Results at a Glance - Evaluation of the Assisted Living Program
Office of Audit and Evaluation
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Table of contents
Introduction
- The Assisted Living Program was created in 1983, using the same financial authorities as the Income Assistance Program. Funding is available to eligible individuals residing on-reserve (and in Yukon), regardless of Indian status or age.
- The objective is that in-home, group-home and institutional care supports are accessible to eligible low income individuals to help maintain their independence for as long as possible in their home communities. It includes in-home, institutional, and adult foster care, as well as a disabilities initiative.
- Expenditures for Assisted Living increased from approximately $100 million to $117 million from 2014-15 and 2017-18.
What the evaluation found
- The increasing needs and growing number of clients, compounded with increasing funding pressures, present growing challenges to First Nations in the provision of sufficient amounts of service.
- There is limited merit in the policy requirement for First Nations to align eligibility and rates to reference provinces.
- Achievement of outcomes would be further supported by capital funding for minor home renovations and, even more substantially, for building long‑term care homes on-reserve where feasible.
- The Assisted Living Program and the First Nations and Inuit Home and Community Care Program (FNIHCC) operate along a continuum. While services have mostly clear distinctions, separate program funding within Indigenous Services Canada is somewhat impractical and has limited merit.
Recommendations and responses
The Assisted Living Program is valued for the level of service and care provided, and for promoting the independence of individuals in their homes and in their communities. However, First Nations are not given the autonomy or flexibility to provide a continuum of care and services most relevant to their needs and circumstances. While there are several areas that could take the form of evaluation recommendations, fundamentally, the first step is to change the approach of the Assisted Living Program to one that promotes the self determination of communities and allows for a continuum of care.
1. Where desired by communities, provide more flexible funding options that cover the spectrum of services currently available through both the First Nations and Inuit Home and Community Care Program and Assisted Living programs, including working with communities who wish to move from set to flexible funding arrangements to better manage services in the long term.
Response:
- Beginning in fiscal year 2019-20, Assisted Living regional staff and regional funding officers will work with communities to move additional communities from set to more flexible funding agreements.
- In 2019-20, the Assisted Living Program will work with FNIHCC and partners to review program authorities to reduce areas of duplication, and identify gaps that could be closed through a clearer definition or elaboration of each programs’ authorities.
- In 2019-20, the Assisted Living Program will work with FNIHCC, partners and communities in determining and implementing options for joint funding arrangements.
- In 2019-20, FNIHCC will work with the Assisted Living Program to develop options for a new policy authority that would fund a continuum of health and social supports and services in communities. These options would then be presented to the Department’s Senior Management Committee by the fourth quarter of 2019-20.
2. In the short term, update program guidance to further clarify which services are eligible for funding, then develop and implement a communications plan to disseminate this revised guidance to First Nations administrators of the Assisted Living Program in all regions.
Response:
- In 2019-20, the Assisted Living Program will identify and clarify areas where challenges exist in the interpretation of eligibility criteria, based on existing information on these gaps and guidance from Indigenous partners.
- In 2019-20, the Assisted Living Program will develop a Communications Plan to disseminate improved program guidance to recipient communities.
3. Develop a strategy to measure current and prospective demand of services relative to capacity to provide services, in order to better inform policy directions on the extent of need as well as the coverage of different types of services.
Response:
- By the end of the second quarter of 2019 20, the Assisted Living Program will collaborate with FNIHCC and partners to develop an approach to engagement regarding the development of data and reporting strategies that could further enhance the understanding of community needs for home and community services.
- By March 2020, engagement will be completed and a report produced that will outline a data strategy that could include the use of non-program data sources, as well as modifications to the collection of program data.
- By April 2021, implementation of the revised data strategy will be completed.
About the evaluation
The evaluation assessed the relevance and performance of the Assisted Living Program between 2013-14 and 2017-18. Methods used were literature review, document review (including performance information), key informant interviews with external and internal stakeholders, case studies, and review of financial data.