Assisted Living/Supportive Housing/Adult Day Programs …/media/sit… · April 17th, 2013 Assisted Living/Supportive Housing/Adult Day Programs for Special Populations Final Report

April 17th, 2013

Assisted Living/Supportive

Housing/Adult Day Programs

for

Special Populations Final Report

Table of Contents

0. Preliminaries

1. Executive Summary

2. Current State

3. Recommendations

4. Implementation

5. Appendix – Future State


Housing/Adult Day Programs for


South West

0. Preliminaries


Housing/Adult Day

Programs for

Special Populations

Table of Contents

0. Preliminaries

1. Acknowledgements

2. Context

3. Project Overview

4. Project Timeline


2. Current State

3. Recommendations

4. Implementation

5. Appendix



Special Populations

Final Report

South West

© 2013 All rights reserved

Acknowledgments

The assistance of the Executive Sponsors and Steering Committee Members in the creation of this report was appreciated:

Sue McCutcheon, Lead, Access to Care

Executive Sponsors

Andria Appeldoorn, Access to Care Elaine Kerr, Participation Lodge Anita Cole, South West CCAC Michael Robbins, Segue Brian Dunne, Participation House Janine Hamilton, Spruce Lodge Michele Pegg, Co-lead Bruce Rankin, John Gordon Home Julie Girard, South West LHIN Nupee Hardeep Sadra, South West CCAC Carol Weigel, Grey Bruce Home and Community Support Services Kathy Scanlon, One Care Support

Assisted Living/Supportive Housing/Adult Day Programs Steering Committee Members

Sue Hillis, Co-Chair Assisted Living/Supportive Housing/Adult Day Programs Gord Milak, Co-Chair Assisted Living/Supportive Housing/Adult Day Programs

Rebecca McKee, South West LHIN Cate Melito, Woodstock Community Health Centre Kristy McQueen, VON Rose Wilson, Red Cross Christine Vallis, VON Linda Dunn, MHA Craig Hennessy, South West CCAC Lisa Gardner, AH Carolyn Ridley, South West LHIN Margo Collver, Co-Lead Magdalen Carter, Alzheimer Outreach Vicky Heard, West Elgin Community Health Centre Amber Alpaugh-Bishop, Access to Care

Mary Jo Dunlop, Project Co-lead Shirley Koch, Project Co-lead

Arminda Dumpierrez, OPTIMUS | SBR Nas Farzan, OPTIMUS | SBR Greg Harrington, OPTIMUS | SBR

Report Authors

5


Context

This project is part of an ongoing strategic effort to improve Access to Care in the South West LHIN, with a focus on Special Populations – adults with complex needs

Access to Care – Is an approach to care focused on supporting people, specifically seniors and adults with complex needs, to live safely in their homes for as long as possible. Access to Care empowers clients to participate in their own care and ensures that they get the right care at the right time and place. It calls for collaboration and integration across the health system. Note: In the South West LHIN there are three streams of work supporting Access to Care: Home First, Complex Continuing Care and Rehabilitation (CCC/Rehab), and Assisted Living, Supportive Housing, and Adult Day Programs (Assisted Living/Supportive Housing/Adult Day Programs).

Assisted Living/Supportive Housing/Adult Day Programs (AL/SH/ADP) – Is focused on realigning and enhancing community capacity in assisted living, supportive housing and adult day programs so that more LHIN residents are able to live safely and comfortably in the community. Instead of requiring that individuals research and compare available services on their own, a CCAC Care Coordinator will act as the client’s personal navigator of the healthcare system, providing patients with coordinated access to local services. This change supports some of the major goals of the government’s Excellent Care For All strategy – to reduce unnecessary hospital visits and increase the quality of each client’s care experience. Special Populations – Is a part of the Assisted Living/Supportive Housing/Adult Day Programs stream focused on populations living with Physical Disabilities, Acquired Brain Injuries or HIV/AIDS. Youth transitioning to adults who

are Medically Fragile/Technology Dependent (MFTD) were also within scope.

6


Project

Mission

Project

Success

Project Overview

Improve Access to Care through:

Alignment of Assisted Living/Supportive Housing/Adult Day Programs services for Specialized Populations on the basis of current need and projected demand (with a particular focus on populations with the greatest need)

Greater understanding of the current utilization of and demand for Assisted

Living/Supportive Housing/Adult Day Programs services for Special Populations across the South West LHIN

Recommendations that support access to the most appropriate service by Special Population type, including a costing model

Recommendations that support the CCAC’s Expanded Role for coordinated access – including appropriate eligibility criteria for each Special Population group requiring Assisted Living/Supportive Housing/Adult Day Programs services, as applicable

Clearer perspective on the current processes for admitting Specialized Populations to access and receive Assisted Living/Supportive Housing/Adult Day Programs services

Engaged Stakeholders who understand and support the proposed changes

7


Steering Committee

Meeting (Feb 15)

Project Timeline

January 2013 February 2013 March 2013

Milestones Steering

Committee Meeting (Jan 18)

1. Project Inception

2. Data Gathering Plan

December 2012

3. Current State Assessment

4. Stakeholder Engagement

5. Future-state Recommendations

April 2013

Final Report

(April 17)

Steering Committee

Meeting (Mar 15)

Steering Committee

Meeting (Apr 12)

Project Reporting, Monitoring, and Control

6. Final Report

8

Executive Summary



for

Special Populations

Table of Contents

0. Preliminaries


1. Current State Findings

2. Recommendations

3. Next Steps

2. Current State

3. Recommendations

4. Implementation

5. Appendix



for

Special Populations

Final Report

South West


Current State

Findings


Definitions

12

The services discussed in this report are sometimes referred to using different terminology. Please refer to the following definitions for the purposes of this report

Context

Within the South West, outreach services are provided to adults with Physical Disabilities and Acquired Brain Injuries, respectively. These individuals receive outreach in their homes by Outreach Staff from one of four (Cheshire, Dale, Participation House, Participation Lodge) organizations. Program eligibility varies based on the population served.

Assisted Living/Supportive Housing (AL/SH) Pertains to the activities provided to Service Recipients (SRs)

who are living in a supportive housing setting or own residence and require assisted living services, accessible on a 24-hour basis. This service may include homemaking, personal support, attendant services and core components of independence training. The supportive housing setting is a location where organizations are responsible for providing services to a number of SRs who live in their own units. Housing is not a component of the service. Service is provided on a scheduled and on-call basis

Organizations providing these services will ensure their staff in various locations are onsite (Supportive Housing) and/or accessible on a 24-hour basis (Assisted Living)

Outreach Based on the individual's service

requirements Personal Support Services and homemaking services are provided under the individual's direction, by an attendant on a pre-scheduled visitation basis. Attendant outreach (AO) services can be provided in the individual's home, place of competitive employment, and/or place where consumers are pursuing adult education programs for the purpose of obtaining a degree/certificate/diploma

© 2013 All rights reserved 13

The following are examples of Assisted Living/Supportive Housing and Outreach Services

Survey information obtained from Assisted Living Providers during the course of this project indicated a range of services provided, including:

Personal care

Meal preparation, assistance with eating, clean up

Laundry and light housekeeping

Definitions

Service Examples

The above three services are provided by most programs although there are also AL providers who provide:

With Special Populations the service variation further increases as does the number of non-LHIN funders:

Medication reminders

Foot clinic

Transportation

Security checks

Child care

Palliative care

Caregiver relief/respite

Shopping

Escorts to appointments

Socialization

Congregate dining

Tracheotomy care

Ventilator care

Intermittent catheterization

Insulin administration

Range of motion exercises

Communication

Recreation

Education

Employment Supports

Service Coordination

Life skills training

24 hour supervision

•Medication administration

Counseling

Family Support


Consultations

14

Stakeholders Consulted

Cheshire Homes of London Children’s Hospital of Western Ontario – Transition Clinic

Dale Brain Injury Services Social Work – Children and Parent Resource Institute

John Gordon Home Spinal Cord Injury Ontario

Participation Lodge Researchers – Parkwood, Victoria and UWO

Spruce Lodge CCAC Pediatrics Care Coordinators and CCAC Coordinators. Other CCACs and LHINs provincially

VON - Middlesex-Elgin Branch Primary Care Lead – SW LHIN

ABI Navigator for SW LHIN Centre for Independent Living

Participation House Parkwood Outreach

Family Directive Team LTCH Client Interview

Focus Group – Parents of Medically Fragile/Technology Dependent Young Adults

Consumers/Participants

Kid’s Country Club School Boards (in progress)

Clinical Team – Children and Parent Resource Institute

Children’s Hospital of Western Ontario – Transition Clinic

A large and diverse group of Stakeholders were consulted on their views of the current and future needs of Special Populations in the South West LHIN

Stakeholders


Current Supply and Demand in the South West

Current demand for programs and services by Special Populations outweighs supply

Note: Consultations suggest that referrals may not be made to programs with large waitlists.

