CENTRAL LHIN CEO REPORT CORRESPONDENCE

Transcription

1 140 Allstate Parkway Suite 210 Markham, ON L3R 5Y CENTRAL LHIN CEO REPORT CORRESPONDENCE

2 140 Allstate Parkway Suite 210 Markham, ON L3R 5Y CENTRAL LHIN CEO REPORT CORRESPONDENCE

3 Central LHIN CEO Report- Correspondence Table of Contents 1.0 MINISTRY OF HEALTH CORRESPONDENCE UPDATES July 20, Long-Term Care Home Subsidy Calculation Worksheet for Long- Term Care Homes (Appendix 1.1) July 20, /2010 Central LHIN Emergency Department LHIN Lead Funding (Appendix 1.2) July 20, /2010 Central LHIN Emergency Room/Alternate Level of Care Performance Lead Funding (Appendix 1.3) July 20, LHIN Emergency Room Length of Stay Target Setting (Appendix 1.4) July 17, Ontario Diabetes Strategy-Health Force Ontario (Appendix 1.5) July 14, 2009-Confirmation of voluntary Inter- LHIN integration- COTA Health (Appendix 1.6) July 8, Draft Annual Business Plan Guidelines (Appendix 1.7) July 8, 2009-LHIN Boundaries (Appendix 1.8) July 7, 2009-Revision to Ministry LHIN Accountability Agreement Addenda Process ( Appendix 1.9) July 6-Balanced Budget Wavier (Appendix 1.10) July 2, 2009-Amendments to Regulations (Appendix 1.11) June 30, 2009-Assignment of Service Agreement regarding Long-Term Care Home Operators (Appendix 1.12) June 29, 2009-Implementation of RAI-MDS 2.0-in Long- Term Care Convalescent, ELDCAP and Interim Beds (Appendix 1.13) June 25, 2009-Special Report on French Language Health Services Planning in Ontario ( Appendix 1.14) June 17, 2009-Consulting Services Procurement and Expenses Policy (Appendix 1.15) June Markham Stouffville Base Hospital Designation (Appendix 1.16) 2.0 LHIN-WIDE CORRESPONDENCE UPDATES July Ontario Releases Mental Health and Addictions Discussion Paper (Appendix 2.1) July 2009-LHIN Collaborative Communiqué (Appendix 2.2) July 2009-Supportive Housing for Ontario Addictions Programs-News Release (Appendix 2.3) June 2009-Ontario Hospital Association- Alternate Level of Care Update (Appendix 2.4) 3.0 CENTRAL LHIN CORRESPONDENCE UPDATES July 17, 2009-Health Sciences Building at Markham Stouffville Hospital (Appendix 3.1) July 15, 2009-H1N1 Influenza Virus (Appendix 3.2) July 14, 2009-Office of the French Language Services Commission-re: French Language Services Act (Appendix 3.3) July 10, West Park Healthcare Centre Redevelopment Plans (Appendix 3.4) June 24, Cataract Wait Time Guarantee Program (Appendix 3.5) June 18, Letter of Support for a CT Simulator at Southlake Regional Health Centre (Appendix 3.6) Central LHIN Board of Directors CEO Report Correspondence- July

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9 Ministry of Health and Long-Term Care Access to Care and Wait Times Implementation Branch Health System Accountability and Performance Division 80 Grosvenor St. 5 th Floor Toronto, Ontario M7A 1R3 Tel: Fax: Ministère de la Santé et des Soins de longue durée Accès aux soins et réduction des temps d'attente Direction de la mise en œuvre Division de la responsabilisation et de la performance du système de santé 80, rue Grosvenor, 5 e étage Toronto (Ontario) M7A 1R3 Tél. : Téléc. : July 20, 2009 MEMORANDUM TO: LHIN CEOs FROM: RE: Melissa Farrell Manager, Access to Care and Wait Times Implementation Branch Final LHIN ER Length-of-Stay Targets for 2009/10 MLAA In follow up to the memo sent by Assistant Deputy Minister Ken Deane in May regarding ER Length-of-Stay (ER LOS) targets, please find attached the final LHIN targets for each of the three ER LOS indicators. The final targets and corridors reflect the full fiscal year of data. Also included is the LHIN baseline or starting point and performance corridor. The same methodology as described in May was used to arrive at the final targets. For information on the methodology, please refer to the attachment entitled LHIN ER LOS Target Setting methodology notes May09 FINAL.pdf. Achievement of these targets is critical to the overall success of the ER/ALC Strategy and your continued leadership in the attainment of these objectives is appreciated. Melissa Farrell cc. LHIN Senior Directors Leela Prasaud, A/Director LHIN Liaison Branch (06/11)

10 LHIN MLAA 2009/2010 Target Setting Methodological Notes Background: The LHIN MLAA 2009/2010 targets align with the Year 2 Pay for Results indicators: Proportion of Admitted patients treated within the LOS target of 8 hours Proportion of Non-admitted high acuity (CTAS I-III) patients treated within their respective targets of 8 hours for CTAS I-II and 6 hours for CTAS III Proportion of Non-admitted low acuity (IV & V) patients treated within the LOS target of 4 hours The goal of Year 2 Pay for Results program is to achieve an absolute 10% improvement in the proportion of cases completed within target for each of the indicators above, for all Year 2 Pay for Results sites in FY 2009/2010 (EDRS data) compared to FY 2008/2009 (EDRS data). Assumptions: The LHIN targets correspond to the aggregated percent completed within target of ALL EDRS SITES in the LHIN based on the following assumptions: All pay for results sites achieve an absolute 10% improvement in the percent completed within target for each indicator compared with April 08 to Jan 08 EDRS data (interim baseline). This is considered an interim baseline as February and March 2009 EDRS data is not currently available. In Q2 09/10 when these two months of data are available, the final baseline will be calculated and MLAA Targets will be recalculated. Performance of non-funded sites will remain constant. (0% improvement from interim baseline) Produced by Access to Care Informatics, Cancer Care Ontario 1

