DRAFT - home care | long term care | community care

DRAFT

Outcomes: DM – Decision Making DS – Discussion IE- Information/Education

Strategic Direction: PDC – Person Driven Care EPP – Engaged and Proactive People SHC – Sustainable Health Care

1

BOARD OF DIRECTORS’ MEETING DATE: December 14, 2016

TIME: 12:00pm-3:30pm PLACE: Labelle Head Office Boardroom

AGENDA

TIM

E

ITEM

NU

MB

ER

TOPIC SP

EA

KER

PO

LIC

Y

REFER

EN

CE

OU

TC

OM

E

STR

ATEG

IC

DIR

EC

TIO

N

IN

CA

MER

A

12:00-12:10

1.0 Call to Order 1.1 Welcome

1.2 Declaration of Conflict of Interest

Denise Alcock

Denise Alcock

V-B-14

2.0 Approval of Agenda (including consent

agenda) Denise Alcock DM

3.0 Consent Agenda (Any Board Member may

request that any item be removed from consent agenda and moved to the regular agenda)

Denise Alcock

DM

3.1 Minutes from the November 16, 2016

Board meeting 3.1.1 Status of Follow-up/Action Items

from Previous Board Minutes

DM

IE

ALL

ALL

3.2 Draft Finance and Audit Committee Minutes – December 5, 2016

3.2.1 Financial Statements

IE IE

ALL SHC

3.3 Quality Reports

3.3.1 Quarterly Events Report 3.3.2 Quarterly Complaints Report

IE ALL

3.4 Bi-Annual Patient and Caregiver Council Update

IE ALL

3.5 SCOPA Report

IE ALL

12:10-12:40

4.0 Board Chair and CEO Reports (verbal) 4.1 System Transformation Update (verbal)

Denise Alcock / Marc Sougavinski

IE ALL

12:40-1:10

5.0 CSQS Reports 5.1 Adverse Events Status (verbal) 5.2 Accreditation Update (verbal) 5.3 QIP Update Q2 FY 2016-17

5.4 Summary Scorecard – Quality Indicators

Melody Isinger / Catherine Butler / Jennifer Proulx

IE DM IE

IE

PDC ALL ALL

ALL

1:10- 1:40

6.0 Financial Reports 6.1 Summary Scorecard 6.2 Financial and Performance Results

Maria Barrados/ Deryl Rasquinha

IE IE

SHC SHC

DRAFT

DRAFT

Outcomes: DM – Decision Making DS – Discussion IE- Information/Education

Strategic Direction: PDC – Person Driven Care EPP – Engaged and Proactive People SHC – Sustainable Health Care

2

TIM

E

ITEM

NU

MB

ER

TOPIC SP

EA

KER

PO

LIC

Y

REFER

EN

CE

OU

TC

OM

E

STR

ATEG

IC

DIR

EC

TIO

N

IN

CA

MER

A

1:40-1:55

7.0 Governance Reports (verbal) Bill Skinner / Patrice Connolly

IE SHC

8.0 Other Business

9.1 Public questions and comments

Denise Alcock

IE

2:00 9.0 In-camera X

Adjournment Denise Alcock DM

Minutes – Champlain CCAC Board of Directors, November 16, 2016

Champlain Community Care Access Centre Centre d’accès aux soins communautaires de Champlain

Head Office

4200 Labelle Street Suite 100 Ottawa ON K1J 1J8 Siège social 4200, rue Labelle Bureau 100 Ottawa ON K1J 1J8

Tel/Tél : 613 745 5525 800 538 0520 Fax/Téléc : 613 745 1422

www.champlain.ccac-ont.ca

MINUTES

Board of Directors Meeting

Held November 16, 2016

Labelle Head Office Boardroom

BOARD

MEMBERS:

Denise Alcock

Maria Barrados

Abebe Engdasaw

Andrée Durieux-Smith

Barbara Foulds

Bill Skinner

Melody Isinger

Michael Ennis

Robert D’Aoust

Chair

Treasurer / Chair of Finance & Audit Committee

Chair of Governance Committee

Chair of CSQS Committee

REGRETS: Sherryl Smith

STAFF

PRESENT:

Marc Sougavinski

Catherine Butler

Patrice Connolly

Deryl Rasquinha

Paula Greco

Joe Muise

Chief Executive Officer

Vice-President, Clinical Care

Vice-President, People and Stakeholder Engagement

Vice-President, Performance and Strategy

Senior Lead, Program Evaluation

Manager, Supplies & Equipment

RECORDER: Linda Stewart Executive Assistant

GUESTS: JP Boisclair

Diane Hupé

Nick Busing

Chair, Champlain LHIN Board

Director, Champlain LHIN Board

Director, Champlain LHIN Board

AGENDA ITEM ACTION TO BE

TAKEN

1.0 CALL TO ORDER

1.1 Welcome

Denise Alcock, Board Chair, welcomed everyone to the meeting.

1.2 Declaration of Conflict of Interest

There was no declaration of conflict.

2


2.0 APPROVAL OF AGENDA

It was moved by Barbara Foulds, seconded by Andrée Durieux-Smith and agreed to

approve the amended agenda (3.2 – Annual Program Evaluation Activity Update was

removed from the consent agenda for further discussion), including the consent

agenda for the November 16, 2016 meeting.

CARRIED

Motion Carried

11-16-62

3.0 CONSENT AGENDA

The consent agenda for the November 16, 2016 Champlain CCAC Board meeting

contained the following information items and motions:

3.1 That the Champlain CCAC Board approves the minutes of the October 19,

2016 meeting.

3.1.1 Status of Follow-up/Action Items from previous Board minutes

3.2 Annual Program Evaluation Activity Update

3.3 Awareness – Patient Relations Advisory Group (PRAG)

Approved by motion 11-16-62

The following item was moved from the consent agenda to the agenda, and was

presented by Paula Greco, Senior Lead, Program Evaluation:

3.2 Annual Program Evaluation Activity Update

o A summary of program evaluation activities completed since the last

Board report included:

Champlain CCAC Palliative Care Model

Palliative Symptom Management Kit (SMK)

Using Interactive Voice Recognition (IVR) System to Evaluate

Patient Experience

Use of Rapid Response Assessment Team (RRAT) to

Strengthen Connections across Sectors and Safe Transitions of

Medically Complex Patients

Champlain CCAC Nursing Clinic Evaluation

o Current areas of focus for program evaluation include: evaluating the

use of an on-demand service delivery model; evaluating an enhanced

or integrated model of care coordination within a family health team;

evaluating the feasibility, utility, and impact of the use of QTUGTM by

non-specialized workers on Falls prevention; and assessing current

practice for IV Therapy in an effort to standardize practice across SPOs

and make recommendations on a service pathway to support care in

this area. Discussions are also underway with the Champlain LHIN to

assess the impacts of Health Links within the Champlain region.

Details of the evaluation are yet to be finalized.

3


4.0 CSQS REPORTS

The Quality indicators of the summary scorecard were discussed, and the following

was noted:

Almost 900 patients waitlisted, with close to 1000 partially waitlisted; still a

ways to go to recoup deficit

Seeing some slippage in quality metrics, which are tied to waitlist activities; as

we continue, the metrics will be more and more in jeopardy (i.e., service wait

time, community – slipped to 34 days in September)

5.0 FINANCIAL REPORTS

5.1 Scorecard, Financial and Performance Results

The Board reviewed the September 2016 financial results :

Currently a little over $6M in deficit

Nursing services still being provided to capacity

Can put spending on a more predictable trajectory, towards 1% deficit (-$2.5M).

Some surplus program funds are under LHIN discretion, and some under

MOHLTC discretion; seeking consideration towards utilizing surplus program

funds to serve more patients

Line of credit: cash flow becomes an issue when we’re running deficit, may draw

beyond our traditional $5M this month, but don’t anticipate further significant

constraints

All pressure is on purchased CS; surpluses are on other lines

Monitoring trends – the trend has yet to reverse itself. Operationally, CCAC

meets weekly to discuss trend and shift, and we’re already seeing improvements

All services are experiencing waitlisting other than PT (targeted budget – currently

a surplus area); only very high needs and clinically at risk are being serviced

today; nursing is going to demand, which is increasing. Should see an improved

trend in October and hopefully will start to recoup in November

5.2 CAPS Submission

The Board was provided with a synopsis of assumptions that went into the CCAC’s

funding submission, which were confirmed by the LHIN. The following points were

made:

This CAPS is really tentative until the transfer takes place, at which time it should

be revised

Will be no shortage of demand going forward, it will be how we manage programs

– where there are dedicated funds, target to capacity and not overspend

Approach to next year: we modeled option 2 – in a simplistic way we started year

with overspending our budget line as we had waitlist from prior year

4


Decision point best way to spend our dollars and serve clients; can apply surpluses

to one-time expenses where it makes sense

Alternate strategy would be to address patient needs and release waitlist, but need

to put a cap on it or expenses will go up

Daily decisions on number of patients we can serve and manage budget flow and

foresee this being in place going forward; can modulate expenditures without

diving into deficit; doesn’t solve waitlist issue, but manages budget flow

Work on assumption of 1.5% funding increase

Demand and capacity analysis should aid us in capacity planning for the future

It was moved by Michael Ennis, seconded by Barbara Foulds and agreed that the

Champlain CCAC Board approves the 2017-2018 Community Accountability

Planning (CAPS) submission to the Champlain LHIN.

CARRIED

Motion Carried

11-16-63

6.0 GOVERNANCE REPORTS

Bill Skinner provided a summary of the morning retreat session:

A table of contents outline was created to frame the transition booklet that the

CCAC Board will pass on to the LHIN and the new organizational Board to not

only demonstrate the governance model of the Champlain CCAC but also

accomplishments and concerns – a legacy document signed by all CCAC Board

members

J.P. Boisclair, the LHIN Board Chair, appreciated the effort that is going into this

information, and sees the importance of transferring corporate memory

This document will also serve as a mechanism to explain how new organization

will be inheriting an organization that has a certain culture associated with it, and

the culture was shaped by what the CCAC Board did; help to understand culture

of employees who will be under new organization’s purview

7.0 SYSTEM TRANSFORMATION UPDATE

The Board Chair and CEO provided the following updates:

HIROC – CW CCAC sent a number of questions back to HIROC, i.e., HIROC

could give 90 days’ notice of cancellation of insurance certificate, or policy

cancellation. When clarification comes, Denise Alcock will pass it along

Denise Alcock will be attending a session at Parliament Hill with focus on

Home care at the federal level – if anyone has any questions that she can ask

on their behalf, please let her know

Bill 41 is in its third reading; unsure if it will be passed before December 9, if

not, it won’t be until January. In the meantime, workstreams are continuing

their work

CCAC and LHIN executives meeting every two weeks now to update/discuss

transition issues (readiness assessment)

5


CCAC encourages keeping transition simple, and keep many of the same

processes / systems until after T-day (i.e., CHRIS, payroll, HRIS)

Once upper management determined for new organization, we can fully

engage in transition work

Big issue is fate of OACCAC; it has been the anchor/hub of the 14 CCACs;

unsure what new shared services will look like; membership payments to the

OA in January will be structured differently (MOHLTC will be funding

directly – unsure how money will be taken from CCACs for this)

Invitations to the public portion of CCAC Board meetings will continue to be

extended to LHIN Board via Sylvie Bleau at the LHIN, and CCAC Board

members are encouraged to join public LHIN Board meetings as well

Next Board meeting staff will bring forward recommendation on

Accreditation; had extension to December 2017, which means we would have

to start process now. Need to either postpone it or let accreditation lapse and

let new Board decide

8.0 SUPPLIES MANAGEMENT

The Board was provided with a presentation on supplies management, in which the

following was discussed:

Supplies management was identified by Board as one of the priority issues to

address on Action Plan

Driven down spend by $1.6M/year; sustainable savings

We serve at any given time 22k patients, most require supplies

Significant decreases in supplies expenditures in the past year

New vendor awarded with supplies and equipment contract last year (after RFP

competition) brought a significant decrease in costs

A root cause analysis was performed based on recent media story; discussed

process with SPO and CCAC wound care specialist

Supplies are ordered by both CCAC staff and SPO nurse

With planned implementation of vendor’s tracking software, we will be able to see

real-time order status; will help nursing SPOs better plan their visits, and there

will be no wasted visits due to lack of/no supplies

Currently care coordinator (CC) takes assessment over phone and sends out a

recommended set of supplies to patient’s home; not always accurate, not always

enough, not always the right supplies

With the car kit pilot in Eastern Counties set to start in January 2017, the CCs

won’t be ordering supplies; initial wound supplies will be carried by SPO nurses

Working with communications team to have an awareness week/month (including

public awareness); things to be discussed will include having a designated spot in

the patient’s home for the supplies, so that nurse will know where to find them and

can inventory/order appropriately

Case study learnings will be shared with staff on the intranet

6


Process changes will be made accordingly (i.e., ordering less and more often for

more complex cases, etc.) – ordering just what is needed

Created new data report that will tell us exactly what products were ordered,

when, how/when delivered, which will more efficiently feed root cause analysis

On average, roughly 13% of what is spent on patient is wasted; 90% of products

are under $20

Leftover supplies are inevitable; will come up with two different strategies to get

supplies out of home; for supplies that can be reused, we will partner with

organizations such as Not Just Tourists, St. Joseph’s Health Care in Toronto (send

supplies to doctors overseas), etc. These ‘recycling’ strategies will become part of

package for patients who are brought on service

9.0 OTHER BUSINESS

9.1 Public Questions and Comments

There were no public questions or comments.

It was moved by Melody Isinger, seconded by Robert D’Aoust and agreed to adjourn

the meeting.

CARRIED

Motion Carried

11-16-64

CONFIRMED:_____________________________ _________________________________

DENISE ALCOCK, CHAIR MARC SOUGAVINSKI, CEO AND

BOARD SECRETARY

Champlain CCAC Board – December 14, 2016

Item 3.1.1 – Status of Follow-up/Action Items from Previous Board Minutes PAGE 1

Submission to the Board

Status of Follow-up/Action Items - Previous Board Minutes

December 14, 2016

INFORMATION ITEM

To provide an update on business arising from the previous Board minutes (as of November 16, 2016 meeting).

BACKGROUND/ISSUE

DATE OF MEETING FOLLOW-UP/ACTION REQUIRED UPDATE

Linda Stewart, Executive Assistant

Minutes – Champlain CCAC Finance Committee & Audit Committee – December 5, 2016

Champlain Community Care Access Centre Centre d’accès aux soins communautaires de Champlain

Head Office 4200 Labelle Street Suite 100 Ottawa ON K1J 1J8 Siège social 4200, rue Labelle Bureau 100 Ottawa ON K1J 1J8

Tel/Tél : 613 745 5525 866-994-8124 Fax/Téléc : 613 745 1422

www.champlain.ccac-ont.ca

MINUTES Finance and Audit Committee (Special Meeting)

Held December 5, 2016

Champlain CCAC Head Office

BOARD COMMITTEE

MEMBERS

(FINANCE):

Maria Barrados

Denise Alcock

Sherryl Smith (by

phone)

Chair

Ex-officio member / Board Chair

FINANCE REGRETS: Robert D’Aoust

STAFF PRESENT: Marc Sougavinski

Deryl Rasquinha

Sara Bisson

Linda Stewart

Chief Executive Officer

Vice-President, Performance and Strategy

Corporate Controller

Executive Assistant

RECORDER: Linda Stewart Executive Assistant

GUESTS: none

AGENDA ITEM ACTION TO BE TAKEN

1.0 Declaration of Conflict

There were no declarations of conflict.

