Canada-Nova Scotia 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 PROVINCE OF NOVA SCOTIA (hereinafter referred to as "Nova Scotia" or "Government of Nova Scotia") as represented by the Minister of Health and Wellness and the Minister of Seniors and Long-Term Care (herein referred to as "the provincial Ministers")

REFERRED to collectively as the "Parties"

PREAMBLE

WHEREAS, on December 23, 2016 Canada and Nova Scotia 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 Nova Scotia 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 Nova Scotia 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, Section 6 of Chapter 376 of the Revised Statutes of Nova Scotia, 1989, the Public Service Act authorizes the provincial Minister to enter into agreements with the Government of Canada under which Canada undertakes to provide funding toward costs incurred by the Government of Nova Scotia for the provision of health services which includes home and community care and mental health and addictions initiatives;

WHEREAS, Nova Scotia 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;

WHEREAS, the Government of Nova Scotia, via Order in Council 2021-214, directed the Department of Seniors be renamed the Department of Seniors and Long Term Care, and assigned all affairs and matters relating to continuing care and continuing care infrastructure, including long term care, from the Department of Health and Wellness or the Minister of Health and Wellness to the Department of Seniors and Long Term Care or the Minister of Seniors and Long Term Care;

AND WHEREAS, the Section 6 of Chapter 376 of the Revised Statutes of Nova Scotia, 1989, the Public Service Act, authorizes the provincial Minister of Seniors and Long Term Care to enter into agreements with the Government of Canada under which Canada undertakes to provide Safe Long-term Care Funding toward expenditures incurred by Nova Scotia for activities to protect residents in long-term care settings through increased infection prevention and control measures.

NOW THEREFORE, Canada and Nova Scotia agree as follows:

1.0 Objectives

1.1 Building on Nova Scotia's existing investments and initiatives, Canada and Nova Scotia 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 Nova Scotia 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 Nova Scotia 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 Nova Scotia's 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 Nova Scotia 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, Nova Scotia 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 Nova Scotia's 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 Subject to sections 4.4 and 4.5, the Safe Long-term Care Funding provided under this Agreement may be used by Nova Scotia for expenditures that are incurred from December 1, 2020, to March 31, 2022.

3.3 Renewal of Bilateral Agreement

3.3.1 Nova Scotia's 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 Nova Scotia and Canada's agreement on a new five-year action plan.

3.3.2 The renewal will provide Nova Scotia 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 Nova Scotia under the Canada Health Transfer to support delivering health care services within their jurisdiction.

4.2 Allocation to Nova Scotia

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 Nova Scotia 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 Nova Scotia 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, Nova Scotia's 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 Nova ScotiaTable 1 Footnote * (subject to annual adjustment)
Mental health and addictions services
Estimated amount to be paid to Nova ScotiaTable 1 Footnote * (subject to annual adjustment)
2018-2019 $15,590,000 $6,500,000
2019-2020 $16,890,000 $11,690,000
2020-2021 $16,890,000 $15,590,000
2021-2022 $23,390,000 $15,590,000
Table 1 Footnote *

Amounts represent annual estimates based on StatCan 2017 population

Table 1 Return to footnote * referrer

4.2.6 Subject to annual adjustment based on the formulas described in subsection 4.2.3, Nova Scotia's estimated share of the amounts will be:

Fiscal Year

Safe Long-Term Care

2021-2022

$27,264,311

Table 2 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 the annual estimates allocation based on StatCan 2021 population.

Table 2 Return to 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 Nova Scotia for the Fiscal Year as determined under sections 4.2.5 and 4.2.3.
  4. Canada will notify Nova Scotia 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 Nova Scotia 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 Nova Scotia 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 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 Nova Scotia's 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 Nova Scotia's 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 Nova Scotia 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 Nova Scotia 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 Nova Scotia, Nova Scotia may retain and carry forward to the next Fiscal Year the amount of up to 10 percent of the contribution paid to Nova Scotia for a Fiscal Year under subsection 4.2.5 that is in excess of the amount of the eligible expenditures actually incurred by Nova Scotia 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 Nova Scotia to retain and carry forward an amount exceeding 10 percent 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 Nova Scotia under subsection 4.2.5 of this Agreement in the next Fiscal Year.

4.4.3 In the event this bilateral agreement is renewed in accordance with the terms of section 3.2.1, and at the request of Nova Scotia, Nova Scotia 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 Nova Scotia to retain and carry forward an amount exceeding 10 percent 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 Nova Scotia exceed the amount to which Nova Scotia is entitled under this Agreement, the amount of the excess is a debt due to Canada and, unless otherwise agreed to in writing by the Parties, Nova Scotia shall repay the amount within sixty (60) calendar days of written notice from Canada.

4.6 Use of Funds

4.6.1 Canada and Nova Scotia agree that funds provided under this Agreement will only be used by Nova Scotia 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 Nova Scotia agree that amounts paid to Nova Scotia under the Safe Long-term Care Fund may be provided by Nova Scotia 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 Nova Scotia provides Safe Long-term Care Funding to privately-owned, for-profit facilities in accordance with this Agreement, Nova Scotia 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 Nova Scotia has cost-recovery agreements in place with one or more privately-owned for-profit facilities pursuant to subsection 4.8.1, Nova Scotia 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, Nova Scotia agrees to participate in a Federal-Provincial-Territorial process, including working with stakeholders and experts, through the Canadian Institute for Health Information (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. Nova Scotia will designate an official or official(s), for the duration of this agreement, to work with CIHI and represent the interests of Nova Scotia 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, Nova Scotia 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 province'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 Nova Scotia's 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 Nova Scotia 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;

5.1.3 As a condition of receiving the second payment installment of the Safe Long-term Care Funding, Nova Scotia 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 Nova Scotia 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 Nova Scotia will use recovered funding to increase infection prevention and control pursuant to the terms of this Agreement.

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

5.3 Evaluation

5.3.1 Responsibility for evaluation of programs rests with Nova Scotia in accordance with its own evaluation policies and practices.

6.0 Communications

6.1 Canada and Nova Scotia 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 spirit of transparency and open government, Canada will make this Agreement, including any amendments, publicly available on a Government of Canada website and Nova Scotia 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 Nova Scotia website.

6.4 Canada, with prior notice to Nova Scotia, may incorporate all or any part or parts of the data and information in 5.1.2 and 5.13, or any parts of evaluation and audit reports made public by Nova Scotia into any report that Canada may prepare for its own purposes, including any reports to the Parliament of Canada or reports that may be made public.

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 Nova Scotia 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 Nova Scotia 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. Nova Scotia 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 Nova Scotia 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 Nova Scotia 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 Nova Scotia, as the case may be, may notify the other party in writing of the failure or breach. Upon such notice, Canada and Nova Scotia 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 Nova Scotia responsible for Health, and if it cannot be resolved by them, then the respective Ministers of Canada and Nova Scotia 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 Nova Scotia, by Nova Scotia's Minister of Health and Wellness and Nova Scotia's Minister of Seniors and Long-term Care.

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 Nova Scotia, 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 Nova Scotia, 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 Nova Scotia, if requested by Nova Scotia. 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 Nova Scotia by giving at least 12 months written notice of its intention to terminate. Nova Scotia 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 Nova Scotia 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. 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 Nova Scotia shall be:

Jeannine Lagassé and Paul Lafleche
1894 Barrington Street,
Barrington Tower
PO Box 488
Halifax NS B3J 2R8

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 Nova Scotia.

12.4 No member of the House of Commons or of the Senate of Canada or of the Legislature of Nova Scotia shall be admitted to any share or part of this Agreement, or to any benefit arising therefrom.

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 30th day of August, 2018.

The Honourable Ginette Petitpas Taylor, Minister of Health

SIGNED on behalf of Nova Scotia by the Minister of Health and Wellness this 30th day of August, 2018.

The Honourable Randy Delorey, Minister of Health and Wellness

Annex 1 to the Agreement

A Common Statement of Principles on Shared Health Priorities

Annex 2 to the Agreement

Nova Scotia Action Plan on Home and Community Care and Mental Health and Addictions Services

Introduction

Healthy, safe, vibrant communities are vital to the success of Nova Scotia. We know that to support these communities, we need to effectively connect our various social services including health, education, community services and justice. The Department of Health and Wellness (DHW) and our partners, including Nova Scotia Health Authority (NSHA) and IWK Health Centre (IWK) recognize the need to think of our health system in this broader context.

We are shifting away from care models based solely on hospitals and facilities, towards a model revolving around care and supports available in the community and close to home. A model that connects health services with other social services. A model that enables and supports self-care. We are also moving towards more person focused approaches away from provider centred approaches to care. People and users need to become the focal point around which care and services revolve, with providers coordinating their efforts to better meet needs. This means ensuring our systems incent providers working collaboratively and to optimal scopes of practice.

To address the needs of Nova Scotians we will leverage federal funding to enhance our provincial investment in the key priority areas of mental health and addictions (MHA) and continuing care. Targeted federal funding will support the Province's efforts to ensure equitable access to care that is integrated across the health continuum.

Home and Community Care

Overview

Nova Scotia has one of the oldest populations in the country - 19.3% of our population is over the age of 65. This is coupled with the highest reported rate of disability in Canada with 18.8% of residents 15 years and older report having a disability, compared to 13.7% of the Canadian populationFootnote 1.

Nearly 30,000 clients annually access home and community programs that respond to needs such as home nursing, personal care, meal preparation and housekeeping, respite and other supports such as home oxygen, home alerts or equipment loans. Care is often multifaceted, involving multiple care providers across the care continuum. As such, we need to ensure that Nova Scotia has a coordinated, responsive and sustainable health care system that optimizes client outcomes.

Nova Scotia's two health authorities enable the development and implementation of province-wide strategies. There is significant interest from health care providers, including physicians, nurses, pharmacists, dieticians and social workers, to work collaboratively to support clients. The primary and acute health systems are supported by emergency services and innovative programs utilizing community paramedicine.

Demand for Home and Community Care

The demand for continuing care services is expected to increase in the next 10 years and beyond. The percentage of the population over the age of 65 is expected to increase from 19.3% in 2016 to 25.1% in 2026Footnote 2. If Nova Scotia's current rates of disability and chronic disease continue, and our mix of services and programs remain unchanged, Nova Scotia will experience increased demand for home support and home nursing services (approximately 10%) over the next 5 yearsFootnote 3. Similar demand increases are projected for long-term care.

Caregivers fulfill a significant role in caring for Nova Scotians and are integral in supporting independence and community connection for those they support. In the future, caregivers may not be as available as they are today to support care recipients given smaller family sizes and the geographic spread of family members. A robust home and community care system for clients that supports independence and provides the right care when needed can help alleviate pressures on caregivers and the formal health system.

