Canada-Nunavut 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 -

THE GOVERNMENT OF NUNAVUT (hereinafter referred to as "Nunavut" or "Government of Nunavut") as represented by the Minister of Health (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 Nunavut 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 Nunavut 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 Nunavut 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, Nunavut 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 Government of Nunavut 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 Nunavut associated with the federal investment for long-term care, and home and community care consistent with the Common Statement; and

NOW THEREFORE, this Agreement sets out the terms between Canada and Nunavut 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 Nunavut 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 Nunavut 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 Nunavut 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 Nunavut 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 Nunavut agree that, with financial support from Canada, Nunavut 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 Nunavut 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 Nunavut 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 Nunavut 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, Nunavut 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 Nunavut'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 territory.

5.2 Allocation to Nunavut

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, 2022
$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

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 Nunavut, 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 2017 Home and Community Care, Nunavut's share of the per capita annual funding allocation for Fiscal Year 2022-23 will be provided to Nunavut in the first four Fiscal Years of the Term of this Agreement starting in 2023-24. This funding is calculated using the following formula: (F x K/L) / 4, where:

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

K is the total population of Nunavut, as determined using the annual population estimates on July 1^st, 2022 from Statistics Canada; and

L is the total population of Canada, as determined using the annual population estimates on July 1^st, 2022 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 Nunavut, as determined using the annual population estimates on July 1^st from Statistics Canada; and

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

5.2.4 Subject to annual adjustment based on the formulas described in section 5.2.3, Nunavut estimated share of the amounts will be:
Fiscal Year	Budget 2017 Home and Community Care	Budget 2017 Home and Community Care	Budget 2021 Long-Term Care
Fiscal Year	Estimated amount to be paid to Nunavut ^{Footnote *} (subject to annual adjustment)	Amount to be paid to Nunavut for share of 2022-23 allocation	Estimated amount to be paid to Nunavut ^{Footnote *} (subject to annual adjustment)
2023-2024	$625,000	$156,150	$1,810,000
2024-2025	$625,000	$156,150	$1,810,000
2025-2026	$625,000	$156,150	$1,810,000
2026-2027	$625,000	$156,150	$1,810,000
2027-2028	n/a	n/a	$1,810,000
Table 1 Footnote * Amount represents annual estimates based on Statistics Canada's July 1^st, 2022, population estimates. Return to table 1 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 also be paid within approximately 30 business days of execution of this Agreement by the Parties, subject to 5.3.1.g.
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.
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 Nunavut 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 Nunavut of the amount of the second installment as determined under sections 5.2.3 and 5.2.4.
Canada shall withhold payments if Nunavut has failed to provide reporting in accordance with 8.1.
Canada shall withhold the second payment in 2023-24 if Nunavut has failed to satisfy all reporting requirements associated with the preceding Canada – Nunavut Home and Community Care and Mental Health and Addictions Services Funding Agreement, 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 Nunavut's Chief Financial Officer, of funding received the preceding Fiscal Year from Canada for home and community care under the Canada – Nunavut Home and Community Care and Mental Health and Addictions Services Funding Agreement 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 Nunavut will use cost-recovery agreements with one or more privately-owned for-profit facilities as an accountability measure and Nunavut 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 Nunavut 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, Nunavut 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, Nunavut 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 Nunavut 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 Nunavut 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, Nunavut 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 Nunavut 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 Nunavut 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, Nunavut agrees to put in place the accountability mechanisms outlined in Annex 4.

6.2 Where Nunavut has cost-recovery agreements in place with one or more privately-owned for-profit facilities pursuant to subsection 6.1, Nunavut 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 Nunavut 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
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, Nunavut 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.
Beginning in Fiscal Year 2024-25, report annually and publicly in an integrated manner to residents of Nunavut 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 Nunavut's Chief 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 Nunavut 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 Nunavut will ensure that expenditure information presented in the annual financial statement is, in accordance with Nunavut's standard accounting practices, complete and accurate.

