2018 to 2022 Canada-Government of Yukon Home and Community Care and Mental Health and Addictions Services Funding Agreement

Table of Contents

Funding Agreement

BETWEEN:

HER MAJESTY THE QUEEN IN RIGHT OF CANADA (hereinafter referred to as "Canada" or "Government of Canada") as represented by the Minister of Health (herein referred to as "the federal Minister")

- and -

GOVERNMENT OF YUKON (hereinafter referred to as "Government of Yukon") as represented by the Minister of Health and Social Services (herein referred to as "the territorial Minister")

REFERRED to collectively as the "Parties"

PREAMBLE

WHEREAS, on January 16, 2017 Canada and Government of Yukon 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 Government of Yukon 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 Government of Yukon 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 Government Organization Act authorizes the territorial Minister to enter into agreements with the Government of Canada under which Canada undertakes to provide funding toward costs incurred by Government of Yukon for the provision of health services which includes home and community care and mental health and addictions initiatives;

WHEREAS, Government of Yukon will make ongoing investments in home and community care and mental health and addictions services, consistent with its broader responsibilities for delivering health care services to its residents;

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

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

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

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

WHEREAS, Canada authorizes the federal Minister to enter into agreements with the provinces and territories, for the purpose of identifying activities provinces and territories will undertake to protect residents in long-term care settings through increased infection prevention and control measures and in keeping with performance measurements and reporting commitments;

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

NOW THEREFORE, Canada and Government of Yukon agree as follows:

1.0 Objectives

1.1 Building on Government of Yukon's existing investments and initiatives, Canada and Government of Yukon commit to work together to improve access to home and community care and strengthen access to mental health and addictions services (listed in the Common Statement, attached as Annex 1).

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

2.0 Action Plan

2.1 Government of Yukon will invest federal funding for Home and Community Care and Mental Health and Addictions Services provided through this Agreement in alignment with the selected action(s) from each menu of actions listed under home and community care and mental health and addictions in the Common Statement.

2.2 Government of Yukon's approach to achieving home and community care and mental health and addictions services objectives is set out in their five-year Action Plan (2017-18 to 2021-22), as set out in Annex 2.

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

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

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

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

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

3.0 Term of Agreement

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

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

3.3 Renewal of Bilateral Agreement

3.3.1 Government of Yukon'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 Government of Yukon and Canada's agreement on a new five-year action plan.

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

4.2 Allocation to Government of Yukon

4.2.1 In this Agreement, "Fiscal Year" means the period commencing on April 1 of any calendar year and terminating on March 31 of the immediately following calendar year.

4.2.2 Canada has designated the following maximum amounts to be transferred in total to all provinces and territories under this initiative on a per capita basis for the Term starting on April 1, 2018 and ending on March 31, 2022.

Home and Community Care

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

Mental Health and Addictions Services

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

Safe Long-term Care

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

4.2.3 For Home and Community Care and Mental Health and Addictions Services, annual funding will be allocated to provinces and territories on a per capita basis, for each Fiscal Year that an agreement is in place. The per capita funding for each Fiscal Year is calculated using the following formula: F x K/L, where:

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

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

  • F is the total one-time funding amount available under this initiative;
  • N is the number of jurisdictions (all 13) that will be provided the base funding of $2,000,000;
  • K is the total population of a particular province or territory, as determined using the annual population estimates from Statistics Canada; and,
  • L is the total population of Canada, as determined using annual population estimates from Statistics Canada.

4.2.4 For the purposes of the formula in section 4.2.3, the population of Yukon for each fiscal year and the total population of all provinces and territories for that Fiscal Year are the respective populations as determined on the basis of the quarterly preliminary estimates of the respective populations on July 1 of that Fiscal Year. These estimates are released by Statistics Canada in September of each Fiscal Year.

4.2.5 Subject to annual adjustment based on the formulas described in section 4.2.3, Government of Yukon's estimated share of the amounts will be:

Fiscal Year Home and community care
Estimated amount to be paid to Government of YukonTable 1 footnote * (subject to annual adjustment)
Mental health and addictions services
Estimated amount to be paid to Government of YukonTable 1 footnote * (subject to annual adjustment)
2018-2019 $630,000 $260,000
2019-2020 $680,000 $470,000
2020-2021 $680,000 $630,000
2021-2022 $940,000 $630,000

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

Fiscal Year Safe Long-Term Care
Estimated amount to be paid to Government of YukonTable 5 footnote * (subject to annual adjustment)
2021-2022 $3,077,710

4.3 Payment

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

  1. The first installment will be paid on or about April 15 of each Fiscal Year. The second installment will be paid on or about November 15 of each Fiscal Year.
  2. The amount of the first installment will be equal to 50% of the notional amount set out in Article 4.2.5 as adjusted by Article 4.2.3.
  3. The amount of the second installment will be equal to the balance of Canada's contribution to Government of Yukon for the Fiscal Year as determined under sections 4.2.5 and 4.2.3.
  4. Canada will notify Government of Yukon 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 Government of Yukon 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 Government of Yukon has failed to provide its annual financial statement for the previous Fiscal Year or to provide data and information related to home and community care and mental health and addictions to CIHI for the previous Fiscal Year in accordance with section 5.1.2.
  6. The sum of both semi-annual installments constitutes a final payment and is not subject to any further adjustment once the second installment of that Fiscal Year has been paid.
  7. Payment of Canada's funding for each Fiscal Year of this Agreement is subject to an annual appropriation by Parliament of Canada for this purpose.

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

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

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

4.4 Carry Over

4.4.1 At the request of Government of Yukon, Government of Yukon may retain and carry forward to the next Fiscal Year the amount of up to 10 percent of the contribution paid to Government of Yukon for a Fiscal Year under subsection 4.2.5 and 4.2.6 that is in excess of the amount of the eligible costs under subsection 4.7 actually incurred by Government of Yukon 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 Government of Yukon to retain and carry forward an amount exceeding 10 percent will be subject to discussion and mutual agreement in writing by the Parties via an exchange of letters.

4.4.2 For greater certainty, any amount carried forward from one Fiscal Year to the next under this subsection is supplementary to the maximum amount payable to Government of Yukon under subsection 4.2.5 and 4.2.6 of this Agreement in the next Fiscal Year.

4.4.3 In the event this bilateral agreement is renewed in accordance with the terms of section 3.2.1, and at the request of Government of Yukon, Government of Yukon 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 Government of Yukon to retain and carry forward an amount exceeding 10 percent will be subject to discussion and mutual agreement in writing by the Parties via an exchange of letters.

4.5 Repayment of overpayment

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

4.6 Use of Funds

4.6.1 Canada and Government of Yukon agree that funds provided under this Agreement will only be used by Government of Yukon in accordance with the areas of action outlined in Annex 2.

4.7 Eligible Expenditures

4.7.1 Eligible expenditures for funds provided under this Agreement are the following:

  • capital and operating funding;
  • salaries and benefits;
  • training, professional development;
  • information and communications material related to programs;
  • data development and collection to support reporting; and,
  • information technology and infrastructure.

