Access to Care. CCC/Rehab Steering Committee Phase 2 Bed Realignment Recommendations Report

Transcription

1 Access to Care CCC/Rehab Steering Committee Phase 2 Bed Realignment Recommendations Report Sponsored by South West LHIN Submitted By: Elaine Gibson and Donna Ladouceur Co-Executive Sponsors June 2, 2014 Page 1 of 16

2 Steering Committee Team Members The authors would like to acknowledge the following members of the CCC/Rehab Steering Committee for their hard work, guidance, and dedication throughout the ongoing journey of realigning Complex Continuing Care and Rehabilitation bed resources and implementing coordinated access to these services. Their work has been integral in the continuous improvement of the health care system, in order to deliver the right care, at the right time, in the right place. Andria Appeldoorn, Access to Care Scott Chambers, South West Local Health Integration Network Brian Ashby, South West Local Health Integration Network Elaine Burns, Grey Bruce Health Services Sue McCutcheon, Access to Care Craig Hennessy, South West Community Care Access Centre Elaine Gibson, St. Joseph s Health Care London Susan Warner, South West Local Health Integration Network Donna Ladouceur, South West Community Care Access Centre Mary Cardinal, Huron Perth Healthcare Alliance Wendy Abbas, Woodstock General Hospital Asha Rawal, London Health Sciences Centre Jennifer Fazakerley, South West Community Care Access Centre Angela Stanley, Listowel Wingham Hospitals Alliance Amber Alpaugh-Bishop, Access to Care David Simpson, St. Thomas Elgin General Hospital Page 2 of 16

3 Table of Contents Executive Summary... 4 Inputs Considered for Phase 2 CCC/Rehab Bed Realignment Recommendations... 5 Guiding Principles... 5 System Impact Matrix... 5 CCC Occupancy Review... 7 Bed Projection Model... 7 Recommendations Appendix A Detailed Description of Bed Projection Model Inputs Page 3 of 16

4 Executive Summary In 2011, the South West LHIN launched the Access to Care Initiative to better meet the needs of Ontarians living in this geographical region. The three components of the initiative and their outcomes are: Implement Home First, a philosophy designed to return individuals to their home with supports to determine their decisions related to future care and living arrangements be it long term care, retirement home, etc.; Realign Assisted Living/Supportive Housing/Adult Day Programs (AL, SH and ADP) community capacity and implement the CCAC expanded role to facilitate coordinated access to these services; and Realign Complex Continuing Care (CCC) and Rehabilitation (Rehab) bed resources in hospitals and facilitate the development and implementation of coordinated access to these services. The overall goal of Access to Care is to provide the right care in the right place at the right time, which when combined with local strategies, is anticipated to reduce the volume of alternate level of care days in the long term. The Complex Continuing Care and Rehabilitation stream of Access to Care consisted of two specific outcomes: Make recommendations on the numbers and siting of CCC and Rehabilitation beds to optimize the distribution of CCC/Rehab bedded services to the citizens of the South West LHIN and to optimize utilization of these valuable resources; and Develop and implement the tools and processes to optimize coordinated access to the CCC and Rehabilitation beds across the South West LHIN. Bed realignment recommendations were initially provided in the Complex Continuing Care & Rehabilitation Access to Care report in May, 2012, based upon a Bed Projection Model (previously known as the CCC/Rehab Logic Model) that was developed by the Project Team and Optimus SBR consultants (see Final Report). In June 2013, the CCC/Rehab Steering Committee reviewed the original 2012 projection-based recommendations and refreshed the model to provide recommendations to the South West LHIN regarding Phase 1 realignment of the CCC/Rehab bed resources across the South West LHIN hospitals (see Bed Realignment Report). These CCC/Rehab Steering Committee recommendations were reviewed as input into the final South West LHIN Board decision on June 26, 2013 to realign CCC and Rehab beds and, through facilitated integration; a portion of those recommendations will be implemented in fiscal 14/15, as summarized below: Reduce 15 CCC beds from STEGH (implemented April 1/14) Implement 2 Rehab beds in Elgin (implemented April 1/14) Reduce 15 CCC beds in Oxford (reduction of 9 beds at Alexandra Hospital targeted for July/14; reduction of 6 beds at Tillsonburg District Memorial Hospital targeted for January/14) Implement 10 CCC beds in GB (targeted for Q3/Q4 fiscal year 14/15) This report focuses on Phase 2 recommendations for CCC/Rehab bed realignment for the South West LHIN. These recommendations were established based upon a review of the previously established Guiding Principles for CCC/Rehab bed realignment recommendations, a review of recent system change impacts within the South West LHIN, a review of empty CCC and Rehab beds across the South West LHIN, and another refresh of the Bed Projection Model. Based on these recommendations, the Steering Committee recommended the following: Add 11 CCC beds to London to increase from 82 to 93 CCC beds Reduce CCC beds from the Huron Perth region to decrease from 76 to CCC beds Add 4-7 Rehab beds to London to increase from 113 to Rehab beds Add 1-2 Rehab beds to the Huron Perth region to increase from 23 to Rehab beds Page 4 of 16

