Mississauga Halton LHIN: Seniors’ Care Strategy Presentation to Dr. Samir K. Sinha MD, Dphil, FRCPC Provincial Lead, Ontario’s Senior Care Strategy Narendra Shah, COO Mississauga Halton LHIN August 2, 2012 1
MH LHIN Presentation Focus MH LHIN Context 1 Strategic approach to enhance care for seniors 2 Performance Results with Aging at Home Investments 3 Leading Programs Pioneered in MH LHIN and Impact 4 5 Go Forward Strategy
MH LHIN Context 1 Context Strategic Approach Performance Leading Programs Go Forward
Our Health Service Providers Public Hospitals 2 with 6 sites Long-Term Care Homes 28 with 4,100 LTC beds Community Support Service 34 Providers Mental Health and Addiction 11 Service Provider Community Care Access 1 Centre (CCAC) 4 Context Strategic Approach Performance Leading Programs Go Forward
Mississauga Halton LHIN Population Trends More than 1.2 million residents: fifth • largest LHIN by population and one Central LHIN of the fastest growing Central West Waterloo Wellington LHIN LHIN By 2025, our population over the • age 65 will increase by 107,000 – South Etobicoke Halton Hills bringing the total number of seniors Southeast Northwest Mississauga to 250,000 Mississauga Culturally diverse: 43% of our • Milton residents identified as immigrants in Oakville the 2006 Census. 36% of our residents are visible minorities. HNHB LHIN 5 Context Strategic Approach Performance Leading Programs Go Forward
Projected Change in MH LHIN Population From 2010 to 2030, the MH LHIN population is projected to • increase by over 530,000 (45.8%)—Net increase of 26,500/year or total pop. of Collingwood every year! The population aged 75 and older will increase by 82,000, an • increase of 143% Total LHIN Population LHIN Population Age 75+ Year % Growth from % Growth from % of Population # # Age 75+ 2010 2010 2010 1,160,904 - 57,303 - 4.9% 2015 1,278,466 10.1% 69,989 22.1% 5.5% 2020 1,410,955 21.5% 86,319 50.6% 6.1% 2030 1,693,170 45.8% 139,498 143.4% 8.2% Source: intelliHealth, Population Projections LHIN. Accessed July 26, 2012. 6 Context Strategic Approach Performance Leading Programs Go Forward
MH LHIN Population 65+ by DA, 2006 MH LHIN Population 65+ by DA, 2006 Brampton South Etobicoke Halton Hills Southeast Northwest Mississauga Mississauga Milton Oakville Burlington Context Strategic Approach Performance Leading Programs Go Forward
Long-Term Care Locations Brampton South Etobicoke Halton Hills Southeast Northwest Mississauga Mississauga Milton Oakville Total of 28 long- Burlington term care homes and 4,100 beds 8 Context Strategic Approach Performance Leading Programs Go Forward
Long-Term Care Home Beds per 100 People Aged 75+ Years Ontario Dec 2010 Feb 2012 LTC Beds per LTC Beds per LHIN 100 people 100 people 12.00 aged > 75 aged >75 10.00 Central 7.25 6.71 8.00 6.00 Central East 9.05 8.62 4.00 Central West 9.90 9.02 2.00 Champlain 9.59 9.19 - Erie St. Clair 8.75 9.02 Hamilton Niagara Haldimand Brant 9.35 9.09 Mississauga Halton 7.22 6.68 North East 10.93 10.80 North Simcoe Muskoka 9.11 8.61 North West 10.59 10.63 South East 10.08 9.76 Dec '2010 Feb'2012 South West 10.13 9.87 Toronto Central 7.47 7.46 Waterloo Wellington 8.62 8.24 Ontario 8.92 8.59 We would need an additional 1,184 beds to get to MH LHIN LOWEST RATIO the provincial average. (4,153 beds to 5,337 beds) Source : MOHLTC LTCH System Report – Dec 2010 and Feb 2012 9 Context Strategic Approach Performance Leading Programs Go Forward
Strategic Approach to Enhance Care for Seniors 3 Context Strategic Approach Performance Leading Programs Go Forward
Evidence-Based Approach Seniors to Strategy Development 1. Seniors made up 60% of all acute hospital days while they represented 13% of Ontario’s population 2. 55,000 ALC patients occupied an equivalent of 2,500 acute beds in 2011/12 3. Over 85% of all ALC patients are seniors 65+ years and over 70% are 75+ years. Focus on age75+ high need seniors MAPLe 3-5 11 Context Strategic Approach Performance Leading Programs Go Forward
Strategy to Enhance Care for Seniors at Home/Community Capacity Most appropriate, least intensive level of care Reduce Post Acute Direct Admissions LTCH Home and Community Reduce Reduce Capacity Enhancement & Transformation Support high need-MAPLe 3-5 Timely Expand hours of operation Transfer Follow-up in hospitals to get Home them back home ER CCAC, CSS & MH&A - $231M and Family Health Care All investments must meet key performance outcomes 12 Context Strategic Approach Performance Leading Programs Go Forward
