WELCOME 7 June 2013. Ontario Telehealth Network Ground Rules Meeting Procedures

WELCOME7 June 2013

Ontario Telehealth Network Ground Rules

Meeting Procedures

ISSUE WORKING GROUPSPrimary Care

Attendant ServicesRespiratory Supports (deferred)

UPDATE: ONF Funded Projects

on Primary Care

Dr. Tara Jeji(slides to be presented at the meeting)

Engagements of Waves 1 to 3

Nathan Hauch

Accessibility of Family Health Teams –

Hi-Lo Tables & Ceiling Track Lifts

CONTEXT

• The Canadian Disability Policy Alliance and SCI Ontario have been working with the Ministry of Health and Long-Term Care to enhance accessibility to Family Health Teams (FHTs) by increasing the number of:– Accessible exam (Hi-Lo) tables; and– Ceiling track lifts

• MOHLTC provided some cost-sharing with FHTs

• Waves 4 and 5 – had been contacted previously; whereby they were encouraged to make requests for the equipment

FINDINGS

• With thanks to McMaster and SCI Action Canada for assisting with data collection:

• Between April and May of this year, Waves 1 to 3 – older FHTs – were contacted (124 to date)

• We were able to connect with 56 (40% response rate)

• Of these, 33 have tables, and 5 have tables and lifts

FINDINGS• Reasons for not making exam rooms accessible include:

– Building too old / requires extensive renovations– Physicians do not see the need / do not want to bear cost– No consumers with disabilities are part of the practice *

* Inaccessible practices are unlikely to receive requests from patients that require accessibility

• How the exam rooms are used:– General use by physicians and Nurse Practitioners– Used for specific procedures such as foot care; may also be used by allied

health professionals– Some rooms may require advance booking; patient needs to identify need

• Differences increased accessibility has made for practitioners:– Easier on backs for practitioners– Makes examination of consumers easier

FINDINGS

• Differences increased accessibility has made for practitioners:– Easier for consumers to transfer– Easier examination of consumers (e.g., PAP smears)– Increased dignity for consumers

• It appears that some FHTs in acute settings may use tables that are not part of the FHTs per se, but rather, part of the hospital at large.

NEXT STEPS

• Further analyze results, develop report tailored to:– Association of Family Health Teams of Ontario– Ministry of Health and Long-Term Care– Consumers

• Engage FHTs without tables and lifts – particularly those that are physically accessible – to expand range of accessibility

• Obtain feedback on non-respondent FHTs via SCI Ontario staff and Ontario SCI Solutions Alliance members

Advocacy Initiatives in Attendant Services (2011-13)

WHERE WE’VE BEEN…AND WHERE WE WANT TO GO

PETER ATHANASOPOULOS

LEAD PARTNER

• Through the leadership of the Ontario Community Support Association, SCI Ontario, the Ontario SCI Solutions Alliance and other organizations have engaged service providers and partners in government to champion increased investments in attendant services.

OTHER PARTNERS INVOLVED

Provincial Attendant Services Advisory Committee• Centre for Independent Living Toronto• Cheshire (London)• March of Dimes Canada• Multiple Sclerosis Society• Muscular Dystrophy Canada• Ontario SCI Solutions Alliance, Regional Alliances• Personal Choice Independent Living (Toronto)• PHARA

OUR APPROACH

• Our approach has been to “feed the bottom to the top” by making some local LHINs aware of the needs of non-seniors with disabilities in the community.

• At the same time, we have meet with Ministry of Health and Long-Term care and Ministry of Finance to indicate the provincial nature of access challenges to attendant services.

• We have shown how attendant services provide “bang for buck” in terms of policy outcomes (such as reducing Emergency Department admissions) in a cost-effective manner.

