item # 1.0 Call to Order

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1 Table of Contents item # 1.0 Call to Order...2 Item # 1.1 Approval of Agenda...3 Item # 1.2 Conflict of Interest...7 Item # 2.0 Consent Agenda...8 Item # 3.0 Report from Board Chair & CEO...44 Item # 3.1 Report from Board Chair...45 Item # 3.2 Report from CEO...46 Item # 4.0 Board Education/Generative Dialogue Item # 4.1 'Patients First' Discussion Paper Item # 5.0 Strategic Dialogue Item # 5.1 Auditor General's Report - Recommendations on LHINs Item # 5.2 Health Quality Ontario - 'Measuring Up' Overview Item # 5.3 Accountability Agreement - LSAA Template Item # 5.4 Accountability Agreement - HSAA Amending Agreement Item # 6.0 Fiduciary Dialogue Item # 6.1 Verbal Report of the Governance Committee Item # 6.2 Verbal Report of the Finance & Audit Committee Item # 6.3 Quarterly CEO Attestation - 3rd Quarter (Q3) Item # 7.0 In-Camera Session Item # 8.0 Adjournment of Meeting...406

2 item # 1.0 Call to Order 2 of 406

3 Item # 1.1 Approval of Agenda 3 of 406

4 BOARD OF DIRECTORS MEETING Regular Agenda WEDNESDAY, JANUARY 27, :00 p.m. 9:00 p.m. Central West LHIN Office 8 Nelson Street West, Suite 300, Brampton, Ontario Local: / Toll-Free: / Conference I.D # Board Members: LHIN Staff: Maria Britto (Board Chair), John McDermid (Vice Chair), Gerry Merkley, Lorraine Gandolfo, Ken Topping, Suzan Hall, Pardeep Singh Nagra, Adrian Bita, Jeff Payne Scott McLeod (CEO), David Colgan, Brock Hovey, Tom Miller, Michele Williams, Elizabeth Salvaterra # Agenda Item To be Accomplished Lead Time 1.0 Call to Order The Chair to welcome Guests and any Observers from the public and clarify the meeting format. 1.1 Approval of Agenda To review and approve the Agenda for the Meeting. (Attachment) 1.2 Conflict of Interest To remind members of the Conflict of Interest Policy and procedures for declaring a potential conflict. 2.0 Consent Agenda (Attachment) To review and approve the Consent Agenda and remove items to the Regular Agenda for further discussion, as required Report from the Board Chair Board Members to receive a verbal update from the Board Chair and opportunity for Board Members to ask questions and seek clarification. Maria Britto Board Members Maria Britto 5:00 5:05 p.m. 5:05 5:10 p.m. 5:10 5:20 p.m. 3.2 Report from the Chief Executive Officer (Attachment) Board Members to receive a brief overview of the CEO s written monthly report and an opportunity to highlight specific activities, as well as an opportunity for Board Members to ask questions and seek clarification. Scott McLeod 5:20 5:30 p.m. 4.0 Board Education / Generative Dialogue 4.1 Patients First Discussion Paper (Attachment) Board Members to engage in a Generative Dialogue with respect to the Patients First Discussion Paper and what it means for the Central West LHIN Board Members 5:30 6:30 p.m. 4 of 406

5 # Agenda Item To be Accomplished Lead Time 5.0 Strategic Dialogue 5.1 Auditor General s Report Recommendations on LHINs (Attachment) Health Quality Ontario 5.2 Measuring Up Overview (Attachment) Board Members to review the Auditor General s Summary of Recommendations for LHINs Board Members to review and discuss the Measuring Up document and related materials from Health Quality Ontario (HQO). Please see link (below) to the main HQO document for information. suring-up-2015-en.pdf Scott McLeod/ Brock Hovey Brock Hovey/ Elizabeth Salvaterra 6:30 7:00 p.m. 7:00 7:30 p.m. 5.3 Accountability Agreements: LSAA Template (Attachment) 5.4 Accountability Agreements: HSAA Amending Agreement (Attachment) 6.0 Fiduciary Dialogue Note it is not expected that you read the entire document prior to the Board Meeting. Also, if you have previously received a hard copy of this publication, please bring it with you to the meeting. Board Members to review and approve the template for the Central West LHIN Long Term Care Sector Accountability Agreements (LSAA) Board Members to review and approve the Amending Agreement for the Hospital Sector Accountability Agreements (HSAA) Brock Hovey Brock Hovey 7:30 7:35 p.m. 7:35 7:40 p.m. 6.1 Verbal Report of the Governance Committee (Attachment) 6.2 Verbal Report of the Finance & Audit Committee (Attachment) Board Members to receive a verbal update on discussions held at the Governance Committee meeting of Thursday, January 14, 2016 and the Board to approve any recommendations coming forward from that meeting. Board Members to receive a verbal update on discussions held at the Finance & Audit Committee meeting of Monday, January 25, 2016 and the Board to approve any recommendations coming forward from that meeting: Lorraine Gandolfo Gerry Merkley 7:40 7:50 p.m. 7:50 8:10 p.m Third Quarter (Q3) Report (for approval) Ministry LHIN Accountability Agreement (MLAA) Third Quarter (Q3) Funding (for approval) In-Year Recovery and Reallocation Report (for information) 6.3 Quarterly CEO Attestation for Third Quarter (Q3) (Attachment) Base and One-Time Funding (for information) Board Members to review and approve the Quarterly CEO Attestation for Third Quarter (Q3) covering the period October 1, 2015 to December 31, :10 8:15 p.m. 2 5 of 406

6 # Agenda Item To be Accomplished Lead Time 7.0 In-Camera Session As required Maria Britto 8:15 p.m. 8.0 Adjournment To summarize action items and adjourn meeting Maria Britto 9:00 p.m. Date of Next Board of Directors Meeting: Wednesday, February 24, 2016 at 5:00 p.m. Central West LHIN Office Board Room 8 Nelson Street West, Suite 300 Brampton, Ontario 3 6 of 406

7 Item # 1.2 Conflict of Interest 7 of 406

8 Item # 2.0 Consent Agenda 8 of 406

9 BOARD OF DIRECTORS MEETING Consent Agenda WEDNESDAY, JANUARY 27, 2016 Central West LHIN Office, 8 Nelson Street West, Suite 300 Brampton, Ontario Attachments: 2.1 Minutes of Board of Directors Meeting held Wednesday, December 16, Minutes of Governance Committee Meeting held Thursday, December 10, IHSP-4 Briefing Note Update - Presented at Governance Committee Meeting held Thursday, January 14, Minutes of Finance and Audit Committee Meeting held Monday, September 21, Whole Board Evaluation Report Deloitte (November 2015) 9 of 406

10 MINUTES OF THE BOARD OF DIRECTORS MEETING WEDNESDAY, DECEMBER 16, :00 p.m. 8:30 p.m. Central West LHIN Office, 8 Nelson Street West, Suite 300 Brampton, Ontario Board Members Present: LHIN Staff Present: Regrets: Guests: Maria Britto (Board Chair), John McDermid (Vice Chair), Lorraine Gandolfo, Ken Topping, Gerry Merkley, Pardeep Singh Nagra, Adrian Bita, Jeff Payne Scott McLeod (CEO), David Colgan, Brock Hovey, Elizabeth Salvaterra, Tom Miller, Michele Williams Suzan Hall (Board Member) Bonnie Cochrane, Director, Partner Development and Coach, Studer Group Canada Mitch Hagins, General Manager, Studer Group Canada 1.0 Call to Order Maria Britto, Board Chair, called the Board Meeting to order at 5:00 p.m. 1.1 Approval of Agenda MOVED by Gerry Merkley and SECONDED by Ken Topping, that the Regular Agenda for the Central West LHIN Board of Directors meeting of Wednesday, December 16, 2015 be approved, as circulated. CARRIED 1.2 Conflict of Interest Maria Britto reminded Members of the need to declare a Conflict of Interest with respect to any items that could potentially place them in a conflict situation. There were no declarations. 2.0 Consent Agenda Maria also reminded Members to observe some of the feedback from the previous board evaluation, specifically to please turn off all cell phones as there will be an opportunity to check messages during a brief break. The Chair reminded Board Members that the process is that they can ask questions for clarification from the Consent Agenda, but if further discussion is required, the item will be pulled from the Consent Agenda and added to the Regular Agenda. There were no requests for further discussion on any of the items as presented within the Consent Agenda. Scott McLeod noted that all actions items as noted in the previous minutes had been addressed. 10 of 406

11 MOVED by Lorraine Gandolfo and SECONDED by Pardeep Singh Nagra, that the Central West LHIN Board of Directors approves the Consent Agenda, as circulated. CARRIED 3.0 Report of the Board Chair and Chief Executive Officer 3.1 Report of the Board Chair Maria provided a brief overview of the meetings and events she had attended over the last month and noted that she would provide a further update on LHIN Leadership Council discussions during the In-Camera Session. She further advised that she had requested that a Year in Review document be prepared for presentation at this meeting and Tom Miller, Director of Communications, will speak to this further under Item # Report of the Chief Executive Officer Scott highlighted the overview of his detailed monthly report noting the following areas: Peel and Waterloo CMHAs These two organizations are continuing the discussions to consider a realignment of the service delivery model. Peace Ranch/Supportive Housing in Peel This integration is moving along well and the Central West LHIN has approved one-time funding to support the full integration. Central West LHIN Quality Lead An offer has been made to the successful candidate for the full-time position of Quality Lead for the Central West LHIN. It is expected that the successful candidate will assume the position in January, Auditor General Report The Auditor General s annual report has been released and includes three health-care related sets of recommendations; one for LHINs, one for CCACs, and one for the Long Term Care sector. Scott noted that the LHIN and CCAC documents had been included in this month s Consent Agenda for information and advised that further discussion on the LHIN recommendations will be discussed in further detail at the January 27, 2016 Board of Directors Meeting. IHSP-4 The IHSP-4 was presented for final content approval at this meeting. The document now incorporates minor feedback that was received from the Ministry of Health and Long-Term Care. An IHSP-4 communications plan and roll-out will be presented at the January Board meeting. Hospital Pressures Scott McLeod reported that as a result of LHIN efforts William Osler Health System has been approved an additional $5 million in base funding from the Ministry of Health and Long-Term Care. It is a significant increase and will help address the multi-year plan to fully open Brampton Civic s full capacity. The proposal for Headwaters Health Care Centre has been withdrawn based on their projections for a balanced budget for 2015/2016. Their real challenges however, will be in the next fiscal year. Minutes of Central West LHIN Board of Directors Meeting held Wednesday, December 16, 2015 Page 2 of 5 11 of 406

12 4.0 Board Education/Generative Dialogue Building a Culture of High Performance (Studer Group) Guests Bonnie Cochrane and Mitch Hagins were introduced and welcomed to the meeting. As a way of preparing the upcoming Governance and Leadership Forum scheduled for Thursday, February 18, 2016 they provided an overview of the Studer Philosophy. There was a good discussion around system level expectations as they relate to the patient experience, and the need for standardized methodology and how some of the metrics for Health Links could be incorporated. Maria Britto thanked Bonnie and Mitch for their time and noted that the Board and the health service provider organizations were looking forward to hearing more about the Studer Philosophy in February, and how to creative a level playing field with respect to the patient experience across the Central West LHIN. 5.0 Strategy Dialogue 5.1 Balanced Scorecard Fall Cycle Elizabeth Salvaterra provided a brief overview of the Balanced Scorecard Fall Cycle, noting that the new Ministry-LHIN Accountability Agreement (MLAA) includes two new developmental indicators that have been defined and reported this quarter, under the LHIN Resident Experience and System Performance sections. There was a brief discussion and general agreement that some of the indicators will require some significant work. 5.2 Quarterly Enterprise Risk Management (ERM) Report Brock Hovey provided an overview of the Quarterly Enterprise Risk Management (ERM) Report, which is an annual review of all Central West LHIN risks. He noted that the number of top risks for the 3 rd Quarter of has increased from 6 to 7, based on a reassessment of mitigation strategies and priority rankings. The new top risk is Risk I.D. #58, Lack of Physician Support for LHIN initiatives. Brock further advised that at the November 2014 Board Meeting, a request had been made for the Board to see the complete listing of all Enterprise Risks being monitored at the LHIN in the 3 rd Quarter of each fiscal year. As a result of this request, information on all risks was provided to the Board. Currently, there are no new Enterprise Risks that have not already been reviewed by the Board. MOVED by Lorraine Gandolfo and SECONDED by Pardeep Singh Nagra, that the Central West LHIN Board of Directors approves the rd Quarter (Q3) Enterprise Risk Management Report, as circulated. 5.3 Central West LHIN Highlights of 2015 and Looking Ahead to 2016 CARRIED Maria advised that she had asked for a comprehensive overview of the major accomplishments of the Central West LHIN over the past year. Tom Miller provided an overview of some of the highlights and a brief discussion followed. Maria noted that this type of review will be undertaken on an annual basis going forward. Minutes of Central West LHIN Board of Directors Meeting held Wednesday, December 16, 2015 Page 3 of 5 12 of 406

13 5.4 Integrated Health Services Plan (IHSP4) David provided an overview of the changes highlighted in red within the IHSP which, reflects feedback received from the Ministry of Health and Long-Term Care. He noted that overall there was significant support for the directions suggested. MOVED by Lorraine Gandolfo and SECONDED by Gerry Merkley, that the Central West LHIN Board of Directors approves the final IHSP-4 document, with changes as highlighted. CARRIED 5.5 Lease of Property on EGH Site for Redevelopment of Ancillary Services Building 6.0 Fiduciary Dialogue David Colgan provided an overview of the briefing note, noting that it was an update to a briefing note presented at the May 27, 2015 meeting. He further advised that upon Board approval, the Central West LHIN will submit its written advice to the Ministry of Health and Long-Term Care to support the leasing of the property for the Ancillary Services Building, along with the supporting documents provided to William Osler, including the full business case document and associated matters listed within this briefing note. A brief discussion followed. MOVED by John McDermid and SECONDED by Adrian Bita, that the Central West LHIN Board of Directors will update its advice to the Ministry of Health and Long-Term Care of its support for the Lease of Property by William Osler Health System on the site of the Etobicoke General Hospital for the Purpose of Development of an Ancillary Services Building. CARRIED 6.1 Verbal Report of Quality Committee Meeting Held Monday, December 7, 2015 John McDermid, Committee Chair, provided a brief update on discussions held at the December 7, 2015 Quality Committee meeting which had been held at William Osler Health System to hear about their Quality Program in partnership with Health Quality Committee. He noted that the Central West CCAC had also been invited and there had been good discussion and feedback from all three organizations. He advised that the Quality Committee will take a break and reconvene in February and is hoping to meet with the Long Term Care sector at that time. He advised the Board that the new Quality Lead for the Central West LHIN, Nancy Labelle, will be starting on January 18, 2016 and noted that he and the Committee is looking forward to working with her. 6.2 Verbal Report of Governance Committee Meeting Held Thursday, December 10, 2015 Lorraine Gandolfo, Committee Chair, provided a brief update on discussions held at the December 10, 2015 Governance Committee meeting, noting that two governance policies had been reviewed and amended at that meeting that require Board approval. The first policy is the Personal Development/Education policy and the second is the Board Effectiveness policy. Minutes of Central West LHIN Board of Directors Meeting held Wednesday, December 16, 2015 Page 4 of 5 13 of 406

14 After a brief discussion, the following motion resulted: MOVED by Lorraine Gandolfo and SECONDED by Gerry Merkley that the Central West LHIN Board of Directors approves both the Personal Development/Education governance policy and the Board Effectiveness governance policy, as presented. CARRIED 7.0 In-Camera Session MOVED by Ken Topping and SECONDED by John McDermid, that at 7:40 p.m., the Central West LHIN Board of Directors consider Matters of Public Interest in a Closed Session as set out by the Local Health Integration Act, 2006, s.9(5)(a), and further, that Staff Members Scott McLeod, Brock Hovey, David Colgan and Michele Williams be invited to stay for this portion of the meeting. CARRIED MOVED by Ken Topping and SECONDED by John McDermid, that at 8:30 p.m., the Central West LHIN Board of Directors meeting be moved Out-of-Camera and back into the Regular Session. CARRIED 8.0 Adjournment of Board Meeting MOVED by Lorraine Gandolfo and SECONDED by Jeff Payne, that there being no further business for discussion, that the Central West LHIN Board of Directors Meeting of Wednesday, December 16, 2015 be adjourned at 8:30 p.m. Maria Britto, Board Chair Scott McLeod, CEO Minutes of Central West LHIN Board of Directors Meeting held Wednesday, December 16, 2015 Page 5 of 5 14 of 406

15 MINUTES OF THE GOVERNANCE COMMITTEE MEETING OF THE CENTRAL WEST LOCAL HEALTH INTEGRATION NETWORK HELD THURSDAY, DECEMBER 10, :00 p.m. 7:00 p.m. 8 Nelson Street West, Suite 300, Brampton, Ontario Committee Members Present: Lorraine Gandolfo (Committee Chair), Maria Britto (Board Chair), John McDermid (Vice Chair), Ken Topping (Member), Jeff Payne (Member), Adrian Bita (Member) Staff Members Present: Scott McLeod (CEO), Michele Williams (Board & CEO Liaison) Regrets: Suzan Hall (Member) 1.0 Call to Order & Declaration of Conflict of Interest Lorraine Gandolfo, Committee Chair, called the meeting to order at 5:00 p.m. and asked if there were any declarations of Conflict of Interest. There were none. 2.0 Approval of Agenda John McDermid requested that an additional item, Heroes in Health Care Award be added to the Agenda. MOVED by Jeff Payne and SECONDED by Adrian Bita, that the Regular Agenda for the Governance Committee meeting of Thursday, December 10, 2015 be approved, as amended. CARRIED 3.0 Consent Agenda 3.1 Approval of Previous Minutes Thursday, October 8, 2015 There were no errors or omissions noted in the previous minutes. Scott McLeod noted that all action items were either underway or complete. MOVED by John McDermid and SECONDED by Ken Topping, that the Consent Agenda, as circulated, be approved. CARRIED 15 of 406

16 4.0 Governance and Leadership Forums (Winter 2015 and Spring 2016) Scott advised that planning for the Winter Governance and Leadership Forum is well underway and will be held on Thursday, February 18, 2016 at the Brampton Courtyard Marriott. The topic will be A Culture of High Performance: Achieving Higher Quality at a Lower Cost, based on the Studer Philosophy and their Mission which is to Make healthcare a better place for employees to work, physicians to practice medicine, and patients to receive care. He noted that it is an interesting approach to creating an organizational culture of high performance, focused fundamentally on quality and patient experience. Both Headwaters Health Care Centre and William Osler Health System have adopted the Studer approach within their organizations, primarily within acute care, and with very good results. Keynote speakers from Studer attending and speaking at the February 18 th event will be Bonnie Cochrane and Mitch Hagins. Scott noted that the Spring Governance and Leadership Forum will take the form of a Central West LHIN Quality Symposium, with John McDermid and the Central West LHIN Quality Team taking the lead in the planning. A date for this Forum, expected to take place sometime in May, has not yet been confirmed. 5.0 Annual Pan-LHIN Whole Board Evaluation Process Maria advised Committee Members that the Pan-LHIN Whole Board Evaluation process has been completed and Deloitte Project Team is currently in the process of scheduling meetings with the LHIN Board Chairs and/or LHIN Governance Committees early in January to review their respective evaluation results. 6.0 Governance Policy Review: Board Education Policy and Board Effectiveness Policy Committee Members reviewed the Board Education Policy which had been discussed at the last meeting and updated accordingly. Two further revisions were made. The footer at the bottom of the document will be changed to reflect the date of December 2015 as the Date of Last Review. On page two of the document, under Item 3 Policy Implementation Strategies, the wording in the fourth paragraph with respect to registration, travel and accommodations expenses also include and other related expenses. MOVED by Ken Topping and SECONDED by John McDermid that the Governance Committee recommends approval of the Board Education Policy, as amended. CARRIED Committee Members reviewed the second governance policy on Board Effectiveness and asked that under Item (xii) with respect to Confidentiality, that the wording Consistent with our Confidentiality Policy, be added. MOVED by Jeff Payne and SECONDED by Adrian Bita, that the Governance Committee recommends approval of the Board Effectiveness Policy, as amended. CARRIED 7.0 Annual Board Retreat There was some discussion as to whether there was a need to hold a Board Retreat in the New Year and it was agreed that while a Board Retreat would be appropriate considering the system changes currently underway, it would most likely not take place until much later in the year. Minutes of Central West LHIN Governance Committee Meeting held Thurs., December 10, 2015 Page 2 of 4 16 of 406

17 This item was put on hold temporarily and will be discussed at a future meeting and most likely not until the Fall of Nominations Committee Terms of Reference Scott advised that a review of the Terms of Reference for the Nominations Committee had not been undertaken during the last round of annual reviews for the Board Committees and noted that some suggested changes had already been incorporated in the document as noted with the track changes. He asked Committee members if there were any additional suggestions for incorporation. A couple of additional changes were noted. The first was to update the footer at the bottom of the page to reflect the Governance Committee s review on December 10, 2015 and the second was under 2.0 Duties, where the fifth bullet will now read as follows: Recommend to the Board of Directors, potential appointees to the LHIN Board. MOVED by John McDermid and SECONDED by Ken Topping, that the Governance Committee recommends approval of the Nominations Committee Terms of Reference, as amended. CARRIED Committee Members suggested that the Nominations Committee Terms of Reference be placed on the Consent Agenda for the Wednesday, December 16 th Board of Directors meeting. 9.0 Heroes in Health Care Award John noted that he had come across a publication while in Florida entitled Heroes in Health Care, recognizing excellence in health care in Southwest Florida. He asked Committee Members whether they thought this might be something that could be considered for the Central West LHIN. After a brief discussion, it was agreed that copies of the document would be circulated to Committee Members for information. Action: Michele Williams There was agreement that further discussion of this item would be more appropriate through the Quality Committee and that it might be something to consider for the Central West LHIN Quality Symposium to be held in the Spring of Adjournment of Meeting MOVED by Adrian Bita and SECONDED by John McDermid, that there being no further business for discussion, that the Governance Committee meeting of Thursday, December 10, 2015 be adjourned at 6:10 p.m. CARRIED Minutes of Central West LHIN Governance Committee Meeting held Thurs., December 10, 2015 Page 3 of 4 17 of 406

18 Lorraine Gandolfo, Committee Chair Minutes of Central West LHIN Governance Committee Meeting held Thurs., December 10, 2015 Page 4 of 4 18 of 406

19 Briefing Note Report To: Agenda Number: Subject: Purpose: Central West LHIN Board of Directors Item # 2.3 (Consent Agenda) Integrated Health Service Plan (IHSP) Roll Out Communications Plan For Information and Discussion Date: Wednesday, January 27, 2016 Key Contact: Scott McLeod, CEO David Colgan, Senior Director Health System Integration Tom Miller, Director, Communications and Community Engagement Recommended Motion: N/A Background Summary IHSP will be released on Monday, February 1, This Briefing Note provides an overview of the roll out communications plan proposed for this release. Options Considered: It is proposed that the Central West LHIN conduct a hard launch of IHSP 4 that is divided into two Phases Phase 1: Release and Phase 2: Engagement/Promotion. Phase 1 Release: A release to local media outlets that highlights IHSP , and the IHSP Microsite. The IHSP microsite will go live on February 1, Additional collaterals provided for use in support of Phase 1 will include a full Digital Version of the document, available off Central West LHIN main and micro sites, as well as an IHSP brochure. Tools and their uses are outlined below. Phase 2 Engagement/Promotion: Consultations related to the Patients First discussion paper continue through February 29, 2016 and, given that IHSP does not come into effect until April 1, 2016, it is proposed that additional engagement and promotional activities about IHSP take place throughout March 2016, leading up to the April 1, 2016 effective date. 19 of 406

20 The Central West LHIN plans to roll out IHSP using the following tools/tactics: Tool Description Audience Timeline/Date IHSP (IHSP 4) Microsite Scheduled to go live on February 1, 2016, a bilingual IHSP microsite will be the primary tool for showcasing IHSP 4. General public. Live on Monday, February 1, Central West LHIN Main Website The Central West LHIN main Website will be used to drive viewers to the IHSP Microsite. General public. Live on Monday, February 1, Press Release Used to notify local media outlets of IHSP Local newspapers. Issued on Monday, February 1, 2016 IHSP Full version Digital Copy AODA compliant, digital versions of IHSP will be made available off the microsite and main Central West LHIN websites for download, in English and French. All marketing materials will drive to the microsite while indicating the availability of the digital version. General public. Available on Monday, February 1, 2016 IHSP Full version Hard Copy Hard copies of IHSP , in English and French, will be printed for select use. Select use among all stakeholders. Available on February 19, 2016 Proposed quantities: 500 English, 200 French Proposed distribution: Local Health Service Providers, community partners. IHSP Brochure IHSP One Pager A bilingual six panel brochure will be used as the primary marketing tool for print. A bilingual one page summary of key components of IHSP 4. Similar to the IHSP brochure, this represents a different way of presenting information. General public. Local Health Service Providers and community partners. General public. Local Health Service Providers and community partners. Available on Monday, February 1, 2016 Available on February 19, of 406

21 Press Release Monday, February 1, 2016 Internal distribution lists Monday, February 1, 2016 Central West LHIN enewsletter January edition Published early February February edition Published early March Teletownhall (with regional partners) March 2016 Presentations to MPPs, Regional March Ongoing and Local Councils Impact Analysis Alignment with Strategic Priorities Improve access to Care Stream Line Transitions and Navigation Drive Quality and Value Build on the Momentum Governance Best Practice Operational Excellence Enterprise Risk Implementation Plan All aspects of this roll out communications plan will be carried out according to the timelines indicated in the tools/tactics table. All tools/tactics are on schedule for release according to the tools/tactics table. A progress report on the Central West LHIN consultation process will be provided to the Central West LHIN Board of Directors at the February Board of Directors meeting with a copy of the final summary report to follow in March. Attachment(s): N/A 3 21 of 406

22 MINUTES OF THE FINANCE & AUDIT COMMITTEE MEETING OF THE CENTRAL WEST LOCAL HEALTH INTEGRATION NETWORK Held Monday, September 21, 2015 at 6:00 p.m. 8 Nelson Street West, Suite 300, Brampton, Ontario Committee Members Present: Ken Topping (Acting Committee Chair), Maria Britto (Board Chair), John McDermid (Vice Chair), Pardeep Singh Nagra (Member), Adrian Bita (Member) Staff Members Present: Scott McLeod (CEO), Brock Hovey, Tellis George, Michael Buchert, Michele Williams Regrets: Gerry Merkley (Committee Chair) 1.1 Call to Order & Declaration of Conflict of Interest Ken Topping, Acting Committee Chair, called the meeting to order at 6:00 p.m. and asked if there were any declarations of conflict of interest. There were none. 1.2 Approval of Agenda MOVED by John McDermid and SECONDED by Adrian Bita, that the Regular Agenda, as circulated, be approved. CARRIED 2.0 Approval of Previous Minutes 2.1 Minutes of Finance & Audit Committee Meeting held Monday, June 22, 2015 MOVED by Adrian Bita and SECONDED by Pardeep Singh Nagra, that the minutes of the Finance & Audit Committee meeting held Monday, June 22, 2015 be approved, as circulated. CARRIED 22 of 406

23 Annual Committee Effectiveness Assessment Committee Members reviewed the summary of feedback from the annual Committee Effectiveness Assessment. Committee Members were very satisfied with the feedback and there were no areas identified for action or follow-up. Ken, on behalf of Gerrry Merkley as Chair of the Finance & Audit Committee, thanked Committee Members and Staff for their excellent work and support over the past year. 4.0 Annual Review of Committee Terms of Reference Committee members conducted their annual review of the Terms of Reference and minor formatting items were suggested in order to be consistent with other Board Committee Terms of Reference. In addition, and as was recommended recently by the Governance Committee, that all Committee Terms of Reference include the following bullet under 3.1 Membership and Term of Office, the second bullet will be replaced with the following: The Board Chair will develop, on an annual basis, the proposed Finance & Audit Committee membership, taking into consideration each potential Member s experience, background and interests for approval by the Board as a whole. Staff will make the necessary revisions to the document and include it as part of the Consent Agenda for approval at the September 25, 2015 Board of Directors Meeting. Action: Michele Williams MOVED BY Adrian Bita and SECONDED by John McDermid, that the Finance & Audit Committee recommends Board approval of the Finance & Audit Committee Terms of Reference, as amended Finance & Audit Committee Annual Work Plan CARRIED Committee Members reviewed the Committee Work Plan and a couple of minor revisions were made. A decision had been made some time ago that the December Finance & Committee meetings would be permanently moved to the month of January. Therefore, the Work Plan items noted under December, will be moved to reflect January. No other changes were noted on the Work Plan. MOVED by Adrian Bita and SECONDED by Pardeep Singh Nagra, that the Finance & Audit Committee recommends Board approval of the Finance & Audit Committee Annual Work Plan, as amended. CARRIED Minutes of Finance & Audit Committee Meeting held Monday, September 21, 2015 Page 2 of 5 23 of 406

24 Second Quarter (Q2) Report Brock Hovey and Michael Buchert provided an overview of the Second Quarter (Q2) Report and reviewed the various components of the Quarterly Report, including: Local Health System Update (required for Q2 only) Status Update on Special Initiatives (required for Q2 only) Status Update on Integration Activities (required for Q2 only) Quarterly Balance Sheet Forecast (required for Q1, Q2 and Q3) Sector Forecast (required for Q1, Q2 and Q3) LHIN Operations Forecast (required for Q1, Q2 and Q3) A couple of minor errors were noted in the Table of Contents section of the narrative which will be changed to reflect the wording Q2 as opposed to Q12. After a detailed review and discussion of the various components of the Quarterly Report, the following motion resulted: MOVED BY John McDermid and SECONDED by Adrian Bita, that the Finance & audit Committee recommends Board approval of the Central West LHIN Second Quarter (Q2) Report, as amended. CARRIED Second Quarter (Q2) Ministry LHIN Performance Agreement (MLPA) Funding Update Brock Hovey and Tellis George provided an overview, for information only, of the HSP funding (MLPA) as at August 31, 2015 and Schedule A which provides an overview (sorted by sector and by HSP list), as follows: - HSP opening base funding as at April Base funding approval since April - Revised total base funding - One-time funding approval from April to August 31, Total funding approved as at August 31, 2015 The report outlines all of the funding that has been flowed through the LHIN between April 1, 2015 and August 31, 2015 as well as all community allocations made during this time. Staff advised that Schedule B provides additional detail in support of Schedule A, allocated by sector, program and funding type and that both tables reconcile to Ministry MLAA funds and the Q2 Quarterly Sector Forecast. Minutes of Finance & Audit Committee Meeting held Monday, September 21, 2015 Page 3 of 5 24 of 406

25 First Quarter (Q1) Procurement Report Brock and staff provided an overview, for information, of the First Quarter (Q1) Procurement Report and provided background on the history of the report. They noted that this Quarter s report is in compliance with procurement requirements and is not intended to reconcile to the consulting line in the LHIN Operations report. They also noted that there were no additions or completions during this timeframe. They advised that the Physician Leads no longer are included within this report. There were some questions and a brief discussion regarding the e-health - Information Management Information Technology (IMIT) funding and a suggestion was made to invite Andrew Hussain, Regional Chief Information Officer for the Central West LHIN, to a future meeting to provide Committee Members on an update on this item. 9.0 Review of Quarterly Compliance Dashboard and Year-End Review Action: Brock Hovey Brock and staff members provided a brief overview of the Quarterly Compliance Dashboard and Year-End Review. There was some discussion regarding the need for staff to do some follow-up in terms of compliance, particularly with respect to United Achievers and Friends and Advocates of Peel. An overview of the approach taken with respect to the Year-End Review, and the recommendations contained within the report, was also discussed in detail Approval of Board Chair Expenses Committee Members reviewed a recommendation to approve a new practice with respect to approval of the Board Chair s expenses, noting that advice received recently from LHIN Legal Services has advised that best governance practice would be for the Audit Committee to approve the Chair s expenses to provide an accountability check and balance and not the CEO, which is currently the process at the Central West LHIN. Alternatively, the Chair of the Audit Committee could also take that role. After a brief discussion and agreement, the following motion resulted: MOVED by John McDermid and SECONDED by Pardeep Singh Nagra, that the Finance & Audit Committee recommends Board approval that, effective immediately, approval of the Board Chair s expenses will be undertaken by the Chair of the Finance & Audit Committee. CARRIED Minutes of Finance & Audit Committee Meeting held Monday, September 21, 2015 Page 4 of 5 25 of 406

26 11.0 In-Camera Session There was no In-Camera business for discussion at this meeting Adjournment of Meeting MOVED by Adrian Bita and SECONDED by Pardeep Singh Nagra, that there being no further business for discussion, that the Finance & Audit Committee meeting of Monday, September 21, 2015 be adjourned at 7:50 p.m. CARRIED Ken Topping, Acting Committee Chair Central West Local Health Integration Network Minutes of Finance & Audit Committee Meeting held Monday, September 21, 2015 Page 5 of 5 26 of 406

27 Central West Local Health Integration Network Board Evaluation Survey Draft Report December of 406

28 Table of Contents Background and Methodology. 2 Board Evaluation Role of the Board 2. Information and Decision-Making 3. Monitoring and Accountability 4. Board Culture 5. Board Structure and Process 6. Overall Feedback 1 Board Evaluation Survey: Draft Report for Central West LHIN (December 2015) 28 of 406

29 Background and Methodology Annually, the Board of Directors for each of Ontario s Local Health Integration Networks (LHINs) undertake a selfassessment to determine opportunities for continued improvement. The survey included a Board-wide evaluation as well as an assessment specific to the Chair of the Board and each Member of the Board Board members and select Staff from each LHIN were invited to complete the survey The online, confidential survey was conducted from November 2 to November 18, 2015, and received the following response rates: Board Chair: 14 of 14 received (100%) Board Member: 89 of 94 received (95%) LHIN Management: 67 of 74 received (91%) The survey focused on a number of key areas: Board and Staff views on the role and priorities of the Board Quality and effectiveness of information and decision making Effectiveness of overall monitoring and accountability Views of the Board s culture Effectiveness of core Board processes How to read the results: For purposes of reporting, each of the options was given a numerical value (Insufficient Knowledge = 0, Very Dissatisfied / Strongly Disagree = 1, Dissatisfied / Disagree = 2, Satisfied / Agree = 3, Very Satisfied / Strongly Agree = 4) and an average was then calculated and is represented as a / (see below) Note. Throughout this report green boxes ( ) have been used to highlight areas for further consideration. In most instances, respondents were aligned on their views; however, where the average score masked a range of opinions commentary was provided in the accompanying observations Given that each Board has a relatively small number of Board members and participating Staff, data and conclusions should be considered as opportunities to begin deeper and more fulsome discussion. Given the limited data, in our reporting, we have focused on the quantitative analysis and limited qualitative or interpretative analysis. We have, however, highlighted those areas that warrant further discussion at the Board. 2 Board Evaluation Survey: Draft Report for Central West LHIN (December 2015) 29 of 406

30 Board Evaluation 3 Board Evaluation Survey: Draft Report for Central West LHIN (December 2015) 30 of 406

31 1. Role of the Board Alignment on understanding of the role of the Board Summary Data Insufficient Knowledge Strongly Disagree Disagree Agree Strongly Agree I believe that I have a strong understanding of the role of this Board. I believe that other Board members have a strong understanding of the role of this Board. I believe that our Board is aligned in its understanding of its role. Board Responses Staff Responses Observations Board members individually reported ( I have ) a strong understanding of the role of the Board and were confident that the full Board is aligned on a shared view of the role of the Board These perception were largely shared by LHIN staff 4 Board Evaluation Survey: Draft Report for Central West LHIN (December 2015) 31 of 406

32 1. Role of the Board Understanding of and ability to deliver on LHIN objectives Summary Data I believe the primary role of this Board is: 0% 20% 40% 60% 80% 100% To lead management To support management To represent key stakeholder interests Insufficient Knowledge Strongly Disagree Disagree Agree Strongly Agree I believe this Board has the necessary tools to deliver on its role. I believe this Board has the necessary authority to deliver on its role. I believe this Board has the necessary influence to deliver on its role. Board Responses Staff Responses Observations The majority of board members and staff were aligned in the belief that the primary role of this board is to represent key stakeholder interests There was a difference in beliefs between the board and staff around the board having the necessary resources to deliver on its role Staff have a stronger belief that the board has the necessary authority to deliver Whil Board members show a stronger belief that they have necessary authority and influence to deliver 5 Board Evaluation Survey: Draft Report for Central West LHIN (December 2015) 32 of 406

33 1. Role of the Board Understanding of and ability to deliver on LHIN objectives Summary Data Participants were asked to rank the relative importance of ten responsibilities of Boards. A weighting was applied to each rank that could be selected and a prioritized order of board responsibilities was identified. The reported rank order of responsibilities is shared below as percentage of the highest ranked response i.e., fulfilling fiduciary and legal duties, as outlined in application legislation. I define the primary responsibility of the Board as: Fulfilling fiduciary and legal duties, as outlined in applicable legislation 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 100% 100% Ensuring that the strategic plan of the LHIN has been properly articulated Ensuring that the operations of the LHIN are consistent with the strategic plan Ensuring that there is an effective performance measurement framework for evaluating the outcomes of strategy execution Providing oversight and performance management of the CEO Ensuring that there is effective controllership and value for money in the usage of LHIN funds Ensuring that there is an effective risk management framework Engaging stakeholders major stakeholders Engaging stakeholders health service providers Engaging stakeholders patients, families, and other community members Board Responses Staff Responses 6 Board Evaluation Survey: Draft Report for Central West LHIN (December 2015) 33 of 406

34 1. Role of the Board Understanding of and ability to deliver on LHIN objectives Summary Data Insufficient Knowledge Strongly Disagree Disagree Agree Strongly Agree I believe Board members should be actively involved in community engagement. Board Responses Staff Responses I believe it is appropriate for Board members to engage in the following examples of community engagement: Communicating priorities set out in the CW LHIN Strategic Plan Performing governance-to-governance / board-to-board meetings with local health service organization Connecting with the local community via town hall meetings Supporting the CW LHIN community advisory committee and meeting with the committee on a frequent basis Engaging in conversations with the community to better understand their needs Communicating the role of the CW LHIN to the broader public Conducting on-site visits to local health service providers Performing consultations with health service providers on appropriate topics Attending Annual General Meetings and events (e.g., announcements, facility openings) organized by local health service providers Participating in training opportunities and conferences / forums Observations (Previous page) Both the Board and Staff prioritized fulfilling fiduciary and legal duties as its primary responsibility (Previous page) The most significant differences in opinions on the primary role of the Board were all around engagement (with major stakeholders, health service providers and patients / families) which the Board prioritized but Staff did not Board members and staff members were aligned to the view that Board members should be actively involved in community engagement 7 Board Evaluation Survey: Draft Report for Central West LHIN (December 2015) 34 of 406

35 1. Role of the Board Value of the Board Board and Staff members provided open ended comments on their views with respect to the value of the Board Board Member Responses A cohesive team that works together in a productive manner Is community focused in its work as a board Represents the community from various perspectives Knowledgeable and committed to delivering the best health care Keeps the system accountable and focused on delivering against the needs of the community Reaches out to health service providers to enable two way dialogue Abides by its directives and operates at a high level of transparency Provides support to patient-focused services Commentary Both the board and staff value the board s patient-centred focus and objective to provide services that fulfill the needs of the community The staff value the board s strong connection with the community and ability to deliver on its role Staff Member Responses Has a strong connection with the broader community Demonstrates a patient-centered focus on ensuring decisions are made and resources are allocated to help address the priority health care needs of residents Understands its governance role vis a vis the management role Fulfills fiduciary and legal duties, as outlined in applicable legislation 8 Board Evaluation Survey: Draft Report for Central West LHIN (December 2015) 35 of 406

36 2. Information and Decision-Making Summary Data Observations I believe this Board has sufficient health sector knowledge to properly engage in asking questions of the management team. I believe this Board receives high quality information that supports effective decision-making. I believe this Board makes efficient use of management s time in preparation for and during meetings. Insufficient Knowledge Strongly Disagree Disagree Agree Strongly Agree Overall, board and staff members expressed confidence in the knowledge / expertise of the board, the quality of information and performance metrics There were differing opinions on the expertise level of the board, with management expressing less confidence in the board s ability to understand of implications I believe this Board has sufficient expertise to understand the implications of information provided. I believe this Board make decisions after sufficient discussion about underlying problems, challenges and opportunities has occurred. I am always comfortable with the decisions made by this Board. I believe this Board is able to make timely decisions. I believe this Board receives timely information related to the implementation of Board decisions. I believe this Board has the appropriate performance metrics to measure the outcomes of Board decisions. Board Responses Staff Responses 9 Board Evaluation Survey: Draft Report for Central West LHIN (December 2015) 36 of 406

37 3. Monitoring and Accountability Summary Data Observations I believe this Board has an effective framework for clarifying the strategic priorities of the LHIN. I believe this Board has an effective framework for guiding the execution of the strategic priorities of the LHIN. Insufficient Knowledge Strongly Disagree Disagree Agree Strongly Agree Overall, the board and staff reported that there are effective tools and frameworks for guiding strategy design and execution Board members expressed a high level confidence in operating with an independent and effective relationship with management; while Staff articulated a slight lower level of confidence I believe this Board has taken responsibility for ensuring the LHIN has an effective risk management framework. I believe this Board has effective reporting processes to assess the LHIN s success at achieving strategic priorities. I believe this Board has effective metrics to assess the LHIN s success at achieving strategic priorities. I believe this Board has taken responsibility for ensuring the LHIN has a framework to manage information security and privacy. I believe this Board has an independent and effective relationship with management. Board Responses Staff Responses 10 Board Evaluation Survey: Draft Report for Central West LHIN (December 2015) 37 of 406

38 4. Board Culture Governance Approach Summary Data Observations I believe this Board s approach to governance has been clearly defined. Insufficient Knowledge Strongly Disagree Disagree Agree Strongly Agree The board and management believe that the board had clearly defined an approach to governance however, both report a highly variable range of views on governance models The dominant approach to governance on this Board can be best described as: It was noted by a respondent that the board may operate with a hybrid strategic-generative model Board Responses Staff Responses Other Generative 25% 38% 33% 38% Strategic 67% Generative Strategic Definitions provided in the survey: Operational: The Board manages the work of the organization by monitoring and directing operations and overseeing the work of management Policy: The Board governs through policies that establish organizational aims and management limitations Strategic: The Board provides strategic direction including setting strategic priorities and monitoring performance in achieving them Generative: The Board engages in conversations that test the assumptions of presented solutions, identify what the right questions should be, and actively define and apply organizational values, beliefs and cultures Board Responses Staff Responses 11 Board Evaluation Survey: Draft Report for Central West LHIN (December 2015) 38 of 406

39 4. Board Culture Perceived Strengths and Challenges Summary Data Observations 100% Top challenges with the culture of this Board in rank order include: 80% 60% 40% 20% 0% Accountable Open Engaged Top strengths with the culture of this Board in rank order include: 0% 20% 40% 60% 80% 100% 100% 100% Participants were asked to rank the relative importance of strengths / challenges with the culture of the Board. A weighting was applied to each rank that could be selected and a prioritized order of strengths / challenges was identified. The reported rank order of responsibilities is shared to the left as percentage of the highest ranked response i.e., (strengths) engaged. 100% 100% 100% Collaborative Efficient Inclusive Definitions provided in the survey: Accountable: Takes responsibility for decisions made and actions taken Open: Welcomes new ideas and questions; unreserved and candid Engaged: Actively and enthusiastically participates in carrying our responsibilities of the Board Collaborative: Works with and supports one another to achieve the objectives of the LHIN Efficient: Focuses on results and stays on topic Inclusive: Encourages and promotes participation from all members The board and staff agreed that the top strength of the board s culture was its engagement Both groups also identified efficiency as the greatest challenge facing the board s culture while Staff also identified inclusion as a top challenge The most significant difference in opinion was around engagement also being considered a top challenge as board members agreed with this sentiment but LHIN staff did not agree Board Responses Staff Responses 12 Board Evaluation Survey: Draft Report for Central West LHIN (December 2015) 39 of 406

40 5. Board Structure and Processes Rated and Open Feedback Summary Data Observations I am satisfied with the following aspects of this Board: Board Appointment Process Board Application Process Board Member Skill-Based Competencies Board Member Diversity (reflective of the populations that are served) Number of Board Positions (irrespective of whether the position is empty/filled) Length of Term as Board Member Structure of Committees Effectiveness of Committees Insufficient Knowledge Very Dissatisfied Dissatisfied Satisfied Very Satisfied Results in this section appear to be fairly satisfied across perspectives of both the board and staff However, a level of dissatisfaction was articulated by both the board and management towards the board application process There was marginal dissatisfaction with the board application process, length of board term and use of one on one interactions with the Board Chair Time Commitment as Board Member Use of One-on-One Time between Board Member and the Board Chair Use of In-Camera / Closed Sessions Effectiveness of CEO Performance Management Process Continuous Improvement of Board Governance Quality and Effectiveness of Board Training and Education Programs Board Responses Staff Responses 13 Board Evaluation Survey: Draft Report for Central West LHIN (December 2015) 40 of 406

41 5. Board Structure and Processes Board Education Summary Data This Board will benefit from additional education on: 0% 20% 40% 60% 80% 100% Mandate of the LHIN Role of the Board Financial Condition Observations The board has a wide range of interests for ongoing education with a focus on healthcare service delivery models and health service provider needs / performance This focus is generally supported by Staff who also note that additional learning in the legislative / regulatory environment would be of value Risks Legislative and Regulatory Environment Healthcare Service Delivery Models Health Service Provider Needs and Performance Community Healthcare Needs Governance Approaches New Board Member Orientation 14 Board Evaluation Survey: Draft Report for Central West LHIN (December 2015) Board Responses Staff Responses 41 of 406

42 6. Overall Feedback Final Reflections Board and Staff members provided open ended comments on their overall views of Board strengths and opportunities Board Member Responses Strong ability to conduct community engagement and the strategic planning process Board governance and focus on accountability were recognized as ongoing strengths The board committee structure was acknowledged as working well Similarly, the efficiency of meetings was an identified strength Opportunities for improvement were identified around: Providing a greater level of one-onone time with the board chair Continuing to improve on quality and value for money for the LHIN Engaging with senior staff other than the CEO Commentary The board was acknowledged as having a strong presence within the community and should continue to develop interactions with health service providers Staff Member Responses The board has a very focused approach on continuous improvement and has collectively improved on focusing on their mandate The board demonstrates an enhanced understanding of regional needs / interests Overall governance process was noted as improving significantly Opportunities for improvement include: Reducing the length of board meetings Reflecting on the current composition of the board to inform additions to the membership Focusing discussions / initiatives on regional needs versus targeted residential needs 15 Board Evaluation Survey: Draft Report for Central West LHIN (December 2015) 42 of 406

43 43 of 406

44 Item # 3.0 Report from Board Chair & CEO 44 of 406

45 Item # 3.1 Report from Board Chair 45 of 406

46 Item # 3.2 Report from CEO 46 of 406

47 CEO Report to the Central West LHIN Board of Directors January 27, Access to Care 1.1 CHRONIC DISEASE PREVENTION AND MANAGEMENT (CDPM) Registration for the Annual Central West Chronic Disease Prevention and Management Conference on February 19 th is underway with ninety health care professionals registered to date. Dr. Barry Simon will be presenting the keynote address on the Impact of Depression on Chronic Illness. Dr. Eileen devilla, the Medical Officer of Health for the Regional Municipality of Peel will share ideas regarding Chronic Disease Prevention: Putting the Health Back into Health Care. Dr. Vikram Comondore will be providing an update on What s New in Chronic Obstructive Pulmonary Disease. This full day event has an exciting program of topics and speakers. The CDPM staff and the Equity and Diversity Lead have planned an educational session for Health Service Providers (HSPs) on the Health Equity Impact Assessment tool. Sixteen persons from across the LHIN, including Diabetes Education Program staff, have registered for the January event. 1.2 MENTAL HEALTH AND ADDICTIONS Immediately following approval of one-time funding on December 9 th, 2015, Peace Ranch and SHIP initiated work with a consultant to conduct the steps toward integration as outlined by the Central West LHIN. The final project schedule was shared with the LHIN on January 12 th including a target date for submission of a draft implementation plan. Staff of both Central West and Waterloo Wellington LHINs have reviewed the interim report received mid-december exploring the transfer of Dufferin County services between Peel and Waterloo Wellington Dufferin branches of the Canadian Mental Health Association (CMHA). On January 15 th, the LHINs discussed the options with both providers and after further discussion internally, followed up with preliminary input. The CMHA branches will continue their collaboration to determine how to transfer services which is aimed at improving accessibility and responsiveness of services as well as accountability to the Central West LHIN on behalf of Dufferin County residents. The Ministry of Children and Youth Services (MCYS) announced the appointment of the CMHA Waterloo Wellington Dufferin as Lead Agency for children s mental health services for Dufferin Wellington. The LHIN accepted CMHA s invitation to participate in early planning activities which will see the development of a community plan for children s services, including transition to adult health care services. The appointment of Lead Agencies supports MCYS s plan Moving on Mental Health so that all children and youth with mental health problems in Ontario, and their families will know what mental health services are available in their communities and how to access the mental health services and supports that meet their needs. 47 of 406

48 Following participation at the Dufferin County Poverty Reduction and Housing Forum in December, LHIN staff have been asked to participate in the County s Steering Committee to begin discussions on strategic direction and next steps to ending poverty locally. The committee seeks to develop a shared view of poverty and begin a Results Based Accountability (RBA) process to establish a draft plan for a Dufferin Poverty Task Force, establish criteria for the recruitment of a coordinator and host agency, and continue the work on acquiring a coordinator for the strategy including a financial plan. The 10-Year Mental Health and Addictions Strategy is aligned to both the provincial Poverty Reduction and Affordable Housing strategies, particularly through housing. LHIN staff are already engaged with the Region of Peel regarding housing and with 15/16 community funding expanded Support Within Housing to 100 clients across the LHIN. The mental health strategy also has a focus on vocational support services. Given the health impact of poverty, this work also dovetails to the high user population targeted through Health Links as well as the LHIN s focus on population health. Peel was the site of one of 18 Provincial Service Collaboratives, a key input by the Ministry of Health and Long-Term Care (MOHLTC) to Years One to Three of the Ten-year strategy. Below is a link to a YouTube video which highlights an outcome of the local collaborative: collaboration between faith communities and mental health service providers to improve recognition of mental health issues and access to support by children and youth. This initiative continues under the leadership of Punjabi Community Health Services SERVICES FOR SENIORS Central West LHIN has increased access to Assisted Living services over the past four years. Currently six Community Support Service agencies receive over $10.6 million to provide Assisted Living services to 763 individuals in 20 locations across the LHIN. Two models of Assisted Living are funded, the hub model which is centred on people living in a specific building, and a spoke model which services people living in the community within 20 minutes of a hub. Additionally, there are various models of tenancy within hub buildings. During the process of yearend reviews questions have emerged about the relative performance of the various models of Assisted Living. The 2015 Community Capacity Plan identified Assisted Living as a key element in reducing the demand for Long-Term Care (LTC). In an effort to better understand the Assisted Living services and to ensure that local funding and performance expectations are grounded in best practice the LHIN has contracted with Lough Barnes to conduct a rapid review of the program. The review will be conducted over the next eight weeks. The Central West LHIN received $245,706 to fund two Nurse Practitioners to work in four LTC Homes. Shelburne Residence and Dufferin Oaks will share one position and Grace Manor and Faith Manor, both operated by Holland Christian Homes, will share the second position. The two new positions will be evaluated to determine if they should be imbedded in the LTC Homes and realigned with the Nurse-Led Out-Reach (NLOT) program. Once these positions have been filled every LTC Home in the LHIN will have access to a Nurse Practitioner either through the NLOT program or through this new initiative. Carolyn Clubine the Director of Seniors Services at the Region of Peel and long-time collaborator with the LHIN has announced her retirement effective the end of January. Carolyn was a member of the Services for Seniors Core Action Group from its inception and was leading the Region s redevelopment plans for the Peel Manor site of 406

49 2. Stream Line Transitions and Navigation 2.1 HEALTH LINKS The Health Links Steering Committee met for the first time this year on January 8 th, the focus of the discussions was to discuss how to reach a greater degree of scale and reach for frail and complex patients. Health Quality Ontario (HQO) took the lead in sharing and presenting some lessons learned from other provincial Health Links. While there were no conclusive examples of a scale model that the Central West LHIN Health Links have not adopted or created, there is a clear appetite and need to build for greater reach to complex patients in the LHIN and throughout the province. The Steering Committee and Health Link Leads will be holding a work shop in the next month to identify opportunities for greater standardization of processes as well as strategies to ensure scale. 2.2 PRIMARY CARE NETWORK Planning is underway for the engagement of physicians into the MOHLTC discussion paper Patients First: A Roadmap to Strengthen Home and Community Care. The session is expected to take place in early February with the participation of the Central West Primary Care Network as well as other invited community physicians. Staff as well as the Provincial Physician LHIN leads will be meeting on January 18 th to discuss the role of primary care in strengthening home and community care as well as system realignment. 2.3 TELEMEDICINE/TELEHOMECARE The Central West LHIN s Telemedicine program is currently being launched in palliative care to bring care closer to home and improve access to acute palliative care support. The Central West CCAC is working with Dr. Naheed Dosani at William Osler Health System (Osler) to provide care to palliative care patients in their homes through the use of Ontario Telemedicine Network (OTN). The status and progress of this launch will be presented at the February Steering Committee. The Central West LHIN is also meeting with Osler to explore the viability of launching a Tele- Mental Health Program similar to the one running at Trillium Health Partners whereby patients are remotely accessing and talking to mental health nurses through the use of OTN. The Regional Telehomecare program has currently enrolled a total of 1,592 patients in the program and has reached 65% of its performance target for this fiscal year. The Telehomecare Team continues to expand the use of the program in newer settings such as Assisted Living spaces and Adult Day Programs. The program was presented to the LHIN s Senior s Core Action Group and there was willingness to pilot Telehomecare in these settings. The Central West LHIN is currently analyzing where the enrolled patients have been coming from and going to overlay socioeconomic status data analysis for presentation at the February Steering Committee. This information will assist in developing strategies and actions to improve accessibility of the program for underserved and vulnerable populations in the LHIN. 2.4 ENABLING TECHNOLOGIES Hospital Report Manager (HRM) HRM is an application that enables primary care providers and specialists, with eligible Electronic Medical Record (EMR) systems, to receive patient reports electronically from participating hospitals. HRM electronically delivers Medical Record reports (e.g. Discharge Summary) and transcribed Diagnostic Imaging (excluding image) reports from hospitals directly into the patients charts in the clinicians EMR. There are currently 252 physicians in the Central West LHIN geography receiving hospital reports electronically into their EMRs and an additional 130 physicians completing activities required to go live with HRM of 406

50 Rapid Electronic Access to Clinical Health Information (REACH) Expansion - REACH is a Clinician portal that enables the sharing of patient acute care and CCAC encounter information across organizations in the Central West and Mississauga Halton LHINs. The Central West and Mississauga Halton LHINs Regional IT Integration Steering Committee identified a valuable opportunity to expand access to REACH to community based HSP clinicians this fiscal. Access to REACH by Community provider clinicians will: o Provide information to support collaboration and coordination of patient care o Facilitate better decision making by the providers o Increase efficiency in provider operations by providing patient information available 24/7 o Leverages existing investments Work is underway to revise the REACH Data Sharing Agreement (DSA) to include the requirements that come with expanding REACH access to community based HSP clinicians. Development of an additional level of security to access the REACH portal is also required when expanding access to community based HSP clinicians. This security development is underway and is expected to be complete this fiscal year. Once both the DSA and security work are complete, access to additional community based HSP clinicians will be provided. 3. Drive Quality and Value 3.1 CENTRAL WEST LHIN QUALITY COMMITTEE QUALITY GOVERNANCE ENGAGEMENTS The Central West LHIN Quality Committee continues with its HSP engagement strategy with a focus on patient experience. In February the Committee will be engaging representatives from the Long-Term Care sector Holland Christian Homes, Region of Peel and Sienna Senior Living Deerwood Creek Care Community. The event will be hosted at one of these HSP sites. 3.2 RECRUITMENT OF CENTRAL WEST LHIN QUALITY LEAD The recruitment process for the Central West LHIN Quality Lead is complete. The successful candidate is Nancy LaBelle, who joined the LHIN on January 18 th, 2016 (see no. 6 Outstanding People, for Nancy s BIO). 3.3 HEALTH SYSTEM FUNDING REFORM (HSFR) PROVINCIAL GOVERNANCE RESTRUCTURING Health System Funding Reform (HSFR) was introduced in Ontario in 2012 as one of the key pillars of Ontario s Excellent Care for All Act (ECFAA). Since the introduction of HSFR, significant progress has been achieved with the implementation of Health Based Allocations Model (HBAM) and Quality Based Procedures (QBPs) in the hospital and Community Care and Access Centers (CCAC) sectors and with the completion of the resident classification system that drives the LTC Case Mix Index (CMI). In preparation for year four of the reform, the MOHLTC engaged with system partners to identify how to further advance HSFR to support the delivery of high quality care. One recommendation was to renew the provincial governance structure to ensure that the appropriate strategic oversight was in place and that the system was moving in a direction that linked quality and funding. The MOHLTC has moved forward and is in the process of implementing a new governance model currently overseen by a Leadership Council with three advisory committees a Hospital Advisory Committee (HAC), a Community Advisory Committee and a Data Strategy Advisory Committee. Roll-out of the HAC is underway with the support of three Subgroups Formulae & Tools Subgroup (Hospital members, LHINs, MOHLTC and Cancer Care Ontario 4 50 of 406

51 (CCO)), Quality & Policy Subgroup (Hospitals, MOHLTC) and Communications, Education / Knowledge Translation Subgroup (CEKT) (Hospitals, LHINs, OHA). The CEKT Subgroup is being co-chaired by Joanne Marr, CEO of Markham Stouffville Hospital and Brock Hovey, Senior Director, Central West LHIN. 3.4 HOSPITAL FUNDING The MOHLTC has provided the LHIN with $5,020,000 base funding for William Osler Health System as part of the $25 Million business case we have been actively advocating for to fully open the Brampton Civic. In total over $11 Million were received over the last two years. The Ministry has indicated that this funding represents its final commitment related to the hospital s October 7, 2013 request for Growth Funding. We will regroup with William Osler to determine our next steps. 4. Build on the Momentum 4.1 ABORIGINAL HEALTH The recommendations of the Truth and Reconciliation Commissions on health will be evaluated at the Provincial Annual Planning Conference in May and where possible incorporated into the Provincial Aboriginal LHIN Network annual work plan and goals. A preliminary analysis highlights the need for more cultural competency training, training and recruiting Aboriginal Health Human Resources and establishing targets to address gaps in health outcomes.. The Aboriginal Health Consultant presented the Central West and Mississauga Joint Aboriginal Work Plan to the Board of the Dufferin County Cultural Resource Centre (DCCRC). This was a second meeting with the organization. As a result of the meeting the DCCRC agreed to participate in the planning of a formal LHIN- Aboriginal Community engagement structure. The Central West and Mississauga Halton LHINs, in collaboration with the Peel Aboriginal Network (PAN), have organized a first meeting of three Aboriginal community groups operating within the LHINs. This meeting taking place on January 20 th with PAN, DCCRC and the Credit River Metis Council, will focus on the attributes and structure of a formal LHIN- Aboriginal Community engagement structure. 4.2 DIVERSITY AND HEALTH EQUITY The Central West LHIN staff is working with pan-lhin colleagues to identify strategies and resources to enhance diversity and health equity training at various levels within the LHIN and HSPs to ensure long-term capacity building in this area. The LHIN is also exploring how health equity charters are developed within organizations and crosssector agencies in order to develop a common health equity charter for the Central West LHIN. HSPs that participate in the Diversity and Health Core Action Group are currently assessing the ability to collect health equity data within their organizations. The Mississauga Halton LHIN is leading this work with community providers and are open to aligning their work to accommodate timelines and work plans in the Central West LHIN. There is also a potential partnership opportunity with the Colour of Change Network that has been funded for a project manager by the Ontario Trillium Foundation to advance work in the health equity data collection. Central West LHIN staff continue to lead training sessions on the Health Equity Impact Assessment (HEIA) Tool. A training session was held for Bethell Hospice Staff on Thursday, November 19 th, More recently a session was led for HSPs mainly working in Chronic Disease and Prevention on Tuesday December 1 st, Feedback to date has been positive with increased understanding of Health Equity and the use of the HEIA Tool of 406

52 4.3 FRENCH LANGUAGE SERVICES (FLS) Reflet Salvéo submitted its draft recommendations for its annual advisory report. The three French Language Services Coordinators are submitting feedback to the Entity. The recommendations centred around four strategic priorities: active offer, mental health, equity and the incorporation of a francophone lens in health planning. The French Language Services Core Action Group met on December 9 th and received a presentation by Lydia Fiorini, the Executive Director of the Sexual Assault Centre of Essex County, on their innovative partnership with three other organizations, including health, community and legal services, to deliver FLS in the region. Their co-location and partnership allowed for a pooling of French speaking human resources and a continuum of services for the Francophone Community. 4.4 PALLIATIVE CARE The MOHLTC continues to fill positions in the new Ontario Palliative Care Network (OPCN) secretariat with the hiring of a Director. The OPCN, through its Implementation Advisory Group and Clinical Council, continue to identify the common elements of a regional palliative care program while the Performance Measurement working group is focused on identifying the top priorities for provincial palliative care indicators. In December, the OPCN worked with the LHINs to circulate a survey on residential hospices. The results are being analyzed and will be reported on in February. In December, the OPCN and Cancer Care Ontario (CCO) were invited to consult with the MOHLTC on physician-assisted death. The Central West Palliative Care Network is following the work of the OPCN closely and will incorporate any new directions into the local structure. The Network is hosting a half day retreat in January to review the recent work of the OPCN, and to incorporate this and the new joint CCO-LHIN reporting relationship into the Strategic Plan. 4.5 HEALTHY CHANGE INITIATIVE The Steering Committee met on January 8 th to review activities and networking that members have been involved in from the month prior. With these meetings starting the pathway ahead will involve a greater numbers of meetings with leaders throughout Brampton as well as with the select schools and principals. To enable this work LHIN staff will be meeting with Osler and Region of Peel staff communicators to develop a supportive package of information. Part of the package will involve a social media component that will be tested with potential audiences. 5. Operational Excellence 5.1 COMMUNICATION AND COMMUNITY ENGAGEMENT Events (Upcoming) - Communications support will be provided to the following events as required: o February (various) Public/Stakeholder consultations re: Patients First discussion paper (See BN contained in January 2016 Board Package for Community Engagement Plan) o February 1 st, 2016 Release of IHSP o (See BN contained in January 2016 Board Package for Communications Plan) February 9 th, 2016 South Asian Community Forum (Maria Britto to deliver welcome remarks) 6 52 of 406

53 o o o February 10 th, 2016 Governance and Leadership Forum February 19 th, th Annual Chronic Disease Prevention and Management Conference (Maria Britto to deliver welcome Remarks) February 20 th, 2016 Government and Community Services Fair (Hosted by MPP Yvan Baker at Cloverdale Mall) News Releases / Advertorials/Advertising o Week of January 25 th, 2016 Advertising to support Patients First discussion paper community/public consultations taking place in February o February 1 st, 2016 News release to support media/public awareness of IHSP o Week of February 8 th, 2016 Advertising to support the release of IHSP General o o Health Service Provider (HSP) Satisfaction Survey 2016 The Central West LHIN has engaged the services of Grosso McCarthy to conduct the 2015/16 HSP Satisfaction Survey, which was initiated on Tuesday, January 12 th, The survey will be available for completion through end of business Tuesday, January 26 th, Results are expected to be presented to the Central West LHIN Board of Directors in February Central West LHIN Citizen Panel As part of community consultations associated with the Patients First discussion paper, the Central West LHIN will engage all LHIN residents who indicated an interest in being part of a Citizens Panel when completing the IHSP telephone or online surveys last fall. This timely consultation provides a unique and important opportunity to engage this group of residents for the first time. 5.2 PATIENTS FIRST DISCUSION PAPER Following the release of the Patients First discussion paper on December 17 th, 2015, the MOHLTC committed to begin an engagement process to discuss how to successfully plan and implement the proposed approach with both the public and health system partners. While the MOHLTC is proposing to engage with stakeholders across a number of channels, LHINs have specifically been asked to hold multiple public consultations that include patients and caregivers. The purpose of these consultations will be to provide an overview of the MOHLTC s four-part proposal for the next steps in transforming the health care system, and to seek feedback from health system partners, patients, clients, and caregivers. A Briefing Note outlining the communications plan associated with Patients First discussion paper community/stakeholder consultations is included with the Board Package for review. 5.3 INTEGRATED HEALTH SERVICE PLAN (IHSP) PLANNING IHSP will be released on Monday, February 1 st, It is proposed that the Central West LHIN conduct a hard launch of IHSP 4 that is divided into two Phases including Phase 1: Release, and Phase 2: Engagement/Promotion. A Briefing Note outlining the communications plan associated with the release of IHSP is included with this Board Package for review of 406

