The First Nations Social Development Society Presents Manual two: AANDC ASSISTED LIVING PROGRAMS

1. The First Nations Social Development Society • Presents • Manual two: • AANDC ASSISTED LIVING PROGRAMS Revised March 2014

2. FNSDS WEBSITE • What can be found on our website www.FNSDS.org? • The FNSD Resource Centre Library • The Online SA Manual • Downloadable and fillable IA Forms • Board Info, BSDW & INAC contact lists • Publications • FNSDS Newsletters and job postings • BSDW Training Info • Training Programs Information, calendar and registration information • Power point presentations • PWD & MNS • Program Information, Forms, Q’s and A’s Revised March 2014

3. CONTACT INFORMATION • PHONE: 604-983-9820 FAX: 604-983-9822 • Melennia Point, Executive Director Melennia@fnsds.org • Gina George, PWD ManagerGina@fnsds.orgPWD line 1-877-985-5565 • Tami Omeasoo, Program OfficerTami@fnsds.org • Chris Lechkobit, Program OfficerChris@fnsds.org • Chelsey George Pwdadminasst@fnsds.org Revised March 2014

4. NON- MEDICAL SERVICE PROGRAMS 1 – Adult in Home Care 2 – Adult Institutional Care 3 – Family Care Home Revised March 2014

5. AANDC NATIONAL MANUAL ASSISTED LIVING PROGRAM (AL) Funded program to provide social support services to persons living on reserve that require non-medical assistance with daily living activities • Main Objective and Program Description • 1.1 Funding to meet the non-medical social support services special needs of seniors, adult with chronic illness and children and adults with disabilities (mental or physical) with the objective of maintaining functional independence and greater self-reliance. • 1.2 AL program is available to all persons residing on reserve or are considered ordinary residence that have been assessed by medical physician to require non-medical social support services and who have no means to otherwise obtain these services. Revised March 2014

6. 3.1 FOUR MAJOR SERVICE COMPONENTS • In-Home Care – financial assistance for non-medical personal care for adults that need assistance with daily living activities. Services cover housekeeping, meal preparation and attendant care to community supports (adult care, meals on wheels, physic-social programs, short-term respite care for caregivers and non-health transportation). • Adult Foster Care – funding for supervision and care for adults in a family-like setting who do not require 24 hour care but are unable to live on their own. • Institutional Care – reimburses for some expenses related to Type I and II care in designated facilities for adults. • Assisted Living Disabilities Initiative – funding to First Nation organizations for projects to improve the coordination and accessibility of existing disability programs and services on reserve. May include advocacy, public awareness or regional workshops. Revised March 2014

7. 2.1 ASSISTED LIVING PROGRAM DEFINITIONS • 2.1.1 Continuing Care – range of holistic medical and social support services for those who do not have, or who have lost some capacity to care for themselves . • 2.1.2 Disabilities Initiative – AANDC initiative to fund projects to improve coordination and accessibility of existing disability programs and services on reserve such as advocacy, public awareness or regional workshop • 2.1.3 Home Support – component of AL program that provides homemaker services to help persons with daily living activities so they can remain at home and remain independent • 2.1.4 Institutional Care – care provided in a care facility such as a personal care home, elders lodge and supportive living home etc. Revised March 2014

8. ORDINARY RESIDENT ON RESERVE • Lives at permanent address on-reserve more than 50% of time • In case of children in joint custody, lives with parent more than 50% of time • Does not have a primary residence off-reserve • Is a person off-reserve for purpose of obtaining care not available on reserve or who is off-reserve to access social services because there is no reasonable comparable service available on-reserve Revised March 2014

9. ADULT IN HOME CARE Revised March 2014

10. INTENTION • Assist clients to live at home as long as it is reasonable and safe • Supplement care, NOT to replace care provided by family or other unpaid caregivers • Promote independence and well-being of a client and their family and other unpaid caregivers • Provide short term respite care to family member or other unpaid caregiver Revised March 2014

11. PHILOSOPHY • Promote personal independence • Promote personal and family responsibility in planning and providing care • Encourage family and community involvement in providing care • Encourage lifestyle consistent with community norms • Work in partnership with other complementary programs and services offered by other federal government departments. Example: Veteran's Affairs, Health Canada First Nation & Inuit Home And Community Care Program Revised March 2014

