Long-Term Care Home Accountability
Planning Submission (LAPS) Guidelines
2016-19
Education Session
Overview
•
Priorities
•
What are the LAPS and LSAA?
•
LAPS Guidelines Development
•
LAPS Overview
•
Instructions for the completion of LAPS Forms
•
Timeframes
•
Questions
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Patients First – Action Plan for Health Care
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Pan-LHIN Health System Aims
Ontario’s LHINs recognize the value of focusing their collective efforts on common
challenges. For this reason, and to better align high-level objectives of Patients First with
the work of local health service providers and community partners, LHINs are working
collaboratively on a series of provincial strategic initiatives:
• Transform the patient experience through a relentless focus on quality
• Drive innovation and sustainable service delivery
• Advancing Population Health
• Hospice/Palliative Care Provincial Strategy
• Mental Health and Addictions Strategy
• Enhance Access to high-quality Long Term Care
• Transforming Home and Community Care
• Supporting the Evolution of Health Links
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LAPS
•
The Long-Term Care Home Accountability Planning Submission (LAPS) is a planning
document that provides information about an individual LTCH and supports the
negotiation of the Long-Term Care Home Service Accountability Agreement (LSAA).
•
Each LTCH owns the LAPS document and is responsible for providing accurate and
complete information to the LHIN. If at anytime, information within the LAPS
document changes (i.e. between April 1st/2016 and March 31st/2019, the LTCH is
responsible for updating the LAPS).
•
Each LTCH governance structure is responsible for reviewing and approving this
information provided in the LAPS as well as the content and commitments of the
LSAA.
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PLACEHOLDER FOR IHSP DETAILS
•
PLEASE INSERT YOUR LHIN’S IHSP DETAILS HERE
•
LHIN Leads – Please utilize this slide to incorporate local content
that your LTCHs may find valuable in the context of the LAPS and
LSAA process.
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LSAA
•
The LSAA is the legal agreement between the LTCH and the LHIN. The LSAA will
replace the current service agreement (expires March 31st/2016). It is required under
LHSIA and the MLPA and will cover a three year term of April 1, 2016 to March 31,
2019.
•
The role of a LSAA is to clarify that the LTCH will be responsible for delivering not
only on performance, but also planning and integration towards the development of a
health system.
The LTCH’s LAPS and LSAA must reflect the home as part of a health care
system versus as an individual health care provider.
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How LAPS & LSAA Fit Together
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LAPS Guidelines Development
•
Consultation sessions were held with associations representing LTCHs in the
province, as well as OLTCA, OANHSS and AMO.
•
Feedback from a sample of LTCHs and the associations was considered and
addressed through three avenues:
o
Comments incorporated in the LAPS Forms & Schedules;
o
Comments incorporated in the LAPS Guidelines;
o
Development of training sessions; and
o
The development of a Question and Answer (Q&A) document.
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Roles and Responsibilities - MOHLTC
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Quality Inspection Program (Compliance, inspection & enforcement of LTCHA);
•
Evaluating the effectiveness of various programs used by the LTCHs;
•
Setting MOHLTC program and LTCH policy (including Funding and Financial Policies and
Capital Policies);
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Development of various funding programs;
•
Monitoring established Quality of Care;
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Licensing & approval of LTC beds, including establishment of fees, applications for beds in
Abeyance;
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Approving changes of ownership, sale of businesses and amalgamations of providers for
purposes of licensing;
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Determining payment models and various funding programs;
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Determining construction cost funding per diem and LTC bed development programs/policies;
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Approving LTCH management contracts;
•
Acting as the lead in the event of a bankruptcy and approving a third-party management
company; and
•
Long - Term Care Redevelopment.