2.0 Financial Updates and Decisions

An update was given and a discussion was held on the current financial

situation:

Haven’t achieved savings anticipated in October, but beginning to see

more in November; we are now forecasting being slightly above -1%

at year-end. Purchased Client Services still experiencing excessive

pressure – and is approximately $-8.3M

PSS controls (centralized admissions) working well – there are

patients being admitted on a daily basis, but we need more discharges

to gain a surplus

Nursing services – continuing to serve to volume. Volumes have gone

down since September, but it’s not due to any measures initiated, so

they could easily go up again (it’s referral and demand based)

2

Minutes – Champlain CCAC Finance Committee & Audit Committee, December 5, 2016


Specialty programs: estimating an overspend of roughly $5M by YE;

CCAC is seeking funding relief from The Ottawa Hospital (for Cancer

Care Ontario) of approximately $800K for PleurX and CHIPP relief,

to continue to serve demand (otherwise we won’t be able to serve our

PleurX/CHIPP patients)

Therapy services: need to ensure we avoid low volume penalty for

therapy services, which could amount up to $500K

Targeting moderate surpluses in November/December, with larger

surpluses in January through to March

Continuing to pursue not having to release surplus funds for dedicated

programs (clawback funds – approximately $1M), to apply to deficit

Anticipating an additional $600K savings in salary and administration

by YE

What does balanced mean to us (historically +/-1%) versus the LHIN’s

expectations for a balanced budget (i.e., zero), and also, balanced at

YE versus balanced at transition day (we are confident we can be

balanced at zero by transition day)

There has been an increase in patient complaints as a result of the

decrease in services, but not at a concerning rate

Important part of our story to share with the LHIN is our forecast on

referral volumes, how it went differently than expected (i.e., number

of referrals reached historic high levels this summer, which has

traditionally been a slower period), and all the steps we took to

compensate; traditional measures (such as partial waitlisting) don’t

apply anymore as we cannot control referrals. Hoping that the demand

and capacity analysis being done for the Champlain region will shed

some light on the excessive pressures (highest acuity, highest referrals)

– preliminary results of the study show that this region is underfunded

Internal audits have been done to determine if there was any bias

towards RAI scoring/coding, but the results have shown no bias exists;

however data still continues to be reviewed

A harder line position would be to suggest that the CCAC not accept

any more referrals (with exceptions), which would then create more

pressure on hospitals – yes, we can be balanced, but at what cost to the

safety of our patients. Need to show impact of what balancing to zero

would be (risks), versus what the impact would be if we were allowed

to carry forward a small deficit that would then be resolved prior to

transfer day

We can’t put patients at any more risk than we already have, can’t in

good conscience allow more cuts to services (unless that meant

patients would remain under hospital care)

Majority of nursing referrals come from hospitals; arguably many of

the services requested used to be offered as outpatient services, but the

hospitals stopped offering due to their own system pressures, which

unfortunately has created a downstream pressure on the CCAC

3

Minutes – Champlain CCAC Finance Committee & Audit Committee, December 5, 2016


Even if the system we have implemented (centralized admissions,

serving to volume etc.) carries over to the new organization, this is not

providing our community with quality services, and not what we

anticipate home and community services to be

Only way to stop the continued oscillation of surplus/deficit/surplus is

to allow for a surplus and continue the waitlist and centralized

admissions

Patients on waitlist who have insurance – or who can afford to pay

out-of-pocket – to cover PSS or other services have been counselled to

do so when they are put on the waitlist

Line of credit from the bank will be a thing of the past in the new

organization, as the MOHLTC not permitted to have bank loans;

however, at YE we expect to be in a positive cash flow position

The Finance & Audit Committee supports initiatives that management

has taken and careful monitoring in terms of triaging and monitoring

PSS Services; however, the Finance & Audit Committee’s

understanding is that the LHIN expects the CCAC’s budget to balance

to zero at YE and will not accept a small -1% deficit variance. The

Finance and Audit Committee suggests that CCAC management

discusses allowing a small carry forward at YE with the LHIN; if this

isn’t approved by the LHIN, describe where we would reduce services

to balance that would keep patients safe, but would have a very big

impact on hospitals/other healthcare institutions

The LHIN Board meeting January 27 will be an opportunity for

Denise Alcock and Marc Sougavinski to clearly state the position of

the CCAC and its financial state – need simplistic approach – Denise

Alcock will suggest format.

It was moved by Maria Barrados, seconded by Sherryl Smith and agreed to

adjourn the Finance & Audit Committee meeting.

CARRIED

CONFIRMED: __________________________________________ MARIA BARRADOS, CHAIR

Champlain CCAC

Board Financial Statements

For the Seven Months Ending October 31, 2016

1 Month 1 Month 1 Month YTD YTD YTD Total

Actuals Budget Variance Actuals Budget Variance Budget

REVENUE

Base Funding 20,692,645 20,180,969 511,676 144,374,668 143,917,849 456,817 246,508,010

One-Time Funding 96,594 65,652 30,942 564,612 462,136 102,476 791,682

BTI 6,355 38,918 (32,563) 21,585 272,426 (250,841) 467,019

Other 66 4,666 (4,600) 7,626 32,662 (25,036) 56,000

Total Revenue 20,795,660 20,290,205 505,455 144,968,491 144,685,073 283,416 247,822,711

EXPENSES

Clinical Care

Purchased Services

Personal Support Services 8,763,414 8,079,601 (683,812) 64,215,526 58,067,627 (6,147,899) 98,625,912

Visit Nursing (includes dialysis) 2,921,049 2,724,453 (196,596) 19,793,848 19,178,015 (615,833) 32,853,702

Visit Nursing - Clinic 513,267 427,539 (85,728) 3,482,940 3,009,536 (473,404) 5,155,612

Nursing Shifts 871,195 803,600 (67,594) 5,496,460 5,656,717 160,257 9,690,476

Community - OT 285,607 346,667 61,059 2,350,842 2,440,262 89,420 4,180,392

Community - PT 363,504 381,672 18,168 2,890,978 2,686,671 (204,307) 4,602,514

Community - Speech 13,602 17,579 3,977 149,193 123,745 (25,448) 211,986

School - OT 213,136 187,120 (26,016) 1,216,721 1,196,951 (19,770) 2,147,736

School - PT 52,227 49,185 (3,042) 264,187 272,170 7,983 519,230

School - Speech 137,400 131,174 (6,226) 797,551 787,387 (10,164) 1,478,517

Social Work 28,823 39,736 10,913 271,932 279,711 7,778 479,170

Nutrition 29,339 38,250 8,911 238,162 269,250 31,088 461,250

Hospice 881,891 375,746 (506,145) 3,126,185 2,630,222 (495,963) 4,508,971

Aphasia 20,833 21,039 206 145,833 148,100 2,267 253,709

Medical Supplies 805,836 1,003,287 197,450 5,957,056 7,062,353 1,105,297 12,098,460

Medical Equipment 332,292 97,470 (234,822) 2,345,151 686,109 (1,659,042) 1,175,368

Recoveries (23,870) (15,207) 8,663 (82,000) (106,449) (24,449) (182,500)

Other 35,580 18,841 (16,739) 133,482 131,885 (1,598) 226,100

Total Purchased Services 16,245,125 14,727,752 (1,517,373) 112,794,048 104,520,260 (8,273,788) 178,486,605

Internal Therapies

Wages 304,947 328,281 23,334 2,019,300 2,280,976 261,676 3,969,045

Benefits 80,611 70,733 (9,878) 645,219 614,302 (30,917) 1,044,137

Travel 25,695 18,414 (7,281) 142,689 128,898 (13,791) 221,000

General Administration Costs 5,124 2,038 (3,086) 11,454 14,266 2,812 24,500

Total Internal Therapies 416,378 419,466 3,088 2,818,662 3,038,442 219,780 5,258,682

Care Coordination

Wages 2,642,173 2,712,815 70,642 18,788,161 18,898,697 110,535 32,816,917

Benefits 665,608 676,896 11,288 5,559,237 5,674,797 115,560 9,657,253

Travel 40,830 41,666 836 270,962 291,662 20,700 500,000

Professional Service 4,599 2,082 (2,517) 4,599 14,576 9,977 75,000

Office Supplies 1,242 4,583 3,341 11,733 32,081 20,348 55,000

Printing 8,997 8,333 (664) 68,114 58,331 (9,783) 100,000

Photocopy Charges 5,232 9,166 3,934 31,479 64,162 32,683 110,000

Delivery & Courier 1,180 1,666 486 7,619 11,662 4,043 20,000

Courses/Training/Conferences 1,591 2,166 575 9,893 15,162 5,269 26,000

Minor Equipment 83 83 581 581 1,000

Page 1 of 5

Champlain CCAC




Actuals Budget Variance Actuals Budget Variance BudgetWireless Service 10,021 9,166 (855) 70,714 64,162 (6,552) 110,000

Recoveries (37,491) (44,692) (7,201) (222,090) (312,844) (90,754) (536,320)

Other 11,050 374 (10,676) 12,106 2,618 (9,488) 4,500

Total Care Coordination 3,355,032 3,424,304 69,271 24,612,527 24,815,647 203,119 42,939,349

Health System Development

Healthlinks-Primary Care 22,716 23,870 1,154 154,513 171,175 16,662 293,800

Healthlinks-HLA1 25,625 22,731 (2,894) 175,961 168,282 (7,678) 290,624

Shared Services 41,183 41,480 297 372,075 297,177 (74,898) 512,085

Total Health System Development 89,524 88,081 (1,443) 702,549 636,634 (65,915) 1,096,510

Nursing Initiatives

Wages 208,015 200,273 (7,742) 1,392,662 1,393,955 1,293 2,426,295

Benefits 48,184 46,952 (1,232) 379,251 395,240 15,989 676,018

Travel 8,120 11,665 3,545 70,471 81,655 11,184 140,000

Other 290 290 7,490 2,030 (5,460) 3,500

Total Nursing Initiatives 264,318 259,180 (5,138) 1,849,540 1,872,880 23,340 3,245,813

Information & Referral

Wages 71,916 76,244 4,328 498,014 534,459 36,445 922,822

Benefits 20,314 22,938 2,625 146,456 171,133 24,677 292,841

Travel 549 83 (466) 628 581 (47) 1,000

Total for Information & Referral 92,778 99,265 6,487 645,098 706,173 61,075 1,216,663

Total Clinical Care 20,463,155 19,018,048 (1,445,108) 143,422,424 135,590,036 (7,832,389) 232,243,622

ADMINISTRATION

Executive Office

Wages 79,510 84,260 4,749 585,085 578,682 (6,403) 1,000,164

Benefits 14,180 15,986 1,806 116,082 125,185 9,102 227,110

Travel 792 1,250 458 13,636 8,750 (4,886) 15,000

Legal Services 25,833 25,833 161,148 180,831 19,683 310,000

Consultants 416 416 2,912 2,912 5,000

Membership (OACCAC) 30,714 30,833 119 219,103 215,831 (3,272) 370,000

Meeting Expenses 291 291 485 2,037 1,552 3,500

Printed Matter & Subscriptions 166 166 1,162 1,162 2,000

Board Expenses 345 2,291 1,946 4,698 16,037 11,339 27,500

Recoveries (342) 342 (2,392) 2,392

Other 291 291 2,037 2,037 3,500

Total for Executive Office 125,200 161,617 36,417 1,097,846 1,133,464 35,618 1,963,774

Performance and Strategy

Business Intelligence

Wages 36,695 35,293 (1,402) 245,886 245,744 (143) 426,947

Benefits 9,838 7,623 (2,214) 81,017 66,018 (14,999) 113,329

Travel 125 125 875 875 1,500

Other 83 83 581 581 1,000

Total for Business Intelligence 46,533 43,124 (3,409) 326,903 313,218 (13,685) 542,776

Page 2 of 5

Champlain CCAC




Actuals Budget Variance Actuals Budget Variance BudgetQuality & Program Evaluation

Wages 35,397 36,307 910 219,122 252,802 33,680 436,171

Benefits 8,321 7,458 (863) 57,784 64,680 6,896 111,158

Travel 333 333 1,371 2,331 960 4,000

Other 12,613 8,102 (4,511) 65,966 56,714 (9,252) 97,250

Recoveries (1,724) 1,724

Total for Quality & Program Evaluation 56,331 52,200 (4,131) 342,519 376,527 34,008 648,579

PMO and Service Provider Programs

Wages 39,950 38,156 (1,795) 260,607 265,063 4,456 457,459

Benefits 10,071 8,181 (1,890) 72,418 65,305 (7,113) 111,952

Travel 224 249 25 936 1,743 807 3,000

Other 41 41 287 287 500

Total for PMO and Service Provider Programs 50,245 46,627 (3,619) 333,961 332,398 (1,563) 572,911

Finance and Payroll

Wages 55,154 49,334 (5,820) 352,164 341,863 (10,301) 589,186

Benefits 14,601 13,027 (1,574) 123,474 101,025 (22,449) 169,889

Travel 83 83 581 581 1,000

Insurance 6,635 6,731 96 45,712 47,117 1,405 80,773

Audit Services 2,667 2,750 84 18,666 19,250 585 33,000

Other 465 333 (132) 2,616 2,331 (285) 4,000

Total for Finance and Payroll 79,522 72,258 (7,264) 542,631 512,167 (30,464) 877,848

Facilities

Wages 11,958 14,271 2,313 98,112 98,831 719 170,362

Benefits 3,080 3,132 53 25,174 24,638 (536) 42,004

Travel 525 500 (25) 2,247 3,500 1,253 6,000

Office Supplies & Services 197 916 719 1,770 6,412 4,642 11,000

Postage, courier & photocopy services 2,235 2,083 (152) 16,224 14,581 (1,643) 25,000

Building Occupancy 178,708 208,822 30,114 1,376,105 1,461,754 85,649 2,505,864

Office Renovations 2,152 15,833 13,681 33,958 110,831 76,873 190,000

Utilities 4,779 4,583 (196) 25,324 32,081 6,757 55,000

Building & Grounds - Other

Misc Supplies/Repairs/Cleaning 5,344 5,833 489 40,372 40,831 459 70,000

Equipment Maintenance-Plant 6,431 5,000 (1,431) 38,459 35,000 (3,459) 60,000

Furniture & Equipment Purchases (Capital Asset)

Leasehold Improvement Purchases (Capital Asset)

Other 1,624 2,457 833 11,240 17,199 5,959 29,500

Recoveries (447) (13,333) (12,886) (44,154) (93,331) (49,177) (160,000)

Total for Facilities 216,583 250,097 33,514 1,624,831 1,752,327 127,496 3,004,730

IT & System Communications

Wages 114,982 112,882 (2,100) 777,825 781,411 3,586 1,351,274

Benefits 27,308 27,739 431 208,837 216,090 7,254 370,617

Travel 304 833 529 4,601 5,831 1,230 10,000

Telephone & System Communications 39,248 36,915 (2,333) 226,096 258,405 32,309 443,000

Telephone Supplies 3,416 3,416 2,726 23,912 21,186 41,000

Telephone Maintenance & Licenses 2,500 2,500 120,044 111,500 (8,544) 124,000

Telephone System Consultant 527 1,666 1,139 1,581 11,662 10,081 20,000

Page 3 of 5

Champlain CCAC




Actuals Budget Variance Actuals Budget Variance BudgetEquipment Maintenance 23,269 2,500 (20,769) 35,947 17,500 (18,447) 30,000

Software Maintenance & Licenses 7,581 20,499 12,918 209,411 143,493 (65,918) 246,000

System Development Consultant/CHRIS Development 1,041 1,041 18,079 7,287 (10,792) 12,500

Computer Supplies 1,910 5,833 3,923 18,844 40,831 21,988 70,000

BTI 6,355 38,918 32,563 21,586 272,426 250,840 467,019

BTI Refresh/Growth 431 4,999 4,568 39,935 34,993 (4,942) 60,000

CCAC eHealth Program 150,494 140,865 (9,629) 1,053,461 986,055 (67,406) 1,690,381

Renovations 94 2,083 1,989 4,540 14,581 10,041 25,000

Other 10,257 5,874 (4,383) 31,523 41,118 9,595 70,500

Recoveries (300) 300 (1,400) 1,400

Equipment Purchases (Capital Asset) 10,993 (10,993)

Total for IT & System Communications 382,461 408,563 26,102 2,784,629 2,967,096 182,467 5,031,291

Health Information

Wages 14,063 14,435 373 95,232 100,181 4,949 172,684

Benefits 3,698 3,640 (58) 28,110 28,565 456 48,835

Travel 280 208 (72) 409 1,456 1,047 2,500

Equipment Maintenance

Shredding & Document Destruction 310 1,250 940 1,419 8,750 7,331 15,000

Scanning Services 83 83 581 581 1,000

Storage 4,555 3,333 (1,222) 26,827 23,331 (3,496) 40,000

Other 138 (138)

Recoveries (105) 105 (1,994) 1,994

Total for Health Information 22,800 22,949 149 150,141 162,864 12,723 280,019

Total Performance and Strategy 854,476 895,818 41,342 6,105,615 6,416,597 310,982 10,958,153

People and Stakeholder Engagement

People Services

Wages 62,165 61,742 (424) 406,293 429,155 22,862 740,603

Benefits 13,124 13,820 696 107,021 119,200 12,179 202,483

Travel 616 833 217 2,987 5,831 2,844 10,000

Consultants - HR 1,725 2,291 566 7,077 16,037 8,960 27,500

Labour Relations 520 6,666 6,146 10,197 46,662 36,465 80,000

Occupational Health & Safety 2,163 8,333 6,170 7,605 58,331 50,726 100,000

Advertising 1,611 4,166 2,555 36,068 29,162 (6,906) 50,000

Employee Assistance Plan 2,500 2,500 14,319 17,500 3,181 30,000

Staff Appreciation 600 4,583 3,983 600 32,081 31,481 55,000

Total People Services 82,524 104,933 22,410 592,166 753,958 161,792 1,295,586

Organizational Development

Wages 28,666 35,741 7,075 225,003 248,447 23,443 430,164

Benefits 5,961 7,503 1,541 58,791 65,084 6,294 111,860

Travel 98 291 193 2,204 2,037 (167) 3,500

Courses/Training/Conferences 1,085 6,000 4,915 42,925 42,000 (925) 72,000

Other 4,000 4,000 44,108 28,000 (16,108) 48,000

Recoveries (1,153) 1,153

Total Organizational Development 35,811 53,535 17,724 371,878 385,568 13,690 665,524

