DRAFT

Appendix E

Waterloo Wellington LHIN Integrated Health Service Plan

Environmental Scan

WWLHIN Integrated Health Service Plan i Appendix E – Population Profile and Health Services Utilization Details Table of Contents

Introduction

Population Profile and Health Services Utilization Framework and Application

1. Population Profile

1.1 Population Characteristics 1.1.1 Population Aging and Growth 1.2 Population Health Status 1.2.1 Chronic Disease in WWLHIN 1.2.2 Causes of Death in WWLHIN 1.3 Determinants of Health 1.3.1 Behavioural Determinants of Chronic Disease and Injury 1.3.2 Tobacco Use and Exposure 1.3.3 Socio-economic Determinants of Health 1.3.4 Families in WWLHIN 1.3.5 Visible Minority and Aboriginal Population in WWLHIN 1.3.6 Language and Immigration in WWLHIN 1.3.7 Education, Employment and Income 1.4 Preventive Health Practices 1.4.1 Influenza Immunization 1.4.2 Breast Screening (Mammography) 1.4.3 Cervical Screening (Pap smear)

2. Health Services and Utilization

2.1 Health Promotion and Prevention 2.1.1 Health Promotion 2.1.2 Health Promotion Services in the WWLHIN 2.1.3 Preventive Practices 2.1.4 Preventive Practices in the WWLHIN 2.2 Primary Care 2.2.1 Family Physician Care 2.2.2 Care Provided by Family Physicians in the WWLHIN 2.2.3 Where do WWLHIN residents go to receive Family Physician care? 2.3 Community Health Centre Care 2.3.1 Care Provided by Community Health Centres in the WWLHIN 2.3.2 Where do WWLHIN residents go to receive Community Health Centre care? 2.4 Family Health Team Care 2.4.1 Care Provided by Family Health Teams in the WWLHIN 2.4.2 Where do WWLHIN residents go to receive Family Health Team care? 2.5 Palliative Care 2.5.1 Provision of Palliative Care in WWLHIN 2.5.2 Where do WWLHIN residents go to access Palliative Care?

WWLHIN Integrated Health Service Plan i Appendix E – Population Profile and Health Services Utilization Details

2.6 Outpatient Care 2.6.1 Emergency Department Care 2.6.2 Provision of Emergency Department Services in the WWLHIN 2.6.3 Reasons WWLHIN Residents Receive Emergency Care 2.6.4 Ambulatory Care 2.6.5 Ambulatory visits in the WWLHIN 2.6.6 Where do WWLHIN residents go to receive Ambulatory care? 2.7 Inpatient Care 2.7.1 Total Separations 2.7.2 Program Cluster Categories in WWLHIN Hospitals 2.7.3 Where do WWLHIN residents go to receive inpatient care and for what? 2.7.4 Preventable Hospitalizations 2.7.5 Acute Care 2.7.6 Critical Care 2.7.7 Where do WWLHIN Residents Receive Acute Care 2.7.8 Acute Inpatient Mental Health 2.7.9 Provision of Acute Inpatient Mental Health in WWLHIN Hospitals 2.7.10 Where do WWLHIN Residents Receive Acute Inpatient Mental Health Care 2.8 Alternate Level of Care (ALC) 2.8.1 Provision of ALC in WWLHIN Hospitals 2.8.2 Where are WWLHIN residents receiving ALC? 2.9 Inpatient Rehabilitation Care 2.9.1 Provision of Inpatient Rehabilitation Services in the WWLHIN 2.9.2 Where do WWLHIN residents go to receive Rehab services? 2.10 Inpatient Complex Continuing Care 2.10.1 Provision of Complex Continuing Care in the WWLHIN 2.10.2 Where do WWLHIN residents go to receive Complex Continuing Care?

3. Community Care

3.1 Community-Based Rehabilitation 3.1.1 Provision of Community-Based Rehabilitation services in the WWLHIN 3.1.2 Where do WWLHIN residents go to receive Community-based Rehabilitation Services? 3.3 Community-Based Mental Health and Addiction 3.2.1 Provision of Community-Based Mental Health and Addiction Services in the WWLHIN 3.2.2 Where do WWLHIN residents go to access community-based Mental Health and Addiction Services? 3.3 Homecare, Community and Residential Care 3.3.1 Provision of Homecare, Community and Residential Care 3.4 Community Support Services 3.4.1 Provision of Community Support Services in the WWLHIN 3.5 Assisted Living Services in Supportive Housing 3.5.1 Provision of Assisted Living Services in Supportive Housing in the WWLHIN 3.6 Acquired Brain Injury 3.6.1 Provision of Acquired Brain Injury Services in the WWLHIN 3.6.2 Where do WWLHIN residents go to access Acquired Brain Injury Services? 3.7 Care Options, Accessing Home, Community Services and Long-Term Care Homes

WWLHIN Integrated Health Service Plan ii Appendix E – Population Profile and Health Services Utilization Details

4. Long-Term Care

4.1 Long-Term Care Homes 4.1.1 Provision of Long-Term Care Homes in the WWLHIN 4.1.2 Where do WWLHIN residents go to access Long-Term Care?

5. Health Human Resources: Providers Operating Across the Continuum of Care

5.1 Specialists 5.1.1 Provision of Specialist Services in the WWLHIN 5.1.2 Where do WWLHIN residents go to access Specialist Services? 5.2 Regulated Health Professionals 5.2.1 Number of Regulated Health Professionals within the WWLHIN

WWLHIN Integrated Health Service Plan iii Appendix E – Population Profile and Health Services Utilization Details Waterloo Wellington Local Health Integration Network Integrated Health Service Plan Appendix E – Environmental Scan: Population Profile and Health Services Utilization and Details

Introduction

Population Profile and Health Services Utilization Review Framework and Application

Many complex factors can influence an individual’s health status, or the health of an entire community. In attempting to plan health services for the future, it is important to reflect on the current situation and how it will affect the future and, to make informed forecasts about the impact of new, emerging or anticipated factors. Two things are certain, change is constant and there will always be unforeseen elements. Changing demographics, advances in science, economic shifts or technological innovations along with other environmental factors will have an impact on future needs. Some can be identified and analyzed now. Some will come as a surprise, so flexibility will be key. Another thing that is certain is that only the best planning can provide a good framework for dealing with both obvious and unexpected challenges.

The elements within the external environment that can, and do affect health services planning, fall into five broad categories:

Industry, which includes health research and education, human resources and healthcare delivery,

Political which includes the realities of managing shifting health priorities with changes in government and government policy,

Economic, which deals with adequately funding and managing the costs of universal access while responding to changing patterns of healthcare need,

Socio-demographic, which deals with the changing requirements for an aging population, new populations (due to immigration) and mobile populations and,

Technological, which deals with changes in information and treatment technologies.

Each of these categories has a set of factors that must be carefully considered:

WWLHIN Integrated Health Service Plan iv Appendix E – Population Profile and Health Services Utilization Details WWLHIN WORLD

Industry (Healthcare) ¾ The need to attract, retain and develop professionals within health services to address an aging workforce and health human resource shortages O ¾ The increased focus on primary healthcare and team-based health services U ¾ The need to coordinate services and integrate health plans to improve health outcomes ¾ The identification and sharing of best practices across the R system ¾ The need for emergency-preparedness ¾ The growing awareness and increased focus on health promotion, illness and accident prevention & chronic disease management

Socio-demographic ¾ The increasing demands of an aging population C ¾ Adapting to ethnic and religious differences ¾ The growing expectations of an increasingly U well-informed consumer ¾ A growing understanding of the impact of socio- economic factors on population health status R ¾ Increased evidence of lifestyle related diseases in younger populations R Political ¾ Competing strategic priorities E ¾ The Healthcare Transformation agenda (e.g. establishment of LHINs, focus on Health Human Resources and e-Health) ¾ Movement towards transparency, accountability and N performance measurement ¾ Increased emphasis on community-based health T service delivery ¾ The issue of private participation in public healthcare delivery ¾ Containing costs without compromising healthcare

R Technological ¾ Recognition of the growing impact of information technologies on the quality and coordination of health service delivery including: E ¾ Increased use of technology for information collection, sharing and accessibility A • Communication • Learning and Development • Service Delivery L • Performance Measurement • Collaboration I

Economic T ¾ Growing and aging populations and the growing demand for services ¾ Escalating healthcare costs ¾ The proportional increase of drug costs as a share Y of the health budget ¾ The alternating expansion and contraction of local, regional and national economies affecting society’s ability to manage costs ¾ The increasing demand for convenient, local health service delivery

WWLHIN Integrated Health Service Plan v Appendix E – Population Profile and Health Services Utilization Details

The Population Profile and Health Services Utilization Details for the Waterloo Wellington LHIN reflects the demographic and socio-economic characteristics of the residents of the WWLHIN. The characteristics of Waterloo Wellington and the trends within the community identified in this document will help us to develop appropriate organizational responses to the community’s health needs for the near term and the long term. It is a fundamental building block of our overall objective of developing a completely integrated health service.

Overall, the health system provides an abundance of choices for people who need care. But, from time to time, and sometimes consistently, services can be in short supply in some of our communities. If access to care is delayed the delay plays into the natural fears associated with illness and can contribute negatively to overall health status. Therefore, another purpose of this population profile and health services utilization review is to create an accurate picture of the current and projected demand for health service, an inventory of the current supply and an analysis of the areas of oversupply and undersupply.

This Population Profile and Health Services Utilization Details also provides a snapshot of the state of health and the health-related activities of the people living in Waterloo Wellington such as:

¾ The health status of an individual (e.g. life expectancy; self-rated health; activity level); ¾ Health outcomes (e.g. births, deaths); ¾ Prevalence of chronic conditions (e.g. diabetes, heart disease) ¾ Causes of mortality and morbidity (i.e. deaths, hospitalizations; potential years of life lost) ¾ Unhealthy behaviours (e.g. smoking; alcohol consumption; diet; stress) ¾ Preventive care (e.g. Pap smears; mammography; flu shots; physician visits)

On their own, and in combination with socio-economic factors, these indicators have an impact on the health of an individual and have implications for the type and amount of healthcare needed in our community.

This Population Profile and Health Services Utilization Details is intended to assist the WWLHIN, its providers and the public in our efforts to design a health system that is customized to the needs of this community. It is a significant first step in creating a ‘home grown’ health service that is easy to use, easy to understand and more effective.

The WWLHIN Population Profile and Health Services Utilization Details involved both quantitative and qualitative research and analysis. The qualitative approach involved input gathered through extensive engagement and consultation with the local public and provider community. The quantitative process involved collection and analysis of statistical data as well as the review of literature and evidence-based reports relevant to our population health and health service delivery – current and proposed.

Limitations

The data contained in Appendix E – Population Profile and Health Services Utilization Details, has been gathered from a variety of sources, including Statistics Canada, the Ministry of Health and Long-Term Care’s Health Systems Intelligence Project, the Provincial Population Health Planning Database (PHPDB) the Wellington-Dufferin-Guelph Health Unit and Health Canada.

WWLHIN Integrated Health Service Plan vi Appendix E – Population Profile and Health Services Utilization Details

However, many of these data sources were not designed specifically for the purposes of this IHSP, and in some cases complete data does not exist in certain areas of focus. Therefore, while this information is reliable within the context of health services planning, in areas where the information is incomplete, the reader is advised to interpret it with caution.

WWLHIN Integrated Health Service Plan vii Appendix E – Population Profile and Health Services Utilization Details 1. Population Profile

1.1 Population Characteristics

1.1.1 Population Aging and Growth

Population aging and population growth are two critical factors in planning for health needs and health service use, since health care usage increases with both aging and population growth. The 2005 population of Waterloo Wellington Local Health Integration Network (WWLHIN) is estimated to be 698,900 and is projected to be 797,600 by 20156 - a growth rate of 14%. WWLHIN has been divided into five areas for planning purposes. These areas and the corresponding municipalities are provided in Table 1. Over 80% of the population of the WWLHIN lives in the two urban planning areas: Urban Waterloo/South Rural Waterloo, which comprises 63% of the population (438,772) and Urban Guelph with 20% (136,114).

Table 1: Designated Planning Areas and Planning Area Map in Waterloo Wellington Local Health Integration Network

WWLHIN Communities within the Proton Planning Planning Area Station Swinton Park Dundalk Areas Central Varney Urban Waterloo City of Waterloo, City of and South Rural Kitchener, City of Cambridge, Waterloo and Township of North Dumfries Holstein Keldon Conn Rural Waterloo Township of Wellesley, Central West

Township of Wilmot, and Clifford Mount Forest Township of Woolwich Damascus

Harriston Urban-Guelph City of Guelph, Kenilworth

Township of Guelph/Eramosa Te vi otd al e Arthur and Township of Puslinch Palmerston Rothsay Hillsburgh Belwood Erin Rural Town of Erin, Township of Drayton Brisbane Wellington Centre Wellington and Township Moorefield Alma Ospringe of Mapleton Salem Fergus Rural North Township of Southgate, Town of Elora Brucedale Floradale Rockwood Wellington & Minto and Township of Eramosa Yatton Macton Marden South Grey Wellington North Dorking Wallenstein West Eden Mills Montrose Ariss Mississauga Linwood Elmira South West Halton Winterbourne Hawkesville St. Jacobs Maryhill Guelph Conestogo Arkell Crosshill St. Clements Heidelberg Bloomingdale Aberfoyle Bamberg Breslau Wellesley Morriston St. Agatha Waterloo Puslinch Little Lake Kitchener Crieff Phillipsburg Petersburg Baden Blair Clyde Mannheim New Hamburg Roseville Cambridge New Dundee Haysville Branchton Hamilton Niagara Haldimand Brant Ayr

Waterloo Wellington LHIN Planning Areas Planning Area Urban Waterloo & Rural Waterloo South LHIN Boundary Urban Guelph Census Division (County) Rural Waterloo Census Subdivision (Municipality) 0 250 500 Rural - South Grey & North Wellington km 0 7.5 15 22.5

Rural Wellington km Source: 2001 Census, Statistics Canada. Prepared for Waterloo Wellington Local Health Integration Network by the Health System Intelligence Project.

The population breakdown by gender and major age group as well as by planning area is provided in Table 2, with the percent of the total WWLHIN population that each represents.

6 Statistics Canada, Demography Division, based on 2001 Census Canada adjusted for undercounting, LHIN Population Projection Table, Provincial Health Planning Database (PHPDB), June 2006. Note: Population projections are not yet available for the five planning areas within WW.

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Table 2: Population breakdown by gender, major age group and WWLHIN Planning area, 2005

Total <1 - Total 20- Total 45- Total 65+ Total All Planning Area Gender 19 yrs 44 yrs 64 yrs yrs Ages Total WWLHIN Female 89,092 130,524 84,857 45,503 349,976 Male 93,208 136,433 83,443 35,007 348,091 Total 182,300 266,957 168,300 80,510 698,067 % of WW Total 26.1% 38.2% 24.1% 11.5% 100.0% Total Urban Waterloo Female 55,287 85,055 52,499 27,135 219,976 South Rural Waterloo Male 57,893 88,924 51,470 20,509 218,796 Total 113,180 173,979 103,969 47,644 438,772 % of WW Total 16.2% 24.9% 14.9% 6.8% 62.9% Total Rural Wellington Female 6,931 7,850 6,414 2,955 24,150 Male 7,098 8,221 6,446 2,611 24,376 Total 14,029 16,071 12,860 5,566 48,526 % of WW Total 2.0% 2.3% 1.8% 0.8% 7.0% Total Urban Guelph Female 16,437 25,889 16,741 9,573 68,640 Male 17,101 27,083 16,148 7,142 67,474 Total 33,538 52,972 32,889 16,715 136,114 % of WW Total 4.8% 7.6% 4.7% 2.4% 19.5% Total North Well South Female 3,801 4,326 3,403 2,425 13,955 Grey Male 4,092 4,613 3,545 1,974 14,224 Total 7,893 8,939 6,948 4,399 28,179 % of WW Total 1.1% 1.3% 1.0% 0.6% 4.0% Total Rural Waterloo Female 6,636 7,404 5,800 3,415 23,255 Male 7,024 7,592 5,834 2,771 23,221 Total 13,660 14,996 11,634 6,186 46,476 % of WW Total 2.0% 2.1% 1.7% 0.9% 6.7% Source: Population Estimates Table, Provincial Health Planning Database, based on 2001 Census corrected for undercounting ad hoc query 12-Jul-06 LHIN File 13

As the ‘baby boomer’ cohort ages, the number of people aged 50 years and older will increase more rapidly than other age groups. This age group comprised 28% of the population (194,800) in 2005 but will grow to 34% of the population by 2015 (273,300). The population aged 65 years and older is expected to increase quickly as well, from 11.5% (80,600) of the population in 2005 to 14% (112,060) in 2015. Conversely, there will be a proportionate decrease in the younger age groups in WWLHIN. Figure 1 provides the population pyramids for 2005 and 2015 indicating this projected age shift.

