Canada-Yukon 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 YUKON (hereinafter referred to as "Yukon" or "Government of Yukon") as represented by the Minister of Health and Social Services (herein referred to as "the territorial Minister")

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

PREAMBLE

WHEREAS, on July 6, 2023, Canada and Yukon 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 Yukon 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 Yukon 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, Yukon 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 Organization Act authorizes 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 Yukon 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 Yukon 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 Yukon 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 Yukon 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 Yukon 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 Yukon 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 Yukon agree that, with financial support from Canada, Yukon 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 Yukon 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 Yukon 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 Yukon 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, Yukon 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 Yukon'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 Yukon

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

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 Yukon, 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.
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 Yukon, 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, Yukon estimated share of the amounts will be:


Fiscal Year	Budget 2017 Home and Community Care Estimated amount to be paid to Yukon^{Footnote *} (subject to annual adjustment)	Budget 2021 Long-Term Care Estimated amount to be paid to Yukon^{Footnote *} (subject to annual adjustment)
2023-2024	$670,000	$1,860,000
2024-2025	$670,000	$1,860,000
2025-2026	$670,000	$1,860,000
2026-2027	$670,000	$1,860,000
2027-2028	n/a	$1,860,000
Table 6 Footnote * Amount represent annual estimates based on Statistics Canada's July 1^st, 2022, population estimates. Return to table 6 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 Yukon 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 Yukon of the amount of the second installment as determined under sections 5.2.3 and 5.2.4.
Canada shall withhold payments if Yukon has failed to provide reporting in accordance with 8.1.
Canada shall withhold the second payment in 2023-24 if Yukon has failed to satisfy all reporting requirements associated with the preceding Canada – Yukon Home and Community Care and Mental Health and Addictions Services Funding Agreement 2022-23, specifically to:
1. continue to participate in a Federal-Provincial-Territorial process to improve reporting on and provide data to CIHI for the 6 common indicators (listed in Annex 3) to measure pan-Canadian progress on improving access to home and community care; and
2. submit an annual financial statement, with attestation from the Government of Yukon's Chief Financial Officer, of funding received the preceding Fiscal Year from Canada for home and community care under the Canada – Yukon Home and Community Care and Mental Health and Addictions Services Funding Agreement 2022-23 compared against the Expenditure Plan, and noting any variances, between actual expenditures and the Expenditure Plan.
The sum of both installments constitutes a final payment and is not subject to any further payment once the second installment has been paid.
Payment of Canada's funding for this Agreement is subject to an annual appropriation by the Parliament of Canada for this purpose.

5.3.2 Where Yukon will use cost-recovery agreements with one or more privately-owned for-profit facilities as an accountability measure and Yukon 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 Yukon 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, Yukon 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, Yukon 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 Yukon 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 Yukon 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, Yukon 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 Yukon 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 Yukon 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, Yukon agrees to put in place the accountability mechanisms outlined in Annex 4.

6.2 Where Yukon has cost-recovery agreements in place with one or more privately-owned for-profit facilities pursuant to subsection 6.1, Yukon 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 Yukon 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, Yukon 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 Yukon on progress made on targets outlined in Annex 4 (Action Plan).
Beginning in Fiscal Year 2024-25, provide to Canada an annual financial statement, with attestation from the Government of Yukon'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 Yukon 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 Yukon will ensure that expenditure information presented in the annual financial statement is, in accordance with Yukon's standard accounting practices, complete and accurate.

8.3 Evaluation

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

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

9.9 Canada and Yukon 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 Yukon 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 Yukon, 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 Yukon shall be:

Assistant Deputy Minister, Corporate Services

Health and Social Services
Government of the Yukon, H-1
P.O. Box 2703
201-#1 Hospital Road
Whitehorse, Yukon
Y1A 3H7

Email: Paul.Payne@yukon.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 Yukon.

