Mississauga Halton LHIN

Transcription

1 Mississauga Halton LHIN Environmental Scan February

2 Table of Contents Geography MH LHIN Population Profile Social Determinants of Health Health Status Chronic Conditions Mental Health & Addictions Cancer Primary Health Care Health Service Providers in the MH LHIN Health Service Utilization Health Human Resources Summary 2

3 Mississauga Halton LHIN Profile Geography Population Profile Aging Diversity 3

4 Geography The Mississauga Halton LHIN is diverse in terms of its geography and population profile. The MH LHIN shares borders with four other LHINs, including Central West, Toronto Central, Hamilton Niagara Haldimand Brant, and Waterloo Wellington. The MH LHIN has six planning areas, including Halton Hills, Oakville, Milton, Northeast Mississauga, Southwest Mississauga, and South Etobicoke (see map next slide). 4

5 Map of Mississauga Halton Sub-LHIN Planning Zones Waterloo Wellington LHIN Central West LHIN Sub-LHIN Planning Zones Halton Hills Milton 2 Mississauga Halton LHIN Oakville Northwest Mississauga Southeast Mississauga South Etobicoke 6 Hamilton Niagara Haldimand Brant LHIN 5

6 Our Population Profile While the Mississauga Halton LHIN is one of the most geographically compact LHINs in the province, it is the sixth largest LHIN based on population. The Mississauga Halton LHIN is home to 1,152,914 residents (2010), containing 8.74% of Ontario s total population. This is up from 7.88% of the Ontario population in 2001 (Statistics Canada, 2006 Census of Population). The MH LHIN will experience a further projected growth of 10.6% from 2010 to 2015, which is an increase in our population of 122,661 residents. Source: Pop Proj Summary LHIN, (Stats Can) Intellihealth, MOHLTC. 6

7 Population by Sub-LHIN Area, 2008 Sub-LHIN Area Population Halton Hills 60,206 Milton 58,755 Oakville 180,775 Northwest Mississauga 343,335 Southeast Mississauga 358,587 South Etobicoke 108,918 TOTAL 1,110,576 Source: 2006 Block to SubLHIN crosswalk, Version 9.1 (Ministry of Health and Long Term Care, Health Analytics Branch, January 2010). Population estimates by age and sex for census subdivisions, July 1, 1996 to 2008, Ontario (Statistics Canada, Demography Division, customized data - Statistique Canada, Division de la démographie, données personnalisées) 7

8 Population by Dissemination Area in the MH LHIN, 2006 Census A dissemination area (DA) is a small, relatively stable geographic unit and is the smallest standard geographic area for which all census data are disseminated. As a general rule of thumb, DAs have relatively consistent population counts, meaning that a geographically smaller DA is likely to be more densely populated than a larger DA. As we would expect, this map shows that the most densely populated areas of the MH LHIN are in the urban areas of South Etobicoke, Mississauga and Oakville, with Milton also having some DAs with large populations. 8

9 Aging The demographic composition of the MH LHIN will continue to change; one notable trend is the aging of the population. Age is the greatest predictor of increased illness and use of health care services; and a higher proportion of residents in older age cohorts will have greater demands on the local health care system. The growing number of seniors in the MH LHIN emphasizes the need to plan for the health care needs of an aging population. 9

10 Percent of Population Aged 65+ by Sub-LHIN Area Distribution of Population 65+, 2008 Southeast Mississauga 31% Northwest Mississauga 29% South Etobicoke- Toronto 13% Milton 4% Halton Hills 5% Oakville 18% 14% 12% 10% 8% 6% 4% 2% 0% Percent of Sub-LHIN Populations Aged 65+, 2008 Of all people aged 65+ in the MH LHIN, 60% live in Mississauga; that is, of the 118, 444 people aged 65+, approximately 71,000 live in Mississauga. South Etobicoke has the highest percentage of residents aged 65+, with approximately 14% of the population being aged 65 or over. Source: Ministry of Finance Population Projections by LHIN from C , based on Census Survey data up to

11 Persons Aged 65+ by Dissemination Area (DA) This map shows the number of persons aged 65 or older by Dissemination Area in the MH LHIN, as per the 2006 Census. The DAs with the largest numbers of persons aged 65 or older are found in Mississauga and South Etobicoke, but there are pockets with large numbers of seniors throughout the MH LHIN. 11

12 Population Growth MH LHIN Growth (from 2010) Ontario Growth (from 2010) ,156,734-13,220,437 - Mississauga Halton LHIN Projected Growth ,277, % 14,025, % ,412, % 14,906, % Mississauga Halton LHIN Projected Growth to 2020 by Age Group Ages MH LHIN (2020) Growth (From 2010) Ontario (2020) Growth (From 2010) , % 2,434, % , % 5,816, % , % 4,043, % , % 1,483, % , % 781, % , % 346, % Source: Ministry of Finance Population Projections by LHIN from C , based on Census Survey data up to

13 MH LHIN Population Projections by Cohort Compared to Ontario, 2010 to 2035 Age Cohort MH LHIN 2010 MH LHIN 2035 % Change Ontario 2010 Ontario 2035 % Change , , % 3,086,259 3,817, % , , % 4,607,157 5,465, % , , % 3,690,665 4,284, % , , % 969,802 1,989, % , , % 866,554 2,112, % TOTAL 1,156,734 1,840, % 13,220,437 17,668, % Source: Ministry of Finance Population Projections by LHIN from C , based on Census Survey data up to

14 MH LHIN Population Projections by Cohort Compared to Ontario, 2010 to 2035 This chart demonstrates population growth by age cohort from 2010 to 2035 in the MH LHIN and the province of Ontario. We can see that the MH LHIN and Ontario follow a similar pattern of growth by age cohort, in that the those aged and 75+ will experience the largest percentage of growth. However, it is projected that the MH LHIN will experience a higher rate of growth than the province across all age cohorts. Source: Ministry of Finance Population Projections by LHIN from C , based on Census Survey data up to

15 MH LHIN Population Growth This chart demonstrates population growth by age group from 2010 to 2035, in terms of actual numbers of residents and percent growth. We can see that there is growth in all age groups. Although people aged will continue to be the largest age cohort, the percent change is highest in those aged 75+, followed by those aged Source: Ministry of Finance Population Projections by LHIN from C , based on Census Survey data up to It is projected that by 2035, there will be almost two and half times more people aged 75+ in the MH LHIN than there are currently. 15

16 Population Growth in the Mississauga Halton adds to the urgency for change Large & growing population. The growth projections by cohort for the MH LHIN are consistent with the provincial trend as a whole, but the growth rate is higher. Over the next 10 years, from 2010 to 2020, the population of the MH LHIN is expected to grow by 22.1% (from 1,156,734 to 1,412,123), compared to 12.8% for the province of Ontario over the same time period. By 2035, MH LHIN population is projected to be over 1.8 million. 16

17 Diversity The MH LHIN is one of the most diverse LHINs, with 36% of the population being a visible minority. Visible Minority Milton Halton Hills Sub-LHIN Area Oakville Northwest Mississauga Southeast Mississauga South Etobicoke LHIN Total Ontario Total population (2006) 53,410 55, , , , ,735 1,002,225 12,028,895 Not a visible minority 82.9% 95.9% 81.6% 48.0% 56.8% 75.9% 639, % 9,283, % Total visible minority population 17.1% 4.1% 18.4% 52.0% 43.2% 24.1% 362, % 2,745, % Chinese 1.5% 0.6% 3.2% 8.2% 6.5% 3.6% 55, % 576, % South Asian 5.8% 0.9% 6.0% 21.2% 15.8% 5.5% 134, % 794, % Black 3.2% 0.8% 2.1% 6.3% 5.0% 4.1% 45, % 473, % Filipino 2.2% 0.4% 1.4% 4.7% 5.0% 2.6% 36, % 203, % Latin American 1.3% 0.5% 1.0% 1.7% 2.0% 1.9% 16, % 147, % Southeast Asian 0.3% 0.1% 0.5% 2.0% 2.3% 0.8% 15, % 110, % Arab 0.7% 0.1% 1.0% 2.8% 2.5% 0.9% 19, % 111, % West Asian 0.4% 0.1% 0.7% 1.0% 0.8% 0.7% 7, % 96, % Korean 0.3% 0.1% 1.1% 1.1% 1.1% 2.4% 11, % 69, % Japanese 0.1% 0.2% 0.3% 0.4% 0.4% 0.7% 3, % 28, % Visible minority, n.i.e. 0.3% 0.1% 0.4% 0.8% 0.7% 0.3% 5, % 56, % Multiple visible minority 0.9% 0.2% 0.7% 1.7% 1.1% 0.5% 10, % 77, % Source: 2006 Census, Statistics Canada 17

18 Visible Minority Population Indicators on the percent of the population who are visible minorities are also useful for planning culturally competent service delivery for communities with diverse ethnic groups. Cultural diversity is an important factor in achieving strategic directions of access and equity of access. The cultural and linguistic differences that exist within the MH LHIN will require providers to plan, innovate and deliver services in culturally competent ways to meet the needs of local residents. 18

19 Diversity Mississauga Halton LHIN has a higher proportion of immigrants and visible minorities than the province, particularly in South Etobicoke and Mississauga. Recent immigrants have different health experiences from the general population in that their health is usually better, and access to health care services is not as good. This indicator does not include non-landed immigrants, refugees, foreign students, or individuals on work or Minister s permits. Population by mother tongue also reveals the diversity of ethnic communities within Mississauga Halton LHIN. Mother tongue is defined as the first language learned at home in childhood and still understood by the individual at the time of the census. In 2006, approximately 41% of Mississauga Halton residents indicated a non-official language as their mother tongue, compared to 27% in Ontario. The top ranked non-official language response was Polish among Mississauga Halton residents. Since effective communication is essential in the provision of health care services and in key messages for health prevention and promotion, language will be an important consideration for health planning in Mississauga Halton LHIN. The predominant visible minority in Oakville, Etobicoke and Mississauga is South Asian, though there are significant populations of residents of Chinese, Black and Filipino origin. 19

