Members - Ontario Long Term Care Association

Members’ Meeting 

February 4, 2011 

AGENDA 

1. Call to Order 

2. Quorum 

3. Approval of Agenda 

4. Minutes of October 29, 2010 

5. President’s Report 

6. Government Relations & Advocacy Update 

7. Financial Liaison Update 

8. CEO’s Report 

9. Member Q & A

President’s Report 

Lois Cormack

LTC Transformation 

LTC has much to offer a changing health care 

system 

Members feeling the weight and magnitude of 

change 

Our sustainability and future success depend on: 

» changes in LTC policy 

» financial investment 

» regulatory change and public confidence 

» sustaining our current capacity at a minimum 

» investing in our future capacity including 

redevelopment 

3

Our Message 

Our success requires government to value current role 

and future potential of LTC by: 

» Funding the new requirements imposed by policy change: 

• The LTCHA and its Regulation 

• Mitigate the effect of the Harmonized Sales Tax (HST) on seniors 

living in private long term care homes in Ontario 

• Significant acuity increase impact on all envelopes 

» Continuing to invest in long term care sustainability by 

addressing inflationary and other cost pressures in all 

envelopes 

» Committing to increase the capacity of the sector by 

adding new health human resources 

» Slowing the pace and modifying the changes imposed 

4

Communicating Our Message 

This is a message that: 

» is backed up by evidence of the impact of 

LTC transformation on members 

» is set out in our Results Based Plan 

» your Board is bringing to over 50 Cabinet 

members, opposition critics, MPPs, Ministry 

political and bureaucratic staff 

This is the message we are asking you to 

take to your community and local MPP 

5

Success Requires Policy Change 

Our success requires government to: 

» Address the unintended consequences of the 

new Act 

» Identify sustainable solutions to operating 

funding 

6

We Have Made Progress 

Sign off by Deputy Minister on staffing 

flexibility recommendations 

Commitment to a regulatory fix for doors, 

generators, elevators and windows 

Commitment to improve rate reduction 

process 

Openness to moving adjustment period in 

future (unique to LTC) 

7

Success Requires Coordination 

A LTC Road Map to: 

» Manage the over 14 Ministry mandated 

initiatives in our sector 

» Influence the pace, timing and resources to 

support homes through implementation 

» Prioritize, coordinate and stage the initiatives 

to maximize the support provided to homes 

8

Our Message is Being Heard 

LTC Roadmap Executive Advisory Panel 

Commitment by Ministry, LHINs and OHQC 

to the Road Map process 

A new opportunity for the sector to influence 

unintended consequences of transformation 

and any new initiatives, monitor issues and 

progress 

9

Success Requires Leadership 

LTC homes demonstrate value to the health 

system: 

» quality improvement and resident outcomes 

» innovative and cost effective service provision 

» transparency and accountability 

10

Our Members Are Stepping Up 

530 homes are involved in Residents First 

quality leadership initiative 

130 homes have volunteered to publicly 

report on 6 resident outcome measures 

Homes continue to make significant strides in 

reducing falls, wounds, avoidable transfers to 

ED, etc. 

11

OLTCA Is Leading the Way 

Successful Applied Research Education Day & 

partnership; 375 people attended 

Conference Board of Canada Report and Expert 

Panel on Innovation 

Collaborative development of funding proposal 

on LTCH Centres of Learning 

Expanded commitment to quality: 2011 QI 

Award includes cash awards & enhanced 

promotional support (deadline March 1 st ) 

12

Success Requires Innovation 

Worked collaboratively with respected 

Conference Board of 

Canada to develop: 

Elements of an 

Effective Innovation 

Strategy for 

Long Term Care 

in Ontario 

13

Innovation Strategy 

First step in creating an LTC Innovation 

Strategy 

Very important project: 

» Our members need to internalize its contents – how 

will we prosper in the future 

» Demonstrates to government & public we are seeking 

solutions to improve long term care 

» Report to be released publicly this month 

14


The report says: 

“If the LTC sector is to survive and thrive in the 

emerging environment, it must undergo 

significant self-transformation and pursue 

improved relationships and integration with 

other parts of the continuum of care to ensure 

the most effective and efficient delivery of 

services to Ontarians.” 

15


It concludes: 

“And, if Ontario is to meet the needs of its aging 

population, it will need to support the innovation 

efforts of the LTC sector.” 

