Waterloo Wellington Community Care Access Centre. Community Needs Assessment

Waterloo Wellington Community Care Access Centre Community Needs Assessment

Table of Contents 1. Geography & Demographics 2. Socio-Economic Status & Population Health Community Needs Assessment 3. Community Health System Current State 4. Community Health System Future State 5. Appendix A

Introduction Report Structure Overview This report begins by setting the context for the community needs assessment of the WWLHIN with an overview of its geographic area, the demographic characteristics of its population, and their aggregate socioeconomic and health characteristics relative to other LHINs. The assessment then provides an update on the care management roles of all 14 CCACs before examining the current Community Care Coordinator burden of the WWCCAC relative to benchmarks. It also analyses the current state of community and home care resources in the LHIN, current gaps in Long term Care, and it concludes by projecting future community-based service needs and Community Care Coordinator volumes.. 2013 All rights reserved 2

1. Geography & Demographics Table of Contents 1. LHIN Catchment Area 2. Total Population by Cohort All LHINs 3. Total Population % by Cohort All LHINs 4. Distribution of Older Adults in WWLHIN (2006) 5. Older Adult Projections (2013-2033) - by LHIN 6. Older Adult Growth Rate Projections (2013 2033) by LHIN

1. Geography & Demographics LHIN Catchment Area WW is the 5 th smallest LHIN by geographic area WWLHIN Boundaries The LHIN s 4,800 square kilometers stretch from Proton Station in the north to Ayr in the south, Clifford at its most westerly point and Erin to the east. Pop. Distribution Map Major Cities Waterloo Kitchener Cambridge Guelph. 2013 All rights reserved 4

1. Geography & Demographics WW is the 6 th smallest LHIN by total population, and has the 5 th lowest number of Older Adults (65+) 2,000,000 1,800,000 1,600,000 1,400,000 1,200,000 1,000,000 800,000 600,000 400,000 200,000 0 LHIN Population by Age Cohort - 2013 Projections Total Population by Cohort All LHINs ESC SW WW HNHB CW MH TC C CE SE CH NSM NE NW 75+ 49,633 76,178 47,134 116,424 38,732 64,618 80,233 112,457 117,229 43,714 84,534 36,695 47,214 17,639 65-74 59,502 88,697 57,225 131,512 56,669 84,383 83,538 136,687 134,175 54,219 107,746 45,503 59,915 21,421 45-64 183,553 276,277 208,184 410,486 223,025 335,604 302,596 519,541 470,529 150,899 366,997 140,293 175,658 71,440 20-44 203,866 314,633 282,156 467,211 319,749 436,755 450,696 678,288 578,339 149,606 452,425 149,280 167,049 73,726 0-19 148,276 220,360 185,145 316,527 224,180 302,810 232,920 428,897 361,066 99,887 282,874 103,954 115,596 55,108 0-19 20-44 45-64 65-74 75+ Source: Ministry of Finance. At 81.8 Years of Expected Life at birth, WW residents only slightly outlive the Ontario average of 81.5. At age 65, residents are expected to live until 85.3, matching the Province 2013 All rights reserved 5

1. Geography & Demographics WW has a lower proportion of Older Adults, with only 13.4% of its inhabitants 65 years of age or older. The provincial average by LHIN is 15.3% 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% LHIN Population % by Age Cohort - 2013 Projections Total Population % by Cohort All LHINs ESC SW WW HNHB CW MH TC C CE SE CH NSM NE NW 75+ 7.7% 7.8% 6.0% 8.1% 4.5% 5.3% 7.0% 6.0% 7.1% 8.8% 6.5% 7.7% 8.4% 7.4% 65-74 9.2% 9.1% 7.3% 9.1% 6.6% 6.9% 7.3% 7.3% 8.1% 10.9% 8.3% 9.6% 10.6% 9.0% 45-64 28.5% 28.3% 26.7% 28.5% 25.9% 27.4% 26.3% 27.7% 28.3% 30.3% 28.3% 29.5% 31.1% 29.8% 20-44 31.6% 32.2% 36.2% 32.4% 37.1% 35.7% 39.2% 36.2% 34.8% 30.0% 34.9% 31.4% 29.5% 30.8% 0-19 23.0% 22.6% 23.7% 21.9% 26.0% 24.7% 20.3% 22.9% 21.7% 20.0% 21.9% 21.9% 20.4% 23.0% 0-19 20-44 45-64 65-74 75+ Source: Ministry of Finance. At 38.2 years, WW has the 3 rd lowest median age of all LHINs, potentially in part due to the presence of three of Canada s 13 largest universities. 2013 All rights reserved 6

