Mississauga Halton LHIN/media/sites/mh...MH LHIN Population Projections by Cohort Compared to Ontario, 2010 to 2035 Source: Ministry of Finance Population Projections by LHIN from

Mississauga Halton LHINEnvironmental Scan

February 2011

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Table of Contents• Geography• MH LHIN Population Profile• Social Determinants of Health• Health Status• Chronic Conditions• Mental Health & Addictions• Cancer• Primary Health Care• Health Service Providers in the MH LHIN• Health Service Utilization• Health Human Resources• Summary

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Mississauga Halton LHIN Profile

Geography

Population Profile

Aging

Diversity

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Geography

• The Mississauga Halton LHIN is diverse in terms of its geography and population profile.

• The MH LHIN shares borders with four other LHINs, including Central West, Toronto Central, Hamilton Niagara Haldimand Brant, and Waterloo Wellington.

• The MH LHIN has six planning areas, including Halton Hills, Oakville, Milton, Northeast Mississauga, Southwest Mississauga, and South Etobicoke (see map next slide).

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Map of Mississauga Halton Sub-LHIN Planning Zones

1

2

3

4

6

5

Sub-LHIN Planning Zones

Halton Hills

Milton

Oakville

Northwest Mississauga

Southeast Mississauga

South Etobicoke

2

3

4

5

6

1Central West LHIN

Waterloo Wellington LHIN

Hamilton Niagara Haldimand Brant LHIN

Mississauga Halton LHIN

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Our Population Profile

• While the Mississauga Halton LHIN is one of the most geographically compact LHINs in the province, it is the sixth largest LHIN based on population.

• The Mississauga Halton LHIN is home to 1,152,914 residents (2010), containing 8.74% of Ontario’s total population.

• This is up from 7.88% of the Ontario population in 2001 (Statistics Canada, 2006 Census of Population).

• The MH LHIN will experience a further projected growth of 10.6% from 2010 to 2015, which is an increase in our population of 122,661 residents.

Source: Pop Proj Summary LHIN, (Stats Can) Intellihealth, MOHLTC.

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Population by Sub-LHIN Area, 2008

Sub-LHIN Area Population

Halton Hills 60,206

Milton 58,755

Oakville 180,775

Northwest Mississauga 343,335

Southeast Mississauga 358,587

South Etobicoke 108,918

TOTAL 1,110,576

Source: 2006 Block to SubLHIN crosswalk, Version 9.1 (Ministry of Health and Long Term Care, Health Analytics Branch, January 2010). Population estimates by age and sex for census subdivisions, July 1, 1996 to 2008, Ontario (Statistics Canada, Demography Division, customized data - Statistique Canada, Division de la démographie, données personnalisées)

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Population by Dissemination Area in the MH LHIN, 2006 CensusA dissemination area (DA) is a small, relatively stable geographic unit and is the smallest standard geographic area for which all census data are disseminated. As a general rule of thumb, DAs have relatively consistent population counts, meaning that a geographically smaller DA is likely to be more densely populated than a larger DA.

As we would expect, this map shows that the most densely populated areas of the MH LHIN are in the urban areas of South Etobicoke, Mississauga and Oakville, with Milton also having some DAs with large populations.

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Aging

• The demographic composition of the MH LHIN will continue to change; one notable trend is the aging of the population.

• Age is the greatest predictor of increased illness and use of health care services; and a higher proportion of residents in older age cohorts will have greater demands on the local health care system.

• The growing number of seniors in the MH LHIN emphasizes the need to plan for the health care needs of an aging population.

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Percent of Population Aged 65+ by Sub-LHIN Area

Of all people aged 65+ in the MH LHIN, 60% live in Mississauga; that is, of the 118, 444 people aged 65+, approximately 71,000 live in Mississauga.

Milton 4%

Halton Hills 5%

Oakville 18%

Northwest Mississauga

29%


31%

South Etobicoke-

Toronto 13%

Distribution of Population 65+, 2008

South Etobicoke has the highest percentage of residents aged 65+, with approximately 14% of the population being aged 65 or over.

0%2%4%6%8%

10%12%14%

Percent of Sub-LHIN Populations Aged 65+, 2008

Source: Ministry of Finance Population Projections by LHIN from C2009-2036, based on Census Survey data up to 2008.

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Persons Aged 65+ by Dissemination Area (DA)This map shows the number of persons aged 65 or older by Dissemination Area in the MH LHIN, as per the 2006 Census.

The DAs with the largest numbers of persons aged 65 or older are found in Mississauga and South Etobicoke, but there are pockets with large numbers of seniors throughout the MH LHIN.

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Population GrowthMississauga Halton LHIN Projected Growth

MH LHIN Growth (from 2010) Ontario Growth

(from 2010)

2010 1,156,734 - 13,220,437 -

2015 1,277,172 10.4% 14,025,225 6.1%

2020 1,412,123 22.1% 14,906,645 12.8%

Ages MH LHIN (2020)

Growth (From 2010)

Ontario (2020)

Growth (From 2010)

0-14 256,439 20.3% 2,434,408 10.3%

15-44 578,677 14.9% 5,816,647 6.0%

45-64 377,308 21.2% 4,043,570 9.6%

65-74 114,593 61.4% 1,483,824 53.0%

75-84 59,474 42.9% 781,316 26.0%

85+ 25,632 61.0% 346,880 40.9%

Mississauga Halton LHIN Projected Growth to 2020 by Age Group


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Age Cohort MH LHIN 2010 MH LHIN 2035 % Change Ontario 2010 Ontario 2035 % Change

0 – 19 295,002 443,349 50.3% 3,086,259 3,817,921 23.7%

20 – 44 421,790 596,044 41.3% 4,607,157 5,465,296 18.6%

45 – 64 311,391 446,788 43.5% 3,690,665 4,284,340 16.1%

65 – 74 71,020 179,915 153.3% 969,802 1,989,347 105.1%

75+ 57,531 174,736 203.7% 866,554 2,112,033 143.7%

TOTAL 1,156,734 1,840,832 59.1% 13,220,437 17,668,937 33.6%

MH LHIN Population Projections by Cohort Compared to Ontario, 2010 to 2035


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MH LHIN Population Projections by Cohort Compared to Ontario, 2010 to 2035


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This chart demonstrates population growth by age cohort from 2010 to 2035in the MH LHIN and the province of Ontario.

We can see that the MH LHIN and Ontario follow a similar pattern of growth by age cohort, in that the those aged 65 – 74 and 75+ will experience the largest percentage of growth.

However, it is projected that the MH LHIN will experience a higher rate of growth than the province across all age cohorts.

MH LHIN Population GrowthThis chart demonstrates population growth by age group from 2010 to 2035, in terms of actual numbers of residents and percent growth.

We can see that there is growth in all age groups. Although people aged 20 –44 will continue to be the largest age cohort, the percent change is highest in those aged 75+, followed by those aged 65 – 74.

It is projected that by 2035, there will be almost two and half times more people aged 75+ in the MH LHIN than there are currently.Source: Ministry of Finance Population Projections by LHIN from C2010-2036, based on Census Survey data up to 2009.

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Population Growth in the Mississauga Halton adds to the urgency for change… Large & growing population.

The growth projections by cohort for the MH LHIN are consistent with the provincial trend as a whole, but the growth rate is higher.

Over the next 10 years, from 2010 to 2020, the population of the MH LHIN is expected to grow by 22.1% (from 1,156,734 to 1,412,123), compared to 12.8% for the province of Ontario over the same time period.

By 2035, MH LHIN population is projected to be over 1.8 million.

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Sub-LHIN AreaLHIN Total Ontario

Visible Minority Milton Halton Hills Oakville Northwest

MississaugaSoutheast

MississaugaSouth

Etobicoke

Total population (2006) 53,410 55,025 164,490 291,750 335,815 101,735 1,002,225 12,028,895

Not a visible minority 82.9% 95.9% 81.6% 48.0% 56.8% 75.9% 639,180 63.8% 9,283,690 77.3%

Total visible minority population 17.1% 4.1% 18.4% 52.0% 43.2% 24.1% 362,975 36.2% 2,745,205 22.8%

Chinese 1.5% 0.6% 3.2% 8.2% 6.5% 3.6% 55,870 5.6% 576,980 4.8%

South Asian 5.8% 0.9% 6.0% 21.2% 15.8% 5.5% 134,160 13.4% 794,170 6.6%

Black 3.2% 0.8% 2.1% 6.3% 5.0% 4.1% 45,020 4.5% 473,760 3.9%

Filipino 2.2% 0.4% 1.4% 4.7% 5.0% 2.6% 36,570 3.6% 203,220 1.7%

Latin American 1.3% 0.5% 1.0% 1.7% 2.0% 1.9% 16,340 1.6% 147,135 1.2%

Southeast Asian 0.3% 0.1% 0.5% 2.0% 2.3% 0.8% 15,355 1.5% 110,045 0.9%

Arab 0.7% 0.1% 1.0% 2.8% 2.5% 0.9% 19,455 1.9% 111,405 0.9%

West Asian 0.4% 0.1% 0.7% 1.0% 0.8% 0.7% 7,975 0.8% 96,620 0.8%

Korean 0.3% 0.1% 1.1% 1.1% 1.1% 2.4% 11,250 1.1% 69,540 0.6%

Japanese 0.1% 0.2% 0.3% 0.4% 0.4% 0.7% 3,730 0.4% 28,080 0.2%

Visible minority, n.i.e. 0.3% 0.1% 0.4% 0.8% 0.7% 0.3% 5,775 0.6% 56,845 0.5%

Multiple visible minority 0.9% 0.2% 0.7% 1.7% 1.1% 0.5% 10,730 1.1% 77,405 0.6%

Diversity The MH LHIN is one of the most diverse LHINs, with 36% of the population being a visible minority.

Source: 2006 Census, Statistics Canada

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Visible Minority Population• Indicators on the percent of the population who are visible

minorities are also useful for planning culturally competent service delivery for communities with diverse ethnic groups.

• Cultural diversity is an important factor in achieving strategic directions of access and equity of access.

• The cultural and linguistic differences that exist within the MH LHIN will require providers to plan, innovate and deliver services in culturally competent ways to meet the needs of local residents.

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Diversity• Mississauga Halton LHIN has a higher proportion of immigrants and visible minorities than

the province, particularly in South Etobicoke and Mississauga.

• Recent immigrants have different health experiences from the general population in that their health is usually better, and access to health care services is not as good. This indicator does not include non-landed immigrants, refugees, foreign students, or individuals on work or Minister’s permits.

• Population by mother tongue also reveals the diversity of ethnic communities within Mississauga Halton LHIN. Mother tongue is defined as the first language learned at home in childhood and still understood by the individual at the time of the census.

• In 2006, approximately 41% of Mississauga Halton residents indicated a non-official language as their mother tongue, compared to 27% in Ontario. The top ranked non-official language response was Polish among Mississauga Halton residents.

• Since effective communication is essential in the provision of health care services and in key messages for health prevention and promotion, language will be an important consideration for health planning in Mississauga Halton LHIN.

• The predominant visible minority in Oakville, Etobicoke and Mississauga is South Asian, though there are significant populations of residents of Chinese, Black and Filipino origin.

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Diversity – 2001 and 2006 Comparison

Mississauga Halton Ontario

LANGUAGE 2001 2006 2001 2006

Total population by language 894,710 1,002,200 11,285,550 12,028,895

Population who include English as mother tongue 569,415 592,045 8,119,835 8,398,255

% population with English mother tongue 63.7% 59.1% 71.9% 69.8%

Population who include French as mother tongue 15,600 16,580 533,960 532,865

% population with French mother tongue 1.8% 1.7% 4.7% 4.4%

Neither English nor French 20,630 26,470 232,775 266,655

% population with no knowledge of English or French 2.3% 2.6% 2.1% 2.2%

Source: LHIN Census 2006 Indicators.

