Mississauga Halton LHIN Community Quarterly Sector Meeting June - - PowerPoint PPT Presentation

Mississauga Halton LHIN Community Quarterly Sector Meeting June 25, 2014

Family Health Care When You Need It Welcome Shehnaz Fakim and Daryn Kilfoyle Senior Leads, Health System Performance 5 min

Finance Team Update

Paulette Zulianello, Senior Director, MH LHIN 15 min LHIN CEO Update Bill MacLeod, CEO, MH LHIN 45 min SDL and Caregiver ReCharge Central Registry Website Beverly John, CEO, Nucleus Independent Living 15 min BREAK & NETWORKING Share the News– 15 Minutes Community Capacity Plan Jim Wright, Vice-President, MH CCAC 40 min Primary Care Integration Strategy Carie Gall, Executive Lead, MH LHIN 15 min Advance Care Planning and Health Care Consent Carol Sloan, Director, Acclaim Health 15 min MH LHIN Falls Prevention Strategy Michelle Collins, Senior Lead Health System Performance 5 min Closing Complete the Feedback Form 10 min

Welcome

Shehnaz Fakim and Daryn Kilfoyle Senior Leads, Health System Performance

Finance Team Update

Paulette Zulianello, Senior Director MH LHIN

MH LHIN

Finance Team Update June 25, 2014

Paulette Zulianello Senior Director, Finance and Risk

6

What’s New and Exciting!

Staffing Changes Mirella Semple - promoted to Executive Lead Ivan Todorov – Financial Analyst (Replaced Chak Lee) Dominic Sloan – starts working with Community Agencies July 1, 2014

What’s Else is New and Exciting!

Return on Investment (ROI)

• incorporate ROI into the LHIN decision

making framework and investment proposal process

• HSP’s will be trained on these requirements
• stay tuned …..more to come

Q4 Reporting Timelines as per M-SAA:

• OHRS/MIS Trial Balance Submission – Due May 30/14 -

Extended to

• 100% submitted – HURRAY!!
• Q4 CAT SRI submission to the LHINs – via SRI
• ARR due to Ministry and LHINs – via SRI (signed copy to LHIN &

Ministry)

• Board Approved Audited Financial Statements (copy to the LHIN

and Ministry)

• Management Letter (only to the LHIN) – Maria Fernandes
• Declaration of Compliance as per M-SAA (as per Oct. 1, 2013 to

March 31/14) ** - Kim Mandalfino - MHLHIN

• 2013-14 LHIN Specific Performance Obligations Year-End

Reporting **-Kim Mdandalfino- MHLHIN

Reminder

• Community Health Service Provider Self

Assessment Tool

• This was sent to our providers in 2012/13.
• A tool to be used by Boards and Management of

HSPs to conduct a self assessment of governance and business practices, identify gaps and/or opportunities for improvement and take the steps required to be compliant.

• And feedback with respect to the tool - email

GovernanceGroup@lhins.on.ca

• Tool is on the MH LHIN web-site:

http://www.mhlhin.on.ca/Page.aspx?id=5808&ekmensel=e2f22c9a_292_308_btnlink

Have a Great Summer ! …..

LHIN CEO REPORT Bill MacLeod, CEO, MH LHIN

SDL and Caregiver ReCharge Central Registry Website

Beverly John, CEO, Nucleus Independent Living

A New Vision of Assisted Living for Seniors

Awarded the 2013 Minister’s Medal for Excellence in Health Quality and Safety

AN AWARD WINNING PROGRAM

Approved SDL Service Providers in the MH LHIN

Supports for Daily Living Central Registry

Coordinated Access for High Risk Seniors

SDL Central Registry

The SDL Central Registry:

• is a single point of coordinated access to Supports for Daily Living

services within the MH LHIN

• works from a healthcare systems-level to

 prioritize incoming referrals  optimize SDL resources in the community  understand the needs of referral sources and work collaboratively to develop strategies to enable SDL to assist in relieving their pressures  Track and trend demand for SDL services across the LHIN

SDL Central Registry Functions

• Works on behalf of 8 SDL Service Providers to:

 Receive and compile referral information from various sources  Conduct assessments for priority referrals  Determine eligibility as per standardized SDL criteria  Assign the most appropriate SDL service provider  Facilitate transfers between SDL Providers  Promote SDL and educate referral sources  Host a centralized repository of information and be a knowledgeable resource about SDL providers and their service

• fferings

 Act as a point of reference for inquiries regarding eligibility and SDL provider capacity/vacancies  Maintain the centralized waitlist for SDL services

SDL Central Registry Functions

Ca Care regiver giver Fi Firs rst t St Stra rategy tegy

"Hear our needs, understand our needs, respond to our needs and provide us the time to recharge."