12. NATIONAL ELIGIBLE EXPENSES • 3.1 In-Home Care provides financial assistance for non-medical personal care services. • Services may include (dependent on budget) Meal programs, meal planning & preparation Day programs Attendant care short-term respite care (defined by Province/Territory) group care laundry ironing mending carrying water carrying wood home management minor home repairs non-medical transportation guide dogs Revised March 2014

13. ELIGIBILITY AND FUNDING • Capped Funding • Once funds finished no more remain for fiscal year • Eligibility • Client must be 19 or older • Must be assessed (medical note is best) • Financial means test required (income tax forms) • IA clients = no charge • Pensioner receiving Old Age Security = no charge Revised March 2014

14. PROCESS Revised March 2014

15. FILES • Identification • Medical request letter • Income Tax Statement • Homemaker Service form 901-38 signed and dated • Homemaker Evaluation form 901-30 signed and dated • Blank cover • In Home Care Tracking Payments form 901-31 • Homemakers schedule • Case notes • Copies of all correspondence to client • Do create a system to help remind you when review is due Revised March 2014

16. ROLES DEFINED BSDW • Monitor budget • Report expenses on quarterly report • Monitor and approve hours (do max at 40 per month- anymore hours required = need to look at care in a Institutional Care facility) • Ensure files are complete • Monitor homemakers hours • Keep case notes on file • Do reviews every 6 months ASSESSOR • Meet with BSDW for information • Set up home visit • Assess who in family or community can provide assistance and care • Complete Homemaker Evaluation form 901-30 • Meet with BSDW to determine eligibility and services • Repeat process every 6 months Revised March 2014

17. BILLING • Do create a set charge for service • Helps with report • Assist in determining hours available each month to helps stay within budget • keep in mind must cover wages, MERC, travel and supplies • Must pay workers at least minimum wage ($10.50 per hour) • Report spending on Assisted Living Quarterly Report Revised March 2014

18. SERVICES AVAILABLE • Light House Keeping (sweeping, mopping, vacuuming, clean & tidy kitchen and bathroom) • Meals (preparing food by cutting up meat and peeling and dicing vegetables) • Personal Care (cleaning & tidying bedroom, doing personal laundry, monitoring their bath and cleaning & tidying up bathroom) • Other Services (travel to medical and/or specialist appointments) Revised March 2014

19. OTHER SUPPORT SERVICES Services limited to availability of budget and resources - Some ideas for programs: • Counselling • Meals (luncheon program) • Psycho-social (socializing activities) • Non-medical transportation • Home maintenance (minor) • Companion care • Respite Care for caregivers • Social Assessment & Case Management Services • Coordination of volunteer & support group services • Services to support councils for seniors &/or Persons With Disabilities Revised March 2014

20. PROCEDUREFOR OTHER SERVICES Contact AANDC Funding Service Officer to discuss reporting requirements which may include: • Type of SD program or service to be established • Number clients served • Program Management structure • Number hours per type of service • Number & training of service providers • Budget for respective program or service • Indicators of comparability with provincial programs • Client profile • Fee structure & financial eligibility Revised March 2014

21. IDEAS TO ENHANCE SERVICES • Create a follow-up letter confirming approved services and what are the rules for services (alcohol or drug consumption = no service that day; not home = no service that day) • During home visits, do allow time to visit and socialize • Create a list for homemaker describing services to provide and any instructions client may have requested • Create a notice card you can hang on door to let client know worker was there but they were not home • Create a notice for times when service my be temporarily stopped due to holidays or sickness Revised March 2014

22. SORRY WE WILL BE CLOSED Due to statutory holiday on _________, office will be closed and services will be cancelled that day. We will reopen on _________ . Please call so we at the Adult In Home Care Program can set up another time to ensure your needs are met. Sincerely Sorry wemissed you. Homemaker _____________ was here at _____________. No one was home at that time. we will return at your next appointment. Take care Revised March 2014

23. ADULT INSITUTIONAL CARE SERVICES Revised March 2014

24. INTENTION • To assist eligible residents living on reserve, who by reason of incapacity, require placement in a licensed Continuing Care Facility • To provide services appropriate to the eligible resident’s long-term functional needs Revised March 2014

25. ELIGIBILITY • Must be 19 years or older • Canadian citizen • Have permanent resident authorization • Last residence before care was on reserve (this determines the jurisdiction responsible for client no matter where care facility located) • Unable to live independently because of on going health problems • Cannot be in an acute or rehabilitative program • Health-related issues should be: • At least 3 months • Due to progressive and/or chronic condition Revised March 2014

