Canada-Northwest Territories Home and Community Care and Mental Health and Addictions Services Funding Agreement
HER MAJESTY THE QUEEN 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”)
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HER MAJESTY THE QUEEN IN RIGHT OF THE NORTHWEST TERRITORIES (hereinafter referred to as “the Northwest Territories” or “Government of the Northwest Territories”) as represented by the Minister of Health and Social Services herein referred to as “the territorial Minister”)
REFERRED to collectively as the “Parties”
WHEREAS, on January 16, 2017 Canada and the Northwest Territories agreed to targeted federal funding over 10 years, beginning in 2017-18, for investments in home and community care and mental health and addictions, in addition to the existing legislated commitments through the Canada Health Transfer;
WHEREAS, Canada and the Northwest Territories agreed to a Common Statement of Principles on Shared Health Priorities (hereinafter referred to as the Common Statement, attached hereto as Annex 1) on August 21, 2017, which articulated their shared vision to improve access to home and community care as well as mental health and addictions services in Canada;
WHEREAS, Canada authorizes the federal Minister to enter into agreements with the provinces and territories, for the purpose of identifying activities provinces and territories will undertake in home and community care and mental health and addictions services, based on a menu of common areas of action and in keeping with the performance measurement and reporting commitments, consistent with the Common Statement;
WHEREAS Canada and the Northwest Territories agree that data collection and public reporting of outcomes is key to reporting results to Canadians on these health system priorities, and that the performance measurement approach taken will recognize and seek to address differences in access to data and health information infrastructure;
WHEREAS, the Hospital Insurance and Health and Social Services Administration 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 the Northwest Territories for the provision of health services which includes home and community care and mental health and addictions initiatives;
WHEREAS, the Northwest Territories makes ongoing investments in home and community care and mental health and addictions services, consistent with its broader responsibilities for delivering health care services to its residents;
AND WHEREAS the Government of Canada makes ongoing investments in home and community care and mental health and addictions services for Indigenous communities and other federal populations.
NOW THEREFORE, Canada and the Northwest Territories agree as follows:
1.1 Building on the Northwest Territories’ existing investments and initiatives, Canada and the Northwest Territories commit to work together to improve access to home and community care and strengthen access to mental health and addictions services (listed in the Common Statement, attached as Annex 1).
2.0 Action Plan
2.1 The Northwest Territories will invest federal funding provided through this Agreement in alignment with the selected action(s) from each menu of actions listed under home and community care and mental health and addictions in the Common Statement.
2.2 The Northwest Territories’ approach to achieving home and community care and mental health and addictions services objectives is set out in their five-year Action Plan (2017-18 to 2021-22), as set out in Annex 2.
3.0 Term of Agreement
3.1 The term of this agreement is four years, from April 1, 2018 to March 31, 2022 (the Term).
3.2 Renewal of Bilateral Agreement
3.2.1 The Northwest Territories’ share of the federal funding for 2022-23 to 2026-27, based on the federal commitment in Budget 2017 of $11 billion over ten years, will be provided upon the renewal of bilateral agreements, subject to appropriation by Parliament, and the Northwest Territories’ and Canada’s agreement on a new five-year action plan.
3.2.2 The renewal will provide the Northwest Territories and Canada the opportunity to review and course correct, if required, and realign new priorities in future bilateral agreements based on progress made to date.
4.0 Financial Provisions
4.1 The contributions made under this Agreement are in addition and not in lieu of those that Canada currently provides to the Northwest Territories under the Canada Health Transfer to support delivering health care services within their jurisdiction.
4.2 Allocation to the Northwest Territories
4.2.1 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.
4.2.2 Canada has designated the following maximum amounts to be transferred in total to all provinces and territories under this initiative on a per capita basis for the Term starting on April 1, 2018 and ending on March 31, 2022.
Home and Community Care
- $600 million for the Fiscal Year beginning on April 1, 2018
- $650 million for the Fiscal Year beginning on April 1, 2019
- $650 million for the Fiscal Year beginning on April 1, 2020
- $900 million for the Fiscal Year beginning on April 1, 2021
Mental Health and Addictions Services
- $250 million for the Fiscal Year beginning on April 1, 2018
- $450 million for the Fiscal Year beginning on April 1, 2019
- $600 million for the Fiscal Year beginning on April 1, 2020
- $600 million for the Fiscal Year beginning on April 1, 2021
4.2.3 Annual funding will be allocated to provinces and territories on a per capita basis, for each Fiscal Year that an agreement is in place. The per capita funding amounts for home and community care and for mental health and addictions services, for each Fiscal Year, are calculated using the following formula: F x K/L, where:
- F is the annual total funding amount available under this program (funding amount will change depending on fiscal year);
- K is the total population of the particular province or territory, as determined using annual population estimates from Statistics Canada; and
- L is the total population of Canada, as determined using annual population estimates from Statistics Canada.
4.2.4 For the purposes of the formula in section 4.2.3, the population of the Northwest Territories for each fiscal year and the total population of all provinces and territories for that Fiscal Year are the respective populations as determined on the basis of the quarterly preliminary estimates of the respective populations on July 1 of that Fiscal Year. These estimates are released by Statistics Canada in September of each Fiscal Year.
4.2.5 Subject to annual adjustment based on the formula described in section 4.2.3, the Northwest Territories’ estimated share of the amounts will be:
Annual Funding for Home and Community Care and Mental Health and Addiction Services
|Fiscal Year||Home and community care
Estimated amount to be paid to the Northwest TerritoriesFootnote * (subject to annual adjustment)
|Mental health and addictions services
Estimated amount to be paid to the Northwest TerritoriesFootnote * (subject to annual adjustment)
4.3.1 Canada’s contribution will be paid in approximately equal semi-annual installments as follows:
- The first installment will be paid on or about April 15 of each Fiscal Year. The second installment will be paid on or about November 15 of each Fiscal Year.
- The amount of the first installment will be equal to 50% of the notional amount set out in Article 4.2.5 as adjusted by Article 4.2.3.
- The amount of the second installment will be equal to the balance of Canada’s contribution to the Northwest Territories for the Fiscal Year as determined under sections 4.2.5 and 4.2.3.
- Canada will notify the Northwest Territories at the beginning of the 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. Canada will notify the Northwest Territories of the actual amount of the second installment in each Fiscal year as determined under the formula set out in sections 4.2.5 and 4.2.3.
- Canada shall withhold payment of the second installment for the Fiscal Year if the Northwest Territories has failed to provide its annual financial statement for the previous Fiscal Year or to provide data and information related to home and community care and mental health and addictions to the Canadian Institute for Health Information (CIHI) for the previous Fiscal Year in accordance with section 5.1.2
- The sum of both semi-annual installments constitutes a final payment and is not subject to any further adjustment once the second installment of that Fiscal Year has been paid.
- Payment of Canada’s funding for each Fiscal Year of this Agreement is subject to an annual appropriation by Parliament of Canada for this purpose.
4.4 Carry Over
4.4.1 At the request of the Northwest Territories, the Northwest Territories may retain and carry forward to the next Fiscal Year, the amount of up to 10 per cent of the contribution paid to the Northwest Territories for a Fiscal Year under subsection 4.2.5. that is in excess of the amount of the eligible expenditures actually incurred by the Northwest Territories in that Fiscal Year, and use the amount carried forward for expenditures on eligible areas of investment incurred in that Fiscal Year. Any request by the Northwest Territories to retain and carry forward an amount exceeding 10 per cent will be subject to discussion and mutual agreement in writing by the Parties via an exchange of letters.