8.3 Evaluation

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

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

9.9 Canada and Nunavut 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 Nunavut 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 Nunavut, 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 Nunavut shall be:

Government of Nunavut
P.O. Box 1000 Stn 1000
Iqaluit, Nunavut
X0A 0H0
Email: CNolan@GOV.NU.CA and VMadsen@GOV.NU.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 Nunavut.

14.3 No member of the House of Commons or of the Senate of Canada or of the Legislature of Nunavut 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 at

The Honourable Mark Holland, Minister of Health

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

SIGNED on behalf of Nunavut by the Minister of Health at

The Honourable John Main, Minister of Health

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

Introduction

Nunavut's health care system provides care to approximately 40,000 residents across 25 communities. These communities are divided into three regions and three time zones: the Qikiqtaaluk, which consists of 13 communities; the Kivalliq, which consists of seven communities; and the Kitikmeot, which consists of five communities.

The territory spans two million square kilometers and covers one-fifth of Canada's total landmass. Communities are small and spread out over hundreds of kilometres accessible only by plane and sea in the warmer months. The geography means it is not feasible to offer all types of health care in-territory and with no roads connecting communities, every community relies heavily on medical travel within Nunavut or to southern jurisdictions.

Health care is delivered through the territory's 35-bed hospital in Iqaluit. Nunavut's entire population could be served by a small hospital, like the one in Iqaluit. However, given the distance between communities, and inability to drive between communities, each community has a health centre where out-patient and 24-hour emergency nursing services are provided by community health nurses. Operating health centres in remote areas poses significant challenges, notably the necessity for separate IT and HR systems, as well as respective staffing complements. Staffing teams in such locations presents difficulties, which can lead to disruptions in services at health centres including closures and emergency services only. Demonstrably, expenses associated with maintaining community health centres are high.

Unlike other jurisdictions, Nunavut does not have the economies of scale to offset health expenditures. Because of this, Health expenditures in Nunavut are considerably higher on a per capita basis than the Canadian average. According to forecasts by the Canadian Institute for Health Information (CIHI), Nunavut has the highest level of spending per capita on health care services ($21,978 per person compared to a national average of $8,563). ^{Footnote 1}

One significant driver of the high health care costs in Nunavut is medical travel. In FY 2022/23, the Department of Health (Health) arranged over 24,000 scheduled airline tickets and over 3,600 medical evacuations for Nunavummiut at a cost exceeding $87M. While Health continues to work towards bringing care closer to home, the territory relies heavily on federal funding agreements to work towards health equity across the territory.

It is imperative that these funding agreements are long-term and stable, that underpin the values of reconciliation, which means an acknowledgment of the distinct needs and challenges of delivering health care in the territory. As well, it is imperative funding agreements are founded in the principle of flexibility to allow Health to be responsive to local needs, which may require reallocation of funds under the priorities.

Continuing Care in Nunavut

In 2021, there were 1,605 Nunavummiut who were 65 and over, representing 4.4% of the total population. That number drops to 80, for Nunavummiut over the age of 85 (representing 0.2% of the population). ^{Footnote 2}

The majority of the population in Nunavut is Inuit (roughly 85%). Over half of the Inuit population consider Inuktut (Inuit) languages as their mother tongue.

Although Nunavut's senior population is relatively small, the number of seniors requiring long-term care exceeds what can be provided by the current continuing care system in Nunavut, which consists of:

The Home and Community Care (HCC) program, funded and provided through Health;
Three Continuing Care Centres (CCCs): government owned and operated, and are located in Igloolik (10 beds), Gjoa Haven (10 beds), and Cambridge Bay (eight beds). CCCs provide residential care (Levels 3 and 4) ^{Footnote 3}; and
Two Elders' Home facilities: government owned but operated by another service provider and are located in Iqaluit (eight beds) and Arviat (eight beds). The Elders' Homes provide assisted living level of care (Levels 2 and 3).

