Long Term Care Homes High-Level Briefing and One-Day Conference

1. Long Term Care HomesHigh-Level Briefing and One-Day Conference Ontario Health Coalition Alliance of Seniors/Older Canadians Network

2. How We Got Here • Rae Government – three acts to formalize system • Harris Government – deregulation, 20,000 new beds most for-profit, “Red Tape Commission” recommended new Act • McGuinty Government – some reversals of Harris-era deregulation. Continuation of Harris tendering – more new beds, continuation of for-profit privatization. Process leading to new Act, regulations. • Monique Smith Report • Bill 140 • Sharkey Report • Sharkey Process • Regulation Process – eliminate Manual, new regulations

3. Coming Up • Sharkey process • Regulations – 30 day consultation • Ombudsman’s report & recommendations

4. Assessing Where We Are At: History of Deregulation/Some Reversals

5. Ownership of LTC Homes –Cross-Canada Comparison

6. Envelope Funding System • Nursing and Personal Care – no profit • Raw Food – no profit • Programs and Support Services – no profit • Accommodation – profit • Capital – separate, profit

7. Large For-Profit Chains Operating in Ontario • Extendicare • Chartwell • Revera (was Central Care Corp.) • Leisure World

8. Ontario Health Coalition Key Issues in LTC homes 2006

9. Ontario Health Coalition Key Issues in LTC homes 2006

10. Ontario Health Coalition Key Issues in LTC homes 2006

11. Ontario Health Coalition Key Issues in LTC homes 2006

12. Ontario Health Coalition Key Issues in LTC homes 2006

15. The missing link: acuity increases, funding increases, care levels stagnant

16. Increasing Acuity • 1992 – 2007 – Acuity increase of 29.7% • In 2007 provincial CMM was 98.13 an increase in 1.87% since 2006 when the provincial CMM was 96.33 • Result of redefinition of complex continuing care, closing of hospital beds, ageing, downloading of mental health patients/closing of beds • By 2007, 74% of Ontario’s ltc residents were classified as Category F (second highest level of acuity)

17. Assessing Acuity • 2001 PriceWaterhouse Coopers Report: • Since then, government has never updated the study, but acuity has continued to increase.

18. Status of Daily Hands-On Care:Stagnant Since 2005

19. Analysis

20. Shirlee Sharkey’s Report

21. Ontario Health CoalitionKey Recommendations in 2008 • A Minimum Care Standard • Attached to measured acuity • Average of 3.5 hours attached to average acuity • Cover RN, RPN, PSW (daily hands-on care) • Public reporting, compliance, enforcement • Note: there are existing minimum levels for Administrator, Director of Nursing, Food Services Supervisor, Therapy Services Coordinator, Registered Dietician, Recreation & Leisure Services

22. Ontario Health CoalitionKey Recommendations in 2008 • Appropriate care settings, special care units, review downloading • Development of a Human Resources strategy as a priority • Provide time and opportunities for staff to talk with residents for social and rehabilitation purposes, and recognize this activity as vital for quality of life for both residents and staff. • Update the findings of the 2001 PriceWaterhouse Cooper’s Report into staffing and acuity levels in Ontario’s nursing homes as per the Coroner’s Jury Recommendations in the Casa Verde homicide. • Other recommendations as per our 2006 key issues.

23. Current MOHLTC Initiatives • Sharkey Process • Regulations Process