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

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

4.8 Cost Recovery

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

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

5.0 Performance Measurement and Reporting to Canadians

5.1 Funding conditions and reporting

5.1.1 As a condition of receiving annual federal funding, Government of Yukon 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. Government of Yukon will designate an official or official(s), for the duration of this agreement, to work with CIHI and represent the interests of Government of Yukon 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, Government of Yukon 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 Government of Yukon'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 Government of Yukon'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 Government of Yukon under section 4.4; and
    4. If applicable, the amount of any surplus funds that is to be repaid to Canada under section 4.5.
  3. For the Safe Long-term Care Funding, the annual financial statement will also set out, for the previous fiscal year:
    1. The amount of the federal funding flowing to each facility, and the type of facility (as set out in 4.7.2);
    2. The estimated amount of funds to be recovered under cost-recovery agreements, where applicable, and the priority areas where those funds will be reinvested; and

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

  1. Provide up-to-date information on performance measures, targets and intended outcomes for the three areas identified in section 2.3, and for any other areas in which Government of Yukon has used Safe Long-term Care Funding to support infection prevention and control, and interim results for each initiative;
  2. Provide a breakdown of the facilities receiving funding under this Agreement, and specifically, identifying those privately-owned, for-profit facilities receiving funding pursuant to this Agreement and whether or not 6.5 Canada reserves the right to conduct public communications, announcements, events, outreach and promotional activities about the Common Statement, Safe Long-term Care Funding and bilateral agreements. Canada agrees to give Government of Yukon 10 days advance notice and advance copies of public communications related to the Common Statement, Safe Long-term Care Funding, bilateral agreements, and results of the investments of this Agreement.

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

5.2 Audit

5.2.1 Government of Yukon will ensure that expenditure information presented in the annual financial statement is, in accordance with Government of Yukon's standard accounting practices, complete and accurate.

5.3 Evaluation

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

6.0 Communications

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

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

6.3 In the spirit of transparency and open government, Canada will make this Agreement, including any amendments, publicly available on a Government of Canada website and Government of Yukon shall make the results under this Agreement related to the Safe Long-term Care Funding, as set out in Annex 2, publicly available on its Government of Yukon website.

6.4 Canada, with prior notice to Government of Yukon, may incorporate all or any part or parts of the data and information in 5.1.2 and 5.1.3, or any parts of evaluation and audit reports made public by Government of Yukon into any report that Canada may prepare for its own purposes, including any reports to the Parliament of Canada or reports that may be made public.

6.5 Canada reserves the right to conduct public communications, announcements, events, outreach and promotional activities about the Common Statement, Safe Long-term Care Funding and bilateral agreements. Canada agrees to give Government of Yukon 10 days advance notice and advance copies of public communications related to the Common Statement, Safe Long-term Care Funding, bilateral agreements, and results of the investments of this Agreement.

6.6 Government of Yukon reserves the right to conduct public communications, announcements, events, outreach and promotional activities about the Common Statement, Safe Long-term Care Funding and bilateral agreements. Government of Yukon agrees to give Canada 10 days advance notice and advance copies of public communications related to the Common Statement, Safe Long-term Care Funding, bilateral agreements, and results of the investments of this Agreement.

7.0 Dispute Resolution

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

8.0 Amendments to the Agreement

8.1 The main text of this Agreement (not including attached annexes) may be amended at any time by mutual consent of the Parties. To be valid, any amendments shall be in writing and signed, in the case of Canada, by Canada's Minister of Health, and in the case of Government of Yukon, by Government of Yukon's Minister of Health and Social Services.

8.2 Annex 2 may be amended at any time by mutual consent of the Parties. To be valid, any amendments to Annex 2 shall be in writing and signed, in the case of Canada, by their Designated Official, and in the case of Government of Yukon, by their Designated Official.

9.0 Equality of Treatment

9.1 During the term of this Agreement, if another province or territory, except the province of Quebec, negotiates and enters into a Home and Community Care and Mental Health and Addictions Services Agreement with Canada, or negotiates and enters into an amendment to such an agreement and if, in the reasonable opinion of Government of Yukon, 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 Government of Yukon, if requested by Government of Yukon. This includes any provision of the bilateral agreement except for the Financial Provisions set out under section 4.0. This amendment shall be retroactive to the date on which the Home and Community Care and Mental Health and Addictions Services Agreement or the amendment to such an agreement with the other province or territory, as the case may be, comes into force.

10.0 Termination

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

11.0 Notice

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

The address for notice or communication to Canada shall be:

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

Email: marcel.saulnier@canada.ca

The address for notice or communication to Government of Yukon shall be:

Attn: Michele Goshulak, Assistant Deputy Minister
Health and Social Services
Government of the Yukon, H-1
P.O. Box 2703
Whitehorse, YT Y1A 2C6
201-#1 Hospital Road
Whitehorse, Yukon
Y1A 3H7

Email: Michele.Goshulak@gov.yk.ca

12.0 General

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

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

12.3 This Agreement shall be governed by and interpreted in accordance with the laws of Canada and Government of Yukon.

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

12.5 If for any reason a provision of this Agreement that is not a fundamental term is found by a court of competent jurisdiction to be or to have become invalid or unenforceable, in whole or in part, it will be deemed to be severable and will be deleted from this Agreement, but all the other provisions of this Agreement will continue to be valid and enforceable.

SIGNED on behalf of Canada by the Minister of Health this 25th day of June, 2018.

The Honourable Larry Bagnell on behalf of the Honourable Ginette Petitpas Taylor, Minister of Health

SIGNED on behalf of Government of Yukon by the Minister of Health and Social Services this 25th day of June, 2018.

The Honourable Pauline Frost, Minister of Health and Social Services

Annex 1 to the Agreement

Common Statement of Principles on Shared Health Priorities

Annex 2 to the Agreement

Yukon Action Plan on Home and Community Care and Mental Health and Addictions Services

Introduction

Yukon is comprised of close to 38,000 people who live both in the urban capital of Whitehorse (~30,000 people) and are spread across 15 rural and remote communities. There are 14 First Nations and eight language groups which make up 23% of the total Yukon population. Among these are 11 Yukon First Nation governments that have established comprehensive land claims and self-government agreements.

Yukon government is committed to supporting a people-centred approach to wellness to help all Yukoners thrive, and to creating healthy, vibrant and sustainable communities across the territory. It is the mandate of the Minister responsible for Health and Social Services to meet this enduring priority including, increased options in service delivery to allow seniors to age in place where possible and improve the provision of mental wellness services in communities. These commitments are further supported jointly by the Government of Yukon and Yukon First Nations Yukon Forum goals to foster reconciliation, develop strong government to government relations and collaborate on shared priorities.

The realities of managing the territory's health system is that service delivery must meet a diversity of needs and address the upstream costs and growing demands of providing health care in the North. Services must take into consideration in their design the unique sub-population groups within the territory including Yukon First Nations, Franco-Yukonnais and other cultural and minority groups. In Yukon, health and social services are integrated not only under the umbrella of one territorial department but across programs more generally, whereby home care and mental wellness and acute care services are constantly working towards a common objective to provide more comprehensive care.

With new targeted federal funds, Yukon seeks to build upon its efforts to improve the mental wellness of Yukoners and to address increasing needs for expanded home and community care. This work aligns with the priorities identified in Yukon's Mental Wellness Strategy and will be informed by service planning within the Continuing Care Division. A strategic population health approach has been applied to both funding streams to focus on identified care needs, increased access to services and improved care coordination.

This action plan outlines Yukon's priorities for use of federal funding to enhance, expand or accelerate home and community care and mental wellness and substance use services. It aligns with the objectives of the Common Statement of Principles on Shared Health Priorities.

Home and Community Care

Overview

There is an aging population in Yukon. Much like other parts of Canada, Yukon continues to see significant growth in the population of older adults. According to the Yukon Bureau of Statistics, seniors currently make up 12% of the population - representing a 50% increase in the last 10 years - and are predicted to be 15% of the population by 2030. An aging population results in increased pressures on, and use of, the health and social service system. Specifically, many older adults require supports from multiple transfer points of care within the health care system in Yukon. These include services provided by a primary care provider, in hospital awaiting long term care, in home and community as well as in a long term care facility or some combination of the above.