In total, there are 44 long-term care beds in-territory (both CCCs and Elders' Homes). Because of the limited number of long-term care beds, there are 70 Nunavummiut receiving long-term care services outside Nunavut ^{Footnote 4}. The majority of these residents have dementia; the other residents have complex care needs.

There are many challenges that exist that impact Health's ability to increase continuing care services in-territory, including:

The limited infrastructure, meaning new buildings and the infrastructure to support new buildings (roads, water, sewage) must be constructed to increase the number of beds;
The high cost of construction and short building season, which means the process to plan and build facilities in Nunavut takes significantly longer than in other jurisdictions;
Recruitment and retention difficulties (for both frontline staff within long-term care facilities and program staff responsible to oversee and support the program) that are compounded by the remoteness of Nunavut's 25 communities; and
The lack of accessible housing which results in earlier admissions to long-term care, placing pressure on the existing long-term care beds in the territory.

Some of the challenges noted above contribute to significant costs to deliver care to long-term residents both in-territory and out-of-territory. The financial snapshot below is an important backdrop in understanding the financial pressures Health faces in addressing the needs of seniors:

The cost of providing care to long-term care residents in Nunavut is $26M/year.
The cost to care for a resident (Level 3 and Level 4) at one of the CCCs is approximately $25,000-$30,000/month.
Health pays more than $1M/month to an out-of-territory facility that provides dementia care and long-term care services to 70 Nunavummiut.

The current government mandate Katujjiluta, identified Aging with Dignity in Nunavut as one of five urgent priorities. The strategic outcomes under this priority include:

Improvement in daily life for Nunavummiut who are aging;
Enhancements to long-term care facilities and supports for independent living;
Fewer Inuit Elders relocated from their home communities;
More Inuit employed as caregivers for Elders;
Better mental health, physical health, and well-being for those who are aging; and
Enduring partnerships with Inuit organizations, communities, and the non-profit sector to enable Nunavummiut to age with dignity and care.

Funding through the Aging with Dignity Funding Agreement will support Health in addressing these strategic outcomes, including enhancing daily life for seniors and supports in long-term facilities, increasing Inuit employment, and bringing care closer to home. Health has already committed to opening new long-term care centres in each regional hub: Rankin Inlet, Cambridge Bay and Iqaluit. Federal funding will also support efforts to increase Health's capacity to manage and oversee the building and operation of these facilities and ensure the facilities meet national standards of care.

Home and community care

Context

Family members and friends from all generations are the first providers of care in the home in all Canadian jurisdictions, including Nunavut. Government-provided service supplements existing care or, in rare cases, is the only support when there are no friends or family members available, willing, or able to provide care.

In Nunavut, an individual may self-refer to the HCC program or be referred by a health care professional or family member. A standard comprehensive assessment is completed to determine the level of care and services that are required. Health also provides education and training opportunities to all employees in the HCC program and has been working with Nunavut Arctic College on the development of a new Personal Support Worker (PSW) certificate program.

The HCC program provides health care and support services, based on assessed needs, in an individual's home. The goal is to promote independent living and support families in caring for people at home, rather than a facility. The main services provided by the HCC program in Nunavut include:

Acute Care Replacement: services provided to clients who are experiencing an acute illness, who have the potential to return to a pre-illness level of functioning and self-care;
Chronic Disease Management: services provided to clients with advanced disease(s) who can be supported at home, with ongoing home care services and family assistance;
Palliative Care: compassionate care offered to a person living with a progressive, life-threatening illness that does not respond to curative treatment. The primary objective is maintenance of the best possible quality of life. Palliative care provides family support, prevention, assessment, and treatment of pain and other distressing symptoms, and integrates the psychological, social, cultural and spiritual aspects of care;
Post-Hospital Care: short-term home care services, of an expected duration of six weeks or less, provided to stable clients who are post-surgical or have had an acute illness which has been diagnosed and treated; and
Individuals who need help with activities of daily living including meal preparation, cleaning and personal care.