54 ANNUAL BUSINESS PLAN (ABP) With the co-leadership of Kevin Davidson, Health System Integration Specialist and Patrick Boily, French Language Service Coordinator the first draft of the ABP was delivered to Senior Directors (SD) before the holidays for review. Their comments are being incorporated into the draft. The draft ABP will be presented to the Board at the February Board meeting 5.5 SYRIAN NEW CANADIANS The Federal Government s commitment to bringing in 25,000 new Syrian Canadians by the end of February 2016 remains unchanged. Update - Upon arrival at a Canadian point of entry, privately sponsored new Canadians will make their way to their final destination in communities across Canada, 39 of which have been announced by the federal government as being in Ontario. Government sponsored arrivals will either be directed to one of six Resettlement Assistance Program (RAP) cities in Ontario, or one of five Interim Lodging Sites (ILSs) in Ontario. Canadian Forces Base (CFB) Kingston will be the first ILS to welcome new government sponsored Syrian Canadians. As previously reported, all new Syrian Canadians will arrive with permanent resident status, and will receive Interim Federal Health Program (IFHP) coverage and documentation at their point of entry. Those who are remaining in Ontario can register for the Ontario Health Insurance Plan (OHIP) at a ServiceOntario Centre. The MOHLTC has approved the deployment of Emergency Medical Assistance Team (EMAT) personnel to provide on-site primary care support at Pearson International Airport. The MEOC is also planning for onsite care at CFB Kingston, and is engaging local partners. Current State - Throughout the course of the Holiday Season and into the new year, refugees have continued (and are continuing) to arrive at Pearson International Airport, in both commercial flights chartered by the federal government as well as in smaller numbers on regular commercial flights. The Emergency Management Assistance Team clinic remains embedded at the Pearson Infield Terminal to provide on-site medical assistance for charter flights which, are arriving at Pearson almost daily, usually bringing refugees with them. o Total Arrivals to Date (Canada): 6,720 arrivals in Canada between November 4 th, 2015 and January 6 th, 2016 o Total Arrivals to Date (Ontario): 4,222 arrivals in Ontario by chartered flights. 2,402 settled in Ontario o Quarantine Officer Screening: 106 screened (67 at Toronto, Pearson). Eight ordered to report to hospital o Airport Clinic: 141 individuals seen at Toronto, Pearson clinic. Eight transported to hospital Additional Resources Ontario Ministry of Health and Long-Term Care o Public Information: Click Here o Ontario s Health Action Plan: Click Here o Emergency Management: Click Here o Minister Memo: Update on Syrian Refugee Resettlement December 1st, 2015: Click Here Government of Canada o Map and list of destination communities for privately sponsored Syrian New Canadians: Click Here o Key Figures: Click Here o Volunteer in your area: Click Here 8 54 of 406

55 5.6 SERVICE ACCOUNTABILITY AGREEMENTS (SAA) UPDATE Hospital - HSAA: The HSAA Advisory Committee continues to work towards a new HSAA template agreement to be put in place by June 30, In the short term, LHIN CEOs have agreed to provide a three month extension beyond the term of the current HSAA. A two-thirds majority of LHINs must approve the extension in order to ensure that it is mandated for use in LHINs across the Province (MOHLTC-LHIN MOU, Section 14.2 b). The HSAA amending agreement will be presented to the Central West LHIN Board for approval when it is released. Long Term-Care Homes - LSAA: A new LSAA agreement has been released by the LSAA Advisory Committee and all LHIN Boards are asked to review it. The new LSAA will be presented at the January, 2016 meeting of the Board. Again, a two-thirds majority of LHINs must approve the new LSAA. Multi-sector - MSAA: LHINs across the Province will also be amending their MSAAs by introducing a refreshed set of schedules for The MSAA amending agreement will apply to the last year of the current MSAA. When the Central West LHIN entered into MSAAs for a three-year term effective April 1, 2014, the budgeted financial data, service activities and performance indicators for the second and third year of the agreement (fiscal years 2015/16 and 2016/17), were replicated based on planning assumptions. The LHIN would now like to update the MSAA to include the required financial, service activity and performance expectations for 2016/17 fiscal year. Board approval of the MSAA Amending Agreement is not required because the Board has already approved this MSAA and the amendment is within the current term of the agreement. 5.7 EMERGENCY PREPAREDNESS From December 9 th through to January 13 th, the Central West LHIN led a weekly call with local HSPs, including public health units, hospitals, the CCAC, and EMS providers, to discuss proactively the status of health system operations across the LHIN during the holiday season. Topics covered at each weekly call included: o Holiday surge in emergency departments and hospital inpatient units: There was an increase in emergency department visits over the holidays, with the Brampton Civic Hospital reaching a record number of visits (456) on December 26 th. Measures that had been put into place in anticipation of this increase were successful in preventing the increased volumes from having an impact on overall patient flow through the hospital and the rest of the system. o Influenza activity or other outbreak: No influenza, and very little respiratory illness of any kind, was seen in patients at the hospitals or reported by public health units over the holiday period. This low incidence is consistent with what was seen during this influenza season in the antipodes; a milder form of influenza is expected in North America in the spring of o Syrian refugees Osler is the destination hospital for all medical emergencies occurring at Pearson International Airport. The province has established an on-site clinic at the airport to see and treat refugees arriving from Syria as part of the federal government s commitment to bring in 25,000 people by the end of February. This measure has been successful in preventing a large number of transfers to the hospital, with only eight transfers occurring out of more than 6,700 refugee arrivals. The impact of these new residents on the Central West LHIN health system has been essentially nil during this period. 6. Outstanding People Nancy LaBelle, joined the LHIN on January 18 th, 2016 as the Quality Lead. Nancy LaBelle is passionate about the provision of quality care to patients, clients and families it is one of the driving reasons she became involved in the quality agenda 9 55 of 406

56 over 20 years ago it allows her to bring together her clinical experience as a registered nurse with a focus on best outcomes through process redesign and improvement. Nancy joins us from Joseph Brant Hospital where she led two successful surveys with Accreditation Canada, with the most recent survey in 2014 resulting in Accreditation with Exemplary Standing for the hospital. She also provided support to the Quality Committee of the Board and led the development of the annual Quality Improvement Plans and critical incident reporting as per the Excellent Care for All Act. Nancy will apply this operational experience to her role as the Quality Lead with a focus on quality planning and integration across the LHIN. Nancy holds a Master of Continuing Education from the University of Calgary where she majored in workplace learning. 7. Select CEO Updates 7.1 SUPPORTIVE HOUSING IN PEEL(SHIP) I attended the SHIP Staff Engagement Session on December 15 th. I provided an overview of the work of the LHIN, our emerging strategic priorities and answered questions from the participants. 7.2 MEETING WITH THE CEO OF ALBERTA HEALTH SERVICES On January 4 th the LHIN CEOs met with Vicki Kaminski, the current CEO of Alberta Health Services. Previously she was CEO of a Newfoundland Health Authority, and prior to that the CEO of the Sudbury Health Science Centre. She shared with the CEO group her insights into the key success factors related to the Discussion Document. 7.3 MOHLTC EXECUTIVE LEADERSHIP TEAM (Previously referred to as MMC) AND LHIN CEOs JOINT MEETING ELT LHIN A meeting was held on January 5th. In addition to the updates from the Deputy, key discussion items included updates on: o Discussion Paper: Engagement Plan The MOHLTC shared the engagement plan outlining expectations of MOHLTC and LHINs. LHINs have been asked to lead public and stakeholder engagements related to the discussion document through January and February. Communication The MOHLTC shared the draft key messages and discussion questions to be used as part of the Engagement Plan. This material is still being refined and final materials are not yet available. Creation and Structure of a Provincial Transition Team The MOHLTC provided an overview of the proposed approach to establishing a Provincial Transition Team using a portfolio management approach. Development of Framework for Transition The MOHLTC and the LHIN Mandate team are currently developing a Transition Checklist that will outline the key due diligence steps that will be required over the next 12 months. o The communication and consultation strategies have continued to evolve since this meeting and staff continue to develop the plan for engaging the public and key stakeholders. An update on the Discussion Document and the engagement strategy is part of the Board Agenda. o ehealth 2.0 Update the MOHLTC provided an update on the work of the ehealth Investment and Sustainability Board (which I sit on) to develop a renewed comprehensive ehealth strategic plan. It is expected that the plan will be finalized by June of 406

57 7.4 WILLIAM OSLER CLINICAL PLAN On January 8th Osler presented to the LHIN their Clinical Services Plan for 2016 to This is effectively their 3- year strategic plan related to clinical services. It is an ambitious plan that is somewhat dependent on the availability of incremental base funding yet to be secured. 7.5 ehealth INVESTMENT AND SUSTAINABILITY BOARD On January 11 th I attended the seventh meeting of the ehealth Investment and Sustainability Board charged with developing the next strategic plan for ehealth in Ontario. Writing of the new strategy is in progress and it is expected that the new plan will be finalized by June MEETING WITH ONTARIO S CHIEF INNOVATION STRATEGIST On January 11 th I met with Bill MacLeod, CEO, Mississauga Halton LHIN and William (Bill) Charnetski, Chief Innovation Strategist to discuss the emerging priorities for innovation in Ontario. He outlined his priorities related to innovation as follows: o o o o o Create Pathways to Adoption Procurement / Supply Chain Management Home an Community Care Consumer ehealth Aboriginal Health He is currently in the process of creating a small team of innovation brokers whose role it will be to help identify, launch, and spread innovation in Ontario. 7.7 RESIDENTIAL HOSPICE On January 13th I, along with members from the Palliative Care Network, met with a team from St Paul s Presbyterian Church from Brampton. They are considering an opportunity to build a residential hospice in Brampton on land they currently own adjacent to their Church. Getting approval for a residential hospice in Brampton is a priority for Central West. We provided answers to specific questions they had as well as an overview of the process currently underway to identify communities that will be allocated the 20 new residential hospices outlined in the Provincial Budget. 8. On the Horizon 8.1 HOME AND COMMUNITY CARE ADVISORY TABLE MEETING #3LHIN LEADERSHIP COUNCIL The next meeting of the Advisory Table is scheduled for January 20th. 8.2 THE LEADERSHIP COUNCIL The next meeting of the LHIN Leadership Council (consisting of the 14 LHIN Chairs and CEOs) will be held on January 21st. A key agenda item is the Discussion Document and reaction to the proposals. 8.3 THE LHIN CEO / SENIOR DIRECTORS AND MOHLTC EXECUTIVE STRATEGIC SESSION of 406

58 On January 22nd the LHIN CEOs, Senior Directors and MOHLTC will be having a retreat focused on the Discussion Document. Key objective include: o To develop a shared understanding of the Discussion Document and non-negotiables; o Consensus on the elements of a compelling vision; o Consensus on what must be different going forward; o Consensus on what needs to (or can) begin now; and o A shared understanding of the conditions required for successful implementation. 8.4 THE CENTRAL WEST LHIN STAFF RETREAT On January 26th we will be having a full Staff Retreat. Key agenda items include: o Living well with stress; o The Respect Program; and o The Patient s First Discussion document and its implications for Central West. 8.5 REGION OF PEEL HEALTH SYSTEM INTEGRATION COMMITTEE On February 4th I will be attending the Region of Peel s new Health System Integration Committee. Sharon Lee Smith, Associate Deputy Minister of Health will be in attendance to provide an overview of the Discussion Document. 8.6 CONSULTATIONS REGARDING THE DISCUSSION DOCUMENT We are currently finalizing a number of consultation sessions with public and key stakeholders to occur through late January and February. We will let the Board Members know when these sessions have been finalized and Board participation is welcomed. Governance and Leadership Forum On February 10 th we will be hosting a repurposed Governance and Leadership Forum with a focus on the Discussion Document. I am very pleased that Dr. Bob Bell has agreed to attend to provide the context and an overview of the discussion document. A revised invitation to the Governance and Leadership Forum has been released and we are expecting a very good turnout. 9. For information 9.1 HEALTH SERVICE PROVIDER INFORMATION Profile of Peel Cheshire Homes (see attachment) 9.2 HOSPITAL PARKING POLICY ANNOUNCEMENT See attachment 9.3 HOW CANADA COMPARES: RESULTS FROM THE COMMONWEALTH FUND 2014 INTERNATIONAL HEALTH POLICY SURVEY OF OLDER ADULTS See attachment of 406

59 Health Service Provider Profiles (Based on Accountability Agreement) HSP Peel Cheshire Home (Brampton) Residential supportive housing unit located at 156 Murray Street, Brampton. Location Hours of Service: Outreach Program - 6:00 a.m. to midnight, 7 days per week, 365 days per year. Aging At Home Program - 6:00 a.m. to midnight, 7 days per week, 365 days per year. Supportive Housing Program - 24 hours per day, 7 days per week, 365 days per year. Adults 16 years of age and older who live life with a physical disability, the majority of clients are confined to wheelchair. Client Population Services open to all cultural communities; services primarily provided in English, however, we have a very multi-cultural staff who speak numerous languages. Applicants: are insured under Health Insurance Act of Ontario have a permanent physical disability are able to clearly direct their own personal support and homemaking services. Geography Served Services are provided in the clients' homes throughout the City of Brampton, or accompanying clients out and about in their community. Residential supportive housing unit located at 156 Murray Street, Brampton. Peel Cheshire Home Brampton Inc. is a charitable not-for-profit organization that provides support to adults who live life with a physical disability. Description of Services Peel Cheshire Home owns and operates a twelve (12) unit supportive housing unit that provides residents with a private room with bathroom, attendant care, food preparation, and other services which support independent living. Peel Cheshire Home also provides an Outreach Program for approximately 40 physically disabled adults who live in their own home within the City of Brampton. Personal Support Workers (PSWs) 59 of 406

60 assist the "consumer" with daily living needs such as bathing, meal preparation, grocery shopping, etc., with some light housekeeping as required. LHIN Funding LHIN Global Base Allocation $1,097,254 Plus other ministry funding - rent supplements $107, one-time $87,662 replacement flooring, lighting and windows one-time $59,000 replacement hot water tank and storage, commercial dishwasher, and wandering detection system. Clinical Activity (by Service Category if required) In-Home Community Services / Personal Support / Independence Training: Individuals Served 40 Hours of Care 6,001 Assisted Living Services: Individuals Served 12 Resident Days 4,380 Total LHIN Funded Full- Time Equivalent Administration In-Home Community Services Assisted Living Services Total 1 FTE 7 FTE 13 FTE 21 FTE Challenges and Opportunities 1. Residential clients are developing secondary illnesses as they age, such as diabetes, loss of strength to self-transfer, chronic pain, eyesight/hearing issues, and Peel Cheshire Home working with clients and other agencies to provide/acquire appropriate supports; train staff to assist; adjust dietary requirements; etc. 2. Facing a high demand for Outreach Services which Peel Cheshire Home is unable to meet, meeting targets and then referring clients to other service providers where able and monitoring expenses closely. 3. Continuing to face 3 year budget freeze while costs continue to rise, tendering contracts to attempt to reduce costs; health benefits continue to increase; WSIB increased by 11% on January 2015; inflationary pressures such as food prices continue to increase. Opportunities to reduce costs are limited as 88% of budget supports staff wages and benefits. 4. Reserve fund study completed in 2013 indicates that reserve fund is underfunded and Peel Cheshire Home has no means to offset this risk. 5. The Board of Directors is concerned that with the increased amount of personal liability attributable to individual Board Members in conjunction with rising costs, frozen budgets, and increased accountability requirements (i.e. Accreditation) that it will become increasingly more difficult to retain and/or attract Board Members of 406

61 NEWS Ministry of Health and Long-Term Care Ontario Making Hospital Parking More Affordable Putting Patients First By Reducing Fees for Frequent Visitors January 18, :00 A.M. Ontario is making hospital parking more affordable for thousands of patients, their loved ones and caregivers. As of October 1, 2016, hospitals that charge more than $10 a day for parking will be required to provide 5-, 10- and 30-day passes that are: Discounted by 50 per cent off their daily rate Transferable between patients and caregivers Equipped with in-and-out privileges throughout a 24-hour period Good for one year from the date of purchase. Ontario consulted with patients, patient advocacy groups, hospitals and the Ontario Hospital Association to find a fair plan that reduces the financial burden of parking fees for patients and their visitors. Between now and October 1, 2016, hospitals will work directly with their Patient and Family Advisory Councils to implement this new policy, ensuring that it is well promoted and easy to understand. Each hospital will provide details on its specific parking policy and discounts. Approximately 900,000 patients and visitors - including 135,000 seniors - are expected to benefit from reduced parking fees each year. Saving patients and their loved ones money on hospital parking is part of the government's plan to build a better Ontario through its Patients First: Action Plan for Health Care, which is providing patients with faster access to the right care, better home and community care, the information they need to stay healthy and a health care system that's sustainable for generations to come. QUOTES " Parking fees should never be a barrier for patients when they go to the hospital. With today s announcement, we are providing relief from the high cost of parking at some hospitals in Ontario. By making parking more affordable for patients and their loved ones who visit the hospital often, we are helping to reduce the burden of parking fees and putting patients first." 61 of 406

62 - Dr. Eric Hoskins Minister of Health and Long-Term Care " We are thrilled that our concerns around the high cost of hospital parking have been addressed in a meaningful way that will help defray the cost of hospital parking for families of children with cancer in Ontario. You heard our voices, included us in the consultation, and have come up with a plan that reflects that in a very positive way. Thank you." - Susan Kuczynski Member of Ontario Parents Advocating for Children with Cancer QUICK FACTS The Ministry was pleased to have consulted with a number of hospitals and the Ontario Hospital Association in regards to parking fee changes in Fall 2015 The Ministry will require other hospitals that do not own their own lots to make best efforts to influence their partners, like municipalities and private operators to cap or cut parking fees for those who must visit the hospital frequently. In Ontario 45 Hospitals currently offer free parking and 54 charge $10 or less per day. It is estimated that 36 hospitals charge more than $10 a day. The government is directing hospitals not to raise their daily parking rates for the next three years starting today. LEARN MORE Patients First: Action Plan for Health Care Media Line Toll-free: media.moh@ontario.ca GTA: Mark Nesbitt Communications and Marketing Division-MOHLTC media.moh@ontario.ca Shae Greenfield Minister's Office For public inquiries call ServiceOntario, INFOline (Toll-free in Ontario only) ontario.ca/health-news Available Online Disponible en Français 62 of 406

63 How Canada Compares: Results From The Commonwealth Fund 2014 International Health Policy Survey of Older Adults Report January of 406

64 Production of this document is made possible by financial contributions from Health Canada and provincial and territorial governments. The views expressed herein do not necessarily represent the views of Health Canada or any provincial or territorial government. All rights reserved. The contents of this publication may be reproduced unaltered, in whole or in part and by any means, solely for non-commercial purposes, provided that the Canadian Institute for Health Information is properly and fully acknowledged as the copyright owner. Any reproduction or use of this publication or its contents for any commercial purpose requires the prior written authorization of the Canadian Institute for Health Information. Reproduction or use that suggests endorsement by, or affiliation with, the Canadian Institute for Health Information is prohibited. For permission or information, please contact CIHI: Canadian Institute for Health Information 495 Richmond Road, Suite 600 Ottawa, Ontario K2A 4H6 Phone: Fax: ISBN Canadian Institute for Health Information How to cite this document: Canadian Institute for Health Information. How Canada Compares: Results From The Commonwealth Fund 2014 International Health Policy Survey of Older Adults. Ottawa, ON: CIHI; Cette publication est aussi disponible en français sous le titre Résultats du Canada : Enquête internationale de 2014 auprès des adultes âgés sur les politiques de santé du Fonds du Commonwealth. ISBN of 406

65 Table of Contents Acknowledgements 4 About this report 5 Executive summary 7 Methodological notes 12 Access to care 15 Timely access to care 16 Cost as a barrier to health care 23 Caregiving and planning for end-of-life care 29 Informal caregiving 30 Planning for end of life and advanced age 33 Quality of care 38 Patient-centred primary and specialist care 39 Medication reviews 44 Chronic condition management and disease prevention 48 Perception of health and health care 55 Appendix 60 Bibliography of 406

66 Acknowledgements Core funding for The Commonwealth Fund 2014 International Health Policy Survey of Older Adults was provided by The Commonwealth Fund with co-funding from the following organizations outside of Canada: Haute Autorité de santé (France); Caisse nationale de l assurance maladie des travailleurs salariés (France); BQS Institute for Quality and Patient Safety (Germany); the German Federal Ministry of Health; the Dutch Ministry of Health, Welfare and Sport; the Scientific Institute for Quality of Healthcare, Radboud University Nijmegen (the Netherlands); the Norwegian Knowledge Centre for the Health Services; the Swedish Ministry of Health and Social Affairs; the Swiss Federal Office of Public Health; the NSW Bureau of Health Information (Australia); and many other country partners. Within Canada, funding for an expanded Canadian sample was provided by the Canadian Institute for Health Information (CIHI), the Canadian Institutes of Health Research (CIHR), the Health Quality Council of Alberta, the Commissaire à la santé et au bien-être du Québec and Health Quality Ontario. Production of this document is made possible by financial contributions from Health Canada and provincial and territorial governments. The views expressed herein do not necessarily represent the views of Health Canada or any provincial or territorial government. 66 of 406 4

67 About This Report Health care is fundamentally about people, and the experience of patients is critical to understanding the performance of a health system. For the past decade, The Commonwealth Fund s International Health Policy surveys have helped fill important information gaps through polls of patients and providers in 11 developed countries. The 2014 edition of this survey focused on the experience of people age 55 and older. The purpose of this companion report is to tell the Canadian story, and to highlight how experiences with health care vary across the country and relative to other countries. For the first time, statistical testing has been performed to understand whether Canadian results are significantly different from the average of 11 Commonwealth Fund (CMWF) surveyed countries. o o In bar graphs, an asterisk (*) indicates that Canadian results are statistically different. Elsewhere in the report where national and provincial results are presented, significance testing is shown with the following colour codes: Above average Same as average Below average Additional questions that were asked of only Canadian respondents are indicated throughout this report using a maple leaf. 67 of 406 5

68 About This Report (cont d) In the body of the report, provincial results are compared with the international average of CMWF countries. In the appendix, provincial results are compared with the Canadian average. Supplementary data tables with expanded questionnaire information are available as a free companion product online. To provide additional context, this report also references information from CIHI, Statistics Canada and other sources. All other data is from the 2014 Commonwealth Fund International Health Policy Survey of Older Adults. 68 of 406 6

69 Executive Summary Canada s demographic realities are not unique. Understanding how to meet the growing health care needs of an aging population and how to deliver high-quality care in a cost-efficient fashion is a challenge that many other nations are trying to address. When comparing the experiences of older people in Canada with those of older people in other countries, this report shows significant variation across the country and mixed results overall. 69 of 406 7

70 Executive Summary (cont d) Access to care Timely access to primary and specialist care remains a significant challenge for older Canadians. While almost all older Canadians (55 and older) have a regular doctor, 53% waited at least 2 days for care the last time they were sick or needed medical attention, and 25% waited at least 2 months to see a specialist. Canada had the longest waits for primary and specialist care of all 11 countries, and every province had significantly longer waits than the international average. Half of older Canadians found it very or somewhat difficult to get medical care in the evenings and on weekends or holidays without going to the hospital emergency department (ED). Consequently, 37% of individuals responded that the last time they went to the ED, it was for a condition that could have been treated by their regular doctor. While cost was not a barrier to medical services for most older Canadians, a significantly higher proportion (7%) than the average of countries said they were prevented from filling a prescription or skipped a medical dose because of the cost. For 15% of older Canadians, cost was also a barrier for dental care. 70 of 406 8

71 Executive Summary (cont d) Caregiving and planning for end-of-life care Older Canadians spent more time on average as informal caregivers; they also spent more time planning for their own end-of-life needs. Almost 1 in 5 older Canadians provided care at least once a week to a person with an age-related problem. Nearly half of them (47%) provided care for at least 10 hours a week, a greater proportion than the international average (40%). Nearly 1 in 4 (23%) Canadian caregivers needed help to provide care but did not receive it, and 34% said they had experienced distress, anger or depression while providing care. Older Canadians were significantly more likely than older people in other countries to have discussions (61%) about their end-of life wishes or to have written plans (39%). 71 of 406 9

72 Executive Summary (cont d) Quality of care Generally, older Canadians reported having positive experiences with their providers that were on par with or better than the international average; however, continuity of care between providers can be improved. Older Canadians were more likely on average to be encouraged to ask questions (70%) by their regular doctor and to be involved in treatment plans (79%) by their specialists than older people in other countries. Most older Canadians were taking multiple medications, and they were significantly more likely to report having medication reviews (80%) with their care providers than the international average. Older Canadians with chronic conditions were also more likely to have discussions about treatment goals (60%) and adopting healthy lifestyles (e.g., diet, exercise) with their providers than older people in other countries. However, only 37% had a written plan to self-manage their conditions. A higher proportion of older Canadians (13%) said that specialists did not have basic information or test results from their family doctor. Similarly, 25% said their family doctor did not seem to be informed and up to date about the specialist care they had received. These results varied widely across the country, however. 72 of

73 Executive Summary (cont d) Perceptions of health and health care While older Canadians were more likely to feel good about their health, they were not as optimistic about their health system. Slightly more than half of older Canadians said their health was very good or excellent, which was significantly higher than the international average. More than half also believed that fundamental changes are required to fix the health system. While perceptions of the health system had improved slightly in the previous 7 years, they were still among the lowest of reporting countries. 73 of

74 Methodological Notes The 2014 Commonwealth Fund International Health Policy Survey of Older Adults randomly sampled the general population age 55 and older in 11 countries: Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom and the United States. In Canada, interviews were conducted from March through May 2014 by Social Science Research Solutions (SSRS). There were 5,269 respondents. CIHI and CIHR provided funding to ensure a minimum of 250 respondents in each province, allowing for provincial comparisons. Sample sizes were further increased in Quebec, Ontario and Alberta with funding from provincial organizations. The overall response rate in Canada was 28%. For a complete list of sample sizes and response rates from all countries surveyed, please see the accompanying methodology notes. Provinces and territories Newfoundland and Labrador Prince Edward Island Number of interviews Percentage distribution 252 5% 261 5% Nova Scotia 258 5% New Brunswick 277 5% Quebec 1,006 19% Ontario 1,502 29% Manitoba 252 5% Saskatchewan 254 5% Alberta % British Columbia 250 5% Yukon 3 0% Northwest Territories 1 0% Nunavut 0 0% Total 5, % 74 of

75 Methodological Notes (cont d) Weighting of results The survey data for Canada was weighted within each of the 10 provinces by age, gender, level of education and knowledge of the official language. Additionally, data was subsequently weighted to reflect Canada s geographic distribution, by provinces and territories. Population parameters for these calculations were derived from the 2011 Census. Averages and trends For this report, the CMWF average was calculated by adding the results from the 11 countries and dividing by the number of countries. The Canadian average represents the average experience of Canadians (as opposed to the mean of provincial results). Except where otherwise noted, results were compared over time using data from previous CMWF general population surveys for respondents age 55 and older. Significance testing CIHI developed statistical methods to determine whether Canadian results were significantly different from the international average of 11 countries; Provincial results were significantly different from the international average; and Provincial results were significantly different from the Canadian average. An asterisk (*) indicates that results are significantly different on bar graphs, and colour codes are used elsewhere in the report. 75 of

76 Methodological Notes (cont d) Interpretation of significance testing The following colour codes are used throughout the report to indicate when results are statistically different from the average: Above average Same as average Below average Above-average results are more desirable, while below-average results often indicate areas in need of improvement. It must be cautioned, however, that sample sizes in some provinces are much smaller than in others and have wider margins of error. (The most robust samples are in Quebec, Ontario and Alberta because there was additional funding from those provinces.) For this reason, 2 provinces may have the same numeric results in different colours (e.g., 1 result might be blue, or same as average, while the other is orange, or below average). This may be due to a difference in margins of error rather than a difference in health system results. The wider the margin of error, the more difficult it is for a result to show up as significantly different from the average. 76 of

77 Access to Care Timely access to care Cost as a barrier to health care 77 of

78 Most older Canadians have a regular doctor 96% of Canadians age 55 and older had 1 or more doctors they usually went to for their medical care. How does Canada compare (2014)? France Netherlands Germany Norway Switzerland Australia CANADA New Zealand CMWF AVERAGE United Kingdom United States Sweden 96%* 93% Older Canadians were more likely to have a regular doctor than younger Canadians. 85% of Canadians older than 12 had a regular doctor. Source Statistics Canada. Table Health indicator profile, annual estimates, by age group and sex, Canada, provinces, territories, health regions (2013 boundaries) and peer groups, occasional. 78 of

79 Older Canadians wait longest for primary care waited for at least 2 days to see a doctor or a nurse the last time 53% they were sick or needed medical attention. How does Canada compare (2014)? CANADA 53%* 2007 Norway United States Sweden United Kingdom CMWF AVERAGE Australia Switzerland Netherlands Germany New Zealand France 32% No improvement since % Source The Commonwealth Fund, 2007 International Health Policy Survey in Seven Countries. 30% of older Canadians waited at least 6 days or gave up (2014). 79 of

80 Canadians are least likely to get timely responses Proportion of older Canadians who always or often got an answer the same day when they called their regular doctor with a medical concern Proportion of older Canadians who wished to or were able to their doctors with a medical question, 2014 France Switzerland United States New Zealand Netherlands United Kingdom CMWF AVERAGE Germany Sweden Norway Australia CANADA 63%* 72% 25% Wished to 4% Were able to In 2012, 11% of family physicians offered patients the option to them about a medical question or concern. Source The Commonwealth Fund, 2012 Commonwealth Fund International Survey of Primary Care Doctors. 80 of

81 Canadians have fewer after-hours options for primary care thought it was very or somewhat difficult to get medical care in the evenings and on weekends or holidays without going to the 51% emergency department (ED). How does Canada compare (2014)? CANADA United States Sweden Australia CMWF AVERAGE 29% Germany Norway United Kingdom New Zealand Switzerland France Netherlands 51%* Proportion of family physicians whose practice had an arrangement for after-hours care % Source The Commonwealth Fund, 2012 Commonwealth Fund International Survey of Primary Care Doctors. 81 of

82 Lack of access to timely care has an impact on ED use of older Canadians went to an ED for a condition that could have been 37% treated by their regular doctor. How does Canada compare (2014)? United States CANADA France New Zealand Switzerland Sweden CMWF AVERAGE Norway Australia United Kingdom Germany Netherlands 28% 37%* In , 1 in 5 emergency visits in Canada was for a condition that could have been treated elsewhere, such as a doctor s office. The most common conditions were upper respiratory infections (13%) and antibiotic therapy (13%). Source Canadian Institute for Health Information. Sources of Potentially Avoidable Emergency Department Visits. Ottawa, ON: CIHI; of

83 Canadians wait longest for specialist care of older Canadians waited for at least 2 months to see a specialist; 25% these waits had not improved over time. How does Canada compare (2014)? Specialist wait times, by year CANADA Norway New Zealand 25%* 60% 50% Sweden Germany Australia CMWF AVERAGE United Kingdom France Netherlands Switzerland 15% 40% 30% 20% 10% 0% <4 weeks 1 month to <2 months 2 months or longer United States Sources The Commonwealth Fund, 2010 and 2013 Commonwealth Fund International Health Policy Survey. 83 of

84 How do the provinces compare? The timeliness of primary and specialist care was significantly below the international average for all Canadian provinces. Older Canadians (55+) who B.C. Alta. Sask. Man. Ont. Que. N.B. N.S. P.E.I. N.L. Can. CMWF Avg. Waited for at least 2 days to see a doctor Said it was very or somewhat difficult to get medical care after hours Went to the ED for a condition that could have been treated by their regular doctor Waited for at least 2 months to see their specialist 50% 55% 57% 54% 50% 58% 54% 55% 53% 53% 53% 32% 47% 45% 49% 55% 47% 60% 53% 59% 57% 65% 51% 29% 30% 39% 33% 34% 39% 38% 42% 37% 40% 50% 37% 28% 24% 28% 32% 32% 24% 25% 29% 27% 28% 34% 25% 15% Compared with the CMWF average Above average Same as average Below average 84 of

85 Is cost a barrier to accessing care? In Canada s publicly funded health care system, most older Canadians accessed the medical care they needed without having to worry about costs. In the past year Canada CMWF average United States Did not see a doctor for a medical problem because of the cost 4% 5% 15% Skipped a medical test, treatment or follow-up recommended by a doctor because of the cost 5% 5% 15% Did not fill a prescription for medicine or skipped doses of medications because of the cost 7% 4% 15% Did not see a dentist when needed to because of the cost 15% N/A N/A Compared with the CMWF average Above average Same as average Below average Not applicable 85 of

86 Cost can be a barrier for prescription drugs Canada was second to only the United States in the proportion of older people who did not fill a prescription because of costs. How does Canada compare (2014)? Did not fill a prescription for medicine or skipped doses because of the cost Public share of total prescribed drug spending, 2012 or nearest year United States CANADA Australia New Zealand CMWF AVERAGE Germany Netherlands Switzerland United Kingdom Sweden Norway France 4% 7%* Germany United Kingdom* Switzerland France New Zealand Netherlands Sweden CMWF AVERAGE Australia Norway CANADA United States 43% 70% Notes * 2008 data data. Source OECD Health Statistics of

87 Drug costs affect a higher proportion of people age 55 to 65 Canadians age 55 to 64 did not fill their prescriptions or skipped 1 in 10 their medications because of the cost. Proportion by age 10% 5% Most Canadian provinces have public drug coverage programs for seniors age of

88 Cost can be a barrier for dental care of older Canadians did not receive the dental care they needed 15% because of the cost. Proportion who did not receive dental care by age, % % 65+ Only 4 jurisdictions (Alberta, Yukon, the Northwest Territories and Nunavut) have public oral health care services for seniors. Source Canadian Academy of Health Sciences. Improving Access to Oral Health Care for Vulnerable People Living in Canada. Ottawa, ON: CAHS; of

89 Public coverage of dental care is lower in Canada Probability of a dental visit, by income, 2009 Share of public spending on outpatient dental care, 2012 or nearest year Low income 47% High income 79% Germany Sweden New Zealand France Australia Norway CMWF AVERAGE Netherlands United States Switzerland Canada 6% 25% Source Organisation for Economic Co-operation and Development. Health at a Glance 2013: OECD Indicators Notes 2011 data. Source OECD Health Statistics of

90 How do the provinces compare? Results were generally comparable to the international average. Differences in public coverage and program design for drug plans may partly explain variation in results between provinces. Did not see a doctor for a medical problem because of doctor visit costs Skipped a medical test, treatment or follow-up recommended by a doctor because of diagnostic/ treatment costs Did not fill a prescription for medicine or skipped doses of medications because of prescription costs B.C. Alta. Sask. Man. Ont. Que. N.B. N.S. P.E.I. N.L. Can. CMWF Avg. 4% 4% 3% 3% 4% 3% 5% 3% 5% 4% 4% 5% 3% 4% 2% 4% 7% 4% 5% 5% 4% 6% 5% 5% 8% 6% 2% 7% 8% 7% 12% 7% 8% 7% 7% 4% Compared with the CMWF average Above average Same as average Below average 90 of

91 Caregiving and Planning for end-of-life Care Informal caregiving Planning for end of life and advanced age 91 of 406

92 Informal caregiving is common across countries of older Canadians provided care at least once a week to a person 19% living with an age-related problem (CMWF average 20%). Relationship with care receiver Proportion providing care for at least 10 hours a week (2014) Family member Someone else else (not family member) Both 5% 18% 76% United States Australia New Zealand CANADA Germany United Kingdom CMWF AVERAGE Netherlands Switzerland Norway France Sweden 40% 47%* 92 of

93 Informal caregivers in Canada don t always get the support they need Proportion of caregivers who needed help to provide care in the past year but did not receive it 23% Reasons for not receiving the help needed to provide care Services were Services not available were not in available the area in the area Did not know where to go 28% 27% Cost was too expensive 16% Waiting times were too long 14% 93 of

94 Distress is common among Canadian caregivers experienced distress, anger or depression while providing care 34% or assistance for a family member or friend. Proportion of caregivers who experienced distress, anger or depression, by hours of care provision 27% 43% Some factors most commonly associated with caregiver distress: Caring for someone with aggressive behaviours Caring for someone with cognition problems (e.g., dementia) Caring for someone for many hours a week <10 hours 10 hours or more Source Canadian Institute for Health Information. Supporting Informal Caregivers The Heart of Home Care. Ottawa, ON: CIHI; of

95 End-of-life care planning is common in Canada In 2014, older Canadians were more likely than older people in other countries to have planned for their end-of-life wishes. Proportion of older Canadians who Had discussions with someone Had a written document naming a substitute decision-maker Had a written plan about their end-of-life wishes 95 of

96 End-of-life care plans are more common with advanced age 39% of older Canadians had a written plan about their end-of-life wishes. How does Canada compare (2014)? Proportions by age Germany United States CANADA 39%* 43% 49% Australia Switzerland 32% CMWF AVERAGE 22% New Zealand United Kingdom Netherlands Sweden France Norway of

97 How do the provinces compare? End-of-life care planning in most provinces exceeded the international average. B.C. Alta. Sask. Man. Ont. Que. N.B. N.S. P.E.I. N.L. Can. CMWF Avg. Had a discussion with someone Named a substitute decision-maker Had a written document about endof-life wishes 61% 62% 57% 60% 64% 57% 55% 56% 55% 47% 61% 44% 46% 53% 44% 50% 60% 52% 47% 43% 42% 32% 53% 31% 36% 43% 29% 35% 44% 40% 24% 29% 26% 18% 39% 22% Compared with the CMWF average Above average Same as average Below average 97 of

98 About half of Canadians are planning for future care needs Proportion who considered supportive living, residential care or home care in future planning Proportion who said they will likely require supportive living or longterm care in their lifetime 47% 48% 46% 45% 48% 47% 42% 45% 47% 32% 36% 53% No significant variation by province B.C. Alta. Sask. Man. Ont. Que. N.B. N.S. P.E.I. N.L. Can. Compared with the Canadian average Above average Same as average Below average 98 of

99 Advanced directives are common in long-term care Proportion of Canadian long-term care residents who had Do not resuscitate order 66% Do not hospitalize order 18% Living will 13% Other end-of-life care restrictions 5% Feeding restrictions 4% Medication restrictions 4% Source Continuing Care Reporting System, 2011, Canadian Institute for Health Information. 99 of

100 Quality of Care Patient-centred primary and specialist care Medication reviews Chronic condition management and disease prevention 100 of 406

101 Most older Canadians have a positive experience with their regular doctor When older Canadians needed care or treatment, their regular doctor always or often Canada CMWF average Knew important information about their medical history 87% 87% Spent enough time with them 82% 86% Encouraged them to ask questions 70% 66% Compared with the CMWF average Above average Same as average Below average 101 of

102 Patient-centred care from specialists is also relatively good in Canada When specialists provided care or treatment, they always or often Canada CMWF average Told patients about treatment choices 72% 72% Involved patients as much as they wanted to be in decisions about treatment or care 79% 77% Compared with the CMWF average Above average Same as average Below average 102 of

103 However, continuity of care between regular doctors and specialists can be improved In the past 2 years, was there a time when Canada CMWF average A specialist did not have basic information or test results from the patient s regular doctor about the reason for the visit 13% 9% A patient s regular doctor did not seem informed and up to date about the specialist care received 25% 18% Compared with the CMWF average Above average Same as average Below average 103 of

104 How do the provinces compare? Regular doctor always or often B.C. Alta. Sask. Man. Ont. Que. N.B. N.S. P.E.I. N.L. Can. CMWF Avg. Knew important information about patients medical history Spent enough time with patients Encouraged patients to ask questions 88% 86% 89% 84% 86% 89% 87% 85% 87% 84% 87% 87% 81% 80% 80% 79% 81% 87% 80% 85% 80% 78% 82% 86% 72% 70% 64% 65% 68% 76% 68% 66% 72% 62% 70% 66% Specialists always or often Told patients about treatment choices Involved patients as much as they wanted to be in decisions 74% 74% 75% 78% 77% 58% 73% 76% 80% 77% 72% 72% 81% 79% 83% 76% 80% 76% 81% 85% 88% 79% 79% 77% Compared with the CMWF average Above average Same as average Below average 104 of

105 How do the provinces compare? Continuity of care between primary doctors and specialists was comparable to the international average in most Canadian provinces. Specialist did not have basic medical information from primary doctor Primary doctor did not seem informed or up to date about care from specialist B.C. Alta. Sask. Man. Ont. Que. N.B. N.S. P.E.I. N.L. Can. CMWF Avg. 8% 8% 8% 11% 10% 26% 13% 6% 4% 9% 13% 9% 16% 18% 18% 18% 18% 46% 22% 10% 13% 10% 25% 18% Compared with the CMWF average Above average Same as average Below average 105 of

106 Medication reviews are common for older Canadians said a health care professional reviewed their medications in the 80% past 12 months. How does Canada compare (2014)? United States New Zealand CANADA Germany Australia United Kingdom Switzerland CMWF AVERAGE Netherlands Norway France Sweden 70% 80%* In Canada, seniors use an average of 7.2 prescription drugs in a year. Source Canadian Institute for Health Information. Drug Use Among Seniors on Public Drug Programs in Canada, 2012: Revised October Ottawa, ON: CIHI; of

107 Canadians are more likely to have discussions about medication use In the past 12 months, has a health care professional Explained potential side effects Provided a written list of all medications CANADA United Kingdom New Zealand United States Australia Germany CMWF AVERAGE France Netherlands Switzerland Norway Sweden 59% 74%* Sweden United Kingdom CANADA New Zealand Netherlands United States Australia CMWF AVERAGE Germany Norway Switzerland France 57% 67%* 107 of

108 Patient safety incidents related to medication use are common in Canada Proportion of seniors on public drug programs taking a potentially inappropriate (Beers list) drug, 2012 Almost 140,000 hospitalizations for adverse drug reactions among seniors between and % Source Canadian Institute for Health Information. Adverse Drug Reaction Related Hospitalizations Among Seniors, 2006 to Ottawa, ON: CIHI; Source Canadian Institute for Health Information. Drug Use Among Seniors on Public Drug Programs in Canada, 2012: Revised October Ottawa, ON: CIHI; of

109 How do the provinces compare? Across provinces, medication management among older patients was equal to or better than that in other countries, on average. In the past 12 months, has a health care professional B.C. Alta. Sask. Man. Ont. Que. N.B. N.S. P.E.I. N.L. Can. CMWF Avg. Reviewed all medications Explained potential side effects Given a written list of all medications 77% 78% 78% 75% 83% 83% 75% 66% 77% 65% 80% 70% 72% 72% 72% 67% 76% 76% 67% 70% 68% 62% 74% 59% 59% 58% 58% 51% 67% 80% 66% 62% 57% 54% 67% 57% Compared with the CMWF average Above average Same as average Below average 109 of

110 Care to help manage chronic conditions is above average in Canada of older Canadians had at least 1 chronic condition* 78% (CMWF average 71%). Older people with chronic conditions who Canada CMWF average Had discussions about main goals or priorities with their health providers 60% 55% Received clear instructions about symptoms to watch for 60% 56% Compared with the CMWF average Above average Same as average Below average * Chronic conditions include hypertension or high blood pressure; heart disease, including heart attack; diabetes; asthma or chronic lung disease such as chronic bronchitis, emphysema or chronic obstructive pulmonary disease; depression, anxiety or other mental health problems; cancer; and joint pain or arthritis. 110 of

111 However, there is room to improve across countries Canada CMWF average People with chronic conditions who received a written plan for self-management from their health provider 37% 35% Compared with the CMWF average Above average Same as average Below average 21% Routinely Occasionally 58% 21% of family physicians routinely gave their patients with chronic conditions written instructions for self-management. Source The Commonwealth Fund, 2012 Commonwealth Fund International Survey of Primary Care Doctors. 111 of

112 Hospitalizations for chronic conditions are declining in Canada but vary widely across the country Ambulatory care sensitive conditions (ACSCs) are chronic conditions that when treated effectively in community settings should not, in most cases, lead to hospitalization. ACSC hospitalization rates (per 100,000) Canadian rates B.C. Alta. Sask. Man. Ont. Que. N.B. N.S. P.E.I. N.L. Can. Compared with the Canadian average Above average Same as average Below average Source Canadian Institute for Health Information. Your Health System. Accessed November 27, of

113 How do the provinces compare? In most provinces, management of chronic conditions was similar to the international average experience. In the past 12 months, has a health professional Discussed with patients their main goals or priorities in caring for this condition Given patients clear instructions about symptoms to watch for and when to seek further care or treatment Given patients a written plan to help them manage their own care B.C. Alta. Sask. Man. Ont. Que. N.B. N.S. P.E.I. N.L. Can. CMWF Avg. 59% 59% 61% 57% 61% 61% 56% 60% 61% 58% 60% 55% 56% 57% 60% 60% 58% 68% 62% 58% 62% 58% 60% 56% 42% 32% 36% 34% 35% 38% 35% 41% 42% 39% 37% 35% Compared with the CMWF average Above average Same as average Below average 113 of

114 Discussions about healthy life habits are more frequent in Canada But they happened less often in 2014 than they used to. During the past 2 years, has a health professional discussed 57% 50% 51%* 43% 61% 54% 55%* 48% 37% 35% 25% 23% A healthy diet and healthy eating Exercise or physical activity Things in life that worry patients or cause stress Canada CMWF Average Source The Commonwealth Fund, 2010 Commonwealth Fund International Health Policy Survey. 114 of

115 Canada leads in smoking cessation discussions of older Canadians who smoked said a health professional talked to them about the health risks of smoking or using tobacco and 78% ways to quit. How does Canada compare (2014)? CANADA United States New Zealand France United Kingdom CMWF AVERAGE Sweden Switzerland Norway Germany Netherlands Australia 63% 78%* Source OECD Health Statistics % of older Canadians smoked, higher than the CMWF average. Lung cancer mortality rates were among the highest in the world for Canadian women at 46 deaths per 100,000 population. 115 of

116 How do the provinces compare? During the past 2 years, has a health professional discussed B.C. Alta. Sask. Man. Ont. Que. N.B. N.S. P.E.I. N.L. Can. CMWF Avg. A healthy diet and healthy eating 54% 52% 49% 47% 52% 48% 48% 52% 52% 47% 51% 43% Exercise or physical activity 60% 55% 52% 51% 55% 55% 49% 54% 55% 51% 55% 48% Things in life that worry patients or cause stress Health risks of smoking or using tobacco and ways to quit 27% 23% 25% 24% 26% 20% 22% 32% 22% 24% 25% 23% 92% 75% 66% 84% 79% 71% 72% 72% 60% 59% 78% 63% Compared with the CMWF average Above average Same as average Below average 116 of

117 Perception of Health and Health Care 117 of 406

118 Older Canadians feel better about their health But they were not as optimistic about their health system. Proportion who rated their health as excellent or very good Proportion who gave the highest rating to the health system New Zealand CANADA Australia United Kingdom United States CMWF AVERAGE Switzerland Sweden Norway Netherlands Germany France 38% 52%* Switzerland United Kingdom Norway Australia New Zealand CMWF AVERAGE Germany Sweden Netherlands France CANADA United States 34%* 44% 118 of

119 Life expectancy for seniors in Canada is about the same as the international average Life expectancy is a different way of measuring the health of a population. Proportion who rated their health as very good or excellent Life expectancy at age 65, 2011 Canada CMWF average Canada 18.8 years CMWF average 18.6 years 52% 38% Compared with the CMWF average Above average Same as average Below average Canada 21.7 years Source OECD Health Statistics CMWF average 21.6 years 119 of

120 Perceptions of health systems are still low in Canada but have improved slightly Overall view of the health care system, 2007 and % 27% 10% 34% 54% 53% On the whole, the system works well and only minor changes are necessary to make it work better. There are some good things in our health care system, but fundamental changes are needed to make it work better. Our health care system has so much wrong with it that we need to completely rebuild it. 120 of

121 How do the provinces compare? Self-reported health status by province B.C. Alta. Sask. Man. Ont. Que. N.B. N.S. P.E.I. N.L. Can. CMWF Avg. Excellent or very good 52% 56% 44% 48% 52% 53% 44% 42% 44% 56% 52% 38% Health system perceptions by province B.C. Alta. Sask. Man. Ont. Que. N.B. N.S. P.E.I. N.L. Can. CMWF Avg. Minor changes 40% 35% 33% 34% 39% 22% 36% 34% 33% 23% 34% 44% Fundamental changes 51% 51% 52% 49% 48% 63% 51% 53% 53% 52% 53% 42% Completely rebuilt 6% 9% 10% 10% 9% 12% 11% 9% 8% 21% 10% 10% Compared with the CMWF average Above average Same as average Below average 121 of

122 Appendix Provincial results compared to the Canadian average Statistical testing indicates whether results are significantly different from the Canadian average. 122 of 406

123 Timely access to primary care Older Canadians (55+) who B.C. Alta. Sask. Man. Ont. Que. N.B. N.S. P.E.I. N.L. Can. Waited for at least 2 days to see a doctor Said it was very or somewhat difficult to get medical care after hours Went to the ED for a condition that could have been treated by their regular doctor Waited for at least 2 months to see their specialist 50% 55% 57% 54% 50% 58% 54% 55% 53% 53% 53% 47% 45% 49% 55% 47% 60% 53% 59% 57% 65% 51% 30% 39% 33% 34% 39% 38% 42% 37% 40% 50% 37% 24% 28% 32% 32% 24% 25% 29% 27% 28% 34% 25% Compared with the Canadian average Above average Same as average Below average 123 of

124 Cost as a barrier to health care B.C. Alta. Sask. Man. Ont. Que. N.B. N.S. P.E.I. N.L. Can. Did not see a doctor for a medical problem because of doctor visit costs Skipped a medical test, treatment or follow-up recommended by a doctor because of diagnostic/treatment costs Did not fill a prescription for medicine or skipped doses of medications because of prescription costs Did not see a dentist when needed to because of the dental costs 4% 4% 3% 3% 4% 3% 5% 3% 5% 4% 4% 3% 4% 2% 4% 7% 4% 5% 5% 4% 6% 5% 8% 6% 2% 7% 8% 7% 12% 7% 8% 7% 7% 17% 12% 9% 15% 16% 14% 19% 18% 11% 16% 15% Compared with the Canadian average Above average Same as average Below average 124 of

125 Quality of care: patient-centred care Regular doctor always or often B.C. Alta. Sask. Man. Ont. Que. N.B. N.S. P.E.I. N.L. Can. Knew important information about patients medical history 88% 86% 89% 84% 86% 89% 87% 85% 87% 84% 87% Spent enough time with patients 81% 80% 80% 79% 81% 87% 80% 85% 80% 78% 82% Encouraged patients to ask questions 72% 70% 64% 65% 68% 76% 68% 66% 72% 62% 70% Specialists always or often Told patients about treatment choices Involved patients as much as they wanted to be in decisions 74% 74% 75% 78% 77% 58% 73% 76% 80% 77% 72% 81% 79% 83% 76% 80% 76% 81% 85% 88% 79% 79% Compared with the Canadian average Above average Same as average Below average 125 of

126 Quality of care: continuity of primary and specialist care B.C. Alta. Sask. Man. Ont. Que. N.B. N.S. P.E.I. N.L. Can. Specialist did not have basic medical information from primary doctor Primary doctor did not seem informed or up to date about care from specialist 8% 8% 8% 11% 10% 26% 13% 6% 4% 9% 13% 16% 18% 18% 18% 18% 46% 22% 10% 13% 10% 25% Compared with the Canadian average Above average Same as average Below average 126 of

127 Quality of care: medication reviews In the past 12 months, has a health care professional B.C. Alta. Sask. Man. Ont. Que. N.B. N.S. P.E.I. N.L. Can. Reviewed all medications 77% 78% 78% 75% 83% 83% 75% 66% 77% 65% 80% Explained potential side effects 72% 72% 72% 67% 76% 76% 67% 70% 68% 62% 74% Given a written list of all medications 59% 58% 58% 51% 67% 80% 66% 62% 57% 54% 67% Compared with the Canadian average Above average Same as average Below average 127 of

128 Quality of care: management of chronic conditions In the past 12 months, has a health professional Discussed with patients their main goals or priorities in caring for this condition Given patients clear instructions about symptoms to watch for and when to seek further care or treatment Given patients a written plan to help them manage their own care B.C. Alta. Sask. Man. Ont. Que. N.B. N.S. P.E.I. N.L. Can. 59% 59% 61% 57% 61% 61% 56% 60% 61% 58% 60% 56% 57% 60% 60% 58% 68% 62% 58% 62% 58% 60% 42% 32% 36% 34% 35% 38% 35% 41% 42% 39% 37% Compared with the Canadian average Above average Same as average Below average 128 of

129 Quality of care: health promotion During the past 2 years, has a health professional discussed B.C. Alta. Sask. Man. Ont. Que. N.B. N.S. P.E.I. N.L. Can. A healthy diet and healthy eating 54% 52% 49% 47% 52% 48% 48% 52% 52% 47% 51% Exercise or physical activity 60% 55% 52% 51% 55% 55% 49% 54% 55% 51% 55% Things in life that worry patients or cause stress Health risks of smoking or using tobacco and ways to quit 27% 23% 25% 24% 26% 20% 22% 32% 22% 24% 25% 92% 75% 66% 84% 79% 71% 72% 72% 60% 59% 78% Compared with the Canadian average Above average Same as average Below average 129 of

130 End-of-life care B.C. Alta. Sask. Man. Ont. Que. N.B. N.S. P.E.I. N.L. Can. Had a discussion with someone 61% 62% 57% 60% 64% 57% 55% 56% 55% 47% 61% Named a substitute decisionmaker Had a written document about end-of-life wishes 46% 53% 44% 50% 60% 52% 47% 43% 42% 32% 53% 36% 43% 29% 35% 44% 40% 24% 29% 26% 18% 39% Compared with the Canadian average Above average Same as average Below average 130 of

131 Perception of health and health care Self-reported health status by province B.C. Alta. Sask. Man. Ont. Que. N.B. N.S. P.E.I. N.L. Can. Excellent or very good 52% 56% 44% 48% 52% 53% 44% 42% 44% 56% 52% Health system ratings by province B.C. Alta. Sask. Man. Ont. Que. N.B. N.S. P.E.I. N.L. Can. Minor changes 40% 35% 33% 34% 39% 22% 36% 34% 33% 23% 34% Fundamental changes 51% 51% 52% 49% 48% 63% 51% 53% 53% 52% 53% Completely rebuilt 6% 9% 10% 10% 9% 12% 11% 9% 8% 21% 10% Compared with the Canadian average Above average Same as average Below average 131 of

132 Bibliography Canadian Academy of Health Sciences. Improving Access to Oral Health Care for Vulnerable People Living in Canada. Ottawa, ON: CAHS; Access_to_Oral_Care_FINAL_REPORT_EN.pdf. Accessed on November 27, Canadian Institute for Health Information. Adverse Drug Reaction Related Hospitalizations Among Seniors, 2006 to Ottawa, ON: CIHI; Hospitalizations%20for%20ADR-ENweb.pdf. Accessed November 27, Canadian Institute for Health Information. Continuing Care Reporting System. Ottawa, ON: CIHI; Canadian Institute for Health Information. Drug Use Among Seniors on Public Drug Programs in Canada, 2012: Revised October Ottawa, ON: CIHI; Drug_Use_in_Seniors_on_Public_Drug_Programs_EN_web_Oct.pdf. Accessed November 27, Canadian Institute for Health Information. Sources of Potentially Avoidable Emergency Department Visits. Ottawa, ON: CIHI; ForWeb_EN_Final.pdf. Accessed November 27, Canadian Institute for Health Information. Supporting Informal Caregivers The Heart of Home Care. Ottawa, ON: CIHI; Accessed November 27, Canadian Institute for Health Information. Your Health System. Accessed November 27, of

133 Bibliography (cont d) The Commonwealth Fund International Health Policy Survey in Seven Countries. New York, U.S.: CMWF; international-health-policy-survey-in-seven-countries/schoen_intlhltpolicysurvey2007_chartpackpdf.pdf. Accessed November 27, The Commonwealth Fund. The Commonwealth Fund 2010 International Health Policy Survey in Eleven Countries. New York, U.S.: CMWF; publications/chartbook/2010/pdf_2010_ihp_survey_chartpack_full_ pdf. Accessed November 27, The Commonwealth Fund Commonwealth Fund International Survey of Primary Care Doctors. New York, U.S.: CMWF; Accessed November 27, The Commonwealth Fund Commonwealth Fund International Health Policy Survey. New York, U.S.: CMWF; Accessed November 27, Organisation for Economic Co-operation and Development. Health at a Glance 2013: OECD Indicators. Paris, France: OECD; of

134 Bibliography (cont d) Organisation for Economic Co-operation and Development. OECD Health Statistics, Paris, France: OECD; Statistics Canada. Table Health indicator profile, annual estimates, by age group and sex, Canada, provinces, territories, health regions (2013 boundaries) and peer groups, occasional. CANSIM (database). Updated June 11, Accessed November 27, of

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136 Item # 4.0 Board Education/Generative Dialogue 136 of 406

137 Item # 4.1 'Patients First' Discussion Paper 137 of 406

138 Briefing Note Report To: Central West LHIN Board of Directors Agenda Number: Item # 4.1 Subject: Purpose: Patients First Discussion Paper Community/Stakeholder Engagement For Information Date: Wednesday, January 27, 2016 Key Contact: Scott McLeod, CEO David Colgan, Senior Director Health System Integration Tom Miller, Director, Communications and Community Engagement Recommended Motion: N/A Background Summary Following release of the Patients First discussion paper on December 17, 2015, the Ministry of Health and Long-Term Care (MOHLTC) committed to an engagement process. While the MHLTC is proposing to engage with stakeholders across a number of channels, LHINs have specifically been asked to hold multiple public consultations that include patients, clients and health system partners. The purpose of these consultations is to provide an overview of the MOHLTC s four-part proposal for the next steps in transforming the health care system, and to obtain feedback from patients, clients and health system partners This Briefing Note outlines the Central West LHIN s approach to conducting these consultations. Options Considered: Stakeholder Group Date Time Location Francophone Community Dufferin County Public Consultation Thursday, January 28, :00 8:00 pm Cercle de l amitié 375 Centre Street N., Brampton Wednesday, February 3, :00 8:30 p.m. Alder Street Recreation Centre TD Canada Trust Room 275 Alder Street, Orangeville 138 of 406

139 Primary Care Network Bramalea Public Consultation Governance and Leadership Forum Brampton Public Consultation Bolton/Caledon Public Consultation Central West LHIN Citizen Panel North Etobicoke - Malton - West Woodbridge Public Consultation Thursday, February 4, :30 7:30 p.m. Lionhead Golf and Conference Ctr Mississauga Road, Brampton Tuesday, February 9, :00 8:30 p.m. Greenbrier Community Centre Multipurpose Room Main Level 1100 Central Park Drive, Brampton Wednesday, February 10, :00 8:30 p.m. Brampton Courtyard Marriott Windsor A & B 90 Biscayne Crescent, Brampton Thursday, February 11, :00 8:30 p.m. Flower City Lawn Bowling Facility Community Room 8910 McLaughlin Road S., Brampton Tuesday, February 16, :00 8:30 p.m. Albion & Bolton Community Centre Auditorium 150 Queen Street S., Bolton Wednesday, February 17, :00 8:30 p.m. Greenbrier Community Centre Community Room Lower Level 1100 Central Park Drive, Brampton Tuesday, February 23, :00 8:30 p.m. Rexdale CHC, Jamestown Hub 21 Panorama Court Unit #3 Impact Analysis: Alignment with Strategic Priorities Implementation Plan Improve access to Care Stream Line Transitions and Navigation Drive Quality and Value Build on the Momentum Governance Best Practice Operational Excellence Enterprise Risk All aspects of this community/stakeholder engagement plan must be complete and a summary report submitted to the MOHLTC by February 29, A progress report on the Central West LHIN consultation process will be provided to the Central West LHIN Board of Directors at the February Board of Directors meeting with a copy of the final summary report to follow in March. Attachment(s): N/A of 406

140 PATI ENTS F l RS i PATIENT-CENTRED HEALTH CARE IN ONTARIO DISCUSSION PAPER December L- 7 Ontario 140 of 406

141 PATIENTS FIRST Message from the Minister of Health and Long-Term Care Over the past decade, Ontario s health care system has improved significantly. Together, we have reduced wait times for surgery, increased the number of Ontarians who have a primary health care provider and expanded services for Ontarians at home and in their communities. There are, however, a number of areas where we need to do more. Too often, health care services can be fragmented, uncoordinated and unevenly distributed across the province. For patients, that means they may have difficulty navigating the system or that not all Ontarians have equitable access to services. Too often our system is not delivering the right kind of care to patients who need it most. The next phase of our plan to put patients first is to address structural issues that create inequities. We propose to truly integrate the health care system so that it provides the care patients need no matter where they live. Our proposal is focused on population health and integration at the local level. It would improve access to primary care, standardize and strengthen home and community care, and strengthen population and public health. It would also ensure that services are distributed equitably across the province and are appropriate for patients. With this paper, we are seeking your input on our proposal, and your advice about how to integrate other improvements including, for example, community mental health and addictions services. Through this engagement process, we want to hear from providers, patients and caregivers around the province, in cities and rural communities, in our diverse cultural communities and in our French-language communities. We want to engage with First Nations, Métis and Inuit partners about how this process can complement our ongoing work to strengthen health outcomes in Indigenous communities of 406

142 As Ontario s Minister of Health and Long-Term Care, I am excited that we have the opportunity to work together to continue developing one of the best health care systems in the world a system that truly puts patients first. I hope you will join us, and contribute your expertise. We can t succeed without it. Dr. Eric Hoskins Minister of Health and Long-Term Care of 406

143 particularly are EXECUTIVE SUMMARY PUTTING PATIENTS FIRST Ontario is committed to developing a health care system that puts patients first. Over the past 10 years, the province has improved access to primary care, provided more care for people at home, reduced hospital wait times, invested in health promotion programs, and taken steps to make the system more transparent and more accountable. But there are still gaps in care. GAPS IN CARE Ontarians, including patients, care providers and system experts have identified challenges in our health care system. Some Ontarians Indigenous peoples, Franco-Ontarians, members of cultural groups (especially newcomers), and people with mental health and addiction challenges not always well-served by the health care system. Although most Ontarians now have a primary care provider, many report having difficulty seeing their provider when they need to, especially in evenings, nights or weekends so they go to emergency departments and walk-in clinics instead. Some families find home and community care services inconsistent and hard to navigate, and many family caregivers are experiencing high levels of stress. Public health services are disconnected from the rest of the health care system, and population health is not a consistent part of health system planning. Health services are fragmented in the way they are planned and delivered. This fragmentation can affect the patient experience. It can also result in inefficient use of patient and provider time and resources, and can result in poor health outcomes. Many of these challenges arise from the disparate way different health services are planned and managed. While local hospital, long-term care, community services, and mental health and addiction services are all planned by the province s 14 Local Health Integration Networks (LHJNs), primary care, home and community care services and public health services are planned by separate entities in different ways. Because of these different structures, the LHINs are not able to align and integrate all health services in their communities of 406

144 A PROPOSAL TO STRENGTHEN PATIENT-CENTRED CARE To reduce gaps and strengthen patient-centred care, the Ministry of Health and Long-Term Care is proposing to expand the role of the Local Health Integration Networks. In Patients First: A Proposal to Strengthen Patient- Centred Health Care in Ontario, the ministry provides more detail about the four components: 1. More effective integration of services and greater equity. To make care more integrated and responsive to local needs, make LHINs responsible and accountable for all health service planning and performance. Identify smaller sub-regions as part of each LHIN to be the focal point for local planning and service management and delivery. In their expanded role, LHINs would be responsible for working with providers across the care continuum to improve access to high-quality and consistent care, and to make the system easier to navigate for all Ontarians. The LHIN sub-regions would take the lead in integrating primary care with home and community care. 2. Timely access to primary care, and seamless links between primary care and other services. Bring the planning and monitoring of primary care closer to the communities where services are delivered. LHINs, in partnership with local clinical leaders, would take responsibility for primary care planning and performance management. The LHINs would work closely with primary care providers to plan services, undertake health human resources planning, improve access to inter professional teams for those who need it most and link patients with primary care services. The ministry would continue to negotiate physician compensation and primary care contracts of 406

145 3. More consistent and accessible home and community care. Strengthen accountability and integration of home and community care. Transfer direct responsibility for service management and delivery from the Community Care Access Centres (CCACs) to the LHINs. With this change, LHINs would govern and manage the delivery of home and community care, and the CCAC boards would cease to exist. CCAC employees providing support to clients would be employed by the LHINs, and home care services would be provided by current service providers. This shift would create an opportunity to integrate home and community care into other services. For example, home care coordinators may be deployed into community settings, such as community health centres, Family Health Teams and hospitals. 4. Stronger links between population and public health and other health services. Integrate local population and public health planning with other health services. Formalize linkages between LHINs and public health units. The Medical Officer of Health for each public health unit would work closely with the LHINs to plan population health services. LHINs would be responsible for accountability agreements with public health units, and ministry funding for public health units would be transferred to the LHINs for allocation to public health units. Local boards of health would continue to set budgets, and public health services would be managed at the municipal level. With the above four changes the ministry would continue to play a strong role in setting standards and performance targets, which would help ensure consistency across the province. The LHINs would be responsible for performance management, and for preparing reports on quality and performance that would be shared with the public and providers. A PATH FORWARD With Patients First: A Proposal to Strengthen PatientCentred Health Gare in Ontario, the ministry will engage the public and providers to discuss the proposal. The ministry has many questions concerning how to plan for and implement the proposed approach successfully. The full paper includes a series of discussion questions. The ministry is committed to listening. You are invited to review the full paper at and submit feedback or pose questions to health.feedback@ontario.ca. The ministry looks forward to continuing the conversation...and to taking the next steps towards building a high-performing, better connected, more integrated, patient-centred health system of 406

146 providing providing making OUR PROMISE Put Patients First In the Patients First: Action Plan for Health Care (February 2015), the Ontario Ministry of Health and Long-Term Care set clear and ambitious goals for Ontario s health care system: Access Improve access - Connect faster access to the right care. Connect services - delivering better coordinated and integrated care in the community closer to home. Inform Support people and patients - the education, information and transparency Ontarians need to make the right decisions about their health. Protect Protect our universal public health care system - decisions based on value and quality, to sustain the system for generations to come. To achieve these goals, the ministry must put patients, clients and caregivers first. We must create a responsive health system where: care providers work together to provide integrated care, patients and their caregivers are heard and play a key role in decision making and in their care plans, people can move easily from one part of the system to another, someone is accountable for ensuring that care is coordinated at the local level of 406