WWLHIN Integrated Health Service Plan 2 Appendix E – Population Profile and Health Services Utilization Details Figure 1: Population Pyramids 2005 and 2015 for WW LHIN, by age group, by gender

5-Yr Age Group 2005: 1%=6,989 people 2015: 1%=7,976 people 90+ 85-89 80-84 75-79 70-74 65-69 60-64 55-59 50-54 45-49 40-44 35-39 30-34 25-29 20-24 15-19 10-14 5-9

5 4 3 2 1 0012345

% of Total

1.2 Population Health Status

In projecting health needs and in planning for future services, it is important to examine the current health status of residents of WWLHIN. This section describes population health status in several areas: chronic diseases, deaths, behavioural determinants of chronic disease and injury, socio-economic determinants of health and preventative health practices.

1.2.1 Chronic Disease in WWLHIN

Table 1 provides data on the proportion of residents of WWLHIN and Ontario, aged 12 years and older, that reported selected chronic diseases as diagnosed by a health professional in 2003. These conditions may not always result in use of the health care system by the individual but they may result in reductions in both function and quality of life.

Table 1: Self-Reported Prevalence* of Selected Chronic Diseases and Conditions in Waterloo Wellington LHIN and Ontario - 2003, Population Aged 12+ Years Waterloo Wellington Ontario LHIN Health Region # % # % 1,798,500 91,500 16% Arthritis/Rheumatism 18%

High Blood Pressure 1,515,600 15% 78,800 14%

Asthma – had symptoms past year 854,600 8% 46,000 8%

Heart Disease 530,400 7% 26,500 7%

Diabetes 475,400 4% 22,700 5% Source: 2003 Canadian Community Health Survey, MoHLTC - Health System Intelligence Project, 2005-07-01. LHIN File 14

WWLHIN Integrated Health Service Plan 3 Appendix E – Population Profile and Health Services Utilization Details Because the Canadian Community Health Survey (CCHS) survey is now repeated bi-annually, these data also provide an opportunity to examine emerging trends in chronic disease. For example, data over time from the CCHS indicate that the number of people living with diabetes in Canada has doubled since 1996/97. The chronic conditions reported are ideally managed through primary prevention by way of lifestyle choices or within the primary care system. However, in areas that are under-serviced for family physicians, such as WWLHIN, these conditions may become acute and result in emergency department visits and hospital admissions, at a much greater cost to the health system. In addition, those with chronic conditions tend to be at greater risk for infectious and communicable diseases (such as influenza) as well.

1.2.2 Causes of Death in WWLHIN

As in all developed nations worldwide, the leading causes of death7 in WWLHIN are non-communicable diseases and injury. The top six leading causes of death for 2000 and 2001 in the WWLHIN were: first - cardiovascular diseases (1526 per year), second - cancers (1201 per year), third - respiratory diseases (301), fourth - diseases of the nervous system (207), fifth - injuries and poisonings, including suicide (188) and sixth - endocrine/metabolic diseases (178). These leading causes are all significantly related to lifestyle factors. Since death is inevitable, and therefore there is no possibility of preventing all deaths, another important statistic to examine is the potential years of life lost (PYLL)8 due to the leading causes of death. PYLL is a measure of premature death that subtracts the age at death from the average life expectancy of 75 years. The total PYLL in WWLHIN in 2000-2001 from all causes was 27,555 and the leading causes of PYLL by ICD10 Chapter are provided in Figure 1. The top three causes accounted for almost 70% of PYLL – cancer (9495), heart disease (4919) and injuries and poisonings, including suicide (4593). These causes are largely preventable and as already mentioned, the prevalence of risk factors for these three is high in Waterloo Wellington. There are also a high number of PYLL for perinatal conditions and congenital anomalies. This is due to the young age at which these deaths occur, i.e., each death for perinatal conditions results in 75 PYLL.

Figure 1: Leading Causes (ICD10 Chapter) of Potential Years of Life Lost in Waterloo Wellington LHIN - Average Annual Number of Potential Years of Life Lost in 2000-2001

10,000

8,000 Potential Years of Life Lost

6,000

4,000

2,000 Avg2000-2001 Annual # PYLL 0

e s er s s m a te rine lies tory nc a Injury ptom oc Ca sys m oma y End an Digestive Infectious ous Respir rv tal igns/s ni Ne S Circulatory dise Perinatal condition onge C

7 Leading causes are grouped by ICD10 Chapter. ICD10 = International Classification of Disease, Version 10. The ICD10 is the accepted international standard for classifying cause of death and hospitalization. It has been used in Canada for hospitalizations since 2002, and for deaths since 2000. 8 Potential Years of Life Lost (PYLL) is calculated for each cause by multiplying the total deaths for that cause for an age group by (75 – middle of age group). For example, if there were 15 deaths for a particular cause in the 45-49 year age group the PYLL = 15 x (75-47) = 15 x 28 = 420.

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1.3 Determinants of Health

1.3.1 Behavioural Determinants of Chronic Disease and Injury

The risk of death, regardless of the cause, increases with age. Since the population in WWLHIN is aging, the death rate is expected to increase over the next few decades. However, non-communicable disease and injury are also influenced by other risk factors that can be changed. If the prevalence of these risk factors increases, then the rate of death and illness from the leading causes will be even higher than is projected because of the aging population. The risk factors of insufficient daily physical activity, tobacco use, exposure to environmental tobacco smoke (ETS), heavy alcohol consumption, and obesity are associated with increased incidence of heart disease, cancer, diabetes, respiratory diseases, and injury.

For example, Cancer Care Ontario reports that following recommended guidelines for tobacco use, diet, and physical activity could prevent about 60% of new cancer cases9. As well, a recent 52-country research project reported that risk factors that can easily be changed, accounted for over 90% of heart attack risk. This finding applied to men and women, young and old, in all regions of the world regardless of socioeconomic status10.

Table 1 compares the percentage of WWLHIN residents aged 12 years and older that reported these modifiable risk factors in 2003 and 2005 to the Cancer 202011 targets and Ontario average. There was little change in the prevalence of these risk factors between 2003 and 2005, and the population remains at a high level of risk for chronic disease and injury.

Table 1: 2003 self-reported prevalence of modifiable risk factors for chronic disease and injury in Waterloo Wellington LHIN and Ontario Residents Aged 12 Years and Older, 2003 and 2005.

Cancer 2020 Ontario WWLHIN WWLHIN Risk Factor Gender Target 2005 2003 2005 Females 10% 52% 50% 51% Physical Inactivity Males 10% 46% 45% 45%

Females 5% 18% 16% 18% Daily/Occasional Smoking Males 5% 27% 22% 23% Females 26% 26% 25% Overweight (Body Mass Index 25-29) Males Total Overweight + 41% 40% 39% Obese - 10% Females 14% 15% 17% Obesity (Body Mass Index 30+) Males 16% 17% 17% Females 6% Heavy drinking (5 or more drinks on one 12% 12% 11% occasion, 12 more times per year) Males 6% 30% 32% 30%

Exposure to Second-hand Smoke (ETS) Females 6% 16% 17% 14% in vehicle/public places Males 6% 19% 22% 16% Source: 2003 and 2005 Canadian Community Health Survey, MOHLTC 2005. Targets from: Targeting Cancer: Cancer 2020 Summary Report, p.8, Canadian Cancer Society, 2004.

In 2005, men in WWLHIN had a higher prevalence of all of these risk factors except physical inactivity. This is consistent with the higher incidence of chronic disease and injury (except falls) in males. The WWLHIN risk factor data compared with the province indicates that residents of this area have similar risk for chronic disease risk.

9 Targeting Cancer: Cancer 2020 Summary Report, p.9, Canadian Cancer Society, 2004. 10 Yusuf S, Hawken S, Ounpuu S, Dans T. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. The Lancet, published online September 3, 2004. http://image.thelancet.com/extras/04art8001web.pdf. 11 Targeting Cancer…, p.8.

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This is surprising given the known association between socioeconomic status and these risk factors, i.e., WWLHIN residents should have lower prevalence of these behavioral risk factors. Based on the high prevalence of these risk factors, chronic disease and injury can be expected to increase at a faster rate in Waterloo Wellington than would be expected based only on population aging and growth.

However, it is encouraging that despite high smoking rates, Waterloo Wellington residents’ rate of exposure to environmental tobacco smoke (ETS) in vehicles and/or public places decreased by 3% for women and 5% for men between 2003 and 2005. This is a testament to the benefits of the more rigorous smoke-free public places policy in Waterloo Wellington since 2001 compared to other regions of the province.

1.3.2 Tobacco Use and Exposure

Tobacco use and exposure remains as the leading preventable cause of illness and death worldwide12. While tobacco use and exposure has gone down in the WWLHIN population over the past two years, there is still significant room for improvement. In general, 2005 self-reported smoking rates in Waterloo Wellington are similar to those for the province as shown in Table 2. However, since the socioeconomic status of the Waterloo Wellington population is significantly higher than the provincial average, it would be expected that smoking rates would be much lower than the provincial rate. The lower smoking rate in the adolescent population is an encouraging sign that anti-tobacco campaigns aimed at this population at both the provincial and local levels, are having the desired effect. The very low smoking rates in the seniors population is evidence of the health impact of lifelong smoking, i.e., that smokers are less likely to reach their senior years.

Table 2: Self Reported Tobacco Use and Exposure in Waterloo Wellington LHIN and Ontario Residents Aged 12 Years and Older, 2003 and 2005

WWLHIN WWLHIN Ontario Tobacco Use/Exposure Gender 2003 2005 2005

% complete restriction on smoking at home Females 67 74 71 Males 66 72 69 Females 67 76 75 % complete restriction on smoking at work Males 50 54 61

% current daily or occasional smoker Females 18 16 18 Males 27 22 23

% exposed to second-hand smoke at home Females 7 6 7 Males 10 7 8 % exposure to second-hand smoke in the past month, in Females 17 14 16 vehicles and/or public places Males 22 16 19 Females 32 33 29 % smoking initiation younger than 15 years) Males 36 36 36

Data source: Statistics Canada, Canadian Community Health Survey (CCHS 2.1 and 3.1), 2003 and 2005. The CANSIM table 105- 0400 is an update of CANSIM table 105-0200.

1.3.3 Socio-economic Determinants of Health

Population characteristics such as family structure, employment, income, education, and ethnicity are known to influence health status and health system use. Recent research has demonstrated that differences in health status between groups are largely due to differences in the presence of major risk factors for chronic disease and injury. For example, smoking rates are more than twice as high in the

12 Murray CJL, Lpez AD (Eds). Global Burden of Disease and Injury, Volume 1. United States: World Health Organization and Harvard School of Public Health, 1996.

WWLHIN Integrated Health Service Plan 6 Appendix E – Population Profile and Health Services Utilization Details low-income group compared with those in mid to high-income groups13. People living alone (particularly the elderly) or those in lone-parent families are often more reliant on the formal health care system because of a lack of informal supports.

1.3.4 Families in WWLHIN

Several factors related to family composition can impact health and the use of the health system. Also important are time-related variables such as distance to work and time spent on unpaid care for seniors and children, since these reduce time available for maintaining or improving personal health and for accessing the health system. The proportion of female lone-parent families and the number of babies born to teen-aged mothers are lower in WWLHIN than in the province as a whole. The rural areas have much lower rates for lone parent families than the urban areas. However, this area has a high proportion of residents who work in another Census Division (CD). Because of this, a smaller proportion of residents live within an active commuting-distance from work.

As well, residents with a long daily commute have less time available for maintaining health and accessing health care.

Waterloo Wellington also has a high proportion of residents who recently moved into the area from other parts of the Province or Canada. These new residents are less likely to have a family doctor. They also may not know how to access health care in the region and are less likely to have a social support network. 1.3.5 Visible Minority and Aboriginal Population in WWLHIN

The visible minority population of a community may also predict health status. For example, the incidence of end-stage renal disease is much higher in the South and Southeast Asian, Black and Aboriginal populations in Canada, while hypertension and diabetes are more common in Black and Aboriginal people than in Caucasians. Table 3 provides a breakdown of the visible minority population by planning area within WWLHIN. There is a much smaller visible minority or aboriginal population in Waterloo Wellington than in Ontario as a whole. The visible minority population in WWLHIN is largely concentrated in the urban planning areas.

Table 3: Visible Minority and Aboriginal Populations in Waterloo Wellington LHIN, 2001

Urban Rural Rural Wat & S Urban Wellingto NW& S Rural Rural Census Variables Guelph n Grey Wat Waterloo WWLHIN Ontario

Total visible minority population* 12630 780 405 43495 690 58,000 2153045

% visible minority population 10.4% 1.8% 1.5% 11.1% 1.6% 9.3% 19.1%

Total Aboriginal identity population** 860 280 190 3165 170 4,665 188315

% Aboriginal identity population 0.7% 0.6% 0.7% 0.8% 0.4% 0.7% 1.7% Source: 2001 Census Canada, 20% Sample, Statistics Canada, 2003. *Visible minority – persons other than Aboriginal peoples who are non-Caucasian in race, or non-white in colour. **Aboriginal – those identifying with at least one Aboriginal group and/or reported to be a Treaty Indian or Registered Indian; and/or reported to be a member of an Indian Band or First Nation. LHIN File 15

13 2001 Canadian Community Health Survey, electronic share file, Ontario Ministry of Health and Long-Term Care, 2003. Ad hoc data analysis by Wellington-Dufferin Guelph Health Unit, 2004.

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1.3.6 Language and Immigration in WWLHIN

While the percent immigrant population of Waterloo Wellington is lower than that of Ontario (20% vs. 27%), this is particularly true of the rural planning areas where the proportion immigrants is one-third the provincial rate (See Table 4). The proportion of the population identifying as recent immigrants is also lower than for the province (3% vs. 5%), with the urban areas of Waterloo Wellington once again having higher rates than the rural areas.

Recent immigrants, as well as those moving into or within WWLHIN from other parts of Canada (internal migrants) may have difficulty accessing the primary care system given the area’s current shortage of family physicians. Recent immigrants may also face language and cultural barriers in accessing health care.

Knowledge of the official languages is also important in accessing health services in Canada. In WWLHIN, English or French is the mother tongue for 82% of the population; while almost 99% of residents have knowledge of the official languages. These proportions are highest in the rural areas of Waterloo Wellington. Table 4: Waterloo Wellington LHIN Immigration Statistics Urban Rural N Wat & S Language/Immigration Urban Rural Well & S Rural Rural Question Guelph Wellington Grey Wat Waterloo WWLHIN Ontario

Immigration Status

Total immigrant population (#) 23,780 5,185 2,200 89,195 3,580 123,940 3,030,075

Total immigrant population (%) 19.6% 11.7% 8.3% 22.8% 8.5% 19.8% 26.8%

Recent immigrants* (#) 3,220 345 125 14,065 245 18,000 538730

Recent immigrants* (%) 2.6% 0.8% 0.5% 3.6% 0.6% 2.9% 4.8%

Mother Tongue (Language first spoken and still understood)

English mother tongue (#) 100,005 38,585 23,560 306,600 32,825 501,575 8,119,840

English mother tongue (%) 82.2% 87.2% 88.5% 78.2% 78.4% 80.1% 71.9%

French mother tongue (#) 1950 480 245 6,295 350 9,320 533,970

French mother tongue (%) 1.6% 1.1% 0.9% 1.6% 0.8% 1.5% 4.7% Knowledge of Official Languages

Neither English nor French (#) 1,300 295 235 5760 695 8,285 232,780

Neither English nor French (%) 1.1% 0.7% 0.9% 1.5% 1.7% 1.3% 2.1% Source: 2001 Census Canada, 20% Sample, Statistics Canada, 2003. * Recent immigrants – immigrants to Canada between 1996 and 2001. LHIN File 15

1.3.7 Education, Employment, and Income

Being unemployed, having a low-paying job, and having a lower education level can all affect your health. They can also affect your ability to access health services. Table 5 shows that in 2001, WWLHIN residents were somewhat better off than the average for Ontario. While unemployment was lower, and fewer families were categorized as low income, the percent of the population aged 20 years and older with completed post-secondary education was lower in all planning areas except Urban - Guelph.

WWLHIN Integrated Health Service Plan 8 Appendix E – Population Profile and Health Services Utilization Details

Table 5: WWLHIN Summary of Education, Employment and Income, 2001

Urban Waterloo Rural N & Education, Employment and Urban Rural Well & S Rural Rural Income Guelph Wellington S Grey Waterloo Waterloo WWLHIN Ontario

Education Level (population 20+ yrs)

Less than grade 9 education (%) 6.2% 10.1% 14.0% 8.0% 18.8% 8.7% 8.7%

Without completed high school (%) 22.0% 28.0% 39.5% 26.1% 35.8% 26.6% 25.7% Completed post-secondary (%) (to be verified) 52.5% 45.8% 33.4% 46.9% 41.7% 47.1% 48.7%

Employment

Participation rate (age 15+) 72.1% 73.7% 67.4% 71.6% 72.9% 71.8% 67.3%

Unemployment rate (age 15+) 5.0% 3.4% 4.6% 5.6% 2.4% 5.1% 6.1%

Unemployed 15-24 yrs (#) 1,455 405 260 4,680 270 7,070 127,185

Unemployment rate 15-24 yrs 11.3% 9.4% 10.2% 11.7% 5.8% 8.0% 12.9% Income

% population in low income 9.4% 5.1% 11.1% 11.5% 5.7% 10.2% 14.4% % households spending 30% or more of income on housing 21.6% 19.6% 22.2% 22.1% 13.8% 21.4% 25.3% Source: 2001 Census Canada, 20% Sample, Statistics Canada, 2003. LHIN File 15

1.4 Preventive Health Practices

1.4.1 Influenza Immunization

Vaccination is the most effective defense against influenza. In Ontario since 2000, the universal vaccination program has increased the seasonal immunization rate above that of other provinces14. In 2005, 38% of WWLHIN residents aged 12 years and older had received a flu vaccine in the past year13 compared with a rate of 41% for all Ontario residents. Waterloo Wellington rates had improved from 32% in 2003. Seasonal immunization rates were lower in males than females in Waterloo Wellington in both 2003 (26% vs. 37%) and 2005 (35% vs. 41%).

