Canada-Northwest Territories Home and Community Care and Mental Health and Addictions Services Funding Agreement

Table of Contents

Funding Agreement

BETWEEN:

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”)

- and -

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”

PREAMBLE

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;

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.

WHEREAS, since March 2020, Canada has been in the midst of the COVID-19 global pandemic, which has disproportionately affected Canadians living in supportive care settings in the community, namely long-term care facilities, assisted living facilities, and seniors’ residences where they receive continuing care services (hereinafter referred to as long-term care settings), and which is requiring provinces and territories to put in place stronger measures to reduce the risk of harm to residents of these facilities;

WHEREAS, the Government of Canada announced an investment of $19 billion to help provinces and territories to safely restart their economies and make Canada more resilient to possible future surges in cases of COVID-19, of which $740M is to support provinces and territories through 2020-21 with one-time investments for infection prevention and control, including in long-term care settings;

WHEREAS, on November 30, 2020, the Government of Canada committed to a further investment of $1 billion to support provinces and territories to protect residents in long-term care settings, given the continued serious risk to health of these vulnerable Canadians;

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 to protect residents in long-term care settings through increased infection prevention and control measures and in keeping with performance measurements and reporting commitments;

AND WHEREAS, the Minister of Health and Social Services authorizes the provincial Minister to enter into agreements with the Government of Canada under which Canada undertakes to provide Safe Long-term Care Funding toward expenditures incurred by the Northwest Territories for activities to protect residents in long-term care settings through increased infection prevention and control measures;

NOW THEREFORE, Canada and the Northwest Territories agree as follows:

1.0 Objectives

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).

1.2 Further, Canada and the Northwest Territories commit to work together to improve access to safe care through increased infection prevention and control in long-term care settings.

2.0 Action Plan

2.1 The Northwest Territories will invest federal funding for Home and Community Care and Mental Health and Addictions Services 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.

2.3 The Northwest Territories will invest the federal Safe Long-term Care Funding provided under this Agreement on infection prevention and control activities in long-term care settings in each of the following three areas:

  • Retention measures for existing staff, including wage top-ups, and/or hiring of additional human resources (e.g. personal support workers, licensed practical nurses, cleaners);
  • new infrastructure and renovations to existing infrastructure, such as ventilation of self-isolation rooms and single rooms; and,
  • readiness assessments conducted in long-term care settings to prevent COVID infections and spread.

2.4 In addition, the Northwest Territories may also invest the federal Safe Long-term Care Funding through this Agreement on infection prevention and control activities in long-term care settings in one or more of the following areas:

  • Strengthened infection prevention and control measures and training for existing staff;
  • adequate supply of personal protective equipment for staff and visitors;
  • rapid training programs to increase the number of supportive care workers, including training for students and workers from other sectors;
  • enhanced screening and regular testing of staff and visitors to quickly detect, prevent or limit spread; and,
  • additional inspectors and infection prevention and control specialists to support in-person inspections of all facilities, as well as accreditation costs associated with meeting long-term care standards.

2.5 The Northwest Territories’ approach to achieving the objective of the Safe Long-term Care Funding, as set out in section 1.2, in the areas identified above, is set out in Annex 2, as amended.

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 Subject to sections 4.4 and 4.5, the Safe Long-term Care Funding provided under this Agreement may be used by the Northwest Territories for expenditures that are incurred from December 1, 2020, to March 31, 2022.

3.2.2 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.

3.2.3 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

  1. $600 million for the Fiscal Year beginning on April 1, 2018
  2. $650 million for the Fiscal Year beginning on April 1, 2019
  3. $650 million for the Fiscal Year beginning on April 1, 2020
  4. $900 million for the Fiscal Year beginning on April 1, 2021

Mental Health and Addictions Services

  1. $250 million for the Fiscal Year beginning on April 1, 2018
  2. $450 million for the Fiscal Year beginning on April 1, 2019
  3. $600 million for the Fiscal Year beginning on April 1, 2020
  4. $600 million for the Fiscal Year beginning on April 1, 2021

Safe Long-term Care

  1. $1 billion for the Fiscal Year beginning on April 1, 2021

4.2.3 For Home and Community Care and Mental Health and Addictions Services, 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 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.

