2022 to 2023 Canada-Prince Edward Island Home and Community Care and Mental Health and Addictions Services Funding Agreement
Table of Contents
- Funding Agreement
- Annex I - Common Statement of Principles on Shared Health Priorities
- Annex II - Expenditure Plan
Funding Agreement
BETWEEN:
HIS MAJESTY THE KING IN RIGHT OF CANADA (hereinafter referred to as "Canada" or "Government of Canada") as represented by the Minister of Health and Minister of Mental Health and Addictions and Associate Minister of Mental Health (herein referred to as "the federal Ministers")
- and -
HIS MAJESTY THE KING IN RIGHT OF THE PROVINCE OF PRINCE EDWARD ISLAND (hereinafter referred to as "Prince Edward Island" or "Government of Prince Edward Island") as represented by the Minister of Health and Wellness (herein referred to as "the provincial Minister")
REFERRED to collectively as the "Parties", and individually as a “Party”
PREAMBLE
WHEREAS, on January 31, 2016 Canada and Prince Edward Island agreed to targeted federal funding over 10 years, beginning in 2017-18, for investments in home and community care and mental health and addictions, in addition to the existing legislated commitments through the Canada Health Transfer;
WHEREAS, Canada and Prince Edward Island agreed to a Common Statement of Principles on Shared Health Priorities (hereinafter referred to as the “Common Statement”, attached hereto as Annex 1) on August 21, 2017, which articulated their shared vision to improve access to home and community care as well as mental health and addictions services in Canada;
WHEREAS, Canada authorizes the federal Ministers to enter into agreements with the provinces and territories, for the purpose of identifying activities provinces and territories will undertake in home and community care and mental health and addictions services, based on a menu of common areas of action and in keeping with the performance measurement and reporting commitments, consistent with the Common Statement;
WHEREAS, Canada and Prince Edward Island agree that data collection and public reporting of outcomes is key to reporting results to Canadians on these health system priorities, and that the performance measurement approach taken will recognize and seek to address differences in access to data and health information infrastructure;
WHEREAS, the Financial Administration Act R.S.P.E.I, c- F-9 authorizes the provincial Minister to enter into agreements with the Government of Canada under which Canada undertakes to provide funding toward costs incurred by the Government of Prince Edward Island for the provision of health services which includes home and community care, and mental health and addictions initiatives;
WHEREAS, Prince Edward Island makes ongoing investments in home and community care and mental health and addictions services, consistent with its broader responsibilities for delivering health care services to its residents;
AND WHEREAS, the Government of Canada makes ongoing investments in home and community care and mental health and addictions services for Indigenous communities and other federal populations;
NOW THEREFORE, Canada and Prince Edward Island agree as follows:
1.0 Objectives
1.1 Building on Prince Edward Island’s existing investments and initiatives, the Parties commit to work together to improve access to home and community care and strengthen access to mental health and addictions services (listed in the Common Statement, attached as Annex 1).
2.0 Action Plan and Expenditure Plan
2.1 Prince Edward Island will invest federal funding provided through this Agreement in alignment with the selected action(s) from each menu of actions listed under home and community care and mental health and addictions services in the Common Statement and the Action Plan (Annex 2 of the Canada-Prince Edward Island Home and Community Care and Mental Health and Addictions Services Funding Agreement (herein the “Previous Agreement”)).
2.2 Consistent with the Initiatives in the Action Plan, Annex 2 sets out the expenditure plan for funding provided through this Agreement. Annex 2 may include a description of any new initiatives.
3.0 Term of Agreement
3.1 The term of this Agreement is one year, from April 1, 2022 to March 31, 2023 (“the Term”).
3.2 Renewal of Agreement
3.2.1 Prince Edward Island's share of the federal funding for 2023-24 to 2026-27, based on the federal commitment in Budget 2017 of $11 billion over ten years, could be provided upon the renewal of an agreement, subject to appropriation by Parliament, and the Parties’ agreement on a new Action Plan. A future agreement would provide the Parties an opportunity to review and course correct, if required, and realign new priorities 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 under the Canada Health Transfer to support delivering health care services within the jurisdictions.
4.2 Allocation to Prince Edward Island
4.2.1 In this Agreement, “Fiscal Year” means the period commencing on April 1 of any calendar year and terminating on March 31 of the immediately following calendar year.
4.2.2 Canada has designated the following maximum amounts to be transferred in total to all provinces and territories under this initiative based on the allocation method outlined in subsection 4.2.3 for the Term of this Agreement.
