1. Hospital Redevelopment Stage 1 Submission Update
Novemebe
May 2108

2. 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

3. 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

4. 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

5. 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…”

6. 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

7. 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

8. 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

9. 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

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

11. Key Programs and Services

12. 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

13. Emergency Care Emergency visits 2016/17 2025/26
- CTAS 1 - Resus /-
- CTAS 2 - Emergency 2, ,500
- CTAS 3 - Urgent 7, ,400
- CTAS 4 - Less Urgent 10, ,100
- CTAS 5 - Non-Urgent 1, ,000
Total 21, , %

14. 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

15. 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.

16. 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.

17. Inpatient Care CMH will continue to provide inpatient medical care:
Beds
Medical Acute
Critical Care
Sub-Acute inc. 6-8
Total
Medical Acute beds would include palliative care suites
Plus potential for 16+ sub-acute beds for transitional/convalescent care

18. 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

19. 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

20. 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

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

22. 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

23. 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

24. Mental Health –
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

25. The Rural Health Hub Concept

26. 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

27. 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

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

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

30. 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

31. 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

32. Master Plan

33. Site Plan
25 Acres

39. 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

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

41. 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 $ ,870,000

42. 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

43. 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 $ ,830,000

44. 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

45. 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

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