CADA Presentation
March 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, forwardthinking
page 2
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.
page 3
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.
page 4
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
page 5
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
page 6
Long Term Care Funding Today
LOC Funding
Physiotherapy
NPC
Per Day
PSS
Per Year
Convalescent Care Subsidy
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
page 7
Other Long Term Care Funding
Other Funding
2012
2013
Apr. 2014
Total Government Funding for Long
Term Care
$3.7 B
$3.8 B
$3.9 B
Total 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
Up to
Direct Care Staff
$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
page 8
Nursing and Personal Care Envelope
• All incontinence costs come out of the NPC Envelope
page 9
2012 OA Cost Breakdown
Based on 315 2012 LTCH Annual Reports
page 10
Increase in Chronic Conditions
• 11
Source: Canadian Institute of Health Information, Continuing Care Reporting System,2008-2013
page 11
Increased Support of Activities of Daily
Living Over 5 Years
• 12
Source: Ontario Ministry of Health and Long Term-Care: IntelliHealth Ontario, 2008-2013
page 12
Increases in Neurological and Behavioural
Disorders over the past 4 years
• 13
Source: OLTCA Research Project-Dr. Colin Prerya
page 13
Action to Date
The problems are
real
• 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
A plan was set in
motion
Key elements are
in place
• Ontario’s Action Plan for
Health Care (Jan. 2012) is
the foundation for
transformation
• A quality regime is in
place (ECFAA) – needs to
expand beyond acute
sector and become more
transparent to consumers
“Make Ontario the
healthiest place in North
America to grow up and
grow old”
• Lack of accountability
and transparency
• Access, quality, and value
drive improvements –
focus on right care, right
time, right place
• Patients were confused
about where to go
• Two years in, progress has
been made:
• If unchecked, changing
demographics would
result in higher costs to
the system
• 99 of 105 C.R.O.P.S.
(Drummond)
recommendations are
fully or in progress
towards being
implemented
• 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
page 14
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
• 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.
page 15
15
Key Initiatives and Areas of Focus
Modernize Home
and
Community Care
Ensure Sustainability
and Quality
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
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
page 16
Health System Funding Reform (HSFR)
Financial Lever with a Quality Focus
Health Based Allocation Model
(HBAM)
•Evidence-based, health-based funding formula
•Enables government to equitably allocate available funding for
local health services
•Estimates future expense based on past service levels and
efficiency, as well as population and health information (e.g.
age, gender, population growth rates, diagnosis and procedures
used
Quality-Based Procedures (QBPs)
•Specific groupings of health services (e.g. cataract, hip
replacement)
•Improves outcomes by reducing practice variation while driving
efficiency by paying for only high quality care
•Allocation at specific groupings level
•Set Price and Volume
page 17
Health System Funding Reform and
Quality-Based Procedures
•
HSFR is a key focus area in ensuring sustainability
and quality across the health system.
•
The future of QBPs
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
Palliative
Eye
Emergency
Room
Pediatric
enhancements
•

Evaluation of HSFR implementation

Change management across the sector
As QBPs are developed across the continuum of
Women’s
Health
Musculoskeletal
Mental
Health
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.
page 18
QBPs and LTC
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)
page 19
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
page 20
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
Quality
Value
Access
Integration
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.
page 21
21
Where to next:
Maximizing our levers to drive health system
improvement
WHERE WE’VE BEEN
WHERE WE CAN STRENGTHEN…
EXAMPLES
1
Sector specific
Integrated approaches across health sectors
Bundled payments /
Episodes of care
2
Primary Care not coordinated
Coordinated care with health system partners
Health Links
3
Leadership concentrated in acute sector Leadership developed across all sectors
IDEAS
4
Care organized around the provider
Care organized around the patient
Patient experience
5
Incremental volume-based approach
System wide capacity planning
Evidenced-based care
6
Silo’d levers
Mutually reinforcing levers
QIPs / QBPs
7
Disease specific
Patient-based
QBPs – next generation
8
Separate, distinct quality focus
Quality embedded in programs and funding
Leveraging HQO role
9
Value = Quality / Cost
+ Appropriateness
Addressing variation
One size fits all
Recognizing differences: size, locale, geography
Customized approaches
10
page 22
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.
page 23
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.
page 24
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
page 25
OLTCA Political Platform
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.
page 26
Solutions
To ensure that seniors receive the safe, highquality care that they need and deserve, the
government needs to act now.
1.
2.
3.
4.
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
page 27
page 28
page 29
page 30
Thank You
page 31
2015-2018 Strategic Plan (DRAFT)
• 32
page 32