Community Support Services Review Priority Project. March 2009

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1 Community Support Services Review Priority Project March 2009

2 Table of Contents Executive Summary 3 Summary of the Recommendations 5 Background 7 Project Charter 7 Purpose of The Project 8 Scope 8 Acknowledgements 9 Challenges for the Project 9 Information Gathering Process 11 Project Results 12 Goal 1: Inventory of CSS Services 12 Goal 2: An Evidence Based Model 13 Goal 3: Redefine the Scope of CSS 15 Goal 4: Barriers and Opportunities to Investing in CSS 16 Goal 5: Integration Options 22 Goal 6: Human Resources 25 Implementation Plan 28 Appendices 30 Appendix 1 31 Appendix 2 42 Appendix 3 43 Appendix 4 46 Appendix 5 50 Appendix 6 51 Appendix 7 77

3 Executive Summary Community Support Services (CSS) are an important but undervalued element in providing creative solutions to current and future health services issues, including Alternate Level of Care (ALC) pressures, Emergency Department pressures and lengthy waiting lists for long term care home beds. A renewed investment and commitment to Community Support Services will assist in maintaining the health and wellbeing of individuals and their care givers in their own home and community. These services prevent unnecessary hospitalizations and facilitate earlier discharges from acute care settings. A well-funded CSS sector can provide wrap-around services as a safety net for the elderly and their families and diminish inappropriate use of emergency departments. Enhancing the existing community support services for people with continuing care needs will promote independence and encourage self care. Evidence shows that health care services such as transportation, respite, and home maintenance, personal care and meal programs can reduce the demand for long-term care home and hospital beds. Many individuals may only need assistance with Instrumental Activities of Daily Living (IADL) to remain in their own home. This is a relatively low cost alternative that will enable people to age in place. Given the rapidly ageing population in Central East it is critical that we take immediate action to strengthen and improve community support services. The review has identified the following options as important steps that will help to strengthen the capacity of the CSS sector: Developing a common assessment tool; Creating Back Office Integration model(s) that allows organizations to opt-in; Identifying new performance measures that reflect the contribution of volunteers in delivering services; and Reducing the amount of fundraising required to support CSS programs. The opportunity to move to common processes and standardized tools will assist in improving the linkage to other health providers and to broader human services. The application of a common assessment is seen as an important initial step in improving access, reducing the fragmentation and overall strengthening the role of the sector. It will also enable the sector and government to accurately plan for the changes required to meet the demand for expanded services in the future while a common assessment tool can be achieved with relatively low cost, it will require an investment of new resources in this sector both for systems and training. Back Office Integration (BOI) has the potential to increase the availability of expertise in information, financial and human resource management equitably across many organizations. This strategy is considered a key building block for the future. The Ministry of Health and Long Term Care (MOHLTC) has not adequately funded the infrastructure required for administration in CSS. With increasing reporting and accountability requirements, pursuing Back Office Integration is an option that will allow the sector to augment administrative capacity and expertise, while ensuring that service delivery remains connected to the local community. This strategy will support the efficient use of scarce human, technological and financial resources. Similar to developing a common assessment tool, creating the option for BOI will require additional funding. The current funding allocated for administration is not sufficient to fully fund a new BOI model. This investment will support improved service and financial data quality and has the capacity to create 3

4 performance measures that accurately reflect the real impact of these services. Furthermore, it will assist the sector to demonstrate the quality of service delivery and participate in accreditation. The value and contribution of volunteers is not adequately reflected in the current performance measures applied to CSS. Volunteers play a critical role in delivering many CSS programs such as transportation, meal delivery, visiting social and safety and social dining. If volunteers were not available the cost of these programs would increase significantly. The CSS sector depends on volunteers and is one of the links that maintains the connection to the community. The majority of CSS programs are funded through a combination of MOHLTC funding, client fees and fundraising. The amount of fundraising required each year is a key issue affecting the future of these services. Reducing the dependency on fundraising is critical to this sector. In summary Community Support Services afford the CE LHIN an efficient and effective way of supporting individuals to remain healthy and active members of their community. Strengthening and investing in these services and their infrastructure, represents a viable alternative to enabling people to age in place. 4

5 Summary of the Recommendations Recommendations for MOHLTC and CE LHIN 1. That CE LHIN requests that MOHLTC provide the financial/service data for Homemakers and Nurses Services Act (HNSA) in our area which may assist in creating new partnerships with the municipal sector. 2. That CE LHIN, the MOHLTC and local Municipal Governments presently using HNSA explore the feasibility of creating a partnership with the CSS sector in providing support for low income seniors through HNSA funding. 3. That MOHLTC and the LHINs develop a protocol to share service data for organizations that provide services in communities outside of their local LHIN 4. That the MOHLTC consider including the following ; Transitional Care Wellness and Health Promotion Elder Abuse 5. That the CE LHIN confirms with MOHLTC that Homemaking as described in the Ontario Healthcare Reporting System (OHRS) extends to all communities and is not limited to First Nations only. 6. That the MOHLTC consults with the Ontario Association for Community Support Services to develop a Human Resource strategy for the sector that ensures fair compensation for employees. 7. That MOHLTC provides access to Personal Support Worker (PSW) Training funds to all CSS providers. 8. That the CE LHIN works with MOHLTC to include the direct service provided by volunteers as a unit producing measurement in MIS. 9. That the CE LHIN works with the MOHLTC to extend the information required in the Community Annual Planning Submissions data on both the number of FTE s and the number of volunteers in each service code. Recommendations for CE LHIN 1. That the CE LHIN review with the affected organizations the feasibility of creating a single or coordinated delivery system in those municipalities where there are multiple service providers for the same CSS service Code. 2. That the CE LHIN updates the Service Inventory annually through the Community Annual Planning Submissions. 3. That the CE LHIN support and fund the implementation of a common assessment tool that has the capacity to share information between the Central East Community Care Access Centre (CE CCAC) and CSS sectors. 4. That the CE LHIN support and fund the creation of an ehealth strategy that supports coordinated entry points to CSS programs. 5

6 5. That the CE LHIN support the expansion of Crisis Intervention Support Services as a priority program for new funding available through the Aging at Home (AAH) strategy. 6. That the CE LHIN supports including the Community Support Initiative-Support Service Training as a priority for new funding available through the Aging at Home (AAH) strategy. 7. That the CE LHIN provide funding for a Human Resource Planning session for all CSS providers that would assist organizations in developing a strategic human resource plan. 8. Recommend that we create an option for Back Office Integration (BOI) for the following administrative functions: Financial Services IT Support Services Human Resources 9. That the CE LHIN reviews the feasibility of establishing a common admission process for all Adult Day Programs that is coordinated through the CE CCAC. 6

7 Background Ontario s health care system is facing enormous challenges. The ageing Baby Boomer population will introduce new demands on the health care system. Many communities in the province have serious shortage of family physicians and other human resources needed to provide health care. Some communities have long waiting lists for services and shortages of both acute care and long term care home beds. The global recession may restrict the government s ability to continue to increase public funding for healthcare. Some would suggest that the current system is not sustainable. There is abundant evidence that one of the keys to creating a sustainable healthcare system is an investment in Community Support Services (CSS). The health system has to create new ways to support individuals and their caregivers to age in place. Research has shown that community services play an important role in maintaining the health and well-being of older adults and people with a disability. CSS represents a broad spectrum of services such as Meal Delivery, Transportation, Adult Day Programs, Crisis Intervention and Support, Respite, Homemaking and Home Maintenance and other programs that assist individuals and caregivers. They also provide specialized services that support individuals with hearing or vision loss as well as those with Acquired Brain Injury. Community Support Services represents approximately 2% of the funding allocated by the Central East LHIN. Although this is a very small amount of money these services play a critical role in enabling people to remain in their own home. Given Ontario s rapidly aging population, additional resources must be invested in this sector to ensure that health care is affordable and accessible in the future. Without this investment, wait times in Emergency Departments will increase, more acute care beds will be required to support people in Alternate Level of Care and there will be longer waiting lists for long term care home beds. The Central East LHIN geography stretches from edge of Toronto north to Algonquin Park and east to the town of Trenton. The area includes heavily populated and culturally diverse communities in Scarborough and the Region of Durham, as well as sparsely populated rural areas of Haliburton County and the City of Kawartha Lakes. The CE LHIN area has the second highest percent of those over 65 in the province. The 85+ age group is projected to grow by 91% from 18,000 to over 35,000 by The mapping of CSS suggests that most services/programs are available in many communities throughout Central East area; however, these programs are at capacity and are unable to add new clients without additional funding. The CE LHIN undertook a review of the Community Support Services so that it could continue to respond and manage the changing demand for health services. The project was designed to explore the opportunities for integration that would enable services to be delivered in a seamless manner and identify where new investments are required. Project Charter The Goals of the project included the following: 1. Create an inventory of the existing system of CSS in Central East; 2. Develop an evidence based model for identifying the current need for the current scope of CSS programs; 3. Apply the evidence-based model identified in goal #2 to generate an assessment of the current needs compared to the current capacity and identify the gaps; 4. Apply the evidence based model in goal #2 to generate an assessment of the future need to 2016; 7

8 5. Redefine the scope of CSS taking into account new types of services and delivery models including current unfunded services, innovative practices and based on the new definition modify the model in goal #2; 6. Identify the barriers and opportunities to investing new resources in the CSS sector; 7. Identify the human resources required to sustain and grow the CSS sector; and 8. Identify existing exemplars of integration and potential for new and innovative integration strategies within the CSS sector and between the CSS sector and other health and human services. Purpose of The Project The purpose of the review was to: Identify the pressures and opportunities to the Community Support Services sector remaining a sustainable and accessible component of the health care system across the Central East area; Assess the current infrastructure within the CSS sector in respect to its ability to support and maintain individuals in their community; Identify the appropriate human resources both paid and volunteer required to sustain and grow the sector in the future; and Consider strategies for enhancing integration both within the sector and with the broader systems of health and social services. A primary tool to assist in the work was the development and utilization of an evidence based model for allocating resources. It was perceived that this would serve to enhance system capacity within the sector by recommending where to invest by geography and service type. Also, it was thought that such a model could help clarify the need to expand the scope of CSS service definitions to improve access to services and achieve a more seamless health care system. Scope Community Support Services that were not part of this review include: Palliative Care Services, including Pain and Symptom Management and Hospice Services which are included within the role of the newly formed CE Hospice Palliative Care Network First Nations CSS which will be included as part of the Aboriginal and First Nations planning; and Psychogeriatic Consulting Program (PRC) which will be considered through work on specialized geriatric services and mental health. 8

9 Acknowledgements This report is the result of many hours of collaborative effort. The Project Team would like to acknowledge and thank the organizations that contributed their time and shared their knowledge by completing the Integration Survey, the Human Resource survey and/or attended the Community Consultation held January 27, The Team depended on your advice and insight in developing the recommendations that are part of this review. The Community Support Services Review Project Team: Valmay Barkey, Chair Brent Farr Candace Chartier Kwong Y Liu Trish Baird Antoinette Larizza Leighanne Quibell David Ross Doreen Anderson-Roy Danielle Belair Don Lethbridge Donna MacDonald Odette Maharaj Margot Fitzpatrick Joan Skelton Community Care City of Kawartha Lakes Community Care Durham Region Omni LTC Homes Yee Hong Centre for Geriatric Care, Scarborough Community Care Northumberland Central East Community Care Access Centre Program Support Program Coordinator Victorian Order of Nurses, Peterborough, Victoria and Haliburton Community Care Peterborough Consumer/Caregiver Peterborough Community Care Haliburton Scarborough Support Services Ross Memorial Hospital City of Kawartha Lakes Durham Alzheimer Society of Durham Region (resigned Sept/08) Challenges for the Project The following challenges were faced by the project team in completing this review. Many of these challenges are not unique to CSS. Health care and the broader human services sectors have historical difficulty in generating quality data that clearly measures performance (Appendix 1). Financial and Service Data Collection for CSS The current method for capturing financial and service data does not adequately convey either the capacity or demand for service. The sector is presently in transition to a new Management Information Systems (MIS) for accounting and reporting financial and service data. This system will improve the data available for this sector. 9