147 many OUR PROGRESS Over the past 10 years, Ontario s health care system has made great progress in improving the patient experience: More access to primary care. Family physicians, nurse practitioners and other health care providers often working in team-based practices have improved access to primary care. Nearly four million Ontarians receive care through these new teams. More care closer to home. Home and community care providers are providing care for more clients with complex conditions at home, for longer periods of time. Shorter hospital wait times. Hospitals have reduced wait times for most surgical procedures and improved emergency department wait times, despite the fact that the number of people needing these services continues to increase. Hospitals are actively using evidence, data and information on the patient experience to improve quality. More support for people to stay healthy. There is a greater focus on disease prevention and health promotion. More protection for our health system. The Excellent Care foralt Act, 2010 has put in place tools and processes that have increased transparency, enhanced the system s focus on quality, and engaged Ontarians in improving health system performance. These accomplishments are the result of a great deal of planning and hard work by all parts of the health system: hospitals, primary care and specialized offices and clinics, home and community care, long-term care homes, LI-TINs, CCACs and other health service organizations that provide care to Ontarians. TODAY, 94% of Ontarians report having a regular primary health care provider. Compared to 2003, OVER 24,000 more nurses and 6,600 more physicians are providing patient care. Physicians representing more than 10 MILLION ONTARIANS now have electronic medical records. OVER 80% of primary care physicians use electronic medical records in their practice. Flu shots are available in 2,500 pharmacies. Vaccines and newborn screening prog rams have been expanded. 1,076 health care organizations submit annual Quality Improvement Programs of 406

148 such are such A PROPOSAL to Strengthen Patient-Centred Care Despite the progress, there is still more to do. Listening to patients, clients, caregivers and providers, we know that some people can struggle to get the primary care and home and community care services they need, and they still find the system fragmented and hard to navigate. We also know services are not as consistent as they should be across the province. What we have heard from Ontariaris has been confirmed in a series of expert reports, including those developed by Health Quality Ontario, the Auditor General of Ontario, the Primary Health Care Expert Advisory Committee, the Expert Group on Home and Community Care, the Commission on the Reform of Ontario s Public Service (the Drummond Report), and the Registered Nurses Association of Ontario. To ensure Ontarians receive seamless, consistent, high quality care regardless of where they live, how much they earn or their ethnicity we must address the challenges that affect the system s ability to provide integrated patient-centred care. Many of these challenges arise from the disparate way these different health services are planned and managed. Some as hospitals, long-term care, community services and mental health and addiction services are planned and managed by the province s Local Health Integration Networks (LHINs). Others as primary care, home and community care services, and population and public health services in different ways. currently planned and managed We propose expanding the LHINs mandate to include primary care planning and performance management; home and community care management and service delivery; and developing formal linkages with public health to improve population and public health planning. Under this proposal, LHINs would assume responsibility for planning, managing and improving the performance of all health services within a region, while still maintaining clinician and patient choice. In this paper, we describe in more detail the challenges facing the health care system as well as the structural changes being proposed. We also pose a series of questions for discussion of 406

149 are IMPROVING HEALTH EQUITY AND REDUCING HEALTH DISPARITI ES Our proposed plan focuses specifically on ways to improve access to consistent, accountable and integrated primary care, home and community care, population health and public health services. Informing this proposal are the needs of diverse Ontarians who rely on our health care system, including seniors and people with disabilities, as well as health equity and the importance of the social determinants of health, such as income level and geography. The ministry also recognizes that some Ontarians struggle to access health and social services. The health outcomes of Indigenous Peoples in Ontario particularly those living in remote and isolated communities significantly poorer than those of the general population. Improving health care and health outcomes for First Nations, Métis and Inuit peoples is a ministry priority. This means the health care system must provide better supports and services for patients, families and caregivers, and these services must respect traditional methods and be culturally appropriate. To develop these services, we will build and maintain productive and respectful working relationships at both the provincial and local levels. We will meaningfully engage Indigenous partners through parallel bilateral processes. Through collaboration, we will identify the changes needed to ensure health care services address the unique needs of First Nations, Métis and Inuit peoples no matter where they live across the province. Franco-Ontarians face challenges obtaining health services in French. To meet their needs, and improve their patient experience and health outcomes, we must ensure that the health care system is culturally sensitive and readily accessible in French. Members of other cultural groups, particularly newcomers, may struggle to get the health care they need. As part of our commitment to health equity, the system must be able to recognize the challenges that newcomers face 10 and provide culturally appropriate care and timely access, 149 of 406

150 making People who experience mental health and addiction challenges also face barriers to getting the care they need when they need it. The ministry is committed to strengthening mental health and addictions services. We will look to the work of the Mental Health and Addictions Leadership Advisory Council to ensure that changes in mental health and addiction services enhance access and improve overall system performance. Over the next few years, as we continue to transform and restructure the health care system and accountable it more integrated, accessible, transparent we will work to improve health equity and reduce health disparities. In their expanded role, LHJNs would be responsible for understanding the unique needs of Indigenous peoples, Franco-Ontarians, newcomers, and people with mental health and addiction issues in their regions, and providing accessible, culturally appropriate services. At the same time, the ministry would pursue discussions with these partners to determine how best to adapt system structures to provide effective person-centred care of 406

151 THE PROPOSAL 1. More Effective Integration of Services and Greater Equity THEISSUE The Ontario health care system offers excellent services, but they are fragmented in the way they are planned and delivered. This fragmentation can affect the patient experience. It can also result in inefficient use of patient and provider time and resources, and have a negative impact on health outcomes. THE SITUATION NOW Under the Local Health System Integration Act, 2006, the 14 LHINs are responsible for managing their local health systems. LHINs plan and manage performance in the acute care, long-term care, community services, and mental health and addictions sectors. Other services are managed differently. For example, CCACs are responsible for planning and contracting home care services and administering the placement process for long-term care. Although CCACs are accountable to the LHINs for their performance and receive funding from the LHINs, they have their own boards and operate rather independently. Other than the ministry, there is no organization accountable for planning primary care or specialist care services, and very little focus on managing or improving primary care performance. The province s public health services also have their own system for planning and delivering services. Since their creation a decade ago, the LHINs have improved regional planning for and integration of some services. Across the LHTNs, we ve seen the impact of some successful efforts to integrate providers and services. However, as the Auditor General recently noted, the LHINs lack the mandate and tools to align and integrate all health services. Under their current mandate, they cannot hold some parts of their local systems accountable or manage improvement in many service areas. Through Health Quality Ontario, we also learned that there is variation across LHINs in terms of health outcomes. We have also heard that some LHIN boundaries may no longer fit patient care patterns in their communities. EXAMPLES OF SUCCESSFUL INTEGRATION Collaborative care models, such as Family Health Teams, Community Health Centres, Aboriginal Health Access Centres and Nurse Practitioner Led Clinics, allow health care providers to work together as an integrated team to deliver comprehensive care and coordinate services with a range of partners, including home and community care. Integrated service models, such as Health Links, bring together health care and other providers in a community to better and more quickly coordinate care for patients with complex needs of 406

152 or that To reduce gaps and ensure that services meet local needs, it is time to enhance the LHINs authority. In a health care system focused on performance management and continuous quality improvement, it is also important for the ministry to hold the LHINs accountable for their performance. As part of any transformation, we must ensure their activities result in better access as well as greater consistency of services across the province. PROPOSAL #1 To provide care that is more integrated and responsive to local needs, make IHINs responsible and accountable for all health service planning and performance. Identify smaller regions as part of each LHIN to be the focal point for local planning and service management and delivery. In their expanded role, LHINs would: Assess local priorities and current performance, and identify areas for improvement. ACROSS ONTARIO S 14 LHINs Life expectancy ranges between 78.6 and 83.6 years old. Smoking, obesity, and physical activity rates vary. The percentage of people who report that their health status is excellent or very good ranges from 6.8 per cent to 11.7 per cent. Work with providers across the care continuum to improve patients access to services, and make it easier for both patients and providers to navigate the system. Integrate and improve primary care, home and community care, acute care, mental health and addiction services and public health across the entire health care system. Drive the adoption of technology to enhance care delivery through, for example, integrated systems or virtual access to care providers through telemedicine. Prepare public reports about the patient experience with different health services and other reported outcomes to help drive improvements. Although the LHINs have demonstrated that they are the right structure to enhance service integration, accountability and quality, they themselves would need some adjustments and additional tools to take on an expanded role. For example, their governance structures would need to be revisited (see Appendix) and their boundaries would need to be reviewed and possibly refined. In addition, LHINs would be asked to identify smaller geographic areas within their regions LHIN sub-regions reflect community geography, such as the current Health Links regions. Such LHIN sub-regions would be the focus for strengthening, coordinating and integrating primary health care, as well as more fully integrating primary care with home and community care, and ultimately fulfilling the clinical coordination responsibilities currently provided by the CCACs of 406

153 In the transformed system, the ministry would retain its role in health workforce planning, in collaboration with LHINs and other partners. QUESTIONS FOR DISCUSSION: How do we support care providers in a more integrated care environment? What do LHINs need to succeed in their expanded role? How do we strengthen consistency and standardization of services while being responsive to local differences? What other local organizations can be engaged to ensure patients are receiving the care they need when they need it? What role should they play? What other opportunities for bundling or integrating funding between hospitals, community care, primary care and possibly other sectors should be explored? What areas of performance should be highlighted through public reporting to drive improvement in the system? Should LHINs be renamed? If so, what should they be called? Should their boundaries be redrawn? A NTICI PATED PERFORMANCE IMPROVEMENTS / Care delivered based on community needs I Appropriate care options enhanced within communities / Easier access to a range of care services / Better connections between care providers in offices, clinics, home and hospital 2. Timely Access to Primary Care, and Seamless Links Between Primary Care and Other Services THEISSUE Despite a significant increase in the number of primary care providers, in some cases, Ontarians still lind it difficult to get care when they iieed it. As a result, many patients use costly emergency departments for primary care problems. At the same time, primary care providers report that, because of the way the system is organized, they find it difficult to connect their patients to the other health services they need of 406

154 THE SITUATION NOW All high-performing health care systems are based on strong primary care services delivered through a variety of models, including family doctors and primary care nurse practitioners working as part of inter-professional teams. Effective primary care is essential to improving health outcomes. To understand how well Ontario s primary care services perform, Health Quality Ontario compared Ontario data with international data from the Commonwealth Fund. Compared to other developed countries, it found that C70/ J I io of Ontarians cannot see their primary care provider the same day or next day when they are sick. Ontario performs poorly on access measures, such as same- or next-day appointments when people are sick or weekend after-hours appointments. 52% It also found that, in Ontario, access to primary care is influenced by where people live and factors such as immigration status or the language spoken most often at home find it difficult to access care in the evenings or on weekends. Low-acuity patients account for The 2015 report Patient Care Groups: A new model of population based 3 4% primary health care for Ontario, prepared by the Primary Health Care of emergency department visits. Expert Advisory Committee led by Dr. David Price and Elizabeth Baker, highlighted the challenges that primary care providers face when trying to connect their patients with other health services and suggested ways to address many of these challenges. PROPOSAL #2 Bring the planning and monitoring of primary care closer to the communities where services are delivered. LHlNs, in partnership with local clinical leaders, would take responsibility for primary care planning and performance management. Set out clearly the principles for successful clinical change, including engagement of local clinical leaders. Every Ontarian who wants a primary care provider should have one. Primary care should act as a patient s Medical Home, offering comprehensive, coordinated, and continuous services and working with other providers across the system to ensure that patient needs are met. Making the LHIN and LHIN sub-regions the focal points for primary care planning and performance measurement would be a crucial step towards achieving these goals. With the proposed approach: LHINs would work closely with primary care leaders, patients and providers to plan and monitor performance within each LHIN sub-region of 406

155 Planning would include improving access to inter-professional teams for those who need it most, facilitating care plans and supporting an integrated, coordinated patient-centred experience. LHINs, in partnership with local clinician leaders, would be responsible for recruitment planning, linking new patients with doctors and nurse practitioners, and improving access and performance in primary care. To make it easier for patients to connect with primary care, each LHIN sub-region would have a process to match unattached patients to primary care providers. Existing relationships between patients and their care providers would continue. Patients will always have the right to choose their primary care provider, and the sub-regions would help patients change physicians or nurse practitioners to get care closer to home. Similarly, clinicians would retain choice for what patients they care for within their sub-regions. While LHINs would play a greater role in primary care health human resources planning, physician compensation and primary care contracts would continue to be negotiated by the government and administered centrally. Ontario Medical Association (OMA) representation rights would continue to be respected. To help drive continuous quality improvement in primary care, the ministry would more methodically measure patient outcomes in primary care to help understand the patient experience accessing primary care, including same-day and after-hours care, and satisfaction with service. LHINs would collect, assess and publish performance indicators at a sub-region level and share that information with health care providers and managers to support performance improvement, as well as to help inform the organization of primary care in each LHIN sub-region. With the proposed emphasis on local care coordination and performance improvement, the primary care sector would be better positioned to meet the needs of communities across the province. These changes will enable the approach to Patient-Centered Medical Homes as recommended by the Ontario College of Family Physicians and others. There are more than primary care physicians in Ontario, and about enter practice each year. A NTICI PATED PERFORMANCE IMPROVEMENTS I All patients who want a primary care provider have one / More same-day, next-day, after-hours and weekend care / Lower rates of hospital readmissions / Lower emergency department use I Higher patient satisfaction QUESTIONS FOR DISCUSSION How can we effectively identify, engage and support primary care clinician leaders? What is most important for Ontarians when it comes to primary care? How can we support primary care providers in navigating and linking with other parts of the system? How should data collected from patients about their primary care experience be used? What data and information should be collected and publicly reported? of 406

156 due 3. More Consistent and Accessible Home and Community Care THEISSUE Home and community care services are inconsistent across the province and can be difficult to navigate. Many family caregivers who look after people at home are experiencing high levels of stress in part to the lack of clear information about the home care services available and how to access them. Primary care providers report problems connecting with home care services. and home care providers say the same thing about their links to primary care. THE SITUATION NOW The last major reform of home and community care was in 1996 with the creation of 43 CCACs responsible for planning, coordinating, delivering and contracting services designed to help people leave hospital earlier and stay independent lxi their homes for as long as possible. In 2007, the 43 CCACs were amalgamated to align geographically with the LHINs. Bringing Care Home, the 2015 report of the Expert. Group on Home and Community Care led by Dr. Gail Donner, highlighted the ongoing service challenges in the home and community care sector. According to that report, the current model is cumbersome. It lacks standardization across the province and is not consistently delivering the services that people need, including our growing population of seniors. However, the Expert Group encouraged the government to focus first on functional change before addressing any structural changes. Timing of first nursing and personal support visits varies by Community Care Access Centre. One-third of informal caregivers are distressed, twice as many asfour years ago. The ministry responded with the Roadmap to Strengthen Home and Community C are, which outlined a plan to improve care delivery. This work is well underway and includes bundled care initiatives, self-directed care and more nursing services at home for those who need them, among other initiatives. The Auditor General recommended that the ministry revisit the model of home care delivery in Ontario echoing recommendations in the 2012 report from the Commission on the Reform of Ontario s Public Service (the Drummond Report. In its 2012 report, Enhancing Community Care for Ontarians, the Registered Nurses Association of Ontario also encouraged the ministry to review the duplication within the current home and community care system, and to improve linkages with primary care of 406

157 PROPOSAL #3 Strengthen accountability and integration of home and community care. Transfer direct responsibility for service management and delivery from the (CACs to the [HINs. The ministry proposes to move all CCAC functions into the LHINs to help integrate home and community care with other parts of the health care system, and to improve quality and accountability. The proposed shift will create opportunities to embed home and community coordinators in other parts of the system. Under this proposal: The LHIN board would govern the delivery of home and community care, and the CCAC boards would be dissolved. CCAC employees providing support to clients would be transitioned to and employed by the LHINs. Home care coordinators would be focused on LHJN sub-regions, and may be deployed into community settings (such as family health teams, community health centres or hospitals). Home care services would continue to be provided by current service providers. Over time, contracts with these service providers would be better coordinated and more consistent within the geographic model of the LHIN sub-regions. LHINs would be responsible for the long-term care placement process currently administered by CCACs. The ministry s ten-point plan for improving home and community care would continue under LHIN leadership. While care planning and delivery would be done at the local level, the function of establishing clinical standards and outcomes-based performance targets for home and community care would be centralized. Having common standards and targets for the whole province will ensure more consistent and higher-quality care. QUESTIONS FOR DISCUSSION A NTICI PATED PERFORMANCE IMPROVEMENTS / Easier transitions from acute, primary and home and community care and long-term care I Clear standards for home and community care / Greater consistency and transparency around the province / Better patient and caregiver experience How can home care delivery be more effective and consistent? How can home care be better integrated with primary care and acute care while not creating an additional layer of bureaucracy? How can we bring the focus on quality into clients homes? of 406

158 such such 4. Stronger Links Between Public Health and Other Health Services THEISSUE Public health has historically been relatively disconnected from the rest of the health care system. Public health services vary considerably in different parts of the province and best practices are not always shared effectively. While local initiatives and partnerships have been successful, public health experts are not consistently part of LHIN planning efforts to improve population health. Many aspects of the health care system are not able to properly benefit from public health expertise, including issues related to health equity, population health and the social determinants of health. THE SITUATION NOW Public health services in Ontario are managed by 36 local public health units, whose mandate is to assess population health (e.g. the health status of their community) and implement programs to improve health. Because the public health system is municipally based, public health unit areas do not align with LHIN boundaries. Improving population health is an important goal for both local public health units and the health care system as a whole. However, many of the complex social, economic and environmental factors that affect health such as income, education, adequate housing and access to healthy foods lie outside the health system. In their efforts to improve health, public health units look at how these complex determinants collectively affect the health of individuals and communities. According to the 2015 Health Quality Ontario report, population health outcomes vary across our communities. To close these gaps, the health system needs more consistent and meaningful collaboration and coordination between public health, the rest of the health care system and LHINs. While many important ublic health functions inspections as restaurant do not overlap with health care planning or delivery, others as surveillance of reportable infectious diseases, documentation of immunizations, smoking cessation programs and other health promotion initiatives do. Where the system s and public health s interests overlap, public health would benefit from more in-depth knowledge of the population s health status available through LHINs as well as the LHINs ability to distribute health resources to address health inequities. LHINs would also benefit from greater access to public health expertise when planning health services of 406

159 PROPOSAL #4 Integrate local population and public health planning with other health services. Formalize linkages between [HINs and public health units. To better integrate population health within our health system, we propose that LHINs and public health units build on the collaborations already underway, and work more closely together to align their work and ensure that population and public health priorities inform health planning, funding and delivery. To support this new formal relationship: The ministry would create a formal relationship between the Medical Officers of Health and each LI-TIN, empowering the Medical Officers of Health to work with LHIN leadership to plan population health services. The ministry would transfer the dedicated provincial funding for public health units to the LHINs for allocation to public health units. The LHINs would ensure that all transferred funds would be used for public health purposes. The LHINs would assume responsibility for the accountability agreements with public health units. Local boards of health would continue to set budgets. The respective boards of health, as well as land ambulance services, would continue to be managed at the municipal level. As part of a separate initiative to support more consistent public health services across the province, the ministry is modernizing the Ontario Public Health Standards and Organizational Standards to identify gaps and duplication in service delivery; determine capacity and resource needs; and develop options for greater effectiveness. The ministry would also appoint an Expert Panel to advise on opportunities to deepen the partnership between LHINs and public health units, and how to further improve public health capacity and delivery. QUESTIONS FOR DISCUSSION ANTIC I PATED PERFORMANCE IMPROVEMENTS / Health service delivery better reflects population needs / Public health and health service delivery better integrated to address the health needs of populations and individuals / Social determinants of health and health equity incorporated into health care planning / Stronger linkages between disease prevention, health promotion and care How can public health be better integrated with the rest of the health system? What connections does public health in your community already have? What additional connections would be valuable? What should the role of the Medical Officers of Health be in informing or influencing decisions across the health care system? of 406

160 including would WHAT WOULD THE PROPOSED CHANGES MEAN FOR ONTARIANS? Patients, clients and family caregivers would have one point of contact in each LHIN sub-region responsible for connecting them with a primary care provider, as well as other health services and resources. All Ontarians should have better access to inter-professional providers including specialists when they need them, including better access to same-day, next-day, and after-hours and weekend care. Ontarians patients recovering from a stay in hospital and people who are frail or who have chronic conditions find it easier to understand, access and navigate the home and community care services available to them. Patient choice will be respected. People who have pre-existing relationships with primary care providers outside their LHIN sub-region will not have to change providers. One of the guiding principles of home care during and after the transition will be ensuring continuity of care providers. Physicians, nurses and other care providers would work in a system and structure that supports integration, helps them do their jobs, maintains their clinical autonomy, makes the most of their time and expertise, and sets clear accountabilities. Clinicians would benefit from improved access to personal health information that makes it easier to coordinate care and track the care patients receive in different parts of the system. Health care providers would also retain choice for deciding what patients they would care for. PATI E NT CHOICE WILL BE PROTECTED No one will haveto change primary care providers. Care decisions will take into account where people live, work and go to school. There will be no new restrictions on long-term care home choices. There will be no new layer of bureaucracy between Ontarians and the health services they need. Specialist physicians would benefit from local planning that enhances access to their services and promotes the use of technology (e.g. e-consult and c-referral) and shared care using telemedicine to provide services for complex patients who live far from specialty care. Hospitals would benefit because changes in the primary care and home and community care sectors would enable them to provide more continuous care, and help address intractable problems such as high rates of hospital readmissions, alternate level of care and inappropriate use of emergency services of 406

161 CCAC employees perform essential work that will continue under this proposal. CCAC employees who support clients would be integrated into the LHINs and their collective agreements will be respected. Some CCAC coordinators may end up working in hospitals or primary care settings, but they will still be employed by the LHINs. The CCAC management structure would be reviewed in conjunction with the management structure of expanded LHINs in order to support service planning and delivery in a way that maximizes care for patients and clients while improving efficiency. Public health staff would see no change in the critical work they do every day in their communities. However, they would have stronger links with other parts of the health system. Long-term care leaders and employees would have better support in managing transitions for clients between acute home and community care, and longterm care. They should benefit from better service planning and delivery in the home and community sector. The health system itself would be more efficient. There would be less duplication of services, better sharing of information and more effective use of technology to ensure quick access to health information, including lab results and diagnostic imaging. Connections across the full continuum of care would mean, for example, that family physicians receive hospital discharge summaries and providers in the acute sector receive community care assessments. Patients would also have access to publicly available information about health system performance that is specific and relevant to them of 406

162 one A PATH FORWARD The proposed structural changes to Ontario s health care system are designed to strengthen patient-centred care and deliver high-quality, consistent and integrated health services to all Ontarians. Implementing these changes while ensuring the continuity and improvement of high-quality services will require a well-thought-out and carefully implemented plan. The ministry has questions about how to successfully plan for and implement this proposed approach. With the release of this discussion paper, the ministry will begin an engagement process to discuss the proposal and its refinement. The ministry is committed to listening to staff and clinicians, patients, clients and caregivers, other health care partners, Indigenous peoples, and municipal and other community and government partners. We hope to receive feedback on the questions in this proposal, including: How can clinicians and health care providers be supported in leadership roles in continued system evolution? How do we ensure changes are supportive of and responsive to future service changes that are still being worked.on, such as home and community care? The proposed model would require changes to legislation including but not limited to the Local Health System Integration Act, 2006, the Community Care Access CorporationsAct, 2001, the Home Care and Community How do we create a platform for further service integration, such as Services Act, 1994, the Health enhanced community mental health and addictions services? Protection and Promotion Act, What accountability measures need to be put in place to ensure progress among others. The ministry is being made in integrating health care services and making them more is reviewing relevant acts responsive to the needs of the local population? and intends to propose draft How do we support improved integration through enhanced information systems, data collection and data sharing? legislation for consideration by What can be done to ensure a smooth transition from the current system the Legislative Assembly in the to the one proposed in this proposal? spring of How would we know whether the plan is working? If there are other questions, please submit them for consideration. Feedback and questions can be sent to health.feedback@ontario.ca or submitted at The ministry looks forward to continuing the conversation about this proposal in a variety of forums. We hope this discussion will result in a plan that can successfully build a high-performing, better connected, more integrated, patient-centred health system committed to continuous quality improvement. that responds to local needs and is of 406

163 APPENDIX System Governance The success of the proposal outlined in this paper is based on the ministry, LH1Ns and health care providers having the tools they need for effective governance and management. Clear and meaningful accountability relationships will be developed, and transparent performance measurement must be strengthened. To fulfill their new responsibilities, the LHINs would require expanded boards and leadership with the necessary skills, expertise and local knowledge. At the same time, LHINs need to be aligned with the ministry s objectives to ensure accountability to Ontarians and consistently equitable services. LHTN activities would need to he carefully defined and performance plans supported and enforced by the ministry. A variety of measures would be put in place to enhance LHIN accountability to the ministry and to Ontarians, including transparency, the identification of standards, funding and enhanced ministry authority. As the 2008 report High Pe?forming Healthcare Systems: Delivering Quality by Design demonstrated, it is possible to develop a culture of quality when objectives and structures are aligned. QUESTIONS FOR DISCUSSION What other tools are needed for effective governance? What would be the most effective structure for LHIN boards and their executive? Flow can LHINs promote leadership at the local level? Catalogue no ISBN no (Print 500 December 2015 Queens Printer for Ontario of 406

164 Item # 5.0 Strategic Dialogue 164 of 406

165 Item # 5.1 Auditor General's Report - Recommendations on LHINs 165 of 406

166 Briefing Note Report to: Agenda Number: Item # 5.1 Subject: Purpose: Central West LHIN Board of Directors Date: Wednesday, January 27, 2016 Key Contact: Auditor General Of Ontario - Value For Money Audit Local Health Integration Network (LHIN) Recommendations For Strategic Discussion Local Implications What Does This Mean for Central West LHIN? Scott McLeod, Chief Executive Officer Recommended Motion: N/A Background Summary : On December 12, 2015 the Office of the Audit General of Ontario released her 2015 Annual Report which included a Value for Money Audit of the Local Health Integration Networks The audit objective was to assess whether LHINs, in conjunction with the Ministry of Health and Long-Term Care (MOHLTC), have effective systems and procedures in place to facilitate the provision of the right care at the right time at the right place for Ontarians. Audit work was conducted between December 2014 and June 2015, primarily at four selected LHINs Central, Hamilton Niagara Haldimand Brant, North east and Toronto Central who represented 44% of the overall provincial LHIN funding in 2015 and the Ministry s Toronto offices as well. Additional consultation undertaken included: all current and former LHIN CEOs and board members, CEOs of health service providers funded by the LHINs and senior representatives from associations that represent all six health sectors that LHINs oversee Addictions and Mental Health Ontario, the Association of Ontario Health Centers, the Association of Community Care Access Centers, the Ontario Community Support Association, the Ontario Hospital Association and the Ontario Long Term Care Association. 166 of 406

167 Key audit observations were: The formation of LHINs has allowed health service providers, such as hospitals, and the home and community sector to work better together to find solutions to common health system issues. To fully realize the value of LHINs, both the MOHLTC and the LHINs need to better ensure that LHINs are meeting their mandate. The MOHLTC has not clearly determined what would constitute a fully integrated health system, or when it would be achieved. The MOHLTC has not yet developed ways of measuring how effective LHINs are performing specifically as planners, funders and integrators of health care. If the LHIN s mandate is to meet all expected performance levels, based on the 15 performance MLPA metrics the LHINs are not meeting their mandate improvement in 6 of the metrics and the remaining 9 have remained the same or deteriorated since the conception of the LHINs and the performance gap among LHINs has widened over time. The MLPA metrics are intended to measure system performance. There are no performance metrics to measure how effectively LHINs are performing. LHINs have not been consistently assessing whether their planning and integration activities were effective in providing a more efficient and integrated health system, and determining how much cost savings have been reinvested into direct patient care as a result of integration. Patients face inequities in accessing certain health services due to inconsistent and variable practices across the province The Ministry takes little action to hold the LHINs accountable to make changes when low performance continues year after year The Ministry responds differently to challenges faced by LHINs (some LHIN s performance targets relaxed if not being met while others held the same or became more stringent). LHINs could do more to define system capacity particularly palliative care, home and community care and rehabilitative services LHINs need to do more to monitor health system provider s performance of 406

168 Tracking of patient complaints lack rigour Group purchasing and back-office integration were not consistently implemented or fully explored The final report makes a number of recommendations to The MOHLTC and to the LHINs, focusing on changes that have the potential to drive system-wide improvement in the areas of performance, accountability, integration and funding.. (Attachment A Outlines all recommendations 9 to the MOHLTC and 9 to the LHINs plus 2 that were applicable to both parties) and (Attachment B outlines just the recommendations to the LHINs and the responses the audited LHINs provided to the Auditor General). Attachment B will be the focus of the strategic discussion. It is intended that the solutions that arise from the recommendations will continue to strengthen performance and quality across the LHINs, and will sharpen shared focus on leading change to improve the patient experience and health care outcomes. By following these recommendations, LHINs can make changes that have the potential to drive systemwide improvement in the areas of performance, accountability, integration and funding. Work on these recommendations is already underway across the LHINs for example, in September 2014 all 14 LHINs and Health Quality Ontario formalized a collaborative relationship by signing a Commitment to Collaboration. The Commitment promotes alignment efforts and accelerates advancement of a high performing health care system. As well, the LHINs developed and posted a standard process for receiving patient complaints and concerns to all 14 LHIN websites. Note: This Briefing Note is based on the Auditor s General Report Content with incorporation of direct content Options Considered: The briefing note provides the basis for the Central West LHIN Board strategic discussion which is to focus on the local implications of the recommendations and what do they mean for Central West Impact Analysis: Alignment with Strategic Priorities Improve access to Care Stream Line Transitions and Navigation Drive Quality and Value Build on the Momentum of 406

169 Governance Best Practice Operational Excellence Enterprise Risk Implementation Plan: TBD Attachments: Attachment A - Table All Recommendations MOHLTC and LHINs Attachment B Table Recommendations only to the LHINs and the responses to the recommendations that the audited LHINs provided to the Auditor General of 406

170 Auditor General LHIN VFM Audit (all recommendations) Attachment A 20 Recommendations MOHLTC (9 Recommendations + 2 joint with LHINs) LHIN (9 Recommendations + 2 joint with MOHLTC) Recommendation 1 To minimize the differences in health service performance among Local Health Integration Networks (LHINs) across the province, the Ministry of Health and Long-Term Care should: analyze the reasons for the widening gap in the performance on LHINs in key performance areas establish the degree of variation it would consider acceptable among LHINs performance in each measured performance area; and set timelines for bringing the performance gaps among LHINs to acceptable levels Recommendation 2 To help ensure that patients across the province receive targeted levels of care, the Local Health Integration Networks should better manage capacity and demand for community-based services and MRI scans within their individual regions. Recommendation 3 To help ensure that patients across the province receive targeted levels of care, the Ministry of Health and Long-Term Care should: ensure that capacity and demand for community-based services and MRI scans are managed province-wide with consideration to existing resources; and develop the provincial plan on heal-care needs in rural and northern communities according to its commitment in Recommendation 4 To ensure Local Health Integration Networks (LHINs) perform at desired levels, the Ministry of Health and Long-Term Care, in conjunction with the LHINs, should: communicate best practices observed in well-performing LHINs to LHINs that need intervention so the latter can identify potential solutions to performance shortfalls; assist LHINs in analyzing the root causes of performance aps and determining appropriate action to address ongoing issues; and require LHINs to establish reasonable timelines to address performance gaps and monitor their progress accordingly Recommendation 5 To ensure that Local Health Integration Networks (LHINs) are assessed objectively and comprehensively on their operational effectiveness and for all health sectors that they manage, the Ministry of Health and Long-Term Care should: develop LHIN-specific performance targets that reflect current evidence-based benchmarks; and of 406

171 Recommendation 6 Recommendation 7 Recommendation 8 Recommendation 9 examine the appropriateness of including additional performance indicators not currently in those recommended by the Indicators Advisory Group and finalize the implementation of the performance indicators that measure non-hospital-sector performance as well as coordination of health services To better meet Local Health Integration Networks (LHINs) mandate of integrating local health systems, the Ministry of Health and Long-Term Care should determine how best LHINs can manage the primary-care sector. To ensure Ontario benefits from a fully integrated system in the foreseeable future, the Ministry of Health and Long-Term Care should: establish a clear picture of what a fully integrated health system looks like, its milestones and final targets, and timelines for when LHINs should achieve those targets; and require that LHINs develop performance measures and targets to meet the goals they propose in their three-year strategic plans, and report on their results To help improve patient care and quality of health services, Local Health Integration Networks, in collaboration with Health Quality Ontario, should: assess patients satisfaction with their health service providers and the extent to which they feel they are receiving quality services; assess whether a quality improvement plan should be required of all health service providers; and ensure health service providers implement the actions contained in the quality improvement plans To ensure that performance issues of health service providers are addressed in an appropriate and timely manner, Local Health Integration Networks (LHINs) should: clarify with the Ministry of Health and Long-Term Care whose responsibility it is to verify data submitted by health service providers; if it is the LHINs responsibility, verify on a sample basis information submitted by health service providers; of 406

172 Recommendation 10 Recommendation 11 Recommendation 12 Recommendation 13 To reduce the variation in the experiences of patients, the Ministry of Health and Long-Term Care should clarify under what circumstances it, as opposed to the Local Health Integration take appropriate remedial action according to the severity and persistence of performance issues; and follow up with health service providers to ensure they provide explanations of performance shortfalls and take effective corrective actions to resolve issues according to a committed timeline To ensure patients receive quality health service, and to facilitate collaboration between Local Health Integration Networks (LHINs) and the Patient Ombudsman, LHINs should: establish a common complaint-management process that, among other things, clearly defines the methods for informing the public on how to register complaints; implement processes to determine whether health service providers have established policies and procedures to address and satisfactorily resolve patient complaints; and clarify the working relationship between LHINs and the incoming Patient Ombudsman To best meet the patients health care needs, Local Health Integration Networks should: assess the effectiveness of each community engagement activity as required by the LHIN Community Engagement Guidelines and Toolkit issues by the Ministry of Health and Long-Term Care; begin to collect, over a reasonable time period, the data needed to determine the existing capacity of all health services in their regions; and develop and implement action plans with timelines to address the service gaps identified To ensure that best practices are effectively identified and shared, Local Health Integration Networks should: develop guidelines ad training to evaluate whether projects result in best practices; and establish a protocol to use for sharing best practices of 406

173 Recommendation 14 Recommendation 15 Recommendation 16 Recommendation 17 Recommendation 18 Recommendation 19 Recommendation 20 Networks, is responsible for establishing common approaches to delivering health services. To ensure that Local Health Integration Networks (LHINs) fully explore integration opportunities among health sectors, the Ministry of Health and Long-Term Care (the Ministry) should clarify with the LHINs what authority they have to reallocate funding among health service providers, and inform them that they can negotiate the use of dedicated funding with the Ministry. To ensure that health services across Ontario are delivered as cost efficiently as possible, Local Health Integration Networks should identify further group-purchasing and back-office integration opportunities in the various health sectors, and implement these cost-saving practices. To ensure integration initiatives improve local health systems and to help identify the most effective types of approaches to integration, Local Health Integration Networks should measure the impact that each integration initiative has on LHIN service levels and costs. To ensure health service providers can properly plan to meet patient-care needs, the Ministry of Health and Long-Term Care, in conjunction with the Local Health Integration Networks, should finalize the annual funding each health service provider will receive before the fiscal year begins or as early in the current fiscal year as possible. To ensure that the share of the Urgent Priorities Fund allocated to each Local Health Integration Network reflects current patient needs, the Ministry of Health and Long-Term Care should: ensure the amount allocated to the Fund is appropriate considering overall funding increases over time; and regularly revise the allocation on the basis of current population and/or other relevant information To ensure the division of the Local Health Integration Networks (LHINs) is conducive to effective planning and integrating of local health care services, the Ministry of Health and Long-Term Care should review existing LHIN boundaries. To ensure health service provider spend funding from the Urgent Priorities Fund only on patient services, as the Fund requires, Local Health Integration Networks should follow a consistent decision-making process and approve applications only on the basis of established criteria of 406

174 Auditor General LHIN VFM Audit (LHIN recommendations and responses) Attachment B # LHIN (11) Response Recommendation 2 To help ensure that patients across the province receive targeted levels of care, the Local Health Integration Networks should better manage capacity and demand for community-based services and MRI scans within their individual regions. LHINs acknowledge the need to be strong leaders in managing local resources, continuing to build capacity and strengthen system sustainability. However, the LHINs recognize they have limitations in managing demand for services. These are influenced by external factors outside of the LHINs scope, such as demographic changes, population health needs, changing technologies and practices. LHINs fully support the Ministry s vision of creating a patient-centred system of care, as articulated in Patients First : Action Plan for Health Care (February 2015) and Patients First: A Road Map to Strengthen Home and Community Care (May 2015). Currently, disparities exist across the province in the capacity of home and community providers, and the availability of health human resources to meet demands. Inequities and challenges need to be addressed by LHINs, which will work in partnership with the Ministry and their health service providers to better manage current and future demands on the system. With our aging population, demands on home and community care services, as well as demands on resources, will continue to grow. LHINs endorse the need to ensure Ontarians who require MRIs receive timely access to this diagnostic service. LHINs have no ability to control the demand for MRIs; however, they have worked and will continue to work with hospitals to improve utilization and efficiency. LHINs will also continue to work closely with their hospitals and the Ministry in the efforts to implement best practices, as well as Recommendation 4 Recommendation 8 To ensure Local Health Integration Networks (LHINs) perform at desired levels, the Ministry of Health and Long-Term Care, in conjunction with the LHINs, should: communicate best practices observed in well-performing LHINs to LHINs that need intervention so the latter can identify potential solutions to performance shortfalls; assist LHINs in analyzing the root causes of performance aps and determining appropriate action to address ongoing issues; and require LHINs to establish reasonable timelines to address performance gaps and monitor their progress accordingly To help improve patient care and quality of health services, Local Health Integration Networks, in collaboration with Health Quality Ontario, should: address geographic and other challenges associated with MRI access. The Ministry accepts this recommendation and will continue to work with LHINs on performance, performance gaps and timelines. The Ministry notes that LHINs have established and spread leading practices by identifying priorities and solutions that are important to their local communities and providers. Examples such as integrated lab systems, vision care strategies, centralized intake and assessment for orthopedics, stroke rehabilitation strategies and mental health integration have all been led by individual LHINs, with adoption by others. Against this backdrop is a strong history of provincial strategies, such as those led by Cancer Care Ontario, the Cardiac Care Network and the Ministry, including the palliative care and the diabetes strategies, all of which have been supported by LHINs and their providers for implementation. LHINs have collaborated to initiate common provincial strategies for shared priorities, such as the Rehabilitative Care Alliance. The Ministry is fully aware and supportive of these LHIN-led initiatives and actively identifies leading LHIN practices to other LHINs. To assist the LHINs with analyzing root causes of performance gaps, the Ministry will continue to provide data, analytics and policy research to LHINs and regularly seek advice from them on provincial priorities and strategies to determine appropriate action to address ongoing issues. LHINs themselves meet regularly to collaborate on common challenges and solutions. LHIN performance data is fully available to all LHINs for review and collaboration. The Ministry will continue to foster community of practice and will work with the LHINs to establish reasonable timelines to address performance gaps and monitor progress. In September 2014, the 14 Ontario LHINs and Health Quality Ontario (HQO) signed a Commitment to Collaboration, which defines a collaborative relationship between the Crown agencies to promote alignment efforts and accelerate advancement of a high-performing health-care system. Significant work has already been initiated by the LHINs and HQO, and the progress and activities on priority areas are reviewed quarterly by the HQO/ LHIN Partnership Table of 406

175 # LHIN (11) Response assess patients satisfaction with their health service providers and the extent to which they feel they are receiving quality services; Recommendation 9 Recommendation 10 assess whether a quality improvement plan should be required of all health service providers; and ensure health service providers implement the actions contained in the quality improvement plans To ensure that performance issues of health service providers are addressed in an appropriate and timely manner, Local Health Integration Networks (LHINs) should: clarify with the Ministry of Health and Long-Term Care whose responsibility it is to verify data submitted by health service providers; if it is the LHINs responsibility, verify on a sample basis information submitted by health service providers; take appropriate remedial action according to the severity and persistence of performance issues; and follow up with health service providers to ensure they provide explanations of performance shortfalls and take effective corrective actions to resolve issues according to a committed timeline To ensure patients receive quality health service, and to facilitate collaboration between Local Health Integration Networks A Patient Experience Measurement Committee, co-chaired by the LHIN CEO Quality Lead and HQO, is developing an inclusive plan to support patient experience measurement for the purposes of quality improvement, public reporting and research, within and across all sectors in Ontario. The secondary goal of the Committee is to make recommendations to HQO and other health system stakeholders about what approaches might be used to develop standards for patient experience measurements in Ontario. LHINs and HQO are also working together to create an aligned, integrated Provincial Quality Improvement strategy aimed at strengthening the impact of the Quality Improvement Plans and advising on future directions for the Quality Improvement Plans required under the Excellent Care for All Act. The opportunities identified within this recommendation will be considered as the work plan is further developed. The LHINs and Ministry acknowledge the importance of high-quality data for decision making. Accountability for reporting accurate and timely data lies with the health service providers. This obligation is embedded in the service accountability agreements for all sectors. The LHINs support health service providers to successfully meet their reporting accountabilities. The LHINs are not resourced or mandated to perform data audits and cannot assume that function. In order to increase confidence in the performance information submitted by health service providers, LHINs will develop or maintain a practice of regularly reviewing data submissions for consistency and reasonableness. LHINs will address concerns with health service providers and identify data quality as a performance issue as appropriate. LHINs have a responsibility to identify and respond to serious and/or persistent performance issues demonstrated by health service providers as outlined in the service accountability agreements. Given the large number of health service providers and numerous services and programs offered by those providers, it is important that LHINs utilize a risk stratified approach to reviewing, prioritizing and resolving performance issues. Each LHIN will adopt or maintain a performance management framework and/or performance accountability policy. The frameworks and policies will outline the risk management approach and an escalating set of interventions to be employed by LHINs in response to serious or persistent performance issues. The LHINs fully support the core promise of the Ministry to build a health system that puts patients first. This means understanding what is important to patients and listening when they have concerns. LHINs are currently working on website messaging that explains and outlines the complaint process to citizens, health service providers and other key stakeholders. LHINs will adopt and/or maintain a patient-complaints management protocol of 406

176 # LHIN (11) Response (LHINs) and the Patient Ombudsman, LHINs should: Recommendation 11 Recommendation 12 establish a common complaintmanagement process that, among other things, clearly defines the methods for informing the public on how to register complaints; implement processes to determine whether health service providers have established policies and procedures to address and satisfactorily resolve patient complaints; and clarify the working relationship between LHINs and the incoming Patient Ombudsman To best meet the patients health care needs, Local Health Integration Networks should: assess the effectiveness of each community engagement activity as required by the LHIN Community Engagement Guidelines and Toolkit issues by the Ministry of Health and Long-Term Care; begin to collect, over a reasonable time period, the data needed to determine the existing capacity of all health services in their regions; and develop and implement action plans with timelines to address the service gaps identified To ensure that best practices are effectively identified and shared, Local Health Integration Networks should: Health service providers are accountable to establish and implement patient relations and complaints policies and procedures under the Excellent Care for All Act and/or their service accountability agreement. LHINs will ensure a process exists whereby health service providers demonstrate compliance with these accountabilities. LHINs will continue to work closely with the Ministry as it implements the role of Patient Ombudsman. Following the Patient Ombudsman s appointment, the Ministry and LHINs will meet with the Patient Ombudsman to define the working relationship and expectations of each party. The Ministry will need to communicate to LHINs how the reporting and communication flow will occur between the Patient Ombudsman and the LHINs. Timelines will be contingent on work by the Ministry and the appointment of the Patient Ombudsman. A key component of the LHINs mandate is to engage with and seek input from their local communities. This includes patients, families, health service providers, residents, professional associations, municipalities and others. The LHINs, in collaboration with the Ministry, are currently in the process of refreshing the LHIN Community Engagement Guidelines and Toolkit. The Guidelines and Toolkit refresh will continue to be aligned with the Local Health Systems Integration Act, 2006 (Act) while reflecting the changing landscape of community and patient engagement, new and emerging technologies, and the maturation of LHIN processes that have now structurally incorporated engagement into routine planning. Direction about what type of community engagement activity lends itself to formal evaluation will be included in the refreshed Guidelines and Toolkit. Work is under way to establish capacity plans in rehabilitative service, palliative care, and home and community care. The LHINs will continue to engage with the Ministry, health service providers, subject matter experts and other stakeholders in capacity assessment at a provincial level. LHINs agree that sharing best practices is key to leveraging successes across the system in order to respond to population health needs. This is evident in the adoption of best practices across LHINs such as the Joint Assessment Centres. In order to drive innovative and sustainable service delivery, LHINs have initiated work in three priority areas to share best practices and minimize duplication of effort of 406

177 # LHIN (11) Response develop guidelines ad training to evaluate whether projects result in best practices; and The Local Health Integration Network Collaborative, a division of LHINs jointly funded by the Ministry to co-ordinate and implement pan- LHIN initiatives, is working with the 14 LHINs in Mental Health & Addictions, Home & Community Care, and End of Life Care using this approach. Leveraging the learnings from these initiatives underway, the LHINs will continue to work toward developing guidelines establish a protocol to use for sharing best practices and training for evaluation of best practices and establishing a protocol for sharing these across LHINs, recognizing the diverse geographies and unique populations that they serve. Recommendation 14 Recommendation 15 Recommendation 17 Recommendation 19 To ensure that health services across Ontario are delivered as cost efficiently as possible, Local Health Integration Networks should identify further group-purchasing and back-office integration opportunities in the various health sectors, and implement these cost-saving practices. To ensure integration initiatives improve local health systems and to help identify the most effective types of approaches to integration, Local Health Integration Networks should measure the impact that each integration initiative has on LHIN service levels and costs. To ensure health service providers can properly plan to meet patient-care needs, the Ministry of Health and Long-Term Care, in conjunction with the Local Health Integration Networks, should finalize the annual funding each health service provider will receive before the fiscal year begins or as early in the current fiscal year as possible. To ensure health service provider spend funding from the Urgent Priorities Fund only on patient services, as the Fund requires, Local Health Integration Networks should follow a consistent decision-making process and approve applications only on the basis of established criteria. The LHINs will support their health service providers to implement group-purchasing and back-office integration initiatives where a case exists to achieve significant value (i.e., realized cost savings, improved quality, improved internal controls and increased capacity). Consistent with the LHIN mandate, LHINs will continue to lead and focus on service integration (i.e., the integration of service delivery to patients, clients and residents) for the benefit of residents. LHINs fully support measurement of the impact that each integration has on LHIN service levels and costs. The LHINs recognize the complexity associated with these evaluations. LHINs will work toward developing a standard framework in which to identify and measure the impact of these integrations demonstrating overall value for service providers, patients and the system. This work will be informed by the Ministry in partnership with health service providers and evaluation specialists in order to ensure an effective and aligned approach. The Ministry supports this recommendation. The majority of LHIN funding is a base budget that continues from one year to the next. The Ministry is working with sector partners to review its funding processes to identify opportunities to finalize allocations earlier, and will work with the LHINs to confirm funding amounts as early as possible. Many LHINs adopted the decision-making framework developed in 2010 by the Local Health Integration Networks Collaborative to help make consistent decisions on funding projects, programs and services. All LHINs will use the revised framework for decision-making about the allocation of discretionary funds of 406

178 Item # 5.2 Health Quality Ontario - 'Measuring Up' Overview 178 of 406

179 Measuring Up HQO Common Quality Agenda 07 December of 406

180 Common Quality Agenda of 406

181 Measuring Up Ontario Poor Performance Wait time for LTC Wait time for home care Drug spending Caregiver distress Bright Spots Smoking rates, Physical inactivity rates Colorectal cancer screening ACSC admissions Avoidable deaths Flat Results Access to primary care Eye exams for Ontarians with diabetes Primary care follow-up post discharge Unequal Progress Avoidable deaths ACSC admissions Physical restraints in LTC Smoking rates Primary care follow-up post discharge of 406

182 Measuring Up Central West LHIN Relatively Poor Performance Premature deaths Evening/weekend access to primary care Time with primary care provider C-section rate Obstetric readmissions Bright Spots Life expectancy Primary care follow-up post discharge ALC Next day access to primary care Hospitalization/re-hospitalization rate for MHA Restraints in LTC of 406

183 of 406

184 Measuring Up 2015: Key Findings Measuring Up is HQO s annual report on the Common Quality Agenda (CQA fig. 1.1 on pg. 10) is the second year that it has been published. The report is structured to have a chapter for each heading in the CQA. New this year: Chapter on mental health Chapter on health spending Additions to home care Not reported this year: Vaccinations (omitted this year for technical reasons, but will be included again in subsequent years Pg. 6 Executive Summary: HQO has described performance in Measuring Up in four categories: Poor performance Some indicators show clearly where improvements need to be made. Flat results Most indicators show little change over time. In some cases stable results can mean progress. In other cases work needs to be done. Bright spots Areas of continued good performance or of improved performance are highlighted. Unequal progress Areas where provincial performance may be good, but the experience of different groups of Ontarians is variable Measuring Up reports performance in Ontario, sometimes showing regional comparisons by LHIN, and often comparing Ontario s performance with that of other provinces in Canada, with Canada overall, and with other developed countries. For indicators that are not reported on by LHIN in Measuring Up, but for which the Central West LHIN has unusually poor or bright performance, notes below are taken from the pan-lhin environmental scan conducted by the Health Analytics Branch of the Ministry of Health and Long Term Care, using the same source material as the data in the CQA reported in Measuring Up. In the notes below, information from the environmental scan is denoted in italicized orange text. Highlights by chapter in Measuring Up 2015 are as follows. Health of Ontarians pg.14 (fig. 2.1) Bright inactivity and smoking in Ontario have decreased, BUT Poor obesity and inadequate vegetable intake have increased Environmental Scan: Poor Central West LHIN residents had a significantly higher rate of physical inactivity compared with Ontario overall. Approximately 56% of residents were overweight or obese. pg. 17 (fig. 2.3) Unequal smoking rates vary across different groups in Ontario Ontarians without a high school diploma are more than twice as likely to smoke (34.9%) as those with post-secondary education (15.5%) pg. 18 (fig. 2.4) Unequal life expectancy is five years shorter in one LHIN region (78.6 years) compared to the regions with the longest average lifespans (83.6 years) Bright Central West is tied with Central for longest life expectancy at birth in Ontario pg. 23 (fig. 2.9) Bright Ontario has the 2 nd lowest rate of avoidable death in Canada, BUT pg. 22 (fig. 2.8) Unequal there is variability across Ontario from 114 (Central) to 258 (North West), AND Environmental Scan Poor 44.7% of Central West LHIN resident deaths occurred in those younger than 75 years and are considered premature this was the largest proportion among all the LHINs. These premature deaths resulted in 29,694 years of potential life lost. 184 of 406

185 System Integration pg. 27 (fig. 3.1) Poor in Ontario, fewer than half of patients hospitalized for heart failure and COPD see a doctor for follow-up within a week of leaving the hospital, AND pg. 28 (fig. 3.2) Unequal follow up with doctor after hospitalization for heart failure varies across Ontario from 55.5% in Central West to 27.2% in North West Bright the Central West LHIN has the highest rate, but there is still room for improvement pg. 31 (fig. 3.5) Bright rates of hospitalization for ambulatory care sensitive conditions continue to improve in Ontario, BUT pg. 32 (fig. 3.6) Unequal the rate of hospitalizations for ambulatory care sensitive conditions per 100,000 people ranges across the province from 146 in Central to 404 in North East pg. 34 (fig.3.8) Poor in Ontario, about one in seven acute care hospital beds is used by a patient considered to be ready to receive care outside the hospital, BUT pg. 35 (fig.3.9) Bright Central West LHIN has lowest %ALC days of all LHINs Primary Care pg. 41 Bright 94% of Ontarians report having a primary care provider, BUT pg. 42 (fig. 4.1) Poor only about half can easily get a timely appointment when they are sick or need after-hours care Bright Central West LHIN has the best access to primary care on the same day/next day, BUT pg. 43 (fig. 4.2) Poor Central West LHIN has the second worst access to primary care on evenings and weekends, AND Environmental Scan: Poor the proportions of attached adults in the Central West LHIN who reported that their primary care provider always or often gives them the opportunity to ask questions (76.8%), and that their provider always or often spends enough time with them (74.5%) were the lowest in the province. pg. 44 (fig. 4.3) Poor access to primary care is poor in Ontario when compared internationally pg. 46 (fig. 4.5) Bright the percentage of Ontarians overdue for colorectal cancer screening has decreased (improved) by 4.7% pg. 48 (fig. 4.7) Flat consistently, fewer adults in Ontario under the age of 65 with diabetes have eye exams Mental Health new in 2015 pg. 54 (fig. 5.2) Unequal rates of hospitalization for a mental illness or an addiction in Ontario vary widely by region Bright Central West LHIN has the 3 rd lowest admission rate for MHA pg. 55 (fig. 5.3) Flat for six years, more than two-thirds of patients hospitalized for a mental illness or an addiction do not see a doctor for follow-up within a week of leaving the hospital pg. 58 (fig. 5.6) Bright Central West LHIN has the 2 nd lowest hospital readmission rate for MHA pg. 60 (fig. 5.8) Flat Ontario s suicide rate has not changed in a decade 185 of 406

186 Home Care pg. 65 (fig. 6.1) Bright Central West has the highest percentage of residents receiving RN within 5 days pg. 66 (fig. 6.2) Unequal while the majority of home care patients with complex needs receive personal support services within the five-day target, it varies substantially across Ontario Bright Central West has the second highest percentage for PSW pg. 67 (fig. 6.3) Unequal the percentage of people who enter a long-term care home with low to moderate care needs varies substantially across the province pg. 68 (fig. 6.4) Poor caregiver distress in Ontario has doubled in four years Hospital Care pg,. 82 (fig. 7.9) Bright the rate of hospital-acquired C. difficile infections has decreased slightly in recent years. pg,. 82 (fig. 7.10) Poor almost one in five very-low-risk births is a Caesarean section delivery. Environmental Scan: Poor Central West LHIN had the highest rate of Caesarean births in the province (32.3%). Poor For residents of the Central West LHIN, the rate of 30-day obstetric readmission rate (2.0%) was one of the highest in the province. Poor the potential years of life lost (PYLL) rate for perinatal conditions for Central West LHIN residents was the highest among all LHINs Long-Term Care pg. 87 (fig. 8.1) Bright median wait time from home for a place in long-term care has improved (116 days in 2013/14) but has grown for patients waiting in hospital (69 days) Flat falls in long-term care homes in Ontario have remained stable over time, AND pg. 89 (fig. 8.3) Bright % in daily restraints continues to drop in Ontario, despite increases in the complexity of residents needs, BUT pg. 90 (fig. 8.4) Unequal practice of physically restraining residents of long-term care has decreased substantially but varies across LHIN regions, from 2.7% in Toronto Central to 14.4% in North West. Bright Central West has the 2 nd lowest proportion of residents in daily restraints (2.9%). Health Workforce pg. 97 (fig. 9.1) Bright over the most recent four years of data, the number of registered practical nurses and nurse practitioners continued to rise; the number of registered nurses has dropped slightly pg. 98 (fig. 9.2) Bright the number of family doctors and specialist doctors per 100,000 people has increased over eight years in Ontario, BUT pg. 99 (fig. 9.3) Unequal The number of family doctors in each LHIN region varies across Ontario, Poor from a low of 68 family doctors per 100,000 people in Central West to a high of 135 per 100,000 people in Toronto Central. pg. 101 (fig. 9.5) Bright lost-time injury rates for the health care sector fell from 2.3 injuries per 100 workers in 2003 to 1.4 injuries in of 406

187 Health Spending new in 2015 pg. 104 (fig. 10.1) Bright after a steady climb for a decade, Ontario s health spending per capita has dropped slightly in the last two years pg. 107 (fig. 10.4) Poor Spending on drugs in Ontario is high compared to some countries pg. 108 (fig. 10.5) Poor 8% of Ontarians surveyed, aged 55 and older, did not fill a prescription or skipped a dose because of cost, three to four times more than in most countries in the survey 187 of 406

188 General Health, Risk Factors, and Prevention Notes: This document contains analyses based on the Canadian Community Health Survey (CCHS). The target population of the CCHS annual survey is Canadians aged 12+. Individuals living on Aboriginal Reserves and on Crown lands, institutional residents, full-time members of the Canadian Forces and residents of certain remote regions are excluded. General Health 62% of Central West LHIN residents reported very good or excellent health. Compared with the province, Central West LHIN had a significantly higher proportion of residents (76%) who reported very good or excellent mental health. Among all LHINs, Central West had the 3 rd highest proportion of residents reporting very good or excellent health and the highest proportion of reporting very good or excellent mental health. 25% of Central West LHIN residents reported their days were quite a bit or extremely stressful. Compared with the province, Central West LHIN had significantly lower proportions of residents reporting pain/discomfort and participation/activity limitations. Approximately 9% of residents reported moderate or severe pain/discomfort, compared to 14% for Ontario. 23% of Central West LHIN residents reported activity limitations because of long-term physical or mental health problems, compared to 31% provincially. 93% of Central West LHIN residents reported having a regular medical doctor. Compared with Ontario, a significantly smaller proportion of Central West LHIN residents (26%) received a flu shot in the past year. Risk Factors Compared with Ontario, Central West LHIN had a significantly lower proportion of smokers, and this proportion was the lowest among all LHINs. Central West also had the second lowest proportion of heavy drinkers (12%) in the province. Central West LHIN residents had a significantly higher rate of physical inactivity compared with Ontario overall. Approximately 56% of residents were overweight or obese. General health, risk factor prevalence: Central West LHIN (2013) Central LHIN Rank LHIN Trend % of population, age 12+ West Ontario (1-14) over time LHIN Very good or excellent self-perceived health Very good or excellent self-perceived mental health favourable Days that are quite a bit or extremely stressful (age 15+) With moderate or severe pain/discomfort With participation/activity limitations sometimes/often Have a regular medical doctor Received flu shot in the past year unfavourable Risk Factors Are daily or occasional smokers favourable Are heavy drinkers favourable Are overweight or obese (age 18+) unfavourable Are physically inactive Consume < 5 servings of fruits/vegetables daily LHIN result is significantly higher than Ontario. LHIN result is significantly lower than Ontario. Ranks: Low ranks (e.g., 1) is better Excerpts from pan-lhin Environmental Scan (June 2015) of 406

189 Appendix: Prevalence of risk factors across LHIN areas, 2013, population age 12+ % of the population age 12+ with 1. ESC 2. SW 3. WW 4. HNHB 5. CW 6. MH 7. TC 8. CEN 9. CE 10. SE 11. CH 12. NSM 13. NE 14. NW ONT Very good or excellent self-perceived health Very good or excellent self-perceived mental health Days that are quite a bit or extremely stressful (age 15+) With moderate or severe pain/discomfort With participation/activity limitations sometimes/often Have a regular medical doctor Received flu shot in the past year Risk Factors Are daily or occasional smokers Are heavy drinkers Are overweight or obese (age 18+) Are physically inactive Consume < 5 servings of fruits/vegetables daily Heavy drinking refers to consuming 5 or more drinks on one occasion (4 for women), at least once a month in the past year. Estimates with high sampling variability (CV between ) - must be used with caution. F - Estimates with CVs greater than 33.3% are too unreliable to be published and have been suppressed due to extreme sampling variability.. Missing data Significance testing: LHINs are compared to Ontario ( higher; lower) 2 Excerpts from pan-lhin Environmental Scan (June 2015) 189 of 406

190 Births and Mortality Notes: This document and the accompanying workbook contain analysis of births and maternal outcomes from the Better Outcomes Registry & Network (BORN) Ontario, and the Canadian Institute for Health Information (CIHI); and analysis of mortality and potential years of life lost (PYLL) using data from Statistics Canada and the Ontario Registrar General. Births and Maternal Outcomes There were 8,321 births in Central West LHIN hospitals in FY 2011/ % of women who gave birth in the Central West LHIN were under 20 years and 19.4% were 35 years or older. Both proportions were slightly lower than the provincial averages of 3.2% and 22.0%, respectively. Central West LHIN had the highest rate of Caesarean births in the province (32.3%). The proportion of births attended by an obstetrician (87.5%) was higher than the provincial average (84.7%), while the proportion of births attended by a family physician (7.5%) was similar to the provincial average (8.6%). 2.8% of births were attended by a midwife; much lower than the Ontario average (5.2%). In the Central West LHIN, 11.7% of newborns were classified as small for gestational age which was the highest proportion in the province. 7.8% of newborns were classified as large for gestational age. This proportion was the second lowest among all LHINs. The rate of exclusive breastfeeding (48.2%) in this LHIN was the lowest in the province. For residents of Central West LHIN, the rate of 30-day obstetric readmission rate (2.0%) was one of the highest in the province. Births and Maternal Outcomes 2011/12 Indicator Central West LHIN Ontario Total births in Central West LHIN hospitals 8, ,386 Distribution of maternal age (%) < Rate of Caesarean delivery (%) Distribution of care provider who attended the hospital birth (%) Obstetrician Family physician Midwife Rate of pre-term birth (< 37 weeks) (%) % births small for gestational age % births large for gestational age Rate of exclusive breastfeeding at discharge among term live births (%) day obstetric readmission rate, LHIN of patient (%) Between 10% and 30% of records and missing information were excluded from calculations in HNHB and Central West LHINs. Individual hospitals in Waterloo Wellington, Toronto Central, Central, Central East, and North East LHIN that did not collect information on breastfeeding at discharge from hospital or had more than 30% of missing records on this variable and were excluded from the denominator used for these calculations. 3 Excerpts from pan-lhin Environmental Scan (June 2015) 190 of 406

191 Mortality and Potential Years of Life Lost 3,593 Central West LHIN residents died in The all-cause mortality rate for Central West LHIN residents was per 100,000 population in Although this was the lowest all-cause mortality rate among all LHINs the rate has increased slightly (by 1.9%) since The leading causes of death for LHIN residents were ischaemic heart disease, dementia and Alzheimer disease, and cancer of lung and bronchus. The rates for all the top 10 causes of mortality were lower than the Ontario rates and all rates were among the lowest among the LHINs. The top 10 causes of mortality accounted for 51.1% of all Central West LHIN resident deaths in % of LHIN resident deaths occurred in those younger than 75 years and are considered premature this was the largest proportion among all the LHINs. These premature deaths resulted in 29,694 years of potential life were lost. The LHIN s PYLL rate was lower than the provincial rate (3,569.3 vs 4,327 per 100,000 population aged less than 75 years). Since 2007, the PYLL rate decreased by 8.9% for Central West LHIN residents. The leading causes of PYLL for Central West LHIN residents were for perinatal conditions, ischaemic heart disease, and cancer of lung and bronchus. The PYLL rate for perinatal conditions for Central West LHIN residents was the highest among all LHINs. The rates of PYLL for cancer of lung and bronchus and intentional self-harm for Central West residents were the second lowest among LHINs. 4 Excerpts from pan-lhin Environmental Scan (June 2015) 191 of 406

192 Mortality and Potential Years of Life Lost, 2011 Mortality Central West LHIN Ontario Total deaths, ,593 88,967 % change in total deaths ( ) 12.5% 2.3% All-cause mortality rate per 100,000 population % change in all-cause mortality rate ( ) 1.9% -1.3% % of deaths that were premature (age < 75) 44.7% 37.2% Top 10 leading causes of death, 2011 (rates per 100,000 population) Comment Ischaemic heart disease nd lowest in province Dementia and Alzheimer disease Lowest in province Cancer of lung & bronchus Lowest in province Cerebrovascular diseases Lowest in province Chronic lower respiratory diseases nd lowest in province Diabetes rd lowest in province Cancer of colon, rectum, anus Lowest in province Cancer of breast nd lowest in province Influenza and pneumonia Lowest in province Cancer of lymph, blood & related Lowest in province Potential years of life lost (PYLL) Total PYLL, , ,071 % change in PYLL ( ) 0.3% -3.4% PYLL rate per 100,000 population (age < 75) 3, ,327.0 % change in PYLL rate ( ) -8.9% -6.5% Top 10 leading causes of PYLL, (rates per 100,000 population, age < 75) Perinatal conditions Highest in province Ischaemic heart disease Cancer of lung & bronchus nd lowest in province Intentional self-harm nd lowest in province Accidental poisoning Congenital malformations, deformations, chromosomal abnormalities Transport accidents Cancer of breast Cerebrovascular diseases rd highest in province Cirrhosis and other liver diseases Note: In the 2011 death file from Statistics Canada, 4% of postal codes for Ontario residents were missing; this is compared to a negligible percentage of missing data since they started using postal codes to assign municipality of residence in Consequently, all the geographic fields that are derived from postal code or municipality (including LHINs) have a higher percentage of missing data in Excerpts from pan-lhin Environmental Scan (June 2015) 192 of 406

