Health Services Department to Extendicare Once Approval Has Been Given from Committee

The District Municipality of Muskoka

Health Services Committee

Meeting HS-12-2019

Minutes

Place: Council Chamber, District Administration Building

Time: 9:00 a.m.

Date: November 21, 2019

Present: Committee Chair S. Clement; District Chair J. Klinck Members P. Cooper, T. Glover, R. Nishikawa

Absent: Members S. Cairns, T. Withey

Officials Present: M. Duben, Chief Administrative Officer; N. Barrette, Commissioner, Health Services

Also Present: K. Landry, Administrator, The Pines; S. McKinnon, Deputy Chief, Paramedic Services and Emergency Planning; R. Jackson, Administrative Assistant; C. Hammond, Deputy Clerk

Call to Order

Committee Chair Clement called the meeting to order at 9:03 a.m.

Declaration of Pecuniary Interests

None were declared.

Muskoka Paramedic Services a) Muskoka Paramedic Services (MPS) Single Source Stretcher Purchase Request Report HS-12-2019-2

Mr. McKinnon outlined the background and reasons for the single source purchase of stretchers.

Moved by P. Cooper and seconded by T. Glover R32/2019-HS

THAT approval be granted to single source Stryker Canada for the replacement of the currently utilized Stryker Power Pro stretchers; AND THAT approval be granted to single source Rowlands Emergency Vehicle Products Inc., for the purchase of replacement parts and maintenance for Stryker Power Pro stretchers:

AND THAT the Commissioner of Health Services and the Chief Administrative Officer be authorized to execute the purchase agreements with Stryker Canada, Rowlands Emergency Vehicle Products Inc. or the future authorized sales and service provider as determined by Stryker Canada for up to a five- year term effective January 1, 2020.

Carried.

Mr. McKinnon departed the meeting at 9:07 a.m.

Health Services a) Health Services Committee Representatives on the Board of the Simcoe Muskoka District Health Unit (SMDHU) Verbal Update

Mr. Barrette advised that a letter was received from SMDHU regarding Public Health Modernization which would be brought forward to District Council in December.

Long-Term Care a) Presentation – AdvantAge Ontario Report Released: Long-Term Care Homes Program – A review of the Plan to Create 15,000 New Long-Term Care Beds in Ontario Presentation HS-12-2019-5

Mr. Barrette reviewed the wait time targets, benchmarking, regional impact and long term implications related to the Long-Term Care Homes Program. He confirmed that wait times assist in determining provincial approval of new beds however the approvals are based on health boundaries not municipal boundaries and local allocations include Simcoe County. Mr. Barrette also confirmed that wait time statistics for long-term care homes in the District of Muskoka would be provided at a future meeting.

To access the presentation please click on the following link: https://muskoka.civicweb.net/document/34766 b) Extension of Consulting Contract with Extendicare (Canada) Inc. Report HS-12-2019-4

Ms. Landry highlighted the one-year contract extension and confirmed that a review would be completed to determine if any of the services currently contracted to Extendicare could be completed by District staff in the future.

Moved by T. Glover and seconded by J. Klinck R33/2019-HS

THAT Muskoka District Council authorize an extension for up to one (1) year with Extendicare (Canada) Inc., to the existing Extendicare Consulting Agreement for The Pines Long-Term Care Home;

AND THAT the terms of the agreement be to the satisfaction of the Commissioner of Health Services, the District Solicitor, and the Chief Administrative Officer;

AND THAT the Commissioner of Health Services and the Chief Administrative Officer be authorized to enter into the one (1) year extension agreement with Extendicare (Canada) Inc., on behalf of the District.

Carried. c) Fairvern Long-Term Care Home Redevelopment and Governance Report HS-12-2019-3

Mr. Barrette highlighted the previous applications for Long-Term Care beds that were submitted to the Ministry of Long-Term Care and the associated implications for the current Ministry undertaking. Mr. Barrette reviewed the options available to the District to move forward with the submitted applications.

A discussion occurred regarding the Fairvern application for redevelopment and Committee directed staff to invite the Fairvern Board to the December Health Services Committee meeting, which would occur prior to Council, in order to provide a recommendation on how the Board would recommend moving forward.

Financial Administration

a) Health Initiatives Capital Funding Allocation Report HS-12-2019-1

Moved by T. Glover and seconded by P. Cooper R34/2019-HS

WHEREAS the Committees of Health Services and Finance and Corporate Services at its October 21, 2019 joint meeting directed staff to create a process for funding requests related to the Hospital Financing Reserve Fund to be forwarded directly to the Health Services Committee for consideration;

AND WHEREAS staff have created a process for application review and awards of funds for Committee’s consideration as outlined in Appendix “I” to staff report HS-12-2019-1;

NOW THEREFORE BE IT RESOLVED THAT the process for funding requests related to the Hospital Financing Reserve Fund be approved.

Carried.

Information Items

a) Correspondence from South Muskoka Memorial Hospital (MAHC) dated November 1, 2019 regarding a letter of endorsement for the continuation of Muskoka Health Links and Community Paramedicine Programs within Muskoka for patients within our area. HS-12-2019-INFO-A

b) Correspondence from Simcoe Muskoka District Health Unit (SMDHU) dated October 2019 entitled Opportunities for Municipal Action on the Opioid Crisis HS-12-2019-INFO-B

c) Correspondence from the Ministry of Health dated November 13, 2019 regarding Ontario Taking Next Steps to Integrate Health Care System HS-12-2019-INFO-C

d) Correspondence from the Ministry of Health dated November 13, 2019 regarding Ontario Taking Next Steps to Integrate Health Care System HS-12-2019-INFO-D e) Correspondence from Ontario Health dated November 13, 2019 regarding Ontario Health Transitional Regional Leadership HS-12-2019-INFO-E f) Capital Project Quarterly Variance Report – Corporate Summary – September 30, 2019 FCS-14-2019-3 g) Operating Budget Variance Report – September 30, 2019 FCS-14-2019-2

Adjournment

Moved by J. Klinck and seconded by R. Nishikawa P35/2019-HS

THAT the Health Services Committee adjourns to meet again on Monday, December 16, 2019, or at the call of the Chair.

Carried.

The meeting adjourned at 10:21 a.m.

______Deputy Clerk

70 PINE STREET, BRACEBRIDGE, ONTARIO P1L 1N3 Telephone (705) 645-2231 / Fax (705) 645-5319 / 1-800-461-4210 (705 area code) www.muskoka.on.ca

To: Chair and Members Health Services Committee

From: Dan Armour Commander, Paramedic Services and Emergency Planning

Date: November 21, 2019

Subject: Muskoka Paramedic Services (MPS) Single Source Stretcher Purchase Request

Report: HS-12-2019-2 ______

Recommendation

THAT approval be granted to single source Stryker Canada for the replacement of the currently utilized Stryker Power Pro stretchers;

AND THAT approval be granted to single source Rowlands Emergency Vehicle Products Inc., for the purchase of replacement parts and maintenance for Stryker Power Pro stretchers:

Origin

Muskoka Paramedic Services (MPS) operates in a unique and dynamic environment with purchases from a variety of products and services in compliance with the Procurement By-law (2016-39, as amended) to provide a wide range of health care services. For some procurement needs, there may only be a limited number of suppliers available that meet Paramedics Services’ highly specialized requirements and which meet current training protocols.

Background

Paramedic Services rely on ergonomic patient stretcher and transport systems as an integral part of safe and effective patient care.

While each piece of paramedic equipment is important to providing patient care, there are few that are used as frequently as the stretcher. The current compliment of Stryker Power Pro stretchers were purchased in 2009 and provide paramedics with a safe way to move patients from the scene, to the ambulance, and then securely to the receiving facility.

Page 1 The current stretchers in-service have reached the end of their lifespan.

Manufacturers of medical devices are required to establish reliable lifespans of the devices in order to limit risk of failure. According to the manufacturer of the stretchers and components in use by MPS, the life spans of these devices have now been reached. Should the devices not be replaced, it is expected that additional maintenance, reduced reliability and increased down time may result in potential service issues. In particular, service delivery during seasonal deployment, where more vehicles are in service, may pose challenges to ensure each vehicle is response ready.

Each stretcher comes with a one year warranty and a life expectancy of 7 years as per the manufacturer. Lifespan is based on the number of lifts, with the stretcher recording how many times it goes up and down. The current stretchers have been in service for 10 years and have begun to fail in areas such as hydraulic hose (seals are leaking) and electronic motherboards. The frequency of failures of the above mentioned items has increased as the stretchers age.

The decommissioned stretchers and components will be disposed of in accordance with the District of Muskoka’s Disposal of Surplus and Obsolete Assets policy.

Analysis

Maintaining compatibility with the current stretchers will avoid ambulance and station re- configuration and additional staff training.

There are only two vendors that provide stretchers that meet Ontario standards. Currently 93% of the services in Ontario are using Stryker Power Pro stretchers, including Ornge, the provincial air ambulance service. Maintaining compatibility with the current stretcher system will avoid the need to purchase new mounts for each ambulance, new cardiac monitor mounts, new battery chargers for each station, and an inventory of replacement parts. In addition, maintaining compatibility will avoid retraining all paramedic staff on the use of a different system.

Rowlands Emergency Vehicles Products is Stryker Canada’s only authorized sales and service provider for Ontario. Rowlands Emergency Vehicles Products maintain a large inventory of parts at their facility in Mississauga and can ship the same day or next day. Rowlands also provide technical specialists that can supply guidance for performing service, maintenance and repairs.

In order to maintain compatibility with the current components, staff recommends single- source purchasing of updated versions of the Stryker Power Pro stretchers from Stryker Canada along with parts and maintenance services from the vendors approved Ontario distributor Rowlands Emergency Vehicles Products Inc.

Schedule A of the by-law under Section 4 of the Policy, identifies one of the primary procurement goals is to obtain the best value for the District when procuring services by regularly conducting a competitive bid process to ensure that the District is receiving the best possible and current market price.

Within Section 8.3.2 of the Policy, there are situations when the requirement for a competitive bid process may be waived and a single source provider may be selected. However, a written report indicating the rationale for a non-competitive selection must be submitted to Muskoka District Council for approval prior to the award of any contract under this exception. There are a Page 2

number of reasons identified in the Policy to support a single source purchase and in this case the following applies:

8.3.2 (v) Standardization on a particular make or model of the required Goods is desirable for the purposes of minimizing inventories of spare parts, minimizing the time and expense associated with operator training, and maximizing operator transferability, etc.

Financial Considerations

MPS has an inventory of 15 Stryker stretchers. Staff are planning to purchase 15 stretchers to replace the entire fleet, as they have all reached the end of their lifespan. The replacement cost per stretcher and attachments are approximately $17,200.

The capital cost of stretcher replacement has been included in the 2019 Tax Supported Capital Budget and Forecast (530031) of $140,000 and the 2020 Draft Tax Supported Capital Budget and Forecast (530031) of $142,800. Staff are deferring the spending of the $140,000 until approval is obtained from Committee and anticipate on implementing the approval with the procurement of the replacement stretchers in early 2020. The additional $142,800 budgeted for the 2020 Tax Supported Capital Budget Forecast will be implemented once the 2020 budget approval process has been finalized.

The cost for the ongoing parts and maintenance of stretchers has been included in the 2019 Tax Supported Operating Budget and the 2020 Draft Tax Supported Operating Budget.

Communications

If approved through this staff report and the subsequent 2020 budget approval process, staff will advise Stryker Canada and implement the approval with the procurement of the replacement stretchers in 2020.

Strategic Priorities

Click on icons below to view strategies under each priority area:

s 2.2, 2.4, s 5.2 2.9

Respectfully submitted,

Original signed by Original signed by

Dan Armour Norm Barrette Commander, Paramedic Services and Commissioner of Health Services Emergency Planning

Page 3

Long-Term Care Services

Health Services Committee

HS-12-2019-5

A presentation on the Long-Term Care Homes Program – A review of the Plan to Create 15,000 New Long-Term Care Beds in Ontario

Page 1

Origin • The Financial Accountability Office of Ontario issued its report on the Review of the Plan to Create 15,000 new Long-Term Care Beds on October 30, 2019

Page 2 Outline • Background and Content • Wait Time Targets and Benchmarking • Regional Impact • Long-Term Implications

Page 3 Background and Content

• In 2018-19 there were nearly 35,000 Ontarians on the wait list for a long-term care bed. • The wait list for long-term care grew from 2011-12 to 2018-19, increasing by approximately 78%.

Source – Financial Accountability Office Page 4 Background and Content LTC homes represented 7% of total health sector spending in 2018-19 ($ billions)

Source – Financial Accountability Office Page 5 Background and Content

• Between 2011 and 2018, the number of long-term care beds in Ontario increased by 0.8% (611 new beds) while the population of Ontarians aged 75 and over grew by 20% (176,211 people).

Source – Financial Accountability Office Page 6 Background and Content

• In the 2019 Ontario Budget, the Province committed to adding 15,000 new long-term care beds over five years. • To date, the Province has allocated 7,889 of the 15,000 new long-term care beds. • On October 1, 2019, the Province launched the application process for the remaining 7,111 beds with applications due by January 17, 2020.

Source – Financial Accountability Office Page 7 Background and Context

Home Municipality Operator Number of Beds

Fairvern Huntsville Not for Profit 96

Muskoka Landing Huntsville Private 94

Muskoka Shores Gravenhurst Private 182

The Pines Bracebridge Government 160

Total 4 n/a 532

Page 8 Wait Time Targets

• The Ministry of Long-Term Care does not have a target for the wait list or wait times for a long-term care bed, or a benchmark. • Health Quality Ontario has not identified an appropriate target or benchmark for LTC wait times.

Source – Financial Accountability Office Page 9 Benchmarking

• Compared to British Columbia and Alberta, Ontario has significantly longer wait times for a long-term care bed. • In British Columbia, there are 28,000 long- term care beds with a wait list of about 1,400 people and a median time to placement of 12 days.

Source – Financial Accountability Office Page 10 Benchmarking

• Alberta has a target of placing 65% of people into continuing care within 30 days. • In 2017-18, Alberta fell short of the target, placing only 52% of people within the 30- day window. • By comparison, less than 3%of long-term care homes in Ontario place 50 per cent of clients within 30 days.

Source – Financial Accountability Office Page 11 Regional Impact

• The Province has indicated that it will prioritize the allocation of new LTC beds to areas where the beds will have the greatest impact on wait times and hallway health care. • New beds have been allocated to the LHIN regions with the longest wait lists and/or wait times.

Source – Financial Accountability Office Page 12 Regional Impact

Number of Median time to LTC wait list LHIN new beds placement (rank) allocated (rank) Central East 1,095 7,080 (1) 263 (1) Hamilton Niagara 1,080 3,027 (4) 105 (12) Haldimand Brant Toronto Central 1,069 2,633 (5) 225 (2) Central 1,064 4,948 (2) 189 (4) Champlain 751 3,356 (3) 186 (5) Mississauga Halton 649 2,300 (6) 180 (7) North Simcoe Muskoka 401 1,959 (8) 182 (6) Source – Financial Accountability Office

Page 13 Long-Term Implications

• High growth in elderly Ontarians will continue past 2023-24. • Growth in the number of Ontarians aged 75 and over is the primary driver of long- term care demand in Ontario. • Over 80 per cent of Ontarians in long-term care are over the age of 75.

Source – Financial Accountability Office Page 14 Long-Term Implications

• It is forecasted that 55,000 more Ontarians will require a long-term care placement in 2033-34 compared to 2023-24. • To maintain the projected wait list in 2023- 24 at approximately 36,900 Ontarians, the Province would need to add 55,000 new long-term care beds by 2033-34 and ensure that all existing beds stay in service.

Source – Financial Accountability Office Page 15 Long-Term Implications

• This would result in a total supply of long- term care beds in 2033-34 of 148,700, up from a projected 93,700 LTC beds in 2023- 24.

Source – Financial Accountability Office Page 16 QUESTIONS?

Page 17

70 PINE STREET, BRACEBRIDGE, ONTARIO P1L 1N3 Telephone (705) 645-2231 / Fax (705) 645-5319 / 1-800-461-4210 (705 area code) www.muskoka.on.ca

To: Chair and Members Health Services Committee

From: Kim Landry Administrator

Date: November 21, 2019

Subject: Extension of Consulting Contract with Extendicare (Canada) Inc.

Report: HS-12-2019-4 ______

Recommendation

THAT Muskoka District Council authorize an extension for up to one (1) year with Extendicare (Canada) Inc., to the existing Extendicare Consulting Agreement for The Pines Long-Term Care Home;

AND THAT the terms of the agreement be to the satisfaction of the Commissioner of Health Services, the District Solicitor, and the Chief Administrative Officer;

Origin

The current service agreement with Extendicare spans from January 1, 2015 and will expire on December 31, 2019.

Background

Since August, 1997 the District has maintained the use of a service contract to provide consulting, management and financial support and policy development for the Pines Long-Term Care home. The amended extended contract expired December 31, 2007. The Service contract was continued on a monthly basis and was discontinued as of December 31, 2009.

Support services provided by Extendicare were procured through a request for proposal and was subsequently renewed through 2019.

Page 1

In 2009, the District issued a request for proposal for support services which was awarded to Extendicare for a five (5) year period. A further extension of a five (5) year period was arranged from 2015 ending December 31, 2019.

Analysis

Currently Extendicare provides the following services in support of The Pines Long-Term Care home operations:

• Financial services including time and payroll benefit administration, accounts receivable and payable, financial reporting and budget development; • Group bulk purchasing; • Manuals and policy supports; and • Consultant support for nursing, environmental, food services and labour relations.

Over the course of 2020, staff will complete a detailed assessment that may result in the in-sourcing of a portion to all of the services currently purchased from Extendicare.

Commencing early in 2020, staff will commence a detailed project to assess the feasibility and benefits of in-sourcing the support services that have been provided through Extendicare. Staff will establish the specific operational requirements and determine if these requirements could be met by the District’s Finance and Corporate Services department, and Human Resources department. Lastly, staff will determine the effort and costs associated to in-source these services. Should the continued outsourcing of a portion or all of the service currently provided by Extendicare be determined as the optimal method, a competitive procurement process will be initiated. Staff would bring back a staff report with the outcomes of the detailed analysis.

In order to maintain operational stability during 2020, it is recommended to grant a one (1) year contract extension.

It is expected that the detailed analysis will be completed by the end of the second quarter. In order to comply with the policy and maintain operational stability in 2020, staff is recommending a one (1) year contract extension.

Financial Considerations

The District pays a fixed sum annually of $253,330 ($21,100 per month), for these services.

Staff have negotiated a reduced price to continue financial service for an additional one- year term.

Page 2

As the agreement expires on December 31, 2019, staff have met with Extendicare to discuss the cost of extending the agreement for an additional one (1) year. Staff have negotiated a slight reduction in the annual fee of $247,330 ($20,610 per month) for the full year of 2020.

Communications

As a result of the potential changes to the consulting agreement, information and communications will be coordinated through the Health Services department to Extendicare once approval has been given from Committee. A staff report will be brought back to Committee with recommendations in the third quarter of 2020 for consideration.

Strategic Priorities

Click on icons below to view strategies under each priority area:

s 2.2, 2.3, s 5.1, 5.2, s 3.1 2.5, 2.7 5.3, 5.4, 5.6

Respectfully submitted,

Original signed by Original signed by

Kim Landry Norm Barrette Administrator Commissioner of Health Services

Page 3

70 PINE STREET, BRACEBRIDGE, ONTARIO P1L 1N3 Telephone (705) 645-2231 / Fax (705) 645-5319 / 1-800-461-4210 (705 area code) www.muskoka.on.ca

To: Chair and Members Health Services Committee

From: Norm Barrette Commissioner of Health Services

Date: November 21, 2019

Subject: Fairvern Long-Term Care Home Redevelopment and Governance

Report: HS-12-2019-3 ______

Recommendation

This report is provided for information purposes.

