Grey Bruce sub-region Descriptive Profile

The purpose of the descriptive profile is to provide an overview of demographics and health service provider landscape in the sub-region to support discussions with Area Provider Tables around the development of sub-region Integration Tables

The data contained in these slides come from a variety of sources available to the LHIN. This is a snap shot in time and may not reflect exact numbers at the time of viewing

Draft: September 1, 2016

1 South West LHIN Overview

• One of the largest LHINs – almost 22,000 km2 • 924,000 people (7.5% of Ontario’s population)

• Significant rural population with many small Hanover communities • Large urban population within City of London • Large proportion of seniors • Small proportion of immigrants • 5 First Nations communities • French Language Services designation

2 Health Service Providers in the South West LHIN

• 19 public hospitals (33 sites) and 1 private hospital • 1 Community Care Access Centre • 54 Community Support Services Agencies • 30 Mental Health and Addiction Agencies • 5 Community Health Centres • 78 Long Term Care Homes

Other providers • Over 600 actively practicing family physicians • 19 Family Health Teams • 7 Public Health units

3 Grey Bruce sub-region

4 Demographics

Grey Huron London South Oxford Elgin Bruce Perth LHIN Total population (2011) 1 144,657 134,212 105,719 439,151 87,461 925,300 % of the population who identify as 2.8% 0.9% 1.3% 2.3% 1.8%* 2.0% Aboriginal 2 * Includes largest First Nation in LHIN (Oneida of the Thames )

Grey Huron London South Oxford Elgin Bruce Perth Middlesex West LHIN

Total population (2011) 1 144,657 134,212 105,719 439,151 87,461 925,300 % of the population that immigrated 0.3% 0.6% 0.6% 2.7% 0.9% 1.6% to Canada between 2006 and 2011 2 % of the population that are visible 1.7% 1.6% 2.5% 13.7% 2.7% 7.6% minority 2 % of the population who report 1.1% 0.8% 1.2% 1.6% 1.2% 1.3% French as their mother tongue 1

1 2011 Census of Canada 2 2011 National Household Survey 5 Demographics (continued)

Grey Huron London South Oxford Elgin Bruce Perth Middlesex West LHIN Total population (2011) 1 144,657 134,212 105,719 439,151 87,461 925,300 % of seniors 65 years and older 1 20.7% 18.0% 16.6% 14.8% 15.6% 16.6% % of seniors 75 years and older 1 9.3% 8.7% 7.9% 7.1% 6.8% 7.8%

Grey Huron London South Oxford Elgin Bruce Perth Middlesex West LHIN Total population (2011) 1 144,657 134,212 105,719 439,151 87,461 925,300 Median household income 2 $61,420 $60,580 $63,180 $57,987 $60,175 $59,496 % of the population who live under 12.2% 10.8% 11.6% 15.7% 15.8% 14.0% the low income cut off 2 % of the population between 25 and 64 years old without a high 13.7% 17.1% 15.5% 10.1% 17.4% 13.2% school diploma 2 % of families who have lone 11.7% 11.5% 13.9% 17.3% 13.9% 14.7% parents 1 It is estimated that up to 10% of Grey Bruce population is old order Amish and Mennonite