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Language Milton Halton Hills Oakville Northwest Mississauga


South Etobicoke

MH LHIN TOTAL ONTARIO

English 78.8% 87.5% 74.1% 54.1% 49.2% 56.0% 59.1% 69.8%

French 1.9% 2.1% 2.1% 1.6% 1.4% 1.5% 1.7% 41.4%

Non-Official 20.5% 11.2% 25.3% 47.1% 51.8% 44.1% 41.4% 27.2%

Milton Halton Hills Oakville Northwest Mississauga


South Etobicoke

MH LHIN TOTAL ONTARIO

Polish2.1%

Polish1.4%

Portuguese2.2%

Urdu6.1%

Polish5.9%

Polish5.5%

Polish4.0%

Italian2.4%

Urdu1.8%

Dutch1.2%

Italian2.1%

Polish3.3%

Portuguese3.6%

Ukrainian3.6%

Urdu3.3%

Chinese,n.o.s.1.8%

Italian1.7%

Italian1.1%

Polish1.9%

Punjabi2.9%

Urdu3.6%

Italian3.5%

Portuguese2.6%

Cantonese1.5%

Spanish1.5%

Portuguese1.1%

Spanish1.4%

Arabic2.9%

Tagalog3.0%

Serbian2.7%

Italian2.4%

Spanish1.3%

Portuguese1.2%

German1.0%

German1.3%

Tagalog2.8%

Italian3.0%

Portuguese2.3%

Tagalog2.1%

German1.3%

Ranking of Top 5 Non-Official Languages by Sub-LHIN, MH LHIN & Province**

Mother Tongue*


* Totals do not add up to 100%, as the counts include those who indicated multiple responses to mother tongue. For example, English mother tongue includes those who responded that their mother tongue was English and French.

** as a percentage of the total population whose mother tongue is a non-official language, single response only.

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Diversity: Percentage of Population, Recent ImmigrantsThis map shows the percentage of the population in each Dissemination Area in the MH LHIN who are recent immigrants.

The DAs with the highest percentage of recent immigrants in the MH LHIN are located in Mississauga. However, there are areas with high percentages of recent immigrants throughout the MH LHIN.

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Diversity: Percentage of Population That Cannot Conduct a Conversation in Either French or English

This map shows the percentage of the population in each Dissemination Area who cannot conduct a conversation in either French or English.

As we may expect, the DAs in the MH LHIN with the highest percentage of people who cannot conduct a conversation in either French or English closely resemble the DAs with the highest percentages of recent immigrants.

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Francophone Residents• Mississauga Halton has a relatively small Francophone population relative to the province. • The area is home to approximately 18,490 residents whose mother tongue is French.1 However,

using the new inclusive definition of francophones (adopted by the Office of Francophone Affairs in January 2010), the number of francophones in the MH LHIN increases to 35,730.2

• There is representation in most communities throughout Mississauga Halton, but over half of francophone residents reside in the City of Mississauga, which is a designated community under Ontario’s French Language Services Act (FLSA).

• 29% of Francophones in the Regional Municipality of Peel are also racial minority (a portion of which is in Mississauga Halton LHIN).3

• While the number of people identified as speaking French in the Mississauga Halton LHIN has increased from 2001 to 2006, the percentage of the population speaking French has actually decreased over this time period.4

• There are five identified French Language health service providers in the Mississauga Halton LHIN.

1. Mother Tongue (8), Age groups (17a) and Census divisions, Census subdivisions, and Dissemination areas (2006 Census Statistics Canada 97-555-XCB2006017).2. 2006 Statistics Canada Census, definition of francophone adopted by the Office of Francophone Affairs and the Trillium Foundation. Francophones were previously defined as those

whose mother tongue is French. The mother tongue category identifies Francophones solely on the basis of French as the first language learned at home in childhood and still understood at the time of the census. The new Inclusive Definition of Francophone (IDF) is based on three questions in the census concerning mother tongue, the language spoken at home, and knowledge of official languages.

3. Statistics Profile – Francophones in Ontario. Government of Ontario Office of Francophone Affairs, September 2005.4. Profile for Canada, Provinces, Territories, Census Divisions, Census Subdivisions and Dissemination Areas, 2006 Census 2006 Census Statistics Canada 94-581-XCB2006002. Profile

for Census Metropolitan Areas, Tracted Census Agglomerations and Census Tracts, 2006 Census 2006 Census Statistics Canada 94-581-XCB2006005.

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Aboriginal Population• The 4,400 identified aboriginals within Mississauga Halton LHIN form a

small portion of the population (0.4%).1

• The highest concentration within the LHIN is in Halton Hills, where 0.9% of the population is of Aboriginal ethnic identity.2

• The range is much smaller than in other LHINs because of the lack of First Nations reserves within the Mississauga Halton LHIN.

• Health status characteristics and non-medical health determinants of Aboriginal people differ from the non-Aboriginal population (e.g. infant mortality, unintentional injury deaths, suicides and smoking rates).

• Census data for Aboriginal populations are particularly susceptible to incomplete enumeration on First Nations reserves.

1 Statistics Canada. 2007. 2006 Community Profiles. 2006 Census. Statistics Canada Catalogue no. 92-591-XWE. Ottawa. Released March 13 2007. http://www12.statcan.ca/census-recensement/2006/dp-pd/prof/92-591/index.cfm?Lang=E.2 2006 Census, Statistics Canada.

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Social Determinants of Health

Socio-Economic Status

Health Status

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Socio-Economic Status

• Socio-economic status (SES) is recognized as an important determinant of health and the link between health status, utilization of health services and SES is well established.

• Socio-economic disadvantage is an important determinant of inequalities in health; people with higher incomes can generally expect to live longer and healthier lives than those earning less, unemployed individuals and their families suffer an increased risk of premature death, and low levels of education are associated with riskier health behaviours.

• At the individual level, socio-economic inequalities in health are generally thought to be related to the prevalence of behavioural risk factors and/or access to material resources.

Source: Socio-Economic Indicators Atlas, Mississauga Halton LHIN. Health System Intelligence Project, Spring 2006.

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Socio-Economic Status IndicatorsSub-LHIN

MH LHIN Total ONTARIO



South Etobicoke

% of total population age 65+ 8.3% 10.2% 11.7% 7.3% 12.0% 18.2% 10.9% 13.6%

% of families with children, headed by lone-parent 15.5% 17.0% 16.9% 17.4% 23.0% 27.6% 20.0% 24.5%

% population with English mother tongue 78.8% 87.5% 74.1% 54.1% 49.2% 56.0% 59.1% 69.8%

% population with French mother tongue 1.9% 2.1% 2.1% 1.6% 1.4% 1.5% 1.7% 4.4%

% population with no knowledge of English or French 1.0% 0.4% 1.1% 3.0% 3.8% 2.4% 2.6% 2.2%

% of population who are immigrants 24.4% 15.2% 30.5% 49.4% 52.0% 41.9% 43.2% 28.3%

% of population who arrived within 5 years 3.4% 0.8% 4.1% 9.7% 11.7% 7.4% 8.4% 4.8%

% of population who are visible minorities 17.1% 4.1% 18.4% 52.0% 43.2% 24.1% 36.2% 22.8%

% population of Aboriginal identity 0.8% 0.9% 0.4% 0.3% 0.4% 0.5% 0.4% 2.0%

Source: 2006 Census, Statistics Canada.

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Socio-Economic Status Indicators (continued)Sub-LHIN

MH LHIN Total ONTARIO



South Etobicoke

Labour force participation rate (age 15+) (% population in labour force) 78.3% 75.1% 70.9% 73.8% 68.8% 64.2% 70.9% 67.1%

Unemployment rate (age 15+) 3.6% 4.2% 5.3% 6.1% 6.7% 6.0% 5.9% 6.4%

Youth unemployment rate (age 15-24) 9.7% 11.4% 14.7% 15.5% 14.0% 15.4% 14.3% 14.5%

% population (age 25+) without certificate, degree, diploma 12.5% 14.3% 9.1% 11.1% 15.5% 14.9% 13.0% 18.7%

% population (age 25+) with completed post-secondary education 63.2% 57.1% 69.9% 67.2% 61.7% 62.9% 64.5% 56.8%

Proportion of population living in low income 5.0% 5.1% 9.7% 13.1% 17.3% 15.6% 13.3% 14.7%

% non-owned private dwellings 11.9% 14.0% 15.9% 15.2% 31.5% 30.8% 22.6% 29.0%

% households spending 30% or more of income on housing 24.1% 21.7% 23.5% 29.1% 32.6% 27.0% 28.5% 27.6%


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Comparison of MH LHIN Population Profiles

ID Total Pop. 2008

% Ontario Pop in LHIN

% Pop Aged 65+

% Econ. Family

Incidence of Low Income

% Total Lone Parent

Families

% Visible Minority

Pop.

% Pop. Aged 20+ with less

than HS Education

Ontario 12,986,332 13.46 11.33 15.29 20.41 24.60

1 Erie St. Clair 666,128 5.12 14.45 11.63 15.12 9.57 27.37

2 South West 957,379 7.35 15.06 12.85 13.63 6.69 27.46

3 Waterloo Wellington 739,272 5.68 11.85 9.23 13.30 10.41 25.25

4 HNHB 1,405,407 10.79 15.57 12.47 15.70 8.32 27.69

5 Central West 800,209 6.15 9.61 7.04 15.86 37.42 26.54

6 Mississauga Halton 1,101,419 8.46 10.83 6.45 13.74 30.99 18.40

7 Toronto Central 1,151,803 8.85 12.70 15.43 19.05 32.62 21.73

8 Central 1,651,681 12.68 12.36 9.39 15.13 36.74 22.36

9 Central East 1,524,018 11.70 13.58 9.00 16.84 30.78 25.43

10 South East 490,156 3.76 17.34 14.19 13.22 4.99 26.41

11 Champlain 1,220,815 9.38 13.21 10.48 14.45 14.24 19.09

12 NSM 454,073 3.49 15.13 10.08 13.77 4.54 26.45

13 North East 579,301 4.45 16.96 17.27 15.06 2.98 32.41

14 North West 244,661 1.88 14.41 13.74 17.28 3.04 31.77

Source: Environics Analytics Demographics Estimates and Projections 2008.

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Mississauga Halton LHIN Population Characteristics

Compared to the Ontario average, the MH LHIN has the following characteristics:

• Higher median and household income

• Higher percentage of visible minorities

• Lower percentage of population aged 65 and older

• Higher percentage of population with high school education

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Health Status

• Determinants of health such as health behaviours, living and working conditions, personal resources and environmental factors are all related to health status measures.

• Self-reported health is a widely used indicator of overall health status; it can reflect aspects of health not captured in other measures.

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Mississauga Halton LHIN Health Profile, 2010

Source: Statistics Canada. 2010. Health Profile. Statistics Canada Catalogue no. 82-228-XWE. Ottawa. Released June 15 2010.http://www12.statcan.gc.ca/health-sante/82-228/index.cfm?Lang=E

Health Conditions MH LHIN OntarioTOTAL Male Female TOTAL Male Female

Overweight or obese 44.8 54.5 35.5 51.4 58.7 44.1Overweight 31.5 38.8 24.4 34.0 40.1 27.8Obese 13.4 15.7 11.1E 17.4 18.6 16.3

Arthritis 13.0 9.7E 16.1 16.8 12.7 20.7Diabetes 7.1 6.2E 7.9E 6.4 6.9 6.0Asthma 8.5 7.7E 9.3E 8.2 6.8 9.6High blood pressure 16.2 17.4 15 17.2 17.1 17.4Mood disorder 5.3 3.9E 6.7E 6.8 5.0 8.6Pain or discomfort; moderate or severe 10.7 8.1E 13.1 11.6 9.7 13.4Pain or discomfort that prevents activities 12.3 10.1E 14.4 13.2 11.0 15.3Low birth weight 6.4 6.0 6.8 6.2 5.8 6.6Chronic obstructive pulmonary disease (COPD) 3.9E F 4.2E 4.0 3.6 4.3Injuries within the past 12 months causing limitation of normal activities 13.3 14.8 11.8 13.8 15.8 11.8

Injuries in the past 12 months; sought medical attention 5.9E 7.4E 4.6E 7.4 8.2 6.7Hospitalized stroke event rate (Age 20+)* 134 159 112 129 151 111Hospitalized acute myocardial infarction event rate (Age 20+)* 174 248 109 216 304 140Injury hospitalization* 330 356 300 420 469 361

E use with cautionF too unreliable to be published

*Per 100,000 populationMH LHIN compares unfavourably to Ontario

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http://www12.statcan.gc.ca/health-sante/82-228/index.cfm?Lang=E�

Health Profiles: MH LHIN and Ontario Comparison

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MH LHIN OntarioTOTAL Male Female TOTAL Male Female

Well Being

Perceived health, very good or excellent 59.2 58.9 59.5 61.2 61.4 60.9

Perceived mental health, very good or excellent 74.7 75.9 73.6 74.0 74.4 73.7

Perceived life stress 28.6 30.1 27.1 24.3 22.2 26.3

Health Behaviours

Current smoker, daily or occasional 16.8 22.7 11.2E 18.6 21.8 15.4

Current smoker, daily 13.7 18.1 9.5E 14.4 16.8 12.2

Heavy drinking 17.1 27.4 7.3E 15.6 22.9 8.7

Leisure-time physical activity, moderately active or active 52.3 58.6 46.3 50.7 54.8 46.7

