Community Support Services Review Priority Project - Central East ...

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Community Support Services Review Priority Project - Central East ...

Community Support Services

Review Priority Project

March 2009


Table of Contents

Executive Summary 3

Summary of the Recommendations 5

Background 7

Project Charter 7

Purpose of The Project 8

Scope 8

Acknowledgements 9

Challenges for the Project 9

Information Gathering Process 11

Project Results 12

Goal 1: Inventory of CSS Services 12

Goal 2: An Evidence Based Model 13

Goal 3: Redefine the Scope of CSS 15

Goal 4: Barriers and Opportunities to Investing in CSS 16

Goal 5: Integration Options 22

Goal 6: Human Resources 25

Implementation Plan 28

Appendices 30

Appendix 1 31

Appendix 2 42

Appendix 3 43

Appendix 4 46

Appendix 5 50

Appendix 6 51

Appendix 7 77


Executive Summary

Community Support Services (CSS) are an important but undervalued element in providing creative

solutions to current and future health services issues, including Alternate Level of Care (ALC) pressures,

Emergency Department pressures and lengthy waiting lists for long term care home beds. A renewed

investment and commitment to Community Support Services will assist in maintaining the health and wellbeing

of individuals and their care givers in their own home and community. These services prevent

unnecessary hospitalizations and facilitate earlier discharges from acute care settings. A well-funded

CSS sector can provide wrap-around services as a ‘safety net’ for the elderly and their families and

diminish inappropriate use of emergency departments.

Enhancing the existing community support services for people with continuing care needs will promote

independence and encourage self care. Evidence shows that health care services such as

transportation, respite, and home maintenance, personal care and meal programs can reduce the

demand for long-term care home and hospital beds. Many individuals may only need assistance with

Instrumental Activities of Daily Living (IADL) to remain in their own home. This is a relatively low cost

alternative that will enable people to age in place. Given the rapidly ageing population in Central East it is

critical that we take immediate action to strengthen and improve community support services.

The review has identified the following options as important steps that will help to strengthen the capacity

of the CSS sector:





Developing a common assessment tool;

Creating Back Office Integration model(s) that allows organizations to opt-in;

Identifying new performance measures that reflect the contribution of volunteers in delivering

services; and

Reducing the amount of fundraising required to support CSS programs.

The opportunity to move to common processes and standardized tools will assist in improving the linkage

to other health providers and to broader human services. The application of a common assessment is

seen as an important initial step in improving access, reducing the fragmentation and overall

strengthening the role of the sector. It will also enable the sector and government to accurately plan for

the changes required to meet the demand for expanded services in the future while a common

assessment tool can be achieved with relatively low cost, it will require an investment of new resources in

this sector both for systems and training.

Back Office Integration (BOI) has the potential to increase the availability of expertise in information,

financial and human resource management equitably across many organizations. This strategy is

considered a key building block for the future. The Ministry of Health and Long Term Care (MOHLTC)

has not adequately funded the infrastructure required for administration in CSS. With increasing reporting

and accountability requirements, pursuing Back Office Integration is an option that will allow the sector to

augment administrative capacity and expertise, while ensuring that service delivery remains connected to

the local community. This strategy will support the efficient use of scarce human, technological and

financial resources.

Similar to developing a common assessment tool, creating the option for BOI will require additional

funding. The current funding allocated for administration is not sufficient to fully fund a new BOI model.

This investment will support improved service and financial data quality and has the capacity to create

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performance measures that accurately reflect the real impact of these services. Furthermore, it will assist

the sector to demonstrate the quality of service delivery and participate in accreditation.

The value and contribution of volunteers is not adequately reflected in the current performance measures

applied to CSS. Volunteers play a critical role in delivering many CSS programs such as transportation,

meal delivery, visiting social and safety and social dining. If volunteers were not available the cost of

these programs would increase significantly. The CSS sector depends on volunteers and is one of the

links that maintains the connection to the community.

The majority of CSS programs are funded through a combination of MOHLTC funding, client fees and

fundraising. The amount of fundraising required each year is a key issue affecting the future of these

services. Reducing the dependency on fundraising is critical to this sector.

In summary Community Support Services afford the CE LHIN an efficient and effective way of supporting

individuals to remain healthy and active members of their community. Strengthening and investing in

these services and their infrastructure, represents a viable alternative to enabling people to age in place.

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Summary of the Recommendations

Recommendations for MOHLTC and CE LHIN

1. That CE LHIN requests that MOHLTC provide the financial/service data for Homemakers and

Nurses Services Act (HNSA) in our area which may assist in creating new partnerships with the

municipal sector.

2. That CE LHIN, the MOHLTC and local Municipal Governments presently using HNSA explore the

feasibility of creating a partnership with the CSS sector in providing support for low income

seniors through HNSA funding.

3. That MOHLTC and the LHINs develop a protocol to share service data for organizations that

provide services in communities outside of their local LHIN

4. That the MOHLTC consider including the following ;




Transitional Care

Wellness and Health Promotion

Elder Abuse

5. That the CE LHIN confirms with MOHLTC that Homemaking as described in the Ontario

Healthcare Reporting System (OHRS) extends to all communities and is not limited to First

Nations only.

6. That the MOHLTC consults with the Ontario Association for Community Support Services to

develop a Human Resource strategy for the sector that ensures fair compensation for employees.

7. That MOHLTC provides access to Personal Support Worker (PSW) Training funds to all CSS

providers.

8. That the CE LHIN works with MOHLTC to include the direct service provided by volunteers as a

unit producing measurement in MIS.

9. That the CE LHIN works with the MOHLTC to extend the information required in the Community

Annual Planning Submissions data on both the number of FTE’s and the number of volunteers in

each service code.

Recommendations for CE LHIN

1. That the CE LHIN review with the affected organizations the feasibility of creating a single or

coordinated delivery system in those municipalities where there are multiple service providers for

the same CSS service Code.

2. That the CE LHIN updates the Service Inventory annually through the Community Annual

Planning Submissions.

3. That the CE LHIN support and fund the implementation of a common assessment tool that has

the capacity to share information between the Central East Community Care Access Centre (CE

CCAC) and CSS sectors.

4. That the CE LHIN support and fund the creation of an ehealth strategy that supports coordinated

entry points to CSS programs.

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5. That the CE LHIN support the expansion of Crisis Intervention Support Services as a priority

program for new funding available through the Aging at Home (AAH) strategy.

6. That the CE LHIN supports including the Community Support Initiative-Support Service Training

as a priority for new funding available through the Aging at Home (AAH) strategy.

7. That the CE LHIN provide funding for a Human Resource Planning session for all CSS providers

that would assist organizations in developing a strategic human resource plan.

8. Recommend that we create an option for Back Office Integration (BOI) for the following

administrative functions:




Financial Services

IT Support Services

Human Resources

9. That the CE LHIN reviews the feasibility of establishing a common admission process for all Adult

Day Programs that is coordinated through the CE CCAC.

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Background

Ontario’s health care system is facing enormous challenges. The ageing Baby Boomer population will

introduce new demands on the health care system. Many communities in the province have serious

shortage of family physicians and other human resources needed to provide health care. Some

communities have long waiting lists for services and shortages of both acute care and long term care

home beds. The global recession may restrict the government’s ability to continue to increase public

funding for healthcare. Some would suggest that the current system is not sustainable.

There is abundant evidence that one of the keys to creating a sustainable healthcare system is an

investment in Community Support Services (CSS). The health system has to create new ways to support

individuals and their caregivers to age in place. Research has shown that community services play an

important role in maintaining the health and well-being of older adults and people with a disability. CSS

represents a broad spectrum of services such as Meal Delivery, Transportation, Adult Day Programs,

Crisis Intervention and Support, Respite, Homemaking and Home Maintenance and other programs that

assist individuals and caregivers. They also provide specialized services that support individuals with

hearing or vision loss as well as those with Acquired Brain Injury.

Community Support Services represents approximately 2% of the funding allocated by the Central East

LHIN. Although this is a very small amount of money these services play a critical role in enabling people

to remain in their own home. Given Ontario’s rapidly aging population, additional resources must be

invested in this sector to ensure that health care is affordable and accessible in the future. Without this

investment, wait times in Emergency Departments will increase, more acute care beds will be required to

support people in Alternate Level of Care and there will be longer waiting lists for long term care home

beds.

The Central East LHIN geography stretches from edge of Toronto north to Algonquin Park and east to the

town of Trenton. The area includes heavily populated and culturally diverse communities in Scarborough

and the Region of Durham, as well as sparsely populated rural areas of Haliburton County and the City of

Kawartha Lakes. The CE LHIN area has the second highest percent of those over 65 in the province.

The 85+ age group is projected to grow by 91% from 18,000 to over 35,000 by 2016. The mapping of

CSS suggests that most services/programs are available in many communities throughout Central East

area; however, these programs are at capacity and are unable to add new clients without additional

funding.

The CE LHIN undertook a review of the Community Support Services so that it could continue to respond

and manage the changing demand for health services. The project was designed to explore the

opportunities for integration that would enable services to be delivered in a seamless manner and identify

where new investments are required.

Project Charter

The Goals of the project included the following:

1. Create an inventory of the existing system of CSS in Central East;

2. Develop an evidence based model for identifying the current need for the current scope

of CSS programs;

3. Apply the evidence-based model identified in goal #2 to generate an assessment of the

current needs compared to the current capacity and identify the gaps;

4. Apply the evidence based model in goal #2 to generate an assessment of the future need

to 2016;

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5. Redefine the scope of CSS taking into account new types of services and delivery

models including current unfunded services, innovative practices and based on the new

definition modify the model in goal #2;

6. Identify the barriers and opportunities to investing new resources in the CSS sector;

7. Identify the human resources required to sustain and grow the CSS sector; and

8. Identify existing exemplars of integration and potential for new and innovative integration

strategies within the CSS sector and between the CSS sector and other health and

human services.

Purpose of The Project

The purpose of the review was to:





Identify the pressures and opportunities to the Community Support Services sector

remaining a sustainable and accessible component of the health care system across the

Central East area;

Assess the current infrastructure within the CSS sector in respect to its ability to support

and maintain individuals in their community;

Identify the appropriate human resources both paid and volunteer required to sustain

and grow the sector in the future; and

Consider strategies for enhancing integration both within the sector and with the broader

systems of health and social services.

A primary tool to assist in the work was the development and utilization of an evidence based model for

allocating resources. It was perceived that this would serve to enhance system capacity within the sector

by recommending where to invest by geography and service type. Also, it was thought that such a model

could help clarify the need to expand the scope of CSS service definitions to improve access to services

and achieve a more seamless health care system.

Scope

Community Support Services that were not part of this review include:




Palliative Care Services, including Pain and Symptom Management and Hospice

Services which are included within the role of the newly formed CE Hospice Palliative

Care Network

First Nations CSS which will be included as part of the Aboriginal and First Nations

planning; and

Psychogeriatic Consulting Program (PRC) which will be considered through work on

specialized geriatric services and mental health.

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Acknowledgements

This report is the result of many hours of collaborative effort. The Project Team would like to

acknowledge and thank the organizations that contributed their time and shared their knowledge by

completing the Integration Survey, the Human Resource survey and/or attended the Community

Consultation held January 27, 2009. The Team depended on your advice and insight in developing the

recommendations that are part of this review.

The Community Support Services Review Project Team:

Valmay Barkey, Chair

Brent Farr

Candace Chartier

Kwong Y Liu

Trish Baird

Antoinette Larizza

Leighanne Quibell

David Ross

Doreen Anderson-Roy

Danielle Belair

Don Lethbridge

Donna MacDonald

Odette Maharaj

Margot Fitzpatrick

Joan Skelton

Community Care City of Kawartha Lakes

Community Care Durham Region

Omni LTC Homes

Yee Hong Centre for Geriatric Care, Scarborough

Community Care Northumberland

Central East Community Care Access Centre

Program Support

Program Coordinator

Victorian Order of Nurses, Peterborough, Victoria and Haliburton

Community Care Peterborough

Consumer/Caregiver Peterborough

Community Care Haliburton

Scarborough Support Services

Ross Memorial Hospital City of Kawartha Lakes

Durham Alzheimer Society of Durham Region (resigned Sept/08)

Challenges for the Project

The following challenges were faced by the project team in completing this review. Many of these

challenges are not unique to CSS. Health care and the broader human services sectors have historical

difficulty in generating quality data that clearly measures performance (Appendix 1).