14.3 No member of the House of Commons or of the Senate of Canada or of the Legislature of Yukon 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 Yukon by the Minister of Health and Social Services

The Honourable Tracy-Anne McPhee, Minister of Health and Social Services

Annex 1 – Common Statement of Principles on Shared Health Priorities

Common Statement of Principles on Shared Health Priorities

Annex 2 – Shared pan-Canadian interoperability roadmap

**Figure 1: 5-Year Shared Pan-Canadian Interoperability Roadmap**

Annex 3 – Indicators: Access to home and community care

Indicator

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

Annex 4 – Action plan

Introduction

The Government of Yukon remains committed to delivering responsive health and social services that place patients, families, caregivers and the dedicated health and social services workforce at the centre of this work. Guided by the 2020 Putting People First report, the Government of Yukon is working to create a health care system that is high-performing, integrated, collaborative, culturally safe, anti-racist and puts Yukoners at the centre.

We value and appreciate what older adults in the Yukon have done and still do for the territory. Older adults and older Elders keep families, workplaces, communities and the whole territory going. We continue to be committed to working with our partners to make sure all older adults in the Yukon experience a good quality of life.

Our Aging in Place Action Plan is a road map to help us meet these goals. It is designed to make life better for people in the Yukon. The plan ensures our housing, health and social services keep supporting and empowering people. It outlines how our government and stakeholders can join forces to improve health and well-being for older adults in a sustainable way.

This road map is also our commitment to better support Yukon Elders through a spirit of reconciliation and partnership. We all have a role to play in helping Yukoners age in place. Our plan provides a framework for governments, including Yukon First Nation governments, Indigenous organizations, NGOs, businesses, individuals, families and communities can work together to ensure that Yukoners can live full and meaningful lives as they age. Our government is committed to the goals of positive aging with outcomes of aging well, being healthy, connection, independence and respect.

The Government of Yukon's Department of Health and Social Services provides Continuing Care programs in the Yukon. The Continuing Care Division's mandate is to provide person-centred and culturally safe care. They offer individualized support for Yukoners to age in place with dignity. This support is available in home-based, community and long-term care settings.

Home and community care

Context – State of home and community care in the Yukon

In the Yukon, more people now have access to home and community care, thanks to a resourcing program model that includes rapid response home care roles and hiring of home support workers through rural community enhancement initiatives in almost all rural and remote communities in the territory. This effort helps people stay in their communities and increases the support for those with complex care needs, so they can stay at home instead of moving to long-term care. Also, programs like the department's Home First Complex Supports and its new reablement program, that help people stay in or return to their community have been very successful, with most people able to return home instead of needing long-term care. These programs have also led to an increase in home care resources. In the Yukon, long-term care and home care are part of the same government division of the Department Health & Social Services. There are three long-term care homes in Whitehorse and one in Dawson City. Home Care has its main program supports in Whitehorse with satellite programs in communities with sufficient population to warrant having a home care nurse as well as home support, for example, Dawson City, Haines Junction, and Watson Lake. Other rural and remote communities have an itinerant Community Liaison Coordinator who visits the community several times each year, completes client assessments and supervises home support workers in those communities. The cost to have home care workers in rural and remote areas is significant compared to staffing in Whitehorse. For example, to provide a home support worker resource to Old Crow, the cost is $3,240.45/week as compared to $1,678.50/week in Whitehorse. Costs related to supporting Yukoners to age in place in their home communities are significant drivers to the home care budget.

Federal funding has helped provide more support for people to live in community and age in place. Program enhancements include improvements to communications equipment and technology which have increased access to professional supports for clients across the rural and remote landscape – though access to reliable internet access in remote regions continues to be a challenge.

The department continues to focus on adjusting and resourcing models of care to support the best health outcomes for Yukoners. All programming is done within the context of the Quadruple Aim and its evolving iterations - an approach to a health system that seeks to simultaneously improve client experience; improve health outcomes; better manage costs and system effectiveness; and provide better experiences for care providers.

The department's Digital Health Strategy, which is in development, will provide a road map outlining further opportunities for leveraging technology to increase access to, and improve, care for people across the Yukon.

