Canada-Alberta Aging with Dignity funding agreement (2023-24 to 2027-28)

Tables of contents

• Funding agreement
• Annex 1 – Common statement of principles on shared health priorities
• Annex 2 – Shared pan-Canadian interoperability roadmap
• Annex 3 – Indicators: Access to home and community care
• Annex 4 – Action plan

Funding agreement

(the "Agreement")

BETWEEN:

- and -

REFERRED to collectively as the "Parties", and individually as a "Party"

PREAMBLE

WHEREAS, on February 27, 2023, Canada and Alberta announced an overarching agreement in principle on Working Together to Improve Health Care for Canadians, supported by almost $200 billion over ten years in federal funding, including $46.2 billion in new funding to provinces and territories, Canada and Alberta acknowledged the importance of helping Canadians age closer to home;

WHEREAS, Canada has also announced a 5 per cent Canada Health Transfer (CHT) guarantee for the next five years, starting in 2023-24, which will be provided through annual top-up payments as required. This is projected to provide approximately an additional $17 billion over 10 years in new support. The last top-up payment will be rolled into the CHT base at the end of the five years to ensure a permanent funding increase, providing certainty and sustainability to provinces and territories;

WHEREAS, in the area of home and community care, Working Together to Improve Health Care for Canadians also includes a commitment by Canada and Alberta to continue to work to support collaboration on the Common Statement of Principles on Shared Health Priorities (hereinafter referred to as the "Common Statement", attached hereto as Annex 1), supported by the federal Budget 2017 investment of $6 billion over ten years;

WHEREAS, this Agreement also provides financial support for long-term care as it relates to the Government of Canada's Budget 2021 investment of $3 billion over 5 years to support provinces and territories in keeping long-term care residents safe and improve their quality of life;

WHEREAS, Alberta makes ongoing investments in health consistent with its broader responsibilities for delivering health care services to its residents and in supporting diversity, equity, and the needs of First Nations, Inuit and Métis; and underserved and/or disadvantaged populations, including, but not limited to official language minority communities, rural and remote communities, children, racialized communities (including Black Canadians), and 2SLGBTQIA+;

WHEREAS, Canada authorized the federal Minister to enter into agreements with the provinces and territories, for the purpose of identifying activities that provinces and territories will undertake in respect of long-term care, and for funding in this Agreement associated with the federal investment for home and community care consistent with the Common Statement (and menu of actions outlined in Annex 1);

WHEREAS, the Government Organization Act authorizes the provincial Ministers to enter into agreements with the Government of Canada under which Canada undertakes to provide funding toward costs incurred by the Government of Alberta associated with the federal investment for long-term care, and home and community care consistent with the Common Statement; and

NOW THEREFORE, this Agreement sets out the terms between Canada and Alberta as follows:

1.0 Key principles and collaboration

The key principles and commitment to collaboration agreed to in Working Together to Improve Health Care for Canadians are outlined below.

1.1 Canada and Alberta acknowledge that this Agreement will mutually respect each government's jurisdiction, and be underpinned by key principles, including:

• A shared responsibility to uphold the Canada Health Act that strengthens public health care systems;
• Principles agreed to in the Common Statement (outlined in Annex 1);
• Reconciliation with Indigenous Peoples, including access to quality and culturally safe health services that is free from racism and discrimination anywhere in Canada, through seamless service delivery across jurisdictions and meaningful engagement and work with First Nations, Métis, and Inuit partners and governments; and
• Equity of access for underserved groups and individuals, including those in official language minority communities.

1.2 Canada and Alberta acknowledge the importance of supporting health data infrastructure, data collection and public reporting, and will work together to improve the collection, sharing and use of de-identified health information, respecting federal/provincial/territorial privacy legislation, to improve transparency on results and to help manage public health emergencies, and to ensure Canadians can access their own health information and benefit from it being shared between health workers across health settings. This includes:

• collecting and securely sharing high-quality, comparable information needed to improve services to Canadians, including disaggregated data on key common health indicators with the Canadian Institute for Health Information (CIHI);
• adopting common interoperability standards (both technical exchange and content of data), including the Shared pan-Canadian Interoperability Roadmap (outlined in Annex 2), to improve Canadians' access to their health information in a usable digital format and support the exchange and analysis of health data within and across Canada's health systems in a way that protects Canadians' privacy and ensures the ethical use of data to improve the health and lives of people;
• work to align provincial and territorial policies and legislative frameworks where necessary and appropriate, to support secure patient access to health information, and stewardship of health information to support the public good, including improving health care quality, patient safety, privacy protection, system governance and oversight, planning and research;
• promoting health information as a public good by working with federal-provincial-territorial Ministers of Health to review and confirm overarching principles, which would affirm Canadians' ability to access their health information and have it follow them across all points of care. The existing Health Data Charter, as outlined in the Pan-Canadian Health Data Strategy would serve as the starting point for the discussion of these principles; and
• collecting and sharing available public health data (e.g., vaccination data, testing data) with the Public Health Agency of Canada to support Canada's preparedness and response to public health events, building on commitments made as part of the Safe Restart Agreements.

1.3 Canada and Alberta acknowledge they will work with other provinces and territories to streamline foreign credential recognition for internationally-educated health professionals, and to advance labour mobility, starting with multi-jurisdictional recognition of health professional licences.

1.4 Canada and Alberta acknowledge a mutual intent to engage in a two-phased formal review process:

1. Phase 1: This review will be done in 2026 by a joint committee of Federal, Provincial, and Territorial health and finance officials to assess results and determine next steps for bilateral agreements related to improvements to home and community care, mental health, substance use, and addiction services associated with the Common Statement and long-term care; and
2. Phase 2: A formal five-year review of the healthcare plan outlined on February 7, 2023, recognizing the importance of long-term sustainability for provincial-territorial health systems. This review would consist of an assessment of both the bilateral agreements (herein) and the CHT investments (not included as part of this bilateral agreement). The review will be done by a joint committee of Federal, Provincial, and Territorial health and finance officials, commencing by March 31, 2027, and concluded by December 31, 2027, to consider results achieved thus far in the four shared health priority areas and will include:
   1. an assessment of progress-to-date on public reporting to Canadians using the common indicators;
   2. sharing of de-identified health information, and other health data commitments; and
   3. current and forward-looking Federal, Provincial, and Territorial investments to support this plan.

2.0 Objectives

2.1 Canada and Alberta agree that, with financial support from Canada, Alberta will continue to build and enhance health care systems towards achieving some or all of the objectives of:

• Improving access to home and community care services (listed in the Common Statement, attached as Annex 1); and
• Supporting workforce improvements for long-term care and standards, to keep long-term care residents safe and to improve their quality of life.

3.0 Action plan

3.1 Alberta set out in their Action Plan (attached as Annex 4) how the federal investment under this Agreement will be used, as well as details on targets and timeframes for each of the initiatives supported under the Agreement.

