Central LHIN Planning Area Profiles

CentralLHINPlanningAreaProfiles

ThepreviouschapterdiscussedhealthservicegapsattheLHINlevel.AstheLHINis subdividedupintosevenplanningareasasshownbelow,notalloftheseareashaveuniform needs.Thepopulationsasdescribedbelowarequiteuniqueandtheirneedsarenot necessarilyconsistentwiththefindings,aspresented,attheLHINlevel.

Itistheseuniquecharacteristicsthatwillbeexaminedinthischapter.Theageprofile,visible minorities,incomeandeducationlevelsvarywidelyacrosseachplanningarea,indicatingthat healthneedsacrosseachoftheplanningareaswillnotbeuniformduetothevarioussocial factorsintheplanningenvironment.Thecurrentsevenplanningareasareasfollowsandas shownonthemapbelow.Theboundariesofeachplanningareaaredescribedinthedetailed descriptionofeachplanningareathatfollows.

1. CentralYork;

2. SouthSimcoeandNorthernYork;

3. SouthWestYork;

4. SouthEastYork;

5. NorthYorkWest;

6. NorthYorkCentral;and

7. NorthYorkEast.

Exhibit 40: Central LHIN Population Age 65+ by Planning Area 2008

Source: Environics Analytics Demographics Estimates and Projections 2008, Infonaut)

Detailsofeachplanningareaincludingitsgeographiclocationareincludedlaterinthissection.

Asdiscussedearlier,thesocialdeterminantsofhealthimpactthehealthstatusandhealth serviceutilizationofthepopulation.Asthetablebelowdemonstratesthereisinfactwide variationamongthesocialdeterminantsofhealth.Thewidevariationsandlargeclustersof differingethnicitiesacrossthevariousplanningareasplacevaryingdemandsforhealthservices ontheLHINaccordingtotheimpactofthesocialdeterminantsofhealth.

ThedefinitionsofeachofthefactorspresentedbelowaredefinedinAppendixE.

Exhibit 41: Social Determinants of Health by Central LHIN Planning Area

% % Econ. Planning Family % Total % % who do not % Pop. Aged Area % Pop. Median Incidence Lone Visible speak English 20+ with less Total Pop. Pop. in Aged Household of Low Parent Minority % as First than HS 2008 LHIN 65+ Income Income Families Pop. Immigrants Language Education

Ontario 12,986,332 13.46 $64,000 11.33 15.29 20.41 30.8 29.7 24.60

CentralLHIN 1,651,681 12.68 12.36 $76,000 9.39 15.13 36.72 49.0 44.1 22.36 SouthSimcoe& 113,257 6.86 11.48 $75,000 6.91 12.60 4.69 15.3 12.4 28.00 NYR CentralYork 204,207 12.36 10.50 $94,000 4.84 12.40 8.87 20.6 15.7 17.32 Region SouthEastYork 465,683 28.19 10.46 $93,000 5.01 11.87 51.57 55.4 52.3 18.52 Region SouthWest 230,536 13.96 9.19 $97,000 3.69 10.47 21.81 45.4 50.6 22.66 YorkRegion NorthYork 237,884 14.40 14.80 $44,000 20.47 26.61 50.41 61.9 54.4 38.65 West NorthYork 276,973 16.77 16.91 $61,000 12.94 16.70 37.78 58.5 54.3 18.45 Central

NorthYorkEast 123,141 7.46 14.41 $55,000 15.28 18.53 55.58 64.8 58.4 17.86

Source: Environics Analytics Demographics Estimates and Projections 2008, Infonaut)

ThetabledemonstratesthewidevariationinpopulationacrosstheCentralLHINplanning areas.Visibleminoritiesrangefromalowof4.69%inSouthSimcoeandNorthernYorkRegion toahighof55.58%inNorthYorkEast.Theageprofile,incomeandeducationlevelsacross eachoftheplanningareasalsovarieswidely,indicatingthatthathealthneedsacrosseachof theplanningareaswillnotbeuniformduetothevarioussocialfactorsintheplanningarea environment.

Thetableshowsthevarietyacrossplanningareawithregardstoprevalenceoflow-income families,loneparentfamilies,visibleminoritiesandthoseinthepopulationwithlessthana high-schooleducation.Typically,higherpercentagesforthesevariants,lowersthehealth statusofthepopulationastheyaremorelikelytobelivinginpovertywhichisastrong predictorofreportedhealthstatus.

OfnoteisNorthYorkWestwherethepopulationisolderthantheCentralLHINaverageand hasthehighestproportionoflow-incomefamiliesandlone-parentfamilies.Italsohasthe secondhighestrateofvisibleminoritiesandthehighestproportionofthepopulationwithless

CentralLHINHealthServiceNeedsAssessment&GapAnalysis 50 © 2008 KPMG All rights reserved thanahighschooleducation.ThisareaissimilartoNorthYorkEast;however,NorthYorkEast hasalowerproportionofthepopulationwithgeneraleducation(lessthanhighschool).

Incontrast,SouthWestYork,whichincludesVaughan,hastheyoungestpopulationofthe LHINandthelowestproportionoflowincomefamiliesandlone-parentfamilies.

Exhibit 42: % Family Incidence of Low Income in North York West Planning Area by DA

Source: Environics Analytics Demographics Estimates and Projections 2008, Infonaut

Population Growth

Acrosseachoftheplanningareastheprojectedpopulationgrowthwilldifferinthenextten years.Acompletetableofpopulationgrowthbyagecohortandplanningareacanbefoundin AppendixG.Currentlytheolderpopulationsareconcentratedinthesouthernandnorthern regionsoftheLHINwiththepopulationinthecentre(YorkRegion)areslightlyyounger.Four planningareaswhichwillseepopulationgrowthacrossallagesbetween15and20%inthe nexttenyearsare:SouthEastYork,SouthWestYork,CentralYorkandSouthSimcoeand NorthernYork.NorthYorkWestandNorthYorkEastareexpectedtoseeaslightdeclinein growthduringthistimeperiodasshowninthetablebelow 3.Justificationforthesegrowth ratesisprovidedinAppendixG.

3Whileitmayseenintuitivethatthepopulationintheseareasshouldbegrowing,theactualexperience thatisreflectedinthesereportsisthattheoverallpopulationisexpectedtobeflatordeclineslightly.This isnottrueforallagegroupsintheseareas,withtheseniorgroupsexperiencingthelargestincrease.There arefairlysignificantdeclinesexpectedacrosstheNorthYorkPlanningAreaswithinsimilaragegroups, primarilyamongthoseaged0to4,5to9and35to44.

Source: Environics Analytics Demographics Estimates and Projections 2008, Infonaut

Currently,theproportionofpeopleovertheageof65intheCentralLHINisslightlybelowthe provincialaverage.Thisisexpectedtochangesignificantlyinthenexttenyearsgivingthe CentralLHINthehighestnumberofpeopleinthisagecategorywhencomparedwithother LHINs.Inallplanningareasthereisanexpectedincreaseinthenumberofpeopleovertheage of65.Theexpectedpopulationgrowthforthoseovertheageof65canbeseeninthe followingexhibit.Whilethosecurrentlyovertheageof65residingintheCentralLHINtendto utilizehealthcareserviceslessthantheirpeersinotherpartsoftheprovince,withtherapid expectedgrowthinthenextfewyears,thishasthepotentialtochange.Thepopulation85+is predictedtogrowat43%toapproximately35,000in2018.Thiswillhaveasignificantimpact onthedeliveryofhealthcareservicesintheCentralLHIN.

Exhibit 44: Population Growth for Central LHIN Planning Areas (65+ Cohort)

Source: Environics Analytics Demographics Estimates and Projections 2008,

CentralLHINHealthServiceNeedsAssessment&GapAnalysis 52 © 2008 KPMG All rights reserved Withrespecttotheseniorspopulation,severalplanningareasareexpectedtoexperience significantgrowthinthiscohort(aged65andolder).GrowthwillbemostpronouncedinSouth EastYork,SouthWestYork,CentralYorkandSouthSimcoeandNorthernYork.Theother planningareaswillseegrowthofapproximatelytwentypercenteach.Theareaswithcurrently thelowestpercentageofseniorsareprojectinggrowthratesofbetween55and65%,with SouthEastYorkleadingthegrowth.Areaswiththehighestpercentageofseniorscurrentlyare expectingmoremoderate,butstillsignificantgrowthintheareaof15to25%.Evenwithinthe populationovertheageof65,therearesignificantvariationsbyplanningareaandbythethree senioragecategories(65-74,75-84and85+).Theirgrowthprojectionsareshownbelow.

Exhibit 45: Population Aged 65-74 by Planning Area

Source: Environics Analytics

Source: Environics Analytics Demographics Estimates and Projections 2008, Infonaut

Exhibit 47: Population Aged 85+ by Planning Area

(Source: Environics Analytics Demographics Estimates and Projections 2008, Infonaut)

Health Status

Thissectionexaminesthepopulationhealthneedsandserviceutilization.Notalldatawas availableatagranularlevelthatalloweddrill-downintotheplanningareas.Inareasthatwere onlyavailableattheLHIN-levelwerepresentedinthepreviousdiscussionontheLHIN-wide servicegaps.Moredetaileddiscussionsofthedomainsanalysedinthisreportcanbefoundin

Diabetes ThreeoutoffourdiabeticsinOntariohadatleastoneotherchroniccondition,while42%had twoormore.Cardiacdiseaseandstrokeoccurearlierindiabetics.Diabeticsarethreetimes morelikelytohaveacardiacorstrokerelatedhospitaladmissionandare12timesmorelikely torequiredialysisbecauseofchronickidneyfailure.Preventingtheonsetofdiabetesand managingthediseaseisvitalforasustainablesystemasthegrowthinthepopulationages. ThemanagementofTypeIIdiabetescanbedonethroughdietandexercisewhichcanbean issueforcertainpopulationsasaccesstoaffordablehealthyfoods,exercisefacilitiesandtime todevotetodiseasemanagementcanbeachallenge.

Overthenexttenyears,thepopulationintheCentralLHINwithdiabetesisexpectedtogrow by50%fromcloseto57,000personstomorethan85,000.Thepopulationisbasedon CanadianCommunityHealthSurveywhereinformationisself-reported.Thenumbersmaybe underreportedastherespondentneedstoknowtheyhavediabetesinordertoanswerthe questionpositively.Thecurrentprevalenceratesandexpectedgrowthratesvaryconsiderably byplanningarea.Prevalenceratesbasedon2005CanadianCommunityHealthSurveyvaryby planningareaandarelistedinthetablebelow.

Exhibit 48: Diabetes Prevalence & Relative Risk in Central LHIN –

Central LHIN Planning Areas Prevalence Cases RR*

NorthYorkWest 7.20% 13,960 1.48

SouthWestYorkRegion 6.08% 10,491 1.25

SouthSimcoe&NorthernYorkRegion 5.07% 4,516 1.04

CentralYorkRegion 3.47% 5,461 0.71

SouthEastYorkRegion 2.82% 10,247 0.58

NorthYorkCentral 2.53% 5,831 0.52

NorthYorkEast 0.93% 957 0.19

CentralLHIN 3.93% 51,463 0.81

Ontario 4.86% 519,904 1.00 *Note: RelativeRisk(RR)istheriskofdevelopingadiseaserelativetoexposure.Itisaratio thatrepresentstheprobabilityofhavingpositivecasesamongtheplanningareas basedontheprevalenceandpopulation. Source: 2005 CCHS Self-Reporting of DM and 2006 Census)

WhileNorthYorkEastwillexperiencethehighestgrowthat96%,therelativenumberof diabeticsinthisregioniscurrentlyrelativelylowwhencomparedtootherplanningareas.The NorthYorkWestareaisexpectedtobetheonlyareathatwillgrowatalowergrowthratethan theOntarioaverage(32%),howeverthisplanningareaisanareacurrentlywiththehighest prevalence.

25000

20000 North York West South West York South Simcoe & Northern York 15000 Central York South East York North York Central

10000 North York East Diabetes patients

5000

0 2008 2013 2018 Year

Source: CCHS 2005, Environics Analytics Demographics Estimates and Projections 2008, Infonaut

Osteoarthritis OsteoarthritisisthemostprevalentchronicdiseaseinOntarioandtheCentralLHIN,according tothe2005CanadianCommunityHealthSurvey.Theprevalencerateofosteoarthritisis expectedtocontinuetoriseasthepopulationages.However,theprevalenceratesforthis chronicdiseaseintheCentralLHINissignificantlylowerthanthatofOntarioforthoseoverthe ageof12,atcloseto14%comparedto17%fortheProvince.ForCentralLHINresidents between65and74,closeto40%reporthavingarthritis.PrevalenceratesintheCentralLHIN andOntarioaresignificantlyhigherforfemalesthanmales.Hospitalseparationsand emergencydepartmentvisitrateswereloweracrossallagecategoriesforCentralLHIN residents.Thereisavariationinosteoarthritisprevalenceratesbyplanningarea.Specifically, SouthSimcoeandNorthernYorkRegion,SouthWestYorkRegionandNorthYorkWesthad prevalencerateshigherthantheProvincialaverage.