Special Populations

Special Population and Service Breakdown Currently

Being Served On Waitlist for

Service Assisted Living/Supportive Housing for Adults with Physical Disabilities 160 137

Attendant Outreach (AO) for Adults with Physical Disabilities 162 131

Adult Day Programs for Adults with Physical Disabilities 150-180 Data unavailable

Assisted Living/Supportive Housing for Adults with Acquired Brain Injury 26 18

Outreach Services for Adults with Acquired Brain Injury 182 63

Adult Day Programs for Adults with Acquired Brain Injury 72 Data unavailable

Adults with HIV/AIDS/Hepatitis C 8 Not applicable

Youth in Transition (Medically Fragile/Technology Dependent (MFTD) Ages 15-17, on CCAC services) 24 Not applicable

Special Populations – Current CCAC Case Loads (Includes ABI and MFTD) 34 Not applicable

Additional Youth in Transition (non-MFTD or ABI, Ages 15-17, on CCAC services) 9

Special Populations on AL/SH/AO waitlists who are now living inappropriately in Long Term Care Homes 3.5% Not applicable

15

Please refer to the Current State section for regional breakdown, explanation and further details for each population


Current State Funding

Special Population funding has not kept up with demand or inflation, creating significant waitlists for these groups and upcoming deficits particularly in Assisted Living/Supportive Housing

Chronic Underfunding

The result of underfunding has been:

AL/SH units have closed over time, translating into fewer services

AL/SH units for Adults with Physical Disabilities outnumber those whom have ABIs by a 4:1 margin. The ABI population has only 26 Assisted Living/Supportive Housing units in the entire LHIN

Request(s) for permanent reallocation of funds from Outreach programs to Supportive Housing

Decreasing supply - as needs increase as people age in place, fewer people can be served

The Good News:

Last year the LHIN funded LHIN-wide Attendant Outreach ($352,000), ABI Outreach ($175,000) and the Urgent Fund ($225,000). This year funding for Overnight Respite and Day Program space increases for the MF/TD population in London ($525,000) was provided

16


Interview Findings - Summary

17

Key Findings

Demand for services greatly outweighs supply

Need for highly individualized services; there is no one size fits all approach

People wish to participate in system design and in developing their individualized plans

Business processes should not hamper innovation or the ability to respond in a crisis

Transitioning to adulthood is traumatic for families because they lose so much support

People have to relocate to access services

Ministry policies may be outdated when it comes to these populations

Funding shortages have contributed to a lack of access to care for Special Populations, resulting in an underserved population that feels isolated and hopeless

Refer to Client Stories for individual experiences.


Current State Assessment

18

Special Populations have been underfunded for years and are currently in crisis. Their situation will continue to deteriorate with projected future demand increases unless changes are made

OVERALL ASSESSMENT Aligned with South West

LHINs Priorities

SPECIAL POPULATIONS

Physical Disabilities ABI HIV/AIDS/HEP C Youth in Transition

Status Trend Status Trend Status Trend Status Trend

Person-Centred Care → → → →

Access to Services ↓ ↓ ↓ ↓

Quality of Care and Services → → → ↓

Summary

Status: Red – in crisis, Yellow – cause for concern, Green – on track (based on input from key stakeholders)

Trend: The potential for downward trend is due to a lack of resources, capacity and funding, which will exacerbate the current lack of services, support and person-centred care.

Sources: Interview and Data


Recommendations


Recommendations

20

Person-centered – the primary focus is on the population’s needs and of their caregivers and families

High-impact – focus on prioritiy issues such as limited access to services versus secondary issues

Innovative and Flexibile – care models reflect the wide range of needs of individuals/caregivers

Evidence-based – recommendations are based on evidence, data and research where possible

Realistic – limited funding and potential for new investments are taken into account

CCAC Expanded Role – the expanded role of the CCAC is reflected in process related recommendations

South West LHIN Alignment – recommendation categories align with the SW LHINs performance areas

of focus

Recommendations were driven by the following:

Guiding Principles


Recommendations Overview

Recommendations were developed to address the most critical issues

21

Increase funding for Adults with ABI Continue funding increase for Youth in Transition Transition toward a geographic hub model for efficient

service delivery for ABI and Physically Disabled populations, and include seniors where possible for critical mass

Recommendations Summary

Summary

1. Person-

Centered

Care

2. Access to

Care

4. Data and

Evaluation

3. Role of

the CCAC

Implement a collaborative process to determine eligibility/suitability

for AL/SH/ADP and Attendant Outreach (AO) Implement a transparent and collaborative waitlist for all providers

that offer AL/SH/ADP and Attendant Outreach services

Use Experience Based Design to plan for unmet needs Ensure that providers to Special Populations have access to

the short term flexible fund Assess the suitability of current clients and realign (care

reviews) Foster enhanced relationships and partnership linkages

Build business processes and confirm the data mechanisms for assessment and reporting

Ask providers to commit to delivering education and training needed to understand and work with Special Populations (CCAC, contracted Service Providers, Hospitals and CSS sector)

5. Education

and Training Short Term – 6 months Medium Term – 6-18 months

Urgency

Short Term Short Term

Medium Term

Short Term Short Term Medium Term

Medium Term

Short Term

Medium Term

Medium Term


Recommendations – Person-Centred Care

22

Realigning Special Populations with the use of a flex fund and deploying Experience Based Design should improve outcomes

All Special Populations

Use Experience Based Design as a framework to develop an approach to address unmet

needs. This will address the needs of those with highly individualized care, providing much

needed support for families and caregivers

Ensure that providers to Special Populations have access to the short term flexible fund in

order to:

avoid their inappropriate admission to ER or LTCHs

mitigate against family breakdown (this could include individualized funding models)

Conduct Care Reviews (Individual Assessments)

Assess the suitability of current clients and programs, and realign as required

Identify who could manage with just attendant outreach or in a cluster model vs. building based services

Examine where a lower cost Adult Day Program (ADP) solution can be used instead of Attendant Outreach

Where possible transition the individual to the most appropriate provider. The overall model of care should be more focused on providing supports to enable independent living where possible, and include some combination of all three types of services (AL/SH, Attendant Outreach and ADP), as required


Recommendations – Access to Care

ABI and Youth in Transition

Lack of funding necessitates the prioritization of those with the highest needs. Individuals with ABIs are at particular risk due to chronic underfunding

Increase funding and resources for Adults with Acquired Brain Injuries. The ABI and MFTD populations are falling through the cracks and they have a general lack of alternatives. The exact amount of funding will need to be informed by the Care Reviews. The range of additional funding needed is provided in the financial projection scenarios

Prioritize Youth in Transition funding. Families whose children are MFTD, as well as the Care Coordinators and other clinical staff involved in their current care, expressed extreme concern about the lack of resources available to these children, particularly as they transition to adulthood and the organizations from whom they receive those services change. In light of recent funding in the City of London, further work is needed to define the urgent needs of families for funding priorities. Consider implementing a working group with parents

Move toward a geographic hub for efficient service delivery. Transition toward a geographic hub model for efficient service delivery for ABI and Physically Disabled populations, and include seniors where possible for critical mass

23


Recommendations – Role of the CCAC

24

Due to the complexity and wide variance in needs of Special Populations, Subject Matter Experts must work together with the CCAC to define eligibility criteria

Implement a collaborative process to determine eligibility/suitability for Assisted

Living/Supportive Housing/Adult Day Programs and Attendant Outreach services. A

collaborative team of CCAC and CSS colleagues should form a working group to fully

outline eligibility and prioritization for specific programs, and determine business

processes for comprehensive and multidisciplinary/multi-partner (in some cases)

assessments. This would include services related to the medically fragile/technology

dependent youth in transition and adult population

Implement a transparent and collaborative waitlist with providers of Assisted

Living/Supportive Housing/Adult Day Programs and Attendant Outreach. The provision of

service for those waitlisted needs to be determined as part of a collaborative process

with the partners involved; in many instances, CCAC would require the assistance of other

partners to care for those on waitlist as they alone may not be able to meet the client’s

needs Include Attendant Outreach Services and individuals with Hepatitis C in the Expanded

Role of the CCAC for AL/SH and Adult Day Program. Providers noted separate business

processes for these individuals as inefficient CCAC should include Attendant Outreach in its mix of coordinated services



Recommendations – Data and Evaluation

25

Build business processes and confirm the data mechanisms for assessment and reporting (e.g. Adult Day Program data, etc.)

Identify the best data sources between the providers and the CCAC as business processes are built and confirmed

Propose a mandatory requirement for regular reporting to the LHIN using a ubiquitous reporting tool:

Current and Waitlisted Clients Numbers

Region of Residence

Client Age

Date of Application for Service

Date of Start of Service (if applicable)

Discharge Date (if applicable)

Program/Service Applied for

Primary Diagnosis/Client Classification (i.e. ABI, Physically Disabled, HIV/HEP

C)

Recommended Frequency of Reporting: Quarterly


There is a need to implement new robust data collection and evaluation processes to leverage in making informed decisions about Special Populations going forward


Recommendations – Education and Training

26

Leverage Human Resources and existing infrastructure in light of funding pressures


In depth education planning is required to assist Care Coodinators in their understanding of options for these populations, including available housing, programming, day programs, respite, etc. This should also include education to help partners understand the CCAC role

Providers should explore communal training to reduce costs and build awareness of one another's capabilities using the Train the Trainer model

Providers should explore collaborative staff sharing models where possible to leverage economies of scale and account for potential staffing shortages

Where possible providers should explore the ability of their sector partners to train, assess, and provide ongoing support for their clients

Further explore respite and convalescent care options in all settings to leverage available resources and accommodate the needs of these special populations despite the reluctance of some parents of MF/TD young adults



Implementation


Implementation Approach

28

1. Engage Special Populations in Experience Based Design process to address unmet needs

2. Ensure providers to Special Populations are informed they can access the short term flexible fund

3. Conduct Care Reviews to assess the suitability of current Special Populations receiving service and re-align

1. Focus on Person-Centred Care

1. Increase funding for Adults with ABI

2. Establish Working Group to identify specific needs of Youth in Transition and increase funding

3. Work with providers to begin planning for a transition to a geographic hub model

2. Increase Access to Care

1. Implement a collaborative process to determine eligibility / suitability for services

2. Implement a transparent and collaborative waitlist process together with providers

3. Ask providers to commit to delivering education and training

3. Leverage the Role of the CCAC

High Level Action Plan


Implementation Roadmap

29

Q1 2013/14 Q2 2013/14 Q3 2013/14 Q4 2014/14 Q1 2014/15

Pe

rso

n C

en

tre

d

Car

ex

Project Close

Project Management, Monitoring, and Control Project

Plan

Expand the Seniors urgent, time limited, flexible fund

Acc

ess

to

Car

e

Implement Collaborative Eligibility/Suitability Process

Approvals

Experience Based Design

Care Reviews

Implement Geographic Hub for ABI and Physically Disabled

Developed Detailed Funding Plan

Timetable R

ole

of

the

C

CA

C

Implement Transparent and Collaborative Waitlist

Main Report • Assisted Living/Supportive

Housing/Adult Day Programs for Special Populations

Current State



for

Special Populations

Table of Contents

0. Preliminaries


2. Current State

1. Consultations

2. Current Demand

3. Funding

4. Interview Findings

5. Client Stories

6. Summary

3. Recommendations

4. Implementation

5. Appendix – Future State



for

Special Populations Draft Final Report

South West


Consultations

33

Stakeholders Consulted

Cheshire Homes of London Children’s Hospital of Western Ontario – Transition Clinic

