Mayor and Members of Council Lanie Hurdle, Commissioner, Community Services

CITY OF KINGSTON REPORT TO COUNCIL Report No.: 13-149 TO: FROM: RESOURCE STAFF: Mayor and Members of Council Lanie Hurdle, Commissioner, Community Services Same DATE OF MEETING: April 9, 2013 SUBJECT: Extendicare Canada and Centric Health Active Contract Renewals for Rideaucrest Home EXECUTIVE SUMMARY: In late 2010, the City retained the services of Extendicare Canada (Extendicare) to provide management support to oversee the day to day operations at Rideaucrest Home for a period of six (6) months. This contract was extend for another two (2) years and expires in May 2013. The current contract includes the provision of a qualified Administrator at the Home and expert consultants to support staff in the implementation of the Long Term Care Act regulations. In the past few years, the Administrator and Extendicare consultants have been proactively working with Rideaucrest staff to identify issues, concerns and possible solutions. Consultants expertise includes safety and security, nursing (infection control, medication administration and skin and wound care), dietary and maintenance. The emphasis in the past few years has been to implement the CAO s Action Plan endorsed by Council in 2010. Relationships between Extendicare, management and front line staff have been strengthened and a clearer direction with a primary focus on resident care has also been established. Consistency in staff and direction is critical as progress on culture change and implementation of the Long Term Care Act continues. A change in leadership and qualified support at this point could impact the progress achieved in the past two (2) years and could put the Home at risk as it relates to compliance with ongoing changes coming from the Ministry of Health and Long Term Care. Although positive initiatives have been implemented, there is still significant work to be accomplished over the next years to continue the implementation of the CAO s Action plan and to ensure compliance. In light of the culture change in progress and work still to do with the implementation of the Long Term Care Act while working with a more complex clientele, it is recommended that the City of Kingston renews its contract with Extendicare Canada for a term of three (3) years. The recommended contract renewal would maintain the same services as provided by Extendicare in the past two (2) years (Administrator position, support from consultants, access to material Council Meeting 11 April 9, 2013 221

REPORT TO COUNCIL. Report No.: 13-149 April 9, 2013 - Page 2 - and resources) and would also add support with day to day purchasing of goods and services. This purchasing function is proposed to be added to the contract, at no additional cost to the City, as Extendicare already applies a purchasing process that is compliant with the Local Health Integration Network s (LHIN) Long-Term Care Sector Accountability Agreement (L-SAA) and also establishes bulk contracts which provide significant savings for all its other owned and assisted Homes. The Option Section of this report provides examples of savings through the Silver Group Purchasing program utilized by Extendicare for day to day purchases. It should be noted that some of the equipment and services to be provided within the Home are highly specialized and unique to the health care sector. The cost of the Extendicare contract is proposed to be reduced from $354,000 per year to $342,000 per year over the next three (3) years with no yearly inflation. This cost includes the salary and benefits for the Administrator position as well as consultant and administration fees. The cost of the contract is included in the 2013 approved operational budget as well as within the 2014 and 2015 draft operational budgets. In 2010, the City established a contract with LifeMark Health Management Inc. (now Centric Health Active) to provide residents with physiotherapy and occupational therapy services. This service must be made available to residents under the Long Term Care Act. The service is charged directly to the resident and therefore there is no direct cost to the City. The original agreement with LifeMark Health Management included a clause enabling staff to renew the contract on a yearly basis but due to a company name change, City staff requires Council s approval for this contract renewal. RECOMMENDATION: THAT the Mayor and Clerk be authorized to enter into a three (3) year contract with Extendicare Canada for $342,000 per year, plus applicable tax, to the satisfaction of the Director of Legal Services; and THAT the Mayor and Clerk be authorized to enter into a contract with Centric Health Active under the same terms and conditions as the existing contract with LifeMark Health Management to the satisfaction of the Director of Legal Services. Council Meeting 11 April 9, 2013 222

REPORT TO COUNCIL. Report No.: 13-149 April 9, 2013 - Page 3 - AUTHORIZING SIGNATURES: Lanie Hurdle, Commissioner, Community Services Gerard Hunt, Chief Administrative Officer CONSULTATION WITH THE FOLLOWING COMMISSIONERS: Cynthia Beach, Sustainability & Growth Denis Leger, Transportation, Properties & Emergency Services Jim Keech, President and CEO, Utilities Kingston N/R N/R N/R (N/R indicates consultation not required) Council Meeting 11 April 9, 2013 223

REPORT TO COUNCIL. Report No.: 13-149 April 9, 2013 - Page 4 - OPTIONS/DISCUSSION: A. Background In 2011, City Council approved an extension of two (2) years for its contract with Extendicare Canada (Extendicare). The current contract with Extendicare, which expires in May 2013, provides a qualified Administrator, access to corporate resources and a number of consultants in the long term care field to work with staff at Rideaucrest Home. The implementation of the CAO s Action Plan at Rideaucrest has been the main focus of the work done in the past few years. Progress has been made but more work is required on culture change and implementation/compliance with the Long Term Care Act. The following outlines some of the steps taken for each of the CAO s Action Plan goals in the past few years to improve operations and compliance with Long Term Care Act: 1. Creating a corporate culture focused on resident-centred care: a. Introduction of Primary Care model. b. Family information sessions are being held on a monthly basis. c. Nursing staff realignments and schedule changes have been implemented to streamline communications between staff and family members. d. Changes in operations of laundry services to improve quality of linen service to residents and health and safety for staff. e. Complaint process developed and implemented. 2. Implementing the requirements of the Long Term Care Act and its regulations: a. A number of consultants (dietary, nursing, environmental services and health & safety) have been assigned to work with staff to review processes and procedures to work towards compliance with the new Long Term Care Act. These consultants have been assigned through the expertise of Extendicare and the contract support established with the City. This service has been extremely valuable and has enabled management staff to properly review some of the policies and procedures. There is still work to be done by both consultants and staff to ensure ongoing compliance. b. A number of training sessions for all nursing staff. c. Implementation of Point Click Care system to improve documentation and reporting to the Ministry of Health and Long Term Care. d. Development and implementation of policies, with Extendicare support, to ensure compliance with Long Term Care Act. 3. Improving the accountability of the staff and management of the Home: a. Regular meetings between union representatives, front line staff and management. b. Streamlining of nursing structure to be in line with other long term care homes and nursing shifts consistency. c. Increased training for staff to better define roles, responsibilities and accountability. d. More regular communication to update all full time and part time staff on changes at the Home. e. Establish nurse leadership and terrace meetings to improve communication and coordination amongst staff and disciplines within the Home. Council Meeting 11 April 9, 2013 224