Home and Community Care in Nova Scotia Today

Nova Scotians have told us they want to remain at home for as long as possible, and with the right services and supports they should be able to do so. In response, Nova Scotia introduced a Home First approach in 2012/13 to help clients remain at home for as long as safely possible. While this aligns with what Nova Scotians want, it also means there is an increased demand for services and more complex clients are remaining in the community for longer periods of time. This has resulted in continued demand for appropriate education, training, information and support for both those providing services and those receiving them.

To support this approach, the Province has made significant investments in home care and community supports over the past number of years. Since 2013/14, the home care budget has increased by 42% and hours of service provided to clients has increased by 44%Footnote 4. This investment has enabled Nova Scotia to expand existing programs and establish new ones to better meet the needs of clients in the community. In 2013, the Province increased the number of spaces in the supportive care program, which provides $500 per month to support clients with cognitive impairments to purchase personal care, respite, meal preparation and household chores. This increased utilization from 194 individuals in 2013/14, to 568 in 2017/18. The Province also established a Community Bed Loan Program which provides hospital-type beds to eligible Nova Scotians who need specialized beds in their homes. In the last year, this program was accessed by approximately 2800 clients. The Seniors Community Wheelchair Loan Program, also established since 2013/14, was accessed by 285 eligible residents of Nova Scotia in 2017/18 to support them in their homes and communities. Collectively, these programs, coupled with home support assistance, have enabled clients to remain in their homes and communities, delaying admission to long-term care.

While significant strides have been made, there is still opportunity to improve home and community supports to ensure we are meeting the needs of clients in an effective and efficient manner. An analysis of our current state, including input from users and providers of continuing care services, has identified challenges in service access and the availability of appropriate programs and services. We have learned we need do better in supporting caregivers, people with dementia, those living with acquired brain injury (ABI), First Nations Nova Scotians and those requiring palliative care. We also acknowledge that improvements are needed to enhance the way continuing care connects with the larger health system as ensuring linkages across the entire continuum is essential to client centred care.

Nova Scotia is committed to improving access to quality and appropriate continuing care services. Federal funding will be used to advance and accelerate actions in the four key areas, noted below.

  • Enhancing Continuing Care Services for Clients: Ensure that services respond to client needs by offering more flexibility and choice, aligning with resources that support health outcomes, promote efficiencies, and leverage community-based resources.
  • Supporting Caregivers: Support caregivers by ensuring they are aware of and have access to services and supports that address their distinct needs.
  • Support Integrated Care: Strengthen partnerships, systems and processes to enable a coordinated, holistic approach to care.
  • Enhancing Sustainability, Accountability and System Performance: Ensure system design, services, and performance are based on evidence, data, sector knowledge, and client experience.

1. Improving Access and Enhancing Continuing Care Services for Clients

Despite Nova Scotia's increased investment in continuing care services to enable clients to stay in, or return to, their community, as noted above, challenges still exist. As with many provinces and territories, the demand for services and programs continues to grow. Access to service is an issue with waitlists for many services. Length of stay in long term care (LTC) in Nova Scotia is longer than some other jurisdictions suggesting individuals may be admitted to facility-based care prematurely. As well, as previously noted, with the shift to care in the community, we are now required to provide services to more complex clients who may require additional and new supports, most notably those with an ABI. The needs of this population are somewhat unique, and in many cases traditional home care services are not meeting their needs. Current eligibility criteria for many continuing care services pose a barrier to this population accessing services, for example, age restrictive criteria.

Challenges also exist with the provision of palliative, end-of-life care in Nova Scotia. It is recognized that there is a need to improve palliative care to meet current and future population needs. In 2016, nearly 60% of Nova Scotians who died, did so in the hospital. This may be suggestive of a lack of access to appropriate palliative care supports in the community. Palliative services in Nova Scotia are currently delivered in hospital settings and in the community. Some areas of the province have organized, well functioning palliative care teams while other areas experience have more limited access to services. Issues of access relate in part to a lack of clinicians with expertise in palliative care. There are also challenges with integration of palliative care across the care continuum with services often being delivered in silos.

Federal funding along with provincial investment will be used to address barriers to remaining in the community; to increase the flexibility of current programs; and to develop new programs that support clients of all ages, particularly those with complex need. Examples of known key enablers to maintaining individuals at home as long as possible include: access to appropriate supports including clinicians, particularly for palliative care clients; equipment; accessible housing; availability of home care workers; caregiver support; and, knowledge of available supports.

Federal funding will be invested in targeted supports shown to be effective in maintaining individuals in the community, as well as to address waitlists for current programs and services proven effective in helping to maintain clients in the community. In addition, federal funding will augment provincial funding to expand access to the bed loan program so that additional beds will be purchased to address current demand and to increase capacity into the future. It will also augment home adaptation funding to enable more seniors and low-income Nova Scotians to carry out home repairs/modifications to ensure their homes are safe and accessible. The Home First program, implemented in 2012/13, while effective in facilitating the discharge of alternate level of clients from acute care back to the community, is facing growing demand. Federal investments will also enable funding to be provided to the NSHA and the IWK to fund short term intensive programs and services that will help facilitate the discharge of more patients back to the community.

In order to support workers and caregivers with the physical demands of care, Nova Scotia will develop and implement a community-based home lift loan program. Federal funding will cover administrative costs and will support the purchase of mechanical lifts which will be provided to eligible clients in the community. This investment will help prevent injuries to clients, caregivers and home support workers. Literature supports that home support workers are more likely than other workers to experience musculoskeletal injuries from handling and assisting clients. In fact, almost 1 in 10 home care workers in Nova Scotia suffers a time-loss injury on the jobFootnote 5 and worker's compensation rates are highest for this sector.

Further, federal investments will be made in addressing identified gaps in servicing those with an ABI. Federal funding will assist with the implementation of the Provincial Acquired Brain Injury Action Plan that will address unmet needs of ABI survivors and their families/caregivers. Federal investment will facilitate the expansion of eligibility criteria for existing programs and services to allow individuals with an ABI to access targeted supports including the Personal Alert, Supportive Care and Wheelchair Loan program. Recognizing the unique needs of this population, federal funding will also support the pilot of an intensive 12-week rehabilitation day program that is currently only available to private pay clients. The customizable 12-week program will allow an individual to remain in their home and stay active within their community while focusing on achieving specific rehabilitation goals to maximize their capabilities. Federal funding will also be used to invest in planning and consultation to create a "Neuro Commons" community-based cluster of existing NSHA ABI rehabilitative and therapeutic recreation programs with existing ABI NGO based social supports. Services will be co-located in an area that will be more accessible to clients and their families. Currently NSHA community based rehabilitative teams are located in hospital facilities. Developing a plan for a Neuro Commons will also provide opportunities to collectively address known gaps in servicing this population.

Federal funding will also be used to address gaps in palliative care, to expand capacity in the palliative care program through the addition of ten new palliative care clinicians who will work in areas which are typically underserved, and through training of existing staff to ensure they are equipped to provide quality palliative care. New clinicians will be integrated into collaborative primary health care teams which will help ensure there is integration and linkage to available palliative services. Current professional development initiatives specific to palliative/end of life care, Learning Essential Approaches to Palliative Care and End-of-Life-Care (LEAP) training, will be expanded to allow a minimum of 600 additional staff to receive this training.

As well, palliative care volunteers will be better supported in Nova Scotia. To ensure we are optimizing this valuable resource, federal funds will be used to support a coordinator position that will help manage volunteer services. Funding will also support the implementation of appropriate training for volunteers to enable them to function at an optimal level in their very important role.

Finally, federal funding will be used to help ensure that those who require supports to be maintained in the community are aware of programs and services available. Current communication pathways funded by the Province, including its website, written fact sheets etc. will be enhanced. Additional funding will support website redesign, broader and targeted distribution of relevant materials to clients, families and NGOs providers with the goal of improving communication and enhancing information sharing.

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

  • Spreading and scaling evidence-based models of home and community care that are more integrated and connected with primary health care; and
  • Enhancing access to palliative and end of life care at home or in hospices.

2. Supporting Caregivers

Caregivers are a crucial part of continuing care services. They provide 70-80%Footnote 6 of all care provided at home, and many are themselves in need of care and support (26% of caregivers connected to clients receiving publicly funded services indicate they have signs of distressFootnote 7). The demands on caregivers can vary with the condition of those they are caring for and typically increases as a disease or condition progresses. For example, caregivers of people living with dementia provide 75% more care than other caregivers and experience higher levels of stressFootnote 8. The literature supports that caregiver burnout is one predictive factor for premature placement of individuals in LTC. Nova Scotia acknowledges that caregivers are an invaluable resource and need to be supported in their efforts to care for their loved one at home, as long as possible. We know that caregivers represent a diverse population with unique needs that require flexible supports.

Supports currently available to caregivers in Nova Scotia include the Caregiver Benefit Program which recognizes the important role of caregivers in their efforts to assist loved ones and friends. Respite care is also available to help prevent caregiver burnout. Care may be provided in the client's home or in a long-term care facility, however, caregivers report there are issues with accessing respite services. Caregivers have noted they are challenged with planning for respite care, especially in LTC, as they have no way of knowing availability. Caregivers also receive support(s) from community organizations such as the Alzheimer's Society and Caregivers Nova Scotia. These organizations, who receive provincial funding, support caregivers through the provision of information, education and training. Technology based supports for caregivers are available through these organizations, however, again access is limited. Information gleaned through the development of Nova Scotia's Continuing Care strategy indicates that caregiver specific programs and supports are limited and that caregivers may not be aware of the full range of supports available to them, or how to access them.

Nova Scotia will utilize federal funding to expand existing programs that we know are working well, and to implement new programs based on best practice that will better support caregivers in their very important role. Investments will be made to expand eligibility criteria for the caregiver benefit program to include caregivers of people living with dementia who have moderate cognitive impairment, caregivers of individuals with mild cognitive impairment as well as caregivers of individuals who have a high level of involvement of others in the performance of independent activities of daily living. This expansion will benefit approximately 1600 more caregivers.

Access to respite care will be improved through the introduction of a web-based respite booking system which will provide a user-friendly interface to facilitate the booking of respite. Funding will support the purchase and implementation of an appropriate IT solution. Federal funding will also be used to expand respite coordination services offered by the Department of Community Supports (DCS) to include adults, and to support an online database of respite providers which will enable a self-service option. Currently this service is only available to families with children who are seeking respite care and the listing of available respite providers is not available electronically. Funding will support the development and administration of the electronic database.

Federal funding will be used to increase current funding to Caregivers Nova Scotia and the Alzheimer's Society of Nova Scotia, and to provide first time funding to the Acquired Brain Injury Association of Nova Scotia. This investment will augment provincial funding to support the expansion of evidence informed programs and services offered by these organizations that have been proven to be effective in supporting caregivers.

