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What can be found on our website www.FNSDS.org?
The FNSD Resource Centre Library
 The Online SA Manual
 Downloadable and fillable IA Forms
 Board Info, BSDW & INAC contact lists
Publications
 FNSDS Newsletters and job postings
BSDW Training Info
 Training Programs Information, calendar and registration
information
 Power point presentations
PWD & MNS
 Program Information, Forms, Q’s and A’s
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CONTACT INFORMATION
PHONE: 604-983-9820
FAX: 604-983-9822
Melennia Point, Executive Director
Gina George, PWD Manager
PWD line
Tami Omeasoo, Program Officer
Chris Lechkobit, Program Officer
Chelsey George
Melennia@fnsds.org
Gina@fnsds.org
1-877-985-5565
Tami@fnsds.org
Chris@fnsds.org
Pwdadminasst@fnsds.org
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NON- MEDICAL SERVICE PROGRAMS
1 – Adult in Home Care
2 – Adult Institutional Care
3 – Family Care Home
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AANDC NATIONAL MANUAL
ASSISTED LIVING PROGRAM (AL)
Funded program to provide social support services to persons living
on reserve that require non-medical assistance with daily living
activities
1. Main Objective and Program Description
 1.1 Funding to meet the non-medical social support services
special needs of seniors, adult with chronic illness and children
and adults with disabilities (mental or physical) with the
objective of maintaining functional independence and greater
self-reliance.
 1.2 AL program is available to all persons residing on reserve or
are considered ordinary residence that have been assessed by
medical physician to require non-medical social support
services and who have no means to otherwise obtain these
services.
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3.1 FOUR MAJOR SERVICE COMPONENTS
1. In-Home Care – financial assistance for non-medical personal care
for adults that need assistance with daily living activities.
Services cover housekeeping, meal preparation and attendant
care to community supports (adult care, meals on wheels,
physic-social programs, short-term respite care for caregivers
and non-health transportation).
2. Adult Foster Care – funding for supervision and care for adults in a
family-like setting who do not require 24 hour care but are
unable to live on their own.
3. Institutional Care – reimburses for some expenses related to Type I
and II care in designated facilities for adults.
4. Assisted Living Disabilities Initiative – funding to First Nation
organizations for projects to improve the coordination and
accessibility of existing disability programs and services on
reserve. May include advocacy, public awareness or regional
workshops.
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2.1 ASSISTED LIVING PROGRAM
DEFINITIONS
 2.1.1 Continuing Care – range of holistic medical and social support
services for those who do not have, or who have lost some capacity to
care for themselves .
 2.1.2 Disabilities Initiative – AANDC initiative to fund projects to
improve coordination and accessibility of existing disability
programs and services on reserve such as advocacy, public awareness
or regional workshop
 2.1.3 Home Support – component of AL program that provides
homemaker services to help persons with daily living activities so
they can remain at home and remain independent
 2.1.4 Institutional Care – care provided in a care facility such as a
personal care home, elders lodge and supportive living home etc.
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ORDINARY RESIDENT ON RESERVE
 Lives at permanent address on-reserve more than 50% of time
 In case of children in joint custody, lives with parent more than
50% of time
 Does not have a primary residence off-reserve
 Is a person off-reserve for purpose of obtaining care not available
on reserve or who is off-reserve to access social services because
there is no reasonable comparable service available on-reserve
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INTENTION
 Assist clients to live at home as long as it is reasonable
and safe
 Supplement care, NOT to replace care provided by family
or other unpaid caregivers
 Promote independence and well-being of a client and
their family and other unpaid caregivers
 Provide short term respite care to family member or other
unpaid caregiver
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PHILOSOPHY
 Promote personal independence
 Promote personal and family responsibility in planning
and providing care
 Encourage family and community involvement in
providing care
 Encourage lifestyle consistent with community norms
 Work in partnership with other complementary programs
and services offered by other federal government
departments. Example: Veteran's Affairs, Health Canada
First Nation & Inuit Home And Community Care Program
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NATIONAL ELIGIBLE EXPENSES
 3.1 In-Home Care provides financial assistance for
non-medical personal care services.