Fruit and vegetable consumption, 5 times or more per day 48.3 47.5 49.1 44.1 38.9 49.1

Bike helmet use 29.9 29.9 29.9 34.3 31.5 38.2

Human Function

Participation and activity limitation; sometimes or often 26.7 23.8 29.4 27.8 25.7 29.7

Functional health; good to full 80.5 80.2 80.8 80.0 81.8 78.3

MH LHIN compares unfavourably to Ontario E use with caution



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Health Profiles: MH LHIN and Ontario Comparison

MH LHIN Ontario

TOTAL Male Female TOTAL Male Female

Environmental Factors

Second-hand smoke; exposure at home 4.6 7.7 2.1 5.3 6.1 4.6

Second-hand smoke; exposure in vehicles and/or public places

17.1 20.4 14.3 15.0 16.3 13.9

Personal Resources

Sense of community belonging 70.2 65.1 75.1 67.1 65.9 68.4

Life satisfaction; satisfied or very satisfied 93.1 93.6 92.6 91.5 91.5 91.5

Living and Working Conditions

High school graduates aged 25 to 29 93.0 91.6 94.2 89.7 88.0 91.3

Post-secondary graduates aged 25 to 54 70.9 70.7 71 63.5 62.5 64.4

Unemployment 9.0 9.0

Youth unemployment; aged 15 to 24 17.9 17.6

Long-term unemployment 3.1 2.7 3.6 3.3 3.0 3.6

Low income 13.3 12.6 14.0 14.7 13.7 15.6

Children aged 17 and under living in low income families 17.2 17.1 17.3 17.9 17.8 18


MH LHIN compares unfavourably to Ontario

37V5.0Source: Statistics Canada. 2010. Health Profile. Statistics Canada Catalogue no. 82-228-XWE. Ottawa. Released June 15 2010.http://www12.statcan.gc.ca/health-sante/82-228/index.cfm?Lang=E


Community MH LHIN OntarioTOTAL Male Female TOTAL Male Female

Population density 956.68 - - 13.4 - -

Dependency ratio 58.6 - - 59.7 - -

Youth; under 20 years; as a proportion of total population 26.1 - - 23.7 - -

Seniors; 65 years and over; as a proportion of total population 10.8 - - 13.7 - -

Aboriginal population 0.4 0.4 0.5 2.0 2.0 2.0

Immigrant population 43.2 42.5 43.9 28.3 27.6 28.9

1 year internal migrants 4.6 4.7 4.6 4.3 4.3 4.3

5 year internal migrants 14.8 14.9 14.7 14.0 14.0 13.9

Population living within a Metropolitan Influenced Zone 100 100 100 93.2 93.1 93.3

Lone-parent families 14.3 2.5 11.8 15.8 2.9 12.9

Visible minority population 36.2 36.2 36.3 22.8 22.7 23


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Chronic Conditions – Introduction• Almost 80% of Ontarians over the age of 45 have a chronic condition, and of

those, about 70% suffer from two or more chronic conditions (CCHC 2003).

• A chronic disease is “an illness, functional limitation or cognitive impairment that lasts (or is expected to last) at least one year, limits what a person can do and requires ongoing care” (MH LHIN IHSP: 2006).

• Chronic conditions generally develop slowly, are long lasting, often progress in severity, and usually cannot be cured (HSIE: 2007).

• In Ontario, the economic burden of chronic disease is estimated at 55% of total direct and indirect health costs (EBIC 2002).

• Chronic conditions place a high burden on the health care system and reduce quality of life of those who suffer from the condition.

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Chronic Conditions – Prevalence

• Prevalence is the proportion of the population with a particular disease at a given moment in time, and provides a measure of disease burden.

• Based on the 2007 Canadian Community Health Survey (CCHS cycle 4.1), Hypertension was the most frequently reported chronic condition for residents of the Mississauga Halton LHIN at 14.8%; Arthritis was second at 13.7%; Asthma was third with 10.2%; and Diabetes was fifth at 5.1%.

• The self reported value for diabetes in the MH LHIN is significantly lower than the prevalence rate obtained through the Ontario Diabetes Database (8.7% in 2006/07; ICES).

Sources: 2007 Canadian Community Health Survey, Statistics Canada, Ontario Share File. ICES In Tool.

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E

Chronic Conditions in Ontario and the Mississauga Halton LHIN, 2007

HSIP. Chronic Conditions in the Mississauga Halton LHIN.

From the chart, we can see that the MH LHIN has lower prevalence rates in most of the selected chronic conditions than the province of Ontario.

The only exceptions are in the prevalence rates for Asthma and Stroke. The MH LHIN prevalence rate for Asthma is 10.2%, compared to 8.2% for the province, while the MH LHIN prevalence rate for stroke is 2.1% compared to 1.3% for Ontario. However, it is important to note that the MH LHIN prevalence rate for stroke must be interpreted with caution, as it is an estimate only.

E EE

E MH LHIN estimate, use with caution (Data with a coefficient of variation between 16.6% to 33.3%).

Source: 2007 Canadian Community Health Survey, Statistics Canada, Ontario Share File.

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Chronic Conditions in the Mississauga Halton LHIN, 2005 and 2007

0%

2%

4%

6%

8%

10%

12%

14%

16%

Arthritis Hypertension Asthma Heart disease Diabetes* Cancer* Stroke*

Prev

alenc

e Rat

e

Prevalence of Selected Chronic Conditions in the MH LHIN, 2005 to 2007

2005 2007

2005 Data from CCHS cycle 3.1, as documented in "Chronic Conditions in the Mississauga Halton LHIN," prepared by HSIP Oct. 2007.

2007 data from CCHS cycle 4.1, provided by Health Analytics, April 2009.

This chart compares prevalence rates of selected chronic conditions in the MH LHIN from 2005 to 2007, as per the Canadian Community Health Survey (CCHS).

While the previous chart showed the MH LHIN generally has lower prevalence rates of the selected chronic conditions than Ontario, the rates of all of the selected chronic conditions in the MH LHIN have increased from 2005 to 2007, with the most dramatic increase being in the prevalence of Asthma (7.5% to 10.2%).

Again, it is important to note that several of the prevalence rates are estimates only and must be interpreted with caution.

* Interpret with caution. Coefficient of variation 16.6% to 33.3%.

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Prevalence Rates* (%) of Chronic Obstructive Pulmonary Disease (COPD) by LHIN, 2009/10

* Prevalence rates (%) are age- and sex-adjusted, aged 35 years and older.

Source: ICES, Prevalence of Chronic Obstructive Pulmonary Disease Ontario, 1996/97 to 2009/10.

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Prevalence Rates* (%) of Chronic Obstructive Pulmonary Disease (COPD) by Age in the MH LHIN and Ontario, 2009/10

* Prevalence rates (%) are age- and sex-adjusted, aged 35 years and older.

Source: ICES, Prevalence of Chronic Obstructive Pulmonary Disease Ontario, 1996/97 to 2009/10.

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Chronic Conditions – Health System Utilization• The following nine (9) chronic conditions (cancer, diabetes, depression, heart

disease, hypertension, stroke, asthma, COPD and arthritis) accounted for:

• 7 out of every 10 deaths in Ontario• 1 out of 4 inpatient hospital separations in the MH LHIN• 1 in 10 ED visits in MH LHIN• 1 in 5 GP/FP visits in MH LHIN

• People with co-morbidities have a higher burden of disease and tend to have longer hospital stays, higher health care costs, increased hospital mortality and higher rates of readmission.

• Conditions such as cancer and heart disease had high rates of inpatient hospital separations whereas high rates of visits to family physicians were found for conditions such as hypertension and arthritis.

Source: HSIE: 2007; ICES In Tool.

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Chronic Conditions: Health System Utilization, MH LHIN and Ontario

Chronic ConditionEmergency Department Visits, Rate Per 100,000

MH LHIN2005/06

MH LHIN2007/08

Ontario2007/08

Malignant Neoplasm (Cancer) 106.1 83.1 119.0

Diabetes 95.5 115.9 232.4

Depression 182.9 143.2 218.0

High Blood Pressure (Hypertension) 114.9 111.7 167.4

Ischemic Heart Disease not available 173.5 263.1

Stroke 141.3 104.3 172.5

Chronic Obstructive Pulmonary Disease 253.5 209.2 556.4

Asthma 235.6 302.9 469.6

Arthritis and related conditions 839.7 777.5 1,387.8

The chart to the left shows that the MH LHIN has significantly fewer ER Visits per 100,000 people in all of the selected chronic conditions than the province of Ontario as a whole.

Moreover, the number of ER Visits per 100,000 in the selected chronic conditions has declined in the MH LHIN in every area from 2005/06 to 2007/08, with the exceptions of Diabetes and Asthma.

Data sources: Numerator: Ambulatory Visits, Ontario Ministry of Health and Long-Term Care: IntelliHealth ONTARIO. Last refreshed [May/2009]. Denominator: Population Estimates Summary LHIN, Ontario Ministry of Health and Long-Term Care: IntelliHealth ONTARIO. Last refreshed [May/2009].

2005 Canadian Community Health Survey, Statistics Canada, Ontario Share File; Ambulatory Visits (2005/06), Medical Services (2005/06), and Population Estimates, Ontario Ministry of Health and Long-Term Care Provincial Health Planning Database.

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Mortality, per 100,000

Hospital Separations per 100,000

ED Visits per 100,000

Prevalence per 10,0000

200

400

600

800

1000

1200

1400

1600

145.3

15.50.3 70.6

3.2 21.20.6 14.6

2.1

354.3

64.39

263

12.5 87.849.6 98.7 238.8

83.1 115.9 143.2 173.5111.7

104.3302.9

209.2

777.5140

510 550

350

1480

210

1020

390

1370

Comparative Burden of Chronic Disease in the MH LHIN

Source: 2007 & 2009 Canadian Community Health Survey, Statistics Canada, Ontario Share File; Deaths, Inpatient Discharges, Ambulatory Visits, Medical Services, and Population Estimates, Ontario Ministry of Health and Long-Term Care Provincial Health Planning Database.

* Note that Depression is not captured in recent CCHS cycles. The prevalence rate listed here reflects that of “Mood Disorder,” which is defined as “Population aged 12 and over who reported that they have been diagnosed by a health professional as suffering from a mood disorder such as depression, bipolar disorder, mania or dysthymia.”

This chart shows the comparative burden of chronic disease in the MH LHIN. We can see that High Blood Pressure and Arthritis have the highest prevalence rates, Asthma and Arthritis contribute to the highest number of ED Visits, and Cancer and Ischemic Heart Disease have the highest rate of hospital separations and also mortality per 100,000.

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Risk Factors for Chronic Conditions• A wide range of factors influence the onset and prognosis of chronic

conditions.

• Age is a major risk factor for chronic conditions, including multiple chronic conditions.

• Socio-economic status is a risk factor. Those who are socio-economically disadvantaged often have a higher risk factor for many chronic conditions.

• Behavioural risk factors (which are also considered modifiable) related to health practices can increase the risk for developing chronic conditions i.e. smoking, alcohol misuse, obesity, physical inactivity and poor diet (we have data on some of these risk factors) (see Peel Health Status report for data on risk factors for residents of Peel).

• Many chronic conditions have common underlying modifiable risk factors that if mitigated might prevent or delay the onset of chronic disease.

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http://www.peelregion.ca/health/health-status-report/chsr/pdfs/entire-report.pdf�

Chronic Disease Risk Factors are Common to Many Conditions

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The Relationship Between Mental Health, Mental Illness and Chronic Physical Conditions

• Mental health and physical health are fundamentally linked. People living with a serious mental illness are at higher risk of experiencing a wide range of chronic physical conditions.

• Conversely, people living with chronic physical health conditions experience depression and anxiety at twice the rate of the general population.

• Co-existing mental and physical conditions can diminish quality of life and lead to longer illness duration and worse health outcomes.

Source: S.B. Patten, "Long-Term Medical Conditions and Major Depression in the Canadian Population," Canadian Journal of Psychiatry 44 no. 2 (1999): 151-157.

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Mental Illnesses and Chronic Physical Conditions

• Canadians who report symptoms of depression also report experiencing three times as many chronic physical conditions as the general population (Canadian Institute for Health Information, 2008).

• Canadians with chronic physical conditions have twice the likelihood of also experiencing a mood or anxiety disorder when compared to those without a chronic physical condition (Government of Canada, 2006).

• One out of every two Canadians with major depression and a co-existing chronic physical condition report limitations in their day-to-day activities (S. Patten, 1999).

