Alberta First Nations Continuing Care Needs Assessment p. 1 Alberta First Nations Continuing Care Needs Assessment - Health and Home Care Program Staff Survey - Definition of Terms Continuing Care: As defined in the Terms of Reference of the Alberta First Nations Working Group on Continuing Care, "Continuing Care is a system of services delivery encompassing a range of health and social services for all age groups, addressing the wholistic health, social and personal care needs of individuals who do not have, or have lost, some capacity for self-care. These integrated services are designed to improve individual functioning and provide culturally sensitive support and care in the community where possible." Continuing Care Facility refers to housing structure (and its associated services) that, when taken as a whole, could potentially be licensed by the Province of Alberta as a group home, a seniors lodge, a supportive living facility (levels I through IV), or a long-term care facility (nursing home or auxiliary hospital) Activities of Daily Living (ADL): The 6 categories of ADL as defined in FNIH's Home and Community Care Program are: (1) feeding, (2) continence, (3) transferring / mobilizing, (4) toileting, (5) dressing and (6) Bathing. Instrumental Activities of Daily Living (IADL): The 8 categories of IADL, as defined in FNIH's Home and Community Care Program, are abilities to: (1) using the telephone, (2) grocery shopping, (3) preparing food, (4) housekeeping, (5) doing laundry, (6) using transportation, (7) handling medications, (8) handling finances Levels of Continuing Care Requirements are defined using Alberta Health and Wellness criteria. Please refer to Appendix A at the end of this survey for a full description table. Briefly, they are: Home Living: Clients can live at home with community support services. Residential Living (L1): Clients may need to live in facilities with personal care services. Lodge Living (L2): Clients may need to live in facilities with personal responses system and expanded personal care services. Assisted Living (L3): Clients may need to live in facilities that meet all the requirements of Level 2 accommodation, plus the provision of certified or trained staff on site 24 hours, and routine checking of residents. Enhanced Assisted Living (L4): Clients may need to live in facilities that meet all the requirement of Level 3 accommodation, plus having regulated professional staff on site on a 24 hour basis, plus the provision of special diets and food/nutrition intake monitoring.
Alberta First Nations Continuing Care Needs Assessment p. 2 Facility Living: Clients may need to live in long-term care facilities such as nursing homes and auxiliary hospitals. FNIH: First Nations and Inuit Health Branch e-sdrt: FNIH Home Care tracking system used by community's Home and Community Care nurse to input monthly statistics regard Home and Community Care services provided to community members. Instructions of How To Best Answer the Survey Questions Answers to some of the survey questions may be found within your community's e-sdrt database. Please consult with your Home Care Nurse and review your community's e-sdrt data prior to answering this survey. Different health program staff in your community may be able to answer different questions in this survey. Some questions can only be answered by having several staff members share and discuss information. It is therefore recommended that the survey be answered in the format of a 'staff workshop' or 'staff meeting' where staff members from health program, social services and/or other First Nation department looking after continuing care services can review and answer the questions as a unit. It is likely that focus groups (either in-person or via tele- or video-conference) will be organized to allow communities to share ideas, concerns, and suggestions regarding the direction of First Nations Home and Community Care in Alberta. Answers provided by communities to this survey will serve as a starting point for these focus groups. Therefore, please ensure that your answers are as accurate and detailed as possible. Thoughtful explanations to your answers and suggestions will go a long way in helping us understand the continuing care needs of your community. We appreciate your time and effort in contributing to this program! Should you have any questions regarding the content of this survey, or need clarification on any of the questions, please feel free to contact: Dora Courteoreille at 780-939-7345 (dcourteoreille@gmail.com Lorene Weigelt at 780-495-5436 (Lorene_weigelt@hc-sc.gc.ca), or Justin Wong, our research consultant for this project, at 780-944-1768 (Justin@jtkreseach.com) Thank you in advance for your assistance!
