NORTH EAST LHIN BOARD PACKAGE BOARD OF DIRECTORS

Transcription

NORTH EAST LHIN BOARD PACKAGE
BOARD OF DIRECTORS MEETING
TELECONFERENCE
WEDNESDAY,
SEPTEMBER 21, 2016
9:30 am
TROUSSE POUR LE CONSEIL D’ADMINISTRATION
DU RLISS DU NORD-EST
PAR TÉLÉCONFÉRENCE
LE MERCREDI LE 21
SEPTEMBRE 2016
9H30
NORTH EAST LOCAL HEALTH INTEGRATION NETWORK
Wednesday, September 21st, 2016
9:30 am
TELECONFERENCE
PUBLIC: 866-696-5894 PASSCODE: 3504679
NOTE:
ITEM
DIRECTORS ARE REQUESTED TO NOTIFY THE CHAIR PRIOR TO THE COMMENCEMENT OF THE
BOARD MEETING WITH RESPECT TO POTENTIAL CONFLICTS OF INTEREST ARISING FROM
ITEMS ON THE AGENDA.
TIME
TOPIC
LEAD
PROPOSED
OUTCOME
BOARD OF DIRECTORS MEETING – REGULAR SESSION
10 mins
Opening Prayer by Elder
1.0
1 min
Call to Order: Introductions of attendees
2.0
1 min
Declaration of Conflict of Interest
3.0
2 mins
Approval of Agenda
4.0
1 min
Approval of Consent Agenda (If there are no
items requiring removal into regular agenda)
Danielle
Bélanger-Corbin
Danielle
Bélanger-Corbin
Danielle
Bélanger-Corbin
Danielle
Bélanger-Corbin
D
*motion
D
*motion
CONSENT AGENDA
5.0
Board Attendance
6.0
Chair and Board Members’ Community
Engagements
Danielle
Bélanger-Corbin
Danielle
Bélanger-Corbin
7.0
Approval of Minutes of past Board meeting of
June 9, 2016
Danielle
Bélanger-Corbin
D
8.0
Q2 Delegation of Authority
Kate Fyfe
D
9.0
Attestation of Compliance
Kate Fyfe
D
10.0
Media Tracker
Cynthia Stables
I
11.0
Action Plan of FLS Designation
Louise Paquette
I
I
I
PAGE #
BUSINESS ARISING
12.0
10 mins
James Bay Coast Update
Carol Philbin
Jolette
I
NEW BUSINESS
13.0
20 mins
North East LHIN Northeastern Ontario Health
Strategy and Reconciliation Action Plan
14.0
15 mins
Report from the Chair
 Attendance Public Health Units meeting
 Correspondence
 Board membership update
 Update from LHIN Chair teleconference
meeting
Report from the CEO
 Update on Patients First
 Performance
o MLAA/Stocktake
Financial Update
• Funding
• Risk Assessment
• Internal Operations
Maison Vale Hospice
• Expansion of hospice palliative care
programs and services
Sault Area Hospital
 Percutaneous Coronary Intervention PreCapital Submission
15.0
16.0
15 mins
15 mins
17.0
20 mins
18.0
10 mins
19.0
5 mins
March of Dimes Canada
 Congregate Care Expansion
20.0
10 mins
Chapleau Health Services
 Pre-Capital Submission
21.0
20 mins
Housing and Health Strategy
22.0
20 mins
Review of Primary Care Services for
Francophones in Timmins
23.0
24.0
1 min
1 min
Next Meetings:
 Board of Directors Meetings
o November 10, 2016
o January 12, 2017
o March 1, 2017
Adjournment of Board Meeting
 Last word from the Chair
D=Decision, I=Information
Louise Paquette
Guest:
Gloria Daybutch
Danielle
Bélanger-Corbin
Rick Cooper
Louise Paquette
Kate Fyfe
Louise Paquette
Guest:
Leo Therrien
Jennifer
Wallenius
Nancy Lacasse
Guest:Deanna
Chisholm-Tullio
Christine Leclair
Louise Paquette
Guests:
Catherine
Matheson
Chris Stewart
Louise Paquette
Guest:
Dr. Raymond
Danielle
Bélanger-Corbin
D
*motion
I
I
I
D
*motion
D
*motion
D
*motion
D
*motion
D
*motion
D
*motion
I
Danielle
Bélanger-Corbin
D
*motion
2016 BOARD OF DIRECTORS MEETING ATTENDANCE
North East Local Health Integration Network
Members of the Board of Directors
January 26
2016
FF
Mar 30,
2016
FF
May 10,
2016
TC
June 9,
2016
FF
Danielle Bélanger-Corbin, Board Chair
FF
Regrets
TC
FF
Dr. Colin Germond
FF
FF
TC
FF
Santina Marasco
FF
Regrets
TC
FF
Rick Cooper
FF
FF
TC
FF
Dawn Madahbee
TC
FF
TC
FF
Denis Bérubé
FF
FF
TC
FF
Toni Nanne-Little
_____
FF
TC
FF
John Febbraro
FF
FF
TC
FF
FF
TC
-
Gary Scripnick
Members of the Board of Directors Audit Committee
Feb 11
May 25, 2016
Dr. Colin Germond, Chair
Danielle Bélanger-Corbin
Rick Cooper
Dawn Madahbee
John Febbraro
Denis Bérubé, Chair (as of May 2016)
TC
TC
TC
TC
TC
TC
TC
TC
TC
TC
Members of the Board of Directors Governance Committee
Feb 11
Rick Cooper, Chair
Santina Marasco
Denis Bérubé
Toni Nanne-Little
LEGEND
*
Meeting held via teleconference
FF
Director attended meeting in person
TC
Director attended meeting via teleconference
VC
Director attended meeting via videoconference
May 5, 2016
____
Director was entirely absent from meeting
TC
TC
N/A
No longer a Board Director
TC
TC
TC
TC
TC
TC
TC
TC
3
Chair / Board Members Community Engagements
Board Member
Toni Nanne-Little
Gary Scripnick
Toni Nanne-Little
John Febbraro
Denis Bérubé
Santina Marasco
Toni Nanne-Little
John Febbraro
John Febbraro
Toni Nanne-Little
John Febbraro
John Febbraro
Event
Description
Format
Date
Meeting with FJ Davey Home Board
members
Associate Minister visit at South
Centennial Manor
Sault Ste Marie
In person
April 5, 2016
MOH visit to approved LTC Homes for
redevelopment project
In person
April 8, 2016
Media Event in Sault Ste Marie
Launch SSM Health Link to Patients
In person
April 15, 2016
April 15, 2016
May 24, 2016
May 26, 2016
May 30, 2016
May 30, 2016
June 15, 2016
June 22, 2016
June 22, 2016
June 20, 2016
Media Event in Sault Ste Marie
Meeting at Sensenbrenner Hospital
Event hosted by NBRHC in North Bay
F.J. Davey Home AGM
F.J. Davey Home AGM
Alzheimers Society - Sault Ste Marie
Canadian Mental Health Association
Canadian Mental Health Association
Sault Area Hospital
Launch SSM Health Link to Patients
Provide input on recruitment
Shaping our Future as Sub-LHIN
Annual General Meeting
4
In person
In person
In person
In person
In person
In person
In person
In person
In person
MINUTES OF PROCEEDINGS
NORTH EAST LOCAL HEALTH INTEGRATION NETWORK
Thursday, June 9, 2016
Teleconference / NE LHIN Sudbury Office
1:30 pm
PARTICIPANTS:
Board of Directors :
Santina Marasco
Rick Cooper
Tamara Shewciw
Denis Bérubé
Dawn Madahbee
John Febbraro
Toni Nanne-Little
REGRETS:
Gary Scripnick
SCRIBE:
Micheline
Beaudry
Public:
Brian Rush – Item
17.0 only
NE LHIN Staff:
Louise Paquette
Cynthia Stables
Kate Fyfe
Catherine Matheson
Tamara Shewciw
Terry Tilleczek
Shana Caliste
Carol Philbin Jolette
Marc Demers
AGENDA ITEM
DISCUSSION
ACTION
ITEM 1.0
Call to order
Chair, Danielle Bélanger-Corbin, called the
meeting to order at 1:32 pm.
ITEM 2.0
Declaration of Conflict
of Interest
ITEM 3.0
Approval of Agenda
No conflicts of interest declared.
Members reviewed the agenda.
Addition to agenda – 16.5 Health Sciences
North Pet Scan
Page 1
5
RESPONSIBLE
{MOTION 2016-BD0174}
That the agenda for the Board of Directors
meeting of Thursday, June 9th, 2016 be
approved with addition.
MOVED: John Febbraro / SECONDED: Rick
Cooper
{CARRIED}
ITEM 4.0
Approval of Consent
Agenda
Members reviewed the consent agenda which
included the following items:
5.0 Board Attendance
6.0 Chair and Board Members’ Community
Engagements
7.0 Approval of Minutes of past Board meeting
of May 10, 2016
8.0 Media Tracker
Modification to item 5.0 - Update Board
Attendance to reflect Denis Bérubé as Chair
of Audit Committee and add Gary Scripnick
The consent agenda for the Board of Directors
meeting of Thursday, June 9th, 2016 be
approved as modified:
 Board Attendance
 Chair and Board Members’ Community
Engagements
 Approval of Minutes of Board meeting
of May 10, 2016
 Media Tracker
MOVED: Toni Nanne-Little / SECONDED: Denis
Bérubé
{CARRIED}
ITEM 11.0
James Bay Coast Update
Louise Paquette
Carol Philbin Jolette
Louise and Carol provided an update which
included:
Attawapiskat  In the last month, Carol has been
working at solidifying relationships with
Health Canada, MCYS, AND Aboriginal
Affairs and Northern Development
Canada, Public Safety Canada and Chief
and Council to ensure required services
are in place when EMAT transitions out
Page 2
6
Update at next
meeting
Carol Philbin
Jolette







of the community of Attawapiskat on
June10th.
EMAT was extended by the province for
an additional month until May 16, and
another extension was approved by the
MOH until June 10th.
All partners started working together
along with the community to ensure the
resources and required process would
continue post-response phase.
NE LHIN worked with Health Sciences
North (HSN) to secure the required staff
for WAHA -- 2 RNs, 2 Crisis Workers and
1 Community Case Manager. These
resources were based on EMAT
recommendations. Staff arrived in
Attawapiskat on June 1st and worked
closely with EMAT and WAHA to
transition the files and information.
NE LHIN is focusing on solidifying
relationships with various partners both
on the ground and at high levels of
various governments.
An executive team comprised of the NE
LHIN Coastal Senior Advisor, and Senior
staff from Health Canada and MCYS has
been established to work with the Chief
and Council and various service
providers to ensure the coordination of
health care services is part of the longer
term plan, and to develop a joint plan
that to ensure community stability and
sustainability.
NE LHIN continues to work closely with
the four hub hospitals to improve the
referral processes to the Schedule 1
beds as well as discharge planning.
The Board thanked Carol for the quality
of her work and the relationship that
she has developed with key people on
this file.
WAHA –
 Meeting on May 30th and 31st in Ottawa
of Tri-Party WAHA Oversite Committee
which included participants from
WAHA, MOHLTC, NE LHIN, Hay Group
and Health Canada.
Page 3
7
ITEM 12.0
Report from the Chair
ITEM 13.0
Report from the CEO
Louise Paquette
ITEM 14.0
Report from Audit
Committee
Denis Bérubé
Other  Ministry recently announced
investments in Indigenous Health as
part of their Indigenous Action Plan –
about $222 million over three years.
Danielle provided a report which included:
 On June 6th, Senior Directors and Board
members received an email from
Deloitte regarding the 2015-16 Board
Survey. The survey closes on June 17th.
Senior team and board members are
requested to complete the survey
before the deadline.
 Board vacancies will not be filled until
the fall when cabinet resumes.
Louise provided a report which included:
 A high-level overview of Bill 210 – the
proposed legislation that is part of
Patient’s First Proposal to Strengthen
Patient-Centred Health Care in Ontario.
 The hub hospital CEOs/Chairs, as well as
the NE CCAC will be meeting on June
15th as part of regular “Hub” meetings.
 On June 13th, a Primary Care meeting
will be held which will bring together
Primary Care clinicians to discuss
current state and possible next steps
with regards to this important sector.
At the Audit Committee of May 25, 2016, the
following items were presented for information:
 2016-17 LHIN Operations Budget
 Report on Insurance Coverage
 Risk Report – Light Touch
In addition, the Audit Committee recommends
the following items for review and approval:
 2016 Auditors Report and a report from
staff on funding allocations and LHIN
operations.
 Report on the use of consultants
RESOLVED THAT:
The NE LHIN Board of Directors approves the
Audited Financial Statements for the year ended
March 31, 2016, as recommended by the Audit
Committee.
Page 4
8
MOVED: Denis Bérubé / SECONDED: Dawn
Madahbee
{CARRIED}
RESOLVED THAT:
The NE LHIN Board of Directors approves the NE
LHIN Report on the Use of Consultants 2015-16.
MOVED: Rick Cooper/ SECONDED: John
Febbraro
{CARRIED}
ITEM 15.0
Report from Board SubCommittee

Rick Copper provided a report on the
HPAC meeting of May 4 and noted the
valuable system-wide energy and
expertise of this group.
Rick Cooper
Dawn Madabhee
Dawn Madahbee provided a report on LAHC:
 Cynthia Stables and Gloria Daybutch
were thanked for their work underway
to develop a Northeastern Ontario
Aboriginal Health Care Strategy and
Reconciliation Action Plan.
 A special meeting of LACH was held in
June to finalize the draft plan.
 Board members suggested that once
the Plan is finalized, it be sent with a
cover letter from Dawn and Gloria to
the Minister of Health and Long-Term
Care.
ITEM 16.0
Financial Update
Kate provided a report on the following:
Kate Fyfe
Currently operating a surplus (April 2016).
Quarterly reports are due to the Ministry at the
end of the month. There will continue to be a
focus on fiscal management to ensure
maintenance of a balanced financial position.
Financial Statements -
Performance MLAA - Status report was
provided on the NE LHIN performance on the
MLAA indicators and Q4 stocktake submission.
For the North East LHIN, performance is beyond
10% of the provincial target on 7 of the 14
Page 5
9
Bring forward NE
Ontario
Aboriginal Health
Strategy and
Reconciliation
Action Plan at
September board
meeting.
Micheline
Beaudry
performance indicators and within 10% of the
provincial target on 7 of the 14 performance
indicators. It was emphasized again that it is
important to look at the numbers within their
context and not just as a stand-alone figure.
ALC strategy – Terry reported on the NE LHIN’s
new ALC Strategy. The Health System Advisory
Committee helped to inform the plan and one
of their first priorities was ALC.
Working funds
 The Hospital Working Funds (WFI) Initiative is
one-time funding to be used solely to
improve a hospital’s adjusted working funds
deficit position.
 In order for hospitals to be eligible for
funding under this initiative they must have
an annual balanced budget and contribute a
portion of their revenue to reducing their
working funds deficit and achieve other WFI
targets.
 The NE LHIN works closely with hospitals to
ensure they meet the terms and conditions
of this funding to improve the financial
health of their organization.
RESOLVED THAT:
The Board of Directors receive and approve the
Timmins and Districts Hospital Working Funds
report.
MOVED: Denis Bérubé / SECONDED: Toni
Nanne-Little
{CARRIED}
{MOTION 2016-BD00179}
RESOLVED THAT:
Health Sciences North Working Funds report.
MOVED: Rick Cooper / SECONDED: Dawn
Madahbee
{CARRIED}
Page 6
10
RESOLVED THAT:
Sault Area Hospital Working Funds report.
MOVED: Santina Marasco / SECONDED: Toni
Nanne-Little
{CARRIED}
RESOLVED THAT:
North Bay Regional Health Centre Working
Funds report.
MOVED: John Febbraro / SECONDED: Santina
Marasco
{CARRIED}
16.5 Pet Scan Capital
proposal
Health Sciences North’s Pet Scan Capital
Proposal was brought forward for endorsement.
Catherine Matheson
That the NE LHIN Board endorse Part A of the
pre capital submission for the PET/CT Suite at
Health Sciences North, and that the proposal be
submitted by Health Sciences North to the
Ministry Health and Long Term Care for the
capital funding.
MOVED: Dawn Madahbee / SECONDED: John
Febbraro
{CARRIED}
ITEM 18.0
Proceed to Closed
session to discuss
matters involving:
Labour relations
Matters prescribed by
regulation
“The members attending this meeting move into
a Closed Session pursuant to the following
exceptions of LHINS set out in s.9(5) of the Local
Health Integration Act, 2006.”
☒ Labour relations
☒ Matters subject to solicitor client privilege
BE IT FURTHER RESOLVED THAT; the following
persons be permitted to attend:
For the discussion regarding Matters prescribed
by regulations:
Louise Paquette, CEO
Kate Fyfe, Senior Director
Page 7
11
Terry Tilleczek, Senior Director
Cynthia Stables, Director
Tamara Shewciw, Senior Director
Catherine Matheson, Senior Director
Laura Freeman
Micheline Beaudry
MOVED: Toni Nanne-Little / SECONDED: Rick
Cooper
{CARRIED}
ITEM 17.0
NE LHIN Addictions
Services Review – Dr.
Rush Report
Note: Meeting went into closed session as
presenter, Dr. Brian Rush, was not available
until later in the meeting.
Note: Meeting returned into open session for
this presentation only.
Dr. Brian Rush presented the NE LHIN
Addictions Services Review.
Dr. Brian Rush
Note: Meeting returned into closed session.
Proceed to Closed
session to discuss
matters involving:
Labour relations
Matters prescribed by
regulation
“The members attending this meeting move into
a Closed Session pursuant to the following
exceptions of LHINS set out in s.9(5) of the Local
Health Integration Act, 2006.”
☒ Labour relations
☒ Matters subject to solicitor client privilege
MOVED: Denis Bérubé / SECONDED: John
Febbraro
{CARRIED}
Report from the Closed
session
The Board of Directors of the NE LHIN received
the report of its Closed Session meeting of June
9th, 2016.
MOVED: Rick Cooper /SECONDED: Dawn
Madahbee
{CARRIED}
ITEM 27.0
Next Meetings

September 21, 2016 (Board of
Directors)
Page 8
12
ITEM 28.0
Adjournment of Board
Meeting
{MOTION 2016-BD0186)
The North East LHIN Board of Directors meeting
of June 9th, 2016 be adjourned at 6:00 pm.
MOVED: Denis Bérubé / SECONDED: John
Febbraro
{CARRIED}
AGENDA
DEVELOPMENT FOR
NEXT MEETING
__________________________
Chair
Rick Cooper
Vice Chair
Page 9
13
RESOLUTION
NORTH EAST LOCAL HEALTH INTEGRATION NETWORK (the “Corporation”)
Motion No.: 2016-BD00XX
MOVED:
_____________________________________
SECONDED:
_____________________________________
September 21, 2016
RESOLVED THAT:
WHEREAS the Quarterly reports are due to the Ministry of Health by September 30, 2016;
AND WHEREAS the North East LHIN has not received the templates in time to meet the deadlines for the
Board meeting;
THEREFORE: The North East LHIN Board of Directors appoint delegates, Danielle Bélanger-Corbin and
Louise Paquette to review and approve the Quarterly reports in order to meet the Ministry deadlines and
that the reports then be brought to Board for review at its next meeting.
_____________________________________
Chair
14
555 Oak Street East, 3rd Floor
North Bay, ON P1B 8E3
Tel: 705 840-2872
Toll Free: 1 866 906-5446
Fax: 705 840-0142
www.nelhin.on.ca
555, rue Oak Est, 3e étage
North Bay, ON P1B 8E3
Téléphone : 705 840-2872
Sans frais : 1 866 906-5446
Télécopieur : 705 840-0142
www.rlissne.on.ca
ATTESTATION
Prepared in accordance with section 14 of the
Broader Public Sector Accountability Act, 2010 (BPSAA)
TO:
The Board of Directors of the North East LHIN, (the “Board”)
FROM:
Louise Paquette
Chief Executive Officer
North East LHIN
Date:
September 6, 2016
RE:
April 1, 2016 to June 30, 2016 (“the Applicable Period”)
On behalf of the North East 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.
The LHIN's compliance with the "Principles for LHIN-Managed (QBP) Volume
Movement”, per the QBP Volume Management Instructions and Operational Policies for
Local Health Integration Networks that are issued by the ministry.
15
…/2
-2In 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.
Dated at Sudbury, Ontario this September 6, 2016:
Louise Paquette
North East LHIN
I certify that this attestation has been approved by the board of the North East LHIN on
September 21, 2016.
Chair, Board of Directors
North East LHIN
16
SCHEDULE A
to
Attestation For
North East LHIN
For the Applicable Period: April 1 to June 30, 2016
1.
2.
MEMORANDUM OF UNDERSTANDING; AND
MINISTRY LHIN ACCOUNTABILITY AGREEMENT/MINISTRY LHIN PERFORMANCE AGREEMENT
Possible Non-Compliance.
The NE 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 NE LHIN is endeavoring to resolve this accidental breach by seeking approvals
required by LHSIA, the Financial Administration Act, the MOU and the MLPA. Toronto Central LHIN, on
behalf of all LHINs, continues to work on a submission to the Ministry of Health and Long-Term Care and
the Ministry of Finance.
3.
COMPLETION AND ACCURACY OF REPORTS REQUIRED PURSUANT TO SECTION 5 OF THE BPSAA
NO KNOWN EXCEPTIONS
4.
PROHIBITION ON ENGAGING LOBBYIST SERVICES USING PUBLIC FUNDS PURSUANT TO SECTION 4 OF THE
BPSAA
NO KNOWN EXCEPTIONS
5.
COMPLIANCE W ITH APPLICABLE DIRECTIVES ISSUED BY MANAGEMENT BOARD OF CABINET
a. OPS PROCUREMENT DIRECTIVE
NO KNOWN EXCEPTIONS
b. OPS TRAVEL, MEAL AND HOSPITALITY EXPENSES DIRECTIVE
NO KNOWN EXCEPTIONS
c.
OPS PERQUISITES DIRECTIVE
NO KNOWN EXCEPTIONS
17
Quarterly Media Tracker and Analysis
April 15, 2016 – September 2, 2016
Key Findings and Analysis
Over a six-month period (April 2016 – September 2016), the NE LHIN was featured in more than 71 news
articles, radio, and TV reports. Some of the most covered topics for this period include:





The release of the NE LHIN’s addiction services review generated great media pick-up with six
outlets covering the review, 313 Facebook hits, and over 825 Twitter hits.
The May NE LHIN board meeting and subsequent media release, where two capital submissions
were supported, received media coverage from four outlets and over 750 twitter hits.
A first-ever North East Dementia Strategy meeting generated great media pick-up with coverage
from two newspapers and CTV television as well as over 745 twitter hits.
The Northern Telemedicine Forum (North Bay) received coverage from one television outlet and
various radio news coverage in North Bay.
Our Healthy Change Champion continues to receive great media coverage in our region. This
quarter, a media release announcing recipient Mary Davis of Nipissing Mental Health and Housing
Support Services received media pick-up from three media outlets in North Bay as well as 610
twitter hits.
Website
The website continues to be the medium with the greatest extent of reach for the NE LHIN. For this time
period, the website had over 44,000 page views, many of which came via news releases and our IHSP
priority web pages. Some of the top pages viewed for this period include: About Us, News and Events,
Goals and Achievements, and our Contact Us page. Our homepage also received nearly 11,000 views,
where many visitors viewed the news stories in the rotating banner. The top search term for this period
was “IHSP,” followed by “Stay on Your Feet.”
Website statistics, April 15, 2016 – September 2, 2016
18
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


Sessions: Number of visits to the website.
Users: Number of people visiting the website. Includes both new and returning visitors.
Page views: The total number of pages viewed. Repeated views of a single page are counted.
Pages/Session: The average number of pages viewed during a visit to the site.
Avg. Session Duration: The average time on our site is slowly increasing. Our content and promotion images are
becoming more engaging and we are now keeping people on our site longer than before.
Bounce Rate: The percentage of single page visits.
% New Sessions: The percentage of new visits continues to be high, at just more than 51%. We’ve always realized
a fairly high percentage of new visits. This could be attributed to the items we are sending out as press releases
linking back to our website.
Facebook
Our number of followers on Facebook continues to grow slowly: we now have 275 people who ‘Like’ us and
follow our updates. The number of people who talk about, share, or like our posts continues to remain steady
overall, with a large spike in views at the end of June, and an increase during the end of July. Popular posts
for this month included a release about a PET scanner in Sudbury, a post about the Minister’s Medal awards,
and a post about the release of the NE LHIN Addiction Services Review. Our Facebook posts often receive
hundreds of views, which lead to increases in readership of the website.
Number of users who viewed North East LHIN Facebook posts from April 15, 2016 – September 2, 2016
19
Twitter
The NE LHIN Twitter account continues to grow, and during this period, we achieved a new record with more
than 2,618 followers, up 108 followers. Our page regularly exceeds 2,000 views per week, with some posts
exceeding 1,000 views alone. Some of our most popular tweets during this period included a tweet on
increasing access to care for Francophones through French language services, a post on the NE LHIN Board
support of the PET scanner for Sudbury, a link to a blog post on improving addiction and mental health
services, and a post on World Breastfeeding Week.
Followers
2,618
2,602
2,588
2,546
2,519
2,497
2,470
2,450
2,440
2,412
2385
2365
2342
2318
2260
2235
2223
2163
2125
2106
2065
Followers
3,000
2,500
2,000
1,500
1,000
500
0
May-12
Nov-12
Jan-13
May-13
Jul-13
1-Sep
13-Nov
1-Jan
1-Mar
1-May
1-Jul
1-Sep
1-Nov
1-Jan
1-Mar
1-May
1-Jul
1-Sep
1-Nov
1-Jan
1-Mar
1-May
1-Jul
1-Sep
Date
September 2016
August 2016
July 2016
June 2016
May 2016
April 2016
March 2016
February 2016
January 2016
December 2015
November 2015
October 2015
September 2015
August 2015
July 2015
June 2015
May 2015
April 2015
March 2015
February 2015
January 2015
Earned Media
Earned Media
1. Improving Access to Long-Term Care for Residents in Iroquois Falls (April 26) – Facebook Hits: 74;
Twitter Hits: 651
2. Home and Community Care Services Are Now Just One Click Away (April 27) – Facebook Hits: 78;
Twitter Hits: 693; Media: North Bay Now, North Bay radio
3. North East LHIN’s First Death Café (April 29) – Facebook Hits: 45; Twitter Hits: 703; Media: Radio
Canada
4. Sault Star: St. Joe hospital keeps ER services (April 30)
5. Sault Today: Matthews Memorial Hospital can breathe a little easier (May 2)
6. Dr. Reena Dhatt - New Clinical Quality Lead for North East LHIN (May 3) – Facebook Hits: 86;
Twitter Hits: 577; Media: North Bay Now, Sudbury Star
20
7. New Video Showcases Regional Success in Transitioning Mental Health Patients from Hospital to
Community Housing (May 4) – Facebook Hits: 177; Twitter Hits: 716
8. Navigator Program Study Shows Stroke Patient Benefits (May 9) – Facebook Hits: 156; Twitter Hits:
670; Media: Timmins Today, SooToday, Sault Star, Sudbury Star
9. North East LHIN Board Supports Two Capital Submissions to Improve Access and Outcomes for
Patient Care (May 10) – Facebook Hits: 132; Twitter Hits: 762; Media: Northern Life, Sudbury Star,
Radio Canada, CTV
10. Increasing access to care for Francophones through French language services (May 13) –
Facebook Hits: 288; Twitter Hits: 1,039; Media: North Bay Now, North Bay Nugget
11. Sudbury Star: New OR reflects surgery advancements (May 23)
12. Northern Life: Every year, 1,200 seniors admitted to hospital after a fall (May 25)
13. Presenting NE LHIN Partnership Success at Calgary Conference (May 25) – Facebook Hits: 81;
Twitter Hits: 702
14. North East LHIN and North Bay Regional Health Centre Bring the District Health Care System
Together for a Day of Integrated Care Planning (June 1) – Facebook Hits: 114; Twitter Hits: 702;
Media: North Bay radio
15. Sudbury Star: Sudbury sends help to troubled First Nation (June 2)
16. Northern Life: Business as usual for the North East CCAC, says senior director (June 7)
17. Northern Life: Local firm to expand supportive housing in Lively (June 7)
18. Sharing patient and provider success stories at Northern Telemedicine Forum (June 9) – Facebook
Hits: 64; Twitter Hits: 554; Media: Cogeco, North Bay radio
19. North East LHIN Board Supports a PET Scanner Suite for Sudbury (June 9) – Facebook Hits: 119;
Twitter Hits: 772; Media: Sudbury Star, Radio Canada inquiry, Northern Life
20. North East LHIN Addiction Services Review Released (June 10) – Facebook Hits: 313; Twitter Hits:
829; Media: Manitoulin Expositor, Sudbury Star, Addictions & Mental Health Ontario, CBC Radio,
BayToday, Kirkland Lake radio, Northern Medical Journal
21. North East Housing and Health Planning Day (June 13) – Facebook Hits: 85; Twitter Hits: 588;
Media: North Bay Now
22. SooToday: ARCH thrilled with funding increase (June 15)
23. Sudbury Star: Doing it 'the Sudbury way' (June 15)
24. Northern Life: Flatlined budgets, siloed services failing addicts, new study finds (June 15)
21
25. NE LHIN CEO Blog: It Takes a Community of Care... (June 16) – Facebook Hits: 131; Twitter Hits:
745; Media: North Bay Now
26. Sudbury Star: Sudbury hospital needs to raise $15 million (June 17)
27. Sudbury Star: Changes won't affect home care in Sudbury: CCAC (June 17)
28. North East LHIN Celebrates the 20th Anniversary of National Aboriginal Day (June 21) – Facebook
Hits: 306; Twitter Hits: 601
29. North East LHIN and Réseau Celebrates St. Jean Baptiste Day and Quality Health Services for
Francophones (June 24) – Facebook Hits: 841; Twitter Hits: 407
30. Expert in Poverty and Health Visits Sudbury (June 27) – Facebook Hits: 86; Twitter Hits: 423; Media:
Sudbury Star
31. North East LHIN Long-Term Care Providers Share Ideas for Delivering Quality Care to Support
Older Northerners (June 28) – Facebook Hits: 329; Twitter Hits: 633
32. First meeting to develop a Northeastern Ontario dementia strategy to improve care for older
Northerners (June 29) – Facebook Hits: 62; Twitter Hits: 748; Media: Timmins Daily Press interview,
North Bay Nugget, CTV
33. Sudbury’s Health System Works To Improve Health for All (June 30) – Facebook Hits: 62; Twitter
Hits: 523
34. North East LHIN supports quality care for Northerners at end of life (June 30) – Facebook Hits: 61;
Twitter Hits: 520; Media: Northern Life interview
35. Northern Life: Men now have access to substance abuse day program (July 1)
36. North East LHIN Engages with Nurse Practitioner-Led Clinics on Primary Care Planning (July 6) –
Facebook Hits: 128; Twitter Hits: 714; Media: Primary care officer interviewed by Sudbury Christian
radio station
37. Hospital Innovation Alive and Well in the North East LHIN (July 8) – Facebook Hits: 71; Twitter Hits:
638; Media: North Bay Now
38. More support for access to hospice beds in Sault Ste. Marie, Sudbury, Kirkland Lake and Englehart
(July 11) – Facebook Hits: 120; Twitter Hits: 555
39. Mary Davis of Nipissing Mental Health Housing and Support Services Named North East LHIN
‘Healthy Change Champion’ (July 12) – Facebook Hits: 71; Twitter Hits: 610; Media: CTV News;
North Bay Nugget; BayToday
40. Sudbury Star: Funding will aid hospice care (July 12)
22
41. Using Behavioural Supports to Help Meet the Unique Care Needs of Older Adults -- like Stan (July
13) – Facebook Hits: 62; Twitter Hits: 515; Media: CTV News; North Bay Now, Northern Life
42. Manitoulin Expositor: Proposed assisted living facility remains in limbo pending support (July 20)
43. NE LHIN CEO Blog: Improving addiction and mental health services for the people of Northeastern
Ontario (July 27) – Facebook Hits 552; Twitter Hits: 1,168; Media: North Bay Now, Shana
interviewed by 2 private radio stations
44. Men like Louis wanted – Falls Prevention and Exercise Classes (July 28) – Facebook Hits 92;
Twitter Hits: 609; Media: Kirkland radio
45. Ontario Investing an Additional $100 Million This Year in Home and Community Care, $5.6 Million to
go to North East (July 29) – Facebook Hits 130; Twitter Hits: 764
46. CBC News: MPP calls for better way to move patients between hospitals (Aug 2)
47. Temiskaming Speaker: Temiskaming support needed – non-urgent transportation (Aug 2)
48. Kirkland radio interview with NE LHIN Officer regarding non-urgent transportation (Aug 2)
49. Premier Announces Two North East LHIN Rural Health Hub Pilots to Improve Coordination of Rural
Health Care (Aug 9) – Facebook Hits 218; Twitter Hits: 490; Media: Mid-North Monitor
50. Ontario Investing over $200,000 in Greater Sudbury to Improve Care in Emergency Rooms (Aug 23)
Facebook Hits 47; Twitter Hits: 183
51. You Could be Driving this SUV! – An media send about PATH and the need for training volunteer
drivers (Aug 25) Facebook Hits 149; Twitter Hits: 308
52. North East LHIN Hospitals Receive Boost in Infrastructure Investments (Aug 29) Facebook Hits 39;
Twitter Hits: 286; Media: Timmins Daily Press, CJKL FM Kirkland Lake, North Bay Radio, North Bay
Nugget, Sudbury Star
53. Culturally Based Approach to Addiction Vital in NE (Aug 30) Facebook Hits 104; Twitter Hits: 471
54. North East LHIN Puts Patient-Centred Quality Front and Centre (Sept 1) Facebook Hits 56; Twitter
Hits: 293
23
24
Appendix A
ACTION PLAN
SUBMITTED TO THE NELHIN
FLS DESIGNATION 2016
CRITERIA
RECOMMENDATION
TASK
LEAD
TIMELINE
The agency must offer quality
services in French on a
permanent basis which is
ensured by employees with the
requisite French language skill.
1-That the FLS and HR policies be
revised to better reflect revised
designation criteria and best
practice, in line with your FLS Active
Offer policy.
1-Review and revise the current
FLS and HR policies to ensure
that the revised designation
criteria are included and in line
with the Active Offer Policy.
2- This will be included in the
policy revision
Michael Resetar
December 1, 2016
Natalie Carle
January 2017
Blaise MacNeil/Maggie
Matear
August 2017
Access to services must be
guaranteed and follow the
principle of an active offer.
Provisions for effective
representation of Francophones
on the board of directors and its
committees are included in the
administrative by-laws and must
reflect the proportion of the
Francophone population within
the community served.
2- That you confirm and clearly
indicated that a minimum of
advanced level is required for
designated positions.
3- That the hospital develops
guidelines for setting consistent
targets throughout the organization
for designating positions when there
is a pool of staff.
That the existing mechanism to
identify Francophone clients be
monitored to ensure consistent
implementation and comprehension.
That the by-laws include a statement
regarding the requirement for
Francophone representation on the
board. Specifically, that the number
of Francophones on the board of
directors and the committees of the
board of directors reflects the
proportion of the Francophone
population in the community served.
3-Develop guidelines for setting
consistent targets of designated
positions in each
service/program providing
direct service/care to the public
where there is a pool of staff.
To review with IS/IT department
the registration process and the
questions related to the
linguistic identity of the client to
ensure they are easy to ask and
to understand and reflect the
needs of the Francophone
population
To amend the hospital’s
administrative by-laws by
including a statement that
clearly specifies the percentage
of elected members required on
the Board and its committees to
reflect the Francophone
proportion in the community
being served.
25
CRITERIA
RECOMMENDATION
TASK
LEAD
TIMELINE
The senior management team
must have an effective
representation of Francophones.
In order to demonstrate
accountability, that there be a plan
to ensure effective representation of
Francophones within the senior
management team. A certain
number of these positions,
proportional to the Francophone
population, should be designated
and be reflected as such in the HR
plan for designated positions.
1-That the by-laws include a
statement describing the
responsibilities of the board of
directors and the senior
management team with respect to
FLS.
2-We support and recommend that
you move forward with the review of
your satisfaction survey and include
this element in your Quality
Improvement Plan
The HR policies and the HR Plan
will be amended to include the
requirement and a plan to
achieve proportional designated
positions at the senior
management level.
Michael Resetar
December 2016
Blaise MacNeil/Maggie
Matear
August 2017
Natalie Carle
September 2016
The board of directors and the
senior management team must
be accountable with respect to
the quality of French Language
Services.
1-The administrative by-laws
will be amended to indicate
that the board of directors and
the senior management team
are accountable for the quality
of French Language Services at
the hospital.
2-Already included in QIP and
patient satisfaction survey. The
survey will be amended to
include a question or questions
related to patient satisfaction
with respect to FLS services.
Final August 31, 2016
26
North East LHIN Aboriginal Health Care
Reconciliation Action Plan
Anishinaabe Mno-nmaadziwin Ngodowendiiwin Teg
Maamwiz-dooying lw Enaaknegying
ᑭᐧᐁᑎᓄᐠ ᐃᑕᐧᐃᓂᐠ ᒥᓄᐱᒪᑎᓯᐧᐃᐣ ᑲᒪᒧᐧᐃ ᐊᑐᐢᑲᒋᑲᑌᐠ ᐃᓂᓂᐧᐃ ᑭᑎᒪᑫᓂᒋᑫᐧᐃ
ᐳᓀᓂᒥᑐᐧᐃᐊᑐᐢᑫᐧᐃᐣ ᐁ ᐅᓇᐢᑕᓂᐧᐊᐠ
Plan daksyon d’rékonsiliasyon d’RLISS du Nord-Est
Sèrvis dsanté Autochtone
September 2016
27
Gloria Antoine of Zhiibaahaasing First Nation with her
grandchildren Sage and Emily attended the Three Fires
Confederacy at M’Chigeeng First Nation on Manitoulin Island
where the North East LHIN staffed a booth to gather input on
how to strengthen health care for Aboriginal Northerners.
Manitoulin Island is home to 12,600 people, including seven
First Nation communities. Every year, the North East LHIN
provides about $24 million to deliver front-line health care on
Manitoulin Island.
28
Aboriginal Health Care Reconciliation Action Plan | 2
Table of Contents
Acknowledgements ............................................................................................................................... 4
Message from the LAHC Chair and NE LHIN CEO ................................................................................ 5
The History of the Aboriginal People ................................................................................................... 6
The Northeastern Ontario Landscape.................................................................................................. 7
NE LHIN and Aboriginal Health Care .................................................................................................... 8
NE LHIN-Funded Aboriginal Health Service Providers ........................................................................ 9
Our Reconciliation Action Plan Journey ............................................................................................ 10
Our Vision for Reconciliation ............................................................................................................. 12
Our Reconciliation Action Plan Values .............................................................................................. 13
Strategic Directions ............................................................................................................................. 14
Conclusion ........................................................................................................................................... 21
Appendices .......................................................................................................................................... 22
Note: Within this plan, the term “Aboriginal” refers to people who self-identify as First Nation, Métis,
Inuit, Indigenous.
29
Aboriginal
Health
CareCare
Reconciliation
Action
PlanPlan
|3 |3
Aboriginal
Health
Reconciliation
Action
Acknowledgements
The North East Local Health Integration Network (NE LHIN) would like to thank
the individuals who participated in engagements that informed the development
of this North East LHIN Aboriginal Health Care Reconciliation Action Plan. In
addition, Helen Bobiwash and members of the 2015-2016 LHIN’s Local Aboriginal
Health Committee (LAHC) were instrumental in putting this plan together. See list
of members below.