1. Geography & Demographics Within the LHIN, Minto and Wellington North have the highest proportion of Older Adults Geographic distribution of WW Older Adults (65+) - 2006 Distribution of Older Adults in WWLHIN (2006) Based on 2006 figures, Census Subdivisions (CSDs) in the WWLHIN that have higher percentages of Older Adults than the provincial average (15.3%) are: Minto (16.9%) Wellington North 16.9% CSDs with the lowest percentage of Older Adults include: Mapleton (7.7%) Wellesley (8.1%) 2013 All rights reserved 7

1. Geography & Demographics Older Adult Projections (2013-2019) - by LHIN The number of Older Adults (65+) in the WWLHIN will increase by 25,000 over the next 6 years 350,000 Older Adults (65+) Projections by LHIN 2013-2019 300,000 250,000 200,000 150,000 100,000 50,000 - ESC SW WW HNHB CW MH TC C CE SE CH NSM NE NW 2013 109,13 164,87 104,35 247,93 95,401 149,00 163,77 249,14 251,40 97,933 192,28 82,199 107,12 39,060 2016 119,55 180,89 116,96 270,24 110,94 170,04 172,62 285,25 281,63 107,44 215,40 91,322 116,23 42,974 2019 130,94 199,26 131,38 296,12 127,44 192,74 182,18 323,95 315,27 117,54 240,63 102,13 126,18 47,549 2013 2016 2019 Source: Ministry of Finance. 2013 All rights reserved 8

1. Geography & Demographics Older Adult Growth Rate Projections (2013 2019) by LHIN WW is a relatively younger LHIN, but it is aging more rapidly than most others. It is projected to have the 3 rd fastest growth rate of Older Adults (65+) between 2013 and 2019 40% 35% 30% 25% 20% Growth Rate of Older Adults (65+) - 2013-2019 WW s growth rate between 2013-2019 (26%) will be 13% higher than the provincial average (23%). 15% 10% 5% 0% ESC SW WW HNHB CW MH TC C CE SE CH NSM NE NW 2013-2016 10% 10% 12% 9% 16% 14% 5% 14% 12% 10% 12% 11% 9% 10% 2013-2019 20% 21% 26% 19% 34% 29% 11% 30% 25% 20% 25% 24% 18% 22% 2013-2016 2013-2019 Source: Ministry of Finance. In 2013, Older Adults (65+) account for 13.3% of the total LHIN s population. By 2023, they will account for 17% of all LHIN inhabitants, and 21% by 2033 2013 All rights reserved 9

2. Socio-Economic Status (SES) & Population Health Table of Contents 1. Social Correlates of Health Overview 2. WWLHIN Atlas Index 3. Proportion of Population with Aboriginal Ancestry by LHIN 4. Proportion of Population of Visible Minority Status by LHIN 5. Proportion of Population that are High School Graduates by LHIN 6. Proportion of Population with Low Income by LHIN 7. Proportion of Population with a Disability by LHIN 8. Select Chronic Conditions Overview 9. Prevalence of Diabetes and Hypertension by LHIN 10. Prevalence of Asthma and COPD by LHIN 11. Prevalence of Arthritis and Stroke Events by LHIN 12. Ranking by LHIN

2. Socio-Economic Status (SES) & Population Health Social Correlates of Health Overview The next few slides explore how the WWLHIN ranks on certain social correlates of health factors that are correlated with the health of a population. Broadly speaking, the lower the value of the indicators, the more likely that the population is in better health. Social Correlate of Health Aboriginal Status Visible Minority Status Income Level Education Level Disability Status Indicators % of Population of Aboriginal Ancestry % of Population that belong to a Visible Minority group % of Population with low income based on after-tax low income measures % of Population (OR Working Age Population) without Certificate, Degree, or Diploma % of Population with a Disability 2013 All rights reserved 11

2. Socio-Economic Status (SES) & Population Health Relative to the province as a whole (WW CSDs) have a considerably lower index score indicating lower levels of relative socio-economic disadvantage on average Also according to the Waterloo Wellington LHIN Atlas: WWLHIN Atlas Index Wellington North and Southgate Census Sub Divisions (CSDs) had higher levels of social disadvantage relative to the provincial average overall Source: Health System Intelligence Project (2006). Waterloo Wellington LHIN Atlas. Toronto: Ontario Ministry of Health, p. 10. 2013 All rights reserved 12

