CADA Presentation

1. CADA Presentation March 11, 2015

2. 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

3. 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.

4. 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.

5. 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

6. 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.

7. Long Term Care Funding Today

8. Other Long Term Care Funding

9. Nursing and Personal Care Envelope All incontinence costs come out of the NPC Envelope

10. 2012 OA Cost Breakdown Based on 315 2012 LTCH Annual Reports

11. Increase in Chronic Conditions Source: Canadian Institute of Health Information, Continuing Care Reporting System,2008-2013

12. Increased Support of Activities of Daily Living Over 5 Years Source: Ontario Ministry of Health and Long Term-Care: IntelliHealth Ontario, 2008-2013

13. Increases in Neurological and Behavioural Disorders over the past 4 years Source: OLTCA Research Project-Dr. Colin Prerya

14. Action to Date The problems are real A plan was set in motion 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 • 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

15. 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 Despite Significant Change, Challenges Remain 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. 15

16. Key Initiatives and Areas of Focus • 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 hospices • Ensure Transparency and Accountability • Patient Ombudsman • Apply FIPPA to CCACs • Spread quality and best practices in care delivery through QIPs, QBPs Modernize Home and Community Care • Health System Funding Reform • Broaden the mandate to community sector; support population health • Quality Improvement • Expand efforts to drive deeper across sectors and embed quality into operations • Drug Reform • Focus on affordable drugs and equitable access • Health Human Resources • Maximize workforce to drive change • Procurement Strategy • Strategy that improves efficiency and cost-effectiveness Ensure Sustainability and Quality

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

18. 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. The future of QBPs Palliative Eye Emergency Room Pediatric Musculoskeletal Women’s Health Mental Health

19. Long-Term Care Home and Chronic Kidney Disease (CKD) Regional Program Collaboration QBPs and LTC • 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)

20. 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 Collective efforts are critical for system progress • 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

21. Integrated Funding Models / Bundled Payments 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 Value Access Integration Quality 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 • 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. 21

22. Where to next: Maximizing our levers to drive health system improvement WHERE WE’VE BEEN WHERE WE CAN STRENGTHEN… EXAMPLES Bundled payments / Episodes of care Sector specific Integrated approaches across health sectors 1 Primary Care not coordinated Coordinated care with health system partners 2 Health Links 3 Leadership concentrated in acute sector Leadership developed across all sectors IDEAS Patient experience 4 Care organized around the provider Care organized around the patient 5 Incremental volume-based approach System wide capacity planning Evidenced-based care 6 Silo’d levers Mutually reinforcing levers QIPs / QBPs Disease specific Patient-based 7 QBPs – next generation 8 Separate, distinct quality focus Quality embedded in programs and funding Leveraging HQO role Value = Quality / Cost + Appropriateness 9 Addressing variation 10 One size fits all Recognizing differences: size, locale, geography Customized approaches

23. 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 equippedto 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.

24. 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.

25. 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

26. Objectives: Serves as our “bible” for communications going forward. Document that is easy to read by all of our key audiences. Shows that OLTCA is sophisticated, strategic and ahead of the curve. OLTCAPoliticalPlatform

27. Solutions To ensure that seniors receive the safe, high-quality care that they need and deserve, the government needs to act now. • Matching staff resources with care needs • Support mental health and dementia care • Tend to the aging LTC home infrastructure • Assist smaller LTC homes through a small homes strategy

31. Thank You

32. 2015-2018 Strategic Plan (DRAFT)