CentralLHINHealthServiceNeedsAssessment&GapAnalysis 56 © 2008 KPMG All rights reserved Exhibit 50: Prevalence rate of osteoarthritis per 100 Ontarians age 20 years and older, by sex and age group, 2006/07 Central LHIN vs. Ontario

Source: ICES InTool

SouthSimcoeandNorthernYorkregion,SouthWestYorkregionandNorthYorkWesthavea higherprevalencerateforwomencomparedtotheProvincialaverageandaslightlyhigheror equalrateformen.

Exhibit 51: Age-adjusted prevalence rate of osteoarthritis per 100 Ontarians aged 20 years and older, by sub-LHIN planning area, 2006/07 Central LHIN vs. Ontario

Source: ICES InTool

Chronic Obstructive Pulmonary Disorder (COPD) COPDaffectscloseto3%ofCentralLHINresidentsovertheageof30,comparedtocloseto 4%ofOntarioresidentsofthesameage.COPDismoreprevalentinolderagecategoriesand symptomsusuallybecomeapparentafterage55.SmokingistheunderlyingcauseofCOPDin nearly80%ofcases.InCentralLHIN,thereisvariationinprevalenceratesbyplanningarea. ThereisahighprevalencerateintheSouthSimcoeandNorthernYorkarea,whichrankseven

Exhibit 52: Age-adjusted prevalence rate of chronic obstructive pulmonary disease (COPD) per 100 Ontarians aged 35 years and older, by sub-LHIN planning area 2006/07

Source: ICES InTool

Hypertension and Cardiac Disease Closeto1in8or12.4%ofCentralLHINresidentsovertheageof12reportedhaving hypertension,whichislessthantheOntarioprevalencerateof15.4%.Theprevalenceratefor CentralLHINresidentsissimilarbetweenmalesandfemales.Thereishowever,sidevariation acrosstheLHINplanningareasasdemonstratedbelow.SouthSimcoeandNorthernYork presentsahighof17.75%whileNorthYorkEastpresentsalowof12.57.FouroftheLHIN’s planningareasreportratesbelowtheOntariorateof15.29%.

Exhibit 53: Prevalence Rate of Hypertension in Central LHIN

% Hypertension LHINaverage:14.8%

Ontario 15.29% Central LHIN 14.81% N York East 12.57% N York Central 14.35% N York West 16.82% S W York Region 15.57% S E York Region 12.80% Central York Region 16.62% South Simcoe & N York Region 17.75%

0% 2% 4% 6% 8% 10% 12% 14% 16% 18% 20% Units

Source: Ontario MOHLTC 2007

CentralLHINHealthServiceNeedsAssessment&GapAnalysis 58 © 2008 KPMG All rights reserved Heartdiseaseislessprevalentthenmanychronicconditions,howeverisaleadingcauseof deathandhashighratesofinpatienthospitalseparationsandemergencydepartmentusage. TheprevalencerateinCentralLHINis4.3%whichissimilartoOntarioat4.8%.The prevalenceofheartdiseaseincreaseswithage,andoneinfourovertheageof75report havingheartdisease.

Mental Health and Addictions MentalHealthandAddictionsdatabyplanningareawasnotavailable.Inordertodetermine thepotentialprevalenceintheplanningareathenumberswereextrapolatedbasedonareview oftheliterature.

Thetablebelowhighlightstheexpectedprevalenceratesforcertainmentalhealthand addictionsconditions.Whilenotallwillrequirehealthservicestotreatthecondition,typically thosewithBipolarDisorderandSchizophreniaareindividualswhoarebestmonitoredby AssertiveCommunityTreatmentTeams(ACT).Therearecurrently7ACTteamsintheCentral LHINservingasmallpercentageofthepopulationwhowouldbenefitfromtheseservices.

Exhibit 54: Mental Health and Addictions Prevalence Rates by Planning Area 2008

Condition Annual South Central South South North North North Prevalence Simcoe York East York West York York York East Northern York West Central York

AnyMentalHealthand 18.6% 21,066 37,983 86,612 42,880 44,246 51,517 22,904 AddictionsDisorder

SeriousMentalIllness 2% 2,265 4,084 9,314 4,611 4,758 5,539 2,463

SubstanceAbuse 7.6% 8,608 15,520 35,392 17,521 18,079 21,050 9,359

Alzheimer’sand 9.0%(65+) 1,170 1,929 4,384 1,907 3,169 4,215 1,597 Dementia

See Exhibit 16 for Source Data

SuicideratesaremuchhigherforCanadianslivingwithinthepoorestincomeareas.In1996, age-standardizeddeathratesformalesinthepoorestincomequintilewere28per100,000 comparedto16per100,000intherichestincomequintile.Thefemalesuicideratewas8.8per 100,000inthepoorestincomequintilecomparedwith3.3per100,000intherichestquintile. Deathsassociatedwithmentaldisordersalsoshowmenandwomeninthepoorestincome areasalsohavethehighestdeathrates(Raphael,2007).

Thediscussionontheplanningareashasfocusedoncomparisonsofthedeterminantsand prevalenceratesofspecificconditionstoprovideanunderstandingofthevaryingneedswithin eachoftheseareas.Thesectionsthatfollowdescribeinmoredetailthecharacteristicsof eachindividualplanningareaandpullsoutsomespecificserviceneeds.

South Simcoe and Northern York Planning Area

TheplanningareaofSouthSimcoeandNorthernYorkisthenorthernmostplanningareainthe CentralLHIN.Thisareaismadeupoftwodistinctgeographiesandpopulations.LakeSimcoe separatesthetwoareas.TheSouthSimcoeareaispredominantlyruralwithsmallcitiesand townssuchasAllistonwhiletheNorthernYorkarea,alsorural,includestheFirstNations communityonGeorginaIsland.Bothareasposetheirownchallengesfortheplanningof healthcareservicedeliverytomeettheneedsofthelocalpopulation.

CentralLHINHealthServiceNeedsAssessment&GapAnalysis 59 © 2008 KPMG All rights reserved Thisplanningareaaccountsfor113,257residents(6.86%oftheCentralLHINpopulation).It hasthelowestpercentageofvisibleminoritiesintheLHINatjustlessthan5%andthelowest percentofimmigrantsat15.3%.ThetopthreevisibleminoritiesinthisplanningareaareBlack (0.7%),SouthAsian(0.4%)andChinese(0.4%).Closeto88%ofthepopulationinthis planningarealistEnglishastheirfirstlanguage.ThenextprominentlanguageisPortugueseat justunder2%.TheplanningareaisslightlyyoungerthantheCentralLHINaveragewith11.5% oftheresidentsovertheageof65.Therearesmallpocketswithintheplanningareawhere thereisahigherpopulationovertheageof65illustratedintheAppendix.Althoughthemedian householdincomeis$75,000,approximately7%offamiliesarelowincome.Theareahasa lowerthanaveragenumberofloneparentfamilies.Italsohasthesecondhighestpercentage ofresidentsovertheageof20withlessthanahigh-schooleducation.Itwasnotedatthe planningareasessionsthattheindustryintheareaincludesagricultureandmanufacturing. Theolderfarmoperatorsintheareatypicallydidnotrequiremorethanahigh-schooleducation andthemanufacturingintheareaisrelativelyhigh-payinganddidnotrequireapost-secondary degree,whichhaschangedinrecentyears.Theplanningareaisnotservicedbypublictransit andisheavilyreliantoncars.

TheFirstNationsCommunityonGeorginaIslandisveryisolated.Thereareapproximately350 -700FirstNationsindividualslivinginthearea.Thecommunityisonlyaccessedbywater.In thewintertheislandis20minutesbyairboator“scoot”tothemainland.Therearenohealth serviceprovidersontheisland,althoughanurseisemployedbytheFederalGovernmentto providehealthpromotion.Thecontractdoesnotallowforclinicalcaretobeprovidedbythe nurse.Therearelimitedhealthservicesavailableonthemainlandintheimmediatevicinity. ThecommunityonGeorginaIslandhasthehighestconcentrationoflow-incomefamiliesinthis planningareaasshownonthefollowingmap.Inadditionmostoftheotherlow-income familiesareconcentratedintheNorthernYorkpartoftheplanningarea,nearGeorginaIsland. Incomparisonwiththerestofthisplanningarea,theGeorginaIslandareaalsocontainsthe highestpercentageoflone-parentfamiliesandthoseovertheageof20withlessthanahigh- schooleducation.ResearchindicatesthatAboriginalpeoplesaremorelikelytoliveinpoverty andshowagreaterincidenceofarangeofafflictionsandprematuredeathfromavarietyof causes(NoojimawinHealthAuthority,“HealthNeedsandPrioritiesoftheAboriginal CommunitiesLocatedwithinCentralLHIN”,2008).Tenyearsagomortalityratesfor Aboriginalswasalmost1.5timeshigherthannationalrateandinfantmortalityrateswereclose to3.5timesnationalrates.(D.Raphael,PovertyandHealth,2007).

CentralLHINHealthServiceNeedsAssessment&GapAnalysis 60 © 2008 KPMG All rights reserved Exhibit 55: % Family Incidence of Low Income in South Simcoe & North York Region Planning Area by Dissemination Area

Source: Environics Analytics Demographics Estimates and Projections 2008, Infonaut)

ThefollowingmapillustratesthelocationofhealthcareserviceprovidersintheSouthSimcoe andNorthernYorkplanningarea.MostofthelimitedservicesareclusteredaroundAlliston, BradfordandKeswick.Therearemanydomiciliaryhostelsandhomesforspecialcareinthe KeswickareawhichwouldaccessacuteandmentalhealthservicesatSouthlakeRegional HealthCentre(Southlake).MostservicesarelocatedintheborderingCentralYorkplanning areaandareclusteredaroundtheSouthlake.Aninventoryofservices,includinghealthand socialserviceprovidersislocatedintheAppendix.Thislistisnotexhaustiveandneedstobe interpretedwithcautionassomeserviceprovidersmayincludetheSouthSimcoeandNorthern Yorkplanningareaintheirgeographybutonlyofferlimitedservicesinthearea.

TheAllistonareaissignificantlyunder-servicedareawithregardstofamilyphysicians. Currentlytheyare13physiciansshortofthedesired27.Therearecurrently42.1active generalpractitionersfor100,000residentscomparedtoacentralLHINratioof71.7andOntario ratioof75.2.Manyofthephysiciansintheareaarenottakingnewpatientsandthepopulation reliesheavilyontheEmergencyDepartmentatStevensonMemorialtoprovidebasicprimary care.TheEDatStevensonMemorialhasahigherthanLHINaveragenumberofCTAS4(less- urgent)andCTAS5(non-urgent)utilization.Asapercentageoftheregion’spopulation,the SouthSimcoeandNorthernYorkRegionaccountedfor13%moreEDcasesthantheaverage fortheLHIN.Thisisthehighestrateforanyoftheplanningareas. ThehighrateofED utilizationcouldbeattributedtolimitedaccesstoprimarycare,walk-inclinics,andcommunity servicestotreatnon-urgentcases.In2006/2007theStevensonEDsaw21,516cases,of 5.2%ofthevolumeinCentralLHINhospitals.Thisareaisalsoexpectingmorethan15% growthofEDcasesforalltriagelevelsoverthenexttenyears.StevensonEDhassignificantly higherratesof“DiseasesandDisordersoftheEar,Nose,MouthandThroat”.Stevenson

CentralLHINHealthServiceNeedsAssessment&GapAnalysis 61 © 2008 KPMG All rights reserved currentlydoesnothaveaCTscannerbutisexpectedtohaveoneinplacefor2009.Stevenson doeshaveaccesstoahelipadfortransfersofmoreseriousEDcases.Itwasnotedinthe interviewsthatthereislimitedspecialistsupportforphysiciansatStevenson,althoughafew programsdohavestrongpartnershipswithSouthlake.

TheSouthSimcoeandNorthernYorkplanningareahasthesecondlowestutilizationof ambulatoryservicesforthoseovertheageof65at1,255per1,000population.Thisnumberis expectedtoincreaseinthenext10yearsby41.3%.

Exhibit 56: Distribution of Health Service Providers in South Simcoe and Northern York Region

(Various sources including Ontario MOHLTC, Central LHIN, Infonaut)

TheSouthSimcoeandNorthernYorkplanningareaisexpectedtoseegrowthinthepopulation overtheageof65by45%inthenexttenyears.Correspondingly,thisareaalsohasprojected growthinthenumberofhomevisitsby43%overthesametimeperiodforthepopulation 65andover.Thispopulationalsohasaslightlyhigherutilizationofinpatientserviceswhen comparedwiththeCentralLHINpopulation.Thepercentageofthepopulationovertheageof 85inthisplanningareais6.2%.Theplanningareahas7.2%oftheLongTermCarebedsin theCentralLHINhoweveraccountsfor10.1%ofthepeoplewaitingforLTCfacilities.The majorityofpeoplewaitingforLTCfacilitiesarewaitinginthecommunity(6.1%);however, 1.6%waitingfortransferfromoneLTCfacilitytoanotherand2.1%waitingfortransfertoLTC fromanotherfacilitysuchasrehaborchroniccare.

