Question Period Note: Home Care and Palliative Care

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• Canadians want to age at home and receive supports from their community, in the setting of their choice. This is especially true when they have a serious illness or are approaching the end of life. Increased access to high-quality home and palliative care services is necessary in order to help people receive the care they need in the setting of their choice, to allow them to live as independently as possible. Federal actions are working to improve access to home care and palliative care in Canada.
KEY MESSAGES
• Canadians want to remain at home or in their community when they are aging, have a serious illness or approaching the end of life.
• Budget 2017 funding of $6 billion over 10 years is expanding supports in provinces and territories for home and community care, including palliative care.
• Budget 2021 announced $29.8 million in funding for the Palliative Care Action Plan.
• Budget 2023 includes new investments to further support the health workforce, including personal support workers, which will be beneficial for home and palliative care.
IF PRESSED ABOUT THE ACTION PLAN ON PALLIATIVE CARE …
• Investments of $54 million to implement Health Canada’s Action Plan support raising awareness about palliative care and grief; improving palliative care skills and supports for health care providers and others; enhancing data and research; and improving access to culturally sensitive palliative care for vulnerable populations.
• A public education campaign is underway to raise awareness around palliative care and grief. Phase I launched in March 2023 for providers who are not palliative specialists. Phase II will launch in Summer 2023 for the public.
IF PRESSED ON HEALTH CARE SYSTEM FUNDING…
• Our Government will increase health funding to provinces and territories by close to $200 billion over 10 years, including $46.2 billion in new funding, in addition to $7.8 billion over five years that has yet to flow for mental health and substance use, home and community care, and long-term care.
• New funding includes $1.7 billion over five years to support wage increases for personal support workers and related professions as federal, provincial, and territorial governments work together on how best to support recruitment and retention.
IF PRESSED ON ADDITIONAL SUPPORT PROVIDED BY THE FEDERAL GOVERNMENT…
• Our Government is committed to strengthening our healthcare system, especially for vulnerable members of our communities, including care at home.
• Budget 2021 announced a $90 million investment to launch the Age Well at Home initiative to assist community-based organizations in providing support to help low-income and vulnerable seniors age in place.
• The National Seniors Council is serving as an expert panel to examine measures to further support Canadians who wish to age at home. Work is well underway, including Canada-wide consultations.

HOME CARE IN CANADA
Healthcare is a shared responsibility between the Government of Canada and provincial and territorial (PT) governments.

While the federal government provides financial support to the provinces and territories for health care services, the responsibility for matters related to the administration and delivery of these services, including home and palliative care, falls within provincial and territorial jurisdiction.

Home care is referenced in the Canada Health Act (CHA) as an “extended health care service.” Extended services are not covered by the five criteria of the Act or its extra billing and user charges provisions, and therefore are not subject to the Act’s penalty provisions.

HEALTH CARE SYSTEM FUNDING
On February 7, 2023, the Prime Minister and his provincial and territorial counterparts met to work together on improving Canada’s health care system. First Ministers discussed shared health priorities to deliver real results for Canadians as well as the importance to uphold the Canada Health Act to protect Canada’s publicly funded health care system.

At the meeting with premiers, the federal government announced it will increase health funding to provinces and territories by close to $200 billion over 10 years, including $46.2 billion in new funding. This amount includes $25 billion to advance shared health priorities through tailored bilateral agreements, building on the $7.8 billion over five years that has yet to flow to provinces and territories for mental health and substance use, home and community care, and long-term care.

In addition, new funding announced includes $1.7 billion over five years to support hourly wage increases for personal support workers and related professions, as federal, provincial, and territorial governments work together on how best to support recruitment and retention.

COMMON STATEMENT OF PRINCIPLES ON SHARED HEALTH PRIORITIES AND BILATERAL AGREEMENTS
In August 2017, FPT Ministers of Health (except Quebec) agreed to the Common Statement of Principles on Shared Health Priorities (CSoP) which sets out a shared agenda for improving access to home and community care (including palliative care) and mental health and addiction services supported by federal investments. Based on the asymmetrical agreements of 2004, the Government of Canada and the Government of Québec agreed to an asymmetrical arrangement distinct from the CSoP.

Following the endorsement of the CSoP, the Government of Canada negotiated and finalized bilateral agreements with each jurisdiction, which are posted publicly online. These agreements detail how each province or territory will use federal investments to increase access to services in the two priority areas. Each jurisdiction developed its own action plan, annexed to the bilateral agreement, which identifies the new or expanded programs in home and community care and mental health and addiction services to be supported by the federal investments.

Budget 2017 committed $6 billion dollars in funding over 10 years for home and community care (including palliative care) and was allocated to each province and territory on a per capita basis.

For home and community care, all bilateral agreements set out provincial/territorial action plans, including activities for the first six years of funding in one or more of the following actions:
• Spreading and scaling evidence-based models of home and community care that are more integrated and connected with primary health care;
• Enhancing access to palliative and end of life care at home or in hospices;
• Increasing support for caregivers; and
• Enhancing home care infrastructure, such as digital connectivity, remote monitoring technology and facilities for community-based service delivery.

New agreements will be required for provinces and territories to access the remaining funding, which is part of the $7.8 billion over five years available to provinces and territories, mentioned above ($2.4 billion over four years for home and community care, $2.4 billion over four years for mental health and addiction, and $3 billion over five years for long-term care).

