City of Sub-region Population Profile 2016

Overview

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

This profile describes the population demographics, health, and health system utilization for the City of Thunder Bay sub-region.

The data presented in these profiles reflects the most up-to-date data - 2015-2016 unless otherwise indicated - compiled from City of survey or census data and health administrative databases. Thunder Bay (128,000)

Map of the North West LHIN City of Thunder Bay Sub-region.

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

Thunder Bay LHH: Thunder Bay, Thunder Bay Unorganized (Armstrong, Fowler), , , Neebing, Fort William First Nation, Conmee, O’Connor, Gillies, , Gull River (Gull Bay First Nation), Lac des Mille Lacs, Bingwi Neyaashi Anishinaabek (Sand Point First Nation), Seine River 22A2

North West Local Health Integration Network Executive Summary Health System The City of Thunder Bay sub-region has 33 unique community The City of Thunder Bay sub-region corresponds with a Local health service providers offering 38 LHIN-funded programs. Health Health (LHH). The North West LHIN funding allocation by health care sector for Population the City of Thunder Bay sub-region is as follows:

ÆÆ The City of Thunder Bay sub-region is the most populated 70.0% Hospitals district in the North West LHIN, with a total population of 130,501 12.0% Long-Term Care Homes ÆÆ The City of Thunder Bay sub-region accounts for 55.4% of 1.0% the North West LHIN’s total population Community Health Centres Æ The City of Thunder Bay has the greatest proportion of Community Mental Health and 5.0% population at working age 20-64 years Addiction Services

Æ The City of Thunder Bay sub-region has the highest 3.0% Community Support Services proportion of immigrants (9.2%); the second most common language spoken at home is Italian 9.0% Community Care Access Centre

ÆÆ The City of Thunder Bay sub-region has an approxiamate 0% 100% total area of 37,100 square kilometers Total number of health service provider (HSP) programs or operations: 38 Total number of HSP organizations: 33 Total allocation of funding: $412,065,474

Source: North West LHIN. Sector Share and Total Expenses Analysis by IDN, 2011. Data extracted from Canadian Management Information System.

Population Characteristics

Table 1: Population Characteristics City of Thunder Bay LHH North West LHIN

Total Population (2015) 130,501 235,666 13,792,052 % Change since 2011 1.9 2.2 7.2 % Female 51 50 51 % Male 49 50 % Children and youth, ages 0-19 years 20 23 22 % Working age, ages 20-64 years 62 60 62 % Seniors, aged 65+ years 19 17 16 % Seniors, ages 75+ years 8 7 7 % of people age 65+ living alone 30.2 29.9 24.4 % Population who report French as their mother tongue 2.8 3.3 4.4 Second language spoken most frequently at home Italian French French % Population who identify as Aboriginal 10.1 21.4 2.3 % population 7.8 18.0 1.5 % Metis population 2.0 3.0 0.6 % Inuk or multiple Aboriginal identities 0.1 0.1 0 % Population who are immigrants 9.2 7.5 28.6 % Total visible minority population 3.0 2.1 25.9

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

2 Table 2: Socio-economic Indicators City of Thunder Bay LHH North West LHIN Ontario % Population age 25-64 who have graduated from high school 87.0 82.5 88.9

