DRAFT Outcomes: DM – Decision Making DS – Discussion IE- Information/Education Strategic Direction: PDC – Person Driven Care EPP – Engaged and Proactive People SHC – Sustainable Health Care 1 BOARD OF DIRECTORS’ MEETING DATE: December 14, 2016 TIME: 12:00pm-3:30pm PLACE: Labelle Head Office Boardroom AGENDA TIME ITEM NUMBER TOPIC SPEAKER POLICY REFERENCE OUTCOME STRATEGIC DIRECTION IN CAMERA 12:00- 12:10 1.0 Call to Order 1.1 Welcome 1.2 Declaration of Conflict of Interest Denise Alcock Denise Alcock V-B-14 2.0 Approval of Agenda (including consent agenda) Denise Alcock DM 3.0 Consent Agenda (Any Board Member may request that any item be removed from consent agenda and moved to the regular agenda) Denise Alcock DM 3.1 Minutes from the November 16, 2016 Board meeting 3.1.1 Status of Follow-up/Action Items from Previous Board Minutes DM IE ALL ALL 3.2 Draft Finance and Audit Committee Minutes – December 5, 2016 3.2.1 Financial Statements IE IE ALL SHC 3.3 Quality Reports 3.3.1 Quarterly Events Report 3.3.2 Quarterly Complaints Report IE ALL 3.4 Bi-Annual Patient and Caregiver Council Update IE ALL 3.5 SCOPA Report IE ALL 12:10- 12:40 4.0 Board Chair and CEO Reports (verbal) 4.1 System Transformation Update (verbal) Denise Alcock / Marc Sougavinski IE ALL 12:40- 1:10 5.0 CSQS Reports 5.1 Adverse Events Status (verbal) 5.2 Accreditation Update (verbal) 5.3 QIP Update Q2 FY 2016-17 5.4 Summary Scorecard – Quality Indicators Melody Isinger / Catherine Butler / Jennifer Proulx IE DM IE IE PDC ALL ALL ALL 1:10- 1:40 6.0 Financial Reports 6.1 Summary Scorecard 6.2 Financial and Performance Results Maria Barrados/ Deryl Rasquinha IE IE SHC SHC
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DRAFT
Outcomes: DM – Decision Making DS – Discussion IE- Information/Education
Strategic Direction: PDC – Person Driven Care EPP – Engaged and Proactive People SHC – Sustainable Health Care
1
BOARD OF DIRECTORS’ MEETING DATE: December 14, 2016
TIME: 12:00pm-3:30pm PLACE: Labelle Head Office Boardroom
AGENDA
TIM
E
ITEM
NU
MB
ER
TOPIC SP
EA
KER
PO
LIC
Y
REFER
EN
CE
OU
TC
OM
E
STR
ATEG
IC
DIR
EC
TIO
N
IN
CA
MER
A
12:00-12:10
1.0 Call to Order 1.1 Welcome
1.2 Declaration of Conflict of Interest
Denise Alcock
Denise Alcock
V-B-14
2.0 Approval of Agenda (including consent
agenda) Denise Alcock DM
3.0 Consent Agenda (Any Board Member may
request that any item be removed from consent agenda and moved to the regular agenda)
Denise Alcock
DM
3.1 Minutes from the November 16, 2016
Board meeting 3.1.1 Status of Follow-up/Action Items
from Previous Board Minutes
DM
IE
ALL
ALL
3.2 Draft Finance and Audit Committee Minutes – December 5, 2016
Champlain CCAC Board of Directors – December 14, 2016
Item 3.3.1 – Quarterly Events Report PAGE 1
Submission to the Champlain CCAC Board of Directors
Quarterly Events Report: July 2016-September 2016 (Q2)
December 14, 2016
EVENT REPORTING
Adverse Events: The last Adverse Event occurred on January 3, 2016 (Q4, 15-16). Top 5 Reported Events in CELS in Q2: Within CELS, the event categories and definitions include those required internally and by the OACCAC reporting requirements and data collection needs. In Q2, the top five reported events were:
1. Client falls – Unwitnessed 2. Quality of Services Provided by SP – General 3. Abuse/Threat/Injury to Staff 4. Compliment about SP 5. Infusion Pump Issues
02468
1012141618202224262830
Jun
-14
Jul-
14
Au
g-1
4
Sep
-14
Oct
-14
No
v-1
4
Dec
-14
Jan
-15
Feb
-15
Mar
-15
Ap
r-1
5
May
-15
Jun
-15
Jul-
15
Au
g-1
5
Sep
-15
Oct
-15
No
v-1
5
Dec
-15
Jan
-16
Feb
-16
Mar
-16
Ap
r-1
6
May
-16
Jun
-16
Jul-
16
Au
g-1
6
Sep
-16
NU
MB
ER O
F EV
ENTS
DATE
UNWITNESSED FALLSJUNE 2014 - SEPTEMBER 2016
Median = 2.5
Champlain CCAC Board of Directors – December 14, 2016
Item 3.3.1 – Quarterly Events Report PAGE 2
Client Falls is captured through four subcategories: - Witnessed – without injury; - Witnessed – with injury; - Unwitnessed - Unwitnessed fall resulting in injury, recommendation to call 911 and/or use of
additional healthcare resources The latter subcategory was added in Q2 of FY 15/16, in order to have improved awareness of the extent to which unwitnessed falls are occurring that require the use of healthcare resources/intervention(s). Client falls continue to be addressed by Champlain CCAC and is an indicator on our annual Quality Improvement Plan. In FY
2016-17, the IMPACTT Centre has initiated field testing of a new intervention for falls screening.
Quality of Services Provided by Service Provider – General Quality of Service, for both CCAC and SPO staff, is captured through the subcategories: professionalism, responsiveness, time management and cleanliness. Quality of Service – General are those complaints which have an impact on the quality of services provided but do not fall into the identified subcategories. Continued review of these events have helped determine two new categories, specifically, Quality of Service – Consistency of Care, and Quality of Service – Continuity of Care. Discussions with our Service Provider partners reflect the importance of ensuring that staff, particularly Personal Support Workers (PSWs), are well informed and knowledgeable about clients’ careplans so that clients and families do not have to review each time they are cared for by a new PSW. In addition, SPOs are aware and trying to provide clients with consistency in the worker(s) that they see.
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Jun
-14
Jul-
14
Au
g-1
4
Sep
-14
Oct
-14
No
v-1
4
Dec
-14
Jan
-15
Feb
-15
Mar
-15
Ap
r-1
5
May
-15
Jun
-15
Jul-
15
Au
g-1
5
Sep
-15
Oct
-15
No
v-1
5
Dec
-15
Jan
-16
Feb
-16
Mar
-16
Ap
r-1
6
May
-16
Jun
-16
Jul-
16
Au
g-1
6
Sep
-16
NU
MB
ER O
F EV
ENTS
DATE
QUALITY OF SERVICES BY SERVICE PROVIDER - GENERALJUNE 2014 - SEPTEMBER 2016
Median = 8
Champlain CCAC Board of Directors – December 14, 2016
Item 3.3.1 – Quarterly Events Report PAGE 3
Abuse/Threat/Harassment/Injury to Staff An updated version of the Patient Bill of Rights and Commitments will be introduced before the end of FY 16/17 and the Champlain CCAC is nearing the end of the consultation process on redefining a standardized set of Case Escalation guidelines. These new guidelines will provide clear direction to staff and Service Provider staff on when to escalate a safety/risk issue involving a client or caregiver, the steps that are required and the appropriate timelines.
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Jun
-14
Jul-
14
Au
g-1
4
Sep
-14
Oct
-14
No
v-1
4
Dec
-14
Jan
-15
Feb
-15
Mar
-15
Ap
r-1
5
May
-15
Jun
-15
Jul-
15
Au
g-1
5
Sep
-15
Oct
-15
No
v-1
5
Dec
-15
Jan
-16
Feb
-16
Mar
-16
Ap
r-1
6
May
-16
Jun
-16
Jul-
16
Au
g-1
6
Sep
-16
NU
MB
ER O
F EV
ENTS
DATE
ABUSE/THREAT/INJURY TO STAFFJUNE 2014 - SEPTEMBER 2016
Median = 10
Champlain CCAC Board of Directors – December 14, 2016
Item 3.3.1 – Quarterly Events Report PAGE 4
Infusion Pump Issues Issues related to the use of infusion pumps in the community is a focus area for Accreditation – Home Care Standards. Events involving infusion pumps are now captured in CELS. In Spring 2016, there was a change to using one type of Continuous Ambulatory Delivery Device (CADD) Pump, which is the CADD Solis Smart Pump. There has been ongoing work with our Supplies and Equipment vendor and with our Service Provider partners to address reported pump issues. Further meetings are being led by Clinical Care and Quality to ensure that an appropriate action plan is developed.
Jennifer Proulx Director, Quality and Program Evaluation
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Jun
-14
Jul-
14
Au
g-1
4
Sep
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Oct
-14
No
v-1
4
Dec
-14
Jan
-15
Feb
-15
Mar
-15
Ap
r-1
5
May
-15
Jun
-15
Jul-
15
Au
g-1
5
Sep
-15
Oct
-15
No
v-1
5
Dec
-15
Jan
-16
Feb
-16
Mar
-16
Ap
r-1
6
May
-16
Jun
-16
Jul-
16
Au
g-1
6
Sep
-16
NU
MB
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F EV
ENTS
DATE
COMPLIMENT ABOUT SPOJUNE 2014 - SEPTEMBER 2016
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Jun
-14
Jul-
14
Au
g-1
4
Sep
-14
Oct
-14
No
v-1
4
Dec
-14
Jan
-15
Feb
-15
Mar
-15
Ap
r-1
5
May
-15
Jun
-15
Jul-
15
Au
g-1
5
Sep
-15
Oct
-15
No
v-1
5
Dec
-15
Jan
-16
Feb
-16
Mar
-16
Ap
r-1
6
May
-16
Jun
-16
Jul-
16
Au
g-1
6
Sep
-16
NU
MB
ER O
F EV
ENTS
DATE
INFUSION PUMP ISSUESJUNE 2014 - SEPTEMBER 2016
Median= 9
Median = 11.5
Champlain CCAC Board of Directors – December 14, 2016
Item 3.3.2 – Quarterly Complaints Report PAGE 1
Submission to the Champlain CCAC Board of Directors
Quarterly Complaints and Compliments Report:
July 2016- September 2016 (Q2)
December 14, 2016
COMPLAINT AND COMPLIMENT REPORTING
Complaint categories: There are six complaint categories captured in CELS 2.0. Compliments provided to both CCAC and SPO staff are also reported:
Amount of services: Complaint regarding the CCAC’s decision about the amount of any particular service included in the plan of service Hey
Eligibility for services: Complaint regarding the CCAC’s decision regarding eligibility for service
Exclusion of Services: Complaint regarding the CCAC’s decision to exclude a particular service from the plan of service
Quality of services: Complaint regarding the quality of service provided or arranged
Termination of services: Complaint regarding the decision to terminate service
Violation of rights: Complaint about violation of client rights: Client Bill of Rights (LTC Act) or the Human Rights Act.
