Appendix E. Summary of South West LHIN Current State Profile

Appendix E Summary of South West LHIN Current State Profile

Health System Design: Blueprint Initiative Phase 2 Summary of South West LHIN current state profile A Healthier Tomorrow 1

Table of Contents Overview of South West LHIN Population LHIN-wide Service Utilization Acute Care LHIN-wide Service Utilization Complex Continuing Care, Rehabilitation and Long Term Care LHIN-wide Service Utilization Community & In-home Services Note: This presentation only includes a high-level overview of the data analysis that was used to inform the models of care. Participants of the symposium were provided an additional level of analysis on specific health programs to inform their decision-making and development of specific models of care. 2

Overview of South West LHIN Populations 3

4 Data Sources Utilized for Project Community Data CCAC data submitted: Health Data* Population Data Qualitative Information Sources* Programmatic breakdown in alignment with blueprint model was not available, thus aggregate data by resident county for CCAC has been included Fiscal Year 07-08 actuals in CAPs 09-11 Long-Term Care Long-Term Care Home System Report January 2009 South West LHIN Long Term Care Beds Inventory CCAC data on waitlists and inappropriate admissions Hospital Data Hospital Annual Planning submissions 2007/08 Intellihealth 2005/06 2007/08 Courtyard Group Emergency Department Analytics Physician Data OPHRDC Active Physician Registry 2007 Current and Historical Populations: Statistics Canada Census: 1996, 2001 and 2006 Population Estimates & Projections Intellihealth May 2008 Canadian Community Health Survey 2007 Consultation themes from interviews & focus groups Blueprint Survey Findings CCC / Rehabilitation Strategic Resources Report March 2009 Critical Care Strategy for LHIN 2 Regional Chronic Disease System Model Priority Action Team Reports Community Annual Planning submissions 2009/10, 2010/2011 Hospital Annual Planning submissions 2008/09, 2009/2010 South West CCAC Fact Sheet FY 2007-08 *Please note that we are in the process of compiling information from the survey and as a result, findings presented here do not capture changes in services beyond years cited.

The LHIN s geographic layout and population distribution naturally falls into three distinct areas For planning and comparison purposes, we will provide our analysis, not only at the county level, but rolled up to the regional level. Waterloo Wellington Central West North Simcoe Muskoka Hamilton Niagara Haldimand Brant Further details regarding the composition and size of the three planning areas are provided in the table below. Area North Municipal Entities Bruce County, Grey County (excluding parts of Southgate Township, West Grey and The Town of the Blue Mountains) Square Kilometres 8,663 Central Huron and Perth Counties 5,626 5 Erie St. Clair South City of London, Middlesex, Oxford and Elgin Counties, Norfolk County (South West LHIN portion) 7,576

The South West LHIN population in 2022 is based on an 0.7% average annual growth rate 6 North Region Age Grp (Census) Population 2007 2012 2017 2022 % of Total LHIN Population Population % of Total LHIN Population Population % of Total LHIN Population Population % of Total LHIN Population 00-14 24,132 3% 23,154 2% 23,990 2% 25,293 2% 15-44 56,138 6% 54,546 6% 54,169 5% 54,537 5% 45-64 47,505 5% 49,717 5% 49,485 5% 48,110 5% 65-74 16,919 2% 20,127 2% 24,017 2% 27,260 3% 75-84 9,528 1% 10,531 1% 11,821 1% 14,465 1% 85+ 2,929 0% 3,450 0% 4,119 0% 4,628 0% North Total 157,151 17% 161,524 17% 167,600 16% 174,293 17% Central 00-14 25,006 3% 23,940 2% 24,309 2% 25,361 2% 15-44 54,022 6% 53,042 5% 52,991 5% 53,045 5% 45-64 37,301 4% 40,056 4% 40,142 4% 38,727 4% 65-74 11,008 1% 12,845 1% 15,340 2% 18,015 2% 75-84 7,986 1% 7,627 1% 8,107 1% 9,700 1% 85+ 3,206 0% 3,653 0% 3,917 0% 3,905 0% Central Total 138,529 15% 141,163 14% 144,806 14% 148,753 14% South 00-14 114,100 12% 108,506 11% 109,944 11% 114,954 11% 15-44 274,522 29% 275,609 28% 279,270 27% 281,640 27% 45-64 171,180 18% 189,042 19% 195,862 19% 195,712 19% 65-74 44,940 5% 54,492 6% 67,141 7% 78,527 7% 75-84 32,462 3% 32,884 3% 35,725 4% 44,188 4% 85+ 11,968 1% 14,354 1% 15,851 2% 16,738 2% South Total 649,172 69% 674,886 69% 703,793 69% 731,758 69% South West LHIN Total 944,852 100% 977,573 100% 1,016,199 100% 1,054,804 100%