10 Service Data for the Central East Community Care Access Centre (CECCAC) The project acknowledges the effort and support of the CE CCAC in attempting to retrieve this data from their information system, unfortunately the data was not available in the categories that were requested. For example, the CE CCAC does not code respite under a unique category and therefore is not able to isolate respite services that are funded as PSW hours. The CSS review was therefore unable to complete the global analysis for the service utilization in each municipal zone, nor identify (through the use of data) the potential for additional partnerships between the CE CCAC and CSS. Cross-LHIN Data Collection There are examples where the CSS programs available in the CE LHIN area are funded through an adjacent Local Health Integration Network. This is most evident in Northumberland County and Scarborough. In these cases the financial and service data is not included in the CE LHIN data base. RECOMMENDATION That MOHLTC and the LHINs develop a protocol to share service data for organizations that provide services in communities outside of their local LHIN. Homemaking and Nursing Services Act (HNSA) Funding Homemaking and Nurses Services Act (HNSA) funding is available to both municipal governments and First Nations communities. The responsibility for this funding was not transferred to the CE LHIN and remains with MOHLTC. The project was not successful in identifying the level of HNSA funding allocated to municipalities in Central East. There is the potential for a new partnership between the CSS sector and municipal governments. In the past, there have been negotiations to transfer these funds from the municipal government to an approved Community Support Service agency for the provision of HNSA service for low income individuals. RECOMMENDATIONS That CE LHIN request that MOHLTC provide the financial/service data for HNSA in our area which may assist in creating new partnerships for service delivery with the municipal sector. That CE LHIN, MOHLTC & Municipal Governments explore the feasibility of creating a partnership with the CSS sector in providing support for low income seniors through HNSA funding. 10

11 Information Gathering Process Financial and Service Data The 2007/08 CSS year-end reports were used to create the inventory for Community Support Services in Central East (see Appendix 1 Service Provider Inventory). In situations where the reports were not available, the coordinator contacted the service provider directly to confirm the CSS programs that they provided. The 2007/08 financial and service data is subject to interpretation for the following reasons: 2007/08 was a transition year with the sector using both the service definitions from either Program, Funding and Accountability Manual (PFAM) or Ontario Health Reporting Standards (OHRS); The financial and service data was not available for some organizations; Data was not available for services delivered in CE LHIN but funded through an adjacent LHIN; and The current data requirements do not include information on clients waiting for service. Appendix 2 shows the amount of funding and the number of individuals served for each CSS program in 2007/08. However, the current financial and service data does not indicate the number of unique individuals being served by this sector or the number of individuals currently waiting for service. It is important to understand the relationship between the investment in CSS and the expenditures in other healthcare sectors. This relationship is particularly important for both the CE CCAC and LTC Home sectors. The CE LHIN provided the allocations for all sectors as of August 1, This data shows that we invest ten times more resources to provide LTC Home placements than we invest in community services. As the population ages are these levels of investment sustainable? Should we build more LTC Home beds or are there other options? Integration and Human Resource Surveys The Project Team conducted two surveys as part of the review process. The Integration Survey received a 60% response rate while the Human Resource Survey received a 30% response rate. The Integration Survey (Appendix 3) was intended to provide the following: Assess the amount of integration currently occurring in administration. Assess the present level of integration in service delivery. Identify the opportunities for integration in CSS. Identify the priorities for integration in CSS. The Human Resource Survey (Appendix 4) was intended to do the following: Create a workplace profile Create an employee profile Create a volunteer profile Assess the % of fundraising required to cover salaries/benefits Better understand the key HR issues facing the sector Community Consultation January 27, 2009 In conjunction with the Supportive Housing Project Team the Community Services Review Team held a community forum in late January The purpose of the day was to share the preliminary findings of both reports and receive community input. The consultation strongly confirmed the need for a common assessment tool for the CSS sector, preferably linked to other components of the health care system; the desire to create shared policies and procedures for the sector and a level of support to consider Back 11

12 Office Integration although many organizations believed that pursuing this option would not result in any cost savings. Literature Review In developing this report the coordinator considered the following studies and/or projects: Sustainability and Vision a Discussion Paper, Toronto Community Support Services Seniors Managing Independent Living Easily, sponsored by VON Canada, SE LHIN Alternate Level of Care Systems Issues and Recommendations, ALC Task Group, CE LHIN Sharing Back Office Service A Model of Collaborative Working On Becoming New Best Friends, David Reville & Associates Aging at Home: Opportunities, Innovations and Best Practices, NE LHIN, Deanne Consulting Targeted Interventions: A Resource Allocation Framework for CSS in Toronto, Toronto District Health Council 2003/04. Project Results The following highlights the results achieved under each goal of the Project Charter. Goal 1: Inventory of CSS Services The mapping of Community Support Services (Appendix 5) suggests that Central East has the capacity to provide the basket of CSS programs throughout the area. Although CSS services are available in most communities, these programs are not adequately funded to meet the current demand. The inventory is helpful in identifying the opportunity to expand and provide enriched programs in Central East. As of April 2009, the Planning, Funding and Accountability Manual (PFAM) is no longer used to define Community Support Services (CSS). This manual has been replaced by the Ontario Health Reporting Standards (Appendix 6). The CSS Project Team has applied the definitions in OHRS for the purposes of this review. The financial and service data used reflects the fiscal year 2007/08 which was a transition year from PFAM to OHRS. Some CSS providers reported their data using the old system while others had already phased in the new MIS reporting requirements. As well, for a small number of organizations data was not available in either system. As a result, the approved annual service targets compared to the actual units of service provided and the actual cost of administration is subject to interpretation. Going forward, it is recommended that the 2009/10 Community Annual Planning Submissions (CAPS) be used to establish the baseline for approved units of service for CSS. Multiple Service Providers per Service Code/Municipality The inventory identifies the potential to improve the efficiency of services and help create a more seamless access to care for clients by moving to either a single provider or coordinated service providers for each municipal or planning zone. The CSS Project Team reviewed situations where there are multiple organizations providing the same Community Support Services in a single municipality (Appendix 1). The CE LHIN presently funds approximately 50 organizations to provide Community Support Services. This doesn t include organizations providing services in the Central East region but whose head office and funding is allocated through another Local Health Integration Network. Although there is little duplication of services in the area there are examples where there are overlapping programs in some municipalities and LHIN planning zones. As well, the Scarborough zone presents unique challenges and opportunities for integration with six key agencies who offer essentially the same of basket of services to their respective communities. It should be noted that while it may look that Scarborough contains six 12

13 agencies providing the same basket of services in a small geographical area it is an area of high population density and cultural diversity. Table 1: CE LHIN Geographic Areas with Multiple Service Providers Zone Meal Del. Social Din. Trans. Crisis Inter. Support ADP Home Main. Respite Emer. Res. Support Visiting Foot Care Northumberland Peterborough Haliburton Kawartha Lakes Scarborough Durham RECOMMENDATIONS That the CE LHIN reviews with the affected organizations the feasibility of creating a single or coordinated delivery system in those municipalities where there are multiple service providers for the same CSS service code. That the CE LHIN updates the Service Inventory annually through the Community Annual Planning Submissions (CAPS). Goal 2: An Evidence Based Model The Central East Local Health Integration Network (CE LHIN) identified the need for a quantitative methodology to assist them in allocation of Aging at Home (AAH) Strategy funds to address the service gaps in supportive housing (SH) and community support services (CSS) within their jurisdiction. As a result, a project was commissioned in early 2008 to develop a population-based allocation model (PBAM). Objective The objective of the PBAM model was to quantify the SH and CSS service gaps within the LHIN area. This information could then be used to support the allocation of AAH funds for target populations. Scope There are currently a variety of CSS and SH services offered throughout the CE LHIN. The cost of services is highly variable, ranging from $6.3 million to less than $5000. Of these various service categories, the CE LHIN identified a few priority areas for future investments. As a result, the model focused on the following six services that accounted for approximately 65% of all the CE LHIN program funding: 13

14 1. Supportive Housing; 2. Adult Day Services - Integrated; 3. Adult Day Services for Cognitively Impaired; 4. Respite; 5. Meal Delivery; and 6. Transportation. The Centre for Research and Health Care Engineering (CRHE) was retained to develop the population based allocation model. 1 CRHE is an initiative of the Department of Mechanical and Industrial Engineering at the University of Toronto, in response to the immediate and compelling desire for efficiency and quality improvements in the Canadian health care system. CRHE research is focused on the application of Industrial/Systems Engineering techniques in relation to demand and capacity modeling and resource allocation issues in the health care industry. Its goals include creating quantitative decision support tools to help policy makers and industry leaders make better informed decisions. Several steps were employed in the evolution of the model focusing on the above six service categories and using various data steps and discussions with providers client groupings were defined data was then extrapolated to quantify the rate of the population that fit the client groupings in various-gender categories. Census data was then used to project the CE LHIN population in client groups. The current average level of service was used to determine population-based demand. Population-based demand was compared with current service utilization data to quantify service gaps for each of the priority services. Given the limitations and assumptions in the current model, several areas were identified for future work in the short term. One such area would be to deploy a provider survey to validate the client profile group. This is because the accuracy of the demand projections relies heavily on the client profile group definitions. A sample survey has been developed. The profiles from the survey could then be used with the updated PALS 2006 data to improve the demand estimates. Another key factor determining the quality of service gap estimates was the accuracy and granularity of the current service capacity. The available data had quality and completeness issues and did not include details about the provider catchment areas. The quality of supply data made it difficult to estimate service gaps accurately. Analysis was further limited since it was not possible to visually represent the gaps in a map without provider catchment areas and details on client location. It is recommended that the CE LHIN conduct client level surveys to improve available data on client location. The CE LHIN should also work with service providers to improve the quality of their reporting about current service capacity and use. Once it becomes possible for both demand and supply data to be represented in a CE LHIN map, it would be possible to consider factors that are currently not quantified in the model, such as rurality, availability of health services (e.g. LTC waitlists) and other public services (e.g. transportation), chronic disease prevalence, and income levels. In addition to facilitating appropriate investments in the right priority services, this would enhance local planning with providers about the optimum location for such services. In the longer term, further work is required to capture information and quantify client flow between and within the different services, including services provided by other sectors of the healthcare system. Together with eligibility assessments and population projections, client flow and referral data would enable the use of system dynamics modeling techniques to develop a model that captures the behaviour 1 The complete report from CRHE titled Population Based Allocation Model: Improving the Distribution of Aging at Home Funds at the Central East LHIN, May 27, 2009 is available from the CE LHIN. 14