Dale Brain Injury Services Social Work – Children and Parent Resource Institute

John Gordon Home Spinal Cord Injury Ontario

Participation Lodge Researchers – Parkwood, Victoria and UWO

Spruce Lodge CCAC Pediatrics Care Coordinators and CCAC Coordinators. Other CCACs and LHINs provincially

VON - Middlesex-Elgin Branch Primary Care Lead – SW LHIN

ABI Navigator for SW LHIN Centre for Independent Living

Participation House Parkwood Outreach

Family Directive Team LTCH Client Interview

Focus Group – Parents of Medically Fragile/Technology Dependent Young Adults

Consumers/Participants

Kid’s Country Club School Boards (in progress)

Clinical Team – Children and Parent Resource Institute

Children’s Hospital of Western Ontario – Transition Clinic

A large and diverse group of Stakeholders were consulted on their views of the current and future needs of Special Populations in the South West LHIN

Stakeholders


Current Demand

CSSAs in the SW LHIN currently serve a total of 610* Special Population clients

Notes:

Regional breakdown is indicative of client residence and not where clients are receiving services

*Exact full Adult Day Program (ADP) volumes by Special Population remains unknown –ADPs have reported about 10% of ADP spaces were attended by Special Populations, translating into approximately 150-180 people across the South West

Some adults with complex needs utilize more than one service in order to remain in the community successfully

Current Clients

Region AL/SH Physically Disabled

Attendant Outreach Physically Disabled

Adult Day Program

Physically Disabled

AL Acquired

Brain Injury

Outreach ABI

Adult Day Program Acquired

Brain Injury

HIV/ AIDS

Grey 38 8 5 20 - -

Bruce - 3 - 4 - -

Huron - 10 - 12 - -

Perth 14 25 - 8 - -

Oxford 7 26 - 11 - -

Middlesex - 9 - 3 - -

London 94 55 21 114 72 8

Norfolk - - - - - -

Elgin 7 26 - 10 - -

Total 160 162 150-180* 26 182 72 8

CURRENT CLIENTS

34


Current Demand

It is clear that there is a shortage of services in the South West LHIN for Special Populations. 375 people are on waitlists

Notes:

Regional breakdown is indicative of client residence and not where clients are receiving services

Full Adult Day Program waitlist volumes are not broken down by Special Populations (data unavailable)

There are 23 people from other LHINS on service waitlists

JGH doesn’t keep a waitlist since those needing the service need immediate response, so another solution must be found

Waitlisted Clients

Region AL/SH Physically Disabled

Attendant Outreach Physically Disabled

AL Acquired

Brain Injury

Outreach Acquired

Brain Injury

Grey 10 6 4 5

Bruce 4 10 3 10

Huron 1 15 - 5

Perth 11 14 - 4

Oxford 4 8 - 3

Middlesex 6 6 - 7

London 93 48 10 26

Norfolk - - - -

Elgin 8 24 1 3

Other LHINs 15 1 6 1

Total 155 132 24 64

35


Current Demand

A point in time snapshot of children receiving CCAC services with Medically Fragile technology Dependent and Acquired Brain Injury Diagnosis

Youth in Transition

ABI Medically Fragile / Technology Dependent

Total

AGE 15-17 18-21 15-17 18-21 15-17 18-21

Grey/Bruce 0 0 1 4 1 4

Huron 6 2 6 0 12 2

London/ Middlesex/ Elgin

2 3 5 4 7 7

Oxford 1 2 10 5 11 7

Perth 1 0 2 0 3 0

Total 10 7 24 13 34 20

Notes:

The South West CCAC children’s care coordinators reviewed all clients on their caseloads to identify those categorized as MFTD and Acquired Brain Injury. The totals in the right hand columns of the chart shaded in grey represent unique (distinct) client counts

This data is a point in time snapshot of Medically Fragile / Technology Dependent children receiving CCAC services

Across the South West (point in time review) there are approximately a total of 20 children aged 18 – 21 receiving CCAC services who are categorized with either Acquired Brain Injury or MFTD, and 31 children between the ages 15 to 17 36


Current Demand

Additional Youth in Transition who need very high/intensive level of supports but who are neither MFTD or Acquired Brain Injury

Youth in Transition

Notes:

This table represents South West CCAC data showing the children that the care coordinators have indicated require a very high/intensive level of supports, that are neither MFTD or Acquired Brain Injury

This is a point in time data snapshot

Children that are not MFTD and require intensive support level Diagnosis Ages 15-17 Ages 18-21 Total

Seizures 1

CP, 2 4 11

CP/seizure disorder 1 1

Autism 1 1 2

Lennox-Gastaut Disorder 1 1

Rhett Syndrome 1

Down Syndrome 1 1

Syndrome not yet

diagnosed

1

Global delays 1 1

Blind 1 1

Muscular Dystrophy 2 3

Spina Bifida 2

Quadriplegic 1 1

Carbohydrate Disorder 1

Neuroparalysis 1 2

Cerebellar 1

Total by Age 9 8 31

37


Current Demand – Transitional Support Services

Housing instability is a key marker of extreme poverty, and is both a cause and effect of the ongoing AIDS crisis in North America. Rates of HIV infection among homeless persons are as much as 16 times higher than in the general population (Denning and Dinenno, 2010; Kerker, 2005; Robertson, 2005; Culhane, 2001)

There was a 10% increase in new HIV diagnoses in Southwestern Ontario between 2009 and 2010 and an average of 15 newly-diagnosed HIV cases and 6 newly-diagnosed AIDS cases were reported in Middlesex-London per year between 2000 and 2010

JGH captures a large number of people who would be homeless otherwise

JGH enjoys strong partnerships with the London Intercommunity Health Centre, the Family Health Team at Centre for Hope, shelters – working collaboratively to develop a proposal for a medical respite facility to provide medical care for all homeless who are discharged (not just addictions)

JGH is really seeing the impact of the intervention – 3 people admitted to JGH and deemed palliative have had their diagnosis now deemed stable – the miracle – getting the drugs and nutrition and a home

The John Gordon Home (JGH) is the only AL provider serving the HIV/AIDS/HEP C population

HIV/AIDS/HEP C

38


Current Demand

Geographic View

Current Adult Clients with Physical Disabilities in SW LHIN (AL/SH and

Attendant Outreach)

Current Clients (2012)

Bruce 3 (0% – 5%)

Grey 46 (11% – 20%)

Huron 10 (0% – 5%)

Perth 39 (11% – 20%)

Middlesex 9 (0% – 5%)

London 149 ( >41%)

Oxford 33 (6% – 10%)

Elgin 33 (6% – 10%)

Norfolk 0 (0% – 5%)

0% – 5%

6% – 10%

11% – 20%

21% – 30%

31% – 40%

>41%

Cheshire Homes of London

Participation House Support Services

Participation Lodge

Spruce Lodge

VON Middlesex-Elgin Branch

39

Note: Cheshire also provides Attendant Outreach services in Middlesex County


Current Demand

Geographic View

Current Waitlisted Adults with Physical Disabilities in South West LHIN

(Assisted Living/Supportive Housing and Attendant Outreach)

Waitlisted Clients (2012)

Bruce 14 (6% – 10%)

Grey 16 (6% – 10%)

Huron 16 (6% – 10%)

Perth 25 (6% – 10%)


London 141 (>41%)

Oxford 12 (0% – 5%)

Elgin 32 (6% – 10%)

Norfolk 0 (0% – 5%)

0% – 5%

6% – 10%

11% – 20%

21% – 30%

31% – 40%

>41%

Cheshire Homes of London


Participation Lodge

Spruce Lodge

VON Middlesex-Elgin Branch

40


Current Demand

Geographic View

Current Adults Clients with Acquired Brain Injury in South West LHIN

(Assisted Living/Supportive Housing and Outreach)

Current Clients (2012)

Bruce 4 (0% – 5%)

Grey 25 (11% – 20%)

Huron 12 (6% – 10%)

Perth 8 (0% – 5%)


London 135 (>41%)

Oxford 11 (0% – 5%)

Elgin 10 (0% – 5%)

Norfolk 0 (0% – 5%)

0% – 5%

6% – 10%

11% – 20%

21% – 30%

31% – 40%

>41%


Participation Lodge

Dale Brain Injury Services Inc.

41

Note: Dale Brain Injury Services provides Outreach Services in all counties


Current Demand

Geographic View

Current Waitlisted Adults with Acquired Brain Injury in South West LHIN

(Assisted Living/Supportive Housing and Outreach)


Bruce 13 (11% – 20%)

Grey 9 (11% – 20%)

Huron 5 (6% – 10%)

Perth 4 (0% – 5%)


London 36 (>41%)

Oxford 3 (0% – 5%)

Elgin 4 (0% – 5%)

Norfolk 0 (0% – 5%)

0% – 5%

6% – 10%

11% – 20%

21% – 30%

31% – 40%

>41%


Participation Lodge

Dale Brain Injury Services Inc.