Home and Community Care
- $600 million for the Fiscal Year beginning on April 1, 2022
Mental Health and Addictions Services
- $600 million for the Fiscal Year beginning on April 1, 2022
4.2.3 Funding will be allocated to provinces and territories on a per capita basis. The per capita funding is calculated using the following formula: F x K/L, where:
- F is the total funding amount available under this initiative as outlined in section 4.2.2 in Fiscal Year 2022-23;
- K is the total population of the particular province or territory, as determined using the annual population estimates on July 1st 2022 from Statistics Canada; and
- L is the total population of Canada, as determined using the annual population estimates on July 1st 2022 from Statistics Canada.
4.2.4 Subject to annual adjustment based on the formula described in section 4.2.3, Prince Edward Island’s estimated share of the amounts will be:
| Fiscal Year | Home and community care Estimated amount to be paid to Prince Edward IslandTable 1 Footnote * |
Mental health and addictions services Estimated amount to be paid to Prince Edward IslandTable 1 Footnote * |
|---|---|---|
| 2022-2023 | $2,630,698 | $2,630,698 |
|
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4.3 Payment
4.3.1 Canada's contribution will be paid as follows:
- The full amount as set out in section 4.2.3 funding formula will be paid within approximately 30 business days of execution of this Agreement by the Parties. Canada shall withhold the payment if Prince Edward Island has failed to provide its annual financial statement for the previous Fiscal Year pursuant to the Previous Agreement or to provide data and information related to home and community care and mental health and addictions to the Canadian Institute for Health Information (CIHI) for the previous Fiscal Year in accordance with section 5.1.
- This constitutes a final payment and is not subject to any further adjustment once the installment has been paid.
- Payment of Canada's funding for this Agreement is subject to an annual appropriation by the Parliament of Canada for this purpose.
4.4 Carry Over
4.4.1 In the event this Agreement is renewed in accordance with the terms of section 3.2.1, and at the request of Prince Edward Island, Prince Edward Island may retain and carry forward up to 10 percent of funding provided in this Agreement that is in excess of the amount of the eligible costs actually incurred and use the amount carried forward for expenditures on eligible areas of investment incurred in Fiscal Year 2023-24. Any request to retain and carry forward an amount exceeding 10 percent will be subject to discussion and mutual agreement in writing by the Designated Officials via an exchange of letters.
4.5 Repayment of overpayment
4.5.1 In the event payments made exceed the amount to which Prince Edward Island is entitled under this Agreement, the amount of the excess is a debt due to Canada and, unless otherwise agreed to in writing by the Parties, Prince Edward Island shall repay the amount within sixty (60) calendar days of written notice from Canada.
4.6 Use of Funds
4.6.1 The Parties agree that funds provided under this Agreement will only be used in accordance with the areas of action outlined in Annex 2.
4.7 Eligible Expenditures
4.7.1 Eligible expenditures under this Agreement are the following:
- capital and operating funding;
- salaries and benefits;
- training, professional development;
- information and communications material related to programs;
- data development and collection to support reporting; and,
- information technology and infrastructure.
5.0 Performance Measurement and Reporting to Canadians
5.1 Funding conditions and reporting
5.1.1 As a condition of receiving funding, Prince Edward Island agrees to participate in a Federal-Provincial-Territorial process, including working with stakeholders and experts, through CIHI, to continue the development of 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.
- Prince Edward Island will designate an official or official(s), for the duration of this agreement, to work with CIHI and represent its interests related to performance measurement and reporting for home and community care and mental health and addictions services.
5.1.2 By no later than October 1, 2022 and October 1, 2023, in respect of the previous Fiscal Year, Prince Edward Island agrees to:
- Provide to CIHI data and information (based on existing and new indicators) related to home and community care and mental health and addictions services annually. This will support CIHI to measure progress on the shared commitments outlined in the Common Statement and report to the public.
- Provide to Canada an annual financial statement, with attestation from the province's Chief Financial Officer, of funding received the preceding Fiscal Year from Canada under this Agreement or the Previous Agreement compared against the Action Plan, and noting any variances, between actual expenditures and the Action Plan:
- The revenue section of the statement shall show the amount received from Canada under this Agreement during the Fiscal Year;
- The total amount of funding used for home and community care and mental health and addictions programs and services;
- If applicable, the amount of any amount carried forward under section 4.4; and
- If applicable, the amount of overpayment that is to be repaid to Canada under section 4.5.
5.2 Audit
5.2.1 Prince Edward Island will ensure that expenditure information presented in the annual financial statement is, in accordance with Prince Edward Island's standard accounting practices, complete and accurate.