Withregardstochronicdisease,theSouthSimcoeandNorthernYorkplanningareahasfew primarycareservicesavailabletoprovideregularmonitoringofthediseases.Theprevalence ratefordiabetesisthethirdhighestintheCentralLHINbasedonCCHS.Therearecurrently 5,262diabetics,whichisprojectedtoincreaseto7,130by2018(35%increase).TheSouth

CentralLHINHealthServiceNeedsAssessment&GapAnalysis 62 © 2008 KPMG All rights reserved SimcoeandNorthernYorkregionhasthehighestprevalenceofhypertensionandheart disease.Thereareapproximately17,000peoplewithhypertensioninthisplanningareaand theexpected10-yeargrowthrateisnearly30%.Thisareaisoneoftwoplanningareaswitha higherrelativerateofheartdiseasecomparedtotheProvince.RegardingEDCardiacCases, SouthSimcoeandNorthernYorkis37.7rateper1,000isthesecondhighestrateintheLHIN andwellabovetheLHINaverageof32.8.

Typically,thosewithBipolarDisorderandSchizophreniaareindividualswhoarebestmonitored byAssertiveCommunityTreatmentTeams(ACT)inadditiontoacomplementofcommunity supportsthatincludecasemanagement,supportivehousing,vocationaloremployment programsandothercommunityservicesasdescribedinthepreviousGapssection.Itwas notedinthefocusgroupsthatwhilethereisanACTteamatSouthlakethatistoservicethe planningarea,thecommunitymentalhealthservicesavailabletothegeographicareaare limited.StevensonMemorialistohaveaccesstotwo(2)inpatientbedsforMentalHealthat RoyalVictoriaHospitalinBarrie,althoughitwasnotedthattheyhavedifficultyaccessingthese inpatientbeds.Thisparticularplanningareaasthefewestnumberofactivepsychiatristsper 100,000residentsat1.8comparedwiththeCentralLHINat8.1andOntarioat12.8. StevensonMemorialdoeshaveacommunitymentalhealthcentrethathastreatmentand counselling,casemanagementandparttimecrisisintervention,withaccesstoa24-hours crisisline.

Issues and Challenges Asnotedearlier,thisareaispredominantlyruralwithsmallcitiesandtown.Thereisnopublic transitinanypartofthearea,whichmakesitdifficultforthosetobewithoutapersonal vehicle.Itwasnotedduringtheplanningareadiscussionsthatmanyofthenewareasinthe Allistonareaarenotbeingbuilttoaccommodateeasywalkingaccesstocommunityfacilities. InadditionmanyintheareacommuteintotheGTAforworkandcannotaccesslocal healthcareservicesduringdaytimeofficehours.IntheGeorginaIslandarea,theonlyaccessto themainlandisa20-minuteridebyferryorairboat(“scoot”)acrosstheice.

TherearelimitedhealthcareservicesavailableintheSouthSimcoeandNorthernYorkplanning area.Whilenotallservicesneedtobeprovidedinthearea,peopleshouldbeabletoaccess primarycarelocallyandthisisachallengeforthepopulationofthisplanningarea.TheAlliston areahasslightlylessthanone-halfthenumberoffamilyphysiciansintheareaandis consideredunder-serviced.ThereisaNursePractitionercurrentlyemployedbyStevenson Memorial,howevertherehavebeenchallengestofullyemploytheirscopeofpracticeasit createsfrictionwithsomephysicians.TherearenoprimarycareprovidersintheGeorgina IslandareaandpeoplemusttravelacrossthelaketoKeswickorfurther,wherethereareafew primarycarephysicians.

Focusgroupparticipants,whoincludedserviceprovidersandmunicipalofficials,notedthat theyhaddifficultygettinghumanresourcestoprovidecareintheSouthSimcoeandNorthern Yorkplanningarea.Thedistances,whilenotexcessive,docreateabarriertoprovidingcarein thearea.TherequirementtotravelacrossthelaketoprovidecareonGeorginaIslandisalsoa barriertoprovidingservicestothatpopulation.

Service Needs and Gaps Thefollowingserviceneedsandgapswereidentifiedthroughtheanalysis.Resultsfrom stakeholderinterviewsandfocusgroupshavebeenincluded.

CentralLHINHealthServiceNeedsAssessment&GapAnalysis 63 © 2008 KPMG All rights reserved Primary Care / Chronic Disease Prevention and Management –needformoreprimarycare accessintheplanningareawithanemphasisonchronicdiseasepreventionandmanagement (oneofthehighestratesofheartdiseaseintheLHIN).Theratiooffamilyphysiciansper 100,000populationiscurrently42.1comparedto75.2fortheprovince.Inadditiontothe identifiedneedforprimarycarephysiciansincertainpartsoftheplanningarea,thismayalso includeutilizingnursepractitioners,aswellasotheralliedhealthprofessionalstothefullextent oftheirscopeofpracticeasattractingphysicianstothisareamayprovechallenging.Itmay alsoincludeencouragingmoreFamilyHealthTeamstoprovidecareforthispopulation.There isalsoaneedforprimarycareservicespecificallytoaddresstheruralpopulationofNorthern YorkandGeorginaIsland.Sincetransportationiscitedasanissue,innovativeservicedelivery mayincludeamobilebuswithaninter-professionalpracticeteam. Protocols and Processes –needforprotocolsandprocessesinplacebetweenhospitals.It wasnotedinseveralsessionsthatpeoplepresentingatStevensonMemorialhavelimited accesstospecialistcareprovidedatotherhospitals.Whiletherearepartnershipsinplacefor certainprograms,suchasCardiacwithSouthlake,itwasnotedthatthereisaneedformore. PartnershipsneedtobestrengthenedbetweenCentralLHINhospitalsaswellasthosethatfall outsidetheboundariesbutaregeographicallyclose,suchasRoyalVictoriainBarrie.As StevensonMemorialisasmallcommunityhospitalandprovideslimitedsecondarycare,the protocolsandprocessesfortransferofcarewillallowpatientsmoretimelycare. Mental Health –needformoreaccesstoMentalHealthservicesintheplanningarea.Itwas notedthattherearelimitedservicesinplaceintheareaandthehospitalEDisnotequippedto handletheseriouslymentallyillinanappropriatemanner.WhilesomeMentalHealthproviders statethattheyincludethisgeographicarea,itwasnotedbymanythatthisdoesnotappearto bethecase.Inaddition,theprovidersnotedthattheyhavedifficultyaccessingthetwoMental HealthbedsthathavebeensetasideforStevensonMemorialatRoyalVictoriaforavarietyof reasons,includingthatthenumberofbedsisnotsufficient. • Community Support Services –needformorecommunitysupportservicetosupport seniorsintheirhomes.Asindicatedadisproportionatenumberofpeoplearewaitingfor LongtermCareplacementintheplanningarea.Morenotablewasthatalargeproportion ofthemarewaitingforplacementinthecommunity.Astheseindividualsarenotrequired towaitinhospital,theremaybeopportunitiestoaddresstheirneedsthroughhome supportsinthecommunity.Asassessmentoftheneedsofindividualsonthewaitlistfor LongTermCareplacementwouldberequiredtovalidatethisassessment.

Central York Planning Area

Thisplanningareaaccountsfor204,207residents(12.36%oftheCentralLHINpopulation).It hasthesecondlowestpercentageofvisibleminoritiesintheLHINatjustlessthan9%.The topthreevisibleminoritiesinthisplanningareaareChinese(1.7%),SouthAsian(1.27%)and Black(1.16%).Closeto85%ofthepopulationinthisplanningarealistEnglishastheirfirst language.ThenextprominentlanguageisItalianatjustunder3%.Theplanningareaisslightly youngerthantheCentralLHINaveragewith10.5%oftheresidentsovertheageof65.There aresmallpocketsofregionswithintheplanningarea,suchasNewmarketandAurora,where thereisahigherproportionofthepopulationovertheageof65.Thisisalsoillustratedinthe Appendix.Approximately5%offamilieshavelowincomeandtheareahasthelowerthan averagenumberofloneparentfamilies.Italsohasthelowestpercentageofresidentsover theageof20withlessthanahigh-schooleducation.

CentralLHINHealthServiceNeedsAssessment&GapAnalysis 64 © 2008 KPMG All rights reserved ThisplanningareaisthelargestgeographicplanningareawithintheCentralLHIN,althoughthe populationispredominantlyinthecentreofthisplanningarea,liningYongeStreet.Themore populatedcitiesinthisplanningareaincludeNewmarket,AuroraandHollandLanding.The followingmapillustratesthelocationofhealthcareserviceprovidersintheCentralYork planningarea.MostoftheservicesareclusteredaroundNewmarketandAurora,especially aroundtheSouthlake.Aninventoryofservices,includinghealthandsocialserviceprovidersis locatedintheAppendix.Thislistisnotexhaustiveandneedstobeinterpretedwithcautionas someserviceprovidersmayincludetheCentralYorkplanningareaintheirgeographybutonly offerservicestolimitedareas.

Exhibit 57: Health Care Service Providers in York Region 2008

Various sources including Ontario MOHLTC, Central LHIN, Infonaut

Currently,thisareahasfewerpeopleovertheageof65;however,thispopulationisexpected toincreaseby20%overthenexttenyears.Thecurrentpopulationover65receivesthe secondhighestnumberofCCAChomevisitsperpopulationwhencomparedtotheother planningareas.Thenumberofhomevisitsisexpectedtoincreasebycloseto55%inthenext tenyears.TheCentralYorkpopulation65+utilizeshospitalinpatientservicesslightlymore thentheproportionofthepopulation.TheCentralYorkplanningareahasapproximately15% oftheLTCbedsand34%oftheshort-staybedsintheCentralLHIN.Thepopulationinthe planningareaovertheageof85isslightlylessthan11%ofthispopulationintheCentralLHIN. Thisplanningareaaccountsforcloseto15%ofthepeoplewaitingforLTCfacilitiesinthe CentralLHIN.Thisplanningareahasthesecondhighestpercentage(1.0%)waitinginhospital facilitiesforLTC.Closeto6%arewaitinginthecommunityandslightlymorethan5%are waitinginotherLTCfacilitiesfortheirpreferredchoice.

CentralLHINHealthServiceNeedsAssessment&GapAnalysis 65 © 2008 KPMG All rights reserved CentralYorkhas1,262ambulatoryservicesper1,000seniors(overtheageof65),thethird lowestwhencomparedtotheotherplanningareas.Overthenexttenyears,thisisexpectedto growby51%.Thisareahas60.2activegeneralpractitionersfor100,000residentsofthe planningarea.CentralLHINhas71.7andOntariohas75.2for100,000residents.CentralYork planningareaexperiencedthethirdhighestrateperthousandofEDcasesinrelationtothe LHINaverage.ThisplanningareacurrentlybearsthelargestpressureforEDservicesandwill continuetodosooverthenexttenyears,withexpectedgrowthforalltriagelevelsmorethan 20%.Currently,SouthlakeRegionalhasslightlylessthan15%oftheEDvolumesforCentral LHINhospitals,followingNorthYorkGeneralandHumberRiverRegionalHospital.Althoughit isthehighestvolumeinasinglesiteED.Southlakeisalsoaregionalcentreforsomeprograms whichmayaccountforsomevolume.

Theprevalencerateofdiabetesandprojectedgrowthrateislowwhencomparedtotheother planningareas.However,therearecurrently5,901identifieddiabeticsinthisplanningareaand thatnumberisexpectedtogrowby51%inthenexttenyearsto8,920.

TheCentralYorkregionhasthethirdhighestprevalenceofhypertensionwhichaccountsfor approximately26,000.AsnotedearlierthehypertensiondataisbasedontheCanadian CommunityHealthSurveysonumbersmaybeunderreportedastheyareself-reported.The projecttenyeargrowthrateisslightlylessthan30%,inlinewiththeOntarioaverageand slightlylessthantheCentralLHINaverage.CentralYork’srateper1,000ofEDcardiaccasesis thehighestofallplanningareasat39.7.

ThereareAssertiveCommunityTreatment(ACT)teamsatSouthlakeservingasmall percentageofthispopulation.Itwasnotedinplanningareasessionsthatone-thirdofthe dischargesfromtheCentreforAddictionandMentalHealth’sQueenStreetsiteinTorontoare tohomesanddomiciliaryhostelsintheSouthlakecatchmentarea.Someofthesefallwithin theplanningareatothenorthdiscussedearlier,butsomearelocatedwithinthisplanningarea. Thereare6.9activepsychiatristsfor100,000residentsintheplanningarea,comparedto8.1 forCentralLHINand12.8forOntario.

SouthlakeRegionalHealthCentrehadthesecondhighestnumberofEDvisitsformental healthconditionsandthethirdhighestnumberofEDvisitsforintentionalself-harminrelation totheotherCentralLHINhospitals.Thiscomparestothethirdhighestnumberofmental healthinpatientseparationsat927.Thehospitalhas29mentalhealthbedsoutof170inthe LHIN(17%).