The population s socio-demographic composition reinforces the diversity of the communities within the South West LHIN The senior cohort over 65 years of age is most prevalent in the central and north regions of the LHIN, where stakeholders have revealed a gap in services to address the needs of this population group. As a whole, the LHIN has a higher percentage of seniors. The southern areas of the LHIN attract diverse, multicultural residents, which may influence the types of health care services offered. Although the unemployment is in line or below the provincial average, the economic downturn may increase this average and negatively impact population health. In February 2009, Statistics Canada reported an increase in unemployment for Ontario to 7.9%. Another key determinant of health, South West LHIN residents are noted to have a lower average household income compared to provincial average. Socio-Demographic Variables Census 2006 % Seniors 65+ % Nonofficial Mother Tongue % Visible Minority % Aboriginal Unemployment Rate % University Avg. household income Single Parent Families Bruce 19.4% 7.0% 1.5% 3.4% 5.3% 11.1% $54,403 10.0% Grey 20.0% 7.0% 1.6% 1.6% 5.2% 11.2% $49,912 11.9% Huron 19.4% 8.1% 1.5% 0.5% 4.4% 7.9% $51,910 10.1% Perth 17.2% 10.4% 2.1% 0.7% 3.7% 10.0% $57,225 12.4% Middlesex 15.3% 18.8% 11.7% 1.6% 6.1% 18.9% $55,435 16.5% Oxford 17.4% 10.2% 2.5% 0.9% 4.8% 8.9% $58,870 13.1% Elgin 15.6% 14.4% 2.4% 1.1% 5.5% 8.7% $57,839 13.8% Haldimand & Norfolk 17.1% 10.9% 1.5% 1.9% 6.0% 8.2% $56,646 11.6% Ontario 13.2% 14.9% 22.6% 1.9% 6.0% 7.3% $69,156 15.8% Statistics Canada 2006 Census

Overview of South West LHIN organizational inventory across sectors Hospital Community 8 Organization Total Locations Grey Bruce Health Services 7 South Bruce Grey Health Centre 4 Hanover and District Hospital 1 Alexandra Marine and General Hospital 1 Huron Perth Healthcare Alliance 4 Listowel Memorial Hospital 1 South Huron Hospital 1 Wingham and District Hospital 1 Alexandra Hospital 1 London Health Sciences Centre 3 St. Joseph s Health Care, London 4 St. Thomas-Elgin General Hospital 1 Strathroy Middlesex General Hospital 1 Four Counties Health Sciences Corp 1 Tillsonburg District Memorial Hospital 1 Woodstock General Hospital 1 Total 33 Region Total Organizations North 10 Central 24 South 53 All Regions (CCAC) 1 Source: CAPS 09-11 Total 88 Region Source: South West LHIN Source: HAPS 2007-08 & Ontario Master Numbering System Long Term Care Total Organizations North 19 Central 19 South 37 Total 75 Community organization numbers reflect multiple sites across the LHIN

Overview of Service Utilization Acute Care 9

South West LHIN Service Capture Rates by Separations and Hospital 10 The map to the left illustrates that there are 4 major referral centres within the South West LHIN: GBHS-Owen Sound for the north region Stratford General Hospital for the central region London Health Sciences Centre St. Joseph s Health Centre The map illustrates that GBHS-Owen Sound appears to capture major market share just north of Wingham and District Hospital. However GBHS-Owen Sound s inpatient service capture rates decline with the presence of the other community sites. It is also possible that transportation is more of a challenge in the north region. Stratford General Hospital captures significant market share in the central region with the service patterns extending north. It is difficult to delineate the service capture of LHSC and SJHC, however, their service capture rate declines going further south, likely due to the availability of services from St. Thomas-Elgin Hospital. Note: further detailed views of these maps for each sub-region are provided in the following pages.