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Prevalence of Mental Health & Addictions in Ontario• It is estimated that 20% of the Ontario population will experience a mental

health / substance abuse problem at some point during their life.• It is further estimated that:

• 2.5% of Ontarians will have a serious mental illness

• 1.3 million Ontario adults (13.2%) have a mood, anxiety or substance abuse disorder

• 9.1% of Ontarians indicated harm to selves from alcohol use in the past year; 12.9% indicated harm from drug use

• 3.8% (340,000) adults in Ontario have moderate or severe gambling problems

• Yet household surveys indicate that 40% to 80% of individuals with mental health & substance abuse conditions do not receive treatment.

• One in four families has at least one member with a mental disorder.Source: An Introduction to Addictions, Mental Health and Problem Gambling in Ontario, Health Program Policy and Standards Branch, February 6, 2009

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There is a significant impact on the quality of life of individuals and their families living with mental illness and addictions:• Health impact: common to have 2 or more mental illnesses/substance use issues, it is also common

to live with co-morbid physical and mental health concerns; mental illness and addictions have been identified as the leading cause of disability burden, and this burden is expected to increase in the future.

• Social and economic impact: mental illness interferes with relationships, productivity and employment/education opportunities and can be a risk factor for homelessness; in 2006 one third of Ontario Disability Support Program recipients had a serious mental illness.

• Stigma is a huge barrier to people with mental illness and addictions, particularly within the health care system and in the workplace.

• As caregivers, families of people with mental illness and addictions face physical, emotional and financial stress.

Years Lived with Disability for Mental Health and Addictions as a Proportion of all Years Lived with Disability

24%20%

12%

43% 43%

31%

0%

10%

20%

30%

40%

50%

Americas Europe World

Disability Adjusted Life Years

Years Lived with DisablitySource: MOHLTC, Mental Health and Addictions Strategy Document, November 4, 2008

Mental Health & Addictions in Ontario

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Cost of Illness in Ontario - Substance Abuse

8%

18%

74%

Health Costs

Legal Costs

Indirect Costs -LostProductivity

Cost of Illness in Ontario - Mental Health

8% 1%

91%

Health Costs

Legal Costs

Indirect Costs - LostProductivity

Source: MOHLTC, Mental Health and Addictions Strategy Document, November 4, 2008.


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• The direct costs of mental illness and addictions in Ontario (for health care, legal costs, capital, research) is $5.2B, however, the costs as a result of the productivity lost due to mental illness and addictions costs are far greater at $28.7B.

• The economic costs (direct and indirect) in Ontario for mental health and addictions is $33.9B per year ($11.7B addictions, $22.2B mental health).

• Mental disorders are 7th among 20 disease categories for both direct and indirect costs; it is 2nd after cardiovascular disease, for direct costs (only those with medically treated, diagnosed mental disorders were included, estimates suggest that about 50% are untreated/undiagnosed).

• Psychological conditions like stress, anxiety, and depression are the leading causes of short and long term disability costs.

People living with the most common chronic physical conditions in Ontario also face worse mental health than the general population. Figure 1 illustrates the elevated rates of mood disorders in Ontarians with diabetes, heart disease, cancer, arthritis and asthma.


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Mental Health & Addictions Clients with Co-Occurring Disorders

• 37% of people with an alcohol abuse disorder and 53% of those with a substance abuse disorder will have a mental health disorder at some point in their lives.

• 29-30% of those with a mental disorder also have a substance dependence disorder with proportions differing by disorder.

• Co-occurrence can complicate service planning and make access to the appropriate range of services difficult.

Source: Skinner W, O’Grady C, Bartha C, Parker C. Concurrent substance use and mental health disorders: an information guide

Mood/Anxiety Psychosis Addictions

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Hospital Name Active Cases

Reason for Admission*Self Threat Threat to Others Unable to Care

for SelfAddiction Problem

Psychiatric Symptoms

Forensic

# % of active cases

# % of active cases

# % of active cases

# % of active cases

# % of active cases

# % of active cases

CREDIT VALLEY HOSPITAL (THE) 714 346 48.5 176 24.6 381 53.4 156 21.8 583 81.7 34 4.8

TRILLIUM HEALTH CENTRE-MISSISSAUGA 962 517 53.7 205 21.3 467 48.5 101 10.5 656 68.2 14 1.5

HALTON HEALTHCARE SERVICES CORP-OAKVILLE 698 439 62.9 127 18.2 179 25.6 156 22.3 436 62.5 63 9.0

MISSISSAUGA HALTON TOTAL 2,374 1,302 54.8 508 21.4 1,027 43.3 413 17.4 1,675 70.6 111 4.7

ONTARIO TOTAL 56,527 27,121 48.0 11,319 20.0 20,468 36.2 14,923 26.4 39,950 70.7 4,703 8.3

MH LHIN Number and Proportion of Active Mental Health Cases by Reason for Admission and Hospital, 2007/08

Source: Ontario Mental Health Reporting System, 2007/08 taken from: Adult Mental Health Data Table in the Ontario Ministry of Health and Long-Term Care Provincial Health Planning Database, extracted May/June 2009.

*There may be multiple reasons for admission identified. Therefore, the sum of all reasons for admission may exceed the number of active cases.

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Hospital Name

2007/08

Active Cases New Admissions

Discharged Cases

Discharges Acute Days

Average Acute

Length of Stay

Discharges with ALC

DaysALC Days

Average ALC

Length of Stay

CREDIT VALLEY HOSPITAL (THE) 714 691 683 7,987 11.7 7 37 5.3

TRILLIUM HEALTH CENTRE-MISSISSAUGA 962 888 885 16,896 19.1 27 831 30.8

HALTON HEALTHCARE SERVICES CORP-OAKVILLE 698 655 614 4,969 8.1 63 834 13.2

MISSISSAUGA HALTON TOTAL 2,374 2,234 2,182 29,852 13.7 97 1,702 17.5

ONTARIO TOTAL 56,527 52,012 51,559 1,149,697 22.3 1,395 36,988 26.5

MH LHIN Number of Active Cases, New Admissions and Discharged Cases by Hospital, 2007/08

Source: Ontario Mental Health Reporting System, 2007/08 taken from: Adult Mental Health Data Table in the Ontario Ministry of Health and Long-Term Care Provincial Health Planning Database, extracted May/June 2009.

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Of the 4% of ED visits, anxiety, schizophrenia and alcohol are the leading diagnoses related to ED visits, repeat visits and longest wait times for people with mental illness or substance use issuesRank Total Visits (of all MH ED Visits) Repeat Visits (percent of visits by diagnosis that are

repeat)Wait Times

1 Anxiety- 31.6% (36,893 visits ) Schizophrenia – 51% Schizophrenia – 6 hours

2 Depression – 23.6% (27,623 visits) Bipolar Disorder – 39% Personality Disorder – 5.7 hours

3 Schizophrenia – 15.4% (17,989 visits) Personality Disorder – 38% Bipolar Disorder – 5.6 hours

Total Mental Health 116,796 32,055 repeat visits (5% of total visits are for individuals with 5 or more visits)

4.5 hours

Rank Total Visits (of all SA ED Visits) Repeat Visits (percent of visits by diagnosis that are repeat)

Wait Times

1 Alcohol –68% (29, 280 visits) Alcohol – 41% Alcohol 5.7 hours

2 Multiple Drugs – 14.3% (6161 visits) Opiods – 28% Other Drugs – 5.45 hours

3 Other Drugs – 10.4% (4513 visits) Multiple Drugs – 26% Multiple Drugs - 4.8 hours

Total Substance Abuse

43, 062 15322 repeat visits (14.4% of total visits are for individuals with 5 or more visits)

5.4 hours

Mental Health ED visits in Ontario

Substance Abuse ED visits in Ontario

Source: MOHLTC, Mental Health and Addictions Strategy Document, November 4, 2008

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Mental Health ED Visits for Mississauga Halton Residents by Diagnostic Category, 2006/07 – 2007/08Diagnostic Category * # of Visits % of TotalSubstance-related disorders 4,416 27.4

Anxiety disorders 3,663 22.7

Depression 2,973 18.4

Schizophrenic & psychotic disorders 1,916 11.9

Acute stress 786 4.9

Bipolar disorder 673 4.2

Organic disorders 611 3.8

Adjustment disorders 387 2.4

All other psychiatric disorders 299 1.9

Personality disorders 184 1.1

Disturbance of conduct 121 0.8

Physiological malfunction arising from mental factors 61 0.4

Other mood disorders 29 0.2

Total 16,119 100.0

* Categories were taken from the Canadian Institute for Health Information's Hospital Mental Health Services in Canada 2005-2006.

Number of unscheduled mental health ED visits and average annual ED visit rates per 1,000 population by CIHI diagnosis category and LHIN of patient residence, 2006/07-2007/08 combined.

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Emergency Room Repeat Visits – Mental Health & AddictionsLHIN of patient residence

Repeat visits within 30 daysTotal Visits# % Rate/100 Visits

Erie St. Clair 2,287 4.0 14.3 15,996

South West 3,909 6.9 15.6 25,004

Waterloo Wellington 2,560 4.5 16.0 15,974

HNHB 6,491 11.4 18.2 35,668

Central West 1,842 3.2 16.1 11,443

Mississauga Halton 2,532 4.5 15.7 16,119

Toronto Central 8,745 15.4 25.9 33,798

Central 3,860 6.8 17.0 22,667

Central East 4,934 8.7 16.3 30,304

South East 2,094 3.7 15.9 13,171

Champlain 4,403 7.8 15.4 28,583

North Simcoe Muskoka 1,698 3.0 15.0 11,346

North East 4,848 8.5 18.8 25,744

North West 2,827 5.0 20.8 13,588

Unknown 3,597 6.3 38.1 9,431

Out-of-province 129 0.2 43.7 295

Total 56,756 100.0 18.4 309,131

Number and rate of repeat visits within 30 days as a proportion of the total unscheduled mental health emergency department visits by LHIN of patient residence, 2006/07-2007/08 combined.Source: Ontario Mental Health Reporting System, 2007/08 taken from: Adult Mental Health Data Table in the Ontario Ministry of Health and Long-Term Care Provincial Health Planning Database, extracted May/June 2009.

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Barriers to Access to Primary Health Care for People with Mental Health and Addiction Needs• Access to primary health care has rated as a top unmet need for people

with mental illnesses.

• People with serious mental illnesses who have access to primary health care are less likely to receive preventive health checks. They also have decreased access to specialist care and lower rates of surgical treatments following diagnosis of a chronic physical condition.

• The mental health of people with chronic physical conditions is also frequently overlooked. Diagnostic overshadowing can mask psychiatric complaints, particularly for the development of mild to moderate mental illnesses. Short appointment times are often not sufficient to discuss mental or emotional health for people with complex chronic health needs.

Source: Canadian Mental Health Association, Ontario, The Relationship Between Mental Health, Mental Illness, and Chronic Physical Conditions, Background Paper, December 2008.

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Cancer• The number of new cancer cases diagnosed each year in

Ontario is expected to increase from approximately 53,000 in 2001 to 80,000 in 2015; representing more than a 50% increase.

• Population aging, population growth and rising cancer risk all contribute to the projected increase in the number of new cases.

• Four types of cancer: female breast, prostate, lung and colon/rectum (bowel) together account for more than half of the cancers diagnosed in Ontario men and women.

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Cancer• More than half of all cancer cases are preventable.

• About half of all cancer deaths are related to tobacco, diet and physical activity.

• Fewer people are smoking and more are physically active and are eating more fruits and vegetables, but Ontario still is below targets for these cancer-related lifestyle factors.

• Rates of obesity continue to grow. Ontarians are drinking more alcohol than recommended and are spending too much time in the sun.

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Cancer System Quality Index (CSQI)• The Cancer System Quality Index (CSQI) is a web-based public reporting tool that

serves as a system-wide monitor for tracking quality and consistency of all key cancer services delivered across the spectrum of Ontario's cancer system, from prevention through to end-of-life care.

• A North American first, the Index was launched in 2005 by the Cancer Quality Council of Ontario, in partnership with Cancer Care Ontario (CCO).

• The CSQI presents a rolling snapshot of activity in 29 evidence-based measures (e.g., smoking rates, colorectal screening rates, cancer surgery wait times, patient satisfaction) from prevention through palliative care and tracks Ontario’s progress towards better outcomes in cancer care and highlights where cancer service providers can advance the quality and performance of care.

• The Index presents cancer system performance within each of Ontario's 14 LHINs and presents a snapshot view of how each LHIN is doing in terms of wait times and cancer prevention.

Source: Cancer Care Ontario, Cancer System Quality Index.

