Final

Appendix 1d:

Health Services Inventory – Rainy River Final

Contents

Health Services Inventory – Rainy River District 1

PopulationEstimatesandProjections 1 AcuteCareHospitalsinRainyRiverDistrict 2 Access to Health Services in Rainy River District 3 Emergency Department Care 8 Long Term Care 10 Community Mental Health and Addictions 12 Emergency Department Use 14 Ambulatory Care Sensitive Conditions 18 HospitalAmbulatoryClinics 19 AlternateLevelofCareDays:Acute 20 Inpatient Days for External Causes 21 Forecasting Health Services in Rainy River District 22 HBAM:ClinicallyAdjustedForecasts 26 Final

Rainy River District: Summary of Empirical Analysis

Population Estimates and Projections

Rainy River District accounts for 9 percent of the North West LHIN’s population and is expected to shrink by 3 percent over the next 10 years. Expected growth rates vary by age group. For example, the population aged 0 to 19 is expected to decrease by 11 percent over the next 10 years while the population of 65 to 79 year olds expected to increase by 34 percent.

Rainy River District

10-year Age Group 2009 2019 Growth

00-19 5,681 5,031 -11%

20-44 6,226 6,043 -3%

45-64 6,351 5,743 -10%

65-79 2,392 3,195 34%

80+ 1,117 1,163 4%

Total 21,767 21,175 -3%

NW LHIN 239,579 238,464 0% Total

Source: Ministry of Finance Population Estimates

Rainy River has the North West LHIN’s lowest rate of population growth in the population 65 and older. Rainy River also has the LHIN’s fastest shrinking population in the 45-64 age group.

Comparison of 10-Year Population Growth Forecasts by sub- LHIN

Rainy Thunder Thunder North Age River Bay Bay West Group District District City District LHIN

00-19 -7% -11% -16% -17% -13%

20-44 4% -3% -7% -7% -3%

45-64 4% -10% -7% -8% -4%

65-79 46% 34% 42% 43% 42%

80+ 19% 4% 14% 14% 14%

Health Services Inventory: Rainy River District: Final 1 Final

Comparison of 10-Year Population Growth Forecasts by sub- LHIN

Rainy Thunder Thunder North Age Kenora River Bay Bay West Group District District City District LHIN

Total 5% -3% -2% -4% 0%

Source: Ontario Ministry of Finance Population Estimates

Acute Care Hospitals in Rainy River District

The table below summarizes the 2009/10 admissions and inpatient days at Rainy River district’s hospitals. The table includes acute care admissions for mental health diagnoses, but excludes admissions to designated mental health beds.

Share of Share of Acute Facility Admissions Days District's LHIN's Beds Admissions Admissions

Atikokan General 343 2,146 11 14% 1%

Riverside - EMO 76 560 3 3% 0%

Riverside-FORTFRANCES 1,888 7,862 27 78% 6%

Riverside - RAINY RIVER 120 797 3 5% 0%

Rainy River Total 2,427 11,365 44 100% 8%

Source: DAD 2009/10; North West LHIN Health Services Inventory

The table below shows the number of beds of each type at Rainy River district hospitals.

Inpatient Mental Newborn Hospital Acute CCC ELDCAP Total Rehab Health Bassinets

ATIKOKAN General 11 8 2 22 43

FORT FRANCES RIVERSIDE - FORT 27 6 6 39 FRANCES

FORT FRANCES RIVERSIDE - EMO 3 12 15

FORT FRANCES RIVERSIDE - RAINY 3 21 24 RIVER

Rainy River District 44 14 8 55 121

Source: North West LHIN Health Services Inventory

Health Services Inventory: Rainy River District: Final 2 Final

The table below shows that Rainy River residents received most of their acute care from local hospitals. 71 percent of the total inpatient days among Rainy River residents were provided by hospitals in Rainy River district, while 22 percent of days were provided at Thunder Bay Regional Health Sciences Centre.

Market share of acute inpatient days by sub-LHIN 2009/10

Rainy Thunder Thunder Kenora Other Total Sub-LHIN of Patient River Bay Bay District LHIN Days District City District

Kenora District 76% 0% 22% 0% 2% 45,312

Rainy River District 4% 71% 22% 0% 3% 14,255

Thunder Bay City 0% 0% 93% 0% 7% 94,928

Thunder Bay District 1% 0% 42% 50% 6% 23,732

Total Days 35,407 10,531 111,248 12,057 8,984 178,227

Source: DAD 2009/10

Access to Health Services in Rainy River District

Acute Inpatient and Day Surgery

The table below shows the ratio of actual to expected inpatient days by diagnosis chapter for each of the NW LHIN’s sub-LHINs. The expected number of inpatient days controls for differences in the age and sex profiles of each sub-LHIN’s population and is based on the provincial average rate of inpatient days per capital in 2009/10.

For example, the number of inpatient days per capita in Rainy River district for Infectious and Parasitic Diseases was 1.77 times higher than expected.

Thunder Kenora Thunder Rainy River District Bay District Bay City District

Actual to Inpatient Actual to Actual to Actual to Chapter Expected Days Expected Expected Expected

01 Infectious/Parasitic Diseases 1.21 513 1.77 1.09 0.97

02 Neoplasms 1.24 1,376 1.20 1.42 1.07

03 Blood and Immune 2.12 134 1.15 1.94 1.91

Health Services Inventory: Rainy River District: Final 3 Final

Thunder Kenora Thunder Rainy River District Bay District Bay City District

Actual to Inpatient Actual to Actual to Actual to Chapter Expected Days Expected Expected Expected

