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JULY 23, 1997, Toronto, Ontario -- The Health Services Restructuring Commission (HSRC), an independent body of health experts and professionals, today released a discussion paper outlining proposed new provincial planning guidelines to help make decisions about services and reinvestment needed in a restructured health system.

Rebuilding Ontario's Health System: Interim Planning Guidelines and Implementation Strategies outlines provincial planning frameworks in five sectors: home care, long term care, mental health, rehabilitation and sub-acute care.

"As the first phase of our work to restructure hospitals nears the midpoint, this document initiates the important second phase of our mandate where we will enhance and build services outside of hospitals to meet future health needs," said HSRC Chair, Dr. Duncan Sinclair. Dr. Sinclair is the former Vice Principal of Health Sciences and Dean of Medicine at Queen's University. "This paper lays the groundwork for planning and will prompt significant reinvestment in other sectors. We're counting on extensive feedback to tell us if we're on the right track."

The deadline for feedback is Tuesday, September 30, 1997.

Suggested reinvestment

The HSRC has advised the Minister of Health that the following reinvestment is required province-wide:

• $110 million in home care across Ontario to provide services to patients after their hospital or day surgery procedure;

• by 2003, 41,660 long term care "places" or a 32 per cent increase to existing supply, consisting of 15,404 additional long term care beds and 26,256 additional "places" for community-based supports such as home care and supportive housing; and
  
• 1,550 beds across the province for a new level of service called sub-acute care.

The HSRC proposes the following planning guidelines to help determine the level of reinvestment needed to redesign the health system. The Commission is adamant that no shifts occur until proper supports are in place to ensure quality patient care and accessibility to services is maintained.

Home Care: A new formula determines the amount of reinvestment required to bring each home care program to the chosen benchmark. Case management, equipment and travel costs are also included.

Rehabilitation: A reorganization of services from general and special to local (short term and long term) rehabilitation, and regional rehabilitation. A planning guideline of 20 beds per 100,000 population with 15 beds for local (short and long term) services; 4 beds for regional services and 1 space for transition to independent living programs.

Mental Health: Interim planning guidelines are recommended to ensure an orderly transition from hospital-based to community-based mental health services. By 2000, 37 beds per 100,000 population (21 acute and 16 longer term beds). By 2003, 35 beds per 100,000 population (21 acute and 14 longer term beds).

Long Term Care(LTC): The broad spectrum of long term care includes chronic care hospitals, chronic care units in acute care hospitals, nursing homes, homes for the aged, supportive housing, longer term home care and community-based services (e.g., attendant care and adult day care).

The proposed planning rangeThe planning range extends from the 25^th percentile to the 75^th percentile. The 25^th percentile rate means that 25 per cent of municipalities meet or exceed this level of use; the remaining 75 per cent require additional capacity to bring them up to the benchmark rate. Communities between the 25^th and 75^th percentile would maintain their current ratio of LTC places per 1,000 population (75+).of places per 1,000 population over 75 years of age is based on current use of LTC services. If current use is less than the low end of the range, then capacity will be increased to the minimum. If current use is above the high

end of the range, then no additional capacity will be added. A "minimum acceptable level" of access to and use of LTC services will be established. All parts of the province would be brought up to the minimum acceptable level. Different planning ranges have been developed for northern and southern Ontario.

The planning guideline for chronic care will be 7 beds per 1,000 population over age 75. With the reduction of chronic care beds, services must be added in other parts of the long term care sector such as nursing homes/homes for the aged. The number of nursing home/homes for the aged beds is based on a minimum bed use in each community which is then compared to the provincial bed average of 96.4 beds per 1,000 population over age 75. If a community is below the provincial average, adjustments may be made based on population and other factors.

Sub-acute Care: A new level of care for patients who do not require acute services but who require skilled therapy or nursing care on a short term basis to regain function and return home. The proposed planning guideline of .14 beds per 1,000 population, calls for approximately 1,550 additional beds across the province.

Feedback invited

The discussion document identifies several policy issues and invites feedback from health professionals and the community-at-large regarding the proposed planning guidelines, including:

• modifying government structures to support restructuring;
  
• developing a common assessment tool for admission to programs/beds to determine service requirements and match patients with appropriate services;
  
• planning and allocating resources based on population needs;
  
• improving data and information systems ; and
  
• adopting a funding mechanism that supports the above elements.

The Health Services Restructuring Commission is a group of individuals appointed by the Government of Ontario to redesign the Ontario health system. It is an independent agency of doctors, academic health science professionals, hospital administrators, former hospital board members and other experts. The Commissioners work with local district health councils, hospital boards and other health professionals to restructure health services for each community. The Commission has a four-year mandate to restructure hospital systems and advise the Minister of Health on reinvesting in and restructuring other services to meet the health needs of the people of Ontario.