District 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 District of Thunder Bay sub- region.

District of The data presented in these profiles reflects the most up-to-date Thunder Bay data - 2015-2016 unless otherwise indicated - compiled from (17,800) survey or census data and health administrative databases.

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

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

Greenstone LHH: Greenstone, Long Lake No. 58 First Nation, , , Animbiigoo Zaagi igan Anishinaabek (Lake ) LHH: Manitouwadge Marathon LHH: Marathon, Pic River First Nation, Pic Mobert First Nation Nipigon LHH: Nipigon, Red Rock, Dorion, Lake Helen First Nation, Biinjitiwaabik Zaaging Anishinaabek (Rocky Bay) LHH: Terrace Bay, Schreiber,

North West Local Health Integration Network Executive Summary

The District of Thunder Bay sub-region is comprised of five Local The North West LHIN funding allocation by health care sector for Health Hubs - Greenstone, Manitouwadge, Marathon, Nipigon the District of Thunder Bay sub-region is as follows: and Terrace Bay.

77.0% Hospitals Population ÆÆ The District of Thunder Bay sub-region is the fifth most 2.0% Long-Term Care Homes populated district in the North West LHIN, with a total 5.0% Community Health Centres population of 17,829 Æ Community Mental Health and Æ The District of Thunder Bay sub-region accounts for 7.7% of 4.0% Addiction Services the North West LHIN’s total population ÆÆ Rural area residents account for 43.7% of the population in 6.0% Community Support Services the District of Thunder Bay sub-region ÆÆ 10.5% of residents identify as Francophone in the District of 6.0% Community Care Access Centre

Thunder Bay sub-region; the highest proportion resides in 0% 100% Greenstone LHH where 22.2% identify as Francophone ÆÆ The District of Thunder Bay sub-region has an approximate Total number of health service provider (HSP) programs or operations: 29 total area of 61,215 square kilometers Total number of HSP organizations: 21 Total allocation of funding: $40,863,413

Health System Source: North West LHIN. Sector Share and Total Expenses Analysis by IDN, 2011. Data extracted from The District of Thunder Bay sub-region has 21 unique health Canadian Management Information System. service providers offering 29 LHIN-funded programs.

Population Characteristics

Table 1: Population Characteristics District of Thunder Bay North West LHIN

Total Population (2015) 17,967 235,666 13,792,052 % Change since 2011 0.8 2.0 3.8 % Female 48.5 50 51 % Male - - - % Children and youth, ages 0-19 years 23 23 22 % Working age, ages 20-64 years 61 60 62 % Seniors, aged 65+ years 16 17 16 % Seniors, ages 75+ 6 7 7 % of people age 65+ living alone 29.3 29.9 24.4 % Population who report French as their mother tongue 13.2 3.3 4.4 Second language spoken most frequently at home French French French % Population who identify as Aboriginal 23.9 21.4 2.3 % population 20.1 18.0 1.5 % Metis population 3.5 3.0 0.6 % Inuk or multiple Aboriginal identities 0 0.1 0 % Population who are immigrants 4.7 7.5 28.6 % Total visible minority population 0.8 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 , 2011. Available at https://www12.statcan.gc.ca/nhs-enm/2011/ref/no13reserves/index.cfm?LANG=E.

2 Table 2: Socio-economic Indicators District of Thunder Bay North West LHIN Ontario % Population age 25-64 who have graduated from high school 80.5 82.4 88.9

