Hospital Redevelopment Stage 1 Submission Update Novemebe May 2108

Objectives - Update Stage 1 Planning Submission that: - Builds on development of strategic partnerships - Reinforces ‘Health Hub’ approach - Updates Capital Costing - Groundwork for Update of Strategic Plan

Current Pressures and Issues CMH is providing care in an aged facility with major infrastructure issues which does not meet modern hospital facility standards Through 2016 and continuing in 2017, CMH has been in a “new normal” state of surge through the winter months with average daily census at close to 110% and as high as 125% of the 34 available inpatient beds With high patient census on acute inpatient unit, admitted patients spend significant time in the Emergency Department and adversely affect patient flow Emergency Department is experiencing a greater number drug/opiod-related admissions The % of Alternate Level of Care (ALC) patients varies from 25%-35% of available acute care beds The lack of LTC Home and sub-acute capacity in Trent Hills area, Northumberland County and the Central East LHIN contribute to the high % of ALCs at CMH and all CE LHIN hospitals Inadequate housing and lack of affordable seniors housing and assisted living services puts additional strain on home and community care services and CMH Northumberland County has the highest proportion of people 65+ years of age in Ontario with associated complex health issues related to aging Trent Hills primary care physicians withdrew from supporting the CMH Acute Unit and Emergency Department in 2016 requiring CMH to develop a new model of providing medical care to inpatients

Strategies to address current issues CMH has initiated a Internal Medicine Hospitalist model of care for Acute Unit patients with expertise to care for more complex inpatients Internal Medicine physicians have been recruited jointly with Northumberland Hills Hospital (NHH) CMH has developed partnerships with community health service organizations to develop as an integrated rural health hub in a campus setting CMH has developed and is pursuing numerous partnerships with other CE LHIN hospitals, ex. 7 hospital partnership for Clinical Information System (CIS) acquisition, Lab partnership with PRHC, Regional CIO, etc. CMH is exploring a strategic partnership with NHH in the Northumberland County Sub Region and has requested support from the CE LHIN in the planning of such a partnership

Themes & Highlights Deloitte Environmental Scan-2017 Market share findings suggest opportunities for CMH to grow and focus: “Some areas of low market share suggest gaps in service to local residents and potential opportunities to grow or modify service delivery… …there may be opportunity for repatriation through innovative partnerships or shared resourcing to facilitate community service delivery…”

Impact of Shared Resourcing Benefits of clinical and support service integration could include: Better access to specialist care and services Expansion of ambulatory care at CMH to enhance access Ability to maintain higher acuity cases at CMH Enhanced ability for recruitment of clinical care staff Capital cost savings

Demographics CMH currently serves a primary and secondary catchment population of 30,200 permanent residents in: Trent Hills Marmora and Lake Havelock - Belmont -Methuen Asphodel – Norwood Stirling Rawdon Source: Deloitte Central East LHIN North East Cluster Environmental Scan Campbellford Memorial Hospital – January 2017

Demographics CMH also serves a population of 15,000 seasonal residents who impact emergency and unscheduled care. Trend for seasonal residents to relocate to the area as full time residents. Source: Township Data and Estimates based on extrapolation of voting rolls

Demographics People over 65 years of age currently represent 29% of the CMH catchment population… compared to 16% for the province. By 2025, this group will represent 38% of the total population … and by 2035, 45% of the total population of the CMH catchment area. Source: Deloitte Central East LHIN North East Cluster Environmental Scan Campbellford Memorial Hospital – January 2017

Demographics By 2025 - 2035, CMH will serve a permanent population of 32,000+ residents and a seasonal population of 12,000 – 15,000 people.

Key Programs and Services

Market Share – Emergency Source: Deloitte Central East LHIN North East Cluster Environmental Scan Campbellford Memorial Hospital – January 2017 81.6% Trent Hills 73.9% Havelock Bethune Methuen 72.7% Marmora & Lake

Emergency Care Emergency visits 2016/17 2025/26 - CTAS 1 - Resus 49 70+/- - CTAS 2 - Emergency 2,069 2,500 - CTAS 3 - Urgent 7,358 8,400 - CTAS 4 - Less Urgent 10,832 11,100 - CTAS 5 - Non-Urgent 1,008 1,000 Total 21,308 23,070 +8.3%

Market Share – All Inpatient Care Source: Deloitte Central East LHIN North East Cluster Environmental Scan Campbellford Memorial Hospital – January 2017 Market share generally reflects CMH range of services offered; i.e. oncology, obstetrics, complex surgical, paediatrics, etc. are provided at regional hospital centres

Current Market Share – Medical Inpatient Source: Deloitte Central East LHIN North East Cluster Environmental Scan Campbellford Memorial Hospital – January 2017 CMH attracts a substantial market share for inpatient medical care; these patient volumes are projected to increase 34% by 2036 with aging population.

Future Market Share – Medical Inpatient CMH should be able to increase its market share by having an Internal Medicine Hospitalist model and by repatriating sub-acute and complex continuing care patients from NHH and PRHC.