Right Care, Right Time, Right Place –Using Home First Philosophy Focus on: • Transformation of community sector to respond to high need seniors to reduce hospitalization • Building Right community capacity to manage MAPLe 3- 5 (with extended hours and resources) in the community • Enhance LTC Homes Capacity to care of its residents Use of evidence-based assessment tools in the community sector and robust performance measurements Context Strategic Approach Performance Leading Programs Go Forward
Home First is About Patient First All hospital patients want to return home (community) after their hospital stay . No patient plans to go to a LTC home. HOME FIRST is about best way for transition from hospital to home as soon as possible after the decision is made that the patient “no longer requires inpatient care” It is about : How best to take care of high need seniors post hospitalization in the community/home with appropriate supports Keeping high need seniors at home with right supports to avoid or reduce hospitalization and admission to LTC homes Changing the “provider driven/knows best” discharge approaches that at times are not reflective of right care, right time, right place at the right cost AND is not inclusive of patient/family engagement Context Strategic Approach Performance Leading Programs Go Forward
Home First is About Patients First Requires significant transformation – fundamental change in processes and culture across the health care continuum: The default to LTC must change - there are other alternatives It is about culture shift for hospital (physicians, nurses), and change in discharge and workflow processes for the BOTH CCACs and hospitals Hospital is a “transition” place not for long-stay and not a destination It is about appropriate and consistent patient/family education Both hospitals and CCAC need to operate as one team with one vision and the same sense of “time clock”. 15 Context Strategic Approach Performance Leading Programs Go Forward
Transformation of Community HSPs MH LHIN Strategic Approach to Reduce ALC Right Care, Right Place, Right Time, Right Cost RAI Suite of Instruments Community Capacity Enhancement Other Assessment Tool Extended Hours Objectives Transitional Beds in Hospitals Assess & Restore LTCH LT (RAI-HC) Objectives LOS Behavioural Unit Sheridan Villa ALC (RAI – HC) Demand CCAC Enhanced (RAI-HC) Right Persons SDL and SDL 24/7 Mobile ER ER (RAI-CHA) Objectives ER Use Behavioural Supports Ontario Program 28 Homes Treatment Time 4,100 Beds Most Investments Use Evidence-Based Provincial Assessment Tools 24/7 Crisis Dementia & Chronic Home Response Specialized Adult Enhanced Alzheimer’s Diseases Enhanced Home Care Psycho- to Continence Geriatric Falls Day Respite NP’s In Outreach & CHF/ Mental Palliative Supports Mgmt Outreach by geriatric Program Programs (CSI) & Day LTC Health & COPD (RAI-HC) 75+ (Internal (RAI-CHA) CCAC Outreach (RAI-HC) Programs RAI-CHA Addiction Screener) (RAI-HC) (RAI-HC) (RAI-HC) (OCAN) 16
Transformation of MH LHIN CSS Sector: Focusing on High Need Seniors to Stay at Home Safely Objective: Increase Community Capacity to Reduce Dependence on Institutions (LTC and Hospitals) Low Acuity High Acuity Pre-LHIN 2007/08 2011/2012 Supportive Housing Supportive Housing 24/7; Integrated Approach Most clients MAPLe 1,2s $13.5M LHIN-wide Mobile Capacity No 24/7 support $29.8M Extensive interaction with hospitals Limited integration with hospitals and CCAC - MAPLe 4,5 Adult Day Services $5.5M Adult Day Services $8.1M Most clients MAPLe 1-3 MAPle Support more “at risk” Seniors - MAPLe 3+ 3 to 5 ABI ABI $3.6M $5.9M Residential with Community Outreach Significant outreach to Hospitals and LTCHs Enhanced Respite Care $2.9M Enhanced Respite Care Day-To-Day Caregiver Relief $4.7M High needs Stand-alone Transportation Services $1.5M $2.3M Integrated Transportation LHIN wide Home Making/Maintenance $1M MAPle $2.8M Integrated Home Making/Maintenance 1 to 2 Other CSS $6.3M $7.7M Other CSS TOTAL $34.3M TOTAL $61.3M Increased funding $27M To support higher need “At Risk” Seniors Context Strategic Approach Performance Leading Programs Go Forward
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