NW NE NSM SE ESC Ont. CH HNHB SW CE WW TC CW MH C 3.3% 2.8% 2.4% 2.0% 2.0% 1.7% 1.4% 1.2% 1.0% 0.8% 0.6% 0.4% 0.4% 9.5% 19.8% 2. Socio-Economic Status (SES) & Population Health Proportion of Population with Aboriginal Ancestry by LHIN The WWLHIN has the 4 th lowest percentage of people of Aboriginal Ancestry Geographic distribution of Aboriginal Population in WWLHIN 2006 % of Population with Aboriginal Ancestry in 2006 by LHIN 25.0% 20.0% 15.0% 10.0% 5.0% 0.0% Source: Health System Intelligence Project (2006). Waterloo Wellington LHIN Atlas. Toronto: Ontario Ministry of Health Statistics Canada. 2013 All rights reserved 13

CW C MH CE TC Ont. CH WW ESC HNHB SW NSM SE NW NE 50.3% 42.1% 36.2% 34.5% 32.6% 22.8% 14.9% 11.7% 10.1% 9.1% 6.5% 3.6% 3.3% 1.8% 1.4% 2. Socio-Economic Status (SES) & Population Health The WWLHIN ranks in the middle in terms of the proportion of its population that is of Visible Minority descent 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% % of Population that are Visible Minorities in 2006 by LHIN Proportion of Population of Visible Minority Status by LHIN Geographic distribution of Visible Minorities in WWLHIN - 2006 0.0% Source: Health System Intelligence Project (2006). Waterloo Wellington LHIN Atlas. Toronto: Ontario Ministry of Health Statistics Canada. 2013 All rights reserved 14

NW NE SW ESC CW WW NSM SE HNHB CE Ont. TC C CH MH 20.3% 18.5% 16.6% 15.8% 15.8% 15.4% 15.4% 15.1% 14.6% 13.6% 13.6% 11.4% 11.4% 10.5% 9.0% 2. Socio-Economic Status (SES) & Population Health WW residents are about 10% less likely to be high school graduates than the provincial average 25.0% 20.0% 15.0% 10.0% 5.0% % of Working Age (25-64) Population Without Certificate, Degree or Diploma in 2006 by LHIN Proportion of Population that are High School Graduates by LHIN Geographic distribution of % Population without completed High School Diploma 0.0% Source: Health System Intelligence Project (2006). Waterloo Wellington LHIN Atlas. Toronto: Ontario Ministry of Health Statistics Canada. 2013 All rights reserved 15

TC C NW CW CE Ont. ESC MH NE SE C HNHB SW NSM WW 21.1% 17.9% 16.8% 16.5% 16.4% 15.2% 15.2% 14.6% 14.2% 13.2% 13.1% 13.1% 12.7% 12.3% 10.8% 2. Socio-Economic Status (SES) & Population Health WW has the lowest percentage of low income residents in the province, approximately 30% lower than the provincial average 25.0% 20.0% 15.0% 10.0% 5.0% % of Population with Low Income Based on After Tax Low Income Measures in 2006 by LHIN Proportion of Population with Low Income by LHIN Geographic distribution of % Economic Families below Low Income Cut-off* 0.0% *These averages were not weighted by population size Source: Health System Intelligence Project (2006). Waterloo Wellington LHIN Atlas. Toronto: Ontario Ministry of Health Statistics Canada. 2013 All rights reserved 16

NE SE NW SW HNHB NSM ESC CE Ont. C TC WW C CW MH 21.7% 20.9% 20.8% 20.4% 20.1% 19.6% 19.0% 18.9% 18.4% 17.1% 17.0% 15.4% 14.9% 24.9% 23.9% 2. Socio-Economic Status (SES) & Population Health Proportion of Population with a Disability by LHIN WW has the 4 th lowest rate of disability of all LHINs, 10% lower (17.1%) than the provincial average (19%) % of Population with a Disability in 2006 by LHIN 30.0% 25.0% 20.0% 15.0% 10.0% 5.0% 0.0% Source: Statistics Canada. 2013 All rights reserved 17

2. Socio-Economic Status (SES) & Population Health Select Chronic Conditions Overview This section explores how the WWLHIN ranks on the prevalence of certain chronic medical conditions. These are used as a barometer for the health status of a population as individuals that have these conditions tend to be repeat users of the local health care system. Chronic Condition Diabetes Hypertension Chronic Obstructive Pulmonary Disease (COPD) Asthma Arthritis Stroke Indicators % of Population Aged 12+ with Diabetes % of Population Aged 12+ with Hypertension % of Population Aged 12+ with COPD % of Population Aged 12+ with Asthma % of Population Aged 12+ with Arthritis Rates of Hospitalized Stroke Events per 100,000 Residents 2013 All rights reserved 18

