National Assisted Living Program Guidelines 2018-2019

Table of contents

1. Introduction

1.1 This purpose of this document to set out the delivery requirements and standards for the Assisted Living Program for funding recipients that have entered into a funding agreement with the Department of Indian Affairs and Northern Development which is also known as the Department of Indigenous Services Canada.

1.2 This document will be in effect as of April 1, 2018 and replaces the Social Programs National Manual published in 2017-2018.

1.3 This document is to be read in conjunction with the funding agreement signed by the funding recipient, as well as the Department of Indigenous Services Canada's Regional Office program manuals or guidance. These documents provide information about provincial services, supports and rates to help funding recipients align the delivery of services and supports with those of provincial and territorial programs, where applicable. These documents can be requested using contact information in section 14.

For funding recipients working on Disabilities Initiative projects, this document should be read in conjunction with their Department of Indigenous Services Canada approved proposal and work plans.

1.4 Where the Department of Indigenous Services Canada has entered into agreements with the provinces, the obligations set out in the agreements, and as amended from time to time, are to be read first and take precedence over the delivery requirements and standards of the Assisted Living Program, as explained in this document.

2. Objective

The Assisted Living program is a component of Canada's social safety net meant to align with similar provincial and territorial programs.

The objective of the Assisted Living Program 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. This residency-based program provides funding to First Nations, provinces and Yukon Territory on an annual basis through negotiated funding agreements for non-medical social supports, as well as training and support for service delivery so that seniors and persons with disabilities can maintain functional independence within their home communities.

3. Expected outcomes

The ultimate outcome for the Assisted Living Program is that eligible individuals have the ability to maintain functional independence within their home communities. In order to achieve this, the Assisted Living program also supports the development of capacity of First Nations communities to deliver Assisted Living social support services, to address and overcome barriers to the delivery of these services, and to provide the social support component of in-home care, adult foster care, and institutional care.

4. Funding recipients

A "funding recipient" means an individual or entity that has met the eligibility criteria of the program and has signed a funding agreement with the Department of Indigenous Services Canada to deliver an initiative (program, service or activity).

4.1 Eligibility criteria

Eligible funding recipients for the delivery of in-home care, adult foster care and institutional social supports are:

Eligible funding recipients for the delivery of projects and activities under the Disabilities Initiative are:

4.2 Assessment criteria for funding recipients

In order to receive funding for the Assisted Living Program, the following criteria will be assessed:

Additional information to help with the determination of comparability to programs and services of the reference province or territory can be found in section 16.

5. Program recipients (clients and individuals)

A program recipient is referred to as a client or an individual throughout this document. A client is the ultimate beneficiary of assisted living services. An individual has not yet been determined as eligible for service (e.g. during the application/eligibility determination phase).

Once an individual has been found eligible or approved for service, they become a "client." A client is an individual who has been determined to be eligible for, and is receiving services through the Assisted Living program.

5.1 Eligibility requirements

5.1.1 For In-home care, adult foster care and institutional components, clients must be:

5.1.2 Ordinarily resident on reserve

"Ordinarily resident on reserve" means that a client has, at the time of applying for a care assessment, demonstrated that he or she:

Note: For the Assisted Living Program, "reserve" is: as defined in the Indian Act; includes the Yukon Territory; and excludes lands which have been designated for commercial purposes (for First Nations operating under the Indian Act) or leased for commercial purposes (for First Nations operating under the First Nations Land Management Act).

5.1.3 A student who is registered and attending a secondary or post-secondary institution or training program and who is in receipt of education funding from, the federal government, a Band or Indigenous organization continues to be considered ordinarily resident on reserve if he or she:

5.1.4 Services provided to individuals residing off reserve may only be funded when:

Funding for in-home care services is not provided for individuals ordinarily residing off reserve.

5.1.5 Residency status is determined at the time an individual applies for assessment and follows the client until he or she no longer requires Assisted Living social supports.

Note: Individuals, who are ordinarily resident on reserve and relocate to another reserve to be admitted to an on reserve institutional care facility, will be considered to be "ordinarily resident on reserve" and eligible to receive funding from the reserve of origin for the Assisted Living Program services for institutional care.

5.2 Minimum required documentation for clients

Funding decisions require that the Administrator collect and keep information that supports the eligibility of the expenditures and the management of a client's circumstances.Foot 1

In accordance with the record keeping requirements set out in the funding agreement, Administrators are required to keep information that is collected from all current and prospective clients, whether or not they are eligible for services, including:

5.3. The types of information that are used to assess and confirm the needs and eligibility of an individual and their related expenditures are:

In addition, Administrators are required to verify and cross reference the funding recipient's information from other programs to the individual's application, to ensure that there is no duplication of supports and benefits, when considered as a whole. The types of information to consider include:

5.4 Documentation for program management activities

There are several key activities that form the overall management of program expenditures. The minimum requirements for documenting key program management activities are outlined in detail below.