Alberta First Nations Continuing Care Needs Assessment Health Staff Survey p. 3 Section I: Continuing Care Needs 1a. Between January and December 2010, how many on-reserve community members required assistance with activities of daily living' (ADL) or instrumental activities of daily living (IADL)? Reasons for requiring Community Members Requiring assistance to ADL or IADL by Age (Yrs) and Gender 0 5 6 10 11-16 17 25 26-45 46-55 56-64 65-74 75+ assistance M F M F M F M F M F M F M F M F M F Acute End-of-Life Rehabilitation Long-term Support Maintenance Care Other Reasons NOTE: YOU MAY BE ABLE TO ANSWER THE ABOVE QUESTION BY HAVING YOUR HOME CARE NURSE ACCESS COMMUNITY DATA FROM THE e-sdrt SYSTEM. 1b. Did you answer the above question using e-sdrt as the main source of information? Yes No; the information is based on
Alberta First Nations Continuing Care Needs Assessment Health Staff Survey p. 4 2a. Among on-reserve community members who required assistance with ADL or IADL between January and December 2010, what level of support do they require?. Levels of Community Members Requiring assistance to ADL or IADL by Age (Yrs) and Gender Continuing Care 0 5 6 10 11-16 17 25 26-45 46-55 56-64 65-74 75+ Requirement M F M F M F M F M F M F M F M F M F Home Living Residential Living (L1) Lodge Living (L2) Assisted Living (L3) Enhanced Assisted Living (L4) Facility Living Don't Know 2b. Please describe the evaluation criteria used by your community to determine the level of continuing care requirements for community members. Are the evaluation criteria based on FNIH standards and/or Alberta's provincial standards?
Alberta First Nations Continuing Care Needs Assessment Health Staff Survey p. 5 3. Among those who required assistance with ADL or IADL between January and December 2010, what is the primary reason for needing assistance? (One reason per person only. In cases where multiple reasons apply, please choose the MOST relevant reason) Types Care Required Specific developmental disorder Speech and language Specific developmental disorder motor functions Specific developmental disorder cognitive Specific developmental disorder mixed Pervasive developmental disorders* Specific physical or neurological disorders Pervasive physical or neurological disorders Injuries Blindness Deafness Post-surgery recovery Alzheimer's disease Community Members Requiring assistance to ADL or IADL by Age (Yrs) and Gender 0 5 6 10 11-16 17 25 26-45 46-55 56-64 65-74 75+ M F M F M F M F M F M F M F M F M F
Alberta First Nations Continuing Care Needs Assessment Health Staff Survey p. 6 Types Care Required Mental disorders / disabilities (other than Alzheimer's disease) Chronic physical disabilities Chronic conditions arthritis Chronic conditions respiratory disorders Chronic conditions cardiovascular Chronic conditions diabetes Chronic conditions chronic pain (other than arthritis) Chronic conditions others Palliative care Others #1 Others #2 Others #3 Community Members Requiring assistance to ADL or IADL by Age (Yrs) and Gender 0 5 6 10 11-16 17 25 26-45 46-55 56-64 65-74 75+ M F M F M F M F M F M F M F M F M F *Pervasive development disorders refers to disorders characterized by delays in the development of multiple basic functions including socialization and communication that have traditionally been referred to as Autism. Don't know, because
Alberta First Nations Continuing Care Needs Assessment Health Staff Survey p. 7 4. Among those who required assistance with ADL or IADL between January and December 2010, what is the main source of assistance for them? Main source of assistance Family members Services provided by Home and Community Care program Home visitations by physiotherapists or occupational therapists Adult day care Adult group home Continuing care facility on reserve Others #1 Others #2 Others #3 N Don't know, because
Alberta First Nations Continuing Care Needs Assessment Health Staff Survey p. 8 5. Among those who required assistance with ADL or IADL between January and December 2010, how many received the following services? Services N Home making / home management Meal services preparation of meal in the home Meal services meals-on-wheels Meal services congregate meals Transportation assistance - medical Transportation assistance recreational Transportation assistance groceries and supplies Transportation assistance others Water delivery Wood cutting Home repairs / maintenance Adult day program Respite care for caregiver (other than adult day program) Personal care services Health teaching of clients and/or caregivers Monitoring for therapeutic intervention Medical administration and management Therapeutic care Wound management Treatment and/or procedures ordered by physician and performed by nurse(s) Therapeutic foot care by nurse(s) Bathing/Toileting/Oral Care/Skin Care/Hair Care/Dressing Foot and Nail Care Feeding Mobilization Rehabilitation Exercises Direct Observation Therapy / Transfer Skills Podiatry (i.e.: diagnosis and treatment of lower legs, ankles, and feet) Nutrition Counselling Occupational Therapy Physical Therapy Speech Therapy Mental Health Consultation Hospital Discharge Planning Home care services needs assessments Case conferences with family and/or other providers of care to clients Consultation with clients' physician Assisting clients in establishing linkages to other resources Others #1 Others #2 Others #3 NOTE: YOU MAY BE ABLE TO ANSWER THIS QUESTION BY HAVING YOUR HOME CARE NURSE ACCESS COMMUNITY DATA FROM THE e-sdrt SYSTEM.