5 Inputs Considered for Phase 2 CCC/Rehab Bed Realignment Recommendations Guiding Principles As per the development of Phase 1 bed realignment recommendations, the following guiding principles were considered while developing recommendations: 1. Data as the main driver, perspectives as input 2. Appropriate utilization of resources 3. Accounting for a projected significant increase in demand 4. Geographic consolidation to leverage economies of scale and caregiver expertise 5. Improving geographical distribution of resources 6. Aligning with the South West LHIN s Blueprint Vision Considering regional priorities concerning minimizing additional capital requirements or human resource needs. System Impact Matrix The following system impact matrix has been developed as context to assist with determining recommendations, and includes information such as Long-Term Care (LTC) bed availability, implementation status of the Access to Care project initiatives, other quality initiatives, and other information the Steering Committee referenced while making recommendations. Page 5 of 16

6 Future Focused Broad Stakeholder Perspectives CCC/Rehab Bed Realignment Implementation Principles Data and Best Evidence / Optimizing Resources CCC/Rehab Bed Alignment - System Impact Matrix (Last updated May 6, 2014) LTC Availability CCC Availability (current) (Mar/14) Rehab Availability (Mar/14) Hospital Availability (June/13) Municipal/Local Stakeholder Engagement on New Steering Committee Recommendations (updated Dec/13) Municipal/Local Stakeholder Engagement on Old Recommendations (updated Dec/13) Community Support (implementation info updated Dec/13) Population Growth (Projected # of people 75 in 2014) Hospitals Predicted to be in deficit position end of FY 13/14 (Yes or No) Other system changes in progress Consideration Wait list (# homes with no wait list for basic beds) (as of January/14; retrieved on March 11/14) (Source: CCAC Website: en/getting-care/getting-long-term- Care/Wait-List) beds/ within 25 km radius (Source: LHIN data and 2011 census; last updated Jan 31/14); = red, = white, >115 = green) Elgin Oxford Grey/Bruce London Middlesex Huron/Perth Elgin - 0 Oxford - 1 Bruce - 2 London - 2 Middlesex - 0 Huron - 1 Hald/Norfolk - 0 Grey - 2 Perth - 2 Oxford Bruce London Middlesex Huron Norfolk - 59 Grey Perth # beds as per Phase 1 Bed Realignment beds/ pop'n as per Phase 1 Bed Realignment beds/1000 age 75 years as per Phase 1 Bed Realignment (Source: Ministry of Finance projections based on 2006 Census) Occupancy less than 93% - April Jan 2014 i.e. capacity in current system *NOTE: Parkwood Occupancy has been self-reported for 82 beds STEGH 42-74% AH % TDMH % WGH % (2m 93%) Current CCC Bed Utilization 28% AH - 7%, TDMH - 9%, WGH - 23% N/A 94% N/A L % W- 6-28% Seaf % Stratford % (7m 93%) St. Mary's % SH % N/A 83% LMH - 25%, SCH - 37% WDH - 11%, SGH - 61%, SMH - 36%, SHHA - 16% 109 including 33 Specialized Rehab beds / 76 not including Specialized Rehab beds # beds as per Phase 1 Bed Realignment beds/ pop'n as per Phase 1 Bed Realignment (Source: Ministry of Finance projections based on 2006 Census) beds/1000 age 75 years as per Phase 1 Bed Realignment (Source: Ministry of Finance projections based on 2006 Census) Occupancy less than 87% - April January 2014 i.e. current capacity in system *NOTE: Parkwood Occupancy has been self-reported for 109 beds inlcuding 33 Specialized Rehab beds/ not including Specialized Rehab beds including 33 Specialized Rehab beds / 2 2 not including Specialized Rehab beds % 10m 87% 64-96% 4m 87% 73-94% 3m 87% W % (3m 87%) Stratford % (10m 87%) SH % (4m 87%) Current Rehab Bed Utilization 84% 85% 75% 84% WDH - 74%, SGH - 90%, SHHA - 80% ER Wait times for admitted pt 23.8 hr STEGH AH HDH UH , VH , MHA - Strathroy - Seaforth - 6.1, Stratford , St. (SW LHIN Target) (February/14 data, TDMH SBGHC - Kinc 5.9, Dur - 6.9, SJHC , Four Counties - Mary's - 8.6, Clinton 5.5, Goderich unless otherwise indicated) (Source: SW LHIN Report on Performance: edfiles/public_community/performance /2014_files/RoPJan2014.html) WGH Walk , Ches GBHS - OS 7.5, Mark , Meaf , South , Wiar - 9.1, LH N/A 12.6 (Jan/14) (Jan/14), Listowel (Dec/13), Wingham (Dec/13), Exeter (Jan/14) Occupancy - acute care (Medicine) Apr - Jan 13/14-85% or less, i.e. capacity in current system Med % AH % TDMH % WGH - Med 82-89% HDH % SBGHC - K 67-73%, D 47-73%, W 55-64%, C % GBHS - LH 55-65%, OS 83-88%, Mk 72-81%, Me 73-82%, S 83-95%, W 72-85% LHSC - Med % MHA - N %, S 81-93% L %, W %, Seaforth %, Stratford - Med 84-90%, Clinton %, St. Mary's %, Goderich % New Funding HF HF, AL HF, ADP HF, ADP, AL HF HF Implementation of Home First partial - HDH, GBHS Rural sites, SBGHC in Q4 13/14 HPHA, SHHA, AMGH, LWHA launching in Q4 13/14 Implementation of AL/SH/ADP in progress in progress Coordinated Access Waitlist for AL (Post Provider AL Eligibility Reviews and CCAC Caseload Reviews of AL Eligibility) (Source: AL/SH/ADP Monthly Reports) Yes Yes Yes Yes Yes Yes Implementation of CCC/Rehab Coordinated Access Elgin in progress Q4 2013/14 Q1 2014/15 Q1 2014/15 Q1 2014/15 6,270 9,110 16,420 33,210 12,190 STEGH - No WGH - No TDMH - Yes AH - Yes GBHS - No SBGHC - No HDH - No LHSC - No St. Joseph's Health Care - No 92% SMGH - Yes FCHS - No Listowel Memorial - Yes Wingham & District - Yes HPHA - No AMGH - Yes SHHA - No People who require long term ventilation being supported in the community; eshift; Palliative Care Changes across the system; Behavioural Support; Rehabilitative Care; Assess and Restore; Knowledge Transfer for ED improvements at Stratford, Woodstock, Tillsonburg, and Strathroy; Regionalization of Stroke Care; Location of Convalescent Beds in the system; Location of Hemodialysis Legend: Italicized Text : System/system change in positive state, there is system capacity : System/system change in cautious state/system change in progress : System in neutral state : System in challenged state : Input into Logic Model Page 6 of 16

