Central East LHIN Environmental Scan. November 2006

Transcription

1 Central East LHIN Environmental Scan November

2 Environmental Scan Introduction: Understanding the environment in which we plan and deliver our health services is essential to the success of our IHSP. The scope of our environmental scan was defined by what we heard during our consultations, by adopting a broad population based definition of health, and by the population and health system characteristics of the LHIN. We Heard during the consultation that care for seniors should be a priority, the environment scan Found supporting information, and the IHSP sets down clearly what we will Do to address this priority. A population health model definition of health defines the scope of our environmental scan. Your LHIN will look at the health needs of its residents to ensure we have the right health services now, and in the future. We need to understand the special demographic characteristics of our LHIN. What does the population profile of our LHIN tell us? What challenges do we face now and in the future to ensure we can deliver the right care in the right place at the right time.

3 Environmental Scan Introduction: Central East LHIN Population Pyramid 2001 vs % Male 2001 % Female 2001 % Male 2016 % Female Age Category % -4% -3% -2% -1% 0% 1% 2% 3% 4% 5% % of Total Central East LHIN Population 3

4 Environmental Scan Introduction: POPULATION HEALTH MODEL HEALTH DETERMINANTS HEALTH CARE SERVICES ECONOMIC ENVIRONMENT SOCIAL ENVIRONMENT PHYSICAL ENVIRONMENT HUMAN BIOLOGY Infants Health Children's Health Adolescent Health Adult Health Seniors Health HEALTH STATUS When you lift the lid on health care, it represents quite a challenge. It s a huge piece to manage and hopefully, through this process, we can make it better. (public consultation, May 17th, 2006) 4

5 Environmental Scan Overview Our Population: The CE LHIN geography stretches from the culturally diverse and densely populated Scarborough planning zones to the rural and less populated areas of Haliburton Highlands, the northern sections of the City of Kawartha Lakes and Peterborough City and County. The population is mainly concentrated in the south west area of the LHIN, with almost 50% of the population in Scarborough. The area is characterized by rapid population growth for certain age groups and the second highest percent of those over 65 in the province. The 85+ age group will increase by over 91% between 2001 and 2016, and the age group will decrease by 0.5% for the same period.

6 Environmental Scan Overview Our Population: Central East Planning Zone Populations (%) for 2006 Scarborough Cliffs - Scarborough Center 26% Durham East 13% Durham North / Central 3% Durham West 24% Scarborough Agincourt - Rouge 19% Peterborough 8% Northumberland Havelock 4% Kawartha 3% Haliburton Highlands 0.3% Population Growth Rates for CE LHIN 100.0% 80.0% % Growth from 2001 Base Year 60.0% 40.0% 20.0% Youth (14-17) Adult (18+) Total 0.0% % Year 6

7 Environmental Scan Overview Our Population: Central East LHIN Planning Zones Haliburton Highlands Peterborough City & County Kawartha Lakes 7

8 Environmental Scan Overview Our Population: The CE LHIN has a high and growing proportion of elderly. The percentage of elderly 85+ will increase by over 91%, and from 1.3% of our total population to 2.1% by Our planning priorities focus on seniors, chronic disease prevention and management, and mental health and addictions. Age is a risk factor for chronic diseases, and for certain mental health disorders like dementia. The CE LHIN is diverse in its geography and demographics. Each planning zone has unique characteristics and challenges for planning its health services. 8

9 Environmental Scan Overview Our Population: Durham West Planning Zone Population Pyramid 2001 vs Haliburton Highlands Planning Zone Population Pyramid 2001 vs % Male 2001 % Female % Male 2001 % Female % Male 2016 % Female % Male 2016 % Female Age Category Age Category % -4% -2% 0% 2% 4% 6% 8% -8% -6% -4% -2% 0% 2% 4% 6% 8% % of Total Planning Zone Population % of Total Planning Zone Population Example: The population pyramid for Durham West shows a broad, although slightly declining, base. Haliburton Highland s population projections show a dramatic and increasing growth in the elderly population relative to its total population. The demographic transition in Haliburton Highlands will have significant implications for its current and future health care needs. 9

10 Environmental Scan Overview Our Population: There are many factors to consider when planning health services other than age and sex composition. Other factors to consider are measures or indicators of general population health, use of health services, and social characteristics. These other measures help your LHIN understand in greater detail some of the underlying demographics of the area, and help us plan for services that match the needs of our population. Highlights: In many respects, the CE LHIN is very similar to the province across a broad range of indicators. Averages can however mask some of the unique characteristics of our planning zones; areas like Scarborough and Haliburton are distinct in terms of their cultural diversity and rural character. Our area does show a higher than average proportion of recent immigrants, and a higher seniors population. There is a pattern in the ASMR data (see next page) indicating a generally healthier population, despite our high growth and proportion of elderly. This pattern is validated in our analysis for the Chronic Disease Prevention and Management priority that shows lower than provincial average PYLL (Potential Years of Lost Life) statistics for the CE LHIN. 10

11 Environmental Scan Overview Our Population: Health Outcomes Indicators Central East ONTARIO % Low birth weight babies ( ) 5.9% 5.6% Preterm birth rate per 1000 ( ) Infant mortality rate per 1000 livebirths ( ) Total Crude mortality rate per 100,000 ( ) Age-standardized mortality rate (ASMR) per 100, ASMR by ICD-10 chapter (top 5 chapters), rate per 100,000 ( ) Circulatory system diseases Neoplasms Respiratory system diseases External causes of mortality Endocrine, nutritional & metabolic diseases % of all deaths that occur before age % 21.3% % of all deaths that occur before age % 41.2% Neoplasms 1, ,590.3 Circulatory system diseases External causes of mortality Perinatal conditions Symptoms, signs not elsewhere classified Tables are based on Ministry of Health and Long-Term Care (HSIP, Discharge Abstract Database, 2001) 11