1 2011 Census of Canada 2 2011 National Household Survey 6 Grey Huron London Oxford Elgin South West LHIN Bruce Perth Middlesex Prevalence of Chronic Conditions, Based on Self- Report (CCHS 2013/14) Arthritis 22.6% 20.9% 17.0% 16.4% 21.9% 20.6% Asthma 8.0% 5.6% 7.2% 9.7% 9.0% 9.0% COPD 4.4% 3.0% 3.1% 1.5% 3.3% 4.8% Cancer 1.5% 1.1% 0.9% 1.2% 1.0% 1.0% Diabetes 7.3% 8.0% 5.6% 6.5% 6.6% 7.0% Hypertension 23.4% 22.4% 17.4% 16.5% 16.9% 17.5% Ischemic Heart Disease 4.7% 5.3% 4.6% 4.1% 5.2% 4.7% Stroke 1.6% 1.1% 0.9% 0.8% 1.7% 1.4% Mortality Rate per 100,000 Population, for Select Chronic Conditions (Statistics Canada 2011) Arthritis 6.4 5.8 2.9 3.0 1.7 3.8 Asthma 0.7 0.7 < 0.5 0.4 0.6 0.5 COPD 44.6 48.0 31.9 27.9 40.0 34.8 Cancer 279.1 245.6 231.6 218.0 216.1 231.6 Diabetes 34.9 31.3 22.0 19.3 29.4 24.6 Hypertension 42.2 12.7 9.1 7.8 10.6 8.6 Ischemic Heart Disease 165.2 141.6 174.4 94.9 156.7 127.7 Stroke 45.9 45.9 37.7 29.0 36.7 35.7 7 Grey Huron London Complex Patients 2013/14 Elgin Oxford Bruce Perth Middlesex Total patients (health care users) 75,222 92,547 116,212 109,169 379,098 Complex Patients (4+ conditions) # 4,265 5,005 7420 5,905 21,200 % of patients that are complex 5.7% 5.4% 6.3% 5.4% 5.6%

# of Complex patients NOT enrolled with a Patient enrollment Model (PEM) 1,135 1,215 1,700 1,295 6,055 % of Complex patients NOT enrolled with a Patient enrollment model (PEM) 27% 24% 22.9% 22% 29%

Complex patients, by age group <18 yrs 80 115 130 150 515 18-44 340 420 635 455 2,225 45-64 1,130 1,185 1,810 1,385 5,735 65-79 1,650 1,845 2,770 2,050 6,965 80+ 1,070 1,435 2,070 1,870 5,760

Complex patients, by sex Female 2,190 2,645 3,685 3,095 11,195 Male 2,075 2,360 3,735 2,815 10,005

This analysis is based on all patients who used health care services in 2013/14. Complex patients are those with 4 or more conditions (i.e.., the 'target population' for Health Links). Note that the number of patients (health service users) is not the same as the estimated population of an area. 8 Distribution of CCAC patients (adult/children at home)

Comm. Ind = community independence 9 Number and percent of CCAC patients attached to a primary care provider

10 Percentage of adults who are very or somewhat satisfied with the health care in their community by Health Link

% satisfied with health care in 95% 95% Health Link community* UCI LCI

Elgin 87.7 79.0 96.4 Oxford 92.9 86.1 99.8 South Grey Bruce NR** NR NR North Grey Bruce 90.0 83.2 96.8 Huron Perth 93.5 89.2 97.8 London Middlesex 86.6 82.6 90.7

* Wide confidence intervals so caution when interpreting ** Number not available due to low response rate 11 Grey Bruce Area Provider Table: Grey Bruce Integrated Health Coalition

Co-chairs:

 Paul Rosebush CEO and President, South Bruce Grey Health Centre

 Jennifer Cornell, Administer, Green Gables

12 Grey Bruce • 3 Hospitals • Grey Bruce Health Services • Lion’s Head • Markdale • Meaford • Owen Sound • Southampton • Wiarton Hanover Hanover • Hanover and District Hospital • South Bruce Grey Health Centre • Chesley • Durham • Kincardine • Walkerton • 1 Community Health Centre • 8 Community support services • 19 Long Term Care Homes • 5 Mental health and addictions programs • 1 CCAC (for whole LHIN)

• 1 Public Health Unit • 105 active family physicians • 6 Family Health Teams 13 LHIN funded Health Service Providers

14 Community Support Services: Lead Agencies

LHIN Sub- HSP Name Contact Region Home and Community Support Grey Bruce Andy Underwood Services of Grey Bruce ONE CARE Home & Community Huron Perth Kathy Scanlon Support Services London Cheshire Homes London Judi Fisher Middlesex Victorian Order of Nurses Elgin Suzanne Mezenberg Middlesex Elgin Branch Victorian Order of Nurses Oxford Oxford Suzanne Mezenberg Branch