Census Mental Health Intentional Self- LHIN Hospital Name Division Conditions Harm

Central Simcoe StevensonMemorial 406 32

HumberRiverRegional(HRR)-Humber Toronto 2,847 121 Memorial

HRR-York-Finch 939 61

NorthYorkGeneral-GeneralSite 2,564 196

NorthYorkGeneral-BransonSite 223 6

York MarkhamStouffville 1,179 107

Southlake Regional Health Centre 3,066 136

YorkCentral 1,516 157

LHIN Total 12,740 816

Provincial Total 189,283 14,936

Source: PHPDB NACRS 2006/07

Issues and Challenges Thisplanningareahasarelativelyhealthyandwealthypopulation.Thepopulationis predominantlylocatedalongtheYongeStreetcorridorinNewmarketandAurora.Itwasnoted duringplanningsessionsthattheissuesandchallengeshavemoretodowiththeneedfor systemintegrationandcollaborationbetweenthemultiplestakeholders.Detailsofwhichare discussedlaterinthisreport.

Service Needs and Gaps Thefollowingserviceneedsandgapswereidentifiedthroughtheanalysis.Resultsfrom stakeholderinterviewsandfocusgroupshavebeenincluded.

Chronic Disease Management and Prevention –needformorechronicdiseaseprevention andmanagementservices.TheareahashighratesofhypertensionintheLHIN.Thishas translatedtothehighestratesofcardiaccases.Throughexpansionoftheprimarycaremodel, focusshouldbeplacedondevelopingchroniccaremodelswithemphasisonprevention, educationandself-management.Thiswillalsohelpmitigateagainstanexpected51%growth indiabetesinthearea. Mental Health and Addictions –needformoreintegratedservicesandprimarycareforthe population.Thisareahasclosetoone-thirdofthegrouphomesanddomiciliaryhostelsfor individualswithmentalhealthconditionsdischargedfromCAMH’sQueenStreetsite.While thereareafewFamilyHealthTeamsprovidingserviceinthisarea,itwasnotedthatmanydo notacceptindividualswhohaveamentalillnessandfindingconsistentprimarycaretomonitor theconditionforthispopulationisdifficult.Itwasnotedintheplanningsessionsthatthereare anumberofcommunityservicesavailableforpeoplewithamentalillness;however, psychiatristsintheareaareunsurewhytheservicesarenotbeingaccessed.Itwasalso discussedthatthereisaneedformoreintegrationbetweenaddictionsandmentalillness services.ThereareonlyfourdetoxificationbedswithintheCentralLHIN(locatedatHRRH)and manyhospitalsthatseeasignificantnumberofindividualsrequiringthisserviceendup observingthepersonduringthisperiodinsteadofprovidingthemthecaretheyrequire.

CentralLHINHealthServiceNeedsAssessment&GapAnalysis 67 © 2008 KPMG All rights reserved Primary Care –needformoreprimarycareservice.Asnoted,thenumberoffamily physiciansintheareafallswellbelowtheprovincialandCentralLHINratioper100,000people. Asthisisahighgrowtharea,effortshouldbeplacedondevelopingalternateprimarycare modelsthatleveragenursepractitionersandinter-professionalteams.

South West York Planning Area

Thisplanningareaaccountsfor230,536residents(13.96%oftheCentralLHINpopulation). Approximatelyoneinfiveresidentsarevisibleminoritiesinthisplanningarea,thethirdlowest amongplanningareas.ThetopthreevisibleminoritiesinthisplanningareaareSouthAsian (6.17%),Chinese(4.16%)andBlack(2.12%).Slightlymorethan50%ofthispopulationlista languageotherthanEnglishastheirmothertongue.ThetopthreelanguagesareEnglish (49%),Italian(20%)andRussian(4.5%).Similarly,theplanningareahasthethirdlowest numberofimmigrantsat45.4percent,althoughwellabovetheprovincialproportionof30.8 percent.

TheplanningareaistheyoungestintheCentralLHINwith9.19%oftheresidentsovertheage of65.Therearesmallpocketsofcommunitieswithintheplanningarea,suchasThornhill, wherethereisaslightlyhigherpopulationovertheageof65(illustratedintheAppendix).This planningareahasthelowestpercentageoflowincomefamiliesat3.69%ofthepopulationand thelowestpercentageofloneparentfamilies.Italsohasanaveragepercentageofresidents overtheageof20withlessthanahigh-schooleducation,withslightlymorethanoneinfive andthehighesthouseholdincomeintheLHINat$97,000.

ThisplanningareaisprimarilydefinedbytheVaughanarea,butalsoincludesMapleandparts ofThornhill.Thefollowingmapillustratesthelocationofhealthcareserviceprovidersinthe SouthWestYorkplanningarea.Thisisanareathatdoesnothaveahighconcentrationof healthcareserviceproviders,whichcanbenotedinthemapbelow.Mostoftheservicesare clusteredaroundMapleandVaughan.Thereisnohospitallocatedinthisplanningareaatthe presenttime,althoughYorkCentralHospitalisjusteastoftheplanningareaborder,inthe SouthEastYorkplanningarea.Aninventoryofservices,includinghealthandsocialservice providersislocatedintheAppendix.Thislistisnotexhaustiveandneedstobeinterpreted withcautionassomeserviceprovidersmayincludetheSouthWestYorkplanningareaintheir geographybutonlyofferservicestolimitedareas.

Various sources including Ontario MOHLTC, Central LHIN, Infonaut)

Therearemoreactivefamilyphysiciansinthesouth-easternpartoftheplanningarea.There areafewthatarelocatedintheMapleandVaughan.SouthWestYorkhas59.0activegeneral practitionersfor100,000residents.TheCentralLHINhas71.7andOntariohas75.2.Thisis oneoftwoplanningareasthathavethesecondlowestnumberofactivegeneralpractitioners forthispopulation.TheeasternborderoftheplanningareaisquiteclosetoNewmarketand Aurorasothepopulationmayaccessprimarycareintheneighbouringplanningarea.Themap belowshowstheofficelocationsofactivefamilyphysiciansinthisplanningarea.

Source: Scott’s Medical Dictionary – Ontario Physician and Specialists 2008, Environics Analytics Demographics Estimates and Projections 2008, Infonaut

Thisareahasslightlymorethen21,000peopleovertheageof65.Theyreceivethehighest numberofCCAChomevisitsperpopulationcomparedtootherplanningareas.Thepopulation overtheageof85intheSouthWestYorkplanningareaaccountsfor7.6%ofthoseoverthe ageof85intheCentralLHIN.Thisplanningareahasslightlylessthan9%oftheLTCbedsand around7%oftheshort-staybeds.ThepopulationinthisplanningareawaitingforLTC accountsfor11.1%ofthewaitlist.Ofthosewaiting,themajority(6.4%)arewaitinginother facilities,suchaschroniccareorrehab,3.4%arewaitinginthecommunityand1.2%are waitingfortransferinotherLTCfacilities.

SouthWestWorkcurrentlyhasarelativelylowproportionofseniors,hasthethirdhighest numberofambulatoryservicesper1,000peopleovertheageof65at1,353.Overthenext tenyears,thisnumberisprojectedtogrowby57%.

SouthWestYorkisoneoftheplanningareaswithalowerutilizationofEDservices.LowED utilizationratesmaysuggestindividualsareseekingservicesthroughprimaryorCommunity- basedcareornotaccessingservicesatall,perhapsduetoEDwaittimesthatmayactasa deterrent.Thisareaisexpectedtoseemorethan25%inEDvisitsoverthenexttenyears.

Therearecurrently11,889diabeticsinSouthWestYork,whichwillincreaseto20,265by2018 (70%increase).Thisareahasthesecondhighestprevalencerateandthesecondhighest numberofdiabetics.Thisplanningareaisoneofthreethathasahigherprevalenceratethan OntarioandtheCentralLHINofosteoarthritisforthoseoverage20.Currently,theSouthWest Yorkregionhasanaveragerateofhypertensionandheartdisease.SouthWestYorkwill experiencethehighestgrowth(70%)inpopulationwithhighbloodpressureovernext10years andover90%growthinheartdisease.

CentralLHINHealthServiceNeedsAssessment&GapAnalysis 70 © 2008 KPMG All rights reserved Itwasnotedattheplanningareasessionsthattherearelimitedservicesintheplanningarea forthosewithmentalillnessandaddictionsandthattheculturalcompositionofthepopulation createsachallengetopositivelytreatmentalillnessandaddictions.Thereare4.5active psychiatristsfor100,000residents.Thisisthethirdlowestwhencomparedwithother planningareas.CentralLHINhas8.1andOntariohas12.8for100,000residents.

Issues and Challenges Thegrowthinthisparticularplanningareahasbeenquitesignificantinthepastfewyears, especiallyintheVaughanarea;howeverserviceshavenotgrowntoaccommodatethe increaseinpopulation.Thisareahasgrownfromasmallbedroomcommunityintoalargeurban area.Manyinthisareacommuteforemploymentandmayaccessservicesinthatlocation, howeverastheareabecomesmoredenselypopulatedtheneedforprimarycareaccessinthe localcommunitybecomesmoreapparent.Theareahasalackofaffordablehousingandlimited rentalaccommodationasmanyofthenewdevelopmentsaresingle-familydwellings.

Itwasnotedintheplanningareasessionthatthereareanumberofhomeopathicclinicsinthe areathatareperceivedtobewellused.Therearealsomanywalk-inclinicsintheplanningarea whichprovideprimarycare,howevertheseclinicsdonotprovideconsistentandfollow-up care.

Itwasidentifiedthatthereareanumberofimmigrantchildrenwhoareenrolledinthe educationsystembuthavenotreceivedbasicscreening(dental,visionandhearing)priorto startingschool.Thelackofbasicscreeninguponentrycanleadtolearningandhealth challengesinthefutureandthereisaneedforpreventativeearlyscreening.Ofparticular challengeisthenumberoforganizationalandMinisterialboundariesthatabasicscreening programcrosses.

Thereisstrongcommunityandpoliticalwillinthisplanningarea.Thecommunityhascome togethertoprovidefundingforanddevelopmentofahealthcampuswhereserviceproviders canprovidebasicprimaryandsomespecialistcare.Therearealsoanumberofprivate providersintheVaughanareawhofundraisetoprovideaddictionsservicestothepopulation.It wasnotedthatwaitlistsforthisfacilityarequitelong.

Service Needs and Gaps Thefollowingserviceneedsandgapswereidentifiedthroughtheanalysis.Resultsfrom stakeholderinterviewsandfocusgroupshavebeenincluded.

Chronic Disease Management and Prevention –needformorechronicdiseaseprevention andmanagementservices.Theareahashighratesofdiabetes(highestintheLHIN)andwill seehighgrowthratesofhighbloodpressure(70%)andheartdisease(90%)inthenextten years.Focusshouldbeplacedondevelopingchroniccaremodelswithemphasison prevention,educationandself-management.Thiswillalsohelpmilitateagainstanexpected futuregrowthinchronicconditions,especiallygiventhehighgrowthrateofseniorsinthearea. Primary Care –needforprimarycareservicesinthisarea.Whiletherearemanywalk-in clinicsintheareatheydonotprovideconsistent,continuingcare.Thereisnofamilyhealth teamprovidingprimarycareinthisplanningarea.ThereisaCommunityHealthCentreopening inVaughaninthenearfuturewhichwillprovideprimarycaretoseniorsandothermarginalized populations. Access and System Navigation –needtoprovideaccessandsystemnavigationtoservicesin languagesotherthanEnglish.Inthisparticularplanningareacloseto50%listanotherlanguage

CentralLHINHealthServiceNeedsAssessment&GapAnalysis 71 © 2008 KPMG All rights reserved otherthanEnglishastheirfirstlanguageand46%areimmigrants.Therearecertainethno- culturalpopulationsthatmaynotaccesshealthservicesintheareaforavarietyofreasons, includingalackofunderstandingofwhatservicesareavailabletoadesiretoaccessculturally diverseservices.

South East York Planning Area

Thisplanningareaaccountsfor465,683residents(28.19%oftheCentralLHINpopulation). ThisismostpopulatedplanningareaintheCentralLHIN.Thisareahasthesecondhighest percentageofvisibleminoritieswithslightlymorethan50%visibleminoritiesinthisplanning area.ThetopthreevisibleminoritiesinthisplanningareaareChinese(27.96%),SouthAsian (10.31%)andBlack(2.97%).Slightlymorethan50%ofthispopulationlistalanguageother thanEnglishastheirmothertongue.ThetopthreelanguagesareEnglish(48%),Cantonese (13%)andChinesen.o.s.(10%).Chinesen.o.s.includesotherChinesedialectsbutdonot includeCantoneseorMandarin.

TheplanningareaisthesecondyoungestintheCentralLHINwithonly10.46%ofthe residentsovertheageof65.Thisplanningareahasthethirdlowestpercentageoflowincome familiesat5.01%ofthepopulationandthesecondlowestpercentageofloneparentfamilies. Italsohasalowpercentageofresidentsovertheageof20withlessthanahigh-school education,whencomparedwiththeCentralLHINaverageandotherplanningareasat18.52% andthesecondhighesthouseholdincomeat$93,000.

ThisplanningareaisprimarilyRichmondHillandMarkham,withabitofThornhill.The southernborderofthisplanningareaisSteelesAve.TheeasternborderisYork&Durham RoadandthewesternborderismostlyBathurstStreet,althoughthereareafewderivations fromthisroad.Thefollowingmapillustratesthebordersoftheplanningareaaswellasthe locationofhealthcareserviceprovidersintheSouthWestYorkplanningarea.Thisisanarea thatdoesnothaveahighconcentrationofhealthcareserviceproviders,whichcanbenotedin themapbelow.MostoftheservicesareclusteredaroundRichmondHillandMarkham.