12 Environmental Scan Overview Our Population: Social & Demographic Characteristics Central East ONTARIO Annual Population Growth Rate (%) 3.1% 1.5% Dependency Ratio (2004) Senior Population: % aged 65+ (2004) 13.4% 12.8% % of all Census families, with children, headed by Lone parent 24.5% 23.4% % of Lone parent families headed by Female 83.2% 82.5% % of Lone parent families headed by Male 16.8% 17.5% % population reporting English mother tongue 74.4% 71.9% % population reporting French mother tongue 1.5% 4.7% % of population who are Immigrants 32.1% 26.8% % of population who are Recent Immigrants ( ) 5.7% 4.8% % of population who are visible minorities 30.4% 19.1% % population of Aboriginal identity 0.9% 1.7% Labour force participation rate (% population in labour force) 66.3% 67.3% Unemployment rate 6.7% 6.1% Incidence of low income (% population age 15+ below LICO) 14.8% 14.4% % of population (age 20+) with less than grade 9 education 7.7% 8.7% % population without high school graduation certificate 26.5% 25.7% % population with completed post-secondary education 46.2% 48.7% General Health Status Indicators % Population (age 12+) with Excellent or Very Good health 55.9% 57.4% % Population (age 12+) with an Activity Limitation 24.8% 24.6% Female life expectancy at birth Male life expectancy at birth Tables are based on 2001 Statistics Canada Census of population. 12

13 Environmental Scan Overview Our Population: Life Expectancy, 2001 Health Status General Health Central East ONTARIO Female life expectancy at birth Male life expectancy at birth Female life expectancy at age Male life expectancy at age Self rated Health Population (age 12+) reporting Excellent or Very Good health 703,100 5,903,100 Total population (age 12+) 1,258,000 10,278,700 % Population (age 12+) with Excellent or Very Good health 55.9% 57.4% Population with Activity Limitation Population (age 12+) with an Activity Limitation 312,300 2,533,600 Total population (age 12+) 1,258,000 10,278,700 % Population (age 12+) with an Activity Limitation 24.8% 24.6% Tables are based on Ministry of Health and Long-Term Care (HSIP, 2001) 13

14 Environmental Scan Overview Rurality: The CE LHIN has many rural areas as measured by the Ontario Medical Association Rurality Index of Ontario Score (RIO). A RIO score of 40 or greater is defined as a rural area. A score of 40 or greater indicates a higher degree of isolation, and difficulty accessing health care services. Availability and access to some health services was highlighted in our community consultation process.

15 Environmental Scan Overview Rurality: Rurality Index of Ontario Scores for Central East LHIN PZ Average of RIO Max of RIO Min of RIO Durham East Durham North / Central Durham West Haliburton Highlands Kawartha Lakes Northumberland Havelock Peterborough City and County Scarborough Agincourt - Rouge Scarborough Cliffs - Scarborough Centre Grand Total Definition of RIO Score: The index consists of 10 distinct, methodically measured factors grouped into two components. Five factors describing a community s relatively fixed geographic and physical situation, such as travel times to nearest referral centres, community population, social indicators, and weather conditions. Five factors relating to medical service delivery and physician workload, such as ratio of patients to family doctors, presence of a hospital, availability of ambulance services and whether selected forms of basic care are delivered locally. 15

16 Environmental Scan Overview Rurality: Population and Population Density of Central East and its Planning Zones LHIN Square Kilometres Total Population Estimate 2006 Pop. Density Population Density Rank Order 1. Central 3,074 1,613, Central East 16,673 1,483, Central West 2, , Champlain 18,625 1,191, Erie St. Clair 7, , Hamilton-Niagara-Haldimand-Brant 6,602 1,377, Mississauga-Halton 1,063 1,085,182 1, North East 414, , North Simcoe Muskoka 9, , North West 458, , South East 19, , South West 21, , Toronto Central 194 1,155,239 5, Waterloo-Wellington 4, , Provincial Averages/Totals 983,940 12,696, Haliburton Highlands 16

17 Environmental Scan Overview Our Health Care Services: Your Central East Local Health Integration Network has over 180 organizations providing health services. These organizations include hospitals, long-term care homes, housing for the frail elderly, community health programs, home care, social recreational programs like elderly persons centres, and mental health and addictions programs. Quick Facts: There are over 9,000 long-term care beds: These beds include basic, semi-private, private, short-stay, convalescent, and interim beds. Long-term care homes provide 24 hour nursing and residential care and services Most of these residents are the frail elderly with multiple and complex health care needs. LTCHs receive over $300 million dollars in funding in your CE LHIN. There are 10 hospital corporations in the CE LHIN, including one private hospital, and one speciality psychiatric hospital. CE LHIN hospitals receive over $1 billion dollars in funding.

18 Environmental Scan Overview Our Health Care Services: 18

19 Environmental Scan Overview Our Health Care Services: Total Program Funding, CE LHIN, , MOHLTC Data Mental Health and Addictions, $37,273,843, 2% LTC Homes, $311,628,145, 20% Acquired Brain Injury, $1,345,912, < 1% CCAC, $171,454,264, 11% Community Health Centres, $6,857,976, < 1% Community Support Services, $32,412,238, 2% Hospitals, $1,019,997,566, 65% 19

20 Environmental Scan Overview Hospital Services Provided to our Residents: People travel into and out of your LHIN to receive hospital and other health care services. It is important for your LHIN to understand these use patterns--maybe some of the care provided outside your LHIN could be provided here. The map example on the following page shows people from outside your LHIN who received obstetric care at the Peterborough Regional Health Centre. The table on the following page shows the percentage of hospital services provided to residents and non-residents. 13.4% of all hospital services in the CE LHIN are provided to out-of-lhin residents, and 25.3% of hospital services used by our residents are from other LHINs. The ratio of these two numbers is 1.89, meaning there is a net outflow of hospital service use by our residents. Some services have to be provided out of our LHIN, but what is the right mix of services we need in the CE LHIN? Some of our highest procedure use is listed in the table, and compared to the provincial average.