04 Endocrine, Nutrition, Metabolic 2.41 556 1.08 3.09 2.54

05 Mental and Behavioural 2.32 803 1.37 3.13 1.22

06 Nervous System 1.38 308 1.12 1.18 1.08

07 Eye and Adnexa 2.01 12 1.31 1.24 2.87

08 Ear and Mastoid 2.81 68 2.64 3.11 2.45

09 Circulatory 1.43 2,158 1.00 2.43 1.50

10Respiratory 1.56 1,312 1.18 2.15 1.40

11 Digestive 1.52 1,170 1.01 1.85 1.83

12SkinandSubcutaneousTissue 2.84 145 1.11 1.45 2.13

13 Musculoskeletal and Connective 1.68 744 1.31 1.38 1.25

14 Genitourinary 1.52 361 0.66 1.56 1.52

15 Pregnancy and Childbirth 1.21 797 1.04 1.37 1.12

16 Perinatal Period 0.56 99 0.23 1.53 1.61

17 Congenital and Chromosomal 0.24 30 0.38 1.05 1.27

19 Injury and Poisoning 1.60 1,326 1.06 2.04 1.39

20 External Causes 3.39 3,023 2.70 6.03 0.94

Source: DAD 2009/10

Access to acute inpatient and day surgery in the North West LHIN was measured using the HBAM framework. HBAM accounts for population size, socio-demographic characteristics (including rural geography and socioeconomic status) and health characteristics. In the table below, positive variances indicate higher use of acute inpatient and day surgery resources than expected and negative variances indicate lower use than expected. Under HBAM, expected service use is the provincial average service use conditional on the patient’s age, SES, rural geography, and disease group. Importantly, expected service use is conditional on admission. Variance therefore shows the difference between actual and expected services for patients admitted to hospital. Regions with high rates of hospital use, including the North West LHIN, do not automatically have high variances.

Health Services Inventory: Rainy River District: Final 4 Final

Rainy Thunder Thunder North Kenora Chapter River Bay Bay LHIN District District District City Total

01 Infectious/Parasitic Diseases 3.1% -8.1% 9.3% -4.0% -1.8%

02 Neoplasms 2.2% -0.3% -1.3% 1.8% 1.3%

03 Blood and Immune -14.0% 19.7% -17.0% -9.1% -9.6%

04 Endocrine, Nutrition, Metabolic -1.0% -12.5% -9.5% 8.2% 2.7%

05 Mental and Behavioural 12.4% -38.1% 13.2% 15.5% 5.7%

06 Nervous System 3.7% 8.2% -5.6% -5.1% -1.3%

07 Eye and Adnexa 9.6% -0.1% -14.3% 4.1% 4.0%

08 Ear and Mastoid -6.8% -2.9% -2.3% -7.3% -6.1%

09 Circulatory -5.1% -0.9% 3.9% 5.9% 2.8%

10 Respiratory -2.7% 5.7% -15.3% -1.3% -3.0%

11 Digestive -0.8% -11.3% 16.9% 1.1% 1.4%

12 Skin and Subcutaneous Tissue -6.3% -5.5% -23.9% 2.3% -3.9%

13 Musculoskeletal and Connective -1.0% 2.7% -5.0% 3.0% 1.1%

14 Genitourinary 2.4% 5.0% -6.0% 3.3% 2.3%

15 Pregnancy and Childbirth -0.3% 0.1% 0.4% -1.0% -0.5%

16 Perinatal Period 0.0% 0.0% 0.0% 0.0% 0.0%

17 Congenital and Chromosomal -0.5% 17.7% 12.5% 0.6% 2.5%

19 Injury and Poisoning -0.7% -7.9% 1.0% -0.5% -1.1%

20 External Causes 0.8% -0.7% -0.8% -1.3% -0.4%

Total Variance -1.2% -2.1% -0.7% 1.8% 0.4%

Source: HBAM 2009/10

Overall, acute service use among Rainy River district’s population was 2.1 percent less than expected. Variance from the population perspective assesses the actual use of services by the district or LHIN’s population regardless of where (in Ontario) they received care. Resource use was higher than expected in the Genitourinary, Infectious and Parasitic Diseases, and Nervous System chapters. Resource use was lower than expected in the Circulatory and Respiratory chapters.

The table below shows variance by clinical chapter for the hospitals in Rainy River district. Overall, Rainy River district hospitals provided 3.7 percent less service than expected given the characteristics of their patients. Atikokan General Hospital had the largest negative variance of all hospitals in Rainy River district.

Health Services Inventory: Rainy River District: Final 5 Final

HBAM Acute Service Variance by Hospital, 2009/10

Actual Expected Hospital Name Weighted Weighted Variance Cases Cases

Dryden Regional Health Centre 1,659 1,687 -1.7%

Kenora Lake-Of-The-Woods District 2,617 2,653 -1.4%

Red Lake Marg Cochenour 597 633 -5.6% Memorial

Sioux Lookout Meno-Ya-Win 1,424 1,446 -1.5%

Kenora District 6,297 6,418 -1.9%

Atikokan General 313 333 -6.0%

Fort Frances Riverside Health Care 1,698 1,756 -3.3%

Rainy River District 2,011 2,088 -3.7%

Thunder Bay Regional Health 22,989 22,718 1.2% Sciences Centre

Thunder Bay City 22,989 22,718 1.2%

Geraldton District Hospital 594 644 -7.6%

Manitouwadge General 225 221 1.9%

Marathon Wilson Memorial 368 371 -0.7%

Nipigon District Memorial 410 436 -5.9%

Terrace Bay McCausland 240 249 -3.7%

Thunder Bay District 1,838 1,920 -4.3%

Total 33,135 33,145 0.0%

Source: HBAM 2009/10

Health Services Inventory: Rainy River District: Final 6 Final

The table below shows the percentage of admissions by residents of North West LHIN that occurred at Manitoba hospitals. Overall, 10 percent of all acute care admissions among Rainy River’s population were to hospitals in Manitoba. This percentage varies by clinical program.