Financial and Service Data Collection for CSS

The current method for capturing financial and service data does not adequately convey either the

capacity or demand for service. The sector is presently in transition to a new Management Information

Systems (MIS) for accounting and reporting financial and service data. This system will improve the data

available for this sector.

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Service Data for the Central East Community Care Access Centre (CECCAC)

The project acknowledges the effort and support of the CE CCAC in attempting to retrieve this data from

their information system, unfortunately the data was not available in the categories that were requested.

For example, the CE CCAC does not code ‘respite’ under a unique category and therefore is not able to

isolate respite services that are funded as PSW hours. The CSS review was therefore unable to complete

the global analysis for the service utilization in each municipal zone, nor identify (through the use of data)

the potential for additional partnerships between the CE CCAC and CSS.

Cross-LHIN Data Collection

There are examples where the CSS programs available in the CE LHIN area are funded through an

adjacent Local Health Integration Network. This is most evident in Northumberland County and

Scarborough. In these cases the financial and service data is not included in the CE LHIN data base.

RECOMMENDATION

That MOHLTC and the LHINs develop a protocol to share service data for organizations that

provide services in communities outside of their local LHIN.

Homemaking and Nursing Services Act (HNSA) Funding

Homemaking and Nurses Services Act (HNSA) funding is available to both municipal governments and

First Nations communities. The responsibility for this funding was not transferred to the CE LHIN and

remains with MOHLTC.

The project was not successful in identifying the level of HNSA funding allocated to municipalities in

Central East. There is the potential for a new partnership between the CSS sector and municipal

governments. In the past, there have been negotiations to transfer these funds from the municipal

government to an approved Community Support Service agency for the provision of HNSA service for low

income individuals.

RECOMMENDATIONS

That CE LHIN request that MOHLTC provide the financial/service data for HNSA in our area which

may assist in creating new partnerships for service delivery with the municipal sector.

That CE LHIN, MOHLTC & Municipal Governments explore the feasibility of creating a partnership

with the CSS sector in providing support for low income seniors through HNSA funding.

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Information Gathering Process

Financial and Service Data

The 2007/08 CSS year-end reports were used to create the inventory for Community Support Services in

Central East (see Appendix 1 Service Provider Inventory). In situations where the reports were not

available, the coordinator contacted the service provider directly to confirm the CSS programs that they

provided. The 2007/08 financial and service data is subject to interpretation for the following reasons:





2007/08 was a transition year with the sector using both the service definitions from

either Program, Funding and Accountability Manual (PFAM) or Ontario Health Reporting

Standards (OHRS);

The financial and service data was not available for some organizations;

Data was not available for services delivered in CE LHIN but funded through an adjacent

LHIN; and

The current data requirements do not include information on clients waiting for service.

Appendix 2 shows the amount of funding and the number of individuals served for each CSS program in

2007/08. However, the current financial and service data does not indicate the number of unique

individuals being served by this sector or the number of individuals currently waiting for service.

It is important to understand the relationship between the investment in CSS and the expenditures in

other healthcare sectors. This relationship is particularly important for both the CE CCAC and LTC Home

sectors. The CE LHIN provided the allocations for all sectors as of August 1, 2008. This data shows that

we invest ten times more resources to provide LTC Home placements than we invest in community

services. As the population ages are these levels of investment sustainable? Should we build more LTC

Home beds or are there other options?

Integration and Human Resource Surveys

The Project Team conducted two surveys as part of the review process. The Integration Survey received

a 60% response rate while the Human Resource Survey received a 30% response rate.

The Integration Survey (Appendix 3) was intended to provide the following:





Assess the amount of integration currently occurring in administration.

Assess the present level of integration in service delivery.

Identify the opportunities for integration in CSS.

Identify the priorities for integration in CSS.

The Human Resource Survey (Appendix 4) was intended to do the following:






Create a workplace profile

Create an employee profile

Create a volunteer profile

Assess the % of fundraising required to cover salaries/benefits

Better understand the key HR issues facing the sector

Community Consultation January 27, 2009

In conjunction with the Supportive Housing Project Team the Community Services Review Team held a

community forum in late January 2009. The purpose of the day was to share the preliminary findings of

both reports and receive community input. The consultation strongly confirmed the need for a common

assessment tool for the CSS sector, preferably linked to other components of the health care system; the

desire to create shared policies and procedures for the sector and a level of support to consider Back

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Office Integration although many organizations believed that pursuing this option would not result in any

cost savings.

Literature Review

In developing this report the coordinator considered the following studies and/or projects:








Sustainability and Vision a Discussion Paper, Toronto Community Support Services

Seniors Managing Independent Living Easily, sponsored by VON Canada, SE LHIN

Alternate Level of Care Systems Issues and Recommendations, ALC Task Group, CE LHIN

Sharing Back Office Service – A Model of Collaborative Working

On Becoming New Best Friends, David Reville & Associates

Aging at Home: Opportunities, Innovations and Best Practices, NE LHIN, Deanne Consulting

Targeted Interventions: A Resource Allocation Framework for CSS in Toronto, Toronto District

Health Council 2003/04.

Project Results

The following highlights the results achieved under each goal of the Project Charter.

Goal 1: Inventory of CSS Services

The mapping of Community Support Services (Appendix 5) suggests that Central East has the capacity to

provide the basket of CSS programs throughout the area. Although CSS services are available in most

communities, these programs are not adequately funded to meet the current demand. The inventory is

helpful in identifying the opportunity to expand and provide enriched programs in Central East.

As of April 2009, the Planning, Funding and Accountability Manual (PFAM) is no longer used to define

Community Support Services (CSS). This manual has been replaced by the Ontario Health Reporting

Standards (Appendix 6). The CSS Project Team has applied the definitions in OHRS for the purposes of

this review.

The financial and service data used reflects the fiscal year 2007/08 which was a transition year from

PFAM to OHRS. Some CSS providers reported their data using the old system while others had already

phased in the new MIS reporting requirements. As well, for a small number of organizations data was not

available in either system. As a result, the approved annual service targets compared to the actual units

of service provided and the actual cost of administration is subject to interpretation. Going forward, it is

recommended that the 2009/10 Community Annual Planning Submissions (CAPS) be used to establish

the baseline for approved units of service for CSS.

Multiple Service Providers per Service Code/Municipality

The inventory identifies the potential to improve the efficiency of services and help create a more

seamless access to care for clients by moving to either a single provider or coordinated service providers

for each municipal or planning zone. The CSS Project Team reviewed situations where there are multiple

organizations providing the same Community Support Services in a single municipality (Appendix 1).

The CE LHIN presently funds approximately 50 organizations to provide Community Support Services.

This doesn’t include organizations providing services in the Central East region but whose head office

and funding is allocated through another Local Health Integration Network. Although there is little

duplication of services in the area there are examples where there are overlapping programs in some

municipalities and LHIN planning zones. As well, the Scarborough zone presents unique challenges and

opportunities for integration with six key agencies who offer essentially the same of basket of services to

their respective communities. It should be noted that while it may look that Scarborough contains six

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agencies providing the same basket of services in a small geographical area it is an area of high

population density and cultural diversity.

Table 1: CE LHIN Geographic Areas with Multiple Service Providers

Zone

Meal

Del.

Social

Din.

Trans.

Crisis

Inter.

Support

ADP

Home

Main.

Respite

Emer.

Res.

Support

Visiting

Foot

Care

Northumberland


Peterborough √ √

Haliburton

Kawartha Lakes


Scarborough √ √ √ √ √ √

Durham √ √ √ √

RECOMMENDATIONS

That the CE LHIN reviews with the affected organizations the feasibility of creating a single or

coordinated delivery system in those municipalities where there are multiple service providers for

the same CSS service code.

That the CE LHIN updates the Service Inventory annually through the Community Annual Planning

Submissions (CAPS).

Goal 2: An Evidence Based Model

The Central East Local Health Integration Network (CE LHIN) identified the need for a quantitative

methodology to assist them in allocation of Aging at Home (AAH) Strategy funds to address the service

gaps in supportive housing (SH) and community support services (CSS) within their jurisdiction. As a

result, a project was commissioned in early 2008 to develop a population-based allocation model

(PBAM).

Objective

The objective of the PBAM model was to quantify the SH and CSS service gaps within the LHIN area.

This information could then be used to support the allocation of AAH funds for target populations.

Scope

There are currently a variety of CSS and SH services offered throughout the CE LHIN. The cost of

services is highly variable, ranging from $6.3 million to less than $5000. Of these various service

categories, the CE LHIN identified a few priority areas for future investments. As a result, the model

focused on the following six services that accounted for approximately 65% of all the CE LHIN program

funding:

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1. Supportive Housing;

2. Adult Day Services - Integrated;

3. Adult Day Services for Cognitively Impaired;

4. Respite;

5. Meal Delivery; and

6. Transportation.

The Centre for Research and Health Care Engineering (CRHE) was retained to develop the population

based allocation model. 1

CRHE is an initiative of the Department of Mechanical and Industrial Engineering at the University of

Toronto, in response to the immediate and compelling desire for efficiency and quality improvements in

the Canadian health care system. CRHE research is focused on the application of Industrial/Systems

Engineering techniques in relation to demand and capacity modeling and resource allocation issues in the

health care industry. Its goals include creating quantitative decision support tools to help policy makers

and industry leaders make better informed decisions.

Several steps were employed in the evolution of the model focusing on the above six service categories

and using various data steps and discussions with providers client groupings were defined data was then

extrapolated to quantify the rate of the population that fit the client groupings in various-gender

categories.

Census data was then used to project the CE LHIN population in client groups. The current average level

of service was used to determine population-based demand. Population-based demand was compared

with current service utilization data to quantify service gaps for each of the priority services.

Given the limitations and assumptions in the current model, several areas were identified for future work

in the short term. One such area would be to deploy a provider survey to validate the client profile group.

This is because the accuracy of the demand projections relies heavily on the client profile group

definitions. A sample survey has been developed. The profiles from the survey could then be used with

the updated PALS 2006 data to improve the demand estimates.

Another key factor determining the quality of service gap estimates was the accuracy and granularity of

the current service capacity. The available data had quality and completeness issues and did not include

details about the provider catchment areas. The quality of supply data made it difficult to estimate service

gaps accurately. Analysis was further limited since it was not possible to visually represent the gaps in a

map without provider catchment areas and details on client location. It is recommended that the CE LHIN

conduct client level surveys to improve available data on client location. The CE LHIN should also work

with service providers to improve the quality of their reporting about current service capacity and use.

Once it becomes possible for both demand and supply data to be represented in a CE LHIN map, it would

be possible to consider factors that are currently not quantified in the model, such as rurality, availability

of health services (e.g. LTC waitlists) and other public services (e.g. transportation), chronic disease

prevalence, and income levels. In addition to facilitating appropriate investments in the right priority

services, this would enhance local planning with providers about the optimum location for such services.

In the longer term, further work is required to capture information and quantify client flow between and

within the different services, including services provided by other sectors of the healthcare system.

Together with eligibility assessments and population projections, client flow and referral data would

enable the use of system dynamics modeling techniques to develop a model that captures the behaviour

1 The complete report from CRHE titled “Population Based Allocation Model: Improving the Distribution of Aging at

Home Funds at the Central East LHIN, May 27, 2009 is available from the CE LHIN.

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of the health system as a whole. This model could then be used to reliably predict the result of alternate

investment strategies with the LHIN areas.

Goal 3: Redefine the Scope of CSS

The CSS Project Team was asked to redefine the scope of Community Support Services taking into

account new types of services and existing programs that are not funded. The following four programs

are recommended to be included as part of the basket of services for Community Support Services.

Transitional Care in the Community

Transitional care is an Alternate Level of Care (ALC) for patients who no longer require acute care

hospitalization. Transitional Care patients are provided with restorative care to promote independence

and maximize their potential to be cared for in retirement homes, long-term care homes, supportive

housing or in their own homes with Community Care Access Centre supports.

The average length of stay for patients is from eight to twelve weeks.

Wellness and Health Promotion

Among the determinants of health recognized by World Health Organization (WHO) are three important

determinants:




Social support network;

Life skills; and

Personal health practices and coping skills.

It is also recognized and evident through research that social isolation affects seniors’ health, both

mentally and physically.

The Chronic Disease Prevention Management paradigm also recognizes the importance of empowering

people to take charge of their own conditions. This empowerment includes helping individuals with

chronic diseases to change to a healthy life style and be competent to sustain this life style.

A Wellness Program in Community Support Services is a preventive program that aims to deal with the

above determinants of health to create a healthy community and in the long run, save the community

through a health care investment. The program includes:




Social and recreational activities to encourage a healthy and active life-style, to help clients

create a social network to combat social isolation.

