Three Year Strategic Plan June, 2014
TABLE OF CONTENTS 1. EXECUTIVE SUMMARY... 3 2. METHODOLOGY OVERVIEW... 4 3. HALIBURTON HIGHLANDS HEALTH SERVICES OVERVIEW... 5 3.1 Summary of last Strategic Plan... 5 3.2 Current Services and Programs... 6 3.3 Current Organizational Priorities and Initiatives... 10 4. HHHS POPULATION AND GEOGRAPHY... 13 4.1 Population... 13 4.2 Socioeconomic Status... 15 4.3 Population Health... 22 5. THE CE LHIN HEALTH SYSTEM... 28 5.1 Other Health Services in the Region... 28 5.2 Central East LHIN Health Service Providers and Health System Utilization... 30 6. POLITICAL, ECONOMIC AND LEGISLATIVE ENVIRONMENT... 36 6.1 Political and Economic Environment... 36 6.2 Emerging Models in Ontario... 43 7. THOUGHT LEADER PERSPECTIVES... 46 8. HHHS STAKEHOLDER PERSPECTIVES... 50 Prepared by OPTIMUS SBR 2014 All rights reserved P a g e 2
1. Executive Summary Haliburton Highlands Health Services (HHHS) has initiated a process to develop a renewed Strategic Plan that will clearly articulate goals and expected outcomes and metrics to guide the organization forward for the next three years. This process includes an, the development and approval of revised Mission, Vision, and Value statements, and draft Strategic Directions and Results. In addition to summarizing highlights from studies and reports, the is also informed by input from a broad range of HHHS partners, health sector stakeholders and community representatives. The information in this scan will be used by the Senior Management Team and Board of Directors to inform the development of the Strategic Directions and Results. Based on our industry knowledge, a review of a variety of relevant documents, and conversations with HHHS administration, staff, and physicians; health service providers; and community partners and representatives of the public, OPTIMUS SBR has established that: Operating in a smaller, rural community, HHHS is viewed as a focal point of health care delivery which extends beyond acute and emergency care to include long-term and palliative care and increasingly community based services. In the near- and mediumterm future, HHHS will need to focus on continuing to provide core rural health care services, and also to ensure the successful integration and change management of recent integration and strategic alliance initiatives. From a demographic, socioeconomic and population health perspective, the North East Cluster of the Central East LHIN, and Haliburton specifically, stand out as an area that is rapidly aging and that has an above average disease burden. Haliburton Highlands has a proportion of seniors (compared to total population) nearly double that of the CE LHIN and provincial averages. This is expected to grow consistently to a point where residents aged 65+ will make up 36% of the population by 2025 and 41% by 2035. Furthermore, while residents of the region have a self-perceived feeling of good health that is in line with the CE LHIN average, the average life expectancy is below both the CE LHIN and Ontario averages at birth and age 65. The prevalence of chronic conditions from Arthritis and Asthma to Diabetes, COPD and Cancer is higher in the Haliburton region than the CE LHIN and province overall. This environmental scan contains additional detail on these findings and provides an overview of influential health sector initiatives and developments at the regional, provincial, and national levels. The information and key findings presented in the following pages will be a useful input into the Strategic Planning process, informing the identification of many of the challenges and opportunities which HHHS will need to address to move forward as a health sector leader in the Haliburton region. Prepared by OPTIMUS SBR 2014 All rights reserved P a g e 3
2. Methodology Overview The has been completed as a key component for developing a revised Strategic Plan for the Haliburton Highlands Health Services. The Strategic Plan will identify future Strategic Directions and desired Results over the next three years to enable the organization to provide the care its clients require. The Strategic Planning process includes: An ; Stakeholder consultations to gather input on the environment in which HHHS operates and opinions on possible Strategic Directions and Results; Facilitated planning sessions with the Senior Team and Board of Directors to develop the draft Strategic Directions and Results. The provides the context and insights to inform subsequent planning activities and has been prepared to achieve an understanding/refresh of four areas that impact HHHS operations as illustrated below, including: 1. Existing strategy, key programs, initiatives, priorities and how HHHS has evolved since its last strategic plan; 2. Central East LHIN population, its health, its needs from the region s health system, and the pressures those needs create in the system. Wherever possible this has been focused on the Haliburton County region and surrounding areas; 3. Recent changes and trends to the political, economic, and legislative environment related to the health sector and the ability of HHHS to meet the needs of the region s population; 4. Emerging trends, approaches and leading practices within acute, long-term, and community care for small and rural providers identified through consultations with health system peers and research. Prepared by OPTIMUS SBR 2014 All rights reserved P a g e 4
3. Haliburton Highlands Health Services Overview Haliburton Highlands Health Services (HHHS) provides an integrated system of health care to the residents, cottagers and visitors of Haliburton County and surrounding areas. Through two acute care and long-term care sites, as well as community programs, HHHS serves the communities of Haliburton, Minden and Wilberforce. 3.1 Summary of last Strategic Plan Haliburton Highlands Health Services most recent strategic plan was developed to guide the organization from 2010 to 2013. This plan acknowledged the outstanding services provided by HHHS since its formation and the unique role it plays within the Central East Local Health Integration Network (CE LHIN). The plan focused on the importance of acting as a system player within a planning system that covers a vast geography and population which sees HHHS serve only 1% of the CE LHIN s population. Finalized in March of 2010, HHHS 2010-2013 Strategic Plan emphasized partnerships, quality, and accountability to provide the residents it serves with the services they need through the priorities of: Sustainability Building Partnerships Employee Engagement Access to Core Rural Health Services Prevention and Health Promotion Seniors Care This plan was carried out within an environment in which integration and strategic alliance discussions and activities were becoming increasingly prominent. Over the past three years, with approval and support from the CE LHIN, HHHS has been actively involved in enhancing partnerships and collaboration on two fronts through a strategic alliance with Ross Memorial Hospital (RMH), and integration activities with community based agencies in Haliburton County. Highlights from these activities are outlined in Section 3.3. Prepared by OPTIMUS SBR 2014 All rights reserved P a g e 5
