Waterloo Wellington Local Health Integration Network. Board of Directors Meeting MINUTES. Thursday, February 25, 2010

Transcription

1 Waterloo Wellington Local Health Integration Network Board of Directors Meeting MINUTES Thursday, February 25, 2010 The following are the minutes of the Board Meeting held at 4:30 p.m. on Thursday, February 25, 2010 at the Hampton Inn, 725 Imperial Rd. N., Guelph, ON. Members Present: K. Durst, Chair, P. Truex, Vice-Chair, G. Heggie, B. Schieck, D. Ross, M. D Alton, D. Small, B. Dinwoody, Regrets: Staff Present: Recording Secretary: Guest: P. Holyoke, Secretary S. Hanmer, S. Sutley, G. Whitson-Shea, G. Holder, B. Lauckner K. Borthwick S. Gandza (student) 1.0 Call to Order K. Durst called the meeting to order at 4:45 p.m. 2.0 Closed Session Motion No Moved by P. Truex Seconded M. D Alton (adopted) THAT the meeting adjourn and move into a closed session to discuss a matter of such a nature that that the desirability of avoiding public disclosure in the public interest outweighs the desirability of adhering to the principle that Board meetings be open to the public under section 9(5) (a) of the Local Health System Integration Act, The open session adjourned at 4:46 p.m. to move into closed session. Motion No Moved by M. D Alton Seconded by G. Heggie (adopted) THAT the closed session adjourn. The closed session adjourned at 5:39 p.m. Note: A break was taken at 5:39 p.m. Note: The meeting reconvened at 6:06 p.m.

2 WWLHIN Board of Directors Page 2 February 25, Welcome K. Durst welcomed board and guests to the meeting. 4.0 Report of the Closed Session K. Durst reported that in the closed session the minutes of the January 27 th, 2010 meeting were approved there was a discussion related to a matter of such a nature that that the desirability of avoiding public disclosure in the public interest outweighs the desirability of adhering to the principle that Board meetings be open to the public under section 9(5) (a) of the Local Health System Integration Act, Motion No Moved by M. D Alton Seconded by G. Heggie (adopted) 5.0 Approval of the Agenda Moved by P. Truex Seconded by M. D Alton (adopted) THAT the Board receive the Chair s report of the closed session for information. THAT the agenda be approved as circulated. 6.0 Declaration of Conflict of Interest There were no declarations of conflict interest made in relation to the matters to be dealt with. 7.0 Education Session D. Ross welcomed and introduced the presenters of the Overview of the HEALTHeCONNECTIONS (HeC) Project project: Glenn Holder, WWLHIN CIO and ehealth Lead; Wayne Michalski, patient; Marg Stevens, Certified Diabetes Educator from North Wellington Health Care; and Ross Kirkconnell, Executive Director of the Guelph Family Health Team (FHT). G. Holder began by explaining that ehealth is a key enabler to achieving the priorities for the Waterloo Wellington LHIN IHSP. He indicated that the purpose of the HeC Project is to build an integrated care model for people with diabetes. Mr. Wayne Michalski shared his experience, as a patient diagnosed with Type II diabetes and a user of the mydoctor.ca health portal. The system is very convenient and user friendly for patients with access to the internet, and he remarked that he feels more in charge of his own health and supported by the health team.