20 Diversity 2001 and 2006 Comparison Mississauga Halton Ontario LANGUAGE Total population by language 894,710 1,002,200 11,285,550 12,028,895 Population who include English as mother tongue % population with English mother tongue Population who include French as mother tongue 569, ,045 8,119,835 8,398, % 59.1% 71.9% 69.8% 15,600 16, , ,865 % population with French mother tongue 1.8% 1.7% 4.7% 4.4% Neither English nor French 20,630 26, , ,655 % population with no knowledge of English or French 2.3% 2.6% 2.1% 2.2% Source: LHIN Census 2006 Indicators. 20

21 Mother Tongue* Language Milton Halton Hills Oakville Northwest Mississauga Southeast Mississauga South Etobicoke MH LHIN TOTAL ONTARIO English 78.8% 87.5% 74.1% 54.1% 49.2% 56.0% 59.1% 69.8% French 1.9% 2.1% 2.1% 1.6% 1.4% 1.5% 1.7% 41.4% Non-Official 20.5% 11.2% 25.3% 47.1% 51.8% 44.1% 41.4% 27.2% Ranking of Top 5 Non-Official Languages by Sub-LHIN, MH LHIN & Province** Milton Halton Hills Oakville Polish 2.1% Urdu 1.8% Italian 1.7% Spanish 1.5% Portuguese 1.2% Polish 1.4% Dutch 1.2% Italian 1.1% Portuguese 1.1% German 1.0% Source: 2006 Census, Statistics Canada Portuguese 2.2% Italian 2.1% Polish 1.9% Spanish 1.4% German 1.3% Northwest Mississauga Urdu 6.1% Polish 3.3% Punjabi 2.9% Arabic 2.9% Tagalog 2.8% Southeast Mississauga Polish 5.9% Portuguese 3.6% Urdu 3.6% Tagalog 3.0% Italian 3.0% South Etobicoke Polish 5.5% Ukrainian 3.6% Italian 3.5% Serbian 2.7% Portuguese 2.3% MH LHIN TOTAL Polish 4.0% Urdu 3.3% Portuguese 2.6% Italian 2.4% Tagalog 2.1% ONTARIO Italian 2.4% Chinese,n.o.s. 1.8% Cantonese 1.5% Spanish 1.3% German 1.3% * Totals do not add up to 100%, as the counts include those who indicated multiple responses to mother tongue. For example, English mother tongue includes those who responded that their mother tongue was English and French. ** as a percentage of the total population whose mother tongue is a non-official language, single response only. 21

22 Diversity: Percentage of Population, Recent Immigrants This map shows the percentage of the population in each Dissemination Area in the MH LHIN who are recent immigrants. The DAs with the highest percentage of recent immigrants in the MH LHIN are located in Mississauga. However, there are areas with high percentages of recent immigrants throughout the MH LHIN. 22

23 Diversity: Percentage of Population That Cannot Conduct a Conversation in Either French or English This map shows the percentage of the population in each Dissemination Area who cannot conduct a conversation in either French or English. As we may expect, the DAs in the MH LHIN with the highest percentage of people who cannot conduct a conversation in either French or English closely resemble the DAs with the highest percentages of recent immigrants. 23

24 Francophone Residents Mississauga Halton has a relatively small Francophone population relative to the province. The area is home to approximately 18,490 residents whose mother tongue is French. 1 However, using the new inclusive definition of francophones (adopted by the Office of Francophone Affairs in January 2010), the number of francophones in the MH LHIN increases to 35, There is representation in most communities throughout Mississauga Halton, but over half of francophone residents reside in the City of Mississauga, which is a designated community under Ontario s French Language Services Act (FLSA). 29% of Francophones in the Regional Municipality of Peel are also racial minority (a portion of which is in Mississauga Halton LHIN). 3 While the number of people identified as speaking French in the Mississauga Halton LHIN has increased from 2001 to 2006, the percentage of the population speaking French has actually decreased over this time period. 4 There are five identified French Language health service providers in the Mississauga Halton LHIN. 1. Mother Tongue (8), Age groups (17a) and Census divisions, Census subdivisions, and Dissemination areas (2006 Census Statistics Canada XCB ) Statistics Canada Census, definition of francophone adopted by the Office of Francophone Affairs and the Trillium Foundation. Francophones were previously defined as those whose mother tongue is French. The mother tongue category identifies Francophones solely on the basis of French as the first language learned at home in childhood and still understood at the time of the census. The new Inclusive Definition of Francophone (IDF) is based on three questions in the census concerning mother tongue, the language spoken at home, and knowledge of official languages. 3. Statistics Profile Francophones in Ontario. Government of Ontario Office of Francophone Affairs, September Profile for Canada, Provinces, Territories, Census Divisions, Census Subdivisions and Dissemination Areas, 2006 Census 2006 Census Statistics Canada XCB Profile for Census Metropolitan Areas, Tracted Census Agglomerations and Census Tracts, 2006 Census 2006 Census Statistics Canada XCB

25 Aboriginal Population The 4,400 identified aboriginals within Mississauga Halton LHIN form a small portion of the population (0.4%). 1 The highest concentration within the LHIN is in Halton Hills, where 0.9% of the population is of Aboriginal ethnic identity. 2 The range is much smaller than in other LHINs because of the lack of First Nations reserves within the Mississauga Halton LHIN. Health status characteristics and non-medical health determinants of Aboriginal people differ from the non-aboriginal population (e.g. infant mortality, unintentional injury deaths, suicides and smoking rates). Census data for Aboriginal populations are particularly susceptible to incomplete enumeration on First Nations reserves. 1 Statistics Canada Community Profiles Census. Statistics Canada Catalogue no XWE. Ottawa. Released March Census, Statistics Canada. 25

26 Social Determinants of Health Socio-Economic Status Health Status 26

27 Socio-Economic Status Socio-economic status (SES) is recognized as an important determinant of health and the link between health status, utilization of health services and SES is well established. Socio-economic disadvantage is an important determinant of inequalities in health; people with higher incomes can generally expect to live longer and healthier lives than those earning less, unemployed individuals and their families suffer an increased risk of premature death, and low levels of education are associated with riskier health behaviours. At the individual level, socio-economic inequalities in health are generally thought to be related to the prevalence of behavioural risk factors and/or access to material resources. Source: Socio-Economic Indicators Atlas, Mississauga Halton LHIN. Health System Intelligence Project, Spring

28 Socio-Economic Status Indicators Milton Halton Hills Oakville Sub-LHIN Northwest Mississauga Southeast Mississauga South Etobicoke MH LHIN Total ONTARIO % of total population age % 10.2% 11.7% 7.3% 12.0% 18.2% 10.9% 13.6% % of families with children, headed by lone-parent 15.5% 17.0% 16.9% 17.4% 23.0% 27.6% 20.0% 24.5% % population with English mother tongue 78.8% 87.5% 74.1% 54.1% 49.2% 56.0% 59.1% 69.8% % population with French mother tongue 1.9% 2.1% 2.1% 1.6% 1.4% 1.5% 1.7% 4.4% % population with no knowledge of English or French 1.0% 0.4% 1.1% 3.0% 3.8% 2.4% 2.6% 2.2% % of population who are immigrants 24.4% 15.2% 30.5% 49.4% 52.0% 41.9% 43.2% 28.3% % of population who arrived within 5 years 3.4% 0.8% 4.1% 9.7% 11.7% 7.4% 8.4% 4.8% % of population who are visible minorities 17.1% 4.1% 18.4% 52.0% 43.2% 24.1% 36.2% 22.8% % population of Aboriginal identity 0.8% 0.9% 0.4% 0.3% 0.4% 0.5% 0.4% 2.0% Source: 2006 Census, Statistics Canada. 28

29 Socio-Economic Status Indicators (continued) Milton Halton Hills Oakville Sub-LHIN Northwest Mississauga Southeast Mississauga South Etobicoke MH LHIN Total ONTARIO Labour force participation rate (age 15+) (% population in labour force) 78.3% 75.1% 70.9% 73.8% 68.8% 64.2% 70.9% 67.1% Unemployment rate (age 15+) 3.6% 4.2% 5.3% 6.1% 6.7% 6.0% 5.9% 6.4% Youth unemployment rate (age 15-24) 9.7% 11.4% 14.7% 15.5% 14.0% 15.4% 14.3% 14.5% % population (age 25+) without certificate, degree, diploma 12.5% 14.3% 9.1% 11.1% 15.5% 14.9% 13.0% 18.7% % population (age 25+) with completed post-secondary education 63.2% 57.1% 69.9% 67.2% 61.7% 62.9% 64.5% 56.8% Proportion of population living in low income 5.0% 5.1% 9.7% 13.1% 17.3% 15.6% 13.3% 14.7% % non-owned private dwellings 11.9% 14.0% 15.9% 15.2% 31.5% 30.8% 22.6% 29.0% % households spending 30% or more of income on housing 24.1% 21.7% 23.5% 29.1% 32.6% 27.0% 28.5% 27.6% Source: 2006 Census, Statistics Canada 29

30 Comparison of MH LHIN Population Profiles ID Total Pop % Ontario Pop in LHIN % Pop Aged 65+ % Econ. Family Incidence of Low Income % Total Lone Parent Families % Visible Minority Pop. % Pop. Aged 20+ with less than HS Education Ontario 12,986, Erie St. Clair 666, South West 957, Waterloo Wellington 739, HNHB 1,405, Central West 800, Mississauga Halton 1,101, Toronto Central 1,151, Central 1,651, Central East 1,524, South East 490, Champlain 1,220, NSM 454, North East 579, North West 244, Source: Environics Analytics Demographics Estimates and Projections

