Canada-Prince Edward Island 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 PRINCE EDWARD ISLAND (hereinafter referred to as “Prince Edward Island” or “Government of Prince Edward Island”) 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 January 31, 2016 Canada and Prince Edward Island 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 Prince Edward Island 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 Prince Edward Island agree that data collection and public reporting of outcomes is key to reporting results to Canadians on these health system priorities, and that the performance measurement approach taken will recognize and seek to address differences in access to data and health information infrastructure;

WHEREAS, the Financial Administration Act R.S.P.E.I, c- F-9 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 Prince Edward Island for the provision of health services which includes home and community care and mental health and addictions initiatives;

WHEREAS, Prince Edward Island 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 Prince Edward Island agree as follows:

1.0 Objectives

1.1 Building on Prince Edward Island’s existing investments and initiatives, Canada and Prince Edward Island 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 Prince Edward Island 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 Prince Edward Island’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 Prince Edward Island’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 Prince Edward Island and Canada’s agreement on a new five-year action plan.

3.2.2 The renewal will provide Prince Edward Island 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 Prince Edward Island under the Canada Health Transfer to support delivering health care services within their jurisdiction.

4.2 Allocation to Prince Edward Island

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 × 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 Prince Edward Island 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, Prince Edward Island's estimated share of the amounts will be:

Fiscal Year Home and community care
Estimated amount to be paid to Prince Edward IslandTable note* (subject to annual adjustment)
Mental health and addictions services
Estimated amount to be paid to Prince Edward IslandTable note* (subject to annual adjustment)
Table note *

Amounts represent annual estimates based on Census 2017 population

Return to table note* referrer

2018-2019 $2,480,000 $1,040,000
2019-2020 $2,690,000 $1,860,000
2020-2021 $2,690,000 $2,480,000
2021-2022 $3,730,000 $2,480,000

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 Prince Edward Island for the Fiscal Year as determined under sections 4.2.5 and 4.2.3.
  4. Canada will notify Prince Edward Island 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 Prince Edward Island 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 Prince Edward Island 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 Prince Edward Island, Prince Edward Island may retain and carry forward to the next Fiscal Year the amount of up to 10 per cent of the contribution paid to Prince Edward Island for a Fiscal Year under subsection 4.2.5. that is in excess of the amount of the eligible costs actually incurred by Prince Edward Island 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 Prince Edward Island to retain and carry forward an amount exceeding 10 per cent will be subject to discussion and mutual agreement in writing by the Parties via an exchange of letters.

4.4.2. For greater certainty, any amount carried forward from one Fiscal Year to the next under this subsection is supplementary to the maximum amount payable to Prince Edward Island 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 Prince Edward Island, Prince Edward Island 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 Prince Edward Island to retain and carry forward an amount exceeding 10 per cent will be subject to discussion and mutual agreement in writing by the Parties via an exchange of letters.

4.5. Repayment of overpayment

4.5.1. In the event payments made to Prince Edward Island exceed the amount to which Prince Edward Island 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, Prince Edward Island shall repay the amount within sixty (60) calendar days of written notice from Canada.

4.6. Use of Funds

4.6.1. Canada and Prince Edward Island agree that funds provided under this Agreement will only be used by Prince Edward Island 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. Performance Measurement and Reporting to Canadians

5.1 Funding conditions and reporting

5.1.1 As a condition of receiving annual federal funding, Prince Edward Island 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. Prince Edward Island will designate an official or official(s), for the duration of this agreement, to work with CIHI and represent the interests of Prince Edward Island 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, Prince Edward Island 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 Prince Edward Island’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 Prince Edward Island 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 Prince Edward Island will ensure that expenditure information presented in the annual financial statement is, in accordance with Prince Edward Island’s standard accounting practices, complete and accurate.

5.3 Evaluation

5.3.1 Responsibility for evaluation of programs rests with Prince Edward Island in accordance with its own evaluation policies and practices.

6 Communications

6.1 Canada and Prince Edward Island agree on the importance of communicating with citizens about the objectives of this Agreement in an open, transparent, effective and proactive manner through appropriate public information activities.

6.2 Each Party will receive the appropriate credit and visibility when investments financed through funds granted under this Agreement are announced to the public.

6.3 In the spirt of transparency and open government, Canada will make this Agreement, including any amendments, publicly available on a Government of Canada website.

6.4 Canada, with prior notice to Prince Edward Island, 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 Prince Edward Island 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 Prince Edward Island 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 Prince Edward Island reserves the right to conduct public communications, announcements, events, outreach and promotional activities about the Common Statement and bilateral agreements. Prince Edward Island 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 Dispute Resolution

7.1 Canada and Prince Edward Island 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 Prince Edward Island 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 Prince Edward Island, as the case may be, may notify the other party in writing of the failure or breach. Upon such notice, Canada and Prince Edward Island 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 Prince Edward Island responsible for health, and if it cannot be resolved by them, then the respective Ministers of Canada and Prince Edward Island most responsible for Health shall endeavour to resolve the dispute.

8 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 Prince Edward Island, by Prince Edward Island’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 Prince Edward Island, by their Designated Official.

9 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 Prince Edward Island, 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 Prince Edward Island, if requested by Prince Edward Island. 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 Termination

10.1 Canada may terminate this Agreement at any time if the terms of this Agreement are not respected by Prince Edward Island by giving at least 12 months written notice of its intention to terminate. Prince Edward Island 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 Prince Edward Island after the date of effective termination.

11 Notice

11.1 Any notice, information, or document provided for under this Agreement will be effectively given if delivered or sent by letter or email, postage or other charges prepaid. Any notice that is delivered will have been received in delivery; and, except in periods of postal disruption, any notice mailed by post will be deemed to have been received eight calendar days after being mailed.

The address for notice or communication to Canada shall be:

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

Email: marcel.saulnier@canada.ca

The address for notice or communication to Prince Edward Island shall be:

Department of Health and Wellness
P.O. Box 2000
Charlottetown, PE
Canada C1A 7N8

Email: smacneill@gov.pe.ca

12 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 Prince Edward Island.

12.4 No member of the House of Commons or of the Senate of Canada or of the Legislature of Prince Edward Island 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 at Charlottetown, Prince Edward Island on this 23rd day of February, 2018.

The Honourable Ginette Petitpas Taylor, Minister of Health

SIGNED on behalf of Prince Edward Island by the Premier of Prince Edward Island at Charlottetown, Prince Edward Island this 23rd day of February 2018.

The Honourable Wade MacLauchlan, Premier of Prince Edward Island

SIGNED on behalf of Prince Edward Island by the Minister of Health and Wellness at Charlottetown, Prince Edward Island on this 23rd day of February, 2018.

The Honourable Robert Mitchell, Minister of Health and Wellness

Annex 1 to the Agreement

Common Statement of Principles on Shared Health Priorities

Annex 2 to the Agreement

Prince Edward Island Action Plan

Overview

The PEI health care system is experiencing a surge in demand for both home care services and across the spectrum of services and programs that address mental health and addictions issues. In a climate of limited resources and competing demands, this has created the push for innovative models of service delivery that move away from institutionalized care and that seek to embed upstream programs that serve clients in their homes and communities. In response to these pressures and demands, the Government of Prince Edward Island (PEI) has made significant efforts to expand access to important services in both home and community care, and in mental health and addictions.