North West LHIN Patients Total Acute Admissions among NW Percentage Admitted to Manitoba Hospitalized in Manitoba LHIN Residents Hospitals

North North Thunde Rainy Thunde Rainy Clinical Program Kenora West Kenora West r Bay River r Bay River LHIN LHIN

01 Infectious/Parasitic Diseases 203 41 128 376 0% 5% 21% 8%

02 Neoplasms 1,028 149 393 1,578 1% 21% 31% 10%

03 Blood and Immune 210 27 91 330 1% 0% 3% 2%

04 Endocrine, Nutrition, 784 95 313 1,199 1% 11% 14% 5% Metabolic

05 Mental and Behavioural 513 139 339 998 1% 0% 3% 1%

06 Nervous System 311 67 161 543 0% 3% 22% 7%

07 Eye and Adnexa 40 14 36 90 50% 71% 72% 62%

08 Ear and Mastoid 115 25 43 184 0% 0% 2% 1%

09Circulatory 3,119 470 1,243 4,851 2% 14% 17% 7%

10 Respiratory 1,774 270 816 2,877 0% 4% 9% 3%

11 Digestive 2,260 317 934 3,559 0% 9% 12% 4%

12 Skin and Subcutaneous Tissue 219 35 127 384 1% 6% 9% 4%

13 Musculoskeletal and 913 162 381 1,465 0% 9% 20% 6% Connective

14 Genitourinary 1,056 142 455 1,666 1% 18% 22% 8%

15 Pregnancy and Childbirth 2,474 447 1,997 4,932 0% 5% 15% 7%

16 Perinatal Period 618 40 358 1,019 0% 28% 29% 11%

17CongenitalandChromosomal 125 14 47 186 2% 43% 55% 18%

19 Injury and Poisoning 1,709 264 915 2,904 1% 10% 18% 7%

20 External Causes 1,494 444 868 2,818 1% 7% 15% 6%

31,96 Total 18,965 3,164 9,648 1% 10% 16% 6% 4

Source: National DAD 2009/10, accessed via CIHI Portal by NW LHIN Staff

Health Services Inventory: Rainy River District: Final 7 Final

Emergency Department Care

The table below shows HBAM emergency department variance for residents of the Rainy River district. As in the acute and day surgery module, HBAM accounts for the socio-demographic and health characteristics of the district’s population. Service variance can be affected by two factors: 1) variance in resource use for each admission; and 2) variance in the number of ED visits per year.

2009/10 ED 2009/10 2012/13 Chapter Weighted Cases Variance Variance

01 Infectious/Parasitic Diseases 19 -3.7% 2.2%

02 Neoplasms 14 -5.0% -0.1%

03 Blood and Immune 5 28.0% 28.5%

04 Endocrine, Nutrition, Metabolic 19 -3.1% 1.9%

05 Mental and Behavioural 27 0.3% 4.0%

06 Nervous System 26 17.8% 23.3%

07 Eye and Adnexa 4 1.7% 8.7%

08 Ear and Mastoid 19 1.4% 7.2%

09 Circulatory 125 11.1% 15.9%

10 Respiratory 140 7.5% 13.0%

11 Digestive 90 5.9% 10.0%

12 Skin and Subcutaneous Tissue 23 12.3% 16.5%

13 Musculoskeletal and Connective 28 28.4% 33.2%

14 Genitourinary 50 6.8% 11.0%

15 Pregnancy and Childbirth 12 0.7% 0.8%

16 Perinatal Period 1 0.0% 9.7%

17 Congenital and Chromosomal 0 19.3% 25.4%

19 Injury and Poisoning 134 0.9% 5.3%

20 External Causes 79 6.1% 10.1%

Rainy River Population 814 6.3% 11.0%

Kenora Population 1,980 -4.3% -2.5%

Thunder Bay District Population 1,071 17.6% 22.1%

Thunder Bay City Population 4,042 18.3% 23.0%

NW Population 7,907 10.4% 14.2%

Source: HBAM 2009/10

Health Services Inventory: Rainy River District: Final 8 Final

Rainy River district’s patients admitted to emergency departments in 2009/10 received 6.3 percent more service than expected. Service variance ranged across the clinical programs with Circulatory and Respiratory chapters having the highest variances.

Emergency Department Variance by Hospital

2009/10 2012/13 Hospital Variance Variance

Dryden Regional Health Centre -5.9% -4.2%

Lake-of –the-Woods District Hospital -3.7% -2.0%

Red Lake Marg Cochenour Memorial -5.2% -3.2%

Sioux Lookout Meno-Ya-WIN -2.4% 0.0%

Atikokan General Hospital 9.7% 14.3%

Riverside Health Care 5.0% 9.6%

Thunder Bay Regional Health Sciences Centre 17.1% 21.5%

GeraldtonDistrictHospital 15.4% 21.4%

Manitouwadge General Hospital 23.3% 26.9%

Wilson Memorial General Hospital 15.1% 20.0%

Nipigon District Memorial Hospital 18.2% 21.4%

McCausland Hospital 17.3% 20.1%

NW LHIN Hospital Total 10.1% 13.8%

Source: HBAM 2009/10

Atikokan General Hospital provided 10 percent more ED service than expected, while Riverside Health Care provided 5 percent more than expected.

Health Services Inventory: Rainy River District: Final 9 Final

HBAM Variance: Complex continuing care, Inpatient Rehabilitation, Home care, and Inpatient mental health

The table below shows variance by district for complex continuing care, inpatient rehabilitation, home care and inpatient mental health. Variance for these programs was estimated using the HBAM framework.

Inpatient Inpatient Home Patient Sub-LHIN CCC Mental Rehabilitation Care Health

Kenora District -17.5% -29.6% -9.7% 1.8%

Rainy River District 40.1% -69.9% -11.7% -0.4%

Thunder Bay District 46.6% -13.9% -13.6% 3.0%

Thunder Bay City 52.9% -6.5% -0.8% 1.3%

NW LHIN Population 39.9% -16.1% -4.6% 1.5%

Source: HBAM 2009/10

Based on their clinical and demographic characteristics, Rainy River residents had 40.1 percent less access to CCC services than expected, 69.9 percent less access to inpatient rehabilitation services, 11.7 percent less home care services than expected, and 0.4 percent more inpatient mental health service than expected. The CCC picture is likely incomplete given that LTC and CCC beds may often be used as substitutes in the NW LHIN. The LTC picture in Rainy River, presented later in this document, will help complete the assessment.

Long Term Care

The table below shows the number of LTC homes and beds available in Rainy River District. There was one LTC home with a total of 164 beds in 2009/10. There were also 55 ELDCAP beds available in the district at Atikokan General and Fort Frances Riverside’s Emo and Rainy River sites.