Page 4 of 5

Champlain CCAC




Actuals Budget Variance Actuals Budget Variance BudgetStakeholder Engagement

Wages 20,305 36,873 16,568 190,123 255,669 65,546 441,351

Benefits 4,337 7,840 3,503 49,899 68,994 19,095 116,201

Travel 216 625 409 1,929 4,375 2,446 7,500

Public Relations 3,208 8,833 5,625 25,949 61,831 35,883 106,000

Translation/Consultants 2,083 2,083 14,329 14,581 252 25,000

Other 1,275 (1,275) 7,559 (7,559)

Total Stakeholder Engagement 29,341 56,254 26,913 289,787 405,450 115,663 696,052

Total People and Stakeholder Engagement 147,675 214,722 67,047 1,253,831 1,544,977 291,146 2,657,162

Total Administration 1,127,351 1,272,157 144,805 8,457,292 9,095,037 637,746 15,579,088

Total Expenses 21,590,506 20,290,205 (1,300,303) 151,879,716 144,685,073 (7,194,643) 247,822,710

Surplus/(Deficit) (794,846) - (794,846) (6,911,225) - (6,911,225) -

Page 5 of 5

Champlain CCAC Board of Directors – December 14, 2016

Item 3.3.1 – Quarterly Events Report PAGE 1

Submission to the Champlain CCAC Board of Directors

Quarterly Events Report: July 2016-September 2016 (Q2)

December 14, 2016

EVENT REPORTING

Adverse Events: The last Adverse Event occurred on January 3, 2016 (Q4, 15-16). Top 5 Reported Events in CELS in Q2: Within CELS, the event categories and definitions include those required internally and by the OACCAC reporting requirements and data collection needs. In Q2, the top five reported events were:

1. Client falls – Unwitnessed 2. Quality of Services Provided by SP – General 3. Abuse/Threat/Injury to Staff 4. Compliment about SP 5. Infusion Pump Issues

02468

1012141618202224262830

Jun

-14

Jul-

14

Au

g-1

4

Sep

-14

Oct

-14

No

v-1

4

Dec

-14

Jan

-15

Feb

-15

Mar

-15

Ap

r-1

5

May

-15

Jun

-15

Jul-

15

Au

g-1

5

Sep

-15

Oct

-15

No

v-1

5

Dec

-15

Jan

-16

Feb

-16

Mar

-16

Ap

r-1

6

May

-16

Jun

-16

Jul-

16

Au

g-1

6

Sep

-16

NU

MB

ER O

F EV

ENTS

DATE

UNWITNESSED FALLSJUNE 2014 - SEPTEMBER 2016

Median = 2.5



Client Falls is captured through four subcategories: - Witnessed – without injury; - Witnessed – with injury; - Unwitnessed - Unwitnessed fall resulting in injury, recommendation to call 911 and/or use of

additional healthcare resources The latter subcategory was added in Q2 of FY 15/16, in order to have improved awareness of the extent to which unwitnessed falls are occurring that require the use of healthcare resources/intervention(s). Client falls continue to be addressed by Champlain CCAC and is an indicator on our annual Quality Improvement Plan. In FY

2016-17, the IMPACTT Centre has initiated field testing of a new intervention for falls screening.

Quality of Services Provided by Service Provider – General Quality of Service, for both CCAC and SPO staff, is captured through the subcategories: professionalism, responsiveness, time management and cleanliness. Quality of Service – General are those complaints which have an impact on the quality of services provided but do not fall into the identified subcategories. Continued review of these events have helped determine two new categories, specifically, Quality of Service – Consistency of Care, and Quality of Service – Continuity of Care. Discussions with our Service Provider partners reflect the importance of ensuring that staff, particularly Personal Support Workers (PSWs), are well informed and knowledgeable about clients’ careplans so that clients and families do not have to review each time they are cared for by a new PSW. In addition, SPOs are aware and trying to provide clients with consistency in the worker(s) that they see.

02468

1012141618202224262830

Jun

-14

Jul-

14

Au

g-1

4

Sep

-14

Oct

-14

No

v-1

4

Dec

-14

Jan

-15

Feb

-15

Mar

-15

Ap

r-1

5

May

-15

Jun

-15

Jul-

15

Au

g-1

5

Sep

-15

Oct

-15

No

v-1

5

Dec

-15

Jan

-16

Feb

-16

Mar

-16

Ap

r-1

6

May

-16

Jun

-16

Jul-

16

Au

g-1

6

Sep

-16

NU

MB

ER O

F EV

ENTS

DATE

QUALITY OF SERVICES BY SERVICE PROVIDER - GENERALJUNE 2014 - SEPTEMBER 2016

Median = 8



Abuse/Threat/Harassment/Injury to Staff An updated version of the Patient Bill of Rights and Commitments will be introduced before the end of FY 16/17 and the Champlain CCAC is nearing the end of the consultation process on redefining a standardized set of Case Escalation guidelines. These new guidelines will provide clear direction to staff and Service Provider staff on when to escalate a safety/risk issue involving a client or caregiver, the steps that are required and the appropriate timelines.

02468

1012141618202224262830

Jun

-14

Jul-

14

Au

g-1

4

Sep

-14

Oct

-14

No

v-1

4

Dec

-14

Jan

-15

Feb

-15

Mar

-15

Ap

r-1

5

May

-15

Jun

-15

Jul-

15

Au

g-1

5

Sep

-15

Oct

-15

No

v-1

5

Dec

-15

Jan

-16

Feb

-16

Mar

-16

Ap

r-1

6

May

-16

Jun

-16

Jul-

16

Au

g-1

6

Sep

-16

NU

MB

ER O

F EV

ENTS

DATE

ABUSE/THREAT/INJURY TO STAFFJUNE 2014 - SEPTEMBER 2016

Median = 10



Infusion Pump Issues Issues related to the use of infusion pumps in the community is a focus area for Accreditation – Home Care Standards. Events involving infusion pumps are now captured in CELS. In Spring 2016, there was a change to using one type of Continuous Ambulatory Delivery Device (CADD) Pump, which is the CADD Solis Smart Pump. There has been ongoing work with our Supplies and Equipment vendor and with our Service Provider partners to address reported pump issues. Further meetings are being led by Clinical Care and Quality to ensure that an appropriate action plan is developed.

Jennifer Proulx Director, Quality and Program Evaluation

02468

1012141618202224262830

Jun

-14

Jul-

14

Au

g-1

4

Sep

-14

Oct

-14

No

v-1

4

Dec

-14

Jan

-15

Feb

-15

Mar

-15

Ap

r-1

5

May

-15

Jun

-15

Jul-

15

Au

g-1

5

Sep

-15

Oct

-15

No

v-1

5

Dec

-15

Jan

-16

Feb

-16

Mar

-16

Ap

r-1

6

May

-16

Jun

-16

Jul-

16

Au

g-1

6

Sep

-16

NU

MB

ER O

F EV

ENTS

DATE

COMPLIMENT ABOUT SPOJUNE 2014 - SEPTEMBER 2016

02468

10121416182022242628303234363840

Jun

-14

Jul-

14

Au

g-1

4

Sep

-14

Oct

-14

No

v-1

4

Dec

-14

Jan

-15

Feb

-15

Mar

-15

Ap

r-1

5

May

-15

Jun

-15

Jul-

15

Au

g-1

5

Sep

-15

Oct

-15

No

v-1

5

Dec

-15

Jan

-16

Feb

-16

Mar

-16

Ap

r-1

6

May

-16

Jun

-16

Jul-

16

Au

g-1

6

Sep

-16

NU

MB

ER O

F EV

ENTS

DATE

INFUSION PUMP ISSUESJUNE 2014 - SEPTEMBER 2016

Median= 9

Median = 11.5


Item 3.3.2 – Quarterly Complaints Report PAGE 1

Submission to the Champlain CCAC Board of Directors

Quarterly Complaints and Compliments Report:

July 2016- September 2016 (Q2)

December 14, 2016

COMPLAINT AND COMPLIMENT REPORTING

Complaint categories: There are six complaint categories captured in CELS 2.0. Compliments provided to both CCAC and SPO staff are also reported:

Amount of services: Complaint regarding the CCAC’s decision about the amount of any particular service included in the plan of service Hey

Eligibility for services: Complaint regarding the CCAC’s decision regarding eligibility for service

Exclusion of Services: Complaint regarding the CCAC’s decision to exclude a particular service from the plan of service

Quality of services: Complaint regarding the quality of service provided or arranged

Termination of services: Complaint regarding the decision to terminate service

Violation of rights: Complaint about violation of client rights: Client Bill of Rights (LTC Act) or the Human Rights Act.

Compliment categories: Compliments provided to both CCAC and SPO staff are reported as follows:

Compliments about CCAC: Expression of appreciation, praise, or commendation of a CCAC staff member.

Compliments about SPO: Expression of appreciation, praise, or commendation of a Service Provider staff member.

Compliment about Health Care Team: Champlain CCAC category; expression of appreciation, praise, or commendation of both CCAC and SPO staff.

Each of the complaint categories are continuously reviewed and broken down into subcategories to better capture the actual area of concern.



Complaints and Compliments Reported in CELS

Total Number

Reported (FY 2015-16)

Number Reported Q2 (FY 2016-17)

Number Reported YTD (FY 2016-17)

Average Days to Resolution (FY 2015/16)

Average Days to Resolution

Q2 (FY 2016-17)

Average Days to Resolution

YTD (FY 2016-17)

Complaints 725 123 226 30 61 52

Compliments 166 33 89 N/A N/A N/A

Total Number Of Complaints Reported In CELS (By Month):

0

10

20

30

40

50

60

70

80

90

100

110

120

Sep

-14

Oct

-14

No

v-1

4

Dec

-14

Jan

-15

Feb

-15

Mar

-15

Ap

r-1

5

May

-15

Jun

-15

Jul-

15

Au

g-1

5

Sep

-15

Oct

-15

No

v-1

5

Dec

-15

Jan

-16

Feb

-16

Mar

-16

Ap

r-1

6

May

-16

Jun

-16

Jul-

16

Au

g-1

6

Sep

-16

NUMBER OF COMPLAINTS BY MONTH SEPTEMBER 2014-SEPTEMBER 2016

Median= 57



Total Number of Complaints and Compliments Reported in CELS (By Theme)

Note: There are no reports under Violation of Rights.

0

2

4

6

8

10

Sep

-14

Oct

-14

No

v-1

4

Dec

-14

Jan

-15

Feb

-15

Mar

-15

Ap

r-1

5

May

-15

Jun

-15

Jul-

15

Au

g-1

5

Sep

-15

Oct

-15

No

v-1

5

Dec

-15

Jan

-16

Feb

-16

Mar

-16

Ap

r-1

6

May

-16

Jun

-16

Jul-

16

Au

g-1

6

Sep

-16N

UM

BER

OF

CO

MO

PLA

INTS

DATE

AMOUNT OF SERVICESEPTEMBER 2014-SEPTEMBER 2016

0123456789

101112

Sep

-14

Oct

-14

No

v-1

4

Dec

-14

Jan

-15

Feb

-15

Mar

-15

Ap

r-1

5

May

-15

Jun

-15

Jul-

15

Au

g-1

5

Sep

-15

Oct

-15

No

v-1

5

Dec

-15

Jan

-16

Feb

-16

Mar

-16

Ap

r-1

6

May

-16

Jun

-16

Jul-

16

Au

g-1

6

Sep

-16

NU

MB

ER O

F C

OM

PLA

INTS

DATE

ELIGIBILITY FOR SERVICESSEPTEMBER 2014 - SEPTEMBER 2016

Median=1

Median = 2



0123456789

10

Sep

-14

Oct

-14

No

v-1

4

Dec

-14

Jan

-15

Feb

-15

Mar

-15

Ap

r-1

5

May

-15

Jun

-15

Jul-

15

Au

g-1

5

Sep

-15

Oct

-15

No

v-1

5

Dec

-15

Jan

-16

Feb

-16

Mar

-16

Ap

r-1

6

May

-16

Jun

-16

Jul-

16

Au

g-1

6

Sep

-16N

UM

BER

OF

CO

MP

LAIN

TS

DATE

EXCLUSION OF SERVICESSEPTEMBER 2014 - SEPTEMBER 2016

0

10

20

30

40

50

60

70

80

90

100

Sep

-14

Oct

-14

No

v-1

4

Dec

-14

Jan

-15

Feb

-15

Mar

-15

Ap

r-1

5

May

-15

Jun

-15

Jul-

15

Au

g-1

5

Sep

-15

Oct

-15

No

v-1

5

Dec

-15

Jan

-16

Feb

-16

Mar

-16

Ap

r-1

6

May

-16

Jun

-16

Jul-

16

Au

g-1

6

Sep

-16

NU

MB

ER O

F C

OM

PLA

INTS

DATE

QUALITY OF SERVICES BY SERVICE PROVIDERSEPTEMBER 2014 - SEPTEMBER 2016

Median=0

Median = 41



0

5

10

15

20

25

30

Sep

-14

Oct

-14

No

v-1

4

Dec

-14

Jan

-15

Feb

-15

Mar

-15

Ap

r-1

5

May

-15

Jun

-15

Jul-

15

Au

g-1

5

Sep

-15

Oct

-15

No

v-1

5

Dec

-15

Jan

-16

Feb

-16

Mar

-16

Ap

r-1

6

May

-16

Jun

-16

Jul-

16

Au

g-1

6

Sep

-16

NU

MB

ER O

F C

OM

PLA

INTS

DATE

QUALITY OF SERVICES BY CCACJUNE 2014 - JUNE 2016

0

1

2

3

4

5

6

7

8

9

10

Sep

-14

Oct

-14

No

v-1

4

Dec

-14

Jan

-15

Feb

-15

Mar

-15

Ap

r-1

5

May

-15

Jun

-15

Jul-

15

Au

g-1

5

Sep

-15

Oct

-15

No

v-1

5

Dec

-15

Jan

-16

Feb

-16

Mar

-16

Ap

r-1

6

May

-16

Jun

-16

Jul-

16

Au

g-1

6

Sep

-16

NU

MB

ER O

F C

OM

PLA

INTS

DATE

TERMINATION OF SERVICESSEPTEMBER 2014 - SEPTEMBER 2016

Median=4

Median = 0



Days to Resolution for Complaints Reported in CELS

In September, there were 11 complaints closed in CELS that were overdue and this has influenced the average days to resolution for the month. The delays did not impact the action(s) taken to address the complaints but rather reflect the technicality of the delay by the responsible individual(s) ‘closing’ the complaints in the CELS system. Jennifer Proulx Director, Quality and Program Evaluation

0102030405060708090

100110120

Sep

-14

Oct

-14

No

v-1

4

Dec

-14

Jan

-15

Feb

-15

Mar

-15

Ap

r-1

5

May

-15

Jun

-15

Jul-

15

Au

g-1

5

Sep

-15

Oct

-15

No

v-1

5

Dec

-15

Jan

-16

Feb

-16

Mar

-16

Ap

r-1

6

May

-16

Jun

-16

Jul-

16

Au

g-1

6

Sep

-16

AV

ERA

GE

NU

MB

ER O

F D

AY

S

DATE

COMPLAINTS: AVERAGE DAYS TO RESOLUTION SEPTEMBER 2014 - SEPTEMBER 2016

Median 26 2462426


Item 3.4 – Bi-Annual Patient and Caregiver Council Update PAGE 1

Submission to Champlain CCAC Board of Directors

Bi-Annual Patient and Caregiver Council Update

December 14, 2016

June 2016 to December 2016

Key Deliverables

The Patient and Caregiver Council is part of the Committee Governance Structure of the Champlain CCAC. In accordance with the Terms of Reference, Council is obliged to report bi-annually to the Champlain CCAC Board of Directors (to the Board in June and to the CSQS Committee in December). As there is no CSQS Committee meeting in December, this report is being provided to the Committee as a Whole. It should be noted that this report provides an overview of activities since the presentation to the Board of Directors on June 22, 2016. Patient and caregiver engagement is an ongoing focus for the Champlain CCAC, and considerable progress has been made to date as outlined in this report. Patient and Caregiver Council

With the expansion of the Patient and Family Advisor Program, the Patient and Caregiver Council is now the body that oversees all patient engagement activities. The Terms of Reference have been amended to reflect this change. (Appendix A - TORS). Patient Advisor Recruitment

As an organization, we recognize the importance of engaging with diverse communities across Champlain. Recruitment efforts for both Patient Advisors and Patient and Caregiver Council members continue to focus on multi-cultural/multi-linguistic communities. Earlier this fall, Lise Racicot, Patient Engagement Coordinator and Jennifer Schenkel, Director, Communications, met with Wen Jean Ho and Sybil C. Braganza, from the Social Planning Council of Ottawa (SPCO) to discuss their new initiative Creating Community for Isolated Ethno-Cultural Seniors and partnership opportunities for the CCAC. This was a highly successful meeting and resulted in a commitment to the CCAC to provide presentations about CCAC programs and services to 18 ethno-cultural community groups connected to the SPCO initiative. Many multicultural communities are not aware of the Champlain CCAC or possible services available to them and their loved ones in the community. This engagement provides us with an important opportunity to increase the visibility of home and community care within these communities and potentially increase multicultural representation for the Patient and Family Advisor Program.