Ongoing management of the health system requires monitoring of services provided to older age groups. This may include examination of readmission rates to hospital and assessment of high users for hospital and home care services as well as identification of case specific needs. The results of this work show referrals for home care services in Yukon continue to grow each year along with an increasing level of client complexity. For example, the average month end caseload in the Yukon Home Care program in 2014/15 was 550; in 2017/18 it was 628. A high percentage of clients in Yukon live alone at the time of home care referral (In 2016/17 there were close to 61% in Yukon compared to 17% in other reporting jurisdictions), which increases demand on home care service delivery and supports provided outside of the home as well as early referral for long term care facility placement. Based on the current demographics, this trend of increasing demand is likely to continue.

Yukoners have expressed the desire for the option to remain at home when recovering from illness or injury or living with a chronic condition as well as a desire to access integrated palliative and end of life care. Services must adapt to meet these needs. Currently in Yukon, in-home respite for caregivers, palliative and end of life care are provided as part of home care services. Increasing access to enhanced home supports through the Home First program and Complex Client Supports will result in enhanced access to these services.

In the 2019/20 fiscal year, Yukon will be establishing a community hospice for palliative and end of life care at the newly constructed Whistle Bend Place. The facility has been designed to meet the need to provide a Community Hospice for those individuals who choose to receive hospice palliative care outside of their home and who do not require acute care.

Broader system change will take time and there are many aspects of the care continuum that continue to be segmented in Yukon. In this environment, clients who are high users of the system are at risk of negative impacts related to a lack of coordination. Individuals with complex needs often need a broad range of supports and integration of care across the health and social services area. These challenges are compounded by the fact that Yukon's health system has evolved with an absence of age-friendly planning and design in mind. Consequently, many processes continue to be provider or institution-focused. This reality points to a need to better identify client goals and to establish a stronger philosophy of person and family-centred care, particularly in the care of older adults. In all the initiatives, effort will be taken to identify and address cultural needs, including those of Indigenous and other minority communities. Both clients and primary care providers need to be involved in building this care system.

Priority Areas

There are three priority areas that have been identified to focus Yukon's Home and Community Care targeted initiatives. These are:

  1. Home First and Complex Client Supports
  2. Rural Community Home Care Enhancements
  3. Technology Support
Funding Allocation
N/A 2017-18Table 2 footnote * 2018-19Table 2 footnote ** 2019-20Table 2 footnote ** 2020-21Table 2 footnote ** 2021-22Table 2 footnote ** TotalTable 2 footnote **
Home First, Complex Client Supports $145,000 $325,000 $340,000 $340,000 $600,000 $1,750,000
Rural Community Home Care Enhancements $65,000 $205,000 $240,000 $290,000 $290,000 $1,090,000
Technology support – mobile charting, virtual visits, home support scheduling, etc. N/A $100,000 $100,000 $50,000 $50,000 $300,000
TotalTable 2 footnote ** $210,000 $630,000 $680,000 $680,000 $940,000 $3,140,000

Improvement Initiatives and Objectives

1. Home First and Complex Client Supports

Enhanced community-based services will support Yukoners to stay in their homes as long as possible, return home from hospital, improve navigation through the health care system and ultimately support better continuity of care. Support for the right services at the right time and place will include the enhancement of Yukon's Home First program and remodelling of the Complex Client Supports program and other initiatives for clients with complex needs, including access to wound care and IV supplies that are not otherwise covered through territorial or private insurers. These programs will also provide palliative and end of life care and be a preventative measure to reduce hospital admissions and improve supports during discharge from acute care facilities.

Through the Home First and Complex Client Supports Initiative, Yukon Home Care Program proposes to shift the utilization of acute and long term care services by providing enhanced services to clients at home who would otherwise be moved into long term care or occupy alternate level of care (ALC) beds in hospital. Similar programs have been implemented in multiple jurisdictions across Canada including "Destination Home" in Alberta, "Home is Best" in British Columbia, "Home Again" in Nova Scotia and "Priority Home" in Manitoba.

These initiatives are supported by the Yukon Home Care Program Mission which states, "The Yukon Home Care Program provides client-focused health services in the home, improving quality of life and supporting Yukoners to live independently".

Home First is a "philosophy to help frail patients get out of the hospital and back into their homes as soon as possible. It's meant for patients who have completed acute care treatment and no longer need 24-hour attention in hospital, patients who can heal safely at home with the right kinds of support," (www.healthcareathome.ca). The objectives for Home First include:

  • Increased quality of life for clients
  • Reduced frequency and length of stay of hospital admissions
  • Maintain or improve the client's current level of function
  • Reduced admissions to emergency department and acute care
  • Decreased caregiver burden
  • Better transitions between home, hospital, and facility-based respite
  • Improved access to care in community
  • Strengthened relationships with community partners

In order to be responsible for meeting the variable needs of clients in a Home First philosophy, new models of scheduling for home support workers will need to be investigated and implemented. These models will improve operations and support more efficient business processes to enhance services delivered by Yukon's Home Care program to all Yukoners, including citizens and elders of Yukon First Nations. Enhancements to the Complex Client Supports program will be based on implementing evidence-based models of home and community care that are more integrated. This will align with community-based service planning, improve overall care coordination and include improved access to home hospice, palliative and end of life care.

Enhanced community care will also include support for in-home care services for the treatment of wounds or provision of certain intravenous (IV) therapies when the cost of these supplies is a barrier to the individual receiving treatment in their home. Home IV administration also had significant implications for the amount of nursing time spent in the home. The cost to manage wounds and provide IV therapy is a strain on the health system, not to mention a personal cost to individuals (pain, loss of function and risk of other consequences such as infection). Greater wound healing and the provision of home IV will increase access to community-based services and better support the continuum of care by preventing unnecessary visits to hospital and decreasing personal and system costs over time. There is strong clinical research to support this approach, including improvements in negative pressure wound therapy that has been proven to be extremely effective in reducing the time it takes to heal wounds and in healing wounds that otherwise have not responded to other treatment options.

Federal funding will be used to enhance the human resource complement and operational costs needed for Home First and Complex Client Supports throughout Yukon. Additionally, funding will be used for human resource and other costs to support in-home delivery of wound care and certain IV treatments.

This initiative will align with the objectives outlined in 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;
  • Increasing support for caregivers; and
  • Enhancing access to palliative and end of life care at home or in hospices.

2. Rural Community Home Care Enhancements

Comprehensive home and community care services are a vital part of supporting individuals to age in place. This is particularly important in rural Yukon where there is a strong desire to support elders to remain in their home community. Given the diversity throughout Yukon, each community requires a community-based approach before determining program and service improvements. Each rural and remote community has unique strengths that can be supported and unique needs to be addressed. In order to ensure the correct home care service enhancements are actioned in rural Yukon, the first step is to connect with individuals in the community to gather information and input. The review process will inform planning to ultimately improve access to home care services (including palliative and end of life care needs) in rural communities. This planning process is vital to inform future initiatives, identify potential community partnerships and home care program improvements unique to each community as well as to inform use of targeted funding in future years. These improvements will need to be considered in partnership with the individual First Nations Home and Community Care programs administered through the various First Nations health programs.

The first step to complete service planning in each rural community will be to identify home care needs throughout Yukon and inform strategies for the Yukon home care program to support aging well in communities. There are 15 rural communities that will be part of the review and all community visits will be completed by the summer of 2018.