Compliment categories: Compliments provided to both CCAC and SPO staff are reported as follows:
Compliments about CCAC: Expression of appreciation, praise, or commendation of a CCAC staff member.
Compliments about SPO: Expression of appreciation, praise, or commendation of a Service Provider staff member.
Compliment about Health Care Team: Champlain CCAC category; expression of appreciation, praise, or commendation of both CCAC and SPO staff.
Each of the complaint categories are continuously reviewed and broken down into subcategories to better capture the actual area of concern.
Champlain CCAC Board of Directors – December 14, 2016
Item 3.3.2 – Quarterly Complaints Report PAGE 2
Complaints and Compliments Reported in CELS
Total Number
Reported (FY 2015-16)
Number Reported Q2 (FY 2016-17)
Number Reported YTD (FY 2016-17)
Average Days to Resolution (FY 2015/16)
Average Days to Resolution
Q2 (FY 2016-17)
Average Days to Resolution
YTD (FY 2016-17)
Complaints 725 123 226 30 61 52
Compliments 166 33 89 N/A N/A N/A
Total Number Of Complaints Reported In CELS (By Month):
0
10
20
30
40
50
60
70
80
90
100
110
120
Sep
-14
Oct
-14
No
v-1
4
Dec
-14
Jan
-15
Feb
-15
Mar
-15
Ap
r-1
5
May
-15
Jun
-15
Jul-
15
Au
g-1
5
Sep
-15
Oct
-15
No
v-1
5
Dec
-15
Jan
-16
Feb
-16
Mar
-16
Ap
r-1
6
May
-16
Jun
-16
Jul-
16
Au
g-1
6
Sep
-16
NUMBER OF COMPLAINTS BY MONTH SEPTEMBER 2014-SEPTEMBER 2016
Median= 57
Champlain CCAC Board of Directors – December 14, 2016
Item 3.3.2 – Quarterly Complaints Report PAGE 3
Total Number of Complaints and Compliments Reported in CELS (By Theme)
Note: There are no reports under Violation of Rights.
0
2
4
6
8
10
Sep
-14
Oct
-14
No
v-1
4
Dec
-14
Jan
-15
Feb
-15
Mar
-15
Ap
r-1
5
May
-15
Jun
-15
Jul-
15
Au
g-1
5
Sep
-15
Oct
-15
No
v-1
5
Dec
-15
Jan
-16
Feb
-16
Mar
-16
Ap
r-1
6
May
-16
Jun
-16
Jul-
16
Au
g-1
6
Sep
-16N
UM
BER
OF
CO
MO
PLA
INTS
DATE
AMOUNT OF SERVICESEPTEMBER 2014-SEPTEMBER 2016
0123456789
101112
Sep
-14
Oct
-14
No
v-1
4
Dec
-14
Jan
-15
Feb
-15
Mar
-15
Ap
r-1
5
May
-15
Jun
-15
Jul-
15
Au
g-1
5
Sep
-15
Oct
-15
No
v-1
5
Dec
-15
Jan
-16
Feb
-16
Mar
-16
Ap
r-1
6
May
-16
Jun
-16
Jul-
16
Au
g-1
6
Sep
-16
NU
MB
ER O
F C
OM
PLA
INTS
DATE
ELIGIBILITY FOR SERVICESSEPTEMBER 2014 - SEPTEMBER 2016
Median=1
Median = 2
Champlain CCAC Board of Directors – December 14, 2016
Item 3.3.2 – Quarterly Complaints Report PAGE 4
0123456789
10
Sep
-14
Oct
-14
No
v-1
4
Dec
-14
Jan
-15
Feb
-15
Mar
-15
Ap
r-1
5
May
-15
Jun
-15
Jul-
15
Au
g-1
5
Sep
-15
Oct
-15
No
v-1
5
Dec
-15
Jan
-16
Feb
-16
Mar
-16
Ap
r-1
6
May
-16
Jun
-16
Jul-
16
Au
g-1
6
Sep
-16N
UM
BER
OF
CO
MP
LAIN
TS
DATE
EXCLUSION OF SERVICESSEPTEMBER 2014 - SEPTEMBER 2016
0
10
20
30
40
50
60
70
80
90
100
Sep
-14
Oct
-14
No
v-1
4
Dec
-14
Jan
-15
Feb
-15
Mar
-15
Ap
r-1
5
May
-15
Jun
-15
Jul-
15
Au
g-1
5
Sep
-15
Oct
-15
No
v-1
5
Dec
-15
Jan
-16
Feb
-16
Mar
-16
Ap
r-1
6
May
-16
Jun
-16
Jul-
16
Au
g-1
6
Sep
-16
NU
MB
ER O
F C
OM
PLA
INTS
DATE
QUALITY OF SERVICES BY SERVICE PROVIDERSEPTEMBER 2014 - SEPTEMBER 2016
Median=0
Median = 41
Champlain CCAC Board of Directors – December 14, 2016
Item 3.3.2 – Quarterly Complaints Report PAGE 5
0
5
10
15
20
25
30
Sep
-14
Oct
-14
No
v-1
4
Dec
-14
Jan
-15
Feb
-15
Mar
-15
Ap
r-1
5
May
-15
Jun
-15
Jul-
15
Au
g-1
5
Sep
-15
Oct
-15
No
v-1
5
Dec
-15
Jan
-16
Feb
-16
Mar
-16
Ap
r-1
6
May
-16
Jun
-16
Jul-
16
Au
g-1
6
Sep
-16
NU
MB
ER O
F C
OM
PLA
INTS
DATE
QUALITY OF SERVICES BY CCACJUNE 2014 - JUNE 2016
0
1
2
3
4
5
6
7
8
9
10
Sep
-14
Oct
-14
No
v-1
4
Dec
-14
Jan
-15
Feb
-15
Mar
-15
Ap
r-1
5
May
-15
Jun
-15
Jul-
15
Au
g-1
5
Sep
-15
Oct
-15
No
v-1
5
Dec
-15
Jan
-16
Feb
-16
Mar
-16
Ap
r-1
6
May
-16
Jun
-16
Jul-
16
Au
g-1
6
Sep
-16
NU
MB
ER O
F C
OM
PLA
INTS
DATE
TERMINATION OF SERVICESSEPTEMBER 2014 - SEPTEMBER 2016
Median=4
Median = 0
Champlain CCAC Board of Directors – December 14, 2016
Item 3.3.2 – Quarterly Complaints Report PAGE 6
Days to Resolution for Complaints Reported in CELS
In September, there were 11 complaints closed in CELS that were overdue and this has influenced the average days to resolution for the month. The delays did not impact the action(s) taken to address the complaints but rather reflect the technicality of the delay by the responsible individual(s) ‘closing’ the complaints in the CELS system. Jennifer Proulx Director, Quality and Program Evaluation
0102030405060708090
100110120
Sep
-14
Oct
-14
No
v-1
4
Dec
-14
Jan
-15
Feb
-15
Mar
-15
Ap
r-1
5
May
-15
Jun
-15
Jul-
15
Au
g-1
5
Sep
-15
Oct
-15
No
v-1
5
Dec
-15
Jan
-16
Feb
-16
Mar
-16
Ap
r-1
6
May
-16
Jun
-16
Jul-
16
Au
g-1
6
Sep
-16
AV
ERA
GE
NU
MB
ER O
F D
AY
S
DATE
COMPLAINTS: AVERAGE DAYS TO RESOLUTION SEPTEMBER 2014 - SEPTEMBER 2016
Median 26 2462426
Champlain CCAC Board of Directors – December 14, 2016
Item 3.4 – Bi-Annual Patient and Caregiver Council Update PAGE 1
Submission to Champlain CCAC Board of Directors
Bi-Annual Patient and Caregiver Council Update
December 14, 2016
June 2016 to December 2016
Key Deliverables
The Patient and Caregiver Council is part of the Committee Governance Structure of the Champlain CCAC. In accordance with the Terms of Reference, Council is obliged to report bi-annually to the Champlain CCAC Board of Directors (to the Board in June and to the CSQS Committee in December). As there is no CSQS Committee meeting in December, this report is being provided to the Committee as a Whole. It should be noted that this report provides an overview of activities since the presentation to the Board of Directors on June 22, 2016. Patient and caregiver engagement is an ongoing focus for the Champlain CCAC, and considerable progress has been made to date as outlined in this report. Patient and Caregiver Council
With the expansion of the Patient and Family Advisor Program, the Patient and Caregiver Council is now the body that oversees all patient engagement activities. The Terms of Reference have been amended to reflect this change. (Appendix A - TORS). Patient Advisor Recruitment
As an organization, we recognize the importance of engaging with diverse communities across Champlain. Recruitment efforts for both Patient Advisors and Patient and Caregiver Council members continue to focus on multi-cultural/multi-linguistic communities. Earlier this fall, Lise Racicot, Patient Engagement Coordinator and Jennifer Schenkel, Director, Communications, met with Wen Jean Ho and Sybil C. Braganza, from the Social Planning Council of Ottawa (SPCO) to discuss their new initiative Creating Community for Isolated Ethno-Cultural Seniors and partnership opportunities for the CCAC. This was a highly successful meeting and resulted in a commitment to the CCAC to provide presentations about CCAC programs and services to 18 ethno-cultural community groups connected to the SPCO initiative. Many multicultural communities are not aware of the Champlain CCAC or possible services available to them and their loved ones in the community. This engagement provides us with an important opportunity to increase the visibility of home and community care within these communities and potentially increase multicultural representation for the Patient and Family Advisor Program.