Various sources including Ontario MOHLTC, Central LHIN, Infonaut

SouthEastYorkplanningareawillexperiencethehighestpopulationgrowthinthenextten yearscomparedtotheotherplanningareas.Thepopulationovertheageof65isexpectedto grownearly65%.Thisplanningareacurrentlyhasnearly49,000peopleovertheageof65,the largestnumberofpeopleinthisagecategory.Thepopulationovertheageof65inthis planningareacurrentlyreceivethesecondlowestnumberofCCAChomevisitsperpopulation incomparisonwithotherplanningareas.Assumingnochangeinthenumberofservices,this amountisexpectedtogrowinlinewiththepopulationgrowthforthoseolderthan65.This planningareacurrentlyhascloseto21%ofthepopulationovertheageof85intheCentral LHIN.Thisareaalsoaccountsformorethan28%oftheclientsonthewaitlistforLTC facilities.OfthosewaitingforLTCfacilities,slightlymorethanhalfarewaitinginthe communityandcloseto10%arewaitinginotherfacilities,suchaschroniccareorrehab. Closeto3.5arewaitingfortransfertoanotherLTCfacilityand0.7%arewaitinginhospital.It wasnotedatplanningareasessionsthatmanypeoplearewaitingforavailablebedsinspecific ethno-culturalfacilities.

Thisplanningareahasthelowestnumberofambulatoryservicesforthepopulationoverthe ageof65(1,039per1,000),althoughitalsocurrentlyhasalowproportionofseniors. However,duetotheexpectedgrowthinthisagecategorytheprojectedgrowthinambulatory servicesis61.4%.

TheSouthEastYorkRegionhasamuchlowerutilizationofinpatientservicesforthepopulation overtheageof65whencomparedwiththeCentralLHINpopulation.Thepopulationbetween theagesof65-74usesinpatientservices5%lessthentheproportionofthepopulationinthat agecategory.The75-84agecategoryusesapproximately4%fewerservicesandthoseover theageof85useapproximately3%fewerservices.Whilethesenumbersarenotnecessarily

CentralLHINHealthServiceNeedsAssessment&GapAnalysis 73 © 2008 KPMG All rights reserved statisticallysignificant,theyarethelargestvariationbyplanningareas.Thelowutilizationcould beduetomanyfactorssuchashigherutilizationofcommunityresourcesandsupportand socio-economicandethniccomposition.

Exhibit 62: Central LHIN Planning Areas – Population and % Hospital Inpatient Case Comparison

ResidentsfromtheCentral LHIN Population%byAgeGroup Inpatient%byAgeGroup TotalCases

65-74 75-84 85+ 65-74 75-84 85+ 2,499

SouthSimcoeandNorth York Region 6.6 6.2 6.2 7.5 6.6 6 4,111

CentralYorkRegion 10.7 10.1 10.8 11.8 11.1 10.4 6,964

SouthEastYorkRegion 25.9 21.9 20.7 21.0 17.8 18.1 3,648

SouthWestYorkRegion 11.7 9.4 7.6 11.7 9.3 8.3 6,782

NorthYorkWest 17.3 17.6 15.5 19.0 19 16.7 8,718

NorthYorkCentral 19.1 25.9 31.4 17.7 25.2 31.6 2,979

NorthYorkEast 8.7 8.9 7.8 8.6 8.2 7.1 931

Source: PHPDB – DAD 2006/07, Environics Analytics Demographics Estimates and Projections 2008, Infonaut

Thisplanningareahas56.9activegeneralpractitionersfor100,000residents.CentralLHINhas 71.7andOntariohas75.2for100,000residents.SouthEastYorkhadthelowestrateper thousandofEDcasescomparedtotherestoftheLHINplanningareas.Whiletheyare currentlyutilizingtheEDatalowerratethenotherplanningareas,duetotheprojected populationgrowthinthearea,SouthEastYorkrankssecondhighestingrowthforprojectedED visitsforalltriagelevelsoverthenexttenyears,whichisprojectedtobecloseto25%.

Therearecurrently11,582diabeticsinSouthEastYork,thethirdhighestwithrespectto planningareasandwhichwillincreaseto20,885by2018(80%increase)andwillbethe highestforallplanningareas.Theprevalenceratefordiabetesformenandwomeniscloseto theOntarioratesforthisdiseaseandslightlylessthentheCentralLHINrates.Thisplanning areaalsohasthelowestprevalenceforosteoarthritisamongthepopulationovertheageof20. ThisinformationisbasedontheCanadianCommunityHealthSurveyandmaybe underreportedduetopossiblelanguageorculturalbarriers.

Thisplanningareahasthelowestrateper1,000ofinpatientcancercaseswhencomparedto otherareasandat1.9ismuchlowerthentheCentralLHINrateof2.5.

Currently,theSouthEastYorkregionhasalowprevalenceofhypertensionandheartdisease. AlthoughSouthEastYorkhasasignificantlylowerrelativerisk,closeto1/4ofCentralLHIN’s populationwithhighbloodpressureliveinthisarea.Thisareawillexperienceagrowthof closeto50%,thesecondhighestgrowthinpopulationwithhighbloodpressureoverthenext tenyears.SouthEastYorkissignificantlylowerthanotherareasoftheCentralLHINand Ontarioforheartdisease.AlthoughrelativeriskforSouthEastYorkislower,approximately 20%oftheCentralLHIN’spopulationwithheartdiseaseliveinthisarea.Heartdiseaserates inSouthEastYorkwillexperiencesignificantgrowthofcloseto75%inthenexttenyears.

100 South Simcoe and Northern York Region 90 Central York Region South East York Region South West York Region 80 North York West North York Central North York East 70 Central LHIN Ontario 60

50 % growth 40

0 2006 2008 2013 2018 Year

Source: CCHS 2005,,Environics Analytics Demographics Estimates and Projections 2008, Infonaut

ItwasnotedattheplanningsessionsthatYorkCentralHospitalhasjustrecentlybecomea Schedule1hospital,whichshouldhelptorelievepressureatotherCentralLHINhospitals. WhilethereisanACTteamintheplanningareaitwasnotedinstakeholdersessionsthatthere isnotenoughcapacitytotreatthosewhorequiretheservices.Inadditionitwasnotedat severalsessionsthattherearelimitedcommunityandhospitalservicesforchildrenand adolescentswithmentalhealthandaddictionsissues.Thisparticularplanningareahas 4.5activepsychiatristsper100,000,comparedtoCentralLHINat8.1andOntarioat12.8.

Issues and Challenges ThisisthelargestplanningareabypopulationintheCentralLHINandhasthesecondhighest numberofvisibleminorities.Manyinthepopulationareimmigrantsandmorethan1in2have alanguageotherthanEnglishastheirfirstlanguage.Itwasnotedthatwhiletherearequitea fewservicesinthisarea,peoplemaynotbeabletoaccessthemduringnormalbusiness hours.Peoplemaybeoutoftheareaforemploymentorlookingaftergrandchildrenduringthe day.

Thetwolargecities,MarkhamandRichmondHill,withinthisplanningareaarequitediverse andareperceivedtohavedifferentpopulations.Planningwithinthisareawouldneedtobe morefocusedatthemunicipallevelinsteadoftheplanningareatoaccommodatethedifferent areas.ItwasnotedattheplanningareasessionthatRichmondHillwaslikelymoresimilarto thepopulationintheSouthWestYorkplanningareathentothepopulationintheMarkham portionoftheSouthEastYorkplanningarea.

Itwasdiscussedbyparticipantsattheplanningareasessionthatthereisaneedtoinvolve faithcommunitiesandpartnerwiththeminprovidinghealthpromotionandinformationthatis bothlanguageandculturallyappropriate.Thereareseveralstrongnetworksinthefaith communitieswithinthisplanningareathatshouldbeleveraged.

CentralLHINHealthServiceNeedsAssessment&GapAnalysis 75 © 2008 KPMG All rights reserved Service Needs and Gaps Thefollowingserviceneedsandgapswereidentifiedthroughtheanalysis.Someissues,such aslackofprimarycare,theneedforaccessforindividualswithamentalhealthconditionand accesstoservicesthatarelanguageandculturallyappropriatearesimilartowhathasbeen discussedinotherplanningareasessions.Resultsfromstakeholderinterviewsandfocus groupshavebeenincluded.

Maternal care –needmoreservicesandsupportsforthispopulation.Itwasnotedduring interviewsandplanningareasessionsthatmanyhospitalsinthisareaarereachingor exceedingcapacityforbirthsandhavecappedthenumberofwomenwhocangivebirthin thesehospitalsforcingthemtoseekcareatCentralEastorTorontoCentralLHINhospitalsor atCentralLHINhospitalsgeographicallyfurtheraway. Specialist coordination –needformoreintegrationbetweenhospitalandcommunity specialists.Itwasnotedintheplanningareasessionsthattherearemanyspecialistsinarea whohavesetupcommunitypracticeswhichareonlyaccessibleduringnormalofficehoursand onlyacceptrelativelypatientswithfewcomplications.Thisleavesthehospitalspecialistto careforthemorecomplexandacutelyillpatientsandprovidecareduringtheeveningand weekendhours. Access –needtoprovideaccesstoservicesinlanguagesotherthanEnglish.Inthisparticular planningareaslightlymorethan50%listanotherlanguageotherthanEnglishastheirfirst languageand54%areimmigrants.Theymaynotaccesshealthservicesintheareafora varietyofreasons,includingalackofunderstandingofwhatservicesareavailableandthe abilitytoaccesssuchservicestoadesiretoaccesslanguageandculturallydiverseservices. Mental Health services –needforambulatoryandoutreachservicesforyouth,adultsand seniors.Itwasnotedthattheservicesavailablearehavingdifficultykeepingupwiththe growthofthepopulationinthisarea.Therearelimitedservicesintheplanningareaavailable fortransition-ageyouth(betweenyouthandadult).Inadditionthisplanningareahasanumber ofculturalcommunitieswherementalillnessisstigmatizedcreatingchallengesforthe individual,familyandproviderintreatingthecondition.Thewaitforproviderswhocanprovide careinboththelanguageandculturerequiredcanbequitelong.Thenumberofrecent immigrantstothisplanningareaalsocreateschallengesasindividualsaredealingwithmultiple stressorsandmentalhealthissues,suchasdepression,maypresent. Senior Services –needformoreculturallyappropriateservicesforthispopulation.This planningareaaccountsforthelargestpercentageofthosewaitingforLTCfacilitiesasthereare limitedoptionsavailablesuchassupportivehousinginthisplanningarea.Itwasnotedatthe planningareathatmanyofthesepeoplearewaitingforthelimitedethno-culturalfacilitiesin theplanningarea.ThisisalsoanareathatreceivesrelativelyfewCCACin-homeservicesper populationovertheageof65whencomparedtootherplanningareas.Almosthalfarebeing maintainedinthecommunitybutarebeingcaredforbyfamilymembersplacingahugestrain onthecaregivers.Inadditionitwasnotedthatthereisaneedformorecoordinationbetween communityorganizationsaswellasanunderstandingofwhatserviceswereavailablefor residents.Serviceprovidersnotedthatwhiletheymaynotbeabletoprovideservicesina particularlanguagethereareopportunitiesforthemtocollaborateandpartnerwithother organizationswhocouldassistwithtranslationsortrainingstafftoprovidecareforspecific cultures.

Thisplanningareaaccountsfor237,884residents(14.4%oftheCentralLHINpopulation). Approximately50%arevisibleminoritiesinthisplanningarea,thesecondhighestamong planningareas.ThetopthreevisibleminoritiesinthisplanningareaareBlack(16.55%),South Asian(10.75%)andLatinAmerica(6.93%).Morethan50%ofthispopulationlistalanguage otherthanEnglishastheirmothertongue.ThetopthreelanguagesareEnglish(44%),Italian (15%)andSpanish(7%).

TheplanningareaisthesecondoldestpopulationintheCentralLHINwith14.8%ofthe residentsovertheageof65.Therearepocketsofregionswithintheplanningareawhere thereisahigherpopulationovertheageof65asillustratedintheAppendix.Thisplanningarea hasthehighestpercentageoflowincomefamiliesat20.47%ofthepopulationandthehighest percentageofloneparentfamiliesat26.61%.Italsohasthehighestpercentageofresidents overtheageof20withlessthanahigh-schooleducation,withslightlymorethan2in5andthe lowesthouseholdincomeintheLHINat$44,000;lessthanhalfthehighestinSouthWest York.