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

1. Home first and complex client support programs

The Home First and Complex Client Supports programs enhance community based services that make it easier for people in the Yukon to stay in their homes, come back home from the hospital, find their way through the healthcare system and support the continuity of care. Federal funding will continue to support the human resource complement, operational costs associated with the programs, and costs related to in-home delivery of wound care and certain IV treatments. The rapid response home care staff are located in Whitehorse to respond to the primary source of referrals which is from Whitehorse General Hospital. Between January and September 2023 (the first three quarters of 2023), the hospital referred 139 people to the Home First rapid response team. During the same period, 11 clients with complex care needs received extra home care support, allowing them to live at home rather than move into long term care.

Alignment with the actions outlined in the 2017 Common Statement of Principles on Shared Health Priorities:

Improving access to home and community care through:
- reducing reliance of acute care settings;
- decreasing length of stay in acute care; and
- enhanced access to care and support services to support living at home.

2. Rural community home care enhancements

Improvements to the Rural Community Home Care program are helping Yukoners to age in place. This is achieved through the development of Home Care Community Profiles and service planning recommendations, in partnership with various Yukon First Nations health programs, local health centres and primary care providers for each of Yukon's 15 home care catchment areas. Federal funds will be used to support the human resource (specifically the costs for existing staff to extend their work into additional communities) and travel requirements to complete community service planning, as well as the implementation costs for community initiatives (e.g., increased access to in-home respite for caregivers) by increasing funding for home support workers in communities based on the assessed needs. This increased funding helps support new home support workers, or increased hours for existing home support workers, when a community has an increased need for this service.

Federal funding supports care coordinator resources within the Home and Community Care Program to oversee the Rural End-of-Life Care funding program. This funding is specific to Yukoners who live in the rural and remote communities outside of Whitehorse. It allows them to hire their own support so they can self-manage the support they need and remain in the home community instead of having to leave their home to receive supports in Whitehorse. Funding of up to $10,000 is distributed either directly to the person receiving the support or to their designate.

Federal funding supports home care staff to have access to satellite phone technology. This allows them to communicate and access mobile health care records when visiting clients in areas without cell service. The safety apps are also able to support scheduling information for home support workers.

Alignment with the actions outlined in the 2017 Common Statement of Principles on Shared Health Priorities:

spreading and scaling evidence-based models of home and community care that are more integrated and connected with primary health care;
enhancing access to palliative and end of life care at home or in hospices; and
enhancing home care infrastructure, such as digital connectivity, remote monitoring technology and facilities for community-based service delivery.

Table 1: Allocation of federal funds for each initiative
Home and Community Care Initiative	2023-24	2024-25	2025-26	2026-27	Total
Initiative 1
Home First and Complex Client Supports	$275,000	$275,000	$275,000	$275,000	$1,100,000
Subtotal	$275,000	$275,000	$275,000	$275,000	$1,100,000
Initiative 2
Rural Community Home Care Enhancements including Technology support – mobile charting, virtual visits, home support scheduling, etc.	$395,000	$395,000	$395,000	$395,000	$1,580,000
Subtotal	$395,000	$395,000	$395,000	$395,000	$1,580,000
TOTAL	$670,000	$670,000	$670,000	$670,000	$2,680,000
Note: Allocations are rounded and notional, based on the 2022 July 1 population estimate published by Statistics Canada.

Measuring and reporting on results

Yukon will continue working with and provide data to the Canadian Institute for Health Information (CIHI) on the six pan-Canadian indicators for home and community care, to support the measurement of improving access, namely through the following indicators:

death at home or in community;
home care cervices helped the recipient stay at home;
caregiver distress; and
new LTC residents who potentially could have been cared for at home.

The numbers of referrals supported by the rapid response team, along with numbers of complex clients supported to live at home (instead of premature entry into long term care homes) will be part of annual reporting, which includes the department's organizational program evaluation. We also distribute a public facing family client newsletter to communicate on program information, education and awareness (e.g., fall prevention) and outcomes related to current goals. Annual territory-level data will be posted in the Continuing Care area of Yukon.ca.