Home and Community Care

In the areas of home and community care, the Government of PEI has made progress in addressing challenges in service access and the availability of services and supports. Enhanced investment in home care and community care has increased the availability of resources and supports in recent years, but this growth has not kept pace with rising demand. Despite the excellent work of provincial home care staff (nurses and supporting staff) as well as the paramedics and allied health professionals who supplement those core services, demand for these services continues to grow.

Fortunately, PEI has showcased a very successful service delivery model that offers a template for expanding access to home and community care services in a way that is impactful, sustainable, and cost effective. Through PEI’s Paramedics Providing Palliative Care at Home program, trained paramedics will provide palliative care patients with pain and symptom management to clients at home, after-hours, and free of charge. This program is open to all Islanders (adults and children) who are part of the Provincial Integrated Palliative Care Program, which has been nationally recognized by the Canadian Foundation for Healthcare Improvement (CFHI) with a 2017 CFHI Palliative and End of Life Care Innovation Award. It utilizes the expertise and capacity of our paramedic community to enhance access to essential publicly funded services, in consultation and coordination with core staff within the public service.

With the anticipated growth in demand for home care services that will impact health system decisions and priorities in the coming decades, this program offers a model for service enhancement that will have an immediate and tangible impact on available services. In conjunction with an enhanced and standardized intake process, and implementation of an information technology platform that provides all health care providers with appropriate access to client information to streamline service delivery, this integrated model of care will leverage the expertise among the Island’s paramedic community and within core home care staff to enhance access to key services.

Priority Areas for Investment in Home and Community Care are:

  1. Mobile Integrated Health Initiative
    • Rapid Bridging - Integrated Palliative Care Program
    • Rapid Bridging - Hospital and Emergency Department Patients
    • Paramedic Check-In Program
  2. Home Care IT Infrastructure Initiative
  3. Implementation of InterRAI Assessment tool

Mental Health and Addictions

Work has been underway since 2012 to develop a long-term vision for mental health and addictions in the Province. This culminated in the 2016 release of Moving Forward Together, a 10-year Mental Health and Addictions Strategy for Prince Edward Island that was jointly issued by the Ministers of the social policy departments (Health, Justice and Public Safety, Family and Human Services, and Education, Early Learning and Culture). This Strategy sets out an ambitious, interdepartmental framework to guide actions that will address gaps in the mental health system, and in the social supports that are intimately tied to that system. The five pillars of the strategy are:

  1. Invest Early: Focus on Children, Young People and Families
  2. Access to the Right Service, Treatment and Support
  3. Mental Health Promotion for People of All Ages
  4. Foster Recovery and Well-being for People of All Ages
  5. Innovative and Collaborative Workforce

This work also identified specific challenges and barriers to addressing the mental health needs of Islanders:

  • Resources required for transformational change
  • Workforce issues (recruitment and retention)
  • System integration between government and community
  • Lack of capacity to deal with wait lists
  • Lack of mental health resources in schools
  • Need for assessment and intervention capacity building in primary care, public health, and education

To address the barriers, and advance work under the five pillars, a Mental Health and Addictions Strategy Action Plan was subsequently developed that outlined 44 specific recommendations to significantly expand both the scope and impact of mental health and addictions services in the province. That Action Plan, and the recommendations within it, was the driving factor behind not only the identification of the specific programs that will be advanced through the allocation of targeted federal funds under this plan, but also led to a number of ongoing investments that are working to improve access to mental health and addictions services Island-wide including:

  • Additional dedicated frontline positions were hired to support in-patient adolescent mental health clients on Unit 9 at the Queen Elizabeth Hospital.
  • Expanding the Strength Program in 2015 to Summerside has virtually eliminated the need to refer youth out of province for treatment. On average, 75 clients are admitted to the program each year.
  • Strongest Families is currently serving 369 Island families, reducing waitlists for other mental health services. On average, the service receives 40 new referrals per month. Families completing the program are very satisfied with the outcomes, of which there is a 94% success rate.
  • The Behavioural Support Team, which helps children aged 4-12 with moderate to severe behavioural difficulties, currently provides service to 51 children and families.
  • The Insight Program provides a stepped care approach for youth who are struggling with significant/persistent primary mood, anxiety and or psychotic disorders. Since it opened in October 2016, there have been 20 participants in the 16-week program.
  • 21 mental health and addictions staff members have been trained in the Triple P Parenting approach to provide earlier intervention and parenting support for behavioral issues.

Mental health walk-in clinics are now available in several communities, including: Charlottetown, Summerside, Lennox Island, O’Leary and at Westisle High School (this clinic is for students only). The clinics offer immediate mental health support to help with anxiety, as well as life events causing stress and other mental health issues. Individuals are seen by a therapist and may receive up to one hour of counseling. Individuals may also be referred on to other programs/services for more support.

Despite this significant work that is underway, additional supports in mental health and addictions are still needed. In 2016-17:

  • there were 1,274 children under 17 years of age referred to Community Mental Health services, of which 1,102 children were referred directly for clinical therapy services and 172 were direct referrals for psychiatry assessment;
  • the most common reasons for hospital admission for children aged 17 and under included: depressive episode, stress reaction/adjustment disorder, and childhood/adolescent disorder; and,
  • the most common reasons associated with longest lengths of hospital stay include: obsessive compulsive disorder, poisoning/toxic effect of drug, and childhood/adolescent disorder.

These and other indicators suggest a need to continue to strengthen both acute metal health services, as well as the capacity to provide mental health and addictions supports to children and youth outside of a hospital setting and in their community.

Priority areas for investment in mental health and addictions are:

  1. Student Well-being Program
  2. Mobile Mental Health Crisis Program

Federal Funding

In recognition of the growing demands that exist in the areas of mental health and addictions, and in home and community care, on January 31, 2017, “the federal government and the Government of PEI agreed to new targeted federal funding over 10 years for investments in home care and mental health care.”Footnote1 This funding was intended to enhance access to essential services in the two targeted areas, and would be steered by the Common Statement of Principles on Shared Health Priorities that was agreed by all Federal-Provincial-Territorial governments on August 21, 2017. Specifically, the Common Statement on Shared Health Priorities outlined the governments’ commitment to “work together to improve access to evidence-supported mental health and addiction services and supports for Canadians and their families” and to “work together to improve access to appropriate services and supports in home and community, including palliative and end-of-life care”.Footnote2

These objectives would be guided by three key principles:

  • Collaboration: FPT Health Ministers agree to work together to achieve the objectives set out in this Statement of Principles;
  • Innovation: FPT Health Ministers agree to continue the development and evaluation of innovations which deliver better outcomes for Canadians, and to share successes and lessons learned with a view to further stimulating improvement across health systems; and,
  • Accountability: FPT Health Ministers agree to measure progress on the collective and jurisdiction-specific goals under this Statement of Principles, and to report to Canadians.

This Action Plan outlines the initiatives and commitments of the Government of PEI that will utilize the targeted federal funding to advance these objectives, while adhering to the agreed principles. By articulating specific actions in the areas of both home and community care, and in mental health and addictions, this plan will improve access to key services within the health care continuum.