For Safe Long-term Care, annual funding will be allocated to provinces and territories with a base amount of $2,000,000 for each province and territory, and the remainder of the fund allocated on a per capita basis, for each Fiscal Year that an agreement is in place. The total amount to be paid to Northwest Territories will be calculated using the following formula: $2,000,000+ (F- (N x 2,000,000)) x (K/L), where:

  • F is the total one-time funding amount available under this initiative;
  • N is the number of jurisdictions (all 13) that will be provided the base funding of $2,000,000;
  • K is the total population of a particular province or territory, as determined using the 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 formulas 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)
2018-2019 $730,000 $300,000
2019-2020 $790,000 $550,000
2020-2021 $790,000 $730,000
2021-2022 $1,090,000 $730,000
Table 1 Footnote *

Amounts represent annual estimates based on Census 2017 population

Return to table 1 footnote * referrer

4.2.6 Subject to annual adjustment based on the formulas described in subsection 4.2.3, the Northwest Territories’ estimated share of the amounts will be:

Fiscal Year Safe Long-Term Care
Estimated amount to be paid to the Northwest TerritoriesFootnote * (subject to annual adjustment)
2021-2022 $3,157,388
Table 3 Footnote *

For Home and Community Care and Mental Health and Addictions Services, amounts represent annual estimates based on StatCan 2017 population. For Safe Long-term Care Funding, amounts represent annual estimates based on StatCan 2020 population.

Return to table 3 footnote * referrer

4.3 Payment

4.3.1 Canada’s contribution for Home and Community Care and Mental Health and Addictions Services will be paid in approximately equal semi-annual installments as follows:

  1. 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.
  2. 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.
  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.
  4. 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.
  5. 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
  6. 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.
  7. 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.

4.3.2 Canada’s contribution for Safe Long-term Care will be paid in approximately equal semi-annual installments as follows:

  1. The first installment will be paid within 30 days of Canada’s acceptance of the Northwest Territories’ proposed approach and initiatives for the use of the Safe Long-term Care Funding, as set out in Annex 2.
  2. The second installment will be paid on or about December 15, 2021, following the Northwest Territories’ fulfillment of the obligations identified in subsection 5.1.2, and amendment of Annex 2 in accordance with subsection 5.1.3.

4.3.3 Where the Northwest Territories fails to put in place a cost-recovery agreement as required pursuant to section 4.8, Canada shall deduct from the payment referred to in subsection 4.3.2(b) an amount equivalent to the amount of funding provided by the Northwest Territories to those facilities with whom they do not have the required cost-recovery agreements in place.

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 and 4.2.6. 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 and 4.2.6. 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.

4.7.2 Canada and the Northwest Territories agree that amounts paid to the Northwest Territories under the Safe Long-term Care Fund may be provided by the Northwest Territories to:

  • Publicly-owned long-term care settings;
  • privately-owned not-for-profit long-term care settings; and,
  • subject to section 4.8, privately-owned for-profit long-term care settings.

4.8 Cost Recovery

4.8.1 Where the Northwest Territories provides Safe Long-term Care Funding to privately-owned, for-profit facilities in accordance with this Agreement, the Northwest Territories agrees to put in place cost-recovery agreements with these facilities and report on these agreements through amendments to Annex 2 by no later than December 1, 2021 in accordance with the requirements set out in subsection 5.1.3

4.8.2 Where the Northwest Territories has cost-recovery agreements in place with one or more privately-owned for-profit facilities pursuant to subsection 4.8.1, the Northwest Territories agrees to invest all funds recovered through those agreements in accordance with the terms of this Agreement and the initiatives outlined in Annex 2.

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.