Gloria Daybutch (Chair), Executive Director, Maamwesying North Shore Community Health
Services Inc., Cutler

Dawn Madahbee, NE LHIN Board Director, and General Manager of Waubetek Business
Development Corporation

Dale Copegog, Director of Health and Social Service, Wasauksing First Nation, Parry Sound

Rachel Cull, Executive Director, Misiway Milopemahtesewin Community Health Centre, Timmins

Sally Dokis, Health Director, Dokis Health Centre, Monetville

Giselle Kataquapit, Health Director, Peetabeck Health Centre, Fort Albany

Julie Morin, Operational Director, Mnaamodzawin Health Centre, Little Current

Veronica Nicholson, Executive Director, Timmins Native Friendship Centre, Timmins

Angela Recollet, Executive Director, Shkagamik-Kwe Health Centre, Sudbury

Janice Soltys, Chief Information Officer, WAHA, James and Hudson Bay

Tyler Twarowski, Program Manager, CMHA Cochrane Timiskaming Branch, Timiskaming

Mary Jo Wabano, Health Services Director, Wikwemikong Health Centre, Manitoulin Island

Pam Williamson, Executive Director, Noojmowin-Teg Health Centre, Little Current

Louise Paquette, NE LHIN Chief Executive Officer

Cynthia Stables, NE LHIN Senior Director, Cultural Diversity, Community Engagement,
Communications

Natalie Atkinson, NE LHIN Aboriginal Lead

Katerine Moyer, NE LHIN Project Coordinator
30
Dear Fellow Northerners,
Aanii Giiwednong Endnaakiiyek Nwiijkiwedik,
ᑭᓇᐧᐊᐤ ᐣᑐᑌᒪᐠ ᑭᐧᐁᑎᓂᐧᐃᓂᓂᐧᐊᐠ
Chèr konpagnyon d’Nord
On behalf of the North East LHIN and the North East Local Aboriginal Health Committee (LAHC), we are pleased to share
our North East LHIN Aboriginal Health Care Reconciliation Action Plan. We developed this plan together. The outcomes
of LHIN-led engagements with Aboriginal Northerners over the past several years have greatly informed this plan.
The plan encompasses four main strategic directions -- Opportunities (East); Relationships
(South); Knowledge and Understanding (West); and Sustainability and Evaluation (North).
The plan will be implemented using the Medicine Wheel as a guide – a widely recognized
approach that represents wholeness, balance and interconnectedness. Each strategic
direction plays an integral role in the success of this plan.
Historically, Aboriginal people in Canada had strong, independent and thriving societies.
They welcomed and created partnerships enabling newcomers to survive and establish a
permanent home here. The federal government used colonial policies and residential
schools to systematically eradicate their distinct social, cultural, legal and spiritual
practices. The health status of Aboriginal people in Ontario is a direct result of the colonial
harm and generational trauma this has caused in the lives of Aboriginal peoples. It is our
moral duty to work with Aboriginal people in Northeastern Ontario to walk the journey of
reconciliation and work toward closing the gaps in health outcomes between Aboriginal and
non-Aboriginal communities.
We recognize that understanding the historical, contemporary and cultural factors that
have an impact on Aboriginal people is key to understanding their current health status
and their need for culturally appropriate health care services. Building on a foundation
that is inclusive and respectful of Aboriginal culture and history, this plan begins a
process for change that will help to address the health disparities of the Aboriginal
population within Northeastern Ontario.
Louise Paquette, NE LHIN
Gloria Daybutch, Chair,
NE LHIN Local Aboriginal
Health Committee
The North East LHIN will incorporate this plan in its efforts to work towards cultural
proficiency across the region and increase the health and wellness of Aboriginal people. We will continue to foster
relationships with partners and organizations, sharing our goals and priorities, and will measure our efforts in our path
towards success. If your organization would like to work with us to accomplish these goals, we welcome hearing from you.
This plan reinforces our commitment to improving health services for Aboriginal people living in Northeastern Ontario
and to achieving greater health equity. Together, we are building a stronger system of care that will benefit all
Northerners today and for generations to come.
Yours in health and wellness,
Kaa-ne Naaghadoonaa Waa-shi Mno-maadzying
Miinwaa Wii-Mnomaajiishkaaying,
ᓂᓇ ᒥᓄᐱᒪᑎᓯᐧᐃ ᐊᑐᐢᑫᐧᐃᐣ ᑲ ᐊᑐᐢᑲᑕᐠ
Bin a vou, santé é biyenèt
Louise Paquette
Gloria Daybutch
North East Local Health Integration Network (NE LHIN)
Chair, NE LHIN Local Aboriginal
Health Committee
31
The History of Aboriginal People
Aboriginal people are the original inhabitants of North America. The Canadian Constitution recognizes
three groups of Aboriginal people — First Nation (Status and Non-Status Indians), Métis and Inuit. Each
group has unique heritage, language, cultural practices and spiritual beliefs.
The history of Aboriginal people in Canada is rich and diverse and reaches back before the arrival of
Europeans. Aboriginal people had thriving societies with flourishing intertribal trade, and a sustainable
approach towards the use of lands and resources. The history of First Nations, Inuit and Métis is
important in the development, and future, of Canada, Ontario and Northeastern Ontario.
Aboriginal people welcomed newcomers to this land and forged partnerships to help them survive and
build a home in a harsh, unknown environment. The British Crown recognized the original occupancy of
Aboriginal people in Canada with the Royal Proclamation in 1763. Treaties were negotiated and signed
to create mutual benefits for the Aboriginal people and newcomers.
By 1867, the year of Canadian Confederation, the federal government implemented policies and
enacted the Indian Act to assimilate Aboriginal people into the colonial society. Aboriginal people were
isolated to reserves, whole communities were relocated, and Aboriginal cultural practices were
outlawed. Many colonial policies continue today.
Children were forced into residential schools and taken from their families and communities for
adoption. Families were fractured. Children experienced mental, physical and sexual abuse. There
were more than 130 residential schools in Canada. The last one closed in 1996. Six of the 18 residential
schools that operated in Ontario were located in Northeastern Ontario. The trauma of the residential
schools and the adoption policies are still felt today by Aboriginal people.
Despite the efforts of the federal government to eradicate Aboriginal culture and societies, Aboriginal
people have survived. However, many policies have left scars on generations as is evidenced in today’s
physical and mental health issues, addiction and substance abuse, violence and high rates of suicide
amongst Aboriginal people. Gaps exist between Aboriginal and non-Aboriginal populations with respect
to health, levels of education attainment, and over-representation among homeless and prison
populations.
In December 2015, Canada’s Truth and Reconciliation Commission (TRC) released its report on what it
heard with respect to the residential schools in Canada. The TRC called for reconciliation to address the
ongoing legacy of colonialism and the creation of a more equitable and inclusive society by closing gaps
in health and other areas.
In May 2016, the Ontario government apologized for the history of colonial policies that disempowered
Aboriginal Ontarians and released Ontario’s First Nations Health Action Plan.
The NE LHIN acknowledges the impact of colonial federal policies on the Aboriginal people residing
within Northeastern Ontario and aims to close the gaps in health through this Aboriginal Health Care
Reconciliation Action Plan.
32
The Northeastern Ontario Landscape
Aboriginal Population within the Region
 About 60,000 Aboriginal people, approximately 11% of the total population
o 39 First Nations; 9 Métis Nation communities; 7 Aboriginal Friendship Centres
 Within this Aboriginal population:
o 62% are First Nation; 37% are Métis; 41% are 24 years of age and younger; 34% are 45 years
of age or older
Health Conditions
In general, Aboriginal people experience a lower health status than other Northerners. The primary health conditions
experienced by Aboriginal Northerners, includes:
 Higher rates of medically complex chronic health conditions such as diabetes, hypertension and mental health disorders.
 Physical aging at a younger age due to multiple chronic conditions.
 Higher cases amongst Aboriginal youth of mental health issues, chronic illnesses and poor oral health.
 High rates of suicide and suicide ideation.
 First Nations people are over-represented as clients in addiction services across Northeastern Ontario.
Health and other Factors
In its 2016 reports Cancer in First Nations in Ontario and Cancer in the Métis People of Ontario, Cancer Care Ontario reports
that:
 More Aboriginal people smoke than the general population.
 The proportion of overweight or obese Aboriginal people is higher than the general population.
 Aboriginal Northerners are less likely to consume the recommended servings of fruit and vegetables.
 According to the National Household Survey (2011)
o The Aboriginal unemployment rate is approximately 4.4% higher than the total unemployment rate in the NE LHIN.
o 24% of private households in the NE LHIN deemed “not suitable” by the National Occupancy Standard
are Aboriginal households.
o 14% of Aboriginal people 15 years and older in private households are unemployed.
Physical Environment
Peoples’ physical environment has an impact on their health outcomes. The 2011 National Household Survey,
Aboriginal Population Profiles reports that:
 One-fifth of private dwellings occupied by Aboriginal people require major repairs.
 There are high mobility rates among the Aboriginal population.
 Almost 30% of people in private Aboriginal households are living under the poverty line.
The Aboriginal Peoples Survey, 2012, reports that 18% of Aboriginal people, aged 6 years and older who live off-reserve,
experience low or very low food security, (an indicator related to the supply of food, and individuals' access to it).
Aboriginal Health Care Structure
 Aboriginal people access a variety of health services through Aboriginal and mainstream providers that are
located on- and off-reserve.
 Funding for health services flows to health service providers from federal, provincial, LHIN and Aboriginal
Political Territorial Organizations. The wide range of funding levels between different jurisdictions often leads
to inequities in service levels, duplication or gaps in program support, and reporting pressures on health service
providers who must account to several levels of government for support received.
 Many urban health service providers offer services to all Aboriginal heritage groups.
33
North East LHIN and Aboriginal Health Care
The NE LHIN is committed to improving the health of Aboriginal people across Northeastern Ontario – a
part of Ontario that spans 400,000 square kilometres. Over the past 10 years, the NE LHIN has engaged
with Aboriginal/First Nation/Métis leadership, communities and health service providers. The outcomes
of these engagements are reflected in the LHIN’s priorities in strengthening the system of care for people
living in Northeastern Ontario.
Since 2009, the NE LHIN has relied on the expertise of its Local Aboriginal Health Committee (LAHC) to guide
its work in better meeting the health care needs of people who identify as Aboriginal, First Nation or Métis.
The LAHC is comprised of senior representatives of Aboriginal health care organizations across the
region. It advises the LHIN Board of Directors on health service priorities, opportunities for engagement,
and better coordination of services within Aboriginal/First Nations/Métis urban and rural communities.
Members travel hundreds of kilometres to meet face-to-face twice per year. In between, meetings are
held via teleconference as needed. Members represent the needs of people living within their
geographic area and not their individual organization.
The NE LHIN holds accountability agreements with 37 Aboriginal providers including:




One Hospital (Weeneebayko Area Health Authority - WAHA, James Bay Coast) – WAHA serves a
remote population of about 7,000 and the communities of Moose Factory, Moosonee,
Peawanuck, Kashechewan, Attawapiskat and Fort Albany. In addition to WAHA, this far northern
part of the LHIN is home to two federally-funded nursing stations (Kashechewan and Peawanuck).
One 59-bed Long-Term Care facility (Wikwemikong)
One Community Health Centre (Misiway, Timmins)
34 Community Support Service Providers, including three Aboriginal Health Access Centres (AHACs),
Six Mental Health and Addiction Providers, and others (see map on next page).
Note: Some organizations provide services in more than one sector and may be counted twice.
North East LHIN funded services delivered through 37 Aboriginal providers:
Hospital (WAHA) - $23.3M
Community Support Services - $9.7M
Mental Health & Addictions - $2.7M
Long-Term Care - $2.5M
Diabetes - $335,000
34
Aboriginal
Health
Reconciliation
Action
Aboriginal
Health
CareCare
Reconciliation
Action
PlanPlan
| 8| 8
NE LHIN-Funded Aboriginal Health Service Providers
Every year, the NE LHIN invests more than $38 million to deliver health care services to Aboriginal people
living in Northeastern Ontario.
To view a map of Aboriginal health service locations across the NE LHIN, including Métis Councils,
Federally-Funded Services, Aboriginal Friendship Centres, Public Health Units, Canadian Red Cross health
services, and Métis Health & Wellness Worker offices, see Appendix B.
35
Our Reconciliation Plan Journey
The need for a Northeastern Ontario Aboriginal Health Care
Strategy and Reconciliation Plan was identified as a result of
engagements held with the LAHC, Aboriginal people and providers
within the LHIN catchment area, including:


Engagements held in five communities along the James and
Hudson Bay Coast to help inform actions needed to increase
access to care for people living in the LHIN’s most Northerly
communities. The LHIN team heard first-hand stories of a
system that is heavy with opposites – gaps/duplications of
service providers, an absence of checks/balances across the
system, new/aging equipment that often sits idle due to
untrained staff, and examples of both tragedy and triumph of
the human spirit.
43 public community engagement sessions and two online
surveys in 2015 to gather input from Northerners on the
LHIN’s 2016-2019 Integrated Health Service Plan (IHSP).
Our North East LHIN
Commitment
We will ensure the North East LHIN
Aboriginal Health Care
Reconciliation Action Plan is an
evolving document that will be
reviewed annually and updated
with new initiatives.
Over the course of the NE LHIN’s
current Integrated Health Service
Plan (2016-2019), our immediate
focus is on delivering high quality
outcomes through a focus on the
following strategic directions:




Opportunities
Relationships
Knowledge and Understanding
Sustainability and Evaluation

15 public engagement sessions and an online survey in
January/February 2016 to gather input and respond to the
Ministry of Health and Long-Term Care’s Patients First: A
Proposal to Strengthen Patient-Centred Health Care in Ontario.
This effort included two Aboriginal-specific engagements and a special meeting of LAHC.

Biannual meetings of the LAHC to discuss opportunities for increased access, coordination and
sustainability of health care services to the region’s Aboriginal population.
Over the years, engagements with Aboriginal Northerners have revealed several ways to strengthen
health care. These include providing mechanisms for cultural competency training with health service
providers, expanding the availability of traditional health programs and services, improving quality of
hospital care and coordination of services upon discharge, increasing mental health and addiction
services, and encouraging all levels of government to work more closely together to deliver quality health
services, to name a few. (Visit www.nelhin.on.ca to learn more about engagement outcomes.)
This plan was also informed by an analysis of an environmental scan (Appendix A). The scan was
completed using outcomes of engagements, available statistical data, and aggregate electronic medical
records data pertaining to the top health conditions of the Aboriginal Health Access Centres and
Aboriginal Community Health Centre within the region.
36
Other recent events reinforce the importance of our Reconciliation Plan, including:

In December 2015, the Truth and Reconciliation Commission (TRC) released its report which includes
94 calls to action to aid in the reconciliation of the legacy of Canada’s residential school system.

In May 2016, the Premier of Ontario apologized for the history of colonial policies that disempowered
and disenfranchised the Indigenous peoples of Ontario and the continued harm this has caused to
Aboriginal cultures, communities, families and individuals.

Ontario’s First Nations Health Action Plan was announced in May 2016. It outlined significant
investments in Aboriginal health care in four key areas: primary care, public health and health
promotion, seniors’ care and hospital services, and life promotion and crisis support.
This North East LHIN Aboriginal Health Care Reconciliation Plan is informed by NE LHIN-led engagements,
the active involvement of LAHC, the Federal and Provincial government response to the impact of
residential schools on Aboriginal people, and the need for a collaborative effort to strengthen the health
care status of Aboriginal Canadians.
The process followed to complete this plan enabled the NE LHIN to focus on building stronger
relationships and raising awareness of fellow Northerners on the need for a shared understanding and
ownership of this plan today, and into the future.
“It is our vision to support
the healing process of our
communities in order for
our future generations to
never have to suffer from
uncontrolled poor health
and well-being”
– Gloria Daybutch, Chair, NE LHIN
Local Aboriginal Health
Committee
37
Aboriginal
Health
Care
Reconciliation
Action
Aboriginal
Health
Care
Reconciliation
Action
PlanPlan
| 11| 11
Our Vision for Reconciliation
Aboriginal people living in Northeastern Ontario will enjoy a quality of
life and health status equal to all Ontarians from birth to end of life.
The NE LHIN and its Local Aboriginal Health Committee acknowledge
that:
 Aboriginal people have an equal right to attain the highest standard of health.
 The current state of Aboriginal health in Northeastern Ontario is a direct result
of previous Canadian government policies, including residential schools.
 Reconciliation means addressing inequities and closing the disparity gap of
Aboriginal health. It is important to educate Northern Ontarians about this
Reconciliation Plan and to distribute information that can be used within
Aboriginal communities.
 Improved health outcomes are based largely on the social determinants of
health and are grounded in Aboriginal practice that culture is treatment and
therapy.
To achieve our vision, we will:
 Value Aboriginal healing practices and advocate for increased understanding of
its importance so that those who request it can receive it.
 Support better access to health education resources for life-long learning and
increased self-care.
 Contribute to closing the gap in life expectancy that exists between Aboriginal
and other Northern Ontarians.
 Support a climate that ensures the patient remains at the centre of a shared
care model for Aboriginal people living in Northeastern Ontario.
 Recognize the impact of social, environmental and economic conditions on the
health and well-being of individuals.
 Work collaboratively with all levels of government, communities and health
service providers, for greater health equity for Aboriginal people living in
Northeastern Ontario.
38
Health
Care Reconciliation
Action
AboriginalAboriginal
Health Care
Reconciliation
Action Plan
| 12 Plan | 12
Our Reconciliation Plan Values
In keeping with the Seven Grandfather Teachings, the following seven values have been identified for our
North East LHIN Aboriginal Health Care Reconciliation Action Plan. Incorporating these values further
grounds our work in Aboriginal culture, keeping us mindful of the people the plan is serving.
Collaboration and Relationship Building (Love)
The teaching of love is required to build relationships and to give freely without conditions. Collaboration
and relationship building, between all levels of the health care system, will address jurisdictional barriers
that impact the health outcomes of Aboriginal people.
Reconciliation (Respect)
The teaching of respect is important in reconciliation as it teaches us to look at things in another way, beyond
what our eyes see. Reconciliation starts with an awareness of the past, acknowledgement of the harm inflicted
on Aboriginal people and action to develop and maintain a mutually respectful relationship. Reconciliation will
support Aboriginal people to heal and help to close the gaps in health outcomes.
Traditional Health and Healing (Bravery)
The teaching of bravery is about doing the right thing and standing up for our convictions even in the face
of adversity. Traditional health and healing is integral to improving Aboriginal population health
outcomes. It is important to facilitate access to Aboriginal healing practices for those who request it.
Diversity (Honesty)
The teaching of honesty is about walking this journey in an honest way and “walking the talk.” It is
important to “walk the talk” to address the health needs of Aboriginal communities in a way that respects
their distinct needs and recognizes their diversity. Special consideration and support must be given to
Coastal communities that are faced with great challenges related to their geographic isolation.
Shared Responsibility (Humility)
The teaching of humility teaches us everyone is equal -- not less than or more than. All involved in the
health care system, including the individual, Aboriginal health service providers, mainstream health
service providers and governments have a shared responsibility to work together to strengthen the
delivery of health care programs and services to Aboriginal people.
Health Equity (Truth)
The teaching of truth is about not deceiving ourselves or others -- to speak truth from the heart. It is vital
to reduce the health disparities between the Aboriginal population and the overall population in the
region. Measurable goals must be identified and reported on to close the gaps in health outcomes.
Cultural Competency (Wisdom)
The teaching of wisdom is about listening and gathering knowledge to be used for the good of the people.
It is important that all health service providers develop cultural competency to better understand the
history of Aboriginal peoples in Canada, and the legacy of residential schools and to learn approaches that
deliver health services in a culturally safe manner to the Aboriginal population.
39
The Four Strategic Directions
The North East LHIN Aboriginal Health Care Reconciliation Action Plan encompasses four strategic
directions. The Medicine Wheel is divided into quadrants often used to signify the four directions,
seasons, life cycles, etc. It is a widely recognized symbol of balance, interconnectedness and the
Aboriginal holistic world view of thinking. Borrowing from these teachings, the four strategic directions of
the NE LHIN have been placed on the medicine wheel are:
Starting in the East, Opportunities – The East is our gift of vision. Creating and identifying opportunities
for new or enhanced initiatives will help us succeed in our vision of optimal health and well-being for
Aboriginal people.
Moving to the South, Relationships – The South is our gift of time. Building relationships and
collaboration takes time, but investing in this time can result in positive healthy outcomes for present and
future generations.
Moving to the West, Knowledge and Understanding – The West is our gift of knowledge and feeling. As
more people learn about the true history of Aboriginal people and its impact on their health, it will create
empathy and understanding which will help to create safe health service delivery environments.
Moving to the North, Sustainability and Evaluation – The North is our gift of movement.
Sustainability and progress of the plan will be achieved through evaluation. The plan will be updated to
reflect the current needs, and the desired outcome of health and well-being for Aboriginal people will be
moved in a positive direction.
(North)
Knowledge and
Understanding
(West)
Opportunities
(East)
Relationships
(South)
40
Strategic Direction – Eastern Door:
Opportunities
GOAL: Increase access to services and close gaps in care to achieve better health
outcomes for Aboriginal people living in Northeastern Ontario.
Action
Timeline
Alignment
Measurable Target
1
Educate health service
providers on the value of
Aboriginal healing practices
and correspond with LHINfunded health service
providers (HSPs) to ask that
they accommodate the use
of traditional healing for
those who request it.
 September 2017
 LHIN IHSP 2016-2019
 LHIN Annual Business
Plan
 TRC Calls to Action
 Ontario’s First Nations
Health Action Plan
 Number of HSPs
contacted and
committed to making
accommodations for
traditional healing
2
Identify the gaps in
diabetes services within
Aboriginal communities
and develop a strategy to
aid in closing the gaps.
 March 2018
 LHIN IHSP 2016-2019
Plan
Health Action Plan
 Report on gaps
 Develop strategy
3
Collaborate with all levels
of government that fund
diabetes services to align
programs, reduce
duplications and address
gaps.
 March 2019
 LHIN IHSP 2016-2019
Plan
Health Action Plan
 Number of meetings
with partners who fund
diabetes programs and
services
 Meeting outcomes/
deliverables
4
Engage with the Ministry of  Ongoing
Children and Youth
Services to explore
strategies to address gaps
in services for Aboriginal
children and youth, such as
mental health services.
 LHIN IHSP 2016-2019
Plan
Health Action Plan
 Journeying Together:
Ontario’s Commitment
to Reconciliation with
Indigenous Peoples.
 Regular Meetings
 Meeting outcomes/
deliverables
41
Action
Timeline
Alignment
Measurable Target
5
Evaluate opportunities to
transfer the delivery of
home and community care
services to Aboriginal
community-based
organizations.
 March 2018
 LHIN IHSP 2016-2019
Plan
 Patients First: Action
Plan for Health Care
Health Action Plan
 Ongoing discussion
with Aboriginal
community-based
organizations who
provide home and
community care
services
6
Engage Aboriginal
Northerners in the
planning to strengthen
mental health and
addictions services for
Aboriginal people and work
through the NE LHIN’s
Mental Health and
Addiction Services
Collaborative to implement
an action plan to help
increase mental health and
addiction services for
Aboriginal Northerners.
 Ongoing
through to
September 2018
 LHIN IHSP 2016-2019
Plan
Health Action Plan
 Journey Together:
Ontario’s Commitment
to Reconciliation with
Indigenous Peoples
 Development of
Memorandums of
Understanding
between the NE LHIN
and health services
providers to increase
access to mental health
and addiction services
 Aboriginal
representation on the
North East Mental
Health and Addictions
Collaborative, including
a Co-Chair
7
Identify opportunities to
develop strategies for
better elders’ health. For
example, building on the
North East Specialized
Geriatric Centre
programming underway in
Coastal communities.
 Ongoing
 LHIN IHSP 2016-2019
Health Action Plan
 Development of a
strategy to address
geriatric needs of
Aboriginal seniors in
Northeastern Ontario
42
Aboriginal
Health
Care Reconciliation
Action
Plan | 16
Aboriginal
Health Care
Reconciliation
Action Plan
| 16
Strategic Direction – Southern Door:
Relationships
Goal: Implement improvements across the health system that result in greater accessibility and
coordination of health services for Aboriginal people while strengthening relationships.
Action
Timeline
Alignment
Measurable Target
1
Facilitate quarterly meetings with the  Ongoing
provincial and federal governments
and health service providers to
explore strategies to address the
jurisdictional complexities.
 LHIN IHSP 2016-2019
 Regular Meetings
 LHIN Annual Business Plan  Meeting outcomes/
deliverables which include an
inventory of issues and a
common work plan
2
Support increased access to
traditional healing programs.
3
Evaluate and assess the current status  By March 31,
of patient transitions of care between
2018
hospitals and community and identify
strategies at the NE LHIN sub-region
level to address the gaps.
 LHIN IHSP 2016-2019
 Needs assessment report
 LHIN Annual Business Plan  Strategy
 Improved coordination of care
Health Action Plan
for Aboriginal patients upon
hospital discharge
4
Work with the region’s five public
 By March 31,
health units and Health Canada to build
2017
opportunities and ensure the sharing of
best practices between Aboriginal
communities and the health units.
Health Action Plan
5
Ensure Aboriginal representation on
LHIN-led health system tables,
including NE LHIN sub-region work.
 Fall 2016 and
as required
 LHIN IHSP 2016-2019
 Increased Aboriginal
representation and
 LHIN Annual Business Plan
participation on LHIN-led
planning tables
6
Ensure continued engagement of
Aboriginal patients and providers to
continue to improve health
care access and system coordination.
 By March 31,
2018
 LHIN IHSP 2016-2019
 Strategy in place to engage
health services providers in
 LHIN Annual Business Plan
system transformation
 Number of Aboriginal patients
and providers actually
engaged
 Ongoing




43
 Completion of an inventory of
LHIN IHSP 2016-2016
available traditional healing
LHIN Annual Business Plan
programs and an assessment
TRC Calls to Action
of gaps and opportunities
Ontario’s First Nations
 Increased availability of
Health Action Plan
traditional healing programs
 Invite a public health unit (PHU)
member to sit on LAHC
 Meet with region’s five PHUs
to establish a process to
strengthen access to PHU
programs/services by
Aboriginal Northerners
Strategic Direction – Western Door:
Knowledge and Understanding
GOAL: Increase knowledge and understanding about Aboriginal people, their language,
culture, and history to create safe and respectful health care environments.
Action
Timeline
Alignment
Measurable Target
1
Develop an accountability
agreement with NE LHIN staff
to ensure commitment to
implementing the plan.
 December 2016
 LHIN IHSP 2016-2019
2
Develop a work plan to
implement cultural
competency/safety training
to all LHIN staff, LHIN Board
members, and NE LHINfunded health service
providers.
 LHIN staff and
board training
by December
31, 2016
 HSP training by
March 31, 2018
 Development of multiyear strategy to ensure
 LHIN IHSP 2016-2019
continued cultural safety
training
Plan

Number of people who
 Ontario’s First
participate in training
Nations Health Action
annually
Plan
3
Share this plan with Northern
post-secondary institutions as
a means of encouraging their
development of competency
training within their
curriculum and operations.
 By December
31, 2017
 Number of postsecondary institutions
engaged
Plan (May 2016)
 Post-secondary response
4
Encourage health service
providers to make their
physical environment more
welcoming to Aboriginal
people, for example: public
display of Aboriginal artwork,
translated way-signage and
promotional material, and a
public display through
signage of the Aboriginal
territory in which the HSP
building is located.
 Ongoing and by
March 31, 2018
 LHIN IHSP 2016-2019
Plan
 TRC Call to Action
44
 100% of LHIN staff with
signed accountability
agreements
 Number of health service
providers who install
signage
 Public acknowledgement
of the offices that make
these efforts
Action
Timeline
Alignment
Measurable Target
5
Undertake an evaluation of
cultural competency training
completed by health service
providers.
 March 2018
 LHIN IHSP 2016-2019  Completion of evaluation
measuring the changes
stemming from the
Plan
training
 Number of HSPs
participating in the
evaluation
Plan
6
Recommend HSPs add
Aboriginal representation on
their Board of Directors to
provide guidance on the
needs of Aboriginal people.
 March 31, 2017
and ongoing
 Increase number of HSPs
with Aboriginal board
representation
7
Develop and implement
culturally appropriate
Personal Support Worker and
mental health training
programs.
 December 2017
 IHSP 2016-2019
Nations Health
Action Plan
 Training program
developed
 Curriculum implemented
45
Health
Care Reconciliation
Action
AboriginalAboriginal
Health Care
Reconciliation
Action Plan
| 19 Plan | 19
Strategic Direction – Northern Door:
GOAL: A sustainable and measured health care system for Aboriginal people living in
Northeastern Ontario that includes ongoing evaluation of this plan and gains
made to improve the health outcomes of Aboriginal people.
Action
Timeline
Alignment
Measurable Target
1
The reconciliation plan is
included in NE LHIN decisionmaking criteria for the
evaluation of proposals and
new programs and services.
 Ongoing
 LHIN IHSP 2016-2019
Plan
 Added criteria to NE LHIN
decision-making
framework
2
The NE LHIN identify an
Aboriginal Lead Officer to
oversee the implementation
of this plan.
 September 2016
 Patients First
 Appointment made
3
Work with Aboriginal
providers to ensure quality
data collection and reporting
through LHIN-supported
training opportunities.
 Ongoing
 LHIN IHSP 2016-2019
Plan
 Number of training
sessions
 % increase in report
submissions
 Enhanced data quality
4
Revisit the plan annually,
review actions achieved, and
report on progress to
to the LAHC, and the NE LHIN
Board of Directors.
 Annually
(Spring)
 LHIN IHSP 2016-2019
Plan
 LAHC and LHIN Board
revisit the plan annually
 Annual report to the
Board and LAHC
 Update actions for the
annual work plan
 Refinements to the plan
5
Identify targeted
engagement activities on the
specific needs of Aboriginal
people and partner with the
LAHC, health service
providers, and/or First
Nations communities.
 Ongoing
 LHIN IHSP 2016-2019
 NE LHIN Annual
Business Plan
 Patients First
 Aboriginal voices are
represented and
incorporated into
planning
46
Conclusion
“Building a better future is all about understanding our past. This
Reconciliation Plan is a starting point on our journey to ensure
more equitable health care services for Northeastern Ontario’s
Aboriginal people. Just as we recognize that we cannot overcome
decades of challenges, we know that we need to deliver on a
vision for the path forward, and we must take these important
first steps together.”
– Louise Paquette, North East LHIN Chief Executive Officer
This plan sets a course with guiding values, including a commitment from the North
East Local Health Integration Network to focus on strategic directions involving
opportunities, relationships, knowledge and understanding, sustainability
and evaluation.
We hope to make this journey with a load that’s lightened through the help of many
hands. We know that about 11% of Northeastern Ontario’s population is Aboriginal.
In this strong company, there are many opportunities to engage, collaborate, initiate,
and evaluate.
It’s important to also acknowledge that this plan requires the strength of relationships
that are respectful and understanding. To contribute to the success of this plan, there
is an expectation that Northeastern health service providers will grow their
knowledge in cultural competency.
In the spirit of building a stronger system of care, this plan outlines goals with
measurable targets.
It is time to begin our journey – together.
47
Aboriginal
HealthHealth
Care Reconciliation
ActionAction
Plan |Plan
21 | 21
Aboriginal
Care Reconciliation
Appendices
Appendix A: Environmental Scan
A. Methodology and Limitations
The environmental scan was completed through the use of the following Aboriginal data:
1. Data from NE LHIN Aboriginal engagements pertaining to the 2016-2019 Integrated Health Service Plan
and Patients First Discussion Paper was reviewed to identify priority needs of Aboriginal people.
2. The Aboriginal Peoples Survey (APS), Ontario, 2012, was reviewed to support what was heard during the
engagement sessions regarding health issues pertaining to the off-reserve Aboriginal population.
3.
Aggregate electronic medical records data pertaining to the top health conditions of the Aboriginal Health
Access Centres and Aboriginal Community Health Centre within the region was reviewed to determine if
health conditions differed in the data gathered from that in the Aboriginal Peoples survey.
4.
National Household Survey (NHS) 2011, Aboriginal Population Profiles, were reviewed to understand
the characteristics of the Aboriginal population in the region.
5. The analysis of the social determinants of health for the off-reserve First Nations population, 15 years
of age and older, Aboriginal Peoples Survey 2012 was reviewed to understand the links between the
social determinants of health and health conditions.
6. Research was conducted into the funding and delivery of Aboriginal health care services to describe
the structure for Aboriginal health care in the region.
The following limitations exist pertaining to the data:
1. The 2012 Aboriginal Peoples Survey provides data pertaining to the Aboriginal off-reserve
population. It excludes people living on Indian reserves and settlements. The APS is a thematic
survey that emphasized education, employment and health, intended to complement the Canadian
Census of Population and National Household Survey.
2. The 2011 National Household Survey (NHS), Aboriginal Population Profile, excludes data from some
Indian reserves and settlements and small towns. Some Indian reserves and settlements didn’t
participate in the NHS because enumeration was either not permitted or it was interrupted because
of natural events. Data was suppressed for towns where the Aboriginal identity population was less
than 250. The impact of incomplete information is greatest on data for First Nations people.
3. Engagement discussions did not specifically pertain to the Aboriginal Health Care and Reconciliation
Plan. Therefore, the needs identified through the engagement discussions may exclude some
Aboriginal health issues that may be considered important to the plan.
Statistical data excludes some of the Aboriginal population, so it is likely that some conditions and the
population of Aboriginal people in the region are underestimated. The data is presented to provide
a foundation for discussions pertaining to Aboriginal health care within Northeastern Ontario. The
LAHC can augment the data with their knowledge and experiences in Aboriginal health to validate or
expand the Aboriginal health care priorities.
48
B. Aboriginal Population
The Aboriginal population in Northeastern Ontario is diverse. Approximately 59,410 Aboriginal people
live in the region, about 11% of the overall population within the region (Statistics Canada, 2016). The
NE LHIN has the second highest proportion of Aboriginal people living within its region (Ontario, 2015).
Within the Aboriginal population, 62% identified themselves as First Nation and 37% identified
themselves as Métis.
There are 39 First Nations, 9 Métis communities and 7 Aboriginal Friendship Centres situated within rural,
remote and urban locations across the region.
C. Health Conditions
Mental health, prevention of chronic illness and oral health is a concern for the Aboriginal youth
population. Youth, under the age of 24, comprise 41% of the Aboriginal population within the region.
Aboriginal people are experiencing physical aging due to multiple chronic conditions. They are requiring
services normally associated with aging at younger chronological ages. Aging adults, 45 years of age and
older, comprise 34% of the Aboriginal population within the region.
One quarter of the Aboriginal population could be responsible for caring for the remainder of the
population within the region.
In 2012, 63% of off-reserve First Nations people aged 15 and older in Canada reported having at least one
chronic condition, compared with 49% of the total population of Canada. Of those Aboriginal people with
a chronic condition, 41% reported one condition, 25% reported two conditions and 35% reported three
or more chronic conditions. (Statistics Canada, 2016)
The 2012 Aboriginal Peoples Survey reported that the top chronic conditions of off-reserve First Nations
people aged 15 and older were the following:
Table 1: Chronic Health Conditions, 2012 Aboriginal Peoples Survey, Canadian Off-Reserve First Nations
Chronic Condition
High Blood Pressure
Arthritis (20%)
Asthma (15%)
Mood Disorder (15%)
Anxiety Disorder (14%)
Diabetes (10%)
% of Canadian Aboriginal Population
22
20
15
15
14
10
The three Aboriginal Health Access Centres and one Aboriginal Community Health Centre (CHC) within
the region provide services to 7,832 patients out of a total Aboriginal population of 28,681 within their
catchment area. The AHACs and CHC reported the following conditions that patients have.
49
Table 2
Health Condition
Diabetes Mellitus
Hypertension
Depressive Disorder/Depression
Anxiety
Post-Traumatic Stress Disorder
Intergenerational Issues
Mental Health Related Illnesses
Gastroesophageal Reflux Disease
Other Mood Disorder
# Patients
3807
997
472
442
307
292
290
283
259
The Métis Nation of Ontario reported the following pertaining to the chronic health conditions of Métis
people living within Ontario. (Métis Nation of Ontario)

The prevalence of diabetes among Métis people in Ontario is 26% higher than in the general
Ontario population.

The prevalence of chronic obstructive pulmonary disease (COPD) is 1.6 time higher among Métis
in Ontario.

Asthma is 1.2 times higher in the Métis population compared to other Ontarians, with the greatest
differences seen in youth aged 18 to 24 years.

One in five Métis citizens in Ontario suffer from osteoarthritis, a rate that is 20% higher than in
the general population.

Métis citizens have similar rates of acute kidney injury, chronic kidney disease, and end-stage
kidney disease compared with other Ontarians.
Statistics Canada reported that as the number of social determinants of health increases, the likelihood
of poor health outcomes increases.
D. Health Factors
The Chiefs of Ontario and Cancer Care Ontario reported the following health factors of First Nations
people in Ontario. (Chiefs of Ontario and Cancer Care Ontario, 2016)

First Nations people in Ontario are almost two times more likely to smoke cigarettes compared
to the general population, 50% of First Nation adults living on reserve and 44% of First Nation
adults living off-reserve compared to 26% of non-Aboriginal adults. A greater proportion of onreserve First Nation teens (30%) reported smoking than off-reserve First Nation teens (14%). Both
are significantly higher than non-Aboriginal teens (4%). Smoking rates declined within First Nation
adults as the level of education increased.

The proportion of obese men was significantly higher among First Nations living on-reserve (48%)
than those living off-reserve (33%) and non-Aboriginal men (19%). On-reserve First Nation
women were significantly more likely to be obese (49%) than off-reserve First Nation women
(28%) and non-Aboriginal women (16%).
50

On-reserve First Nation women were the least likely to be physically active (27%), about half as
likely as off-reserve First Nation women (50%) and non-Aboriginal women (48%). On-reserve First
Nation men (44%) were also significantly less likely to be physically active compared to off-reserve
First Nation men (60%) and non-Aboriginal men (53%).

