south west lhin long-term care home accountability .../media/sites/sw... · processes to align...

South West LHIN Long-Term Care Home Accountability

Planning Submission (LAPS) Guidelines 2013-16

Education Session

October 9 and 10, 2012

A Healthier Tomorrow

Overview

1. Priorities 2. What are LAPS and L-SAA 3. LAPS Guidelines Development 4. LAPS Overview 5. Instructions for the Completion of LAPS Forms 6. Timeframes 7. Questions

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Minister’s Action Plan Keeps people healthy

• Focused on prevention, promotion, and self-management

• Developed strategies for priority populations Faster access to family health care

• Have built a strong primary care foundation, with broad access to specialty and community services Right care, right time, right place

• Focused on patient-centric delivery

• Implemented standardized system-wide approach to quality management and improvement

• Have governance models that engage clinicians and the public in decision-making, enabling informed service provision that meets community needs in a timely way

• Developed a system structure to integrate services along the continuum of care, optimize coordination, and foster effective partnerships

• Utilized shared electronic medical records 3


Pan-LHIN Health System Imperatives Enhancing Access to Primary Care – focused on advancing strategies to ensure people

have timely access to a primary care provider and creating enabling structures and processes to align primary care more effectively within the overall continuum

Enhancing Coordination & Transitions of Care for Targeted Populations – e.g Seniors Strategy: focus on seniors have individualized plans of care that allow them to receive the care they need, when and where they need it; and the transitions post-acute are smooth and coordinated

Implementing Evidence Based Practice to Drive Safety - focused on high priority safety issues that require consistent, coordinated responses to ensure that patents are safe and that adverse events are minimized/eliminated

Holding the Gains – focused on ensuring that new initiatives will not cause previous gains to be eroded (e.g., ER/ALC, ER Wait Times, and access to care, coordination amongst providers, enhanced focus on accountability)

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Enhance coordination and transitions of care for targeted

populations

1. Continually respond to the needs of the evolving population of people with the greatest unmet health care needs utilizing a significant proportion of the health care resources

2. Create a collaborative person-centered response to better support the growing population of people living with chronic conditions and those at risk

3. Enable people to manage their health

Our mission, values and

key drivers

help us to

execute

the objectives

that drive

customer/ stakeholder

value

To achieve our vision

1. Continue to drive improvements in quality, equitable access and wait times to appropriate hospital, long term care and community based care and services by maximizing capacity and efficiency

2. Implement cross sector system redesign strategies

1. Implement coordinated prevention strategies to reduce safety issues across health sectors and during transitions of care for falls, wounds, adverse drug events and infections

1. Increase timely access to family health care

2. Integrate family health care as the first point of contact for people living with multiple complex and chronic conditions and those at risk

3. Increase access to local and LHIN wide interdisciplinary teams in and across health care settings

4. Facilitate access to specialized services and community based services and supports

5. Divert avoidable ER visits to the appropriate care setting

Enhance access to family health care

Increase the value of our healthcare system for the people we serve

Drive safety through evidence-based practice

VISION: A health system that helps people stay healthy, delivers good care to them when they are sick and will be there for their children & grandchildren.

VALUES: Compassion • Courage • Evidence Informed • Innovation • Integrity • Trust and Respect • Culture and Diversity MISSION: The South West LHIN is accountable for bringing people & organizations together to build a health system that balances quality, access & sustainability to achieve better health outcomes.

Improve population health & wellness • Improve person experience with the health system • Improve the sustainability of our health system

INFORMATION and COMMUNICATION TECHNOLOGY: 1. Strengthen electronic exchange of patient/client/resident information between providers and between providers and individuals 2. Expand the use of technology to enhance “hands on” care and leverage human resources 3. Implement decision support electronic applications 4. Improve electronic system navigation tools and information QUALITY and VALUE: 1. Champion improvements to the care experience through Experience Based Design techniques, 2. Leverage multi-provider accountability agreements, accreditation outcomes, quality improvement plans, alignment of provider strategic plans to IHSP 3. Build a culture of continuous quality improvement and performance monitoring 4. Expand partnerships within LHIN and non LHIN funded services, particularly with local social services, Public Health Units, and Health Quality Ontario PEOPLE, CULTURE, and SOCIAL DETERMINANTS: 1. Partner with people and their caregivers 2. Confirm strategies to improve healthcare for Francophone and Aboriginal priority populations and diverse populations 3. Advance health promotion, prevention and alignment of social determinants of health with partners 4. Identify and spread Human Resource best practices