21 Environmental Scan Overview Hospital Services Provided to our Residents: Inter-LHIN Analysis, Inflow and Outflow of Patients Receiving Hospital Care (Service Volumes) LHIN % Provided to Non- Residents % Provided to Residents (outof-lhin service) Net Outflow Ratio Erie-St.Clair 1.2% 13.5% South West 14.4% 6.3% 0.44 Waterloo Wellington 7.3% 15.6% 2.13 Hamilton Niagara Haldimand 6.2% 7.1% 1.16 Central West 19.2% 38.2% 1.99 Mississauga Halton 20.5% 24.7% 1.21 Toronto Central 54.8% 16.9% 0.31 Central 31.3% 35.8% 1.14 Central East 13.4% 25.3% 1.89 South East 6.1% 11.0% 1.82 Champlain 9.8% 2.4% 0.25 North Simcoe Muskoka 10.6% 19.1% 1.80 North East 2.7% 8.9% 3.29 North West 2.4% 5.4% 2.21 Selected Statistics for Central East LHIN Total Inflow and Outflow, Service Volumes % of Service Volumes Inflow Outflow 25,428 55,739 Highest Volume Procedures Non-Residents Out-of-LHIN Provincial Outflow % Orthopaedics 22.7% 37.9% 24.7% Obstetrics 15.6% 23.6% 15.7% Cardio/Thoracic Surgery 14.9% 68.5% 37.0% Cardiology 9.4% 17.0% 11.6% Oncology 12.7% 38.0% 23.6% 21

22 Environmental Scan Overview Emergency Room Use Everyone at some time or another needs to rely on emergency medical care. In your CE LHIN, it is important to understand how this care is used, and for what purposes. The information we obtain on emergency room use is useful for deciding if we have enough care of the right type in the right areas. Patterns of use might indicate a gap in access to primary care, for example. The two pie charts on the following page show emergency room use by category of use. The category Treatment for Abnormal Findings group is high; this is service for undiagnosed problems. This category is higher for the 65+ age group, where diagnosing medical problems is known to be more difficult. The table on the following page shows emergency room visits for each planning zone, and some related statistics. In 2005, 319,633 people visited emergency rooms in the CE LHIN. The total visits by this group were 538,316, meaning on average people who used emergency services had 1.7 visits. In Haliburton Highlands, one is much more likely to use emergency room services, and more likely to need repeat services. There is a very strong and positive correlation between emergency room use and rurality (r=.850), meaning the more rural an area, the more likely one will visit an emergency room.

23 Environmental Scan Overview Emergency Room Use: Emergency Room Visits, Central East LHIN, 2005, 65+ Only Emergency Visits, CE LHIN, 2005 All Ages, MOHLTC NACRS Data Circulatory 11% Digestive System 7% Other 15% External Caused, i.e. injuries and poisonings 16% Eye and Mastoid Process 3% Joint and muscle pain, including arthritis 6% Treatment for abnormal findings 26% Skin and subcutaneous tissue diseases 3% Respiratory 9% Renal failure, urinary tract infections 4% Digestive System 7% Circulatory 4% External Caused, i.e. injuries and poisonings 25% Other 16% Eye and Mastoid Process 4% Treatment for abnormal findings 20% Skin and subcutaneous tissue diseases 3% Respiratory 11% Renal failure, urinary tract infections 4% Joint and muscle pain, including arthritis 6% Planning Zone Patients Rate/1,000 Number of Visits Visits per Patient % of Population that Visited ER Rurality Score Durham East 41, , % 14.8 Durham North / Central 14, , % 42.8 Durham West 61, , % 10.3 Haliburton Highlands 9, , % 76.9 Kawartha Lakes 25, , % 58.4 Northumberland Havelock 24, , % 58.5 Peterborough City and County 42, , % 42.3 Scarborough Agincourt - Rouge 34, , % 5.2 Scarborough Cliffs - Scarborough Centre 57, , % 5.5 Missing PZ designation 9,008 N/A 12, N/A CE LHIN Totals 319, , %

24 Planning Zone 1 Profile Haliburton Highlands Highlights Highest % of Population over age 65 Highest % Population with less than grade 9 Highest % Population without High school Lowest % of post-secondary completed Haliburton Highlands Planning Zone 24

25 Planning Zone 1 Profile Haliburton Highlands Health Care Provider Profile LHIN Planning Zone Haliburton Highlands Health Care Provider Total per 1,000 pop. PZ Rank Dentists th Nurse Practitioner th - tied Other th - tied Physicians th Practitioners th Psychiatry th Total th Chronic Diseases Profile Major Diagnostic Category Haliburton Rate / 100,000 pop. Highlands Rank CE LHIN Ontario Cancer th Diabetes Rate rd Obesity Rate th Mental Illness Rate th Cardio-Vascular th Respiratory Rate th Arthritis th