Additional Department of Indigenous Services Canada Regional Office requirements for documenting key program management activities may also apply. Please contact the Regional Office to confirm whether additional requirements apply.

When determining an individual's eligibility for the Assisted Living Program, the Administrator must:

When the individual is not in receipt of Income Assistance benefits at the time of applying for Assisted Living supports or services, the verifications of eligibility outlined in sections 5.4.4 and 5.4.5 of this document must be completed and documented in the individual's file before providing any Assisted Living services to the individual.

5.4.1. Application form

An application must be completed in full and contain all of the following information and supporting documentation before issuing benefits to the individual:

Applications must be updated annually, or as changes in financial circumstances and need for Assisted Living social supports require.

5.4.2. Primary residence

The Administrator must confirm that the individual is ordinarily resident on reserve before issuing benefits. The requirements for ordinarily resident on reserve are set out in this document.

Documentation containing the current home address for the individual and each of his or her dependents must be kept in the individual's file.

The documentation must contain the current home address on at least one of the following pieces of information:

When the documentation listed above cannot be obtained, a Band Council Resolution verifying the individual's residency on reserve may be accepted by Department of Indigenous Services Canada. However, there must be evidence on file that other sources of identification are unavailable.

5.4.3. Identity verification

Within 60 days of the date of the initial application, the Administrator must confirm the identity of the individual as listed in the application and ensure that copies of each person's identification are placed on file. The individual applying for assistance has up to 60 days to provide proof of identification for the individual and legal guardian if applicable.

If, after 60 days of the date of initial application, the individual has not provided identity documentation for the individual and legal guardian if applicable, he or she will be ineligible to receive benefits. However, if the individual demonstrates that he or she is actively pursuing the missing identity documentation, the Administrator may extend the 60 day period until such time as it is received. In this situation, it is important that the Administrator note in the individual's file the efforts made by the individual to obtain the missing documentation.

5.4.4. Financial needs assessment

A clear demonstration of financial need, taking into consideration all financial resources available to the individual and household, must be obtained from the individual prior to issuing benefits to the individual.

This means that prior to issuing benefits the Administrator must verify the individual's financial need by:

Note: Personal property and assets identified in the financial needs assessment should be evaluated and assessed in a manner that aligns with the reference province or territory of residence.

The financial needs assessment must include copies and verification of the supporting documentation for the individual and his or her household:

5.4.4.1 Budget and Decision Sheets

Budget and decision sheets must:

5.4.5. Documentation to support the financial needs assessment

The following documentation, supporting the financial needs assessment must always be in the file:

Note: When, by exception, someone is unable to meet a mandatory requirement, a record of ongoing efforts to obtain the documentation or an explanation of why it cannot be obtained must always be clearly documented in the file.

In addition to the mandatory documentation described above, the following additional sources of documentation can be used to document the individual and his or her family circumstances:

5.4.6. Formal assessment for non-medical social support

The formal assessment for non-medical services (original or a copy of the original) must be on file, and must be completed by a health or social professional and include the following:

5.4.7. Expenditure documentation

Expenditures require supporting documentation and information.

When reimbursing expenditures, the following requirements apply:

5.4.8. Licensing and accreditation guidelines

For adult foster care and institutional care, documentation confirming that the care home or facility operates according to the licensing, recognition, or accreditation guidelines of the relevant province or territory is required.

Examples of documentation include a copy of the license provided by the reference province or territory or a letter from the province or territory confirming that the facility meets licensing standards.

6. Activities

6.1 There are three components available through the Assisted Living Program.

6.1.1 All three program components respond to three distinct and progressively intensive care needs:

Note: Provinces and territories are responsible for providing higher levels (i.e. Types III, IV and V) of institutional care on and off reserve.

Type I and II Levels of CareFootnote 3

Type I care is "residential care for persons requiring primarily supervision and assistance with daily living activities and social and recreational services – ½ to 1 ½ hours therapeutic and personal care or supervision daily".

Type II care is "extended care for persons requiring availability of personal care on a 24-hour basis, under medical and nursing supervision – 1 ½ to 2 ½ hours care or supervision".

Additional information to help with the determination of comparability to programs and services of the reference province or territory can be found in section 16.

6.1.2 Funding recipients who deliver the Assisted Living Program receive resources to support the administration of the program.

6.1.3 For Disabilities Initiative projects to improve the coordination and accessibility of existing disability programs and community services to persons living on reserve, eligible activities for funding recipients are set out in the funding recipient's approved work plan/proposal.