Origin

Fairvern Long-Term Care Home (Fairvern) has been the subject of many reports to Committee and Muskoka District Council along with a presentation made by the Fairvern Board. The primary intention of this report is to provide Health Services Committee with an update of the status of the submissions to the Province for additional beds for Fairvern, along with staff recommendations for Committees approval and direction on how to proceed.

Background

In April 2018, (through staff reports 3(2018)-8 and CS-3-2018-3), the District on behalf of Fairvern submitted an application to the Province for an additional 64 bed expansion which, if approved, would see the total number of beds in the proposed new facility rise from 76 currently to 160. The District also submitted an application for a new 160 bed home for the south of Muskoka at that time.

Analysis

Consultant work is currently underway to assess the financial and governance options to best inform Muskoka District Council on the redevelopment and future operation of the Fairvern Long-Term Care home.

In order to understand the implications associated with key project options and their corresponding impact on capital costs, operational sustainability and governance, Colliers International has been engaged to complete a financial and governance review. Work on this project began in early October, 2019.

Page 1

Subsequent to the procurement for the financial and governance review, the province announced applications for new Long-Term Care beds were being accepted.

Staff presented the Ministry of Long-Term Care news release at its October 24, 2019 Committee meeting (HS-11-2019-E), which announced that “Ontario is now accepting applications from current and potential operators to build new long-term care beds and redevelop existing ones in Ontario. These long-term care beds are part of the government’s commitment to build 15,000 new beds and redevelop 15,000 existing beds over five years.”

The full consultant review will not be completed before the current Ministry application deadline.

The province is inviting all interested parties to apply to build and redevelop the remaining beds, including existing municipal operators, for-profit, and non-profit as well as organizations new to the long-term care sector, to submit an online application by Friday, January 17, 2020. The project plan developed by Colliers International, despite efforts to accelerate the completion of work, would not be completed until the end of January or early February of 2020.

Preliminary Findings from the consultant will be available for the December District Council meeting.

The consultants will provide their preliminary findings on governance analysis and financial modelling for the District Council meeting of December 16, 2019.

As a result, either the District or the Fairvern Long-Term Care Home must take action to meet the January 17, 2020 deadline without the full benefit of the completed review.

To ensure the highest probability of a successful application for new beds, only the future operator of the home should submit an application.

Based on discussions with Ministry of Long-Term Care staff that were following up on the District’s previously submitted applications from 2018, District staff were advised that it would be imperative that the application is updated and submitted only by the future operating organization. As the District had submitted an application for expansion on behalf of Fairvern in 2018, the application would not be able to be considered for approval.

Any governance change during redevelopment application process should be clearly outlined.

The Ministry advised District staff that operational governance should be clearly identified in any future application. Should there not be a clear transition plan, there may be delays in the application review or even denial of the application.

Withdrawing the 2018 application for a new long-term care home in south Muskoka may reduce any possible competition with the Fairvern application.

In the 2018 call for new Long-Term Care beds, the District submitted an application on behalf of Fairvern for an additional 64 bed to bring the new home to 160 beds in total. In addition, the District submitted a second application for a new 160 bed home to be located in south-Muskoka.

Page 2 Given the high demand for new beds province-wide, the likelihood that a total of 224 new beds be allocated to the Muskoka area is low. The Fairvern Long-Term Care home must redevelop as its current design does not meet the Ministry’s requirements. By withdrawing the 2018 application for a new home in south-Muskoka, the chance of unintended competition for bed allocations will best position the application for the Fairvern expansion for approval.

Staff have identified the two most likely approaches along with their associated implications and risks.

Staff have researched and analysed the needs that best fit for Muskoka residents, consulted with Fairvern staff and board chair as well as Colliers International and have determined that the best course of action is the following two options. These options assume the approval by the Ministry of Long-Term Care for additional beds is approved.

Option One:

• The District will submit an application for additional expansion beds; • The District would bear the responsibility for funding, design and construction of the redevelopment, if Ministry approved; • The District may realize efficiencies with current programs and services which will be determined in the final consultant report; • The District may realize qualitative improvement with resident care and staffing supports which will be identified in the final consultant report; and • The District will maintain governance and direct operation, once the transition has taken place.

Risks of Option One:

• The capital construction costs would fall to the District and are not yet fully known; and • The ongoing operational costs are not yet fully known, however are likely to be in the range of the current costs of the Pines Long-Term Care home as noted in the Financial Considerations section.

Option Two:

• Fairvern will submit an application for additional expansion beds; • Fairvern would bear the responsibility for funding, design and construction of the redevelopment, if Ministry approved; and • Fairvern will maintain governance and operation, which is their board’s preferred choice.

Risks of Option Two:

• The operational sustainability of the home during the redevelopment process is uncertain; • The ability to secure the required capital funding, beyond the District’s commitment of $10.5 million, is uncertain; • Local fundraising ability may be strained due to concurrent hospital redevelopment efforts; and • The internal capacity to support the redevelopment is uncertain.

Page 3 Should the Ministry not approve additional beds for Fairvern; further implications will need to be considered.

Currently, Fairvern is approved to redevelop to a 96 bed home and the District has made a commitment of up to $10.5 million in funding. As highlighted in the original 2016 report, given the significant contribution requested of the District and its desire for Fairvern to achieve sustainability, it is important for Council to consider the issue of on-going governance of Fairvern. Since that time, the Fairvern Board has concluded that a 96 bed home will not be financially sustainable in the future. As a result, the issue of ongoing sustainability and governance will have to be evaluated by both Fairvern and the District, should the Ministry not approve additional beds for Fairvern.

Financial Considerations

Staff are working closely with Colliers International to determine the financial implications with the options that are outlined above.

The application for Fairvern, if successful, would expand the proposed redevelopment to a 160- bed home which is the same size as the Pines Long-Term Care home. As such, staff has provided the Pines 2019 operating budget to demonstrate the magnitude of costs that would be incurred, if the operations were a District home. The net debt costs of approximately $252,350 have been removed as financing costs are discussed in the Capital Cost section below.

2019 Pines Long-Term Care Home (excluding net debt costs) Revised Budget Total Operating Expenditures & Internal Service Charges 12,567,236 Reserves 555,000 Total Expenditures 13,122,236 Operating Grants and Resident Fees (11,850,489) Total Revenues (11,850,489) Net Levy (excluding net debt costs) 1,271,747 % of the General Levy 1.7% # of Full Time Equivalent (FTE) Staff 134.14

Staff believe that there could be synergies that result in cost reductions to one or both homes, should Council approve that Fairvern become a municipal home. It is expected Colliers will be able to provide these cost saving ideas in its final report. In addition, as the proposed development is a new build, there may be design and operating efficiencies compared to the Pines that would reduce the associated costs.

The following are several areas of potential savings related to a Fairvern/Pines integration:

• Extension of service arrangements (food, purchasing, drug support, consultant expertise, scheduling software) to Fairvern; • Specialized leadership across both homes (business office, program, maintenance, etc.); • Shared access to call-in and related supports (notably in nursing care where supply is challenged); and • Shared services in support areas (HR, Labour Relations, IT, etc.).

Page 4 Capital Costs

As noted in staff report HS-6-2019-1, the current estimate for the total project cost is $30.7 million for a 96 bed home. This costing is considered a Class D estimate with a margin of error of approximately +/- 20% to 30%. Accordingly, the final project costs could range between $21.5 million and $39.9 million. In addition, soft costs for consultants, project management, contingencies, furniture, fixtures and equipment, move planning and management have not been included in cost estimates to date. From the District’s experience, these additional project costs could be in the range of $5.2 to $6.7 million for a 96-bed home.

Should application for additional beds be approved, the capital cost will increase significantly. If the combined capital and soft costs per bed for the 96 bed home noted above are extrapolated to a 128 and 160 bed home, the capital and soft costs may range between $48.9 million and $61.1 million. It is likely that there are economies of scale with a larger home, but this range provides some scope for Council. Colliers has been requested to provide project capital costs for both a 128 and 160 bed home which is expected with the final report in early 2020.

LTC capital funding requires the Province to play a very active role in all aspects of the design and approval process for all newly built LTC facilities. Funding is based on a 25-year debt retirement commitment. Based on current funding levels, this equates to maximum funding support of approximately $203,000 per bed.

The estimated financing costs for a build of 128 or 160 beds based on the construction costs noted above and net of the Provincial construction grant, are estimated at $1.7 million to $2.1 million per year which represents between 2.3% and 2.8% of the general levy, respectively. These costs would be in addition to the operating costs noted above.

Communications

This report will be sent to the Fairvern Long-Term Care Home Board Chair and Executive Director.

Strategic Priorities

Click on icons below to view strategies under each priority area:

s 2.3, 2.4, s 5.1, 5.2, 5.3, 2.5, 2.8, s 3.1, 3.5 s 4.6 5.4, 5.5, 5.6 2.9

Respectfully submitted,

Original signed by Original signed by

Norm Barrette Michael Duben, B.A. LL.B. Commissioner of Health Services Chief Administrative Officer

Page 5

70 PINE STREET, BRACEBRIDGE, ONTARIO P1L 1N3 Telephone (705) 645-2231 / Fax (705) 645-5319 / 1-800-461-4210 (705 area code) www.muskoka.on.ca

To: Chair and Members Health Services Committee

From: Norm Barrette Commissioner of Health Services

Date: November 21, 2019

Subject: Health Initiatives Capital Funding Allocation

Report: HS-12-2019-1 ______

Recommendation

AND WHEREAS staff have created a process for application review and awards of funds for Committee’s consideration as outlined in Appendix “I” to staff report HS-12-2019-1;

NOW THEREFORE BE IT RESOLVED THAT the process for funding requests related to the Hospital Financing Reserve Fund be approved.

Origin

In 1972, The District Municipality of Muskoka (District) established a Hospital Reserve for the purposes of granting aid for construction, erection, establishment, acquisition, maintenance, equipping and carrying on the business of public hospitals including municipal hospitals, public sanatoria, municipal isolation hospitals and other health care facilities in the District area.

From District staff’s review, it does not appear that the reserve was utilized until 1997. Between 1997 and 1999, the District provided $2.2 million to assist the funding for the expansion of the South Muskoka Hospital. Of this total, $590,000 was funded from the Hospital Reserve and $1,610,000 was financed from the Corporate Capital Reserve. Between 1999 and 2009, there were no additional grants made to hospitals and there was not an annual contribution to the hospital reserve.

However, in 2009 an annual levy for hospital financing was established. Between 2009 and 2011, the annual levy was $500,000. This amount was reduced to $400,000 in 2012 and remained at that level until 2018. Staff report CES-8-2015-11 provides a background and brief history of the creation of the Hospital Funding Advisory Committee.

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Financing provided to Hospitals and the Huntsville Hospice, as well as the commitments for 2018 and 2019 from the Hospital Financing Reserve fund, are outlined in staff report CES-15- 2015-1.

Background

On January 31, 2018 a resolution was passed (33/2018) at Committee of the Whole Council, which was subsequently endorsed by Muskoka District Council at its February 20, 2018 meeting. Through this resolution the annual funding was increased from $400,000 to $600,000 and the Hospital Funding Advisory Committee as established through Corporate and Emergency Services Committee resolution R42/2009 was disbanded. The resolution also directed the establishment of a joint Committee of MAHC representatives and Muskoka District Councillors to review future expenditures.

At the February 21, 2019 meeting of the Health Services Committee (HS-3-2019), staff presented a staff report (HS-3-2019-1), outlining the formation of the District Hospital Funding Support (DHFS) Committee. Through discussion, the Committee withdrew the motion outlined in the staff report and passed the following resolution (R8/2019-HS) which is written out below:

“THAT staff be directed to report back to the Committee regarding the protocol and formation of a Health Initiatives Fund Working Group to provide alternatives to the proposed framework and membership, which aligns with Councils’ desire to consider other potential fund recipients.”

At the March 21, 2019 meeting of the Health Services Committee (HS-4-2019), staff presented a staff report (HS-4-2019-4), outlining the formation of the Health Initiatives Fund Working Group. Through discussion, the Committee deferred this report to a future meeting due to changes being made by the Provincial Health Care Programs and Initiatives.

At the October 21, 2019 joint meeting of the Health Services and Finance and Corporate Services Committees, staff presented a staff report (HS-10-2019-5 and FCS-11-2019-5), outlining the establishment of the working group. Through discussion, the Committees determined that funding requests related to the Hospital Financing Reserve Fund should be forwarded directly to the Health Services Committee for consideration. Committee defeated the resolution outlined in the staff report, and directed staff to prepare a report to outline a process for application review and award of funds for Committee’s consideration at a future meeting.

Analysis

Staff are proposing the following process for the application review and awards of funds for Health Services Committee’s consideration after the direction that was given from the joint Committee meeting held on October 21, 2019, which differs from resolution 33/2018:

Proposed process:

In order to identify the allocation of funds, it is proposed that staff:

• Develop criteria to inform calls for proposals from interested health care partners to ensure that the expenditures service the residents of Muskoka (Appendix II of this staff report contains draft criteria in the form of a funding application); • Issue a call for proposal ensuring broad awareness of the initiative;

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• Evaluate proposals based on the established review criteria (once created, as indicated in the first bullet to this proposed process) to optimize the best use of available funding by measuring the capital requests submitted against the medical needs of Muskoka; and • Make recommendations to the Health Services Committee on the allocation of funding based on proposal criteria including a description of the proposed projects, the individual project’s cost and funding sources, justification for the project and a description.

Financial Considerations

There is approximately $482,899 available for distribution to identified MAHC facility needs and other projects. This balance is comprised of approximately $205,000 from the 2018 allocation, including interest earned, and $277,000 from the 2019 budget allocation. However, during the joint Committee meeting in October, Committee approved a grant in lieu of development charges totaling $14,151.98 to be paid to Hospice Muskoka from this revenue. In addition, to provide an additional $200,000 to Hospice Muskoka from this reserve is being considered at Muskoka District Council on November 18, 2019. If both of these items are approved, the remaining balance will be $268,747.

Communications

This report will be circulated to the CEO of MAHC and of the Central Regional Health Lead, the CEO of Orillia Soldiers’ Memorial Hospital, Royal Victoria Regional Health Centre, Georgian Bay General Hospital and the West Parry Sound Health Centre.

Strategic Priorities

Click on icons below to view strategies under each priority area:

s 2.2, 2.3, s 5.1, 5.2, s 3.1 2.5, 2.7 5.3, 5.4, 5.6

Respectfully submitted,

Original signed by Original signed by

Norm Barrette Michael Duben, B.A. LL.B. Commissioner of Health Services Chief Administrative Officer

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HS-12-2019-1-Appendix “I”

The Process for Health Initiatives Capital Funding Allocation

Draft Terms of Reference

Version 1

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HS-12-2019-1-Appendix “I”

Health Initiatives Capital Funding Allocation Type of Process • Internal Process Purpose • To ensure the informed allocation of funding of health related capital projects. Background • Staff Report HS-12-2019-1 outlines the background of how the process was developed. District Staff • The initial composition for the District staff would be comprised of the Composition following: • The Commissioner of Health Services; • The Commissioner of Finance and Corporate Services; and • Support staff

Staff’s Scope, • Develop criteria to inform calls for proposals from interested health care Responsibilities & partners; Goals • Issue a call for proposal process and ensure broad awareness of the initiative; • Evaluate proposals based on the established review criteria; • Make recommendations to Muskoka District Council via the Health Services Committee on the allocation of funding based on proposal criteria; and • Ensure proposed expenditures are in alignment with goals and objectives of the broader healthcare system

Meeting • Meetings will be held at a minimum annually; attendance will be Frequency/ identified as in person. Attendance Accountability • Update reports will be communicated to the committee regarding the progress of previous topics discussed as made available.

Amendment to Terms • Re-visited as directed by the Health Services Committee of Reference

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HS-12-2019-1-Appendix “II” Draft Health Initiatives Capital Funding Application

This form is made available as a common template for submission of capital funding requests for existing, new or expanded service offerings.

Instructions:

• Proposals must be approved by your organization’s CEO / Executive Director • All sections must be completed • Please keep in mind that it will be evaluated against the following considerations:

O Does it improve the health of our population? O Explain the alternatives that may achieve similar outcomes and why this approach is preferred O What are the risks of not getting funding? O Explain the resource requirements

Health Initiatives Capital Funding Application

Contact information / CEO Approval:

Proposal Name:

Lead HSP Contact Name:

Organization:

Email / Telephone:

CEO/ED Name:

Signature:

Please indicate if the capital investment is required for…

Renovation

Expansion

Equipment Investment

I.T. Investment

Please provide a description of why the District should support this initiative?

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Project Definition:

Benefit to the Community:

Alternatives and Rational:

Risks of Not Funding:

Service Details and Funding Impact:

Proposed service change Details: Increased number of clients/visits, increased services provided, residents served

No change Increase Decrease Other (comments)

Financial details:

Capital funding required:

Project timeline, milestones, and key deliverables:

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HS-12-2019-INFO-A

From: "Vanclieaf, Catherine" Date: November 1, 2019 at 3:01:10 PM EDT To: "[email protected]" Subject: Letter of Endorsement

HI Ashley, I want to take the time to provide you with a letter of endorsement for you in your current role. As you are well aware, there are certain demographic and social determinants within our population served at the hospital that makes safe discharge transitions difficult. It is very frustrating for the hospital discharge team to try and bridge these gaps, and help to make good and sustainable choices available for our patients. I have particularly appreciated the voice you have brought to the table, and the endless support and effort that you have provided to this patient population and to the teams here. You have helped us to understand options, navigate social and community resources, and provide support such as community paramedics, and social work to ensure that the discharge is successful and patient centred. You have gone above and beyond, and as far as to offer yourself and your own personal time to move furniture or transport patients. You have been an integral care partner in your role, and an invaluable resource to our team. I hope that this is a role that is valued by those funding it and continued, recognizing it as an essential enabler of community reintegration and support for patients within our area.

Thanks so much for all you do, Catherine

Catherine Vanclieaf, RN, BAHSc(HONS) Manager Inpatient & Rehabilitation Services South Muskoka Memorial Hospital T:705 645 4400 ext 3471 C:705 787 6391 F: 705 645 4594 [email protected] HS-12-2019-INFO-B

Opportunities for Municipal Action on the Opioid Crisis

Prepared by the Steering Committee of the Simcoe Muskoka Opioid Strategy (SMOS), October 2019

SMOS is a cross-sector partnership of agencies and individuals addressing the opioid crisis in Simcoe and Muskoka

Through 2018 and 2019 to date, awareness of the impacts of the opioid crisis amongst communities in Simcoe and Muskoka has grown considerably. Several municipal councils have expressed interest in taking action to help address this urgent situation. As a support to municipalities, the steering committee of SMOS has developed this document of suggested opportunities for action within the realm of municipal jurisdiction. These ideas are relevant to Simcoe and Muskoka broadly speaking, but should be tailored to the needs of each municipality as some items may be more relevant than others, and additional items may be important. Local information and partnership may be available through the following collaborative opioid/drug strategy working groups in Simcoe Muskoka, connected to the work of SMOS:

Location Group Name Contact Email Barrie Barrie Drug Awareness Partnership Mia Brown [email protected] Orillia Orillia Drug Strategy Task Group Claudia Swoboda [email protected] Nottawasaga Nottawasaga Opioid Advisory Working Group Cathy Eisener [email protected] Muskoka Muskoka Drug Strategy Brittney Hillier [email protected]

Many of the suggested opportunities are inter-related, and may be best achieved in coordination with each other. In particular, the ongoing development of Community Safety & Wellbeing Plans by municipalities in Ontario provide an important opportunity to consider many of these items. These plans encourage multi-sectoral partnerships to develop strategies, programs and services in order to help minimize risk factors and improve the overall well-being of our communities.