26 Planning Zone 1 Profile Haliburton Highlands Demographic Statistics Haliburton Highlands Central East LHIN Province of Ontario Population, ,085 1,347,017 11,410,046 Total population age 65 and over 3, ,660 1,472,170 % population age 65 and over 24% 13% 13% % lone parent families 20% 24% 23% % non-owned private dwellings 16% 27% 32% % population English mother tongue 94% 74% 72% % population with no knowledge of English or French 0% 3% 2% % immigrant population 10% 32% 27% % recent immigrant population 1% 6% 5% % visible minority population 0% 30% 19% % Aboriginal identity population 1% 1% 2% Participation rate (age 15+) 51% 66% 67% Unemployment rate (age 15+) 5% 7% 6% % population with less than grade 9 education 11% 8% 9% % population without completed high school education 36% 26% 26% % population with completed post-secondary education 39% 46% 49% % population in low income 13% 15% 14% Low birth weight babies ( ) 5% 6% 6% Infant mortality rate per 1000 livebirths ( )

27 Planning Zone 2 Profile Kawartha Lakes Highlights Lowest Immigrant population 27

28 Planning Zone 2 Profile Kawartha Lakes Health Care Provider Profile LHIN Planning Zone Kawartha Lakes Health Care Provider Total per 1,000 pop. PZ Rank Dentists nd Nurse Practitioner rd Other th - tied Physicians nd Practitioners st Psychiatry th Total nd Chronic Diseases Profile Major Diagnostic Category Kawartha Lakes Rank CE LHIN Ontario Cancer th Diabetes Rate th Obesity Rate th Mental Illness Rate th Cardio-Vascular th Respiratory Rate th Arthritis th

29 Planning Zone 2 Profile Kawartha Lakes Demographic Statistics Kawartha Lakes Central East LHIN Province of Ontario Population, ,179 1,347,017 11,410,046 Total population age 65 and over 13, ,660 1,472,170 % population age 65 and over 19% 13% 13% % lone parent families 21% 24% 23% % non-owned private dwellings 17% 27% 32% % population English mother tongue 95% 74% 72% % population with no knowledge of English or French 0% 3% 2% % immigrant population 8% 32% 27% % recent immigrant population 0% 6% 5% % visible minority population 1% 30% 19% % Aboriginal identity population 1% 1% 2% Participation rate (age 15+) 60% 66% 67% Unemployment rate (age 15+) 7% 7% 6% % population with less than grade 9 education 8% 8% 9% % population without completed high school education 34% 26% 26% % population with completed post-secondary education 40% 46% 49% % population in low income 10% 15% 14% Low birth weight babies ( ) 5% 6% 6% Infant mortality rate per 1000 livebirths ( )

30 Planning Zone 3 Profile Peterborough City & County Highlights Highest % of Aboriginal People (+ 3,000) Highest Youth Unemployment Rate at 16.7% 30

31 Planning Zone 3 Profile Peterborough City & County Health Care Provider Profile LHIN Planning Zone Peterborough City & County Health Care Provider Total per 1,000 pop. PZ Rank Dentists st Nurse Practitioner st Other st Physicians st Practitioners nd Psychiatry st Total st Chronic Diseases Profile Major Diagnostic Category Peterborough Rank CE LHIN Ontario Cancer th Diabetes Rate th Obesity Rate th Mental Illness Rate th Cardio-Vascular th Respiratory Rate th Arthritis th

32 Planning Zone 3 Profile Peterborough City & County Demographic Statistics Peterborough City and County Central East LHIN Province of Ontario Population, ,377 1,347,017 11,410,046 Total population age 65 and over 21, ,660 1,472,170 % population age 65 and over 18% 13% 13% % lone parent families 25% 24% 23% % non-owned private dwellings 26% 27% 32% % population English mother tongue 94% 74% 72% % population with no knowledge of English or French 0% 3% 2% % immigrant population 9% 32% 27% % recent immigrant population 1% 6% 5% % visible minority population 2% 30% 19% % Aboriginal identity population 3% 1% 2% Participation rate (age 15+) 62% 66% 67% Unemployment rate (age 15+) 7% 7% 6% % population with less than grade 9 education 7% 8% 9% % population without completed high school education 27% 26% 26% % population with completed post-secondary education 47% 46% 49% % population in low income 14% 15% 14% Low birth weight babies ( ) 5% 6% 6% Infant mortality rate per 1000 livebirths ( )

33 Planning Zone 4 Profile Northumberland & Havelock Highlights Highest % Population who s mother tongue is English 33

34 Planning Zone 4 Profile Northumberland & Havelock Health Care Provider Profile LHIN Planning Zone Northumberland & Havelock Health Care Provider Total per 1,000 pop. PZ Rank Dentists rd Nurse Practitioner th - tied Other th - tied Physicians rd Practitioners th Psychiatry th Total rd Chronic Diseases Profile Major Diagnostic Category North. & Rate / 100,000 pop. Havelock Rank CE LHIN Ontario Cancer nd Diabetes Rate th Obesity Rate 2.3 1st Mental Illness Rate th Cardio-Vascular nd Respiratory Rate nd Arthritis nd

35 Planning Zone 4 Profile Northumberland & Havelock Demographic Statistics Northumberland Havelock Central East LHIN Province of Ontario Population, ,527 1,347,017 11,410,046 Total population age 65 and over 12, ,660 1,472,170 % population age 65 and over 18% 13% 13% % lone parent families 22% 24% 23% % non-owned private dwellings 22% 27% 32% % population English mother tongue 95% 74% 72% % population with no knowledge of English or French 0% 3% 2% % immigrant population 10% 32% 27% % recent immigrant population 0% 6% 5% % visible minority population 2% 30% 19% % Aboriginal identity population 2% 1% 2% Participation rate (age 15+) 62% 66% 67% Unemployment rate (age 15+) 7% 7% 6% % population with less than grade 9 education 7% 8% 9% % population without completed high school education 31% 26% 26% % population with completed post-secondary education 42% 46% 49% % population in low income 9% 15% 14% Low birth weight babies ( ) 5% 6% 6% Infant mortality rate per 1000 livebirths ( )