3.2 Current Services and Programs Haliburton Highlands Health Services (HHHS) is an integrated health service provider located in Haliburton County providing services to residents, cottagers, and visitors of the county and neighbouring areas. HHHS is spread across two primary locations in Haliburton and Minden and provides supportive housing and mental health services in the community. Acute Care Services Both the Minden and Haliburton sites provide 24 hour emergency department care 7 days a week. Emergency Departments have physician coverage and are staffed by Registered Nurses, Registered Practical Nurses, and an X-ray technician. The Haliburton Site contains a 14-bed acute inpatient unit, where physicians from the Haliburton Family Health Team and HHHS staff provide hospital oversight and care. Of these beds, one Palliative Care suite is operated using a multi-disciplinary team approach to meet the needs of patients and families. Physiotherapy is also provided at both sites with a focus on acute injuries (i.e. post-surgical, sudden injury, etc.). The Haliburton Physiotherapy Department provides outpatient and inpatient services five-days a week while the Minden site operates outpatient services three days a week. Services include: Therapeutic exercise Education classes for chronic (long-standing) conditions including back, neck and shoulder pain Heat and cold therapy Ultrasound Traction Provided by two-full time Physiotherapists and one full-time Physiotherapy Assistant, outpatient physiotherapy at HHHS helps to enable treatment and recovery in a setting close to home for Haliburton residents. Prepared by OPTIMUS SBR 2014 All rights reserved P a g e 6
Apr-11 Jun-11 Aug-11 Oct-11 Dec-11 Feb-12 Apr-12 Jun-12 Aug-12 Oct-12 Dec-12 Feb-13 Apr-13 Jun-13 Aug-13 Oct-13 Dec-13 Feb-14 ED Volume ER Volume H AL I B U R T O N H I G H L A N D S H E AL T H S E R V I C E S Emergency Department On a year-by-year basis, overall ED volumes have decreased slightly at both the Haliburton and Minden location. From the 2012/13 fiscal year to 2013/14, ED visits decreased by 6% and 11% for Haliburton and Minden, respectively (Haliburton decreased from 11,732 to 11,036 while Minden decreased from 15,043 to 13,401). Monthly ED Volumes Fiscal 11/12-13/14 - By Year 20000 15000 10000 5000 0 11/12 12/13 13/14 Fiscal Year Haliburton Minden Utilization data shows that there is considerably more variation in ED volume at a month-bymonth level. Monthly ED Volumes Fiscal 11/12-13/14 - By Month 2500 2000 1500 1000 500 0 Haliburton Minden 11/12 12/13 13/14 Across all three years and both sites, July is the busiest month for the HHHS Emergency Department (ED) with a range of 2,076 to 1,949 patient visits in the month of July at Minden and 1,673 to 1,543 at Haliburton. These summer peaks compare to the winter lulls in ED volume. Over the last three years the least busy month has always been February at the Minden site and split between January, November and February at the Haliburton site. Across both sites and in all three years the busiest month has resulted in at least double the ED volume compared to the least busy month. In the case of Minden in 2012/13 and 2013/14 the ED volume in July was Prepared by OPTIMUS SBR 2014 All rights reserved P a g e 7
Number of ALC Cases Number of ALC Cases % of ALC Days to Total Patient Days H AL I B U R T O N H I G H L A N D S H E AL T H S E R V I C E S more than 2.5 times that of February s volume. While such peaks and valleys in volume can cause operational challenges, it does appear that there is a repetitive pattern in ED volume. This pattern is also largely attributed to the influx of cottage-goers, visitors, and tourists during the summer months which contribute to a significant increase in the region s seasonal population. Alternate Level of Care Reducing Alternate Level of Care (ALC) rates is a top priority for the Ministry of Health and Long- Term Care, Central East Local Health Integration Network (CE LHIN), and HHHS. With the exception of a reduction in ALC during the 2010/11 fiscal year (during which the average ALC length of stay decreased), ALC rates have generally been increasing at HHHS. As a proportion of total patient days, HHHS ALC rate has increased from 22% in 2009/10 to 32% during 2013/14. 1 35% 30% 25% 20% 15% 10% 5% 0% ALC as % of Patient Days 09/10 10/11 11/12 12/13 13/14 Fiscal Year ALC as % of Patient Days In 2012/13 (the last year for which detailed data is available), nearly half (48%) of all ALC patients at HHHS were designated ALC to Long-Term Care. This was followed by ALC to Home with Support (22%). 2 ALC Cases Total ALC Days 25 20 15 10 5 0 09/10 10/11 11/12 12/13 Fiscal Year ALC Cases 1500 1000 500 0 09/10 10/11 11/12 12/13 Fiscal Year ALC LOS in Days (Sum) 1 Data Source: Fiscal Year ALC Data HHHS, FY 2009/10 2013/14. Provided by HHHS on May 6, 2014. Analysis by OPTIMUS SBR 2 Data Source: Fiscal Year ALC Data HHHS, FY 2009/10 2013/14. Provided by HHHS on May 6, 2014. Analysis by OPTIMUS SBR Prepared by OPTIMUS SBR 2014 All rights reserved P a g e 8
Long-Term Care Services HHHS operates two Long-Term Care Facilities; one is located at the Minden site and the other at the Haliburton site. Hyland Crest in Minden is a 62-bed home and Highland Wood provides 30 long-term care beds in Haliburton. HHHS also provides Supportive Housing Services to clients living in and immediately around the villages of Minden, Haliburton and Wilberforce. These services aim to support individuals to maintain their independence and to prevent or delay their admission to a long-term care facility and include a full range of homemaking and personal support services. This includes assistance with personal hygiene and daily living as well as services a client needs to remain in their home. As of May 2014, HHHS was supporting 30 clients through its Supportive Housing Services across its three sites. Table 1: HHHS Client Statistics Minden Haliburton Wilberforce Number of Clients 9 12 9 Average Age of Clients 68.1 79.6 73.7 Average Length of Stay 4.7 4.1 3.3 Male/Female Ration 66.6%/33.4% 8.4%/91.6% 22%/78% Across all three sites, the most common medical diagnosis of clients are hypertension, diabetes, arthritis and congestive heart failure. Community Services HHHS currently provides mental health, supportive housing and diabetes education services and programs to the community. Ongoing community health services integration activities in Haliburton County will see HHHS amalgamate with Community Care Haliburton County and assume responsibility for community hospice, adult day programs, and foot care services. Prepared by OPTIMUS SBR 2014 All rights reserved P a g e 9