3.2 Alberta will invest federal funding as part of the 2017 commitment for home and community care provided through this Agreement in alignment with the menu of actions listed in the Common Statement.

3.3 Alberta will invest federal funding for long-term care provided through this Agreement to bolster efforts to support workforce improvements and standards by:

• Supporting activities/initiatives to achieve stability in the long-term care workforce, including through hiring and wage top-ups and/or improvements to workplace conditions (e.g., staff to patient ratios, hours of work); and
• Applying long-term care standards, with an emphasis on strengthened enforcement (e.g., enhanced inspection and enforcement capacity, quality and safety improvements).

3.4 In developing initiatives under this Agreement, Alberta agrees to implement the commitments in the Action Plan specific to the needs of First Nations, Inuit and Métis; and underserved and/or disadvantaged populations, including, but not limited to official language minority communities, rural and remote communities, children, racialized communities (including Black Canadians), and 2SLGBTQIA+.

3.5 Alberta's approach to achieving home and community care and long-term care objectives is set out in their five-year Action Plan, as set out in Annex 4.

4.0 Term of agreement

4.1 This Agreement comes into effect upon the date of the last signature of the Parties and will remain in effect until March 31, 2028, unless terminated in accordance with section 12 of this Agreement. Funding provided under this Agreement will be for five years and will cover the period April 1, 2023 to March 31, 2028 ("the Term").

5.0 Financial provisions

5.1 The funding provided under this Agreement is in addition to and not in lieu of those that Canada currently provides under the CHT to support delivering health care services within the province.

5.2 Allocation to Alberta

• 5.2.1 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.
• 5.2.2 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 5.2.3 for the Term of this Agreement.

  Budget 2017 Home and Community Care

  1. $600 million for the Fiscal Year beginning on April 1, 2023
  2. $600 million for the Fiscal Year beginning on April 1, 2024
  3. $600 million for the Fiscal Year beginning on April 1, 2025
  4. $600 million for the Fiscal Year beginning on April 1, 2026

  Budget 2021 Long-Term Care

  1. $600 million for the Fiscal Year beginning on April 1, 2023
  2. $600 million for the Fiscal Year beginning on April 1, 2024
  3. $600 million for the Fiscal Year beginning on April 1, 2025
  4. $600 million for the Fiscal Year beginning on April 1, 2026
  5. $600 million for the Fiscal Year beginning on April 1, 2027
• 5.2.3 Allocation Method
  1. For the funding associated with Budget 2017 Home and Community Care committed by the federal government in 2017, annual funding will be allocated to provinces and territories on a per capita basis. 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;
     • K is the total population of Alberta, as determined using the annual population estimates on July 1st from Statistics Canada; and
     • L is the total population of Canada, as determined using the annual population estimates on July 1st from Statistics Canada.
  2. For the funding associated with Budget 2021 Long-Term Care committed by the federal government in 2021, annual funding will be allocated to provinces and territories with a base amount of $1,200,000 and the remainder of the funding allocated on a per capita basis. The total amount to be paid will be calculated using the following formula: $1,200,000+(F-(N x 1,200,000)) x (K/L), where:
     • F is the annual total funding amount available under this program;
     • N is the number of jurisdictions (13) that will be provided the base funding of $1,200,000;
     • K is the total population of Alberta, as determined using the annual population estimates on July 1st from Statistics Canada; and
     • L is the total population of Canada, as determined using the annual population estimates on July 1st from Statistics Canada.
• 5.2.4 Subject to annual adjustment based on the formulas described in section 5.2.3, Alberta estimated share of the amounts will be:

  Fiscal Year	Budget 2017 Home and Community Care Estimated amount to be paid to AlbertaFootnote * (subject to annual adjustment)	Budget 2021 Long-Term Care Estimated amount to be paid to AlbertaFootnote * (subject to annual adjustment)
  2023-2024	$70,020,000	$69,400,000
  2024-2025	$70,020,000	$69,400,000
  2025-2026	$70,020,000	$69,400,000
  2026-2027	$70,020,000	$69,400,000
  2027-2028	n/a	$69,400,000
  Footnote * Amount represent annual estimates based on Statistics Canada's July 1st, 2022, population estimates. Return to Footnote * referrer

5.3 Payment

• 5.3.1 Funding provided by Canada will be paid in semi-annual installments as follows:
  1. In 2023-24, the first installment will be paid within approximately 30 business days of execution of this Agreement by the Parties. The second installment will also be paid within approximately 30 business days of execution of this Agreement by the Parties, subject to section 5.3.1.g.
  2. Starting in 2024-25, the first installment will be paid on or about April 15 of each Fiscal Year and the second installment will be paid on or about November 15 of each Fiscal Year.
  3. The first installment will be equal to 50% of the notional amount set out in section 5.2.4 as adjusted by section 5.2.3.
  4. The second installment will be equal to the balance of funding provided by Canada for the Fiscal Year as determined under sections 5.2.3 and 5.2.4.
  5. Canada will notify Alberta prior to the first payment of each 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. Prior to the second payment, Canada will notify Alberta of the amount of the second installment as determined under sections 5.2.3 and 5.2.4.
  6. Canada shall withhold payments if Alberta has failed to provide reporting in accordance with section 8.1.
  7. Canada shall withhold the second payment in 2023-24 if Alberta has failed to satisfy all reporting requirements associated with the preceding Canada – Alberta Home and Community Care and Mental Health and Addictions Services Funding Agreement 2022-23, specifically to:
     1. continue to participate in a Federal-Provincial-Territorial process to improve reporting on and provide data to CIHI for the 6 common indicators (listed in Annex 3) to measure pan-Canadian progress on improving access to home and community care; and
     2. provide the annual financial statement, with attestation from Alberta's senior financial officer for Alberta Health of funding received the preceding Fiscal Year from Canada for home and community care under the Canada – Alberta Home and Community Care and Mental Health and Addictions Services Funding Agreement 2022-23 compared against the Expenditure Plan 2022-23, and noting any variances, between actual expenditures and the Expenditure Plan 2022-23.
  8. The sum of both installments constitutes a final payment and is not subject to any further payment once the second installment has been paid.
  9. Payment of Canada's funding for this Agreement is subject to an annual appropriation by the Parliament of Canada for this purpose.
• 5.3.2 Where Alberta will use cost-recovery agreements with one or more privately-owned for-profit facilities as an accountability measure and Alberta has failed to put in place a cost-recovery agreement at the time it delivers funding to facilities, Canada shall deduct from the payment referred to in subsection 5.3.1(b) an amount equivalent to the amount of funding tied to the specific identified initiative noted in Annex 4 to be provided by Alberta to those facilities with whom they do not have the required cost-recovery agreements in place.

