Long-term care

1. Long-term care Ontario chiefs committee on Long-Term Care At the Joint disc coo gathering Wednesday may 15, 2019

2. Coo mandate

3. Ltc status in Ontario

4. Ltc status in Ontario • In the South East LHIN’s responsible for the Mohawks of the Bay of Quinte, there are 1,444 clients on a waiting list with an additional 290 hospital patients waiting for a bed in a long-term care facility. The 22 LTC homes in the South East LHIN’s wait list is up to 2 years or longer. • Most LTCs propose to increase the construction subsidy to $18.03 per bed per day for 25 years to encourage new builds • During the last 25 years only Oneida First Nation received an LTC license to build a 63 bed LTC facility. • Only 4 large First Nations have a long-term care facility. First Nations have 273 of 78,667 LTC beds in Ontario representing less than 1% of the LTC beds in Ontario • Chronic underinvestment by both Ontario and Canada persists despite recommendations of the 1993 report from the Ontario Advisory Council on Senior Citizens titled “Denied Too Long”, which recommended increasing the availability of LTC for First Nation Communities

5. Health status of first nations in Ontario • There are many gaps and health services inequities for Ontario First Nations. This can include lack of primary care, safe drinking water, housing, long-term care, high rates of morbidity, diabetes, mental health and addiction, and chronic disease which includes cardiovascular renal, frailty, and amputations. • Studies have concluded First Nations experience frailty at a much younger age than the Ontario and Canadian population. • With age frailty increases with adults with 2 or more chronic conditions. Ranging from 30% ages 45-54 and 70% for those 75 years and older

6. The tripartite working group Report & resultsChaired by Sharon Lee Smith, Associate Deputy Minister Policy and Transformation and Chief R. Donald Maracle, Mohawks of the Bay of Quinte • First Nations citizens want to be near their loved ones in their own communities. Most First Nations communities do not have LTC homes nor adequate housing options for seniors. Seniors are forced to leave their communities to access appropriate housing and care. This can be traumatizing for seniors. The TWG highlights this is compounded by poverty, high rates of chronic disease and lack of core housing needs and lack of data collection. • Canada in 1999 initiated the Home and Community Care program to provide limited assistance to First Nations and Inuit communities in their home setting for nursing and personal support workers. This program does not address seniors and disabled persons requiring a higher level of care due to frailty, lack of mobility, chronic conditions, dementia, mental health & addictions, transportation issues to medical appointments, and inability to manage on their own. In 2013-14 home and community care program expenditures where $110.8 million of which 96% was in transfer payments to First Nations, however 2017-19 planned expenditures decreased to an estimated $105 million. • There is a lack of support for caregivers as well as housing shortages, lack of equipment, and limited access to home care. • On May 4th 2018 MOHLTC announced 30,000 new LTC beds of which 500 LTC beds allocated to First Nations.

7. Recommendation TWG The TWG recommends Canada and Ontario work together to meet joint goals. • New LTC licenses for First Nations as a priority through a LTC bed set aside. “Aging with Confidence” Ontario’s Action Plan. • Ontario and Canada make investments across the housing and care continuum (LTC, home and community care, supportive housing, and identify solutions for First Nations) • Provide capital planning grants for First Nations ($250,000) to determine investment for required health needs. • Innovative capital arrangements for LTC, assisted living, and supportive housing. • One window for Federal/Provincial capital financing. • Data collection improvement for seniors and disabled persons • Health resources to improve culturally appropriate staff training to meet challenges in delivering services to First Nation Clients and strengthening community decision making.

8. The challenges of delivering continuing care in first nations communities - report of the standing committee on indigenous and northern affairs – December 2018 • Indigenous health outcomes tend to be poorer than the Canadian average. This is due to complex factors including intergenerational trauma attributed to colonialism and discriminatory policies with many gaps in services, chronic disease at a younger age, and lack of care that is offered to non-indigenous populations and urban centers. • There is a lack of jurisdictional clarity regrading the delivery of health services on-reserve the responsibility to deliver health care on reserve is unclear and therefore shared by the provincial and federal governments, First Nations, third-party service providers in a complicated and ambiguous framework.