42

Note: Dale Brain Injury Services provides Outreach Services in all counties


Current Demand

Geographic View


Bruce 0 (0% – 5%)

Grey 0 (0% – 5%)

Huron 0 (0% – 5%)

Perth 0 (0% – 5%)


London 8 (>41%)

Oxford 0 (0% – 5%)

Elgin 0 (0% – 5%)

Norfolk 0 (0% – 5%)

Current Adult Clients with HIV/AIDS/Hep C in the South West LHIN

0% – 5%

6% – 10%

11% – 20%

21% – 30%

31% – 40%

>41%

John Gordon Home

Note: John Gordon Home doesn’t keep a waitlist

43


Current Demand – Long Term Care (LTC)

Based on the Cheshire experience, approximately 3.5% of Special Populations awaiting service (AL/SH or Attendant Outreach) are inappropriately living in Long Term Care Homes as of April 2013

Consultations suggest that when shortages in service occur that those in need may be inappropriately placed in other types of housing such as Long Term Care Homes, particularly in non-urban regions were options are more limited. It is known that some of these individuals could be living in their own units with the appropriate outreach services in place.

While long term care is a very appropriate level of care for the right individual, it is important that clients in long term care as part of their transition are not lost and that their housing needs are addressed in order that they can be served in the right place.

Cheshire Experience:

There were approximately 200 Special Populations adults awaiting service at Cheshire Homes of London as of April 2013

Of these individuals, 7 (3.5%) were currently living in Long Term Care Homes and awaiting AL/SH and Outreach services

LTC Estimate

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Current State Funding

Special Population funding has not kept up with demand or inflation, creating significant waitlists for these groups and upcoming deficits particularly in Assisted Living/Supportive Housing

Chronic Underfunding

The result of underfunding has been:

AL/SH units have closed over time, translating into fewer services

AL/SH units for Adults with Physical Disabilities outnumber those whom have Acquired Brain Injuries by a 4:1 margin. The Acquired Brain Injury population has only 26 Assisted Living/Supportive Housing units in the entire LHIN

Request(s) for permanent reallocation of funds from Outreach programs to Supportive Housing

Decreasing supply - as needs increase as people age in place, fewer people can be served

The Good News:

Last year the LHIN funded LHIN-wide Attendant Outreach ($352,000), Acquired Brain Injury Outreach ($175,000) and the Urgent Fund ($225,000). This year funding for Overnight Respite and Day Program space increases for the MF/TD population in London ($525,000) was provided

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Interview Findings - Summary

46

Key Findings

Demand for services greatly outweighs supply

Need for highly individualized services; there is no one size fits all approach

People wish to participate in system design and in developing their individualized plans

Business processes should not hamper innovation or the ability to respond in a crisis

Transitioning to adulthood is traumatic for families because they lose so much support

People have to relocate to access services

Ministry policies may be outdated when it comes to these populations

Funding shortages have contributed to a lack of access to care for Special Populations, resulting in an underserved population that feels isolated and hopeless

Refer to Client Stories for individual experiences.


Interview Findings

Current Challenges

It’s clear that demand far outweighs supply for services

We’ve also discovered that while the care needs of Special Populations, whom are more likely to suffer from multiple chronic conditions, generally increase in magnitude as they age in comparison to non-Special Populations, funding has not kept up, meaning that over time they are having to compromise either quality or quantity of care

We’ve learned that the lack of bridge funding means that some clients and families have to use ERs and LTCHs in times of crises. This may contribute to the use of ERs for non-emergencies, potentially contributing to ALC use of acute and post-acute care beds

We heard from the client families we met with that there isn’t enough respite support available to them, and that this is leaving them susceptible to burn-out and additional stress

We also heard that clients and their families sometimes feel alone as a result of what they perceive to be insufficient continuity in service planning

Funding for AL/SH projects has not increased for several years necessitating fewer spaces and fewer people served

System Challenges Funding shortages have contributed to a lack of access to care for Special Populations

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Interview Findings

Special Populations require an increased focus on person-centered care that provides individuals and families input and choice into the type of care they receive

What Clients do not want in a Future Model

It’s been echoed in the Living Longer, Living Well report and elsewhere – clients and their families want choice, and they’re concerned that their ability to make the choices they believe are best may be compromised if they lose control of the process

Moreover, we heard concerns that the centralization of care management may hamper coordination between health service providers and between those providers and patient families

Concern was also expressed that waitlisted clients would be left to their own devices, not receiving the guidance the support they require. Accountability about managing the needs of waitlisted clients was noted as a particularly important requirement to mitigate against this

Finally, the highly specialized features of Special Populations were highlighted – these individuals are different than typical patients in that the focus of a future model ought to be about providing them with the individualized solutions designed to support them rather than fix them

Client Needs

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Interview Findings

Special Populations require a flexible approach to coordinating needed services. Care Coordinators can play a central role if they work closely with Stakeholders

Key Success Factors to Implementation

Stakeholders whom we engaged by-and-large believe that clients and their families are most knowledgeable about their care needs and that individual-tailored funding would best position them to make choices about the services they need, which, as is often the case, may involve receiving services from more than one service provider

We heard repeatedly that the future role of the CCAC as Care Coordinator must have sufficient flexibility to allow service providers to work collaboratively to manage crises as they occur, and this is particularly important given that one of the outcomes may be reduced use of hospital ERs

Care Coordinators play a central role working closely with stakeholders in coordinating the necessary supports for clients that are awaiting services, especially considering the long waiting lists

The implementation of the Care Coordinator as system navigator must occur seamlessly so as to not impact clients

Implementation

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Interview Findings – Summary

Special Populations and their families feel isolated, alone, frustrated and hopeless

Client Experience

Investigation of other models in terms of accessing service

No one wants a model in which there can be a barrier between a client/family and a potential provider. Those involved feel it will impact the ability of the individual and provider(s) to deploy innovative solutions

Models in which funding does not recognize the changing needs of the individual do not support the individual/family/caregiver for successful living in the community

Transition to adult services is traumatic for families and their children

There is fear of losing more control and independence

There is the fear that the medical model will be reinstated for Adults with Physical Disabilities who live in an Independent Living environment; they don’t want to be “cared for”. They are not sick. “Why doesn’t anyone value the ability to be maintained in the community as a productive member of society?” (Client)

Other Special Populations too want to be as independent as possible

Many older adults with physical disabilities had to fight for Independent Living and Direct Funding for Attendant Services– they don’t want to lose that

Money for Special Populations and their families is an ongoing issue

Most people with disabilities (all these Special Populations) are poor

Individuals/Families in crisis don’t receive the support they need

The current system has limited ability to respond to people and families in crisis or to be proactive in preventing crisis

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Interview Findings – Summary Continued

Individuals are both grateful for and frustrated with their services

Client Experience

Relocation to access services

“There was no similar service in Guelph. When you think about all the years (14) I have tried different

things.” (Client)

There are people on waitlists for services that are provided in the South West LHIN from outside the

South West LHIN

There are people waitlisted for supportive housing willing to relocate from one city to another

Numerous individuals told us they moved to London for the services

The impact they have

“I had honestly forgotten that there are nice people.” (Client)

They shared their detailed programming and schedules and told us how it helped them cope in the

community

Q -“If you didn’t come here and you were still at home. How would life be different?” (Co-Lead)

A – “I would be probably be dead by now. “ (Client)

“Just being able to get groceries every week. That was a huge step up.” (Client)

And when they are not available

Sometimes families qualify for service but no workers are available in their geography

Parents say “Give me the money then; I can’t work because I have to look after my child.” (Parent)

Parents pay privately for a worker to attend Fanshawe with their medically fragile daughter

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Current Clients – Medically Fragile Children

Client Stories

Parents of Medically Fragile Children suffer from lack of support and respite

What if your job required you to work 24 hours a day 7 days a week? What if when you did get a break, you had to be ‘on call’ and available to respond to an emergency? What if you never had a night of uninterrupted sleep? What if you were so exhausted that you could barely go on, but someone you love depended on you for their every want and need, year after year after year? What if you became too old, or too ill to care for them any longer? What if you were the parent of a medically fragile child? Who are these children? Client Example: Cerebral Palsy, spastic, quadriplegic, scoliosis, developmentally delayed, requires 24/7 total care, chest physio, uses a wheelchair and is non verbal. Mom has not worked outside of the home resulting is loss of income and lack of retirement funding. Lack of sleep takes its toll on parents who have not had a vacation in years. This is a Special Population whose caregivers have limited respite resources and will have even fewer respite and support options once their ‘child’ turns 18. The father of a 29 year old medically fragile daughter stated: “We love her but need a break to help us rejuvenate and perhaps have a holiday. The government seems to think there is a miraculous cure after our kids turn 18.” While there is often dollars available for families to contract out care providers, frequently there are no workers, or a very limited pool of workers available, especially in rural areas where staff have to travel long distance for what is often limited hours of work. The time spent searching for candidates puts enormous stress and pressure on families/caregivers. ..Continued on the next slide…

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Current Clients – Medically Fragile Children Cont’d

Client Stories Resources who support families with medically fragile children must be specially trained; regular staff turnover puts additional strain families

These same staff require extensive, specialized training and this training must be repeated with every new person when staff turnover occurs, which is often frequent, and yet consistency of care is one of the things that has been reported as being extremely important to the families of medically fragile children. These children/young adults are sometimes unable to verbalize or express their needs, so having someone there that knows how to read the signs and communicate with them is critical. The mother of a medically fragile 10 year old describes it as a wild “quest to find others to care for our fragile and vulnerable child”. If a client is lucky enough to have a trained worker from a home care agency, there are often limits in place that affect the type of care that can be provided. For example, many agencies have a 40-50 lb lift restriction, so in order to lift or transfer this 10 year old client – who happens to be 55 lbs. – there would need to be 2 workers present. As parents/caregivers age, their worries only increase. What will happen to their children when they are no longer able to care for them themselves? Even Long-term care is not an option as they often don’t have the equipment, staff or resources necessary to provide adequate care to support the complex, extensive care required for this population. The other respite resources that exist do not have nurses or doctors on site and so parents must remain close to home and available to come and get their child in the event of an emergency. A mother writing advocating for additional supports for her daughter expressed that their family was continually “trying to find creative ways to not let our circumstances rob us of a fulfilling, happy family life.” Sounds like a fair request.

