District of Rainy River Sub-Region Population Profile 2016

Home , Atikokan, Couchiching First Nation, Fort Frances, Seine River (Ontario), Seine River First Nation, Thunder Bay District

District of Rainy River Sub-region Population Profile 2016

Overview

This profile is one in a series of five profiles for each of the sub-regions (Integrated District Networks - IDN) in the North West LHIN. The North West LHIN has five sub-regions that represent local planning areas for health services. These sub- regions correspond to Integrated District Networks implemented through the Health Services Blueprint, which focus on providing equitable access to health care services for the residents within the district, improving health outcomes for the population and arranging for people to receive the level of care they need closer to home.

This profile describes the population demographics, health, and health system utilization for the District of Rainy River sub- region.

The data presented in these profiles reflects the most up-to-date data - 2015-2016 unless otherwise indicated - compiled from survey or census data and health administrative databases. District of Rainy River (20,400)

Map of the North West LHIN District of Rainy River Sub-region.

Community (census sub-divisions) within each Local Health Hub (LHH)

Atikokan LHH: Atikokan, Seine River First Nation (Seine River 23A/23B), Lac La Croix First Nation (Neguaguon Lake) Emo LHH: Emo, Chapple, Manitou Rapids Fort Frances LHH: Fort Frances, Rainy River Unorganized, La Vallee, Alberton, Couchiching First Nation, Naicatchewenin (Rainy Lake 17A/17B), Mitaanjigamiing First Nation (Rainy Lake 18C), Nigigoonsiminikaaning First Nation (Rainy Lake 26A), Ojibways of Onigaming (Sabaskong 35C) Rainy River LHH: Rainy River, Dawson, Morley, Lake of the Woods, Mishkosiminiziibiing Anishinaabeg (Big Grassy), Anishinaabeg of Naongashing (Big Island, Saug-a-Gaw- Sing), Rainy River First Nations (Long Sault 12)

North West Local Health Integration Network Executive Summary

The District of Rainy River sub-region contains four Local Health The North West LHIN funding allocation by health care sector for Hubs, including: Rainy River, Emo, Fort Frances, and Atikokan. the District of Rainy River sub-region is as follows:

Population 64.0% Hospitals ÆÆ The District of Rainy River sub-region is the fourth most populated district in the North West LHIN, with a total 13.0% Long-Term Care Homes population of 20, 047 0.0% Community Health Centres ÆÆ The District of Rainy River sub-region accounts for 8.5% of Community Mental Health and the North West LHIN’s total population 10.0% Addiction Services ÆÆ The District of Rainy River sub-region has the highest proportion of adults over the age of sixty-five (65) which 5.0% Community Support Services accounts for 20.1% of the district population ÆÆ The District of Rainy River sub-region has an approximate 8.0% Community Care Access Centre

total area of 15,474 square kilometers 0% 100%

Total number of health service provider (HSP) programs or operations: 28 Health System Total number of HSP organizations: 18 Total allocation of funding: $50,018,487 The District of Rainy River sub-region has 18 unique health service providers offering 28 LHIN-funded programs. Source: North West LHIN. Sector Share and Total Expenses Analysis by IDN, 2011. Data extracted from Canadian Management Information System.

Population Characteristics

Table 1: Population Characteristics District of Rainy River North West LHIN Ontario

Total Population (2015) 20,047 235,666 13,792,052 % Change since 2011 -1.6 2.2 7.2 % Female 50 50 51 % Male 50 50 49 % Children and youth, ages 0-19 years 24 23 22 % Working age, ages 20-64 years 57 60 62 % Seniors, aged 65+ years 19 17 16 % Seniors, ages 75+ 8 7 7 % of people age 65+ living alone 32.9 29.9 24.4 % Population who report French as their mother tongue 1.8 3.3 4.4 Second language spoken most frequently at home Ojibway French French % Population who identify as Aboriginal 22.3 21.4 2.3 % First Nations population 17.8 18.0 1.5 % Metis population 4.0 3.0 0.6 % Inuk or multiple Aboriginal identities 0.1 0.1 0 % Population who are immigrants 6.7 7.5 28.6 % Total visible minority population 0.6 2.1 25.9

Sources: Population Estimates: 2015 LHIN sub-region population estimates. Health Analytics Branch, MOHLTC, 2017. Census Profile - Age, Sex, Marital Status, Families, Households, Dwellings and Language for Canada, Prov- inces, Territories, Census Divisions, Census Subdivisions and Dissemination Areas, 2011 Census. 2011 Census Statistics Canada 98-314-XCB2011007. 2011 NHS Semi-custom Profile for Canada, Provinces, Territories, Census Divisions, Census Subdivisions and Dissemination Areas , National Household Survey, 2011 (all GNRs). 2011 National Household Survey - Statistics Canada. NHS Special Collection: Profile for the NHS Special Collection for 13 Indian reserves and Indian settlements in Northern Ontario, 2011. Available at https://www12.statcan.gc.ca/nhs-enm/2011/ref/no13reserves/index.cfm?LANG=E.