Acute Care Services: LHIN-wide Service utilization - Total Separations by Region LHIN-wide Service Utilization* Average LOS Average ELOS Average RIW North 5.73 4.71 1.18 Central 4.50 4.33 0.97 South 6.18 4.52 1.39 Source: Intellihealth FY 2007-08 Source: Intellihealth FY 2007-08 * Average LOS & ELOS includes ALC days 11 There was a total of 94,118 separations for the South West LHIN. Hospital service utilization appears to be consistent with one might expect given the current population distribution in the LHIN. The LOS (length of stay) and RIW (resource intensity weighting) figures may reflect characteristics, such as available resources, acuity or workload. Due to the large tertiary care centres in the south, the higher average LOS and RIW is expected. All regions are reporting a higher average LOS relative to average estimated LOS (ELOS)

Service Capture Rates by Separations and Hospital North Region The map to the left illustrates the inpatient service utilization of Bruce and Grey county hospitals. GBHS-Owen Sound appears to have the greatest market share in this region capturing 50% of total separations, which is likely due to the fact that this is the regional referral centre for Grey and Bruce Counties In the southern area of this region, SBGH-Walkerton and Hanover and District Hospital have similar service capture patterns, with the Hanover site capturing a slightly bigger market share within a smaller radius. Note: Hospitals with less than 40% market share are not shown on the map. Source: Intellihealth FY 2007-08 12

50% of total separations in the North were attributed to GBHS-Owen Sound, which is likely due to the fact that this is the regional referral centre for Grey and Bruce Counties South West LHIN: Separations by North Region Hospitals FY 2007-08 Hospital Total Separations Avg LOS Avg ELOS Avg RIW GREY BRUCE HEALTH SERVICES-OWEN SOUND 7,095 4.33 4.33 1.17 GREY BRUCE HEALTH SERVICES-MEAFORD SITE 975 7.29 4.90 1.32 GREY BRUCE HEALTH SERVICES-MARKDALE SITE 673 5.97 5.66 1.16 GREY BRUCE HEALTH SERVICES-WIARTON SITE 587 8.28 5.01 1.37 GREY BRUCE HEALTH SERVICES-SOUTHAMPTON 530 8.66 4.93 1.43 GREY BRUCE HEALTH SERVICES-LIONS HEAD 183 6.72 5.49 1.29 SOUTH BRUCE GREY HEALTH CENTRE-WALKERTON 1,283 6.03 3.95 0.92 SOUTH BRUCE GREY HEALTH CTR-KINCARDINE 968 8.88 5.45 1.30 SOUTH BRUCE GREY HEALTH CENTRE-DURHAM 439 7.46 6.10 1.21 SOUTH BRUCE GREY HEALTH CENTRE-CHESLEY 423 5.81 5.78 1.12 HANOVER AND DISTRICT HOSPITAL 1,082 6.53 5.35 1.14 TOTAL 14,238 5.73 4.71 1.18 Source: Intellihealth FY 2007-08 13

Service Capture Rates by Separations and Hospital Central Region Service utilization for hospitals in Huron and Perth are depicted in this contour map. Stratford General Hospital s service capture reach extends along a wide geographic area, including beyond the LHIN borders. The site accounted for 54% of total admissions within this region. Stratford s capture rates flatten out at the top of its pattern, as a result of the presence of Listowel Memorial and Alexandra Marine and General hospitals. Note: Hospitals with less than 40% market share are not shown on the map. 14 Source: Intellihealth FY 2007-08