1.4.2 Breast screening (mammography)

Early detection of breast cancer through regular screening mammography for the female population aged 50 years and older has been proven to reduce mortality15. Self-reported data from the 2003 Canadian Community Health Survey13 provides information on mammography rates for the WWLHIN (questions about mammography in the CCHS were asked of women aged 50 to 69 years).

In 2005, 47% of women aged 50 to 69 years in The WWLHIN reported having had a screening mammography within the past two years. This was lower than the provincial rate (53%) and also lower than the rate for Waterloo Wellington in 2003 (51%).

14 Kwong, Sambell, Johansen, et al., The effect of universal influenza immunization on vaccination rates in Ontario, Health Reports, Vol 17, pp. May 2006. 15 Targeting Cancer: Cancer 2020 Summary Report, Canadian Cancer Society, Ontario, 2004

WWLHIN Integrated Health Service Plan 9 Appendix E – Population Profile and Health Services Utilization Details 1.4.3 Cervical Screening (Pap smear)

Early detection of cervical cancer through regular cervical screening (Pap smear test) reduces mortality. Self-reported data from the 2003 Canadian Community Health Survey13 provides information on cervical screening rates for the WWLHIN. Females between 18 and 69 years were asked if they are or have ever been sexually active.

In both 2003 and 2005, 73% of respondents between the ages of 18 and 69 years had had a pap test within the past three years. The Mandatory Health Programs and Services Guidelines for Ontario indicate that the objective for cervical screening is to increase the proportion screened according to the guidelines of the Ontario Cervical Screening Collaborative16 to 85% and to increase the proportion ever screened to 95% by 2010. The CCHS data indicate that women in the WWLHIN aged 18-69 years are at risk of not reaching this target.

16 Ontario Cervical Screening Guidelines, Canadian Cancer Society website, accessed 25-May-06, http://www.cancer.ca/ccs/internet/standard/0,3182,3543_314740__langId-en,00.html.

WWLHIN Integrated Health Service Plan 10 Appendix E – Population Profile and Health Services Utilization Details 2. Services and Utilization

Understanding patterns of healthcare service utilization is essential to effective health system planning. Two aspects of utilization should be considered:

1. the health services delivered by WWLHIN providers and 2. where WWLHIN residents go to access care.

2.1 Health Promotion and Prevention

2.1.1 Health Promotion

Adopting healthy behaviours such as eating nutritious foods, being physically active and avoiding tobacco can prevent or control the devastating effects of many diseases. Health promotion programs reduce the health and economic consequences of the leading causes of death and disability and contribute to a long, productive, healthy life for all people.

2.1.2 Health Promotion Services in the WWLHIN

In the WWLHIN, people access health promotion services in primary care settings (clinics, family doctors), through public health education and services, and as the wellness component of long-term care, chronic disease management and senior care. Health Promotion programming is sometimes delivered outside of traditional healthcare settings, such as in schools.

2.1.3 Preventive Practices

Strong evidence exists that preventative practices help reduce illness, and prevent diseases and certain disabilities in many populations. For example, early detection of breast cancer through regular screening mammography for the female population aged 50 years and older has been proven to reduce the number of breast cancer-related deaths.

2.1.4 Preventive Practices in the WWLHIN

In the WWLHIN, residents take advantage of preventive practices such as breast screening (mammography), immunizations, cervical screening (Pap smear), PSA tests and colorectal screening.

• Self reported data regarding preventative practices indicates that fewer LHIN residents were immunized for influenza in 2005 than 2003, and fewer women aged 50 – 69 were screened for breast cancer in 2005 than 2003.

• Self-reported data from the 2003 Canadian Community Health Survey provides information on cervical screening rates for WWLHIN.

• In both 2003 and 2005, 73% of women between the ages of 18 and 69 years had a pap test within the past three years. The Mandatory Health Programs and Services Guidelines for Ontario indicate that the objective for cervical screening is to increase the proportion screened according to the guidelines of the Ontario Cervical Screening Collaborative17 to 85% and to increase the proportion ever screened to 95% by 2010. The CCHS data indicate that women in WWLHIN aged 18-69 years are at risk of not reaching this target.

17 Ontario Cervical Screening Guidelines, Canadian Cancer Society website, accessed 25-May-06, http://www.cancer.ca/ccs/internet/standard/0,3182,3543_314740__langId-en,00.html.

WWLHIN Integrated Health Service Plan 11 Appendix E – Population Profile and Health Services Utilization Details 2.2 Primary Care

Primary health care is generally the first point of contact that people have with the health care system. Primary health care is provided by physicians, nurse practitioners, and other health care professionals such as nurses, social workers, dietitians and pharmacists. Primary care includes, but is not limited to, disease management and prevention, disease cure, rehabilitation, palliative care and health promotion.

2.2.1 Family Physician Care

While primary care is not limited to family medicine, it is important to have an understanding of how general practitioner services are delivered within the WWLHIN, because family practitioners play a gatekeeper role in accessing the health system.

2.2.2 Care Provided by Family Physicians in the WWLHIN

In 2004, the WWLHIN had 517 family physicians (see Table 1). Of these, over 90% were in family medicine/ general practice.

Table 1: 2004 WWLHIN Family Physicians by Type

Family Medicine/General Practice 476 F.P./Anesthesia 1 F.P./Emergency Medicine 40 Source: Ontario Physician Human Resources Data Centre, Active Physician Registry, December 31, 2004, Report prepared by MOHLTC May 17, 2005 LHIN File 3 - Physicians

The population per physician ratio that is used by the Ministry of Health and Long Term Care to designate which communities are under-serviced for family physicians is 1 physician for a population of 1,380 patients. This means that based on a projected 2005 population of 698,900, WWLHIN should have 522 general practitioners providing family medicine. Estimates from the Ontario Physician Human Resource Data Centre are that 476 general practitioners provide family medicine within the LHIN. This figure includes all practitioners regardless of whether they operate a full time practice.

That being said, there are many challenges associated with determining the optimal number of physicians for a given area. The availability, quality and cost of alternate services, the value that individuals place on having a family physician and other factors are all relevant. Nonetheless, understanding the number of family physicians is an important input to planning decisions. Table 2 provides the rate of family physicians per 100,000 population within Ontario LHINs.

WWLHIN Integrated Health Service Plan 12 Appendix E – Population Profile and Health Services Utilization Details

Table 2: Rate of Family Physicians in Ontario LHINs in 2004/100,000 population

Family Physicians 2004 Population 2004 Rate/ LHIN (2004) Estimates 100,000 Toronto Central 1,600 1,146,817 139.52 Champlain 1,241 1,177,544 105.39 North West 247 242,246 101.96 South East 479 480,127 99.77 North East 512 568,120 90.12 North Simcoe Muskoka 352 418,442 84.12 Central 1,250 1,542,246 81.05 South West 723 923,473 78.29 Waterloo Wellington 517 685,666 75.40 Hamilton Niagara Haldimand Brant 995 1,352,329 73.58 Mississauga - Halton 732 1,030,881 71.01 Central East 986 1,450,682 67.97 Central West 432 728,907 59.27 Erie-St.Clair 373 645,240 57.81 Ontario 10,439 12,392,720 84.66 LHIN File 3 - Physicians

2.2.3 Where do WWLHIN residents go to receive Family Physician Care?

Access to primary care services is limited by a shortage of family physicians. A year 2000 survey conducted by the Central-West Health Planning Intelligence Unit revealed that 9% of Waterloo Region and Wellington and Dufferin County residents reported that they did not have access to a family physician (2000 Primary Care Survey: Waterloo Region Wellington Dufferin District Health Council, Central West Health Planning Information Network, 2000). The Canadian Community Health Survey indicates that in 2003, 92.8% of WWLHIN residents had a regular medical doctor, and in 2005, 92.2% of residents reported having access to a regular medical doctor (Canadian Community Health Survey 2003, 2005). This means that 54,512 residents of the WWLHIN aged 12 plus did not have access to a regular medical doctor, based on a projected population estimate for 2005 of 698,866. Table 3 shows the distribution of physicians and patients.

WWLHIN Integrated Health Service Plan 13 Appendix E – Population Profile and Health Services Utilization Details Table 3: Location of Family Physicians Accessed by WWLHIN Residents, 2004

Location of Family Med/GP Provider Patient/WWLHIN area of residence

Waterloo Rural - S Rural Urban - Guelph Rural WWLHIN Total Urban & Rural Grey & N Wellington Waterloo S Well Waterloo Urban & S Number of Services 1,994,247 4,390 10,492 48,518 99,342 2,156,989 Rural % of Area Total 74.9% 2.3% 3.5% 5.8% 55.9% 51.8% Rural Wellington Number of Services 11,931 25,088 161,223 23,215 4790 226,247 % of Area Total 0.4% 13.1% 53.5% 2.8% 2.7% 5.4% Urban - Guelph Number of Services* 45,735 3,627 21,458 559,943 4,592 635,355 % of Area Total 1.7% 1.9% 7.1% 67.4% 2.6% 15.3% Rural - S Grey & N Number of Services 1703 95,940 8,355 1716 691 108,405 Well % of Area Total 0.1% 50.3% 2.8% 0.2% 0.4% 2.6% Rural Waterloo Number of Services 42,852 321 2,067 5,544 22,323 73,107 % of Area Total 1.6% 0.2% 0.7% 0.7% 12.6% 1.8% All WWLHIN providers Number of Services* 2,096,468 129,366 203,595 638,936 131,738 3,200,103 % of Area Total 78.7% 67.8% 67.6% 76.9% 74.1% 76.9% Providers Outside Number of Services 566,929 61,458 97,608 191,810 45,995 963,800 WWLHIN % of Area Total 21.3% 32.2% 32.4% 23.1% 25.9% 23.1% All Family Med/GP Number* of Services 2,663,397 190,824 301,203 830,746 177,733 4,163,903 Providers % of Area Total 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% *Includes 4,208 medical services provided by emergency medicine specialist located in Urban - Guelph. ** Providers may have more than one location - this is the location used for medical service billing. Source: Medical Services Table (1 Yr), based on OHIP billing data, Provincial Health Planning Database, ad hoc query 2006-06-22. LHIN File 10 Issues/Observations:

• Over half of all family physicians providing care to WWLHIN residents are located in the Kitchener/Waterloo/Cambridge area.

• In 2004, 77% of WWLHIN residents accessing a family physician did so within the Waterloo Wellington LHIN.

• However, access to family physicians was lower in Rural South Grey and North Wellington and Rural Wellington areas. About 32% of residents in these areas accessed family physicians outside our LHIN.

2.3 Community Health Centre (CHC) Care

2.3.1 Care Provided by Community Health Centres in the WWLHIN

In the WWLHIN, we have four Community Health Centres plus three satellite locations. The Kitchener Downtown CHC also operates outreach services at three downtown locations.

WWLHIN Integrated Health Service Plan 14 Appendix E – Population Profile and Health Services Utilization Details

CHC Satellite Guelph CHC Shelldale Neighbourhood Lang’s Farm, Cambridge North Dumfries Township Kitchener Downtown Outreach services at three downtown locations Woolwich CHC Wellesley

CHCs provide expanded access to primary care, health promotion and coordination and delivery of community-based programs. CHCs are funded on a program basis and all staff, including physicians, are paid on a salary basis. Key components of CHCs are:

• Governed by community-based, not-for-profit Boards; • Serve a specific geographical catchment area; • Mandated & funded to serve marginalized / specific population groups such as, rural farm families, urban core neighbourhoods and people with low income, people with language barriers, street youth/teens, the homeless, mentally ill etc. Emphasis is on the determinants of health; • Patients are registered/rostered for primary health care services however, programs are open to registered & non-registered participants; • Most CHCs provide some evening and weekend services.

2.3.2 Where do WWLHIN residents go to receive Community Health Centre Care? Issues/Observations:

• By their nature, Community Health Centres provide services to the specific communities and populations they serve. Therefore, some residents of the WWLHIN are able to access CHC services, depending on whether they fit the criteria for the CHCs priority populations. These typically include a neighbourhood or community boundary, and can also include specific population groups.

• CHCs have faced difficulty with professional recruitment due to the disparity in compensation between CHC providers and physicians and health professionals practicing in other primary care models. This limits the capacity of the CHC to provide services.

• CHCs are reporting waiting lists for primary care services. As roster sizes increase, CHCs will experience difficulty in providing services from their allied health professionals such as social workers and dietitians who are also at capacity.

• Marginalized people served by a CHC may find it more difficult to access other forms of primary care, both within and outside of the WWLHIN. Issues such as availability and cost of transportation, language and cultural barriers impact negatively on access.

WWLHIN Integrated Health Service Plan 15 Appendix E – Population Profile and Health Services Utilization Details • Table 1: Summary of CHC Patients as of Dec 2005

CHC # Patients rostered and non-rostered Guelph • 4,000 clinical clients • 5,000 community health program users • 5,000 Ontario Early Years users Satellite - Shelldale Neighbourhood • 1,600 clients based on projected satellite operations* Lang’s Farm – Cambridge • 4,000 patients • (includes approximately 600 individuals reached through outreach or access services from other providers) • 3,000 community health program participants • 7,000 total different individuals access services Satellite - North Dumfries Township • 125 patients registered patients accessing services at an interim site with additional township residents be added to a waiting list until the satellite is established Kitchener Downtown • 2,800 clients and 600 additional clients served at 3 outreach locations – based on approval of satellite funding Woolwich CHC • 3,786 Primary health care patients • additional clients, who are not registered primary health care patients, who access chiropodists, dietitians, therapists and group programs • 4,476 participants in group programs in 2004-05 Wellesley CHC (satellite) • target caseload of 2100 primary health care patients, with assessment of additional capacity on the basis of demand and client waiting times Source: Survey of CHCs, December, 2005 (* updated CHC statistics August 2006)

2.4 Family Health Team Care

2.4.1 Care Provided by Family Health Teams in the WWLHIN Family Health Teams (FHTs) are interdisciplinary teams of physicians and other providers such as nurse practitioners, nurses, social workers and dieticians, working in teams, to see more patients and to keep them healthy. FHTs are designed to give doctors support from other complementary professionals. Most Teams consist of doctors, nurses, nurse practitioners and other health care professionals who work collaboratively, each utilizing their experience and skills so that optimal care is delivered. Family Health Teams differ from CHCs in that they serve the general population and governance can be provided by physicians and/or community boards.

In the WWLHIN, nine physician and/or community-based groups have been approved to develop Family Health Teams:

Centre for Family Medicine Kitchener Erin FHT Erin Grandview FHT Cambridge Guelph FHT Guelph Minto-Mapleton FHT Palmerston Mount Forest-North Wellington FHT Mount Forest New Vision Kitchener Two Rivers FHT Cambridge Upper Grand FHT Fergus

FHTs will provide core primary health care services, and will be enhanced by: ƒ access to an individual’s own family doctor during regular office hours ƒ access to other health care professionals within that Family Health Team, such as nurse practitioners, nurses, dieticians and pharmacists.

WWLHIN Integrated Health Service Plan 16 Appendix E – Population Profile and Health Services Utilization Details ƒ access to a Family Health Team doctor during extended evening and weekend hours for urgent problems. ƒ If a patient sees another doctor in the Family Health Team for treatment, the patient’s own doctor will receive documentation about the nature of the encounter ƒ after-hours assistance will be provided by the Telephone Health Advisory Service (THAS) where a registered nurse will provide advice about urgent health care concerns. Physician on-call services can also be arranged through THAS. ƒ The physician will receive a written summary of the call the next day, so that he/she is informed of the nature of the problem and the advice provided. ƒ Family Health Teams will be able to take advantage of specially funded information technology to organize health information and share it securely with other health professionals.

2.4.2 Where do WWLHIN residents go to receive Family Health Team Care? Issues/Observations:

• Patients rostered with a FHT physician will be able to access the Team. Because currently the vast majority of FHT physicians are at full capacity, many Teams will not immediately be able to roster additional patients.

• However, the intent is that as care is shared among Team members, physician capacity will increase and more people will be able to access primary care services through the FHT. This should help to address the physician shortage in WWLHIN, and reduce the number of people travelling outside of the WWLHIN for primary care. FHTs should also reduce the numbers of people within the WWLHIN without any access to primary care.

2.5 Palliative Care

2.5.1 Provision of Palliative Care in the WWLHIN

Palliative care includes the full range of services and supports for people living with and dying from a terminal illness, and their families. In WWLHIN, palliative care is provided in acute care and complex continuing care hospitals, in the community, and in one free-standing hospice.