11 Steps in the Calculation of LHIN 09/10 ER MLAA targets: Below are the steps to calculate the LHINs 09/10 ER MLAA targets for all three indicators. An example has been used to explain each step of the methodology. STEP 1: Calculate the interim baseline using only April 2008 to January 2009 EDRS data. For this time period, calculate the ER LOS Volume* (Column A) for each EDRS site and the number of cases completed within target for each EDRS site (Column B). *Note: ER LOS Volume (Column A) refers to the number of cases for which ER LOS can be calculated. The number of cases excluded is based on the current Overall Exclusion Criteria and the additional criteria used to calculate ER LOS (please see Appendix A). STEP 2: Calculate the total volume of the LHIN by adding the ER LOS volume (Column A) and Number of Cases completed within target (Column B) of all the EDRS sites Produced by Access to Care Informatics, Cancer Care Ontario 2

12 STEP 3: Calculate the Percent Completed within Target (interim baseline) of all the sites and the LHIN using the formula: Column B = Percent Completed within Target (Column C) Column A STEP 4: Calculate the percent improvement from interim baseline for the Percent Completed within Target (based on assumptions): For all pay for results year 2 sites, enter the value 0.10 in Column D. For all non-pay for results sites, enter the value 0 in Column D Note: Column D can be formatted in Percent to show 10% instead of 0.1. Produced by Access to Care Informatics, Cancer Care Ontario 3

13 STEP 5: Calculate the 09/10 Percent Completed within Target (Column E) for each EDRS site by adding the values in Column C and Column D. NOTE: Column E cannot be more than 100% (i.e. if a funded hospital has already reached 95% percent completed within target at interim baseline (Column C), add only 5% in Column D to reach 100% in Column E). STEP 6: Calculate the number of cases completed within 09/10 targets for EDRS sites by multiplying Column E and Column A in Column F. Produced by Access to Care Informatics, Cancer Care Ontario 4

14 STEP 7: Calculate the number of cases completed within 09/10 targets for the LHIN by adding the values for each EDRS site in Column F. STEP 8: Calculate the 09/10 Percent Completed within Target for the LHIN by dividing the LHIN Number of Cases Completed within Target (Column F) by the LHIN ER LOS Volume (Column A). 103/210 = 0.49 or 49% In this example the LHIN Percent Completed within Target interim baseline is 43%. The LHIN 09/10 percent completed within target is 49%. Produced by Access to Care Informatics, Cancer Care Ontario 5

15 Performance Corridor Methodology Background: The Performance Corridor was derived based on the Year 2 Pay for Results recovery process methodology where only a 5 out of 10 percent improvement is a threshold for recovery. Calculation Methodology: The same calculation detailed above was used; however, instead of applying a 10% improvement to interim baseline for Pay for Results sites, a 5% (0.05) improvement was applied. Produced by Access to Care Informatics, Cancer Care Ontario 6

16 Appendix A: Exclusion Criteria Overall Exclusion Criteria: Exclude records that do not conform with EDRS Data Validation Rules ER visits where Registration Date/Time and Triage Date/Time are both missing ER visits where Left ED Date/Time and Disposition Date/Time are both missing ER visits where patients are over the age of 125 on earlier of triage or registration date Negative ER LOS (earlier of registration or triage before date/time patient left ED) Duplicate records within the same functional centre where all data elements have the same values. ER LOS Exclusion Criteria: Cases where Date/Time Patient left ED is missing and the Disposition Code is (admitted patients and transferred patients) Cases where patient has left without being seen by a physician during his/her visit (Disposition Code 02 & 03) Produced by Access to Care Informatics, Cancer Care Ontario 7

17 Ministry of Health and Long-Term Care Health Human Resources Strategy Division Ministère de la Santé et des Soins de longue durée Division de la stratégie des ressources humaines dans le domaine de la santé 10th Floor, Hepburn Block Édifice Hepburn, 10 e étage 80 Grosvenor Street 80, rue Grosvenor Toronto ON M7A 1R3 Toronto ON M7A 1R3 Tel.: OCMS (416) Number Tél.: (416) Fax: (416) Téléc.: (416) July 17, 2009 Kim Baker Central Local Health Integration Network 140 Allstate Parkway Markham ON L3R 5Y8 Dear Ms. Baker, This letter is in follow-up to the recent memo you received regarding the Ontario Diabetes Strategy (ODS). We recognize the important role of the Local Health Integration Networks (LHINs) and look forward to working with you. Accompanying this letter is some background information on the Ontario Diabetes Strategy. A key element of the strategy is the expansion of Diabetes Education Programs in each LHIN. We are asking each LHIN to recommend suitable locations (e.g., FHTs, CHCs) for the expansion of new diabetes teams. Recommendations should target areas of unmet need, high prevalence, and increasing incidence of diabetes. We ask that recommended locations be prioritized in order to begin immediate expansion of the first two to three sites. Suggested parameters for prioritization of locations are: Locations with existing Diabetes Education Programs Ease of implementation Capacity to expand Availability of human resources (i.e., availability of RNs, RDs, MSWs, etc.) We are working with CCO and ICES to determine diabetes service needs across all LHINs. The resources allocated to each LHIN will be based on the number of existing teams, diabetes prevalence, geography, and other relevant data. We will be communicating shortly the total allocation for each LHIN. In the meantime, we will provide you with ICES prevalence maps, and FHT specific information to support planning for service expansion in your LHIN. This information will be forwarded to you shortly. The ODS will be supported by regional coordinating centres for diabetes within each LHIN. We will also be asking you to identify an existing centre in your region suitable for a regional leadership role. Proposed criteria for the centre and a job description for this role will be provided to you shortly. /2