31 Mississauga Halton LHIN Population Characteristics Compared to the Ontario average, the MH LHIN has the following characteristics: Higher median and household income Higher percentage of visible minorities Lower percentage of population aged 65 and older Higher percentage of population with high school education 31

32 Health Status Determinants of health such as health behaviours, living and working conditions, personal resources and environmental factors are all related to health status measures. Self-reported health is a widely used indicator of overall health status; it can reflect aspects of health not captured in other measures. 32

33 Mississauga Halton LHIN Health Profile, 2010 MH LHIN Ontario Health Conditions TOTAL Male Female TOTAL Male Female Overweight or obese Overweight Obese E Arthritis E Diabetes E 7.9 E Asthma E 9.3 E High blood pressure Mood disorder E 6.7 E Pain or discomfort; moderate or severe E Pain or discomfort that prevents activities E Low birth weight Chronic obstructive pulmonary disease (COPD) 3.9 E F 4.2 E Injuries within the past 12 months causing limitation of normal activities Injuries in the past 12 months; sought medical attention 5.9 E 7.4 E 4.6 E Hospitalized stroke event rate (Age 20+)* Hospitalized acute myocardial infarction event rate (Age 20+)* Injury hospitalization* *Per 100,000 population MH LHIN compares unfavourably to Ontario Source: Statistics Canada Health Profile. Statistics Canada Catalogue no XWE. Ottawa. Released June E F use with caution too unreliable to be published 33

34 Health Profiles: MH LHIN and Ontario Comparison 34

35 Mississauga Halton LHIN Health Profile, 2010 Well Being MH LHIN Ontario TOTAL Male Female TOTAL Male Female Perceived health, very good or excellent Perceived mental health, very good or excellent Perceived life stress Health Behaviours Current smoker, daily or occasional E Current smoker, daily E Heavy drinking E Leisure-time physical activity, moderately active or active Fruit and vegetable consumption, 5 times or more per day Bike helmet use Human Function Participation and activity limitation; sometimes or often Functional health; good to full MH LHIN compares unfavourably to Ontario Source: Statistics Canada Health Profile. Statistics Canada Catalogue no XWE. Ottawa. Released June E use with caution 35

36 Health Profiles: MH LHIN and Ontario Comparison 36

37 Mississauga Halton LHIN Health Profile, 2010 Environmental Factors MH LHIN Ontario TOTAL Male Female TOTAL Male Female Second-hand smoke; exposure at home Second-hand smoke; exposure in vehicles and/or public places Personal Resources Sense of community belonging Life satisfaction; satisfied or very satisfied Living and Working Conditions High school graduates aged 25 to Post-secondary graduates aged 25 to Unemployment Youth unemployment; aged 15 to Long-term unemployment Low income Children aged 17 and under living in low income families MH LHIN compares unfavourably to Ontario Source: Statistics Canada Health Profile. Statistics Canada Catalogue no XWE. Ottawa. Released June

38 Mississauga Halton LHIN Health Profile, 2010 Community MH LHIN Ontario TOTAL Male Female TOTAL Male Female Population density Dependency ratio Youth; under 20 years; as a proportion of total population Seniors; 65 years and over; as a proportion of total population Aboriginal population Immigrant population year internal migrants year internal migrants Population living within a Metropolitan Influenced Zone Lone-parent families Visible minority population Source: Statistics Canada Health Profile. Statistics Canada Catalogue no XWE. Ottawa. Released June

39 Chronic Conditions Introduction Almost 80% of Ontarians over the age of 45 have a chronic condition, and of those, about 70% suffer from two or more chronic conditions (CCHC 2003). A chronic disease is an illness, functional limitation or cognitive impairment that lasts (or is expected to last) at least one year, limits what a person can do and requires ongoing care (MH LHIN IHSP: 2006). Chronic conditions generally develop slowly, are long lasting, often progress in severity, and usually cannot be cured (HSIE: 2007). In Ontario, the economic burden of chronic disease is estimated at 55% of total direct and indirect health costs (EBIC 2002). Chronic conditions place a high burden on the health care system and reduce quality of life of those who suffer from the condition. 39

40 Chronic Conditions Prevalence Prevalence is the proportion of the population with a particular disease at a given moment in time, and provides a measure of disease burden. Based on the 2007 Canadian Community Health Survey (CCHS cycle 4.1), Hypertension was the most frequently reported chronic condition for residents of the Mississauga Halton LHIN at 14.8%; Arthritis was second at 13.7%; Asthma was third with 10.2%; and Diabetes was fifth at 5.1%. The self reported value for diabetes in the MH LHIN is significantly lower than the prevalence rate obtained through the Ontario Diabetes Database (8.7% in 2006/07; ICES). Sources: 2007 Canadian Community Health Survey, Statistics Canada, Ontario Share File. ICES In Tool. 40

41 Chronic Conditions in Ontario and the Mississauga Halton LHIN, 2007 From the chart, we can see that the MH LHIN has lower prevalence rates in most of the selected chronic conditions than the province of Ontario. E E E E The only exceptions are in the prevalence rates for Asthma and Stroke. The MH LHIN prevalence rate for Asthma is 10.2%, compared to 8.2% for the province, while the MH LHIN prevalence rate for stroke is 2.1% compared to 1.3% for Ontario. However, it is important to note that the MH LHIN prevalence rate for stroke must be interpreted with caution, as it is an estimate only. E MH LHIN estimate, use with caution (Data with a coefficient of variation between 16.6% to 33.3%). Source: 2007 Canadian Community Health Survey, Statistics Canada, Ontario Share File. 41 HSIP. Chronic Conditions in the Mississauga Halton LHIN.

42 Chronic Conditions in the Mississauga Halton LHIN, 2005 and 2007 Prevalence Rate 16% 14% 12% 10% 8% 6% 4% 2% 0% Prevalence of Selected Chronic Conditions in the MH LHIN, 2005 to 2007 Arthritis Hypertension Asthma Heart disease Diabetes* Cancer* Stroke* * Interpret with caution. Coefficient of variation 16.6% to 33.3%. This chart compares prevalence rates of selected chronic conditions in the MH LHIN from 2005 to 2007, as per the Canadian Community Health Survey (CCHS). While the previous chart showed the MH LHIN generally has lower prevalence rates of the selected chronic conditions than Ontario, the rates of all of the selected chronic conditions in the MH LHIN have increased from 2005 to 2007, with the most dramatic increase being in the prevalence of Asthma (7.5% to 10.2%). Again, it is important to note that several of the prevalence rates are estimates only and must be interpreted with caution Data from CCHS cycle 3.1, as documented in "Chronic Conditions in the Mississauga Halton LHIN," prepared by HSIP Oct data from CCHS cycle 4.1, provided by Health Analytics, April

43 Prevalence Rates* (%) of Chronic Obstructive Pulmonary Disease (COPD) by LHIN, 2009/10 * Prevalence rates (%) are age- and sex-adjusted, aged 35 years and older. Source: ICES, Prevalence of Chronic Obstructive Pulmonary Disease Ontario, 1996/97 to 2009/10. 43

44 Prevalence Rates* (%) of Chronic Obstructive Pulmonary Disease (COPD) by Age in the MH LHIN and Ontario, 2009/10 * Prevalence rates (%) are age- and sex-adjusted, aged 35 years and older. Source: ICES, Prevalence of Chronic Obstructive Pulmonary Disease Ontario, 1996/97 to 2009/10. 44

45 Chronic Conditions Health System Utilization The following nine (9) chronic conditions (cancer, diabetes, depression, heart disease, hypertension, stroke, asthma, COPD and arthritis) accounted for: 7 out of every 10 deaths in Ontario 1 out of 4 inpatient hospital separations in the MH LHIN 1 in 10 ED visits in MH LHIN 1 in 5 GP/FP visits in MH LHIN People with co-morbidities have a higher burden of disease and tend to have longer hospital stays, higher health care costs, increased hospital mortality and higher rates of readmission. Conditions such as cancer and heart disease had high rates of inpatient hospital separations whereas high rates of visits to family physicians were found for conditions such as hypertension and arthritis. Source: HSIE: 2007; ICES In Tool. 45

46 Chronic Conditions: Health System Utilization, MH LHIN and Ontario Chronic Condition Emergency Department Visits, Rate Per 100,000 MH LHIN 2005/06 MH LHIN 2007/08 Ontario 2007/08 Malignant Neoplasm (Cancer) Diabetes Depression High Blood Pressure (Hypertension) Ischemic Heart Disease not available Stroke Chronic Obstructive Pulmonary Disease Asthma Arthritis and related conditions ,387.8 The chart to the left shows that the MH LHIN has significantly fewer ER Visits per 100,000 people in all of the selected chronic conditions than the province of Ontario as a whole. Moreover, the number of ER Visits per 100,000 in the selected chronic conditions has declined in the MH LHIN in every area from 2005/06 to 2007/08, with the exceptions of Diabetes and Asthma. Data sources: Numerator: Ambulatory Visits, Ontario Ministry of Health and Long-Term Care: IntelliHealth ONTARIO. Last refreshed [May/2009]. Denominator: Population Estimates Summary LHIN, Ontario Ministry of Health and Long-Term Care: IntelliHealth ONTARIO. Last refreshed [May/2009] Canadian Community Health Survey, Statistics Canada, Ontario Share File; Ambulatory Visits (2005/06), Medical Services (2005/06), and Population Estimates, Ontario Ministry of Health and Long-Term Care Provincial Health Planning Database. 46

47 Comparative Burden of Chronic Disease in the MH LHIN ED Visits per 100,000 Hospital Separations per 100,000 Mortality, per 100,000 This chart shows the comparative burden of chronic disease in the MH LHIN. We can see that High Blood Pressure and Arthritis have the highest prevalence rates, Asthma and Arthritis contribute to the highest number of ED Visits, and Cancer and Ischemic Heart Disease have the highest rate of hospital separations and also mortality per 100,000. Prevalence per 10,000 Source: 2007 & 2009 Canadian Community Health Survey, Statistics Canada, Ontario Share File; Deaths, Inpatient Discharges, Ambulatory Visits, Medical Services, and Population Estimates, Ontario Ministry of Health and Long-Term Care Provincial Health Planning Database. * Note that Depression is not captured in recent CCHS cycles. The prevalence rate listed here reflects that of Mood Disorder, which is defined as Population aged 12 and over who reported that they have been diagnosed by a health professional as suffering from a mood disorder such as depression, bipolar disorder, mania or dysthymia. 47