Key IHSP Actions for Long-Term Care Homes Enhance Access to Family Health Care • Optimize the skillsets of interdisciplinary team members to leverage team capacity

and effectiveness Enhance Coordination and Transitions of Care for Targeted Populations • Identify and implement health and social service strategies to support the evolving

populations of people living with the greatest unmet health care needs (e.g. frail seniors, people requiring end of life care, 1%, 5% of the population utilizing a significant proportion of health care resources

• Develop and implement an integrated cross continuum/sector palliative care program for the South West LHIN

• Continue to build a Behavioural Support System of Care by implementing coordinated prevention, care and educational strategies across primary care, seniors MH&A teams and specialist resources, Alzheimer Societies, Long- Term Care homes, CCAC and other community based services

• Implement culturally appropriate care and services 7


Key IHSP Actions for Long-Term Care Homes Drive Safety through Evidence-based Practice • In partnership with Public Health Units, implement the Falls

Prevention Strategy, by utilizing evidence-based tools/protocols/training to screen, identify, manage and/or refer individuals to appropriate services

• Participate in the implementation of the South West Regional Wound Care Program sustainability plan

• Implement a cross sector infection prevention strategy that utilizes evidence-based tools/ protocols/training to manage risk factors for infections and ensure effective transfer of information during transition of care

• Ensure timely medication reconciliation and follow up appointment with physician or nurse practitioner following discharge from hospital and coordinate care with other providers in alignment with home first philosophy

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Key IHSP Actions for Long-Term Care Homes Increase the Value of the Health Care System for the People we Serve • Prioritize, develop and implement restorative care options

across hospital, long term care and community based care • Collaborate across organizations and geography to increase

capacity and efficiency of teams and services • Influence and manage the distribution of Long-Term Care home

beds as older homes redevelop

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LAPS The Long-Term Care Home Accountability Planning Submission

(LAPS) is a planning document that provides information about an individual LTC Home, to support the negotiation of the Long-Term Care Home Service Accountability Agreement (L-SAA).

Each LTC Home owns the LAPS document and is responsible for

the completeness and accuracy of the information provided to the LHIN.

Each LTC Home governance structure is responsible for reviewing

and approving the information provided in the LAPS and also the content and commitments of the L-SAA.

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L-SAA The Long-Term Care Home Service Accountability Agreement (L-

SAA) is the legal agreement between the LTC Home and the LHIN. The current L-SAA expires on March 31, 2013 and is required under Local Health System Integration Act (LHSIA) and the Ministry-LHIN Performance Agreement (MLPA). It will cover a three year term of April 1, 2013 to March 31, 2016.

The role of a L-SAA is to clarify that the LTC Home will be

responsible for delivering not only performance, but also planning and integration towards the development of a health system.

The LTC Home’s LAPS and L-SAA must reflect the home as

part of a health care system versus as an individual health care provider.

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How the LAPS & L-SAA Fit Together

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LAPS Guidelines Development Consultation sessions were held with associations representing LTC

Homes in the province, as well as OLTCA, OANHSS, OHA and AMO.

Feedback from a sample of LTC Homes and the associations was

considered and addressed through three avenues: Comments incorporated in the LAPS Guidelines Development of training sessions The development of a LAPS Frequently Asked Questions (FAQ)

document

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Roles and Responsibilities - MOHLTC • Quality Inspection Program (Compliance, inspection & enforcement of LTCHA) • Setting MOHLTC program and LTCH policy (including Funding and Financial Policies and

Capital Policies) • Monitoring established Quality of Care • Licensing & approval of LTC beds, including establishment of fees. • Determining payment models and various funding programs • Determining construction cost funding per diem and LTC bed development

programs/policies. • Approving changes of ownership, sale of businesses and amalgamations of providers for

purposes of licensing. • Approving LTCH management contracts. • Acting as the lead in the event of a bankruptcy and approving a third-party management

company. • Development of various funding programs • Evaluating the effectiveness of various programs used by the LTC Homes

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Roles and Responsibilities - LHINs • Establishing quality and performance indicators for health service

delivery • Monitor the achievement of performance indicators • Performance management. • Review and monitor: Occupancy/Utilization of beds; Placement

refusal trends; Transfer request trends; Wait list profiles. • Participate, as appropriate, in the preparation and submission of

funding requests related to LTC Homes through the MOHLTC annual planning cycle.

• Approve the conversion of existing long-stay beds as short-stay respite beds.

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LTCH Funding – MOHLTC Responsibilities For the review and reconciliation of funding on behalf of the LHINs using using Audited

Annual Report, Revenue Occupancy Report, and administering the Subsidy Calculation Worksheet, on behalf of the LHINs.

