The Future of Long Term Care in Ontario Adrienne Palmer Ontario Long Term Care Association
LTC Transformation in Ontario March 2012 – Why Not Now? LTC Innovation Report July 2010 – released Long Term May 2008 – Shirlee Sharkey’s Fall 2010 – Care Homes “ People Caring for People ” Implementation April 2013 – Act, 2007 report is released, Funding changes of RAI-MDS 2.0 comes into recommends public reporting complete for physiotherapy effect and development of quality announced measurement tools Fall 2012 – Full public reporting Mar 2013 – through HQO Second three-year LTC LSAA signed Dec 2009 – July 2010 – new Residents compliance inspection First begins process implemented January 2004 – MOHLTC Issues Nov 2011 – Jan 2013 – LTC Task “Commitment to Dr. Samir Sinha Force on Care” report, provides January 2010 March 2010 – launching the Resident recommendations – HQO begins First three-year Safety & renewal of LTC in to inform seniors’ June 2008 – reporting on LTC LSAA Ontario Care strategy HQO individual LTC signed Launched assigned to homes publicly report on LTC quality July 2005 – Implementation of 2 RAI-MDS 2.0 Begins
Environmental Scan Increased investment in home care and the community, as well as “Home First” policies are having intended impacts on long term care: » Increased resident acuity » Decreased length of stay Dr. Sinha’s report recommendations closely align with vision established in Why Not Now? report: » Increasing convalescent care bed capacity » Enabling LTC to provide higher levels of complex care » Exploring community hub concept » Improve resident flow and placement Stalled B&C Redevelopment Program. Lack of clarity around future alignment of Supportive Housing and LTC capacity. 3 3
Environmental Scan Role of public oversight, “granny cams” and media reports on critical incidents. 1/5 – 1/3 of population intended to be addressed through Health LINKs are LTC residents. Additionally, others could benefit from convalescent care delivered through LTC. What is LTC’s role and capacity for this initiative? Scope of impact of Health Sector Funding Reform on LTC still uncertain. Sector is closely watching how this is rolling out in the hospital sector. Recent physiotherapy announcement presents uncertainty on resident services provided through previous agreements with providers. 4 4
Transformation in Long Term Care Ontario’s long term care providers aren’t doing the same work today as we’ve done in the past. We are undergoing significant change, driven by the success of Ontario’s Aging At Home strategy. LTC residents have unprecedented levels of complexity and fragility. 5
A Fundamental Shift in Complexity Percentage of Residents with High or Very High Care Needs The success of Ontario’s aging at home strategy is shifting the needs of Ontario’s long term care residents. By the time Ontario seniors require care that can only be delivered in long term care homes, they are frailer and more complex than in the past. The trend is set to continue. Ontario seniors entering long term care homes will continue to have more complex needs than ever before. Dr. Sinha recommended enabling homes to provide higher levels of care 2008 2009 2010 2011 to individuals with complex care needs. Source: OACCAC 2012 Action on this required now. 6 6
Ontario Long Term Care: Resident Profile Residents today are more frail and complex than ever. 83% of those admitted to long term care in 2010/11 had “ high ” or “ very high ” care needs compared to 72% in 2007/08. 92.8% of new residents have 2 or more chronic illnesses like diabetes, COPD and chronic heart failure 38% are being monitored for an acute condition 60% have a dementia diagnosis, but only 17% are in an Alzheimer's or dementia care unit 29% have severe cognitive impairment 47% show aggressive behaviour, 67% show some level of depressive symptoms 77% require extensive assistance or are totally dependent for help with activities of daily living » Source: www.cihi.ca 7 7
Why Not Now? LTC Innovation Expert Panel June 2010- Ontario Long Term Care Association (OLTCA) commissioned the Conference Board of Canada (CBoC) to investigate the innovation potential of Ontario’s 634 LTC homes In the CBoC report released in the Fall of 2010 it was recommended that the residential long term care sector develop a comprehensive innovation strategy to address growing demand, sector constraints and health system sustainability 8 8
Our Vision for Long Term Care The long term care sector will be an integral partner in a sustainable health care system as a provider of high quality integrated person-centred care, services and accommodation for older adults and a source of innovation on care and services for an aging population, providing each consumer with the right care, at the right time, in the right place. Ontario’s long term care sector is a vital partner in an integrated provincial health care system. 9 9
Guiding Principles Ontario’s System of care of older adults should: Promote health and well-being Empower older Ontarians to make informed choices Be seamless and easy to navigate Provide access to high quality services that address hierarchy of needs and promote quality of life Be responsive to evolving consumer needs and preferences Support front-line and family caregivers Be affordable for consumers and taxpayers Be regulated in a manner that promotes innovation and continuous quality improvement 10 10
Untapped Potential Based on sustainable private/public funding model o Significant presence: 78,000 beds in 634 communities across o Ontario Homes embedded in local communities o Mix of ownership types; healthy balance of collaboration and o competition Limited number of providers enabling economies of scale and o capacity for rapid roll out Many providers offer range of services beyond LTC creating o untapped opportunities for innovation and system transformation 11 11
65+ Recommendations o Simplify consumer choice and improve coordination and access to quality care o Spur innovation in care organization and delivery o Dramatically increase support for caregivers and access to services for those at highest need o Strengthen the evidence-base in elder care o Shift care and resources to the most appropriate and cost-effective setting o Reduce wait times and free up hospital beds occupied by patients who do not need to be there o Reduce the need for new long term care beds o Increase productivity and cost-savings that could be reinvested elsewhere. o Improve resident, caregiver and staff satisfaction 12
A Win for the Whole Health Care System Adequate resources that match the increasing complexity of care required by Ontario’s residents means a win for the whole health care system. The right mix of staff and skills in long term care helps avoid unnecessary trips to the emergency room due to specialized resident care needs, preventable injury or for end of life care. Resourcing a better link between long term care and seniors in the community and primary care will contribute to our seniors' ability to age safely at home. Long term care is a cost-effective solution for those residents that require 24 hour nursing care or access to complex care. Long term care doesn't just provide care; we reduce isolation and provide wellness services like diet, nutrition and social activities that produces a better quality of life and outcomes for long and short-stay residents. 13 13
Maintaining the Future Capacity of our Homes to Deliver Safe, Quality Care Ontario has more than 35,000 beds in 329 homes that are in need of renewal. In 2009, the government announced its intent to provide a program for operators to redevelop these homes over a 15 year period, but less than 4,000 beds have been approved to date. Current mix of LTC capacity affects entire health care system capacity and contributes to waitlist and placement and flow challenges. OLTCA has participated in a number of committees looking at challenges in the redevelopment program and has presented solutions that we believe would allow operators to redevelop. We are urging government to get redevelopment underway as soon as possible. 14 14
What’s Next for LTC: 2013/14 Continued work to enable the LTC sector to contribute to health system transformation and the response to Dr. Sinha’s Senior Strategy for Ontario Further progress and implementation of actions from The Long-Term Care Task Force on Resident Care and Safety Health System Funding Reform – implementation work for LTC sector Implementation of 2013-2016 LSAA Next steps on Capital Redevelopment, new Supportive Housing Algorithm Roll out of Health LINKs Implementation of Ontario’s Action Plan for Health Care 15
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