48 Risk Factors for Chronic Conditions A wide range of factors influence the onset and prognosis of chronic conditions. Age is a major risk factor for chronic conditions, including multiple chronic conditions. Socio-economic status is a risk factor. Those who are socio-economically disadvantaged often have a higher risk factor for many chronic conditions. Behavioural risk factors (which are also considered modifiable) related to health practices can increase the risk for developing chronic conditions i.e. smoking, alcohol misuse, obesity, physical inactivity and poor diet (we have data on some of these risk factors) (see Peel Health Status report for data on risk factors for residents of Peel). Many chronic conditions have common underlying modifiable risk factors that if mitigated might prevent or delay the onset of chronic disease. 48

49 Chronic Disease Risk Factors are Common to Many Conditions 49

50 The Relationship Between Mental Health, Mental Illness and Chronic Physical Conditions Mental health and physical health are fundamentally linked. People living with a serious mental illness are at higher risk of experiencing a wide range of chronic physical conditions. Conversely, people living with chronic physical health conditions experience depression and anxiety at twice the rate of the general population. Co-existing mental and physical conditions can diminish quality of life and lead to longer illness duration and worse health outcomes. Source: S.B. Patten, "Long-Term Medical Conditions and Major Depression in the Canadian Population," Canadian Journal of Psychiatry 44 no. 2 (1999):

51 Mental Illnesses and Chronic Physical Conditions Canadians who report symptoms of depression also report experiencing three times as many chronic physical conditions as the general population (Canadian Institute for Health Information, 2008). Canadians with chronic physical conditions have twice the likelihood of also experiencing a mood or anxiety disorder when compared to those without a chronic physical condition (Government of Canada, 2006). One out of every two Canadians with major depression and a coexisting chronic physical condition report limitations in their day-today activities (S. Patten, 1999). 51

52 Prevalence of Mental Health & Addictions in Ontario It is estimated that 20% of the Ontario population will experience a mental health / substance abuse problem at some point during their life. It is further estimated that: 2.5% of Ontarians will have a serious mental illness 1.3 million Ontario adults (13.2%) have a mood, anxiety or substance abuse disorder 9.1% of Ontarians indicated harm to selves from alcohol use in the past year; 12.9% indicated harm from drug use 3.8% (340,000) adults in Ontario have moderate or severe gambling problems Yet household surveys indicate that 40% to 80% of individuals with mental health & substance abuse conditions do not receive treatment. One in four families has at least one member with a mental disorder. Source: An Introduction to Addictions, Mental Health and Problem Gambling in Ontario, Health Program Policy and Standards Branch, February 6,

53 Mental Health & Addictions in Ontario There is a significant impact on the quality of life of individuals and their families living with mental illness and addictions: Health impact: common to have 2 or more mental illnesses/substance use issues, it is also common to live with co-morbid physical and mental health concerns; mental illness and addictions have been identified as the leading cause of disability burden, and this burden is expected to increase in the future. Social and economic impact: mental illness interferes with relationships, productivity and employment/education opportunities and can be a risk factor for homelessness; in 2006 one third of Ontario Disability Support Program recipients had a serious mental illness. Stigma is a huge barrier to people with mental illness and addictions, particularly within the health care system and in the workplace. As caregivers, families of people with mental illness and addictions face physical, emotional and financial stress. Years Lived with Disability for Mental Health and Addictions as a Proportion of all Years Lived with Disability 50% 43% 43% 40% 31% Disability Adjusted Life Years 30% 20% 24% 20% 12% Years Lived with Disablity Source: MOHLTC, Mental Health and Addictions Strategy Document, November 4, % 0% Am ericas Europe World 53

54 Mental Health & Addictions in Ontario The direct costs of mental illness and addictions in Ontario (for health care, legal costs, capital, research) is $5.2B, however, the costs as a result of the productivity lost due to mental illness and addictions costs are far greater at $28.7B. The economic costs (direct and indirect) in Ontario for mental health and addictions is $33.9B per year ($11.7B addictions, $22.2B mental health). Mental disorders are 7th among 20 disease categories for both direct and indirect costs; it is 2 nd after cardiovascular disease, for direct costs (only those with medically treated, diagnosed mental disorders were included, estimates suggest that about 50% are untreated/undiagnosed). Psychological conditions like stress, anxiety, and depression are the leading causes of short and long term disability costs. Cost of Illness in Ontario - Substance Abuse 8% Cost of Illness in Ontario - Mental Health 8% 1% 18% Health Costs Legal Costs Health Costs Legal Costs 74% Indirect Costs - Lost Productivity 91% Indirect Costs - Lost Productivity Source: MOHLTC, Mental Health and Addictions Strategy Document, November 4,

55 Mental Health & Addictions in Ontario People living with the most common chronic physical conditions in Ontario also face worse mental health than the general population. Figure 1 illustrates the elevated rates of mood disorders in Ontarians with diabetes, heart disease, cancer, arthritis and asthma. 55

56 Mental Health & Addictions Clients with Co-Occurring Disorders 37% of people with an alcohol abuse disorder and 53% of those with a substance abuse disorder will have a mental health disorder at some point in their lives % of those with a mental disorder also have a substance dependence disorder with proportions differing by disorder. Co-occurrence can complicate service planning and make access to the appropriate range of services difficult. Mood/Anxiety Psychosis Addictions Source: Skinner W, O Grady C, Bartha C, Parker C. Concurrent substance use and mental health disorders: an information guide 56

57 MH LHIN Number and Proportion of Active Mental Health Cases by Reason for Admission and Hospital, 2007/08 Hospital Name Active Cases Reason for Admission* Self Threat Threat to Others Unable to Care for Self Addiction Problem # % of # % of # % of # % of active active active active cases cases cases cases Psychiatric Symptoms # % of active cases Forensic # % of active cases CREDIT VALLEY HOSPITAL (THE) TRILLIUM HEALTH CENTRE- MISSISSAUGA HALTON HEALTHCARE SERVICES CORP-OAKVILLE MISSISSAUGA HALTON TOTAL 2,374 1, , , ONTARIO TOTAL 56,527 27, , , , , , *There may be multiple reasons for admission identified. Therefore, the sum of all reasons for admission may exceed the number of active cases. Source: Ontario Mental Health Reporting System, 2007/08 taken from: Adult Mental Health Data Table in the Ontario Ministry of Health and Long-Term Care Provincial Health Planning Database, extracted May/June

58 MH LHIN Number of Active Cases, New Admissions and Discharged Cases by Hospital, 2007/ /08 Discharged Cases Hospital Name Active Cases New Admissions Discharges Acute Days Average Acute Length of Stay Discharges with ALC Days ALC Days Average ALC Length of Stay CREDIT VALLEY HOSPITAL (THE) , TRILLIUM HEALTH CENTRE-MISSISSAUGA , HALTON HEALTHCARE SERVICES CORP- OAKVILLE , MISSISSAUGA HALTON TOTAL 2,374 2,234 2,182 29, , ONTARIO TOTAL 56,527 52,012 51,559 1,149, ,395 36, Source: Ontario Mental Health Reporting System, 2007/08 taken from: Adult Mental Health Data Table in the Ontario Ministry of Health and Long-Term Care Provincial Health Planning Database, extracted May/June

59 Of the 4% of ED visits, anxiety, schizophrenia and alcohol are the leading diagnoses related to ED visits, repeat visits and longest wait times for people with mental illness or substance use issues Mental Health ED visits in Ontario Rank Total Visits (of all MH ED Visits) Repeat Visits (percent of visits by diagnosis that are repeat) Wait Times 1 Anxiety- 31.6% (36,893 visits ) Schizophrenia 51% Schizophrenia 6 hours 2 Depression 23.6% (27,623 visits) Bipolar Disorder 39% Personality Disorder 5.7 hours 3 Schizophrenia 15.4% (17,989 visits) Personality Disorder 38% Bipolar Disorder 5.6 hours Total Mental Health 116,796 32,055 repeat visits (5% of total visits are for individuals with 5 or more visits) 4.5 hours Substance Abuse ED visits in Ontario Rank Total Visits (of all SA ED Visits) Repeat Visits (percent of visits by diagnosis that are repeat) Wait Times 1 Alcohol 68% (29, 280 visits) Alcohol 41% Alcohol 5.7 hours 2 Multiple Drugs 14.3% (6161 visits) Opiods 28% Other Drugs 5.45 hours 3 Other Drugs 10.4% (4513 visits) Multiple Drugs 26% Multiple Drugs hours Total Substance Abuse 43, repeat visits (14.4% of total visits are for individuals with 5 or more visits) 5.4 hours Source: MOHLTC, Mental Health and Addictions Strategy Document, November 4,

60 Mental Health ED Visits for Mississauga Halton Residents by Diagnostic Category, 2006/ /08 Diagnostic Category * # of Visits % of Total Substance-related disorders 4, Anxiety disorders 3, Depression 2, Schizophrenic & psychotic disorders 1, Acute stress Bipolar disorder Organic disorders Adjustment disorders All other psychiatric disorders Personality disorders Disturbance of conduct Physiological malfunction arising from mental factors Other mood disorders Total 16, Number of unscheduled mental health ED visits and average annual ED visit rates per 1,000 population by CIHI diagnosis category and LHIN of patient residence, 2006/ /08 combined. * Categories were taken from the Canadian Institute for Health Information's Hospital Mental Health Services in Canada