REPORT TO COUNCIL. Report No.: 13-149 April 9, 2013 - Page 5 - Reports with detailed updates on the implementation of the CAO s Action Plan have been submitted to the Rideaucrest Board of Management over the past two (2) years. B. Extendicare Canada and Management Support Extendicare has significant experience in the management of long term care homes as it works with municipal, private and not for profit homes. Extendicare owns and manages thirty-four (34) long term care homes and provides management support to another twenty-seven (27) long term care homes in Ontario. Extendicare also has experience working with unionized environments including CUPE, CAW, ONA and Steelworkers. In the past two years, Extendicare has provided support at Rideaucrest in the following areas: 1. Regional Director (RD) on site, available by phone daily and during an emergency 24/7. RD has been on site, has monitored critical incidents off site to ensure proper action plans in place, has monitored off site Point Click Care (PCC) for falls risk assessments, has monitored off site responsive behaviours to ensure proper follow up as well as readiness for public reporting and ministry visits. 2. Long term care consultants on site regularly to assist with training, guidance, reviews, attend morning meetings, attend nursing practice and attend management meetings. Daily support calls to Administrator, Director of Care (DOC) related to nursing and infection control, quality protocols and nursing administration. Daily monitoring of progress notes, including weekends, for written notices from the Ministry of Health and Long Term Care to alert Administrator and DOC of high risk and potential high risk incidents. Assist Home with developing compliance plans, develop terms of reference for committees, quality protocols and schedules and to provide support to the RAI coordinators. 3. Infection Control consultant visits, educates and completes follow up reports. 4. RAI/MDS Consultant weekly visits to the Home to assist with education role out and conversion to PCC. Confirm status of documentation, provide training where required and assist DOC. 5. Fire Safety Consultant visits to Rideaucrest in November and December 2010, and a return visit in January 2011. These visits were done to assess the overall fire safety aspects in the Home and included conducting fire drills on all three shifts. Fire plan was updated. Regular fire safety inspections were done in the summer of 2011 and in the summer of 2012. Inspections for 2013 are slated for this summer. 6. Dietary Consultant visited the Home 5 times in the first 18 months to assist with the education of front line staff and the implementation of the pleasurable dining program. 7. Environmental Consultants visited to review housekeeping and laundry services. 8. Engineering Consultant consulted on resident surveillance system. 9. Financial Consultants completed review of Resident Trust, office procedures and assisted with transition of financial portion to PCC. 10. Access to Extendicare policies and procedures and ability to customize for the Home. Policies are kept up to date by Extendicare. 11. Financial training and support to office personnel. 12. Training sessions on site and off site (quality improvement) with Extendicare resource teams. Council Meeting 11 April 9, 2013 225

REPORT TO COUNCIL. Report No.: 13-149 April 9, 2013 - Page 6 - C. Extendicare Proposed Contract Renewal On March 20, 2013, City staff and Extendicare representatives presented information to Council on changes in the long term care sector as well as the increasing complexities as it relates to the long term clienteles. City staff also presented information on Rideaucrest Home s progress, opportunities and challenges. In the past two years, there have been improvements made in the Home s operations, culture and compliance with the Long Term Care Act. The Home has been successful in reducing its municipal tax contribution by $353,000 between 2011 and 2012. Considering the complexity of the long term care sector and its clientele as well as increasing challenges, Kingston is one of the municipalities that have contracted management support from specialized health care private companies such as Extendicare. Kawartha Lakes and London are two municipalities that have recently contracted expertise to provide support with the management of their long term care facilities. Staff are recommending the renewal of the Extendicare contract for a period of three (3) years for the provision of the same services as provided in the past two years (qualified administrator, access to resources and tools, support from consultants) with the addition of the purchasing function for day to day goods and services. Examples of support provided by Extendicare and included in the contract are listed in the previous section B. Extendicare Canada and Management Support. This type of support is applicable to all disciplines within the Home and is included within the contract fee. Extendicare utilizes Silver Group Purchasing which enables it to purchase specialized equipment and products in bulk and at lower costs. Table 1 below provides examples of cost comparison between average costs for goods purchased through Silver Group Purchasing (SGP) and through an individual long term care home. Table 1 Cost Comparison Between Average Costs for Goods Purchased Through SGP and Individual Long Term Care Homes Description SGP Case Cost Individual Home Case Cost Gloves vinyl P/F M $30.00 $41.20 Brief Tena med/reg $42.66 $50.50 Gauze 8 ply 4X4 $56.25 $63.40 Cup medicine plastic 1 oz $31.00 $55.50 Pad incontinence Tena day plus $37.43 $42.60 Syringe tuber $34.10 $73.60 Denture tablets $5.00 $7.50 Needle pen 29GX5/16 in $108.00 $145.00 Total savings achieved through SGP will vary depending on the quantity of products and goods consumed as well as current prices paid for these products and goods. Overall, significant savings can be achieved through SGP which also includes food supplies which has been over budget at Rideaucrest in the past years. Council Meeting 11 April 9, 2013 226

