An Overview for the Senior Environment in Ontario and

Canada

Candace Chartier, CEO

Safe Haven Consulting Inc.

A System Under Strain: Key FindingsPremier’s Council on Improving Health Care and Ending Hallway Medicine released first report in late January

• Patient and caregiver stress is increasing. Wait times too long.

• System does not have the appropriate mix of services, beds, or digital tools to be ready for the projected increase in complex care needs and capacity pressures.

• Needs to be more effective coordination of services, both at system-level and patient-level. Health care system not efficient.

Changes to health care

• Bill 74 (The People’s Health Care Act) acclaimed. New “Super Agency” Ontario Health, will absorb/replace LHINs and many health care agencies.

• Goal is to reduce and restructure bureaucracy that currently manages the flow of money between MOH and providers such as hospitals and long-term care

• “MyCare Groups” Ontario Health Teams of providers that form a unit to provide care

• Digital Health is a priority, improving access to secure digital tools, including online health records and virtual care options for patients Susan Fitzpatrick

Interim CEO Ontario Health

MyCare Groups (Ontario Health Teams)

• Integrated care delivery and funding

• Groups of providers are held clinically and fiscally accountable for delivering coordinated care to a group of patients or region

• Public reporting on performance

• Similar systems exist in the US

Current Environment

Long Term Care Plus

POST-ACUTE CARE MODEL

• short term intensive nursing and rehab care for medically complex and injured or disabled older adults

• follows a hospital stay• focus is on stabilizing or improving the person’s condition

so they can return home

Long Term Care Plus

THE HUB MODEL

• long-term care home is the centre for delivery of a wide range of seniors’ services, some located in the home and others managed by the home

• could include primary care, chronic disease management, rehabilitation, adult day/night programs, and specialized geriatric services

• particularly well suited to homes in smaller

communities or rural and northern areas

Long Term Care Plus

CONTINUUM OF CARE MODEL

• many long-term care providers also offer retirement homes on the same site

• providers that currently have these continuums of care could also offer a variety of integrated health care and support services for seniors

Long Term Care Plus

DESIGNATED ASSISTED LIVING MODEL

• long-term care homes are caring for residents with much higher physical and cognitive needs than even five years ago

• seniors with a lesser degree of physical and mentally frailty need a protected environment where they can live independently with assistance and publicly funded services

Long Term Care Plus

SPECIALIZED CARE MODEL

• a higher level of care for populations with special needs

• includes those with late stage dementia, severe mental illness and addictions, and those at the end of life

• offers a blend of medical and social care, with an emphasis on specialized care, pain and symptom management, quality of life, and family support

Solid line is Ontario;

dotted line is Canada

overall

Ministry falls prevention strategy: ideas• Falls are climbing - Ontario

is now among highest in Canada

• Ministry developing LTC falls strategy

• Ministry seeking to enhance their fall

• Ministry looking for innovative solutions and successful programs from vendors and homes

Ministry falls prevention strategy: goalsObjectives:

•Reduce the number of falls•Reduce the number of fall-related injuries•Reduce transfers to hospital emergency department from LTC•homes•Reduce avoidable hospitalizations of LTC residents•Promote increased mobility and quality of life for residents The LTC Falls Prevention Strategy will also help

deliver on a key government priority of reducing hallway health care.

Falls and ED visits•In Ontario, there were approximately 1,000 ED visits from LTC residents per month.

•Overall, 18% (or approximately 1 in 5) of all ED visits for LTC residents in Ontario were related to falls.

•Direct costs of these ED visits were at least $4.5 Million.

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LTC Strategies to End Hallway Health Care

1. Improving and innovating on LTC program supports will reduce the flow of LTC residents into

hospitals.

2. Adding new LTC capacity where it is needed and ensuring the appropriate level of service is

available will increase system flow into LTC homes.

3. Refining eligibility and making improvements to the placement process will ensure that applicants

are placed faster and LTC capacity is maximized.

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Delivering on Government Commitments & Priorities

Expanding access to specialized services, enhancing resident experience and ensuring resident safety

Expansion of non-invasive mechanical ventilation to long-term Care

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• The ministry is considering further extension in ADP policy to enhance support for medically complex residents who require non-invasive ventilation (NIV) and Cough Assist Devices (CAD).

• Under the current ADP policy as of January 2019, to receive life-support equipment from Ventilator Equipment Pool (VEP), the residents of Long-Term Care (LTC) homes are not eligible to receive VEP-provided life-support equipment.

• In December 2018, the ministry convened a Program Engagement Meeting to discuss options to expand access to NIV in LTC, including an overview of VEP, the current and future patient journey, and training requirements to placement. This group will reconvene in February 2019 to discuss user pool estimates and process mapping.