7 CCC Occupancy Review The following table summarizes the number and types of beds by hospital site and also indicates how many CCC beds are currently empty, based upon occupancy. It should be noted that the target occupancy rate for CCC beds is 93% resulting in a target number of 7% unoccupied beds. Unoccupied beds, beyond target = target number of beds occupied actual number of beds occupied Unoccupied beds, beyond target = (0.93 x current number of beds) (current % occupancy x current number of beds) Bed Projection Model The bed projection model (previously known as CCC/Rehab Logic Model) considers the current number of beds, system level inputs (population growth, health risk factors, ALC target occupancy, system change, unmet need, target utilization) and current utilization to result in projected bed numbers. The inputs and formulae for each CCC and Rehab follow. Page 7 of 16

8 Bed Projection Model Inputs and Calculation: CCC INPUTS Select Year -> with only population growth 2015 adjustment Pop. Growth 5% 2% 4% 4% Risk Factors 3% 3% 3% 5% ALC Use 25% 25% 25% 20% System Change 5% 5% 5% 7% Unmet Need 3% 3% 3% 1% Utilization 93% 93% 93% 93% Number of Projected CCC Beds = (Current Number of Beds x Current Utilization x Population Growth x Risk Factors x ALC Occupancy x System Change x Unmet Need) Projected Utilization of 93% Number of Projected CCC Beds for 2014 = [(Current Number of Beds) x (Current Utilization %) x (1+0.02) x (1+0.03) x (1+0.25) x (1-0.03) x (1+0.05)] 0.93 REHAB INPUTS Select Year -> with only population growth 2015 adjustment Pop. Growth 2% 4% 4% Risk Factors 3% 3% 5% ALC Use 5% 5% 4% Unmet Need 3% 3% 1% Utilization 87% 87% 87% Number of Projected Rehab Beds = (Current Number of Beds x Current Utilization x Population Growth x Risk Factors x ALC Occupancy x Unmet Need) Projected Utilization of 87% Number of Projected Rehab Beds for 2014 = [(Current Number of Beds) x (Current Utilization %) x (1+0.02) x (1+0.03) x (1+0.25) x (1+0.05)] 0.87 The CCC/Rehab Steering Committee supported all of these input values for the refresh of the Bed Projection Model at their February 20/14 meeting. Refer to Appendix A for a complete description of the CCC/Rehab Bed Projection Model inputs. The following tables summarize the results of the Bed Projection Model refresh. Page 8 of 16

9 Results of CCC Bed Projection Refresh by Hospital Results of Rehab Bed Projection Refresh by Hospital Page 9 of 16

10 Recommendations The following recommendations are being submitted for Phase 2 of this CCC/Rehab bed realignment work. Recommendation 1: The bed projection model refresh indicated further shifts in the utilization of CCC beds, strengthening the case to increase CCC beds in London and further reduce the number of CCC beds across the remaining area of the South West LHIN, most particularly in Huron Perth. Since Phase 1 recommendations focused on Oxford, Elgin, and Grey- Bruce Counties, with implementation of the recommendations currently underway, the steering committee decided to make no further recommendations for these regions. Instead, Phase 2 recommendations focused on only Huron- Perth and London. As represented by the tables below, the committee decided to build CCC and Rehab bed realignment recommendations for these two areas, based on a combination of the bed projection model and on current data regarding empty beds. Page 10 of 16

11 In order to provide equitable access to and maximize utilization of CCC and rehabilitation beds across the South West LHIN further realign beds as follows: Add 11 CCC beds to London to increase from 82 to 93 CCC beds Reduce CCC beds from the Huron Perth region to decrease from 76 to CCC beds Add 4-7 Rehab beds to London to increase from 113 to Rehab beds Add 1-2 Rehab beds to the Huron Perth region to increase from 23 to Rehab beds Recommendation 2 In order to optimize resources, facilitate access to interdisciplinary expertise, promote best practices, and optimize patient outcomes, consider working toward a system with fewer inpatient CCC/Rehab inpatient sites across the South West LHIN. Page 11 of 16