15 Community Support Service agencies (LHIN funded) providing service in Grey Bruce Grey Bruce only or Provider Name LHIN-wide service provision Alzheimer Society Of Grey-Bruce Grey Bruce Chippewas Of Nawash Unceded First Nation Grey Bruce Home And Community Support Services Of Grey-Bruce Grey Bruce Participation Lodge - Grey Bruce Grey Bruce The Governing Council of the Salvation Army in Canada - Owen Sound Grey Bruce Victorian Order Of Nurses For Canada - Ontario Branch Grey-Bruce Grey Bruce LHIN-wide (except London Community Health Services - Canadian Red Cross - Woodstock Branch Middlesex) Dale Brain Injury Services Inc. LHIN-wide Participation House Support Services - London And Area LHIN-wide Regional HIV/AIDS Connection LHIN-wide Southwest Ontario Aboriginal Health Access Centre LHIN-wide The Canadian Hearing Society - London Region LHIN-wide The Canadian National Institute For The Blind - Ont Div - London LHIN-wide

16 Home and community care providers contracted by CCAC providing service in Grey Bruce

Provider name

CarePartners Closing the Gap ParaMed Home Health Care Victorian Order of Nursing

17 Mental Health and Addiction agencies (LHIN funded) providing service in Grey Bruce

Grey Bruce only or LHIN-wide Provider name service provision Canadian Mental Health Association, Grey Bruce Grey Bruce Branch Grey Bruce Health Services: Community Mental Health Services, Withdrawal Management and Grey Bruce Behavioural Supports Ontario Outreach Team HopeGreyBruce Mental Health and Addictions Grey Bruce Services G&B House, Recovery Home Provincial Southwestern Ontario Aboriginal Health Access Grey Bruce and London Centre Middlesex

Community Health Centre in Grey Bruce

South East Grey Community Health Centre - Markdale

18 Assisted Living Organizations New AL hubs Number of people served and Locations since 2014

VON Grey Bruce - (3 locations in Owen Sound) 40 (HRS) 0 VON Grey Bruce - (1 location in Meaford) 4 (HRS) 2 VON Grey Bruce - (2 locations in Thornbury) 3 (HRS) 0 VON Grey Bruce - (2 locations in Wiarton)) 18 (HRS) 0 VON Grey Bruce - (1 location in Southampton) 0 (HRS) 0 VON Grey Bruce – (1 location in Port Elgin, ON) 5 (HRS) 0 VON Grey Bruce - (2 locations in Kincardine) 12 (HRS) 2 Participation Lodge Grey Bruce (1 location in 5 (APD), 5 (ABI) 0 Owen Sound) Participation Lodge Grey Bruce (1 location in 8 (APD), 1 (HRS), 1 (ABI) 0 Hanover) Participation Lodge Grey Bruce (Outreach – Grey 12 (APD) 0 Bruce) Participation Lodge Grey Bruce (1 location in 6 (ABI) 0 Holland Centre) Dale Brain Injury (Outreach - Grey Bruce) 19 clients (ABI) 0

25 APD = Adults with physical disabilities 83 HRS = High Risk Seniors 31 ABI = Acquired brain injury

Total = 139

19 Adult Day Program: locations and spaces available

ADP # Days / wk Mon Tues Wed Thurs Fri Sat Sun # Spaces / Week

VON Oxford Woodstock 5 30 15 15 15 15 90 VON Oxford Ingersoll 3 15 15 15 45 VON Oxford Tillsonburg 5 15 15 15 15 15 75

Oxford County 60 30 45 30 45 0 0 210

Four Counties (Newbury) 3 15 15 15 45 Craigwiel (Ailsa Craig) 5 15 15 15 18 15 78 VON ME Strathroy 5 16 16 16 16 16 80 VON ME Dorchester 5 15 15 15 15 15 75 Salvation Army (London) 5 25 25 25 25 25 125 McCormick (London) 7 75 75 75 75 75 15 15 405 Dearness Home (London) 5 30 30 30 30 30 150