Health education in raising health awareness and managing one’s health.

Programs to develop life skills and positive personal health practices and coping skills in order to

empower seniors to manage their chronic health conditions.

Elder Abuse Service

The goal of an Elder Abuse Service includes:



Developing a collaborative response to identifying and responding to Elder Abuse;

Formalizing and strengthening the capacity of a local network to respond; and

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Educating the public and enhancing capacity of individuals to identify and break out of the

abuse cycle.

The cost of providing this service has been born by agencies that often provide a form of a response as a

member of a local elder Abuse Network. Funding for regional human resource assistance has been

provided from the Province through the Seniors Secretariat.

Homemaking (non-brokerage)

This service refers to the activities that assist clients living at home with shopping, light housekeeping,

meal preparation, paying bills, etc. The MOHLTC will fund the administration, coordination, labour and

transportation costs of providing this service.

In the case of HNSA services, the municipality has the option of hiring employees directly or contacting

with a service provider. In HNSA this is a claims based program based on eligibility determined in part

through the application of a ‘needs test’.

This service code is included in the basket of services funded under the Ontario Health Reporting

Standards (OHRS) and was similarly in the previous PFAM, however, limited to First Nations

Communities only. The OHRS does not restrict this service to First Nations and appears to be now open

to the CSS sector.

It is important that Homemaking services be coordinated between CSS, CECCAC and HNSA to ensure

affordable and accessible services are equitably available throughout the CE LHIN area.

RECOMMENDATIONS

That the MOHLTC consider including the following programs as part of the basket of services

available through CSS.




Transitional Care

Wellness and Health Promotion

Elder Abuse

That the CE LHIN confirm with MOHLTC that Homemaking as described in the OHRS extends to all

communities and not limited to First Nations only.

Goal 4: Barriers and Opportunities to Investing in CSS

The Community Support Services Review Project Team was asked to identify barriers and opportunities

to investing in this sector. The Project Charter was developed prior to the recent shift in global economy.

These tougher economic times will increase the pressure on organizations that depend on a combination

of public funding, fundraising and charitable donations and client fees to cover the cost of their

operations. The tough times will also emphasize the problems associated with not investing in

administrative and marketing activities that are so essential to support the delivery of these services.

Quick Facts about CSS Sector in the CE LHIN:





Over 50 organizations providing CSS programs in CE LHIN

CSS receives approximately $30.0M in provincial funding

Represents less than 2% of the total health funding allocated under the LHIN

Volunteers play a critical role in the delivery of many programs and services

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CSS is dependent on client fees and local fund raising to deliver services (estimate that on

average $1.48 in value-added service for every $1.00 of government funding)

Based on 2007/08 data, CSS provided services to over 60,000 individuals in CE LHIN

OCSA reports that over 100,000 volunteers contribute $103 million in value to CSS across

Ontario

Barriers to Investing in CSS – The Reality

The True Cost of Fund Raising

Few of the services delivered by community support services organizations are 100% funded by the

Ministry. In many cases the government’s subsidy represents less than 60% of the actual cost,

necessitating the need for fundraising to staff and deliver the service and/or program. The Ministry further

determines that staff time spent to fundraise is not an eligible expense. This places significant pressure

on the organization to use volunteers or have staff volunteer to plan and deliver fundraising events.

The few exceptions to this are those programs delivered through the hospital sector for Psycho-Geriatric

Consulting or Palliative Care programs. The remaining programs require providers to raise funds in their

community to subsidize the service. The historical process used to allocate new funding often resulted in

the same service being funded at different levels depending on the organizations’ ability to raise

charitable donations. This pattern is not sustainable and is a hidden cost to the viability of Community

Support Services.

Human Resources/Investing in People

The present level of funding for CSS does not provide a competitive compensation package for staff. As

indicated by the Human Resource Survey, many agencies, in addition to government funding, charitable

donations and client fees (if applicable), have to use fundraised dollars to meet the cost of salaries and

benefits. It is not reasonable to expect staff to volunteer to do fundraising in order to cover the cost of

their salaries. The current agency budgets are stretched to the point where most organizations do not

have the capacity to fund the education/training required to develop the next generation of strategic

leaders required for this sector.

Using volunteers to assist in delivering services is a key feature of community support services. It

provides an opportunity for people to stay connected to their community and to develop an understanding

and compassion for others. As already noted, the Ministry’s present accounting process requires

organizations to show the cost of supporting and supervising volunteers as a cost of administration rather

than unit producing. The services provided by volunteers are not included as a direct service which

inflates the cost of administration provided by CSS.

It is also becoming more difficult to attract and retain volunteers. The perception is that the current

generation of retiree’s are less likely to volunteer than their parents. This presents new challenges for

services that depend on volunteers to deliver them, e.g. transportation. When volunteers are not

available, agencies have to rely on staff to deliver these services.

Understanding the Value of Community Support Services

Community Support Services are essential to ensuring that quality healthcare is accessible across the

Central East area. Both funders and policy makers need to understand the contribution and direct impact

that these services have in reducing the cost of health care. If the health system continues to focus on

the immediate pressures in acute care, we will continue to achieve the same results, with higher costs

and longer wait times. A renewed leadership and vision is required to break this cycle and increase the

funds allocated to support people in their own home and community.

17


Community Support Services are funded through the Long-Term Care Act. This legislation is flexible and

provides eligibility for a wide range of clients and is not limited by age or disability. This flexibility allows

the sector to support diverse needs in our community but also contributes to the confusion as to the target

group that the sector supports. The following are some examples of who may benefit from a Meal

Delivery Program and services provided by CSS agencies:








Seniors and adults with disabilities that require assistance with their main meal due to dietary

restraints.

High risk clients who are cognitively impaired and live on their own with minimal family

support.

Diabetic clients depending on service to assist with their main meal of the day.

Clients with special dietary needs due to chronic illness.

Clients with swallowing difficulties requiring purée or minced meals.

Adults with mental health problems who need assistance with special dietary meals, with

limited income and require fee subsidies.

Dementia clients who are unable to prepare their own meals and may also be living alone.

In these examples the function of providing the Meal is simply the means by which the volunteer or staff

has contact with the client. It also provides an opportunity to provide for a visit, a reassurance check and

assess if changes are happening in the client’s status. If other services are required, referrals can be

made immediately. The meal delivery program has the potential to initiate wrap-around services for the

client.

Common Entry Point

CSS does not have a defined access point for each municipality or planning zone where individuals,

caregivers and other health professionals can easily understand and access the services available in their

area. Similarly, a common policy and procedures tool to assess eligibility for services is not in use,

although the various organizations have developed these in response to their own capacity to serve and

the community’s service needs. Although this flexibility enables organizations to respond to unique

demands in their community, it also contributes to the sector appearing to be fragmented.

The Project Team believes that the CSS sector would benefit from a coordinated delivery system that

shares policy and procedures on eligibility, intake, client fees and best practice models. A coordinated

system would help to provide consistency across the sector and also help to provide equity in accessing

services consistent with the LHIN’s Integrated Health Service Plan (IHSP).

Performance Measures

The current service data does not adequately define either the capacity or the demand for community

support services. Many programs do not maintain a waiting list for transportation, meal delivery,

caregiver support or social and congregate dining services. If the demand exceeds the capacity, then

organizations will attempt to meet these needs by increasing the amount of charitable funding for that

year. Although this is positive for the client, increasing services in this manner is not sustainable. This

also contributes to variances in service volumes from one year to the next and makes it difficult to project

the actual capacity that is supported by Ministry funding. The reliability of the service data makes it

difficult for funders to accurately project the future cost of a unit of service and the level of Ministry funding

required as demand increases.

The performance measures provided for the sector do not show the number of unique individuals using

these programs. It is impossible to tell using the service data, if Community Support Services are

providing many services to a few individuals or a few services to many individuals. Application of the new

MIS reporting system should help to resolve some of the issues although there remain challenges with

18


some of the definitions still not accurately capturing service delivery or infrastructure unique to the CSS

sector (e.g. volunteer “staff”).

Given the pressure on staff, volunteers, board members and donors, there is a need to ensure absolute

clarity on the function CSS plays in supporting people to remain in their own homes. The sector has to

focus on and define outcomes achieved within a defined target population. This focus will allow others to

understand the benefits and contribution of their investment. However, it must be understood, that

measurement and evaluation of services will require requisite investment in human and technological

resources.

Funding Silos and Business Models

The present funding silos and the RFP Business Model used by the CE CCAC restricts the ability of both

sectors to develop wrap around services for clients. The CE CCAC primary relationship is with their

contracted providers. There appears to be difficulty in sharing client information with the CSS sector

which contributes to inefficiencies. Although both sectors strive to support individuals to remain in their

own home, the system lacks the formal means to develop joint care plans and easily transfer information

to support individuals and their caregivers.

Investment for Infrastructure

The Ministry has not invested in administrative and marketing activities that are essential to support the

delivery of programs in this sector. The under investment is particularly evident in funding allocated for

managing information. An investment in Information Technology (IT) is critical for the CSS sector to

develop integrated services with both the hospital and CE CCAC sectors.

Support for continuous quality improvement, innovation and standardized systems will create confidence

in the services provided through CSS and the significant role it plays in the health system. Marketing and

branding CSS will help to ensure that both the broader community and other health providers understand

the services that the sector provides and the knowledge required to access these supports.

Overarching Strategies to Overcome Barriers

The barriers identified to investing in the sector can be addressed. The following highlights the strategies

that can be phased in to remove the barriers to investing in CSS:

1. Create Common Assessment Tool





Provides the foundation to compare service data.

Provides a way for CSS to share information on the needs of clients.

Ensures standardization within CSS.

Builds on existing investments being made such as use of the interRAI CHA.

2. Create Coordinated Entry System






Develop a single point of access for each County or Region or multiple access portals

that lead to a common reception through an ehealth Strategy.

Provide simplified access for the public and other health professionals.

Ensure coordinated information exchange with CE CCAC.

Acknowledge and support current role with service coordination and system navigation.

Consider CSS as potential location for expanded Client Intervention and Support.

19


3. Investments for Infrastructure








Develop a model for Back Office functions.

Phase in model and support voluntary participation as per recommendations under

integration.

Facilitate the investment in IT, Financial Services and Human Resource management.

Advance capacity to achieve timely and consistent financial and service data for the

sector.

Facilitate global analysis of financial and service data required for strategic planning for

the sector.

Develop new performance measures that reflect the impact on health care.

See further details outlined in the Integration Section of this report.

4. Decrease Dependency on Fundraising




Through the CAPS submission for 2009/10 establish a standardized range for fundraising

for all CSS programs across the CE LHIN area. For example, e.g. Meal Delivery

programs will be funded at no less than 70% of the actual cost. The remaining 30% may

be generated from client fees.

In consultation with service providers, each service code is reviewed and a benchmark

for the level of minimal provincial funding is established.

Enhanced funding is phased in to the new level as new funds become available.

5. New Partnerships




There is an opportunity to connect with similar organizations and create synergies by

working together.

This may extend beyond back office integrations to creating a donor program, volunteer

recognition and recruitment strategies.

Create shared mission and vision statements that can lead to branding CSS sector both

in the community and other health providers.

Opportunities for Investing in Community Support Services

The Community Support Services sector provides opportunities for key strategic investments in health

care. Our aging population requires a comprehensive, accessible and integrated system of care that

provides the range of supports required to remain in their own home. The system must ensure that longterm

care and the home support programs provided by both the CE CCAC and CSS sectors are

integrated to ensure that clients have access to a seamless system of appropriate services.

The CSS sector should focus on their core competencies to strengthen their fundamental values of

enabling individuals to stay connected to their communities through circles of care that integrate both paid

staff, volunteers and family members.

Core Strengths of CSS:





Community based

Accountable to the client

Accountable to the local community

Volunteerism promotes connection to the community for both the agency and client

20


Flexibility in that most programs are not tied to capital or fixed assets

Low cost

Common Assessment and Coordinated Entry Points

The mitigating strategies provide immediate opportunities for investing in the sector. These strategies

enhance the core strengths and can help to ensure a smooth transition to other health and social

services. One of the keys is developing an e-health strategy including a common assessment tool that

supports the sharing of client information within the sector and with the CE CCAC. This may be extended

later to both the hospital and other parts of primary care. This should also enable the system to identify

at-risk seniors and create wrap-around supports that include both CSS and CE CCAC services prior to

the individual presenting as a crisis admission at the emergency department.

