Long-Term Care Home Accountability Planning Submission (LAPS) Guidelines

2016-19

Education Session

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Overview

• Priorities

• What are the LAPS and LSAA?

• LAPS Guidelines Development

• LAPS Overview

• Instructions for the completion of LAPS Forms

• Timeframes

• Questions

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Patients First – Action Plan for Health Care

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Pan-LHIN Health System AimsOntario’s LHINs recognize the value of focusing their collective efforts on common challenges. For this reason, and to better align high-level objectives of Patients First with the work of local health service providers and community partners, LHINs are working collaboratively on a series of provincial strategic initiatives:

• Transform the patient experience through a relentless focus on quality

• Drive innovation and sustainable service delivery

• Advancing Population Health

• Hospice/Palliative Care Provincial Strategy

• Mental Health and Addictions Strategy

• Enhance Access to high-quality Long Term Care

• Transforming Home and Community Care

• Supporting the Evolution of Health Links

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LAPS

• The Long-Term Care Home Accountability Planning Submission (LAPS) is a planning document that provides information about an individual LTCH and supports the negotiation of the Long-Term Care Home Service Accountability Agreement (LSAA).

• Each LTCH owns the LAPS document and is responsible for providing accurate and complete information to the LHIN. If at anytime, information within the LAPS document changes (i.e. between April 1st/2016 and March 31st/2019, the LTCH is responsible for updating the LAPS).

• Each LTCH governance structure is responsible for reviewing and approving this information provided in the LAPS as well as the content and commitments of the LSAA.

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PLACEHOLDER FOR IHSP DETAILS

• PLEASE INSERT YOUR LHIN’S IHSP DETAILS HERE

• LHIN Leads – Please utilize this slide to incorporate local content that your LTCHs may find valuable in the context of the LAPS and LSAA process.

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LSAA

• The LSAA is the legal agreement between the LTCH and the LHIN. The LSAA will replace the current service agreement (expires March 31st/2016). It is required under LHSIA and the MLPA and will cover a three year term of April 1, 2016 to March 31, 2019.

• The role of a LSAA is to clarify that the LTCH will be responsible for delivering not only on performance, but also planning and integration towards the development of a health system.

The LTCH’s LAPS and LSAA must reflect the home as part of a health care system versus as an individual health care provider.

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How LAPS & LSAA Fit Together

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LAPS Guidelines Development

• Consultation sessions were held with associations representing LTCHs in the province, as well as OLTCA, OANHSS and AMO.

• Feedback from a sample of LTCHs and the associations was considered and addressed through three avenues:

o Comments incorporated in the LAPS Forms & Schedules;o Comments incorporated in the LAPS Guidelines;o Development of training sessions; ando The development of a Question and Answer (Q&A) document.

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Roles and Responsibilities - MOHLTC• Quality Inspection Program (Compliance, inspection & enforcement of LTCHA);

• Evaluating the effectiveness of various programs used by the LTCHs;

• Setting MOHLTC program and LTCH policy (including Funding and Financial Policies and Capital Policies);

• Development of various funding programs;

• Monitoring established Quality of Care;

• Licensing & approval of LTC beds, including establishment of fees, applications for beds in Abeyance;

• Approving changes of ownership, sale of businesses and amalgamations of providers for purposes of licensing;

• Determining payment models and various funding programs;

• Determining construction cost funding per diem and LTC bed development programs/policies;

• Approving LTCH management contracts;

• Acting as the lead in the event of a bankruptcy and approving a third-party management company; and

• Long - Term Care Redevelopment.

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Roles and Responsibilities - LHINs

• Establishing quality and performance indicators for health service delivery;

• Monitoring the achievement of performance indicators;

• Performance management;

• Review and monitor: Occupancy/Utilization of beds, Placement refusal trends, Transfer request trends, Wait list profiles;

• Participate, as appropriate, in the preparation and submission of funding requests related to LTCHs through the MOHLTC annual planning cycle;

• Approve the conversion of existing long-stay beds as short-stay respite beds or terminate the designation of convalescent care beds; and

• Participating in long-term redevelopment in conjunction with the MOHLTC.

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LTCH Funding – MOHLTC Responsibilities

• For the review and reconciliation of funding on behalf of the LHINs using Audited Annual Report, Revenue Occupancy Report, and administering the Subsidy Calculation Worksheet, on behalf of the LHINs.

• Examples of MOHLTC funded programs include:o High Intensity Needs Funding;o High Wage Transition Funding;o Municipal Tax Allowance Funding;o Pay Equity Funding;o Physician On-call Funding;o Structural Compliance Premium;o Laboratory Services Funding;o RAI/MDS Sustainability Funding; ando Peritoneal Dialysis (PD) Funding.

• The MOHLTC is also responsible for the development of funding models and processes.