4.4.2 For greater certainty, any amount carried forward from one Fiscal Year to the next under this subsection is supplementary to the maximum amount payable to the Northwest Territories under subsection 4.2.5. of this Agreement in the next Fiscal Year.
4.4.3 In the event this bilateral agreement is renewed in accordance with the terms of section 3.2.1, and at the request of the Northwest Territories, the Northwest Territories may retain and carry forward up to 10 percent of funding provided in the last Fiscal Year of this Agreement for eligible areas of investment in the renewed 5-year agreement (2022-23 to 2026-27), subject to the terms and conditions of that renewed agreement. The new Action Plan (2022-23 to 2026-27) will provide details on how any retained funds carried forward will be expended. Any request by the Northwest Territories to retain and carry forward an amount exceeding 10 per cent will be subject to discussion and mutual agreement in writing by the Parties via an exchange of letters.
4.5 Repayment of overpayment
4.5.1 In the event payments made to the Northwest Territories exceed the amount to which the Northwest Territories is entitled under this Agreement, the amount of the excess is a debt due to Canada and, unless otherwise agreed to in writing by the Parties, the Northwest Territories shall repay the amount within sixty (60) calendar days of written notice from Canada.
4.6 Use of Funds
4.6.1 Canada and the Northwest Territories agree that funds provided under this Agreement will only be used by the Northwest Territories in accordance with the areas of action outlined in Annex 2.
4.7 Eligible Expenditures
4.7.1 Eligible expenditures for funds provided under this Agreement are the following:
- capital and operating funding,
- salaries and benefits;
- training, professional development;
- information and communications material related to programs;
- data development and collection to support reporting; and,
- information technology and infrastructure.
5.0 Performance Measurement and Reporting to Canadians
5.1 Funding conditions and reporting
5.1.1 As a condition of receiving annual federal funding, the Northwest Territories agrees to participate in a Federal-Provincial-Territorial process, including working with stakeholders and experts, through CIHI, to develop common indicators and to share relevant data in order to permit CIHI to produce annual public reports that will measure pan-Canadian progress on home and community care and mental health and addictions services.
- The Northwest Territories will designate an official or official(s), for the duration of this agreement, to work with CIHI and represent the interests of the Northwest Territories related to performance measurement and reporting for home and community care, as well as mental health and addictions services.
5.1.2 As a condition of receiving annual federal funding, by no later than October 1 of each Fiscal Year during the Term of this Agreement, the Northwest Territories agrees to:
- Provide data and information (based on existing and new indicators) related to home and community care and mental health and addictions services to the Canadian Institute for Health Information annually. This will support the Canadian Institute for Health Information to measure progress on the shared commitments outlined in the Common Statement and report to the public.
- Provide to Canada an annual financial statement, with attestation from the territory’s Chief Financial Officer, of funding received from Canada under this Agreement during the Fiscal Year compared against the action plan, and noting any variances, between actual expenditures and the Northwest Territories’ Action Plan (Annex 2):
- The revenue section of the statement shall show the amount received from Canada under this Agreement during the Fiscal Year;
- The total amount of funding used for home and community care and mental health and addictions programs and services;
- If applicable, the amount of any amount carried forward by the Northwest Territories under section 4.4; and
- If applicable, the amount of any surplus funds that is to be repaid to Canada under section 4.5.
5.2.1 The Northwest Territories will ensure that expenditure information presented in the annual financial statement is, in accordance with the Northwest Territories’ standard accounting practices, complete and accurate.
5.3.1 Responsibility for evaluation of programs rests with the Northwest Territories in accordance with its own evaluation policies and practices.
6.1 Canada and the Northwest Territories 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.
6.2 Each Party will receive the appropriate credit and visibility when investments financed through funds granted under this Agreement are announced to the public.
6.3 In the spirt of transparency and open government, Canada will make this Agreement, including any amendments, publicly available on a Government of Canada website.
6.4 Canada, with prior notice to the Northwest Territories, may incorporate all or any part or parts of the data and information in 5.1.2, or any parts of evaluation and audit reports made public by the Northwest Territories into any report that Canada may prepare for its own purposes, including any reports to the Parliament of Canada or reports that may be made public.
6.5 Canada reserves the right to conduct public communications, announcements, events, outreach and promotional activities about the Common Statement and bilateral agreements. Canada agrees to give the Northwest Territories 10 days advance notice and advance copies of public communications related to the Common Statement, bilateral agreements, and results of the investments of this Agreement.
6.6 The Northwest Territories reserves the right to conduct public communications, announcements, events, outreach and promotional activities about the Common Statement and bilateral agreements. The Northwest Territories agrees to give Canada 10 days advance notice and advance copies of public communications related to the Common Statement, bilateral agreements, and results of the investments of this Agreement.
7.0 Dispute Resolution
7.1 Canada and the Northwest Territories 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.
7.2 If at any time either Canada or the Northwest Territories 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, Canada or the Northwest Territories, as the case may be, may notify the other party in writing of the failure or breach. Upon such notice, Canada and the Northwest Territories will endeavour to resolve the issue in dispute bilaterally through their designated officials, at the Assistant Deputy Minister level (hereinafter the “Designated Officials”).
7.3 If a dispute cannot be resolved by Designated Officials, then the dispute will be referred to the Deputy Ministers of Canada and the Northwest Territories responsible for health, and if it cannot be resolved by them, then the respective Ministers of Canada and the Northwest Territories most responsible for Health shall endeavour to resolve the dispute.
8.0 Amendments to the Agreement
8.1 The main text of this Agreement (not including attached annexes) may be amended at any time by mutual consent of the Parties. To be valid, any amendments shall be in writing and, signed, in the case of Canada, by Canada’s Minister of Health, and in the case of the Northwest Territories, by the Northwest Territories’ Minister of Health and Social Services.
8.2 Annex 2 may be amended at any time by mutual consent of the Parties. To be valid, any amendments to Annex 2 shall be in writing and, signed, in the case of Canada, by their Designated Official, and in the case of the Northwest Territories, by their Designated Official.
9.0 Equality of Treatment
9.1 During the term of this Agreement, if another province or territory, except the province of Quebec, negotiates and enters into a Home and Community Care and Mental Health and Addictions Services Agreement with Canada, or negotiates and enters into an amendment to such an agreement and if, in the reasonable opinion of the Northwest Territories, any provision of that agreement or amended agreement is more favourable to that province or territory than the terms set forth in this Agreement, Canada agrees to amend this Agreement in order to afford similar treatment to the Northwest Territories, if requested by the Northwest Territories. This includes any provision of the bilateral agreement except for the Financial Provisions set out under section 4.0. This amendment shall be retroactive to the date on which the Home and Community Care and Mental Health and Addictions Services Agreement or the amendment to such an agreement with the other province or territory, as the case may be, comes into force.
10.1 Canada may terminate this Agreement at any time if the terms of this Agreement are not respected by the Northwest Territories by giving at least 12 months written notice of its intention to terminate. The Northwest Territories may terminate this Agreement at any time if the terms of this Agreement are not respected by Canada by giving at least 12 months written notice of its intention to terminate.
10.2 As of the effective date of termination of this Agreement under section 10.1, Canada shall have no obligation to make any further payments to the Northwest Territories after the date of effective termination.
11.1 Any notice, information, or document provided for under this Agreement will be effectively given if delivered or sent by letter or email, postage or other charges prepaid. Any notice that is delivered will have been received in delivery; and, except in periods of postal disruption, any notice mailed by post will be deemed to have been received eight calendar days after being mailed.