Caregiver ReCharge Project Goals

"Hear our needs, understand

• ur needs, respond to our

needs and provide us the time

• To provide caregivers with respite
• ptions that meets their individual

needs and improve caregiver’s quality

• f life by reducing stress and burnout

and reduce avoidable hospitalizations and long-term care demand.

Ca Care regiver giver Re ReCh Charge arge Se Serv rvices ices

"Hear our needs, understand our needs, respond to our needs and provide us the time to recharge."

• The Central Registry for the Caregiver

ReCharge services activity is modeled after the success of the SDL Central Registry activity Similarities:

• Works on behalf of 3 Providers

(Nucleus/AbleLiving, Alzheimer’s/Home Instead, Links2Care)

• Assessments conducted prior to

determination of eligibility (Caregiver Stress Index and interRAI CHA/HC (60

Ca Care regiver giver Re ReCh Charge arge Se Serv rvices ices

"Hear our needs, understand our needs, respond to our needs and provide us the time to recharge."

Differences:

• Caregiver Respite hours allocation

determined by Central Registry (in additional to eligibility)

• Most appropriate provider assigned on

rotational basis (not geographical)

• Different priority for referrals

(acuity vs. referral source)

Co Cont ntact act In Info formation rmation

"Hear our needs, understand our needs, respond to our needs and provide us the time to recharge."

Pho hone: ne: 905 05-281 281-4443 4443 Fax ax: : 905 05-337 337-0770 0770 Ema mail: il: res espit pitereferr ereferrals@cen als@centralr tralregistry egistry.ca .ca sdl dlref referrals@ errals@central centralregis registry.ca try.ca www ww.ce .centra ntralre lregist gistry. ry.ca ca

Ad Addi ditional tional Re Reso sources urces

"Hear our needs, understand our needs, respond to our needs and provide us the time to recharge."

Additional SDL Resources: SDL Promotional Video SDL Resource Guide SDL Standards Manual http://www.centralregistry.ca/

BREAK

Share the News

Community Capacity Plan

Jim Wright, Vice President, MH CCAC

Community Capacity Planning for Mississauga Halton LHIN, Central West LHIN and their Health Partners

Jim Wright Colin Preyra, PhD Gavin Wardle, PhD

Purpose of the Session

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• Context for our work
• Five important facts
• Approach
• Community Assets
• Population Need
• Advice from our consultations
• Highlights from our findings
• End of life care
• Informal care
• Long Term Care home substitution
• Population based Home Care planning
• What’s next

30

Helen Angus. A Plan to Transform the Ontario Health Care System. September 2012.

Health Care for the Next Generation of Seniors Might be Expensive

Context: Living Longer, Living Well (Sinha, 2012)

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“…invest more in home care and community support services sectors” “providing a wider range of home care, community support services, and affordable housing options (to) allow more people to remain independent and age in the place of their choice, rather than requiring more costly living

• ptions”

“The Ministry of Health and Long-Term Care should at least maintain its committment to increase home and community sector funding by 4 per cent (for the next three) years and is encouraged to invest future budget increases and savings achieved through efficiency gains into its home and community care sector” “develop an evidence-informed capacity planning process to meet the needs

• f current and future eligible long-term care populations and others who

could be better supported in supportive housing, in assisted living residential environments, or in their own homes with home care”

The Mississauga Halton Central West Collaborative Community Capacity Study

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• The Collaborative Community Capacity Study will develop a plan to

meet current and future community needs for Central West and Mississauga Halton LHIN seniors

• The plan will identify appropriate models of care delivery, including

service types, human resources and innovative approaches that expand, improve and coordinate services to support residents to live longer in their communities

• The overarching goal is to identify the appropriate amount, mix and

network of community based services to support seniors to age at home

33

LHIN Health Link Name Total Population % Age 65+ % Seniors Age 85+ % Seniors Low SES Central West Dufferin Area 72,860 13% 10% 8% NE-M-WW 214,170 14% 13% 28% Bramalea and Area 257,928 9% 8% 11% Brampton and Area 315,029 9% 11% 12% Bolton - Caledon 39,969 11% 11% 2% Mississauga Halton Halton Hills 61,801 12% 11% 3% Milton 94,626 8% 12% 1% Oakville 191,476 13% 14% 5% Northwest Mississauga 332,148 9% 13% 5% Southwest Mississauga 81,768 14% 11% 8% East Mississauga 300,335 13% 11% 21% South Etobicoke 116,022 17% 17% 11%

Fact 1: Senior Population and Socioeconomic Status Differ by Health Link Region

Fact 2: Senior Population Growth Varies Within and Across LHINs

34

Fact 3: Health Care Resources per Senior in MHCW LHINs are Among the Lowest in the Province

36

Fact 4: Health Care Resources per Senior in the MHCW LHINs Will Likely Fall in the Future Because of Faster Population Growth than in Other LHINs

Five Facts

37

• 1. Senior population and socioeconomic status differs by Health Link Region.
• 2. Senior population growth:
• in MHCW LHINs are among the highest in the Province.
• varies within MHCW LHINs.
• 3. Health care resources per senior in MHCW LHINs are among the lowest in

the Province.