Acknowledging the psychological and emotional toll caregiving may have on an individual, and the importance of supporting people in maintaining this role, federal funding will be used to introduce virtual care options to intervene early for caregivers of ABI survivors. The use of technology to provide needed supports will allow Nova Scotians to access supports from their own homes, on their own schedule, without travelling or taking time off work. The program will be adapted from the Strongest Families intervention with youth to provide online and telephone-based psychoeducation and enhanced Behavioral Activation interventions in a group format to those experiencing depression, anxiety and high levels of stress in their role as caregiver for someone living with an ABI. As lessons are learned during the implementation, decisions regarding expansion of the programs to other groups of caregivers will be considered.

Federal funding will also support ongoing research regarding complementary models and best practice in caregiver support. Information gathered will be used to inform any required changes to our programs and services to ensure we are supporting caregivers in the most meaningful and appropriate way.

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

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

3. Support Integrated Care

As noted above, improvements are needed with respect to the integration and coordination of care in the community and across the entire care continuum. While there are an array of services offered across the care continuum, many times programs/providers operate in silos. Lack of communication amongst care providers often results in fragmented care and inappropriate use of the acute care system and LTC. Care pathways are often difficult to navigate and are not integrated. This is particularly relevant to the frail elderly and those with complex care needs. The First Nations population in Nova Scotia is also more vulnerable to fragmented care. Continuing care services available for Status First Nations Nova Scotians living on reserve are not consistent with services available to Nova Scotians living off reserve and there are challenges with information sharing across the various groups in the province, and federally, who are responsible for the provision of continuing care services. While federal funding will not address all these issues, it will support current provincial funding in moving towards more integrated, coordinated care in the province.

Efforts have been made to help ensure care is integrated and coordinated, however, more work needs to be done. Nova Scotia, through its Emergency Health Services (EHS) Program delivers two innovative programs that leverage paramedic resources to support clients in the community and in many cases avoiding the need for acute care services. The Extended Care Paramedic Program (ECPP) provides services to clients in LTC facilities suffering from low acuity complaints, to manage their care within the facility, preventing the need for costly and unnecessary transfers to acute care facilities. The Special Patient Program (SPP) allows the care directives and wishes of specific patients who expect to require EHS care to be communicated in advance to care providers across the care continuum. The SPP, launched in 2000 with a focus on pediatric patients with rare conditions has evolved to include patients with other complex healthcare needs, including palliative care clients. These programs support collaboration between primary healthcare providers, EHS medical oversight and responding paramedics resulting in a more streamlined integrated service delivery model. While effective, these programs are currently limited in scope and are only available in certain areas of the province.

The need for coordinated, integrated care is perhaps most evident when providing care to clients with complex needs. The IWK have noted particular challenges in providing care to children with autism, especially with respect to crisis prevention/management in the community. They have identified the need for new resources to support a more coordinated approach to crisis prevention/stabilization. The inability to respond appropriately often results in crisis escalation, the breakdown of care arrangements, and inappropriate admissions to acute care.

Federal funding will be used to support initiatives that will help facilitate system integration and greater coordination of care. The ECPP will be expanded to include other geographic regions of the province and other cohorts of patients. The program will support individuals who have been discharged early from acute care/emergency departments to support adherence to their discharge plan, frequent users of either EHS, emergency department services or hospital care will be supported in the community through tele-health consults or in-home visits, as well as individuals with select chronic diseases. The SPP will also be expanded to include additional clients and to develop alternative care pathways for these clients, as appropriate, to meet their needs. Funding will support additional paramedics, telehealth nursing services, program coordinator, administrative services, medical oversight, training, database and web face interface enhancements, software licensing fees and vehicle cost.

Federal funding will also be used to enhance coordination between the Provincial Continuing Care Program, First Nations and Inuit Home and Community Care Program (FNIHCCP). Culturally appropriate information regarding programs and services will be developed, regularly updated, and distributed through a variety of mediums including the DHW Aboriginal Continuing Care Website. Cultural safety training specific to First Nations continuing care needs will be developed and made available to all staff administering the program. To ensure ongoing communication, funding will also be used to facilitate regular meetings /information sessions with NSHA/IWK continuing care staff and FNIHCCP. These initiatives will result in improved relationships, coordination and communication between NSHA/IWK and FNIHCCP; improved continuity of care for First Nations clients; enhanced quality of care and efficiency within the health care system. Federal funding will also support a needs assessment to determine other gaps in continuing care services that may be addressed through federal funding in out years.

The Province will use federal funding to develop and implement an intensive outreach team across the province to help ensure a coordinated response to children and youth with complex presentations/significant behaviour difficulties at risk for crisis situations. Short-term intensive interventions will focus on crisis stability, case formulation and capacity building. The team will include a nurse, social worker, certified behavioural support specials, occupational therapist, a psychologist and an outreach worker. This team will provide capacity building for families, schools, DCS providers, health providers, group home staff, recreation staff etc. and will support clients and families with Autism within their own environment.

Lastly, federal funding will be invested in the development and implementation of a provincial network of care for ABI that will improve care for clients and their families. The network will bring together leaders, providers and key stakeholders across programs, services, sectors and regions to form an integrated health care service group for ABI that spans the continuum of care for planning, management and delivery of health services, to best support patients and their families. The network will be responsible for the establishment of standards and performance expectations for the service area, identification of areas for innovation and/or the advancement of technology to address issues/areas of focus and will design service delivery models and implementation strategies to achieve agreed upon goals. Funding will support the implementation and administration of the network.

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

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

4. Enhancing Sustainability, Accountability and System Performance

In Nova Scotia, there are known gaps in information required to make evidence informed decisions regarding continuing care programs and services. Improvements are needed in accountability and performance monitoring to help ensure the sustainability of the continuing care system. To increase accountability, Nova Scotia is moving towards a performance-based contract management approach with home care service providers funded through Continuing Care. Some information regarding performance is currently collected, however, it is a manual process that requires considerable effort, is onerous for providers and there is an increased risk of errors.

Nova Scotia is also challenged with collecting standardized client assessment data that is crucial to service planning and measuring outcomes of care, a key indicator of system performance. While Nova Scotia is currently utilizing the interRAI Home Care Assessment tool in the home care sector, similar assessment data is not available after clients enter long-term care.

Federal funds will be used to implement a data submission portal for home care service providers that will replace current manual data collection efforts. A technical solution will be developed to enable the collection of more robust data. It will provide data quality checks for providers, track submissions, compile data into a standardized data base; and, greatly improve reporting capabilities. This investment in data collection, management and reporting will enhance our understanding of care provided to clients, outcomes of care and will help ensure optimal value for clients receiving service. The implementation of the portal will also result in more reliable information to support home care policy.

Nova Scotia will also invest federal funding to implement the interRAI Long-Term Care Facilities Assessment Tool in long term care facilities (LTCFs) to enable comprehensive, standardized evaluation of all LTC clients. Implementation of this tool will enable the development of more appropriate client centred care plans. Data gathered from the assessments will help identify clients that may be discharged back to the community, specifically those that have improved since admission to LTC or who may have been prematurely admitted to LTC. Clients receiving convalescent care in LTCFs will benefit from the use of this assessment tool as the information gathered will inform an appropriate care plan that will facilitate more timely discharge of clients back home. Standardized assessments of LTC clients, informing the level of care required, will help ensure we are appropriately using LTC beds. The implementation of this assessment tool will inform system wide analyses of client care goals and will address a known gap in Nova Scotia; it will enable us to track client needs and care outcomes (such as care coordination between home care and long-term care) and better share information with other health care system partners, i.e., primary health care.

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

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

To ensure federal funding is used as intended, implemented in a timely manner and evaluated as required, federal funding will be used to support a project management team. This cost is included in the overall cost attributed to the above initiatives.

The following table summarizes the proposed allocation of federal funding for Home and Continuing Care.

Funding Breakdown by Initiative
Funding Breakdown by Initiative 17/18Footnote * 18/19Footnote * 19/20Footnote ** 20/21Footnote ** 21/22Footnote ** 5 Year Total
Total Federal Investment in Home and Community Care $5,230,000 $15,540,000 $16,800,000 $16,800,000 $23,260,000 $77,630,000
Home and Continuing Care $5,230,000         $5,230,000
Enhancing Continuing Care Services for Clients   $4,018,000 $7,897,000 $6,240,000 $2,219,000 $20,374,000
Supporting Caregivers   $1,488,000 $3,161,000 $6,896,000 $9,963,000 $21,508,000
Support Integrated Care   $1,450,000 $7,568,000 $4,251,000 $7,501,000 $20,770,000
Enhancing Sustainability, Accountability and System Performance   $496,000 $1,713,000 $3,962,000 $3,577,000 $9,748,000
Total Federal Investment from above minus/plus Carry-Over $5,230,000 $7,452,000 $20,339,000 $21,349,000 $23,260,000 $77,630,000
Carry-overFootnote ***   $8,088,000 $4,549,000      
Prior year funding to be spent in year     $8,088,000 $4,549,000    
Percentage carry-over of total federal funding for home and community care   52.0% 27.1% 0.0%    
*

2017-18 funding provided through legislation. 2018-19 and 2019-20 are rounded allocations based on section 4.2.3 of the Agreement.

Return to footnote * referrer

**

Allocations are notional. Funding allocations are subject to annual adjustment based on the formula described in section 4.2.3 of the Agreement.

Return to footnote ** referrer

***

Carry-over to accommodate additional time required to introduce and run programs.

Return to footnote *** referrer

Proposed Performance Measures

The Investment and Decision Support Division of the Department has identified a resource to support and participate in the CIHI-led process to develop common indicators and will share data with CIHI on agreed-upon indicators.

The Department of Health and Wellness has developed an accountability and monitoring framework for the initiatives in this agreement. The framework supports strategic planning, continuous quality improvement and financial management. The indicators below will be used to track progress; others may be added as required.

Home and Community Care Proposed Performance Measures
Initiative Outcome Measure Target by 2021/22

Enhancing Continuing Care services for clients

Improved programs and services that better respond to client needs

  1. Increase in number of units and amounts approved for home modifications with DHW funding
  2. Decrease in LTC length of stay

All targets will be identified by December 2019.

Enhanced community-based end-of-life care

  1. Increase in the number of people accessing palliative home care services

Improved access to coordinated and inclusive programs and services

  1. Increased awareness of programs and services among clients, providers, and the general public
  2. Increase in the number of ABI clients accessing rehabilitative and therapeutic programs
  3. Increase in the number ABI clients accessing continuing care programs and services

Supporting caregivers

Improved awareness and access to services and supports that address caregivers' needs

  1. Increased awareness among caregiver of programs and services offered by CNS
  2. Increase in the percentage of carers receiving the caregiver benefit

All targets will be identified by December 2019.