REPORT TO COUNCIL. Report No.: 13-149 April 9, 2013 - Page 7 - Purchases and contracts at Rideaucrest Home must comply with the Local Health Integration Network s (LHIN) Long-Term Care Sector Accountability Agreements (L-SAA). Currently, the City s Purchasing Policies and Procedures By-Law is not in line with the LHIN`s L-SAA requirements. Extendicare is already implementing the purchasing process required by the LHIN for all its owned and managed long term care homes. Extendicare would ensure that Rideaucrest Home is also compliant with its L-SAA which was effective on April 1, 2013. It is anticipated that the purchasing through SPG would provide the Home with additional savings. D. Centric Health Active and Other Contracts Rideaucrest Home has a number of contracted services to ensure the provision and availability of specialized services within the Home as mandated under the Long Term Care Act. Some of these contracts are for medication, physicians, supply of oxygen services, etc. Charges and costs related to some of these contracts are charged to the Ministry or directly to the resident and not to the City. This is the case with the contract established with LifeMark Health Management in 2010 to provide physiotherapy and occupational services to residents. The contract between the City and LifeMark Health Management included a clause delegating authority for staff to renew the contract on a yearly basis. Staff require Council s approval for this contract renewal as LifeMark Health Management has changed its name to Centric Health Active. Rideaucrest Home has made changes to some of its other contracts in the past few years. The City cancelled the following contracts in the past few years and moved operations in house: 1. Sodexho Canada Fee was $213,057 per year in its last year, prior to cancellation. Contract provided a Supervisor of Dietary Services and some additional support for dietician services. This contract only provided support in the Dietary Division of the Home. 2. Regional Laundry Fee was approximately $181,000 in its last year, prior to cancellation. This contract was based on poundage of linens. EXISTING POLICY/BY LAW: By-Law 2000-134 A By-Law to Establish Purchasing Policies and Procedures NOTICE PROVISIONS: There are no notice provisions with this report. ACCESSIBILITY CONSIDERATIONS: This report is available in alternate formats. FINANCIAL CONSIDERATIONS: This contract in the amount of $342,000 per year includes costs for the salary and benefits for the Administrator of the Home and consultant expertise as a resource to Rideaucrest Home. This cost is included in the 2013 operational budget as well as within the 2014 and 2015 operational budget forecasts. CONTACTS: Lanie Hurdle, Commissioner, Community Services 613-546-4291 ext. 1231 Council Meeting 11 April 9, 2013 227

REPORT TO COUNCIL. Report No.: 13-149 April 9, 2013 - Page 8 - OTHER CITY OF KINGSTON STAFF CONSULTED: Debra Green, Rideaucrest Home Administrator Alan McLeod, Senior Legal Counsel EXHIBITS ATTACHED: Exhibit A Extendicare Canada Contract Renewal Proposal Council Meeting 11 April 9, 2013 228

'~XTENDICARE Proposal to Extend the Partnership with the City of Kingston to Provide Leadership at the Rideaucrest Home Submitted to: THE CITY OF KINGSTON 216 Ontario Street Kingston, ON K7L 223 Attention: Lanie Hurdle, Commissioner Submitted by: Extendicare (Canada) Inc. 3000 Steeles Ave. East, Suite 700 Markham, Ontario L3R 9W2 Tel: 905 470 4000 Fax: 905-470-5588 Email: ptuttle@extendicare.com Contact Person: Paul Tuttle, President The information contained in this document is the exclusive property of Extendicare (Canada) Inc. This information is strictly confidential and shall noi be distributed or reproduced without the written permission of Exlendicare (Canada) Inc. Council Meeting 11 April 9, 2013 229

EXTENDfCA RE The Corporat ion of the City of Kingston to provide Leadership at the Rideaucresl Home Table of Contents Executive Summary... 2 Extendicare's Experience in Long-Term Care... 4 Knowledge of Current Legislative Guidelines and Regulations... 8 Experience in Managing Municipal, Regional and Not-far-Profit Homes... 8 Interfacing with other Service Providers... 9 References... 10 Our Understanding of Your Requirements... II t. Creating a Corporate Culture Focused on Resident-Centred Care... 11 2. Implementing the Requirements ofthe Long-Term Care Homes Act... 11 3. Improving the Accountability of the Staff and Management of Rideaucresl..... 11 4. Identify opportunities to achieve efficiencies in operations...... 12 Deliverables... 13 1. Leadership... 13 2. Extendicare's ManagemenUConsulting Services Support Team... 14 Fees... 17 Submitted by Extendicare (Canada) Inc. March, 20 13 Page 1 Council Meeting 11 April 9, 2013 230

