o TD 150-19(2) TABLED ON JUNE 12, 2020 Prepared by: Government of Northwest Territories NWT Home and Community Care Review Final Report September 2625, 2019 TABLE OF CONTENTS Executive Summary ........................................................................................................................... i Introduction .................................................................................................................................................................................................. i Purpose and Scope of the Review ....................................................................................................................................................... i Review Approach ..................................................................................................................................................................................... ii Conclusions ................................................................................................................................................................................................ iii Recommendations .................................................................................................................................................................................. vi 1. Introduction ............................................................................................................................. 1 1.1 Home and Community Care in the NWT ........................................................................................................................... 1 1.2 Purpose and Scope of the Review ........................................................................................................................................ 4 2. Approach and Methodology ................................................................................................ 6 2.1 Report Limitations ...................................................................................................................................................................... 9 3. Current State Assessment Findings................................................................................ 11 3.1 Supply-Side Analysis ................................................................................................................................................................ 11 3.2 Effectiveness of HCC Service Delivery Across the NWT ........................................................................................... 28 3.3 Usage of Forms, Policies, and Procedures ...................................................................................................................... 33 3.4 Efficiency of HCC Service Delivery Across the NWT .................................................................................................. 43 4. Future Requirements and Projected Demand for NWT HCC Services ............... 46 4.1 Service Delivery Improvements ......................................................................................................................................... 46 4.2 Perceived Service Delivery Gaps for HCC Clients ...................................................................................................... 49 4.3 Projected Demand for HCC Services in the NWT ........................................................................................................ 54 5. Jurisdictional Analysis ........................................................................................................ 65 5.1 Home and Community Care Services Across Canada ................................................................................................ 65 5.2 Models, Standards and Practices in Select Jurisdictions .......................................................................................... 71 6. Conclusions and Recommendations .............................................................................. 85 6.1 Key Conlusions and Themes................................................................................................................................................. 85 6.2 Recommendations .................................................................................................................................................................... 88 Appendices .................................................................................................................................... 101 Appendix A – Review Matrix .......................................................................................................................................................... 101 Appendix B – Interview Guides ..................................................................................................................................................... 106 Appendix C – Form Inventory and Category Defintions .................................................................................................... 118 Appendix D – Key Assumptions for Projection Model 1 .................................................................................................... 127 Appendix E – Key Assumptions for Projection Model 2 ..................................................................................................... 130 Appendix F – Key Assumptions for Recommendation 9.................................................................................................... 133 NWT Home and Community Care Review – Final Report LIST OF TABLES Table 1: Overview of NWT HCC Program .................................................................................................... 2 Table 2: Summary of Key Informant Interviews ...................................................................................... 8 Table 3: Summary of HCC Staffing Complements by Funding Source (2014/15 to 2017/18) and 2018/19 Projection .................................................................................................................................. 14 Table 4: Ratio of HCC Staff to Population by Community and HSSA/Region ............................. 18 Table 5: Utilization of NWT HCC Services by HSSA, Region and Community............................. 19 Table 6: Estimated Client Caseload in 2017/18 Based on Revised Data ...................................... 22 Table 7: Breakdown of HCC Service Hours by Type of Service by HSSA/Region ..................... 24 Table 8: Breakdown of HCC Service Hours by Activity by HSSA/Region ..................................... 25 Table 9: Summary of Annual HCC Referral, Admission, and Discharge Data by Community and HSSA/Region ............................................................................................................................................... 27 Table 10: NWT HCC Program Variance Analysis ................................................................................... 44 Table 11: Population Growth by Age Group in the NWT from 2008 to 2018 ............................ 55 Table 12: Population Growth of 60 Plus Age Demographic by Community from 2007 to 2017 ........................................................................................................................................................................ 56 Table 13: HCC Client Age Distribution by Community ........................................................................ 57 Table 14: Population Age Projections by Age Group and HSSA/Region to the Year 2035.... 58 Table 15: Comparison of Maximum Home Support Hours of Service in Canadian Jurisdictions ......................................................................................................................................................... 65 NWT Home and Community Care Review – Final Report LIST OF FIGURES Figure 1: Approach to Review .......................................................................................................................... 6 Figure 2: NWT HCC Program Areas of Review .......................................................................................... 7 Figure 3: Comparison of HCC Services by NWT Region ...................................................................... 12 Figure 4: Trends in HCC Client Numbers by HSSA and Region ........................................................ 20 Figure 5: Trends in HCC Client Numbers for NTHSSA – Yellowknife Region and NWT Overall .................................................................................................................................................................... 21 Figure 6: Trends in Hours of HCC Service by HSSA and Region ...................................................... 23 Figure 7: Types of Documents Used by Different HSSAs/Regions in the NWT ......................... 34 Figure 8: Level of Spending and Budget per HCC Client by HSSA and Region in 2017/18 ... 45 Figure 9: Projected Demand for HCC Services by Age Group and HSSA/Region in the NWT under Projection Model 1 ............................................................................................................................... 61 Figure 10: Projected HSW Staffing Requirements by HSSA/Region under Projection Model 1 ................................................................................................................................................................................ 62 Figure 11: Projected Nursing Staff Requirements by HSSA/Region under Projection