In an effort to advance these important objectives, the Government of Canada has committed to provide 10 years of targeted funds to the Government of PEI in the following estimated amounts (based on 2017 Statistics Canada population estimates, to be updated annually):

Funding under the Common Statement of Principles for PEI
$ millions 17-18 18-19 19-20 20-21 21-22 5-yr Total 22-23 23-24 24-25 25-26 26-27 10-yr Total
Note: The values of all allocations noted above are estimates that will be revised each year based on Statistics Canada’s population estimates. Equal per capita allocations will be determined based on PEI’s share of the Canadian population (approx 0.4%).
Home Care 0.82 2.48 2.69 2.69 3.73 12.41 2.48 2.48 2.48 2.48 2.48 24.81
Mental Health 0.41 1.04 1.86 2.48 2.48 8.27 2.48 2.48 2.48 2.48 2.48 20.67
Total 1.23 3.52 4.56 5.18 6.21 20.68 4.96 4.96 4.96 4.96 4.96 45.48

As a condition of receiving this funding, the Government of PEI has committed to specific initiatives and reporting requirements that acknowledge the need for accountability of these funds.

Part 1 - Home and Community Care

Consistent with a broader regional trend in Atlantic Canada, the population in PEI is older than the Canadian average, with higher rates of most chronic diseases (and higher occurrence of co-morbidities of those diseases). These factors are already impacting health care costs, and these impacts will grow in the coming years. This demand will drive the need for innovative approaches that are not only effective, but which are also cost-effective.

According to the 2016 Census, the percentage of people aged 65 and older was 19.4% in PEI, compared to the national average of 16.9%. While ambitious immigration targets are seeking to redress this imbalance, the large cohort of seniors will put significant pressures on health care resources as they age. These pressures will be felt both within the system via acute and primary care systems, and in the community where demand already taxes the available supports and programs.

Compounding this issue are rates of chronic disease that are both regionally and provincially higher than the national average. Compared to the Canadian average, PEI has significantly higher rates of chronic disease at ages 50 years and older, following the trend of the other Atlantic Provinces. The Canadian Community Health Survey (CCHS) provides comprehensive, current information that shows significant prevalence of many chronic conditions.

Percentage of Population (PEI vs Canada) with chronic conditions in 2014, CCHSFootnote3
  PEI Canada
Arthritis 21.2% 16.5%
COPD 5.7% 4%
Diabetes 8.4% 6.7%
High Blood Pressure 22% 17.7%

As our population ages and chronic disease rates continue to increase, Islanders will need access to more health care services outside the traditional settings such as physicians’ offices and hospitals. This will necessitate ongoing investment in innovative models of care that are cost-effective and which provide access to patient-centred services in the setting of their choice.

To date, PEI’s investment in home care services has lagged behind other areas of need, such as investment in the acute care system or the institution-based long term care (LTC) system. While approximately 4,500 Islanders received home care services last year (2016), with staff supporting approximately 2,200 clients each month, public funding of home care as a share of provincial health spending is markedly lower in PEI when compared to other Canadian Jurisdictions (2.8% in PEI versus 4% nationally). This lower investment has led to pressures on other parts of the health care system, such as wait lists for LTC beds, which in turn leads to bed shortages in hospitals caused by an inability to discharge patients who could be medically discharged but who cannot move into an LTC bed or receive the necessary home care supports in a timely manner.

As a result, the PEI Government is putting in place new approaches to service delivery that will enhance access to vital health care and support services at home and in the community, and reduce reliance on more expensive hospital infrastructure. Shifting the paradigm of service delivery is needed to ensure sustainability of programs and services while still meeting Islander’s expectations. This will be done by pursuing a vision of home care that offers a broad spectrum of home based services which are accessible to all Islanders, which supports their choice to remain at home and age-in-place as long as possible and to live with dignity and independence, and which allows them to return home more quickly from hospital, or delay or even avoid admission to a hospital or long-term care home. The investments made through this Plan will build on the Island’s current range of health care and support services to individuals who have acute, chronic, palliative or rehabilitative health care needs. These services currently include:

  • Nursing care – including health monitoring, IV therapy, injections, wound care and patient teaching.
  • Home support – Assistance with daily activities such as bathing and dressing.
  • Palliative care – comfort and support to live fully until the end of life.
  • Social work – individual and family counseling for illness, loss or end-of-life issues.
  • Dietitian services – nutrition assessment and education.
  • Physiotherapy – to maximize independence, function and mobility.
  • Occupational therapy - support for daily living, special devices/equipment or modification to home/ workplace.
  • Adult protection – for vulnerable adults who need protection from neglect or abuse.
  • Long-term care – assessment for nursing home admission.
  • Adult day programs – enriching social activities for seniors.

To help achieve this vision, the PEI Government is taking steps to improve access to appropriate services and supports in the community. These actions will not replace the existing publically funded home care program, but will build off of the strengths and successes that program, including the Integrated Home Palliative Care Program.

Priority areas for investment

To assist with improving access to appropriate home and community care, the federal government will provide provincial and territorial governments with $6.0 billion over the next 10 years. For PEI, the provincial share of these funds amounts to approximately $24.8M over the next ten years (2017-2027). In alignment with the principles and objectives noted in the Common Statement of Principles, the Government of PEI will pursue the following programs to enhance access to services in Home and Community Care:

  1. Mobile Integrated Health Program
  2. Home Care IT Infrastructure Initiative
  3. Implementation Plan for InterRAI Assessment tool
Funding Allocation and Initiatives
  2017-18Footnote * 2018-19Footnote ** 2019-20Footnote ** 2020-21Footnote ** 2021-22Footnote ** Total
Total Federal Funding $820,000 $2,480,000 $2,690,000 $2,690,000 $3,730,000 $12,410,000
Mobile Integrated Health (MIH): $620,000 $1,110,000 $1,440,000 $1,290,000 $2,130,000 $6,590,000
Home Care IT Infrastructure Initiative $200,000 $400,000 $400,000 $400,000 $400,000 $1,800,000
Implementation of InterRAI $0 $0 $1,820,000 $1,000,000 $1,200,000 $4,020,000
Total $820,000 $1,510,000 $3,660,000 $2,690,000 $3,730,000 $12,410,000
Carry-overFootnote ***   $970,000        
Prior year funding to be spent in year     $970,000      
Percentage carry-over of total federal funding for home and community care   39%        

Footnotes

Footnote 1

Funding for 2017-18 has already been provided through legislation.

Return to footnote * referrer

Footnote 2

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

Footnote 3

Due to the complexity of the process to implement the Homecare InterRAI Assessment Tool and minor delays in the implementation of Mobile Integrated Health, federal funding is being carried over to the 2019-2020 to accommodate the additional time needed to implement these programs.

Return to footnote *** referrer

Please Note: Funding allocations noted in the table above are estimated based on current information. As such, decisions on funding allocations in future years noted in the table may be subject to change. This flexibility reflects an acknowledgement that current planning activities do not allow articulation of a totally fixed five-year spending plan. Despite this, the Government of PEI is fully committed to advancing the principles and objectives outlined in the Common Statement of Principles on Shared Health Priorities. In addition, the current work on a Seniors Health and Wellness Strategy and a report on the continuum of care in PEI will inform future decisions about targeted activities to advance access to home and community care.

