A continuum of care is designed to create alignment between an individual’s changing care needs, the place they live and the services being delivered to them. Theoretical models of these  continuums illustrate seamless transitions for those in need of care, where growing needs are met by an integrated network of health and housing options available in one’s community. However, the reality for Nishnawbe Aski Nation (NAN) First Nations is a fragmented system that at various points, leaves them with limited or no access to the care, housing or services they need.

NAN Territory is a unique and challenging context for health care service delivery, as urban and southern models are neither applicable nor appropriate. Small, remote communities lack the medical infrastructure and skilled health professionals to provide a continuum of care locally. This forces many NAN members, in absence of other options, to leave their homes, families and communities to access care in urban centres. Institutional health care facilities should be seen as a last resort, however without alternative options available at home or in their communities, NAN members find themselves admitted to hospitals and long-term care far too often and early. 

Identifying and Codifying a Continuum of Care for Nishnawbe Aski Nation: A systems approach and Building Towards a Continuum of Care for Nishnawbe Aski Nation are a series of sequential  research projects undertaken through a partnership between Nishnawbe Aski Nation Health and Advocacy Department (formerly Health Transformation) and Together Design Lab at Toronto Metropolitan University (TDL). Since 2021, this research has taken a collaborative and holistic approach to understanding health service delivery and infrastructure in NAN territory. TDL and NAN are now working to engage a variety of NAN members with professional and lived experience to support evaluation of the care programs available for NAN First Nations, advocacy for policy and program change and imagining alternative futures for care provision in community. 

Guided by curiosity, the projects began by asking: 

What does the continuum of care currently look like in NAN territory? What alternative models of housing with care supports and care service provision are available elsewhere? How can we keep NAN members with care needs at home and in the community for longer?

Who was involved?

TDL and the NAN Health and Advocacy department collaborated to share project learnings with the NAN Health Advisory Group and the NAN Chiefs Council on Health Transformation. Project learnings were also disseminated through presentations at the NAN Health Transformation Virtual Long Term Care Engagement event in Fall 2021 and at the 2022 NAN Housing Summit. In the upcoming phase of the project, a suite of new audiences will be engaged in the work including: NAN Health Directors, frontline formal caregivers working in NAN communities and NAN members with care needs and their informal caregivers.  

What was TDL’s role?

TDL conducted policy and literature review to identify and codify the existing care services and infrastructure in Nishnawbe Aski Nation. Case study models of alternative best practices for the provision of care in remote and rural communities were assembled and analyzed. Where possible, interviews were conducted with the service providers who administered these models. TDL created an engagement Strategy to engage a variety of audiences in NAN territory with first-hand experience–either personal or professional-of the continuum of care, including a suite of contextually specific engagement activities that are inclusive to all relevant audiences. TDL will continue to support NAN in the implementation of this engagement strategy, including troubleshooting, data synthesis, analysis and resulting dissemination. 

What types of engagement occurred?

The majority of the first program of this research (Identifying and codifying) conducted engagement through presentations and question and answer periods. Going forward, the engagement strategy and its activities will be implemented. This will include both individual and group workshop sessions with a variety of relevant audiences, recording the challenges, successes and future visions for a continuum of care in NAN territory. 

What was learned?

There are immediate steps that can be taken to improve the well-being of community members. 

Current gaps in the continuum of care can be alleviated, or have their effects minimized by increasing access to existing care programs, removing discriminatory barriers to care faced on reserve; and allowing for greater community control and flexibility in service delivery.  Ongoing advocacy for investment in housing and infrastructure is also required to create living environments throughout NAN territory that are supportive of individual, family and community well-being. 

There is no singular model that will meet care needs.

Transformation requires a holistic approach with a complex mix of service delivery and infrastructure, not only addressing immediate needs but long-term goals. The vision for a continuum of care will not be the same across NAN and transformative change must respond to the unique context, needs, and desires of each community. Further engagement is required to identify the specific interventions that would have the greatest impact for different populations and geographies in NAN territory.