The items on this list are complementary to the work of SMOS. Some go beyond the scope of SMOS member organizations, to that of municipalities, and therefore are not articulated in SMOS plans. For information on the work of SMOS, please see our Action Plan and 2018 Update, and other materials at PreventOD.ca.

For further information about SMOS or the below opportunities for municipal action Simcoe Muskoka-wide, please contact Janice Greco at: [email protected].

1 HS-12-2019-INFO-B

Theme Opportunities for Municipal Action Description Cross- 1. Contribute funding for a A Drug Strategy Coordinator would be primarily responsible for facilitating a multi sectoral collaboration cutting drug strategy coordinator of key community stakeholders in the planning, implementation and evaluation of a municipal and/or at the County, District, or regional drug strategy. Strategies are based on the integrated components of prevention, harm Municipal level. reduction, treatment and enforcement/justice, such as SMOS. A Drug Strategy Coordinator could support and enhance the work of SMOS in future.

For examples of various drug strategies within Ontario, please visit: http://www.drugstrategy.ca/about.html 2. Continue to work on Housing First is an approach that addresses the immediate housing needs of people with addictions and implementing your mental illness. municipal affordable housing strategy using a For more information, please visit: https://www.homelesshub.ca/solutions/housing-accommodation- Housing First approach. and-supports/housing-first 3. For County of Simcoe only: Drug Treatment Courts (DTC) operate on the notion that traditional sentencing standards generally do not Provide bus passes and/or influence recidivism in offenders whose criminal conduct is driven by problematic substance abuse. DTC transportation funding to aims to improve social stability and reduce criminal behaviour associated with deep-rooted substance help clients from other abuse. communities in Simcoe County attend Drug For more information, please contact: [email protected] Treatment Court in Barrie. Prevention 4. Support all municipal staff The AFWI is an educational initiative that takes a science-based approach to addressing early childhood and Council to participate development and preventing harmful substance use, through promoting positive brain development. in the Alberta Family Educational resources and full ‘Brain Story Certification’ are available at no cost. Wellness Initiative (AFWI). For more information, please visit: https://www.albertafamilywellness.org/ Treatment 5. Support efforts to increase For example, host career fairs specific to the field of mental health and addictions. the number of local residents seeking training for careers in mental health and addictions.

HS-12-2019-INFO-B

Harm 6. Coordinate and/or fund a This approach has been used in other communities to improve the local business climate, reduce calls to Reduction peer worker to provide emergency services through de-escalation, and assist individuals in need. outreach to marginalized individuals and assist For examples, please visit: businesses in downtown Barrie’s Connected Core Project: https://connectedcore.ca/ cores. Guelph’s Welcoming Streets Initiative: http://guelphchc.ca/welcoming-streets-initiative-wsi/ 7. Access or purchase outdoor Municipalities can also work in collaboration with community partners to encourage safe disposal of mounted sharps disposal sharps. units to reduce publically discarded needles and For more information, please visit: other drug paraphernalia. http://www.simcoemuskokahealth.org/Topics/Drugs/SaferSubstanceUse/DisposalOfUsedSupplies.aspx or contact Health Connection at 705-721-7520 or 1-877-721-7520. 8. Fund naloxone access at Provide naloxone education and training to municipal staff and public transit drivers, and provide municipal buildings and on information to the public on how to access and use this naloxone. public transit. For example, Kingston, Ontario has made naloxone kits available in the automated external defibrillator (AED) stations in City facilities for use by the public: https://www.amhs-kfla.ca/naloxone-now-available- city-kingston-facilities-info-session-february-14/ 9. Support supervised In municipalities with high numbers of opioid overdoses, support the application process for an SCS to the consumption site (SCS) federal and provincial governments by community agencies. models in the community. For more information, please visit: http://www.simcoemuskokahealth.org/Topics/Drugs/opioids/Supervised-consumption-sites https://www.canada.ca/en/health-canada/services/substance-use/supervised-consumption- sites/explained.html

HS-12-2019-INFO-C

NEWS Ministry of Health

Ontario Taking Next Steps to Integrate Health Care System Changes will Protect Uninterrupted Access to Patient Care November 13, 2019 9:30 A.M.

TORONTO — Ontario is taking the next steps in its plan to better integrate the province's health care system to help end hallway health care.

On December 2, 2019, five provincial agencies will begin transferring into Ontario Health while the 14 Local Health Integration Networks (LHINs) have been clustered into five interim and transitional geographic regions.

This is an administrative step only and not a merger of the LHIN boundaries. Further, there will be no impact to patients' access to home and community care or long-term care placement as Ontarians continue to receive the care they need from the care providers they have built relationships with at the 14 LHINs. These changes are a means of streamlining the regional oversight as an interim measure as the government continues to work toward moving home and community care supports out of bureaucracy to integrate them with Ontario Health Teams.

"Our government has said from the beginning that we are working toward ending hallway health care," said Doug Ford, Premier of Ontario. "In order to bring our world-class health care system into the 21st century, we need to get rid of the inefficiencies and back office duplication. This is how we are continuing to put patients first and ensure sustainability for future generations."

As part of this next step to cluster the LHINs, the number of chief executive officer (CEO) positions has been reduced to five to ensure alignment and to eliminate duplication of roles and responsibilities. These five CEOs will now serve as interim regional leads and will be responsible for supporting the work required to transition LHIN functions into Ontario Health or to Ontario Health Teams, and to ensure that patient services continue uninterrupted. The money saved from this change will be redirected into frontline patient care.

"As we take the next steps to integrate Ontario's health care system, continuity of patient care remains our top priority," said Christine Elliott, Deputy Premier and Minister of Health. "This transfer will combine the knowledge, strength and expertise of many talented professionals under one roof as part of our plan to better coordinate and connect Ontario's health care system

Page 1 HS-12-2019-INFO-C to end hallway health care. We would like to acknowledge and thank the LHIN executive leadership for the ongoing professionalism, dedication and support as the government continues to modernize and strengthen Ontario's health care system."

"Ontario Health's goal is to ensure Ontarians receive high-quality health care services where and when they need them," said Bill Hatanaka, Ontario Health Board Chair. "On December 2, we bring the knowledge, skills and experience of this first wave of transferring organizations into Ontario Health and begin working with the five interim regional leads too. We are building our talent base to become one agency with one strategy and one set of priorities; applying the best of our collective expertise to all Ontario patients."

QUICK FACTS

• The five agencies transferring into Ontario Health are: Cancer Care Ontario; Health Quality Ontario; eHealth Ontario; Health Shared Services Ontario; and HealthForceOntario Marketing and Recruitment Agency. • The 14 LHINs have been clustered into five interim geographic regions and will be led by five transitional regional leads. The new appointees are: Bruce Lauckner (West), Scott McLeod (Central), Tess Romain (Toronto), Renato Discenza (East), and Rhonda Crocker Ellacott (North). • Trillium Gift of Life Network will transfer in at a later date to ensure there will be no disruption to patients and families involved with organ and tissue donation. • LHIN functions will eventually transition into Ontario Health or to local Ontario Health Teams over time based on a careful plan the ministry is developing with Ontario Health and LHINs.

LEARN MORE

• Improving Health Care in Ontario • Ontario Health • Ontario's Government for the People to Break Down Barriers to Better Patient Care • Building a Connected Public Health Care System for the Patient • Hallway Health Care: A System Under Strain • Image: Ontario Health Interim and Transitional Regions

David Jensen Communications Branch Available Online [email protected] Disponible en Français 416-314-6197 Hayley Chazan Senior Manager, Media Relations [email protected] 416-726-9941

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LONG-TERM CARE HOMES PROGRAM A Review of the Plan to Create 15,000 New Long-Term Care Beds in Ontario

2019

Page 1 HS-12-2019-INFO-D About this Document

Established by the Financial Accountability Officer Act, 2013, the Financial Accountability Office (FAO) provides independent analysis on the state of the Province’s finances, trends in the provincial economy and related matters important to the Legislative Assembly of Ontario.

The FAO produces independent analysis on the initiative of the Financial Accountability Officer. Upon request from a member or committee of the Assembly, the Officer may also direct the FAO to undertake research to estimate the financial costs or financial benefits to the Province of any bill or proposal under the jurisdiction of the legislature.

This report was prepared on the initiative of the Financial Accountability Officer in response to a request from a member of the Assembly. In keeping with the FAO’s mandate to provide the Legislative Assembly of Ontario with independent economic and financial analysis, this report makes no policy recommendations.

This analysis was prepared by Matt Gurnham under the direction of Jeffrey Novak, with a contribution from Ben Premi- Reiller.

External reviewers provided comments on early drafts of the report. The assistance of external reviewers implies no responsibility for the final product, which rests solely with the FAO.

ISBN 978-1-4868-3887-5 (Print) ISBN 978-1-4868-3888-2 (Online) © Queen’s Printer for Ontario, 2019

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Table of Contents

1 | Executive Summary 1

2 | Background and Context 6

The Wait List and Wait Times for LTC Beds are Growing 6

Why Has the Wait List Increased? 8

Commitment to Increase LTC Beds 8

Purpose and Structure of this Report 8

3 | Provincial Spending on Long-Term Care 10

How Long-Term Care Spending Works 10

4 | Timing and Cost of the LTC Expansion 12

Timing of the LTC Expansion 12

Impact to the Province’s Budget Balance 13

5 | Effect on LTC Wait Times 16

Total Number of LTC Beds by 2023-24 16

Wait List by 2023-24 16

Wait Times by 2023-24 18

Regional Impact 19

Wait Time Targets and Benchmarks 20

6 | Long-Term Implications 21

High Growth in Elderly Ontarians Will Continue Past 2023-24 21

55,000 More Ontarians Will Require an LTC Bed by 2033-34 21

7 | Impact of the LTC Expansion on Hallway Health Care 23

LTC Bed Wait Times Contribute to Hallway Health Care 23

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ALC Patients in Hospitals More Costly than Residents in Long-Term Care 24

Will the LTC Expansion Help End Hallway Health Care? 24

8 | Appendices 26

Appendix A: LTC Homes Program Spending Details 26

Appendix B: Detailed Long-Term Care Homes Program Spending Forecast 29

Appendix C: Development of this Report 30

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Table of Abbreviations

Abbreviation Long Form

ALC Alternate Level of Care

FAO Financial Accountability Office

LHIN Local Health Integration Network

LOC Level of Care

LTC Long-Term Care

MLTC Ministry of Long-Term Care

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1 | Executive Summary

Long-term care (LTC) homes provide accommodation to eligible Ontarians that require the availability of 24/7 nursing care and frequent assistance with daily activities. There are currently 626 LTC homes in Ontario that house over 78,000 residents.

LTC homes must be licensed by the Ministry of Long-Term Care (MLTC) and the ministry determines the number and location of long-term care beds in Ontario. LTC homes receive funding from the ministry through the long-term care homes program. Funding is provided based on the number of beds each LTC home has in operation and the types of services the LTC home provides.1 The Wait List and Wait Times for Long-Term Care Beds are Growing

In 2018-19 there were nearly 35,000 Ontarians on the wait list for a long-term care bed. The wait list for long-term care grew substantially from 2011-12 to 2018-19, increasing by approximately 78 per cent.

The growing LTC wait list has also led to increasing wait times for long-term care. From 2011-12 to 2018- 19, the median time to placement (or wait time) for a long-term care bed increased from 99 days to 152 days. Why Has the Wait List Increased?

High growth in the number of Ontarians aged 75 and over, combined with a lack of investment in new long-term care beds, have been the primary drivers of the growth in the long-term care wait list and wait times. Between 2011 and 2018, the number of long-term care beds in Ontario increased by only 0.8 per cent while the population of Ontarians aged 75 and over grew by 20 per cent.

Growth in elderly Ontarians has exceeded growth in the number of long-term care beds

90,000 1,100,000 88,000 1,053,097 1,050,000 86,000 84,000 20% growth 1,000,000 82,000 0.8% growth 80,000 950,000 78,053 78,664 78,000 900,000 76,000 876,886 74,000 850,000 72,000 70,000 800,000 2011 | 2018 2011 | 2018 Long-Term Care Beds (left axis) Ontarians Aged 75+ (right axis)

Source: Statistics Canada, Table 17-10-0005-01, Ministry of Finance, Ontario Population Projections 2018-2046, updated October 1, 2019, and information provided to the FAO by MLTC.

1 In addition to funding provided by the ministry through the long-term care homes program, LTC homes also receive payments directly from residents.

Executive Summary | 1 Page 6

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Commitment to Increase LTC Beds

In July 2018, the Province announced its commitment to address wait times for long-term care by adding 15,000 new long-term care beds over five years (the LTC expansion).2 In the 2019 Ontario Budget, the Province re-affirmed this commitment.3 This is the largest new health sector spending commitment in the 2019 budget and is “a crucial part of the government’s priority to end hallway health care.”4 Timing of the LTC Expansion

As of the writing of this report, the Province has allocated 7,889 of the 15,000 new long-term care beds. Most of the 7,889 new beds were allocated in the 2018-19 fiscal year and should be in service by 2021-22. On October 1, 2019, the Province launched the application process for the remaining 7,111 beds with applications due by January 2020.

Overall, the FAO estimates that the Province must allocate the remaining beds by March 2021 if the remaining 7,111 LTC beds are to be in service by the end of the 2023-24 fiscal year. The following chart outlines the FAO forecast of when the new beds will be in service by fiscal year.

FAO projection of number of new LTC beds in service by fiscal year

16,000

14,000

12,000 5,079

10,000 2,757 8,000 15,000 6,000 Number of Beds 4,000 6,134

2,000 1,030 0 2020-21 2021-22 2022-23 2023-24 Total

Source: FAO analysis of information provided by MLTC. Impact to the Province’s Budget Balance

The 15,000 new beds will not impact the Province’s budget balance until each bed comes into service.5 Under the assumption that all 15,000 new LTC beds will be in operation by 2023-24, the FAO estimates that the LTC expansion will increase LTC homes program spending by a total of $1.7 billion over the next five years.

2 Legislative Assembly of Ontario, Hansard, 42nd Parliament, 1st Sess, No 2 (12 July 2018). 3 2019 Ontario Budget, p. 117. The 2019 budget also committed to redevelop 15,000 existing long-term care beds to current design standards. 4 2019 Ontario Budget, p. 117. See also, FAO, “Expenditure Estimates 2019-20: Ministry of Health and Long-Term Care,” 2019. 5 The cost of constructing the 15,000 new beds is subsidized by the Province over a 25-year period starting when a new bed comes into service.

2 | Financial Accountability Office of Ontario Page 7

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15,000 new beds will increase LTC homes program spending by $1.7 billion over five years

($ millions) 2019-20 2020-21 2021-22 2022-23 2023-24 Total LTC homes program spending 0 14 350 505 863 1,732 increase for 15,000 new LTC beds Source: FAO.

The annual cost will rise each year as more new beds come into service. Once all 15,000 new beds are in service, the LTC expansion will increase long-term care homes program spending by an ongoing annual amount of approximately $970 million.

The 15,000 new beds represent the first meaningful increase to the supply of long-term care beds in over 15 years and will result in LTC homes program spending growing much faster than the historical average. The FAO estimates that total LTC homes program spending will grow at an annual average of 5.4 per cent over the next five years, increasing from $4.3 billion in 2018-19 to $5.6 billion in 2023-24. Wait List by 2023-24

Despite the significant increase in the number of long-term care beds, the FAO projects that the wait list for long-term care will increase by about 2,000 Ontarians over the next five years, from 34,900 in 2018-19 to approximately 36,900 Ontarians in 2023-24. The FAO projects that the wait list will peak at 40,200 Ontarians in 2020-21, an increase of about 5,300 from 2018-19, and will be reduced to 36,900 by 2023-24 as the new beds come into service.

LTC wait list projected to increase to 36,900 Ontarians by 2023-24

42,000 40,206 40,000 38,456 37,664 38,000 37,229 36,876

36,000 34,862 Term Care Wait list - 34,000 Long 32,000

30,000 2018-19 2019-20 2020-21 2021-22 2022-23 2023-24

Source: FAO.

The reason that the wait list for an LTC bed is projected to increase over the next five years, even with 15,000 new long-term care beds, is that the growth rate in the number of Ontarians aged 75 and over is projected to outpace the growth rate in LTC beds.

Executive Summary | 3 Page 8

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Wait Times by 2023-24

Despite the expected increase in the long-term care wait list over the next five years, the FAO projects a decrease in wait times by 2023-24. In 2018-19, the median time to placement for long-term care in Ontario was 152 days. Large numbers of new beds will not begin to come into service until the 2021-22 fiscal year. Therefore, the FAO projects time to placement will increase to 179 days by 2020-21. As the 15,000 new beds come into service, the FAO projects wait times will gradually decrease to 140 days by the 2023-24 fiscal year, reflecting a higher turnover of beds.

FAO projection for median time to placement (wait time) for a long-term care bed

250

200 179 152 159 158 159 150 140

100 Days to Placement 50

0 2018-19 2019-20 2020-21 2021-22 2022-23 2023-24

Source: FAO. 55,000 More Ontarians Will Require an LTC Bed by 2033-34

After 2023-24, in order to maintain the projected wait list at approximately 36,900 Ontarians, the Province would need to create an additional 55,000 new long-term care beds by 2033-34. The need for 55,000 more long-term care beds to maintain the wait list results from higher projected demand growth for long- term care. From 2023-24 to 2033-34, the growth rate in the population of Ontarians aged 85 and older is projected to average 4.7 per cent, up from an average annual growth rate of 3.0 per cent from 2018-19 to 2023-24. Will the LTC Expansion Help End Hallway Health Care?

“Hallway health care” refers to the estimated 1,000 patients waiting for a hospital bed in an unconventional space or emergency department stretcher on an average day in Ontario.

The wait time for a long-term care bed placement is a significant contributor to the problem of hallway health care in Ontario.6 In 2017-18, there were approximately 6,300 hospital patients that spent time waiting for an LTC bed placement. Those patients occupied over 340,000 hospital bed days or about five per cent of all hospital bed days in Ontario.

6 Approximately 24 per cent of long-term care residents are placed from hospitals.

4 | Financial Accountability Office of Ontario Page 9

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community) from 152 days in 2018-19 to 140 days in 2023-24. However, the FAO projects that the wait time for a long-term care bed will peak at 179 days in 2020-21. This implies that, in the absence of other health sector changes, the problem of hallway health care will get worse over the next two years.

By 2023-24, if all 15,000 new LTC beds have been opened, the wait time for an LTC bed is projected to decline to 140 days. If this improvement in LTC bed wait times also leads to patients spending less time in hospitals waiting for a long-term care bed, then, all else being equal, there could be an improvement in hallway health care by 2023-24 from the LTC bed expansion.