2. Socio-Economic Status (SES) & Population Health Prevalence of Diabetes and Hypertension by LHIN The WW population has the 5 th lowest prevalence of diabetes, and 3 rd lowest rate of hypertension SE CE CW NE ESC NW Ont. C CH HNHB WW MH SW TC NSM % of Population Aged 12+ with Diabetes, 2010 10.4% 9.4% 9.2% 8.8% 8.1% 7.5% 7.2% 7.2% 6.9% 6.9% 6.9% 5.9% 5.7% 5.0% 4.6% 0.0% 5.0% 10.0% 15.0% NE SE NW ESC CW SW NSM HN CE Ont. MH CH WW TC C % of Population Aged 12+ with Hypertension, 2010 21.0% 20.9% 20.8% 20.5% 19.9% 19.3% 19.3% 18.7% 18.2% 17.6% 16.3% 15.9% 15.4% 14.9% 14.7% 0.0% 5.0% 10.0% 15.0% 20.0% 25.0% Source: Statistics Canada. Health Profile. 2013 All rights reserved 19

2. Socio-Economic Status (SES) & Population Health Prevalence of Asthma and COPD by LHIN The WW population has the 3 rd lowest prevalence of asthma, and ranks in the middle in prevalence of COPD CH SE HNHB NE NW Ont. ESC C CE MH SW CW WW NSM TC % of Population Aged 12+ with Asthma, 2010 8.7% 8.6% 8.4% 8.3% 7.9% 7.9% 7.8% 7.7% 7.6% 7.5% 7.2% 7.0% 7.0% 12.3% 11.1% 0.0% 5.0% 10.0% 15.0% NE NW SE NSM SW CE HNHB WW CH Ont. ESC TC C MH CW % of Population Aged 12+ with Chronic Obstructive Pulmonary Disease (COPD), 2010 3.0% 2.5% 2.4% 5.4% 4.9% 4.5% 4.4% 4.4% 4.2% 8.2% 7.3% 6.8% 6.6% 6.5% 0.0% 2.0% 4.0% 6.0% 8.0% 10.0% Source: Statistics Canada. Health Profile. 2013 All rights reserved 20

2. Socio-Economic Status (SES) & Population Health Prevalence of Arthritis and Stroke Events by LHIN The WW population has the 4 th lowest prevalence of arthritis, and 3 rd lowest rate of hospitalized stroke events SE NE NW NSM ESC HNHB SW CH Ont. CE CW WW C TC MH % of Population Aged 12+ with Arthritis, 2010 24.0% 23.8% 23.7% 22.7% 22.2% 20.9% 19.4% 19.2% 17.4% 16.8% 14.7% 14.5% 14.1% 13.5% 11.0% 0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% ESC NW NE NSM SW TC CW HNHB Ont. SE CE MH WW C CH Rate of Hospitalized Stroke Events per 100,000 population, 2009 161 160 148 141 133 128 127 127 126 125 120 119 118 115 104 0 50 100 150 200 Source: Statistics Canada. Health Profile. 2013 All rights reserved 21

2. Socio-Economic Status (SES) & Population Health In the next slide, the variables in the Population Health and Socio- Economic Status sections are put together to graphically illustrate the relationship that exists between the socio-economic characteristics of a population and its health. To learn more about the methodology of these rankings, refer to Appendix A. No inferences are made concerning whether the aggregate socioeconomic status and disease burden of a population are causally related or merely correlated. 2013 All rights reserved 22

Socio-Economic Ranking 2. Socio-Economic Status (SES) & Population Health The WW population has a disease burden than one would expect on the basis of its aggregate socio-economic profile Ranking by LHIN 15 14 13 12 11 10 9 8 7 6 5 4 3 2 1 0 SES vs. Disease Ranking - All LHINs NW NE ESC SE SW CE CW TC C NSM HNHB CH WW MH 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Disease Ranking Refer to Appendix A for methodology details 2013 All rights reserved 23

3. Community Health System Current State Sub-section Table of Contents 1. Care Coordination & System Navigation Update 2. Community Care Services 3. Other Health System Metrics

3. Community Health System Current State Section Overview This section provides an update on the care management role of the province s 14 CCACs in terms of implementing their mandated Expanded Role. The WWCCAC s current Community Care Coordinator volumes are also examined to determine whether a shortage or overabundance of staffing resources exist on the basis of provincial benchmarks. Next, the current state of Community and Home Care, Community Support Services, and Long Term Care beds is examined, as are metrics that reflect the broad success of the 14 LHINs in transitioning clients out of hospitals (ALC rates), the proportion of physicians the LHINs have relative to one another, and the extent to which community members are satisfied with community care resources.. 2013 All rights reserved 25

