CADA Presentation March 11, 2015. page 2 Who We Are Ontario Long Term Care Association (OLTCA)...

CADA PresentationMarch 11, 2015

Who We Are

Ontario Long Term Care Association (OLTCA) represents Ontario long-term care home operators: charitable, not-for-profit, private, and municipal

440 member homes provide care, accommodation and services to approximately 100,000 seniors annually

Our mission: To build excellence in long term care through leadership, analysis, advocacy and member services

Our approach: solutions-oriented, evidence-based, forward-thinking

From Residential Care to Health Service Provider

• Increased home care is resulting in delayed admission to LTC for seniors and the LHIN’s alternate level of care (ALC) stay reduction targets have combined to dramatically change the role of LTC in the health care continuum.

• Residents are more clinically complex and frail than even five years ago. This change is rapidly accelerating:

» 93% of residents have two or more chronic diseases.

» 61% have Alzheimer’s or dementia – 46% have some level of aggressive behaviour.

» Some long term care homes now delivering medical procedures previously done in hospital:

dialysis, IV therapy, chemotherapy tube feeds, convalescent and palliative care = health care

system savings.

» Impact of institutional mental health closures – many patients now in long term care.

» Support with activities of daily living continues to rise – for example, rate of residents

requiring assistance with dressing has risen from 40% to 64% in just five years.

Business at Hand

Business is finally moving now at the Ministry with staffs in place – will be

able to move the dial on advocacy items

Betterseniorscare.ca refresh with increased hits to site and media tour to

continue in Spring

Ministers Mandate Letters as well as Legislative and Parliamentary

Assistants published – new era of transparency

We need to continue to ramp up our sectors’ focus on quality – We have

been told: Success through Health System Funding Reform (= $$$

on the table) is about:

(1) good quality data (naked beach)

(2) being seen as high quality care provider.

Advancing Health Care Transformation

The need for transformation is well understood and accepted by the sector focusing on sustainability, accountability, quality improvement and integration.

Change is taking hold and has been accomplished at a time of significant fiscal restraint.

Progress must continue to deliver the end results of:

People receiving the right care at the right time in the right place;

An accountable, high quality and transparent health care system that demonstrates leadership and performance at the international level

More cost effective care

Promoting healthier lifestyles by educating and enabling Ontarians so they are confident in the decisions they make about their health and the health care system as a whole

LTC Today Many LTC residents are

clinically similar to those in other care settings, yet cost of care is typically much lower in LTC than in other care settings.

Additional funding in LTC might divert care from more expensive settings; decrease movement between sectors and additional costs; and ensure access to restorative, preventative services.

Exhibit 22: Comparative Per Diem Cost in Ontario

Sector Total Estimated Cost per Day

ALC IP $584

LTC $158

CCC-CC $476

LTC -CC $172

IP MH $692

LTC-MH $145

Long Term Care Funding Today

LOC Funding Physiotherapy Convalescent Care Subsidy

NPC PSS Per Day Per Year NPC PSS OA PT

Prior April 1, 2014 $ 88.93

$ 8.87

$ 2.05

$ 750.00

$ 46.53

$ 19.95

$ 5.88

$ 10.27

2% Increase $ 1.78

$ 0.18

$ 0.04

$ 15.00

$ 0.93

$ 0.40

$ 0.12*

$ 0.21

Starting April 1, 2014 $ 90.71

$ 9.05

$ 2.10

$ 765.00

$ 47.46

$ 20.35

$ 6.00

$ 10.48

Other Long Term Care Funding

Other Funding 2012 2013 Apr. 2014Total Government Funding for Long Term Care $3.7 B $3.8 B $3.9 BTotal Level of Care Funding (Includes co-payment)

$ 4,361,614,950 $4,450,707,800 $4,518,554,555

Total Preferred Accommodation - New/A Beds (revised guesstimate)*

$ 139,136,613 $152,012,280

$ 161,087,640

HINF 2012/13 $10,052,700 HINF - NPC $17,706,150 $17,706,150 HINF - RF $3,372,600 $3,372,600 Physiotherapy Funding $58,500,000 $59,670,000 One Time Fire and Safety Up to $10,000,000 $14,247,000 One Time Training and Development of Direct Care Staff

Up to $10,000,000 $10,057,800

Total One Time Funding $20,000,000 $24,304,800 -Total LOC and One Time Funding $4,381,614,950 $4,475,012,600 $4,518,554,555

Nursing and Personal Care Envelope

• All incontinence costs come out of the NPC Envelope

2012 OA Cost Breakdown

Based on 315 2012 LTCH Annual Reports

Increase in Chronic Conditions

Source: Canadian Institute of Health Information, Continuing Care Reporting System,2008-2013

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Increased Support of Activities of Daily Living Over 5 Years

Source: Ontario Ministry of Health and Long Term-Care: IntelliHealth Ontario, 2008-2013

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Increases in Neurological and Behavioural Disorders over the past 4 years