  1. 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: 

  1. 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.
  2. 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):
    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 mental health and addictions programs and services;
    3. If applicable, the amount of any amount carried forward by the Northwest Territories under section 4.4; and
    4. If applicable, the amount of any surplus funds that is to be repaid to Canada under section 4.5.
  3. For the Safe Long-term Care Funding, the annual financial statement will also set out, for the previous fiscal year:
    1. The amount of the federal funding flowing to each facility, and the type of facility (as set out in 4.7.2);
    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; and

5.1.3 As a condition of receiving the second payment installment of the Safe Long-term Care Funding, the Northwest Territories agrees to, by no later than December 1, 2021, amend Annex 2 to:

  1. Provide up-to-date information on performance measures, targets and intended outcomes for the three areas identified in section 2.3, and for any other areas in which the Northwest Territories has used Safe Long-term Care Funding to support infection prevention and control, and interim results for each initiative.
  2. Provide a breakdown of the facilities receiving funding under this Agreement, and specifically, identifying those privately-owned, for-profit facilities receiving funding pursuant to this Agreement and whether or not cost-recovery agreements are in place with them with respect to this funding;
  3. Indicate the amount paid to each recipient operating a privately-owned, for-profit facility and describe the incremental impact that will be achieved through these investments;
  4. Provide information on the estimated amount of funding to be recovered pursuant to the cost-recovery agreements; and,
  5. Indicate how the Northwest Territories will use recovered funding to increase infection prevention and control pursuant to the terms of this Agreement.

5.1.4 The Northwest Territories also agrees to amend Annex 2, by March 31, 2022, to report, in accordance with the performance measures set out in Annex 2, on the outcomes and results achieved using the Safe Long-term Care Funding.

5.2 Audit

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 Evaluation

5.3.1 Responsibility for evaluation of programs rests with the Northwest Territories in accordance with its own evaluation policies and practices. 

6.0 Communications

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 and the Northwest Territories shall make the results under this Agreement related to the Safe Long-term Care Funding, as set out in Annex 2, publicly available on its Government of Northwest Territories 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 and 5.1.3, 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, Safe Long-term Care Funding 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, Safe Long-term Care Funding, 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, Safe Long-term Care Funding 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, Safe Long-term Care Funding, 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. 

10.0 Termination

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.

11.0 Notice

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:

Health Canada
70 Colombine Driveway
Brooke Claxton Building
Ottawa, Ontario
K1A 0K9

Email: marcel.saulnier@canada.ca

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
Yellowknife, NWT
X1A 2L9

Email: bruce_cooper@gov.nt.ca

12.0 General

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

A Common Statement of Principles on Shared Health Priorities

Annex 2 to the Agreement

Northwest Territories' Action Plan on Mental Health and Addiction Services and Home and Community Care

Introduction

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:

1. Prevention

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.

2. Intervention

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.

3. Postvention

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:
  • Compensation
$123,000 $270,000 $275,000 $275,000 $275,000 $1,218,000
Prevention   - $25,000 $225,000 $225,000 $475,000
Postvention:   $30,000 $70,000 $50,000 $50,000 $200,000
Postvention:   - $180,000 $180,000 $180,000 $540,000
Total $123,000 $300,000 $550,000 $730,000 $730,000 $2,433,000
Table 2 Footnote *

Funding already provided through legislation.

Return to table 2 footnote * referrer

Table 2 Footnote **

The budgeted amount for these areas will need to be flexible as bilateral funding is adjusted based on annual population estimates.

Return to table 2 footnote ** referrer

Performance Measurement

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:

  • Common suicide risk assessment tool
  • Stepped care model of service provision

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.

Established protocols

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
$250,000 $530,000 $590,000 $590,000 $795,000 $2,755,000
Paid Family/Community Caregiver
Human Resources –
Project Coordination and administration
- $200,000 $200,000 $200,000 $290,000 $890,000
Total $250,000 $730,000 $790,000 $790,000 $1,085,000 $3,645,000
Table 4 Footnote *

Funding already provided through legislation.