36 Planning Zone 5 Profile Durham East Highlights Almost average in every category 36

37 Planning Zone 5 Profile Durham East Health Care Provider Profile LHIN Planning Zone Durham East Health Care Provider Total per 1,000 pop. PZ Rank Dentists th Nurse Practitioner th Other rd Physicians th Practitioners th Psychiatry th Total th Chronic Diseases Profile Major Diagnostic Category Rate / 100,000 pop. Durham East Rank CE LHIN Ontario Cancer rd Diabetes Rate nd Obesity Rate th Mental Illness Rate nd Cardio-Vascular rd Respiratory Rate th Arthritis rd

38 Planning Zone 5 Profile Durham East Demographic Statistics Durham East Central East LHIN Province of Ontario Population, ,885 1,347,017 11,410,046 Total population age 65 and over 23, ,660 1,472,170 % population age 65 and over 11% 13% 13% % lone parent families 25% 24% 23% % non-owned private dwellings 27% 27% 32% % population English mother tongue 89% 74% 72% % population with no knowledge of English or French 0% 3% 2% % immigrant population 14% 32% 27% % recent immigrant population 1% 6% 5% % visible minority population 5% 30% 19% % Aboriginal identity population 1% 1% 2% Participation rate (age 15+) 69% 66% 67% Unemployment rate (age 15+) 6% 7% 6% % population with less than grade 9 education 7% 8% 9% % population without completed high school education 28% 26% 26% % population with completed post-secondary education 44% 46% 49% % population in low income 11% 15% 14% Low birth weight babies ( ) 5% 6% 6% Infant mortality rate per 1000 livebirths ( )

39 Planning Zone 6 Profile Durham West Highlights Lowest % population age 65+ Lowest % of rented private dwellings Lowest % Population with less than grade 9 Lowest % Population without High school Highest % of post-secondary completed 39

40 Planning Zone 6 Profile Durham West Health Care Provider Profile LHIN Planning Zone Durham West Health Care Provider Total per 1,000 pop. PZ Rank Dentists th Nurse Practitioner th Other th Physicians th Practitioners th Psychiatry nd Total th Chronic Diseases Profile Major Diagnostic Category Durham West Rank CE LHIN Ontario Cancer th Diabetes Rate th Obesity Rate th Mental Illness Rate th Cardio-Vascular th Respiratory Rate th Arthritis th

41 Planning Zone 6 Profile Durham West Demographic Statistics Durham West Central East LHIN Province of Ontario Population, ,305 1,347,017 11,410,046 Total population age 65 and over 19, ,660 1,472,170 % population age 65 and over 8% 13% 13% % lone parent families 19% 24% 23% % non-owned private dwellings 15% 27% 32% % population English mother tongue 85% 74% 72% % population with no knowledge of English or French 0% 3% 2% % immigrant population 24% 32% 27% % recent immigrant population 2% 6% 5% % visible minority population 20% 30% 19% % Aboriginal identity population 1% 1% 2% Participation rate (age 15+) 75% 66% 67% Unemployment rate (age 15+) 5% 7% 6% % population with less than grade 9 education 4% 8% 9% % population without completed high school education 18% 26% 26% % population with completed post-secondary education 53% 46% 49% % population in low income 7% 15% 14% Low birth weight babies ( ) 6% 6% 6% Infant mortality rate per 1000 livebirths ( )

42 Planning Zone 7 Profile Durham North/Central Highlights Lowest % of Lone Parent Families Lowest Unemployment Rate (4.6%) Lowest youth Unemployment Rate Lowest % Population identified as low income 42

43 Planning Zone 7 Profile Durham North/Central Health Care Provider Profile LHIN Planning Zone Durham North / Central Health Care Provider Total per 1,000 pop. PZ Rank Dentists th Nurse Practitioner nd Other th - tied Physicians th Practitioners rd Psychiatry th Total th Chronic Diseases Profile Major Diagnostic Category Rate / 100,000 pop. Durham North / Central Rank CE LHIN Ontario Cancer th Diabetes Rate th Obesity Rate th Mental Illness Rate rd Cardio-Vascular th Respiratory Rate rd Arthritis th

44 Planning Zone 7 Profile Durham North/Central Demographic Statistics Durham North/Central Central East LHIN Province of Ontario Population, ,711 1,347,017 11,410,046 Total population age 65 and over 6, ,660 1,472,170 % population age 65 and over 14% 13% 13% % lone parent families 17% 24% 23% % non-owned private dwellings 16% 27% 32% % population English mother tongue 94% 74% 72% % population with no knowledge of English or French 0% 3% 2% % immigrant population 10% 32% 27% % recent immigrant population 0% 6% 5% % visible minority population 2% 30% 19% % Aboriginal identity population 1% 1% 2% Participation rate (age 15+) 70% 66% 67% Unemployment rate (age 15+) 5% 7% 6% % population with less than grade 9 education 6% 8% 9% % population without completed high school education 27% 26% 26% % population with completed post-secondary education 45% 46% 49% % population in low income 6% 15% 14% Low birth weight babies ( ) 5% 6% 6% Infant mortality rate per 1000 livebirths ( )

45 Planning Zone 8 Profile Scarborough Agincourt Rouge Highlights Lowest % of Population where English is Mother Tongue Highest % of Population with no knowledge of French or English Highest % of rented private dwellings Highest Percent of Immigrant population (61.7%) High Percent of Low Birth Babies (7.2%) 45