RECOMMENDATIONS

That the CE LHIN support and fund the implementation of a common assessment tool that has the

capacity at a minimum to share information between the CE CCAC and CSS sectors.

That the CE LHIN support and fund the creation of an eHealth strategy that supports a

coordinated entry point to CSS programs.

Capacity Building and Back Office Integration

The Ministry has not invested in administrative support for this sector. Implementing the new MIS

accounting system in CSS provides an opportunity to create shared Back Office Integration for this

sector. This will help to promote efficiency for administration and more robust financial and service data.

In the present environment, the fundamentals have to be right to thrive which includes being able to

report the true cost and benefits of delivering CSS programs. Back Office Integration is one of the

building blocks that will position the sector to identify and implement improved performance measures

that accurately reflect the impact of this sector in the health care system.

RECOMMENDATION

That the CE LHIN supports the development of Back Office Integration that provides CSS with

information technology management, human resource management and financial services

management. (For additional details see section on integration).

Crisis Intervention and Support

At the present time Crisis Intervention and Support is provided by four different CSS providers in

Scarborough. It is not available in other parts of the CE LHIN. Crisis Intervention and Support is

summarized by the Ontario Health Reporting Standards as follows: “the service provides crisis

intervention and support in critical situations until the situation is stabilized and a follow-up plan is in

place. A case coordinator is responsible for problem identification, direct service, service coordination

and discharge planning.” If this service were available throughout the CE LHIN area, it would be a key

system navigator for at risk seniors and support the development of a coordinated plan of care that

includes both CSS and CECCAC services.

RECOMMENDATION

That the CE LHIN support the expansion of Crisis Intervention Support Services as a priority

program for new funding available through the Aging at Home (AAH) strategy.

21


Education and Training

The Ministry has also underinvested in education and training for most parts of this sector. The budget

line for training is often the first one to be cut in tough economic times. Education and training will help to

create the new leadership required for the future. The Ministry does provide a code for sector wide

training (Refer to FC 72 5 84 10 Community Support Initiative Support Service Training). There is the

potential to create a Staff Education/Training Committee for CSS that would be responsible to develop a

system wide training plan funded through this code. This should be linked with the existing PSW Training

Funds that are currently available to CE CCAC contracted providers and organizations providing

Supportive Housing and Adult Day Programs.

RECOMMENDATION

That the CE LHIN supports including the Community Support Initiative-Support Service Training

as a priority for new funding available through the Aging at Home (AAH) strategy.

Goal 5: Integration Options

The project was asked to identify existing examples of integration within the CSS sector and between the

CSS sector and other health and human services. The deliverables included identifying existing and

potential new integration strategies and to create a priority setting process to highlight new high priority

strategies for integration for the CE LHIN to pursue.

It is important to note that integration is not a new concept in Community Support Services. Many

organizations have had a long history of working efficiently with other parts of the health and human

service system to improve services in their community.

The Project Team developed the following process to develop the recommendations for this goal:

1. Define Integration as per the LHSIA (Local Health System Integration Act)

2. Identify the Characteristics of an Integrated Model

3. Recommend the Principles to Guide Decisions on Integration Strategies

4. Create a survey to identify both exemplars of integration and the priorities for integration that

agencies are currently developing

5. Identify the Barriers/Risks of Integration

6. Identify the Priorities for Strategic Restructuring in CE LHIN

A

Definition of Integration as per LHSIA (Local Health System Integration Act)

The LHSIA provides a broad framework for integration activity that includes:






Coordination of services and interactions;

Partnering with others to provide services;

Transferring, merging or amalgamating operations;

Starting, ceasing to provide services;

Ceasing to operate.

22


Although the LHIN has the primary responsibility of integrating the health care system, the Act also

requires health care providers also find ways to integrate services. To this end, organizations have been

working to coordinate and partner with others to improve quality and to ensure the sustainability of the

local services. The challenge is how to strengthen the existing partnerships and develop new strategies

that help to coordinate services and ensure that the sector is easy to navigate and seamless for clients.

Models of Integration as Identified in LHSIA

The LHSIA identifies the following alternatives as a continuum for integration:

1. Collaboration




Sharing information

Joint planning

Joint budgeting and service plan development

2. Sharing Resources






Sharing administrative services

Sharing IT or HR expertise

Sharing clinical and/or professional services

Common processes for intake and assessment

Creating common policy and procedures

3. Potential Benefits of a Merger






To make better use of the current resources

Make more efficient use of scarce human and volunteer resources

Improve the access for their consumers

Organizations have shared values and can more readily achieve their mission by combining

forces

Can attract more public funding by joining forces

B

Identify the Characteristics of an Integrated Model

It is important that we understand the characteristics of an integrated model of care and the benefits that

the model should provide for the client. Integration should strive to make the health care system more

responsive and improve the quality of service for the client in the following ways:






Focus on meeting the needs of the client

Coordinates the care across the continuum of health services

Ensures an efficient and effective flow of information throughout the system

Provided reliable and comparable financial and service data

Flexible and responsive to the changing needs of clients and their caregivers.

The initial focus should be on ensuring that we have maximized the opportunities for integration within the

CSS sector itself and between the CSS sector and the Community Care Access Centre.

23


C

Recommend the Principles to Guide Decisions on Integration Strategies

a. The integration activity should simplify the access to Community Support Services and support a

coordinated seamless continuum of care.

b. The integration activity should be cost efficient when compared to the current model of service.

c. The integration activity must be sustainable in respect to human resources for both paid and

volunteer staff.

d. The integration activity should strengthen and improve the linkages with other health and social

services agencies.

e. The integration activity must promote financial stability within the sector.

f. The integration activity must include a transition plan that minimizes instability for organizations

and their staff while the system moves to new structures and processes.

D. Examples of Integration within Central East

The integration survey was used to identify the exemplars of integration in the Community Support

Services Sector (Appendix 7). It is important to note that this is only a sample of the integration that has

occurred and continues to be developed in this sector.

E. Barriers and Risks of Integration

Integration within the CSS sector provides an opportunity to address some of the fragmentation and gaps

in services for the elderly. Although there are obvious benefits, there are also barriers and risks

associated in pursuing these options.

The sector is heavily dependent on the local community for both fund raising and volunteers. Most CSS

programs are dependent on both client fees and local fund raising to sustain these programs. As stated

in the Project Charter CSS agencies provide on average $1.48 in services for every dollar of government

funding. Many agencies also subsidize the cost of fees for low income seniors through additional fund

raising activities. Integration strategies that undermine the ability of these services to remain connected to

their local community and continue to raise funds or attract volunteers may seriously affect the ongoing

viability of these programs.

As well, in the current economic climate not-for-profit organizations may be reluctant to assume additional

services transferred from another agency as it will involve transferring both the assets (MOHLTC funding)

plus the liability (fund raising portion of the program). Notwithstanding that the transfer of the service will

help to make the system more seamless for the client, the action may result in the loss of volunteers and

community funding with limited or no incentives from the Ministry.

The following highlights some of the challenges for integration in the CSS sector:




The potential loss of volunteers for services such as Transportation Services, Meal Programs and

Visiting Social and Safety.

Potential to undermine the organization’s capacity to fundraise.

The new model may risk losing the programs connection to the local community.

24


Transfer of the program will require transferring both the asset (government funding) and the

liability (fee portion and fundraising portion of the service).

Back Office Integration is hampered by the lack of base funding for administrative services.

Smaller organizations lack the infrastructure and capacity to implement integration opportunities.

Integration is limited by the fear of losing the organization’s autonomy and identity.

Programs that are sensitive to the needs of cultural groups may be reluctant to consider new

approaches.

Funding for some CE services are held in agency operating budgets that are administered

through adjacent LHINs. There must be a clear protocol for how funding can be transferred

between LHINs prior to implementing new models of service delivery.

F. Strategic Restructuring Options

Administration

Many CSS agencies are familiar with purchasing back office functions from an outside provider e.g.

payroll. This is usually from a provider who does not deliver health or social services, e.g. financial

institution. It is important to note that this recommendation is not based on the fact that there are

significant resources available to be reallocated from administrative services. The CSS sector needs to

develop strategies for BOI to sustain and grow in increasingly complex requirements for financial, human

resource and IT services.

Partnership with the CECCAC

The CSS and CE CCAC need to create a stronger partnership in order to respond to both the current

demand for service and to respond to the increased demand from a rapidly aging population in Ontario.

There CE CCAC and CSS need to be able to create wrap-around supports for clients depending on

Homecare services. There also needs to be a consistent way to share information and develop

community options for individuals waiting for placement in Long-Term Care Homes.

RECOMMENDATION

That the CE LHIN review the feasibility of establishing a common admission process for all Adult

Day Programs that is coordinated through the CE CCAC.

Goal 6: Human Resources

Ensuring that you have access to a highly trained and stable workforce is critical for the success of any

business. The same principle applies to the healthcare sector including Community Support Services.

The Project Team developed a survey to identify and quantify the Human Resources needs affecting the

CSS sector. This includes both paid staff and volunteers who participate in the providing programs such

as Meal Delivery and Transportation.

Analysis the results of the survey the Project Team compiled a profile for the survey was designed to do

the following:





Create a employer profile

Create an employee profile

Create a Volunteer profile

Identify Mitigating strategies

25


Key Findings for Human Resources

Workplace Profile

The majority of CSS organizations are small to medium size organizations with less than 50 FTE. In fact

40% of the agencies in the survey reported that they have less than 10 FTE’s. Over half of the agencies

employee’s are not unionized and of those most did not believe that this would occur in the near future.

Approximately 60% of the respondents indicated that they do not have a Human Resources plan and

most did not have dedicated Human Resource staff. The Executive Director was most likely identified as

the individual in the organization responsible to recruit/hire staff.

More than 70% of the CSS organizations in the survey reported that 90% to 100% of their staff was

female. Almost half of the organizations reported that part time positions represented a quarter of their

workforce. However, in other organizations part time positions comprise over half of their staff.

Low salaries and benefits were often identified as a key issue affecting this sector. In fact many

organizations reported that they had to use fundraising dollars in their budget to offset the cost of

salaries/benefits. The level of fundraising required in this sector is a key pressure that impacts on the

future viability of these services.

Most agencies reported that staff turnover rate was low, with many individuals remaining with the

organization for extended periods. The key exception to this was for trained personal support workers

(PSW), Information Technology (IT), finance and middle management. These groups were identified as

staff that were the most difficult to recruit and retain. The CSS sector is competing with LTC Homes,

Hospital sector and CCAC contracted providers for PSW staff. Based on the survey LTC Homes and the

Hospital sectors appear to be able to provide for full time positions and improved salaries and benefits

compared to CSS. Finance, IT and middle managers also tended to have a higher staff turnover rate.

Most organizations have achieved pay equity, however, for agencies who are still working towards their

pay equity plan they must continue to reallocate 1% of their total compensation package each year to this

goal. Unlike the hospital and CCAC sectors pay equity has not been fully funded by the Ministry.

In analysis staff turnover, 50% of CSS organizations reported that employees left for employment in other

healthcare sectors. The key reasons for staff leaving the CSS sector, include, higher salaries/benefits

and the opportunity for full time work.

Volunteers

Volunteers play a significant role in the delivery of certain CSS programs, such as Meals Delivery,

Transportation and Visiting Social and Safety. Over half of the organizations who responded to the

survey reported that they were having difficulty in attracting and retaining volunteers. Almost 60%

indicated that the average age of their volunteers were between 60 to 70 years of age. Given that studies

have indicated that many ‘baby boomers’ will continue to work after the age of 65 the difficulty the sector

has in attracting volunteers will worsen. In fact many respondents indicated that the reason why they lose

volunteers is because they find employment.

Another common issue that was identified was the lack of a full time volunteer coordinator. In the past

the Ministry has not consistently recognized the need for this position. This responsibility was often

assigned to various parts of the organizations which contribute to inconsistencies throughout the sector.

The lack of volunteers, the high cost of fuel, concern for personal safety in specific neighbourhoods and

the more complex needs of clients, have all contributed to changes in how some CSS programs are

26


provided. As an example, transportation programs are increasingly depending on paid drivers to provide

services in many communities. This trend will continue.

When asked to identify the most critical human resource issues affecting the sector organizations

identified the following:





Number of staff with limited IT training

Pressure to increase salaries/benefits without Ministry funding

Compensation packages for middle and senior managers in CSS are not competitive with other

health sectors which contributes to staff turnover

High workloads which contributes to staff burnout

RECOMMENDATIONS

Given the relatively small size of the majority of organizations providing CSS programs the key

human resource issue is improving the salaries/benefits for all staff. The sector is not able to

provide a competitive compensation package for scarce professional and/or technical staff.

