical nursing staff have the knowledge and skills needed to care for residents/clients with complex care needs (e.g., treatment of acute infections and dehydration via IV, medication adjustments for pain management as part of end-of-life care, adjustment of medications as part of mental health treatment) and to support the "Choosing Wisely" approach in continuing care to reduce the overuse tests and treatments that do not add value and have a negative impact on the acute care system.
  • Grow Your Own CCA - $2,875,000 to cover the salary for 115 students while they engage in CCA training.
  • RN Authorized Prescribing - $1,200,000 to cover tuition and release time for a cohort of 25 students to participate in an RN Authorized Prescribing program.
  • CCA Philippines Recruitment - $500,000 to support the recruitment of 100 individuals for CCA roles.
  • Workforce Prototypes - $3,615,000 to 'test and try' workforce opportunities to rapidly shift from planning to action through the implementation of 14 prototypes across the province.
    • The prototypes are intended to support Nova Scotia's commitment to a transformation journey to improve the quality of long-term care for residents, create a system where seniors can age in place and feel at home, and position the sector as a place where care providers feel supported and where they want to work. To support this work, SLTC has engaged sector leaders, staff and system partners to identify prototypes to be implanted in a "test and try approach" focused on 3 themes:
      • Standardization: Prototypes will focus on ensuring consistency in roles, care delivery and effective use of resources (e.g., standardizing the role of CCAs).
      • Innovation: Prototypes will focus on supporting LTC teams to work to their full potential and scope of practice by thinking differently about care delivery (e.g., exploring the role of CCAs administering more medications).
      • Collaboration: Prototypes will enable new or improved ways of working across care settings. For instance, strengthening relationships between nursing homes, EHS and Emergency Departments (ED) so that residents can have more of their care needs met without being transferred to ED, or if a transfer is required, it is done in a streamlined manner (e.g., reducing ED wait times).
    • Compensation Framework- $300,000 - work with the sector to gather information needed to support the development of a management compensation framework. This is an initial step in the development of a management compensation framework.
• Quality Supports
  • InterRAI-LTCF and PathWays enhancement - $370,000 for enhancement to current data systems that will allows for better integration across NS system.
  • Deferring LTC - $5,540,000 to fund the annual cost of two programs that support seniors to remain at home and defer entrance to long-term care. Community Aging in Place, Advancing Better Living for Elders program (CAPABLE) pairs seniors with a registered nurse, an occupational therapist and a handyperson who will work with them to identify needs in their daily activities and homes that will help them age in place. Funding will allow the program to operate for an additional year while an evaluation is conducted to support future planning decisions. The Welcome Home Program is a new hospital discharge program that provides one full week of dedicated Home Aid support + one day of advance home prep (8 hour days) to clients with very limited or no unpaid caregiver support to support discharge. This program will be piloted using one-time federal funds.

The work that will be undertaken by SLTC, as described above, reflects Nova Scotia Long Term Care Program Requirements, and is in alignment with the updated version of Health Standards Organization (HSO) National Long-Term Care Services Standards, released in January 2023. The updated standards address the delivery of safe, reliable, and high-quality LTC services, and are based on findings from literature reviews, clinical expertise, evidence-informed practices, and those with lived experiences. Specifically, SLTC sees strong alignment with Health Standards Organization (HSO) National Long-Term Care Services Standard Section 6: Promoting Quality Improvement.

Allocation Table – Long-Term Care

Long-Term Care Initiative	2023-24	2024-25	2025-26	2026-27	2027-28	Total
Priority Area: Workforce Stability
Palliative Care Training Program	$710,000					$710,000
Clinical Practice Units	$1,400,000					$1,400,000
Grow Your Own CCA	$2,875,000					$2,875,000
RN Authorized Prescribing	$1,200,000					$1,200,000
CCA Recruitment in the Philippines	$500,000					$500,000
Workforce Prototypes	$3,615,000					$3,615,000
Compensation Framework	$300,000					$300,000
Priority Area: Long-Term Care Standards
Support an enhanced staffing model and enhanced accountability and quality improvement in LTC		$16.51M	$16.51M	$16.51M	$16.51M	$66.04M
InterRAI-LTCF and PathWays enhancements	$370,000					$370,000
Deferring LTC through pilot program support (CAPABLE and Welcome Home Program)	$5,540,000					$5,540,000
Total	$16.51M	$16.51M	$16.51M	$16.51M	$16.51M	$82.55M

* Allocations are rounded and notional, based on the 2022 July 1st population estimate published by Statistics Canada.

Measuring and Reporting on Results

Nova Scotia reports indicators related to long-term care through the Action for Health plan. Interactive data dashboards are updated daily to provide information on the health services Nova Scotians use, and quarterly updates highlight meaningful accomplishments and significant data points from the previous quarter.

As interRAI-LTCF reaches full implementation in Nova Scotia, it is anticipated that SLTC may be able to share additional indicators related to long-term care. As such, Nova Scotia commits to ongoing review of potential indicators related to long-term care to determine if additional data can be shared.

Nova Scotia has identified the following indicators related to long-term care, and will commit to reporting on these, as well as any others that may be included in Action for Health reporting at a future date.

Indicators – Long-Term Care

Indicator	Baseline	Targets	Timeframe
Priority Area 1 – Workforce Stability
Total registered Continuing Care Assistants	8,214	tbdFootnote 3	March 31, 2028
Priority Area 2 – Long-Term Care Standards
Number of LTC facilities who have signed new service agreements	0	91	March 31, 2028

Nova Scotia will also continue to participate in the Canadian Institute for Health Information led indicator process to improve reporting to measure access to home and community care, develop new common indicators for long-term care, and share and improve the availability of disaggregated data to enable reporting on progress for underserved and/or disadvantaged populations.

Overall Funding Allocations

	2023-24	2024-25	2025-26	2026-27	2027-28	Total
Home and Community Care	$15.72M	$15.72M	$15.72M	$15.72M	n/a	$62.88M
Long-Term Care	$16.51M	$16.51M	$16.51M	$16.51M	$16.51M	$82.55M
Total	$32.23M	$32.23M	$32.23M	$32.23M	$16.51M	$145M