7. Expenditures

The Department of Indigenous Services Canada funds the Assisted Living Program supports and services for clients that are aligned with the requirements outlined in this document and with the eligibility criteria and rates established by the reference province or territory. Assisted Living funding can be used for eligible service delivery expenditures.

7.1 Guiding principles:

Where it is not clear whether or not a particular service would be eligible for funding under the Assisted Living Program, the following guiding principles should be considered:

7.2 The in-home care component provides funding support for non-medical support services. These services include:

7.3. The adult foster care component provides funding support for supervision and care to individuals unable to live on their own due to physical, cognitive or psychological limitations, who do not need continuous medical attention.

Before client expenses in adult foster care can be reimbursed, eligible funding recipients must verify that the adult foster home:

7.4. The institutional care component of the program provides funding support for individuals requiring Types I and II care in institutions operating according to provincial or territorial laws and standards both on and off reserve.

7.4.1. Provinces and territories are responsible for providing funding for higher levels (i.e. Types III, IV and V) of institutional care on and off reserve.

7.4.2. Co-payment and user fees

Clients residing in an institution are expected to pay the provincial or territorial government established co-insurance or user fee for care, maintenance, clothing and personal expenses to the extent that they are financially able to do so. This may require using or assigning income received from alternate income-support programs (e.g., Old Age Security, Guaranteed Income Supplement Canada Pension Plan, Employment Insurance, and personal income from all sources).

7.4.3 Eligible institutional care expenditures:

Note: Specialized medical and capital items are not eligible expenditures.

7.4.4 Eligible service delivery expenses

Eligible expenditures to support the administration of the Assisted Living Program are:

7.4.5. For the proposal-based Disability Initiative, eligible program expenditures are set out in the approved work plan/proposal referred to in the funding agreement.

8. Funding

8.1 Maximum amount of funding

The maximum amount of funding to be provided to a funding recipient in a fiscal year is set out in the funding agreement signed by the funding recipient.

8.2 Stacking limits and duplication of funding

The maximum funding that will be provided to a funding recipient by the Department of Indigenous Services Canada are 100 percent of the eligible costs associated with a particular program (activity, initiative or project) to be funded.

A Funding Recipient is required to declare any and all sources of funding for the program that are expected to be received or that are received, including all funding from the Government of Canada and from provincial, territorial, and municipal governments. Annual financial reporting must show all sources of funding received.

Provision for repayment will be made when the Department of Indigenous Services Canada 's contribution is in excess of $100,000 and when funding from all sources exceeds eligible expenditures. Funding recipients must provide the Department of Indigenous Services Canada with information showing the amount to be repaid and the basis for calculating that amount. The reimbursement should be proportionate to the Department of Indigenous Services Canada's contribution, expressed as a percentage of the total funding obtained by the funding recipient from all government sources for that program.

9. Reporting requirements and monitoring and oversight activities

9.1 The reporting requirements (program and financial reports) and their respective due dates are listed in the recipient's funding agreement, and details on these requirements are available in the Reporting Guide.

9.2 All funding recipient reporting requirements are subject to monitoring and oversight activities to determine the accuracy of the information provided to the Department of Indigenous Services Canada.

10. Personal information

10.1 The Department of Indigenous Services Canada collection and use of personal information and other records for the purposes of program compliance reviews will be limited to what is necessary to ensure program delivery requirements are met, in accordance with the Canada Privacy Act.

10.2 The Department of Indigenous Services Canada is responsible for all information and records in its possession. The confidentiality of the information will be managed by the Department of Indigenous Services Canada in accordance with the Privacy Act and other related policies on privacy. Funding recipients are responsible for the protection of personal information per the privacy legislation, regulations and/or policies that govern them up to the point that it is transferred to the Department of Indigenous Services Canada.

10.3 Funding recipients shall develop and implement by-laws, policies and procedures to protect personal information, collected in the course of complying with the program delivery requirements, from unauthorized access, use, or disclosure.

11. Accountability

11.1 The Department of Indigenous Services Canada is committed to providing assistance to recipients in order for them to effectively carry out obligations set out in this document and funding agreements.

11.2 Funding recipients must deliver the programs in accordance with the provisions of their funding agreement and the program delivery requirements outlined this document while also ensuring that the necessary management controls are in place to manage funding and monitor activities. Funding recipients are required to exercise due diligence when approving expenditures and must ensure that such expenditures are in accordance with the eligible expenditures set out in this document.

11.3 Funding recipients have a responsibility to ensure that program Administrators are properly trained and possess the skills and knowledge to deliver the programs.

12. Official languages

Funding recipients are responsible for providing access to services in both English and French in compliance with the requirements of Part IV of the Official Languages Act.