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Cancer Care Ontario: Cancer System Quality Index (CSQI) 2010

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Cancer Care Ontario: Cancer System Quality Index (CSQI) 2010 The information on the following slides is presented as it appears on the Cancer System Quality Index (CSQI) website: http://csqi.cancercare.on.ca/cms/One.aspx?portalId=63405&pageId=67095

Please use the legend that appears below when reviewing the data on slides 68 to 76:

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http://csqi.cancercare.on.ca/cms/One.aspx?portalId=63405&pageId=67095�

Cancer Incidence and Survival

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Modifiable Risk Factors

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Prevention

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Screening

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Diagnosis

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Treatment

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Treatment (continued)

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Treatment (continued)

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End-of-Life Care

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Primary Health Care

• General practitioners and family physicians (GP/FPs) play a key role in Ontario’s health care system.

• GP/FPs are the main source for primary care and are often the patient’s initial point of contact with the health care system.

• GP/FPs not only provide treatment, but also act as a conduit to more specialized services.

Source: Jaakkimainen L, Upshur REG, Schultz SE, Maaten S (Editors). Primary Care in Ontario. ICES Atlas. Toronto: Institute for Clinical Evaluative Sciences; November, 2006.

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• In 2003, there were 721 GP/FPs in the MH LHIN. This count has increased to 853 in 2009 (Source: Ontario Physician Human Resources Data Centre, Active Physician Registry).

• The overall supply of GP/FPs (based on headcounts) in the MH LHIN continues to be lower than the average supply in Ontario (i.e. 7.5 vs 8.8 per 10,000 population in 2009).

• The particular mix of physicians’ work settings may influence patients’ access to services.

• Currently, there are a range of primary care models across the province aimed at providing continuity of care, preventive care (including health promotion), and improved chronic disease management.

• As of October 2008, 522 GP/FPs in the MH LHIN were providing care in models that blend traditional fee-for-service with capitation and salary options serving approximately 701,244 patients (61.6%). There were 264 solo practitioners in the MH LHIN.

Primary Health Care Stats

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GP / FP Supply

• In the following slides, the GP / FP Supply per 10,000 Population has been used to measure the relative supply of General / Family Practitioners.

• In theory, the higher the number, the greater the access to a physician.• It is important to note that due to data availability, the ratio of

physician to population has been calculated using a Headcount (i.e. the total number of GP/FPs in active practice regardless of level of activity) rather than full-time equivalents (FTE). As not all physicians have the same workload (e.g. some may work fewer hours, or have research and administrative responsibilities that limit the amount of time they devote to clinic practice), this should be considered in future planning.

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GP/FP Supply in the MH LHINGP/FP supply per 10,000 population, headcount, Mississauga Halton LHIN and Ontario, 2006-2009.

Source: Active Physician Registry and Ontario Physician Workforce Database, Ontario Physician Human Resources Data Centre. Population Estimates: Ministry of Finance, for the Ontario Ministry of Health and Long-Term Care.

The supply of GP/FPs in the MH LHIN continues to be slightly lower than the Ontario average.

At the provincial level, the GP/FP Supply per 10,000 Population has been trending up over the past four years.

The MH LHIN GP/FP Supply per 10,000 Population increased in 2009 after decreasing the previous two years.

MH LHIN 7.7 7.5 7.4 7.5

Ontario 8.5 8.6 8.7 8.8

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GP/FP per 10,000 Population: LHIN Comparison, 2009

Source: Ontario Physician Human Resources Data Centre, Active Physician Registry, December 31, 2009.

In terms of the GP/FP Supply per 10,000 population, the MH LHIN is the fourth lowest at 7.5 and below the provincial average of 8.8.

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Mississauga Halton LHIN: General Practitioner and Specialist Totals, 2009

Sub-LHIN Area Family Medicine Specialists Total

Halton Hills 44 7 51

Milton 52 21 73

Mississauga 494 475 969

Oakville 180 144 324

South Etobicoke 82 61 144

TOTALS 853 708 1,561

Source: Ontario Physician Human Resources Data Centre, Active Physician Registry, December 31, 2009.

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Halton HillsGP: 43SPC: 7

Population (2008): 60,206

MiltonGP: 45

SPC: 18Population (2008): 58,755

MississaugaGP: 478

SPC: 448Population (2008): 701,922

OakvilleGP: 177

SPC: 135Population (2008): 180,775

South EtobicokeGP: 79

SPC: 67Population (2008): 108,918

General Practitioner (GP) & Specialist (SPC) Totals by Sub-LHIN Area, 2008*

Population figures from Statistics Canada, Demography Division, customized data, MOHLTC. Physician numbers from Ontario Physician Human Resources Data Centre, Active Physician Registry, January 2010.* Note: 2008 physician numbers were used to align with 2008 sub-LHIN population data.

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MH LHIN GP/FP Supply by Sub-LHIN AreaGP/FP supply per 10,000 population, headcount, Mississauga Halton LHIN and sub-LHIN Areas, 2008.

Source: Active Physician Registry and Ontario Physician Workforce Database, Ontario Physician Human Resources Data Centre. Population Estimates: Ministry of Finance, for the Ontario Ministry of Health and Long-Term Care.

In the MH LHIN, the supply of GP/FPs per 10,000 population is highest in Oakville and lowest in Mississauga.

7.1 7.7 6.8 9.8 7.2 7.4

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Physician Profile as of Aug 31/08

# of Groups # of Physicians

Primary Care

Family Health Network 1 4

Family Health Group 30 419

Comprehensive Care Model 22 22

Family Health Organization 7 99

Blended Salary Model 1 3

Solo / No Group Model - 264

Family Health Team* [6] [83]

Sub-Total 811

Specialists

Endocrinologists - 15

General Internists - 38

General Pediatricians - 50

All other specialists - 560

Sub-Total - 663

TOTAL PHYSICANS - 1474

Patient Profile as of January 2011

Projected Population

Patients enrolled in a

Patient Enrollment

Model

% of Population Enrolled in Primary Enrollment Models

1,152,917 718,603 62.3%

Source: Ministry of Health and Long-Term Care

Physician and Patient Profile

Sources: Ministry of Health and Long-Term Care, Ontario Physicians Human Resource Data Centre, OntarioMD.

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Contact with a Medical Doctor

Source: Statistics Canada, Canadian Community Health Survey, 2009.

From this chart, in comparing all LHINs across the province, the MH LHIN had the highest percentage of population reporting contact with a medical doctor in the previous 12 months (85.1% of men and 90.8% of women).

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Average Number of Visits to a Family Physician by Age and Sex, Mississauga Halton LHIN (2008/09)

0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

8.0

0-4

5-9

10-1

4

15-1

9

20-2

4

25-2

9

30-3

4

35-3

9

40-4

4

45-4

9

50-5

4

55-5

9

60-6

4

65-6

9

70-7

4

75-7

9

80-8

4

85-8

9

90+

Aver

age

# vi

sits

/per

son

Age group

Average number of GP/FP visits by age group and sex, Mississauga Halton LHIN residents, 2008/09

Females Males

Sources: Patient Visits: Medical Service 1 Yr, Intellihealth Ontario, Ministry of Health and Long−Term Care. Population Estimates: Population Estimates LHIN, Intellihealth Ontario, Ministry of Health and Long-Term Care. Retrieved October, 2010.

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Frequency of Visits• Of all LHINs, the MH LHIN had the highest percentage of population reporting contact

with a medical doctor in the previous 12 months (88% for the MH LHIN, compared to the provincial average of 82.9%).

• Mississauga Halton LHIN residents made just over 4.3 million visits to GP/FPs during FY2008/09, which resulted in an average of 3.9 visits per person.

• The average number of visits per person was lowest for those aged 5-9 and 10-14, while rates for seniors were highest.

• The average number of visits per person by sex were relatively similar until age 15, when the rates for females became higher. For some groups, the rates for females were twice those of males (20-24, 25-29, 30-34).

• At age 75, the rates were relatively similar in both genders, but by age 85, the rates for males overtook those for females.

• It is interesting to note that while the MH LHIN’s GP/FP supply per population is one of the lowest in the province, it had the highest percentage of population reporting contact with a medical doctor in the previous 12 months.

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Health Service Providers in MH LHIN

CCAC

Community Support Services

Hospitals

Long-Term Care Homes

Mental Health & Addictions

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• The MH LHIN funds 77 organizations providing health services.

• Included in this are: • Hospitals• Long-Term Care Homes• Mental Health and Addictions agencies• Community Support Services• Mississauga Halton Community Care Access Centre

Our Health Care Services

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Our Health Care Services

Mental Health Services

7 community programs

2 supportive housing sites

3 agencies for drug, alcohol and problem gambling treatment services

3 psychiatric outpatient medical services

Long Term Care Homes

27 long term care (LTC) homes

4,156 long term care beds

Community Services

1 Acquired Brain Injury Agency

12 supportive housing programs

23 Community Support Services (CSS)

3 Palliative Care Programs

Community Care Access Centre

1 Community Care Access Centre

Hospitals

3 corporations on 6 sites

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Funding Percentages by Sector, 2009/10

Long-Term Care; 14%

Community Care Access Centre; 10%

Community Support Services and Assisted Living; 4%

Mental Health & Addictions Services; 3%

Initiatives; 1%

Hospitals; 68%

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Community Care Access CentreMississauga Halton CCAC:

CCACs are the local point of access to government funded community-based health care services, and were created to coordinate a variety of health services to maintain an individual’s health, independence and quality of life.

Their mandate is to help people live independently at home, and also to help people apply for admissions to long-term care homes.

They also provide information about local community support service agencies and can link people to these agencies to arrange services.

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Mississauga Halton CCAC

1. In-Home Services: Nursing Personal support (help with bathing, dressing,

etc.) Physiotherapy Occupational therapy Speech-language therapy Social work Nutritional counseling Medical supplies and equipment

2. Specialized programs geared towards specific health needs: Acquired brain injury Convalescent Care Child and family services School Health Support Mental Health Palliative care (care at the end of life)

3. Information and Referral to other services: Adult day programs Meal delivery services Assistance with shopping or cleaning Transportation assistance

There may be consumer fees for services obtained through community agencies.

4. Placement into Long-Term Care Homes

When living independently is no longer possiblewe coordinate applications to Long-Term CareHomes in the area and across Ontario.

A CCAC Case Manager/Placement Coordinator will:

Provide information about long-term care homes Determine suitability and eligibility for placement Provide assistance in the application process.

Services provided by the Mississauga Halton CCAC include:

Visit the Mississauga Halton CCAC website for more information.

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http://www.ccac-ont.ca/Content.aspx?EnterpriseID=6&LanguageID=1&MenuID=1�

Community Support ServicesCommunity Support Services:

Community support services provide an array of services to assist individuals who need help to function independently because of a disability, illness or limitation due to aging. These services help individuals to remain comfortably and safely in their own homes and communities.

There are 34 Community support services agencies in the MH LHIN, together providing :

Adult Day Programs Attendant Care Client Intervention and Assistance Respite Care / Caregiver Support Transportation Meal Programs / Congregate Dining Personal Support Services Home Maintenance and Repair Social Recreational & Intergenerational Programs Home Help / Homemaking Assisted Living in Supportive Housing Foot Care Friendly Visiting / Security Check / Reassurance Caregiver Support: Education & Counselling Emergency Response Systems End of Life / Palliative Care Life Skills Services

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Hospital SitesHospitals:

• The Credit Valley Hospital

• Halton Healthcare Services○ Georgetown Hospital○ Milton District Hospital○ Oakville-Trafalgar

Memorial Hospital

• Trillium Health Centre○ Mississauga Site○ West Toronto Site

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• Addictions and Concurrent Disorders Centre • Ambulatory Care • Asthma Education • Blood Conservation Clinic • Cancer Care • Cardiopulmonary • Cardiovascular Rehabilitation • Credit Valley Rehabilitation Centre • Diabetes Care Centre • Diagnostic Imaging • Eating Disorders Program • Emergency Medicine • Endoscopy Suite• Genetics

• Geriatric Assessment Unit • Laboratory Medicine • Maternal Child Services • Mental Health • Occupational Therapy • Paediatrics • Physiotherapy Service • Psychology Support • Pulmonary Rehabilitation Program (PReP)• Rehabilitation Services • Seniors and Rehabilitation Day Hospital• Surgery Services • Therapeutic Recreation • Trillium Gift of Life

Credit Valley HospitalKey Services & Programs Include:

Visit www.cvh.on.ca for more information.

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http://www.cvh.on.ca/�

Credit Valley HospitalRegional Centre for…Cancer Centre:

The Carlo Fidani Peel Regional Cancer entre is a specialized treatment centre for people living with cancer. The centre focuses on partnership with the patient, their family and friends in order to provide the highest quality care. Quality care includes meeting the patients’ physical, emotional, social, spiritual and practical needs.