ELDCAP LTC LTC Home Total Beds Beds

Birchwood Terrace Nursing Home 96 96

Northwood Lodge Home for the Aged 32 32

Pinecrest Home for the Aged 126 126

Princess Court 97 97

William A. "Bill" George Extended Care Facility 20 20

Health Services Inventory: Rainy River District: Final 10 Final

ELDCAP LTC LTC Home Total Beds Beds

Kenora District Total 20 351 371

Atikokan General Hospital 22 22

Fort Francis Riverside - Emo 12 12

Fort Francis Riverside - Rainy River 21 21

Rainycrest Long-Term Care 164 164

Rainy River District Total 55 164 219

Bethammi Nursing Home 110 110

Dawson Court Home for the Aged 150 150

Grandview Lodge Home for the Aged 150 150

Hogarth Riverview Manor 96 96

Pinewood Court 128 128

Pioneer Ridge Home for the Aged 150 150

Roseview Manor 157 157

Thunder Bay Interim Long-Term Care Centre 65 65

Versa Care Limited 131 131

Thunder Bay City Total 1,137 1,137

Geraldton District Hospital 19 19

Manitouwadge General Hospital 9 9

Nipigon District Memorial Hospital 14 14

Wilkes Terrace 22 22

Thunder Bay District Total 42 22 64

North West LHIN Total 117 1,674 1,791

Source: North West CCAC, August 21, 2011

The table below shows the difference between the actual and expected discharges from acute care to Long Term Care and Complex Continuing Care for each patient sub-LHIN. Expected discharges to LTC/CCC were calculated based on the provincial average discharge probabilities by patient frailty. For example, in 2009/10, 51 fewer patients from Rainy River district were discharged to LTC/CCC than would have been the case at the provincial

Health Services Inventory: Rainy River District: Final 11 Final

average discharge practice. While acute care patients from Kenora, Rainy River, and Thunder Bay District were less likely to be discharged to LTC/CCC, patients from Thunder Bay City were much more likely to be discharged to LTC/CCC. At the provincial average, 420 fewer Thunder Bay City patients would have been discharged to LTC/CCC in 2009/10. Put differently, low frailty patients from Thunder Bay city are much more likely to be discharged to LTC/CCC than patients elsewhere in the LHIN. That there were 192 more actual acute discharges to LTC/CCC than expected in the LHIN in 2009/10 suggests that the combined supply of LTC/CCC resources in the LHIN is adequate for the requirements of the acute population.

The variation observed across the sub-LHIN areas suggests that the distribution or access to the LTC/CCC resources is inconsistent across the LHIN. Rainy River District had 65 fewer post-acute discharges to LTC than expected and 14 more discharges to CCC. Rainy River’s hospitalized patients therefore had 51 fewer discharges to CCC/LTC than expected.

Actual and Expected Discharges to LTC and CCC, 2009/10

Long Term Care Complex Continuing Care CCC/LTC Combined Actual - Actual - Actual - Sub-LHIN of Patient Actual Expected Actual Expected Expected Expected Expected

Kenora District 88 151 -63 54 108 -54 -117

Rainy River District 14 79 -65 66 52 14 -51

Thunder Bay District 12 69 -57 48 50 -2 -59

Thunder Bay City 363 383 -20 694 254 440 420

NW LHIN 477 683 -206 862 464 398 192

Source: DAD 2009/10

Community Mental Health and Addictions

The table below shows the CMH&A providers and their 2009/10 total operating expenses. Operating expenses were retrieved from MIS.

Operating CMH&A Provider Name Expenses 2009/10

FORT FRANCES Community Counselling 198,177

FORT FRANCES CMHA/Fort Frances 2,454,325

ATIKOKAN General 544,431

Health Services Inventory: Rainy River District: Final 12 Final

Operating CMH&A Provider Name Expenses 2009/10

FORT FRANCES RIVERSIDE HEALTH CARE FACILITIES INC 2,504,252

FORT FRANCES Gizhewaadiziwin 132,511

Rainy River District 5,833,696

Source: North West LHIN Health Services Inventory

The table below shows the total number of CMH&A clinic visits by sub-LHIN.

CMH & Addictions

CMH&A Clinic Rainy Thunder Kenora Thunder Visits 2009/10 River Bay District Bay City District District

FacetoFace 77,152 74,780 113,895 3,376

Telephone 22,075 6,665 38,543 798

Total Visits 99,227 81,445 152,438 4,174

Source: North West LHIN Health Services Inventory

Ratio of Clinic Visits to Acute Inpatient Mental Health Admissions

Hospital CMH&A Sub-LHIN of Hospital/Clinic All MH Clinic Clinic Clinic

Kenora District 0 182 182

Rainy River District 0 590 590

Thunder Bay City 25 97 122

Thunder Bay District 0 22 22

North West 16 138 154

Province 13 96 109

Source: North West LHIN Health Services Inventory; DAD 2009/10; OMHRS 2009/10

The North West LHIN had 154 mental health clinic visits per inpatient admission which was 42 percent higher than the provincial average. The results for Thunder Bay district may be spurious because of services provided by

Health Services Inventory: Rainy River District: Final 13 Final

agencies located in Thunder Bay city to residents of Thunder Bay district are assigned to Thunder Bay City. Lack of consistent client level data in this sector precludes identifying the sub-LHIN of the service recipient. It may therefore be more accurate to combine the activity for Thunder Bay City and Thunder Bay district for this analysis. The ratio of mental health clinic visits to inpatient admissions is 113 for the combined regions, which is approximately the provincial average. It is also important to note that discussions with the LHIN revealed that there may be agencies providing service that do not report data to Ontario Ministry of Health and Long Term Care’s MIS system.