Stratford General Hospital inpatient separations accounted for 54% of total admissions within this region South West LHIN: Separations by Central Region Hospitals FY 2007-08 Hospital Total Separations Avg LOS Avg ELOS Avg RIW HPHA - STRATFORD GENERAL HOSPITAL 6,889 3.71 3.79 0.96 HPHA - CLINTON PUBLIC HOSPITAL 728 4.82 4.37 0.88 HPHA - ST MARYS MEMORIAL HOSPITAL 566 7.89 5.85 1.18 HPHA - SEAFORTH COMMUNITY HOSPITAL 323 6.20 6.05 1.06 WINGHAM AND DISTRICT HOSPITAL 1,360 4.06 4.62 0.88 LISTOWEL MEMORIAL HOSPITAL 1,116 5.18 4.39 0.86 ALEXANDRA MARINE AND GENERAL HOSPITAL 1,254 5.46 5.02 1.01 SOUTH HURON HOSPITAL 574 6.81 5.93 1.28 TOTAL 12,810 4.50 4.33 0.97 Source: Intellihealth FY 2007-08 Although admissions accounted for only 4.5% of total separations within the central region, South Huron Hospital had the greatest RIW associated with their admissions. 15

Service Capture Rates by Separations and Hospital South Region Hospitals located in the south region managed the largest proportion of inpatient separations in the South West LHIN. As depicted in the contour map, London Health Sciences, St. Joseph s Health Centre and St. Thomas-Elgin have broad catchment areas. The relative geographic breadth of the market share that is being captured London based hospitals is consistent with their role as a tertiary care provider. Source: Intellihealth FY 2007-08 16 Note: Hospitals with less than 40% market share are not shown on the map.

The hospitals located in the south region managed the largest proportion of inpatient admissions in the South West LHIN Hospital South West LHIN: Separations by South Region Hospitals FY 2007-08 Total Separations Avg LOS Avg ELOS Avg RIW LONDON HLTH SCIENCES CTR-UNIVERSITY HOSP 38,223 7.02 4.89 1.68 ST.JOSEPH'S HEALTH CARE,LONDON 10,810 3.56 3.55 0.84 ST THOMAS-ELGIN GENERAL HOSPITAL 6,713 4.99 3.98 1.00 WOODSTOCK GENERAL HOSPITAL 5,005 5.74 4.00 1.07 STRATHROY MIDDLESEX GENERAL HOSPITAL 3,244 5.33 4.26 1.08 TILLSONBURG DISTRICT MEMORIAL HOSPITAL 1,664 8.78 5.57 1.39 ALEXANDRA HOSPITAL 762 9.12 5.49 1.40 FOUR COUNTIES HEALTH SERVICES CORP 556 5.27 5.27 1.03 Total 66,977 6.13 4.51 1.39 Source: Intellihealth FY 2007-08 As the academic health sciences centre for the South West LHIN, LHSC admitted 57% of total inpatient cases in this area while 16% of total separation volumes are attributed to SJHC, London. 17

An overview of the LHIN s emergency visit volumes illustrate that all hospitals played a significant role in serving population needs 18 South West LHIN Emergency Visits by Hospital FY 2007-08 Hospital Visits GREY BRUCE HEALTH SERVICES OWEN SOUND 34,670 SOUTH BRUCE GREY HEALTH CTR KINCARDINE 18,500 GREY BRUCE HEALTH SERVICES SOUTHAMPTON 17,510 GREY BRUCE HEALTH SERVICES MARKDALE SITE 17,482 HANOVER AND DISTRICT HOSPITAL 17,028 GREY BRUCE HEALTH SERVICES WIARTON SITE 14,551 SOUTH BRUCE GREY HEALTH CENTRE WALKERTON 13,989 GREY BRUCE HEALTH SERVICES MEAFORD SITE 10,401 SOUTH BRUCE GREY HEALTH CENTRE DURHAM 9,905 SOUTH BRUCE GREY HEALTH CENTRE CHESLEY 6,270 GREY BRUCE HEALTH SERVICES LIONS HEAD 4,747 GREY BRUCE HEALTH SERVICES TOBERMORY 655 STRATFORD GENERAL HOSPITAL 23,574 ALEXANDRA MARINE AND GENERAL HOSPITAL 15,165 LISTOWEL MEMORIAL HOSPITAL 11,606 WINGHAM AND DISTRICT HOSPITAL 11,033 CLINTON PUBLIC HOSPITAL 10,956 SOUTH HURON HOSPITAL 9,801 SEAFORTH COMMUNITY HOSPITAL 9,766 ST MARYS MEMORIAL HOSPITAL 8,556 LONDON HLTH SCIENCES CTR VICTORIA HOSP 98,893 ST.JOSEPH'S HEALTH CARE,LONDON 47,620 LONDON HLTH SCIENCES CTR UNIVERSITY HOSP 44,999 ST THOMAS ELGIN GENERAL HOSPITAL 35,281 WOODSTOCK GENERAL HOSPITAL 28,047 STRATHROY MIDDLESEX GENERAL HOSPITAL 27,938 TILLSONBURG DISTRICT MEMORIAL HOSPITAL 23,279 ALEXANDRA HOSPITAL 20,809 FOUR COUNTIES HEALTH SERVICES CORP 9,131 Total 602,162 Source: Intellihealth FY 2007-08 Emergency Visits by Region FY 2007-08 Region Visits Ratio to 1000 Population North 165,708 1054 Central 100,457 725 South 335,997 518 Total 602,162 637 The north and central communities had a greater number of visits per 1000 population compared to the south. Of the 29 sites that registered ED visits, 21 sites managed greater than 10,000 visits in FY 2007-08. LHSC-Victoria site was the busiest ED, which saw nearly 100,000 visits. Note that SJHC, London operates an Urgent Care Centre.