Expert Panel on Aging at Home
In October 2022, the Minister of Health and the Minister of Seniors announced that the National Seniors Council will serve as an expert panel to examine measures, including a potential aging at home benefit, to further support Canadians who wish to age within the comfort of their own homes. The panel will report to the Minister of Seniors and the Minister of Health.

NEED FOR IMPROVEMENT IN PALLIATIVE CARE SERVICES
A 2023 report by the Canadian Institute for Health Information (CIHI), updating their 2018 report, noted that:
• More people are receiving some form of palliative care compared with 5 years ago.
o 58% of Canadians who died in 2021–2022 received palliative care, a 6% increase from 52% in 2016–2017.
• More people are dying at home with palliative support compared with 5 years ago.
• More people are getting palliative care across settings, although it is still often late in life, and some are transferred to hospital when palliative care services may have been available at home or in their community.
• Some people experience greater barriers to accessing palliative care because of their age, where they live or their disease diagnosis.

PALLIATIVE CARE FRAMEWORK AND ACTION PLAN
The Framework on Palliative Care sets out an approach under which all governments, communities, and Canadians play a role in improving palliative and end-of-life care. The Framework was built through participation and direction-setting with key organizations, provinces and territories (P/Ts), other federal government departments and individuals, including people living with a life-limiting illness, caregivers, health care providers, and researchers.

The Action Plan on Palliative Care focuses on the federal role in implementing the Framework. The Common Statement of Principles on Shared Health Priorities, as described above, outlines the way that the federal government and provincial and territorial governments work together to improve home and palliative care, and complements the Framework and Action Plan.

RESPONDING TO CURRENT PRIORITIES IN PALLIATIVE CARE
Health Canada is funding partners to implement the Action Plan on Palliative Care through initiatives such as:
• Training, through development of competency-based training resources; and increasing volunteer navigators for palliative home care;
• Increasing Palliative Care Specialists, by helping physicians prepare for the specialist exam in palliative care; and enabling palliative care specialists to mentor non-specialists through case-based webinars;
• Improving access, through expanding strategies and resources for underserved populations such as people who are experiencing homeless or who are vulnerably housed, children who are grieving, and people living in long-term care facilities; and
• Ongoing research to improve quality and access to palliative care for Canadians.

PALLIATIVE CARE FOR INDIGENOUS PEOPLES
Budget 2017 allocated Indigenous Services Canada (ISC) $184.6 million over five years with $69.1 million ongoing to improve home and palliative care for First Nations and Inuit communities. In addition, funding was identified in Budget 2021 for Health Canada to implement the Action Plan on Palliative Care, including funding earmarked for the development of a palliative care framework for Indigenous Peoples and targeted investments for Indigenous palliative care.

Health Canada is currently co-developing the palliative care framework with Indigenous partners. This co-development includes a diversity of Indigenous voices including First Nations, Inuit, Métis, Urban-residing Indigenous Peoples, and 2SLGBTQIA+ and gender-diverse Peoples. This work includes leveraging results from relevant engagement processes led by other government departments to reduce engagement fatigue and partnering with Indigenous organizations carrying out Indigenous-led engagement. The resulting framework will provide a road map for initiatives to improve palliative care for Indigenous peoples in Canada.

OTHER FEDERAL INVESTMENTS IN PALLIATIVE CARE
In terms of research funding, the Canadian Institutes of Health Research (CIHR), along with the Natural Sciences and Engineering Research Council of Canada (NSERC) and the Social Sciences and Humanities Research Council (SSHRC), is supporting the Canadian Frailty Network through the Networks of Centres of Excellence Program, with an investment of $47.8 million between 2012 and 2023. This network aims to improve the care of seriously ill, frail elderly patients/families through the development, evaluation, and implementation of health care technologies.

Between 2017-2018 and 2021-2022, CIHR invested more than $484 million in research on aging. This includes research to promote healthy aging and to address causes, prevention, treatment and palliation for a wide range of conditions associated with aging.

• Budget 2017 federal investments of $6 billion over 10 years to provinces and territories for home and community care, including palliative care, have been provided under the Common Statement of Principles on Shared Health Priorities.
• Funding for home and community care will help provinces and territories:
• Spread and scale models of home and community care that are integrated and connected to primary care;
• Enhance access to palliative and end-of-life care at home or in hospices;
• Increase support for caregivers; and
• Enhance home care infrastructure, such as digital connectivity, remote monitoring technology and facilities for community-based service delivery.
• Budget 2023 confirmed the Government’s commitment to an increase in health care funding of close to $200 billion over 10 years, including $46.2 billion in new funding for provinces and territories.
• It includes a federal investment of $1.7 billion over five years to support hourly wage increases for personal support workers and related professions, as federal, provincial, and territorial governments work together on how best to support recruitment and retention.
• This funding builds on the $7.8 billion over five years that has yet to flow to provinces and territories for mental health and substance use, home and community care, and long-term care.
• This funding also complements federal investments of nearly $54 million from 2019 to 2027 ($24 million in existing funding; $29.8 million in new investments from Budget 2021) to advance the Government’s Action Plan on Palliative Care.
• In October 2022, the Minister of Health and the Minister of Seniors announced that the National Seniors Council will serve as an expert panel to examine measures, including a potential aging at home benefit, to further support Canadians who wish to age within the comfort of their own homes and communities. The work of the expert panel is well underway, including public consultations of Canadians and stakeholders from across Canada.