Alberta First Nations Continuing Care Needs Assessment Health Staff Survey p. 9 6. Are there services needed by, but are not available to, those who required assistance with ADL or IADL between January and December 2010? Yes No Please describe what those services are, and how your community manages those unmet needs. 7. Between January and December 2010, are there on-reserve community members who have 'fallen through the cracks?' In other words, are there individuals who could have benefited from existing home and community care services, but did not receive the service? No Yes - a few (indicate approximately how many: ) Yes - many (indicate approximately how many: ) Don't know Please elaborate (e.g.: why are they not receiving the level of services they need? What could be done to facilitate service provision to these community members?) 8. Between January and December 2010, roughly how many on-reserve community members have experienced challenges that were severe enough to warrant residency in a supportive living or continuing care facility, but did not do so? Estimate #: Don't know Please indicate the reasons for their decision to not stay in a facility: (One reason per individual. IN cases where more than 1 reason applies, please choose the most relevant reason for the individual) Reasons for not staying at a supportive living or continuing care facility N Lack of funding from Facility is too far away from reserve The individual does not want to live away from family The individual does not want to live away from the reserve Inappropriate age for the available facility Others #1 Others #2 Others #3
Alberta First Nations Continuing Care Needs Assessment Health Staff Survey p. 10 9a. As far as you know, how many supportive living or continuing care facilities are located within 50 kilometers outside your community? Estimate #: Don't know 9b. As far as you know, how many supportive living or continuing care facilities are located within 100 kilometers outside your community (please do not count any facility that has already been counted in Q9a)? Estimate #: Don't know 10a Between January and December 2010, how many on-reserve community members have stayed in supportive living or continuing care facilities outside your community? Estimate #: Don't know 10b. What are some of the most common reasons for on-reserve community members choosing a supportive living or continuing care facility outside your community? (SKIP IF NOT APPLICABLE) a. b. c. 11. Does your community have a discharge planning protocol in place with Alberta Health Services? Yes, since (year: ) No, but is In the process of developing one (GO TO Q12) No (GO TO Q12) Don't know (GO TO Q12) 12a. Between January and December 2010, how consistently has your health program been receiving discharge care plans for community members after hospitalization? Fewer than 25% of the time (specify percentage if known ) Between 25% and 49% of the time (specify percentage if known ) Between 50% and 74% of the time (specify percentage if known ) At least 75% of the time (specify percentage if known ) Don't know, because
Alberta First Nations Continuing Care Needs Assessment Health Staff Survey p. 11 12b. In your estimation, what percentage of the discharge care plan are useful/effective in helping your program provide post hospital care for community members? Approximately % of the discharge plans are useful / effective. 13. Is your program currently using the Reassessment Tool developed by FNIH to help determine the changes in your program that are needed in order to compile with the new Community Health Plan? Yes No, but I have heard of / seen this tool. No, and I have NOT heard of / seen this tool. 14. What are the key challenges your program faces when trying to provide quality home and community care to your community? 15. How do you determine and project home and community care needs among your members? 16a. Would it be helpful for your on-reserve community members to participate in a home and community care needs assessment? Why or why not? 16b. What would you foresee as the greatest challenge in having your on-reserve community members participate in a continuing care needs assessment?
