WORKING DRAFT FOR DISCUSSION PURPOSES ONLY Building a

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

Central LHIN CSS Providers Less than $1 M $1 -4 Million $3 million + • Aphasia Institute • Chippewas of Georgina Island • Hospital Special Needs Inc. • Hazel Burns Hospice • Hesperus • Alliance Hospice • CNIB • Canadian Hearing Society • York Central Hospital • York-Durham Aphasia Centre • Fruili Terrace • St. Demetrius Supportive Care Services • Bernard Betel Centre • North Yorkers for Disabled Persons Inc. • Palliative Care Network of York Region • York West Senior Citizens Centre • Unionville Home Society • North York Seniors Centre • Alzheimer Society of York Region • Arts Carousel • Villa Colombo Home for the Aged Inc. • Downsview Services to Seniors • St. Clair West Services for Seniors • Participation House Markham • Better Living Health & Community Services • Circle of Care • Etobicoke Services for Seniors • COTA Health • Access Apartments • Community Home Assistance to Seniors (CHATS) • Regional Municipality of York • Community Head Injury Resource Services of Toronto (CHIRS) • Ontario March of Dimes • PACE Independent Living Based on 2009/10 approved budget (excludes Aging At Home funding) No Direct LHIN Funding • Philip Aziz Centre • St. Demetrius Supportive Care Services • Family Service Toronto • Hospice Toronto • Baycrest Centre • Canadian Red Cross • Carefirst Seniors & Community Services Association • Doane House Hospice* • Hospice Georgina* • Hospice King-Aurora* • Hospice Thornhill* • Evergreen Hospice* • Yee Hong Centre for Geriatric Care • Note: * funded through Palliative Care Network of York Region

Provider Profile by Geography & Specialized/Ethno-cultural York-Simcoe • Chippewas of Georgina Island • Hesperus • York Central Hospital • Fruili Terrace • Unionville Home Society • Community Home Assistance to Seniors (CHATS) • Regional Municipality of York • Ontario March of Dimes • Participation House Markham - Cerebral Palsy Parent Council of Toronto North York • Access Apartments • York West Senior Citizens Centre • Hospital Special Needs Inc. • North Yorkers for Disabled Persons Inc. • North York Seniors Centre • Arts Carousel • Downsview Services to Seniors • St. Clair West Services for Seniors • Better Living Health & Community Services • Etobicoke Services for Seniors • PACE Independent Living • No Direct C-LHIN Funding • Family Service Toronto • Canadian Red Cross Central Community Support Services Network Specialized/Ethno. Cultural • CNIB • Canadian Hearing Society • Bernard Betel Centre • Aphasia Institute • York-Durham Aphasia Centre • Palliative Care Network of York Region (includes YR hospice providers) • Alzheimer Society of York Region • Villa Colombo • St. Demetrius Supportive Care Services • Circle of Care • Community Head Injury Resource Services of Toronto (CHIRS) • Hazel Burns Hospice • Alliance Hospice • No Direct C-LHIN Funding: • Baycrest Centre • Carefirst Seniors & Community Services Association • Yee Hong Centre for Geriatric Care • Evergreen Hospice • Philip Aziz Centre • Hospice Toronto

Quick Facts on LHIN Funding 2007/08 Clients Served Central LHIN funded agencies* Including other LHIN funded agencies** 2007/08 Total Units of Service Number of individual programs from 2007 CSS Survey Number of program types used by Central LHIN providers by Ministry definition Central LHIN Funding 2007/08 Central LHIN Funding 2009/10 (excludes Aging at Home) 33, 509 53, 000 1, 040, 383 170 45 $46 million $54. 6 million Number of Central LHIN funded providers 33 Number of providers in the Central LHIN and not funded directly by the Central LHIN 27 Number of Central CSS Network members 44 Number of CSS employees from 2007 survey Number of Volunteers 1, 400+ 7, 000

2007/08 Direct Service > 50, 000 Units Service Personal Support, Homemaking, Respite, Independence Training, Overnight Stay Care Meals on Wheels Assisted Living Transportation Day Services Social and Congregate Dining Visiting-Social & Safety Central Community Support Services Network Clients Units 4, 862 467, 159 2, 761 236, 936 721 158, 008 14, 818 130, 503 2, 034 94, 667 3. 805 86, 080 274 80, 807

2007/08 Direct Service < 50, 000 Units Service Clients Units Visiting Hospice Services/Caregiver support 3, 381 28, 262 Client Intervention & Assistance 2, 863 29, 817 Caregiver Support – Training, Information & Education Health Promotion & Education 7, 811 22, 507 7, 822 15, 128 Less than 10: 000 units: foot care, vision impaired services, support service training, aphasia service, palliative care pain and symptom management, special services for persons with acquired hearing loss, psychogeriatric consulting services, home maintenance and repair, social work, speech language pathology, social recreational services, emergency response systems Central Community Support Services Network

Profile of LHIN Funded Agencies 2009/10 Approved Budget Primary Target Population Central LHIN Funded Agencies Seniors Non-Central LHIN Funded Agencies Central LHIN Funding 15 4 20, 617, 154 People with Physical Disabilities 7 1 17, 441, 451 Acquired Brain Injury 2 Specialty Service Providers (hearing, aphasia, visual, alzheimers) 6 0 3, 212, 214 Palliative/Hospice 4 7 1, 486, 229 34 12 $54, 556, 865 TOTALS Note: Circle of Care counted twice due to palliative funding Central Community Support Services Network 11, 799, 817

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

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 redistribution 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

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

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

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

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

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

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

M-SAA CSS Year 1 Requirements Standard Requirements LHIN-Specific Requirements Balanced budget a requirement for providers to submit integration proposals related to access, co-ordination, quality and efficiency and back-office Variance forecast to actual expenditure development of a health equities plan and community engagement strategy proportion of budget spent on administration participation and alignment with e-health strategy wait times (from referral date to assessment date community and hospital, from assessment to service initiation). regular meetings with other Community Health Service Provider Executive Directors and the Central LHIN to identify initiatives that lead to system level improvements cost per individual served and other reporting requirements vacancy rate turnover rate Central Community Support Services Network

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

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

Agencies Adopting inter. RAI-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

Supportive Housing and Day Program Providers Not Yet on Inter. RAI-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