15 of the health system as a whole. This model could then be used to reliably predict the result of alternate investment strategies with the LHIN areas. Goal 3: Redefine the Scope of CSS The CSS Project Team was asked to redefine the scope of Community Support Services taking into account new types of services and existing programs that are not funded. The following four programs are recommended to be included as part of the basket of services for Community Support Services. Transitional Care in the Community Transitional care is an Alternate Level of Care (ALC) for patients who no longer require acute care hospitalization. Transitional Care patients are provided with restorative care to promote independence and maximize their potential to be cared for in retirement homes, long-term care homes, supportive housing or in their own homes with Community Care Access Centre supports. The average length of stay for patients is from eight to twelve weeks. Wellness and Health Promotion Among the determinants of health recognized by World Health Organization (WHO) are three important determinants: Social support network; Life skills; and Personal health practices and coping skills. It is also recognized and evident through research that social isolation affects seniors health, both mentally and physically. The Chronic Disease Prevention Management paradigm also recognizes the importance of empowering people to take charge of their own conditions. This empowerment includes helping individuals with chronic diseases to change to a healthy life style and be competent to sustain this life style. A Wellness Program in Community Support Services is a preventive program that aims to deal with the above determinants of health to create a healthy community and in the long run, save the community through a health care investment. The program includes: Social and recreational activities to encourage a healthy and active life-style, to help clients create a social network to combat social isolation. Health education in raising health awareness and managing one s health. Programs to develop life skills and positive personal health practices and coping skills in order to empower seniors to manage their chronic health conditions. Elder Abuse Service The goal of an Elder Abuse Service includes: Developing a collaborative response to identifying and responding to Elder Abuse; Formalizing and strengthening the capacity of a local network to respond; and 15

16 Educating the public and enhancing capacity of individuals to identify and break out of the abuse cycle. The cost of providing this service has been born by agencies that often provide a form of a response as a member of a local elder Abuse Network. Funding for regional human resource assistance has been provided from the Province through the Seniors Secretariat. Homemaking (non-brokerage) This service refers to the activities that assist clients living at home with shopping, light housekeeping, meal preparation, paying bills, etc. The MOHLTC will fund the administration, coordination, labour and transportation costs of providing this service. In the case of HNSA services, the municipality has the option of hiring employees directly or contacting with a service provider. In HNSA this is a claims based program based on eligibility determined in part through the application of a needs test. This service code is included in the basket of services funded under the Ontario Health Reporting Standards (OHRS) and was similarly in the previous PFAM, however, limited to First Nations Communities only. The OHRS does not restrict this service to First Nations and appears to be now open to the CSS sector. It is important that Homemaking services be coordinated between CSS, CECCAC and HNSA to ensure affordable and accessible services are equitably available throughout the CE LHIN area. RECOMMENDATIONS That the MOHLTC consider including the following programs as part of the basket of services available through CSS. Transitional Care Wellness and Health Promotion Elder Abuse That the CE LHIN confirm with MOHLTC that Homemaking as described in the OHRS extends to all communities and not limited to First Nations only. Goal 4: Barriers and Opportunities to Investing in CSS The Community Support Services Review Project Team was asked to identify barriers and opportunities to investing in this sector. The Project Charter was developed prior to the recent shift in global economy. These tougher economic times will increase the pressure on organizations that depend on a combination of public funding, fundraising and charitable donations and client fees to cover the cost of their operations. The tough times will also emphasize the problems associated with not investing in administrative and marketing activities that are so essential to support the delivery of these services. Quick Facts about CSS Sector in the CE LHIN: Over 50 organizations providing CSS programs in CE LHIN CSS receives approximately $30.0M in provincial funding Represents less than 2% of the total health funding allocated under the LHIN Volunteers play a critical role in the delivery of many programs and services 16

17 CSS is dependent on client fees and local fund raising to deliver services (estimate that on average $1.48 in value-added service for every $1.00 of government funding) Based on 2007/08 data, CSS provided services to over 60,000 individuals in CE LHIN OCSA reports that over 100,000 volunteers contribute $103 million in value to CSS across Ontario Barriers to Investing in CSS The Reality The True Cost of Fund Raising Few of the services delivered by community support services organizations are 100% funded by the Ministry. In many cases the government s subsidy represents less than 60% of the actual cost, necessitating the need for fundraising to staff and deliver the service and/or program. The Ministry further determines that staff time spent to fundraise is not an eligible expense. This places significant pressure on the organization to use volunteers or have staff volunteer to plan and deliver fundraising events. The few exceptions to this are those programs delivered through the hospital sector for Psycho-Geriatric Consulting or Palliative Care programs. The remaining programs require providers to raise funds in their community to subsidize the service. The historical process used to allocate new funding often resulted in the same service being funded at different levels depending on the organizations ability to raise charitable donations. This pattern is not sustainable and is a hidden cost to the viability of Community Support Services. Human Resources/Investing in People The present level of funding for CSS does not provide a competitive compensation package for staff. As indicated by the Human Resource Survey, many agencies, in addition to government funding, charitable donations and client fees (if applicable), have to use fundraised dollars to meet the cost of salaries and benefits. It is not reasonable to expect staff to volunteer to do fundraising in order to cover the cost of their salaries. The current agency budgets are stretched to the point where most organizations do not have the capacity to fund the education/training required to develop the next generation of strategic leaders required for this sector. Using volunteers to assist in delivering services is a key feature of community support services. It provides an opportunity for people to stay connected to their community and to develop an understanding and compassion for others. As already noted, the Ministry s present accounting process requires organizations to show the cost of supporting and supervising volunteers as a cost of administration rather than unit producing. The services provided by volunteers are not included as a direct service which inflates the cost of administration provided by CSS. It is also becoming more difficult to attract and retain volunteers. The perception is that the current generation of retiree s are less likely to volunteer than their parents. This presents new challenges for services that depend on volunteers to deliver them, e.g. transportation. When volunteers are not available, agencies have to rely on staff to deliver these services. Understanding the Value of Community Support Services Community Support Services are essential to ensuring that quality healthcare is accessible across the Central East area. Both funders and policy makers need to understand the contribution and direct impact that these services have in reducing the cost of health care. If the health system continues to focus on the immediate pressures in acute care, we will continue to achieve the same results, with higher costs and longer wait times. A renewed leadership and vision is required to break this cycle and increase the funds allocated to support people in their own home and community. 17

18 Community Support Services are funded through the Long-Term Care Act. This legislation is flexible and provides eligibility for a wide range of clients and is not limited by age or disability. This flexibility allows the sector to support diverse needs in our community but also contributes to the confusion as to the target group that the sector supports. The following are some examples of who may benefit from a Meal Delivery Program and services provided by CSS agencies: Seniors and adults with disabilities that require assistance with their main meal due to dietary restraints. High risk clients who are cognitively impaired and live on their own with minimal family support. Diabetic clients depending on service to assist with their main meal of the day. Clients with special dietary needs due to chronic illness. Clients with swallowing difficulties requiring purée or minced meals. Adults with mental health problems who need assistance with special dietary meals, with limited income and require fee subsidies. Dementia clients who are unable to prepare their own meals and may also be living alone. In these examples the function of providing the Meal is simply the means by which the volunteer or staff has contact with the client. It also provides an opportunity to provide for a visit, a reassurance check and assess if changes are happening in the client s status. If other services are required, referrals can be made immediately. The meal delivery program has the potential to initiate wrap-around services for the client. Common Entry Point CSS does not have a defined access point for each municipality or planning zone where individuals, caregivers and other health professionals can easily understand and access the services available in their area. Similarly, a common policy and procedures tool to assess eligibility for services is not in use, although the various organizations have developed these in response to their own capacity to serve and the community s service needs. Although this flexibility enables organizations to respond to unique demands in their community, it also contributes to the sector appearing to be fragmented. The Project Team believes that the CSS sector would benefit from a coordinated delivery system that shares policy and procedures on eligibility, intake, client fees and best practice models. A coordinated system would help to provide consistency across the sector and also help to provide equity in accessing services consistent with the LHIN s Integrated Health Service Plan (IHSP). Performance Measures The current service data does not adequately define either the capacity or the demand for community support services. Many programs do not maintain a waiting list for transportation, meal delivery, caregiver support or social and congregate dining services. If the demand exceeds the capacity, then organizations will attempt to meet these needs by increasing the amount of charitable funding for that year. Although this is positive for the client, increasing services in this manner is not sustainable. This also contributes to variances in service volumes from one year to the next and makes it difficult to project the actual capacity that is supported by Ministry funding. The reliability of the service data makes it difficult for funders to accurately project the future cost of a unit of service and the level of Ministry funding required as demand increases. The performance measures provided for the sector do not show the number of unique individuals using these programs. It is impossible to tell using the service data, if Community Support Services are providing many services to a few individuals or a few services to many individuals. Application of the new MIS reporting system should help to resolve some of the issues although there remain challenges with 18

19 some of the definitions still not accurately capturing service delivery or infrastructure unique to the CSS sector (e.g. volunteer staff ). Given the pressure on staff, volunteers, board members and donors, there is a need to ensure absolute clarity on the function CSS plays in supporting people to remain in their own homes. The sector has to focus on and define outcomes achieved within a defined target population. This focus will allow others to understand the benefits and contribution of their investment. However, it must be understood, that measurement and evaluation of services will require requisite investment in human and technological resources. Funding Silos and Business Models The present funding silos and the RFP Business Model used by the CE CCAC restricts the ability of both sectors to develop wrap around services for clients. The CE CCAC primary relationship is with their contracted providers. There appears to be difficulty in sharing client information with the CSS sector which contributes to inefficiencies. Although both sectors strive to support individuals to remain in their own home, the system lacks the formal means to develop joint care plans and easily transfer information to support individuals and their caregivers. Investment for Infrastructure The Ministry has not invested in administrative and marketing activities that are essential to support the delivery of programs in this sector. The under investment is particularly evident in funding allocated for managing information. An investment in Information Technology (IT) is critical for the CSS sector to develop integrated services with both the hospital and CE CCAC sectors. Support for continuous quality improvement, innovation and standardized systems will create confidence in the services provided through CSS and the significant role it plays in the health system. Marketing and branding CSS will help to ensure that both the broader community and other health providers understand the services that the sector provides and the knowledge required to access these supports. Overarching Strategies to Overcome Barriers The barriers identified to investing in the sector can be addressed. The following highlights the strategies that can be phased in to remove the barriers to investing in CSS: 1. Create Common Assessment Tool Provides the foundation to compare service data. Provides a way for CSS to share information on the needs of clients. Ensures standardization within CSS. Builds on existing investments being made such as use of the interrai CHA. 2. Create Coordinated Entry System Develop a single point of access for each County or Region or multiple access portals that lead to a common reception through an ehealth Strategy. Provide simplified access for the public and other health professionals. Ensure coordinated information exchange with CE CCAC. Acknowledge and support current role with service coordination and system navigation. Consider CSS as potential location for expanded Client Intervention and Support. 19

20 3. Investments for Infrastructure Develop a model for Back Office functions. Phase in model and support voluntary participation as per recommendations under integration. Facilitate the investment in IT, Financial Services and Human Resource management. Advance capacity to achieve timely and consistent financial and service data for the sector. Facilitate global analysis of financial and service data required for strategic planning for the sector. Develop new performance measures that reflect the impact on health care. See further details outlined in the Integration Section of this report. 4. Decrease Dependency on Fundraising Through the CAPS submission for 2009/10 establish a standardized range for fundraising for all CSS programs across the CE LHIN area. For example, e.g. Meal Delivery programs will be funded at no less than 70% of the actual cost. The remaining 30% may be generated from client fees. In consultation with service providers, each service code is reviewed and a benchmark for the level of minimal provincial funding is established. Enhanced funding is phased in to the new level as new funds become available. 5. New Partnerships There is an opportunity to connect with similar organizations and create synergies by working together. This may extend beyond back office integrations to creating a donor program, volunteer recognition and recruitment strategies. Create shared mission and vision statements that can lead to branding CSS sector both in the community and other health providers. Opportunities for Investing in Community Support Services The Community Support Services sector provides opportunities for key strategic investments in health care. Our aging population requires a comprehensive, accessible and integrated system of care that provides the range of supports required to remain in their own home. The system must ensure that longterm care and the home support programs provided by both the CE CCAC and CSS sectors are integrated to ensure that clients have access to a seamless system of appropriate services. The CSS sector should focus on their core competencies to strengthen their fundamental values of enabling individuals to stay connected to their communities through circles of care that integrate both paid staff, volunteers and family members. Core Strengths of CSS: Community based Accountable to the client Accountable to the local community Volunteerism promotes connection to the community for both the agency and client 20

