https://www.infirmiere-canadienne.com/blogs/ic-contenu/2024/10/28/outil-devaluation-home-for-life
New Brunswick initiative aimed at practising reconciliation receives approval for scale-up
By Jennifer L. Dobbelsteyn
October 28, 2024
istockphoto.com/mikyso
The Home for Life Assessment Tool consists of five key components, each with five assessment items. The components include food insecurity, loneliness, safety/security, housing conditions, and the need for supportive long-term care services in the community.
Takeaway messages
- The number of Indigenous Elders in Canada is increasing significantly and will continue to do so in the next decade.
- This is creating a demand for services and programs to enable Indigenous Elders to live at home in their own communities as they age.
- The Home for Life Assessment Tool evaluates the needs of Elders to live at home for life in their own communities. The results can be used for the planning and implementation of services and programs provided in a culturally appropriate way.
“Helplessness begins when you cannot live in your own community.” (Indigenous Elder)
Articulating the need
In Canada, we are in a time of reconciliation between Indigenous and non-Indigenous people. Rather than talking about reconciliation, it is important to practise reconciliation. One such research study is doing that.
This study was conducted by myself, in conjunction with the Home for Life team, and is called Eimeg Tan Tleiaoltieg/Home for Life. The first half of the study’s title is written in Mi’kmaq and translates to “we are home where we belong.” The study was published by the United Nations on their Decade of Healthy Ageing platform as a case study from the field (Dobbelsteyn, 2023). The purpose of this research study was to explore the needs of Elders* living at Elsipogtog First Nation and understand the services and support they need to continue to live in their own homes and community in culturally appropriate settings. In this work, we are referring to Elders as aging Indigenous peoples who are 55 years of age or older.
The subsequent scale-up of an evidence-based innovation called the Home for Life Assessment Tool is also an example of practising reconciliation, and is the subject of this article.
For more information about the Home for Life Assessment Tool, including its availability, email Jennifer L. Dobbelsteyn.
The National Centre for Truth and Reconciliation has published 94 Calls to Action along with 46 articles of the United Nations Declaration on the Rights of Indigenous Peoples (UNDRIP). The research we conducted responds to some of the Calls to Action: article 19, regarding the availability of appropriate health services; articles 8 and 9, regarding the right to belong to a First Nation community and not be assimilated elsewhere; article 22, regarding special attention to the needs of Indigenous Elders; and article 34, regarding the right to culturally appropriate processes and institutions (United Nations, 2006).
Currently, the number of Indigenous Elders is increasing significantly and is projected to continue this trajectory over the next decade (Statistics Canada, 2017). This increase in the number of Elders creates increased demand for programs and services to meet identified needs. Understanding the needs begins with assessment; therefore, the Home for Life Assessment Tool was developed and validated to identify the needs of Indigenous Elders to live in their homes and in their own communities as they age.
What is the Home for Life Assessment Tool?
The Home for Life Assessment Tool consists of five key components, each with five assessment items. The components include food insecurity, loneliness, safety/security, housing conditions, and the need for supportive long-term care services in the community. The results are tabulated and presented in pie charts. It is possible to identify which components are most problematic for a community, as well as what the areas of strength are. Community leaders can then use these results to strategically manage resources to meet the most problematic issues for Elders.
For example, food insecurity emerged from our research study as an issue impacting Elders and their ability to continue to live in their homes. Under this component, there are five statements that are used to assess the Elder’s needs:
- I usually eat three meals a day.
- I eat a variety of foods, including meat, fish, fruits and vegetables.
- I can afford to buy enough food for meals each month.
- I can usually get help buying food if I need it.
- I never skip meals.
The responses to these statements were simplified based on team members’ input. The response choices are yes, maybe or no.
Based on the percentages for responses to each of these assessment items, the results are presented as a pie chart to visualize which areas are more problematic, indicating where support may be needed. A comment section was included, and many Elders took the time to expand on the concerns that affected them regarding aging in place in their homes and communities. More than one Elder spoke about how the assessment resonated with them, and they were pleased that the issues of Elders were being studied.
Similarly, each of the other four components includes five statements that capture the results for that component, as perceived by community Elders. This evidence-based innovation is new and was developed specifically for use in First Nations communities as an initial assessment of the community’s ability to support Elders who want to live at home for life. Based on a review of the previous literature, no other assessment tools measuring these components in First Nations are available.