Genetics Program:

The program consists of both clinical and laboratory services provided by a number of specialists including clinical geneticists(physicians), cytogeneticist and molecular geneticist (Ph.D), genetic counsellors (M.Sc.) and technologists (M.L.T.) with subspecialty training in cytogenetics, molecular genetics or both. Counsellors see over 3,200 individuals each year.

Maternal Child:

The Multicultural Perinatal Network in a part of this service and has language capabilities in 13 languages for expecting and new mothers.

Renal Program:

The Renal Program cares for patients with diminished kidney function and provides dialysis support when a patient’s kidneys are no longer functioning adequately. There is a partnership with several transplant centres to prepare patients with kidney disease for transplants. Patients with functioning kidney transplants may have their on-going clinic follow-up care provided by our renal team. Services include:

• Nephropathy Clinic • Kidney Care Clinic• Transplant Follow-up Clinic • Home Peritoneal Dialysis • Home Hemodialysis• Hemodialysis (Credit Valley Hospital site & Renal Care Centre site) • In-patient Nephrology Unit

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• Diagnostic Imaging

• Emergency

• Medical and Surgical

• Obstetrics

• Maternal/Child

• Medicine

• Mental Health

• Asthma Education

• Cardiac Rehabilitation & Education Program

• Falls Intervention

• Respiratory Rehabilitation

• Assistance to quit smoking (QuitCare)

• Rehabilitation & Geriatrics

• Surgery

• Sleep Clinic

• Speech Language Pathology

• Audiology and Hearing Aid Dispensing

• Supportive Housing

Halton Healthcare Services CorporationGeorgetown, Milton & Oakville sites

Key Services & Programs Include:

Visit www.haltonhealthcare.com/home.php for more information.

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http://www.haltonhealthcare.com/home.php�

Halton Healthcare Services CorporationGeorgetown, Milton & Oakville sitesRegional Centres for…Central West Eating Disorder

The Outpatient program at Halton Healthcare Services is located in Oakville and offers services to people of all ages living in South Halton, and adolescents up to 19 years, living in South Peel. The program serves those individuals and their families who are affected by Anorexia Nervosa, Bulimia Nervosa, or Binge Eating Disorder.

The treatment program offers several services including Psychiatric assessment and follow up; Nutrition Assessment and Counselling; Psychosocial Assessment; Family Education and Individual Counselling. The group programs include Adult Psychoeducation; Family Psychoeducation; Skill Building Group and a Body Image Group.

Halton Renal Dialysis Clinics:

Housed in Oakville Trafalgar Memorial Hospital, Progressive Renal Insufficiency (PRI) Clinic and the Early Renal Insufficiency (ERI) Clinic are both outpatient clinics. The Clinics provide education and support to approximately 180 individuals who have lost a portion of their renal function. The approach is multi-disciplinary with a team that is made up of a dietician, a social worker, a pharmacist, a nurse, a clerk and two nephrologists. The Clinics were created (and are being expanded) in order to reduce travel for the residents of the Halton Region and will increase the capacity of full-care, in-centre hemodialysis in the Region. This will accommodate both the rapid population growth of the region and the 15 per cent projected growth rate of End Stage Renal Failure.

Halton Diabetes Program:

The Halton Diabetes Program promotes diabetes self-care by providing education and support to adults with diabetes and their families. The program aims to help people with diabetes learn to make healthy lifestyle choices. Through education, the program strives to reduce the risk of and delay the progression of complications. This is achieved by working with people who have diabetes, and their doctors, to help increase knowledge and skill in diabetes management. The program includes:

• Patient Services (for patients and their families)• Health Professional Services (including individual consultations)• Community Education • Prevention and Management strategy and self-help resources

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• Neurosciences & Musculoskeletal• Outpatient, Inpatient & Rehabilitation Services• Mental Health• West GTA Stroke Network (main areas are

stroke prevention, emergency and acute are management, rehabilitation and community participation)

• Surgical• Women’s Health• Children’s Health• Others (Infection Prevention & Control, etc.)

• Falls Intervention

• Respiratory Rehabilitation

• Assistance to quit smoking (QuitCare)

• Rehabilitation & Geriatrics

• Surgery

• Sleep Clinic

• Speech Language Pathology

• Audiology and Hearing Aid Dispensing

Trillium Health CentreAcute Services – Mississauga Site; Ambulatory Services – West Toronto Site

Key Services & Programs Include:

Visit www.trilliumhealthcentre.org for more information.

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http://www.trilliumhealthcentre.org/�

Trillium Health CentreAcute Services – Mississauga Site; Ambulatory Services – West Toronto Site

Regional Centre for…

Cardiac Services:

As a regional cardiac care centre, Cardiac Services sees patients from its surrounding communities of Peel, Halton, and West Toronto, as well as from across the province. Today, Trillium's Cardiac Services conducts approximately ten per cent of all cardiac procedures in Ontario. Services include:

• Angioplasty (Coronary)• Cardiac Catheterization• Cardiac Diagnostics• Cardiac Services Follow-up Clinic• Cardiac Surgery• Cardiac Wellness & Rehabilitation Centre• Heart Function Clinic• Pacemaker Program

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Mental Health & AddictionsMental Health & Addictions

Mental Health and Addiction services provide a range of services to people living with mental health and addiction problems.

8 Mental Health organizations, together providing:- Assertive Community Treatment- Case management- Counselling and Treatment- Crisis response- Employment support- Peer Support- Seniors – outreach, counselling,

treatment- Supported housing

3 Addiction Services, together providing:- Case management- Counselling and treatment- Concurrent disorders- Outreach to Seniors- Residential treatment

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Long-Term Care HomesLong-Term Care Homes:

There are 27 long-term care homes in the MH LHIN

There are a total of 4,156 licensed beds

Long-term care homes provide:

24-hour availability of nursing care and high levels of personal care

A setting that can accommodate varying health needs with on-site supervision for your personal safety

Government-funded nursing and personal care

Possibility of subsidized accommodations

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Health Service Utilization

Acute • Beds / Services• Emergency Department / ALC• Rehab• Complex Continuing Care• Ambulatory Care

Community Based• CCAC• Community Support Services• Long-Term Care Homes• Mental Health & Addictions

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Acute ServicesBed Distribution of Mississauga Halton LHIN Hospitals, 2008/09

The Credit Valley Hospital

Halton Healthcare Services Corp.*

Trillium Health Centre TOTAL

Chronic 40 71 207 318

General Rehabilitation 40 39 75 154

Medical 135 143 198 476

Surgical 63 45 154 262

Combined Medical/Surgical 0 55 0 55

Intensive and Coronary Care 20 24 49 93

Obstetrics 31 34 37 102

Paediatrics 22 6 16 44

Mental Health** 30 42 51 123

Total Acute 301 349 505 1,155

*Includes Georgetown, Milton and Oakville sites** Includes both Adult and Child.Source: Planning Decision Support Tool, Ontario Ministry of Health and Long-Term Care

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Hospitals – Functional Centres, 2008/09The Credit

Valley HospitalHalton Healthcare

Services Corp.*Trillium Health

Centre TOTAL

Average Beds Staffed and in Operation 381 448 774 1,603Acute Patient Days 106,148 100,004 145,283 351,435ICU Patient Days 6,344 7,086 16,569 29,999Rehab Patient Days 14,026 13,934 25,541 53,501Mental Health Patient Days 6,410 14,137 17,959 38,506Chronic Patient Days 13,658 31,420 72,100 117,178

Total Patient Days 146,586 166,581 277,452 590,619

Visits Face-to-Face (In-House) (incl. ER visits) 474,008 317,434 386,502 1,177,944

Visits Telephone (In-House) 6,052 2,377 5,340 13,769

ER Visits 83,748 126,353 130,932 341,033

Day Surgery OR Surgical Cases 25,819 30,130 23,137 79,086

Separations 24,994 25,136 32,245 82,375Source: Healthcare Indicator Tool, Ministry of Health and Long-Term Care

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Inpatient Services – Supply and Demand TrendsThis section of the Environmental Scan will examine Inpatient Services.

Definitions for these terms are as follows:• Supply = The ability of MH LHIN hospitals to provide Inpatient (IP)

services to residents of MH LHIN and other LHINs.• Demand = IP services required by local LHIN patients as provided by

local hospitals and non-local hospitals in the Province. • Surplus (+) / Deficit (-) = Excess or shortage in capacity to provide IP

services within the MH LHIN and its hospitals.

Four key metrics have been included to present as robust a picture as possible of Inpatient Services involving MH LHIN hospitals and MH LHIN residents.

Additionally, the data presented in the following slides represents a four-year period (2006/07 to 2009/10) in order to identify potential trends.

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Separations: Market ShareSeparations*:

This chart shows that there was an increase of both supply and demand for inpatient services by MH LHIN patients from 2006/07 to 2009/10.

Additionally, the Inflow (i.e. non-MH LHIN residents coming into the MH LHIN for services) and Outflow (i.e. MH LHIN residents receiving services outside of the MH LHIN) have remained relatively consistent from 2006/07 to 2009/10.

In 2009/10, both the Inflow and Outflow decreased slightly from the previous year.

* Separation: A completed case treated in a hospital resulting in any of the following: discharge home, transfer to another facility, death or sign out.

Source: intelliHealth, Inpatient Discharge Main Table. CIHI, DAD.

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Separations: Supply & Demand• Over the same period, the MH LHIN has been in a “deficit” position (i.e.

more local residents have been receiving care from non-MH LHIN hospitals than non-MH LHIN residents receiving care from MH LHIN hospitals).

• This deficit had been slowly decreasing from 2006/07 to 2008/09, but increased slightly from 2.7% in 2008/09 to 2.9% in 2009/10.

• From the Demand (Outflow) perspective, an examination into the Major Clinical Category (MCC) grouping of services indicates that the top four services required by local residents during all four years are Pregnancy and Childbirth, Newborn and Perinatal Conditions, Circulatory System and Digestive System.

• It should also be noted that the MH LHIN hospitals have the largest imbalance in Demand versus Supply in Digestive System, Significant Trauma, Kidney/Urinary Tract and Male Reproductive System, and Blood and Lymphatic System (see Table 1).

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Separations: Supply and DemandTABLE 1


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Weighted Cases: Market ShareWeighted cases measure the intensity of resource utilization for each acute inpatient separation (or episode); weights affect the overall utilization picture as an increase or decrease in the volume and type of separations take place.

This chart indicates that during the past four years, the trend is almost identical to separations from a Supply and Demand perspective, as both are slowly increasing.

The rate of outflow has fluctuated only slightly over the past four years, ranging from a low of 28.4% in 2008/09 to a high of 29.7% in 2006/07. Inflow had been decreasing slightly from 2006/07 to 2008/09, but increased 0.3% from the previous year in 2009/10. The MH LHIN’s flow deficit has remained relatively stable over the past four years, with a variance of only 0.7% between the lowest and highest rates.


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Weighted Cases: Supply and Demand

From the Demand perspective, the Weighted Cases scenario presents a different picture than Separations, with the top four MCC groups being ‘Circulatory System,’ ‘Digestive System,’ ‘Respiratory System’ and ‘Pregnancy & Childbirth.’

The imbalance in Supply versus Demand per the Weighted Case indicator are flow deficits in ‘Newborns & Neonates with Perinatal Conditions,’ ‘Blood & Lymphatic System,’ ‘Significant Trauma,’ and ‘Digestive System.’

From the supply perspective, during the past four years, Respiratory System, Circulatory System, Digestive System and Pregnancy & Childbirth are among the top four services provided by MH LHIN hospitals based on weighted cases (see Table 2).

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Weighted Cases: Supply and DemandTABLE 2


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Patient Days: Market ShareThis chart shows that in terms of Patient Days, over the past four year period, the trend has been a small decrease in Inflow and a slight increase in Outflow. As a result, the flow deficit has decreased to 6.8% versus 5.8% from 2006/07 to 2009/10.

In looking at total supply and demand, both were increasing from 2006/07 to 2008/09, but actually decreased in 2009/10. This is unexpected since the trends on Separations and Weighted Cases do not exhibit a similar reduction in demand during these two years.


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Patient Days: Market ShareTABLE 3


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Summary

• Our population is growing, and growing quickly in comparison to Ontario as a whole.

• In terms of both supply and demand, volumes are increasing in certain Major Clinical Categories (Tables 1 – 3) when looking at Separations and Weighted Cases, but Total Patient Days actually declined from 2008/09 to 2009/10.