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Roles and Responsibilities - LHINs
•
Establishing quality and performance indicators for health service delivery;
•
Monitoring the achievement of performance indicators;
•
Performance management;
•
Review and monitor: Occupancy/Utilization of beds, Placement refusal trends,
Transfer request trends, Wait list profiles;
•
Participate, as appropriate, in the preparation and submission of funding requests
related to LTCHs through the MOHLTC annual planning cycle;
•
Approve the conversion of existing long-stay beds as short-stay respite beds or
terminate the designation of convalescent care beds; and
•
Participating in long-term redevelopment in conjunction with the MOHLTC.
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LTCH Funding – MOHLTC Responsibilities
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For the review and reconciliation of funding on behalf of the LHINs using Audited
Annual Report, Revenue Occupancy Report, and administering the Subsidy
Calculation Worksheet, on behalf of the LHINs.
•
Examples of MOHLTC funded programs include:
o High Intensity Needs Funding;
o High Wage Transition Funding;
o Municipal Tax Allowance Funding;
o Pay Equity Funding;
o Physician On-call Funding;
o Structural Compliance Premium;
o Laboratory Services Funding;
o RAI/MDS Sustainability Funding; and
o Peritoneal Dialysis (PD) Funding.
•
The MOHLTC is also responsible for the development of funding models and
processes.
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LTCH Funding – LHIN Responsibilities
•
LHINs provide and administer the following types of LTCH funding:
o Level of Care Per Diem funding
o Non-Level of Care funding such as:
- Registered Practical Nurse Funding;
- Construction Cost Subsidy; and
- Convalescent Care Bed Additional Subsidy.
•
Authorize the recovery of unspent LHIN operating funds identified through the
revenue occupancy report and annual reconciliation process.
•
Re-allocate operating funds recovered through the revenue occupancy report.
•
CMI Calculation notification
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Changes to LAPS
•
The Service Plan Narrative has been adjusted to reflect some of the language
included in the Community Annual Planning Submissions (CAPS) as follows:
o
o
o
•
Included a question related to integrations and partnerships;
Added a section on Risk and Mitigations; and
Added a section on the Redevelopment Project.
The Description of Services Form has been aligned to the Schedule A to avoid
additional work and duplication involved in populating the schedules.
o
o
In 2015-16, Schedule A included sections covering A.1 – Site Identification
Information, A.2 - Licensed or Approved Beds & Classification, and A.3 - Bed
Type.
In 2016-17, Schedule A will include A.1- Site Identification Information, A.2 Bed
Types and Numbers and new this year, A.3 - Structural Information.
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LAPS Guidelines
Table of Contents
1. Introduction
2. Roles and Responsibilities
3. Key Planning Consideration for the LAPS and LSAA
4. LAPS Components
5. LHIN Evaluation of LAPS
6. Linking the LAPS to the LSAA
7. Directives, Guidelines and Policies
8. Changes Needing LHIN Review/Approval
Appendix A: Glossary
Appendix B: Description of Services and Service Plan Narrative
Appendix C: LHIN Contact Information
Appendix D: LHIN Provincial Strategic Framework
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Reporting Requirements…
•
Schedule C of the LSAA outlines financial and performance reporting required during
the term of the LSAA beginning April 1, 2016.
•
Financial Reporting continues to be based upon the calendar year.
o
OHRS/MIS Trial Balance;
o
Revenue/Occupancy Report;
o
Audited Annual Report; and
o
Financial Statements.
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Reporting Requirements (cont’d)
•
Reporting requirements based on the fiscal year and include but not limited to:
o
o
•
Staffing Report – annually; and
French Language Services Report – annually (particularly for designated
and identified homes only).
Reporting schedule will be available upon final approval of LSAA by LHIN Boards
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Description of Services and Service Plan Narrative
•
Each LTCH is required to complete the Description of Services and Service Plan
Narrative (LAPS - Appendix B).
•
The Service Plan Narrative provides the LTCH the opportunity to provide the LHIN
with an overview of the home including the unique features of the home, a description
of the population that the home serves and services that the home provides to meet
the needs of their resident group and community.