Given the present economic environment the project team acknowledges that a single strategy

that recommends investing funds to improve salaries/benefits isn’t likely to be supported by the

funder. Nevertheless it is a critical issue that needs to be addressed.

Provincial Recommendation

1. That the Ministry of Health and Long-Term Care in consultation with the Ontario Association for

Community Support Services develop a Human Resource strategy for the sector that ensures fair

compensation for employees.

2. That MOHLTC consider extending the access to PSW Training funds to

CE LHIN Recommendation

1. That the CE LHIN ensures that Back Office Integration includes the capacity to provide Human

Resource expertise to the CSS sector.

2. That the CE LHIN fiscally fund under Community Support Initiative – Support Service Training the

development and implementation of a shared staff training events for CSS providers in the area.

3. That the CE LHIN fiscally fund under the above initiative a Human Resource Strategy Planning

session for all CSS providers that would assist in developing a baseline for future Human

Resource planning.

CSS Organization Recommendation

1. Partner in each planning zone to develop a HSIP for a volunteer coordinator in each

Collaborative.

27


Implementation Plan

The following begins the process to implement the recommendations found in this report.

Strategy to Move to a Single or Coordinate Service Provider in each municipal zone:

In the process of negotiating the 2009/10 MSAA and CAPS the LHIN and service providers share the

responsibility to identify the opportunity to move to a single or coordinated service delivery for each

service code in CSS. Where there is an opportunity the service providers should prepare a business

case for the transfer or coordination of these services, including any fiscal cost associated with the

integration activity. If a voluntary agreement isn’t feasible then the LHIN will be required to make the

decision on the transfer of resources.

Once the opportunities have been confirmed the sector should create a work plan that allows for the

orderly transition.

Steps:

1. Use the 2009/10 CAPS to confirm the list of multiple service providers in each municipality.

2. LHIN request that the organizations develop a business case that enables the transition to a

single or coordinated service provision for each code in the OHRS.

3. In the situation where the service providers are supporting moving to a single provider the

organizations prepare a business case identifying all costs associated with the transfer for LHIN

approval.

4. In situations where there isn’t agreement between the organizations affected by this transfer the

LHIN will be required to make the decision.

Application of a Common Assessment:

The LHIN should consult with the CSS sector on selecting a common assessment tool and identify the

process to phase in the application. It is anticipated that staff training that will be required. The 2009/10

fiscal year should be used to support training and building the IT capacity if required. The cost of the

application and training should be supported fiscally by the CE LHIN.

Steps:

1. Under the direction of the LHIN the CSS providers will select representatives to review the

options in selecting a common assessment tool.

2. Once the common assessment tool has been confirmed the committee should create an

implementation plan that includes the cost of the tool, infrastructure requirements, staff training

needs and how the assessment tool can be phased in starting in 2010/11.

28


3. The SE LHIN is also moving to a common assessment format for CSS and it is recommended

that both LHINs consult on the potential to share knowledge and expertise in supporting this

direction.

4. All costs associated with supporting a common assessment should be supported by the CE LHIN.

Back Office Integration:

BOI should be a voluntary option where agencies are allowed to opt-in rather than mandating BOI for the

entire sector.

Steps:

1. LHIN request that organizations interested in considering BOI participate in an advisory

committee that will help to design the model.

2. LHIN hire a consultant to assist the advisory committee to develop the model. The key features

include:







CSS providers voluntarily opt-in to the model.

Participating agencies create the new shared services office (BOI) with the support of a

consultant.

After the model is developed, advisory committee assists in recruiting the manager to

lead the implementation.

Participating financial, human resources and IT staff are assigned to the new shared

service office.

BO functions are phased in over the two year period.

Cost of BO to participating agencies is determined by the level of administrative costs

indentified in the 2009/10 CAPS unless otherwise negotiated with the LHIN.

3. Initiative is fiscally funded by the LHIN until the project can be fully self-funded by participating

organizations.

29


Appendices

Appendix 1:

Appendix 2:

Appendix 3:

Appendix 4:

Appendix 5:

Appendix 6:

Appendix 7:

Service Provider Inventory

Level of Expenditure per Service Code

Integration Survey

Human Resource Survey

Mapping of Community Support Services

Ontario Health Reporting Standards Definitions for CSS

Examples of Integration

30


Appendix 1

CSS Service Provider Inventory 2

Haliburton

Agency Address Services

Haliburton Community

Care

Victorian Order of Nurses

PVH Branch

Victorian Order of Nurses

PVH Branch

83 Maple Avenue

Haliburton, ON

K0M 1S0

83 Maple Avenue

Haliburton, ON

K0M 1S0

6 McPherson Street

Minden, ON

K0M 2K0

Service Arrangement

Coordination

Transportation

Meals Delivery

Friendly Visiting

Social Congregate Dining

Emergency Response

Support

Adult Day Program

Foot Care Services

Adult Day Program

Foot Care Services

Alzheimer Society

Peterborough Haliburton,

Northumberland

Canadian Hearing Society

SIRCH

4663 County Rd 21

K0M 1S0

370 Kent Street West

Whitney Town Centre

Lindsay, ON

K9V 6G8

Caregiver Support

Hearing Support Services

2 Community Support Services that were not part of this review include:




Palliative Care Services, including Pain and Symptom Management and Hospice Services which are included

within the role of the newly formed CE Hospice Palliative Care Network

First Nations CSS which will be included as part of the Aboriginal and First Nations planning; and

Psychogeriatic Consulting Program (PRC) which will be considered through work on specialized geriatric

services and mental health.

31


Agency Address Services

City of Kawartha Lakes

Alzheimer Sociey City of

Kawartha Lakes

Community Care City of

Kawartha Lakes

55 Mary Street West

Lindsay, ON

K9V 5Z6

34 Cambridge Street South

Lindsay, ON

K9V 3B8

Caregiver Support

Health Promotion

Education

Transportation

Meal Delivery

Homemaking

Emergency Response

Support

Visiting Social and Safety

Social Congregate Dining

Community Care City of

Kawartha Lakes

Community Care City of

Kawartha Lakes

Community Care City of

Kawartha Lakes

Victorian Order of Nurses

PVH Branch

Victorian Order of Nurses

PVH Branch

Canadian Hearing Society

Box 941, 71 Bolton St., Unit D

Bobcaygeon ON K0M 1A0

70 Murray Street

Fenelon Falls ON

K0M 1N0

1027 Portage Rd.,

Kirkfield, ON

K0M 2B0

51 Mary Street West

Lindsay, ON

K9V 5Z6

51 Mary Street West

Lindsay, ON

K9V 5Z6

370 Kent Street

Lindsay, ON

K9V 6G8

Transportation

Meal Delivery

Adult Day Program

Homemaking

Visiting Social and Safety

Social Congregate Dining

Transportation

Meal Delivery

Adult Day Program

Respite

Homemaking

Visiting Social and Safety

Social Congregate Dining

Transportation

Meal Delivery

Visiting Social and Safety

Social Congregate Dining

Adult Day Program

Adult Day Program

Acquired Brain Injury

Hearing Support Services

32


Agency Address Services

Northumberland County

Canadian Red Cross 330 Ward St, Unit 3

Port Hope, ON

L1A 4A6

Victorian Order of Nurses

HNPE Branch(funding held

by SE LHIN)

Victorian Order of Nurses

HNPE Branch (funding held

by SE LHIN)

Community Care

Northumberland

Community Care

Northumberland

Community Care

Northumberland

Community Care

Northumberland

Community Care

Northumberland

Canadian Hearing Society

Campbellford, ON

K0L 1L0

Cobourg, ON

K9A 3K3

174 Oliver Road, Campbellford

K0L 1L0

74 Queen Street

Port Hope, ON

L1A 2Y9

6 Albert Street

Hastings, ON

K0L 1Y0

1005 Elgin Street

Cobourg, ON

K9A 5J4

46 Prince Edward Street

Brighton, ON

K0K 1H0

Services provided through the

Peterborough site.

Meal Delivery

Adult Day Program

Respite

Adult Day Program

Respite

Transportation

Meal Delivery

Caregiver Support

Homemaking Brokered

Model

Transportation

Caregiver Support

Homemaking Brokered

Model

Transportation

Meal Delivery

Caregiver Support

Homemaking Brokered

Model

Transportation

Meal Delivery

Caregiver Support

Homemaking Brokered

Model

Transportation

Meal Delivery

Caregiver Support

Homemaking Brokered

Model

33


Agency Address Services

Peterborough County

Activity Haven

Alzheimer Society

Peterborough, Haliburton,

Northumberland

Community Care

Peterborough

Community Care

Peterborough

Community Care

Peterborough

Community Care

Peterborough

180 Barnardo Avenue

Peterborough, ON

K9H 5V3

183 Simcoe Street

Peterborough, ON

K9H 2H6

180 Barnardo Avenue

Peterborough, ON

K9H 5V3

Box 303, Burleigh Street

Apsley, ON

K0L 1A0

Box 86, 3 George Street West

Havelock, ON

K0L 1Z0

Box 158, 275 Queen Street

Lakefield, ON

K0L 2H0

Adult Day Program

Social Congregate Dining

Caregiver Support

Health Promotion

Education

Promotion

Education/Geriatric

Meal Delivery

Transportation

Service Arrangement/

Coordination

Emergency Response

Support

Visiting Social and Safety

Meal Delivery

Social Congregate Dining

Transportation

Service Arrangement

/Coordination

Emergency Response

Support

Visiting Social and Safety

Meal Delivery

Social Congregate Dining

Transportation

Service

Arrangement/Coordination

Emergency Response

Support

Visiting Social and Safety

Meal Delivery

Social Congregate Dining

Transportation

Service

Arrangement/Coordination

Emergency Response

Support

Visiting Social and Safety

34


Community Care

Peterborough

Agency Address Services

Box 257, 22 King Street East

Millbrook, ON

L0A 1G0

Meal Delivery

Social Congregate Dining

Transportation

Service

Arrangement/Coordination

Emergency Response

Support

Visiting Social and Safety

Community Care

Peterborough

Community Care

Peterborough (Harvey

Office)

Victorian Order of Nurses

PVH Branch

Victorian Order of Nurses

PVH Branch

Victorian Order of Nurses

PVH Branch

York Durham Aphasia

Services (funding held by CE

LHIN

Canadian Hearing Society

Canadian Institute for the

Blind

Community Counseling and

Resource Centre

Four Counties Acquired

Brain Injury Assoc.