193 Primary Care Primary Care: Selected indicators from the Health Care Experience Survey Follow-up with a primary care physician following acute hospital discharge Notes: This document and the accompanying workbook contain analysis of selected indicators from the Health Care Experience Survey; percentage of patients who saw a primary care physician within seven days of acute discharge from hospital for selected conditions (based on 25 Case Mix Groups (CMGs)), derived from data from the Discharge Abstract Database (DAD), Claims History Database (CHDB), and Corporate Provider Database (CPDB); and primary care enrolment, obtained from the Primary Health Care Status Report, derived from the Client Agency Program Enrolment (CAPE) and CPDB. ONTARIO Primary care access and satisfaction, adults (aged 16 and older), by LHIN of residence, January 2014-December 2014 % patient attachment % same/next day access when sick Access to, and satisfaction with, primary care % aware of after-hours clinic offered by provider % with difficulty accessing afterhours care without going to ED % whose provider allows opportunity for questions % whose provider spends enough time with them LHIN of residence Erie St. Clair 96.0% 42.5% 35.5% 61.9% 84.8% 82.2% South West 94.8% 41.3% 42.5% 56.9% 87.6% 81.7% Waterloo Wellington 96.5% 42.6% 50.9% 54.1% 86.7% 83.6% HNHB 95.7% 48.7% 49.6% 48.3% 88.3% 84.5% Central West 93.8% 57.0% 32.2% 46.8% 76.8% 74.5% Mississauga Halton 94.5% 47.6% 36.9% 45.3% 80.9% 80.7% Toronto Central 91.8% 49.3% 34.5% 49.4% 89.3% 85.0% Central 94.2% 48.1% 30.0% 48.6% 84.6% 82.8% Central East 93.7% 39.0% 37.1% 49.5% 83.0% 81.5% South East 97.3% 39.5% 41.9% 59.6% 91.8% 86.9% Champlain 92.5% 44.0% 37.8% 56.4% 87.4% 83.5% North Simcoe 96.5% 29.4% 34.8% 61.1% 87.1% 81.7% Muskoka North East 88.3% 31.9% 34.6% 61.1% 84.0% 85.5% North West 87.3% 28.4% 38.7% 73.0% 82.1% 80.4% Ontario 94.0% 44.3% 38.1% 52.4% 85.3% 82.5% 6 Excerpts from pan-lhin Environmental Scan (June 2015) 193 of 406

194 Percentage of patients who saw a primary care physician within seven days of acute discharge from hospital for selected conditions based on 25 Case Mix Groups, by LHIN of patient, 2013/14 Total number of discharges for all conditions (based on 25 CMGs) Primary care physician follow-up within 7 days of discharge % with visits in 7 days Discharges for CHF patients % with visits in 7 days Discharges for COPD patients % with visits in 7 days LHIN of patient Erie St. Clair 2, % % % South West 3, % % % Waterloo 2, % % % Wellington HNHB 6, % % % Central West 3, % % % Mississauga Halton 3, % % % Toronto Central 3, % % % Central 5, % % % Central East 5, % % % South East 2, % % % Champlain 3, % % % North Simcoe 1, % % % Muskoka North East 2, % % % North West 1, % % % Ontario 47, % 6, % 6, % Access to, and satisfaction with, primary care In 2014, 93.8% of Central West adults (aged 16 years and older) had a primary care provider. 57.0% of adults in the Central West LHIN were able to see a primary care provider on the same day or next day when they were sick. This was the highest proportion in the province. Only 32.2% of adults were aware that their provider offers an after-hours clinic (the second lowest proportion in the province); as well, 46.8% had difficulty accessing after-hours care without going to an emergency department (also second lowest proportion in Ontario). The proportions of attached adults in the Central West LHIN who reported that their primary care provider always or often gives them the opportunity to ask questions (76.8%), and that their provider always or often spends enough time with them (74.5%) were the lowest in the province. Primary care physician follow-up In 2013/14, 46.3% of patients in the Central West LHIN who had an acute hospital discharge (for selected conditions based on 25 CMGs) saw a primary care physician within seven days of their discharge; this was the highest proportion in the province. The percent of LHIN patients who saw a primary care physician was 52.4% for CHF discharges and 44.4% for COPD discharges; these were the also highest proportions in the province. 7 Excerpts from pan-lhin Environmental Scan (June 2015) 194 of 406

195 Item # 5.3 Accountability Agreement - LSAA Template 195 of 406

196 Briefing Note Report To: Central West LHIN Board of Directors Agenda Number: Item # 5.3 Subject: LSAA Template Agreement Purpose: For Approval Date: Wednesday, January 27, 2016 Key Contact: Brock Hovey, Senior Director, Health System Performance Recommended Motion: That the Central West Local Health Integration Network Board of Directors: approve the LHIN s use of the draft Long-Term Care Service Accountability Agreement (LSAA) templates for as presented to this Board; and authorize the Board Chair and LHIN CEO to execute LSAAs on behalf of the LHIN provided that each execution version of the LSAA is substantially the same as the draft templates attached to the minutes of this meeting. Background Summary : The 14 LHIN Chairs and CEOs meet regularly and have established a process to represent the LHINs in their consultations and negotiations. In this case, the CEO Council identified an LSAA Negotiating Team, consisting of 3 CEOs, which acted on behalf of the LHINs in discussions at the LSAA Advisory Committee. This Negotiation team held a series of consultations with sector representatives to negotiate a new template agreement for as well as a Multi-home LSAA template agreement for owners of multiple homes in the same LHIN, attached. Use of the multi-home agreement in the Central West LHIN will reduce the number of LSAAs from 23 to 17. In keeping with governance best practice, Central West LHIN should approve the use of the draft LSAA (single and multi-home) for and provide the LHIN Board Chair and LHIN CEO the authority to execute the Long-Term Care Service Accountability Agreements (LSAA) for In areas where LHINs need to act together the Ministry-LHIN Memorandum of Understanding (MOU) requires that each LHIN must respect and abide by the position approved by a two-thirds majority of LHINs (Ministry-LHIN MOU, Section 14.2 b). 196 of 406

197 A summary of the main differences between the LSAA and its predecessor is attached. Also attached, are both clean and red-lined versions of the new LSAA for single-home and multi-home agreements. Options Considered: N/A Impact Analysis: Alignment with Strategic Priorities Improve access to Care Stream Line Transitions and Navigation Drive Quality and Value Build on the Momentum Governance Best Practice Operational Excellence Enterprise Risk Implementation Plan: The Central West LHI N will continue to work with its 17 Long-Term Care Home Operators (23 LTC Homes) to renegotiate Long-Term Care Service Accountability Agreements (LSAAs). The Central West LHIN (Board Chair and CEO) will execute the agreements prior to their effective date, April 1, Attachments: 1) TEMPLATE LONG-TERM CARE HOME SERVICE ACCOUNTABILITY AGREEMENT - April 1, 2016 to March 31, 2019 clean 2) TEMPLATE LONG-TERM CARE HOME SERVICE ACCOUNTABILITY AGREEMENT - April 1, 2016 to March 31, 2019 red-lined 3) TEMPLATE LONG-TERM CARE HOME SERVICE ACCOUNTABILITY AGREEMENT MULTI HOMES - April 1, 2016 to March 31, clean 4) TEMPLATE LONG-TERM CARE HOME SERVICE ACCOUNTABILITY AGREEMENT MULTI HOMES - April 1, 2016 to March 31, 2019 red-lined 5) SUMMARY OF MAIN DIFFERENCES BETWEEN THE LSAA AND THE PROPOSED LSAA of 406

198 3 198 of 406

199 TEMPLATE LONG-TERM CARE HOME SERVICE ACCOUNTABILITY AGREEMENT For the Period: April 1, to March 31, 2019 SERVICE ACCOUNTABILITY AGREEMENT with [Legal Name of the Health Service Provider] Effective Date: April 1, 2016 Index to Agreement ARTICLE TOPIC PAGE 1.0 Definitions & Interpretation Term and Nature of this Agreement Provision of Services Funding Adjustment of Funding Planning and Integration Performance Reporting, Accounting and Review Acknowledgement of LHIN Support Representations, Warranties and Covenants Limitation of Liability, Indemnity & Insurance Termination Notice Interpretation Additional Provisions Entire Agreement 26 Schedules A B Description of Home and Beds Additional Terms and Conditions Applicable to the Funding Model 199 of 406

200 C D E Reporting Requirements Performance Form of Compliance Declaration ARTICLE DEFINITIONS & INTERPRETATION... 4 ARTICLE TERM AND NATURE OF THIS AGREEMENT ARTICLE PROVISION OF SERVICES ARTICLE FUNDING ARTICLE ADJUSTMENT AND RECOVERY OF FUNDING ARTICLE PLANNING & INTEGRATION ARTICLE PERFORMANCE ARTICLE REPORTING, ACCOUNTING AND REVIEW ARTICLE ACKNOWLEDGEMENT OF LHIN SUPPORT ARTICLE REPRESENTATIONS, WARRANTIES AND COVENANTS ARTICLE LIMITATION OF LIABILITY, INDEMNITY & INSURANCE ARTICLE TERMINATION ARTICLE NOTICE ARTICLE INTERPRETATION ARTICLE ADDITIONAL PROVISIONS ARTICLE ENTIRE AGREEMENT Schedules A - Description of Home and Beds B - Additional Terms and Conditions Applicable to the Funding Model C - Reporting Requirements D - Performance E - Form of Compliance Declaration of 406

201 THIS SERVICE ACCOUNTABILITY AGREEMENT effective as of April 1, B E T W E E N: B E T W E E N : [insert name] LOCAL HEALTH INTEGRATION NETWORK (the LHIN ) AND [Legal Name(s) of the organization(s) holding the licence to operate the Home (if in doubt, check the licence issued by the MOHLTC)] (the HSP ) IN RESPECT OF: [insert legal name of long term care home] located at [insert address] (the Home ) Background: The Local Health System Integration Act, 2006 requires that the LHIN and the HSP enter into a service accountability agreement. The service accountability agreement supports a collaborative relationship between the LHIN and the HSP: to improve the health of Ontarians through better access to high quality health services,; to co-ordinate health care in local health systems and, by such actions as supporting the implementation of Health Links to facilitate regional integrated health care service delivery; to manage the health care system at the local level effectively and efficiently. ; and, to create a health care system that is person-centered, accountable, transparent, and evidence-based. In this context, the HSP and the LHIN agree that the LHIN will provide funding to the HSP on the terms and conditions set out in this Agreement to enable the provision of services to the local health system by the HSP. In consideration of their respective agreements set out below, the LHIN and the HSP covenant and agree as follows of 406

202 ARTICLE DEFINITIONS & INTERPRETATION 1.1 Definitions. In this Agreement the following terms will have the following meanings:. Act means the Long-Term Care Homes Act, 2007 and the regulations made under the Long Term Care Homes Act, 2007 as it and they may be amended from time to time;. Accountability Agreement refers to thisthe Agreement in place between the Minister and the LHIN pursuant to the terms of s.section 18 of LHSIA;. Agreement means this agreement and includes the Schedules and any instrument amending this agreement or the Schedules;. Annual Balanced Budget means that, in each calendar year of the term of this Agreement, the total expenses of the HSP in respect of the Services are less than or equal to the total revenue of the HSP in respect of the Services. Applicable Law means all federal, provincial or municipal laws, orders, rules, regulations, common law, licence terms or by-laws, and includes terms or conditions of a licence or approval issued under the Act, that are applicable to the HSP, the Services, this Agreement and the Parties obligations under this Agreement during the term of this Agreement;. Applicable Policy means any orders, rules, policies, directives or standards of practice issued or adopted by the LHIN, by the MOHLTC or by other ministries or agencies of the province of Ontario that are applicable to the HSP, the Services, this Agreement and the Parties obligations under this Agreement during the term of this Agreement. Without limiting the generality of the foregoing, Applicable Policy includes the Design Manual and the Long Term Care Funding and Financial Management Policies and all other manuals, guidelines, policies and other documents listed on the Policy Web Pages as those manuals, guidelines, policies and other documents may be amended from time to time;. Approved Funding has the meaning ascribed to it in Schedule B;. Beds means the long term care home beds that are licensed or approved under the Act and identified in Schedule A, as the same may be amended from time to time;. Board means in respect of an HSP that is: of 406

203 (i)(a) a corporation, the board of directors; (ii)(b) A First Nation, the band council; (iii)(c) a municipality, the committee of management; (iv)(d) a board of management established by one or more municipalities or by one or more First Nations band councils, the members of the board of management; (v)(e) a partnership, the partners; and (f) (vi) a sole proprietorship, the sole proprietor. BPSAA means the Broader Public Sector Accountability Act, 2010, and the regulations made under the Broader Public Sector Accountability Act, 2010 as it and they may be amended from time to time;. CEO means the individual accountable to the Board for the provision of the Services in accordance with the terms of this Agreement;, which individual may be the executive director or administrator of the HSP, or may hold some other position or title within the HSP. CFMA means the Commitment to the Future of Medicare Act, 2004, and the regulations made under the Commitment to the Future of Medicare Act, 2004, as it and they may be amended from time to time;. Compliance Declaration means a compliance declaration substantially in the form set out in Schedule E ;. Confidential Information means information that is (i) marked or otherwise identified as confidential by the disclosing Party at the time the information is provided to the receiving Party; and (ii) eligible for exclusion from disclosure at a public board meeting in accordance with section 9 of LHSIA. Confidential Information does not include information that (a) was known to the receiving Party prior to receiving the information from the disclosing Party; (b) has become publicly known through no wrongful act of the receiving Party; or (c) is required to be disclosed by law, provided that the receiving Party provides Notice in a timely manner of such requirement to the disclosing Party, consults with the disclosing Party on the proposed form and nature of the disclosure, and ensures that any disclosure is made in strict accordance with Applicable Law;. Conflict of Interest in respect of an HSP, includes any situation or circumstance where: in relation to the performance of its obligations under this Agreement (i)(a) the HSP; (ii)(b) a member of the HSP s Board; or (iii)(c) any person employed by the HSP who has the capacity to influence the HSP s decision, of 406

204 has other commitments, relationships or financial interests that: (a) (iv) could or could be seen to interfere with the HSP s objective, unbiased and impartial exercise of its judgement; or (b) (v) could or could be seen to compromise, impair or be incompatible with the effective performance of its obligations under this Agreement;. Construction Funding Subsidy has the meaning ascribed to it in Schedule B;. controlling shareholder of a corporation means a shareholder who or which holds (or another person who or which holds for the benefit of such shareholder), other than by way of security only, voting securities of such corporation carrying more than 50% of the votes for the election of directors, provided that the votes carried by such securities are sufficient, if exercised, to elect a majority of the board of directors of such corporation. Days means calendar days;. Design Manual means the MOHLTC design manual or manuals in effect and applicable to the development, upgrade, retrofit, renovation or redevelopment of the Home or Beds subject to this Agreement;. Director has the same meaning as the term Director in the Act;. Effective Date means April 1, 2013;2016. e-health means the coordinated and integrated use of electronic systems, information and communication technologies to facilitate the collection, exchange and management of personal health information in order to improve the quality, access, productivity and sustainability of the healthcare system. Explanatory Indicator means a measure of HSP performance for which no Performance Target is set. Technical specifications of specific Explanatory Indicators can be found in the L-SAA Indicator Technical Specifications document. FIPPA means the Freedom of Information and Protection of Privacy Act, (Ontario) and the regulations made under the Freedom of Information and Protection of Privacy Act, (Ontario,), as it and they may be amended from time to time;. Funding means the amounts of money provided by the LHIN to the HSP in each of 406

205 Funding Year of this Agreement. Funding includes Approved Funding and Construction Funding Subsidy;. Funding Year means in the case of the first Funding Year, the period commencing on the January 1 prior to the Effective Date and ending on the following December 31, and in the case of Funding Years subsequent to the first Funding Year, the period commencing on the date that is January 1 following the end of the previous Funding Year and ending on the following December 31;. Home means the building where the Beds are located and for greater certainty, includes the Beds and the common areas and common elements which will be used at least in part, for the Beds, but excludes any other part of the building which will not be used for the Beds being operated pursuant to this Agreement;. HSP s Personnel and Volunteers means the controlling shareholders (if any), directors, officers, employees, agents, volunteers and other representatives of the HSP. In addition to the foregoing HSP s Personnel and Volunteers shall include the contractors and subcontractors and their respective shareholders, directors, officers, employees, agents, volunteers or other representatives;. Indemnified Parties means the LHIN and its officers, employees, directors, independent contractors, subcontractors, agents, successors and assigns and her Majesty the Queen in Right of Ontario and her Ministers, appointees and employees, independent contractors, subcontractors, agents and assigns. Indemnified Parties also includes any person participating on behalf of the LHIN in a Review.;. Interest Income means interest earned on the Funding;. Licence means one or more of the licences or the approvals granted to the HSP in respect of the Beds at the Home under Part VII or Part VIII of the Act;. LHSIA means the Local Health System Integration Act, 2006 and the regulations under the Local Health System Integration Act, 2006 as it and they may be amended from time to time;. Minister means the Minister of Health and Long-Term Care;. MOHLTC means the Minister or the Ministry of Health and Long-Term Care, as is appropriate in the context;. Notice means any notice or other communication required to be provided pursuant to of 406

206 this Agreement, LHSIA, the Act or the CFMA;. Party means either of the LHIN or the HSP and Parties mean both of the LHIN and the HSP;. Performance Agreement means an agreement between an HSP and its CEO that requires the CEO to perform in a manner that enables the HSP to achieve the terms of this Agreement;. Performance Corridor means the acceptable range of results around a Performance Target;. Performance Factor means any matter that could or will significantly affect a Party s ability to fulfill its obligations under this Agreement;, and for certainty, includes any such matter that may be brought to the attention of the LHIN, whether by PICB or otherwise. Performance Indicator means a measure of HSP performance for which a Performance Target is set; Technical specifications of specific Performance Indicators can be found in the L-SAA Indicator Technical Specifications document;. Performance Standard means the acceptable range of performance for a Performance Indicator or a Service Volume that results when a Performance Corridor is applied to a Performance Target;. Performance Target means the level of performance expected of the HSP in respect of a Performance Indicator or a Service Volume;. PICB means Performance Improvement and Compliance Branch of MOHLTC, or any other Branch or organizational unit of MOHLTC that may succeed or replace it. Planning Submission means the planning document submitted by the HSP to the LHIN. The form, content and scheduling of the Planning Submission will be identified by the LHIN;. Policy Web Pages means the web pages available at and at or such other URLs or Web pages as the LHIN or the Ministry may advise from time to time. Capital policies can be found at :// of 406

207 RAI MDS Tools means the standardized Resident Assessment Instrument Minimum Data Set (( RAI MDS ) 2.0, the RAI MDS 2.0 User Manual and the RAI MDS Practice Requirements, as the same may be amended from time to time;. Reports means the reports described in Schedule C as well as any other reports or information required to be provided under LHSIA, the Act or this Agreement;. Resident has the meaning ascribed to the term resident under the Act;. Review means a financial or operational audit, investigation, inspection or other form of review requested or required by the LHIN under the terms of LHSIA or this Agreement, but does not include the annual audit of the HSP s financial statements;. Schedule means any one of, and Schedules mean any two or more, as the context requires, of the schedules appended to this Agreement and includes: Schedule A. Description of Home and Beds ; Schedule B. Additional Terms and Conditions Applicable to the Funding Model ; Schedule C. Reporting Requirements; Schedule D. Performance; and Schedule E. Form of Compliance Declaration. Services means the operation of the Beds and the Home and the accommodation, care, programs, goods and other services that are provided to residentsresidents (i) to meet the requirements of the Act; (ii) to obtain Approved Funding; and (iii) to fulfill all commitments made to obtain a Construction Funding Subsidy. Service Volume means a measure of Services for which a Performance Target is set. 1.2 Interpretation. Words in the singular include the plural and vice-versa. Words in one gender include bothall genders. The headings do not form part of this Agreement. They are for convenience of reference only and will not affect the interpretation of this Agreement. Terms used in the Schedules shall have the meanings set out in this Agreement unless separately and specifically defined in a Schedule in which case the definition in the Schedule shall govern for the purposes of that Schedule of 406

208 ARTICLE TERM AND NATURE OF THIS AGREEMENT 2.1 Term. The term of this Agreement will commence on the Effective Date and will expire on the earlier of (i1) March 31, or (ii2) the expiration or termination of all Licences, unless this Agreement is terminated earlier or extended pursuant to its terms. 2.2 A Service Accountability Agreement. This Agreement is a service accountability agreement for the purposes of subsectionsection 20(1) of LHSIA and Part III of the CFMA. 2.3 Notice. Notice was given to the HSP that the LHIN intended to enter into this Agreement. The HSP hereby acknowledges receipt of such Notice in accordance with the terms of the CFMA. 2.4 Prior Agreements. The partiesparties acknowledge and agree that all prior agreements for the Services are terminated. ARTICLE PROVISION OF SERVICES 3.1 Provision of Services. (a) (a) The HSP will provide the Services in accordance with, and otherwise comply with: (1) (i) the terms of this Agreement; (2) (ii) Applicable Law; and (3) (iii) Applicable Policy. (b) (b) Unless otherwise provided in this Agreement, the HSP will not reduce, stop, start, expand, cease to provide or transfer the provision of the Services except with Notice to the LHIN and if required by Applicable Law or Applicable Policy, the prior written consent of the LHIN of 406

209 (c) (c) The HSP will not restrict or refuse the provision of Services to an individual, directly or indirectly, based on the geographic area in which the person resides in Ontario. 3.2 Subcontracting for the Provision of Services. (a) (a) The Parties acknowledge that, subject to the provisions of the Act and LHSIA, the HSP may subcontract the provision of some or all of the Services. For the purposepurposes of this Agreement, actions taken or not taken by the subcontractor and Services provided by the subcontractor will be deemed actions taken or not taken by the HSP and Services provided by the HSP. (b) (b) When entering into a subcontract the HSP agrees that the terms of the subcontract will enable the HSP to meet its obligations under this Agreement. Without limiting the foregoing, the HSP will include a provision that permits the LHIN or its authorized representatives, to audit the subcontractor in respect of the subcontract if the LHIN or its authorized representatives determines that such an audit would be necessary to confirm that the HSP has complied with the terms of this Agreement. (c) (c) Nothing contained in this Agreement or a subcontract will create a contractual relationship between any subcontractor or its directors, officers, employees, agents, partners, affiliates or volunteers and the LHIN. 3.3 Conflict of Interest. The HSP will use the Funding, provide the Services and otherwise fulfil its obligations under this Agreement without an actual, potential or perceived Conflict of Interest. The HSP will disclose to the LHIN without delay any situation that a reasonable person would interpret as an actual, potential or perceived Conflict of Interest and comply with any requirements prescribed by the LHIN to resolve any Conflict of Interest. 3.4 Ee-health/Information Technology Compliance. The HSP agrees to: (a) assist the LHIN to implement provincial e-health priorities for and thereafter in accordance with the Accountability Agreement, as may be amended from time to time; (i)(b) comply with any technical and information management standards, including those related to data, architecture, technology, privacy and security set for health service providers by the MOHLTC, ehealth Ontario or the LHIN within the timeframes set by the MOHLTC or the LHIN as the case may be; (ii)(c) implement and use the approved provincial e-health solutions identified in the LHIN e-health plan; and (iii)(d) implement technology solutions that are compatible or interoperable with the provincial blueprint and with the LHIN e-health plan.; and of 406

210 (e) include in its annual planning submission, plans for achieving ehealth priority initiatives. ARTICLE FUNDING 4.1 Funding. Subject to the terms of this Agreement, and in accordance with the applicable provisions of the Accountability Agreement, the LHIN will provide the Funding by depositing the Funding in monthly instalments over the Term, into an account designated by the HSP provided that the account resides at a Canadian financial institution and is in the name of the HSP. 4.2 Conditions of Funding. (a) (a) The HSP will: (1) (i) use the Funding only for the purpose of providing the Services in accordance with Applicable Law, Applicable Policy and the terms of this Agreement; (2) (ii) not use the Funding for compensation increases prohibited by Applicable Law; (3) (iii) meet all obligations in the Schedules; (4) (iv) fulfill all other obligations under this Agreement; and (5) (v) maintainplan for and achieve an Annual Balanced Budget. (b) (b) Interest Income will be reported to the LHIN and is subject to a year-end reconciliation. The LHIN may deduct the amount equal to the Interest Income from any further funding instalments under this or any other agreement with the HSP or the LHIN may require the HSP to pay an amount equal to the unused Interest Income to the Ministry of Finance. 4.3 Limitation on Payment of Funding. Despite section 4.1, the LHIN: (i)(a) will not provide any funds to the HSP until this Agreement is fully executed; (b) (ii) may pro-rate the Funding if this Agreement is signed after the Effective of 406

211 Date; (c) (iii) will not provide any funds to the HSP until the HSP meets the insurance requirements described in section 11.4; (d) (iv) will not be required to continue to provide funds, (1) (a) if the Minister or the Director so directs under the terms of the Act; (2) (b) while the Home is under the control of an Interim Manager pursuant to s. section 157 of the Act; or (3) (c) in the event the HSP breaches any of its obligations under this Agreement until the breach is remedied to the LHIN s satisfaction; and (e) (iv) upon notice to the HSP, may adjust the amount of funds it provides to the HSP in any Funding Year pursuant to Article Additional Funding. Unless the LHIN has agreed to do so in writing, the LHIN is not required to provide additional funds to the HSP for providing services other than the Services or for exceeding the requirements of Schedule D. 4.5 Additional Terms and Conditions. The LHIN may add such further terms or conditions on the use of the Funding as are required for the LHIN to meet its obligations under the Accountability Agreement, Applicable Law or Applicable Policy as the same may be amended during the Term. 4.6 Appropriation. Funding under this Agreement is conditional upon an appropriation of moneys by the Legislature of Ontario to the MOHLTC and funding of the LHIN by the MOHLTC pursuant to LHSIA. If the LHIN does not receive its anticipated funding the LHIN will not be obligated to make the payments required by this Agreement. 4.7 Procurement of Goods and Services. (a) If the HSP is subject to the procurement provisions of the BPSAA, the HSP will abide by all applicable directives and guidelines issued by the Management Board of Cabinet that are applicable to the HSP pursuant to the BPSAA. (b) (b) If the HSP is not subject to the procurement provisions of the BPSAA, the HSP will have a procurement policy in place that requires the acquisition of supplies, equipment or services valued at over $25,000 through a competitive process that ensures the best value for funds expended. If the HSP acquires supplies, equipment or services with the Funding it will do so through a process that is consistent with this policy of 406

212 4.8 Disposition. The HSP will not sell, lease or otherwise dispose of any assets purchased with Funding, except as may be required by Applicable Law or otherwise in accordance with Applicable Policy. ARTICLE ADJUSTMENT AND RECOVERY OF FUNDING 5.1 Adjustment of Funding. (a) (a) The LHIN may adjust the Funding in any of the following circumstances: (1) (i) in the event of changes to Applicable Law or Applicable Policy that affect Funding; (2) (ii) on a change to the Services; (3) (iii) if required by either the Director or the Minister under the Act; (4) (iv) in the event that a breach of this Agreement is not remedied to the satisfaction of the LHIN; and (5) (v) as otherwise permitted by this Agreement. (b) Funding recoveries or adjustments required pursuant to 5.1(a) may be accomplished through the adjustment of Funding, requiring the repayment of Funding and/or through the adjustment of the amount of any future funding installments. Approved Funding already expended properly in accordance with this Agreement will not be subject to adjustment. The LHIN will, at its sole discretion, and without liability or penalty, determine whether the Funding has been expended properly in accordance with this Agreement. (c) (c) In determining the amount of a funding adjustment under 5.1 (a) (iv4) or (v5), LHIN shall take into account the following principles: (1) (i) residentresident care must not be compromised through a funding adjustment arising from a breach of this Agreement; (2) (ii) the HSP should not gain from a breach of this Agreement; (3) (iii) if the breach reduces the value of the Services, the funding adjustment should be at least equal to the reduction in value; and (4) (iv) the funding adjustment should be sufficient to encourage subsequent compliance with this Agreement;, of 406

213 and such other principles as may be articulated in Applicable Law or Applicable Policy from time to time Provision for the Recovery of Funding. The HSP will make reasonable and prudent provision for the recovery by the LHIN of any Funding for which the conditions of Funding set out in subsectionsection 4.2(a) are not met and will hold this Funding in an interest bearing account until such time as reconciliation and settlement has occurred with the LHIN. 5.3 Settlement and Recovery of Funding for Prior Years. (a) (a) The HSP acknowledges that settlement and recovery of Funding can occur up to seven years after the provision of Funding. (b) (b) Recognizing the transition of responsibilities from the MOHLTC to the LHIN, the HSP agrees that if the Parties are directed in writing to do so by the MOHLTC, the LHIN will settle and recover funding provided by the MOHLTC to the HSP prior to the transition of the funding for the Services to the LHIN, provided that such settlement and recovery occurs within seven years of the provision of the funding by the MOHLTC. All such settlements and recoveries will be subject to the terms applicable to the original provision of funding. 5.4 Debt Due. (a) (a) If the LHIN requires the re-payment by the HSP of any Funding, the amount required will be deemed to be a debt owing to the Crown by the HSP. The LHIN may adjust future funding instalments to recover the amounts owed or may, at its discretion, direct the HSP to pay the amount owing to the Crown and the HSP shall comply immediately with any such direction. (b) (b) All amounts repayable to the Crown will be paid by cheque payable to the Ontario Minister of Finance and mailed or delivered to the LHIN at the address provided in section Interest Rate. The LHIN may charge the HSP interest on any amount owing by the HSP at the then current interest rate charged by the Province of Ontario on accounts receivable. ARTICLE PLANNING & INTEGRATION of 406

214 6.1 Planning for Future Years. (a) (a) Advance Notice. The LHIN will give at least sixty Days Notice to the HSP of the date by which a Planning Submission, approved by the HSP s governing body, must be submitted to the LHIN. (b) (b) Multi-Year Planning. The Planning Submission will be in a form acceptable to the LHIN and may be required to incorporate (i1) prudent multiyear financial forecasts; (ii2) plans for the achievement of Performance Targets; and (iii3) realistic risk management strategies. It will be aligned with the LHIN s then current Integrated Health Service Plan and will reflect local LHIN priorities and initiatives. If the LHIN has provided multi-year planning targets for the HSP, the Planning Submission will reflect the planning targets. (c) Multi-year Planning Targets. with. The Parties acknowledge that the HSP is not eligible to receive multi-year planning targets under the terms of Schedule B in effect as of the Effective Date. In the event that Schedule B is amended over the Term and the LHIN is able to provide the HSP with multi-year planning targets, (the HSP acknowledges that these targets are: (A1) targets only, (B2) provided solely for the purposes of planning, (C3) are subject to confirmation and (D4) may be changed at the discretion of the LHIN. The HSP will proactively manage the risks associated with multi-year planning and the potential changes to the planning targets. The LHIN agrees that it will communicate any material changes to the planning targets as soon as reasonably possible. (d) (d) Service Accountability Agreements. Subject to advice from the Director about the HSP s history of compliance under the Act and provided that the HSP has fulfilled its obligations under this Agreement, the partiesparties expect that they will enter into a new service accountability agreement at the end of the Term. The LHIN will give the HSP at least six months Notice if the LHIN does not intend to enter into negotiations for a subsequent service accountability agreement because the HSP has not fulfilled its obligations under this Agreement. The HSP acknowledges that if the LHIN and the HSP enter into negotiations for a subsequent service accountability agreement, subsequent funding may be interrupted if the next service accountability agreement is not executed on or before the expiration date of this Agreement. 6.2 Community Engagement & Integration Activities (a) (a) Community Engagement. The HSP will engage the community of diverse persons and entities in the area where it provides health services when setting priorities for the delivery of health services and when developing plans for submission to the LHIN including but not limited to the HSP s Planning Submission and integration proposals of 406

215 (b) (b) Integration. The HSP will, separately and in conjunction with the LHIN and other health service providers, identify opportunities to integrate the services of the local health system to provide appropriate, co-coordinated, effective and efficient services. (c) (c) Reporting. The HSP will report on its community engagement and integration activities as requested by the LHIN and in any event, in its Q4 Performance Report to the LHIN. 6.3 Planning and Integration Activity Pre-proposals. (a) (a) General: A pre-proposal process has been developed to (i1) reduce the costs incurred by an HSP when proposing operational or service changes; (ii2) assist the HSP to carry out its statutory obligations; and (iii3) enable an effective and efficient response by the LHIN. Subject to specific direction from the LHIN, this pre-proposal process will be used in the following instances: (1) (i) the HSP is considering an integration, or an integration of services, as defined in LHSIA between the HSP and another person or entity; (2) (ii) the HSP is proposing to reduce, stop, start, expand or transfer the location of Services; (3) (iii) to identify opportunities to integrate the services of the local health system, other than those identified in (i1) or (ii2) above; or (4) (iv) if requested by the LHIN. (b) LHIN Evaluation of the Pre-proposal: Use of the pre -proposal process is not formal Notice of a proposed integration under ssection. 27 of LHSIA. LHIN consent to develop the project concept outlined in a pre-proposal does not constitute approval to proceed with the project. Nor does the LHIN consent to develop a project concept presume the issuance of a favourable decision, should such a decision be required by section 25 or 27 of LHSIA. Following the LHIN s review and evaluation, the HSP may be invited to submit a detailed proposal and a business plan for further analysis. Guidelines for the development of a detailed proposal and business case will be provided by the LHIN. (c) (c) Where an HSP integrates its services with those of another person and the integration relates to services funded in whole or in part by the LHIN, the HSP will follow the provisions of s.section 27 of LHSIA. Without limiting the foregoing, a transfer of services from the HSP to another person or entity is an example of an integration to which s.section 27 may apply of 406

216 6.4 Proposing Integration Activities in the Planning Submission. No integration activity described in subsectionsection 6.3 may be proposed in a Planning Submission unless the LHIN has consented, in writing, to its inclusion pursuant to the process set out in section Termination of Designation of Convalescent Care Beds. (a) Notwithstanding s.section 6.3, the provisions in this sub articlesection 6.5 apply to the termination of a designation of convalescent care Beds. (b) The HSP may at any time terminate the designation of theone or more convalescent care Beds and revert them back to long-stay Beds by giving thirty (30) calendar days at any time provided the HSP gives the Ministry and the LHIN at least six months prior written notice of terminationnotice. Such Notice shall include: (1) a detailed transition plan, satisfactory to the Ministry and LHIN acting reasonably, setting out the dates, after the end of the six month Notice period, on which the HSP plans to the LHIN. Aterminate the designation of each convalescent care Bed and to revert same to a long-stay Bed; and, (2) a detailed explanation of the factors considered in the selection of those dates. (b) The designation of a convalescent care Bed will terminate and the Bed will revert to a long-stay Bed on the later of thirty (30) calendar daysdate, after the HSP has given the notice of termination, orsix month Notice period, on which the day that the residentresident who is occupying that convalescent care Bed at the end of the six month Notice period has been discharged from that Bed, unless otherwise agreed by the LHIN and the HSP. (c) The LHIN may terminate the designation of the convalescent care Beds at any time, upon by giving at least sixty (60) calendar days six months prior written noticenotice to the HSP. A convalescent care Bed will revert to a long-stay Bed on Upon receipt of any such Notice, the later of sixty (60) calendar dayshsp shall, within the timeframe set out in the Notice, provide the LHIN with: (1) a detailed transition plan, satisfactory to the LHIN acting reasonably, setting out the dates, after the LHIN has given the noticeend of termination, orthe six month Notice period, on the day that the residentwhich the HSP plans to terminate the designation of each convalescent care Bed and, if required by the Notice, to revert same to a long-stay Bed; and, (2) a detailed explanation of the factors considered in the selection of those dates of 406

217 (c) The designation of a convalescent care Bed will terminate, and if applicable revert to a long-stay Bed on the date, after the six month Notice period, on which the Resident who is occupying that convalescent care Bed at the end of the Notice period has been discharged from that Bed., unless otherwise agreed by the LHIN and the HSP. 6.6 In this Article 6, the terms integrate, integration and services have the same meanings attributed to them in subsectionsection 2(1) and section 23 respectively of LHSIA, as it and they may be amended from time to time. (a) service includes,; (a)(1) a service or program that is provided directly to people, (b)(2) a service or program, other than a service or program described in clause (i1), that supports a service or program described in that clause, or (c)(3) a function that supports the operations of a person or entity that provides a service or program described in clause (i1) or (ii2). (b) integrate includes,; (1) (i) to co-ordinate services and interactions between different persons and entities, (2) (ii) to partner with another person or entity in providing services or in operating, (3) (iii) to transfer, merge or amalgamate services, operations, persons or entities, (4) (iv) to start or cease providing services, (5) (v) to cease to operate or to dissolve or wind up the operations of a person or entity, and integration has a similar meaning;. ARTICLE PERFORMANCE 7.1 Performance. The Parties will strive to achieve on-going performance improvement. They will address performance improvement in a proactive, collaborative and responsive manner. 7.2 Performance Factors of 406

218 (a) (a) Each Party will notify the other Party of the existence of a Performance Factor, as soon as reasonably possible after the Party becomes aware of the Performance Factor. The Notice will: (1) (i) describe the Performance Factor and its actual or anticipated impact; (2) (ii) include a description of any action the Party is undertaking, or plans to undertake, to remedy or mitigate the Performance Factor; (3) (iii) indicate whether the Party is requesting a meeting to discuss the Performance Factor; and (4) (iv) address any other issue or matter the Party wishes to raise with the other Party. (b) (b) The recipient Party will provide a written acknowledgment of receipt of the Notice within seven Days of the date on which the Notice was received ( Date of the Notice ). (c) (c) Where a meeting has been requested under section 7.2(a)), the Parties agree to meet and discuss the Performance Factors within fourteen Days of the Date of the Notice, in accordance with the provisions of subsection 7.3section 7.3. PICB may be included in any such meeting at the request of either Party. 7.3 Performance Meetings. During a meeting on performance, the Parties will: (a) (i) discuss the causes of a Performance Factor; (b) (ii) discuss the impact of a Performance Factor on the local health system and the risk resulting from non-performance; and (c) (iii) determine the steps to be taken to remedy or mitigate the impact of the Performance Factor (the Performance Improvement Process ). 7.4 The Performance Improvement Process. (a) (a) The Performance Improvement Process will focus on the risks of nonperformance and problem-solving. It may include one or more of the following actions: (1) (i) a requirement that the HSP develop and implement an improvement plan that is acceptable to the LHIN; (2) (ii) the conduct of a Review; (3) (iii) a revision and amendment of the HSP s obligations; and or (4) (iv) an in-year, or year end, adjustment to the Funding;, among other possible means of responding to the Performance Factor or improving performance of 406

219 (b) (B) Any performance improvement process begun under a prior service accountability agreement that was not completed under the prior agreement will continue under this Agreement. Any performance improvement required by a LHIN under a prior service accountability agreement will be deemed to be a requirement of this Agreement until fulfilled or waived by the LHIN. ARTICLE REPORTING, ACCOUNTING AND REVIEW 8.1 Reporting. (a) (a) Generally. The LHIN s ability to enable its local health system to provide appropriate, co-ordinated, effective and efficient health services as contemplated by LHSIA, is heavily dependent on the timely collection and analysis of accurate information. The HSP acknowledges that the timely provision of accurate information related to the HSP, its Residents and its performance of its obligations under this Agreement, is under the HSP s control. (b) (b) Specific Obligations. The HSP (1) (i) will provide to the LHIN, or to such other entity as the LHIN may direct, in the form and within the time specified by the LHIN, the Reports other than personal health information as defined in subsectionsection 31 (5) of the CFMA, that (i1) the LHIN requires for the purposes of exercising its powers and duties under this Agreement, LHSIA or for the purposes that are prescribed under LHSIA, or (ii2) may be requested under the CFMA; (2) (ii) will comply with the applicable reporting standards and requirements in both Chapter 9 of the Ontario Healthcare Reporting Standards and the RAI MDS Tools; (3) (iii) will fulfil the specific reporting requirements set out in Schedule C; (4) (iv) will ensure that every Report is complete, accurate, signed on behalf of the HSP by an authorized signing officer where required and provided in a timely manner and in a form satisfactory to the LHIN; and of 406

220 (5) (v) agrees that every Report submitted by or on behalf of the HSP, will be deemed to have been authorized by the HSP for submission. (c) (c) RAI/ MDS. Without limiting the foregoing, the HSP (i)(1) will conduct quarterly assessments of Residents, and all other assessments of Residents required by the RAI/ MDS Tools, using the RAI/ MDS Tools; (2) (ii) will ensure that the RAI- MDS Tools are used correctly to produce an accurate assessment of the HSP s Residents (RAI MDS Data); (3) (iii) will submit the RAI- MDS Data to the Canadian Institute for Health Information in an electronic format at least quarterly in accordance with the submission guidelines set out by CIHI; and (4) (iv) acknowledges that if used incorrectly, the RAI- MDS Tools can increase Funding beyond that to which the HSP would otherwise be entitled. The HSP will therefore have systems in place to regularly monitor, evaluate and where necessary correct the quality and accuracy of the RAI- MDS Data. (d) (d) Health Quality Ontario. The HSP will work with Health Quality Ontario and other providers to advance the quality agenda and align quality improvement efforts across the local health care system; and, will submit a report to the LHIN that outlines how the HSP has done so. Without limiting the foregoing, the HSP will submit a Quality Improvement Plan to Health Quality Ontario that is aligned with this Agreement and supports local health system priorities. (e) French Language Services. If the HSP is required to provide services to the public in French under the provisions of the French Language Services Act, the HSP will be required to submit a French language services report to the LHIN. If the HSP is not required to provide services to the public in French under the provisions of the French Language Service Act, it will be required to provide a report to the LHIN that outlines how the HSP addresses the needs of its local Francophone community. (f) (e) Declaration of Compliance. On or before March 1 of each Funding Year, the Board will issue a Compliance Declaration declaring that the HSP has complied with the terms of this Agreement. The form of the declaration is set out in Schedule E and may be amended from time to time through the term of this Agreement. (g) (f) Financial Reductions. Notwithstanding any other provision of this Agreement, and at the discretion of the LHIN, the HSP may be subject to a financial reduction if any of the Reports are received after the due date, are incomplete, or are inaccurate where the errors or delay were not as a result of either LHIN actions or inaction or the actions or inactions of persons acting on of 406

221 behalf of the LHIN. If assessed, the financial reduction will be taken from funding designated for this purpose in Schedule B as follows: (1) (i) if received within 7 days after the due date, incomplete or inaccurate, the financial penalty will be the greater of (i1) a reduction of 0.02 percent (0.02%) of the Funding; or (ii2) two hundred and fifty dollars ($250.00);), and (2) (II) for every full or partial week of non-compliance thereafter, the rate will be one half of the initial reduction. 8.2 Reviews. (a) (a) During the term of this Agreement and for seven (7) years after the term of this Agreement, the HSP agrees that the LHIN or its authorized representatives may conduct a Review of the HSP to confirm the HSP s fulfillment of its obligations under this Agreement. For these purposes the LHIN or its authorized representatives may, upon twenty-four hours Notice to the HSP and during normal business hours enter the HSP s premises to: (1) (i) inspect and copy any financial records, invoices and other financiallyfinance-related documents, other than personal health information as defined in subsectionsection 31(5) of the CFMA, in the possession or under the control of the HSP which relate to the Funding or otherwise to the Services;, and (2) (ii) inspect and copy non-financial records, other than personal health information as defined in subsectionsection 31(5) of the CFMA, in the possession or under the control of the HSP which relate to the Funding, the Services or otherwise to the performance of the HSP under this Agreement. (b) (b) The cost of any Review will be borne by the HSP if the Review (i1) was made necessary because the HSP did not comply with Applicable Lawa requirement under the Act or Policythis Agreement; or (ii) determines2) indicates that the HSP has not fulfilled its obligations under this Agreement, including its obligations under Applicable Law or Applicable Policy.. (c) (c) To assist in respect of the rights set out in (b) above the HSP shall disclose any information requested by the LHIN or its authorized representatives, and shall do so in a form requested by the LHIN or its authorized representatives. (d) (d) The HSP may not commence a proceeding for damages or otherwise against any person with respect to any act done or omitted to be done, any of 406

222 conclusion reached or report submitted that is done in good faith in respect of a Review... (e) (e) HSP s obligations under sub articlethis section 8.2 will survive any termination or expiration of this Agreement. 8.3 Document Retention and Record Maintenance. The HSP will (i)(a) retain all records (as that term is defined in FIPPA) related to the HSP s performance of its obligations under this Agreement for seven (7) years after the termination or expiration of the term of this Agreement. The HSP s obligations under this paragraphsection will survive any termination or expiry of this Agreement; (b) (ii) keep all financial records, invoices and other financiallyfinance-related documents relating to the Funding or otherwise to the Services in a manner consistent with either generally accepted accounting principles or international financial reporting standards as advised by the HSP s auditor; and (c) (iii) keep all non-financial documents and records relating to the Funding or otherwise to the Services in a manner consistent with all Applicable Law. 8.4 Disclosure of Information. (a) FIPPA. The HSP acknowledges that the LHIN is bound by FIPPA and that any information provided to the LHIN in connection with this Agreement may be subject to disclosure in accordance with FIPPA. (b) (b) Confidential Information. The Parties will treat Confidential Information as confidential and will not disclose Confidential Information except with the consent of the disclosing Party or as permitted or required under FIPPA, the Municipal Freedom of Information and Protection of Privacy Act, the Personal Health Information Protection Act, 2004, the Act, court order, subpoena or other Applicable Law. Notwithstanding the foregoing, the LHIN may disclose information that it collects under this Agreement in accordance with LHSIA and the CFMA Transparency. The HSP will post a copy of this Agreement and each Compliance Declaration submitted to the LHIN during the term of this Agreement in a conspicuous and easily accessible public place at the Home and on its public website if the HSP operates a public website. 8.6 Auditor General. For greater certainty the LHIN s rights under this article are in addition to any rights provided to the Auditor General under the Auditor General Act (Ontario) of 406

223 ARTICLE ACKNOWLEDGEMENT OF LHIN SUPPORT 9.1 Publication. For the purposes of this Article 9, the term publication means any material on or concerning the Services that the HSP makes available to the public, regardless of whether the material is provided electronically or in hard copy. Examples include a web-site, an advertisement, a brochure, promotional documents and a report. Materials that are prepared by the HSP in order to fulfil its reporting obligations under this Agreement are not included in the term publication. 9.2 Acknowledgment of Funding Support. (a) (a) The HSP agrees all publications will include (1) (i) an acknowledgment of the Funding provided by the LHIN and the Government of Ontario. Prior to including an acknowledgement in any publication, the HSP will obtain the LHIN s approval of the form of acknowledgement. The LHIN may, at its discretion, decide that an acknowledgement is not necessary; and (2) (ii) a statement indicating that the views expressed in the publication are the views of the HSP and do not necessarily reflect those of the LHIN or the Government of Ontario. (b) The HSP shall not use any insignia or logo of Her Majesty the Queen in right of Ontario, including those of the LHIN, unless it has received the prior written permission of the LHIN to do so. ARTICLE REPRESENTATIONS, WARRANTIES AND COVENANTS 10.1 General. The HSP represents, warrants and covenants that: of 406

224 (a) (i) it is, and will continue for the term of this Agreement to be, a validly existing legal entity with full power to fulfill its obligations under this Agreement; (b) (ii) it has the experience and expertise necessary to carry out the Services; (c) (iii) it holds all permits, licences, consents intellectual property rights and authorities necessary to perform its obligations under this Agreement; (d) (iv) all information that the HSP provided to the LHIN in its Planning Submission or otherwise in support of its application for funding was true and complete at the time the HSP provided it, and will, subject to the provision of Notice otherwise, continue to be true and complete for the term of this Agreement; (e) (v) it has not and will not for the term of this Agreement, enter into a nonarm s transaction that is prohibited by the Act; and (f) (vi) it does, and will continue for the term of this Agreement to, operate in compliance with all Applicable Law and Applicable Policy Execution of Agreement. The HSP represents and warrants that: (a) (i) it has the full power and authority to enter into this Agreement; and (b) (ii) it has taken all necessary actions to authorize the execution of the Agreement Governance. (a) The HSP represents, warrants and covenants that it has established, and will maintain for the period during which this Agreement is in effect, policies and procedures: (i)(1) that set out a code of conduct for, and that identify, the ethical obligations of HSP s Personnel and Volunteers; (ii)(2) Toto ensure the ongoing effective functioning of the HSP; (iii)(3) for effective and appropriate decision-making; (4) (iv) for effective and prudent risk-management, including the identification and management of potential, actual and perceived conflicts of interest; (5) (v) for the prudent and effective management of the Funding; of 406

225 (6) (vi) to monitor and ensure the accurate and timely fulfillment of the HSP s obligations under this Agreement and compliance with the Act and LHSIA; (7) (vii) to enable the preparation, approval and delivery of all Reports; and (viii)(8) to address complaints about the provision of Services, the management or governance of the HSP. ; and (b) (9) to deal with such other matters as the HSP considers necessary to ensure that the HSP carries out its obligations under this Agreement. The HSP represents and warrants that it: (i)(1) has, or will have within 60 days of the execution of this Agreement, a Performance Agreement with its CEO. (ii)(2) will take all reasonable care to ensure that its CEO complies with the Performance Agreement; and (iii)(3) will enforce the HSP s rights under the Performance Agreement Funding, Services and Reporting. The HSP represents warrants and covenants that: (a) (b) Thethe Funding is, and will be continuedcontinue to be, used only to provide the Services in accordance with the terms of this Agreement: the Services are and will continue to be provided: (1) (i) by persons with the expertise, professional qualifications, licensing and skills necessary to complete their respective tasks; and (2) (ii) in compliance with Applicable Law and Applicable Policy; and (c) Everyevery Report is, and will continue to be, accurate and in full compliance with the provisions of this Agreement, including any particular requirements applicable to the Report Supporting Documentation. Upon request, the HSP will provide the LHIN with proof of the matters referred to in this Article. ARTICLE LIMITATION OF LIABILITY, INDEMNITY & INSURANCE 11.1 Limitation of Liability. The Indemnified Parties will not be liable to the HSP or any of the HSP s Personnel and Volunteers for costs, losses, claims, liabilities and damages howsoever caused (including any incidental, indirect, special or consequential damages, of 406

226 injury or any loss of use or profit of the HSP) arising out of or in any way related to the Services or otherwise in connection with this Agreement, unless caused by the gross negligence or wilful act of any of the Indemnified Parties Same. For greater certainty and without limiting subsectionsection 11.1, the LHIN is not liable for how the HSP and the HSP s Personnel and Volunteers carry out the Services and is therefore not responsible to the HSP for such Services. Moreover the LHIN is not contracting with or employing any HSP s Personnel and Volunteers to carry out the terms of this Agreement. As such, it is not liable for contracting with, employing or terminating a contract with or the employment of any HSP s Personnel and Volunteers required to carry out this Agreement, nor for the withholding, collection or payment of any taxes, premiums, contributions or any other remittances due to government for the HSP s Personnel and Volunteers required by the HSP to carry out this Agreement Indemnification. The HSP hereby agrees to indemnify and hold harmless the Indemnified Parties from and against any and all liability, loss, costs, damages and expenses (including legal, expert and consultant costs), causes of action, actions, claims, demands, lawsuits or other proceedings, (collectively, the Claims ), by whomever made, sustained, brought or prosecuted, including for third party bodily injury (including death), personal injury and property damage, in any way based upon, occasioned by or attributable to anything done or omitted to be done by the HSP or the HSP s Personnel and Volunteers in the course of the performance of the HSP s obligations under, or otherwise in connection with, this Agreement, unless solely caused by the negligence or wilful misconduct of any Indemnified Parties. The HSP further agrees to indemnify and hold harmless the Indemnified Parties for any incidental, indirect, special or consequential damages, or any loss of use, revenue or profit, by any person, entity or organization, including without limitation the LHIN, claimed or resulting from such Claims Insurance. (a) (a) Generally. The HSP shall protect itself from and against all claims that might arise from anything done or omitted to be done by the HSP and the HSP s Personnel and Volunteers under this Agreement and more specifically all claims that might arise from anything done or omitted to be done under this Agreement where bodily injury (including personal injury), death or property damage, including loss of use of property is caused. (b) (b) Required Insurance. The HSP will put into effect and maintain, with insurers having a secure A.M. Best rating of B+ or greater, or the equivalent, all the necessary and appropriate insurance that a prudent person in the business of the HSP would maintain including, but not limited to, the following at its own expense of 406

227 (1) 1. Commercial General Liability Insurance. Commercial General Liability Insurance, for third party bodily injury, personal injury and property damages to andamage to an inclusive limit of not less than five two million dollars per occurrence and not less than two million dollars products and completed operations aggregate. The policy will include the following clauses: (i)a. The Indemnified Parties as additional insureds;, (ii)b. Contractual Liability;, (iii)c. Cross-Liability, (iv) Independent Contractors; (v)d. Products and Completed Operations Liability;, (vi)e. A valid WSIB Clearance Certificate, or Employers Liability and Voluntary Compensation, which ever applies; unless the HSP complies with the Section below entitled Proof of WSIA Coverage, (vii)f. Tenants Legal Liability (for premises/building leases only);), (viii)g. Non-Owned automobile coverage with blanket contractual and physical damage coverage for hired automobiles;, and, (ix)h. A thirty-day written notice of cancellation, termination or material change. (2) Proof of WSIA Coverage. Unless the HSP put into effect and maintains Employers Liability and Voluntary Compensation as set out above, the HSP will provide the LHIN with a valid Workplace Safety and Insurance Act, 1997 (WSIA) Clearance Certificate and any renewal replacements, and will pay all amounts required to be paid to maintain a valid WSIA Clearance Certificate throughout the term of this Agreement. 2.(3) All Risk Property insuranceinsurance on property of every description, including business interruption for the term of all risk of physical loss or damage, providing coverage to a limit of not less than the full replacement cost, including earthquake and flood. Such insurance shall be written to include replacement cost value and shall not include a co-insurance clause. All reasonable deductibles and/or selfinsured retentions are the responsibility of the HSP. 3. Boiler and machinery insurance (including pressure objects, machinery objects and service supply objects) on a comprehensive basis. Such insurance shall be written to include repair and replacement value and shall not include a co-insurance clause. All reasonable deductibles and/or self insured retentions are the responsibility of the HSP. (4) 4. Comprehensive Crime insurance, Disappearance, Destruction and Dishonest coverage. 5. ProfessionalErrors and Omissions Liability Insurance. Professional Liability Insurance to an inclusive limit insuring liability for errors and omissions in of 406

228 the provision of any professional services as part of the Services or failure to perform any such professional services, in the amount of not less than fivetwo million dollars per occurrence for each claim of negligence resulting in bodily injury, death or property damage, arising directly or indirectly from the professional services rendered byand in the HSP, its officers, agents or employees. 6.(5) Administrators Errors & Omission Liability Insurance, to an inclusive limit of not less than 2 million dollars per claim, with an annual aggregate of not less than 4 million dollars, responding to claims of wrongful acts of the HSP directors, board members, employees and volunteers in the discharge of their duties on behalf of the HSP. (c) (c) Certificates of Insurance. The HSP will provide the LHIN with proof of the insurance required by this Agreement in the form of a valid certificate of insurance that references this Agreement and confirms the required coverage, on or before the commencement of this Agreement, and renewal replacements on or before the expiry of any such insurance. Upon the request of the LHIN, a copy of each insurance policy shall be made available to it. The HSP shall ensure that each of its subcontractors obtains all the necessary and appropriate insurance that a prudent person in the business of the subcontractor would maintain and that the Indemnified Parties are named as additional insureds with respect to any liability arising in the course of performance of the subcontractor's obligations under the subcontract. ARTICLE TERMINATION 12.1 Termination by the LHIN. (a) (a) Immediate Termination. The LHIN may terminate this Agreement immediately upon giving Notice to the HSP if: (1) (i) the HSP is unable to provide or has discontinued the Services in whole or in part or the HSP ceases to carry on business; (2) (ii) the HSP makes an assignment, proposal, compromise, or arrangement for the benefit of creditors, or is petitioned into bankruptcy, or files for the appointment of a receiver; of 406

229 (3) (iii) the LHIN is directed, pursuant to the Act, to terminate this Agreement by the Minister or the Director; (4) (iv) the Home has been closed in accordance with the Act; or (5) (v) as provided for in section 4.6, the LHIN does not receive the necessary funding from the MOHLTC. (b) (b) Termination in the Event of Financial Difficulties. If the HSP makes an assignment, proposal, compromise, or arrangement for the benefit of creditors, or is petitioned into bankruptcy, or files for the appointment of a receiver the LHIN will consult with the Director before determining whether this Agreement will be terminated. If the LHIN terminates this Agreement because a person has exercised a security interest as contemplated by section 107 of the Act, the LHIN would expect to enter into a service accountability agreement with the person exercising the security interest or the receiver or other agent acting on behalf of that person where the person has obtained the Director's approval under s.section 110 of the Act and has met all other relevant requirements of Applicable Law. (c) (c) Opportunity to Remedy Material Breach. If an HSP breaches any material provision of this Agreement, including, but not limited to, the reporting requirements in Article 8 and the representations and warranties in Article 10 and the breach has not been satisfactorily resolved under Article 7, the LHIN will give the HSP Notice of the particulars of the breach and of the period of time within which the HSP is required to remedy the breach. The Notice will advise the HSP that the LHIN will terminate this Agreement: (1) (i) at the end of the Notice period provided for in the Notice if the HSP fails to remedy the breach within the time specified in the Notice; or (2) (ii) prior to the end of the Notice period provided for in the Notice if it becomes apparent to the LHIN that the HSP cannot completely remedy the breach within that time or such further period of time as the LHIN considers reasonable, or the HSP is not proceeding to remedy the breach in a way that is satisfactory to the LHIN; and the LHIN may then terminate this Agreement in accordance with the Notice Termination of Services by the HSP. (a) Except as provided in 12.2(b) and (c) below, the HSP may terminate this Agreement at any time, for any reason, upon giving the LHIN at least six months Notice of 406

230 (b) Where the HSP intends to cease providing the Services and close the Home, the HSP will provide Notice to the LHIN at the same time the HSP is required to provide notice to the Director under the Act. The HSP will ensure that the closure plan required by the Act is acceptable to the LHIN. (c) (c) Where the HSP intends to cease providing the Services as a result of an intended sale or transfer of a License in whole or in part, the HSP will comply with s.section 6.3 of this Agreement. Notice under s.section 27 of LHSIA will not be effective unless accompanied by a transition plan that is acceptable to the LHIN, if such a transition plan is requested pursuant to s.section Consequences of Termination. (a) If this Agreement is terminated pursuant to this Article, the LHIN may: (1) (i) cancel all further Funding instalments; (2) (ii) demand the repayment of any Funding remaining in the possession or under the control of the HSP; (3) (iii) determine the HSP s reasonable costs to wind down the Services; and (4) (iv) permit the HSP to offset the costs determined pursuant to subsection (iiisection (3), against the amount owing pursuant to subsection (iisection (2). (b) (b) Despite (a), if the cost determined pursuant to section 12.3(a) (iii3) exceeds the Funding remaining in the possession or under the control of the HSP the LHIN will not provide additional monies to the HSP to wind down the Services Effective Date. The effective date of any terminationtermination under this Article will be the last Day oftake effect as set out in the Notice period, the last Day of any subsequent Notice period or immediately, which ever applies Corrective Action. Despite its right to terminate this Agreement pursuant to this Article, the LHIN may choose not to terminate this Agreement and may take whatever corrective action it considers necessary and appropriate, including suspending Funding for such period as the LHIN determines, to ensure the successful completion of the Services in accordance with the terms of this Agreement. ARTICLE NOTICE of 406

231 13.1 Notice. A Notice will be in writing; delivered personally, by pre-paid courier, or sent by facsimile or with confirmation of receipt, or by any form of mail where evidence of receipt is provided by the post office. When a Notice is sent by , a confirmation of receipt shall include acknowledgment by the Notice recipient of an automated request for receipt, or a written reply from the Notice recipient acknowledging receipt. A Notice will be addressed to the other Party as provided below or as either Party will later designate to the other in writing: To the LHIN: Insert name of LHIN Insert address of LHIN Attention: [insert position] Fax: Telephone: To the HSP: insert name of HSP insert address of HSP Attention:[insert position] Fax: Telephone: 13.2 Notices Effective From. A Notice will be effective at the time the delivery is made if the Notice is delivered personally, or by pre-paid courier or by facsimile.. If delivered by mail, a Notice will be effective five business days after the day it was mailed. A Notice that is delivered by facsimile or by will be effective when its receipt is acknowledged as required by this Article. ARTICLE INTERPRETATION 14.1 Interpretation. In the event of a conflict or inconsistency in any provision of this Agreement, the main body of this Agreement will prevail over the Schedules Jurisdiction. Where this Agreement requires compliance with the Act, the Director will determine compliance and advise the LHIN. Where the Act requires compliance with this Agreement, the LHIN will determine compliance and advise the Director of 406

232 14.3 Determinations by the Director. All determinations required by the Director under this Agreement are subject to an HSP s rights of review and appeal under the Act The Act. For greater clarity, nothing in this Agreement supplants or otherwise excuses the HSP from the fulfillment of any requirements of the Act. The HSP s obligations in respect of LHSIA and this Agreement are separate and distinct from the HSP s obligations under the Act. ARTICLE ADDITIONAL PROVISIONS 15.1 Currency. All payment to be made by the LHIN or the HSP under this Agreement shall be made in the lawful currency of Canada Invalidity or Unenforceability of Any Provision. The invalidity or unenforceability of any provision of this Agreement will not affect the validity or enforceability of any other provision of this Agreement and any invalid or unenforceable provision will be deemed to be severed Terms and Conditions on Any Consent. Any consent or approval that the LHIN may grant under this Agreement is subject to such terms and conditions as the LHIN may reasonably require Waiver. A Party may only rely on a waiver of the Party s failure to comply with any term of this Agreement if the other Party has provided a written and signed Notice of waiver. Any waiver must refer to a specific failure to comply and will not have the effect of waiving any subsequent failures to comply Parties Independent. The Parties are and will at all times remain independent of each other and are not and will not represent themselves to be the agent, joint venturer, of 406

233 partner or employee of the other. No representations will be made or acts taken by either Party which could establish or imply any apparent relationship of agency, joint venture, partnership or employment and neither Party will be bound in any manner whatsoever by any agreements, warranties or representations made by the other Party to any other person or entity, nor with respect to any other action of the other Party LHIN is an Agent of the Crown. The Parties acknowledge that the LHIN is an agent of the Crown and may only act as an agent of the Crown in accordance with the provisions of LHSIA. Notwithstanding anything else in this Agreement, any express or implied reference to the LHIN providing an indemnity or any other form of indebtedness or contingent liability that would directly or indirectly increase the indebtedness or contingent liabilities of the LHIN or of Ontario, whether at the time of execution of this Agreement or at any time during the term of this Agreement, will be void and of no legal effect Express Rights and Remedies Not Limited. The express rights and remedies of the LHIN are in addition to and will not limit any other rights and remedies available to the LHIN at law or in equity. For further certainty, the LHIN has not waived any provision of any applicable statute, including the Act, LHSIA and the CFMA, nor the right to exercise its right under these statutes at any time No Assignment. The HSP will not assign either this Agreement or the Funding in whole or in part, directly or indirectly, without the prior written consent of the LHIN which consent shall not be unreasonably withheld. No assignment or subcontract shall relieve the HSP from its obligations under this Agreement or impose any liability upon the LHIN to any assignee or subcontractor. The LHIN may assign this Agreement or any of its rights and obligations under this Agreement to any one or more of the LHINs or to the MOHLTC Governing Law. This Agreement and the rights, obligations and relations of the Parties hereto will be governed by and construed in accordance with the laws of the Province of Ontario and the federal laws of Canada applicable therein. Any litigation or arbitration arising in connection with this Agreement will be conducted in Ontario unless the Parties agree in writing otherwise Survival. The provisions in Articles 1.0, 2.4, 4.6, 5.0, 8.0, 10.5, 11.0, 13.0, 14.0 and 15.0 and sections 2.4, 4.6, 10.4, 10.5 and 12.3 will continue in full force and effect for a period of seven years from the date of expiry or termination of this Agreement Further Assurances. The Parties agree to do or cause to be done all acts or things necessary to implement and carry into effect this Agreement to its full extent of 406

234 15.12 Amendment of Agreement. This Agreement may only be amended by a written agreement duly executed by the Parties Counterparts. This Agreement may be executed in any number of counterparts, each of which will be deemed an original, but all of which together will constitute one and the same instrument. ARTICLE ENTIRE AGREEMENT 16.1 Entire Agreement. This Agreement together with the appended Schedules constitutes the entire Agreement between the Parties with respect to the subject matter contained in this Agreement and supersedes all prior oral or written representations and agreements. The Parties have executed this Agreement on the dates set out below. XXX LOCAL HEALTH INTEGRATION NETWORK By: [Name], Chair [Name], Chair Date And by: [Name], CEO of 406

235 [Name], CEO Date [Insert Full Legal Name of HSP] By: [Name], [Title/Position] [Name], Chair Date I have authority to bind the HSP And by: [Name], [Title/Position] [Name], [Title] Date I have authority to bind the HSP of 406

236 Description of Home and Services LTCH Name: Description of Home and Services A.-1 General Information LTCH Legal Name LTCH Common NameLTCH Legal Name LTCH Common Name LTCH Facility ID Number LTCH Facility (master number for RAI MDS) Owner/Parent Organization Address City Geography served (catchment area) Accreditation organization Date of Last Accreditation Postal Code Year(s) Awarded A.2 - Licensed or Approved Beds & ClassificationA-2 LTCH Classification Licensed/Approved Beds Temporary Beds Total # Beds Total # of BedsA AB BC CD DNew New OtherTotal # Beds A.2 Licensed or Approved Beds & Classification / Bed Type A.3 - Bed Type Bed Types Regular Long Stay Beds Convalescent Care Beds Respite Beds Beds in Abeyance ELDCAP Beds Interim Beds Veterans Priority Access beds Other beds available under a Temporary Emergency Licence or Short-Term Authorization* Sub Total # all Bed Types Note: Total should equal the number under Total # Beds in A.2 above. Total # of Beds A B C D New Comments/Additional Information Term of Licence Comments/Additional Information of 406