Return to table 4 footnote * referrer

Table 4 Footnote **

The budgeted amount for these areas will need to be flexible as bilateral funding is adjusted based on annual population estimates.

Return to table 4 footnote ** referrer

Performance Measurement

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
# of long-term care facilities that are using interRAI - LTC
# of HSS and NTHSSA homecare  and LTC staff that have completed interRAI training
% of seniors and elders assessed in home and community careFootnote 19
% of residents assessed in continuing care facilitiesFootnote 20

Enhanced distribution and utilization of Home and Community Care resources
Allocation of resources meets the needs of home care clients

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

Northwest Territories Action Plan - Safe Long-term Care Fund

Introduction

Seniors and elders (60 years and older) are the fastest growing demographic in the NWT, the greatest growth projected in the 75 years and older population. They are projected to make up over 20% of our territory’s population by 2035. As is the case across most of Canada, this rise in the age of this population intersects with rising rates of chronic disease diagnosis within the NWT. The majority of the prevalence of chronic health conditions occurs in those aged 60 and older. As chronic health conditions advance and the individual’s functional independence often declines, they will rely on community level supports.  When these supports are not adequate at the community level and an individual’s chronic health conditions or frailty result in care needs that exceed family and community capacity, application to Long-Term Care (LTC) is considered.

LTC is defined as a range of facility-based services that address the health, social and personal care needs of individuals who have reduced or no capacity for self-care. LTC facilities in the Northwest Territories (NWT) are designed for people with Levels 3, 4 and 5 care needs who require professional nursing services and continuing medical supervision 24 hours a day. Levels 3 and 4 include people who may not be able to get around on their own, who need complex medical support, or might be at risk of harm because of their condition. Level 5 care is available to those clients with the highest and most complex care needs and who are considered at high risk of injury to self or others.

There are 9 regional LTC facilities in the NWT and all of these LTC beds are publically funded and operated by the Government of the NWT (GNWT) or are operated on behalf of the GNWT. Compliance with the Department of Health and Social Services (Department) Continuing Care Standards is required by all operators of LTC facilities. At present this is monitored through management reporting and accreditation.  Admission into all LTC beds in the NWT is determined through a single point of application whereby The Territorial Admissions Committee reviews all applications to LTC to determine eligibility.  In the NWT, from April 1, 2020 to March 31, 2021 a total of 214 individuals accessed LTC in the NWT. 93% of the 214 LTC residents were over the age of 60, and 64% of the total 214 residents were indigenous, with the majority being male (64%).

The Department is implementing the International Resident Assessment Instrument (interRAI) assessments for LTC and HCC within an online, paperless Continuing Care Information System (CCIS).  interRAI is an internationally recognized, evidence-based assessment system that is used by provincial / territorial jurisdictions across Canada within LTC and home and community care.  Given the increasing demand for LTC and home and community care services with an aging population, it will be important to ensure we are providing care according to assessed care needs. Implementing interRAI will allow LTC and home and community care programs to allocate resources to address the needs of each individual client and monitor the outcome of these services. interRAI assessment tools will enable the Department to capture, record, and analyze clinical, demographic, and administrative and resource utilization data of home and community care and LTC clients at the client, community, facility, regional and territorial levels. Overall the CCIS will provide screening tools, care planning and scheduling templates, and other elements essential to meet the Department’s strategic objectives and NWT Program Standards.

The Mandate of the Government of the Northwest Territories 2019-2023 outlines the 22 priorities of the 19th Legislative Assembly. One of the priorities within the Mandate is to “Enable Seniors to Age in Place with Dignity”. In order to meet our goal of aging in place with dignity, the GNWT has committed to focusing on improving key service areas including housing, financial and income supports, accessible community infrastructure (including LTC), and prevention of elder abuse. It is important that the GNWT has the right mix of programs and services in place to support seniors and elders now and into the future.  The planned initiatives through the Safe Long-term Care (Safe LTC) fund will further assist and support the GNWT in achieving the objectives, specifically now during a changing workplace environment during COVID-19 pandemic response and is expected to continue to evolve in the future.