Executive Summary | 5 Page 10

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2 | Background and Context

Long-term care homes can be for-profit, not-for-profit or municipal organizations which are governed by the Long-Term Care Homes Act, 2007. LTC homes must be licensed by the Ministry of Long-Term Care (MLTC) and the ministry determines the number and location of long-term care beds in Ontario. LTC homes receive funding from the ministry through the long-term care homes program. Funding is provided based on the number of beds each LTC home has in operation and the types of services the LTC home provides. In addition to funding provided by the ministry through the long-term care homes program, LTC homes also receive payments directly from residents. The Wait List and Wait Times for LTC Beds are Growing

In 2018-19 there were nearly 35,000 Ontarians on the wait list for a long-term care bed. The wait list for long-term care has grown substantially since 2011-12, increasing by approximately 78 per cent over the last seven years.

Long-term care wait list

40,000 34,862 35,000 32,773 30,713 30,000 26,737

25,000 22,434 20,666 21,439 19,615 20,000

Term Care Wait List 15,000 -

Long 10,000

5,000

- 2011-12 2012-13 2013-14 2014-15 2015-16 2016-17 2017-18 2018-19

Source: Information provided to the FAO by MLTC.

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Median time to placement (wait time) for a long-term care bed

160 152 146 140 133 133 126 120 111 113 99 100

60 Days to Placement 40

0 2011-12 2012-13 2013-14 2014-15 2015-16 2016-17 2017-18 2018-19

Note: 2018-19 is an FAO estimate based on partial data on LTC placements in 2018-19. Source: Information provided to the FAO by MLTC.

Wait times for long-term care vary significantly depending on where the individual is located in Ontario. The Province tracks wait times for long-term care geographically based on the Province’s 14 Local Health Integration Networks (LHINs).7 In 2017-18, the median wait time for a long-term care bed ranged from 263 days in the Central East LHIN to 68 days in the Erie St. Clair LHIN.

Median time to placement (wait time) for a long-term care bed by LHIN (2017-18)

300 263 250 225 186 189 198 200 180 182 146 153 120 125 150 105 116 83 100 68 50 Days to Placement 0

Source: Health Quality Ontario.

7 See http://www.lhins.on.ca/ for a map of Ontario’s 14 LHINs. LHINs are responsible for planning, funding and delivering health care services to the communities within their networks. In February 2019, the Province announced that it would dissolve the 14 LHINs and consolidate their functions under a new agency, Ontario Health.

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Why Has the Wait List Increased?

Over 80 per cent of long-term care residents are over the age of 75. High growth in the number of Ontarians aged 75 and over, combined with a lack of investment in new long-term care beds, have been the primary drivers of the growth in the long-term care wait list and wait times. Between 2011 and 2018, the number of long-term care beds in Ontario increased by only 0.8 per cent while the population of Ontarians aged 75 and over grew by 20 per cent.

Growth in elderly Ontarians has exceeded growth in the number of long-term care beds

90,000 1,100,000

88,000 1,053,097 1,050,000 86,000 20% growth 84,000 1,000,000 82,000 0.8% growth

80,000 950,000 78,053 78,664 78,000 900,000 76,000 876,886

74,000 850,000 72,000

70,000 800,000 2011 | 2018 2011 | 2018

Long-Term Care Beds (left axis) Ontarians Aged 75+ (right axis)

Source: Statistics Canada, Table 17-10-0005-01, Ministry of Finance, Ontario Population Projections 2018-2046, updated October 1, 2019, and information provided to the FAO by MLTC. Commitment to Increase LTC Beds

In July 2018, the Province announced its commitment to address wait times for long-term care by adding 15,000 new long-term care beds over five years.8 In the 2019 Ontario Budget, the Province re-affirmed this commitment.9 This is the largest new health sector spending commitment in the 2019 budget and is “a crucial part of the government’s priority to end hallway health care.”10 Purpose and Structure of this Report

The purpose of this report is to analyze the Province’s commitment to create 15,000 new long-term care beds (the LTC expansion). The report explains how long-term care is funded by the Province and estimates the cost to the Province of the long-term care bed expansion commitment. The report then

8 Legislative Assembly of Ontario, Hansard, 42nd Parliament, 1st Sess, No 2 (12 July 2018). 9 2019 Ontario Budget, p. 117. The 2019 budget also committed to redevelop 15,000 existing long-term care beds to current design standards. 10 2019 Ontario Budget, p. 117. See also, FAO, “Expenditure Estimates 2019-20: Ministry of Health and Long-Term Care,” 2019.

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analyzes how the LTC expansion is expected to impact the wait list and wait times for LTC in the medium (5 years) and long-term (15 years). Finally, the report discusses the potential impact of the LTC expansion on the Province’s commitment to “end hallway health care”.

This report is structured as follows:

• Chapter 3 provides an overview of provincial spending on long-term care through the long-term care homes program.

• Chapter 4 presents the FAO’s estimate of the timing and cost of the LTC expansion.

• Chapters 5 and 6 project the impact of the LTC expansion on the wait list and wait times for long- term care over the medium and long-term.

• Lastly, Chapter 7 discusses how individuals waiting for long-term care impact hospital capacity and hallway health care.

Appendix C provides more information on the development of this report.

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3 | Provincial Spending on Long-Term Care

In 2018-19, the Province spent $61.5 billion in the Ontario health sector, of which $4.3 billion, or 7 per cent, was spent in the long-term care homes program area.

LTC homes program represented 7 per cent of total health sector spending in 2018-19 ($ billions)

Hospitals, 22.4, 36% OHIP (Physicians and Practitioners), 14.9, Capital, 1.8, 3% 24%

Other Programs, 7.7, 13% Ontario Drug Community Programs, 4.7, 8% Programs, 5.7, 9% Long-Term Care Homes, 4.3, 7%

Source: 2018-19 Public Accounts of Ontario and information provided to the FAO by MLTC. How Long-Term Care Spending Works

There are 626 long-term care homes in Ontario. LTC homes can be for-profit, not-for-profit, or municipally run organizations. LTC home operators receive funding from the Ministry of Long-Term Care, through the long-term care homes program, based on the number of beds in operation and the type of services provided. Long-term care home operators also receive payments from LTC residents. LTC residents are required to pay accommodation rates (co-payments) for long-term care which vary based on the type of accommodation they receive (e.g. basic, semi-private or private room).11 A portion of the payments made by residents for accommodation is remitted back to the Province to offset some of the cost of the long-term care homes program.12 In 2018-19, LTC residents offset $1.5 billion of the $5.8 billion cost of the long-term care homes program, for a net cost to the Province of $4.3 billion.

Most of the cost of the long-term care homes program (87 per cent) flows through a daily subsidy called the level of care (LOC) per diem payment, which is paid to long-term care home operators for each bed in operation. The LOC per diem payment covers the cost of nursing and personal care, basic

11 Monthly rates paid by residents range from $1,891 for basic accommodation to $2,702 for private accommodation. 12 The remaining payments made by residents are kept by the long-term care home operators.

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accommodation, programs and support services, and raw food. The remaining 13 per cent cost of the LTC homes program flows through numerous supplementary funding streams that support specific ministry policy objectives. Supplementary funding streams include construction funding subsidies for new or redeveloped beds and funding for physiotherapy and behavioural supports. On average, each of the 78,664 beds in operation in 2018-19 cost the Province $149 per day. (See appendix A for more details on the LTC homes program spending categories.)

2018-19 long-term care homes program spending by category, $ millions

Category $ millions % Nursing and Personal Care 2,919 50 Program and Support Services 279 5 Raw Food 268 5 Basic Accommodation 1,595 27 Total LOC Per Diem 5,062 87 Supplementary Funding Programs 764 13 Total Cost of Long-Term Care Homes Program 5,826 100 Less: Resident Co-payments -1,537 Net Cost to Province of Long-Term Care Homes 4,289 Program Note: Excludes payments made by residents that are retained by LTC home operators (e.g. for semi-private and private rooms). Source: Information provided to the FAO by MLTC.

From 2011-12 to 2018-19 long-term care homes program spending grew by an annual average of 2.5 per cent, increasing from $3.6 billion in 2011-12 to $4.3 billion in 2018-19. Level of care per diem funding increased at an annual average of 2.1 per cent which is slightly higher than the rate of inflation over the same time period at 1.7 per cent. Supplementary funding increased at an annual average of 4.2 per cent. The high growth rate in supplementary funding was primarily driven by new funding streams introduced for physiotherapy and behavioural supports.

Long-term care homes spending, 2011-12 to 2018-19

Average $ billions 2011-12 2012-13 2013-14 2014-15 2015-16 2016-17 2017-18 2018-19 Annual Growth Nursing and Personal Care 2.5 2.5 2.6 2.6 2.7 2.7 2.8 2.9 2.3% Program and Support Services 0.2 0.2 0.2 0.3 0.3 0.3 0.3 0.3 2.4% Raw Food 0.2 0.2 0.2 0.2 0.2 0.2 0.3 0.3 3.6% Basic Accommodation 1.4 1.5 1.5 1.5 1.5 1.5 1.6 1.6 1.5% Total LOC Per Diem 4.4 4.4 4.5 4.6 4.7 4.8 4.9 5.1 2.1% Supplementary Funding Programs 0.6 0.6 0.7 0.7 0.7 0.7 0.7 0.8 4.2% Total Cost of Long-Term Care 4.9 5.0 5.2 5.3 5.4 5.5 5.6 5.8 2.4% Homes Program Less: Resident Co-payments -1.3 -1.4 -1.4 -1.4 -1.5 -1.5 -1.5 -1.5 2.1% Net Cost to Province of Long- 3.6 3.7 3.8 3.9 3.9 4.0 4.1 4.3 2.5% Term Care Homes Program

Number of Beds 78,053 77,444 77,862 78,006 78,340 78,357 78,517 78,664 0.1% Source: Information provided to the FAO by MLTC.

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4 | Timing and Cost of the LTC Expansion Timing of the LTC Expansion

In July 2018, the Province announced its commitment to add 15,000 new long-term care beds over the next five years (the LTC expansion).13 The process for building or redeveloping a long-term care bed in Ontario begins when the LTC home operator signs a development agreement with the Ministry of Long- Term Care. Once the development agreement is executed, the LTC operator must finance and construct the beds in accordance with the terms of the agreement. It takes approximately three years from the execution of a development agreement to when the first resident occupies a new bed.

As of the writing of this report, the Province has allocated 7,889 of the 15,000 new long-term care beds.14 Most of the 7,889 new beds were allocated in the 2018-19 fiscal year and should be in service by 2021-22. On October 1, 2019, the Province launched the application process for the remaining 7,111 beds with applications due by January 2020. The ministry was not authorized to provide to the FAO its projection for when the remaining 7,111 beds will be in service,15 although the ministry notes to potential applicants that they should consider the feasibility of completing projects by 2023 when applying.16 Overall, the FAO estimates that the Province must allocate the remaining beds by March 2021 if the remaining 7,111 LTC beds are to be in service by the end of the 2023-24 fiscal year.17

The following chart outlines the FAO forecast of when the new beds will be in service by fiscal year. The forecast assumes that the 7,889 beds that have already been allocated will be in service three years from their allocation date.18 The FAO forecast also assumes that the Province will receive enough applications so that the remaining 7,111 beds will be allocated by the end of the 2020-21 fiscal year and all 15,000 new beds will be in service by the end of the 2023-24 fiscal year.

13 Legislative Assembly of Ontario, Hansard, 42nd Parliament, 1st Sess, No 2 (12 July 2018). For the purposes of this report, the FAO interprets the commitment to mean that the 15,000 new beds are intended to be in service by the end of the 2023-24 fiscal year. 14 Ontario Ministry of Long-Term Care, “Ontario One Step Closer to Creating 15,000 New Long-Term Care Beds,” Oct. 1, 2019. 15 The ministry states that the information is a Cabinet record that is not authorized to be released under Order in Councils 1002/2018 or 1412/2016. 16 http://www.health.gov.on.ca/en/pro/programs/ltc/. 17 Although three years is used as an approximate guideline for the amount of time required from the execution of a development agreement to when a new bed is in service, projects can take considerably longer. Therefore, even if the remaining 7,111 beds are allocated by March 2021, there is no guarantee that all beds will be in service by the end of the 2023-24 fiscal year. 18 The Ministry of Long-Term Care has provided the FAO with projected timelines for some projects. For those projects the FAO has incorporated the actual project timeline into its forecast. For other projects the FAO assumes a three-year lead time from when the ministry approves a project to when the beds are in service.

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FAO projection of number of new LTC beds in service by fiscal year

16,000

14,000

5,079 12,000

10,000

2,757 8,000 15,000

6,000 Number of Beds

4,000 6,134

2,000

1,030 0 2020-21 2021-22 2022-23 2023-24 Total

Source: FAO analysis of information provided by MLTC. Impact to the Province’s Budget Balance

The 15,000 new beds will not impact the Province’s budget balance until each bed comes into service and begins to receive LOC per diem payments and supplementary funding.19 The cost of constructing the new beds is subsidized by the Province after each new bed comes into service. Payment is made through the construction funding subsidy of the supplementary funding stream. As of 2019, a newly constructed bed that is in operation is eligible to receive a daily payment of between $18.03 and $23.03 over 25 years to cover the cost of construction.20 In total, the FAO estimates the construction of the 15,000 new beds will cost the Province $2.0 billion (in 2019 dollars) over 25 years or about $135,000 (in 2019 dollars) per bed.21

Under the assumption that all 15,000 new LTC beds will be in operation by 2023-24, the FAO estimates that the LTC expansion will increase LTC homes program spending by a total of $1.7 billion over the next five years. This cost estimate includes the LOC per diem payments and supplementary funding paid by the Province (including construction funding subsidy payments). The annual cost will rise each year as more new beds come into service. Once all 15,000 new beds are in service, the LTC expansion will increase long- term care homes program spending by an ongoing annual amount of approximately $970 million.

19 There are some exceptions to this statement. For example, not-for-profit or municipal operators are eligible for a planning grant of up to $250,000 that is paid before the beds are in operation. 20 The amount of the construction funding subsidy is adjusted based on the size of the home and the proportion of basic accommodation beds in the home. See The Province's Construction Funding Subsidy Policy for more detail. 21 The construction funding subsidy is a fixed amount provided by the Province that is not intended to cover the full cost of construction. For example, the Conference Board of Canada estimates the capital cost of a long-term care bed to be $320,000 in 2017 dollars. The LTC home operator is responsible for the remaining cost of construction.

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15,000 new beds will increase LTC homes program spending by $1.7 billion over five years

($ millions) 2019-20 2020-21 2021-22 2022-23 2023-24 Total LTC homes program spending 0 14 350 505 863 1,732 increase for 15,000 new LTC beds Source: FAO.

Overall, the FAO estimates total LTC homes program spending will grow at an annual average of 5.4 per cent over the next five years, increasing from $4.3 billion in 2018-19 to $5.6 billion in 2023-24.22 LTC homes program spending growth will begin to accelerate in the 2021-22 fiscal year as 6,134 new beds are projected to come into service in that year. The FAO estimates LTC homes program spending will grow at an annual average of 7.9 per cent from 2020-21 to 2023-24.

LTC homes program spending forecast ($ billions)

6.0 5.6 5.5 5.1 5.0 4.9

4.4 4.4 4.5 4.3

4.0

LTC Homes Program Spending 3.5

3.0 2018-19 2019-20 2020-21 2021-22 2022-23 2023-24

Source: FAO.

The 15,000 new beds represent the first meaningful increase to the supply of long-term care beds in over 15 years and will result in LTC homes program spending growing much faster than the historical average. For reference, from 2011-12 to 2018-19, long-term care homes program spending increased by an annual average of only 2.5 per cent.

22 See appendix B for a detailed forecast.

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LTC homes program spending annual growth rate will increase significantly over the next five years ($ billions)

6.0 5.4% average annual growth from 2018-19 to 2023-24 2.5% average annual growth from 5.0 2011-12 to 2018-19

4.0

3.0

2.0

1.0 LTC Homes Program Spending

0.0

Source: Information provided to the FAO by MLTC and FAO.

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5 | Effect on LTC Wait Times Total Number of LTC Beds by 2023-24

Based on the assumptions in the previous chapter on the timing of the LTC expansion, the 15,000 new long-term care beds will increase the supply of long-term care spaces in Ontario from 78,700 in 2018-19 to approximately 93,700 in 2023-24. The growth in the number of LTC beds will begin to accelerate in the 2021-22 fiscal year as approximately 6,134 new beds are projected to be completed in that year.

Projected number of long-term care beds in Ontario

95,000 93,664

90,000 88,585

85,828 85,000

79,694 80,000 78,664 Number of Beds

75,000

70,000 2019-20 2020-21 2021-22 2022-23 2023-24

Source: FAO analysis of information provided by MLTC. Wait List by 2023-24

Despite the significant increase in the number of long-term care beds, the FAO projects that the wait list for long-term care will increase by about 2,000 Ontarians over the next five years, from 34,900 in 2018-19 to approximately 36,900 Ontarians in 2023-24.23 The FAO projects that the wait list will peak at 40,200 Ontarians in 2020-21, an increase of about 5,300 from 2018-19, and will be reduced to 36,900 by 2023-24 as the new beds come into service.

23 The wait list forecast assumes no additional program changes (e.g., expanded community care programming) or long-term care homes program policy changes (e.g., changes to eligibility for the LTC wait list) that could affect long-term care demand.

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LTC wait list projected to increase to 36,900 Ontarians by 2023-24

42,000

40,206 40,000 38,456 37,664 38,000 37,229 36,876

36,000 34,862 Term Care Wait list - 34,000 Long 32,000

30,000 2018-19 2019-20 2020-21 2021-22 2022-23 2023-24

Source: FAO.

The reason the wait list for an LTC bed is projected to increase (even with 15,000 more LTC beds) is that the number of Ontarians in need of a long-term care bed placement (or LTC demand) is expected to increase by 17,000, outpacing the 15,000 new beds. The large increase in LTC demand over the next five years is primarily due to an expected accelerated growth rate in the number of elderly Ontarians. From 2018-19 to 2023-24, the number of Ontarians aged 75 and over is projected to grow by an annual average of 4.3 per cent.24 For comparison, from 2013-14 to 2018-19, the number of Ontarians aged 75 and over grew at an annual average rate of only 2.8 per cent.25 Over that time period, the wait list for long-term care beds increased by 13,000 Ontarians.

24 Ministry of Finance, Ontario Population Projections 2018-2046, updated October 1, 2019. 25 Statistics Canada, Table 17-10-0005-01. Population estimates on July 1, by age and sex.

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Growth in Ontarians aged 75 and over will accelerate over the next five years

4.5% 4.3% 4.0% 3.5% 3.0% 2.8% 2.5% 2.0% 1.5% 1.0% Average Annual Growth 0.5% 0.0% 2013-14 to 2018-19 2018-19 to 2023-24

Source: Statistics Canada, Table 17-10-0005-01 and Ministry of Finance, Ontario Population Projections 2018-2046, updated October 1, 2019. Wait Times by 2023-24

Despite the expected increase in the long-term care wait list over the next five years, the FAO projects a decrease in wait times by 2023-24. In 2018-19, the median time to placement for long-term care in Ontario was 152 days. As large numbers of new beds will not begin to come into service until the 2021-22 fiscal year, the FAO projects time to placement will increase to 179 days by 2020-21. As the new beds come into service, the FAO projects wait times will gradually decrease to 140 days by the 2023-24 fiscal year.

FAO projection for median time to placement (wait time) for a long-term care bed

250

200 179 159 152 158 159 150 140

100 Days to Placement 50

0 2018-19 2019-20 2020-21 2021-22 2022-23 2023-24

Source: FAO.