Alberta First Nations Continuing Care Needs Assessment Health Staff Survey p. 12 17. Overall, do you feel that the home and community care services provided by your program meet the needs of your community? Home and Community Care Services Meeting Community Needs? Yes / Mostly Yes Yes overall, but it is lacking in a few specific areas Not really, it is lacking in many areas Don't know N Please explain your answer 18. Does your community have a continuing care facility? If so, is the facility currently used to care for individuals with supportive living or continuing care needs? No Has facility, but it is currently not used for anything Has facility, but it is NOT currently used for something else other than caring for individuals with continuing care needs Has facility, and it is being used to care for individuals with continuing care needs. (IF FACILITY IS NOT CURRENTLY BEING USED FOR MEETING CONTINUING CARE NEEDS) Please explain why the facility is currently not used to care for individuals with continuing care needs. 19. Has your community implemented strategies for integrating INAC's Homemakers Program with FNIH's Home and Community Care Program? If so, what barriers and opportunities did your community experience during the integration process and what suggestions do you have for other communities regarding this process? Yes In progress No
Alberta First Nations Continuing Care Needs Assessment Health Staff Survey p. 13 20. Are you aware of any First Nations Continuing Care assessments and/or documents that communities have produced over the past 2 years? If so, would you be able to provide us with information regarding the source of that assessment/document so that we can reference it in our final report (if appropriate)? No Yes; Information: IF YOUR ANSWER TO QUESTION 18 IS 'No' or 'Has facility, but it is currently not used for anything,' there is no need for you to continue with Section II of this survey. Thank you very much for completing this section of the survey!
Alberta First Nations Continuing Care Needs Assessment Health Staff Survey p. 14 Section II: Continuing Care Facility Needs Assessment 1. Which of the following best describes the type of continuing care facility in your community? Seniors Lodge Group Home Supportive Living Facility Level 1 Supportive Living Facility Level 2 Supportive Living Facility Level 3 Supportive Living Facility Level 4 Long-term Care Facility Other (please describe: ) 2. Among residents of your continuing care facility between January and December 2010, how many of them are members of your community, how many of them are... First Nations heritage from your community First Nations heritage from other First Nations communities First Nations heritage who were living off-reserve Non-First Nations heritage 3. Please provide a breakdown, by age and gender, the type of care provided to residents of your continuing care facility between January and December 2010. Type of Care Provided Acute End-of-Life Rehabilitation Long-term Support Maintenance Care Other Reasons Residents of Your Continuing Care Facility between January and December 2010 0 5 6 10 11-16 17 25 26-45 46-55 56-64 65-74 75+ M F M F M F M F M F M F M F M F M F
Alberta First Nations Continuing Care Needs Assessment Health Staff Survey p. 15 4. Please provide a breakdown, by age, gender and level of continuing care requirement, residents of your continuing care facility between January and December 2010 (NOTE: TOTAL OF EACH TABLE MUST EQUAL TOTAL OF QUESTION 3). Levels of Care Required Residential Living (L1) Lodge Living (L2) Assisted Living (L3) Enhanced Assisted Living (L4) Others Facility Living Residents of Your Continuing Care Facility between January and December 2010 0 5 6 10 11-16 17 25 26-45 46-55 56-64 65-74 75+ M F M F M F M F M F M F M F M F M F Don't Know VERIFICATION CHECK: TOTAL FROM QUESTION 3: TOTAL FROM QUESTION 4: (these 2 numbers should be the same!)