The objectives include:

  • To gain an understanding of each community's unique home, palliative and end of life care needs.
  • To determine how home care can contribute to aging in place for seniors who live in rural communities.
  • To obtain detailed information to guide home care services over the upcoming years.

This work will involve:

  • Developing a Home Care Community Profile for each of 15 Yukon communities. This will include the following information:
    • Community demographics
    • A profile of home care clients in each community
    • Number of home support hours per community, and
    • Home care resources and position in each community
  • Completing a community visit to each rural community in Yukon and meeting with key stakeholders (including home care employees, First Nations Health Programs, home care clients, community partners and community health centres) to identify home care needs
  • Analyzing and Interpreting data obtained from the stakeholder meetings
  • Developing recommendations for home care services for each community in the Yukon

After completion of service planning, the second step will be to create an implementation plan for the home care service enhancements for each rural community. Federal funds will be used to support the unique community identified home care service needs.

Federal funding will be used to support the human resource and travel requirements to complete community service planning as well as the implementation costs for community identified initiatives. To date, one area of home care service enhancement that has been identified by several communities is the need for increased access to in-home respite for family caregivers.

This initiative will align with the objectives outlined in 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; and
  • Increasing support for caregivers.

3. Technology Support

Multiple areas within home care services will benefit from improved technology, including a scale up of a virtual visits project within home care which was recently concluded. Technology enhancements will be applied to expand accessibility to mobile charting through cell phone hardware, software and bandwidth. Technology enhancements will also be a key feature to support a new quality improvement initiative aimed at increasing efficiency of home support worker scheduling. The enhanced technology supports will seek to achieve greater efficiency in meeting clients' needs within the home and community setting.

'Virtual visits' are not intended to replace home visits, but evidence suggests that a combination of virtual visits with in-person visits can result in improved health outcomes. The objectives are to promote social inclusion and reduce feelings of social isolation for clients, and to explore how more regular contact with clients supports symptom management and avoids acute care intervention. Innovative use of technology in this manner can empower clients to stay at home and improve access to health care services in rural and remote settings.

Other evidence-informed models for increased use of technology, including mobile charting and a home support neighbourhood model which uses smart phones and scheduling applications will also be explored.

Federal funding will be used to support the addition of the required hardware, software and bandwidth in order to expand access to virtual visits and mobile charting. The funds will also be used for program development and initiation of a quality improvement initiative focused on home support worker scheduling.

This initiative will align with the objectives outlined in 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.

Mental Wellness and Substance Use Services

Overview

An estimated 7,500 Yukon people struggle with mental health or substance use challenges per year, and Statistics Canada (2015) estimates that 65% of Yukon people over age 12 reported very good or excellent mental health in 2013/14, compared to 71% nationally. On average, more than 1,000 emergency department visits per year in Yukon are directly related to drugs and/or alcohol. In the same time period, children and youth made an average of about 40 visits annually to Yukon emergency departments due to intentional self-injury.

Like other jurisdictions in Canada, Yukon is striving to make changes to better address mental health and substance use issues. In recent years, efforts have been actively focused on establishing a coordinated and collective approach to improving mental wellness and substance use services in Yukon. This work has involved making a substantial system shift from a series of treatment-based programs and services to one that is more integrated and puts greater emphasis on early interventions and prevention. Yukon has also adopted the terminology 'Mental Wellness and Substance Use' to encompass broader and diverse definitions of the mainstream medical terms 'mental health and addictions.' This language is also more reflective of Yukon's notions of promoting wellness and a commitment to greater collaboration across health and social service sectors.

In early 2016, Yukon underwent an engagement exercise to examine the mental wellness needs of Yukoners. This process revealed that there are diverse unmet needs in the territory and that often people needing services do not know where to go for assistance. The process also served to highlight the complexity of the existing system and identify service gaps, particularly among individuals with complex needs who are repeat users of the system due to health and environmental factors.

Guided by Yukon's Mental Wellness Strategy, Yukon is shifting its approach to strengthen partnerships around a common goal to better coordinate mental wellness, trauma and substance use care for Yukon people. This approach involves a collective vision for improved mental wellness and substance use services across the territory. The Mental Wellness Strategy aims to move the system to a place where care providers and programs are working together to provide coordinated, holistic and seamless care. This approach represents a significant change in how health and social system change has occurred previously. Collaborative evidence-informed innovation is intended to make lasting impacts not only on the way treatment is delivered but also improved health outcomes.

The Mental Wellness Strategy provides the framework to ensure the diversity of perspectives and approaches lead to the best results for Yukon people. The activities of the Strategy include improving access to a range of culturally-safe services, with a focus on strengthening relationships with Yukon First Nations and bringing appropriate services closer to communities outside of Whitehorse. First Nations people make up a greater portion of the population in most communities outside of Whitehorse. Activities also include addressing intra-departmental issues, as well as cross-departmental relationships in order to build stronger partnerships with First Nations, community providers, and informal care providers.

Mental wellness and substance use programs have recently been reorganized into a territory-wide 'hub and spoke' model, and new community mental wellness positions and programming have been introduced. Through this work, Yukon aims to achieve greater inter-program coordination, improved access to services close to where individuals live and improved collaboration and team-based care. Ultimately, the structural changes will support further system integration, coordination and transformation and improve the health system's ability to adapt to future population needs.

Priority Areas

Two key areas have been identified for Yukon's Mental Wellness and Substance Use Services targeted initiatives:

  1. Improved access to community-based mental wellness and substance use services
  2. Culturally appropriate and integrated interventions
Funding Allocation
N/A 2017-18Table 3 footnote * 2018-19Table 3 footnote ** 2019-20Table 3 footnote ** 2020-21Table 3 footnote ** 2021-22Table 3 footnote ** TotalTable 3 footnote **
Improving access to community-based mental wellness and substance use services $100,000 $120,000 $170,000 $230,000 $230,000 $850,000
Culturally appropriate and Integrated interventions $0 $140,000 $300,000 $400,000 $400,000 $1,240,000
TotalTable 3 footnote ** $100,000 $260,000 $470,000 $630,000 $630,000 $2,090,000

Improvement Initiatives and Objectives

1. Improving access to community-based mental wellness and substance use services for children and youth

Yukon is placing a strong focus on client-centred care to enhance services for children, youth and families in Whitehorse and in rural communities. This will include greater partnerships with service providers and government departments to increase access points in a greater number of locations with a focus on providing earlier intervention and prevention activities that will become part of the continuum of mental wellness and substance use services available to Yukon people. It will be particularly important to build awareness and promote education around safe substance use and self-management of mental health symptoms. This will help ensure that children and youth are receiving coordinated services and have improved access to counseling supports to ensure long-term wellness. Improved access will also allow for the mental wellness system to be more responsive to clients' needs and would allow individuals access to a greater range of appropriate supports when and where they need it. This change in approach to service delivery will have a lasting impact on wellness in Yukon's communities.

A major priority under the Mental Wellness Strategy is the improvement of access to a range of mental wellness and substance use services closer to where people live. This work will require dedicated resources to engage with community service providers and community members with lived experience across Yukon in the planning of delivery models that reflect the needs of each community. Strengthening relationships with community service providers and First Nation partners to develop child and youth programming will enable innovative approaches to early interventions in schools and other existing youth programs.

The objectives of improving access to community-based mental wellness and substance use services for children and youth include:

  • Earlier intervention for, and prevention of, mental wellness and substance use services concerns;
  • Fewer children and youth having to leave their communities to access mental wellness and substance use services;
  • Ensuring there are clinical staff available to deliver programs/services in locations across Yukon.