3. Community Health System Current State 1. Care Coordination & System Navigation Update Table of Contents 1. Care Coordination & System Navigation Update 2. Expanded Role of CCACs 3. Care Coordinator Caseloads 4. WWCCAC Current Client & Caseload Mix

Expanded Role Service 3. Community Health System Current State Care Coordinator & System Navigation Update Expanded Role of CCACs CCACs have been mandated with an expanded role. The chart below marks the progress of the 14 LHINs in implementing the expanded role of the CCAC as of January 2013. WW s progress is in line with other LHINs Local Health Integration Network ESC SW WW HNHB CW MH TC C CE SE CH NSM NE NW ADP AL/SH CCC REHAB Notes: High likelihood that targets will be revised in the months ahead Mississauga Halton has an internal referral system for ADP that was implemented shortly prior to the requirement that CCACs to manage access to ADP services 2013 All rights reserved Legend Implementation Complete In Progress Q4 2012/2013 Target In Progress Q1 2013/2014 Target In Progress Q4 2013/2014 Target Has Not Begun Source: OACCAC 27

Client Type (CCM) 3. Community Health System Current State Care Coordinator & System Navigation Update - Care Coordinator Caseloads Based on current caseloads, a minimum of 61 Community Care Coordinator FTEs are required to meet current implementation targets.* The WWCCAC currently has 59 # of Clients per Community Care Coordinator OACCAC Target Range WWCCAC Implementation Target WWCCAC Actual Complex Senior 40 60 60 67.86 Complex/ Chronic Adult* 40-100 80 81.8 Chronic Senior 80 100 100 112.45 Notes: Community Independent 140 160 160 161.41 Short Stay 200 300 300 272.38 Internal project currently underway analyzing feedback to determine if current target caseload (60 clients) for complex seniors is too high and whether 40/CC would be more appropriate Comparative information for other CCACs not readily available *Assumes that portfolios can be optimally balanced, and that the WWCCAC complies with the high end of the OACCAC target range. **Client Type classification is WWCCAC s. No OACCAC values provided. Range based on low end of Complex Senior and high end of OACCAC Target. 2013 All rights reserved 28

3. Community Health System Current State Care Coordinator & System Navigation Update - WWCCAC Current Client & Caseload Mix On the basis of Weighted Caseloads, Community Care Coordinators with portfolios of Chronic Seniors have the greatest burden, while those that manage care for Short Stay clients have the least 26.3% WWCCAC Current Client Mix 33.1% 5.7% 4.9% 29.9% N = 8281 Complex Senior Chronic Senior Complex/Chronic Adult Community Independence Short Stay Client Type # of Clients # of Care Coordinators (CC) - 2013 Weighted Caseload per CC Complex Senior 475 7 105 Complex/Chronic Adult 409 5 102 Chronic Senior 2474 22 112 Community Independent 2744 17 101 Short Stay 2179 8 90 Weighted Caseload per Community Care Coordinator Total 8281 59 104 The Weighted Caseload is a metric used by the WWCCAC to assess the relative care coordination needs of clients relative to one another on the basis of their type. This is predicated on the notion that the more complex the client, the greater their care coordination needs. Chronic Seniors are assigned a weight of 1, and other client types are weighed relative to them. 2013 All rights reserved 29

3. Community Health System Current State 2. Community Care Services Table of Contents 1. Current State Methodology 2. Current State Data Overview 3. Home & Community Care Service Usage 4. Expected vs. Actual Supply of Community Support Services by LHIN 5. Actual Funding Rate by CCAC 2010/2011 6. Expected vs. Actual Supply of Community Support Services by LHIN 7. Long Term Care Bed Usage & Waitlists 8. Overview

3. Community Health System Current State Community Care Services Current State Methodology Community needs and the care and services required to serve them adequately can be interpreted in several different ways. The following model is used for the purposes of this: 1 2 3 4 5 Chronic Disease Burden Estimated Service Needs Actual/ Estimates of Services Provided Cost of Services Provided Cost of Services related to Est. Service Needs 2013 All rights reserved 31

3. Community Health System Current State Community Care Services Current State Data Overview Limited and different types of data are available to understand different aspects of these needs Estimated Services Needs Estimated Service Gaps Actual/ Estimated Services Expected Service Costs (HBAM) Actual Cost Gap in Costs (Actual- Expected) Actual Share/ Expected Share (Pop. Based) Community & Home Care Community Support Services Long Term Care 2013 All rights reserved 32