Table 2: Yukon Indicators
Indicator	Baseline	Target	Timeframe
Initiative 1 – Home First and Client Supports Programs
Home First – Rapid Response # of annual rapid response referrals # of complex client care clients supported to live at home	185 per year 11	200 per year 15	March 2025^{Footnote 1} March 2025^{Footnote 2}
Initiative 2 – Rural Community Home Care Enhancements
Rural Community Home Care Enhancements % of rural communities with identified Home Care need that have home care support available	93%	100%	March 2026^{Footnote 3}
Table 2 Footnote 1 The target of 200 referrals will be maintained to the end of the funding period. Return to table 2 footnote 1 referrer Table 2 Footnote 2 The target of 15 clients supported to live at home will be maintained to the end of the funding period. Return to table 2 footnote 2 referrer Table 2 Footnote 3 The target of 100% of communities will be maintained to the end of the funding period. Return to table 2 footnote 3 referrer

Long-term care

Context – State of LTC services in the Yukon:

In the Yukon, long-term care and home care are part of the same government division of the Department Health & Social Services. There are three long-term care homes in Whitehorse (Copper Ridge Place, Thomson Centre and Whistle Bend Place) and one in Dawson City (McDonald Lodge). All are owned and operated by the Government of Yukon.

During the pandemic, the department adapted its staffing models across long-term care (LTC) and continues to make adjustments to ensure the right mix and number of interdisciplinary care professionals work together in an integrated model of care. This approach aims to provide clients with culturally safe, quality person-centred care in a psychologically safe environment. This means care that is respectful of people's cultural backgrounds, focuses on the individual's needs, and ensures a mentally supportive environment. The interdisciplinary model balances allied health across shared program areas in buildings and is designed to provide 4 hours of direct nursing (including Nursing Home Attendant, Licensed Practical Nurse and Registered Nurse hours combined) care per day per resident.

In the context of the international health human resource challenges, models of care are actively evaluated with staff and clients, to find ways to optimize the existing resources we have available. For example, residents, family members, staff, and other stakeholders were included in evaluating the difference in trialing a care coordinator model within long term care designed to decrease the administrative load on direct care nurses while providing for quality health outcomes for residents. With positive feedback all around the care coordinator model is being implemented with a requirement to add some positions for care coordinators while shifting some other positions into care coordinators to adopt this model of care.

Specific enhancements to our organizational design will support the education, health, and wellness of staff, to provide quality care and a work environment that supports industry standard infection prevention and control.

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

Priority Area 1 – Workforce stability

Context – State of LTC services in the Yukon:

Population characteristics:

The Yukon has an estimated population of 44,692 (Yukon Bureau of Statistics March 2023).
The population has increased by 2.2% from the year before and by 22.8% over the past 10 years.
Twenty-eight percent (28%) of the population is 55 years or older.
Seventy-four percent (74%) of those 55 or older live in the Whitehorse area.
Yukon's Indigenous population is approximately 22.3% of the total population.
- Generally, slightly more than 25% of LTC residents are Indigenous in Yukon LTC facilities. See above for some examples of programming focusing on First Nation Culture and community.
Approximately 14% of Yukoners are bilingual.

During the pandemic, the department adapted its staffing models across long-term care (LTC) and continues to make adjustments to ensure the right mix and number of interdisciplinary care professionals work together in an integrated model of care. This approach aims to provide clients with culturally safe, quality person-centred care in a psychologically safe environment. Now that the staff are starting to be hired into positions of the trialed model, ongoing measurement of the ability to keep nursing hours at specific levels per day along with monitoring clinical outcomes for residents will be tracked and reported to monitor efficacy of the new model to have the desired outcome.