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LTCH Funding – LHIN Responsibilities

• LHINs provide and administer the following types of LTCH funding: o Level of Care Per Diem funding o Non-Level of Care funding such as:

- Registered Practical Nurse Funding;- Construction Cost Subsidy; and- Convalescent Care Bed Additional Subsidy.

• Authorize the recovery of unspent LHIN operating funds identified through the revenue occupancy report and annual reconciliation process.

• Re-allocate operating funds recovered through the revenue occupancy report.

• CMI Calculation notification

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Changes to LAPS

• The Service Plan Narrative has been adjusted to reflect some of the language included in the Community Annual Planning Submissions (CAPS) as follows:

o Included a question related to integrations and partnerships;o Added a section on Risk and Mitigations; ando Added a section on the Redevelopment Project.

• The Description of Services Form has been aligned to the Schedule A to avoid additional work and duplication involved in populating the schedules.

o In 2015-16, Schedule A included sections covering A.1 – Site Identification Information, A.2 - Licensed or Approved Beds & Classification, and A.3 - Bed Type.

o In 2016-17, Schedule A will include A.1- Site Identification Information, A.2 Bed Types and Numbers and new this year, A.3 - Structural Information.

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LAPS Guidelines

Table of Contents

1. Introduction2. Roles and Responsibilities3. Key Planning Consideration for the LAPS and LSAA4. LAPS Components5. LHIN Evaluation of LAPS6. Linking the LAPS to the LSAA7. Directives, Guidelines and Policies8. Changes Needing LHIN Review/ApprovalAppendix A: GlossaryAppendix B: Description of Services and Service Plan NarrativeAppendix C: LHIN Contact InformationAppendix D: LHIN Provincial Strategic Framework

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Reporting Requirements…

• Schedule C of the LSAA outlines financial and performance reporting required during the term of the LSAA beginning April 1, 2016.

• Financial Reporting continues to be based upon the calendar year.o OHRS/MIS Trial Balance;o Revenue/Occupancy Report;o Audited Annual Report; ando Financial Statements.

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Reporting Requirements (cont’d)

• Reporting requirements based on the fiscal year and include but not limited to:o Staffing Report – annually; ando French Language Services Report – annually (particularly for designated and

identified homes only).

• Reporting schedule will be available upon final approval of LSAA by LHIN Boards

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Description of Services and Service Plan Narrative

• Each LTCH is required to complete the Description of Services and Service Plan Narrative (LAPS - Appendix B).

• The Service Plan Narrative provides the LTCH the opportunity to provide the LHIN with an overview of the home including the unique features of the home, a description of the population that the home serves and services that the home provides to meet the needs of their resident group and community.

• The LAPS consists of two components:o The Description of Home and Services; ando The Service Plan Narrative.

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Description of Services

• The Description of services provides an overview of the LTCH and includes the following information:

o Site Identification Information;o Bed Types and Numbers;o Structural information;o Additional or Unique Services;o Specialized Designations;o Community linkages;o Services Supporting the Local Community; and o Quality Improvement Practices.

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A.1 General Information (will be a part of Schedule A in LSAA)

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A.2 Licensed or Approved Beds & Classification/Bed Type(will be a part of Schedule A in LSAA)

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A.3 Structural Information (will be a part of Schedule A in LSAA)

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A.4 Additional Services Provided(will not be a part of Schedule A in LSAA)

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A.5 Specialized Designations (will not be a part of Schedule A in LSAA)

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A.6 Community Linkages (will not be a part of Schedule A in LSAA)

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A.7 Services Provided to the Community (will not be a part of Schedule A in LSAA)

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A.8 Quality Improvement Practices(will not be a part of Schedule A in LSAA)

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Service Plan Narrative

• Details the services that the LTCHs provide to meet the unique needs of their resident group and identify how they support the local community.

• The information provided shall identify those services beyond the basic services provided in LTC.

• Information to be included within the narrative service plan will include:

o Strategic Goals and Priorities;o Advancement of the IHSP;o Partnership/Integration Opportunities;o Situation Analysis;o Evaluation of Prior Year Performance (optional);o Changes to Operations Summary (optional);o Risks and Mitigations; ando Impact of Redevelopment Project (if any).

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Service Plan Narrative (cont’d)

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LSAA Indicators

• The LSAA Indicator Work Group has been established to support the LSAA Advisory Committee.

• Based on direction from the LHIN CEOs, this Work Group produces documents and recommendations for discussion by the Advisory Committee, including a list of recommended LSAA indicators, technical specifications, target setting guidelines and education materials.

• This Work Group is comprised of representation from the LTC sector, including leadership from various homes, OANHSS, OLTCA, MOHLTC, LHINs, HQO and various municipalities.

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LSAA Indicators 2016-2019

• A number of new indicators were introduced to the LSAA in 2015-16.

• Given this, the Advisory Committee approved the decision to carry over the 2015-16 slate of indicators into 2016-17.

• The indicators are reflected on the following slide.