Detailed Program Descriptions - Home & Community Care

1. Mobile Integrated Health

  • The Mobile Integrated Health (MIH) initiative will be delivered through three inter-related projects that utilize and build on the capacity and expertise within PEI’s paramedic community and will be provided free of charge to eligible clients. These three integrated initiatives will be implemented in tandem to leverage potential administrative efficiencies and economies of scale. The three programs identified are:
    1. Rapid Bridging - Integrated Palliative Care Program;
    2. Rapid Bridging - Hospital and Emergency Department Patients; and,
    3. Paramedic Check-In Program.

Within this cluster of services, administrative capacity and other supports will be shared to leverage the maximum investment in new front line service delivery. While some of the federal funding will be used to establish the infrastructure and mechanisms necessary to administer the programs (such as a Clinical Navigation Desk that will work with home care staff to coordinate paramedic care) as well as administration of the program’s evaluation framework, the bulk of the funding will be used to support the addition of new service delivery staff resources within the paramedic fleet. This investment will bring these additional front line staff into the home care program, and will represent a substantial increase in available human resource capacity that will be integrated into home care management plans, thereby building on the existing system of supports that are currently in place.

Paramedic services are available and accessible to all areas of the province. The current fleet includes 14 ambulances, 2 Rapid Response Units (non-transport SUVs), and 2 inter-facility ambulance transfer units. As a result of these investments, extra capacity will be added to the Rapid Response Units, including the addition of one additional vehicle and the extension of coverage hours to 7 days per week. The additional fleet resource is equivalent to approximately 5-6 new full-time Advanced Care Paramedic (ACP) positions. In addition, new clinical capacity (Registered Nurse positions) will also be added to the Emergency Communications Center to support the MIH programs.

While the number of new clients served will vary by MIH initiative, it is expected the “Paramedic Check-In Program” will be the most resource demanding program during these first two years. For reference, in the only existing MIH Initiative (Paramedics Providing Palliative Care at Home Program), over 450 palliative clients have accessed the program to date.

This period of time that a patient can participate in an MIH initiative will vary depending on the specific care needs of the patient (and their family) enrolled in an MIH Program. As each specific MIH Program is developed, clinical practice guidelines and clinical pathways will continue to be co-developed by emergency services and the referring service area or agency (i.e. home care, palliative care, emergency departments, long term care, etc.). When a patient is referred to any one (or more) of the MIH Programs, each referral will be individually screened and reviewed for eligibility and in-take (against the developed clinical pathway). If accepted, a specialized care plan will be developed using the approved clinical practice guideline as a template that can be tailored to meet the needs of each patient or family with respect to type and frequency of visits. Each clinical practice guideline will be regularly reviewed/updated between the MIH program (i.e., program coordinator, registered nurse, medical oversight), the referring program/service area (i.e., hospital, emergency department, etc.) and home care/palliative care (i.e., palliative care coordinator, home care in-take coordinator/liaison etc.).

In the Island’s two largest First Nations communities, paramedics will work with nurses in the community health centres to ensure that home care services are culturally sensitive. Community leaders were engaged during the planning of on-reserve services, and paramedics will meet with community elders to help ensure successful implementation of the services. These services will also be rolled out with specific strategies for the Island’s francophone residents. Program planners will work with the Acadian and Francophone Community Advisory Committee to ensure that the MIH program is fully integrated with ongoing efforts to meet the home care needs of these communities. These efforts include meeting with a range of key stakeholders and informants to review appropriate service delivery models that could be adapted to meet the needs of the Island’s Acadian and francophone residents.

This investment aligns with the 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;
  • Enhancing access to palliative and end of life care at home or in hospices;
  • Increasing support to caregivers; and,
  • Enhancing home care infrastructure, such as digital connectivity, remote monitoring technology and facilities for community-based service delivery (in this case through the addition mobile non-transport units).

A brief description of the 3 MIH programs are as follows.

MIH 1 - Rapid Bridging - Integrated Palliative Care Program

  • Supports discharge from acute care of patients registered with the Provincial Integrated Palliative Care Program by arranging paramedic follow up at home until home care and palliative care services are available to assume care for these patients.
Project Description and Goals:

At the present time, many palliative patients must remain in hospital to receive necessary medications and treatments (i.e., IV medication administration) until a receiving home care team is able to assess them and implement the necessary services in their home. Due to service demands and other system bottlenecks, there are often delays in a patient being able to move directly into their home to receive palliative care. In addition, some treatments are not currently provided in the homes (i.e., episodic IV therapy or medication administrations). The latter is also true for nursing home and community care environments where many palliative patients may require episodic IV therapies. Taken together, these factors can often lead to significant delays for palliative patients seeking to receive treatment in their home, which in turn impacts bed utilization and other resource allocation considerations within the acute care system.

Given this dynamic, there is an opportunity for interventions, follow up, assessments and support of these patients by having advanced care paramedics assess and, when necessary, administer the necessary medication in the patient’s home. This would allow patients to be discharged from acute care and receive necessary follow up and treatment in a timely manner by health care providers working well within their recognized scope of practice. Patients would be able to return to their homes as soon as possible while receiving safe follow-up care by paramedics until home care nursing is able to assume care to these patients.

Working in collaboration with the patient’s attending physician, nurse practitioner, or palliative care physician, the advance care paramedics will perform treatments including medication review and administration to those palliative patients under the medical oversight of a palliative or attending physician. The palliative patient will be discharged from the hospital and a paramedic will be contacted to provide treatments and to help with the “rapid bridging” back to home.

Program Objectives:
  • Support for post-acute palliative clients;
  • Arranging facilitated transports to home from hospital; and,
  • Focus on treating and supporting patients in community.
Target Populations:

Palliative care patients registered in the Provincial Integrated Palliative Care Program who are hospitalized but ready to return to their home with the appropriate and necessary supports.

Overall Outcomes

  • Decreased average length of stay in hospital for patients registered in the Provincial Integrated Palliative Care Program;
  • Decrease re-admission rates for patients registered in the Provincial Integrated Palliative Care Program;
  • Develop a template for the “rapid” bridging to home between acute care and home care services utilizing emergency health services (EHS) to inform potential opportunity for future expansion in other areas (i.e., long term care, mental health & addictions etc.);
  • Develop a template for the “rapid” bridging to home between acute care and home care services utilizing EHS, to support a potential opportunity for future expansion in other areas (i.e., long term care, mental health & addictions etc.); and,
  • Improved patient and family satisfaction.

MIH 2 - Rapid Bridging - Hospital and Emergency Department Patients

  • Eligible patients may be discharged from hospital with an individualized care plan, developed in collaboration with care team. Paramedic(s) would provide treatments and assist with rapid bridging back to home in conjunction with acute care and home care services.
Project Description and Goals:

Many patients must remain in hospital to receive necessary medications or treatments that could be managed more effectively in the home. This project will support patients at home until a receiving home care team is able to assess and support them. The patient will be discharged from hospital with an individualized care plan, developed in collaboration with care team. Paramedics will provide treatments and other corollary supports to assist with rapid bridging back to home in conjunction with home care staff.