HCC programming is available to all Nunavummiut. In FY 2021/22, there were 2,201 home care clients, a 20.4% increase from the prior year, likely due to the impact of the first year of the COVID-19 pandemic. The majority of those receiving home care are Inuit and over the age of 50.

Over the last six years, with the support of federal funding, Nunavut has been able to provide HCC services in all 25 communities. The majority of the staff on the HCC team are Inuit. Funding has supported Health in strengthening professional development provided to the team. Some examples of this include the in-person delivery of Pallium Canada's best practice Learning Essential Approaches to Palliative Care (LEAP) courses, Advanced Gerontological Education's Gentle Persuasive Approaches (GPA) in dementia care, and, with Nunavut Arctic College, the ongoing development of a made-in-Nunavut PSW certificate program.

Federal funding also supported Health in increasing its readiness to implement the International Resident Assessment (interRAI) tool, a recognized set of clinical assessment instruments compatible across multiple health care sectors. In order to use the interRAI tool in Nunavut, it was determined that a common model for service delivery is required, for all three regions. Work completed to date includes a current and future state analysis of Nunavut home care services and a business process map to develop a common model for service delivery.

New federal funding will be directed towards strengthening the HCC program to improve and increase services delivered to Nunavummiut.

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

Home Care Program Review
The HCC program is delivered by Health, to all Nunavummiut and those with a Nunavut health care card. The program is available to all ages and is delivered by Registered Nurses (RNs), Licensed Practical Nurses (LPNs), and Home and Community Care Workers (HCCWs). Some HCCWs focus on light housekeeping and meal preparation while others provide personal care services to residents.

Many of the HCCWs speak Inuktitut. However, many of the nurses that support the HCC program do not. Medical interpretation services are provided when required.

A comprehensive review of home care services is required to ensure the services are meeting the needs of the population and are aligned with best-practice evidence-based models of care. This builds upon the 2015 Continuing Care in Nunavut (2015 to 2023) report, which provided several recommendations to strengthen continuing care in Nunavut. Several of the recommendations have already been addressed, but more work is needed to analyze the current service delivery structure, model of care, service gaps, policies, and continuing education opportunities for team members.

The review will also include a jurisdictional scan of best practices from across the country. The future requirements and projected service demands will be used to determine organizational design changes and recommendations for additional positions, and expansion of service hours. The review will also help to inform the operational structure of the home care program in Nunavut. As the foundation of continuing care, it is important that services are patient and family centred while being equally accessible and standardized across the territory.

A home care program review will ensure Health has a better understanding of what is needed to provide quality care to Nunavummiut and meet the needs of each individual admitted to the program.

Funding will be used to hire a consultant to conduct a review of the services by region and community. This will include an analysis to identify gaps in programs and services in the territory, in addition to a jurisdictional review of models, standards, and practices in other parts of the country.
Home Care Program Expansion
Following the HCC program review, Health anticipates additional staff will be recommended, based on current capacity concerns. Funding will be used to recruit and train new staff, with an emphasis on hiring and training Inuit within these positions to ensure care is culturally relevant and offered in Inuktitut where possible. Funding will also be used to increase the hours of service provided where there is a demonstrated need.

Increasing hours of service and the number of trained HCC staff in communities will help seniors stay in their homes and communities longer. Keeping seniors well supported at home will also reduce pressure on the 44 long-term care beds in territory, as well as the acute care centres.
Home, Community, and Continuing Care Education
Supporting and providing opportunities for continuing education is an important element of strengthening the workforce and providing quality care to seniors. Funding will support HCC employees to take online courses, attend in-person training or clinical observations with southern partners. Areas of practice may include palliation, peritoneal dialysis, dementia care and cancer care. Maintaining a well-trained HCC workforce will help teams provide quality, best-practice services to Nunavummiut in their homes, which increases the quality of life for clients.
Home and Community Care Services
The HCC program helps Nunavummiut care for themselves with help from family and community members and to keep their sense of independence and well-being. The program provides a variety of health and support services including homemaking, personal care, nursing care, respite care, and rehabilitation. Federal funds will be used for nursing services to support patients and their families. Home care services are available to Nunavummiut in all 25 communities and of all ages.

