1. Presentation City of Greater Sudbury Sudbury Alternate Level of Care Community Steering Group May 27, 2009

2. Objectives of Presentation To provide an update on the 10 point action plan of the ALC Community Steering Group including details on the options related to the transitional strategy to accommodate the needs of Alternate Level of Care Patients to enable consolidation of acute care services at Hopital regional de Sudbury Regional Hospital in December 2009 and provide ongoing capacity for Transitional Care Patients over the next 36 monthsTo provide an update on the 10 point action plan of the ALC Community Steering Group including details on the options related to the transitional strategy to accommodate the needs of Alternate Level of Care Patients to enable consolidation of acute care services at Hopital regional de Sudbury Regional Hospital in December 2009 and provide ongoing capacity for Transitional Care Patients over the next 36 months

3. ALC Community Steering Group History and Mandate of Group History and Mandate of Group Formed in December, 2008Formed in December, 2008 Co-Chaired by NE LHIN and Sudbury Physician Task ForceCo-Chaired by NE LHIN and Sudbury Physician Task Force Members include a wide spectrum of community partnersMembers include a wide spectrum of community partners Purpose Purpose To act as a coordinating and oversight mechanism for planning and program implementation activities related to the ALC challenge in SudburyTo act as a coordinating and oversight mechanism for planning and program implementation activities related to the ALC challenge in Sudbury

4. ALC Community Steering Group MembershipMembership Dr. Zalan - HRSRH Physician Task Force (co-chair)Dr. Zalan - HRSRH Physician Task Force (co-chair) Terry Tilleczek - NE LHIN (co-chair)Terry Tilleczek - NE LHIN (co-chair) Brenda Roseborough – NE LHINBrenda Roseborough – NE LHIN Dr. Jordi Cisa – HRSRH Physician Task ForceDr. Jordi Cisa – HRSRH Physician Task Force Jim Gordon – Health Cluster Task Force Chair - City of Greater SudburyJim Gordon – Health Cluster Task Force Chair - City of Greater Sudbury Catherine Matheson - City of Greater SudburyCatherine Matheson - City of Greater Sudbury David McNeil - HRSRH AdministrationDavid McNeil - HRSRH Administration Frankie Vitone - NE CCACFrankie Vitone - NE CCAC Jo-Anne Palkovits – St. Joseph’s Health CentreJo-Anne Palkovits – St. Joseph’s Health Centre Dr. Jo-Anne Clarke – Affiliate Regional Geriatric ProgramDr. Jo-Anne Clarke – Affiliate Regional Geriatric Program Russ DeCou - Manitoulin–Sudbury Community Support Services NetworkRuss DeCou - Manitoulin–Sudbury Community Support Services Network

5. ALC Community Steering Group ResourcesResources Phil Kilbertus – NE LHINPhil Kilbertus – NE LHIN Cynthia Stables – NE LHINCynthia Stables – NE LHIN Viviane Lapointe – HRSRHViviane Lapointe – HRSRH Kim Morris – NE CCACKim Morris – NE CCAC Eliza Bennett – City of Greater SudburyEliza Bennett – City of Greater Sudbury

6. ALC Community Steering Group 10 Point Plan Endorsed StrategiesEndorsed Strategies Prevention and Health PromotionPrevention and Health Promotion Supportive HousingSupportive Housing Alternative Care and Housing OptionsAlternative Care and Housing Options Bed Capacity Options for Single Site Bed Capacity Options for Single Site Specialized Services DevelopmentSpecialized Services Development Integrated Clinical PathwaysIntegrated Clinical Pathways Nurse-Led Long Term Care Outreach TeamNurse-Led Long Term Care Outreach Team Enhancing Primary Care Services in the HomeEnhancing Primary Care Services in the Home Health Human ResourcesHealth Human Resources Long-Term Care Bed Needs AnalysisLong-Term Care Bed Needs Analysis