Alberta First Nations Continuing Care Needs Assessment Health Staff Survey p. 16 5. Between January and December 2010, how many residents of your facility fall into the following categories? (NOTE: ONE CATEGORY PER RESIDENT; TOTAL MUST EQUAL THE TOTAL FIGURE YOU PROVIDED FOR QUESTION 3) residents needing acute care residents needing long-term care residents needing rehabilitative care residents needing palliative residents needing other types of care (please list: ) 6. How many rooms and beds are there in your continuing care facility? private rooms (i.e.: room with one bed occupied by a single residents) shared double-rooms (i.e.: rooms with 2 beds shared between 2 residents) multiple-occupancy rooms (i.e.: rooms with 3 or more beds) Total # of beds: 7a. Between January and December 2010, what is the occupancy rate of your continuing care facility by month? 2010 Monthly Occupancy Rate (%) Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 7b. Between January and December 2010, is there a period when a waiting list has to be maintained due to insufficient beds at your facility? No Yes, for months 7c. On average, how long must an applicant on the waiting list wait before he/she is admitted to your facility? (SKIP IF NOT APPLICABLE) days / weeks / months (PLEASE CIRCLE THE UNIT USED TO MEASURE WAIT TIME) 7d. For individuals who were placed on a waiting list, how many of them... waited at home until a bed became available went to a different facility waited, then decided not to reside in a facility Others ( ) Don't know
Alberta First Nations Continuing Care Needs Assessment Health Staff Survey p. 17 8a. Between January and December 2010, how many residents have left your facility? Estimate #: Don't know 8b. What are the main reasons for residents leaving your facility between January and December 2010? (MULTIPLE REASONS FOR EACH RESIDENT IS PERMITTED) Reasons as to Why Residents Left the Facility No longer required assistance Family members became available to care for resident at home Moved to a different facility, including hospitalization Facility no longer met the medical needs of the resident Resident could no longer afford the residential fees Resident being dissatisfied with the facility Family members of the resident being dissatisfied with the facility Resident passed away Other (Please specify #1 ) Other (Please specify #2 ) Other (Please specify #3 ) N 9a. Is your continuing care facility licensed? No No, but in progress Yes, by (list all licensing agencies that apply ) 9b. Is your continuing care facility accredited? No No, but in progress Yes, by (list all accreditation agencies that apply ) 10. Which standards, if any, is your facility currently following? None (GO TO QUESTION 12) Our own internally developed standards Alberta Provincial standards Other (please specify )
Alberta First Nations Continuing Care Needs Assessment Health Staff Survey p. 18 11. Based on the standards your facility follows (as specified in your answer to Question 10), please indicate the degree of compliance in the following areas: (NOTE: Details on the latest Alberta Standards for continuing care facilities may be downloaded at: http://www.seniors.alberta.ca/continuingcare/system/standardssupportiveliving.pdf and http://www.seniors.alberta.ca/continuingcare/system/standardslongtermcare.pdf. Please consult these 2 documents if you are unsure about the meaning of these terminology used in this question) Areas Comply with Standards In No, but In Not in N/A compliance process compliance Building code requirements Safety requirements Maintenance Requirements Environmental Requirements Personalized Spaces Window Coverings Bedding Laundry / Personal Laundry Services Personal Choice Services Medication Assistance or Reminders Contracted Services Social or Leisure Activities Nutritional Requirements Menu Requirements Cleaning Requirements Continuation of Services Prevention of Abuse Resident Safety and Security Trust Accounts Safeguarding of Personal Possessions Water Temperature General Information Information Respecting the Accommodation Concerns and Complaints Assessment Reassessment Risk Management Policies Respecting Safety and Security Job Descriptions Residents' Personal Affairs Criminal Record Checks Privacy and personal Information Insurance Posting of Certificate Other: (#1 ) Other: (#2 )
Alberta First Nations Continuing Care Needs Assessment Health Staff Survey p. 19 12. What quality control measures are utilized by your continuing care facility? Nothing systematic Exit survey of residents and/or their family members Following requirements set forth by licensing / accreditation agency Scheduled visits by licensing / accreditation agency Other (please describe) 13. How is your continuing care facility funded? Source of Funding (percentage of total) % Residential fees INAC FNIH Province of Alberta Band fund (including coverage of budget deficit) Other (please specify ) TOTAL NOTE: TOTAL MUST ADD TO 100% 14. What are some of the most significant challenges faced by your continuing care facility? This is the end of the survey. Thank you very much for your time and effort in completing this survey!
