LHINs Now

1. LHINs Now Lois Cormack Vice President At Large OLTCA Board

2. They’re Here! • LHINs have been evolving and are now an operational reality: • 2005/06: LHINs established and developed IHSP • April 1st, 2007 LHINs receive legislated powers to implement IHSP: • Have started to directly contact LTC homes as part of daily operations

3. Up until April 1st, 2007 • OLTCA structured to engage and monitor LHINs: • Identified VP at Large as Board LHIN Lead (currently L. Cormack, Specialty Care, Inc.) • Identified OLTCA member LHIN Leads in each LHIN as information conduits between members in LHIN and OLTCA via Senior Staff • Approached OANHSS to partner in LHIN-based support structure (unsuccessful)

4. Up until April 1st, 2007 • Provided strategy and common messaging tools to assist LHIN Leads: • Orientation, face to face meetings and teleconferences with assigned Senior Staff • Tools for presentations to LHIN Board Chairs & CEOs during community engagement, IHSP development

5. Up until April 1st, 2007 • Support for sector-wide approach, i.e. engage all LTC homes (OLTCA & OANHSS members) in the field • Currently engaging LHIN Boards to present: • Long Term Care 101 • ALC Solutions

6. Up until April 1st, 2007 • OLTCA positioning key issues centrally: • Funding per diem for LTC homes • Compliance program • Service Accountability Agreement template • Performance Indicators and Report Card

7. What we have learned • No two LHINs are operationally alike • LHINs are competitive • HSPs are competing to position themselves: • Community Mental Health & Supportive Housing have been quick off the mark to set up as alternative to LTC homes • LHINs have minimal understanding of LTC home sector

8. April 1st, 2007 The “world” changed for all health service providers (HSPs): • Local Health Systems Integration Act (LHSIA) transferred powers to the LHIN Boards • LHIN community engagement now focused on: • “Positive obligation” by all to integrate • “Testing” their new accountability powers

9. April 1st, 2007 Want to show you what this now looks like “in the field”: • Handout on your table - key LHIN messages to LTC homes at transition & typical LHIN structure • LHIN leads to present examples of LHIN engagement by LTC homes: • C. Chartier, OMNI Health Ltd. • C. Nurenberger, Leisureworld Inc. & M. MacDonald, Chartwell Seniors Housing REIT

10. LHIN Involvement Getting Involved Has To Be A Priority Now Candace Chartier LHIN Lead for LHIN 9

11. Corporate Involvement • OMNI Health Care – 16 Homes dispersed across 4 Local Health Integration Networks • Corporate Lead – liaison with OLTCA • Created Engagement Team to ensure every home involved with LHIN leads • Engagement Team meets every two months to discuss priority challenges, opportunities and engagement opportunities

12. Engagement Committee

13. Trends In Central East LHIN • Networks are meeting monthly (CDPM, Collaboratives, ALC Task Group, SCS) • Collaboratives - also want to have impromptu meetings – have to ensure a presence at these meetings • Proposals being forwarded for approval (Supportive Housing/Community Care teaming up with Canadian Mental Health Association with minimal LTC involvement)

14. Trends Continued • Supportive Housing/Mental Health have become competitive which will impact LTC if LHINs have local dollars to move around • In Central East long history of certain sectors working together – LTC has to position itself to be a strong entity in this group – focus on centralized funding, systems and benefits for low costs

15. Moving Forward • Ensure there is a LTC voice in every Network or priority group • Maintaining close collaboration with OLTCA • Determining costs to live in community vs cost of living in LTC-can we determine definitive numbers as supportive housing stating costs are extremely lower • Highlighting benefits of LTC and the quality of living, innovative stories

16. Moving Forward • Get involved at the corporate level as well as the home level – make time to be in the know or you may miss opportunities for engagement • The more you network and enhance who you are and the great things you do the stronger voice LTC will have • Participation is not an option!

17. Next Six Months • June Symposium 5th-7th – will decide where action items from the IHSP are delegated and who will be responsible (signals the time to move towards action) • Members reviewing commitments and selecting terms of office • All proposals to be reviewed by Networks and Collaboratives for input to LHIN – essential to know what is in each proposal

18. Next Six Months • Core message from Symposium: -Era of micromanagement is over and accountability is on (Queens Park not in control, it is up to HSP to live within your means-get your house in order) -Owners, operators and senior executives should have been there -Section 25 and 26 of LHIN Act reinforced-not only are you expected to balance your budget, you will realign yourself and prove where you have participated/integrated with others We are good the balanced budgets as this is not new to us however we are not so good at the integration piece and we have to pull our socks up! -Stop orders and integration decisions do not have to follow a negotiation pattern (you will do it!)

19. Key message • It is up to you to work collaboratively in your community, get your house in order and “story tell” about what you are good at • Get involved in your LHIN and get to know who your leaders are • Participation is not an option!