3 WWLHIN Board of Directors Page 3 February 25, 2010 Marg Stevens talked about the health portal from the care provider s perspective. When accessing the system on a regular basis, information about patients receiving care is at readily available and trends that may require attention can be addressed very quickly, rather than waiting for the next physician visit. As a diabetes educator, she can give better advice and identify issues earlier before they become more serious for the patient. 7.0 Consent Agenda a) Minutes of the Last Meeting January 27, 2010 b) CEO Report February 2010 c) Nominating Committee Feb 4, 2010 d) Governance Committee Feb 9, 2010 e) Finance & Audit Committee February 18, 2010 Motion No Moved by D. Ross Seconded by B. Schieck (adopted) THAT the items on the consent agenda be approved. 8.0 Chair s Remarks K. Durst reported that the Nominating Committee recently met and asked G. Heggie to provide an update on their activities. In 2010, two vacancies on the Board of Directors will result from the completion of a term of appointment for one board member and the early completion of another Board member. G. Heggie noted that during the week of March 1 st, there will be an advertisement in local newspapers to call for applications. This will be the first step in the recruiting process that will be followed by a review of applications and interviews for qualified candidates. The Nominating Committee will continue to provide updates about the appointments process through reports to the Board. Motion No Moved by P. Truex Seconded by B. Dinwoody (adopted) THAT the Chair s remarks be received for information. 9.0 CEO s Remarks S. Hanmer noted that her written report to the Board was circulated with the agenda package. In addition, she gave an update about the Cambridge Memorial Hospital s (CMH s) capital expansion plans. The WWLHIN has been working very closely with CMH to determine services that would be contained in the plans, and this work is ongoing to ensure that plans are aligned with the Integrated Health Services Plan (IHSP) for

4 WWLHIN Board of Directors Page 4 February 25, 2010 S. Hanmer also commented about the requests that the WWLHIN received under the Freedom of Information and Protection of Privacy Act (FIPPA), Recently, the WWLHIN received a request for information about the sole source contracts for consulting, since the inception of the WWLHIN. The request has been fulfilled S. Hanmer assured the Board that all contracts met the procurement directives in effect at the time. She indicated that procurement policies have been updated to reflect the most recent Procurement Directive (July 2009) Motion No Moved by P. Truex Seconded by D. Small (adopted) THAT the CEO s remarks be received for information Aging at Home Year 3 B. Lauckner gave a presentation about the Aging at Home Strategy and the plans for year 3 of this initiative. The presentation is appended to these minutes as Attachment 1. Two priority investments were proposed: (1) An additional Long-Term Care Home bed at Pinehaven Nursing Home, and (2) The 2010/11 Transitional Care Program. B. Lauckner explained that investment for one additional LTC bed at Pinehaven Nursing would have a positive impact on the pressures resulting from hospital alternative level of care (ALC) patients waiting for LTC. The 43 additional beds are transferring from another LHIN into WWLHIN, and with one additional bed, Pinehaven will be able to optimize the building specifications for 44 beds. To present the background about the Transitional Care Program, B. Lauckner invited E. Bain, Chief Nursing Executive for Guelph General Hospital (GGH) and K. Voelker, Director, Client Services for Waterloo Wellington CCAC to continue the presentation. On a day-to-day basis, hospitals struggle with capacity and wait times in emergency departments (EDs), and hospitals, along with the WWCCAC have worked with the WWLHIN to come up with ways to manage this issue from a client-centred perspective. In 2009/10 it was proposed that hospitals could work with LTC homes and retirement homes to enable patients to wait in a stable environment with appropriate care. This program had significant outcomes for the patients and they were able to wait for LTC in more comfortable and nurturing environment. E. Bain shared examples of patient experiences, where they were placed into a transition care bed and then were reassessed, and in some cases, patients ended up not needing LTC and could manage in other care settings such as a retirement home. Overall, the Transition Care Program benefits include: Clients conditions improving; no longer needing LTC placement Improved health status entering LTC Families and patients happy with care Hospital ED patients able to be admitted; improved patient flow improved care

5 WWLHIN Board of Directors Page 5 February 25, 2010 The recommended Transitional Care Program for 2010/11 was presented., K. Voelker commented that this program in conjunction with other initiatives to improve emergency department waiting times and patient flow will have a significant impact for patients and for the health care system. Other initiatives include the ED process improvement projects (ED PIP) and the Home First philosophy that is being implemented in hospitals. Motion No Moved by P. Truex Seconded by M. D Alton (adopted) THAT the Board approve an allocation of one-time funding, in the amount of $7,090,053, to the 2010/11 Transitional Care Program and THAT the Board approve an allocation of Aging at Home base funding, in the amount of $36,500, for one long-term care bed at Pinehaven Nursing Home Finance & Audit Report P. Truex gave the report of Finance & Audit Committee, which included the report of WWLHIN Operations for January 2010 and an overview of the operating assumptions for 2010/11. The report also noted that the Committee received an update on the health service provider funding reallocations for 2009/10. At the March Board meeting, there will be a presentation of the 2010/11 Operating Plan and the 2010/11 Health Service Provider Allocations. Motion Moved by P. Truex Seconded by B. Dinwoody (adopted) 12.0 Next Meeting THAT the Finance & Audit Committee report including the report of the WWLHIN Operations Finance Summary for January 2010 be received for information. Thursday, March 25, :30 9:00 p.m. Location: Hampton Inn, 725 Imperial Rd. N., Guelph 13.0 Adjourn On a motion by M. D Alton seconded by D. Ross, there being no further business, the meeting adjourned at 8:12 p.m. Original signed by, Original signed by, K. Durst, P. Truex Chair Vice-Chair