46 Planning Zone 8 Profile Scarborough Agincourt Rouge Health Care Provider Profile LHIN Planning Zone Scarborough Agincourt - Rouge Health Care Provider Total per 1,000 pop. PZ Rank Dentists th Nurse Practitioner th - tied Other nd Physicians th Practitioners th Psychiatry th Total th Chronic Diseases Profile Major Diagnostic Category Scarb. Agincourt - Rank Rate / 100,000 pop. Rouge CE LHIN Ontario Cancer st Diabetes Rate st Obesity Rate 7.0 2nd Mental Illness Rate st Cardio-Vascular st Respiratory Rate st Arthritis st

47 Planning Zone 8 Profile Scarborough Agincourt Rouge Demographic Statistics Scarborough Agincourt - Rouge Central East LHIN Province of Ontario Population, ,149 1,347,017 11,410,046 Total population age 65 and over 31, ,660 1,472,170 % population age 65 and over 12% 13% 13% % lone parent families 24% 24% 23% % non-owned private dwellings 27% 27% 32% % population English mother tongue 46% 74% 72% % population with no knowledge of English or French 8% 3% 2% % immigrant population 62% 32% 27% % recent immigrant population 12% 6% 5% % visible minority population 72% 30% 19% % Aboriginal identity population 0% 1% 2% Participation rate (age 15+) 65% 66% 67% Unemployment rate (age 15+) 7% 7% 6% % population with less than grade 9 education 10% 8% 9% % population without completed high school education 26% 26% 26% % population with completed post-secondary education 48% 46% 49% % population in low income 19% 15% 14% Low birth weight babies ( ) 7% 6% 6% Infant mortality rate per 1000 livebirths ( )

48 Planning Zone 9 Profile Scarborough Cliffs Centre Highlights Highest % of Lone Parent Families Highest % of rented private dwellings (44.5%) Highest % of Recent immigrant population (12.3%) Highest Unemployment Rate (8.0%) Highest % Population in Low Income (24.7%) 48

49 Planning Zone 9 Profile Scarborough Cliffs Centre Health Care Provider Profile LHIN Planning Zone Scarborough Cliffs - Scarborough Centre Health Care Provider Total per 1,000 pop. PZ Rank Dentists th Nurse Practitioner th Other th Physicians th Practitioners th Psychiatry rd Total th Chronic Diseases Profile Major Diagnostic Category Scarb. Cliffs - Rate / 100,000 pop. Centre Rank CE LHIN Ontario Cancer th Diabetes Rate th Obesity Rate 8.8 3rd Mental Illness Rate th Cardio-Vascular th Respiratory Rate th Arthritis th

50 Planning Zone 9 Profile Scarborough Cliffs Centre Demographic Statistics Scarborough Cliffs - Centre Central East LHIN Province of Ontario Population, ,799 1,347,017 11,410,046 Total population age 65 and over 40, ,660 1,472,170 % population age 65 and over 14% 13% 13% % lone parent families 32% 24% 23% % non-owned private dwellings 44% 27% 32% % population English mother tongue 59% 74% 72% % population with no knowledge of English or French 4% 3% 2% % immigrant population 50% 32% 27% % recent immigrant population 12% 6% 5% % visible minority population 50% 30% 19% % Aboriginal identity population 1% 1% 2% Participation rate (age 15+) 63% 66% 67% Unemployment rate (age 15+) 8% 7% 6% % population with less than grade 9 education 9% 8% 9% % population without completed high school education 29% 26% 26% % population with completed post-secondary education 44% 46% 49% % population in low income 25% 15% 14% Low birth weight babies ( ) 8% 6% 6% Infant mortality rate per 1000 livebirths ( )

51 = Value is above Central East Average As can be seen in the above chart, the two Scarborough Planning Zones (and the associated large populations) drive a lot of the averages. The weight and diversity of this population balances with the other planing zones, and thus gives the CE LHIN the illusion of being very similar to the average population of the province in most of the top demographic categories. The true effect is that in most cases, the Scarborough PZ s are above the provincial average, and the remaining PZ s are below (or vice versa), resulting in a calculated Central East LHIN average similar to the provincial average. 51

52 Environmental Scan Priority Area Analysis: Seamless Care for Seniors Like many places in Ontario, the people of your CE LHIN are getting older at a higher than average rate. There are many reasons for this demographic shift: an ageing baby boomer population overall, for many people the CE LHIN is a desirable place to retire, and rural areas such as those in your LHIN, tend to have an older population. Health care use increases as we age. While there is much one can do to maintain good health at any age, age and sex composition of a population remains one of the most predictable indicators of health care use. One area of concern we heard throughout our community engagement was the importance of providing seamless care and supports for seniors. A significant consequence of our ageing population is the increase in age related mental disorders like dementia, depression and other age related illnesses. The table on the next page shows how our population is ageing between 2001 and 2016, and the estimate of age related mental disorders. The chart graphically shows these changes over the next 10 years.