61 Emergency Room Repeat Visits Mental Health & Addictions LHIN of patient residence Repeat visits within 30 days # % Rate/100 Visits Total Visits Erie St. Clair 2, ,996 South West 3, ,004 Waterloo Wellington 2, ,974 HNHB 6, ,668 Central West 1, ,443 Mississauga Halton 2, ,119 Toronto Central 8, ,798 Central 3, ,667 Central East 4, ,304 South East 2, ,171 Champlain 4, ,583 North Simcoe Muskoka 1, ,346 North East 4, ,744 North West 2, ,588 Unknown 3, ,431 Out-of-province Total 56, ,131 Number and rate of repeat visits within 30 days as a proportion of the total unscheduled mental health emergency department visits by LHIN of patient residence, 2006/ /08 combined. Source: Ontario Mental Health Reporting System, 2007/08 taken from: Adult Mental Health Data Table in the Ontario Ministry of Health and Long- Term Care Provincial Health Planning Database, extracted May/June

62 Barriers to Access to Primary Health Care for People with Mental Health and Addiction Needs Access to primary health care has rated as a top unmet need for people with mental illnesses. People with serious mental illnesses who have access to primary health care are less likely to receive preventive health checks. They also have decreased access to specialist care and lower rates of surgical treatments following diagnosis of a chronic physical condition. The mental health of people with chronic physical conditions is also frequently overlooked. Diagnostic overshadowing can mask psychiatric complaints, particularly for the development of mild to moderate mental illnesses. Short appointment times are often not sufficient to discuss mental or emotional health for people with complex chronic health needs. Source: Canadian Mental Health Association, Ontario, The Relationship Between Mental Health, Mental Illness, and Chronic Physical Conditions, Background Paper, December

63 Cancer The number of new cancer cases diagnosed each year in Ontario is expected to increase from approximately 53,000 in 2001 to 80,000 in 2015; representing more than a 50% increase. Population aging, population growth and rising cancer risk all contribute to the projected increase in the number of new cases. Four types of cancer: female breast, prostate, lung and colon/rectum (bowel) together account for more than half of the cancers diagnosed in Ontario men and women. 63

64 Cancer More than half of all cancer cases are preventable. About half of all cancer deaths are related to tobacco, diet and physical activity. Fewer people are smoking and more are physically active and are eating more fruits and vegetables, but Ontario still is below targets for these cancer-related lifestyle factors. Rates of obesity continue to grow. Ontarians are drinking more alcohol than recommended and are spending too much time in the sun. 64

65 Cancer System Quality Index (CSQI) The Cancer System Quality Index (CSQI) is a web-based public reporting tool that serves as a system-wide monitor for tracking quality and consistency of all key cancer services delivered across the spectrum of Ontario's cancer system, from prevention through to end-of-life care. A North American first, the Index was launched in 2005 by the Cancer Quality Council of Ontario, in partnership with Cancer Care Ontario (CCO). The CSQI presents a rolling snapshot of activity in 29 evidence-based measures (e.g., smoking rates, colorectal screening rates, cancer surgery wait times, patient satisfaction) from prevention through palliative care and tracks Ontario s progress towards better outcomes in cancer care and highlights where cancer service providers can advance the quality and performance of care. The Index presents cancer system performance within each of Ontario's 14 LHINs and presents a snapshot view of how each LHIN is doing in terms of wait times and cancer prevention. Source: Cancer Care Ontario, Cancer System Quality Index. 65

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

67 Cancer Care Ontario: Cancer System Quality Index (CSQI) 2010 The information on the following slides is presented as it appears on the Cancer System Quality Index (CSQI) website: Please use the legend that appears below when reviewing the data on slides 68 to 76: 67

68 Cancer Incidence and Survival 68

69 Modifiable Risk Factors 69

70 Prevention 70

71 Screening 71

72 Diagnosis 72

73 Treatment 73

74 Treatment (continued) 74

75 Treatment (continued) 75

76 End-of-Life Care 76

77 Primary Health Care General practitioners and family physicians (GP/FPs) play a key role in Ontario s health care system. GP/FPs are the main source for primary care and are often the patient s initial point of contact with the health care system. GP/FPs not only provide treatment, but also act as a conduit to more specialized services. Source: Jaakkimainen L, Upshur REG, Schultz SE, Maaten S (Editors). Primary Care in Ontario. ICES Atlas. Toronto: Institute for Clinical Evaluative Sciences; November,

78 Primary Health Care Stats In 2003, there were 721 GP/FPs in the MH LHIN. This count has increased to 853 in 2009 (Source: Ontario Physician Human Resources Data Centre, Active Physician Registry). The overall supply of GP/FPs (based on headcounts) in the MH LHIN continues to be lower than the average supply in Ontario (i.e. 7.5 vs 8.8 per 10,000 population in 2009). The particular mix of physicians work settings may influence patients access to services. Currently, there are a range of primary care models across the province aimed at providing continuity of care, preventive care (including health promotion), and improved chronic disease management. As of October 2008, 522 GP/FPs in the MH LHIN were providing care in models that blend traditional fee-for-service with capitation and salary options serving approximately 701,244 patients (61.6%). There were 264 solo practitioners in the MH LHIN. 78

79 GP / FP Supply In the following slides, the GP / FP Supply per 10,000 Population has been used to measure the relative supply of General / Family Practitioners. In theory, the higher the number, the greater the access to a physician. It is important to note that due to data availability, the ratio of physician to population has been calculated using a Headcount (i.e. the total number of GP/FPs in active practice regardless of level of activity) rather than full-time equivalents (FTE). As not all physicians have the same workload (e.g. some may work fewer hours, or have research and administrative responsibilities that limit the amount of time they devote to clinic practice), this should be considered in future planning. 79

80 GP/FP Supply in the MH LHIN GP/FP supply per 10,000 population, headcount, Mississauga Halton LHIN and Ontario, The supply of GP/FPs in the MH LHIN continues to be slightly lower than the Ontario average. At the provincial level, the GP/FP Supply per 10,000 Population has been trending up over the past four years. MH LHIN Ontario The MH LHIN GP/FP Supply per 10,000 Population increased in 2009 after decreasing the previous two years. Source: Active Physician Registry and Ontario Physician Workforce Database, Ontario Physician Human Resources Data Centre. Population Estimates: Ministry of Finance, for the Ontario Ministry of Health and Long-Term Care. 80

81 GP/FP per 10,000 Population: LHIN Comparison, 2009 In terms of the GP/FP Supply per 10,000 population, the MH LHIN is the fourth lowest at 7.5 and below the provincial average of 8.8. Source: Ontario Physician Human Resources Data Centre, Active Physician Registry, December 31,

82 Mississauga Halton LHIN: General Practitioner and Specialist Totals, 2009 Sub-LHIN Area Family Medicine Specialists Total Halton Hills Milton Mississauga Oakville South Etobicoke TOTALS ,561 Source: Ontario Physician Human Resources Data Centre, Active Physician Registry, December 31,

83 General Practitioner (GP) & Specialist (SPC) Totals by Sub-LHIN Area, 2008* Halton Hills GP: 43 SPC: 7 Population (2008): 60,206 Mississauga GP: 478 SPC: 448 Population (2008): 701,922 South Etobicoke GP: 79 SPC: 67 Population (2008): 108,918 Milton GP: 45 SPC: 18 Population (2008): 58,755 Oakville GP: 177 SPC: 135 Population (2008): 180,775 Population figures from Statistics Canada, Demography Division, customized data, MOHLTC. Physician numbers from Ontario Physician Human Resources Data Centre, Active Physician Registry, January * Note: 2008 physician numbers were used to align with 2008 sub-lhin population data.

84 MH LHIN GP/FP Supply by Sub-LHIN Area GP/FP supply per 10,000 population, headcount, Mississauga Halton LHIN and sub-lhin Areas, In the MH LHIN, the supply of GP/FPs per 10,000 population is highest in Oakville and lowest in Mississauga Source: Active Physician Registry and Ontario Physician Workforce Database, Ontario Physician Human Resources Data Centre. Population Estimates: Ministry of Finance, for the Ontario Ministry of Health and Long-Term Care. 84

85 Physician and Patient Profile Physician Profile as of Aug 31/08 # of Groups # of Physicians Primary Care Family Health Network 1 4 Family Health Group Comprehensive Care Model Patient Profile as of January 2011 Projected Population Patients enrolled in a Patient Enrollment Model % of Population Enrolled in Primary Enrollment Models 1,152, , % Source: Ministry of Health and Long-Term Care Family Health Organization 7 99 Blended Salary Model 1 3 Solo / No Group Model Family Health Team* [6] [83] Sub-Total 811 Specialists Endocrinologists - 15 General Internists - 38 General Pediatricians - 50 All other specialists Sub-Total TOTAL PHYSICANS Sources: Ministry of Health and Long-Term Care, Ontario Physicians Human Resource Data Centre, OntarioMD. 85

86 Contact with a Medical Doctor From this chart, in comparing all LHINs across the province, the MH LHIN had the highest percentage of population reporting contact with a medical doctor in the previous 12 months (85.1% of men and 90.8% of women). Source: Statistics Canada, Canadian Community Health Survey,

87 Average Number of Visits to a Family Physician by Age and Sex, Mississauga Halton LHIN (2008/09) Average number of GP/FP visits by age group and sex, Mississauga Halton LHIN residents, 2008/09 Average # visits/person Age group Females Males Sources: Patient Visits: Medical Service 1 Yr, Intellihealth Ontario, Ministry of Health and Long Term Care. Population Estimates: Population Estimates LHIN, Intellihealth Ontario, Ministry of Health and Long-Term Care. Retrieved October,