On Reserve Expenses per Expenses per Sub-LHIN Expenses Population Aboriginal Capita - Off Capita Population Reserve

Kenora District $12,771,575 66,451 19,303 $192 $271

Rainy River District $5,833,696 21,767 2,204 $268 $298

Thunder Bay City $24,875,719 124,945 2,825 $199 $204

Thunder Bay District $3,694,196 26,416 923 $140 $145

North West LHIN Total $47,175,186 239,579 25,255 $197 $220

Source: MIS 2009/10; Ontario Ministry of Finance Population Estimates and Projections

The table above shows Community Mental Health and Addictions spending per capita by sub-LHIN. In all sub- LHINs spending per capita far exceeded the provincial average of $78. Because some Community Mental Health and Addiction providers located in Thunder Bay City provide services to residents of Thunder Bay District, it might be more accurate to combine these for this analysis. Spending per capita in the combined Thunder Bay City and Thunder Bay District sub-LHINs was $189.

Emergency Department Use

The table below shows the volume 2009/10 volume of emergency department visits by residents of the Rainy River District.

Rainy 1 - 2 - 3 - 4 - Less- 5 - Non- CTAS Level River Resuscitation Emergent Urgent urgent urgent Total

Atikokan General Hospital 1 42 510 2,057 1,441 4,051

Dryden Regional Health Centre 1 12 24 6 43

Geraldton District Hospital 1 4 4 9

Lake of the Woods District Hospital 6 35 63 17 121

Manitouwadge General Hospital 1 3 3 7

Health Services Inventory: Rainy River District: Final 14 Final

Rainy 1 - 2 - 3 - 4 - Less- 5 - Non- CTAS Level River Resuscitation Emergent Urgent urgent urgent Total

McCausland Hospital 1 3 4

Nipigon District Memorial Hospital 6 6

Red Lake Memorial Hospital 1 2 2 8 13

RIVERSIDE HEALTH CARE FAC-EMO SITE 3 29 169 574 775

RIVERSIDE HEALTH CARE FAC- 39 248 2,113 7,269 5,455 15,124 LAVERENDRYE

RIVERSIDE HEALTH CARE FAC-RAINY 2 48 239 797 1,279 2,365 RIVER

Sioux Lookout Meno Ya Win Health Centre 1 1 9 4 15

Thunder Bay Regional Health Sciences Centre 4 129 223 105 12 473

Wilson Memorial General Hospital 1 2 3

Rainy River Total 46 479 3,166 10,504 8,814 23,009

Source: NACRS 2009/10

This table shows 2009/10 CTAS level 1 and 2 ED visits by district of patient.

District of NW LHIN Resident

Rainy Thunder Thunder Kenora Facility Period of Admission to ED River Bay Bay Total District District City District

Weekday between 10pm and 7am 3 3 Atikokan General Weekday between 7am and 10pm 28 4 32 Hospital Weekend 12 12

Weekday between 10pm and 7am 81 1 82 Dryden Regional Weekday between 7am and 10pm 303 2 305 Health Centre Weekend 153 2 155

Weekday between 10pm and 7am 1 23 24 Geraldton District Weekday between 7am and 10pm 2 6 111 119 Hospital Weekend 1 52 53

Lake of the Woods Weekday between 10pm and 7am 101 1 102

Health Services Inventory: Rainy River District: Final 15 Final

District of NW LHIN Resident

Rainy Thunder Thunder Kenora Facility Period of Admission to ED River Bay Bay Total District District City District

District Hospital Weekday between 7am and 10pm 257 6 263

Weekend 138 138

Weekday between 10pm and 7am 1 1 Manitouwadge Weekday between 7am and 10pm 18 18 General Hospital Weekend 3 3

Weekday between 10pm and 7am 7 7 McCausland Weekday between 7am and 10pm 14 14 Hospital Weekend 6 6

Weekday between 10pm and 7am 5 5 Nipigon District Weekday between 7am and 10pm 3 36 39 Memorial Hospital Weekend 4 13 17

Weekday between 10pm and 7am 22 22 Red Lake Weekday between 7am and 10pm 56 2 58 Memorial Hospital Weekend 30 1 1 32

Weekday between 10pm and 7am RIVERSIDE HEALTH CARE Weekday between 7am and 10pm 3 3 FAC-EMO SITE Weekend

RIVERSIDE Weekday between 10pm and 7am 2 66 68 HEALTH CARE Weekday between 7am and 10pm 124 3 127 FAC- LAVERENDRYE Weekend 1 97 2 100

RIVERSIDE Weekday between 10pm and 7am 5 5 HEALTH CARE Weekday between 7am and 10pm 28 28 FAC-RAINY RIVER Weekend 1 17 18

Weekday between 10pm and 7am 15 15 Sioux Lookout Meno Ya Win Weekday between 7am and 10pm 86 1 1 88 Health Centre Weekend 36 1 37

Health Services Inventory: Rainy River District: Final 16 Final

District of NW LHIN Resident

Rainy Thunder Thunder Kenora Facility Period of Admission to ED River Bay Bay Total District District City District

Weekday between 10pm and 7am 127 20 2,658 142 2,947 Thunder Bay Regional Health Weekday between 7am and 10pm 294 82 11,106 520 12,002 Sciences Centre Weekend 179 31 5,220 226 5,656

Weekday between 10pm and 7am 2 14 16 Wilson Memorial Weekday between 7am and 10pm 7 110 117 General Hospital Weekend 1 4 48 53

Total 1,885 525 19,030 1,350 22,790

Source: NACRS 2009/10

Visits per Person among Emergency Department Users

This table shows the average annual number of visits to the ED among people with at least one ED visit. Overall, ED users in Rainy River had an average of 2.6 visits per person which is 43 percent higher than the provincial average of 1.8 visits per person. ED visits per person for Mental and Behavioural diagnoses was 3.1 in Rainy River, and was 38 percent higher than the provincial average of 2.3. Visits per person for Neoplasms were 131 percent higher in Rainy River than the provincial average.