This work will include:

  • Planning and design session with communities to identify services delivery models and staffing supports to improve access to mental wellness and substance use services;
  • Initiate the first phase of integration of mental health and addiction services to ensure a holistic and coordinated approach to providing improved access to individuals seeking services based on the tiered services delivery model that would be matched to client needs, with an emphasis on early interventions;
  • Adding clinical counseling positions to support child, youth and family counselling and treatment capacity in communities;
  • Rolling out community wellness plans to improve capacity in rural communities with the addition of new positions working within a collaborative care team or Hub model; and
  • Implementing child and youth programming in schools, youth programs, youth drop-ins and other locations youth access in communities outside of Whitehorse. These programs will address and support early intervention and prevention activities to build skills in self-management of mental health and substance misuse symptoms, as well as build awareness and understanding of substances and their connection to overall wellness.

This work will be aligned with other federally-funded initiatives to support mental health training and capacity building through Yukon's Territorial Health Investment Fund (THIF).

Federal funding will be used to support community engagement, planning and development of programs and services, staff positions to deliver services and training for service providers.

This initiative will align with the objectives outlined in 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;
  • 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.

2.0 Culturally-appropriate and integrated interventions

Through Yukon's work with First Nation partners, a strategic goal is to position Yukon as a leader for northern, remote and First Nation innovation and delivery of mental wellness and substance use programming. This work will depend on sustained partnerships and collaboration with Yukon First Nations to ensure it is culturally relevant. Initiatives will include data system improvements to support better case management and coordination of services between community-based programs (e.g., community nursing, chronic disease management and long term care etc.) and the hospital. Projects will advance the use of technology as a tool to address local health needs. Targeted funds will support tele-psychiatry supports in rural, remote and/or First Nation communities and will be linked with the outcomes of the work identified in the first priority area.

In addition, Yukon has been aligning delivery models to increase capacity to address concurrent disorders (mental health and addiction) as well as to work more collaboratively with the primary care system to better address individuals with complex health needs. An integrated approach to providing services recognises that an individual will often have more than a single presenting issue – and that the interconnection between service providers of different professional backgrounds allows for the health and social system to provide more effective services. Support for providers to better match services to meet the needs of the individual regardless of where they enter the system is a critical component of this work.

Mental wellness and substance use interventions are just one part of a holistic view of the health and wellness of Yukon people. Being able to provide appropriate and timely services and supports when an individual enters the health system will be critical to improving the overall health and wellness of the population. The rural and remote nature of service delivery in Yukon must factor in disperse populations and the realities of community life outside of Whitehorse. This will build on work that has already been completed to identify gaps in the continuum of care. These improvement initiatives will look at enhancing integrated services for people with complex health needs at various access points across the existing health and social system. New funding provides an opportunity to be creative and innovative in developing new methods to address local health needs.

The objectives of culturally appropriate and integrated interventions include:

  • Improved transitions for clients accessing multiple health and social services
  • Improved provider collaboration and connections between system-entry points.

This work will include:

  • Implementing and expanding use of a Mental Health Nurse in the Emergency Department at Whitehorse General Hospital to triage, assess, determine appropriateness to reduce unnecessary admission, redirect and coordinate referrals to community programs and provide other needed supports for individuals presenting at the hospital with a mental health and/or addiction issue;
  • Implementing an electronic client information data system to ensure effective case management, coordination of services and monitoring of key performance indicators to support the client's journey; this will involve database upgrade, software and culturally appropriate digital health records;
  • Partner with Department of Education, and youth service providers to identify innovative approaches to use technology (e.g. video connections, hand-held devices with apps, interactive games, smart phones, etc.) in classrooms to allow teachers and youth workers to deliver mental health and substance use information to youth, in many cases providing for unique cultural needs; and
  • Developing an initiative for child and youth tele-psychiatry supports for communities outside of Whitehorse as a way to ensure connections with speciality health services are provided in rural locations from a culturally appropriate perspective. This initiative must be an iterative process in order for it to be truly community-focused. It will require responsive adjustments to ensure that the effective delivery of supports are provided to rural communities. This initiative will act as a model for other jurisdictions with underserved rural, remote and/or First Nation communities. Results will be monitored throughout the first phase of this work and inform the development of Yukon's next five-year work plan.

This work will align with other THIF initiatives to support collaborative care delivery through a community hub-based health and social services model and greater collaboration with Yukon First Nation partners to identify community priorities.

Federal funding will be used to fund key positions in locations where individuals need mental wellness and substance use supports, to cover costs of new ways of integrating services delivery models, and to purchase equipment and computer systems to allow for coordinated care between providers.

These initiatives will align with the objectives outlined in 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 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.

To some extent, these project plans will remain dynamic and responsive to the communities and population groups served. Through an evolving process, improvements will continue to be developed in a collaborative way, incite ongoing conversations and require continual adaption to reflect the changing needs across Yukon. In this way, projects in the first five years of the agreement will lay the foundation for further development in future years.

Performance Measurement

A monitoring and evaluation plan will be developed for the initiatives. The plan will include the intermediate and ultimate outcome indicators listed below. The monitoring and evaluation plan will focus on jurisdiction-specific indicators and align with the cross-jurisdiction indicators developed with CIHI.

Yukon's Health and Social Services will be participating in the development of common indicators that will measure improvements in access to home and community care services.

Yukon Health and Social Services has an agreement with CIHI to share data.

While recognizing where possible that funding performance will be demonstrated, the approach taken in Yukon also acknowledges that performance measures may be dynamic and not all measures will necessarily be defined at the outset of the 10-year funding. This approach aligns with the objectives of the Common Statement of Principles on Shared Health Priorities and reflects the unique circumstances, including considerations for northern and remote delivery models, data capacity limitations and infrastructure requirements.

Summary of Expected Results

Performance Measurement Strategy

Short-Term (1 to 5 years)
Initiative(s) Outcome(s) Performance Indicator(s) Target(s) and Baseline Data Strategy

Improving access to community-based mental wellness and substance use services

Culturally appropriate and Integrated interventions

  • Earlier intervention for, and prevention of, mental wellness and substance use concerns.
  • Fewer children and youth having to leave their communities to access mental wellness and substance use services.
  • Improved transitions for clients accessing multiple health and social services.
  • Improved provider collaboration.
Percentage of individuals with mental wellness and substance use needs connected through virtual technologies

Target:

Maintain or increase by March 2019

Baseline:

To be established in April 2018

Data Source:

THIF Mental Wellness Administrative DataTable 4 footnote 1

Frequency: Annual

Methodology:

Standard administrative data collection

The numerator is the number of individuals with mental health issues who were or are connected through remote patient care technologies. The denominator is the number of individuals (calculated for 12+ and 18+) self-reporting as having a mood and/or anxiety disorder, as reported in the CCHS.

Medium-Term (5 to 10 years)
Initiative(s) Outcome(s) Performance Indicator(s) Target(s) and Baseline Data Strategy

Improving access to community-based mental wellness and substance use services

Culturally appropriate and Integrated interventions

  • Earlier intervention for, and prevention of, mental health and addiction concerns.
  • Fewer children and youth having to leave their communities to access mental health and addiction services.
  • Improved transitions for clients accessing multiple health and social services.
  • Improved provider collaboration.
Percentage of individuals receiving mental wellness and substance use services reporting they were able to have their mental wellness and substance use care needs met in their own community

Target:

Maintain or increase by March 2021

Baseline:

Baseline to be established by 2019

Data Source:

THIF Mental Wellness Administrative Data client survey

Frequency:

Annual

Methodology:

Data to be collected through a Client survey of individuals who received mental health and addictions services. Question: Do you feel that you are able to have your mental health needs or concerns addressed in your own community?