21 Flexibility in that most programs are not tied to capital or fixed assets Low cost Common Assessment and Coordinated Entry Points The mitigating strategies provide immediate opportunities for investing in the sector. These strategies enhance the core strengths and can help to ensure a smooth transition to other health and social services. One of the keys is developing an e-health strategy including a common assessment tool that supports the sharing of client information within the sector and with the CE CCAC. This may be extended later to both the hospital and other parts of primary care. This should also enable the system to identify at-risk seniors and create wrap-around supports that include both CSS and CE CCAC services prior to the individual presenting as a crisis admission at the emergency department. RECOMMENDATIONS That the CE LHIN support and fund the implementation of a common assessment tool that has the capacity at a minimum to share information between the CE CCAC and CSS sectors. That the CE LHIN support and fund the creation of an ehealth strategy that supports a coordinated entry point to CSS programs. Capacity Building and Back Office Integration The Ministry has not invested in administrative support for this sector. Implementing the new MIS accounting system in CSS provides an opportunity to create shared Back Office Integration for this sector. This will help to promote efficiency for administration and more robust financial and service data. In the present environment, the fundamentals have to be right to thrive which includes being able to report the true cost and benefits of delivering CSS programs. Back Office Integration is one of the building blocks that will position the sector to identify and implement improved performance measures that accurately reflect the impact of this sector in the health care system. RECOMMENDATION That the CE LHIN supports the development of Back Office Integration that provides CSS with information technology management, human resource management and financial services management. (For additional details see section on integration). Crisis Intervention and Support At the present time Crisis Intervention and Support is provided by four different CSS providers in Scarborough. It is not available in other parts of the CE LHIN. Crisis Intervention and Support is summarized by the Ontario Health Reporting Standards as follows: the service provides crisis intervention and support in critical situations until the situation is stabilized and a follow-up plan is in place. A case coordinator is responsible for problem identification, direct service, service coordination and discharge planning. If this service were available throughout the CE LHIN area, it would be a key system navigator for at risk seniors and support the development of a coordinated plan of care that includes both CSS and CECCAC services. RECOMMENDATION That the CE LHIN support the expansion of Crisis Intervention Support Services as a priority program for new funding available through the Aging at Home (AAH) strategy. 21

22 Education and Training The Ministry has also underinvested in education and training for most parts of this sector. The budget line for training is often the first one to be cut in tough economic times. Education and training will help to create the new leadership required for the future. The Ministry does provide a code for sector wide training (Refer to FC Community Support Initiative Support Service Training). There is the potential to create a Staff Education/Training Committee for CSS that would be responsible to develop a system wide training plan funded through this code. This should be linked with the existing PSW Training Funds that are currently available to CE CCAC contracted providers and organizations providing Supportive Housing and Adult Day Programs. RECOMMENDATION That the CE LHIN supports including the Community Support Initiative-Support Service Training as a priority for new funding available through the Aging at Home (AAH) strategy. Goal 5: Integration Options The project was asked to identify existing examples of integration within the CSS sector and between the CSS sector and other health and human services. The deliverables included identifying existing and potential new integration strategies and to create a priority setting process to highlight new high priority strategies for integration for the CE LHIN to pursue. It is important to note that integration is not a new concept in Community Support Services. Many organizations have had a long history of working efficiently with other parts of the health and human service system to improve services in their community. The Project Team developed the following process to develop the recommendations for this goal: 1. Define Integration as per the LHSIA (Local Health System Integration Act) 2. Identify the Characteristics of an Integrated Model 3. Recommend the Principles to Guide Decisions on Integration Strategies 4. Create a survey to identify both exemplars of integration and the priorities for integration that agencies are currently developing 5. Identify the Barriers/Risks of Integration 6. Identify the Priorities for Strategic Restructuring in CE LHIN A Definition of Integration as per LHSIA (Local Health System Integration Act) The LHSIA provides a broad framework for integration activity that includes: Coordination of services and interactions; Partnering with others to provide services; Transferring, merging or amalgamating operations; Starting, ceasing to provide services; Ceasing to operate. 22

23 Although the LHIN has the primary responsibility of integrating the health care system, the Act also requires health care providers also find ways to integrate services. To this end, organizations have been working to coordinate and partner with others to improve quality and to ensure the sustainability of the local services. The challenge is how to strengthen the existing partnerships and develop new strategies that help to coordinate services and ensure that the sector is easy to navigate and seamless for clients. Models of Integration as Identified in LHSIA The LHSIA identifies the following alternatives as a continuum for integration: 1. Collaboration Sharing information Joint planning Joint budgeting and service plan development 2. Sharing Resources Sharing administrative services Sharing IT or HR expertise Sharing clinical and/or professional services Common processes for intake and assessment Creating common policy and procedures 3. Potential Benefits of a Merger To make better use of the current resources Make more efficient use of scarce human and volunteer resources Improve the access for their consumers Organizations have shared values and can more readily achieve their mission by combining forces Can attract more public funding by joining forces B Identify the Characteristics of an Integrated Model It is important that we understand the characteristics of an integrated model of care and the benefits that the model should provide for the client. Integration should strive to make the health care system more responsive and improve the quality of service for the client in the following ways: Focus on meeting the needs of the client Coordinates the care across the continuum of health services Ensures an efficient and effective flow of information throughout the system Provided reliable and comparable financial and service data Flexible and responsive to the changing needs of clients and their caregivers. The initial focus should be on ensuring that we have maximized the opportunities for integration within the CSS sector itself and between the CSS sector and the Community Care Access Centre. 23

24 C Recommend the Principles to Guide Decisions on Integration Strategies a. The integration activity should simplify the access to Community Support Services and support a coordinated seamless continuum of care. b. The integration activity should be cost efficient when compared to the current model of service. c. The integration activity must be sustainable in respect to human resources for both paid and volunteer staff. d. The integration activity should strengthen and improve the linkages with other health and social services agencies. e. The integration activity must promote financial stability within the sector. f. The integration activity must include a transition plan that minimizes instability for organizations and their staff while the system moves to new structures and processes. D. Examples of Integration within Central East The integration survey was used to identify the exemplars of integration in the Community Support Services Sector (Appendix 7). It is important to note that this is only a sample of the integration that has occurred and continues to be developed in this sector. E. Barriers and Risks of Integration Integration within the CSS sector provides an opportunity to address some of the fragmentation and gaps in services for the elderly. Although there are obvious benefits, there are also barriers and risks associated in pursuing these options. The sector is heavily dependent on the local community for both fund raising and volunteers. Most CSS programs are dependent on both client fees and local fund raising to sustain these programs. As stated in the Project Charter CSS agencies provide on average $1.48 in services for every dollar of government funding. Many agencies also subsidize the cost of fees for low income seniors through additional fund raising activities. Integration strategies that undermine the ability of these services to remain connected to their local community and continue to raise funds or attract volunteers may seriously affect the ongoing viability of these programs. As well, in the current economic climate not-for-profit organizations may be reluctant to assume additional services transferred from another agency as it will involve transferring both the assets (MOHLTC funding) plus the liability (fund raising portion of the program). Notwithstanding that the transfer of the service will help to make the system more seamless for the client, the action may result in the loss of volunteers and community funding with limited or no incentives from the Ministry. The following highlights some of the challenges for integration in the CSS sector: The potential loss of volunteers for services such as Transportation Services, Meal Programs and Visiting Social and Safety. Potential to undermine the organization s capacity to fundraise. The new model may risk losing the programs connection to the local community. 24

25 Transfer of the program will require transferring both the asset (government funding) and the liability (fee portion and fundraising portion of the service). Back Office Integration is hampered by the lack of base funding for administrative services. Smaller organizations lack the infrastructure and capacity to implement integration opportunities. Integration is limited by the fear of losing the organization s autonomy and identity. Programs that are sensitive to the needs of cultural groups may be reluctant to consider new approaches. Funding for some CE services are held in agency operating budgets that are administered through adjacent LHINs. There must be a clear protocol for how funding can be transferred between LHINs prior to implementing new models of service delivery. F. Strategic Restructuring Options Administration Many CSS agencies are familiar with purchasing back office functions from an outside provider e.g. payroll. This is usually from a provider who does not deliver health or social services, e.g. financial institution. It is important to note that this recommendation is not based on the fact that there are significant resources available to be reallocated from administrative services. The CSS sector needs to develop strategies for BOI to sustain and grow in increasingly complex requirements for financial, human resource and IT services. Partnership with the CECCAC The CSS and CE CCAC need to create a stronger partnership in order to respond to both the current demand for service and to respond to the increased demand from a rapidly aging population in Ontario. There CE CCAC and CSS need to be able to create wrap-around supports for clients depending on Homecare services. There also needs to be a consistent way to share information and develop community options for individuals waiting for placement in Long-Term Care Homes. RECOMMENDATION That the CE LHIN review the feasibility of establishing a common admission process for all Adult Day Programs that is coordinated through the CE CCAC. Goal 6: Human Resources Ensuring that you have access to a highly trained and stable workforce is critical for the success of any business. The same principle applies to the healthcare sector including Community Support Services. The Project Team developed a survey to identify and quantify the Human Resources needs affecting the CSS sector. This includes both paid staff and volunteers who participate in the providing programs such as Meal Delivery and Transportation. Analysis the results of the survey the Project Team compiled a profile for the survey was designed to do the following: Create a employer profile Create an employee profile Create a Volunteer profile Identify Mitigating strategies 25

26 Key Findings for Human Resources Workplace Profile The majority of CSS organizations are small to medium size organizations with less than 50 FTE. In fact 40% of the agencies in the survey reported that they have less than 10 FTE s. Over half of the agencies employee s are not unionized and of those most did not believe that this would occur in the near future. Approximately 60% of the respondents indicated that they do not have a Human Resources plan and most did not have dedicated Human Resource staff. The Executive Director was most likely identified as the individual in the organization responsible to recruit/hire staff. More than 70% of the CSS organizations in the survey reported that 90% to 100% of their staff was female. Almost half of the organizations reported that part time positions represented a quarter of their workforce. However, in other organizations part time positions comprise over half of their staff. Low salaries and benefits were often identified as a key issue affecting this sector. In fact many organizations reported that they had to use fundraising dollars in their budget to offset the cost of salaries/benefits. The level of fundraising required in this sector is a key pressure that impacts on the future viability of these services. Most agencies reported that staff turnover rate was low, with many individuals remaining with the organization for extended periods. The key exception to this was for trained personal support workers (PSW), Information Technology (IT), finance and middle management. These groups were identified as staff that were the most difficult to recruit and retain. The CSS sector is competing with LTC Homes, Hospital sector and CCAC contracted providers for PSW staff. Based on the survey LTC Homes and the Hospital sectors appear to be able to provide for full time positions and improved salaries and benefits compared to CSS. Finance, IT and middle managers also tended to have a higher staff turnover rate. Most organizations have achieved pay equity, however, for agencies who are still working towards their pay equity plan they must continue to reallocate 1% of their total compensation package each year to this goal. Unlike the hospital and CCAC sectors pay equity has not been fully funded by the Ministry. In analysis staff turnover, 50% of CSS organizations reported that employees left for employment in other healthcare sectors. The key reasons for staff leaving the CSS sector, include, higher salaries/benefits and the opportunity for full time work. Volunteers Volunteers play a significant role in the delivery of certain CSS programs, such as Meals Delivery, Transportation and Visiting Social and Safety. Over half of the organizations who responded to the survey reported that they were having difficulty in attracting and retaining volunteers. Almost 60% indicated that the average age of their volunteers were between 60 to 70 years of age. Given that studies have indicated that many baby boomers will continue to work after the age of 65 the difficulty the sector has in attracting volunteers will worsen. In fact many respondents indicated that the reason why they lose volunteers is because they find employment. Another common issue that was identified was the lack of a full time volunteer coordinator. In the past the Ministry has not consistently recognized the need for this position. This responsibility was often assigned to various parts of the organizations which contribute to inconsistencies throughout the sector. The lack of volunteers, the high cost of fuel, concern for personal safety in specific neighbourhoods and the more complex needs of clients, have all contributed to changes in how some CSS programs are 26