16

Strong Membership, Strong Association 

Member success requires a strong association 

that is: 

» Is financially effective in achieving our mission 

» Is organizationally effective in achieving results 

for members 

» Is innovative, solution oriented and forward 

looking 

» Understands member needs and facilitates 

member involvement 

17

Our Commitment 

Challenging times 

require not only sound 

strategy but also 

strategic flexibility 

We will continue to 

focus on: 

» Funding and Policy 

» Sector performance 

» System partners 

» Member satisfaction 

18

Advocacy Committee Report 

David Cutler 

VP, Government Relations

2010: A Year of Unprecedented Change 

 

 

 

 

 

 

 

 

The new LTCHA (July 1, 2010) and new 

regulations 

Compliance transformation 

OHQC public reporting & Residents First 

L-SAA; accountability for most funding 

transferred to LHINs 

RAI-MDS and MIS implementation 

Funding Review 

Capital Renewal 

HST 

20

Advocacy Strategy 

Stage 1 

» Raise key issues at Queen’s Park Day and elsewhere 

- Completed 

Stage 2 

» Refine our ‘ask’, meet with MOHLTC, educate 

government, opposition leaders, key MPPs 

- On-going 

Stage 3 

» Launch advocacy campaign, reinforce and build 

support in key budget decision-making period 

- On-going 

Stage 4 

» Design public advocacy campaign (will require levy) 

21

Our Advocacy Message 

The burden of these simultaneous changes coupled 

with a lack of investments/regulatory changes/policy 

clarifications, now means that we are perilously close 

to being unable to achieve government’s plan for long 

term care: 

» Unfunded regulations means non-compliance with the 

Act 

» Unfunded arbitrated settlements and WSIB increases 

means layoff of staff and deterioration of services to 

residents 

» Inadequate capital renewal program means inability 

to redevelop 35,000 B and C class beds and 

inadequate living environment for residents 

22

23 

Our Message 

Government 

Priorities 

LTC 

Initiatives 

Health Human Resources 

Property Tax Reimbursement 

Inflationary Cost Pressures 

Other Accommodation Erosion 

Other Policy Changes 

Achieving 

Better 

Outcomes 

HST 

Resident 

Acuity 

Adjustment 

WSIB 

Increases 

Long Term 

Care Act and 

Regulations 

Compensation 

Increases 

Sustainability 

Resources 

Regulations/ 

Policies 

23

Our Message 

NPC PSS OA 

Long Term Care Home Act and 

Regulations 

Base funding 

sufficient 

Base funding 

sufficient 

$13.4M 

($0.48prd) 

Resident Acuity Adjustments 

(2% adjustment in all envelopes) 

$45.9M 

($1.64prd) 

$4.5M 

($0.16prd) 

$27.8M 

($0.99prd) 

Compensation Increases 

(2% based on pattern set by 

arbitrated settlements) 

$45M 

($1.61prd) 

$3M 

($0.11prd) 

$12M ($0.43prd) 

WSIB Premium Increases 

(17% increase) 

$10.35M 

($0.37prd) 

$0.69M 

($0.03prd) 

$2.76M 

($0.10prd) 

Harmonized Sales Tax 

$0.74M 

$1.91M 

$11.75M 

($0.05prd) 

($0.13prd) 

($0.80prd) 

TOTAL $102M 

($3.67prd) 

$10.1M 

($0.43prd) 

$67.71M 

($2.80prd) 

24

Our Message 

OLTCA member homes can continue to be an innovative 

contributor in an integrated health system with 

appropriate resources, regulations and policies: 

» Funding of 2 % increase across all envelopes to cover 

compensation increases 

» Funding of 2 % increase across all envelopes to cover 

acuity increases 

» Policy changes 

• Generators, doors 

• Funding policies 

• Approval of funding review steering committee 

recommendations 

» Viable Capital Renewal program 

25

Message Being Delivered 

RBP submission to Government – November 2010 

Over 25 meetings to date: 

» Minister and senior staff 

» Opposition Leaders and senior staff 

» Key Government MPPs 

» Members and their MPPs underway 

Presentations and submissions to Government’s prebudget 

consultation initiative (Ottawa, Windsor) 

26

Current Status 

MOHLTC understands the issues 

> Letter from Deputy Minister re: door alarms, generators 

& windows 

Minister fully briefed 

MPPs get the issue and overall are 

supportive: no significant push back 

Keep meeting, keep pushing 

27

Making Ourselves Heard 

Keep the pressure on through: 

» Continued government meetings 

» Meetings with key cabinet ministers 

» Launch Innovation Strategy initiative 

» Meet MPPs with our Advocacy Campaign 

message: It Takes a Team to Care 

Member involvement at local level is crucial 

28

Advocacy Campaign 

It Takes a TEAM to Care 

29


A focus on our teams 

Our teams play an important role in 

providing quality of life and well-being to 

some of Ontario’s frailest elderly. These are 

the dedicated people who provide care 

and service to residents everyday, and each 

member of our teams ensures a caring and 

safe home. 