Funding allocation
Home and community care initiatives	2023-24	2024-25	2025-26	2026-27	Total
Home Care Program Review	--	$200,000	--	--	$200,000
Home Care Program Expansion	--	$700,000	$900,000	$900,000	$2,500,000
Home Care Program Education	--	$120,000	$130,000	$154,000	$404,000
Home and Community Care Services ^{Footnote *}	$927,000	--	--	--	$927,000
Total:	$927,000	$1,020,000	$1,030,000	$1,054,000	$4,031,000
Total funding available ^{Footnote }**	1,703,000	$776,000	$776,000	$776,000	$4,031,000
Table 2 Footnote * This funding is carry forward from 2022-23 from the Canada-Nunavut Home and Community Care and Mental Health and Addiction Services Funding Agreement. Return to table 2 footnote * referrer Table 2 Footnote The funding also includes funding reprofiled specific to Nunavut that occurred in 2019 (roughly $156,000/year). Return to table 2 footnote referrer

Measuring and reporting

Nunavut continues to work on the phased implementation and expansion of its clinical information system (MEDITECH) which will be the data source for some of the below indicators.

Over the past few years, significant progress has been made in Nunavut to strengthen and streamline data collection. For instance, in Fall 2020 Health established the Health Information Unit (HIU). The HIU serves as the primary structure for the creation, management, protection, and utilization of health information resources and services within Health. Prior to the establishment of the HIU, Health did not have a single organizational unit dedicated to this. Rather, these functions were spread across different organizational units, such as eHealth, Population Health Information, the Office of the Chief Public Health Officer, Population Health, and Policy & Planning. This led to significant functional gaps in the overall health data management, affecting health program design, delivery, and management.

The initial establishment of the HIU saw the consolidation of the different units including eHealth and Population Health within a single unit under a single management team, which has played a critical role in advancing Health's capacities within data collection and reporting.

More recently, in 2023 Health secured funds to expand HIU's efforts in data collection and reporting.

However, there are ongoing challenges in Nunavut related to its capacity to collect and report on data for its health system, including those related to the maturity of data collection systems, privacy associated with small sample sizes and health workforce supply and stability.

Health is committed to developing performance measurement targets. As per the Canada-Nunavut Aging with Dignity Funding Agreement, a dedicated staff is required to work with CIHI to improve reporting on common indicators and support efforts to report on those indicators. As such, Health will work to hire additional staff who will be responsible for this work. Once staff are hired, Health will work with Health Canada to revisit the indicators; as such, some indicators and targets will be refined. It is anticipated that these targets will be updated by September 2024.

Targets and timeframes
Indicator	Baseline	Target	Time frame
Home care review completion	--	Report completion	2024/25
*Number of new FTEs ^{Footnote }**	0 (2023/24)	+7 FTEs	2024/25
Number of courses delivered per year	1 (2023/24)	3	2025/26
Number of people receiving home care services	2,259 (2022/23)	3,000	2027/28
Table 3 Footnote * To be determined by the review. However, Health anticipates additional licensed practical nurses will be established. Return to table 3 footnote * referrer

Long-term care

Context

Nunavut has five facilities that provide nursing and personal care services to Nunavummiut who have exceeded the ability of the HCC program to help them stay in their own homes (three CCCs and two Elders' Homes). These facilities have a combined total of 44 beds (includes 5 respite beds). The number of seniors in Nunavut requiring long-term care exceeds current in-territory capacity; there are currently 70 seniors placed in care out-of-territory and another 20 on the wait list.

Health is working to increase its long-term care bed capacity in the territory, consistent with the government's mandate priority Aging with Dignity in Nunavut, and the following strategic outcomes:

Improvement in daily life for Nunavummiut who are aging;
Enhancements to long-term care facilities and supports for independent living;
Fewer Inuit Elders relocated from their home communities;
More Inuit employed as caregivers for Elders;
Better mental health, physical health, and well-being for those who are aging; and
Enduring partnerships with Inuit organizations, communities, and the non-profit sector to enable Nunavummiut to age with dignity and care.