Enhanced supports for caregivers to recognize their role

  1. Increase in percentage of clients using the home lift loan program

Improved support for caregivers mental, psychological, and emotional health

  1. Decrease in the number of clients reporting having distressed caregivers

Support integrated care

Strengthened partnerships

  1. Increase in amount of allocated resources to community-based supports in First Nations Communities

All targets will be identified by December 2019.

Improved access to integrated health care in the community

  1. Increase in percentage of children and youth with autism accessing the Intensive Outreach team resources
  2. Decrease in EHS transports for non-urgent cases
  3. Increase in Special Patient Program enrollment

Improved client outcomes

  1. Decrease in the rate of hospitalization for ambulatory care sensitive conditions (focused on chronic conditions)

Enhancing sustainability, accountability, and system performance

Increased use of evidence to ensure services are accountable and sustainable

  1. Deployment of RAI-LTC in all nursing home throughout NS
  2. Reported increase in the efficiency and effectiveness of home care information reporting.

All targets will be identified by December 2019.

Mental Health and Addiction Services

Overview

In any given year across Canada, 1 in 5 people will experience mental illness, with a cost of over $50 billion to the Canadian economyFootnote 9. Of particular concern, is the trend showing that MHA issues manifest at greater rates and incidence for individuals and families of lower socio-economic status. Nova Scotians who did not complete high school are over 3 times more likely to rate their own mental health as fair or poor compared to people with a university degree. Nova Scotia males within the lowest income category are nearly 2 times as likely to be hospitalized because of a mental illness than those in the highest income categoryFootnote 10. Similar relationships exist between the determinants listed above and other important health outcomes, such as rates of suicide mortality and usage of tobacco and alcohol. More specific social determinants of health are also strongly associated with poorer mental health status. People who experience food insecurity, or the condition where a person faces inadequate or insecure access to food, are more likely to also suffer from increased stress, mood and anxiety disorders, and poorer overall mental health. A similar relationship exists between housing status and mental health, in that living in substandard housing (e.g., physically inadequate, crowded, noisy, unsafe) is related to poorer mental health outcomes.

Mental health and addiction services in Nova Scotia consist of a range of health promotion and prevention, and general and specialized treatment programs. These programs include ambulatory community-based programs, home or school-based interventions and in-patient services. Following the creation of the NSHA, a scan of the existing MHA system in the province was completed. The scan noted a range of strengths and challenges. Strengths of the system included many examples of innovation and evidence-based practice within the service delivery model as well people who work within the system, are working collaboratively, and with strong leadership. The identified challenges include gaps in the continuum of care, system variation throughout the province, and the provision of services or practices in some areas that are not evidence based. Wait-times for community-based care, barriers to accessing in-client care, lack of after-hour and weekend out-client services, and challenges trying to navigate the system were all cited by Nova Scotians as problems. We recognize the need for better access to mental health services and in particular support for youth in First Nations communities.

To best meet Nova Scotia's current and emerging MHA needs, the Province supports a stepped care/shared care approach. This comprehensive, integrated, person-centred approach aligns service functions/core services with the needs of the population. Aligned with best practice in other areas of health care planning, a tiered approach has been developed to structure MHA services. Tier 1 reaches the largest groups of people with the strategies intended to improve positive mental health status of an entire population. Tier 2 provides access to early identification, intervention and self-management functions, targeted to people at risk but delivered in a community setting often outside of the formal health system. Tier 3 offers treatment planning, risk/crisis management and support functions targeted to individuals with identified challenges in either community-based or out-client /ambulatory care settings within the formal health care system. Tiers 4 and 5 focus on those experiencing the most acute and severe challenges requiring the most intensive, specialized and costly services within the formal health services. The graphic below outlines estimates of the percentage of the population in need of each tier of service.

Estimated Percentage of the Population in Need of Each Tier of Service
Tier Percentage in need
1 49.5
2 35.5
3 10.2
4/5 4.9

To improve access to MHA services and to ensure that we have a comprehensive approach to this area within the tiered continuum from promotion and prevention to highly specialized care, Nova Scotia has invested significant funding to support a number of initiatives focused on addressing identified gaps in services and programs:

  1. Integrated service delivery to increase population-based health promotion and prevention functions targeted to the population, including specific actions targeted to children, youth and their families;
  2. New and Expanded MHA community-based support to increase access to early intervention and self-management supports for people at risk of MHA challenges; and
  3. IT/IM supports to enhance access to treatment planning, crisis management and support for people with identified challenges.

The following MHA service initiatives will be supported with additional federal funding to advance and accelerate planned provincial action.

1. Enhance Integrated Service Delivery for Children and Youth

Nova Scotia acknowledges the need for a more integrated approach to MHA services for children and youth. Efforts have been underway to support a model of service delivery that is evidence and needs based, client focused and youth friendly, providing a full scope of needed supports and interventions. DHW is working with community partners and the Department of Education and Early Childhood (DEECD) to support a more integrated approach to care. DHW currently supports SchoolsPlus, a DEECD/DHW joint initiative that supports a collaborative interagency approach, supporting the whole child and their family with the school often as the centre of service delivery. SchoolsPlus employs, through the DEECD, SchoolsPlus facilitators who work to bring a range of services, including mental health services, together with mentoring, social work, after school programing, homework support, recreational and justice services into schools where students and families can easily access them. In addition, DEECD employs SchoolsPlus Community Outreach workers who are focused on outreach to services outside the school setting that are needed to meet the needs of the children and youth. Child and youth mental health is supported within the SchoolsPlus approach by attaching children, youth and their families with MHA clinicians and community supports. Mental health clinicians employed by NSHA or the IWK provide clinical services support e.g., counselling, to students who are referred for such services. These clinicians work within the school setting or other settings in the community to provide the services where the children and youth need them.

This model of service delivery is managed by the Department of Education and Early Childhood Development (DoEECD) and the DHW. The blend of the health and education systems enables early identification and treatment of children and youth experiencing MHA problems/illnesses. Early evaluation has shown that advantages of the approach include improved student engagement and school success, integrated services, collaborative team approach to complex needs, reduction of gaps in services and/or duplication of services, and summer programming.

The province also supports CaperBase, an adolescent outreach model, that includes an interdisciplinary team of health professionals that work with youth, families, schools and other community partners to create solutions, opportunities and supports that provide youth with the building blocks to live healthy, fulfilling and productive lives. Such a model can reduce risks for youth by targeting those at risk with evidence-based and known to be effective health promotion approaches, resilience and skill building approaches, screening, brief intervention, referral and navigation as well as with targeted programs designed to intervene with adolescents with risk-factors. Adolescents with risk factors are known to be at higher risk than other peers to develop MHA disordersFootnote 11. This model is currently being utilized in select areas of the province. MHA experts in Nova Scotia have recommended the expansion of this model across Nova Scotia. The target population for this initiative is youth at high risk for or presenting with mild substance use and mental health concerns who are living in small towns and rural communities, and also youth in school and community settings. Research indicates that people living in rural areas are sometimes not sure where to go to access services and supports in the evenings, weekends and at nights. Services are not easily obtainable or equally available in certain areas, especially small towns and rural communities.

Building on the success of the programs above, federal funding will be leveraged to support the expansion of SchoolsPlus through the provision of additional mental health clinicians to support the delivery of the clinical services required, with the goal of ultimately expanding to full coverage of all schools in Nova Scotia. Furthermore, it will support the expansion of the CaperBase model in Cape Breton and through a staged process to other health zones to better meet the needs of the youth in these communities. Funding will support costs associated with the delivery of programs and services and additional human resources. The expansion of this program is expected to address gaps in service in prevention and early intervention for youth at risk of developing MHA challenges, and for those who have mild problems. This program also contributes to reduced stigma and discrimination and could reduce wait times for clinical services.

Youth Health Centres (YHCs) in NS, supported through provincial funding, use a youth-centred approach to help young people with a variety of health issues that impact their lives. The predominate issues include sexual health, mental health, healthy relationships, substance use and addiction, and food security. There are currently 69 school-based Youth Health Centres (YHCs) throughout Nova Scotia managed and staffed by the NSHA. They are staffed by coordinators who work along the continuum of health promotion to early intervention and brief clinical services. Key components of their work include youth involvement and engagement, health promotion activities, community development and partnerships, providing navigation support for youth accessing primary care services or MHA services, and individual and group intervention with the goal of enhancing personal skills and capacity to self-advocate. YHC Coordinators liaise regularly with school administrators and other student services that are available in the school, fostering an integrated approach to care.

Federal funding, along with provincial funding will support the development of a YHC standardized model reflective of current evidence and need. The model will be piloted and evaluated in four sites beginning in the 2018/2019 schoolyear. The funding will support the cost of model development, implementation at the sites, cost of services included in the model, and evaluation. Once the model is implemented and evaluated it will be expanded to new sites throughout the province.

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

  • Expanding access to community-based MHA services for children and youth (age 10–25), recognizing the effectiveness of early interventions to treat mild to moderate mental health disorders;
  • Spreading evidence-based models of community mental health care and culturally-appropriate interventions that are integrated with primary health services.

2. Enhance Access to Community Based MHA Supports

As previously noted, Nova Scotians have noted issues accessing MHA services. There are wait-times for community-based care, a lack of after-hour and weekend community MHA services, inconsistencies in crisis service coverage provided to emergency departments of regional facilities across NSHA, and patients seen in crisis often experience long waits for follow-up. We know that access issues are more prevalent in rural areas and First Nations communities. While the Province has made significant investments in improving access, challenges still exist. Federal funding will augment provincial funding to support further efforts to improve access to care.

Federal funding will be used to increase the number of mental health clinicians in the community sector, for children and adults. The type, number, and geographic location of additional resources will be determined based on need. We already know additional clinicians are needed in First Nations communities; as such, planning is underway to add eight new clinicians in this area. Addressing known areas of need (both geographic and type of clinical interventions) will facilitate access to appropriate services where and when needed.

Nova Scotia will leverage federal funding to support the development and implementation of a standardized care model that will integrate community-based MHA supports into Nova Scotia's collaborative primary health care model. This integration will improve access to services for children, youth, adults and families, and will create solutions, opportunities and supports through comprehensive primary health care. This model will encompass evidence-based, effective health promotion, prevention and treatment. It will be rolled out in accordance with the development of collaborative primary health care teams and identified need. Funding will support the cost of integrated supports, recruitment and training of clinicians, implementation of services, and evaluation. Once evaluated, effectiveness and need will determine future expansion throughout the province.