The address for notice or communication to Canada shall be:
70 Colombine Driveway
Brooke Claxton Building
The address for notice or communication to the Northwest Territories shall be:
Government of the Northwest Territories
New Government Building, 7th Floor
5015 - 49th Street
P.O. Box 1320
12.1 This Agreement, including Annexes 1 and 2, comprise the entire agreement entered into by the Parties with respect to the subject matter hereof.
12.2 This Agreement is based on the Common Statement of Principles on Shared Health Priorities, Annex 1, finalized on August 21, 2017.
12.3 This Agreement shall be governed by and interpreted in accordance with the laws of Canada and the Northwest Territories.
12.4 No member of the House of Commons or of the Senate of Canada or of the Legislature of the Northwest Territories shall be admitted to any share or part of this Agreement, or to any benefit arising therefrom.
12.5 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 deemed to be severable and will be deleted from this Agreement, but all the other provisions of this Agreement will continue to be valid and enforceable.
SIGNED on behalf of Canada by the Minister of Health this 21st day of February, 2018.
The Honourable Ginette Petitpas Taylor, Minister of Health
SIGNED on behalf of the Northwest Territories by the Minister of Health and Social Services this 21st day of February, 2018.
The Honourable Glen Abernethy, Minister of Health and Social Services
Annex 1 to the Agreement
Annex 2 to the Agreement
Northwest Territories' Action Plan on Mental Health and Addiction Services and Home and Community Care
The Northwest Territories (NWT) Health and Social Services system serves 44,520 people spread over 33 communities on a land mass of 1,144,000 km2, with many communities without year-round access to larger centres (“fly-in communities”)Footnote 1. NWT communities range in size from the capital city of Yellowknife with a population of 20,690 to the community of Kakisa with under 50 peopleFootnote 1. While the NWT population is relatively young, with 35% of the population under age 25 versus 28% nationally, the population is aging. Between 2016 and 2035, the NWT population age 60 and over is expected to increase by over 80% from 5,193 to 9,383. Just over two thirds of the current senior population is concentrated in and around the four largest communities of the NWT while the remaining third is spread out over more than 25 communities. NWT communities also vary in living experiences and conditions; culture; and access to services and programs.
The history of the NWT is filled with stories of strength and resilience in the face of adversity and strong commitment to the land, communities and one another. While this strength is undeniable, the legacy of colonization and residential schools and the associated intergenerational traumas continue to affect the wellness of residents and communities. Despite the challenges experienced by NWT residents, there are many committed people in our communities who are working hard to keep communities healthy and support the people around them. Communities know what they need to achieve increased wellness. Therefore, in developing initiatives to improve access to health and social services, community participation needs to be fostered and demographic differences need to be reflected.
The NWT has a large and diverse Indigenous population, who represent approximately 51% of the current population, which creates a heightened need to ensure any response to mental health, and home and community care needs is culturally respectful and safe, and developed in collaboration with the collective needs of the individual, family and community. As a result, any healthcare organization and administration decisions need to be collaborative and creative to ensure the equitable access to supports and services that meet the diverse needs of each community.
Mental Health and Addictions Services
Northwest Territories Overview
The goal of the Health and Social Services (HSS) system is to ensure that our mental health and addictions services recognize the strengths of NWT communities and residents, and work to foster hope, self-determination and recovery. This goal is supported by the Government of the Northwest Territories’ (GNWT) commitments to:
- Focus on mental health and addictions by ensuring that services are delivered locally with culturally appropriate methodsFootnote 2;
- Support individuals through prevention and early intervention initiatives that effectively promote mental wellness and addictions recovery in the NWTFootnote 3; and
- Support prevention and early intervention initiatives, such as upstream approaches, aimed at preventing mental health problems and substance abuse from developing in the first placeFootnote 3.
One of the key successes of the HSS system is the range of options currently offered to individuals impacted by or living with mental health and addictions challenges or mental illness:
- Promotion and Prevention efforts are delivered across the territory and include a focus on enhancing resiliency and connection to culture, reducing stigma, and improving community capacity to recognize signs/symptoms and respond:
- DHSS sponsors Community Healthy Living Fairs annually in small communities across the NWT. The Fairs are similar to a trade show event with service providers setting up booths to raise awareness about health and social services programs and supports, information on access, healthy choices and ways to mitigate health related issues.
- DHSS provides funding to Aboriginal Community Governments and works with communities to develop Community Wellness Plans that meet local needs and priorities through Community Wellness Funding. Projects may include activities like family retreats, youth wellness programs, mom and baby programs, culture camps, et cetera.
- DHSS delivers the Talking About Mental Illness (TAMI) program in partnership with schools. TAMI is a five-module program delivered in schools to reduce the stigma associated with mental illness among youth. The program provides youth and schools with information to increase awareness, understanding, and compassion around mental illness. Elements of the program aim to promote safe spaces, encourage youth in need to reach out for help, and develop lasting viewpoints that will reduce the stigma associated with mental illness.
- Mental Health First Aid – Northern Peoples (MHFA-N) is delivered in communities across the NWT by the Health and Social Services Authorities. MHFA creates awareness about mental illness and teaches participants (typically community members and/or professionals) how to support and safely intervene when an individual is experiencing a mental health crisis. The Authorities also deliver Applied Suicide Intervention Skills Training (ASIST), which is a two-day workshop that trains individuals to recognize the signs of someone at risk for suicide and how to safely respond and connect them to resources.
- Intervention Services provide integrated and collaborative support and treatment to individuals at risk of mental health difficulties and to those who are experiencing mental illness or a mental health crisis:
- The Community Counselling Program (CCP) offers free counselling and referrals to other resources for all residents of the NWT, regardless of age. The CCP is a key community-level component in the continuum of mental health services offered to NWT residents. Community counselling positions are located in 19 communities across all seven regions of the NWT. Telephone counselling and fly-in services are available to all communities without a local resident counsellor or Community Wellness Worker.
- The NWT Help Line is a free, confidential and anonymous crisis telephone service available 24 hours a day, 7 days a week to residents across the NWT for issues related to mental health. Calls are answered by Care Coaches who are trained counsellors that specialize in mental health and addictions. In 2017, the Department expanded the Help Line service to include telephone group sessions and a Facebook page which includes the option to contact a NWT Help Line Care Coach with questions via private messaging.
- The On the Land Healing Fund supports regional and community Indigenous Governments to deliver community-designed, culturally-relevant land-based healing programs. Funds are available annually with an allocation for each Indigenous Government. DHSS provides support and capacity building for the design, delivery and evaluation of these programs which work to enhance a sense of hope, belonging, meaning and purpose for Indigenous people.
- Primary Community Care Services are provided by local health clinics and centres across NWT communities. Services include health protection and prevention, screening, diagnostic and laboratory services, access to psychiatric care and treatment (both in and outpatient).
- Psychiatric assessment and treatment for youth and adults is provided by the Northwest Territories Health and Social Services Authority (NTHSSA). The NWT has three psychiatrist positions (two adult, one adolescent).
- The NWT Mental Health Act provides for the short term, inpatient care and treatment of individuals in need of involuntary services as a result of a mental disorder. The NTHSSA’s Stanton Territorial Hospital located in Yellowknife houses the NWT’s only psychiatric unit. The Unit has 10 adult beds. Youth requiring inpatient care are provided services via the pediatric unit in the hospital.