Long-term Care homes in the WWLHIN do provide pain management, and some are in varying stages of developing palliative care programs.

Cancer Care Ontario statistics indicate that 80-90% of palliative care patients have cancer, while the remainder have terminal illnesses such as AIDS, renal failure, heart disease, Alzheimer’s disease, MS, ALS and other conditions.

2.5.2 Where WWLHIN residents go to access Palliative Care Issues/Observations:

• It is estimated that only a small percentage of those who need palliative care receive it. • In many cases palliative care services are not available or accessible. • As the population ages, the demand for palliative care services will increase. • As palliative care is shifting from the hospital to the community, with the intention of giving people choice about where they will receive their care, patients’ families and communities share a greater burden of care.

WWLHIN Integrated Health Service Plan 17 Appendix E – Population Profile and Health Services Utilization Details 2.6 Outpatient Care

2.6.1 Emergency Department Care

Emergency care is provided 24 hours a day, 7 days a week at all 7 acute hospital sites in WWLHIN.

2.6.2 Provision of Emergency Department Services in the WWLHIN

Table 1: Emergency Department Visits in WWLHIN 2004 – 2005

Hospital 2004/2005 GROVES MEMORIAL COMMUNITY HOSPITAL 22,721 CAMBRIDGE MEMORIAL HOSPITAL 39,465 GUELPH GENERAL HOSPITAL 42,927 ST MARY'S GENERAL HOSPITAL 43,380 GRAND RIVER HOSPITAL CORPORATION 54,911 NORTH WELLINGTON HEALTH CARE CORPORATION 18,340 Total 221,744 Source: PHPDB, ad hoc query, June 2006 LHIN File 10 – Emerg x Hosp X Disposition Tab

Disposition Status

What happens to individuals after they are admitted to an emergency department is one indicator of the nature of emergency department visits. This can be depicted by examining what we call “disposition status” which is a chart describing where people were sent after leaving the emergency department. Table 2 sets out the disposition status of individuals entering emergency departments in the WWLHIN in 2004.

Over 80% of visits resulted in individuals being treated and then released to go home. About 10% were admitted to hospital as an inpatient, and another 5% left the emergency department without being seen.

WWLHIN Integrated Health Service Plan 18 Appendix E – Population Profile and Health Services Utilization Details

Table 2: Emergency Visits to Waterloo Wellington LHIN Hospitals, by Disposition Status of Visit - 2004 (Fiscal)

Disposition North North Status of Welling Wellingt % of Emergency St. ton HC on HC – Total All All Visits to WW Cambridge Groves Guelph Mary's - Mt Palmer- WWLHIN Visit Hospitals MH MCH General GRHC General Forest ston Hospitals s Discharged To Place Of Residence 29,377 20,261 33,239 41,814 37,161 6,615 10,351 178,818 80.6% Client Admitted As Inpatient To Other Units In Reporting Facility Direct 4,599 1,217 4,855 6,386 3,398 390 465 21,310 9.6% Client Admitted As Inpatient To Critical Care Unit/Operating Room In Reporting Facility Direct 1,571 24 410 1,006 547 47 95 3,700 1.7% Client Triaged, Registered And Assessed But Left Without Treatment 160 10 174 1,938 44 31 55 2,412 1.1% Transferred To Another Acute Care Facility Directly From An Ambulatory Care Visit Functional Centre 220 290 259 289 582 78 132 1,850 0.8% Client Triaged, Registered, And Assessed But Left Before Treatment Completed 514 39 86 235 106 5 4 989 0.4% Transferred To Another Non-Acute Care Facility Directly From An Amb. Care Visit Functional Centre 32 43 518 103 17 14 19 746 0.3% Intra Facility Transfer To Day Surgery 37 18 216 8 45 7 331 0.1% Intra Facility Transfer To Clinic 31 115 26 138 310 0.1% Death After Arrival (Daa)/Death In Emergency (Die) 21 13 24 66 61 4 6 195 0.1% Death On Arrival (Doa) 18 8 56 2 5 12 2 103 0.0% Client Registered But Left Without Being Seen Or Treated By Service Provider 5 30 3 4 42 0.0% Intra Facility Transfer To The Emergency Department 1 1 2 0.0% Total All Emergency Visits 100.0 to WW Hospitals 39,465 22,721 42,927 54,911 43,380 7,206 11,134 221,744 % Source: PHPDB, ad hoc query, June 2006 LHIN File 10 - Emerg x Hosp x Disposition Tab

There were fewer emergency department visits to WWLHIN hospitals (221,744) than there were visits for all WW residents making emergency visits (235,530) resulting in an inflow/outflow ratio of 0.94.

WWLHIN Integrated Health Service Plan 19 Appendix E – Population Profile and Health Services Utilization Details

Triage Level of Visit

In 2004, over half the visits to emergency departments in North Wellington HC hospitals were for non- urgent problems (56% of visits to the Mount Forest site; 54% to the Palmerston site) and as illustrated in Table 4, over 40% of visits by Rural North Wellington/South Grey are also non-urgent, The percent non- urgent for this rural area was significantly higher than in any other rural or urban WWLHIN area (Rural Wellington - 14%, Rural Waterloo - 6%, Urban Waterloo & S Rural Waterloo - 5%, and Urban Guelph - 4%). This suggests that residents of the area may have had inadequate access to 24/7 primary care or that there is an opportunity for public education about the appropriate use of emergency departments. Caution should be exercised in drawing conclusions since the data is from 2004 and changes may have occurred since that time. However, further investigation is warranted.

Table 3: Emergency Visits to Waterloo Wellington LHIN Hospitals, by Triage Level of Visit - 2004 (Fiscal)

North North St. Wellingto Wellington Total All Cambridge Groves Guelph Mary's n HC – HC - WWLHIN MH MCH GH GRHC GH Mt Forest Palmerston Hospitals Triage Level of Visit # Visits # Visits # Visits # Visits # Visits # Visits # Visits # Visits Resuscitation/life threatening 107 23 125 129 109 15 13 521 Resusc/life threaten as % of area total 0.3% 0.1% 0.3% 0.2% 0.3% 0.2% 0.1% 0.2% Emergent/potentially life threatening 3,763 717 4,743 9,499 3,591 55 113 22,481 Emerg/potentially life threat. as % of area total 9.5% 3.2% 11.0% 17.3% 8.3% 0.8% 1.0% 10.1% Urgent/potentially serious 20,205 5,825 19,660 24,494 17,965 355 1,215 89,719 Urgent/potentially serious as % of area total 51.2% 25.6% 45.8% 44.6% 41.4% 4.9% 10.9% 40.5% Less-urgent/semi-urgent 13,926 13,625 17,395 19,221 19,371 2,720 3,743 90,001 Less/semi-urgent as % of area total 35.3% 60.0% 40.5% 35.0% 44.7% 37.7% 33.6% 40.6% Non-urgent 1,464 2,526 1,004 1,568 2,314 4,058 6,046 18,980 Non-urgent as % of area total 3.7% 11.1% 2.3% 2.9% 5.3% 56.3% 54.3% 8.6% Not stated/not applic. 5 30 3 4 42 Total All Visits 39,465 22,721 42,927 54,911 43,380 7,206 11,134 221,744 Weekly Average number of visits 759 437 826 1,056 834 139 214 4,264 Source: PHPDB, ad hoc query, June 2006 LHIN File 10 - Emerg x Hosp x Triage tab

WWLHIN Integrated Health Service Plan 20 Appendix E – Population Profile and Health Services Utilization Details 2.6.3 Reasons WWLHIN Residents Receive Emergency Care

Issues/Observations: • In examining utilization in other parts of the health continuum, we examined where WWLHIN residents go to receive services. However, in the case of Emergency Care, admissions to an emergency department outside the WWLHIN does not indicate a lack of emergency care in the WWLHIN. More often it is because WWLHIN residents are travelling in those areas outside the WWLHIN when an emergency arises.

• For planning purposes within the WWLHIN, it is important to examine the nature of visits to emergency departments by Waterloo Wellington residents. In conjunction with information outlined in section 1 above, observations can be made. For example, the over 40% of visits by Rural North Wellington/South Grey residents are non urgent. This, coupled with the fact that over half the visits to emergency departments in North Wellington HC hospitals were for non-urgent problems (and the vast majority of visits to North Wellington HC hospitals were by WWLHIN residents) suggests residents of that area may have had inadequate access to 24/7 primary care. or that there is an opportunity for public education about the appropriate use of emergency departments.

• The percent non-urgent for this rural area was significantly higher than in any other rural or urban WWLHIN area (Rural Wellington - 14%, Rural Waterloo - 6%, Urban Waterloo & S Rural Waterloo - 5%, and Urban Guelph - 4%).

Table 4: Emergency Department Visits by Waterloo Wellington LHIN Residents, by Triage Level – 2004

Urban Rural N Total Waterlo Rural Wellingto Rural WWLHIN o & S Wellingto Urban - n & S Waterlo Resident Rural n Guelph Grey o s Triage Level of Visit # Visits # Visits # Visits # Visits # Visits # Visits Resuscitation/life threatening 391 46 148 47 31 663 Resusc/life threaten as % of area total 0.3% 0.2% 0.3% 0.2% 0.3% 0.3% Emergent/potentially life threatening 15,910 1,027 4,742 486 1,204 23,369 Emerg/potentially life threat. as % of area total 11.7% 4.8% 10.3% 2.1% 12.5% 9.9% Urgent/potentially serious 60,062 5,790 19,826 3,112 3,959 92,749 Urgent/potentially serious as % of area total 44.2% 26.9% 43.1% 13.8% 41.1% 39.4% Less-urgent/semi-urgent 52,977 11,691 19,580 9,630 3,834 97,712 Less/semi-urgent as % of area total 39.0% 54.3% 42.6% 42.6% 39.8% 41.5% Non-urgent 6,375 2,966 1,687 9,335 615 20,978 Non-urgent as % of area total 4.7% 13.8% 3.7% 41.3% 6.4% 8.9% Not stated/not applic 36 6 5 12 59 Total All Visits 135,751 21,526 45,988 22,622 9,643 235,530 Weekly average number of visits 2,611 414 884 435 185 4,529 Source: PHPDB, ad hoc query, June 2006 LHIN File 10 - Emerg x Pt Residence x Triage tab

• The main reason WWLHIN residents enter emergency departments is common in most jurisdictions in Ontario – abnormal symptoms (22% of the total). (See Table 5) Injury and poisonings make up another 21%. It is important to note that diseases of the respiratory system contribute 10% of visits. One in five Canadians has a respiratory problem and as the baby boomers age, chronic lung diseases such as COPD will be on the increase. By 2020, the burden of disease attributable to tobacco is expected to outweigh that caused by any single disease.18

18 http://www.on.lung.ca/media/lungfacts.html

WWLHIN Integrated Health Service Plan 21 Appendix E – Population Profile and Health Services Utilization Details

Table 5: Main Problem Reported for WWLHIN Residents Presenting to Emergency Departments

Urban Waterloo Rural Rural South Diagnosis Chapter Waterloo Rural Urban Grey North Rural WWLHIN % of of Main Problem South Wellington Guelph Wellington Waterloo Total Total Symptoms, Signs & Abnormal Clinical Findings 15,954 1,914 5,460 1,645 982 25,955 22.1% Injury, Poisonings & Other External Causes 14,263 2,344 5,533 1,859 1,082 25,081 21.3% Diseases of the Respiratory System 6,665 1,543 2,205 1,663 441 12,517 10.6% Factors Influencing Health Status & Contacts with Health System 3,811 967 1,136 2,132 320 8,366 7.1% Diseases of the Digestive System 4,863 553 1,608 560 287 7,871 6.7% Diseases of Genitourinary System 4,053 568 1,156 564 252 6,593 5.6% Diseases of Musculoskeletal System 3,669 521 1,352 591 232 6,365 5.4% Diseases of Circulatory System 2,484 253 742 299 209 3,987 3.4% Mental & Behavioural Disorders 2,576 193 726 219 87 3,801 3.2% Pregnancy & Childbirth 2,031 219 672 162 115 3,199 2.7% Diseases of Skin & Subcutaneous 1,656 351 556 433 126 3,122 2.7% Diseases of Ear 1,377 457 472 423 93 2,822 2.4% Infectious & Parasitic Diseases 1,254 230 417 239 82 2,222 1.9% Diseases of Nervous System 1,224 170 353 266 67 2,080 1.8% Diseases of Eye 947 220 316 203 67 1,753 1.5% Endocrine, Metabolic Diseases 648 52 184 68 19 971 0.8% Diseases of Blood 262 16 80 22 17 397 0.3% Neoplasms 204 25 57 39 16 341 0.3% Perinatal Conditions 81 4 14 7 6 112 0.1% Congenital Malformations 11 2 6 2 21 0.0% Total All Emergency Visits 68,033 10,602 23,045 11,394 4,502 117,576 100.0% Source: Ambulatory Care Table (Amb Case Type = EMG), PHPDB, ad hoc query, June 2006. LHIN, File 5 – Emergency x Main Problem tab

2.6.4 Ambulatory Care

Ambulatory Care refers to outpatient hospital visits, other than those to the emergency department. Patients may be seen by a physician or other healthcare provider.

WWLHIN Integrated Health Service Plan 22 Appendix E – Population Profile and Health Services Utilization Details

2.6.5 Ambulatory Visits in the WWLHIN

Table 1: Provision of Ambulatory Care Services* by WWLHIN Facilities, by Type of Case, by Place of Residence of Patient - 2004 (Fiscal) WWLHIN Ambulatory Care Facility North Place of Grand Groves Well. N. Well. St. Ambulatory Residence of Cambridge RHC- Memorial Guelph HC-Mt HC- Mary's Case Type Patient MH Waterloo CH GH Forest Palm. GH Total Clinical Urban Waterloo Rural Waterloo South 7,328 7,328 Rural Wellington 274 274 Urban Guelph 544 544 Rural South Grey, North Wellington 179 179 Rural Waterloo 1,014 1,014 WWLHIN Patients 9,339 9,339 % of Total who are WWLHIN Patients 91.4% 91.4% Other LHIN Patients 874 874 All Patients in WWLHIN Facilities 10,213 0 0 0 0 0 10,213 Medical Urban Waterloo Day/Night Rural Waterloo South 9,092 52,545 11 731 62,379 Rural Wellington 39 2,296 66 115 2,516 Urban Guelph 379 10,007 916 290 11,592 Rural South Grey, North Wellington 965 110 57 1,132 Rural Waterloo 29 4,065 5 80 4,179 WWLHIN Total 9,539 69,878 1,108 1,273 81,798 % of Total who are WWLHIN Patients 95.7% 92.7% 91.0% 55.9% 92.1% Other LHINs 427 5,518 0 109 0 0 1,004 7,058 All Patients in WWLHIN Facilities 9,966 75,396 0 1,217 0 0 2,277 88,856 Surgical Urban Waterloo Day/Night Rural Waterloo South 6,998 8,550 30 512 1 8 17,658 33,757 Rural Wellington 22 121 919 1,472 5 214 284 3,037 Urban Guelph 165 208 143 9,835 1 6 240 10,598 Rural South Grey, North Wellington 8 58 237 627 374 322 137 1,763 Rural Waterloo 50 1,005 15 111 1 23 2,330 3,535 WWLHIN Total 7,243 9,942 1,344 12,557 382 573 20,649 52,690 % of Total who are WWLHIN Patients 94.3% 95.3% 93.5% 87.6% 85.7% 83.2% 93.5% 92.3% Other LHINs 440 495 94 1,780 64 116 1,428 4,417 All Patients in WWLHIN Facilities 7,683 10,437 1,438 14,337 446 689 22,077 57,107 Source: Ambulatory Care Table, PHPDB, ad query 03-August-2006. Excluding ambulatory case types 'other', 'emergency', 'scheduled emergency

All WWLHIN hospitals provide ambulatory care, though only medical day/night care is available in Rural Wellington and Rural South Grey and North Wellington.

WWLHIN Integrated Health Service Plan 23 Appendix E – Population Profile and Health Services Utilization Details 2.6.6 Where do WWLHIN residents go to receive ambulatory care?

Issues/Observations:

More than 90% of ambulatory visits in WWLHIN facilities are by WWLHIN residents and 84% of WWLHIN residents received their ambulatory care in WWLHIN facilities the remaining 16% may be attributable to patient/referring physician choice and the fact that WWLHIN has limited tertiary/quaternary services.