26. NOT ELIGIBLE & EXEMPTIONS • Person who is sponsored to be in Canada • 65+ and receiving a pension Exemptions: • IA client or IA PWD earned income applies • No other sources available, may sign up for Community Volunteer Supplement • In Continuing Special Care facility can receive Comfort Allowance Revised March 2014

27. PROCESS Revised March 2014

28. Revised March 2014

29. AANDC NATIONAL DEFINITION OF INSTITUTIONAL CARE LEVEL I &II 3.3.1 AANDC has limited responsibility for non-medical Type I and II levels of care Type I • Independently mobile with decreased physical or mental facilities • Requires supervision or assistance with activities of daily living and provision to meet psycho-social needs through social and recreational services • Service requirements are indeterminate and related to individual conditions • Normally would not be admitted to residential care facility Type II • Relatively stabilized (physical or mental) chronic disease or functional disability • Reached limit of recovery • Require personal care on 24 hour basis with medical and professional nursing supervision for meeting psycho-social needs 3.3.2 Province and Territories responsible for licensing and monitoring facilities 3.3.3 AANDC may fund per diem portion of institutional care on case by case basis. Client expected to pay Provincial or Territorial government established co-institutional fees, clothing and personal expenses to extent they can financially afford Revised March 2014

30. AANDC NATIONAL ELIGIBILITY 3.3.4 Eligibility Requirements for Institutional Care – may bereimbursed, eligible recipients must verify care facility can demonstrate that: • Operates according to licensing and /or recognition or accreditation guidelines of relevant provincial and territory • Care services which care facility is invoicing do not exceed Types I and II levels of care 3.3.5 Eligible Institutional Care expenditures to be funded may include: standard accommodation meals; including therapeutic diets food Laundry clothingspecial diets guide dog necessary emergency & routine treatment supplies skilled care with professional supervision as needed & planned programs for social & recreational activities age allowance personal living allowance Revised March 2014

31. LEVEL OF CARE • Personal Care Funding AANDC • Able to stay at home, require some homemaking • Intermediate Care Level 1(1C1) Funding AANDC • Still independently mobile with or without mechanical aide • Require moderate assistance with daily activities • Require daily professional care and/or supervision • Intermediate Care Level 2 (2C2) Funding AANDC • Still independently mobile with or without mechanical aide • Requires heavier care • Requires heavier supervision and additional care time • Intermediate Care Level 3 (3C3) Funding AANDC • Severe behavioural problems on continuous basis or personal issues that require considerably more care and supervision • Require considerably heavier care • Not eligible for Extended Care • Extended Care Level Funding Provincial /HCFNIH • Chronic cases require 24 hour professional nursing services & continuing medical supervision • Usually this level of care is permanent Revised March 2014

32. REVIEWS & ASSESSMENTS • Taken at request of • Client Service Provider • Family member  Physician • Health Care Professional • Request for reviews or reassessment goes directly to Home and Community Care Case Manager Revised March 2014

33. SERVICE DELIVERY ELIGIBLITY EXPENSES • 4.1 Eligible funding - recipients who deliver the AL program receive additional resources to support the administration of the AL program • 4.2 Eligible expenses to deliver AL program include • Salaries • Travel • Transportation • Training for professional or paraprofessional administrator and case workers • related office costs • activities related to collecting and managing data required program • monitoring, planning, reporting and evaluation Revised March 2014

34. Maintaining and upgrading system • Developing operational policy and related documents • Developing delivery options to encourage local integration where possible of education, health and social services needed to effectively deliver and administer AL programs • Developing and implementing case management systems including • structured client assessment • referral • re-assessment and counselling • training • professional support for administration and case management * Out of Canada must be preapproved in writing by Director General Programs (AANDC) Revised March 2014

35. FAMILY HOME CARE SERVICES Revised March 2014

36. ADULT FOSTER CARE ELIGILBE EXPENDITURES • Provides supervision and care in a family – like setting to people who cannot live on their own due to physical or psychological limitations but who do not need constant medical attention. This service is an alternative To institutional care. To be reimbursed for services adult foster care needs to • 3.2.1 Conform to provincial or territorial per diem rates • 3.2.2 Operate according to licencing and/or recognitions or accreditation guidelines of relevant province or territory. Revised March 2014