3. Community Health System Current State Community Care Services Home & Community Care Service Usage WW estimated to have spent $62.8M on community and home care expenses during the 2012/2013 fiscal year Service Type Estimated Visits (2012/2013) Nursing 321,724 Nutrition & Dietetics 5,536 Physiotherapy 36,602 Service Type Estimated Hours (2012/2013) Nursing Support 88,274 Personal Support Worker 86,660 PSW & Homemaking 978,015 Occupational Therapy 36,140 Speech Language Therapy 13,610 Social Work 5,383 Case Management 101,808 Note: Estimated values based on applying the service rate per 1,000 people per service type to 2012/2013 population projections 2013 All rights reserved 33

(Actual -Expected Expenditures)/ Expected Expenditures 3. Community Health System Current State Community Care Services Expected vs. Actual Supply of Community Support Services by LHIN According to the Health-Based Allocation Model, the WWCCAC s actual expenses were 6% higher in 2010/2011 than expected 10% 5% 0% 9% CCAC Actual Expenditures relative to HBAM-expected Expenditures, 2010/11 6% 6% 6% 5% 4% 2% -5% -1% -2% -3% -6% -7% -7% -10% -10% -15% ESC SE TC WW CH MH CW HNHB NE SW C CE NW NSM 2013 All rights reserved 34

3. Community Health System Current State Community Care Services Actual Funding Rate by CCAC 2010/2011 In 2010/2011 eight other CCACs received more community care funding per 1,000 people than Waterloo Wellington 140000 120000 100000 80000 60000 40000 20000 0 CCAC Community Expenses per 1000 Population - 2010/2011 ESC SW WW HNHB CW MH TC C CE SE CH NSM NE NW 2013 All rights reserved 35

3. Community Health System Current State Community Care Services Expected vs. Actual Supply of Community Support Services by LHIN As of 2009/2010 there was a 20% undersupply of Community Support Services in the WWLHIN* 16% 14% 12% 10% 8% 6% 4% 2% 0% Actual & Weighted Population-based CSS Share ESC SW WW HNHB CW MH TC C CE SE CH NSM NE NW Actual Share 4% 7% 4% 13% 1% 8% 15% 13% 9% 4% 12% 3% 4% 3% Expected Share 5% 8% 5% 12% 5% 8% 9% 12% 12% 4% 9% 4% 5% 2% Actual Share Expected Share CE LHIN Building a Model of Sustainable Access to Community Health Care Services, May 2011 WW s expected share of resources, calculated on the basis of the Health-Based Allocation Model, should be 5% of all provincial resources, but is currently 4%. *As HBAM has not yet been implemented for the CSS sector, significant conclusions should not be drawn from this analysis. 2013 All rights reserved 36

3. Community Health System Current State Community Care Services Long Term Care Bed Usage & Waitlists Of the 730 individuals on the WW LTC Waitlist, it is estimated that 40% of them (292) are already in a LTC bed, suggesting that only 438 beds are required to meet demand LTC Bed Waitlist by LHIN Dec 2011 4,500 4,000 3,500 3,000 2,500 2,000 1,500 1,000 500-1 2 3 4 5 6 7 8 9 10 11 12 13 14 In LTC Bed 302 576 292 757 126 403 650 961 1,689 354 963 368 424 192 Not in LTC Bed 454 863 438 1,136 190 605 975 1,442 2,534 531 1,445 553 635 288 Total LTC Beds: 3,776 LTC Residents: 3,696 LTC Waitlist: 730 LTC Waitlist already in LTC bed: 292* LTC Waitlist not in LTC bed: 438* Not in LTC Bed In LTC Bed Integrated Health Service Plan 2013-2016. Common Environment Scan. 2012. LTC Demand 3 rd lowest in Province (98.6 per 1,000 75+ vs. 107.5 for Ontario) Median Time to Placement: 63 Days (Provincial average is 89) *According to Provincial data, 40% of clients on LTC waitlists are already in a LTC bed but are awaiting admission to a more preferred home. Source: Long-term-care Home Placement Process. Office of the Auditor General of Ontario 2013 All rights reserved 37

3. Community Health System Current State Community Care Services Overview Based on the Community Health System Current State: Home & Community Care: WWCCAC s waitlists are the best indicators of current needs vs. services provided. WW spent 6% more than expected according to HBAM CSS: There is a 20% undersupply of CSS resources in the WWLHIN* LTC: A shortage of 438 long term care beds exists in the WWLHIN** Community Care Spend: 8 other CCACs spent more money on community and home care services per capita than WW *Based on HBAM. Refer to Slide 36. **Based on estimate of proportion of LTC Waitlist clients not already in an LTC bed. Refer to Slide 37. 2013 All rights reserved 38