27 provided. As an example, transportation programs are increasingly depending on paid drivers to provide services in many communities. This trend will continue. When asked to identify the most critical human resource issues affecting the sector organizations identified the following: Number of staff with limited IT training Pressure to increase salaries/benefits without Ministry funding Compensation packages for middle and senior managers in CSS are not competitive with other health sectors which contributes to staff turnover High workloads which contributes to staff burnout RECOMMENDATIONS Given the relatively small size of the majority of organizations providing CSS programs the key human resource issue is improving the salaries/benefits for all staff. The sector is not able to provide a competitive compensation package for scarce professional and/or technical staff. Given the present economic environment the project team acknowledges that a single strategy that recommends investing funds to improve salaries/benefits isn t likely to be supported by the funder. Nevertheless it is a critical issue that needs to be addressed. Provincial Recommendation 1. That the Ministry of Health and Long-Term Care in consultation with the Ontario Association for Community Support Services develop a Human Resource strategy for the sector that ensures fair compensation for employees. 2. That MOHLTC consider extending the access to PSW Training funds to CE LHIN Recommendation 1. That the CE LHIN ensures that Back Office Integration includes the capacity to provide Human Resource expertise to the CSS sector. 2. That the CE LHIN fiscally fund under Community Support Initiative Support Service Training the development and implementation of a shared staff training events for CSS providers in the area. 3. That the CE LHIN fiscally fund under the above initiative a Human Resource Strategy Planning session for all CSS providers that would assist in developing a baseline for future Human Resource planning. CSS Organization Recommendation 1. Partner in each planning zone to develop a HSIP for a volunteer coordinator in each Collaborative. 27

28 Implementation Plan The following begins the process to implement the recommendations found in this report. Strategy to Move to a Single or Coordinate Service Provider in each municipal zone: In the process of negotiating the 2009/10 MSAA and CAPS the LHIN and service providers share the responsibility to identify the opportunity to move to a single or coordinated service delivery for each service code in CSS. Where there is an opportunity the service providers should prepare a business case for the transfer or coordination of these services, including any fiscal cost associated with the integration activity. If a voluntary agreement isn t feasible then the LHIN will be required to make the decision on the transfer of resources. Once the opportunities have been confirmed the sector should create a work plan that allows for the orderly transition. Steps: 1. Use the 2009/10 CAPS to confirm the list of multiple service providers in each municipality. 2. LHIN request that the organizations develop a business case that enables the transition to a single or coordinated service provision for each code in the OHRS. 3. In the situation where the service providers are supporting moving to a single provider the organizations prepare a business case identifying all costs associated with the transfer for LHIN approval. 4. In situations where there isn t agreement between the organizations affected by this transfer the LHIN will be required to make the decision. Application of a Common Assessment: The LHIN should consult with the CSS sector on selecting a common assessment tool and identify the process to phase in the application. It is anticipated that staff training that will be required. The 2009/10 fiscal year should be used to support training and building the IT capacity if required. The cost of the application and training should be supported fiscally by the CE LHIN. Steps: 1. Under the direction of the LHIN the CSS providers will select representatives to review the options in selecting a common assessment tool. 2. Once the common assessment tool has been confirmed the committee should create an implementation plan that includes the cost of the tool, infrastructure requirements, staff training needs and how the assessment tool can be phased in starting in 2010/11. 28

29 3. The SE LHIN is also moving to a common assessment format for CSS and it is recommended that both LHINs consult on the potential to share knowledge and expertise in supporting this direction. 4. All costs associated with supporting a common assessment should be supported by the CE LHIN. Back Office Integration: BOI should be a voluntary option where agencies are allowed to opt-in rather than mandating BOI for the entire sector. Steps: 1. LHIN request that organizations interested in considering BOI participate in an advisory committee that will help to design the model. 2. LHIN hire a consultant to assist the advisory committee to develop the model. The key features include: CSS providers voluntarily opt-in to the model. Participating agencies create the new shared services office (BOI) with the support of a consultant. After the model is developed, advisory committee assists in recruiting the manager to lead the implementation. Participating financial, human resources and IT staff are assigned to the new shared service office. BO functions are phased in over the two year period. Cost of BO to participating agencies is determined by the level of administrative costs indentified in the 2009/10 CAPS unless otherwise negotiated with the LHIN. 3. Initiative is fiscally funded by the LHIN until the project can be fully self-funded by participating organizations. 29

30 Appendices Appendix 1: Appendix 2: Appendix 3: Appendix 4: Appendix 5: Appendix 6: Appendix 7: Service Provider Inventory Level of Expenditure per Service Code Integration Survey Human Resource Survey Mapping of Community Support Services Ontario Health Reporting Standards Definitions for CSS Examples of Integration 30

31 Appendix 1 CSS Service Provider Inventory 2 Haliburton Agency Address Services Haliburton Community Care Victorian Order of Nurses PVH Branch Victorian Order of Nurses PVH Branch 83 Maple Avenue Haliburton, ON K0M 1S0 83 Maple Avenue Haliburton, ON K0M 1S0 6 McPherson Street Minden, ON K0M 2K0 Service Arrangement Coordination Transportation Meals Delivery Friendly Visiting Social Congregate Dining Emergency Response Support Adult Day Program Foot Care Services Adult Day Program Foot Care Services Alzheimer Society Peterborough Haliburton, Northumberland Canadian Hearing Society SIRCH 4663 County Rd 21 K0M 1S0 370 Kent Street West Whitney Town Centre Lindsay, ON K9V 6G8 Caregiver Support Hearing Support Services 2 Community Support Services that were not part of this review include: Palliative Care Services, including Pain and Symptom Management and Hospice Services which are included within the role of the newly formed CE Hospice Palliative Care Network First Nations CSS which will be included as part of the Aboriginal and First Nations planning; and Psychogeriatic Consulting Program (PRC) which will be considered through work on specialized geriatric services and mental health. 31

32 Agency Address Services City of Kawartha Lakes Alzheimer Sociey City of Kawartha Lakes Community Care City of Kawartha Lakes 55 Mary Street West Lindsay, ON K9V 5Z6 34 Cambridge Street South Lindsay, ON K9V 3B8 Caregiver Support Health Promotion Education Transportation Meal Delivery Homemaking Emergency Response Support Visiting Social and Safety Social Congregate Dining Community Care City of Kawartha Lakes Community Care City of Kawartha Lakes Community Care City of Kawartha Lakes Victorian Order of Nurses PVH Branch Victorian Order of Nurses PVH Branch Canadian Hearing Society Box 941, 71 Bolton St., Unit D Bobcaygeon ON K0M 1A0 70 Murray Street Fenelon Falls ON K0M 1N Portage Rd., Kirkfield, ON K0M 2B0 51 Mary Street West Lindsay, ON K9V 5Z6 51 Mary Street West Lindsay, ON K9V 5Z6 370 Kent Street Lindsay, ON K9V 6G8 Transportation Meal Delivery Adult Day Program Homemaking Visiting Social and Safety Social Congregate Dining Transportation Meal Delivery Adult Day Program Respite Homemaking Visiting Social and Safety Social Congregate Dining Transportation Meal Delivery Visiting Social and Safety Social Congregate Dining Adult Day Program Adult Day Program Acquired Brain Injury Hearing Support Services 32

33 Agency Address Services Northumberland County Canadian Red Cross 330 Ward St, Unit 3 Port Hope, ON L1A 4A6 Victorian Order of Nurses HNPE Branch(funding held by SE LHIN) Victorian Order of Nurses HNPE Branch (funding held by SE LHIN) Community Care Northumberland Community Care Northumberland Community Care Northumberland Community Care Northumberland Community Care Northumberland Canadian Hearing Society Campbellford, ON K0L 1L0 Cobourg, ON K9A 3K3 174 Oliver Road, Campbellford K0L 1L0 74 Queen Street Port Hope, ON L1A 2Y9 6 Albert Street Hastings, ON K0L 1Y Elgin Street Cobourg, ON K9A 5J4 46 Prince Edward Street Brighton, ON K0K 1H0 Services provided through the Peterborough site. Meal Delivery Adult Day Program Respite Adult Day Program Respite Transportation Meal Delivery Caregiver Support Homemaking Brokered Model Transportation Caregiver Support Homemaking Brokered Model Transportation Meal Delivery Caregiver Support Homemaking Brokered Model Transportation Meal Delivery Caregiver Support Homemaking Brokered Model Transportation Meal Delivery Caregiver Support Homemaking Brokered Model 33

34 Agency Address Services Peterborough County Activity Haven Alzheimer Society Peterborough, Haliburton, Northumberland Community Care Peterborough Community Care Peterborough Community Care Peterborough Community Care Peterborough 180 Barnardo Avenue Peterborough, ON K9H 5V3 183 Simcoe Street Peterborough, ON K9H 2H6 180 Barnardo Avenue Peterborough, ON K9H 5V3 Box 303, Burleigh Street Apsley, ON K0L 1A0 Box 86, 3 George Street West Havelock, ON K0L 1Z0 Box 158, 275 Queen Street Lakefield, ON K0L 2H0 Adult Day Program Social Congregate Dining Caregiver Support Health Promotion Education Promotion Education/Geriatric Meal Delivery Transportation Service Arrangement/ Coordination Emergency Response Support Visiting Social and Safety Meal Delivery Social Congregate Dining Transportation Service Arrangement /Coordination Emergency Response Support Visiting Social and Safety Meal Delivery Social Congregate Dining Transportation Service Arrangement/Coordination Emergency Response Support Visiting Social and Safety Meal Delivery Social Congregate Dining Transportation Service Arrangement/Coordination Emergency Response Support Visiting Social and Safety 34

35 Community Care Peterborough Agency Address Services Box 257, 22 King Street East Millbrook, ON L0A 1G0 Meal Delivery Social Congregate Dining Transportation Service Arrangement/Coordination Emergency Response Support Visiting Social and Safety Community Care Peterborough Community Care Peterborough (Harvey Office) Victorian Order of Nurses PVH Branch Victorian Order of Nurses PVH Branch Victorian Order of Nurses PVH Branch York Durham Aphasia Services (funding held by CE LHIN Canadian Hearing Society Canadian Institute for the Blind Community Counseling and Resource Centre Four Counties Acquired Brain Injury Assoc. Box County Rd. 45 Norwood, ON K0L 2V0 Box 12, St. Matthew s Anglican Church Buckhorn, ON K0L 1J0 360 George Street North Peterborough, ON K9H 7E7 64 Hague Blvd. Lakefield, ON K0L 2H0 8 Oak Street Havelock, ON K0L 1Z0 180 Barnardo Avenue Peterborough, ON K9H 5V3 315 Reid Street Peterborough, ON K9J 3R2 159 King Street Peterborough, ON K9J 2R8 459 Reid Street Peterborough, ON K9H 4G7 160 Charlotte Street Peterborough, ON K9J 2X5 Meal Delivery Social Congregate Dining Transportation Service Arrangement/Coordination Emergency Response Support Visiting Social and Safety Meal Delivery Social Congregate Dining Transportation Service Arrangement/Coordination Emergency Response Support Visiting Social and Safety Adult Day Program Respite Services Adult Day Program Adult Day Program Aphasia/Communication Support Hearing Support Services Vision Support Services Social Work Caregiver Support ABI - Assisted Living Services 35