- For residents requiring facility-based treatment for addictions or mental health, DHSS draws upon agreements with facilities based in southern Canada. DHSS has contracts with four addictions treatment facilities that offer specialized treatment options for residents (gender specific, trauma informed, concurrent disorders, and opiate addiction). For individuals requiring facility-based mental health treatment, the GNWT utilizes Homewood Health centre in Ontario.
- Specialized Treatment services are available to children, youth and adults with complex needs, which include mental health related issues (i.e. developmental needs, psychiatric illness, acquired brain injuries, etc.):
- The GNWT offers supported living for adults with mental illness through a partnership with a local, non-government organization. The Salvation Army in Yellowknife offers an eight-bed group supported living program which offers 24-hour supports, life skills and medication administration.
- The GNWT offers specialized treatment resources to children and youth via the Territorial Treatment Centre in Yellowknife and the Trailcross Treatment Centre in Fort Smith. These facilities offer high quality, integrated, person-centred services to address cognitive, behavioural, mental health or addictions issues for children and youth.
- The Out-of-Territory (OOT) Placement Program provides residential placements with accredited agencies in southern Canada for residents who present with complex needs that cannot be met in the NWT. The OOT program matches clients’ needs with the appropriate out-of-territory placement resource. Services are individualized based upon each client’s unique needs.
Strengths are also evident in results from the 2015-16 Canadian Community Health Survey. For example, for individuals aged 12 and over:
- 79% self-reported a sense of belonging to a local community as very strong or somewhat strong in the NWT compared to the national average of 68%
- 18% self-reported life stress (most days quite a bit or extremely stressful) in the NWT compared to the national average of 22%, and
- 61% self-reported being at least moderately active for 150 minutes a week in the NWT compared to the national average of 58%Footnote 4.
Despite the strengths and successes of mental health and addictions supports and services, there are gaps remaining in the NWT HSS system and communities to address residents’ needs. Gaps were identified by NWT residents through extensive public engagements in the development of the Mind & Spirit: Mental Health and Addictions Strategic Framework; Mental Health Act; and Child and Youth Mental Wellness Action Plan. For example, NWT youth and adults identified the lack of community-based supports and wellness initiatives, particularly in rural and remote NWT communities, as a gap for mental health services’ needs. Where mental health and addictions services exist, DHSS heard from the public that these services need to be better integrated and matched to the needs of NWT residents. These gaps are evident in higher than national average rates as outlined below:
- The rate of suicide in the NWT (21.1 per 100,000 population) is almost two times the national rate (11.5 per 100,000 population)Footnote 5;
- The rate of self-injury hospitalizations in the NWT (195 per 100,000 population) is almost three times the national rate (66 per 100,000 population)Footnote 6;
- The rate of mental health hospitalizations in the NWT (1,365 per 100,000 population) is over two times the national rate (551 per 100,000 population)Footnote 7;
- The rate of alcohol-related hospitalizations in the NWT (1,315 per 100,000 population) is over five times the national rate (239 per 100,000 population)Footnote 8;
- For individuals aged 15 and over:
- 42% self-report being heavy drinkers in the NWT in compared to the national average of 23%; and
- 17% self-report to using hallucinogens in the NWT in compared to the national average of 13%Footnote 9.
- The incidence of police-reported family violence in the NWT (1,897 per 100,000 population) is almost eight times the national rate (243 per 100,000 population)Footnote 10.
The suicide rates of approximately twice the national average noted above are especially concerning for the territory. Suicide rates among Indigenous people are several times higher than the national average – approximately twice the national average for First Nations and as high as 11 times the national average for Inuit (Aboriginal Healing Foundation). This is influenced by the history of colonization and residential schools; intergenerational trauma; mental health related issues and addictions; and socioeconomic factors such as poverty, family disruption, low levels of education, limited employment opportunities, and inadequate housing that affect the many Indigenous groups living on this land (National Aboriginal Health Organization, Aboriginal Healing Foundation, Royal Commission on Aboriginal Peoples). Furthermore, mental health and addictions have a reinforcing and reciprocal relationship with suicide and its risk factors.
Providing for the mental health and addictions needs of the population in a manner that is timely, safe and recovery-oriented is a priority for both the GNWT and the Government of Canada. In moving forward, the GNWT will follow the goal and commitments outlined earlier in this document, and NWT residents’ feedback in guiding the GNWT’s priority areas for investment to address mental health and addiction services needs over the next four years.
Priority Areas for Investment
The issue of suicide emerged as one of the top priorities identified for many NWT residents. As part of the development of the Child and Youth Mental Wellness Action Plan, extensive engagement activities were conducted with youth from across the NWT. It was not surprising that the issue of suicide was an area of priority identified by this group. This message has been echoed by other groups including community leadership, members of the public and members of the Legislative Assembly. It is clear that there is a need to do more to prevent suicide and to ensure better care and treatment for those who are at risk and those who have been personally impacted. Suicide prevention, intervention and postvention are therefore priority areas for the GNWT.
Therefore, DHSS will allocate federal funding under this agreement to develop and implement a Territorial Suicide Prevention and Crisis Support Network (TSPCSN).
Targeted towards all NWT residents impacted by a suicide-related or other type of mental health crisis, the ultimate goal of the TSPCSN is to support communities in proactive suicide prevention activities as well as provide expert and timely intervention in times of crisis. This will include enhancing culturally-appropriate approaches to the prevention of suicide-related crises while also improving our ability to respond to community and family needs when a crisis does occur. The TSPCSN will use leading practices, research and lessons learned in other jurisdictions to establish a comprehensive process for providing community based suicide prevention and intervention, as well as postvention (follow-up) supports for individuals and communities when death by suicides occur. The work will see the establishment of clear policies and protocols as well as roles and responsibilities for responding in a suicide crisis. The work will involve training in critical incident management for local professionals, paraprofessionals and community members. These individuals can work together to support the immediate crisis debriefing needs of the community and impacted parties.
The TSPCSN follows a population health approach, which encompasses a broader notion of health that recognizes the range of social, economic, and physical environmental factors that contribute to health and wellness. This approach also recognizes that NWT residents need access to a broad range of services that protect and promote their physical, mental and social wellbeing. The TSPCSN aligns with the activities in the Common Statement of Principles for Shared Health Priorities by:
- expanding access to community-based mental health and addiction services for children and youth (age 10–25), recognizing the effectiveness of early interventions to treat mild to moderate mental health disorders; and,
- spreading evidence-based models of community mental health care and culturally-appropriate interventions that are integrated with primary health services.
Over the next four years, the federal investment will allow the TSPCSN to build on existing resources and partnerships, better integrate supports and services, and introduce new training and resources for NWT communities.
To support the implementation of this work (prevention, intervention and postvention activities), the GNWT will require two FTE positions located within the Health and Social Services System. The two employees will work closely together, with partners in their respective organizations and with community members and stakeholders, to ensure a holistic, wrap around, community-centred approach to the implementation of the Suicide Prevention and Crisis Support Network.
The following subsections outline the three main components to the planned Territorial Suicide Prevention and Crisis Support Network and how the funding will be used in each component:
The GNWT has identified that there is a need for a comprehensive approach to suicide prevention that, at its core, is based in community development theory and cultural safety. Creating opportunities for communities to develop culturally safe and appropriate programs that facilitate resilience and a sense of hope, belonging, meaning and purpose is one of the main ways that the GNWT can work towards reconciliation and the healing of intergenerational trauma caused by colonization. Suicide prevention within the TSPCSN recognizes that mental health promotion intervention should increase the wellbeing in a community as a means of decreasing the incidence of mental disordersFootnote 11. NWT residents have emphasized the desire to have community wellness activities (i.e., art-based recreation and land-based activities, leadership opportunities) as early interventions to mental health related issues.