Ambulatory Care Visits by Type of Care by Residence of Patient by Location of Facility – 2004

Urban Wat. Rural - S S Rural Rural Urban - Grey, N Rural Wat Wellington Guelph Well Waterloo WWLHIN Total Type of Ambulatory #AC % of all AC Care Location of Facility #AC Visits Visits #AC Visits #AC Visits #AC Visits #AC Visits Visits Clinics WWLHIN Facilities 7,328 274 544 179 1,014 9,339 2.2% % in WWLHIN 55.8% 19.8% 10.0% 16.1% 65.0% 41.3% 41.3% Other LHIN Facilities 5,813 1,112 4,879 933 546 13,283 3.1% All Facilities 13,141 1,386 5,423 1,112 1,560 22,622 5.3% Medical Day/Night WWLHIN Facilities 62,379 2,516 11,592 1,132 4,179 81,798 19.3% Care % in WWLHIN 88.2% 67.0% 64.8% 39.7% 84.5% 81.6% 81.6% Other LHIN Facilities 8,372 1,239 6,289 1,721 769 18,390 4.3% All Facilities 70,751 3,755 17,881 2,853 4,948 100,188 23.7% Surgical Day/Night WWLHIN Facilities 33,757 3,037 10,598 1,763 3,535 52,690 12.5% Care % in WWLHIN 89.5% 73.3% 83.4% 60.6% 88.7% 85.7% 85.7% Other LHIN Facilities 3,966 1,104 2,104 1,148 449 8,771 2.1% All Facilities 37,723 4,141 12,702 2,911 3,984 61,461 14.5% Other Ambulatory WWLHIN Facilities 558 4 9 1 44 616 0.1% Care % in WWLHIN 54.4% 7.4% 4.7% 2.0% 48.9% 43.6% 43.6% Other LHIN Facilities 468 50 184 48 46 796 0.2% All Facilities 1,026 54 193 49 90 1,412 0.3% Total All Ambulatory WWLHIN Facilities 229,010 24,056 64,660 20,938 16,582 355,246 84.0% Care % in WWLHIN 88.6% 77.1% 78.6% 68.1% 81.8% 84.0% 84.0% Other LHIN Facilities 29,557 7,133 17,593 9,791 3,699 67,773 16.0% All Facilities 258,567 31,189 82,253 30,729 20,281 423,019 100.0% Source: Ambulatory Care Table, Provincial Health Planning Database, ad hoc query 2006-06-27.

2.7 Inpatient Care

Inpatient care is provided by 8 hospitals at 10 sites throughout the WWLHIN and is provided as: • Acute care o Alternate Levels of Care • Critical Care • Acute Inpatient Mental Health • Rehabilitation • Complex Continuing Care

WWLHIN Integrated Health Service Plan 24 Appendix E – Population Profile and Health Services Utilization Details

2.7.1 Total Separations

Separations are completed hospital cases resulting in any of the following: discharge home, transfer to another facility, death or patient sign out. Separations refer to the activity completed per facility so patients transferred for further care to other acute facilities will result in multiple separations19.

There were 46,481 total separations and 260,023 total patient days from acute hospitals in Waterloo Wellington LHIN in 2004/05. These numbers represented 4.6% of the total separations and 4.1% of the total days from acute care beds within all Ontario hospitals.

In Waterloo Wellington LHIN hospitals, 49.5% of separations were primary, 43.2% were secondary, and 7.3% were tertiary/quaternary20 (see Table 1). On average, Waterloo Wellington LHIN hospitals had a smaller proportion of tertiary/quaternary separations compared to Ontario hospitals (10.8%); there is no academic health science centre in the WWLHIN.

In 2004/05, 92.7% of total separations from Waterloo Wellington LHIN hospitals were for Waterloo Wellington LHIN residents. South West LHIN residents accounted for 3.7% and Hamilton Niagara Haldimand Brant LHIN residents represented 1.3%.

As complexity of care increased, the proportion of non-residents served within Waterloo Wellington LHIN hospitals increased. Residents from outside Waterloo Wellington LHIN represented 4.5% of primary, 8.6% of secondary, and 18.2% of the tertiary/quaternary separations from Waterloo Wellington hospitals. For tertiary/quaternary separations from Waterloo Wellington hospitals, 81.8% were by Waterloo Wellington residents, 9.7% were by residents of the South West LHIN, and 4.9% were by residents of the Hamilton Niagara Haldimand Brant LHIN.

Source: LHIN – from 2006 Acute Care Utilization Report 21

19 http://www.health.gov.on.ca/transformation/providers/information/resources/utilization/acute_waterloo.pdf page iv 20 Primary Level of Care: Procedures or treatments that can be provided in any hospital setting by general practitioners or specialists. Secondary Level of Care: Surgical and other procedures provided by medical specialists, usually in larger community hospitals. Tertiary/Quaternary Level of Care: Procedures or treatments provided to seriously ill patients that involve highly specialized, costly care most often provided in larger regional referral centres or teaching hospitals. http://www.health.gov.on.ca/transformation/providers/information/resources/utilization/acute_waterloo.pdf page 14 21 http://www.health.gov.on.ca/transformation/providers/information/resources/utilization/acute_waterloo.pdf page 1

WWLHIN Integrated Health Service Plan 25 Appendix E – Population Profile and Health Services Utilization Details

2.7.2 Program Cluster Categories in WWLHIN Hospitals

Program Cluster Categories (PCCs) consist of Case Mix Groups (CMGs) aggregated into 30 broad programs and provide a means to analyze groups of patients by the types of services received. Figure 1 shows the top ten PCCs (based on separations) in Waterloo Wellington hospitals. Obstetrics accounted for the largest proportion of separations (17.8%) from Waterloo Wellington hospitals, and had the shortest ALOS among the top ten PCCs at 2.1 days, while psychiatry accounted for 5.7% of separations, and had the longest ALOS (10.5 days). Waterloo Wellington hospitals had a noticeably larger proportion of obstetrics separations compared to Ontario hospitals (15.6%)22, which is perhaps reflective of the younger population base.

2.7.3 Where do WWLHIN residents go to receive inpatient care and for what?

As complexity of care increased, the proportion of Waterloo Wellington residents served in local hospitals decreased. Waterloo Wellington hospitals provided care to 91.6% of Waterloo Wellington residents’ primary, 83.2% of secondary, and 54.6% of tertiary/quaternary total separations23. Hamilton Niagara Haldimand Brant LHIN hospitals provided care to 15.5% of Waterloo Wellington residents’ tertiary/quaternary separations, while hospitals in the South West and Toronto Central LHINs provided care to 14.0% and 12.1%, respectively (Table 2).

22 http://www.health.gov.on.ca/transformation/providers/information/resources/utilization/acute_waterloo.pdf page 2 23 http://www.health.gov.on.ca/transformation/providers/information/resources/utilization/acute_waterloo.pdf page 4

WWLHIN Integrated Health Service Plan 26 Appendix E – Population Profile and Health Services Utilization Details

Table 2: Location of Hospital providing separations for WWLHIN residents

Location of Hospital Separations % of Total Waterloo Wellington 43,086 84.3% Hamilton Niagara Haldimand Brant 2,504 4.9% South West 2,402 4.7% Toronto Central 1,380 2.7% 51,110 51,110 LHIN File - from 2006 Acute Care Report

Of the total separations for WWLHIN residents, 46.9% received primary level of hospital care, 43.3% received secondary level of care and 9.9% received tertiary/quaternary level of care (Table 3).

Table 3: Total Separations by Level of Care, by Area of Residence, Waterloo Wellington & Ontario Residents, 2004/05

The top ten PCCs for Waterloo Wellington residents (based on separations) are shown in Figure 2. Again, obstetrics accounted for the largest proportion of Waterloo Wellington residents’ separations (17.3%), and had the shortest ALOS (2.2 days) among the top ten categories, while psychiatry had the longest ALOS (10.9 days) and accounted for 5.4% of Waterloo Wellington residents’ separations. Waterloo Wellington had a noticeably larger proportion of obstetrics separations and a smaller proportion of cardiology separations (8.9%) compared to Ontario residents (15.6% and 10.6%, respectively).

Figure 2: Leading Program Cluster Categories (PCCs) as a Proportion of Separations Waterloo Wellington & Ontario Residents, 2004/05

WWLHIN Integrated Health Service Plan 27 Appendix E – Population Profile and Health Services Utilization Details

2.7.4 Preventable Hospitalizations

Better access and quality of primary care, such as the use of ambulatory care in a community setting are important factors in maintaining the health of the population and can prevent costly hospital services. Ambulatory Care Sensitive Conditions (ACSC) are health conditions that can be effectively managed in the community either through adequate monitoring or proper patient education, thereby preventing or reducing admissions to hospital.

• WWLHIN had 337 preventable hospitalizations per 100,000 population in 2004/05, lower than the provincial average and about the middle of the pack of all Ontario LHINs; • Key factors contributing to the variation in rates are: age, socioeconomic factors, disease prevalence in the community, personal choice about seeking health care, access to care, hospital admitting practices, adequately prescribed treatments after care is obtained, and patient compliance24.

On the whole the hospitals of the WWLHIN appear to be meeting the needs of the WWLHIN residents, however, let’s take a look at the subgroups of total separations:

• Acute care (excluding Mental Health) • Critical Care • Acute Inpatient Mental Health • Alternate Level of Care (ALC)

2.7.5 Acute Care

Acute care refers to short-term, intensive inpatient care for serious health problems involving a variety of medical and surgical services. Patterns of acute inpatient utilization are influenced by a broad range of factors including system capacity, the availability of physicians and community services, and the age structure, health and socio-economic status of the population25. This section focuses on the acute care portion of hospital stay, thus ALC days are not included. Mental health separations (psychiatry PCC) have also been excluded and will be covered in a subsequent section.

2.7.6 Critical Care

Patients who need critical care have a serious life-threatening disease or injury and need to be in hospital critical care units since their care involves the use of mechanical ventilation to help them breathe, sophisticated technologies and drugs, and/or highly specialized staff that may need to provide intense one-on-one care. Critical care is a pivotal service that can “make or break” other hospital services. Patients who need critical care come from operating rooms, the emergency department and hospitals wards. If critical care services are not available, surgeries can be delayed or cancelled, wait times for surgeries and emergency services increased, etc26. It is therefore important to consider critical care services as a sub-set of acute care.

24 http://www.hospitalreport.ca/downloads/2006/AC/acute_report_2006.pdf page 5 25 http://www.health.gov.on.ca/transformation/providers/information/resources/utilization/acute_waterloo.pdf p.iii 26 http://www.health.gov.on.ca/transformation/wait_times/wt_reports/criticalcare_0305.pdf page 1

WWLHIN Integrated Health Service Plan 28 Appendix E – Population Profile and Health Services Utilization Details Table 4: Acute, Acute Inpatient Mental Health and ALC Separations and Average Length of Stay (ALOS) in WWLHIN Hospitals

Separations, Days & Average Length of Stay (ALOS), 2004/05 - By Hospital Total ALC Acute Mental Health Acute Days Dis- Separations Days ALOS charges Days ALOS Separations Days ALOS R.S. Grey and N. Wellington N. W. H. C.- Mount Forest 28 174 6.2 46 266 5.8 721 3,522 4.9 3,962 N. W. H.C. C - Palmerston 11 57 5.2 73 369 5.1 751 3,018 4.0 3,444

Subtotal 39 231 5.9 119 635 5.3 1,472 6,540 4.4 7,406 Rural Wellington Groves Memorial Community Hospital 17 127 7.5 89 564 6.3 1,872 9,981 5.3 10,672

Subtotal 17 127 7.5 89 564 6.3 1,872 9,981 5.3 10,672 Urban-Guelph Guelph General Hospital 677 5,685 8.4 113 564 5.0 9,805 47,110 4.8 53,359 Homewood Health Centre 2,701 95,345 35.3 95,345

Subtotal 677 5,685 8.4 2,814 95,909 34.1 9,805 47,110 4.8 148,704 U. Waterloo South and R. Waterloo South Cambridge Memorial Hospital 287 7,285 25.4 586 4,361 7.4 9,114 37,578 4.1 49,224 Grand River Hospital- Waterloo Site 424 5,374 12.7 1,702 18,148 10.7 14,693 71,050 4.8 94,572 St Mary’s General Hosp. 201 5,710 28.4 51 323 6.3 6,865 38,723 5.6 44,756

Subtotal 912 18,369 20.1 2,339 22,832 9.8 30,672 147,351 4.8 188,552

LHIN TOTAL 1,645 24,412 14.8 5,361 119,940 22.4 43,821 210,982 4.8 355,334 TOTAL (-Homewood) 2,660 24,595 9.2 MoHLTC & Ontario Healthcare Financial and Statistical Database

WWLHIN Integrated Health Service Plan 29 Appendix E – Population Profile and Health Services Utilization Details Table 5 Acute, Acute Inpatient Mental Health and ALC Separations, Days & Average Length of Stay (ALOS), 2004/05 - By Area of Residence (DOES NOT INCLUDE HOMEWOOD)

Separations, Days Acute Total & Average Length ALC Acute Mental Health Days of Stay (ALOS), 2004/05 - By Area Separation of Residence Separations Days ALOS s Days ALOS Separations Days ALOS Rural South Grey and North Wellington 68 790 11.6 130 794 6.1 2,863 14,721 5.1 16,305

Rural Waterloo 54 747 13.8 91 1,060 11.6 2,526 12,891 5.1 14,698

Rural Wellington 55 355 6.5 122 858 7.0 3,406 17,352 5.1 18,565

Urban-Guelph 625 5,397 8.6 205 1,746 8.5 10,105 51,155 5.1 58,298 Urban Waterloo S. and Rural Waterloo S. 876 17,612 20.1 2,190 21,916 10.0 29,472 144,415 4.9 183,943

LHIN TOTAL 1,678 24,901 14.8 2,738 26,374 9.6 48,372 240,534 5.0 291,809 LHIN File 16 (adapted from File 6) Provision of Acute & Critical Care in WWLHIN hospitals

Table 6: WWLHIN Acute (not Mental Health) Inpatient and Critical Care Beds by facility, 2004-05

Acute* Critical Hospital Care Total Cambridge Memorial Hospital 134 15 149 Grand River Hospital Corporation 239 15 254 Groves Memorial Community Hospital 34 3 37 Guelph General Hospital 159 22 181 Homewood Health Centre 0 0 0 North Wellington Health Care Corporation 47 4 51 St Joseph's Health Centre, Guelph 0 0 0 St Mary's General Hospital 122 21 143

Total 735 80 815

In 2004/05, there were 43,821 acute separations and 210,982 acute days from hospitals in WWLHIN. Overall the acute average length of stay (ALOS) in WWLHIN hospitals (4.8 days) was shorter than the acute ALOS in Ontario hospitals (5.5 days).

The majority of acute separations from hospitals in Waterloo Wellington (92.5%) were by Waterloo Wellington residents. The South West LHIN (3.8%) and Hamilton Niagara Haldimand Brant LHIN (1.3%) were the next most common areas of patient origin for separations from Waterloo Wellington hospitals.

Acute hospital separations can be grouped into CMGs. Each CMG is identified as either surgical or medical, based on the presence or absence of a surgical procedure during the hospital stay. Waterloo Wellington hospitals had a greater proportion of medical separations (69.2%) compared to Ontario hospitals (65.8%), and accordingly, a smaller proportion of surgical separations (30.8% and 34.2%, respectively).

WWLHIN Integrated Health Service Plan 30 Appendix E – Population Profile and Health Services Utilization Details Table 7: WWLHIN Critical Care Days, 2004/05

Critical Care Patient Hospital Days Cambridge Memorial Hospital 4,104 Grand River Hospital Corporation 4,303 Groves Memorial Community Hospital 435 Guelph General Hospital 6,799 Homewood Health Centre 0 North Wellington Health Care Corporation 237 St Joseph's Health Centre 0 St Mary's General Hospital 5,053 Ontario Healthcare Financial and Statistical Database

2.7.7 Where do WWLHIN residents get their acute in-patient care?

In 2004/05, there were 48,372 acute separations and 240,534 acute days for Waterloo Wellington residents (from all Ontario hospitals), as shown in Table 5. Overall, the acute ALOS for Waterloo Wellington residents (5.0 days) was slightly shorter than the acute ALOS for Ontario residents (5.5 days).

The majority of acute separations for residents of Waterloo Wellington (83.8%) were from Waterloo Wellington hospitals. The Hamilton Niagara Haldimand Brant (5.1%), South West (4.8%), and Toronto Central (2.9%) LHINs were the next most common locations for residents’ hospitalizations. Waterloo Wellington residents had a larger proportion of medical (66.6%) and a smaller proportion of surgical (33.4%) separations compared to Ontario residents (65.8% and 34.2%, respectively).

2.7.8 Acute Inpatient Mental Health

In addition to acute inpatient mental health services provided in the WWLHIN acute care hospitals Homewood Health Centre in Guelph is a privately owned, publicly funded specialized mental health facility. In addition to Schedule 1 psychiatric beds Homewood provides highly specialized psychiatric in- patient and out-patient care to patients from across Canada and around the world.23

2.7.9 Provision of Acute Inpatient Mental Health in WWLHIN hospitals

In-patient mental health services are available in WWLHIN in the following designated programs: Acute, Child & Adolescent, Addictions and Longer Term. Although Table 8 shows the number of designated psychiatric beds in WWLHIN hospitals, acute mental health separations, as reported by the Health Services Intelligence Project (HSIP) and shown in Table 4, are based on the psychiatry PCC, and patients with such conditions can also be cared for in other acute beds24. In 2004/05, there were 5,361 acute mental health separations and 119,940 days from WWLHIN hospitals. However, it is important to bear in mind that the majority of inpatients admitted to the Homewood Health Centre are from outside the WWLHIN. Also, given the specialized nature of many of the programs offered by Homewood, it is difficult to draw comparisons at this level with other mental health services provided within the WWLHIN, therefore Table 4 also shows the totals, minus Homewood.