ThisplanningareaistheNorthWestneighbourhoodsofTorontoandisborderedbySteeles AvenuetotheNorthandDufferinStreettotheEast.Thisplanningareaincludesthe“Jane- Finch”neighbourhood.TheJane-Finchneighbourhoodisapproximately60%immigrants,of which14%immigratedwithinlastfiveyears.BasedoninformationprovidedbytheJane-Finch CommunityofPracticeworkinggroup,thisneighbourhoodhasahighbirthrateamongadult womenandteensinrelationtoCityofTorontoaswellasahighpercentageoflowbirthweight babies.Thereisalowutilizationrateofpreventativehealthcareservicesforearlydetectionof disease,suchasmammogramsinJaneandFinchcommunitycomparedtoCityofTorontoand OntariointheJane-Finchneighbourhood,whichmaybeattributedtothehighnumberofrecent immigrants,languagebarriers,andaccesstoservicesoutsideMondaytoFriday9-to-5. Strategiestoexaminehealthoutcomesinthisneighborhoodmustconsiderlanguageand culturalbarriers,alongwithsocio-economic,familymake-upandeducation,andothersocial factors

ThefollowingmapillustratesthelocationofhealthcareserviceprovidersintheNorthYork planningarea.Thisisanareathatdoeshaveahighconcentrationofhealthcareservice providers,whichcanbenotedinthemapbelow.Aninventoryofservices,includinghealthand socialserviceprovidersislocatedintheAppendix.Thislistisnotexhaustiveandneedstobe interpretedwithcautionassomeserviceprovidersmayincludetheNorthYorkWestplanning areaintheirgeographybutonlyofferservicestolimitedareas.

Various sources including Ontario MOHLTC, Central LHIN, Infonaut

Thereareanumberofactivefamilyphysiciansinthisplanningarea.Thisparticularplanning areahas80.1activegeneralpractitionersfor100,000residentscomparedwiththeCentral LHINandOntarioratiosof71.7and75.2respectively.Itwasnotedattheplanningsessionthat whiletherearequiteanumberoffamilyphysiciansinthisplanningarea,thepopulationhas difficultyaccessingprimarycareservices.ThereisaHealthCentreinthisplanningarea providingprimarycareservicestoapartofthepopulation.

NorthYorkWestwillexperiencegrowthofabout18%overthenexttenyearsinthisage cohort.Thisplanningareacurrentlyhasthethirdlargestnumberofpeopleovertheageof65, atslightlymorethan35,000.TheNorthYorkWestplanningareaisexpectedtoseea correspondinggrowthinCCAChomevisitsforthose65andoversimilartothepopulation growthforthisagecategory.Thisareahasslightlymorethan15%oftheCentralLHIN populationthatisovertheageof85.Approximately22%oftheLTCbedsarelocatedinthis planningarea.Residentsofthisplanningareaaccountforcloseto20%oftheclientswaiting forLTCfacilitiesintheCentralLHIN.Closeto40%oftheclientsonthewaitlistarewaitingfor LTCfacilitiesinthecommunityand30%arewaitingfortransferfromoneLTCfacilityto another.ThisplanningareahasthehighestnumberofclientsontheLTClistwaitingin hospital.TheNorthYorkWestregionhasahigherutilizationofinpatientservicesinrelationto theotherplanningareas.ThehigherutilizationandthosewaitingforLTCfacilitiesinthe hospital,couldbeduetomanyfactors,suchaslimitedcommunityresourcesandfamily supportstokeeptheindividualoutofhospitalfacilitiesandinahomeenvironment.

NorthYorkWesthasthehighestnumberofambulatoryservicesper1,000seniorsat1,632. Duetotheprojectedgrowthofthepopulationinthisarea,theexpectedgrowthforambulatory servicesoverthenext10yearsisexpectedtogrowslightlymorethan14%.

CentralLHINHealthServiceNeedsAssessment&GapAnalysis 78 © 2008 KPMG All rights reserved NorthYorkWesthadthesecondhighestrateofEDcasesthehighestnumberofEDcasesin comparisontotheotherplanningareas.Italsohasthesecondhighestrateper1,000ofED casesintheCentralLHIN.ThehighrateofEDutilizationcouldbeattributedtolimitedaccess toprimarycare,walk-inclinics,communityservicestotreatnon-urgentcases.Itwasnoted duringplanningsessionmeetingsthatthispopulationtendstowaittoaccesshealthcare servicesuntiltheyarequiteillpossiblyresultinginmoreadmissionstohospitalforissuesthat couldhavebeentreatedinthecommunityifdetectedearlier.Thewaitispossiblydueto limitedaccessoutsidebusinesshours,limitedprimarycareservicesinthearea,inabilityto affordpublictransportation,bothincostandtime,toaccesssuchservices.

TheplanningareaofNorthYorkWestcurrentlyhasthelargestnumberofdiabetics,15,551, andthisisexpectedtoincreaseto18,197by2018(17%increase).Whilethisexpected increaseisnotasdramaticassomeoftheotherplanningareas,NorthYorkWestwillstillhave alargenumberofdiabeticsandwillhavethethirdhighestnumberin2018.Analysisconducted byICEShighlightsdiabetesprevalenceamonglow-income,visibleminoritiesandlowlevelsof Education.Accordingtothisreport,NorthYorkWestistheplanningareawiththehighest prevalencerateofdiabetesintheCentralLHIN.Itisalsotheareathathasthehighestpoverty rateandlowesteducationrate.ThethreeplanningareasinNorthYorkhavethehighestratesof diabetesprevalenceintheCentralLHIN,whichmaysuggestacorrelationbetweendiabetes prevalenceandsocialdeterminantsofhealth(povertyandeducation),highlevelofethnic populationsusceptibletodiabetestype2andincreasingageofthepopulation.Thiswillrequire uniqueapproachesandpartnershipstopreventtype2diabetesorprovidesecondary prevention.

Researchindicatesthatthediabetesrateformalesinlow-incomecommunitiesis40%higher, andamonglowermiddle-incomecommunities,50%higherthaninhigherincomecommunities (Raphael,2007).Cross-Canadiandataindicatesthattheprevalenceofdiabetesamong Canadiansaged45-64yearswithhouseholdincomesof$10,000-29,999istwice(6%)thatof thoselivinginhouseholdswithincomesof$60,000ormore(3%).Tonote,diabetesamong maleshavehighermortalityratesinlowerincomebracketsversushigherincomebrackets. Thereisasignificantcorrelationbetweenoverallmortalityratesandsocio-economicdisparities indiabetesmortality.

NorthYorkWesthasthesecondhighestprevalencerateofosteoarthritisforthoseoverthe ageof20whencomparedwiththeotherLHINplanningareas.Womenovertheageof20have ahigherprevalenceratethentheOntarioandCentralLHINrate.Menolderthan20arehavea higherprevalenceratethenCentralLHINandareclosetotheOntariorate.Primaryriskfactors forosteoporosisincludelackofexercise,poordietandage.

Riskfactorsfordiabetesaresimilartothoseidentifiedforhighbloodpressure.NorthYork Westisanareawithapopulationthathasanumberofriskfactorsidentified(e.g.lowlevelsof education,lowincomelevels,significantimmigrantpopulation).Itcurrentlyhasthesecond highestprevalencerateforhypertensionandslightlylessthan33,000haveself-identifiedthat theyhavehypertension.Theexpectedgrowthrateisnotexpectedtobeassignificantasother planningareasduetothelowerexpectedoverallpopulationgrowthinthisplanningarea.Itis howevercloseto20%bringingthenumberscloserto40,000intenyears.NorthYorkWestis oneoftwoplanningareaswithheartdiseaseprevalencegreaterthantheProvincialaverage andhasapproximately20%ofthepopulationlivingwithheartdisease.

CentralLHINHealthServiceNeedsAssessment&GapAnalysis 79 © 2008 KPMG All rights reserved Asstatedearlier,thenumbersfordiabetes,hypertensionandosteoarthritisarebasedon CanadianCommunityHealthSurveydataandareself-reported.Anindividualmustbeaware thattheyhavetheconditioninordertopositivelyanswerthequestion.Itwasnotedinseveral stakeholdersessionsthatindividualsinthisarealackaccesstoprimarycareandthereforemay notbeawaretheyhavethecondition.

TheHumberRiverRegionalHospitalhandlesforcloseto30%oftheMentalHealthEmergency DepartmentvisitsinCentralLHINhospitals.Althoughnotallthesevisitscanbeattributedto CentralLHINresidents,HRRHdrawsstronglyfromthelocalarea.HRRHhastheonly detoxificationbedsintheCentralLHIN.ItalsohasastrongpartnershipwiththeCanadian MentalHealthAssociation(CMHA)andhasdevelopedprojectstotreatthispopulationbuthave notedthattheyareonlyreachingarelativelysmallpercentage.Thisparticularplanningarea hasthesecondhighestnumberofactivepsychiatristsat9.8per100,000residents.Central LHINhas8.1andOntariohas12.8per100,000residents.

Issues and Challenges ManyissuesandchallengesmentionedherealsoexistintheNorthYorkCentralandNorth YorkEastplanningareasandneedtobetakenintoconsiderationinallthreeplanningareas.

Asdiscussedabovethisparticularplanningareahasseveralsocio-economicchallenges. Neighbourhoodswithinthisparticularplanningarea,aswellasNorthYorkCentralandNorth YorkEast,haveseenthenumberof“very-high”povertyneighbourhoods(40%ofmore) increasefrom0in1981to7in2001accordingtotheUnitedWayReport“PovertybyPostal Code”.Thenumberof“high”povertyneighbourhoods(26-39.9%ofthepopulationlivingin poverty)hasincreasedfrom7to29inthissametimeperiodandthenumberof“moderate” povertyneighbourhoods(13-25.9%)hasincreasedfrom35to53.Thenumberoflowerpoverty neighbourhoods(0-12.9%)hasdecreasedsubstantiallyinthistimeperiodfrom56to27. Wherepovertyoncetookona“U”shapewhenlookingatthecityofToronto,itisquickly takingonan“O”shapearoundthecityofTorontowiththeplanningareasofNorthYorkWest, NorthYorkCentralandNorthYorkEastexperiencingasignificantincreaseintheconcentration ofpoverty.ThisposesseveralchallengesfortheNorthYorkWestplanningareaasissues relatedtopovertynegativelyaffectthehealthofthepopulationasdiscussedearlierinthis section.

In2008theCentralLHINimplementedaCommunityofPracticeprojectfortheJane-Finch neighbourhoodlocatedinNorthYorkWest.Thisprojectlookedatthefollowing:

• Anenvironmentalscandescribingthepopulationandserviceprovidersinthearea; • Communityandstakeholderengagementstrategy; • StakeholdergroupandtheCommunityofPractice;and • BestPracticesummaryandInventory.

BarriersidentifiedwiththisCommunityofPracticeaswellastheplanningareasessionand stakeholderinterviewsidentifiedsimilarbarriersfortheneighbourhoodwhenaccessinghealth servicesandmaintainingthehealthoftheindividual.Thesebarriersinclude:

• Accessingappropriatehealthservicesduetolanguageorculturalissues; • Inabilitytopayformedicationanduninsuredhealthservicessuchasphysiotherapy; • Difficultiesaccessingconsistentprimarycare;and • Inabilitytopayforqualityfoodaswellaseasyaccesstogreengrocers.

CentralLHINHealthServiceNeedsAssessment&GapAnalysis 80 © 2008 KPMG All rights reserved Whilethisareaisrelativelywellservicedbypublictransit,serviceprovidersandplanning sessionparticipantsnotedthatoftentheindividuallackstheabilitytoaffordthefareorrequire multiplebusesmakingservicesthatarearelativelyshortdistanceawaydifficulttoaccess withincertaintimeparameters.

Also,itwasnotedbymanystakeholdersthattheinabilitytoaccessnutritiousfoodandasafe facilityforphysicalfitnessledtomanypotentiallypreventableillnessesandhealthissues.This areahasthereputationforbeingunsafeandmanyserviceprovidersprefernottoprovide servicestothisclientele.CommunitySupportServicesnotedthattheyoftenhavedifficulty gettingprovidersandvolunteerstoservethisparticulararea.Itisalsodifficultforresidentsof theareatoparticipateinfreephysicalactivities(walking,playgrounds)duetosafetyconcerns.

Thenumberoffamilieslivingbelowthepovertylineinthisplanningareahasseveral implicationsforthehealthofthechildrenandneedforservices.Theinfantmortalityrateof thoselivinginthepoorestquintileofCanadianurbanareasis60%higherandlow-birthweight rateis43%higher.Lowbirth-weight(lessthan2,500grams)isanimportantmeasureofhealth statusasitisrelatedtotheexperienceofsomechronicdiseasesinadulthood.Childrenlivingin povertyarethemostlikelytohaveasthmaorotherchronicdiseases,visitEDsanddiefrom injuries.LongitudinalEuropeanstudieshavefoundthatchildrenlivinginpovertyaremorelikely todevelopcardiovasculardisease,TypeIIdiabetes,respiratoryproblemsandsomeformsof cancerasadults.Thepovertyandhealthrelationshipspersistregardlessofadultincomestatus asadults.Anindividualwithlowincomehasanalmostfour-times-greaterriskofreportingfair orpoorhealththanhigh-incomeindividuals.Thelow-incomeeffectsweremuchstrongerthan theeffectsofnoregularexercise,smokingandhavinglesseducation(D.Raphael,Povertyand PolicyinCanada ,2007).

Service Needs and Gaps Thefollowingserviceneedsandgapswereidentifiedthroughtheanalysis.Resultsfrom stakeholderinterviewsandfocusgroupshavebeenincluded.Severalserviceneedsandgaps mentionedherealsoexistintheNorthYorkCentralandNorthYorkEastplanningareas. AdditionalserviceneedsandgapsinNorthYorkCentralandNorthYorkEastcanalsobe appliedtothisplanningarea.