The FTEs being funded under this Action Plan will work directly with communities to develop community level suicide prevention plans that work to increase resiliency, instil a sense of hope and belonging, and increase mental health and suicide awareness in order to reduce stigma. The level of collaboration, strategies to work with the communities and timing will depend on each community’s readiness and availability to participate in the development of these suicide prevention plans. These efforts will be focused on the general public and individuals who are not (yet) at risk for suicide. The federal funding will also be used to support the implementation of the initiatives identified within the community level suicide prevention plans.
Equally important is the need for a coordinated and integrated approach to delivering services to all individuals who are at risk regardless of their cultural background. There is a need to reduce fragmentation, improve communication and ensure clear policies and standards of care that are rooted in a person-centred, recovery-oriented approach to care.
This funding opportunity will be used to support the adoption of a seamless care pathway (integrated stepped care) approach to service delivery. This collaborative, seamless care pathway approach is critical to ensuring that system gaps are filled and that individuals who may be at risk are provided the most appropriate level and type of service required to meet their needs, whether it means accessing addictions treatment, counselling, psychiatry, recovery and aftercare programs; or participating in resiliency and skill building programs. This model recognizes that mental health and wellness services need to be tailored to the needs of the individual.
This funding opportunity will also provide timely access to quality services for individuals who have been identified as being at risk for suicide. DHSS will focus on addressing gaps and enhancing evidence-based approaches to delivering services to these individuals.
The FTEs being funded under this Action Plan will support the following intervention initiatives:
- In partnership with the Canadian Foundation for Healthcare Improvement (CFHI), develop a culturally-relevant, common suicide risk assessment tool to be used across the NWT Health and Social Services System;
- For individuals requiring psychiatric care, develop improved referral pathways, information sharing and discharge planning processes between Territorial level resources and community caregivers; and
- Across the mental health and addictions service delivery continuum, adopt a collaborative, stepped care model of service provision. A stepped care model of service provision is a collaborative approach where a variety of mental health and wellness services, from least to most intensive, are matched to the needs of the individual. A person does not have to start at the lowest level of intervention to go to the next ‘step’. Instead, the person is matched with the service that best meets their need at that point in time.
Despite best efforts, crises can and will occur. When this happens, the GNWT is committed to a timely, evidence-based response that meets the identified needs of the impacted community. The ability to respond in a timely manner will require a pool of trained, qualified professionals with the required skills to intervene in a crisis as well as clearly laid out processes, protocols, roles and responsibilities so that there is no lack of clarity in terms of what is required and how it will be provided. This approach will include the need for surge capacity. There is a need to ensure that responding to a crisis does not overwhelm local resources or cause gaps in other areas of the system.
This work will focus on providing a coordinated response and healing supports for individuals, families and communities impacted by a suicide or other crisis. DHSS will focus on providing comprehensive, evidence based crisis intervention supports, identifying others who may be at risk, linking to resources, and providing aftercare support and healing for those who have been impacted.
The FTEs being funded under this Action Plan will support the following postvention initiatives with help of federal funding:
- Development of policies and protocols outlining a coordinated, interdepartmental approach to providing timely response in the immediate aftermath of a crisis and in the days, weeks and months that follow;
- Establishment of clear roles and responsibilities with a focus on connecting with the community to understand needs; and
- Establishment of a territorial team of community members and professionals (from the HSS system or other GNWT Departments) with the competencies and skills to respond in a crisis and who are able to travel on short notice.
Federal funding will also be used to implement Critical Incident Management training for HSS, other GNWT staff and community members. Having trained people in the community will help in providing additional support to families and first responders impacted by a crisis. Additionally, the federal funding will be used to contract an itinerant private counselling team that can provide surge capacity to the HSS system through timely, crisis supports when local resources are either unavailable or overwhelmed.
The following table outlines the funding allocation for the TSPCSN:
Allocation of Health Accord Funding – Mental Health and Addictions
|Funding Breakdown by Initiative||2017-18Table 2 Footnote *||2018-19Table 2 Footnote **||2019-20||2020-21||2021-22||Total|
|Prevention, Intervention and Postvention:
A monitoring and evaluation plan for the Territorial Suicide and Crisis Support Network will be developed and implemented during the 2018/2019 fiscal year. This plan will focus on qualitatively and quantitatively measuring progress, as well as provide ongoing information that allows the Territorial Suicide and Crisis Support Network to be adapted as needed. The monitoring and evaluation plan will focus on jurisdiction-specific indicators and align with the cross-jurisdiction indicators developed with CIHI. The monitoring and evaluation plan will establish targets and indicators based on the outputs and outcomes defined in the following section (“Summary of Expected Results”).
The GNWT will be participating in the development of common indicators. Having a set of common indicators will help to reduce “indicator chaos” in the health system by working with partners to identify which mental health indicators are most important, how they relate to each other, and how they can best support improvements to mental health programs and services, as well as the overall health of Canadians.
While the NWT does not currently have a systematic method of collecting and reporting on these program areas, there is commitment to work with CIHI on the development of national indicators. The NWT has nominated a representative to participate on the CIHI led initiative towards the development of common indicators.
Summary of Expected Results
Mental Health and Addiction Services
|Initiatives||Outputs||Output Indicators||Outcomes||Outcome Indicators||Target by 2021|
Prevention: Develop and support the implementation of community level suicide prevention plans
Community level suicide prevention plans developed by the communities who expressed interest to participate
Supports provided to communities for implementation of community level suicide prevention plans
Number of communities that expressed interest to participate in plan development
Number of community level prevention plans developed
Description of supports provided to communities, by category
Increased community level initiatives to improve resiliency and reduce risk factors for suicide
Description of initiatives that were implemented as per individual community level suicide prevention plans, by category
To be established when the monitoring and evaluation plan is developed in 2019.
Intervention: Develop and implement a common suicide risk assessment tool partnership with the Canadian Foundation for Healthcare Improvement.
A common suicide risk assessment tool is developed and implemented in the NWT.
Common suicide risk assessment tool is established
Number of training sessions on the common suicide risk assessment tool, by region
Common understanding among practitioners on how to assess suicide risk
Common understanding among practitioners on stepped care model
Feedback from helping professionals on their understanding and use of the:
To be established when the monitoring and evaluation plan is developed in 2019.
Intervention: Adopt a collaborative, stepped care model of service provision
Referral pathways, information sharing and discharge planning processes are established.
Established referral pathways, information sharing and discharge planning processes
Postvention: Develop protocols and pathways for critical incident management.
Protocols and pathways are in place for critical incident management.
Responses to critical incidents adhere to established protocols
Communities have access to trained professionals during critical incidents
Description of responses to critical incidents in relation to the protocols
Percentage of communities/ regions with trained people in Critical Incident Management
To be established when the monitoring and evaluation plan is developed in 2019.
Postvention: Provide Critical Incident Management training for HSS, other GNWT staff and community members.
Critical Incident Management training is provided to relevant HSS, other GNWT staff and community members.
Number of HSS, other GNWT staff and community members who were trained in Critical Incident Management.
Postvention: Establish an itinerant counselling team to provide surge capacity in times of critical incidents.
An itinerant counselling team is established to provide surge capacity in times of critical incidents.