5.4 Retaining funds

• 5.4.1 For Fiscal Years 2023-24 through 2026-27, upon request, Alberta may retain and carry forward to the next Fiscal Year up to 10 percent of funding that is in excess of the amount of the eligible costs actually incurred in a Fiscal Year and use the amount carried forward for expenditures on eligible areas of investment. Any request to retain and carry forward an amount exceeding 10 percent will be subject to discussion and mutual agreement in writing by the Parties' designated officials, at the Assistant Deputy Minister level (herein referred to as "Designated Officials"), and is subject to monitoring and reporting to Canada on the management and spending of the funds carried forward on a quarterly basis.
• 5.4.2 For Fiscal Year 2027-28, Alberta is not entitled to retain any amounts beyond March 31, 2028. Any amounts that remain unexpended at the end of that Fiscal Year are considered debts due to Canada and shall be repaid in accordance with section 5.5.2.
• 5.4.3 Any amount carried forward from one Fiscal Year to the next under this subsection is supplementary to the maximum amount payable to Alberta under subsection 5.2.4 of this Agreement in the next Fiscal Year.

5.5 Repayment of overpayment

• 5.5.1 In the event payments made exceed the amount to which Alberta 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, Alberta shall repay the amount within sixty (60) calendar days of written notice from Canada.
• 5.5.2 Funds not spent within the Term of the Agreement will be considered a debt due to Canada and Alberta shall repay the amount within sixty (60) calendar days of written notice from Canada.

5.6 Use of funds

• 5.6.1 The Parties agree that funds provided under this Agreement will only be used by Alberta in accordance with the initiatives outlined in Annex 4 (Action Plan).

5.7 Eligible expenditures

• 5.7.1 Eligible expenditures under this Agreement are the following:
  • data development and collection to support reporting;
  • information technology and health information infrastructure;
  • capital and operating funding;
  • salaries and benefits;
  • training, professional development; and
  • information and communications material related to programs.
• 5.7.2 The Parties agree that the long-term care funding may be provided to:
  • publicly-owned long-term care settings;
  • privately-owned not-for-profit long-term care settings; and
  • subject to section 6.0, privately-owned for-profit long-term care settings.

6.0 Accountability mechanisms for long-term care

6.1 Where federal funding is provided to privately-owned, for-profit facilities in accordance with this Agreement, Alberta agrees to put in place the accountability mechanisms outlined in Annex 4.

6.2 Where Alberta has cost-recovery agreements in place with one or more privately-owned for-profit facilities pursuant to subsection 6.1, Alberta agrees to report on these in accordance with the requirements set out in subsection 8.1.1 and invest all funds recovered through those agreements in accordance with the terms of this Agreement and the initiatives outlined in Annex 4.

7.0 Performance measurement

7.1 Alberta agrees to designate an official or official(s), for the duration of this Agreement to participate in a CIHI led Federal-Provincial-Territorial indicator process to:

1. Improve reporting on common indicators to measure pan-Canadian progress on improving access to home and community care, associated with the commitment in the Common Statement;
2. Work to develop new common indicators for long-term care that are mutually agreed upon; and
3. Share available disaggregated data with CIHI and work with CIHI to improve availability of disaggregated data for existing and new common indicators to enable reporting on progress for Indigenous peoples, First Nations, Inuit, Métis; and underserved and/or disadvantaged populations including, but not limited to, official language minority communities, rural and remote communities, children, racialized communities (including Black Canadians), and 2SLGBTQIA+.

8.0 Reporting to Canadians

8.1 Funding conditions and reporting

• 8.1.1 By no later than October 1, in each Fiscal Year, in respect of the previous Fiscal Year, Alberta agrees to:
  1. Provide data and information annually to CIHI related to the home and community care common indicators (listed in Annex 3) identified as part of the commitment made in the Common Statement and new common indicators on long-term care that are mutually agreed upon.
  2. Beginning in Fiscal Year 2024-25, report annually and publicly in an integrated manner to residents of Alberta on progress made on targets outlined in Annex 4.
  3. Beginning in Fiscal Year 2024-25, provide to Canada an annual financial statement, with attestation from Alberta's senior financial officer for Alberta Health 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:
     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 long-term care;
     3. If applicable, the amount of any funding carried forward under section 5.4;
     4. If applicable, the amount of overpayment that is to be repaid to Canada under section 5.5; and
     5. With respect to the long-term care funding under this Agreement, where cost-recovery is used, the annual financial statement will also set out:
        1. The amount of the federal funding flowing to private, for-profit facilities; and
        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.
• 8.1.2 Alberta will provide quarterly reporting to Canada on the management and spending of the funds retained to the next Fiscal Year.

8.2 Audit

• 8.2.1 Alberta will ensure that expenditure information presented in the annual financial statement is, in accordance with Alberta's standard accounting practices, complete and accurate.

8.3 Evaluation

• 8.3.1 Responsibility for evaluation of programs rests with Alberta in accordance with its own evaluation policies and practices.

9.0 Communications

9.1 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.

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

9.3 In the spirit of transparency and open government, Canada will make this Agreement, including any amendments, publicly available on a Government of Canada website.

9.4 Alberta will make publicly available, clearly identified on a Government of Alberta website, this Agreement, including any amendments.

9.5 Canada, with prior notice to Alberta, may incorporate all or any part of the data and information in 8.1, or any part of evaluation and audit reports made public by Alberta 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.

9.6 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 Alberta 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.

9.7 Alberta reserves the right to conduct public communications, announcements, events, outreach and promotional activities about the Common Statement and this Agreement. Alberta 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.

9.8 Canada and Alberta agree to participate in a joint announcement upon signing of this Agreement.

9.9 Canada and Alberta agree to work together to identify mutually agreeable opportunities for joint announcements relating to programs funded under this Agreement.

10.0 Dispute resolution

10.1 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.

10.2 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.

10.3 If a dispute cannot be resolved by Designated Officials, then the dispute will be referred to the Deputy Ministers of Canada responsible for health and to Alberta's Deputy Minister responsible for health, and if it cannot be resolved by them, then the federal Minister(s) and the provincial Minister shall endeavour to resolve the dispute.

11.0 Amendments to the agreement

11.1 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 Alberta, by the provincial Minister(s).

11.2 Annex 4 may be amended at any time by mutual consent of the Parties. Any amendments to Annex 4 shall be in writing and signed by each Party's Designated Official.

12.0 Termination

12.1 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.

12.2 As of the effective date of termination of this Agreement, Canada shall have no obligation to make any further payments.

12.3 Sections 1.0 and 9.0 of this Agreement survive for the period of the 10-year Working Together to Improve Health Care for Canadians plan.

12.4 Sections 5.4 and 8.0 of this Agreement survive the termination or expiration of this Agreement until reporting obligations are completed.

