Canada-Nova Scotia Home and Community Care and Mental Health and Addictions Services 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 (herein referred to as "the provincial Minister")

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;

AND WHEREAS the Government of Canada makes ongoing investments in home and community care and mental health and addictions services for Indigenous communities and other federal populations.

NOW THEREFORE, Canada and 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).

2.0 Action Plan

2.1 Nova Scotia will invest federal funding provided through this Agreement in alignment with the selected action(s) from each menu of actions listed under home and community care and mental health and addictions in the Common Statement.

2.2 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. 

3.0 Term of Agreement

3.1 The term of this agreement is four years, from April 1, 2018 to March 31, 2022 (the Term).

3.2 Renewal of Bilateral Agreement

3.2.1 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.

3.2.2 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

4.2.3 Annual funding will be allocated to provinces and territories on a per capita basis, for each fiscal year that an agreement is in place. The per capita funding amounts for home and community care and for mental health and addictions services, for each fiscal year, are calculated using the following formula: F x K/L, where:

  • F is the annual total funding amount available under this program (funding amount will change depending on fiscal year);
  • K is the total population of the particular province or territory, as determined using annual population estimates from Statistics Canada; and
  • L is the total population of Canada, as determined using annual population estimates from Statistics Canada.

4.2.4 For the purposes of the formula in section 4.2.3, the population of 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 formula 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

4.3 Payment

4.3.1 Canada's contribution 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.

4.4 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.

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.

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.

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, 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 and bilateral agreements. Canada agrees to give Nova Scotia 10 days advance notice and advance copies of public communications related to the Common Statement, bilateral agreements, and results of the investments of this Agreement.

6.6 Nova Scotia reserves the right to conduct public communications, announcements, events, outreach and promotional activities about the Common Statement and bilateral agreements. Nova Scotia agrees to give Canada 10 days advance notice and advance copies of public communications related to the Common Statement, bilateral agreements, and results of the investments of this Agreement.

7.0 Dispute Resolution

7.1 Canada and 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.

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:

Denise M. Perret, Q.C.
1894 Barrington Street,
Barrington Tower
PO Box 488
Halifax NS B3J 2R8

Email: Denise.Perret@novascotia.ca

12.0 General

12.1 This Agreement, including Annexes 1 and 2, comprise the entire agreement entered into by the Parties with respect to the subject matter hereof.

12.2 This Agreement is based on the Common Statement of Principles on Shared Health Priorities, Annex 1, finalized on August 21, 2017.

12.3 This Agreement shall be governed by and interpreted in accordance with the laws of Canada and 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 * 18/19 19/20 20/21 21/22 5 Year Total
Total Federal Investment in Home and Community Care $5,230,000 $15,540,000Footnote * $16,840,000Footnote * $16,890,000 $23,390,000 $77,890,000Footnote *
Home and Continuing Care $5,230,000         $5,230,000
Enhancing Continuing Care Services for Clients   $3,761,400 $7,461,300 $2,412,300 $2,502,300 $16,137,300
Supporting Caregivers   $1,527,600 $6,726,100 $6,307,900 $10,150,700 $24,712,300
Support Integrated Care   $1,593,000 $6,430,400 $4,223,000 $7,160,000 $19,406,400
Enhancing Sustainability, Accountability and System Performance   $570,000 $4,310,200 $3,946,800 $3,577,000 $12,404,000
Total Federal Investment from above minus/plus Carry-Over $5,230,000 $7,452,000 $24,928,000 $16,890,000 $23,390,000 $77,890,000
Carry-overFootnote **   $8,088,000        
Prior year funding to be spent in year     $8,088,000      
Percentage carry-over of total federal funding for home and community care   52.1%        
*

Funding allocation was adjusted based on the per-capita 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 * 18/19 19/20 20/21 21/22 5 Year Total
Total Federal Investment in Mental Health and Addictions Services $2,620,000 $6,480,000Footnote * $11,650,000Footnote * $15,590,000 $15,590,000 $51,940,000Footnote *
Mental Health and Addictions Services $2,620,000         $2,620,000
Enhance Integrated Service Delivery for Children and Youth   $4,653,000 $8,009,000 $6,400,000 $6,400,000 $25,462,000
Enhance Access to Community Based MHA Services   $915,000 $4,553,000 $9,190,000 $9,190,000 $23,848,000
Total Federal Investment from above minus/plus Carry-Over $2,620,000 $5,568,000 $12,562,000 $15,590,000 $15,590,000 $51,930,000
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%        
*

Funding allocation was adjusted based on the per-capita 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.

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

Return to footnote 2 referrer

Footnote 3

Nova Scotia Department of Health and Wellness, 2017

Return to footnote 3 referrer

Footnote 4

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

Return to footnote 4 referrer

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

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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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