A network of available GNWT counsellors is established to provide surge capacity in times of critical incidents
Established an itinerant counselling team
Home and Community Care Services
Northwest Territories Overview
Home and Community Care (HCC) is one of three service streams within Continuing Care, a core service of the NWT Department of Health and Social Services (DHSS). Along with Supported Living (SL) and Long-Term Care (LTC), the three Continuing Care service areas maintain or improve the physical, social, and psychological health of seniors/elders and individuals who for a variety of reasons may not be able to fully care for themselves. Community inclusion and full participation in cultural activities are valued by Continuing Care services.
The goal of the DHSS is to ensure that HCC services are provided in a culturally-safe manner to improve the independence and quality of life of individuals and their families, enabling them to live at home, often with the effect of preventing, delaying, or substituting for acute care or LTC alternatives. This goal is supported by the Government of the Northwest Territories’ commitments to:
- Support elders to live in their own homes for as long as possible and ensure adequate supports are available for those who can no longer do so (GNWT Mandate 2017);
- Ensure Home Care responds to more complex care needs and better supports residents in their homes and communities (DHSS Strategic Priorities 2017);
- Ensure communities are involved in making decisions about how services should be delivered and services are culturally respectful (DHSS Strategic Priorities 2017);
- Ensure Home and Community Care decisions are evidence-informed and based on comprehensive planning and assessment of the system’s ability to meet the current and future needs to our aging population (DHSS Strategic Priorities 2017);
- Support options to respond to identified shortfalls in existing resources/capacity to ensure that they are innovative and reflect the government’s fiscal situation (DHSS Strategic Priorities 2017);
- Implement information systems to enable comprehensive client assessments and support informed decision-making on placements to ensure clients receive the appropriate level of care base on their needs (DHSS Strategic Priorities 2017); and
- Implement information systems to support clinical, administrative and policy decision making and monitor outcomes (DHSS Strategic Priorities 2017).
HCC services are a suite of services delivered to NWT residents of all ages in their homes, or other places of residence such as group homes, assisted living apartments, and independent seniors housing units. HCC services include nursing and personal care services which are delivered based on an assessment of the individual’s needs. Also offered through HCC are adult day services and respite services which focus specifically on supporting both the individual and their family caregivers to ensure this caregiving relationship can continue. Home-based palliative care services and acute care nursing services related to early discharge from the hospital are also provided as part of the suite of HCC services.
HCC services are integrated with other core health and social services of the DHSS such as LTC, Primary Community Care Services, Rehabilitation Services and Mental Health and Addictions Services. This integration ensures that NWT residents have access to a multidisciplinary team to support assessment and intervention, and facilitates access to specialist services and medical equipment and supplies. The integration with LTC also provides support to family and community caregivers through access to facility based respite care beds in LTC.
HCC services are available to all residents of the NWT, however the majority of services are provided to seniors and elders. Population projections for the NWT indicate that the age structure of the territorial population will undergo continued ‘aging’ with seniors representing the fastest growing age group in the territory.Footnote 12 Between 2016 and 2035, the NWT population age 60 and over is expected to increase from 5,193 individuals (11.7% of the population) to 9,383 individuals (20.4% of the population), an increase of over 80%. Additionally, during this same time frame, the NWT population of those aged 70 plus is projected to nearly triple, growing from 1,991 individuals (4.5% of the population) to 5,207 individuals (11.6% of the population). Currently, just over two thirds of the senior population is concentrated in the four largest communities of the NWT while the remaining third is spread out over more than 25 communities.
Like much of Canada, the steady rise in chronic disease diagnosis and incidence is seen in the NWT, with higher prevalence rates existing in the senior population (60 years and older). In 2011, roughly 20.2% of seniors, and 21.6% of older seniors (75+) were living with diabetes in the NWT.Footnote 13 These trends are projected to persist as the NWT population ages. Cancer cases also reflect similar trends; with the majority of cases occurring in seniors aged 65 years and older. This is strongly linked to lifestyle choices, where the NWT population fares worse than the rest of Canada in lifestyle indicators such as physical activity, daily smoking, heavy drinking, health eating and obesity.Footnote 14
The rates of overall self-reported health are significantly lower in the NWT than the national average, and have also shown to decrease with age in the NWTFootnote 15. Most notably, self-reported mental health was significantly lower than the national average. However, sense of community has always been higher than the national average, reflecting a strong commitment to family and community.Footnote 16
The NWT Long Term Care Program Review completed in 2015 confirmed that the main contributors to long term care utilization in the NWT include increasing age, increased life expectancy, and the health status of the population. NWT hospitalization rates confirm health disparity in the NWT’s Indigenous population, where Indigenous persons had a utilization rate of 91 per 1,000, compared to non-Indigenous residents at 61 per 1,000.Footnote 17 This disparity is also reflected in the utilization of LTC, where 62% of the individuals in LTC between 2009 and 2014 were Indigenous, while the population >70 years of age was 59% Indigenous.Footnote 18 The combination of a growing senior’s population in the NWT, rising chronic disease rates, age-related reductions in self-rated health and disparities in the health status of our Indigenous population are driving an increased need for HCC services. As our population ages, we expect the demand for HCC services to rise proportionally. With a large proportion of our aging residents living in small remote communities, adequate and equitable service delivery is a key priority to ensure seniors and elders can continue to age in place. Enabling access to more equitable HCC service delivery in small remote communities will also assist the GNWT in addressing health and social disparities in our Indigenous population.
As early as 2013, the DHSS identified a need to be ready to respond to the growing demand for Continuing Care services and contracted MNPLLP (MNP) to review the delivery of Continuing Care services across the NWT. This Review identified some systemic gaps in the way that HCC services are delivered across regions of the NWT, which result in inequities in the services available to residents. Some of these gaps relate to the number and ratio of HCC providers in each community and region, and the processes of intake, assessment and assignment of services to meet needs of residents.
In June 2014, based on the findings of the Continuing Care Review, the GNWT released the strategic framework for aging in place, Our Elders, Our Communities. It outlines seven priorities that we will use to guide future program design for older adults to assist them to remain in their communities as long as possible. Aging in place, for us, is about developing strategies and services to assist elders who wish to continue to live independently and with dignity in the comfort of their own homes and communities. We are working towards delivering effective home care services to maximize aging in place, and to delay or avoid placing our residents in long term care.
Informed by the Review, DHSS has moved forward with a number of initiatives aimed at improving the access and reducing inequities in HCC services. In 2015, the DHSS released NWT Continuing Care Standards (CC Standards) that outline the operational requirement of NWT Continuing Care programs to ensure the quality and safety of care that is delivered through these programs. Based on the CC Standards, the DHSS has also collaborated with the Health and Social Services Authorities to develop Territorial policies to support implementation of the CC Standards. The DHSS has made investments in adult day programs and services in each region to increase caregiver support and opportunities for healthy aging. Additionally, some regions have been able to expand the hours of HCC services to better address the needs of individuals and their families. The DHSS has supported ongoing investments in HCC workforce training to assist in the provision of evidenced-based quality care for individuals with chronic health conditions and complex needs resulting from dementia and frailty.
The GNWT finalized a Continuing Care Services Action Plan (Action Plan) in September 2017 that supports the 7 priorities of Our Elders, Our Communities and works towards fulfilling the commitments of the GNWT and DHSS. The Action Plan focuses on the priority areas of Home Care, Long Term Care and Palliative Care over the 2017/18 to 2021/22 fiscal years, with an aim of reducing some of the gaps in our health and social services system for seniors and other adults who require supportive services to remain living at home. Through this Action Plan we are engaging our partners in the GNWT, non-government organizations, and other levels of government around actions to align our efforts with joint priorities to address the increasing demand for HCC services.