18 Kim Baker We ask that you provide your recommendations for service expansion and the regional coordinating centre by August 31, A funding letter will be forthcoming in the next couple of weeks. In the meantime, if you could identify an individual within your LHIN responsible for leading the development of recommendations, we can begin engaging them immediately in ongoing communications and coordination of forthcoming materials. We thank you for your participation, and look forward to working with you on this important government initiative. Please direct the name of your representative as well as any questions to Alexandra Magistretti, Project Implementation Manager, at , or Alexandra.Magistretti@ontario.ca. Sincerely, Joshua Tepper Assistant Deputy Minister c. Cal DiFalco, Director, Implementation Branch David Stolte, Project Director (A), Ontario Diabetes Strategy Leela Prasaud, Director (A), LHIN Liaison Branch Joan Canavan, Manager, Provincial Programs Branch Terrence Sullivan, President and CEO, Cancer Care Ontario Helen Angus, Executive Lead, Chronic Diseases Implementation, Cancer Care Ontario

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28 Health Ministry System of Health Information Management and Investment Division and Long-Term Care Ministère Division de de la gestion la Santé de l'information et de l'investissement pour et le système des Soins de santé de longue durée Health Analytics Branch Direction de l analytique en matiére de Santé 1075 Bay Street, 13 th Floor 1075, rue Bay, 13 e étage Toronto ON M5S 2B1 Toronto ON M5S 2B1 Telephone: Téléphone : Facsimile: Télécopieur : DATE: July 8, 2009 TO: FROM: LHIN CEOs Sten Ardal Director, Health Analytics Branch SUBJECT: LHIN Boundaries It has recently been brought to my attention that our analysis of Statistics Canada boundary changes has been misinterpreted to suggest that some Ontario residents can not be properly assigned to LHINs. This is not the case. All addresses can be specifically identified with a LHIN, and this is not impacted by changes made to Statistics Canada Dissemination Areas (DAs). DAs are a geographic grouping used to create the original LHIN boundaries, which were organized to reflect referral patterns observed in administrative data. When using administrative data, exact addresses are typically not used instead, the data are usually grouped using postal codes which can be mapped to the LHIN boundaries. It is this process that is affected by the change in DAs. LHINs have worked with the ministry to ensure that all residents are assigned to a specific LHIN in analyses using postal codes. In summary, individual Ontario residents can be matched with their LHIN through address information, and when residents are geographically grouped for LHIN and Sub-LHIN analyses there is an accepted allocation method. Please do not hesitate to contact me should you have any questions. Sincerely, Sten Ardal Attachments: DA to LHIN Cross-Walk Agreement DA Boundary Issue Statement and Research Note

29 Memo to all LHIN CEOs July 8, 2009 C: LHIN Senior Directors Performance, Contracts & Allocation LHIN Senior Directors Planning, Integration and Community Engagement Ruben Rosen Chair, North Simcoe Muskoka LHIN John McKinley Assistant Deputy Minister Health System Information Management and Investment Division Ken Keane Assistant Deputy Minister Health System Accountability and Performance Division Leela Prasaud (A) Director, LHIN Liaison Branch Health System Accountability and Performance Division Nam Bains Team Lead, LHIN Support, Health Analytics Branch Health System Information Management and Investment Division 2

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32 NEWS Ministry of Health and Long-Term Care Ontario Releases Mental Health And Addictions Discussion Paper McGuinty Government Launches Consultation At Mental Health And Addictions Strategy Summit NEWS July 14, /nr-061 Ontario has released a discussion paper, Every Door is the Right Door to contribute to the development of a 10-year mental health and addictions strategy. The paper was released at the Open Minds. Healthy Minds Summit co-hosted by Minister David Caplan and his Advisory Group on Mental Health and Addictions. The provincial summit is an opportunity for approximately 1,000 consumers and experts from across Ontario to contribute ideas towards the development of Ontario s Mental Health and Addictions Strategy. Further consultations and round tables on the discussion paper will be held across Ontario in the fall. The advisory group will report to the Minister in winter 2009/10. QUOTES This provincial summit will not only help to raise the profile of mental health and addictions, but also the feedback taken from it and other consultations will shape our final strategy. David Caplan, Minister of Health and Long-Term Care QUICK FACTS Ontario has more than 300 community-based mental health programs offering a range of services and supports that provide alternatives to inpatient services, reduce admissions at psychiatric facilities and support people right in the communities. Ontario funds 150 substance abuse treatment programs and provincial initiatives including withdrawal management, community counselling, residential treatment and support services. One in every five Ontarians will experience a serious mental health illness or harmful substance use. LEARN MORE Read the Advisory Group s discussion paper at Find out more about the Select Committee on Mental Health and Addictions Learn more about treatment for Mental Health and Addictions in Ontario Steve Erwin, Minister s Office, David Jensen, Ministry of Health and Long-Term Care, ontario.ca/health-news Disponible en français