The reason the wait list is expected to increase while wait times are expected to decline reflects the fact that with 15,000 more long-term care beds in operation there will be a higher turnover of beds.

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Approximately 28 per cent of long-term care beds turnover each year and from 2013-14 to 2017-18 there was an average of 21,000 long-term care placements each year. With the addition of 15,000 new beds, approximately 4,200 more beds will turnover each year, which the FAO estimates will result in reduced wait times despite the growing wait list. Regional Impact

The Province has indicated that it will prioritize the allocation of new LTC beds to areas where the beds will have the greatest impact on wait times and hallway health care.26 As noted previously, wait lists and time to placement vary significantly by LHIN geographic region. The variation is due to differences in the supply/demand balance, demographics, and the availability of alternatives to long-term care such as community-based care.27

To date, the Ministry of Long-Term Care has allocated 7,889 of the 15,000 new bed commitment. For the most part, the 7,889 new beds have been allocated to the LHIN regions with the longest wait lists and/or wait times. For example, the six LHIN regions that have received the most new beds also have the longest wait lists.

7,889 new long-term care beds allocated by LHIN region

Number of new LTC wait list Median time to LHIN beds allocated (rank) placement (rank) Central East 1,095 7,080 (1) 263 (1) Hamilton Niagara Haldimand Brant 1,080 3,027 (4) 105 (12) Toronto Central 1,069 2,633 (5) 225 (2) Central 1,064 4,948 (2) 189 (4) Champlain 751 3,356 (3) 186 (5) Mississauga Halton 649 2,300 (6) 180 (7) North Simcoe Muskoka 401 1,959 (8) 182 (6) South East 400 1,400 (11) 153 (8) North East 384 2,040 (7) 116 (11) South West 291 1,769 (9) 83 (13) Central West 266 997 (12) 125 (9) North West 201 817 (13) 198 (3) Waterloo Wellington 186 1,726 (10) 120 (10) Erie St. Clair 52 810 (14) 68 (14) Source: FAO analysis of information provided to the FAO by MLTC. Note: Median time to placement reflects placements from both hospitals and the community.

Looking forward, the FAO is unable to project the overall impact of the 15,000 LTC bed expansion on the wait list or time to placement by LHIN region as the remaining 7,111 beds have yet to be allocated.

26 Information provided to the FAO by MLTC. 27 Examples of community-based care include provincially funded home care, care from family members and privately funded retirement homes.

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Wait Time Targets and Benchmarks

The Ministry of Long-Term Care does not have a target for the wait list or wait times for a long-term care bed, or a benchmark (such as another jurisdiction) to compare against changes to the wait list or wait times.

Health Quality Ontario (HQO)28 publicly reports on 12 indicators or measures of the quality of long-term care. However, only five of the indicators currently have targets or benchmarks. While median time to placement (or wait times) is an indicator measured by HQO, and reported publicly, HQO has not identified an appropriate target or benchmark for LTC wait times.29

Compared to British Columbia and Alberta, Ontario has significantly longer wait times for a long-term care bed. In British Columbia, there are 28,000 long-term care beds with a wait list of about 1,400 people and a median time to placement (wait time) of 12 days. In addition, some provinces do have wait time targets. For example, Alberta has a target of placing 65 per cent of patients into continuing care30 within 30 days.31 In 2017-18, Alberta fell short of the target, placing only 52 per cent of clients within the 30-day window.32 By comparison, less than three per cent of long-term care homes in Ontario place 50 per cent of clients within 30 days.

28 HQO is an agency of the Ministry of Health that acts as the Province’s advisor on health quality. 29 Health Quality Ontario, “Results from Health Quality Ontario’s Benchmark Setting for Long-Term Care Indicators,” Feb 2017. 30 Continuing care refers to a range of services that support the health and wellbeing of individuals living in their own home, a supportive living or long- term care setting. 31 Health Quality Council of Alberta, “Review of Alberta Health Services’ Continuing Care Wait List,” March 2014. This measure has also been recommended to be adopted in British Columbia. See https://bccare.ca/wp-content/uploads/2019/05/Bedlam_in_BC_Continuing_Care_Sector.pdf. 32 Calgary Herald, “Alberta government missing targets for accessing long-term care,” July 2018.

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6 | Long-Term Implications High Growth in Elderly Ontarians Will Continue Past 2023-24

Growth in the number of Ontarians aged 75 and over is the primary driver of long-term care demand in Ontario. Over 80 per cent of Ontarians in long-term care are over the age of 75. However, as a person ages, the likelihood they will be in provincially funded long-term care increases. For example, an individual aged 85 or older is over seven times more likely to be in long-term care than a 75-year-old.33

As noted in chapter 5, the growth rate of the Ontario population aged 75 and over is projected to accelerate to 4.3 per cent annual growth from 2018-19 to 2023-24 compared to 2.8 per cent over the prior five-year period. This accelerated growth rate is projected to continue for the 10-year period from 2023-24 to 2033-34 at 4.2 per cent average annual growth.

More importantly, the growth rate of Ontarians over the age of 85 is projected to increase significantly. From 2023-24 to 2033-34, the growth rate in the population of Ontarians aged 85 and older is projected to average 4.7 per cent, up from an average annual growth rate of 3.0 per cent from 2018-19 to 2023-24.

Growth in Ontarians aged 85 and over will accelerate over the long-term

75+ Population Growth 85+ Population Growth 5.0% 4.7% 4.5% 4.3% 4.2% 4.0% 3.5% 3.0% 3.0% 2.5% 2.0% 1.5%

Average Annual Growth 1.0% 0.5% 0.0% 2018-19 to 2023-24 2023-24 to 2033-34

Source: FAO analysis of Ministry of Finance, Ontario Population Projections 2018-2046, updated October 1, 2019. 55,000 More Ontarians Will Require an LTC Bed by 2033-34

Based on the projections for Ontario population growth and population aging noted above, the FAO forecasts that 55,000 more Ontarians will require a long-term care placement in 2033-34 compared to

33 In 2018-19, approximately 19.1 per cent of Ontarians aged 85 and over were either in long-term care or on the long-term care wait list, compared to 4.2 per cent of Ontarians aged 75 to 84.

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2023-24.34 Therefore, to maintain the projected wait list in 2023-24 at approximately 36,900 Ontarians, the Province would need to add 55,000 new long-term care beds by 2033-34 and ensure that all existing beds stay in service.35 This would result in a total supply of long-term care beds in 2033-34 of 148,700, up from a projected 93,700 LTC beds in 2023-24.

34 The FAO estimates LTC demand growth will accelerate from an annual average of 2.8% from 2018-19 to 2023-24 to 3.6% from 2023-24 to 2033-34. 35 Assumes no additional program changes (e.g., expanded community care programming) or long-term care homes program policy changes (e.g., changes to eligibility for the LTC wait list) that could affect long-term care demand.

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7 | Impact of the LTC Expansion on Hallway Health Care LTC Bed Wait Times Contribute to Hallway Health Care

“Hallway health care” refers to the estimated 1,000 patients waiting for a hospital bed in an unconventional space or emergency department stretcher on an average day in Ontario. Hallway health care is a symptom of capacity pressures in the Ontario health sector resulting from Ontario not having the appropriate mix of services and beds throughout the health system.36

The wait time for a long-term care bed placement is a significant contributor to the problem of hallway health care in Ontario. Approximately 24 per cent of long-term care residents are placed from hospitals. In 2018-19, the median time to placement (or wait time) for a long-term care bed for residents from hospitals was 98 days. From 2012-13 to 2018-19 the wait time for a long-term care bed for patients waiting in hospitals increased by 27 per cent, from 77 days to 98 days. Overall, increasing wait times for hospital patients requiring a long-term care bed occupies valuable hospital capacity and is detrimental to patients’ health and well-being.37

Median time to long-term care bed placement for patients waiting in hospitals

120

98 100 92 94

80 77 72 70

60 60

Median Time to PlacementMedianTime to (days) 20

0 2012-13 2013-14 2014-15 2015-16 2016-17 2017-18 2018-19

Source: Health Quality Ontario and information provided to the FAO by MLTC.

Patients discharged to long-term care homes from hospitals represent about two per cent of all hospital patients. However, due to long LTC wait times, those patients represent one-third of the alternate level of

36 “Hallway Health Care: A System Under Strain,” Premier’s Council on Improving Healthcare and Ending Hallway Medicine, p. 2. 37 Dr. David Walker, “Caring for Our Aging Population and Addressing Alternate Level of Care,” June 2011.

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care (ALC) days in Ontario. A patient is designated as ALC when they no longer need care in hospital but continue to occupy a hospital bed while waiting to go elsewhere like a long-term care home or rehabilitation facility. In November 2018, over 4,600 of the Province’s 34,000 hospital beds were occupied by ALC patients waiting to go elsewhere.38

ALC patients waiting for a long-term care bed spend much more time occupying a hospital bed than other ALC patients. On average, ALC patients that are transferred to a long-term care bed spend 69 days in the hospital, with 54 of those days designated as ALC. On the other hand, all other ALC patients spend an average of 29 days in the hospital, with only 15 of those days designated as ALC.

Average hospital length of stay for ALC patients in Ontario

Total average length Acute Care Days ALC Days of stay in hospital ALC patients waiting for a long-term 15 54 69 care bed All other ALC patients 14 15 29 Source: Information provided to the FAO by MLTC. ALC Patients in Hospitals More Costly than Residents in Long- Term Care

In 2017-18, there were approximately 6,300 hospital patients designated as ALC that spent time waiting for an LTC placement. Those patients occupied over 340,000 hospital bed days or about five per cent of all hospital bed days in Ontario. Each day a patient remains in hospital designated as ALC while waiting for an LTC bed costs the Province approximately $500 more than if the patient were in a long-term care home bed. Therefore, in 2017-18 ALC patients waiting in hospitals for long-term care beds cost the Province approximately $170 million. Will the LTC Expansion Help End Hallway Health Care?

The Province has indicated that it will prioritize the allocation of new long-term care beds to areas where the beds will have the greatest impact on wait times and hallway health care. For the most part, the 7,889 currently allocated beds are being placed in areas with the longest wait lists and the highest number of hospital bed days being occupied by patients waiting for a long-term care placement. The five LHINs with the most beds allocated all had the longest wait lists and also the highest number of hospital ALC days.

38 “Hallway Health Care: A System Under Strain,” Premier’s Council on Improving Healthcare and Ending Hallway Medicine, p. 14.

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Allocation of 7,889 new LTC beds by LHIN

Median time Total number Number of LTC wait list to placement LHIN of ALC days beds allocated (rank) from hospital (rank) (rank) Central East 1,095 53,354 (1) 7,080 (1) 185 (1) Hamilton Niagara Haldimand 1,080 46,559 (2) 3,027 (4) 82 (9) Brant Toronto Central 1,069 30,310 (5) 2,633 (5) 113 (6) Central 1,064 35,755 (4) 4,948 (2) 153 (2) Champlain 751 37,207 (3) 3,356 (3) 98 (8) Mississauga Halton 649 25,412 (7) 2,300 (6) 152 (3) North Simcoe Muskoka 401 11,921 (11) 1,959 (8) 140 (4) South East 400 20,236 (9) 1,400 (11) 80 (10) North East 384 29,470 (6) 2,040 (7) 71 (11) South West 291 22,683 (8) 1,769 (9) 44 (14) Central West 266 5,687 (14) 997 (12) 106 (7) North West 201 18,567 (10) 817 (13) 139 (5) Waterloo Wellington 186 10,915 (12) 1,726 (10) 70 (12) Erie St. Clair 52 10,243 (13) 810 (14) 50 (13) Note: “Total number of ALC days (rank)” only includes ALC patients waiting for a long-term care placement. Source: FAO analysis of information provided by MLTC.

As noted above, by 2023-24 the FAO is projecting a 2,000 person increase in the number of Ontarians on the long-term care wait list and a decrease in the median time to placement (from hospitals and the community) from 152 days in 2018-19 to 140 days in 2023-24. However, the FAO projects that the wait time for a long-term care bed will peak at 179 days in 2020-21. This implies that, in the absence of other health sector changes, the problem of hallway health care will get worse over the next two years.

By 2023-24, if all 15,000 new LTC beds have been opened, the wait time for an LTC bed is projected to decline to 140 days. If this improvement in LTC bed wait times also leads to ALC patients spending less time in hospitals waiting for a long-term care bed, then, all else being equal, there could be an improvement in hallway health care by 2023-24 from the LTC bed expansion.

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8 | Appendices Appendix A: LTC Homes Program Spending Details

Long-term care homes program spending has two main channels: level of care (LOC) per diem payments and supplementary payments that reflect provincial priorities. Level of Care Per Diem Payments

Province

For each day that an LTC home operator has a bed in operation, the operator receives an LOC per diem payment from the Ministry of Long-Term Care through four funding envelopes.39

Long-term care homes program LOC per diem summary

Per Diem 2019 Category Description ($)

Cost of staffing for nursing and personal Nursing and Personal Care support services that meet the needs of 102* residents of each particular home

Funding for recreational and social activities, Program and Support Services 12 medical services, religious practices, etc.

Cost of food (does not include the Raw Food 10 preparation of food)

Basic Accommodation Funding for the basic rate of accommodation 57

Funding that can be applied to any of the Global Increase 2 four LOC per diem funding envelopes

* The Nursing and Personal Care per diem is adjusted based on the Case Mix Index of each home to reflect the acuity of the home’s residents. Source: Ontario Ministry of Long-Term Care long-term care homes financing policy.

Resident Co-payments

Residents are required to contribute to the cost of accommodation through resident co-payments. All residents are required to pay the basic accommodation rate which is designed to offset the basic accommodation cost paid by the Province to long-term care home operators (see above). However, for low income residents, the Province will cover some or all of the basic rate of accommodation and will reduce the resident’s co-payment.40

In addition, residents may choose accommodation in private or semi-private rooms at an additional cost. The added cost for private or semi-private rooms is regulated by the Province and results in additional

39 Effective April 1, 2019, a fifth funding envelope was added to the LOC per diem called the “Global Increase”. LTC homes may allocate up to 32 per cent of the Global Increase funding envelope to the Basic Accommodation envelope. The greater of the remaining balance or 68 per cent of the Global Increase funding envelope must be applied to the remaining three funding envelopes: Nursing and Personal Care, Program and Support Services, and Raw Food. 40 See https://www.ontario.ca/page/get-help-paying-long-term-care for more information.

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revenue for long-term care home operators. Overall, monthly rates paid by residents range from $1,891 for basic accommodation to $2,702 for private accommodation.

Long-term care accommodation rates paid by residents as of July 1, 2019

Type of Accommodation Daily Rate Monthly Rate Long-stay basic $62.18 $1,891.31 Long-stay semi-private $74.96 $2,280.04 Long-stay private $88.82 $2,701.61 Short-stay $40.24 N/A

Source: Ontario Ministry of Long-Term Care long-term care accommodation costs and subsidy. Note: The above table shows the maximum accommodation rates; actual rates may be less depending on the structure and age of the long-term care home. Supplementary Funding

In addition to the LOC per diem payment, there are a number of supplementary funding streams under the long-term care homes program. Many of these funding streams are claims based and can vary from home to home based on the services each long-term care home offers.

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Long-term care homes program supplementary funding summary

2018-19 amount Funding Stream Description ($ millions)

Per diem amount provided for new and redeveloped Construction Funding Subsidy beds subject to a development agreement with 150 MLTC

Physiotherapy Funded at an annual amount per bed for all homes 67

Claims-based reimbursement up to 85% of property Municipal Tax and Allowance Fund 63 tax bill

Behavioural Supports Ontario (BSO) Amount provided to homes with BSO designation 58

Claims-based funding to help prevent unnecessary High Intensity Needs Fund admissions to hospitals and to enable the discharge 61 of patients from hospitals to long-term care

Equalization Adjustment & Pay Equity Fixed amount subject to pay equity agreement 126

Funding for RAI coordinators that administer the Resident Assessment Instruments. The RAI is a tool Resident Assessment Instrument (RAI) 40 used to assess the care needs of long-term care residents.

This includes the following funding streams: • Laboratory services fund Other Supplementary Funding • High wage transition fund 198 Streams • Planning grants • Structural compliance premium

Total Supplementary Funding 764

Note: In July 2019, the Province announced that the high wage transition fund and the structural compliance premium would be terminated in August 2019. That decision was reversed in September 2019 and now the high wage transition fund will end on December 31, 2020 and the structural compliance premium will end on March 31, 2020. Source: Information provided to the FAO by MLTC.

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Appendix B: Detailed Long-Term Care Homes Program Spending Forecast

Average FAO Forecast ($ billions) 2018-19 2019-20 2020-21 2021-22 2022-23 2023-24 Annual Growth Nursing and Personal Care 2.9 2.9 3.0 3.2 3.4 3.6 4.5% Program and Support Services 0.3 0.3 0.3 0.3 0.3 0.4 5.3% Raw Food 0.3 0.3 0.3 0.3 0.3 0.3 5.1% Basic Accommodation 1.6 1.6 1.7 1.8 1.9 2.0 5.0% LOC Per Diem 5.1 5.2 5.3 5.7 6.0 6.4 4.9% Supplementary Funding Programs 0.8 0.8 0.8 0.9 1.0 1.1 7.5% Total Cost of Long-Term Care Homes 5.8 5.9 6.0 6.6 6.9 7.5 5.3% Program Less: Resident Co-payments -1.5 -1.6 -1.6 -1.7 -1.8 -2.0 5.0% Net Cost to Province of Long-Term Care 4.3 4.4 4.4 4.9 5.1 5.6 5.4% Homes Program

Number of Beds (end of year) 78,664 78,664 79,694 85,828 88,585 93,664 3.6% Cost Per Bed Per Day 149 152 154 158 162 167 2.3% Note: LOC per diem totals include the new Global Increase introduced in August 2019. Totals do not reflect the reallocation of physiotherapy and RAI supplementary funding streams to the Nursing and Personal Care and Program and Support Services categories of the LOC per diem introduced in 2019. Source: FAO.

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Appendix C: Development of this Report

Authority

The Financial Accountability Officer decided to undertake the analysis presented in this report under paragraph 10(1)(b) of the Financial Accountability Officer Act, 2013. Key Questions

The following key questions were used as a guide while undertaking research for this report:

• What is the current number of long-term care (LTC) beds in Ontario?

o How has the number of LTC beds changed since 2005? • What is the current wait list for LTC beds in the province?

o How has the wait list changed since 2005?

o Where are individuals on the wait list located (e.g. hospitals, at home, etc.)?

o What is the Province’s benchmark/target for LTC bed wait times? • How many new LTC beds is the Province expected to create over the next five years?

o What is the estimated cost of the new LTC bed commitment?

o What is the FAO’s projection for the LTC bed waitlist over the next five years given the Province’s new LTC bed commitment?

o What is the FAO’s estimate of LTC bed supply that is required to keep the LTC bed waitlist constant and/or to reduce the LTC bed waitlist?

• What is the per bed cost difference between an individual waiting in a hospital for an LTC bed compared to a resident at an LTC home?

Methodology

This report has been prepared with the benefit of information provided by, and meetings with staff from, the Ministry of Long-Term Care and a review of relevant literature and other publicly available information. Specific sources are referenced throughout.

All dollar amounts are in Canadian, current dollars (i.e. not adjusted for inflation) unless otherwise noted.

The projected long-term care bed wait list is calculated as the difference between the FAO’s projection of long-term care demand and the number of available long-term care beds in Ontario.