2 Table 2: Socio-economic Indicators District of Rainy River North West LHIN Ontario % Population age 25-64 who have graduated from high school 83.7 82.5 88.9 % Population age 25-64 with completed post-secondary 55.7 58.0 64.8 education % In the labour force (Participation rate) 60.3 61.8 52.6 % Employed 90.9 90.5 91.7 % Population living below low-income measure (LIM-AT) 12.6 12.9 13.8 % Children living in low income households/LIM (age<18) 16.9 17.9 16.3 % Housing affordability-spending 30% or more on rent 10.6 14.6 22.1 or payments % of dwellings in need of major repairs 11.2 12.1 5.9

Sources: 2011 NHS Semi-custom Profile for Canada, Provinces, Territories, Census Divisions, Census Subdivisions and Dissemination Areas , National Household Survey, 2011 (all GNRs). 2011 National Household Survey - Statistics Canada. NHS Special Collection: Profile for the NHS Special Collection for 13 Indian reserves and Indian settlements in Northern Ontario, 2011. Available at https://www12.statcan.gc.ca/nhs-enm/2011/ref/no13re- serves/index.cfm?LANG=E.

Health System Characteristics

Table 3: Description of Acute Care Services by Local Health Hub Fort Frances Atikokan District of Indicator Rainy River LHH Emo LHH North West LHIN LHH LHH Rainy River

Riverside Riverside Atikokan Riverside Health Acute Care Hospital Health Care - Health Care - General Care - Rainy River Emo La Verendrye Hospital

# Acute beds 3 3 40 11 57 601 # Complex continuing care beds 0 0 20 8 28 299 # Elderly capital assistance beds 21 12 0 22 55 118 # Inpatient mental health beds 0 0 0 0 0 122 # Inpatient rehab beds 0 0 0 0 0 50

Table 4: Description of Health Service Providers by Local Health Hub and Sector Fort Frances Atikokan District of Indicator Rainy River LHH Emo LHH North West LHIN LHH LHH Rainy River Organizations specializing in 4 3 8 4 10 29 mental health Organizations specializing in 1 1 3 1 4 20 addictions Community support and 4 4 7 5 15 60 assertive outreach services Home and Community Care 1 1 1 1 1 1 Services Acquired brain injury services 0 0 1-164 0 1-164 14-1601 (ABI) Assisted living - ABI and 1 1 1 1 1 1 physical disability Seniors supportive housing, 1 - 10 0 0 0 - 7 1 - 17 11 - 504 buildings - beds

Long-Term Care Homes - beds 0 0 1 - 164 0 1 - 164 14 - 1601

3 Public Health Table 5: Public Health and Population Health Indicators by Health Unit and LHIN, 2015-2016 Thunder Bay District Northwestern District North West LHIN Ontario Health Unit 1 Health Unit 2 Population 154,082 81,584 235,666 13,792,052 PROPORTION WITH CHILDHOOD VACCINATIONS Childhood Vaccinations: 98 98 - 87.9 Measles, mumps, rubella (MMR) 7 years Childhood Vaccinations 98 96 - 93.7 (MMR) 17 years Meningococcal 84 89 - 81.5 Pertussis (17 years) 77 99 - 69.9 HPV 45 61 - 80.2 Teenage pregnancy rates 2014, per 1,000 females of reproductive age 40.4 45.8 - 17.5 (2014) Avoidable deaths per 100,000 338 (2011) 268 (2011) 309 (2010-2012) 196 (2010-2012) (crude rate) Life expectancy (at birth) (2007-2009) 79.3 77.4 78.6 81.5 ED visits for injuries, children 0-19 22,434 18,820 20,980 13, 252.4 years (2015), rate per 100,000 City of District District District of Northern Thunder of Rainy of North West LHIN Ontario Thunder Bay District Bay River Kenora ED visits for injuries, children 0-19 years (2015), rate per 100,000 25,961 8,363 10,965 23,206 19,987 20,980 13, 252.4 (by sub-region) Sources: Thunder Bay District Health Unit report, extracted using PEAR in July, 2016. Data extracted January 18, 2017. Northwestern Health Unit report, prepared in December 2016. Data extracted January 18, 2017. Ontario Agency for Health Protection and Promotion (Public Health Ontario). Immunization coverage report for school pupils: 2012-13 school year. Toronto, ON: Queen’s Printer for Ontario; 2014. Public Health Ontario Snapshots: Thunder Bay Health Unit and Northwestern Health Unit: Emergency department visits for all injuries – age-specific rate (0-19 years) 2015. Toronto, ON: Ontario Agency for Health Protection and Promotion; 2017 March 8 (cited 2017 March 8). Intellihealth National Ambulatory Care Reporting System, Ambulatory All Visit Problem Dx and External Cause Table, extracted January 30, 2017. Note: The ED visits for injuries in children for the North West LHIN was calculated as a summation of the cases in the two Health Units – it was not calculated uniquely. Additionally, the Northern sub-region is divided between the two health units, and therefore some of the sums may not add up appropriately.

