The following are the highlights of the Champlain Local Health Integration Network Board of Directors meeting held in Ottawa, Ontario on January 23, 2019.
Board Chair Report
Champlain LHIN Board Chair Jean-Pierre Boisclair set the stage for the meeting by emphasizing the importance of the LHIN’s work in areas such as home and community care, expanding community-based services to reduce hospital pressures, and providing high-quality, efficient, and sustainable health care. He noted the future uncertainties that have recently been the subject of media reporting.
The Chair commented on several important dimensions of the LHIN’s role, accomplishments and operations, and tabled the document, Pathways Forward to Better Patient Care - Strategies and Integration Successes. He invited those present to review this document, with particular reference to the financial and qualitative cost-benefit analysis of seven recent, major LHIN initiatives. These programs exemplify how services can be tailored to better meet local needs, improve access to and quality of health services, and produce significant savings that have been reinvested to meet growing demand for health services. For example, for every dollar invested in these initiatives, the health system gets nine dollars back in savings.
The imperative of adapting programs and services to meet local needs is critically important. “Ontario is a very large and diverse province,” Mr. Boisclair said. “The health needs of its population vary.”
Examples of successful LHIN initiatives are a central intake and assessment process for hip and knee surgery, a regional orthopedic program, a regional lung health program, integrated health services for the homeless, a community stroke rehabilitation program, and an electronic consultation tool for primary-care professionals to obtain advice from specialists.
Describing the Champlain LHIN as a lean organization, Mr. Boisclair said that nearly 99 per cent of its budget is dedicated to direct patient services. Very few providers can claim such low overhead costs. In the most recent fiscal year, the Champlain LHIN reduced its own annual management and administration costs by $1.4 million.
The health system is made up of a complex array of programs, services and providers, he added. Someone needs to oversee and coordinate all the different parts in order to build a cohesive and comprehensive whole for the benefit of the 1.3 million people who live in the Champlain region. This job is akin to having "air traffic control" to ensure the smooth functioning of many individual parts.
In conclusion, Mr. Boisclair stated that the LHIN, as a Crown corporation, recognizes that the provincial government has the prerogative to set policy and design the health system.
“We share in the desire to improve the quality and efficiency of health care in Ontario,” he said. “The aging population and growth of the population makes this an imperative to ensure sustainable health care for all.”
The January 2019 Board meeting focused on modernizing home care, with discussions on home-care facts and figures, recent successes, the patient experience, and a strategic direction for the future.
Champlain LHIN Home Care
Facts and Figures
The Champlain LHIN provides services in home and at clinics for about 65,000 clients every year, and has roughly 20,000 active clients at any given time. This amounts to 4 million client visits annually for personal support, nursing, and therapies such as physiotherapy, occupational therapy, and speech therapy.
The LHIN’s home-care services play a key role in helping seniors stay at home safely and independently for as long as possible. These services also provide support to informal caregivers, who often feel stressed and alone.
The LHIN employs care coordinators, mental-health nurses in schools, rapid response nurses serving patients recently discharged from hospital, and some health professionals who provide therapies. It contracts with service provider agencies mainly to provide personal support (e.g. assistance in bathing, getting dressed) and nursing (e.g. wound care, giving medications).
At a time when the population is aging and experiencing more complex health conditions, the demand for home care expected to increase significantly. By 2028, in less than a decade, the number of home-care clients to be served each year will rise from about 65,000 to approximately 87,000—a difference of almost 34 per cent. By 2038, that demand will further rise to almost 120,000—an increase of about 85 per cent from the current state. For every dollar spent on home care by our LHIN, four dollars are saved in avoidable hospital and long-term care home costs, making home care a cost-effective solution in addressing current health-system pressures.
In fact, if home-care patients in the Champlain region were to be treated in hospitals or long-term care homes, it would cost an additional $130 million every year, requiring about 260 extra acute-care hospital beds, roughly 1,500 added long-term care home beds, and 100,000 more hospital emergency room visits—creating additional burdens to an already challenged system.
Patients in the Champlain region have benefitted from a number of improvements to home care in recent years.
“This organization has been successful in implementing high-impact changes that have provided better quality of care for our patients,” said Catherine Butler, Champlain LHIN Vice President of Home and Community Care. For example:
- Last year, the LHIN implemented a community stroke rehabilitation program that not only provides high-quality services, but also saves the health system more than $1 million every year.
- In 2017, the LHIN put in place a caregiver distress and respite program that has served almost 500 families to date. The program has been successful in relieving caregiver strain and preventing caregiver burnout. The respite services provided are more aligned to the needs of the family, and respite hours are scheduled to be more convenient for families.
- After an overhaul in 2016 of the way medical supplies and equipment were procured, the organization will have saved the health system more than $7 million over 5 years.
LHIN Board members welcomed Idongesit Inyang and her husband Ubong, who gave a presentation about their experiences with home-care services in Ottawa.
By involving members of the public in meetings, LHIN Board members can better understand how policies, programs and services in the health system are impacting patients, both positively and negatively.