Alberta Support Living Framework Levels of Continuing Care Requirement Appendix A Residential Living L1 Lodge Living - L2 Assisted Living - L3 Enhanced Assisted Living - L4 RESIDENT NEEDS -Can arrange, manage and direct own care and is responsible for decisions about day-to-day activities. -Can manage most daily tasks independently. -Some supports/services are required. -All personal assistance can be scheduled. -Primarily needs housing for safety, security and socialization -Can arrange, manage and direct own care and is responsible for decisions about day-to-day activities. -Can manage some daily tasks independently. -A basic set of supports/services is required. -All or most personal assistance can be scheduled. -May require some assistance/encouragement to participate in social, recreational and rehabilitation programs. -Has choices but may need assistance in making some decisions about day-to-day activities. -Requires assistance with many daily tasks. -Most personal assistance can be scheduled. The need for unscheduled personal assistance is infrequent. -May require increased assistance to participate in social, recreational and rehabilitation programs. -Needs assistance in making decisions about day-today activities, but should still be given as many choices as possible. -Requires assistance with most/all daily tasks. -The need for unscheduled personal assistance is frequent. -Requires enhanced assistance to participate in social, recreational and rehabilitation programs. BUILDING FEATURES All Levels - Building safety and design features are appropriate for residents needs Ideally, each suite is private, includes a lockable door, a bedroom, sitting area, bathroom and a kitchenette. Suites for residents with Residential Living - Level 1 needs may also include a full kitchen. Except for Residential Living - Level 1, that might only contain a common area for dining, all other levels of supportive living are expected to have common areas for dining and social/recreational activities. Meal Services At least one main meal per day is available Housekeeping Services Services are available Personal Laundry Personal laundry equipment is available Personal laundry services may be available Laundry and Linen Services Laundry and linen services may be available. Safety & Security 24 hour security is provided Social, Leisure & Recreational Opportunities Services may be available Coordination and Referral Services to Community Supports Guidance/Advocacy/Advisory role may be available Assistance with accessing community services may be available May be Available-Housing operators may or may not have the ability or capacity to co-ordinate this service or provide it to residents. Is/Are Available The housing operator has the capacity to provide the service directly or arrange for its delivery by another source, if the resident needs or wants the service. Provided These are the services that housing operators supply to meet residents needs. HOSPITALITY SERVICES Meal Services Full meal services are available (2 meals if kitchenette in suite) Housekeeping Services Weekly services are available Personal Laundry Personal laundry equipment is available Personal laundry services may be available Laundry and Linen Services Weekly laundry and linen services are available Safety & Security 24 hour staff on site Personal response system is provided Social, Leisure & Recreational Opportunities Services are available Coordination and Referral Services to Community Supports Guidance/Advocacy/Advisory role is available Assistance with accessing community services is available Meal Services Full meal services are available Some special dietary requirements can be met Housekeeping Services More than weekly services are available Additional sanitization as required Personal Laundry Personal laundry equipment is available Personal laundry services are available Laundry and Linen Services Weekly laundry and linen services are available Safety & Security 24 hour staff on site Routine checking of residents as required Personal response system is provided Social, Leisure & Recreational Opportunities Services are available Coordination and Referral Services to Community Supports Guidance/Advocacy/Advisory role is provided Assistance with accessing community services is provided Meal Services Full meal services are provided Most special dietary requirements can be met Food/nutrition intake monitored Housekeeping Services Daily services are provided Additional sanitization as required Personal Laundry Personal laundry equipment is available Personal laundry services are available Laundry and Linen Services Weekly/daily laundry and linen services are provided Safety & Security 24 hour staff on site Routine checking of residents as required Personal response system is provided Social, Leisure & Recreational Opportunities Services are provided Coordination and Referral Services to Community Supports Guidance/Advocacy/Advisory role is provided Assistance with accessing community services is provided HEALTH AND WELLNESS SERVICES All Levels: General Service Needs - Case management by RHAs for publicly funded services - Assessment for publicly funded health and personal care services completed by the RHA based on unmet need. - Other health services, services of health professionals are available as arranged locally and on an as needed basis. - Personal assistance and/or professional services may be provided to residents by: the RHA directly, the operator on contract to the RHA, the operator privately, or private pay by an alternate vendor. All Levels: Medication Support - Support will be provided by RHA s based on assessed unmet need. Support can also be purchased privately. Residents are responsible for the costs of their medications including dispensing fees. Staff Scheduled visits by RHA staff and other community supports. No health staff on site on a 24-hour basis. Staff Scheduled visits by RHA staff and other community supports. No health staff on site on a 24-hour basis. Staff Scheduled visits by RHA staff and other community supports. Suitably qualified, certified or trained staff on site on a 24-hour basis Staff Scheduled visits by RHA staff and other community supports. Suitably qualified, certified or trained staff on site on a 24-hour basis. Regulated professional staff on site on a 24-hour basis