• This scenario will change over time and we need to keep an eye on the growth occurring over the next 3-5 years

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Emergency Room Utilization

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

90,000

2006 2007 2008 2009

Nub

mer

of E

R V

isit

s

ER Visits in the MH LHIN

(3986) CREDIT VALLEY HOSPITAL (THE)

(4624) HALTON HEALTHCARE SERVICES CORP-GEORGETO

(4193) HALTON HEALTHCARE SERVICES CORP-MILTON

(4192) HALTON HEALTHCARE SERVICES CORP-OAKVILLE

(4090) TRILLIUM HEALTH CENTRE-MISSISSAUGA

(4363) TRILLIUM HEALTH CENTRE-WEST TORONTO

Source: NACRS, CIHI. Ambulatory All Visits Main Table.

This graph illustrates the number of visits to an Emergency Department in the Mississauga Halton LHIN over the past four years by hospital site.

All hospital sites saw an increase in the number of ED Visits in 2009/10 from 2008/09, which is reflective of the increase of total ED Visits in the MH LHIN (up to 330,489 in 2009/10 from 309,536 in 2008/09).

The Credit Valley Hospital recorded the highest volume of ED Visits in 2009/10 for the Mississauga Halton LHIN.

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MH LHIN ER Visits, All Ages, CTAS Level Trend Chart


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This graph shows the number of ER Visits to MH LHIN hospitals by Triage / CTAS Level over the past four years.

The CTAS levels are designed such that level 1 represents the sickest patients and level 5 represents the least ill group of patients.

We can see that the largest percentage of ER Visits in the MH LHIN were CTAS Level 3 (Urgent / Potentially Serious).

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MH LHIN ER Visits, All Ages, CTAS Level Trend ChartThis graph illustrates that there was an increase in the number of ER Visits in the MH LHIN across all CTAS levels from 2008 to 2009, although the increases were quite small in CTAS Levels 1 and 5.


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MH LHIN ER Visits, All Ages, CTAS Level Trend ChartThis graph illustrates that the proportion of ER Visits by CTAS level has remained relatively stable over the past four years, with the bulk of ER Visits being CTAS Level 3, followed by Level 4 and then Level 2.

CTAS Level 1 ER Visits comprise the smallest percentage of ER Visits.

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MH LHIN ER Visits, Age 75+, CTAS Level Trend ChartThis chart showing ER Visits in the MH LHIN over the past four years by people over age 75 is similar to the trend of overall ER Visits (i.e. by all ages) in that CTAS Level 3 comprise nearly 50% of the ER Visits.

The main difference lies in the percentages for CTAS Level 2 and CTAS Level 4 ER Visits, with a larger proportion of those aged 75+ designated as CTAS Level 2 (Emergent / Potentially Life-Threatening).


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Total Time Spent in ER – Mississauga Halton LHIN

Source: Ontario Ministry of Health and Long Term Care: http://www.ontariowaittimes.com August 2010.

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http://www.ontariowaittimes.com/�

Emergency Room Wait Times – Trend DataMississauga Halton (April 2008 – September 2010)


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Emergency Room Wait Times – Trend DataMississauga Halton (November 2009 – October 2010)


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Alternate Level of Care (ALC)

• “Alternate level of care” or ALC is a phrase used to describe a level of care provided to patients occupying hospital beds who no longer need acute services while they wait to be discharged to a more appropriate setting1.

• These non-acute hospital days are captured in hospitalization data as patients awaiting an alternate level of care (or ALC patients).

• Uncovering how ALC is being used in acute settings may inform discussions on whether the health care system has sufficient capacity to provide necessary care in the most appropriate setting.

Source: Alternate Level of Care in Canada, January 14, 2009, Canadian Institute for Health Information Analysis in Brief.

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ALC Days – MH LHINThe chart below shows that after a rise in ALC days from 2006/07 to 2008/09, ALC days were down sharply in 2009/10 to levels lower than in 2007/08, with a reduction of nearly 15,000 ALC Days from 2008/09 to 2009/10!

While the difference in supply and demand of ALC days is relatively small, it appears that more and more ALC days have been incurred in other LHINs’ hospitals by MH LHIN residents. This is evident by looking at the inflow and outflow percentage trend lines. As of 2009/10, the “deficit” rate is at 10.4%, a notable increase from 5.4% during 2006/07.


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ALC Days – MH LHIN

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ALC Days – MH LHIN

Looking at the Outflow of total ALC Days over the past four years, the Top 4 MCC groups are Significant Trauma, Nervous System, Circulatory System and Mental Diseases and Disorders.

There appear to be significant shifts in days attributed to MCC groups from year to year in terms of Outflow of ALC Days. For example, from 2008/09 to 2009/10 the demand of ALC Days by MH LHIN residents to a hospital outside of the MH LHIN attributed to Mental Diseases and Disorders more than doubled from 562 to 1,159 while the number for Ear, Nose, Mouth and Throat jumped from 54 in 2008/09 to 335 in 2009/10.

The Top 4 MCC groups where MH LHIN receives most of the ALC days from non-local LHIN (i.e. Inflow) are the Nervous System, Circulatory System, Significant Trauma and Respiratory System. These 4 MCC groups have remained relatively consistent over the past four years, but there is a large degree of variance in most other MCC groups.

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Rehabilitation – Patient Days

Source: Planning Decision Support Tool, Ministry of Health and Long-Term Care

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Rehabilitation - Separations


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General Rehab – Occupancy Rates


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Complex Continuing CareComplex Continuing Care (CCC) is a distinct level of care unique to Ontario. It provides continuing, medically complex and specialized services to both young and old, sometimes over extended periods of time. Such care also includes support to families who have palliative or respite care needs.

There is evidence that acuity of illness is rising and CCC programs are becoming more and more specialized in the care they provide, including an increased emphasis on transitional or rehabilitative care. As such, relationships between facilities offering CCC and their counterparts both in acute care and in the community are becoming increasingly important.1

Mississauga Halton LHIN hospitals treat complex continuing care patients in 286 CCC beds among their institutions. The following table reflects an average case mix index (CMI) (measure of intensity of care) for the LHIN at 1.014. Over 65% of all patient days occur at the Trillium Health Centre Queensway site.

1 Canadian Institute for Health Information. 2004. Complex Continuing Care in Ontario. OCCPS 1996–1997 to 2002–2003: Resident Demographics and System Characteristics.

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Complex Continuing Care

Institution Patient DaysRUGs –

Weighted Patient Days

Case Mix Index

The Credit Valley Hospital 14,083 14,532 1.032

Halton Healthcare Services Corp - Georgetown 8,784 8,638 0.983

Halton Healthcare Services Corp - Milton 8,582 9,206 1.073

Halton Healthcare Services Corp - Oakville 8,102 9,706 1.198

Trillium Health Centre – Queensway Site 73,921 73,014 0.988

Mississauga Halton LHIN TOTAL 113,472 115,095 1.014

2008/09 RUG-Weighted Patient Day (RWPD) Summary

Source: CIHI, Continuing Care Reporting System – Provincial RWPD Report

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Ambulatory Care Trend – Inpatient Visits


* Number of Day/Night Visits (excl. Dialysis)

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Ambulatory Care by Facility – Outpatient Visits


* Number of Day/Night Visits (excl. Dialysis)

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Health Service Utilization - Community Based

• Community Care Access Centre

• Community Support Services

• Long-Term Care Homes

• Mental Health & Addictions

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Mississauga Halton CCAC Service Utilization 2007/08

Service Individuals Served Visits: In-House & Contracted Out

Average Visits per Individual Served

Visit Nursing 9,722 304,494 31.3Physiotherapy 5,084 36,326 7.1Nutrition / Dietetic 563 2,284 4.1Occupational Therapy 8,784 43,215 4.9Speech Language Pathology 2,609 24,128 9.2Social Work 487 2,973 6.1

Service Individuals Served Hours of Care: In-House & Contracted Out

Average Hours per Individual Served

Shift Nursing 707 76,799 108.6

In-Home Support Services 7,773 1,066,066 137.1

Respite Services 547 42,202 77.2

Source: CCAC MIS Comparative Reports 2007/2008YE, Ministry of Health and Long-Term Care Finance & Information Branch

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Mississauga Halton CCAC: Admissions by Service Recipient and Age Category, Comparison of 2007/08 to 2009/10*

*Does not include admissions not yet categorized.

CCAC MIS Comparative Reports , FY2007/08 & FY2009/10, TABLE 6C1: CASE MANAGEMENT (PA 7250930) - Admissions by Service Recipient and Age Category (S5019*** excl. S5019*90), Ministry of Health and Long-Term Care Finance and Information Branch.

FISCAL YEAR

Acute (SR91) Rehab (SR92) Maintenance (SR93) LT Supportive (SR94) End of Life (SR95)

TotalElderly S5019120

Adult S5019140

Pediatric S5019160

Elderly S5019220

Adult S5019240

Pediatric S5019260

Elderly S5019320

Adult S5019340

Pediatric S5019360

Elderly S5019420

Adult S5019440

Pediatric S5019460

Elderly S5019520

Adult S5019540

Pediatric S5019560

2007/08 4,276 5,799 575 2,670 933 1,835 3,308 802 128 922 250 24 405 210 26 22,163

2009/10 5,928 6,788 499 1,636 545 1,380 3,851 812 133 404 72 13 540 213 16 22,830

% Change 2007/08 to 2009/10

38.6% 17.1% -13.2% -38.7% -41.6% -24.8% 16.4% 1.2% 3.9% -56.2% -71.2% -45.8% 33.3% 1.4% -38.5% 3.0%

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Mississauga Halton CCAC

CCAC MIS Comparative Reports , FY2007/08 & FY2009/10, TABLE 6C1: CASE MANAGEMENT (PA 7250930) - Admissions by Service Recipient and Age Category (S5019*** excl. S5019*90), Ministry of Health and Long-Term Care Finance and Information Branch.

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Units ClientsHomemaking, home help, home maintenance and repair 177,496 2,262

Meals on wheels, congregate dining 155,517 2,094

Health Promotion Education, Training, Counseling 144,247 11,555

Supportive, assisted living services 141,603 2,143

Visits, security checks 126,560 3,017

Day Programs / Service 54,741 987

Transportation 50,277 1,771

Caregiver support, respite 70,248 3,636

Specialty Services (Blind, Hearing) 15,200 2,551

MH LHIN CSS Services, FY 2007/08

Source: CSS WERS Report, 2007/08 Actuals

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LTC BedsSupports for Daily

LivingAdult Day Services

CCAC

- 4,031 Beds- 99.5% utilization- 29.2% turnover/yr- 12% ‘inappropriate’Avg CMI (07): 102.35

Range: 90.59-106.87 excluding 5 RAI early adopters

- Total LTC bed supply/1000 population 75+

- MH LHIN -7.9%- Province -9.3%

- Biggest capacity challenge:

- Alternatives to more LTC beds

- Increase community capacity

- 1,018 clients on the program in 07/08

- 17% /367 inappropriate (research)

- Introduction of evidence based tool (CHA)

- Common program framework & reorientation to focus on alternative to LTC Beds

- Those needing 24/7 care – supervision

- Central referral to SDL coordinators from CCACs, D/C planners

- 1084 clients on the program in 07/08

- Increase capacity to move towards Diversion from LTC and caregiver relief to remain at home

- Referral from CCAC only

- Increased services for 75+ target age group

- Intensity- 37%/205 inappropriate

– CCAC Wt list (research)

- 10%/1419 inappropriate – CCAC Community (research)

Understand Seniors’ Needs

- Environics Poll 2008- Focus groups with

Elderly – Summer 2008

Evidence Based Approach and investments made in the Community – to address Appropriate Level of Care/ER use

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Long-Term Care Homes

• In April 2010, a total of 1,115 people in the community were waiting for placement into a long-term care home bed. The April 2010 bed occupancy was 99.2% compared to one year earlier (April 2009), which was 98.7% - an increase of 0.5%. The provincial average for April 2010 was 98.9%.

• In April 2010, the average Length of Stay in the MH LHIN in a LTC bed was 3.3 years vs. the provincial average of 3.0 years.

• The turn over rate for April 2010 was 30.2% of total bed supply. The provincial average was 32.9% for this period.

• There are a total of 1,177 'B' and 'C' rated LTC home beds in the MH LHIN that are eligible for redevelopment within the province's long-term care bed redevelopment program that started in 2009/2010 and will continue over the next 10 years.

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82

1

9

21

24

14

25

7

22

3

412

13

18

19

27

11

15

20

17

26

5

6

1023

16

130

66

200

168

133128

228

133140

161

86

160

180

118

200

140160

20355

237

192

151

187

90

250

66

192

196

200

790

1,045

1,138

785

* STATSCAN and MOHLTC Health Analytics

June 2008

Mississauga HaltonLocal Health Integration Network

Long-Term Care Home Beds

Sub-LHIN LTC BedsBed / 75+ (per 100)

Milton 200 9.7Halton Hills 196 7.6Oakville 790 8.4Halton Region 1,186 8.5NW Mississauga 1,045 11.3SE Mississauga 1,138 6.2Mississauga 2,183 7.9South Etobicoke 785 7.5

MH LHIN 4,154 8.0

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• In the past 10 years, Ontario invested in beds without sufficient investment in other LTC services (e.g. Long-Stay Home Care, Supportive Housing, or Community Support Services).