• 4. Health care resources per senior will likely fall in the future since the senior

population is increasing faster than in other LHINS.

• 5. The next cohort of seniors is different from past cohorts of seniors

What to do?

What to do?

38

Traditional Needs Assessment Asset-Based Capacity Assessment What don’t we have? How can we strengthen and make best use

• f what we have?

Asset Based Plan: A Case Study of Brazil’s HIV/AIDs Epidemic

39

World Bank Questions World Bank Conclusions Brazil Questions Brazil Response

• What resources are

needed to:

• Provide treatment

to patients?

• Manage drug

therapies for illiterate patients?

• Assure compliance

with drug associated nutrition?

• Implement an

effective prevention program?

• Brazil needs a

sophisticated, integrated national health care system

• Brazil cannot afford

the resources to manage treatment compliance

• Brazil’s limited

resources should be focused more on prevention than treatment; it will take a long time to end the epidemic

• How can we:
• Reduce costs to

provide treatment to all in need?

• Communicate drug

therapy routines to homeless, illiterate patients?

• Ensure greater food

compliance by linking people with charities/food banks/ churches?

• Achieve prevention

goals while treating all currently infected?

• Used over 600 NGOs,

churches, and other community care

• rganizations
• Nurses drew pictures
• n pill bottle labels

and helped poorest people connect with NGOs and churches that offered free food

• Prevention education

delivered when people go to hospitals/clinics for treatment

• In 1990, the World Bank predicted that Brazil did not have the resources to resist HIV

infections and would have 1.2M cases of HIV/AIDS by 2000; instead it had 0.5M

Adapted from Zimmerman (2010). Getting to Maybe: Nurses as Social Innovators

Asset Based Capacity Assessment: Connecting Communities in Need to Available Resources

40

Other community assets include:

• pharmacies
• physicians
• religious institutions
• schools
• libraries

Community Asset Plan: Connecting Seniors to Local Assets

41

?

42

Expected Project Outcomes

Project Outcomes Understand Population Health Need Assess Community Assets Describe and Quantify How to Meet Population Need

Approach: Client Segmentation

43

Home Care Service Groups Short-Stay: Acute Short-Stay: Rehab No RAI Assessment Community Independence Chronic Complex End-of-Life Children

Segmentation by Care Setting, Service and Health Status: MH LHIN

Site Group % Seniors MH CCC All 0.7% LTC Intact Cognition 0.5% LTC Moderate Cognitive Impairment 1.4% LTC Severe Cognitive Impairment 1.3% ALSH All 1.3% Community IP Mental Health 0.2% Community Acute IP with Rehab 1.1% Community Acute IP with ED 4.5% Community Acute IP with HC 4.9% Community Acute IP Other 1.2% Community Home Care and living alone 0.4% Community Home Care, not living alone 5.7% Community At least one ED visit 12% Community At least one physician visit, 0 chronic conditions 6.2% Community At least one physician visit, 1-2 chronic conditions 36% Community At least one physician visit, 3 chronic conditions 17% Other 5.2% All Seniors 138,836

Source: DAD, NACRS, OMHRS databases, CCRS, RAI-LTC, RAI-HC, NRRS, Statistics Canada, ALSH statistical data; Fiscal year 2011/12.

Approach: Population Segmentation

45

Our segmentation approach expands the current methods to include: 1. People in need that did not access service 2. Health information accumulated across different settings, including CCAC, Long Term Care homes, hospital emergency, inpatient, rehabilitation, mental health and complex continuing care 3. Clinical segmentation that combines our constructed health profiles according to

• purpose. In particular the segments themselves are flexibly defined depending on the
• utcome that is being measured and managed.

Examples of Senior Segments

• 1. Healthy with Minimal or No Health Issues and Needs
• 2. Acutely ill, with likely return to health
• 3. Chronic conditions, with generally "normal" function
• 4. Significant but relatively stable disability, including mental disability
• 5. "Dying" with short decline
• 6. Limited reserve and exacerbations
• 7. Frailty, with or without dementia

Based on: Lynn J, Straube BM, Bell KM, Jencks SF, Kambic RT. Using population segmentation to provide better health care for all: The “Bridges to Health” model. The Milbank Quarterly. 2007 June;85(2):185-208.