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Current Clients – Acquired Brain Injury

Client Stories

The ability of Adults with Acquired Brain Injuries to access services is sometimes the difference between being homeless rather than being able to improve their lives

G is a young man who came from an abusive household. Unable to continue living at home he found himself living in rooming houses. He had been successful with a job but had had a devastating bike injury coming home from work one day and that was a major setback. Over the last couple of years he found himself often living on the streets. About six months ago he was severely beaten and in addition to a broken jaw, broken arm, broken leg, he also suffered a brain injury. While in hospital at Parkwood he was referred to Dale Brain Injury Services but G described it as Dale finding him. G had no resources. Dale took him into an assisted living environment, and subsidized his treatment until such time as he could complete his application for the Ontario Disability Support Program. The Dale staff helped him through all his paperwork, they help him with his instrumental activities of daily living and they are the difference between G being homeless and being on his way to a better life.

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Current State Assessment

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Special Populations have been underfunded for years and are currently in crisis. Their situation will continue to deteriorate with projected future demand increases unless changes are made

OVERALL ASSESSMENT Aligned with South West

LHINs Priorities

SPECIAL POPULATIONS

Physical Disabilities Acquired Brain Injury HIV/AIDS/HEP C Youth in Transition

Status Trend Status Trend Status Trend Status Trend

Person-Centred Care → → → →

Access to Services ↓ ↓ ↓ ↓

Quality of Care and Services → → → ↓

Summary

Status: Red – in crisis, Yellow – cause for concern, Green – on track (based on input from key stakeholders)

Trend: The potential for downward trend is due to a lack of resources, capacity and funding, which will exacerbate the current lack of services, support and person-centred care.

Sources: Interview and Data

Recommendations


Housing/Adult Day

Programs for

Special Populations

Table of Contents

1. Recommendation Guiding Principles

2. Recommendation Summary

3. Key Recommendations by Area

1. Person-Centred Care

2. Access to Care

3. Role of the CCAC

4. Data and Evaluation

5. Education and Training

4. Key Recommendations by Population

1. Physical Disability

2. Acquired Brain Injury

3. HIV/AIDS/HEP C

4. Youth in Transition

5. Additional Recommendations

6. Implementation Considerations



for

Special Populations

Recommendations

South West


Recommendations

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Person-centered – the primary focus is on the population’s needs and their caregivers and

families

High-impact – focus on prioritiy issues such as limited access to services versus secondary

issues

Innovative and Flexibile – care models reflect the wide range of needs of

individuals/caregivers

Evidence-based – recommendations are based on evidence, data and research where

possible

Realistic – limited funding and potential for new investments are taken into account

CCAC Expanded Role – the expanded role of the CCAC is reflected in process related

recommendations

South West LHIN Alignment – recommendation categories align with the SW LHINs

performance areas of focus

Recommendations were driven by the following:

Guiding Principles


Recommendations Overview

Recommendations were developed to address the most critical issues

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Increase funding for Adults with Acquired Brain Injury Continue funding increase for Youth in Transition Transition toward a geographic hub model for efficient

service delivery for Acquired Brain Injury and Physically Disabled populations, and include seniors where possible for critical mass

Recommendations Summary

Summary

1. Person-

Centered

Care

2. Access to

Care

4. Data and

Evaluation

3. Role of

the CCAC

Implement a collaborative process to determine eligibility/suitability for Assisted

Living/Supportive Housing/Adult Day Programs and Attendant Outreach Implement a transparent and collaborative waitlist for all providers that offer

AL/SH/ADP and Attendant Outreach services

Use Experience Based Design to plan for unmet needs Ensure that providers to Special Populations have access to

the short term flexible fund Assess the suitability of current clients and realign (care

reviews) Foster enhanced relationships and partnership linkages

Build business processes and confirm the data mechanisms for assessment and reporting


5. Education

and Training Short Term – 6 months Medium Term – 6-18 months

Urgency

Short Term Short Term

Medium Term

Short Term Short Term Medium Term

Medium Term

Short Term

Medium Term

Medium Term



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Realigning Special Populations with the use of a flex fund and deploying Experience Based Design should improve outcomes


Use Experience Based Design as a framework to develop an approach to address unmet

needs. This will address the needs of those with highly individualized care, providing much

needed support for families and caregivers

Ensure that providers to Special Populations have access to the short term flexible fund in

order to:

avoid their inappropriate admission to ER or LTCHs; and

mitigate against family breakdown (this could include individualized funding models)

Conduct Care Reviews (Individual Assessments)

Assess the suitability of current clients and programs, and realign as required

Identify who could manage with just attendant outreach or in a cluster model vs. building based services

Examine where a lower cost Adult Day Program (ADP) solution can be used instead of Attendant Outreach

Where possible transition the individual to the most appropriate provider. The overall model of care should be more focused on providing supports to enable independent living where possible, and include some combination of all three types of services (AL/SH, Attendant Outreach and ADP), as required

© 2013 All rights reserved 61

Use enhanced relationships developed as a result of Access to Care to better serve individuals within the South West LHIN

Enhance rehabilitation in the community – Access to Care also facilitates access to rehab in hospitals

Emphasize linkages with all Partners. Examples:

Behavioural Supports Ontario (BSO)

Health Links

Acute Care

Rehab

Inpatient Pediatrics

Leverage technology as an enabler (examples)

Chair exercise class by video link

Care Innovations – a joint Intel & General Electric venture, allows patients to remotely access primary care through provider-issued web enabled devices. This has resulted in improved access to care while reducing care management costs

Known as Remote Care Management





Acquired Brain Injury and Youth in Transition

Lack of funding necessitates the prioritization of those with the highest needs. Individuals with ABIs are at particular risk due to chronic underfunding

Increase funding and resources for Adults with Acquired Brain Injuries (ABI). The ABI and Medically Fragile/Technology Dependent (MFTD) populations are falling through the cracks and they have a general lack of alternatives. The exact amount of funding will be determined by the Care Reviews. The range of additional funding needed is provided in the financial projection scenarios

Prioritize Youth in Transition funding. Families whose children are MFTD, as well as the Care Coordinators and other clinical staff involved in their current care, expressed extreme concern about the lack of resources available to these children, particularly as they transition to adulthood and the organizations from whom they receive those services change. In light of recent funding, further work is needed to define the urgent needs of families for funding priorities. Consider implementing a working group with parents

Move toward a geographic hub for efficient service delivery. Transition toward a geographic hub model for efficient service delivery for ABI and Physical Disabilities populations, and include seniors where possible for critical mass

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Many providers use existing Assisted Living/Supportive Housing buildings as their base of operations for their outreach programs. This model is efficient and should not be changed

Gradually shift to geographic hubs from building based models, where possible. This will require substantial time and effort on the part of some providers to fully implement. Sufficient behaviour management training may be required

Continue to support existing Supportive Housing units for those needing 24/7 support

Expand the capacity for more intense rehabilitation to be provided in the community through CCAC and other appropriate providers. For example use IT to deliver rehab / maintenance programs

Connect Parkwood researchers/clinicians and CCAC Self Management Program Managers to explore innovative technology-based models of care for those with spinal cord injuries

Where possible transition the individual to the most appropriate provider – the CCAC and CSS providers to Adults with Disabilities share many long successful service plans to these individuals

There was investment in Attendant Outreach for Adults with Physical Disabilities in 2012/13. This is helping reduce but not eliminate service waitlists

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Due to the complexity and wide variance in needs of Special Populations, Subject Matter Experts must work together with the CCAC to define eligibility criteria

Implement a collaborative process to determine eligibility/suitability for AL/SH /ADP

and Attendant Outreach services. A collaborative team of CCAC and CSS colleagues

should form a working group to fully outline eligibility and prioritization for specific

programs, and determine business processes for comprehensive and

multidisciplinary/multi-partner (in some cases) assessments

Implement a transparent and collaborative waitlist with providers of Assisted

Living/Supportive Housing/Adult Day Programs and Attendant Outreach. The provision of

service for those waitlisted needs to be determined as part of a collaborative process

with the partners involved; in many instances, CCAC would require the assistance of other

partners to care for those on waitlist as they alone may not be able to meet the client’s

needs

Include Attendant Outreach Services and individuals with Hepatitis C in the Expanded

Role of the CCAC for AL/SH and ADP. Providers noted separate business processes for

these individuals as inefficient CCAC should include Attendant Outreach in its mix of coordinated services




Care Coordinators should work closely with Subject Matter Experts to provide the best care coordination options for Special Populations

While Assisted Living/Supportive Housing/Adult Day Programs providers have adapted the

use of the interRAI-CHA assessment tool (and are often familiar with the RAI-HC, CA and

PC), these instruments don’t, in isolation, help to develop the comprehensive service

plans some of these populations require. A collaborative eligibility, assessment and

planning process should be initiated to develop business processes that include subject

matter experts for assessment based on the individual’s needs and degree of specialization

(complexity)

John Gordon Home (JGH) is participating in the Common Measures Project. With the

support of the Ontario HIV/AIDS Treatment Network (OHTN), JGH and 5 other HIV/AIDS

Housing Programs in Ontario are implementing a common intake/assessment tool. The

tool has been approved and JGH begun implementation in March, 2013. A key benefit of

this tool is that it will allow JGH to follow residents after they leave and monitor their

situations

Assessment and Eligibility

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CCACs should use collaboration and ensure transparency to manage waitlists

CCACs should monitor and maintain a collaborative and transparent waitlist for Special Populations

In most cases, if CCAC services are appropriate to the client need, the CCAC should provide service to these individuals until such time as they can be transitioned to the most appropriate longer term provider. Where this is not possible the CCAC Care Coordinator should work with the most appropriate provider toward a short term solution for the individual

The provision of service for those waitlisted needs to be determined as part of a collaborative process with the partners involved; in many instances, CCAC would require the assistance of other partners to care for those on waitlist as they alone may not be able to meet the individual’s needs

The CCAC to facilitate collaborative “care conferencing,” including pre-discharge, with specific providers as necessary to ensure individuals waiting for service are connecting to supports while waiting

Waitlist Management

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Recommendations – Data and Evaluation

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Build business processes and confirm the data mechanisms for assessment and reporting (e.g. Adult Day Program data, etc.)