Thunder Kenora Thunder Rainy River District Bay Ontario District Bay City District

Visits Visits Visits Visits Visits Chapter per Visits per per per per Person Person Person Person Person

01 Infectious/Parasitic Diseases 2.0 884 2.3 2.2 1.8 1.7

02 Neoplasms 2.6 614 5.5 3.8 3.0 2.4

03 Blood and Immune 2.3 20 2.5 5.5 2.7 2.3

04 Endocrine, Nutrition, Metabolic 2.7 293 2.5 5.9 2.2 2.1

05 Mental and Behavioural 3.1 565 3.1 3.7 2.8 2.3

06 Nervous System 2.5 684 3.0 3.4 2.1 2.0

07 Eye and Adnexa 1.8 472 2.2 2.4 1.8 1.6

08 Ear and Mastoid 2.1 1,183 2.3 2.3 1.9 1.7

Health Services Inventory: Rainy River District: Final 17 Final

Thunder Kenora Thunder Rainy River District Bay Ontario District Bay City District

Visits Visits Visits Visits Visits Chapter per Visits per per per per Person Person Person Person Person

09 Circulatory 2.3 1,530 2.9 3.0 2.1 1.8

10 Respiratory 2.2 3,945 2.2 2.7 2.0 1.8

11 Digestive 2.4 1,571 2.5 2.8 2.1 1.8

12 Skin and Subcutaneous Tissue 2.5 1,743 3.0 3.5 2.8 2.2

13 Musculoskeletal and Connective 2.3 1,805 2.7 3.1 2.1 1.8

14 Genitourinary 2.4 1,236 2.6 2.8 2.2 1.9

15 Pregnancy and Childbirth 2.6 237 2.8 3.1 2.2 2.0

16 Perinatal Period 2.3 60 4.0 2.2 3.0 1.8

17 Congenital and Chromosomal 1.9 7 7.0 4.3 1.6 2.0

19 Injury and Poisoning 2.0 4,579 2.2 2.4 1.8 1.6

20 External Causes 2.6 2,961 3.1 4.0 2.3 2.0

Total 2.3 24,389 2.6 3.0 2.1 1.8

Source: NACRS 2009/10

Ambulatory Care Sensitive Conditions

The table below shows by district of patient, the hospital admissions for ambulatory care sensitive conditions that would have been avoided if the district had had the provincial average standardized admission rate.

Potentially Avoidable 2009/10 Hospital Admissions at Provincial Average Standardized Admission Rate

Rainy Thunder Ambulatory Care Sensitive Kenora Thunder River Bay Total Condition District Bay City District District

Influenza / pneumonia 167 57 111 394 729

COPD 50 38 57 266 411

Atrial fibrillation 36 28 16 98 178

Health Services Inventory: Rainy River District: Final 18 Final

Rainy Thunder Ambulatory Care Sensitive Kenora Thunder River Bay Total Condition District Bay City District District

Diabetes with complications 45 27 52 79 203

Angina 53 24 30 84 192

Alcohol related 136 24 41 45 246

CHF 32 19 23 141 216

Fractured promixalfemur 13 17 -2 33 62

Senility dementia 15 14 1 0 30

Cellulitis 44 13 12 87 155

Total Rainy River Top 10 592 261 340 1,229 2,421

All ACSC 701 324 403 1,439 2,867

Source: DAD 2009/10

Rainy River patients with influenza / pneumonia had high rates of admission to acute hospitals. At the provincial average rate of admission, controlling for the age and sex profile of the district’s population, Rainy River patients would have had 57 fewer admissions for influenza / pneumonia in 2009/10. Rainy River’s top 10 ACSC by potentially avoidable admissions accounted for 261 of 324 total potentially avoidable admissions.

Hospital Ambulatory Clinics

The high rates of admissions for ambulatory care sensitive conditions observed in Rainy River and throughout the NW LHIN prompts an examination of the availability of ambulatory care. The table below shows the ratio of hospital-based ambulatory clinic visits to inpatient admissions in 2009/10. These ratios aim to assess the mix of ambulatory and inpatient activity at each hospital.

Hospital Ambulatory Clinic Visits per Inpatient Admission, 2009/10.

Diabetes , Combined Mental Cardiac Geriatric Oncology Endocrinology All Sub-LHIN of Hospital Medical / Health Clinics Clinics Clinics and Metabolic Clinics Surgical Clinics Clinics

Kenora District 3.3 0.0 0.0 0.0 18.2 0.0 3.8

Rainy River District 0.3 0.0 0.0 0.0 10.9 0.0 0.7

Thunder Bay City 3.1 31.8 4.3 1.2 30.5 8.8 9.6

Health Services Inventory: Rainy River District: Final 19 Final

Diabetes , Combined Mental Cardiac Geriatric Oncology Endocrinology All Sub-LHIN of Hospital Medical / Health Clinics Clinics Clinics and Metabolic Clinics Surgical Clinics Clinics

Thunder Bay District 1.2 0.0 0.0 0.0 3.9 0.0 1.3

North West LHIN Total 2.8 27.0 2.8 0.7 26.9 5.5 7.1

Provincial LHIN 5.2 17.3 2.9 0.5 18.5 13.0 8.6 AVERAGE

Source: North West LHIN Health Services Inventory; DAD 2009/10

The table shows that Rainy River’s hospitals had fewer ambulatory clinic visits per admission for all clinic types. Overall, the ratio of clinic visits per admission was less than one tenth the provincial average.

Alternate Level of Care Days: Acute

The table below shows the top case mix groups by ALC among Rainy River district’s hospitalized patients. Awaiting Placement, Convalescence, Palliative, and Rehabilitation accounted for the highest number of ALC days among Rainy River’s hospitalized patients.