46

Our Approach

Project Approach Literature and Experience Review Consultations Data Analysis Community Assets Population Health Describe and Quantify Approach to Meet Population Need

Steering Committee Members

47

Community Capacity Planning Steering Committee Membership LHIN Position Bill Macleod CEO, Mississauga Halton LHIN Scott Mcleod CEO, Central West LHIN (Co-Chair) Liane Fernandes Senior Director, Health System Development & Community Engagement, MH LHIN David Colgan Senior Director, Health System Integration Central West LHIN CCAC Caroline Brereton CEO, Mississauga Halton CCAC (Co-Chair) Cathy Hecimovich CEO, Central West CCAC Jim Wright Vice President, Corporate Services, Mississauga Halton CCAC Alan P. Iskiw Vice President , Finance & Technology, Central West CCAC Community Support Services Sushil Sharma Senior Program Manager, India Rainbow Ray Applebaum Executive Director, Peel Senior Link Valerie Quarrie Administrator, Dufferin Oaks Home for Seniors Citizens Angela Brewer Chief Executive Officer, Acclaim Health Community Mental Health and Addictions Services Radhika Subramanyan CEO CMHA Halton Nurse Practitioner Lori Brown Coordinator & NP NPSTAT, NP LTC Rapid Response Team, Trillium Health Partners Physicians Dr Samir Sinha Director of Geriatrics Dr Frank Martino Primary Care Lead Central West LHIN, Chief Family Practice, Osler, FHT family doctor, President Ontario College of Family Physicians Dr Dante Morra Chief, Medical Staff, Trillium Health Partners Public Health Units Joyce See Director, Community Health Services, Halton Region Health Department Janette Smith Commissioner of Health, Region of Peel Safia Ahmed Executive Director, Rexdale Community Health Centre

Consultations

48

We held 56 sessions, including roughly 200 participants Sample of session groups: 1. Senior centre users 2. Central West Palliative Care Network 3. Mississauga Halton Transportation Working Group 4. Caregiver First Collaborative 5. Peel Emergency Medical Services 6. Mississauga Halton Behavioural Working Group 7. Central West Cultural Services / Diverse Communities 8. Family Health Teams 9. Health Links

• 10. Ontario Association of Non Profit Homes and Services for Seniors
• 11. Community Health Centres
• 12. Mississauga Halton Adult Day Services

At all sessions, participants: 1. Were engaged and enthusiastic 2. Provided clear and relevant information 3. Suggested innovative ideas

Important Topics from the Consultations

49

• 1. Long Term Care
• 2. Home Care
• 3. Informal care, including respite care and caregiver supports
• 4. End of life and palliative care
• 5. Housing
• 6. Transportation
• 7. Adult Day Programs
• 8. Medication management
• 9. PSW training and skill, particularly related to dementia and behaviours
• 10. Coordination of care between providers, including transitions
• 11. Chronic disease management and prevention
• 12. Needs of people with mental health conditions
• 13. Needs of people with developmental disabilities
• 14. Social connections
• 15. Matching programs and services with client’s cultural preferences
• 16. Service boundaries
• 17. Technology and telemedicine
• 18. Information exchange between providers
• 19. Built environment
• 20. Home modifications and renovations

How are we using the information from the consultations?

50

For all topics, the report will: 1. Summarize what we learned from the consultations 2. Summarize what is known from the grey and peer reviewed literature 3. Include statistics from our data collection The steering committee chose priority topics for additional data analysis: 1. Long Term Care 2. Assisted Living and Supportive Housing 3. Home Care 4. End of Life 5. Informal Care 6. Transportation 7. Adult Day Programs The data analysis will: 1. Analyze services, population segments, and assets 2. Estimate the size and cost of service gaps by segment and geography 3. Inform recommendations for resource allocation

Some Themes of Focus

51

For the rest of the presentation, we will highlight some of our findings on these topics:

• 1. Informal Care
• 2. End of Life
• 3. Long Term Care Substitution
• 4. Home Care Population Based Planning

End of Life: Changes in End of Life Use

• f Hospitals by LHIN 2008/09 to 2012/13

52

LHIN 2008 2012 Central West 0.89 0.90 Mississauga Halton 0.95 1.18 Ontario 1.0 0.94

Source: RPDB 2011/12, 2012/13; DAD 2008/09 to 2012/13

Expected days are standardized using the 2008/09 inpatient days per capita and each Health Link’s standardized mortality ratio Across the province, standardized inpatient days for deaths fell by 6 percent Mississauga Halton LHIN’s days increased substantially

Actual to Expected Hospital Inpatient Days for Decedents 65+

End of Life: Health Link Variation in Death Setting: By Diagnosis

53 Source: 2012/13 RPDB, DAD, RAI-LTC

The proportion of deaths by setting varies by LHIN, Health Link, and diagnosis Compared to Mississauga Halton, Central West’s cancer decedents have a higher probability of dying in hospital and a lower probability of dying in a community setting

Cancer Setting 2012/13 Deaths Acute LTC Other Central West LHIN 1,179 66% 3% 31% Oakville 318 42% 3% 55% Northwest Mississauga 403 67% 3% 31% Mississauga Halton LHIN 1,912 56% 2% 41% Provincial Average 24,507 55% 3% 42%

End of Life: Simulating Out of Hospital Deaths Under Better Practice

54

At the practice of the reference LHINs, Central West would have had 461 fewer deaths in hospital, 78 more deaths in LTC, and 383 more deaths in the community. Central West decedents would have used 20 fewer acute IP beds. Some Health Links in both LHINs are very near the distribution of the reference LHINs.

