Tim Burns Karen Slater Director Program Manager Long-Term Care Homes Branch East Region Community He

1. Meeting with OPADD: Ontario Partnerships in Aging and Developmental DisabilitiesSupporting LTC Residents with Developmental DisabilitiesPresentation by: Tim Burns Karen Slater Director Program Manager Long-Term Care Homes Branch East Region Community Health Division MOHLTC MOHLTC October 30, 2006

2. The Ministry is focusing on seniors health in the context of the integrated health service planning • Canada’s National Advisory Council on Aging describes aging successfully as: • maintain a high level of mental and physical functioning ; and • active engagement with life • the ability to adapt to change and compensate for limitations; and • having a low risk for disease-related disability • In 2031 after the full effect of the baby boom has occurred seniors will represent 21.8% of the population of Ontario compared to 12.8% now.

3. Where are we now? • The confidence of Ontarians in the health care system is most • threatened by the following concerns: • Patient-/Resident-centred care– ensuring decision making processes are equitable • Access – better access to publicly funded health care services • Quality - getting value from the growing financial investment in health care • Sustainability – having a system in place they can depend on in the future • To address these concerns, the ministry has embarked on a transformation

4. The entire process will be based on principles that put • Ontarians at the centre • Transparency (the results of public consultations and policy reviews will be posted on the web) • Diversity (public engagement will directly engage a broad group of Ontarians) • Direct engagement (the engagement will give voice to Ontarians typically neglected in traditional stakeholder engagements) • Respect (the process will build on consultations with Ontarians from the last five years) • Evidence-based ( the process will support the role of evidence in determining the likely effectiveness of policies)

5. Key areas to improve Senior’s Health • The 5 key areas to improve the health, dignity, independence and quality of life for seniors are: • Prevention to facilitate healthy living and to reduce the burden and progression of chronic diseases • Community Supports to enable community living for the frail elderly and to better sustain the health care system • System level changes to produce quality integrated care and case management for seniors and high risk elders • Organizational changes to improve quality of care to integrate care • Knowledge transfer to support its adoption of the ‘shared’ model

6. Community Health Services Overview • Long-Term Community Care Agencies • Over 800 agencies provide personal support and homemaking services, meal programs, transportation and other community services. • Community Health Centres • 54 centres that provide primary care services with an emphasis on priority populations with access barriers to health care. • Long-Term Care Homes • 619 homes with 75,444 beds providing nursing, personal support, dietary and programming services to seniors and other vulnerable members of the community. • Admissions by consent of the applicant or Substitute Decision Maker • Care is delivered consistent with individualized care plan • All homes are accountable to meet common provincial standards • New proposed legislation, the Long-Term Care Homes Act further strengthens residents rights and safeguards.

7. Community Health Services Overview • Community Care Access Centres • 42 CCACs determine eligibility and coordinate visiting health care services in the home and in schools as well as admission to long-term care homes. • CCACs served over 500,000 clients in 2005/06. Age breakdown of admissions are: • 53% are seniors - the majority of home care clients are seniors • 36% are adults • 11% are paediatrics • CCACs are responsible for admissions into LTC homes, including the RAI-HC assessment, obtaining consent from the applicant or Substitute Decision Maker, and management of the referral-to-placement process consistent with legislation, preferences and availability of beds. • Community Mental Health Investments • $601.4M in 2006-07, growing to $631.2M serving 79,000 clients by 2007-08.

8. LTC homes sector capacity • The long-term care home sector has the capacity to serve a range of residents with both health and personal care needs as long as the appropriate planning is conducted and supplementary resources are available. • The joint efforts of MCSS and MOHLTC are required to develop: • Resources for LTC Home Operators to provide appropriate accommodations, equipment and services, and the skills and expertise to sustain support for developmentally disabled adults entering the long-term care sector. • Community and professional educational strategies to foster/promote a positive professional profile for those working or aspiring to work in the developmental sector • Case management resolution mechanisms at the local and regional levels for all clients with a developmental disability.

9. LTC homes sector capacity (contd.) • Resources required to increase capacity in the LTC Homes Sector to serve this special needs population, could include accommodation and services such as: 1. Small, developmental service units in long-term care homes so thatfriends and lifelong roommates could continue to reside together; 2. Specialized equipment and specialized support services to support special needs; 3. Training and education of long-term care homes, community and CCAC staff; 4. Individual transition support planning and implementation; and 5. Other special ongoing long-term care supports to improve individual’s quality of life, e.g., day program and case management supports

10. Community Capacity • Community Capacity to develop expertise, provide services and supports needs to be assessed to maintain a quality of life for individuals with a developmental disability in these communities. • Assessments of MCSS and MOHLTC Service Supports in those communities where these individuals will likely be placed, to close any gaps in services and ensure transition is seamless. • Coordinated Placement and Case Management to enable access the appropriate community service supports. • Community Supports to attract volunteers and service agencies to: • meet the recreational, social, spiritual and developmental needs of this special population, • ensure their integration into the community, and • promote positive and mutually reinforcing experiences in the community.