• Describing what happens when attendant services is not available

ENGAGING DECISION MAKERS – 2011 PROVINCIAL ELECTION

• In the 2011 election, in partnership with the Ontario Community Support Association, the Ontario SCI Solutions Alliance and SCI Ontario submitted an ask to the three main parties for:– A $16 million investment in Community Outreach; and– Funding for accessible exam tables and lifts for half of all Family Health Teams

• The NDP pledged to get rid of the waitlist, and the PCs provided a form letter response

• The Liberals pledged $1.7 million for Direct Funding

ENGAGING DECISION MAKERS – 2011 PROVINCIAL ELECTION

We did not get all that we asked for, but this was a breakthrough for the first time - in a long time!

ENGAGING DECISION MAKERS – PROVINCIAL BUDGET (2012-2013)

• Here, regional Alliances made submissions to local MPPs around the value of attendant services in terms of cost and outcomes.

• Here, we learned that many MPPs assumed that CCACs were performing the work that attendants would do – they were broadly unaware that there was a problem.

• We knew we had to better educate decision-makers!


• In September 2012, the Toronto Rehabilitation Institute – University Health Network released its report on behalf of MOHLTC’s Provincial Liaison Committee for Persons with a Physical Disability:

Home and Community Support Services for People with a Physical Disability in Ontario: Wait Lists and Wait-Times Description

…the FIRST comprehensive, cross-provincial report showing systemic access barriers to Community Outreach, Direct Funding, and supportive housing, among others.Report was presented at the last Ontario Alliance Meeting


• In this last budgetary round, we were ready.

• The Provincial Attendant Services Advisory Committee, through the Ontario Community Support Association, revised its Ask to better reflect the cost benefits of attendant services.


Our core ask:

REDUCE THE WAITLIST FOR OUTREACH ATTENDANT SERVICES BY

50% OUTRIGHT

BOTH COMMUNITY OUTREACH AND DIRECT FUNDING ARE WAYS TO DO THIS


• We presented in person to the Standing Committee on Finance and Economic Affairs where we reiterated our support for seniors and non-seniors alike getting the services they need.


We made a conscious choice NOT to “compete” with other deserving populations.

“We’re in this together!”


• We reiterated what makes attendant services as provided by the Community Support Services sector different: self-directed services, low administrative costs, and a wider range of services.

• A presentation was made to the Minister of Finance directly, and SCI Ontario was invited to attend the Budget Lock-Up on May 2nd.


• We also asked our supporters to email the Premier directly; a template email was made available on our site. Of those that CC’d their correspondence, approximately 100 emails were sent.

• We also encouraged them to spread the message on Facebook, as well as Twitter, with the hashtag, #ILhomecare

• We will be following up with these people to thank them.

WHAT WE GOT

• WIN: The new dollars allocated to CCACs are now for seniors and those with “complex health conditions” – as opposed to seniors alone.

• WIN: While we did not get an expansion of non-CCAC attendant services outright, we have a commitment to meet with senior policy staff in the Premier’s office to examine expansion opportunities .

• The door is not closed – it’s up to us to widen it.

NEXT STEPS

• Peter has met with Amanda McGoey with the Premier’s Office and asked that the remaining one (1) percent of community expansion dollars be allocated to attendant services. (285million over 3 years in budget – year 1 spent, 185million – remainder not allocated yet)

• We will need to monitor the implementation of the budget, and similarly around its drafting, mobilize our membership.

• We have met with several MPPs across the province on attendant services

• Meeting requests have been sent to the opposition health critics (NDP & PC)

Moving Forward

Are we ready to rumble?

What are we willing to do as individuals and as representatives of organizations?

follow the campaign!

@sci_ontario #ILhomecare

OTHER UPDATES

Provincial BudgetAssistive Devices Program

Response to Catastrophic Impairment Definition

Attendant ServicesEmployment

Social Assistance

NATHAN HAUCH

Analysis of the 2013Provincial Budget

CONTEXT

• The provincial budget was presented to the legislature on May 2nd.

• Following discussions with the NDP, an accountability officer was added.

• The budget passed First Reading with NDP support.