EXTENDICA RE to provide Leadership at the Rideaucrest Home Executive Summary Extendicare (Canada) Inc. is pleased to submit this amended Proposal to the City of Kingston (the City) to extend its partnership with the City to provide leadership at the Rideaucrest Home (the Horne) for an additional three year term. During this period our leadership role would include providing a well qualified and experienced Administrator to lead activities at the horne and address issues identified by the Ministry of Health and Long Term Care, address ongoing issues identified by Extendicare during the term of this agreement and facilitate the tasks identified in the Home's Actionllmplementation Plan outlined in the Rideaucrest Action Plan Update, dated Septembcr 9, 2010 Extendicare appreciates and understands that considerable time and resources have been invested in the development of this Action Plan which addresses organizational issues within the Horne. In the past two years, Extendieare has worked on the implementation of the Action Plan and is proposing to continue to focus on the following goals: 1. Creating a corporate culture focused on resident-centred care 2. Implementing the requirements of the Long Term Care Homes Act and its regulations 3. Improving the accountability of the staff and management of Rideaucrest 4. Identify opportunities to achieve efficiencies in operations The relationship we have built since October 10, 20 I 0 demonstrates our experience and ability to provide the assistance needed at the Rideaucrest Home; our understanding of your requirements; summarize the deliverables and provides our updated fee structurc. Extendicare understands the sensitivity of the issues di scussed and is very conscious of the need to keep this proposal and its contents confidential. The daily assistance to be provided will be built around a supportive model that will foster strong working relationships with the City, stat'(, unions, residents, families and corrununity stakeholders while maintaining excellent communications at all levels. This assistance will be provided by the on site Administrator who will be responsible for the day-to-day operations of the home. The Administrator will assist in the analysis of processes and procedures that contribute to successful outcomes and will make recommendations on resources or tools that will enhance operational efficiencies and accountabilities to meet the needs of the City and the Home. Our philosophy of " " whether they be residents, staft or families will be followed in the discussions with any stakeholders as we move forward. Discussions will be held with and approval will be granted by the designated responsible person of the City prior to any engagement of additional services. As one of North America's largest long~tenn care providers, with 258 senior care centres, Extendicare is well qualified to partner with the City to provide the services required to meet the needs of the Home. Extendicare offers to the City our extensive expertise and access to superior clinical, administrative and support services. We have demonstrated our ability to work with municipal government in managing day to day operations within the LHIN / MOHLTC funding guidelines. Extendicare has reviewed the issues proposed by the City to extend this agreement; we believe we understand the needs of the City Submitted by Extendicare (Canada) Inc. March, 2013 Page 2 Council Meeting 11 April 9, 2013 231

JEXTENDICARE to provide Leadership at the Rideaucrcst Home and the Home. We are prepared to continue our work as a partner to assist with improving the day to-day operations including strengthening relationships while improving quality of life for those we work with and care for. The information provided in this proposal demonstrates our best understanding of the project and our ability to manage the project effectively and efficiently. Extendicare is willing to clarify and/or verify any statements herein. Extendicare is pleased about the opportunity to extend our partnership with the City of Kingston and we would welcome the opportunity to provide further infonnation at the request of the City.. Submitted by Extcndicare (Canada) Inc. March, 2013 Page 3 Council Meeting 11 April 9, 2013 232

EXTENDICARE Proposal [0 extend the partnership with to provide Leadership at the Rideaucrest Home Extendicare's Experience in Long-Term Care Founded in 1968, Extendicare is one of North America's largest long-tenn care providers with 258 senior care centres and capacity for approximately 28,800 residents. Over morc than 40 years, Extendicare has developed a reputation for providing quality, clinically-based services in a cost-effective manner. The hallmarks of Extendicarc's philosophy are dignity and respect, which guide its interactions with residents and their families, as well as with staff and business partners. Extendicarc's goal is to be the provider of choice in every community where it operates. In Canada, Extcndicare operates 76 long-term care and four assisted living centres in four provinces with capacity for approximately 11,500 beds. Extendicare is also a major provider of home health care in Canada through its ParaMed Home Health Care division and we provide purchasing, management and consulting services to third-party providers. Extendicare has remained true to the principles that have always guided us. Our Mission, Vision and Values, and our Commitment to Residents have given us the solid foundation we need to provide the exceptional, quali ty care and service for which we are known. Extendicare is about... "" We help our residents and clients to live better by promoting quality of life. We will do this by creating remarkable moments through highly engaged and motivated team members. Stakeholders will know this because we will continuously measure, improve and publicly share our perfonnance. - Over the years we have learned a great deal about what it takes to care for people and we have shared that knowledge through the provision of management and consulting services on behalf of partners and clients. Our partners and clients include government, hospitals, not-for-profit homes, private-sector businesses and receivers in bankruptcy. Our clients tell us they choose Extendicare because we provide them with affordable and creative options to address the many challenges of providing long-term care in an ever evolving complex environment. Accomplishments: Our experience over the years includes many major accomplishments. Below we have highlighted some of our key successes in the long-term care sector that demonstrate our suitability to partner with the City to provide leadership at the Rideaucrest Home. All Extendicare's homes have been accredited by a third party accreditation body, either Accreditation Canada or Commission on Accreditation of Rehabilitation Facili ties (CARF). Extendicare manages 27 long-term care homes in Ontario Of the 27 homes we manage, five (693 beds) are municipal or regional homes including: The Pines, Pine Meadows, Rideaucrest, Dearness and Manitoulin and seven (1,011 beds) are with ~ i : Submitted by Extendicare (Canada) Inc. March, 2013 Page 4 Council Meeting 11 April 9, 2013 233

EXTENDICARE to provide Leadership at the Rideaucrest Home hospital partners. Our hospital partners are: Halton Health Care Services, Sault Area Hospital, Southlake Regional Health Centre, Toronto Rehab, Trillium Health Centre and the West Park Hospital. Extendicare provides management, consulting, and group pur~hasirig services. Extendicare has expertise in planning, developing and managing new and redeveloped longterm care and chronic s:are homes. We designed and built a 120 bed chronic care hospital for Trillium Health Centre and have been managing this' home for 26 years. Extendicare was the first in the province to open and manage beds under the interim bed program at Trilliwn Health Centre in 1997, which was expanded to other hospital partners including Southlake Regional Health Centre, Hamilton Health Sciences and Etobicoke General Hospital. Extendicare's team has designed, built and opened 17 new long-term care homes, five (5) of these homes were with hospital partners including: Halton Health Services, Southlake Regional Health Centre, Toronto Rehab and the West Park Hospital. Through ParaMed Home Health Care we provide home health care and services in two provinces. ParaMed's current contract volumes total over 4.6 million hours per year and include contracted personal support services, nursing, and therapies. Extendieai"e has earned a reputation as a leader in the long-tenn care industry, in no small part because of our commitment to quality. We demonstrate this commitment time and again through a well-established quality improvement program and innovative initiatives such as our CARE customer service program. Key Contributors to Extendicare's Success: We believe the success of our homes and the homes we manage are based on six criteria: 1. LEADERSHIP Our homes are managed by a seasoned team who have been orientated and mentored by successful Extendicare managers. Regular visits, audits and oversight of the home by an experienced Extendicare team member such as a Consultant or Regional Director ensures the home is advancing in a manner that is consistent with the corporate or partner's goals, objectives and strategies. Regular reports are available and reviewed to monitor performance. Our homes are successful because we are constantly challenging ourselves. We use the quality programs and tools developed to measure ourselves against the sector and ministry standards. We are constantly looking to improve. Submitted by Extendicare (Canada) Inc. March, 2013 Page 5 Council Meeting 11 April 9, 2013 234