In October, with the assistance of Wen Jean Ho, who provided translation, a presentation was given to the Kanata Chinese Seniors Support Centre – Women’s Group. Many of those who attended the session are primary caregivers to their parents and are dealing with linguistic and cultural barriers. The goal of this presentation was to provide a brief overview of who we are, what we do and how to access CCAC services. A presentation to the Chinese Senior Group in Barrhaven is scheduled for the New Year and the Settlement Counselor at the Ottawa Chinese Community Service Centre will provide translation. (Appendix B - SPCO Initiative) New Patient Advisor

In November, Shailja Verma was interviewed as a potential Patient Advisor. Shailja is originally from India and was a caregiver to her mother. She was Manager of Continuing Education with the Ottawa Carleton School Board and has experience working with organizations serving immigrant populations including English as a Second Language. She is also well versed in cultural competency and provided training to the Ottawa and National Police Associations. With such a diverse perspective, Ms. Verma has been invited to join as a Patient Advisor and a member of the Patient and Caregiver Council. Patient Engagement

Listening, engaging and working with patients and caregivers is fundamental to the Champlain CCAC Patient and Family Advisory Program. We continue to add patient and caregiver representation to a variety of committees, projects and programs: Current Patient Advisor Activities (2016)

Onboarding of High Intensity Patients – Scott, Rachel, Carl (Fall/winter2016)

Setting of Service Expectations – Dee, Kelsey This initiative is now being led by Catherine Butler, Vice President, Clinical Care

Supplies and Equipment Delivery – Dee, Kelsey (on-going)

Patients on Hiring Committees – PA involvement TBC Betty Christie, Manager, People Services, HROD is currently developing an overview of the roll-out for this initiative (obligation, constraints, training)

Patient Rights and Commitments – Russ, Dee, Rachel, Carl (in the final stages)

Patient Escalation Process - Russ, Dee, Rachel, Carl, Scott (in progress)

PSW Educational Video – Russ, Rachel, Carl, Mattie, Janet (roll out December 2016)

Cancer Care Guidelines Review - U of Ottawa –Lead Claire Ludwig – Norma (October 2016)

Mental Health and Addiction – Kelsey (on-going)

Committees

Caregiver representation to the IMPACTT Centre Steering Committee – Janet

CCAC Donations Committee – Kelsey



Patient Representative to Client Services and Quality Committee of the Board – Russ

Patient Advisor Activities Highlights

PSW educational video

The Patient and Caregiver Council identified education of home care providers as an important work plan priority. An educational video featuring the firsthand perspectives of patients and caregivers was developed to educate personal support workers on creating a positive care experience. Carl and Rachel, and Russ participated in this initiative as well as, Patient Advisors Janet and Mattie. The video will be shared with the Service Provider Leadership Committee as a proposed training video for PSWs and will be shared with CCAC staff. A communication plan to promote this video will be developed and will include outreach to learning institutions such as Algonquin and St. Lawrence Colleges. Patient and Caregiver Charter of Rights and Responsibilities

In February 2016, a working group of Council members met to begin discussing the elements of a Patient and Caregiver Charter of Rights and Responsibilities. The working group comprising Patient Advisors members, CCAC staff and Service Providers, discussed the core elements and intent of the document – that it be the foundation for a partnership between patients/caregivers and their home care providers. It was determined that this new “charter” should align with the current Patient and Caregiver Declaration of Values (trust, dignity and respect). After much discussion and Patient Advisor input, a new Patient Rights and Commitments document was developed. This new Patient Rights and Commitments document was reviewed and approved by the Champlain CCAC Executive Committee as well as the Partnership Leadership Table, which includes leadership from all of the Service Provider Organizations. A new document was developed: (Appendix C “The Patient Rights and Commitments”). The next phase of this project is to review the Champlain CCAC Complaint Escalation Process. Patient Advisors met with Samantha Soubliere, Patient Experience and Risk Specialist, Quality & Program Evaluation, to review the current process and provide input from the patient/caregiver perspective. Members of Clinical Care and Service Provider Organizations will also be asked to review the process and provide input. IMPACTT Centre – Janet, Patient Advisor

The IMPACTT Centre is an innovation hub that monitors and moves home care technology from ideas all the way through to real solutions in patient homes. It is a unique testing ground that allows staff to try out, refine and evaluate technological solutions in a realistic home setting. The Centre is engaged in a number of projects, which use home care technologies to enhance care and supports to patients, caregivers and home care providers. Janet Keefe is a member of the IMPACTT Centre steering committee. Janet’s role is to use



her experiences as a caregiver to assess potential usefulness, practicality and acceptability of various home health technologies, and to identify areas for potential development. In this capacity, Janet has provided a caregiver perspective related to the “Connected Wellness Project”, between NexJ; (the company creating the software) and the IMPACTT team as they worked on the design, development, refinement and measurement of this multifaceted support program. The Wandering Detection and Diversion project will soon enter its trail phase and Janet was involved in the initial discussions around the design for its practical application and purpose -- to give caregivers of people with dementia better quality sleep and detect potentially dangerous wandering behavior. Activities Highlights July to November 2016

Patient Advisors are engaged in a variety of initiatives, including: Champlain LHIN/CCAC Board Retreat, August 31st 2016

Russ, as Co-chair of the Patient and Caregiver Council was invited to attend to the Champlain LHIN and CCAC Board Retreat to represent and bring the table the patient/caregiver voice and perspective. University of Ottawa MHA Bear Pit Session 2: Leading Change: Effective Engagement of Patients and Families, October 11, 2016

Kelsey, Patient Engagement Advisor, presented and was part of a panel discussion. Other members of the panel included Jacquie Dale, consultant and a partner at One World Inc., Robin Sully, Co-Chair of the Ottawa- Gatineau Multiple Myeloma Support Group and Chair of the Multiple Myeloma Ontario Advocacy Committee and, Mireille Brosseau, Experience Based Co-Design (EBCD) Facilitator with CHEO. Leading approaches in the field were profiled including practice examples from the perspective of patients/caregivers and those that support engagement work. MHA students and potential MHA students attended the session. Local

4th Dundas County 50 Plus Wellness Day, October 13, 2016 Scott assisted with Champlain CCAC booth. 186 attendees and 28 organizations hosted booths at this event held in Dixon’s Corners in Dundas County.

Kanata Senior Centre presentation, September 21, 2016 Dee co-presented with Champlain CCAC Care Coordinator Melanie Neale. An overview of CCAC services and programs was provided and Dee shared information about the Patient and Family Advisor Program and how to get involved.

ReThink Dementia Conference, November 1, 2016 The Champlain CCAC hosted a booth at this event and Janet, Patient Advisor, attended the event.



Upcoming opportunities

On January 26th 2017, the Patient and Family Advisor Program will be presented to the Champlain CCAC Rounds, an opportunity to highlight the important role of the Patient Advisor to CCAC staff and community partners. Lise Racicot, Patient and Stakeholder Engagement Coordinator will provide an overview of the program and Russ as Co-chair of Patient and Caregiver Council will highlight Council and Patient Advisor activities and the value of their perspective to CCAC process, programs and new initiatives.

Update – Family Caregiver Day Act, 2016 / Loi de 2016 sur les aidants naturel

Due to the government being prorogued in September, the original Family Caregiver Day Bill died. On November 15th, Ontario NDP Health critic France Gélinas, with the support of the Ontario Caregiver Coalition (OCC), re-introduced a bill in the Ontario Legislature. This bill is to increase recognition and awareness of family caregivers by proclaiming the first Tuesday of every April as Family Caregiver Day. Update Bill 41, Patients First Act, 2016

Due to the legislature being prorogued, Bill 210 Patients First legislation tabled on June 2nd, will be reintroduced in the legislature in early October. The proposed legislation will be introduced as Bill 41, Patients First Act, 2016. Chantale LeClerc, Champlain LHIN CEO is leading the Patient Engagement stream to which Patrice is a member. This committee will be looking at best practices across the province and are currently compiling resources such as TORs. The proposed Patients First act states that each local health integration network shall establish one or more patient and family advisory committees. It is not yet known what the Champlain LHIN Patient and Family Advisory committee would look like i.e. governance, membership etc. Patient and Caregiver Council members agreed that it would be an opportune time to invite Chantale LeClerc to come speak to members. The invitation was extended and Chantale agreed to attend the December 8th Council meeting. EXECUTIVE SPONSOR:

Patrice Connolly, Vice-President, People and Stakeholder Engagement

http://www.ontla.on.ca/web/house-proceedings/house_detail.do?Date=2016-11-15&Parl=41&Sess=2&locale=en#P1053_193314

http://www.ontla.on.ca/web/bills/bills_detail.do;jsessionid=2b9a8ec8d143f19ff8072db51da540bbbfbaaaf6c242220fd64ca2f1442b6b14.e34QbNyOaxmRci0TbxiOah4Lb3f0n6jAmljGr5XDqQLvpAe?locale=en&BillID=4215&isCurrent=false&ParlSessionID=

http://www.ontla.on.ca/web/bills/bills_detail.do;jsessionid=2b9a8ec8d143f19ff8072db51da540bbbfbaaaf6c242220fd64ca2f1442b6b14.e34QbNyOaxmRci0TbxiOah4Lb3f0n6jAmljGr5XDqQLvpAe?locale=en&BillID=4215&isCurrent=false&ParlSessionID=

CHAMPLAIN CCAC PATIENT AND CAREGIVER COUNCIL Leadership Sponsor: Patrice Connolly Vice-President People and Stakeholder Engagement

Terms of Reference

1. Purpose

The Champlain Community Care Access Centre (CCAC) recognizes patients,

caregivers and families as essential partners in care. The Patient and Caregiver

Council is a forum to improve the home and community care experience in the

Champlain region for former, current and future patients and caregivers.

The purpose of the Council is to provide direction – oversight on patient and

family centred care strategies and initiatives related to improvements in the

patient experience.

The objectives of this Council are:

• To provide input regarding their personal experiences to inform CCAC

planning, implementation and evaluation of services

• To reflect the needs of patients and caregivers in order to improve the quality

of care and services

• To provide input on matters concerning the health and well-being of patients

and their caregivers

• To identify gaps in information, services and education for patients and

caregivers

• To provide an opportunity to identify and monitor emerging issues concerning

patients and their caregivers

2. Framework

The Patient and Caregiver Council is part of the Committee Governance Structure of the Champlain CCAC.

The Patient and Caregiver Council will primarily use the following Framework to guide their planning and work:

• The Patient and Family Centred Care Framework, based on the work by KL Carman et al. in the ‘Patient and Family Engagement: A Framework for

Champlain CCAC Patient and Caregiver Council – TORS APPROVED October 4, 20162016

Understanding the Elements and Developing Interventions and Policies’, Health Affairs 32, no.2 (2013)

• The Champlain CCAC Engagement Framework (2015) • The PFC will use their work plan priorities to feed into the Champlain CCAC

Engagement Framework.

3. Responsibilities

The responsibilities of the Champlain CCAC Patient and Caregiver Council are:

• To declare conflict of interest at meetings where indicated

• To give input from the perspective of the patient and family to the CCAC on

its directions, initiatives and services

• To go beyond their experiences to improve care for others

• To be willing to share their story or contribute to public awareness

• To provide input to improve services for patients and their families

• Represent on other local, provincial or internal CCAC committees as required

The responsibilities of the Champlain CCAC are:

• To include the patient and caregiver voice in board meetings

• To support the efforts of the Council and its members

• To maintain transparent and open communications

• To ensure responsiveness and awareness of caregiver needs, where possible

thru unique programs for caregivers

• To have regular dialogues between the organization’s leaders and clients and

families to solicit and incorporate client and family perspectives into

opportunities for improvement

4. Members

• The Council will be between 6 and 8 members who represent a cross-section of patients and caregivers from the territory served by the Champlain CCAC.

• Members will be current, former and future home care patients and caregivers.

Membership is at the invitation of the CCAC and selected by an internal working group composed of staff and council members.


Members will represent operational departments including, but not limited to:

• VP People and Stakeholder Engagement

• VP of Clinical Care or designate/ Senior Director, Clinical Care

• Director, Quality

• Care Coordinator Representation

• Patient and Stakeholder Engagement Coordinator

• Other staff on invitation

• Invited guests on an ad-hoc basis

Trial Period There will be an initial trial period of 6-month for all new members to ensure

“fit”.

The purpose of the trial period is to provide orientation, guidance, and coaching to a new council member. This period is also the final phase of the selection process that will provide co-chairs and the new member an opportunity to mutually evaluate their position on council to ensure a suitable and acceptable fit and purpose. Orientation

All new members will receive an orientation providing an overview of the Champlain CCAC including governing provincial legislation, providing a better understanding of the who, what, when, where, and why of the organization, and how they as a new member of council fit within the larger picture. New members will be assigned a mentor. Membership Term

• The term is a two-year membership with the possibility of a one-term renewal (max. 4 consecutive years)

• Members may withdraw from membership at any time and by any means (i.e. written or verbal)

• In the management of term renewals, consideration will be made to maintain a balance of new and experienced members

• Terms of Reference and Membership to be reviewed annually • In recognition that patients may experience difficult periods due to their

condition or circumstances, a member may request a leave of absence or alternately Council may suggest a leave of absence.


Leadership

The VP of People and Stakeholder Engagement will be the Executive sponsor.

There will be two (2) Co- Chairs of the Patient and Caregiver Council. Co-chairs

shouldn’t change at the same time. Co-chairs should come from current council

members.

5. Meetings The Patient and Caregiver Council will meet a minimum of four times per year. A draft agenda for each meeting shall be sent one week prior to the meeting. The Council Co-Chairs will ensure that the following documents are circulated at least three (3) days in advance of each meeting: • The Agenda for the meeting; • The Minutes of the previous meeting; • Any other documentation related to the business to be conducted by the

Council. The Council shall record and make available Meeting Highlights for all meetings. The Minutes shall be recorded by the Patient and Stakeholder Engagement Coordinator.

6. Infrastructure Supports For members who wish to participate in face-to-face meetings, mileage will be reimbursed at the standard CCAC rate. Respite care will be covered on advance request by the family or caregiver. For members who wish to participate from home, teleconference services will be arranged. Videoconferencing from a CCAC branch office can also be arranged.

Staff Support

The Council will be supported by the Patient and Stakeholder Engagement Coordinator. This person will provide administrative support to the Council. The meetings shall be recorded by the Coordinator for all meetings and a log of all meetings minutes including past agendas will be kept. The Patient and Stakeholder Engagement Coordinator will be the primary point of contact with the membership.


7. Accountabilities All members are obligated to sign a non-disclosure, confidentiality and conflict of interest agreements. All meetings will be recorded and Meeting Highlights will be translated and posted on the Champlain CCAC website. The Patient and Caregiver Council will develop an annual a work plan. The Patient and Caregiver Council is accountable to the Champlain CCAC Executive Committee. The Executive Sponsor is the VP, People and Stakeholder Engagement. The Council will report annually to the Champlain CCAC Board of Directors (June) and annually to the CQSC of the Board (December). Expectations of Members Members of the Champlain CCAC Patient and Caregiver Council are expected to: • Suggest agenda items and priority areas of work for the Council. • Regularly attend and be an active participant in Council meetings. • Prepare for meetings by reviewing minutes and reports. • Be prepared to draw on their personal experiences. At the same time, reflect

on the broad needs of patients, caregivers and families. • Represent the voice of patients and caregivers on other CCAC initiatives, as

requested. • Assist with recruitment of new members. • Respect the privacy and confidentiality of other members and their personal

experiences. • Represent the organization at public or specific engagements. Date Reviewed: Date Updated: December 8 2015

Date Updated: October 4 2016

Next Review Date: Fall 2017


12/1/2016

1

SPCO Four Priorities

• Community Economic Development

• Access to Basics

• Creating Inclusion

• Research and Voluntary Sector Supports

Creating Community for Isolated Ethno‐Cultural Seniors

Funded by Employment and Social Development Canada (ESDC)

New Horizons for Seniors Program

12/1/2016

2

Ottawa Impact Plan • The Council on Aging of Ottawa

– Ottawa West Community Support – Healthy Connections; Healthy Communities

– Nepean, Rideau and Osgoode Community Resource Centre (NROCRC) – Elder Abuse Response and Referral Service

– South East Ottawa Community Health Centre –Strengthening Senior Neighbourhood Networks

– Catholic Centre for Immigration – Senior Centered ESL Program.

– Western Ottawa Community Resource Centre –Reducing Rural Isolation

Overall Project Objectives

• To reduce the social isolation of ethno‐cultural seniors by supporting ethno‐cultural community groups in providing services and supports to isolated seniors.