Evidence of this includes the 24-bed Kivalliq Long-Term Care facility under construction in Rankin Inlet, scheduled to open in summer 2024. Other facilities are planned for Iqaluit (48 beds) and Cambridge Bay (24 beds) to help the territory meet the demand for long-term care. All these new territorial facilities are designed to best practice standards.

Previous federal funding for long-term care assisted Health in responding adequately to the COVID-19 pandemic. This included:

Hiring additional staff to ensure back-up staff were on the ground in an affected community in the event of an outbreak at a long-term care facility;
Strengthened infection prevention and control measures by ensuring there was an adequate supply of PPE for staff and visitors;
An assessment of gaps to determine where more COVID-19 pandemic measures were required; and
An infection prevention and control consultant to help monitor, measure, and teach infection prevention and control best practices.

New federal funding will be directed towards establishing a Nunavut PSW program, increase Inuit employment within long-term care, increase culturally appropriate supports for seniors within facilities and enhance Health's capacity to oversee and plan for the continued expansion of long-term care in Nunavut.

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

Priority Area 1 – Workforce stability

Development of a Made-in-Nunavut Personal Support Worker Program
Health offers home care services in all 25 of Nunavut's communities. Home and Community Care Workers (HCCWs) provide essential services to the community, and largely to seniors, who require additional supports to live successfully in their homes. The services and supports provided by HCCWs reduce dependence on the health centres and acute care admissions. Supports include providing personal and respite care and home making support. Similarly, the CCCs employ Continuing Care Workers (CCWs) who provide care support to the nursing team for residents who live in long-term care.

Many of Health's HCCWs and CCWs have been trained on the job, and some have participated in previous courses offered by Nunavut Arctic College (NAC). Health is partnering with NAC to develop and deliver a PSW certificate program that will enable current and future HCCWs and CCWs to complete training for these essential roles. The theory and practical skills gained in the course will provide students with the opportunity to enhance their abilities, skills, and knowledge in the provision of personal care and support to individuals within the community and in long-term care facilities.

The coursework for this program will be developed and designed to meet the training needs of Nunavut's HCCWs and CCWs as well as Nunavummiut interested in training for a career in this field. The program will be developed to allow for in-person and remote delivery options. Funding will cover the cost to complete the PSW certificate program, including content development, multimedia development, and a pilot delivery of the first course.
Supporting the Continuing Education of HCCWs and CCWs
The leadership team will continue to support the learning needs of all staff. This includes both in- territory and out-of-territory travel to attend various professional development events in addition to virtual education such as Pallium's LEAP. Federal funding will be used for staff to complete courses of NAC's PSW certificate program, including tuition, books, and travel. Funding will also assist staff to obtain wound care training, to better meet the needs of long-term care residents with chronic wounds. Increasing the number of staff who have taken these courses and certifications helps in the provision of evidence-based safe and quality care by enhancing knowledge and skills.
Virtual Nurse Practitioner Support
This initiative will provide virtual Nurse Practitioner (NP) resources to support the long-term care facilities in Arviat, Cambridge Bay, Gjoa Haven, Igloolik, Iqaluit, and Rankin Inlet. NPs have advanced education and training that allows them to comprehensively assess, diagnose, prescribe, and treat residents living with chronic conditions and episodic acute challenges. The virtual NPs will also monitor and establish routine lab work to monitor chronic diseases. Assigning NPs to long-term care facilities in Nunavut will help support the health care team within the facility and increase resident well-being. In addition, the NP will help reduce additional demands on acute care facilities, such as health centres, as chronic and acute disease will be appropriately assessed and managed.

Funding will cover the salary of the NP resources providing the services outlined above.