3.3 Current Organizational Priorities and Initiatives In 2012, the CE LHIN Board approved a motion to initiate integration planning between HHHS and community agencies including: Community Care Haliburton County (CCHC), Supportive Initiative for Residents in the County of Haliburton (SIRCH), and the Victoria Order of Nurses (VON). The integration, which was directed by the CE LHIN and also involved input from Ross Memorial Hospital (RMH) and Community Care City of Kawartha Lakes (CCCKL) and was to explore the integration of front-line services, back-office functions, leadership and/or governance. The ultimate goal of this was to: Improve client access to high-quality services, Create readiness for future health system transformation and, Make the best use of the public s investment. Much of 2013 was spent planning the proposed integration and developing a plan that recommended establishing a single LHIN-funded health services delivery organization in Haliburton County with RMH and CCCKL continuing to operate as separately governed organizations in the City of Kawartha Lakes. This plan will see HHHS become the single provider of LHIN-funded health services as CCHC programs are transferred to HHHS and CCHC winds down as a corporation. This will involve a transfer of CCHC Board members to the HHHS Board of Directors. SIRCH and VON programs, funding, and accountabilities will also transfer to HHHS. These integration activities are now in the Implementation Planning phase for which a core transition team has been identified and key planning activities and milestones established. The Transition Plan is scheduled to be submitted to the CE LHIN by June 1, 2014 with implementation of activities to occur immediately thereafter and conclude by the end of September, 2014. The second front for integration activities has focused on furthering the Strategic Alliance Partnership between HHHS and Ross Memorial Hospital (RMH). This Strategic Alliance has been created with the objective of enhancing quality of services, improving access to services, and improving the value for which services are delivered. To date, this Strategic Alliance has resulted in: Acute Care Pharmacy Services for HHHS two Emergency Sites and Acute Care Patients at the Haliburton Site Just-In-Time Procurement for Medical / Surgical Supplies Mental Health Leadership which has involved the recruitment of a new Integrated Regional Director for Mental Health Services (shared between HHHS and RMH) that will support the identification and development of Mental Health initiatives within the catchment areas of both hospitals Information Technology Integration to capitalize skills, expertise and infrastructure in both HHHS and RMH while eliminating duplications. Prepared by OPTIMUS SBR 2014 All rights reserved P a g e 10
HHHS has also proceeded with integrated medical imaging management and leadership. The approved initiative would plan to expand Mammography and Ultrasound services at HHHS to be available five days per week. This will reduce the need for patient transport by providing imaging closer to home. The shared administration between HHHS and RMH will also allow for improved access to medical imaging leadership, staff, quality and safety expertise, and clear referral patterns. The initiative, which could be built on to include the provision of other medical imaging services at HHHS (i.e. Bone Densitometry) will help to improve access to rural health services. Beyond integration and strategic alliance activities, HHHS is moving forward on a number of initiatives including: An expansion of Palliative Care Services Responding to recent changes in the way Physiotherapy services are funded and provided across the Province Palliative Care Expansion With the aim of providing core health care services to rural residents and enhancing seniors care in the Haliburton region, palliative care has been a focus of HHHS. In April 2011, with the support of the CE LHIN, one acute care bed at HHHS was redesigned to be a Palliative Care bed to provide seamless end-of-life care to rural residents. HHHS is now involved in the Ministry of Health and Long-Term Care capital planning process to further expand its Palliative Care capacity by building an additional dedicated palliative bed/suite and additional space for family members. This proposed two bed palliative centre will be able to better meet the demands of Haliburton County (the estimated demand for Palliative/Hospice beds is 2.2) and facilitate the delivery of longer term palliation and shorter term symptom and pain management. The proposed 2-bed suite would also closely coordinate with community hospice services. The scope of services under this proposal would remain the same as those within the current scope but would be extended to the second bed. The project is expected to cost between $700,000-$900,000, with the HHHS Foundation committed to raising the bulk of this figure beginning in late May 2014. Construction should start in the Fall of 2014 with a targeted completion date of March 2015. Physiotherapy Reform In April, 2013 the Ontario Government introduced reforms to physiotherapy services paid for by the Ontario Health Insurance Plan (OHIP) by phasing in publicly funded clinics. Having received no submissions from private physiotherapy service providers in the region, the Ministry of Health and Long-Term Care approached HHHS to submit an application to provide community physiotherapy clinic services. To maximize the ability to provide services locally to residents of Haliburton County, HHHS submitted an application that made a break-even business case. Prepared by OPTIMUS SBR 2014 All rights reserved P a g e 11