Nova Scotia will also use federal funding to support provincial investments targeted at improving access to MHA crisis services. Additional funding will allow the expansion of MHA crisis teams who provide consultative services to emergency departments in regional facilities. Additional clinicians will be added to teams across the province, to ensure core crisis service coverage levels across all emergency departments in regional hospitals. Enhancements will also be made to the Provincial Crisis Line, funding will support telephone system upgrades which will allow callers to wait for the next available intervenor rather than leaving a message. As well, Crisis Line capacity will be increased through the addition of new staff. Additional funding will also be used to Increase capacity for urgent follow up of clients seen by a crisis response teams. Federal funding will support additional clinicians who will provide rapid follow up and short-term assistance to clients who have experienced a crisis, while they wait for an appointment with an outpatient/community-based MHA clinic.

Investments will also be made in IT/IM solutions that will improve access to MHA service. Federal funding will be used to support the implementation of central Intake for MHA services. Employing a central intake system will facilitate consistent MHA client screening and triage, and hence appropriate referrals for service. It will facilitate a single point of entry for MHA services within NSHA and IWK assisting clients and providers with navigating a complex system. This investment will also facilitate enhanced consistency and integration of practices across the four management zones under NSHA and IWK. Federal funding will support the ongoing development of IT/IM infrastructure that maximizes the integration with current and future systems. Funding will also support the development of triage materials, staff training, additional clinicians, and to raise awareness of single-point of entry for Nova Scotians.

Finally, Nova Scotia will invest federal funding in technology-based interventions that will improve access to MHA treatment services. Federal funding will be leveraged to enhance Provincial investment in evidence-based virtual care solutions, such as video-conferencing, telephone or online programming for treatment including therapist-assisted cognitive behavioural therapy. The utilization of virtual solutions in Nova Scotia will enhance access to services by augmenting and or replacing traditional therapies. It will also support enhanced integration between MHA services and primary health care by diversifying the basket of service options available in primary health care settings.

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

  • Expanding access to community-based MHA 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 MHA care and culturally-appropriate interventions that are integrated with primary health care services.
  • Expanding availability of integrated community-based MHA services for people with complex health needs.

As with continuing care inductivities, to ensure MHA federal funding is used as intended, implemented in a timely manner and evaluated as required, federal funding will be used to support a project management team. This cost is included in the overall cost attributed to the above initiatives.

The following table summarizes the proposed allocation of federal funding for Mental Health and Addictions.

Funding Breakdown by Initiative
Funding Breakdown by Initiative 17/18Footnote * 18/19Footnote * 19/20Footnote * 20/21Footnote ** 21/22Footnote ** 5 Year Total
Total Federal Investment in Mental Health and Addictions Services $2,620,000 $6,480,000 $11,630,000 $15,510,000 $15,510,000 $51,750,000
Mental Health and Addictions Services $2,620,000         $2,620,000
Enhance Integrated Service Delivery for Children and Youth   $4,653,000 $6,595,000 $8,190,000 $8,150,000 $27,588,000
Enhance Access to Community Based MHA Services   $915,000 $5,947,000 $7,320,000 $7,360,000 $21,542,000
Total Federal Investment from above minus/plus Carry-Over $2,620,000 $5,568,000 $12,542,000 $15,510,000 $15,510,000 $51,750,000
Carry-overFootnote ***   $912,000        
Prior year funding to be spent in year     $912,000      
Percentage carry-over of total federal funding for mental health and addiction services   14.1% 0.0%
     
*

2017-18 funding provided through legislation. 2018-19 and 2019-20 are rounded allocations based on section 4.2.3 of the Agreement.

Return to footnote * referrer

**

Allocations are notional. Funding allocations are subject to annual adjustment based on the formula described in section 4.2.3 of the Agreement.

Return to footnote ** referrer

***

Carry-over to accommodate additional time required to introduce and run programs.

Return to footnote *** referrer

Proposed Performance Measurement

The Investment and Decision Support Division of the Department has identified a resource to support and participate in the CIHI-led process to develop common indicators and will share data with CIHI on agreed-upon indicators.

The Department of Health and Wellness has developed an accountability and monitoring framework for the initiatives in this agreement. The framework supports strategic planning, continuous quality improvement and financial management. The indicators below will be used to track progress; others may be added as required.

Mental Health and Addictions Proposed Performance Measurement
Initiative Output/Outcome Measures Target by 2021/22

Enhance integrated service delivery for children and youth

Increased access to MHA resources for youth in community and in schools.
Increased accessibility to MHA programming for youth, especially in rural areas. 
A standardized provincial approach to prevention and early intervention.

  1. Increase in number of SchoolsPlus visits
  2. Deployment, provider type and location of new FTEs
  3. Increase in the number of youth accessing CaperBase services
  4. Deployment, provider type and location of new FTEs
  5. Increase in the percentage of youth health centres implementing a provincial, standardized approach to prevention and early intervention

Targets will be identified as initiatives are developed and implemented.
All targets will be identified by December 2019.

Enhance Access to Community-based MHA Services

Decreased demand for inpatient and emergency department services due to enhanced crisis response services
Better integration with primary health care; enhanced efficiency and effectiveness in delivery of services.

  1. Wait Times for Urgent/Priority Visits within Benchmark (7 Days)
  2. Increase in the volume (percentage) of people who receive crisis support and rapid follow-up
  3. Increase in the number of new MHA clinicians hired across the province
  4. Increase in the percentage of priority triage wait-time to first Visit to Community MHA services, within target
  5. Increase in the percentage regular triage wait-time to first visit to Community MHA services, within target
  6. Increase in the percentage priority triage wait-time to first treatment to Community MHA services, within target
  7. Increase in the percentage of triage wait-time to first treatment to Community MHA services, within target
  8. Increase in the number of sites employing central intake to support access/% completion of Central Intake Initiative

Targets will be identified as initiatives are developed and implemented.
All targets will be identified by December 2019.

Nova Scotia Action Plan for Increased Infection Prevention and Control

I. Overview

Background

Nova Scotia (NS) provides a range of services and funding to support the health and wellbeing of individuals living in their own home or in a long-term care residence. Nova Scotia has committed just over $1B in continuing care services for 2021-22, which represents 18% of the provincial health budget.

The Department of Seniors and Long-Term Care (DSLTC) is a newly formed department, and Continuing Care was formerly a branch within the Department of Health and Wellness (DHWFootnote 12).

Continuing Care is broken into two main categories of service – home and community support (including direct benefits) and long-term care (LTC) facilities. Continuing Care supports almost 40,000 Nova Scotians annually, over 80 percent of whom are over the age of 65. There are approximately 7,800 nursing home beds in 133 facilities, 1.1 million home nursing visits, and 3 million direct service hours delivered for home support. Support is also provided to young adults and pediatric clients through continuing care programs and services.

Demographic summary for Long-term care facilities (as of October 14, 2021):

  • Residents age range 92% are 65 and over
  • 68% Female, 32% Male
  • Primary language is 96% English, 3% French, 1% Other (none over 0.5% in any zone)
  • There are smaller French communities across NS and there are LTC facilities in or close to these communities.
  • There is currently a nursing home being built in the Indigenous community of Eskasoni.

LTC facilities are across four zones in Nova Scotia:

Number of clients Column labels
Age Range2 Western Zone 1 Northern Zone 2 Eastern Zone 3 Central Zone 4 Grand Total
0 to 18 8 - 1 - 9
19 to 35 15 2 3 8 28
36 to 65 129 112 131 221 593
66 to 85 939 748 858 1,144 3,689
86+ 907 683 758 945 3,293
Total 1,998 1,545 1,751 2,318 7,612

LTC facilities referred to in this document are licensed and funded by the DLSTC.

LTC facilities provide services for people who need ongoing care; either on a long-term basis (permanent placement) or short-term basis (respite care). There are two types of LTC facilities available, nursing homes (the highest care option available) and residential care facilities (for lighter care). These LTC facilities include profit and not for profit operators.

There are private, unlicensed facilities across Nova Scotia that provide various levels of service to Nova Scotians who seek and pay for private services. The Department does not license, nor fund these private facilities and does not have a line of sight into these private facilities. These private facilities do not receive provincial funding, nor will they be recipients of federal funding.

DSLTC is responsible for licensing nursing homes and residential care facilities under the Homes for Special Care Act. The licensee is responsible for ensuring facilities comply with legislation, provincial policies, and program requirements. All facilities are inspected twice per year, and the results of those inspections are posted publicly. Some facilities are accredited; however, this is a voluntary process and not mandated. At this time, DSLTC does not collect data on the number of homes accredited.

LTC has changed substantially over the last few decades, with resident care needs becoming more complex and acute. At the same time, staffing models and infrastructure design have not kept pace. In December 2018, a LTC Expert Panel provided DHW with a list of 22 recommendations to support improved care in LTC, many of which were related to staffing. While improved staffing levels have been supported through increased funding, recruitment of staff continues to be an issue in this sector across the province.

Actions Taken Since Spring 2020

Following the COVID-19 pandemic's first wave, a review was completed and a report submitted to the Minister on September 21, 2020. This report is publicly available on the Department's website. This report, COVID-19 First Wave Review identified the challenges and solutions that has informed the continued response and planning for future waves in NS. Early lessons learned included:

  • Outbreak responses in LTC were performed on a facility-by-facility basis as opposed to applying a consistent provincial approach, leading to variability in responses.
  • Accessible and real-time Infection Prevention and Control (IPAC) and Occupational Health and Safety (OHS) supports, information and guidelines were limited within the sector and are key components to successfully minimizing COVID-19 pandemic impacts.
  • Enhanced screening protocols, positive test results and other challenges led to a reduced workforce capacity. In outbreak situations, staffing challenges were compounded by contact tracing and isolation requirements for COVID positive cases, close contacts of positive cases and sick staff.
  • While individual LTC facilities were supported to hold bed vacancies in the case of outbreaks (in order to cohort COVID-19 positive residents), this led to challenges within the health system overall, increasing LTC waitlists both in hospital and in community.
  • LTC service providers were accessing PPE from existing suppliers or wherever possible, and in many cases were struggling to consistently secure the PPE required.
  • With the lockdown that occurred during Wave I, families were unable to visit their loved ones, which led to a reported decrease in mental health and wellbeing in residents.

The Response to Date

A number of steps were taken by NS to support the LTC sector in the implementation of public health and other supportive measures to mitigate COVID-19 impacts, including:

  • A Directive for LTC was issued under the Health Protection Act early in Wave I, and this has evolved over time to reflect changes in restrictions as per the epidemiology and vaccination status of residents and staff.
  • Robust set of guidelines and directives, established in collaboration with Public Health, Nova Scotia Heath Authority Infection Prevention and Control team, service providers and the department.
  • Regular teleconference calls were held to update the provincial sector and provide the most current information, raise concerns and answer questions. At the height of the pandemic, these calls were weekly. Professionals across the sector such as Occupational Health Sector, Infection Prevention and Control, Public Health and other key stakeholders were included.
  • Development of processes/funding to support acute oxygen therapy in LTC, specific to COVID related illness.
  • Financial support to LTC for COVID-19-related expenses (such as enhanced environmental cleaning, additional staffing, PPE, etc.)
  • Provision of additional OHS supports to the sector.
  • Active participation in outbreak management, including the establishment of an HHR deployment centre to support facility staffing needs during critical shortages.
  • Support and guidance from key stakeholders at outbreak management meetings.