Source: OLTCA Research Project-Dr. Colin Prerya

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Key elements are in place

•Health outcomes were not what they should be

• The fiscal environment required us to get better value from our investments

•System was fragmented, operated and funded in silos

• Lack of accountability and transparency

• Patients were confused about where to go

• If unchecked, changing demographics would result in higher costs to the system

•Health outcomes were not what they should be

• The fiscal environment required us to get better value from our investments

•System was fragmented, operated and funded in silos

• Lack of accountability and transparency

• Patients were confused about where to go

• If unchecked, changing demographics would result in higher costs to the system

The problems are real

•Ontario’s Action Plan for Health Care (Jan. 2012) is the foundation for transformation

“Make Ontario the healthiest place in North America to grow up and

grow old”

•Access, quality, and value drive improvements – focus on right care, right time, right place

• Two years in, progress has been made:

•99 of 105 C.R.O.P.S. (Drummond) recommendations are fully or in progress towards being implemented

•Ontario’s Action Plan for Health Care (Jan. 2012) is the foundation for transformation

“Make Ontario the healthiest place in North America to grow up and

grow old”

•Access, quality, and value drive improvements – focus on right care, right time, right place

• Two years in, progress has been made:

•99 of 105 C.R.O.P.S. (Drummond) recommendations are fully or in progress towards being implemented

•A quality regime is in place (ECFAA) – needs to expand beyond acute sector and become more transparent to consumers

• Integrated coordinated care is showing early results – intensifying Health Links as clinical networks is essential

•A focus on patient engagement is taking hold – need to empower decision making through education and knowledge translation

• Funding reform has just begun – bold approaches to procurement and benefits needed

•A quality regime is in place (ECFAA) – needs to expand beyond acute sector and become more transparent to consumers

• Integrated coordinated care is showing early results – intensifying Health Links as clinical networks is essential

•A focus on patient engagement is taking hold – need to empower decision making through education and knowledge translation

• Funding reform has just begun – bold approaches to procurement and benefits needed

A plan was set in motion

Action to Date

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Despite Significant Change, Challenges Remain• Over the past few years, the ministry has been able to bend the cost curve through

targeted efforts and an ability to find efficiencies in certain high cost areas of the system:

Drug Reform - $500M annual savings since 2009

Hospitals – kept to 0% growth

Physicians - $850 million in saving over past 2 years

Original Trajectory

• Going forward, maintaining system growth at 2% requires an honest conversation on structural change to our health system.

• Deepening our implementation efforts in home and community care and clarifying the roles of delivery partners will be the key to lasting success.

Drive Integration •Increase connection of home and community with care journey (i.e., hospitals for post-acute services)Enhance Care•Greater service flexibility (i.e. service maximums)•Self-directed funding options•Increase use of technologies such as tele-homecare•Support MCSS strategy for disability support clients•Add residential hospicesEnsure Transparency and Accountability•Patient Ombudsman•Apply FIPPA to CCACs•Spread quality and best practices in care delivery through QIPs, QBPs

Health System Funding Reform•Broaden the mandate to community sector; support population healthQuality Improvement•Expand efforts to drive deeper across sectors and embed quality into operationsDrug Reform•Focus on affordable drugs and equitable accessHealth Human Resources•Maximize workforce to drive changeProcurement Strategy•Strategy that improves efficiency and cost-effectiveness

Modernize Home and

Community Care

Ensure Sustainability and Quality

Key Initiatives and Areas of Focus

Health System Funding Reform (HSFR)Financial Lever with a Quality Focus

Health System Funding Reform andQuality-Based Procedures

• HSFR is a key focus area in ensuring sustainability

and quality across the health system.

• As HSFR moves forward in Year 3 (2014-15), the

ministry and its partners will focus on:

Community sector expansion

On-going model assessment and

enhancements

Evaluation of HSFR implementation

Change management across the sector

• As QBPs are developed across the continuum of

care, different approaches will be required for

addressing the varying needs of patient/ client

populations.

• From a patient perspective, develop QBPs to better

enhance patient experience and outcomes.

Mental Health

Women’s Health

Musculoskeletal

Pediatric

EyePalliative

Emergency Room

The future of QBPs

Long-Term Care Home and Chronic Kidney Disease (CKD)

Regional Program Collaboration

The CKD QBP will be extended to the LTC sector

• The design of the QBP will necessitate some data gathering and in 2014-15, the Ontario Renal Network will enter into CKD management agreements with 27 LTCH that provide Peritoneal Dialysis (PD) services to gather this data

• LTC homes will continue to collaborate on the management of PD patients and the delivery of services with its local CKD Regional Program(s)

QBPs and LTC

QIPs Cont’d• QIPs promote ‘priority indicators’ that reflect sector- and system-wide priorities

where improved performance is co-dependent on collaboration within and between sectors

• Priority indicators are selected through a collaborative process: MOHLTC, HQO, and sectors consider key needs, investments, commitments and data infrastructure

