In 2017, St. Joseph’s Care Group (SJCG) Northwest Regional Rehabilitative Care Program (RRCP) formally identified significant gaps in rehabilitative services throughout remote Indigenous communities. Gaps include a need to improve rehabilitation programming to support transitions from hospitals to home, and support healthy aging to improve quality of life and reduce chronic disease.1 As essential rehabilitation programs are not available in most remote First Nations, elders are particularly at risk and are often required to travel out of their home community to receive specialized care. The Sioux Lookout First Nation Health Authority Primary Care Team (SLFNHA PCT) provides rehabilitation monthly in community and supports clients virtually between visits. However, there is a persistent need for local providers to support rehabilitative care needs in between clinicians’ visits. Other regions with similar access challenges have developed creative local solutions.2-6 They recognize that training local people with an understanding of the environment and social conditions helps to build community capacity, fosters a person-centered approach, and enhances effectiveness of rehabilitation efforts.7-9
Based on this knowledge and with First Nation partners, we developed a Community Rehabilitation Worker (CRW) role within existing Home and Community Care (HCC) programs that specifically employs local community members trained in rehabilitation principles and skills to support elders and HCC clients. The goals of the new role are to improve equity in access to quality, culturally-safe rehabilitative care; build capacity in Indigenous communities as called for by the Truth and Reconciliation Committee10; and affirm Indigenous peoples’ inherent right to self-determination.
1. North West LHIN (2017). North West LHIN Rehabilitation and Complex Continuing Care Capacity
Plan, May 2017.
2. Employment and Social Development Canada (2018). Social Isolation of Seniors: A focus on
Indigenous Seniors in Canada. (
3. Dawad, S. & Jobson, G. (2011) Community-based rehabilitation programme as a model for task-
shifting. Disability and Rehabilitation. 33:21-22, 1997-2005.
4. Lowe W. (2003). Rural Western Australian therapy assistant project. Perth: Disabilities Services
Commission and Combined Universities Centre for Rural Health.
5. Miller-Mifflin, T., McNeil, C., Driedger, D., Fricke, M., Achtemichuk, M., Bzdell, M., & Robison, J.
(2011) Inuit community therapy assistants: A unique education program and innovative service
delivery model for a remote practice context in Nunavut. Congress 2012 Abstracts, Physiotherapy
Canada 63 (Suppl 1): 44.
6. Roots R. (2020). Community-based rehabilitation workers: Canadian examples of building capacity in
Indigenous communities. Accepted abstract: Canadian Physiotherapy Association Congress, May
7. Reinikka K., Ferris C. (2019). Personal communication.
8. Dew, A., Bulkeley, K., Veitch, C., et al (2012). Addressing the barriers to accessing therapy services
in rural and remote areas. Disability and Rehabilitation, 35:18, 1564-1570.
9. Minore, B., Jacklin, K., Boone, M. and Cromarty, H. (2009). Realistic Expectations: The Changing role
of paraprofessional health workers in the First Nation communities in Canada. Educ Health: 22:298.
10. Truth and Reconciliation Commission of Canada (2012).Truth and Reconciliation Commission of
Canada: Calls to Action.