Another priority of the 19th Legislative Assembly Mandate is to increase the resident workforce in the NWT.  With an ever-increasing demand for health and social services professionals, a need for decreased employee turnover and increased continuity of care in NWT communities, and the Legislative Assembly mandate of increased resident health and social services workers in the Northwest Territories, there is a greater need than ever for a strong, capable resident health and social services workforce. To achieve this vision requires the development and support of the Indigenous and Northern population into careers within the health and social services professions. This will help address current and future demand within the HSS System, and support a more representative workforce for safe care to Indigenous and Northern populations.  This is especially important to support the staffing of the long term care facilities with community staff trained in the north who are best-placed to respond to the needs of our Elders, and to increase the ability to deliver culturally safe and appropriate services and care.

I. Overview

The COVID-19 pandemic has required a significant coordinated response by the Department and the Health and Social Services Authorities, which stood up and continue to lead a Continuing Care COVID-19 Working Group with managers of all the LTC facilities and home care programs in the NWT.  Common COVID-19 pandemic response policy is established by the Health and Social Services Authorities based on Public Health Orders and the Department’s Outbreak Management of COVID-19 in LTC facilities guidelines, and communicated to the operational managers via this Working Group, including requirements for enhanced Infection Prevention and Control (IPAC) practices. The IPAC teams have been struggling to respond to the needs of the pandemic while re-establishing the Territorial IPAC program. The Territorial program was established in 2012, however since that time a lack of trained IPAC professionals have limited the ability of the program to move forward.

Personal Protective Equipment (PPE) and IPAC supplies remain a crucial component of protecting frontline healthcare workers and ensuring effective IPAC measures across the health and social services system. A continuous masking policy was implemented in LTC facilities in April of 2020, which requires all staff and essential visitors at all facilities to wear medical masks, which have significantly increased burn rates. PPE stockpiling has been identified globally as an important procurement strategy to ensure health care systems are adequately prepared for changes in the level of response for the pandemic, or any future pandemics or outbreaks that may follow. This is being achieved centrally by the Health and Social Services Authorities, and all NWT LTC facilities have access to required PPE to meet current IPAC policies.

In order to meet the pandemic urgency a range of medical equipment purchases are required to strengthen available resources in the system. The additional need for medical equipment is currently being managed through repurposing, extending service life, leasing, borrowing, and purchasing.

A recent report released by the Canadian Foundation for Healthcare Improvement (CFHI) (now Healthcare Excellence Canada), “Reimagining Care for Older Adults: Next Steps in COVID-19 Response in Long-Term Care and Retirement Homes”, includes several recommendations that are being considered in ongoing LTC pandemic response planning for the Health and Social Services System. Relevant recommendations for the NWT relate to sufficient surge capacity, and single site staffing.  The need for surge capacity staffing for LTC facilities was identified in the NWT Pandemic Response Plan. This includes increased Personal Support Worker (PSW) and Licensed Practical Nurse (LPN) positions within LTC settings. Addressing these priority areas has presented additional costs for the Health and Social Services System, which has been covered through the Safe Restart funding.  However, there are a number challenges affecting the HSS System and its workforce to ensure necessary staff are available post-pandemic, including underrepresentation of Indigenous peoples within the HSS System, broad geographic distribution of communities, with limited year-round access to many communities, remoteness of the Northwest Territories presents hiring and recruitment challenges; and limited housing options in some communities.  To address some of these challenges the Department is partnering with Aurora College to meet the staffing needs of new long-term care facilities across the territory, through creative solutions such as modification and expansion of existing Personal Support Worker (PSW) and Practical Nurse (PN) programs, by increasing program delivery options including new approaches to distance education.