Identify the best data sources between the providers and the CCAC as business processes are built and confirmed

Propose a mandatory requirement for regular reporting to the LHIN using a ubiquitous reporting tool:

Current and Waitlisted Clients Numbers

Region of Residence

Client Age

Date of Application for Service

Date of Start of Service (if applicable)

Discharge Date (if applicable)

Program/Service Applied for

Primary Diagnosis/Client Classification (i.e. Acquired Brain Injury, Physically

Disabled, HIV/HEP C)

Recommended Frequency of Reporting: Quarterly

There is a need to implement new robust data collection and evaluation processes to leverage in making informed decisions about Special Populations going forward




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Leverage Human Resources and existing infrastructure in light of funding pressures


In depth education planning is required to assist Care Coodinators in their understanding of options for these populations, including available housing, programming, day programs, respite, etc. Education should be provided to providers also to understand CCAC role

Providers should explore communal training to reduce costs and build awareness of one another's capabilities using the Train the Trainer model

Providers should explore collaborative staff sharing models where possible to leverage economies of scale and account for potential staffing shortages

Where possible providers should explore the ability of their sector partners to train, assess, and provide ongoing support for their clients





Since access to affordable, accessible housing is a barrier to receiving care in the community, explore the creation of a position within the South West LHIN for an expert on housing issues that can work across ministries to assist providers to come up with innovative solutions for those requiring housing. This would prevent premature admission to long term care

The South West LHIN has already initiated a dialogue with municipal housing providers. Assisted Living providers should be included in future discussions where appropriate in order to help develop housing solutions

Encourage any municipalities who have not opted to continue with Ontario Renovates to reconsider their decision in order to improve access for residents


Specific expertise on housing for Adults with Physical Disabilities is needed to address a growing issue driven primarily by a lack of Assisted Living/Supportive Housing

People with Physical Disabilities

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Population Specific Recommendations

Those Adults with Physical Disabilities who are accustomed to independent living do not wish to be “medicalized”

That those Adults with Physical Disabilities who are currently on Direct Funding not be included in the Expanded Role of the CCAC unless they have a need to access professional services

Ensure access to Adult Day Programs for Adults with Physical Disabilities who wish to participate

Maintaining as much independence as possible is key to maximizing the quality of life for Adults with Physical Disabilities

People with Physical Disabilities

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Acquired Brain Injury should become a priority group within specialized populations. Acquired Brain Injury is such a specialty that lack of appropriate supports often results in the Acquired Brain Injury client being inappropriately placed in long term care, ending up homeless or incarcerated

Parkwood is hard-pressed to provide sufficient outreach until community providers have an opening and the Acquired Brain Injury Navigator for the South West LHIN spends two days per week at the jail looking out for brain injured clients

The South West LHIN should provide additional funding for Outreach in order to address the most severe injuries on the waitlist and prevent inappropriate placement

Currently providers often cobble together resources to serve people in crisis or on a waitlist. It will be essential to maintain this flexibility and not create business processes that get in the way of innovation

Continue to support the Adult Day Program for Acquired Brain Injury; deemed essential by its members to successful living in the community

Acquired Brain Injury population is so highly specialized that a lack of appropriate care impacts other parts of the healthcare system

Acquired Brain Injury

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It is recommended that the South West LHIN support JGH as they pursue current research projects

Transition Housing/Care is a relatively new service model. JGH is participating in two research projects to quantify and assess its benefits

The Transitional Housing Study is a multi-site community-based pilot study that aims to understand the individual and structural factors relevant to ‘housing readiness’ among persons living with HIV/AIDS (PHA), the range of support services and practices that best enhance ‘housing readiness’, and the changing needs of PHAs throughout residency. Preliminary findings indicate that three key services provided by transitional housing programs that encouraged housing readiness among participants include: management of HIV drug therapies; personal assistance with appointments; and service referrals

The second research project is the Common Measures Project mentioned previously

JGH to report to South West LHIN quarterly on the demand for housing that they have been unable to meet for future transitional housing planning

Recognize the importance of the values of GIPA and MIPA: greater involvement and meaningful involvement of PHAs and the role PHAs play in the governance, leadership and activities in the sector, also known as ‘Nothing About Us Without Us’

The John Gordon Home is currently looking at how to address the housing issues for the HIV/AID/HEP C populations

HIV/AIDS/HEP C

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More comprehensive discharge planning - don’t just refer to one provider but wrap the person in the centre with the support they require

This population may include those that are developmentally delayed as well as medically complex

Human resources are a concern with this population. Families experience continual retraining of support workers for their children with complex conditions. In some instances even though they are eligible for service they cannot find staff in their geographic location

In some circumstances parents have been so desperate for support they have requested that the money allowed to purchase services be redirected to them to help with overall household expenses and the cost of caregiving by the parent. Explore individualized funding models for these life long conditions with the flexibility for parents to purchase what they need

The need for respite for these families is significant. Kids Country Club provides respite for those until they are 18 and parents whose children are treated at CPRI benefit from their admission with time free from caregiving. After that no respite is available for these families unless it is delivered in complex and continuing care or long-term care. The parents and children are reluctant to use these options

Individualized Funding models should be explored to mitigate the lack of resources and funding for the Special Populations, whom typically fall through the cracks

Youth in Transition

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To assist with future service planning for the MF/TD population at all ages, additional data and information needs to be collected by CCAC and CSS providers

College\university students don't have the same support as younger kids at school. The education assistance that are in the classroom also go away at 18 or after 7 years of high school (or 21). Further consider ways to support college and university students

Increase the number of day program spaces and other respite services where possible

Assess innovative Housing models – specific suggestions for innovative housing models were presented during these consultations. It would be of benefit to communities to further investigate the feasibility of these models and how the CCAC and CSS providers can better support these families such as:

Additional group homes Parents offered to buy a home for their children with CCAC or other staff supports Use wing of an existing facility with specialized staff Individualized funding

Families/Caregivers need additional supports for Medically Fragile/technology Dependent Youth who age into adults at home

Youth in Transition

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Assisted Living Options To Improve Access

Operating on the assumption that there will be no new facilities built in the foreseeable future, a range of lower cost models to increase AL have been considered

Increase Capacity Options

(within LHIN control and excluding new builds)

Special Populations

Benefits Risks/Considerations

Community Options – Assess underutilized living accommodations such as academic residences, retirement

homes, garage conversions, ‘granny flats’ etc.

No new build required, less capital investment upfront. Can potentially leverage the Health Homes Renovation Tax Credit.

Still includes a cost and significant resources for conversions, including permits, taxes etc.

Affordable Housing – Leverage municipal approaches to Affordable Housing combined with Outreach Services

Leverage existing municipal programs and resources that are looking at affordable housing.

Affordable housing may still have an additional cost for equipment, renovations etc.

Private-Public Partnerships – Use private funding (corporate, family, fundraising) to augment funding deficits

More flexibility to raise money through non government channels.

Fundraising efforts need to be balanced against private interests and expectations.

Transitional Housing – Use ‘patient hotels’ or virtual wards depending on need for short term crisis

Can be more cost-effective than an acute care setting.

Can still be costly if not shared with multiple providers and with high occupancy.


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Additional Recommendations

Other opportunities to improve the provision of services to Special Populations exist despite the reality that increasing access and system capacity remain the primary issues


Use various models of community-based Restorative and Rehabilitative Care

and deploy technology innovatively to maintain individuals in their own

homes for as long as possible

Use Day Programming models with appropriately skilled staff and activities to

create appropriate wrap around supports for successful community living

Define Crisis Prevention roles amongst partners so that there is increased

collaboration to problem-solve in times of crises. Include transitional housing

solutions

More effective navigation support and tools for Special Populations and their

families/caregivers, especially during transition to adulthood

Improve Transportation options to access community services, including rural

settings

Additional Recommendations Common to ALL Special Populations

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Recommendations – Implementation

Collaboration – Include provider partners and consumers at the table for a transparent and

collaborative approach that is person-centred and links the transitions across the continuum of

care

Specialized Resources – Explore where specialistis among the South West LHIN providers,

CCAC and representatives from other Ministries would be beneficial

Leverage Existing Resources – Train other providers on Special Populations and continue using

respite supports in Long Term Care

Align with other Inititiatives – Identify dependencies and linkages with other

iniatitives/programs

Deploy IT – Identify further e-enablers and proceed with ER Notification for CSS clients and

two way communication strategy as planned

Metrics – Move forward with considerable thought on agreed upon metrics that meaure the

success of the implementation of these recommendations, considering ALC is not currently

used

The following should be considered during implementation:

Successful implementation of creative solutions to care for these highly specialized populations requires that partners, individuals and families be at the planning table

Considerations

77

Implementation





Implementation Approach

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1. Engage Special Populations in Experience Based Design process to address unmet needs