5.3 Evaluation
5.3.1 Responsibility for evaluation of programs rests with Prince Edward Island in accordance with its own evaluation policies and practices.
6.0 Communications
6.1 The Parties 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.
6.4 Canada, with prior notice to Prince Edward Island, may incorporate all or any part of the data and information in 5.1.2, or any part of evaluation and audit reports made public by Prince Edward Island into any report that Canada may prepare for its own purposes, including any reports to the Parliament of Canada or reports that may be made public.
6.5 Canada reserves the right to conduct public communications, announcements, events, outreach and promotional activities about the Common Statement and this Agreement. Canada agrees to give Prince Edward Island 10 days advance notice and advance copies of public communications related to the Common Statement, this Agreement, and results of the investments of this Agreement.
6.6 Prince Edward Island reserves the right to conduct public communications, announcements, events, outreach and promotional activities about the Common Statement and this Agreement. Prince Edward Island agrees to give Canada 10 days advance notice and advance copies of public communications related to the Common Statement, this Agreement, and results of the investments of this Agreement.
7.0 Dispute Resolution
7.1 The Parties 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 a Party 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, that Party may notify the other Party in writing of the failure or breach. Upon such notice, the Parties will endeavour to resolve the issue in dispute bilaterally through their designated officials, at the Assistant Deputy Minister level ("Designated Officials").
7.3 If a dispute cannot be resolved by Designated Officials, then the dispute will be referred to the Deputy Ministers of Canada and Prince Edward Island responsible for health, and if it cannot be resolved by them, then the federal Minister(s) and the provincial Minister(s) shall endeavour to resolve the dispute.
8.0 Amendments to the Agreement
8.1 The main text of this Agreement may be amended at any time by mutual consent of the Parties. Any amendments shall be in writing and signed, in the case of Canada, by the federal Minister(s), and in the case of Prince Edward Island, by the provincial Minister(s).
8.2 Annex 2 may be amended at any time by mutual consent of the Parties. Any amendments to Annex 2 shall be in writing and signed by each Party’s 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, enters into a home and community care and mental health and addictions services agreement with Canada, or the Parties agree to an amendment to such an agreement and if, in the reasonable opinion of Prince Edward Island, any provision of that agreement or an 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, upon request. This includes any provision of the Agreement except for the Financial Provisions set out under section 4.0. This amendment shall be retroactive to the date on which the Agreement or the amendment to such an agreement with the other province or territory came into force.
10.0 Termination
10.1 Either Party may terminate this Agreement at any time if the terms are not respected by giving at least 6 months written notice of intention to terminate.
10.2 As of the effective date of termination of this Agreement, Canada shall have no obligation to make any further payments.
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 communication that is delivered will be deemed to have been received in delivery; and, except in periods of postal disruption, any communication mailed by post will be deemed to have been received eight calendar days after being mailed.
The address for communication to Canada shall be:
Health Canada
70 Colombine Driveway
Brooke Claxton Building
Ottawa, Ontario
K1A 0K9
Email: jocelyne.voisin@hc-sc.gc.ca
The address for communication to Prince Edward Island shall be:
Department of Health and Wellness
P.O. Box 2000
Charlottetown, PE
Canada C1A 7N8
Email: smacneill@gov.pe.ca
12.0 General
12.1 This Agreement, including Annexes 1 and 2, comprise the entire Agreement entered into by the Parties.
12.2 This Agreement is based on the Common Statement of Principles on Shared Health Priorities, Annex 1, finalized on August 21, 2017.
12.3 This Agreement shall be governed by and interpreted in accordance with the laws of Canada and Prince Edward Island.
12.4 No member of the House of Commons or of the Senate of Canada or of the Legislature of Prince Edward Island shall be admitted to any share or part of this Agreement, or to any benefit arising therefrom.
12.5 If for any reason a provision of this Agreement, that is not a fundamental term, is found by a court of competent jurisdiction to be or to have become invalid or unenforceable, in whole or in part, it will be severed and deleted from this Agreement, but all the other provisions of this Agreement will continue to be valid and enforceable.
SIGNED on behalf of Canada by the Minister of Health at Ottawa, Ontario this 10th day of March, 2023.
The Honourable Jean-Yves Duclos, Minister of Health
SIGNED on behalf of Canada by the Minister of Mental Health and Addictions and Associate Minister of Health at Ottawa, Ontario this 9th day of March, 2023.