Primary Care –needformoreconsistentprimarycareservicesinthearea.Whilethereis BlackCreekCommunityHealthCentrethatprovidesservicestoasub-populationofthis planningarea,thereisaneedforexpandedservices.BlackCreekiscurrentlynotaccepting newpatientsandhasdifficultyattractingandretainingprimarycarephysicians.Participantsin planningsessionsalsoindicatedthatwhilethereareanumberofactivephysiciansinthearea manyarenottakingnewpatients,donotprovideserviceinthelanguageorculturerequiredor providelimitedservicesfortheresidentsofthisplanningarea.Participantsalsonotethatthere areanumberofwalk-inclinicsintheareabutdonotprovideconsistentprimarycareor monitoring.Serviceprovidersalsonotedifficultyaccessingspecialistsupportforresidentsin theareaoftenrequiringtravelwhichmaybeacostandtimebarrier. Social Determinants –needformoreemphasisonthesocialdeterminantsofhealth.The povertyinthisplanningareaprovidesmanychallengesforboththeresidentsandtheservice providers.Thereislimitedabilityoftheresidentstopayformedicationsandotherservices thatareuninsured.Manyindividualsreportworkinginmultiple,low-payingpositionsthatoffer fewaddedbenefitsandmedicationsortheneedtocareforafamilymemberduringanillness cansendanindividualintoseriousfinancialhardship.Peoplehavetomakechoicesbetween

CentralLHINHealthServiceNeedsAssessment&GapAnalysis 81 © 2008 KPMG All rights reserved fillingaprescription,rent,foodorutilities.Individualsandserviceprovidesalsonotethat peoplehavedifficultyaccessingaffordablehealthyfoodandaccessinghealthservicesduring regularofficehoursastheycannotaffordtotaketimeoffformedicalappointments. Cultural and Language –needformoreservicesandinformationprovidedinlanguagesother thanEnglish.Manynoteddifficultyaccessingservicesastheywereunawaretheservicesand resourcesavailableinthearea.Thisareahasahighnumberofrecentimmigrantswhomaynot beeligibleformedicalinsuranceuntiltheyhavebeenaresidentforacertaintimeperiod.Many newcomershavedifficultynavigatingthesystemandfindingphysiciansandserviceproviders withwhotheycancommunicate.Languagebarriersmayleadtomisdiagnosisandnon- complianceintreatment. Youth services –needfor“youthfriendly”spaces,counsellingandpartnershipswith education,publichealthandothernon-healthproviders.Itwasnotedinplanningsessionsand stakeholderinterviewsthatduetothepovertyintheareamanyyouthdonothaveaccessto nutritiousmealsthroughouttheschooldayandthelimitedcommunityservicesinthearea createsafetyconcerns.

North York Central Planning Area

Thisplanningareaaccountsfor276,973residents(16.77%oftheCentralLHINpopulation). Approximately40%arevisibleminoritiesinthisplanningarea,thefourthhighestamong planningareas.ThetopthreevisibleminoritiesinthisplanningareaareChinese(14.6%), Filipino(3.7%)andKorean(3.6%).Approximately55%ofthispopulationlistalanguageother thanEnglishastheirmothertongue.ThetopthreelanguagesareEnglish(46%),Russian(7%) andChinesen.o.s.(6%).(Chinesen.o.s.doesnotincludeCantoneseorMandarin)

TheplanningareaistheoldestintheCentralLHINwithcloseto17%oftheresidentsoverthe ageof65.Thisplanningareahasthethirdhighestpercentageoflowincomefamiliesat 12.94%ofthepopulationandthethirdhighestpercentageofloneparentfamilies(16.7%).It alsohasthesecondlowestpercentageofresidentsovertheageof20withlessthanahigh- schooleducationat18.45%.

ThisplanningareaisprimarilytheNorthYorkpartofToronto.Itisborderedtothenorthby SteelesAve.,theeastbyLeslieAve.andtheDonRiverandtotheWestbyDufferinAve.The southernborderisslightlysouthoftheHighway401andisillustratedonthefollowingmap whichhighlightslocationofhealthcareserviceprovidersintheNorthYorkCentralplanning area.Thisisanareathathasahighconcentrationofhealthcareserviceproviders,whichcan benotedinthemapbelow.

Exhibit 65: North York Central Planning Area Health Care Service Provider Distribution

Various sources including Ontario MOHLTC, Central LHIN, Infonaut

TheNorthYorkCentralplanningareahasthesecondhighestnumberofpeopleovertheage of65,withcloseto47,000people.Thisareacurrentlyreceivesarelativelyhighnumberof CCACin-homevisitsbasedonthepopulationovertheageof65whencomparedtoother planningareasandthegrowthinhomevisitsisexpectedtobeinlinewiththegrowthofthis population.TheNorthYorkCentralplanningareahas31.4%oftheCentralLHINpopulation overtheageof85butrepresentsonly15%oftheclientswaitingforLTCfacilities.Itwas notedinplanningsessionsthatsomecouldbewaitingforspecificethno-culturalandreligious facilities,suchasBaycrest,locatedjusttothesouthofthisplanningareaintheTorontoCentral LHIN.OfthosewaitingforLTCfacilities,closeto6%arewaitinginthecommunityandslightly morearewaitingfortransferinotherLTCfacilities.Thisareaalsohasthethirdhighest percentagewaitinginhospitalforLTCfacilities.TheNorthYorkCentralplanningareahasclose to21%oftheLTCbedsintheCentralLHINand14%oftheshort-staybeds.

Thisplanningareahasthesecondhighestnumberofambulatoryservicesforthepopulation overtheageof65at1,427per1,000.Whiletheexpectedgrowthinthispopulationforthe planningareaisnotasdramaticassomeoftheotherplanningareas,thenumberofambulatory servicesisexpectedtogrowby22%.

NorthYorkCentralhasthehighestnumberofactivefamilyphysiciansper100,000residentsat 130.2.CentralLHINhas71.7andOntariohas75.2.Thenexthighestratioisinthebordering planningareaofNorthYorkWest.NorthYorkCentralhadanaveragerateperthousandofED casescomparedtotherestoftheLHINplanningareasandaccountsforapproximately70,000

CentralLHINHealthServiceNeedsAssessment&GapAnalysis 83 visitsor17%oftheCentralLHINresidentvolumes.Thisisexpectedtogrowbycloseto10% overthenexttenyears.

Therearecurrently5,620diabeticsinNorthYorkCentral,whichwillincreaseto8,079by2018 (44%increase).NorthYorkCentralwillexperienceaveragegrowthindiabetescomparedto theotherplanningareasoftheCentralLHINandwillremainthethirdlowestcomparedtothe others.NorthYorkCentralalsoreportsalowerthanCentralLHINaverageofosteoarthritisfor thoseovertheageof20andthistrendissimilarwhenaccountingforgender.

Thisplanningareahasthesecondhighestnumberofinpatientcancercasesandthehighest numberofcasesper1,000oftheplanningareas(3.1)comparedtoaLHINaverageof2.5. Whilethisplanningareahasthethirdlowestprevalenceforhypertension,ithasthesecond highestpopulationwiththisconditionwithapproximately33,000.Thetenyearexpected growthrateisthelowestamongplanningareasandisaround10%.Theprojectedgrowthrate forthosewithheartdiseaseisalsothelowestincomparisonaround20%.

TheNorthYorkGeneralHospitalaccountsforcloseto22%oftheEDvisitsforclientswitha primarydiagnosisofMentalHealthtoCentralLHINhospitalsandabout30%oftheacute inpatientdays.Itwasnotedthatwhilethisareahasanumberofactivepsychiatristsaccessto serviceswasaconcernthatwasbroughtforwardinplanningareasessions.Thisplanningarea hasthehighestnumberofactivepsychiatryper100,000residentsat23.4.CentralLHINhas 8.1andOntariohas12.8.

Exhibit 66: Locations of Psychiatrists by Population Distribution in the North York Central Region

Source: Scott’s Medical Dictionary – Ontario Physician and Specialists 2008, Environics Analytics Demographics Estimates and Projections 2008, Infonaut)

CentralLHINHealthServiceNeedsAssessment&GapAnalysis 84 © 2008 KPMG All rights reserved Issues and Challenges BasedontheUnitedWay“PovertybyPostalCode”Report,theNorthYorkCentralplanning areahasseenanincreaseinthenumberofneighbourhoodswithlow-povertyoverthepasttwo decades.Thisincreaseinpovertycreatesseveralhealthchallengesasmentionedpreviouslyin theNorthYorkWestplanningsection.

Thisparticularplanningareahasanumberofhealthandcommunityservicesbutparticipantsin theplanningsessionsfeltthattheywerenotbeingfullyaccessedpossiblyduetolanguageor culturalbarriersorcouldreachabroaderpopulation.Manyoftheservicesarelocatednear NorthYorkGeneralHospitalwhichhasastrongprimarycarefocusandalargeFamilyHealth Teamassociatedwiththehospital,howeversomestillnoteddifficultywithaccessingprimary careservicesforcertainpopulations,suchasthosewithmentalhealthconditions.

Service Needs and Gaps Thefollowingserviceneedsandgapswereidentifiedthroughtheanalysis.Resultsfrom stakeholderinterviewsandfocusgroupshavebeenincluded.

Access -theneedtomakethecurrentservicesmoreaccessibleinmultiplelanguagesand cultures.Manyparticipantsnotedthattherewerequiteafewservicesavailableintheplanning areabutmaynotbefullyaccessed.Itwasfeltthatmanyoftheserviceswerenotprovidedin thelanguageorculturerequired. Partnership –needforstrengtheningpartnershipsbetweenserviceproviders.NorthYork GeneralhasastrongpartnershipformanyprogramswithSunnybrookHealthSciencesCentre intheTorontoCentralLHINwherepatientsreceivespecializedservicesatSunnybrookandare transferredbackforcare.Participantsnotedthatthereopportunitiestopartnerwith organizationsinthecommunitythatprovideservicesinthelanguageandculturerequiredfor theplanningarea.

North York East Planning Area

Thisplanningareaaccountsfor123,141residents(7.46%oftheCentralLHINpopulation).This areahasthehighestnumberofvisibleminoritiesinthisplanningareaataround56%.Closeto 63%ofthepopulationinthisareaareimmigrants.Thetopthreevisibleminoritiesinthis planningareaareChinese(18.18%),SouthAsian(11.15%)andBlack(6.44%).Closeto60%of thispopulationlistalanguageotherthanEnglishastheirmothertongue.Thetopthree languagesareEnglish(42%),Chinesen.o.s.(8.5%)andPersian(5.5%).

TheplanningareaisthethirdoldestintheCentralLHINwith14.41%oftheresidentsoverthe ageof65.Thisplanningareahasthesecondhighestpercentageoflowincomefamiliesat 15.28%ofthepopulationandthesecondhighestpercentageofloneparentfamiliesat 18.53%.Italsohasansecondlowestpercentageofresidentsovertheageof20withlessthan ahigh-schooleducation,at17.86%andthesecondlowestmedianhouseholdincomeat $55,000.

ThisplanningareaisasmallportionoftheNorthYorkpartofToronto.Theeasternborderof thisplanningareaisVictoriaParkandthewesternborderisLeslieStreetandtheDonRiver. ThisareaisborderedbySteelesAveintheNorthandEglintonAveintheSouth.Thefollowing mapillustratesthelocationofhealthcareserviceprovidersintheNorthYorkEastplanning

CentralLHINHealthServiceNeedsAssessment&GapAnalysis 85 © 2008 KPMG All rights reserved area.Thisisanareathathasarelativelyhighconcentrationofhealthcareserviceproviders, whichcanbenotedinthemapbelow.Itwasnotedintheplanningareadiscussionsthatthere arebarrierstoaccessingtheseservices,suchaslanguageandculture.

Exhibit 67: North York East Planning Area Health Care Service Provider Distribution (Various sources including Ontario MOHLTC, Central LHIN, Infonaut

Various sources including Ontario MOHLTC, Central LHIN, Infonaut

NorthYorkEastplanningareahasfeweractivefamilyphysiciansper100,000thantheCentral LHINandlessthanhalfthenumberoftheborderingplanningareaofNorthYorkCentral.They currentlyhave63.1activefamilyphysicians,whichcorrelatestoonepractitionerto1,585 patients.AcomparisonoftheplanningareascanbefoundintheAppendix.Themapbelow showstheofficelocationsofactivefamilyphysiciansinthisplanningarea.

Source: Scott’s Medical Dictionary – Ontario Physician and Specialists 2008, Environics Analytics Demographics Estimates and Projections 2008, Infonaut

Acrosseachoftheplanningareas,projectedpopulationgrowthwilldifferoverthenextten yearswithaslightnegativegrowthtooccurintheNorthYorkEastregionforallages. Howeverthepopulationovertheageof65inthisplanningareaisexpectedtogrowslightly lessthan20%inthenexttenyears.TheresidentsinNorthYorkEastcurrentlyreceivethe leastamountofCCACin-homeservicesperpopulationovertheageof65whencomparedto otherplanningareas.Itwasnotedintheplanningareasessionsthatthiscouldpotentiallybe explainedbythehighnumberofimmigrantsintheplanningarea,closeto63%,whichmaynot beawareoftheservicesavailable.