Long-term care demand in 2018-19 is estimated based on the number of individuals in long-term care and on the long-term care wait list. The 2018-19 demand was then broken down into five-year age groups and future demand is estimated based on the projected growth of the population in each five- year age group over time using the Ministry of Finance’s “Ontario Population Projections 2018-2046” (updated October 1, 2019). The demand growth in each year is then reduced by 0.54 percentage points to

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account for an observed trend over time of long-term care demand growth being lower than the growth demographics would indicate.

The number of beds in operation is calculated based on the number of existing beds, and the FAO’s projection of when the 15,000 new beds will be in service, less the number of beds that will be placed in abeyance for redevelopment.

Long-term care wait times are estimated based on an observed relationship between the length of the wait list, the number of beds in operation and the provincial average time to placement.

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Date: November 13, 2019

To: All Staff

From: Bill Hatanaka Susan Fitzpatrick Ontario Health Board Chair Ontario Health Interim CEO

Re: Ontario Health Transitional Regional Leadership

We are writing to provide you with two updates taking place today.

In order to provide ongoing oversight of the 14 LHINs while enabling the continued delivery and coordination of regional care across the health care system, we are aligning the LHINs during this transitionary period to five interim and transitional regions. This is not a merger of the LHIN boundaries. Rather, these changes are a means of streamlining the regional oversight as an interim measure as the ministry continues its work to integrate home and community care supports with Ontario Health Teams.

Effective today, 14 LHINs have been clustered into five interim and transitional geographic regions that are to be led by five LHIN CEOs who have been cross-appointed as Transitional Regional Leads and will report to Susan Fitzpatrick, Interim CEO of Ontario Health, in addition to the LHIN boards, to support Ontario Health with transition planning.

The five Transitional Regional Leads are responsible for the ongoing management of operations including:

 Coordinating patients’ access to home and community care and long-term care;  Continuing the day-to-day administrative oversight of health service providers;  Engaging with patients and families through your patient and family advisory councils;  Engaging with Indigenous and Francophone peoples, and;  Leading and managing the LHIN workforces within their region.

Please join us in welcoming the following leaders in their new roles:

 Bruce Lauckner will become the Transitional Regional Lead in western Ontario (and managing Erie St. Clair, Hamilton Niagara Haldimand Brant, South West and Waterloo Wellington).  Renato Discenza will become the Transitional Regional Lead in eastern Ontario (and managing Champlain, South East and Central East).  Scott McLeod will become the Transitional Regional Lead in central Ontario (and managing Central, Central West, Mississauga Halton, and North Simcoe Muskoka).  Tess Romain will become the Transitional Regional Lead in Toronto (and managing Toronto Central).  Rhonda Crocker Ellacott will become the Transitional Regional Lead in northern Ontario (and managing North East and North West).

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As we transition to five Transitional Regional Leads, patient safety and quality care will not be affected, and home and community care services will not be impacted. Your workforces will be well supported in their delivery of critical services on the frontlines.

Together, as a leadership table with the Ontario Health Transition Team, the Transitional Regional Leads will have a view of the big picture across the province, ensuring effective transition planning for LHIN functions.

The Transitional Regional Leads will soon be in touch with staff in their respective regions about next steps.

We also want to share that the Ontario Health Board of Directors express their sincerest and deepest appreciation to the departing CEOs for their tremendous contributions and years of dedicated service. Ontario has greatly benefitted from their leadership, commitment, ongoing professionalism and excellence in ensuring high quality health service planning and delivery in their regions.

And lastly, we want to share with you that transfer orders were issued today by the Honourable Christine Elliott, Deputy Premier and Minister of Health, to Cancer Care Ontario, eHealth Ontario, HealthForceOntario Marking and Recruitment Agency, Health Shared Services Ontario and Ontario Health Quality Council operating as Health Quality Ontario. The transfer orders state that those agencies will be transferred to Ontario Health on December 2, 2019.

Your organizations and the Trillium Gift of Life Network are not transferring into Ontario Health at this time as the ministry and Ontario Health are taking every precaution to ensure the continuity of direct patient care and services are maintained while their detailed planning moves forward, enabling a smooth transition at the right time and in the right way.

Looking Ahead

Since the proclamation of the Connecting Care Act, 2019 last June, the agencies that will eventually form Ontario Health have been working diligently and cooperatively towards the goal of transferring. We would like to thank all of you for your patience, professionalism, and ongoing commitment to high- quality patient care during this transition. Continuity of patient care will remain a top priority.

This is an exciting time for health care delivery in the province and you are all part of its evolution. We will continue to update you on our progress. In the meantime, we look forward to our continued work together – improving health care delivery for all Ontarians.

Until next time,

Bill and Susan

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Date: 13 novembre, 2019

À: Tout le personnel

De: Bill Hatanaka Susan Fitzpatrick Président du conseil de Santé Ontario PDG intérimaire de Santé Ontario

Objet : Direction régionale transitionnelle de Santé Ontario

Nous vous écrivons pour vous informer de deux changements apportés aujourd’hui.

Afin d’offrir une supervision continue des 14 RLISS tout en permettant la poursuite de la prestation et la coordination de soins régionaux dans l’ensemble du système de santé, nous alignons les RLISS avec cinq régions provisoires et transitionnelles pendant cette période de transition. Il ne s’agit pas d’une fusion des délimitations des RLISS. Ces changements constituent plutôt un moyen de simplifier la supervision régionale de manière provisoire pendant que le ministère poursuit son travail d’intégration des soutiens de soins à domicile et dans la communauté avec les équipes de Santé Ontario.

À compter d’aujourd’hui, 14 RLISS ont été regroupés en cinq régions géographiques provisoires transitionnelles qui seront dirigées par cinq PDG de RLISS qui ont été nommés conjointement comme responsables régionaux transitionnels et travailleront sous la direction de Susan Fitzpatrick, PDG intérimaire de Santé Ontario, en plus des conseils des RLISS, pour contribuer à la planification de la transition de Santé Ontario.

Les cinq responsables régionaux transitionnels sont chargés de la gestion continue des opérations, y compris :

 Coordonner l’accès des patients à des soins à domiciles et en milieu communautaire et à des soins de longue durée;  Poursuivre la supervision administrative quotidienne des fournisseurs de services de santé;  Communiquer avec les patients et les familles par l’intermédiaire de vos conseils consultatifs des patients et des familles;  Mobiliser les peuples autochtones et francophones;  Diriger et gérer la main d’œuvre des RLISS au sein de leur région.

Ensemble, souhaitons la bienvenue aux responsables suivants dans l’exercice de leurs nouvelles fonctions :

 Bruce Lauckner qui deviendra responsable régional de la transition de l’Ouest de l’Ontario (et directeur des RLISS d’ Érie St. Clair, Hamilton Niagara Haldimand Brant, Sud-Ouest et Waterloo Wellington).  Renato Discenza qui deviendra responsable régional de la transition de l’Est de l’Ontario (et directeur des RLISS de Champlain, du Sud-Est et du Centre-Est).

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 Scott McLeod qui deviendra responsable régional de la transition du Centre de l’Ontario (et directeur des RLISS du Centre, du Centre-Ouest, de Mississauga Halton, et de Nord-Simcoe Muskoka).  Tess Romain qui deviendra responsable régionale de la transition à Toronto (et directeur général du RLISS du centre de Toronto).  Rhonda Crocker Ellacott qui deviendra responsable régionale de la transition du Nord de l’Ontario (et directeur général des RLISS du Nord-Est et du Nord-Ouest).

Ce passage à cinq responsables régionaux transitionnels n’affectera aucunement la sécurité des patients, la qualité des soins ni les services de soins à domicile et en milieu communautaire. Votre personnel sera bien appuyé dans la prestation de services critiques de première ligne.

Ensemble, en tant que comité de leadership avec l’équipe de transition de Santé Ontario, les responsables régionaux transitionnels se feront une idée de la situation globale de la province, garantissant une planification efficace de la transition des fonctions des RLISS.

Les responsables régionaux transitionnels prendront bientôt contact avec le personnel de leurs régions respectives au sujet des prochaines étapes.

Nous souhaitons également, au nom du conseil d’administration de Santé Ontario, remercier infiniment les PDG qui nous quittent pour leurs immenses contributions et leurs années de service et de dévouement. L’Ontario a grandement bénéficié de leur leadership, engagement, professionnalisme et excellence pour assurer la planification et la prestation de services de santé de qualité supérieure dans leur région.

Et pour finir, nous souhaitons vous annoncer que des ordonnances de transfert ont été délivrées aujourd’hui par l’honorable Christine Elliott, vice-première ministre et ministre de la Santé, à Action Cancer Ontario, cyberSanté Ontario, l’Agence de promotion et de recrutement de ProfessionSantéOntario, Services communs pour la santé Ontario, et le Conseil ontarien de la qualité des services de santé qui mène ses activités sous le nom de Qualité des services de santé Ontario. Les ordonnances de transfert indiquent que ces organismes seront transférés vers Santé Ontario le 2 décembre 2019.

Vos organismes et le Réseau Trillium pour le don de vie ne sont pas transférés vers Santé Ontario à l’heure actuelle, car le ministère et Santé Ontario prennent toutes les mesures nécessaires pour assurer la continuité des soins et les services offerts aux patients pendant la planification détaillée, afin d’offrir une transition harmonieuse opportune et adéquate.

Un regard vers l’avenir

Depuis la promulgation de la Loi de 2019 pour des soins interconnectés en juin dernier, les organismes qui finiront par composer Santé Ontario travaillent avec ardeur et coopération pour se préparer au transfert. Nous souhaitons tous vous remercier pour votre patience, votre professionnalisme, et votre

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engagement continu envers des soins de haute qualité pendant cette transition. La continuité des soins des patients demeure une priorité absolue.

Il s’agit d’une période charnière de la prestation de soins de santé dans la province, et vous participez tous à cette évolution. Nous continuerons à vous informer de nos progrès. En attendant, nous sommes impatients de continuer à travailler ensemble, pour améliorer la prestation de soins à tous les Ontariens.

À très bientôt,

Bill et Susan

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70 PINE STREET, BRACEBRIDGE, ONTARIO P1L 1N3 Telephone (705) 645-2231 / Fax (705) 645-5319 / 1-800-461-4210 (705 area code) www.muskoka.on.ca

To: Chair and Members Finance and Corporate Services Committee

From: Sharon Donald Director of Budgets and Financial Planning

Date: November 20, 2019

Subject: Capital Project Quarterly Variance Report – Corporate Summary – September 30, 2019

Report: FCS-14-2019-3 ______

Recommendation

THAT the Tax and Rate Supported Capital Project Quarterly Variance Report as at September 30, 2019 be received;

AND THAT the recommendations related to the individual Tax Supported Capital Budget projects, as summarized in the following table, be adopted:

Total Proposed Proposed Amended Amendment Amended Recommendation Budget Budget

360021 Future Development 2019 $650,000 $1,056 $651,056 Amend Budget & Close Project 360023 Governance Review $110,400 $1,475 $111,875 Amend Budget & Close Project Total (Favourable)/Unfavourable Expenditure Amendments $2,531

Origin

In 2005, Council adopted Policy AD:51 Capital Budget Preparation, Monitoring and Reporting. The revised policy requires staff to submit formal reports to the Standing Committees and Council on the status of the District of Muskoka’s capital program as at March 31st, June 30th, September 30th and December 31st.

In June 2018, staff brought report CES-5-2018-2 to the Corporate and Emergency Services Committee to consider a more condensed variance reporting following comments received from some Councillors. Committee members directed staff to provide summarized reporting for the variance report for evaluation. The purpose of this report is to highlight material variances from an overall corporate perspective.

It should be noted that the detailed variance analysis that has historically been shown on schedules will continue to be completed by staff in order to manage capital projects and to provide the summarized information being proposed. Should significant issues come to light, this analysis

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allows senior staff to mitigate the impact.

Analysis

Tax Supported Capital Budget (Schedule “A”):

Within the Tax Supported Capital Budget, $35,952,550 remains to be spent as at September 30, 2019. The projected forecast to complete all projects is $34,820,115, leaving a projected favourable variance of $1,132,435, as shown in Schedule “A” (pages 8-10) attached and summarized in the following table. There are a total of 144 projects. Fifty-two projects are being closed and one project will be rebudgeted to a future year, leaving 91 ongoing projects.

Favourable/ Amended LTD Budget Forecast to (Unfavourable) Tax Supported Budget 2019 Remaining 2019 Complete Variance Finance and Corporate Services $6,479,554 $3,527,691 $3,513,617 $14,074 Hauled Sewage $3,497,500 $3,464,247 $3,464,247 $0 Roads $38,710,552 $25,486,556 $24,617,551 $869,005 Port Carling Locks $675,000 $548,623 $548,623 $0 Community and Planning Services $3,216,000 $2,125,800 $1,873,913 $251,887 Health Services $868,100 $587,911 $587,911 $0 Airport $1,075,400 $211,722 $214,253 ($2,531) $54,522,106 $35,952,550 $34,820,115 $1,132,435

Finance and Corporate Services

Within the Finance and Corporate Services capital program, there is a favourable variance of $14,074 due to a project being completed under budget (70 Pine St – Oak Room Furniture). Three projects are being closed with no expected variance once final transactions have been posted.

Hauled Sewage

Within the Hauled Sewage capital program, there is no expected variance. All four projects are ongoing.

Roads

Within the Roads capital program, there is an expected favourable variance of $869,005 which is mainly due to large savings totaling $809,949 resulting from contingencies not being required (311158 BB MR 118 and 311254 ML MR 4) and lower pricing than originally estimated (311184 MR MR 7 and 311035 LB MR 117). Twenty-eight additional projects are being closed once final transactions have been posted with a net favourable variance of $59,056.

Port Carling Locks

Within the Port Carling Locks capital program, there is no expected variance. Two projects are being closed once final transactions have been processed, leaving two ongoing projects.

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Community and Planning Services

Within the Community and Planning Services capital program, there is an expected favourable variance of $251,887 mainly due to one project being rebudgeted to a future year to coincide with the Mountview/Golden Pheasant work (710024 Foundation Drain Improvements $135K), and two projects being cancelled as they have not been identified as priority projects and will not proceed at this time (810037 Transportation Master Plan $100K and 810030 Closing the Gap Study $25K). Project 810007 Tourism Policy Review is being closed and the $23,700 in remaining funds is being transferred to project 810041 Resort Policy Review in order to defend policies that might arise. One project (710096 Security Camera - Aubrey) is being closed over budget by $8,113. It is expected that there will be savings within the other security camera projects (710089, 710090 and 710095) that may be realized once all transactions have been processed to offset this overrun. Nine projects are being closed with no expected variance once final transactions have been posted.

Health Services

Within the Health Services capital program, there is no variance expected. Two projects are being closed once all transactions have been posted. A change order for project 620027 Pines Muskoka Room Balcony Repairs is being evaluated due to additional water damage to the structure below the balcony with expected costs not to exceed $40,000. Staff will follow the defined procedures to amend the budget once final figures are confirmed.

Airport

Within the Airport capital program, there is an expected unfavourable variance of $2,531 due to two projects being closed over budget once all final transactions have been posted (360021 Future Development 2019 and 360023 Governance Review). Three projects are ongoing.

In summary, within the Tax Supported program, there are 52 projects being closed with a net favourable variance of $997,435. One project is being rebudgeted to a future year showing a current year variance of $135,000.

A summary of the project closures are listed in Table 1 and is provided for information. Amendments to Tax Supported projects will be considered by the respective department Committees for approval.

Rate Supported Capital Budget

Within the Rate Supported Capital Budget, $61,272,811 remains to be spent as at September 30, 2019. The projected forecast to complete all projects is $60,710,208, leaving a projected favourable variance of $562,603, as shown in Schedule “A” (pages 11-12) attached and summarized in the following table. There are a total of 160 projects. Thirty-five projects are being closed, leaving 125 ongoing projects.

Favourable/ Amended LTD Budget Forecast to (Unfavourable) Rate Supported Budget 2019 Remaining 2019 Complete Variance Water $25,646,375 $18,444,668 $18,444,668 $0 Wastewater $44,159,155 $36,454,628 $35,892,025 $562,603 Solid Waste $7,871,600 $6,373,515 $6,373,515 $0 $77,677,130 $61,272,811 $60,710,208 $562,603

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Water

Within the Water capital program, there is no expected variance. Twelve projects are being closed once final transactions have been processed.

Wastewater

Within the Wastewater capital program, there is a favourable variance of $562,603. Of this amount, two annual allocation projects were not required and are being closed with a favourable variance of $179,800. One project (413050 BB Robert Dollar Drive) is being closed with a favourable variance of $382,803 as this work will be completed within another contract (412020 BB Lagoon Lane). Nineteen additional projects are being closed once final transactions have been processed with no variance.

Solid Waste

Within the Solid Waste capital program, there is no expected variance. One project is being closed once final transactions have been processed.

A summary of the project closures for the Rate Supported Budget are listed in Table 2. Any amendments will be considered by the Engineering and Public Works Committee for approval.

Financial Considerations

The total decrease in financing requirements from reserve funds resulting from the Tax Supported project variances is $1,132,435, as summarized in the following table:

Tax Supported Capital Project Quarterly Financing Variance Report - September 2019

Community Corporate Roads Housing Planning Airport Use of Reserve Funds (Increase)/Decrease Capital Capital Capital Capital Capital DC Roads Total Finance and Corporate Services 130131 70 Pine St - Oak Room Furniture $14,074 $14,074 Finance and Corporate Services Subtotal - (Increase) / Decrease $ 14,074 $0 $0 $0 $0 $0 $14,074

Roads 311184 ML MR 7 from Joseph River Bridge to MR 28 2.1 km $200,000 $200,000 314015 HV Riverside School Pedestrian Crossing $25,000 $25,000 311158 BB MR 118 from West Mall Dr to BB/ML Bndry $190,000 $10,000 $200,000 311254 ML MR 4 from MR 25 to Rostrevor Rd 3.2 km $190,000 $10,000 $200,000 311243 DMM Miscellaneous Gravel Shoulder Improvement 2018 ($8,259) ($8,259) 313095 ML Wahta Culvert #038080 $20,000 $20,000 311035 LB MR 117 from Paint Lk Bridge to Hwy 35 2.4 km $199,453 $10,496 $209,949 313107 DMM Minor Structure Rehab 2018 $22,316 $22,316 Roads Subtotal - (Increase)/Decrease $0 $838,510 $0 $0 $0 $30,496 $869,006

Community and Planning Services 710096 Security Camera (Aubrey) ($8,113) ($8,113) 710024 Foundation Drain Improvements (MPD) $135,000 $135,000 810007 Tourism Policy Review $23,700 $23,700 810030 Closing the Gap Study $25,000 $25,000 810037 Transportation Master Plan $100,000 $100,000 810041 Resort Policy Review ($23,700) ($23,700) Community and Planning Services Subtotal - (Increase)/Decrease $0 $0 $126,887 $125,000 $0 $0 $251,887

Airport 360021 Future Development 2019 ($1,056) ($1,056) 360023 Governance Review ($1,476) ($1,476) Airport Services Subtotal - (Increase)/Decrease $0 $0 $0 $0 ($2,532) $0 ($2,532)

Tax Supported Grand Total Use of Funds $14,074 $838,510 $126,887 $125,000 ($2,532) $30,496 $1,132,435 Reserve Fund Impact - (Increase)/Decrease $1,132,435 External Funding - (Increase)/Decrease $0

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The total decrease in financing requirements from reserve funds resulting from the Rate Supported project variances is $600,453, as summarized in the following table:

Rate Supported Capital Project Quarterly Variance Report - September 2019

Wastewater Municipal Use of Reserve Funds (Increase)/Decrease Water Capital Capital Contribution Total Water 431104 BB Ontario St from Church to Kimberley $10,344 ($10,344) $0 Water Subtotal - (Increase)/Decrease $10,344 $0 ($10,344) $0

Wastewater 413050 BB Sewer & Forcemain Robert Dollar Dr $382,803 $382,803 411096 BB Ontario St from Church to Kimberly St $27,506 ($27,506) $0 411201 BB MH Repairs 2019 $89,900 $89,900 411202 HV MH Repairs 2019 $89,900 $89,900 Wastewater Subtotal - (Increase)/Decrease $0 $590,109 ($27,506) $562,603

Public Works - Rate Supported - (Increase)/Decrease $10,344 $590,109 ($37,850) $562,603 Reserve Fund Impact - (Increase)/Decrease $600,453 External Funding - (Increase)/Decrease ($37,850)

A summary of the impact on reserves will be included in the Status of Reserves and Reserve Funds – September 30, 2019 report, scheduled for the December 2019 Finance and Corporate Services Committee meeting cycle.