% Population age 25-64 with completed post-secondary 54.5 58.0 64.8 education

% In the labour force (Participation rate) 60.4 61.8 52.6

% Employed 88.9 90.5 91.7

% Population living below low-income measure (LIM-AT) 11.8 12.9 13.8

% Children living in low income households/LIM (age<18) 16.6 17.8 16.3

% Housing affordability-spending 30% or more on rent 10.3 14.5 22.1 or payments

% of dwellings in need of major repairs 13.2 12.0 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 Nipigon Terrace Bay Marathon Manitou- Greenstone District of North West Indicator LHH LHH LHH wadge LHH LHH Thunder Bay LHIN North of Nipigon North of Superior Manitou- Geraldton District Superior Health Group- wadge Acute Care Hospital District Memorial Health Group- Wilson General Hospital Hospital McCausland Memorial Hospital General # Acute beds 15 10 9 9 23 66 601 # Complex continuing care beds 7 13 12 0 7 39 299 # Elderly capital assistance beds 15 0 0 9 19 43 118 # Inpatient mental health beds 05 0 0 0 0 0 122 # Inpatient rehab beds 0 0 0 0 0 0 50

Table 4: Description of Health Service Providers by Local Health Hub and Sector Nipigon Terrace Bay Marathon Manitou- Greenstone District of North West Indicator LHH LHH LHH wadge LHH LHH Thunder Bay LHIN Organizations specializing in 5 5 4 4 5 6 29 mental health Organizations specializing in 1 1 1 1 1 1 20 addictions Community support and 7 6 7 5 9 11 57 assertive outreach services Home and Community Care 1 1 1 1 1 1 1 Services Acquired brain injury services 1 1 0 0 0 1 1 (ABI) Assisted living - ABI and 1 0 0 0 0 1 3 physical disability Seniors supportive housing, 0 - 7 0 0 - 5 0 0 0 - 12 11 - 504 buildings - beds Long-Term Care Homes - beds 0 1 - 22 0 0 0 1 - 22 14 - 160

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

Primary Care

Table 6: Self-reported Primary Care Experience Indicators by Sub-region (January 2013 - September 2016) District of Thunder Bay North West LHIN Ontario % Population with a primary care provider 84.5 86.3 94.5 % Population without a primary care provider - 58.0 64.8 % Males unattached - 16.5% 7.2%

% Females unattached - 11.6% 4.1%

16-44 years - 18.8% 8.3% 45-64 years - 14.1% 4.5% 65+ years - 6.4% 2.1% % of population able to get same day/next day 27.4 25.0 44.7 appointments % Who found it “easy” to get after-hours care 26.2 28.5 46.9 (without going to the ED) % Who waited 90 or more days to see a specialist 29.1 37.5 30.7 after being advised to see one % Taking prescription medications 69.0 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 Inpatient Hospital Data

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

District of North Nipigon Marathon Manitouwadge Greenstone Terrace Bay LHH Thunder West Ontario LHH LHH LHH LHH Bay LHIN Memorial Hospital Nipigon District McCausland NOSH - Memorial General NOSH -Wilson General Hospital Manitouwadge Hospital Geraldton District

Hospital occupancy rate % NA 49.9 82.6 46.2 62.6 - (2014-2015) Hospital Standardized Mortality 87 61 62 120 196 - 96 91 Ratio (HSMR) Cost of a standard hospital stay ($) $5,581 $6,662 $3,588 $8,134 $6,238 - $5,242 $5,407 (2014-2015) % Low risk pregnancies delivered by NA NA NA NA NA - 17.5 15.2 Caesarean section (2014-2015) Percentage of patients discharged from hospital inpatient beds (acute 88.8 90.5 97.1 91.8 95.9 93.7 90.4 94.2 and post-acute) without an ALC designation Percentage of Patient Days in 51.0 33.0 33.1 41.4 47.3 - 20.6 13.8 Alternate Level of Care # of acute care hospital stays 226 252 383 133 386 1,380 28,668 1,167,388 Ambulatory care sensitive 7.3 6.1 6.7 7.9 3.6 5.9 5.8 3.4 conditions (per 1000, <75 years) Diabetes related amputation unique 0.0 0.0 59.3 0.0 0.0 13.3 26.5 11.2 patient rate per 100,000* DAY SURGERY Knee replacement completed cases ------575 26,547 (Total, partial, revisions) % Knee replacement surgeries within ------71 79 target time (Total, partial, revisions) Hip replacement completed cases ------394 15,596 (Total, partial, revisions) % Hip replacement surgeries within ------83 80 target time (Total, partial, revisions) Cataract surgery completed cases - - 54 - - 54 2,671 130,422