88 Frequency of Visits Of all LHINs, the MH LHIN had the highest percentage of population reporting contact with a medical doctor in the previous 12 months (88% for the MH LHIN, compared to the provincial average of 82.9%). Mississauga Halton LHIN residents made just over 4.3 million visits to GP/FPs during FY2008/09, which resulted in an average of 3.9 visits per person. The average number of visits per person was lowest for those aged 5-9 and 10-14, while rates for seniors were highest. The average number of visits per person by sex were relatively similar until age 15, when the rates for females became higher. For some groups, the rates for females were twice those of males (20-24, 25-29, 30-34). At age 75, the rates were relatively similar in both genders, but by age 85, the rates for males overtook those for females. It is interesting to note that while the MH LHIN s GP/FP supply per population is one of the lowest in the province, it had the highest percentage of population reporting contact with a medical doctor in the previous 12 months. 88

89 Health Service Providers in MH LHIN CCAC Community Support Services Hospitals Long-Term Care Homes Mental Health & Addictions 89

90 Our Health Care Services The MH LHIN funds 77 organizations providing health services. Included in this are: Hospitals Long-Term Care Homes Mental Health and Addictions agencies Community Support Services Mississauga Halton Community Care Access Centre 90

91 Our Health Care Services Community Services 1 Acquired Brain Injury Agency 12 supportive housing programs 23 Community Support Services (CSS) 3 Palliative Care Programs Long Term Care Homes 27 long term care (LTC) homes 4,156 long term care beds Mental Health Services 7 community programs 2 supportive housing sites 3 agencies for drug, alcohol and problem gambling treatment services 3 psychiatric outpatient medical services Hospitals 3 corporations on 6 sites 1 Community Care Access Centre Community Care Access Centre 91

92 Funding Percentages by Sector, 2009/10 Community Support Services and Assisted Living; 4% Mental Health & Addictions Services; 3% Initiatives; 1% Community Care Access Centre; 10% Long-Term Care; 14% Hospitals; 68% 92

93 Community Care Access Centre Mississauga Halton CCAC: CCACs are the local point of access to government funded community-based health care services, and were created to coordinate a variety of health services to maintain an individual s health, independence and quality of life. Their mandate is to help people live independently at home, and also to help people apply for admissions to long-term care homes. They also provide information about local community support service agencies and can link people to these agencies to arrange services. 93

94 Mississauga Halton CCAC Services provided by the Mississauga Halton CCAC include: 1. In-Home Services: Nursing Personal support (help with bathing, dressing, etc.) Physiotherapy Occupational therapy Speech-language therapy Social work Nutritional counseling Medical supplies and equipment 2. Specialized programs geared towards specific health needs: Acquired brain injury Convalescent Care Child and family services School Health Support Mental Health Palliative care (care at the end of life) 3. Information and Referral to other services: Adult day programs Meal delivery services Assistance with shopping or cleaning Transportation assistance There may be consumer fees for services obtained through community agencies. 4. Placement into Long-Term Care Homes When living independently is no longer possible we coordinate applications to Long-Term Care Homes in the area and across Ontario. A CCAC Case Manager/Placement Coordinator will: Provide information about long-term care homes Determine suitability and eligibility for placement Provide assistance in the application process. Visit the Mississauga Halton CCAC website for more information. 94

95 Community Support Services Community Support Services: Community support services provide an array of services to assist individuals who need help to function independently because of a disability, illness or limitation due to aging. These services help individuals to remain comfortably and safely in their own homes and communities. There are 34 Community support services agencies in the MH LHIN, together providing : Adult Day Programs Attendant Care Client Intervention and Assistance Respite Care / Caregiver Support Transportation Meal Programs / Congregate Dining Personal Support Services Home Maintenance and Repair Social Recreational & Intergenerational Programs Home Help / Homemaking Assisted Living in Supportive Housing Foot Care Friendly Visiting / Security Check / Reassurance Caregiver Support: Education & Counselling Emergency Response Systems End of Life / Palliative Care Life Skills Services 95

96 Hospital Sites Hospitals: The Credit Valley Hospital Halton Healthcare Services Georgetown Hospital Milton District Hospital Oakville-Trafalgar Memorial Hospital Trillium Health Centre Mississauga Site West Toronto Site 96

97 Credit Valley Hospital Key Services & Programs Include: Addictions and Concurrent Disorders Centre Ambulatory Care Asthma Education Blood Conservation Clinic Cancer Care Cardiopulmonary Cardiovascular Rehabilitation Credit Valley Rehabilitation Centre Diabetes Care Centre Diagnostic Imaging Eating Disorders Program Emergency Medicine Endoscopy Suite Genetics Geriatric Assessment Unit Laboratory Medicine Maternal Child Services Mental Health Occupational Therapy Paediatrics Physiotherapy Service Psychology Support Pulmonary Rehabilitation Program (PReP) Rehabilitation Services Seniors and Rehabilitation Day Hospital Surgery Services Therapeutic Recreation Trillium Gift of Life Visit for more information. 97

98 Credit Valley Hospital Regional Centre for Cancer Centre: The Carlo Fidani Peel Regional Cancer entre is a specialized treatment centre for people living with cancer. The centre focuses on partnership with the patient, their family and friends in order to provide the highest quality care. Quality care includes meeting the patients physical, emotional, social, spiritual and practical needs. Genetics Program: The program consists of both clinical and laboratory services provided by a number of specialists including clinical geneticists (physicians), cytogeneticist and molecular geneticist (Ph.D), genetic counsellors (M.Sc.) and technologists (M.L.T.) with subspecialty training in cytogenetics, molecular genetics or both. Counsellors see over 3,200 individuals each year. Maternal Child: The Multicultural Perinatal Network in a part of this service and has language capabilities in 13 languages for expecting and new mothers. Renal Program: The Renal Program cares for patients with diminished kidney function and provides dialysis support when a patient s kidneys are no longer functioning adequately. There is a partnership with several transplant centres to prepare patients with kidney disease for transplants. Patients with functioning kidney transplants may have their on-going clinic follow-up care provided by our renal team. Services include: Nephropathy Clinic Kidney Care Clinic Transplant Follow-up Clinic Home Peritoneal Dialysis Home Hemodialysis Hemodialysis (Credit Valley Hospital site & Renal Care Centre site) In-patient Nephrology Unit 98

99 Halton Healthcare Services Corporation Georgetown, Milton & Oakville sites Key Services & Programs Include: Diagnostic Imaging Emergency Medical and Surgical Obstetrics Maternal/Child Medicine Mental Health Asthma Education Cardiac Rehabilitation & Education Program Falls Intervention Respiratory Rehabilitation Assistance to quit smoking (QuitCare) Rehabilitation & Geriatrics Surgery Sleep Clinic Speech Language Pathology Audiology and Hearing Aid Dispensing Supportive Housing Visit for more information. 99

100 Halton Healthcare Services Corporation Georgetown, Milton & Oakville sites Regional Centres for Central West Eating Disorder The Outpatient program at Halton Healthcare Services is located in Oakville and offers services to people of all ages living in South Halton, and adolescents up to 19 years, living in South Peel. The program serves those individuals and their families who are affected by Anorexia Nervosa, Bulimia Nervosa, or Binge Eating Disorder. The treatment program offers several services including Psychiatric assessment and follow up; Nutrition Assessment and Counselling; Psychosocial Assessment; Family Education and Individual Counselling. The group programs include Adult Psychoeducation; Family Psychoeducation; Skill Building Group and a Body Image Group. Halton Renal Dialysis Clinics: Housed in Oakville Trafalgar Memorial Hospital, Progressive Renal Insufficiency (PRI) Clinic and the Early Renal Insufficiency (ERI) Clinic are both outpatient clinics. The Clinics provide education and support to approximately 180 individuals who have lost a portion of their renal function. The approach is multi-disciplinary with a team that is made up of a dietician, a social worker, a pharmacist, a nurse, a clerk and two nephrologists. The Clinics were created (and are being expanded) in order to reduce travel for the residents of the Halton Region and will increase the capacity of full-care, in-centre hemodialysis in the Region. This will accommodate both the rapid population growth of the region and the 15 per cent projected growth rate of End Stage Renal Failure. Halton Diabetes Program: The Halton Diabetes Program promotes diabetes self-care by providing education and support to adults with diabetes and their families. The program aims to help people with diabetes learn to make healthy lifestyle choices. Through education, the program strives to reduce the risk of and delay the progression of complications. This is achieved by working with people who have diabetes, and their doctors, to help increase knowledge and skill in diabetes management. The program includes: Patient Services (for patients and their families) Health Professional Services (including individual consultations) Community Education Prevention and Management strategy and self-help resources 100

101 Trillium Health Centre Acute Services Mississauga Site; Ambulatory Services West Toronto Site Key Services & Programs Include: Neurosciences & Musculoskeletal Respiratory Rehabilitation Outpatient, Inpatient & Rehabilitation Services Assistance to quit smoking (QuitCare) Mental Health Rehabilitation & Geriatrics West GTA Stroke Network (main areas are stroke prevention, emergency and acute are Surgery management, rehabilitation and community participation) Sleep Clinic Surgical Women s Health Children s Health Others (Infection Prevention & Control, etc.) Falls Intervention Speech Language Pathology Audiology and Hearing Aid Dispensing Visit for more information. 101

102 Trillium Health Centre Acute Services Mississauga Site; Ambulatory Services West Toronto Site Regional Centre for Cardiac Services: As a regional cardiac care centre, Cardiac Services sees patients from its surrounding communities of Peel, Halton, and West Toronto, as well as from across the province. Today, Trillium's Cardiac Services conducts approximately ten per cent of all cardiac procedures in Ontario. Services include: Angioplasty (Coronary) Cardiac Catheterization Cardiac Diagnostics Cardiac Services Follow-up Clinic Cardiac Surgery Cardiac Wellness & Rehabilitation Centre Heart Function Clinic Pacemaker Program 102

103 Mental Health & Addictions Mental Health & Addictions Mental Health and Addiction services provide a range of services to people living with mental health and addiction problems. 8 Mental Health organizations, together providing: - Assertive Community Treatment - Case management - Counselling and Treatment - Crisis response - Employment support - Peer Support - Seniors outreach, counselling, treatment - Supported housing 3 Addiction Services, together providing: - Case management - Counselling and treatment - Concurrent disorders - Outreach to Seniors - Residential treatment 103