Priority Areas for Investment
The GNWT and the Government of Canada share the priority of addressing access to appropriate services and supports in home and community to meet the needs of the growing population of elders in a manner that supports these valuable members of society to age in place in their homes and communities. This is of particular significance in the NWT, where there is a strong desire by Indigenous people to have elders remain in their communities as important contributors to cultural preservation and overall community wellness.
The GNWT is committed to improving the equity and access to HCC services. The federal investment in improving access to home and community care will assist the GNWT in achieving the priorities of Our Elders: Our Communities and some of the goals of the 2017 Continuing Care Services Action Plan.
One of the key challenges faced in HCC that is to be addressed through the Continuing Care Services Action Plan and with support of this federal investment is the lack of a consistent, evidence-based assessment tool to use across the HCC program to determine the service needs of NWT residents. In the absence of a consistent evidenced-based assessment tool to guide care planning for HCC clients, service allocation is not strongly linked to the assessed care needs of individuals. This impacts the overall utilization of HCC resources, and ultimately, the equity of access to HCC services within communities and across the NWT. It is foreseeable that this gap would result in diminished capacity to support individuals with high care needs in community and inefficient use of existing resources.
Another significant challenge to be addressed through the Continuing Care Services Action Plan and with support of this federal investment is providing access to flexible care options to address care needs of individuals and their existing caregivers, particularly in small NWT communities, where there is limited infrastructure and services to support an aging population. HCC programs in our small communities are supported by nurses working within Primary Community Care services, and the programs have limited resources and often struggle to address the various needs of community members while still responding to Health Centre operations, including addressing the needs of clients requiring a palliative approach to care.
To address these challenges, the GNWT will utilize this federal investment to supplement GNWT funding to implement two projects identified within the Continuing Care Services Action Plan and which support the achievement of the GNWT Mandate and DHSS Strategic Plan: 1) Implementation of International Resident Assessment Instrument (interRAI) tools; and, 2) introduction of the Paid Family/Community Caregiving Option Pilot.
Activity 1 - InterRAI Assessment Tool Project (FY 2017-18 - 20-2022)
A priority of the Continuing Care Services Action Plan is to implement the International Resident Assessment Instrument (interRAI) throughout the NWT, across all Continuing Care programs, facilities and processes. InterRAI is an internationally-researched and recognized set of clinical assessment instruments compatible across multiple health care sectors. These tools are widely regarded as a best practice assessment tool, particularly in home care and continuing care service delivery areas. They are in use in many Canadian jurisdictions and have been accepted as the national standard and form the basis of the Canadian Institute for Health Information (CIHI)’s Home Care Reporting System (HCRS), a key source of system level information aimed at supporting front-line care planning and quality improvement, and funding and accountability at the management and policy-making levels.
CIHI supports interRAI assessment instruments designed for specific sectors of the health care environment. We aim to implement three of these assessment instruments into Continuing Care Service areas:
- interRAI-Home Care (HC);
- interRAI–Long Term Care (LTCF); and,
- interRAI–Contact Assessment (CA) for Home Care.
Implementing the interRAI tools across Continuing Care settings will directly support improved access and service delivery of home and community services by ensuring that HCC services are allocated to individuals based on their assessed care needs, and that the amount and quality of HCC services they receive are meeting their needs so as to avoid admission into LTC for as long as possible. Implementing interRAI within LTC will also ensure that care is being delivered in the correct setting, such that individuals whose care needs can be met within the community are provided the opportunity to return there with the appropriate HCC supports in place.
The GNWT developed a business case in 2016-17, including an implementation strategy and estimated budget, to support implementation of interRAI within the Continuing Care Services areas of HCC and LTC facilities in NWT. The plan is to implement interRAI in a phased approach, building upon the lessons learned through an implementation evaluation process. Implementation planning is currently occurring and will continue into 2018-19, with procurement occurring in 2018-19. Training and implementation of interRAI in HCC services scheduled to begin in 2019-20 and be completed in 2020-21. Funds from this initiative will be used in collaboration with GNWT investments to support the costs associated with a project team that will interface and directly support HCC service providers as they lead the planning, training and deployment of the tools in the HCC service area.
When implemented, inter-RAI will facilitate consistent evidence-based assessment and care planning for HCC clients, allow for the timely communication of pertinent client data and information between service providers across the continuum of care, and assist in decisions regarding effective resource utilization. This is of particular importance in small remote communities where limited resources are available but the disparities in health are high and linked to overall Indigenous health and wellness.
The GNWT currently does not use InterRAI, nor does it submit data to the HCRS, resulting in a limited understanding of the overall HCC care needs of NWT residents, how our current HCC resources are addressing these needs, and if we are adequately resourced to effectively support seniors to age in place in community. Implementing InterRAI will allow the DHSS to report data to the CIHI-HCRS, allowing for improved monitoring, reporting and evaluation through access to primary and secondary data. This will improve the ability of the GNWT to distribute and utilize HCC resources with the aim of reducing adverse client outcomes through improved matching of resources to needs of our home care clients. It will also help to validate when long term care admissions are required.
The initiative aligns with the activities in the Common Statement of Principles for Shared Health Priorities by:
- spreading and scaling evidence-based models of home and community care that are more integrated and connected with primary health care; and,
- enhancing home care infrastructure, such as digital connectivity, remote monitoring technology and facilities for community-based service delivery.
Activity 2 - Paid Family/Community Caregiving Option Pilot (FY 2017-18 - 20-2021)
The GNWT has identified a need for more options to support the unmet care needs of seniors, adults with disabilities, and their caregivers across the NWT. The Action Plan includes work related to developing and implementing a Paid/Family/Community Caregiver Program that will provide individuals with an option to meet their unmet care needs and access home supports currently not available to them through the traditional HCC program due to limited resources and/or scope of service providers. This option would operate under the applicable components of the NWT Continuing Care Standards (2015) in relation to Home and Community Care operations to ensure quality and appropriateness of client services.
Over the next several months, DHSS will be working on program development and learning from the experience of other jurisdictions. Newfoundland & Labrador and Nova Scotia, along with other Canadian jurisdictions, have introduced similar funding models that provide eligible individuals with the option to either directly manage an individualized funding budget and employ caregiver(s) of their choosing to meet their care needs (self-managed care), or choose a caregiver(s) who will work with HCC and existing family caregivers to meet care needs that cannot be met by the public system (paid caregiver).
These program options provide individuals with choice about who cares for them, and with flexibility to meet their care needs while reducing administrative burden. By addressing unmet care needs, existing family caregiving relationships are preserved and supported. Implementing this type of program is of particular significance in small Indigenous communities where HCC resources are limited, connection to family is strong, and access to increased community-based services will help the individual remain living safely in their community.
The second year of funding will involve a limited pilot implementation and data collection phase. This will provide HSS with an opportunity to better understand any policy or program barriers and will also provide an opportunity for individuals who participate in the pilot to provide some direct feedback on how the program meets their expectations and care needs. The third year of funding will be used to expand the pilot project to additional locations, informed by the initial implementation evaluation. Funding in year four will support the roll-out of the core program across the NWT. In summary:
- Year 1 – program development
- Year 2 – limited pilot implementation and data gathering
- Year 3 – pilot expansion based on the results of the implementation evaluation
- Year 4 – core program roll-out
Implementing a Paid Caregiver program will help support the GNWT’s strategic framework for Aging in place, by ensuring an individual’s care needs are met in their home setting while increasing caregiver supports. This also aligns with both the GNWT Action Plan and Common Statement of Principles for Shared Health Priorities by:
- increasing support for caregivers; and,
- spreading and scaling evidence-based models of home and community care that are more integrated and connected with primary health care.