The numerator is the number of individuals who reported being able to have their mental health and addictions care needs met in their own community. The denominator is the total number of individuals in Yukon who received the mental health and addictions services survey.

Home First and Complex Client Supports

Rural community home care enhancements

Technology support

  • Increased quality of life for client.
  • Reduced frequency and length of stay of hospital admissions.
  • Clients' current level of functioning maintained or improved.
  • Reduced admissions to emergency department and acute care.
  • Decreased care giver burden.
  • Better transitions between home, hospital, and facility based respite.
  • Improved access to care in community.
  • Strengthened relationships with community partners.
  • Improved wound healing.
  • An understanding of each community's unique home and palliative care needs guides home care service provision in communities.
  • Increased social inclusion.
  • Reduced feelings of social isolation for clients.
  • Improved symptom management.
  • Fewer unnecessary acute care interventions due to use of technology supports.
  • Clients empowered to stay at home.
  • Improved access to health care services in rural and remote settings.
Number of days of Hospital and facility stays for Home Care Clients prevented through complex supports provided in their home

Target:

4300 days/year by 2021

Baseline:

3395 days in 2016/17

Data Source: Continuing Care Administrative and interRAI 2.0 data

Frequency: Collection is monthly, analysis is annually

Methodology:

Days of in home support for clients in Home First or Complex Client Support program counted.

Percentage of long term maintenance home care clients with Method for Assigning Priority Levels (MAPLe) scores of 4 or more

Target:

40% by 2021

Baseline:

2016/17: 39.8% (Canadian percentage is 52.1%).

Data Source: interRai HC; CIHI HCRS annual report

Frequency: Annual

Methodology:

Number of Yukon Home Care long term maintenance clients with MAPLe score of 4 plus score of 5 over total number of completed interRAI HC assessments. Data collected and collated by CIHI.

Long-Term (more than 10 years)
Initiative(s) Outcome(s)/Result(s) Performance Indicator(s) Target(s) and Baseline Data Strategy

Improving access to community-based mental wellness and substance use services

Culturally appropriate and Integrated interventions

  • Earlier intervention for, and prevention of, mental health and addiction concerns.
  • Fewer children and youth having to leave their communities to access mental health and addiction services.
  • Improved transitions for clients accessing multiple health and social services.
  • Improved provider collaboration.
Percentage of population reporting their mental health as excellent or very good

Target:

71.6% by 2028 (This is the current national rate)

Baseline:

68.6% (2015/16)

Data Source:

Statistics Canada CCHS Two-year period estimates (CANSIM Table 105-0509)

Frequency:

Bi-annual

Methodology:

The numerator is the population 12 and over reporting their mental health as being very good or excellent. The denominator is the total population aged 12 and over.

Yukon Action Plan for Increased Infection Prevention and Control

Overview

Long-term care in Yukon

There are four long-term care (LTC) homes in Yukon, all of which are operated by the Continuing Care division of the Government of Yukon’s Department of Health and Social Services. Copper Ridge Place, Thomson Centre and Whistle Bend Place are located in Whitehorse. McDonald Lodge provides care services in Dawson City. Of the 311 LTC rooms in the four LTC homes, a select number are used for specialty programs (hospice care, complex behaviour care), respite, and reablement.

Throughout the four LTC homes in Yukon, there are various levels of care from personal care (only at McDonald Lodge in Dawson City and available to rural Yukoners only), intermediate care, extended care and dementia care.

LTC Home Location Number of Rooms
Thomson Centre Whitehorse 39 permanent
7 respite
4 reablement
Copper Ridge Place Whitehorse 92 permanent
4 respite
Whistle Bend Place Whitehorse 121 permanent
5 respite
12 hospice (phased opening 2020-21)
12 complex behavior (opening TBD)
Alexander McDonald Lodge Dawson City 13 permanent
2 respite

All of Yukon’s LTC rooms are private rooms. Recent pandemic and LTC outbreak information has shown that managing infections in the LTC home environment is greatly challenged by shared rooms. The rooms within Whistle Bend Place are larger than legislated double rooms in other jurisdictions. It may be possible for couples to share a typical room, however, currently couples only share the bariatric specific-rooms.

In Yukon, 96% of the population over the age of 65 does not live in LTC,Footnote 1which is very close to the Canadian average. The need for LTC is not an inevitable part of aging, but it is a key pillar within the health system for those who require this level of care.

In collaboration with partners across the health system and in the community, Continuing Care provides a continuum of care to support Yukoners. Within the home care program, there were 1,196 people who received home care services in the 2020-21 fiscal year.Footnote 2

The number of people served refers to individuals who have had an assessment, are accepted or are discharged from LTC. In Yukon, the 75-84 age group for number of people served in LTC is higher than the rest of Canada, and the 85 – 95 and 95 and older age groups are significantly lower in Yukon than the rest of Canada as seen in Table 1.Footnote 3 This may be partly due to Yukon’s lower life expectancy at age 65 (19.3 years for 2014-16) compared to the Canadian average (20.7 years in 2014-16).Footnote 4 Yukon has higher percentages of individuals served in the 0-64 and 64-74 age group compared to the rest of CanadaFootnote 5, although some of this is because the actual numbers are small. In 2018-19, half of the individuals admitted into LTC in Yukon were admitted from hospital.Footnote 6

Referrals for admission to long-term care can be accepted from any source. This can include:

  • the applicant themselves;
  • an applicant's family or caregiver; or
  • an applicant's professional health-care provider.

Referrals are screened for eligibility. Applicants are assessed before they are admitted into a long-term care home. To be eligible, applicants must:

  • have a valid Yukon health care insurance card;
  • have an assessed need to live in long-term care;
  • be legally allowed to live in in Canada; and
  • have resided in Yukon for:
    • 12 consecutive months; or
    • 10 consecutive years in their lifetime; and
    • not resided outside of Yukon for more than 10 consecutive years.

Yukon’s Financial Administration Act sets out the fees for room and board in Yukon long-term care homes. Room and board costs $1,217 per month, or $40 per day for eligible residents. Day charges will only be used if a resident stay is shorter than 1 month.

The cost for non-eligible residents is $509 per day. This day charge applies until the resident has lived in Yukon for 12 consecutive months.

Yukon currently does not have a regulatory regime in place for LTC.

Yukon’s Home Care Program and all of Yukon’s LTC homes are currently accredited with commendation through Accreditation Canada.

Challenges in the delivery of LTC in Yukon prior to spring 2020

Yukon’s challenges in the delivery of LTC impact access to services in both urban settings as well as the rural/remote locations. This includes limitations to internet access for rural and remote areas and the ability to offer virtual health care options. Throughout Yukon, residents continue to be restricted in their mobility into the community for infection control guidelines. Whitehorse does not have a versatile robust public transportation system that supports people with limited mobility and fixed incomes to access programs.

At the beginning of the COVID-19 pandemic, lack of access to in-person visits with specialists resulted in the need for an increased investment of IT hardware/software. Yukon purchased ipads and laptops and enhanced wifi where possible in order for residents in LTC to be able to maintain virtual contact with friends and family, and to access specialist appointments using Doxy or Zoom (Healthcare) platforms.

Staffing challenges to recruit skilled health care professionals are prevalent both in Whitehorse and in rural communities. It is challenging to recruit health care staff to move to Yukon from the southern provinces without a guarantee of regular and permanent hours. Furthermore, many employees are accustomed to having access to public transit in larger centers and Whitehorse does not have bus service on Sundays or statutory holidays. Since the beginning of the pandemic recruitment to increase the number of specific types of positions to promote safe care and infection control practices has meant an increased cost of hiring staff into permanent positions in order to attract them to Yukon and meet the demands posed by a changed staffing model necessary for pandemic context.