•
The LAPS consists of two components:
o
The Description of Home and Services; and
o
The Service Plan Narrative.
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Description of Services
•
The Description of services provides an overview of the LTCH and includes the
following information:
o
Site Identification Information;
o
Bed Types and Numbers;
o
Structural information;
o
Additional or Unique Services;
o
Specialized Designations;
o
Community linkages;
o
Services Supporting the Local Community; and
o
Quality Improvement Practices.
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A.1 General Information
(will be a part of Schedule A in LSAA)
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A.2 Licensed or Approved Beds & Classification/Bed Type
(will be a part of Schedule A in LSAA)
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A.3 Structural Information
(will be a part of Schedule A in LSAA)
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A.4 Additional Services Provided
(will not be a part of Schedule A in LSAA)
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A.5 Specialized Designations
(will not be a part of Schedule A in LSAA)
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A.6 Community Linkages
(will not be a part of Schedule A in LSAA)
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A.7 Services Provided to the Community
(will not be a part of Schedule A in LSAA)
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A.8 Quality Improvement Practices
(will not be a part of Schedule A in LSAA)
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Service Plan Narrative
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Details the services that the LTCHs provide to meet the unique needs of their resident
group and identify how they support the local community.
•
The information provided shall identify those services beyond the basic services
provided in LTC.
•
Information to be included within the narrative service plan will include:
o
o
o
o
o
o
o
o
Strategic Goals and Priorities;
Advancement of the IHSP;
Partnership/Integration Opportunities;
Situation Analysis;
Evaluation of Prior Year Performance (optional);
Changes to Operations Summary (optional);
Risks and Mitigations; and
Impact of Redevelopment Project (if any).
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Service Plan Narrative (cont’d)
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LSAA Indicators
•
The LSAA Indicator Work Group has been established to support the LSAA Advisory
Committee.
•
Based on direction from the LHIN CEOs, this Work Group produces documents and
recommendations for discussion by the Advisory Committee, including a list of
recommended LSAA indicators, technical specifications, target setting guidelines and
education materials.
•
This Work Group is comprised of representation from the LTC sector, including
leadership from various homes, OANHSS, OLTCA, MOHLTC, LHINs, HQO and
various municipalities.
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LSAA Indicators 2016-2019
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A number of new indicators were introduced to the LSAA in 2015-16.
•
Given this, the Advisory Committee approved the decision to carry over the 2015-16
slate of indicators into 2016-17.
•
The indicators are reflected on the following slide.
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LSAA Indicators 2016-2019
#
Indicator Name
Quality and Resident Safety
1
Percent of Residents who had a Fall in the Last 30 Days
2
Percent of Residents whose Pressure Ulcer Worsened
3
Percent of Residents on Antipsychotics without a Diagnosis of Psychosis
Status
Explanatory
Explanatory
Explanatory
4
Percent of Residents in Daily Physical Restraints
Organizational Health and Financial
5
Total Margin
6
Debt Service Coverage Ratio
Coordination, Access and Primary Care
7
Long-Stay Utilization
Explanatory
8
Number of Resident Transfers to ER from LTC Homes Resulting in Inpatient Admissions
per 1,000 LTC Home Residents*
Developmental
9
Wait Time from CCAC Determination of Eligibility to LTCH Response
Explanatory
10
Wait Time from LTCH Acceptance to Placement*
Developmental
11
Long-Term Care Home Refusal Rate
Explanatory
*Note: Developmental indicators are not included within SAAs.
Performance
Performance
Explanatory (Note: Percent
Resident Days will eventually
replace this indicator)
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LAPS Forms – Submission Process – Retrieving the LAPS
•
LAPS Forms will be made available by the LHINs; or LTCHs may go to
https://hsimi.ca/LTCHome website to download the LAPS Forms.
•
To download the LAPS Forms from the Ministry website (https://hsimi.ca/LTCHome),
log in to the site and click the “Facility Main” button.