Champlain CCAC Board of Directors – December 14, 2016
Item 3.4 – Bi-Annual Patient and Caregiver Council Update PAGE 2
In October, with the assistance of Wen Jean Ho, who provided translation, a presentation was given to the Kanata Chinese Seniors Support Centre – Women’s Group. Many of those who attended the session are primary caregivers to their parents and are dealing with linguistic and cultural barriers. The goal of this presentation was to provide a brief overview of who we are, what we do and how to access CCAC services. A presentation to the Chinese Senior Group in Barrhaven is scheduled for the New Year and the Settlement Counselor at the Ottawa Chinese Community Service Centre will provide translation. (Appendix B - SPCO Initiative) New Patient Advisor
In November, Shailja Verma was interviewed as a potential Patient Advisor. Shailja is originally from India and was a caregiver to her mother. She was Manager of Continuing Education with the Ottawa Carleton School Board and has experience working with organizations serving immigrant populations including English as a Second Language. She is also well versed in cultural competency and provided training to the Ottawa and National Police Associations. With such a diverse perspective, Ms. Verma has been invited to join as a Patient Advisor and a member of the Patient and Caregiver Council. Patient Engagement
Listening, engaging and working with patients and caregivers is fundamental to the Champlain CCAC Patient and Family Advisory Program. We continue to add patient and caregiver representation to a variety of committees, projects and programs: Current Patient Advisor Activities (2016)
Onboarding of High Intensity Patients – Scott, Rachel, Carl (Fall/winter2016)
Setting of Service Expectations – Dee, Kelsey This initiative is now being led by Catherine Butler, Vice President, Clinical Care
Supplies and Equipment Delivery – Dee, Kelsey (on-going)
Patients on Hiring Committees – PA involvement TBC Betty Christie, Manager, People Services, HROD is currently developing an overview of the roll-out for this initiative (obligation, constraints, training)
Patient Rights and Commitments – Russ, Dee, Rachel, Carl (in the final stages)
Patient Escalation Process - Russ, Dee, Rachel, Carl, Scott (in progress)
PSW Educational Video – Russ, Rachel, Carl, Mattie, Janet (roll out December 2016)
Cancer Care Guidelines Review - U of Ottawa –Lead Claire Ludwig – Norma (October 2016)
Mental Health and Addiction – Kelsey (on-going)
Committees
Caregiver representation to the IMPACTT Centre Steering Committee – Janet
CCAC Donations Committee – Kelsey
Champlain CCAC Board of Directors – December 14, 2016
Item 3.4 – Bi-Annual Patient and Caregiver Council Update PAGE 3
Patient Representative to Client Services and Quality Committee of the Board – Russ
Patient Advisor Activities Highlights
PSW educational video
The Patient and Caregiver Council identified education of home care providers as an important work plan priority. An educational video featuring the firsthand perspectives of patients and caregivers was developed to educate personal support workers on creating a positive care experience. Carl and Rachel, and Russ participated in this initiative as well as, Patient Advisors Janet and Mattie. The video will be shared with the Service Provider Leadership Committee as a proposed training video for PSWs and will be shared with CCAC staff. A communication plan to promote this video will be developed and will include outreach to learning institutions such as Algonquin and St. Lawrence Colleges. Patient and Caregiver Charter of Rights and Responsibilities
In February 2016, a working group of Council members met to begin discussing the elements of a Patient and Caregiver Charter of Rights and Responsibilities. The working group comprising Patient Advisors members, CCAC staff and Service Providers, discussed the core elements and intent of the document – that it be the foundation for a partnership between patients/caregivers and their home care providers. It was determined that this new “charter” should align with the current Patient and Caregiver Declaration of Values (trust, dignity and respect). After much discussion and Patient Advisor input, a new Patient Rights and Commitments document was developed. This new Patient Rights and Commitments document was reviewed and approved by the Champlain CCAC Executive Committee as well as the Partnership Leadership Table, which includes leadership from all of the Service Provider Organizations. A new document was developed: (Appendix C “The Patient Rights and Commitments”). The next phase of this project is to review the Champlain CCAC Complaint Escalation Process. Patient Advisors met with Samantha Soubliere, Patient Experience and Risk Specialist, Quality & Program Evaluation, to review the current process and provide input from the patient/caregiver perspective. Members of Clinical Care and Service Provider Organizations will also be asked to review the process and provide input. IMPACTT Centre – Janet, Patient Advisor
The IMPACTT Centre is an innovation hub that monitors and moves home care technology from ideas all the way through to real solutions in patient homes. It is a unique testing ground that allows staff to try out, refine and evaluate technological solutions in a realistic home setting. The Centre is engaged in a number of projects, which use home care technologies to enhance care and supports to patients, caregivers and home care providers. Janet Keefe is a member of the IMPACTT Centre steering committee. Janet’s role is to use
Champlain CCAC Board of Directors – December 14, 2016
Item 3.4 – Bi-Annual Patient and Caregiver Council Update PAGE 4
her experiences as a caregiver to assess potential usefulness, practicality and acceptability of various home health technologies, and to identify areas for potential development. In this capacity, Janet has provided a caregiver perspective related to the “Connected Wellness Project”, between NexJ; (the company creating the software) and the IMPACTT team as they worked on the design, development, refinement and measurement of this multifaceted support program. The Wandering Detection and Diversion project will soon enter its trail phase and Janet was involved in the initial discussions around the design for its practical application and purpose -- to give caregivers of people with dementia better quality sleep and detect potentially dangerous wandering behavior. Activities Highlights July to November 2016
Patient Advisors are engaged in a variety of initiatives, including: Champlain LHIN/CCAC Board Retreat, August 31st 2016
Russ, as Co-chair of the Patient and Caregiver Council was invited to attend to the Champlain LHIN and CCAC Board Retreat to represent and bring the table the patient/caregiver voice and perspective. University of Ottawa MHA Bear Pit Session 2: Leading Change: Effective Engagement of Patients and Families, October 11, 2016
Kelsey, Patient Engagement Advisor, presented and was part of a panel discussion. Other members of the panel included Jacquie Dale, consultant and a partner at One World Inc., Robin Sully, Co-Chair of the Ottawa- Gatineau Multiple Myeloma Support Group and Chair of the Multiple Myeloma Ontario Advocacy Committee and, Mireille Brosseau, Experience Based Co-Design (EBCD) Facilitator with CHEO. Leading approaches in the field were profiled including practice examples from the perspective of patients/caregivers and those that support engagement work. MHA students and potential MHA students attended the session. Local
4th Dundas County 50 Plus Wellness Day, October 13, 2016 Scott assisted with Champlain CCAC booth. 186 attendees and 28 organizations hosted booths at this event held in Dixon’s Corners in Dundas County.
Kanata Senior Centre presentation, September 21, 2016 Dee co-presented with Champlain CCAC Care Coordinator Melanie Neale. An overview of CCAC services and programs was provided and Dee shared information about the Patient and Family Advisor Program and how to get involved.
ReThink Dementia Conference, November 1, 2016 The Champlain CCAC hosted a booth at this event and Janet, Patient Advisor, attended the event.
Champlain CCAC Board of Directors – December 14, 2016
Item 3.4 – Bi-Annual Patient and Caregiver Council Update PAGE 5
Upcoming opportunities
On January 26th 2017, the Patient and Family Advisor Program will be presented to the Champlain CCAC Rounds, an opportunity to highlight the important role of the Patient Advisor to CCAC staff and community partners. Lise Racicot, Patient and Stakeholder Engagement Coordinator will provide an overview of the program and Russ as Co-chair of Patient and Caregiver Council will highlight Council and Patient Advisor activities and the value of their perspective to CCAC process, programs and new initiatives.
Update – Family Caregiver Day Act, 2016 / Loi de 2016 sur les aidants naturel
Due to the government being prorogued in September, the original Family Caregiver Day Bill died. On November 15th, Ontario NDP Health critic France Gélinas, with the support of the Ontario Caregiver Coalition (OCC), re-introduced a bill in the Ontario Legislature. This bill is to increase recognition and awareness of family caregivers by proclaiming the first Tuesday of every April as Family Caregiver Day. Update Bill 41, Patients First Act, 2016
Due to the legislature being prorogued, Bill 210 Patients First legislation tabled on June 2nd, will be reintroduced in the legislature in early October. The proposed legislation will be introduced as Bill 41, Patients First Act, 2016. Chantale LeClerc, Champlain LHIN CEO is leading the Patient Engagement stream to which Patrice is a member. This committee will be looking at best practices across the province and are currently compiling resources such as TORs. The proposed Patients First act states that each local health integration network shall establish one or more patient and family advisory committees. It is not yet known what the Champlain LHIN Patient and Family Advisory committee would look like i.e. governance, membership etc. Patient and Caregiver Council members agreed that it would be an opportune time to invite Chantale LeClerc to come speak to members. The invitation was extended and Chantale agreed to attend the December 8th Council meeting. EXECUTIVE SPONSOR:
Patrice Connolly, Vice-President, People and Stakeholder Engagement
CHAMPLAIN CCAC PATIENT AND CAREGIVER COUNCIL Leadership Sponsor: Patrice Connolly Vice-President People and Stakeholder Engagement
Terms of Reference
1. Purpose
The Champlain Community Care Access Centre (CCAC) recognizes patients,
caregivers and families as essential partners in care. The Patient and Caregiver
Council is a forum to improve the home and community care experience in the
Champlain region for former, current and future patients and caregivers.
The purpose of the Council is to provide direction – oversight on patient and
family centred care strategies and initiatives related to improvements in the
patient experience.
The objectives of this Council are:
• To provide input regarding their personal experiences to inform CCAC
planning, implementation and evaluation of services
• To reflect the needs of patients and caregivers in order to improve the quality
of care and services
• To provide input on matters concerning the health and well-being of patients
and their caregivers
• To identify gaps in information, services and education for patients and
caregivers
• To provide an opportunity to identify and monitor emerging issues concerning
patients and their caregivers
2. Framework
The Patient and Caregiver Council is part of the Committee Governance Structure of the Champlain CCAC.
The Patient and Caregiver Council will primarily use the following Framework to guide their planning and work:
• The Patient and Family Centred Care Framework, based on the work by KL Carman et al. in the ‘Patient and Family Engagement: A Framework for
Champlain CCAC Patient and Caregiver Council – TORS APPROVED October 4, 20162016
Understanding the Elements and Developing Interventions and Policies’, Health Affairs 32, no.2 (2013)
• The Champlain CCAC Engagement Framework (2015) • The PFC will use their work plan priorities to feed into the Champlain CCAC
Engagement Framework.
3. Responsibilities
The responsibilities of the Champlain CCAC Patient and Caregiver Council are:
• To declare conflict of interest at meetings where indicated
• To give input from the perspective of the patient and family to the CCAC on
its directions, initiatives and services
• To go beyond their experiences to improve care for others
• To be willing to share their story or contribute to public awareness
• To provide input to improve services for patients and their families
• Represent on other local, provincial or internal CCAC committees as required
The responsibilities of the Champlain CCAC are:
• To include the patient and caregiver voice in board meetings
• To support the efforts of the Council and its members
• To maintain transparent and open communications
• To ensure responsiveness and awareness of caregiver needs, where possible
thru unique programs for caregivers
• To have regular dialogues between the organization’s leaders and clients and
families to solicit and incorporate client and family perspectives into
opportunities for improvement
4. Members
• The Council will be between 6 and 8 members who represent a cross-section of patients and caregivers from the territory served by the Champlain CCAC.
• Members will be current, former and future home care patients and caregivers.
Membership is at the invitation of the CCAC and selected by an internal working group composed of staff and council members.
Champlain CCAC Patient and Caregiver Council – TORS APPROVED October 4, 20162016
Members will represent operational departments including, but not limited to:
• VP People and Stakeholder Engagement
• VP of Clinical Care or designate/ Senior Director, Clinical Care
• Director, Quality
• Care Coordinator Representation
• Patient and Stakeholder Engagement Coordinator
• Other staff on invitation
• Invited guests on an ad-hoc basis
Trial Period There will be an initial trial period of 6-month for all new members to ensure
“fit”.
The purpose of the trial period is to provide orientation, guidance, and coaching to a new council member. This period is also the final phase of the selection process that will provide co-chairs and the new member an opportunity to mutually evaluate their position on council to ensure a suitable and acceptable fit and purpose. Orientation
All new members will receive an orientation providing an overview of the Champlain CCAC including governing provincial legislation, providing a better understanding of the who, what, when, where, and why of the organization, and how they as a new member of council fit within the larger picture. New members will be assigned a mentor. Membership Term
• The term is a two-year membership with the possibility of a one-term renewal (max. 4 consecutive years)
• Members may withdraw from membership at any time and by any means (i.e. written or verbal)
• In the management of term renewals, consideration will be made to maintain a balance of new and experienced members
• Terms of Reference and Membership to be reviewed annually • In recognition that patients may experience difficult periods due to their
condition or circumstances, a member may request a leave of absence or alternately Council may suggest a leave of absence.