Decrease in Deaths by Setting Decrease in Acute IP Days (beds) Health Link Acute LTC Other Central West LHIN 461

• 78
• 383

6,588 (20) Oakville

• 3
• 23

26

• 55

Northwest Mississauga 153

• 17
• 136

2,923 Mississauga Halton LHIN 434

• 151
• 283

7,908 (24) CW and MH LHIN Total 896

• 229
• 666

14,497 (44)

Informal Care: What we learned at the consultation sessions

55

What did we hear about informal care during the consultations?

• 1. Informal care can delay admission to LTC
• 2. Caregivers need more support, including
• 1. More respite care, both in-home and short term residential
• 2. Better access to adult day programs for care recipients
• 3. More social connections
• 3. Caregivers need training, particularly on caring for patients with

dementia, Alzheimer’s, and behaviours

Informal Care: Relationship of Caregiver

56

Who provides informal care?

Source: RAI LTC 2012/13

Share of Total Informal Hours Relationship of Primary Caregiver to Recipient Central West Mississauga Halton Child 54% 48% Spouse 35% 41% Other Relative 9% 10% Friend/Neighbour 2% 2%

Compared to Mississauga Halton, a higher proportion of total informal care is provided by the children of clients in the Central West LHIN Variations in the share of informal hours by relationship to client will have implications for the future supply of informal care

Informal Care: Health Link Variation in Informal to Formal Care Ratios

57

Health Link PSW Hours Informal Care Hours Informal Hours per Formal Hour Dufferin Area 68,153 227,091 3.3 NE-M-WW 269,306 1,227,235 4.6 Central West LHIN 784,753 3,306,466

4.2

Milton 53,181 163,761 3.1 Oakville 246,517 381,404 1.5 Mississauga Halton LHIN 1,430,680 3,685,224

2.6

Informal Care: Formal and Informal Care Gaps: Now and in the Future

58

Informal Care: Closing the Gaps: Estimated Costs by LHIN

59

To close the gap in formal care and assuming 1,600 hours per year per PSW:

• Central West LHIN will need 730 more PSWs in 20 years
• Mississauga Halton wiil need 1,330 more PSWs in 20 years

Current Formal Care Central West Mississauga Halton 2012/13 CCAC Cost of PSW Hours $23,500,000 $42,900,000 Future Formal Care 2032/33 Cost to Care for 2032 Population at 2012 PSW Hours per Person $58,400,000 $107,200,000 Future Formal Care Gap $34,900,000 $64,300,000 Future Informal Care 2032/33 Forecast 2032 Demand in Informal Care (hours) 8,200,000 9,200,000 Forecast 2032 Supply of Informal Care (hours) 5,500,000 6,600,000 Future Informal Care Gap (hours) 2,700,000 2,600,000 CCAC Cost to Close Informal Care Gap $81,900,000 $78,600,000

Informal Care: Increasing the Supply of Informal Care A Start: Bill 21

60

Informal Care: How can the gaps between demand and supply be reduced?

61

Sample of ways to reduce demand and supply gaps in formal and informal care 1. Substitute formal for informal care by providing more CCAC funded PSW hours 2. Increase use of privately funded PSW care 3. Increase supply of informal care hours through initiatives to: a. Increase the number of informal caregivers b. Increase hours per caregiver 4. Reduce demand through: 1. Use of technology 2. Primary and secondary prevention 3. Care coordination and system navigation 4. Chronic disease management 5. Delaying disease onset

62

• Many jurisdictions have implemented policies to increase the

number of seniors that return to the community following LTC home admission

• For example, States with mature nursing home transition

programs have managed to relocate 25% to 35% of their nursing home residents to assisted living*

• Two important policy components:
• identify people who could be transferred back to the

community

• ensure that care needs are met after the transition

*Susan C. Reinhard Health Affairs, 29, no.1 (2010):44-48 Diversion, Transition Programs Target Nursing Homes' Status Quo

Long Term Care Substitution: Community Transitions

63

• Most MH LTC homes are below the provincial average Low Care prevalence
• Low Care prevalence varies across CW and MH LTC homes

Long Term Care Substitution: Low Care

Two Methods of Population Based Home Care Planning

Population Based Planning

• 1. Demographic Model
• Age, Gender and Income
• Independent of LHIN CCAC allocation
• Does not account for population morbidity beyond

demographics

• No clinical detail to understand variance within LHIN
• 2. Clinical Model
• Age, Gender, Clinical Characteristics
• Independent of LHIN CCAC allocation
• Clinical detail to understand variance within LHIN