Health Human Resource Profile 19

There were 1,805 physicians registered in the South West LHIN, 79% were practicing in the south South West LHIN Specialist to Family Medicine Physicians Distribution by Region 20 1600 1400 1200 1000 800 600 400 200 0 70 69 131 117 868 550 North Central South Source: Ontario Physician Human Resources Data Centre December 2007 Ratio of Physicians to 1000 Population FY 2007-08 All Family Medicine Specialists North 1.27 0.83 0.44 Central 1.35 0.84 0.51 South 2.18 0.85 1.34 Specialists Family Medicine The majority of physicians are registered in the counties in the south. Non-specialists include Family Medicine physicians and Specialists comprise the remaining categories. There is a reduced availability of specialists in the north and central regions. Only 11% and 20% of physicians are registered in counties in the north and central regions, respectively. However, 17% and 15% of the South West LHIN population resides in the north and central regions, respectively. All regions had a equivalent distribution of Family Medicine physicians based on the population served in each region. Central and north had a similar ratio of specialists to 1000 population. The more concentrated distribution of specialists in the South is aligned to the academic health centres, LHSC and SJHC.

Detailed family medicine and specialist distribution Type Grey Total North Bruce Total North Total Huron Total Central Perth Total Central Total Middlesex Total Norfolk Total South Elgin Total Oxford Total South Total Grand Total Family Medicine Internal Medicine 79 52 131 52 65 117 394 36 60 60 550 798 10 ** 10-14 ** 8 8-12 207 ** 5 6 218-222 244 Pediatrics 5 0 5 0 ** <4 66 0 ** 0 66-70 79 Surgery 24 ** 24-28 ** 23 23-27 178 5 12 15 210 262 Laboratory Medicine Other Specialty Specialist Total* ** 0 <4 0 5 5 33 ** ** ** 33-39 44 23 ** 23-27 ** 19 19-23 299 ** 22 7 328-332 378 65 ** 69 11 59 70 783 12 44 29 868 1,007 Grand Total 144 56 200 63 124 187 1,177 48 104 89 1418 1,805 Source: Ontario Physician Registry 2007 provided by the Ontario Physician Human Resources Data Centre December 2007 * Specialist total excludes Family Medicine 21 The above table shows the breakdown of specialists and family medicine physicians across the various counties. Where ** appears indicate that there are less than 5 registered specialists. This information is not provided due to privacy concerns. As a result, the total line in many cases show a range in the number of specialists. Other specialty category includes anaesthesiology, community medicine, critical care medicine, diagnostic radiology, emergency medicine, medical genetics, nuclear medicine, physical medicine & rehab, psychiatry and radiation oncology.