London Middlesex 176 176 191 194 191 15 15 958

Valleyview (St. Thomas) 5 20 20 30 20 20 110 Bobier Villa (Dutton) 3 15 15 15 45 Terrace Lodge (Aylmer) 5 15 15 15 15 15 75

Elgin County 50 50 45 50 35 0 0 230 Alzheimer/Dementia Specific Stroke Days Day HCSS Owen Sound 6 18 18 18 18 18 16 106 HCSS Port Elgin 5 17 18 17 18 17 87

HCSS Wiarton 2 18 18 36

HCSS Markdale 3 16 16 16 48 HCSS Meaford 3 16 16 16 48 HCSS Hanover 5 17.8 17.8 17.8 17.8 17.8 89

Grey Bruce 52.8 103.8 67 87.8 68.8 33.8 0 414

One Care Clinton 5 15 15 15 15 15 75 One Care Exeter 3 15 15 15 45 One Care Wingham 4 15 15 15 15 60 One Care Goderich 5 15 15 15 15 15 75 One Care Grand Bend 3 15 15 15 45 Huron County 60 60 60 60 60 0 0 300 VON PH Stratford Romeo 4 15 15 15 15 60 VON PH Stratford Spruce 3 15 15 15 45 VON PH Listowel 3 15 15 15 45 VON PH St. Marys 3 15 15 15 45

Perth County 60 60 45 15 15 0 0 195

LHIN-wide Totals 0 458.8 479.8 453 437 414.8 48.8 15 2,307 draft profile - July 18, 2016 20 Grey Bruce Long Term Care Homes Total Long term Name of Home Location stay Beds Country Lane Long Term Care Residence Chatsworth 34 Elgin Abbey Nursing Home Chesley 27 Parkview Manor Health Care Centre Chesley 34 Rockwood Terrace Home for the Aged Durham 100 Hanover Care Centre Hanover 41 The Village Seniors Community Hanover 70 Trillium Court Kincardine 40 Golden Dawn Nursing Home Lion's Head 45 Pinecrest Manor Lucknow 61 Grey Gables Home for the Aged Markdale 66 Meaford Long Term Care Centre Meaford 77 Lee Manor Home Owen Sound 150 Maple View Owen Sound 29 Summit Place Owen Sound 119 Versa-Care Georgian Heights Owen Sound 40 Southampton Care Centre Southampton 88 Errinrung Nursing Home, division of Provincial Nursing Home Limited Thornbury 60 Partnership Brucelea Haven Long Term Care Home Walkerton 144 Gateway Haven Wiarton 10021 Grey Bruce: Long Term Care Home Locations

22 Grey Bruce: Clients waiting for LTC as of the first day of the Month Mar 2015 – May 2016

Clients Waiting For LTC as of the 1st Day of the Waiting - Community Waiting - Retirement Home Month - GREY BRUCE Waiting - Hospital ALC Waiting - Hospital Other 70 60 63 50 54 54 54 52 53 53 50 40 48 46 42 43 41 30 31 20 26 29 29 29 28 27 26 24 25 22 24 25 10 18 20 17 1819 18 1512 1614 1610 5 8 1410 7 6 11 16 9 7 15 8 10 5 0 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16

As of Spring 2016 Average wait time in LHIN = 75 days 1409 people waiting in the LHIN Average wait time in Grey Bruce = 24 88 people waiting in Grey Bruce (excludes those waiting in LTC for first choice) 88 long stay beds/1000 over 75 yrs of age in Grey Bruce (low compared to South West LHIN

Total number of long stay beds = 1305 Total number of short stay (respite) beds = 5 Total number of LTC Homes = 19 Total number of convalescent care program beds = 6 Number of beds = 1,325

Of the 18 home – 13 are to redevelop by 2025 (865 beds) 23 Hospitals Inpatient physician staffing models to be completed by Sue