12/1/2016

3

Social Isolation

• Social isolation can be defined as the absence of relationships with family or friends on an individual level, and with society on a broader level.

Ref: Mental Health Foundation

The Lonely Society? Mental Health Foundation, 2010, p 14.

Challenges Faced by Ethno‐Cultural Seniors

• Socio‐economic disadvantage; • Loss of traditional roles;• English language barriers; • lack of exposure to Canadian services and systems; and

• Low knowledge of and ability to access services.Additionally, those who migrated to Canada at an older age, or who are from refugee background, face a higher risk of mental and physical health issues.

12/1/2016

4

Project Objectives

• Identify isolated seniors.

• Inform isolated seniors of available services and provide support in navigating and accessing them.

• Connect with and engage isolated seniors in knowledge building activities.

• Develop opportunities for isolated seniors to socialize and engage them in recreational activities.

Project Objectives

• Empower isolated seniors to contribute their knowledge and skills.

• Expand awareness of dementia and dementia supports among seniors and volunteers.

• Train seniors and volunteers to recognize elder abuse and identify appropriate supports.

• Increase the capacity of ethno‐cultural groups to serve their communities.

12/1/2016

5

Your Role

• Provide bi‐weekly recreation activities for seniors.

• Provide peer phone supports and friendly visiting for senior who are unable to attend activities.

• Provide information workshops on available services for seniors.

Your Role

• Encourage group volunteering.

• Share your own lessons learned and tools you have used.

12/1/2016

6

Workshops and Training

• Elder Abuse

• Alzheimer and Dementia Supports

• Neighbours Helping Neighbhours

Evaluation and Measurement Tools

• Qualitative and Quantitative Data

– Activity/Participation Record

– Pre and Post‐Participation Survey

– Social Network Mapping

– Participant Satisfaction Survey

– Learning Event Evaluation

12/1/2016

7

Questions

Quality Care Together Champlain CCAC Patient Rights and Commitments

● Be treated with courtesy and respect, including freedom from unwanted physical and verbal conduct, threats, attempts or acts of violence.

● Be treated in a manner that respects your dignity and privacy, and promotes your independence.

● Be free from discrimination, recognizing your cultural, gender, spiritual, linguistic, ethnic, sexual orientation and regional differences.

● Have care providers who are knowledgeable, trained and informed to provide the care you require.

● Participate with all partners in developing your care plan and to have continued involvement in your care. This care will be provided within the parameters of best practices, legislation and CCAC policies and procedures.

● Give or withhold appropriate consent to the provision of service, having been informed of risks and benefits of these services. CCAC and service providers will ensure you have the information required to make decisions.

● Have your health information kept confidential in accordance with the law.

● Tell us who you want to be involved in your care, and with whom you would allow us to share information.

● Raise concerns or recommend changes in connection with the services provided without fear of interference, coercion, discrimination or reprisal.

● Be treated fairly based on your individual requirements.

● Be informed about the procedure for initiating complaints, concerns and compliments about the service provider and CCAC, and to have incidents reviewed promptly.

● Treat us with courtesy and

respect, including freedom

from unwanted physical and

verbal conduct, threats,

attempts, or acts of violence by

you or someone in your home.

● Treat us in a manner that

respects our dignity and

privacy, and is free from

discrimination, recognizing

cultural, gender, spiritual,

linguistic, ethnic, sexual

orientation and regional

differences.

● Provide a safe work

environment, respecting

guidelines and legislation,

including those related to pets,

smoking, alcohol, drugs, and

safe entry into your home.

● Engage in the development and

ongoing management of your

care plan and to report any

changes that may impact your

care needs.

● Use health care resources

responsibly, including making

yourself available for visits and

assessments, notifying us as

soon as possible when you

need to cancel or reschedule

visits, when you will be

unavailable, and when you no

longer require care.

A patient receiving Champlain CCAC services

commits to:

A patient receiving Champlain CCAC services has the right to:

We are here to help. If you have any questions or concerns about your care or the services that youare receiving, please call your Care Coordinator.

Last updated: October 2016

Legislative Assembly of

Ontario

Assemblée législative de l'Ontario

STANDING COMMITTEE ON PUBLIC ACCOUNTS

CCACs—COMMUNITY CARE ACCESS CENTRES—HOME CARE PROGRAM

(Section 3.01, 2015 Annual Report of the Office of the Auditor General of Ontario)

2nd

Session, 41st Parliament

65 Elizabeth II

ISBN 978-1-4606-8864-9 (Print) ISBN 978-1-4606-8866-3 [English] (PDF) ISBN 978-1-4606-8868-7 [French] (PDF) ISBN 978-1-4606-8865-6 [English] (HTML) ISBN 978-1-4606-8867-0 [French] (HTML)

Legislative Assembly of

Ontario

Assemblée législative de l'Ontario

The Honourable Dave Levac, MPP Speaker of the Legislative Assembly

Sir,

Your Standing Committee on Public Accounts has the honour to present its Report and commends it to the House.

Ernie Hardeman, MPP Chair of the Committee

Queen’s Park December 2016

STANDING COMMITTEE ON PUBLIC ACCOUNTS COMITÉ PERMANENT DES COMPTES PUBLICS

Toronto, Ontario M7A 1A2

STANDING COMMITTEE ON PUBLIC ACCOUNTS

MEMBERSHIP LIST

2nd Session, 41st Parliament

ERNIE HARDEMAN Chair

LISA MACLEOD Vice-Chair

JOHN FRASER PERCY HATFIELD

*MONTE KWINTER HARINDER MALHI

PETER MILCZYN JULIA MUNRO

*ARTHUR POTTS

*CHRIS BALLARD and LOU RINALDI were replaced by MONTE KWINTER and ARTHUR POTTS on September 13, 2016.

FRANCE GÉLINAS regularly served as a substitute member of the Committee.

VALERIE QUIOC LIM Clerk of the Committee

ERICA SIMMONS Research Officer

i

CONTENTS

PREAMBLE 1

ACKNOWLEDGEMENTS 1

BACKGROUND 1

Legislation 1

Service Delivery Model 2

Accountability Relationship 2

Spending on Home Care 2

2015 AUDIT OBJECTIVE AND SCOPE 2

Related Audits 3

MAIN POINTS OF 2015 AUDIT 3

ISSUES RAISED IN THE AUDIT AND BEFORE THE COMMITTEE 4

Service Levels and Hours of Care 5

Community Support Services 6

Client Assessments 7

Discharge and Follow-Up 7

Oversight of Service Providers 8

Support for Caregivers 9

CONSOLIDATED LIST OF COMMITTEE RECOMMENDATIONS 10

1

PREAMBLE

On May 11, 2016 the Standing Committee on Public Accounts held public hearings on the audit (Section 3.01 of the Auditor General’s 2015 Annual Report) of the Community Care Access Centres (CCACs) – Home Care Program administered by the Ministry of Health and Long-Term Care.

The Committee endorses the Auditor’s findings and recommendations, and presents its own findings, views, and recommendations in this report. The Committee requests that the Ministry provide the Clerk of the Committee with written responses to the recommendations within 120 calendar days of the tabling of this report with the Speaker of the Legislative Assembly, unless otherwise specified.

ACKNOWLEDGEMENTS

The Committee extends its appreciation to officials from the Ministry of Health and Long-Term Care, the Ontario Association of Community Care Access Centres, and from the Central Community Care Access Centre, the Champlain Community Care Access Centre, and the North East Community Care Access Centre.

BACKGROUND

Ontario’s 14 Community Care Access Centres (CCACs) are responsible for helping people to access home- and community-based health care and related social services in order to live independently. The Ministry of Health and Long-Term Care (the Ministry) funds the CCACs through the Local Health Integration Networks (LHINs). CCAC services are free to Ontarians who are insured under the Ontario Health Insurance Plan (OHIP). Since 2009 the CCACs have served increasing numbers of clients with more complex medical and social-support needs. In the year ending March 31, 2015 approximately 60% of home care clients were senior adults (age 65 years and over), 20% were adults (age 18-64 years), 15% were children, and 5% were palliative care clients.

Legislation

A Regulation under the Home Care and Community Services Act, 1994 (Act) specifies the maximum amount of personal support services that may be provided to a client. At the time of the audit, the Regulation allowed a maximum of 120 hours in the first 30 days of service and 90 hours in any subsequent 30-day period. These limits could be exceeded indefinitely in “extraordinary circumstances” for palliative clients and those waiting for placement in a long-term care home, or for up to 90 days in any 12-month period for other clients.1

The Regulation is silent on the minimum amount of services that can be provided.

1 Effective October 1, 2015, a regulatory amendment (O. Reg. 304/15) under the Act

increases the maximum amount of nursing services that the CCACs may provide to their clients. (The amendment does not increase the maximum amount of personal support and homemaking services that the CCACs may provide.)

2

Service Delivery Model

Through their staff of care coordinators, the CCACs assess individuals to determine if their health needs qualify for home-care services, and develop care plans for those who qualify. The CCACs then contract with any of about 160 private-sector service providers to provide home-care services directly to clients. CCAC care coordinators manage client cases, and reassess and adjust care plans on an ongoing basis. The service providers are either for-profit or not-for-profit. Some community support services and homemaking services may require co-payment from clients. A 2014 regulatory amendment and associated Ministry guidelines allow community support service agencies (support agencies) to provide personal support services for lower-needs clients.

Accountability Relationship

Each of Ontario’s 14 CCACs is accountable to one of the Province’s 14 LHINs, which are mandated to fund health service providers, including hospitals, CCACs, and support agencies, in defined geographic areas. The LHINs are accountable to the Ministry, which sets the overall strategic direction for health care in the province. The CCACs are represented by the Ontario Association of Community Care Access Centres (the Association). The Association provides shared services for the CCACs such as procurement, policy and research, and data and information management.

Spending on Home Care

Ontario spent a total of $2.5 billion to provide home-care services to 713,500 clients in the year ending March 31, 2015. This was a 42% increase in funding and a 22% increase in clients served compared to the year ending March 31, 2009. Over the past decade, overall funding for CCAC home care and other services has increased by 73% from $1.4 billion to $2.5 billion, while remaining at a relatively constant 4% to 5% of overall provincial health spending. The 2015 Budget included funding increases for CCAC home care of 5% per year over three years, for a total of $750 million. According to funding agreements with their respective LHINs, the CCACs must not spend more than they receive each year.

2015 AUDIT OBJECTIVE AND SCOPE

The audit assessed whether the CCACs, in partnership with the Ministry and the LHINs, have processes in place to provide care coordination to home-care clients in a seamless and equitable manner, monitor service providers in accordance with contractual and other requirements, and measure and report on the quality and effectiveness of home-care services provided.

Audit staff visited three CCACs: the Central CCAC (head office in north Toronto), the North East CCAC (head office in Sudbury), and the Champlain CCAC (head office in Ottawa). The Ministry, through the LHINs, provided these CCACs with a total of $644 million in funding in the year ending March 31, 2015, representing 26% of funding provided to all 14 CCACs, for about 25% of the total CCAC clients in Ontario. The audit focused on services provided to senior adults (age 65 and older) and adults (aged 18 to 64), rather than to children.

3

Related Audits

A previous audit of home care was conducted by the Auditor General in 2010.

In September 2015 the Auditor released a Special Report on CCAC financial operations and service delivery.

MAIN POINTS OF 2015 AUDIT

The 2015 audit noted that some of the issues raised in the earlier 2010 audit had still not been fully addressed, including that

clients continue to be put on wait-lists and face long wait times to obtain personal support services; and

clients with similar assessed needs continue to receive different levels of services depending on where they live in Ontario.

The Auditor explained that home-care funding to each CCAC is

predominantly based on what each received in prior years rather than on actual client needs and priorities. As a result, to stay within budget, each CCAC exercises its own discretion on the types and levels of services it provides—thereby contributing to significant differences in admission criteria and service levels between CCACs. . . . [B]ecause there are no provincial standards in many critical areas, such as the level of personal support services warranted for different levels of client needs, some clients may receive more services than others.2

Specific observations from the 2015 audit included the following:

Whether a person receives personal support services, and the amount of service provided, if any, depends on where the person lives (that is, which CCAC serves their geographic area).

Supports to caregivers such as family members of home-care clients are limited and not consistently available across the province.

The CCACs’ oversight of contracted service providers needs improvement.

Care coordinators’ caseload sizes vary significantly, and some exceed the suggested ranges in the Association’s guidelines, so there is little assurance on whether care coordination services were consistently provided to all clients.

2 Office of the Auditor General, “CCACs—Community Care Access Centres—Home Care

Program,” 2015 Annual Report, p. 77.

4

Not all care coordinators maintained their proficiency in, and some were not regularly tested on, the use of assessment tools.

CCAC care coordinators may experience difficulties in effectively referring clients to obtain community support services because assessment information and wait-lists are not centralized.

Clients may not receive appropriate levels of services as CCAC care coordinators did not assess or reassess clients on a timely basis.

CCACs are not able to provide personal support services to the maximum levels allowed by law (90 hours per month).

Each CCAC’s performance is measured against different targets for performing client services.

ISSUES RAISED IN THE AUDIT AND BEFORE THE COMMITTEE

Significant issues were raised in the audit and before the Committee. The Committee considers the issues below to be of particular importance.

The Ministry has received advice from the expert group on home and community care whose March 2015 report, Bringing Care Home, highlighted ongoing service challenges including lack of consistency, lack of support for caregivers, and difficult transitions from hospital to home. This was followed by the release in May 2015 of Patients First: A Roadmap to Strengthen Home and Community Care (Roadmap), which laid out steps to be taken to implement the recommendations made in the expert group’s report.3 The Ministry also convened a Patient and Caregiver Advisory Table on Home and Community Care to provide feedback and advice on the implementation of the Roadmap.

The Ministry has also been working to address the Auditor’s recommendations in key areas including

the need to expand supports for caregivers in Ontario;

the need for standardized guidelines for prioritizing clients to improve consistency of service;

the need to better utilize health resources by diverting low-needs clients from the CCACs to community support service agencies; and

the need to review home-care indicators to improve performance.

3 On June 2, 2016, the government introduced Bill 210, the Patients First Act, 2016. The

Bill died when the Legislature was prorogued on September 8, 2016, and was reintroduced on October 6, 2016 as Bill 41. If passed, the Act would (among other things) transfer service delivery and management of home care from the CCACs to the LHINs. CCAC employees, including care coordinators (responsible for assessing a client’s requirements, including determining eligibility and developing a care plan) would also be transferred, and the CCACs would be eliminated.

5

Specifically, the Ministry has

conducted an inventory of caregiver training and education programs across other jurisdictions to explore approaches that can be adapted in Ontario;

initiated the development of a levels-of-care framework that will support clients with similar needs to receive similar levels of service regardless of where they live; and will be based on best practices consistent across the province; and

initiated work with Health Quality Ontario to review home care indicators and begin development of quality standards for home care.

The Committee heard that Ontario’s 14 CCACs care for some 720,000 clients each year, more than double the numbers served just over a decade ago, and these clients also have more complex health needs. CCAC staff indicated that funding provided by the Ministry has not kept up with this exponential growth. The Ministry believes that improved efficiency of management and delivery will increase the funding available for client care and would improve access to needed services. The development of clinical standards, decision-making supports, and enhanced monitoring will improve the quality of care and strengthen public confidence in the system.

A representative of the Champlain CCAC noted that the CCACs support changes that will enable the delivery of higher-quality, more consistent, equitable, and better integrated home and community care across the province. The Champlain CCAC’s adult complex care clients have increased by 33% in the last two years.

The North East CCAC serves a population of 554,000 people in a mix of urban, rural, and very remote communities scattered across 415,000 square kilometres. This CCAC provides individualized nursing, personal support, and rehabilitation services to more than 15,000 clients in their homes and home communities.

The Central CCAC reported the highest absolute number of seniors and the second-highest growth rate of aging seniors of all the CCACs. This CCAC responded to approximately 300,000 calls (900 calls daily) from clients and families and delivered care to more than 82,000 clients in the community. The CCAC’s care coordinators completed over 70,000 face-to-face visits with clients and their families and helped over 39,000 clients transition home from hospital. Over 95% of this CCAC’s clients receive nursing services within five days of being assessed. In response to the Auditor’s recommendation on auditing service provider organizations, the Central CCAC has conducted 21 scheduled and random audits.

Service Levels and Hours of Care

The Auditor noted that the CCACs are not able to provide personal support services to the maximum levels allowed by law. The CCACs visited during the audit generally provided no more than 60 hours of support services even though the regulation allowed for up to 90 hours (and up to 120 hours in exceptional cases such as palliative care).

6

The Committee asked about the number of hours per month of personal support services that are provided to clients. A representative of the Association explained that the CCACs’ goal is not to target the maximum number of hours but rather to provide the right level of care for individual clients.