Services may include (dependent on budget)
Meal programs, meal planning & preparation
Day programs
Attendant care
short-term respite care (defined by Province/Territory)
group care
laundry
ironing
mending
carrying water
carrying wood
home management
minor home repairs
non-medical transportation guide dogs
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ELIGIBILITY AND FUNDING
Capped Funding
 Once funds finished no more remain for fiscal year
Eligibility
 Client must be 19 or older
 Must be assessed (medical note is best)
 Financial means test required (income tax forms)
IA clients = no charge
Pensioner receiving Old Age Security = no charge
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PROCESS
8. Every 6
months BSDW
reviews
application and
may go through
steps 1 to 7 if
necessary
1. Request for
services
2. BSDW has
applicant fill in the
Application for
Homemaker
Services (901-38)file open
7. BSDW &
applicant
complete part IV
of Application
for Homemaker
Services (90138)
6. BSDW
completes part III
of Application for
Homemaker
Services (90138).
3. BSDW
contacts an
assessor to help
determine care
requirements
5. BSDW and
Assessor review
application and
make decision
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4. Assessor does
home visit- checks
to see if anyone in
family/community
can assist
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FILES
 Identification
 Medical request letter
 Income Tax Statement
 Homemaker Service form
901-38 signed and dated
 Homemaker Evaluation
form 901-30 signed and
dated
 Blank cover
 In Home Care Tracking
Payments form 901-31
 Homemakers schedule
 Case notes
 Copies of all
correspondence to client
 Do create a system to help
remind you when review
is due
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ROLES DEFINED
BSDW
ASSESSOR
 Monitor budget
 Report expenses on quarterly
report
 Monitor and approve hours (do
max at 40 per month- anymore
hours required = need to look at
care in a Institutional Care
facility)
 Ensure files are complete
 Monitor homemakers hours
 Keep case notes on file
 Do reviews every 6 months
 Meet with BSDW for
information
 Set up home visit
 Assess who in family or
community can provide
assistance and care
 Complete Homemaker
Evaluation form 901-30
 Meet with BSDW to determine
eligibility and services
 Repeat process every 6 months
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BILLING
 Do create a set charge for service
 Helps with report
 Assist in determining hours available each month
to helps stay within budget
 keep in mind must cover wages, MERC, travel and supplies
 Must pay workers at least minimum wage ($10.50 per hour)
 Report spending on Assisted Living Quarterly Report
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SERVICES AVAILABLE
 Light House Keeping (sweeping, mopping, vacuuming,
clean & tidy kitchen and bathroom)
 Meals (preparing food by cutting up meat and peeling and
dicing vegetables)
 Personal Care (cleaning & tidying bedroom, doing
personal laundry, monitoring their bath and cleaning &
tidying up bathroom)
 Other Services (travel to medical and/or specialist
appointments)
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OTHER SUPPORT SERVICES
Services limited to availability of budget and resources - Some
ideas for programs:










Counselling
Meals (luncheon program)
Psycho-social (socializing activities)
Non-medical transportation
Home maintenance (minor)
Companion care
Respite Care for caregivers
Social Assessment & Case Management Services
Coordination of volunteer & support group services
Services to support councils for seniors &/or Persons With Disabilities
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PROCEDURE FOR OTHER SERVICES
Contact AANDC Funding Service Officer to discuss reporting
requirements which may include:
 Type of SD program or service to be established
 Number clients served
 Program Management structure
 Number hours per type of service
 Number & training of service providers
 Budget for respective program or service
 Indicators of comparability with provincial programs
 Client profile
 Fee structure & financial eligibility
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IDEAS TO ENHANCE SERVICES
 Create a follow-up letter confirming approved services
and what are the rules for services (alcohol or drug
consumption = no service that day; not home = no service that
day)
 During home visits, do allow time to visit and socialize
 Create a list for homemaker describing services to
provide and any instructions client may have requested
 Create a notice card you can hang on door to let client
know worker was there but they were not home
 Create a notice for times when service my be temporarily
stopped due to holidays or sickness
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SORRY WE WILL BE CLOSED
Sorry we missed
you. Homemaker
_____________
was here at
_____________.
No one was home
at that time. we
will return at
your next
appointment.
Due to statutory holiday on _________,
office will be closed and services will be
cancelled that day. We will reopen on
_________ .
Please call so we at the Adult In Home
Care Program can set up another time to
ensure your needs are met.