Priority Area 2 – Long-term care standards

Strengthening Best Practice Supports for Long-Term Care Residents
Two of the new national long-term care standards (Health Standards Organization [HSO], 2023) stress the importance of culturally appropriate and trauma-informed approaches to care:
- 1.1.8 The governing body ensures the LTC home has a trauma-informed approach to care to support the delivery of services; and
- 2.2.4 The LTC home leaders implement a trauma-informed approach to care in the delivery of services.
Federal funding will assist Health to meet these standards, strengthen cultural programming and increase access to counselling for long-term care residents.

Partnering with Nunavut's Department of Culture and Heritage, Health will review the existing cultural programming in all long-term care facilities in the territory. The review will look at current cultural programming and activities that are provided in long-term care facilities in Nunavut and out-of-territory. There will be recommendations for additional cultural programming that can support and enrich the lives of the seniors in those facilities. This initiative is in line with the Nunavut government's Katujjiluta mandate.

Due to in-territory capacity challenges, there are nearly 70 individuals placed in long-term-care at Embassy West Senior Living in Ottawa. The residents who accept placement in Ottawa must leave their family, community, and the territory to access long-term care. Understandably, this can be extremely difficult for the resident and their families. This can be especially hard when an individual suffers a loss or a new diagnosis.

Offering culturally appropriate care is an important standard across long-term care. For residents placed outside of Nunavut, having access to culturally appropriate Inuit-specific counselling services is an essential component of their care.

How a facility responds to traumatic situations (e.g., new diagnosis, recent relocation) and pro-actively provides supports to minimize such situations are key to an integrated trauma-informed approach to care. As part of this approach, Nunavut will provide more access to clinical counselling for long-term care residents in and out-of-territory.

Federal funding will help establish a small, gender-balanced team of counsellors who can offer regular sessions and be on standby for crisis care. This will give residents access to counsellors with several years of experience working with rural, northern, and Indigenous communities, and who have advanced experience and training in trauma recovery and trauma-informed practice. Inuit traditional counsellors will be a component of this service.
Building the Capacity of Nunavut's Home and Continuing Care Division
The new national HSO long-term care services standard developed out of the need for additional capacity to respond to the growing and complex needs of long-term care residents, stronger infection prevention and control practices, and standards and accountability measures to enable the delivery of high-quality, safe, and resident-centered care.

HCC services in Nunavut are organizationally fragmented between two divisions: Programs and Standards and Health Operations. There is also a noted lack of capacity to accomplish all the work that is necessary in areas such as development and implementation of standards and policies, accreditation readiness, long-term care facility planning, and facility inspections. This has been amplified with the plans to build three new long-term care facilities to provide more in-territory care to seniors.

The first part of this work, supported with federal funding, will include a comprehensive review of the existing organizational structure, followed by the determination of additional positions required to ensure Nunavut can demonstrate that its long-term care facilities are meeting the applicable HSO national long-term care standards.

Health is planning to obtain accreditation for the currently operating purpose-built long-term care facilities (Gjoa Haven and Igloolik), in addition to the new Rankin Inlet long-term care facility which will be operated under contract. That contract indicates that accreditation must be achieved within this time window. Federal funding will help support the cost of accrediting these three facilities which represent 50% of Health's facilities including the new Rankin Inlet long-term care facility. The additional new facilities planned for Iqaluit and Cambridge Bay will also include accreditation requirements in their operational service contracts. However, the planning and construction schedule of those facilities is not within the term of this agreement.

This work will also ensure that there is sufficient capacity to develop and implement a plan to achieve accreditation for those long-term care facilities. A framework for regular inspections and enforcement will also be developed and incorporated into future legislation.

It is anticipated that additional positions will be required in areas such as quality improvement, accreditation readiness, policy development, contract management, leadership, and operational support. This will strengthen accountability and demonstrate that the facilities are meeting national standards of care.