Rainy River Sub-LHIN High ALC Users Low ALC Users

Total ALC ALC ALC ALC CMG ALC Patients Days Patients Days Days

809 Await Placement 2 131 11 148 279

806 Convalescence 0 0 17 187 187

810 Palliative 1 43 6 137 180

805 Rehabilitation 3 94 4 44 138

670 Dementia 1 30 6 102 132

812 Other Factors 0 0 12 126 126

19 Significant Trauma - Other 1 91 0 0 91

811 General Symptom/Sign 0 0 5 76 76

193-194, 196 Myocardial Infarction/HeartFail 0 0 5 68 68

17 Mental Diseases And Disorders - Other 1 53 2 9 62

06 Digestive System - Other 0 0 3 56 56

202 Arrhythmia 0 0 2 39 39

Health Services Inventory: Rainy River District: Final 20 Final

Rainy River Sub-LHIN High ALC Users Low ALC Users

Total ALC ALC ALC ALC CMG ALC Patients Days Patients Days Days

11 Kidney And Urinary Tract - Other 1 29 1 8 37

12 Female Reproductive System - Other 0 0 1 36 36

025-028 Stroke 0 0 6 33 33

135-139 Pneumonia/COPD 0 0 4 33 33

180 Amputation of Limb except Hand/Foot 1 29 0 0 29

05 Circulatory System - Other 0 0 2 22 22

07 Hepatobiliary System And Pancreas - Other 0 0 1 19 19

10 Endocrine, Nutritional And Metabolic Disorders - Other 0 0 1 18 18

Other CMGs 0 0 15 113 113

Total 11 500 104 1,274 1,774

Source: DAD 2009/10

The table above shows that Rainy River patients had long ALC days in hospital for awaiting placement, convalescent, and palliative care. These findings are consistent, and are likely associated, with those presented earlier showing that residents of Rainy district had less access to inpatient rehabilitation and home care services. It was also shown earlier that Rainy River’s post-acute population had less access than expected to CCC and LTC.

Inpatient Days for External Causes

As presented earlier, Rainy River’s standardized rate of inpatient days per capita for in ‘External Causes’ was 2.7 times the provincial average in 2009/10. The table below shows that the majority of days in External Causes were associated with palliative care, rehabilitation care, awaiting placement, and convalescent care.

Rainy River District

Rainy Thunder Kenora Thunder Diagnosis River Bay District Bay City District District

PALLIATIVE CARE 940 668 273 1541

OTHER PHYSICAL THERAPY (Rehabilitation care; fitting of prostheses; and adjustment 1891 421 34 of devices)

PERSON AWAITING ADMISSION TO ADEQUATE FACILITY ELSEWHERE 1343 418 1408 57

Health Services Inventory: Rainy River District: Final 21 Final

Rainy River District

Rainy Thunder Kenora Thunder Diagnosis River Bay District Bay City District District

CONVALESCENCE FOLLOWING SURGERY 1228 346 937 497

NEED FOR ASSISTANCE AT HOME AND NO OTHER HOUSEHOLD MEMBER ABLE 277 228 69 TO PROVIDE

CONVALESCENCE FOLLOWING TREATMENT OF FRACTURE 317 115 61 37

CARE INVOLVING USE OF OTHER REHABILITATION PROCEDURES 171 90

MALAISE AND FATIGUE 128 78 1561 159

CONVALESCENCE FOLLOWING OTHER TREATMENT 478 75 87 85

SYNCOPE AND COLLAPSE 133 73 56 427

OTHER AND UNSPECIFIED ABDOMINAL PAIN 190 58 51 392

PAIN MANAGEMENT THERAPY FOR OTHER AND UNSPECIFIED PAIN 15 52 18 172

CONVALESCENCE FOLLOWING COMBINED TREATMENT 76 33 72

HOLIDAY RELIEF CARE 72 33 38

NAUSEA WITH VOMITING 23 33 3 180

Total Rainy River Top 15 Diagnoses 7,282 2,721 4,668 3,547

Total Days in External Causes 8,243 3,023 6,090 6,063

Share of Rainy River's Top 15 Diagnoses 88% 90% 77% 59%

Source: DAD 2009/10

Forecasting Health Services in Rainy River District

The table below shows 10 year forecast growth by clinical chapter for residents of the Rainy River District. Rainy River District has the LHIN’s lowest expected growth rate, which is consistent with the expectations for population growth presented earlier.

Because requirements for health services in the Rainy River district are expected to grow slower than the LHIN average, the district will gradually decrease its share of the LHIN’s health care resources.

Among the larger programs, growth is expected to be highest in Circulatory care (14 percent), cancer care (14 percent), and respiratory care (10 percent).

Health Services Inventory: Rainy River District: Final 22 Final

10-year Growth Forecast by Chapter for Acute Inpatient and Day Surgical Care, 2009/10

2009/10 Activity Expected 10-year Growth

Chapter Cases Days RIW Cases Days RIW

01 Infectious/Parasitic Diseases 67 784 197 11% 11% 11%

02 Neoplasms 152 1,562 302 13% 14% 15%

03 Blood and Immune 23 125 20 2% 6% 4%

04 Endocrine, Nutrition, Metabolic 74 480 89 8% 14% 13%

05 Mental and Behavioural 10 54 10 9% 10% 10%

06 Nervous System 67 379 91 1% -4% -10%

07 Eye and Adnexa 4 12 3 -9% -11% -10%

08 Ear and Mastoid 15 42 8 8% 13% 11%

09 Circulatory 483 2,744 539 13% 14% 14%

10 Respiratory 278 1,403 314 8% 10% 8%

11 Digestive 233 863 189 3% 4% 4%

12 Skin and Subcutaneous Tissue 39 191 34 2% 6% 4%

13 Musculoskeletal and Connective 154 704 193 12% 13% 13%

14 Genitourinary 114 391 94 -5% 0% -3%

15 Pregnancy and Childbirth 412 785 157 8% 7% 7%

16 Perinatal Period 29 99 13 7% 7% 8%

17 Congenital and Chromosomal 6 19 5 3% 2% 0%

19 Injury and Poisoning 267 1,610 355 8% 13% 13%

20 External Causes 273 2,008 293 9% 14% 13%

Rainy River District Total 2,700 14,255 2,905 8% 11% 10%

Kenora District Total 7,645 45,312 8,608 16% 21% 20%

ThunderBayDistrictTotal 3,357 23,732 4,562 8% 15% 14%

Thunder Bay City Total 14,736 94,928 19,394 9% 14% 13%

NWLHINTotal 28,438 178,227 35,468 11% 16% 15%

Source: HBAM 2009/10; DAD 2009/10

Health Services Inventory: Rainy River District: Final 23 Final

Growth by Hospital

10-year Growth Forecast by Hospital for Acute Inpatient and Day Surgical Care, 2009/10