% Population age 25-64 with completed post-secondary 62.8 58.0 64.8 education

% In the labour force (Participation rate) 61.7 61.8 52.6

% Employed 91.4 90.5 91.7

% Population living below low-income measure (LIM-AT) 13.9 12.9 13.8

% Children living in low income households/LIM (age<18) 19.6 17.9 16.3

% Housing affordability-spending 30% or more on rent 15.7 14.6 22.1 or payments

% of dwellings in need of major repairs 9.3 12.1 5.9

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

Health System Characteristics

Table 3: Description of Acute Care Services by Local Health Hub

Indicator City of Thunder Bay LHH North West LHIN

# Acute beds 331 601

# Complex continuing care beds 200 299

# Elderly capital assistance beds 0 118

# Inpatient mental health beds 98 122

# Inpatient rehab beds 50 50

Table 4: Description of Health Service Providers by Local Health Hub and Sector

Indicator City of Thunder Bay LHH North West LHIN

Organizations specializing in mental health 11 29

Organizations specializing in addictions 8 20

Community support and assertive outreach services 15 60

Home and Community Care Services 1 1

# Long-term care homes (LTCH) - number of beds 8 - 1,074 14 - 1,601

Acquired brain injury (ABI) services 1 1

Assisted living - ABI and physical disability (PD) 2 3

Seniors supportive housing, buildings - beds 3 - 346 11 - 504

Note that some long term care beds are part of the hospital, known as elderly capital assistance beds. These are reflected in Table 3, but not here. Long term care is provided to patients in both. Source: North West Local Health Integration Network, 2013/2014 Community Sector Health Service Provider Base Funding, based on MLPA as of September 30, 2012 and SAA's as of November 15, 2012. Analyzed on April 19, 2017. 3 Public Health

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

Primary Care

Table 6: Self-reported Primary Care Experience Indicators by Sub-region (January 2013 - September 2016) City of Thunder Bay LHH North West LHIN Ontario % Population with a primary care provider 87.6 86.3 94.5

% Population without a primary care provider Males unattached (%) - 16.5 7.2

Females unattached (%) - 11.6 4.1

16-44 years (%) - 18.8 8.3 45-64 years (%) - 14.1 4.5

65+ years (%) - 6.4 2.1 % of population able to get same day/next day 24.5 25.0 44.7 appointments % Who found it “easy” to get after-hours care 41.2 28.5 46.9 (without going to the ED) % Who waited 90 or more days to see a specialist after 38.9 37.5 30.7 being advised to see one % Taking prescription medications 63.6 63.8 53.4

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

4 North West LHIN Home and Community Care

Table 7: Select Home and Community Care Indicators by LHH, 2015-2016 (unless otherwise indicated)

Indicator City of Thunder Bay LHH North West LHIN Ontario

# of unique clients 9,527 14,188 584,296

% of clients with end-of-life service goal 3.8 3.3 5.6

Personal support worker/homemaking services as 71.2 70.7 67.3 percent of total services

Sources: Intellihealth Ontario, Home Care Services Table, accessed March 22, 2016. Cancer Care Ontario, iPort Access. Accessed March 23, 2017.

Ambulatory Care Hospital Data

Table 8: Select Ambulatory Care Indicators by LHH, 2015-2016 (unless otherwise indicated)

Indicator City of Thunder Bay LHH North West LHIN Ontario

Thunder Bay Regional Health Ambulatory Care Unit Sciences Centre (TBRHSC)

# of ED Visits 107,480 213,431 6,249,503

% of ED visits that are CTAS IV and V 22.3 40.1 35.6 (low acuity)

% of ED visits that are CTAS I-III (high acuity) 77.7 58.6 65.0

ED visits that are best managed elsewhere (per 2.1 4.3 1.9 1,000 population)

90th percentile ED length of stay 8.3 6.9 8.0

Emergency Department Wait Time for Physician 2.3 2.4 3.0 Initial Assessment (Hours, 90th Percentile) *

% of repeat visits (within 30 days) for mental health 17.4 16.8 20.1 condition **

% of repeat visits (within 30 days) for substance use 53.4 46.4 33.0 condition

* The sub-region percentile represents an average across the sub-region, weighted by number of ED visits per hospital.

Source: Canadian Institute for Health Information, National Ambulatory Care Reporting System. Accessed March 22, 2017. Note: some of these estimates may not represent exact counts because of suppressed data. These values were calculated from the SAA Performance Indicator Results (November 2016) for FY 2015-2016. Averages were used to estimate quarterly counts for the following hospitals (due to occasional data suppression): North of Superior Healthcare Group – Wilson Memorial General Hospital, District Memorial Hospital, General Hospital, Atikokan General Hospital, Riverside Health Care Facilities – Rainy River, and Red Lake Margaret Cochenour Memorial Hospital. North of Superior Healthcare Group – McCausland Hospital and Riverside Health Care Facilities – Emo are suppressed because of low total number of visits (data confidentiality).