104 Long-Term Care Homes Long-Term Care Homes: There are 27 long-term care homes in the MH LHIN There are a total of 4,156 licensed beds Long-term care homes provide: 24-hour availability of nursing care and high levels of personal care A setting that can accommodate varying health needs with onsite supervision for your personal safety Government-funded nursing and personal care Possibility of subsidized accommodations 104

105 Health Service Utilization Acute Beds / Services Emergency Department / ALC Rehab Complex Continuing Care Ambulatory Care Community Based CCAC Community Support Services Long-Term Care Homes Mental Health & Addictions 105

106 Acute Services Bed Distribution of Mississauga Halton LHIN Hospitals, 2008/09 The Credit Valley Hospital Halton Healthcare Services Corp.* Trillium Health Centre TOTAL Chronic General Rehabilitation Medical Surgical Combined Medical/Surgical Intensive and Coronary Care Obstetrics Paediatrics Mental Health** Total Acute ,155 *Includes Georgetown, Milton and Oakville sites ** Includes both Adult and Child. Source: Planning Decision Support Tool, Ontario Ministry of Health and Long-Term Care 106

107 Hospitals Functional Centres, 2008/09 The Credit Valley Hospital Halton Healthcare Services Corp.* Trillium Health Centre TOTAL Average Beds Staffed and in Operation ,603 Acute Patient Days 106, , , ,435 ICU Patient Days 6,344 7,086 16,569 29,999 Rehab Patient Days 14,026 13,934 25,541 53,501 Mental Health Patient Days 6,410 14,137 17,959 38,506 Chronic Patient Days 13,658 31,420 72, ,178 Total Patient Days 146, , , ,619 Visits Face-to-Face (In-House) (incl. ER visits) 474, , ,502 1,177,944 Visits Telephone (In-House) 6,052 2,377 5,340 13,769 ER Visits 83, , , ,033 Day Surgery OR Surgical Cases 25,819 30,130 23,137 79,086 Separations 24,994 25,136 32,245 82,375 Source: Healthcare Indicator Tool, Ministry of Health and Long-Term Care 107

108 Inpatient Services Supply and Demand Trends This section of the Environmental Scan will examine Inpatient Services. Definitions for these terms are as follows: Supply = The ability of MH LHIN hospitals to provide Inpatient (IP) services to residents of MH LHIN and other LHINs. Demand = IP services required by local LHIN patients as provided by local hospitals and non-local hospitals in the Province. Surplus (+) / Deficit (-) = Excess or shortage in capacity to provide IP services within the MH LHIN and its hospitals. Four key metrics have been included to present as robust a picture as possible of Inpatient Services involving MH LHIN hospitals and MH LHIN residents. Additionally, the data presented in the following slides represents a four-year period (2006/07 to 2009/10) in order to identify potential trends. 108

109 Separations: Market Share Separations*: This chart shows that there was an increase of both supply and demand for inpatient services by MH LHIN patients from 2006/07 to 2009/10. Additionally, the Inflow (i.e. non- MH LHIN residents coming into the MH LHIN for services) and Outflow (i.e. MH LHIN residents receiving services outside of the MH LHIN) have remained relatively consistent from 2006/07 to 2009/10. In 2009/10, both the Inflow and Outflow decreased slightly from the previous year. * Separation: A completed case treated in a hospital resulting in any of the following: discharge home, transfer to another facility, death or sign out. Source: intellihealth, Inpatient Discharge Main Table. CIHI, DAD. 109

110 Separations: Supply & Demand Over the same period, the MH LHIN has been in a deficit position (i.e. more local residents have been receiving care from non-mh LHIN hospitals than non-mh LHIN residents receiving care from MH LHIN hospitals). This deficit had been slowly decreasing from 2006/07 to 2008/09, but increased slightly from 2.7% in 2008/09 to 2.9% in 2009/10. From the Demand (Outflow) perspective, an examination into the Major Clinical Category (MCC) grouping of services indicates that the top four services required by local residents during all four years are Pregnancy and Childbirth, Newborn and Perinatal Conditions, Circulatory System and Digestive System. It should also be noted that the MH LHIN hospitals have the largest imbalance in Demand versus Supply in Digestive System, Significant Trauma, Kidney/Urinary Tract and Male Reproductive System, and Blood and Lymphatic System (see Table 1). 110

111 Separations: Supply and Demand TABLE 1 Source: intellihealth, Inpatient Discharge Main Table. CIHI, DAD. 111

112 Weighted Cases: Market Share Weighted cases measure the intensity of resource utilization for each acute inpatient separation (or episode); weights affect the overall utilization picture as an increase or decrease in the volume and type of separations take place. This chart indicates that during the past four years, the trend is almost identical to separations from a Supply and Demand perspective, as both are slowly increasing. The rate of outflow has fluctuated only slightly over the past four years, ranging from a low of 28.4% in 2008/09 to a high of 29.7% in 2006/07. Inflow had been decreasing slightly from 2006/07 to 2008/09, but increased 0.3% from the previous year in 2009/10. The MH LHIN s flow deficit has remained relatively stable over the past four years, with a variance of only 0.7% between the lowest and highest rates. Source: intellihealth, Inpatient Discharge Main Table. CIHI, DAD. 112

113 Weighted Cases: Supply and Demand From the Demand perspective, the Weighted Cases scenario presents a different picture than Separations, with the top four MCC groups being Circulatory System, Digestive System, Respiratory System and Pregnancy & Childbirth. The imbalance in Supply versus Demand per the Weighted Case indicator are flow deficits in Newborns & Neonates with Perinatal Conditions, Blood & Lymphatic System, Significant Trauma, and Digestive System. From the supply perspective, during the past four years, Respiratory System, Circulatory System, Digestive System and Pregnancy & Childbirth are among the top four services provided by MH LHIN hospitals based on weighted cases (see Table 2). 113

114 Weighted Cases: Supply and Demand TABLE 2 Source: intellihealth, Inpatient Discharge Main Table. CIHI, DAD. 114

115 Patient Days: Market Share This chart shows that in terms of Patient Days, over the past four year period, the trend has been a small decrease in Inflow and a slight increase in Outflow. As a result, the flow deficit has decreased to 6.8% versus 5.8% from 2006/07 to 2009/10. In looking at total supply and demand, both were increasing from 2006/07 to 2008/09, but actually decreased in 2009/10. This is unexpected since the trends on Separations and Weighted Cases do not exhibit a similar reduction in demand during these two years. Source: intellihealth, Inpatient Discharge Main Table. CIHI, DAD. 115

116 Patient Days: Market Share TABLE 3 Source: intellihealth, Inpatient Discharge Main Table. CIHI, DAD. 116

117 Summary Our population is growing, and growing quickly in comparison to Ontario as a whole. In terms of both supply and demand, volumes are increasing in certain Major Clinical Categories (Tables 1 3) when looking at Separations and Weighted Cases, but Total Patient Days actually declined from 2008/09 to 2009/10. This scenario will change over time and we need to keep an eye on the growth occurring over the next 3-5 years 117

118 Emergency Room Utilization Nubmer of ER Visits ER Visits in the MH LHIN 90,000 80,000 70,000 60,000 50,000 40,000 30,000 20,000 10, Source: NACRS, CIHI. Ambulatory All Visits Main Table. (3986) CREDIT VALLEY HOSPITAL (THE) (4624) HALTON HEALTHCARE SERVICES CORP-GEORGETO (4193) HALTON HEALTHCARE SERVICES CORP-MILTON (4192) HALTON HEALTHCARE SERVICES CORP-OAKVILLE (4090) TRILLIUM HEALTH CENTRE-MISSISSAUGA (4363) TRILLIUM HEALTH CENTRE-WEST TORONTO This graph illustrates the number of visits to an Emergency Department in the Mississauga Halton LHIN over the past four years by hospital site. All hospital sites saw an increase in the number of ED Visits in 2009/10 from 2008/09, which is reflective of the increase of total ED Visits in the MH LHIN (up to 330,489 in 2009/10 from 309,536 in 2008/09). The Credit Valley Hospital recorded the highest volume of ED Visits in 2009/10 for the Mississauga Halton LHIN. 118

119 MH LHIN ER Visits, All Ages, CTAS Level Trend Chart This graph shows the number of ER Visits to MH LHIN hospitals by Triage / CTAS Level over the past four years. The CTAS levels are designed such that level 1 represents the sickest patients and level 5 represents the least ill group of patients. We can see that the largest percentage of ER Visits in the MH LHIN were CTAS Level 3 (Urgent / Potentially Serious). Source: NACRS, CIHI. Ambulatory All Visits Main Table. 119

120 MH LHIN ER Visits, All Ages, CTAS Level Trend Chart This graph illustrates that there was an increase in the number of ER Visits in the MH LHIN across all CTAS levels from 2008 to 2009, although the increases were quite small in CTAS Levels 1 and 5. Source: NACRS, CIHI. Ambulatory All Visits Main Table. 120

121 MH LHIN ER Visits, All Ages, CTAS Level Trend Chart This graph illustrates that the proportion of ER Visits by CTAS level has remained relatively stable over the past four years, with the bulk of ER Visits being CTAS Level 3, followed by Level 4 and then Level 2. CTAS Level 1 ER Visits comprise the smallest percentage of ER Visits. Source: NACRS, CIHI. Ambulatory All Visits Main Table. 121

122 MH LHIN ER Visits, Age 75+, CTAS Level Trend Chart Source: NACRS, CIHI. Ambulatory All Visits Main Table. This chart showing ER Visits in the MH LHIN over the past four years by people over age 75 is similar to the trend of overall ER Visits (i.e. by all ages) in that CTAS Level 3 comprise nearly 50% of the ER Visits. The main difference lies in the percentages for CTAS Level 2 and CTAS Level 4 ER Visits, with a larger proportion of those aged 75+ designated as CTAS Level 2 (Emergent / Potentially Life- Threatening). 122