Similar to the first Rapid Bridging program, this program will provide interventions, follow-up assessments and supports, including administration of medications, for individuals who would otherwise remain in hospital. Suggested types of care to be provided by paramedics could include the following:

  • Patient/Family Education;
    • New-start medication concerns (i.e., insulin / warfarin supportive training;
    • Medication reconciliation (storage, sorting, management, timing, education etc).
    • Home safety (e.g. smoke detectors) and risk of fall concerns;
  • Vital monitoring and reporting;
  • Venipuncture/Point of care testing;
  • Medication administration;
  • Urinary catheter care;
  • Feeding tube care (G-Tube, J-Tube);
  • Ostomy care and management;
  • Wound care management (site assessment, dressing changes etc); and,
  • Identification of barriers and direct referral / navigation to community resources for follow-up.

By facilitating this expanded range of services provided in the home, this program will allow patients to return to home as soon as possible while receiving safe follow-up by paramedics until home care nursing is able to assume care to these patients. In doing so, this program will facilitate the discharge of patients to a more appropriate setting while receiving necessary services to support care in the community.

Program Objectives:
  • Support for post-acute clients;
  • Arranging facilitated transports to home from hospital; and,
  • Focus on treating and supporting patients in community.
Overall Outcomes:
  • Decreased average length of stay (LOS) in hospital;
  • Decrease re-admission rates;
  • Develop a template for the “rapid” bridging to home between acute care and home care services utilizing EHS, to support a potential opportunity for future expansion in other areas (i.e., long term care, mental health & addictions etc.); and,
  • Improved patient and family satisfaction.

MIH 3 - Paramedic Check-In Program

  • Seniors living at home who are at increased risk for poor health outcomes, falls, disability or hospitalization, may be referred to local paramedics for scheduled home visits during periods of downtime.

The Paramedic Check-In Program will improve the response and support available to frequent users of EHS by referring them for community-based paramedic support, when appropriate. Through the identification of frequent users of the Island’s emergency medical services (facilitated by the Medacom Atlantic communications center, and through identification by individual paramedics), high priority clients would be enrolled in the program. These clients would generally be seniors that are living at home, and who are at increased risk for poor health outcomes, falls, disability, hospitalization and death. These target clients would be referred to local paramedics for scheduled home visits during periods of downtime. In turn, theses paramedics would provide home-based services such as assessments for those with chronic conditions or with mobility issues. Provision of these services and supports in the home aligns directly with an established provincial objective of increasing support for frail seniors.

This program would leverage recent investments made in the EHS Dispatch technology (Computer Assisted Dispatch, Emergency Medical Dispatch) to further streamline service delivery and integration. Given that the intent is to leverage idle or “down” time of existing paramedic resources to support this initiative, federal funding requirements for this specific element of MIH would be modest, and would relate to the administrative and coordination capacity within the Medacom Atlantic communications center.

Target Populations

As an initial, priority population, the program would target frequent callers to 911 that are 65 and over. Residents 65 years of age and over make up 58% of the pre-hospital emergency call volume. Approximately 80% of all calls to 911 by residents over the age of 65+ are for non-emergent purposes. Investments in MIH infrastructure/resources (i.e., addition of ambulance fleet, registered nurses, and clinical expertise to the emergency communication center) will significantly improve capacity for navigation and direct referral to more appropriate care areas vs. emergency department visits.

The Medacom Atlantic communications centre currently monitors calls/clients to identify these frequent users of EMS, who are ideal candidates for the early stage of the program. In addition, paramedics may identify high-needs clients that would benefit from this program. While precise numbers of potential clients are not known at this time, comprehensive analytic work is underway to identify the most frequent callers (by address/name/medical record number) in real time. The initial program participants for the Paramedic Check-In Program will be identified using this process.

Overall Outcomes:
  • Decrease in 911 calls within target populations;
  • Decrease number of non-emergent transports from home to the emergency department; and,
  • Upstream health care support for seniors living at home in the community.

Evaluation of the 3 MIH Initiatives

An Evaluation Working Group has been constituted to plan and oversee the evaluation component of the three MIH initiatives and will develop a comprehensive and systematic evaluation framework for the three MIH initiatives, and to establish baseline data to support this evaluation. An initial set of indicators could include, but would not be limited to:

  • Hospital length of stay (LOS);
  • Hospital re-admission rates;
  • Emergency department visits by seniors for non-emergent concerns;
  • Admission age and LOS in long-term care (as seniors will have additional supports in the community);
  • Patient and family satisfaction with care;
  • Frequency of 911 (among Check-in Program target populations); and,
  • Number of non-emergent transports from home to emergency department (among Check-in Program target populations).

Aside from indicator data, additional evaluation work is being planned that will include components of the following:

  • Formative evaluation: Provides information to makes changes in the program.
  • Process evaluation: Understanding of how the program worked and why.
  • Summative evaluation: Did the program achieve what it set to?
  • Impact/outcome evaluation: Measuring the overall impact/outcomes of the program in relation to the program goals.

It should also be noted that MIH planners have engaged a variety of different stakeholders while determining the activities of the committee, and are seeking to appoint a patient advocate to the committee to ensure that a client-centered approach is incorporated into the finalized evaluation plan.

2. Home Care IT Infrastructure Initiative

  • The Province will implement a cost-effective, cloud-based EMR tool to support the needs of patients, health care providers, and administrators within the Home Care system.

PEI’s health care system aspires to provide "the right care, in the right place, by the right provider". The MIH initiative noted above is a key element of this philosophy, seeking to provide client care in the setting of their choice (at home) by clinicians working well within their identified scope of practice. A key enabler within this delivery model is an e-health platform that allows authorized care providers to access crucial patient information in a secure IT environment, regardless of location. Despite past efforts to procure a suitable electronic medical record (EMR), the Government of PEI has to date not been successful in obtaining an effective EMR solution that could support an integrated model of home care service delivery utilizing a range of service providers (e.g. home care nurses and specially trained paramedics electronically accessing a health record established in large part by a primary care physician or team). Addressing this crucial gap/barrier is a key step in providing seamless home care services to clients across the province.

EMRs allow for better care by providing all involved clinicians (whether home care nurses, MIH paramedics, or other care providers) with appropriate real-time access to client medical information. This investment will allow improved communication and coordination of care and care planning between acute care, home care and emergency health services. For example, in the existing MIH palliative care initiative, excessive time is spent by palliative providers who must manually generate a MIH care plan and regularly update shared care plans electronically and in the client’s home. The planned initiative will ensure pertinent patient information can be communicated in real time (vs. delays in enrollment due to gaps in information sharing capacity). This investment will also improve the remote support available to home care and palliative care providers and physicians working in the field who will be able to access the MIH registered nurses at the Emergency Communication Center for support and advice, including the ability to update a care plan remotely, to obtain additional patient care information (i.e., from another information system accessible by the MIH registered nurses), or to schedule an appointment, coordinate a referral, or facilitate communication with other services/programs/providers on behalf of the in-field provider.

Further to this, PEI is piloting a cost-effective EMR tool that meets the needs of patients, health care providers, and administrators within the home care system. As a first step in the longer term process of implementation, the Province is testing the capacity of the proposed EMR tool to support the delivery of services across a range of providers. Within this project, the proponent will work with Health PEI to secure a small number of work sites, provide clinician and staff training at those sites, and participate in a thorough evaluation of the EMR tool with respect to the parameters noted below. While the initial roll-out of this tool will be used to support core home and community care staff and a small number of clinicians, the tool will eventually be provided to all primary care physicians in the province as a core piece of e-health infrastructure in the province, accessible by all clinicians in a secure environment.