EXTENDICA RE to provide Leadership at the Rideaucrest Home 2. QUALITY Extendicare's quality improvement program is managed by our quality division headed by a Vice President with national responsibilities. We have established rigorous national standards for care and service which we evaluate and revise as necessary to ensure that we continue to meet the physical, spiritual, social, emotional and intellectual needs of our residents and our health care customers. As part of an overall strategy to enhance and support this objective, a quality and performance improvement framework is being implemented as a national initiative. The framework incorporates a robust and comprehensive risk management framework. The primary objective of our quality and perfonnance improvement framework is to support the organization in its efforts to leverage perfonnance excellence and to mitigate risk to the client, the community and the organization in a proactive, timely and effective manner. Specifically, the model currently focuses on si x key areas: 1) Standards & Expectations Development 6) Risk Assessment & Management 2) Education, Coaching & Mentorship 5) Quality Management 3) Accountabitity 4) Communications 3. EMPLOYEES Extendicare believes that our staff are the key to the provision of quality services. Our staff provides care based on a simple principle: that they look after peoples' moms, dads and loved ones. Extendicare has a large number of long tenn service employees who continue to receive ongoing training and education which ensures they provide the best quality care to our residents. Being part of a large organization our staff benefit from education, experience and feedback from our family of homes. This network ofresources enables Extendicare to provide quality care founded on the most current research and knowledge available in the health care industry. Submitted by Extendicare (Canada) Inc. March, 20 13 Page 6 Council Meeting 11 April 9, 2013 235

EXTENDICARE to provide Leadership at the Rideaucrest Home 4. COMMUNITY Homes that are successful afe organized and responsive to community needs. Some homes have developed specialized programs or services to address local Community, LHIN or Ministry challenges. For example: The establishment of interim bed units to address emergency pressures or the over crowding of acute beds by ALe patients. The development of a restorative program with one of our partners makes that home unique in its delivery of service and its response to partner challenges and needs. Extendicare is connected to the locallong-tenn care community and is knowledgeable of current issues that challenge the long-tenn care environment including hospital partnerships. We are active members of the OL TCA and many of our senior managers hold or have held seats on the Board or Board committees. We participate in advocacy campaigns and our membership on the OLTCA Board allows us the opportunity to be involved in the planning stages of new government policy development and directly influence policy decisions that impact the long-term care sector. 5. FAMILY/RESIDENT COUNCIL Successful homes have an active resident council, family council and in some cases, a combined resident/family council. Feedback from residents and families is welcomed and information gained is used to improve the quality of life of those we care for. We manage in partnership with families and encourage families to be part of the overall care and service delivery team. Family concerns are addressed immediately and written feedback is provided to appropriate stakeholders including the Ministry of Health and Extendicare senior management. All Extendicare owned and managed homes have an active resident and/or fami ly council. RELATIONSHIPS Excellent working relationships are a key to success. Homes that are successful have scheduled meetings with set agendas that are planned throughout the year to review financial performance, quality initiatives and care issues. Monthly, quarterly, semiannually or annual meetings can be arranged based on the partner's requirements. These meetings are structured such that the partner receives the information required to review progress to date and support the making of informed decisions. Other signs of success are: being proactive in problem identification and resolution, receiving positive feedback from resident and staff, fostering a truly interdisciplinary approach to care and service provision, participating actively in Extendicare's quality management program and consistently following Extendicare policies and procedures. We find our most successful managed homes are those that approach the business as a partnership; a team that has active members who have a mutual respect for everyone's contribution. These homes work within set budget targets, review fi nancial variances and report progress on a regular basis. Two way communication is critical and necessary to advance decisions that are made to move outside the targeted goals. Accountability is a key domain of a successful home. Submitted by Extendicare (Canada) Inc. March, 2013 Page 7 Council Meeting 11 April 9, 2013 236