12 Appendix A Detailed Description of Bed Projection Model Inputs Specific Utilization of CCC and Rehab beds in the South West Standard definitions for ALC were implemented province wide in July and 2013 Utilization: ALC information was collected from Cancer Care Ontario for Q2 and Q3 (July 1 st December 31 st 2011) of 2011/2012 for the May 2012 report and Q2 and Q3 (July 1 st December 31 st 2012) of 2012/13 for the May 2013 report. This information was used to determine the utilization of CCC and rehab beds at each reporting hospital. ALC information included all ALC patients and not just a subset (i.e. ALC-LTC). ALC information was provided for the following hospitals: i. St. Joseph s Health Care, London ii. Woodstock General Hospital iii. Alexandra Hospital iv. Seaforth Community Hospital v. St. Thomas Elgin Hospital vi. Tillsonburg District Memorial Hospital vii. St. Marys Memorial Hospital viii. Grey Bruce Health Services ix. Stratford General Hospital Where ALC data was unavailable (either not reported or unavailable due to the recent addition of new beds, for example, Woodstock), the results of a one-day snapshot were used to determine utilization of CCC and Rehab beds. The snapshot data was used for the following hospitals: i. Listowel Memorial (CCC) ii. Wingham & District (CCC & Rehab) iii. South Huron (CCC & Rehab) iv. Woodstock General Hospital (Rehab for 2011 Report) v. Oxford County hospitals (Alexandra Hospital, Tillsonburg District Memorial Hospital, and Woodstock) to offer further data on the use of CCC beds in that County. In 2012, Occupancy was assumed at 93% for CCC and 87% for Rehab, based on expert opinion from the CCC/Rehab Steering Committee regarding best practice targets. In 2013, actual Occupancy data was collected from the Ministry Health Data Branch Utilization ALC information was collected from Cancer Care Ontario for Q2 and Q3 (July 1 st December 31 st 2013) of 2013/2014 for the 2014 Refresh. However, information was now available for all hospitals, except the following, for which one-day snapshot data from February 21/14 was used to determine utilization of CCC and Rehab beds: i. Listowel Memorial ii. Wingham & District (CCC & Rehab) iii. South Huron (CCC & Rehab) In 2013, actual Occupancy data was again collected from the Ministry Health Data Branch. Utilization = Occupancy - ALC Page 12 of 16

13 The tables below summarize the utilization and occupancy data for past projections and the 2014 refresh. CCC REHAB Page 13 of 16