In the context of the international health human resource challenges, the department actively evaluates its models of care with staff and clients, to find ways to optimize the existing resources that are available. Feedback is sought from staff and residents (or their substitute decision makers) using surveys that are designed to address requirements for Accreditation Canada's accreditation program. Survey information is shared with all staff and in family/resident newsletters.

Workforce stability for business continuity

Rationale and objectives: to meet the objective of 3.5h/day per resident of direct care, nursing home attendants and nursing staff will be added into the staffing model as required.

This can be measured by the department's ability to:
- ensure all staff have a qualified supervisor/educator;
- ensure there are enough nursing staff to provide enough hours of direct care per day to each resident, resulting in quality health outcomes as measured using RAI 2.0; and
- ensure staffing stability supports delivery of cultural programming which results in residents indicating increased satisfaction and a sense of wellness through access and participation in cultural programming.
Activities and programs: supporting workforce stability will enable the second priority initiative to be enacted e.g., sufficient direct care staff to provide quality care that has measurable outcomes as measured by RAI 2.0. Workforce stability supports continued delivery of and enhancements to cultural programming including the Traditional Food Program (long-term care homes in the Yukon accept donations of wild game, bones (caribou, moose, elk or bison) and berries which are then included as part of meal planning for Elders), and intergenerational and language programming (such as partnering with First Nation Language Program for youth to practice speaking Indigenous languages with Elders living in long term care) and aligns with responding to the needs Yukon's Indigenous population. As of December 2023, there are four distinct languages being spoken by Elders with students and the interest in this program is quickly increasing.
Type and number of staff: a systemic view has been taken that incorporates increasing the number of full-time employees (FTEs) for nursing home attendants (also known as PSWs) along with targeted system support positions in supervisory, clinical education, infection control, occupational health and safety, and quality improvement analyst positions.
- Positions proposed include nursing home attendants, care coordinators, resident care managers and transition liaison coordinators.
Type and number of facilities: four government owned and operated LTC facilities are part of this initiative with a room count of 288.
Partnerships/Third Party involvement: the department's Continuing Care Division is accredited through Accreditation Canada and participates in committee work with Health Excellence Canada, Canadian Home Care Association, reporting to CIHI.

Priority Area 2 – Long-term care standards

Federal funding will be used to increase the number of supervisors and educators to support the education, health and wellness of staff to provide quality care to residents, and work in an environment that supports industry standard infection prevention and control based on CSA Z8004:22. These positions provide education/mentorship/supervision to direct care staff enabling them to identify and respond to need for changes in infection control practices (e.g. respiratory outbreaks), or manage unanticipated care needs such as evacuating residents from one area to another.

Rationale and objectives: funding specific to crucial areas that support the department to provide quality care and services that are adaptable to rapidly changing contexts e.g., outbreaks, natural disasters, workforce disruptions.

This can be measured by ability to:
- ensure all staff have a qualified supervisor/educator;
- ensure there are enough nursing staff to provide enough hours of care per day to each resident that result in quality health outcomes as measured using RAI 2.0; and
- track how often direct care nursing hours drop below 3.5 hours in a 24h period per resident in LTC.
Activities and programs: the department's Continuing Care Division commits to quarterly tracking at the senior management level to evaluate infection prevention and control programming across the LTC homes as demonstrated by:
- documentation in ADM reports and in senior management minutes will include review of trends and any actions that are recommended in relation to education campaigns, change of physical environment to support infection prevention, change of practice or policy, etc.;
- staff reporting that they know what to do in outbreak situations to keep themselves and others safe;
- staff reporting that they are given the education and access to PPE to work safely; and
- regular hand hygiene audits are conducted across long term care home programs and results are posted on quality boards for staff, residents, visitors.
Type and numbers of staff: the Continuing Care Division proposes to increase the number of full-time employees to support quality organizational design in the areas of clinical education; infection control; occupational health and safety; and Quality Improvement Analyst positions.
- These positions are also critical to having the ability to operationalize the work required to meet Accreditation Canada standards.
- Positions proposed include:
  - training and occupational health coordinators;
  - occupational health nurses; and
  - a safety quality improvement lead.
Number and type of facilities: four government owned and operated LTC facilities are part of this initiative, with a room count of 288.
Partnerships/third party involvement: Continuing Care is accredited through Accreditation Canada and participates in committee work with Health Excellence Canada, Canadian Home Care Association, reporting to CIHI. The department is also committed to delivering culturally safe, quality care that is offered by staff who feel valued, connected, and physically and psychologically safe. Incident reporting is measured related to psychological issues or harassment that may include discrimination, racism, bullying, etc.