Therefore it is important that a consistent and standardized approach to IPAC measures occurs across all NWT LTC facilities. To date, some measures have already been undertaken with existing resources and the Safe Restart funding within the primary areas of focus including:

  • Additional Nursing, Personal Support Workers and Residential Care Aides per shift;
  • Ongoing IPAC auditing and training for staff;
  • Implementation of a standardized hand hygiene program;
  • Increased housekeeping personnel for additional cleaning and laundry;
  • Increased management time for PPE coordination and housekeeping duties;
  • Establishment and ongoing monitoring of screening stations (e.g. temperature monitoring) for all staff and visitors;
  • Establishment and ongoing monitoring of visitor restrictions (e.g. communications, administration)
  • Purchasing of additional supplies such as PPE, cleaning supplies, monitoring/screening devices, and signage; and
  • Installation and upkeep of handwashing stations for staff due to segregated entry requirements.

II. Areas of Focus

Even with the efforts that have been underway in the NWT to ensure a consistent approach to IPAC across all facilities, there continues to be shortfalls which can significantly impact the quality of care and outcomes for our residents in LTC.

Like many jurisdictions, the NWT is not immune to aging infrastructure and equipment that support our elders in LTC. Mobile medical equipment that moves from room to room, such as vital sign monitors and resident lifts, also contain high touch surfaces and have been found to increase the likelihood of spread of viruses such as those that cause COVID-19.  Ideally some resident care equipment should be dedicated to an individual resident, however this is not always possible depending in the type of equipment and individual resident care needs.  Increasing our complement of mobile equipment will reduce the risk of transmission of communicable diseases by reducing the frequency of room to room movement.

Other types of equipment that are communal, such as medication fridges, or have a high tendency for exposure to bodily fluids, such as resident beds, are also nearing or past end of life in older LTC facilities in the NWT.  Replacing these older ‘high touch’ devices with new equipment that will provide a ‘home-like’ feel for residents while withstanding rigorous cleaning procedures will contribute both to resident experience and improved IPAC within the facilities.

Prior to the amalgamation of health regions and facilities in the NWT, each location had individual IPAC policies and procedures, sometimes based on current best practices, but most times based on the out dated 2012 NWT Infection Prevention and Control Manual.  The NWT IPAC team identified this significant gap in the provision of care to elders across the Territory and had a goal of eliminating this gap and ensuring all residents are treated equitably through the standardizing of IPAC of policies and procedures. Unfortunately, in 2020 every last IPAC resource was completely dedicated to the NWT response to COVID.  The lack of current, standardized IPAC policies and procedures places all residents in LTC at risk of harm.

The NWT will address these shortfalls with the Safe LTC Fund. Our areas of focus for the Safe LTC Funding will strengthen IPAC measures within our LTC facilities through: targeted improvements in facility equipment (which includes replacing worn-out existing equipment and the purchase of additional equipment to better meet IPAC standards and reduce the risk of disease transmission); revising and standardizing IPAC policies and procedures for NWT LTC facilities; and, staffing costs for increased direct care to LTC residents.

III. Initiatives

The funding from the Safe LTC initiative will be incremental in supporting the ongoing quality and safety of residents and staff in NWT LTC facilities.

1. Medical Equipment Increase and Replacement

While the medical equipment requirements within these facilities have been met in part by the measures described in the Overview section, additional investment in two specific areas would improve equipment-related IPAC procedures within the facilities:

  • Procuring additional ‘mobile’ equipment including basic diagnostic and therapeutic devices (such as vital sign monitors and oxygen concentrators) and resident transfer and handling devices (such as shower chairs and patient lifts and slings) to reduce room to room movement of this equipment and therefore transmission risk.
  • Replacing near- and past- end of life ‘high touch’ equipment (such as resident beds, medication carts, and medication fridges) with new equipment that will provide more of a ‘home-like’ feel for residents while withstanding rigorous cleaning procedures.