23 http://www.homewood.org/healthcentre/main.php?tID=0&lID=0 (bed #s are from FIM) 24 http://www.health.gov.on.ca/transformation/providers/information/resources/utilization/acute_waterloo.pdf page 7

WWLHIN Integrated Health Service Plan 31 Appendix E – Population Profile and Health Services Utilization Details Table 8: WWLHIN Psychiatric Beds by Facility, 2004-05

Acut Chil Addiction Longe e d & s r Adol Term Hospital . Total Cambridge Memorial Hospital 11 0 0 0 11 Grand River Hospital Corporation 44 8 0 0 52 Groves Memorial Community Hospital 0 0 0 0 0 Guelph General Hospital 0 0 0 0 0 Homewood Health Centre* 133 22 84 23 262 North Wellington Health Care Corporation 0 0 0 0 0 St Joseph's Health Centre, Guelph 0 0 0 0 0 St Mary's General Hospital 0 0 0 0 0

Total 188 30 84 23 325 MoHLTC & Ontario Healthcare Financial and Statistical Database 23

2.7.10 Where do LHIN residents get their acute in-patient mental health care?

Table 5 shows Acute Inpatient Mental Health Separations, Days & ALOS, for WWLHIN residents. However this information is not currently available for Homewood Health Centre. The majority of mental health separations for residents of Waterloo Wellington (94.4%) were from Waterloo Wellington hospitals. The South West (2.0%) and Hamilton Niagara Haldimand Brant (1.1%) LHINs were the next most common locations for residents’ hospitalizations.

2.8 Alternate Level of Care (ALC)

The Alternate Level of Care (ALC) designation refers to cases where patients have completed the acute care phase of treatment but remain in acute care beds while awaiting placement elsewhere. The patient is classified as ALC when the attending physician or authorized designate indicates that acute care is no longer required and requests a transfer to another setting. If an appropriate level of care is not available in the other setting(s), a patient is designated as requiring an Alternative Level of Care. ALC days are considered an inefficient use of acute care resources and reflect problems with access to post-acute services such as rehabilitation, long-term care homes, home care, etc.25

However it is worth noting that ALC is only measured in the acute hospital setting (not including Homewood Health Centre, as ALC data is not reported by the MoHLTC), therefore is not a total measure of demand for services since residents are also waiting in other settings. In addition, ALC and wait lists are only a reflection of demand within the system as it exists. For example, some individuals currently on nursing home wait lists may in fact benefit from supportive housing for the elderly.

2.8.1 Provision of ALC in WWLHIN Hospitals

ALC separations accounted for 3.5% of the total separations and 9.4% of the total days from Waterloo Wellington hospitals. In other words 96.5% of discharges from WWLHIN hospitals are discharged when the acute phase of their illness was over. There were 1,645 ALC separations and 24,412 ALC days from Waterloo Wellington hospitals in 2004/05, as shown in Table 4.

On average, the ALC ALOS for Waterloo Wellington hospitals was slightly longer (14.8 days) than that for Ontario hospitals (14.5 days).26

25http://fimdata.com/dcs/cr_mth.asp?pMth=March 26 http://www.health.gov.on.ca/transformation/providers/information/resources/utilization/acute_waterloo.pdf page 10

WWLHIN Integrated Health Service Plan 32 Appendix E – Population Profile and Health Services Utilization Details

Bed equivalents estimate the number of beds used based on ALC days at benchmark levels of occupancy (95% for these calculations). In 2004/05 there were approximately 70 acute care beds (8%) in Waterloo Wellington hospitals filled by ALC patients who were more suited for service elsewhere. This represented 4.3% of the 1,637 ALC patient bed equivalents in Ontario hospitals.

Approximately 97% of ALC separations from Waterloo Wellington hospitals were by residents of Waterloo Wellington.27 Figure 3 shows the five PCCs associated with the largest proportion of ALC days for Waterloo Wellington hospitals.

Figure 3: Leading Program Cluster Categories (PCCs) as a Proportion of Alternate Level of Care (ALC) Days, Waterloo Wellington & Ontario Hospitals, 2004/05

2.8.2 Where are WWLHIN residents receiving ALC?

There were 1,678 ALC separations and 24,901 ALC days for Waterloo Wellington residents (from all Ontario hospitals), as shown in Table 5. The ALC ALOS for Waterloo Wellington residents (14.8 days) was slightly longer than the ALC ALOS for Ontario residents (14.5 days), and Waterloo Wellington residents’ ALC days were equivalent to 72 beds, based on 95% occupancy, as previously described.28

Waterloo Wellington hospitals accounted for 94.8% of ALC separations for Waterloo Wellington residents. Hospitals within the South West LHIN served 2.0% of residents’ ALC separations (see footnote 26).

Figure 4 shows the five PCCs associated with the largest proportion of ALC days for Waterloo Wellington residents. Compared to Ontario residents, a much larger proportion of Waterloo Wellington residents’ ALC days were related to general medicine, while larger proportions were associated with psychiatry, neurology and general surgery29.

27 http://www.health.gov.on.ca/transformation/providers/information/resources/utilization/acute_waterloo.pdf page 10 28 http://www.health.gov.on.ca/transformation/providers/information/resources/utilization/acute_waterloo.pdf page 10 29 http://www.health.gov.on.ca/transformation/providers/information/resources/utilization/acute_waterloo.pdf page 12

WWLHIN Integrated Health Service Plan 33 Appendix E – Population Profile and Health Services Utilization Details

Figure 4: Leading Program Cluster Categories (PCCs) as a Proportion of Alternate Level of Care (ALC) Days, Waterloo Wellington & Ontario Residents, 2004/05

Table 8: ALC Separations, Days & ALOS for Specific Transfer Locations, Waterloo Wellington & Ontario Residents, 2004/05

However, although 14.3% of ALC days were associated with a psychiatric PCC (Figure 4) only 0.3% of ALC days were associated with transfer to a psychiatric facility (Table 8). This may be explained by the fact that although patients may have a psychiatric diagnosis they may not require placement in a psychiatric facility, however it warrants further investigation to determine whether this represents a gap in services or not.

Compared to Ontario residents, Waterloo Wellington residents’ ALC ALOS was longer for patients transferred to long-term care homes and unclassified/other facilities, but shorter or similar to the ALC ALOS for all other categories.

WWLHIN Integrated Health Service Plan 34 Appendix E – Population Profile and Health Services Utilization Details 2.9 Inpatient Rehabilitation Services

Rehabilitation is provided in a variety of settings spanning a continuum of care from acute care to home care. This section focuses only on publicly funded designated adult inpatient rehabilitation beds, and does not include rehabilitation provided in acute care or private settings. Publicly funded community based rehabilitation services are discussed in a later section.

2.9.1 Provision of Inpatient Rehabilitation Services in the WWLHIN Table 1: WWLHIN Inpatient Rehab Beds by facility, 2004-05

Hospital Rehab Cambridge Memorial Hospital 0 Grand River Hospital Corporation 41 Groves Memorial Community Hospital 0 Guelph General Hospital 12 Homewood Health Centre 0 North Wellington Health Care Corporation 0 St. Joseph's Health Centre, Guelph 10 St. Mary's General Hospital 15 Total 78 Ontario Healthcare Financial and Statistical Database

Table 2: WWLHIN Inpatient Rehab Days, 2004/05

Rehab Patient Hospital Days Cambridge Memorial Hospital 0 Grand River Hospital Corporation 9,430 Groves Memorial Community Hospital 0 Guelph General Hospital 3,260 Homewood Health Centre 0 North Wellington Health Care Corporation 0 St Joseph's Health Centre 3,447 St Mary's General Hospital 2,890 Total 19,027

In-patient rehabilitation services are provided by four hospitals at five sites in WWLHIN. None of the beds in WWLHIN are designated as specialized inpatient rehabilitation. As shown in the accompanying tables, WWLHIN rehabilitation facilities admitted 1232 patients into the 78 rehabilitation beds and provided 20, 845 days of care and 87.3% of those patients were WWLHIN residents.

WWLHIN Integrated Health Service Plan 35 Appendix E – Population Profile and Health Services Utilization Details

Table 3: Rehabilitation Admissions Provided by WWLHIN Facilities, by Place of Residence of Patient – 2004

WWLHIN Rehabilitation Facility All Place of Residence of Grand River Grand River St. Joseph's WWLHIN Patient HC-Freeport HC-Waterloo Guelph GH HC St. Mary's GH Facilities Urban Waterloo Rural Waterloo South 100 142 6 1 291 540 Rural Wellington 9 6 29 8 2 54 Urban Guelph 23 302 75 7 407 Rural South Grey, North Wellington 10 2 6 1 2 21 Rural Waterloo 11 19 1 23 54 All Patients from WWLHIN 153 169 344 85 325 1,076 Pts from Other LHINs 36 35 52 17 16 156 All Patients in WWLHIN Facilities 189 204 396 102 341 1,232 Source: Rehabilitation Table, PHPDB, ad hoc query 03-Aug-2006. LHIN file 11

2.9.2 Where do WWLHIN residents go to receive Rehabilitation Services?

Although 14% of WWLHIN residents requiring in-patient rehabilitation did not receive it at a WWLHIN hospital, it is unclear whether this was due to patient preference, referral patterns, because they required a specialized type of rehabilitation or because a WWLHIN bed was not available to them, though 12.7% of patients in WWLHIN beds resided outside of WWLHIN. In addition, although (2,877 (11.8%* to be verified) WWLHIN hospital ALC days resulted in transfer to in-patient rehabilitation, occupancy rates in WWLHIN rehabilitation beds ranged from 66% to 90%30. Further investigation is required, but this would indicate that in some cases efficiencies could be achieved to increase in-patient rehabilitation capacity in WWLHIN.

There are no designated in-patient rehabilitation beds in Rural South Grey & North Wellington or Rural Wellington 86% of WWLHIN residents requiring in-patient rehabilitation received it in WWLHIN facilities.

Table 4: 2004 Rehabilitation Hospitalizations - Waterloo Wellington LHIN, by Residence of Patient, by Location of Hospital

Residence of Patient

Rural Rural Urban Waterloo Rural Urban - S.Grey & Waterlo Location of Facility Variables & S Rural Wat Wellington Guelph N.Well, o Total WWLHIN Facilities Total LOS (Dschg) 8,471 1,131 6,021 562 767 16,952 WWLHIN Facilities # Admissions 540 54 407 21 54 1,076 WWLHIN Facilities % of all Admissions 90.2% 64.3% 90.4% 46.7% 84.4% 86.6% WWLHIN Facilities Avg LOS 15.7 20.9 14.8 26.8 14.2 15.8 Other LHIN Facilities Total LOS (Dschg) 1,785 554 735 965 313 4,352 Other LHIN Facilities # Admissions 59 30 43 24 10 166 Other LHIN Facilities Avg LOS 30.3 18.5 17.1 40.2 31.3 26.2 Total All Facilities Total LOS (Dschg) 10,256 1,685 6,756 1,527 1,080 21,304 Total All Facilities # Admissions 599 84 450 45 64 1,242 Total All Facilities Avg LOS 17.1 20.1 15.0 33.9 16.9 17.2

Source: Rehabilitation Table, Provincial Health Planning Database, ad hoc query, June 2006. LHIN File 10

30 http://fimdata.com/dcs/cr_ocr.asp?pYR=2004%2F2005

WWLHIN Integrated Health Service Plan 36 Appendix E – Population Profile and Health Services Utilization Details 2.10 Complex Continuing Care

Complex Continuing Care (CCC) is provided to people with non-acute medical conditions whose care needs are too complex to be managed in the home or long-term care setting. This includes long-term complex medical care; geriatric assessment and rehabilitation; and psychogeriatric, palliative and respite care.

2.10.1 Provision of Complex Continuing Care in the WWLHIN

Table 1: WWLHIN Inpatient Complex Continuing Care Beds by facility, 2004-05

Complex Continuing Hospital Care Cambridge Memorial Hospital 59 Grand River Hospital Corporation 139 Groves Memorial Community Hospital 18 Guelph General Hospital 0 Homewood Health Centre 0 North Wellington Health Care Corporation 9 St Joseph's Health Centre, Guelph 64 St Mary's General Hospital 0 Total 289 Source: Ontario Healthcare Financial and Statistical Database

CCC is provided by five organizations at five sites in the WWLHIN. Although many patients do transition to the community, the length of stay for some continues to be measured in months or years rather than days. For example, in 2004/05 there were 1348 admissions to 289 WWLHIN CCC beds and 94% of those admitted were WWLHIN residents.

Table 2: WWLHIN Inpatient Complex Continuing Care Days, 2004/05

Hospital CCC Patient Days Cambridge Memorial Hospital 18,073 Grand River Hospital Corporation 46,148 Groves Memorial Community Hospital 4,666 Guelph General Hospital 0 Homewood Health Centre 0 North Wellington Health Care Corporation 150 St Joseph's Health Centre 22,787 St Mary's General Hospital 0 91,824 Source: Ontario Healthcare Financial and Statistical Database

WWLHIN Integrated Health Service Plan 37 Appendix E – Population Profile and Health Services Utilization Details

Table 3: Providers of Complex Continuing Care (CCC) Services - 2004 Admissions by Patient Place of Residence

CCC Facilities in WWLHIN All N Wellington St. WWLHIN Cambridge Grand River Groves HC- Joseph's CCC Place of Residence of Patients MH HC-Freeport Memorial CH Palmerston HC Facilities Pts from WWLHIN 342 757 108 2 60 1,269 Urban Waterloo, Rural Waterloo South 338 600 1 939 Rural Wellington 6 90 9 105 Urban Guelph 3 73 12 51 139 Rural South Grey, North Wellington 6 4 1 11 Rural Waterloo 1 72 2 75 Pts from Other LHINs 14 54 2 1 8 79 WW Patients as % of Admissions 96.1% 93.3% 98.2% 66.7% 88.2% 94.1% Total All CCC Admissions 356 811 110 3 68 1,348 Source: Complex Continuing Care Table, PHPDB, ad hoc query 03-Aug-2006. LHIN file 11

2.10.2 Where do WWLHIN residents go to receive Complex Continuing Care?

Table 1 shows where WWLHIN residents received CCC in the 2004/05 fiscal year. 96% of WWLHIN residents requiring admission for CCC were admitted to a WWLHIN facility.

Although 4% of WWLHIN residents requiring CCC did not receive it at a WWLHIN hospital, it is unclear whether this was due to patient preference or because a WWLHIN bed was not available to them, though 6% of patients in WWLHIN beds resided outside of WWLHIN. In addition, although (2342 or 9.6% to be verified) WWLHIN hospital ALC days resulted in transfer to CCC, occupancy rates in WWLHIN CCC beds ranged from 66% to 100%31. Further investigation is required, but this would indicate that in some cases efficiencies could be achieved to increase complex continuing care capacity in WWLHIN.

Table 1: Complex Continuing Care (CCC) Admissions for WWLHIN Residents, by Location of CCC Facility – 2004

Place of Residence of CCC Patient

Urban Waterloo, Rural South Rural Waterloo Rural Urban Grey, North Rural Total WWLHIN Location of CCC Facility South Wellington Guelph Wellington Waterloo Residents Facilities In WWLHIN 939 105 139 11 75 1,269 Cambridge Memorial Hospital 338 3 1 342 Grand River Hospital Corp-Freeport Site 600 6 73 6 72 757 Groves Memorial Community Hospital 90 12 4 2 108 North Wellington Hlth Care-Palmerston 1 1 2 St Joseph's Health Centre, Guelph 9 51 60 Facilities In Other LHINs 13 14 6 13 6 52 All Facilities 952 119 145 24 81 1,321 Source: Complex Continuing Care Table, PHPDB, 03-Aug- 2006.

31 http://fimdata.com/dcs/cr_ocr.asp?pYR=2004%2F2005

WWLHIN Integrated Health Service Plan 38 Appendix E – Population Profile and Health Services Utilization Details 3. Community Care

Community care refers to health services and supports provided within the community, including those provided by mental health and addiction community-based organizations, community support organizations, post-acute services provided in the home, and services provided to people with chronic conditions to maintain independent living.

While community-based services are an important contributor to the health care system, there is, in some cases, limited utilization information systematically collected for these services.

By their nature, community-based services and supports are provided and accessed within the home community of Waterloo and/or Wellington.

3.1 Community-based Rehabilitation

3.1.1 Provision of Community-Based Rehab Services in the WWLHIN

In Waterloo Wellington, publicly funded community-based rehabilitation is provided in people’s homes by organizations under contract with the Community Care Access Centre. CCAC rehabilitation services include physiotherapy, occupational therapy and speech language services.

While the Community Care Access Centres provide adult rehabilitation services, the majority of children’s rehabilitation is provided by the Children’s Treatment Centre (CTC).

3.1.2 Where do WWLHIN residents go to access community-based Rehab Services?

In Waterloo Wellington, KidsAbility CTC provides centre-based rehabilitation services to child and youth residents of Waterloo Region and Wellington County with physical, developmental and communication disabilities. In-home rehabilitation services provided by the CCACs are described in Table 1, section 3.4 (the number of rehabilitation visits delivered in the community in 2005) and table 2 in section 3.4 (the average number of rehabilitation service visits per client in 2005).