237 Description of Home and Services LTCH Name: Total # all Bed Types *Other beds available under a Temporary Emergency Licence or Short-Term Authorization A.3 Structural Information Type of Room (this refers to structural layout rather than what is charged in accommodations) Number of rooms with 1 bed Number of rooms with 2 beds Number of rooms with 3 beds Number of rooms with 4 beds Other Separate Infirmary (Y/N) Year of Construction Opening Date Number of Rooms Year(s) of renovations Number of Floors Number of Units/Resident Home Areas and Beds Unit/Resident Home Area Number of Beds A.-3 4 Structural Information Type of Room (this refers to structural layout rather than what is charged in accommodations) Number of rooms with 1 bed Number of rooms with 3 beds Other Separate Infirmary (Y/N) Year of Construction Opening Date Number of rooms with 2 beds Number of rooms with 4 beds Number of Rooms Year(s) of renovations Number of Floors Number of Units/Resident Home Areas and Beds Unit/Resident Home Area Number of Beds of 406

238 Schedule B Additional Terms and Conditions Applicable to the Funding Model 1.0 Background. The LHINs provide subsidy funding to long-term care home health service providers pursuant to a funding model set by the MOHLTC. The current model provides estimated per diem funding that is subsequently reconciled. The current funding model is under review and may change during the term of the Agreement.Term (as defined below). As a result, and for ease of amendment during its term, the Term, this Agreement incorporates certain terms and conditions that relate to the funding model in this Schedule B. 2.0 Additional Definitions. Any terms not otherwise defined in this Schedule have the same meaning attributed to them in the main body of this Agreement. The following terms have the following meanings: "Approved Funding" means the allowable subsidy for the Term determined by reconciling the Estimated Provincial Subsidy (as defined below) in accordance with Applicable Law and Applicable Policy Construction Funding Subsidy or CFS means the funding that the MOHLTC agreed to provide, or to ensure the provision of, to the HSP, in an agreement for the construction, development, redevelopment, retrofitting or upgrading of beds (a Development Agreement ). CFS Commitments means (a) commitments of the HSP related to a Development Agreement, identified in Schedule A of the service agreement in respect of the Home, in effect between the HSP and the LHIN on June 30, 2010, orand (b) where there were no commitments under clause (a), commitments of the HSP identified in a Development Agreement in respect of beds that were developed or redeveloped and opened for occupancy after June 30, 2010, (including, without limitation, any commitments set out in the HSP s Application as defined in the Development Agreement, and any conditions agreed to in the Development Agreement in respect of any permitted variances from standard design standards.) "Envelope" is a portion of the Estimated Provincial Subsidy that is designated for a specific use. There are four Envelopes in the Estimated Provincial Subsidy as follows: (a) the Nursing and Personal Care envelopeenvelope; (b) the Program and Support Services envelopeenvelope; (c) the Raw Food envelopeenvelope; and (d) the Other Accommodation envelopeenvelope. Estimated Provincial Subsidy means the estimated provincial subsidy calculated in accordance with Applicable Policy. Reconciliation Reports means the reports as required by Applicable Policy including the Long-term Care Home Annual Report and, the In-Year Revenue/Occupancy Report. Term means the term of this Agreement. 238 of 406

239 3.0 Provision of Funding. 3.1 In each Funding Year, the LHIN shall advise the HSP of the amount of its Estimated Provincial Subsidy. The amount of the Estimated Provincial Subsidy shall be calculated on both a monthly basis and an annual basis and will be allocated among the Envelopes and other funding streams applicable to the HSP, including the CFS. 3.2 The Estimated Provincial Subsidy shall be provided to the HSP on a monthly basis in accordance with the monthly calculation described in 3.1. and otherwise in accordance with this Agreement. Payments will be made to the HSP on or about the twenty-second (22 nd ) day of each month of the Term. 3.3 CFS will be provided as part of the Estimated Provincial Subsidy and in accordance with the terms of the Development Agreement and Applicable Policy. This obligation survives any termination of thethis Agreement. 4.0 Use of Funding. 4.1 The Unless otherwise provided in this Schedule B, the HSP shall use the fundingall Funding allocated for ana particular Envelope only for the use or uses set out in the Applicable Policy. 4.2 The HSP shall not transfer any such portion of the Estimated Provincial Subsidy in the Raw Food envelope,envelope to any other Envelope: 4.3 The HSP may transfer all or any of the part of the Estimated Provincial Subsidy for the Other Accommodation Envelope to any other Envelope without the prior written approval of the LHIN, provided that the HSP has complied with the standards and criteria for the Other Accommodation Envelope as set out in Applicable Policy. 4.4 The HSP may transfer any part of the Estimated Provincial Subsidy in the (a) Nursing and Personal Care envelopeenvelope; or (b) the Program and Support Services envelopeenvelope; to any Envelope other than the Other Accommodation Envelope without the prior written approval of the LHIN provided that the transfer is done in accordance with Applicable Policy. 4.5 In the event that a financial reduction is determined by the LHIN, the financial reduction will be applied against the portion of the Estimated Provincial Subsidy in the Other Accommodation Envelope. 5.0 Construction Funding Subsidies. 5.1 Subject to 5.2 and 5.3 the HSP is required to continue to fulfill alcfsall CFS Commitments, and the CFS Commitments are hereby incorporated into and deemed part of thisthe Agreement. 5.2 The HSP is not required to continue to fulfill those CFS Commitments that the MinistryMOHLTC has agreed in writing: (i) have been satisfactorily fulfilled; or (ii) are no longer required to be fulfilled; and the HSP is able to provide the LHIN with a copy of such written agreement. 239 of 406

240 5.3 Where this Agreement establishes or requires a service requirement that surpasses the service commitment set out in the CFS Commitments, the HSP is required to comply with the service requirements in this Agreement. 5.4 The MOHLTC will beis responsible for monitoring the HSP s on-going compliance with the CFS Commitments. Notwithstanding the foregoing, the HSP agrees to certify its compliance with the CFS Commitments when requested to do so by the LHIN. 6.0 Reconciliation. 6.1 The HSP shall complete the Reconciliation Reports and submit them to the LHINMOHLTC in accordance with Schedule C. The Reconciliation Reports shall be in such form and containing such information as required by Applicable Policy or as otherwise required by the LHIN pursuant to Article 8 of thethis Agreement. 6.2 The Estimated Provincial Subsidy provided by the LHIN under section 3.0 of this Schedule shall be reconciled by the LHIN in accordance with Applicable Law and Applicable Policy to produce the Approved Funding. 6.3 In accordance with the Applicable Law and Applicable Policy, if the Estimated Provincial Subsidy paid to the HSP exceeds the Approved Funding for any period, the excess is a debt due and owing by the HSP to the Crown in right of Ontario which shall be paid by the HSP to the Crown in right of Ontario and, in addition to any other methods available to recover the debt, the LHIN may deduct the amount of the debt from any subsequent amounts to be provided by the LHIN to the HSP. If the Estimated Provincial Subsidy paid for any period is less than the Approved Funding, the LHIN shall provide the difference to the HSP. 240 of 406

241 Schedule C Reporting Requirements 1. In-Year Revenue/Occupancy Report Reporting Period Estimated Due Dates Jan to Sept By October 15, Jan to Sept By October 15, Jan to Sept By October 15, Long-Term Care Home Annual Report Reporting Period Estimated Due Dates Jan to Dec By September 30, Jan to Dec By September 30, Jan to Dec By September 30, Performance Report Due Dates Q2 Apr to Sept October 31, 2013 Q3 Apr to Dec January 31, 2014 Q4 Apr to March April 30, Due Dates Q2 Apr to Sept October 31, 2014 Q3 Apr to Dec January 31, 2015 Q4 Apr to March April 30, Due Dates Q2 Apr to Sept October 30, 2015 Q3 Apr to Dec January 29, 2016 Q4 Apr to March April 29, French Language Services Report Fiscal Year Due Dates Apr to March April 3028, Apr to March April 30, Apr to March April 2930, OHRS/MIS Trial Balance Submission Due Dates (Must pass 3c Edits) Q2 Apr to Sept (Fiscal Year) October 31, Q2 Jan to Jun (Calendar Year) Q3 Apr to Dec (Fiscal Year) January 31, Q3 Jan to Sept (Calendar Year) Optional Submission Q4 Apr to March (Fiscal Year) May 3031, Q4 Jan to Dec (Calendar Year) 1 These are estimated dates from the MOHLTC and are subject to change. If the estimated due date falls on a weekend, reporting will be due the preceding Friday of 406

242 Schedule C Reporting Requirements Cont d/ 5. OHRS/MIS Trial Balance Submission Cont d Due Dates (Must pass 3c Edits) Q2 Apr to Sept (Fiscal Year) October 31, Q2 Jan to June (Calendar Year) Q3 Apr to Dec (Fiscal Year) January 31, Q3 Jan to Sept (Calendar Year) Optional Submission Q4 Apr to March (Fiscal Year) May 3031, Q4 Jan to Dec (Calendar Year) Due Dates (Must pass 3c Edits) Q2 Apr to Sept (Fiscal Year) October 31, Q2 Jan to June (Calendar Year) Q3 Apr to Dec (Fiscal Year) January 31, Q3 Jan to Sep (Calendar Year) Optional Submission Q4 Apr to March (Fiscal Year) May 3031, Q4 Jan to Dec (Calendar Year) 6. Compliance Declaration Funding Year Due Dates January 1, December 31, March 1, January 1, December 31, March 1, January 1, December 31, March 1, RAI MDS Funding Year Due Dates At least quarterly during each Funding Year in the term of this Agreement, or otherwise in accordance with the As established and advised by the Ministry on behalf of the LHIN. submission guidelines set out by CIHI. 8. Staffing Report Reporting Period Estimated Due Dates 1 January 1, December 31, July 7, January 1, December 31, July 6, January 1, December 31, July 5, Quality Improvement Plan Reporting Period Due Dates April 1, 2016 March 31, 2017 April 1, 2016 April 1, 2017 March 31, 2018 April 1, 2017 April 1, 2018 March 31, 2019 April 1, [Note to LHINS please insert additional local reporting requirements if any] of 406

243 Schedule D Performance 1.0 Performance Indicators The HSP s delivery of the Services will be measured by the following Indicators, Targets and where applicable Performance Standards. In the following table: n/a means not-applicable, that there is no defined Performance Standard for the indicator for the applicable year. tbd means a Target, and a Performance Standard, if applicable, will be determined during the applicable year. INDICATOR CATEGORY INDICATOR P=Performance Indicator E=Explanatory Indicator /1617 Performance Target Standard Organizational Health and Financial Indicators Coordination and Access Indicators Debt Service Coverage Ratio (P) 1 1 Total Margin (P) 0 0 Average Long-Stay Occupancy / Average Long-Stay Utilization (E) n/a n/a Wait Time from CCAC Determination of Eligibility to LTC Home Response (E) n/a n/a Long-Term Care Home Refusal Rate (E) n/a n/a Quality and Resident Safety Indicators Percentage of Residents Who Fell in the Last 30 days (E) n/a n/a Percentage of Residents Whose Pressure Ulcer Worsened (E) n/a n/a Percentage of Residents on Antipsychotics Without a Diagnosis of Psychosis (E) n/a n/a Percentage of Residents in Daily Physical Restraints (E) n/a n/a 2.0 LHIN-Specific Performance Obligations 243 of 406

244 Schedule E Form of Compliance Declaration DECLARATION OF COMPLIANCE Issued pursuant to the Long Term Care Service Accountability Agreement To: From: For: Date: Re: The Board of Directors of the [insert name of LHIN] Local Health Integration Network (the LHIN ). Attn: Board Chair. The Board of Directors (the Board ) of the [insert name of License Holder] (the HSP ) [insert name of Home] (the Home ) [insert date] [January 1, 201X December 31, 201x] (the Applicable Period ) The Board has authorized me, by resolution dated [insert date], to declare to you as follows: After making inquiries of the [insert name and position of person responsible for managing the Home on a day to day basis, e.g. the Chief Executive Office or the Executive Director] and other appropriate officers of the HSP and subject to any exceptions identified on Appendix 1 to this Declaration of Compliance, to the best of the Board s knowledge and belief, the HSP has fulfilled, its obligations under the long-term care service accountability agreement (the Agreement ) in effect during the Applicable Period. Without limiting the generality of the foregoing, the HSP confirms that (i) (ii) it has complied with the provisions of the Local Health System Integration Act, 2006 and with any compensation restraint legislation which applies to the HSP; and every Report submitted by the HSP is accurate in all respects and in full compliance with the terms of the Agreement; Unless otherwise defined in this declaration, capitalized terms have the same meaning as set out in the Agreement between the LHIN and the HSP effective April 1, [insert name of individual authorized by the Board to make the Declaration on the Board s behalf], [insert title] of 406

245 Schedule E Form of Compliance Declaration Cont d. Appendix 1 - Exceptions [Please identify each obligation under the LSAA that the HSP did not meet during the Applicable Period, together with an explanation as to why the obligation was not met and an estimated date by which the HSP expects to be in compliance.] of 406

246 TEMPLATE LONG-TERM CARE HOME SERVICE ACCOUNTABILITY AGREEMENT April 1, 2016 to March 31, 2019 SERVICE ACCOUNTABILITY AGREEMENT with [Legal Name of the Health Service Provider] Effective Date: April 1, 2016 Index to Agreement ARTICLE DEFINITIONS & INTERPRETATION... 2 ARTICLE TERM AND NATURE OF THIS AGREEMENT... 7 ARTICLE PROVISION OF SERVICES... 7 ARTICLE FUNDING... 8 ARTICLE ADJUSTMENT AND RECOVERY OF FUNDING ARTICLE PLANNING & INTEGRATION ARTICLE PERFORMANCE ARTICLE REPORTING, ACCOUNTING AND REVIEW ARTICLE ACKNOWLEDGEMENT OF LHIN SUPPORT ARTICLE REPRESENTATIONS, WARRANTIES AND COVENANTS ARTICLE LIMITATION OF LIABILITY, INDEMNITY & INSURANCE ARTICLE TERMINATION ARTICLE NOTICE ARTICLE INTERPRETATION ARTICLE ADDITIONAL PROVISIONS ARTICLE ENTIRE AGREEMENT Schedules A - Description of Home and Beds B - Additional Terms and Conditions Applicable to the Funding Model C - Reporting Requirements D - Performance E - Form of Compliance Declaration 246 of 406

247 THIS SERVICE ACCOUNTABILITY AGREEMENT effective as of April 1, 2016 BETWEEN: AND [insert name] LOCAL HEALTH INTEGRATION NETWORK (the LHIN ) [Legal Name(s) of the organization(s) holding the licence to operate the Home (if in doubt, check the licence issued by the MOHLTC)] (the HSP ) IN RESPECT OF: Background: [insert legal name of long term care home] located at [insert address] (the Home ) The Local Health System Integration Act, 2006 requires that the LHIN and the HSP enter into a service accountability agreement. The service accountability agreement supports a collaborative relationship between the LHIN and the HSP: to improve the health of Ontarians through better access to high quality health services; to co-ordinate health care in local health systems, by such actions as supporting the implementation of Health Links to facilitate regional integrated health care service delivery; to manage the health care system at the local level effectively and efficiently; and, to create a health care system that is person-centered, accountable, transparent, and evidence-based. In this context, the HSP and the LHIN agree that the LHIN will provide funding to the HSP on the terms and conditions set out in this Agreement to enable the provision of services to the local health system by the HSP. In consideration of their respective agreements set out below, the LHIN and the HSP covenant and agree as follows. ARTICLE DEFINITIONS & INTERPRETATION 1.1 Definitions. In this Agreement the following terms will have the following meanings. Act means the Long-Term Care Homes Act, 2007 and the regulations made under the Long Term Care Homes Act, 2007 as it and they may be amended from time to time. Accountability Agreement refers to the Agreement in place between the Minister and the LHIN pursuant to the terms of section 18 of LHSIA. Agreement means this agreement and includes the Schedules and any instrument amending this agreement or the Schedules. Annual Balanced Budget means that, in each calendar year of the term of this Agreement, the total expenses of the HSP in respect of the Services are less than or equal to the total revenue of the HSP in respect of the Services of 406

248 Applicable Law means all federal, provincial or municipal laws, orders, rules, regulations, common law, licence terms or by-laws, and includes terms or conditions of a licence or approval issued under the Act, that are applicable to the HSP, the Services, this Agreement and the Parties obligations under this Agreement during the term of this Agreement. Applicable Policy means any orders, rules, policies, directives or standards of practice issued or adopted by the LHIN, by the MOHLTC or by other ministries or agencies of the province of Ontario that are applicable to the HSP, the Services, this Agreement and the Parties obligations under this Agreement during the term of this Agreement. Without limiting the generality of the foregoing, Applicable Policy includes the Design Manual and the Long Term Care Funding and Financial Management Policies and all other manuals, guidelines, policies and other documents listed on the Policy Web Pages as those manuals, guidelines, policies and other documents may be amended from time to time. Approved Funding has the meaning ascribed to it in Schedule B. Beds means the long term care home beds that are licensed or approved under the Act and identified in Schedule A, as the same may be amended from time to time. Board means in respect of an HSP that is: (a) (b) (c) (d) (e) (f) a corporation, the board of directors; A First Nation, the band council; a municipality, the committee of management; a board of management established by one or more municipalities or by one or more First Nations band councils, the members of the board of management; a partnership, the partners; and a sole proprietorship, the sole proprietor. BPSAA means the Broader Public Sector Accountability Act, 2010, and the regulations made under the Broader Public Sector Accountability Act, 2010 as it and they may be amended from time to time. CEO means the individual accountable to the Board for the provision of the Services in accordance with the terms of this Agreement, which individual may be the executive director or administrator of the HSP, or may hold some other position or title within the HSP. CFMA means the Commitment to the Future of Medicare Act, 2004, and the regulations made under the Commitment to the Future of Medicare Act, 2004, as it and they may be amended from time to time. Compliance Declaration means a compliance declaration substantially in the form set out in Schedule E. Confidential Information means information that is (i) marked or otherwise identified as confidential by the disclosing Party at the time the information is provided to the receiving Party; and (ii) eligible for exclusion from disclosure at a public board meeting in accordance with section 9 of LHSIA. Confidential Information does not include of 406

249 information that (a) was known to the receiving Party prior to receiving the information from the disclosing Party; (b) has become publicly known through no wrongful act of the receiving Party; or (c) is required to be disclosed by law, provided that the receiving Party provides Notice in a timely manner of such requirement to the disclosing Party, consults with the disclosing Party on the proposed form and nature of the disclosure, and ensures that any disclosure is made in strict accordance with Applicable Law. Conflict of Interest in respect of an HSP, includes any situation or circumstance where: in relation to the performance of its obligations under this Agreement (a) (b) (c) the HSP; a member of the HSP s Board; or any person employed by the HSP who has the capacity to influence the HSP s decision, has other commitments, relationships or financial interests that: (a) (b) could or could be seen to interfere with the HSP s objective, unbiased and impartial exercise of its judgement; or could or could be seen to compromise, impair or be incompatible with the effective performance of its obligations under this Agreement. Construction Funding Subsidy has the meaning ascribed to it in Schedule B. controlling shareholder of a corporation means a shareholder who or which holds (or another person who or which holds for the benefit of such shareholder), other than by way of security only, voting securities of such corporation carrying more than 50% of the votes for the election of directors, provided that the votes carried by such securities are sufficient, if exercised, to elect a majority of the board of directors of such corporation. Days means calendar days. Design Manual means the MOHLTC design manual or manuals in effect and applicable to the development, upgrade, retrofit, renovation or redevelopment of the Home or Beds subject to this Agreement. Director has the same meaning as the term Director in the Act. Effective Date means April 1, e-health means the coordinated and integrated use of electronic systems, information and communication technologies to facilitate the collection, exchange and management of personal health information in order to improve the quality, access, productivity and sustainability of the healthcare system. Explanatory Indicator means a measure of HSP performance for which no Performance Target is set. Technical specifications of specific Explanatory Indicators can be found in the L-SAA Indicator Technical Specifications document. FIPPA means the Freedom of Information and Protection of Privacy Act, (Ontario) and the regulations made under the Freedom of Information and Protection of Privacy Act, of 406

250 (Ontario), as it and they may be amended from time to time. Funding means the amounts of money provided by the LHIN to the HSP in each Funding Year of this Agreement. Funding includes Approved Funding and Construction Funding Subsidy. Funding Year means in the case of the first Funding Year, the period commencing on the January 1 prior to the Effective Date and ending on the following December 31, and in the case of Funding Years subsequent to the first Funding Year, the period commencing on the date that is January 1 following the end of the previous Funding Year and ending on the following December 31. Home means the building where the Beds are located and for greater certainty, includes the Beds and the common areas and common elements which will be used at least in part, for the Beds, but excludes any other part of the building which will not be used for the Beds being operated pursuant to this Agreement. HSP s Personnel and Volunteers means the controlling shareholders (if any), directors, officers, employees, agents, volunteers and other representatives of the HSP. In addition to the foregoing HSP s Personnel and Volunteers shall include the contractors and subcontractors and their respective shareholders, directors, officers, employees, agents, volunteers or other representatives. Indemnified Parties means the LHIN and its officers, employees, directors, independent contractors, subcontractors, agents, successors and assigns and her Majesty the Queen in Right of Ontario and her Ministers, appointees and employees, independent contractors, subcontractors, agents and assigns. Indemnified Parties also includes any person participating on behalf of the LHIN in a Review. Interest Income means interest earned on the Funding. Licence means one or more of the licences or the approvals granted to the HSP in respect of the Beds at the Home under Part VII or Part VIII of the Act. LHSIA means the Local Health System Integration Act, 2006 and the regulations under the Local Health System Integration Act, 2006 as it and they may be amended from time to time. Minister means the Minister of Health and Long-Term Care. MOHLTC means the Minister or the Ministry of Health and Long-Term Care, as is appropriate in the context. Notice means any notice or other communication required to be provided pursuant to this Agreement, LHSIA, the Act or the CFMA. Party means either of the LHIN or the HSP and Parties mean both of the LHIN and the HSP. Performance Agreement means an agreement between an HSP and its CEO that requires the CEO to perform in a manner that enables the HSP to achieve the terms of of 406

251 this Agreement. Performance Corridor means the acceptable range of results around a Performance Target. Performance Factor means any matter that could or will significantly affect a Party s ability to fulfill its obligations under this Agreement, and for certainty, includes any such matter that may be brought to the attention of the LHIN, whether by PICB or otherwise. Performance Indicator means a measure of HSP performance for which a Performance Target is set; Technical specifications of specific Performance Indicators can be found in the L-SAA Indicator Technical Specifications document. Performance Standard means the acceptable range of performance for a Performance Indicator or a Service Volume that results when a Performance Corridor is applied to a Performance Target. Performance Target means the level of performance expected of the HSP in respect of a Performance Indicator or a Service Volume. PICB means Performance Improvement and Compliance Branch of MOHLTC, or any other Branch or organizational unit of MOHLTC that may succeed or replace it. Planning Submission means the planning document submitted by the HSP to the LHIN. The form, content and scheduling of the Planning Submission will be identified by the LHIN. Policy Web Pages means the web pages available at and at or such other URLs or Web pages as the LHIN or the Ministry may advise from time to time. Capital policies can be found at RAI MDS Tools means the standardized Resident Assessment Instrument Minimum Data Set ( RAI MDS ) 2.0, the RAI MDS 2.0 User Manual and the RAI MDS Practice Requirements, as the same may be amended from time to time. Reports means the reports described in Schedule C as well as any other reports or information required to be provided under LHSIA, the Act or this Agreement. Resident has the meaning ascribed to the term resident under the Act. Review means a financial or operational audit, investigation, inspection or other form of review requested or required by the LHIN under the terms of LHSIA or this Agreement, but does not include the annual audit of the HSP s financial statements. Schedule means any one of, and Schedules mean any two or more, as the context requires, of the schedules appended to this Agreement and includes: Schedule A. Schedule B. Schedule C. Description of Home and Beds; Additional Terms and Conditions Applicable to the Funding Model; Reporting Requirements; of 406

252 Schedule D. Schedule E. Performance; and Form of Compliance Declaration. Services means the operation of the Beds and the Home and the accommodation, care, programs, goods and other services that are provided to Residents (i) to meet the requirements of the Act; (ii) to obtain Approved Funding; and (iii) to fulfill all commitments made to obtain a Construction Funding Subsidy. Service Volume means a measure of Services for which a Performance Target is set. 1.2 Interpretation. Words in the singular include the plural and vice-versa. Words in one gender include all genders. The headings do not form part of this Agreement. They are for convenience of reference only and will not affect the interpretation of this Agreement. Terms used in the Schedules shall have the meanings set out in this Agreement unless separately and specifically defined in a Schedule in which case the definition in the Schedule shall govern for the purposes of that Schedule. ARTICLE TERM AND NATURE OF THIS AGREEMENT 2.1 Term. The term of this Agreement will commence on the Effective Date and will expire on the earlier of (1) March 31, 2019 or (2) the expiration or termination of all Licences, unless this Agreement is terminated earlier or extended pursuant to its terms. 2.2 A Service Accountability Agreement. This Agreement is a service accountability agreement for the purposes of section 20(1) of LHSIA and Part III of the CFMA. 2.3 Notice. Notice was given to the HSP that the LHIN intended to enter into this Agreement. The HSP hereby acknowledges receipt of such Notice in accordance with the terms of the CFMA. 2.4 Prior Agreements. The Parties acknowledge and agree that all prior agreements for the Services are terminated. ARTICLE PROVISION OF SERVICES 3.1 Provision of Services. (a) (b) (c) The HSP will provide the Services in accordance with, and otherwise comply with: (1) the terms of this Agreement; (2) Applicable Law; and (3) Applicable Policy. Unless otherwise provided in this Agreement, the HSP will not reduce, stop, start, expand, cease to provide or transfer the provision of the Services except with Notice to the LHIN and if required by Applicable Law or Applicable Policy, the prior written consent of the LHIN. The HSP will not restrict or refuse the provision of Services to an individual, of 406

253 directly or indirectly, based on the geographic area in which the person resides in Ontario. 3.2 Subcontracting for the Provision of Services. (a) (b) (c) The Parties acknowledge that, subject to the provisions of the Act and LHSIA, the HSP may subcontract the provision of some or all of the Services. For the purposes of this Agreement, actions taken or not taken by the subcontractor and Services provided by the subcontractor will be deemed actions taken or not taken by the HSP and Services provided by the HSP. When entering into a subcontract the HSP agrees that the terms of the subcontract will enable the HSP to meet its obligations under this Agreement. Without limiting the foregoing, the HSP will include a provision that permits the LHIN or its authorized representatives, to audit the subcontractor in respect of the subcontract if the LHIN or its authorized representatives determines that such an audit would be necessary to confirm that the HSP has complied with the terms of this Agreement. Nothing contained in this Agreement or a subcontract will create a contractual relationship between any subcontractor or its directors, officers, employees, agents, partners, affiliates or volunteers and the LHIN. 3.3 Conflict of Interest. The HSP will use the Funding, provide the Services and otherwise fulfil its obligations under this Agreement without an actual, potential or perceived Conflict of Interest. The HSP will disclose to the LHIN without delay any situation that a reasonable person would interpret as an actual, potential or perceived Conflict of Interest and comply with any requirements prescribed by the LHIN to resolve any Conflict of Interest. 3.4 e-health/information Technology Compliance. The HSP agrees to: (a) (b) (c) (d) (e) assist the LHIN to implement provincial e-health priorities for and thereafter in accordance with the Accountability Agreement, as may be amended from time to time; comply with any technical and information management standards, including those related to data, architecture, technology, privacy and security set for health service providers by the MOHLTC, ehealth Ontario or the LHIN within the timeframes set by the MOHLTC or the LHIN as the case may be; implement and use the approved provincial e-health solutions identified in the LHIN e-health plan; implement technology solutions that are compatible or interoperable with the provincial blueprint and with the LHIN e-health plan; and include in its annual planning submission, plans for achieving ehealth priority initiatives. ARTICLE FUNDING 4.1 Funding. Subject to the terms of this Agreement, and in accordance with the of 406

254 applicable provisions of the Accountability Agreement, the LHIN will provide the Funding by depositing the Funding in monthly instalments over the Term, into an account designated by the HSP provided that the account resides at a Canadian financial institution and is in the name of the HSP. 4.2 Conditions of Funding. (a) (b) The HSP will: (1) use the Funding only for the purpose of providing the Services in accordance with Applicable Law, Applicable Policy and the terms of this Agreement; (2) not use the Funding for compensation increases prohibited by Applicable Law; (3) meet all obligations in the Schedules; (4) fulfill all other obligations under this Agreement; and (5) plan for and achieve an Annual Balanced Budget. Interest Income will be reported to the LHIN and is subject to a year-end reconciliation. The LHIN may deduct the amount equal to the Interest Income from any further funding instalments under this or any other agreement with the HSP or the LHIN may require the HSP to pay an amount equal to the unused Interest Income to the Ministry of Finance. 4.3 Limitation on Payment of Funding. Despite section 4.1, the LHIN: (a) (b) (c) (d) (e) will not provide any funds to the HSP until this Agreement is fully executed; may pro-rate the Funding if this Agreement is signed after the Effective Date; will not provide any funds to the HSP until the HSP meets the insurance requirements described in section 11.4; will not be required to continue to provide funds, (1) if the Minister or the Director so directs under the terms of the Act; (2) while the Home is under the control of an Interim Manager pursuant to section 157 of the Act; or (3) in the event the HSP breaches any of its obligations under this Agreement until the breach is remedied to the LHIN s satisfaction; and upon notice to the HSP, may adjust the amount of funds it provides to the HSP in any Funding Year pursuant to Article Additional Funding. Unless the LHIN has agreed to do so in writing, the LHIN is not required to provide additional funds to the HSP for providing services other than the Services or for exceeding the requirements of Schedule D. 4.5 Additional Terms and Conditions. The LHIN may add such further terms or conditions on the use of the Funding as are required for the LHIN to meet its obligations under the Accountability Agreement, Applicable Law or Applicable Policy as the same may be amended during the Term. 4.6 Appropriation. Funding under this Agreement is conditional upon an appropriation of of 406

255 moneys by the Legislature of Ontario to the MOHLTC and funding of the LHIN by the MOHLTC pursuant to LHSIA. If the LHIN does not receive its anticipated funding the LHIN will not be obligated to make the payments required by this Agreement. 4.7 Procurement of Goods and Services. (a) (b) If the HSP is subject to the procurement provisions of the BPSAA, the HSP will abide by all directives and guidelines issued by the Management Board of Cabinet that are applicable to the HSP pursuant to the BPSAA. If the HSP is not subject to the procurement provisions of the BPSAA, the HSP will have a procurement policy in place that requires the acquisition of supplies, equipment or services valued at over $25,000 through a competitive process that ensures the best value for funds expended. If the HSP acquires supplies, equipment or services with the Funding it will do so through a process that is consistent with this policy. 4.8 Disposition. The HSP will not sell, lease or otherwise dispose of any assets purchased with Funding, except as may be required by Applicable Law or otherwise in accordance with Applicable Policy. ARTICLE ADJUSTMENT AND RECOVERY OF FUNDING 5.1 Adjustment of Funding. (a) The LHIN may adjust the Funding in any of the following circumstances: (1) in the event of changes to Applicable Law or Applicable Policy that affect Funding; (2) on a change to the Services; (3) if required by either the Director or the Minister under the Act; (4) in the event that a breach of this Agreement is not remedied to the satisfaction of the LHIN; and (5) as otherwise permitted by this Agreement. (b) (c) Funding recoveries or adjustments required pursuant to 5.1(a) may be accomplished through the adjustment of Funding, requiring the repayment of Funding and/or through the adjustment of the amount of any future funding installments. Approved Funding already expended properly in accordance with this Agreement will not be subject to adjustment. The LHIN will, at its sole discretion, and without liability or penalty, determine whether the Funding has been expended properly in accordance with this Agreement. In determining the amount of a funding adjustment under 5.1 (a) (4) or (5), LHIN shall take into account the following principles: (1) Resident care must not be compromised through a funding adjustment arising from a breach of this Agreement; (2) the HSP should not gain from a breach of this Agreement; (3) if the breach reduces the value of the Services, the funding adjustment should be at least equal to the reduction in value; and of 406

256 (4) the funding adjustment should be sufficient to encourage subsequent compliance with this Agreement, and such other principles as may be articulated in Applicable Law or Applicable Policy from time to time. 5.2 Provision for the Recovery of Funding. The HSP will make reasonable and prudent provision for the recovery by the LHIN of any Funding for which the conditions of Funding set out in section 4.2(a) are not met and will hold this Funding in an interest bearing account until such time as reconciliation and settlement has occurred with the LHIN. 5.3 Settlement and Recovery of Funding for Prior Years. (a) (b) 5.4 Debt Due. The HSP acknowledges that settlement and recovery of Funding can occur up to seven years after the provision of Funding. Recognizing the transition of responsibilities from the MOHLTC to the LHIN, the HSP agrees that if the Parties are directed in writing to do so by the MOHLTC, the LHIN will settle and recover funding provided by the MOHLTC to the HSP prior to the transition of the funding for the Services to the LHIN, provided that such settlement and recovery occurs within seven years of the provision of the funding by the MOHLTC. All such settlements and recoveries will be subject to the terms applicable to the original provision of funding. (a) (b) If the LHIN requires the re-payment by the HSP of any Funding, the amount required will be deemed to be a debt owing to the Crown by the HSP. The LHIN may adjust future funding instalments to recover the amounts owed or may, at its discretion, direct the HSP to pay the amount owing to the Crown and the HSP shall comply immediately with any such direction. All amounts repayable to the Crown will be paid by cheque payable to the Ontario Minister of Finance and mailed or delivered to the LHIN at the address provided in section Interest Rate. The LHIN may charge the HSP interest on any amount owing by the HSP at the then current interest rate charged by the Province of Ontario on accounts receivable. ARTICLE PLANNING & INTEGRATION 6.1 Planning for Future Years. (a) (b) Advance Notice. The LHIN will give at least sixty Days Notice to the HSP of the date by which a Planning Submission, approved by the HSP s governing body, must be submitted to the LHIN. Multi-Year Planning. The Planning Submission will be in a form acceptable to the LHIN and may be required to incorporate (1) prudent multi-year financial forecasts; (2) plans for the achievement of Performance Targets; and (3) realistic of 406

257 (c) (d) risk management strategies. It will be aligned with the LHIN s then current Integrated Health Service Plan and will reflect local LHIN priorities and initiatives. If the LHIN has provided multi-year planning targets for the HSP, the Planning Submission will reflect the planning targets. Multi-year Planning Targets. Parties acknowledge that the HSP is not eligible to receive multi-year planning targets under the terms of Schedule B in effect as of the Effective Date. In the event that Schedule B is amended over the Term and the LHIN is able to provide the HSP with multi-year planning targets, (the HSP acknowledges that these targets are: (1) targets only, (2) provided solely for the purposes of planning, (3) are subject to confirmation and (4) may be changed at the discretion of the LHIN. The HSP will proactively manage the risks associated with multi-year planning and the potential changes to the planning targets. The LHIN agrees that it will communicate any material changes to the planning targets as soon as reasonably possible. Service Accountability Agreements. Subject to advice from the Director about the HSP s history of compliance under the Act and provided that the HSP has fulfilled its obligations under this Agreement, the Parties expect that they will enter into a new service accountability agreement at the end of the Term. The LHIN will give the HSP at least six months Notice if the LHIN does not intend to enter into negotiations for a subsequent service accountability agreement because the HSP has not fulfilled its obligations under this Agreement. The HSP acknowledges that if the LHIN and the HSP enter into negotiations for a subsequent service accountability agreement, subsequent funding may be interrupted if the next service accountability agreement is not executed on or before the expiration date of this Agreement. 6.2 Community Engagement & Integration Activities (a) (b) (c) Community Engagement. The HSP will engage the community of diverse persons and entities in the area where it provides health services when setting priorities for the delivery of health services and when developing plans for submission to the LHIN including but not limited to the HSP s Planning Submission and integration proposals. Integration. The HSP will, separately and in conjunction with the LHIN and other health service providers, identify opportunities to integrate the services of the local health system to provide appropriate, co-coordinated, effective and efficient services. Reporting. The HSP will report on its community engagement and integration activities as requested by the LHIN and in any event, in its Q4 Performance Report to the LHIN. 6.3 Planning and Integration Activity Pre-proposals. (a) General: A pre-proposal process has been developed to (1) reduce the costs incurred by an HSP when proposing operational or service changes; (2) assist the HSP to carry out its statutory obligations; and (3) enable an effective and efficient response by the LHIN. Subject to specific direction from the LHIN, this pre-proposal process will be used in the following instances: of 406

258 (b) (c) (1) the HSP is considering an integration, or an integration of services, as defined in LHSIA between the HSP and another person or entity; (2) the HSP is proposing to reduce, stop, start, expand or transfer the location of Services; (3) to identify opportunities to integrate the services of the local health system, other than those identified in (1) or (2) above; or (4) if requested by the LHIN. LHIN Evaluation of the Pre-proposal: Use of the pre-proposal process is not formal Notice of a proposed integration under section. 27 of LHSIA. LHIN consent to develop the project concept outlined in a pre-proposal does not constitute approval to proceed with the project. Nor does the LHIN consent to develop a project concept presume the issuance of a favourable decision, should such a decision be required by section 25 or 27 of LHSIA. Following the LHIN s review and evaluation, the HSP may be invited to submit a detailed proposal and a business plan for further analysis. Guidelines for the development of a detailed proposal and business case will be provided by the LHIN. Where an HSP integrates its services with those of another person and the integration relates to services funded in whole or in part by the LHIN, the HSP will follow the provisions of section 27 of LHSIA. Without limiting the foregoing, a transfer of services from the HSP to another person or entity is an example of an integration to which section 27 may apply. 6.4 Proposing Integration Activities in the Planning Submission. No integration activity described in section 6.3 may be proposed in a Planning Submission unless the LHIN has consented, in writing, to its inclusion pursuant to the process set out in section Termination of Designation of Convalescent Care Beds. (a) (b) Notwithstanding section 6.3, the provisions in this section 6.5 apply to the termination of a designation of convalescent care Beds. The HSP may terminate the designation of one or more convalescent care Beds and revert them back to long-stay Beds at any time provided the HSP gives the Ministry and the LHIN at least six months prior written Notice. Such Notice shall include: (1) a detailed transition plan, satisfactory to the LHIN acting reasonably, setting out the dates, after the end of the six month Notice period, on which the HSP plans to terminate the designation of each convalescent care Bed and to revert same to a long-stay Bed; and, (2) a detailed explanation of the factors considered in the selection of those dates. The designation of a convalescent care Bed will terminate and the Bed will revert to a long-stay Bed on the date, after the six month Notice period, on which the Resident who is occupying that convalescent care Bed at the end of the six month Notice period has been discharged from that Bed, unless otherwise agreed by the LHIN and the HSP. (c) The LHIN may terminate the designation of the convalescent care Beds at any time by giving at least six months prior written Notice to the HSP. Upon receipt of 406

259 of any such Notice, the HSP shall, within the timeframe set out in the Notice, provide the LHIN with: (1) a detailed transition plan, satisfactory to the LHIN acting reasonably, setting out the dates, after the end of the six month Notice period, on which the HSP plans to terminate the designation of each convalescent care Bed and, if required by the Notice, to revert same to a long-stay Bed; and, (2) a detailed explanation of the factors considered in the selection of those dates. The designation of a convalescent care Bed will terminate, and if applicable revert to a long-stay Bed on the date, after the six month Notice period, on which the Resident who is occupying that convalescent care Bed at the end of the Notice period has been discharged from that Bed, unless otherwise agreed by the LHIN and the HSP. 6.6 In this Article 6, the terms integrate, integration and services have the same meanings attributed to them in section 2(1) and section 23 respectively of LHSIA, as it and they may be amended from time to time. (a) (b) service includes; (1) a service or program that is provided directly to people, (2) a service or program, other than a service or program described in clause (1), that supports a service or program described in that clause, or (3) a function that supports the operations of a person or entity that provides a service or program described in clause (1) or (2). integrate includes; (1) to co-ordinate services and interactions between different persons and entities, (2) to partner with another person or entity in providing services or in operating, (3) to transfer, merge or amalgamate services, operations, persons or entities, (4) to start or cease providing services, (5) to cease to operate or to dissolve or wind up the operations of a person or entity, and integration has a similar meaning. ARTICLE PERFORMANCE 7.1 Performance. The Parties will strive to achieve on-going performance improvement. They will address performance improvement in a proactive, collaborative and responsive manner. 7.2 Performance Factors of 406

260 (a) (b) (c) Each Party will notify the other Party of the existence of a Performance Factor, as soon as reasonably possible after the Party becomes aware of the Performance Factor. The Notice will: (1) describe the Performance Factor and its actual or anticipated impact; (2) include a description of any action the Party is undertaking, or plans to undertake, to remedy or mitigate the Performance Factor; (3) indicate whether the Party is requesting a meeting to discuss the Performance Factor; and (4) address any other issue or matter the Party wishes to raise with the other Party. The recipient Party will provide a written acknowledgment of receipt of the Notice within seven Days of the date on which the Notice was received ( Date of the Notice ). Where a meeting has been requested under section 7.2(a), the Parties agree to meet and discuss the Performance Factors within fourteen Days of the Date of the Notice, in accordance with the provisions of section 7.3. PICB may be included in any such meeting at the request of either Party. 7.3 Performance Meetings. During a meeting on performance, the Parties will: (a) (b) (c) discuss the causes of a Performance Factor; discuss the impact of a Performance Factor on the local health system and the risk resulting from non-performance; and determine the steps to be taken to remedy or mitigate the impact of the Performance Factor (the Performance Improvement Process ). 7.4 The Performance Improvement Process. (a) The Performance Improvement Process will focus on the risks of nonperformance and problem-solving. It may include one or more of the following actions: (1) a requirement that the HSP develop and implement an improvement plan that is acceptable to the LHIN; (2) the conduct of a Review; (3) a revision and amendment of the HSP s obligations; and (4) an in-year, or year end, adjustment to the Funding, among other possible means of responding to the Performance Factor or improving performance. (b) Any performance improvement process begun under a prior service accountability agreement that was not completed under the prior agreement will continue under this Agreement. Any performance improvement required by a LHIN under a prior service accountability agreement will be deemed to be a requirement of this Agreement until fulfilled or waived by the LHIN. ARTICLE REPORTING, ACCOUNTING AND REVIEW of 406

261 8.1 Reporting. (a) (b) Generally. The LHIN s ability to enable its local health system to provide appropriate, co-ordinated, effective and efficient health services as contemplated by LHSIA, is heavily dependent on the timely collection and analysis of accurate information. The HSP acknowledges that the timely provision of accurate information related to the HSP, its Residents and its performance of its obligations under this Agreement, is under the HSP s control. Specific Obligations. The HSP (1) will provide to the LHIN, or to such other entity as the LHIN may direct, in the form and within the time specified by the LHIN, the Reports other than personal health information as defined in section 31 (5) of the CFMA, that (1) the LHIN requires for the purposes of exercising its powers and duties under this Agreement, LHSIA or for the purposes that are prescribed under LHSIA, or (2) may be requested under the CFMA; (2) will comply with the applicable reporting standards and requirements in both Chapter 9 of the Ontario Healthcare Reporting Standards and the RAI MDS Tools; (3) will fulfil the specific reporting requirements set out in Schedule C; (4) will ensure that every Report is complete, accurate, signed on behalf of the HSP by an authorized signing officer where required and provided in a timely manner and in a form satisfactory to the LHIN; and (5) agrees that every Report submitted by or on behalf of the HSP, will be deemed to have been authorized by the HSP for submission. (c) (d) (e) RAI MDS. Without limiting the foregoing, the HSP (1) will conduct quarterly assessments of Residents, and all other assessments of Residents required by the RAI MDS Tools, using the RAI MDS Tools; (2) will ensure that the RAI MDS Tools are used correctly to produce an accurate assessment of the HSP s Residents (RAI MDS Data); (3) will submit the RAI MDS Data to the Canadian Institute for Health Information in an electronic format at least quarterly in accordance with the submission guidelines set out by CIHI; and (4) acknowledges that if used incorrectly, the RAI MDS Tools can increase Funding beyond that to which the HSP would otherwise be entitled. The HSP will therefore have systems in place to regularly monitor, evaluate and where necessary correct the quality and accuracy of the RAI MDS Data. Health Quality Ontario. The HSP will work with Health Quality Ontario and other providers to advance the quality agenda and align quality improvement efforts across the local health care system; and, will submit a report to the LHIN that outlines how the HSP has done so. Without limiting the foregoing, the HSP will submit a Quality Improvement Plan to Health Quality Ontario that is aligned with this Agreement and supports local health system priorities. French Language Services. If the HSP is required to provide services to the of 406

262 (f) (g) 8.2 Reviews. public in French under the provisions of the French Language Services Act, the HSP will be required to submit a French language services report to the LHIN. If the HSP is not required to provide services to the public in French under the provisions of the French Language Service Act, it will be required to provide a report to the LHIN that outlines how the HSP addresses the needs of its local Francophone community. Declaration of Compliance. On or before March 1 of each Funding Year, the Board will issue a Compliance Declaration declaring that the HSP has complied with the terms of this Agreement. The form of the declaration is set out in Schedule E and may be amended from time to time through the term of this Agreement. Financial Reductions. Notwithstanding any other provision of this Agreement, and at the discretion of the LHIN, the HSP may be subject to a financial reduction if any of the Reports are received after the due date, are incomplete, or are inaccurate where the errors or delay were not as a result of either LHIN actions or inaction or the actions or inactions of persons acting on behalf of the LHIN. If assessed, the financial reduction will be taken from funding designated for this purpose in Schedule B as follows: (1) if received within 7 days after the due date, incomplete or inaccurate, the financial penalty will be the greater of (1) a reduction of 0.02 percent (0.02%) of the Funding; or (2) two hundred and fifty dollars ($250.00), and (2) for every full or partial week of non-compliance thereafter, the rate will be one half of the initial reduction. (a) (b) During the term of this Agreement and for seven years after the term of this Agreement, the HSP agrees that the LHIN or its authorized representatives may conduct a Review of the HSP to confirm the HSP s fulfillment of its obligations under this Agreement. For these purposes the LHIN or its authorized representatives may, upon twenty-four hours Notice to the HSP and during normal business hours enter the HSP s premises to: (1) inspect and copy any financial records, invoices and other financerelated documents, other than personal health information as defined in section 31(5) of the CFMA, in the possession or under the control of the HSP which relate to the Funding or otherwise to the Services, and (2) inspect and copy non-financial records, other than personal health information as defined in section 31(5) of the CFMA, in the possession or under the control of the HSP which relate to the Funding, the Services or otherwise to the performance of the HSP under this Agreement. The cost of any Review will be borne by the HSP if the Review (1) was made necessary because the HSP did not comply with a requirement under the Act or this Agreement; or (2) indicates that the HSP has not fulfilled its obligations under this Agreement, including its obligations under Applicable Law or Applicable Policy of 406

263 (c) (d) (e) To assist in respect of the rights set out in (b) above the HSP shall disclose any information requested by the LHIN or its authorized representatives, and shall do so in a form requested by the LHIN or its authorized representatives. The HSP may not commence a proceeding for damages or otherwise against any person with respect to any act done or omitted to be done, any conclusion reached or report submitted that is done in good faith in respect of a Review. HSP s obligations under this section 8.2 will survive any termination or expiration of this Agreement. 8.3 Document Retention and Record Maintenance. The HSP will (a) (b) (c) retain all records (as that term is defined in FIPPA) related to the HSP s performance of its obligations under this Agreement for seven (7) years after the termination or expiration of the term of this Agreement. The HSP s obligations under this section will survive any termination or expiry of this Agreement; keep all financial records, invoices and other finance-related documents relating to the Funding or otherwise to the Services in a manner consistent with either generally accepted accounting principles or international financial reporting standards as advised by the HSP s auditor; and keep all non-financial documents and records relating to the Funding or otherwise to the Services in a manner consistent with all Applicable Law. 8.4 Disclosure of Information. (a) (b) FIPPA. The HSP acknowledges that the LHIN is bound by FIPPA and that any information provided to the LHIN in connection with this Agreement may be subject to disclosure in accordance with FIPPA. Confidential Information. The Parties will treat Confidential Information as confidential and will not disclose Confidential Information except with the consent of the disclosing Party or as permitted or required under FIPPA, the Municipal Freedom of Information and Protection of Privacy Act, the Personal Health Information Protection Act, 2004, the Act, court order, subpoena or other Applicable Law. Notwithstanding the foregoing, the LHIN may disclose information that it collects under this Agreement in accordance with LHSIA and the CFMA Transparency. The HSP will post a copy of this Agreement and each Compliance Declaration submitted to the LHIN during the term of this Agreement in a conspicuous and easily accessible public place at the Home and on its public website if the HSP operates a public website. 8.6 Auditor General. For greater certainty the LHIN s rights under this article are in addition to any rights provided to the Auditor General under the Auditor General Act (Ontario). ARTICLE ACKNOWLEDGEMENT OF LHIN SUPPORT 9.1 Publication. For the purposes of this Article 9, the term publication means any material on or concerning the Services that the HSP makes available to the public, of 406

264 regardless of whether the material is provided electronically or in hard copy. Examples include a web-site, an advertisement, a brochure, promotional documents and a report. Materials that are prepared by the HSP in order to fulfil its reporting obligations under this Agreement are not included in the term publication. 9.2 Acknowledgment of Funding Support. (a) (b) The HSP agrees all publications will include (1) an acknowledgment of the Funding provided by the LHIN and the Government of Ontario. Prior to including an acknowledgement in any publication, the HSP will obtain the LHIN s approval of the form of acknowledgement. The LHIN may, at its discretion, decide that an acknowledgement is not necessary; and (2) a statement indicating that the views expressed in the publication are the views of the HSP and do not necessarily reflect those of the LHIN or the Government of Ontario. The HSP shall not use any insignia or logo of Her Majesty the Queen in right of Ontario, including those of the LHIN, unless it has received the prior written permission of the LHIN to do so. ARTICLE REPRESENTATIONS, WARRANTIES AND COVENANTS 10.1 General. The HSP represents, warrants and covenants that: (a) (b) (c) (d) (e) (f) it is, and will continue for the term of this Agreement to be, a validly existing legal entity with full power to fulfill its obligations under this Agreement; it has the experience and expertise necessary to carry out the Services; it holds all permits, licences, consents intellectual property rights and authorities necessary to perform its obligations under this Agreement; all information that the HSP provided to the LHIN in its Planning Submission or otherwise in support of its application for funding was true and complete at the time the HSP provided it, and will, subject to the provision of Notice otherwise, continue to be true and complete for the term of this Agreement; it has not and will not for the term of this Agreement, enter into a non-arm s transaction that is prohibited by the Act; and it does, and will continue for the term of this Agreement to, operate in compliance with all Applicable Law and Applicable Policy Execution of Agreement. The HSP represents and warrants that: (a) (b) it has the full power and authority to enter into this Agreement; and it has taken all necessary actions to authorize the execution of the Agreement Governance of 406

265 (a) (b) The HSP represents, warrants and covenants that it has established, and will maintain for the period during which this Agreement is in effect, policies and procedures: (1) that set out a code of conduct for, and that identify, the ethical obligations of HSP s Personnel and Volunteers; (2) to ensure the ongoing effective functioning of the HSP; (3) for effective and appropriate decision-making; (4) for effective and prudent risk-management, including the identification and management of potential, actual and perceived conflicts of interest; (5) for the prudent and effective management of the Funding; (6) to monitor and ensure the accurate and timely fulfillment of the HSP s obligations under this Agreement and compliance with the Act and LHSIA; (7) to enable the preparation, approval and delivery of all Reports; and (8) to address complaints about the provision of Services, the management or governance of the HSP; and (9) to deal with such other matters as the HSP considers necessary to ensure that the HSP carries out its obligations under this Agreement. The HSP represents and warrants that it: (1) has, or will have within 60 days of the execution of this Agreement, a Performance Agreement with its CEO. (2) will take all reasonable care to ensure that its CEO complies with the Performance Agreement; and (3) will enforce the HSP s rights under the Performance Agreement Funding, Services and Reporting. The HSP represents warrants and covenants that: (a) (b) (c) the Funding is, and will continue to be, used only to provide the Services in accordance with the terms of this Agreement: the Services are and will continue to be provided: (1) by persons with the expertise, professional qualifications, licensing and skills necessary to complete their respective tasks; and (2) in compliance with Applicable Law and Applicable Policy; and every Report is, and will continue to be, accurate and in full compliance with the provisions of this Agreement, including any particular requirements applicable to the Report Supporting Documentation. Upon request, the HSP will provide the LHIN with proof of the matters referred to in this Article. ARTICLE LIMITATION OF LIABILITY, INDEMNITY & INSURANCE 11.1 Limitation of Liability. The Indemnified Parties will not be liable to the HSP or any of the HSP s Personnel and Volunteers for costs, losses, claims, liabilities and damages howsoever caused arising out of or in any way related to the Services or otherwise in connection with this Agreement, unless caused by the negligence or wilful act of any of of 406

266 the Indemnified Parties Same. For greater certainty and without limiting section 11.1, the LHIN is not liable for how the HSP and the HSP s Personnel and Volunteers carry out the Services and is therefore not responsible to the HSP for such Services. Moreover the LHIN is not contracting with or employing any HSP s Personnel and Volunteers to carry out the terms of this Agreement. As such, it is not liable for contracting with, employing or terminating a contract with or the employment of any HSP s Personnel and Volunteers required to carry out this Agreement, nor for the withholding, collection or payment of any taxes, premiums, contributions or any other remittances due to government for the HSP s Personnel and Volunteers required by the HSP to carry out this Agreement Indemnification. The HSP hereby agrees to indemnify and hold harmless the Indemnified Parties from and against any and all liability, loss, costs, damages and expenses (including legal, expert and consultant costs), causes of action, actions, claims, demands, lawsuits or other proceedings (collectively, the Claims ), by whomever made, sustained, brought or prosecuted, including for third party bodily injury (including death), personal injury and property damage, in any way based upon, occasioned by or attributable to anything done or omitted to be done by the HSP or the HSP s Personnel and Volunteers in the course of the performance of the HSP s obligations under, or otherwise in connection with, this Agreement, unless caused by the negligence or wilful misconduct of any Indemnified Parties Insurance. (a) (b) Generally. The HSP shall protect itself from and against all claims that might arise from anything done or omitted to be done by the HSP and the HSP s Personnel and Volunteers under this Agreement and more specifically all claims that might arise from anything done or omitted to be done under this Agreement where bodily injury (including personal injury), death or property damage, including loss of use of property is caused. Required Insurance. The HSP will put into effect and maintain, with insurers having a secure A.M. Best rating of B+ or greater, or the equivalent, all the necessary and appropriate insurance that a prudent person in the business of the HSP would maintain including, but not limited to, the following at its own expense. (1) Commercial General Liability Insurance. Commercial General Liability Insurance, for third party bodily injury, personal injury and property damage to an inclusive limit of not less than two million dollars per occurrence and not less than two million dollars products and completed operations aggregate. The policy will include the following clauses: A. The Indemnified Parties as additional insureds, B. Contractual Liability, C. Cross-Liability, D. Products and Completed Operations Liability, E. Employers Liability and Voluntary Compensation unless the HSP complies with the Section below entitled Proof of WSIA Coverage, F. Tenants Legal Liability (for premises/building leases only), of 406

267 (c) G. Non-Owned automobile coverage with blanket contractual coverage for hired automobiles, and H. A thirty-day written notice of cancellation, termination or material change. (2) Proof of WSIA Coverage. Unless the HSP put into effect and maintains Employers Liability and Voluntary Compensation as set out above, the HSP will provide the LHIN with a valid Workplace Safety and Insurance Act, 1997 (WSIA) Clearance Certificate and any renewal replacements, and will pay all amounts required to be paid to maintain a valid WSIA Clearance Certificate throughout the term of this Agreement. (3) All Risk Property Insurance on property of every description, for the term, providing coverage to a limit of not less than the full replacement cost, including earthquake and flood. All reasonable deductibles and self-insured retentions are the responsibility of the HSP. (4) Comprehensive Crime insurance, Disappearance, Destruction and Dishonest coverage. (5) Errors and Omissions Liability Insurance insuring liability for errors and omissions in the provision of any professional services as part of the Services or failure to perform any such professional services, in the amount of not less than two million dollars per claim and in the annual aggregate. Certificates of Insurance. The HSP will provide the LHIN with proof of the insurance required by this Agreement in the form of a valid certificate of insurance that references this Agreement and confirms the required coverage, on or before the commencement of this Agreement, and renewal replacements on or before the expiry of any such insurance. Upon the request of the LHIN, a copy of each insurance policy shall be made available to it. The HSP shall ensure that each of its subcontractors obtains all the necessary and appropriate insurance that a prudent person in the business of the subcontractor would maintain and that the Indemnified Parties are named as additional insureds with respect to any liability arising in the course of performance of the subcontractor's obligations under the subcontract. ARTICLE TERMINATION 12.1 Termination by the LHIN. (a) Immediate Termination. The LHIN may terminate this Agreement immediately upon giving Notice to the HSP if: (1) the HSP is unable to provide or has discontinued the Services in whole or in part or the HSP ceases to carry on business; (2) the HSP makes an assignment, proposal, compromise, or arrangement for the benefit of creditors, or is petitioned into bankruptcy, or files for the appointment of a receiver; (3) the LHIN is directed, pursuant to the Act, to terminate this Agreement by the Minister or the Director; of 406

268 (b) (c) (4) the Home has been closed in accordance with the Act; or (5) as provided for in section 4.6, the LHIN does not receive the necessary funding from the MOHLTC. Termination in the Event of Financial Difficulties. If the HSP makes an assignment, proposal, compromise, or arrangement for the benefit of creditors, or is petitioned into bankruptcy, or files for the appointment of a receiver the LHIN will consult with the Director before determining whether this Agreement will be terminated. If the LHIN terminates this Agreement because a person has exercised a security interest as contemplated by section 107 of the Act, the LHIN would expect to enter into a service accountability agreement with the person exercising the security interest or the receiver or other agent acting on behalf of that person where the person has obtained the Director's approval under section 110 of the Act and has met all other relevant requirements of Applicable Law. Opportunity to Remedy Material Breach. If an HSP breaches any material provision of this Agreement, including, but not limited to, the reporting requirements in Article 8 and the representations and warranties in Article 10 and the breach has not been satisfactorily resolved under Article 7, the LHIN will give the HSP Notice of the particulars of the breach and of the period of time within which the HSP is required to remedy the breach. The Notice will advise the HSP that the LHIN will terminate this Agreement: (1) at the end of the Notice period provided for in the Notice if the HSP fails to remedy the breach within the time specified in the Notice; or (2) prior to the end of the Notice period provided for in the Notice if it becomes apparent to the LHIN that the HSP cannot completely remedy the breach within that time or such further period of time as the LHIN considers reasonable, or the HSP is not proceeding to remedy the breach in a way that is satisfactory to the LHIN; and the LHIN may then terminate this Agreement in accordance with the Notice Termination of Services by the HSP. (a) (b) (c) Except as provided in 12.2(b) and (c) below, the HSP may terminate this Agreement at any time, for any reason, upon giving the LHIN at least six months Notice. Where the HSP intends to cease providing the Services and close the Home, the HSP will provide Notice to the LHIN at the same time the HSP is required to provide notice to the Director under the Act. The HSP will ensure that the closure plan required by the Act is acceptable to the LHIN. Where the HSP intends to cease providing the Services as a result of an intended sale or transfer of a License in whole or in part, the HSP will comply with section 6.3 of this Agreement. Notice under section 27 of LHSIA will not be effective unless accompanied by a transition plan that is acceptable to the LHIN, if such a transition plan is requested pursuant to section Consequences of Termination of 406

269 (a) (b) If this Agreement is terminated pursuant to this Article, the LHIN may: (1) cancel all further Funding instalments; (2) demand the repayment of any Funding remaining in the possession or under the control of the HSP; (3) determine the HSP s reasonable costs to wind down the Services; and (4) permit the HSP to offset the costs determined pursuant to section (3), against the amount owing pursuant to section (2). Despite (a), if the cost determined pursuant to section 12.3(a) (3) exceeds the Funding remaining in the possession or under the control of the HSP the LHIN will not provide additional monies to the HSP to wind down the Services Effective Date. Termination under this Article will take effect as set out in the Notice Corrective Action. Despite its right to terminate this Agreement pursuant to this Article, the LHIN may choose not to terminate this Agreement and may take whatever corrective action it considers necessary and appropriate, including suspending Funding for such period as the LHIN determines, to ensure the successful completion of the Services in accordance with the terms of this Agreement. ARTICLE NOTICE 13.1 Notice. A Notice will be in writing; delivered personally, by pre-paid courier, or sent by facsimile or with confirmation of receipt, or by any form of mail where evidence of receipt is provided by the post office. When a Notice is sent by , a confirmation of receipt shall include acknowledgment by the Notice recipient of an automated request for receipt, or a written reply from the Notice recipient acknowledging receipt. A Notice will be addressed to the other Party as provided below or as either Party will later designate to the other in writing: To the LHIN: Insert name of LHIN Insert address of LHIN Attention: [insert position] Fax: Telephone: To the HSP: insert name of HSP insert address of HSP Attention:[insert position] Fax: Telephone: 13.2 Notices Effective From. A Notice will be effective at the time the delivery is made if the Notice is delivered personally or by pre-paid courier. If delivered by mail, a Notice will be effective five business days after the day it was mailed. A Notice that is delivered by facsimile or by will be effective when its receipt is acknowledged as required by this Article. ARTICLE INTERPRETATION of 406

270 14.1 Interpretation. In the event of a conflict or inconsistency in any provision of this Agreement, the main body of this Agreement will prevail over the Schedules Jurisdiction. Where this Agreement requires compliance with the Act, the Director will determine compliance and advise the LHIN. Where the Act requires compliance with this Agreement, the LHIN will determine compliance and advise the Director Determinations by the Director. All determinations required by the Director under this Agreement are subject to an HSP s rights of review and appeal under the Act The Act. For greater clarity, nothing in this Agreement supplants or otherwise excuses the HSP from the fulfillment of any requirements of the Act. The HSP s obligations in respect of LHSIA and this Agreement are separate and distinct from the HSP s obligations under the Act. ARTICLE ADDITIONAL PROVISIONS 15.1 Currency. All payment to be made by the LHIN or the HSP under this Agreement shall be made in the lawful currency of Canada Invalidity or Unenforceability of Any Provision. The invalidity or unenforceability of any provision of this Agreement will not affect the validity or enforceability of any other provision of this Agreement and any invalid or unenforceable provision will be deemed to be severed Terms and Conditions on Any Consent. Any consent or approval that the LHIN may grant under this Agreement is subject to such terms and conditions as the LHIN may reasonably require Waiver. A Party may only rely on a waiver of the Party s failure to comply with any term of this Agreement if the other Party has provided a written and signed Notice of waiver. Any waiver must refer to a specific failure to comply and will not have the effect of waiving any subsequent failures to comply Parties Independent. The Parties are and will at all times remain independent of each other and are not and will not represent themselves to be the agent, joint venturer, partner or employee of the other. No representations will be made or acts taken by either Party which could establish or imply any apparent relationship of agency, joint venture, partnership or employment and neither Party will be bound in any manner whatsoever by any agreements, warranties or representations made by the other Party to any other person or entity, nor with respect to any other action of the other Party LHIN is an Agent of the Crown. The Parties acknowledge that the LHIN is an agent of the Crown and may only act as an agent of the Crown in accordance with the provisions of LHSIA. Notwithstanding anything else in this Agreement, any express or implied reference to the LHIN providing an indemnity or any other form of indebtedness or contingent liability that would directly or indirectly increase the indebtedness or contingent liabilities of the LHIN or of Ontario, whether at the time of execution of this Agreement or at any time during the term of this Agreement, will be void and of no legal effect of 406

271 15.7 Express Rights and Remedies Not Limited. The express rights and remedies of the LHIN are in addition to and will not limit any other rights and remedies available to the LHIN at law or in equity. For further certainty, the LHIN has not waived any provision of any applicable statute, including the Act, LHSIA and the CFMA, nor the right to exercise its right under these statutes at any time No Assignment. The HSP will not assign either this Agreement or the Funding in whole or in part, directly or indirectly, without the prior written consent of the LHIN which consent shall not be unreasonably withheld. No assignment or subcontract shall relieve the HSP from its obligations under this Agreement or impose any liability upon the LHIN to any assignee or subcontractor. The LHIN may assign this Agreement or any of its rights and obligations under this Agreement to any one or more of the LHINs or to the MOHLTC Governing Law. This Agreement and the rights, obligations and relations of the Parties hereto will be governed by and construed in accordance with the laws of the Province of Ontario and the federal laws of Canada applicable therein. Any litigation arising in connection with this Agreement will be conducted in Ontario unless the Parties agree in writing otherwise Survival. The provisions in Articles 1.0, 5.0, 8.0, 11.0, 13.0, 14.0 and 15.0 and sections 2.4, 4.6, 10.4, 10.5 and 12.3 will continue in full force and effect for a period of seven years from the date of expiry or termination of this Agreement Further Assurances. The Parties agree to do or cause to be done all acts or things necessary to implement and carry into effect this Agreement to its full extent Amendment of Agreement. This Agreement may only be amended by a written agreement duly executed by the Parties Counterparts. This Agreement may be executed in any number of counterparts, each of which will be deemed an original, but all of which together will constitute one and the same instrument. ARTICLE ENTIRE AGREEMENT 16.1 Entire Agreement. This Agreement together with the appended Schedules constitutes the entire Agreement between the Parties with respect to the subject matter contained in this Agreement and supersedes all prior oral or written representations and agreements. The Parties have executed this Agreement on the dates set out below. XXX LOCAL HEALTH INTEGRATION NETWORK By: of 406

272 [Name], Chair Date And by: [Name], CEO Date [Insert Full Legal Name of HSP] By: [Name], Chair Date I have authority to bind the HSP And by: [Name], [Title] Date I have authority to bind the HSP of 406

273 Schedule A: Description of Home and Beds A.1 General Information LTCH Legal Name / Licensee LTCH Common Name LTCH Facility ID Number LTCH Facility (master number for RAI MDS) Address City Geography served (catchment area) Accreditation organization Date of Last Accreditation Postal Code Year(s) Awarded A.2 Licensed or Approved Beds & Classification / Bed Type Bed Types Total # of Beds A B C D New Term of Licence Regular Long Stay Beds Convalescent Care Beds Respite Beds Comments/Additional Information Beds in Abeyance ELDCAP Beds Interim Beds Veterans Priority Access beds Other beds * Sub Total # all Bed Types Total # all Bed Types *Other beds available under a Temporary Emergency Licence or Short-Term Authorization of 406