11. Developmentally Disabled Residents in LTC Homes • Developmentally disabled residents account for about 2.2% of the total LTC Home resident population across the province. • About 1,691 residents in LTC homes are classified with one or more developmental disabilities from a list of diagnoses selected by MCSS. • The average age is 52.6 years; the average age of the general LTC population is about 30 years older-median is 83 years. • Differences in the developmentally disabled residents and the general population result in differences in care needs.

12. Developmentally Disabled Residents in LTC Homes (contd.)Age distribution is broader than the general LTC population • Figure 1 – Age of All Residents (maximum count = 4,000 residents) • Figure 2 – Age of Developmentally DisabledResidents (maximum count = 40 residents) • The difference in age between developmentally disabled and other residents has impacts on such issues as illness acuity, the nature of secondary diagnoses, care needs, and medication needs.

13. Developmentally Disabled Residents in LTC Homes (contd.) • Developmentally disabled LTC residents are physically healthier— more independent and use less medication (about 15% less): • Physical care needs for Activities of Daily Living (ADLs) are one-fifth (22% less than) the requirements for the average older LTC resident. • 13% have movement-related diagnosis-- neurological, muskoskeletal coordination as a secondary diagnosis • Developmentally disabled residents have higher Behaviours of Daily Living (BDLs) needs for the following listed behaviours (2 to 3 times greater than the general LTC population): • hoarding, aggression, agitation, inappropriate sexual conduct, demands for attention and anxiety (general population more likely to exhibit wandering, sadness/depression)

14. Developmentally Disabled Residents in LTC Homes (contd.) • Secondary diagnosis also includes combination diagnoses such as cerebral palsy(17%), Down’s or Klinefelter’s Syndrorme (11%) • Dual diagnoses as secondary diagnosis for developmentally disabled residents include: • ‘non-specific’ mental disorders(20%), schizophrenia (28%), affective disorders, e.g. manic depression (14%), neurotic disorders (13%); paranoid states (3%) • compared with 1% each for the above secondary diagnosis in the rest of the general LTC population.

15. LTC homes with Developmentally Disabled residents • Developmentally delayed residents live in LTC homes throughout the province. Divided into 7 MOHLTC regions, LTC homes with these residents have the following average portion of LTC residents as developmentally disabled residents by region: • 4.5% in Central West • 3.6% in Central South • 7.5% in Central East Region • 11.5% in East Region • 6.0% in North Region • 7.3% in the South West • Some of these LTC homes have a number of developmentally disabled residents living in group-type arrangements: • 7 homes have 8 or more developmentally disabled residents • 27 homes have 6 or 7 developmentally disabled residents • 65 homes have 4 or 5 developmentally disabled residents • the remaining homes have 3 or less.

16. Current Context of Joint MOHLTC- MCSS Initiatives • A joint initiative to create an accessible, fair and sustainable system of community-based supports, including MOHLTC to ensure a seamless transition for aged people who have a developmental disability into: • Long-Term Care Homes; • Complex Continuing Care; and • Supports in the community. • Jointly develop protocol(s) for working together to integrate services and ensure a continuum of care for DS adult individuals who are eligible for transferring from MCSS-DS facilities and the community into LTC Homes.

17. Joint MOHLTC & MCSS “Directors Steering Committee” • Established in June 2005, membership consists of three corporate Directors and two Regional Directors from each Ministry. • Objectives: • Plan for services that follow each client where their needs exceed the services generally availablethrough the long term care system. • ensure the coordination of policy, business practices and program-management decision across ministries; • deal with the complex inter-ministerial issues of resource sharing, to meet the needs of adults requiring long term care supports coming from Group Homes anticipated in the future; and • serve as an effective forum to discuss common approaches to stakeholders, such as the Ontario Partnerships in Aging and Developmental Disabilities (OPADD).

18. The Planning Principles • Include older adults who have a developmental disability in the life and services of the community to the extent possible. • Work on processes that ensure a secure and comfortable transition for the individual requiring placement, and that is safe and comfortable for residents already in long-term care homes. • Provide common advice and input to all stakeholders, including the Ontario Partnership on Aging and Developmental Disabilities • Jointly determine models for specific services, equipment and accommodations, essential to these individuals to maintain their quality of life in LTC homes. • Co-ordinate community services and resources.

19. The MOHLTC – MCSS Protocol • Protocol approved by the Joint Committee for the admission of developmentally disabled adults into Long-Term Care in May 2006 and recommends the following approach: • Information Sharing and coordination of activities • Obtaining and analyzing information and assessment data on this developmentally disabled population and on long-term care and community resource capacities • Issues Identification at the Local Level • Issues Resolution at Corporate Level • Building capacity for Specific Groups and Individuals • November 1, 2006 meeting of regional program managers from both ministries will meet to address protocol issues.