33 BACKGROUNDER Ministry of Health and Long-Term Care Mental Health And Addictions MINISTER S ADVISORY GROUP July 14, 2009 David Caplan, Minister of Health and Long-Term Care, has established an Advisory Group on Mental Health and Addictions to provide advice on overall direction and priorities for a 10-year provincial strategy. The Group is responsible for the creation of the discussion paper, Every Door is the Right Door. This discussion paper will help guide the Advisory Group s fall consultations, leading to a report in winter 2009/10 The Minister s Advisory Group is made up of mental health and addictions consumers and family members, health care providers and researchers. It reflects a range of perspectives, from Aboriginal Peoples, to seniors, women and adults and in the workplace. The Advisory Group began their work in March, consulting with over a hundred Ontarians representing various organizations, providers and consumers. The Group has also held work shops and commissioned background research on issues related to mental health and addictions. Feedback on the discussion paper will be sought in a number of ways: On the ministry website at At roundtables consultations to discuss opportunities for children, youth, Aboriginal Peoples, seniors, employers and justice; Meetings with the Interministerial Committee on mental health and addictions on ways to improve the overall system and lever change, and; Further consultation with consumers, front line providers and provincial organizations. LINKAGES WITH THE SELECT COMMITTEE The Minister s Advisory Group will complement the work of the all-party Select Committee of the Legislature on mental health and addictions. Both initiatives will raise the profile of mental health and addiction issues and identify opportunities to leverage existing resources to address the needs of people living with mental illness. The all-party committee will continue to work with consumers, health care providers, experts and other interested parties to determine the mental health and addictions needs that currently exist. The committee is expected to issue a report in early 2010 that will: Determine the mental health and addictions needs of children and young adults, First Nations, Inuit and Métis peoples as well as seniors; Explore innovative approaches to delivering services in the community; Identify ways to leverage existing opportunities and initiatives within the current mental health and addictions system.

34 MENTAL HEALTH AND ADDICTIONS FUNDING Community services for people with serious mental illness enable them to live their lives fully and reduce inappropriate hospitalization and lengths of stay in hospital. In 2009/10, the province is providing $696.7 million for the provision of community mental health care in Ontario, an increase of $70% since Ontario recognizes that to recover from addictions, people must have easy access to the appropriate type and level of services. The ministry currently allocates about $163.2 million for 150 substance abuse treatment programs and provincial initiatives. The treatment programs include withdrawal management, community counseling and residential treatment and support services. For public inquiries call ServiceOntario, INFOline at (Toll-free in Ontario only) Steve Erwin, Minister s Office, David Jensen, Ministry of Health and Long-Term Care, ontario.ca/health-news Disponible en français

35 LHIN Collaborative (LHINC) Communiqué July 2009 INTRODUCTION This communiqué is the second in a series to be distributed to LHIN stakeholders regarding the implementation of the LHIN Collaborative (LHINC). In the interests of open and transparent communications, we invite you to share this communiqué broadly with individuals, health service providers and associations. LHINC STAFF Our last communiqué indicated that efforts were underway to recruit a permanent leader for LHINC. We are pleased to announce the appointment of two individuals into important LHINC positions. Executive Director Mario Tino has been selected as full-time executive director (ED). Mario holds a MHSc degree in health administration from the University of Toronto and has more than twenty years of experience in Ontario s health sector. For the last nine years he managed his own consulting firm where his practice focused on health sector change initiatives. Prior to entering the consulting field, Mario was a senior consultant with Ontario s Health Services Restructuring Commission. Mario has also held progressively senior management positions in Ontario s Ministry of Health and Long-Term Care where he led several departments and programs. Mario s start date is July 13 th, Team Lead Liane Fernandes has been selected as full-time Team Lead. Liane holds a MHSc degree in health administration from the University of Toronto and has over fifteen years of experience in the health sector including planning, administration, training and development, and clinical service. Since starting with LHINC on June 15 th, Liane has been supporting the development of the Hospital Accountability Planning Submission (HAPS). Over the summer Liane s responsibilities will expand as the LHINC Implementation Team is phased out and permanent staff takes over overall coordination and support of LHINC activities. Administrative Assistant Silvia Puentes will be joining the team to provide administrative support on a part-time basis. Silvia has broad experience in an office environment including at the executive level. Silvia s start date is July 6 th, LHINC LOCATION Starting July 1 st, 2009 LHINC will be co-located with the LHIN Shared Services Office (LSSO) at 120 Eglinton Avenue, East, Suite 500. Mario, Liane and Silvia can be reached as follows: Mario Tino (mario.tino@lhins.on.ca, Ph. # ) Liane Fernandes (liane.fernandes@lhins.on.ca, Ph. # ) Silvia Puentes (silvia.puentes@lhins.on.ca, Ph.# LHINC COUNCIL Work is underway to recruit members for the LHINC Council. The role of the LHINC Council will be to set priorities for the organization and to recruit and monitor the performance of the Executive Director. Membership on the council will include LHIN management, members of provincial associations within the LHIN mandate, as well as representation from cancer care, public health and primary care. Inaugural membership on the council will be carried out in two steps. This two step process is intended to approximate the future nomination and replacement process, whereby LHINC Council members participate in membership selection. The initial two step process is as follows: 1

