Indigenous and Northern Affairs committee  For sure. The other point that I think is worthwhile pointing out is the fact that the wait times are long, but is the care that's received in the long-term care facilities culturally appropriate? Too, is it culturally safe? I think that's another thing that's important to take into consideration—long wait times, and then making sure that people delivering care in the long-term care facilities have the cultural competencies required to deliver the appropriate services.

Indigenous and Northern Affairs committee  We are. We've been asked to look at the issue of long-term care and explore what the policy options are. We actually have CIHR, the Canadian Institutes of Health Research, working with us to put on a “best brains exchange”, a knowledge-sharing event, in June. That will look at the issue of long-term care and the potential models.

Indigenous and Northern Affairs committee  For us, I would say, looking at the issue of long-term care, we're really trying to make sure that we don't determine the solution before we've really assessed the problem. Again, I would look at the importance of working with partners and thinking about that continuum of care. Long-term care isn't necessarily the solution for everybody.

Indigenous and Northern Affairs committee  I do think we have that information available. I don't have it at my fingertips, but I think we certainly could pull that together for the committee. The wait times are long.

Indigenous and Northern Affairs committee  Who's responsible for the training of the people delivering the services in those communities?

Indigenous and Northern Affairs committee  Maybe Keith will expand on that. It's a formula that's based on population size and the remoteness. That's how the funds are divided.

Indigenous and Northern Affairs committee  With our home care program and with our regions, we have regional staff who would work to support the communities.

Indigenous and Northern Affairs committee  Sure. Indigenous Services Canada has headquarters—that's us—here in Ottawa, and then there are regional offices. For example, in Manitoba it's in Winnipeg. Staff there are responsible for working with the bands and the communities that have been funded to deliver home care. They work with them to take care of the education that's required of the nurses, the ongoing education to make sure that they have the competencies they need to be able to deliver the services.

Indigenous and Northern Affairs committee  As I mentioned, the band is funded through the contribution agreement. They set up their home and community care program. They hire the nurses and the home support workers. They manage the program. The program was nicely designed. Certain things have to be seen. For example, the nurse needs to do an assessment of the individual and what their care needs are.

Indigenous and Northern Affairs committee  They could live in the community. They could visit the community. A recurring theme is that you'll see various models. In isolated communities it's much like nursing stations, with issues in terms of trying to recruit and retain nurses. Generally speaking, the program is similar to what you would see or what you would have experienced with your mother.

Indigenous and Northern Affairs committee  No, you're right. When the program was originally designed in 1999, we ran with a budget of $90 million every year—Keith will correct me if I'm wrong—until budget 2017. There was no increase. I think the branch worked really hard to find additional money to insert into the home care program.

Indigenous and Northern Affairs committee  No, you go ahead.

Indigenous and Northern Affairs committee  I'll also respond to MP McLeod's question in terms of the dollars. I didn't offer much specificity, but I just found it within my notes. The budget for palliative care is $19.5 million over four years and, as I've said a couple of times, we very much want to work with our community partners to determine how the palliative care will roll out.

Indigenous and Northern Affairs committee  That's a tough question. In terms of medical assistance in dying, certainly it's quite obviously a delicate question. From a home care perspective—recognizing that it's the area I'm most directly responsible for—the way we have been looking at it within that program is in terms of the importance of making sure we have good investments in palliative care and end-of-life care prior to having the discussion about medical assistance in dying.

Indigenous and Northern Affairs committee  I don't think I have a lot to add to that. I think that it really makes sense. Certainly we've heard from some first nation communities who are thinking about the opportunities in building long-term care facilities where they're not just serving first nations. So there's a business opportunity too for first nation communities.