123 Total Time Spent in ER Mississauga Halton LHIN Source: Ontario Ministry of Health and Long Term Care: August

124 Emergency Room Wait Times Trend Data Mississauga Halton (April 2008 September 2010) Source: Ontario Ministry of Health and Long Term Care: August

125 Emergency Room Wait Times Trend Data Mississauga Halton (November 2009 October 2010) Source: Ontario Ministry of Health and Long Term Care: August

126 Alternate Level of Care (ALC) Alternate level of care or ALC is a phrase used to describe a level of care provided to patients occupying hospital beds who no longer need acute services while they wait to be discharged to a more appropriate setting 1. These non-acute hospital days are captured in hospitalization data as patients awaiting an alternate level of care (or ALC patients). Uncovering how ALC is being used in acute settings may inform discussions on whether the health care system has sufficient capacity to provide necessary care in the most appropriate setting. Source: Alternate Level of Care in Canada, January 14, 2009, Canadian Institute for Health Information Analysis in Brief. 126

127 ALC Days MH LHIN The chart below shows that after a rise in ALC days from 2006/07 to 2008/09, ALC days were down sharply in 2009/10 to levels lower than in 2007/08, with a reduction of nearly 15,000 ALC Days from 2008/09 to 2009/10! While the difference in supply and demand of ALC days is relatively small, it appears that more and more ALC days have been incurred in other LHINs hospitals by MH LHIN residents. This is evident by looking at the inflow and outflow percentage trend lines. As of 2009/10, the deficit rate is at 10.4%, a notable increase from 5.4% during 2006/07. Source: intellihealth, Inpatient Discharge Main Table. CIHI, DAD. 127

128 ALC Days MH LHIN 128

129 ALC Days MH LHIN Looking at the Outflow of total ALC Days over the past four years, the Top 4 MCC groups are Significant Trauma, Nervous System, Circulatory System and Mental Diseases and Disorders. There appear to be significant shifts in days attributed to MCC groups from year to year in terms of Outflow of ALC Days. For example, from 2008/09 to 2009/10 the demand of ALC Days by MH LHIN residents to a hospital outside of the MH LHIN attributed to Mental Diseases and Disorders more than doubled from 562 to 1,159 while the number for Ear, Nose, Mouth and Throat jumped from 54 in 2008/09 to 335 in 2009/10. The Top 4 MCC groups where MH LHIN receives most of the ALC days from nonlocal LHIN (i.e. Inflow) are the Nervous System, Circulatory System, Significant Trauma and Respiratory System. These 4 MCC groups have remained relatively consistent over the past four years, but there is a large degree of variance in most other MCC groups. 129

130 Rehabilitation Patient Days Source: Planning Decision Support Tool, Ministry of Health and Long-Term Care 130

131 Rehabilitation - Separations Source: Planning Decision Support Tool, Ministry of Health and Long-Term Care 131

132 General Rehab Occupancy Rates Source: Planning Decision Support Tool, Ministry of Health and Long-Term Care 132

133 Complex Continuing Care Complex Continuing Care (CCC) is a distinct level of care unique to Ontario. It provides continuing, medically complex and specialized services to both young and old, sometimes over extended periods of time. Such care also includes support to families who have palliative or respite care needs. There is evidence that acuity of illness is rising and CCC programs are becoming more and more specialized in the care they provide, including an increased emphasis on transitional or rehabilitative care. As such, relationships between facilities offering CCC and their counterparts both in acute care and in the community are becoming increasingly important. 1 Mississauga Halton LHIN hospitals treat complex continuing care patients in 286 CCC beds among their institutions. The following table reflects an average case mix index (CMI) (measure of intensity of care) for the LHIN at Over 65% of all patient days occur at the Trillium Health Centre Queensway site. 1 Canadian Institute for Health Information Complex Continuing Care in Ontario. OCCPS to : Resident Demographics and System Characteristics. 133

134 Complex Continuing Care 2008/09 RUG-Weighted Patient Day (RWPD) Summary Institution Patient Days RUGs Weighted Patient Days Case Mix Index The Credit Valley Hospital 14,083 14, Halton Healthcare Services Corp - Georgetown 8,784 8, Halton Healthcare Services Corp - Milton 8,582 9, Halton Healthcare Services Corp - Oakville 8,102 9, Trillium Health Centre Queensway Site 73,921 73, Mississauga Halton LHIN TOTAL 113, , Source: CIHI, Continuing Care Reporting System Provincial RWPD Report 134

135 Ambulatory Care Trend Inpatient Visits * Number of Day/Night Visits (excl. Dialysis) Source: Planning Decision Support Tool, Ministry of Health and Long-Term Care 135

136 Ambulatory Care by Facility Outpatient Visits * Number of Day/Night Visits (excl. Dialysis) Source: Planning Decision Support Tool, Ministry of Health and Long-Term Care 136

137 Health Service Utilization - Community Based Community Care Access Centre Community Support Services Long-Term Care Homes Mental Health & Addictions 137

138 Mississauga Halton CCAC Service Utilization 2007/08 Service Individuals Served Visits: In-House & Contracted Out Average Visits per Individual Served Visit Nursing 9, , Physiotherapy 5,084 36, Nutrition / Dietetic 563 2, Occupational Therapy 8,784 43, Speech Language Pathology 2,609 24, Social Work 487 2, Service Individuals Served Hours of Care: In-House & Contracted Out Average Hours per Individual Served Shift Nursing , In-Home Support Services 7,773 1,066, Respite Services , Source: CCAC MIS Comparative Reports 2007/2008YE, Ministry of Health and Long-Term Care Finance & Information Branch 138

139 Mississauga Halton CCAC: Admissions by Service Recipient and Age Category, Comparison of 2007/08 to 2009/10* FISCAL YEAR Elderly S Acute (SR91) Rehab (SR92) Maintenance (SR93) LT Supportive (SR94) End of Life (SR95) Adult S Pediatric S Elderly S Adult S Pediatric S Elderly S Adult S Pediatric S Elderly S Adult S Pediatric S Elderly S Adult S Pediatric S Total 2007/08 4,276 5, , ,835 3, , /10 5,928 6, , ,380 3, ,830 % Change 2007/08 to 2009/ % 17.1% -13.2% -38.7% -41.6% -24.8% 16.4% 1.2% 3.9% -56.2% -71.2% -45.8% 33.3% 1.4% -38.5% 3.0% *Does not include admissions not yet categorized. CCAC MIS Comparative Reports, FY2007/08 & FY2009/10, TABLE 6C1: CASE MANAGEMENT (PA ) - Admissions by Service Recipient and Age Category (S5019*** excl. S5019*90), Ministry of Health and Long-Term Care Finance and Information Branch. 139

140 Mississauga Halton CCAC CCAC MIS Comparative Reports, FY2007/08 & FY2009/10, TABLE 6C1: CASE MANAGEMENT (PA ) - Admissions by Service Recipient and Age Category (S5019*** excl. S5019*90), Ministry of Health and Long-Term Care Finance and Information Branch. 140

141 MH LHIN CSS Services, FY 2007/08 Units Clients Homemaking, home help, home maintenance and repair 177,496 2,262 Meals on wheels, congregate dining 155,517 2,094 Health Promotion Education, Training, Counseling 144,247 11,555 Supportive, assisted living services 141,603 2,143 Visits, security checks 126,560 3,017 Day Programs / Service 54, Transportation 50,277 1,771 Caregiver support, respite 70,248 3,636 Specialty Services (Blind, Hearing) 15,200 2,551 Source: CSS WERS Report, 2007/08 Actuals 141

142 Evidence Based Approach and investments made in the Community to address Appropriate Level of Care/ER use LTC Beds Supports for Daily Living Adult Day Services CCAC Understand Seniors Needs - 4,031 Beds % utilization % turnover/yr - 12% inappropriate Avg CMI (07): Range: excluding 5 RAI early adopters - Total LTC bed supply/1000 population MH LHIN -7.9% - Province -9.3% - Biggest capacity challenge: - Alternatives to more LTC beds - Increase community capacity - 1,018 clients on the program in 07/08-17% /367 inappropriate (research) - Introduction of evidence based tool (CHA) - Common program framework & reorientation to focus on alternative to LTC Beds - Those needing 24/7 care supervision - Central referral to SDL coordinators from CCACs, D/C planners clients on the program in 07/08 - Increase capacity to move towards Diversion from LTC and caregiver relief to remain at home - Referral from CCAC only - Increased services for 75+ target age group - Intensity - 37%/205 inappropriate CCAC Wt list (research) - 10%/1419 inappropriate CCAC Community (research) - Environics Poll Focus groups with Elderly Summer

143 Long-Term Care Homes In April 2010, a total of 1,115 people in the community were waiting for placement into a long-term care home bed. The April 2010 bed occupancy was 99.2% compared to one year earlier (April 2009), which was 98.7% - an increase of 0.5%. The provincial average for April 2010 was 98.9%. In April 2010, the average Length of Stay in the MH LHIN in a LTC bed was 3.3 years vs. the provincial average of 3.0 years. The turn over rate for April 2010 was 30.2% of total bed supply. The provincial average was 32.9% for this period. There are a total of 1,177 'B' and 'C' rated LTC home beds in the MH LHIN that are eligible for redevelopment within the province's longterm care bed redevelopment program that started in 2009/2010 and will continue over the next 10 years. 143

144 Mississauga Halton Local Health Integration Network Long-Term Care Home Beds 1, ,138 Sub-LHIN LTC Beds Bed / 75+ (per 100) Milton Halton Hills Oakville Halton Region 1, NW Mississauga 1, SE Mississauga 1, Mississauga 2, South Etobicoke MH LHIN 4, * STATSCAN and MOHLTC Health Analytics June