3. Community Health System Current State 3. Other Health System Metrics Table of Contents 1. Acute & Post Acute ALC Percentage by LHIN 2. Family Medicine & Geriatric Physicians by LHIN 3. Client Satisfaction with Community Care by LHIN

3. Community Health System Current State Other Health System Metrics - Acute & Post Acute ALC Percentage by LHIN WW has the lowest percentage of ALC clients in inpatient settings in Ontario. This suggests that the WW health system does a better job of transitioning clients out to the community than most other LHINs 25% % of Inpatient Care Beds in Acute & Post-Acute Occupied by ALC Patients - August 2012 20% 15% 10% 5% 0% Ontario Hospital Association. 2012. Note: Rates include Acute, CCC, Rehab and Mental Health beds 2013 All rights reserved 40

3. Community Health System Current State Other Health System Metrics - Family Medicine & Geriatric Physicians by LHIN WW has fewer Family Medicine and Geriatric Physicians per capita than the provincial average Family Medicine & Geriatric Physicians per 1,000 People - By LHIN 1.6 1.4 1.2 1 0.8 0.6 0.4 0.2 0 ESC SW WW HNHB CW MH TC C CE SE CH NSM NE NW Physicians 0.64 0.83 0.81 0.8 0.65 0.77 1.41 0.82 0.71 1.03 1.19 0.9 0.96 1.09 ESC SW WW HNHB CW MH TC C CE SE CH NSM NE NW CE LHIN Building a Model of Sustainable Access to Community Health Care Services, May 2011 At approximately 82 family medicine and geriatric physicians per 100,000 people, WWLHIN s ratio of physicians to population is close the 45 th percentile within the province (with an average of 88 family medicine and geriatric physicians per 100,000 population). 8 LHINs having higher ratios. The relative lack of primary care support in the community potentially increases reliance on other health services, creating more transitions and reducing continuity of care. 2013 All rights reserved 41

3. Community Health System Current State Other Health System Metrics - Client Satisfaction with Community Care by LHIN Just over two-thirds of residents rated the availability of community care in the WWLHIN as being good of excellent. The provincial average was 66.4% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Client Satisfaction with Availability & Quality of Community Care by LHIN - 2010 ESC SW WW HNHB CW MH TC C CE SE CH NSM NE NW Availability 58% 68% 69% 64% 67% 76% 76% 70% 66% 66% 62% 53% 48% 53% Quality 69% 81% 76% 72% 73% 80% 80% 77% 77% 76% 75% 71% 63% 71% About 3 in 4 clients rated the quality of community care services as being good or excellent, matching the provincial average. Availability Quality Integrated Health Service Plan 2013-2016. Common Environment Scan. 2012. 2013 All rights reserved 42

4. Community Health System Future State Table of Contents 1. Community Care Coordinator Projections for the Future (2014 2016) 2. Home & Community Care Service Usage & Cost Projections 3. Long Term Care Bed Usage & Waitlists 4. Projections Overview

4. Community Health System Future State Section Overview This section projects the future Community Care Coordinator needs of WWCCAC for 2014 2016 under the assumption that it plans to meet provincial caseload parameters. It also provides an overview of estimated future service requirements by type of service, highlighting what the projected funding requirements will be to meet the demand increase. It concludes by estimating the anticipated shortage in long term care beds assuming that no new beds are added. 2013 All rights reserved 44

4. Community Health System Future State A model was developed to determine the future (2014 2016) Community Care Coordinator requirements of the WWCCAC. For more information on model inputs, please refer to Appendix A. 2013 All rights reserved 45

4. Community Health System Future State Community Care Coordinator Projections for the Future (2014 2016) The figures below are projected Community Care Coordinator requirements based on low, medium and high scenarios of OACCAC Target caseload ranges. **Note that this projection assumes continuation of the current care coordination model and does not take into account new models of care. 2014 2015 2016 Client Type L M H L M H L M H Complex Senior 12 10 8 13 10 9 13 11 9 Complex/ Chronic Adult 10 6 4 10 6 4 11 6 4 Chronic Senior 32 29 26 33 30 27 35 31 28 Community Independent 20 19 18 21 20 19 22 21 19 Short Stay 11 9 7 12 9 87 11 9 7 TOTAL 85 73 63 89 75 65 92 77 67 The WWCCAC had 59 Community Care Coordinator FTEs as of January 2013. Note: Addition error in scenarios due to rounding. Refer to Appendix A for methodology. 2013 All rights reserved 46