2. Ensure providers to Special Populations are informed they can access the short term flexible fund

3. Conduct Care Reviews to assess the suitability of current Special Populations receiving service and re-align

1. Focus on Person-Centred Care

1. Increase funding for Adults with Acquired Brain Injury

2. Establish Working Group to identify specific needs of Youth in Transition and increase funding

3. Work with providers to begin planning for a transition to a geographic hub model

2. Increase Access to Care

1. Implement a collaborative process to determine eligibility / suitability for services

2. Implement a transparent and collaborative waitlist process together with providers

3. Ask providers to commit to delivering education and training

3. Leverage the Role of the CCAC

High Level Action Plan


Implementation Roadmap

80

Q1 2013/14 Q2 2013/14 Q3 2013/14 Q4 2014/14 Q1 2014/15

Pe

rso

n C

en

tre

d

Car

ex

Project Close

Project Management, Monitoring, and Control Project

Plan

Expand the Seniors urgent, time limited, flexible fund

Acc

ess

to

Car

e

Implement Collaborative Eligibility/Suitability Process

Approvals

Experience Based Design

Care Reviews

Implement Geographic Hub for Acquired Brain Injury and Physically Disabled

Developed Detailed Funding Plan

Timetable R

ole

of

the

C

CA

C

Implement Transparent and Collaborative Waitlist

Appendix – Future State




Table of Contents

0. Preliminaries


2. Current State

3. Recommendations

4. Implementation

5. Appendix Future State

1. Methodology

2. Projections for Physical Disabilities

3. Projections for Acquired Brain Injury

4. Projections for HIV/AIDS

5. Costing Summary



for


South West


Future State Disclaimer

Important Disclaimer for Forecasting Future Demand

Due to the lack of a comprehensive reporting mechanism, projecting the future demand for services by Special Populations is challenging.

In the absence of more accurate data, the utilized methodology provides the best means in forecasting future service requirements.

Regardless of the potential margin of error of the forecasted numbers, the fact remains that there is significantly more demand than supply in programs and services for Special Populations.

A PDSA approach for the highest needs populations appears to be the most practical way to begin to address the issue of access to care.

*The Institute of Healthcare Improvement defines PDSA (Plan-Do-Study-Act) as way to implement change by developing a plan to test the change (Plan), carrying out the test (Do), observing and learning from the consequences (Study), and determining what modifications should be made to the test (Act).

83


Outcome: Understanding who is currently using services within the LHIN.

Methodology to Calculate Future Demand

The following model provided the basis for calculating future service requirements for Assisted Living/Supportive Housing/Adult Day Programs and Attendant Outreach programs for Special Populations

1 2 4 Setting a

Utilization Target

Adjust to meet benchmark utilization target by population, if required: Current

assumption is based on 100% utilization

Adjusting for Demographics

Adjust for population growth of Acquired Brain Injury, HIV and Physically Disabled population in the SW LHIN: 2016 2018 2022

3

Use prevalence rates to estimate the total number of Special Populations in the South West LHIN. Use scenario analysis based on current % of population served to project future demand for services.

Accounting for Unmet Need

Determining current service use by Special Population type in the SW LHIN.

Determining Current Usage

Outcome: Insight into future service need.

Outcome: Accounting for projected future demand on basis of population growth.

Outcome: Utilization target buffer if needed.

Logic Model

84


Future Demand Methodology by Population

Estimating Current Population of Adults with Physical Disabilities

One report was used to estimate the number of individuals in the SW LHIN that are Adults with Physical Disabilities and required assistance:

Participation and Activation Limitation Survey. 2006. Statistics Canada.

Physically Disabled and Acquired Brain Injury methodology

Filter Elements

1. Type of Disability • Pain • Mobility • Agility • Developmental

2. Help Status • Have some help but need more

• Have no help but need some

3. Severity of Disability • Very Severe Only

Estimating Current Population of those with Acquired Brain Injuries

Two reports were used to estimate the number of individuals in the SW LHIN that have Acquired Brain Injuries:

SW LHIN Acquired Brain Injury Needs Assessment. 2010. medHR/Ontario Brain Injury Association.

Acquired Brain Injury Dataset Project: South West LHIN Report. Ontario Neurotrauma Foundation.

Filter Elements

1. Prevalence of Acquired Brain Injuries within population

• Percentage of Population (18+) with Acquired Brain Injury

2. Severity of Injury • Percentage of Individuals with Acquired Brain Injury whose injuries are classified as severe

85


Future Demand by Population

Notes:

This number does not represent the total potential population of Adults with Physical Disabilities, only those estimated as very severe in impairments and therefore requiring service

The ratio of current clients receiving AL/SH vs. Attendant Outreach is 49.7% vs. 50.3%. This split was used to determine future service requirements

Inference percentage does not necessarily include those clients currently being served by CCAC, due to waitlists in CSS

Less than half of need is being met. Demand is expected to be 10% higher in 3 years

Adults with Physical Disabilities

2016 2018 2022

Projected Number 834 846 875

Service Type Requirements (if all are served)

AL/SH 414 420 435

Attendant Outreach 419 426 440

Service Type Requirements (current service ratio of 42%)

AL/SH 174 177 183

Attendant Outreach 176 179 185

Current Clients (2012): 322

Assisted Living/Supportive Housing: 160

Attendant Outreach: 162

Estimated Physically Disabled Population (2012): 764 Inference: 42% of need is being met

86



It’s likely that only a fraction of Adults with Acquired Brain Injury are currently receiving services

Adults with Acquired Brain Injuries

2016 2018 2022

Projected Number 3,902 3,961 4,098

Service Type Requirements (if all are served)

Assisted Living 488 495 512

Outreach Services 3,415 3,465 3,586

Service Type Requirements (current service ratio of 5.8%)

Assisted Living 28 29 30

Outreach Services 199 202 209


Assisted Living: 26

Outreach Services: 182

Estimated ABI Population (2012): 3,576 Inference: 5.8% of need is being met

Notes:

This number does not represent the total potential population of Adults with Acquired Brain Injuries, only those estimated as requiring service

The ratio of current clients receiving AL vs. Outreach services is 12.5% vs. 87.5%. This split was used to determine future service requirements

87


Future Demand Methodology by Population

Estimating Current Population of Adults with HIV or Hepatitis C

HIV Approach

Report on HIV/AIDS in Ontario. 2009.

HIV and Hep C Methodology

Filter Elements

Prevalence Rate of HIV among Adults

• Total: 0.129%

Hepatitis C Approach

A Proposed Strategy to Address Hepatitis C in Ontario 2009 – 2014.

Filter Elements

Prevalence Rate of Hepatitis C among Adults

• Total: 0.85%

Note:

Not everyone with HIV or Hepatitis C would require the specialized services of John Gordon Home. It is assumed the only 1% of the individuals will require the services offered at JGH

88



Quantifying the magnitude of need is made challenging by the absence of a reporting system

Adults with HIV/AIDS and Hep C

2016 2018 2022

Projected Number HIV 1,102 1,118 1,157

Hep C 7,257 7,364 7,621

Total 8,359 8,482 8,778

Needs Filter 1% applicable for services

1% applicable for services

1% applicable for services

Estimated Total 84 85 88


John Gordon Home

Estimated HIV Population (2012): 980 Estimated Hep C Population (2012): 6,454 Total: 7,434

Notes:

Because not everyone with HIV or Hepatitis C would require the specialized services of John Gordon Home, we added an additional filter, our current estimate is that only 1% of the population would need to be addressed, but this assumption needs to be validated

Since this population cannot wait for service, they may be served by the Mental Health and Addictions sector, this demand is not captured

89


Current Demand

A point in time snapshot of children receiving CCAC services with Medically Fragile Technology Dependent and Acquired Brain Injury Diagnosis

Youth in Transition

Acquired Brain Injury

Medically Fragile / Technology Dependent

Total

AGE 15-17 18-21 15-17 18-21 15-17 18-21

Grey/Bruce 0 0 1 4 1 4

Huron 6 2 6 0 12 2

London/ Middlesex/ Elgin

2 3 5 4 7 7

Oxford 1 2 10 5 11 7

Perth 1 0 2 0 3 0

Total 10 7 24 13 34 20

Notes:

The South West CCAC children’s care coordinators reviewed all clients on their caseloads to identify those categorized as MFTD and ABI. The totals in the right hand columns of the chart shaded in grey represent unique (distinct) client counts

This data is a point in time snapshot of Medically Fragile / Technology Dependent children receiving CCAC services

Across the South West (point in time review) there are approximately a total of 20 children aged 18 – 21 receiving CCAC services who are categorized with either ABI or MFTD, and 31 children between the ages 15 to 17

90


Current Demand

Additional Youth in Transition who need very high/intensive level of supports but who are neither MFTD or Acquired Brain Injury

Youth in Transition

Notes:

This table represents South West CCAC data showing the children that the care coordinators have indicated require a very high/intensive level of supports, that are neither MFTD or Acquired Brain Injury

This is a point in time data snapshot

Children that are not MFTD and require intensive support level Diagnosis Ages 15-17 Ages 18-21 Total

Seizures 1

CP, 2 4 11

CP/seizure disorder 1 1

Autism 1 1 2

Lennox-Gastaut Disorder 1 1

Rhett Syndrome 1

Down Syndrome 1 1

Syndrome not yet

diagnosed

1

Global delays 1 1

Blind 1 1

Muscular Dystrophy 2 3

Spina Bifida 2

Quadriplegic 1 1

Carbohydrate Disorder 1

Neuroparalysis 1 2

Cerebellar 1

Total by Age 9 8 31

91


Financial Projections

Financials projections for 2016, 2018 and 2022 have been made on the basis of 3 scenarios: 1. Maintaining the Status Quo; 2. Reducing the Service Waitlist; and 3. Servicing Total Projected Need. Some scenarios have multiple options

1. Maintaining the Status Quo

1. No Increase: Assumes that 2013 service levels are maintained

2. Population Increase: Assumes that service levels increase with the population growth of individuals 18 year of age and older