Primary Care

Table 6: Self-reported Primary Care Experience Indicators by Sub-region (January 2013 - September 2016) District of Rainy River North West LHIN Ontario % Population with a primary care provider 81.6 86.3 94.5 % Population without a primary care provider - 58.0 64.8 % Males unattached - 16.5 7.2

% Females unattached - 11.6 4.1

16-44 years - 18.8 8.3 45-64 years - 14.1 4.5 65+ years - 6.4 2.1 % of population able to get same day/next day 32.6 25.0 44.7 appointments % Who found it “easy” to get after-hours care 17.0 28.5 46.9 (without going to the ED) % Who waited 90 or more days to see a specialist 47.5 37.5 30.7 after being advised to see one % Taking prescription medications 65.6 63.8 53.4

Sources: Health Analytics Branch, Ministry of Health and Long Term Care. Health Care Experience Survey Results, January 2013 – September 2016. Extracted March 6, 2017. 4 North West LHIN Home and Community Care

Table 7: Select Home and Community Care Indicators by LHH, 2015-2016 (unless otherwise indicated) Rainy River Fort Frances Atikokan District of North West Emo LHH Ontario LHH LHH LHH Rainy River LHIN

# of unique clients 139 87 581 195 1,002 14,188 584,296

% of clients with end- 2.2 5.7 3.4 3.1 3.4 3.3 5.6 of-life service goal

Personal support worker/homemaking 52.9 62.3 74.5 70.2 70.5 70.7 67.3 services as % of total services

Ambulatory Care Hospital Data

Table 8: Select Ambulatory Care Indicators by LHH, 2015-2016 (unless otherwise indicated) Rainy River Fort Frances District of North West Emo LHH Atikokan LHH Ontario LHH LHH Rainy River LHIN Rainy River Health Care – Riverside Emo Health Care – Riverside La Verendrye Health Care – Riverside Hospital General Atikokan

# of ED Visits 2,510 591 18,380 4,647 26,578 213,431 6,249,503

% of visits that are CTAS IV and V 79.3 91.7 41.8 62.4 50.2 40.1 35.6 (low acuity)

% of ED visits that are CTAS I-III 19.0 7.8 47.9 36.1 42.1 58.6 65.0 (high acuity)

% of ED visits that are best man- 34.9 0.63 11.4 7.6 8.4 4.3 1.9 aged elsewhere

90th percentile ED length of stay 6.6 2.1 5.2 3.4 4.9 6.9 8

ED Wait Time for Physician Initial Assessment (Hours, 90th 2.6 1.0 3.2 1.3 - 2.4 3.0 Percentile) *

% of repeat visits (within 30 days) 22.7 - 17.8 13.8 17.4 16.8 20.1 for mental health condition

% of repeat visits (within 30 days) 26.3 - 42.6 21.3 39.2 46.4 33.0 for substance use condition

5 Inpatient Hospital Data

Table 9: Select Inpatient Care Indicators by LHH, 2015-2016 (unless otherwise indicated)

Rainy River Fort Frances District of North West Emo LHH Atikokan LHH Ontario LHH LHH Rainy River LHIN Care – Rainy River Riverside Health Care – Emo Riverside Health Care – La Verendrye Riverside Health Hospital Atikokan General

Hospital occupancy rate % 87.0 87.0 87.0 55.9 - - - (2014-2015) Hospital Standardized Mortality 120 68 107 135 - 96 91 Ratio (HSMR) Cost of a standard hospital stay ($) $7,654 $7,654 $7,654 $6,977 - $5,242 $5,407 (2014-2015) % Low risk pregnancies delivered by 9.2 9.2 9.2 NA - 17.5 15.2 Caesarean section (2014-2015) % of patients discharged from hospital inpatient beds (acute - - - - - 89.5 - and post-acute) without an ALC designation % of Patient Days in Alternate 39.8 39.8 39.8 23.7 - 20.6 13.8 Level of Care (ALC) # of acute care hospital stays 115 45 1,628 224 2,012 28,668 1,167,388 Ambulatory care sensitive 1.5 - 7.3 3.5 5.5 5.8 3.4 conditions (per 1000, <75 years) Diabetes related amputation unique 32.1 112.1 55.8 0.0 48.3 26.5 11.2 patient rate per 100,000* DAY SURGERY Knee replacement completed cases - - 56 - 56 575 26,547 (Total, partial, revisions) % Knee replacement surgeries within - - 79 - 79 71 79 target time (Total, partial, revisions) Hip replacement completed cases - - - - - 394 15,596 (Total, partial, revisions) % Hip replacement surgeries within - - - - - 83 80 target time (Total, partial, revisions) Cataract surgery completed cases - - - - - 2,671 130,422