The Honourable Carolyn Bennett, Minister of Mental Health and Addictions and Associate Minister of Health
SIGNED on behalf of Prince Edward Island by the Minister of Health and Wellness at Charlottetown, Prince Edward Island this 6th day of March, 2023.
The Honourable Ernie Hudson, Minister of Health and Wellness
Annex 1 to the Agreement
Common Statement of Principles on Shared Health Priorities
Annex 2 to the Agreement
Prince Edward Island’s Expenditure Plan on Home and Community Care and Mental Health and Addictions Services 2022-2023
Building on the Action Plan in Annex 2 of the previous Canada-Prince Edward Island Home and Community Care and Mental Health and Addictions Services Funding Agreement’sFootnote 1, Prince Edward Island is planning to use federal funding as follow:
Section 1: Expenditure Tables
Home and Community Care
| Initiative | 2022-23 ($M) |
|---|---|
Mobile Integrated Health (MIH) Support the implementation of three integrated projects in tandem to leverage administrative efficiencies, economies of scale and maximize front line delivery of services from Prince Edward Island’s paramedic community. This initiative includes considerations for the First Nations communities in Prince Edward Island, as well as the Island’s francophone residents. The planned projects are:
|
$1.20 |
Home and Community Care IT Infrastructure
|
$2.28 |
Delivering Evidence-Based Models of Community Care
|
$1.96 |
| Total federal funding - Home and Community Care | $5.63Footnote 2 |
Mental Health and Addictions Services
| Initiative | 2022-23 ($M) |
|---|---|
Student Well-being Program Support the staffing of mental health nurses in schools to promote positive mental health and well-being, and to provide strategies on how to manage mental health issues as they emerge. Nurses will also act as navigators of the existing mental health care system and help coordinate access to mental health services for students with acute needs (and their families). Bilingual positions will be established to support the Island’s francophone population, and nurses working within the program will also collaborate with Indigenous nurses from First Nations health centres to delivery culturally appropriate care. |
$1.86 |
Mobile Mental Health Crisis Program Establish a 24-7 provincial mobile mental health crisis program, consisting of mental health professionals (nurses and social workers), to respond and support those in crisis within the community. This initiative will improve timely access to mental health services, including improving wait times at the emergency department, by assessing, stabilizing and creating a plan for ongoing care directly within the patients’ community setting. |
$0.77 |
| Total federal funding - Mental Health and Addictions Services | $2.63 |
Section 2: New Initiatives and Programs for Home and Community Care Supported by Federal Funds in 2022-23
Mobile Integrated Health (MIH)
Expansion of MIH Bridging and ED Pharmacist for Rapid Bridging Program
This initiative will integrate allied healthcare providers within emergency departments (ED) to “pull” potential clients (as opposed to reliance on referral). The team members would support clients and develop a plan of care to support transition to home, as part of an integrated collaborative team. By instating a healthcare provider within the ED who is solely focused on connecting the two aspects of care (emergency department stay and transition to home) it would address this gap. (This program may also be coordinated with a new ED pharmacist function immediately below)
In support of the Rapid Bridging Program, this program would also assist with ED volume and wait times by returning non-urgent patients to their homes to be cared for by an Advanced Care Paramedic, with guidance from an ED physician, until they could be transitioned to a member of their primary care team or Home Care. This is a very large area of opportunity for ED pharmacists as they have the skills to adequately screen, refer, create care plans, assist with drug procurement and coverage, and provide monitoring plans to ensure continuity of care for qualifying patients – all of which will increase uptake of the existing Rapid Bridging Program.
This initiative aligns with the Common Statement of Principles on Shared Health Priorities through the following priority area: Spreading and scaling evidence-based models of home and community care that are more integrated and connected with primary health care.
Home and Community Care IT Infrastructure
ITSS Infrastructure (AlayaCare/InterRAI system connectivity)
This initiative will focus on connectivity and hardware upgrades to support IT needs within LTC. Specifically, this enhanced connectivity is necessary to support the full realization of AlayaCare, the electronic platform that has been deployed for the home care clinical information system. Connectivity is therefore essential for full access to InterRAI functionality, including client assessment, care planning, staff scheduling, system reporting and an array of other functions. This initiative advances and provides internet and WIFI connectivity at a number of sites (Wedgewood, Community Hospital, Souris Hospital, Day Program and Palliative Care Centre). The continued development, evolution and stabilization of this digital infrastructure is a high priority for the system.
This initiative aligns with the Common Statement of Principles on Shared Health Priorities through the following priority area: Enhancing home care infrastructure, such as digital connectivity, remote monitoring technology and facilities for community-based service delivery.