6 WWLHIN Board of Directors Page 6 February 25, 2010 Attachment 1 Copy of presentation Aging at Home Year 3 & Transitional Care Program.

7 Aging at Home Year 3 & Transitional Care Program Board of Directors February 25, 2010

8 Overview Aging at Home Year 3 LTC Capacity at Pinehaven 2010/11 Transitional Care Program Next Steps Summary 2

9 Overview of Aging at Home Strategy To provide a suite of services for frail seniors to enable them to live as independently as possible, for as long as possible, in a safe home of their choice WWLHIN Plan has three focus areas: to improve the health and wellness of seniors to increase supportive living/housing services to provide complex and frail care to seniors Investments in prevention, promotion and diversion from increasingly costly acute care 3

10 Overview of Aging at Home Strategy $596 M across 14 LHINs $37.7 M for WWLHIN over 3 years; base increase of $20.9 M $4.8 M - Year 1 (2008/09) - 20 initiatives $11.9M - Year 2 (2009/10) 8 initiatives 4

11 Aging at Home Year 3 MOHLTC holding back 25% of Year 3 funding Potential reallocation to those areas of province with greatest ALC and/or ED Wait Time challenges Including prior Year 1 and Year 2 commitments $4,104,438 available for Year 3 5

12 Priorities for Aging at Home Year 3 Ministry direction to invest in initiatives that directly reduce ED Wait Times and/or ALC Additional Temporary Care Bed Capacity Admission Avoidance / Timely Discharge Initiatives (Hospital process enhancements) Enhanced Home Care (Building community based services) Outreach Teams 6

13 ALC in WWLHIN WWLHIN % Alternate Level of Care (ALC) Days 30.00% 25.00% 20.00% 17.85% % ALC 15.00% 10.00% 9.46% 5.00% % ALC 0.00% Jun- 08 Jul- 08 Aug- 08 Sep- 08 Oct- 08 Nov- 08 Dec- 08 Jan- 09 Feb- 09 Mar- 09 Apr- 09 May- 09 Jun- 09 Jul- 09 Aug- 09 Sep- 09 W W LHIN 2009/10 Target Oct- 09 Nov- 09 Dec- 09 Jan- 10 7

14 ALC Patients - Destination WWLHIN ALC Days: Acute Beds by Destination (Apr '09-Jan '10) Retirement Home/Return Home 3.3% Rehab 21.8% Other 4.3% CCAC 2.1% Complex Medicine 4.9% Convalescent Care 1.8% Palliative 8.7% Mental Health/Neurobehaviou ral 0.8% LTC/Nursing Home 52.2% 8

15 ALC Patients Location WWLHIN ALC Patient Days by Bed Type (Apr '09-Dec '09) Rehab 1.8% CCC 42.6% Acute 54.7% Mental Health 0.9% 9

16 ALC Patients Destination All Beds WWLHIN ALC Patient Days by Patient Destination - All Bed Types (Apr '09-Dec '09) Retirement Home/Return Home 2.0% Palliative 4.8% Rehab 11.9% Other 2.6% CCAC 1.1% Complex Medicine 2.7% Convalescent Care 1.0% Mental Health/ Neurobehavioural 0.7% LTC/Nursing Home 73.3% 10