Nova Scotia is divided into 4 zones which include Central, Northern, Eastern and Western and is based on geographical boundaries. The response to Covid-19 was to all the LTC facilities within these zones and an equitable lens was applied to every initiative and every communication.
Following Wave I, DHW partnered with sector representatives and the Nova Scotia Health Authority to identify 'lessons learned', which resulted in the implementation of a Wave II Plan. The Wave II plan included four key areas of focus:

1. Coordinated Outbreak Response and Supports:

Rapid Response Teams were created across the province to be a single point of contact for facilities and coordinate the management of outbreaks, including provision of IPAC and OHS supports. In addition, the province implemented Regional Care Units (RCU) in each zone. The RCU allowed residents who tested positive for COVID-19, to be transferred to receive safe, effective and coordinated care. This approach supported residents and health care providers within long-term care.

2. Increasing Health Workforce Supply and Supporting Employee Safety, including:

  • The introduction of a staff deployment model to better manage the deployment of resources across the health system,
  • The introduction of Nova Scotia Health Authority (NSHA) Infection Control Practitioners (ICP) and NSHA-OHS supports to staff. This initiative will be supported through Safe Restart funding.
  • Processes for obtaining and ordering Personal Protective Equipment (PPE) was put into place and proactive distribution of PPE was established. This initiative will be supported through Safe Restart funding.
  • Universal access to employee and family assistance programs was also provided to all employees working in Continuing Care.
  • Additional on-site HR supports included funding for temporary long-term care assistant (LTCA) role, extra cleaning staff, and for Infection Control (IC) designates-clinical nurse at the LTC site level. The temporary LTCA role and the IC designates-clinical nurse at the LTC site level will be supported through Safe Restart funding. Staff in LTC participated in serial testing programs. In many homes it is the IC-clinical nurse at the LTC that lead/participate in this work.
  • Residents, staff and designated care providers and were prioritized for vaccines starting in December 2020. Vaccine boosters for LTC residents will start in October 2021. In many homes it is the IC designates-clinical nurse at the LTC that lead/participate in this work. The IC designates-clinical nurse at the LTC site level will be supported though Safe Restart funds.

3. Communication and Information Sharing. Mechanisms to communicate and share updates and critical information with the sector were developed, including:

  • Sector-wide teleconferencing with all Continuing Care stakeholders to ensure equitable and timely access to information. This mechanism provided opportunity for questions and discussions. The approach was responsive to the needs of the sector.
  • The development of a COVID-19 inbox to field and respond to questions in a timely manner with consistent messaging.
  • The development of a secured website where providers were able to access most current guidelines and resources in a timely manner. The approach was responsive to the needs of the sector.
  • DHW developed Outbreak Response Toolkits to support facilities in developing and implementing their response plans.

4. Maintaining Resident Quality of Life:

During Wave I, DHW provided iPads to all LTC facilities in the province to facilitate ongoing family connections with residents who were unable to accept in-person visitors. Post Wave I, a phased approach to shifting restrictions that balanced physical safety with the mental health and well-being of residents and families was implemented. As epidemiology shifted, so did the restrictions.

The introduction of the role of Designated Caregiver ensured that even during lockdown, family and friends who were integral to the resident care team were able to maintain a presence in facilities. Designated Caregivers were prioritized for vaccines through on-site clinics to ensure the health of residents would not be compromised during future outbreaks.

Measures taken with respect to Infection Prevention and Control (IPAC) Readiness:

  1. Long-term Care Assistant (LTCA): The LTCA role was scaled up to support additional processes required to enable IPAC and public health requirements such as screening and cleaning protocols.
  2. Staff Deployment Model: A provincial COVID-19 Staff Deployment Model was rapidly put in place in partnership with the NSHA, leveraging the HR recruitment and deployment capacity that existed within the province's largest health care employer. The deployment model supported staffing needs in LTC facilities in outbreak situations.
  3. Essential Worker Program: NS implemented the Essential Healthcare Workers Program with Federal funding support to provide bonuses to those health care staff who worked directly with clients during the first wave of COVID-19. This program is the result of a partnership between the Provincial and Federal government.
    This 4-month program was for eligible employees who worked between March 13, 2020 and July 12, 2020. All claims that met program criteria have been paid and no further claims are being accepted.
    • Approximately 36,000 employees received this benefit.
    • Eligible employees received $500/month for each month worked in the four-month period.
    • Eligible employees included: publicly funded long term care and home care workers, paramedics, dispatchers, telehealth, transition houses, shelters and pop-up shelters, Adult Residential Centres, Regional Rehabilitation Centres, Small Options, Groups Homes Development Residences and Residential Care Facilities.
  4. EFAP: Financial support to access mental health programs for Continuing Care staff who supported the most vulnerable populations in Nova Scotia during the COVID-19 pandemic.

Measures taken with respect to Infrastructure and Renovations:

  1. IPAC infrastructure investments/capital renewal: Supporting capital and small infrastructure projects to provide IPAC support to LTC homes to, for example, upgrade high touch surfaces for easier sanitization, reconfigure entrances to effectively control entry to the facility and repurpose common spaces to allow for distancing of people.
  2. Elimination of high occupancy rooms: 127 beds have been removed from operations to reduce shared accommodations. This included the elimination of triple occupancy rooms and 27 beds were removed to eliminate triple rooms.
    100 of the eliminated beds were within Northwood Halifax, which was the hardest hit LTC facility in NS. These beds will be rebuilt in single rooms in a new location within the Halifax Regional Municipality.
  3. Creation of extra capacity (and hotel): Where suitable infrastructure was available, new capacity was created to enable isolation and COVID-19 treatment models, and to mitigate the loss of capacity due to the implementation of IPAC measures. To build capacity the department converted 32 respite nursing home beds to temporary permanent nursing home beds for a period of 18-24 months and kept 13 emergency respite beds.
  4. Regional Care Units: In response to lessons learned from the first wave of the COVID-19 pandemic, Regional Care Units (RCUs) have been implemented to provide safe, effective, and coordinated care to LTC residents who test positive for COVID-19, for the duration of their infectious period. Moving the resident with COVID-19 to a RCU reduces risk to other residents within the LTC facility.

Measures taken in relation to Readiness Assessments for the prevention of COVID infections:

  1. IPAC and OH&S teams: Robust teams dedicated to supporting the Continuing Care providers with training, education, tools, best practices, monitoring and reviews, surveillance, and outbreak management.
  2. COVID-19 First Wave Review: The 2020 COVID-19 pandemic highlighted the importance of IPAC to ensure the health and safety of LTC residents/clients and staff in our province. The purpose of this project was to conduct a review of IPAC policies, processes, practices, resources, and accountability in Nova Scotia's LTC sector to strengthen the sector's preparedness for, and response to, infectious disease outbreaks. The Project Team completed a comprehensive review of the current state, identified sector challenges, and, through collaboration with sector partners, developed solutions to address the challenges. Twenty-four recommendations/solutions were proposed; twenty-three are now complete with one long-term recommendation underway.
  3. Northwood Quality-improvement Review: Northwood represents the largest COVID-19 outbreak in Nova Scotia. This report focuses on quality-improvement and was informed by consultations with more than 350 stakeholders including residents and their families, staff members, healthcare practitioners and leaders involved in the response to the outbreak. To help Northwood and other long-term care facilities better prepare for possible future waves of COVID-19, seventeen recommendations were made. Twelve of these have been implemented, while five long-term recommendations are underway.

Additional Measures Underway:

  1. Serial Testing: Based on concerns for the asymptomatic transmission of COVID, serial asymptomatic testing of LTC staff was implemented. This initially was PCR testing however as of July 2021 has now pivoted to rapid, point of care testing unless directed by Public Health.
  2. Environmental service: Funding was provided to sites for supplies, staff and/or equipment to support additional cleaning.
  3. PPE distribution (and other supplies): DHW has partnered with the Health Association of Nova Scotia (HANS) to support the coordination of access to PPE. PPE for COVID-19-related purposes is supplied by the provincial PPE inventory. HANS facilitates access to, and delivery of, inventory across LTC and home care providers and schedules proactive bi-monthly deliveries.
  4. IPAC education and training: Staff in long-term care were provided with tools, resources and training throughout the pandemic, in addition to site visits and in-person advice and guidance provided by Infection Control Practitioners.

II. Areas of Focus

Areas of Focus for Increased Infection Prevention and Control to be Supported by Safe Long-term Care Funding. The areas of focus outlined below have been key in the provincial response. and federal funding will be used towards the initiatives:

  1. Continued support of the Long-term Care Assistant (LTCA) role: The temporary LTCA role has been critical to the COVID-19 response in our long-term care settings. LTCAs have played an active role in scheduling, screening, and supervising visitations and volunteers, while supporting nurses and Continuing Care Assistants (CCAs) where appropriate. This has been extremely important during a time when the supply of CCAs who provide the personal care is limited. The funding for this role was extended knowing Safe Long-Term Care funding was coming to the province.
  2. Creation of extra capacity (and hotel): Where suitable infrastructure was available, capacity was created to enable isolation and COVID-19 treatment models. Several minor renovations were supported to support IPAC, the LTC annual capital budget increased by $9M, and several facility replacements have been announced. Federal funding will support the provinces approach and ability to flex up when needed and support isolation models appropriate to the situation.
    To build capacity within the sector DHW converted 32 respite nursing home beds to temporary permanent nursing home beds for a period of 18-24 months and kept 13 emergency respite beds
  3. Tools and resources provision: Tools were provided to allow LTC facilities to conduct their own readiness assessments; in addition, Infection Control Practitioners visited every nursing home in the province to perform IPAC assessments and provide advice and guidance to inform capital improvement requests. The goal of this work is to increase IPAC knowledge at the LTC sites and allow staff to conduct IPAC assessments and surveillance. The primary focus has been COVID-19 response and building knowledge and capacity within LTC sites will take time.
  4. Continuation of 4 provincial Infection Control Practitioners (ICPs) and 1 Infection Control manager dedicated to support the Continuing Care sector with education, tools, best practices, monitoring and reviews, surveillance guidance, and outbreak management. The ICP works with the IC designate (clinical nurse) to build capacity at the Long-term care site level.
  5. Continuation of dedicated temporary funding for Infection Control (IC) designates; clinical nurses in LTC to promote and lead healthcare-associated infection prevention initiatives by engaging and educating colleagues on site, solving problems, and communicating across all levels of leadership in their organization.
    *The areas of focus identified as 3, 4 and 5 provide a coordinated effort in this area as the ICPs lead the programs with education, tools and resources for the IC designates on site at the LTC homes. Federal funding will support LTC to be better prepared and responsive in their approach to Infection Prevention and Control.
  6. Continued support of the established OH&S Team that is dedicated to supporting the Continuing Care providers with support, training, and education.
  7. PPE distribution (and other supplies) via the Health Association of NS (HANS). PPE for COVID-19 purposes is supplied by the provincial PPE inventory. HANS facilitates access and ordering from that inventory across LTC and home care providers and schedules proactive bi-monthly deliveries to ensure sites have supplies on hand in the event of an emergency.