Why scale up?
Scaling up an innovation in health care is defined as follows: “The deliberate effort to increase the impact of an innovation in health services to benefit more people and foster program development” (ExpandNet, n.d.). The rationale for scaling up this innovation was to extend the impact of the tool to other First Nations and evaluate the effectiveness of the tool and the scale-up process.
Scale-up strategy
A crucial element to scaling up an innovation is the scale-up strategy. Our main goal was to conduct the assessments in a culturally safe manner that created a comfortable environment for Elders. Based on this goal, we developed a Nation-to-Nation, Elder-to-Elder scale-up strategy. For example, the Elder-to-Elder approach was used by Elsipogtog Elders sitting with Elders in scale-up communities to speak in their own language, walk through the assessment with the Elder, and thank the Elders for participating in the process. The evaluation results indicated that the Nation-to-Nation, Elder-to-Elder approach was very much appreciated by participants. It was a crucial element to a successful scale-up and equally as important as the evidence-based innovation.
Indigenous Services Canada approved and provided funding for further scale-up as of July 2024.
Results
The Home for Life Assessment Tool was scaled up in six First Nations communities. The sizes of the communities varied from very small (25 homes) to the largest Mi’kmaq community in the province (3,500 community members), and 138 Elders participated in the assessment process. A community visit was scheduled to review the results of the assessment with each community and provide copies of the report to Elders, health centre staff and community leaders. Discussions were held about using assessment results to plan and implement services for Elders.
The results included the following:
- Best practices were shared from one community to another to mitigate issues such as fear/insecurity by training people to ensure a safe community such as the peacemaker initiative, administered by Mi’gmawe’l Tplu’taqnn Inc. in New Brunswick.
- A significant research impact of this project was that it elevated the voices of Elders in First Nations. The assessment tool has a section for comments, and many Elders took the time to write comments to express their needs in their own words. These words were strong and were sending a message to decision-makers such as the chief in the community and band council members.
- Health directors and home and community care nurses appreciated the data that the Home for Life Assessment Tool provided to use for strategic resource allocation to provide needed programs and services.
- The results created a sense of responsibility in the research team to continue this work until a continuum of long-term care is developed in First Nations to meet the needs for respite care, Elder day programs, memory care, assisted-living care, nursing home care and hospice care.
- The Home for Life Assessment Tool was evaluated by end-users as a simple, effective, relevant and quick method to collect information on the important components related to living at home for life in a First Nations community.
- The data was discussed with Elders and health-care providers in each community to suggest ways in which the knowledge could be used to create needed change by planning programs based on priority need. A longitudinal study would be indicated to assess the effects of the usefulness of the tool in impacting change over time.
Conclusion
Assessment, planning, implementation and evaluation are the steps in the nursing process. The first step, assessment, is foundational to all other steps. The Home for Life Assessment Tool is an evidence-based tool developed specifically to assess the needs of Indigenous Elders to enable them to live in their own communities as they age. This allows for the connectedness they need to culture, language, traditional foods, ceremonies and friends and family. All respondents from all scale-up communities answered “yes” to the statement, “I want to live in my own community as I get older.” The right to do so is documented in the United Nations Declaration on the Rights of Indigenous Peoples. Therefore, a continuum of long-term care in First Nations needs to be developed and implemented now to meet the growing demand.
References
Dobbelsteyn, J. L. (2023). Eimeg tan Tleiaoltieg (We are home where we belong): Home for Life - Home and Community Care, Canada. United Nations Decade of Healthy Aging Platform. Retrieved from https://www.decadeofhealthyageing.org/find-knowledge/innovation/reports-from-the-field/home-and-community-care-canada
ExpandNet. (n.d.). Advancing the science and practice of scale up. Retrieved from www.expandnet.net
Statistics Canada. (2017). Aboriginal Peoples Survey. Retrieved from https://www150.statcan.gc.ca/n1/en/catalogue/89-653-X
United Nations. (2006). United Nations Declaration on the Rights of Indigenous Peoples. Retrieved from www.social.desa.un.org
* The Home for Life project uses the word “Elder” to represent all Indigenous elderly people. This was discussed at length, and we followed their preference for what sounds right to them.
Jennifer L. Dobbelsteyn, PhD, MBA, BN, is president of Dobbelsteyn Consulting Group International Inc. in Fredericton, N.B.
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