Political advocacy and research both needed to address federal-provincial gaps in service: Manitoba First Nations Personal Care Homes.

BACKGROUND: First Nation residents within Personal Care Homes (PCHs) are the most vulnerable segment of First Nations society and are in need of continuing care. Recent conditions imposed through unilateral decision-making by the federal government are placing the existence and continued operations of PCHs in jeopardy. METHODS: This article documents the current state of First Nation PCHs in Manitoba. In January 2003, the federal Minister of Indian and Northern Affairs Canada (INAC) announced conditions with which First Nation PCHs must comply or face closure. For instance, none of the PCHs were licensed in accordance with provincial legislation. Such provincial licensing would enable them to access provincial funding. However, provinces are wary of licensing on-reserve PCHs, and First Nations are reluctant to come under provincial health authority. First Nations continue to press for recognition of their own jurisdiction to set standards which emphasize their own culturally-based responsibilities and rights. RESULTS: As of October 2003, on-reserve PCHs have undergone infrastructure assessments to determine upgrades required to meet provincial building codes and standards in preparation for licensing. The First Nations plan to develop their own standards and licensing. Conditional licensing would ensure that PCHs continued to operate while renovations are made and funding allocations worked out. CONCLUSIONS: PCHs are a critical component in the spectrum of health care offered in First Nations communities. The imposition of conditions on the continued provision of federal funding to on-reserve PCHs is seen by First Nations as a restriction of the accessibility of culturally appropriate care for the most vulnerable segment of the First Nations population.