Approval of this application will see the HHHS physiotherapy clinic, which currently provides services to 176 patients, add an additional full-time physiotherapist to complement the current contingent of two full-time physiotherapists (although one of these positions is currently vacant with recruitment efforts underway) and one full time physiotherapy assistant. Recruitment of two full-time physiotherapists may prove to be a challenge and risk to the successful establishment of this program. Prepared by OPTIMUS SBR 2014 All rights reserved P a g e 12
4. HHHS Population and Geography 4.1 Population Haliburton Highlands Health Services (HHHS) is located in the Central East Local Health Integration Network (CE LHIN). The CE LHIN is home to 1,466,708 people spread across a significant rural-urban divide as the LHIN s geography stretches from the urban settings of Lake Ontario to suburbs, farming towns, cottage country and to Algonquin Park. The LHIN is divided into three planning clusters (Scarborough, Durham, and the North East). These clusters are further divided into sub-clusters. HHHS falls within the Haliburton Minden sub-cluster of the North East. 3 The Haliburton Minden sub-cluster is made up of four Census Subdivisions defined by Statistics Canada: Algonquin Highlands Dysart and Others Minden Hills Highlands East Haliburton Highlands is the smallest sub-lhin region in terms of population (see next page), and has experienced the highest population growth (as a percentage of total population) in the North East Cluster, and has the third highest growth overall in the LHIN next to Durham West and Durham East. The North East cluster is home to 307,299 individuals with roughly 17,026 (5%) residing in the Haliburton Highlands region (1% of the LHIN s total population). 3 Central East LHIN. (2009) Integrated Health Service Plan 2010-2013 : Engaged Communities. Healthy Communities. pg. 14. Prepared by OPTIMUS SBR 2014 All rights reserved P a g e 13
Table 2: Central East LHIN Population by Cluster 4 Cluster Sub-LHIN region 2011 Population 2006 % change Northumberland-Havelock 82,126 80,963 1.4% North East 5 Peterborough City & County 134,933 133,080 1.4% Kawartha Lakes 73,214 74,561-1.8% Haliburton Highlands 17,026 16,147 5.4% North East Total 307,299 304,751 0.8% Durham West 320,343 289,189 10.8% Durham Durham East 234,155 219,410 6.7% Durham North/Central 53,626 52,659 1.8% Durham Total 608,12 561,258 8.4% Scarborough Agincourt-Rouge 260,920 N/A - Scarborough Scarborough Cliffs Scarborough Centre 290,365 N/A - Scarborough Total 551,285 N/A - Central East Total 1,466,708 Table 3: Haliburton Highlands Sub-LHIN Region Population 6 Sub-LHIN Region Census Subdivision 2011 Population 2006 % change Haliburton Highlands Minden Hills 5,655 5,556 1.8% Highlands East 3,249 3,089 5% Dysart and Others 5,966 5,526 8% Algonquin Highlands 2,156 1,976 9% Haliburton Highlands Total 17,026 16,147 5.4% 4 Statistics Canada (2011). Census Data Population and dwelling Counts Population in 2011 and Population in 2006. 5 North East Data Notes: Statistics Canada (and therefore the data in this chart) includes Havelock-Belmont-Methuen in the Peterborough County Census division. Therefore the figures reported for the Peterborough City and County are likely higher than the actual population count for that LHIN-sub region by an estimated 4,500 residents. 6 Statistics Canada (2011). Census Data Population and dwelling Counts Population in 2011 and Population in 2006. Prepared by OPTIMUS SBR 2014 All rights reserved P a g e 14
4.2 Socioeconomic Status Examining the socioeconomic characteristics of a region s population can be of significant interest to better understanding that population s health. While there is significant literature on the social determinants of health, there is much debate on whether indicators of a population s health are causally determined by these characteristics or merely correlated. The purpose of this report is not to take a position on that debate, but rather to provide a better understanding of the types of health issues and burdens which could be reasonably expected within the LHIN based on various socioeconomic indicators. Using 2011 Statistics Canada data it is possible to examine the socioeconomic status of residents in the HHHS catchment area (Haliburton County 7 ) and compare to figures at both the LHIN and provincial level. To further explore this, six social correlates of health have been investigated as they are described below. Social Correlate of Health Aboriginal Status Visible Minority Immigration New Immigrant Non-official languages Low Income Education Indicator(s) % of Population with Aboriginal ancestry % of population, other than Aboriginal peoples, who are non-caucasian in race or non-white in colour % of population identified as immigrants (i.e. person who is or ever has been a landed immigrant/permanent resident) % of population having arrived in Canada between 2001 and 2011 % of population who speak English or French as their mother tongue % of population with low income based on after tax low income measures % of working age population (25-64) without certificate, degree, or diploma Based on 2011 Census of Canada Data, a few Haliburton socioeconomic indicators stand out when compared to the Central East LHIN as a whole. Specifically, Haliburton Highlands has a lower percentage of people with Aboriginal Status, who are Visible Minorities, and who are New Immigrants relative to other Census Subdivisions in the North East Cluster, the CE LHIN as a whole and the Ontario average. Haliburton Highlands does have a higher population of Immigrants (as a percentage of total population) than both Kawartha Lakes and Peterborough City and County, however it is still significantly below both the CE LHIN and Ontario averages. Haliburton Highlands has the highest percentage of individuals aged 15+ without a certificate, 7 As stated above, Haliburton County includes: Algonquin Highlands; Dysart and Others; Minden Hills; and Highlands East. Prepared by OPTIMUS SBR 2014 All rights reserved P a g e 15
diploma, or degree (relative to other regions of the North East Cluster), however the percentage of individuals living in low income (13%) is in line with the CE LHIN and Ontario percentage (15% and 14%). 8 35% 30% 25% 20% 15% 10% 5% 0% % of Population - Immigrants 40% 35% 30% 25% 20% 15% 10% 5% 0% % of Population - Visible Minority 4.0% 3.5% 3.0% 2.5% 2.0% 1.5% 1.0% 0.5% 0.0% % of Population - Aboriginal Status 5% 4% 4% 3% 3% 2% 2% 1% 1% 0% % of Population - New Immigrant 8 Source for all Demographic Data (including Charts): Statistics Canada. (2011).2011 National Household Survey. Government of Canada. Analysis by OPTIMUS SBR. Prepared by OPTIMUS SBR 2014 All rights reserved P a g e 16
