Building a Profile of the Central Community Support Services Sector

1. WORKING DRAFT FOR DISCUSSION PURPOSES ONLY Building a Profile of the Central Community Support Services Sector Towards Sustainability and Integration Revised November 24-09 Central Community Support Services Network

2. Central LHIN CSS Providers Based on 2009/10 approved budget (excludes Aging At Home funding)

3. Provider Profile by Geography & Specialized/Ethno-cultural Central Community Support Services Network

4. Quick Facts on LHIN Funding

5. 2007/08 Direct Service > 50,000 Units Central Community Support Services Network

6. 2007/08 Direct Service < 50,000 Units Central Community Support Services Network

7. Profile of LHIN Funded Agencies 2009/10 Approved Budget Note: Circle of Care counted twice due to palliative funding Central Community Support Services Network

8. 2009/10 Approved Funding by Sub-sector CSS base funding is fairly evenly distributed between providers serving seniors and people with physical disabilities at 38% and 32% respectively. Aging at Home funding is currently shifting the funding focus to seniors. 22% of CSS funding is allocated to providers specializing in serving people with acquired brain injuries. The remaining CSS funds are distributed to specialty and palliative services at 6% and 3% respectively. What is missing is the per capita needs to effectively serve these populations. Central Community Support Services Network

9. CSS Revenue 2008/09 Total CSS Revenue is $60.8 million The combined LHIN and MOHLTC funding accounts for 79.8% of total revenue User fees account for 9.6% of total revenues. There is potential for re-distribution of these funds to move to more equitable fee structures. Other funding sources which directly support LHIN funded programs is 8.6% of revenue. The Central LHIN will need to take a position on defining core services and quality standards which are then 100% funded (less applicable co-payment). Agencies would be in a position to allocate other revenue to non-core services which would not be funded by the Central LHIN in the future. Central Community Support Services Network

10. 2008/09 Direct Program Expenses Total program expenditures are $45.5 million (not including administration) The 5 largest programs account for almost 80% of total program expenditures All other programs account for 20% of total program expenditures. Of these, the top 3 are Elderly Persons Centres, Meals on Wheels and Caregiver Support Central Community Support Services Network

11. Understanding Administrative Overhead in the CSS Sector • CSS overhead cannot be benchmarked with other health service providers • CSS overhead is calculated on considerably lower cost direct program expenses in comparison to other health providers of which many rely heavily on front-line workers with low income or volunteers • Overhead cost definitions require that lease and operating costs of program locations be included • There is non-standardized interpretation of the allocations used in agencies that may have staff perform multiple functions Central Community Support Services Network

12. Implications The administrative overhead load carried by the Central CSS sector is reported as higher than other GTA/Central area LHINS and the provincial average at 24.4% of total expenses, $14.7 million is spent on overhead expenses is it realistic to ask if benchmark savings of 3.3% (provincial) to 6.5% (Toronto Central) can be achieved through targeted administrative consolidation strategies? This equates to $2 to $3.9 million Central Community Support Services Network

13. Administration Allocation The distribution of administration overhead profiles the high degree of generalization in administrative overhead accounting for more than half of all administrative expenses. This suggests a lack of dedicated resources in key functions. Plant operations and maintenance will be a growing component of administration overhead with the inclusion of program space for day programs in this definition. Two key enablers identified in the Central LHIN IHSP include: Human Resources (includes volunteer services) and Information Management. The CSS sector allocates less than 2% and 1% of total expenses respectively. Central Community Support Services Network

14. Programs where the LHIN is Less than 50% Funder These programs will be most difficult to standardize as the LHIN may not be the primary funder or there is high usage and variation in user fees • Elderly Persons Centres • Respite • Social and Congregate Dining • Meals on Wheels Central Community Support Services Network

15. Programs with Most Significant Financial Reporting Variations These programs have unusual reporting variances which require data quality follow-up Attention should be given to those programs where the most LHIN funding is allocated or future expansion funding • Assisted Living • Day Services • Personal Support Independence Training • ABI Personal Support Independence Training • Meals Delivery • Homemaking • ABI Assisted Living Central Community Support Services Network

16. M-SAA CSS Year 1 Requirements Central Community Support Services Network

17. Data We Don’t Have and Need in the CSS Sector • Standardized sector profile of clients served including MAPLE priority level and chronic disease profile • Standard outcome measures • Ability to demonstrate that CSS clients are less likely to present at emerg or utilize more costly health system resources such as family doctors • How much CSS funds were returned to the Central LHIN • Per capita CSS funding comparison with other LHIN areas • CSS referral sources collected and reported • Reliable unit cost and cost per client data • Performance data including: referral acceptance, continuity of service providers, significant event and discharge reporting, client complaint and occurrence rates, goal achievement, emergency preparedness planning Central Community Support Services Network

18. Common Integrated Database Year 1 Pilots • Unionville Home Society • CHATS • Better Living Health & Community Services Year 2 Expression of Interest • Etobicoke Services for Seniors • Downsview Services for Seniors • North York Seniors Centre • Villa Colombo • Region of York (TBD) Central Community Support Services Network

19. Agencies Adopting interRAI-CHA Year 1 Pilots • Etobicoke Services for Seniors • St. Clair West Services for Seniors • CHATS • Villa Colombo Year 2 Expression of Interest • Better Living Health & Community Services • North York Seniors Centre • Downsview Services for Seniors • Regional Municipality of York • Unionville Home Society • PACE (non-seniors demonstration) Central Community Support Services Network

20. Supportive Housing and Day Program Providers Not Yet on InterRAI-CHA Supportive Housing • Circle of Care • Hesperus • Friuli Day Programs • Circle of Care • Aphasia Institute • Baycrest • Friuli • Yee Hong • York Central Hospital • Carefirst Central Community Support Services Network