On-reserve First Nation adults were significantly less likely to consume the recommended
minimum of 4 servings of fruit and vegetables per day (12% men, 20% women) than off-reserve
First Nation adults (27% men, 40% women). There was no significant geographic variation
between the north and south in the consumption of fruit and vegetables.
The Métis Nation of Ontario and Cancer Care Ontario reported the following health factors of Métis
people in Ontario. (Métis Nation of Ontario)
•
Métis adults in Ontario are 1.7 times more likely to smoke cigarettes compared to the general
population (37% vs. 22%, respectively). More Métis adults living in Northern Ontario (43%) are
smokers than those living in Southern Ontario (34%). Métis teens are more likely to smoke
compared to non-Aboriginal teens (17% vs. 8%, respectively). Smoking rates declined in Métis
adults as their level of education increased.
•
Métis adults are twice as likely to exceed drinking guidelines for cancer prevention and smoke
compared to the general provincial population.
•
Over half of Métis adults in Ontario are either overweight or obese (66% men, 55% women).
•
A similar proportion of Métis and non-Aboriginal Ontarians are overweight; however, Métis adults
are more likely to be obese than the general provincial population.
•
Nearly half of all Métis adults are inactive.
•
Approximately 70% of Métis adults in Ontario fail to consume the recommended number of
vegetables and fruits daily.
E. Physical Environment
Private Dwellings by Condition
Within the 2011 National Household Survey, the total number of private dwellings occupied by an
Aboriginal household was reported at 30,360. Twenty percent (20.8%) of the private dwellings occupied
by an Aboriginal household were reported as requiring major repairs.
Mobility
Some Aboriginal people move frequently. As a result, they may experience barriers to maintaining a
continuum of health care. The 2011 National Household Survey, Aboriginal Peoples Profile reported that
15% of the Ontario Aboriginal population moved within one year prior and 42% of the Ontario Aboriginal
population moved within five years prior.
51
Education
Less than half (44.5%) of the Aboriginal population aged 15 years and older possess a post-secondary
certificate, diploma or degree. Less than a quarter (22.9%) of the Aboriginal population aged 15 years and
older possess a high school diploma or equivalent as their highest certificate received.
Income of Private Households
Almost 30% of private Aboriginal households are living under the poverty line.
Figure 1: Total Income in 2010 of Private Aboriginal Households
Source 1: 2011 National Household Survey, Aboriginal Population Profile
Food Security
Food security is defined as having “physical and economic access to sufficient, safe and nutritious food to
meet their dietary needs and food preferences for an active and healthy life (Food and Agriculture
Organization of the United Nations, 2016).” In 2012, 18% of the Aboriginal population in Ontario aged 6
years and over reported low to very low food security.
Figure 2: Food Security of Aboriginal Peoples Aged 6 Years of Age and Over, Ontario
4%
9%
High or Marginal Food
Security
9%
Low Food Security
Very Low Food Security
78%
Food security not
specified
Source 2: Aboriginal Peoples Survey 2012, CANSIM Table 577-0009
52
F. Structure for Aboriginal Health Care in Northeastern Ontario
The Aboriginal health care system in Northeastern Ontario is a complex system that involves federal,
provincial and First Nation jurisdictions. As illustrated in Figure 3, funding of health services spans four
different levels: federal, provincial, NE LHIN and Aboriginal Political Territorial Organizations (PTOs).
Aboriginal people access services through a variety of Aboriginal and mainstream providers that are
located both on- and off-reserve.
Figure 3: Structure of Aboriginal Health Care in Northeastern Ontario
Government of Canada
The federal government has jurisdiction over on-reserve matters. Health Canada is the lead federal
department that is responsible for health care on First Nations. It provides funding for First Nation-based
health services. Indigenous and Northern Affairs Canada (INAC) is responsible for meeting the federal
government’s responsibilities for Aboriginal people and the North. INAC transfers funds for social services
that contribute toward improved health outcomes on First Nations. The Public Health Agency of Canada
(PHAC) is responsible for health promotion, prevention and control of infectious diseases and responding
to public health emergencies. PHAC transfers funds for health-related services to off-reserve populations.
Table 3 lists the health services that are funded by federal departments.
53
Table 3: Health Services Funded by the Federal Departments
Health Canada
 Children and Youth (Healthy
Child Development –
Aboriginal Head Start,
Maternal Child Health, Fetal
Alcohol Syndrome Disorder
(FASD)
 Mental Health and Addictions
(Brighter Futures Program,
Building Healthy Communities
Program, Indian Residential
Schools Resolution Health
Support Program, National
Native Alcohol & Drug Abuse
Program)
 Chronic Disease and Injury
Prevention (Aboriginal
Diabetes Initiative)
 Communicable Disease &
Environmental Health (Vaccine
Preventable Diseases, FN
Environmental Contaminants
Program, Drinking Water and
Wastewater, Communicable
Disease Emergency Planning &
Response
 Health Governance and
Infrastructure Support (Health
Planning Management,
Community Facilities, Security
Services for FNIHB Health
Facilities)
 Primary, Home and
Community Care (Public
Health Nursing Service
Delivery, First Nation Inuit
Home and Community Care,
Children’s Oral Health
Initiative)
 Non-Insured Health Benefits
(Drug, dental, vision care,
medical supplies &
equipment, mental health
counselling, medical
transportation)
Indigenous and Northern
Affairs Canada
 National Child Benefit
Program
 Assisted Living Program (In
home care, adult foster
care, institutional care and
disabilities initiative)
 Family Violence Prevention
Program
54
Public Health Agency of Canada
 Community Action Program
for Children (CAPC)
 Aboriginal Head Start in
Urban and Northern
Communities (AHSUNC)
 Fetal Alcohol Spectrum
Disorder Initiative
 Canadian Prenatal Nutrition
Program
Government of Ontario
The provincial government has jurisdiction over health services. Health services on-reserve is excluded
from the province’s legislated responsibility due to the federal responsibility over Aboriginal people.
However, the provincial government does provide support for Aboriginal health matters both on and offreserve. The Ministry of Health and Long Term Care is the lead Ministry responsible for health services.
The Ministry of Children and Youth Services delivers health services geared toward children and youth.
The Ministry of Community and Social Services delivers social services and community-based supports.
These three ministries provide funding for the delivery of health services that are listed in Table 4.
Table 4: Health Services Funded by Provincial Ministries
Ministry of Health and LongTerm Care
 Homemakers Program
 Healthy Kids Community
Challenge
 Home, Community and
Residential Care Services
 Aboriginal Health Access
Centres
 HIV/AIDS and Hepatitis C
Programs
 Other Ambulance
Operations
 Community Health Programs
 Small Hospital Projects
 Disease Prevention Strategy
 Nutrition and Healthy Eating
 Prevent Disease, Injury and
Addiction
 Healthy Communities Fund
 Smoke-Free Ontario
Ministry of Children and Youth Ministry of Community and
Services
Social Services
 First Nations Student
 Aboriginal Healing and
Nutrition Program
Wellness Strategy
(Community wellness
 Mental Health and
programs, Aboriginal
Addictions Workers
Healthy Babies/Healthy
 Akwe:go Children and WasaChildren Program, Mental
Nabin Youth Programs
Health Counselling, Crisis
through the Ontario
Intervention Services,
Federation of Indian
Healing Lodges, Health Care
Friendship Centres (OFIFC)
and Health Promotion,
 Aboriginal Fetal Alcohol
Shelters and Safe Houses,
Spectrum Disorder and Child
Pre and Post-Natal Care,
Nutrition Program through
Substance Abuse Treatment
the First Nation Political
Centres)
Territorial Organizations,
 Outpatient Hostel through
Aboriginal Health Access
Weeneebayko Area Health
Centres, and OFIFC
Authority (WAHA)
 Translation Services to help
people talk with health care
professionals through
WAHA (Timmins) and
N’Swakamok Friendship
Centre
 Crisis Intervention
Coordinator Services
 Healing Lodge in Shawanaga
North East Local Health Integration Network
The NE LHIN provides $38 million to 37 Aboriginal Health Service providers located on- and off-reserve in
the areas of community support services, community mental health & addictions, diabetes education, a
long-term care home, a community health centre and a hospital.
55
Political Territorial Organizations
The provincial Aboriginal political territorial organizations (PTOs) deliver regionally based programs
geared toward their population. They advocate for health services for the citizens that they represent.
They also flow funds through to local communities/or deliver services within local offices to deliver
community based programs as listed in Table 5.
Table 5: Health Services Funded by Aboriginal Political Territorial Organizations
Anishinabek
Nation
Métis Nation of
Ontario
 Aboriginal
Diabetes
Initiative
 Aboriginal
Healing
& Wellness
Strategy –
Community
Wellness
Worker
Program
 Aboriginal
Healthy
Babies/Healthy
Children
 Family
Violence
 HIV/AIDS
 Problem
Gambling
 Aboriginal
Diabetes
Education
Project
 Aboriginal
Healing &
Wellness
Strategy –
Community
Wellness
Worker
Program
 Aboriginal
Healthy
Babies/Healthy
Children
 Community
Action
Program for
Children
(CAP-C)
 Community
Support
Services
 Problem
Gambling
Prevention
Program
Association of
Iroquois and Allied
Indians
 Aboriginal
Diabetes
Education
 Aboriginal
Health
Babies/Healthy
Children
 HIV/AIDS
Problem
Gambling
Ontario Federation of
Indian Friendship
Centres
 Akwe:go Urban
Aboriginal
Children’s
Program
 Aboriginal
Diabetes Program
 Aboriginal Healthy
Aboriginal Healing
& Wellness
Strategy – Healing
& Wellness
Coordinators
 Babies/Healthy
Children
 Addictions and
Mental Health
Program
 Children’s Mental
Health Project
(Sudbury only)
 Health Outreach
Program (centres
not serviced by an
AHAC)
 Lifelong Care
Program
(Community
Support Services)
 Urban Alcohol
Fetal Alcohol
Spectrum
Disorder Program
 Urban Aboriginal
Healthy Living
Program
 Wasa-Nabin
Urban Aboriginal
Youth Program
Nishnawbe Aski
Nation
 Aboriginal
Healthy
Babies/Healthy
Children
 Aboriginal
Responsible
Gambling
Strategy
 AIDS/Healthy
Lifestyles
Program
 FASD/Child
Nutrition
 Food Security
Program
Note: Chart is based on information available. Additional health programs may be delivered through the Aboriginal PTOs.
56
First Nations
First Nations develop and implement community health programs based on their community needs. Some
First Nations have assumed responsibility for the delivery of health services under Health Transfer agreements
with Health Canada. For some First Nations that have been deemed too small for the transfer of health
services, health responsibilities have been transferred to regional Aboriginal service providers that are
overseen and controlled by community representatives. Services that are delivered directly by First Nations
may include health promotion and injury prevention, communicable disease surveillance and prevention,
home and community care, mental health and additions, diabetes education, traditional health and early
childhood development. One First Nation operates a long-term care facilities and one First Nation operates a
residential addictions treatment service.
Regional Aboriginal Health Service Providers
Regionally based Aboriginal-controlled organizations deliver culturally appropriate health services
amongst multiple communities within the region. Regionally delivered services vary, but they may include
primary health care, traditional health, diabetes education, child and youth support, fetal alcohol
spectrum disorder, hospital services, ambulance services and non-insured health benefits. Table 6 lists
the regional Aboriginal organizations and the health services delivered by each.
Table 6: Services Delivered by Regional Aboriginal Health Service Providers
Organization Name
Maamwesying North Shore
Community Health Services
Communities Serviced
1 urban centre
8 First Nations
Misiway Milopemahtesiwin
Community Health Centre
1 urban centre
4 First Nations
Mnaamodzawin Health Services
5 First Nations
Noojmowin Teg Health Centre
7 First Nations
Shkagamik Kwe Health Centre
1 urban centre
3 First Nations
Wabun Tribal Council
6 First Nations
Weeneebayko Area Health
Authority
1 urban centre
6 First Nations
57
Services Delivered
Primary health care, mental health and
addictions, community support services,
traditional health, fetal alcohol spectrum
disorder, diabetes support.
Primary health care, traditional health, mental
health, diabetes education, child and youth
support.
Community health, mental health, home care,
diabetes, healthy child development, healthy
babies/healthy children.
Primary health care, mental health, traditional
health, community nutrition, child nutrition,
fetal alcohol spectrum disorder, children’s
recreation, diabetes wellness, community
support services.
Primary health care, diabetes care, fetal
alcohol spectrum disorder, health
education/promotion, mental health, and
traditional health.
Community health nursing, patient
transportation, diabetes, crisis team
coordination, long-term care.
Community health, hospital, midwifery, renal
dialysis, Ontario breast screening
mammography, dental, diabetes support, noninsured health benefits, ambulance, diagnostic
services, laboratory, emergency room,
operating room, community mental health,
traditional healing.
Off-Reserve Aboriginal Health Service Providers
Off-reserve Aboriginal-controlled organizations also deliver health services within Aboriginal communities
that are urban or rural based. Services may include child and youth support, problem gambling
prevention, community wellness worker services, community support services, primary care and
residential addictions treatment. Table 7 lists the off-reserve organizations and the health services
delivered by each.
Table 7: Services Delivered by Off-Reserve Aboriginal Health Service Providers
*Services listed are not provided at all locations
Organization Name
Métis Nation of Ontario offices
# Sites
4
Services Delivered
Healthy babies/healthy children, community
wellness workers, community action plan for
children (CAP-C), community support services,
diabetes education, problem gambling prevention.
Friendship Centres
7*
Healthy babies/healthy children, healing & wellness
coordinators, addictions and mental health, diabetes
education, lifelong care program, healthy living
program, fetal alcohol spectrum disorder, children’s
mental health, health outreach, Akwe:go Aboriginal
children’s program, Wasa-Nabin Aboriginal youth
program.
Aboriginal Peoples Alliance of
Northern Ontario
5*
Family medical care, community based health,
access to health professionals, Aboriginal healthy
babies/healthy children, community wellness
workers, and head start.
Benbowopka Treatment Centre
1
Residential addictions treatment
Sagashtawao Healing Lodge
1
Residential addictions treatment
58
Appendix B: Aboriginal Health Services in the North East LHIN
59
Appendix C: Truth and Reconciliation Commission
The Truth and Reconciliation Commission (TRC) was established in 2008 under the Indian Residential
Schools Settlement Agreement. The TRC’s responsibility was to reveal the truth about Canada’s
residential schools and the ongoing legacy of the schools by:


gathering documents and statements about residential schools,
setting up a research centre to permanently house the Commission’s records and documents,
and
issuing a report with recommendations.

The Commission held seven national events between June 2010 and March 2014 that were attended by
approximately 155,000 participants and 9,000 registered survivors. It also held regional events and
community hearings across Canada. The Commission received over 6,750 statements from residential
school survivors and their families. The Commission also received statements from former staff and
their family members in separate interviews, events and community hearings.
The TRC issued its final report in 2015. Within the report, it issued 94 calls to action to redress the
legacy of residential schools and address the process of reconciliation pertaining to











child welfare
education
language and culture
health
justice
Canadian government and the United
Nations Declaration on the Rights of
Aboriginal People
Royal Proclamation and Covenant of
Reconciliation
settlement agreement parties and the
United Nations Declaration on the Rights of
Aboriginal People
equity for Aboriginal people in the legal
system











national council for reconciliation
professional development and training for
public servants
church apologies and reconciliation
education for reconciliation
youth programs
museums and archives
missing children and burial information
national centre for truth and reconciliation
commemoration
media and reconciliation
sports and reconciliation
business and reconciliation, and
newcomers to Canada.
Calls to action (Truth and Reconciliation Commission of Canada, 2015) relevant to the delivery of health
services to Aboriginal people are listed below.
Health
“18) We call upon the federal, provincial, territorial, and Aboriginal governments to acknowledge
that the current state of Aboriginal health in Canada is a direct result of previous Canadian
government policies, including residential schools, and to recognize and implement the healthcare rights of Aboriginal people as identified in international law, constitutional law, and under
the Treaties.
60
19) We call upon the federal government, in consultation with Aboriginal peoples, to establish
measurable goals to identify and close the gaps in health outcomes between Aboriginal and nonAboriginal communities, and to publish annual progress reports and assess long-term trends. Such
efforts would focus on indicators such as: infant mortality, maternal health, suicide, mental
health, addictions, life expectancy, birth rates, infant and child health issues, chronic diseases,
illness and injury incidence, and the availability of appropriate health services.
20) In order to address the jurisdictional disputes concerning Aboriginal people who do not reside
on reserves, we call upon the federal government to recognize, respect, and address the distinct
health needs of the Métis, Inuit, and off-reserve Aboriginal peoples.
21) We call upon the federal government to provide sustainable funding for existing and new
Aboriginal healing centres to address the physical, mental, emotional, and spiritual harms caused
by residential schools, and to ensure that the funding of healing centres in Nunavut and the
Northwest Territories is a priority.
22) We call upon those who can effect change within the Canadian health-care system to
recognize the value of Aboriginal healing practices and use them in the treatment of Aboriginal
patients in collaboration with Aboriginal healers and Elders where requested by Aboriginal
patients.
23) We call upon all levels of government to:
i. Increase the number of Aboriginal professionals working in the health-care field.
ii. Ensure the retention of Aboriginal health-care providers in Aboriginal communities.
iii. Provide cultural competency training for all health-care professionals.
24) We call upon medical and nursing schools in Canada to require all students to take a course
dealing with Aboriginal health issues, including the history and legacy of residential schools, the
United Nations Declaration on the Rights of Indigenous Peoples, Treaties and Aboriginal rights,
and Indigenous teachings and practices. This will require skills-based training in intercultural
competency, conflict resolution, human rights, and anti-racism.
Professional Development and Training for Public Servants
57) We call upon federal, provincial, territorial, and municipal governments to provide education
to public servants on the history of Aboriginal peoples, including the history and legacy of
residential schools, the United Nations Declaration on the Rights of Indigenous Peoples, Treaties
and Aboriginal rights, Indigenous law, and Aboriginal–Crown relations. This will require skills
based training in intercultural competency, conflict resolution, human rights, and anti-racism.”
The TRC documented the experiences of people who attended residential schools and the
effects on the individuals and their families. It was important for a Northeastern Ontario health
plan to address the TRC’s calls to action.
61
Aboriginal
AboriginalHealth
HealthCare
CareReconciliation
ReconciliationAction
ActionPlan
Plan||35
34
Learn More
Visit our website at www.nelhin.on.ca or call 1-866-906-5446
62
MLAA Performance Scorecard - 2016/17
Report generation date: August 22, 2016 based on Stocktake MLPA Indiators at Q1 2016/17
P.I. #
Performance Indicator
Provincial
Target
Current
HUB Hospitals
Metric
date:
NE LHIN
HSN
NBRHC
SAH
TDH
Home and Community - Reduce wait time for home care (improve access); More days at home (including end of life care)
1
Percentage of Home Care Patients with Complex Needs who received their first Personal
Support Visit within 5 Days of the date that they were authorized for Personal Support Services
95%
86.0%
Q4 15/16
82.2%
92.9%
79.2%
78.0%
79.0%
2
Percentage of Home Care Patients who received their first nursing visit within 5 days of the date
they were authorized for Nursing Services
95%
93.8%
Q4 15/16
93.6%
95.2%
94.8%
95.4%
94.2%
3
90th Percentile Wait Time from community for CCAC In-Home Services: Application from
community setting to first CCAC service (excluding case management)
21 days
29
Q4 15/16
43
44
43
37
43
System Integration and Access - Provide care in most appropriate setting; Improve coordinated care; Reduce wait times (specialists, surgeries)
4
90th Percentile Emergency Department (ED) Length of Stay for Complex (CTAS I-III) Patients
8 hrs
10.0
Q1 16/17
8.6
14.4
7.1
10.8
5.9
5
90th Percentile ED Length of Stay for Non-Admitted Minor Uncomplicated (CTAS IV-V) Patients
4 hrs
4.1
Q1 16/17
4.1
4.5
4.3
3.4
3.8
6
Percent of Priority 2, 3, and 4 Cases Completed Within Access Target for MRI Scan
90%
42%
Q1 16/17
50%
22%
16%
94%
77%
7
Percent of Priority 2, 3, and 4 Cases Completed Within Access Target for Diagnostic CT Scan
90%
73%
Q1 16/17
73%
63%
85%
73%
79%
8
Percent of Priority 2, 3 and 4 Cases Completed Within Access Targets for Hip Replacement
90%
78%
Q1 16/17
83%
87%
100%
85%
81%
9
Percent of Priority 2, 3 and 4 Cases Completed Within Access Target for Knee Replacement
90%
76%
Q1 16/17
83%
84%
100%
86%
82%
10
Percentage of Alternate Level of Care (ALC) Days (Discharged ALC days from Acute in
reporting period)
9.46%
15.4%
Q4 15/16
26.4%
22.4%
8.5%
20.9%
28.2%
11
ALC Rate (Burden of ALC days both open and closed ALC cases, Acute + Post Acute care)
12.7%
14.5%
Q1 16/17
20.9%
19.0%
18.5%
25.6%
20.4%
Health and Wellness of Ontarians - Mental Health - Reduce any unnecessary health care provider visits; Improve coordination of care for mental health patients
12
Repeat Unscheduled Emergency Visits within 30 Days for Mental Health Conditions (%)
16.3%
19.8%
Q4 15/16
16.9%
17.2%
15.0%
17.4%
19.6%
13
Repeat Unscheduled Emergency Visits within 30 Days for Substance Abuse Conditions (%)
22.4%
31.7%
Q4 15/16
28.6%
28.0%
23.2%
25.0%
16.2%
18.2%
16.2%
18.5%
18.4%
Sustainability and Quality - Improve patient satisfaction; Reduce unnecessary readmissions
14
Readmissions within 30 days for Selected HIG Grouper Conditions
Achieved Provincial Target
Within 10% of Provincial Target
15.5%
16.5%
Q3 15/16
17.5%
Hospital results are identified in green if at target, else no colour CCAC results by hospital
reflect performance at CCAC Branch in that HUB area.
> 10% from Provincial Target
63
Page 1 of 2
MONITORING INDICATORS
System Integration and Access Provide care in most appropriate setting; Improve coordinated
care; Reduce wait times (specialists, surgeries)
Provincial
Target
Current
HUB Hospitals
Metric
date
NE LHIN
HSN
NBRHC
SAH
TDH
99%
85%
81%
1
Percent of Priority 2, 3 and 4 Cases Completed Within Access Target for Cancer Surgery
90%
88.4%
Q1 16/17
94.0%
96%
2
Percent of Priority 2, 3 and 4 Cases Completed Within Access Target for Cardiac By-Pass
Procedures
90%
94.0%
Q1 16/17 100.0%
100%
3
Percent of Priority 2, 3 and 4 Cases Completed Within Access Target for Cataract Surgery
90%
84.7%
Q1 16/17
93.0%
89%
1) Community setting;
NA
NA
Q3 15/16
NA
not available
2) Acute care setting:
NA
NA
Q3 15/16
NA
not available
5
Rate of emergency visits for conditions best managed elsewhere (per 1,000 population)
NA
5.5 Q4 15/16
15.2
8.2 *
19.5 *
11.7 *
30.4 *
6
Hospitalization rate for ambulatory care sensitive conditions (per 100,000 population)
NA
88.1 Q4 15/16
164.7
145.4 *
164.6 *
116.4 *
185.6 *
7
Percent of Acute Care Patients who have had a follow-up with a physician within 7 days of
discharge
NA
Do not provide CABG
100%
98%
96%
Wait Time from when CCAC receives application to Long-Term Care Home to when Assessment
for Eligibility is Completed:
4
46%
Q3 15/16
not available
37%
* denotes Sub‐Region areas not hospitals
DEVELOPMENTAL INDICATORS
Home and Community Reduce wait time for home care (improve access); More days at home
(including end of life care)
Provincial
Target Current
Metric
date
NE LHIN
1
Percent of palliative care patients discharged from hospital with home support
NA
83.3%
Q4 15/16
79.8%
2
Overall satisfaction with health care in the community
NA
86.7%
FY 15/16
79.6%
HSN
84%
78.4% **
HUB Hospitals
NBRHC
SAH
83%
69.3% **
69%
85% **
TDH
33%
76.1% **
** denotes old Health Link in HUB community, geography to be updated
64
Page 2 of 2
BUSINESS CASE
EXPANSION OF HOSPICE PALLIATIVE CARE PROGRAMS & SERVICES
AT MAISON VALE HOSPICE IN SUDBURY
September 1, 2016
‘‘When you dream, do not be realistic and fit your dreams to what exists and is possible.
Fit your dreams to what should exist and should be possible.’’
June Callwood
The following individuals have contributed to the development of this Business Case and the Community Quality
Improvement Project Proposal through their involvement in the expansion of hospice palliative care programs and
services at Maison Vale Hospice:
• Advanced Practice Nurse and Palliative Physician – Northeast Cancer Centre Symptom Management Clinic
• Manager of Care Coordination and Nurse Practitioner – North East Community Care Access Centre
• Clinical Lead, Director of Care, Executive Director, and Quality Assurance Coordinator – Maison Vale Hospice
65
1
MAISON VALE HOSPICE
Maison Vale Hospice is a Centre of Excellence dedicated to the collaborative delivery of quality hospice palliative
care in both official languages in the Manitoulin-Sudbury Districts. The Hospice helps individuals and their families
realize their full potential to live even when they are dying, by attending to their physical, psychosocial, spiritual,
and practical needs, in the location of their choice.
Now in its eighth year of operation, the Hospice has reviewed its infrastructural needs and has confirmed that its
facility is too small to accommodate its present and future Hospice Palliative Care programs and services.
BUSINESS CASE ISSUES
1. Inadequate number of adult community residential hospice beds in the City of Greater Sudbury and the
Sudbury District to meet current and future needs.
2. Need for a coordinated and integrated approach for community hospice palliative care for cancer and noncancer population (via the combination of a community hospice palliative care interdisciplinary expert team, a
community ambulatory hospice palliative care clinic, palliative short-stay/respite beds, and a
transition/education bedroom) to facilitate a smooth transition between home, hospital, hospice, and long-term
care homes.
3. No dedicated pediatric hospice palliative care/respite beds/suites in Northern Ontario to serve youth aged
1-18 with cancer or non-cancer diagnoses.
BACKGROUND AND CONTEXT
EVOLUTION OF MAISON VALE HOSPICE AS A CENTRE OF EXCELLENCE IN HOSPICE PALLIATIVE
CARE
Maison Vale Hospice opened its 10-bed community residential hospice in September 2008. Since then, 1,150
residents have lived their last journey at the Hospice, surrounded by family and friends, as well as caring staff
and volunteers (with an additional 37 residents who were discharged home or to another facility). Of that total:
 64% of residents came directly from home (first priority),
 29% from hospital,
 5% from the Emergency Department, and
 2% from long-term care facilities;
 89% had a cancer diagnosis, and
 69% were over the age of 65, with
 an occupancy rate of 94%, and
 Vacant bed days between residents (turnover interval) was 1.3 days in 2015/16.
From September 2008 to May 2014, the average length of stay was 21 days. Since June 2014, that average
length of stay has increased to 27.4 days (or 4 weeks).
From January 2014 to December 2015, over 30% of family members who responded to the Hospice Family
Survey had the impression that their loved one experienced a statistical improvement (minimum of +2 points) in
their overall sense of wellbeing during their time at the Hospice.
66
2
Maison Vale Hospice has since expanded its programs and services beyond a 10-bed end-of-life care facility,
becoming a Centre of Excellence in hospice palliative care, which now includes the following programs and
services:
 Residential Care Program (2008)
 Residential Hospice Volunteer Service (2008)
 Supportive Care Program (2008)
 Shared Care Program (2013)
 Visiting Hospice Service (2014)
 Interdisciplinary Education Program (2014)
 Pediatric Care Program (2014)
The 2015-2018 Strategic Plan for the Hospice includes an objective to become the educational lead in the
community for death and dying, hospice palliative care, and related health care navigation, as well as improving
access for, and meeting the needs of, those requiring hospice palliative care services. The recent addition of 1.2
acres of land in 2015 (from St. Joseph’s Health Centre) to the existing 2.2 acre site enables the Hospice to
continue to house all of its existing and future programs & services in one location, and opens the door for the
upcoming expansion.
ADDITIONAL REFERENCE MATERIAL
Maison Vale Hospice Residential Hospice Statistics (2015/2016)
Maison Vale Hospice Residential Hospice Statistics (Year-to-Year Comparison, September 2008 to July
2016)
Maison Vale Hospice End-of-Life Care Survey, Family/Caregiver Feedback Re: Loved One’s Overall
Sense of Wellbeing
Maison Vale Hospice Strategic Map (2015-2016 to 2017-2018)
Maison Vale Hospice Strategic Plan Summary of Progress @ March 31, 2016
APPENDIX PG #
A1, pg. 30
A2, pg. 31
A3, pg. 32
A4, pg. 33
A5, pg. 34
In June 2015, consultations between Maison Vale Hospice staff and hospice palliative care community partners
regarding the expansion of the Hospice’s programs and services resulted in the following sequence of events:
1.
Creation of an expansion steering committee and five working groups (Land & Building, Pediatric,
Community Hospice Palliative Care, Supportive Care/Grief & Bereavement, and Education) made up of
Hospice staff, Board members, volunteers, family members, and community partners.
Its mandate is to facilitate the planning and implementation of the expansion of the community residential
hospice as a Centre of Excellence in hospice palliative care. This expansion will include the development of
the Hospice’s programs and services, as well an overview of space management and utilization in order to
ensure the delivery of a coordinated, comprehensive, and accessible system of end-of-life care in ManitoulinSudbury Districts.
Maison Vale Hospice Expansion – Hospice Staff and Community Partners Consultation Report
Membership of Maison Vale Hospice Expansion Steering Committee and Working Groups
2.
APPENDIX PG #
A6, pg. 37
A7, pg. 39
Establishment of a Collaborative Practice Pilot – “Enhancing Transitions in Care”.
A partnership was established in November 2015 with the Northeast Cancer Centre Symptom Management
Clinic (Advanced Practice Nurse and Palliative Physician), the North East Community Care Access Centre
(Nurse Practitioner), and the Hospice’s Shared Care Team (Nursing Staff, Palliative Physician), in
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collaboration with the Hospice’s Supportive Care Program and Visiting Hospice Service, to test a working
relationship focused on effectively meeting the needs of end-of-life clients in their homes.
Since January 2016, clinicians from the above programs have been providing home visits to end-of-life clients
in the comfort of their homes, while supported by the Hospice’s Shared Care Team (following training
provided at the Symptom Management Clinic by the Advanced Practice Nurse). The benefits of this
collaboration have included:
 Supporting clients and their families by providing crisis management (as needed), resulting in patients
not accessing the Emergency Department for incidents that could be managed at home.
 Introducing hospice palliative care earlier in the client’s disease trajectory, resulting in earlier advance
care planning.
 Enabling clients to live their last days in the location of their choice.
 Offering additional support for family physicians, health service providers, and families.
 Reducing the cost to the health care system as a result of in-home crisis management and service
integration.
 Reducing the wait time for a home visit by a palliative specialist.
 Providing 24/7 support for clients in their homes.
Maison Vale Hospice March 2/16 PowerPoint Presentation Excerpt, Enhancing Transitions in
Care – Patient Data
Maison Vale Hospice March 2/16 PowerPoint Presentation Excerpt, Enhancing Transitions in
Care – Goals
3.
APPENDIX PG #
A8, pg. 41
A9, pg. 42
Development of a community ambulatory hospice palliative care clinic at the Hospice for pain &
symptom management of cancer patients discharged from Medical/Radiation Oncology, and non-cancer
patients on the palliative roster, while the Symptom Management Clinic continues to see cancer patients
receiving treatment, with the support of the Palliative Nurse Practitioner and the Shared Care Team nursing
staff. The clinic would include:
 3 patient examination rooms and 1 consultation/coaching room for clients/patients, caregivers, and
family members;
 Office space for Shared Care Program and Visiting Hospice Service;
 Waiting room for clients of the ambulatory clinic.
Prior to their collaboration, the Hospice’s Shared Care Team used to focus on non-cancer clients, while the
Symptom Management Clinic focused on cancer clients. This resulted in a long waiting list for the Symptom
Management Clinic.
“Devoting more doctors and more beds to palliative care won't be enough to fix the problem, say the authors
of the article in CMAJ. They argue that palliative care runs under a model that is out-date: a model geared to
provide supportive care for people with cancer who have just three to six months to live. The authors argue
that deaths not due to cancer make up two-thirds of all deaths in Canada - a huge cohort that is largely underserved by palliative care.” White Coat, Black Art. Dr. Brian Goldman. Aug. 22/16
4.
Implementation of community-wide scheduling, in collaboration with the above partners and Health
Sciences North, which will serve as a platform for booking, revisiting, and data capture for home visit clients
and health care professionals.
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5.
Identification of the need to:
 Increase the number of adult residential hospice beds in the Sudbury region.
 Add designated beds for palliative short-stay/respite.
 Create pediatric hospice palliative/respite care suites.
 Create adequate capacity & capability for hospice palliative care education and training of staff, students,
medical residents, volunteers, and caregivers, including one transition/education bedroom.
o The Hospice employs over 50 part-time and full-time staff, has more than 200 residential and
visiting hospice volunteers, and offers placement opportunities yearly to over 40 students (nursing,
personal support workers, social work, and medical students/residents) from post-secondary
institutions (Laurentian University, Cambrian College, Collège Boréal, Northern Ontario School of
Medicine, CTS, St. Albert’s).
 Offer additional grief & bereavement support, coaching and counselling, complementary therapy,
discussion support groups, Grief Recovery Program, and education sessions on Death, Dying, Grief &
Bereavement (all with the assistance of a new on-call Supportive Care Team).
 Increase space for all Hospice programs and services, including wellness/complementary therapy
room, offices, associated ancillary spaces, and storage, as well as additional parking capacity for staff,
volunteers, and families/visitors.
ISSUE #1
INADEQUATE NUMBER OF RESIDENTIAL HOSPICE BEDS
“The only thing that would make the Hospice better is to be bigger. More beds so that more people can be as
blessed as my mother to have that care & compassion.” Hospice Family
1.1 Additional Community Residential Hospice Beds
There is a gap in the supply of adult end-of-life beds in the City of Greater Sudbury and the Sudbury District.
Since 2008, the Hospice has an average occupancy rate of 94%, with 1,150 deaths, and a growing length of
stay now reaching 27 days. 30% (400/1,282) of clients assessed between 2011 and 2016 died prior to
admission to the Hospice. The Ontario Palliative Care Network’s methodology supports 13 beds in the City
of Greater Sudbury.
The LHINs also apply the following formula to plan capacity for residential hospice beds in their area:
• 5.1 beds per 100,000 population for a 3-week length of stay, and
• 6.8 beds per 100,000 population for a 4-week length of stay.
With an average occupancy rate of 94% at Maison Vale Hospice since 2008, an average length of stay of
27.4 days since June 2014, and a population of 185,355 (2011), the City of Greater Sudbury and the Sudbury
District would be entitled to at least 13 beds. This represents 3 additional residential hospice beds to
complement the present 10-bed end-of-life residential facility. We should be planning for the future,
requesting between 3-6 additional residential hospice beds in Greater Sudbury.
Additionally, between 2011 and 2016, the Hospice admitted 882 residents. Approximately 400 additional
clients were assessed but died prior to admission at the Hospice, due to limited bed availability. These unmet
needs represent another 80 residents per year that could have been admitted in a residential hospice bed,
clearly demonstrating the need for additional beds in Greater Sudbury.
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Maison Vale Hospice (MVH)
Representation of Unmet Need
(Residential Hospice Beds)
Assessed But Died Prior to Admission to MVH
Admitted to MVH
200
180
160
140
120
100
80
60
40
20
0
2015-16
2014-15
2013-14
2012-13
2011-12
1.2 Lower Cost of Residential Beds
‘’An adequate supply of residential beds could provide an option to the more expensive route of
accommodating seniors in ALC beds situations in hospital or in long-term care, thereby providing a more
satisfactory living environment and also reducing costs.’’ Source: SHS Consulting. 2009. Seniors’
Residential/Housing options – Capacity Assessment and Projections. Final Report. NELHIN Aging at Home Strategy
The cost of a residential hospice bed in Ontario is estimated at $457 per day (Hospice Palliative Care Ontario
2012 Business Case), compared to over $1,000 per day in an acute hospital bed. In 2015/2016, Maison Vale
Hospice admitted 42 inpatients/Emergency Department patients from Health Sciences North, for a total of
1,503 resident bed days at the Hospice. This represents a potential saving of $1.5 M for the Hospital. In
total, from September 2008 to July 2016, the Hospice admitted 401 inpatients/Emergency Department
patients from Health Sciences North, for a total of 9,679 bed days, representing a potential saving of over
$9.6 M for the Hospital. An additional 752 patients were admitted directly from home (admission priority is
given to patients who live alone and/or cannot manage at home), for a total of 14,417 bed days.
1.3 Projection for Residential Hospice Beds in the NE LHIN
A NE LHIN study that was conducted in 2009 as part of the Aging at Home Strategy projected the demand
for residential hospice beds in Greater Sudbury to reach 16 beds by 2031. With only 10 community residential
hospice beds, the City of Greater Sudbury and the Sudbury District are presently inadequately equipped to
cope with the anticipated rapid increase in the seniors’ population, especially in the more elderly age groups.
Source: SHS Consulting. 2009. Seniors’ Residential/Housing options – Capacity Assessment and Projections. Final
Report. NELHIN Aging at Home Strategy
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1.4 Increased Caregiver Support Through Centre of Excellence
“In the final emotional days of one's loved one, there are two patients – the one who is passing and the
one who is attending. In both instances, from first contact to the final moment, I have nothing but praise
for the staff.” Hospice Family
In his 2016 Palliative and End-of-Life Care Provincial Roundtable Report, John Fraser indicates it
may be possible for residential hospices “to provide more service and achieve even better outcomes ... by
operating as centres of excellence and service hubs for their communities.” By offering hospice palliative
care programs & services from diagnosis, through the dying process at the end of life, including grief and
bereavement, the Hospice supports caregivers throughout the continuum of care and helps normalize death
and dying.
Ensuring quality hospice palliative care is available to everyone in the Manitoulin-Sudbury Districts is a
collaborative effort between policy makers; academics and researchers; funders; and health service
providers. This Centre of Excellence isn’t a brick and mortar project. The work of this Centre will be
accomplished through partnerships with academic centres and local hospice palliative care organizations.
This Centre of Excellence will:
 Develop standards and best practice guides for hospice palliative care;
 Promote innovation and best practice in hospice palliative care through education and knowledge
mobilization;
 Facilitate research about community-based hospice palliative care, and
 Collaboratively create tools that support local hospice palliative care programs in the delivery of quality
hospice palliative care.
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
Allow caregivers to have access to increased support in residential hospice as part of a Centre of
Excellence or a service hub for their communities by having access to an array of programs and services
through the entire spectrum of care, both preceding and following death.
“It would be great if there were a much larger Hospice to serve the needs of many people.” Hospice Family
ISSUE # 2
COORDINATED AND INTEGRATED APPROACH FOR COMMUNITY HOSPICE PALLIATIVE CARE FOR
CANCER AND NON-CANCER PATIENTS
2.1
Community Hospice Palliative Care Interdisciplinary Expert Team
A collaboration of experts in different areas maximizes patient services and access to hospice palliative
care. These experts include:
 Northeast Cancer Centre’s Symptom Management Clinic (Advanced Practice Nurse and Palliative
Physicians)
 North East Community Care Access Centre Nurse Practitioner Program
 Maison Vale Hospice’s Shared Care Team (including Registered Nurses, Clinical Lead, Manager of
Supportive Care, and Navigator), in collaboration with the Visiting Hospice Service volunteers.
This collaboration discussion arose in the fall of 2015 as a result of the need to address Northeast Cancer
Centre palliative care nursing resource issues where the clinic growth – in terms of patient numbers and
physician interest – outstripped nursing availability.
As a result, there was a decrease in access to nursing care which led to decreased patient/family
satisfaction and primary nursing workload issues. Community providers became aware of the challenges
as a result of complaints received from patients and families.
Value Stream Mapping was completed to evaluate and analyze the:
 Current state of care for clients who prefer to die at home.
 Process of assessment and service provision.
 Utilization and duplication of assessment and services required.
 Eligible clients who are not receiving optimal palliative services at home.
 Unequal distribution and utilization of current resources for cancer and non-cancer diagnosis.
A three patient pilot project was initiated in which care of these patients was handed over by the Northeast
Cancer Centre Symptom Management Clinic to the Hospice’s Shared Care Team once a clinic visit was
no longer appropriate. Goals included:
 Allow each patient to die in the place of his/her choice with optimal palliative supports.
 Palliative supports in place for patients in times of crisis.
 Reduction in wait list or wait time for a clinician with hospice palliative care experience, which results
in reduced Emergency Department visits when patient is in crisis.
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
Patients that are being followed by team and choose to die at Hospice are referred at the right time,
as a result of improved prognostication due to ongoing monitoring of patient and disease progression
(reduces Emergency Department visits).
The benefits of this collaboration were quickly apparent with the number of interventions (face-to-face and
by telephone, 7 days/week) performed by the Hospice’s Shared Care Team for the purpose of
care/treatment planning and/or education. Between 2015/16 Q3 and Q4, interventions almost tripled
(from 112 to 314), and then in 2016/17 Q1, increased twofold from 314 to 610. In that same period,
the active Shared Care Team caseload increased from 38 to 71. As a result, in 2016/17 Q1, the
Hospice’s Shared Care Team increased the Registered Nurse capacity from 1.4 FTE to 1.8 FTE, and
added a Casual Navigator for weekends specifically (4 hours per day). In consideration of these significant
ongoing increases, the Hospice plans to add another 3 days (weekdays) of Registered Nurse coverage,
and increase the Navigator role to a full-time position (during weekdays). The Hospice also reallocated
funds to meet the needs of the increasing caseload/workload. It is worthy to note: (1) that these
interventions do not include additional work which was performed by other members of the community
hospice palliative care interdisciplinary expert team (Palliative Physician, Nurse Practitioner, and
Advanced Practice Nurse), as they report their statistics to their own employers, and (2) these statistics
do not account for related time spent faxing, emailing, chart reviews, meetings, etc.
“Caring for her at home was very emotional. The nurses on call were always available and very tuned to
her needs. Thumbs up to all the staff, they all did an amazing job for my wife and me.” Hospice Family
Maison Vale Hospice Shared Care Team – Performance Indicators (2015/16 Q1-Q4)
Maison Vale Hospice Shared Care Team – Performance Indicators (2016/17 Q1)
2.2
APPENDIX PG #
A10, pg. 43
A11, pg. 44
A12, pg. 45
The Community Ambulatory Hospice Palliative Care Clinic will:
• Care for both cancer and non-cancer patients in the community (who are still able to attend an
outpatient clinic), reducing the number of patients who access the Emergency Department at
end-of-life.
• Identify failure to cope palliative clients in the community; those individuals and their
families/caregivers will benefit from the transition/education bedroom and supportive care program.
• Allow for more end-of-life clients to be served outside of a hospital setting, thereby de-institutionalizing
care and increasing knowledge and access to hospice palliative care and advance care planning.
According to Health Quality Ontario (2016), between April 2014 and March 2015, 64.9% of Ontarians who
were documented as being in receipt of Palliative Care died in Hospital, and 62.7% had unplanned visits
to the Emergency Department in the last month of life.
Bringing a community ambulatory hospice palliative care clinic and interdisciplinary expert team at the
Hospice will:
 Serve to de-institutionalize care, which normalizes death and dying, and enhances grief, loss, and
bereavement services, thereby enhancing caregiver support.
 Further strengthen the development of community palliative interdisciplinary expert teams which
provide education and support to primary care providers and front line workers who currently provide
hospice palliative/end-of-life care in all sectors of the NE LHIN. Health service providers have relayed
that the support of the expert team is of great value, as their community nurses often work in isolation.
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