64

Demographic Model: Risk Groups

Source: Home Care Database 2012/13, Statistics Canada Population Data

66

Demographic Model: Home Care Cost Variance by Age

Source: Home Care Database 2012/13, Statistics Canada Population Data

67

Actual to Expected Home Care Costs: Demographic Model

Only persons aged 65+ Source: DAD 2011/12 to 2012/13, NACRS 2011/12 to 2012/13, Home Care Database 2011/12 to 2012/13 Central West: 0.84 Mississauga Halton: 1.05

Clinical Model: High Home Care Cost Conditions

68 Principal Problem Provincial Home Care Cost, 2011/12 to 2012/13 People, 65+, 2011/12 Home Care Cost per Person MOTOR NEURON DISEASE : ALS $6,254,508 357 $17,520 TRACHEOSTOMY COMPLICATION $2,478,565 236 $10,502 GASTRIC TUBE : MANAGEMENT & REMOVAL $10,076,963 986 $10,220 DIABETES : WITH FOOT ULCER $20,423,931 2,248 $9,085 MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA $8,056,090 1,003 $8,032 CARE PROVIDER DEPENDENCY $18,506,971 2,313 $8,001 CHRONIC SKIN ULCER $49,419,972 6,308 $7,834 DIABETES : WITH PERIPHERAL ANGIOPATHY AND GANGRENE $2,039,774 261 $7,815 PARKINSON'S DISEASE $11,940,932 1,624 $7,353 VARICOSE VEINS : WITH DEEP VEIN THROMBOSIS $3,531,176 492 $7,177 OSTEOMYELITIS $8,577,149 1,277 $6,717 POST PROCEDURAL URINARY INFECTIONS $3,446,216 518 $6,653 Sources: DAD 2011/12 to 2012/13, NACRS 2011/12 to 2012/13, Home Care Database 2011/12 to 2012/13

Clinical Model Example: Client Severity and Home Care Cost

69 Principal Problem Provincial Home Care Cost, 2011/12 to 2012/13 People, 65+, 2011/12 Home Care Cost per Person DIABETES : TYPE 2 WITHOUT COMPLICATIONS OR WITH MINOR COMPLICATIONS $40,146,508 52,022 $772 DIABETES : WITH PERIPHERAL ANGIOPATHY $23,685,437 17,591 $1,346 DIABETES : WITH NEUROLOGICAL COMPLICATIONS $1,506,161 1,001 $1,505 DIABETES : WITH RENAL COMPLICATIONS $7,281,119 2,660 $2,737 DIABETES : WITH PERIPHERAL ANGIOPATHY AND GANGRENE $2,039,774 261 $7,815 DIABETES : WITH FOOT ULCER $20,423,931 2,248 $9,085 Sources: DAD 2011/12 to 2012/13, NACRS 2011/12 to 2012/13, Home Care Database2011/12 to 2012/13

Clinical Model Example: Client Complexity and Home Care Cost

70 Principal Problem Comorbid Clinical Condition or Secondary Procedure Provincial Home Care Cost, 2011/12 to 2012/13 People, 65+, 2011/12 Home Care Cost per Person DIABETES : WITHOUT COMPLICATIONS OR WITH MINOR COMPLICATIONS $40,146,508 52,022 $772 None $2,918,140 4,637 $629 Anemia $1,253,359 1,706 $735 Kidney and Urinary System $1,453,556 1,759 $826 Heart $2,650,187 2,057 $1,288 Renal Failure $790,899 273 $2,897 DIABETES : WITH PERIPHERAL ANGIOPATHY $23,685,437 17,591 $1,346 None $1,643,868 1,465 $1,122 Aftercare $1,085,732 799 $1,359 Endocrine, Nutritional and Metabolic System $641,577 326 $1,968 Kidney and Urinary System $1,567,680 471 $3,328 Dialysis $462,215 132 $3,502 Sources: DAD 2011/12 to 2012/13, NACRS 2011/12 to 2012/13, Home Care Database 2011/12 to 2012/13

Clinical Model: Summary Statistics

Per Person, Ontario Fiscal Years 2011/12 and 2012/13 Clinical Group People, 2011/12 Home Care Cost LTC Admissions Hospital Days Hospital ALC Days 1 5,342 $102 0.00 0.8 0.0 2 34,242 $225 0.00 1.3 0.1 3 180,618 $538 0.01 2.6 0.3 4 98,763 $1,103 0.03 6.2 0.7 5 36,995 $1,779 0.05 10.4 1.2 6 70,906 $2,449 0.07 14.7 2.1 7 40,897 $3,262 0.11 21.3 4.2 8 30,780 $4,368 0.18 26.0 6.9 9 14,938 $4,919 0.30 34.9 13.0 10 6,423 $6,235 0.30 33.6 11.9 11 2,620 $6,918 0.28 33.6 11.5 12 3,739 $7,648 0.28 40.9 13.4 13 1,280 $8,520 0.21 41.7 11.8 14 567 $9,314 0.26 39.7 12.1 15 390 $10,861 0.26 50.4 19.0