Planned activities include:

  1. Requirements validation (April – September 2021): site assessments will be performed to validate the information contained in the biomedical equipment database.
  2. Planning (June – September 2021): an equipment procurement plan will be drafted based on the confirmed priorities for replacement at each site.
  3. Procurement (Sept – Jan 2022): equipment will be procured through several different procurement exercises to meet the requirements outlined in the plan.
  4. Implementation (Jan – Mar 2022): equipment will be installed and commissioned on site and old equipment that has been replaced will be removed from site and managed through the HSSAs’ Biomedical Engineering health technology retirement procedure.

2. IPAC Policy Creation- Revision and Standardization of IPAC policies and procedures:

The revision and standardization of the policies and procedures across the NWT based on current IPAC Canada standards will ensure all residents in the NWT are kept free from harm related to the possible transmission of infectious diseases.  An IPAC Consultant or Coordinator will be hired to ensure there are adequate resources in place to support the development of the IPAC LTC policies and procedures.

Planned activities include:

  1. Updated Assessment (April – May 2021): Building on the previous work of the team, an IPAC Consultant/Coordinator will be hired to complete a SWOT analysis and identify the gaps in the current system.
  2. Planning (June – July 2021): an action plan will be developed based on the SWOT to ensure all IPAC LTC policies and procedures are updated and risks are mitigated. Policy and Procedure development will be done based on a risk mitigation strategy where the higher risk of harm to elder policies will be updated or developed first.
  3. Draft (August 2021- December 2021): IPAC Consultant/Coordinator will develop and update drafts of all IPAC policies and procedures.
  4. Approval (August 2021 – December 2021):  Policies and Procedures will be submitted for approval as they are written to ensure any outstanding risks are mitigated.
  5. Implementation (Aug 2021– Mar 2022): Once the policies are approved, they will be implemented on an ongoing basis and then as a complete package by February 2022.

3. Increased Direct Care Staffing:

Long-Term Care (LTC) facilities across the country have faced critical staffing shortages since the onset of the pandemic, impacting the quality of resident care and employee safety. Increasing the number of direct care staff in NWT facilities will strengthen human resource capacity to improve resiliency in the event of an outbreak.

Enhanced IPAC practices, such as daily temperature checks for both residents and staff have been in place in NWT LTC facilities since the onset of the pandemic. When risk increases within the territory or at the community level, all group activities for LTC residents are postponed and visitors are no longer permitted at the facilities. These factors have also increased the demands on LTC staff and driven the need for additional resources.

The ability for the NWT healthcare system to mobilize and maximize staff resources is one of the key principles of the Northwest Territories Health and Social Services Authorities’ COVID-19 Response Team’s Pandemic Response Plan for Health Services. This includes adding additional staff resources as required, ensuring all staff can work the maximum scope or in an expanded role such as granting temporary licensure for graduate nurses, or requiring staff to work overtime.

To address the increased risks in LTC the Department has increased staffing at each of the nine facilities within the territory. Two additional Licensed Practical Nurse (LPN) and Residential Care Aide (RCA) positions have been added to each LTC facility (i.e. 18 positions) at an anticipated cost of up to $2.8 million in 2021-22. The plan is to allocate some of the Safe Long Term Care  funds offset these costs in 2021-22, while ongoing needs for increased LTC staffing are assessed as part of post pandemic resource planning.

IV. Funding Allocation Table

Funding Allocation Table
Total funding to Northwest Territories $3,200,000
2020-21 2021-22 Total
Medical Equipment Increase and Replacement - $1,500,000 $1,500,000
IPAC Policy Creation - $200,000 $200,000
Increased Direct Care Staffing - $1,500,000 $1,500,000
$3,200,000

V. Breakdown of facilities and cost recovery

Support provided to facilities by category
Number of Facilities 2020-21 2021-22 Total
Funding for publicly funded facilities/residences 9 - 9 9
Funding for private not-for profit facilities 0 - 0 0
Funding for private for-profit facilities 0 - 0 0

VI. Performance Measurement and Expected Results

The collection of performance measures and the continued monitoring of these outputs will ensure that LTC and home and community care services are being provided according to the assessed care needs of the population.  Continued follow up and monitoring will ensure that the medical equipment being considered is validated and implemented ensuring patients are transferred and cared for in the safest manner possible. In order to ensure the highest risk areas are addressed, equipment will be validated and the highest needed equipment will be purchased.  It has been determined that given the age of the 9 facilities and previous equipment purchases, only 4 facilities will require equipment upgrades.