30% 25% 20% 15% 10% 5% 0% % of Population - Non-official Language as Mother Tongue 16% 14% 12% 10% 8% 6% 4% 2% 0% % of Population - Living in Low Income 25% 20% 15% 10% 5% 0% % of Population - 15+ without a certificate/degree/diploma $100,000.00 $90,000.00 $80,000.00 $70,000.00 $60,000.00 $50,000.00 $40,000.00 $30,000.00 $20,000.00 $10,000.00 $- Average Income (household) Prepared by OPTIMUS SBR 2014 All rights reserved P a g e 17
Proportion of Seniors Haliburton Highlands has the highest proportion of seniors, and the lowest proportion of individuals 0-24 of the four North East Clusters. The proportion of seniors in Haliburton Highlands (28%) is also well above both the CE LHIN and Ontario proportion (15% for both). The proportion of those individuals aged 75+ is also the highest in Haliburton Highlands (12%) when compared to the other Sub-LHIN Regions of the North East Cluster and the CE LHIN (10%) and Ontario Average (6%). % of Total Population in 2011 Age Group 0-24 24-64 65+ 28% 22% 20% 22% 15% 15% 57% 58% 59% 58% 61% 62% 16% 20% 21% 20% 24% 24% Prepared by OPTIMUS SBR 2014 All rights reserved P a g e 18
Using data from Ontario s Ministry of Finance, the future population growth, including the portion of seniors, can be analyzed for the North East Cluster of the CE LHIN and the CE LHIN as a whole. Haliburton Kawartha Peterborough Northumberland CE LHIN Table 4: Expected Population Growth in Selected Areas of the CE LHIN Percent of Population by Age 9 2010 2015 2020 2025 2030 2035 0-64 74% 71% 68% 64% 60% 59% 65-74 15% 17% 18% 20% 21% 20% 75+ 11% 13% 14% 16% 18% 21% 0-64 79% 75% 72% 68% 65% 66% 65-74 11% 13% 14% 16% 18% 17% 75+ 11% 13% 14% 16% 18% 17% 0-64 81% 79% 77% 74% 71% 70% 65-74 10% 11% 13% 14% 14% 13% 75+ 10% 10% 11% 12% 14% 16% 0-64 79% 76% 72% 68% 63% 61% 65-74 11% 13% 15% 17% 19% 17% 75+ 10% 12% 13% 16% 18% 22% 0-64 86% 84% 82% 80% 78% 76% 65-74 7% 9% 10% 11% 12% 11% 75+ 7% 7% 8% 9% 10% 12% By 2025, the total population in Haliburton is expected to increase to 19,575 and by 2035 reach 21,262. Haliburton County, which already has the highest proportion of seniors in the CE LHIN will continue to see this proportion increase over the next 20 years. By 2035, it is expected that 41% of residents will be over the age of 64. In 2025, over 7,000 Haliburton residents will be over the age of 64, and by 2035 over 8,700 will be aged 64+. This will place an increased strain on health resources in the region, and will demand a focus on additional senior-targeted and senior-friendly services. It should be noted that the Ministry of Finance projections do not account for seasonal fluctuations in volumes. 9 Ontario Ministry of Finance. (2012) Population of Ontario Census Divisions by Age and Sex, 1986-2036. Statistics Canada Estimates for 1986-2011 and Ontario Ministry of Finance projections. Analysis by OPTIMUS SBR Prepared by OPTIMUS SBR 2014 All rights reserved P a g e 19
2001 2004 2007 2010 2013 2016 2019 2022 2025 2028 2031 2034 2001 2004 2007 2010 2013 2016 2019 2022 2025 2028 2031 2034 Population Population 2001 2004 2007 2010 2013 2016 2019 2022 2025 2028 2031 2034 2001 2004 2007 2010 2013 2016 2019 2022 2025 2028 2031 2034 Population Population H AL I B U R T O N H I G H L A N D S H E AL T H S E R V I C E S 25,000 20,000 Haliburton Population Projection Kawartha Lakes Population Projection 100,000 80,000 15,000 10,000 5,000-75+ 65-74 0-64 60,000 40,000 20,000-75+ 65-74 0-64 Year Year Peterborough Population Projection Northumberland Population Projection 200,000 120,000 150,000 100,000 80,000 100,000 50,000-75+ 65-74 0-64 60,000 40,000 20,000-75+ 65-74 0-64 Year Year Prepared by OPTIMUS SBR 2014 All rights reserved P a g e 20
2001 2003 2005 2007 2009 2011 2013 2015 2017 2019 2021 2023 2025 2027 2029 2031 2033 2035 Population H AL I B U R T O N H I G H L A N D S H E AL T H S E R V I C E S 2,500,000 2,000,000 Central East LHIN Population Projection 1,500,000 1,000,000 500,000 75+ 65-74 0-64 - Year Prepared by OPTIMUS SBR 2014 All rights reserved P a g e 21
4.3 Population Health The most detailed information about the health of the population which HHHS serves can be found at the Health Unit level. Because of small sample sizes and data quality concerns, detailed Health Status information is not available at the Census Subdivision level. The Haliburton, Kawartha, Pine Ridge District Health Unit (HKP Health Unit) covers the HHHS catchment area, including: Highlands East Minden Hills Algonquin Highlands Dysart and Others Data collected at this level can be reviewed and compared to information available at both the Central East LHIN and Ontario levels. Viewed against the Ontario average life expectancy at birth and at age 65 is lower in the HKP Health Unit for both birth and age 65. This is despite a CE LHIN life expectancy that is above the Ontario average at both birth and at age 65. Table 5: Life Expectancy at Birth and Age 65 Years of Expected Life 10 At Birth At age 65 HKP Health Unit 80.5 20 CE LHIN 82.1 20.9 Ontario 81.5 20.3 10 Ontario. (2012). Integrated Health Service Plan 2013-16: Common Technical Document. pg.28 Prepared by OPTIMUS SBR 2014 All rights reserved P a g e 22
Considering both Health and Mental Health status, residents of the HKP Health Unit have a perceived sense of very good or excellent health which is in line with the CE LHIN and Ontario rate. 11 % of Population (15+) with Very Good or Excellent Perceived Health % of Population (15+) with Very Good or Excellent Perceived Mental Health 100 100 80 60 58.7% 58.5% 60.4% 80 60 71% 72.9% 72.4% 40 40 20 20 0 HKP Health Unit CE LHIN Ontario 0 HKP Health Unit CE LHIN Ontario Despite this self-reported perception of good health, the prevalence of select chronic conditions and deaths are above CE LHIN and Ontario averages. The HKP Health Unit population has a higher rate of arthritis, asthma, diabetes, high blood pressure, cancer, and COPD than both the CE LHIN and Ontario averages. The CE LHIN average is also higher than the Ontario average for all of these chronic conditions with the exception of cancer. 11 Note: All Population Health Information from: Statistics Canada. 2013. Health Profile. Health Profiles used include: Haliburton Kawartha Pine Ridge District Health Unit (Health Region) Ontario; Central East (Health Region) Ontario; Ontario. Prepared by OPTIMUS SBR 2014 All rights reserved P a g e 23
30 25 % of Population (15+) with Arthritis 26% 10 8 % of Population (12+) with Asthma 9.20% 8% 7.90% 20 15 10 5 17.60% 17.20% 6 4 2 0 HKP Health Unit CE LHIN Ontario 0 HKP Health Unit CE LHIN Ontario Prepared by OPTIMUS SBR 2014 All rights reserved P a g e 24