13. Definitions

13.1 For the purposes of this document, the definitions in the Indian Act and the Funding Agreement apply.

13.2 Additional definitions necessary to interpret the delivery requirements and standards set out in this document include:

Administrator – The person who has been delegated responsibility by a Funding Recipient to carry out functions on behalf of the Funding Recipient.

Age of majority – The age at which a person is granted the rights and responsibilities of an adult in accordance with provincial or territorial legislation.

Child (Children) – A person under the Age of Majority in the relevant province or territory.

Family – Please refer to the definition of family in the relevant province or territory.

Client – A person who ultimately receives the benefit of programs or services funded by the Department of Indigenous Services Canada.

Funding Agreement – A written agreement or documentation between the Government of Canada and a Funding Recipient setting out the obligations of both with respect to one or more grants or contributions.

Funding Recipient – An individual or entity that has met the eligibility criteria of the program and has signed a funding agreement with the Department of Indigenous Services Canada to deliver an initiative (program, service or activity).

14. Contact information

The regional offices coordinates can be found on the Regional Offices page.

You can also write to:

Director of Income Support and Urban Programming for Indigenous Peoples
Department of Indigenous Services Canada
10 Wellington,
Gatineau, QC K1A 0H4

15. Related links

For further program information, please visit our website at: Department of Indigenous Services Canada Assisted Living Program.

16. Summary of federal classification system for institutional care

This section summarizes the Report of the Working Party on Patient Care Classification to the Advisory Committee on Hospital Insurance and Diagnostic Services (1973), and the Memorandum of Understanding Regarding the Delineation of Responsibility Between the Medical Services Branch of the Department of National Health and Welfare, and the Department of Indian Affairs and Northern Development, now the Department of Indigenous Services Canada, for Adult Care for Elderly, Disabled and Handicapped Indians (1984).

It is provided as a reference to help determine reasonable comparability among similar services and programs.

When it is not clear which Type of Care a patient falls into, the patient should be treated as the higher, more specialized Type of Care, e.g., if it cannot be determined whether a patient is Type II or Type III, the patient should be treated as Type III.

16.1. Generally, Type I care is required by a person who is ambulant and/or independently mobile, who has decreased physical and/or mental faculties, and who primarily requires supervision and or assistance with activities of daily living and provision for meeting psycho-social needs through social and recreational services. The period of time during which care is required is indeterminate and related to individual condition.

Operationally, Type I care is residential care for persons requiring primarily supervision and assistance with daily living activities and social and recreational services – ½ to 1 ½ hours therapeutic and personal care or supervision daily.

16.2 Type II care is required by a person with a relatively stabilized physical or mental chronic disease or functional disability who having reached the apparent limit of his recovery, is not likely to change in, near future, who has relatively little need for the diagnostic and therapeutic services of a hospital but who requires the availability of personal care on a continuing 24-hour basis, with medical and professional nursing supervision and provision for meeting psychosocial needs. The period of time during which care is required is unpredictable but usually consists of a matter of months or years.

Operationally, Type II care is extended care for persons requiring availability of personal care on a 24-hour basis, under medical and nursing supervision – 1 ½ to 2 ½ hours care or supervision.

16.3 Type III care is required by a person who is chronically ill and/or has a functional disability (physical or mental), whose acute phase of illness is over, whose vital processes may or may not be stable, whose potential for rehabilitation may be limited, and who requires a range of therapeutic services, medical management and skilled nursing care plus provision for meeting psycho-social needs. The period of time during which care is required is unpredictable but usually consists of a matter of months or years.

Operationally, Type III is chronic care for persons who require a range of therapeutic services, medical management and skilled nursing care – minimum 2 ½ hours care and supervision.

16.4 Type IV care is required by a person with relatively stable disability such as congenital defect, post-traumatic deficits or the disabling sequelae of disease, which is unlikely to be resolved through convalescence or the normal healing process, who requires a specialized rehabilitative program to restore or improve functional ability. Adaptation to this impairment is an important part of the rehabilitation process. Emotional problems may be present and may require psychiatric treatment along with physical restoration. The intensity and duration of this type of care is dependent on the nature of the disability and the patient's progress, but maximum benefits usually can be expected within a period of several months.

Operationally, Type IV is rehabilitative care to restore or improve functional ability – may require psychiatric treatment along with physical restoration. When rehabilitation treatments are the primary focus of the overall treatment plan, rather than just a part of it, the type of care is definitely Type IV.

16.5 Type V is required by a person who:

Operationally, Type V is acute care for persons who present a need for investigation, diagnosis or treatment and who are critically, acutely or seriously ill or convalescing – rehabilitative centres and acute care hospitals.

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