Nova Scotia's Broader Strategy for Long-term Care

COVID-19 has highlighted the many challenges that exist in the current design and delivery of continuing care in Nova Scotia. The Infection Prevention and Control (IPAC) review COVID-19 First Wave Review and the Northwood review led to several recommendations related to governance and accountability, legislation, workforce, infrastructure, and resident quality of life. Many of these themes have been emulated in other reviews undertaken just prior to COVID-19, such as the Minister's Expert Advisory Panel on LTC.

Significant work to date has been completed to understand the challenges and issues creating pressures on our policies and programs, and to define the path for change. Fundamental changes in how the system is designed, staffed and governed needs to address growing demand for services, improved quality and access to care, and create a more sustainable system for our Seniors and their families. Work to modernize the system has begun in all LTC, and an equitable lens is applied to all the licensed and funded LTC sites (profit and not for profit). These initiatives include the following:

  • investment in the Inter-RAI (International Resident Assessment Instrument) in LTC to improve data and inform more responsive care for residents,
  • new and renovated infrastructure (taking into consideration IPAC lessons from COVID-19),
  • increasing allied health staff in LTC, and reviewing staffing models across the system,
  • designing improved accountability and quality improvement frameworks, and
  • modernizing legislation.

III. Initiatives

1. Initiatives in the three main priority areas

  1. Staff Support: Long-Term Care Assistants (LTCA) - $12.319M

This role was initiated in LTC to provide immediate support to alleviate an overstressed workforce and improve work conditions. This role became very significant in supporting the sector through the COVID-19 pandemic, as the working conditions within LTC have remained stressful and COVID 19 guidelines remain in place for LTC.

Funding is distributed directly to long term care providers, who complete the hiring and management of the LTCA in their facility (both for profit and not for profit). Lump sum payments were made to facilities so they could plan for their staffing. Letters were provided to all facilities, identifying the purpose of the funding, and LTC facilities were made aware to retain supporting documentation as they may be audited in the future. Prior to implementing the lump sum payments, we had used a claims-based model; however, the decision was made to give LTC facilities the funding in advance. This way, they would know the amount of funding available to them and adjust the hiring of LTCA accordingly.

Temporary funding was initiated in 2020 and continued as necessary to support the COVID response in 2021. Provincial funding of $10.87M was used from March 2020 to March 2021. However, this initiative is still ongoing and additional funding is required to sustain the COVID -19 response.
This funding supports over 350 Full time equivalents (FTEs) of Long-term Care Assistants. An equitable lens is applied, and allocations are based on the size of the facility.

Approximately $4.5M of the $12.15M requested has been spent as of October 2021.

  1. Infrastructure/ Environmental: to support infection prevention and control (IPAC) - $8.95M

Where suitable infrastructure was available, capacity was created to mitigate the loss of capacity in creating isolation rooms, eliminating triple rooms across the province, and moving to single rooms at the Northwood Halifax location.

Funding was provided to support infrastructure to enhance infection prevention and control measures. Funding to enhance infection prevention and control measures began in March 2020.

  1. Readiness: Infection Control Designate - $4.6M

A robust Infection Prevention and Control (IPAC) program can significantly reduce the impact of healthcare-associated infections.

DHW partnered with NSHA to develop a sustainable IPAC program for LTC. The NSHA IPAC team dedicated to LTC was established in the fall, following a review of IPAC in LTC after the first wave of COVID 19. The model was developed to train and empower the Infection Control (IC) designates-clinical nurses in LTC to promote and lead healthcare-associated IPAC initiatives. This initiative will ensure a sustainable network of IC designates that can serve to promote best practices in their facilities and build a culture of IPAC in LTC.

The initial work focused on COVID-19 response, however, next steps include developing and enhancing IPAC surveillance programs in LTC facilities. Success is incumbent on IC designates (clinical nurses) being present on site to collect the data correctly, interpret findings, identify trends and implement measures that will immediately reduce infections and support quality improvement.

Federal funding will be used to support the IC designate role. Funding was provided directly to the LTC facility (both for profit and not for profit). Before funding was issued, the department required confirmation that the LTC homes were able to implement this initiative. As well, facilities were given written notice that they are subject to auditing, if requested. This funding supports 48.05 FTEs; an equitable lens is applied and allocation of FTEs per LTC home are based on the size of the facility.

INITIATIVES IN THREE MAIN PRIORITY AREAS
Funding Allocation by Initiative and Facility
Priority Area 2020-21 2021-22 Total
Staff support measures and hiring additional human resources   $12,319,000 $12,319,000
Infrastructure/Environment to support IPAC   $8,950,000 $8,950,000
Readiness assessment-IC Designate   $4,600,000 $4,600,000
By Facility Category Facilities 2021-22 2021-22 Total
Publicly funded facilities/ residences 133 Facilities across 4 health zones   $25,869,000 $25,869,000
Total support for publicly funded facilities/residences   $25,869,000 $25,869,000
Footnote *

To be updated in February 2022 to provide additional information, if not currently available, and to align with cost recovery requirements

Return to footnote * referrer

2. Additional initiatives to increase infection prevention and control

  1. IPAC Team Supports - $1.215M

The NSHA IPAC are a team of 5 clinicians at Nova Scotia Health that provide dedicated support to LTC and have partnered with the Government of Nova Scotia. The team members are considered experts, are formally accredited and have Certification in Infection Control (CIC) designation. They work with IC designates in LTC and share/ provide education as well as provide ongoing support to build capacity within facilities.

The team is dedicated to LTC, and the support model was developed to build capacity in the sector and empower the IC designates-clinical nurses in LTC to promote and lead healthcare-associated IPAC initiatives. This initiative will ensure a sustainable network of IC designates that can serve to promote best practices in their facilities and build a culture of IPAC in LTC. Funding is provided directly to Nova Scotia Health Authority (NSHA) and they provide education and support to all LTC facilities in all zones across the sector.

NSHA will maintain records and documentation on funding received through this initiative.

  1. PPE distribution (and other supplies) - $0.18M

DHW has partnered with the Health Association of Nova Scotia (HANS) to support the coordination of access to PPE. PPE for COVID-19 purposes is supplied by the provincial PPE inventory. HANS facilitates access and ordering from that inventory across LTC and home care providers and schedules proactive bi-monthly deliveries to ensure sites have readiness supplies on hand in the event of an emergency.

Funding is provided directly to HANS, and they distribute to private and not for profit facilities. It is HANS's responsibility to maintain records for accountability and may be audited in the future for accountability. HANS takes the orders for PPE and delivers products across the province.

ADDITIONAL INITIATIVES
Funding Allocation by Initiative and Facility
Initiative areas 2020-21 2021-22 Total
IPAC Team Supports (see above)   $1,215,000 $1,215,000
PPE Coordination $60,000 $120,000 $180,000
By Facility Category Facilities 2020-21 2021-22 Total
Publicly funded facilities/ residences Health Association of Nova Scotia $60,000 $120,000 $180,000
Nova Scotia Health Authority   $1,215,000 $1,215,000
Total support for publicly funded facilities/residences $60,000 $1,335,000 $1,395,000

IV. Cost Recovery in For-Profit Facilities/Residences

The current financial accountability process with licensed and funded LTC facilities is to send a funding letter that outlines the amount of funding, time period for the funding, expectations on the use of funding, any conditions specific to the funding and a requirement for invoices along with ability to report on the utilization of funding, should more information be required. Accountability for funding is the same for all facilities (for-profit and not-for-profit) that fall under the jurisdiction of the DSLTC.

Nova Scotia uses cost share methodology that funds all facilities for a portion of total expenses. To ensure Safe Long-term Care funding support does not displace existing investments made by these for-profit operators, and to demonstrate the facilities' commitment to enhanced infection prevention and control measures, facilities will also contribute financial and in kind support to implement IPAC measures and system supports. Through this implementation, DSLTC will seek to identify how funding has continued to enhance overall COVID response and continue to promote and support infection prevention and control measures.

Finance has compiled this table to show the breakdown of the funding to the licenced LTC facilities in the two categories of profit and not for profit homes:

BREAKDOWN BY FACILITY OWNERSHIP
Funding Allocation by Facility
Initiative areas For Profit
(% of total funding)
Not For Profit
(% of total funding)
Total
Staff support measures and hiring additional human resources $4,882,000 (40%) $7,437,000 (60%) $12,319,000
Infrastructure/Environment to support IPAC $3,943,000 (44%) $5,007,000 (56%) $8,950,000
Readiness assessment-IC Designate $1,946,000 (42%) $2,654,000 (58%) $4,600,000
IPAC Team Supports - $1,215,000 (100%) $1,215,000
PPE Coordination $80,000 (44%) $100,000 (56%) $180,000
Total $10,851,000 (40%) $16,413,000 (60%) $27,264,000

V. Performance Measurement and Expected Results

MAIN PRIORITY AREAS
Priority Area Performance Measure Target / Outcomes Reporting and Results

Staff support/retention measures:

  • Wages and salaries
  • hiring additional human resources
  • other

# FTE human resources added

All FTE positions filled

Outcomes:

  • Limited outbreaks and spread in LTC
  • Long-Term care staff will be supported.

Status Reports (Nov 10, 2021)
FTEs funded vs planned

All FTEs in LTC are not at full complement due to inability to recruit and retain workers. Through provincial funding there is a $3M strategy on Recruitment and Retention that was recently announced with the goal to build the workforce across NS.

The long-term care assistant role provided additional staffing to support the LTC homes in maintaining infection prevention and control such as screening of visitors, supporting social/physical distancing, assisting the staff where needed.

Final Results (February 22, 2022)

Investment for fiscal year 2021-2022 is $14.8 million in funding, and this includes $12.3 million dollars from the Safe Long-term Care Funding. This investment supports over 340 FTEs of the temporary Long-term Care Assistants.

The LTCA’s have been instrumental in supporting infection prevention and control measures for residents, designated caregivers, and visitors in long-term care. For example, screening of visitors and designated care givers, supporting social/physical distancing, assisting the staff where needed to support resident care.

Facilities were provided two lump sum funding payments to cover the fiscal year 2021/ 2022. This allowed facilities to plan for additional resources and expenditures.