Funding allocation
Long-term care initiatives	2023-24	2024-25	2025-26	2026-27	2027-28	Total
Priority Area 1 – Workforce Stability
Establishing a Nunavut PSW Certificate Program	$100,000	$325,000	--	--	--	$425,000
Continuing Education of HCC Team	$30,000	$250,000	$500,000	$500,000	$500,000	$1,780,000
Virtual Nurse Practitioner Support	--	$100,000	$100,000	$100,000	$100,000	$400,000
Subtotal	$130,000	$675,000	$600,000	$600,000	$600,000	$2,605,000
Priority Area 2 – Long-Term Care Standards
Supports for Long-Term Care Residents	$300,000	$400,000	$400,000	$400,000	$400,000	$1,900,000
Building the Capacity of the HCC Division	$130,000	$1,085,000	$1,110,000	$1,110,000	$1,110,000	$4,545,000
Subtotal	$430,000	$1,485,000	$1,510,000	$1,510,000	$1,510,000	$6,445,000
Total:	$560,000	$2,160,000	$2,110,000	$2,110,000	$2,110,000	$9,050,000
Total Funding Available:	$1.81M	$1.81M	$1.81M	$1.81M	$1.81M	$9.05M

Measuring and reporting

At this time, Nunavut is unable to provide long-term care services data to the Canadian Institute for Health Information (CIHI). This will change as Nunavut further implements its clinical information systems.

Targets and timeframes
Indicator	Baseline	Targets	Timeframe
Priority Area 1 – Workforce Stability
Number of PSW program courses offered per year overall	1 course (2023/24)	20 courses	2025/26
Average number of hours of virtual NP services per resident per year	0 hours per resident (2023/24)	12 hours per resident	2025/26
Priority Area 2 – Long-Term Care Standards
Counselling hours available per year	0 (2023/24)	200 hours	2024/25
Number of final policies compliant with national standard	50% (2023/24)	100%	2025/26
Proportion of long-term care facilities accredited	0% (2023/24)	50%	2027/28

Overall funding allocation
	2023-24	2024-25	2025-26	2026-27	2027-28	Total
Home and Community Care	$1,703,000	$776,000	$776,000	$776,000		$4,031,000
Long-Term Care	$1,810,000	$1,810,000	$1,810,000	$1,810,000	$1,810,000	$9,050,000
Total	$3,513,000	$2,586,000	$2,586,000	$2,586,000	$1,810,000	$13,081,000

Footnotes

Footnote 1

https://www.cihi.ca/en/how-do-the-provinces-and-territories-compare

Return to footnote 1 referrer

Footnote 2

https://www12.statcan.gc.ca/census-recensement/2021/dp-pd/prof/details/page.cfm?Lang=E&SearchText=Nunavut&DGUIDlist=2021A000262&GENDERlist=1,2,3&STATISTIClist=1&HEADERlist=0

Return to footnote 2 referrer

Footnote 3

Health assesses need based on five categories, known as the levels of care. Care increases as an individual moves from Level 1 to Level 5 (Level 1 means a low level of support is required – individual can live independently with occasional support; Level 5 care means a significant amount of support is required – individual requires 24-hour supervision and care).

Return to footnote 3 referrer

Footnote 4

The number of Nunavummiut at this facility fluctuates frequently.

Return to footnote 4 referrer

Page details

Date modified:: 2024-03-05

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

Tables of contents

Funding agreement

1.0 Key principles and collaboration

2.0 Objectives

3.0 Action plan

4.0 Term of agreement

5.0 Financial provisions

6.0 Accountability mechanisms for long-term care

7.0 Performance measurement

8.0 Reporting to Canadians

9.0 Communications

10.0 Dispute resolution

11.0 Amendments to the agreement

12.0 Termination

13.0 Notice

14.0 General

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

Indicator

Annex 4 – Action plan

Introduction

Continuing Care in Nunavut

Home and community care

Context

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

Measuring and reporting

Long-term care

Context

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

Priority Area 1 – Workforce stability

Priority Area 2 – Long-term care standards

Measuring and reporting

Footnotes

Page details

5.0 Financial provisions