5 Inpatient Hospital Data

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

Indicator City of Thunder Bay LHH North West LHIN Ontario

Thunder Bay Regional Health Sciences Centre (TBRHSC)

Hospital occupancy rate % (2014-2015) 96.8 - -

Hospital Standardized Mortality Ratio (HSMR) 85 96 91

Cost of a standard hospital stay ($) $4,758 $5,242 $5,407 (2014-2015) % Low risk pregnancies delivered by Caesarean 17.4 17.5 15.2 section (2014-2015) % of patients discharged from hospital inpatient beds 89.1 90.4 94.2 (acute and post-acute) without an ALC designation

% of Patient Days in Alternate Level of Care 17.0 20.6 13.8

# of acute care hospital stays 18,823 28,668 1,167,388

Ambulatory care sensitive conditions 6.8 5.8 3.4 (per 1000, <75 years) Diabetes related amputation unique patient rate per 100,000* DAY SURGERY Knee replacement completed 428 575 26,547 cases (Total, partial, & revisions) % Knee replacement surgeries within target time 68 71 79 (Total, partial, revisions) Hip replacement completed cases 325 394 15,596 (Total, partial, revisions) % Hip replacement surgeries within target time 79 83 80 (Total, partial, revisions)

Cataract surgery completed cases 2,073 2,671 130,422

% Cataract surgeries within target 94 92 88

DIAGNOSTICS

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

% Completed within access target 40 40 36

CT Completed cases 17,610 24,561 1,412,466

% Completed cases within access target 69 75 73

INPATIENT REHAB

% ALC cases for general rehab (SJCG/Lakehead/TBRHSC) 0/0/0 0 7

% ALC cases for special rehab (SJCG/Lakehead/TBRHSC) 6/0/18 13 20

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

6 Long-Term Care

Table 10: Select Long-Term Care Indicators by LHH, 2015-2016 (unless otherwise indicated) City of North West City of Thunder Bay Ontario Thunder Bay LHIN Pioneer Ridge Pinewood Court Roseview Manor Lakehead Manor Joseph’s) Bethammi (St. (St. Joseph’s) Riverview Hogarth

Worsened Pressure Ulcer 2.8 2.7 6.1 3.8 5.8 4.4 4.1 3.5 2.9 in Long-Term Care *

The number of potentially avoidable visits to the emergency department made 45.9 39.2 32.0 by residents of (LTCH) per 100 LTCH residents admitted **

# Admissions to LTCH 87 47 85 142 103 350 939 1,420 56,999

* The sub-region estimate represents an average across the sub-region, weighted by number of LTCH admissions this year. ** Reporting at the facility-level not recommended, and in most cases, would be suppressed due to small cell size: http://www.hqontario.ca/Portals/0/documents/system-performance/ltc-indicator-review-report november-2015.pdf Source: Intellihealth Ontario, Long Term Care Database. Accessed March 27, 2017. Canadian Institute for Health Information, National Ambulatory Care Reporting System. Accessed March 27, 2017. Canadian Institute for Health Information, www.yourhealthsystem.cihi.ca, accessed March 2017.

Limitations

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

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

Acronyms Used

ALC - Alternate Level of Care ED – Emergency Department LTCH – Long-Term Care Home CCAC – Community Care Access Centre HCC – Home and Community Care “-“ – Not Available or suppressed CIHI – Canadian Institute for Health Information IDN – Integrated District Network LHIN - Local Health Integration Network CTAS - Canadian Triage and Acuity Scale LHH – Local Health Hub SJCG - St Joseph's Care Group TBRHSC - Thunder Bay Regional Health Sciences Centre

7 Contact

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

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

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

Data updated: March 2017 Printed: December 2017 8