Actions taken since spring 2020

Some of the steps taken to protect the residents and staff of LTC homes in the early stages of the pandemic included limiting care staff movement between different homes; restricting visitors to only those providing essential care or essential end of life visits; and screening staff and visitors for COVID-19 symptoms.

Federal funding received for COVID-19 response in 20-21 was used for specific increases in direct nursing care staff to ensure adequate staff were available for single site staffing beginning the spring of 2020. Additional environmental services staff were hired to clean high traffic areas, and screeners and security staff were hired to ensure access & egress occurred through controlled screening station at main entry to all LTC buildings in Whitehorse. Yukon also increased material management/maintenance staff to handle the large increase in work to manage PPE acquisition and distribution.

LTC home visitation guidelines

Yukon Continuing Care has strong, existing infection control measures, and started working with partners early in the pandemic to plan and implement additional measures. In Yukon, as of July 2021, we have been fortunate that we have had zero cases of COVID-19 within our LTC homes.

Continuing Care developed and implemented LTC visitation guidelines to protect the health and safety of residents and staff in LTC homes. Our guidelines for LTC continue to evolve as the situation in the territory changes, and we are communicating with our partners, staff, families, and residents through this process.

We recognize that visitors play a crucial role in the lives of LTC residents. Social connection can happen with little to no risk of virus spread. The best options for these include:

  • letter writing;
  • phone calls;
  • video visits; and
  • window visits.

Outdoor visits were eventually supported after the purchase of gazebos and safe visiting stations. We also implemented safe indoor visiting stations that included plexiglass partitions, enhanced cleaning and sanitization, and a strictly enforced booking system.

Continuing Care supports a variety of methods of social connection during the pandemic.

These are the principles used to plan and change our guidelines:

  • Safety. Visits must meet the health and safety needs of residents. The safety of staff and visitors are also important.
  • Emotional well-being. Visits support the emotional well-being of residents and their families/friends. These visits reduce the negative impacts of social isolation.
  • Equitable access. A one-size-fits-all approach is not likely to support equity. Access should consider a resident’s preferences. It should also meet reasonable restrictions to safeguard the health of all residents.
  • Flexibility. We consider:
    • the design of the building;
    • staff availability; and
    • any required personal protective equipment.

The guidelines for visitors to LTC homes have evolved during the territory’s response to COVID-19:

  • March 2020 – General visiting conditions suspended except for designated essential visitors at end-of-life or for essential care purposes.
  • August 2020 – Safe indoor visits with two identified general visitors, and outdoor visits with two identified general visitors (including essential visitor).
  • November 2020 – Four general visitors per residents allowed for indoor visits, two at a time (including essential visitor).
  • Christmas 2020 – Festive visits with identified visitors (including essential visitor).

There are currently a variety of visiting methods being supported in LTC homes. These include:

  • essential care visiting;
  • general visiting;
  • virtual and telephone visiting;
  • window visiting; and
  • letter writing.

In the case of an outbreak, LTC homes will suspend all visiting and non-essential services. In exceptional circumstances, exceptions (for example: end of life, visitor provides essential care) may be made. These decisions are made on a compassionate basis based on a case-by-case risk assessment by the Chief Medical Officer of Health.

Outbreak guidelines for COVID in LTC homes

Yukon Communicable Disease Control has developed guidance and best practice recommendations that staff have agreed to, to respond to any outbreaks of COVID-19 within a home. This guidance builds on existing approaches to respiratory outbreaks, available evidence on COVID-19, and current national and international experience with COVID-19 control in these settings.

Overall, guidance set out by YCDC provides:

  • A clear definition of an outbreak and the different ways that COVID-19 may present in individuals;
  • Recommendations for personal protective equipment for staff;
  • How to monitor for COVID-19 cases; and
  • Steps to follow should there be a suspected case, a positive test result for one or more residents, and/or a positive test result for one or more staff members

Continuing Care conducted tabletop exercises to simulate a response to a positive case of COVID-19 in all LTC homes throughout December 2020 and January 2021. These exercises further prepared staff to respond promptly to any positive results and effectively contain the spread of COVID-19. In addition, Continuing Care’s participation in accreditation ensures that we meet infection prevention and control standards for LTC and Home Care.

Continuing Care has resumed some programming and services when and where possible in line with COVID-19 guidelines. This includes registered volunteer visits, hairdressing services, spiritual care across all LTC homes and bus outings into the community. All of these activities are undertaken while following the appropriate public health measures to ensure the health and safety of LTC residents and staff. Additionally, outside health care providers such as private foot care providers and physiotherapists are also now able to enter LTC homes with approved COVID-19 safety plans.

Vaccinations for LTC residents and staff

On January, 4 2021, we began vaccinating residents and staff in our LTC homes. As of July 7, 2021, 90% of Yukon LTC residents have been immunized with both doses and 91% of LTC residents have been immunized with at least one dose.

Impact of COVID-19 on the delivery of LTC in Yukon

Like in many other jurisdictions, visitors and volunteers were stopped. This resulted in a significant change to the social environment for LTC residents.  Resident outings were also discouraged or stopped completely. These measures were necessary in order to decrease the risk of transmission of COVID-19 into Yukon’s LTC homes.

Some residents of LTC still chose to access the community to purchase alcohol, cannabis, and tobacco products putting themselves in position to be exposed in an uncontrolled public environment. Isolation practices that were subsequently put into place were a challenge for people who smoke.

Hours for the tuck shops in Yukon’s LTC homes were increased from minimal hours a few times per week to Monday to Friday to support residents to have a « destination » for walking to within the LTC homes and to offer additional social opportunity within the homes without having to access the community.

With money provided by Canada including Safe Restart funding for vulnerable populations and PPE in support of COVID-19 response, additional personnel related to infection prevention and control have been hired to work in Yukon’s LTC homes as follows:

  • All of Yukon’s LTC homes now have screeners at the entrances of each LTC home to document and screen all staff and visitors/contractors who enter into the LTC homes.
  • More Domestic Aide staff have been hired to provide for enhanced surface cleaning of high use areas in all buildings.
  • An Infection Control Nurse has been hired to assist with assessing and managing operational plans, monitoring of rosters and sick leave, and to coordinate isolation practices.
  • An additional Occupational Health and Safety Leader has been hired to support planning and evaluating safe work practices during pandemic.
  • An additional Administrative Assistant has been hired help with the increased volume of staff and resident data tracking related to COVID-19.

Areas of Focus

The Safe Long-term Care Funding may be used to support increased infection prevention and control in the following three priority areas:

  1. Additional human resources to assist with enhanced screening and regular testing of staff and visitors to all Yukon LTC homes to quickly detect, prevent or limit spread, and additional inspectors and infection prevention and control specialists to support in-person inspections of all facilities
  2. Adequate supply of personal protective equipment for staff and visitors, as well as ongoing infrastructure investments to support safe infection control practices such as additional wifi, ipads and laptops, and new hand wash sinks in resident living areas. In 20-21 we also performed a thorough, professional cleaning of the HVAC system at Copper Ridge Place to maximize air quality and ensure the safety of residents and staff.
  3. We participated in the accreditation process to ensure continued adherence to LTC standards. Staff continued to adhere to evidence-based practice, infection control standards, and person-centered care. The expected outcome is that we will receive Accreditation Canada passing grades in all required organizational practices in 2021.