36 Durham Region Agency Address Services York Durham Aphasia (funding by CE LHIN) Victorian Order of Nurses Durham Branch Canadian Hearing Society Whitby Seniors Activity Centre Corp. Town of Whitby Head Injury Association of Durham CNIB Durham District Region of Durham Hillsdale Region of Durham Lakeview Alzheimer Society of Durham Sunrise Senior's Place 1850 Rossland Rd. Whitby, ON L1N 3P2 50 Richmond Street Oshawa, ON L1G 7C7 575 Thornton Rd. Oshawa, ON L1J 8L5 801 Brock Street Whitby, ON L1N 4L4 850 King St. West Oshawa, ON L1J 8N5 1 Mary Street North Oshawa, ON L1G 5T9 590 Oshawa Blvd North Oshawa, ON L1G 5T9 133 Main Street Beaverton, ON L0K 5T9 419 King Street West Oshawa, ON L1J 2K5 75 John Street West Oshawa, ON L1H 1W9 Aphasia/Communication Support Visiting Social and Safety Hearing Support Services Foot Care ABI Day Program ABI Independence Training Vision Services Adult Day Services Adult Day Services Caregiver Support Health Promotion Education Promotion Education Geriatric Social Congregate Dining 36

37 Agency Address Services 43 John Street Oshawa, ON L1H 1W8 Oshawa Senior Citizens Centre Community Care Durham Community Care Durham Community Care Durham Community Care Durham 1420 Bayly Street Pickering, ON L1W 3R4 1 Cameron Street Cannington, ON L0E 1E0 26 Beech Avenue Bowmanville, ON L1C 3A2 45 Bloor Street East Oshawa, ON L1H 3L9 Social Congregate Dining Crisis Intervention Support Adult Day Program Foot Care Transportation Meal Delivery Social Congregate Dining Transportation Visiting Social and Safety Emergency Response Support Home Help Respite Adult Day Program Meal Delivery Transportation Visiting Social and Safety Emergency Response Support Home Help Respite Foot Care Meal Delivery Transportation Visiting Social and Safety Emergency Response Support Home Help Respite Foot Care Adult Day Program Meal Delivery Transportation Visiting Social and Safety Emergency Response Support Home Help Respite 37

38 Agency Address Services Community Care Durham 181 Perry Street Port Perry, ON L9L 1B7 Meal Delivery Transportation Visiting Social and Safety Emergency Response Support Home Help Respite Foot Care Community Care Durham Community Care Durham 75 Marietta Street Uxbridge, ON L9P 1K7 114 Dundas Street Whitby, ON L1N 2H7 Meal Delivery Transportation Visiting Social and Safety Emergency Response Support Home Help Respite Foot Care Adult Day Program Meal Delivery Transportation Visiting Social and Safety Emergency Response Support Home Help Respite 38

39 Scarborough Scarborough Support Services Yee Hong Centre for Geriatric Care Agency Address Services Centre of Information and Community Services of Ontario Momiji Health Care Society St. Paul's L'Amoreaux 1045 McNicoll Avenue Scarborough, ON M1W 3W McNicoll Avenue Scarborough, ON M1V 5L Finch Avenue East Scarborough, ON M1W 3T Kingston Road Scarborough, ON M1M 3W Finch Avenue East Scarborough, ON M1W 2R9 Transportation Meal Delivery Social Congregate Dining Adult Day Services Homemaking/Home Help Service Coordination Client Intervention and Support Respite Home Maintenance Visiting Social and Safety Transportation Meal Delivery Social Congregate Dining Adult Day Services Caregiver Support Visiting Social and Safety Client Intervention and Support Recreation Client Intervention and Support Social Congregate Dining Transportation Visiting Social and Safety Meal Delivery Social Congregate Dining Transportation Client Intervention and Support Adult Day Services Home Help/Homemaking Home Maintenance Respite Caregiver Support Visiting Social and Safety 39

40 Agency Address Services 3601 Victoria Avenue Scarborough, ON M1W 3Y3 Carefirst Seniors and Community Services Association West Hill Community Services 3645 Kingston Road Scarborough, ON M1M 1R6 Social Congregate Dining Transportation Client Intervention and Support Adult Day Services Homemaking Visiting Social and Safety Meal Delivery Home Maintenance Home Help Caregiver Support Respite Social and Congregate Dining Transportation Visiting Social and Safety Adult Day Services 40

41 Agency Address Service NOTE: Project Team did not map these programs SIRCH Box 687 Haliburton, ON K0M 1S0 Hospice Kawartha Lakes 112 McLaughlin Road Lindsay, ON K9V 6B5 Peterborough Hospice 439 Rubidge Street Peterborough, ON K9H 4E4 Lovesick Lake Native Women's Assoc. Curve Lake Peterborough Regional Health Centre Hospice Durham Whitby Mental Health Centre (New Name: Ontario Shores Centre for Mental Health Sciences) Lakeridge Health Corporation Hospice Northumberland Lakeshore Campbellford and District Palliative Care Services 7 Albert Street PO Box 220 Lakefield ON K0L 2H0 22 Winookeeda Road Curve Lake, Ontario K0L 1R0 1 Hospital Drive Peterborough, ON K9J 7C6 209 Dundas Street East Lower Level Whitby, ON L1N 7H8 700 Gordon Street Whitby, ON L1N 5S9 1 Hospital Court Oshawa, ON L1G 2B9 259 Division Street Cobourg, ON K9A 4K5 P.O. Box Oliver, Campbellford, ON K0L 1L0 Alderville First Nations 8467 County Road 45 P.O. Box 12 Alderville ON K0K 2X0 Regional Geriatric Program of Toronto VON Toronto York Region Branch 2075 Bayview Avenue, Suite H478 Toronto, ON M4N 3M Bayview Avenue, Suite H478 Toronto, ON M4N 3M5 Hospice Visiting Hospice Visiting Hospice Visiting First Nations - Off Reserve Supportive Housing/First Nations Promotion and Education - Psychogeriatric Hospice Visiting Promotion and Education - Psychogeriatric Palliative Services Hospice Visiting Hospice Visiting CSS/First Nations Promotion and Education - Psychogeriatric Hospice Visiting 41

42 Appendix 2 Level of Expenditure per Service Code CSS Services CE LHIN 2007/08 Code Service Total Expenditure Individuals Served % of Total Expenditure Administration NA 18% Service Arrangement/Coord. $200, % Meals Delivery 2,372, % Social and Congregate Dining 1,722, % Transportation 2,885, % Crisis Intervention; Support 451, % Day Services 4,324, % Homemaking 1,016, % Personal Support/Independence Tr. 2,552, % Respite 1,838, % Comb. PS/HM/Respite Services Overnight Stay Care (Alz. & Related) Assisted Living Services 5,435, % Caregiver Support 574, % Emergency Response Support Service 186, % Visiting Social and Safety 781, % Foot Care 285, % Vision Impaired Service 410, % Hearing Impaired Service 437, % ABI Day Service 37, % ABI Personal Support and Ind. Training 288, % Total 31,756, % * data for administration was not available for all CSS providers **service data was not available for all CSS providers 42

43 Appendix 3 Integration Survey for Community Support Services Background The Project Charter approved for the Review of Community Support Services includes identifying exemplars of integration and the potential for new and innovative integration strategies within the Community Support Services sector and between our sector and other health and human services. To this end, we would appreciate your time and input in completing the following survey. Thanking you advance for your cooperation and support, Definition of Integration Integration is a broad concept that includes but not limited to the following kinds of activities: Coordination of services and interactions; Partnering with others in providing indirect services (often referred to as back office functions e.g. technology, finance or other administrative services, etc.); Partnering with others in providing direct service; Transferring, merging or amalgamating programs or operations Intended Outcomes of Integration Improving accessibility of health services to allow people to move easily through the health system; Improving the match between services provided and the multiple needs of clients; Making the health care system more sustainable while promoting service innovation by enabling effective and efficient use of resources and capacity. 43

44 Survey Administration: 1. Do you provide any back office functions for other health/social services providers? Financial Services Human Resource Support Technology or IT Services Planning Marketing Other If other, please explain: 2. Do you receive any back office functions from other health/social services providers? Financial Services Human Resource Support Technology or IT Services Planning Marketing Other If other, please explain: 3. Do you have a purchase of service agreement for any administrative services with a private organization e.g. payroll service. Financial Services Human Resource Support Technology or IT Services Planning Marketing Other If other, please explain: 4. Are you presently in negotiations to provide/receive any back office functions in the coming fiscal period and if so, what services? Financial Services Human Resource Support Technology or IT Services Planning Marketing Other If other, please explain: 5. Do you share office space or equipment with other health providers? 6. Do you participate in bulk purchasing with other organizations e.g. Ontario Buys? 44

45 7. Are there other opportunities for shared administrative services that you would like to comment on? 8. Other comments on integrating administrative services: Service Delivery 9. Do you have any service protocols with other health/social service organizations? Common point of access Common eligibility/assessment process Joint fund raising Volunteer Recognition/Recruitment Other If other, please explain: 10. Do you coordinate service delivery with other social/health service organizations? For example, adult day programs that use a meal or transportation program from another provider in the delivery of their service. If yes, please explain: 11. Do you contract out any services mandated through your organization? If yes, please explain: 12. Are you planning to develop any new service protocols with other providers? If yes, please explain: 13. What are the priorities for integration in your service area? Please provide further details: Opportunities/Barriers to Integration 14. What would you consider to be a priority for integration in Community Support Services? Please provide further details: 15. What would you consider to be the central barrier for integration in Community Support Services? Please provide further details: What action can be taken to remove this barrier? Other Comments 16. Do you have other comments or ideas that would help to promote an integrated system of services? 45

46 Appendix 4 Human Resources Survey for Community Support Services Sector 1. How many of staff does your agency employed to provide CSS programs? Less than 10 employees Between 10 to 20 employees Between 20 to 30 employees Between 30 to 50 employees More than 50 employees 2. What percentage of your agency staff is providing CSS funded services? Less than 25% Between 25% to 50% Between 50% to 90% 100% of the staff 3. What percentage of staff salaries/benefits are covered by fund raising and/or client fees? Less than 10% Between 10% and 25% Between 25% and 50% More than 50% 4. What percentage of your staff are part time employees? Less than 10% Between 10% to 25% Between 25% to 50% More than 50% 5. What best describes the annual staff turnover rate in your organization? Minimal (less than 5% per year) Medium (more than 5% but less than 10%) High (more than 10% but less than 25%) Very High (more than 25% a year) 6. What is the average length of stay for all positions within your agency? Less than 5 years Between 5 to 10 years Between 10 to 20 years 20 years and longer 46

47 7. What do you consider to be the key reasons for staff leaving your agency? Low salary/benefits Lack of full time hours Demanding stressful work Job opportunities in other sectors Pursue additional education Retirement Other 8. What do you consider to be the key reasons for staff staying with your agency? Salary/benefits Staff training Job satisfaction Positive work environment Other 9. How many staff in your organization will be retiring in the next five years? None Less than 10% More than 10% Don t know 10. Who is responsible for recruiting staff for your agency? F/T HR staff P/T HR staff Program Management staff Executive Director Other 11. Does your agency have Human Resource Strategy Plan developed for 2010 and beyond? No Yes 12. If yes, what key strategies have you identified? Improved compensation packages Improved benefit packages Increased staff training Recruitment strategies Other 47