10 8 6 % of Population (12+) with Diabetes 8.40% 7.70% 6.60% 25 20 15 % of Population (12+) with High Blood Pressure 23.6% 18.8% 17.6% 4 10 2 5 0 HKP Health Unit CE LHIN Ontario 0 HKP Health Unit CE LHIN Ontario 500 400 300 Cancer Rate per 100,000 population 441.2 394.3 398.8 6 5 4 % of Population (25+) with Diagnosed with COPD 5.1% 4.1% 3.8% 200 100 3 2 1 0 HKP Health Unit CE LHIN Ontario 0 HKP Health Unit CE LHIN Ontario The HKP Health Unit also has nearly 70 more hospitalizations due to injury per 100,000 populations than the CE LHIN average. This could be a result of limited alternative to acute care (i.e. community clinics) and/or a higher occurrence of recreational activities which could lead to injury. The impact of summer population increases with cottagers may also have an upward skew on this number. 500 400 300 200 100 0 Rate of Acute Care Hospitalization due to Injury per 100,000 population 454 335 409 HKP Health Unit CE LHIN Ontario Prepared by OPTIMUS SBR 2014 All rights reserved P a g e 25
200 180 160 140 120 100 80 60 40 20 0 Deaths per 100,000 Population for Select Conditions 178 172 156 159 156 142 All cancers, deaths (per 100,000 population) Circulatory diseases, deaths (per 100,000 population) 95 78 87 Ischaemic heart diseases, deaths (per 100,000 population) 50 41 41 Respiratory diseases, deaths (per 100,000 population) HKP Health Unit CE LHIN Ontario Deaths per 100,000 are higher in the HKP Health Unit for all conditions for which data is available on the HKP Health Unit, CE LHIN, and Ontario. This includes cancers, circulatory diseases, ischaemic heart diseases and respiratory diseases. Health Behaviours In terms of health behaviours, the HKP Health Unit population does appear to be more active than both the average of the CE LHIN and Ontario. In addition, this group consumes a healthier diet with respect to fruits and vegetables compared to the CE LHIN average. 70 60 50 40 30 20 10 0 % of Population (12+) Reported Moderately Active or Active 57.7% 50.6% 53.8% HKP Health Unit CE LHIN Ontario 40 38 36 34 32 % of Population (12+) Reported as Usually Consuming Fruits or Vegetables 5 or More Times per Day 36.2% 34.7% 38.9% HKP Health Unit CE LHIN Ontario Prepared by OPTIMUS SBR 2014 All rights reserved P a g e 26
A higher percentage of the population of the HKP Health Unit appears to be engaged in unhealthy activities including smoking and heavy drinking than both the CE LHIN and Ontario averages. % of Population (12+) Reported as Daily or Occasionally Smoker % of Population (12+) Reported as Heavy Drinker 30 25 20 24.2% 19.6% 19.2% 20 15 18.7% 14.1% 16.9% 15 10 10 5 5 0 HKP Health Unit CE LHIN Ontario 0 HKP Health Unit CE LHIN Ontario Prepared by OPTIMUS SBR 2014 All rights reserved P a g e 27
5. The CE LHIN Health System 5.1 Other Health Services in the Region The Central East LHIN has embarked on an ambitious health system integration agenda with multiple community support sector agencies, Community Health Centres (CHCs) and some hospitals formalizing integrated regional structures. Haliburton County in particular, is unique to other parts of the Central East LHIN because of its relative geographic isolation, distinct population and socioeconomic realities. Recognizing these differences has presented a unique opportunity in Haliburton County to create a comprehensive, integrated service delivery system, that includes primary care, hospital services, and community based care, centred around the same outcomes of quality, safety and access to services. As described above, in Haliburton County, integration planning initially involved input and participation from Community Care Haliburton County, Haliburton Highlands Health Services, SIRCH Community Services (Hospice), the Central East CCAC and the Haliburton Highland Family Health Team In the second community health services integration planning exercise, the CE CCAC and the HHFHT were replaced by Ross Memorial Hospital and Community Care City of Kawartha Lakes, along with the Victorian Order of Nurses (VON). The CE LHIN is committed to creating a health system that delivers on the Triple Aim of better health for the community, better patient experiences, and better value-for-money from the health care system. 12 In its Integrated Health Service Plan 2013-16 (IHSP) the Central East LHIN lays out its vision and direction for Engaged Communities-Healthy Communities. 13 The plan builds on strategic aims and common enablers routed in the Ministry of Health and Long-Term Care s Action Plan for Health. This blends the need to move forward with provincial priorities with the necessary focus on regional system imperatives to ensure residents of the CE LHIN receive the care and services they require. Though the IHSP the CE LHIN aims to: 14 Reduce the demand for long-term care so that seniors spend 320,000 more days in their communities by 2016 Continue to improve the vascular health of residents so they spend 25,000 more days at home in their communities by 2016 Strengthen the system of supports for people with Mental Health and Addiction issues so that they spend 15,000 more days at home in their communities by 2016 12 CE LHIN. (2012). Community First Integrated Health Service Plan 2013-16. P. 3 13 CE LHIN. (2012). Community First Integrated Health Service Plan 2013-16. P. 3 14 CE LHIN. (2012). Community First Integrated Health Service Plan 2013-16. P. 3 Prepared by OPTIMUS SBR 2014 All rights reserved P a g e 28
Increase the number of palliative patients who die at home by choice and spend 12,000 more days in their communities by 2016 The CE LHIN has recognized that archiving these aims will not occur without collaborative and coordinated effort by the LHIN, health service providers and other social service partners and the community itself. Six common enablers around the areas of health system design and improvement have been identified as contributors to reaching the aims of the CE LHIN. These include: Improving Access to Primary Care Access and Wait Times Including Emergency Department, Surgical and Diagnostic Services Health System Funding Reform System Design and Integration Transitions in Care and Electronic Health Information Management Quality and Safety The priorities of the CE LHIN s IHSP reflect the shifting nature of health care in Ontario. The focus is on ensuring that care is provided in the most appropriate setting and that individuals are given the support they need to manage their health conditions. Hospitals, long-term care providers, and community support agencies will need to be cognizant of the role they play in providing services and coordinating efforts to support individuals live health and at home. Prepared by OPTIMUS SBR 2014 All rights reserved P a g e 29