17 ED Wait Times ED Wait Times are improving due to: ED and hospital process improvement Staffing changes IT/communication initiatives (e.g. MARI) Aging at Home initiatives (e.g. GEMS nurses) Home First philosophy Enhanced collaboration and referral processes with community services Reducing ALC also improves ED Wait Times 11

18 Key Considerations for Aging at Home Year 3 Considered many factors including: Quality patient care MLAA obligations Current system performance IHSP priorities AAH Y3 priorities (as per Ministry directive) ED/ALC impact Strategic outcomes Bridging to full implementation of key initiatives and enhanced capacity 12

19 Priority Initiatives for Aging at Home Year 3 Two initiatives most closely address the Key Considerations: Increasing LTC capacity at Pinehaven 2010/11 Transitional Care program 13

20 LTC Capacity at Pinehaven Pinehaven moving 43 beds from outside of WWLHIN to Waterloo Optimal build specifications require 44 beds Directly enhances local LTC capacity and improves patient care through decreasing ALC 44 beds for the price of 1 ($36,500) 14

21 2010/11 WWLHIN Transitional Care Program Guest Presenters: Kim Voelker, Waterloo Wellington Community Care Access Centre Eileen Bain, Guelph General Hospital

22 Transition Program 2009/10 Type Transition Beds Interim LTC Beds Palliative Supportive Care Description Restorative care to facilitate going home and appropriate level of care while waiting for LTC 48 Beds in Guelph, Kitchener, Cambridge Increased LTC Capacity 9 Beds in points around WWLHIN (including rural sites) Increased palliative care capacity 16 Beds in Kitchener and Guelph 73 Beds Cost $4.1M 16

23 Results 97% occupancy Assisted 297 ALC patients April 2009 Jan 2010 Saved 20,270 hospital ALC days April 2009 Jan

24 What it s all about: Patient Care Clients conditions improving; no longer needing LTC placement Improved health status entering LTC Families and patients happy with care Hospital ED patients able to be admitted; improved patient flow improved care 18

25 2010/11 Transitional Care Program Development What worked well here and in other LHINs Timing of solutions and capacity coming online Data analysis MoH Transitional Care Program Framework Available physical space 19

26 Transitional Care Program 2010/11 Proposed Type Interim Beds Restorative Care Description Increase LTC capacity while waiting for additional LTC beds to be built 77 Beds in Guelph, Kitchener, Cambridge and rural sites Increase capacity to facilitate recovery to safely go home 32 Beds in Guelph, Kitchener ad Cambridge $3.8M $2.5M Palliative Supportive Care Increase palliative care capacity 10 Beds in Kitchener 119 beds $0.8M $7.1M Note: Final Program composition to be finalized and may require adjustment; total funding will not exceed $7.1M 20

27 Decreasing ALC More than Transitional Care Program Process Improvements Enhancing linkages of hospitals with community services Home First philosophy across WWLHIN Solutions for the unique needs of long-stay ALC patients 21

28 2010/11 Transitional Care Program Transitional Care Program bridges gap between current situation and more permanent solutions: new LTC beds Full effect of Aging at Home Initiatives Roll out of Home First 22

29 Summary These initiatives will directly impact ED/ALC and provide the opportunity for hospitals to start fresh to improve their patient flow and adopt the Home First philosophy Support of Pinehaven and the 2010/11 Transitional Care Program would expend all AAH Y3 funds and most available one time surplus dollars. 23

30 Next Steps Recommendation from Finance and Audit Committee Upon approval, staff will: submit Aging at Home Service Plan to MOHLTC Feb 28, 2010 communicate Board decisions to proponents Finalize services and locations in conjunction with Compliance and Health Service Providers reassess outcomes associated with programs in as part of regular 2010/11 performance review process bring recommendations for any future Aging at Home allocations to Board in Winter 2010/11 24

31 Discussion 25

32 Recommendations THAT the Finance & Audit Committee recommend that the Board approve Allocation of one-time funding, in the amount of $7,090,053 to the 2010/11 Transitional Care Program, and Allocation of Aging at Home base funding, in the amount of $36,500 for one long-term care bed at Pinehaven Nursing Home. 26

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