30


ePostCards being sent electronically to MPPs 

Posters for display in homes 

Flyers for distribution 

» Throughout homes 

» In resident invoices (March) 

Paper postcards (for those without Internet) 

Local MPP visits 

31


ePostCard 

32


Most powerful way to get our message across to 

government is through local MPPs 

Local meetings are taking place – get involved! We still 

need Riding Leads. 

Send an ePostCard to your MPP 

Educate staff, residents, families know about the 

campaign – have them send a postcard. 

Campaign will run through end of March, so lots of 

opportunity to get involved. 

33

Conclusion 

We have been very active on your behalf meeting with 

elected officials and senior staff 

One of the best RBPs submitted to government – they are 

impressed 

Government has heard us 

Getting positive signals on our requests 

> Hold off on non-CMI layoffs if possible (survey pending) 

But “life is uncertain,” so we must keep up the pressure 

Will continue to meet with government and seek 

commitment to our requests 

Will keep members updated as we move along 

34

In the meantime … 

Please support the Advocacy Campaign 

www.oltca.com/we-care 

35

Financial Liaison Committee Update 

Sheri Annable 

Vice President, FLC

Agenda 

Case Mix and Special Rehab 

Rate Reduction 

Other Funding Issues 

» Occupancy Targets 

» Wage Settlement Accruals 

» Year-end surplus PSW Funds 

» Financial Policies 

» Data Required - ARRs 

37 37

Case Mix and Special Rehab 

Homes are receiving their 2009/10 CMI letters from 

the Ministry this week 

On recommendation of the associations, the Ministry 

had planned to use a CMI measurement period from 

October 1,2009 to September 30, 2010 

Due to unresolved questions in respect of data 

quality, MOHLTC made a decision to use April 1, 

2009 to March 31, 2010. 

38

What is the Ministry doing 

 

 

 

Alerted sector to this trend in Communique 7 (May 

2010) when they also announced a data quality initiative 

to look at increasing special rehab assessments 

Monitoring the distribution of Special Rehab RUG 

categories 

» Algorithm to flag homes with high % of residents in the Special 

Rehab categories 

• Visits to homes to understand how therapies and nursing 

restorative care are organized and how that is recorded on the 

MDS assessment tool 

• Data analysis to explore the appropriateness of therapies and 

nursing restorative e.g. comatose; ADLs 

Providing education on the coding of P1b and P3 

42

What are others doing 

 

 

 

 

CIHI and InterRAI have made some changes to the 

RAI-MDS 2.0 and RAPs User’s Manual to help 

provide clarity for these areas 

» CIHI indicated earlier this week that many homes still 

have not ordered the new RAI-MDS 2.0 Manual 

CIHI and InterRAI provided a WebEx session in 

September on this issue 

Homes are now revisiting their data quality checks 

OLTCA and OANHSS through the Case Mix 

Transition Work Group are collaborating with the 

Ministry to find the answer to this trend 

43


Current Status 

» Association achieved extension to March 2, 2011 for 

applications, but we are also aware that there are 

numerous and significant concerns. 

» As of Feb 3: 

• 8500 of 32000 applications submitted; 

• 404 of 625 homes have submitted at least one application; 

• 1358 tickets received of which 1156 he been closed 

• Weekly working group meetings 

» Long way to go….brainstorming session held 

yesterday with Ministry and stakeholders to determine 

barriers to completion and action plan 

44


Action Plan 

» Ministry (Tim Burns) to communicate with sector next 

week on critical path 

• Appreciates that this is a mammoth task and the roll-out 

could have been far smoother 

• 221 homes have not submitted, MOHLTC to start making 

outreach calls 

• Ministry to release approaches to handling the most common 

resident scenarios 

• Focused on getting as many applications as possible by 

March 2; recognizes that there may be unique cases that 

cannot be addressed by deadline, but at this time not 

prepared to offer an extension at this stage 

• We will continue to push for further extension 

45

Other Funding Issues: Occupancy Targets 

Through the Long Term Care Funding Review table 

the current policy on occupancy targets (i.e. 97% 

threshold) is being reviewed with the goal of creating 

a fair policy that rewards all homes for systemic 

vacancies that occur from turnover, outbreak etc. 