53 Environmental Scan Priority Area Analysis: Seamless Care for Seniors Percentage Growth from Base Year 100.0% 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% Population Projections and Psychogeriatric Estimates for Central East LHIN Year Dementia Depression Other Disorders 53

54 Environmental Scan Priority Area Analysis: Seamless Care for Seniors Base Year (2001) Population Estimates from the Ministry of Finance. Disorder rates from the Canadian Study on Health and Aging CE LHIN Population % of Population Population % of Population % Increase from Base Year CE LHIN Population % of Population % Increase from Base Year Total Population 1,402, % 1,483, % 5.7% 1,677, % 19.6% ,223, % 1,287, % 5.2% 1,412, % 15.5% , % 195, % 9.1% 264, % 47.5% , % 101, % 2.2% 150, % 50.4% , % 70, % 15.2% 79, % 29.7% , % 23, % 26.6% 35, % 91.3% Dementia Estimate 15, % 18, % 17.6% 24, % 56.8% Other Disorders 14, % 15, % 9.1% 21, % 47.5% 54

55 Environmental Scan Priority Area Analysis: Seamless Care for Seniors The previous page showed how our LHIN population is ageing, and in particular, the increase in age related mental disorders. A significant challenge for your LHIN will be how we plan, manage and fund the services our seniors require. Continuing to fund program growth to match our ageing population is probably not sustainable. We need to ensure that we are making the best use of current health care programs by investing strategically in services that will ensure the right care in the right place at the right time for our seniors and their caregivers. The chart on the right shows the decline in the long-term care bed ratio for the 75+ population (see next page). This ratio declines because our population is ageing, and the bed numbers are fixed. Should your LHIN simply respond to this decline by requesting more funding for these beds, or are there better alternatives? Most people want to stay in their own homes as long as possible. A better response might be to invest in home care and supportive housing. A similar problem is apparent for community support programs (CSS) for seniors. The left chart s red line is our projected demand for CSS programs at the current use rate can we continue to fund programs at this rate, and should we? The table on the bottom right shows some of our major programs, and our use rate compared to the provincial average (see next page). 55

56 Environmental Scan Priority Area Analysis: Seamless Care for Seniors Projected Units for CSS Over 65 Years Programs Projected LTC Beds per 1, Total Units Required Based on ,600,000 1,500,000 1,400,000 1,300,000 1,200,000 1,100,000 1,000, Year Beds per 1, Gap in bed supply assuming no changes Year Projected Units Currents Units Central East Ontario Major Community Support Services Programs Utilization Rate / 1,000 Elderly Ontario CE LHIN CE LHIN Rate Over/(Under) Adult Day Programs Client Intervention and Assistance Service Meal Programs (not including MOW) Emergency Response Systems Foot Care Friendly Visiting and Security Checks 1, , Home Help and Homemaking Programs Supportive Housing (personal support) 1, , Meals on Wheels 1, , Psychogeriatric Consulting Services Transportation , Public Education Coordinator Average Rate 6, ,

57 Environmental Scan Priority Area Analysis: Chronic Disease Prevention and Management Chronic disease has been defined as: Illnesses that are prolonged, do not resolve spontaneously and are rarely cured completely. * The diseases that can be included in this definition can vary. Your CE LHIN has decided to use a set of diseases typically used by the Ministry of Health and Long-Term Care, and these are profiled in the table on the following page.there is a pattern in the rates of these diseases that reflect our ageing population in the CE LHIN. Age related diseases like diabetes, dementias, cardiovascular, respiratory and arthritis are higher in the CE LHIN compared to the provincial average. A common measure of the effect of disease on a population is the indicator Potential Years of Lost Life or PYLL. This indicator measures the incidence of death before age 75. The table on the following page shows the comparative statistics for the chronic disease profile for the Central East LHIN and Ontario. * Marks, J.S. The Burden of Chronic Disease and Future of Public Health. National Center for Chronic Disease Prevention & Health Promotion, January 13, 2003.

58 Environmental Scan Priority Area Analysis: Chronic Disease Prevention and Management Hospitalizations: Chronic Diseases (Data from Discharge Abstract Database, MOHLTC, 2004) Disease Chronic Disease Group Rate / 100,000 Cases % to Total Cases Average Age Average Stay Days Rate / 100,000 Cases % to Total Cases Average Age Colo-rectal cancer Lung cancer Skin cancer Breast cancer Prostate cancer Diabetes type 1 Diabetes type 2 Diabetes unspecified Obesity Cancer Diabetes Obesity ,455 12, % 4.7% 0.4% ,867 1, % 4.7% 0.5% Senile Depression Alzheimer's disease Hypertension/HT heart disease without CHF IHD (Angina, AMI) Congestive Heart Failure/HT heart disease with CHF Stroke Atherosclerosis COPD (Bronchitis+Emphysema) Asthma Arthritis Mental Illness Cardiovascular Respiratory Arthritis , ,194 32,536 28, % 42.5% 12.7% 11.2% ,054 12,410 3,658 3, % 42.7% 12.6% 11.4% Gout Fractures Falls Non-trauma (slip, fall from chair, bed, in building etc.) Parkinson's disease Migraine headaches Epilepsy Multiple sclerosis Other , % , % 58 8 Total 2, , ,000 29, Population 2004 Provincial 12,407,348 Central East Local Health Integration Network 1,453,232 Average Stay Days Potential Years of Lost Life (PYLL) Calculations for Selected Diagnostic Categories. PYLL rate=years of life lost before 75 yr. (Data Source: Ontario 2003 Vital Statistics Database) Major Diagnostic Category Central East Ontario Cancer Average Age PYLL Rate / 1, Diabetes Average Age PYLL Rate / 1, Obesity Average Age PYLL Rate / 1, Mental Illness Average Age PYLL Rate / 1, Cardio-Vascular Average Age PYLL Rate / 1, Respiratory Average Age PYLL Rate / 1, Arthritis Average Age PYLL Rate / 1, Other Average Age PYLL Rate / 1, Total by LHIN 12, ,656 PYLL Rate / 1,