20. LHIN InvolvementThe Central LHIN: LTC’s place in the big scheme of things – April 2006 Christine Nuernberger and Mike MacDonald LHIN Leads for LHIN 8

21. Background on The Central LHIN • Number of LTC homes in the LHIN (breakdown of municipal, charitable, private) • - Number of OLTCA represented homes 75% • - Number of OANHSS represented homes 25% • Area had no pre-existing, sector-specific forum for deliberation, idea sharing ie) “Administrators’ Roundtable”. • Similarly, no evidence of grassroots mobilization of homes to establish a united means of engaging with the LHIN unlike in other sectors, specifically Mental Health and Addictions

22. Consulting the sector • October 2005: Central LHIN moving into consultative mode; Meet and Greets, Advisory Groups being convened and the “one and only” sector-specific set of consultations held • Spring 2006: CEO poses the question: “How do you – as a sector – suggest we consult LTCHs?” • OLTCA LHIN communication leads hold information session regarding funding, compliance and placement. Homes from both associations attend. Attendance holds promise for a LHIN focused forum for dialogue • June 2006: OLTCA and OANHSS representatives call sector meeting with CEO as invited speaker

23. Questions for the sector • The CEO of the Central LHIN restates central questions: • 1) How can the LHIN increase the opportunities for the engagement of LTC homes? •  2) Is there a process/mechanism that LTCHs could agree upon for appointing appropriate representation of the sector in LHIN activities? •  Broad discussion ensues, no specific resolution but a shared belief among participants that a sector-endorsed solution was desirable and attainable. • Next step? Sector reps arrange for a facilitated session to explore these questions 

24. Terms of Reference Key components: Preamble: “LTCH providers have created a LTCH Liaison Committee … which will … operate on behalf of LTCH providers to broker and facilitate their participation and engagement in Central LHIN planning activities. “ Committee Composition: Reflection of geographic location with LHIN, varying size of operations, varying incorporated status Working Assumptions: Includes commitment to two-way communication between homes and the LHIN; no profit, not-for-profit preference on part of the LHIN; acceptance that consulting all homes on every issue is impossible; homes will remain active in own associations and share as they see fit; business specific to individual provider and LHIN will continue independent of LHIN.

25. Terms of Reference (Cont’d) Role and Activities of : - TheCommittee - LTCH Providers - LTCH Reps on LHIN committees/work groups Communications: - LHIN to LTCH providers - LHIN to Liaison Committee - Liaison Committee to LTCH Providers - Liaison Committee to Central LHIN

26. Electing a LTCH Liaison Committee • In keeping with Terms of Reference, composition should include consideration of following criteria: • i) 3 for-profit LTCH providers, 3 not-for-profit providers • 2 from the each area of the LHIN ie) south, middle and north • 2 from small homes (less than 125 beds), 2 from large homes (more than 125 beds) and two representatives from multi-service providers • Balloting in July 2006 resulted in inaugural Liaison Committee, reflecting the intent of the composition criteria.

27. Populating Committees • Primary function of Liaison Committee has been to populate work groups, committees and advisory bodies • LTC reps active on following LHIN : • * Specialized Geriatric Services – 1 rep • * Senior-Friendly Activities – 1 rep • * Seniors’ Transportation Work Group – 1 rep • * LTC Work Group –3 reps • * Palliative/End of Life Care – 1 rep • * Communication Advisory Group – 1 rep • Representation from LTCHs also found on e-health, Health Human Resources, Seniors Advisory

28. Challenges • ISSUE #1: Communication • How do 6 Liaison Committee members maintain the communication flow between themselves? Between the committee and 50 homes? Very real logistical constraints have limited the communication flow. • ISSUE #2: Representing the diversity within the sector • Since the T of R isn’t about ‘brokering consensus’, how well can committee members represent the diversity of providers? • ISSUE #3: Keeping the expectations realistic • Both the LHIN and individual providers must recognize the limitations of this model. It cannot be seen as a substitute for individual responsibility of each provider to stay engaged and informed.

29. Where to from here?

30. Challenges Ahead • Positive obligation for everyone to integrate • LHIN Board authority to ask for reports, service agreements, etc. • Historically, private sector not as involved (or not invited) in local community & mental health networks, collaboratives, etc. • LHIN Board collaborative governance model currently omits homes without Boards (private & municipal homes)

31. Challenges Ahead, cont’d • New contacts and key players replace central access: • Ministry central Financial Management Branch (FMB) for financial issues • Ministry Service Area Office (SAO) for compliance issues • LHIN for IHSP and emerging accountability issues • Local hospitals, CCACs, community support & mental health organizations for integration opportunities

32. Next Steps for OLTCA • Continue to evolve structure & role to provide strategic leadership: • Build on decision-making structure developed to balance our role and that of individual member homes • Identify potential risks as LHINs “test” their accountability powers (e.g. requests for operational information)

33. Next Steps for OLTCA • Identify trends for provincial solutions when appropriate • e.g. collaborative governance, specialty programs (CCP, PD, etc.), burden of LHIN reporting requirements • Re-approach OANHSS to strategically avoid “divide and conquer”

34. Next Steps for OLTCA, cont’d • Keep existing provincial issues on track: • Capital renewal • Centralized funding • Service accountability agreement template • Performance indicators & score card

35. OLTCA Next Steps • Support LHIN Leads: • Quarterly meetings/teleconferences with all • Ongoing support/communication via Senior Staff • Develop and assist with key messaging for identified common strategic issues (e.g. ALC)

36. Next steps for Members • Step up: • Develop incentives for Administrators to participate • Communicate with OLTCA LHIN Leads • Get to know the new contacts and key players in the LHIN, SAO and Ministry’s central FMB

37. Next steps for Members Step up, cont’d: • Build relationships with the “natural leaders” among the other LTC homes and HSPs (hospitals, CCACs, CS & MH agencies) • Browse your LHIN’s web page for updates, committee minutes, etc. • Attend (or host) an open LHIN Board meeting