EXTENDICARE The Corporation of the City of Kingslon to provide Leadership at the Rideaucrest Home Knowledge of Current Legislative Guidelines and Regulations Extendicare's experience in the health care sector has included keeping current with government and legislative requirements according to the Long Term Care Homes Act (L TCHA), Hospital Act and other regulatory agencies and governing bodies (i.e. Ministry of Labour, WSIB, etc.). Extendicarc's senior management team and experienced Regional Directors implement changes when notification is received from the Ministry of Health and Long-Term Care, the LHIN's and other regulatory bodies. The successful homes we own and manage have strong, consistent leadership; are accredited, compliant with Ministry of Health and Long Tenn Care Program Standards, applicable legislation and regulations and meet or exceed negotiated budgetary projections and expectations. Experience in Managing Municipal, Regional and Not-for-Profit Homes Extendicare has successfully managed municipal, regional and not-for-profit homes for more than 30 years. Some of the initiatives processes and accomplishments that have made us successful include, but are not limited to, the following: Developed quality reporting tools and processes for managed partners specific to individual needs. Assisted managed sites to achieve their goals, including financial targets, while maintaining a high level of quality care and service within the funding framework provide by the LHIN / MOHLTC. Provided monthly, quarterly and annual reports and analysis to Boards of Directors, liaison committees and other reporting structures specific to individual managed partnerships. Worked with the LH1N's, MOHL TC and partners to develop programs that address regional or municipal needs. Provided ongoing education and training to management teams and conducted regional peer group meetings that foster consistent communication and messaging. Provided advice and guidance on a 2417 emergency basis with regular access to department specific consulting services. Partnered wi th Pine Meadow Nursing Home in the Phase I process to manage the redevelopment of the current site to meet new design standards. Partnered with Grove Park Lodge and Pine I-Iaven Nursing Horne to complete the Phase I application process and provide consulting services for the redevelopment to the new design standards. Assisted managed homes to achieve accreditation status by a third party accreditation body, either Accreditation Canada or Commission on Accreditation of Rehabilitation Facilities (CARP) In addition to the municipal and regional home partnerships the following are examples of partnerships that have been formed over the years with other not-for-profit partners: Submitted by Extendicare (Canada) Inc. March, 2013 Page 8 Council Meeting 11 April 9, 2013 237

EXTENDICARE to provide Leadership at the Rideaucrest Home Selected by the Sault Area Hospital to "Develop a Business Case to Keep a Site Open and Convert to Transitional Care Beds to meet the Growing ALe Pressures in Sault Stc. Marie". Management of Interim Nursing Home beds, partnering with the Sault Area Hospital at Great Northern Nursing Centre in Sault Ste. Marie. Restore Program partnering with Trillium Health Centre, Credit Valley Hospital and Halton Healthcare Services at Mississauga Lifecare in Mississauga. Restore Program partnering with Joseph Brant Memorial Hospital at Brantwood Lifecare in Burlington. Nurse Led Outreach Team partnering with Sudbury Regional Hospital at Extendicare York and Extendicare Falconbridge in Sudbury. Convalescent Care Programs at six Extendicare facilities: Sault Ste. Marie, Sudbury, Scarborough, Peterborough, Oshawa and Brampton. Implementation and management of Interim Nursing Home Beds at Southlake Residential Care Village for Southlake Regional Health Centre. On several occasions we have been invited by the MOHL TC to manage, operate and stabilize homes that have faced challenges in the "not for profit", and "for profit" sectors including: Rainy Crest Home for the Aged, Wellington House and Craiglee Nursing Horne, to mention a few. Performance outcomes and benefits of the above listed programs and partnerships are: improved communications and relationships between stakeholders; stability and consistency in operations, labour relations and human resources; improved overall performance and satisfaction; access to quality information for better and timelier decision making; reduced length of hospital stays for designated client groups; reduced number of ALe patients in acute care beds; wmecessary hospital and long-term care admissions are averted or deferred; patients are provided with appropriate care enabling them to return to the community faster and better; fe-admissions to hospitals are minimized; and quality care for clients throughout the health care continuum. Interfacing with other Service Providers Tn Kingston, Extendicare has a history of collaborative partnership with other service providers including, but not limited to: Local Health Integrations Networks - sit on various committees including the nurse led initiative; Community Care Access Centres; Submitted by Extcndicare (Canada) Inc. March, 2013 Page 9 Council Meeting 11 April 9, 2013 238

EXTENDICA RE to provide Leadership at the Rideaucrest Home Long-Term Care Facilities; Psycho-geriatric program with Providence Continuing Care; and Various City groups including Physician recruitment Our partnerships ensure that patients are placed in the most appropriate setting in a timely and cost effective manner ensuring proper supports are provided. This requires ongoing liaising with community partners, physicians, service providers, the resident and families in order to establish the most viable transition plans. Extendicare's knowledge, experience and network of partners with the local community in Kingston are key to making this partnership successful. References References can be supplied upon request. Submitted by Extendicare (Canada) Inc. March, 2013 Page [0 Council Meeting 11 April 9, 2013 239

EXTENDICARE The Corporation of the City of K iogston to provide Leadership at the Rideaucrest Home Our Understanding of Your Requirements Extendicare understands that the current environment in the long-term care sector in Ontario is challenged with many changes that require organizations to invest in significant resources. OUf 34 long-term homes and 27 managed homes across Ontario, are able to respond to the new expectations of the MOHLTC efficiently and effectively because our corporate management develops strategies and comprehensive action plans to address these changes as they occur, providing support and guidance as needed, such as: education, training, preparation and implementation afthc LTCHA 2007Act; preparation/implementation of the requirements of the Excellent Care for All Act in conjunction with Ontario Health Quality Council (OHQC); ongoing relationship building/interaction with the LHINs; L-SAA agreement negotiations; RAI MDS 2.0 implementation; preparation for implementation of the Accessibilities for Ontarians Disabilities Act and other activities. Our partnership with the City over the past two years places Extendicare in an invaluable and unique position to both understand your requirements, the ministry issues that need to be addressed and your primary goals which are: 1. Creating a corporate culture focused on resident-centred care 2. Implementing the requirements of the Long-Tenn Care Homes Act and its regulations 3. Improving the accountability of the staff and management of Rideaucrest 4. Identify opportunities to achieve efficiencies in operations Below we have further identified our understanding of your requirements as they relate to your three primary goals briefly providing related objectives. Our Administrator will take the lead in directing the Home's management team focusing on the importance of working in a cooperative and supportive manner being respectful of the sensitive nature of some of the tasks. 1. Creating a Corporate Culture Focused on Resident-Centred Care Objective: Building a Centre of Excellence by continuing to improve infrastructures, resident activities and quality activities. (policies, procedures, programs, etc. utilizing councils/committees in an effective manner). 2. Implementing the Requirements of the Long-Term Care Homes Act Objective: Ongoing Compliance witb MORL TC Legislation by reviewing changes, planning and implementing according to a well defined schedule utilizing appropriate human resources. 3. Improving the Accountability of the Staff and Management of Rideaucrest Objective: Developing a New Working Culture by continuing to build relationships; improving communication and morale; and improving the labour relations environment. Submitted by Extendicare (Canada) Inc. March, 2013 Page 11 Council Meeting 11 April 9, 2013 240