48 13. Are the employees in your agency represented by a union? No Yes 14. If no, do you anticipate this occurring? Yes, within the next year Yes, within the next 3-5 years Yes, but unsure when. 15. Have you achieved your Pay Equity Plan? Pay Equity not applicable to our agency Yes, pay equity plan completed Pay equity plan still in progress that is, still directing the required amount to achieve pay equity as per the legislation. 16. What percentage of your workforce is female? Less than 50% More than 50% but less than 75% More than 75% but less than 90% Between 90% and 100% 17. What positions does your agency have the most difficulty in filling? PSW trained staff Administrative staff including finance and IT Middle Management Professional staff Senior Management Other 18. Do you use volunteers in delivering services? No Yes 19. How many volunteers to you have to support CSS services? Less than 20 Between 20 and 50 Between 50 and 80 More than What is the average age of your volunteers 50 years of age or less 50 to 60 years of age 48

49 60 to 70 years of age 70 years of age and over 21. Do you have difficulty in attracting and keeping volunteers? No Yes If yes, what do you believe think is the primary reason? 22. What do you believe are the most critical Human Resource issues facing the CSS sector? Please explain: 23. What do strategies do you think the sector can pursue to mitigate Human Resources facing this sector? Please explain: 24. Do you think partnering with other agencies and/or sectors would help to mitigate Human Resources issues facing your agency? No Yes If yes, how might this assist your organization? 25. What strategies to you believe the local health integration network should pursue to assist the CSS sector in developing a sustainable Human Resource plan? Facilitate group purchasing for benefits Coordination of Human Resource Plans Investment in additional infrastructure to support Human Resources Review current compensation packages for CSS sector Other 49

50 Appendix 5 Community Support Services Maps CE LHIN Figure 1: Visiting/Social and Safety Services 50

51 Figure 2: Vision Support Services 51

52 Figure 3: Transportation Services 52

53 Figure 4: Social and Congregate Dining 53

54 Figure 5: Service Arrangement and Coordination Services 54

55 Figure 6: Meal Delivery Services 55

56 Figure 7: Home Help and Homemaking Services 56

57 Figure 8: Hearing Support Services 57

58 Figure 9: Health Promotion and Education Services 58

59 Figure 10: Foot Care Services 59

60 Figure 11: Crisis Intervention Services 60

61 Figure 12: Crisis Intervention Services 61

62 Figure 13: Aphasia and Communication Support Services 62

63 Figure 14: Adult Day Programs 63

64 Figure 15: Acquired Brain Injury Programs 64

65 Figure 16: Supportive Housing Services 65

66 Appendix 6 Definitions for Community Support Services Ontario Health Reporting Standards FC COM In-Home Health Care - Social Work Pertaining to helping service recipients and their families deal with personal, socio-economic and environmental problems which influence the SRs' condition. For CSS, to enable SRs and families to develop the skills and abilities necessary to optimize their functioning and thus reduce the risk of psychosocial breakdown, through a trained professional. Includes: Compensation social workers FC COM Health Promotion Education General Geriatric Pertaining to promoting health, and educating the community, including the public, professionals, and other sectors about general geriatrics. For CSS, the services focus on promoting health, public awareness and educating Alzheimer disease and related disorders. This may include local public education activities to raise awareness, recruit and train volunteers with knowledge of the disease, develop/facilitate family or significant others support groups and coordinate/implement training events for volunteers, significant others, staff and other target groups. Includes: Coordination costs - direct staff compensation Costs related to volunteers recruitment Costs related to training/education sessions Excludes: Volunteer compensation FC CSS IH COM - Service Arrangement/Coordination Pertaining to the activities that arrange services to be provided in a service recipient's (SRs) home. Generally, the job is beyond the SR's or their caregivers capability to undertake or arrange themselves. The job may be undertaken regularly, occasionally or one time only. The jobs arranged may include home maintenance, repair and homemaking and respite services. The entity may use brokerage, contractors and/or volunteers for the services. The funding is not for the labour and transportation cost of providing the services at the SRs residence. Services include: Service coordination costs - direct staff compensation (linking service recipients with services and supports) Monitoring and evaluation of services provided to recipients 66

67 Client fees for the job, if applicable Excludes: Labour costs and direct costs to complete the job, e.g. cleaning supplies FC CSS IH COM Meals Delivery Pertaining to activities that arrange meals delivery to service recipients (SRs) at their residence to meet their nutritional requirements. The meals are delivered by volunteers who may provide a regular social contact and check the health and safety of the SR. Includes: Coordination costs - direct staff compensation Meal costs Client fees to assist in covering the food costs Transportation costs (e.g. mileage, public transit costs, gas) which will be reported using F Travel Expense Staff Delivery of Service Recipient Service Excludes: Volunteer compensation FC CSS IH COM Social and Congregate Dining Pertaining to coordination of and delivering services and activities that promote health and wellness, and provide social activities based on needs of service recipient (SR) groups with the goal of maintaining or promoting their wellness. The services, may or may not include a nutritious meal, are for the SRs who are either in receipt of or eligible to receive other long-term care community services. The social activities may include recreation activities such as swimming, cards and crafts. Includes: Coordination costs (direct staff compensation, if any) for activities Social activity supplies Transportaiton cost for volunteers (F Travel Expense Staff Delivery of SR Service) Meal costs and recoveries from SRs for meals, where applicable Excludes: Volunteer compensation SR transportation costs report related costs under FC 7* Transportation when transportation is arranged for the SRs FC CSS IH COM Transportation-Client Pertaining to activities that arrange to provide transportation to medical appointments, shopping and to various social activities and programs. Transportation is provided by the entity's staff or volunteers to 67

68 eligible service recipients using private cars, entity's vehicles, and public transportation or assisting the service recipient to walk to the destination. This is a door-to-door service. Includes: Coordination costs - direct staff compensation Expenses incurred by volunteers, such as public transportation, etc. when they accompany or transport the the Service Recipient (F Travel Expense SR) Costs related to vehicles owned and used by the providers to provide the service Cost recoveries from service recipients Excludes: Volunteer compensation FC CSS IH COM Crisis Intervention and Support Pertaining to the service provided to service recipients with different types of crisis needs. For CSS, the service provides crisis intervention and support in critical situations until the situation is stabilized and a follow-up plan is in place. The target groups are vulnerable and at risk seniors, persons with physical disabilities and/or their significant others. This includes people facing homelessness, a critical or impending change in life situation, abuse or isolation. A case coordinator is responsible for problem identification, direct service, service coordination and discharge planning. The services must be delivered through a provider offering other community support services. Includes: Coordination costs - direct staff compensation Direct employee compensation case coordinator Excludes: SRs receiving assisted living services and this being a component of the combined services FC CSS IH COM Day Services An integrated support service which provides supervised programming in a group setting for SRs who require close monitoring and assistance with personal activities (e.g. hygiene, dressing, etc.) The SRs include the frail and elderly and those with Alzheimer disease or related disorders, or physically impaired individuals who are relatively independent and can manage certain personal activities. Individuals may attend this service for five to twelve hours on average for a fee. This service assists the participants to achieve and maintain their maximum level of functioning, to prevent early or inappropriate institutionalization and provides respite and information to their significant others. Components of the service include planned social and recreational activities, meals, assistance with the activities of daily living and minor health care assistance; e.g. monitoring essential medications. Includes: Direct employee compensation, e.g. attendant, supervision Supplies for social or other activities, e.g. fees for guest speakers 68

69 Cost of food, if meals are provided Service recipient fees, where applicable Excludes: Volunteer compensation FC CSS IH COM Homemaking Pertaining to the activities that assist service recipients living in home with shopping, light housekeeping, meal preparation, paying bills, caring for children and laundry and training the person to perform these activities. The funding is for both the administration/coordination costs of providing the service to eligible SRs as well as the labour and transportation costs of providing the service. The SR is responsible for the direct cost of service, i.e. shopping items, food, etc. For services under the Homemaking Nurses Services Act, the services will be provided by hired employees or contracted resource through a claims based program, on a monthly basis. Includes: Coordination costs - direct staff compensation Costs of labour and transportation to carry out homemaking services Excludes: Costs related to food and shopping items, etc. FC CSS IH COM Home Maintenance Pertaining to the activities to undertake a home maintenance and repair for service recipients (SRs) through individual workers. For CSS, this service is mainly provided to eligible First Nations SRs. Generally, the job is beyond the SR's or their significant others capability to undertake or arrange themselves, friend or family. The job may be undertaken regularly, occasionally or one time only. Examples include heavy house cleaning, snow shoveling, washing outside windows, seasonal housecleaning and cleaning out wood burning stoves, etc. Includes: Coordination costs - direct staff compensation Direct costs of carrying out the work - compensation to workers Excludes: Direct service costs for non-eligible service recipients Change due to adding the combined FC FC CSS IH COM Personal Support/Independence Training Pertaining to services to assist service recipients (SRs) with routine personal hygiene activities, activities of daily living, and train the SR to carry out these activities. This may include the core components of independence training service; through working with SRs and/or family members to teach the activities of 69

70 daily living and necessary skills to increase personal independence. The skills may be taught include physical development and health, sensory-motor development, communications and social skills, emotional and spiritual development, independent living skills and behavioural management. This service is provided for SRs living with families as well as those living in institutions and making arrangements for living in the community. The services are provided at the SR s residence and may be on a continuous basis. Includes: Coordination costs - direct staff compensation, e.g. personal support workers and independence trainers Compensation for employees delivering the training Transportation costs to service recipient s location, where applicable Excludes: SRs receiving assisted living services as this is a component of the combined services Direct costs of homemaking cleaning supplies, etc. FC CSS IH COM Respite The provision of short or long-term significant others relief within service maximums and available resources through a Personal Support Worker. The service may include homemaking, some personal care, light housekeeping, attendant care, monitoring, supervision, and/or activation. Includes: Employee compensation for providing direct services homemaking and respite workers Coordination costs - direct staff compensation Transportation costs (e.g. fuel, public transit costs, gas, and mileage) Excludes: Volunteer compensation FC CSS IH COM Comb. PS/HM/Respite Services The provision of combined in home support services which may include homemaking, personal support/independence training, home maintenance and respite. Report under this combined service FC or the detailed FC * accounts. Organizations should decide on the need to provide detailed reporting based on volume of service, materiality, funding sources and other internal or external reporting requirements. FC CSS IH COM Overnight Stay Care An integrated support service which provides overnight service in a group setting for service recipients with Alzheimer disease and related disorders. This service is to provide short-term support or temporary relief for families of SRs, such as during weekends. Components of the service include accommodation, 70

71 meals, social activities, assistance with the activities of daily living and certain health care assistance, e.g. monitoring essential medications. Includes: Direct employee compensation, e.g. attendant, supervision, nursing Supplies Cost of food Client fees, where applicable Excludes: Volunteer compensation FC CSS IH COM Assisted Living Services Pertaining to the activities provided to Service Recipients (SRs) who are living in a supportive housing setting and require assisted living services, accessible on a 24-hour basis. This service may include homemaking, personal support, attendant services and core components of independence training. The supportive housing setting is a location where organization may be responsible for providing services to a number of SRs who live in their own units and housing is not a component of the service. Organizations providing these services will ensure their staff in various locations are onsite and accessible on a 24-hour basis. Includes: Compensation costs - homemaking, personal support and attendant workers Excludes: Building operations and maintenance costs which will be recorded under the Plant Operations functional centre Costs of homemaking cleaning supplies, etc. FC CSS IH COM Caregiver Support Pertaining to the activities that provide information, education, training and therapeutic counseling that will assist the service recipient (SR) who is the caregiver. For this service, a SR is the caregiver or family member(s) and/or other service providers for the purposes of providing care and support to a particular individual directly or indirectly. The service provides education which can be either in group or individual sessions, or under the direction of a professionally trained individual and/or one who has demonstrated knowledge and expertise in the SR's area of need for support/counseling. The services may be provided on a time limited and goal-directed basis, target to meet the caregiver's social and emotional needs. Includes: Professional costs Transportation costs Expenses for education and training sessions, e.g. room bookings, supplies Direct employee compensation costs coordination 71