Priority Area Performance Measure Target / Outcomes Reporting and Results

Infrastructure/ renovations and environment to support IPAC

# New beds added to the system

Environmental supports to enhance IPAC and limit outbreaks

# of single beds added in the system during COVID-19, every nursing home to have an isolation room during COVID-19
Much of the current work is solutions that can be actioned now and respond to current state.
Government has committed to adding beds to the system and a team is being formed and will develop a detailed roadmap for the future.
Outcomes:
Limited outbreaks and spread in LTC

Status Reports (Nov 10, 2021)

The following capacity has been added across NS:
- 106 Veteran Affair (VAC) beds have been converted to public licenced and funded beds
- 25 bed Community Transition Unit (CTU) that offered LTC placement as a transition from hospital to LTC for a defined population to better support access and flow within the system
- Conversion of lower care level beds (RCF) to higher level of care beds (NH). This includes:
- 21 Ivany RCF to NH
- 7 Ryan Hall RCF to NH
- 10 Wynn Park RCF to NH

Total of 144 beds added to the system since Fall 2020, plus 25 bed CTU.

Final Reporting Results (February 22, 2022)

Safe Long-Term Care funding has been directed to support environmental costs to enhance IPAC as it was recognized as an area requiring additional support.

Environmental:

Facilities were provided two lump sum funding payments to cover the fiscal year 2021/ 2022. This allowed facilities to plan for additional resources and expenditures.

The funding continues to assist sites in environmental and outbreak management, funding cleaning supplies, cleaning equipment, and/or hiring of additional staff for the purposes of enhanced cleaning, as required.

Safe Long-Term Care funding in the amount of $8,950,000 has been directed to support environmental costs to enhance the environment to promote infection prevention and control.

Infrastructure:

The additional costs for Infrastructure were not funded through Safe Long-Term Care fund.

Priority Area Performance Measure Target / Outcomes Reporting and Results

IC Readiness assessment at LTC sites – Infection Control Designates

# Readiness assessments

All facilities to have completed a readiness assessment as relates to IPAC

Outcomes:
Limited outbreaks and spread in LTC

Improved IPAC measures as reported
-Increased compliance with IPAC standards
-Improved access experts for information related to IPAC
-Improved standardization of education, policy and processes related to IPAC

Status Reports (Nov 10, 2021)

The LTC sites now have access to the IPAC consultants within each zone to work with the onsite Infection Control (IC) designates to support current outbreaks and building their knowledge with standard educations and tools. This work is ongoing.

Due to the current 4th wave in NS and ongoing work related to COVID 19, starting on site surveillance programs has been delayed at some sites.

Final Reporting Results (February 22, 2022)

In December of 2020, 131 LTC facilities were funded to appoint a dedicated Infection Control (IC) Designate. Funding was based on facility size for a total for 48.05 FTEs across the province.

This role has continued into 2021/2022 with the support of the Safe Long-Term Care fund. The IC Designate supports infection control assessment and readiness at the site level.

Facilities were provided two lump sum funding payments to cover the fiscal year 2021/ 2022. This allowed facilities to plan for the IC Designate resource.

Survey responses from LTC facilities indicated that the funding of IC Designates provided sector wide improvements in five categories:

  1. staff training & education
  2. Vaccine preparation & audits
  3. Acting as a consistent resource for staff
  4. COVID/IC leadership within the facility and
  5. Development and/or enhancement of screening, cleaning, and compliance protocols.

Positive feedback from facilities has continued.

The IC Designates continue to be supported by the NSH Infection Prevention and Control (IPAC) team, with their ongoing provision of expertise.

The IPAC team is available for virtual and on-site visits providing support for the IC Designates to complete readiness assessments to support prevention and outbreak management along with ongoing surveillance. This has prepared facilities and promoted increased awareness and compliance with standards across the province.

The IPAC Team provides consistent education and tools for the IC Designates to utilize, in the delivery of training and education of staff, designated caregivers and visitors. This support has enhanced facilities readiness and management of COVID-19. Please refer to the specifics in the IPAC Team section below.

The IC Designates continue to be supported by the OHS Support Team in collaboration with the 833 Intake line. The team provides expert advise and improved access to consultations related to staff measures during outbreaks, contract tracing and can expedite health care worker testing. Please refer to the specifics in the IPAC section below.

The IC Designates support contract tracing onsite which contributes to the facilities ability in prevention and management of outbreaks.

Some for-profit facilities/organizations have chosen to provide additional centralized infection control oversite that is not funded directly by government nor reported to government. Some organizations have persons dedicated to this role while others have this role incorporated into one of their management roles.

Safe Long-Term Care funding has contributed $4,600,000 to the IC Designate role to support at LTC sites.

ADDITIONAL PRIORITY AREAS
Priority Area Performance Measure Target / Outcomes Reporting and Results

PPE & supplies

# PPE deliveries and depleted stock levels

All facilities have on hand PPE stock and access to quick delivery when needed

Outcomes:
Limited outbreaks and spread in LTC
along with available supplies when required

Status Reports (Nov 10, 2021)

Homes have ability to order the stock required to support them on an ongoing basis. It is direct ordering process.

They can set their reserve amounts based on their census and usage.

Final Reporting Results (February 22, 2022)

Safe Restart funding (SRA) supported this arrangement in 2020/2021 prior to the initiation of Safe Long-term Care funding in 2021/2022.

HANS continues to coordinate the delivery of PPE supplies to long-term care. LTC facilities have the ability to order supplies directly utilizing Shopify.

There have been no concerns raised from the facilities regarding this process and they continue to receive supplies quickly.

Safe Long-Term Care has funded $180,000 to the PPE initiative in 2021-2022.

Priority Area Performance Measure Target / Outcomes Reporting and Results

IPAC Team

# IPAC clinicians dedicated to LTC

All facilities have access to dedicated IPAC consultant

Outcomes:
Limited outbreaks and spread in LTC
Improved supports for staff and improved outcomes for residents

Status Reports (Nov 10, 2021)

The LTC sites now have access to dedicated IPAC consultants within each zone to support current outbreaks and building the staff's knowledge with standard educations and tools.

The IPAC team does virtual and onsite visits and the team has been available to help prepare teams for outbreak, onsite at the time of outbreak and lessons learned pots outbreak.
The support has been tremendous, and they have wrapped their arms around LTC to improve conditions for residents.

Final Reporting Results (February 22, 2022)

Prior to IPAC Team funding there was no provincial program to provide consistent infectious disease prevention and management dedicated for long-term care.

A provincial program for long-term care includes IPAC Clinicians, administrative staff, Clinical Nurse Educators, a portion of an OHS Manager, Occupational Health Nurses, Fit testers, and Occupational Health phone line consultants.

The Safe Long-Term Care funding has contributed to the establishment of a robust IPAC, Occupational Health and Safety program, which directly impacts healthcare for residents and health care workers, in the long-term care sector in Nova Scotia.

Feedback from the sector continues to be very positive.

A survey was conducted to understand the merits of the IPAC program.

Survey responses from LTC facilities indicated that the top 3 merits of having access to the IPAC consultants were:Survey responses from LTC facilities indicated that the top 3 merits of having access to the IPAC consultants were:

  1. Clear and effective solutions to IPAC concerns
  2. Consistent and supportive IPAC messaging and
  3. Directly influenced changes within the facility based on best practices

IPAC Clinicians provide virtual and/or onsite consultations/visits, to support outbreak management and surveillance.

In this fiscal year to date the IPAC Team has:

  • Completed onsite visits to 92 facilities and visited 102 facilities, as a follow up to their virtual visit.
  • Provided IPAC expertise and rapid response to outbreaks. The team attended 32 facilities for a total of 52 site visits.
  • Provided 18 IC Designate educational sessions to a total of 540 participants.
  • Provided 7 sessions on COVID-19 response to 150+ participants involving 98 facilities in total.
  • Provided 5 sessions on Environmental Services: Cleaning & Disinfection to 500 participants.
  • Provided electronic learning modules on Personal Protective Equipment (PPE), Droplet and Contact Precautions and Management of COVID-19.
  • Developed a suite of IPAC guidance materials targeted to address COVID-19 responses.
  • Developed a promotional campaign to promote use of IPAC measures in the workplace.
  • Promoted designated caregiver video and toolkit.
  • Available and attended all regular sector calls

The OHS team, provides virtual and/or onsite consultations/visits to support healthcare workers in outbreak occurrences, as well as access to telephone support for their questions and concerns. This work is ongoing and during 2021/2022 the following has occurred:

The Occupational Health Nurses have:

  • Provided support to 134 facilities.
  • Acted as a lead for calling staff and providing return to work guidance.
  • Acted as a lead resource for Occupational Health related matters for facilities.
  • Provided consultations on staff measures during outbreaks.
  • Performed 2,440 positive contact tracing
  • Participated facility outbreak meetings and Zone LTC outbreak review meetings

The 833 Intake lines:

  • Answered and/or returned 2755 calls with the LTC sector.
  • Provided health care worker advice and guidance regarding symptom identification
  • Provided PCR (Lab) COVID-19 testing referrals and expedited testing as required
  • Acted as the intake point for referrals to OHS Nurses for consultation/testing or facility concerns

The IPAC/OHS proposal was initially funded through SRA Federal funding fiscal year 2020/2021.

Safe Long-Term Care funding has contributed $1,215,000 to the IPAC team for 2021/2022.

Nova Scotia Health Authority (NSHA) has confirmed the actuals for the IPAC program as of January 31, 2022, is $1,421,758.

Footnotes

Footnote 1

Statistics Canada, Canadian Survey on Disability, 2012

Return to footnote 1 referrer

Footnote 2

Nova Scotia Department of Finance based on Statistics Canada, 2016

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Footnote 3

Nova Scotia Department of Health and Wellness, 2017

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Footnote 4

Nova Scotia Department of Finance 13-14 to 18-19 budget

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Footnote 5

https://www.wcb.ns.ca/About-Us/News-Room/News/Continued-progress-in-Nova-Scotias-workplace-injury-rate-but-its-taking-longer-for-those-who-are-hurt-to-return-to-work.aspx

Return to footnote 5 referrer

Footnote 6

Canadian Institute for Health Information, A Focus on Seniors and Aging, 2011, quoting Human Resources and Skills Development Canada, Caregivers

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Footnote 7

Analysis of DHW client assessment data (Seascape dataset)

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Footnote 8

Caring for Seniors with Alzheimer's Disease and Other Forms of Dementia, Analysis in Brief, Canadian Institute for Health Information (CIHI), August 2010

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Footnote 9

Mental Health Commission of Canada

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Footnote 10

Pan-Canadian Health Inequalities Data Tool, 2017 Edition

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Footnote 11

Domitrovich et al., 2010

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Footnote 12

In September 2021, the Department of Seniors and Long-Term Care was formed, and much of the current work and funding relationships was formerly with the Department of Health and Wellness.

Return to footnote 12 referrer

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