EXTEN DICA RE to provide Leadership at the Rideaucrest Home 4. Identify opportunities to achieve efficiencies in operations Objective: Ensuring that the Home is efficient by identifying ways to utilize existing resources differently or reducing costs through operational changes such as purchasing, staffing patterns, etc. Submitted by Extendicare (Canada) Inc. March, 2013 Page 12 Council Meeting 11 April 9, 2013 241

EXTEN DrCA RE to provide Leadership at the Rideaucrcst Home Deliverables 1. Leadership Extendicare will provide direction to the leadership team through the provision of a full-time, onsitc, qualified Administrator that will ensure consistency in operations and strategic direction of the Home. Extendicare's approach to execute the deliverables will incorporate our philosophy of "helping people live better" by promoting quality of life. The administrator will continue to proceed carefully to build trust and confidence while exploring and understanding the Home's unique situation. This approach will ensure we have a plan based on a solid understanding as opposed to instant advice arising from first impressions or preconceived notions. Below we have provided an outline of what we consider to be reasonable responsibilities of the Administrator, knowing relationships, ensuring compliance, resident focused care and finances are the focus to the success of this extended partnership. We will continue to identify potential areas for improvement that will have a positive impact on relationships and finances. This proposal is based on providing an experienced Administrator to work with the management team by providing effective and consistent leadership. Summary of Responsibilities Build relationships and focus on team building - be visible to staff, residents and families, build confidence and maintain stabi lity in the day to day operations of the home. Address issues in a timely manner and communicate desired ou~comes and accomplishments. Extendicare representatives will meet with City of Kingston designates a few times per year to monitor progress and discuss issues. Review Quality and Risk Management programs to detennine consistency and compliance with legislative requirements. Review the education and training plan - identify and provide training to meet the needs of the home and regulatory obligations. Attend committee and council meetings and review protocols to ensure regular meetings are held and communications are open and consistent. Review implementation requirements of new legislation - ensure in-selvices are compliant. Review staffing models by department and make suggestions on potential efficiencies based on vacancies and scheduli'ng requirements. Review manager accountabilities - for consistency with expectations. Comment on policies and procedures in place and test for availability, consistency and amend practices as needed. Submitted by Extendicare (Canada) Inc. March, 2013 Page 13 Council Meeting 11 April 9, 2013 242

EXTENDICA RE to provide Leadership at the Rideaucrest Home Provide advice as requested on Collective Agreement negotiations and labour relations matters. Extendicare will, through Silver Group Purchasing, procure goods and services, within the MOH & LHIN guidelines and long tenn care standards, on behalf of the City, excluding major capital items, to ensure effective and efficient daily operation of the home. Service providers' contracts will be reviewed, renegotiated and updated where necessary to ensure consistent high quality services meet provincial standards. Extendicare will maintain a list of goods and services purchased for Rideaucrest. Review process for identifying and reporting risk issues - ensure compliance with MOHL TC standards. Observe Dietary, Laundry and Housekeeping services and attend meal service regularly discuss services with staff, residents and families - make recommendations on efficiencies identified. Review reporting requirements to the City and assess need for improvements. Complete a quality assessment report on a semi-annual and annual basis for the indicators to be reported on. 2. Extendicare's Management/Consulting Services Support Team Below we have provided profiles of some of the Extendicarc's Team which demonstrates the inhouse expertise at Extendicare: Paul Tuttle, BA. M.Ed.. President Paul Tuttle was named President of Extendicare's Canadian operations in January of 2006. Prior to joining Extendicare in 2003 as Vice-President of Eastern Operations, Paul was with the Ontario MOHL TC for 13 years most recently as Director of the Long-Term Care Branch with responsibility for regulatory and policy oversight of all long-term care homes in Ontario. At the MOHL TC, Paul's time was spent working on issues in long-term care homes as well as community support and homecare. Paul has experience in various non-profit operations in the community and institutional sectors in both administrative and service delivery capacities working with a variety of populations including the elderly, and people with physical or mental health challenges. Paul was the founding President of Ontario Home Support Association which later merged with Meals on Wheels and Seniors Centres to become OCSA. He has also served on a variety of non-profit boards. Paul or a member of the senior management team will attend regular board meetings. Elaine Everson, CA. BM, Vice-President and Controller Elaine Everson is the Vice-President and Controller for Extendicare's Canadian operations. Before joining Extendicare in 1985, Elaine graduated from the University of Waterloo with a Bachelor of Mathematics Oegree and obtained her Chartered Accountant designation while working in public accounting. As a member of the senior management team, Elaine's accountabilities include financial reporting and analysis, accounts receivable, accounts payable, payroll, government financial and tax reporting, field audit functions, daily cash management and development projects. Submitted by Extendicarc (Canada) Inc. March, 2013 Page 14 Council Meeting 11 April 9, 2013 243