36 LHIN Collaborative (LHINC) Communiqué July 2009 First, members from those health sectors with only one association/agency have been asked to nominate 3 potential members for council. LHIN members of the LHINC Steering Committee will review the list of potential members and select one to represent each sector. Selection will be based on experience in the health system, geographic location within the province and gender balance. Second, members from those health sectors with more than one association/agency have been asked to nominate 3 potential members for the LHINC Council. These nominations are by sector, not by association/agency. LHIN members of the LHINC Steering Committee as well as new LHINC Council members from step one above will review the list of nominees and select one to represent each remaining sector. Again selection will be based on experience in the health system, geographic location with the province and gender balance. Following is a list of associations/agencies and the sector that they represent. Sector Association/Agency Community Care Access Centres Ontario Association of Community Care Access Centres (OACCAC) Community Health Centres Association of Ontario Health Centres (AOHC) Community Support Service Ontario Community Support Association (OCSA) Organizations Hospitals Ontario Hospital Association (OHA) Long Term Care Ontario Long-Term Care Association (OLTCA) Ontario Association of Non-Profit Homes and Services for Seniors (OANHSS) Mental Health and Addictions Canadian Mental Health Association, Ontario (CMHA-Ontario) Ontario Federation of Community Mental Health and Addiction Programs OTHER Cancer Care Cancer Care Ontario (CCO) Primary Care College of Family Physicians of Ontario Ontario Medical Association (OMA) Public Health Association of Local Public Health Agencies (alpha) Ontario Public Health Association (OPHA) LHINC Council will be holding its first meeting at the end of August, There will be many opportunities for health sector associations and health service providers to participate in the work of LHINC. We will be communicating to the field in the fall regarding LHINC s committee structure and additional opportunities for participation. CONSISTENCY WORKSHOP On March 30-31, 2009, the chairs of the boards and the CEOs of the 14 LHINs, provincial thought leaders, and representatives of health service organisations and the ministry participated in a workshop on consistency in the health system. The objectives of the workshop included: To identify top areas for LHIN consistency and any areas where variability may be preferred; and To identify the structures and supports needed for LHINs to successfully implement consistency. The results of the workshop were assembled as proceedings and are attached for your reference. LHINC SUPPORT The LHINC Implementation Team is continuing to support the following initiatives: 2

37 LHIN Collaborative (LHINC) Communiqué July 2009 Long-Term Care Home Service Accountability Agreement (L-SAA) development; Long-Term Care Home Accountability Planning Submission (LAPS) development; Hospital Service Accountability Agreement (H-SAA) development; Hospital Accountability Planning Submission (HAPS) development; H-SAA indicator selection. NEXT STEPS Over the summer months the LHINC Implementation Team will be winding down and permanent staff will be stepping in to support LHINC activities. The team will be very busy supporting the accountability agreement development processes that are already underway, and as well preparing for the first LHINC Council meeting. WHO CAN I CONTACT FOR MORE INFORMATION? Mario will succeed Barry Monaghan, who has been acting as our interim leader on a part-time basis. We would like to thank Barry for his significant contributions in these early stages of LHINC s implementation. Barry will remain in the interim position until July 10 th, Therefore, for further information please contact: Barry Monaghan (Barry.J.Monaghan@ontario.ca) until July 10 th, 2009 or Mario Tino (mario.tino@lhins.on.ca) starting July 13 th,

38 NEWS RELEASE SUPPORTIVE HOUSING FOR ONTARIO ADDICTIONS PROGRAMS McGuinty Government Funds Supportive Housing for Healthier Communities NEWS July 13, 2009 Central LHIN is pleased to announce $110,300 in funding for eight supportive housing units in Central LHIN to help people living with addictions increase stability and security in their lives and reduce pressure on hospital emergency rooms. Ontario is providing $16 million province-wide over three years, with $5 million in year one, to fund 1,000 supportive housing units for people with substance use issues. The program is targeted to help people who are homeless or at risk of homelessness and who may have one of the following characteristics: Repeat users of addictions treatment system; Complex addiction problems; A concurrent disorder. This funding comes as Minister of Health and Long-Term Care David Caplan launches a discussion paper towards the development of a 10-year mental health and addictions strategy this week at his Open Minds. Healthy Minds summit in Toronto. QUOTES I m pleased this client-centred initiative is part of our commitment to improve mental health and addictions services in Ontario. Providing stable, safe and supportive housing not only improves the mental health and well-being of those who need the service, but also opens doors to healthier communities. David Caplan, Minister of Health and Long-Term Care As one of the priorities of our Integrated Health Service Plan, building capacity and enhancing services for those requiring mental health and addictions support continues to be a key area of focus for the Central LHIN. We are pleased the Ministry of Health and Long-Term Care has recognized supportive housing as a key lever to improving the health outcomes of some of the most vulnerable people living in our communities. We look forward to seeing the positive impact these supportive housing units will have in our LHIN. Ken Morrison, Chairman of the Board of Directors, Central LHIN We understand the importance and need for supportive housing for individuals who may face barriers to accessing service, by providing them with an affordable, stable and secure place to call home while they seek the help they require. Our recent Health Service Needs Assessment and Gap Analysis project identified the need for more supportive housing in our LHIN and so these units are a welcome addition to those Central LHIN already funds through other programs such as Aging at Home. Kim Baker, Acting CEO, Central LHIN

39 QUICK FACTS Ontario has approximately 8,500 supportive housing units for people with a serious mental illness. In 2006/07, 9,650 clients receiving addiction treatment stated no fixed address' when asked where they live. LEARN MORE Find out more about the health care services in your LHIN. Find out more about addiction treatment services in Ontario. Get more information on Minister Caplan's Advisory Group on Mental Health and Addictions. For more information: Sheena Campbell Communications Manager Central LHIN ext 214 sjarviscampbell@lhins.on.ca