Box 436

2368 County Rd. 45

Norwood, ON

K0L 2V0

Box 12, St. Matthew’s Anglican

Church

Buckhorn, ON

K0L 1J0

360 George Street North

Peterborough, ON

K9H 7E7

64 Hague Blvd.

Lakefield, ON

K0L 2H0

8 Oak Street

Havelock, ON

K0L 1Z0

180 Barnardo Avenue

Peterborough, ON

K9H 5V3

315 Reid Street

Peterborough, ON

K9J 3R2

159 King Street

Peterborough, ON

K9J 2R8

459 Reid Street

Peterborough, ON

K9H 4G7

160 Charlotte Street

Peterborough, ON

K9J 2X5

Meal Delivery

Social Congregate Dining

Transportation

Service

Arrangement/Coordination

Emergency Response

Support

Visiting Social and Safety

Meal Delivery

Social Congregate Dining

Transportation

Service

Arrangement/Coordination

Emergency Response

Support

Visiting Social and Safety

Adult Day Program

Respite Services

Adult Day Program

Adult Day Program

Aphasia/Communication

Support

Hearing Support Services

Vision Support Services

Social Work

Caregiver Support

ABI - Assisted Living

Services

35


Durham Region

Agency Address Services

York Durham Aphasia

(funding by CE LHIN)

Victorian Order of Nurses

Durham Branch

Canadian Hearing Society

Whitby Seniors Activity

Centre Corp. Town of Whitby

Head Injury Association of

Durham

CNIB Durham District

Region of Durham Hillsdale

Region of Durham Lakeview

Alzheimer Society of

Durham

Sunrise Senior's Place

1850 Rossland Rd.

Whitby, ON

L1N 3P2

50 Richmond Street

Oshawa, ON

L1G 7C7

575 Thornton Rd.

Oshawa, ON

L1J 8L5

801 Brock Street

Whitby, ON

L1N 4L4

850 King St. West

Oshawa, ON

L1J 8N5

1 Mary Street North

Oshawa, ON

L1G 5T9

590 Oshawa Blvd North

Oshawa, ON

L1G 5T9

133 Main Street

Beaverton, ON

L0K 5T9

419 King Street West

Oshawa, ON

L1J 2K5

75 John Street West

Oshawa, ON

L1H 1W9

Aphasia/Communication

Support

Visiting Social and

Safety

Hearing Support

Services

Foot Care

ABI Day Program

ABI Independence

Training

Vision Services

Adult Day Services

Adult Day Services

Caregiver Support

Health Promotion

Education

Promotion Education

Geriatric

Social Congregate

Dining

36


Agency Address Services

43 John Street

Oshawa, ON

L1H 1W8

Oshawa Senior Citizens

Centre

Community Care Durham

Community Care Durham

Community Care Durham

Community Care Durham

1420 Bayly Street

Pickering, ON

L1W 3R4

1 Cameron Street

Cannington, ON

L0E 1E0

26 Beech Avenue

Bowmanville, ON

L1C 3A2

45 Bloor Street East

Oshawa, ON

L1H 3L9

Social Congregate

Dining

Crisis Intervention

Support

Adult Day Program

Foot Care

Transportation

Meal Delivery

Social Congregate

Dining

Transportation

Visiting Social and

Safety

Emergency Response

Support

Home Help

Respite

Adult Day Program

Meal Delivery

Transportation

Visiting Social and

Safety

Emergency Response

Support

Home Help

Respite

Foot Care

Meal Delivery

Transportation

Visiting Social and

Safety

Emergency Response

Support

Home Help

Respite

Foot Care

Adult Day Program

Meal Delivery

Transportation

Visiting Social and

Safety

Emergency Response

Support

Home Help

Respite

37


Agency Address Services

Community Care Durham 181 Perry Street

Port Perry, ON

L9L 1B7

Meal Delivery

Transportation

Visiting Social and

Safety

Emergency Response

Support

Home Help

Respite

Foot Care

Community Care Durham

Community Care Durham

75 Marietta Street

Uxbridge, ON

L9P 1K7

114 Dundas Street

Whitby, ON

L1N 2H7

Meal Delivery

Transportation

Visiting Social and

Safety

Emergency Response

Support

Home Help

Respite

Foot Care

Adult Day Program

Meal Delivery

Transportation

Visiting Social and

Safety

Emergency Response

Support

Home Help

Respite

38


Scarborough

Scarborough Support

Services

Yee Hong Centre for

Geriatric Care

Agency Address Services

Centre of Information and

Community Services of

Ontario

Momiji Health Care Society

St. Paul's L'Amoreaux

1045 McNicoll Avenue

Scarborough, ON

M1W 3W6

2311 McNicoll Avenue

Scarborough, ON

M1V 5L3

3850 Finch Avenue East

Scarborough, ON

M1W 3T6

3555 Kingston Road

Scarborough, ON

M1M 3W4

3333 Finch Avenue East

Scarborough, ON

M1W 2R9

Transportation

Meal Delivery

Social Congregate

Dining

Adult Day Services

Homemaking/Home

Help

Service Coordination

Client Intervention and

Support

Respite

Home Maintenance

Visiting Social and

Safety

Transportation

Meal Delivery

Social Congregate

Dining

Adult Day Services

Caregiver Support

Visiting Social and

Safety

Client Intervention and

Support

Recreation

Client Intervention and

Support

Social Congregate

Dining

Transportation

Visiting Social and

Safety

Meal Delivery

Social Congregate

Dining

Transportation

Client Intervention and

Support

Adult Day Services

Home

Help/Homemaking

Home Maintenance

Respite

Caregiver Support

Visiting Social and

Safety

39


Agency Address Services

3601 Victoria Avenue

Scarborough, ON

M1W 3Y3

Carefirst Seniors and

Community Services

Association

West Hill Community

Services

3645 Kingston Road

Scarborough, ON

M1M 1R6

Social Congregate

Dining

Transportation

Client Intervention and

Support

Adult Day Services

Homemaking

Visiting Social and

Safety

Meal Delivery

Home Maintenance

Home Help

Caregiver Support

Respite

Social and Congregate

Dining

Transportation

Visiting Social and

Safety

Adult Day Services

40


Agency Address Service

NOTE: Project Team did not map these programs

SIRCH Box 687

Haliburton, ON

K0M 1S0

Hospice Kawartha Lakes 112 McLaughlin Road

Lindsay, ON

K9V 6B5

Peterborough Hospice 439 Rubidge Street

Peterborough, ON

K9H 4E4

Lovesick Lake Native

Women's Assoc.

Curve Lake

Peterborough Regional

Health Centre

Hospice Durham

Whitby Mental Health Centre

(New Name: Ontario Shores

Centre for Mental Health

Sciences)

Lakeridge Health

Corporation

Hospice Northumberland

Lakeshore

Campbellford and District

Palliative Care Services

7 Albert Street

PO Box 220

Lakefield ON

K0L 2H0

22 Winookeeda Road

Curve Lake, Ontario

K0L 1R0

1 Hospital Drive

Peterborough, ON

K9J 7C6

209 Dundas Street East

Lower Level

Whitby, ON

L1N 7H8

700 Gordon Street

Whitby, ON

L1N 5S9

1 Hospital Court

Oshawa, ON

L1G 2B9

259 Division Street

Cobourg, ON

K9A 4K5

P.O. Box 154

174 Oliver,

Campbellford, ON

K0L 1L0

Alderville First Nations 8467 County Road 45 P.O. Box 12

Alderville ON

K0K 2X0

Regional Geriatric Program

of Toronto

VON Toronto York Region

Branch

2075 Bayview Avenue, Suite H478

Toronto, ON

M4N 3M5

2075 Bayview Avenue, Suite H478

Toronto, ON

M4N 3M5

Hospice Visiting

Hospice Visiting

Hospice Visiting

First Nations - Off

Reserve

Supportive Housing/First

Nations

Promotion and

Education -

Psychogeriatric

Hospice Visiting

Promotion and

Education -

Psychogeriatric

Palliative Services

Hospice Visiting

Hospice Visiting

CSS/First Nations

Promotion and

Education -

Psychogeriatric

Hospice Visiting

41


Appendix 2

Level of Expenditure per Service Code

CSS Services CE LHIN 2007/08

Code

Service

Total

Expenditure

Individuals

Served

% of Total

Expenditure

Administration 5964351 NA 18%

82 05 Service Arrangement/Coord. $200,365 994 2.00%

82 10 Meals Delivery 2,372,846 3875 7.50%

82 12 Social and Congregate Dining 1,722,372 12326 5.00%

82 14 Transportation 2,885,629 8672 9.00%

82 15 Crisis Intervention; Support 451,491 3198 1.50%

82 20 Day Services 4,324,319 4315 14%

82 31 Homemaking 1,016,662 929 3.00%

82 33 Personal Support/Independence Tr. 2,552,556 264 8.00%

82 34 Respite 1,838,400 431 6.00%

82 35 Comb. PS/HM/Respite Services

82 40 Overnight Stay Care (Alz. & Related)

82 45 Assisted Living Services 5,435,260 595 17.00%

82 50 Caregiver Support 574,712 8002 1.80%

82 55 Emergency Response Support Service 186,718 857 0.50%

82 60 Visiting Social and Safety 781,428 4767 2.50%

82 70 Foot Care 285,143 3492 1.00%

82 75 Vision Impaired Service 410,009 1325 1.20%

82 77 Hearing Impaired Service 437,181 799 1.30%

83 20 ABI Day Service 37,840 10 0.10%

24 33 ABI Personal Support and Ind. Training 288,572 84 1.00%

Total 31,756,854 54935 100.00%

* data for administration was not available for all CSS providers

**service data was not available for all CSS providers

42


Appendix 3

Integration Survey for Community Support Services

Background

The Project Charter approved for the Review of Community Support Services includes identifying

exemplars of integration and the potential for new and innovative integration strategies within the

Community Support Services sector and between our sector and other health and human services. To

this end, we would appreciate your time and input in completing the following survey.

Thanking you advance for your cooperation and support,

Definition of Integration

Integration is a broad concept that includes but not limited to the following kinds of activities:





Coordination of services and interactions;

Partnering with others in providing indirect services (often referred to as ‘back office functions’

e.g. technology, finance or other administrative services, etc.);

Partnering with others in providing direct service;

Transferring, merging or amalgamating programs or operations

Intended Outcomes of Integration




Improving accessibility of health services to allow people to move easily through the health

system;

Improving the match between services provided and the multiple needs of clients;

Making the health care system more sustainable while promoting service innovation by enabling

effective and efficient use of resources and capacity.

43


Survey

Administration:

1. Do you provide any ‘back office’ functions for other health/social services providers?

Financial Services

Human Resource Support

Technology or IT Services

Planning

Marketing

Other

If other, please explain:

2. Do you receive any ‘back office’ functions from other health/social services providers?

Financial Services

Human Resource Support

Technology or IT Services

Planning

Marketing

Other

If other, please explain:

3. Do you have a purchase of service agreement for any administrative services with a private

organization e.g. payroll service.

Financial Services

Human Resource Support

Technology or IT Services

Planning

Marketing

Other

If other, please explain:

4. Are you presently in negotiations to provide/receive any back office functions in the coming fiscal

period and if so, what services?

Financial Services

Human Resource Support

Technology or IT Services

Planning

Marketing

Other

If other, please explain:

5. Do you share office space or equipment with other health providers?

6. Do you participate in bulk purchasing with other organizations e.g. Ontario Buys?

44


7. Are there other opportunities for shared administrative services that you would like to comment on?

8. Other comments on integrating administrative services:

Service Delivery

9. Do you have any service protocols with other health/social service organizations?

Common point of access

Common eligibility/assessment process

Joint fund raising

Volunteer Recognition/Recruitment

Other

If other, please explain:

10. Do you coordinate service delivery with other social/health service organizations? For example,

adult day programs that use a meal or transportation program from another provider in the

delivery of their service.

If yes, please explain:

11. Do you “contract out” any services mandated through your organization?

If yes, please explain:

12. Are you planning to develop any new service protocols with other providers?

If yes, please explain:

13. What are the priorities for integration in your service area?

Please provide further details:

Opportunities/Barriers to Integration

14. What would you consider to be a priority for integration in Community Support Services?

Please provide further details:

15. What would you consider to be the central barrier for integration in Community Support Services?

Please provide further details:

What action can be taken to remove this barrier?

Other Comments

16. Do you have other comments or ideas that would help to promote an integrated system of

services?

45


Appendix 4

Human Resources Survey for Community Support Services Sector

1. How many of staff does your agency employed to provide CSS programs?

Less than 10 employees

Between 10 to 20 employees

Between 20 to 30 employees

Between 30 to 50 employees

More than 50 employees

2. What percentage of your agency staff is providing CSS funded services?

Less than 25%

Between 25% to 50%

Between 50% to 90%

100% of the staff

3. What percentage of staff salaries/benefits are covered by fund raising and/or client fees?

Less than 10%

Between 10% and 25%

Between 25% and 50%

More than 50%

4. What percentage of your staff are part time employees?

Less than 10%

Between 10% to 25%

Between 25% to 50%

More than 50%

5. What best describes the annual staff turnover rate in your organization?

Minimal (less than 5% per year)

Medium (more than 5% but less than 10%)

High (more than 10% but less than 25%)

Very High (more than 25% a year)

6. What is the average length of stay for all positions within your agency?

Less than 5 years

Between 5 to 10 years

Between 10 to 20 years

20 years and longer

46


7. What do you consider to be the key reasons for staff leaving your agency?

Low salary/benefits

Lack of full time hours

Demanding stressful work

Job opportunities in other sectors

Pursue additional education

Retirement

Other

8. What do you consider to be the key reasons for staff staying with your agency?

Salary/benefits

Staff training

Job satisfaction

Positive work environment

Other

9. How many staff in your organization will be retiring in the next five years?

None

Less than 10%

More than 10%

Don’t know

10. Who is responsible for recruiting staff for your agency?

F/T HR staff

P/T HR staff

Program Management staff

Executive Director

Other

11. Does your agency have Human Resource Strategy Plan developed for 2010 and beyond?

No

Yes

12. If yes, what key strategies have you identified?

Improved compensation packages

Improved benefit packages

Increased staff training

Recruitment strategies

Other

47


13. Are the employees in your agency represented by a union?

No

Yes

14. If no, do you anticipate this occurring?

Yes, within the next year

Yes, within the next 3-5 years

Yes, but unsure when.