• Members can read SCI Ontario’s analysis here:http://www.sciontario.org/sites/sciontario.org/files/Provincial%20Budget%20Brief.pdf

http://www.sciontario.org/sites/sciontario.org/files/Provincial%20Budget%20Brief.pdf




ATTENDANT SERVICES

• In terms of Attendant Services, as noted, of the $185 million devoted to CCACs, programs will not be targeted solely towards seniors.

• It remains to be seen if funds from the additional one (1) percent to the community sector will be used to expand outreach, direct funding, and supportive housing.

EMPLOYMENT SUPPORTS

• The province has committed to: – The creation of a Partnership Council on Employment

Opportunities for People with Disabilities– Dialogue with service delivery partners for employment services– Changes to Employment Ontario in partnership with

municipalities, First Nations and employment service providers– Expanded youth employment supports

• SCI Ontario has taken the position that all initiatives – including youth employment initiatives – should include persons with disabilities

EMPLOYMENT SUPPORTS

• We have also emphasized the need for disability-specific supports – the expanded role for Employment Ontario was a win for us.

SOCIAL ASSISTANCE

• There were a number of changes, including:– A 1 percent increase to the ODSP benefit rate;– Permitting recipients to keep the first $200 of earned income

without reductions in benefits– Treating income from self-employment as the same as that from

employers for the purposes of calculating benefits

• It is not yet clear what recommendations of the Commission for the Review of Social Assistance will be implemented; we remain wary of mandatory Pathways to Employment Plans, as they do not appear to account for systemic barriers to workforce participation for some recipients with disabilities

SOCIAL ASSISTANCE

• We support some simplified programs – such as the Northern Health Travel Grant – provided benefits are not reduced.

OTHER

• The Accessibility Directorate of Ontario has been moved to the Ministry of Economic Development, Trade and Employment. – A letter of congratulations has been sent to the Accessibility

Directorate ADM, Anne Hoy by SCI Ontario

• Caregiver support has been expanded for the purposes of keeping employment (Employment Standards Act)

• A transitional housing fund for all low income First Nations persons – not just those on social assistance - will be implemented

NEXT STEPS

• Details matter – we will be monitoring the implementation of the budget

• Please keep your ear to the ground and let us know what you hear!

Advocacy Update


Assistive Devices Program

WHERE WE ARE

• We analyzed – and proposed solutions for – a range of equipment purchase, customer service, and vendor certification among them.

• In January, a brief was submitted to MOHLTC Minister Matthews. This brief outlined solutions for the following, among others:– Approval processes;– Pricing of wheelchairs;– Expanding eligibility of devices to include pressure sore mattresses,

commode chairs, cough machines, and all-terrain wheelchairs; and– Clarification of what services vendors provide.

WHERE WE ARE

• From this meeting, we requested – and received – the full report Pricing and Supply Chain Review.

• This report lays out several opportunities – and challenges – for the pricing reviews of equipment. At its core, the question arises as to the kind and scope of such a review, and the resources required to be cost effective (with over 8000 devices on the price list, this undertaking is extensive; it may be best to start with “high use” items on the list).

NEXT STEPS

• We have asked for a formalized advisory role with ADP; this has yet to materialize.

• Amanda McGoey and Michelle Rossi with the Premier’s Office/MOH Office has suggested looking at disability service organization partners to administer funds for other, needed devices.

DiscussionGovernment Subsidy outside of ADP

• Commodes• Pressure relief mattresses• Cough Machines• All Terrain Wheelchairs

Status Update


Definition of Catastrophic Impairment

STATUS

• While the Expert Panel has accepted some of our recommendations (such as removing the provision that only those consumers who undergo inpatient rehabilitation be eligible for compensation), there has been some significant debate around the appropriate tool to assess the degree of Catastrophic Impairment

• ONTARIO ALLIANCE emphasized that an approach such as the Autonomic Standard may be more appropriate.

NEXT STEPS

• We are waiting for the report from the Superintendent before we proceed further.

• We will be engaging with our members accordingly.

