Homecare update

Aboriginal Nurse, The, Apr 2000 by Downey, Bernice

Background: The Federal Government announced funding for Home & Community Care in the budget announcement of February 1999.The goal for this initiative is: `To implement an enhanced Home and Community Care program comprised of a continuum of services, under First Nations and Inuit control, that are comprehensive, culturally sensitive, accessible, effective and equitable to that of other Canadian citizens and which responds to the unique health and social needs of First Nations and Inuit.'1 The program is targeted to First Nations and Inuit of any age; who live on a First Nations reserve, Inuit settlement or First Nations community North of 60.

Partnerships and collaboration with First Nations and Inuit were indicated as the methodological approach to the planning and implementation of this new initiative. A national steering committee was struck which included representatives from Health Canada-Medical Services Branch (MSB), Department of Indian and Northern Affairs (DIAND), Assembly of First Nations (AFN) and Inuit Tapirisat of Canada (ITC). Three working groups were established to support the planning and implementation activities. These three groups are: the Planning Working Group, the Standards, Scope of Practice, Liability and Training Working Group and the Information Management, Evaluation and Accountability Working Group. Implementation activities were identified and an information sharing and feedback process at the Regional level occurred during the summer of 1999. The First Nations and Inuit Home and Community Care Program (FNHCCP) received Treasury Board approval on November 18, 1999. There is $45 million targeted for the fiscal year 00/01 and $90 million for 01/02.

The Aboriginal Nurses Association of Canada (ANAC) participated in the Peer Review process during this past year's planning phase via our appointed representative and ANAC member; Faye North-Piegan FN., M.A.. Faye is the Health Co-ordinator at Aecium-kiyii Health Services in Brocket Alberta and has been involved in preliminary planning and implementation activities related to establishing a home care program in her community. Many more of our members will also play an active role in establishing a home care program at the community level. The core elements of a home care program include: client assessment, case management, care co-ordinated with Social Services, NIHB, MSB and DIAND, home care nursing, home care support, short term respite care and linkage with other services. Each community will be required to do a community needs assessment and develop a training plan which will meet their individual implementation needs. Some of the potential professional issues nurses may have to consider may include: increased work load, liability issues, employee-employer relationships, peer support, training and education, reporting mechanisms, inter-disciplinary communication and supervision, pay equity and home care standards and consistency. The organizational issues may include: capacity building, transfer considerations, access to and funding of quality equipment, need for social determinants to be addressed, accountability, relevant distribution of funds, communication between FN & Inuit leadership, MSB and other health care providers, non-insured health benefits issues, diversity of needs relative to region and community, education and awareness of FN health authorities and community members.

Update: ANAC participated in the Regional Nursing Officers/Regional Nursing Educators Home Care planning and information sharing meeting held in Calgary on January 28th & 29th. The purpose of the meeting was to provide recommendations to the National Home Care Working Groups on issues relating to Home Care (HC) nursing practice, education, human resources and administration. Areas of focus for discussion included:

Practice- to outline practice requirements for the Home Care Nurses (HCN)

Education - to outline the education requirements for HCN

Human Resources - to outline a Human Resource (HR) strategy for staffing and recruiting HCN with scenarios of FN decision to have MSB hire HCN; or if they are to be Band employees or if there will be a mix

Administration - to identify administration and organizational issues surrounding the introduction of the HC program.

Some of the issues raised during discussion were:

liability - there is a need to explore liability issues further and develop guidelines; educational component may be required; generic home care standards will be developed and may be used as guidelines for communities

support - will be required for home care nurses, HCN's and other health care workers will require supervision and clear reporting mechanisms

education - home care nurse education preparation should be BScN preferred or Diploma prepared with additional education in home care

role of the HCN - work descriptions are being developed by the regions; a detailed job description is critical

community - each will have individual needs and capacity building issues