WWCCAC transitioning services towards the high

Waterloo Wellington CCAC
Streamlining Services For High
and Lower Need Patients
Building Community Capacity - A Collaborative
Planning Initiative for CCAC and CSS
WWCCAC strategic plan work underway is positioning the organization for the future.
WWCCAC is defining its target population and will focus services on moderate to high
complex patients. The context of this initiative considers the findings in the Sinha
Excerpt from Dr. Sinha’s Report – Living Longer, Living Well
KEY RECOMMENDATION : Enhance the Provision of Home and Community Care
“The Ministry of Health and Long Term Care should support the LHIN’s their
CCAC’s and CSS agencies to formalize a collaborative Standardized Care Model
that can allow acuity based wait-lists and Care Coordination assignments
between CCAC’s and select CSS Agencies. This will allow both sectors to provide
publicly funded personal support services in each LHIN. This will allow both
sector organizations to play to their strengths and better address client needs.”
Context Cont’d
The volume of client referrals to CCACs from the hospitals has increased (due to initiatives to
reduce hospital length of stay and ALC days and improve patient flow)
The increased volume of higher acuity clients on CCAC caseloads adds tremendous pressure
on CCAC budgets and lower needs clients may end up waiting for service
The Seniors Strategy for Ontario recommends that LHINs, CCACs and CSS agencies formalize a
Standardized Collaborative Care Model and collectively build the capacity to enable CSS
agencies to provide PSW services to lower needs clients
WW CCAC’s strategic planning work aligns nicely with this opportunity to work collaboratively
with the LHIN, CCAC and CSS sector to consider how to:
 Best serve the lower acuity home care clients
 Collectively build capacity across the community sector
 Deliver the best value for money
 Effectively facilitate patient flow through the healthcare system
Context Cont’d
 The WW LHIN envisions greater system capacity, improved patient
satisfaction and outcomes and more effective transitions with greater
patient support through the continuum of care through the efforts of this
 Create “Early -Single Entry Point -Coordinated Access” to care
 Shift CCAC resources to higher needs– higher acuity clients
 Find better solutions through a more robust CSS Network for lower needs –
lower acuity clients
 Ensure services are “targeted”
 Focus on transitions to better suited partner providers within the CSS Network
 Engage all stakeholders through the process
 Ensure the process is transparent and open
Project Overview – Mission and Success
 Work in partnership with the WWLHIN, CCAC and CSS sector to
 A collaboratively developed plan that establishes the strategy, processes,
develop a plan that will enable CSS agencies to provide personal
support worker services to certain categories of home care clients
structures, roles, capacity and operations required to shift the care of
some categories of home care clients from the CCAC to CSS agencies
 A well-defined implementation plan that identifies the key tasks, roles,
responsibilities and considerations for all partners to ensure clients
receive the support they require from the CCAC and CSS agencies
 The collaborative development of key governance and accountability
terms and agreements to ensure that all parties clearly understand their
relative authorities, accountabilities and responsibilities
Project Overview – Scope
In Scope
 An Environmental Scan of Leading Practices for this client
 Stakeholder Engagement
 A Business Plan identifying benefits, risks and recommended
operational processes, policies, roles and responsibilities
 Implementation Plan with Accountability Tools (i.e. Draft
Memorandum of Understanding)
Out of
 Implementation of Recommendations
 Award of PSW Business to CSS Agencies
 Transition of CCAC Clients to CSS Agencies
Project Advisory Committee
Gloria Cardoso
Waterloo Wellington CCAC – EXECUTIVE LEAD
Cathy Harrington
Community Care Concepts – Co Lead
Michelle Martin
Victorian Order of Nurses
Joanne Young Evans
Guelph Independent Living
Dale Howatt
Community Support Connections
Lisa Bitonti-Bengert
Waterloo Wellington LHIN
Barry Monaghan
Waterloo Wellington CCAC
Leanne Murray
Waterloo Wellington CCAC
Martina Rosza
Waterloo Wellington CCAC
Dana Khan
Waterloo Wellington CCAC
The advisory committee has met three times since the project inception - March 7th, April 3rd and April 30th.