Sincerely
Take care
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INTENTION
 To assist eligible residents living on reserve, who by
reason of incapacity, require placement in a licensed
Continuing Care Facility
 To provide services appropriate to the eligible
resident’s long-term functional needs
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ELIGIBILITY




Must be 19 years or older
Canadian citizen
Have permanent resident authorization
Last residence before care was on reserve (this determines the
jurisdiction responsible for client no matter where care facility located)
 Unable to live independently because of on going health
problems
 Cannot be in an acute or rehabilitative program
 Health-related issues should be:
 At least 3 months
 Due to progressive and/or chronic condition
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NOT ELIGIBLE & EXEMPTIONS
 Person who is sponsored to be in Canada
 65+ and receiving a pension
Exemptions:
 IA client or IA PWD earned income applies
 No other sources available, may sign up for Community
Volunteer Supplement
 In Continuing Special Care facility can receive Comfort
Allowance
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PROCESS
1
2
3
4
5
6
7
8
• Referral made
• BSDW opens case file
• Applicant completes Medical Release & Report form SA 115
• Request local health authority`s Home & Community Care Manager to do assessment
• Assessor does home visit
• Assessor makes recommendation for level of care
• If required, assessor team will be established by local health authority
• Placement in Continuing Care Facility approved, the Home & Community Care Case Manager
does home visit & inform applicant
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9
10
11
12
13
14
15
• BSDW sends copy of Medical Release form SA115 to Home & Community Care Case Manager and
requests copy of Applicant Assessment LTC 1 and Provincial Financial Profile & calculations HLTH 1.6
• Applicant unable to cover User Charges, BSDW will assess for Income Assistance
• BSDW will request the Adult Institutional Care & Adult Family Care Home Client admission form be
completed
• BSDW will fax forms to AANDC FSO: AIC&AFCHCAF LTC 1 & Provincial FPC HLTH 1.6
• AANDC BC Region if form accepted, will send confirmation letter & state payment start date
• BSDW keeps all required forms on file
• BSDW will send in monthly financial information to AANDC & ensure client continues to meet
eligibility requirements
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AANDC NATIONAL DEFINITION OF
INSTITUTIONAL CARE LEVEL I &II
AANDC has limited responsibility for non-medical Type I and II levels of
3.3.1
care
Type I
 Independently mobile with decreased physical or mental facilities
 Requires supervision or assistance with activities of daily living and provision
to meet psycho-social needs through social and recreational services
 Service requirements are indeterminate and related to individual conditions
 Normally would not be admitted to residential care facility
Type II
 Relatively stabilized (physical or mental) chronic disease or functional
disability
 Reached limit of recovery
 Require personal care on 24 hour basis with medical and professional nursing
supervision for meeting psycho-social needs
3.3.2 Province and Territories responsible for licensing and monitoring facilities
3.3.3 AANDC may fund per diem portion of institutional care on case by case basis.
Client expected to pay Provincial or Territorial government established co-institutional
fees, clothing and personal expenses to extent they can financially afford
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AANDC NATIONAL ELIGIBILITY
3.3.4 Eligibility Requirements for Institutional Care – may be reimbursed,
eligible recipients must verify care facility can demonstrate that:
 Operates according to licensing and /or recognition or accreditation
guidelines of relevant provincial and territory
 Care services which care facility is invoicing do not exceed Types I
and II levels of care
3.3.5 Eligible Institutional Care expenditures to be funded may include:
standard accommodation meals; including therapeutic diets
food Laundry clothing
special diets
guide dog
necessary emergency & routine treatment supplies
skilled care with professional supervision as needed & planned
programs for social & recreational activities
age allowance personal living allowance
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LEVEL OF CARE
 Personal Care
Funding AANDC
 Able to stay at home, require some homemaking
 Intermediate Care Level 1(1C1)
Funding AANDC
 Still independently mobile with or without mechanical aide
 Require moderate assistance with daily activities
 Require daily professional care and/or supervision
 Intermediate Care Level 2 (2C2)
Funding AANDC
 Still independently mobile with or without mechanical aide
 Requires heavier care
 Requires heavier supervision and additional care time
 Intermediate Care Level 3 (3C3)
Funding AANDC
 Severe behavioural problems on continuous basis or personal issues that
require considerably more care and supervision
 Require considerably heavier care
 Not eligible for Extended Care
 Extended Care Level
Funding Provincial /HCFNIH
 Chronic cases require 24 hour professional nursing services & continuing
medical supervision
 Usually this level of care is permanent
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REVIEWS & ASSESSMENTS
Taken at request of
 Client
 Service Provider
 Family member
 Physician
 Health Care Professional
 Request for reviews or reassessment goes directly to
Home and Community Care Case Manager
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SERVICE DELIVERY ELIGIBLITY
EXPENSES
 4.1 Eligible funding - recipients who deliver the AL program receive
additional resources to support the administration of the AL program
 4.2 Eligible expenses to deliver AL program include
 Salaries
 Travel
 Transportation
 Training for professional or paraprofessional administrator
and case workers
 related office costs
 activities related to collecting and managing data required
program
 monitoring, planning, reporting and evaluation
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 Maintaining and upgrading system
 Developing operational policy and related documents
 Developing delivery options to encourage local integration
where possible of education, health and social services needed to
effectively deliver and administer AL programs
 Developing and implementing case management systems
including
 structured client assessment
 referral
 re-assessment and counselling
 training
 professional support for administration and case
management
* Out of Canada must be preapproved in writing by Director
General Programs (AANDC)
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ADULT FOSTER CARE ELIGILBE
EXPENDITURES
 Provides supervision and care in a family – like setting to people
who cannot live on their own due to physical or psychological
limitations but who do not need constant medical attention. This
service is an alternative To institutional care.