In addition, we invested in person-centered activities specifically to focus on our Indigenous residents. We spent $50,000 for drums, beads and stick-gambling materials as individuals were not able to travel to their home communities to participate in these activities, reducing the risk of infection through travel.

Focusing on these three areas will establish a baseline knowledge capacity in the system to prepare for future outbreak identification and response, building capacity within to be resilient and adapt to changing health care environment.

Initiatives

Human Resources

The hiring of additional personnel will support Yukon’s four LTC homes. This initiative will benefit all residents of Yukon LTC homes, with approximately 300 residents across the four homes.

All of the positions listed below were implemented in order to meet the needs of the pandemic. We expect that all positions will be needed on an on-going basis in order to maintain a safe environment for residents and staff and to meet the post-pandemic requirements and increased expectations for client care in LTC homes.

The following additional human resources have been engaged to assist with enhanced screening and cleaning and mitigating the risk of staff working in multiple locations across all four of Yukon’s LTC homes: 

  • Infection control nurse x 1 – required for increasing infection prevention and control practices
  • Quality improvement project lead x 1 - required for collecting, analyzing and reporting clinical outcomes to ensure that safe care is occurring
  • Administrative assistant x 1 – higher volume of data inputting and urgent communication occurring during the pandemic requires additional administrative support to prioritize clinician time for residents
  • Screener x 9 – infection control screeners at entrance to all LTC homes 0600h-2100h daily to screen all visitors and staff for COVID-19 symptoms
  • Domestic aide x 8 – enhanced cleaning required during pandemic
  • Registered nurse x 1 – required to meet clinical needs of residents and mitigate need to work in multiple areas
  • Maintenance x 1 – maintaining equipment/environment for infection control and safety, management and reporting of PPE usage during pandemic
  • Program management x 3 – Additional oversight and span of control is required to supervise and mentor direct care providers, to oversee COVID-19 outbreak drills, to inform policy and practice decisions in ambiguous changing outbreak environment and to provide on-call support for testing/isolation/visitation/essential staffing of all of Yukon’s LTC homes.
  • Dietary aides x 2 – required to ensure single site staffing and not have staff working in multiple locations
  • Nursing home attendants x 6 – requirement to ensure single site staffing

Supply of Personal Protective Equipment

An adequate supply of personal protective equipment will be maintained at all four of Yukon’s LTC homes to provide for sufficient medical grade PPE (including N95 masks) for all staff and visitors for every shift, to ensure the health and safety of residents, staff and visitors. If recommendations change for PPE requirements, we will comply and purchase accordingly.

Accreditation

Participation in the Accreditation Canada process will ensure Yukon Continuing Care’s continued adherence to LTC standards. The implementation of the hand-wash sinks is linked to required organizational infection control standard that are part of Accreditation Canada. Because the Yukon does not have its own legislation, we chose to go through the Accreditation Canada process to ensure that we meet or exceed their standards. Our current standing is “Accredited with Commendation”. Our investment in the Occupational Health and Safety position and the additional Infection Control nurse support us in being able to monitor and track resident and staff health and safety.

In addition, HSS continues to make infrastructure improvements. One that is specific to LTC staff as part of our COVID-19 response supporting residents in LTC, is the installation of additional phone lines and integration with Nurse Call system and Real Time Locating System (RTLS). While the work will be completed in 21-22, we don’t have a cost at this time as a contractor has not yet been retained.

Funding Allocation

Priority Area 2021-22
Staff retention measures and hiring additional human resources $2,833,606
Supply of PPE $175,000
Accreditation $69,104
Totals $3,077,710
Care Home and/or Program Area Position Name # of Personnel Total
Safety Clinical Excellence Infection Control Nurse 1.0 123,551
Safety Clinical Excellence Quality Improvement Project Lead 1.0 105,000
Safety Clinical Excellence Administrative Assistant 1.0 71,904
Safety Clinical Excellence Leader, Resident & Client Safety 1.0 111,300
Safety Clinical Excellence Occupational Health & Safety Leader 1.0 107,100
Safety Clinical Excellence Systems & Administration Coordinator 1.0 96,500
Copper Ridge Place Screener 1.0 66,707
Copper Ridge Place Screener 1.0 66,707
Copper Ridge Place Screener 1.0 66,707
Copper Ridge Place Domestic Aide 1.0 64,361
Copper Ridge Place Domestic Aide 1.0 74,775
McDonald Lodge Domestic Aide 1.0 72,692
McDonald Lodge Domestic Aide 1.0 36,346
McDonald Lodge Registered Nurse 1.0 110,278
Thomson Centre Domestic Aide 1.0 64,938
Thomson Centre Screener 1.0 66,707
Thomson Centre Screener 1.0 66,707
Thomson Centre Screener 1.0 66,707
Thomson Centre Maintenance 1.0 45,772
Thomson Centre Dietary Aides 4.0 140,000
Whistle Bend Place Screener 1.0 66,707
Whistle Bend Place Screener 1.0 66,707
Whistle Bend Place Screener 1.0 66,707
Whistle Bend Place Domestic Aide 1.0 65,129
Whistle Bend Place Domestic Aide 1.0 65,129
Whistle Bend Place Nursing Home Attendants 6.0 679,107
Home Care Domestic Aide 1.0 64,361
All areas Numerous - covid related leave - 135,000
Total Personnel for Continuing Care 35.0 2,833,606
All of Continuing Care - PPE supplies and accreditation   244,104
Total Covid Costs for Continuing Care for 2021/22 35.0 3,077,710

Performance Measurement and Expected Results

Priority Areas Output Interim Results (reported by December 1 2021)Footnote 7 Results (reported by March 31, 2022)
Hiring additional human resources
  • Hire 35 additional staff to work across all four of Yukon’s LTC homes
35 staff have been hired across all four of Yukon's LTC homes. These 35 additional staff continue to work across all four of Yukon’s LTC homes, maintaining a safe environment for residents and staff and meeting post-pandemic requirements and increased expectations for client care.
PPE
  • 100% of staff and visitors have access to medical grade PPE
  • 0 COVID-19 exposures linked to lack of PPE provision in Yukon’s LTC homes

100% of staff and visitors have access to medical grade PPE

0 COVID-19 exposures linked to lack of PPE provision in Yukon's LTC homes

Staff and visitors continue to have access to medical grade PPE.  Audits are done on a regular basis to ensure staff and visitors are wearing PPE properly and in the moment education occurs during these audits.  Ongoing education regarding PPE also takes place.

Accreditation
  • 100% of Yukon Continuing Care programs will successfully meet accreditation standards and the required organizational practices relating to COVID-19
HSS met all accreditation standards related to infection control including COVID

HSS met all accreditation standards related to infection control, and met the required organizational practices related to COVID-19.

Footnote 1

YBS 2020 Q4 Population Report and Continuing Care April 2021 bed occupancy report

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Footnote 2

Fiscal Year Activity report 2020-21 for Home Care

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Footnote 3

Continuing Care Report System (CCRS) Quick Facts 2019-20 data, graph by Population and Public Health Evidence and Evaluation (HSS)

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Footnote 4

Stats Canada 2014 – 16 Life Expectancy at Birth and at age 65, https://www150.statcan.gc.ca/n1/pub/84-537-x/2019002/xls/2014-2016_Tbl-eng.xlsx.

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Footnote 5

Canadian Institute for Health Improvement (CIHI) presentation on Yukon Information to HSS

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Footnote 6

CIHI Yukon Information presentation

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Footnote 7

Interim and updated results are to be updated by the jurisdiction in its Action Plans by December 1, 2021 and March 31, 2022. These updates will be posted publicly by way of amendments to the Action Plan.

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