Mrs Inyang told the story of her remarkable healing journey, which began in 2013 after she experienced a heart attack when she was 30. She was revived by paramedics, and then spent time comatose in an intensive care unit on life support, followed by a lengthy hospitalization.
Suffering from brain damage that resulted in paralysis, blindness, and deafness, she was advised by her health care team to apply for a long-term care home bed. Instead, she chose to recover at home with her husband and two children by her side, and with home-care services in place to support her daily needs.
Mrs Inyang highly appreciated the services of her LHIN care coordinator Lyne Lalonde, who became an invaluable resource in determining her needs and organizing her services at home, including personal support, physiotherapy, and occupational therapy.
“Lyne Lalonde is like a mother to me,” Mrs Inyang said. “She is always accessible. It is the presence of people like her that helps recovery. The support that was provided, it helped my family survive.”
|L to R: Lyne Lalonde, Ubong and Idongesit Inyang
While praising the overall care received, the couple also described challenges and proposed potential solutions. For instance, Mr Inyang suggested there should be more periodic evaluations of patients to check their progress and re-align services to their changing needs.
“The patient must be assessed regularly to see where she is in her recovery,” he advised. “Then you can adjust the treatment to be able to go further in their recovery. Otherwise, we may see lesser gains.”
Other issues raised by the couple were:
- Inconsistent communication between the LHIN and its contracted service provider agencies, and between health providers and patients
- Insufficient support for family caregivers
- Inconsistencies in level of knowledge and degree of compassion among personal support workers, an issue that could be improved through more comprehensive training
- Missed visits by personal support workers.
During the past several years, Mrs Inyang has regained much of her strength. She is now able to transfer herself from her bed to her wheelchair on her own. Her sight and hearing have returned, and she can once again participate in her family’s day-to-day life.
The decision to recover at home made all the difference, the couple believes.
“I realize that coming home was like a therapy to her,” Mr Inyang told LHIN Board members.
“Immediately, she got back in touch with the kids. The healing was emotional. The love between mother and children was more than any medication prescribed. That was the key. So thank you for what you have done. You save lives. You are the reason my wife is alive.”
Board members thanked Mr and Mrs Inyang for their valuable insights, which will help inform future priorities and activities.
Setting the Future Direction
To ensure the LHIN’s services continue to be driven by excellence and ensure they meet the growing and evolving needs of our residents, the Champlain LHIN is embarking on a major region-wide initiative to modernize home care.
This means transforming the way in which the LHIN conducts its business. The aim is to be more patient-centred, achieve better health outcomes for patients, and provide taxpayers more value for money.
Here is what patients can expect as home care evolves:
- Currently, coordinating care for clients focuses on client assessments and allocation of appropriate health services. In a modernized home care system, care coordination will concentrate even more on the unique needs, strengths and goals of patients and their families
- Rehabilitation services are now often based on patients’ short-term clinical goals, which doesn’t always re-enable them to live independently in the community. By putting in place more effective models of care for rehabilitation, patients will become more autonomous, have an improved quality of life, and costs will be decreased
- Services delivered by agencies contracted by the LHIN can sometimes be inconsistent in terms of quality, continuity of care, and reliability. In future, these issues will be resolved by improving communication between providers and patients, collaborating more with agencies to reduce duplication of efforts and processes using a team-based approach, and employing more robust metrics to track systemic challenges and make positive change.
The LHIN Board went further in their discussion, exploring overarching principles and future propositions in modernizing home care. The key elements under discussion were:
- Unlocking the value of people, including care coordinators, personal support workers, and family caregivers. In particular, the Board recognizes that we cannot underestimate the significant role of family caregivers in the home-care system. A key question on informal caregivers is: What actions should be taken to nurture and protect this critical human resource?
- Unlocking value from delivery approaches, systems, and instruments. This work will involve care coordination, discharge practices, service contractor and contract models, service contractor competitiveness, quality oversight and contractor performance/compliance. Part of this work relates to ‘paying for outcomes’ rather than ‘units of service’. What would it take to move in that direction?
- Streamlining a complex system. Across the region, more than 130 organizations deliver diverse and often interdependent services, all of which have an impact on home care and other health services. Are there opportunities to streamline the system through mergers or service reallocations?
- Simplifying system navigation. It is the LHIN’s responsibility to ensure the health system can not only be navigated easily, but also that patients and their families have an appropriate level of navigation support. What constitutes an appropriate level of support? Are web-based information systems sufficient, or is there a need for a full-service call centre that books health-system appointments for patients?
For more details, please see the Champlain LHIN Board’s document entitled, Modernizing Home Care.
French-Language Services in Eastern Ottawa
The Champlain LHIN Board of Directors is responsible for ensuring that Francophones across the region have access to quality services in French.
To that end, the Board approved an updated French-language services plan submitted by the Eastern Ottawa Resource Centre, a LHIN-funded agency that provides a range of services such as meal delivery, transportation and day programs for seniors. About one-third of its clients are Francophone, and roughly 90 per cent of its employees are bilingual.
As a partially designated agency under the provincial French Language Services Act, the Eastern Ottawa Resource Centre is required to submit an updated French language services plan to the LHIN every three years.
For more on the Champlain LHIN's work in French-language health services, please click here.