Examples of MOHLTC funded programs include: High Intensity Needs Funding High Wage Transition Funding Municipal Tax Allowance Funding Pay Equity Funding Physician On-call Funding Structural Compliance Premium Laboratory Services Funding RAI/MDS Sustainability Funding Peritoneal Dialysis (PD) Funding

The MOHLTC is also responsible for the development of funding models and processes.

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LTC Home Funding – LHIN Responsibilities LHINs provide and administer the following types of LTC Home funding:

Per Diem Funding (Levels of Care) funding Non-Per Diem funding such as:

• Registered Practical Nurse Funding • Construction Cost Subsidy • Convalescent Care Bed Funding

Authorize the recovery of unspent LHIN operating funds identified through

the revenue occupancy report and annual reconciliation process. Re-allocate operating funds recovered through the revenue occupancy

report.

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Changes to LAPS

Addition to Description of Home and Services: Section A-8 Quality Improvement Practices

• Residents First Leading Quality Program (for Senior Managers)

• Residents First Improvement Facilitators • Residents First Data Improvement Teams • Lean Methods

The Financial Schedule is no longer required

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LAPS Guidelines Table of Contents 1. Introduction 2. Roles and Responsibilities 3. Key Planning Consideration for the LAPS and L-SAA 4. LAPS Components 5. LHIN Evaluation of LAPS 6. Linking the LAPS to the L-SAA 7. Directives, Guidelines and Policies 8. Changes Needing LHIN Review/Approval Appendix A: Glossary Appendix B: Description of Services and Service Plan Narrative Appendix C: LHIN Contact Information

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A Healthier Tomorrow 19

Reporting Requirements • Schedule C of the L-SAA outlines financial and performance

reporting required during the term of the L-SAA beginning April 1, 2013.

• Financial Reporting continues to be based upon the calendar

year. OHRS/MIS Trial Balance Revenue/Occupancy Report Audited Annual Report Financial Statements

A Healthier Tomorrow 20

Reporting Requirements

• Reporting requirements based on the fiscal year and include but not limited to:

Performance Indicator Report – quarterly Sharkey Staffing Plan – annually French Language Services Report – annually (for designated and

identified homes only)

• Reporting schedule will be available upon final approval of L-

SAA by LHIN Boards


Service Plan Each LTC Home is required to complete the Service Plan (LAPS -

Appendix B). The service plan provides the LTC Home the opportunity to provide

the LHIN with an overview of the home including the unique features of the home, a description the population that you serve and services that the home provides to meet the needs of their resident group and community.

The service plan consists of two components:

The Description of Services The Service Plan Narrative

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Service Plan - Description of Services The Description of Services provides an overview of the LTC Home

and includes the following information: Site Identification Information Bed Types and Numbers Structural information Additional or Unique Services Specialized Designations Community linkages Services Supporting the Local Community Quality Improvement Practices

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A-1 Site Identification Information

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Description of Home and Services

A-1 General Information LTCH Legal Name LTCH Common Name LTCH Facility ID Number LTCH Facility (master number for RAI MDS)

Owner/Parent Organization Address City Postal Code Geography served (catchment area)

Accreditation organization Date of Last Accreditation Year(s) Awarded


A-2 Bed Types and Numbers A-2 LTCH Classification

Total # of Beds A B C D New Other

Licensed/Approved Beds

Bed Types Total # of Beds Comments/Additional Information

Convalescent Care Beds

Respite Beds Beds in Abeyance ELDCAP Beds Interim Beds

Veterans’ Priority Access beds

Other beds available under a Temporary Emergency Licence or Short-Term Authorization

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A-3 Structural Information A-3 Structural Information Type of Room (this refers to structural layout rather than what is charged in accommodations) Number of rooms with 1 bed Number of rooms with 2 beds Number of rooms with 3 beds Number of rooms with 4 beds Other Separate Infirmary (Y/N) Number of Rooms Year of Construction Year(s) of renovations Opening Date Number of Floors

Number of Units/Resident Home Areas and Beds Unit/Resident Home Area Number of Beds

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A-4 Additional or Unique Services A-4 Additional Services Provided

Service Provided

Contract for Service Explanation if

applicable Yes No Yes No Nurse Practitioner Physiotherapy Occupational therapy Ophthalmology/Optometry Audiology Dental Respiratory Technology Denturist IV Therapy (antibiotics or hydration) Peritoneal Dialysis (PD) Support for hemodialysis (HD) French Language Services Secure residential home area(s) Specialized Dementia Care unit(s) Designated smoking room(s) Specialized unit for younger physically disabled adults Support for Feeding Tubes Specialized Behavioural Treatment unit(s) Additional service commitments for new bed awards (1987 to 1998) Other (specify)