Due to the need to ensure security while testing the EMR, the initial roll-out of this tool will occur within select offices and facilities staffed by Health PEI, including the provincial Home Care Program. However, after the initial assessment period, additional rollout will be immediately prioritized for Island EMS staff involved in the MIH program. This will further advance the integration of program delivery within home and community care by providing a shared e-health platform accessible to home care staff, MIH staff, physicians, specialists, and other key service providers. As a result, all clients of the home care program – and all those receiving primary care in a community setting – will benefit from this initiative.

Federal funding will be applied to the associated subscription fee, which includes all related training and support costs.

This investment aligns with the Common Statement of Principles on Shared Health Priorities by:

  • Increasing support to caregivers; and,
  • Enhancing home care infrastructure, such as digital connectivity, remote monitoring technology and facilities for community-based service delivery.

Evaluation and Performance Measurement

During the initial project period, an Evaluation and Assessment Committee has been constituted to plan, oversee, and report on the evaluation of the EMR. Preliminary membership includes involved clinicians and program managers, representatives from the Department of Health and Wellness, Health PEI, the provincial government’s IT Shared Services branch, the proponent, and others as needed.

The stated objectives of this Committee will be to ensure evaluation of the EMR with respect to:

  • Security - protection of privacy and client information
  • Compatibility - interoperability with other elements of PEI’s e-health infrastructure
  • Utility - demonstrable value to both care providers and health system administrators

This important new investment will allow for a degree of integration and coordination within home and community care that was previously not possible under a hybrid information system that mixed elements of e-health with traditional paper-based systems. By enhancing the level of digital connectivity between all home and community care service providers, both clients and care providers will benefit greatly.

3. Implementation of the Home Care InterRAI Assessment tool

  • To standardize client assessment and ensure consistency and evidence-informed decision making, a detailed implementation plan for adoption of the InterRAI Home Care Assessment Tool will be developed and then executed within the province’s home care and long term care system.

The Resident Assessment Instrument (RAI) is a suite of over twenty assessment tools which are utilized across the continuum of the health care system. Most jurisdictions (such as Alberta, British Columbia, Manitoba, Newfoundland and Labrador, Nova Scotia, Ontario, Saskatchewan, and Yukon) currently use at least some of the InterRAI tools to assess individuals’ need for home support services. In the Northwest Territories, Nunavut and New Brunswick, a continuing care assessment package is used. Québec uses a multi-client assessment tool, and PEI applies the Seniors Assessment Screening Tool, as well as other resources.

In PEI’s Caring for Our Seniors Report (2016), it was recommended that the province consider replacing the Seniors Assessment Screening Tool (SAST) with InterRAI tools. Despite the anticipated implementation challenges (including new technology and the need for significant staff training and education), the InterRAI instruments are standardized, reliable, and validated tools which offer several benefits, including helping clinicians identify important health issues among patients, developing appropriate care plans, and monitoring patient progress. InterRAI instruments also provide quality indicators to assess care quality, and case-mix classification algorithms to facilitate appropriate funding of health services.

Given these benefits to clients, clinicians and administrators, this is an opportune time to implement the Home Care InterRAI assessment tool to support improved services for Island seniors. Further to this, a business plan is being developed (with assistance from the Canadian Institute for Health information (CIHI)) that will provide a roadmap for adoption of the full InterRAI suite, including identification of costs, barriers, benefits, potential synergies, etc. Once this business plan is developed, the Department of Health and Wellness, in coordination with Health PEI, will use it to plan and guide the full implementation of InterRAI in the PEI Home Care system.

This initiative will dovetail with the ongoing regional push to harmonize data standards, information management processes, and program parameters within Atlantic health care programs and services. As noted previously, elements of InterRAI are already present in some of the region’s health care, home care, and/or long term care systems. Thus, PEI’s adoption of this tool within the home care and long term care system will represent an important step towards a regionally harmonized approach to client assessment. This approach would not only aid in ensuring the application of common criteria across multiple programs in multiple jurisdictions, but would also open up the future potential to leverage truly regional data sets to facilitate better population health analysis.

This investment aligns with the Common Statement of Principles on Shared Health Priorities by:

  • Enhancing home care infrastructure, such as digital connectivity, remote monitoring technology and facilities for community-based service delivery.

Aside from the inter-jurisdictional potential of InterRAI adoption, there are also intra-jurisdictional benefits that may accrue, insofar as the Department of Health and Wellness’ planned adoption of the InterRAI tool may eventually fit into a broader framework of standardized data and assessment processes within the PEI Government. A broader corporate initiative is being explored that could lead to the implementation of a cross-Departmental client assessment platform that can be utilized across different domains. This horizontal initiative would enable greater integration of service delivery and more seamless care of clients within PEI Government departments. Thus the potential (albeit limited) implementation of InterRAI Assessment tools in the home care and long term care system could serve a s a precursor to its adoption in other social policy departments with overlapping clients/interests. Insofar as InterRAI is a candidate for consideration within this broader process, the early adoption of its proven assessment tools related to home care and long term care would establish the health care system as a demonstration platform for the value of this tool.

Target Populations: Current and future clients of the Island’s home care system will benefit from the adoption of a standardized assessment tool to better inform decision-making. Given the administrative nature of this initiative, Island clinicians, service providers, and administrative staff could also be considered a secondary “target population” since the implementation of InterRAI will leverage efficiencies in planning and programming activities.

Given the costs associated with transitioning to InterRAI, federal funding will be used to partially offset the costs associated with securing the necessary software licenses, to purchase any additional hardware that is required for implementation, and to support staff during the transition to the new assessment regime through appropriate training and education. It is anticipated that the bulk of these costs will occur in the first 2 years of implementation, with “maintenance” costs (ongoing software licensing and ongoing staff training) occurring annually thereafter.

Overall Outcomes

Implementing InterRAI in the Province will introduce an evidence-based assessment process for seniors and will facilitate the development of individualized care plans as well as ensuring that individuals are more appropriately supported in the community. This assessment tool will also inform the development of evidence-based policy and practices with a lens towards continuous quality improvement for the continuum of care. This will lead to greater consistency between client assessments and decisions about appropriate care pathways, and greater opportunity for harmonization both between departments in PEI with overlapping clients/interests and within different health care systems in the Atlantic region. In addition, the more robust assessment framework will provide significantly better data over the medium- to long-term to better inform program planning and design.

Performance Measurement

Given the nature of this initiative, performance measurement and evaluation of the InterRAI tool would be a longer term undertaking, assessing the tool in practice. This would be initiated during the later years of this Action Plan. Expected outcomes would include the ability to enable better-informed client decisions and planning processes and better quality of care for patients, by having more appropriate care plans and consistency for all clients.

Part 2 - Mental Health & Addictions

PEI is currently experiencing significant demands across the spectrum of mental health and addictions programs and services. Despite rising investments, which saw an increase of approximately $3.5 million in the last year, significant pressures remain in all parts of the system – from early interventions and preventative mental health care to acute specialized psychiatric care.

This lack of resources in this program area is being felt in other parts of the health care system. In the absence of additional services, PEI continues to experience higher than necessary emergency department use and police response to mental health issues. The Queen Elizabeth Hospital emergency department had 296 mental health related visits in the first six months of 2017. The RCMP on PEI responded to over 200 mental health related calls in the same time period. Clearly, these interventions are not in the best interest of clients, and indicate a need for more targeted services and programs.