• The reaction to ALC / ER problems is commonly identified as a lack of LTCH beds, but seniors want alternatives, not just beds.

• Lack of community services for seniors necessitates placement of clients in LTC Homes - There are inappropriate clients placed in LTC Homes.

• The MH LHIN will look to provide more programs like Supports For Daily Living (formerly Supportive Housing) to deal with LTC system pressures.

IndependentLiving

CommunitySupportServices

Supports for Daily Living Home Care

LTCHomes

Low Needs High Needs

AcuteCare

Costs$

Continuum of Services

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Health Human Resources

Selected Regulated Health Professions

Physicians

Nursing

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Health Human ResourcesNew Roles in Health Care – new roles for Nurses is one of the key components of the HealthForceOntario strategy involves establishing innovative new health care professional roles in areas of high need. New roles include:

• Nurse Performed Flexible Sigmidoscopy - A registered nurse with extended specialized education in anatomy, physiology and pathophysiology who works with a physician to perform flexible sigmoidoscopies (i.e., diagnostic procedure used to screen for abnormalities in the lower third of the colon). These individuals can support Ontario’s colon cancer screening initiative.

• Surgical First Assist - Works with the surgeon and the rest of the operating room team to ensure the safe outcome for a surgical patient before, during and after surgery. A registered nurse can perform this role with an additional certification in surgical first assistance.

• Physician Assistant - The Physician Assistant (PA) in Ontario will assist supervising physicians to deliver medical services within patient care teams in various settings. Under direction of the supervising physician, these services may include conducting patient interviews, medical histories, physical examinations; performing selected diagnostic or therapeutic tests and interventions; and counselling patients on preventive health care.

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• Clinical Specialist Radiation Therapist - The Clinical Specialist Radiation Therapist (CSRT) is a medical radiation technologist (radiation therapist) with advanced clinical competencies. The CSRT works in collaboration with radiation oncologists, specialist nurses, medical physicists and other team members to ensure safe and optimal patient outcomes in radiation treatment cancer care settings. Increasing the flexibility of staffing through this role is designed to improve system efficiency and contribute to improved access of Ontarians to cancer care.

• Anesthesia Assistant – is a health professional who participates in the care of the stable surgical patient during anesthesia, under medical directives and under the supervision of the anesthesiologist. Respiratory therapists and registered nurses who successfully complete the program will work in anesthesia departments as part of an anesthesia care team.

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Regulated Health Care Professions in the MH LHINHealth Care Profession Total Number of Active Members (ON) Number in MH LHIN % of Prov Total in MH LHIN

Audiologist 541 37 7%

Chiropodist 504 31 6%

Chiropractor 3,542 284 8%

Dental Hygienist 9,204 825 9%

Dental Technologist 480 63 13%

Dentist 8,339 712 9%

Denturist 530 Not Available Not Available

Dietitian 2,908 Not Available Not Available

Massage Therapist 8,910 642 7%

Medical Lab Technologist 7,702 456 6%

Medical Radiation Technologist 6,324 338 5%

Midwife 403 26 6%

Occupational Therapist 4,432 231 5%

Optician 2,256 222 10%

Optometrist 1,579 122 8%

Pharmacist 11,426 916 8%

Physiotherapist 6,374 437 7%

Psychologist 3,072 222 7%

Respiratory Therapist 2,510 133 5%

Speech Language Pathologist 2,463 205 8%Source: HealthForceOntario, Health Professions Database 2008 Stat Book, September 2010.

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Nursing*• In the Mississauga Halton LHIN, 77.46% of Nurses (Registered Nurses

(RN), Registered Practical Nurses (RPN), and Nurse Practitioners (NP) combined) are employed full-time in hospitals, long-term care homes and CCACs.

• 25% of Acute Care hospitals are below 70% total full-time for all nurses (RN, RPN & NP combined).

• 91% of Long-Term Care facilities are below 70% total full-time for all nurses (RN, RPN & NP combined).

* Notes About Data:

• Obtained through Health Data Branch

• Only data for Acute Care Hospitals, Long-Term Care Homes and Community Care Access Centres were available for analysis

• Data aggregation resulted in some figures not summing to 100%

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LHIN Rankings – All Sectors

Rank LHINID

LHIN NAME TOTAL RN RPN NP

%FT %PT %FT %PT %FT %PT %FT %PT

01 6 Mississauga Halton LHIN 77.46 20.7 78.55 19.77 66.14 30.48 95.86 4.14

02 7 Toronto Central LHIN 75.25 22.67 77.38 21.11 64.63 31.29 80.5 4.22

03 14 North West LHIN 73.07 25.69 76.39 22.98 66.4 31.26 93.06 2.31

04 4 Hamilton Niagara Haldimand Brant LHIN 72.33 26.24 74.56 24.39 64.74 32.64 91.16 6.68

05 8 Central LHIN 72.18 23.78 74.91 21.18 61.53 33.9 99.21 0.79

06 2 South West LHIN 71.83 27.66 74.72 24.77 63.2 36.34 94.58 3

07 12 North Simcoe Muskoka LHIN 71.57 26.82 74.04 24.78 65.56 31.87 89.29 -

08 13 North East LHIN 69.92 28.85 73.97 25.12 60.13 37.98 76.73 14.85

09 9 Central East LHIN 69.72 28.82 73.01 25.84 62.2 35.64 100 -

10 5 Central West LHIN 69.12 27.8 71.95 24.75 58.15 39.59 - -

11 11 Champlain LHIN 69.05 29.55 72.18 26.6 57.26 40.63 94.77 5.23

12 10 South East LHIN 68.94 29.99 72.12 27.2 59.18 38.57 92.25 7.75

13 1 Erie St. Clair LHIN 68.82 30.56 72.13 27.52 57.7 40.8 91.04 7.96

14 3 Waterloo Wellington LHIN 65.89 33.24 69.5 29.79 55.92 42.77 83.59 16.41

* Acute Care, LTC and CCAC (does not include home care nurses)

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Mississauga Halton - Acute Care Hospitals

FACILITY NAMETOTAL RN RPN NP


OAKVILLE Halton Health Care Corp 69.6 26.3 70.4 25.1 65.7 32.2 100 -

MISSISSAUGA Trillium Health Centre 74 25.6 74.9 24.6 63.6 36.4 89.9 10.1

MISSISSAUGA Credit Valley 77.7 21.6 77.9 21.3 65 35 97.9 2.1

Percentage of Registered Nurses, Registered Practical Nurses and Nurse Practitioners Employed Full-Time

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Mississauga Halton – Long-Term Care Homes

FACILITY NAMETOTAL RN RPN

%FT %PT %FT %PT %FT %PT

MISSISSAUGA LONG TERM CARE FACILITY 29.03 70.97 29.03 - - -

CHELSEY PARK/STREETSVILLE 33.46 66.54 42.26 80.77 19.23 80.77

NORTHRIDGE LONG TERM CARE CENTRE 48.53 41.33 40.26 45.7 54.3 45.7

HIGHBOURNE LIFECARE CENTRE 49.03 14.54 48.52 14.63 49.4 14.63

EXTENDICARE MISSISSAUGA 50 20.27 43.48 49.43 50.57 49.43

POST INN VILLAGE 53.21 46.79 55.07 47.62 52.38 47.62

WESBURN MANOR 56.51 43.49 47.96 40.18 59.82 40.18

THE WATERFORD 57.28 34.22 52.42 30.27 63.24 30.27

VILLA FORUM 57.36 29.64 54.25 34.23 60.81 34.23

CAWTHRA GARDENS LONG TERM CARE COMMUNITY 57.53 42.47 60.71 44.05 55.95 44.05

ALLENDALE 58.75 41.25 61.11 42.98 57.02 42.98

EXTENDICARE HALTON HILLS 59.55 31.21 54.21 28.02 62.32 28.02

WYNDHAM MANOR LONG TERM CARE CENTRE 60.06 27.36 25.25 14.16 75.8 14.16

BENNETT HEALTH CARE CENTRE 60.11 37.64 54.24 28.33 71.67 28.33

Percentage of Registered Nurses and Registered Practical Nurses Employed Full-Time

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154

Mississauga Halton – Long-Term Care Homes (cont.)

FACILITY NAMETOTAL RN RPN

%FT %PT %FT %PT %FT %PT

YEE HONG CENTRE MISSISSAUGA 60.3 31.57 61.52 35.82 56.72 35.82

WYNDHAM MANOR LONG TERM CARE CENTRE 60.06 27.36 25.25 14.16 75.8 14.16

WEST OAK VILLAGE LONG TERM CARE CENTRE 61.16 34.99 32.4 10.87 89.13 10.87

THE WENLEIGH 64.82 29.16 60 26.82 69.09 26.82

CHELSEY PARK/MISSISSAUGA 66.94 33.06 67.53 33.8 66.2 33.8

SPECIALTY CARE MISSISSAUGA ROAD 68.01 13.56 43.7 30.04 68.16 30.04

THE WESTBURY 71.67 24.33 79.24 39.67 57.61 39.67

TYNDALL NURSING HOME 82.05 17.95 72.32 5.19 94.81 5.19

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Mississauga Halton – Community Care Access Centre*

CCAC NameTOTAL RN RPN NP


Mississauga Halton CCAC 80.1 19.9 100 - 79.9 20.1 100 -

Percentage of Registered Nurses, Registered Practical Nurses and Nurse Practitioners Employed Full-Time

*Data does not include home-care nurses

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Full Time Employment Status Overview

Acute Care Long-Term Care CCAC

FT RN FT RPN FT NP FT RN FT RPN FT NP FT RN FT RPN FT NP

Mississauga Halton LHIN

Average77.2 70.3 96.3 55.8 62.1 --- 100 79.9 100

Provincial Average 71.8 61.6 92.7 53.4 56.0 --- 96.8 86.7 96.5

*Provides Overall Average Percentage of Nurses Working Full Time in Acute Care Hospitals, Long-Term Care Homes and CCAC

156V5.0

Summary – Overall Key Findings with a view of looking at what the data shows for the next 3-5 years

Mississauga Halton Profile

Social Determinants of Health

Health Service Providers

Health Service Utilization


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Summary – Mississauga Halton Profile• The MH LHIN’s population has increased by 11.7%

(from 2005 to 2010), compared to the provincial overall population increase of 5.5%.

• The MH LHIN will experience population aging, with the 65 – 74 age cohort expected to grow the most (by 60.2%, for an increase of 42,560 individuals) from 2010 to 2020.

• The demands of our growing and aging population will have a significant impact for our LHIN.

• The MH LHIN also has a higher proportion of immigrants and visible minorities than the province.

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Summary – Social Determinants of Health

• While the prevalence of people living with chronic diseases such as diabetes, asthma, heart disease, arthritis, and high blood pressure is slightly lower in the MH LHIN than the provincial average, the chronic nature of these diseases increases with age and results in increased visits to family doctors and emergency departments.

• However, according to ICES data (InTool, 07/08), the age- and sex-adjusted prevalence rate of diabetes was 8.6 (aged 20 years and older) for the MH LHIN, which is slightly higher than the provincial average.

• Chronic conditions place a high burden on the health care system and reduce quality of life for those who suffer from the condition(s).

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Summary – Health Service Providers

• To meet some of the challenges brought on by rapid population growth in our LHIN, some additional capacity is currently being added to all of our hospitals.

• Total occupancy in MH LHIN LTC homes is at 99.2% (April 2010). The MH LHIN is currently below the provincial average of bed supply per population over 75+.

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Summary – Health Service Utilization

• A continued area of focus in our LHIN is on ALC days

• ED wait times need to be addressed in the LHIN, as well as the high usage by individuals who are aged 75+ and the high rate of return visits for Mental Health & Addictions.

• Increased supports in community settings and a multi-faceted approach to address the above pressures is being mobilized by the LHIN.

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Summary – Health Human Resources

• The supply of GP/FPs in the MH LHIN is slightly lower than the Ontario average.

• 25% of Acute Care hospitals are below 70% total full-time for all nurses (RN, RPN & NP combined).

• 91% of Long-Term Care facilities are below 70% total full-time for all nurses (RN, RPN & NP combined).

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Documents

Mississauga Halton LHIN/media/sites/mh...MH LHIN Population Projections by Cohort Compared to Ontario, 2010 to 2035 Source: Ministry of Finance Population Projections by LHIN from