Health Human Resources (HHR) Scheduling Software
Federal funding would support the purchase of HHR scheduling software (which includes training, licenses, change management, and project resources) that would be implemented within Prince Edward Island’s home and community care sector, as well as the long-term care and mental health and addiction services sector. This investment will improve access to services in the community by helping ensure appropriate staff coverage in home and community care, especially given the challenges encountered throughout the COVID response.
Increasing staffing levels would free up limited staff resources from administering a time-intensive, manual scheduling process. This investment would result in more time directly spent on service delivery and would allow for better coordination within and between different service providers and interdisciplinary teams (such as in Mobile Integrated Health).
This initiative aligns with the Common Statement of Principles on Shared Health Priorities through the following priority area: Enhancing home care infrastructure, such as digital connectivity, remote monitoring technology and facilities for community-based service delivery.
Delivering Evidence-Based Models of Community Care
The below activities align with the Common Statement of Principles on Shared Health Priorities through the following priority area: Spreading and scaling evidence-based models of home and community care that are more integrated and connected with primary health care.
Primary Care at Home
This initiative aims to address the gap of meeting community care needs of clients without primary care physicians. Federal funds will support the hiring of four nurse practitioners who would assist by provide care at home, inclusive of the COACH (Caring for Older Adults in Community and at Home) and the Provincial Integrated Palliative Care Program, using client-appropriate and available technology such as remote client monitoring.
Through supplementing primary care by hiring additional community nurse practitioners, clients will increase their length of stay at home and decrease the need for walk-in clinic and emergency department visits. This improvement in community care delivery would increase efficiency for care coordinators assisting unaffiliated clients, and improve overall access to community care supports. This initiative will be supplemented by provincial funding and supports.
Brackley Stables and Small Option Home
This investment would address the needs of clients who no longer require acute, in-hospital mental health and addictions care services but are not able to be discharged to the community due to their complex mental health and behavioral issues. Federal funds will be used to support enhanced programming and stabilize staffing to provide enhanced care and support for clients with chronic mental health and addictions concerns, who are unable to reside in traditional care settings. These supports will be available to clients at the Brackley Stables and the Small Option Home in Charlottetown.
Given the complex behavioral needs of the clients in these facilities, more robust behavioral / life-skill programming is needed to facilitate integration of clients back into the community. This investment would fill an important gap within our continuum of care and avoid unnecessary hospitalizations of clients who are unable to be discharged to community or placed within another facility.
Flexible Assertive Community Treatment (FACT) Teams
FACT teams provide a multidisciplinary outreach support required for specific clients to successfully operate in the community, including allowing Islanders to receive the care they need, when they need it, in the most appropriate community setting as close to home as possible. This program would provide optimal community services to islanders through guideline-compliant treatment, patient care and rehabilitation programs, patient recovery support and working with support systems in the family and the community. FACT teams also provide long-term care for people with severe mental illness who are unable to be placed in a designated psychiatric facility. In addition to mental health concerns, these clients also often have limited support systems and have limitations in their social functioning relating to housing, self-care, employment and finances. The FACT teams conduct direct-to-client outreach to support social functioning through going to the client’s home, work, family, or other venues to provide support for community integration and social inclusion. Their work recognizes and emphasises the important role of family as well as neighbours, volunteers and various organizations in the community.
This initiative will ensure continuity of care to patients by improving access to necessary community supports, thereby preventing unnecessary admissions to hospitals. FACT teams also aim to stimulate inclusion, so that clients feel like they belong within the community. The presence of this additional support will be a deciding factor in determining whether some complex clients are accepted by community residential programs and are therefore key to more efficient bed flow and more appropriate placement of clients in community.
Mental Health Intensive Day Program
This new program, which began accepting clients in fall 2022, provides people who require intensive mental health supports with access to appropriate multidisciplinary individual and group programming and services on an outpatient basis. The program will allow individuals with more complex needs the opportunity to access an appropriate level of care while living in the community, which will allow clients to move more quickly out of acute care or to avoid acute care stays altogether. This increased access to community supports will alleviate demand for inpatient beds and improve client care delivery. Participation in the program will be voluntary, and available to individuals aged 18 and older of all gender identities. It will be 4 weeks in duration, with continuous intake.
Footnotes
- Footnote 1
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https://www.canada.ca/en/health-canada/corporate/transparency/health-agreements/shared-health-priorities/prince-edward-island.html#a5
- Footnote 2
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Total federal funding for 2022-23 includes the amount of funding carried forward from fiscal year 2021-22 and an expected $.19M to be carried forward into 2023-24.
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