4. Community Health System Future State Home & Community Care Service Usage & Cost Projections Approximately $2.66M is needed to fund the estimated 22,037 additional visits and 45,118 more hours of service that are forecasted to be required by 2015/2016 relative to 2012/2013 Service Type Estimated Visits (2015/2016) Service Type Estimated Hours (2012/2013) Nursing 335,338 Nutrition & Dietetics 5,771 Physiotherapy 38,150 Occupational Therapy 37,669 Speech Language Therapy 14,186 Social Work 5,610 Case Management 106,115 Nursing Support 92,009 Personal Support Worker 90,326 PSW & Homemaking 1,019,398 Based on 2010/2011 rates, an additional $1.3M is required for projected increase in visits, and $1.36M for the projected increase in service hours, from 2012/2013 levels. Note: Community and Home Care service usage is projected assuming that 2010/2011 service usage rates for visits and hours apply. 2013 All rights reserved 47

4. Community Health System Future State Long Term Care Bed Usage & Waitlists Assuming the December 2011 LTC Demand Rate and number of LTC beds for WW remain the same, the shortage of LTC beds in the LHIN is expected to almost double by 2015/2016 2013/2014 2014/2015 2015/2016 Projected Need (beds) Projected Shortage (beds) 4,455 4,534 4,638 668 757 862 Projected need is calculated by projecting the population of adults 75 years of age or older between 2014 2016. *Note that this projection assumes continuation of the current LTC policy and eligibility criteria for LTC. No inferences are made concerning whether adding more LTC beds is a better solution than increasing investments in the community to increase capacity to treat clients in their homes. For example, Denmark no longer builds conventional nursing homes. During the last 20 years, the availability of nursing home places has been reduced from approximately 40 places to approximately 20 places per 100 persons aged 80 or more. Independent adapted dwellings with 24-hour assistance service have replaced the nursing homes and 24-hour assistance services are provided to all elderly independent of where they live. Integrated Health Service Plan 2013-2016. Common Environment Scan. 2012. 2013 All rights reserved 48

4. Community Health System Future State Projections Overview Based on current state data, the following projections can be made: Home & Community Care: An additional 22,037 visits and 45,118 more hours of service will be required by 2015/2016, estimated to cost around $2.66M LTC: A shortage of 862 LTC beds will exist in 2015/2016 assuming no new beds are added from January 2013 levels *Note that changes to the model of care coordination, configuration of community and primary care services and LTC policy and eligibility criteria may significantly influence the realization of these projections. Again, no inferences are made concerning whether adding more LTC beds is a better solution than increasing investments in the community to increase the health system s capacity to allow clients to stay at home as long as possible 2013 All rights reserved 49

5. Appendix A Table of Contents 1. Population Health vs. Socio-Economic Status Ranking Methodology 2. Community Care Coordinator Forecasting Methodology

5. Appendix A Population Health vs. Socio-Economic Status Ranking Methodology The five social-correlates of health, listed below, are each weighted 20% in calculating the Socio-Economic Status Ranking of a LHIN. 1. Aboriginal Status 2. Visible Minority Status 3. Income Level 4. Education Level 5. Disability Level The prevalence of the six chronic conditions that have been chosen to represent a population s disease burden, listed below, are each weighted 16.67% in calculating the Disease Burden Ranking of a LHIN. 1. Diabetes 2. Hypertension 3. Chronic Obstructive Pulmonary Disorder 4. Asthma 5. Arthritis 6. Stroke The indicators in a particular macro ranking (i.e. Disease Burden) are ranked equally as sufficient information is not available to determine what their appropriate weightings ought to be relative to one another. 2013 All rights reserved 51

5. Appendix A Community Care Coordinator Forecasting Methodology The Community Care Coordinator Projection Model applies 2013 Client Type proportions to the projected growth of the 18-64, and 65+ population in the WW catchment area. The number of Community Care Coordinators is calculated on the basis of adherence to provincial targets 1. Proportion of Client Type in 2013 x 2. Year s Projected Population x 3. OACCAC Target Care Coordinator Caseload Ranges Client Type Low Medium High Projected Population Complex Senior 40 50 60 65+ Complex/Chronic Adult 40 70 100 18-64 Chronic Senior 80 90 100 65+ Community Independence 140 150 160 65+ Short Stay 200 250 300 18-64 *Client Type classification is WWCCAC s. No OACCAC values provided. Range based on low end of Complex Senior and high end of OACCAC Target. 2013 All rights reserved 52