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A-5 Specialized Designations

A.-5 Specialized Designations

Designated

Comments Yes No

Religious

Ethnic

Linguistic

French Language Service Designation

Aboriginal

Other (specify)

Other (specify)

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A-6 Community Linkages A-6 Community Linkages

Service Provided Comments

Yes No

Volunteer program

Service groups

Language interpreters

Cultural interpreters

Advisory council

Community board

Faith communities

Other (specify)

Other (specify)

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A-7 Services Supporting the Local Community A-7 Services Provided to the Community

Services Provided Comments

Yes No

Meal Services

Social Congregate Dining

Supportive Housing /SDL

Adult Day Program

Retirement living

Other (specify)

Other (specify)

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A-8 Quality Improvement Practices A-8 Quality Improvement Practices

Residents First Leading Quality Program (for Senior Managers)

Residents First Improvement Facilitators

Residents First Data Improvement Teams

Lean Methods

Other (specify)

Other (specify)

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Narrative Service Plan Details the services that the LTC Homes provide to meet the unique

needs of their resident group and identify how they support the local community.

The information provided shall identify those services beyond the basic

services provided in LTC Homes.

• Information to be included within the narrative service plan will include: Strategic Goals and Priorities Advancement of the IHSP Situation Analysis Evaluation of Prior Year Performance (optional) Changes to Operations Summary (optional)

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Narrative Service Plan LTCH Name:

Facility Number:

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Service Plan Narrative – Part A: 2013/16

Strategic Goals and Priorities:

Advancement of the IHSP:

Situation Analysis

Evaluation of Prior Year Performance (optional)

Changes to Operations Summary (optional)


L-SAA Indicators LTC SECTOR ADVANCING HEALTH SYSTEM PRIORITIES: The LTC sector is an important and active partner in advancing the Minister’s Action Plan

and the four pan-LHIN health system imperatives (see slides 3-4). The L-SAA indicators are aligned with those goals and consistent with the LTC sector’s priorities (i.e. resident safety, continuous quality improvement).

RIGOROUS INDICATOR SELECTION PROCESS: Through a consultative and evidence-based process, the L-SAA Indicator Work Group, (comprised of

representatives from the LTC sector, LHINs, Health Quality Ontario, MOHLTC), developed an initial list of provincial indicators in collaboration with the provincial Health System Indicator Initiative (HSII).* HSII consists of nearly 30 members including representation from 10 LHINs, MOHLTC Health Analytics Branch and Health Quality Branch, LHIN Liaison Branch, Health Quality Ontario, the Canadian Institute for Health Information, Cancer Care Ontario, the Institute for Clinical Evaluative Sciences and Health System Performance Research Network.

INDICATORS ENDORSED BY LTC ASSOCIATIONS AND LTC HOME REPRESENTATIVES: The final list of indicators has been endorsed by the L-

SAA Steering Committee** (comprised of representatives from OLTCA, OANHSS, AMO, OHA, LTC homes, MOHLTC) and approved by the LHINs.

COMMITMENT TO LEVERAGING EXISTING REPORTING SOURCES AND MECHANISMS: Included in the HSII principles for indicator development is

a commitment to leveraging existing reporting sources and mechanisms in order to diminish the administrative reporting burden on the LTC homes.

LOCAL CONSULTATIONS TO DETERMINE TARGETS IN EARLY JANUARY 2013: A detailed guide to calculating the performance indicators,

performance standards, performance targets and performance corridors is being prepared by the L-SAA Indicators Work Group and scheduled to be made available in early January, 2013. At that time, LHINs and HSPs will engage in a dialogue to establish performance targets that are appropriate to the organization and local circumstances.