Similarly, with respect to specific youth impacts, there are a host of indicators that point to the extent of the problem in PEI. As of 2014-15, the following statistics underscore the need for investment:

  • Wait time for psycho-educational assessment for youth is approximately 3.25 years
  • 225 children in care of Province and over 3000 referrals to child protection
  • Average wait time to see psychiatrist for youth (<18 years): 50 days (75 days for adults)
  • Average wait time to see mental health provider for youth (<18 years): 25 days for individual triaged as urgent (16 days for adults)
  • Per cent of youth clients seen by CMH within current access standards: 23% (57% for adults)
  • PEI students (Grades 7-12) have the highest rate of binge drinking in Canada at 32.2%
  • PEI students have highest rate of cannabis use in Canada at 24.8%

Following the release of the Mental Health and Addictions Strategy, and the subsequent development of the action plan to guide progress, a significant number of initiatives have already been implemented or are currently being rolled out, that will advance the central themes and objectives of the Strategy. Some highlights of work that has been completed to date include the establishment of:

  • Behavioural Support Team
  • Strongest Families Program
  • INSIGHT Program
  • Women’s Wellness Centre
  • Triple P Parenting Program
  • Support and partnership with the Reach Foundation
  • Safety and security review for inpatient mental health

Despite the progress of these initiatives however, areas of need still exist, and more needs to be done to further enhance access to crucial mental health and addictions services. Strengthening the direct access to mental health services among children and youth is a key priority that requires additional investment.

This Action Plan identifies two key initiatives that advance ongoing work to address the challenges associated with mental health and addictions in the Province: the Student Well-being Program and the Mobile Mental Health Crisis Program. These two initiatives will directly advance the themes and objectives set out in the Mental Health and Addictions Strategy and will take an integrated approach to providing mental health and addictions services to Islanders. Specifically, the Student Well-being Program will impact the Strategy pillars focused on early investment in children and youth and fostering collaboration among service providers. With a more acute focus, the Mobile Mental Health Crisis Program will provide an innovative new pathway for mental health and addictions services in the province and will emphasize providing the right service at the right time. These key initiatives, taken from the provincial mental health and addictions action plan, represent important new investments in mental health and addictions care in the province.

Priority areas for investment

To assist with improving access to appropriate mental health and addictions services, the federal government will provide provincial and territorial governments with $5.0 billion over the next 10 years. For PEI, the provincial share of these funds amounts to approximately $20.7M over the next ten years (2017-2027). In alignment with the principles and objectives noted in the Common Statement of Principles, and consistent with the priorities identified in the Mental Health and Addictions Strategy, the Government of PEI will invest in the following programs:

  • Student Well-being Program
  • Mobile Mental Health Crisis Program (MMHCP)

This investment is aligned with the Common Statement of Principles on Shared Health Priorities by:

  • Spreading evidence-based models of community mental health care and culturally-appropriate interventions that are integrated with primary health services; and,
  • Expanding availability of integrated community-based mental health and addiction services for people with complex health needs.

Specifically, the Student Well-being Program will provide a meaningful expansion of access to community-based (delivered in schools) mental health and addiction services for children and youth, in recognition of the effectiveness of early interventions to treat mild to moderate mental health disorders. Similarly, the Mobile Mental Health Crisis Program represents a significant addition to the suite of integrated mental health and addiction services delivered in the community, and targeting people with complex health needs.

Allocation of Health Accord Funding – Mental Health and Addictions
Funding Breakdown by Initiative 2017-18Table note* 2018-19 2019-20 2020-21 2021-22 Total
Table note *

Funding for 2017-18 has already been provided through legislation.

Return to table note* referrer

Total Federal Funding $410,000 $1,040,000 $1,860,000 $2,480,000 $2,480,000 $8,270,000
Student Well-being Program $410,000 $820,000 $1,240,000 $1,860,000 $1,860,000 $6,190,000
Mobile Mental Health Crisis Program ---- $220,000 $620,000 $620,000 $620,000 $2,080,000

Detailed Program Descriptions – Mental Health and Addictions

1. Student Well-being Program

  • Multi-disciplinary teams will be established and embedded within families of schools across the island to advise, consult with, and provide direct service to children and youth who are struggling with mental, social and physical health issues. Registered nurses with mental health training will provide mental health counseling to students with non-acute mental health needs and serve as navigators within the community mental health system for those students with more acute needs. This integrated approach to student well-being will help address identified gaps in school-based service delivery that may lead to poor health outcomes, learning difficulties, barriers to participation, lack of coping skills, and eventually mental health and addictions concerns.

The Student Well-being Program provides a collaborative approach to working with children and families to provide education, support and guidance for the overall well-being, including mental health and disease prevention. The Program’s priority is to promote knowledge, resilience and coping skills so that students and families can make informed decisions affecting mental health and addictions, psycho-social and physical health.

Federal funding will be to support the staffing of registered nurses, with training in mental health, who will focus on upstream efforts to build resiliency within the school population, to promote positive mental health, and to avoid and/or mitigate mental health issues as they emerge. These mental health trained registered nurses will work with other mental health staff resources to provide direct mental health counseling to students with non-acute mental health needs. In addition, these nurses will provide a navigation function within the mental health system for those students with more acute needs by coordinating access to community-based mental health services for students and their families. They will work within an integrated team of allied health professionals, with staff that includes social workers and occupational therapists funded by the Province. Together, these teams will collaborate on care for their child and youth clients.

While new staffing resources will be limited during the early phase of this initiative (4 FTE school health nurses in year 1), the planned complement of 20.5 FTE federally funded school health nurses will be in place by the end of year 3, and will work within the broader school wellness teams that will include mental health therapists, school outreach workers, and counselling consultants, who will all work together to support students and families. This holistic approach to student well-being will seek to prevent mental health issues from materializing in some cases, and where they are present, to prevent them from escalating.

To meet the needs of the Island’s francophone student population, bilingual positions will be established to support the French Language Schools in both the eastern and western parts of the province. In addition, plans are in place to fully integrate the Island’s First Nations schools and students into the school wellness program. School nurses will work with Indigenous nurses in the Island’s First Nations health centres to ensure that services are provided in a culturally sensitive and appropriate way.

This investment is aligned with the Common Statement of Principles on Shared Health Priorities by:

  • Expanding access to community-based mental health and addiction services for children and youth (age 10-25), recognizing the effectiveness of early interventions to treat mild to moderate mental health disorders.

Program Principles

Student well-being teams will focus on wellness and timely access to services for children, youth and their families, based on the following principles:

Child-centered: Every aspect of the program has the child, youth and family at the center. Teams strive to build on the strengths of the child and to make accessing and receiving services as easy as possible. Services are tailored to meet the needs of children and youth, ensuring they receive the right service at the right time where they are.

Every door is the right door: Children and youth have additional opportunities to seek support. They can approach a core team member directly during drop-in hours, or speak to a trusted school staff member who will help them access the support they need.

Early Intervention: Every effort will be made to meet the needs of children, youth and families as early as possible and in the least-intrusive manner. Having services available in schools makes accessing services easier and more timely, allows issues to be addressed earlier, and prevents these issues from escalating and impacting their ability to succeed in school and throughout life.