40 BACKGROUNDER SUPPORTIVE HOUSING FOR PEOPLE WITH SUBSTANCE USE ISSUES July 13, 2009 Ontario is providing $16 million over three years to fund 1,000 supportive housing units for people with substance use issues or concurrent disorders. This client-centered supportive housing program includes services based on the Housing First model for a harm-reduction. This model provides supportive housing to homeless people with substance abuse issues, whether or not they are enrolled in treatment programs. The housing is integrated into the community so that clients can feel safe and secure in the housing environment. The funding also provides for case managers who provide support on issues such as landlord-tenant relations, budgeting and crisis intervention. Housing supports reduce homelessness and introduce stability into peoples lives. Flexible and tailored to each client, it builds on existing links to other community supports, such as social assistance, affordable housing, and life skills and education /employment counselling. Effective treatment for people with chronic substance use problems or concurrent disorders requires comprehensive, integrated and client-centred services, and stable housing: Most people who have substance use issues or concurrent disorders can be successfully housed if they are given the right supports when they want them (e.g. harm reduction approach); Most people with concurrent disorders will not accept an environment that is too restrictive or rigid and heavily controlled. MINISTER S ADVISORY GROUP ON MENTAL HEALTH AND ADDICTIONS The Minister of Health and Long-Term Care has created the Minister s Advisory Group on Mental Health and Addictions made up of consumers, family members, health care providers and researchers from across the province. It includes a range of perspectives such as children and youth, Aboriginal peoples, seniors, women and adults in the workplace. Input from this group, the Select Committee and the Interministerial Committee will be used to develop a long-term strategy for mental health and addictions for the province. Five working (theme) groups have been established to support the Advisory Group, including; system design, healthy communities, consumer partnerships, early identification and early intervention, and strengthening the workforce.

41 The Advisory Group recognizes that people with varied backgrounds, life experiences and expertise can make an important contribution to their work, and plan to engage stakeholders across the province. SELECT COMMITTEE ON MENTAL HEALTH AND ADDICTIONS An all-party committee has been formed by the Ontario legislature to help develop ways to improve access to mental health and addictions services in the province. The Select Committee on Mental Health and Addictions with representatives from all three political parties will work with consumers, health care providers, experts and other interested parties to determine the mental health and addictions needs that currently exist. The committee is expected to issue a report in 2010 that will: Determine the mental health and addictions needs of children and young adults, First Nations, Inuit and Métis peoples as well as seniors Explore innovative approaches to delivering services in the community Identify ways to leverage existing opportunities and initiatives within the current mental health and addictions system. For public inquires call ServiceOntario, INFOline at (Toll-free in Ontario only) Media Contacts: Steve Erwin, Minister s Office, David Jensen, Ministry of Health and Long-Term Care, ontario.ca/health-news Disponible en français

42 June 30, 2009 For the Attention of Hospital and LHIN CEOs, Board Chairs, OHA Board of Directors and CCAC CEOs From: Tom Closson, President and CEO Alternate Level of Care (ALC) Update June 2009 Attached to this Bulletin, you will find the results of the OHA s June 2009 ALC survey. The ALC results for June are consistent with the downward trend in the number of ALC patients waiting in emergency departments. During the last twelve months, the number of patients in emergency departments has dropped by 17%. Nevertheless, the OHA June survey results indicate that a total of 4,609 beds (16% of beds) were occupied by ALC patients in June 2009 a slight (0.1%) increase from one year ago. Additional results indicate that a total of: 606 patients were in emergency departments waiting for an in-patient bed a decrease of 6% or 42 beds from May 2009 and a decrease of 17% or 123 beds from one year ago; A total of 2,698 (17%) of acute care beds (staffed and in operation) were occupied by ALC patients, down 115 patients waiting last month; A total of 2,382 (24%) of medical beds were occupied by ALC patients; A total of 1,911 (15%) of other in-patient beds (i.e. complex continuing care, rehabilitation and mental health) were occupied by ALC patients - an increase of 3% (52) from last month and a 7% (119) increase since April 2009; 3,006 beds (65% of total ALC beds) were occupied by people waiting to be transitioned into long-term care a decrease of 40 beds from one year ago;

43 As of April 2009, the long-term care sector was still reporting a 98.9% occupancy rate; and 82 admitted patients were reportedly waiting in hallways or other public spaces, similar to last month. (This question was added to the survey in February 2009 in relation to concerns expressed regarding the increasing risks of caring for people in hallways. The OHA continues to work to refine this figure). The OHA has been conducting monthly ALC surveys since November This data is provided to stakeholders and government to monitor the severity of the problem from a provincial perspective, analyze trends and inform the development of useful solutions and strategies. Provincial ALC Definition Adoption All Ontario hospitals will be required to use the provincial Alternate Level of Care (ALC) definition starting July 1, Collecting consistent ALC data in acute, complex continuing care, rehabilitation and mental health for all adult and paediatric populations is key to understanding and addressing the current and future needs of Ontarians, and the OHA supports the use of this definition. Wait time Information System It is important to note that the full implementation of the Wait Time Information System (WTIS) for measuring ALC wait times is scheduled for March 31, However, the Wait Time Information Program (WTIP) at Cancer Care Ontario will be introducing an interim data collection solution, called the ALC Interim Upload Tool, to 92 acute and 21 post-acute care hospitals this fall. The first reports will be available in December The deployment team in the Wait Time Information Program will provide guidance and support to hospitals throughout the implementation of the interim solution. In the coming weeks, a "Getting Ready for the ALC Interim Upload Tool" information package will be distributed to all participating hospitals. This guide will provide an overview of the project and will outline the activities involved to achieve a successful implementation at your hospital. For further information about this Bulletin, contact Lou Reidel at ( lreidel@oha.com) or Enza Ferro at ( eferro@oha.com). 2