14 2012, 2013, 2014 Population Growth and Risk Factors Population growth rates were from the Ministry of Finance data and, based on expert knowledge of the Steering Committee members; the population growth rates for adults 75 years of age and older were used The population growth rates were calculated using LHIN wide information as i. Hospital catchment areas do overlap, and ii. There were not significant differences (i.e. >5%) in growth between counties, meaning the impact on actual bed numbers is likely to be small (i.e. ~1 bed). This same approach was supported, for the 2014 refresh, by the CCC/Rehab Committee on February 20/14, upon review of the following table: Population Growth by County for people aged 75+ between 2012 and 2014 (Ministry of Finance, 2013): County Bruce Elgin Grey Huron Mdsx Oxford Perth % growth 5.7% 5.0% 4.2% 2.7% 3.9% 3.1% 4.6% A Risk Factor buffer was used to account for the population in the South West LHIN being slightly less healthy than the provincial average on the basis of four health indicators prevalence of COPD, Hypertension, Stroke events and Arthritis. The CCC/Rehab Steering Committee supported maintaining the risk factor buffer at 3% as there is no indication that the health of South West residents has changed significantly. 2012, 2013, 2014 Adjustment for continued ALC use of CCC beds It was assumed that, in response to the launch of Home First, it would take time to decrease the ALC utilization of CCC beds and, as such, the ALC Use input assumes a gradual decrease from 2013 to An early examination of Home First hospitals in March, 2013 indicated that the 2013 value of 25% is a reasonable target. Home First has been implemented at London Health Sciences Centre (LHSC) (Oct/11), St. Thomas Elgin General Hospital (STEGH) (Jan/12), Tillsonburg District Memorial Hospital (TDMH) (Jul/12), Grey Bruce Health Services (GBHS) - Owen Sound (Sept/12), Alexandra Hospital (AH) (Dec/12), Woodstock General Hospital (WGH) (Jan/13), and St. Joseph s Health Care - Parkwood (Sept/13). Home First was most recently launched at Middlesex Health Alliance (MHA) (Dec/13), Huron Perth Healthcare Alliance (HPHA) (Jan/14), Grey Bruce Health Services (GBHS) - Rural Hospitals (Feb/14), Alexandra Marine & General Hospital (AMGH) (Feb/14), South Huron Hospital Association (SHHA) (Feb/14), Listowel Wingham Hospitals Alliance (LWHA) (Mar/14), Hanover District Hospital (Mar/14) and South Bruce Grey Health Centre (SBGHC) (Mar/14). Of those hospitals who have implemented Home First, the following have CCC beds within their organization: STEGH, TDMH, AH, WGH and SJHC. Changes in active alternate level of care cases for those hospitals that have adopted the Home First philosophy for than more than six months can be seen in the following table. Page 14 of 16

15 STEGH TDMH AH WGH SJHC Number of CCC beds (current) Percentage ALC in CCC Beds (July - 53% 92% 76% 41% 19% December 2011 in CCC/Rehab Report released May 2012) Percentage ALC in CCC Beds (July to 35.9% 52.8% 49.7% 47.7% 12.7% December 2012 released June 2013) ALC designated cases in CCC - Pre Home First ALC designated cases in CCC - Post Home First (first 6 months of implementation) ALC designated cases in CCC - Post Home First (time after 6 months implementation) ALC Designated cases in CCC Post Home First (last 1 year Jan/13 Jan/14; from HF reports) Number of CCC beds (recommended for 2013) Number of CCC beds (Decision for 14/15) ALC cases in future CCC (25% ALC, 93% occupancy) Grey shading added February 2014 Range Average Range (4m) Average Range Average 17.1 Range Average No change No shading from March 2013 briefing note Based on these results, the CCC/Rehab Steering Committee agreed that 25% ALC is still a stretch goal for four of the five organizations with CCC beds and therefore, decided to maintain this bed projection model input as 25% for the 2014 refresh. 2012, 2013, 2014 Unmet Need An assumption was made by the Steering Committee that there could be an increase in demand for two reasons: i. There might be individuals not eligible under the old eligibility criteria that would now be eligible. ii. Redistributing CCC beds in the north part of the LHIN might lead to greater demand. The Steering Committee supported maintaining the 3% input for unmet need for the 2014 refresh. 2012, 2013, 2014 Overall Utilization Target A target utilization rate of 93% was set on the basis of best practices research that suggests CCC utilization rates should be between 90-95% to optimally balance variability in demand with volume required to achieve economies of scale. A target utilization of 87% was set for Rehabilitation utilization rates. The CCC/Rehab Steering Committee decided that the targets are still considered reasonable for the 2014 refresh, from both a patient and clinical point of view, as the review of HBAM impact has not revealed any information that directs a change; further analysis may be necessary regarding impact of HBAM in future years. Page 15 of 16

16 System Change reduction The assumption made by the Steering Committee was that system changes such as Home First, Community Stroke Programs, etc., would decrease the demand for CCC in the future. The Steering Committee did not deem it necessary to adjust the 5% input into the bed projection model for the 2014 refresh. NOTE: The system change reduction input is only applied to the CCC bed projection model, not the Rehab bed projection model. Page 16 of 16