15. Have you achieved your Pay Equity Plan?

Pay Equity not applicable to our agency

Yes, pay equity plan completed

Pay equity plan still in progress that is, still directing the required amount to achieve pay

equity as per the legislation.

16. What percentage of your workforce is female?

Less than 50%

More than 50% but less than 75%

More than 75% but less than 90%

Between 90% and 100%

17. What positions does your agency have the most difficulty in filling?

PSW trained staff

Administrative staff including finance and IT

Middle Management

Professional staff

Senior Management

Other

18. Do you use volunteers in delivering services?

No

Yes

19. How many volunteers to you have to support CSS services?

Less than 20

Between 20 and 50

Between 50 and 80

More than 80

20. What is the average age of your volunteers

50 years of age or less

50 to 60 years of age

48


60 to 70 years of age

70 years of age and over

21. Do you have difficulty in attracting and keeping volunteers?

No

Yes

If yes, what do you believe think is the primary reason?

22. What do you believe are the most critical Human Resource issues facing the CSS sector?

Please explain:

23. What do strategies do you think the sector can pursue to mitigate Human Resources facing this

sector?

Please explain:

24. Do you think partnering with other agencies and/or sectors would help to mitigate Human

Resources issues facing your agency?

No

Yes

If yes, how might this assist your organization?

25. What strategies to you believe the local health integration network should pursue to assist the

CSS sector in developing a sustainable Human Resource plan?

Facilitate group purchasing for benefits

Coordination of Human Resource Plans

Investment in additional infrastructure to support Human Resources

Review current compensation packages for CSS sector

Other

49


Appendix 5

Community Support Services Maps – CE LHIN

Figure 1: Visiting/Social and Safety Services

50


Figure 2: Vision Support Services

51


Figure 3: Transportation Services

52


Figure 4: Social and Congregate Dining

53


Figure 5: Service Arrangement and Coordination Services

54


Figure 6: Meal Delivery Services

55


Figure 7: Home Help and Homemaking Services

56


Figure 8: Hearing Support Services

57


Figure 9: Health Promotion and Education Services

58


Figure 10: Foot Care Services

59


Figure 11: Crisis Intervention Services

60


Figure 12: Crisis Intervention Services

61


Figure 13: Aphasia and Communication Support Services

62


Figure 14: Adult Day Programs

63


Figure 15: Acquired Brain Injury Programs

64


Figure 16: Supportive Housing Services

65


Appendix 6

Definitions for Community Support Services

Ontario Health Reporting Standards

FC 72 5 30 40 70

COM In-Home Health Care - Social Work

Pertaining to helping service recipients and their families deal with personal, socio-economic and

environmental problems which influence the SRs' condition. For CSS, to enable SRs and families to

develop the skills and abilities necessary to optimize their functioning and thus reduce the risk of psychosocial

breakdown, through a trained professional.

Includes:


Compensation – social workers

FC 72 5 50 96 10

COM Health Promotion Education – General Geriatric

Pertaining to promoting health, and educating the community, including the public, professionals, and

other sectors about general geriatrics. For CSS, the services focus on promoting health, public

awareness and educating Alzheimer disease and related disorders. This may include local public

education activities to raise awareness, recruit and train volunteers with knowledge of the disease,

develop/facilitate family or significant others support groups and coordinate/implement training events for

volunteers, significant others, staff and other target groups.

Includes:




Coordination costs - direct staff compensation

Costs related to volunteers recruitment

Costs related to training/education sessions

Excludes:


Volunteer compensation

FC 72 5 82 05

CSS IH COM - Service Arrangement/Coordination

Pertaining to the activities that arrange services to be provided in a service recipient's (SRs) home.

Generally, the job is beyond the SR's or their caregivers capability to undertake or arrange themselves.

The job may be undertaken regularly, occasionally or one time only. The jobs arranged may include

home maintenance, repair and homemaking and respite services. The entity may use brokerage,

contractors and/or volunteers for the services. The funding is not for the labour and transportation cost of

providing the services at the SRs’ residence.

Services include:



Service coordination costs - direct staff compensation (linking service recipients with services and

supports)

Monitoring and evaluation of services provided to recipients

66


Client fees for the job, if applicable

Excludes:


Labour costs and direct costs to complete the job, e.g. cleaning supplies

FC 72 5 82 10

CSS IH COM – Meals Delivery

Pertaining to activities that arrange meals delivery to service recipients (SRs) at their residence to meet

their nutritional requirements. The meals are delivered by volunteers who may provide a regular social

contact and check the health and safety of the SR.

Includes:

Coordination costs - direct staff compensation

Meal costs

Client fees to assist in covering the food costs

Transportation costs (e.g. mileage, public transit costs, gas) – which will be reported using F. 6 23 00

Travel Expense – Staff Delivery of Service Recipient Service

Excludes:


Volunteer compensation

FC 72 5 82 12

CSS IH COM – Social and Congregate Dining

Pertaining to coordination of and delivering services and activities that promote health and wellness, and

provide social activities based on needs of service recipient (SR) groups with the goal of maintaining or

promoting their wellness. The services, may or may not include a nutritious meal, are for the SRs who

are either in receipt of or eligible to receive other long-term care community services. The social activities

may include recreation activities such as swimming, cards and crafts.

Includes:





Coordination costs (direct staff compensation, if any) for activities

Social activity supplies

Transportaiton cost for volunteers (F. 6 23 00 Travel Expense – Staff Delivery of SR Service)

Meal costs and recoveries from SRs for meals, where applicable

Excludes:



Volunteer compensation

SR transportation costs – report related costs under FC 7* 5 82 14 Transportation when

transportation is arranged for the SRs

FC 72 5 82 14

CSS IH COM – Transportation-Client

Pertaining to activities that arrange to provide transportation to medical appointments, shopping and to

various social activities and programs. Transportation is provided by the entity's staff or volunteers to

67


eligible service recipients using private cars, entity's vehicles, and public transportation or assisting the

service recipient to walk to the destination. This is a door-to-door service.

Includes:





Coordination costs - direct staff compensation

Expenses incurred by volunteers, such as public transportation, etc. when they accompany or

transport the the Service Recipient (F. 6 20 00 Travel Expense SR)

Costs related to vehicles owned and used by the providers to provide the service

Cost recoveries from service recipients

Excludes:


Volunteer compensation

FC 72 5 82 15

CSS IH COM – Crisis Intervention and Support

Pertaining to the service provided to service recipients with different types of crisis needs. For CSS, the

service provides crisis intervention and support in critical situations until the situation is stabilized and a

follow-up plan is in place. The target groups are vulnerable and at risk seniors, persons with physical

disabilities and/or their significant others. This includes people facing homelessness, a critical or

impending change in life situation, abuse or isolation. A case coordinator is responsible for problem

identification, direct service, service coordination and discharge planning. The services must be delivered

through a provider offering other community support services.

Includes:



Coordination costs - direct staff compensation

Direct employee compensation – case coordinator

Excludes:


SRs receiving assisted living services and this being a component of the combined services

FC 72 5 82 20

CSS IH COM – Day Services

An integrated support service which provides supervised programming in a group setting for SRs who

require close monitoring and assistance with personal activities (e.g. hygiene, dressing, etc.) The SRs

include the frail and elderly and those with Alzheimer disease or related disorders, or physically impaired

individuals who are relatively independent and can manage certain personal activities. Individuals may

attend this service for five to twelve hours on average for a fee. This service assists the participants to

achieve and maintain their maximum level of functioning, to prevent early or inappropriate

institutionalization and provides respite and information to their significant others. Components of the

service include planned social and recreational activities, meals, assistance with the activities of daily

living and minor health care assistance; e.g. monitoring essential medications.

Includes:



Direct employee compensation, e.g. attendant, supervision

Supplies for social or other activities, e.g. fees for guest speakers

68


Cost of food, if meals are provided

Service recipient fees, where applicable

Excludes:


Volunteer compensation

FC 72 5 82 31

CSS IH COM – Homemaking

Pertaining to the activities that assist service recipients living in home with shopping, light housekeeping,

meal preparation, paying bills, caring for children and laundry and training the person to perform these

activities. The funding is for both the administration/coordination costs of providing the service to eligible

SRs as well as the labour and transportation costs of providing the service. The SR is responsible for the

direct cost of service, i.e. shopping items, food, etc. For services under the Homemaking Nurses

Services Act, the services will be provided by hired employees or contracted resource through a claims

based program, on a monthly basis.

Includes:

Coordination costs - direct staff compensation

Costs of labour and transportation to carry out homemaking services

Excludes:


Costs related to food and shopping items, etc.

FC 72 5 82 32

CSS IH COM – Home Maintenance

Pertaining to the activities to undertake a home maintenance and repair for service recipients (SRs)

through individual workers. For CSS, this service is mainly provided to eligible First Nations SRs.

Generally, the job is beyond the SR's or their significant others’ capability to undertake or arrange

themselves, friend or family. The job may be undertaken regularly, occasionally or one time only.

Examples include heavy house cleaning, snow shoveling, washing outside windows, seasonal

housecleaning and cleaning out wood burning stoves, etc.

Includes:



Coordination costs - direct staff compensation

Direct costs of carrying out the work - compensation to workers

Excludes:



Direct service costs for non-eligible service recipients

Change due to adding the combined FC

FC 72 5 82 33

CSS IH COM – Personal Support/Independence Training

Pertaining to services to assist service recipients (SRs) with routine personal hygiene activities, activities

of daily living, and train the SR to carry out these activities. This may include the core components of

independence training service; through working with SRs and/or family members to teach the activities of

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daily living and necessary skills to increase personal independence. The skills may be taught include

physical development and health, sensory-motor development, communications and social skills,

emotional and spiritual development, independent living skills and behavioural management. This

service is provided for SRs living with families as well as those living in institutions and making

arrangements for living in the community. The services are provided at the SR’s residence and may be

on a continuous basis.

Includes:




Coordination costs - direct staff compensation, e.g. personal support workers and independence

trainers

Compensation for employees delivering the training

Transportation costs to service recipient’s location, where applicable

Excludes:



SRs receiving assisted living services as this is a component of the combined services

Direct costs of homemaking – cleaning supplies, etc.

FC 72 5 82 34

CSS IH COM – Respite

The provision of short or long-term significant others relief within service maximums and available

resources through a Personal Support Worker. The service may include homemaking, some personal

care, light housekeeping, attendant care, monitoring, supervision, and/or activation.

Includes:




Employee compensation for providing direct services – homemaking and respite workers

Coordination costs - direct staff compensation

Transportation costs (e.g. fuel, public transit costs, gas, and mileage)

Excludes:


Volunteer compensation

FC 72 5 82 35

CSS IH COM – Comb. PS/HM/Respite Services

The provision of combined in home support services which may include homemaking, personal

support/independence training, home maintenance and respite.

Report under this combined service FC or the detailed FC 725 82 3* accounts. Organizations should

decide on the need to provide detailed reporting based on volume of service, materiality, funding sources

and other internal or external reporting requirements.

FC 72 5 82 40

CSS IH COM – Overnight Stay Care

An integrated support service which provides overnight service in a group setting for service recipients

with Alzheimer disease and related disorders. This service is to provide short-term support or temporary

relief for families of SRs, such as during weekends. Components of the service include accommodation,

70


meals, social activities, assistance with the activities of daily living and certain health care assistance, e.g.

monitoring essential medications.

Includes:





Direct employee compensation, e.g. attendant, supervision, nursing

Supplies

Cost of food

Client fees, where applicable

Excludes:


Volunteer compensation

FC 72 5 82 45

CSS IH COM – Assisted Living Services

Pertaining to the activities provided to Service Recipients (SRs) who are living in a supportive housing

setting and require assisted living services, accessible on a 24-hour basis. This service may include

homemaking, personal support, attendant services and core components of independence training. The

supportive housing setting is a location where organization may be responsible for providing services to a

number of SRs who live in their own units and housing is not a component of the service. Organizations

providing these services will ensure their staff in various locations are onsite and accessible on a 24-hour

basis.

Includes:


Compensation costs - homemaking, personal support and attendant workers

Excludes:



Building operations and maintenance costs which will be recorded under the Plant Operations

functional centre

Costs of homemaking – cleaning supplies, etc.