13.0 Notice

13.1 Any notice, information, or document provided for under this Agreement will be effectively given if delivered or sent by letter, 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 of the Designated Official for Canada shall be:

Assistant Deputy Minister, Strategic Policy Branch

Health Canada
70 Colombine Driveway
Brooke Claxton Building
Ottawa, Ontario
K1A 0K9
Email: jocelyne.voisin@hc-sc.gc.ca

The address of the Designated Officials for Alberta shall be:

Assistant Deputy Minister, Continuing Care

Alberta Health
18^th Floor, ATB Place North Tower
10025 Jasper Avenue NW
Edmonton, AB
T5J 1S6
Email: corinne.schalm@gov.ab.ca

14.0 General

14.1 This Agreement, including Annexes, comprises the entire Agreement entered into by the Parties.

14.2 This Agreement shall be governed by and interpreted in accordance with the laws of Canada and Alberta.

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

14.4 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.

14.5 This Agreement may be executed in counterparts, in which case (i) the Parties have caused this Agreement to be duly signed by the undersigned authorized representatives in separate signature pages in accordance with the following signature process, which together shall constitute one agreement, and (ii) the Parties agree that facsimile signature(s) and signature(s) transmitted by PDF shall be treated as original signature(s). Electronic signature(s) may be accepted as originals so long as the source of the transmission can be reasonably connected to the signatory.

IN WITNESS WHEREOF the Parties have executed this Agreement through duly authorized representatives.

SIGNED on behalf of Canada by the Minister of Health

The Honourable Mark Holland, Minister of Health

IN WITNESS WHEREOF the Parties have executed this Agreement through duly authorized representatives.

SIGNED on behalf of Alberta by the Minister of Health

The Honourable Adriana LaGrange, Minister of Health

IN WITNESS WHEREOF the Parties have executed this Agreement through duly authorized representatives.

Approved pursuant to Alberta's Government Organization Act:
Intergovernmental Relations, Executive Council

Annex 1 – Common Statement of Principles on Shared Health Priorities

Common Statement of Principles on Shared Health Priorities

Annex 2 – Shared pan-Canadian interoperability roadmap

Figure 1: Text description

5-Year Shared Pan-Canadian Interoperability Roadmap

The Roadmap outlines 8 categories of activities planned for fiscal years 2023 to 2027, followed by anticipated outcomes enabled. Notes are also included throughout to highlight a "milestone", where "vendor input is required", and/or when an activity is "continued" across multiple fiscal years.

Patient Summary

• Fiscal Year 2023
  • Alberta & Ontario Trial Implementation & onboard 2-3 Jurisdictions
  • Update based on Trial Implementations
  • Update and publish the Canadian Health Data Exchange (CA:FeX) Specification
• Fiscal Year 2024
  • Update specification to fully align to IPS/CA Core+ and reflect implementation feedback
  • Onboard remaining jurisdictions
  • Publish vendor conformance requirements and represent in national procurements [vendor input required]
• Fiscal Year 2025
  • Advance implementation and adoption
  • Pan-Canadian vendor compliance service *(Pan-Canadian interoperability compliance testing service in place, vendors conform to pan-Canadian standards in stages.) [vendor input required]
• Fiscal Year 2026
  • Advance implementation and adoption [continued]
  • Conduct performance evaluation
  • Update specification to reflect updated CA Core+ [milestone]
• Fiscal Year 2027
  • Advance implementation and adoption [continued]
  • Conduct performance evaluation [continued]

Data Portability

• Fiscal Year 2023
  • Develop Primary Care Dataset V1 & EMR Extract Specification V1 [milestone]
  • Represent Data Portability components in the Canadian Health Data Exchange (CA:FeX) Specification
• Fiscal Year 2024
  • Trial Implementation of specifications
  • Extend CA Core+ to include other settings (e.g. Acute Care, Mental Health)
• Fiscal Year 2025
  • Expand adoption and refinement to include LTC, Community Care and implementation feedback
  • Include requirements in national procurements (e.g. Acute Care, LTC, Mental Health, Community Care)
• Fiscal Year 2026
  • Expand adoption of Specifications
  • Complete specifications [milestone]
  • Pan-Canadian vendor compliance service *(Pan-Canadian interoperability compliance testing service in place, vendors conform to pan-Canadian standards in stages.) [vendor input required]
  • Conduct performance evaluation
• Fiscal Year 2027
  • Expand adoption of Specifications [continued]
  • Conduct performance evaluation [continued]

Patient Access

• Fiscal Year 2023
  • Assess patient data and access needs across jurisdictions
  • Assess the feasibility of IPA standard and decide on Canadian adoption of same
• Fiscal Year 2024
  • Co-design patient data access design/Blueprint to represent policy and consent in alignment with IPA
  • Implementation and refinement of the Canadian Health Data Exchange Specification to include Patient Access components [milestone]
• Fiscal Year 2025
  • Update data exchange specification to support patient Digital Identities
  • Expand adoption of Canadian Health Data Exchange Specification
• Fiscal Year 2026
  • Develop pan-Canadian guidance documentation for basic digital consent
  • Expand adoption of Canadian Health Data Exchange Specification [continued]
  • Conduct performance evaluation
• Fiscal Year 2027
  • Develop advanced guidance documentation to integrate policy and consent into data access
  • Expand adoption of Canadian Health Data Exchange Specification [continued]
  • Conduct performance evaluation [continued]

eReferral & eConsult

• Fiscal Year 2023
  • Consolidate existing specifications and publish pan-Canadian specification with procurement requirements [milestone]
• Fiscal Year 2024
  • Publish conformance requirements for vendors [vendor input required]
  • Implementation of pan-Canadian specifications
• Fiscal Year 2025
  • Evolve specification to integrate other services (e.g. PS-CA. Provider Directories and Digital Identities)
  • Pan-Canadian vendor compliance service *(Pan-Canadian interoperability compliance testing service in place, vendors conform to pan-Canadian standards in stages.) [vendor input required]
• Fiscal Year 2026
  • Complete Specification [milestone]
  • Conduct performance evaluation [continued]
• Fiscal Year 2027
  • Conduct performance evaluation [continued]

Enablers

• Fiscal Years 2023 to 2027
  • Governance
  • Change Management
  • Vendor Mobilization

Data

• Fiscal Year 2023
  • p-CHDCF, CA Core+ and Consistent Data Semantics
  • Data Matching
• Fiscal Year 2024
  • p-CHDCF, CA Core+ and Consistent Data Semantics [continued]
  • Data Matching [continued]
• Fiscal Year 2025
  • p-CHDCF, CA Core+ and Consistent Data Semantics [continued]
  • Data Matching [continued]
• Fiscal Year 2026
  • p-CHDCF, CA Core+ and Consistent Data Semantics [continued]
• Fiscal Year 2027
  • N/A