Specialist ratio to 1000 population Ratio of Specialists to 1000 Population FY 2007-08 Specialty North Central South Internal Medicine 0.06 0.09 0.06 0.09 0.34 Pediatrics 0.03 <0.03 0.10 0.11 Surgery 0.15 0.18 0.17 0.19 0.32 Laboratory Medicine <0.03 0.04 0.05 0.06 Other Specialty 0.15 0.17 0.14 0.17 0.51 Specialist Total 0.44 0.51 1.34 Source: Ontario Physician Registry 2007 provided by the Ontario Physician Human Resources Data Centre December 2007 22 The above table illustrates the specialist to 1000 population ratio across the South West LHIN planning regions. It appears that based on the population distribution that specialists are proportionately distributed, with the exception of surgery. Other specialty total includes anaesthesiology, community medicine, critical care medicine, diagnostic radiology, emergency medicine, medical genetics, nuclear medicine, physical medicine & rehab, psychiatry and radiation oncology. For psychiatry, the south had a ratio between 0.18-0.19 per 1000 population. In contrast, the north had the lowest proportion of psychiatrists at 0.03. Central was only marginally better with 0.06-0.09 psychiatrists to 1000 population.

The percentage of registered professionals in the South West LHIN is proportional to the population Demographic shift with both patient and clinician populations will exacerbate the HHR shortage crisis Increasing need for interdiscipilinary teams to play the primary care role within the health system Practitioners will need to work to their full scope of practice, which will impact legislation and organizational policies/practices Given that 7% of the population of Ontario resides in the South West LHIN, there appears to be a proportionate distribution of registered professionals, with the only exception being Nurse Practitioners. Overview of Ontario Distribution & Characteristics of Registered Professionals Registered Members South West LHIN % % 45-54 years overall >54 years overall Chiropidists 480 n/a 22% 10% Midwives 334 7% 25% 7% Registered Nurses 89,054 9% 32% 21% Registered Practical Nurses 24,482 11% 35% 21% Nurse Practitioners 594 5% 29% 3% Occupational Therapists 4,010 10% 20% 7% Physiotherapists 6,080 10% 23% 13% Source: HealthForceOntario HHR Toolkit: April 2007 23

Overview of Service Utilization Complex Continuing Care and Rehabilitation 24

The distribution of beds and discharges from designated Complex Continuing Care beds appear to align with the LHIN population density Sub-Region Hospital # of beds Discharges ALOS North GREY BRUCE HEALTH SERVICES OWEN SOUND 6 32 46.8 Central South CCC Discharges from South West LHIN Hospitals FY 2007-08 ALEXANDRA MARINE AND GENERAL HOSPITAL 5 7 29.1 LISTOWEL MEMORIAL HOSPITAL 25 38 59.9 SEAFORTH COMMUNITY HOSPITAL 10 97 28.0 SOUTH HURON HOSPITAL 4 26 33.2 ST MARYS MEMORIAL HOSPITAL 5 34 34.9 STRATFORD GENERAL HOSPITAL 30 357 23.8 WINGHAM AND DISTRICT HOSPITAL 12 63 59.3 Total 91 622 31.3 ALEXANDRA HOSPITAL 14 82 49.4 FOUR COUNTIES HEALTH SERVICES CORP 6 22 22.2 ST THOMAS ELGIN GENERAL HOSPITAL 49 124 56.3 ST.JOSEPH'S HEALTH CARE,LONDON PARKWOOD 216 337 45.1 STRATHROY MIDDLESEX GENERAL HOSPITAL 25 191 34.9 TILLSONBURG DISTRICT MEMORIAL HOSPITAL 24 52 91.3 WOODSTOCK GENERAL HOSPITAL 25 194 39.8 Total 359 1002 45.8 LHIN Total 456 1,624 40.4 Note: This information presented does not account for changes to bed allocation post FY 2007-08. Source: South West LHIN CCC & Rehabilitation Strategic Resources Report March 2009 25 Ratio of CCC Beds per 1,000 Population FY 2007-08 North 0.04 Central 0.66 South 0.55