Only ages 65+ Sources: RAI-LTC 2011/12 to 2012/13, Home Care Database 2011/12 to 2012/13, DAD 2011/12 to 2012/13, NACRS 2011/12 to 2012/13

Variation in Home Care Cost by Clinical Group

72 Sources: RAI-LTC, Home Care Database, DAD, NACRS 2011/12 to 2012/13

Ratio of Actual to Expected Home Care Cost Diagnosis Share of Total Home Care Cost Central West Mississauga Halton Aftercare 5% 1.13 1.16 Arthritis And Musculoskeletal 13% 1.04 1.04 Circulatory System 5% 0.84 0.84 Diabetes 5% 0.80 1.18 Digestive System 7% 1.10 1.18 Endocrine, Nutritional And Metabolic System 4% 0.90 1.03 Heart 4% 0.70 0.75 Injuries, Poisoning And Toxic Drug Effects 3% 1.07 1.11 Kidney And Urinary System 12% 0.81 1.09 Malignancy 3% 0.88 0.85 Mental Diseases And Disorders 9% 1.03 1.21 Nervous System 5% 0.79 1.14 Respiratory System 7% 0.73 1.06 Skin And Subcutaneous Tissue 4% 0.81 1.14 Vision And Eyes 3% 0.74 0.63 All Diagnoses 100% 0.89 1.04

Percent PSW and Home Care Cost

73

What’s Next

74

Step Completion Analysis July 2014 Stakeholder Information Sessions July 2014 Report August 2014 Capacity Planning Tool September 2014

Primary Care Integration Strategy

Carie Gall, Executive Lead, MH LHIN

75

Primary Care Integration Strategy

Quarterly Sector Meeting - June 25, 2014 Carie Gall & Lara DeSousa

77

Improve access to family health care

• Attaching patients; Same/next day appointments;

After hours; Home visits; Multi-disciplinary healthcare teams Increase linkages between family health care and

• ther health care providers to improve

communication, coordination and integration across the continuum of care

• Health Links; Improve coordination of care;

Increase capacity/access to specialists; Timely information sharing; Leverage technology

78

Current State

Primary Care Integration Strategy

Integration

• f Primary

Care

Awareness Capacity Access

Primary Care Integration Initiative

Primary Care Provider Data Base Mississauga Halton Primary Care Network Primary Care Advisors

Primary Care Data Base

• Significant demand to communicate with primary care
• Need a single resource that can be centrally updated and

maintained but used throughout the LHIN

• Development of physician profiles will allow individualized

engagement for future activities

Question: Beyond the need to communicate with primary care

physicians, does your sector have any specific needs related to physician profiles?

Mississauga Halton Primary Care Network

• Provides the structure to support physician capacity building

and engagement

• Provides forum to organize the voice of primary care to

articulate regional issues

• Provides centralized method for reaching out to and

communicating with primary care

Opportunity: CSS & MHA agencies can share program

information with primary care providers or seek input from providers when developing new programs/services.

Primary Care Advisors

• Geographically assigned team of 5 members housed at CCAC
• Will establish connections with primary care through office visits

and individualized communications

• Will gain an understanding of physicians’ interests and needs &

support development of appropriate linkages

• Inform primary care of LHIN wide programs & resources,

primary care focused and system wide initiatives

• Engage primary care to support achievement of system goals

Question: What opportunities can we leverage to bring these

staff up to speed on your program/service offerings? Who is the key contact for your organization?

Advance Care Planning and Health Care Consent

Carol Sloan, Director, Acclaim Health

MH LHIN Community Sector Meeting June 25, 2014 Health Care Consent & Advance Care Planning Carol Sloan Director, Palliative Care Consultation Acclaim Health

The Palliative Care Consultation consultants (or Palliative Pain and Symptom Management Consultants as we are known in some areas) help build capacity among all front line service providers in the provision of hospice palliative care. Our program covers the regions of Halton, Peel & Dufferin. We promote hospice palliative care learning among front line health care providers by facilitating the integration of evidenced based knowledge into clinical practice. We do not provide direct care. We collaborate at local, provincial and national levels.