Inpatient Care CMH will continue to provide inpatient medical care: Beds 2017 2025-2036 Medical Acute 30 36 Critical Care 4 4-5 Sub-Acute inc. 6-8 Total 34 46-50 Medical Acute beds would include palliative care suites Plus potential for 16+ sub-acute beds for transitional/convalescent care

Ambulatory Care CMH will continue to focus on ambulatory care, including: Medical and Surgical Clinics Ambulatory Surgical Procedures Cardiopulmonary Care Mental Health Care Diabetic Care & Clinical Nutrition

Market Share – Ambulatory Procedures Source: Deloitte Central East LHIN North East Cluster Environmental Scan Campbellford Memorial Hospital – January 2017 Most area residents use PRHC for their ambulatory surgical care… 47% Trent Hills 60% Havelock Bethune Methuen 25% Marmora & Lake

Ambulatory Procedures – 2025-2035 CMH will continue to offer ambulatory surgical care: - Surgical clinics (pre and post procedure) - Colonoscopies &Endoscopies - Excisions & Biopsies - Venous Procedures - Other minor procedures

Ambulatory Clinics – 2025-2035 Opportunities for future additional clinics offered by visiting specialists include: Gynaecology & Obstetrics Gerontology Pre-Dialysis & renal disease management Chemotherapy

Cardio Pulmonary Services – 2025-2035 CMH will continue to offer co-ordinated services as a designated Stroke Centre, linked with PRHC Cardiac Services: Blood Pressure Clinic Echocardiography Electrocardiography Ambulatory Blood Pressure Monitoring Holter Monitoring Stress Testing Cardiac Education Program

Diabetic Care CMH will continue to provide appropriate primary care for a growing population with diabetic disease: - Community Education Programs - Group and Individual Teaching & Counselling - Multi-disciplinary Team Access - Diabetes Support Group

Mental Health – 2025-2035 CMH will continue to offer a full range of primary care mental health services in partnership with other providers: - Crisis Intervention - Psychiatric Consultation - Counselling & Treatment - Clinical Case Management - Mental Health Court Support Services - Early psychosis intervention

The Rural Health Hub Concept

Core Health Hub Services Core Services provided by a rural Health Hub: - Acute Care - inpatient and outpatient - Emergency Care - Complex Continuing Care - Rehabilitation - Community Mental Health and Addictions - Primary Family Health Care OHA - The Case for Implementing Fully Integrated Rural Health Hubs on a Pilot Project Basis, 2016

Core Health Hub Services Other Core Services can include: - Long Term Care Facility - Community Support Services (housing) OHA - The Case for Implementing Fully Integrated Rural Health Hubs on a Pilot Project Basis, 2016

CMH is already a Health Services Hub Campbellford Memorial Hospital Family Health Centre Supportive Care Seniors Housing Community Mental Health Community Care

CMH Partners - Campbellford Memorial Multicare Lodge - Trent Hills Family Health Team - Community Living - Community Care Northumberland - Northumberland County Health Links

Future CMH Partnerships - Long Term Care providers - Other Supportive Care Housing Providers - Other Allied Health Professionals (AHPs) Within a small, rural and aging community, the future Trent Hills Health Services Hub is envisioned to focus on Seniors and provide an “aging-in-place” centralized campus of care with its partners

Future Trent Hills Health Services Hub Campbellford Memorial Hospital Family Health Centre Long Term Care Supportive Care Seniors Housing AHP’s Community Mental Health Community Care

Master Plan 2025-2035

Site Plan 25 Acres

Updated Capital Cost Projections - Eliminated EMS building costs (-$2.5 million) - Deleted demolition of existing building (-$3.5 million) - Reflect potential reduction in facility requirements through clinical and support service partnerships - Reflect increase to 2017 costs based on RMS Means - Reflect escalation to 2023/24 construction completion

Updated Capital Cost Projections Option A–R1 (48 Beds) - Project Cost $125,500,000 - MoHLTC Share $ 98,630,000 - Community Share $ 26,370,000

Community Share Option A–R1 (48 Beds) - Construction $ 9,010,000 - Furnishings & Equipment $ 10,860,000 - IT $ 3,100,000 - Contingencies & Escalation $ 3,900,000 Total $ 26,870,000

Updated Capital Cost Projections Option A–R2 (16 +/- Shelled Beds) - Project Cost $135,460,000 - MoHLTC Share $ 98,630,000 - Community Share $ 36,830,000

Community Share Option A–R2 (16-20 Shelled Beds) - Construction $ 17,070,000 - Furnishings & Equipment $ 10,860,000 - IT $ 3,100,000 - Contingencies & Escalation $ 5,800,000 Total $ 36,830,000

Updated Capital Cost Projections Option A–R3 (Additional 16+ sub-acute Beds) - Project Cost $146,200,000 - MoHLTC Share $114,630,000 - Community Share $ 31,570,000

Community Share Option A–R3(Additional 16-20 Beds) - Construction $ 10,480,000 - Furnishings & Equipment $ 13,060,000 - IT $ 3,730,000 - Contingencies & Escalation $ 4,300,000 Total $ 31,570,000

Next Steps - Continue exploring Strategic Partnership with NHH - Submit Updated Master Plan to LHIN and MoHLTC