In my community, Bella Coola, we have a fully integrated home and community care program situated in a new health centre on-reserve that is used by everyone in the community, whether they are First Nations or not. But it wasn’t always that way.
Bella Coola is a geographically remote community with limited resources. I was the federal health nurse there for years, until I went back to university. When I returned, I was hired by the province to set up home care in the region. I saw that people on-reserve weren’t getting services. There was no structured home and community care program, and no integrated service delivery model between the services offered on-reserve and those offered by the province. We had five long-term care beds in a small community hospital, and no assisted living. Complicating the situation were factors such as budget constraints, nursing shortages, and a lack of clarity around staff roles and responsibilities.
We wanted to give people equal access to care and the option to remain at home as long as possible—not just in their community but in their own homes. We needed an integrated care program to support this and we wanted to build capacity for culturally sensitive care. We started the planning by going to the Chief and Council of Nuxalk Nation and saying, “Why don’t we work together and set up a program for everyone?” Then we went out on the road talking to the community, conducting a community needs assessment, and meeting with the many different organizations and government representatives who needed to be consulted. In the end, we made just one home care program where there had been two (the province’s program and the federal FNIHCC program). There is no new money; we pooled our funding streams to work around budget constraints. And by coming together, we expanded our capacity and flexibility. For instance, there is a four-hour cap on the number of hours of home support we can provide to a client in a day. But if a couple of more hours a day means that the client can stay in the community and in their home, then we provide more hours. It’s good quality care, and it’s cost effective for the system.
Other communities have asked us how they can do similar types of integrated programs. We tell them the standards of care are going to be the same—how you do your assessments, how you clean your tools, how you chart—but how you deliver the care might be a little different because of the culture in your community. You have to know the community.
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