• These program meetings will be used inform ongoing ministry discussions of amending current ADP policy and how a future program could be successfully delivered.

The ministry is considering further extension in ADP policy to enhance support for medically complex residents who require non-invasive ventilation (NIV) and Cough Assist Devices (CAD).

caltc.ca

Caring for Canada’s Seniors

Opportunities for meeting the needs of an aging population

Population estimates for 2015 indicated that the number ofpersons 65 and older outnumbered those under the age of 15.

Current Trends

Canadian Association for Long Term Care | caltc.ca

Source: Statistics Canada. Population Projections for Canada (2013 to 2016), Provinces and Territories (2013 to 2038)Source: Statistics Canada. Canada year book 2012, seniors.

Residents are more frail and need complex care.

Our seniors are living longer and coming into long-term care at a later stage oflife, with more complex health issues and more physically frail.

Current Trends

20.9

70.8

58.3

39

25.561.5

3.40.2

1.7

0.6

0.6

1.4

0 10 20 30 40 50 60 70 80

Gastrointestinal Disease

Hypertension

Diabetes

% of assessed long-term care residents

Prevalence as of 2015-2016

Source: Canadian Institute for Health Information, Continuing Care Reporting System (CCRS 2011-2012 and CCRS 2015-2016)

Canadian Association for Long Term Care | caltc.ca

CIHI: Top 5 Reasons for Hospitalizations

So What Does This Mean?Timing is critical:

Same trends across the country, same pressures, more focus on alignment related to quality programs and innovations (CIHI, Digitalization, etc.)

Federal government feeling the pressures of an aging population and need to work with provinces (Dementia Strategy, End of Life Strategy)

Commercial industry aligning Value ads to address the pain points operators are facing in a new fiscally restrained environment

Recognizing the day to day challenges in a LTCH and how their products and/or programs can alleviate some of those pressures (i.e., falls, wounds, ED transfers)

Ontario Long Term Care

627 homes are homes licensed and approved to operate in Ontario, this is going to increase over the next five years

77,574 long-stay beds are allocated to provide care, accommodation and services to frail seniors who require permanent placement, this government is adding 15,000 beds over the next 5 years and committed to an additional 15,000 beds within the next 10 years

619 convalescent care beds are allocated to provide short-term care as a bridge between hospitalization and a patient's home, this is going to change and increasewith the introduction of LTC+ (additional models of care)

Ontario Long Term Care

343 beds are allocated to provide respite to families who need a break from caring 24/7 for their loved one, this is going to increase due to new Care Giver Strategy and models of care

Average time to placement is 161 days, Wait list for long-stay beds is 33,080, this has to end and is this governments mandate to end Hallway Medicine and LTC is right at the center

Business planning is happening right now with a major provincial digital strategy, Virtual Long Term Care, Focus on Home Care-putting patient at the centre

OHT focus: If they include at a minimum hospital, Home Care, Community Care, Primary Care and Long Term Care Services will be prioritized at application stage

Ontario’s long-term care homes.

626licensed homes

58% of homes are privately owned

24% are non-profit/charitable

16% are municipal

77,343 long-stay beds provide care,

accommodation and services to frail seniors who require permanent placement

652 convalescent care beds provide short-term care as a

bridge between hospitalization and a

patient's home

348 beds provide respite to families

who need a break from caring 24/7 for their

loved one

About 40% of long-term care

homes are small(96 or fewer beds)

47% are located in rural communities that often have limited home care

or retirement home option

32,835Ontarians were waiting for a long-term care bed

as of April 2018.

Long-term care is at a tipping point.

90%of the residents in our long-term care homes have some

form of cognitive impairment.

15 yearsof unaddressed challenges left by the previous government.

The numbers:

What can we do about it.To enable a system-wide solution, government must do three things better than it has in the last 15 years.

1. Hire more staff.

2. Build and modernize homes.

3. Focus on care, not on unnecessary government paperwork.

Government must help us to:

Homes have not been able to utilize flexible approaches to staffing.

80% of homes surveyed reported difficulty filling shifts and 90% experienced challenges recruiting staff.

The previous government BSO program does not provide residents with consistent and timely on-site mental health supports they need.

HR challenges significantly affects staff morale and increases workplace stress.

Hire more staff.Understaffed homes, overworked staff and rising rates of dementia and clinical complexity are putting a strain on today’s long-term care workers.

Half of Ontario’s long-term care homes need to be rebuilt.

We will need to modernize or rebuild 30,000 beds before the operating licenses expire in 2025 just to maintain the numbers we currently have.