20. Long-Term Care (LTC) Home Admissions • Community Care Access Centres (CCACs) are the designated placement co-ordinators under the Nursing Homes Act, Charitable Institutions Act and the Charitable Homes for the Aged and Rest Homes Act • LONG-TERM CARE ELIGIBILITY CRITERIA IS SAME FOR ALL APPLICANTS : • at least 18 years old • have a valid OHIP card • need 24/7 nursing care or help with ADLs or ongoing supervision or risk of abuse at home or risk of harm at home or may harm others • community-based resources to meet client needs exhausted • care requirements can be met in a nursing home

21. LTC Home Placement Application • CCACs will work with MCSS Regional Placement Facilitators (RPFs) ifa facility resident qualifies for LTC home placement, given the individual’s health care needs • The Planning process for individuals moving from DS facilities to LTC homes is an extension of the established, individualized planning process in the developmental services sector that focuses on the individual and involved the Substitute Decision Marker [SDM] if the individual is not competent. • Although CCACs are responsible for the LTC home placement process, RPFs are responsible for placement planning, transition and placement follow-up on the indivituals moving from DS facilities.

22. LTC Placement Application (contd.) • The request for admission to a LTC home is made by the individual or their Substitute Decision Maker [SDM], with assistance from the agency or the Regional MCSS Placement Facilitators [RPFs] supporting the individual in a facility. • The request is made to the local CCAC. The agency or RPF coordinates the development of a individualized Support Plan based on information collected from family, friends, agency staff, health care professionals and relevant assessments. • The CCAC, in collaboration with the agency or RPF, obtains the required consents and releases of information for admission to a LTC home and releases of information

23. LTC Home Placement Application (contd.) • If the individual is determined eligible for LTC home placement, the individual or the SDM is able to select up to a maximum of three LTC homes. • The agency or RPF works with the applicant, family/SDM, other community-based developmental services and the local CCAC to identify/coordinate appropriate services options within the LTC home where the individual is to move. • Where a LTC placement does not occur within a six-month period consent must be obtained from the individual, if competent, or their SDM for reassessment to keep the application active.

24. Highlights of Placement Process • Once the eligible individual has made the selection of one to three LTC home(s), the individual/SDM must apply for authorization of admission. The CCAC, in collaboration with the designated RPF, will assist the individual/SDM to complete the applications. • The application will then be sent to the selected home(s) along with all the assessment information, and will indicated the individual/SDM’s preferences for accommodation (private, semi-private, or basic). The individual/SDM may select LTC homes based on factors, which include ethnic, spiritual, linguistic, familial and cultural preferences. • If an appropriate vacancy exists in one of the LTC homes to which an application has been made, the CCAC will notify the individual/or SDM. The individual, if competent or the SDM will have 24 hours within which to accept or decline the offer.

25. Highlights of the CCAC Role • The CCAC must determine, as the first step of the LTC home placement process, that all community-based resources to meet client needs have been exhausted. • LTC home placement planning for an individual includes identification of necessary supports for successful placement through the development of a Personal Plan. • The plan may include additional supports are specific to the individual’s developmental disability, beyond the basic LTC home service offering. • Where applicable le, planning will include a confirmation of the service providers who would be involved in providing direct of indirect support through the developmental services system.

26. Highlights of the RPF Role • The RPF coordinates the development of a draft Personal Plan based on information collected from family, friends, facility staff, health care professionals and relevant assessments. • The RPF may coordinate with the assistance of the CCAC, visits by the individual and/or family member/SDM to the proposed LTC home(s). • The RPF will work with all relevant stakeholders to identify and coordinate access to any additional resources necessary to support an individual within the selected LTC home(s) e.g. training LTC home staff and establishment of arrangements for the provision of services by DS service providers.

27. Specific Placement Details for DS facility residents transferring to LTC Homes • Individuals will not move from the DS facilities until the appropriate supports are in place. • The Support Plan will become finalized through a written agreement between the individual, SDM (if applicable), family, DS supporting agency (if applicable) and LTC home provider which will state what supports will be provided, by whom, and the roles and responsibilities of each party in relation to the ongoing assessment/ evaluation of the Support Plan. • The RPF will conduct a 3 month post-placement follow-up in conjunction with the LTC home provider, CCAC and DS service provider (if applicable) as appropriate to review the individual’s status/progress and the Support Plan in relation to the individual’s current situation and circumstances.

28. Alternative placement options • Where a LTC placement is not appropriate: • CCACs also assist agencies in planning alternative delivery options for health-based supports. • Alternative placement options may include in-home health care supports and training DS providers to provide specific personal support services that are not provided by staff or family members or where staff or family members do not have the expertise and require training and support.

29. Effective and Appropriate LTC Placements • Working towards effective and appropriate placements in LTC Homes requires the involvement of: • Residents (LTC Home Resident Councils) • Families (Family Councils) • LTC Staff and administration • LTC community volunteers • LTC Home Associations (OANHSS and OLTCA) and advocacy groups (e.g., Concerned Friends, ACE) • Community service providers and agencies • Medical and Therapeutic Care Professionals • The Community • Governments and ministries

30. Questions?