It is expected the committee will met another 4 times before the completion of this project
Communiques of each meeting will be available on our website and sent directly to key stakeholder
Comments, feedback and questions are welcomed by Gloria Cardoso, WWCCAC Senior Director – Planning,
Communications & Community Engagement, at [email protected] or (519) 748-2222 ext.
Cathy Harrington, co-lead of the CSS Network and Executive Director of the Community Care Concepts is
also willing to take questions and comments. Cathy can be reached at [email protected]
or (519) 664-1900
Project Overview – Guiding Principles
The advisory committee developed the following Guiding
Principles for the Initiative
 To Be Patient/Client-Centred
 To Be Data Driven And Evidenced-Based
 To Position The Community Sector For Greater
Capacity To Prepare For The Future
 To Better Utilize Resources By Leveraging Technology
 To Ensure Policy Alignment
 To Be Fiscally Responsible and Ensure Value for
Project Plan
First Advisory Mtg.
We are
CSS network engagement
Contracted Service Provide
Advisory Committee
Contracted Service Provider Advisory Committee
Data Collection and Analysis
We are here.
Advisory Mtg.
Environmental Scan of Leading
Advisory Mtg.
Advisory Mtg.
Advisory Mtg.
Stakeholder Engagement
CSS network
Benefit and Risk Analysis
Business Plan Development
Implementation Planning
Project Management, Monitoring, and Control
Early Project Considerations
Project Structure Considerations
 Appropriate stakeholder representation in the project structure
 Clear roles and responsibilities for project members
 Ensure the planning process is open and transparent
Broad Stakeholder Engagement Considerations
 Establish the list of all key stakeholders early in the project
 Provide multiple channels and opportunities to provide input to the plan
 Ongoing communications and updates – all stakeholders have easy access to all
relevant planning information
 Identify barriers and risks that may limit the degree of stakeholder support for
the project
Current Project Undertakings
Data Collection and Analysis
 Current utilization, wait list, number of health human resources (HHR)
 Services offered - (service type offered)
 Current active patient volume (separated by service type)
Environmental and Jurisdictional Scan of Leading Practices
 Research and present innovative models of community sector partnership
for target populations e.g. lower need persons
 Identify key model considerations and dependencies (infrastructure,
capacity etc.)
 Assess state of local sector readiness based on degree of change in various
 Identify preferred model options
Key Stakeholder Engagement
CSS Network
CCAC Contracted Service Providers Advisory Committee
SGS, Retirement homes
Planned Phone Interviews:
MOHLTC - Catherine Brown
OCSA - President and CEO
Key LHIN Senior Leaders who have successfully help build CSS Capacity
 MH, Champlain, Central East, Toronto Central
 Key CCAC Senior Leaders who have work underway to transition lower need
population to CSS
 MH CCAC, Champlain
 CSS Thought Leaders across the province
 Survey:
 CCAC’s
Stakeholder Engagement Findings Highlights
April 9th CSS Network Meeting
It is simplistic to think in terms of ‘low’ and ‘high’ needs clients
Can’t base evaluation solely on RAI scores (blend of art and science)
Broad range of services and providers
Need to determine where there is capacity
Don’t forget about (specialty services, ABI, rec centres and wellness, dementia)
How will care coordination be differentiated for CCAC and CSS?
April 16th Contracted Service Provider Advisory Committee
What will be the impact on SP PSW market share?
CCAC transitioning to higher need population is consistent with other CCAC’s provincially
PSW’s may choose to go to a CSS agency if the population care is lighter
What are the HHR considerations knowing PSW’s are in demand. What are the union
implications if staff are moving from one organization to another?
Immediate Next Steps
Next Steps
Final draft environmental and jurisdictional scan
Mid May
Finalize data collection and analysis
Mid May
Stakeholder Interviews
Draft Benefit and Risk Analysis
Week of
May 12th
Do you have any questions or comments about the
Do you have suggestions for us as we consider this
planning moving forward?

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