Older homes do not meet the needs of residents with a high incidence of cognitive impairment, dementias and Alzheimer’s disease.

The program implemented by the previous government to encourage building failed to allow many long-term care operators to redevelop homes that needed to be rebuilt.

Build and modernize homes.Ensuring safety and quality of care that meets the needs of residents by rebuilding today’s homes and increasing capacity for tomorrow.

It takes significant staff resources to complete forms, enter data, and undergo inspections.

Reporting requirements introduced by the Long-Term Care Homes Act only adds to what is already required by professional colleges and standards of practice.

The cost of doing two common types of reporting is estimated to consume more than 1 million care hours and $50 million annually.

Ontario is performing better than other provinces in key areas of quality.

Focus on care, not on unnecessary government paperwork.Overregulation and compliance measures are affecting direct care hours.

Growing demand, not enough capacity and dated supply – LHIN level Feb 2019

www.oltca.com/BetterSeniorsCare

LHINTotal Beds

in LHINTotal Beds to

RedevelopWait List

Average Days to Placement

Toronto Central 5,878 2,961 2,479 227

Central 7,247 2,717 4,661 201

Central West 3,505 953 947 155

Central East 9,682 4,477 6,674 289

Mississauga -Halton

4,163 1,144 2,246 153

HNHB 10,678 4,005 2,894 121

South West 7,376 3,594 1,566 99

South East 4,070 1,980 1,301 152

Champlain 7,591 3,124 3,429 219

Growing demand, not enough capacity and dated supply – LHIN level Feb 2019

LHIN Total Beds in LHIN

Total Beds to Redevelop

Wait List Average Days to Placement

Waterloo Wellington

4,142 1,387 1,647 151

Erie St Clair 4,606 1,244 675 97

North Simcoe Muskoka

3,066 832 1,829 177

North East 5,085 1,962 1,947 133

North West 1,865 369 785 156

Ontario Total: 78,954 30,749 33,080 161

Resident profile update – continued Percentage of residents who need extensive or complete support:

Source: Canadian Institute for Health Information, Continuing Care Reporting System 2011-2012 and 2016-2017.

Resident profile update – continued Majority of residents need help with activities of daily living Increased needs are accompanied by a need for more staff time, skills, and resources

Source: RAI-MDS 2011-12 to 2016-17, Ontario Ministry of Health and Long-Term Care, Intellihealth Ontario.

Funding Model (As of August 2013) $ Per Bed Per Day

Nursing and Personal Care @ 1.00 CMI $88.93

Program and Support Services $8.87

Raw Food $7.80

Other Accommodation $52.76

Total $158.36

At 1.00 CMI

Ontario Level of Care Funding±$176.76 per resident per day (July 1, 2018)

Nursing & Personal Care

Program & Support Services

Raw Food Other Accommodation

±$100.91 $9.79 $9.54 $56.52

Salaries & Benefits of

direct care staff, nursing

and medical equipment

(including lifts, surfaces

if approved by Doctor)

and supplies, medical

director fees. Envelope is

case mix adjusted and

reconciled annually.

Salaries & benefits of

program staff, dieticians,

therapy & recreation

equipment and supplies,

program-specific food

costs & pastoral care.

Envelope is reconciled

annually

Costs of raw food

including approved

nutritional supplements.

Excludes cost of food

preparation. Envelope is

reconciled annually.

Salaries & wages,

equipment (eg: beds,

bathing, equipment) and

supplies for dietary,

laundry and

housekeeping (including

infection control):

indoor/outdoor

furnishings; maintenance

and operating costs;

administration costs

• The model is based on four envelopes described above. Funding is provided to each envelope for the home to cover the cost of specific types of services and items. The NPC funding envelope is adjusted based on the acuity levels of residents.

• Profit and funds to service debt is only available from OA unspent funds and preferred revenue. All unspent funds in NPC, PSS and Raw Food must be returned to the Ministry.

Funding approach

Hot topics – clinical issues

Key projects underway to support innovation in LTC

LTC eConnect

Working to connect 20,000 clinical users from 500+ LTC homes with one-touch, secure access to provincial EHRsSolution is expected to reduce duplicate orders, eliminate unnecessary paperwork and follow-up calls, and support better clinical decision-making

Clinical Support Tools

Clinical Support Tools include care plan items for nursing staff; tasks for PSWs; structured progress notes to support interprofessional communicationGuidelines currently in development for diabetes, dementia, incontinence, wound care, end-of-life, COPD, and seasonal influenza/respiratory virus prevention.

Virtual Care

How does care follow the patient across the continuum?

Thank you.Any questions?