Ministry representatives acknowledged that there are historically-rooted funding inequities across the province that they are working to correct. The aim is to ensure that health funding is aligned with growing populations and the increasing complexity of health needs. Using information from Public Health Ontario, the Ministry is bringing more attention to population health planning. The Ministry is also actively considering the possibility of revising the LHIN boundaries to be better aligned with municipal and board of health boundaries.

The Committee expressed concern about discrepancies in wait times between the CCACs and asked how the Ministry is responding to the Auditor’s recommendations regarding consistency of care. Ministry staff explained that work is being done on a levels-of-care framework that would define priority levels and acuity levels in the sector, and help to standardize service levels across the province. The standardization of care coordinators’ caseloads is a government priority.

Committee Recommendation

The Standing Committee on Public Accounts recommends that:

1. The Ministry of Health and Long-Term Care

a) address funding inequities between Community Care Access Centres;

b) establish a minimum level of care, based on assessed need, that clients can expect to receive;

c) develop standard guidelines for prioritizing clients for services, and monitor compliance with those guidelines; and

d) ensure that clients with the highest level of assessed need are provided hours of care closer to the regulated maximum.

Community Support Services

The Auditor noted the importance of better utilizing health resources by diverting low-needs clients from the CCACs to community support services agencies. However, the audit found that CCAC care coordinators may experience difficulties in effectively referring clients to obtain community support services because assessment information and wait-lists are not centralized, and many community support service agencies have long wait-lists.

7

Committee Recommendations


2. The Local Health Integration Networks

a) develop centralized wait-list information for all community-based support services in order to provide current information on the availability of such services to all health service providers and clients; and

b) ensure that all home care health-service providers and community support service agencies share assessment information on a common system.

3. The Ministry of Health and Long-Term Care, in conjunction with the Local Health Integration Networks, ensure that low-needs clients who require personal support services receive these services from community support service agencies, where appropriate, rather than through the Community Care Access Centres or, as the pending Patients First Act, 2016 would enact, through the community care function within the Local Health Integration Networks.

Client Assessments

The Auditor found that clients may not receive appropriate levels of services when CCAC care coordinators do not assess or reassess clients on a timely basis. In addition, the Auditor found that not all care coordinators maintained their proficiency in, and some were not regularly tested on, the use of assessment tools.



4. The Ministry of Health and Long-Term Care, in conjunction with the Local Health Integration Networks, ensure

a) that home-care clients are assessed and reassessed within the required time frames; and

b) that care coordinators maintain their proficiency in, and are regularly tested on, the use of assessment tools.

Discharge and Follow-Up

The Committee noted that the Auditor found significant variations in the extent to which CCACs followed up with clients discharged from home care. A CCAC representative said that work is underway to standardize this process. Ministry staff are also piloting a “bundled care” model. Under this model, clients will experience a more seamless transition from hospital care to home care as they

8

are looked after by substantially the same team of health care providers in both settings.



5. The Ministry of Health and Long-Term Care, in conjunction with the Local Health Integration Networks, ensure that all home-care clients are contacted for follow-up after discharge.

Oversight of Service Providers

The Committee asked about the Auditor’s finding that the CCACs were not monitoring whether service providers were complying with the required wage increases for PSWs. Ministry representatives explained that they have achieved good compliance overall and asked the LHINs not to allocate any new service volumes to employers unless they were fully compliant. The Committee noted the importance of strengthening oversight of service providers.



6. The Ministry of Health and Long-Term Care, in conjunction with the Local Health Integration Networks,

a) demonstrate that funding meant for Personal Support Worker wage increases was spent as intended;

b) develop performance indicators and targets for home-care services;

c) collect relevant data that measures client outcomes;

d) collect data on missed, rescheduled, and late visits from each contracted service provider;

e) conduct routine site visits to monitor the quality of care provided by service providers;

f) review and revise the client satisfaction survey methodology to ensure that client satisfaction survey results can be used to effectively monitor the performance of service providers; and

g) apply appropriate corrective actions to service providers that perform below expectations.

9

Support for Caregivers

All present agreed on the importance of ensuring that caregivers—the relatives, friends and other non-professionals who help clients at home—are given necessary assistance such as respite support. The Ministry is exploring ways to provide more support to caregivers.



7. The Ministry of Health and Long-Term Care ensure that caregivers receive a sufficient level of appropriate support.

10

CONSOLIDATED LIST OF COMMITTEE RECOMMENDATIONS


1. The Ministry of Health and Long-Term Care

a) address funding inequities between Community Care Access Centres;

b) establish a minimum level of care, based on assessed need, that clients can expect to receive;

c) develop standard guidelines for prioritizing clients for services, and monitor compliance with those guidelines; and

d) ensure that clients with the highest level of assessed need are provided hours of care closer to the regulated maximum.

2. The Local Health Integration Networks

a) develop centralized wait-list information for all community-based support services in order to provide current information on the availability of such services to all health service providers and clients; and

b) ensure that all home care health-service providers and community support service agencies share assessment information on a common system.

3. The Ministry of Health and Long-Term Care, in conjunction with the Local Health Integration Networks, ensure that low-needs clients who require personal support services receive these services from community support service agencies, where appropriate, rather than through the Community Care Access Centres or, as the pending Patients First Act, 2016 would enact, through the community care function within the Local Health Integration Networks.

4. The Ministry of Health and Long-Term Care, in conjunction with the Local Health Integration Networks, ensure

a) that home-care clients are assessed and reassessed within the required time frames; and

b) that care coordinators maintain their proficiency in, and are regularly tested on, the use of assessment tools.

5. The Ministry of Health and Long-Term Care, in conjunction with the Local Health Integration Networks, ensure that all home-care clients are contacted for follow-up after discharge.

11

6. The Ministry of Health and Long-Term Care, in conjunction with the Local Health Integration Networks,

a) demonstrate that funding meant for Personal Support Worker wage increases was spent as intended;

b) develop performance indicators and targets for home-care services;

c) collect relevant data that measures client outcomes;

d) collect data on missed, rescheduled, and late visits from each contracted service provider;

e) conduct routine site visits to monitor the quality of care provided by service providers;

f) review and revise the client satisfaction survey methodology to ensure that client satisfaction survey results can be used to effectively monitor the performance of service providers; and

g) apply appropriate corrective actions to service providers that perform below expectations.

7. The Ministry of Health and Long-Term Care ensure that caregivers receive a sufficient level of appropriate support.

CASC de Champlain CCACCASC de Champlain CCAC

FY 16-17 Quality Improvement Plan (QIP)

Q2 Update

Board of DirectorsDecember 14th, 2016

Jennifer Proulx – Director, Quality & Program Evaluation

CASC de Champlain CCACCASC de Champlain CCAC 2

Indicator PerformanceIndicator Target Q1 Q2 Q3 Q4 Baseline*

Falls ≤36.5% 39.3% 39.5% -- -- 39.3%

Unplanned ED Visits ≤6.8% 6.7%*Q3 15-16

6.8%*Q4 15-16

-- -- 7.0%

Hospital Readmissions ≤17.2% 19.0%*Q3 15-16

19.3%*Q4 15-16

-- -- 18.8%

5-Day Wait for Nursing ≥95.0% 93.7% 94.6% -- -- 93.6%

5-Day Wait for PSS ≥84.8% 83.5% 81.0% -- -- 73.8%

Overall Satisfaction ≥94.0% 92.0%(15-16 Q1-Q2)

92.0%( FY 15-16)

-- -- 92.8%

Palliative & End of Life patients who passed away in preferred place of death

Establishbaseline

74.8% 75.9% -- -- n/a

* HQO identifies specific timeframes for each indicator in order to establish baseline performance. These timeframes vary by QIP indicator.


Falls

% of adult long-stay home care patients who record a fall on their follow-up of the international research network's Resident Assessment Instrument (InterRAI) for home care

Initiative Status

Educate Rapid Response Nurses, Care Coordinators on impact of medications on falls risk

CCAC EducationRounds held Dec 8

Pilot electronic change in status tool with PSWs for timely intervention for complex patients

Incorporated into Automated

Provider Reporting

Initiate new intervention for Falls screening (Via IMPACTT Centre)Field test in

progress


ED Visits and Hospital Readmissions

% of home care patients with an unplanned, less-urgent ED visit within the first 30 days of discharge from hospital

Initiative Status

Collaborate with hospitals within the Champlain Association of Small Hospitals on improving and sustaining implementation of "ED Notification" system

4 hospitals live1 hospital in progress

Work with hospitals within the Champlain Association of Small Hospitals to measure % of patients seen by Rapid Response Nurse who return to hospital for unplanned ED visit or readmission to hospital

Delayed

Trial use of Divert Scale to identify improvement initiatives for patients at high risk for unplanned ED visits or readmissions

Delayed

% of home care patients who experienced an unplanned readmission to hospital within 30 days of discharge from hospital


5-Day Wait Time for Home Care

% of complex patients who received their first personal support service within 5 days of the service authorization date

Initiative Status

Reduce percentage of service authorization data fields that are incorrectly entered

91.6% correct data entry

Improve SPO compliance with meeting requested first visit dates or required service start dates

PSS: 81%Nursing: 87%

Allied Health: 83%

Measure 5-day wait time for PSS for complex patients excluding preference or availability requirements

89.5%

% of patients who received their first nursing within 5 days of the service authorization date


Client/Patient Experience

% of home care patients who responded “Good”, “Very Good”, or “Excellent” to any of the following survey questions:• Overall rating of CCAC services• Overall rating of management/handling of care by Care Coordinator• Overall rating of service provided by service provider

Initiative Status

Improve real time quality surveillance through the use of Interactive Voice Recognition (IVR) technology

Post-admit calls;Post discharge calls;

PSS Quality calls

Work with SPOs and Patient Advisory Council to develop and implement patient care "team" with clear accountabilities for consistency and continuity of care

Delayed: Action Plan pilot

Develop and implement pilot to review scheduled vs unscheduled care

Postponed due to financial situation: possible launch if

large PSS waitlist release

Identify key drivers of Overall Satisfaction by regularly reviewing highest correlated CCEE items

Ongoing


Palliative and End of Life

Improve % Palliative and of End of Life patients who passed away in their preferred place of death

Initiative Status

Achieve ≥90% compliance with documented preferred place of death

84.9%

Implement COSTARS practice guidelines related to cancer symptom management with Nurses

Pilot phase launched in JuneFall implementation in progress

Develop, pilot and implement sub-cutaneous line care practice guideline

Complete

Implement palliative education with Allied Health professionals

Complete

Establish baseline performance on VOICES survey Complete


Planning for FY 17/18 QIP

Given the current climate of change in the home care sector, the core priority indicators for the home care sector have not been revised for the 2017/18 QIP submission

The following additional (optional) indicators have been added for the home care sector:

• Identification of complex patients for Health Links

• Percentage of palliative patients who died in their preferred place of death

The latter indicator was developed as a result of a proactive effort by CCACs, seven of which (including Champlain) have already pioneered the indicator in their 2016/17 QIPs.


We will follow past process in developing, reviewing, and approving the FY 17/18 QIP:

• CCAC and LHIN leadership invited to participate in QIP webinars (Dec. 5th for Beginning Users and Dec.9th for Advanced Users)

• Dec to Feb: Consultation with internal stakeholders, patients and caregivers, and Service Provider Organizations

• Feb 2017: Review at the internal Quality and Safety Committee and at the Board of Directors

• Mar 2017: Final approval by the Board of Directors

• Mar 2017: Translation of QIP

• By Apr 1 2017: Submission to Health Quality Ontario and posted on our public website

Planning for FY 17/18 QIP

Champlain

Board Scorecard

November 2016

(Data as of October 2016)

Champlain

Operational Dashboard

2

Patients

Financial

Quality

People

Patient Trends Oct-15 FY 2015/16Target (T) / Baseline (B)

Local (L) / Provincial (P)Sep-16 Oct-16 FY 2016/17

Referral Volume 4938 4585 B: 4600 (L) 4975 4915 4846

Monthly CCAC Patient Capacity 102.9% 101.7% T: 100% (L) 104.7% 102.5% 107.1%

% of Patients Reassessed Within Guidelines

of Care (RAI-HC)92% 71% T: 80% (L) 72% 71% 72%

Total Home Care PSS Patients Waitlisted

Fully Waitlisted12 315 T: 0 (L) 307 712 176

Total Home Care PSS Patients Waitlisted

Partially Waitlisted1 255 T: 0 (L) 866 976 522

Total Home Care PT Patients Waitlisted 4 102 T: 0 (L) 7 14 40Total Home Care OT Patients Waitlisted 4 174 T: 0 (L) 428 666 250Total School OT Patients Waitlisted 179 385 T: 0 (L) 626 661 499Total School PT Patients Waitlisted 19 34 T: 0 (L) 57 66 54Total School SP Patients Waitlisted 118 187 T: 0 (L) 397 539 305

Quality Trends Oct-15 FY 2015/16Target (T) / Baseline (B)


Service Wait-time Community (90th

Percentile Days Waiting)**51.9 57 T: 21 days (P) 34 34 30.7

2015/16 Q2 FY 2015/16 Target / Baseline 2016/17 Q1 2016/17 Q2 FY 2016/17

5 day wait time – Complex PSS* 75.7% 77.1% T: 95% (P) 83.5% 81.0% 82.3%Adjusted 5 day wait time - Complex PSS N/A N/A T: 95% (L) 90.4% 89.5% 90.0%5 day wait time – nursing* 93.9% 93.5% T: 95% (P) 93.7% 94.7% 94.2%% of Care Visits Delivered 99.87% 99.79% T: 99.95% (P) 99.86% 99.85% 99.81%

2014/15 Q4 FY 2015/16 Target / Baseline 2015/16 Q3 2015/16 Q4 FY 2015/16

Patient Experience* 92.8% 91.5% T: 94.5% (L) 91.7% 93.3% 91.5%*QIP Metrics

** MSAA Metrics

People Trends 2015/16 Q1 FY 2015/16Target (T) / Baseline (B)

Local (L) / Provincial (P)2016/17 Q1 2016/17 Q2 FY 2016/17

Staff Turnover 7.0% 11.0% T: 8.5% (L) 6.0% 5.4% 5.4%

% of Performance Agreements completed on

time

44/216

20.4%

215/217

99.5%

T: 186/371 (L)

50%

21/371

5.7%

81/371

21.8%

81/371

21.8%

Oct-15 FY 2015/16Target (T) / Baseline (B)


Absenteeism annualized rate 12.2 12.1 T: 9 days (L) 12.1 12.1 12.1

Financial Trends Oct-16

FY 2016/17

Variance vs.

Plan

FY 2016/17

Variance vs.

Plan %

FY 2016/17

Projected Deficit

Tracking to Budget Targets -$795k -$6,911k -4.78%-$2,500k

(-1%)

FYTD Target

+$0k

Champlain

3

Financial

People

Metric Definition Discussion Questions

Referral Volume

The count of new referrals to the CCAC during the time period. Only referrals that initiate Case Management intake Assessments are counted in this indicator.

Is CCAC demand increasing? Is it from hospitals, physicians, or community?

Monthly CCAC Visit Capacity

The count of patients, by population groups, who received direct care visits or S&E as compared to the budgeted number of patients.

Are care plans efficient, ensuring creating additional capacity? Are there alternate parts of the health system to address particular care needs?

% of patients Reassessed Within Guidelines of Care

Percent of patients (per population coding), who receive their RAI reassessments within guidelines. E.g. Complex Population patients are to receive a reassessment every 3-6 months, whereas Community Independence patients are to receive reassessments every 12 months.

Are Care Coordinators focusing their time on assessing patients? Are processes and tools in place to ensure efficiencies in processes, allowing time for Care Coordinators to assess their patients?

Total Personal Support Services (PSS) patients Waitlisted

A snapshot view of the count of the number of PSS patients on the waitlist as at the end of the month, divided by those who are fully waitlisted (having no PSS service), and those that are partially waitlisted (having some PSS service, but assessed for needing more).

What is being done to manage patient risk?

Total Physiotherapy (PT) patients Waitlisted

A snapshot view of the count of the number of PT patients on the waitlist as at the end of the month

How are patient risks being managed?

Total Occupational Therapy (OT) patients Waitlisted

A snapshot view of the count of the number of OT patients on the waitlist as at the end of the month


Total School Therapy Patients Waitlisted by Service

A snapshot view of the count of the number of school patients on the waitlist as at the end of the month


Are we helping to navigate patients to other sources of care (insurance, etc.)?


Tracking to Budget targets Net surplus/deficit as calculated by Revenue minus Expenses, as per plan.

Are we tracking to budget plans? Are our cost/patients to plan? Is demand for service to expectations? What additional actions if any, are required at this time?


Staff Turnover Rate at which employees leave an organization. Calculated as number of permanent employees who terminate or cease employment, divided by the average number of permanent employees on staff

If not as expected, what is the underlying cause and mitigating action plan?

% of Performance Appraisals Completed on Time

FYTD percent of staff whose performance appraisal is completed on time.

Is staff development being appropriately managed?