FC 72 5 82 50

CSS IH COM – Caregiver Support

Pertaining to the activities that provide information, education, training and therapeutic counseling that will

assist the service recipient (SR) who is the caregiver. For this service, a SR is the caregiver or family

member(s) and/or other service providers for the purposes of providing care and support to a particular

individual directly or indirectly. The service provides education which can be either in group or individual

sessions, or under the direction of a professionally trained individual and/or one who has demonstrated

knowledge and expertise in the SR's area of need for support/counseling. The services may be provided

on a time limited and goal-directed basis, target to meet the caregiver's social and emotional needs.

Includes:





Professional costs

Transportation costs

Expenses for education and training sessions, e.g. room bookings, supplies

Direct employee compensation costs – coordination

71


Excludes:


Volunteer compensation

FC 72 5 82 55

CSS IH COM – Emergency Response Support Services

Pertaining to the service that provides an electronic device in a service recipient's (SR) home so that the

SR can communicate, in an emergency, with a centre staffed 24 hours a day that can summon

emergency help. This service includes billing and repair on the device. Generally, SRs are expected to

pay a user fee for the electronic device. The funding may be used to fund those who cannot afford the

emergency response system service and to defray administrative fees.

Includes:






Coordination costs - direct staff compensation

Transportation expenses incurred

Long distant telephone costs, if applicable

Supplies - cost of electronic communication device

Service recipient recoveries

Excludes:


Emergency service fees, e.g. ambulance fees

FC 72 5 82 60

CSS IH COM – Visiting – Social and Safety

Pertaining to coordination and delivery of the activities that provide a contact to a service recipient (SR)

on a regular basis to check the health, safety and social needs of the SR. The SRs may be isolated

seniors, physically disabled adults, persons with Alzheimer disease or other dementias, or their significant

others. The contact can be through a phone call (phone visit) or face to face visit. The face to face visits

are made to the SR's home and volunteers may also perform shopping or take the SR out for daily living

activities, e.g. banking, social event.

Includes:





Coordination costs - direct staff compensation

Expenses incurred by volunteers for the visiting, e.g. transportation

Transportation expenses incurred

Long distance telephone costs, if applicable

Excludes:


Volunteer compensation

FC 72 5 82 70

CSS IH COM - Foot Care Services

Pertaining to the activities that arrange for individuals trained for foot care to provide services in a

congregate setting. Service includes trimming toe nails, monitoring the condition of feet, soaking and

may include massaging feet. A fee is charged to cover some of the direct cost of supplies and the

72


individuals who provide the service. Funding support is limited to administrative cost of arranging the

service.

Includes:




Supplies

Client fees to cover some of the direct costs

Coordination costs - direct staff compensation

Excludes:

SRs receiving assisted living services and this being a component of the combined services.

FC 72 5 82 75

CSS IH COM – Vision Impaired Care Services

Pertaining to the services provided by trained specialists; such as independent living specialists, low

vision specialists, rehabilitation teachers, vision rehabilitation workers and orientation and mobility

specialists; to vision impaired service recipients. Services include assessment, rehabilitation teaching,

orientation and mobility, low vision rehabilitation and assistive technology.

Includes:




Direct employee compensation

Training supplies

Cost related to service coordination, intake and referral services.

FC 72 5 82 77

CSS IH COM – Hearing Impaired Care Services

Pertaining to counseling and support service for deaf, deafened or hard of hearing service recipients

(SRs), their families and significant others provided by hearing care counselors and communication

disorder assistants. The service includes identification, assessment, education/training, coping and

consultation related to hearing loss and deafness. This program is provided in home-based setting to

seniors and adults with acquired hearing loss. General Support Services are provided by counselors

primarily office based to SRs who are deaf, deafened or hard of hearing, their families, significant others

in a cultural/linguistic approach. Information, education and training about hearing loss issues are

provided to the public and service providers. The service may include long-term support to SRs with

communication disorders arising from stroke, ABI and other brain diseases.

FC 72 5 83 20

CSS ABI – Day Services

An integrated support service which provides supervised programming in a group setting for service

recipients (SRs) living with the affects of an Acquired Brain Injury (ABI). The SRs require assistance or

supervision to perform routine activities of daily living safely or independently as a result of the effects of

an ABI. SRs may attend this service for two to twelve hours on average and may or may not pay a fee.

This service assists the participants to achieve and maintain their maximum level of functioning and self

respect as well as provides respite to their significant others. Components of the service include work

structured day, planned social and recreational activities, meals, and minor health care assistance; e.g.

monitoring essential medications.

73


Includes:





Direct employee compensation, e.g. attendant, supervision

Supplies for activities

Cost of food, if meals are provided

Client fees, where applicable

Excludes:


Volunteer compensation

FC 72 5 83 30

CSS ABI – Vocational Training and Education Services

A support service which provides vocational training and education information to service recipients (SRs)

with acquired brain injury to assist them to enter the work force or education system in the community.

This service is for SRs who are expected to restore or improve functional ability. The service can be

offered in a series of sessions for up to a pre-determined duration per week.

Includes:



Direct employee compensation, e.g. attendant, supervision

Supplies for activities

Excludes:


Volunteer compensation

FC 72 5 83 33

CSS ABI – Personal Support/Independence Training

Pertaining to services to assist acquired brain injury service recipients (SRs) with routine personal

hygiene activities, activities of daily living, which may include homemaking services, and train the SR to

carry out these activities. This may also include personal support, respite and the core components of

independence training service; through working with SRs and/or family members. The skills that may be

taught include physical development and health, sensory-motor development, communications and social

skills, emotional and spiritual development, independent living skills and behavioural management. This

service is provided for SRs living with families as well as those living in institutions and making

arrangements for living in the community. The services are provided at the SR’s residence and may be

on a continuous basis.

Includes:





Coordination costs

Direct staff compensation, e.g. personal support workers, employees delivering the training

Transportation costs to service recipient’s location, where applicable

Training supplies

Excludes:


Individuals receiving 24-hour assisted living services

74


Professional service fees – training program development and professional supervision which is

funded through the psychological services

FC 72 5 83 45

CSS ABI – Assisted Living Services

Pertaining to the activities provided to Service Recipients (SRs) with acquired brain injury who are living in

a supportive housing setting and require assisted living services, accessible on a 24-hour basis. The

services may include, but not limited to, homemaking, personal support and attendant/ personal hygiene

services. This service may also include the core components of independence training service and SR

specific behavioural management programs developed and/or supervised by the professional service

funded through the Psychological services. The supportive housing setting is a location where

orgganization may be responsible for providing services to a number of SRs who live in their own units

and housing is not a component of the service. Organizations providing these services will ensure their

staff in various locations are onsite and accessible on a 24-hour basis.

Includes:


Compensation costs - homemaking, personal support, attendant and training

Excludes:




Building operations and maintenance costs which will be recorded under the Plant Operations

functional centre

Professional service fees – training program development and professional supervision which is

funded through the psychological services

Direct costs of homemaking – cleaning supplies, food, etc.

FC 72 5 84 10

CSS Com Sup Init – Support Service Training

Pertaining to the activities that provide information, education and training that will assist the service

providers or support the growth and development of organizations for the purposes of supporting the

service recipients directly or indirectly. The services may be provided on a goal-directed basis as well as

promoting the concept and value of volunteerism. The service can be in group or individual sessions.

This service may apply to CSS service providers, general volunteers and volunteers for hospice services,

First Nations or Aboriginal organizations and self organizations, etc. The First Nations service includes

support for their members with information, referral, advocacy and access to mainstream long-term care

services.

Includes:






Direct staff compensation

Costs associated with volunteer training

Volunteer incurred expenses, e.g. transportation

Expenses for education and training sessions, including supplies

Transportation costs

Excludes:


Volunteer compensation

75


FC 72 5 84 30

CSS Com Sup Init – Personal Support Worker Training

Pertaining to the activities that provides personal support worker (PSW) training to a selected number of

current employees of providers or companies that have contracts to provide Homemaking/Personal

Support/Attendant/Respite Service to CCAC and provider that receive ministry funding to deliver assisted

living services and adult day programs. The training is provided by community colleges, private

vocational schools and some Boards of Education to train adults.

In addition to the number of employees (students) receive the PSW training. The provider is required to

maintain the records on the names and dates of the course(s).

Includes:




Course fees related to personal support worker training

Employee salaries (benefit hours) while attending the training

Supplies and travel expenses

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Appendix 7

Examples of Integration

Community Support Services have been built on a foundation of partnering and sharing resources. The

following chart demonstrates a few examples of the integration activities that have developed. This is not

intended to be an exhaustive list and the sector has a history of both vertical and horizontal integration

that has created efficient and effective service delivery.

Coordination Partnering Transferring and Merging

Planning (Volunteer)

Many organizations reported that

Board members participated on

the Board to Board Collaborative.

CSS providers in Haliburton work

cooperatively to recruit volunteers

for the SMART exercise program.

CSS providers in Scarborough

jointly provide training to

caregivers in the Ambassador

Training Program.

Planning (Staff):

Many organizations reported that

their staff participated on the

following structures:







CELHIN Collaborative

Seamless Care for

Seniors

Project Teams for CSS

Review, Caregiver

Support, Home at Last,

Rural Transportation and

Supportive Housing

Service Provider

Networks

Elder Abuse Prevention

Networks

Falls Prevention Networks

such as Partners in Aging

Peterborough

CSS organizations in

Peterborough and Haliburton

have created a purchase of

service agreement to provide

Caregiver Support Services for

clients dementia in Haliburton

County.

CSS partners with other sectors

including the broader Human

Services sectors in sharing

space and equipment.

Peterborough CSS providers

have created a partnership with

Central LHIN CSS agency to

provide Social Work services to

the Peterborough site.

Scarborough CSS agency

partners with Mt. Sinai Wellness

Centre to assist with providing

screening for mental health.

Scarborough CSS agencies

partner to provide Supportive

Housing to Wishing Well Manor

to both Chinese and non-

Chinese residents of a senior

housing complex.

CSS providers in Scarborough

contract with a variety of

healthcare organizations to subcontract

agreements to provide

Homemaking Service for both

the CECCAC and the

Homemaking and Nursing

Services program with the City

of Toronto.

CSS provider in Scarborough

contracts to with the City of

Toronto to provide direct

services with City sponsored

supportive housing programs.

CSS providers in the City of

Kawartha Lakes has partnered

CSS organizations in

Peterborough, Durham, City of

Kawartha Lakes and

Northumberland amalgamated

local chapters to provide the

common basket of CSS

programs to their community.

Many provincial CSS

organizations have consolidated

local branches to reduce the cost

of administration and reflect new

LHIN boundaries.

77


Administration:

MIS Advisory Working

Group


A number of

organizations reported

that they participated in a

Bulk Purchasing

agreement with other

Health sectors.

Many CSS agencies

participate in bulk

purchasing agreement

Ontario Community

Support Association

(OCSA) for both health

benefits and insurance.

Broader Human and Social

Services:

CSS providers coordinate

transportation and meal delivery

for both ODSP and DVA clients.

CSS agencies provide support

services for people with disability

that are coordinated with

Community Living organizations.

CECCAC coordinates admission

to Adult Day Programs in

Peterborough County, City of

Kawartha Lakes, Haliburton

County and Northumberland

CECCAC completes the

assessment as part of the

admission process for some

Supportive Housing program.

with CMHA, and Community

Living and the municipal

government to develop a

supportive housing project as

part of an Affordable Housing

initiative.

CSS providers across the

CELHIN area work cooperatively

to provide transportation and

meal programs for Adult Day

Services.

CSS providers coordinate

support with the District Stroke

Strategy Staff to jointly support

the Stroke Support Group for

survivors and their family.

CSS provider in the City of

Kawartha Lakes purchases

payroll services from the

Hospital sector.

CSS providers contract with

municipalities to provide

Accessible Transportation

Services for the community.

CSS providers contract with the

Hospital sector for nonemergency

transportation

services.

CSS providers throughout the

CELHIN area partner with

Nissan Canada Foundation in

the provision of Transportation

and Meal Delivery Programs.

Many CSS organizations

providing Meal Delivery

programs purchase the meals

from both LTC Homes and the

Hospital sectors.

CSS providers in Durham

coordinate transportation

services for the Region of

Durham.

Peterborough CSS providers

merged to create a single Meal

Delivery Program for

Peterborough City and County.

78


Ontario March of Dimes Durham

has service protocols for program

delivery, assess and volunteer

recruitment and recognition with

other organizations.

CSS organizations coordinate

services with Mental Health and

Community Living organizations

for shared clients.

CSS agency in Scarborough

provides Back Office support

(Financial, HR, IT and Marketing

to other local health and social

services organizations.

79

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