Access & Exchange

• Fiscal Year 2023
  • Consistent, Secure, HIE Exchange
  • Healthcare Directories and Resource Locations
• Fiscal Year 2024
  • Consistent, Secure, HIE Exchange [continued]
  • Provider Directories
  • Digital Identities & Identity Proofing
  • Healthcare Directories and Resource Locations [continued]
• Fiscal Year 2025
  • Consistent, Secure, HIE Exchange [continued]
  • Provider Directories [continued]
  • Digital Identities & Identity Proofing [continued]
  • Healthcare Directories and Resource Locations [continued]
• Fiscal Year 2026
  • Consistent, Secure, HIE Exchange [continued]
  • Provider Directories [continued]
  • Digital Identities & Identity Proofing [continued]
  • Consistent Patient Access
  • Healthcare Directories and Resource Locations [continued]
• Fiscal Year 2027
  • Consistent, Secure, HIE Exchange [continued]
  • Consistent Patient Access [continued]

Trusted Framework

• Fiscal Year 2023
  • Jurisdictional Needs Assessment [milestone]
  • Scalable Data Sharing Governance Framework
  • Industry-wide, Testing and Conformance
• Fiscal Year 2024
  • TEF development (contingent on PT support)
  • Scalable Data Sharing Governance Framework [continued]
  • Industry-wide, Testing and Conformance [continued]
• Fiscal Year 2025
  • Consistent Representation of Policy & Consent
  • Scalable Data Sharing Governance Framework [continued]
  • Industry-wide, Testing and Conformance [continued]
• Fiscal Year 2026
  • Consistent Representation of Policy & Consent [continued]
  • Scalable Data Sharing Governance Framework [continued]
  • Industry-wide, Testing and Conformance [continued]
• Fiscal Year 2027
  • Consistent Representation of Policy & Consent [continued]
  • Scalable Data Sharing Governance Framework [continued]
  • Industry-wide, Testing and Conformance [continued]

Outcomes

• Ability to import/export primary care data to, from and between EMRs
• Clinicians able to change EMRs
• Governance model established
• Vendor support services available to all jurisdictions
• National procurement framework established
• Change management program in place
• 50% of Canadians enabled to directly access their longitudinal record
• 60% of primary care physicians reporting ability to exchange patient summary record
• 70% of clinicians with EMRs enabled to send clinical summaries through a vendor conformed solution
• 75% of Canadians enabled to access their patient summary record
• Benefits realized:
  • Health System – $500M in improved interactions, effective use of ED, in-patient services, an reduction in duplicate tests
  • Canadians – over $500M in saved patient time
  • Clinicians – over $350M in saved time

Annex 3 – Indicators: Access to home and community care

Indicator

• Death at home or in community (Percentage)
• Home care services helped the recipient stay at home (Percentage)
• Wait times for home care services (Median, in days)
• Caregiver distress (Percentage)
• New long-term care residents who potentially could have been cared for at home (Percentage)
• Hospital stay extended until home care services or supports ready (Median, in days)

Annex 4 – Action plan

Working Together to Improve Health Care for Canadians: Alberta Action Plan - Aging with Dignity

Introduction of Home and Community Care and Continuing Care Homes

The Government of Alberta is committed to a stable, accountable, high quality, and person-centered health system that emphasizes staying healthy and well, while also supporting equitable access to required care when needed. The Government of Alberta continues to prioritize strengthening the continuing care system in order to meet the increasing demand for continuing care in a more sustainable way and to ensure the needs and desires of Albertans are met. We are also committed to reducing the gap in health outcomes between Indigenous and non-Indigenous peoples through collaborative program design and delivery.

As the population increases and demographics change, the demand for health services in Alberta continues to grow. There is an increased need for continuing care services, including both home and community care and facility-based continuing care services. Currently, about 16% of Alberta's population is age 65 or older. By 2046, this population is projected to exceed 1.2 million, representing one in five, or 20% of Albertans. Alberta's demand for continuing care services is projected to increase by 80% over the next 10 years.

To help Albertans remain independent and active in their communities as they age or as their needs change, Alberta is shifting focus towards increasing community-based care to support seniors and those living with disabilities to stay in their homes longer, particularly in rural areas. Doing so meets the expressed desire of Albertans to remain in their homes as they age. However, for those who require facility-based care, resident quality of life and care remains an utmost priority. Supporting both home and community care, as well as facility-based care, requires investments in the continuing care workforce to ensure that the workforce needed is available and supported.

Alberta's continuing care system offers a spectrum of health and personal care services and accommodation settings to support safety, independence, and quality of life for Albertans of any age. Eligibility for publicly funded health care services is based on a professional assessment of a person's care needs. Any Albertan can receive continuing care services, no matter their age, diagnosis, or the length of time they need support. Continuing care services include assistance with dressing, eating, bathing, respite, wound care, medication administration, and various other health care and support services.

In Alberta, continuing care includes home and community care, continuing care homes (long-term care and designated supportive living accommodations), and palliative and end-of-life care.

• In 2022/23, 127,000 Albertans received services from the home care program.^{Footnote 1}
• Of these 127,000 clients, approximately 76% were seniors, and 24% were children and adults under the age of 65.^{Footnote 2}
• As of March 31, 2023, there were 28,863 continuing care home spaces in Alberta.^{Footnote 3}
• In 2022/23, 9% of residents in Alberta's long-term care facilities (nursing homes and auxiliary hospitals) were under 65 years of age, while 76% were 75 years of age or older.^{Footnote 4}

Alberta's publicly funded continuing care system has a mixed model of publicly and privately operated (both for-profit and not-for-profit) continuing care providers. As of March 31, 2023, Alberta Health Services (AHS) operated 29% (107) of the continuing care home sites, not-for-profit organizations operated 36.7% (137) of the sites, and for-profit organizations operated 34.3% (128) of the sites.^{Footnote 5}

Continuing care homes are governed by several pieces of legislation, which include the Nursing Homes Act, the Hospitals Act, the Supportive Living Accommodation Licensing Act and subsequent standards that operators must comply with, including:

• Supportive Living Accommodation Standards – Set requirements for operators in the delivery of quality accommodation services to residents of all licensed supportive living accommodations (including designated supportive living).
• Long-Term Care Accommodation Standards – Set requirements in the delivery of quality accommodation services to residents of all long-term care facilities (including nursing homes and auxiliary hospitals).
• Continuing Care Health Service Standards – Apply to all publicly funded health and personal care services provided to continuing care clients in home and community care and continuing care homes and set minimum requirements for the provision of health care.

The Government of Alberta monitors all licensed supportive living and long-term care accommodations at least annually to verify their compliance to the Accommodation Standards. The Government of Alberta investigates complaints related to the Accommodation Standards as required. Additionally, AHS and Alberta Health regularly audit compliance of continuing care homes and home care (by inspecting AHS Home Care offices and some contracted providers) to the Continuing Care Health Services Standards. Public reporting on continuing care homes' compliance to standards is posted online.

The Government of Alberta is modernizing the provincial continuing care legislative framework to bring all existing continuing care legislation and regulations into a single framework while addressing gaps and barriers in the current legislation and regulations. The new Continuing Care Act is expected to be in effect on April 1, 2024, and will streamline legislation for the continuing care sector; enable improvements for continuing care residents and clients, their families, support staff, and operators; increase clarity regarding continuing care services; and support health system accountability and sustainability.