Communications

Capital Project Quarterly Variance Reports are submitted to the Standing Committees and Council on the status of the District’s capital program as at March 31st, June 30th, September 30th and December 31st.

Strategic Priorities

Click on icons below to view strategies under each priority area:

s 2.2, 2.3,

2.9

Respectfully submitted,

Original signed by Original signed by

Sharon Donald, CPA, CMA Julie Stevens, CPA, CA Director of Budgets and Commissioner of Finance and Financial Planning Corporate Services

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Table 1 Summary of Amendments and Closures - Tax Support Total Proposed Amended Proposed Amended Budget Amendment Budget Recommendation 130131 70 Pine St - Oak Room Furniture $20,400 ($14,074) $6,326 Close Project 311035 LB MR 117 from Paint Lk Bridge to Hwy 35 2.4 km $1,447,708 ($209,949) $1,237,759 Close Project 313095 ML Wahta Culvert #038080 $20,000 ($20,000) $0 Close Project 313107 DMM Minor Structure Rehab 2018 $135,000 ($22,316) $112,684 Close Project 710097 Balcony Railings (Aubrey) $20,000 $0 $20,000 Close Project 810030 Closing the Gap Study $25,000 ($25,000) $0 Close Project 810037 Transportation Master Plan $100,000 ($100,000) $0 Close Project 300094 DMM Miscellaneous Land 2019 $123,800 $0 $123,800 Close project after current year transactions posted 311250 DMM Road Base Improvement & Stabilization 2019 $250,000 $0 $250,000 Close project after current year transactions posted 313111 DMM Culvert Replace/ Rehab Program 2019 $606,300 $0 $606,300 Close project after current year transactions posted 313112 DMM Minor Structure Rehab 2019 $249,700 $0 $249,700 Close project after current year transactions posted 130343 Landfill Software Upgrade (Paradigm) $134,900 $0 $134,900 Close project once final payments processed 130351 Data Centre Infrastructure Management 2019 $85,000 $0 $85,000 Close project once final payments processed 311184 ML MR 7 from Joseph River Bridge to MR 28 2.1 km $1,645,000 ($200,000) $1,445,000 Close project once final payments processed 311158 BB MR 118 from West Mall Dr to BB/ML Bndry $2,815,880 ($200,000) $2,615,880 Close project once final payments processed 311247 GH MR 13 from MR 19 to S Morrison Lk Rd 6.3 km $63,000 $0 $63,000 Close project once final payments processed 311252 ML MR 28 from MR 7 Past Entrance of Cleveland's House 0.6 $305,000 $0 $305,000 Close project once final payments processed 311254 ML MR 4 from MR 25 to Rostrevor Rd 3.2 km $2,260,000 ($200,000) $2,060,000 Close project once final payments processed 311256 BB MR 16 Stephens Bay Rd to Kirby's Beach Rd 2.1 km $365,000 $0 $365,000 Close project once final payments processed 311258 ML MR 47 Butter & Egg Rd to 4km E of Butter & Egg Rd 4 k $570,000 $0 $570,000 Close project once final payments processed 311259 LB MR 8 Scott Ln to North Tasso Lk Rd 2 km $345,000 $0 $345,000 Close project once final payments processed 311260 HV MR 46 1 km N of Bonnie Lk Camp Rd to BB/HV Bndry 2. $410,000 $0 $410,000 Close project once final payments processed 311261 GH MR 6 from Halls Rd to Black River Rd 4 km $790,000 $0 $790,000 Close project once final payments processed 311262 GH MR 13 fr Clipsham Rd to Kilworthy Rd 2 km $36,300 $0 $36,300 Close project once final payments processed 311263 GH MR 6 fr Halls Rd to Black River Rd 5 km $83,250 $0 $83,250 Close project once final payments processed 311264 ML MR 26 fr Eveleigh Rd to Mortimer's Pt Rd 4.1 km $69,500 $0 $69,500 Close project once final payments processed 311265 ML MR 47 4 km E of Butter & Egg Rd to Houston Rd 2.2 km $39,500 $0 $39,500 Close project once final payments processed 311270 Microsurfacing - Area Contract $167,595 $0 $167,595 Close project once final payments processed 311271 Slurry Seal - Area Contract $545,455 $0 $545,455 Close project once final payments processed 311272 Pulverizing & High Float Area Contract 2019 $2,075,000 $0 $2,075,000 Close project once final payments processed 313069 ML MR 118 Indian River Bridge Repair #118315 $825,000 $0 $825,000 Close project once final payments processed 313092 GB MR 34 Culvert Repl #03406055 & 03406050 $1,200,000 $0 $1,200,000 Close project once final payments processed 313096 DMM Bridge & Culvert Inspections (OSIM) $165,000 $0 $165,000 Close project once final payments processed 314015 HV Riverside School Pedestrian Crossing $100,000 ($25,000) $75,000 Close project once final payments processed 314018 DMM Traffic Audible Program 2019 $100,000 $0 $100,000 Close project once final payments processed 316002 GB MR 11 Drainage - Mactier $3,133,000 $0 $3,133,000 Close project once final payments processed 370028 Large Lock Structural/Mechanical/Electrical $50,000 $0 $50,000 Close project once final payments processed 370040 Repair/Repl Interlocking Brick & Trip Hazards 2019 $50,000 $0 $50,000 Close project once final payments processed 530030 Vehicles 2019 $350,900 $0 $350,900 Close project once final payments processed 710089 Security Cameras (845 & 865 Bethune Dr) $60,000 $0 $60,000 Close project once final payments processed 710090 Security Cameras (Brunel) $50,000 $0 $50,000 Close project once final payments processed 710093 Stair Replacements (Pinedale) $65,000 $0 $65,000 Close project once final payments processed 710095 Security Cameras (Alice) $35,100 $0 $35,100 Close project once final payments processed 810014 Official Plan Updates 2018-2019 $41,700 $0 $41,700 Close project once final payments processed 810019 OP Updates $145,300 $0 $145,300 Close project once final payments processed 810033 Air Photos 2018 $65,000 $0 $65,000 Close project once final payments processed 810036 PED Accommodations Renovations $30,000 $0 $30,000 Close project once final payments processed Total (Favourable)/Unfavourable Expenditure Amendments ($1,016,339)

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Table 2 Summary of Amendments and Closures - Rate Support Total Proposed Amended Proposed Amended Budget AmendmentBudget Recommendation 413050 BB Sewer & Forcemain Robert Dollar Dr $385,050 ($382,803) $2,247 Close Project 411201 BB MH Repairs 2019 $89,900 ($89,900) $0 Close Project 411202 HV MH Repairs 2019 $89,900 ($89,900) $0 Close Project 411199 PC Various Sewer Rehabilitation 2019 $52,900 $0 $52,900 Close project after current year transactions 411203 GH MH Repairs 2019 $79,400 $0 $79,400 Close project after current year transactions 431159 GH John St N (Bay to Peter) 310m CI Repl $668,600 $0 $668,600 Close project once final payments processed 432048 GH WTP Exterior Rehab/Repl $211,600 $0 $211,600 Close project once final payments processed 432096 GH WTP Pipe Coatings & Valve Actuators $50,000 $0 $50,000 Close project once final payments processed 433003 BB Pump Rehab Ecclestone / Pine BPS $50,000 $0 $50,000 Close project once final payments processed 432092 DMM - Variable Drives 2018 $51,900 $0 $51,900 Close project once final payments processed 431020 BB James from MacDonald to Ann $422,530 $0 $422,530 Close project once final payments processed 431103 BB Kimberley St from Quebec to Ontario $327,000 $0 $327,000 Close project once final payments processed 431104 BB Ontario St from Church to Kimberley $524,900 $0 $524,900 Close project once final payments processed 431141 BB Ontario St - Kimberley to Dominion Svc Transfer $444,200 $0 $444,200 Close project once final payments processed 434009 BALA Repair/Paint Tower $502,000 $0 $502,000 Close project once final payments processed 434010 PC Repair/Paint Tower $702,000 $0 $702,000 Close project once final payments processed 439010 DMM Water Modelling $200,000 $0 $200,000 Close project once final payments processed 413137 HV Greens SPS Pumps $50,000 $0 $50,000 Close project once final payments processed 411049 BB James St from Ann to MacDonald $289,800 $0 $289,800 Close project once final payments processed 411096 BB Ontario St from Church to Kimberly St $606,600 $0 $606,600 Close project once final payments processed 411188 GH John St N A29-A65 (Brown to Bay) 200m $264,000 $0 $264,000 Close project once final payments processed 411189 GH Brown St (John St N to MH A28) 50m $85,000 $0 $85,000 Close project once final payments processed 412115 BB Lagoon Lane Fine Screen Overhaul $79,000 $0 $79,000 Close project once final payments processed 412087 HV GP STP Gas Detection System Repl $31,200 $0 $31,200 Close project once final payments processed 412133 HV STP Grinder Repl 2019 $31,700 $0 $31,700 Close project once final payments processed 412138 BAYS Grinder $25,000 $0 $25,000 Close project once final payments processed 411172 BB Kimberley St Sewer Repl 65m $224,000 $0 $224,000 Close project once final payments processed 411196 BB MH Repairs 2018 $83,100 $0 $83,100 Close project once final payments processed 412091 BAYS STP Chemical Feed $31,200 $0 $31,200 Close project once final payments processed 412093 MT STP HVAC Repairs $50,000 $0 $50,000 Close project once final payments processed 412122 DMM Repl Program Logic Controllers 2018 $51,900 $0 $51,900 Close project once final payments processed 412127 HV MV STP Headworks Repairs Until Decommission $65,000 $0 $65,000 Close project once final payments processed 413140 DMM - Variable Drives 2019 $52,900 $0 $52,900 Close project once final payments processed 419006 DMM Sewer Modelling $200,000 $0 $200,000 Close project once final payments processed 450061 Tower Rd Transfer Stn Upgrades $50,000 $0 $50,000 Close project once final payments processed Total (Favourable)/Unfavourable Expenditure Amendments ($562,603)

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Tax Supported by Division Capital Project Quarterly Variance Report - Corporate Summary Run Date: 12/11/19 9:33 AM For period ending September 30, 2019 Schedule A

PY Budget 2019 Approved Total LTD LTD Budget Forecast Favourable/ Open Annual Amend- Amended Actuals Remaining to Complete (Unfavourable) Projects * Budget * ments * Budget * 2019 2019 Proj. Variance Finance and Corporate Services Finance and Corporate Services General Administration 165,000 205,800 370,800 34,054 336,746 336,746 General Administration Non-Tangible Capital 66,000 17,000 83,000 76,569 6,431 6,431 Computer Services 620,000 686,200 357,954 1,664,154 689,469 974,685 974,685 Fleet 260,400 1,225,400 1,485,800 580,152 905,648 905,648 Facility Services 434,900 426,000 1,880,000 2,740,900 1,455,361 1,285,539 1,271,465 14,074 Close Once Final Transactions Posted 76,900 58,000 134,900 116,258 18,642 18,642 Total Finance and Corporate Services 1,623,200 2,337,600 2,518,754 6,479,554 2,951,863 3,527,691 3,513,617 14,074 Total Finance and Corporate Services 1,623,200 2,337,600 2,518,754 6,479,554 2,951,863 3,527,691 3,513,617 14,074 Public Works - Hauled Sewage Hauled Sewage Hauled Sewage 2,970,000 527,500 3,497,500 33,253 3,464,247 3,464,247 Total Hauled Sewage 2,970,000 527,500 3,497,500 33,253 3,464,247 3,464,247 Total Public Works - Hauled Sewage 2,970,000 527,500 3,497,500 33,253 3,464,247 3,464,247 Public Works - Roads Roads Roads Construction 7,810,000 9,622,650 1,153,746 18,586,396 6,764,379 11,822,017 11,597,017 225,000 Asphalt Surfacing 50,000 6,000,000 2,540,880 8,590,880 682,114 7,908,766 7,508,766 400,000 Micro Surfacing 590,400 182,595 772,995 772,995 772,995 Emulsion Surfacing (High Float) 3,275,000 1,280,000 4,555,000 2,268,645 2,286,355 2,286,355 Emulsion Surfacing (Slurry Seal) 98,000 208,550 530,455 837,005 1,000 836,005 836,005 Non-Tangible Capital 751,900 949,600 25,000 1,726,500 333,279 1,393,221 1,381,481 11,740 Close Once Final Transactions Posted 3,205,000 402,708 3,607,708 3,140,510 467,198 234,933 232,265 Deferred Projects - Roads 25,000 9,068 34,068 34,069 (1) (1) Total Roads 11,939,900 20,646,200 6,124,452 38,710,552 13,223,996 25,486,556 24,617,551 869,005 Total Public Works - Roads 11,939,900 20,646,200 6,124,452 38,710,552 13,223,996 25,486,556 24,617,551 869,005 Public Works - Port Carling Locks Port Carling Locks Large Locks 50,000 50,000 38,009 11,991 11,991

Capital Forecast September* This column does not tie to budget reports as numbers only reflect active projects. Closed projects have been removed from the report. Capital Budget Variance CES Page 8 HS-12-2019-INFO-F

Tax Supported by Division Capital Project Quarterly Variance Report - Corporate Summary Run Date: 12/11/19 9:33 AM For period ending September 30, 2019 Schedule A

PY Budget 2019 Approved Total LTD LTD Budget Forecast Favourable/ Open Annual Amend- Amended Actuals Remaining to Complete (Unfavourable) Projects * Budget * ments * Budget * 2019 2019 Proj. Variance Docks 500,000 475,000 (475,000) 500,000 21,858 478,142 478,142 Park 50,000 50,000 50,000 50,000 Close Once Final Transactions Posted 75,000 75,000 66,510 8,490 8,490 Total Port Carling Locks 575,000 575,000 (475,000) 675,000 126,377 548,623 548,623 Total Public Works - Port Carling Locks 575,000 575,000 (475,000) 675,000 126,377 548,623 548,623 Community and Planning Services Planning Services Official Plan Non-Tangible Capital 359,300 441,000 110,000 910,300 357,927 552,373 427,373 125,000 Water Strategy 900,000 900,000 536,763 363,237 363,237 Water Strategy Non-Tangible Capital 40,000 65,000 105,000 105,000 105,000 Geomatics 115,000 115,000 31,319 83,681 83,681 Total Planning Services 514,300 506,000 1,010,000 2,030,300 926,009 1,104,291 979,291 125,000 Community Services Affordable Housing 144,000 144,000 144,000 144,000 Total Community Services 144,000 144,000 144,000 144,000 Community Housing Aubrey St 33,100 20,000 (33,100) 20,000 1,425 18,575 18,575 Alice St 251,100 41,600 (151,900) 140,800 672 140,128 140,128 Bethune Dr 389,000 (154,500) 234,500 234,500 234,500 Brunel Rd 263,400 (131,100) 132,300 132,300 132,300 Meadow Park Dr 135,000 51,000 186,000 186,000 51,000 135,000 Multi Property 50,000 51,000 101,000 51,937 49,063 49,063 Close Once Final Transactions Posted 175,000 52,100 227,100 110,157 116,943 125,056 (8,113) Total Community Housing 1,296,600 163,600 (418,500) 1,041,700 164,191 877,509 750,622 126,887 Total Community and Planning Services 1,810,900 669,600 735,500 3,216,000 1,090,200 2,125,800 1,873,913 251,887 Health Services Health Services Paramedic Services 585,900 585,900 272,345 313,555 313,555 Pines 282,200 282,200 7,844 274,356 274,356 Total Health Services 868,100 868,100 280,189 587,911 587,911

Tax Supported by Division Capital Project Quarterly Variance Report - Corporate Summary Run Date: 12/11/19 9:33 AM For period ending September 30, 2019 Schedule A

PY Budget 2019 Approved Total LTD LTD Budget Forecast Favourable/ Open Annual Amend- Amended Actuals Remaining to Complete (Unfavourable) Projects * Budget * ments * Budget * 2019 2019 Proj. Variance Total Health Services 868,100 868,100 280,189 587,911 587,911 Airport Airport Airport Operations 715,000 140,000 855,000 751,803 103,197 104,253 (1,056) Airport Studies 60,000 50,000 110,000 110,000 110,000 Close Once Final Transactions Posted 103,000 7,400 110,400 111,875 (1,475) (1,475) Total Airport 878,000 50,000 147,400 1,075,400 863,678 211,722 214,253 (2,531) Total Airport 878,000 50,000 147,400 1,075,400 863,678 211,722 214,253 (2,531) Total Tax Supported by Division 19,797,000 25,674,000 9,051,106 54,522,106 18,569,556 35,952,550 34,820,115 1,132,435

Rate Supported by Division Capital Project Quarterly Variance Report - Corporate Summary Run Date: 12/11/19 9:33 AM For period ending September 30, 2019 Schedule A

PY Budget 2019 Approved Total LTD LTD Budget Forecast Favourable/ Open Annual Amend- Amended Actuals Remaining to Complete (Unfavourable) Projects * Budget * ments * Budget * 2019 2019 Proj. Variance Public Works - Water Distribution Water Replacement/Upgrade Water 1,426,800 2,403,400 (137,525) 3,692,675 786,716 2,905,959 2,905,959 Rehabilitation Water 450,000 307,100 757,100 63,455 693,645 693,645 Total Distribution Water 1,426,800 2,853,400 169,575 4,449,775 850,171 3,599,604 3,599,604 Treatment Water Plant Water 7,918,800 6,508,600 849,600 15,277,000 3,181,094 12,095,906 12,095,906 Reservoir Water 25,000 284,200 309,200 64,794 244,406 244,406 Scada 1,084,500 732,900 (57,730) 1,759,670 75,559 1,684,111 1,684,111 Total Treatment Water 9,028,300 7,525,700 791,870 17,345,870 3,321,447 14,024,423 14,024,423 Non-Tangible Capital Water Studies Water 50,000 50,000 22,938 27,062 27,062 Repairs and Maintenance 233,100 445,000 678,100 231,655 446,445 446,445 Total Non-Tangible Capital Water 283,100 445,000 728,100 254,593 473,507 473,507 Close Once Final Transactions Posted Water Close Once Final Transactions Posted Water 2,720,100 402,530 3,122,630 2,775,496 347,134 347,134 Total Close Once Final Transactions Posted Water 2,720,100 402,530 3,122,630 2,775,496 347,134 347,134 Total Public Works - Water 13,458,300 10,824,100 1,363,975 25,646,375 7,201,707 18,444,668 18,444,668 Public Works - Wastewater Collection Wastewater Pumping Station Large 2,208,900 2,438,700 (1,156,850) 3,490,750 92,260 3,398,490 3,015,687 382,803 Pumping Station Small 370,000 256,300 (81,870) 544,430 95,644 448,786 448,786 Replacements/Upgrade Wastewater 1,277,000 616,500 2,811,900 4,705,400 1,614,844 3,090,556 3,090,556 Rehabilitation Wastewater 788,000 57,900 (5,000) 840,900 83,216 757,684 757,684 Total Collection Wastewater 4,643,900 3,369,400 1,568,180 9,581,480 1,885,964 7,695,516 7,312,713 382,803 Treatment Wastewater Plant Wastewater 11,781,900 947,200 (1,102,425) 11,626,675 1,027,513 10,599,162 10,599,162 Mountview/Golden Pheasant 3,550,000 9,750,000 5,780,000 19,080,000 4,115,314 14,964,686 14,964,686 Scada 740,200 827,900 1,568,100 68,399 1,499,701 1,499,701 Total Treatment Wastewater 16,072,100 11,525,100 4,677,575 32,274,775 5,211,226 27,063,549 27,063,549