Thisplanningareahascloseto8%ofthepopulationovertheageof85fromtheCentralLHIN butonlyhas2.5%oftheLTCbeds.Thisplanningareadoeshoweverhavethesecondlargest percentageofshort-staybedsat20.5%.Thisareaalsoonlyhas0.5%oftheclientsonthe waitlistforLTCfacilities.Theplanningareadiscussiongroupshighlightedthattheethnicmake- upofthepopulationandthenumberofimmigrantsintheareaarenotlikelytousethesetypes offacilities.

Thisplanningareautilizes1,270ambulatoryservicesper1,000forthepopulationovertheage of65.Thisisexpectedtogrowby14.6%inlinewiththeexpectedpopulationgrowthforthis agecategory.

NorthYorkEasthas60.8activegeneralpractitionersper100,000residents.Itislowerthanthe CentralLHINratioof71.7andtheOntarioratioof75.2.Thisplanningareapopulationaccounts

CentralLHINHealthServiceNeedsAssessment&GapAnalysis 87 © 2008 KPMG All rights reserved forslightlylessthan7%ofthevolumeofEDvisitsbyCentralLHINresidents.Giventhe slightlynegativedeclineinthepopulationexpectedoverthenexttenyears,theEDvolumesfor thispopulationalsofollowsthisprojectedtrend.Thereisnohospitalinthisplanningarea,butit isgeographicallyclosetoNorthYorkGeneralHospitalintheCentralLHINandSunnybrook HealthSciencesintheTorontoCentralLHIN.

Therearecurrently1,132casesofdiabetesinNorthYorkEast,whichwillincreaseto2,213by 2018(96%increase).ThisplanningareawillexperiencethehighestgrowthratefortheLHIN inthenexttenyears.Whilethenumbersmaybesmallithasthesecondhighestprevalence rateformenbyplanningarea.Itwasdiscussedintheplanningareasessionthatthisnumber appearstobeanunderestimateandmaybeduetothenumberofrecentimmigrantsinthe areaandlanguagebarrierstoansweringthesurvey.Thechartbelowshowstheprevalence ratesbygenderandplanningareasforcomparativepurposes.

Exhibit 69: Prevalence rates for Diabetes per 100 Ontarians by sex and planning area in Central LHIN (2005)

Prevalence rates for Diabetes per 100 Ontarians by sex and planning area in Central LHIN (2004/05)

14 12 10

4 2

Prevalencerateper100Ontarians 0 Ontario Central South Central South East South West North York North York North York LHIN Simcoe and York York York West Central East Northern Region Region Region York Region

M en Women

Source: ICES 2004/05

AswasdiscussedintheNorthYorkWestplanningareasectionofthisreport,thisisanarea withrelativelyhighpoverty.TheriskfactorsinthisplanningareaaresimilartoNorthYorkWest planningarea.Thereisasignificantcorrelationbetweenoverallmortalityratesandsocio- economicdisparitiesindiabetesmortality.

Theprevalencerateforosteoarthritisisthesecondlowestbyplanningarea.Theprevalence rateofhypertensionisthelowestincomparison.Giventherelativeageofthisplanningarea andstressorsassociatedwithbeingrecentimmigrants,participantsattheplanningarea sessionsfeltthenumberwaspotentiallyunderestimatedforsimilarreasonstothediabetes discussedabove.

CentralLHINHealthServiceNeedsAssessment&GapAnalysis 88 © 2008 KPMG All rights reserved Itwasdiscussedattheplanningareasessionsthattherearelimitedmentalhealthservices availableforresidentsinthisplanningarea.Thisplanningareahas5.4ActivePsychiatristsfor 100,000populationwhichisapproximatelyonePsychiatristfor18,500people.TheCentral LHINhas8.1andOntariohas12.8activepsychiatristsper100,000.Itwasnotedthatthereare fewservicesavailableinthelanguageandculturerequiredfortheplanningarea.Theethnic compositionoftheareaisfromculturesthatdonotseektreatmentformentalhealthissues duetothestigmaassociatedwithit.Thestigmaplacedonthoserequiringtreatmentfor mentalhealthissuesincertainculturesismorethanwhatisportrayedinsomeWestern cultures.

Itwasnotedintheplanningareasessionsthatthereislittleifanysupportivehousingavailable inthearea.Thoseinvolvedwithprovidingservicesinthecommunityindicatedthatpeopledid notwishtohavesupportivehousingintheareaasthecommunityrecreationandvocational programsinthisplanningareaareverylimitedornon-existent.Theserviceprovidersfelt stronglythatthistypeofserviceneedstobeprovidedinstrongpartnershipwithother communityandsocialservices.

Issues and Challenges ManyissuesandchallengesdiscussedintheNorthYorkWestandNorthYorkCentralplanning areasaresimilarforthisplanningarea.Withtheexceptionofthepercentageofthoseoverthe ageof20withmorethanahighschooleducation,thisplanningareaisquitesimilartoNorth YorkWestwithregardstothepovertychallengesitfaces.Recentimmigrantslikelyhavepost- secondaryeducationbutlackCanadianexperienceandcredentialssoarepreventedfrom workingintheirfieldofstudyandtakelower-payingpositionswithlimitedbenefits.Recent immigrantsmakeupmorethan60%ofthepopulation.Thelanguageandculturalbarriersand thestressorsassociatedwithimmigrationaresimilartotheotherplanningareas.

Service Needs and Gaps ManyserviceneedsandgapsidentifiedinNorthYorkWestandNorthYorkCentralcanbe appliedtothisplanningareaduetotheirsimilarities.Thefollowingserviceneedsandgaps wereidentifiedthroughtheanalysis.Resultsfromstakeholderinterviewsandfocusgroups havebeenincluded.

Access for new immigrants –needforimprovedservicesandaccessforthispopulation.For recentimmigrantsthestressorsofstartingoutinanewcountrycanbeoverwhelmingand maintaininghealthmaynotbeapriority.Manyareunawareoftheservicesthatareavailable andhowtoaccesssuchservices.Languageandculturalbarriersalsoexist.Findingaprovider whocanunderstandthemandwhotheycanunderstandcanbedifficultandifitdoesnotoccur hasthepotentialtoresultinmisdiagnosisandnon-compliancewithtreatment.Whileitmaynot benecessaryfororganizationstomaintaintheresourcestoprovideprogramsinalllanguages andculturesthatarerequired,itisnecessaryfortheorganizationstobuildstrongpartnerships withorganizationsthathavethespecializedskillsinthoseareas. Community Supports –needforenhancedcommunitysupportsintheplanningarea.Itwas notedintheplanningsessionthatthereislittle-to-nosupportivehousingintheareahowever individualsdonotwantsupportivehousingintheareaastherearenocommunitysocial supports,suchasrecreationorvocationalprogramsintheplanningarea.Thereisaneedto

CentralLHINHealthServiceNeedsAssessment&GapAnalysis 89 © 2008 KPMG All rights reserved partnerwithproviderswhoprovideservicesinthenorthernpartofTorontotoofferprograms andservicestothisparticularplanningarea.

Summary of Planning Areas

ThestoryoftheLHINisthatitishealthy,wealthyandwell-educatedwhencomparedtothe provinceasawhole.Asjustdescribed,thisisnotthestoryacrosseachoftheplanningareas. Infact,thereiswidevariationinhealthstatus,educationlevelsandincomes;fromalowof $44,000medianhouseholdincomeinNorthYorkWesttoahighof$97,000inSouthWestYork Region.Thesevariationsimpacttheneedforhealthservicesineachareainadifferentway. Theirgrowthwillalsonotbeuniforminthenexttenyearsandtheirindividualcharacteristics willalsoimpacttheirneedforhealthservicesdifferently.

AcrossthesouthoftheLHINinNorthYork,theseareasaredefinedbythedeterminantsof healthsuchaslow-incomeandlowerlevelsofeducation.Thesedeterminantsimpactthe population’shealthstatusandmustbeaddressedifrealgainsinhealthstatusaretobemade. Primarycarewasaconsistentthemeinmanyoftheplanningareas.Limitedaccesstoprimary careisalsoakeydriverinthepopulation’sabilitytoaccessselfmanagementprogramsfor chronicdiseasepreventionandmanagement.Inareaswhereprimarycarewaslimited,these areasalsowerelikelydefinedbyhighratesofchronicdisease.Asthesepopulationsgrowand chronicdiseasesbecomemoreprevalent,itwillbenecessaryfortheLHINtodevelopother modelsofcareforthechronicdiseasesastherecruitmentofphysiciansbecomesincreasingly difficult.

Aconsistentthemeinmanyoftheplanningareaswaslimitedaccessforethno-culturalgroups. Thesegroupshaddifficultyaccessingandnavigatingthehealthsystemacrossthecontinuum. ServicedeliveryplanningintheLHINshouldconsidermultiplemethodsofengagingethno- culturalcommunitiesthroughdirectserviceprovisioninmultiplecultural-linguisticapplications tothedevelopmentofnetworksthatservevariousethnicpopulations.

ThegapinMentalHealthandAddictionsserviceswasaconsistentthemeinmanyofthe planningareas.TheneedintheLHINisprimarilydrivenbytheneedforcommunitymental healthandaddictionsservicesandsupportwithinhousingandhomesforspecialcare.The highrateofgrowthacrosstheplanningareashasmadeitdifficultforserviceproviderstokeep pacewiththatgrowth.Waittimesforethniccommunitiesareespeciallylongforsomeone wantingtoseeaproviderintheirownlanguage.Thesechallengeswillincreaseasthe populationgrows.

Finally,oneofthemostresilientthemesacrosstheplanningareaswasthecontinued functioningofprovidersworkinginsiloswithlittlecoordinationorfamiliaritywithothers’ services.Focusgroupparticipantsspokeoftheneedforservicedeliveryintegrationand coordinationandtheneedtostreamlineserviceespeciallyintheeyesoftheclient.Thereisa needtocoordinateservicedeliveryonalocallevel,especiallyforchronicandlonger-term conditionsandforthoselocalnetworkstobelinkedintoabroaderregionalprogramtoensure consistencyandreduceduplicationofeffortacrosstheLHINindevelopingstandards,protocols andprogrammanagement.

CentralLHINHealthServiceNeedsAssessment&GapAnalysis 90 © 2008 KPMG All rights reserved Planning Area Consolidation Theanalysesofthesevenplanningareashavedemonstratedthatthereissignificantvaluein examiningpopulationneedsatasub-LHINlevel.Theanalyseshavealsosuggestedthatthere maybebetterwaystodrawtheboundariesoftheseplanningareas.Oneconsiderationforthe LHINistoconsolidatethecurrentplanningareasintoasmallernumberbasedonsimilar populationcharacteristics,municipalrelationshipsandhospitallinkages.Thisconsolidation couldhavethebenefitofcreatingplanningareasthataremorenaturalserviceareas.Itwould alsoreducethenumberofplanningareasandcreatemoremanageablelocalservice coordinationnetworksasdescribedlaterinthisreport.

Possibleconfigurationsfortheplanningareasareasfollows:

Combine South Simcoe and Northern York with Central York –thiswouldcreatea planningareawithapopulationofslightlymorethan315,000.Thepopulationsinthisplanning areaarerelativelysimilarinthattheyareprimarilyCaucasianandhavefewvisibleminorities. TheruralareasoftheLHINwouldbeincludedinthisplanningarea,aswouldthesmallercities andtowns.Inaddition,thetwohospitals(StevensonMemorialandSouthlake)workclosely togetherandaredevelopingprocessesandprotocolstoprovideStevensonMemorialpatients withalevelofcarethatcannotbeprovidedatStevenson.Southlakeisprovidingthe managementatStevensonandthereareseveralcloseworkingrelationships. Combine North York West, North York Central and North York East planning areas – This willmakearatherlargeplanningareawithapopulationofcloseto640,000.Howeverthe planningareaswouldcombinethepartsoftheLHINthatfallwithintheCityofTorontoborders makingitmoreinlinewithsomeoftheotherprovidersandpartnerssuchaspublichealthand education.Whilethereareslightdifferenceswithineachoftheplanningareapopulations,they facesimilarchallengeswithregardstothenumberofvisibleminorities,newimmigrantsand povertythatisnotseenintheotherplanningareas. The boundaries between South West York and South East York –shouldbereviewedto seewhetheraligningRichmondHillwithSouthEastYorkremainsthebestfit.Thepopulation ofSouthEastYorkandSouthWestYorkisverysimilarwiththeexceptionofthepercentageof visibleminorities.Currentlythedatahasnotbeenanalysedatamunicipalleveltoseewhether thepopulationofRichmondHillwouldbemorealignedwithSouthWestYork,anecdotallythe projectteamwastoldthatthepopulationandprovidersinRichmondHillhaveacloserworking relationshiptothoseinSouthWestYorkthantothoseinSouthEastYork. Withineachoftheseplanningareastherewouldstillneedtobeflexibilitytocreatesmaller community-specificgroups,suchasAlliston,GeorginaIsland,theJane/Finchneighbourhood, onanas-neededbasistoincorporatecommunityspecificrequirements.

Theseconfigurationsareonlyintendedasstartingpointsforfuturediscussionsandwillrequire furtheranalysesandconsultationsbytheLHIN.