To be reimbursed for services adult foster care needs to
 3.2.1 Conform to provincial or territorial per diem rates
 3.2.2 Operate according to licencing and/or recognitions or
accreditation guidelines of relevant province or territory.
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OBJECTIVE
To provide a protective and supportive environment
within a Private Family Home to eligible on-reserve
elderly or disabled persons as an alternative to
admission to a long term care institution.
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WHAT IS A FAMILY CARE HOME?
 Is a private family home that provides services to
adults that require 24 hours supervision
 Is not normally the Client’s family home
 Located on-reserve
 Provides a home like atmosphere, meals and other
housekeeping services. Within an atmosphere of a
caring, supportive and assistive services with daily
living activities to the elderly or disabled client
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ELIGIBLITY
 Must be a resident on-reserve at time of application
 Must be Canadian citizen, or authorized under
Immigration Act to be a permanent resident of
Canada
 Must be 19 years or older
 Assessed to need Residential Care by Continuing
Care Division of Ministry of Health
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ROLES AND RESPONSIBILITIES DEFINED
Administering Authority
Approves Family Care
Home based on
screening information
BSDW
MOH-CCD
Completes the Family
Care Home Operator
Approval Form (DK0201) and Adult Family
Home Approval
Checklist (DK02-02)
Ensures Family Care
Home Service Provider
Agreement (DK02-04) is
completed and signed
Identifies eligible
by home operator
clients and matches
client and Family Care
Does ongoing
Home operator
monitoring of home
Completes needs test,
Collects the daily user
monitors care of
fee
individual and services
as link between client,
Reimburses the home
family and service
provider
operator based on
submitted claims
Provides assessment
and establishes level of
care for prospective
client
May assist to complete
forms DK02-01 and
DK02-02
AANDC
Funding Services
Directorates provided
agreement to proceed
with placement
following approval of
home by Administering
Authority and based on
available funds
May assist with
assessment of the
compatibility of home
and prospective client
FSO provides
reimbursement of per
diem and associated
charges based on
submitted billing from
May assist with ongoing appropriate
monitoring, as
Administering
appropriate
Authority
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CHECK LIST FOR HOME
Fire safety
Do consult with local fire authority
BSDW needs to ensure presents of
smoke alarms, fire extinguishers etc.
Operator has a suitable fire evacuation
plan
Outdoor environment
Yard safe for client - especially a
wandering client
No uneven surfaces
Check for hazards such as ditches and
wells
General safety
Check the floors, lighting and stairs to ensure in good repair
General cleanliness
Check for hygiene not just tidiness, especially kitchen and bathroom
Living space
Check to ensure space is adequate if client uses mechanical
assistance to walk or a wheelchair
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Revised March 2014
Adequate living area to accommodate clients needs
CHECK LIST FOR HOME continued
Basic nutrition, food preparation and meal planning
Discuss with operator benefits of meal planning to assist
Operator practices nutrition according to the Canada Food
with evaluating their general knowledge and ability
Guide/Native Food Guide
regarding meals
Wash and toilet facilities
Clean and safe bathing and toilet facilities
Is it near client’s bedroom for easy access and safety of client
Bedroom
Comfortably furnished single room
Best on main floor- not acceptable to
be in basement
Room has a window, is warm, dry and
well ventilated
Furnishings
Comfortable bed and adequate storage
space
Locked draw or alternative
arrangement for clients valuables
If possible, client able to use their own
furnishings
Insurance
Operator must hold valid personal liability, fire, and automobile insurance
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ROLES FOR OPERATING HOME
Administering Authority
Operator
Client
Ensures operators of homes continue to
provide high quality service
Medication is in safe secure place and
administered as instructed by pharmacist
Visits home once a month
Provides appropriate meals including
therapeutic diet
Ensure they have such personal care items as
deodorant, toothpaste, talcum powder, hand
lotion, denture cleaner, comb and brush,
shampoo & conditioner and any special soap.