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LSAA Indicators 2016-2019

# Indicator Name Status

Quality and Resident Safety

1 Percent of Residents who had a Fall in the Last 30 Days Explanatory2 Percent of Residents whose Pressure Ulcer Worsened Explanatory3 Percent of Residents on Antipsychotics without a Diagnosis of Psychosis Explanatory

4 Percent of Residents in Daily Physical Restraints ExplanatoryOrganizational Health and Financial

5 Total Margin Performance6 Debt Service Coverage Ratio Performance Coordination, Access and Primary Care

7 Long-Stay Utilization Explanatory (Note: Percent Resident Days will eventually replace this indicator)

8 Number of Resident Transfers to ER from LTC Homes Resulting in Inpatient Admissions per 1,000 LTC Home Residents*

Developmental

9 Wait Time from CCAC Determination of Eligibility to LTCH Response Explanatory

10 Wait Time from LTCH Acceptance to Placement* Developmental

11 Long-Term Care Home Refusal Rate Explanatory

*Note: Developmental indicators are not included within SAAs.

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LAPS Forms – Submission Process – Retrieving the LAPS

• LAPS Forms will be made available by the LHINs; or LTCHs may go to https://hsimi.ca/LTCHome website to download the LAPS Forms.

• To download the LAPS Forms from the Ministry website (https://hsimi.ca/LTCHome), log in to the site and click the “Facility Main” button.

• Locate the “LAPS FORMS” link and click on the link.

• This will bring you to the LAPS FORMS menu which lists the available forms (both current and previous LAPS documents are listed). Use the “File Name” to locate the current 2016-19 LAPS forms, which is comprised of two separate files:

1. Description of Services; and 2. Service Plan Narrative.

• Download and save the forms using the same file name as displayed on the website.• File names must maintain the same standard format name of

“FileName_FacilityNumber.doc” (e.g. 2016-19DescriptionOfServices_NH4321.doc).

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LAPS Forms – Submission Process – Retrieving the LAPS (cont’d)(screen capture from HSIMI website)

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LAPS Forms – Submission Process – Retrieving the LAPS (cont’d)Screen Capture from https://hsimi.ca/LTCHome/Common/LAPS

The current LAPS Forms are not in the list below but will be once they are released online.

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LAPS Forms – Submission Process – Submitting the LAPS (cont’d)

• LAPS Forms must be submitted by uploading both forms into the Ministry website (https://hsimi.ca/LTCHome)

• Complete submission and upload files (one form at a time) to the website

• Files being uploaded must maintain the standard naming convention of “FileName_FacilityNumber.doc”

• Note: Files must be in the Microsoft Word “.doc” format type

• LAPS forms can continue to be uploaded (updated) until “locked” by the LHIN

• LTCHs experiencing technical issues with accessing the Ministry website, uploading LAPS files, or requiring a new account to log in can call the Ministry’s tech support at 1-866-414-0013 for assistance

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LHIN Review of LAPS

Each LAPS document will be reviewed by LHIN staff to

• Ensure that the submission is complete;

• Ensure the LTCH is maintaining required services;

• Compare the narrative component with other information for consistency;

• Review assumptions for consistency and reasonableness;

• Confirm that community engagement has occurred;

• Identify any inconsistencies or anomalies in the submission; and

• Generate a list of questions for the LTCH.

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LSAA Project Timeline

Early Oct LHINS will conduct local LAPS education sessions to provide HSPs with LAPS Guidelines and supporting materials to complete the LAPS.

Late Nov LSAA education sessions conducted by LHINS will provide HSPs with information needed to complete the LSAA including indicators.

Nov 23 Completed LAPS are due to the LHINS by November 23, 2015. The LAPS will facilitate the development of home-specific schedules that accompany the LSAA template agreement.

Jan-Mar Local LSAA consultations between LHINs and HSPs to finalize LSAAs for HSP Boards sign off will take place between January and March, 2016.

Mar 31 New LSAAs signed. All LSAAs are due to LHINs with HSP Board/Operator sign-off by March 31, 2016.

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CONTACTS

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LSAA PSWG MEMBERS

LHIN Lead Emily Van de Klippe Central East LHINLHIN Secondary Lead Kiran Kumar Hamilton Niagara Haldimand Brant LHINLHIN Secondary Lead Elliot Fung Waterloo Wellington LHINLHIN Ron Eng Central LHINLHIN Sheila Stirling Central East LHINOLTCA David Beirnes OLTCAOLTCA member rep Kimberley Shea Revera, Inc.OANHSS Jeffrey Graham OANHSSOANHSS Jacques Dupuis Au ChateauAMO Dean Lett Garry J. Armstrong Home in the City of OttawaMOHLTC Feng Ding MOHLTC, HDBMOHLTC Gary Thompson MOHLTC, LHIN Liaison BranchMOHLTC John Giangregorio MOHLTC, FMBMOHLTC Ifeolu Ogunyankin MOHLTC, HDBWG Support (Lead) Andrea Tsuji LHINC