% Cataract surgeries within target - - 100 - - 100 92 88

DIAGNOSTICS

MRI completed cases ------15,911 821,836

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

CT Completed cases ------24,541 1,412,466 % Completed cases within ------75 73 access target INPATIENT REHAB

% ALC cases for general rehab 15 0 0 0 0 4 0 7

% ALC cases for special rehab 0 6 0 0 10 4 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.

5 North West LHIN Home and Community Care

Table 8: Select Home and Community Care Indicators by LHH, 2015-2016 (unless otherwise indicated) Nipigon Terrace Bay Marathon Manitou- Greenstone District of North West Ontario LHH LHH LHH wadge LHH LHH Thunder Bay LHIN # of unique 236 159 168 86 282 931 14,188 584,296 clients % of clients with end-of-life 3.8 6.3 1.2 0.0 3.2 3.2 3.3 5.6 service goal

PSW/ homemaking 67.0 77.8 72.9 79.6 77.7 75.0 70.7 67.3 services as % of total services

Ambulatory Care Hospital Data

Table 9: Select Ambulatory Care Indicators by LHH, 2015-2016 (unless otherwise indicated) Nipigon Terrace Marathon Manitouwadge Greenstone District of North West Ontario LHH Bay LHH LHH LHH LHH Thunder Bay LHIN Hospital Memorial District Nipigon McCausland NOSH - General Memorial NOSH -Wilson Hospital General Manitouwadge Hospital District Geraldton

Number of ED Visits 4,383 3,083 5,640 2,728 8,753 24,587 213,431 6,249,503

% of visits that are CTAS 61.9 84.4 61.5 90.1 72.3 71.4 40.1 35.6 IV and V (low acuity)

% of ED visits that are 38.2 15.4 32.3 9.7 27.2 26.9 58.6 65.0 CTAS I-III (high acuity)

Rate of ED visits that are 113.7 76.7 57.4 122.8 123.3 99.4 43.1 18.5 best managed elsewhere

90th percentile ED LOS* 4.5 3.0 3.4 3.2 5.0 3.2 6.9 8

Emergency Department Wait Time for Physician 1.3 2.1 1.5 3.1 2.4 2.0* 2.4 3.0 Initial Assessment (Hours, 90th Percentile) *

% of repeat visits (within 9.4 NA 14.6 22.6 15.6 14.9 16.8 20.1 30 days) for MH condition

% of repeat visits (within 23.7 NA 18.9 47.8 32.8 30.6 46.4 33.0 30 days) for SU condition

6 Long-Term Care

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

Nipigon Terrace Marathon Manitouwadge Greenstone District of North West Ontario LHH Bay LHH LHH LHH LHH Thunder Bay LHIN Memorial Hospital Nipigon District Wilkes Terrace NOSH - Memorial General NOSH - Wilson General Hospital Manitouwadge Hospital Geraldton District

Worsened Pressure Ulcer 3.4 3.1 NA NA 4.3 3.0 3.5 3.0 in Long-Term Care *

The number of potentially avoidable visits to the emergency department made 44.7 44.7 44.7 44.7 44.7 44.7 39.2 32.0 by residents of long-term care homes (LTCH) per 100 LTCH residents admitted **

# Admissions to LTC homes 19 8 NA 5 6 38 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 (MOHLTC), and Health Quality Ontario (HQO). 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 (LHH) 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 FY 2015- 2016.

7 Acronyms Used

CIHI – Canadian Institute for Health Information LHH – Local Health Hub “-“ – Not Available or suppressed ED – Emergency Department LTC – Long-Term Care SU – Substance Use HCC – Home and Community Care LTCH – Long-Term Care Homes PD - Physical Disability IDN – Integrated District Network MH – Mental Health

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

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