The Government of Alberta completed a comprehensive review of continuing care homes in 2021. The Facility-Based Continuing Care Review final report was released in May 2021, and includes 42 recommendations for system-wide improvements that will benefit residents and families, improve the work environment for staff, and increase system sustainability. Alberta has already implemented several recommendations including improving public reporting on continuing care inspections; phasing out ward rooms in facility-based continuing care; allocating capital grant funding to support Indigenous communities and organizations; and expanding access to client-directed home care. Actions to implement recommendations will continue for several years to come, particularly in the areas of: increased community-based services and supports to ensure Albertans receive the care they need to age in place; enhanced workforce capacity and supports to meet client and resident needs; increased choices for clients and residents; enhanced innovation amongst care providers and operators; and enhanced quality across the continuing care system. To this end, in Budget 2023, the Government of Alberta invested $1 billion over three years to initiate transformation of the continuing care system.

The Office of the Auditor General released its findings on the Government's response to COVID-19 in Continuing Care Facilities in February 2023. Aligned with continuing care transformation, the findings provide the Government of Alberta additional information on ways to provide Albertans with more choices of continuing care services, with a focus on increasing care services and supports, improving pandemic preparedness, increasing workforce resilience, and improving facility infrastructure.

Areas of Action

This Action Plan supports the commitment to the bilateral agreement structure. Initiatives described in this action plan represent incremental investments in areas that align with the Government of Alberta and federal government's shared commitment to help Albertans age with dignity, closer to home, with access to home care or care in a safe long-term care facility.

The Action Plan is designed to ensure Alberta has maximum flexibility to adapt its approach to reflect the evolving needs of Albertans. Should Albertans provide new direction, the Government of Alberta will work with Health Canada under the terms of the agreement to pursue new, revised, or enhanced initiatives that align with the shared priorities as necessary.

Home and Community Care

Context of Home and Community Care

Alberta's Home Care Program offers an array of health and support services to Albertans of all ages in their own homes and communities. Home care is designed to support the wellness and independence of clients within a wide range of settings including private homes or apartments, community settings and congregate living facilities (e.g., seniors' lodges, supportive living facilities). In Alberta, home care service delivery is flexible to reflect the unique needs of clients, families, and healthcare staff. Flexibility is considered as part of the home care intake processes and services that may be adjusted as needed to support clients and families with diverse needs of language, culture, level of education, lifestyle, and complex care needs.

In 2020/21, provincial funding of $20 million was committed to improving access to palliative and end-of-life care for Albertans and their families.^{Footnote 6} The Government of Alberta also invested approximately $2 million in health- and community-based partners for initiatives to support Albertans living with dementia.^{Footnote 7} Furthermore, in 2021/22, provincial funding was used to support targeted COVID-19 initiatives including funding for personal protective equipment and additional cleaning supplies, as well as $12 million to support wage increases for home care agencies contracted with AHS to help retain and recruit additional staff.^{Footnote 8} The additional funding provided a pay increase of $2 an hour for health-care aides working in home care agencies contracted with Alberta Health Services.^{Footnote 9} Federal funding from 2017/18 – 2022/23 complemented provincial efforts to improve Alberta's existing home and community care programs and services and helped to scale and spread innovative initiatives over the past six years in areas such as home support services and provision of medical supplies and equipment, caregiver respite, adult day programs, and palliative and end-of-life care.

To further support Alberta's shift towards improved home and community-based care, Alberta's Budget 2023 included an investment of $893 million, an increase of $149 million or 20% from 2022/23, to support a shift to home and community care from facility-based care. This investment includes increasing the number of home care hours provided and the number of unique/individual clients served. Alberta continues to invest in improved access for palliative and end-of-life care in the community, supporting Albertans to remain in their communities through increased investment in palliative-focused home care and increased community hospice capacity.

The funding provided through this Agreement will complement Alberta's investments to have increased choice and flexibility about how to receive the care services they require to age in place. As well, the funding will enhance supports for the home and community care workforce and caregivers, as they are both critical enablers to aging in place.

Description of Home and Community Care Initiatives Supported by Federal Funding

Priority 1: Spreading and scaling evidence-based models of home and community care that are more integrated and connected with primary health care

• 1. Enhanced home and community care capacity

  Description: This initiative will focus on supporting the delivery of enhanced home care services accessible by all Albertans regardless of where they reside in the province. This will include increasing the standardized basket of home and community care services for long-term home care clients; increasing hours of home and community care, particularly in rural and remote areas; and providing more intensive services, restorative care, and team-based care for clients with complex care needs. Examples of initiatives include offering more client-directed funding options (e.g., an approach whereby clients choose an eligible home care provider to deliver personal care services, which enables greater client control over scheduling and directing their care while minimizing administrative responsibilities and financial burdens), coordination and integration with primary care services, and offering in-person and/or virtual resource hub options for clients to connect with diverse health and non-health professionals and community service providers to advance health outcomes and enhance quality of life while aging in the community.

  The target population for this initiative is Albertans requiring home and community care services, particularly those in rural and remote areas of the province (including Indigenous communities), and those with complex care needs, who have been historically under-served. More intensive and restorative services will target clients at risk for hospitalization, and support clients to return safely to community more quickly after hospitalization.

  Expected outcomes: This initiative will enable a larger proportion of individuals to receive care and support within their homes and communities rather than in higher cost hospitals or facility-based continuing care. Fewer people will be assessed for facility-based continuing care while in hospital, and more people will be supported to return home and given a chance to rehabilitate prior to being assessed for facility-based continuing care. Enhanced integration with primary care will establish increased coordination of professional and non-professional supports to enable aging in the community, while minimizing the need for emergency department visits.

Priority 2: Enhancing access to palliative and end-of-life care at home or in hospice

• 2. Enhanced palliative and end-of-life care

  Description: This initiative will include investments in enhancing palliative and end-of-life care services for home care clients to live comfortably in their preferred location for longer or die at home. This initiative will also focus on the scale and spread of palliative and end-of-life services, such as complex symptom assessment and management, coordination of care, specialized direct care, psychosocial supports, and planning for preferred place of death. As well, this initiative will contribute to increased palliative and end-of-life care spaces in home and hospice, expanding these services for clients in alignment with their goals of care. Making hospice spaces available across the province would improve the quality of life for people in their final stages of their lives.

  Expected outcomes: This initiative will increase community-based supports, which will increase the number of Albertans who are receiving appropriate and timely palliative and end-of-life care supports in settings other than acute care, whether that is in their home and communities, through home care or in continuing care homes, such as residential hospices.