*For more information on HSII visit: http://www.lhincollaborative.ca/Page.aspx?id=1898&ekmensel=e2f22c9a_72_572_1898_4 **For more information on the L-SAA Steering Committee visit: http://www.lhincollaborative.ca/lsaa/lsaahome.aspx 33

http://www.lhincollaborative.ca/Page.aspx?id=1898&ekmensel=e2f22c9a_72_572_1898_4

http://www.lhincollaborative.ca/lsaa/lsaahome.aspx


L-SAA Indicators 2013-2016

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Pan-LHIN System Imperative

Outcome Objectives L-SAA Indicators

1. Evidence-Based Practice to Drive Safety

Resident safety / Preventing functional and cognitive decline

% of residents with worsening bladder control (Performance) % of residents whose mid-loss ADL functioning improved or who remained completely

independent in mid-loss ADLs (Explanatory) % of residents whose language, memory and thinking abilities have recently decreased

(Explanatory) To reduce falls % of residents who had a fall in the last 30 day (Performance) To reduce risks and adverse events % of residents whose pressure ulcer worsened (Performance)

% of residents in daily physical restraints (Explanatory)

% of residents with a urinary tract infection (Explanatory) To better manage residents with responsive behaviors % of residents on antipsychotics without a diagnosis of psychosis (Explanatory)

2. Enabling Coordination and Transitions of Care for Targeted Populations

To reduce readmission # of resident transfers to ER from LTC homes resulting in inpatient admissions per 1,000 LTC home residents (Developmental)

To reduce ALC days Long–stay utilization (Performance) 3. Holding the Gains (i.e. ER wait times, access to care)

To reduce avoidable hospital admission, reduce ED/Utilization visits # of unscheduled emergency department visits for residents of LTC homes for low acuity

level per 1,000 LTC home residents by NLOT and non-NLOT homes (Developmental)

Median wait time to placement in LTC home (Performance) # of emergency department visits for ambulatory care sensitive conditions (ACSC) per 100

residents per year (Developmental) 4. Improving Access to Primary Care

To improve access to primary care for LTC residents Indicator that tracks access to Medical Directors, NPs or Nurses at facility level (Developmental)

Organizational Health To ensure the organizational health of the home Compliance Status (Performance) Case Mix Index (CMI) (Developmental) Debt service coverage (DSC) ratio for non-municipal homes, organizations (Explanatory)

LEGEND Performance indicator are valid, feasible measures of system performance that are associated with a target and a corridor Explanatory indicators are complementary to performance indicators and support consultation and problem-solving Developmental indicators are existing indicators that require further validation to ensure data quality criteria


LAPS Forms

LAPS forms will be available at: https://hsimi.ca/LTCHome website under the “LAPS FORMS” link This will bring you to the LAPS FORMS menu

1. Service Plan – Description of Services 2. Service Plan – Narrative

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https://hsimi.ca/LTCHome



How to Access LAPS Forms Go to the https://hsimi.ca/LTCHome website Select the “LAPS FORMS”. Download all forms to local drive. Complete submission and upload (one form at a time) to the website. File name upload should be standard format of name, underscore,

account number and file type e.g.: FinancialSummary_NH4321.xls

LAPS forms can continue to be uploaded (updated) until “locked” by the LHIN.

LHINs can apply the “lock” and “unlock” functions to an individual form or to all forms simultaneously.

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LHIN Review of LAPS Each LAPS document will be reviewed by LHIN staff to :

• Ensure that the submission is complete • Ensure the LTC Home is maintaining required services • Compare the narrative component with other information for

consistency • Review assumptions for consistency and reasonableness • Confirm that community engagement has occurred • Identify any inconsistencies or anomalies in the submission • Generate a list of questions for the LTC Home

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L-SAA Project Timeline Early Oct - LHINS will conduct local LAPS education sessions to provide HSPs with LAPS guidelines and

supporting materials to complete the LAPS.

Nov 15 Early Jan

- Completed LAPS are due to be completed and uploaded into https://hsimi.ca/LTCHome website by November 15. The LAPS will facilitate the development of home-specific schedules that accompany the L-SAA template agreement.

- L-SAA education sessions conducted by LHINs will provide HSPs with information needed to

complete the L-SAA including indicators.

Jan-Mar Mar 31

- Local L-SAA consultations between LHINs and HSPs to finalize L-SAAs for HSP Boards sign off will take place between January and March.

- New L-SAAs signed. All L-SAAs are due to LHINs with HSP Board/Operator sign-off by March 31,

2013.

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Questions?

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Contacts Name & Title Geography/HSP Phone Email

Scott Chambers Team Lead, Finance

LHSC, SJHC London and South West CCAC 519-640-2578 [email protected]

Carolyn Ridley Financial Analyst Huron, Perth Counties 519-640-2581 [email protected]

Laura Salisbury Financial Analyst

London-Middlesex, Oxford, Elgin, Norfolk Counties

Please contact Scott Chambers until Laura’s return in

December.

Sarah Davis Financial Analyst Grey, Bruce Counties 519-640-2584 [email protected]

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For more information, visit LHIN website: www.southwestlhin.on.ca.

mailto:[email protected]



http://www.southwestlhin.on.ca/

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