The Arthritis Society of Ontario provides people waiting for joint replacements with the Pre-hab service, designed to maximize a rehabilitation experience through increasing one’s fitness before surgery, teaching the rehabilitative exercises prior to surgery, and coordinating the discharge plan prior to surgery.

3.2 Community-Based Mental Health and Addiction

3.2.1 Provision of Community-based Mental Health and Addiction Services in the WWLHIN Community-based mental health services and supports provide a core basket of services, enabling people who use the mental health system to achieve the greatest degree of independence possible. In Waterloo Wellington, there are numerous community-based organizations providing mental health and addiction services funded by the Ministry, including, for example, case management, housing support and social/family support. These organizations and the corresponding programs that they provide are listed in Table 1.

WWLHIN Integrated Health Service Plan 39 Appendix E – Population Profile and Health Services Utilization Details Table1: Community-based Mental Health and Addiction Organizations and Programs in Waterloo Wellington

Organization Name Program Name

Waterloo Regional Self-help Waterloo Regional Self-Help for Psychiatric Consumer/Survivors

Family Counselling and Support Services for Guelph-Wellington Outreach Program for Adult Survivors of Sexual Assault - Outreach Program

Catholic Family Counselling Centre - Region of Waterloo Catholic Family Counselling -Sexual Assault

Torchlight Services - Community Options Program to COPE Employment (COPE) Wellington-Dufferin Homes for Psychiatric Rehabilitation Wellington/Dufferin Homes for Psychiatric Rehabilitation

Canadian Mental Health Association/Wellington - Dufferin Branch Community Link Program

Canadian Mental Health Association/Waterloo Regional Branch Community Support Services

Waterloo Regional Homes for Mental Health Inc. Waterloo Regional Homes for Mental Health inc.

House of Friendship of Kitchener Alcontrol and 174 King Street North

Stonehenge Therapeutic Community inc. Stonehenge Therapeutic Community

Community Mental Health Clinic - Wellington-Dufferin Community Mental Health Program

Homewood Health Centre inc Geropsychiatry Community Education Program

Homewood Health Centre inc Homewood Health Centre, Community Alcohol and Drug Services Homewood Health Centre inc Homewood Health Centre inc.

Homewood Community Alcohol and Drug Services (problem Homewood Health Centre inc gambling) Cambridge Memorial Hospital Day Treatment/Aftercare

Cambridge Memorial Hospital Grandside Psychogeriatric Clinic

St Mary's General Hospital St. Mary's Counselling Service (substance abuse)

St Mary's General Hospital St. Mary's Counselling Service (problem gambling)

Grand River Hospital Corporation Hazelglen House Outreach Mental Health Program

Grand River Hospital Corporation Young Adult Program

Grand River Hospital Corporation Withdrawal Management Centre

Source: Ministry of Health and Long Term Care, June 2006

3.2.2 Where do WWLHIN residents go to access Community-based Mental Health and Addictions Services?

Issues/Observations:

• By their nature, community-based mental health services are provided in the individual’s home community.

• The IHSP community engagement processes, including the citizen survey and the Town Hall meetings, revealed that the availability of community-based mental health services and supports is problematic in Waterloo Wellington.

WWLHIN Integrated Health Service Plan 40 Appendix E – Population Profile and Health Services Utilization Details 3.3 Homecare, Community and Residential Care

3.3.1 Provision of Homecare, Community and Residential Care in the WWLHIN

Homecare, community and residential care are provided through a variety of organizations with many of them under contract to the three Community Care Access Centres that serve Waterloo, Wellington and South Grey. Table 1 sets out the volume of services provided in 2005 through publicly funded organizations including those with contracts through the CCAC.

Table 1: Number of Home Care Services Provided by Service Type by Planning Area and Gender WWLHIN – 2005

Waterloo & S. Urban - Rural R. N. Well Rural WWLHIN Type of Service Gender R. Waterloo Guelph Wellington & S. Grey Waterloo Total Nursing Female 17,226 7,319 2,023 2,141 1,404 30,113 Male 15,709 6,116 1,815 1,052 1,360 26,052 Total 32,935 13,435 3,838 3,193 2,764 56,165 % 23.8% 26.6% 28.8% 22.5% 23.0% 24.6% Social Work Female 465 227 90 77 45 904 Male 309 104 50 88 12 563 Total 774 331 140 165 57 1,467 % 0.6% 0.7% 1.0% 1.2% 0.5% 0.6% Nutrition/Dietician Female 540 154 36 32 31 793 Male 435 130 18 38 49 670 Total 975 284 54 70 80 1,463 % 0.7% 0.6% 0.4% 0.5% 0.7% 0.6% Speech Pathology/Audiology Female 561 402 159 74 49 1,245 Male 1,221 753 315 235 65 2,589 Total 1,782 1,155 474 309 114 3,834 % 1.3% 2.3% 3.6% 2.2% 1.0% 1.7% Physiotherapy Female 3,697 1,779 654 416 438 6,984 Male 1,804 918 372 223 309 3,626 Total 5,501 2,697 1,026 639 747 10,610 % 4.0% 5.3% 7.7% 4.5% 6.2% 4.6% Occupational Therapy Female 3,074 1,203 238 212 205 4,932 Male 2,805 1,257 345 205 188 4,800 Total 5,879 2,460 583 417 393 9,732 % 4.3% 4.9% 4.4% 2.9% 3.3% 4.3% Enterostomoal Therapy Female 758 0 0 0 105 863 Male 661 0 0 0 48 709 Total 1,419 0 0 0 153 1,572 % 1.0% 0.0% 0.0% 0.0% 1.3% 0.7% Personal Support/Homemaking Female 63,636 21,432 5,905 6,992 5,290 103,255 Male 25,380 8,697 1,329 2,399 2,396 40,201 Total 89,016 30,129 7,234 9,391 7,686 143,456 % 64.4% 59.7% 54.2% 66.2% 64.1% 62.8% Total Number of Services Female 89,957 32,516 9,105 9,944 7,567 149,089 Male 48,324 17,975 4,244 4,240 4,427 79,210 Total 138,281 50,491 13,349 14,184 11,994 228,299 Source: Ministry of Health and Long-Term Care

WWLHIN Integrated Health Service Plan 41 Appendix E – Population Profile and Health Services Utilization Details

Table 2: Average Number of Services per Patient, by Service Type, by Planning Area and Gender WWLHIN 2005

Urban Waterloo Urban - R. R. N Well & WWLHIN Type of Service Group S.R. Wat Guelph Wellington S. Grey Rural Waterloo Total

Female 14.9 18.1 17.3 16.5 15.4 15.8 Nursing Male 14.5 17.9 22.7 14.6 10.8 15.3 Total 14.7 18.0 19.5 15.8 12.7 15.6 Female 2.4 3.9 3.2 4.5 2.6 2.9 Social Work Male 2.4 3.1 3.3 4.2 1.7 2.7 Total 2.4 3.6 3.3 4.3 2.4 2.8 Female 2.7 2.5 2.1 2.1 2.8 2.6 Nutrition/Diet Male 2.6 2.3 1.8 2.5 2.7 2.5 Total 2.6 2.4 2.0 2.3 2.8 2.6 Female 4.1 4.9 4.3 4.6 3.5 4.3 Speech Pathology/Audiology Male 5.2 4.7 5.1 5.0 5.0 5.0 Total 4.8 4.8 4.8 4.9 4.2 4.8 Female 3.7 4.2 4.9 4.4 4.2 4.0 Physiotherapy Male 3.0 3.4 5.0 3.5 4.7 3.4 Total 3.4 3.9 4.9 4.0 4.4 3.8 Female 2.7 2.9 2.6 2.5 2.5 2.7 Occupational Therapy Male 2.9 3.0 2.9 2.5 2.8 2.9 Total 2.8 3.0 2.7 2.5 2.6 2.8 Female 2.9 n/a n/a n/a 4.2 3.0 Enterostomal Therapy Male 3.0 n/a n/a n/a 2.3 3.0 Total 2.9 n/a n/a n/a 3.3 3.0 Female 31.5 37.7 34.5 34.6 32.1 33.0 Personal Support/Homemaking Male 34.5 35.1 25.1 29.6 31.9 33.7 Total 32.3 36.9 32.3 33.2 32.0 33.2 Female 14.7 16.2 15.3 17.8 14.8 15.2 Number of Services/Patient Male 11.7 11.8 10.2 11.1 11.2 11.6 Total 13.5 14.3 13.2 15.1 13.3 13.7 Source: Ministry of Health and Long-Term Care

3.4 Community Support Services

3.4.1 Provision of Community Support Services in the WWLHIN Community Support Services (CSS) encompass a range of health and social services aimed at helping people who need assistance with the activities of daily living to live as independently as possible in the community. People who access CSS are typically seniors, but increasingly include people with physical disabilities. CSS services include, for example, transportation, meal services, caregiver respite, social and recreational services and homemaking/personal support. Services are delivered either in the home or in different locations in the WWLHIN. Table 1 sets out the 32 publicly funded services we currently have in Waterloo Wellington along with the estimated number of clients served in 2005/06 based on new government investments.

WWLHIN Integrated Health Service Plan 42 Appendix E – Population Profile and Health Services Utilization Details

Table 1: Publicly Funded Community Support Services in Waterloo Wellington, 2005-06

Service Category Description Number of Est. number of Total Estimated Clients Served clients served with Clients Served (2004/05) the new investment in 2005/06 05/06 Adult Day Service (Alzheimer’s/Other Aging Dementia) 69 86 155 Adult Day Service (Frail Elderly) 315 315 Adult Day Service-Integrated-Frail/Alzheimer’s/Other Dementia 112 71 183 Adult Day Service 71 71 Alzheimer’s/Dementia Overnight Service 35 35 Meals on Wheels 1,240 130 1,370 Diners Club/Wheels to Meals/Congregate Dining 204 12 216 Transportation 430 8 438 Home Maintenance and Repair (Brokerage) 257 257 Friendly Visiting 313 20 333 Security Checks/Reassurance Service 97 25 122 Caregiver Support - Support and Counselling 178 685 863 Caregiver Support - Volunteer Hospice Visiting Service 588 94 682 Caregiver Support (Volunteer) 41 225 266 Public Education Coordinator 4,306 4,306 Independence Training - ABI Outreach 31 31 Client Intervention and Assistance Service (Seniors) 100 100 Home Help/Homemaking (brokerage) 779 779 Supportive Living Service - Physically Disabled Adults 77 77 Homemaking/Personal Supp/Attendant/Respite-Phys Dis Outreach 213 5 218 Supportive Living Service - ABI in SHU 6 6 Community & Facility Palliative Care Interdisciplinary Ed 121 121 Pain and Symptom Management 297 204 501 Special Services For the Blind and Visually Impaired 0 160 160 Adult Day Service (Alzheimer’s/Other Aging Dementia) 166 166 Adult Day Service-Integrated-Frail/Alzheimer’s/Other Dementia 281 70 351 Adult Day Service 21 21 Meals on Wheels 247 247 Transportation 213 213 Friendly Visiting 39 39 Security Checks/Reassurance Service 59 59 Caregiver Support - Volunteer Hospice Visiting Service 640 45 685 Caregiver Support (Volunteer) 17 17 Public Education Coordinator 906 906 Psychogeriatric Consulting Services (Alzheimer Strategy) 376 376 Home Help/Homemaking (brokerage) 26 26 Supportive Living Service - Physically Disabled Adults 34 34 Homemaking/Personal Supp/Attendant/Respite-Phys Dis Outreach 29 29 Pain and Symptom Management 204 204 Total 12,834 2,144 14,978 Source: Ministry of Health and Long-term Care

WWLHIN Integrated Health Service Plan 43 Appendix E – Population Profile and Health Services Utilization Details 3.5 Assisted Living Services in Supportive Housing

3.5.1 Provision of Assisted Living Services in Supportive Housing in the WWLHIN for People with Physical Disabilities

In Waterloo Wellington, there are have four organizations providing assisted living services in supportive housing environments:

• Guelph Services for Persons with Disabilities • Independent Living Centre of Waterloo Region • Participation House – Waterloo Region • Rehabilitation Foundation for the Disabled - Waterloo

Supportive Housing is designed for people who only need minimal to moderate care -- such as homemaking or personal care and support – to live independently. Accommodations usually consist of rental units within an apartment building. In a few cases, the accommodation is a small group residence.

Supportive housing buildings are owned and operated by municipal governments or non-profit group. Accommodations, on-site services, costs, and the availability of government subsidies vary with each building. The care arrangements between a tenant and a service provider are usually defined through a contract between the two parties.

Services can include on-site personal care and support such as routine hygiene, dressing and washing, daily visits or phone check-ins and can include services like shopping, meals, and transportation. Residents can also apply for visiting health professional services through the Community Care Access Centre if required.

3.6 Acquired Brain Injury

3.6.1 Provision of Acquired Brain Injury Services in the WWLHIN

In Waterloo Wellington, there is one organization providing supportive housing, outreach and day programs for individuals with acquired brain injury - Participation House of Waterloo Wellington.

An acquired brain injury is a trauma that occurs after birth and is not related to a congenital disorder or a degenerative disease such as Alzheimer disease or multiple sclerosis. Traffic accidents cause half of all acquired brain injuries in Ontario and 70% of the most severe cases. Young men aged 16 to 24 are the largest group affected. Many people with acquired brain injuries live in supportive housing with staff who are available on-site 24 hours a day to help them live independently in their own apartments. Others receive outreach services to maintain community living, including services and supports provided by the Community Care Access Centres.

3.7 Care Options, Accessing Home, Community Services and Long-Term Care Homes

In Waterloo Wellington, we have two Community Care Access Centres - the CCAC of Waterloo Region and the CCAC of Wellington Dufferin.

CCACs are local agencies that provide information about care options and help the public access government-funded home and community services and long-term care homes. CCACs provide a simplified point of access to long-term care in the community or in Long Term Care homes.

The Provincial Government is in the process of merging CCACs to parallel LHIN service areas. As a result, part of the Wellington Dufferin CCAC will merge with the CCAC of Waterloo Region in 2006.

WWLHIN Integrated Health Service Plan 44 Appendix E – Population Profile and Health Services Utilization Details

4. Long-Term Care

Long-Term Care homes provide 24-hour availability of nursing care and high levels of personal care, in settings that can accommodate varying health needs. LTC homes provide government-funded nursing and personal care, and some subsidized accommodations. LTC homes are not intended for people who need 24-hour hospital care.

4.1 Long-Term Care Homes

4.1.1 Provision of Long-Term Care Homes in the WWLHIN

In Waterloo Wellington, we have 35 long-term care homes providing over 3,600 beds. 6 of the homes have charitable status, 2 are operated by municipal governments, and 27 are for-profit. Almost half the beds are basic, meaning that they provide care in a ward-type setting. 13% are semi-private and 40% are private.

Table 1: Snapshot of beds in WWLHIN as at Sept 30, 2005

Type # of # of Beds Homes Long-Stay Basic Semi Private Sub- Short- Total All % Total Stay Beds Charitable 6 244 56 299 599 5 604 16.5% Municipal 2 216 0 215 431 8 439 12.0% For-Profit 27 1,268 422 925 2615 4 2,619 71.5% Total 35 1,728 478 1,439 3,645 17 3,662 47.2% 13.1% 39.3% 99.5% 0.5% 100.0% Source – MOHLTC, data as of Sept 20, 2005 LHIN File 12

Utilization of all homes is high in any given period, averaging close to 99%.