274 Schedule A: Description of Home and Beds Cont d A.3 Structural Information Type of Room (this refers to structural layout rather than what is charged in accommodations) Number of rooms with 1 Number of rooms with Number of Floors bed 2 beds Number of rooms with 3 beds Number of rooms with 4 beds Total # Rooms Original Construction Date (Year) Renovations: Please list year and details (unit/resident home area, design standards, # beds, reason for renovating) 1) 2) 3) 4) Number of Units/Resident Home Areas and Beds Unit/Resident Home Area Number of Beds of 406

275 Schedule B Additional Terms and Conditions Applicable to the Funding Model 1.0 Background. The LHINs provide subsidy funding to long-term care home health service providers pursuant to a funding model set by MOHLTC. The current model provides estimated per diem funding that is subsequently reconciled. The current funding model is under review and may change during the Term (as defined below). As a result, and for ease of amendment during the Term, this Agreement incorporates certain terms and conditions that relate to the funding model in this Schedule B. 2.0 Additional Definitions. Any terms not otherwise defined in this Schedule have the same meaning attributed to them in the main body of this Agreement. The following terms have the following meanings: "Approved Funding" means the allowable subsidy for the Term determined by reconciling the Estimated Provincial Subsidy (as defined below) in accordance with Applicable Law and Applicable Policy Construction Funding Subsidy or CFS means the funding that the MOHLTC agreed to provide, or to ensure the provision of, to the HSP, in an agreement for the construction, development, redevelopment, retrofitting or upgrading of beds (a Development Agreement ). CFS Commitments means (a) commitments of the HSP related to a Development Agreement, identified in Schedule A of the service agreement in respect of the Home, in effect between the HSP and the LHIN on June 30, 2010, and (b) commitments of the HSP identified in a Development Agreement in respect of beds that were developed or redeveloped and opened for occupancy after June 30, 2010, (including, without limitation, any commitments set out in the HSP s Application as defined in the Development Agreement, and any conditions agreed to in the Development Agreement in respect of any permitted variances from standard design standards.) "Envelope" is a portion of the Estimated Provincial Subsidy that is designated for a specific use. There are four Envelopes in the Estimated Provincial Subsidy as follows: (a) the Nursing and Personal Care Envelope; (b) the Program and Support Services Envelope; (c) the Raw Food Envelope; and (d) the Other Accommodation Envelope. Estimated Provincial Subsidy means the estimated provincial subsidy calculated in accordance with Applicable Policy. Reconciliation Reports means the reports required by Applicable Policy including the Long-term Care Home Annual Report and, the In-Year Revenue/Occupancy Report. Term means the term of this Agreement. 3.0 Provision of Funding. 275 of 406

276 3.1 In each Funding Year, the LHIN shall advise the HSP of the amount of its Estimated Provincial Subsidy. The amount of the Estimated Provincial Subsidy shall be calculated on both a monthly basis and an annual basis and will be allocated among the Envelopes and other funding streams applicable to the HSP, including the CFS. 3.2 The Estimated Provincial Subsidy shall be provided to the HSP on a monthly basis in accordance with the monthly calculation described in 3.1 and otherwise in accordance with this Agreement. Payments will be made to the HSP on or about the twenty-second (22 nd ) day of each month of the Term. 3.3 CFS will be provided as part of the Estimated Provincial Subsidy and in accordance with the terms of the Development Agreement and Applicable Policy. This obligation survives any termination of this Agreement. 4.0 Use of Funding. 4.1 Unless otherwise provided in this Schedule B, the HSP shall use All Funding allocated for a particular Envelope only for the use or uses set out in the Applicable Policy. 4.2 The HSP shall not transfer any portion of the Estimated Provincial Subsidy in the Raw Food Envelope to any other Envelope: 4.3 The HSP may transfer all or any of the part of the Estimated Provincial Subsidy for the Other Accommodation Envelope to any other Envelope without the prior written approval of the LHIN, provided that the HSP has complied with the standards and criteria for the Other Accommodation Envelope as set out in Applicable Policy. 4.4 The HSP may transfer any part of the Estimated Provincial Subsidy in the (a) Nursing and Personal Care Envelope; or (b) the Program and Support Services Envelope; to any Envelope other than the Other Accommodation Envelope without the prior written approval of the LHIN provided that the transfer is done in accordance with Applicable Policy. 4.5 In the event that a financial reduction is determined by the LHIN, the financial reduction will be applied against the portion of the Estimated Provincial Subsidy in the Other Accommodation Envelope. 5.0 Construction Funding Subsidies. 5.1 Subject to 5.2 and 5.3 the HSP is required to continue to fulfill all CFS Commitments, and the CFS Commitments are hereby incorporated into and deemed part of the Agreement. 5.2 The HSP is not required to continue to fulfill CFS Commitments that the MOHLTC has agreed in writing: (i) have been satisfactorily fulfilled; or (ii) are no longer required to be fulfilled; and the HSP is able to provide the LHIN with a copy of such written agreement. 5.3 Where this Agreement establishes or requires a service requirement that surpasses 276 of 406

277 the service commitment set out in the CFS Commitments, the HSP is required to comply with the service requirements in this Agreement. 5.4 MOHLTC is responsible for monitoring the HSP s on-going compliance with the CFS Commitments. Notwithstanding the foregoing, the HSP agrees to certify its compliance with the CFS Commitments when requested to do so by the LHIN. 6.0 Reconciliation. 6.1 The HSP shall complete the Reconciliation Reports and submit them to MOHLTC in accordance with Schedule C. The Reconciliation Reports shall be in such form and containing such information as required by Applicable Policy or as otherwise required by the LHIN pursuant this Agreement. 6.2 The Estimated Provincial Subsidy provided by the LHIN under section 3.0 of this Schedule shall be reconciled by the LHIN in accordance with Applicable Law and Applicable Policy to produce the Approved Funding. 6.3 In accordance with the Applicable Law and Applicable Policy, if the Estimated Provincial Subsidy paid to the HSP exceeds the Approved Funding for any period, the excess is a debt due and owing by the HSP to the Crown in right of Ontario which shall be paid by the HSP to the Crown in right of Ontario and, in addition to any other methods available to recover the debt, the LHIN may deduct the amount of the debt from any subsequent amounts to be provided by the LHIN to the HSP. If the Estimated Provincial Subsidy paid for any period is less than the Approved Funding, the LHIN shall provide the difference to the HSP. 277 of 406

278 Schedule C Reporting Requirements 1. In-Year Revenue/Occupancy Report Reporting Period Estimated Due Dates Jan to Sept By October 15, Jan to Sept By October 15, Jan to Sept By October 15, Long-Term Care Home Annual Report Reporting Period Estimated Due Dates Jan to Dec By September 30, Jan to Dec By September 30, Jan to Dec By September 30, French Language Services Report Fiscal Year Due Dates Apr to March April 28, Apr to March April 30, Apr to March April 30, OHRS/MIS Trial Balance Submission Due Dates (Must pass 3c Edits) Q2 Apr to Sept (Fiscal Year) October 31, 2016 Q2 Jan to Jun (Calendar Year) Q3 Apr to Dec (Fiscal Year) January 31, 2017 Optional Submission Q3 Jan to Sept (Calendar Year) Q4 Apr to March (Fiscal Year) May 31, 2017 Q4 Jan to Dec (Calendar Year) Due Dates (Must pass 3c Edits) Q2 Apr to Sept (Fiscal Year) October 31, 2017 Q2 Jan to June (Calendar Year) Q3 Apr to Dec (Fiscal Year) January 31, 2018 Optional Submission Q3 Jan to Sept (Calendar Year) Q4 Apr to March (Fiscal Year) May 31, 2018 Q4 Jan to Dec (Calendar Year) Due Dates (Must pass 3c Edits) Q2 Apr to Sept (Fiscal Year) October 31, 2018 Q2 Jan to June (Calendar Year) Q3 Apr to Dec (Fiscal Year) January 31, 2019 Optional Submission Q3 Jan to Sep (Calendar Year) Q4 Apr to March (Fiscal Year) May 31, 2019 Q4 Jan to Dec (Calendar Year) 5. Compliance Declaration Funding Year Due Dates January 1, 2016 December 31, 2016 March 1, 2017 January 1, 2017 December 31, 2017 March 1, 2018 January 1, 2018 December 31, 2018 March 1, These are estimated dates provided by the MOHLTC and are subject to change. If the due date falls on a weekend, reporting will be due the following business day of 406

279 Schedule C Reporting Requirements Cont d 6. Continuing Care Reporting System (CCRS)/RAI MDS Reporting Period Estimated Final Due Dates Q1 August 31, Q2 November 30, Q3 February 28, Q4 May 31, Q1 August 31, Q2 November 30, Q3 February 28, Q4 May 31, Q1 August 31, Q2 November 30, Q3 February 28, Q4 May 31, Staffing Report Reporting Period Estimated Due Dates 1 January 1, 2016 December 31, 2016 July 7, 2017 January 1, 2017 December 31, 2017 July 6, 2018 January 1, 2018 December 31, 2018 July 5, Quality Improvement Plan (submitted to Health Quality Ontario (HQO) with a copy sent to the LHIN) Planning Period Due Dates April 1, 2016 March 31, 2017 April 1, 2016 April 1, 2017 March 31, 2018 April 1, 2017 April 1, 2018 March 31, 2019 April 1, of 406

280 Schedule D Performance 1.0 Performance Indicators The HSP s delivery of the Services will be measured by the following Indicators, Targets and where applicable Performance Standards. In the following table: n/a means not-applicable, that there is no defined Performance Standard for the indicator for the applicable year. tbd means a Target, and a Performance Standard, if applicable, will be determined during the applicable year. INDICATOR CATEGORY INDICATOR P=Performance Indicator E=Explanatory Indicator 2016/17 Performance Target Standard Organizational Health and Financial Indicators Coordination and Access Indicators Debt Service Coverage Ratio (P) 1 1 Total Margin (P) 0 0 Average Long-Stay Occupancy / Average Long-Stay Utilization (E) n/a n/a Wait Time from CCAC Determination of Eligibility to LTC Home Response (E) n/a n/a Long-Term Care Home Refusal Rate (E) n/a n/a Quality and Resident Safety Indicators Percentage of Residents Who Fell in the Last 30 days (E) n/a n/a Percentage of Residents Whose Pressure Ulcer Worsened (E) n/a n/a Percentage of Residents on Antipsychotics Without a Diagnosis of Psychosis (E) n/a n/a Percentage of Residents in Daily Physical Restraints (E) n/a n/a 2.0 LHIN-Specific Performance Obligations 280 of 406

281 Schedule E Form of Compliance Declaration DECLARATION OF COMPLIANCE Issued pursuant to the Long Term Care Service Accountability Agreement To: From: For: Date: Re: The Board of Directors of the [insert name of LHIN] Local Health Integration Network (the LHIN ). Attn: Board Chair. The Board of Directors (the Board ) of the [insert name of License Holder] (the HSP ) [insert name of Home] (the Home ) [insert date] [January 1, 201X December 31, 201x] (the Applicable Period ) The Board has authorized me, by resolution dated [insert date], to declare to you as follows: After making inquiries of the [insert name and position of person responsible for managing the Home on a day to day basis, e.g. the Chief Executive Office or the Executive Director] and other appropriate officers of the HSP and subject to any exceptions identified on Appendix 1 to this Declaration of Compliance, to the best of the Board s knowledge and belief, the HSP has fulfilled, its obligations under the long-term care service accountability agreement (the Agreement ) in effect during the Applicable Period. Without limiting the generality of the foregoing, the HSP confirms that (i) (ii) it has complied with the provisions of the Local Health System Integration Act, 2006 and with any compensation restraint legislation which applies to the HSP; and every Report submitted by the HSP is accurate in all respects and in full compliance with the terms of the Agreement; Unless otherwise defined in this declaration, capitalized terms have the same meaning as set out in the Agreement between the LHIN and the HSP effective April 1, [insert name of individual authorized by the Board to make the Declaration on the Board s behalf], [insert title] of 406

282 Schedule E Form of Compliance Declaration Cont d. Appendix 1 - Exceptions [Please identify each obligation under the LSAA that the HSP did not meet during the Applicable Period, together with an explanation as to why the obligation was not met and an estimated date by which the HSP expects to be in compliance.] of 406

283 TEMPLATE LONG-TERM CARE HOME SERVICE ACCOUNTABILITY AGREEMENT MULTI HOMES April 1, 2016 to March 31, 2019 SERVICE ACCOUNTABILITY AGREEMENT with [Legal Name of the Health Service Provider] Effective Date: April 1, 2016 Index to Agreement ARTICLE DEFINITIONS & INTERPRETATION... 2 ARTICLE TERM AND NATURE OF THIS AGREEMENT... 7 ARTICLE PROVISION OF SERVICES ARTICLE FUNDING ARTICLE ADJUSTMENT AND RECOVERY OF FUNDING ARTICLE PLANNING & INTEGRATION ARTICLE PERFORMANCE ARTICLE REPORTING, ACCOUNTING AND REVIEW ARTICLE ACKNOWLEDGEMENT OF LHIN SUPPORT ARTICLE REPRESENTATIONS, WARRANTIES AND COVENANTS ARTICLE LIMITATION OF LIABILITY, INDEMNITY & INSURANCE ARTICLE TERMINATION ARTICLE NOTICE ARTICLE INTERPRETATION ARTICLE ADDITIONAL PROVISIONS ARTICLE ENTIRE AGREEMENT Schedules A - Description of Home and Beds B - Additional Terms and Conditions Applicable to the Funding Model C - Reporting Requirements D - Performance E - Form of Compliance Declaration 283 of 406

284 THIS SERVICE ACCOUNTABILITY AGREEMENT effective as of April 1, 2016 B E T W E E N : AND [insert name] LOCAL HEALTH INTEGRATION NETWORK (the LHIN ) [Legal Name(s) of the organization(s) holding the licence to operate the Home (if in doubt, check the licence issued by the MOHLTC)] (the HSP ) IN RESPECT OF SERVICES PROVIDED AT: [insert legal name of long term care home] located at [insert address] (the Home ) and [insert legal name of long term care home]located at [insert address] and [insert legal name of long term care home]located at [insert address] (individually referred to as a Home, one or more referred to as the Homes ) Background: The Local Health System Integration Act, 2006 requires that the LHIN and the HSP enter into a service accountability agreement. The service accountability agreement supports a collaborative relationship between the LHIN and the HSP: to improve the health of Ontarians through better access to high quality health services; to co-ordinate health care in local health systems, by such actions as supporting the implementation of Health Links to facilitate regional integrated health care service delivery; to manage the health care system at the local level effectively and efficiently; and, to create a health care system that is person-centered, accountable, transparent, and evidence-based. In this context, the HSP and the LHIN agree that the LHIN will provide funding to the HSP on the terms and conditions set out in this Agreement to enable the provision of services to the local health system by the HSP. In consideration of their respective agreements set out below, the LHIN and the HSP covenant and agree as follows. ARTICLE DEFINITIONS & INTERPRETATION 1.1 Definitions. In this Agreement the following terms will have the following meanings of 406

285 Act means the Long-Term Care Homes Act, 2007 and the regulations made under the Long Term Care Homes Act, 2007 as it and they may be amended from time to time. Accountability Agreement refers to this the Agreement in place between the Minister and the LHIN pursuant to the terms of section 18 of LHSIA. Agreement means this agreement and includes the Schedules and any instrument amending this agreement or the Schedules. Annual Balanced Budget means that, in each calendar year of the term of this Agreement, the total expenses of the HSP in respect of the Services at a Home are less than or equal to the total revenue of the HSP in respect of the Services at the same Home. Applicable Law means all federal, provincial or municipal laws, orders, rules, regulations, common law, licence terms or by-laws, and includes terms or conditions of a licence or approval issued under the Act, that are applicable to the HSP, the Services, this Agreement and the Parties obligations under this Agreement during the term of this Agreement. Applicable Policy means any orders, rules, policies, directives or standards of practice issued or adopted by the LHIN, by the MOHLTC or by other ministries or agencies of the province of Ontario that are applicable to the HSP, the Services, this Agreement and the Parties obligations under this Agreement during the term of this Agreement. Without limiting the generality of the foregoing, Applicable Policy includes the Design Manual and the Long Term Care Funding and Financial Management Policies and all other manuals, guidelines, policies and other documents listed on the Policy Web Pages as those manuals, guidelines, policies and other documents may be amended from time to time. Approved Funding has the meaning ascribed to it in Schedule B. Beds means the long term care home beds that are licensed or approved under the Act for each Home and identified in Schedule A, as the same may be amended from time to time. Board means in respect of an HSP that is: (a) (b) (c) (d) (e) (f) a corporation, the board of directors; A First Nation, the band council; a municipality, the committee of management; a board of management established by one or more municipalities or by one or more First Nations band councils, the members of the board of management; a partnership, the partners; and a sole proprietorship, the sole proprietor. BPSAA means the Broader Public Sector Accountability Act, 2010, and the regulations made under the Broader Public Sector Accountability Act, 2010 as it and they may be amended from time to time. CEO means the individual accountable to the Board for the provision of the Services at of 406

286 each Home in accordance with the terms of this Agreement, which individual may be the executive director or administrator of the HSP, or may hold some other position or title within the HSP. CFMA means the Commitment to the Future of Medicare Act, 2004, and the regulations made under the Commitment to the Future of Medicare Act, 2004, as it and they may be amended from time to time. Compliance Declaration means a compliance declaration substantially in the form set out in Schedule E. Confidential Information means information that is (i) marked or otherwise identified as confidential by the disclosing Party at the time the information is provided to the receiving Party; and (ii) eligible for exclusion from disclosure at a public board meeting in accordance with section 9 of LHSIA. Confidential Information does not include information that (a) was known to the receiving Party prior to receiving the information from the disclosing Party; (b) has become publicly known through no wrongful act of the receiving Party; or (c) is required to be disclosed by law, provided that the receiving Party provides Notice in a timely manner of such requirement to the disclosing Party, consults with the disclosing Party on the proposed form and nature of the disclosure, and ensures that any disclosure is made in strict accordance with Applicable Law. Conflict of Interest in respect of an HSP, includes any situation or circumstance where: in relation to the performance of its obligations under this Agreement (a) (b) (c) the HSP; a member of the HSP s Board; or any person employed by the HSP who has the capacity to influence the HSP s decision, has other commitments, relationships or financial interests that: (a) (b) could or could be seen to interfere with the HSP s objective, unbiased and impartial exercise of its judgement; or could or could be seen to compromise, impair or be incompatible with the effective performance of its obligations under this Agreement. Construction Funding Subsidy has the meaning ascribed to it in Schedule B. controlling shareholder of a corporation means a shareholder who or which holds (or another person who or which holds for the benefit of such shareholder), other than by way of security only, voting securities of such corporation carrying more than 50% of the votes for the election of directors, provided that the votes carried by such securities are sufficient, if exercised, to elect a majority of the board of directors of such corporation. Days means calendar days. Design Manual means the MOHLTC design manual or manuals in effect and applicable to the development, upgrade, retrofit, renovation or redevelopment of the a Home or Beds subject to this Agreement of 406

287 Director has the same meaning as the term Director in the Act. Effective Date means April 1, e-health means the coordinated and integrated use of electronic systems, information and communication technologies to facilitate the collection, exchange and management of personal health information in order to improve the quality, access, productivity and sustainability of the healthcare system. Explanatory Indicator means a measure of HSP performance for which no Performance Target is set. Technical specifications of specific Explanatory Indicators can be found in the L-SAA Indicator Technical Specifications document. FIPPA means the Freedom of Information and Protection of Privacy Act, (Ontario) and the regulations made under the Freedom of Information and Protection of Privacy Act, (Ontario), as it and they may be amended from time to time. Funding means the amounts of money provided by the LHIN to the HSP in each Funding Year of this Agreement for a Home. Funding includes Approved Funding and Construction Funding Subsidy. Funding Year means in the case of the first Funding Year, the period commencing on the January 1 prior to the Effective Date and ending on the following December 31, and in the case of Funding Years subsequent to the first Funding Year, the period commencing on the date that is January 1 following the end of the previous Funding Year and ending on the following December 31. Home means the each building identified above where the Beds are located and for greater certainty, Home includes the Beds and the common areas and common elements which will be used at least in part, for the Beds, but excludes any other part of the building which will not be used for the Beds being operated pursuant to this Agreement. HSP s Personnel and Volunteers means the controlling shareholders (if any), directors, officers, employees, agents, volunteers and other representatives of the HSP. In addition to the foregoing HSP s Personnel and Volunteers shall include the contractors and subcontractors and their respective shareholders, directors, officers, employees, agents, volunteers or other representatives. Indemnified Parties means the LHIN and its officers, employees, directors, independent contractors, subcontractors, agents, successors and assigns and her Majesty the Queen in Right of Ontario and her Ministers, appointees and employees, independent contractors, subcontractors, agents and assigns. Indemnified Parties also includes any person participating on behalf of the LHIN in a Review. Interest Income means interest earned on the Funding. Licence means one or more of the licences or the approvals granted to the HSP in respect of the Beds at the each Home under Part VII or Part VIII of the Act. LHSIA means the Local Health System Integration Act, 2006 and the regulations of 406

288 under the Local Health System Integration Act, 2006 as it and they may be amended from time to time. Minister means the Minister of Health and Long-Term Care. MOHLTC means the Minister or the Ministry of Health and Long-Term Care, as is appropriate in the context. Notice means any notice or other communication required to be provided pursuant to this Agreement, LHSIA, the Act or the CFMA. Party means either of the LHIN or the HSP and Parties mean both of the LHIN and the HSP. Performance Agreement means an agreement between an HSP and its CEO that requires the CEO to perform in a manner that enables the HSP to achieve the terms of this Agreement. Performance Corridor means the acceptable range of results around a Performance Target. Performance Factor means any matter that could or will significantly affect a Party s ability to fulfill its obligations under this Agreement, and for certainty, includes any such matter that may be brought to the attention of the LHIN, whether by PICB or otherwise. Performance Indicator means a measure of HSP performance for which a Performance Target is set; Technical specifications of specific Performance Indicators can be found in the L-SAA Indicator Technical Specifications document. Performance Standard means the acceptable range of performance for a Performance Indicator or a Service Volume that results when a Performance Corridor is applied to a Performance Target. Performance Target means the level of performance expected of the HSP in respect of a Performance Indicator or a Service Volume. PICB means Performance Improvement and Compliance Branch of MOHLTC, or any other Branch or organizational unit of MOHLTC that may succeed or replace it. Planning Submission means the planning document submitted by the HSP to the LHIN. The form, content and scheduling of the Planning Submission will be identified by the LHIN. Policy Web Pages means the web pages available at and at or such other URLs or Web pages as the LHIN or the Ministry may advise from time to time. Capital policies can be found at RAI MDS Tools means the standardized Resident Assessment Instrument Minimum Data Set ( RAI MDS ) 2.0, the RAI MDS 2.0 User Manual and the RAI MDS Practice Requirements, as the same may be amended from time to time of 406

289 Reports means the reports described in Schedule C as well as any other reports or information required to be provided under LHSIA, the Act or this Agreement, in respect of a Home. Resident has the meaning ascribed to the term resident under the Act. Review means a financial or operational audit, investigation, inspection or other form of review requested or required by the LHIN under the terms of LHSIA or this Agreement, in respect of the HSP or of one or more Homes, but does not include the annual audit of the HSP s financial statements. Schedule means any one of, and Schedules mean any two or more, as the context requires, of the schedules appended to this Agreement and includes: Schedule A. Schedule B. Schedule C. Schedule D. Schedule E. Description of Homes and Beds; Additional Terms and Conditions Applicable to the Funding Model; Reporting Requirements; Performance; and Form of Compliance Declaration. Services means, in respect of each Home, the operation of the Beds and the Home and the accommodation, care, programs, goods and other services that are provided to residents Residents of the Home (i) to meet the requirements of the Act; (ii) to obtain Approved Funding; and (iii) to fulfill all commitments made to obtain a Construction Funding Subsidy. Service Volume means a measure of Services for which a Performance Target is set. 1.2 Interpretation. (a) (b) Words in the singular include the plural and vice-versa. Words in one gender include all genders. The headings do not form part of this Agreement. They are for convenience of reference only and will not affect the interpretation of this Agreement. Terms used in the Schedules shall have the meanings set out in this Agreement unless separately and specifically defined in a Schedule in which case the definition in the Schedule shall govern for the purposes of that Schedule. Notwithstanding anything else in this Agreement, the Parties agree that this Agreement and each Party s obligations under this Agreement, are to be interpreted in respect of each Home as if the Parties had entered into individual agreements for that Home. The inclusion of multiple Homes in this Agreement is for administrative convenience only. Unless otherwise provided, the rights, obligations and remedies of each Party are to be considered the rights, obligations and remedies of that Party in respect of Services provided by the HSP at an individual Home only and not at all of the Homes. ARTICLE TERM AND NATURE OF THIS AGREEMENT of 406

290 2.1 Term. The term of this Agreement will commence on the Effective Date and will expire on the earlier of (1) March 31, or (2) the expiration or termination of all Licences, unless this Agreement is terminated earlier or extended pursuant to its terms. 2.2 A Service Accountability Agreement. This Agreement is a service accountability agreement for the purposes of section 20(1) of LHSIA and Part III of the CFMA. 2.3 Notice. Notice was given to the HSP that the LHIN intended to enter into this Agreement. The HSP hereby acknowledges receipt of such Notice in accordance with the terms of the CFMA. 2.4 Prior Agreements. The Parties acknowledge and agree that all prior agreements for the Services at each Home are terminated. ARTICLE PROVISION OF SERVICES 3.1 Provision of Services. (a) (b) (c) The HSP will provide the Services at each Home in accordance with, and otherwise comply with: (1) the terms of this Agreement; (2) Applicable Law; and (3) Applicable Policy. Unless otherwise provided in this Agreement, the HSP will not reduce, stop, start, expand, cease to provide or transfer the provision of the Services at any Home except with Notice to the LHIN and if required by Applicable Law or Applicable Policy, the prior written consent of the LHIN. The HSP will not restrict or refuse the provision of Services at any Home to an individual, directly or indirectly, based on the geographic area in which the person resides in Ontario. 3.2 Subcontracting for the Provision of Services. (a) (b) (c) The Parties acknowledge that, subject to the provisions of the Act and LHSIA, the HSP may subcontract the provision of some or all of the Services. For the purposes of this Agreement, actions taken or not taken by the subcontractor and Services provided by the subcontractor will be deemed actions taken or not taken by the HSP and Services provided by the HSP. When entering into a subcontract the HSP agrees that the terms of the subcontract will enable the HSP to meet its obligations under this Agreement. Without limiting the foregoing, the HSP will include a provision that permits the LHIN or its authorized representatives, to audit the subcontractor in respect of the subcontract if the LHIN or its authorized representatives determines that such an audit would be necessary to confirm that the HSP has complied with the terms of this Agreement. Nothing contained in this Agreement or a subcontract will create a contractual relationship between any subcontractor or its directors, officers, employees, agents, partners, affiliates or volunteers and the LHIN of 406

291 3.3 Conflict of Interest. The HSP will use the Funding, provide the Services and otherwise fulfil its obligations under this Agreement without an actual, potential or perceived Conflict of Interest. The HSP will disclose to the LHIN without delay any situation that a reasonable person would interpret as an actual, potential or perceived Conflict of Interest and comply with any requirements prescribed by the LHIN to resolve any Conflict of Interest. 3.4 e-health/information Technology Compliance. The HSP agrees to: (a) (b) (c) (d) (e) assist the LHIN to implement provincial e-health priorities for and thereafter in accordance with the Accountability Agreement, as may be amended from time to time; comply with any technical and information management standards, including those related to data, architecture, technology, privacy and security set for health service providers by the MOHLTC, ehealth Ontario or the LHIN within the timeframes set by the MOHLTC or the LHIN as the case may be; implement and use the approved provincial e-health solutions identified in the LHIN e-health plan; implement technology solutions that are compatible or interoperable with the provincial blueprint and with the LHIN e-health plan; and include in its annual planning submission, plans for achieving ehealth priority initiatives. ARTICLE FUNDING 4.1 Funding. Subject to the terms of this Agreement, and in accordance with the applicable provisions of the Accountability Agreement, the LHIN will provide the Funding in respect of each Home by depositing the Funding in monthly instalments over the Term, into an account designated by the HSP provided that the account resides at a Canadian financial institution and is in the name of the HSP. 4.2 Conditions of Funding. (a) (b) The HSP will: (1) use the Funding only for the purpose of providing the Services at the Home for which the Funding was provided in accordance with Applicable Law, Applicable Policy and the terms of this Agreement; (2) not use the Funding for compensation increases prohibited by Applicable Law; (3) meet all obligations in the Schedules; (4) fulfill all other obligations under this Agreement; and (5) plan for and achieve an Annual Balanced Budget. Interest Income will be reported to the LHIN and is subject to a year-end reconciliation. The LHIN may deduct the amount equal to the Interest Income from any further funding instalments under this or any other agreement with the of 406

292 HSP or the LHIN may require the HSP to pay an amount equal to the unused Interest Income to the Ministry of Finance. 4.3 Limitation on Payment of Funding. Despite section 4.1, the LHIN: (a) (b) (c) (d) (e) will not provide any funds to the HSP until this Agreement is fully executed; may pro-rate the Funding if this Agreement is signed after the Effective Date; will not provide any funds to the HSP until the HSP meets the insurance requirements described in section 11.4 in respect of each Home; will not be required to continue to provide funds in respect of a Home, (1) if the Minister or the Director so directs under the terms of the Act; (2) while the Home is under the control of an Interim Manager pursuant to section 157 of the Act; or (3) in the event the HSP breaches any of its obligations under this Agreement until the breach is remedied to the LHIN s satisfaction; and upon notice to the HSP, may adjust the amount of funds it provides to the HSP in any Funding Year in respect of a Home pursuant to Article Additional Funding. Unless the LHIN has agreed to do so in writing, the LHIN is not required to provide additional funds to the HSP for providing services other than the Services or for exceeding the requirements of Schedule D. 4.5 Additional Terms and Conditions. The LHIN may add such further terms or conditions on the use of the Funding as are required for the LHIN to meet its obligations under the Accountability Agreement, Applicable Law or Applicable Policy as the same may be amended during the Term. 4.6 Appropriation. Funding under this Agreement is conditional upon an appropriation of moneys by the Legislature of Ontario to the MOHLTC and funding of the LHIN by the MOHLTC pursuant to LHSIA. If the LHIN does not receive its anticipated funding the LHIN will not be obligated to make the payments required by this Agreement. 4.7 Procurement of Goods and Services. (a) (b) If the HSP is subject to the procurement provisions of the BPSAA, the HSP will abide by all directives and guidelines issued by the Management Board of Cabinet that are applicable to the HSP pursuant to the BPSAA. If the HSP is not subject to the procurement provisions of the BPSAA, the HSP will have a procurement policy in place that requires the acquisition of supplies, equipment or services valued at over $25,000 through a competitive process that ensures the best value for funds expended. If the HSP acquires supplies, equipment or services with the Funding it will do so through a process that is consistent with this policy. 4.8 Disposition. The HSP will not sell, lease or otherwise dispose of any assets purchased with Funding, except as may be required by Applicable Law or otherwise in accordance with Applicable Policy of 406

293 ARTICLE ADJUSTMENT AND RECOVERY OF FUNDING 5.1 Adjustment of Funding. (a) The LHIN may adjust the Funding in any of the following circumstances: (1) in the event of changes to Applicable Law or Applicable Policy that affect Funding; (2) on a change to the Services; (3) if required by either the Director or the Minister under the Act; (4) in the event that a breach of this Agreement is not remedied to the satisfaction of the LHIN; and (5) as otherwise permitted by this Agreement. (b) (c) Funding recoveries or adjustments required pursuant to 5.1(a) may be accomplished through the adjustment of Funding, requiring the repayment of Funding and/or through the adjustment of the amount of any future funding installments. Approved Funding already expended properly in accordance with this Agreement will not be subject to adjustment. The LHIN will, at its sole discretion, and without liability or penalty, determine whether the Funding has been expended properly in accordance with this Agreement. In determining the amount of a funding adjustment under 5.1 (a) (4) or (5), LHIN shall take into account the following principles: (1) resident Resident care must not be compromised through a funding adjustment arising from a breach of this Agreement; (2) the HSP should not gain from a breach of this Agreement; (3) if the breach reduces the value of the Services, the funding adjustment should be at least equal to the reduction in value; and (4) the funding adjustment should be sufficient to encourage subsequent compliance with this Agreement, and such other principles as may be articulated in Applicable Law or Applicable Policy from time to time. 5.2 Provision for the Recovery of Funding. The HSP will make reasonable and prudent provision for the recovery by the LHIN of any Funding for which the conditions of Funding set out in section 4.2(a) are not met and will hold this Funding in an interest bearing account until such time as reconciliation and settlement has occurred with the LHIN. 5.3 Settlement and Recovery of Funding for Prior Years. (a) (b) The HSP acknowledges that settlement and recovery of Funding for Services at a Home can occur up to seven years after the provision of Funding. Recognizing the transition of responsibilities from the MOHLTC to the LHIN, the HSP agrees that if the Parties are directed in writing to do so by the MOHLTC, the LHIN will settle and recover funding provided by the MOHLTC to the HSP prior to the transition of the funding for the Services to the LHIN, provided that of 406

294 5.4 Debt Due. such settlement and recovery occurs within seven years of the provision of the funding by the MOHLTC. All such settlements and recoveries will be subject to the terms applicable to the original provision of funding. (a) (b) If the LHIN requires the re-payment by the HSP of any Funding, the amount required will be deemed to be a debt owing to the Crown by the HSP. The LHIN may adjust future funding instalments to recover the amounts owed or may, at its discretion, direct the HSP to pay the amount owing to the Crown and the HSP shall comply immediately with any such direction. All amounts repayable to the Crown will be paid by cheque payable to the Ontario Minister of Finance and mailed or delivered to the LHIN at the address provided in section Interest Rate. The LHIN may charge the HSP interest on any amount owing by the HSP at the then current interest rate charged by the Province of Ontario on accounts receivable. ARTICLE PLANNING & INTEGRATION 6.1 Planning for Future Years. (a) (b) (c) (d) Advance Notice. The LHIN will give at least sixty Days Notice to the HSP of the date by which a Planning Submission, approved by the HSP s governing body, must be submitted to the LHIN. Unless otherwise advised by the LHIN, the HSP will provide a Planning Submission for each Home. Multi-Year Planning. The Planning Submission will be in a form acceptable to the LHIN and may be required to incorporate (1) prudent multi-year financial forecasts; (2) plans for the achievement of Performance Targets; and (3) realistic risk management strategies. It will be aligned with the LHIN s then current Integrated Health Service Plan and will reflect local LHIN priorities and initiatives. If the LHIN has provided multi-year planning targets for the HSP, the Planning Submission will reflect the planning targets. Multi-year Planning Targets. Parties acknowledge that the HSP is not eligible to receive multi-year planning targets under the terms of Schedule B in effect as of the Effective Date. In the event that Schedule B is amended over the Term and the LHIN is able to provide the HSP with multi-year planning targets, (the HSP acknowledges that these targets are: (1) targets only, (2) provided solely for the purposes of planning, (3) are subject to confirmation and (4) may be changed at the discretion of the LHIN. The HSP will proactively manage the risks associated with multi-year planning and the potential changes to the planning targets. The LHIN agrees that it will communicate any material changes to the planning targets as soon as reasonably possible. Service Accountability Agreements. Subject to advice from the Director about the HSP s history of compliance under the Act and provided that the HSP has fulfilled its obligations under this Agreement, the Parties expect that they will enter into a new service accountability agreement at the end of the Term. The of 406

295 LHIN will give the HSP at least six months Notice if the LHIN does not intend to enter into negotiations for a subsequent service accountability agreement because the HSP has not fulfilled its obligations under this Agreement. The HSP acknowledges that if the LHIN and the HSP enter into negotiations for a subsequent service accountability agreement, subsequent funding may be interrupted if the next service accountability agreement is not executed on or before the expiration date of this Agreement. 6.2 Community Engagement & Integration Activities (a) (b) (c) Community Engagement. The HSP will engage the community of diverse persons and entities in the each area where it provides health services when setting priorities for the delivery of health services in that area and when developing plans for submission to the LHIN including but not limited to the HSP s Planning Submissions and integration proposals. Integration. The HSP will, separately and in conjunction with the LHIN and other health service providers, identify opportunities to integrate the services of the local health system to provide appropriate, co-coordinated, effective and efficient services. Reporting. The HSP will report on its community engagement and integration activities as requested by the LHIN and in any event, in its Q4 Performance Report to the LHIN. 6.3 Planning and Integration Activity Pre-proposals. (a) (b) (c) General: A pre-proposal process has been developed to (1) reduce the costs incurred by an HSP when proposing operational or service changes at a Home; (2) assist the HSP to carry out its statutory obligations; and (3) enable an effective and efficient response by the LHIN. Subject to specific direction from the LHIN, this pre-proposal process will be used in the following instances: (1) the HSP is considering an integration, or an integration of services, as defined in LHSIA between the HSP and another person or entity; (2) the HSP is proposing to reduce, stop, start, expand or transfer the location of Services; (3) to identify opportunities to integrate the services of the local health system, other than those identified in (A) or (B) above; or (4) if requested by the LHIN. LHIN Evaluation of the Pre-proposal: Use of the pre-proposal process is not formal Notice of a proposed integration under section. 27 of LHSIA. LHIN consent to develop the project concept outlined in a pre-proposal does not constitute approval to proceed with the project. Nor does the LHIN consent to develop a project concept presume the issuance of a favourable decision, should such a decision be required by section 25 or 27 of LHSIA. Following the LHIN s review and evaluation, the HSP may be invited to submit a detailed proposal and a business plan for further analysis. Guidelines for the development of a detailed proposal and business case will be provided by the LHIN. Where an HSP integrates its services with those of another person and the integration relates to services funded in whole or in part by the LHIN, the HSP will follow the provisions of section 27 of LHSIA. Without limiting the foregoing, a of 406

296 transfer of services from the HSP to another person or entity is an example of an integration to which section 27 may apply. 6.4 Proposing Integration Activities in the Planning Submission. No integration activity described in section 6.3 may be proposed in a Planning Submission unless the LHIN has consented, in writing, to its inclusion pursuant to the process set out in section Termination of Designation of Convalescent Care Beds. (a) (b) Notwithstanding section 6.3, the provisions in this section 6.5 apply to the termination of a designation of convalescent care Beds. The HSP may terminate the designation of one or more convalescent care Beds at a Home and revert them back to long-stay Beds at any time provided the HSP gives the Ministry and the LHIN at least six months prior written Notice. Such Notice shall include: (1) a detailed transition plan, satisfactory to the LHIN acting reasonably, setting out the dates, after the end of the six month Notice period, on which the HSP plans to terminate the designation of each convalescent care Bed and to revert same to a long-stay Bed; and, (2) a detailed explanation of the factors considered in the selection of those dates. The designation of a convalescent care Bed will terminate and the Bed will revert to a long-stay Bed on the date, after the six month Notice period, on which the Rresident who is occupying that convalescent care Bed at the end of the six month Notice period has been discharged from that Bed, unless otherwise agreed by the LHIN and the HSP. (c) The LHIN may terminate the designation of the convalescent care Beds at a Home at any time by giving at least six months prior written Notice to the HSP. Upon receipt of any such Notice, the HSP shall, within the timeframe set out in the Notice, provide the LHIN with: (1) a detailed transition plan, satisfactory to the LHIN acting reasonably, setting out the dates, after the end of the six month Notice period, on which the HSP plans to terminate the designation of each convalescent care Bed and, if required by the Notice, to revert same to a long-stay Bed; and, (2) a detailed explanation of the factors considered in the selection of those dates. The designation of athe convalescent care Bed will terminate, and if applicable revert to a long-stay Bed on the date, after the six month Notice period, on which the resident Resident who is occupying that convalescent care Bed at the end of the Notice period has been discharged from that Bed, unless otherwise agreed by the LHIN and the HSP. 6.6 In this Article 6, the terms integrate, integration and services have the same meanings attributed to them in section 2(1) and section 23 respectively of LHSIA, as it and they may be amended from time to time of 406

297 (a) (b) service includes; (1) a service or program that is provided directly to people, (2) a service or program, other than a service or program described in clause (1), that supports a service or program described in that clause, or (3) a function that supports the operations of a person or entity that provides a service or program described in clause (1) or (2). integrate includes; (1) to co-ordinate services and interactions between different persons and entities, (2) to partner with another person or entity in providing services or in operating, (3) to transfer, merge or amalgamate services, operations, persons or entities, (4) to start or cease providing services, (5) to cease to operate or to dissolve or wind up the operations of a person or entity, and integration has a similar meaning. ARTICLE PERFORMANCE 7.1 Performance. The Parties will strive to achieve on-going performance improvement. They will address performance improvement in a proactive, collaborative and responsive manner. 7.2 Performance Factors. (a) (b) (c) Each Party will notify the other Party of the existence of a Performance Factor, as soon as reasonably possible after the Party becomes aware of the Performance Factor. The Notice will: (1) describe the Performance Factor and its actual or anticipated impact; (2) include a description of any action the Party is undertaking, or plans to undertake, to remedy or mitigate the Performance Factor; (3) indicate whether the Party is requesting a meeting to discuss the Performance Factor; and (4) address any other issue or matter the Party wishes to raise with the other Party. The recipient Party will provide a written acknowledgment of receipt of the Notice within seven Days of the date on which the Notice was received ( Date of the Notice ). Where a meeting has been requested under section 7.2(a), the Parties agree to meet and discuss the Performance Factors within fourteen Days of the Date of the Notice, in accordance with the provisions of section 7.3. PICB may be included in any such meeting at the request of either Party of 406

298 7.3 Performance Meetings. During a meeting on performance, the Parties will: (a) (b) (c) discuss the causes of a Performance Factor; discuss the impact of a Performance Factor on the local health system and the risk resulting from non-performance; and determine the steps to be taken to remedy or mitigate the impact of the Performance Factor (the Performance Improvement Process ). 7.4 The Performance Improvement Process. (a) The Performance Improvement Process will focus on the risks of nonperformance and problem-solving. It may include one or more of the following actions: (1) a requirement that the HSP develop and implement an improvement plan that is acceptable to the LHIN; (2) the conduct of a Review; (3) a revision and amendment of the HSP s obligations; and (4) an in-year, or year end, adjustment to the Funding, among other possible means of responding to the Performance Factor or improving performance. (b) Any performance improvement process begun under a prior service accountability agreement that was not completed under the prior agreement will continue under this Agreement. Any performance improvement required by a LHIN under a prior service accountability agreement will be deemed to be a requirement of this Agreement until fulfilled or waived by the LHIN. ARTICLE REPORTING, ACCOUNTING AND REVIEW 8.1 Reporting. (a) (a)(b) (b)(c) Generally. The LHIN s ability to enable its local health system to provide appropriate, co-ordinated, effective and efficient health services as contemplated by LHSIA, is heavily dependent on the timely collection and analysis of accurate information. The HSP acknowledges that the timely provision of accurate information related to the HSP, the Homes, theirits Residents and its the HSP s performance of its obligations under this Agreement, is under the HSP s control. Reporting by Home. For certainty, notwithstanding anything else in this Agreement and consistent with the requirements under the Act, the HSP s reporting obligations under this Agreement apply with respect to each Home individually. Specific Obligations. The HSP (1) will provide to the LHIN, or to such other entity as the LHIN may direct, in the form and within the time specified by the LHIN, the Reports other than personal health information as defined in section 31 (5) of the CFMA, that (1) the LHIN requires for the purposes of exercising its powers and duties under this Agreement, LHSIA or for of 406

299 the purposes that are prescribed under LHSIA, or (2) may be requested under the CFMA; (2) will comply with the applicable reporting standards and requirements in both Chapter 9 of the Ontario Healthcare Reporting Standards and the RAI MDS Tools; (3) will fulfil the specific reporting requirements set out in Schedule C; (4) will ensure that every Report is complete, accurate, signed on behalf of the HSP by an authorized signing officer where required and provided in a timely manner and in a form satisfactory to the LHIN; and (5) agrees that every Report submitted by or on behalf of the HSP, will be deemed to have been authorized by the HSP for submission. (c)(d) RAI/ MDS. Without limiting the foregoing, the HSP (1) will conduct quarterly assessments of Residents at each Home, and all other assessments of Residents required by the RAI/ MDS Tools, using the RAI/ MDS Tools; (2) will ensure that the RAI-MDS Tools are used correctly to produce an accurate assessment of the HSP s Residents at each Home (RAI MDS Data); (3) will submit the RAI -MDS Data to the Canadian Institute for Health Information in an electronic format at least quarterly in accordance with the submission guidelines set out by CIHI; and (4) acknowledges that if used incorrectly, the RAI- MDS Tools can increase Funding beyond that to which the HSP would otherwise be entitled. The HSP will therefore have systems in place to regularly monitor, evaluate and where necessary correct the quality and accuracy of the RAI- MDS Data provided in respect of the Residents at each Home. (d)(e) Health Quality Ontario. The HSP will work with Health Quality Ontario and other providers to advance the quality agenda and align quality improvement efforts across the local health care system; and, will submit a report to the LHIN that outlines how the HSP has done so. Without limiting the foregoing, the HSP will submit a Quality Improvement Plan to Health Quality Ontario that is aligned with this Agreement and supports local health system priorities. (e)(f) (f)(g) French Language Services. If the HSP is required to provide services to the public in French at a Home under the provisions of the French Language Services Act, the HSP will be required to submit a French language services report to the LHIN in respect of the Home. If the HSP is not required to provide services to the public in French at a Home under the provisions of the French Language Service Act, it will be required to provide a report to the LHIN that outlines how the HSP addresses the needs of its local Francophone community at the Home. Declaration of Compliance. On or before March 1 of each Funding Year, the Board will issue a Compliance Declaration declaring that the HSP has complied with the terms of this Agreement in respect of each Home. The form of the declaration is set out in Schedule E and may be amended from time to time through the term of this Agreement of 406

300 (g)(h) Financial Reductions. Notwithstanding any other provision of this Agreement, and at the discretion of the LHIN, the HSP may be subject to a financial reduction if any of the Reports are received after the due date, are incomplete, or are inaccurate where the errors or delay were not as a result of either LHIN actions or inaction or the actions or inactions of persons acting on behalf of the LHIN. If assessed, the financial reduction will be taken from funding designated for this purpose in Schedule B as follows: (1) if received within 7 days after the due date, incomplete or inaccurate, the financial penalty will be the greater of (1) a reduction of 0.02 percent (0.02%) of the Funding; or (2) two hundred and fifty dollars ($250.00), and (2) for every full or partial week of non-compliance thereafter, the rate will be one half of the initial reduction. (2) If assessed, financial reductions will be assessed in respect of each Home for which a Report was late, incomplete or inaccurate. 8.2 Reviews. (a) (b) (c) (d) (e) During the term of this Agreement and for seven years after the term of this Agreement, the HSP agrees that the LHIN or its authorized representatives may conduct a Review of the HSP and any one or more of the Homes, to confirm the HSP s fulfillment of its obligations under this Agreement. For these purposes the LHIN or its authorized representatives may, upon twenty-four hours Notice to the HSP and during normal business hours enter the HSP s premises, including any one or more Homes, to: (1) inspect and copy any financial records, invoices and other financerelated documents, other than personal health information as defined in section 31(5) of the CFMA, in the possession or under the control of the HSP which relate to the Funding or otherwise to the Services, and (2) inspect and copy non-financial records, other than personal health information as defined in section 31(5) of the CFMA, in the possession or under the control of the HSP which relate to the Funding, the Services or otherwise to the performance of the HSP under this Agreement. The cost of any Review will be borne by the HSP if the Review (1) was made necessary because the HSP did not comply with a requirement under the Act or this Agreement; or (2) indicates that the HSP has not fulfilled its obligations under this Agreement, including its obligations under Applicable Law or Applicable Policy. To assist in respect of the rights set out in (b) above the HSP shall disclose any information requested by the LHIN or its authorized representatives, and shall do so in a form requested by the LHIN or its authorized representatives. The HSP may not commence a proceeding for damages or otherwise against any person with respect to any act done or omitted to be done, any conclusion reached or report submitted that is done in good faith in respect of a Review. HSP s obligations under this section 8.2 will survive any termination or expiration of this Agreement of 406

301 8.3 Document Retention and Record Maintenance. The HSP will (a) (b) (c) retain all records (as that term is defined in FIPPA) related to the HSP s performance of its obligations under this Agreement for seven (7) years after the termination or expiration of the term of this Agreement. The HSP s obligations under this section will survive any termination or expiry of this Agreement; keep all financial records, invoices and other finance-related documents relating to the Funding or otherwise to the Services by Home and in a manner consistent with either generally accepted accounting principles or international financial reporting standards as advised by the HSP s auditor; and keep all non-financial documents and records relating to the Funding or otherwise to the Services by Home in a manner consistent with all Applicable Law. 8.4 Disclosure of Information. (a) (b) FIPPA. The HSP acknowledges that the LHIN is bound by FIPPA and that any information provided to the LHIN in connection with this Agreement may be subject to disclosure in accordance with FIPPA. Confidential Information. The Parties will treat Confidential Information as confidential and will not disclose Confidential Information except with the consent of the disclosing Party or as permitted or required under FIPPA, the Municipal Freedom of Information and Protection of Privacy Act, the Personal Health Information Protection Act, 2004, the Act, court order, subpoena or other Applicable Law. Notwithstanding the foregoing, the LHIN may disclose information that it collects under this Agreement in accordance with LHSIA and the CFMA Transparency. The HSP will post a copy of this Agreement and each Compliance Declaration submitted to the LHIN during the term of this Agreement in a conspicuous and easily accessible public place at the each Home. and on its public website if If the HSP or a Home operates a public website, this Agreement will also be posted on those websites Auditor General. For greater certainty the LHIN s rights under this article are in addition to any rights provided to the Auditor General under the Auditor General Act (Ontario). ARTICLE ACKNOWLEDGEMENT OF LHIN SUPPORT 9.1 Publication. For the purposes of this Article 9, the term publication means any material on or concerning the Services that the HSP makes available to the public, regardless of whether the material is provided electronically or in hard copy. Examples include a web-site, an advertisement, a brochure, promotional documents and a report. Materials that are prepared by the HSP in order to fulfil its reporting obligations under this Agreement are not included in the term publication. 9.2 Acknowledgment of Funding Support. (a) The HSP agrees all publications will include of 406

302 (1) an acknowledgment of the Funding provided by the LHIN and the Government of Ontario. Prior to including an acknowledgement in any publication, the HSP will obtain the LHIN s approval of the form of acknowledgement. The LHIN may, at its discretion, decide that an acknowledgement is not necessary; and (2) a statement indicating that the views expressed in the publication are the views of the HSP and do not necessarily reflect those of the LHIN or the Government of Ontario. (b) The HSP shall not use any insignia or logo of Her Majesty the Queen in right of Ontario, including those of the LHIN, unless it has received the prior written permission of the LHIN to do so. ARTICLE REPRESENTATIONS, WARRANTIES AND COVENANTS 10.1 General. The HSP represents, warrants and covenants that: (a) (b) (c) (d) (e) (f) it is, and will continue for the term of this Agreement to be, a validly existing legal entity with full power to fulfill its obligations under this Agreement; it has the experience and expertise necessary to carry out the Services at each Home; it holds all permits, licences, consents intellectual property rights and authorities necessary to perform its obligations under this Agreement; all information that the HSP provided to the LHIN in its Planning Submissions or otherwise in support of its application for funding was true and complete at the time the HSP provided it, and will, subject to the provision of Notice otherwise, continue to be true and complete for the term of this Agreement; it has not and will not for the term of this Agreement, enter into a non-arm s transaction that is prohibited by the Act; and it does, and will continue for the term of this Agreement to, operate in compliance with all Applicable Law and Applicable Policy Execution of Agreement. The HSP represents and warrants that: (a) (b) it has the full power and authority to enter into this Agreement; and it has taken all necessary actions to authorize the execution of the Agreement Governance. (a) The HSP represents, warrants and covenants that it has established, and will maintain for the period during which this Agreement is in effect, policies and procedures: (1) that set out a code of conduct for, and that identify, the ethical obligations of HSP s Personnel and Volunteers; (2) to ensure the ongoing effective functioning of the HSP; (3) for effective and appropriate decision-making; of 406

303 (b) (4) for effective and prudent risk-management, including the identification and management of potential, actual and perceived conflicts of interest; (5) for the prudent and effective management of the Funding; (6) to monitor and ensure the accurate and timely fulfillment of the HSP s obligations under this Agreement and compliance with the Act and LHSIA; (7) to enable the preparation, approval and delivery of all Reports; and (8) to address complaints about the provision of Services, the management or governance of a Home or the HSP; and (9) to deal with such other matters as the HSP considers necessary to ensure that the HSP carries out its obligations under this Agreement. The HSP represents and warrants that it: (1) has, or will have within 60 days of the execution of this Agreement, a Performance Agreement with its CEO. (2) will take all reasonable care to ensure that its CEO complies with the Performance Agreement; and (3) will enforce the HSP s rights under the Performance Agreement Funding, Services and Reporting. The HSP represents warrants and covenants that: (a) (b) (c) the Funding is, and will continue to be, used only to provide the Services at the Homes in accordance with the terms of this Agreement: the Services are and will continue to be provided at the Homes: (1) by persons with the expertise, professional qualifications, licensing and skills necessary to complete their respective tasks; and (2) in compliance with Applicable Law and Applicable Policy; and every Report is, and will continue to be, accurate and in full compliance with the provisions of this Agreement, including any particular requirements applicable to the Report Supporting Documentation. Upon request, the HSP will provide the LHIN with proof of the matters referred to in this Article. ARTICLE LIMITATION OF LIABILITY, INDEMNITY & INSURANCE 11.1 Limitation of Liability. The Indemnified Parties will not be liable to the HSP or any of the HSP s Personnel and Volunteers for costs, losses, claims, liabilities and damages howsoever caused arising out of or in any way related to the Services or otherwise in connection with this Agreement, unless caused by the negligence or wilful act of any of the Indemnified Parties Same. For greater certainty and without limiting section 11.1, the LHIN is not liable for how the HSP and the HSP s Personnel and Volunteers carry out the Services and is therefore not responsible to the HSP for such Services. Moreover the LHIN is not contracting with or employing any HSP s Personnel and Volunteers to carry out the terms of this Agreement. As such, it is not liable for contracting with, employing or terminating a contract with or the employment of any HSP s Personnel and Volunteers of 406

304 required to carry out this Agreement, nor for the withholding, collection or payment of any taxes, premiums, contributions or any other remittances due to government for the HSP s Personnel and Volunteers required by the HSP to carry out this Agreement Indemnification. The HSP hereby agrees to indemnify and hold harmless the Indemnified Parties from and against any and all liability, loss, costs, damages and expenses (including legal, expert and consultant costs), causes of action, actions, claims, demands, lawsuits or other proceedings (collectively, the Claims ), by whomever made, sustained, brought or prosecuted, including for third party bodily injury (including death), personal injury and property damage, in any way based upon, occasioned by or attributable to anything done or omitted to be done by the HSP or the HSP s Personnel and Volunteers in the course of the performance of the HSP s obligations under, or otherwise in connection with, this Agreement, unless caused by the negligence or wilful misconduct of any Indemnified Parties Insurance. (a) (b) Generally. The HSP shall protect itself from and against all claims that might arise from anything done or omitted to be done by the HSP and the HSP s Personnel and Volunteers under this Agreement and more specifically all claims that might arise from anything done or omitted to be done under this Agreement where bodily injury (including personal injury), death or property damage, including loss of use of property is caused. Required Insurance. The HSP will put into effect and maintain, with insurers having a secure A.M. Best rating of B+ or greater, or the equivalent, all the necessary and appropriate insurance that a prudent person in the business of the HSP would maintain including, but not limited to, the following at its own expense. (1) Commercial General Liability Insurance. Commercial General Liability Insurance, for third party bodily injury, personal injury and property damage to an inclusive limit of not less than two million dollars per occurrence and not less than two million dollars products and completed operations aggregate. The policy will include the following clauses: A. The Indemnified Parties as additional insureds, B. Contractual Liability, C. Cross-Liability, D. Products and Completed Operations Liability, E. Employers Liability and Voluntary Compensation unless the HSP complies with the Section below entitled Proof of WSIA Coverage, F. Tenants Legal Liability (for premises/building leases only), G. Non-Owned automobile coverage with blanket contractual coverage for hired automobiles, and H. A thirty-day written notice of cancellation, termination or material change. (2) Proof of WSIA Coverage. Unless the HSP put into effect and maintains Employers Liability and Voluntary Compensation as set out above, the HSP will provide the LHIN with a valid Workplace Safety of 406

305 (c) and Insurance Act, 1997 (WSIA) Clearance Certificate and any renewal replacements, and will pay all amounts required to be paid to maintain a valid WSIA Clearance Certificate throughout the term of this Agreement. (3) All Risk Property Insurance on property of every description, for the term, providing coverage to a limit of not less than the full replacement cost, including earthquake and flood. All reasonable deductibles and self-insured retentions are the responsibility of the HSP. (4) Comprehensive Crime insurance, Disappearance, Destruction and Dishonest coverage. (5) Errors and Omissions Liability Insurance insuring liability for errors and omissions in the provision of any professional services as part of the Services or failure to perform any such professional services, in the amount of not less than two million dollars per claim and in the annual aggregate. Certificates of Insurance. The HSP will provide the LHIN with proof of the insurance required by this Agreement in the form of a valid certificate of insurance that references this Agreement and confirms the required coverage, on or before the commencement of this Agreement, and renewal replacements on or before the expiry of any such insurance. Upon the request of the LHIN, a copy of each insurance policy shall be made available to it. The HSP shall ensure that each of its subcontractors obtains all the necessary and appropriate insurance that a prudent person in the business of the subcontractor would maintain and that the Indemnified Parties are named as additional insureds with respect to any liability arising in the course of performance of the subcontractor's obligations under the subcontract. ARTICLE TERMINATION 12.1 General Provision. This Agreement may be terminated in accordance with the provisions of this Article, with respect to one or more Homes. In the event that this Agreement is terminated in respect of a specific Home, the Agreement is only terminated with respect to those Services at that Home and the Agreement remains in full force and effect in respect of Services provided by the HSP at the remaining Homes Termination by the LHIN. (a) Immediate Termination in Respect of a Single Home. The LHIN may terminate this Agreement in respect of a Home immediately upon giving Notice to the HSP if: (1) the HSP is unable to provide or has discontinued the Services in whole or in part or the HSP ceases to carry on business; or (2) the Home has been closed of 406

306 (b) Immediate Termination in Respect of Any or All Homes. In addition to the foregoing, the LHIN may terminate this Agreement in respect of any or all Homes, immediately upon giving Notice to the HSP if: (1) The HSP ceases to carry on business; (2) the HSP makes an assignment, proposal, compromise, or arrangement for the benefit of creditors, or is petitioned into bankruptcy, or files for the appointment of a receiver; (3) the LHIN is directed, pursuant to the Act, to terminate this Agreement by the Minister or the Director; or (4) the Home has been closed in accordance with the Act; or (5)(4) as provided for in section 4.6, the LHIN does not receive the necessary funding from the MOHLTC. (b)(c) Termination in the Event of Financial Difficulties. If the HSP makes an assignment, proposal, compromise, or arrangement for the benefit of creditors, or is petitioned into bankruptcy, or files for the appointment of a receiver the LHIN will consult with the Director before determining whether this Agreement will be terminated in respect of a Home. If the LHIN terminates this Agreement in respect of a Home because a person has exercised a security interest as contemplated by section 107 of the Act, the LHIN would expect to enter into a service accountability agreement with the person exercising the security interest or the receiver or other agent acting on behalf of that person where the person has obtained the Director's approval under section 110 of the Act and has met all other relevant requirements of Applicable Law. (c)(d) Opportunity to Remedy Material Breach. If an HSP breaches any material provision of this Agreement, including, but not limited to, the reporting requirements in Article 8 and the representations and warranties in Article 10 and the breach has not been satisfactorily resolved under Article 7, the LHIN will give the HSP Notice, which Notice shall identify the subject Home and of thespecify the particulars of the breach and of the period of time within which the HSP is required to remedy the breach. In the event that one or more Homes are to be subject to termination in accordance with this Section, each Home shall be subject of a separate Notice. The Notice will advise the HSP that the LHIN will terminate this Agreement in respect of the Home: (1) at the end of the Notice period provided for in the Notice if the HSP fails to remedy the breach within the time specified in the Notice; or (2) prior to the end of the Notice period provided for in the Notice if it becomes apparent to the LHIN that the HSP cannot completely remedy the breach within that time or such further period of time as the LHIN considers reasonable, or the HSP is not proceeding to remedy the breach in a way that is satisfactory to the LHIN; and the LHIN may then terminate this Agreement in accordance with the Notice Termination of Services by the HSP. (a) Except as provided in 12.23(b) and (c) below, the HSP may terminate this Agreement at any time, for any reason, in respect of one or more Homes, upon giving the LHIN at least six months Notice of 406

307 (b) (c) Where the HSP intends to cease providing the Services and close the a Home, the HSP will provide Notice to the LHIN at the same time the HSP is required to provide notice to the Director under the Act. The HSP will ensure that the closure plan required by the Act is acceptable to the LHIN. Where the HSP intends to cease providing the Services as a result of an intended sale or transfer of a License in whole or in part, the HSP will comply with section 6.3 of this Agreement. Notice under section 27 of LHSIA will not be effective unless accompanied by a transition plan that is acceptable to the LHIN, if such a transition plan is requested pursuant to section Consequences of Termination. (a) (b) If this Agreement is terminated in respect of a Home, pursuant to this Article, the LHIN may: (1) cancel all further Funding instalments; (2) demand the repayment of any Funding remaining in the possession or under the control of the HSP; (3) determine the HSP s reasonable costs to wind down the Services; and (4) permit the HSP to offset the costs determined pursuant to section (3), against the amount owing pursuant to section (2). Despite (a), if the cost determined pursuant to section 12.3(a) (3) exceeds the Funding remaining in the possession or under the control of the HSP the LHIN will not provide additional monies to the HSP to wind down the Services Effective Date. Termination under this Article will take effect as set out in the Notice Corrective Action. Despite its right to terminate this Agreement pursuant to this Article, the LHIN may choose not to terminate this Agreement and may take whatever corrective action it considers necessary and appropriate, including suspending Funding for such period as the LHIN determines, to ensure the successful completion of the Services in accordance with the terms of this Agreement. ARTICLE NOTICE 13.1 Notice. A Notice will be in writing; delivered personally, by pre-paid courier, or sent by facsimile or with confirmation of receipt, or by any form of mail where evidence of receipt is provided by the post office. When a Notice is sent by , a confirmation of receipt shall include acknowledgment by the Notice recipient of an automated request for receipt, or a written reply from the Notice recipient acknowledging receipt. A Notice will be addressed to the other Party as provided below or as either Party will later designate to the other in writing: of 406

308 To the LHIN: Insert name of LHIN Insert address of LHIN Attention: [insert position] Fax: Telephone: To the HSP: insert name of HSP insert address of HSP Attention:[insert position] Fax: Telephone: 13.2 Notices Effective From. A Notice will be effective at the time the delivery is made if the Notice is delivered personally or by pre-paid courier. If delivered by mail, a Notice will be effective five business days after the day it was mailed. A Notice that is delivered by facsimile or by will be effective when its receipt is acknowledged as required by this Article. ARTICLE INTERPRETATION 14.1 Interpretation. In the event of a conflict or inconsistency in any provision of this Agreement, the main body of this Agreement will prevail over the Schedules Jurisdiction. Where this Agreement requires compliance with the Act, the Director will determine compliance and advise the LHIN. Where the Act requires compliance with this Agreement, the LHIN will determine compliance and advise the Director Determinations by the Director. All determinations required by the Director under this Agreement are subject to an HSP s rights of review and appeal under the Act The Act. For greater clarity, nothing in this Agreement supplants or otherwise excuses the HSP from the fulfillment of any requirements of the Act. The HSP s obligations in respect of LHSIA and this Agreement are separate and distinct from the HSP s obligations under the Act. ARTICLE ADDITIONAL PROVISIONS 15.1 Currency. All payment to be made by the LHIN or the HSP under this Agreement shall be made in the lawful currency of Canada Invalidity or Unenforceability of Any Provision. The invalidity or unenforceability of any provision of this Agreement will not affect the validity or enforceability of any other provision of this Agreement and any invalid or unenforceable provision will be deemed to be severed Terms and Conditions on Any Consent. Any consent or approval that the LHIN may grant under this Agreement is subject to such terms and conditions as the LHIN may reasonably require of 406