5.2 Central East LHIN Health Service Providers and Health System Utilization Including Haliburton Highlands Health Services, the Central East LHIN supports 138 organizations across seven sectors. In 2012-13 this translated to over $2.2 billion in allocations to funded service providers including: Table 6: CE LHIN Funding Programs and Funding Allocation by Sector (2012-13) Organizations Sector Annual Allocation ($) 9 Hospitals $ 1,263,627,071* 68 Long-Term Care Homes $ 414,237,631 1 Community Care Access Centre $ 241,514,062 32 Community Mental Health & Addictions Programs $ 59,747,858 7 Community Health Centres $ 22,142,397 39 Community Support Services $ 34,631,413 1 Specialty Psychiatric Hospitals* $ 112,540,862 17 Assisted Living Services in Supportive Housing $ 13,880,255 3 Acquired Brain Injury $ 1,469,786 138 $ 2,163,791,335 *Includes Grants to compensate for municipal taxation Sources: Organisation Numbers - CE LHIN Community First Integrated Health Service Plan 2013-16; Financials - CE LHIN. Year in Review 2012-13. Acute and Post-Acute Care ALC Rates 15 In January 2014, 22% of Inpatient Beds (Acute and Post-Acute) in the CE LHIN were occupied by Alternate Level of Care (ALC) Patients. This was the third highest rate in the province (high: North West 27%, low: Waterloo Wellington 8%) and above the provincial average of 14%. As of February 28, 2014 73% of ALC Patients were designated as waiting for Long-Term Care placement. This is the highest percentage of ALC-LTC in the province (low: Waterloo Wellington 3%, Ontario average: 45%). This represents 325 ALC patients waiting for Long-Term Care in the CE LHIN. 15 Cancer Care Ontario. 2014. Alternate Level of Care. February. Available at: http://www.oha.com/currentissues/issues/documents/feb%2014%20alc%20oha%20release.pdf Prepared by OPTIMUS SBR 2014 All rights reserved P a g e 30
Acute Care ALC Rates 16 When reviewing patients designated ALC in Acute Care Beds only, the CE LHIN has more favourable outcomes. As of February 28, 2014, 16% of Acute Care Beds in the CE LHIN were occupied by ALC patients, in line with the provincial average of 15% (high: North East 24%, low: Central West 10%). However, the CE LHIN again has a high proportion of ALC Patients waiting for Long Term Care in Acute Care Beds. In the CE LHIN 67% of ALC Patients in Acute Care Beds are waiting for Long-Term Care. This is the second highest percentage in the province and is double the Ontario average of 29% (high: South East 72%, low: Waterloo Wellington 0%). This represents 180 patients in CE LHIN Acute Care Beds waiting for Long-Term Care. Post-Acute Care ALC Rates 17 In Ontario, 14% of Post-Acute Care Beds are occupied by ALC patients. In the CE LHIN this figure is fourth highest in Ontario at 20% and compares to a high in the province of 38% (North West) and low of 3% (Mississauga Halton). In the CE LHIN 81% of ALC Patients in Post-Acute Beds are waiting for Long-Term Care which is tied (with South West) for the highest proportion in the province (low: Mississauga Halton 5%, Ontario average 64%). This represents 175 patients in CE LHIN Post-Acute Care Beds waiting for Long-Term Care ALC Rates in the CE LHIN Compared to Provincial Figures Acute and Post-Acute Care Acute Care Post-Acute Care % of Patients Designated ALC in Acute and Post- Acute Care Beds % of Patients Designated ALC in Acute and Post- Acute Care Beds waiting for Long-Term Care % of Patients Designated ALC in Acute Beds % of Patients Designated ALC in Acute Beds waiting for Long-Term Care % of Patients Designated ALC in Post- Acute Care Beds % of Patients Designated ALC in Post- Acute Care Beds waiting for Long-Term Care CE LHIN 16% 73% 17% 67% 20% 81% Provincial High 27% (NW) 73% (CE) 24% (NE) 72% (SE) 38% (NW) 81% (CE) Provincial Low 8% (WW) 3% (WW) 10% (CW) 0% (WW) 3% (MH) 5% (MH) Ontario Average 14% 43% 15% 29% 14% 64% Source: Cancer Care Ontario (Feb 2014) Access to Care: Alternate Level of Care (ALC) Note: Acute and Post-Acute Care data as of January 2014. All other as of February 28, 2014 16 Cancer Care Ontario. 2014. Alternate Level of Care. February. Available at: http://www.oha.com/currentissues/issues/documents/feb%2014%20alc%20oha%20release.pdf 17 Cancer Care Ontario. 2014. Alternate Level of Care. February. Available at: http://www.oha.com/currentissues/issues/documents/feb%2014%20alc%20oha%20release.pdf Prepared by OPTIMUS SBR 2014 All rights reserved P a g e 31
While the figures above represent a snap-shot of ALC rates at a single point of time the information is valuable to planning efforts as the figures are within the general trend of CE LHIN ALC rates since Q2 2011/12 and ALC data is a time-sensitive metric which is most useful when current. CE LHIN ALC Rate Q2 11/12- Q3 13/14 Source: Cancer Care Ontario. Access to Care: Alternate Level of Care ALC Rate and ER Wait Times by LHIN Q2 FY 11/12 to Q3 FY 13/14 Prepared by OPTIMUS SBR 2014 All rights reserved P a g e 32
Long-Term Care Utilization The supply of Long-Term Care (LTC) beds is roughly the same as the provincial rate per 100,000 population aged 75+ (CE LHIN rate of 87.6). Although the supply of LTC beds is in line with the Ontario average, demand in the CE LHIN is high, with the largest waitlist in the province at 4,223 individuals (38.1 individuals per 100,000 population aged 75+ compared to the Ontario average of 22.7). Time to Placement to an LTC bed is among the highest in the province; time to placement from Acute Care is 99 days, more than double the Ontario average of 48 days. Time to placement from the community is also above the Ontario average, as is the overall (community and acute care) time to placement. Central East (rate per 1,000 population aged 75+) Ontario Average (rate per 1,000 population aged 75+) Total LTC beds in operation 87.6 87.6 LTC residents 85.0 84.7 LTC beds waitlist 38.1 22.7 LTC demand (residents + waitlist) 123.1 107.5 Source: Ontario. (2012). Integrated Health Service Plan 2013-16: Common Technical Document. p 349 Overall Median time to LTC Placement (in days) Median time to LTC placement from Acute Care only Median time to LTC placement from Community CE LHIN Time to Placement (in days) Ontario Average Time to Placement (in days) 120 89 99 48 127 114 Source: Ontario. (2012). Integrated Health Service Plan 2013-16: Common Technical Document. p 349 Prepared by OPTIMUS SBR 2014 All rights reserved P a g e 33