44 Alternate Level of Care (ALC) OHA ALC Survey Results: June 2009

45 OHA Survey Results: Acute Care (By LHIN)

46 OHA ALC Survey Acute Care Beds To get an up to date provincial picture, OHA had hospitals complete a survey in: 2007: Jan, Mar, Jun, Aug, Sept, Oct, Nov & Dec 2008: Feb, Mar, Apr, May, Jun, Jul, Sept, Oct, Nov & Dec 2009: Jan, Feb, Mar, Apr, May & Jun Survey represents self-reporting by 100%* of acute care beds in the province All results that follow are based only on the most recent data of those responding to the survey * Excludes Hospital for Sick Children and Children s Hospital of Eastern Ontario Source: OHA June 2009 ALC Survey Results Slide # 3

47 June 2009 OHA Survey Results Acute Care Beds Baseline of 15,968 acute care beds used to calculate survey results Currently, about 2,698 patients are waiting in an acute bed for an alternate level of care on a daily basis This represents 17% of acute beds* that are staffed and in operation The majority (56% in acute beds) are waiting for long term care On average, 606 patients were waiting in the emergency department to be admitted to an inpatient bed, representing 3.8%** of the 15,968 acute beds * Paediatrics and Obstetrics beds are excluded ** Assuming all patients in the ER are waiting for an acute in-patient bed Source: OHA June 2009 ALC Survey Results Slide # 4

48 Percent of Acute Care Beds Occupied by ALC Patients By LHIN North East Hamilton Niagara Haldimand Brant Central Waterloo Wellington Central East North West North Simcoe Muskoka Champlain Toronto Central Erie St. Clair South East South West Mississauga Halton Central West Ontario 6% 11% 10% 9% 14% 13% 19% 19% 19% 18% 17% 17% 22% 25% 25% Percent of Acute Care Beds Occupied by ALC Patients = Number of patients in an acute care bed waiting for an ALC Total acute care beds Source: OHA June 2009 ALC Survey Results Slide # 5

49 Number of Acute Care Beds Occupied by ALC Patients By LHIN North East Hamilton Niagara Haldimand Brant Central Waterloo Wellington Central East North West North Simcoe Muskoka Champlain Toronto Central Erie St. Clair South East South West Mississauga Halton Central West Ontario = 2, Source: OHA June 2009 ALC Survey Results Slide # 6

50 ALC Patients in Acute Care, Ontario November 2007 to June 2009 # of ALC patients in acute care beds % of acute care beds occupied by ALC ,8112, ,9092,927 2,852 2,8292,7872,7852,814 2,9583,074 2,969 3, ,9352,953 2,7932,813 2,698 20% % % % Nov-07 Dec-07 Jan-08 Feb-08 Mar-08 Apr-08 May-08 Jun-08 Jul-08 Sep-08 Oct-08 Nov-08 Dec-08 Jan-09 Feb-09 Mar-09 Apr-09 May-09 Jun-09 0% Source: OHA June November ALC Survey to June Results 2009 ALC Survey Results Slide # 7

51 Percent of ALC Patients in Acute Care Waiting for Long-Term Care By LHIN South East Champlain North East South West Waterloo Wellington Central East Hamilton Niagara Haldimand Brant Central North West North Simcoe Muskoka Toronto Central Erie St. Clair Central West Mississauga Halton Ontario 47% 40% 35% 31% 29% 23% 69% 63% 59% 58% 58% 55% 56% 83% 77% Percent of ALC Patients in Acute Care Waiting for Long-Term Care = Number of patients in acute care waiting for long-term care Total ALC patients in acute care Source: OHA June 2009 ALC Survey Results Slide # 8

52 Number of ALC Patients in Acute Care Waiting for Long-Term Care By LHIN South East Champlain North East South West Waterloo Wellington Central East Hamilton Niagara Haldimand Brant Central North West North Simcoe Muskoka Toronto Central Erie St. Clair Central West Mississauga Halton Ontario = 1, Source: OHA June 2009 ALC Survey Results Slide # 9

53 Other ALC Reasons Patients in Acute Care Beds Rehabilitation 389 Complex Continuing Care 203 Palliative Care 137 Convalescent Care 110 Home 64 Assisted Living / Supportive Housing 30 Home Care 24 Mental Health 24 Other 214 Source: OHA June 2009 ALC Survey Results Slide # 10

54 Number of Patients in Emergency Waiting for an In-patient Bed By LHIN (at any given point in time) Hamilton Niagara Haldimand Brant Central East Toronto Central Central Mississauga Halton Central West Champlain South West North East South East Erie St. Clair North West North Simcoe Muskoka Waterloo Wellington Ontario = 606 Source: OHA June 2009 ALC Survey Results Slide # 11

55 Number of Patients in Emergency Waiting for an In-patient Bed Nov Jun (at any given point in time) Nov-07 16% increase in one year (Nov Nov. 2008) Dec-07 Jan-08 Feb-08 Mar-08 Apr-08 May-08 Jun-08 Jul-08 Aug-08 Sep-08 Oct-08 Nov-08 Dec-08 Jan-09 Feb-09 Mar Apr-09 May-09 Jun-09 27% increase from Nov. 07 to Apr % decrease from April 2008 to June 2009 Source: OHA June November ALC Survey to June Results 2009 ALC Survey Results Slide # 12