59 Environmental Scan Priority Area Analysis: Chronic Disease Prevention and Management Identifying and accessing services can be a challenge for people with a chronic disease. Healthcare providers are also challenged to provide care to a growing number of newly diagnosed individuals and to those whose needs are intensifying and/or have more than one chronic condition. The total prevalence of individuals with a chronic condition in CE is very similar to the province. In the CE LHIN there are higher rates of diabetes, heart disease, high blood pressure and arthritis/rheumatism for some zones, a finding that is consistent with their age profile. The table below shows physician access rates by age category for diabetes treatment (OHIP data billing code=250). Diabetes: Physician Access (individuals) / 100 people CE LHIN and Ontario, OHIP Data from MOHLTC, 2004 Central East LHIN Ontario Age Group Total Cases Rate/100 Total Cases Rate/ , , , , , , , , Total 83, ,

60 Environmental Scan Priority Area Analysis: Chronic Disease Prevention and Management North. & Havelock Peterborough Scarb. Agincourt Rouge Scarb. Cliffs Center Average Age Rate / 100, Total Inpatient Days Avg. Length of Stay Average Age Rate / 100, Total Inpatient Days Avg. Length of Stay Average Age Rate / 100, Ontario Kawartha 3372 Avg. Length of Stay CE LHIN Haliburton Minden Total Inpatient Days Major Diagnostic Category Durham East Durham North / Central The table on the right show hospitalizations for the chronic disease profile. Effective management of chronic disease can assist in reducing the need to access urgent/emergency care. In 2005, there were 60,983 visits to a CE hospital Emergency Room by individuals with a chronic disease; this represents 11.3% of the total ER visits in the LHIN. The pie chart below shows the breakdown of ER visits by chronic condition. Durham West Hospitalizations for Selected Chronic Diseases by Central East Region Planning Zone Areas. Data and calculations based on MOHLTC Discharge Abstract Database, and Ministry of Finance Population Projections for 2004 Cancer Diabetes Obesity Mental Illness Total Inpatient Days Avg. Length of Stay Average Age Rate / 100, Cardio-Vascular Emergency Room Visits for Individuals with a Chronic Disease, CE LHIN, 2005, NACRS Diabetes 5% Cancer 3% Mental Illness 3% Total Inpatient Days Average Length of Stay Average Age Rate / 100, Total Inpatient Days Avg. Length of Stay Average Age Rate / 100, Total Inpatient Days Avg. Length of Stay Average Age Rate / 100, Total Inpatient Days Avg. Length of Stay Average Age Rate / 100, Total Inpatient Days Avg. Length of Stay Average Age Average Rate / 100, Respiratory Arthritis Other Totals

61 Environmental Scan Priority Area Analysis: Mental Health and Addictions Mental health and addictions were identified as a priority during our community engagement process. In Ontario in 2004 there were over 1.8 million individuals over 15 years old (18% of the total population) who visited their doctor for a mental health problem, for a total of 8.4 million visits. On average, therefore, each individual visited their doctor almost five times for their mental health problems. These visits do not include institutional patients (those in a hospital or a long-term care home, for example).

62 Environmental Scan Priority Area Analysis: Mental Health and Addictions Mental health contact recorded in Ontario Health Insurance Plan (OHIP) 2004 Number of People Prevalence Rate /1,000 Population 15+ Proportion of the Total Population (%) Total 1,831, % Sex Men 727, % Women 1,103, % These disorder codes were used to prepare the pie charts on the following pages. Age Group (years) , % , % , % 65 and over 356, % Local Health Integration Networks Disorder Groupings Based on DSM-IV Block Codes Central East Local Health Integration Network 216, % Central Local Health Integration Network 220, % Central West Local Health Integration Network 102, % Anxiety Disorders, Somataform, and Dissociative Disorders Delirium, Dementia, Amnestic and Other Cognitive Disorders Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence Mood Disorders Other conditions Personality Disorders Schizophrenia and Other Psychotic Disorders Substance-Related Disorders Champlain Local Health Integration Network 189, % Erie St. Clair Local Health Integration Network 98, % Hamilton Niagara Haldimand Brant Local Health Integration Network 200, % Mississauga Halton Local Health Integration Network 140, % North East Local Health Integration Network 85, % North Simcoe Muskoka Local Health Integration Network 64, % North West Local Health Integration Network 28, % South East Local Health Integration Network 69, % South West Local Health Integration Network 132, % Toronto Central Local Health Integration Network 201, % Waterloo Wellington Local Health Integration Network 81, % 62

63 Environmental Scan Priority Area Analysis: Mental Health and Addictions Primary Care Access for Mental Health and Addiction Services, Data from 1 year Medical Services Tables for Exluding Institutional Patients, Total Visits by Grouped Diagnostic Codes 290 to 319 Ontario Schizophrenia and Other Psychotic Disorders 10% Substance-Related Disorders 8% Personality Disorders 2% Anxiety Disorders 50% Other Conditions 9% Mood Disorders 10% Disorders Diagnosed in Infancy, Childhood, or Adolescence 1% Delirium, Dementia, Amnestic and Other Cognitive Disorders 10% These charts display the distribution of the diagnostic categories between non-community based services: primary care (97% of all visits), ambulatory and emergency services (2% of all visits), and acute hospital care (1% of all visits). 63

64 Environmental Scan Priority Area Analysis: Mental Health and Addictions Mental Health and Addictions Diagnoses in Acute Care Hospitalizations All Ages, Breakout by DSM-IV Diagnosis, CE LHIN Only, Percent, 2004 Substance-Related Disorders 14% Anxiety Disorders, Somataform, and Dissociative Disorders 10% Delirium, Dementia, Amnestic and Other Cognitive Disorders 7% Schizophrenia and Other Psychotic Disorders 23% Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence 3% Personality Disorders 3% Other conditions 1% Mood Disorders 39% 64