The figures above are drawn from the Ministry of Health and Long-Term Care s 2012 Common. Although that document uses 2011 data, it also highlights that between 2006/07 the CE LHIN experienced a considerable increase in the Median Time to Placement for LTC beds. From approximately 50 days in 2006/07, the Median Time to Placement increased to 120 in 2011. 18 The CE LHIN 2013-16 IHSP that this figure has been stable at approximately 120 days since 2011. 19 The CE LHIN s IHSP further detailed this trend, and presented an expected 35% growth in LTC expenditures over the next 10 years, as an issue to address. As stated above, Reducing the demand for long-term care so that seniors spend 320,000 more days in their communities by 2016 is a key strategic aim of the CE LHIN. Supporting seniors to remain healthy and in their homes is a key tactic in improving access to LTC beds for those who do require that level of care and improving overall system sustainability. Interestingly, there is also likely a link between these figures and the high ALC to LTC figures described above. Supporting seniors to live at home will likely have a positive impact on both access to LTC beds as well as overall ALC rates in the CE LHIN. Initiatives focused on seniors in the CE LHIN to date include: Geriatric Assessment and Intervention Network To support seniors remain in the community and gain independence, the CE LHIN has developed clinics focused on identifying the root cause of issues experienced by seniors through comprehensive geriatric assessments. Four clinics in the CE LHIN have been created and staffed with interprofessional teams specializing in geriatric care. Restorative Care Programming Specialized, programs and dedicated beds have been established in the CE LHIN to help promote maintenance of functional status. This includes 16 new rehab beds, 3 focused hospital units, 15 Convalescent Care beds, and 3 hospital-based activation programs. Assisted Living Services for High Risk Seniors Through the Aging At Home Strategy the CE LHIN has continued to fund senior s Supportive Housing including individuals living in the community who are at risk of premature institutionalization and/or hospitalization. Nurse Practitioners Supporting Teams Averting Transfers (NPSTAT) To support access to, and the quality of, care provided to residents of LTC homes, the CE LHIN has implemented Nurse Practitioners to support LTC homes in the timely and safe care in placement and avoiding preventable transfers to hospital emergency departments. 18 Ontario. (2012). Integrated Health Service Plan 2013-16: Common Technical Document. p 349 19 Central East LHIN. 2012. Central east LHIN Proposed 2013-2016 Integrated Health Service Plan. September. Available at: http://www.centraleastlhin.on.ca/uploadedfiles/home_page/integrated_health_service_plan/2013_ihsp_large_deck.pdf Prepared by OPTIMUS SBR 2014 All rights reserved P a g e 34
Behavioural Supports Ontario (BSO) As one of four BSO early adopters, the CE LHIN has invested in supporting LTC residents with behavioural challenges through additional LTC nurses and personal support workers, new tools and approaches to care and improved understanding of how to support residents live in their homes without restraint. Central East Regional Specialized Geriatrics Services Entity (CE RSGS) To provide leadership towards clinical and service delivery improvements the CE LHIN has established the CE RSGS entity to support improved outcomes for Frail Seniors across the region. Prepared by OPTIMUS SBR 2014 All rights reserved P a g e 35
6. Political, Economic and Legislative Environment 6.1 Political and Economic Environment Commission on the Reform of Ontario s Public Services In 2011, the Government asked economist Don Drummond to propose strategies to manage the growing provincial deficit. The theme of this report and the direction it sets is expected to have a significant influence on Ontario financial and spending policies for the foreseeable future. Mr. Drummond's Commission on the Reform of Ontario's Public Services was released in February 2012 and warned that, without extensive reductions in government spending, the Province would face a $30-billion deficit by 2017/18. While the Drummond Report estimated that the economy would grow at 2% per year until 2017, health care costs were projected to grow by 6.5% annually over the next two decades. 20 The Report highlighted the consequences of such a situation calling for limits to health care costs and more focus on ensuring value for money spent within the Ontario health system. Among the 105 recommendations made in the Drummond Report was the recommendation to limit spending growth across the health care sector to an unprecedented 2.5% per year. This came with the acknowledgement that the same spending constraints should not be applied universally across the system. The system envisioned by Mr. Drummond would see some areas growing above the average rate with others growing below the average rate. Mr. Drummond proposed a health care system with more integration of the long-term care, community care and home care sectors, with particular emphasis on home care. All three areas were described as underfunded, with too much emphasis on long-term care facilities and too little on integration of services. In this system, a focus should be on directing patients to the most appropriate care setting for their health concerns (family physician, clinic, etc.) rather than drawing patients into hospitals for care. This is a sentiment clearly shared by the Ministry of Health and Long-Term Care. Together with a shift away from hospitals that try to offer everything to everyone towards increased differentiation and specialization to reduce service overlaps, Mr. Drummond emphasized the need for a new approach to hospital financing. The system described would blend traditional base-funding with pay-by-activity funding that would recognize complex and expensive cases taken on by hospitals. Again, this is aligned with the Ministry of Health and Long-Term Care and their Health System Funding Reform and Health Based Allocation Model initiative (described below). The overall theme of Mr. Drummond s message to hospitals is to find new, innovative and collaborative ways to deliver services more sustainably, effectively and without relying on significant funding increases. 20 Commission on the Reform of Ontario s Public Services (2012). Public Services for Ontarians: A Path to Sustainability and Excellence. Toronto: Queen s Printer Prepared by OPTIMUS SBR 2014 All rights reserved P a g e 36