BREAK

15 MINUTES

STRATEGIC DIRECTIONSSCI Action Canada

Pressure Sore Surgery Rehab & Performance Based Funding Model

DISCUSSION:

Pressure Sore Surgery Rehab & Performance Based

Funding Model

Heather Flett (University Health Network)Sera Nicosia and Deb Mings (Hamilton Health Sciences)

Toba Miller (The Rehabilitation Centre of The Ottawa Hospital)Julie Gagliardi (Parkwood Hospital)

SCI Research Network

Dr. Keith Hayes

Where We Are

• RHI Federal Funds $35 million announced in Toronto on Wednesday, June 5, 2013– Research and Best Practice Implementation; agenda under

development.

Partnerships Formalized

• Neuro Recovery Network (NRN): to implement harness supported locomotion training protocol at Lyndhurst – as first centre in Ontario and Canada

• North American Clinical Trials Network (NACTN) to conduct trial of the neuroprotective agent Riluzole in acute injuries (Toronto trauma centres)

• AUSCAN: partnership with Institute for Safety, Compensation Research and Rehabilitation (Melbourne, Australia), RHI and ONF to study access to care (modelling methods), implementation of international standardized data sets, a clinical trial of a self-management program for pressure ulcer prevention and treatment. Workshop on international collaboration on research and best practice implementation to be put on at ISCOS (Istanbul, October 2013).

Next Steps

• Network Meeting scheduled for October 4, 2013 at Old Mill, Kingsway. Agenda to follow.

• Three ONF/OSCIRN sponsored provincial teams progressing well with their research agendas: – Time is spine: Streamlining the Pre Hospital Transport of Patients

with Acute Traumatic SCI in Ontario

– Heath Economics in SCI Team

– Integration of Health Services and Supports (Self-Management Primary Care, Rehabilitation) in Persons with SCI.

A Platform for Education & Mobilization

Nathan Hauch

SCI Ontario’s Public Policy Program

Website Portal

CONTEXT

• We want to have a private site where Alliance members can locate documents, presentations and the like.

• For the public site, we want to

– Inform our supporters and the public on “standing” issues (those that are long-term in nature, such as access to primary care) and “emerging” (those that require more immediate engagement)

– Provide our supporters with the means to easily express their views to decision makers (MPPs and the like).

CONTEXT

• We are also in the process of developing an online government relations training for those that want to meet with decision makers. These “Change Makers” take a series of online modules on how government works, how to keep “on message” and the like.

PRIVATE – JOINING THE SITE

• We will be signing up members of the Alliance to the site, with information on how to navigate it.

PRIVATE – A VERSION OF WHAT YOU’LL SEE• We will upload minutes, documents and the like. We will

continue to send attachments, but the information will be stored in, and emails sent from, one place.

PUBLIC – JOINING THE SITE

• Supporters will be invited to provide their contact information, areas of interest, and the like.

• This will enable us to ensure “buy-in” from supporters.

PUBLIC – JOINING THE SITE

PUBLIC – A VERSION OF WHAT YOU’LL SEE

• The front page provides context for the work we do, links to a campaign or emerging issue, and also provides information on standing issues.

PUBLIC – A VERSION OF WHAT YOU’LL SEEfront page

PUBLIC – A VERSION OF WHAT YOU’LL SEEissue page

• Background documents and the like are linked to various issues.

PUBLIC – A VERSION OF WHAT YOU’LL SEE

• Campaigns allow for people to input their postal codes, and the site automatically puts in that person’s MPP.

• Alternatively, we can support campaigns of other organizations, such as the AODA Alliance

NEXT STEPS

• We are in beta phase – we are still testing the use of the “back end” of the site

• Instructions on how to use the private site will be developed

• The design of the site will be enhanced with graphics

• We encourage feedback from our members

http://alliance.sciontario.org

The Public Policy Program of Spinal Cord Injury Ontario is supported by the Personal Injury Alliance (www.pialaw.ca)

http://www.pialaw.ca/

CONCLUSIONMeeting Schedule(SEPTEMBER 2013)

Closing Remarks

Documents

WELCOME 7 June 2013. Ontario Telehealth Network Ground Rules Meeting Procedures