Priority 3: Increasing support for caregivers

• 3. Expanded caregiver supports

  Description: This initiative will focus on investments to enhance caregiver supports, including building awareness of caregivers' roles, increasing capacity for expanding caregiver and client programming availability, and training for caregivers. This initiative also includes increasing in-home respite service hours, improving access to temporary respite stays in facility-based care, as well as expanding community day programming to offer goal-oriented social and recreation activities, exercise, health monitoring and assistance to support client needs. Caregiver supports may include specific resources and programming for caretakers of those with dementia and complex needs, including embedding dementia expertise and dementia related caregiver supports into primary health care teams to better connect caregivers to services prior to caregiver burnout arising or the development of crisis situations. Additionally, this initiative may support the expanded reach of caregiver organizations in rural areas, and enabling culturally appropriate and supportive resources in cultural communities, including Indigenous communities.

  Expected outcomes: As the population ages, the demand for caregivers continues to grow. Alberta intends to utilize federal funding to support caregivers and the valuable work they do to support their loved ones to remain in their community. This initiative will enhance caregivers' well-being through increased respite, training, and other supports. It is also anticipated that this initiative will strengthen integration between community-based seniors' organizations and caregivers to support improved caregiver well-being.

Priority 4: Enhancing home care infrastructure

• 4. a. Expanded use of remote devices, virtual technologies, and information technologies

  Description: This initiative will focus on investments for expanding the scale of available remote devices (e.g. digital tools to monitor and manage vital signs, telehealthcare, remote health monitoring devices, and smartphone applications), virtual technologies (e.g. Hospital at Home digital and virtual care hospital discharge planning solutions), and information technologies (e.g. predictive analytic technologies, chronic disease management registry, and digital access to patient navigation, social prescribing services and health records). These investments will enable client independence for Albertans receiving home and community care, particularly those in rural and remote areas, to age in one's community for as long as possible.

  Expected outcomes: This initiative will better connect clients receiving care at home or in the community with essential health professional and non-professional services through investments in digital health care.

• 4. b. Expanded non-medical supports

  Description: This initiative will focus on expanded investments in social prescribing for Albertans, including seniors, and particularly for those living in rural and remote areas. Investments will focus on intervention and direct services of housekeeping and meal assistance, assisted transportation, enabled social connection (including peer and intergenerational activities), help in navigating the health system, and case co-ordination for individuals with complex care needs. Investments will support in reducing barriers, such as language and/or cultural barriers and service location, which prevent people from accessing the non-medical supports they may need to remain at home or in the community safely. Additionally, investments may be used to support a workforce analysis of the community-based senior serving sector to ensure community organization resource capacity and integration with healthcare providers that enable effective wrap around care services.

  Expected outcomes: This initiative will enable community-based organizations resources to support complex care clients to age in their community.

• 4. c. Residential access modification program (RAMP) enhancement

  Description: This initiative will focus on enhancements for residential access modification programming availability for low-income Albertans of any age living with mobility challenges due to specific diagnoses, including progressive neuro-degenerative diseases, who reside in their owned or rental home. Current funding of up to $7,500 per person each benefit year and up to $15,000 per person within ten years is available for eligible Albertans to modify the interior and/or exterior of their home to remain living safely in their own homes. Modifications include but are not limited to: purchase/installation of hand rails, porch lifts, and wheelchair ramps; purchase/installation of bathroom fixtures; and widening of doorways and entrance hallways to support safe and comfortable mobility. Federal funding may support increased maximum grant funding available per client for residential modifications and/or additional eligible clients served.

  Expected outcomes: This initiative will expand programming availability for clients receiving residential access modifications to support aging in their community.

Continuing Care Homes

Context of Continuing Care Homes

Alberta's continuing care homes include long-term care and designated supportive living accommodations. Long-term care (which includes nursing homes and auxiliary hospitals) is provided for Albertans with complex medical needs who are unable to remain safely at home or in a supportive living setting. In long-term care, residents receive accommodation, meals, and publicly funded 24-hour on-site professional health services and personal care. Designated supportive living settings are a community-based living option where publicly funded 24-hour on-site professional health services and personal care are provided for Albertans who are no longer able to live independently, however, can have their care needs met without complex intervention.

Access to continuing care homes is determined based on a client's assessed care needs. Those that are admitted to continuing care homes reflect diverse communities, including rural Albertans, multicultural communities, and Indigenous communities. Continuing care home operators are committed to ensuring that accommodations may provide residents with inclusiveness and recognition of individual religious practices, cultural customs, and language needs. Operators are also committed to empowering a continuing care workforce that is diverse, ensuring that culturally competent care is provided for resident quality of care and wellbeing.

The Government of Alberta continues to prioritize improvements in facility-based continuing care. In Budget 2023, the Government of Alberta invested $1.4 billion for continuing care homes, an increase of $120 million or 9.4% from 2022/23. This investment supports increased average hours of care provided to continuing care home residents, enabling more person-centred care. This is expected to result in increasing quality of life and care for residents. As well, Alberta is investing significant capital funding to meet the rising needs of Alberta's aging population by modernizing existing continuing care spaces, developing culturally appropriate spaces to support Indigenous groups, creating small care homes, and adding new spaces in priority areas with the greatest needs. Furthermore, the Government of Alberta is supporting a strong and resilient continuing care workforce through targeted investments in recruitment and retention, and mental health supports.

The funding provided through this Agreement will complement Alberta's investments to improve quality of life and person-centred care for all continuing care home residents, increase resident care choices and improve coordination of assessed health service needs, increase direct hours of care, and improve workplace conditions and wellness supports for staff. The funding will also support Alberta's efforts to enhance compliance and monitoring capacity as well as the implementation of quality-of-care best practices and standards.

Description of Continuing Care Homes Initiatives Supported by Federal Funding

Priority 1: Workforce

• 1. a. Expansion of continuing care workforce education, training, development, engagement, and data collection

  Description: This initiative will provide funding to expand alternative education pathways and provide supports and paid practicums for health care aide students. Investments will support the recruitment of health care aides and reduce barriers to health care aide education, including but not limited to financial, geographic, and language barriers (i.e., for those who speak English as a second language). Specific programming may be developed for historically under-served populations (e.g., newcomers, English language learners, rural students, and Indigenous learners). This initiative will also provide funding to support continuing care workforce training and development, including but not limited to additional formal education opportunities, specialty courses, innovative delivery methods, mentorship programming, and front-line management and leadership training.

  These investments will build staff capacity at all levels, giving staff additional tools to provide high-quality care to clients/residents. As part of this initiative, Alberta aims to further engage the workforce and collect both quantitative and qualitative data on the home and community care and continuing care workforce. Investments will support a better understanding of workforce demographics and experiences, including challenges and areas of opportunity for strengthening workforce recruitment and retention best practices, and supporting the development of current and future health care leaders.

  Expected outcomes: This initiative will reduce barriers to recruitment and retention for health care aides and ultimately increase the supply of health care aides in Alberta. It is anticipated that this initiative will expand access to workforce training and development opportunities, including leadership training. Further, this initiative will help inform future workforce recruitment and retention interventions and workforce equity, diversity, and inclusion goals.