Champlain CCAC Patient and Caregiver Council – TORS APPROVED October 4, 20162016
Leadership
The VP of People and Stakeholder Engagement will be the Executive sponsor.
There will be two (2) Co- Chairs of the Patient and Caregiver Council. Co-chairs
shouldn’t change at the same time. Co-chairs should come from current council
members.
5. Meetings The Patient and Caregiver Council will meet a minimum of four times per year. A draft agenda for each meeting shall be sent one week prior to the meeting. The Council Co-Chairs will ensure that the following documents are circulated at least three (3) days in advance of each meeting: • The Agenda for the meeting; • The Minutes of the previous meeting; • Any other documentation related to the business to be conducted by the
Council. The Council shall record and make available Meeting Highlights for all meetings. The Minutes shall be recorded by the Patient and Stakeholder Engagement Coordinator.
6. Infrastructure Supports For members who wish to participate in face-to-face meetings, mileage will be reimbursed at the standard CCAC rate. Respite care will be covered on advance request by the family or caregiver. For members who wish to participate from home, teleconference services will be arranged. Videoconferencing from a CCAC branch office can also be arranged.
Staff Support
The Council will be supported by the Patient and Stakeholder Engagement Coordinator. This person will provide administrative support to the Council. The meetings shall be recorded by the Coordinator for all meetings and a log of all meetings minutes including past agendas will be kept. The Patient and Stakeholder Engagement Coordinator will be the primary point of contact with the membership.
Champlain CCAC Patient and Caregiver Council – TORS APPROVED October 4, 20162016
7. Accountabilities All members are obligated to sign a non-disclosure, confidentiality and conflict of interest agreements. All meetings will be recorded and Meeting Highlights will be translated and posted on the Champlain CCAC website. The Patient and Caregiver Council will develop an annual a work plan. The Patient and Caregiver Council is accountable to the Champlain CCAC Executive Committee. The Executive Sponsor is the VP, People and Stakeholder Engagement. The Council will report annually to the Champlain CCAC Board of Directors (June) and annually to the CQSC of the Board (December). Expectations of Members Members of the Champlain CCAC Patient and Caregiver Council are expected to: • Suggest agenda items and priority areas of work for the Council. • Regularly attend and be an active participant in Council meetings. • Prepare for meetings by reviewing minutes and reports. • Be prepared to draw on their personal experiences. At the same time, reflect
on the broad needs of patients, caregivers and families. • Represent the voice of patients and caregivers on other CCAC initiatives, as
requested. • Assist with recruitment of new members. • Respect the privacy and confidentiality of other members and their personal
experiences. • Represent the organization at public or specific engagements. Date Reviewed: Date Updated: December 8 2015
Date Updated: October 4 2016
Next Review Date: Fall 2017
Champlain CCAC Patient and Caregiver Council – TORS APPROVED October 4, 20162016
12/1/2016
1
SPCO Four Priorities
• Community Economic Development
• Access to Basics
• Creating Inclusion
• Research and Voluntary Sector Supports
Creating Community for Isolated Ethno‐Cultural Seniors
Funded by Employment and Social Development Canada (ESDC)
New Horizons for Seniors Program
12/1/2016
2
Ottawa Impact Plan • The Council on Aging of Ottawa
– Ottawa West Community Support – Healthy Connections; Healthy Communities
– Nepean, Rideau and Osgoode Community Resource Centre (NROCRC) – Elder Abuse Response and Referral Service
– South East Ottawa Community Health Centre –Strengthening Senior Neighbourhood Networks
– Catholic Centre for Immigration – Senior Centered ESL Program.
– Western Ottawa Community Resource Centre –Reducing Rural Isolation
Overall Project Objectives
• To reduce the social isolation of ethno‐cultural seniors by supporting ethno‐cultural community groups in providing services and supports to isolated seniors.
12/1/2016
3
Social Isolation
• Social isolation can be defined as the absence of relationships with family or friends on an individual level, and with society on a broader level.
Ref: Mental Health Foundation
The Lonely Society? Mental Health Foundation, 2010, p 14.
Challenges Faced by Ethno‐Cultural Seniors
• Socio‐economic disadvantage; • Loss of traditional roles;• English language barriers; • lack of exposure to Canadian services and systems; and
• Low knowledge of and ability to access services.Additionally, those who migrated to Canada at an older age, or who are from refugee background, face a higher risk of mental and physical health issues.
12/1/2016
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Project Objectives
• Identify isolated seniors.
• Inform isolated seniors of available services and provide support in navigating and accessing them.
• Connect with and engage isolated seniors in knowledge building activities.
• Develop opportunities for isolated seniors to socialize and engage them in recreational activities.
Project Objectives
• Empower isolated seniors to contribute their knowledge and skills.
• Expand awareness of dementia and dementia supports among seniors and volunteers.
• Train seniors and volunteers to recognize elder abuse and identify appropriate supports.
• Increase the capacity of ethno‐cultural groups to serve their communities.
12/1/2016
5
Your Role
• Provide bi‐weekly recreation activities for seniors.
• Provide peer phone supports and friendly visiting for senior who are unable to attend activities.
• Provide information workshops on available services for seniors.
Your Role
• Encourage group volunteering.
• Share your own lessons learned and tools you have used.
12/1/2016
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Workshops and Training
• Elder Abuse
• Alzheimer and Dementia Supports
• Neighbours Helping Neighbhours
Evaluation and Measurement Tools
• Qualitative and Quantitative Data
– Activity/Participation Record
– Pre and Post‐Participation Survey
– Social Network Mapping
– Participant Satisfaction Survey
– Learning Event Evaluation
12/1/2016
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Questions
Quality Care Together Champlain CCAC Patient Rights and Commitments
● Be treated with courtesy and respect, including freedom from unwanted physical and verbal conduct, threats, attempts or acts of violence.
● Be treated in a manner that respects your dignity and privacy, and promotes your independence.
● Be free from discrimination, recognizing your cultural, gender, spiritual, linguistic, ethnic, sexual orientation and regional differences.
● Have care providers who are knowledgeable, trained and informed to provide the care you require.
● Participate with all partners in developing your care plan and to have continued involvement in your care. This care will be provided within the parameters of best practices, legislation and CCAC policies and procedures.
● Give or withhold appropriate consent to the provision of service, having been informed of risks and benefits of these services. CCAC and service providers will ensure you have the information required to make decisions.
● Have your health information kept confidential in accordance with the law.
● Tell us who you want to be involved in your care, and with whom you would allow us to share information.
● Raise concerns or recommend changes in connection with the services provided without fear of interference, coercion, discrimination or reprisal.
● Be treated fairly based on your individual requirements.
● Be informed about the procedure for initiating complaints, concerns and compliments about the service provider and CCAC, and to have incidents reviewed promptly.
● Treat us with courtesy and
respect, including freedom
from unwanted physical and
verbal conduct, threats,
attempts, or acts of violence by
you or someone in your home.
● Treat us in a manner that
respects our dignity and
privacy, and is free from
discrimination, recognizing
cultural, gender, spiritual,
linguistic, ethnic, sexual
orientation and regional
differences.
● Provide a safe work
environment, respecting
guidelines and legislation,
including those related to pets,
smoking, alcohol, drugs, and
safe entry into your home.
● Engage in the development and
ongoing management of your
care plan and to report any
changes that may impact your
care needs.
● Use health care resources
responsibly, including making
yourself available for visits and
assessments, notifying us as
soon as possible when you
need to cancel or reschedule
visits, when you will be
unavailable, and when you no
longer require care.
A patient receiving Champlain CCAC services
commits to:
A patient receiving Champlain CCAC services has the right to:
We are here to help. If you have any questions or concerns about your care or the services that youare receiving, please call your Care Coordinator.
Last updated: October 2016
Legislative Assembly of
Ontario
Assemblée législative de l'Ontario
STANDING COMMITTEE ON PUBLIC ACCOUNTS
CCACs—COMMUNITY CARE ACCESS CENTRES—HOME CARE PROGRAM
(Section 3.01, 2015 Annual Report of the Office of the Auditor General of Ontario)
2nd
Session, 41st Parliament
65 Elizabeth II
ISBN 978-1-4606-8864-9 (Print) ISBN 978-1-4606-8866-3 [English] (PDF) ISBN 978-1-4606-8868-7 [French] (PDF) ISBN 978-1-4606-8865-6 [English] (HTML) ISBN 978-1-4606-8867-0 [French] (HTML)
Legislative Assembly of
Ontario
Assemblée législative de l'Ontario
The Honourable Dave Levac, MPP Speaker of the Legislative Assembly
Sir,
Your Standing Committee on Public Accounts has the honour to present its Report and commends it to the House.
Ernie Hardeman, MPP Chair of the Committee
Queen’s Park December 2016
STANDING COMMITTEE ON PUBLIC ACCOUNTS COMITÉ PERMANENT DES COMPTES PUBLICS
Toronto, Ontario M7A 1A2
STANDING COMMITTEE ON PUBLIC ACCOUNTS
MEMBERSHIP LIST
2nd Session, 41st Parliament
ERNIE HARDEMAN Chair
LISA MACLEOD Vice-Chair
JOHN FRASER PERCY HATFIELD
*MONTE KWINTER HARINDER MALHI
PETER MILCZYN JULIA MUNRO
*ARTHUR POTTS
*CHRIS BALLARD and LOU RINALDI were replaced by MONTE KWINTER and ARTHUR POTTS on September 13, 2016.
FRANCE GÉLINAS regularly served as a substitute member of the Committee.
VALERIE QUIOC LIM Clerk of the Committee
ERICA SIMMONS Research Officer
i
CONTENTS
PREAMBLE 1
ACKNOWLEDGEMENTS 1
BACKGROUND 1
Legislation 1
Service Delivery Model 2
Accountability Relationship 2
Spending on Home Care 2
2015 AUDIT OBJECTIVE AND SCOPE 2
Related Audits 3
MAIN POINTS OF 2015 AUDIT 3
ISSUES RAISED IN THE AUDIT AND BEFORE THE COMMITTEE 4
Service Levels and Hours of Care 5
Community Support Services 6
Client Assessments 7
Discharge and Follow-Up 7
Oversight of Service Providers 8
Support for Caregivers 9
CONSOLIDATED LIST OF COMMITTEE RECOMMENDATIONS 10
1
PREAMBLE
On May 11, 2016 the Standing Committee on Public Accounts held public hearings on the audit (Section 3.01 of the Auditor General’s 2015 Annual Report) of the Community Care Access Centres (CCACs) – Home Care Program administered by the Ministry of Health and Long-Term Care.
The Committee endorses the Auditor’s findings and recommendations, and presents its own findings, views, and recommendations in this report. The Committee requests that the Ministry provide the Clerk of the Committee with written responses to the recommendations within 120 calendar days of the tabling of this report with the Speaker of the Legislative Assembly, unless otherwise specified.
ACKNOWLEDGEMENTS
The Committee extends its appreciation to officials from the Ministry of Health and Long-Term Care, the Ontario Association of Community Care Access Centres, and from the Central Community Care Access Centre, the Champlain Community Care Access Centre, and the North East Community Care Access Centre.
BACKGROUND
Ontario’s 14 Community Care Access Centres (CCACs) are responsible for helping people to access home- and community-based health care and related social services in order to live independently. The Ministry of Health and Long-Term Care (the Ministry) funds the CCACs through the Local Health Integration Networks (LHINs). CCAC services are free to Ontarians who are insured under the Ontario Health Insurance Plan (OHIP). Since 2009 the CCACs have served increasing numbers of clients with more complex medical and social-support needs. In the year ending March 31, 2015 approximately 60% of home care clients were senior adults (age 65 years and over), 20% were adults (age 18-64 years), 15% were children, and 5% were palliative care clients.
Legislation
A Regulation under the Home Care and Community Services Act, 1994 (Act) specifies the maximum amount of personal support services that may be provided to a client. At the time of the audit, the Regulation allowed a maximum of 120 hours in the first 30 days of service and 90 hours in any subsequent 30-day period. These limits could be exceeded indefinitely in “extraordinary circumstances” for palliative clients and those waiting for placement in a long-term care home, or for up to 90 days in any 12-month period for other clients.1
The Regulation is silent on the minimum amount of services that can be provided.
1 Effective October 1, 2015, a regulatory amendment (O. Reg. 304/15) under the Act
increases the maximum amount of nursing services that the CCACs may provide to their clients. (The amendment does not increase the maximum amount of personal support and homemaking services that the CCACs may provide.)
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Service Delivery Model
Through their staff of care coordinators, the CCACs assess individuals to determine if their health needs qualify for home-care services, and develop care plans for those who qualify. The CCACs then contract with any of about 160 private-sector service providers to provide home-care services directly to clients. CCAC care coordinators manage client cases, and reassess and adjust care plans on an ongoing basis. The service providers are either for-profit or not-for-profit. Some community support services and homemaking services may require co-payment from clients. A 2014 regulatory amendment and associated Ministry guidelines allow community support service agencies (support agencies) to provide personal support services for lower-needs clients.
Accountability Relationship
Each of Ontario’s 14 CCACs is accountable to one of the Province’s 14 LHINs, which are mandated to fund health service providers, including hospitals, CCACs, and support agencies, in defined geographic areas. The LHINs are accountable to the Ministry, which sets the overall strategic direction for health care in the province. The CCACs are represented by the Ontario Association of Community Care Access Centres (the Association). The Association provides shared services for the CCACs such as procurement, policy and research, and data and information management.
Spending on Home Care
Ontario spent a total of $2.5 billion to provide home-care services to 713,500 clients in the year ending March 31, 2015. This was a 42% increase in funding and a 22% increase in clients served compared to the year ending March 31, 2009. Over the past decade, overall funding for CCAC home care and other services has increased by 73% from $1.4 billion to $2.5 billion, while remaining at a relatively constant 4% to 5% of overall provincial health spending. The 2015 Budget included funding increases for CCAC home care of 5% per year over three years, for a total of $750 million. According to funding agreements with their respective LHINs, the CCACs must not spend more than they receive each year.
2015 AUDIT OBJECTIVE AND SCOPE
The audit assessed whether the CCACs, in partnership with the Ministry and the LHINs, have processes in place to provide care coordination to home-care clients in a seamless and equitable manner, monitor service providers in accordance with contractual and other requirements, and measure and report on the quality and effectiveness of home-care services provided.
Audit staff visited three CCACs: the Central CCAC (head office in north Toronto), the North East CCAC (head office in Sudbury), and the Champlain CCAC (head office in Ottawa). The Ministry, through the LHINs, provided these CCACs with a total of $644 million in funding in the year ending March 31, 2015, representing 26% of funding provided to all 14 CCACs, for about 25% of the total CCAC clients in Ontario. The audit focused on services provided to senior adults (age 65 and older) and adults (aged 18 to 64), rather than to children.
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Related Audits
A previous audit of home care was conducted by the Auditor General in 2010.
In September 2015 the Auditor released a Special Report on CCAC financial operations and service delivery.
MAIN POINTS OF 2015 AUDIT
The 2015 audit noted that some of the issues raised in the earlier 2010 audit had still not been fully addressed, including that
clients continue to be put on wait-lists and face long wait times to obtain personal support services; and
clients with similar assessed needs continue to receive different levels of services depending on where they live in Ontario.
The Auditor explained that home-care funding to each CCAC is
predominantly based on what each received in prior years rather than on actual client needs and priorities. As a result, to stay within budget, each CCAC exercises its own discretion on the types and levels of services it provides—thereby contributing to significant differences in admission criteria and service levels between CCACs. . . . [B]ecause there are no provincial standards in many critical areas, such as the level of personal support services warranted for different levels of client needs, some clients may receive more services than others.2
Specific observations from the 2015 audit included the following:
Whether a person receives personal support services, and the amount of service provided, if any, depends on where the person lives (that is, which CCAC serves their geographic area).
Supports to caregivers such as family members of home-care clients are limited and not consistently available across the province.
The CCACs’ oversight of contracted service providers needs improvement.
Care coordinators’ caseload sizes vary significantly, and some exceed the suggested ranges in the Association’s guidelines, so there is little assurance on whether care coordination services were consistently provided to all clients.
2 Office of the Auditor General, “CCACs—Community Care Access Centres—Home Care
Program,” 2015 Annual Report, p. 77.
4
Not all care coordinators maintained their proficiency in, and some were not regularly tested on, the use of assessment tools.
CCAC care coordinators may experience difficulties in effectively referring clients to obtain community support services because assessment information and wait-lists are not centralized.
Clients may not receive appropriate levels of services as CCAC care coordinators did not assess or reassess clients on a timely basis.
CCACs are not able to provide personal support services to the maximum levels allowed by law (90 hours per month).
Each CCAC’s performance is measured against different targets for performing client services.
ISSUES RAISED IN THE AUDIT AND BEFORE THE COMMITTEE
Significant issues were raised in the audit and before the Committee. The Committee considers the issues below to be of particular importance.
The Ministry has received advice from the expert group on home and community care whose March 2015 report, Bringing Care Home, highlighted ongoing service challenges including lack of consistency, lack of support for caregivers, and difficult transitions from hospital to home. This was followed by the release in May 2015 of Patients First: A Roadmap to Strengthen Home and Community Care (Roadmap), which laid out steps to be taken to implement the recommendations made in the expert group’s report.3 The Ministry also convened a Patient and Caregiver Advisory Table on Home and Community Care to provide feedback and advice on the implementation of the Roadmap.
The Ministry has also been working to address the Auditor’s recommendations in key areas including
the need to expand supports for caregivers in Ontario;
the need for standardized guidelines for prioritizing clients to improve consistency of service;
the need to better utilize health resources by diverting low-needs clients from the CCACs to community support service agencies; and
the need to review home-care indicators to improve performance.
3 On June 2, 2016, the government introduced Bill 210, the Patients First Act, 2016. The
Bill died when the Legislature was prorogued on September 8, 2016, and was reintroduced on October 6, 2016 as Bill 41. If passed, the Act would (among other things) transfer service delivery and management of home care from the CCACs to the LHINs. CCAC employees, including care coordinators (responsible for assessing a client’s requirements, including determining eligibility and developing a care plan) would also be transferred, and the CCACs would be eliminated.
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Specifically, the Ministry has
conducted an inventory of caregiver training and education programs across other jurisdictions to explore approaches that can be adapted in Ontario;
initiated the development of a levels-of-care framework that will support clients with similar needs to receive similar levels of service regardless of where they live; and will be based on best practices consistent across the province; and
initiated work with Health Quality Ontario to review home care indicators and begin development of quality standards for home care.
The Committee heard that Ontario’s 14 CCACs care for some 720,000 clients each year, more than double the numbers served just over a decade ago, and these clients also have more complex health needs. CCAC staff indicated that funding provided by the Ministry has not kept up with this exponential growth. The Ministry believes that improved efficiency of management and delivery will increase the funding available for client care and would improve access to needed services. The development of clinical standards, decision-making supports, and enhanced monitoring will improve the quality of care and strengthen public confidence in the system.
A representative of the Champlain CCAC noted that the CCACs support changes that will enable the delivery of higher-quality, more consistent, equitable, and better integrated home and community care across the province. The Champlain CCAC’s adult complex care clients have increased by 33% in the last two years.
The North East CCAC serves a population of 554,000 people in a mix of urban, rural, and very remote communities scattered across 415,000 square kilometres. This CCAC provides individualized nursing, personal support, and rehabilitation services to more than 15,000 clients in their homes and home communities.
The Central CCAC reported the highest absolute number of seniors and the second-highest growth rate of aging seniors of all the CCACs. This CCAC responded to approximately 300,000 calls (900 calls daily) from clients and families and delivered care to more than 82,000 clients in the community. The CCAC’s care coordinators completed over 70,000 face-to-face visits with clients and their families and helped over 39,000 clients transition home from hospital. Over 95% of this CCAC’s clients receive nursing services within five days of being assessed. In response to the Auditor’s recommendation on auditing service provider organizations, the Central CCAC has conducted 21 scheduled and random audits.
Service Levels and Hours of Care
The Auditor noted that the CCACs are not able to provide personal support services to the maximum levels allowed by law. The CCACs visited during the audit generally provided no more than 60 hours of support services even though the regulation allowed for up to 90 hours (and up to 120 hours in exceptional cases such as palliative care).
6
The Committee asked about the number of hours per month of personal support services that are provided to clients. A representative of the Association explained that the CCACs’ goal is not to target the maximum number of hours but rather to provide the right level of care for individual clients.
Ministry representatives acknowledged that there are historically-rooted funding inequities across the province that they are working to correct. The aim is to ensure that health funding is aligned with growing populations and the increasing complexity of health needs. Using information from Public Health Ontario, the Ministry is bringing more attention to population health planning. The Ministry is also actively considering the possibility of revising the LHIN boundaries to be better aligned with municipal and board of health boundaries.
The Committee expressed concern about discrepancies in wait times between the CCACs and asked how the Ministry is responding to the Auditor’s recommendations regarding consistency of care. Ministry staff explained that work is being done on a levels-of-care framework that would define priority levels and acuity levels in the sector, and help to standardize service levels across the province. The standardization of care coordinators’ caseloads is a government priority.
Committee Recommendation
The Standing Committee on Public Accounts recommends that:
1. The Ministry of Health and Long-Term Care
a) address funding inequities between Community Care Access Centres;
b) establish a minimum level of care, based on assessed need, that clients can expect to receive;
c) develop standard guidelines for prioritizing clients for services, and monitor compliance with those guidelines; and
d) ensure that clients with the highest level of assessed need are provided hours of care closer to the regulated maximum.
Community Support Services
The Auditor noted the importance of better utilizing health resources by diverting low-needs clients from the CCACs to community support services agencies. However, the audit found that CCAC care coordinators may experience difficulties in effectively referring clients to obtain community support services because assessment information and wait-lists are not centralized, and many community support service agencies have long wait-lists.
7
Committee Recommendations
The Standing Committee on Public Accounts recommends that:
2. The Local Health Integration Networks
a) develop centralized wait-list information for all community-based support services in order to provide current information on the availability of such services to all health service providers and clients; and
b) ensure that all home care health-service providers and community support service agencies share assessment information on a common system.
3. The Ministry of Health and Long-Term Care, in conjunction with the Local Health Integration Networks, ensure that low-needs clients who require personal support services receive these services from community support service agencies, where appropriate, rather than through the Community Care Access Centres or, as the pending Patients First Act, 2016 would enact, through the community care function within the Local Health Integration Networks.
Client Assessments
The Auditor found that clients may not receive appropriate levels of services when CCAC care coordinators do not assess or reassess clients on a timely basis. In addition, the Auditor found that not all care coordinators maintained their proficiency in, and some were not regularly tested on, the use of assessment tools.
Committee Recommendation
The Standing Committee on Public Accounts recommends that:
4. The Ministry of Health and Long-Term Care, in conjunction with the Local Health Integration Networks, ensure
a) that home-care clients are assessed and reassessed within the required time frames; and
b) that care coordinators maintain their proficiency in, and are regularly tested on, the use of assessment tools.
Discharge and Follow-Up
The Committee noted that the Auditor found significant variations in the extent to which CCACs followed up with clients discharged from home care. A CCAC representative said that work is underway to standardize this process. Ministry staff are also piloting a “bundled care” model. Under this model, clients will experience a more seamless transition from hospital care to home care as they
8
are looked after by substantially the same team of health care providers in both settings.
Committee Recommendation
The Standing Committee on Public Accounts recommends that:
5. The Ministry of Health and Long-Term Care, in conjunction with the Local Health Integration Networks, ensure that all home-care clients are contacted for follow-up after discharge.
Oversight of Service Providers
The Committee asked about the Auditor’s finding that the CCACs were not monitoring whether service providers were complying with the required wage increases for PSWs. Ministry representatives explained that they have achieved good compliance overall and asked the LHINs not to allocate any new service volumes to employers unless they were fully compliant. The Committee noted the importance of strengthening oversight of service providers.
Committee Recommendation
The Standing Committee on Public Accounts recommends that:
6. The Ministry of Health and Long-Term Care, in conjunction with the Local Health Integration Networks,
a) demonstrate that funding meant for Personal Support Worker wage increases was spent as intended;
b) develop performance indicators and targets for home-care services;
c) collect relevant data that measures client outcomes;
d) collect data on missed, rescheduled, and late visits from each contracted service provider;
e) conduct routine site visits to monitor the quality of care provided by service providers;
f) review and revise the client satisfaction survey methodology to ensure that client satisfaction survey results can be used to effectively monitor the performance of service providers; and
g) apply appropriate corrective actions to service providers that perform below expectations.
9
Support for Caregivers
All present agreed on the importance of ensuring that caregivers—the relatives, friends and other non-professionals who help clients at home—are given necessary assistance such as respite support. The Ministry is exploring ways to provide more support to caregivers.
Committee Recommendation
The Standing Committee on Public Accounts recommends that:
7. The Ministry of Health and Long-Term Care ensure that caregivers receive a sufficient level of appropriate support.
10
CONSOLIDATED LIST OF COMMITTEE RECOMMENDATIONS
The Standing Committee on Public Accounts recommends that:
1. The Ministry of Health and Long-Term Care
a) address funding inequities between Community Care Access Centres;
b) establish a minimum level of care, based on assessed need, that clients can expect to receive;
c) develop standard guidelines for prioritizing clients for services, and monitor compliance with those guidelines; and
d) ensure that clients with the highest level of assessed need are provided hours of care closer to the regulated maximum.
2. The Local Health Integration Networks
a) develop centralized wait-list information for all community-based support services in order to provide current information on the availability of such services to all health service providers and clients; and
b) ensure that all home care health-service providers and community support service agencies share assessment information on a common system.
3. The Ministry of Health and Long-Term Care, in conjunction with the Local Health Integration Networks, ensure that low-needs clients who require personal support services receive these services from community support service agencies, where appropriate, rather than through the Community Care Access Centres or, as the pending Patients First Act, 2016 would enact, through the community care function within the Local Health Integration Networks.
4. The Ministry of Health and Long-Term Care, in conjunction with the Local Health Integration Networks, ensure
a) that home-care clients are assessed and reassessed within the required time frames; and
b) that care coordinators maintain their proficiency in, and are regularly tested on, the use of assessment tools.
5. The Ministry of Health and Long-Term Care, in conjunction with the Local Health Integration Networks, ensure that all home-care clients are contacted for follow-up after discharge.
11
6. The Ministry of Health and Long-Term Care, in conjunction with the Local Health Integration Networks,
a) demonstrate that funding meant for Personal Support Worker wage increases was spent as intended;
b) develop performance indicators and targets for home-care services;
c) collect relevant data that measures client outcomes;
d) collect data on missed, rescheduled, and late visits from each contracted service provider;
e) conduct routine site visits to monitor the quality of care provided by service providers;
f) review and revise the client satisfaction survey methodology to ensure that client satisfaction survey results can be used to effectively monitor the performance of service providers; and
g) apply appropriate corrective actions to service providers that perform below expectations.
7. The Ministry of Health and Long-Term Care ensure that caregivers receive a sufficient level of appropriate support.
CASC de Champlain CCACCASC de Champlain CCAC
FY 16-17 Quality Improvement Plan (QIP)
Q2 Update
Board of DirectorsDecember 14th, 2016
Jennifer Proulx – Director, Quality & Program Evaluation
5-Day Wait for Nursing ≥95.0% 93.7% 94.6% -- -- 93.6%
5-Day Wait for PSS ≥84.8% 83.5% 81.0% -- -- 73.8%
Overall Satisfaction ≥94.0% 92.0%(15-16 Q1-Q2)
92.0%( FY 15-16)
-- -- 92.8%
Palliative & End of Life patients who passed away in preferred place of death
Establishbaseline
74.8% 75.9% -- -- n/a
* HQO identifies specific timeframes for each indicator in order to establish baseline performance. These timeframes vary by QIP indicator.
CASC de Champlain CCACCASC de Champlain CCAC 3
Falls
% of adult long-stay home care patients who record a fall on their follow-up of the international research network's Resident Assessment Instrument (InterRAI) for home care
Initiative Status
Educate Rapid Response Nurses, Care Coordinators on impact of medications on falls risk
CCAC EducationRounds held Dec 8
Pilot electronic change in status tool with PSWs for timely intervention for complex patients
Incorporated into Automated
Provider Reporting
Initiate new intervention for Falls screening (Via IMPACTT Centre)Field test in
progress
CASC de Champlain CCACCASC de Champlain CCAC 4
ED Visits and Hospital Readmissions
% of home care patients with an unplanned, less-urgent ED visit within the first 30 days of discharge from hospital
Initiative Status
Collaborate with hospitals within the Champlain Association of Small Hospitals on improving and sustaining implementation of "ED Notification" system
4 hospitals live1 hospital in progress
Work with hospitals within the Champlain Association of Small Hospitals to measure % of patients seen by Rapid Response Nurse who return to hospital for unplanned ED visit or readmission to hospital
Delayed
Trial use of Divert Scale to identify improvement initiatives for patients at high risk for unplanned ED visits or readmissions
Delayed
% of home care patients who experienced an unplanned readmission to hospital within 30 days of discharge from hospital
CASC de Champlain CCACCASC de Champlain CCAC 5
5-Day Wait Time for Home Care
% of complex patients who received their first personal support service within 5 days of the service authorization date
Initiative Status
Reduce percentage of service authorization data fields that are incorrectly entered
91.6% correct data entry
Improve SPO compliance with meeting requested first visit dates or required service start dates
PSS: 81%Nursing: 87%
Allied Health: 83%
Measure 5-day wait time for PSS for complex patients excluding preference or availability requirements
89.5%
% of patients who received their first nursing within 5 days of the service authorization date
CASC de Champlain CCACCASC de Champlain CCAC 6
Client/Patient Experience
% of home care patients who responded “Good”, “Very Good”, or “Excellent” to any of the following survey questions:• Overall rating of CCAC services• Overall rating of management/handling of care by Care Coordinator• Overall rating of service provided by service provider
Initiative Status
Improve real time quality surveillance through the use of Interactive Voice Recognition (IVR) technology
Post-admit calls;Post discharge calls;
PSS Quality calls
Work with SPOs and Patient Advisory Council to develop and implement patient care "team" with clear accountabilities for consistency and continuity of care
Delayed: Action Plan pilot
Develop and implement pilot to review scheduled vs unscheduled care
Postponed due to financial situation: possible launch if
large PSS waitlist release
Identify key drivers of Overall Satisfaction by regularly reviewing highest correlated CCEE items
Ongoing
CASC de Champlain CCACCASC de Champlain CCAC 7
Palliative and End of Life
Improve % Palliative and of End of Life patients who passed away in their preferred place of death
Initiative Status
Achieve ≥90% compliance with documented preferred place of death
84.9%
Implement COSTARS practice guidelines related to cancer symptom management with Nurses
Pilot phase launched in JuneFall implementation in progress
Develop, pilot and implement sub-cutaneous line care practice guideline
Complete
Implement palliative education with Allied Health professionals
Complete
Establish baseline performance on VOICES survey Complete
CASC de Champlain CCACCASC de Champlain CCAC 8
Planning for FY 17/18 QIP
Given the current climate of change in the home care sector, the core priority indicators for the home care sector have not been revised for the 2017/18 QIP submission
The following additional (optional) indicators have been added for the home care sector:
• Identification of complex patients for Health Links
• Percentage of palliative patients who died in their preferred place of death
The latter indicator was developed as a result of a proactive effort by CCACs, seven of which (including Champlain) have already pioneered the indicator in their 2016/17 QIPs.
CASC de Champlain CCACCASC de Champlain CCAC 9
We will follow past process in developing, reviewing, and approving the FY 17/18 QIP:
• CCAC and LHIN leadership invited to participate in QIP webinars (Dec. 5th for Beginning Users and Dec.9th for Advanced Users)
• Dec to Feb: Consultation with internal stakeholders, patients and caregivers, and Service Provider Organizations
• Feb 2017: Review at the internal Quality and Safety Committee and at the Board of Directors
• Mar 2017: Final approval by the Board of Directors
• Mar 2017: Translation of QIP
• By Apr 1 2017: Submission to Health Quality Ontario and posted on our public website
Tracking to Budget Targets -$795k -$6,911k -4.78%-$2,500k
(-1%)
FYTD Target
+$0k
Champlain
3
Financial
People
Metric Definition Discussion Questions
Referral Volume
The count of new referrals to the CCAC during the time period. Only referrals that initiate Case Management intake Assessments are counted in this indicator.
Is CCAC demand increasing? Is it from hospitals, physicians, or community?
Monthly CCAC Visit Capacity
The count of patients, by population groups, who received direct care visits or S&E as compared to the budgeted number of patients.
Are care plans efficient, ensuring creating additional capacity? Are there alternate parts of the health system to address particular care needs?
% of patients Reassessed Within Guidelines of Care
Percent of patients (per population coding), who receive their RAI reassessments within guidelines. E.g. Complex Population patients are to receive a reassessment every 3-6 months, whereas Community Independence patients are to receive reassessments every 12 months.
Are Care Coordinators focusing their time on assessing patients? Are processes and tools in place to ensure efficiencies in processes, allowing time for Care Coordinators to assess their patients?
Total Personal Support Services (PSS) patients Waitlisted
A snapshot view of the count of the number of PSS patients on the waitlist as at the end of the month, divided by those who are fully waitlisted (having no PSS service), and those that are partially waitlisted (having some PSS service, but assessed for needing more).
What is being done to manage patient risk?
Total Physiotherapy (PT) patients Waitlisted
A snapshot view of the count of the number of PT patients on the waitlist as at the end of the month
How are patient risks being managed?
Total Occupational Therapy (OT) patients Waitlisted
A snapshot view of the count of the number of OT patients on the waitlist as at the end of the month
How are patient risks being managed?
Total School Therapy Patients Waitlisted by Service
A snapshot view of the count of the number of school patients on the waitlist as at the end of the month
How are patient risks being managed?
Are we helping to navigate patients to other sources of care (insurance, etc.)?
Metric Definition Discussion Questions
Tracking to Budget targets Net surplus/deficit as calculated by Revenue minus Expenses, as per plan.
Are we tracking to budget plans? Are our cost/patients to plan? Is demand for service to expectations? What additional actions if any, are required at this time?
Metric Definition Discussion Questions
Staff Turnover Rate at which employees leave an organization. Calculated as number of permanent employees who terminate or cease employment, divided by the average number of permanent employees on staff
If not as expected, what is the underlying cause and mitigating action plan?
% of Performance Appraisals Completed on Time
FYTD percent of staff whose performance appraisal is completed on time.
Is staff development being appropriately managed?
Absenteeism annualizedRate
Total number of sick hours, paid and unpaid for all permanent and temporary staff (excludes casuals), divided by number of permanent staff.
If not as expected, what is the underlying cause and mitigating action plan?
Patients Quality
Operational Dashboard: Glossary
Metric Definition Discussion Questions
Service Wait-timeCommunity (90th
Percentile Days Waiting)
Wait time from patient intake / application date for referrals sourced from the community (e.g. Family, Self) to receiving the first direct care service visit, where the patient is an adult patient on Home Care services. The 90th percentile focuses on ensuring that 90% of patients will receive a visit in the targeted time frame, or better.
Should service eligibility or service guidelines be reviewed/reduced? What advocacy should the Board engage in?
5 day wait time –Complex PersonalSupport Services (PSS)
Measures the percent of patients whose 1st PSS visit was achieved within 5 days, from Service Authorization Date to the 1st PSS Visit Date for the episode of care. patients with an “On-Hold” episode between the authorization and 1st visit, are excluded from the measure. (On hold is used, for example, if a patients discharge is delayed from hospital due to complications)
How have Quality Improvement Plan (QIP) action plans improved performance?
Adjusted 5 Day Wait Time-PSS
Measures the percent of patients whose 1st PSS visit was achieved within 5 days, from Service Authorization Date or Patient Availability Date to the 1st PSS Visit Date for the episode of care.
Where are the remaining areas of focus to improve the performance? Is the target achievable?
5 day wait time -Nursing
Measures the percent of patients whose 1st Nursing visit was achieved within 5 days, from Service Authorization Date to the 1st Nursing Visit Date for the episode of care. patients with an “On-Hold” episode between the authorization and 1st visit, are excluded from the measure. (On hold is used, for example, if a patients discharge is delayed from hospital due to complications)
How have QIP action plans improved performance?
% of Care Visits Delivered
Measures the percent of visits provided to patients, of all scheduled visits, for direct care visits. The metric is self reported by SPOs on a quarterly basis.
Are there variances amongst providers or services? Are there adverse affects on patients due to missed care?
patient Experience Measures the percent positive rating for overall satisfaction with care. How have Person Driven Care action plans improved patient experience?
Champlain
Supporting Complex Patients Sustainable Health Care
% Clinic Visit Utilization 30.7% 27.1% T: 25% (L) 31.1% 30.0% 29.6%*Champlain is ranked consistently amongst the highest MAPLe proportion provincially. ; Long Stay populations using provincial reference rates.
** Champlain continues to increase special programs, such as NPWT and CHIPP programs, impacting avg. cost; Short Stay Population costs are calculated
using local CCAC rates.
Ranking relative to other CCACs for
average cost/Patient across all Patient
groups
Champlain
Supporting Complex Patients Sustainable Health System
Metrics Definition Discussion Questions
Complex Population Definition
The complex population are patients who are coded in CHRIS as “Complex” using Provincial patient Care Model definitions.The provincial Complex Populations is defined as Long Stay patients having: 1 or more health/chronic conditions with complicating factors; Direct care needs are unstable & unpredictable; The individual or support network is not self-reliant with high risks in more than 1 area; RAI score 17 +; High/intensive case management is required to support patient goals & outcomes; Multiple care partners across sectors; overall poor coping; multiple complex psychosocial issues; unmanageable behavioural/mental health issues;
How do other “complex” patients get identified, such as those in Short Stay populations?
Besides service costs, what are the implications of a growing base of Complex Patients on Case Management and the skills and resources needed?
Reassessment of Complex Patients within Guidelines
Percent of patients (per population coding), who receive their RAI reassessments within guidelines. E.g. Complex Population patients are to receive a reassessment every 3-6 months,.
Are Care Coordinators focusing their time on assessing patients? Are processes and tools in place to ensure efficiencies in processes, allowing time for Care Coordinators to assess their patients?
% of Complex Patients with a Care Coordinator Contact (tel./FtoF) within X Months
Count of the number of complex population patients who have had a Care Coordinator contact within last 3 months out of all complex population patients.
Are complex patients being monitored closely? Are there risks for some patients? If patients do not have a contact within last 3 months, what are the potential impacts?
% of Complex Patients with 1 Care Coordinator in Past 12 Months
Percent of complex patients active in the current month, who have had 1 Care Coordinator consistently assigned to the patient in the past 12 months.
When there are transitions, are Care Coordinators briefing peers effectively? What may cause higher number of assigned Care Coordinators (turnover, reassignments, etc.)?
% of Complex PSS Patients with Targeted Number of SPO Staff Within Past 3 Months
Percent of complex patients active in the current month, who have had the appropriate number of SPO staff assigned to the patient, within the past 3 months.
Is there consistency in care within the PSS care team? Do high numbers of SPO assigned staff create risk or a need for constant retraining? How do SPOs ensure consistency of care within the care team?
% of Complex Patients With aCompleted Medication Reconciliation
% of Complex Population patients with a BPMH completed within 30 days of either a RAI-HC completed with triggers for needing a Medication Reconciliation, or within 30 days of an initial face to face visit by a RRN or MHAN nurse.
Are there risks to patients if the CCAC is not completing a medication reconciliation? Are there other health professionals completing the Med Rec? Are there barriers to completing a Med Rec. ?
Metrics Definition Discussion Questions
ALC Rate New Indicator: Counts the total ALC bed days as a percentage of Total Bed days, during the period. Includes sub-acute (rehab and complex care bed and counts patients not yet discharged).
Are our programs appropriately supporting LHIN-Wide ALC targets? What if any additional actions are required to improve performance?
Very High & High MAPLe Score % supported by Champlain CCAC
The proportion of CCAC patients assessed by a RAI-HC, with a MAPLe Score of High or Very High, out of the total number of patients with a RAI-HC assessment.
What is the financial impact of sustaining higher needs patients? What effects does this have for provincial HBAM funding/
Ranking relative to other CCACs for average cost/patient across all patient groups
Using the LHIN Benchmark report, average costs per patient are reported by population group. Ranking can be achieved through the comparison of average cost per patient, across peers.
Are we delivering appropriate service levels to different patient populations (HBAM neutral or positive) and properly balancing cost & patient risk/safety?
% Clinic Visit Utilization Percent of Clinic Visits out of total Visit Nursing and Clinic Nursing Visits
FINANCIAL ANALYSIS OCTOBER MONTH AND YTD _ REVENUE Base Funding: October base variance of $500K is due to targeted Hospice funding received and matched to expenses. One-time Funding: The favourable variance is due to additional one-time funds received that were not included in the
budget. These additional one-time funds have been matched to expenses. BTI & Other Funding: Revenue is matched to expenses (timing variance and no impact to bottom line). This is for the BTI
computer leases which are charged by Dell but paid by the OACCAC. EXPENSES Purchased Client Services: The unfavourable variances to budget of $1.5M for the month and $8.3M year-to-date are due to
continued higher demand for PSS and Nursing Services to the end of October as portrayed in the spend rate charts shown below.
Internal Therapies The favourable variances to budget of $219K year-to-date are in salaries and benefits due to vacancies. Care Coordination: The year-to-date favourable variance of $203K year-to-date is due to vacancies, lower actual rates than
budgeted, fewer maternity leaves and timing differences in other care coordination administrative expenses.
Health System Development: The expenses relating to these programs have targeted funding which is matched as expenses are
incurred. Variances are due to timing and programs do not impact the overall CCAC bottom line. Nursing Initiatives and I&R: Variances not material Administration: The favourable variance in administration year-to-date of $637K is due in part to vacancies and
occupancy savings. However, a portion of this variance is timing related (BTI and other).
Page 3
FORECAST TO MARCH 31, 2017 YE forecast is slightly above the 1% range, at roughly $3M. There could be a variance of +/- $1M on this forecast, as the forecast is very sensitive to actual realized week over week savings due to the various parallel measures in place. Also, due to the nature of waitlisting being cumulative month/month, the savings in turn cumulate month/month – thus the majority of the savings are back-ended in the fiscal year and will be realized in February and March. In terms of cost controls, the following mechanisms are in place.
1. We have implemented centralized admission controls on PSS service since September 2016. This measure is working well on the patient admission side – continued reduction in PSS costs is dependent on ongoing discharges being maintained at current rates
2. We have reduced expenditures on therapy services since Sept 2016, and are maintaining volumes at a reduced level, but at a level to avoid low volume penalties
3. Nursing services are however still being served to demand to avoid hospital partner impacts – and we are susceptible to demand increases for our nursing services, which in turn would add to costs
4. Administrative cost controls have been in place since May 2016, and continue to contribute positively month over month to the financials
We have detailed expenditure tracking in place on a week/week basis that allows us to update our expected YE outcome weekly. Our budget management committee also meets on a weekly basis to discuss results and options for mitigation. In addition, the LHIN is working with the CCAC to clarify if revenues traditionally clawed back if underspent to program/volume commitments, can be used by the CCAC to address current financial pressures – this could positively impact our YE forecast by $1M if confirmed.
Page 4
ADDITIONAL INFORMATION
Page 5
CCAC Patient Capacity (Budgeted Number of Patients vs. Actual Patient Counts)
Page 6
Page 7
Special Program Costs
Page 8
Appendix I – Revenue Confirmations PURPOSE The Champlain CCAC has a fiduciary obligation to balance its budget each fiscal year. This log keeps track of changes to in year funding (both one
time and base) as a means of understanding the variance in funding introduced over the year.
Balancing annual budgets is challenging not only due to changes in revenue assumptions, but also by variations in patient demand and acuity as
well as factors impacting other partners which impact CCAC operations.
Measures in place to manage the budget are limited to operational efficiencies and introducing service waitlists or transferring patients to other
community services.
FUNDING CONFIRMATIONS RECEIVED
Date Funding changes Impact to budget presented on monthly
Financial statements
2016/2017 2016/2017 Budget reflects an increase of 0.5% as
confirmed by the LHIN, representing $1.1M plus an additional $1.1M for PSS stabilization
N/A: this is reflected in the original and refreshed budget presented
28-Aug-15 Received funding letter confirming new base funding of
$215,500 for Stroke Rehab Services. N/A: this is reflected in the original and
refreshed budget presented
4-Mar-16 Received funding letter for new one-time funding of
$143,800 for Health Links Primary Care. N/A: this is reflected in the original and
refreshed budget presented
9-Mar-16 Received funding letter for one-time funding of $84,145 for PSS Implementation and Home and Community Care
Resource.
N/A: this is reflected in the original and refreshed budget presented
Page 9
Date Funding changes Impact to budget presented on monthly
Financial statements
9-Mar-16 Received funding letter for one-time funding of $1,000
for additional program support for Health Links. N/A: this is reflected in the original and
refreshed budget presented
13-Apr-16 Received funding letter for one-time funding of
$150,000 for Implementation of Health Links and Primary Care Networks in the Champlain region.
N/A: this is reflected in the original and refreshed budget presented
13-Apr-16 Received funding letter for one-time funding of $72,656
for the first quarter of F2016/17 to support the Prescott-Russell Health Link.
N/A: this is reflected in the original and refreshed budget presented
3-Jun-16 Received funding letter for new base funding of
$2,498,500 for Year 3 Wage Enhancement for Personal Support Services.
This is reflected in the refreshed budget (effective July 2016).
15-Jun-16 Received funding letter for one-time funding of $60,000
for the Ottawa East Health Links Business Plan development.
This is reflected in the refreshed budget (effective July 2016).
24-Jun-16 Received funding letter for one-time funding reallocation of $795,982 related to F2015/16
underspending in certain programs.
This is reflected in the refreshed budget (effective July 2016).
5-Jul-16 Received funding letter for one-time funding of
$220,000 to further support the work of the Shared Services Organization (SSO).
This is reflected in the refreshed budget (effective July 2016).
11-Jul-16 Received funding letter for one-time allocation of
$5,000 to support travel expenses for the Early Adopter PSS Community Resource.
+$5,000 but with offsetting expenses
Page 10
Date Funding changes Impact to budget presented on monthly
Financial statements
11-Jul-16
Received funding letter for one-time allocation of $120,000 to implement the recommendations outlines in the Champlain Sub Acute Capacity Plan. (One-time
funding also confirmed for 2017/18 and 2018/19)
+120,000 but with offsetting expenses
11-Jul-16
Received funding letter for one-time allocation of $72,766 to hire and equip a decision support/business intelligence analyst for Health Links, Primary are and
LHIN sub-region analysis. (One-time funding also confirmed for 2017/18).
+72,766 but with offsetting expenses
29-Jul-16
Received funding letter for new base funding of $11,015,800 for expanding service provision for high
needs patients, to provide respite services for caregivers, and a base funding adjustment.
This is reflected in the refreshed budget (effective July 2016).
5-Aug-16
Received “revised” funding letter to replace the July 5, 2016 letter for new one-time funding of $220,000 to
further support the work of the Shared Services Organization (SSO).
This is reflected in the refreshed budget (effective July 2016).
7-Sep-16 Received funding letter for new one-time funding of $60,000 for Community Support Services Projects –
Secondment for Business Analyst.
This is reflected in the refreshed budget (effective July 2016).
9-Sep-16 Received funding letter for $850,591 in new base
funding to provide nursing and PSS services in residential hospices.
+$850,591 (to be flowed to hospices)
27-Sep-16 Received funding letter for new one-time funding of $315,000 to expand capacity at Marianhill hospice.
+$315,000 (to be flowed to hospice)
4-Oct-16
Received funding letter for one-time funding of $1,200 to support Prescott-Russell Health Link representatives
to attend the annual HQO Health Links Leadership Summit
+$1,200 (but with offsetting expenses)
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Date Funding changes Impact to budget presented on monthly
Financial statements
4-Oct-16 Received funding letter for one-time funding of $1,200 to support Ottawa East Health Link representatives to
attend the annual HQO Health Links Leadership Summit +$1,200 (but with offsetting expenses)
24-Oct-16
Received funding letter confirming recovery of $3,312 from CSS Exercise and Fall Prevention Initiative funds. These funds will be reallocated to Akwesasne who will
provide the services in their community
-$3,312 (not material)
28-Oct-16 Received funding letter from MOHLTC confirming
additional $17,000 base funding to support Regional Translation Network Program.
+$17,000 (targeted non-LHIN funding)
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Appendix II – Statement of Financial Position
October 31, 2016 September 30, 2016 March 31, 2016
ASSETS
CURRENT ASSETS
Cash-CDN $3,275,142 $7,064,857 $11,588,108
Accounts Receivable 1,033,206 920,095 1,516,689
Prepaid Expenses 21,288 27,924 289,133
4,329,636 8,012,876 13,393,930
CAPITAL ASSETS 803,379 803,379 995,228
$5,133,015 $8,816,255 $14,389,158
LIABILITIES
CURRENT LIABILITIES
Accounts Payable and Accrued
Liabilities $11,110,246 $14,004,074 $13,902,384
Due to/(from) MOHLTC 1,973,357 1,970,624 1,339,613
13,083,603 15,974,698 15,241,997
LONG-TERM LIABILITIES
Deferred Contributions - Capital
Assets 803,378 803,378 995,228
13,886,981 16,778,076 16,237,225
NET ASSETS
Carry-over 15/16 (1,848,067) (1,848,067)
Operational (6,905,899) (6,113,754) (1,848,067)
(8,753,966) (7,961,821) (1,848,067)
$5,133,015 $8,816,255 $14,389,158
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Appendix III – Cash Flow Forecast
The cash flow forecast presented below takes into consideration the impact of the Waitlisting assumptions presented above.
Date Description
Funding receipts/
(payments)
Cash surplus/
(deficit) position Date Description
Funding receipts/
(payments)
Cash surplus/
(deficit) position
Nov 23 Actual Balance 312,850 Jan 30 Cheque run (3,295,862) (2,607,753)
Nov 24 Payroll (1,321,641) (1,008,791) Jan 31 Funding 10,421,081 7,813,328
Nov 28 Cheque run (3,651,207) (4,659,998) Feb 1 Funding 119,055 7,932,383
Nov 29 Payroll Gov't Submissions (401,058) (5,061,056) Feb 1 Cheque run (643,602) 7,288,780
Nov 30 Funding 10,415,540 5,354,484 Feb 2 Payroll (1,297,650) 5,991,130
Dec 1 Funding 119,055 5,473,539 Feb 6 Cheque run (3,256,379) 2,734,751
Dec 1 Cheque run (643,602) 4,829,937 Feb 6 Payroll Gov't Submissions (524,853) 2,209,898
Dec 5 Cheque run (3,611,724) 1,218,213 Feb 13 Cheque run (3,216,897) (1,006,999)
Dec 8 Payroll (1,321,641) (103,428) Feb 15 Funding 10,421,081 9,414,082
Dec 12 Cheque run (3,572,241) (3,675,669) Feb 16 Payroll (1,297,650) 8,116,432
Dec 13 Payroll Gov't Submissions (401,058) (4,076,727) Feb 20 Cheque run (3,177,414) 4,939,018
Dec 15 Funding 10,419,237 6,342,510 Feb 21 Payroll Gov't Submissions (524,853) 4,414,165
Dec 19 Cheque run (3,532,759) 2,809,751 Feb 27 Cheque run (3,137,931) 1,276,234
Dec 22 Payroll (1,321,641) 1,488,110 Feb 28 Funding 10,421,081 11,697,315
Dec 26 Cheque run (3,493,276) (2,005,166) Mar 1 Funding 119,055 11,816,370
Dec 27 Payroll Gov't Submissions (401,058) (2,406,224) Mar 1 Cheque run (643,602) 11,172,768
Dec 30 Funding 10,421,081 8,014,857 Mar 2 Payroll (1,297,650) 9,875,118
Jan 1 Cheque run (643,602) 7,371,255 Mar 5 Payroll Gov't Submissions (524,853) 9,350,265
Jan 2 Cheque run (3,453,793) 3,917,462 Mar 6 Cheque run (3,098,448) 6,251,817
Jan 3 Funding 119,055 4,036,517 Mar 13 Cheque run (3,058,966) 3,192,851
Jan 5 Payroll (1,297,650) 2,738,867 Mar 15 Funding 10,421,081 13,613,932
Jan 9 Cheque run (3,414,310) (675,443) Mar 16 Payroll (1,297,650) 12,316,282
Jan 10 Payroll Gov't Submissions (524,853) (1,200,296) Mar 20 Cheque run (3,019,483) 9,296,799
Jan 15 Funding 10,421,081 9,220,785 Mar 21 Payroll Gov't Submissions (524,853) 8,771,946
Jan 16 Cheque run (3,374,828) 5,845,957 Mar 27 Cheque run (2,980,000) 5,791,946
Jan 19 Payroll (1,297,650) 4,548,307 Mar 30 Payroll (1,297,650) 4,494,296
Jan 23 Cheque run (3,335,345) 1,212,962 Mar 31 Funding 10,421,081 14,915,377
Jan 24 Payroll Gov't Submissions (524,853) 688,109
$2,800,000
$2,900,000
$3,000,000
$3,100,000
$3,200,000
$3,300,000
$3,400,000
$3,500,000
$3,600,000
20
16
-03
-28
20
16
-04
-04
20
16
-04
-11
20
16
-04
-18
20
16
-04
-25
20
16
-05
-02
20
16
-05
-09
20
16
-05
-16
20
16
-05
-23
20
16
-05
-30
20
16
-06
-06
20
16
-06
-13
20
16
-06
-20
20
16
-06
-27
20
16
-07
-04
20
16
-07
-11
20
16
-07
-18
20
16
-07
-25
20
16
-08
-01
20
16
-08
-08
20
16
-08
-15
20
16
-08
-22
20
16
-08
-29
20
16
-09
-05
20
16
-09
-12
20
16
-09
-19
20
16
-09
-26
20
16
-10
-03
20
16
-10
-10
20
16
-10
-17
20
16
-10
-24
20
16
-10
-31
11
/7/2
01
6
11
/14
/20
16
11
/21
/20
16
11
/28
/20
16
12
/5/2
01
6
12
/12
/20
16
12
/19
/20
16
12
/26
/20
16
1/2
/20
17
1/9
/20
17
1/1
6/2
01
7
1/2
3/2
01
7
1/3
0/2
01
7
2/6
/20
17
2/1
3/2
01
7
2/2
0/2
01
7
2/2
7/2
01
7
3/6
/20
17
3/1
3/2
01
7
3/2
0/2
01
7
3/2
7/2
01
7
FY 2016/17 Weekly Spend Target as of November 2016 (due to YTD Actuals)
Actual New Target CHRIS Budget
summer without School costs
Months CHRIS Budget CHRIS Estimate CHRIS Variance Cumulative Estimated Savings