Rate Supported by Division Capital Project Quarterly Variance Report - Corporate Summary Run Date: 12/11/19 9:33 AM For period ending September 30, 2019 Schedule A

PY Budget 2019 Approved Total LTD LTD Budget Forecast Favourable/ Open Annual Amend- Amended Actuals Remaining to Complete (Unfavourable) Projects * Budget * ments * Budget * 2019 2019 Proj. Variance Non-Tangible Capital Wastewater Studies Wastewater 120,000 135,000 255,000 20,329 234,671 234,671 Repairs and Maintenance 583,100 706,700 1,289,800 86,851 1,202,949 1,023,149 179,800 Total Non-Tangible Capital Wastewater 703,100 841,700 1,544,800 107,180 1,437,620 1,257,820 179,800 Close Once Final Transactions Posted Wastewater Close Once Final Transactions Posted Wastewater 556,200 52,900 149,000 758,100 500,157 257,943 257,943 Total Close Once Final Transactions Posted Wastewater 556,200 52,900 149,000 758,100 500,157 257,943 257,943 Total Public Works - Wastewater 21,975,300 15,789,100 6,394,755 44,159,155 7,704,527 36,454,628 35,892,025 562,603 Public Works - Solid Waste Management Solid Waste Capital Transfer Stations 953,800 830,000 (450,000) 1,333,800 76,410 1,257,390 1,257,390 Rosewarne 1,887,500 642,500 240,000 2,770,000 727,142 2,042,858 2,042,858 Compactors 300,000 300,000 300,000 300,000 Land Purchase 530,700 25,000 (255,700) 300,000 50,427 249,573 249,573 Total Solid Waste Capital 3,372,000 1,797,500 (465,700) 4,703,800 853,979 3,849,821 3,849,821 Solid Waste Non-Tangible Studies 150,000 150,000 4,696 145,304 145,304 Closed Landfills - Transferred from Area Municipalities 1,140,500 150,000 (425,000) 865,500 306,802 558,698 558,698 District Landfill Closure Plans 1,475,000 1,063,800 (600,000) 1,938,800 268,946 1,669,854 1,669,854 Other Non-Tangible 100,000 63,500 163,500 21,224 142,276 142,276 Total Solid Waste Non-Tangible 2,865,500 1,277,300 (1,025,000) 3,117,800 601,668 2,516,132 2,516,132 Close Once Final Transactions Posted Close Once Final Transactions Posted Solid Waste 50,000 50,000 42,438 7,562 7,562 Total Close Once Final Transactions Posted 50,000 50,000 42,438 7,562 7,562 Total Public Works - Solid Waste Management 6,287,500 3,074,800 (1,490,700) 7,871,600 1,498,085 6,373,515 6,373,515 Total Rate Supported by Division 41,721,100 29,688,000 6,268,030 77,677,130 16,404,319 61,272,811 60,710,208 562,603

70 PINE STREET, BRACEBRIDGE, ONTARIO P1L 1N3 Telephone (705) 645-2231 / Fax (705) 645-5319 / 1-800-461-4210 (705 area code) www.muskoka.on.ca

To: Chair and Members Finance and Corporate Services Committee

From: Julie Stevens Commissioner of Finance and Corporate Services

Date: November 20, 2019

Subject: Operating Budget Variance Report – September 30, 2019

Report: FCS-14-2019-2 ______

Recommendation

THAT the Operating Budget Variance Report as at September 30, 2019 be received.

Origin

Policy AD:52 Operating Budget Administration requires the Commissioner of Finance and Corporate Services to provide each Standing Committee and Council with a written status report on the yearly budgets for the quarters ending in June, September and December.

In June 2018, staff brought report CES-5-2018-2 to the Corporate and Emergency Services Committee to consider a more condensed variance report following comments received from some Councillors. Committee members directed staff to provide summarized reporting for variance reports. This report highlights significant budget variances for the Tax and Rate Supported Operating Budgets.

It should be noted that the detailed variance analysis that has historically been shown on schedules will continue to be completed by staff in order to manage operations and to provide the summarized information being proposed. Should significant issues come to light, this analysis allows senior staff to mitigate the impact.

Analysis

Attached to this report are schedules that outline the significant forecasted year-end budget variances as at the period ending September 30, 2019. The schedules provide a summary view by program net levy for both the tax and rate supported operating budgets.

. The Tax Supported Operating Variance Net Levy Summary shows the year-to-date (YTD) actuals ending September 30, 2018 and the annual revised budget for 2018, YTD actuals ending September 30, 2019 and the annual revised budget for 2019. The next two columns compare the YTD actuals to the annual budget in terms of dollars remaining in the budget and the percentage of budget spent. The final column indicates projected annual variance.

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• The second and third pages are the Rate Supported Operating Variance Net Levy Summaries, which are in the same format as the first summary, and show the bottom line net levy for each program/division within Water, Wastewater and Solid Waste.

Financial Considerations

The following chart serves to summarize the variances in each section.

Net Levy Variance Department Favourable/ (Unfavourable)

Finance and Corporate Services and Non-Program $545,000

Public Works Tax Supported – including Administration, Transportation ($1,946,000) – Roads, Port Carling Locks and Environment General Community and Planning Services ($97,000) Health Services ($160,200) Airport ($78,000)

Total Tax Supported Budget Variance ($1,736,200)

Public Works Rate Supported – Solid Waste ($43,500)

Public Works Rate Supported – Water and Wastewater $562,200

Total Rate Supported Budget Variance $518,700

Total Corporate Budget Variance ($1,217,500)

Overall, staff are projecting an unfavourable variance at year-end of $1.2 million across the organization (0.7% of expenditures). The Tax Supported operations are forecasted to be unfavourable to budget by $1,736,200 or 1.4% of expenditures. The Rate Supported operations are forecasted to be favourable to budget by $518,700, which is made up of favourable variances for Water and Wastewater of $562,200 or 1.9% of expenditures and unfavourable variance for Solid Waste Operations of $43,500 or 0.3% of expenditures. The major contributors to the projected variances are noted by Department or Service below.

Tax Supported Budget Variance

Within Finance and Corporate Services and Non-Program, there is a favourable variance of $545,000 forecast for year-end. The most significant contributors to this variance are: • Finance Services is trending below budget primarily due to personnel vacancies and rate gapping as well as timing differences for expenditures that are booked at year-end. The favourable personnel gapping is included in net figure noted in non-program below. • IT Services is trending below budget currently, but is expected to end the year on budget as a result of year-end entries. • Accessibility is forecast to have a favourable variance of $20k. It is anticipated that costs will be ramping up starting in 2020 based on legislative requirements.

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• The Provincial Offences division is forecast to be over budget by $50k at year-end due to higher than anticipated prosecution costs associated with contracting services. Council approved the addition of one paralegal position for this work, but the recruitment for this position is ongoing. While Fines revenue is currently trending higher than budget, volumes in the last quarter usually decrease, which will result in this line being on budget at year-end. • Police Services is expected to be over budget by approximately $250k due to a reconciling adjustment for the 2018 results which increased costs by $438,661 primarily due to higher court security costs and higher provincial costs for benefits and health and safety. This amount is partially offset by additional revenue from the Court Security and Prisoner Transportation grant of $188,903. • Under the Non-Program section, there is a favourable variance within the Financial section, due to projected gapping across other departments estimated at $825k or approximately 2% of total annual personnel costs. The main contributor to this projected favourable variance is within Community and Planning Services. Due to the number of programs under review by the Province and the potential impact on staffing, conscious efforts have been made to temporarily leave certain positions vacant. Once funding is confirmed, it is anticipated that staffing positions will be filled as appropriate in 2020. The Modernization Grant of $725k has been transferred to the Corporate Capital Reserve and as a result is not included in the forecast projections. Staff will provide recommendations for Council approval regarding utilization of this funding during the 2020 budget deliberations.

In summary, at this time, the Finance and Corporate Services and Non-Program departments are expected to end the year in an overall favourable position of $545,000.

Within Public Works Tax Supported, there is an unfavourable variance of $1,946,000 projected for year-end which is comprised of the following significant items: • Administration is expected to end the year on budget. • Within Transportation – Roads, staff are projecting an overall unfavourable variance of $1,907,000. Winter control costs are higher than last year, at 83.5% spent at end of June compared with 65.5% for the same period last year, resulting in an unfavourable variance projected at year-end of $1,381,000. The actual Winter Control variances are dependent on the weather conditions in the last quarter of the year. Paved Roads has a projected unfavourable variance of $286,000 mainly due to higher than expected repairs this spring. Disaster Recovery incurred $530,000 in expenditures that were not budgeted due to the spring flood. Traffic is anticipated to have a favourable variance of $175,000 due primarily to reductions for personnel and operating supplies. Structure, Maintenance and Drainage, and Stormwater Management are projected to have a combined favourable variance of $15,000. In the June variance report, staff expected to be favourable in these areas by $250,000. There were a number of instances where road conditions required immediate remediation which eliminated this favourable projection. Lastly, Roads Financing and Administration personnel is expected to be favourable by approximately $100,000 partially due to vacancies, as well as, transferring staff to the Locks to cover shortages. • Port Carling Locks projected variance is unfavourable by $205,000. Personnel costs are projected to be $125k over budget due to a lack of seasonal staffing availability which required full time staffing to be utilized, as well as, the pairing of staff to avoid certain working alone situations requiring additional staff hours. In addition, subcontractor and consultant costs will be unfavourable by $62k due to ongoing maintenance issues, as well as, additional fleet costs of $18k which is due to the staffing issues noted. • Hauled Sewage Operations is forecasting a favourable variance of $166,000 primarily for additional revenues estimated to be $99k. Additional favourable variances for Personnel, Fleet and Operating Supplies of $106k are partially offset by an unfavourable variance of $39k for Supernatant Treatment costs.

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In summary, the Tax Supported Public Works budgets are projected to be unfavourable by $1,946,000 compared to budget which represents 6.3% of expenditures.

Within Community and Planning Services, there is an expected unfavourable variance of $97,000 at year-end made up of the following significant items: • Community Housing is forecasting an unfavourable variance of $52,000 mainly for high building and grounds maintenance costs, as well as unit turnovers. The 2020 budget has been adjusted for these costs. • Affordable Housing is currently showing a favourable variance. Staff are actively reviewing the MAHIP program with the objective of recommending other approaches that will better facilitate the production of additional affordable units as reported in Report CPS-19-2019-2. The MAHIP budget is expected to end the year on budget. It should be noted that approximately $495,000 has been committed for Council-approved affordable developments. Funds for these commitments will be released as the applicable projects proceed. • Homelessness is estimated to have an unfavourable variance at year-end of approximately $75k due to extenuating circumstances related to the spring flooding and 19 households that were displaced from a property on Monck Road in Bracebridge due to a fire. • There is a pending funding transfer between the Community Transportation and Community Initiatives sections that will bring these programs in line with the budget. • The Ontario Works (OW) Financial program is under budget with the caseload being lower than budgeted by approximately 24 cases. This reflects flow through monthly benefits to clients, but does not include programming. As these costs are now fully uploaded to the province, there will be no variance. In addition, although the OW caseload is down, the number of Ontario Disability Support Program clients participating in programs (with related funding) is up, with no significant change to total caseloads as a result. • Children’s Services is trending over budget due to pending revenue entries. The overall program is forecast to be on budget at year-end. • Strengthening Communities provides funds to the Legal Clinic for Program Services and it has been identified that they are carrying over funds from previous years that must be utilized before additional funding is released. A favourable variance of $30,000 is projected.

In summary, at this time, the Community and Planning Services department is expected to end the year in an overall unfavourable position of $97,000.

Within Health Services, there is an unfavourable variance forecast of $160,200 which is comprised of the following: • The Simcoe Muskoka District Health Unit will have a favourable variance of $24,800 based on the annual funding notice, which was received after the budget was approved. • Pines Operations is projecting an unfavourable variance of $185,000. Expenditures are forecast to be unfavourable by $185k mainly in Nursing personnel due to Agency fees, which are partially offset by savings from vacancy and rate gapping in other programs. Maintenance contract and repair costs are also over budget, partially offset by savings in electricity costs. Although Long Term Care revenues are expected to be under budget by $54k based on the Province’s most recent funding announcements, resident fee revenues are trending above budget and expected to offset this impact. • Paramedic Services is expected to end the year on budget. Expenditures are trending below budget due primarily to lower health and safety costs than budgeted. However, this favourable variance is expected to be offset by an unfavourable revenue variance as the 2019 provincial grant was lower than expected by $83,000. • The Fairvern costs to repay the Debt Reduction Reserve will be recorded at year-end and will be on budget.

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In summary, the Health Services department is expected to end the year with an overall unfavourable result of $160,200.

Within Airport, there is an unfavourable variance forecast of $78,000. The largest contributor to this variance is due to net fuel sales, which are projected to be below budget by $45,000 due to the reduction in purchases by a large customer. The unusually rainy spring created an absence of the Ministry of Natural Resources water bombers, which are typically fueled for fire-fighting operations and caused a reduction in Avgas sales. In addition, the winter months created inferior icy runway conditions which resulted in the reduction of traffic, thus fuel sales. The second main contributor to the unfavourable variance is approximately $45,000 of additional costs attributed to increased scheduled service costs that were unplanned. These costs are partially offset by additional revenue estimated at $12,000.

Within the overall tax supported operating budget, staff are projecting an unfavourable variance at year-end of $1,736,200. However, there are a number of factors which can impact this estimate during the final quarter.

Rate Supported Budget Variance

Solid Waste Management

Within Public Works Rate Supported – Solid Waste, there is an unfavourable variance of $43,500 projected.

Overall, expenditures are projected to be $62,000 higher than budget. A rate increase from the contractor for the recycle processing costs is resulting in a $200,000 unfavourable variance. The procurement process continues for recycle processing services. As well, the disposal of recycling residue has an unfavourable variance of $195,000. However, this is offset by tip fee revenue for this waste of a similar amount. The composting operations subcontractor expenses are projected to be unfavourable by $50,000 primarily for trucking of leaf and yard material from transfer station sites. Bank fees are projected to be unfavourable by $8,500. Offsetting these unfavourable projections are favourable variances including the Mattress Diversion subcontractor which is favourable by $103,000 due to lower volumes of mattresses. Hazardous waste disposal is projected to be favourable by $72,000. Other favourable variances are anticipated for Wood Chipping, Leachate Haulage and Treatment, Site Security, and Large Item Events totalling $96,500. Lastly, there is a projected favourable variance of $120,000 in personnel costs due to rate and vacancy gapping.

Total revenues are projected to be $18,500 higher than budget. The Waste Diversion Ontario (WDO) grant is $144,000 higher than budgeted. Landfill tip fee revenues are tracking to be on budget. There is a net favourable $3,500 for Freon, bagged garbage excess and clean shingles programs. Recycle sales rebates are projecting to be unfavourable to budget by $147,000 due to the further decline of market rates. Scrap metal market rates are declining and have a projected unfavourable variance of $30,000. Biosolids tip fees have a projected shortfall of $57,000 due to a reduced composting term in 2019. Mattress diversion tip fees are projected to be unfavourable by $90,000 as is the subcontractor expense noted above due to lesser volume of units than budgeted. The MRF residue tip fee is projected at $195,000 offsetting the residue fees as noted above.

In summary, the Rate Supported Solid Waste budget is projected to be unfavourable by $43,500 at year end.

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Water and Wastewater

Within Public Works Rate Supported – Water and Wastewater, there is a favourable variance projected of $562,200.

Total expenditures are projected to be favourable by $314,300. Personnel is anticipated to be favourable by $200,000 due primarily to vacancies throughout the year. Electricity also continues to trend favourable to budget and is projected to be $198,000 below budget by year end. This favourability is offset in part by projected unfavourable variances totalling $83,700 for taxes, cell phones and answering/alarm services, memberships/subscriptions travel and for safety equipment.

Total revenues are projected to be favourable by $247,900 overall. Consumption revenues are estimated to be favourable by $148,100 due to higher volumetric charges of approximately 0.95%. Increased revenue from Application fees/permits, as well as, increased volumes from septic haulers that are taken directly to the wastewater plants are projected to be favourable by $99,800.

In summary, the Rate Supported Water and Wastewater budgets are projected to be favourable by $562,200 at year end.

Summary

In summary, staff are projecting an unfavourable variance at year end of just over $1.2 million or 0.7% of expenditures across the organization. However, there are a number of factors which can impact this estimate in the final quarter of the year as noted above. It should also be noted that staff considered these results when establishing the 2020 draft budgets. For example, within the Solid Waste budget, revenues for the WDO grant were increased to reflect the favourable variance experienced in 2019 and, similarly, electricity costs in Water and Wastewater have been reduced.

The projected surplus/deficit in the Rate Supported budget will be managed with through an adjusting entry to the respective reserve contributions at year-end so that there is no impact to the general levy. Staff is proposing that the projected deficit within the Tax Supported budget be financed by reducing the contribution to the debt reduction reserve which is consistent with the practice over the last six years. Report FCS-12-2019-5 provided a history of these results.

Communications

Operating Budget Variance Reports are submitted to the Standing Committees and Council for results as at June 30th, September 30th and December 31st of each year.

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Strategic Priorities

Click on icons below to view strategies under each priority area:

s 2.2, 2.3,

2.9

Respectfully submitted,

Original Signed By Original Signed By

Julie Stevens, CPA, CA Michael Duben, B.A. LL.B Commissioner of Finance and Chief Administrative Officer Corporate Services

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Tax Supported Operating Variance Net Levy Summary

All General Run Date: 11/15/19 1:39 PM

TS Variance Net Levy Summary New

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Tax Supported Operating Variance Net Levy Summary

All General Run Date: 11/15/19 1:39 PM

TS Variance Net Levy Summary New

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Tax Supported Operating Variance Net Levy Summary

All General Run Date: 11/15/19 1:39 PM

TS Variance Net Levy Summary New

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Tax Supported Operating Variance Net Levy Summary

All General Run Date: 11/15/19 1:39 PM

TS Variance Net Levy Summary New

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Rate Supported Operating Variance Net Levy Summary

Solid Waste Levy Run Date: 13/11/19 3:32 PM

RS Variance by Program SW

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Rate Supported Operating Variance Net Levy Summary

Water and Wastewater Levy Run Date: 15/11/19 1:44 PM

RS Variance Net Levy Summary

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