Holds a crucial role in supporting and
monitoring Family Care Home operator’s
effectiveness as a care provider
Responsible for own personal dry cleaning
Diet supplements provided if needed by client
Laundry service provided on a routine bases
If a person reports suspecting that a home is
putting client at risk, they can contact the
Administering Authority who will take
necessary steps to resolve situation
General hygiene supplies provided for client
as needed
Responsible for personal phone, TV,
newspapers, magazines, smokes, and
transportation
Responsible for any extra craft supplies and
activities of personal hobbies
Medical supplies are covered under health
and operator is to ensure they are available as
needed
Incontinence care supplies and a routine set
up to ensure client properly taken care of
Physical, social and recreational activities are
provided.
Provides transportation to medical
appointments, pick up prescriptions, shopping
and recreational activities
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Exceptional transportation is to be
preapproved by Administering Authority
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RESTRICTIONS
 Pre-approved by Administering Authority for care of 1-2
clients
 3 or 4 clients in home could result in home being closed
 Except where an extra client would as beneficial for both (and if
home has room/ operator capable taking on extra capacity)
 Operator cannot be immediate family of client
Exception to family rule:
 No qualified and available caregivers
 Rural or remote location
 Cultural barriers
 Language barriers
 Behavioural barriers
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RESPITE
 AANDC does special adjustment of $7.12 per resident
per day to allow operator to purchase respite care up to
24 days per year. Operator still receives per diem rate
when on respite therefore responsible for costs
 Approved respite care are
 In Home Respite – must have BSDW approval (not
family member)
 Out of Home Respite – either licensed facility or
another Family Care Home where the option available
and suitable for client
 Respite Day Care – approved by Administering
Authority and arranged by BDSW
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REPORT REQUIRED FOR RESPITE
 On form DK02-03 Adult Family Care Home Planned
& Actual Respite
 Year end report to Administering Authority on respite
taken and copy goes to AANDC
 Respite is 2 days per month when pro-rated
 One day = 24 hours
 Operators should take respite at a minimum of 1 day
per month
 If the Operator is not using the respite allowance,
they may have funds discontinued
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CLOSURE OF HOME PROCESS
 BSDW must notify Administering Authority
immediately
 Administering Authority, Chief and Council are
notified immediately and are in agreement then client
is removed from home
 Administering Authority must notify AANDC
Funding Service Officer of action taken
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SERVICE IS UNSATISFACTORY?
 BSDW must verbally advise operator of areas that must be
improved
 Give a set time to comply
 Verbal Notice must be confirmed in writing within 2 days by
BSDW
 BSDW must revisit home at end of specified time to ensure
changes and service are satisfactory
 If found not satisfactory, BSDW must serve notice if situation
not corrected, service may no longer be required
 Service remains unsatisfactory, BSDW must notify
Administering Authority, who will verify findings
 If Administering Authority agrees with closure, operator is
served 14 day written notice that services are terminated
 AANDC is to be notified immediately
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HEALTH CANADA’S FIRST NATION & INUIT
HOME & COMMUNITY CARE (HCC)
5.1 General
5.1.1 AL program has close link to Health Canada’s HCC program which
provides health services to eligible FN persons living on reserve and
Inuit living in Inuit communities
5.1.2 HCC services are provided on comprehensive assessed needs and
enable people with disabilities, chronic illnesses and elderly to
receive care they need in their home communities
5.1.3 Both programs make up vital part of continuum care for FN persons.
Services often begin in the home and progress through to more
intensive levels of care normally associated with Institutional Care
5.1.4 The Social (non-medical) services funded by AL program support
AANDC Child & Family services, Income Assistance, Special
Education as well as the AL programs supports programs funded by
other government departments (Health Canada) Provinces or
Territories
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THREE MAIN AREAS OF HCC ARE
 Home Support – medical personal care (ex. Wound bandaging)
 Community Support – includes process evaluating how HCC programs
are functioning
 Nursing – nursing care (ex. Administering medications)

These include:
 Client Assessments & Care Planning
 Case Management
 Personal Care provided by trained personnel
 Home Nursing
 In-Home Respite
 System or process to assess medical equipment and supplies
 Program linkages with Health & Social Services both internal and
external to community
 Client record & data system
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Thank you for your sharing and taking
part in the workshop
Have a safe trip home and please do
contact the FNSDS or myself if you
have any questions or concerns
Take care
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