•
Locate the “LAPS FORMS” link and click on the link.
•
This will bring you to the LAPS FORMS menu which lists the available forms (both
current and previous LAPS documents are listed). Use the “File Name” to locate the
current 2016-19 LAPS forms, which is comprised of two separate files:
1. Description of Services; and
2. Service Plan Narrative.
Download and save the forms using the same file name as displayed on the website.
File names must maintain the same standard format name of
“FileName_FacilityNumber.doc” (e.g. 2016-19DescriptionOfServices_NH4321.doc).
•
•
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LAPS Forms – Submission Process – Retrieving the LAPS (cont’d)
(screen capture from HSIMI website)
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LAPS Forms – Submission Process – Retrieving the LAPS (cont’d)
Screen Capture from https://hsimi.ca/LTCHome/Common/LAPS
The current LAPS Forms are not in the list below but will be once they are released online.
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LAPS Forms – Submission Process – Submitting the LAPS (cont’d)
•
LAPS Forms must be submitted by uploading both forms into the Ministry website
(https://hsimi.ca/LTCHome)
•
Complete submission and upload files (one form at a time) to the website
•
Files being uploaded must maintain the standard naming convention of
“FileName_FacilityNumber.doc”
•
Note: Files must be in the Microsoft Word “.doc” format type
•
LAPS forms can continue to be uploaded (updated) until “locked” by the LHIN
•
LTCHs experiencing technical issues with accessing the Ministry website, uploading
LAPS files, or requiring a new account to log in can call the Ministry’s tech support at
1-866-414-0013 for assistance
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LHIN Review of LAPS
Each LAPS document will be reviewed by LHIN staff to
• Ensure that the submission is complete;
• Ensure the LTCH is maintaining required services;
• Compare the narrative component with other information for consistency;
• Review assumptions for consistency and reasonableness;
• Confirm that community engagement has occurred;
• Identify any inconsistencies or anomalies in the submission; and
• Generate a list of questions for the LTCH.
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LSAA Project Timeline
Early Oct
LHINS will conduct local LAPS education sessions to provide HSPs
with LAPS Guidelines and supporting materials to complete the LAPS.
Late Nov
LSAA education sessions conducted by LHINS will provide HSPs with
information needed to complete the LSAA including indicators.
Nov 23
Completed LAPS are due to the LHINS by November 23, 2015. The
LAPS will facilitate the development of home-specific schedules that
accompany the LSAA template agreement.
Jan-Mar
Local LSAA consultations between LHINs and HSPs to finalize
LSAAs for HSP Boards sign off will take place between January and
March, 2016.
Mar 31
New LSAAs signed. All LSAAs are due to LHINs with HSP
Board/Operator sign-off by March 31, 2016.
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CONTACTS
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LSAA PSWG MEMBERS
LHIN Lead
LHIN Secondary Lead
LHIN Secondary Lead
LHIN
LHIN
OLTCA
OLTCA member rep
OANHSS
OANHSS
AMO
MOHLTC
MOHLTC
MOHLTC
MOHLTC
WG Support (Lead)
Emily Van de Klippe
Kiran Kumar
Elliot Fung
Ron Eng
Sheila Stirling
David Beirnes
Kimberley Shea
Jeffrey Graham
Jacques Dupuis
Dean Lett
Feng Ding
Gary Thompson
John Giangregorio
Ifeolu Ogunyankin
Andrea Tsuji
Central East LHIN
Hamilton Niagara Haldimand Brant LHIN
Waterloo Wellington LHIN
Central LHIN
Central East LHIN
OLTCA
Revera, Inc.
OANHSS
Au Chateau
Garry J. Armstrong Home in the City of Ottawa
MOHLTC, HDB
MOHLTC, LHIN Liaison Branch
MOHLTC, FMB
MOHLTC, HDB
LHINC
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