Total Beds: 85

Med/surg – 79 Chesley Site Total Beds: 224 OB - 6 Durham Site Kincardine Site Medical – 48 Lions Head site: 4 Walkerton Site Surgical – 28 Markdale site: 14 Med/Surg – 61 Meaford site: 15 IC – 6 OB – 11 Owen Sound site: 173 PI –MH – 39 Southampton Site: 16 CCC – 10 Wiarton Site: 12 AR - 16 Total beds: 28 Med/Surg – 24 Intensive care – 2 OB - 2 24 Residential Hospice Care

25 Residential Hospice Care

FY 2014-2015

Total RH Deaths Deaths per per Total 2014 RH Deaths Total RH County Sakura St. Josesph's Grey Bruce Deaths Population per 10,000 Deaths (Projected (Projected Estimates Population Vital VS) Statistics)

Patient County Grey 0 0 63 63 968 6.5% 90,447 7.0 Bruce 4 0 30 34 656 5.2% 67,994 5.0 Huron 2 1 0 3 666 0.5% 58,119 0.5 Perth 20 3 0 23 716 3.2% 78,056 2.9 Oxford Norfolk 111 1 0 112 1,195 9.4% 124,728 9.0 Middlesex 2 111 0 113 3,593 3.1% 465,545 2.4 Elgin 9 3 0 12 798 1.5% 90,703 1.3 Outside of LHIN/Other 11 6 0 17 South West LHIN Total 159 125 93 377 8,477 4.4% 966,407 3.9

26 Mental Health Bed Numbers by sub-region

Total Acute Long Child Sub-region Facility & Location Forensic Crisis Unit Total Adult Total Beds Psych Term and Youth

OWEN SOUND GREY BRUCE HEALTH SERVICES-OWEN Grey Bruce 32 0 7 0 39 39 SOUND GREY BRUCE REG.H.C. SITE STRATFORD GENERAL Huron Perth 15 0 0 0 15 15 HOSPITAL GODERICH ALEXANDRA Huron Perth MARINE AND GENERAL 20 0 0 0 20 20 HOSPITAL

LONDON HEALTH SCIENCES Middlesex CENTRE-LONDON VICTORIA 87 0 0 0 87 16 103 London WESTMINISTER SITE

LONDON ST.JOSEPH'S Middlesex MENTAL HEATLH CARE 0 0 0 141 141 9 150 London BUILDING-PARKWOOD INSTITUTE

WOODSTOCK GENERAL Oxford 16 0 0 0 16 16 HOSPITAL TRUST

ST THOMAS-ELGIN GENERAL Elgin 15 0 0 0 15 15 HOSPITAL

ST THOMAS ST.JOSEPH'S HEALTH CARE,LONDON- Elgin SOUTH WEST CTR FOR 0 88 0 0 88 88 FORENSIC MH-ST THOMAS SITE

27 Primary care statistics

Grey Huron London South Oxford Elgin Bruce Perth Middlesex West LHIN Total population (2011) 1 144,657 134,212 105,719 439,151 87,461 925,300 # of active primary care providers 108 101 56 312 40 617 (GP/FP + NP’s in NPLCs) 2,3 % of family physicians aged 60+ 2 22% 15% 24% 21% 34% 21% % of primary care providers 67% 80% 48% 41% 53% 53% affiliated with team based care 2 # of CHC/NPLC/AHAC 1/0/1 0/0/0 1/1/0 1/1/2 2/0/0 5/2/3 # of walk-in clinics 1 1 1 21 1 25

Grey Huron London South Oxford Elgin Bruce Perth Middlesex West LHIN Total population (2011) 1 144,657 134,212 105,719 439,151 87,461 925,300 % of population self-reporting 86.5% 93.0% 96.3% 90.1% 89.9% 90.9% access to a regular family physician 4