Table 3: Allocation of federal funds for the Yukon's Long-Term Care Initiative
Long-Term Care Initiative	2023-24	2024-25	2025-26	2026-27	2027-28	Total
Priority Area 1 – Workforce Stability
Initiative 1: Workforce stability for business continuity – increase FTE for direct care nursing and Nursing Home Attendant positions to achieve goal of 3.5 h/day per resident.	$1,151,487	$1,151,487	$1,151,487	$1,151,487	$1,151,487	$5,757,435
Subtotal	$1,151,487	$1,151,487	$1,151,487	$1,151,487	$1,151,487	$5,757,435
Priority Area 2 – Long-Term Care Standards
Initiative 1: Enhancements to organizational design to meet IPAC needs and Accreditation Canada required organizational practices	$698,513	$708,513	$708,513	$708,513	$708,513	$3,532,565
Subtotal	$698,513	$708,513	$708,513	$708,513	$708,513	$3,532,565
Total	$1,850,000	$1,860,000	$1,860,000	$1,860,000	$1,860,000	$9,290,000
Note: Allocations are rounded and notional, based on the 2022 July 1 population estimate published by Statistics Canada.

Accountability measures in place for funds directed to private for-profit facilities

Not applicable.

Measuring and reporting on results

Working with CIHI: existing processes are in place for reporting through to CIHI. The Yukon is also committed to participating in a CIHI led process with federal, provincial, and territorial officials to improve the data available on LTC outcomes through the development of new common indicators for LTC.

Funding: funding will strengthen the department's ability to support designated staff to assist with designing, collecting, and analyzing data related to these specific activities. Funding will enable the Yukon to begin measuring and reporting on relevant measures. The department proposes to track and report to residents and their families on number of days that direct nursing hours fall below 3.5h per resident in a 24h period. This will be done annually, at minimum, and posted in Continuing Care area of the government's website.

Table 4: Summary of the Yukon's indicators and targets
Indicator	Baseline	Targets	Timeframe
Priority Area 1 – Workforce Stability for Business Continuity
Workforce Stability for Business Continuity % of days total nursing hours are at minimum 3.5h/resident/24h period	90% of days	100% of days	March 2026^{Footnote 1}
Priority Area 2 – Long-Term Care Standards
Long-Term Care Standards Program level statistics for infection control per long term care home	Zero	4 per year – quarterly report for internal use with annual reporting to residents/families	March 2026^{Footnote 2}
Table 4 Footnote 1 The target of 100% of days will be maintained to the end of the funding period. Return to table 4 footnote 1 referrer Table 4 Footnote 2 The target of four reports per year and annual reporting to residents/families will be maintained to the end of the funding period. Return to table 4 footnote 2 referrer

Table 5 - Overall funding allocations
	2023-24	2024-25	2025-26	2026-27	2027-28	Total
Home and community care	$670,000	$670,000	$670,000	$670,000	n/a	$2,680,000
Long-Term Care	$1,850,000	$1,860,000	$1,860,000	$1,860,000	$1,860,000	$9,290,000
Total	$2,520,000	$2,530,000	$2,530,000	$2,530,000	$1,860,000	$11,970,000

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Date modified:: 2024-03-12

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Canada-Yukon 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

Home and community care

Context – State of home and community care in the Yukon

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

Measuring and reporting on results

Long-term care

Context – State of LTC services in the Yukon:

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

Accountability measures in place for funds directed to private for-profit facilities

Measuring and reporting on results

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