• 1. b. Continuing care workforce mental health supports

  Description: This initiative will expand investments that have been informed by input of continuing care workers to support the mental health of home and community care and continuing care home workers. This includes potential investments in psychological supports, spiritual care (including Indigenous Elders), peer support programming, trauma-informed care training, and staff recognition. Investments in these areas will better support the health and well-being of continuing care workers, including Indigenous and new Canadians, to aid in optimal organizational performance and support improved client and resident outcomes.

  Expected outcomes: This initiative will improve the mental health and well-being of the continuing care workforce, contribute to better work environments, and improve staff retention.

• 1. c. Rural continuing care workforce capacity development

  Description: This initiative will focus on supporting investments in recruitment and retention in difficult-to-recruit continuing care sites, programs, and positions in the rural and remote areas in Alberta. Stakeholder input and analysis is underway and will inform actions to target local challenges and workers' needs, including needs of Indigenous workers and communities. Investments will be informed by Alberta's Health Workforce Strategy, and may include: development of rural-specific funding models (e.g. increased funding to cover higher wages and/or increased full-time equivalents in rural areas), targeted recruitment of new staff (e.g., through bonuses and return-of-service commitments), initiatives to support staff retention (e.g. retention incentives), addressing site/program-specific concerns of vacancy rates (e.g., staff vacancy due to child-care obligations), and supporting rural mentorship(e.g. funding to support informal mentorship programs and more rural preceptors).

  Expected outcomes: This initiative will enable recruitment in areas of priority need, including enabling recruitment of new staff, addressing site/program specific concerns, or broader recruitment and retention challenges for the employer/sector.

Priority 2: Compliance and enforcement of quality and safety

• 2. a. Enhanced compliance and monitoring capacity

  Description: This initiative will focus on enhancing regular and robust inspection and monitoring of continuing care homes, enhancing structures for residents/clients to file care complaints, minimizing complaint response times, and enhancing responses to complaints/concerns. Activities will include increasing staff resourcing and increasing caseloads to support increased frequency of inspections and timely complaints handling as continuing care homes are currently audited every four years, which could be reduced to 18 months. This is a positive change of approach as this will create an environment where inspectors are actively engaging with and supporting operators. The increase of frequency would also support operators and providers to take necessary action to address non-compliances in a timely manner. This will promote safety, security and well-being of residents/clients. Activities will also include the development of surveys to complainants and continuing care operators to gather information about their experiences, including for rural operators and operators of continuing care homes that are located on First Nation reserves and/or serve indigenous communities. As well, this initiative will support increasing resources in compliance monitoring that will support education for operators in awareness of continuing care standards and legislative requirements, strengthening performance measure reporting, and identification of trends for system level improvements in continuing care.

  Expected outcomes: This initiative will support a regular and robust inspection and monitoring program of continuing care homes to ensure that clients receive quality accommodation and care services. Activities will enhance public trust, improve the quality of public reporting on operators' performance, and improve overall client satisfaction with the continuing care system.

• 2. b. Enhanced quality of life best practices and initiatives

  Description: This initiative will focus on investments to implement best practices designed to improve quality of life for home and community care clients, as well as continuing care home residents. This initiative will enable investments in operators' adoption of quality of life and care best practices (including but not limited to those linked with accreditation processes), including trauma-informed and culturally competent approaches to care to better address the needs of those served by continuing care. It will also advance quality of life activities within continuing care homes, which may include supporting scale and spread of proven/impactful quality of life initiatives (e.g., initiatives that may have already been shown to have a positive impact within Alberta continuing care homes through funded grants or other provincial initiatives), or that may be identified as promising through research and evidence (i.e., from other jurisdictions). This initiative will also support advancing quality of life activities and/or by potentially enabling a grant call for operators to identify quality of life initiatives anticipated to have positive impact. Further, this initiative will support improvements in quality of life and activity impact, as within whatever mechanism used to implement the initiative(s) (i.e. grants or other implementation method). The success and impact of the implementation will be assessed, which is expected to include the use of standardized quality of life and/or quality of care measures relevant to the objective of the initiative.

  Expected outcomes: This initiative will advance continuing care client well-being through the implementation of quality of life and care best practices, initiatives, and measurement.

• 2. c. Continuing care home equipment, technology, and training

  Description: This initiative will focus on increasing investments for operators to gain new capital equipment (e.g., beds and lifts) and modernize aging equipment to support clients/residents in meeting their assessed care needs. This initiative may also focus on investments for operators, including particularly rural operators, to adopt expanded technology infrastructure to support client/resident accessibility to meaningful activities. As well, this initiative will include targeted staff training opportunities to support effective use of infrastructure.

  Expected outcomes: This initiative will support expansion of continuing care capital equipment and technology to support operators in meeting assessed client needs, including staff training supports to utilize the capital equipment and technology effectively and safely.

• 2. d. Continuing care homes operational and capital investments

  Description: This initiative will support continuing care home residents' safety and quality of care by addressing critical operational challenges that impact operators' ability to maintain appropriate hours of care. Continuing care homes play an essential role in providing accommodations and/or a variety of health and personal care services designed to meet the assessed needs of some of Alberta's most vulnerable populations, including those with complex health care needs. It is necessary that continuing care homes have adequate supports and remain open to ensure residents receive safe, quality care in an appropriate setting.

  Some operators in Alberta are expressing challenges in being able to provide adequate levels of care to their residents, as required in legislation, or are at risk of closure due to increasing costs in staffing, and ongoing operations. For example, in order to meet minimum staffing requirements of an on-site Registered Nurse 24/7, and to ensure safe, quality care is provided, operators have had to rely on staffing agencies to supply their workforce, which has additional costs to the operator. This issue is most predominant in rural Alberta. Supporting operators to ensure they can continue to provide safe, quality care, will avoid disruptions to client care and protect against unnecessary visits to emergency rooms.

  The federal funding will be used to provide grant funding for operators, to ensure they can afford to remain open and continue to meet legislative requirements and provide safe, quality care to their residents.

  Furthermore, this initiative may include expanding operational funding supports for operators of small care homes in small, rural and remote communities that serve populations with complex health needs that are underserved by current housing options (e.g., people with dementia, young adults living with disabilities, and people experiencing mental health and addictions issues). Operational funding may be used to ensure sustainability of care services provided to clients in small care homes by maintaining hours of care by staff that require high training and skill complements to address complex client needs.

  Expected outcomes: This initiative will support continuing care home resident quality of life by ensuring that operators are able to maintain an appropriate amount of care hours.

Funding Allocations

Accountability Measures

• Funding will be provided based on agreed upon eligible costs for inputs needed to provide the desired outcomes.
• Appropriate use of funds will be confirmed using existing tools such as the Financial Information and Management Reporting tool, grant agreements, attestations, and Alberta's right to conduct audits.
• Where funds are recovered, they will be redirected in line with initiatives outlined in this action plan.

Reporting on Results