9. Standing Committee Recommendations • Standing committee report makes 10 recommendations. • ISC provides increased funds for home and community care and palliative care. • ISC evaluate the current needs regarding in-home respite care for home and community care and report on it publicly. • ISC establish a funding formula to provide stable, predicable long term funding to build and maintain LTC facilities on reserves and take into account factors such as population growth, inflation, and remoteness of communities. Support partnership initiatives to build LTC facilities, develop pilot projects to build and maintain LTC facilities on reserves • Culturally appropriate programing including language and traditional foods. • Develop mandatory training for indigenous and non-indigenous health professionals. • Implement the call to Action 22 of the Truth & Reconciliation Commission for traditional healing. • Improve access to post-secondary education and occupational training for First Nations students. • ISC coordinate with First Nations and Provinces for delivery of continuing care on reserve • Minister of Indigenous Services Canada convene tripartite meeting with the Provinces and Territories to address jurisdictional challenges regarding home and community care, palliative care, and LTC on reserves • Use the OCAP principles regarding First Nations data and governance and work with First Nations to develop and integrate data collection protocols specific to health and wellbeing of First Nations.

10. CHMC National Co-investment fund • The National Housing Strategy is a 10 year, $55+ billion dollar plan creating a new generation of housing in Canada giving more Canadians a place to call home. The Strategy is delivered by CMHC. • Minister Duclos is charged with implementation of the plan and is based on the right to housing. • The National Housing Strategy prioritizes the most vulnerable Canadians including women and children fleeing family violence, Indigenous Peoples, seniors, people with disabilities, those dealing with mental health and addictions, Veteransand young adults. • Trim Kanieff, CMHC Housing Specialist represented CMHC on the TWG and worked with the Regional Manager Terri Gibbons for policy change to the CMHC’s National Co-Investment Fund for a broader interpretation of housing to include long-term care facilities. First Nations can now apply and the Mohawks of the Bay of Quinte will be applying to the National Co-Investment Fund for a 40% capital grant for this project. Applications are reviewed on a case-by-case basis. • So far only 3 First Nations in Canada have applied to the National Co-Investment Fund. • First Nations should work with their CMHC Housing Specialist on applications to the National Co-Investment Fund for the construction of LTC Facilities • Chief Maracle and Others have lobbied MPs and Minister Duclos’s senior staff regarding First Nations access to CMHC National Co-Investment Fund for LTC projects.

11. MBQ’s Financial Model for LTC Facility • REVENUES: • MOHLTC-Construction Mortgage Subsidy $12,000,000 • ($16.65/day/bed x 365 days x 25 years) • FEDEV* $ 5,000,000 • ISC - CORP* $ 1,000,000 • MIRR (ICCGP)* $ 500,000 • CMHC National Co-Investment Grant $11,292,672 • TOTAL REVENUES $29,792,672 • EXPENSES: • Construction $23,552,000 • Soft Costs $ 3,835,200 • Land Acquisition $ 200,000 • Debt Servicing for Mortgage $ 1,360,992 • Contingency $ 844,480 • TOTAL EXPENSES $29,792,672 Note: MBQ obtained Robert Berg and Bernard Bouchard of Assured Care Consulting to develop a feasibility study for the MOHLTC application for LTC License which was accepted by the MOHLTC for a 128-bed facility. Once Federal funding is confirmed MBQ will enter into an agreement with the MOHLTC. First Nations must comply with all design and operational requirements of the MOLTC.

12. MOHLTC construction and Operating subsidies Operation: Capital: • From: "Girard, Julie A. (MOHLTC)" <Julie.A.Girard@ontario.ca> • Date: April 30, 2019 at 10:13:19 AM EDT • To: "'R. Donald Maracle'" <rdonm@mbq-tmt.org> • Subject: Financial Information Requested • Hi again, • I am just following up on your request for financial information: • Operating funding - The co-pay (resident pays) and level of care per diem (Ministry pays) documents attached are the current rates paid. • Construction funding - I have also included the current Construction Funding Policy. Once the provincial budget passes we are expecting a construction funding policy adjustment to the current base rate of $16.65 per bed/per day. The base rate is expected to change to $18.03 per bed/per day although there will no longer be any provisions for LEED or enhanced transition support. • I am happy to chat with you about this. I am working remotely today if you would like to reach me by cell 1-519-630-5599. • I hope this helps. • Thanks, Julie • Julie Girard • Project Manager | Long-Term Care Home Renewal Branch • Ministry of Health and Long-Term Care | Long-Term Care Homes Division • 1075 Bay St, 11th Floor, Toronto, ON M5S 2B1 • T: 416-212-3956 E: Julie.A.Girard@ontario.ca