Absenteeism annualizedRate

Total number of sick hours, paid and unpaid for all permanent and temporary staff (excludes casuals), divided by number of permanent staff.

If not as expected, what is the underlying cause and mitigating action plan?

Patients Quality

Operational Dashboard: Glossary


Service Wait-timeCommunity (90th

Percentile Days Waiting)

Wait time from patient intake / application date for referrals sourced from the community (e.g. Family, Self) to receiving the first direct care service visit, where the patient is an adult patient on Home Care services. The 90th percentile focuses on ensuring that 90% of patients will receive a visit in the targeted time frame, or better.

Should service eligibility or service guidelines be reviewed/reduced? What advocacy should the Board engage in?

5 day wait time –Complex PersonalSupport Services (PSS)

Measures the percent of patients whose 1st PSS visit was achieved within 5 days, from Service Authorization Date to the 1st PSS Visit Date for the episode of care. patients with an “On-Hold” episode between the authorization and 1st visit, are excluded from the measure. (On hold is used, for example, if a patients discharge is delayed from hospital due to complications)

How have Quality Improvement Plan (QIP) action plans improved performance?

Adjusted 5 Day Wait Time-PSS

Measures the percent of patients whose 1st PSS visit was achieved within 5 days, from Service Authorization Date or Patient Availability Date to the 1st PSS Visit Date for the episode of care.

Where are the remaining areas of focus to improve the performance? Is the target achievable?

5 day wait time -Nursing

Measures the percent of patients whose 1st Nursing visit was achieved within 5 days, from Service Authorization Date to the 1st Nursing Visit Date for the episode of care. patients with an “On-Hold” episode between the authorization and 1st visit, are excluded from the measure. (On hold is used, for example, if a patients discharge is delayed from hospital due to complications)

How have QIP action plans improved performance?

% of Care Visits Delivered

Measures the percent of visits provided to patients, of all scheduled visits, for direct care visits. The metric is self reported by SPOs on a quarterly basis.

Are there variances amongst providers or services? Are there adverse affects on patients due to missed care?

patient Experience Measures the percent positive rating for overall satisfaction with care. How have Person Driven Care action plans improved patient experience?

Champlain

Supporting Complex Patients Sustainable Health Care

4

Strategic Dashboard

Supporting Complex Patients Oct-15 FY 2015/16Target (T) / Baseline (B)


Reassessment of Complex Patients within

Guideline88% 88% T: 90% (L) 89% 88% 83%

% of Complex Patients with a Care

Coordinator Contact (tel./FtoF) within 3

months81% 83% T: 85% (L) 78% 77% 80%

% of Complex Patients with 1 Care

Coordinator in past 12 Months91% 92% T: 95% (L) 94% 95% 92%

Aug-15 FY 2015/16 Aug-16 Sep-16 FY 2016/17

% of Complex Patients With a Completed

Mediconciliation70% 74% T: 90% (L) 83% 78% 75%

Sustainable Health Care Trends Aug-15 FY 2015/16Target (T) / Baseline (B)

Local (L) / Provincial (P)Jul-16 Aug-16 2016/17 YTD

ALC Rate 12.8% 12.4% T: 12.7% (P) 13.7% 13.8% 13.3%

2014/15 Q4 FY 2015/16 2016/17 Q1 2016/17 Q2 FY 2016/17

Very High and High MAPLe Score %

supported by Champlain CCAC, compared

to Provincial Averages

59.9%

(2)

56.3%

(1)T: Top Quartile (L)

62.3%

(1)

62.4%

(1)

62.3%

(1)

1.0 1.0T: 'Long Stay (L)

Top Quartile*4.0 4.0 4.0

7.3 7.3T: 'Short Stay (L)

Top Quartile**7.0 7.0 7.0

Oct-15 FY 2015/16 Sep-16 Oct-16 FY 2016/17

% Clinic Visit Utilization 30.7% 27.1% T: 25% (L) 31.1% 30.0% 29.6%*Champlain is ranked consistently amongst the highest MAPLe proportion provincially. ; Long Stay populations using provincial reference rates.

** Champlain continues to increase special programs, such as NPWT and CHIPP programs, impacting avg. cost; Short Stay Population costs are calculated

using local CCAC rates.

Ranking relative to other CCACs for

average cost/Patient across all Patient

groups

Champlain

Supporting Complex Patients Sustainable Health System

Metrics Definition Discussion Questions

Complex Population Definition

The complex population are patients who are coded in CHRIS as “Complex” using Provincial patient Care Model definitions.The provincial Complex Populations is defined as Long Stay patients having: 1 or more health/chronic conditions with complicating factors; Direct care needs are unstable & unpredictable; The individual or support network is not self-reliant with high risks in more than 1 area; RAI score 17 +; High/intensive case management is required to support patient goals & outcomes; Multiple care partners across sectors; overall poor coping; multiple complex psychosocial issues; unmanageable behavioural/mental health issues;

How do other “complex” patients get identified, such as those in Short Stay populations?

Besides service costs, what are the implications of a growing base of Complex Patients on Case Management and the skills and resources needed?

Reassessment of Complex Patients within Guidelines

Percent of patients (per population coding), who receive their RAI reassessments within guidelines. E.g. Complex Population patients are to receive a reassessment every 3-6 months,.

Are Care Coordinators focusing their time on assessing patients? Are processes and tools in place to ensure efficiencies in processes, allowing time for Care Coordinators to assess their patients?

% of Complex Patients with a Care Coordinator Contact (tel./FtoF) within X Months

Count of the number of complex population patients who have had a Care Coordinator contact within last 3 months out of all complex population patients.

Are complex patients being monitored closely? Are there risks for some patients? If patients do not have a contact within last 3 months, what are the potential impacts?

% of Complex Patients with 1 Care Coordinator in Past 12 Months

Percent of complex patients active in the current month, who have had 1 Care Coordinator consistently assigned to the patient in the past 12 months.

When there are transitions, are Care Coordinators briefing peers effectively? What may cause higher number of assigned Care Coordinators (turnover, reassignments, etc.)?

% of Complex PSS Patients with Targeted Number of SPO Staff Within Past 3 Months

Percent of complex patients active in the current month, who have had the appropriate number of SPO staff assigned to the patient, within the past 3 months.

Is there consistency in care within the PSS care team? Do high numbers of SPO assigned staff create risk or a need for constant retraining? How do SPOs ensure consistency of care within the care team?

% of Complex Patients With aCompleted Medication Reconciliation

% of Complex Population patients with a BPMH completed within 30 days of either a RAI-HC completed with triggers for needing a Medication Reconciliation, or within 30 days of an initial face to face visit by a RRN or MHAN nurse.

Are there risks to patients if the CCAC is not completing a medication reconciliation? Are there other health professionals completing the Med Rec? Are there barriers to completing a Med Rec. ?

Metrics Definition Discussion Questions

ALC Rate New Indicator: Counts the total ALC bed days as a percentage of Total Bed days, during the period. Includes sub-acute (rehab and complex care bed and counts patients not yet discharged).

Are our programs appropriately supporting LHIN-Wide ALC targets? What if any additional actions are required to improve performance?

Very High & High MAPLe Score % supported by Champlain CCAC

The proportion of CCAC patients assessed by a RAI-HC, with a MAPLe Score of High or Very High, out of the total number of patients with a RAI-HC assessment.

What is the financial impact of sustaining higher needs patients? What effects does this have for provincial HBAM funding/

Ranking relative to other CCACs for average cost/patient across all patient groups

Using the LHIN Benchmark report, average costs per patient are reported by population group. Ranking can be achieved through the comparison of average cost per patient, across peers.

Are we delivering appropriate service levels to different patient populations (HBAM neutral or positive) and properly balancing cost & patient risk/safety?

% Clinic Visit Utilization Percent of Clinic Visits out of total Visit Nursing and Clinic Nursing Visits

Strategic Dashboard: Glossary

Champlain CCAC Financial Results – Executive Summary

For the month ended October 31, 2016 OVERVIEW This executive summary covers Champlain CCAC’s financial results for the month ending October 31, 2016.

BUDGET ASSUMPTIONS AND UPDATES The F2016/17 budget was refreshed in July 2016 after the receipt of an additional $11.0M in funding.

CONDENSED OPERATING STATEMENT

1 Month 1 Month 1 Month YTD YTD YTD YTD Total Total 15/16

Actuals Budget Variance Actuals Budget Variance Var % Budget Budget

REVENUE

Base Funding 20,692,645 20,180,969 511,676 144,374,668 143,917,849 456,817 0.32% 246,508,010 233,401,895

One-Time Funding 96,594 65,652 30,942 564,612 462,136 102,476 22.17% 791,682 1,067,232

BTI & Other Funding 6,421 43,584 (37,163) 29,211 305,088 (275,877) (90.43%) 523,019 523,019

TOTAL REVENUE 20,795,660 20,290,205 505,455 144,968,491 144,685,073 283,416 0.20% 247,822,711 234,992,146

EXPENSES

Purchased Client Services 16,245,125 14,727,752 (1,517,373) 112,794,049 104,520,260 (8,273,789) (7.92%) 178,486,606 166,847,325

Internal Therapies 416,378 419,466 3,088 2,818,662 3,038,442 219,780 7.23% 5,258,682 4,866,307

Care Coordination 3,355,032 3,424,304 69,272 24,612,526 24,815,647 203,122 0.82% 42,939,349 42,066,852

Health System Development 89,524 88,081 (1,443) 702,549 636,634 (65,915) (10.35%) 1,096,510 695,603

Nursing Initiatives 264,318 259,180 (5,138) 1,849,540 1,872,880 23,340 1.25% 3,245,813 3,241,926

Information & Referral 92,778 99,265 6,487 645,098 706,173 61,075 8.65% 1,216,663 1,173,843

Administration 1,127,351 1,272,157 144,806 8,457,292 9,095,037 637,746 7.01% 15,579,088 16,100,290

TOTAL EXPENSES 21,590,506 20,290,205 (1,300,301) 151,879,716 144,685,073 (7,194,641) (4.97%) 247,822,711 234,992,146

TOTAL SURPLUS/(DEFICIT) (794,846) - (794,846) (6,911,225) - (6,911,225) (4.78%) - -

FINANCIAL ANALYSIS OCTOBER MONTH AND YTD _ REVENUE Base Funding: October base variance of $500K is due to targeted Hospice funding received and matched to expenses. One-time Funding: The favourable variance is due to additional one-time funds received that were not included in the

budget. These additional one-time funds have been matched to expenses. BTI & Other Funding: Revenue is matched to expenses (timing variance and no impact to bottom line). This is for the BTI

computer leases which are charged by Dell but paid by the OACCAC. EXPENSES Purchased Client Services: The unfavourable variances to budget of $1.5M for the month and $8.3M year-to-date are due to

continued higher demand for PSS and Nursing Services to the end of October as portrayed in the spend rate charts shown below.

Internal Therapies The favourable variances to budget of $219K year-to-date are in salaries and benefits due to vacancies. Care Coordination: The year-to-date favourable variance of $203K year-to-date is due to vacancies, lower actual rates than

budgeted, fewer maternity leaves and timing differences in other care coordination administrative expenses.

Health System Development: The expenses relating to these programs have targeted funding which is matched as expenses are

incurred. Variances are due to timing and programs do not impact the overall CCAC bottom line. Nursing Initiatives and I&R: Variances not material Administration: The favourable variance in administration year-to-date of $637K is due in part to vacancies and

occupancy savings. However, a portion of this variance is timing related (BTI and other).

FORECAST TO MARCH 31, 2017 YE forecast is slightly above the 1% range, at roughly $3M. There could be a variance of +/- $1M on this forecast, as the forecast is very sensitive to actual realized week over week savings due to the various parallel measures in place. Also, due to the nature of waitlisting being cumulative month/month, the savings in turn cumulate month/month – thus the majority of the savings are back-ended in the fiscal year and will be realized in February and March. In terms of cost controls, the following mechanisms are in place.

1. We have implemented centralized admission controls on PSS service since September 2016. This measure is working well on the patient admission side – continued reduction in PSS costs is dependent on ongoing discharges being maintained at current rates

2. We have reduced expenditures on therapy services since Sept 2016, and are maintaining volumes at a reduced level, but at a level to avoid low volume penalties

3. Nursing services are however still being served to demand to avoid hospital partner impacts – and we are susceptible to demand increases for our nursing services, which in turn would add to costs

4. Administrative cost controls have been in place since May 2016, and continue to contribute positively month over month to the financials

We have detailed expenditure tracking in place on a week/week basis that allows us to update our expected YE outcome weekly. Our budget management committee also meets on a weekly basis to discuss results and options for mitigation. In addition, the LHIN is working with the CCAC to clarify if revenues traditionally clawed back if underspent to program/volume commitments, can be used by the CCAC to address current financial pressures – this could positively impact our YE forecast by $1M if confirmed.

ADDITIONAL INFORMATION

CCAC Patient Capacity (Budgeted Number of Patients vs. Actual Patient Counts)

Special Program Costs

Appendix I – Revenue Confirmations PURPOSE The Champlain CCAC has a fiduciary obligation to balance its budget each fiscal year. This log keeps track of changes to in year funding (both one

time and base) as a means of understanding the variance in funding introduced over the year.

Balancing annual budgets is challenging not only due to changes in revenue assumptions, but also by variations in patient demand and acuity as

well as factors impacting other partners which impact CCAC operations.

Measures in place to manage the budget are limited to operational efficiencies and introducing service waitlists or transferring patients to other

community services.

FUNDING CONFIRMATIONS RECEIVED

Date Funding changes Impact to budget presented on monthly

Financial statements

2016/2017 2016/2017 Budget reflects an increase of 0.5% as

confirmed by the LHIN, representing $1.1M plus an additional $1.1M for PSS stabilization

N/A: this is reflected in the original and refreshed budget presented

28-Aug-15 Received funding letter confirming new base funding of

$215,500 for Stroke Rehab Services. N/A: this is reflected in the original and

refreshed budget presented

4-Mar-16 Received funding letter for new one-time funding of

$143,800 for Health Links Primary Care. N/A: this is reflected in the original and


9-Mar-16 Received funding letter for one-time funding of $84,145 for PSS Implementation and Home and Community Care

Resource.




9-Mar-16 Received funding letter for one-time funding of $1,000

for additional program support for Health Links. N/A: this is reflected in the original and


13-Apr-16 Received funding letter for one-time funding of

$150,000 for Implementation of Health Links and Primary Care Networks in the Champlain region.


13-Apr-16 Received funding letter for one-time funding of $72,656

for the first quarter of F2016/17 to support the Prescott-Russell Health Link.


3-Jun-16 Received funding letter for new base funding of

$2,498,500 for Year 3 Wage Enhancement for Personal Support Services.

This is reflected in the refreshed budget (effective July 2016).

15-Jun-16 Received funding letter for one-time funding of $60,000

for the Ottawa East Health Links Business Plan development.


24-Jun-16 Received funding letter for one-time funding reallocation of $795,982 related to F2015/16

underspending in certain programs.


5-Jul-16 Received funding letter for one-time funding of

$220,000 to further support the work of the Shared Services Organization (SSO).


11-Jul-16 Received funding letter for one-time allocation of

$5,000 to support travel expenses for the Early Adopter PSS Community Resource.

+$5,000 but with offsetting expenses



11-Jul-16

Received funding letter for one-time allocation of $120,000 to implement the recommendations outlines in the Champlain Sub Acute Capacity Plan. (One-time

funding also confirmed for 2017/18 and 2018/19)

+120,000 but with offsetting expenses

11-Jul-16

Received funding letter for one-time allocation of $72,766 to hire and equip a decision support/business intelligence analyst for Health Links, Primary are and

LHIN sub-region analysis. (One-time funding also confirmed for 2017/18).

+72,766 but with offsetting expenses

29-Jul-16

Received funding letter for new base funding of $11,015,800 for expanding service provision for high

needs patients, to provide respite services for caregivers, and a base funding adjustment.


5-Aug-16

Received “revised” funding letter to replace the July 5, 2016 letter for new one-time funding of $220,000 to

further support the work of the Shared Services Organization (SSO).


7-Sep-16 Received funding letter for new one-time funding of $60,000 for Community Support Services Projects –

Secondment for Business Analyst.


9-Sep-16 Received funding letter for $850,591 in new base

funding to provide nursing and PSS services in residential hospices.

+$850,591 (to be flowed to hospices)

27-Sep-16 Received funding letter for new one-time funding of $315,000 to expand capacity at Marianhill hospice.

+$315,000 (to be flowed to hospice)

4-Oct-16

Received funding letter for one-time funding of $1,200 to support Prescott-Russell Health Link representatives

to attend the annual HQO Health Links Leadership Summit

+$1,200 (but with offsetting expenses)



4-Oct-16 Received funding letter for one-time funding of $1,200 to support Ottawa East Health Link representatives to

attend the annual HQO Health Links Leadership Summit +$1,200 (but with offsetting expenses)

24-Oct-16

Received funding letter confirming recovery of $3,312 from CSS Exercise and Fall Prevention Initiative funds. These funds will be reallocated to Akwesasne who will

provide the services in their community

-$3,312 (not material)

28-Oct-16 Received funding letter from MOHLTC confirming

additional $17,000 base funding to support Regional Translation Network Program.