56 Number of Admitted Patients Waiting in Hallways or Other Public Space *Results based on responses by 124 of 148 hospitals (84%) to question 82 admitted patients (not in ED) are waiting in hallways or other public space (ALC or otherwise) * Results exclude Hospital for Sick Children, Children s Hospital of Eastern Ontario and Bloorview Kids Rehab Source: OHA June 2009 ALC Survey Results Slide # 13

57 Number of Admitted Patients Waiting in Hallways or Other Public Space By LHIN Central 20 North East 14 Waterloo Wellington 11 Champlain 11 Toronto Central 10 North West 8 North Simcoe Muskoka 5 South East South West 1 2 Ontario = 82 Mississauga Halton 0 Hamilton Niagara Haldimand Brant 0 Erie St. Clair 0 Central West 0 Central East 0 Source: OHA June 2009 ALC Survey Results Slide # 14

58 Percentage of General Medical Beds Occupied by ALC Patients Results based on responses by 120 of 126 hospitals (95%) with general medical beds* On average, 24% of general medical beds are occupied by ALC patients Percentage of general medical beds occupied by ALC patients ranges from 0% to 77% * Calculation of general medical beds includes combined medical and surgical beds. Excludes Hospital for Sick Children and Children s Hospital of Eastern Ontario. Source: OHA June 2009 ALC Survey Results Slide # 15

59 OHA Survey Results: Other In-patient Care* (By LHIN) *Other in-patient care reflects those beds that are not acute, and therefore may include CCC, Rehab, Mental Health, etc.

60 June 2009 OHA Survey Results Other In-patient Care Beds Baseline of 12,960 other in-patient beds used to calculate survey results Currently, about 1,911 patients are waiting in an other in-patient bed for an alternate level of care on a daily basis This represents 15% of other in-patient beds* that are staffed and in operation The majority (79% in other in-patient care beds) are waiting for long-term care * Paediatrics and Obstetrics beds are excluded; Bloorview Kids Rehab excluded from results Source: OHA June 2009 ALC Survey Results Slide # 17

61 Percent of Other In-patient Care Beds Occupied by ALC Patients By LHIN North East Erie St. Clair Hamilton Niagara Haldimand Brant Central East South East North West South West Champlain North Simcoe Muskoka Mississauga Halton Waterloo Wellington Central Toronto Central Central West Ontario 6% 13% 13% 12% 10% 9% 9% 8% 15% 25% 23% 21% 21% 20% 29% Percent of Other In-patient Care Beds Occupied by ALC Patients = Number of patients in an other in-patient care bed waiting for an ALC Total other in-patient care beds Source: OHA June 2009 ALC Survey Results Slide # 18

62 Short-Term Strategies to Relieve ALC Pressures Expand Capacity for Transitional LTC Beds 60 Increase CCAC Service Provision Hours 57 Subsidize LTC Preferred Beds 39 Subsidize Retirement Homes 35 Funding & Development of Supportive Housing Units 34 Expand Capacity Funding for CCC & Rehab Programs 33 Expand Resources for Specialized Geriatric Behaviours 31 MOHLTC Support Hospital First Available Bed Policy 29 Implementation of Nurse Practitioners in LTC Homes 15 Expand Capacity for Palliative Care Programs 8 Note: Hospitals were asked to select, from the above list, three short-term strategies that would be most effective in reducing ALC pressures for their hospital or to provide their own suggestions. Results based on responses from 116 of 152 hospitals (73%) to question. Source: OHA June February ALC ALC Survey Survey Results Results Slide # 19

63 140 Allstate Parkway, Suite 210 Markham, ON L3R 5Y8 Tel: Fax: Toll Free: July 17, 2009 Mr. David W. Clarke 777 Bay Street 7th Floor, Suite 702 Toronto, Ontario M5G 2E5 Dear Mr. Clarke: RE: Health Services Building at Markham Stouffville Hospital The Central LHIN management have reviewed the business case prepared and submitted by Markham Stouffville Hospital to the Ministry on April 30, The business case proposes to construct and operate a Health Services Building on Markham Stouffville Hospital property that once operational will be self sufficient.. Central LHIN management have reviewed the business case for which there are a number of options to finance the design and construction of the Health Services Building which are not intended to impact current operations. Central LHIN management have reviewed the business case, which provides there will be no negative impacts on clinical programs and services as a result of this proposal. Further, the project may generate incremental cash flow that can be directed to hospital needs. Based on this review and the understanding of Central LHIN management, we have no objections to what is proposed and support this initiative. Sincerely, Kim Baker Acting CEO Central LHIN /rs c: Janet Beed, CEO, Markham Stouffville Hospital Shaukat Moloo, Senior Director, Performance, Contracts and Allocations, Central LHIN

64 140 Allstate Parkway, Suite 210 Markham, ON L3R 5Y8 Tel: Fax: Toll Free: MEMORANDUM July 15, 2009 TO: FROM: RE: Central LHIN Health Service Providers Beth Snyder, Interim Senior Director, Planning, Integration and Community Engagement H1N1 Influenza Virus I just want to thank all the Health Service Providers who worked so hard during the recent H1N1 influenza situation in the Central LHIN. There has been much learning since the SARS experience. Our teleconferences served to keep all of us in the loop, helped facilitate practical solutions, as well as, raise challenges previously not identified. The H1N1 virus has not subsided and it is expected to continue to be present as we enter the traditional upcoming flu season. I would encourage you to continue to use this time to fine tune your processes and ensure supplies/strategies are in place. Thank you for your vigilance and support and please contact Joel Moody at joel.moody@lhins.on.ca or (905) ext. 206 if you have any questions or updates. Sincerely, Beth Snyder Interim Senior Director, Planning, Integration and Community Engagement Central LHIN /cs