Actual 2009/10 Activity Expected 10-year Growth

Hospital Name Cases Days RIW Cases Days RIW

Dryden Regional Health Centre 1,287 9,759 1,659 19% 21% 21%

Kenora Lake-Of-The-Woods District 2,366 14,208 2,617 18% 22% 21%

Red Lake Marg Cochenour Memorial 784 3,153 597 14% 23% 19%

Sioux Lookout Meno-Ya-Win 1,849 8,966 1,424 12% 20% 17%

Kenora District Total 6,286 36,086 6,297 16% 22% 20%

Atikokan General 302 2,005 313 8% 13% 13%

Fort Frances Riverside Health Care - Emo 71 490 84 15% 16% 16%

Fort Frances Riverside Health Care - 1,764 7,298 1,492 8% 11% 11% Laverendrye

Fort Frances Riverside Health Care - Rainy 114 782 122 14% 13% 14% River

Rainy River District Total 2,251 10,575 2,011 9% 12% 12%

Thunder Bay Regional Health Sciences 17,721 113,294 22,989 9% 14% 13%

Thunder Bay City Total 17,721 113,294 22,989 9% 14% 13%

Geraldton District Hospital 465 3,700 594 9% 21% 22%

Manitouwadge General 136 1,599 225 15% 26% 25%

Marathon Wilson Memorial 278 2,462 368 6% 15% 14%

Nipigon District Memorial 365 2,808 410 17% 26% 23%

Terrace Bay McCausland 192 1,645 240 14% 14% 14%

Thunder Bay District Total 1,436 12,214 1,838 12% 20% 20%

NW LHIN Hospital Total 27,694 172,169 33,135 11% 16% 15%

Source: HBAM 2009/10; DAD 2009/10

Health Services Inventory: Rainy River District: Final 24 Final

Forecast 10-year Growth

Mental Complex Inpatient Health Home Care Long Term Continuing Rehabilitation Inpatient Expenses Care Care Days Days Days

Kenora District 12% 17% 18% 18% 22%

Rainy River District 4% 7% 9% 16% 11%

Thunder Bay District 8% 13% 18% 15% 20%

Thunder Bay City 3% 15% 19% 19% 20%

North West LHIN 5% 14% 18% 18% 20% Total

10-Year Forecasts of Community Sector Growth in Expenses

2009/10 Expenses

Assisted Living Community CMH & Services in Support Addiction Total Supportive Services Agencies Housing

Kenora District $2,156,444 1,052,037 12,771,575 28,825,341

Rainy River District 566,320 22,295 5,833,696 12,600,102

Thunder Bay City 9,413,310 3,015,528 27,160,288 82,419,298

Thunder Bay District 348,533 1,409,627 2,586,888

North West LHIN 12,484,607 4,089,860 47,175,186 126,431,628

Health Services Inventory: Rainy River District: Final 25 Final

Forecast 10-Year Growth

Assisted Living Community CMH & Services in Support Addiction Total Supportive Services Agencies Housing

Kenora District 17% 17% 12% 17%

Rainy River District 7% 7% 4% 8%

ThunderBayCity 15% 15% 3% 14%

Thunder Bay District 13% 8% 13%

North West LHIN 15% 15% 6% 14%

10 Year Forecast Expenses

Assisted Living Community CMH & Services in Support Addiction Total Supportive Services Agencies Housing

Kenora District $2,523,206 1,230,964 14,360,570 33,792,831

Rainy River District 605,211 23,826 6,074,536 13,559,855

Thunder Bay City 10,789,773 3,456,475 28,024,450 93,880,628

Thunder Bay District 393,982 1,527,949 2,918,356

North West LHIN 14,312,171 4,711,264 49,987,505 144,151,669

Source: North West LHIN Health Services Inventory; HBAM 2009/10

HBAM: Clinically Adjusted Forecasts

The table below shows naïve and HBAM-CAP forecasts of inpatient days by clinical chapter for residents of Rainy River district. Chapters with large differences between the HBAM and HBAM-CAP forecasts are those where rates of hospital service use in Rainy River are very different from the provincial reference rates. For example, under the naïve HBAM forecasts, acute inpatient days required by Rainy River’s population for cancer care are expected to increase by 29 percent over the next 10 years. The naïve forecasts are based on Rainy River district’s 2009/10 rate of acute inpatient days for neoplasms and account for population growth and aging. HBAM-CAP forecasts also account for population changes, but assume that the Rainy River district will move towards the 2009/10 provincial

Health Services Inventory: Rainy River District: Final 26 Final

25th percentile rate of inpatient days for neoplasms. Under the HBAM-CAP assumptions, the number of inpatient days for neoplasms would decrease by 18 percent over the next 10 years.

10-year Growth

Share of HBAM- Chapter 2009/10 HBAM CAP Days

01 Infectious/Parasitic Diseases 4% 25% 30%

02 Neoplasms 10% 29% -18%

03 Blood and Immune 1% 16% 5%

04 Endocrine, Nutrition, Metabolic 4% 25% 20%

06 Nervous System 2% 16% -10%

07 Eye and Adnexa 0% 35% -30%

08 Ear and Mastoid 0% 18% -10%

09 Circulatory 15% 27% -14%

10 Respiratory 9% 20% -7%

11 Digestive 8% 16% -1%

12 Skin and Subcutaneous Tissue 1% 3% 0%

13 Musculoskeletal and Connective 5% 21% 9%

14 Genitourinary 3% 21% 9%

15 Pregnancy and Childbirth 6% 12% -9%

16 Perinatal Period 1% 9% 0%

17 Congenital and Chromosomal 0% 4% 2%

19 Injury and Poisoning 9% 16% 13%

20 External Causes 21% 24% -2%

Rainy River District Total 100% 11% -2%

Kenora District Total 100% 21% 4%

Thunder Bay District 100% 15% 3%

Thunder Bay City Total 100% 14% 0%

North West LHIN Total 100% 16% 1%

Source: HBAM, HBAM-CAP 2009/10

Health Services Inventory: Rainy River District: Final 27