 The Fundamentals of Hospice Palliative Care  Advanced Hospice Palliative Care Education

(AHPCE) for support workers

 Comprehensive Advanced Hospice Palliative

Care Education (CAPCE) for RPNs, RNs, APNs, NPs

 Assessment and Management of Pain (new

pilot program)

• A process
• cess of reflection and communication
• The communication of wishes

shes (verbal, written

• r otherwise)
• A way to let others know your future health and

personal care wishes shes

• A time to consider who will speak for you when

you are no longer capable of directing your care (SDM)

Research has shown that:

 If you have expressed your wishes in

advance, you are much more likely to have your end-of-life care wishes known and followed

 Your family members will have less stress and

anxiety because they will know your wishes

 You will be more satisfied with your care as

will your family and your Substitute Decision Maker(s)

 You will have a better quality of life and death  Most of us hope that we will be able to

communicate until the very end, but in reality most deaths do not occur that way so we need to communicate our wishes now while we can.

 It also means for us as health care providers

that we are providing client centred care. This means that the person is more likely to not have to go to the local ER because they are receiving the care that they want, where and when they want it.

 It is all about communication!!!

Many people get confused about Health Care Consent requirements and how it interfaces with Advance Care Planning. Do you think that if you plan for care in the future based on your current medical condition it is Advance Care Planning? This is not Advance Care Planning, this is consent. Only the person themselves can advance care plan, Substitute Decision Maker(s) can only interpret the persons prior expressed wishes and provide the health care provider with consent.

Provincially, I have been involved with the Health

Care Consent and Advance Care Planning Community of Practice (CoP) now sponsored by Hospice Palliative Care Ontario (HPCO). This Community of Practice has worked collaboratively with the Canadian Hospice Palliative Care Association to adapt their Speak Up- Start the conversation about end-of-life care workbook to an Ontario version which meets with Ontario Health Care Consent law. Laws differ from province to province, so we needed something specific to our laws.

Part of our work was the development of two different PowerPoint's and accompanying facilitation guides to assist in the understanding of Health Care Consent and Advance Care Planning for both the public and the health care provider. Anyone may take these presentations and use them.

 These tools can be found on our website

http://www.acclaimhealth.ca/menu- services/palliative-care- consultation/resources/advance-care-planning/

 HPCO Website http://www.hpco.ca/acp-hcc-hsp/  CHPCA website

http://advancecareplanning.ca/making-your- plan/how-to-make-your- plan/provincialresources/advance-care-planning-in- relation-to-health-care-consent-training- materials.aspx

The Health Care Consent and Advance Care Planning Community of Practice worked collaboratively with HPCO who sought out funding to produce some videos for educational purposes. We are fortunate to say that the MH LHIN assisted in sponsoring part of the editing for one of the presentations and funded the production of putting these videos onto DVDs to share with primary care providers for their use.

There are 4 individual video presentations on each DVD:

1.

Health Care Consent in Relation to Advance Care Planning for Health Care Providers

2.

Advance Care Planning and Health Care Consent in Ontario: Making Your Wishes Known

3.

Speak Up Ontario: Train The Trainer

4.

Health Care Consent and Advance Care Planning for Health Care Practitioners with a focus for physicians

If at any time you wish for one of the consultants to facilitate an educational session for you please contact us at our

• ffice.

905-827-8111

MH LHIN Falls Prevention Strategy

Michelle Collins, Senior Lead Health System Performance

Living with Osteoporosis: Education & Exercise Program

1.

Why?

2.

Targeted Groups

3.

When and where

Introduction

 1.5 million Canadians 40 years of age or older

(10%) are reported to have been diagnosed with

• steoporosis, and 1 in 5 Canadians over the age of

40 have reported having had a fracture. (Community Health survey from Statistics Canada in 2009 )

 The overall yearly cost to the Canadian healthcare

system of treating osteoporosis and associated fractures was over $2.3 billion as of 2010.

Why

 Those that are at Risk  Those that have been diagnosed with Osteopenia  Those that have been diagnosed with

Osteoporosis

 Those with a history of Osteoporosis or

Osteopenia

Target Groups

 Improved knowledge of Osteoporosis and Osteopenia

and associated risk factors

 Implementing prevention and management strategies

into activities of daily living

 Complete a home safety assessment that will draw

attention to potential home hazards

 Complete a Medscheck Review with a registered

Pharmacist

 Participate in a Fracture Prevention Exercise program

Program Goals

 2 streams – Primary and Secondary  Primary Stream is a 12 week program with:

 A pre and post assessment  Exercise  Education Classes  Med Review with a Pharmacist  Home Safety Assessment  Educator from Osteoporosis Canada  Follow up to determine knowledge transfer – 6 months &

12 months

Program Overview

 Primary Stream Topics include:

 Importance of exercise, nutrition,  Pain Relief  Fracture prevention strategies including safe body

mechanics, safe house and yard work techniques

 Secondary Stream

 Exercise specific to increasing bone mineralization

and falls prevention

Program Overview

 Program launches July 7th in 20 sites across the

MHLHIN region

 Call MODC 1-877-427-6990 to register

When and Where

Thanks for your Participation

Complete the Feedback Form Next Meeting Date: September 24, 2014