309 15.4 Waiver. A Party may only rely on a waiver of the Party s failure to comply with any term of this Agreement if the other Party has provided a written and signed Notice of waiver. Any waiver must refer to a specific failure to comply and will not have the effect of waiving any subsequent failures to comply Parties Independent. The Parties are and will at all times remain independent of each other and are not and will not represent themselves to be the agent, joint venturer, partner or employee of the other. No representations will be made or acts taken by either Party which could establish or imply any apparent relationship of agency, joint venture, partnership or employment and neither Party will be bound in any manner whatsoever by any agreements, warranties or representations made by the other Party to any other person or entity, nor with respect to any other action of the other Party LHIN is an Agent of the Crown. The Parties acknowledge that the LHIN is an agent of the Crown and may only act as an agent of the Crown in accordance with the provisions of LHSIA. Notwithstanding anything else in this Agreement, any express or implied reference to the LHIN providing an indemnity or any other form of indebtedness or contingent liability that would directly or indirectly increase the indebtedness or contingent liabilities of the LHIN or of Ontario, whether at the time of execution of this Agreement or at any time during the term of this Agreement, will be void and of no legal effect Express Rights and Remedies Not Limited. The express rights and remedies of the LHIN are in addition to and will not limit any other rights and remedies available to the LHIN at law or in equity. For further certainty, the LHIN has not waived any provision of any applicable statute, including the Act, LHSIA and the CFMA, nor the right to exercise its right under these statutes at any time No Assignment. The HSP will not assign either this Agreement or the Funding in whole or in part, directly or indirectly, without the prior written consent of the LHIN which consent shall not be unreasonably withheld. No assignment or subcontract shall relieve the HSP from its obligations under this Agreement or impose any liability upon the LHIN to any assignee or subcontractor. The LHIN may assign this Agreement or any of its rights and obligations under this Agreement to any one or more of the LHINs or to the MOHLTC Governing Law. This Agreement and the rights, obligations and relations of the Parties hereto will be governed by and construed in accordance with the laws of the Province of Ontario and the federal laws of Canada applicable therein. Any litigation arising in connection with this Agreement will be conducted in Ontario unless the Parties agree in writing otherwise Survival. The provisions in Articles 1.0, 5.0, 8.0, 11.0, 13.0, 14.0 and 15.0 and sections 2.4, 4.6, 10.4, 10.5 and 12.3 will continue in full force and effect for a period of seven years from the date of expiry or termination of this Agreement Further Assurances. The Parties agree to do or cause to be done all acts or things necessary to implement and carry into effect this Agreement to its full extent Amendment of Agreement. This Agreement may only be amended by a written agreement duly executed by the Parties of 406

310 15.13 Counterparts. This Agreement may be executed in any number of counterparts, each of which will be deemed an original, but all of which together will constitute one and the same instrument. ARTICLE ENTIRE AGREEMENT 16.1 Entire Agreement. This Agreement together with the appended Schedules constitutes the entire Agreement between the Parties with respect to the subject matter contained in this Agreement and supersedes all prior oral or written representations and agreements. The Parties have executed this Agreement on the dates set out below. XXX LOCAL HEALTH INTEGRATION NETWORK By: [Name], Chair Date And by: [Name], CEO Date [Insert Full Legal Name of HSP] By: [Name], Chair Date I have authority to bind the HSP And by: [Name], [Title] Date I have authority to bind the HSP of 406

311 Description of Home and Services LTCH Name: Description of Home and Services A.-1 General Information LTCH Legal Name LTCH Common NameLTCH Legal Name LTCH Common Name LTCH Facility ID Number LTCH Facility (master number for RAI MDS) Owner/Parent Organization Address City Geography served (catchment area) Accreditation organization Date of Last Accreditation Postal Code Year(s) Awarded A.2 - Licensed or Approved Beds & ClassificationA-2 LTCH Classification Licensed/Approved Beds Temporary Beds Total # Beds Total # of BedsA AB BC CD DNew New OtherTotal # Beds A.2 Licensed or Approved Beds & Classification / Bed Type A.3 - Bed Type Bed Types Regular Long Stay Beds Convalescent Care Beds Respite Beds Beds in Abeyance ELDCAP Beds Interim Beds Veterans Priority Access beds Other beds available under a Temporary Emergency Licence or Short-Term Authorization* Sub Total # all Bed Types Note: Total should equal the number under Total # Beds in A.2 above. Total # of Beds A B C D New Comments/Additional Information Term of Licence Comments/Additional Information of 406

312 Description of Home and Services LTCH Name: Total # all Bed Types *Other beds available under a Temporary Emergency Licence or Short-Term Authorization A.3 Structural Information Type of Room (this refers to structural layout rather than what is charged in accommodations) Number of rooms with 1 bed Number of rooms with 2 beds Number of rooms with 3 beds Number of rooms with 4 beds Other Separate Infirmary (Y/N) Year of Construction Opening Date Number of Rooms Year(s) of renovations Number of Floors Number of Units/Resident Home Areas and Beds Unit/Resident Home Area Number of Beds A.-3 4 Structural Information Type of Room (this refers to structural layout rather than what is charged in accommodations) Number of rooms with 1 bed Number of rooms with 3 beds Other Separate Infirmary (Y/N) Year of Construction Opening Date Number of rooms with 2 beds Number of rooms with 4 beds Number of Rooms Year(s) of renovations Number of Floors Number of Units/Resident Home Areas and Beds Unit/Resident Home Area Number of Beds of 406

313 Schedule B Additional Terms and Conditions Applicable to the Funding Model 1.0 Background. The LHINs provide subsidy funding to long-term care home health service providers pursuant to a funding model set by the MOHLTC. The current model provides estimated per diem funding that is subsequently reconciled. The current funding model is under review and may change during the term of the Agreement.Term (as defined below). As a result, and for ease of amendment during its term, the Term, this Agreement incorporates certain terms and conditions that relate to the funding model in this Schedule B. 2.0 Additional Definitions. Any terms not otherwise defined in this Schedule have the same meaning attributed to them in the main body of this Agreement. The following terms have the following meanings: "Approved Funding" means the allowable subsidy for the Term determined by reconciling the Estimated Provincial Subsidy (as defined below) in accordance with Applicable Law and Applicable Policy Construction Funding Subsidy or CFS means the funding that the MOHLTC agreed to provide, or to ensure the provision of, to the HSP, in an agreement for the construction, development, redevelopment, retrofitting or upgrading of beds (a Development Agreement ). CFS Commitments means (a) commitments of the HSP related to a Development Agreement, identified in Schedule A of the service agreement in respect of the Home, in effect between the HSP and the LHIN on June 30, 2010, orand (b) where there were no commitments under clause (a), commitments of the HSP identified in a Development Agreement in respect of beds that were developed or redeveloped and opened for occupancy after June 30, 2010, (including, without limitation, any commitments set out in the HSP s Application as defined in the Development Agreement, and any conditions agreed to in the Development Agreement in respect of any permitted variances from standard design standards.) "Envelope" is a portion of the Estimated Provincial Subsidy that is designated for a specific use. There are four Envelopes in the Estimated Provincial Subsidy as follows: (a) the Nursing and Personal Care envelopeenvelope; (b) the Program and Support Services envelopeenvelope; (c) the Raw Food envelopeenvelope; and (d) the Other Accommodation envelopeenvelope. Estimated Provincial Subsidy means the estimated provincial subsidy calculated in accordance with Applicable Policy. Reconciliation Reports means the reports as required by Applicable Policy including the Long-term Care Home Annual Report and, the In-Year Revenue/Occupancy Report. Term means the term of this Agreement. 313 of 406

314 3.0 Provision of Funding. 3.1 In each Funding Year, the LHIN shall advise the HSP of the amount of its Estimated Provincial Subsidy. The amount of the Estimated Provincial Subsidy shall be calculated on both a monthly basis and an annual basis and will be allocated among the Envelopes and other funding streams applicable to the HSP, including the CFS. 3.2 The Estimated Provincial Subsidy shall be provided to the HSP on a monthly basis in accordance with the monthly calculation described in 3.1. and otherwise in accordance with this Agreement. Payments will be made to the HSP on or about the twenty-second (22 nd ) day of each month of the Term. 3.3 CFS will be provided as part of the Estimated Provincial Subsidy and in accordance with the terms of the Development Agreement and Applicable Policy. This obligation survives any termination of thethis Agreement. 4.0 Use of Funding. 4.1 The Unless otherwise provided in this Schedule B, the HSP shall use the fundingall Funding allocated for ana particular Envelope only for the use or uses set out in the Applicable Policy. 4.2 The HSP shall not transfer any such portion of the Estimated Provincial Subsidy in the Raw Food envelope,envelope to any other Envelope: 4.3 The HSP may transfer all or any of the part of the Estimated Provincial Subsidy for the Other Accommodation Envelope to any other Envelope without the prior written approval of the LHIN, provided that the HSP has complied with the standards and criteria for the Other Accommodation Envelope as set out in Applicable Policy. 4.4 The HSP may transfer any part of the Estimated Provincial Subsidy in the (a) Nursing and Personal Care envelopeenvelope; or (b) the Program and Support Services envelopeenvelope; to any Envelope other than the Other Accommodation Envelope without the prior written approval of the LHIN provided that the transfer is done in accordance with Applicable Policy. 4.5 In the event that a financial reduction is determined by the LHIN, the financial reduction will be applied against the portion of the Estimated Provincial Subsidy in the Other Accommodation Envelope. 5.0 Construction Funding Subsidies. 5.1 Subject to 5.2 and 5.3 the HSP is required to continue to fulfill alcfsall CFS Commitments, and the CFS Commitments are hereby incorporated into and deemed part of thisthe Agreement. 5.2 The HSP is not required to continue to fulfill those CFS Commitments that the MinistryMOHLTC has agreed in writing: (i) have been satisfactorily fulfilled; or (ii) are no longer required to be fulfilled; and the HSP is able to provide the LHIN with a copy of such written agreement. 314 of 406

315 5.3 Where this Agreement establishes or requires a service requirement that surpasses the service commitment set out in the CFS Commitments, the HSP is required to comply with the service requirements in this Agreement. 5.4 The MOHLTC will beis responsible for monitoring the HSP s on-going compliance with the CFS Commitments. Notwithstanding the foregoing, the HSP agrees to certify its compliance with the CFS Commitments when requested to do so by the LHIN. 6.0 Reconciliation. 6.1 The HSP shall complete the Reconciliation Reports and submit them to the LHINMOHLTC in accordance with Schedule C. The Reconciliation Reports shall be in such form and containing such information as required by Applicable Policy or as otherwise required by the LHIN pursuant to Article 8 of thethis Agreement. 6.2 The Estimated Provincial Subsidy provided by the LHIN under section 3.0 of this Schedule shall be reconciled by the LHIN in accordance with Applicable Law and Applicable Policy to produce the Approved Funding. 6.3 In accordance with the Applicable Law and Applicable Policy, if the Estimated Provincial Subsidy paid to the HSP exceeds the Approved Funding for any period, the excess is a debt due and owing by the HSP to the Crown in right of Ontario which shall be paid by the HSP to the Crown in right of Ontario and, in addition to any other methods available to recover the debt, the LHIN may deduct the amount of the debt from any subsequent amounts to be provided by the LHIN to the HSP. If the Estimated Provincial Subsidy paid for any period is less than the Approved Funding, the LHIN shall provide the difference to the HSP. 315 of 406

316 Schedule C Reporting Requirements 1. In-Year Revenue/Occupancy Report Reporting Period Estimated Due Dates Jan to Sept By October 15, Jan to Sept By October 15, Jan to Sept By October 15, Long-Term Care Home Annual Report Reporting Period Estimated Due Dates Jan to Dec By September 30, Jan to Dec By September 30, Jan to Dec By September 30, Performance Report Due Dates Q2 Apr to Sept October 31, 2013 Q3 Apr to Dec January 31, 2014 Q4 Apr to March April 30, Due Dates Q2 Apr to Sept October 31, 2014 Q3 Apr to Dec January 31, 2015 Q4 Apr to March April 30, Due Dates Q2 Apr to Sept October 30, 2015 Q3 Apr to Dec January 29, 2016 Q4 Apr to March April 29, French Language Services Report Fiscal Year Due Dates Apr to March April 3028, Apr to March April 30, Apr to March April 2930, OHRS/MIS Trial Balance Submission Due Dates (Must pass 3c Edits) Q2 Apr to Sept (Fiscal Year) October 31, Q2 Jan to Jun (Calendar Year) Q3 Apr to Dec (Fiscal Year) January 31, Q3 Jan to Sept (Calendar Year) Optional Submission Q4 Apr to March (Fiscal Year) May 3031, Q4 Jan to Dec (Calendar Year) 1 These are estimated dates from the MOHLTC and are subject to change. If the estimated due date falls on a weekend, reporting will be due the preceding Friday of 406

317 Schedule C Reporting Requirements Cont d/ 5. OHRS/MIS Trial Balance Submission Cont d Due Dates (Must pass 3c Edits) Q2 Apr to Sept (Fiscal Year) October 31, Q2 Jan to June (Calendar Year) Q3 Apr to Dec (Fiscal Year) January 31, Q3 Jan to Sept (Calendar Year) Optional Submission Q4 Apr to March (Fiscal Year) May 3031, Q4 Jan to Dec (Calendar Year) Due Dates (Must pass 3c Edits) Q2 Apr to Sept (Fiscal Year) October 31, Q2 Jan to June (Calendar Year) Q3 Apr to Dec (Fiscal Year) January 31, Q3 Jan to Sep (Calendar Year) Optional Submission Q4 Apr to March (Fiscal Year) May 3031, Q4 Jan to Dec (Calendar Year) 6. Compliance Declaration Funding Year Due Dates January 1, December 31, March 1, January 1, December 31, March 1, January 1, December 31, March 1, RAI MDS Funding Year Due Dates At least quarterly during each Funding Year in the term of this Agreement, or otherwise in accordance with the As established and advised by the Ministry on behalf of the LHIN. submission guidelines set out by CIHI. 8. Staffing Report Reporting Period Estimated Due Dates 1 January 1, December 31, July 7, January 1, December 31, July 6, January 1, December 31, July 5, Quality Improvement Plan Reporting Period Due Dates April 1, 2016 March 31, 2017 April 1, 2016 April 1, 2017 March 31, 2018 April 1, 2017 April 1, 2018 March 31, 2019 April 1, [Note to LHINS please insert additional local reporting requirements if any] of 406

318 Schedule D Performance 1.0 Performance Indicators The HSP s delivery of the Services will be measured by the following Indicators, Targets and where applicable Performance Standards. In the following table: n/a means not-applicable, that there is no defined Performance Standard for the indicator for the applicable year. tbd means a Target, and a Performance Standard, if applicable, will be determined during the applicable year. INDICATOR CATEGORY INDICATOR P=Performance Indicator E=Explanatory Indicator /1617 Performance Target Standard Organizational Health and Financial Indicators Coordination and Access Indicators Debt Service Coverage Ratio (P) 1 1 Total Margin (P) 0 0 Average Long-Stay Occupancy / Average Long-Stay Utilization (E) n/a n/a Wait Time from CCAC Determination of Eligibility to LTC Home Response (E) n/a n/a Long-Term Care Home Refusal Rate (E) n/a n/a Quality and Resident Safety Indicators Percentage of Residents Who Fell in the Last 30 days (E) n/a n/a Percentage of Residents Whose Pressure Ulcer Worsened (E) n/a n/a Percentage of Residents on Antipsychotics Without a Diagnosis of Psychosis (E) n/a n/a Percentage of Residents in Daily Physical Restraints (E) n/a n/a 2.0 LHIN-Specific Performance Obligations 318 of 406

319 Schedule E Form of Compliance Declaration DECLARATION OF COMPLIANCE Issued pursuant to the Long Term Care Service Accountability Agreement To: From: For: Date: Re: The Board of Directors of the [insert name of LHIN] Local Health Integration Network (the LHIN ). Attn: Board Chair. The Board of Directors (the Board ) of the [insert name of License Holder] (the HSP ) [insert name of Home] (the Home ) [insert date] [January 1, 201X December 31, 201x] (the Applicable Period ) The Board has authorized me, by resolution dated [insert date], to declare to you as follows: After making inquiries of the [insert name and position of person responsible for managing the Home on a day to day basis, e.g. the Chief Executive Office or the Executive Director] and other appropriate officers of the HSP and subject to any exceptions identified on Appendix 1 to this Declaration of Compliance, to the best of the Board s knowledge and belief, the HSP has fulfilled, its obligations under the long-term care service accountability agreement (the Agreement ) in effect during the Applicable Period. Without limiting the generality of the foregoing, the HSP confirms that (i) (ii) it has complied with the provisions of the Local Health System Integration Act, 2006 and with any compensation restraint legislation which applies to the HSP; and every Report submitted by the HSP is accurate in all respects and in full compliance with the terms of the Agreement; Unless otherwise defined in this declaration, capitalized terms have the same meaning as set out in the Agreement between the LHIN and the HSP effective April 1, [insert name of individual authorized by the Board to make the Declaration on the Board s behalf], [insert title] of 406

320 Schedule E Form of Compliance Declaration Cont d. Appendix 1 - Exceptions [Please identify each obligation under the LSAA that the HSP did not meet during the Applicable Period, together with an explanation as to why the obligation was not met and an estimated date by which the HSP expects to be in compliance.] of 406

321 TEMPLATE LONG-TERM CARE HOME SERVICE ACCOUNTABILITY AGREEMENT MULTI HOMES April 1, 2016 to March 31, 2019 SERVICE ACCOUNTABILITY AGREEMENT with [Legal Name of the Health Service Provider] Effective Date: April 1, 2016 Index to Agreement ARTICLE DEFINITIONS & INTERPRETATION... 2 ARTICLE TERM AND NATURE OF THIS AGREEMENT... 7 ARTICLE PROVISION OF SERVICES... 8 ARTICLE FUNDING... 9 ARTICLE ADJUSTMENT AND RECOVERY OF FUNDING ARTICLE PLANNING & INTEGRATION ARTICLE PERFORMANCE ARTICLE REPORTING, ACCOUNTING AND REVIEW ARTICLE ACKNOWLEDGEMENT OF LHIN SUPPORT ARTICLE REPRESENTATIONS, WARRANTIES AND COVENANTS ARTICLE LIMITATION OF LIABILITY, INDEMNITY & INSURANCE ARTICLE TERMINATION ARTICLE NOTICE ARTICLE INTERPRETATION ARTICLE ADDITIONAL PROVISIONS ARTICLE ENTIRE AGREEMENT Schedules A - Description of Home and Beds B - Additional Terms and Conditions Applicable to the Funding Model C - Reporting Requirements D - Performance E - Form of Compliance Declaration 321 of 406

322 THIS SERVICE ACCOUNTABILITY AGREEMENT effective as of April 1, 2016 BETWEEN: AND [insert name] LOCAL HEALTH INTEGRATION NETWORK (the LHIN ) [Legal Name(s) of the organization(s) holding the licence to operate the Home (if in doubt, check the licence issued by the MOHLTC)] (the HSP ) IN RESPECT OF SERVICES PROVIDED AT: [insert legal name of long term care home] located at [insert address] and [insert legal name of long term care home] located at [insert address] and [insert legal name of long term care home] located at [insert address] (individually referred to as a Home, one or more referred to as the Homes ) Background: The Local Health System Integration Act, 2006 requires that the LHIN and the HSP enter into a service accountability agreement. The service accountability agreement supports a collaborative relationship between the LHIN and the HSP: to improve the health of Ontarians through better access to high quality health services; to co-ordinate health care in local health systems, by such actions as supporting the implementation of Health Links to facilitate regional integrated health care service delivery; to manage the health care system at the local level effectively and efficiently; and, to create a health care system that is person-centered, accountable, transparent, and evidence-based. In this context, the HSP and the LHIN agree that the LHIN will provide funding to the HSP on the terms and conditions set out in this Agreement to enable the provision of services to the local health system by the HSP. In consideration of their respective agreements set out below, the LHIN and the HSP covenant and agree as follows. ARTICLE DEFINITIONS & INTERPRETATION 1.1 Definitions. In this Agreement the following terms will have the following meanings of 406

323 Act means the Long-Term Care Homes Act, 2007 and the regulations made under the Long Term Care Homes Act, 2007 as it and they may be amended from time to time. Accountability Agreement refers to the Agreement in place between the Minister and the LHIN pursuant to the terms of section 18 of LHSIA. Agreement means this agreement and includes the Schedules and any instrument amending this agreement or the Schedules. Annual Balanced Budget means that, in each calendar year of the term of this Agreement, the total expenses of the HSP in respect of the Services at a Home are less than or equal to the total revenue of the HSP in respect of the Services at the same Home. Applicable Law means all federal, provincial or municipal laws, orders, rules, regulations, common law, licence terms or by-laws, and includes terms or conditions of a licence or approval issued under the Act, that are applicable to the HSP, the Services, this Agreement and the Parties obligations under this Agreement during the term of this Agreement. Applicable Policy means any orders, rules, policies, directives or standards of practice issued or adopted by the LHIN, by the MOHLTC or by other ministries or agencies of the province of Ontario that are applicable to the HSP, the Services, this Agreement and the Parties obligations under this Agreement during the term of this Agreement. Without limiting the generality of the foregoing, Applicable Policy includes the Design Manual and the Long Term Care Funding and Financial Management Policies and all other manuals, guidelines, policies and other documents listed on the Policy Web Pages as those manuals, guidelines, policies and other documents may be amended from time to time. Approved Funding has the meaning ascribed to it in Schedule B. Beds means the long term care home beds that are licensed or approved under the Act for each Home and identified in Schedule A, as the same may be amended from time to time. Board means in respect of an HSP that is: (a) (b) (c) (d) (e) (f) a corporation, the board of directors; A First Nation, the band council; a municipality, the committee of management; a board of management established by one or more municipalities or by one or more First Nations band councils, the members of the board of management; a partnership, the partners; and a sole proprietorship, the sole proprietor. BPSAA means the Broader Public Sector Accountability Act, 2010, and the regulations made under the Broader Public Sector Accountability Act, 2010 as it and they may be amended from time to time. CEO means the individual accountable to the Board for the provision of the Services at of 406

324 each Home in accordance with the terms of this Agreement, which individual may be the executive director or administrator of the HSP, or may hold some other position or title within the HSP. CFMA means the Commitment to the Future of Medicare Act, 2004, and the regulations made under the Commitment to the Future of Medicare Act, 2004, as it and they may be amended from time to time. Compliance Declaration means a compliance declaration substantially in the form set out in Schedule E. Confidential Information means information that is (i) marked or otherwise identified as confidential by the disclosing Party at the time the information is provided to the receiving Party; and (ii) eligible for exclusion from disclosure at a public board meeting in accordance with section 9 of LHSIA. Confidential Information does not include information that (a) was known to the receiving Party prior to receiving the information from the disclosing Party; (b) has become publicly known through no wrongful act of the receiving Party; or (c) is required to be disclosed by law, provided that the receiving Party provides Notice in a timely manner of such requirement to the disclosing Party, consults with the disclosing Party on the proposed form and nature of the disclosure, and ensures that any disclosure is made in strict accordance with Applicable Law. Conflict of Interest in respect of an HSP, includes any situation or circumstance where: in relation to the performance of its obligations under this Agreement (a) (b) (c) the HSP; a member of the HSP s Board; or any person employed by the HSP who has the capacity to influence the HSP s decision, has other commitments, relationships or financial interests that: (a) (b) could or could be seen to interfere with the HSP s objective, unbiased and impartial exercise of its judgement; or could or could be seen to compromise, impair or be incompatible with the effective performance of its obligations under this Agreement. Construction Funding Subsidy has the meaning ascribed to it in Schedule B. controlling shareholder of a corporation means a shareholder who or which holds (or another person who or which holds for the benefit of such shareholder), other than by way of security only, voting securities of such corporation carrying more than 50% of the votes for the election of directors, provided that the votes carried by such securities are sufficient, if exercised, to elect a majority of the board of directors of such corporation. Days means calendar days. Design Manual means the MOHLTC design manual or manuals in effect and applicable to the development, upgrade, retrofit, renovation or redevelopment of a Home or Beds subject to this Agreement of 406

325 Director has the same meaning as the term Director in the Act. Effective Date means April 1, e-health means the coordinated and integrated use of electronic systems, information and communication technologies to facilitate the collection, exchange and management of personal health information in order to improve the quality, access, productivity and sustainability of the healthcare system. Explanatory Indicator means a measure of HSP performance for which no Performance Target is set. Technical specifications of specific Explanatory Indicators can be found in the L-SAA Indicator Technical Specifications document. FIPPA means the Freedom of Information and Protection of Privacy Act, (Ontario) and the regulations made under the Freedom of Information and Protection of Privacy Act, (Ontario), as it and they may be amended from time to time. Funding means the amounts of money provided by the LHIN to the HSP in each Funding Year of this Agreement for a Home. Funding includes Approved Funding and Construction Funding Subsidy. Funding Year means in the case of the first Funding Year, the period commencing on the January 1 prior to the Effective Date and ending on the following December 31, and in the case of Funding Years subsequent to the first Funding Year, the period commencing on the date that is January 1 following the end of the previous Funding Year and ending on the following December 31. Home means each building identified above where Beds are located and for greater certainty, Home includes the Beds and the common areas and common elements which will be used at least in part, for the Beds, but excludes any other part of the building which will not be used for the Beds being operated pursuant to this Agreement. HSP s Personnel and Volunteers means the controlling shareholders (if any), directors, officers, employees, agents, volunteers and other representatives of the HSP. In addition to the foregoing HSP s Personnel and Volunteers shall include the contractors and subcontractors and their respective shareholders, directors, officers, employees, agents, volunteers or other representatives. Indemnified Parties means the LHIN and its officers, employees, directors, independent contractors, subcontractors, agents, successors and assigns and her Majesty the Queen in Right of Ontario and her Ministers, appointees and employees, independent contractors, subcontractors, agents and assigns. Indemnified Parties also includes any person participating on behalf of the LHIN in a Review. Interest Income means interest earned on the Funding. Licence means one or more of the licences or the approvals granted to the HSP in respect of the Beds at each Home under Part VII or Part VIII of the Act. LHSIA means the Local Health System Integration Act, 2006 and the regulations under the Local Health System Integration Act, 2006 as it and they may be amended of 406

326 from time to time. Minister means the Minister of Health and Long-Term Care. MOHLTC means the Minister or the Ministry of Health and Long-Term Care, as is appropriate in the context. Notice means any notice or other communication required to be provided pursuant to this Agreement, LHSIA, the Act or the CFMA. Party means either of the LHIN or the HSP and Parties mean both of the LHIN and the HSP. Performance Agreement means an agreement between an HSP and its CEO that requires the CEO to perform in a manner that enables the HSP to achieve the terms of this Agreement. Performance Corridor means the acceptable range of results around a Performance Target. Performance Factor means any matter that could or will significantly affect a Party s ability to fulfill its obligations under this Agreement, and for certainty, includes any such matter that may be brought to the attention of the LHIN, whether by PICB or otherwise. Performance Indicator means a measure of HSP performance for which a Performance Target is set; Technical specifications of specific Performance Indicators can be found in the L-SAA Indicator Technical Specifications document. Performance Standard means the acceptable range of performance for a Performance Indicator or a Service Volume that results when a Performance Corridor is applied to a Performance Target. Performance Target means the level of performance expected of the HSP in respect of a Performance Indicator or a Service Volume. PICB means Performance Improvement and Compliance Branch of MOHLTC, or any other Branch or organizational unit of MOHLTC that may succeed or replace it. Planning Submission means the planning document submitted by the HSP to the LHIN. The form, content and scheduling of the Planning Submission will be identified by the LHIN. Policy Web Pages means the web pages available at and at or such other URLs or Web pages as the LHIN or the Ministry may advise from time to time. Capital policies can be found at RAI MDS Tools means the standardized Resident Assessment Instrument Minimum Data Set ( RAI MDS ) 2.0, the RAI MDS 2.0 User Manual and the RAI MDS Practice Requirements, as the same may be amended from time to time of 406

327 Reports means the reports described in Schedule C as well as any other reports or information required to be provided under LHSIA, the Act or this Agreement, in respect of a Home. Resident has the meaning ascribed to the term resident under the Act. Review means a financial or operational audit, investigation, inspection or other form of review requested or required by the LHIN under the terms of LHSIA or this Agreement, in respect of the HSP or of one or more Homes, but does not include the annual audit of the HSP s financial statements. Schedule means any one of, and Schedules mean any two or more, as the context requires, of the schedules appended to this Agreement and includes: Schedule A. Schedule B. Schedule C. Schedule D. Schedule E. Description of Homes and Beds; Additional Terms and Conditions Applicable to the Funding Model; Reporting Requirements; Performance; and Form of Compliance Declaration. Services means, in respect of each Home, the operation of the Beds and the Home and the accommodation, care, programs, goods and other services that are provided to Residents of the Home (i) to meet the requirements of the Act; (ii) to obtain Approved Funding; and (iii) to fulfill all commitments made to obtain a Construction Funding Subsidy. Service Volume means a measure of Services for which a Performance Target is set. 1.2 Interpretation. (a) (b) Words in the singular include the plural and vice-versa. Words in one gender include all genders. The headings do not form part of this Agreement. They are for convenience of reference only and will not affect the interpretation of this Agreement. Terms used in the Schedules shall have the meanings set out in this Agreement unless separately and specifically defined in a Schedule in which case the definition in the Schedule shall govern for the purposes of that Schedule. Notwithstanding anything else in this Agreement, the Parties agree that this Agreement and each Party s obligations under this Agreement, are to be interpreted in respect of each Home as if the Parties had entered into individual agreements for that Home. The inclusion of multiple Homes in this Agreement is for administrative convenience only. Unless otherwise provided, the rights, obligations and remedies of each Party are to be considered the rights, obligations and remedies of that Party in respect of Services provided by the HSP at an individual Home only and not at all of the Homes. ARTICLE TERM AND NATURE OF THIS AGREEMENT of 406

328 2.1 Term. The term of this Agreement will commence on the Effective Date and will expire on the earlier of (1) March 31, 2019 or (2) the expiration or termination of all Licences, unless this Agreement is terminated earlier or extended pursuant to its terms. 2.2 A Service Accountability Agreement. This Agreement is a service accountability agreement for the purposes of section 20(1) of LHSIA and Part III of the CFMA. 2.3 Notice. Notice was given to the HSP that the LHIN intended to enter into this Agreement. The HSP hereby acknowledges receipt of such Notice in accordance with the terms of the CFMA. 2.4 Prior Agreements. The Parties acknowledge and agree that all prior agreements for the Services at each Home are terminated. ARTICLE PROVISION OF SERVICES 3.1 Provision of Services. (a) (b) (c) The HSP will provide the Services at each Home in accordance with, and otherwise comply with: (1) the terms of this Agreement; (2) Applicable Law; and (3) Applicable Policy. Unless otherwise provided in this Agreement, the HSP will not reduce, stop, start, expand, cease to provide or transfer the provision of the Services at any Home except with Notice to the LHIN and if required by Applicable Law or Applicable Policy, the prior written consent of the LHIN. The HSP will not restrict or refuse the provision of Services at any Home to an individual, directly or indirectly, based on the geographic area in which the person resides in Ontario. 3.2 Subcontracting for the Provision of Services. (a) (b) (c) The Parties acknowledge that, subject to the provisions of the Act and LHSIA, the HSP may subcontract the provision of some or all of the Services. For the purposes of this Agreement, actions taken or not taken by the subcontractor and Services provided by the subcontractor will be deemed actions taken or not taken by the HSP and Services provided by the HSP. When entering into a subcontract the HSP agrees that the terms of the subcontract will enable the HSP to meet its obligations under this Agreement. Without limiting the foregoing, the HSP will include a provision that permits the LHIN or its authorized representatives, to audit the subcontractor in respect of the subcontract if the LHIN or its authorized representatives determines that such an audit would be necessary to confirm that the HSP has complied with the terms of this Agreement. Nothing contained in this Agreement or a subcontract will create a contractual relationship between any subcontractor or its directors, officers, employees, agents, partners, affiliates or volunteers and the LHIN of 406

329 3.3 Conflict of Interest. The HSP will use the Funding, provide the Services and otherwise fulfil its obligations under this Agreement without an actual, potential or perceived Conflict of Interest. The HSP will disclose to the LHIN without delay any situation that a reasonable person would interpret as an actual, potential or perceived Conflict of Interest and comply with any requirements prescribed by the LHIN to resolve any Conflict of Interest. 3.4 e-health/information Technology Compliance. The HSP agrees to: (a) (b) (c) (d) (e) assist the LHIN to implement provincial e-health priorities for and thereafter in accordance with the Accountability Agreement, as may be amended from time to time; comply with any technical and information management standards, including those related to data, architecture, technology, privacy and security set for health service providers by the MOHLTC, ehealth Ontario or the LHIN within the timeframes set by the MOHLTC or the LHIN as the case may be; implement and use the approved provincial e-health solutions identified in the LHIN e-health plan; implement technology solutions that are compatible or interoperable with the provincial blueprint and with the LHIN e-health plan; and include in its annual planning submission, plans for achieving ehealth priority initiatives. ARTICLE FUNDING 4.1 Funding. Subject to the terms of this Agreement, and in accordance with the applicable provisions of the Accountability Agreement, the LHIN will provide Funding in respect of each Home by depositing the Funding in monthly instalments over the Term, into an account designated by the HSP provided that the account resides at a Canadian financial institution and is in the name of the HSP. 4.2 Conditions of Funding. (a) (b) The HSP will: (1) use the Funding only for the purpose of providing the Services at the Home for which the Funding was provided in accordance with Applicable Law, Applicable Policy and the terms of this Agreement; (2) not use the Funding for compensation increases prohibited by Applicable Law; (3) meet all obligations in the Schedules; (4) fulfill all other obligations under this Agreement; and (5) plan for and achieve an Annual Balanced Budget. Interest Income will be reported to the LHIN and is subject to a year-end reconciliation. The LHIN may deduct the amount equal to the Interest Income from any further funding instalments under this or any other agreement with the of 406

330 HSP or the LHIN may require the HSP to pay an amount equal to the unused Interest Income to the Ministry of Finance. 4.3 Limitation on Payment of Funding. Despite section 4.1, the LHIN: (a) (b) (c) (d) (e) will not provide any funds to the HSP until this Agreement is fully executed; may pro-rate the Funding if this Agreement is signed after the Effective Date; will not provide any funds to the HSP until the HSP meets the insurance requirements described in section 11.4 in respect of each Home; will not be required to continue to provide funds in respect of a Home, (1) if the Minister or the Director so directs under the terms of the Act; (2) while the Home is under the control of an Interim Manager pursuant to section 157 of the Act; or (3) in the event the HSP breaches any of its obligations under this Agreement until the breach is remedied to the LHIN s satisfaction; and upon notice to the HSP, may adjust the amount of funds it provides to the HSP in any Funding Year in respect of a Home pursuant to Article Additional Funding. Unless the LHIN has agreed to do so in writing, the LHIN is not required to provide additional funds to the HSP for providing services other than the Services or for exceeding the requirements of Schedule D. 4.5 Additional Terms and Conditions. The LHIN may add such further terms or conditions on the use of the Funding as are required for the LHIN to meet its obligations under the Accountability Agreement, Applicable Law or Applicable Policy as the same may be amended during the Term. 4.6 Appropriation. Funding under this Agreement is conditional upon an appropriation of moneys by the Legislature of Ontario to the MOHLTC and funding of the LHIN by the MOHLTC pursuant to LHSIA. If the LHIN does not receive its anticipated funding the LHIN will not be obligated to make the payments required by this Agreement. 4.7 Procurement of Goods and Services. (a) (b) If the HSP is subject to the procurement provisions of the BPSAA, the HSP will abide by all directives and guidelines issued by the Management Board of Cabinet that are applicable to the HSP pursuant to the BPSAA. If the HSP is not subject to the procurement provisions of the BPSAA, the HSP will have a procurement policy in place that requires the acquisition of supplies, equipment or services valued at over $25,000 through a competitive process that ensures the best value for funds expended. If the HSP acquires supplies, equipment or services with the Funding it will do so through a process that is consistent with this policy. 4.8 Disposition. The HSP will not sell, lease or otherwise dispose of any assets purchased with Funding, except as may be required by Applicable Law or otherwise in accordance with Applicable Policy of 406

331 ARTICLE ADJUSTMENT AND RECOVERY OF FUNDING 5.1 Adjustment of Funding. (a) The LHIN may adjust the Funding in any of the following circumstances: (1) in the event of changes to Applicable Law or Applicable Policy that affect Funding; (2) on a change to the Services; (3) if required by either the Director or the Minister under the Act; (4) in the event that a breach of this Agreement is not remedied to the satisfaction of the LHIN; and (5) as otherwise permitted by this Agreement. (b) (c) Funding recoveries or adjustments required pursuant to 5.1(a) may be accomplished through the adjustment of Funding, requiring the repayment of Funding and/or through the adjustment of the amount of any future funding installments. Approved Funding already expended properly in accordance with this Agreement will not be subject to adjustment. The LHIN will, at its sole discretion, and without liability or penalty, determine whether the Funding has been expended properly in accordance with this Agreement. In determining the amount of a funding adjustment under 5.1 (a) (4) or (5), LHIN shall take into account the following principles: (1) Resident care must not be compromised through a funding adjustment arising from a breach of this Agreement; (2) the HSP should not gain from a breach of this Agreement; (3) if the breach reduces the value of the Services, the funding adjustment should be at least equal to the reduction in value; and (4) the funding adjustment should be sufficient to encourage subsequent compliance with this Agreement, and such other principles as may be articulated in Applicable Law or Applicable Policy from time to time. 5.2 Provision for the Recovery of Funding. The HSP will make reasonable and prudent provision for the recovery by the LHIN of any Funding for which the conditions of Funding set out in section 4.2(a) are not met and will hold this Funding in an interest bearing account until such time as reconciliation and settlement has occurred with the LHIN. 5.3 Settlement and Recovery of Funding for Prior Years. (a) (b) The HSP acknowledges that settlement and recovery of Funding for Services at a Home can occur up to seven years after the provision of Funding. Recognizing the transition of responsibilities from the MOHLTC to the LHIN, the HSP agrees that if the Parties are directed in writing to do so by the MOHLTC, the LHIN will settle and recover funding provided by the MOHLTC to the HSP prior to the transition of the funding for the Services to the LHIN, provided that of 406

332 5.4 Debt Due. such settlement and recovery occurs within seven years of the provision of the funding by the MOHLTC. All such settlements and recoveries will be subject to the terms applicable to the original provision of funding. (a) (b) If the LHIN requires the re-payment by the HSP of any Funding, the amount required will be deemed to be a debt owing to the Crown by the HSP. The LHIN may adjust future funding instalments to recover the amounts owed or may, at its discretion, direct the HSP to pay the amount owing to the Crown and the HSP shall comply immediately with any such direction. All amounts repayable to the Crown will be paid by cheque payable to the Ontario Minister of Finance and mailed or delivered to the LHIN at the address provided in section Interest Rate. The LHIN may charge the HSP interest on any amount owing by the HSP at the then current interest rate charged by the Province of Ontario on accounts receivable. ARTICLE PLANNING & INTEGRATION 6.1 Planning for Future Years. (a) (b) (c) (d) Advance Notice. The LHIN will give at least sixty Days Notice to the HSP of the date by which a Planning Submission, approved by the HSP s governing body, must be submitted to the LHIN. Unless otherwise advised by the LHIN, the HSP will provide a Planning Submission for each Home. Multi-Year Planning. The Planning Submission will be in a form acceptable to the LHIN and may be required to incorporate (1) prudent multi-year financial forecasts; (2) plans for the achievement of Performance Targets; and (3) realistic risk management strategies. It will be aligned with the LHIN s then current Integrated Health Service Plan and will reflect local LHIN priorities and initiatives. If the LHIN has provided multi-year planning targets for the HSP, the Planning Submission will reflect the planning targets. Multi-year Planning Targets. Parties acknowledge that the HSP is not eligible to receive multi-year planning targets under the terms of Schedule B in effect as of the Effective Date. In the event that Schedule B is amended over the Term and the LHIN is able to provide the HSP with multi-year planning targets, (the HSP acknowledges that these targets are: (1) targets only, (2) provided solely for the purposes of planning, (3) are subject to confirmation and (4) may be changed at the discretion of the LHIN. The HSP will proactively manage the risks associated with multi-year planning and the potential changes to the planning targets. The LHIN agrees that it will communicate any material changes to the planning targets as soon as reasonably possible. Service Accountability Agreements. Subject to advice from the Director about the HSP s history of compliance under the Act and provided that the HSP has fulfilled its obligations under this Agreement, the Parties expect that they will enter into a new service accountability agreement at the end of the Term. The of 406

333 LHIN will give the HSP at least six months Notice if the LHIN does not intend to enter into negotiations for a subsequent service accountability agreement because the HSP has not fulfilled its obligations under this Agreement. The HSP acknowledges that if the LHIN and the HSP enter into negotiations for a subsequent service accountability agreement, subsequent funding may be interrupted if the next service accountability agreement is not executed on or before the expiration date of this Agreement. 6.2 Community Engagement & Integration Activities (a) (b) (c) Community Engagement. The HSP will engage the community of diverse persons and entities in each area where it provides health services when setting priorities for the delivery of health services in that area and when developing plans for submission to the LHIN including but not limited to the HSP s Planning Submissions and integration proposals. Integration. The HSP will, separately and in conjunction with the LHIN and other health service providers, identify opportunities to integrate the services of the local health system to provide appropriate, co-coordinated, effective and efficient services. Reporting. The HSP will report on its community engagement and integration activities as requested by the LHIN and in any event, in its Q4 Performance Report to the LHIN. 6.3 Planning and Integration Activity Pre-proposals. (a) (b) (c) General: A pre-proposal process has been developed to (1) reduce the costs incurred by an HSP when proposing operational or service changes at a Home; (2) assist the HSP to carry out its statutory obligations; and (3) enable an effective and efficient response by the LHIN. Subject to specific direction from the LHIN, this pre-proposal process will be used in the following instances: (1) the HSP is considering an integration, or an integration of services, as defined in LHSIA between the HSP and another person or entity; (2) the HSP is proposing to reduce, stop, start, expand or transfer the location of Services; (3) to identify opportunities to integrate the services of the local health system, other than those identified in (A) or (B) above; or (4) if requested by the LHIN. LHIN Evaluation of the Pre-proposal: Use of the pre-proposal process is not formal Notice of a proposed integration under section. 27 of LHSIA. LHIN consent to develop the project concept outlined in a pre-proposal does not constitute approval to proceed with the project. Nor does the LHIN consent to develop a project concept presume the issuance of a favourable decision, should such a decision be required by section 25 or 27 of LHSIA. Following the LHIN s review and evaluation, the HSP may be invited to submit a detailed proposal and a business plan for further analysis. Guidelines for the development of a detailed proposal and business case will be provided by the LHIN. Where an HSP integrates its services with those of another person and the integration relates to services funded in whole or in part by the LHIN, the HSP will follow the provisions of section 27 of LHSIA. Without limiting the foregoing, a of 406

334 transfer of services from the HSP to another person or entity is an example of an integration to which section 27 may apply. 6.4 Proposing Integration Activities in the Planning Submission. No integration activity described in section 6.3 may be proposed in a Planning Submission unless the LHIN has consented, in writing, to its inclusion pursuant to the process set out in section Termination of Designation of Convalescent Care Beds. (a) (b) Notwithstanding section 6.3, the provisions in this section 6.5 apply to the termination of a designation of convalescent care Beds. The HSP may terminate the designation of one or more convalescent care Beds at a Home and revert them back to long-stay Beds at any time provided the HSP gives the Ministry and the LHIN at least six months prior written Notice. Such Notice shall include: (1) a detailed transition plan, satisfactory to the LHIN acting reasonably, setting out the dates, after the end of the six month Notice period, on which the HSP plans to terminate the designation of each convalescent care Bed and to revert same to a long-stay Bed; and, (2) a detailed explanation of the factors considered in the selection of those dates. The designation of a convalescent care Bed will terminate and the Bed will revert to a long-stay Bed on the date, after the six month Notice period, on which the Resident who is occupying that convalescent care Bed at the end of the six month Notice period has been discharged from that Bed, unless otherwise agreed by the LHIN and the HSP. (c) The LHIN may terminate the designation of the convalescent care Beds at a Home at any time by giving at least six months prior written Notice to the HSP. Upon receipt of any such Notice, the HSP shall, within the timeframe set out in the Notice, provide the LHIN with: (1) a detailed transition plan, satisfactory to the LHIN acting reasonably, setting out the dates, after the end of the six month Notice period, on which the HSP plans to terminate the designation of each convalescent care Bed and, if required by the Notice, to revert same to a long-stay Bed; and, (2) a detailed explanation of the factors considered in the selection of those dates. The designation of a convalescent care Bed will terminate, and if applicable revert to a long-stay Bed on the date, after the six month Notice period, on which the Resident who is occupying that convalescent care Bed at the end of the Notice period has been discharged from that Bed, unless otherwise agreed by the LHIN and the HSP. 6.6 In this Article 6, the terms integrate, integration and services have the same meanings attributed to them in section 2(1) and section 23 respectively of LHSIA, as it and they may be amended from time to time of 406

335 (a) (b) service includes; (1) a service or program that is provided directly to people, (2) a service or program, other than a service or program described in clause (1), that supports a service or program described in that clause, or (3) a function that supports the operations of a person or entity that provides a service or program described in clause (1) or (2). integrate includes; (1) to co-ordinate services and interactions between different persons and entities, (2) to partner with another person or entity in providing services or in operating, (3) to transfer, merge or amalgamate services, operations, persons or entities, (4) to start or cease providing services, (5) to cease to operate or to dissolve or wind up the operations of a person or entity, and integration has a similar meaning. ARTICLE PERFORMANCE 7.1 Performance. The Parties will strive to achieve on-going performance improvement. They will address performance improvement in a proactive, collaborative and responsive manner. 7.2 Performance Factors. (a) (b) (c) Each Party will notify the other Party of the existence of a Performance Factor, as soon as reasonably possible after the Party becomes aware of the Performance Factor. The Notice will: (1) describe the Performance Factor and its actual or anticipated impact; (2) include a description of any action the Party is undertaking, or plans to undertake, to remedy or mitigate the Performance Factor; (3) indicate whether the Party is requesting a meeting to discuss the Performance Factor; and (4) address any other issue or matter the Party wishes to raise with the other Party. The recipient Party will provide a written acknowledgment of receipt of the Notice within seven Days of the date on which the Notice was received ( Date of the Notice ). Where a meeting has been requested under section 7.2(a), the Parties agree to meet and discuss the Performance Factors within fourteen Days of the Date of the Notice, in accordance with the provisions of section 7.3. PICB may be included in any such meeting at the request of either Party of 406

336 7.3 Performance Meetings. During a meeting on performance, the Parties will: (a) (b) (c) discuss the causes of a Performance Factor; discuss the impact of a Performance Factor on the local health system and the risk resulting from non-performance; and determine the steps to be taken to remedy or mitigate the impact of the Performance Factor (the Performance Improvement Process ). 7.4 The Performance Improvement Process. (a) The Performance Improvement Process will focus on the risks of nonperformance and problem-solving. It may include one or more of the following actions: (1) a requirement that the HSP develop and implement an improvement plan that is acceptable to the LHIN; (2) the conduct of a Review; (3) a revision and amendment of the HSP s obligations; and (4) an in-year, or year end, adjustment to the Funding, among other possible means of responding to the Performance Factor or improving performance. (b) Any performance improvement process begun under a prior service accountability agreement that was not completed under the prior agreement will continue under this Agreement. Any performance improvement required by a LHIN under a prior service accountability agreement will be deemed to be a requirement of this Agreement until fulfilled or waived by the LHIN. ARTICLE REPORTING, ACCOUNTING AND REVIEW 8.1 Reporting. (a) (b) (c) Generally. The LHIN s ability to enable its local health system to provide appropriate, co-ordinated, effective and efficient health services as contemplated by LHSIA, is heavily dependent on the timely collection and analysis of accurate information. The HSP acknowledges that the timely provision of accurate information related to the HSP, the Homes, their Residents and the HSP s performance of its obligations under this Agreement, is under the HSP s control. Reporting by Home. For certainty, notwithstanding anything else in this Agreement and consistent with the requirements under the Act, the HSP s reporting obligations under this Agreement apply with respect to each Home individually. Specific Obligations. The HSP (1) will provide to the LHIN, or to such other entity as the LHIN may direct, in the form and within the time specified by the LHIN, the Reports other than personal health information as defined in section 31 (5) of the CFMA, that (1) the LHIN requires for the purposes of exercising its powers and duties under this Agreement, LHSIA or for of 406

337 the purposes that are prescribed under LHSIA, or (2) may be requested under the CFMA; (2) will comply with the applicable reporting standards and requirements in both Chapter 9 of the Ontario Healthcare Reporting Standards and the RAI MDS Tools; (3) will fulfil the specific reporting requirements set out in Schedule C; (4) will ensure that every Report is complete, accurate, signed on behalf of the HSP by an authorized signing officer where required and provided in a timely manner and in a form satisfactory to the LHIN; and (5) agrees that every Report submitted by or on behalf of the HSP, will be deemed to have been authorized by the HSP for submission. (d) (e) (f) (g) RAI MDS. Without limiting the foregoing, the HSP (1) will conduct quarterly assessments of Residents at each Home, and all other assessments of Residents required by the RAI MDS Tools, using the RAI MDS Tools; (2) will ensure that the RAI-MDS Tools are used correctly to produce an accurate assessment of the Residents at each Home (RAI MDS Data); (3) will submit the RAI MDS Data to the Canadian Institute for Health Information in an electronic format at least quarterly in accordance with the submission guidelines set out by CIHI; and (4) acknowledges that if used incorrectly, the RAI MDS Tools can increase Funding beyond that to which the HSP would otherwise be entitled. The HSP will therefore have systems in place to regularly monitor, evaluate and where necessary correct the quality and accuracy of the RAI MDS Data provided in respect of the Residents at each Home. Health Quality Ontario. The HSP will work with Health Quality Ontario and other providers to advance the quality agenda and align quality improvement efforts across the local health care system; and, will submit a report to the LHIN that outlines how the HSP has done so. Without limiting the foregoing, the HSP will submit a Quality Improvement Plan to Health Quality Ontario that is aligned with this Agreement and supports local health system priorities. French Language Services. If the HSP is required to provide services to the public in French at a Home under the provisions of the French Language Services Act, the HSP will be required to submit a French language services report to the LHIN in respect of the Home. If the HSP is not required to provide services to the public in French at a Home under the provisions of the French Language Service Act, it will be required to provide a report to the LHIN that outlines how the HSP addresses the needs of its local Francophone community at the Home. Declaration of Compliance. On or before March 1 of each Funding Year, the Board will issue a Compliance Declaration declaring that the HSP has complied with the terms of this Agreement in respect of each Home. The form of the declaration is set out in Schedule E and may be amended from time to time through the term of this Agreement of 406

338 (h) Financial Reductions. Notwithstanding any other provision of this Agreement, and at the discretion of the LHIN, the HSP may be subject to a financial reduction if any of the Reports are received after the due date, are incomplete, or are inaccurate where the errors or delay were not as a result of either LHIN actions or inaction or the actions or inactions of persons acting on behalf of the LHIN. If assessed, the financial reduction will be taken from funding designated for this purpose in Schedule B as follows: (1) if received within 7 days after the due date, incomplete or inaccurate, the financial penalty will be the greater of (1) a reduction of 0.02 percent (0.02%) of the Funding; or (2) two hundred and fifty dollars ($250.00), and (2) for every full or partial week of non-compliance thereafter, the rate will be one half of the initial reduction. If assessed, financial reductions will be assessed in respect of each Home for which a Report was late, incomplete or inaccurate. 8.2 Reviews. (a) (b) (c) (d) (e) During the term of this Agreement and for seven years after the term of this Agreement, the HSP agrees that the LHIN or its authorized representatives may conduct a Review of the HSP and any one or more of the Homes, to confirm the HSP s fulfillment of its obligations under this Agreement. For these purposes the LHIN or its authorized representatives may, upon twenty-four hours Notice to the HSP and during normal business hours enter the HSP s premises, including any one or more Homes, to: (1) inspect and copy any financial records, invoices and other financerelated documents, other than personal health information as defined in section 31(5) of the CFMA, in the possession or under the control of the HSP which relate to the Funding or otherwise to the Services, and (2) inspect and copy non-financial records, other than personal health information as defined in section 31(5) of the CFMA, in the possession or under the control of the HSP which relate to the Funding, the Services or otherwise to the performance of the HSP under this Agreement. The cost of any Review will be borne by the HSP if the Review (1) was made necessary because the HSP did not comply with a requirement under the Act or this Agreement; or (2) indicates that the HSP has not fulfilled its obligations under this Agreement, including its obligations under Applicable Law or Applicable Policy. To assist in respect of the rights set out in (b) above the HSP shall disclose any information requested by the LHIN or its authorized representatives, and shall do so in a form requested by the LHIN or its authorized representatives. The HSP may not commence a proceeding for damages or otherwise against any person with respect to any act done or omitted to be done, any conclusion reached or report submitted that is done in good faith in respect of a Review. HSP s obligations under this section 8.2 will survive any termination or expiration of this Agreement of 406

339 8.3 Document Retention and Record Maintenance. The HSP will (a) (b) (c) retain all records (as that term is defined in FIPPA) related to the HSP s performance of its obligations under this Agreement for seven (7) years after the termination or expiration of the term of this Agreement. The HSP s obligations under this section will survive any termination or expiry of this Agreement; keep all financial records, invoices and other finance-related documents relating to the Funding or otherwise to the Services by Home and in a manner consistent with either generally accepted accounting principles or international financial reporting standards as advised by the HSP s auditor; and keep all non-financial documents and records relating to the Funding or otherwise to the Services by Home in a manner consistent with all Applicable Law. 8.4 Disclosure of Information. (a) (b) FIPPA. The HSP acknowledges that the LHIN is bound by FIPPA and that any information provided to the LHIN in connection with this Agreement may be subject to disclosure in accordance with FIPPA. Confidential Information. The Parties will treat Confidential Information as confidential and will not disclose Confidential Information except with the consent of the disclosing Party or as permitted or required under FIPPA, the Municipal Freedom of Information and Protection of Privacy Act, the Personal Health Information Protection Act, 2004, the Act, court order, subpoena or other Applicable Law. Notwithstanding the foregoing, the LHIN may disclose information that it collects under this Agreement in accordance with LHSIA and the CFMA Transparency. The HSP will post a copy of this Agreement and each Compliance Declaration submitted to the LHIN during the term of this Agreement in a conspicuous and easily accessible public place at each Home. If the HSP or a Home operates a public website, this Agreement will also be posted on those websites. 8.6 Auditor General. For greater certainty the LHIN s rights under this article are in addition to any rights provided to the Auditor General under the Auditor General Act (Ontario). ARTICLE ACKNOWLEDGEMENT OF LHIN SUPPORT 9.1 Publication. For the purposes of this Article 9, the term publication means any material on or concerning the Services that the HSP makes available to the public, regardless of whether the material is provided electronically or in hard copy. Examples include a web-site, an advertisement, a brochure, promotional documents and a report. Materials that are prepared by the HSP in order to fulfil its reporting obligations under this Agreement are not included in the term publication. 9.2 Acknowledgment of Funding Support. (a) The HSP agrees all publications will include of 406

340 (1) an acknowledgment of the Funding provided by the LHIN and the Government of Ontario. Prior to including an acknowledgement in any publication, the HSP will obtain the LHIN s approval of the form of acknowledgement. The LHIN may, at its discretion, decide that an acknowledgement is not necessary; and (2) a statement indicating that the views expressed in the publication are the views of the HSP and do not necessarily reflect those of the LHIN or the Government of Ontario. (b) The HSP shall not use any insignia or logo of Her Majesty the Queen in right of Ontario, including those of the LHIN, unless it has received the prior written permission of the LHIN to do so. ARTICLE REPRESENTATIONS, WARRANTIES AND COVENANTS 10.1 General. The HSP represents, warrants and covenants that: (a) (b) (c) (d) (e) (f) it is, and will continue for the term of this Agreement to be, a validly existing legal entity with full power to fulfill its obligations under this Agreement; it has the experience and expertise necessary to carry out the Services at each Home; it holds all permits, licences, consents intellectual property rights and authorities necessary to perform its obligations under this Agreement; all information that the HSP provided to the LHIN in its Planning Submissions or otherwise in support of its application for funding was true and complete at the time the HSP provided it, and will, subject to the provision of Notice otherwise, continue to be true and complete for the term of this Agreement; it has not and will not for the term of this Agreement, enter into a non-arm s transaction that is prohibited by the Act; and it does, and will continue for the term of this Agreement to, operate in compliance with all Applicable Law and Applicable Policy Execution of Agreement. The HSP represents and warrants that: (a) (b) it has the full power and authority to enter into this Agreement; and it has taken all necessary actions to authorize the execution of the Agreement Governance. (a) The HSP represents, warrants and covenants that it has established, and will maintain for the period during which this Agreement is in effect, policies and procedures: (1) that set out a code of conduct for, and that identify, the ethical obligations of HSP s Personnel and Volunteers; (2) to ensure the ongoing effective functioning of the HSP; (3) for effective and appropriate decision-making; of 406

341 (b) (4) for effective and prudent risk-management, including the identification and management of potential, actual and perceived conflicts of interest; (5) for the prudent and effective management of the Funding; (6) to monitor and ensure the accurate and timely fulfillment of the HSP s obligations under this Agreement and compliance with the Act and LHSIA; (7) to enable the preparation, approval and delivery of all Reports; and (8) to address complaints about the provision of Services, the management or governance of a Home or the HSP; and (9) to deal with such other matters as the HSP considers necessary to ensure that the HSP carries out its obligations under this Agreement. The HSP represents and warrants that it: (1) has, or will have within 60 days of the execution of this Agreement, a Performance Agreement with its CEO. (2) will take all reasonable care to ensure that its CEO complies with the Performance Agreement; and (3) will enforce the HSP s rights under the Performance Agreement Funding, Services and Reporting. The HSP represents warrants and covenants that: (a) (b) (c) the Funding is, and will continue to be, used only to provide the Services at the Homes in accordance with the terms of this Agreement: the Services are and will continue to be provided at the Homes: (1) by persons with the expertise, professional qualifications, licensing and skills necessary to complete their respective tasks; and (2) in compliance with Applicable Law and Applicable Policy; and every Report is, and will continue to be, accurate and in full compliance with the provisions of this Agreement, including any particular requirements applicable to the Report Supporting Documentation. Upon request, the HSP will provide the LHIN with proof of the matters referred to in this Article. ARTICLE LIMITATION OF LIABILITY, INDEMNITY & INSURANCE 11.1 Limitation of Liability. The Indemnified Parties will not be liable to the HSP or any of the HSP s Personnel and Volunteers for costs, losses, claims, liabilities and damages howsoever caused arising out of or in any way related to the Services or otherwise in connection with this Agreement, unless caused by the negligence or wilful act of any of the Indemnified Parties Same. For greater certainty and without limiting section 11.1, the LHIN is not liable for how the HSP and the HSP s Personnel and Volunteers carry out the Services and is therefore not responsible to the HSP for such Services. Moreover the LHIN is not contracting with or employing any HSP s Personnel and Volunteers to carry out the terms of this Agreement. As such, it is not liable for contracting with, employing or terminating a contract with or the employment of any HSP s Personnel and Volunteers of 406

342 required to carry out this Agreement, nor for the withholding, collection or payment of any taxes, premiums, contributions or any other remittances due to government for the HSP s Personnel and Volunteers required by the HSP to carry out this Agreement Indemnification. The HSP hereby agrees to indemnify and hold harmless the Indemnified Parties from and against any and all liability, loss, costs, damages and expenses (including legal, expert and consultant costs), causes of action, actions, claims, demands, lawsuits or other proceedings (collectively, the Claims ), by whomever made, sustained, brought or prosecuted, including for third party bodily injury (including death), personal injury and property damage, in any way based upon, occasioned by or attributable to anything done or omitted to be done by the HSP or the HSP s Personnel and Volunteers in the course of the performance of the HSP s obligations under, or otherwise in connection with, this Agreement, unless caused by the negligence or wilful misconduct of any Indemnified Parties Insurance. (a) (b) Generally. The HSP shall protect itself from and against all claims that might arise from anything done or omitted to be done by the HSP and the HSP s Personnel and Volunteers under this Agreement and more specifically all claims that might arise from anything done or omitted to be done under this Agreement where bodily injury (including personal injury), death or property damage, including loss of use of property is caused. Required Insurance. The HSP will put into effect and maintain, with insurers having a secure A.M. Best rating of B+ or greater, or the equivalent, all the necessary and appropriate insurance that a prudent person in the business of the HSP would maintain including, but not limited to, the following at its own expense. (1) Commercial General Liability Insurance. Commercial General Liability Insurance, for third party bodily injury, personal injury and property damage to an inclusive limit of not less than two million dollars per occurrence and not less than two million dollars products and completed operations aggregate. The policy will include the following clauses: A. The Indemnified Parties as additional insureds, B. Contractual Liability, C. Cross-Liability, D. Products and Completed Operations Liability, E. Employers Liability and Voluntary Compensation unless the HSP complies with the Section below entitled Proof of WSIA Coverage, F. Tenants Legal Liability (for premises/building leases only), G. Non-Owned automobile coverage with blanket contractual coverage for hired automobiles, and H. A thirty-day written notice of cancellation, termination or material change. (2) Proof of WSIA Coverage. Unless the HSP put into effect and maintains Employers Liability and Voluntary Compensation as set out above, the HSP will provide the LHIN with a valid Workplace Safety of 406

343 (c) and Insurance Act, 1997 (WSIA) Clearance Certificate and any renewal replacements, and will pay all amounts required to be paid to maintain a valid WSIA Clearance Certificate throughout the term of this Agreement. (3) All Risk Property Insurance on property of every description, for the term, providing coverage to a limit of not less than the full replacement cost, including earthquake and flood. All reasonable deductibles and self-insured retentions are the responsibility of the HSP. (4) Comprehensive Crime insurance, Disappearance, Destruction and Dishonest coverage. (5) Errors and Omissions Liability Insurance insuring liability for errors and omissions in the provision of any professional services as part of the Services or failure to perform any such professional services, in the amount of not less than two million dollars per claim and in the annual aggregate. Certificates of Insurance. The HSP will provide the LHIN with proof of the insurance required by this Agreement in the form of a valid certificate of insurance that references this Agreement and confirms the required coverage, on or before the commencement of this Agreement, and renewal replacements on or before the expiry of any such insurance. Upon the request of the LHIN, a copy of each insurance policy shall be made available to it. The HSP shall ensure that each of its subcontractors obtains all the necessary and appropriate insurance that a prudent person in the business of the subcontractor would maintain and that the Indemnified Parties are named as additional insureds with respect to any liability arising in the course of performance of the subcontractor's obligations under the subcontract. ARTICLE TERMINATION 12.1 General Provision. This Agreement may be terminated in accordance with the provisions of this Article, with respect to one or more Homes. In the event that this Agreement is terminated in respect of a specific Home, the Agreement is only terminated with respect to those Services at that Home and the Agreement remains in full force and effect in respect of Services provided by the HSP at the remaining Homes Termination by the LHIN. (a) Immediate Termination in Respect of a Single Home. The LHIN may terminate this Agreement in respect of a Home immediately upon giving Notice to the HSP if: (1) the HSP is unable to provide or has discontinued the Services in whole or in part or the HSP ceases to carry on business; or (2) the Home has been closed of 406

344 (b) Immediate Termination in Respect of Any or All Homes. In addition to the foregoing, the LHIN may terminate this Agreement in respect of any or all Homes, immediately upon giving Notice to the HSP if: (1) The HSP ceases to carry on business; (2) the HSP makes an assignment, proposal, compromise, or arrangement for the benefit of creditors, or is petitioned into bankruptcy, or files for the appointment of a receiver; (3) the LHIN is directed, pursuant to the Act, to terminate this Agreement by the Minister or the Director; or (4) as provided for in section 4.6, the LHIN does not receive the necessary funding from the MOHLTC. (c) (d) Termination in the Event of Financial Difficulties. If the HSP makes an assignment, proposal, compromise, or arrangement for the benefit of creditors, or is petitioned into bankruptcy, or files for the appointment of a receiver the LHIN will consult with the Director before determining whether this Agreement will be terminated in respect of a Home. If the LHIN terminates this Agreement in respect of a Home because a person has exercised a security interest as contemplated by section 107 of the Act, the LHIN would expect to enter into a service accountability agreement with the person exercising the security interest or the receiver or other agent acting on behalf of that person where the person has obtained the Director's approval under section 110 of the Act and has met all other relevant requirements of Applicable Law. Opportunity to Remedy Material Breach. If an HSP breaches any material provision of this Agreement, including, but not limited to, the reporting requirements in Article 8 and the representations and warranties in Article 10 and the breach has not been satisfactorily resolved under Article 7, the LHIN will give the HSP Notice, which Notice shall identify the subject Home and specify the particulars of the breach and the period of time within which the HSP is required to remedy the breach. In the event that one or more Homes are to be subject to termination in accordance with this Section, each Home shall be subject of a separate Notice. The Notice will advise the HSP that the LHIN will terminate this Agreement in respect of the Home: (1) at the end of the Notice period provided for in the Notice if the HSP fails to remedy the breach within the time specified in the Notice; or (2) prior to the end of the Notice period provided for in the Notice if it becomes apparent to the LHIN that the HSP cannot completely remedy the breach within that time or such further period of time as the LHIN considers reasonable, or the HSP is not proceeding to remedy the breach in a way that is satisfactory to the LHIN; and the LHIN may then terminate this Agreement in accordance with the Notice Termination of Services by the HSP. (a) Except as provided in 12.3(b) and (c) below, the HSP may terminate this Agreement at any time, for any reason, in respect of one or more Homes, upon giving the LHIN at least six months Notice of 406

345 (b) (c) Where the HSP intends to cease providing the Services and close a Home, the HSP will provide Notice to the LHIN at the same time the HSP is required to provide notice to the Director under the Act. The HSP will ensure that the closure plan required by the Act is acceptable to the LHIN. Where the HSP intends to cease providing the Services as a result of an intended sale or transfer of a License in whole or in part, the HSP will comply with section 6.3 of this Agreement. Notice under section 27 of LHSIA will not be effective unless accompanied by a transition plan that is acceptable to the LHIN, if such a transition plan is requested pursuant to section Consequences of Termination. (a) (b) If this Agreement is terminated in respect of a Home, pursuant to this Article, the LHIN may: (1) cancel all further Funding instalments; (2) demand the repayment of any Funding remaining in the possession or under the control of the HSP; (3) determine the HSP s reasonable costs to wind down the Services; and (4) permit the HSP to offset the costs determined pursuant to section (3), against the amount owing pursuant to section (2). Despite (a), if the cost determined pursuant to section 12.3(a) (3) exceeds the Funding remaining in the possession or under the control of the HSP the LHIN will not provide additional monies to the HSP to wind down the Services Effective Date. Termination under this Article will take effect as set out in the Notice Corrective Action. Despite its right to terminate this Agreement pursuant to this Article, the LHIN may choose not to terminate this Agreement and may take whatever corrective action it considers necessary and appropriate, including suspending Funding for such period as the LHIN determines, to ensure the successful completion of the Services in accordance with the terms of this Agreement. ARTICLE NOTICE 13.1 Notice. A Notice will be in writing; delivered personally, by pre-paid courier, or sent by facsimile or with confirmation of receipt, or by any form of mail where evidence of receipt is provided by the post office. When a Notice is sent by , a confirmation of receipt shall include acknowledgment by the Notice recipient of an automated request for receipt, or a written reply from the Notice recipient acknowledging receipt. A Notice will be addressed to the other Party as provided below or as either Party will later designate to the other in writing: of 406