EXTEND[CARE to provide Leadership at the Rideaucrest Home Deborah 8akti. Vice-President. Human Resources Deborah Bakti is the Vice-President Human Resources, for Extendicare and ParaMed's Canadian Operations, leading a team that provides support with Labour Relations and Human Resources expertise. She joined Extendicare in September 2006 as Vice President, ParaMed, and then assumed responsibility in her current role in 2009. Prior to joining Extendicare, Deborah's career focus was in sales and marketing and later migrated to the growing world of professional recruitment selvices. Deborah has worked in the insurance industry and professional recruitment industry in senior leadership roles with operational accountability. VVhile the majority of her career has been focused on business development and sales management, her love of providing client solutions and total co mmitment to customer satisfaction has resulted in a great opportunity to bring that strength and passion to support Operations through Human Resources. Kathy O'Reilly, RN. Vice-President Quality and Performance Improvement Kathy O'Reilly joined Extendicare in September 2007. She began her career as an RN in Edmonton at the Royal Alexandra Hospital. She has worked as a Director of Care/Administrator as well as a Canadian Director, Operational Compliance with a large long-term care operator based in Ontario. She joined the MOHL TC as a compliance advisor and later assumed several senior positions including compliance manager and program consultant. Prior to joining Extendicare, she was the Manager of Enforcement with the Compliance and Inspection Enforcement Unit with the MOHL TC e in Ontario. Kathy brings extensive experience in longterm care policy development, compliance management, as well as significant LTC home operational experience to the table. She is a Registered Nurse, Certified Nursing Home Administrator and is also a Surveyor with Accreditation Canada. Sue Pearl-Agar. RN z ascn. MBA. CHEz Vice-President. ParaMed Sue Pearl-Agar is responsible for the operation of ParaMed Home Health Care, a subsidiary of Extendicare (Canada) Inc. She joined Extendicare in 1992 as Regional Director overseeing the Long Term Care and Managed Homes in South Eastern Ontario. Sue held this position until February 2007, at which time she was appointed Managing Director for Lifecare Operations, reporting to the receiver, Ernst and Young. In November 2007, Sue transferred to ParaMed in the role of Director of Operations, shortly after became Senior Director, and in 2010 she was appointed Vice President. Sue has over 30 years of experience in both the public and private health care sectors, as well as in acute, long-term, and home health care settings. She has also worked in a variety of management, administrative and educational capacities. Sue holds a Bachelor of Science in Nursing from the University of Toronto, a Masters of Busine.ss Administration from the Schulich School of Business, and is a Certified Health Executive of the Canadian College of Health Leaders. Sue has also been a board member of the Ontario Home Care Providers Association since 2010. Gary Loder. Senior Director. Extendicare Assist Gary Loder joined Extendicare in 1988 and has held a variety of positions including Administrator, Assistant Executive Director Human Resources, Executive Director Continuing Care, and Regional Director. Gary was part of the Extendicare operational team that commissioned the new homes for Extendicare and several new homes for Extendicare longterm care partners in Ontario. In 2009 Gary was appointed Director of Redevelopment & Consulting Services and more recently became the Director of Business Development. Prior to Submitted by Extendicare (Canada) Inc. March, 2013 Page IS Council Meeting 11 April 9, 2013 244

EXTENDICARE to provide Leadership at the Ridcaucrest Home his work with Extendicare, Gary was a Labour Relations Consultant with the Newfoundland Hospital and Nursing Home Association, and Director of Human Resources with a long-term care home. Sharon Gilmour. Regional Director. Extendicare Assist Sharon Gilmour has worked with Extendicare for the past 20 years. Her first role was with Para Med as branch manager for both Lindsay and Oshawa centres. In 2010, she opened the first of Extendicare's new builds in Lindsay - Extendicare Kawartha lakes where she held the position of Administrator and later as Senior Administrator of the Southeast Region. In 2011, Sharon she became Regional Director of the Southeast Region, returning to Kawartha Lakes as Senior Administrator at the end of that year. In March of 2012, she then joined the Extendicare Assist team as Regional Director. Patti Kennedy. BBA. Director. Systems Development and Field Systems Support Patti Kennedy joined Extendicare in 1984 and has held a number of managerial positions. In her current role, she is responsible for conducting and reporting financial audits of our long term care homes and ParaMed centres; developing and implementing process improvements; and training and supporting office staff. Patti has a Bachelor of Business Administration from Wilfrid Laurier University. Prior to her current position, Patti was responsible for the accounts payable, payroll and benefits departments. She is an active member in the International Association of Lions Clubs. Mike Boyle. BA, CMA. Director. Information Technology and Privacy Officer Mike Boyle joined Extendicare in July 2005 as the Director of Information Technology. In his current role, Mike is responsible for driving the vision, strategy and execution of technology programs across the Nursing Home, Homecare and Corporate Office environments. Also, as Privacy Officer, he ensures organizational policies I procedures comply with all Federal and Provincial legislation impacting Extendicare's operations. Mike has a Math Degree from York University and is a Certified Management Accountant. Mike's worked in Healthcare organizations Agfa Medical Imaging, Bayer Pharmaceutical and Bayer Blood Services. Dave Rough. BBA. CMA. Director. Finance. Extendicare Assist Dave joined Extendicare in April of 2002 in his current position. Dave is responsible for the financial reporting of all of Extendicare's managed nursing homes, retirement homes and assisted living homes. Dave's 15 years of finance experience prior to joining Extendicare includes Director of Finance for Alliance Atlantis Motion Picture Group, as well as Controller for Cineplex Odeon Corp. Dave's experience includes supervisory responsibilities, business planning, budgeting and management reporting expertise. Dave has the ability to identify and analyse business problems and recommend solutions. Consultants Extendicare has a full range of qualified consultants from Financial, Nursing, Program, Dietary, and Human Resources including Labour Relations, Environmental Services including Maintenance, Engineering and Information Technology that will be available to support the management team of the home. Consultants will have regularly scheduled visits as well as respond to day to day needs of the home. Submitted by Extendicare (Canada) Inc. March, 2013 Page 16 Council Meeting 11 April 9, 2013 245