The data reveals that the largest number of rehabilitation admissions occurred in the southern hospitals, largely at SJHC-Parkwood (65%) Admissions to Designated Rehabilitation Beds in South West LHIN Hospitals FY 2007-08 Region Hospital # Acute Rehab Beds Admits Avg. LOS North GREY BRUCE HEALTH SERVICES OWEN SOUND 16 181 25.1 SOUTH HURON HOSPITAL 4 19 10.9 Central South STRATFORD GENERAL HOSPITAL 15 166 26.9 WINGHAM AND DISTRICT HOSPITAL 3 21 19.1 Total 22 206 ST.JOSEPH'S HEALTH CARE,LONDON PARKWOOD 118 925 33.8 ST THOMAS ELGIN GENERAL HOSPITAL 10 92 22.6 Total 128 1017 Total 166 1,404 30.6 Source: Intellihealth FY 2007-08 Examples of rehabilitation categories include those related to musculoskeletal, stroke, cardiac, and respiratory cases. Ratio of Rehabilitation Beds per 1,000 Population FY 2007-08 26 North 0.10 Central 0.16 South 0.20

Overview of Service Utilization Long-Term Care 27

Although LTC utilization performance closely aligns with provincial averages, system turnover was higher in 2009 LTC Performance January 2009 Region Long Term Care Homes Retirement Residences # of Orgs # of Orgs North 19 6 Central 19 8 South 37 5 Total 75 19 Source: South West LHIN Indicator South West LHIN Ontario Long Stay Utilization 98.6% 98.8% Long Stay Supply Beds 6,746 75,291 Long Stay Residents 6,654 74,366 Long Stay Waitlists 2,072 24,596 Male 683 8,094 Female 1,387 16,497 Source: South West LHIN Ratio of LTC Beds to 1000 Population 75+ years North 106 Central 119 South* 94 *Current ratio not including new 608 beds Acute 144 2,476 Average Length of Stay (years) 2.6 3.0 System Turnover 38.0% 33.1% Home Turnover 38.2% 33.5% Source: Long-Term Care Home System Report - January 2009 According to 2007-08 data, the distribution of long term care beds is lowest in the south given the population density. However, with the release of the new 608 LTC beds in the south, its distribution will be on par with the other regions at 107 beds per 1000 population. LTC long stay utilization has declined by 0.7% from 99.3% in 2008 to 98.6% in 2009. The South West LHIN provides 9% of provincial long stay beds and its waitlist is 8% of the provincial wait list. The turnover of LTC beds is higher than the Ontario average. Based on CCAC data, the average time spent on the waitlist was 146 days in 2007/08. 28

Overview of Service Utilization Community & In-Home Services 29

A range of community & in-home services were provided across the LHIN Community In-home Support Services - Homemaking Region Visits Individuals Served Hours of Care North - 275 9,926 Central - 409 23,283 South - 505 17,510 SWCCAC - 5,539 215,273 Community In-home Support Services - Personal Support/ Independence Training Region Visits Individuals Served Hours of Care North - 17 18,564 Central - - - South 178 274 140,556 SWCCAC - 11,253 783,468 Source:: FY 07-08 from CAP 09-11 The CCHS also reported that 2.5% of South West LHIN respondents needed help with personal care. Of the 2.2% who indicated that they had a self-perceived unmet home care needs, 1.6% indicated that they required personal care support. A number of key community programs funded through the South West LHIN drive the services applicable to this program: Several organizations provided assistance to individuals within their home environment, including a high proportion of services facilitated by South West CCAC to clients across the LHIN overall Homemaking services appear proportionate to population in the respective regions. Although the data reveals an absence of in-home personal support by LHIN TPA-funded organizations in the central region, Cheshire does provide this service to residents in the central region. NOTE: South West CCAC services were provided throughout the LHIN. Client origin by region and service was not available. This CCAC data includes all contracted providers (private, lhinfunded, etc) Certain organizations that are contracted through CCAC may have also submitted a CAPs form which may result in duplication. 30