72 Excludes: Volunteer compensation FC CSS IH COM Emergency Response Support Services Pertaining to the service that provides an electronic device in a service recipient's (SR) home so that the SR can communicate, in an emergency, with a centre staffed 24 hours a day that can summon emergency help. This service includes billing and repair on the device. Generally, SRs are expected to pay a user fee for the electronic device. The funding may be used to fund those who cannot afford the emergency response system service and to defray administrative fees. Includes: Coordination costs - direct staff compensation Transportation expenses incurred Long distant telephone costs, if applicable Supplies - cost of electronic communication device Service recipient recoveries Excludes: Emergency service fees, e.g. ambulance fees FC CSS IH COM Visiting Social and Safety Pertaining to coordination and delivery of the activities that provide a contact to a service recipient (SR) on a regular basis to check the health, safety and social needs of the SR. The SRs may be isolated seniors, physically disabled adults, persons with Alzheimer disease or other dementias, or their significant others. The contact can be through a phone call (phone visit) or face to face visit. The face to face visits are made to the SR's home and volunteers may also perform shopping or take the SR out for daily living activities, e.g. banking, social event. Includes: Coordination costs - direct staff compensation Expenses incurred by volunteers for the visiting, e.g. transportation Transportation expenses incurred Long distance telephone costs, if applicable Excludes: Volunteer compensation FC CSS IH COM - Foot Care Services Pertaining to the activities that arrange for individuals trained for foot care to provide services in a congregate setting. Service includes trimming toe nails, monitoring the condition of feet, soaking and may include massaging feet. A fee is charged to cover some of the direct cost of supplies and the 72

73 individuals who provide the service. Funding support is limited to administrative cost of arranging the service. Includes: Supplies Client fees to cover some of the direct costs Coordination costs - direct staff compensation Excludes: SRs receiving assisted living services and this being a component of the combined services. FC CSS IH COM Vision Impaired Care Services Pertaining to the services provided by trained specialists; such as independent living specialists, low vision specialists, rehabilitation teachers, vision rehabilitation workers and orientation and mobility specialists; to vision impaired service recipients. Services include assessment, rehabilitation teaching, orientation and mobility, low vision rehabilitation and assistive technology. Includes: Direct employee compensation Training supplies Cost related to service coordination, intake and referral services. FC CSS IH COM Hearing Impaired Care Services Pertaining to counseling and support service for deaf, deafened or hard of hearing service recipients (SRs), their families and significant others provided by hearing care counselors and communication disorder assistants. The service includes identification, assessment, education/training, coping and consultation related to hearing loss and deafness. This program is provided in home-based setting to seniors and adults with acquired hearing loss. General Support Services are provided by counselors primarily office based to SRs who are deaf, deafened or hard of hearing, their families, significant others in a cultural/linguistic approach. Information, education and training about hearing loss issues are provided to the public and service providers. The service may include long-term support to SRs with communication disorders arising from stroke, ABI and other brain diseases. FC CSS ABI Day Services An integrated support service which provides supervised programming in a group setting for service recipients (SRs) living with the affects of an Acquired Brain Injury (ABI). The SRs require assistance or supervision to perform routine activities of daily living safely or independently as a result of the effects of an ABI. SRs may attend this service for two to twelve hours on average and may or may not pay a fee. This service assists the participants to achieve and maintain their maximum level of functioning and self respect as well as provides respite to their significant others. Components of the service include work structured day, planned social and recreational activities, meals, and minor health care assistance; e.g. monitoring essential medications. 73

74 Includes: Direct employee compensation, e.g. attendant, supervision Supplies for activities Cost of food, if meals are provided Client fees, where applicable Excludes: Volunteer compensation FC CSS ABI Vocational Training and Education Services A support service which provides vocational training and education information to service recipients (SRs) with acquired brain injury to assist them to enter the work force or education system in the community. This service is for SRs who are expected to restore or improve functional ability. The service can be offered in a series of sessions for up to a pre-determined duration per week. Includes: Direct employee compensation, e.g. attendant, supervision Supplies for activities Excludes: Volunteer compensation FC CSS ABI Personal Support/Independence Training Pertaining to services to assist acquired brain injury service recipients (SRs) with routine personal hygiene activities, activities of daily living, which may include homemaking services, and train the SR to carry out these activities. This may also include personal support, respite and the core components of independence training service; through working with SRs and/or family members. The skills that may be taught include physical development and health, sensory-motor development, communications and social skills, emotional and spiritual development, independent living skills and behavioural management. This service is provided for SRs living with families as well as those living in institutions and making arrangements for living in the community. The services are provided at the SR s residence and may be on a continuous basis. Includes: Coordination costs Direct staff compensation, e.g. personal support workers, employees delivering the training Transportation costs to service recipient s location, where applicable Training supplies Excludes: Individuals receiving 24-hour assisted living services 74

75 Professional service fees training program development and professional supervision which is funded through the psychological services FC CSS ABI Assisted Living Services Pertaining to the activities provided to Service Recipients (SRs) with acquired brain injury who are living in a supportive housing setting and require assisted living services, accessible on a 24-hour basis. The services may include, but not limited to, homemaking, personal support and attendant/ personal hygiene services. This service may also include the core components of independence training service and SR specific behavioural management programs developed and/or supervised by the professional service funded through the Psychological services. The supportive housing setting is a location where orgganization may be responsible for providing services to a number of SRs who live in their own units and housing is not a component of the service. Organizations providing these services will ensure their staff in various locations are onsite and accessible on a 24-hour basis. Includes: Compensation costs - homemaking, personal support, attendant and training Excludes: Building operations and maintenance costs which will be recorded under the Plant Operations functional centre Professional service fees training program development and professional supervision which is funded through the psychological services Direct costs of homemaking cleaning supplies, food, etc. FC CSS Com Sup Init Support Service Training Pertaining to the activities that provide information, education and training that will assist the service providers or support the growth and development of organizations for the purposes of supporting the service recipients directly or indirectly. The services may be provided on a goal-directed basis as well as promoting the concept and value of volunteerism. The service can be in group or individual sessions. This service may apply to CSS service providers, general volunteers and volunteers for hospice services, First Nations or Aboriginal organizations and self organizations, etc. The First Nations service includes support for their members with information, referral, advocacy and access to mainstream long-term care services. Includes: Direct staff compensation Costs associated with volunteer training Volunteer incurred expenses, e.g. transportation Expenses for education and training sessions, including supplies Transportation costs Excludes: Volunteer compensation 75

76 FC CSS Com Sup Init Personal Support Worker Training Pertaining to the activities that provides personal support worker (PSW) training to a selected number of current employees of providers or companies that have contracts to provide Homemaking/Personal Support/Attendant/Respite Service to CCAC and provider that receive ministry funding to deliver assisted living services and adult day programs. The training is provided by community colleges, private vocational schools and some Boards of Education to train adults. In addition to the number of employees (students) receive the PSW training. The provider is required to maintain the records on the names and dates of the course(s). Includes: Course fees related to personal support worker training Employee salaries (benefit hours) while attending the training Supplies and travel expenses 76

77 Appendix 7 Examples of Integration Community Support Services have been built on a foundation of partnering and sharing resources. The following chart demonstrates a few examples of the integration activities that have developed. This is not intended to be an exhaustive list and the sector has a history of both vertical and horizontal integration that has created efficient and effective service delivery. Coordination Partnering Transferring and Merging Planning (Volunteer) Many organizations reported that Board members participated on the Board to Board Collaborative. CSS providers in Haliburton work cooperatively to recruit volunteers for the SMART exercise program. CSS providers in Scarborough jointly provide training to caregivers in the Ambassador Training Program. Planning (Staff): Many organizations reported that their staff participated on the following structures: CELHIN Collaborative Seamless Care for Seniors Project Teams for CSS Review, Caregiver Support, Home at Last, Rural Transportation and Supportive Housing Service Provider Networks Elder Abuse Prevention Networks Falls Prevention Networks such as Partners in Aging Peterborough CSS organizations in Peterborough and Haliburton have created a purchase of service agreement to provide Caregiver Support Services for clients dementia in Haliburton County. CSS partners with other sectors including the broader Human Services sectors in sharing space and equipment. Peterborough CSS providers have created a partnership with Central LHIN CSS agency to provide Social Work services to the Peterborough site. Scarborough CSS agency partners with Mt. Sinai Wellness Centre to assist with providing screening for mental health. Scarborough CSS agencies partner to provide Supportive Housing to Wishing Well Manor to both Chinese and non- Chinese residents of a senior housing complex. CSS providers in Scarborough contract with a variety of healthcare organizations to subcontract agreements to provide Homemaking Service for both the CECCAC and the Homemaking and Nursing Services program with the City of Toronto. CSS provider in Scarborough contracts to with the City of Toronto to provide direct services with City sponsored supportive housing programs. CSS providers in the City of Kawartha Lakes has partnered CSS organizations in Peterborough, Durham, City of Kawartha Lakes and Northumberland amalgamated local chapters to provide the common basket of CSS programs to their community. Many provincial CSS organizations have consolidated local branches to reduce the cost of administration and reflect new LHIN boundaries. 77

78 Administration: MIS Advisory Working Group A number of organizations reported that they participated in a Bulk Purchasing agreement with other Health sectors. Many CSS agencies participate in bulk purchasing agreement Ontario Community Support Association (OCSA) for both health benefits and insurance. Broader Human and Social Services: CSS providers coordinate transportation and meal delivery for both ODSP and DVA clients. CSS agencies provide support services for people with disability that are coordinated with Community Living organizations. CECCAC coordinates admission to Adult Day Programs in Peterborough County, City of Kawartha Lakes, Haliburton County and Northumberland CECCAC completes the assessment as part of the admission process for some Supportive Housing program. with CMHA, and Community Living and the municipal government to develop a supportive housing project as part of an Affordable Housing initiative. CSS providers across the CELHIN area work cooperatively to provide transportation and meal programs for Adult Day Services. CSS providers coordinate support with the District Stroke Strategy Staff to jointly support the Stroke Support Group for survivors and their family. CSS provider in the City of Kawartha Lakes purchases payroll services from the Hospital sector. CSS providers contract with municipalities to provide Accessible Transportation Services for the community. CSS providers contract with the Hospital sector for nonemergency transportation services. CSS providers throughout the CELHIN area partner with Nissan Canada Foundation in the provision of Transportation and Meal Delivery Programs. Many CSS organizations providing Meal Delivery programs purchase the meals from both LTC Homes and the Hospital sectors. CSS providers in Durham coordinate transportation services for the Region of Durham. Peterborough CSS providers merged to create a single Meal Delivery Program for Peterborough City and County. 78

79 Ontario March of Dimes Durham has service protocols for program delivery, assess and volunteer recruitment and recognition with other organizations. CSS organizations coordinate services with Mental Health and Community Living organizations for shared clients. CSS agency in Scarborough provides Back Office support (Financial, HR, IT and Marketing to other local health and social services organizations. 79

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