Monitoring the implementation and development of IPAC policies and procedures will ensure services are aligned with current best practices.  These performance measurements were chosen to provide a way for the organization to monitor the number of policies that require updating or development and how effectively they are being developed and implemented.  It is anticipated that with the new policies and procedures, patient harm incidents related to IPAC will decrease or at minimum remain unchanged therefore the indicator is linked to incident management.

These initiatives will improve resident care and safety by providing better access to updated equipment and more standardized IPAC policies. Having the availability of more mobile equipment such as vital sign machines will reduce the transmission of communicable diseases among our residents. Replacing equipment that will soon be outdated with newer equipment that has a more home-like feel will increase residents feeling of well-being and allow for more effective cleaning to prevent transmission of communicable diseases. Investing in staffing will provide better capacity to implement IPAC requirements and allow for capacity in circumstances where an outbreak occurs within the community or facility. Monitoring the implementation of additional staff will allow insights into how each increase in staffing influences the provision of care and services, as well as how patient safety across the system will be improved.

Initiatives Performance Measure Target / Outcomes Interim Results (reported by December 1 2021) Results (reported by March 31, 2022)Footnote 1
Initiative 1 – Medical Equipment Increase and Replacement (for the highest priority facilities based on age & condition) 1.1 – % of planned equipment replaced 1.3 – 80%
Initiative 2 – IPAC Policy Creation 2.1 - % of P&P’s drafted compared to the total identified for development
2.2 - % of IPAC related patient harm issues in LTC compared to the total patient hard issues in LTC
2.1 – 100%
2.2 – less than 3%
Initiative 3 – Increased Direct Care Staffing 3.1 – # of LPNs hired (2 per facility)
3.2 – # of RCAs hired (2 per facility)
3.1 – 18 total
3.2 – 18 total
Table 4 Footnote 1

Interim and updated results are to be updated and posted publicly in the Action Plans by December 1, 2021 and March 31, 2022.

Return to table 4 footnote 1 referrer

Footnotes

Footnote 1

NWT Bureau of Statistics. (2017). Population Estimates by Community. Retrieved from: www.statsnwt.ca/population/population-estimates/bycommunity.php

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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

Return to footnote 2 referrer

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

Return to footnote 3 referrer

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.

Return to footnote 4 referrer

Footnote 5

NWT 2011-2015 average, 2013 Canada, NWT Department of Health, NWT Coroner’s Office, and Social Services and Statistics Canada);

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Footnote 6

Canadian Institute for Health Information.

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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).

Return to footnote 7 referrer

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

Return to footnote 8 referrer

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

Return to footnote 9 referrer

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

Return to footnote 10 referrer

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.

Return to footnote 11 referrer

Footnote 12

Northwest Territories Long-Term Care Program Review Final Report (2015), Department of Health and Social Services.

Return to footnote 12 referrer

Footnote 13

Northwest Territories Health Status Report (2011). Department of Health and Social Services.

Return to footnote 13 referrer

Footnote 14

Caring for our People, Strategic Plan for the NWT Health and Social Services System (2016). Department of Health and Social Services.

Return to footnote 14 referrer

Footnote 15

Northwest Territories Health Status Report (2011). Department of Health and Social Services.

Return to footnote 15 referrer

Footnote 16

Caring for our People, Strategic Plan for the NWT Health and Social Services System (2016). Department of Health and Social Services.

Return to footnote 16 referrer

Footnote 17

NWT Hospitalization Report (2013). Department of Health and Social Services.

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Footnote 18

Northwest Territories Long-Term Care Program Review Final Report (2015), Department of Health and Social Services,

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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.

Return to footnote 19 referrer

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.

Return to footnote 20 referrer

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