Community & in-home services aided residents to access activities and resources in order to sustain a level of independence 31 Region Community In-home Support Services Day Services Visits Individuals Served Ratio per 1000 population 75+ years Attendance Days Hours of Care North - 222 17.8 8,412 - Central - 409 36.5 15,882 - South 21,062 864 19.4 16,556 - Region Community In-home Support Services Assisted Living Resident Days Individuals Served Ratio per 1000 population 75+ years Attendance Days Hours of Care North 18,705 54 4.33 - - Central 41,739 76 6.79 - - South 54,699 161 3.62-4,628 Region Community In-home Support Services Transportation Visits Ratio per 1000 population 75+ years Individuals Served Attendance Days Hours of Care North 13,715 1,101 1,466 - - Central 69,708 6,228 3,706 3,500 - South 66,603 1,499 4,748 - - Day services were provided by organizations such as the Victorian Order of Nurses or other sites that focus on the needs of seniors. This service category reveals a lower proportion of programs were delivered in the north relative to the population ratios in the other regions, which may require further analysis due to growth projected with older cohorts residing in the north. Outreach organizations appear to provide a higher concentration of assisted living programs in the central and south regions of the LHIN. Recently, there have been an increase in Day Services and Assisted Living through the Aging at Home strategy and this is not captured in the 2007/08 data. Despite the high volume of assistance provided through LHIN TPA-funded groups, transportation challenges were raised during consultations across the LHIN, especially by rural service providers. Community representatives stated a proportion of clients would cancel diagnostic and specialist appointments if unable to acquire assistance in travelling long distances. Source:: FY 07-08 from CAP 09-11

~80% of CCAC clients were referred by a hospital and/or institution Age of Active Clients as of April 23, 2008 3,562, 20% 3,689, 21% 0-18 Years 19-64 Years 65-84 Years 3,633, 21% 85+ Years 6,636, 38% Service Recipient Distribution 07-08 4,265, 9% 1,467, 3% 16,024, 35% Long Term End-of-life Maintenance 12,613, 27% Rehab Acute 12,268, 26% The following summarizes CCAC highlights in 2007/08: In 2007/08, there were a total of 53,008 CCAC referrals, with ~80% of clients being referred from either a hospital and / or institution. Seniors between 65-84 years comprise of 38% of the active clients for the CCAC; this percentage increases to 58% when seniors who are 85+ in age are included. South West LHIN recipients tend to use more maintenance services followed by rehab and acute care related care. 32 Source: 2007-08 CCAC Fact Sheet

CCAC facilitated a variety of services, with nursing and personal care support comprising the largest proportions Number of Clients by Service Type FY 2006-07 and FY 2007-08 While nursing services may have assisted patients in avoiding admission into acute care, personal care and rehabilitative services also enabled a proportion of patients to remain in the community and maintain their baseline functioning or adjust to a new functional status. Service Utilization Averages FY 2007-08 Shift Nursing Visiting Nursing PSU/HOM/ RES PT OT SP SW NUT 33 Average Hours per Client Source: 2007-08 CCAC Fact Sheet 97.84 6.8 13.89 2.02 1.43 1.93 1.7 1.51

Non-LHIN Funded Primary Health Care Services 34

A significant portion of primary health services are provided by Public Health Units Community Health Centres and Family Health Teams Included is a compilation of non-lhin funded health organizations providing public health and primary health care services Public Health Units Community Health Centres Family Health Teams North 1 0 and 1 under development 4 Central 2 0 9 South 4 2 plus 2 under development 3 Total 7 2 plus 3 under development 16 These organizations, for many individuals, are the first point of access to the health system and provide an array of educational and early intervention services. Based on these critical roles, it will be important to consider their impact when evaluating the future models of care for all health programs within the South West LHIN. For example, the following programs are directly impacted by the delivery of these services: Women s Health these organizations provide prenatal and sexual health screening services that often serve as the stepping stone into education and early intervention Chronic Disease Prevention & Management these organizations provide health education and promotion services which can help reduce the incidence of chronic illnesses Paediatrics these organizations provide healthy baby and primary health care services which can help with early identification of any health issues Mental health & addictions these organizations often are a preliminary contact to diagnosing a mental health illness and can help refer them to the appropriate care in a timely fashion There are three developing CHCs that will augment the service capacity in the South West LHIN in Elgin, Oxford, and South East Grey 35