2. Population Increase + Waitlist Reduction

1. 25%: Assumes that service levels increase with the population growth of individuals 18 years of age and older, and additional resources are added to provide service to 25% of waitlisted individuals



3. Servicing Total Projected Need

1. All Need: Assumes that service levels are increased to meet all projected need

Scenario Overviews

92



The graphs below outline the projected service and cost requirements in 2016 for Adults with Physical Disabilities on the basis of the 3 scenarios

Adults with Physical Disabilities – 2016

0

100

200

300

400

500

600

700

800

900

1.1 NoIncrease

1.2 Pop.Increase

2.1 WL 25% 2.2 WL 50% 2.3 WL100%

3.1 All Need

Service Requirements and Mix – 2016

AL/SH AO

$-

$5,000,000

$10,000,000

$15,000,000

$20,000,000

$25,000,000

$30,000,000

$35,000,000

1.1 NoIncrease

1.2 Pop.Increase

2.1 WL25%

2.2 WL50%

2.3 WL100%

3.1 AllNeed

Funding Requirements – 2016

AL/SH AO

93

Notes:

Funding numbers represent projections based on assumptions on MOHLTC funding, and represent only program related costs for fiscal 2011/12 (doesn’t include administration and support costs as defined through Ontario Health Reporting Standards)

Total number of Adults with Physical Disabilities in ADPs is unclear as numbers are constantly in a state of flux. Thus current and future funding details remain unknown

London Outreach model for 24/7 – costs are about $28-29,000 for 60 people in 2012/2013 – 24/7 coverage is not included in above costs

Projected funding requirements assume that future services are allocated among CSSAs as they are today

Costs/Funding based on assumed annual inflation rate of 1.5%

Max scenario assumes that all projected need is met (based on projected need for service not total population)

Waitlist growth is projected on the basis of population growth



94

Projected volumes and costs for Adults with Physical Disabilities in 2016 are calculated on the basis of three scenarios: 1. Maintaining the Status Quo; 2. Reducing Service Waitlists; and 3. Servicing Total Projected Need. Some scenarios have multiple options

Notes:


Total number of Adults with Physical Disabilities in Adult Day Programs is unclear as numbers are constantly in a state of flux. Thus current and future funding details remain unknown






AO = Attendant Outreach

Adults with Physical Disabilities - 2016

1. Status Quo 2. Pop Increase + Waitlist Reduction 3. Max

No Increase Pop. Increase 25% 50% 100% All Need

Clients Funded

AL/SH 160 174 212 249 324 414

AO 162 177 212 248 320 419

Total Client Need

AL/SH 254 240 203 165 90 0

AO 257 243 207 171 100 0

Required Funding ($M)

AL/SH $8.6 $9.3 $11.3 $13.3 $17.3 $22.1

AO $3.3 $3.7 $4.1 $5.2 $6.6 $8.7



The graphs below outline the projected service and cost requirements in 2016 for Adults with Acquired Brain Injuries on the basis of the 3 scenarios

Adults with Acquired Brain Injuries (ABI) – 2016

95

0

500

1000

1500

2000

2500

3000

3500

4000

4500

1.1 NoIncrease

1.2 Pop.Increase

2.1 WL 25% 2.2 WL 50% 2.3 WL100%

3.1 All Need

Service Requirements and Mix - 2016

AL AO

$-

$20,000,000

$40,000,000

$60,000,000

$80,000,000

$100,000,000

$120,000,000

1.1 NoIncrease

1.2 Pop.Increase

2.1 WL25%

2.2 WL50%

2.3 WL100%

3.1 AllNeed

Funding Requirements - 2016

AL AO

Notes:

AL costs include estimated $1.65M MOHLTC funding for 10 beds that are provincial resources at Dale Brain Injury Service Inc.

Costs only include program related costs for fiscal 2011/12 (doesn’t include administration and support costs as defined through Ontario Health Reporting Standards)

Approximately $1.04M was spent providing Adult Day Programs at Dale (ABI) and Hutton House (non ABI) during 2012/2013







96

Notes:



Approximately $1.04M was spent providing ADPs at Dale (Acquired Brain Injury) and Hutton House (non ABI) during 2012/2013





Projected volumes and costs for Adults with Acquired Brain Injuries in 2016 are calculated on the basis of three scenarios: 1. Maintaining the Status Quo; 2. Reducing Service Waitlists; and 3. Servicing Total Projected Need. Some scenarios have multiple options

1. Status Quo 2. Pop Increase + Waitlist Reduction 3. Max

No

Increase Pop. Increase 25% 50% 100% All Need

Clients Funded

AL 26 28 33 38 48 488

Outreach 182 199 216 233 267 3415

Total Client Need

AL 462 459 455 450 440 0

Outreach 3233 3216 3199 3182 3148 0


AL $3.7 $4.0 $4.8 $5.5 $6.9 $70.0

Outreach $1.7 $1.9 $2.0 $2.2 $2.5 $32.0

Adults with Acquired Brain Injuries – 2016





0

100

200

300

400

500

600

700

800

900

1.1 NoIncrease

1.2 Pop.Increase

2.1 WL 25% 2.2 WL 50% 2.3 WL100%

3.1 All Need


AL/SH AO

$-

$5,000,000

$10,000,000

$15,000,000

$20,000,000

$25,000,000

$30,000,000

$35,000,000

1.1 NoIncrease

1.2 Pop.Increase

2.1 WL25%

2.2 WL50%

2.3 WL100%

3.1 AllNeed

Funding Requirements – 2018

AL/SH AO

97

Notes:










The table below outlines the projected service and cost requirements in 2018 for Adults with Physical Disabilities on the basis of the 3 scenarios


98

1. Status Quo 2. Pop Increase + Waitlist Reduction 3. Ideal


Clients Funded

AL/SH 160 177 215 253 329 421

AO 162 179 215 252 324 426

Total Client Need

AL/SH 261 243 206 168 92 0

AO 264 246 210 174 101 0


AL/SH $8.8 $9.8 $11.9 $13.9 $18.1 $23.1

AO $3.4 $3.8 $4.6 $5.4 $6.9 $9.1 Notes:








AO= Attendant Outreach





99

Notes:



Approximately $1.04M was spent providing ADPs at Dale (ABI) and Hutton House (non ABI) during 2012/2013





0

500

1000

1500

2000

2500

3000

3500

4000

4500

1.1 NoIncrease

1.2 Pop.Increase

2.1 WL 25% 2.2 WL 50% 2.3 WL100%

3.1 All Need


AL AO

$-

$20,000,000

$40,000,000

$60,000,000

$80,000,000

$100,000,000

$120,000,000

1.1 NoIncrease

1.2 Pop.Increase

2.1 WL25%

2.2 WL50%

2.3 WL100%

3.1 AllNeed


AL AO



The table below outlines the projected service and cost requirements in 2018 for Adults with Acquired Brain Injuries on the basis of the 3 scenarios

Adults with Acquired Brain Injuries – 2018

100


No


Clients Funded

AL 26 29 34 39 49 495

Outreach 182 202 219 236 271 3465

Total Client Need

AL 469 466 461 456 446 0

Outreach 3283 3264 3246 3229 3194 0


AL $3.8 $4.3 $5.0 $5.7 $7.2 $73.2

Outreach $1.8 $1.9 $2.1 $2.2 $2.3 $33.4

Notes:












0

100

200

300

400

500

600

700

800

900

1000

1.1 NoIncrease

1.2 Pop.Increase

2.1 WL 25% 2.2 WL 50% 2.3 WL100%

3.1 All Need


AL/SH AO

$-

$5,000,000

$10,000,000

$15,000,000

$20,000,000

$25,000,000

$30,000,000

$35,000,000

$40,000,000

1.1 NoIncrease

1.2 Pop.Increase

2.1 WL25%

2.2 WL50%

2.3 WL100%

3.1 AllNeed


AL/SH Costs AO Costs

101

Notes:










The table below outlines the projected service and cost requirements in 2022 for Adults with Physical Disabilities on the basis of the 3 scenarios


102



Clients Funded

AL/SH 160 183 222 262 340 435

AO 162 185 223 269 336 440

Total Client Need

AL/SH 275 252 213 173 95 0

AO 278 255 217 180 105 0


AL/SH $9.4 $10.7 $13.0 $15.3 $19.9 $25.5

AO $3.7 $4.2 $5.0 $5.9 $7.6 $10.0 Notes:








AO= Attendant Outreach





103

Notes:


Costs only include program related costs for fiscal 2011/12 (doesn’t include administration and support costs as defined through Ontario Health Reporting Standards






0

500

1000

1500

2000

2500

3000

3500

4000

4500

1.1 NoIncrease

1.2 Pop.Increase

2.1 WL 25% 2.2 WL 50% 2.3 WL100%

3.1 All Need


AL AO

$-

$20,000,000

$40,000,000

$60,000,000

$80,000,000

$100,000,000

$120,000,000

$140,000,000

1.1 NoIncrease

1.2 Pop.Increase

2.1 WL25%

2.2 WL50%

2.3 WL100%

3.1 AllNeed


AL AO



The table below outlines the projected service and cost requirements in 2022 for Adults with Acquired Brain Injuries on the basis of the 3 scenarios


104


No


Clients Funded

AL 26 30 35 40 50 590

Outreach 182 209 227 245 281 3508

Total Client Need

AL 486 483 477 472 462 0

Outreach 3404 3378 3359 3341 3305 0


AL $4.1 $4.7 $5.5 $6.3 $7.9 $92.6

Outreach $1.9 $2.1 $2.3 $2.5 $2.9 $36.0

Notes:








Documents

Assisted Living/Supportive Housing/Adult Day Programs …/media/sit… · April 17th, 2013 Assisted Living/Supportive Housing/Adult Day Programs for Special Populations Final Report