• What we saw in 2014/15: • ~90 early adopter homes voluntarily submitted QIPs to HQO• LTC QIPs were aligned with regional and system level priorities• LTC homes have committed to working with their partners in other sectors to

improve transitions of care for individuals as they travel through the health system

• What we saw in 2014/15: • ~90 early adopter homes voluntarily submitted QIPs to HQO• LTC QIPs were aligned with regional and system level priorities• LTC homes have committed to working with their partners in other sectors to

improve transitions of care for individuals as they travel through the health system

Collective efforts are critical for system progress

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Integrated Funding Models / Bundled Payments

• Starting in Fall 2014, the ministry will:

• Engage sector partners to seek innovative approaches to integrating funding across more than one phase of care; and

• Evaluate these models to identify success factors for, and potential barriers to, implementation of integrated funding models across the system.

AccessValueQuality Integration

Intent is to achieve quality outcomes for patients and efficiency in health care spending by focusing on providing the right care, at the right time, in the right place

and at the right price

Through an integrated funding model, or bundled payment approach,a single payment is provided to multiple providers for all services

related to an episode of care

Where to next: Maximizing our levers to drive health system improvement

Sector specific Integrated approaches across health sectors

Primary Care not coordinated Coordinated care with health system partners

Leadership concentrated in acute sector Leadership developed across all sectors

Care organized around the provider Care organized around the patient

Incremental volume-based approach System wide capacity planning

Silo’d levers Mutually reinforcing levers

Disease specific Patient-based

Separate, distinct quality focus Quality embedded in programs and funding

Value = Quality / Cost + Appropriateness

One size fits all Recognizing differences: size, locale, geography

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WHERE WE’VE BEEN WHERE WE CAN STRENGTHEN… EXAMPLES

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Bundled payments /Episodes of care

Health Links

IDEAS

Patient experience

Evidenced-based care

QIPs / QBPs

QBPs – next generation

Leveraging HQO role

Addressing variation

Customized approaches

The Possibilities in Long Term Care

OLTCA believes that the long term care sector should be an integral part and partner in the spectrum of community care.

The Association endorses the Why Not Now? Expert Panel Report definition of the full continuity of community of care, which includes:

» Retirement settings

» Home delivered care

» A full range of short and long stay residential care services that meet an older adult’s changing needs

LTC Homes are regulated and equipped to provide restorative care in a home-like setting – categorizing the sector as “institutional care” is counterintuitive to the care model long term care homes are there to provide.

The Possibilities in Long Term Care The shift to the community presents excellent opportunities to reposition long term

care capacity to integrate and maximize its benefit to Ontario’s health care system.

This requires a shift from a one-size fits all funding, regulatory and capital model to

one that supports specialization and integration.

Innovation in LTC requires an exploration of different models of care, and a continued

shift of services out of acute care into LTC:

Post-acute – short skilled nursing and rehab/assess and restore

Specialized stream – higher level of care for special needs populations

Hub model – long term care serves as centre for seniors’ service delivery

Integrated Care/Assisted Living Model – providers of continuums, with an

enrolled population

These models are consistent with recommendations put forward by Dr. Sinha in the

Seniors’ Strategy.

OLTCA has just issued a white paper for stakeholder consultation called 15 Ways to

Improve Long Term Care Planning by Dr. Colin Preyra. The focus of the research is on

capacity planning, service delivery mix and supporting the shift to the community.

The Possibilities in Long Term Care

OLTCA believes that the long term care can develop best practice approaches that shift the focus to what is possible

OLTCA Diabetes Best Practice Protocol (shared with OHA, ORCA, OCSA, Home Care Ontario, HQO, MOHLTC, OAHNSS and CALTC)-Minister Damerla acknowledged and linked us with provincial Diabetes Lead – Dr. Steele enhancing a streamlined approach and 300+ users on Diabetes Connect

OLTCA COPD Best Practice Protocol (piloting with Revera, Leisureworld and Chartwell)

OLTCA Crisis Communication Kit – shared nationally through CALTC and presenting at Global Ageing Conference 2015 in Perth, Australia

All being featured at “This is Long Term Care 2015” November 23-25th

Objectives:

1. Serves as our “bible” for communications going forward.

2. Document that is easy to read by all of our key audiences.

3. Shows that OLTCA is sophisticated, strategic and ahead of the curve.

OLTCA Political Platform

Solutions

To ensure that seniors receive the safe, high-quality care that they need and deserve, the government needs to act now.

1.Matching staff resources with care needs2.Support mental health and dementia care3.Tend to the aging LTC home infrastructure4.Assist smaller LTC homes through a small homes strategy

Thank You

2015-2018 Strategic Plan (DRAFT)

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CADA Presentation March 11, 2015. page 2 Who We Are Ontario Long Term Care Association (OLTCA)...

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Transcript of CADA Presentation March 11, 2015. page 2 Who We Are Ontario Long Term Care Association (OLTCA)...