346 To the LHIN: Insert name of LHIN Insert address of LHIN Attention: [insert position] Fax: Telephone: To the HSP: insert name of HSP insert address of HSP Attention:[insert position] Fax: Telephone: 13.2 Notices Effective From. A Notice will be effective at the time the delivery is made if the Notice is delivered personally or by pre-paid courier. If delivered by mail, a Notice will be effective five business days after the day it was mailed. A Notice that is delivered by facsimile or by will be effective when its receipt is acknowledged as required by this Article. ARTICLE INTERPRETATION 14.1 Interpretation. In the event of a conflict or inconsistency in any provision of this Agreement, the main body of this Agreement will prevail over the Schedules Jurisdiction. Where this Agreement requires compliance with the Act, the Director will determine compliance and advise the LHIN. Where the Act requires compliance with this Agreement, the LHIN will determine compliance and advise the Director Determinations by the Director. All determinations required by the Director under this Agreement are subject to an HSP s rights of review and appeal under the Act The Act. For greater clarity, nothing in this Agreement supplants or otherwise excuses the HSP from the fulfillment of any requirements of the Act. The HSP s obligations in respect of LHSIA and this Agreement are separate and distinct from the HSP s obligations under the Act. ARTICLE ADDITIONAL PROVISIONS 15.1 Currency. All payment to be made by the LHIN or the HSP under this Agreement shall be made in the lawful currency of Canada Invalidity or Unenforceability of Any Provision. The invalidity or unenforceability of any provision of this Agreement will not affect the validity or enforceability of any other provision of this Agreement and any invalid or unenforceable provision will be deemed to be severed Terms and Conditions on Any Consent. Any consent or approval that the LHIN may grant under this Agreement is subject to such terms and conditions as the LHIN may reasonably require of 406

347 15.4 Waiver. A Party may only rely on a waiver of the Party s failure to comply with any term of this Agreement if the other Party has provided a written and signed Notice of waiver. Any waiver must refer to a specific failure to comply and will not have the effect of waiving any subsequent failures to comply Parties Independent. The Parties are and will at all times remain independent of each other and are not and will not represent themselves to be the agent, joint venturer, partner or employee of the other. No representations will be made or acts taken by either Party which could establish or imply any apparent relationship of agency, joint venture, partnership or employment and neither Party will be bound in any manner whatsoever by any agreements, warranties or representations made by the other Party to any other person or entity, nor with respect to any other action of the other Party LHIN is an Agent of the Crown. The Parties acknowledge that the LHIN is an agent of the Crown and may only act as an agent of the Crown in accordance with the provisions of LHSIA. Notwithstanding anything else in this Agreement, any express or implied reference to the LHIN providing an indemnity or any other form of indebtedness or contingent liability that would directly or indirectly increase the indebtedness or contingent liabilities of the LHIN or of Ontario, whether at the time of execution of this Agreement or at any time during the term of this Agreement, will be void and of no legal effect Express Rights and Remedies Not Limited. The express rights and remedies of the LHIN are in addition to and will not limit any other rights and remedies available to the LHIN at law or in equity. For further certainty, the LHIN has not waived any provision of any applicable statute, including the Act, LHSIA and the CFMA, nor the right to exercise its right under these statutes at any time No Assignment. The HSP will not assign either this Agreement or the Funding in whole or in part, directly or indirectly, without the prior written consent of the LHIN which consent shall not be unreasonably withheld. No assignment or subcontract shall relieve the HSP from its obligations under this Agreement or impose any liability upon the LHIN to any assignee or subcontractor. The LHIN may assign this Agreement or any of its rights and obligations under this Agreement to any one or more of the LHINs or to the MOHLTC Governing Law. This Agreement and the rights, obligations and relations of the Parties hereto will be governed by and construed in accordance with the laws of the Province of Ontario and the federal laws of Canada applicable therein. Any litigation arising in connection with this Agreement will be conducted in Ontario unless the Parties agree in writing otherwise Survival. The provisions in Articles 1.0, 5.0, 8.0, 11.0, 13.0, 14.0 and 15.0 and sections 2.4, 4.6, 10.4, 10.5 and 12.3 will continue in full force and effect for a period of seven years from the date of expiry or termination of this Agreement Further Assurances. The Parties agree to do or cause to be done all acts or things necessary to implement and carry into effect this Agreement to its full extent Amendment of Agreement. This Agreement may only be amended by a written agreement duly executed by the Parties of 406

348 15.13 Counterparts. This Agreement may be executed in any number of counterparts, each of which will be deemed an original, but all of which together will constitute one and the same instrument. ARTICLE ENTIRE AGREEMENT 16.1 Entire Agreement. This Agreement together with the appended Schedules constitutes the entire Agreement between the Parties with respect to the subject matter contained in this Agreement and supersedes all prior oral or written representations and agreements. The Parties have executed this Agreement on the dates set out below. XXX LOCAL HEALTH INTEGRATION NETWORK By: [Name], Chair Date And by: [Name], CEO Date [Insert Full Legal Name of HSP] By: [Name], Chair Date I have authority to bind the HSP And by: [Name], [Title] Date I have authority to bind the HSP of 406

349 Schedule A: Description of Home and Beds A.1 General Information LTCH Legal Name / Licensee LTCH Common Name LTCH Facility ID Number LTCH Facility (master number for RAI MDS) Address City Geography served (catchment area) Accreditation organization Date of Last Accreditation Postal Code Year(s) Awarded A.2 Licensed or Approved Beds & Classification / Bed Type Bed Types Total # of Beds A B C D New Term of Licence Regular Long Stay Beds Convalescent Care Beds Respite Beds Comments/Additional Information Beds in Abeyance ELDCAP Beds Interim Beds Veterans Priority Access beds Other beds * Sub Total # all Bed Types Total # all Bed Types *Other beds available under a Temporary Emergency Licence or Short-Term Authorization of 406

350 Schedule A: Description of Home and Beds Cont d A.3 Structural Information Type of Room (this refers to structural layout rather than what is charged in accommodations) Number of rooms with 1 Number of rooms with Number of Floors bed 2 beds Number of rooms with 3 beds Number of rooms with 4 beds Total # Rooms Original Construction Date (Year) Renovations: Please list year and details (unit/resident home area, design standards, # beds, reason for renovating) 1) 2) 3) 4) Number of Units/Resident Home Areas and Beds Unit/Resident Home Area Number of Beds of 406

351 Schedule B Additional Terms and Conditions Applicable to the Funding Model 1.0 Background. The LHINs provide subsidy funding to long-term care home health service providers pursuant to a funding model set by MOHLTC. The current model provides estimated per diem funding that is subsequently reconciled. The current funding model is under review and may change during the Term (as defined below). As a result, and for ease of amendment during the Term, this Agreement incorporates certain terms and conditions that relate to the funding model in this Schedule B. 2.0 Additional Definitions. Any terms not otherwise defined in this Schedule have the same meaning attributed to them in the main body of this Agreement. The following terms have the following meanings: "Approved Funding" means the allowable subsidy for the Term determined by reconciling the Estimated Provincial Subsidy (as defined below) in accordance with Applicable Law and Applicable Policy Construction Funding Subsidy or CFS means the funding that the MOHLTC agreed to provide, or to ensure the provision of, to the HSP, in an agreement for the construction, development, redevelopment, retrofitting or upgrading of beds (a Development Agreement ). CFS Commitments means (a) commitments of the HSP related to a Development Agreement, identified in Schedule A of the service agreement in respect of the Home, in effect between the HSP and the LHIN on June 30, 2010, and (b) commitments of the HSP identified in a Development Agreement in respect of beds that were developed or redeveloped and opened for occupancy after June 30, 2010, (including, without limitation, any commitments set out in the HSP s Application as defined in the Development Agreement, and any conditions agreed to in the Development Agreement in respect of any permitted variances from standard design standards.) "Envelope" is a portion of the Estimated Provincial Subsidy that is designated for a specific use. There are four Envelopes in the Estimated Provincial Subsidy as follows: (a) the Nursing and Personal Care Envelope; (b) the Program and Support Services Envelope; (c) the Raw Food Envelope; and (d) the Other Accommodation Envelope. Estimated Provincial Subsidy means the estimated provincial subsidy calculated in accordance with Applicable Policy. Reconciliation Reports means the reports required by Applicable Policy including the Long-term Care Home Annual Report and, the In-Year Revenue/Occupancy Report. Term means the term of this Agreement. 3.0 Provision of Funding. 351 of 406

352 3.1 In each Funding Year, the LHIN shall advise the HSP of the amount of its Estimated Provincial Subsidy. The amount of the Estimated Provincial Subsidy shall be calculated on both a monthly basis and an annual basis and will be allocated among the Envelopes and other funding streams applicable to the HSP, including the CFS. 3.2 The Estimated Provincial Subsidy shall be provided to the HSP on a monthly basis in accordance with the monthly calculation described in 3.1 and otherwise in accordance with this Agreement. Payments will be made to the HSP on or about the twenty-second (22 nd ) day of each month of the Term. 3.3 CFS will be provided as part of the Estimated Provincial Subsidy and in accordance with the terms of the Development Agreement and Applicable Policy. This obligation survives any termination of this Agreement. 4.0 Use of Funding. 4.1 Unless otherwise provided in this Schedule B, the HSP shall use All Funding allocated for a particular Envelope only for the use or uses set out in the Applicable Policy. 4.2 The HSP shall not transfer any portion of the Estimated Provincial Subsidy in the Raw Food Envelope to any other Envelope: 4.3 The HSP may transfer all or any of the part of the Estimated Provincial Subsidy for the Other Accommodation Envelope to any other Envelope without the prior written approval of the LHIN, provided that the HSP has complied with the standards and criteria for the Other Accommodation Envelope as set out in Applicable Policy. 4.4 The HSP may transfer any part of the Estimated Provincial Subsidy in the (a) Nursing and Personal Care Envelope; or (b) the Program and Support Services Envelope; to any Envelope other than the Other Accommodation Envelope without the prior written approval of the LHIN provided that the transfer is done in accordance with Applicable Policy. 4.5 In the event that a financial reduction is determined by the LHIN, the financial reduction will be applied against the portion of the Estimated Provincial Subsidy in the Other Accommodation Envelope. 5.0 Construction Funding Subsidies. 5.1 Subject to 5.2 and 5.3 the HSP is required to continue to fulfill all CFS Commitments, and the CFS Commitments are hereby incorporated into and deemed part of the Agreement. 5.2 The HSP is not required to continue to fulfill CFS Commitments that the MOHLTC has agreed in writing: (i) have been satisfactorily fulfilled; or (ii) are no longer required to be fulfilled; and the HSP is able to provide the LHIN with a copy of such written agreement. 5.3 Where this Agreement establishes or requires a service requirement that surpasses 352 of 406

353 the service commitment set out in the CFS Commitments, the HSP is required to comply with the service requirements in this Agreement. 5.4 MOHLTC is responsible for monitoring the HSP s on-going compliance with the CFS Commitments. Notwithstanding the foregoing, the HSP agrees to certify its compliance with the CFS Commitments when requested to do so by the LHIN. 6.0 Reconciliation. 6.1 The HSP shall complete the Reconciliation Reports and submit them to MOHLTC in accordance with Schedule C. The Reconciliation Reports shall be in such form and containing such information as required by Applicable Policy or as otherwise required by the LHIN pursuant this Agreement. 6.2 The Estimated Provincial Subsidy provided by the LHIN under section 3.0 of this Schedule shall be reconciled by the LHIN in accordance with Applicable Law and Applicable Policy to produce the Approved Funding. 6.3 In accordance with the Applicable Law and Applicable Policy, if the Estimated Provincial Subsidy paid to the HSP exceeds the Approved Funding for any period, the excess is a debt due and owing by the HSP to the Crown in right of Ontario which shall be paid by the HSP to the Crown in right of Ontario and, in addition to any other methods available to recover the debt, the LHIN may deduct the amount of the debt from any subsequent amounts to be provided by the LHIN to the HSP. If the Estimated Provincial Subsidy paid for any period is less than the Approved Funding, the LHIN shall provide the difference to the HSP. 353 of 406

354 Schedule C Reporting Requirements 1. In-Year Revenue/Occupancy Report Reporting Period Estimated Due Dates Jan to Sept By October 15, Jan to Sept By October 15, Jan to Sept By October 15, Long-Term Care Home Annual Report Reporting Period Estimated Due Dates Jan to Dec By September 30, Jan to Dec By September 30, Jan to Dec By September 30, French Language Services Report Fiscal Year Due Dates Apr to March April 28, Apr to March April 30, Apr to March April 30, OHRS/MIS Trial Balance Submission Due Dates (Must pass 3c Edits) Q2 Apr to Sept (Fiscal Year) October 31, 2016 Q2 Jan to Jun (Calendar Year) Q3 Apr to Dec (Fiscal Year) January 31, 2017 Optional Submission Q3 Jan to Sept (Calendar Year) Q4 Apr to March (Fiscal Year) May 31, 2017 Q4 Jan to Dec (Calendar Year) Due Dates (Must pass 3c Edits) Q2 Apr to Sept (Fiscal Year) October 31, 2017 Q2 Jan to June (Calendar Year) Q3 Apr to Dec (Fiscal Year) January 31, 2018 Optional Submission Q3 Jan to Sept (Calendar Year) Q4 Apr to March (Fiscal Year) May 31, 2018 Q4 Jan to Dec (Calendar Year) Due Dates (Must pass 3c Edits) Q2 Apr to Sept (Fiscal Year) October 31, 2018 Q2 Jan to June (Calendar Year) Q3 Apr to Dec (Fiscal Year) January 31, 2019 Optional Submission Q3 Jan to Sep (Calendar Year) Q4 Apr to March (Fiscal Year) May 31, 2019 Q4 Jan to Dec (Calendar Year) 5. Compliance Declaration Funding Year Due Dates January 1, 2016 December 31, 2016 March 1, 2017 January 1, 2017 December 31, 2017 March 1, 2018 January 1, 2018 December 31, 2018 March 1, These are estimated dates provided by the MOHLTC and are subject to change. If the due date falls on a weekend, reporting will be due the following business day of 406

355 Schedule C Reporting Requirements Cont d 6. Continuing Care Reporting System (CCRS)/RAI MDS Reporting Period Estimated Final Due Dates Q1 August 31, Q2 November 30, Q3 February 28, Q4 May 31, Q1 August 31, Q2 November 30, Q3 February 28, Q4 May 31, Q1 August 31, Q2 November 30, Q3 February 28, Q4 May 31, Staffing Report Reporting Period Estimated Due Dates 1 January 1, 2016 December 31, 2016 July 7, 2017 January 1, 2017 December 31, 2017 July 6, 2018 January 1, 2018 December 31, 2018 July 5, Quality Improvement Plan (submitted to Health Quality Ontario (HQO) with a copy sent to the LHIN) Planning Period Due Dates April 1, 2016 March 31, 2017 April 1, 2016 April 1, 2017 March 31, 2018 April 1, 2017 April 1, 2018 March 31, 2019 April 1, of 406

356 Schedule D Performance 1.0 Performance Indicators The HSP s delivery of the Services will be measured by the following Indicators, Targets and where applicable Performance Standards. In the following table: n/a means not-applicable, that there is no defined Performance Standard for the indicator for the applicable year. tbd means a Target, and a Performance Standard, if applicable, will be determined during the applicable year. INDICATOR CATEGORY INDICATOR P=Performance Indicator E=Explanatory Indicator 2016/17 Performance Target Standard Organizational Health and Financial Indicators Coordination and Access Indicators Debt Service Coverage Ratio (P) 1 1 Total Margin (P) 0 0 Average Long-Stay Occupancy / Average Long-Stay Utilization (E) n/a n/a Wait Time from CCAC Determination of Eligibility to LTC Home Response (E) n/a n/a Long-Term Care Home Refusal Rate (E) n/a n/a Quality and Resident Safety Indicators Percentage of Residents Who Fell in the Last 30 days (E) n/a n/a Percentage of Residents Whose Pressure Ulcer Worsened (E) n/a n/a Percentage of Residents on Antipsychotics Without a Diagnosis of Psychosis (E) n/a n/a Percentage of Residents in Daily Physical Restraints (E) n/a n/a 2.0 LHIN-Specific Performance Obligations 356 of 406

357 Schedule E Form of Compliance Declaration DECLARATION OF COMPLIANCE Issued pursuant to the Long Term Care Service Accountability Agreement To: From: For: Date: Re: The Board of Directors of the [insert name of LHIN] Local Health Integration Network (the LHIN ). Attn: Board Chair. The Board of Directors (the Board ) of the [insert name of License Holder] (the HSP ) [insert name of Home] (the Home ) [insert date] [January 1, 201X December 31, 201x] (the Applicable Period ) The Board has authorized me, by resolution dated [insert date], to declare to you as follows: After making inquiries of the [insert name and position of person responsible for managing the Home on a day to day basis, e.g. the Chief Executive Office or the Executive Director] and other appropriate officers of the HSP and subject to any exceptions identified on Appendix 1 to this Declaration of Compliance, to the best of the Board s knowledge and belief, the HSP has fulfilled, its obligations under the long-term care service accountability agreement (the Agreement ) in effect during the Applicable Period. Without limiting the generality of the foregoing, the HSP confirms that (i) (ii) it has complied with the provisions of the Local Health System Integration Act, 2006 and with any compensation restraint legislation which applies to the HSP; and every Report submitted by the HSP is accurate in all respects and in full compliance with the terms of the Agreement; Unless otherwise defined in this declaration, capitalized terms have the same meaning as set out in the Agreement between the LHIN and the HSP effective April 1, [insert name of individual authorized by the Board to make the Declaration on the Board s behalf], [insert title] of 406

358 Schedule E Form of Compliance Declaration Cont d. Appendix 1 - Exceptions [Please identify each obligation under the LSAA that the HSP did not meet during the Applicable Period, together with an explanation as to why the obligation was not met and an estimated date by which the HSP expects to be in compliance.] of 406

359 SUMMARY OF MAIN DIFFERENCES BETWEEN THE LSAA AND THE PROPOSED LSAA Reference Difference Reason for Change General A variety of changes were made to correct minor errors in To correct inadvertent errors and typographical errors. Update references, use of defined terms, conformance and formatting. Background Background introduction revised to reference implementation of Health Links and emphasize priorities for the health care system as a whole. Single SAA Definitions The LHINs have made available a version of the LSAA template that accommodates multiple homes operated within a single LHIN and by a single licensee. The parties to this LSAA would therefore be a single LHIN and a single licensee (HSP). It is comprised of a single LSAA template agreement with a separate set of schedules for each of the homes covered by it. Amended. The following definitions were amended: New: The following definition was added: To reflect current priorities and the scope of collaboration the LHIN and the HSP that is expected. This new multi-home agreement reduces administrative burden and enhances efficiencies overall for all parties. CEO Definition was clarified. Design Manual Definition was expanded to be more likely to capture subsequent changes. HSP s Personnel and Volunteers 3.4 Amendment e-health/information Technology Compliance provision to reflect HSP contribution to implementation of provincial e-health priorities for and thereafter. 4.2 Revised provision to highlight requirement for compliance with applicable law. Defined term HSP s Personnel was changed to HSP s Personnel and Volunteers make it highlight that the definition includes volunteers. Performance Factor Definition was clarified. PICB This definition was added because the terms is used in other new parts of the LSAA (i.e. definition of Performance Factor and Section 7.2). The e-health provisions were amended to reflect the requirements of the LHINs' accountability agreements with the Ministry. Revisions reflect need to comply with law and policy and the requirements of the LHINs' accountability agreements with the Ministry. 4.3 Amended (iv) Revision requires LHINs to provide notice to funding adjustments. December, of 406

360 Reference Difference Reason for Change 6.5 Revised Termination of Designation of Convalescent Care Beds provision (b) Revisions supports the LHINs system planning duties by providing a more appropriate notice period and relevant information. 7.2 (c) has been amended. Revision allows either party to include PICB to contribute to the performance management process. 8.1 Added sub-section (d): Health Quality Ontario Revisions result from changes to the LHINs accountability agreement with the Ministry. 8.2 (b) has been amended To clarify drafting Updated reps and warranties re governance Added reps and warranties re 10.3.a.ix 11.3 Updated indemnification provisions. The scope of the indemnity has been significantly reduced and is reasonably limited All of the insurance provisions have been thoroughly reviewed and revised, including elimination of noted duplications Revised language Clarification Added as a means of providing notice. The provision has been amended so that in all cases, Notices by fax or are effective when acknowledged in accordance with the requirements of the Notices provisions of the LSAA. Schedules Revision clarifies that the list of policies and procedures in the Section is not exhaustive. The HSP has an obligation to have any other policies and procedures that the HSP considers necessary. The revised scope is considered to be adequate for the purposes of the agreement. The revised requirements are considered to be appropriate for the purposes of the agreement. To update means of notice and to clarify when notice becomes effective. Schedule A Combined sections A1-A4 (from the LAPS Forms) into 3 To clarify drafting. sections for clarity and to avoid duplication. The Structural Information Section (A3) is a new addition to Schedule A. Schedule B Construction funding subsidy section updated. To ensure that the language and scope is consistent with current practice and the enhanced LTC renewal Schedule C Removed Reference to Performance Reporting. Included Quality Improvement Plan Reporting (with a copy to the LHIN) strategy. Update to reflect removal of reporting that is no longer relevant and to include new reporting requirements. December, of 406

361 Schedule D Indicators updated. Targets for both Financial Indicators Update adjusted to included performance standards Schedule E Revised language Updated for consistency with MSAA December, of 406

362 Item # 5.4 Accountability Agreement - HSAA Amending Agreement 362 of 406

363 Briefing Note Report To: Central West LHIN Board of Directors Agenda Number: Item # 5.4 Subject: Hospital Sector Accountability Agreement (HSAA) - Amending Agreement Purpose: For Approval Date: Wednesday, January 27, 2016 Key Contact: Brock Hovey, Senior Director, Health System Performance Recommended Motion: The Central West Local Health Integration Network Board of Directors are resolved: (i) that the proposed H-SAA Amending Agreement to be made as of April 1, 2016, and amending the 2008/16 H-SAA by extending its term to June 30, 2016 and by replacing the 2015/16 Schedules with 2016/17 Schedules, be approved as presented to the Board. Background Summary : Negotiations between LHINs and OHA legal teams continue on the development of a new multi-year HSAA. To allow sufficient time for this work to be completed, there was consensus by LHIN CEOs for a three month extension to the current HSAA. The OHA is in agreement with this recommendation and LHIN Legal Services has been directed to draft the required Amending Agreement, attached, for review by OHA and approval by 2/3 LHIN Boards. The two parties will continue to work diligently to have a new template agreement in place by June 30, Board approval of the proposed 3 month extension to the HSAA is required because the extension takes the HSAA beyond its current term; ie., March 31, In areas where LHINs need to act in together the Ministry-LHIN Memorandum of Understanding (MOU) requires that each LHIN must respect and abide by the position approved by a two-thirds majority of LHINs (Ministry-LHIN MOU, Section 14.2 b). 363 of 406

364 Options Considered: N/A Impact Analysis: Alignment with Strategic Priorities Improve access to Care Stream Line Transitions and Navigation Drive Quality and Value Build on the Momentum Governance Best Practice Operational Excellence Enterprise Risk Implementation Plan: The Central West LHIN will implement the HSAA amending agreement with refreshed schedules by March 31, 2016 and prepare for the implementation of a new multi-year HSAA by June 30, Attachments: 1. H-SAA Amending Agreement Extension to June 30, of 406

365 H-SAA AMENDING AGREEMENT THIS AMENDING AGREEMENT (the Agreement ) is made as of the 1 st day of April, 2016 B E T W E E N: XXX LOCAL HEALTH INTEGRATION NETWORK (the LHIN ) AND [Legal Name of the Hospital] (the Hospital ) WHEREAS the LHIN and the Hospital (together the Parties ) entered into a hospital service accountability agreement that took effect April 1, 2008 (the H-SAA ); AND WHEREAS pursuant to various amending agreements the term of the H-SAA has been extended to March 31, 2016; AND WHEREAS the LHIN and the Hospital have agreed to extend the H-SAA for a further three month period to permit the LHIN and the Hospital to continue to work toward a new multi-year hospital service accountability agreement; NOW THEREFORE in consideration of mutual promises and agreements contained in this Agreement and other good and valuable consideration, the parties agree as follows: 1.0 Definitions. Except as otherwise defined in this Agreement, all terms shall have the meaning ascribed to them in the H-SAA. References in this Agreement to the H-SAA mean the H-SAA as amended and extended. 2.0 Amendments. 2.1 Agreed Amendments. The H-SAA is amended as set out in this Article Amended Definitions. (a) The following terms have the following meanings. Schedule means any one of, and Schedules means any two or more as the context requires, of the Schedules appended to this Agreement, including the following: Schedule A: Funding Allocation Schedule B: Reporting Schedule C: Indicators and Volumes C.1. Performance Indicators C.2. Service Volumes C.3. LHIN Indicators and Volumes C.4. PCOP Targeted Funding and Volumes 2.3 Term. This Agreement and the H-SAA will terminate on June 30, H-SAA Amending Agreement Extension to June 30, 2016 Page of 406

366 3.0 Effective Date. The amendments set out in Article 2 shall take effect on April 1, All other terms of the H-SAA shall remain in full force and effect. 4.0 Governing Law. This Agreement and the rights, obligations and relations of the Parties will be governed by and construed in accordance with the laws of the Province of Ontario and the federal laws of Canada applicable therein. 5.0 Counterparts. This Agreement may be executed in any number of counterparts, each of which will be deemed an original, but all of which together will constitute one and the same instrument. 6.0 Entire Agreement. This Agreement constitutes the entire agreement between the Parties with respect to the subject matter contained in this Agreement and supersedes all prior oral or written representations and agreements. IN WITNESS WHEREOF the Parties have executed this Agreement on the dates set out below. XXX LOCAL HEALTH INTEGRATION NETWORK By: [Name], Chair Date And by: [Name], CEO Date [Insert Full Legal Name of Hospital] By: [Name], Chair Date And by: [Name], CEO Date H-SAA Amending Agreement Extension to June 30, 2016 Page of 406

367 Item # 6.0 Fiduciary Dialogue 367 of 406

368 Item # 6.1 Verbal Report of the Governance Committee 368 of 406

369 Item # 6.2 Verbal Report of the Finance & Audit Committee 369 of 406

370 CENTRAL WEST LHIN Third Quarter Report Submitted to the Ministry of Health and Long Term Care January 25, of 406

371 8 Nelson Street West, Suite 300 Brampton, ON L6X 4J2 Tel : Fax: , rue Nelson Ouest, bureau 300 Brampton, ON L6X 4J2 Tél : Téléc : TABLE OF CONTENTS A Transmittal Letter... 2 B Local Health System Update... 3 C Status Update on Special Initiatives... 3 D Status Update on Integration Activities... 3 E Quarterly Balance Sheet Forecast... 3 F Sector Forecast... 3 G Report on LHIN Operations... 3 Attachment 1, CW LHIN Balance Sheet Forecast for Q , January 25 Attachment 2, CW LHIN Sector Forecast for Q , January 25 Attachment 3, CW LHIN LHIN Operation Forecast for Q , January of 406

372 8 Nelson Street West, Suite 300 Brampton, ON L6X 4J2 Tel : Fax: , rue Nelson Ouest, bureau 300 Brampton, ON L6X 4J2 Tél : Téléc : A Transmittal Letter January 25, 2016 MEMORANDUM TO: FROM: RE: Kathryn McCulloch, Director, LHIN Liaison Branch Ministry of Health and Long-Term Care Scott McLeod CEO Central West LHIN 2015/16 THIRD QUARTER REPORT Please accept the attached report on Central West LHIN s 2015/16 Third Quarter position, a draft version of which was submitted on December 24, It is submitted in accordance with the reporting requirements established in the Ministry-LHIN Performance Agreement. This Third Quarter Report was recommended for approval to the Board at the Central West LHIN s Finance and Audit Committee meeting of January 25, 2016 and subsequently approved by the Central West LHIN Board of Directors on January 27, If you have any questions or comments, please contact me at (905) x211. Sincerely Scott McLeod CEO, Central West LHIN of 406

373 B Local Health System Update As per the Quarterly Reporting Guidelines, updates on the major issues related to the Central West LHIN s local health system are only to be completed for the Second Quarter Report. C Status Update on Special Initiatives As per the Quarterly Reporting Guidelines and direction received from the Ministry of Health and Long-Term Care (Ministry), status updates on Special Initiatives in the Central West LHIN are required at the request of the Ministry. The Ministry has not requested a status update for the Third Quarter. D Status Update on Integration Activities As per the Quarterly Reporting Guidelines, updates on the major issues related to the Central West LHIN s local health system are only to be completed for the Second Quarter Report. E Quarterly Balance Sheet Forecast Tables See Attachment 1, CW-LHIN - Balance Sheet Forecast for Q , January 25, F Sector Forecast The Central West LHIN is forecasting a balanced position by year end, 2015/16. See Attachment 2, CW-LHIN - Sector Forecast for Q , January 25, G Report on LHIN Operations As of Q3 2015/16, the Central West LHIN is projecting a $6K surplus. See Attachment 3, CW LHIN - LHIN Operation Forecast for Q , January 25, of 406

374 LHIN #: Central West Attachment 1: Q3 Quarterly Balance Sheet Forecast Purpose: To collect quarterly balance sheet forecasts information for central agency submission as required by the Treasury Board Secretariat. Instructions: 1. Please input all values as positives i.e. absolute dollars. Boxes marked grey are formulae which will produce the expected results. 2. Column E: is the 12 months actual for 2014/15. This column should match the March 31st, 2015 audited financial statements 3. Column G: input Q3 estimates for the first three quarters (i.e.9 months) of fiscal year. 4. Column I: input the 12 months forecast as at March 31, 2016 for fiscal for Deferred Capital Contributions and Deferred Operating Revenues only. 5. If you need further clarification, please contact: Tao Qian tel , tao.qian@ontario.ca E G I ACTUAL Q3 ESTIMATE FORECAST (12 months) (9 months) (12 months) Balance Sheet As at: March 31, 2015 December 30, 2015 March 31, 2016 ASSETS: 1. Cash 706,145 1,007, Accounts Receivable from: MOHLTC 6,781,259 - Health Service Providers (including Hospitals) LHINs 89,518 - Other Govt. Reporting Entities ( excluding Hospitals and GREs above) Other Accounts Receivable & Prepaid 78,356 63,151 Sub-Total 6,949,133 63, Tangible Capital Assets i. Capital Costs: a. Beginning Balance 1,056,873 1,107,910 b. In-year additions / (disposals) 51,037 c. Ending balance 1,107,910 1,107,910 ii. Accumulated Amortization: a. Beginning Balance 995,964 1,069,562 b. less: amortization on disposed assets c. In-year amortization 73,598 d. Ending balance 1,069,562 1,069,562 NET BOOK VALUE (i less ii) 38,348 38, All Other Assets: 14,157 18,509 TOTAL ASSETS 7,707,783 1,127,769 LIABILITIES: 5. Accounts Payable and Accrued Liabilities to: MOHLTC 214, ,830 Health Service Providers (including Hospitals) 6,781,259 - LHINs 1,426 2,000 Other Govt. Reporting Entities ( Excluding Hospitals and GREs above) Other Accounts Payable 671, ,591 Sub-Total 7,669,435 1,089, Deferred Capital Contributions from the Province (i.e. MOHLTC & Other GREs) a. Beginning Balance 60,909 38,348 38,348 b. In-year Capital Contributions Received/To Be Recei 51,037 c. Amortization for the Year 73,598 d. Ending Balance 38,348 38,348 38, Deferred Revenue from the Province (i.e. MOHLTC & Other GREs) a. Beginning Balance - - b. In-year Contributions Received/To Be Received c. Recognized in Income for the Year d. Ending Balance All Other liabilities TOTAL LIABILITIES 7,707,783 1,127,769 NET ASSETS / (LIABILITIES) 0 0 Notes/Comments: Completed by: Contact Tel. #: Date Completed: 374 of 406

375 Attachment Two (a) CENTRAL WEST LHIN QUARTERLY FORECAST BY SECTOR - THIRD QUARTER ($000'S) By Sector (A) Funding Allocation (Note 1) (B) In-Year Adjustments (C=A+B) Revised Allocation (Based on draft MLPA November 30/2015 Update) (Note 1) (Note 1) Payments to Government Reporting Entity (GREs) (D) Actuals (IFIS) by Quarter 1 (Q1) (Note 1) Payments to non- GRE Recipients TOTAL Q1 ACTUAL % Expended to-date (E) Actuals (IFIS) by Quarter 2 (Q2) (Note 1) Payments to Payments to non- Government GRE Recipients Reporting Entity (GREs) TOTAL ACTUALS % Expended to-date (F) Actuals (IFIS) October to November (Note 1) Payments to Government Reporting Entity (GREs) Payments to non-gre Recipients TOTAL Q2 ACTUALS Payments to Government Reporting Entity (GREs) (G) Estimated December Forecast (Note 2) Payments to non-gre Recipients TOTAL ESTIMATE Operation of Hospitals TOTAL 518, , ,166.2 (7,163.4) 129, % 131, , % 87, , , ,000.0 Grants to compensate for municipal taxation - public hospitals TOTAL % % Long-Term Care Homes TOTAL 157, , , , % , , % , , , ,773.0 Community Care Access Centres TOTAL 114, , , , % , , % , , , ,767.0 Community Support Services TOTAL 13, , , , % , , % , , , ,168.0 Acquired Brain Injury TOTAL % % Assisted Living Services in Supportive Housing TOTAL 11, , , , % 0.0 2, , % 0.0 2, , Community Health Centres TOTAL 12, , , , % 0.0 3, , % 0.0 2, , , ,015.0 Community Mental Health TOTAL 31, , , , % , , % , , , ,897.0 Addictions Program TOTAL 5, , , % , % Specialty Psychiatric Hospitals TOTAL % % Grants to compensate for municipal taxation - psych hospitals TOTAL % % Initiatives (Note 3) 2, , % % TOTAL LHIN 868, , , , , % 132, , , % 88, , , , , ,739.0 Notes: 1. No input required for labelled Column A to F, H, J and K. These columns are locked. 2. Detail input required for labelled Column G, I and L related to the monthly/quarterly Estimated Expenditure. 3. Actual payments (IFIS) for TP sectors above may include payments related to initiatives. 375 of 406

376 By Sector Payments to Government Reporting Entity (GREs) (H) Forecast by Quarter 3 (Q3) Payments to non-gre Recipients TOTAL Q3 FORECAST % Expended to-date Payments to Government Reporting Entity (GREs) (I) Forecast by Quarter 4 (Q4) Payments to non-gre Recipients TOTAL Q4 FORECAST % Expended to-date Payments to Government Reporting Entity (GREs) (J=D+E+F+G+H+I) Forecast Year-end Position Payments to non-gre Recipients TOTAL YEAR- END POSITION (K=J-C) Variance L = Explanation of Variance Operation of Hospitals TOTAL Grants to compensate for municipal taxation - public hospitals TOTAL Long-Term Care Homes TOTAL Community Care Access Centres TOTAL Community Support Services TOTAL Acquired Brain Injury TOTAL Assisted Living Services in Supportive Housing TOTAL Community Health Centres TOTAL Community Mental Health TOTAL Addictions Program TOTAL Specialty Psychiatric Hospitals TOTAL Grants to compensate for municipal taxation - psych hospitals TOTAL Initiatives (Note 3) 128, , % 129, , % 525,389.3 (6,631.7) 518, % % , , % , , % , , , , % , , % , , , , % , , % , , % % , , % 0.0 2, , % , , , , % 0.0 3, , % , , , , % , , % 3, , , , % , % 3, , , % % % % % 0.0 2, , % 0.0 2, , TOTAL LHIN 130, , , % 131, , , % 532, , , Notes: 1. No input required for labelled Column A to F, H, J a 2. Detail input required for labelled Column G, I and L 3. Actual payments (IFIS) for TP sectors above may inc 376 of 406

377 CENTRAL WEST LOCAL HEALTH INTEGRATION NETWORK LHIN Operations and Initiatives Forecast Fiscal Attachment 4 Page 1 of 2 Central West Local Health Integration Network Q3 LHIN Operations Report and Forecast YTD Budget vs YTD Actuals Annual Budget vs Annual Forecast Category YTD Budget December 2015 YTD November 2015 Actuals & December 2015 Forecast YTD Variance Surplus/(Deficit) Annual Budget Forecast to Year End Variance Surplus/(Deficit) Variance Explanation SALARY & WAGES Salaries & Wages 2,346, ,209, ,335 3,128,377 3,108,377 20,000 Primarily related to staff turnover and recruitment challenges. HOOPP 214, ,590 (6,363) 285, ,636 - Other Benefits 236, ,540 25, , ,879-2,797,419 2,642, ,341 3,729,892 3,709,892 20,000 TRANSPORTATION & COMMUNICATION Staff Travel 17,250 12,549 4,701 23,000 23,000 - Governance Travel 11,250 10,000 1,250 15,000 15,000 - Communications 49,500 49, ,000 66,000-78,000 71,729 6, , ,000 - SERVICES Accommodation 176, ,994 9, , ,200 - Advertising 15,000 13,145 1,855 20,000 20,000 - Banking Consulting Fees 121, ,158 6, , ,637 (15,700) Assisted Living Review consulting project planned for Q4 Equipment Rentals 7,875 4,582 3,293 10,500 10,500 - Insurance 5,250 4, ,000 7,000 - LSSO Shared Costs 260, ,136 6, , ,267 (40,000) Additional contribution to LSSO LHIN Collaborative 31,172 34,508 (3,336) 41,563 41,563 - Other Meeting Expenses 37,500 28,322 9,178 50,000 50,000 - Board Chair's Per Diem expenses 54,600 32,350 22,250 72,800 45,000 27,800 Lower utilization Other Board Members' Per Diem expenses 69,225 51,400 17,825 92,300 72,000 20,300 Lower utilization Other Governance Costs 22,500 19,635 2,865 30,000 30,000 - Printing and Translation 45,000 38,000 7,000 60,000 60,000 - Staff Development 42,000 39,392 2,608 56,000 56, , ,547 85,953 1,184,667 1,192,267 (7,600) SUPPLIES & EQUIPMENT IT Equipment 18,750 49,284 (30,534) 25,000 50,000 (25,000) IT equipment purchased to keep staff computers on support Office Supplies & Equipment 37,091 50,932 (13,842) 49,454 64,844 (15,390) Updated Boardroom and meeting room facilities 55, ,216 (44,376) 74, ,844 (40,390) MINOR CAPITAL ASSETS Minor Capital Assets Purchased 20,993-20,993 27,990-27,990 Funds used from capital to offset IT equipment purchased 20,993-20,993 27,990-27,990 TOTAL LHIN OPERATIONS, DRCC, ER/ALC 3,840,752 3,616, ,182 5,121,003 5,121, of 406

378 CENTRAL WEST LOCAL HEALTH INTEGRATION NETWORK LHIN Operations and Initiatives Forecast Fiscal Attachment 4 Page 2 of 2 YTD Budget vs YTD Actuals Annual Budget vs Annual Forecast Category YTD Budget December 2015 YTD November 2015 Actuals & December 2015 Forecast YTD Variance Surplus/(Deficit) Annual Budget Forecast to Year End Variance Surplus/(Deficit) Variance Explanation ABORIGINAL COMMUNITY ENGAGEMENT 5,625 5, ,500 7,500-5,625 5, ,500 7,500 - FRENCH LANGUAGE SERVICES 79,500 82,237 (2,737) 106, ,000-79,500 82,237 (2,737) 106, ,000 - CRITICAL CARE LEAD 56,250 54,000 2,250 75,000 74,000 1,000 lower expense claims 56,250 54,000 2,250 75,000 74,000 1,000 ED LEAD 56,250 54,000 2,250 75,000 74,000 1,000 lower expense claims 56,250 54,000 2,250 75,000 74,000 1,000 PRIMARY CARE LEAD 56,250 51,277 4,973 75,000 71,000 4, month of a vacancy due to transition of new contract 56,250 51,277 4,973 75,000 71,000 4,000 E-HEALTH * CW LHIN 304, ,333 55, , ,000 - * PROJECT MANAGEMENT OFFICE 390, ,667 33, , , , ,000 88, , ,000 - TOTAL LHIN INITIATIVES 948, ,706 95,669 1,264,500 1,258,500 6,000 GRAND TOTAL 4,789,127 4,469, ,851 6,385,503 6,379,503 6,000 * Budget amounts reflect current year CW LHIN managed funds - balance of cluster funding to be distributed to other LHIN's 378 of 406

379 Briefing Note Report To: Central West LHIN Finance & Audit Committee Agenda Number: Item # 6.0 Subject: MLAA - Health Service Providers Funding as at December 31, 2015 Purpose: For Information Date: Monday, January 25, 2016 Key Contact: Brock Hovey, Senior Director, Health System Performance Tellis George, Director Funding & Allocation Recommended Motion: N/A Background Summary : To update the Central West LHIN Board of Directors of the 2015/16 Central West LHIN - Health Service Provider funding as reflected from April1, 2015 to December 31, The attached Schedules provide funding details as follows: Schedule A Sorted by sector and by HSP list 1. HSP opening base funding as at April Base funding approval since April 3. Revised total base funding 4. One time funding approval from April to December 31, Total funding approved as at December 31, 2015 Schedule B Provides additional detail in support of Schedule A, allocated by sector, program and funding type. Tables reconcile to Ministry MLAA funds and Q3 Quarterly Sector Forecast 379 of 406

380 Options Considered: Central West LHIN staff will continue to monitor and reconcile new funding approvals with the Ministry LHIN Performance Agreement Impact Analysis: Alignment with Strategic Priorities Improve access to Care Stream Line Transitions and Navigation Drive Quality and Value Build on the Momentum Governance Best Practice Operational Excellence Enterprise Risk Implementation Plan: N/A Attachments: /2016 Health Service Providers funding approval summary by sector from April to December 31, /2016 Health Service Provider Funding Detail by Sector from April to December 31, of 406

381 Central West LHIN - MLPA Health Service Providers Funding Approvals April to December 31, 2015 Schedule A Provider Initiative Base Onetime Additional Information Hospitals Headwaters Health Care Centre Health Links 329,500 Care Coordination Tool (CCT) pilot project & ongoing Operations Municipal taxes 8,100 Municipal taxes for hospital beds in operations Funding Transferred to Cancer Care Ontario (CCO) (176,100) New CCO managed QBPs - Colorectal Cancer and Prostate Surgeries Health System Funding Reform ( HSFR) 134, /16 HSFR impact resulted in additional funding to HHCC Additional Growth Funding for Quality 127,448 Funding to address high growth in QBPs Based Procedures (QBP) Sexual Assault Domestic Violence Treatment Centre Program (SADVTC) 28,100 Counselling services in hospital-based SADVTC Critical Care 23,400 Training of Critical Care Nurses Pay for Results 1,621,000 Various projects related to Emergency Room & Alternate Level of Care strategy Sub Total 85,548 2,010,100 William Osler Health System Funding Transferred from hospital Global to Cancer Care Ontario (CCO) (3,174,800) New CCO managed QBPs - Colorectal Cancer and Prostate Surgeries Health System Funding Reform ( HSFR) (917,590) 2015/16 HSFR impact resulted in a recovery for Osler Additional Growth Funding for Quality Based Procedures (QBP) 351,791 Funding to address high growth in QBPs Municipal taxes 88,875 Municipal taxes for hospital beds in operations 552,500 Cardiac services 78,000 Training of Critical Care Nurses Alternate Level of Care 707,453 Assess & Restroe initiative Pay for Results 1,986,000 Various projects related to Emergency Room & Alternate Level of Care strategy Integrated Funded Model Hospital 2 Home (H2H) 175,000 To support implementation of H2H Sub Total (3,188,099) 3,035,328 Pay for Results funding to be utliized as part of in-year reallocation 742,900 To support ED volumes and Telehomecare services Hospital Total (3,102,551) 5,788,328 Community Care Access Centre CW CCAC Personal Support Worker (PSW) 2,388,600 $1.5 hourly increase plus benefits for PSW Wage Enhancement in CCAC In Home - PSW 535,920 To offset pressure resulting from Kipling Acres Beds in Abeyance (BIA) Assess & Restore 376,600 To support home independence program Health System Funding Reform ( HSFR) 1,857,800 (949,700) 2015/16 HSFR impact resulted in net additional funding of $908,100 to CCAC 2015/2016 Community Funding Investment 949,700 Pay for Results 421,000 Various projects related to Emergency Room & Alternate Level of Care strategy Health Links (HL) 163,000 HL Ongoing operations CCAC Total Total CW CCAC 5,196, ,820 1/18/ of 406

382 Central West LHIN - MLPA Health Service Providers Funding Approvals April to December 31, 2015 Provider Initiative Base Onetime Additional Information Schedule A Community Support Services (CSS) Personal Support Worker (PSW) 157,005 25,171 $1.5 hourly increase plus benefits to a maximum of $19 per hour for PSW Wage Enhancement Adult Day Program - Region of Peel 1,063,287 To offset pressure resulting from Kipling Acres Beds in Abeyance (BIA) Adult Day Program - SHIP 154,735 To offset pressure resulting from Kipling Acres Beds in Abeyance (BIA) CANES 105,000 To offset Dialysis transportation pressures 2015/2016 Community Funding Investment 138,815 Base investments - Bethel Hospice $7,800 Hospice Dufferin $2,072 Caledon Meals on Wheels $56,321 Alzheimer Dufferin $9,540 Brampton Meals on Wheels $46,582 Caledon Community Services $16,500 Total CSS 295,820 1,348,193 Assisted Living In Supportive Housing (ALSSH) Community Mental Health (CMH) Addictions Personal Support Worker (PSW) 299,064 8,935 $1.5 hourly increase plus benefits to a maximum of $19 per hour for PSW Wage Enhancement Peel Senior Links 620,093 Program transfer from Mississauga Halton LHIN to CW LHIN 2015/2016 Community Funding Investment 28,968 Base Investments - Cheshire Homes $17,368 Richview Community Services $11,600 Alternate Level of Care (707,453) funding transferred to Osler In Year Reallocation funds (59,193) Funds to be reallocated to various sectors Total ALSSH 948,125 (757,711) Various providers 253,666 Enhanced Sessional fee CMHA - Peel 243, ,380 Enhanced programing Peace Rance 50,000 Farming equipment Supportive Housing in Peel 619, ,100 Enhanced Programming to support new supportive housing units Family Transition Place 5,333 Enhanced programing Friends & Advocates 81,490 (3,238) Enhanced programing William Osler Health System 12,444 Enhanced programing Punjabi 71,109 (22,412) New Programming Allocation of Mental Health prior year funds (356,234) (197,180) Allocated In-year reallocation 215,950 Funds to be reallocated to various sectors Total CMH 930, ,600 Punjabi Community Health Services 97,517 Program transfer from Mississauga Halton LHIN to CW LHIN Salvation Army - Hope Acres 75,000 Stabilization funding William Osler Health System 17,550 Expanded programming Supportive Housing in Peel 36,350 18, /2016 Community Funding Investment Total LTC 226,417 18,500 Community Health Centre Physician Funding reduction (55,123) 59,193 Physician funding reduction Total CHC (55,123) 59,193 1/18/ of 406

383 Central West LHIN - MLPA Health Service Providers Funding Approvals April to December 31, 2015 Provider Initiative Base Onetime Additional Information Schedule A Long Term Care Homes (LTC) Long Term Care Homes annual increase - All LTC Homes 3,729,300 Annual increase adjustments Resident Care Needs Increase, RF and OA per diem increase, Co-Payment Increase. Less an adjustment for convalescent care beds Total LTC 3,729,300 - Total Transfer payments 8,168,632 7,454,923 Initiatives (unallocated to date) 2015/16 as at August 31, 2015 Residual Community Investment (105,000) - Transfer to CANES - Renal transportation Residual PSW Wage Enhancement 104,925 Protected Residual BIA 188,758 Protected balance 2015/16 Community Investment 726,746 To be allocated Health Link 357,500 William Osler health System Total unallocated Total 726, ,258 Grand Total incremental change 8,895,303 8,001,181 1/18/ of 406

384 Central West Local Health Integration Network Health Service Provider Funding Detail MLPA as at December 31, 2015 Schedule B Sector Health Service Provider Name April 1, 2015 Opening MLPA Subsequent Base Funding Announcements Revised Base Funding One Time Funding Total Funding 1 2 3= =3+4 Hospital HEADWATERS HEALTH CARE CENTRE (HHCC) 42,235,010 85,548 42,320,558 2,002,000 44,322,558 Hospital WILLIAM OSLER HEALTH SYSTEM (WOHC) 478,413,187-3,188, ,225,088 2,946, ,171,541 Hospital HOSPITALS MUNICIPAL TAXATION GRANT 96,975 96,975 Hospital Unallocated Pay for Results 742, ,900 Total Hospital 520,648,197-3,102, ,545,646 5,788, ,333,974 CCAC CENTRAL WEST COMMUNITY CARE ACCESS CENTRE (C 109,730,743 5,196, ,926, , ,473,663 Total Community Care Access Centre 109,730,743 5,196, ,926, , ,473,663 CSS BETHELL HOSPICE 229,230 7, , ,030 CSS HOSPICE DUFFERIN 48,389 2,072 50,461 50,461 CSS CANES COMMUNITY CARE 2,399,847 11,017 2,410, ,000 2,515,864 CSS CALEDON MEALS ON WHEELS 291,626 56, , ,947 CSS ALZHEIMER SOCIETY OF DUFFERIN COUNTY 1,081,074 9,540 1,090,614 1,090,614 CSS UNITED ACHIEVERS COMMUNITY SERVICES 63,869 63,869 63,869 CSS ALZHEIMER SOCIETY O F Peel 517,108 47, ,059 25, ,230 CSS BRAMPTON MEALS ON WHEELS 230,993 46, , ,575 CSS COUNTY OF DUFFERIN 825,620 7, , ,212 CSS CENTRAL WEST COMMUNITY CARE ACCESS CENTRE 478,682 67, , ,882 CSS REGIONAL MUNICIPALITY OF PEEL 2,267,216 2,267,216 1,063,287 3,330,503 CSS PUNJABI COMMUNITY HEALTH SERVICES 963, , ,733 CSS PEEL CHESHIRE HOMES INC 373,225 7, , ,728 CSS HOLLAND CHRISTIAN HOMES INC 133, , ,101 CSS CALEDON COMMUNITY SERVICES 768,717 21, , ,113 CSS WILLIAM OSLER HEALTH SYSTEM 104, , ,349 CSS RICHVIEW COMMUNITY CARE SERVICES 379,173 10, , ,019 CSS SUPPORTIVE HOUSING IN PEEL 1,123,420 1,123, ,735 1,278,155 To be utilized as part of in-year reallocation for HSPs one 3,434 CSS time purchases 3,434 3,434 Total Community Support Services 12,282, ,820 12,578,626 1,348,193 13,926,819 ALSSH CANES COMMUNITY CARE 4,306, ,267 4,417,500 4,417,500 ALSSH Peel Senior Links 654, , ,293 ALSSH Dufferin County Community Support Services 554,243 20, , ,620 ALSSH PEEL CHESHIRE HOMES INC 786,113 21, , ,949 ALSSH HOLLAND CHRISTIA447797N HOMES INC 743, , ,975 ALSSH CALEDON COMMUNITY SERVICES 2,379,389 42,258 2,421,647 2,421,647 RICHVIEW COMMUNITY CARE SERVICES 1,332,582 80,619 1,413,201 (285,494) 1,127,707 ALSSH CORPORATION Supportive Housing in Peel (SHIP) 17,475 17,475 8,935 26,410 Funds to be transferred to Osler for Access & restore 707,453 services 707,453 (707,453) - To be utilized as part of in-year reallocation for HSPs onetime 226, ,301 purchases Total Assisted Living in Supportive Housing 10,809, ,125 11,758,113 (757,711) 11,000,402 CMHP CANADIAN MENTAL HEALTH ASSOCIATION - PEEL 13,450, ,666 13,711, ,380 13,995,881 CMHP FRIENDS & ADVOCATES-PEEL 757,018 81, ,508-3, ,270 CMHP PUNJABI COMMUNITY HEALTH SERVICES 498,097 76, ,056-22, ,644 CMHP PEACE RANCH 530, ,885 50, ,885 CMHP FAMILY TRANSITION PLACE 181,899 5, ,232-5, ,411 POMS WILLIAM OSLER HEALTH SYSTEM 3,340, ,477 3,543,860 3,543,860 CMHP REXDALE COMMUNITY HEALTH CENTRE 41,263 11,700 52,963 52,963 CMHP SUPPORTIVE HOUSING IN PEEL 11,677, ,153 12,324, ,100 12,448,597 $70,788 - To be utilized as part of in-year reallocation for HSPs one-time purchases 624, , , ,180 70,788 To be utilized as part of in-year reallocation for HSPs onetime purchases 221, ,771 Total Community Mental Health Services 31,101, ,544 32,032, ,600 32,484,070 SAP CANADIAN MENTAL HEALTH ASSOCIATION - PEEL BRANCH 468, , ,125 SAP PUNJABI COMMUNITY HEALTH SERVICES 598,225 97, , ,742 SAP FAMILY TRANSITION PLACE 98,750 98,750 98,750 SAP GOVERNING COUNCIL OF THE SALVATION ARMY IN 814,029 75, , ,029 SAP WILLIAM OSLER HEALTH SYSTEM 3,295,248 17,550 3,312,798-3,312,798 SAP SUPPORTIVE HOUSING IN PEEL 170,520 36, ,870 18, ,370 SAP To be utilized as part of in-year reallocation for HSPs onetime purchases 1,982 1,982 1,982 Total Addictions Services 5,446, ,417 5,673,296 18,500 5,691,796 1/18/ of 406

385 Sector Health Service Provider Name April 1, 2015 Opening MLPA Subsequent Base Funding Announcements Revised Base Funding One Time Funding Total Funding 1 2 3= =3+4 CHC Wellfort Community Health Services 6,031,774 (24,043) 6,007,731 (5,183) 6,002,548 CHC REXDALE COMMUNITY HEALTH CENTRE 6,136,138 (31,080) 6,105,058 64,376 6,169,434 To be utilized as part of in-year reallocation for HSPs one time purchases 12,450 12,450 12,450 Total Community Health Centre 12,180,362 (55,123) 12,125,239 59,193 12,184,432 LTC VERA M. DAVIS - PEEL HOUSING CORP. 2,635, ,659 2,790,351-2,790,351 LTC AVALON CARE CENTRE ONTARIO INC. 5,752,428 82,266 5,834,694-5,834,694 LTC EXTENDICARE BRAMPTON 7,542,384 22,108 7,564,492-7,564,492 LTC KING NURSING HOME 3,898, ,591 4,009,743-4,009,743 LTC PINE GROVE LODGE 4,752,312 64,436 4,816,748-4,816,748 LTC BURTON MANOR ONTARIO INC. 5,822, ,639 5,936,943-5,936,943 LTC DUFFERIN OAKS HOME FOR SENIOR CITIZENS - CORPO 7,214, ,815 7,428,791-7,428,791 LTC Sienna Senior Living - Woodbridge Vista Care Community 10,467, ,647 10,571,067-10,571,067 LTC Sienna Senior Living - Deerwood Creek Care Community 7,564, ,049 7,811,249-7,811,249 LTC Sienna Senior Living - Hawthorn Woods Care community 7,959, ,883 8,231,363-8,231,363 LTC Sienna Senior Living - Maple Grove Care community 7,692, ,148 7,804,388-7,804,388 LTC KIPLING ACRES 10,453,080 59,527 10,512,607-10,512,607 LTC PEEL MANOR LONG TERM CARE FACILITY - REGIONAL M 7,598, ,356 8,310,984-8,310,984 MALTON VILLAGE LONG-TERM CARE CENTRE 8,202,060 60,257 8,262,317 8,262,317 LTC TALL PINES LONG TERM CARE CENTRE - REGIONAL MUN 7,341, ,313 7,822,541 7,822,541 LTC Vigour Limited Partnership - Tullamore Care Community 7,285, ,745 7,395,701-7,395,701 LTC WESTSIDE 9,749, ,755 9,881,263-9,881,263 LTC HUMBER VALLEY TERRACE - REVERA LONG TERM CARE 6,703, ,749 6,843,309-6,843,309 LTC FAITH MANOR - HOLLAND CHRISTIAN HOMES INC 4,954, ,912 5,148,556-5,148,556 LTC GRACE MANOR - HOLLAND CHRISTIAN HOMES INC. 5,332,536 89,673 5,422,209-5,422,209 LTC VILLAGE OF SANDALWOOD PARK (THE) - SCHLEGEL VIL 5,603,880 28,215 5,632,095-5,632,095 Woodhall Park - Royale Development LP 6,755,472-38,914 6,716,558 6,716,558 LTC SHELBURNE RESIDENCE - PROVINCIAL LONG TERM CAR 2,674, ,471 2,938,211-2,938,211 LTC Unallocated 0 0 Total Long Term Care 153,956,880 3,729, ,686, ,686,180 Grand Sectors 856,157,781 8,168, ,326,413 7,454, ,781,336 Unallocated to date 0 Urgent Priority 473, , ,700 Community Investment residual 125, ,000 20,716 20,716 BIA residual 36,855 36, , ,613 PSW residual 4, , , , /16 Community Investment 726, , ,746 Health Link 357, ,500 Total To be determined 640, ,671 1,367, ,258 1,913,798 Grand Total Sector & TBD 856,798,650 8,895, ,693,953 8,001, ,695,134 Percent base funding change & percent overall change 1.0% 1.9% 1/18/ of 406

386 Central West Local Health Integration Network Q3 Reallocation Summary by Sector as at Jan 15, 2016 Reallocations Resulting from Q3 forecasted Surplus and Recoveries HSP / Sector Forecasted Surplus by Sector One Time Approved Requests Net Payout/ Recovery Description of One time Approval / Notes CSS - Attendant Outreach 1 Peel Cheshire Homes 59,000 59,000 Commercial Dishwasher, Hot Water Tank replacement, and Wandering Detection System 2 Bethel Hospice 5,000 5,000 Information Technology requirements 3 Brampton Meals on Wheels 16,000 16,000 IT equipment, Commercial Freezer and Microwave, Office Furniture 5 Caledon Community Services 157, ,084 Furniture and Fixtures, Bus Replacement, Van replacement 6 CANES Community Service 97,762 97,762 Information Technology requirements, Van Replacement 7 Dufferin County Community Services 57,490 57,490 Accessibility Improvements, Van Replacement 8 Hospice Dufferin 8,216 8,216 Hspice Wellness Program, IT requirements, Group resources 9 Peel Senior Link 12,130 12,130 IT equipment, Office Furniture, and scheduling software IT equipment, Leasehold Improvments for Bathing Program, Exterior 10 India Rainbow (SHIP) 100, ,000 Window Upgrages 11 Alzheimer Society of Dufferin County 4,350 4,350 First Aid Training, and Family Support Worker expanded hours 12 Region of Peel (B) 120,498 (120,498) Sub-Total CSS 120, , ,534 ALSSH 13 Richview Community Support Services (A) 285,494 (285,494) Community Mental Health 14 CMHA - Peel (B) 456, ,021 (232,794) Leasehold Improvements to support site amalgamation 15 Punjabi Community Services 47,946 25,528 (22,418) IT equipment and Programming Furniture 16 Family Transition Place 5,821 (5,821) 17 Friends and Advocates Peel 10,738 (10,738) 18 Hope Acres 63,613 63,613 Client Housing upgrades (bathrooms) - Fixtures and Flooring 19 Peace Ranch 50,000 50,000 Framing Equipment and Greenhouse Upgrades to support programming 20 Supportive Housing In Peel** (B) 139, ,115 (25,863) Leasehold Improvements, IT Equipment, and Ergonomic Equipment Sub-Total CMH 661, ,277 (184,021) Community Health Centres 21 Rexdale CHC (C) 64,376 64,376 HVAC replacement for main site. 22 Wellfort CHC (formerly Bramalea CHC) (C) 5,183 10,900 5,717 Chiropodist Clinic Equipment Sub-Total CHC 5,183 75,276 70,093 Grand Total of Reallocations** 1,072,473 1,069,585 (2,888) balance to be distributed in Q4 Surplus Explanations: A. Health Service Provider has delayed ramping up of Staffing to align with referral pattern in Assisted Living Services. B. Health Service Provider is experiencing Staff turnover and hiring delays associated with program expansion. C. Health Service Provider has experienced staff turnover 386 of 406

387 Briefing Note Report To: Agenda Number: Item # 7.0 Subject: Purpose: Central West LHIN Finance and Audit Committee In-Year Reallocation Process Update Q3 For Information Date: Monday, January 25, 2016 Key Contact: Brock Hovey, Senior Director Health System Performance Michael Buchert, Director Funding and Allocation Recommended Motion: N/A Background Summary : The Central West LHIN has completed the in -year surplus funding recovery and allocation process for 2015/16 fiscal year. The recoveries are based on both the 2 nd Quarter Health Service Provider reports and 3 rd Quarter Interim forecast to year end. The Central West LHIN engaged Health Service Providers to submit one time requests that supported service delivery and pressures. The Central West LHIN staff reviewed all requests to ensure that the requested items supported service delivery and where able to be completed by March 31, The Central West LHIN was able to recover $1,072,473 in one time funds from various providers primarily related to staff turnover. Based on the staff review of the business cases submitted, $1,069,585 was distributed to 17 Health Services Providers on a one time basis to support various initiatives (detailed report attached). The balance of funds are to be distributed in Q4. All allocations and recoveries are within the CEO delegation of authority limits. Options Considered: N/A 387 of 406

388 Impact Analysis: Alignment with Strategic Priorities Improve access to Care Stream Line Transitions and Navigation Drive Quality and Value Build on the Momentum Governance Best Practice Operational Excellence Enterprise Risk Implementation Plan: N/A Attachments: Q3 Reallocation Summary by Sector as at Jan 15, of 406

389 Item # 6.3 Quarterly CEO Attestation - 3rd Quarter (Q3) of 406

390 Central West LHIN I RUSS du Centre-Ouest CENTRAL WEST LOCAL HEALTH INTEGRATION NETWORK CEO ATTESTATION rd Quarter (Q3) Prepared in accordance with section 14 of the Broader Public Sector Accountability Act, 2010 (BPSAA) To: From: The Board of the Central West Local Health Integration Network (the Board ) Scott McLeod, Chief Executive Officer Central West Local Health Integration Network Date: Wednesday, January 20, 2016 Re: CEO Attestation for 3rd Quarter (Q3) of (October 1, 2015 to December 31, 2015)- the Applicable Period On behalf of the Central West LHIN (the LHIN) I attest to: the completion and accuracy of reports required of the LHIN, pursuant to section 5 of the BPSAA, on the use of consultants; the LHIN s compliance with the prohibition, in section 4 of the BPSAA, on engaging lobbyist services using public funds; the LHIN s compliance with all of its obligations under applicable directives issued by the Management Board of Cabinet; the LHIN s compliance with its obligations under the Memorandum of Understanding with the Ministry of Health and Long-Term Care; and the LHIN s compliance with its obligations under the Ministry LHIN Accountability Agreement/Ministry LHIN Performance Agreement in effect, during the Applicable Period. In making this Attestation, I have exercised care and diligence that would reasonably be expected of a Chief Executive Officer in these circumstances, including making due inquiries of LHIN staff that have knowledge of these matters. I further certify that any material exceptions to this Attestation are documented in the attached Schedule A. t Ontario LoI H.Ih Int.g,.tlon 390 of 406

391 Dated at Brampton, Ontao on Wednesday, January 20, S cleod Chi f xecutive Officer Central West Local Health Integration Network I hereby certify that this Attestation has been approved by the Board of Directors of the Central West Local Health Integration Network. Maria Britto Chair, Board of Directors Central West Local Health Integration Network of 406

392 Central West Local Health Integration Network SCHEDULE A TO CEO ATTESTATION For the Applicable Period rd Quarter (Q3) (October 1, 2015 to December 31, 2015) Note to LHIN Boards re Schedule A. If the LHIN has no exceptions to declare, please insert flo known exceptions under each of following below: 1. Memorandum of Understanding No known exceptions. 2. Ministry-LHIN Accountability Agreement (MLAA), Ministry-LHIN Performance Agreement (MLPA) in effect No known exceptions. 3. Completion and accuracy of reports required pursuant to Section 5 of the BPSAA; EXCEPTION: The LHIN has determined that the terms and conditions on which all fourteen LHINs acquired insurance breach the LHINs obligations under LHSIA, the Financial Administration Act, the MOU and possibly the MLPA. The LHIN is endeavouring to resolve this accidental breach by seeking approvals required by LHSIA, the Financial Administration Act, the MOU and the MLPA. This process began with a submission by Toronto Central LHIN, on behalf of all LHINs, to the Ministry of Health and Long-Term Care (the Ministry ). The LHINs await a response from the Ministry. 4. Prohibition, in section 4, of the BPSAA, on engaging lobbyist services using public funds; No known exceptions. 5. Compliance with applicable directives issued by the Management Board of Cabinet (including Procurement, Travel, Meals and Hospitality, and Perquisites Directives) No known exceptions of 406