The Association has a long-standing position of 

Actual + 3%, but this option is not gaining traction at 

the table due to the Ministry’s concern that this 

might be a disincentive to maximize occupancy. 

46


The Board is recommending to the 

membership that as an alternative we adopt a 

graduated approach that recognizes systemic 

vacancies based on occupancy levels, and 

maintains an incentive to maximize 

occupancy. 

47


Formal motion: 

» That, a graduated scale concept that 

recognizes systemic vacancies and retains 

>97% +3 to max of 100, be adopted as a 

position of the membership 

48

Eligibility of Wage Accruals 

 

Two scenarios in which the eligibility of 

wage accruals is being questioned by FMB: 

1. That wage accruals for unsettled collective 

agreements from 2007-2009 are not eligible 

per the program manual 

This is incorrect 

Program manual page being cited was replaced 

with explanation of how to treat wage 

accruals and they are eligible 

49

Eligibility of Wage Accruals 

2. That wage accruals for unsettled collective 

agreements from 2010 onwards are not eligible as 

a result of the Public Sector Compensation 

Restraint Act and the government’s direction that 

they will not fund any settlements. 

» Per the new eligibility rules wage accruals are 

eligible 

Both Deloitte and KPMG have written expert opinion 

letters stating that wage accruals are GAAP that 

auditors would use HLDAA to gauge accuracy of 

accruals. 

50

Surplus PSW Funds 

PSW funds from last year have not been fully 

utilized due to timing of the funds were 

announced. 

Requested that the Ministry allow these 

surplus funds to be used on a one-time basis 

for investments in: 

» High-low beds 

» Point of care technology 

» Patient lift replacement 

Timing is a challenge 

51

Financial Policies 

Priority policies: 

» Bad debt 

» Reconciliation and recovery 

52

OA Erosion Data Update Required 

ARR’s were used to calculate and provide 

hard evidence of OA erosion and provided 

the support for successfully getting the $1.55 

into base. 

Need to update our work & support. 

Request will be sent for 2007, 2008 and 2009 

ARR’s. 

53

CEO’s Report 

Christina Bisanz

High Performing Organization 

Member Services 

Partnerships 

Capacity for Quality 

Funding 

Health Human 

Resources 

Data Analytics 

Residents First 

LTC Roadmap 

Sector Performance 

Legislation 

Accountability 

Agreements 

Public Confidence 

Future Capacity 

System Integration 

Member Collaboration 


Placement 

MDS Roll Out 

LTC as Hub 

55

High Performing Organization 

Moving to a balanced budget: 

» Ended 2010 with 70% decrease in budgeted 

annual deficit 

» Reduced 2011 budgeted deficit without fee 

increase 

56

High-Performing Organization - 

Value-Added Services 

Member benefits 

» RBC group banking & more to come 

LTCHA education 

» new and linked with OANHSS 

57

High-Performing Organization - 

Membership 

3 month trial membership 

» Timed for advocacy & convention 

participation 

» “We are long term care” 

Membership recruitment: Commercial & 

Research/Education 

» “Have we got an app for you” 

Member engagement 

» Independent small operators’ (< 3 homes 

and up to 250 beds) dinner – Feb 4 

58

Capacity for Quality 

OLTCA 2011 Quality Awards (March 1 st ) 

LTCH Centres of Learning 

Aging Care and Services Consortium 

Colleges Ontario Advisory Group on Sector 

Education 

Beers List Campaign 

59

Sector Performance & System Integration 


» Conference Board Report & Expert Panel recruitment 

Public confidence 

» Auditor General, Ombudsman, IRPP, Toronto Star 

CALTC web site & common positions 

60

Strategic Focus for 2011 

Budget 

» Clarity and rapid roll out of funding required 

» Poised for public campaign if required 

Election 

» Government policy shutdown increases lag time 

» Enhanced period of scrutiny (Ombudsman, AG) 

» Opportunity to influence campaign platforms 

Public reporting 

» 6 indicators increase reputational risk 

» Data analytics – building internal capacity 

61

Members - Ontario Long Term Care Association

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