The high utilization rates impact the number of beds available for those waiting. In Sept 2005 for example, 705 Waterloo Wellington residents living in the community were waiting for their first choice long-term care home. An additional 426 residents living in long-term care homes were waiting for their first choice location. Table 2: Snapshot of beds in WWLHIN as at Sept 30, 2005

Type # of # of Beds Utilization Clients Waiting Home (at Sept 30, 2005) for First Choice s Long-Stay Avg. Low High Living in Living Communit in LTC y Home Basic Sem Priv Total Short- Total i -ate Stay Charitable 6 244 56 299 599 5 604 100% 100% 100% 244 115 Municipal 2 216 0 215 431 8 439 99% 98% 100% 112 83 For-Profit 27 1,268 422 925 2615 4 2,619 98.7% 89.7% 100% 349 228 Total 35 3,622 99% 705 426 Source: MOHLTC, data as of Sept 20, 2005

WWLHIN Integrated Health Service Plan 45 Appendix E – Population Profile and Health Services Utilization Details Table 3: Snapshot of beds in WWLHIN as at Sept 30, 2005

Type # of # of Beds Homes Long-Stay Basic Semi Private Sub- Short- Total All % Total Stay Beds Charitable 6 244 56 299 599 5 604 16.5% Municipal 2 216 0 215 431 8 439 12.0% For-Profit 27 1,268 422 925 2615 4 2,619 71.5% Total 35 1,728 478 1,439 3,645 17 3,662 47.2% 13.1% 39.3% 99.5% 0.5% 100.0% Source: MOHLTC, data as of Sept 20, 2005

Table 4: Snapshot of beds in WWLHIN by Facility as at Sept 30, 2005 Long-Stay Waiting (1st Waiting (1st Choice) Long- Short- Total Occupancy Choice) (trnsf from other Home Name: Sector Class Term Stay Beds Rate (Community) LTC) A R GOUDIE EVENTIDE HOME(SAL. ARMY) Charitable A 79 1 80 100.0% 14 10 ELLIOTT HOME (THE) Charitable New 85 0 85 100.0% 61 22 FAIRVIEW MENNONITE HOME Charitable A 84 0 84 100.0% 48 31 NITHVIEW HOME Charitable B 96 1 97 100.0% 23 7 SAINT LUKE'S PLACE Charitable C 112 2 114 100.0% 9 14 ST JOSEPH'S HEALTH CENTRE Charitable New 143 1 144 100.0% 89 31 SUNNYSIDE HOME Municipal New 255 8 263 98.8% 90 77 WELLINGTON TERRACE Municipal D 176 0 176 100.0% 22 6 CAMBRIDGE COUNTRY MANOR Nursing Home - For Profit C 79 0 79 98.7% 0 0 CARESSANT CARE ARTHUR NURSING HOME Nursing Home - For Profit C 80 0 80 98.8% 0 0 CARESSANT CARE FERGUS NURSING HOME Nursing Home - For Profit C 87 0 87 89.7% 0 0 CARESSANT CARE HARRISTON Nursing Home - For Profit C 89 0 89 89.9% 0 1 CHATEAU GARDENS (ELMIRA) N. H. Nursing Home - For Profit C 48 0 48 100.0% 6 4 COLUMBIA FOREST LONG TERM CARE CENTRE Nursing Home - For Profit New 156 0 156 100.0% 13 8 DERBECKER'S HERITAGE HOUSE Nursing Home - For Profit C 72 0 72 98.6% 4 1 EDEN HOUSE NURSING HOME Nursing Home - For Profit B 58 0 58 100.0% 20 5 FOREST HEIGHTS LONG TERM CARE CENTRE Nursing Home - For Profit C 240 0 240 97.9% 1 0 GOLDEN YEARS NURSING HOME Nursing Home - For Profit C 88 0 88 100.0% 3 1 HILLTOP MANOR NURSING HOME Nursing Home - For Profit C 89 0 89 98.9% 1 1 LANARK HEIGHTS LONG TERM CARE CENTRE Nursing Home - For Profit New 160 0 160 100.0% 15 14 LAPOINTE-FISHER NURSING HOME Nursing Home - For Profit C 91 1 92 100.0% 8 5 LEISUREWORLD CAREGIVING CTR - ELMIRA Nursing Home - For Profit New 94 2 96 98.9% 7 7 MORRISTON PARK NURSING HOME Nursing Home - For Profit C 28 0 28 100.0% 3 0 PINEHAVEN NURSING HOME Nursing Home - For Profit B 84 0 84 100.0% 6 1 RIVERBEND PLACE Nursing Home - For Profit C 53 0 53 100.0% 4 4 ROYAL TERRACE Nursing Home - For Profit B 67 0 67 98.5% 3 8 SAUGEEN VALLEY NURSING CENTER Nursing Home - For Profit C 86 1 87 97.7% 0 0 ST ANDREW'S TERRACE LONG TERM CARE COMMUNIT Nursing Home - For Profit New 128 0 128 100.0% 33 40 STIRLING HEIGHTS Nursing Home - For Profit New 110 0 110 100.0% 12 13 TWIN OAKS OF MARYHILL Nursing Home - For Profit B 31 0 31 100.0% 1 1 WESTMOUNT (THE) Nursing Home - For Profit New 160 0 160 98.8% 27 24 WINSTON PARK NURSING HOME Nursing Home - For Profit B 95 0 95 100.0% 66 18 PARKWOOD MENNONITE HOME INC. Nursing Home - Non Profit New 96 0 96 100.0% 13 20 RIVERSIDE GLEN LONG TERM CARE FACILITY Nursing Home - Non Profit New 96 0 96 100.0% 77 31 TRINITY VILLAGE CARE CENTRE Nursing Home - Non Profit New 150 0 150 99.3% 26 21 TOTAL 3,645 17 3,662 99.0%

4.1.2 Where do WWLHIN residents go to access Long-Term Care Beds?

Issues/Observations:

• Although there appears to be limited capacity within the LTC home sector, bed capacity is not aligned with where people reside and choose to live; that is, some capacity exists in rural parts of WWLHIN (rural Wellington and North Wellington).

• “First available bed” policy means people may have to reside outside of their own communities and then wait for the opportunity to move to their facility of choice.

WWLHIN Integrated Health Service Plan 46 Appendix E – Population Profile and Health Services Utilization Details 5.0 Health Human Resources in WWLHIN: Providers Operating Across the Continuum of Care

5.1 Specialists

5.1.1 Provision of Specialist Physician Services in the WWLHIN

Table 1: Specialists Physicians in WWLHIN in 2004 Anaesthesia 38 Pediatrics 19 Community Med./Public Health 3 Pediatric Cardiology 0 Diagnostic Radiology 28 Pediatric Clinical Immunology 0 Emergency Medicine 5 Pediatric Endocrinology 0 Medical Genetics 0 Pediatric Gastroenterology 0 Nuclear Medicine 2 Pediatric Haematology 0 Occupational Medicine 1 Pediatric Infectious Diseases 0 Physical Medicine and Rehab. 2 Pediatric Nephrology 0 Psychiatry 51 Pediatric Neurology 0 Radiation Oncology 4 Pediatric Respirology 0 Other Specialty Total 134 Pediatric Rheumatology 0 General Internal Medicine 20 Pediatrics Total 19 Cardiology 18 General Surgery 20 Clinical Immunology 3 Cardio. and Thoracic Surgery 2 Dermatology 6 Neurosurgery 0 Endocrinology 5 Obstetrics and Gynecology 30 Gastroenterology 9 Ophthalmology 14 Geriatric Medicine 5 Orthopedic Surgery 15 Haematology 4 Otolaryngology 7 Infectious Diseases 1 Pediatric Surgery 0 Medical Oncology 3 Plastic Surgery 8 Nephrology 5 Thoracic Surgery 0 Neurology 7 Urology 10 Respirology 8 Vascular Surgery ? Rheumatology 4 Surgery Total 106 Internal Medicine Total 98 General Pathology 4 Anatomical Pathology 15 Hematological Pathology 0 Medical Biochemistry 0 Medical Microbiology 0 Neuropathology 0 Laboratory Medicine Total 19 Specialists Total 382 Source: Ontario Physician Human Resources Data Centre, Active Physician Registry, Dec 31, 2004

In 2004, the WWLHIN had 382 specialists. The largest concentration of specialists is in surgery, followed by internal medicine and psychiatry. Those areas where specialists are not present are one of several factors to be considered when examining services for which residents of Waterloo Wellington travel outside the LHIN.

WWLHIN Integrated Health Service Plan 47 Appendix E – Population Profile and Health Services Utilization Details 5.1.2 Where do WWLHIN residents go to access Specialist Services?

Table 2: Location of Specialist Accessed by WWLHIN Residents

Patient Place of Residence Waterloo Rural - S Rural Urban - Rural WWLHIN Location of Specialist Urban & Grey & N Wellington Guelph Waterloo Total Provider Rural S Well Waterloo Number 2,357,294 30,261 51,991 98,750 205,105 2,743,401 Urban & S. Rural % of Area Total 85.9% 1.1% 1.9% 3.6% 7.5% 100.0% % of WWLHIN Total 44.0% 0.6% 1.0% 1.8% 3.8% 51.2% Rural Number 1,023 3,409 37,039 3,604 661 45,736 Wellington % of Area Total 2.2% 7.5% 81.0% 7.9% 1.4% 100.0% % of WWLHIN Total 0.0% 0.1% 0.7% 0.1% 0.0% 0.9% Urban – Number 56,068 31,545 76,473 582,262 7,140 753,488 Guelph % of Area Total 7.4% 4.2% 10.1% 77.3% 0.9% 100.0% % of WWLHIN Total 1.0% 0.6% 1.4% 10.9% 0.1% 14.1% Rural – Number 112 8,388 1,485 118 82 10,185 S Grey & N Well % of Area Total 1.1% 82.4% 14.6% 1.2% 0.8% 100.0% % of WWLHIN Total 0.0% 0.2% 0.0% 0.0% 0.0% 0.2% Rural Number 39,268 3,121 10,424 17,800 25,409 96,022 Waterloo % of Area Total 40.9% 3.3% 10.9% 18.5% 26.5% 100.0% % of WWLHIN Total 0.7% 0.1% 0.2% 0.3% 0.5% 1.8% All WWLHIN Number 2,453,765 76,724 177,412 702,534 238,397 3,648,832 providers % of Area Total 67.2% 2.1% 4.9% 19.3% 6.5% 100.0% % of WWLHIN Total 45.8% 1.4% 3.3% 13.1% 4.5% 68.1% Providers Number 1,010,549 108,087 140,904 364,132 83,148 1,706,820 Outside WWLHIN % of Area Total 59.2% 6.3% 8.3% 21.3% 4.9% 100.0% % of WWLHIN Total 18.9% 2.0% 2.6% 6.8% 1.6% 31.9% All Providers Number 3,464,314 184,811 318,316 1,066,666 321,545 5,355,652 % of WWLHIN Total 64.7% 3.5% 5.9% 19.9% 6.0% 100.0% Providers may have more than one location - this is the location used for medical service billing. Source: Medical Services Table (1 Yr), based on OHIP billing data, Provincial Health Planning Database, ad hoc query 2006-06-22.

WWLHIN Integrated Health Service Plan 48 Appendix E – Population Profile and Health Services Utilization Details Table 3: Specialty Accessed by WWLHIN Residents (Source: *Rate based on 2004 WWLHIN population = 688,739.) Patient Place of Residence

Waterloo Rural – Urban & S. Grey & Rural Urban – Rural 2004 WW Rate (Services/ % of Specialty of Provider Rural S N. Well Wellington Guelph Waterloo Total 100000*) Total Diagnostic Radiology 874,203 56,183 90,703 322,955 77,824 1,421,868 206,445 14.9% Internal Medicine 446,300 20,835 43,265 109,175 41,587 661,162 95,996 6.9% Chiropractics 353,750 22,001 38,214 93,099 51,837 558,901 81,148 5.9% Obstetrics & Gynaecology 197,474 8,055 14,028 57,511 14,499 291,567 42,333 3.1% Optometry 161,268 11,429 16,690 38,265 18,178 245,830 35,693 2.6% Physiotherapy – Off. & Hm 195,996 2,819 2,513 30,247 5,180 236,755 34,375 2.5% Anaesthesia 127,031 9,136 12,120 43,447 11,337 203,071 29,484 2.1% Cardiology 117,560 4,831 10,447 51,340 8,312 192,490 27,948 2.0% Ophthalmology 110,446 7,472 12,559 45,297 11,075 186,849 27,129 2.0% General Surgery 105,718 10,005 15,042 37,635 10,056 178,456 25,911 1.9% Paediatrics 91,701 3,459 7,894 39,615 6,806 149,475 21,703 1.6% Otolaryngology 95,593 4,148 7,019 19,941 9,170 135,871 19,728 1.4% Psychiatry 75,981 3,639 7,031 29,354 5,221 121,226 17,601 1.3% Orthopaedic Surgery 74,511 3,716 6,271 16,775 7,126 108,399 15,739 1.1% Dermatology 59,255 1,736 5,742 27,906 3,889 98,528 14,306 1.0% Urology 59,919 3,458 5,504 20,860 6,829 96,570 14,021 1.0% Pathology 73,097 734 1,586 9,319 6,830 91,566 13,295 1.0% Gastroenterology 36,321 1,613 4,978 22,105 3,393 68,410 9,933 0.7% Respiratory Disease 53,276 1,425 1,720 3,367 6,489 66,277 9,623 0.7% Neurology 32,373 2,000 3,050 9,520 2,540 49,483 7,185 0.5% Nuclear Medicine 29,594 1,348 2,571 5,410 3,586 42,509 6,172 0.4% Plastic Surgery 25,863 774 1,651 4,193 2,706 35,187 5,109 0.4% Chiropody (Podiatry) 19,506 290 1,060 9,099 1,747 31,702 4,603 0.3% Haematology 13,366 661 1,616 3,603 1,857 21,103 3,064 0.2% Therapeutic Radiology 9,564 727 896 2,560 1,135 14,882 2,161 0.2% Emerg Med 6,789 243 524 4,670 738 12,964 1,882 0.1% Physical Medicine 4,995 817 1,113 4,106 543 11,574 1,680 0.1% Cardio. & Thoracic Surgery 6,840 436 880 2,049 669 10,874 1,579 0.1% Rheumatology 1,548 434 995 2,994 163 6,134 891 0.1% Geriatrics 3,402 116 164 2,246 184 6,112 887 0.1% Neurosurgery 3,595 264 512 1,205 395 5,971 867 0.1% Microbiology 1,889 23 58 109 42 2,121 308 0.0% General Thoracic Surgery 701 91 215 436 159 1,602 233 0.0% Oral Surgery 933 73 99 369 75 1,549 225 0.0% Clinical Immunology 277 20 39 410 26 772 112 0.0% Dental Surgery 156 14 18 22 28 238 35 0.0% Clinical Biochemistry 73 8 13 24 14 132 19 0.0% Oral Pathology 59 10 16 26 10 121 18 0.0% Genetics 48 2 10 24 4 88 13 0.0% Paedodontics 56 2 8 17 3 86 12 0.0% Oral Radiology 26 3 5 23 3 60 9 0.0% Osteopathy 30 2 17 49 7 0.0% Orthodontics 14 3 1 3 1 22 3 0.0% Prosthodontics 2 3 5 1 0.0% Community Medicine 4 4 1 0.0% Periodontics 1 1 0 0.0% All Specialties 3,471,103 185,054 318,840 1,071,336 322,283 5,368,616 779,485 56.3%

WWLHIN Integrated Health Service Plan 49 Appendix E – Population Profile and Health Services Utilization Details Patient Place of Residence

Waterloo Rural – Urban & S. Grey & Rural Urban – Rural 2004 WW Rate (Services/ % of Specialty of Provider Rural S N. Well Wellington Guelph Waterloo Total 100000*) Total All Services Provided 6,134,338 375,842 619,953 1,898,180 499,998 9,528,311 1,383,443 100.0%

5.2 Regulated Health Professionals

5.2.1 Number of Regulated Health Professionals within the WWLHIN

Table 4 provides the number of Regulated Health Professionals (RHPs) with active registration status in December 2005. This number will be higher than the number of RHPs employed in the WWLHIN because active registration does not indicate employment within the sector.

Table 4: Regulated Health Professionals with Active Registration Status in WWLHIN December 2005

Regulated Health Professional Number of RHPs with Active Registration Status as of December 2005 Pharmacist 412 Occupational Therapist 220 Dietitian 137 Physiotherapist 391 Midwife 34 Medical Laboratory Technologist Data not available Medical Radiation Technologists Data not available Speech Language Pathologist Data not available Registered Nurses 3884 Registered Nurses Extended Class 75 Registered Practical Nurses 1350 Source: Pilot Allied Health Human Resources Database, Ministry of Health and Long Term Care; Regulatory Colleges

Table 5 provides the Provincial numbers of RHPs by active registration status and age cohort. This information is helpful for planning purposes as it provides an indicator of workforce age.

Table 5: Regulated Health Professionals in Ontario by Age Cohort Regulated < 25 25-34 35-44 45-54 55-64 65+ Other Health Professional Pharmacist 82 2366 3112 2819 1414 557 Occupational Therapist 44 1646 1238 812 250 19 Dietitian 43 775 826 697 252 16 Physiotherapist 53 1989 1761 1396 696 102 83 Midwife < 5 89 132 85 23 < 5 Medical Laboratory 64 861 2245 2992 1501 70 5 Technologist Medical Radiation 211 1416 1910 1625 733 44 Technologists Speech Language 7 783 809 566 198 22 Pathologist Registered Nurses 1353 15424 24647 28603 17232 1791 Registered Nurses 65 128 266 174 15 < 5 Extended Class Registered Practical 635 3787 6418 8606 4725 309 Nurses Source: Pilot Allied Health Human Resources Database, Ministry of Health and Long Term Care; Regulatory Colleges Notes: Nursing Data is for employed nurses in Ontario Regulatory Professional College data includes all members with active registration status in Ontario as of December 2005

Table 6 provides further information about the workforce in each RHP, by indicating employment status.

WWLHIN Integrated Health Service Plan 50 Appendix E – Population Profile and Health Services Utilization Details Table 6: Regulated Health Professionals in Ontario by Work Status

Regulated Health Full time Part time Casual Unknown Profession Pharmacist Data Not Available Occupational Therapist 2589 1576 441 163 Dietitian 1526 925 606 Physiotherapist 3877 3621 471 Midwife Data Not Available Medical Laboratory Technologist 5268 1515 947 Medical Radiation Technologists Data Not Available Speech Language Pathologist 1610 561 214 Registered Nurses 53355 27799 7900 Registered Nurses Extended Class 449 130 15 Registered Practical Nurses 13460 8754 2268 Source: Pilot Allied Health Human Resources Database, Ministry of Health and Long Term Care; Regulatory Colleges Notes: Nursing Data is for employed nurses in Ontario Regulatory Professional College data includes all members with active registration status in Ontario as of December 2005

WWLHIN Integrated Health Service Plan 51 Appendix E – Population Profile and Health Services Utilization Details