+$17,000 (targeted non-LHIN funding)

Appendix II – Statement of Financial Position

October 31, 2016 September 30, 2016 March 31, 2016

ASSETS

CURRENT ASSETS

Cash-CDN $3,275,142 $7,064,857 $11,588,108

Accounts Receivable 1,033,206 920,095 1,516,689

Prepaid Expenses 21,288 27,924 289,133

4,329,636 8,012,876 13,393,930

CAPITAL ASSETS 803,379 803,379 995,228

$5,133,015 $8,816,255 $14,389,158

LIABILITIES

CURRENT LIABILITIES

Accounts Payable and Accrued

Liabilities $11,110,246 $14,004,074 $13,902,384

Due to/(from) MOHLTC 1,973,357 1,970,624 1,339,613

13,083,603 15,974,698 15,241,997

LONG-TERM LIABILITIES

Deferred Contributions - Capital

Assets 803,378 803,378 995,228

13,886,981 16,778,076 16,237,225

NET ASSETS

Carry-over 15/16 (1,848,067) (1,848,067)

Operational (6,905,899) (6,113,754) (1,848,067)

(8,753,966) (7,961,821) (1,848,067)

$5,133,015 $8,816,255 $14,389,158

Appendix III – Cash Flow Forecast

The cash flow forecast presented below takes into consideration the impact of the Waitlisting assumptions presented above.

Date Description

Funding receipts/

(payments)

Cash surplus/

(deficit) position Date Description

Funding receipts/

(payments)

Cash surplus/

(deficit) position

Nov 23 Actual Balance 312,850 Jan 30 Cheque run (3,295,862) (2,607,753)

Nov 24 Payroll (1,321,641) (1,008,791) Jan 31 Funding 10,421,081 7,813,328

Nov 28 Cheque run (3,651,207) (4,659,998) Feb 1 Funding 119,055 7,932,383

Nov 29 Payroll Gov't Submissions (401,058) (5,061,056) Feb 1 Cheque run (643,602) 7,288,780

Nov 30 Funding 10,415,540 5,354,484 Feb 2 Payroll (1,297,650) 5,991,130

Dec 1 Funding 119,055 5,473,539 Feb 6 Cheque run (3,256,379) 2,734,751

Dec 1 Cheque run (643,602) 4,829,937 Feb 6 Payroll Gov't Submissions (524,853) 2,209,898

Dec 5 Cheque run (3,611,724) 1,218,213 Feb 13 Cheque run (3,216,897) (1,006,999)

Dec 8 Payroll (1,321,641) (103,428) Feb 15 Funding 10,421,081 9,414,082

Dec 12 Cheque run (3,572,241) (3,675,669) Feb 16 Payroll (1,297,650) 8,116,432

Dec 13 Payroll Gov't Submissions (401,058) (4,076,727) Feb 20 Cheque run (3,177,414) 4,939,018

Dec 15 Funding 10,419,237 6,342,510 Feb 21 Payroll Gov't Submissions (524,853) 4,414,165

Dec 19 Cheque run (3,532,759) 2,809,751 Feb 27 Cheque run (3,137,931) 1,276,234

Dec 22 Payroll (1,321,641) 1,488,110 Feb 28 Funding 10,421,081 11,697,315

Dec 26 Cheque run (3,493,276) (2,005,166) Mar 1 Funding 119,055 11,816,370

Dec 27 Payroll Gov't Submissions (401,058) (2,406,224) Mar 1 Cheque run (643,602) 11,172,768

Dec 30 Funding 10,421,081 8,014,857 Mar 2 Payroll (1,297,650) 9,875,118

Jan 1 Cheque run (643,602) 7,371,255 Mar 5 Payroll Gov't Submissions (524,853) 9,350,265

Jan 2 Cheque run (3,453,793) 3,917,462 Mar 6 Cheque run (3,098,448) 6,251,817

Jan 3 Funding 119,055 4,036,517 Mar 13 Cheque run (3,058,966) 3,192,851

Jan 5 Payroll (1,297,650) 2,738,867 Mar 15 Funding 10,421,081 13,613,932

Jan 9 Cheque run (3,414,310) (675,443) Mar 16 Payroll (1,297,650) 12,316,282

Jan 10 Payroll Gov't Submissions (524,853) (1,200,296) Mar 20 Cheque run (3,019,483) 9,296,799

Jan 15 Funding 10,421,081 9,220,785 Mar 21 Payroll Gov't Submissions (524,853) 8,771,946

Jan 16 Cheque run (3,374,828) 5,845,957 Mar 27 Cheque run (2,980,000) 5,791,946

Jan 19 Payroll (1,297,650) 4,548,307 Mar 30 Payroll (1,297,650) 4,494,296

Jan 23 Cheque run (3,335,345) 1,212,962 Mar 31 Funding 10,421,081 14,915,377

Jan 24 Payroll Gov't Submissions (524,853) 688,109

$2,800,000

$2,900,000

$3,000,000

$3,100,000

$3,200,000

$3,300,000

$3,400,000

$3,500,000

$3,600,000

20

16

-03

-28

20

16

-04

-04

20

16

-04

-11

20

16

-04

-18

20

16

-04

-25

20

16

-05

-02

20

16

-05

-09

20

16

-05

-16

20

16

-05

-23

20

16

-05

-30

20

16

-06

-06

20

16

-06

-13

20

16

-06

-20

20

16

-06

-27

20

16

-07

-04

20

16

-07

-11

20

16

-07

-18

20

16

-07

-25

20

16

-08

-01

20

16

-08

-08

20

16

-08

-15

20

16

-08

-22

20

16

-08

-29

20

16

-09

-05

20

16

-09

-12

20

16

-09

-19

20

16

-09

-26

20

16

-10

-03

20

16

-10

-10

20

16

-10

-17

20

16

-10

-24

20

16

-10

-31

11

/7/2

01

6

11

/14

/20

16

11

/21

/20

16

11

/28

/20

16

12

/5/2

01

6

12

/12

/20

16

12

/19

/20

16

12

/26

/20

16

1/2

/20

17

1/9

/20

17

1/1

6/2

01

7

1/2

3/2

01

7

1/3

0/2

01

7

2/6

/20

17

2/1

3/2

01

7

2/2

0/2

01

7

2/2

7/2

01

7

3/6

/20

17

3/1

3/2

01

7

3/2

0/2

01

7

3/2

7/2

01

7

FY 2016/17 Weekly Spend Target as of November 2016 (due to YTD Actuals)

Actual New Target CHRIS Budget

summer without School costs

Months CHRIS Budget CHRIS Estimate CHRIS Variance Cumulative Estimated Savings

Nov-16 13,535,650$ $13,539,310 3,660-$ 3,660-$

Dec-16 13,273,106$ $13,097,815 175,291$ 171,631$

Jan-17 13,535,650$ $13,129,153 406,497$ 578,128$

Feb-17 12,485,475$ $11,269,158 1,216,317$ 1,794,445$

Mar-17 13,840,269$ $12,226,453 1,613,816$ 3,408,262$

($6,912,000)$3,408,262

$600,000

($2,903,738)

($2,653,738)

($1,660,738)

Year End Impact

More Weekly Savings $2,500 632,500$

Less Weekly Savings -$2,500 -$632,500

Impact of Variation in Trendline

Projected YE with ADJUSTMENTS & Incremental Revenue

Deficit as at October 2016

Non-CHRIS Savings

Champlain CCAC Year End Modelling (Post Full Waitlist Initiative)

Projected YE Deficit (No Incremental Revenue)

Projected YE with ADJUSTMENTS (No Incremental

Revenue)

Estimated Cumulative CHRIS Savings

-$2,000,000

$-

$2,000,000

$4,000,000

$6,000,000

$8,000,000

$10,000,000

$12,000,000

$14,000,000

$16,000,000

Nov-16 Dec-16 Jan-17 Feb-17 Mar-17

CHRIS Expenditure Estimates

Cumulative Estimated Savings CHRIS Variance CHRIS Budget CHRIS Estimate

Dim Date.Fiscal Period (Multiple Items)

GL Cost Amount Column Labels

Service Service Total Equipment Supply Grand Total

Row Labels HOM NUR - Clinic NUR - Hour NUR - Visit NUT OT PT SP SW

2016-09-12 $1,823,297 $123,362 $199,933 $652,401 $9,056 $134,752 $110,144 $42,897 $8,442 $3,104,284 $74,999 $201,210 $3,380,493

2016-09-19 $1,808,120 $119,618 $201,241 $657,728 $8,620 $122,574 $101,453 $39,474 $8,467 $3,067,295 $74,181 $205,574 $3,347,050

2016-09-26 $1,794,509 $119,777 $187,316 $643,387 $7,812 $114,790 $99,343 $39,019 $7,966 $3,013,920 $76,254 $193,518 $3,283,692

2016-10-03 $1,762,575 $116,230 $182,323 $643,139 $6,539 $120,731 $105,208 $37,163 $9,125 $2,983,033 $76,267 $197,726 $3,257,026

2016-10-10 $1,722,950 $106,172 $172,680 $630,910 $5,902 $102,723 $92,957 $33,149 $5,723 $2,873,167 $73,899 $174,881 $3,121,948

2016-10-17 $1,745,949 $113,159 $185,855 $632,582 $7,099 $121,237 $94,794 $35,908 $6,251 $2,942,833 $73,866 $179,937 $3,196,635

2016-10-24 $1,722,410 $111,236 $192,069 $612,996 $6,318 $113,084 $99,295 $35,002 $6,234 $2,898,644 $75,221 $197,139 $3,171,004

Change week to week

2016-09-19 -$15,177 -$3,744 $1,308 $5,327 -$436 -$12,179 -$8,691 -$3,423 $26 -$36,989 -$819 $4,364 -$33,443

2016-09-26 -$13,611 $159 -$13,925 -$14,340 -$808 -$7,783 -$2,110 -$455 -$502 -$53,375 $2,073 -$12,056 -$63,358

2016-10-03 -$31,935 -$3,547 -$4,993 -$249 -$1,272 $5,940 $5,865 -$1,856 $1,160 -$30,887 $13 $4,208 -$26,666

2016-10-10

2016-10-17

2016-10-24 -$23,539 -$1,923 $6,214 -$19,586 -$781 -$8,153 $4,501 -$905 -$17 -$44,189 $1,355 $17,203 -$25,631

Average -$27,737 $0 $0 $0 $0 $0 $0 $0 $0 $656 $3,430 -$37,275

10/31/2016 $1,694,673 $115,000 $192,069 $630,000 $6,318 $113,084 $99,295 $35,002 $6,234 $75,877 $200,569 $3,168,121

11/7/2016 $1,666,936 $115,000 $192,069 $630,000 $6,318 $113,084 $99,295 $35,002 $6,234 $76,533 $203,999 $3,144,469

11/14/2016 $1,639,199 $115,000 $192,069 $630,000 $6,318 $113,084 $99,295 $35,002 $6,234 $77,189 $207,428 $3,120,817

11/21/2016 $1,611,462 $115,000 $192,069 $630,000 $6,318 $113,084 $99,295 $35,002 $6,234 $77,845 $210,858 $3,097,166

11/28/2016 $1,583,725 $115,000 $192,069 $630,000 $6,318 $113,084 $99,295 $35,002 $6,234 $78,500 $214,287 $3,073,514

12/5/2016 $1,555,988 $115,000 $192,069 $630,000 $6,318 $113,084 $99,295 $35,002 $6,234 $79,156 $217,717 $3,049,863

12/12/2016 $1,528,251 $115,000 $192,069 $630,000 $6,318 $113,084 $99,295 $35,002 $6,234 $79,812 $221,147 $3,026,211

12/19/2016 $1,500,514 $115,000 $192,069 $630,000 $6,318 $113,084 $99,295 $35,002 $6,234 $80,468 $224,576 $3,002,560

12/26/2016 $1,472,777 $115,000 $192,069 $630,000 $6,318 $113,084 $99,295 $35,002 $6,234 $81,124 $228,006 $2,978,908

1/2/2017 $1,445,040 $115,000 $192,069 $630,000 $6,318 $113,084 $99,295 $35,002 $6,234 $81,780 $231,435 $2,955,257

1/9/2017 $1,417,303 $115,000 $192,069 $630,000 $6,318 $113,084 $99,295 $35,002 $6,234 $82,436 $234,865 $2,931,605

1/16/2017 $1,389,566 $115,000 $192,069 $630,000 $6,318 $113,084 $99,295 $35,002 $6,234 $83,091 $238,295 $2,907,954

1/23/2017 $1,361,829 $115,000 $192,069 $630,000 $6,318 $113,084 $99,295 $35,002 $6,234 $83,747 $241,724 $2,884,302

1/30/2017 $1,334,092 $115,000 $192,069 $630,000 $6,318 $113,084 $99,295 $35,002 $6,234 $84,403 $245,154 $2,860,651

2/6/2017 $1,306,355 $115,000 $192,069 $630,000 $6,318 $113,084 $99,295 $35,002 $6,234 $85,059 $248,583 $2,836,999

2/13/2017 $1,278,618 $115,000 $192,069 $630,000 $6,318 $113,084 $99,295 $35,002 $6,234 $85,715 $252,013 $2,813,348

2/20/2017 $1,250,881 $115,000 $192,069 $630,000 $6,318 $113,084 $99,295 $35,002 $6,234 $86,371 $255,443 $2,789,696

2/27/2017 $1,223,144 $115,000 $192,069 $630,000 $6,318 $113,084 $99,295 $35,002 $6,234 $87,027 $258,872 $2,766,044

3/6/2017 $1,195,407 $115,000 $192,069 $630,000 $6,318 $113,084 $99,295 $35,002 $6,234 $87,682 $262,302 $2,742,393

3/13/2017 $1,167,670 $115,000 $192,069 $630,000 $6,318 $113,084 $99,295 $35,002 $6,234 $88,338 $265,732 $2,718,741

3/20/2017 $1,139,933 $115,000 $192,069 $630,000 $6,318 $113,084 $99,295 $35,002 $6,234 $88,994 $269,161 $2,695,090

3/27/2017 $1,112,196 $115,000 $192,069 $630,000 $6,318 $113,084 $99,295 $35,002 $6,234 $89,650 $272,591 $2,671,438

4/3/2017 $1,084,459 $115,000 $192,069 $630,000 $6,318 $113,084 $99,295 $35,002 $6,234 $90,306 $276,020 $2,647,787

$66,882,935

October $7,535,415 $485,926 $796,157 $2,731,859 $28,214 $495,753 $425,359 $153,560 $29,700 $324,609 $815,364 $13,821,915Estimates

CLIENT

expenditures

Budget CLIENT

expenditures VarianceNovember $7,121,688 $498,333 $832,297 $2,730,000 $27,378 $490,031 $430,276 $151,677 $27,014 $334,047 $896,569 $13,539,310 13,535,650$ 3,660-$

December $6,603,930 $498,333 $832,297 $2,730,000 $27,378 $490,031 $430,276 $151,677 $27,014 $346,290 $960,588 $13,097,815 13,273,106$ 175,291$

January $6,303,899 $517,500 $864,309 $2,835,000 $28,431 $508,879 $446,825 $157,511 $28,053 $372,709 $1,066,038 $13,129,153 13,535,650$ 406,497$

February $5,132,964 $460,000 $768,274 $2,520,000 $25,272 $452,336 $397,178 $140,010 $24,936 $342,422 $1,005,766 $11,269,158 12,485,475$ 1,216,317$

March $5,245,270 $517,500 $864,309 $2,835,000 $28,431 $508,879 $446,825 $157,511 $28,053 $397,741 $1,196,935 $12,226,453 13,840,269$ 1,613,816$

Nov to Mar $63,261,888 66,670,150$ 3,408,262$

Estimate Details

CHRIS Budget Only $M $M

CHRIS budget - 5

months 66.7 66,670,150$

Forecast 63.4 $63,261,888

Surplus to budget 3.3 3,408,262$

Current total YTD

October deficit -6.9 ($6,912,000)

-3.6 ($3,503,738)

Non-CHRIS surplus

(CC Salary, Admin) 0.6 $600,000

Projected Total

deficit -3.0 ($2,903,738)

PSW Volumes vs PSW

Wage Enhancements $200,000 TBD

Transition Expenses

(eg HIROC) ($50,000)

Legal Expenses vs

accruals $150,000 TBD

LTD Insurance (Feb,

Mar) ($50,000)

last minute

adjustments/revenue

s

Total $250,000

QBP $600,000

PT $318,000

MHAN $75,000

Total $993,000

Year End Adjustments Possibilities

Forecast to Budget

November to March 31, 2017

Incremental Revenue

DRAFT - home care | long term care | community care

Documents

Transcript of DRAFT - home care | long term care | community care