The following table outlines the funding allocation for interRAI Assessment Tool and the Paid Family/Community Caregiver initiative:
Allocation of Health Accord Funding – Home and Community Care
|Funding Breakdown by Initiative||2017-18Table 4 Footnote *||2018-19Table 4 Footnote **||2019-20||2020-21||2021-22||Total|
|interRAI Assessment Tool
Human Resources -project team
|Paid Family/Community Caregiver
Human Resources –
Project Coordination and administration
A monitoring and evaluation plan for the interRAI and Paid Caregiver Pilot will be developed and implemented during the 2018-2019 fiscal year as part of the project planning phase. This plan will focus on qualitatively and quantitatively measuring progress, as well as provide ongoing information that allows the projects to be successfully managed and adjusted as needed. The monitoring and evaluation plan will focus on jurisdiction-specific indicators and align with the cross-jurisdiction indicators developed with CIHI.
The GNWT will be participating in the development of common indicators that will measure improvements in access to home and community care services. Having a set of common indicators will help to reduce “indicator chaos” in the health system by working with partners to identify which health indicators are most important, how they relate to each other, and how they can best support improvements to home and community care programs and services, as well as the overall health of Canadians.
The GNWT presently has an agreement with CIHI to share data and understands the value of inter-RAI as a clinical decision and provision tool that also has a robust data management and reporting ability.
While the NWT does not currently have a systematic method of collecting and reporting on HCC, there is commitment to work with CIHI on the development of national indicators. The NWT has nominated a representative to participate on the CIHI led initiative towards the development of common indicators.
Summary of Expected Results
Home and Community Care
|Initiatives||Outputs||Output Indicators||Outcomes||Outcome Indicators||Target by 2021|
interRAI Assessment Tool Project
interRAI is implemented in Home and Community Care and Long-term Care facilities throughout the NWT:
Access to standardized primary and secondary data to inform clinical, administrative, and policy decision making
# of communities that are using interRAI – HC and CA
Enhanced distribution and utilization of Home and Community Care resources
interRAI system use is sustained
Length of time between client assessment and allocation of resources
Reporting on HCC indicators to CIHI to monitor quality of care
Number of palliative deaths in community
# of HCC clients admitted to long-term care
Number of providers trained and using interRAI
interRAI data and information is used by decision makers in the allocation of HCC resources
interRAI system is implemented to support access to standardized primary and secondary data to inform clinical, administrative, and policy decision making
Paid Family/Community Caregiver model
Paid family/community caregiver model is piloted in target communities in the NWT
Paid family/community caregiver model pilot is evaluated
Paid family/community caregiver model is available in communities throughout the NWT
# of HCC clients participating in the Paid Family and Community Caregiver pilot
# of HCC clients benefitting from additional support
# of caregivers benefitting from additional support
# of individuals accessing the Paid Family and Community Caregiver program
Family/Community remain a key component for client care
Ensure quality and the appropriateness of client services
Increased flexibility for clients to meet their care needs
Clients are able to stay in their home rather than go to a long-term care
Number of HCC clients that have family caregivers engaged in their care.
Perception of HCC clients who feel that the funding model has improved their quality of life
Trend in average level of care needs on admittance into long-term care facilities
Trend in average age of admittance into long-term care facilities
Paid Family/Community Caregiver model has been evaluated and implemented in 50% of the NWT
- Footnote 1
NWT Bureau of Statistics. (2017). Population Estimates by Community. Retrieved from: www.statsnwt.ca/population/population-estimates/bycommunity.php
- Footnote 2
Government of the Northwest Territories (2017). Mandate of the Government of the Northwest Territories 2016-2019 - Revised. Retrieved from: http://www.assembly.gov.nt.ca/sites/default/files/td_19-183_0.pdf
- Footnote 3
Department of Health and Social Services (2017). Caring for Our People Strategic Plan for the NWT Health and Social Services System 2017 to 2020. Retrieved from: www.hss.gov.nt.ca/sites/www.hss.gov.nt.ca/files/resources/caring-our-people-strategic-plan-2017-2020.pdf
- Footnote 4
Statistics Canada (2015-2016). Canadian health characteristics, two year period estimates, by age group and sex, Canada, provinces, territories, and health regions, Cansim Table 105-0509. Retrieved from: http://www5.statcan.gc.ca/cansim/a47.
- Footnote 5
NWT 2011-2015 average, 2013 Canada, NWT Department of Health, NWT Coroner’s Office, and Social Services and Statistics Canada);
- Footnote 6
Canadian Institute for Health Information.
- Footnote 7
NWT rate reflects the 2012/13-16/17 average; sources include NWT Department of Health and Social Services, Canadian Institute for Health Information, and Statistics Canada. Canadian rate reflects 2014/15 – source: Canadian Institute for Health Information).
- Footnote 8
Canadian Institute for Health Information. (2017). Alcohol Harm in Canada Examining Hospitalizations Entirely Caused by Alcohol and Strategies to Reduce Alcohol Harm. Retrieved from: https://www.cihi.ca/sites/default/files/document/report-alcohol-hospitalizations-en-web.pdf
- Footnote 9
Department of Health and Social Services. (2012). NWT Report on Substance Use and Addiction. Retrieved from: http://www.hss.gov.nt.ca/sites/www.hss.gov.nt.ca/files/report-on-substance-use-and-addiction-2012.pdf
- Footnote 10
Statistics Canada. (2016). The Chief Public Health Officer's Report on the State of Public Health in Canada 2016 - A Focus on Family Violence in Canada. Retrieved from: https://www.canada.ca/en/public-health/services/publications/chief-public-health-officer-reports-state-public-health-canada/2016-focus-family-violence-canada.html
- Footnote 11
Centre for Addiction and Mental Health.(2012). Mental Health Promotion. Retrieved from: http://en.healthnexus.ca/sites/en.healthnexus.ca/files/u4/definitionsofmhpvsmip.pdf.
- Footnote 12
Northwest Territories Long-Term Care Program Review Final Report (2015), Department of Health and Social Services.
- Footnote 13
Northwest Territories Health Status Report (2011). Department of Health and Social Services.
- Footnote 14
Caring for our People, Strategic Plan for the NWT Health and Social Services System (2016). Department of Health and Social Services.
- Footnote 15
Northwest Territories Health Status Report (2011). Department of Health and Social Services.
- Footnote 16
Caring for our People, Strategic Plan for the NWT Health and Social Services System (2016). Department of Health and Social Services.
- Footnote 17
NWT Hospitalization Report (2013). Department of Health and Social Services.
- Footnote 18
Northwest Territories Long-Term Care Program Review Final Report (2015), Department of Health and Social Services,
- Footnote 19
This indicator measures reach of interRAI and is calculated by dividing the number of seniors and elders assessed with the interRAI assessment instrument by the total number of senior and elders in home and community care.
- Footnote 20
This indicator measures reach of interRAI and is calculated by dividing the number of residents assessed with the interRAI assessment instrument by the total number of residents who were in a facility and were admitted, assessed or discharged.
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