37. OBJECTIVE To provide a protective and supportive environment within a Private Family Home to eligible on-reserve elderly or disabled persons as an alternative to admission to a long term care institution. Revised March 2014

38. WHAT IS A FAMILY CARE HOME? • Is a private family home that provides services to adults that require 24 hours supervision • Is not normally the Client’s family home • Located on-reserve • Provides a home like atmosphere, meals and other housekeeping services. Within an atmosphere of a caring, supportive and assistive services with daily living activities to the elderly or disabled client Revised March 2014

39. ELIGIBLITY • Must be a resident on-reserve at time of application • Must be Canadian citizen, or authorized under Immigration Act to be a permanent resident of Canada • Must be 19 years or older • Assessed to need Residential Care by Continuing Care Division of Ministry of Health Revised March 2014

40. ROLES AND RESPONSIBILITIES DEFINED Revised March 2014

41. CHECK LIST FOR HOME Revised March 2014

42. CHECK LIST FOR HOME continued Revised March 2014

43. ROLES FOR OPERATING HOME Revised March 2014

44. RESTRICTIONS • Pre-approved by Administering Authority for care of 1-2 clients • 3 or 4 clients in home could result in home being closed • Except where an extra client would as beneficial for both (and if home has room/ operator capable taking on extra capacity) • Operator cannot be immediate family of client Exception to family rule: • No qualified and available caregivers • Rural or remote location • Cultural barriers • Language barriers • Behavioural barriers Revised March 2014

45. RESPITE • AANDC does special adjustment of $7.12 per resident per day to allow operator to purchase respite care up to 24 days per year. Operator still receives per diem rate when on respite therefore responsible for costs • Approved respite care are • In Home Respite – must have BSDW approval (not family member) • Out of Home Respite – either licensed facility or another Family Care Home where the option available and suitable for client • Respite Day Care – approved by Administering Authority and arranged by BDSW Revised March 2014

46. REPORT REQUIRED FOR RESPITE • On form DK02-03 Adult Family Care Home Planned & Actual Respite • Year end report to Administering Authority on respite taken and copy goes to AANDC • Respite is 2 days per month when pro-rated • One day = 24 hours • Operators should take respite at a minimum of 1 day per month • If the Operator is not using the respite allowance, they may have funds discontinued Revised March 2014

47. CLOSURE OF HOME PROCESS • BSDW must notify Administering Authority immediately • Administering Authority, Chief and Council are notified immediately and are in agreement then client is removed from home • Administering Authority must notify AANDC Funding Service Officer of action taken Revised March 2014

48. SERVICE IS UNSATISFACTORY? • BSDW must verbally advise operator of areas that must be improved • Give a set time to comply • Verbal Notice must be confirmed in writing within 2 days by BSDW • BSDW must revisit home at end of specified time to ensure changes and service are satisfactory • If found not satisfactory, BSDW must serve notice if situation not corrected, service may no longer be required • Service remains unsatisfactory, BSDW must notify Administering Authority, who will verify findings • If Administering Authority agrees with closure, operator is served 14 day written notice that services are terminated • AANDC is to be notified immediately Revised March 2014

49. HEALTH CANADA’S FIRST NATION & INUIT HOME & COMMUNITY CARE (HCC) 5.1 General 5.1.1 AL program has close link to Health Canada’s HCC program which provides health services to eligible FN persons living on reserve and Inuit living in Inuit communities 5.1.2 HCC services are provided on comprehensive assessed needs and enable people with disabilities, chronic illnesses and elderly to receive care they need in their home communities 5.1.3 Both programs make up vital part of continuum care for FN persons. Services often begin in the home and progress through to more intensive levels of care normally associated with Institutional Care 5.1.4 The Social (non-medical) services funded by AL program support AANDC Child & Family services, Income Assistance, Special Education as well as the AL programs supports programs funded by other government departments (Health Canada) Provinces or Territories Revised March 2014

50. THREE MAIN AREAS OF HCC ARE • Home Support– medical personal care (ex. Wound bandaging) • Community Support– includes process evaluating how HCC programs are functioning • Nursing – nursing care (ex. Administering medications) • These include: • Client Assessments & Care Planning • Case Management • Personal Care provided by trained personnel • Home Nursing • In-Home Respite • System or process to assess medical equipment and supplies • Program linkages with Health & Social Services both internal and external to community • Client record & data system Revised March 2014