1 Census of Canada 2011 2 College of Physicians and Surgeons of Ontario Corporate Provider Database (2015), Provided by Health Analytics Branch MOHLTC. 3 South West LHIN Funding Accounts (2015) 4 Canadian Community Health Survey, 2013-2014. Ontario LHIN Share File 28 29 30 Implementing the Health Links Approach in Grey Bruce North Grey Bruce Health Link

• Lead agencies: Owen Sound Family Health Team & Grey Bruce Health Services

South Grey Bruce Health Link

• Lead agencies: Brockton and Area Family Health Team and South Bruce Grey Health Centre

Together, they have

• A Steering Committee and Working Group • A 2016/17 target to work with 250 people with high care needs to develop a Coordinated Care Plan • Worked with 136 people to develop a coordinated care (from inception to July 2016) 31 eEnablers to support our South West Health Links

eScreener Electronic Care Telemedicine (e.g. OTN eVisit) eNotification Integrated Decision Coordination Plan in Telehomecare Telemedicine (e.g. OTN Support (IDS) (formerly CHRIS (CCP) / ORION meeting) known as RIDS) Care Coordination Tool thehealthline.ca (CCT) Clinical Connect Clinical Connect Telemedicine (e.g. OTN SPIRE/HRM Portals (e.g. Health Partner Gateway (HPG), meeting) Ontario Laboratories Community Health Portal Clinical Connect Information System (OLIS) (CHP)) Portals for Providers (e.g. Drug Profile Viewer (DPV) Portals for Patients and Health Partner Gateway eReferral (Hospital - CCAC) Families (e.g. My eShift, (HPG), Community NexJ) Health Portal (CHP)) eReferral (CCAC and Community Partners) Portals for Patients and eConsult/Telepsychiatry/ Families (e.g. My eShift, Teledermatology/ NexJ) Teleophthamology/ eShift Medication List Integrated Assessment Record (IAR) eHealth Ontario Applications SPIRE = South West Physicians Office Interface to Regional Electronic Medical Record Patient Tracking Tool HRM = Hospital Report Manager RIDS 32 Current State Map of eEnablers across our South West Health Links Electronic Enabler Availability

Huron Perth London South Grey Bruce North Grey Bruce Oxford Elgin Medication List Specialist Directory eScreener for Health Links pts Provincial Care Coordination Tool (CCT) CCAC CHRIS Coordinated Care Plan (CCP) Telehomecare eConsult Health Link Patient Management & Tracking Tool eNotification (Hospital-CCAC) eScreener for Complex Discharge/eReferral to CCAC SPIRE/HRM Integrated Decision Support (IDS) Telemedicine/eVisits CHRIS HPG/CHP thehealthline.ca ClinicalConnect eShift Integrated Assessment Record (IAR) Drug Profile Viewer (DPV) Ontario Laboratories Information System (OLIS) Tele-Psych, Opth, Derm

Last updated: January 29, 2016 Available to the majority of partners of the Health Link now Available to some partners of the Health Link now In Planning/Build Phase Not available for the Health Link and no confirmed timeline for availability 33 Facts to consider when planning

• Percentage of the population that is Indigenous (5.2 %) is the largest proportion in the LHIN which is approximately 7,700 people and includes 2 First Nations. There is limited culturally safe primary care in Grey Bruce – individuals must drive long distances for care

• Significant Mennonite/Amish population

• Transportation an ongoing challenge because of rurality

• Area providers have a strong Chronic Disease Prevention and Management focus

• The sub-region has a strong, well organized Area Provider Table

• Many provider partnerships in existence (e.g. Information Network, Hospital/CCAC/Public Health Network)

34 Facts continued

• 67% of primary care physicians are affiliated with a team based practice

• Strong mental health and addictions agencies

• One Community Health Centre in Markdale (satellite sites in Chatsworth and Dundalk)

• There is one Public Health Unit in the sub-region with a recent change in leadership

• Historically, the Public Health Unit has had a strong voice in the community

• Both Health Links are up and running

35 For more information please visit www.southwestlhin.on.ca