7. Recent NE LHIN Funding – Sudbury and Area HRSRH - Nurse-led Outreach Team – ongoing from year 1HRSRH - Nurse-led Outreach Team – ongoing from year 1 HRSRH – ER Pay for Results - $1,434,800HRSRH – ER Pay for Results - $1,434,800 HRSRH – 24 Transitional Care Beds - $2,400,000HRSRH – 24 Transitional Care Beds - $2,400,000 NECCAC - Geriatric Community Case Managers - $383,145 (Manitoulin – Sudbury)NECCAC - Geriatric Community Case Managers - $383,145 (Manitoulin – Sudbury) NE CCAC – Increase home care services - $3,500,000 (NE Ontario)NE CCAC – Increase home care services - $3,500,000 (NE Ontario) Canadian Red Cross - Fall Prevention Program - $150,000 (Manitoulin-Sudbury)Canadian Red Cross - Fall Prevention Program - $150,000 (Manitoulin-Sudbury)

8. Linking to ER/ ALC

9. Sequence of Activities

10. Occupancy Plan The HRSRH will start the occupancy of the single site starting in the summer 2009.The HRSRH will start the occupancy of the single site starting in the summer 2009. In January 2010 the decanting the of the Memorial site will be completedIn January 2010 the decanting the of the Memorial site will be completed In March 2010 the decanting of the SJHC site will be completedIn March 2010 the decanting of the SJHC site will be completed

11. The Challenge There are no facilities to accommodate the Alternative Level of Care patients currently accommodated at the HRSRH when it consolidates to a single site. There are currently 177 patients in hospital facilities that need longer term solutions: There are no facilities to accommodate the Alternative Level of Care patients currently accommodated at the HRSRH when it consolidates to a single site. There are currently 177 patients in hospital facilities that need longer term solutions: 100 in acute medical and surgical beds; 100 in acute medical and surgical beds; 21 in transitional care beds; 21 in transitional care beds; 56 in Interim Long Term Care beds operated by Pioneer Manor 56 in Interim Long Term Care beds operated by Pioneer Manor On average 130 of these patients are in beds at the Laurentian site. On average 130 of these patients are in beds at the Laurentian site.

12. Overview of Options 36 month Transitional Capacity - January 2010 Option 1 : Transitional Care Facility up to 150 Beds operated by HRSRH Option 1 : Transitional Care Facility up to 150 Beds operated by HRSRH Option 2 : Interim Long Term Care Beds up to 150 operated by Pioneer Manor, St Joseph’s and or other LTC provider Option 2 : Interim Long Term Care Beds up to 150 operated by Pioneer Manor, St Joseph’s and or other LTC provider Option 3 : Initially Transitional Care Facility of up to 150 beds converted to a compliant Interim Long Term Care Facility Option 3 : Initially Transitional Care Facility of up to 150 beds converted to a compliant Interim Long Term Care Facility

13. HRSRH Utilization Performance 2004/052005/062006/072007/08 2008/09 Forecast Patient Days 133,813136,917140,359134,592142,918 Separations22,46622,73721,57421,02420,317 Total LOS 5.966.026.516.47.03 Expected LOS 5.025.155.455.385.33 + or - ELOS 0.940.871.061.021.7 Acute LOS 5.195.085.285.35.33 + or - ELOS 0.17-0.07-0.17-0.080 Conservable Days 20,98819,91822,77821,40034,204 ALC Days as a % of Conservable Patient Days 82%107%116%108%102% ALC Days 17,19721,34726,39623,14834,958

14. Recommendation The Sudbury ALC Community Steering Group recommends that the North East Local Health Integration Network engage the Ministry of Health and Long-Term Care in selecting a cost- effective solution that will safely meet our clients’ needs.The Sudbury ALC Community Steering Group recommends that the North East Local Health Integration Network engage the Ministry of Health and Long-Term Care in selecting a cost- effective solution that will safely meet our clients’ needs.

15. 10 Point Plan - Summary Approximate Number of ALC Patients at HRSRH as of October 2008:Approximate Number of ALC Patients at HRSRH as of October 2008: 129 in Medical/Surgical Beds129 in Medical/Surgical Beds Approximate Number of ALC Patients at HRSRH as of May 2009:Approximate Number of ALC Patients at HRSRH as of May 2009: 104 Medical Surgical Beds104 Medical Surgical Beds 21 Transitional Care Beds21 Transitional Care Beds 8 Retirement Home Bed8 Retirement Home Bed

16. Sudbury ALC Community Steering Group Thank You Questions?