Collaboration: Team members will work together to meet the individual needs of children, youth and their families, by accessing all necessary programs and services as early as possible –while building a culture of wellness in the school community.

Target Populations

This initiative will target school-aged children and youth, a currently under-serviced group where demands are high and where upstream investment can be an effective way of preventing the development more acute conditions. When the initiative is rolled out across the Island’s 10 families of schools, this will provide access to non-acute mental health and addictions services to over 20,000 Island students, and will also provide them with a streamlined point of access into the formal mental health and addictions system where warranted. For those families of schools with significant First Nations representation within the student populations, cultural safety and awareness training would be a key component for the involved staff.

Program Goals

The Student Well-being Program has identified clear and defined objectives:

  • Increase collaboration for student wellness by:
    • Increasing information sharing, networking and communication between government
    • Identifying and addressing gaps in services among professionals and programs
    • Building capacity of existing services within schools
  • Improve access to government and community services by:
    • Reducing or eliminating timeline gaps and duplication of services among professionals and programs
    • Providing services via a team approach across a family of schools
    • Improving student engagement and school success
    • Improving community engagement
  • Establish a flexible, child youth and family centered program that strengthens capacity in youth and families by:
    • Developing an array of programming and services offered at school sites
    • Identifying and responding to children, youth and families in need of additional supports and services in a timely manner

Performance Measurement

Evaluation work for the Student Well-being Program is being developed to measure process and impact of the program. The purpose of the evaluation framework is to inform future roll-out of the program and to assess short and long term impact. Phase 1 of the project involves implementation of the model within two families of schools on the Island, with eventual implementation within the remaining eight families of Island schools. In the end, this will provide direct access to services for the more than 20,000 Island students. With this implementation plan in mind, the emerging evaluation plan is being designed to monitor immediate results and help inform subsequent roll-outs. While measures of student interactions and key outcomes from those interactions would be a primary indicator, additional monitoring will be undertaken to assess coordinated interactions with the formal mental health and addictions system. These detailed assessments will primarily take two forms.

First, surveys and focus groups for students participating in the program (and their family members) will be conducted regarding:

  • Self-perceived changes for the student in various aspects of social/emotional well-being, physical well-being and mental well-being;
  • Level of accessibility to program;
  • Level of timeliness to program;
  • Level of communication and active participation through pathways for services; and,
  • Level of ease of transition through pathways for services (e.g., less re-telling of stories; streamlined referral process).

In addition, analysis of the provincial education, health, social services and justice system data sets will be used to assess the impact of intervention on students with respect to the various aspects of social/emotional well-being, physical well-being and mental well-being. This will include documenting changes in:

  • Children/youth at emergency for services that could be dealt with through Student Well-being Program;
  • Acute care readmissions;
  • Reporting of child neglect/abuse;
  • Children/youth placed into care under child protection;
  • Children/youth in formal justice system; and,
  • Youth referred to community mental health.

The results of these monitoring efforts will be used to inform future planning of programs and services targeting children and youth.

2. Mobile Mental Health Crisis Program

This initiative would establish a 24-7 provincial mobile mental health crisis program composed of highly trained mental health professionals (in most cases, registered nurses and social workers) supported by psychiatry. While planning for this program is still evolving, the broad vision and parameters for the program are outlined below.

Mobile crisis teams are a leading approach to providing mental health services to people in crisis in the community. In a crisis situation, individuals are best served by responsive access to mental health assessment, stabilization and connection to appropriate ongoing care. Other provinces have established some form of mobile mental health crisis team (whether run in collaboration with hospital emergency departments or regional police, or operating as stand-alone teams of clinicians), and have seen reductions in presentation to emergency departments and psychiatric hospital admissions as a result of these mobile mental health crisis. In the absence of this service, PEI will continue to experience higher than necessary emergency department and police response to mental health issues. In the first six months of 2017, the Queen Elizabeth Hospital emergency department had 296 mental health related visits, and the RCMP on PEI responded to over 200 mental health related calls during that same time period. These pressures resulted from a lack of timely access to mental health and addictions services at both the time and place they were needed. In other jurisdictions, the establishment of mobile mental health crisis teams have resulted in significant reductions in presentation to emergency departments and psychiatric hospital admissions.

Under the proposed model, new teams of clinicians will be connected with other first points of contact for individuals in mental health crisis (e.g., police, child and adult protection, etc.) who will also receive training in recognizing mental health issues and responding appropriately. The mobile mental health crisis teams will provide a key support for those first points of contact when the level of acuity out-strips their ability to respond.

These mobile mental health crisis teams will be composed of highly trained mental health professionals (in most cases, registered nurses with mental health training and social workers) embedded in each county of the province and supported by psychiatric resources. Effective teams are connected with other first points of contact for individuals in mental health crisis (e.g., police, child and adult protection, etc.) who also receive extensive training in recognizing mental health issues and responding appropriately. The teams will provide 24-7 rapid response either via telephone or in-person, thereby supporting earlier and more appropriate mental health care.

Federal funding will be used to support additional practitioners who would staff these response units, with any additional administrative, infrastructure and support costs funded by the Province.

Aside from addressing a key gap in the Island’s mental health and addictions system, the addition of community-based mobile mental health crisis teams will meet a key goal of the Common Statement of Principles on Shared Health Priorities. Specifically, it will represent spread of evidence-based models of community mental health care.

While the cost associated with the mobile mental health crisis teams will exceed the available federal funds, the targeted funding will be used to offset the cost of hiring the necessary front line staff, with the remaining staffing costs and any necessary administrative costs funded by the Province.

Target Populations

While target populations for this initiative will be diverse, a key mechanism for identification of clients would be the inputs of those aforementioned first responders and first points of contact that encounter individuals in crisis. Thus strong partnerships with police, paramedics, child and adult protection, etc., would facilitate a clear pathway for individuals to receive services. This initiative would also build on the Province’s ongoing efforts to ensure cultural safety and awareness training for many mental health and addictions staff, including members of the mobile mental health crisis teams.

Performance Measurement

Given the dynamic nature of this initiative and the current state of planning, a robust performance measurement framework has not yet been articulated. However, given the significance of this undertaking, it is expected that performance and monitoring metrics would be developed to assess the ongoing impact of the program, both in terms of individual outcomes for referred clients, as well as the program’s overall impact on pressure points and service utilization within the broader mental health and addictions system.

Overall Performance Measurement and Monitoring of the Action Plan

In addition to the monitoring and evaluation that will be taking place within individual programs and initiatives described under the initiatives above, the Province of PEI is also committed to full participation in the development and reporting of a set of pan-Canadian indicators intended to monitor progress in the two areas of focus. Further to this, provincial representatives are currently engaged in discussions with CIHI and other Provincial-Territorial representatives to collaborate on the development of an appropriate set of indicators. Based on discussions among FPT Deputy Ministers of Health, the preliminary expectation is that this work will identify 3-5 indicators for each priority area, and that a phased approach to reporting will be rolled out over the term of the funding agreement. PEI is fully committed to working with CIHI and the other provinces and territories to establish an appropriate suite of indicators, and to report on them annually thereafter.

Report a problem or mistake on this page
Please select all that apply:

Thank you for your help!

You will not receive a reply. For enquiries, contact us.

Date modified: