1 Aging at Home Strategy allowing seniors to live safely at home with dignity and independence 7 th Annual Invitational Elder Think Tank November 19, 2008

2 Government Priorities For Health Care WAIT TIMES (ER) Emergency Departments Alternate Levels of Care Aging at Home Diabetes/CDPM Mental Health and Addiction High Growth Areas Hospital Funding FAMILY HEALTH CARE FOR ALL 9000 Nurses 100 Medical Spaces/International Medical Graduates 50 FHTs 25 NP Led Clinics Integrated Cancer Screening Health Care Connect Enablers Information Management e-Health Equity LHIN

3 Aging at Home Strategy will expand community services for seniors and their caregivers and relieve pressures on hospitals and long-term care homes Unprecedented $700 million investment over three years to provide support to seniors and their caregivers to stay healthy and live with dignity and independence The right services in the right place, at the right time transition supports from hospitals to community services home care and community supports when seniors’ needs create high risk of ER visits and institutionalization community supports to keep seniors healthy and active in their homes and communities LHINs’ opportunity to change the way services and supports are delivered and provide more equitable access for Ontario’s diverse population New possibilities emphasizing community-based partnerships and an integrated continuum of services

4 The following principles will guide LHINs in implementation of the Aging at Home Strategy Senior centered Services must respond to the needs of seniors Community based and integrated with broader healthcare system Equitable must recognize demographic and geographic challenges Cost-effective best care at optimal cost recognizing benefits of volunteerism and community economic development Results oriented results defined and measured to ensure outcomes Local community oriented strategies that rely upon and leverage capacity in local neighbourhoods and within communities of like interest (ethno-cultural, linguistic, religious, sexual orientation)

5 LHIN Allocation to enhance community-based supports : Community Support ServicesAssistive Living Services/Supportive Housing Home CareLong Term Care Beds End of Life CareAssistive Devices 20% or more of funding earmarked for innovative approaches to ensure equitable access to services for a diverse population Central Priorities Provincially managed funding to enable some solutions at a provincial level, e.g. 100 vans to provide seniors with rides to appointments; NW Centre of Excellence for Integrated Seniors’ Services (CEISS) Assistive Devices Program Supporting increased mobility, devices to make seniors’ homes safer and prevent injuries Funding will increase overall mix and quantity of traditional and innovative services that support seniors to stay healthy and live with independence and dignity in their homes

6 Funding of $702M over 3 years resulting in a base increase of $382M primarily through the LHINs Allocations07/0808/0909/1010/11Total LHIN Planning$3.0M LHIN Allocations*$75.6M$187.2M$330.6M$593.4M Assistive Devices Program$10.0M$15.0M $40.0M Central Priorities$8.4M$20.8M$36.8M$66.0M Total Investment$3.0M$94.0M$223.0M$382.4M$702.4M * At least 20% ($118.7M minimum over 3 years) to be used for individual LHIN innovative solutions.

7 Collaborative and respective roles of MOHLTC and LHINs LHIN RoleMOHLTC Role Plan and identify required Aging at Home services LHIN boards approve proposals/plan within each LHIN allocation Manage implementation of LHIN Aging at Home services Annually review outcomes of implementing the previous year’s services in light of the upcoming year’s planning process Provide overall policy direction Monitoring of plans, performance indicators and ensure program evaluation Facilitate implementation and removal of legislative, regulatory or policy barriers Determine provincial priorities and allocation of Central Priorities and ADP funding Collaboration Develop planning approach and share planning tools/resources Enable innovation by sharing innovative service approaches and engaging “grassroot” providers Accountability through evaluation plan and performance measures Joint ministry/LHIN communication to seniors, caregivers and providers

8 Planning for year 1 involved broad community engagement, innovation forums and resulted in 290 LHIN initiatives Fall 2007 – January LHINs engaged in broad consultation with local health care providers, consumers and other members of the community of interest; provincial consultation also held in November with provincial health care provider associations and seniors groups February/April 2008 – 900 local service providers, seniors and grassroots organizations participated across 43 sites in a Community Innovation Exchange (videoconference and local discussions) and over 600 participants attended April 23, 2008 provincial expo which showcased LHIN achievements and shared innovative proposals Spring LHIN Detailed Service Plans included 301 proposals 290 funded as of October ($17.5M) were approved as innovation based on joint ministry LHIN review MOHLTC worked with the LHINs to identify and mitigate legislative, regulatory or policy issues, and to facilitate implementation

9 To ensure seniors’ homes support them, there are more residential options that support seniors Supportive housing (SH) expansion (e.g. seniors living at existing sites and bringing new SH services into buildings with many elderly tenants) Hospital discharge strategies and risk identification tools for seniors going home Mobile nursing teams/nurse practitioners for long-term care homes Increased access to assistive devices information, resources & assessments A number of proposals show promise towards significant system improvement over time including, Central LHIN program to help EMS staff assist high emergency department (ED)-use seniors to better navigate system and reduce dependency on ED services Assisted living supports targeted to specific seniors congregate living buildings to serve high-risk and vulnerable seniors in Toronto Central and Champlain LHINs Transitional Care Plans (post-hospital discharge follow-up care)

10 Supportive social environments will decrease social isolation for seniors and caregivers Caregiver support and consumer/ caregiver education e.g., adult day and overnight programs; and caregiver counseling Social engagement and physical activities e.g., social recreation and exercise programs; peer mentors Congregate dining (including a volunteer-run tax clinic for local seniors) More friendly visiting/calling ( e.g., leveraging community capacity by engaging like groups and underemployed persons) Examples of proposals showing promise towards significant system improvement over time: ‘ Young Carers’ initiative through Alzheimer Society of Haldimand Norfolk Telephone assurance calls to isolated seniors provided by volunteers from Community Living Sector (i.e. developmentally disabled adults)

11 Senior-centred care that is easy to access providing access to a flexible continuum of services and supports Increased transportation ; delivered meals; telephone security checks Personal support, homemaking and caregiver respite Case coordination/system navigation ( building capacity of new and existing services to better serve seniors and improve system integration) Outreach or mobile services to bring the services to isolated frail seniors (including group settings like day programs or congregate dining) Flexible baskets of service and self-selected care options Expansion of geriatric outreach services and community-based program partnerships with family health teams and community health centres Examples of proposals showing promise towards significant system improvement over time: Single-point access centre to coordinate recruitment, selection, and retention of volunteers to increase capacity of community services for seniors in NSM LHIN Telehomecare program through partnership between CCAC and primary care providers

12 Innovative solutions to keep seniors healthy and ensure equitable access to services for a diverse population Partnerships with non-traditional providers that allow and recognize “informal services”. e.g. SE LHIN program with individualized care options including client choice of service providers New services that include preventive and wellness philosophies. e.g. seniors fitness and falls prevention programs Approaches that take advantage of like groups and individuals to deliver informal care such as friendly home visits, telephone calling and transportation to appointments. e.g. - well seniors providing peer support for frail senior stroke survivors; - culturally sensitive services targeted to hard-to-serve seniors such as Parish nursing delivered in partnership with a downtown Community Health Centre; and - South Asian community-led day program

13  Creative solutions such as  “tweaking” proposals to make them compliant with legislation  services considered and approved under various legislation  “pilot” status to allow time to develop definition of a new service and evaluate program effectiveness  Regulations amended to increase CCAC Service Maximums for homemaking/personal hours giving seniors more supports at home  Existing process for approval of new agencies and services was clarified and accelerated  OMA Agreement provisions for new interdisciplinary models for care of the elderly  Proposed regulatory changes to provide flexibility to serve people in the community Solutions were found to address legislative, regulatory and policy challenges

14 Measures are being put in place to monitor success What does success look like? Under the Ministry LHIN Accountability Agreement (MLAA), two key indicators (ALC days and median time to LTC placement) will be used for Aging at Home (for 65+ sub-population) Specifically, success of Aging at Home Strategy will assess whether: Seniors can easily access the services required to meet their needs – seniors and their caregivers are satisfied that they are receiving the right care and that their needs are being met Fewer seniors require hospitalization or emergency services - their needs are being met without recourse to these services Fewer seniors require admission to long-term care homes and waiting time to placement is reduced – alternative residential settings are available to those with lesser needs

15 Current Aging at Home Strategy performance indicators and data sources provide results for part of the picture What questions do we want to answer? What data could provide answers? What are possible performance indicators? Is there a decreased need for hospital services? Are more clients being discharged home? Hospital discharge and ED visit data 1.Alternate level of care days 2.Unscheduled ED visits Is there a decreased need for long-term care home placement? Is this having an impact on wait times? Placement and assessment data 3.Wait to placement 4.Proportion with high MAPLe scores* Are home care services helping to avoid hospitalizations/emergency visits? Assessment data5.ED visits/hospitalizations among home care clients Are the needs of seniors at home or alternative residential settings being met in those settings? Assessment data Indicators to be developed. Examine assessed needs of seniors at home and services delivered to meet the needs. Are seniors and their caregivers satisfied with access to care and to the services themselves? Survey data6.Satisfaction with health care in the community Additional satisfaction and experience measures to be developed. * Baseline data for this indicator are currently not available for calculation.

/10 Aging at Home initiatives are being better aligned with reduced ER Wait Times and ALC Challenges ALC was identified as a priority as part of the 2007/08 AAH announcement; many LHINs addressed ALC in their 2008/09 Aging at Home proposals MOHLTC and LHINs are meeting with Kevin Smith, Provincial ALC Lead, to align AAH strategy with ER/ALC and other initiatives Analysis of year 1 alignment, options for strengthening alignment, and agreement to put in context of all LHIN initiatives and Ministry LHIN Accountability Agreement targets Overarching ER/ALC Plan (due December 15, 2008) LHINs will submit an overarching plan for 2009/10 outlining how each LHIN will reduce ER/ALC using ED Pay for Performance funding, Aging at Home, Urgent Priority and CCACs service maximums

17 Year 1 Proposals have varying degrees of impact on ER Wait Times and ALC days

18 In Year 2, performance monitoring will be strengthened and a robust evaluation plan will be put in place. LHINs undertaking community engagement activities in their local area with their providers to identify proposals for year 2 Joint MOHLTC/LHIN review of overarching ER/ALC plan including Aging at Home Process for monitoring performance indicators and develop research project to determine whether services meet seniors’ assessed needs MOHLTC, LHINs and evaluation experts developing an evaluation plan of the impact of the Aging at Home Strategy Review, decisions and funding of year 2 LHIN proposals, central priorities and assistive devices