% Cataract surgeries within target - - - - - 92 88

DIAGNOSTICS

MRI completed cases - - - - - 15,911 821,830

% Completed within access target - - - - - 40 36

CT Completed cases - - 2,144 - 2,144 24,561 1,412,466 % Completed cases within - - 97 - 97 75 73 access target INPATIENT REHAB

% ALC cases for general rehab 0 14 1 0 1 0 7

% ALC cases for special rehab 0 0 0 0 0 13 20

Sources: Canadian Institutes for Health Information, Discharge Abstract Database. Data extracted February 27, 2017. Canadian Institute for Health Information, www.yourhealthsystem.cihi.ca, accessed March 2017. Cancer Care Ontario, iPort Access. Accessed October 2, 2017. IntelliHealth Ontario, Inpatient Rehab Database, accessed March 29, 2017.

6 Long-Term Care

Table 10: Select Long-Term Care Indicators by LHH, 2015-2016 (unless otherwise indicated)

Rainy River Fort Frances District of North West Emo LHH Atikokan LHH Ontario LHH LHH Rainy River LHIN Care – Rainy River Riverside Health Care – Emo Riverside Health Care – Rainycrest Riverside Health Hospital Atikokan General

Worsened Pressure Ulcer 1.2 - 4.6 1.1 3.8 3.5 3.0 in Long-Term Care *

The number of potentially avoidable visits to the emergency department made - - - - 23.5 39.2 32.0 by residents of LTCH per 100 LTCH residents admitted **

# Admissions to LTC Homes 21 5 140 13 179 1,420 56,999

* The sub-region estimate represents an average across the sub-region, weighted by number of LTCH admissions this year. ** Reporting at the facility-level not recommended, and in most cases, would be suppressed due to small cell size: http://www.hqontario.ca/Portals/0/documents/system-performance/ltc-indicator-review-report november-2015.pdf

Source: Intellihealth Ontario, Long Term Care Database. Accessed March 27, 2017. Canadian Institute for Health Information, National Ambulatory Care Reporting System. Accessed March 27, 2017. Canadian Institute for Health Information, www.yourhealthsystem.cihi.ca, accessed March 2017.

Limitations

The sub-region profile provides an overview of the health system at the LHIN sub-region level, sometimes providing an overview at the local health hub level and/or the entire sub-region. There are some limitations with the data presented here:

• Many of the indicators reported here are used by Canadian Institute for Health Information, the Ministry of Health and Long Term Care, and Health Quality Ontario. However, some of the indicators presented in this profile have not been validated, and therefore may not be the most appropriate illustration of population health need or health system practice. Some of the suggested indicators were not accessible at the time of analysis, or needed to be suppressed because of confidentiality. • Sample size is a major consideration when conducting analyses at a sub-LHIN level or local health hub level. The robustness of the estimates depends on how common an outcome/event is, therefore we may observe a lot of variability in these measures over time. • Some of the sub-region level indicators represent weighted averages of local health hub indicators, and may deviate from estimates that are calculated using the entire sub-region. • The data presented here is the most up-to-date complete data available, though some measures were not available for fiscal year 2015-2016.

Acronyms Used

ALC - Alternate Level of Care HCC – Home and Community Care “-“ – Not Available or suppressed CIHI – Canadian Institute for Health Information IDN – Integrated District Network LHIN - Local Health Integration Network CTAS - Canadian Triage and Acuity Scale LHH – Local Health Hub ED – Emergency Department LTCH – Long-Term Care Home

7 Contact

For more information or to request a hard copy of the sub-region profiles, please contact the North West LHIN Communications and Engagement Division. North West LHIN documents can be made available in alternate formats to meet accessibility needs.

Contact Information Email: [email protected] Telephone: 807-684-9425 Fax: 807-684-9533 www.northwestlhin.on.ca

Mailing Address North West LHIN (Head Office) 975 Alloy Drive, Suite 201 Thunder Bay, Ontario P7B 5Z8 Canada