Serve as a hub to identify clients/patients, caregivers/families in need of respite, transitional and
supportive care, education, and volunteer visiting services earlier in the trajectory of care; thereby
enhancing the likelihood of home deaths and the avoidance of Emergency Department visits and
crisis admissions.
Accommodate additional referrals while enabling more people to die in the location of their choice.
“The Hospice helped me come to terms with a situation and process I had never imagined. Hospice
continues good work to all of us who continue through the healing process.” Hospice Family
This coordinated and integrated approach to community hospice palliative care will help Greater Sudbury
and the Sudbury District achieve the Provincial Palliative Care Indicators recommended by Ontario
Palliative Care Network (June 2016):
1. Percentage of Ontario decedents who visited the ER in the last 2 weeks of life.
2. Percentage of palliative care patients discharged home from hospital with the discharge status “home
with support”.
3. Percentage of palliative care patients discharged from hospital who were readmitted within 30 days.
4. Percentage of palliative care patients discharged from hospital that were seen in the ER within 30
days.
2.3
Short-Stay/Respite Beds
“This was 10 days of comfort for my wife that I was unable to offer at home. For me, I was at the end of the
rope. I couldn't manage anymore. Thank you everyone in this place, it was my life saver!” Hospice Family
The Maison Vale Hospice Feasibility Study confirmed that dedicated beds for palliative short-stay/respite
would assist families who are presently caring for palliative clients (in their last 12 months of life) who live at
home, by offering them relief from the physical and psychological demands of providing care in the home.
Short-stay/respite beds will also help build capacity and capability for community personal support workers
by offering them on-the-job training and mentoring (at no cost to their employers) in a hospice palliative care
environment supported by a community interdisciplinary expert team. Community personal support workers
will be able to visit 4-5 clients at a time, instead of doing 5 different visits in different homes, in collaboration
with the personal support workers who work 24/7 at the Hospice.
Lack of palliative short-stay/respite services often leads to caregiver burnout and patients accessing the
Emergency Department in their last months of life. This is often due to the fact that clients’ needs exceed
caregivers’ capacity to cope or the failure to cope is as a result of poor symptom control of the client.
On August 31, 2016, within the Hospice’s Shared Care Team caseload, 33 clients existed and were
reviewed by the Team. Two of these clients were hospitalized due to failure to cope/caregiver issues and
were unable to return home. Five others were home, but were barely managing with crisis add-on visits,
increased Community Care Access Centre hours of support, and required frequent Shared Care Team
“Throughout the palliative care process, it is critical that caregivers have access to respite services so that
they can take breaks and manage other responsibilities... Participants asked the ministry to expand
caregiver supports, which would allow family members and friends to continue caring for their loved ones
at home or in the community.’’ Source: John Fraser. 2016 Palliative and End-of-life Provincial Roundtable Report.
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nursing calls. All five were at risk daily of attending the Emergency Department for admission, as their ability
to stay home was questionable.
A number of additional reports have highlighted the importance of caregiver supports and additional respite
services to enable caregivers to better care for their loved ones and themselves:
• “The Donner Report – Bringing Care Home (2015)” recommends that the Ministry of Health & Long-Term
Care provide more resources to increase the availability of services that support family caregivers and,
in particular, increase the capacity for in-home and out-of-home scheduled and emergency respite
services.
• “Patients First: A Roadmap to Strengthen Home and Community Care (2015)” is introducing expanded
caregiver supports to better recognize the important role of caregivers and to empower both the
caregivers and the clients.
• Dr. Sinha’s report, “Living Longer, Living Well”, calls for the need to provide more support to caregivers
so that Ontarians can age in their place of choice for as long as possible.
“As caregiver and speaking on behalf of the family, the Hospice relieved us from the care & stress of looking
after a loved one at home, therefore, allowing us to devote 100% of our remaining time with our loved one
to share memories, love, and compassion and, to some degree, to start the grieving process and acceptance
(as difficult as it may be) of the loss that is to come. Hospitals, try as they may, cannot provide this.” Hospice
Family
PDSA Cycles
http://www.hqontario.ca/portals/0/documents/qi/rf-document-pdsa-cycles1-en.pdf
2.4
APPENDIX PG #
N/A
Transition/Education Bedroom
“I felt a load lifted from my shoulders as could not take care of her anymore. I also knew she would get
the best care. I was able to take care of her up to that point. I was at peace knowing the care she would
receive.” Hospice Family
This bedroom would be used for palliative transitional care, supporting clients who require temporary
admission to the Hospice and/or support from the Community Ambulatory Care Clinic for pain & symptom
management and/or supportive care, with the goal to return home or to remain at the Hospice.
Since April 1, 2016 there have been a total of 297 patients with an SRC 95 status (prognosis of 6 months
or less) in the Sudbury NE CCAC branch. 46 of them required enhanced services in their homes (greater
than 14 hours/week) as they were identified as having complex needs. 25 of these 46 patients were
admitted to the Hospice. It was also reported that 70 of the 297 patients attended the Emergency
Department at least 2 times each in that 5 month period, which represents at least 140 individual visits.
Source: NE CCAC Director of Business Intelligence (August 2016). These are examples of patients that could
benefit from admission to a transition/education bed or to a respite bed at Maison Vale Hospice. These
patients could then be transitioned back home or to a residential hospice bed. Since April 1, 2016, there
have been 43 Emergency Department diversions.
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The bedroom (equipped a low-fidelity mannequin) would also be used as a ‘teaching’ bedroom for
medical students and residents, nurses, personal support workers, Residential and Visiting Hospice
Services volunteers, and caregivers & family members.
 The bedroom will help build capacity with health professionals, offer training opportunities for
volunteers, and provide hands-on training and increase the capacity for in-home support for caregivers
who care for their loved ones at home.
 As the agency responsible for Interdisciplinary Education for the Manitoulin-Sudbury District, an on-site
multi-use classroom space will be developed to better fulfill this role with all above users, with
information technology linkage to the ‘teaching’ bedroom, and access to a control/debriefing room
adjacent to the ‘teaching’ bedroom.
 The multi-use classroom will be used for:
o Hospice Board/committee/working group/staff meetings;
o Hospice Palliative Care Sudbury (local planning table) monthly meetings, and working group
meetings;
o Community education/training/networking/meetings;
o Hospice tours and Hospice family gatherings;
o Residential and Visiting Hospice Services volunteer training sessions (30 hours), offered twice per
year in both official languages, in addition to monthly volunteer debriefing and training sessions;
 Volunteers who work directly with clients at home or with Hospice residents presently access
resources and equipment at Cambrian College during the Transfers, Repositioning, and
Feeding training module because of shortage of space/equipment at the Hospice;
 The same Transfers, Repositioning, and Feeding training module will be used in the ‘teaching’
room for caregivers/families who care for their loved ones at home as part of a new caregivers’
training program;
o Bi-monthly grief & bereavement discussion groups and bi-annual (8-week) grief recovery groups.
As part of its mandate, the Education Working Group, in collaboration with the Sudbury Planning Table
(HPC Sudbury) and the Northeast Regional Palliative Care Network, also initiated the following
deliverables:
 Working with learning institutes (including, but not limited to, Laurentian University, Northern Ontario
School of Medicine, Collège Boréal, Cambrian College) regarding the undergrad needs (competencies)
of students entering the work force as generalists in hospice palliative care and the
development/delivery of hospice palliative care education.
 Working with primary care physicians to build capacity in hospice palliative care.
 Working with community nursing providers regarding education competencies/education of Personal
Support Workers and nursing staff with a focus on hospice palliative care.
 Compiling a spreadsheet of individuals in the NE LHIN who have demonstrated teaching skills for
hospice palliative care providers (including details regarding what level of education they can provide
and for which disciplines).
 Compiling a spreadsheet of education courses/opportunities currently available in Ontario specifically,
and in Canada widely (if available as distance education).
o The last 2 developments, initiated by the Expansion Education Working Group, were launched
regionally as part of the Northeast Regional Palliative Care Network education collaborative work
plan.
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2.5
Quality Improvement Project
The Hospice is now submitting a Quality Improvement Project proposal to the NE LHIN under the
Community Health Capital Programs, for subsequent submission to the Ministry of Health & Long-Term
Care’s Health Capital Investment Branch by September 2016. The Hospice’s Quality Improvement Project
will include Plan/Do/Study/Act (PDSA) cycles that will be repeated several times over the course of the
project. With this information, the Hospice will be able to advise Hospice Palliative Care Ontario and the
Ministry of Health & Long-Term Care as to how to make its short-stay respite/transition/education bed
project sustainable, and how to replicate it across Ontario. In addition, as a way to better integrate care
for clients and their caregivers/families throughout their journeys, as well as to maintain continuity in care,
short-stay/respite will be supported by (1) trained volunteers of the Hospice’s Visiting Hospice Services,
(2) community Personal Support Workers, and (3) trained volunteers of the Residential Hospice Volunteer
Services.
“All the staff & volunteers were especially sensitive and helpful to all my mom's needs - and mine and my
entire family.” Hospice Family
ISSUE #3
PEDIATRIC HOSPICE PALLIATIVE CARE/RESPITE SUITES
3.1 Pediatric Hospice Palliative Care
After personally experiencing the care offered by Maison Vale Hospice in 2012, the Medical Director of NEO
Kids in Sudbury approached the Hospice regarding admitting children at the Hospice. Knowing that pediatric
clients could benefit from the environment and support at the Hospice, he asked why pediatric clients weren’t
being admitted. His impression was that the Hospice was another option for families that aren’t able to
cope, or in situations where a home or hospital setting isn’t adequate. He cited pediatric cases where there
would have been a better outcome for the clients in Hospice.
Historically, residential hospices in Ontario haven’t admitted pediatric clients; however, more hospices are
now either offering or considering this option (Brantford, Sault Ste. Marie, and Simcoe). In December 2012,
the Hospice’s Board of Directors recommended that the palliative care for youth project be delegated to its
Ethics Committee for a more in depth review and recommendations. The Pediatric Hospice Palliative Care
Working Group was established in November 2013, and a Pediatric Pilot Project was launched in June
2014, with the mandate to make preparations for, monitor, evaluate, and report on a pilot project involving
Maison Vale Hospice admitting and caring for one pediatric resident (age 12-18) with a cancer diagnosis
before November 12, 2014. Hospice staff received training and visited pediatric hospices [Roger’s House
(Ottawa) and Emily’s House (Toronto)], and the pilot was successfully conducted.
The Hospice’s Board of Directors agreed that Northern Ontario palliative pediatric clients should be able to
be cared for in a homelike environment in the North. As a result, in November 2014, the Hospice’s admission
criteria were expanded to include children between the ages of 12-18 with a cancer diagnosis. Two youth
were admitted to, and died at, the Hospice in 2016, with the support of the NEO Kids Medical Director and
Interlink Nurse.
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3.2 Pediatric Hospice Palliative/Respite Care
Locally, pediatric palliative respite is currently unavailable as a result of inadequate physical infrastructure
and knowledgeable providers. This proposal addresses both of these limitations allowing ManitoulinSudbury children to remain close to their homes and support systems.
The pediatric hospice palliative/respite care suites will be staffed by skilled and experienced personnel who
have access to specialized equipment, thereby addressing the main reasons families cite for not adequately
accessing respite services in Sudbury.
The results of the survey also highlight the challenges that families feel within the respite system. Of these,
the prevailing comment was the need for more funding and/or respite options. Twenty-four respondents
indicated that they were not utilizing their respite. The typical reasons for this were a lack of respite workers
with specific skills and experience, and respite being unavailable when needed. Some families further
identified displeasure with their inability to use respite funds to pay for activities. Source: Gilchrist, Stephanie.
2015. The Respite Steering Committee - Respite Survey Results
3.3
There are presently no dedicated pediatric palliative or respite beds/suites in Northern Ontario. Children who
need these services must travel to Toronto (Emily’s House) or Ottawa (Roger’s House) to access them. In
September 2014, Maison Vale Hospice piloted end-of-life services for youth between the ages of 12 to 18
years of age with a cancer diagnosis. Two youths, aged 18 and 14, were admitted to, and died at, Maison
Vale Hospice in January and July 2016 respectively, with support from NEO Kids at Health Sciences North.
The Hospice’s pediatric care program (which is now beyond the pilot phase and is permanent) for youth
between the ages of 12 to 18 years of age with a cancer diagnosis.
3.4
The proposed 2-bed pediatric hospice palliative/respite care program will support children and their families
living with a life-limiting or life-threatening illness through respite care and, when needed, end-of-life care.
Both controlled-entrance pediatric suites will have ample space for family; will include a washroom, shared
shower/bathtub, a Murphy bed, a kitchen/living area, and access to a washer/dryer. The Hospice already
has a children playroom thanks to the generous support of the Ten Rainbows Children’s Foundation.
3.5
Pediatric respite beds/suites also reduce the use of hospital inpatient services.
‘‘Respite services offered by Roger’s House (Ottawa) have proven to be beneficial from a cost-containment
perspective as compared with continuous hospital stays or long-term institutional care. The cost differences
observed for respite care patients before and after the hospice was made available are driven by the hospital’s
relatively higher overhead costs.’’ Roger’s House, 2010
3.6
The Hospice will offer family-centered care for pediatric residents and their families. Alternatively, the two
proposed pediatric suites could also be designated as multi-use [i.e., to serve end-of-life residents,
respite clients, and compassionate admissions (couples, siblings, etc. who are dying at the same
time)].
3.7
With the proposed expansion, the criteria for pediatric clients will expand to include children between the
age of 3-18 with a cancer or non-cancer diagnosis, contingent on bed and staff/equipment levels/availability,
in accordance with acuity of client, care needs that can be managed in a hospice setting, and at the
discretion of Hospice Management. Treatment plan is at the discretion of the Most Responsible
Physician/Practitioner (in collaboration with NEO Kids) and may include active treatment (i.e. radiation,
chemotherapy, etc.).
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3.8
Prioritization
Admissions to the Pediatric Hospice Palliative/Respite Care suites will be prioritized on a scale of 1 to 5,
and will be contingent on bed and staff/equipment availability and at the discretion of Maison Vale Hospice
Management.
1.
2.
3.
4.
5.
End-of-life care
Emergency respite
Pain & symptom management
Transition from hospital to home (care provided by parent with nursing backup)
Additional (as available) respite
1.
End-of-Life Care
 Priority for admission is always given to children who are at the end of their lives.
 Children who are in the terminal phase of their illness will be given additional consideration for
respite, with the understanding that they may have increased physical and emotional needs.
2.
Emergency Respite
 Available to children whose primary caregiver is ill and not able to care for them, and to families who
are experiencing a crisis (to be determined by Hospice Management).
 Care will be offered within 24 hours of the request, for a maximum of 72 hours. Extensions may be
provided as occupancy & resources permit.
3.
Pain & Symptom Management
 Available to children who are experiencing pain and symptom issues that cannot be managed at
home.
4.
Transition from hospital to home (care by parent with nursing backup)
 Available to children during a transition period who have complex medical needs, and cannot be
managed at home. Families will be transitioned according to their medical needs.
5.
Additional (as available) Respite:
 When occupancy and resources permit, additional respite time will be offered to children and families
on an as-available basis. The Hospice will maintain a waiting list to accommodate additional
requests. The Hospice will try to provide as much notice as possible when these opportunities arise.
CURRENT STATUS & ANALYSIS
1.
Expansion Steering Committee and Working Groups
Over 30 Hospice staff and community partners participated in consultations in June 2015. The majority of
these individuals, and many more (including Board members, volunteers, and family members), became
members of the Expansion Steering Committee and the five working groups that met regularly until the
Expansion Feasibility Report and Recommendations were presented and approved by the Hospice Board
of Directors on June 27, 2016. (List in Appendix)
The working groups continue to meet, and some initiatives have since been taken on by the Sudbury
planning table (Hospice Palliative Care Sudbury) as priorities for the Sudbury region, as well as the
Northeast Regional Palliative Network (Current Ontario Education Offerings and Providers of Hospice
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15
Palliative Care Education Spreadsheets). Hospice Palliative Care Sudbury has approved the major
recommendations for this expansion project, and has adopted them as part of its annual work plan. The
Northeast Regional Palliative Network has approved the additional 3 residential hospice beds and the 2
pediatric/respite beds, and will be reviewing the Hospice’s Quality Improvement Project proposal in midSeptember 2016.
2.
Architectural Services
On April 11, 2016 the Hospice Board approved the hiring of architectural services of Yallowega Bélanger
Salach Architecture. The firm presented a Functional Program to the Hospice Board and the Sudbury
Hospice Foundation Board on June 27 and 29, which included preliminary plans for future expansion of the
Hospice, as well as an overview of space management and utilization of the existing building.
The Functional Program identified a shortage of:
•
Office and program & service spaces to suit current staffing needs,
•
Functional support spaces,
•
General storage,
•
Food storage and refrigeration,
•
Laundry facilities,
•
Pharmacy space,
•
Public and staff washrooms,
•
Parking,
and the following deficiencies:
•
Front entrance canopy is too low for ambulances.
•
North side entrance requires a wider door and a canopy (for beds).
•
Lack of ventilation system for bedroom and common areas.
•
Existing exits are too narrow for beds.
The Functional Program also developed and identified needs of the Hospice to meet present and future
hospice palliative care programs and services, totalling an additional 16,095 sq. ft., with preliminary plans
for:
•
3 new residential suites,
•
2 new pediatric suites,
•
Expanded administration offices to suit current deficiencies,
Expanded functional support spaces,
•
•
Expanded outreach and program and services spaces,
•
New Community Ambulatory Hospice Palliative Care clinic,
•
1 transition/education bedroom with multipurpose meeting room, and
•
4 Short-stay/Respite beds.
On June 27, 2016, the Hospice Board recommended proceeding with the expansion capital project at a cost
between $8.2 M and $8.7M (plus HST), contingent on receiving the additional ministry funding. The Sudbury
Hospice Foundation also gave its approval on June 29, 2016. The proposed costs included existing
upgrades, site work, equipment, and soft costs, as well as 5% design and 10% construction contingencies.
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3.
Project Timeline
Proceed with Schematic Design Based on Board of Directors Approval
Provide Schematic Design Report
Construction Documents
Tendering and Approvals
Construction
Project Completion
July 2016
Sept 2016
Oct 2016-Feb 2017
March 2017
April 2017-April 2018
April 2018
4. Hospice Palliative Care Community Quality Improvement Project
The Hospice is presenting a Community Quality Improvement Project proposal to NE LHIN by September
21, 2016 under the Health Capital Programs, for submission to the MOHLTC’s Health Capital Investment
Branch, and needs endorsement from NE LHIN.
5. Analysis
“Our last days should be our best. At Hospice, they will be as comfortable as you would expect at your own
home.” Hospice Family
In order to care for 3 residential hospice adult beds, 1 pediatric/adult bed, and 1 transition/education bed 24/7,
the Hospice will require one additional Registered Nurse 24/7 (168 hours). Since the Ontario Palliative Care
Network suggests 3 beds but the other study suggests 6, we feel that we should be planning for the future
with 5 beds, thereby providing us with the funding required for various scenarios involving specialized care.
The transition bed will be primarily designated for use by clients in the community who are (1) in crisis, (2)
have complex needs, (3) have pain & symptom management issues, and/or (4) experiencing failure to cope.
These community clients would otherwise possibly:
 Have to visit the Emergency Department, or
 Be admitted to the Hospice, have their crisis situation addressed, and then become a long-term Hospice
resident until alternate living arrangements can be made.
This bed must be funded on the same basis as a regular residential hospice bed ($105,000) because, at a
minimum, the clients will require the same level of care. For the past 8 years, the Hospice has had a nurseto-resident ratio of 1:5 – the same principle will apply with the additional beds. The additional funding for the
5 beds ($525,000) will allow for additional nursing staff during peak hours and for pediatric admissions,
specialized education, and pediatric training for existing and new nursing/PSW staff (to ensure that the staff
have the ability to care for pediatric AND adult residents concurrently). The Hospice will also consider
charging a nominal fee (i.e., $35, geared-to-income, etc.) for respite beds; this income could be used for
meals, complementary therapy, play therapy, art therapy, etc.
The 5 respite clients (which could include children/youth) will need 24/7 care from Personal Support Workers
who will be, in turn, supported by a Registered Nurse 24/7. The interdisciplinary expert team will be a central
resource for the expansion of the Hospice’s programs & services, and NEO Kids (Interlink Nurse and Medical
Director) will continue to support the pediatric palliative/respite beds.
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FINANCIAL INFORMATION
Summary of Maison Vale Hospice Expansion Requirements
Residential Hospice Beds (3)
2,805 SF
Multi-Use Paediatric/Adult Palliative/Respite Suites (2)
1,560 SF
Administration Offices
1,035 SF
Support Spaces
3,615 SF
Shared Care Program and
Visiting Hospice Service
810 SF
Community Ambulatory HPC Clinic
1,620 SF
Education-Transitional Room (1) and Multipurpose Class/Meeting Room
1,950 SF
Palliative Respite Beds (4)
2,700 SF
Total Gross Floor Area
16,095 SF
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19
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Expansion Capital Funding Requirements
Funding Source
Amount
Capital Campaign *
$3,800,000
MOHLTC’s Health Capital Investment Branch
$3,000,000
Northern Ontario Heritage Fund Corporation**
$1,000,000
FedNor**
$500,000
City of Greater Sudbury**
$200,000
TOTAL
$8,500,000
* $1 Million currently committed from Sudbury Family plus $500,000 from Hospice
Reserve (September 1, 2016)
** Conditional on receiving Residential Hospice Bed Allocation Funding
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22
87
23
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Hospice Expansion Site Plan
(Need additional .75 acres of land from St. Joseph’s Health Centre
EVOLUTION OF MAISON VALE HOSPICE CENTRE OF EXCELLENCE IN HOSPICE PALLIATIVE CARE
Maison Vale Hospice has taken the lead in ensuring that hospice palliative care and end-of-life needs are taken
care of in Greater Sudbury and the Sudbury District, while supporting the development of hospice palliative care
programs and services elsewhere in Northeastern Ontario and across the province.
The Sudbury Hospice Foundation will launch a capital campaign in late 2016 for the expansion of programs
and services offered by Maison Vale Hospice. The NE LHIN’s support and endorsement of this expansion and
Quality Improvement Initiative are vital. The Hospice incorporates a full range of hospice palliative care programs
and services, and it could be showcased by the NE LHIN as the model for a Centre of Excellence in hospice
palliative care in Northeastern Ontario, and elsewhere in the province.
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Maison Vale Hospice will continue to align itself with the regional priorities of Hospice Palliative Care Sudbury,
the North East Palliative Care Network, the provincial palliative care indicators recommended by the Ontario
Palliative Care Network, and the NE LHIN’s 2016-19 Integrated Health Service Plan. The Hospice will continue
to solidify its position as a Centre of Excellence in hospice palliative care, as well as in pediatric palliative/respite
care. Adhering to its own 2015-2018 continuum of strategic objectives, the Hospice will achieve its goal of striving
to embed the voice of the community in its processes, programs, and services.
Achievements
 Providing strong leadership, mentoring, and capacity-building for community health professionals as it continues
to develop and implement proactive and innovative ideas and strategies. For example, the Hospice:
o Along with a Hospice Palliative Care Ontario Working Group, initiated the development of three policy
statements regarding permitting, prohibiting, and facilitating the provision of Medical Assistance in Dying in
Ontario. The Hospice does not permit the provision of Medical Assistance in Dying.
o Developed and implemented the first Shared Care Team in Northeastern Ontario.
o Successfully integrated the largest Visiting Hospice Service (Warmhearts Palliative Caregivers) in
Northeastern Ontario into its complement of programs & services.
o Will soon become the first residential hospice in the province to be officially designated under the French
Language Services Act.
o Established a Foundation to solicit and manage charitable donations and revenues obtained in support of
the Hospice.
Education Collaborative
 The Hospice’s current strategic map includes an objective to become the educational lead in the community.
Ultimately, the Hospice could become the Education Collaborative for the NE LHIN.
o The Hospice can position itself as a support/resource hub for future development of hospice beds throughout
the Region, as well as supporting the development of additional Visiting Hospice Services and Shared Care
Teams in Northeastern Ontario. Nurses from small community hospitals in the Northeast can participate in
training delivered by the Hospice as part of Education Collaborative (on site or via OTN), thereby ensuring
consistent training methods, materials, and best practices. Since 2008, the Hospice has supported the
development of hospice palliative care programs and services across the Northeast (Elliott Lake, Kirkland
Lake, Mattawa, North Bay, North Shore, Parry Sound, Sault Ste. Marie, Temiskaming, Thunder Bay,
Timmins, Wikwemikong First Nation), as well as elsewhere across the province.
o In the last two years, the Hospice has offered 81 placements to nursing (30), personal support workers (22),
NOSM medical students (13), residents (13), and social work students (3). With the expansion, the Hospice
will be able to accommodate a higher volume of placements.
Education: The Hospice will:
 Provide education and mentoring to other health care professionals and agencies by phone, in person, and
via Ontario Telemedicine Network.
 Equip its new classroom and education bedroom with technology that will facilitate distance education for
professionals, volunteers, caregivers/families [i.e., Fundamentals; Learning Essential Approaches to Palliative
Care (LEAP); Transfers, Repositioning, and Feeding module (as part of the Hospice Palliative Care Ontario
volunteer training program), etc.]. Training provided to caregiver/families will equip them with the skills and
knowledge required to keep their loved one at home and have them live and die in the location of their choice.
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
Partner with Laurentian University School of Nursing (based on the Conestoga College developed with
Innisfree House in Kitchener) to develop standardized RN and PSW enhanced hospice palliative care training
and education, including a classroom and hands-on components that will be offered in the Hospice’s education
bedroom. Note that Collège Boréal and Cambrian College have an education partnership agreement with
Laurentian University School of Nursing.
Collaboration
 Continuing collaboration with Hospice Palliative Care Ontario, continuing to develop and implement
standardized outcome mapping and performance indicators to help improve the care provided to
clients/residents of the Hospice Residential Care Program, Visiting Hospice Service, and Shared Care Team,
and their families, in collaboration with Brian Tramontini of Stratim (initiated in 2014).
 This work has led to the creation of a pilot project with Hospice Palliative Care Ontario, Stratim and 7
Visiting Hospice Services in the North East in June 2016 [Near North Palliative Care Network (Nipissing),
Maison Vale Hospice (Sudbury/Manitoulin), Horizon Palliative Care (Cochrane), VON (Algoma and
Espanola), Hospice West Parry Sound, Elliot Lake Palliative Care Program and Timiskaming Hospice
Palliative Care]. The indicators will capture the value of volunteers' contributions to supporting patients
and their families. Once developed, Hospice Palliative Care Ontario will roll the indicators out to all Visiting
Hospice Services across the province, with future plans to include all hospice palliative care programs and
services.
 Seeking opportunities to collaborate and align with new community or provincial partners, and to create
common tools that will streamline shared processes (i.e., community-wide scheduling for the community
hospice palliative care interdisciplinary expert team that will serve as a platform for booking, revisiting, and
data capturing for home visit patient and health professionals). The Hospice would also utilize existing
Outpatient Palliative Care Clinics in Ontario as a valuable resource in the development of its own clinic (i.e.,
Lakeridge
Health
https://www.lakeridgehealth.on.ca/en/ourservices/Outpatient-Palliative-Care.asp,
Scarborough Hospital http://www.tsh.to/areas-of-care/cancer-care/palliative-care/, and St. Joseph’s
Hospice in Sarnia http://www.stjosephshospice.ca/?q=residentialhospice).
 Strengthen and aligning its processes and enhancing its accountability by obtaining Hospice Palliative Care
Ontario accredited status for its Visiting Hospice Services and Residential Hospice.
 Play a vital role with Hospice Palliative Care Sudbury. The Sudbury planning table that was reignited as a
result of the work on the Hospice expansion. The table has endorsed the recommendations in this Business
Case. These recommendations are now reflected as priorities in the local planning table’s work plan, and the
Hospice expansion working groups have now become the working groups of the new planning table.
Consultation & Training
 The new clinic will offer more space to accommodate physicians who want to provide hospice palliative care
outreach in the community. The Hospice currently has a collaborative relationship with the Symptom
Management Clinic’s advanced practice nurse and palliative physicians, as well as with the NECCAC Nurse
Practitioner.
 The Care Coordinator from the North East Community Care Access Centre, and the Palliative Pain &
Symptom Management Consultant (PPSMC) from VON should be assigned to the Hospice’s Community
Hospice Palliative Care Interdisciplinary Expert Team. Note that the previous three PPSMCs operated out of
the Hospice under a memorandum of understanding with VON.
 The number of volunteers will increase for Visiting and Residential Hospice Services, as their skillset will be
required to serve the increased number of Hospice residents, respite, and community clients.
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Transition Care
 Transition beds are innovative. They haven’t been funded or trialled previously in residential hospices in
Ontario. Ottawa is planning to open two respite beds as part of its new 12-bed expansion in Kanata. Hospice
Renfrew presently offers respite services when their 6-bed residential hospice is at 4-bed capacity or less (in
order to ensure the 80% capacity). This proposed bed would provide an advantage to clients who are in crisis,
as the Hospice would conduct a short period of observation and treatment, and then either discharge them
home once they are stable, or admit them to Hospice if warranted (vs. being triaged through the Emergency
Department).
Supportive Care and Grief & Bereavement Program
 Continuing to build upon its Supportive Care Program (which has increased its volume of individual and group
interventions, offers an 8-week grief recovery program twice per year, and has added, since September 2016,
a Supportive Care On-Call Team to ensure coverage on weekends and vacations).
 The Supportive Care Program will have increased capacity, especially with the addition of the On-Call Team.
The Hospice plans to have a second FTE to complement the Supportive Care Program to provide full coverage,
both in the Hospice and in the community.
NE LHIN Announcement Northeastern Ontario Visiting Hospice Services – Performance Indicators
Pilot Group
Grief & Bereavement Discussion Group Schedule (Example)
APPENDIX PG #
A13, pg. 46
A14, pg. 47
PROPOSED RESOLUTIONS
Expansion of hospice palliative care programs and services at Maison Vale Hospice in order for the right
person to die in the right place at the right time. It is requested that the NE LHIN Board of Directors endorse
the following recommendations:
1. Increase the number of adult community residential hospice beds by 3.
2. Create/implement new coordinated and integrated approach for community hospice palliative care for clients
with cancer or non-cancer diagnoses (Quality Improvement Initiative), which includes:
 A community hospice palliative care interdisciplinary expert team,
 A community ambulatory hospice palliative care clinic,
 4 adult short-stay/respite beds, and
 1 transition/education bedroom, with
o A control/debriefing room and
o Information technology linkage to a multi-purpose classroom.
3. Create 2 designated multi-use suites (pediatric/adult hospice palliative respite care suites), with access to a
shared living room/kitchen area, to support children and their families living with a life-limiting or life-threatening
illness through respite care and, when needed, end-of-life care. These multi-use suites will serve adult
residential hospice/short-stay respite clients/residents, and/or compassionate admissions (couples,
siblings, etc. who are dying at the same time) when not occupied by children.
Note that the Hospice is proposing Budget Option #2 as its preference. The Hospice expansion will add a total of 16,095
SF to the existing facility at a cost of $8.2 – 8.7 M. Value includes existing upgrades, site work, equipment, soft costs, 5%
design and 10% construction contingency. The footprint for this expansion remains the same for both options; the savings
are found in operational costs ($178,000), due to the fact that the Hospice is not dedicating pediatric palliative/respite
beds, as they are now multi-use beds (for adult end-of-life and respite care).
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APPENDIX CONTENTS
Item
Description
Page #
A1
Maison Vale Hospice Residential Hospice Statistics (2015/2016)
30
A2
Maison Vale Hospice Residential Hospice Statistics – Year-to-Year Comparison
(Sept 2008 to Aug 2016)
31
A3
Maison Vale Hospice End-of-Life Care Survey – Caregiver Feedback Regarding
Residents’ Overall Sense of Wellbeing (2014-2015)
32
A4
Maison Vale Hospice Strategic Map (2015/2016 to 2017/2018)
33
A5
Maison Vale Hospice Strategic Plan Summary of Progress @ March 31/16
34
A6
Maison Vale Hospice Expansion – Hospice Staff and Community Partners Consultation
Report
37
A7
Membership of Maison Vale Hospice Expansion Steering Committee (MVHESC)
and Working Groups
39
A8
Maison Vale Hospice March 2/16 PowerPoint Presentation Excerpt, “Enhancing
Transitions In Care – Patient Data”
41
A9
Maison Vale Hospice March 2/16 PowerPoint Presentation Excerpt, “Enhancing
Transitions In Care – Goals”
42
A10
43
A11
Maison Vale Hospice Shared Care Team – Performance Indicators (2015/16 Q1-Q4)
44
A12
Maison Vale Hospice Shared Care Team – Performance Indicators (2016/17 Q1)
45
A13
NE LHIN Announcement re: Northeastern Ontario Visiting Hospice Services
Performance Indicators Pilot Group
46
A14
Grief & Bereavement Discussion Group Schedule (Example)
47
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A1 - MAISON VALE HOSPICE RESIDENTIAL HOSPICE STATISTICS
2015/2016
94
30
95
31
A2 - MAISON VALE HOSPICE RESIDENTIALHOSPICE STATISTICS
YEAR-TO-YEAR COMPARISON (SEPT 2008 TO JULY 2016)
A3 - MAISON VALE HOSPICE END-OF-LIFE CARE SURVEY
FAMILY/CAREGIVER FEEDBACK RE: LOVED ONES’ OVERALL SENSE OF WELLBEING
5
8%
Jan-Dec 2015
72 responses for 2-part Question #33
21
32%
39
60%
Improvement of 1-10 pts
7
10%
No change
Decline
Jan-Dec 2014
65 responses for 2-part Question #33
22
30%
43
60%
Improvement of 1-10 pts
96
No change
Decline
32
A4 - MAISON VALE HOSPICE STRATEGIC MAP
2015/16 TO 2017/18
97
33
A5 - MAISON VALE HOSPICE STRATEGIC PLAN
SUMMARY OF PROGRESS @ MARCH 31/16
98
34
99
35
100
36
A6 - MAISON VALE HOSPICE EXPANSION
HOSPICE STAFF AND COMMUNITY PARTNERS CONSULTATION REPORT
101
37
102
38
A7 - MEMBERSHIP OF MAISON VALE HOSPICE EXPANSION STEERING COMMITTEE (MVHESC)
AND WORKING GROUPS
Maison Vale Hospice Expansion Steering Committee
Chair: Maison Vale Hospice Board & Maison Vale Hospice Expansion Steering Committee
Chair, Education/Training Capacity/Hospice Palliative Care Curriculum Development Working Group
Chair, Supportive Care/Grief & Bereavement Working Group
Director of Administrative Services, Maison Vale Hospice
Chair, Land & Building Working Group
Maison Vale Hospice Board Member
Director of Care, Maison Vale Hospice
Chair, Community Hospice Palliative Care Working Group
Family Member
Executive Director, Maison Vale Hospice
Chair, Pediatric Hospice Palliative Care Working Group
Land & Building Working Group
Chair: Landscaping Architect
Director of Administrative Services, Maison Vale Hospice
Retired Architect
Associate Professor, School of Architecture
President, Southside Health & Life Management
Capital Project Manager, Laurentian University
Executive Director, Laurentian University Physical Plant & Planning
Pediatric Hospice Palliative Care Working Group
Chair: Pediatric Interlink Nurse, Northeast Cancer Centre
Members at large (2)
Social Worker, Health Sciences North Children’s Treatment Centre
Registered Nurse, Maison Vale Hospice
Chief of Pediatrics & Medical Director, Health Sciences North NEO Kids
Board Member, Maison Vale Hospice
Community Hospice Palliative Care Working Group
Chair: CEO, For Seniors Only
Advance Practice Nurse, Northeast Cancer Centre
Navigator, Maison Vale Hospice Shared Care Team/Visiting Hospice Service
Manager of Volunteers Services, Maison Vale Hospice
Clinical Lead, Maison Vale Hospice
Manager of Care Coordination, North East Community Care Access Centre
Physician, Centre de santé communautaire du Grand Sudbury
Physician, Symptom Management Clinic – Northeast Cancer Centre
Nurse Practitioner, North East Community Care Access Centre
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Education/Training Capacity/HPC Curriculum Development Working Group
Chair: Advance Practice Nurse, Northeast Cancer Centre
PN/BSCN Professors, Collège Boréal School of Nursing
Navigator, Maison Vale Hospice Residential Care/Interdisciplinary Education Programs
Manager of Care Coordination, North East Community Care Access Centre
Director of Clinical Management, Bayshore
Palliative Physicians (3)
Professor, Laurentian University School of Nursing
Palliative Pain & Symptom Management Consultant, Victorian Order of Nurses
Chair of Nursing, Cambrian College School of Health Sciences and Emergency Services
Supportive Care/Grief & Bereavement Working Group
Chair: Manager of Supportive Care, Maison Vale Hospice
Funeral Director, Lougheed’s Funeral Homes
Director of Spiritual Care Services (Retired), University of Sudbury
Minister, Trinity United Church – Lively
Family Member
Funeral Director, Cooperative Funeral Homes
Chaplain, St. Joseph’s Health Centre
Coordinator, Sudbury Bereavement Foundation & NE LHIN Board Member
Clinical Lead & Manager, Northeast Cancer Centre Supportive Care Program
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A8 - MAISON VALE HOSPICE MARCH 2/16 POWERPOINT PRESENTATION EXCERPT
ENHANCING TRANSITIONS IN CARE – PATIENT DATA
105
41
A9 - MAISON VALE HOSPICE MARCH 2/16 POWERPOINT PRESENTATION EXCERPT
ENHANCING TRANSITIONS IN CARE – GOALS
106
42
A10 - COMMUNITY HOSPICE PALLIATIVE CARE INTERDISCIPLINARY EXPERT TEAM
Maison Vale Hospice is a Centre of Excellence in hospice palliative care that provides palliative and end-of-life
care to patients in their homes, performed by an integrated, interdisciplinary team of health care professionals
who are experts in their fields. This shared care model of care is a community-based program that provides 24/7
access to palliative care and is designed to assist people in their last year of life. The team provides support to
patients, caregivers, and families regarding important palliative care discussions and symptom management
needs. The goals of this program are to increase access to palliative care, avoid unnecessary Emergency Room
visits and hospital admissions, and to support end-of-life care in the location of the patient’s choice. This
collaborative approach to care facilitates a seamless transition within various sectors of the health care system.
The team consists of:











A Clinical Lead, Registered Nurses, and a Navigator who are employees of Maison Vale Hospice Shared
Care Team: supports physician and nurse practitioner, advanced practice nurse and community nursing
providers.
North East Cancer Centre Symptom Management Clinic: Advanced Practice Nurse and Palliative
Physicians provide home visits and on call coverage after hours and on weekends.
North East Community Care Access Centre: Nurse Practitioner and Palliative Care Coordinators provide
home visits and have ongoing contact amongst the team re: patient cases.
Physicians (Palliative/Primary Care): Palliative physician lead is most responsible practitioner however
provides consultation to primary care physicians if requested. Some primary care physicians follow their
own Shared Care patients in collaboration with the Nurse Practitioner and nursing support from Shared
Care Team.
Manager of Supportive Care: Offers supportive care services by facilitating discussions/conversations
with clients/residents, and caregivers/families regarding emotional and spiritual distress. Offers
additional one-on-one and group grief & bereavement support, coaching and counselling, including bimonthly discussion support groups and a bi-annual Grief Recovery Program.
Supportive Care On-Call Team: Supports work of the Expert Team by providing emotional, physical status
of clients, and support care services needed/requested.
Community Nursing Providers: provides ongoing status updates to Shared Care staff which is triaged for
Nurse Practitioner, Advanced Practice Nurse, and Palliative Physician.
Medigas: Registered Respiratory Therapy Homecare Consultant participates in biweekly rounds and
assists with care of community patients.
Visiting Hospice Service: The core Visiting Hospice Service team consists of two staff members – the
Manager of Volunteer Services, and the Shared Care Team/Visiting Hospice Service Navigator, with the
support of visiting volunteers.
Volunteers: As part of the clients’ circle of care, volunteers report to the Manager of Volunteer Services
and/or the Shared Care Team/Visiting Hospice Service Navigator any pertinent changes in their clients’
conditions, i.e., liability issues, safety risks, emotional distress observed, etc.
Family Members/Caregivers: Information provided by families and caregivers allows for conversations to
occur among the Expert Team, and for information to be shared to provide updates, and potentially
additional support services, if and when needed.
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43
A11 - HOSPICE PALLIATIVE CARE SHARED CARE TEAM
PERFORMANCE INDICATORS
2015/16 Q1-Q4
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44
A12 - HOSPICE PALLIATIVE CARE SHARED CARE TEAM
PERFORMANCE INDICATORS
2016/17 Q1
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45
A13 - NE LHIN ANNOUNCEMENT
Northeastern Ontario Visiting Hospice Services
Performance Indicators Pilot Group
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46
A14 – GRIEF & BEREAVEMENT DISCUSSION GROUP SCHEDULE
111
47
Merci • Thank You • Miigwetch
For what matters at the end of life is not so much to add days to life,
but to add life to the remaining days.
WORDS OF WISDOM
“The greater danger for most of us lies not in setting our aim too high and falling short;
but in setting our aim too low, and achieving our mark.”
Michelangelo
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Pre-Capital Submission Form
Chapter 1
Pre-Capital Submission Form (PCSF)
Proposing Health Service Provider (HSP) Information
Proposed Project
Name:
Chapleau Site Redevelopment
HSP Name (Legal):
Service de santé de Chapleau Health Services
Site Name, Address
and Postal Code:
6 Broomhead Road, Chapleau, ON, P0M 1K0
Submission Date:
August 11, 2016
For LHIN Use
Proposal #:
For MOHLTC Use
HCIS#:
LHIN:
NE-LHIN
Facility Type– Please Select
Public Hospitals (including own funds projects as per legislation)
X
Community Health Centres
Community-Based Mental Health Programs
X
Community-Based Substance Abuse (Addiction) Programs
X
Long-term Care Supportive Housing Providers (typically supporting
programs for the frail elderly, acquired brain injury, physically disabled and
HIV/AIDS)
HSP Primary Contact
HSP Secondary Contact
Name:
Gail Bignucolo
Natasha Comte
Email:
[email protected]
[email protected]
Tel:
705-864-3050
705-864-3056
HSP Approval:
Board Approved August 10, 2016
CEO/ED Name:
Gail Bignucolo
CEO/ED Signature:
MOHLTC/LHIN Capital Working Group – Capital Planning Toolkit
November 9, 2010
129
Component 3 – Checklists
Chapter 1 - pg 3.1.1
Section 2 – Proposal Overview
Build Type Descriptions
Addition
X
Green field
Infrastructure
Renovation
X
Remediation
Leasehold Improvement
Decommissioning
Property acquisition
Brown field
Other
Service Type Descriptions
Is this a proposal for a single or multi-service project?
Acute
Ambulatory
ELDCAP
X
CCC
Adult
Critical
Care/ICU
Other Service
Type
Emerg
X
Mental Health – Longer
Term
X
Rehab
X
Neonatal ICU
Infrastructure
Provincial
Program
Mental Health – Acute
Support Service – Please Select
Laboratory
X
CT
Pharmacy
X
Allied Disciplines
General DI
X
Counselling
Maintenance
Staff Facilities
Other
MRI
Food Services
X
X
Housekeeping
November 9, 2010
130
Completion Guideline: It is expected that the response to Section 3 (Part A and Part B) will be
completed in 15 regularly spaced pages.
It is important that HSPs ensure their submissions closely follow the format outlined in the guidelines and
checklists for each stage, to ensure LHIN and ministry review and to facilitate endorsement /approval.
Section 3 - Proposal
PART A
Program/Service Proposal – LHIN Review
1. Provide a narrative description of the program/service need to be addressed by this initiative.
Examples include, but are not limited to:
a. Need for new program(s)/service(s).
b. Need for expanded program(s)/service(s).
c. Need for program redesign or integration.
Chapleau Health Services (CHS) provides a comprehensive continuum of care to the
residents of Chapleau, Foleyet, Ramsey, Sultan, Pineal Lake, and the three First
Nations communities of the Chapleau Cree, Brunswick House and the Chapleau
Ojibway. The total population of this area is approximately 2,600.
Healthcare is provided to meet the diverse needs of the Chapleau community through a
model which contains all of the components found in “Rural Health Hubs”, although the
organization has not yet been formally designated as such. The overall goal of CHS is
to facilitate the seamless integration of healthcare services in a community which is
geographically remote from other providers and thus which must be self-reliant. The
continuum of care available includes: Acute Care; Complex Continuing Care; Long-term
Care; Primary Care through a Family Health Team (FHT); Mental Health and Addictions;
Home Care; and Senior’s Housing.
In order to fully actualize its role as a Health Hub, CHS requires government
infrastructure investment to promote seamless sustainable service integration. The
current infrastructure issues which CHS is faced with fall into three categories: the
Medical Clinic Building/Family Health Team; the Turning Point Mental Health and
Addictions Program; and need for better organization of services within the hospital
facility.
Medical Clinic/Family Health Team (FHT)
The Medical Clinic Building, constructed in 1989, does not meet the needs of the FHT
nor the hospital staff housed in this building, and even with major infrastructure
investment to ameliorate the identified deficits in this building, it would still be inadequate
to meet the needs of the programs provided.
November 9, 2010
131
The issues identified with this building can be organized into three categories: (1) the
Building Condition is sub-standard and building systems are close to the end of their
rated life; (2) there is Insufficient Space to adequately meet program and service
needs; and (3) the building does not meet the Accessibility Standards which are key in
meeting the needs of an aging population and/or those with chronic health conditions.
The Building Condition issues are as follows:
 The MOHLTC Facility Condition Assessment Project, completed by VFA Canada
in 2015, identified a required investment of $193,823 for items which were
classified as “Asset Integrity – Imminent Breakdown” and further required
investment of $143,607 for items which were classified as “Asset Integrity –
Proactive Replacement”, for a total investment of $336,890 in 2015 dollars. It is
important to note that VFA identified that replacement, rather than renewal, was
required for all identified building deficits;
 The “Asset Integrity – Imminent Breakdown” category includes: exterior doors;
plumbing fixtures; exhaust system; roofing; lighting equipment; furnace; and
exterior windows, all of which rated as below standard, negatively impacting
energy efficiency and operating beyond their rated life;
 The “Asset Integrity – Proactive Replacement” category includes: floor finishes;
ceiling finishes; and fixed furnishings and equipment; and,
 CHS building support staff have also reported that due to sub-standard
construction, it is clear that the building is deteriorating, which is evidenced
through the building “settling”, resulting in soft spots on the floors of the building
which demonstrate “sinkage”.
The hospital had an appraisal completed on the Medical Clinic Building in early 2016 by
Coldwell Banker. The estimated current market value as at February 10, 2016 is
$290,000.00, which is $46,000.00 less than the required infrastructure upgrades
identified by VFA Canada. This appraisal clearly indicates that the building has outlived
its useful life as a healthcare facility.
The Insufficient Space issues are as follows:
 The Medical Clinic Building is of insufficient size for the programs which it offers:
o There are an insufficient number of exam rooms to facilitate effective and
efficient patient flow and thus programs such as the Well Baby Clinic are
operated in the clinic hallway;
o Exam rooms at 70 square feet fall far below the current standard of 120
square feet per room. This results in insufficient space in the exam
rooms for accompanying family members/parents/caregivers, as there is
not enough space to accommodate two chairs in addition to the exam
table.
o Insufficient space to add a fourth physician to the practice.
o The exam rooms are too small to accommodate medical learners from
the Northern Ontario School of Medicine, which is key to remote
communities such as Chapleau, in order to facilitate the education of
medical students in northern, remote and rural healthcare to ensure that
medical manpower shortages, such as that experienced by CHS for
November 9, 2010
132
o
o
o
seven years, does not continue to negatively impact the availability and
quality of care for those in the north;
There is no administration space in the building and thus the Clinic
Director’s office and clinic team meeting space are housed in a trailer
adjacent to the clinic building, which does not have sanitary facilities;
There is no flexible space for visiting specialists or allied health providers;
and
There is very limited service and support space.
The Accessibility issues are as follows:
 The clinic building is not accessible and does not meet the standards required by
the Ontarians with Disabilities Act, which further compromises the facilities ability
to meet the needs of an aging population, as demonstrated by:
o No accessible washrooms;
o Hallways too narrow to accommodate people with mobility challenges or
those using electric wheelchairs; and,
o Exam rooms too small to accommodate mobility devices, and for those
with electric wheelchairs from entering the room in their chair.
Turning Point Mental Health and Addictions Program
The Turning Point Program is located in leased office space in the centre of the Town of
Chapleau. While the amount of space provided for this program is adequate, its location
is not. The program’s location in the centre of a small town, with a highly visible
entrance, severely compromises the confidentiality of clients enrolled in the program, as
anyone in the vicinity can see who enters the building. To maintain confidentiality and
deal with the stigma resulting from living with a mental health and/or addictions problem,
many clients choose to enter from an emergency entrance at the rear of the building.
The program space is located directly across the street from a liquor store, which
presents a “trigger for substance use” for those dealing with addiction issues.
Additionally, the market rent and associated costs of operating a service outside of the
hospital site places additional operating cost pressure on the hospital budget, which is
not sustainable in the long term.
Service Reorganization
A Peer Review of CHS was carried out by a team from Health Sciences North – the
Sudbury Hospital in May 2015. The recommendations from this report included
suggested operational initiatives and physical facility alterations/renovations to improve
operational efficiency and reduce operating funding pressures. Subsequent to the Peer
Review, CHS engaged Stantec Architecture in early 2016 to complete a Clinical
Functionality Study of the existing facilities. The Final Report from this study, dated
March 31, 2016, is included as an appendix to this Pre-Capital submission.
In addition to the issues identified with the Medical Clinic Building and the location of the
Turning Point Program, the following were among other issues identified with the
Chapleau General Hospital building:
November 9, 2010
133








A lack of inpatient/outpatient/ service flow separation, as a result of the facility
being developed in two phases plus several interventions over time to alter the
original hospital design in order to promote operational efficiency and adapt to
changes in the healthcare delivery model. This presents serious risks to both
Infection Control and patient Privacy and Confidentiality, in addition to
operational inefficiency;
Undersized Laboratory and Pharmacy;
Under-utilization of freed-up Diagnostic Imaging space, resulting from the change
from film storage to electronic storage of images;
Food Services located away from the inpatient areas, resulting in the requirement
for food carts to travel long distances through both public and service corridors,
which are already narrow;
Physiotherapy located in the centre of the building, within an area with security
access control for inpatient safety, requires outpatients, the primary users of
these services, to travel long distances from the public entrance through public
and service corridors;
The Loading Dock is unprotected from the elements and the shipping/receiving
area has more space than required, which could be re-purposed for other uses;
Inefficient administrative areas; and
General lack of storage.
2. Provide a statistical description of the program/service need to be addressed by this initiative:
This should include:
a. Demographic profile (current and projected population for 5, 10 and 20 years).
b. Utilization profile (current and projected demand for 5, 10 and 20 years).
Analysis of the demographic profile of the catchment area of Chapleau Health Services,
and determination of the future projected population from 2015 to 2041, was completed
using the Ontario Ministry of Finance Population Projections for the entire Northeast
LHIN, as it is believed that this data provides a good picture of the organizations’
catchment area.
Ontario Ministry of Finance Population Projections 2015 to 2041
The population of the Northeast LHIN is projected to decrease 3.9% from 558,765 in
2015 to 537,822 in 2041. However, the population of those aged 70 years plus is
projected to increase 84% from 74,412 to 137,034, during the same time period. All
other age groups are projected to decrease.
The following table outlines projected population increase in those aged 70 years and
older.
Age Group
Population in
2015
Projected
Population in
2041
Percentage
Increase 2015 to
2041
November 9, 2010
134
70-74
75-79
80-84
85-89
90+
Total 70+
26,435
20,269
14,760
8,727
4,221
74,412
32,195
36,460
31,755
20,781
15,843
137,034
% of Total NELHIN Population
13.3%
25.5%
21.8%
79.9%
215.1%
238.1%
375.3%
84.2%
This substantive increase in the population aged 70 years and older will result in service
volume pressures on both the hospital and the Family Health Team, as it is widely
recognized that the population of those aged 60 plus are the largest users of healthcare
services, particularly for chronic disease management services. Ensuring a robust
chronic disease management program will decrease emergency room visits and allow
seniors to live independently as long as possible, thus delaying and potentially
preventing the need for Long-term Care placement.
Medical Clinic/Family Health Team Activity
Year
Clinic Visits Primary Care
Providers
Clinic Visits - FHT
Staff
Total Visits to Clinic
2013/2014
5,908
1,519
7,427
2014/2015
7,482
2,612
10,094
2015/2016
8,746
2,390
11,136
The Chapleau community and Family Health Team were served by locum physicians for
a seven- year period from 2007 to 2014. This level of medical coverage was able to
meet the demand for acute intervention, but was totally insufficient in providing the
community with continuity of care and comprehensive chronic disease management
services.
Examination of Family Health Team activity for the last three fiscal years illustrates a
35.9% increase in visits in 2014/2015 over 2013/2014 and a further 10.3% increase from
2014/2015 to 2015/2016. While demand for services did increase with the aging of the
population, the primary reason for the dramatic increase in volumes was the time
required to build patient charts and to establish chronic disease management services,
with the arrival of three permanent Primary Care Physicians.
Family Health Team Rostered Clients
Age Group
Number of Rostered
Clients
November 9, 2010
135
Under 50
51 to 60
61 to 70
71 to 80
81 to 90
91 +
Total
1,113
422
294
174
83
11
2,097
As illustrated in the table above, the Chapleau FHT has 2,097 rostered clients, which
represents 80.7 % of the total catchment area population. The balance receives their
medical care from a physician in Chapleau, who maintains a private independent
practice. This individual is nearing retirement, and therefore over the next few years the
FHT will be required to absorb this physician’s patients, adding approximately 500
additional patients to the roster. This will result in a 25% increase in the number of FHT
patient visits, assuming that these additional patients have a profile similar to the current
FHT clients.
There is one additional factor which could potentially influence increase in demand for
services at CHS. The Goldcorp corporation has identified a new mine, 12 km east of
Chapleau, in Borden Lake. The Town of Chapleau is currently undertaking a Mining
Readiness Study, which will identify the impacts of this future project on population
growth and potential service impacts. The full impact of this new mine will not be fully
understood until the outcome of the Mining Readiness study is completed, although an
increase in population is anticipated based on the need for skilled labour for mining
operations. As Chapleau is a relatively isolated community, mine workers would be
housed in Chapleau, and will at a minimum require access to primary care.
In summary, even in the face of an overall decline in the size of the population in the NELHIN, demand on the services provided by CHS will increase. This projected increase
cannot be adequately met with the existing number of physicians nor with existing
infrastructure.
Additionally, the aging of the population in the catchment area requires the
implementation of an integrated chronic disease management solution, utilizing the
principles of Senior Friendly Hospitals/Healthcare. Addressing the issues identified in
Question # 1 of this submission would achieve that goal.
3. Describe how this program(s)/service(s) need supports local health system integration and a
unified system of care.
a. MOHLTC – Provincial programs (e.g. Cardiac Care and Transplantation)
b. LHIN – Integrated Health Services Plan, Clinical Services Plan, agreement with Provincial
Agencies such as Cancer Care Ontario and Ontario Renal Network, as required
c. HSP – Strategic Plan, Organizational Goals, Accountability Agreements
Rural Health Hub
November 9, 2010
136
Although not officially designated as a Rural Health Hub, CHS has functioned using this
fully integrated model since the mid-1990’s. The hospital is continually looking for new
opportunities to enhance integration of services as well as achieve economies of scale,
and create full time roles for healthcare professionals by doing so. Having full time
positions allows the organization to attract and retain Healthcare professionals in the
community.
CHS’s ultimate goal is to be formally designated a Rural Health Hub, with the
amalgamation of all of the healthcare services in the community into one fully integrated
organization. This would formally bring together the programs and services currently
offered by CHS, with those offered by the Chapleau District Family Health Team, the
Home Care Program and the Public Health Unit, into one umbrella organization.
Designation as a Rural Health Hub, with the resultant organizational amalgamation,
would benefit the organization through its ability to identify, examine and implement
process redesign initiatives, and to identify and eliminate redundancies, with the goal of
creating operational efficiencies resulting in overall operating cost savings.
Patients First: Action Plan for Health Care (2015)
Implementation of these program integration initiatives, would promote a seamless
continuum of care for the people served by CHS, in line with the Government of
Ontario’s Patients First: Action Plan for Health Care (2015) and its four pillars, Access,
Connect, Inform and Protect:
 Co-location of all healthcare services would facilitate patients receiving the right
care from the right provider at the right time, improving coordination of care for
seniors and those living with multiple complex conditions, who are the primary
population served by CHS;
 Promotion of a Chronic Disease Management Model would be enhanced through
a single point of access to all available outpatient services including primary care,
rehabilitation services and diagnostic testing. This is key for the CHS population,
the majority of which are seniors, and is in line with the Patients First goal of
integrating rehabilitation services for seniors into primary care and Family Health
Teams;
 An integrated Chronic Disease Management model would enhance the ability of
community-dwelling seniors to remain independent, delaying and/or preventing
long-term care facility admission, facilitating overall costs savings for the system
and promotion of system sustainability;
 Co-location of all providers would promote a more collaborative continuum of
care by enhancing providers’ ability to work together as a team in managing
complex patients. “Patients First” supports this philosophy is their statement that
when hospitals, family doctors, long-term care facilities and community
organizations work together as a team, that patients with complex conditions
receive better, more coordinated care; and
 Formal designation as a Rural Health Hub and amalgamation of all healthcare
services into one organization, would serve to control costs and allow CHS to
examine initiatives which would improve organizational efficiency and
effectiveness, with the goal of re-direct funding from operational overhead to
November 9, 2010
137
direct patient services.
4. What discussions have occurred and please describe what level of support has been received
from other stakeholders with regard to this initiative? Other stakeholders may include:
d.
e.
f.
g.
h.
i.
Internal staff, physicians and/or Board members
Other HSPs
Neighbouring LHINs
Provincial agencies (e.g. Cancer Care Ontario)
Service partners
Community stakeholders [Local Health System Integration Act, Section 16 (6) Each
health service provider shall engage the community of diverse persons and entities in
the area where it provides health services when developing plans and setting priorities
for the delivery of health services. 2006. c. 4, s. 16 (6)]
The Chapleau community as a whole, including staff, physicians and Board Members,
strongly support this initiative, which would improve the quality of care which they
receive in the only healthcare organization which they can access for 200 km, which is
located in one of the more remote parts of the Northeast (NE) LHIN.
The NE-LHIN has been made aware by the hospital CEO that a Pre-Capital submission
is in the process of being developed. Additionally, the Executive Director of the
Chapleau District Family Health Team has had discussions with the CEO of the NELHIN on the benefits of physical co-location of the Family Health Team with the Hospital.
The Recommendations in the Peer Review Report, carried out by a team from Health
Sciences North – the Sudbury Hospital in May 2015, included the recommendation that
CHS “Move the medical clinic into a renovated, expanded emergency department; then
sell the medical clinic.”
5. Describe any significant operational implications in terms of:
a. Operating cost
b. Staffing
Addressing the issues identified in Questions # 1 and # 2 would have a positive impact
in reducing overall operating costs.
Moving the Turning Point Program from leased space to the hospital site has the
potential to reduce operating costs for rent and associated facility costs of between $
30,000 and $40,000 annually.
Integrating the services provided in the Medical Clinic Building, into the hospital, would
eliminate ongoing operating costs for line items such as property taxes ($8,000
annually), reduce costs for municipal services (hydro, waste etc.) and avoid the
November 9, 2010
138
maintenance costs from maintaining a building which is beyond its useful life. This
decrease in operating costs would allow the rent received by the hospital from the
Family Health Team to offset the operating costs incurred through co-location.
There is the potential, once CHS is formally designated as a Rural Health Hub, that
staffing efficiencies could be realized through process redesign and integration of “back
of house services”, thus generating additional operating cost savings.
6. Describe any alternative program/service solutions considered to address the need identified in
Question 1 and 2 above. Examples may include:
a. Integration opportunities.
b. Program /service redesign opportunities.
c. Alternative service delivery models.
After careful analysis of the results of the Clinical Functionality Study, it has been
determined that there are no opportunities to ameliorate the issues identified in
Questions 1 and 2, without infrastructure enhancement funding support.
November 9, 2010
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November 9, 2010
140
Innovative Housing with Health
Supports in Northeastern Ontario
Strategic Plan: 2016-2019
141
Table of Contents
Acknowledgements ....................................................................................................................................... 3
Executive Summary ...................................................................................................................................... 4
Background ................................................................................................................................................... 5
Innovative LHIN-funded Housing Models ..................................................................................................... 8
Strategic Planning ......................................................................................................................................... 9
Strengths, Weaknesses, Opportunities and Threats .................................................................................. 10
Mission, Vision, Values ... ........................................................................................................................... 12
Goals and Objectives ................................................................................................................................. 14
Conclusion ................................................................................................................................................. 21
Appendix 1: Housing Expert Panel Member List......................................................................................... 22
Appendix 2: Vulnerable Tenants Research Study ....................................................................................... 23
Appendix 3: Innovative Housing with Health Supports in NE Ontario: Financial Modelling Tool. ............. 74
Innovative Housing with Health Supports in Northeastern Ontario| 2
142
Acknowledgements
The North East Local Health Integration Network (NE LHIN) Expert Panel with support from the
Northern Ontario Service Deliverers Association (NOSDA), Housing Services Corporation, SHS
Consulting, Canadian Mental Health Association Manitoulin-Sudbury formulated this Strategic
Plan to guide Innovative Housing with Health Supports in Northeastern Ontario. As a
social determinant of health, housing is an all-government agenda item and has been identified
by the NE LHIN as a key element supporting health care transformation and quality of life.
The NE LHIN sponsored a forum entitled “Building for the Future” in October, 2015. That first
forum on housing and health in Northeastern (NE) Ontario was dedicated to fostering
partnerships, identifying barriers and opportunities, as well as exploring creative solutions to
meet the future housing and health needs of NE Ontario communities. As a result of that forum,
there was a request for the NE LHIN to undertake additional work on the matters of housing and
health. The NE LHIN created an expert panel on the matter and has sponsored this innovative
housing and support-related, strategic initiative.
The Expert Panel chaired by Gary Scripnick, NE LHIN Board member and Past Chair of
NOSDA, led a second housing forum (see Appendix 1) in June 2016 which was attended by
over 100 participants. The draft plan was further discussed at the forum and was circulated to
community partners for comment and feedback. The final version will be presented to the NE
LHIN Board in September 2016.
This strategic plan is the result of significant community engagement, consultation and
collaboration. The vision, mission, values, goals and objectives as put forth by the Expert Panel
are clear and actionable. Further to NE LHIN Board endorsement, it is recommended that the
plan be brought forward to the City of Greater Sudbury (CGS) and DSSABs across NE Ontario
for endorsement.
August, 2016
143
Executive Summary
General population health is dependent upon appreciation and investment into social
determinants of health. As such, the NE LHIN has taken a leadership role in the conversation
about housing and health. A dialogue with experts in housing, health, development, and
government in the fall of 2015 resulted in the formation of an expert panel on housing and
health. Consideration of the facts, opinions, and opportunities in NE Ontario has resulted in this
strategic plan.
The foundation of this strategy is the recognition that there is a shortage of affordable and/or
appropriate housing stock across NE Ontario. In addition, with growing pressures on the acute
care sector and appreciation of the importance of housing individuals in community with
appropriate supports to advance quality of life and population health has resulted in a series of
recommendations to increase the housing stock, and to provide adequate supports in
community.
The intention of the expert panel was to stretch limits, leverage opportunity and funding to
support investments into housing, and health and enable care close to home.
The values guiding development of the plan include:

Client-Centered, People-Oriented

System Driven, Service Provider Sensitive

Mutually Accountable
Four overarching themes from were identified during the course of planning and include:
1. Clients / People
2. Innovative Housing and Infrastructure
3. Innovative Health / Social Support Provision
4. Innovative Leadership and Sponsorships
Within this report, the expert panel has prepared a comprehensive list of objectives that cascade
from the overarching themes. It is proposed that the expert panel will meet on an annual basis to be
briefed on the progress on the strategy and advise the NE LHIN accordingly.
144
Background
Northeastern Ontario includes the Districts of Sault Ste. Marie, Algoma, Manitoulin-Sudbury, the
City of Greater Sudbury, Cochrane, Nipissing, Temiskaming, James Bay Coast and Parry
Sound. To say the population in NE Ontario, indeed all Northern Ontario, deserves special
attention when it comes to developing innovative housing with health supports is an
understatement.
It is well documented that Canada’s population is aging. This is especially evident in the
demographic makeup of Northern Ontario. The proportion of senior households is increasing
relative to its’ overall population. One reason is that younger people are moving out of the North
in search of education and employment, while older people tend to stay in their communities
Fewer young and working aged adults (e.g. aged 15 to 54) results in a tax burden on older
adults who may be on fixed incomes. Further, high numbers of seniors in communities put
pressures on municipal services (e.g. EMS, Housing) which are funded by the municipal service
manager. Seniors may have a reduced ability to pay the resulting increased costs of the
property tax burden due to fixed incomes. An aging population has implications on social
housing as persons on fixed or low incomes may have increasing difficulty maintaining and
living in their own homes. An aging population has implications on Emergency Medical
Services as need for medical services increases with age.
Historically, culturally or linguistically appropriate specialized health or social services have been
developed where there have been critical masses of demand. This means that services are
diffused throughout the region, and that people with specific health or social service needs often
have to travel great distances or sometimes move to access specific, needed services.
Over ten percent of the population in the North is Indigenous, representing about 40% of all
indigenous people in Ontario. 26% of Ontario’s Francophones live in Northern Ontario. There
are 15 Friendship Centres and one satellite office located in Northern Ontario – six of which are
located across the NE (including one satellite office). Friendship Centres are community hubs,
providing multi-sectoral services to urban Indigenous people and in many cases have been
serving the community in their respective towns or cities for over 20 years and may be the only
urban Indigenous organization in their location.
Considering that 84.1% of Indigenous people in Ontario live off-reserve1, and that Indigenous
people represent one-third of the total population in northern Ontario2, urban Indigenous
engagement in creating social service delivery in Northern Ontario is crucial. Key factors
influencing the increased migration to urban centres by Indigenous people are the perceived
educational and employment opportunities, the perception of greater access to supports and
Statistics Canada., National Household Survey (Ottawa, ON: Statistics Canada, 2011).
Service Canada., Client Segment Profile: Aboriginal Peoples, Ontario (Ottawa, ON: Service Canada,
2014).
1
2
145
services, and the hope of adequate housing. Nonetheless, for many, the socio-economic
challenges that have influenced their migration continue to impact their daily lives and a
disproportionate percentage of urban Indigenous people continue to live below the poverty line. 3
Another issue affecting housing and services in the North is the regular need to evacuate
communities in the Far North to more southern communities in Northern Ontario due to climate
change and fires. This puts, short term, but severe pressure on housing and support services.
In the rural areas of the region, there is a higher than national/provincial average dependency
on government transfer payments (pensions, assistance, etc.) due to a lack of earning
opportunities. There is relatively high mobility of younger families across the region and into and
out of the North in search of education and employment. They are adversely affected by
externally driven, resource-based cyclical economic downturns, limited economic diversity and
job opportunities, an aging-in-place workforce reducing upward occupational mobility, lower
literacy, at-risk youth, lower than average family incomes and higher than average low income
families and single parents. Poverty rates are higher due to a lack of employment opportunities;
disability is more prevalent in Northern Ontario. This also has a negative impact on the
availability of informal caregivers to address the needs of aging relatives and neighbors. These
determinants of health factors have an impact on the health status of Northern Ontarians: on
average the health status of Northern Ontarians is lower than their Southern Ontario
counterparts. As a result of these phenomena, northern communities are generally more
immediately and severely affected by economic and demographic changes. All of these
challenging factors are affecting the long-term viability of some depopulating, de-serviced
municipalities.
As noted in the research conducted by SHS Consulting for this project(see Appendix 2), there is
great concern across the province regarding the lack of supports for the growing number of
vulnerable individuals being housed within social housing portfolios and particularly in Northern
communities. There are many vulnerable populations in communities across the NE LHIN who
are at risk of suffering poor health outcomes and, at the same time, likely to experience difficulty
managing those outcomes. While the Housing First policy is strongly supported and there is
widespread agreement that social housing provides a critical foundation for helping reduce
poverty among these individuals, these providers are finding a widespread lack of supports for
addressing their clients’ needs. It is also worth noting that indigenous housing providers have
noted Housing First is too narrow a focus to holistically address social housing needs. In
addition to the need for supportive services, investments are required across the housing
continuum starting with both homelessness and emergency housing and supportive and
transitional housing. Staff responsible for operating social housing, such as property managers
and building superintendents, or volunteer boards themselves, are often left to try and cope with
meeting these needs; most are lacking in the required skills and resources and are not trained
OFIFC, OMAA, ONWA, Urban Aboriginal Task Force: Final Report (Toronto, ON: Ontario Federation of
Indigenous Friendship Centres, Ontario Métis Aboriginal Association, Ontario Native Women’s
Association, 2007). 185-186
3
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to fulfill this role. This issue is being experienced not only among the mainstream population;
Indigenous housing providers and agencies such as Ontario Aboriginal Housing Services are
also finding similar concerns within their social housing portfolios as well.
At the same time, the support system for these individuals consists of a dizzying array of
services, programs and agencies that can be difficult for clients to navigate. Clients often have
to tell their story over and over. There isn’t dedicated, long-term funding for such services and
no coordinated approach to providing a consistent and effective level of support for these
individuals between and among the various services a client may need at a given time. On top
of that, data on which to plan appropriate services is disparate and limited.
Findings from research activities suggest that there is a need to enhance home and community
care across the NE LHIN and indeed across Ontario. This includes increasing access to inhome services and expanding the supply of specialized supportive housing. This housing with
health support services should provide long-term, flexible and, when necessary, more intensive
supports to particular population groups who may not be appropriate candidates for long-term
care. Currently, it appears that there are significant populations of vulnerable groups suffering
from multi-vulnerability. Their unmet needs many not only create a risk for poor health
outcomes and potentially avoidable health crises for these clients, but also could lead to a loss
of independence through an inability to sustain their housing, a frequent use of emergency
services, increased demand on Alternative Levels of Care, increasing caregiver burnout and
can lead to premature admission to long-term care homes. This may or more likely may not be
a good fit for the individual.
All levels of government along with the private sector need to strategically plan and execute
projects that bring social housing and services together across Ontario to maximize the impact
of scarce public resources. Nowhere is this initiative more urgent than in NE Ontario, where the
population of seniors and persons with low income is higher than the provincial average. The
NE also contains numerous small communities with aging populations and few options for
people who require supports to live in their own homes and remain in their own communities.
The concept behind planning for the development and/or integration of social housing with
health supports is to take advantage of the current climate and growing need for affordable
housing in this region of the province.
Why now? Interest rates are at historic lows in Ontario. With the stimulative budgets tabled by
the Federal and Ontario governments earlier this year, it’s time to address social housing and
infrastructure deficits that have accumulated in this province over the past number of years.
Further, integrated health and service delivery should be less expensive to the taxpayer to
deliver. However, these plans must recognize that the historical approach of funding
infrastructure and putting increasing demands on local property taxes is insufficient to meet the
challenges ahead. The monies for social housing required are substantial, and will require
judicious project evaluation and selection.
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Innovative LHIN-funded Housing Models
Creativity and innovation are critical to meeting the varying health care needs of the population.
More creativity is required to tackle the shortage of affordable housing. The NE LHIN has
supported a number of innovative programs and some are listed below and were also identified
at the October, 2015 Forum:
Carruthers Home (Permanent Housing Model)
Three men have moved from North Bay Regional Health Centre to live in this community home
for clients living with acquired brain injury. The core transition team from the hospital is a
registered nurse, social worker and behavioural therapist, with additional access to an
occupational therapist, with peer support staff from People for Equal Partnership in Mental
Health (PEP) to complement the clinical staffing of the home.
North Bay-based Physically Handicapped Adults’ Rehabilitation Association (PHARA)
PHARA started providing supports to people with physical disabilities in 1982. Its services have
expanded to providing housing opportunities for low to moderate income families. It owns and
operates three housing complexes in North Bay with a total of 143 housing units. There are 36
totally accessible units for people with physical disabilities and the persons in these units are
part of the Attendant Care Program. The Outreach program provides supports to people in their
home in communities from Mattawa to Warren. In partnership with the North Bay Regional
Health Centre, PHARA has a Transition to Home program that enables people to leave the
hospital and enter the program for a period of 90 days.
Wade Hampton House, March of Dimes
The renovated former Ridgemount Public School now houses 10 people, the majority under the
age of 44, with moderate to severe brain injuries. Prior to its construction, most of these young
adults would have ended up in long term care homes. Wade Hampton House is now the only
congregate care home for individuals with an acquired brain injury (ABI) between Etobicoke and
Thunder Bay.
Moonlight Residential Home
The Sudbury residence supports up to eight people as they transition back into community after
being in hospital. This housing model represents a unique partnership between the North Bay
Regional Health Centre, the CMHA Sudbury-Manitoulin and the Northern Initiative for Social
Action (NISA). The home uses a Peer Support staffing model. Peer Support Workers are those
who have lived experience of mental illness and who offer recovery-based support using their
own experience.
A further example of innovation undertaken by the NE LHIN is the development of a behavioural
support program for individuals who have been traditionally housed in hospital but who can be
supported in long term care with enhanced staffing support. It is examples such as these which
provide incentive to continue to seek appropriate accommodations for individuals.
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Strategic Planning
Key to planning for systems change in government is identifying areas of alignment with the goals
and aspirations of potential partners. The proposed Innovative Housing and Health Supports
Strategy has been developed in the context of the Ministry of Health and Long Term Care’s new
Patients First initiatives, the NE LHIN’s Integrated Health Services Plan 2016-2019, the
Ministry of Housing’s March, 2016 Long Term Affordable Housing Strategy and its July, 2016
Housing and Homelessness Policy Statement, as well as NOSDA’s November, 2014
Consolidated Pan Northern Housing and Homelessness Report and its’ most recent
Strategic Plan (2013-2016). Another key component of the current provincial policy and program
context is the Province’s The Journey Together: Ontario’s Commitment to Reconciliation
with Indigenous Peoples (2016), which highlights the collective responsibility to work with
Indigenous communities to address the range of social service gaps that face these communities
in the North.
Aligning this strategic plan with the above initiatives and plans will maximize their collective
impact and improve quality of life for those requiring housing with health and social supports in
NE Ontario.
While there is considerable variety in the form, content, process and duration of strategic plans
in the public and not-for-profit sectors, each tend to have some common elements. First, the
process reflects on recent history, current accomplishments and future challenges. Most include
an internal diagnostic – a so-called SWOT analysis – looking at the organization’s StrengthsWeaknesses-Opportunities-and-Threats and in this case, an external assessment – also
referred to as a PEST review – looking at relevant Political, Economic, Social and Technological
impacts that have a direct bearing on the local operating environment. This information
provides a frank assessment of current issues and future trends.
Next, the organization reviews the activities with which it is involved – its reason for existing.
These mandates are then expressed in a Mission Statement. In parallel with this exercise, the
organization determines the direction that their leadership wishes to take over the term of the
strategic plan. This Vision Statement sets the overall direction for the organization in a way that
all those involved can understand.
Finally, the strategic planning process describes what is to be achieved as well as the manner in
which to achieve it. The Strategic Plan aims to establish broad Goals for the organization. To
achieve these goals, the plan then identifies Objectives that will either achieve or advance the
goals. These objectives require action plans on the part of all system players with identified
lead organizations for accountability purposes.
The Strategic Plan addresses the ways in which progress will be driven, actions taken and measured,
course corrections made and overall achievements evaluated when the Strategic Plan comes up for
renewal. Successful strategic planning is a shared process – it’s about engagement.
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Strengths, Weaknesses, Opportunities and Threats
The Expert Panel and ex-officio advisors were surveyed and the following is a summary of the
panel’s assessment of the strengths, weaknesses, opportunities and threats that have
significant impact on the development of Innovative Housing with Health Supports in NE
Ontario.
Strengths
Strengths identified by the Expert Panel included:
 Communities are its greatest strength.
 Well-developed infrastructure
 Northern people are a strength (resilient, growing Indigenous population both on-reserve
and off, etc.)
 Generally positive and cooperative relationships among providers and between sectors
Weaknesses
Weaknesses identified by the Expert Panel included:
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Large geographic area
Higher construction, service and energy costs/affordability
Cyclical economy
Low population densities and an aging population with slow to negative population growth.
Lack of expertise/understanding in a wide variety of areas – lack of people with the right
skills to develop appropriate housing and/or support service networks in all communities
Lack of coordination/bureaucracy/silo mentality between ministries, sectors, organizations
Discrimination – against race, gender, age, ability, sexual orientation, persons with mental
health issues by service providers, landlords, other tenants, general public
Lack of volunteers to assist people (diminishing informal support networks)
Long-term care not always able to handle some individual behaviours
Alternative levels of care needs are growing
Lack of housing with adequate levels of support
Service gaps between rural and urban population
Opportunities
Opportunities identified by the Expert Panel included:
 Alignment with other levels of government/timing is ‘right’
 Cooperation/collaboration between senior levels of government, municipalities, housing
service providers, health and social services, private sector
 Addressing the needs of an aging population
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 Use of a wide variety of educational facilities to develop knowledge, training opportunities,
research on better housing techniques, better data for planning of health and social services
delivery
 Use of technology
 Affordable, serviced land is available in many communities across NE Ontario
 Need for cross-sectoral funding support
Threats
Threats identified by Expert Panelists included:
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Aging public housing stock
Lack of funding for ‘bricks and mortar’ and supports
Geography – vast rural and isolated areas
Aging population and declining population
Capacity – widely distributed, low population base leads to many areas not having people
with needed expertise
Discrimination
Disparity of availability of housing/services
Silos/leadership that will witness the continued diminishment of delivery capacity in NE
Ontario
Inadvertent creation of care homes in social housing – as social housing residents continue
to ‘age in place’ increasing pressure is put on social housing staff to provide support
services
Political, Economic, Social and Technological Implications for Innovative Housing with
Health Supports in NE Ontario
The Expert Panel identified political, economic, social and technological trends that impacts
Innovative Housing with Health Support development in NE Ontario.
Political Implications
Limited political representation/voice in senior levels of government
Need for inter-ministerial cooperation and understanding and the reduction of ‘silos’
Need for inter-agency cooperation
Need for recognition of limitations of municipalities to fund housing and/or health in the
North off of local property tax bases
 Need for First Nations Accords in health and housing funding agreements
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What are the Economic Implications?
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Housing and healthy population are economic drivers
Lack of economies of scale, higher construction costs
The need for a poverty reduction strategy specifically in the North
The need for capital grants and more public/private partnerships and new ways to fund and
deliver housing and health and social supports
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What are the Social Implications?
Aging population
Cultural diversity
Geographical isolation and the need for transportation
Vulnerable populations
Health and social programs and the private sector have not historically worked together in
NE Ontario
 Social isolation
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What are the Technological Implications?
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Opportunities for technology in housing construction and renovation
Opportunities for technology in health care – telemedicine/record keeping
Opportunities for technology applications in telecommunication (need for speed)
Issues/concerns about technology – lack of adoption by aging Northern population; variety
of vendors and formats; FOI concerns
Mission
The Mission of the Expert Panel is to enable progress toward achieving the goals and objectives
contained within this Innovative Housing with Health Supports Strategic Plan, to meet on an
annual basis to develop and maintain activity in these sectors in NE Ontario and to advise the
North East Local Health Integration Network, the Northern Ontario Service Deliverers
Association, DSSABs, the Ministry of Housing, City of Greater Sudbury, the Ministry of Health
and Long-Term Care and others as appropriate on related issues.
Vision
The vision of the Expert Panel is that every person in Northeastern Ontario has an affordable,
suitable and adequate home to provide shelter with high quality and well-coordinated health and
social services available to support independence.
Values
Values identified by the Expert Panelists, through focus group and stakeholder research and
during the June 8, 2016 Forum are highlighted below:
Client-Centered, People-Oriented
The Expert Panel values a ‘People First’, anti-racist, non-discriminatory, Indigenous cultural
competency-trained approach, which fosters trust between clients and service providers and
which ensures that no client is ever turned away because they tried to access services through
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the ‘wrong door’. Cooperation between service providers is valued as is a willingness to make
organizational or corporate cultural changes for the betterment of the well-being of clients.
System Responsive, Service Provider Sensitive
The Expert Panel values a system which is collaborative, communicative, coordinated and
adaptable, and which encourages flexible funding and information sharing among all service
providers. The care system must be responsive and supportive of clients and their informal
networks. Bureaucratic barriers and ‘red tape’ needs to be eliminated. The housing, health and
social service network in NE Ontario needs to be accessible, responsive and respectful of all
clients (including but not limited to First Nations, urban Indigenous, Lesbian, Gay, Bi, Transsexual, racialized, mentally or physically challenged persons, victims of violence, youth at risk,
seniors and other marginalized populations). The service network and the services provided
should be community-driven; responsive to objective measures (i.e. data); and open to changes
that data supports; and be affordable to users and accountable for monies spent. Most
importantly, the dignity of the individual – including both staff and clients – must always be
respected.
Mutually Accountable
The Expert Panel would value a new approach to government funding which promotes longerterm funding that is flexible enough to deal with unforeseen issues or opportunities. Funding
decisions should be data driven, applying a ‘wellness’ lens, encourage the breaking down of
silos and be made in a thoughtful, logical fashion. Mutual accountability of funders, service
providers and clients is valued as is open, ongoing and clear communications. These values
promote a ‘pro-active, can-do’ attitude among service providers and are reassuring to clients.
Finally, service providers should take all possible steps to engage the private as well as the
public sectors, promote affordability, energy efficiency and above all, service integration for the
benefit of clients and the public.
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Goals and Objectives
There are more than 10,000 vulnerable tenants who live in social housing and many other
vulnerable adults who live on their own across NE Ontario (SHS, 2016). It is critical that a
coordinated system of innovative housing with health supports be in place to help meet the
needs of these vulnerable persons. To support this, parties involved need to engage in a
collaboration of committed public and private partners with shared responsibility to better,
objectively meet the needs of clients. This can be done through the development of innovative
solutions and addressing District Housing and Homelessness Ten Year Plan directions and
service provider housing gaps developed by DSSABs and the CGS. Below are four goals and
related objectives:
 Goals provide a broad set of themes
 Objectives are categorized by related Goals and identify observable activities. They are
further broken down by Time to Implement: Immediate Term (less than 6 months); Short
Term (six months to one year); Intermediate Term (one year to two years) and Long
Term (over two years).
 There will need to be further definition of this strategy by assigning prioritized objectives
to leads / organizations.
GOAL 1: Clients/People
To develop a ‘People First’ approach to the development of Innovative Housing with Health and
Social Supports in NE Ontario, citizens must be involved in a meaningful, ongoing way in the
design and provide input into that development process.
Objective:
1) Develop strategies to engage, reduce and prevent the number of people experiencing
chronic homelessness and homelessness among vulnerable persons, youth and
Indigenous peoples, as appropriate to the local context incorporating innovative
approaches and a Housing First philosophy (INTERMEDIATE TERM)
GOAL 2: Innovative Housing and Infrastructure
Identify a range of innovative funding mechanisms to aid in the development /creation,
renovation or re-purposing of a range of adequate, affordable, safe and energy efficient housing
through the judicious and accountable use of government, public and private sector funds to
reduce/eliminate homelessness and/or inadequate housing.
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Objectives:
1) Explore and develop innovative funding and construction/renovation/repurposing/energy
conservation methodologies (ONGOING)
2) Develop/use consistent, objective methods of measuring need, including households
experiencing homelessness/inadequate housing. These methods must go beyond the
Housing First policy’s reliance on Point in Time counts, which ignore issues of ‘hidden
homelessness’ (INTERMEDIATE TERM)
3) ‘Bench test’ and modify the financial analysis tool developed by Housing Services
Corporation, with a view to maximize its utility for communities/organizations considering
developing innovative housing in NE Ontario (IMMEDIATE TERM)
4) Engage the private sector to seek innovative ways to involve them in investing in
affordable housing (ONGOING; INTERMEDIATE TERM)
5) Housing builders and providers need to know how to engage Home Care and/or service
providers if they are to develop or provide units for the "frail" community members or a
hospital discharge program. This link needs to exist to emphasize the connection
between integrated service delivery and the development of community homes for high
needs citizens (INTERMEDIATE TERM)
6) Mandate more education for property managers/building superintendents to help them
link tenants with service providers. If a social housing provider or developer doesn’t
want to invest in expanding the role of their staff, they could partner with a support
services agency who could a) provide assessments b) deliver care/interventions where
appropriate. Property owners could accelerate this process by offering some space in
their building where agencies delivering care (could be multiple agencies) can write their
reports/share information with other caregivers where appropriate as well as reach out to
tenants or provide several units that an agency is responsible to fill and provide
care. This approach allows for a natural nucleus of service delivery in the building while
respecting the fact that there will be all levels of independence represented in the
housing (INTERMEDIATE TERM)
7) Where there are buildings housing vulnerable citizens such as frail seniors, or adults
with physical disabilities and where a minimum of 4 individuals require personal support
care services and there are a minimum of 12 individuals living in that building:
a. A single provider be contracted to service all personal support needs to the
citizens of the building
b. Personal support hours are extended for each eligible individual in that location
to enable variability and flexibility on a daily basis to care of all individuals in that
building.
c. Consistency in attendant care be a standard of expectation
d. Flexibility in range of type of services provided be pursued and supported
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e. The facility be utilized as a ‘community hub’ to serve the health needs of
neighboring residents – volume permitting
f. A model that supports these concepts be developed by the NE LHIN by
December 31, 2016 and implemented by April 1, 2017 (SHORT TERM)
8)
Where there are buildings and neighborhoods where this is a high concentration of
vulnerable citizens:
a. Satellite support offices be positioned within a close geographic proximity
b. Social housing complexes be encouraged to provide rental arrangements to such
support agencies using a variable cost recovery for rent
c. The LHIN and local health service providers commit to supporting a community hub
model which is premised upon improving the social determinants of health be
prioritized for the most marginalized neighborhoods across the NE LHIN in particular
in alignment with the rural health hub strategy and urban areas of the NE LHIN
d. When new health care models are being developed such as community health
centres they be prioritized to areas where there are a high concentration of
vulnerable citizens.
e. Within the social housing portfolios of local communities where there are units
that are 3-4 bedrooms and identified as surplus, they be identified as sites
supported for accommodations for individuals identified as Alternative Level of
Care (ALC), pending service commitment (SHORT TERM)
9) Where there are long term care, hospital, or agencies providing concentrated health
services within close proximity to assisted or retirement living or social housing projects,
these organizations coordinate health and ancillary services (INTERMEDIATE TERM)
10) Ensure energy efficiency is prioritized (SHORT TERM)
11) The funding complexities at start-up could be eased if there was a basic Memorandum
of Understanding that assigned a matrix of funding available for the creation of Home
Care units e.g. "5+ Bachelor apartments with Home Care available will be awarded
$7,000 each for initial construction costs." Having such a commitment would encourage
easier facilitation of loans or grants for the builders and still allow the actual amount of
funding to be controlled with-in predetermined limits (INTERMEDIATE TERM)
GOAL 3: Innovative Health/Social Support Provision (Service Design and Delivery)
Goals for the development of innovative health and social supports in NE Ontario include:
-The development of effective, innovative and inclusive partnerships/networks that are
responsive and flexible in addressing client needs and apply a No Wrong Door
approach. These ‘Resource hubs’ should employ ‘best practice’ identification, capture
and communication of these practices. These groupings should be adequately
resourced and have skilled workers.
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-These organizations are oriented to providing early intervention/prevention (i.e.
assessment tool), provide appropriate transitional support, responsive crisis care and
use a ‘wrap around’, integrated care team approach/continuum of support
(prevention/early intervention to life skills to intensive care to crisis support).
-These organizations provide equal access to support services that provide accessible
and available support systems in all communities. They make effective use of
technology, 211 services and mobile options to address geographic, physical and
psychological isolation.
Objectives:
1)
Develop a system of support for social housing tenants/providers to allow streamlined
access to health and social services to allow them to remain in their homes (LONG TERM)
2)
Address collaboration with community partners and provincial ministries to reduce and
prevent homelessness amongst those transitioning from provincially funded institutions
and service systems, as appropriate to the local context (ONGOING; IMMEDIATE TERM)
3)
A System and Patient ‘navigator’ or a Transitional Support Worker approach should be
pilot tested between agencies providing services in housing, including First Nations and
Urban Indigenous organizations with a view to improving quick access to services for
clients and early resolution of issues clients face (SHORT TERM)
4)
Develop coordinated ‘success teams’ which could include housing, financial, health,
system navigation, employment or other support(s) to provide ‘wrap around’ service to
clients where warranted (SHORT TERM)
5) Where managed alcohol programs are implemented across the NE to deal with the
chronic homeless issue crossing over the housing and health continuum, the shelter
component be prioritized by the DSSABs and the City of Greater Sudbury, and the
supports funded by the NE LHIN (INTERMEDIATE TERM)
6) A Central Client Registry of persons requiring health or social supports and/or housing
should be established, using ‘best practice’ technology to maximize support and
minimize wait times (SHORT TERM)
7) Develop standardized data on clients. Develop a common intake form that identifies all
services a client is receiving. Work in collaboration with First Nations/Urban Indigenous
organizations to develop appropriate methods of data collection (SHORT TERM)
8) Enhance use of 211 system technology to provide coordinated and timely health and
social service information and referral (INTERMEDIATE TERM)
9) Mandate that front-line service and health care treatment promotes well-being by
ensuring all service providers are trained in human rights and Indigenous cultural
competency. Implement human-rights based frameworks that are incorporated in
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service delivery operations and audited regularly for compliance (INTERMEDIATE
TERM)
10) Support the training, hiring and promotion of service providers and health care
professionals who reflect the community they serve (INTERMEDIATE TERM)
GOAL 4: Innovative Leadership and Sponsorships
Funding should come with appropriate, flexible, objective oversight and advice and both the
funder and funded agencies should be accountable for monies spent. Funders/sponsors should
be pro-active, responsive and listen to community needs, engaging service providers, cultural
and Indigenous groups and clients. Funders/sponsors should promote integration, energy
efficiency and affordability of housing and/or supports. There should be ongoing engagement
with communities and local level partnerships should be encouraged. Finally, cultural
competency training should be promoted.
Objectives:
1) Intensify the link between housing and health and support services and continue the
work of the Expert Panel. The Expert Panel should meet annually and report to the NE
LHIN on action associated with this strategic plan. A ‘report card’ should be developed
to report results back to the community for transparency and accountability(IMMEDIATE
TERM)
2) Prioritize action for housing and health which supports Alternative Levels of Care
solutions. (ONGOING; SHORT TERM)
3) Pilot projects should be evaluated for Return on Investment and other objective
measures and if value is proven, longer term funding should be allocated. Pilot projects
should not exceed eighteen months (SHORT TERM)
4) Coordination, consultation and collaboration amongst DSSABs/CGS and the NE LHIN
should occur with respect to new capital housing considerations for investments and
LHIN considerations for supports for assisted living and/or other support services within
affected communities or client groups. LHIN contracts with existing service providers
should have built in mechanisms to allow collaboration between organizations and use
of collective resources is to be encouraged/incentivized (e.g. nursing, cafeteria,
maintenance, custodial, etc.) (INTERMEDIATE TERM)
5) Funding should be transferable between line items to achieve outcomes as identified in
work plans. Make Service Agreements more flexible, provide more flexibility to expend
funds (SHORT TERM)
6) Service providers should be allocated funds for longer than one year intervals in order to
leverage these funds by evidencing stability to enable housing and service development
in their areas (INTERMEDIATE TERM)
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7) Align service boundaries between health and social services to promote efficiencies in
service delivery for clients (INTERMEDIATE TERM)
8) Where the NE LHIN receives community investment dollars on an annual basis
a. 25% of the community funding envelope be allocated to supports and services
for vulnerable populations across the NE LHIN and half of those investments be
for services in the new builds in communities, with long term commitments to
housing providers.
b. New investments in supports be cognizant of the holistic needs of individuals
recognizing health, social, cultural and spiritual differences (INTERMEDIATE
TERM)
9) The NE LHIN educate service providers and front line staff on alternative support
services available to citizens within their communities with the purpose of assisting
vulnerable citizens transitioning to varying levels of support closest to home (SHORT
TERM)
10) Identify ways to reduce bureaucracy and develop a simplified regulatory framework
(INTERMEDIATE TERM)
11) Promote communication between NE LHIN, DSSABs, City of Greater Sudbury,
hospitals, housing providers and health and social service providers at the local level.
Develop clear lines of communication between those writing policies and those whose
work is governed by those policies. (SHORT TERM)
12) Ensure rural and urban differences are taken into account when planning expenditures
to ensure equity (LONG TERM)
13) Research and develop options between institutional care and home care. Fund pilot
projects that provide the most promise. (INTERMEDIATE TERM)
14) Fund a system ‘navigator’ pilot test across the NE LHIN catchment between agencies
providing service including First Nations and Urban Indigenous organizations to help
clients with a view to improving quick access to services for clients and early resolution
of issues clients face (SHORT TERM)
15) Where the ALC continues to pressure access to acute care services across the NE, a
commitment from the NE LHIN and health service providers needs to be given, in order
to:
a. Develop urgent priority wait lists for social housing for persons without shelter or with
inadequate shelter or supports prioritize individuals identified as ALC in hospital to
return to community via urgent local priority status for social housing, and provide NE
LHIN assistance for their personal care and support needs in that setting.
b. Consideration be given to determine what is required to assist individuals in ALC
who do not quality for social housing to be given incentive to move to non-subsidized
units in the community (SHORT TERM)
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16) Recognizing variability in eligibility for support care hours:
a. The Provincial Government permit equitable service level maximum for care
regardless of an individual’s type of residential setting.
b. The NE LHIN coordinate a regional policy discussion amongst sector leaders which
seeks equity and patient centred care regardless of the individual’s residential type by
December 31, 2016 and implemented before April1, 2017 (SHORT TERM)
17) The document, "Community Hubs in Ontario: A Strategic Framework & Action Plan"
suggested that an action item for removing barriers and creating incentives could be,
"Increase Local Health Integration Networks' capital approval authority for community
health projects." p. 38. This Provincial recommendation should be pursued as a method
of promoting and controlling more investment in supportive housing/ community and
health hubs creation (SHORT TERM)
18) The NE LHIN, CGS and DSSABs lead efforts for the continuation of the community
paramedicine program which supports individuals in their homes (INTERMEDIATE
TERM)
19) The NE LHIN establish a coordinated roster of college and university placements and
promote placements in the health and social services fields through the development of
partnerships via Memoranda of Understanding with post-secondary institutions to
address health professional capacity shortages.
20) The NE LHIN provincially escalate the importance of additional housing and health
investments as a means of keeping individuals in their homes longer which is in keeping
with the provincial directives for access to care close to home (Poverty Reduction
Strategy, Patients First, Policy Statement on Housing and Homelessness, etc.)
(ONGOING; SHORT TERM)
21) This document be sent to DSSABs and the City of Greater Sudbury (IMMEDIATE
TERM)
160
Conclusion
It is the Expert Panel’s hope that supports to housing will improve over the next three years.
This improvement will only occur if all stakeholders – the NE LHIN, DSSABs, CGS, Mental
Health and Addictions specialists, First Nations, urban Indigenous organizations, francophone
health providers, their respective associations and a host of others work together. .
As outlined in this plan, important next steps will include stakeholder review of the plan.
Following that a focused effort to prioritize and assign the objectives in order to ensure that the
plan is actionable and achievable needs to be undertaken.
The physical and mental well-being and sense of independence of citizens will improve and our
local communities will be stronger as a result of such effort. This collective effort will make for a
stronger and healthier Northern Ontario.
161
Appendix 1: Housing Expert Panel Member List
Name
Panelists
Title
Organization
1
Andrea Lee
Director of Rehabilitation and Community Care Program
Health Sciences North
2
Angele Desormeau
Executive Director
South Cochrane Addiction Services
3
Brian Marks
Director Housing Services
Cochrane DSSAB
4
Dan O'Mara
Retired CEO MICs
Retired
5
Don McBain
Executive Director
Ontario Aboriginal Housing Services
6
Gail Spencer
Homelessness Coordinator
City of Greater Sudbury
7
Gary Scripnick
Board Liaison
NE LHIN Board
8
Janice Bray
Manager of Housing and Community Services
Parry Sound DSSAB
9
Janice Newsome
Director of Planning, Town of Hearst
Secretary, Town of Hearst Non-Profit Housing Corp.
10
Jeff Barban
Service Manager
11
Jeff Perry
President
City of Sault Ste. Marie/District of SSM Social
Services Board
Perry + Perry Architects Inc.
12
Joe Bradbury
CAO
Nipissing District Social Services Admin. Board
13
Joe Dipietro
President
Autumnwood Mature Lifestyle Communities
14
Sharad Kerur
Executive Director
15
Kris Longston
Acting Manager, Community and Strategic Planning
The Ontario Non-Profit Housing Association
(ONPHA)
16
Lisa H. Meawasige
Mental Health Expert
Maamwesying North Shore CHS
17
Lyle Hall
Mayor
Mayor of Sundridge
18
Marion Quigley
CEO
Canadian Mental Health Association S/M
19
Marliese Gause
CEO
The Friends
20
Maury O'Neill
CEO
Economic Development Corporation of Wawa
21
Michael Cullen
Executive Director
United Way Sudbury & Nipissing Districts
22
Michel Mayer
Executive Director
Centre de santé communautaire de Sudbury Est
23
Padraic Taaffe
Support Services Manager
Service de santé de Chapleau Health Services
24
Tanya Nixon
Vice President - Mental Health
North Bay Regional Health Centre
Ex-Officio Members & Resources
25
Bill Bradica
Chief Administrative Officer
District of Thunder Bay SSAB
26
Catherine Matheson
Senior Director
NE LHIN
27
Chris Stewart
Expert Panel Coordinator/ Executive Coordinator
28
Cindy Couillard
Team Lead - Regional Housing Services
Northern Ontario Service Deliverers Association
(NOSDA)
North Municipal Service Office, MMAH
29
Denis Desmeules
Director of Housing Services
30
Ed Starr
Principal
SHS Consulting
31
Fern Dominelli
CEO Lead
NOSDA
32
Howie Wong
CEO
Housing Services Corp.
33
Jeff Kolibash
Affordable Housing Consultant
Canada Mortgage and Housing Corporation
34
Kate Fyfe
Senior Director
NE LHIN
35
Mike O’Shea
MHA Officer
NE LHIN
36
Siobhan Farrell
Senior Planning and Integration Consultant (MH and
Addiction Lead)
NW LHIN
162
Appendix 2
163
Acknowledgements
The Vulnerable Tenants Research Study was undertaken on behalf of NE LHIN in partnership Canadian
Mental Health Association Sudbury/Manitoulin, NOSDA, and Housing Services Corporation (HSC). We
would like to thank Marion Quigley, Chief Executive Director at CMHA Sudbury/Manitoulin, Karen
Henze, Manager of Community Development and Housing at CMHA Sudbury/Manitoulin, Mike O’Shea,
Senior Officer – Mental Health at the NE LHIN, Catherine Matheson, Senior Director, Health System
Transformation & Implementation at the NE LHIN, Chris Stewart, C.J. Stewart Consulting, as well the
members of the Northern Ontario Service Deliverers Association (NOSDA) - Expert Housing Panel for
their input and direction during the preparation of this report and throughout all research activities.
We would like to also thank local District Social Services Administration Boards (DSSAB)/ Consolidated
Municipal Service Managers (CMSM) for providing data on the supply and demand of social housing
across the study area and for their assistance in identifying and engaging local stakeholders.
We would also like to thank local housing providers and support service agency staff for completing our
study survey and attending focus groups. In particular, we would like to acknowledge and thank the
twenty social housing tenants who completed a tenant questionnaire and shared their experiences with
us.
Together, the experiences from this range of stakeholders coupled with other research activities has
contributed towards a better understanding of the support needs of tenants currently living within
social housing across the NE LHIN and provides a foundation for moving forward in developing a
coordinated service delivery model.
Thank-you.
164
1.0 Table of Contents
1.0
2.0
2.1
3.0
3.1
4.0
4.1
4.2
4.3
5.0
5.1
5.2
6.0
7.0
Table of Contents ........................................................................................................ 25
Background ................................................................................................................. 26
Innovative Housing and Health Strategic Models for North Eastern Ontario ............................... 27
Study Purpose and Approach ...................................................................................... 28
Study Approach ............................................................................................................................. 28
Context for Vulnerability within the NE LHIN .............................................................. 29
Demographics ................................................................................................................................ 29
Vulnerability .................................................................................................................................. 31
Summary ....................................................................................................................................... 35
Findings from the Literature........................................................................................ 35
Defining Vulnerability in Social Housing ........................................................................................ 35
Support Needs in Social Housing ................................................................................................... 35
What We Heard .......................................................................................................... 38
Social Housing Needs Analysis .................................................................................... 40
7.1 Introduction ................................................................................................................................... 40
7.2 Inventory of Social Housing ........................................................................................................... 41
7.2.1 Supply of Social Housing across NE LHIN ............................................................................... 41
7.2.2 Supply of Social Housing By Community ................................................................................ 43
7.2.3 Modified/ Accessible Units in the NE LHIN ............................................................................ 48
7.2.4 Rent Supplement Supportive Housing Units in the NE LHIN ................................................. 51
7.2.5 Waiting for Social Housing in the NE LHIN ............................................................................. 52
7.2.6 Waiting Lists By Community .................................................................................................. 53
7.3 Support Service Inventory ............................................................................................................. 57
7.3.1 Support Service Network in the NE LHIN ............................................................................... 58
7.4 Estimating Number of Vulnerable People in Social Housing ......................................................... 59
7.4.1 Vulnerable Tenants ................................................................................................................ 59
7.4.2 Tenants with a Serious and Persistent Mental Illness ........................................................... 60
7.4.3 Seniors Requiring Supports .................................................................................................... 60
7.4.4 Tenants with a Disability ........................................................................................................ 61
7.4.5 Summary of Vulnerable Persons Living in Social Housing across NE LHIN ............................ 62
7.5 Summary of Social Housing Needs Analysis .................................................................................. 63
8.0
8.1
8.2
8.3
Summary of Gaps and Opportunities .......................................................................... 64
Supports ........................................................................................................................................ 64
Housing .......................................................................................................................................... 65
Partnerships................................................................................................................................... 65
9.0 The Way Forward ........................................................................................................ 67
10.0 Bibliography ................................................................................................................ 70
11.0 Appendix A: Support Services by Area ........................................................................ 71
165
2.0 Background
Ontario’s social housing stock plays a particularly significant role in helping vulnerable individuals, such
as those with mental health and addictions challenges and the frail elderly, reduce the risk of poverty by
providing a stable, secure and affordable place to live. Across the province, aided by the Housing First
policy that is the foundation for most of the Ten Year Housing and Homelessness Plans developed by
Ontario’s 47 Service Managers and approved by the Ministry of Municipal Affairs and Housing, a
growing number of these individuals are being housed within social housing being operated by Local
Housing Corporations (which have Service Managers as their sole shareholder) and other social housing
providers, providing a crucial element towards the goal of poverty reduction among these segments of
the population.
At the same time, however, discussions with Service Managers and other housing providers have found
great concern across the province about the lack of supports for the growing number of vulnerable
individuals being housed within social housing portfolios. While the Housing First policy is strongly
supported and there is widespread agreement that social housing provides a critical foundation for
helping reduce poverty among these individuals, these providers are finding a widespread lack of
supports for addressing their needs. Staff responsible for operating social housing, such as property
managers and building superintendents, or volunteer boards themselves, are often left to try and cope
with meeting these needs; most are lacking in the required skills and resources and are not trained to
fulfill this role. This issue is being experienced not only among the mainstream population; Aboriginal
housing providers and agencies such as Ontario Aboriginal Housing Services are also finding similar
concerns within their social housing portfolios as well.
At the same time, the support system for these individuals consists of a “mishmash” of services,
programs and agencies. There is no dedicated funding for such services and no coordinated approach to
providing a consistent and effective level of support for these individuals.
To better understand the above concerns and to identify solutions, in June 2015, CMHA SudburyManitoulin submitted a proposal under the Ontario Local Poverty Reduction Fund. Funding from this
proposal was to be used to develop an innovative and coordinated service delivery model, or system, to
assist vulnerable individuals living in social housing to maintain their housing, thereby reducing the risk
of homelessness and improving housing security. While the submission was not successful in getting
funded, more recently, CMHA Sudbury-Manitoulin has been given the opportunity to work in
collaboration with the NE LHIN to conduct research that would help lay the foundation for the proposed
system; in particular conducting a needs analysis and capacity assessment of vulnerable tenants living
within social housing across the NE LHIN. This research would then form the foundation of a more wellinformed submission to the Poverty Reduction Fund for the funding to move ahead with development of
an effective support system across the NE LHIN service area.
166
2.1 Innovative Housing and Health Strategic Models for
North Eastern Ontario
Further to the above context, the NE LHIN has created an expert housing panel under the guidance of
the Northern Ontario Service Deliverers Association (NOSDA) to create a strategy entitled: Innovative
Housing and Health Strategic Models for North Eastern Ontario. This initiative stems from the NE LHIN
2016-2019 Strategic Plan and the commitment to building a better future for housing and health across
communities,
The Northern Ontario Service Deliverers Association (NOSDA) is an incorporated body of Service
Managers in Northern Ontario who are responsible for local planning, coordination and delivery of a
range of local health and social services. The Panel includes representation from housing, health,
private, public, and not-for-profit organizations at the senor administration level.
The strategic plan was initiated in in February 2016 with a housing forum held in June 2016. The
strategic plan will be completed and presented to the NE LHIN Board in September 2016. The research
and findings conducted as part of this study – Vulnerable Tenants Research Study – will inform direction
of the strategic plan.
167
3.0 Study Purpose and Approach
The purpose of this study is to create an improved understanding of the support service needs of
vulnerable persons living in social housing, and to evaluate these needs within the current capacity of
housing providers and support agencies. Ultimately, it is the goal of this research study to identify
opportunities for a regional approach to meeting the support service needs of vulnerable persons living
within social housing across the NE LHIN.
To realize this, the study aims to achieve the following objectives:
1. To identify the current support needs of vulnerable persons living in social housing within the NE
LHIN service area
2. To identify the current capacity for meeting the identified needs
3. To conduct a gap analysis
4. To recommend a methodology for the development of a service delivery system, aimed at
maintaining housing for vulnerable tenants, that would form the basis of a revised funding
submission to the Poverty Reduction Fund
3.1 Study Approach
In order to achieve the above objectives, a number of activities were undertaken as part of this
research study. These include:
Scan of the
Literature
Stakeholder
Engagement
Gap Analysis
•Defining
•Inventory of social
vulnerability
housing
•Vulnerability across •Estimates of
the NE LHIN
vulnerable
population
•Support needs in
social housing
•Inventory of
support services
•Study team
•Focus groups
•Surveys
•Think Tank
•Interviews
Research
Report
•Recommendations
on potential service
delivery system
•Poverty Reduction
Funding Submission
The following sections will present a summary of the above initiatives and outline the key
findings in understanding the support needs of vulnerable people currently living within social
housing across the NE LHIN. Following this summary, a series of recommendations are put
forth for consideration in moving forward in creating a regional service delivery system.
168
4.0 Context for Vulnerability within the NE LHIN
This section introduces the North East LHIN (NE LHIN) in terms of its geography and population
distribution and sets out the context for vulnerability within the NE LHIN service area.
4.1 Demographics
The NE LHIN is divided into five Hub Regions: Sudbury, Manitoulin & Parry Sound, Algoma, NipissingTemiskaming and the James and Hudson Bay Coasts. These are shown below, in a map prepared by the
NE LHIN.
As pictured in grey in the map below, the NE LHIN is bordered immediately to the south by the North
Simcoe-Muskoka LHIN, and to the west by the Northwest LHIN.
In terms of population distribution, the LHIN’s 2013-2016 Integrated Health Services Plan provides the
following breakdown by hub region using data from the 2011 National Household Survey:
Table 1: Population of NE LHIN Hub Planning Areas, Statistics Canada (2011)
Hub Planning Area
Total Population
Algoma
115,870
Cochrane
76,856
James Bay & Hudson Bay Coasts
6,213
Nipissing & Temiskaming
117,370
Sudbury, Manitoulin & Parry Sound
236,782
NE LHIN Region
553,091
% of NE LHIN
20.95
13.90
1.12
21.22
42.81
100
Important to note is that approximately 9.5% of the LHIN’s population identifies as Aboriginal / First
Nations / Metis and over 100,000 residents are seniors aged 65+ years. North Eastern Ontario is aging
much quicker than the Province of Ontario, overall.
169
Figure 1: Map of the North East LHIN by Hub Region
The Sudbury-Manitoulin & Parry Sound District is the largest hub region; about twice the size of
Nipissing & Temiskaming, which is second largest, followed closely by Algoma. It should be noted that,
due to challenges counting on-reserve First Nations populations, the population of the Coasts may be
under-estimated here; by our estimates the First Nation population in the Coasts hub region is closer to
10,000. Of the southern hub regions in the NE LHIN, Cochrane is by far the smallest, with Timmins, the
hub’s Census Metropolitan Area, and comprising over 43,000 people. The table below compares the
population of the four largest hub regions to the population of the largest urban centres within each, to
illustrate the size of the population that is more remote.
170
Table 2: Population of NE LHIN Hub Planning Areas Compared to Largest Urban Centres, Statistics
Canada (2011)
Hub Planning
Area
Algoma
Cochrane
Nipissing &
Temiskaming
Sudbury,
Manitoulin &
Parry Sound
Total
Population
115,870
76,856
117,370
236,782
Largest Urban Centre
Name
Population
Sault Ste.
75,141
Marie
Timmins
43,165
North Bay
64,043
Greater
Sudbury
160,275
Population Residing Outside
Number
Percent
40,729
35%
33,691
53,327
44%
45%
76,507
32%
It is noted that the boundaries of the NE LHIN’s hub regions do not correspond to boundaries used by
Statistics Canada in collecting and analyzing Census data, nor do they correspond to provincial
boundaries used to delineate catchment areas for District Social Services Administration Boards and
Consolidated Municipal Service Managers, or Public Health Units. As such, roles and responsibilities for
regional health, housing and social services administration are assigned to different geographic areas.
4.2 Vulnerability
There is a long-established link between the experience of poverty and vulnerability to poor health
outcomes, given that individuals and families living in poverty are likely to be exposed to multiple risk
factors, as noted above. This may be referred to as “multi-vulnerability.”
The concept of “multi-vulnerability” is important to understand in order to identify who is most
vulnerable; whether in the NE LHIN, or any context.
The University of California San Francisco’s Center for Vulnerable Populations at San Francisco General
Hospital refers to vulnerable populations as those “for whom social conditions often conspire to both
promote various chronic diseases and make their management more challenging.”4 This approach
highlights the direct link between multi-vulnerability and multi-morbidity (i.e. multiple chronic
conditions). More than one-in-five of residents of the NE LHIN have been diagnosed with multiple
chronic conditions, compared to 15% in the Province, overall.
Similarly, BMC Health Services Research completed a scoping review in 2013 that looked at the
interrelationship between multiple vulnerability factors and health care disparities. They found that
“high levels of vulnerability (due to the co-existence of multiple vulnerability aspects) would increase
health care needs and would be associated to lower health care accessibility and quality.” The study’s
authors point out that these studies are consistent with the findings of other similar studies completed
in the Canadian context.
Both sources point to the intersection not only between multi-vulnerability and negative health
4
https://cvp.ucsf.edu/about/
171
outcomes, but also to experiencing greater difficulty in managing those outcomes. This helps to explain
the depth of vulnerability in rural, remote and northern communities where local populations not only
tend to experience a lack of access to education and income-earning opportunities, but also lack of
access to health and social care.
As noted in the following chapter of the report, the literature points to particular population sub-groups
as being among the most vulnerable. In the context of the North East LHIN, the following groups are
likely to be among the most significant vulnerable groups, by population count:







Aboriginal, First Nations and Metis
Lone Parent Families
Seniors with Support Needs
Individuals with a Disability
Individuals with Serious and Persistent Mental Illness
Middle Aged Caucasian Men at Risk of Suicide
Immigrants and Racialized Groups
The table below estimates the overall population of these vulnerable groups within the NE LHIN, and
ranks the four hub regions in terms of where the populations are most and least concentrated. Please
note that since data is not available through Statistics Canada by the LHIN’s hub regions, we have sought
data at the District level. For data collection purposes, the Districts included: Sudbury, Greater Sudbury,
Parry Sound (Sudbury, Manitoulin & Parry Sound); Nipissing (Nipissing-Temiskaming); Algoma;
Cochrane; and, Kenora – Unorganized (includes the Coasts).
This data provides a picture of the relative size of vulnerable population groups in each of the LHIN’s hub
regions, despite small differences due to the difference in geographic boundaries.
Table 3: Estimated Size of Vulnerable Groups in the NE LHIN
Population Group
Estimated Size
Aboriginal / First Nations / Metis
(includes on and off reserve)
63,277
Lone Parent Families
(Including both Female and Male-Led Lone Parent
Families)
21,220
Community Ranking
Number
 Sudbury, Manitoulin &
Parry Sound
 Algoma
 Coasts
 Cochrane
 Nipissing &
Temiskaming
Parry Sound
 Algoma
 Nipissing &
Temiskaming
 Cochrane
 Coasts
172
Population Group
Seniors with Support Needs
(15%-18% of seniors; use 16.5% of ~100,000)5
Estimated Size
16,500
Individuals with a Life-Limiting Disability
(15.4% of all Ontarians)6
86,702
Individuals with Serious and Persistent Mental
Illness
(3% of all Canadians)7
16,890
Middle-Aged Caucasian Men at Risk of Suicide
(26.3 per 100,000 men in their 50’s)8
10
Immigrants and Racialized Groups
1,655
Community Ranking
Parry Sound
 Nipissing &
Temiskaming
 Algoma
 Cochrane
 Coasts
Parry Sound
 Nipissing &
Temiskaming
 Algoma
 Cochrane
 Coasts
Parry Sound
 Nipissing &
Temiskaming
 Algoma
 Cochrane
 Coasts
Parry Sound
 Algoma
 Cochrane
 Nipissing &
Temiskaming
 Coasts
Parry Sound
 Algoma
 Nipissing &
Temiskaming
 Cochrane
 Coasts
The table above demonstrates that, by the numbers, the greatest numbers of vulnerable people reside in
the Sudbury, Manitoulin & Parry Sound hub region. Given that this hub region is, by far, the largest of the
five, this is to be expected. However, there is some variation; particularly in terms of the numbers of
Aboriginal / First Nations / Metis people and lone parent families, which are found in greater numbers in
5
O’Keefe
Canadian Disability Survey (2012)
7
ONPHA (2015)
8
http://www.cbc.ca/news/health/suicide-men-50s-causes-1.3263412
6
173
Algoma than in Nipissing-Temiskaming, although the latter has a larger total population. It is also
important to note the size of the Aboriginal / First Nations / Metis population in the Coasts, which is
relatively large in terms of both number and proportion given the size of the hub region’s total population.
It is also worth noting that while the number of men at risk of suicide may appear low, the estimate only
considers the risk of suicide among men in their 50’s, while research suggests that men in their 40’s and
also senior men in their 80’s are also at a heightened risk. Moreover, the proxy measure employed is
based on national statistics, which do not consider risk factors that may be more pronounced locally,
such as the relatively low educational attainment, higher rate of unemployment and low income and
more common use of substances in rural areas, which comprise over half of the NE LHIN region. That is
to say that the number of Caucasian men at risk of suicide in the NE LHIN may be higher than 10, given
the influence of local risk factors.
Finally, while the number of immigrants and racialized groups may appear small, there is a trend of
diversification in the NE LHIN that decision-makers should consider. Research on rural health outcomes
in Canada has found a link between areas where immigrants comprise over 5% of the local population to
poorer overall health outcomes. Recently, the NE LHIN, and other regions in Canada, welcomed a
number of Syrian refugees, including a single mother with nine children.9
Some of these same estimates have been prepared to determine the size of the vulnerable population
residing in social housing in the NE LHIN. These findings are presented in Section 6.4.5 of this report.
Background Report Two: Assessing Vulnerability in the NE LHIN further examines other elements of
multi-vulnerability including the co-occurrence of housing issues with other risk factors, relative
deprivation, and access to health and social care.
Some key findings include:






9
Individuals experiencing housing issues, such as homelessness, also have multiple co-occurring
issues, such as mental health issues, alcohol use, physical health needs, challenges meeting their
basic needs, drug use, anti-social / negative behaviour, and risk of suicide or criminal
involvement, which place their overall health and wellbeing at risk.
Results from the provincial Deprivation Index highlight that areas within the NE LHIN are among
the most deprived in the province.
Challenges to meeting the health and social care needs of residents in the NE LHIN are
compounded by the fact that the out-migration of young people appears to have destabilized
the base of traditional informal caregivers in rural and remote communities.
Consultation results point to caregiver burnout as a key driver of admissions to hospital, and a
lack of appropriate community care options for persons with complex needs create challenges in
discharging from hospital.
Data on the number of missed shifts by CCAC practice area shows that of all missed shifts
reported in the large communities of the NE LHIN, 94% were by personal support workers.
In many cases over one-third of all hospital days are dedicated to ALC in both 2014 and 2015.
https://www.baytoday.ca/local-news/new-refugee-family-coming-to-north-bay-268654
174
4.3 Summary
Overall, there are many vulnerable populations in the NE LHIN who are at risk of suffering poor health
outcomes and, at the same time, likely to experience difficulty managing those outcomes.
Findings from research activities suggest that there is a need to enhance home and community care across
the NE LHIN, including increasing access to in-home services and expanding the supply of specialized
supportive housing that provides long-term term, flexible and, when necessary, more intensive supports to
particular population groups who may not be appropriate to long-term care homes. Currently, it appears
that there are significant populations of vulnerable groups suffering from multi-vulnerability whose unmet
needs many not only create a risk for poor health outcomes and potentially avoidable health crises, but
also lead to loss of housing, frequent use of emergency services, caregiver burnout and premature
admission to long-term care homes, which may or may not be a good fit.
5.0 Findings from the Literature
The literature scan is aimed at providing a greater understanding of the needs, issues and gaps of
vulnerable tenants living in social housing with a particular focus on mental health and senior support
services needed to help maintain successful tenancies.
The review is based on online resources from educational institutions, health care agencies, government
bodies, support services agencies and community organizations.
The following section presents a summary of the findings from the literature scan. A full report is
available as a separate document: Background Report One: Literature Scan.
5.1 Defining Vulnerability in Social Housing
Based on a brief scan of available literature, vulnerability is a dynamic term that tends to be used in
reference to particular population groups who, due to their exposure to one or more risk factors, are
predisposed to adverse social, economic and/or health outcomes; sometimes in the context of a
particular set of circumstances. For the purposes of this research study the following definition from the
Ontario Non-Profit Housing Association (2015) is most applicable:
“Anyone who needs additional support – for any reason – to maintain a successful tenancy.
Tenants may be, or may become, vulnerable because of a mental or physical illness or disability,
an addiction, trauma, dislocation, isolation, experience of violence or a history of homelessness or
institutionalization. A tenant’s need for support may be episodic or increase or decrease over time,
and may be exacerbated by the absence of support or a reluctance to accept support when
offered.”
5.2 Support Needs in Social Housing
The following section provides an overview of key findings from the literature review. Findings are
organized by research topic and are aimed at identifying particular needs of various population groups.
175
Social Housing and Mental Health
For individuals living in social housing and suffering from mental health illness, there is a gap in the
availability, consistency and coordination of health services. There is a need for a clear understanding of
roles in the provision of housing and the related support services. It is important that housing staff are
adequately trained with the sensitivity, support and skills needed to deal with tenants suffering from a
mental illness. There is a need to redefine the basket of services to address the range of determinants of
health. A holistic basket of service will include services in 3 key areas: housing, clinical and peer
supports. Sub-populations with mental health challenges living in social housing that are underserved
include individuals with concurrent disorders, people with dual diagnoses, young adults under the age of
24, and immigrants.
There are areas of opportunity to address these gaps and needs. The introduction of on-site supports in
housing may be beneficial in buildings with a high number of vulnerable tenants. Front line staff and
tenants could be trained to spot emerging problems. Certain tenants require individualized and intensive
supports. A peer-based support system in partnership with mental health agencies could be introduced.
There is an idea to delink support services from housing to permit the flow of people through the housing
system and meet the changing level of support need. Three levels of prevention were identified, (1)
community building (2) identify & address problems immediately (3) provide on-going support for tenant
needs. An area of opportunity from a different angle is to address not only the needs of individuals
suffering from the effects of mental illness, but neighbours and staff who suffer the effects as well.
Seniors in Social Housing
From the literature scan it was revealed that seniors living in social housing face several barriers. There
are built form challenges because the aging social housing building stock cannot easily accommodate
modifications for accessibility. The community environment is a barrier because seniors feel unsafe in
mixed-age buildings, the sites are not pedestrian friendly, and the lack of amenities nearby leads to
social isolation. Seniors have increased support needs and are underserved. Forty-one percent (41%) of
seniors with disabilities reported either not receiving the help they needed or need more. They are likely
to live alone without the support of informal caregivers and no one to help them with medication,
meals, exercise, or to recognize mental health challenges. Factors such as physical barriers, low-income,
living alone, chronic health needs, and feeling unsafe in the building can lead to social isolation; and the
lack of a supportive social network can lead to dementia and cognitive-health decline.
Aboriginal / First Nation / Metis Populations in Social Housing
Aboriginal, First Nation and Metis populations face higher rates of chronic diseases, co-morbidity, lower
life expectancy, higher infant mortality, greater incidences of suicide, and higher rates of infectious
diseases. This population group is nearly twice as likely to be living on low income, resulting in higher
rates of diabetes, arthritis and chronic health conditions. The high rate of chronic diseases has led to
faster aging; therefore, care needs to be extended to this younger group of older adults.
Aboriginal women are nearly three times more likely than non-Aboriginal women to report being victims
of a violent crime. Women fleeing abuse and trauma can serve as indicators of vulnerability in social
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housing. Aboriginal, First Nation and Metis populations have unique cultural needs that need to be
targeted through linguistically and culturally appropriate health care services, and partnering with
Aboriginal health service providers.
Northern, Rural and Remote Communities
Northern, rural and remote communities experience increased physical, mental health and addictions
issues and have a higher rate of individuals with complex care needs compared to the rest of Ontario.
There are fewer health professionals per capita in Northern communities and the population is
underserved by family physicians. As a result, diagnoses of mental health issues may go untreated.
Remote housing providers highlighted the need for (1) adequate staff training and (2) identification of
lead agencies to address housing and support needs. They also identified the following barriers that
prevent people from accessing support needs which contributes to housing instability:








Existing service models do not meet aging needs
Existing service models do not meet youth-specific needs
Lack of transition aged youth services
Criminal justice support needs
Culture and gender specific needs
Non-existent inter agency partnerships
Insufficient staff training /skill level
Fragmentation of service delivery systems
Areas of opportunity for Northern, rural and remote communities include making effective use of
technology and implementing a Tele-Mental Health initiative.
Lesbian, Gay, Bisexual and Transgendered (LGBT) Communities
There are steps that can be taken to provide the LGBT community with an inclusive living environment
in social housing. It is key to adopt a comprehensive approach to promote and implement inclusivity. A
comprehensive approach will include elements such as: providing LGBT sensitivity training for staff;
having a paid staff member mandated to address the needs of LGBT tenants; including visual
affirmations of LGBT presence; outreaching to the LGBT community to enrich programming; ensuring
language used in all communications is inclusive; having inclusive hiring policies; and engaging in
networking and information sharing.
A point of contention in addressing this unique community’s needs is that LGBT initiatives are usually
geared towards lesbian women and/or gay men. Bisexual and transgendered residents are often
overlooked. It is important to ensure that the concerns and aspirations of LGBT residents are heard and
responded to.
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6.0 What We Heard
Understanding the opportunities and priorities to better meet the needs of vulnerable tenants requires
the perspective of stakeholders who connect with residents and families on a regular, sometimes daily,
basis. As part of this study, a number of community engagement initiatives were undertaken. Inperson focus groups with both housing providers and support service agencies were held in Sault Ste.
Marie, Sudbury, North Bay, and Parry Sound10. In addition, two online (web-based) focus groups were
held with stakeholders in the Cochrane District. Overall 10 focus groups were held and two
supplemental interviews. Forty housing providers and 59 support service agencies participated in focus
groups.
Given the vast geography of the research study area, questionnaires were also used in an effort to
gather input from a broader range of housing providers and support agencies across the NE LHIN. In
total 281 surveys were distributed across the area. Forty-seven housing providers and 51 support
service agencies completed a survey.
To supplement these surveys, a third questionnaire aimed at social housing tenants was created and
distributed through the local DSSAB/Service Managers. In total 20 tenant surveys were completed and
submitted. While this is not nearly representative of the approximate 20,000 individuals living in social
housing across the NE LHIN, the aim of the questionnaire was to hear from people living in social
housing on where they felt the opportunities existed to better support tenants.
A summary of findings from all of the above-mentioned activities is described in detail within
Background Report Three: “What We Heard” Consultation Summary Report. This report provides a
summary of results by consultation activity, by stakeholder group, and by area.
A number of key issues, challenges and opportunities were identified by stakeholders throughout the
consultation activities. These are summarized below.
Rental Arrears and Hoarding Identified as Top Reason for Evictions
Rental arrears was identified by all stakeholder groups as the main reason for eviction or risk of eviction.
Mental health and addiction challenges were also emphasized by both housing providers and support
service agencies. Hoarding was a particular challenge identified putting tenants at risk of eviction.
Housing Providers Often Find Themselves in Role of Support Provider or Advocate
There are growing concerns about the number of individuals housed in social housing who need support services.
Housing providers/landlords and volunteer staff often find they are in the position of first responder to tenants in
need of assistance or in crisis, and typically do not have the resources or skills to meet these needs.
Some Tenants Do Not Want Assistance, Even if Needed
A particular challenge within social housing communities, is that a need for support might be identified
but some tenants do not want support. This puts landlords in a particularly difficult situation and
several stakeholders, housing providers and support service agencies, expressed that there is little they
can do to help.
10
Of note, the Parry Sound session was a combined group of both housing providers and support service agencies.
178
More ‘Life Skills’ Support Needed
All stakeholder groups identified the need for more support with life skills (i.e. budgeting, cooking,
housekeeping). Many times tenants are living on their own for the first time and have not developed
the skills needed to live independently.
More Housing Options Identified as a Priority
In general, stakeholders expressed the need for more affordable housing options across the NE LHIN.
Several stakeholders noted that while ‘new’ social housing units would be helpful so would having
portable rent subsidies. Accessible housing was also identified as a need.
Other housing forms, such as supportive housing models including models with 24 hour support, were
identified as a need in many communities.
Need for Early Intervention
Several stakeholders expressed that early intervention with tenants can be critical. It was suggested
that some form of centralized assessment tool or mechanism could be really helpful. The tool or
mechanism would evaluate life skills, mental health, physical health and social support needs. Some
suggested that an access point could be at the time of the housing application.
Partnerships Exist But Greater Collaboration and Coordination Needed
While several partnerships are in place and many are working successfully to better meet the needs of
residents, stakeholders expressed the need for more coordinated work, more sharing of ideas, and more
awareness of the partners and stakeholders in the ‘system’.
Stakeholders also identified that partnerships and coordination of services should be broad and include
a full range of support agencies/staff including primary care, hospitals, para-medicine, community
agencies, housing providers, and informal support networks.
Not Enough Support for Persons in Crisis
Although early intervention is identified by stakeholders as a strategy to reducing the number of people in
crisis, there is still a strong need for more support persons for individuals in crisis. Stakeholders also
emphasized that recruiting, training and maintaining staff with specialized training is essential.
More Support for Persons with Mental Health and Addiction Challenges
Persons with mental health and addiction issues were identified as a key population in need of more
support. Stakeholders acknowledge that there are good supports available such as ACT but often this is
not enough and is not available in all communities.
Persons with dementia was also identified as a specific population where it can be difficult to get the
supports needed within social housing.
Inequality of Access to Support Services across NE LHIN
The geography of the NE LHIN is vast and includes large urban centres, small urban centres, rural and remote
communities. This presents a particular challenge in the delivery of support services. Several stakeholders in
remote areas expressed that support services, such as in-home care, are simply unavailable, delivery is inconsistent,
179
or they have to ‘fight’ to get them. Other stakeholders expressed feeling ‘underserved’ in their community.
Greater “Access” and “Presence” of Support Staff Fundamental
Several stakeholders emphasized that having better access to support services can have a very positive
impact on maintaining successfully tenancies by getting people connected to the right supports at the
right time. Greater presence of support agencies on site was also seen as positive in getting people
more involved in their community and supporting one another.
More Coordination with Hospitals Identified as Priority
Tenants being discharged by hospitals back to social housing was a critical issue identified by many
stakeholders, both housing providers and support service agencies. Often support services needed,
upon release from hospital, to support tenants’ transition back to home are not in place. Stakeholders
also emphasized the need for better communication between housing providers, support agencies, and
hospital staff.
Lack of Family Support and Need for “One Person for Everyone”
Lack of family support, or the support of an informal (i.e. unpaid) caregiver was seen as one of the
greatest risks for people living alone in social housing (or housing in general). If there is no formal
support in place, and no advocate for the tenant, often needs can go unnoticed and a person’s health
and well-being deteriorate. Isolation was identified as a particular challenge for many tenants.
This need for informal support was emphasized in the tenant survey results, where most respondents
(16) identified family as part of their support network. Many also noted friends and neighbours.
One of the largest priorities identified by participants is the need for tenant navigators, advocators or
‘success teams’. Having “someone for everyone” was a key message to preventing evictions, and
improving the overall health and well-being of tenants. The tenant navigator/success team would assist
tenants in identifying and accessing support services, assisting with life skill development as appropriate
and simply being a ‘go to person’ for a tenant. Participants further described ‘success teams’ as helping
connect landlords with support services and conducting assessments to best determine supports
needed by tenants.
7.0 Social Housing Needs Analysis
7.1 Introduction
Social housing plays an important role maintaining healthy communities. It provides affordable rental
housing for low to moderate income families who are otherwise unable to afford housing in the private
rental market. Rents are typically set at 30% of gross household income (rent-geared-to-income (RGI)
housing) or market rent – whichever is lower.
The following sections provide a summary of the inventory of social housing across the NE LHIN as well
as the inventory of support service agencies across the NE LHIN. Following these inventories, an analysis
of the number of vulnerable people living in social housing across the NE LHIN is presented.
180
7.2 Inventory of Social Housing
This section of the report focuses on the supply and demand of social housing in the North East Local
Health Integration Network (NE LHIN) area. Data was collected from current reports, local housing and
homelessness plans and local District Social Services Administration Boards and Service Managers. The
inventory focuses on the number of social housing units by size and mandate.
Data was collected for the following 8 service managers within the NE LHIN study area:
1)
2)
3)
4)
5)
6)
7)
8)
Algoma District Services Administration Board
Cochrane District Social Services Administration Board
Manitoulin-Sudbury District Services Board
District of Nipissing Social Services Administration Board
Parry Sound District Social Services Administration Board
District of Sault Ste. Marie Social Services Administration Board
City of Greater Sudbury Consolidated Municipal Service Manager
District of Temiskaming Social Services Administration Board
7.2.1 Supply of Social Housing across NE LHIN
The total number of social housing units for each service area is based on information provided in
housing and homelessness plans. Where housing plans were not available, counts were taken from
social housing registration forms and websites.
The total supply of social housing in the NE LHIN is 14,154units11. Over one-third of the supply is
located in the City of Greater Sudbury (34.3%). Sault Ste. Marie (17.2%), Cochrane (16.3%), and Nipissing
(16.1%) each have about half of the proportion found in the City of Greater Sudbury. Temiskaming
(6.0%), Algoma (4.0%), Manitoulin-Sudbury (3.2%), and Parry Sound (2.8%) each have less than 10% of
the total social housing stock and the fewest amount of units.
The findings are generally consistent with population distribution across the NE LHIN. SudburyManitoulin (6.7%) and Algoma (7.9%) have a slightly higher proportion of social housing units when
considering the proportion of total population for the NE LHIN while Parry Sound (1.1%) and Sault Ste.
Marie (14.6%) have a slightly lower (1.1%) proportion.
11
Based on total counts provided in area housing and homelessness plans, housing reports/documents, or
provided directly by area DSSABs/Service Managers where available.
181
Figure 2: Total Number of Social Housing Units by Service Area; NE LHIN, 2016
4,859
2,430
2,310
2,285
571
453
396
Timiskaming
Algoma
ManitoulinSudbury
Parry Sound
Nipissing
Cochrane
Sault Ste.
Marie
Greater
Sudbury
850
Sources: ADSAB Housing and Homelessness Plan, 2013; Cochrane DSSAB Community Profile Data Report, 2014; City of Greater
Sudbury, 2016 (Email Reply); MSDSB Revised 10-Year Housing and Homelessness Plan, 2014; MSDSB Subsidized Housing Providers;
DNSSAB Putting People First: 10-year Housing & Homelessness Plan - Current Housing Supply in Nipissing District. Sub Report #5,
2013; DPSSSAB Application for Rental Accommodation, 2012; District of Parry Sound Housing and Homelessness Plan, 2013;
DSSMSSAB Housing and Homelessness Plan Update, 2014; Source: DTSSAB Your Guide to Rent Geared to Income Housing, 2011
Close to half of the social housing units in the NE LHIN have an ‘all’ or ‘mixed’ mandate (44.9%). More
than a quarter of the units are mandated for seniors only (27.3%), followed by family housing (23.4%). A
small proportion of the housing is designated Natives and/or Aboriginals (4.5%). A small proportion of all
social housing units have been modified to be accessible.
Figure 3: Estimated Proportions of Social Housing Units by Mandate; NE LHIN, 2016
Native/
Aboriginal
4.5%
Family
23.4%
All/Mixed
44.9%
Senior
27.3%
Sources: ADSAB Project Listings Update Form, 2016; ADSAB Housing Unit Locations, Accessed March 26, 2016:
http://www.adsab.on.ca/en/social-services/housing/housing-unit-locations/; CDSSAB Application for Housing, 2012; City of Greater
Sudbury Application for Rent Geared to Income Assistance, 2015; City of Greater Sudbury, 2016; MSDSB Subsidized Housing Providers;
MSDSB Revised 10-Year Housing and Homelessness Plan, 2014; MSDB Social Housing Locations, Accessed March 25, 2016:
http://www.msdsb.net/sh-housing-locations; MSDSB Subsidized Housing Providers; MSDSB Revised 10-Year Housing and Homelessness
Plan, 2014; MSDB Social Housing Locations, Accessed March 25, 2016: http://www.msdsb.net/sh-housing-locations; Nipissing District 10Year Housing and Homelessness Plan, 2013; DPSSSAB Application for Rental Accommodation, 2012; DPSSSAB Summary Chart of Housing
Providers in the District; DPSSSAB Details of Housing Units in the Service Area; DSSMSSAB, 2016; DSSMSSAB Housing Application Package,
2015; DSSMSSAB Rental Locations, Accessed: March 27, 2016: http://www.ssm-dssab.ca/HousingProviders/index.cfm; DTSSAB, 2016;
DTSSAB Your Guide to Rent Geared to Income Housing, 2011
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7.2.2 Supply of Social Housing By Community
The supply of social housing by mandate is estimated using information provided on District Social
Services Administration Board/ social housing websites, RGI application documents and information
from housing providers. The social housing unit counts by mandate differ from the total amounts
provided in the various housing and homelessness plans, generally due to variations in the type of unit
recorded by different providers (i.e. Investment in Affordable Housing Program units, rent supplement
units, Aboriginal/Native housing portfolio).
Algoma
About two-thirds of the social housing stock in Algoma is mandated as mixed for singles & couples
(29.8%) and singles & families (29.7%). A small proportion of housing is dedicated for seniors (13.9%)
and an even smaller proportion for Native Housing (3.9%).
Table 4: Estimated Number of Social Housing Units by Mandate; Algoma, 2016
Number of Units
Proportion of Total
Units
Single / Couple
182
29.8%
Single / Family
181
29.7%
Family
138
22.6%
Senior
85
13.9%
Native Housing
24
3.9%
Mandate
Total
610
Source: ADSAB Project Listings Update Form, 2016; ADSAB Housing Unit Locations, Accessed March 26, 2016:
http://www.adsab.on.ca/en/social-services/housing/housing-unit-locations/
The number of units by bedroom size was not reported by all housing providers and therefore has not
been reported.
Cochrane
Nearly half of the social housing stock in Cochrane has a mixed mandate for families & singles (45.9%).
This is followed by a mixed mandate for seniors & singles (26.6%), and seniors-only units (21.1%). A
small proportion of units are for Native families (4.3%). Cochrane is the only service area to specifically
mandate units as supportive/accessible. There are a total of 48 social housing units dedicated for those
with supportive and/or accessibility needs, which make up 2.1% of Cochrane’s social housing supply.
Other units within the portfolio have been modified to be accessible as well.
The number of units by bedroom size was not available.
183
Table 5: Estimated Number of Social Housing Units by Mandate; Cochrane, 2012
Number of Units
Proportion of Total
Units
Family / Single
1,069
45.9%
Senior / Single
620
26.6%
Senior
492
21.1%
Native
100
4.3%
Supportive / Accessible
48
2.1%
Mandate
Total
2,329
Source: CDSSAB Application for Housing, 2012
The City of Greater Sudbury has a greater proportion of its social housing stock mandated for families
(36.8%). This is followed by a mixed mandate for seniors, couples & singles (24.4%), seniors-only
(19.2%), all household types (17.5%) and lastly Aboriginals (2.0%).
Table 6: Estimated Number of Social Housing Units by Mandate; City of Greater Sudbury, 2016
Number of Units
Proportion of Total
Units
Family
1,690
36.8%
Seniors / Couples / Singles
1,123
24.4%
Seniors
884
19.2%
All
806
17.5%
Aboriginal
93
2.0%
Mandate
Total
4,596
Source: Application for Rent Geared to Income Assistance, 2015; City of Greater Sudbury, 2016
The City of Greater Sudbury reported a total of 4,859 social housing units within the service area. Unit
sizes were not available for the 59 rent supplement units and are therefore removed from the unit size
break down.
The remaining 4,800 units range in size from bachelor to five-bedroom units. Close to half of the units
are one-bedrooms (46.3%). A quarter of the units are two-bedrooms (25.1%); followed by threebedrooms (22.6%). A small proportion of the social housing stock is made up of four-bedroom (4.1%),
five-bedroom (1.0%), and bachelor (0.9%) units.
184
Figure 4: Proportion of Social Housing Units by Bedroom Size; City of Greater Sudbury, 2016
4 BR
4.1%
5 BR
1.0%
Bachelor
0.9%
3 BR
22.6%
1 BR
46.3%
2 BR
25.1%
Source: City of Greater Sudbury, 2016
Manitoulin-Sudbury
There are a total of 453 social housing units in Manitoulin-Sudbury. Over half of the units are mandated
for “all ages” (55.6%). These units are made up of one-bedroom (246 units) and bachelor (6 units)
apartments. Seniors-only housing makes up 19.9% of the social housing stock; followed by
Aboriginal/Native housing at 16.6%. Family units make up the smallest proportion of all household types
at 7.9%. Family units have two-, three- and four-bedroom sized units.
Table 7: Number of Social Housing Units by Mandate; Manitoulin - Sudbury, 2016
Mandate
Number of Units
Proportion of Total
Units
All Ages
252
55.6%
Seniors
90
19.9%
Aboriginal/Native
75
16.6%
Family
36
7.9%
Total
453
Source: MSDSB Subsidized Housing Providers; MSDSB Revised 10-Year Housing and Homelessness Plan, 2014;
MSDB Social Housing Locations, Accessed March 25, 2016: http://www.msdsb.net/sh-housing-locations
The number of units by bedroom size was not reported by all housing providers and therefore cannot be
accurately reported.
Nipissing
There are a total of 2,285 units in Nipissing’s social housing portfolio. The social housing stock is split
between family (48.6%) and seniors-only (45.8%) units. The small remaining portion of units has a mixed
mandate for both families & seniors (5.6%). It was noted that of the total units, 56 units are native
housing for families and seniors, which equals to 2.5% of the total social housing stock.
185
Table 8: Number of Social Housing Units by Mandate; Nipissing, 2013
Number of Units
Proportion of Total
Units
Family
1,110
48.6%
Seniors
1,046
45.8%
129
5.6%
Mandate
Family / Senior
Total
2,285
Source: Nipissing District 10-Year Housing and Homelessness Plan, 2013
The number of units by bedroom size was not available.
Parry Sound
There are a total of 396 social housing units in Parry Sound. Over half of the social housing supply has an
all-inclusive mandate for singles, families & seniors (51.3%). The remaining stock is made up of seniors’
only units (40.4%) and Aboriginal family units (8.3%).
Table 9: Number of Social Housing Units by Mandate; Parry Sound, 2012
Number of Units
Proportion of Total
Units
Single / Family / Senior
203
51.3%
Seniors
160
40.4%
Aboriginal
33
8.3%
Mandate
Total
396
Source: DPSSSAB Application for Rental Accommodation, 2012; DPSSSAB Summary Chart of Housing Providers in
the District; DPSSSAB Details of Housing Units in the Service Area
accurately reported.
Sault Ste. Marie
There are 2,234 social housing units in Sault Ste. Marie. Half of the units have a mixed mandate for
families & singles (49.6%). Seniors housing makes up a larger portion of the social housing stock at
37.7% compared to Aboriginal & Native (5.7%), family (5.3%), and single (1.7%) units which make up
considerably smaller portions of the social housing supply.
186
Table 10: Number of Social Housing Units by Mandate; Sault St. Marie, 2016
Number of Units
Proportion of Total
Units
1,107
49.6%
Senior
843
37.7%
Aboriginal / Native
127
5.7%
Family
118
5.3%
Single
39
1.7%
Mandate
Family / Single
Total
2,234
Source: DSSMSSAB, 2016; DSSMSSAB Housing Application Package, 2015; DSSMSSAB Rental Locations, Accessed:
March 27, 2016: http://www.ssm-dssab.ca/HousingProviders/index.cfm
The Sault Ste. Marie Housing and Homelessness Plan Update (2014), identifies that there are 2,43012
units in the social housing portfolio. The report breaks down the total number of units into percentages.
Over half of the units are one-bedrooms (51%) followed by two-bedrooms (24%), three-bedrooms
(18%), bachelor units (4%), and four or more bedrooms (3%).
Figure 5: Proportion of Social Housing Units by Bedroom Size; Sault Ste. Marie, 2014
4+ BR
3%
Bachelor
4%
3 BR
18%
2 BR
24%
1 BR
51%
Source: Housing and Homelessness Plan Update, 2014
Temiskaming
There are a total of 850 units of social housing in Temiskaming. Over half of the units have a mixed
mandate for seniors & singles (51.8%) and are all one-bedroom units. Temiskaming has the greatest
proportion of Aboriginal/Native housing at 18.9% compared to the other service areas in the NE LHIN.
12
The number of units in the Housing and Homelessness Plan Update (2,430) is greater than the total by mandate
(2,234) because it includes a number of rent supplement units that could not be identified by mandate.
187
Seniors-only units make up 15.9% of the social housing stock and are comprised of one-bedroom (116
units) and two-bedroom (19 units) sized units. Family units make up the smallest portion of all housing
types at (13.4%).
Table 11: Number of Social Housing Units by Mandate; Temiskaming, 2011
Number of Units
Proportion of Total
Units
Seniors / Singles
440
51.8%
Native Housing (Family Units)
161
18.9%
Seniors
135
15.9%
Family
114
13.4%
Mandate
Total
850
Source: DTSSAB, 2016; DTSSAB Your Guide to Rent Geared to Income Housing, 2011
accurately reported. However, based on the above proportions of total units by mandate, one-bedroom
units make up at least 65.4% of Temiskaming’s social housing portfolio. The remaining portion is made
up of two- to five-bedroom units.
7.2.3 Modified/ Accessible Units in the NE LHIN
Based on available data, there are at least 375 modified social housing units13 in the NE LHIN, making up
just less than 3% of the total social housing supply. It is likely that there are additional modified units as
not all housing providers reported on this unit type.
Table 12: Estimated Number of Modified Social Housing Units by Service Area; NE LHIN, 2016
Modified Units
Proportion of Total Units
in Service Area
Algoma
16
2.6%
Cochrane
--
--
140
3.2%
Manitoulin-Sudbury
6
1.3%
Nipissing
68
3.0%
Parry Sound
8
2.0%
Sault Ste. Marie
127
5.7%
Temiskaming
10
1.2%
Service Area
Greater Sudbury
13
Data was not available for all areas.
188
Service Area
Modified Units
Proportion of Total Units
in Service Area
Total
375
The following section provides an overview of the number of modified units by community.
Algoma
There are 16 social housing units modified for accessibility in Algoma. The majority of the modified units
are in seniors-only buildings and are identified as ‘handicap’ units. Additional modified units are
available but specific counts were not provided.
Table 13: Estimated Number of Modified Social Housing Units; Algoma, 2016
Mandate
Modified Units
Family
3
Senior*
11
Single/Couple
0
Single Family
2
Native Housing
0
Total
16
Source: Algoma District Services Administration Board, 2016
* Additional units available
Cochrane
There are several modified social housing units available for all housing types in Cochrane. However,
the specific number of units was not identified.
The modifications are made for wheel chair accessibility. The availability of modified units is more
frequent in family/singles, and seniors-only mandated units than in senior/single units, and Native
housing.
In addition to the modified social housing units, Cochrane has 48 units of social housing mandated for
supportive housing/accessible units.
The City of Greater Sudbury reported modified unit data on 4,448 units of its social housing stock (data
was not available for 411 units of Federal Cooperative housing). Of the 4,448 units, 140 are modified
units. There are a greater number of modified one-bedroom units (83 units), compared to half as many
modified two-bedroom units (41 units).
189
Figure 6: Proportion of Modified Social Housing Units by Bedroom Size; City of Greater Sudbury, 2016
3 BR
11.4%
2 BR
29.3%
1 BR
59.3%
Source: City of Greater Sudbury, 2016
Manitoulin-Sudbury
There are six modified social housing units in seniors-only buildings in Manitoulin-Sudbury. In addition,
there is an all-ages non-profit building in Mindemoya that is fully accessible and often houses victims of
violence.
Nipissing
There are a total of 68 modified social housing units in Nipissing. The majority are for family household
types (47 units; 69.1%), followed by a limited number for seniors-only household types (12 units;
17.6%).
Table 14: Number of Modified Social Housing Units; Nipissing, 2013
Household Type
Modified Units
Families
47
Seniors
12
Families / Seniors
9
Total
68
Source: 10-Year Housing and Homelessness Plan, 2013
Parry Sound
There are eight modified social housing units in Parry Sound, five of which belong to all-inclusive
mandated units and three belong to seniors-only units.
Six of the modified units are one-bedroom units and two are three-bedroom units.
Sault Ste. Marie
There are 127 units described as “special needs / modified” in Sault Ste. Marie’s social housing portfolio.
The majority of the units belong to family/single mandated units (67.7%), and seniors-only units (27.6%).
The remaining small proportion of special needs / modified units are family units (3.1%) and Aboriginal /
Native housing (1.6%).
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Table 15: Number of Modified Social Housing Units; Sault Ste. Marie, 2016
Special Needs /
Modified Units
Mandate
Family
4
Family / Single
86
Senior
35
Single
0
Aboriginal / Native
2
Total
127
Source: DSSMSSAB Housing Directory, 2016
Temiskaming
A total of 10 social housing units have been modified for wheel chair accessibility. Five of these belong
to family mandated units and another five belong to seniors-only units. The District of Temiskaming also
noted that several walk-in showers have been installed in approximately 75 single units.
7.2.4 Rent Supplement Supportive Housing Units in the NE LHIN
A number of agencies have LHIN-funded rent supplement units for tenants with mental health and
addictions challenges. In 2015, there were a total of 484 units across the NE LHIN. Of the total units, 430
units were dedicated for tenants with mental health challenges (88.8%) and 54 units were dedicated for
tenants suffering with addictions (11.2%). The majority of the units are located in the Districts of
Cochrane-Temiskaming (33.3%), the District of Algoma (29.8%), and the City of Greater Sudbury (27.3%).
The remaining units are located in Nipissing District (9.7%).
Table 16: Rent Supplement Units by Agencies; NE LHIN, 2014 - 2015
North East LHIN
Mental Health
Addictions
Total
Algoma Health Unit
130
14
144
CMHA Cochrane Temiskaming
149
12
161
CMHA Nipissing
23
12
35
CMHA Sudbury
116
16
132
North Bay Community Housing Initiative
12
0
12
430
54
484
Total
Source: Ministry of Health and Long-Term Care, 2014-2015
191
7.2.5 Waiting for Social Housing in the NE LHIN
Waiting list statistics are based on The Ontario Non-Profit Housing Association’s (ONPHA) 2015 Waiting
Lists Survey report. The report details findings and statistics from the social housing waiting lists of the
47 municipal service managers across Ontario.
In communities across the NE LHIN, there are a total of 6,615 active households on social housing
waiting lists as of December 31, 2014. Cochrane, Sault Ste. Marie, Nipissing, and the City of Greater
Sudbury each have over 1,000 active households on their social housing waiting lists. Manitoulin—
Sudbury, Temiskaming, Parry Sound and Algoma each have less than 500 active households.
Table 17: Active Households on Social Housing Waiting Lists by Service Area; NE LHIN, 2014
Active Households on
Service Area
Social Housing Units
Waiting List
Cochrane
1,583
2,310
Sault Ste. Marie
1,274
2,430
Nipissing
1,185
2,285
Greater Sudbury
1,068
4,859
Manitoulin-Sudbury
437
453
Temiskaming
410
850
Parry Sound
350
396
Algoma
308
571
6,615
14,154
Total
Source: ONPHA Waiting Lists Survey, 2015
Active households on social housing waiting lists are organized by the following household types:
Seniors, Families, and Single Adults & Couples. The City of Greater Sudbury has the greatest proportion
of single adult & couple households waiting for social housing in the NE LHIN (72.3%). The City of
Greater Sudbury, Temiskaming, Sault Ste. Marie, and Parry Sound each have over half of their subsidized
social housing waiting lists represented by single adult & couples family household types.
Manitoulin-Sudbury has the greatest proportion of seniors on their social housing waiting list at 43.7% in
the NE LHIN. Cochrane is the only service area to have senior households as the greatest proportion of
all household types waiting for subsidized housing.
Although there are family household types waiting for social housing, they do not represent the majority
proportion of active households on social housing waiting lists in the NE LHIN. Of all the service areas,
Cochrane has the greatest amount (495) and proportion (31.3%) of family households waiting for
subsidized housing in the NE LHIN.
192
Figure 7: Proportion of Active Households on Social Housing Waiting Lists by Service Area and
Mandate; NE LHIN, 2014
Seniors
41.2%
29.4%
Families
72.3%
35.0%
31.3%
41.4%
56.0%
56.7%
24.6%
28.2%
69.3%
21.3%
26.0%
29.2%
43.7%
13.8%
39.4%
12.7%
32.7%
15.1%
18.0%
Timiskaming
Nipissing
Manitoulin-Sudbury
Greater Sudbury
Cochrane
Algoma
19.4%
Sault Ste. Marie
14.0%
Parry Sound
29.5%
Single Adults & Couples
7.2.6 Waiting Lists By Community
Algoma
There are a total of 308 active households on social housing waiting lists for subsidized housing. Active
households on the waiting list represent 2% of all households14 in Algoma. There are a greater number
of single adult & couple household types (127) on the waiting lists and nearly equal numbers of senior
(91) and family (90) households.
Table 18: Active Households on RGI Waiting Lists; Algoma, Dec. 31 2014
Average Wait Time
Household Type
Total
(Years)
Seniors
91
1.04
Families
90
0.90
127
1.00
Total
308
14
ONPHA Waiting Lists Survey, 2015
Calculation based on 2011 total household data.
193
Cochrane
There are a total of 1,583 active households waiting for subsidized housing. Active households on the
waiting list represent 5% of all households in Cochrane. There are a greater number of senior households
(623) waiting for subsidized housing followed by family households (495) and single adults & couples (465).
Table 19: Active Households on RGI Waiting Lists; Cochrane, Dec. 31 2014
Average Wait Time
Household Type
Total
(Years)
Seniors
623
3.16
Families
495
1.24
465
3.37
Total
1,583
There are a total of 1,068 active households on the social housing waiting list for subsidized housing.
Active households on the waiting list represent 2% of all households in the City of Greater Sudbury. The
number of single adult and couple households (772) waiting for subsidized housing far exceeds the
number of senior (149) and family (147) households.
Table 20: Active Households on RGI Waiting Lists; City of Greater Sudbury, Dec. 31 2014
Average Wait Time
Household Type
Total Units
(Years)
Seniors
149
3.24
Families
147
0.57
772
2.10
Total
1,068
Manitoulin-Sudbury
There are a total of 437 active households on the social housing waiting list for subsidized housing.
Active households on the waiting list represent 4% of all households in the Manitoulin-Sudbury. There
are a greater number of senior households (191) waiting for subsidized housing followed by single adults
and couple (153) and family (93) households.
194
Table 21: Active Households on RGI Waiting Lists; Manitoulin-Sudbury, Dec. 31 2014
Average Wait Time
Household Type
Total Units
(Years)
Seniors
191
2.42
Families
93
0.98
153
0.59
Total
437
Nipissing
There are a total of 1,185 active households on the social housing waiting list for subsidized housing.
Active households on the waiting list represent 4% of all households in Nipissing. There are more single
adult and couple households (490) waiting for subsidized housing followed by senior (387) and family
(308) households.
Table 22: Active Households on RGI Waiting Lists; Nipissing, Dec. 31 2014
Average Wait Time
Household Type
Total Units
(Years)
Seniors
387
1.64
Families
308
1.10
490
1.98
Total
1,185
Parry Sound
Active households on the waiting list represent 2% of all households in Parry Sound. More than half of
the active households on the waiting list are single adults and couples (196); followed by family (86) and
senior (68) households.
Table 23: Active Households on RGI Waiting Lists; Parry Sound, Dec. 31 2014
Average Wait Time
Household Type
Total Units
(Years)
Seniors
68
4.10
Families
86
3.10
196
3.30
Total
350
195
Sault Ste. Marie
There are a total of 1,274 active households on the waiting list for subsidized housing. Active households
on the waiting list represent 4% of all households in Sault Ste. Marie. More than half of the active
households on the waiting list are single adults and couples (722); followed by family (359) and senior
(193) households.
Table 24: Active Households on RGI Waiting Lists; Sault Ste. Marie, Dec. 31 2014
Average Wait Time
Household Type
Total Units
(Years)
Seniors
193
1.50
Families
359
0.75
722
1.50
Total
1,274
Temiskaming
Active households on the waiting list represent 3% of all households in Temiskaming. The number of
single adult and couple households (284) waiting for subsidized housing far exceeds the number of
senior (74) and family (52) households.
Table 25: Active Households on RGI Waiting Lists; Temiskaming, Dec. 31 2014
Average Wait Time
Household Type
Total Units
(Years)
Seniors
74
2.93
Families
52
0.54
284
1.75
Total
410
196
7.3 Support Service Inventory
This section of the report focuses on support services offered in communities across the NE LHIN area. The
inventory was created based on information provided by the NE LHIN, CMHA Sudbury-Manitoulin and
through an online scan. The inventory was updated based on feedback received as part of consultation
activities.
The inventory is not a complete inventory of support services available across the area; rather, it is a
starting point for support services available to assist social housing tenants either directly within the
housing itself or within the community (i.e. drop-in centres, day programs).
The inventory of community service providers is organized into the following sectors.15
Community Care Access Centres
In collaboration with family health care providers, hospitals and other health care partners,
CCACs help Ontarians of all ages to access and navigate the health care services they need,
when and where they need them.
Community Health Centres
Provide primary care, health promotion, education and illness prevention services using a
community development approach. Health Centres are staffed by health care professionals
including physicians, nurse practitioners, nurses, counsellors, community workers and dietitians.
Community support services
Are intended for seniors, or people with disabilities who prefer to stay at home. Services can be
offered at the client’s home or in the community.
Hospitals
Provide a variety of inpatient and outpatient programs and services. Many provide learning
opportunities for health science students and participate in the conduct of health and medical
research.
Mental Health and Addictions
Community mental health programs provide a variety of services to help support people who
have serious and ongoing mental health issues living in the community. Services offered include
information and referral, advocacy, case management, housing advocacy, rehabilitation,
employment assistance, counselling, support groups and social and recreational opportunities,
and peer support services for consumers and survivors.
Public Health Units
Provide programs that protect and improve the health of the community through
comprehensive efforts to prevent, control and eradicate communicable disease; eliminate
environmental health hazards; and recognize, prevent and control occupational health hazards
and illnesses.
15
Definitions provided by the North East Health Line website
197
Data was provided and analysed based on the following regions:
1) Algoma
2) Cochrane-Temiskaming
3) Sudbury/Manitoulin (including the City of Greater Sudbury)
4) Parry Sound
5) Nipissing
6) James and Hudson Bay Coasts
The purpose of the inventory is provide a greater understanding and awareness of the support service
network that is available to social housing tenants. The inventory will provide information on the
existing supply of support agencies in the NE LHIN and help identify where service improvements are
needed. It forms the basis of the needs analysis.
7.3.1 Support Service Network in the NE LHIN
Based on our existing inventory, there are a total of 233 support agencies in the NE LHIN area. Over half
of the agencies fall under the Community Support Services sector (53.2%). This is followed by mental
health & addictions (26.6%), hospitals (8.6%), community health centres (4.3%), public health units
(4.7%), and Community Care Access Centres (2.6%).
The majority of identified services are located in the Sudbury/Manitoulin (26.6%) and CochraneTemiskaming (26.2%) regions. The regions of Algoma (15.0%), the Coast (14.6%), and Nipissing (13.3%)
have relatively the same number of agencies. Parry Sound (4.3%) has the least amount with 10
identified agencies in the area.
Table 26: Number of Support Agencies by Sector & by Region
Sector
Community Care Access
Centre Sites
Community Health
Centre
Community Support
Services
Hospital
Mental Health &
Addictions
Public Health Unit Sites
Total
Algoma
Coast
Nipissing
0
CochraneTemiskaming
1
Sudbury/
Manitoulin
1
Total
3
Parry
Sound
0
1
1
2
3
2
0
2
10
15
8
35
16
6
44
124
5
12
1
17
9
12
1
8
1
2
3
11
20
62
1
35
6
34
1
61
1
31
1
10
1
62
11
233
6
Looking at communities across the NE LHIN, the Coast region has the greatest proportion identified
support agencies providing mental health & addictions services at 50%. Parry Sound and the Coast are
the only regions that do not have a Community Care Access Centre Site. The largest number of hospitals
are located in the Cochrane-Temiskaming region (9 Hospitals).
198
Figure 8: Proportion of Support Services by Region and Sector; NE LHIN
0.0%
17.1%
1.9%
0.0%
2.0%
22.2%
22.2%
15.7%
35.5%
5.9%
16.7%
16.1%
11.1%
Public Health Unit
48.6%
68.6%
51.9%
66.7%
5.7%
2.9%
5.6%
1.9%
0.0%
Coast
CochraneTemiskami
ng
Parry
Sound
2.9%
Community Support
Services
Community Health
Centre
38.7%
22.9%
3.2%
3.2%
3.9%
3.9%
Sudbury/
Manitoulin
Algoma
0.0%
Mental Health &
Addictions
Hospital
A review of support services by area is provided in Appendix A.
7.4 Estimating Number of Vulnerable People in Social Housing
The following section estimates the number of vulnerable persons living in social hosing across the NE
LHIN. Estimates are based on research findings from the literature and applying these
findings/calculations to the supply of social housing in the NE LHIN presented in the above sections.
Results are provided for vulnerable tenants in general (based on ONPHA definition and research
findings), as well as particular vulnerable population groups including tenants with a serious and
persistent mental illness, seniors, and persons with disabilities.
7.4.1 Vulnerable Tenants
There are 13,70516 social housing units in the North East LHIN with approximately 20,558 tenants. While
a large proportion of these tenants only require supports in the form of financial assistance, there are a
proportion of tenants who require additional supports, including assistance with activities of daily living
and help with life skills.
There are different approaches to estimate the number of tenants in social housing who require
16
The number of social housing units in the North East LHIN is based on SHS Calculations from reports and email
requests.
199
supports. For example, an ONPHA study found that in recent years, social housing providers filled
vacancies with Special Priority applicants or local priority applicants including those who had
experienced violence, those who were homeless or persons with special needs. This study found that
54.6% of vacancies in all social housing units were filled with people who identified themselves as
vulnerable in some way17. Using this proportion, there are an estimated 11,224 vulnerable tenants in
social housing units throughout the NE LHIN. These tenants would likely have a wide range of support
service needs, from personal care to assistance with life skills. Estimates on several vulnerable
population groups are further explored in the following sections.
7.4.2 Tenants with a Serious and Persistent Mental Illness
There are also tenants living in social housing with serious and persistent mental illness. Serious and
persistent mental illness, or SPMI, is the term mental health professionals use to describe mental
illnesses with complex symptoms that require ongoing treatment and management, most often varying
types and dosages of medication and therapy18.
It is estimated that approximately 3% of all Canadians have a serious and persistent mental illness19,20.
In addition, research found that the prevalence rate for serious mental illness and concurrent disorders
is greater for people in low socioeconomic groups, with the lowest socioeconomic groups showing rates
of mental illness at approximately 2 to 2.5 times that of higher socioeconomic groups. Based on this,
the ONPHA report, Strengthening Social Housing Communities: Helping Vulnerable Tenants Maintain
Successful Tenancies (2015), estimates that 7% of tenants in rent-geared-to-income (RGI) housing and
3% of tenants in market rate social housing have a serious and persistent mental illness21. Using this
methodology, there are between 617 and 1,439 social housing tenants in the NE LHIN who have a
serious and persistent mental illness. While some of these tenants may already be receiving supports, it
is highly likely that there is a proportion who are not receiving any supports and others who are not
receiving enough supports.
7.4.3 Seniors Requiring Supports
As experienced in communities across Ontario and Canada, the population is aging, including the
population living in social housing. ONPHA estimates that there are as many seniors living in social
housing as there are in long term care and that a great proportion of waiting lists for social housing are
17
ONPHA (2015). Strengthening Social Housing Communities: Helping Vulnerable Tenants Maintain Successful
Tenancies.
18
UNC School of Medicine, Department of Psychiatry. Found at: https://www.med.unc.edu/psych/cecmh/patientclient-information/patient-client-information-and-resources/clients-and-familes-resources/just-what-is-a-severeand-persistent-mental-illness
19
Tenancies AND Ontario Ministry of Health and Long Term Care (2009). Every Door is the Right Door: Towards a 10Year Mental Health and Addictions Strategy.
20
It is not certain whether the definition of persons with serious and persistent mental health includes persons
with addictions. This population, however, is likely captured within the percentage of vulnerable tenants outlined
in Section 5.5.1.
21
Tenancies p.10
200
made up of seniors22. Indeed, our analysis as shown above finds that 1,176 senior households are on
waiting lists for social housing in the NE LHIN service area, representing about 27% of all social housing
applicants.
Keefe, et. al. (2007) estimates that between 15% and 18% of seniors 65 years and older will require
assistance with everyday activities (e.g. shopping, personal care, housework and meal preparation)
based on disability rates and the availability of supports. While the proportion is projected to remain
constant from 2001 to 2031, Keefe, et. al notes that the number of seniors requiring assistance will
greatly increase due to the aging of the baby boomers. Applying Keefe’s estimates to the number of
tenants in senior and non-family social housing units in the NE LHIN, it is estimated that there are
currently 2,224 – 2,669 seniors living in social housing who require supports.
7.4.4 Tenants with a Disability
Using data from the Canadian Survey on Disability, 2012, Arim (2015) found that 15.4% of all Ontarians
15 years and older and 14% of Canadians overall have a disability that limits their daily activities. When
applied to social housing tenants in the NE LHIN, this shows that there are about 3,166 tenants who
have a disability which limits their daily activities. While many of these tenants likely have some
supports, Turcotte (2014) found that 1.6% of the population 15 years and older who have a chronic
health condition do not receive the help they require. When this is applied to the estimated number of
tenants in social housing in the NE LHIN, approximately 51 tenants have a disability but are not receiving
the supports they require.
The following table shows the estimates based on the approaches discussed above for the number of
tenants who require supports in each of the communities within the NE LHIN as well as the total number
for the entire LHIN. It should be noted, however, that there may be some double counting, particularly
with regard to the estimated number of vulnerable tenants using the 54.6% proportion as well as the
fact that different sources of information have been used. In addition, these estimates consider only the
number of people who are currently living in social housing and do not take into account the number of
people who are applying for social housing in the NE LHIN, which stood at 6,615 as of the end of 201423.
22
23
ONPHA (2015). Ibid, p.11
ONPHA (2015). 2015 Waiting Lists Survey.
201
7.4.5 Summary of Vulnerable Persons Living in Social Housing across NE LHIN
Based on the above findings, the following Table provides a summary of the estimated number of vulnerable persons living in social housing
across the NE LHIN.
Table 27: Estimated Number of Vulnerable Persons Living in Social Housing across the NE LHIN
Total
Number
of Units1
Estimated
Number of Social
Housing Tenants2
1.5
3.0%
7.0%
15.0%
610
915
27
64
101
Cochrane
2,281
3,422
103
240
Greater Sudbury
4,596
6,894
207
453
680
20
2,285
3,428
396
Algoma
Manitoulin-Sudbury
Nipissing
Parry Sound
Sault Ste Marie
Temiskaming
All LHIN
Estimated Number of Tenants
with Serious and Persistent
Mental Illness3
Estimated Number of
Seniors Requiring
Supports4
Estimated
Number of
Tenants with
a Disability5
Estimated Number
of Tenants who
have Unmet Help
or Care Needs6
Estimated
Number of
Vulnerable
Tenants7
18.0%
15.4%
1.6%
54.6%
121
141
2
500
491
589
527
8
1,868
483
633
760
1,062
17
3,764
48
77
92
105
2
371
103
240
264
317
528
8
1,871
594
18
42
82
98
91
1
324
2,234
3,351
101
235
448
537
516
8
1,830
850
1,275
38
89
129
155
196
3
696
13,705
20,558
617
1,439
2,224
2,669
3,166
51
11,224
1
The total number of units is based on email correspondence from housing providers and data from reports and websites
2
The estimated number of social housing tenants is based on the average number of adults per household with children and without children in Ontario from ONPHA (2015).
3
The estimated number of tenants with a serious and persistent mental illness is based on the approach used in the ONPHA (2015) report based on a prevalence rate of 3% among all Canadians and 7%
prevalence rate among adults in RGI housing.
4
The estimated number of seniors requiring supports is based on Keefe et. al. (2007).
5
The estimated number of tenants with a disability is based on the prevalence rate of disability in Ontario from Arim (2015) which uses data from the Canadian Survey on Disability, 2012.
6
The estimated number of tenants who have unmet help or care needs is based on Turcotte (2014) using the rate of the population 15 years and older who needed help for a chronic health condition
but did not receive it.
7
The estimated number of vulnerable tenants is based on ONPHA (2015) which states that 54.6% of vacancies in all age social housing were filled by people who identified themselves as vulnerable.
202
7.5 Summary of Social Housing Needs Analysis
Based on the review of social housing across the NE LHIN there are approximately 14,000 social housing
units across eight service areas. Almost half of these units (45%) are for all housing types, just over onequarter (27%) are for seniors, 23% for families and about 4% for Aboriginal and First Nation households.
Approximately 3% of the units are modified for persons with disabilities. In addition there are
approximately 484 NE LHIN funded supportive housing units for persons with mental health and
addiction challenges.
By area, over one-third of the supply is located in the City of Greater Sudbury (34.3%). Sault Ste. Marie
(17.2%), Cochrane (16.3%), and Nipissing (16.1%) each have about half of the proportion found in the
City of Greater Sudbury. Temiskaming (6.0%), Algoma (4.0%), Manitoulin-Sudbury (3.2%), and Parry
Sound (2.8%) each have less than 10% of the total social housing stock and the fewest numbers of units.
These findings are generally consistent with population distribution across the NE LHIN. SudburyManitoulin (6.7%) and Algoma (7.9%) have a slightly higher proportion of social housing units when
considering the proportion of total population for the NE LHIN while Parry Sound (1.1%) and Sault Ste.
Marie (14.6%) have a slightly lower (1.1%) proportion.
The following Table summarizes the supply and demand for social housing across the NE LHIN by area as
well as estimates of vulnerability within the social housing supply.
Table 28: Summary of Demand and Supply of Social Housing across the NE LHIN
Area
Proportion
of Social
Housing
Supply
Proportion
of Social
Housing
Demand
Households
on Waiting
List
5%
24%
16%
7%
Estimated
Number of
Social
Housing
Tenants24
915
3,422
6,894
680
Algoma
Cochrane
Greater Sudbury
ManitoulinSudbury
Nipissing
Parry Sound
Sault Ste. Marie
Temiskaming
All LHIN
4%
16%
34%
3%
16%
3%
17%
6%
100%
Estimate of
Number of
Vulnerable
Tenants26
308
1,583
1,068
437
Estimate of Number
of Tenants with
Serious and
Persistent Mental
Illness25
64
240
483
48
18%
5%
19%
6%
100%
3,428
594
3,351
1,275
20,558
1,185
350
1,274
410
6,615
240
42
235
89
1,439
1,871
324
1,830
696
11,224
500
1,868
3,764
371
24
The estimated number of social housing tenants is based on the average number of adults per household with children and
without children in Ontario from ONPHA (2015).
25
The estimated number of tenants with a serious and persistent mental illness is based on the approach used in the ONPHA (2015) report
based on a prevalence rate of 3% among all Canadians and 7% prevalence rate among adults in RGI housing.
26
The estimated number of vulnerable tenants is based on ONPHA (2015) which states that 54.6% of vacancies in all age social housing were
filled by people who identified themselves as vulnerable.
203
8.0 Summary of Gaps and Opportunities
Throughout the various research activities a number of common themes and key messages emerged.
These key messages are organized by three critical elements to creating more successful tenancies:
supports, housing, and partnerships.
8.1 Supports
Vulnerability
The definition of vulnerable tenants utilizes the ONPHA definition of vulnerability in social housing which
is essentially “anyone who needs additional support – for any reason – to maintain a successful
tenancy”. Based on the methodology within the ONPHA Strengthening Social Housing Communities
report (2015), it is estimated that there are approximately 11,224 vulnerable tenants across the NE
LHIN. Particular populations were identified within the literature and through the consultations as being
at a greater risk of losing their housing as a result of an unmet need. These groups include persons with
mental health and addictions, seniors, persons with disabilities (in particular persons with dual diagnosis
and concurrent disorders), Aboriginal and First Nation persons, youth, persons living in rural and remote
communities and also persons within the LGBT community.
Access
Many stakeholders expressed concern with a lack of access to various support services, in particular within the
NE LHIN’s remote and rural communities. As identified within the literature, there are fewer health
professionals per capita in Northern communities which can result in an increase in a number of health issues.
In addition to concerns regarding access to support services within particular communities, awareness
and access in general to support services was identified as a critical component of maintaining
successful tenancies. The literature review highlights that connecting people to the right supports at the
right time is important. Stakeholders shared success stories and examples where having on-site
supports or coordinated response teams can make a huge difference in maintaining tenancies and
providing proper supports to residents in need.
Family and Peer Support
A lack of family support or other forms of informal support (i.e. neighbour) was seen as one of the
greatest risks for people living alone in social housing. This family or peer support can be critical in
identifying needs, advocating for supports, and connecting with appropriate agencies. In addition, the
literature points to declines in health and well-being resulting from a lack of supportive social networks.
Early Intervention
The literature emphasizes the importance of early intervention, as did our study stakeholders. Some
form of mechanism or framework for identifying and evaluating life skills, mental health, physical health
and social supports was considered a key aspect in creating successful tenancies and providing the
supports needed before a crisis occurred or the issue worsened.
Study stakeholders also identified that a particular challenge within social housing communities is that a
need for support for a tenant may be identified, either by a housing provider or support agency, but that
individual does not want help. Early intervention may help to address issues sooner when the tenant
may be more open to seeking assistance.
204
Life Skills
As identified by stakeholders, often tenants of social housing are living on their own for the first time
and do not have the necessary life skills to maintain a successful tenancy. This might include
housekeeping, healthy eating and budgeting. Similar to the note above regarding early intervention,
understanding these needs quickly can help maintain successful tenancies before there is any risk of
eviction.
Crisis Support
While early intervention and prevention is key, also identified as equally important is the need for more
support services for individuals in crisis or in need of complex care and support. Having sufficient staff
and adequately trained staff was identified as a concern, and emphasized as a particular gap within rural
and remote areas of the NE LHIN, by study stakeholders.
8.2 Housing
Affordable
As identified within the needs analysis there are approximately 6,615 applicants waiting for social
housing across the NE LHIN, creating long waiting lists (typically several years). Stakeholders also clearly
identified the need for more affordable housing options, in particular, the need for additional rent
subsidies. Portable rent subsidies were seen as a preferred option as these provide choice and flexibility
to tenants.
Accessible
The needs analysis also points to a gap in the number of accessible units, which was also articulated
through the various consultations. The built form can have challenges for seniors and persons with
disabilities as well as people with dementia and other mental health issues. In some areas, an aging
housing stock cannot easily accommodate modifications for accessibility.
Supportive
In addition to social housing, stakeholders identified the need for more supportive housing options; in
particular, intensive support homes for persons with severe mental health needs. While rental arrears
was identified as the greatest risk to eviction, stakeholders emphasized that there are often other
factors contributing to rental arrears such as mental health issues or lack of budgeting and life skills.
8.3 Partnerships
Housing Providers
Outlined clearly by housing provider stakeholders and validated within the literature review, landlords
and housing providers typically do not have the resources or skills to meet the growing support needs of
tenants. Yet, they are frequently in the position of responding to a need or crisis either directly through
the tenant or through neighbours and family. Including housing providers within the ‘Circle of Care’ is
important for the tenant and also can help providers understand what services are available in their
community and how to connect tenants to the right support agencies.
205
Hospitals
Hospitals were identified as a key partner in providing care and supports to social housing tenants.
Many stakeholders raised concerns regarding a lack of communication between support agencies,
hospitals and housing providers, which can leave tenants with inappropriate or insufficient support
services in place to help them transition back into their home, ultimately making them extremely
vulnerable to eviction.
‘System Stakeholders’
In addition to hospitals and housing providers noted above, a number of support service agencies are
involved in providing care and supports to social housing tenants. While there are many partnerships
across communities in the NE LHIN, study stakeholders highlighted that there is a strong need for more
coordinated work, more sharing of ideas and more awareness of each other and the services provided
within the ‘system’. Included in the system are local agencies such as Canadian Mental Health
Association, Community Living, Red Cross and many others. Also included are primary care physicians,
informal support networks (i.e. family, neighbours, church), public health units and community health
centres, emergency medical services, municipalities/local service managers/DSSABs, as well as CCAC and
the LHIN itself. Other potential partners might include local school boards, transportation services, and
post-secondary institutions.
206
9.0 The Way Forward
There is currently a gap in the availability, consistency and coordination of support services for persons
living in social housing across the North East LHIN.
Based on the research activities described in the above sections, there is a strong need for a
coordinated model of service delivery to persons living in social housing. As shown, more than 10,000
vulnerable tenants live in social housing across the area, and it is critical that this type of coordinated
system be set in place to help meet their needs and reduce the risk of eviction and homelessness. Using
the key findings from this research the following recommendations are put forward for consideration by
CMHA Sudbury-Manitoulin, the NE LHIN and partners across the area.
Recommendation 1: Move forward in developing a coordinating service delivery model for persons
living in social housing
The model should integrate a vision that there is “someone for everyone”, that essentially each tenant
has someone to call that can help identify and access support services, assist in life skill development as
appropriate, or simply be a friend or a ‘go to person’.
To support this vision, the model should also consider the following four principles:
COMMUNITY BUILDING – a collaboration of committed partners with a shared responsibility to
better meet the support needs of residents.
Goals might include:



Adequate resources and skilled workers
Adequate housing
Effective and inclusive partnerships
RESPONSIVE – identifies, responds and is flexible to changes in tenant needs.



Early intervention/prevention (i.e. assessment tool)
Appropriate transitional support
Responsive crisis care
INCLUSIVE – an accessible system of supports for individuals and families from all communities.


Equal access to support services
Identification of resource hubs
207
CONTINUOUS CIRCLE OF CARE – that residents are supported in their unique needs and
experiences which are central to planning and decision making.




Care team approach
Continuum of support (prevention/early intervention to life skills to intensive care to crisis
support)
On-site support or access to 24 hour support
Effective use of technology and mobile options
Recommendation 2: Conduct a review of housing options across the North East LHIN
The North East LHIN is a large geographic area with a diverse range of urban, rural and remote
communities. Through this research study, an inventory of social housing was identified. However,
there is little understanding and awareness of other forms of housing, such as supportive housing
models, across the LHIN. Preparing housing profiles across various service areas would be helpful in
understanding the housing gaps and opportunities.
Recommendation 3: Share and further develop the support agency inventory
Currently, the inventory developed as part of this study includes 233 agencies. The database is a
comprehensive document which includes agency names, lead staff and contact information and can be
sorted by community and by sector. Sharing this resource with stakeholders would help create a greater
understanding of the services available within communities. Expanding on this database over time
would also help identify resources and potential gaps in the types of services offered. This means not
only adding agencies and organizations to the database but including which services they offer (such as
in-home care, meal program, transportation, etc.).
Recommendation 4: Build on current best practices
A number of success stories were identified throughout this research. Moving forward in developing a
coordinated service delivery model should consider and build on current best practices such as: CMHA
Sudbury-Manitoulin’s successful partnership with the Manitoulin-Sudbury District Services Board to
offer transitional on-site supportive housing at a social housing building in Espanola; the Housing
Success Team in Nipissing, which offer housing supports and referrals to individuals experiencing various
housing issues in the community; and, the Community or Rapid Mobilization Teams, which involve local
multi-agency, and cross-sector, partnerships to assess and respond to the needs of vulnerable
individuals and families in crisis.
Recommendation 5: Leverage non-traditional and informal support options
While there are certainly a number of partnerships across the North East LHIN, there may be
opportunities to leverage non-traditional and informal support options to help fill current ‘gaps’ in the
system. For example, looking at some of the case studies, the research identifies an opportunity to work
with post-secondary institutions to encourage volunteerism among neighbourhood residents, and
provide on-site programs such as after school homework programs, nutrition classes, and resume
writing lessons. Another example includes creating opportunities for local residents to provide services
to help people age-in-home (i.e. SMILE program). Services might include laundry, assistance with
housekeeping and yard maintenance, and transportation. While helping people live at home longer, it
also promotes local economic development and could be of particular assistance in more rural areas.
208
Recommendation 6: Engage Tenants
A research limitation of this current project was the engagement of tenants. Given the timeframe and
scope of the study, only twenty tenants participated in the research. For the purposes of this
background research study, emphasis was placed on identifying findings from the literature and
gathering feedback from housing providers and support service agencies. Moving forward in developing
the coordinated service delivery model, it will be important to engage tenants within the
implementation and evaluation of the model. It is recommended that the evaluation component
incorporate a participatory approach incorporating several methods for the involvement and coleadership from the people most impacted by the project.
209
10.0 Bibliography
Arim, R. for Statistics Canada (2015). Canadian Survey on Disability, 2012: A profile of persons with
disabilities among Canadians aged 15 years or older, 2012. Catalogue no. 89-654-X. Accessed from:
http://www.statcan.gc.ca/pub/89-654-x/89-654-x2015001-eng.htm
Keefe, J., Legare, J. and Carriere, Y. (2007). Developing New Strategies to Support Future Caregivers of
Older Canadians with Disabilities: Projections of Need and their Policy Implications. Canadian Public
Policy, Vol. XXXIII.
ONPHA (2015). Strengthening Social Housing Communities
ONPHA (2015). 2015 Waiting Lists Survey.
Ontario Ministry of Health and Long Term Care (2009). Every Door is the Right Door: Towards a 10-Year
Mental Health and Addictions Strategy.
Turcotte, M. for Statistics Canada (2014). Insights on Canadian Society: Canadians with unmet home
care needs. Catalogue no. 75-006-X. Accessed from: http://www.statcan.gc.ca/pub/75-006x/2014001/article/14042-eng.htm
210
11.0
Appendix A: Support Services by Area
Algoma
The Algoma region has a total of 36 support agencies. It is mainly serviced by the community support
service (41.7%) and mental health & addictions (33.3%) sectors. There are five hospitals (13.9%), and
one Community Care Access Centre (2.8%), community health centre (2.8%), public health unit (2.8%),
and women’s shelter (2.8%).
Table 29: Number of Support Agencies by Sector; Algoma
Support
Agencies
1
Sector
Community Care Access Centre
Proportion
2.8%
1
2.8%
Community Support Services
15
41.7%
Hospital
5
13.9%
Mental Health & Addictions
12
33.3%
Public Health Unit
1
2.8%
Women's Shelter
1
2.8%
Total
36
Cochrane-Temiskaming
The Cochrane-Temiskaming region has a total of 61 support agencies. Over half the support service
network is made up of community support services (57.4%). This is followed by mental health &
addictions services (19.7%), hospitals (14.8%), community health centres (4.9%), one public health unit
(1.6%), and one Community Care Access Centre (1.6%).
Table 30: Number of Support Agencies by Sector; Cochrane-Temiskaming
Support
Agencies
1
Sector
Proportion
1.6%
3
4.9%
35
57.4%
Hospital
9
14.8%
12
19.7%
Public Health Unit
1
1.6%
Total
61
211
Sudbury/Manitoulin
The Sudbury/Manitoulin region has a total of 62 support agencies. It is primarily serviced by community
support services (71.0%). There are eleven mental health & addictions support agencies (17.7%), three
hospitals (4.8%), two community health centres (3.2%), one Community Care Access Centre (1.6%), and
one public health unit 1.6%) servicing the area.
Table 31: Number of Support Agencies by Sector; Sudbury/Manitoulin
Support
Agencies
1
Sector
Proportion
1.6%
2
3.2%
44
71.0%
Hospital
3
4.8%
11
17.7%
Public Health Unit
1
1.6%
Total
62
Parry Sound
There are a total of 10 support agencies in the Parry Sound region. There are six community support
service providers, two mental health & addiction providers, and one hospital and one public health unit.
There are no community health centres or Community Care Access Centres.
Table 32: Number of Support Agencies by Sector; Parry Sound
Support
Agencies
0
Sector
Proportion
0.0%
0
0.0%
6
60.0%
Hospital
1
10.0%
2
20.0%
Public Health Unit
1
10.0%
Total
10
212
Nipissing
The Nipissing region has a total of 31 service providers. It is primarily serviced by 16 community support
service agencies (51.6%). There are eight mental health & addictions service providers, three Community
Care Access Centres, two community health centres, one hospital, and one public health unit.
Table 33: Number of Support Agencies by Sector; Nipissing
Support
Agencies
3
Sector
Proportion
9.7%
2
6.5%
16
51.6%
Hospital
1
3.2%
8
25.8%
Public Health Unit
1
3.2%
Total
31
James and Hudson Bay Coasts
The Coast region has a total of 34 support agencies. The 17 mental health & addictions service providers
make up half of the support service network. This is followed by eight community support service
providers (23.5%), six public health units (17.6%), two community health centres (5.9%), and one
hospital (2.9%). There are no Community Care Access Centres located in the Coast Region.
Table 34: Number of Support Agencies by Sector; James and Hudson Bay Coasts
Support
Agencies
Proportion
1
2.9%
2
5.7%
8
22.9%
Hospital
1
2.9%
17
48.6%
Public Health Unit
6
17.1%
Sector
Total
35
213
Appendix 3
Innovative Housing with Health Supports in Northeastern Ontario:
Financial Modelling Tool (Note: This Financial Modelling Tool can be Accessed at
http://share.hscorp.ca )
Purpose:
In support of the strategy development of the Innovative Housing and Health Supports in
Northeastern Ontario, the North East Local Housing Integration Network (NE LHIN) commissioned
a project to develop a financial modelling tool as the first step to analyze and assess a potential
range of innovative funding mechanisms to aid in the development/ creation, renovation or repurposing of a range of adequate, affordable, safe and energy efficient housing through various
funding mechanisms. This aligns with “Innovative Housing” goal of the Strategic Plan.
Housing Services Corporation (HSC) in consultation with the NE LHIN and the Expert Panel,
created the financial modelling tool27 outlined in the attached spreadsheets. The financial tool is
designed to assist in developing, sustaining, enhancing and growing the affordable housing
supply. The tool templates are to be utilized in undertaking financial analysis and developing a
business case to support decision making when considering financing options to develop
affordable housing in Northern Ontario.
The base model is designed for a new build and financing the project but also integrates four
scenarios such as exploring additional revenue and municipal incentives, undertaking financing
upgrades and retrofits and sub debt.
About the Financial Modelling Tool
The tool is structured to conduct financial analyses to determine the financial structure, shortfall
in financing (if any) and viability of a project. In addition it allows stress testing of a project when
considering various financing options. The templates integrated in the tool enable users to input
information, with variables that can be changed to determine outcome.
The key components of the tool are:
 Project capital cost
o Capital cost structure of a new build or retrofit
 Project funding
o Proponents equity
o Grants (federal, provincial, municipal, other)
o Gifts/donations
o Debt financing required to cover shortfall
 Project operating budget
o Revenue
o Expenses ( building and operational expenses )
 Debt Service Coverage Ratio (see additional explanation for Debt Service
Coverage Ratio)
27
The financial modelling tool and its usability were presented to the Expert Panel and at the 2016 Forum.
214
The model has the ability to factor in supportive services and partnerships but the cooperative
housing example used is for demonstration purposes only and does not include supportive
services data (long term and flexible service agreements).
Using the base model, HSC has stress tested various scenarios as outlined in the spreadsheets
and noted below (PLEASE SEE http://share.hscorp.ca ).
Scenario ( A )
Scenario ( B )
Scenario ( C)
Scenario ( D)
Scenario ( E )
Base Model of a New Build and the Financing the Project
Additional Revenue - Rental space (i.e. Shared Space) for a Service Providers
Additional Municipal Incentives
Financing Upgrades and Retrofits
Sub Debt is introduced to replace equity reduction. Equity is reduced in order leverage
another property.
Users of these models are encouraged to adjust the variables identified to actual conditions
and amounts in order to develop appropriate funding strategies for each of the projects under
consideration. This should be done with a view to arriving at an overall funding strategy to get
to a DSCR that is higher than 1.0, for the housing project they are considering.
BASE MODEL- EXAMPLE
A cooperative housing corporation in Northern Ontario would like to build 34 residential
units. The assumptions used for the base model are:





Funding for these units has been requested from the Ontario Ministry of Housing and
the Canada Mortgage and Housing Corporation (CMHC).
The proposed units will form a seniors’ residence/community living environment.
A needs analysis had been undertaken and the need for such an affordable housing
facility was shown and confirmed.
A longstanding non-profit is willing to address the need and bring forth the project.
The local municipality offered the coop a parcel of land to develop for the proposed
housing facility.
The information for the model was compiled from a variety of actual and considered projects in
Northern Ontario however; the information/examples used by Housing Service Corporation are
for illustration purposes only and do not reflect an actual case.
The Debt Service Coverage Ratio (DSCR) is an indicator of the financial viability of the project.
The ratio signifies the ability of the net operating income (Earnings before interest, taxes,
depreciation, and amortization (EBITDA)) to service the annual principal and interest payments.
To warrant financing and to make the business case to go ahead with developing the housing
under consideration, the Debt Service Coverage Ratio (DSCR) will need to exceed a ratio of 1.0.
DSCR = Net Operating Income (EBITDA)
Total Debt Service
Any debt service coverage ratio below 1.0 indicates that there is not enough cash flow to cover
loan payments. Debt coverage of 1.2 or higher is generally considered sufficient in these types
of projects to achieve adequate funding and ensure that the project can proceed and operate in
a financially sustainable manner.
215
216
/
« Des services de soins primaires de qualité,
sensibles à la culture et accessibles en
français à Timmins »
Rapport final
Examen des
services de soins
primaires
destinés aux
francophones de
Timmins
Août 2016
217
L’information présentée dans ce document provient de données disponibles publiquement, de discussions et
échanges avec diverses organisations publiques et privées, de sites Web ainsi que de consultations menées
auprès de professionnels de la santé et la population francophone de Timmins. Elle constitue le portrait qui a été
peint à partir de ces diverses sources d’information, mais ne se veut pas un inventaire parfaitement juste et
exhaustif de la situation. Le lecteur de ce document doit garder cette réalité à l'esprit en le parcourant.
PGF CONSULTANTS INC.
202-291, RUE DALHOUSIE
OTTAWA (ONTARIO) K1N 7E5
BENOÎT HUBERT, PRÉSIDENT
TÉL. : (613) 241-2251 POSTE 237
TÉLÉC. : (613) 241-2252
COURRIEL : [email protected]
218
Examen des services de soins primaires
destinés aux francophones de Timmins
Rapport final
TABLE DES MATIÈRES
Sommaire exécutif .................................................................................................................................... 1
1. Introduction............................................................................................................................................ 8
1.1 Mise en contexte ........................................................................................................................ 8
1.2 Compréhension du mandat ........................................................................................................ 9
1.3 Approche ................................................................................................................................... 9
2. Revue de littérature ............................................................................................................................. 12
2.1 Un système en évolution .......................................................................................................... 12
2.2 Modèles de soins et modèles de rémunération ........................................................................ 13
2.3 Nouvelles tendances ................................................................................................................ 16
2.4 Soins primaires et statut linguistique minoritaire ....................................................................... 19
3. Profil démographique, socio-économique et de santé .................................................................... 22
3.1 Profil démographique de la population francophone de Timmins ............................................. 22
3.2 Profil socio-économique de la population francophone de Timmins ......................................... 24
3.3 Profil de santé de la population francophone de Timmins ........................................................ 28
3.4 Discussion................................................................................................................................ 35
4. Inventaire des services de soins primaires ...................................................................................... 37
4.1 L’offre de services de soins primaires en français .................................................................... 38
4.2 Discussion................................................................................................................................ 45
5. Compte-rendu des discussions avec les professionnels de la santé et avec la communauté ... 47
5.1 Ce qui a été entendu lors des discussions avec les professionnels .......................................... 47
5.2 Ce qui a été entendu lors de la consultation avec la communauté ........................................... 50
5.3 Discussion................................................................................................................................ 54
6. Conclusions et recommandations..................................................................................................... 56
6.1 Conclusions ............................................................................................................................. 56
6.2 Recommandations ................................................................................................................... 61
Bibliographie sélective ........................................................................................................................... 70
Annexe 1 : Comparaison de certains coûts pour une Équipe de santé familiale et un Centre de
santé communautaire ............................................................................................................................. 72
Annexe 2 : Questionnaire destiné aux professionnels de santé ........................................................ 73
Annexe 3 : Questionnaire destiné à la population ............................................................................... 74
219
RLISS du Nord-Est
i
220
Rapport final
SOMMAIRE EXÉCUTIF
Au Canada, les communautés de langue officielle vivant en situation minoritaire représentent plus de 2
millions d’habitants, dispersés sur tout le territoire. Ces communautés sont confrontées à des barrières
systémiques d’accès aux ressources et services dans leur langue officielle première, particulièrement
dans le domaine de la santé. Plusieurs recherches récentes menées au Canada, notamment en
Ontario, confirment d’ailleurs les inégalités en matière de santé pour les communautés francophones
en situation minoritaire. Cette situation est de plus en plus décriée par les communautés elles-mêmes
en quête d’une meilleure offre et d’un meilleur accès à des services de santé en français de qualité.
C’est dans ce contexte qu’un examen des services de soins primaires destinés aux francophones de
Timmins devenait de plus en plus nécessaire.
Le Réseau local d’intégration des services de santé (RLISS) du Nord-Est a retenu les services de PGF
consultants pour procéder à cet examen. L'objectif global de l'examen était de définir une vision, étayée
par des données et des recommandations, en vue d’améliorer la prestation de services de soins
primaires destinés aux francophones de Timmins, et d'élaborer un plan à court et à long terme. De
façon plus précise, les objectifs suivants étaient visés :
-
Entreprendre une revue de la littérature portant sur les pratiques se fondant sur les données
probantes et les pratiques exemplaires, y compris les modèles de soins. Cette revue de la
littérature permettra de guider l’examen
Dresser le profil socioéconomique et démographique des francophones habitant la Ville de
Timmins, qui fournira des renseignements permettant de guider l’examen
Rassembler des informations sur les services de soins primaires offerts dans la Ville de
Timmins afin d’élaborer une analyse de l’état actuel et de guider l’analyse des besoins non
satisfaits et des lacunes dans cette communauté
Mobiliser la communauté francophone pour qu’elle participe à la validation de l’analyse de l’état
actuel, à la détermination des besoins non satisfaits et des lacunes et à la formulation de
recommandations visant l’amélioration du continuum des services de soins primaires dans la
communauté
Revue de littérature
La littérature parle abondamment des divers défis en lien avec les systèmes de santé en occident,
lesquels pourraient se résumer ainsi : une population vieillissante nécessitant davantage de soins, une
augmentation de la prévalence de maladies chroniques et de comorbidité, l’accès à de nouvelles
technologies et traitements, un accès limité à des services sociaux, ainsi que des attentes de plus en
plus grandes de la part des patients.
Dans ce contexte, la revue de littérature a permis de constater de quelle façon le système de santé de
l’Ontario se transforme pour s’adapter à un environnement en constante évolution. Depuis plusieurs
années, de nouveaux modèles de soins primaires ont été mis en place, laissant de moins en moins de
médecins en pratique privée. Ces nouveaux modèles misent ainsi sur une plus grande intégration des
diverses composantes du système. De plus, de nouveaux modèles en cours d’étude pourraient voir le
jour au cours des prochaines années. Ces changements à venir pourraient constituer une opportunité
en ce qui a trait à l’amélioration des services pour les communautés francophones en situation
minoritaire de la province.
Chacun des modèles de soins primaires en place en Ontario a ses caractéristiques propres, et ils sont
assortis de divers modèles de rémunération qui, aussi, les différencient. Ainsi, certains modèles
semblent mieux adaptés que d’autres pour répondre à des besoins particuliers ou à une clientèle
particulière. Par contre, peu d’études viennent différencier de façon précise les divers modèles ou
affirmer qu’ils répondent de façon optimale à des situations particulières.
221
RLISS du Nord-Est
1
Rapport final
Par ailleurs, beaucoup d’études ont été faites sur les défis particuliers des communautés de langue
officielle en situation minoritaire au niveau de la santé, que ce soit en lien avec les déterminants de la
santé, avec l’état de santé de la population, ou avec les difficultés à accéder à des soins dans sa
langue. Certains modèles mis en place dans des communautés francophones hors-Québec sont
d’ailleurs forts intéressants, tel que c’est le cas pour le Centre de santé communautaire Saint-Thomas
(Alberta) et le Centre Albert-Galliot, Centre de bien-être (Manitoba). Ceux-ci semblent bien répondre
aux besoins de leur communauté.
Profil démographique, socio-économique et de santé
Les déterminants de la santé sont des éléments ou caractéristiques d’une population qui permettent
d’estimer la santé probable de cette même population. Bien que la relation entre ces éléments et la
santé ne soit pas directe, les déterminants constituent une lentille intéressante à travers laquelle il est
possible de mieux cerner la santé d’une population et par extension, les besoins en matière de santé
pour cette même population. Ainsi, le niveau de revenu et le statut social, le niveau d’éducation,
l’emploi et les conditions de travail, les habitudes de vie, le système de santé ainsi que les
environnements physiques et sociaux constituent les déterminants les plus importants.
À l’aide de divers indicateurs socio-économiques comparant francophones et anglophones à Timmins,
l’analyse nous a permis de constater que certaines caractéristiques socio-économiques de la
population francophone étaient d’ailleurs directement liées à d’importants déterminants de la santé.
Ainsi, les francophones de Timmins ont des niveaux d’éducation plus bas ou une éducation davantage
axée sur les métiers comparativement à la majorité anglophone. De plus, ils occupent des emplois
nécessitant moins d’éducation et sont dans des environnements de travail plus à risque.
Bien que l’âge ne soit pas un déterminant de la santé en tant que tel, elle est directement liée à l’état
de santé. Une population plus âgée fait davantage appel au système de santé alors que la fréquence et
la complexité des interventions croît avec l’âge. La ville de Timmins comptait 43 165 habitants en 2011,
dont 15 895 personnes disant avoir le français comme langue maternelle, représentant 37,2% de la
population. L’analyse a révélé que cette population francophone était significativement plus âgée que la
majorité anglophone, et que cette tendance risquait d’aller en s’accentuant au cours des prochaines
années étant donné la structure démographique de cette population.
Par manque de données, il a été plus difficile de dresser le profil de santé de la population de Timmins,
et plus spécifiquement la santé des francophones. Quoi qu’il en soit, au niveau provincial, les données
nous révèlent que de façon générale, les francophones font moins bonne figure que les anglophones
sur la plupart des indicateurs de santé : indicateurs liés au bien-être, indicateurs liés aux
comportements ayant une incidence sur la santé, indicateurs sur l’état de santé, ainsi qu’autres
indicateurs n’appartenant pas à l’une de ces catégories. Les données nous révèlent aussi que la
situation est pire au niveau de la région socio-sanitaire de Porcupine où la population de Timmins et les
francophones ont un grand poids.
En considérant le profil démographique de la population francophone de Timmins, certaines
caractéristiques socio-économiques de cette population ainsi que ce qui ressort des données sur la
santé au niveau de la province et de la région socio-sanitaire de Porcupine, il est possible par
extrapolation d’en conclure que les francophones de Timmins sont probablement confrontés à des
défis particuliers au niveau de la santé, et davantage que la population anglophone majoritaire. Les
données fournies par l’hôpital viennent d’ailleurs corroborer ce constat, du fait que les services liés aux
défis de santé les plus importants sont fréquentés dans une grande proportion par les francophones,
l’âge de ceux-ci y étant pour quelque chose.
Services de soins primaires offerts à la population francophone
L’analyse des services de soins primaires offerts à Timmins a révélé que la plupart des fournisseurs de
services et de soins sur le territoire de la ville sont en mesure d’offrir un grand nombre de services en
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français, mais que cette offre n’est pas égale d’un fournisseur de services et de soins à l’autre, ni n’est
constante ou gérée avec la même rigueur. Certains fournisseurs semblent avoir misé grandement sur
l’offre de services en français, entre autres en demandant la désignation sous la Loi sur les services en
français de l’Ontario et/ou en ayant en place des politiques à cet égard (en lien avec l’offre active, etc.).
D’autres fournisseurs disent s’assurer de l’offre de tels services, mais sans la présence de politiques
claires à cet effet. Dans d’autres cas, l’offre n’est pas institutionnalisée, mais la présence d’employés
ayant la capacité de parler français constitue la façon de répondre à la demande de services en
français.
Il en résulte que les services ne sont pas toujours offerts en français, et dans une moindre mesure
dans le cas de services de prévention et de promotion de la santé. L’offre ne se fait donc pas
systématiquement dans les deux langues officielles. Nos échanges avec les fournisseurs de services et
de soins ont révélé deux raisons pour cette différence : demande pour des services en français ne
justifiant pas l’offre, manque de ressources humaines ayant la capacité de travailler en français. Pour
ce dernier point, il semble que le défi soit rehaussé lorsqu’il s’agit de professionnels davantage
spécialisés. Ce défi est d’ailleurs bien réel et est présent dans l’ensemble des communautés
francophones minoritaires en Ontario.
Consultations
Des discussions ont été menées avec des professionnels de la santé ainsi qu’avec la population
francophone de la ville de Timmins visant à mieux comprendre leur point de vue concernant les
services offerts à la population francophone, les lacunes, ainsi que les solutions possibles.
Les professionnels ainsi que la communauté ont tous deux reconnu certaines lacunes dans le
système : l’accès à des services spécialisés en français et l’intégration et la coordination des diverses
composantes des soins de santé primaires. L’offre active a été identifiée comme étant problématique
par les professionnels et la communauté, mais les professionnels voyaient le problème comme étant lié
à la faible demande pour des services en français, alors que pour la population francophone, le
problème était plutôt lié au manque d’offre active.
Les améliorations suggérées par les professionnels consultés ont été variées, passant par la mise sur
pied d’un Centre de santé communautaire à gouvernance francophone avec une programmation de
services bien intégrée aux services existants, l’amélioration des services en français existants par une
meilleure intégration et coordination de ceux-ci, une augmentation des programmes de promotion de la
santé et prévention de la maladie en français et un continuum de services en français plus complet
pour le traitement des maladies chroniques.
La communauté francophone de Timmins considère qu’elle doit fournir des efforts importants pour sa
survie. Nombre des défis qu’elle rencontre portent atteinte à sa pérennité et à son épanouissement.
Selon la communauté, des demandes répétées sans suites apparentes pour l’obtention de services de
santé en français, de qualité égale à ceux offerts en anglais, est un défi qui s’ajoute aux autres. Une
iniquité importante entre les services offerts en français et ceux offerts en anglais a été identifiée
comme étant la principale source de frustration des francophones. Ceux-ci ont exprimé leur lassitude
devant les vains efforts depuis plusieurs années l’obtention de services de santé en français.
La communauté a donc massivement proposé la mise sur pied d’un Centre de santé communautaire
comme étant la solution la plus susceptible de combler les lacunes identifiées. Notre analyse des
discussions nous porte à croire que la communauté prône la mise sur pied d’un tel centre sans
nécessairement être au fait des lacunes dans l’offre de soins en français qu’un tel centre pourra et ne
pourra pas combler, puisqu’il ne pourra les combler toutes. Quoi qu’il en soit, la communauté a parlé
haut et fort.
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Recommandations
L’analyse et la recherche effectuées dans le cadre de cette étude sur les besoins de santé des
francophones de Timmins nous ont conduits à l’identification de huit considérations essentielles pour le
développement de recommandations. D’une part, elles ont été retenues de par leur omniprésence dans
la littérature sur l’accès aux services de santé pour les populations minoritaires. D’autre part, elles ont
été évoquées à maintes reprises lors des entretiens avec les membres de la communauté ainsi que les
professionnels de la santé de Timmins. Ces considérations forment donc le cadre d’analyse ayant servi
à la formulation des recommandations. Les 8 considérations essentielles sont les suivantes :
- Mission/mandat francophone
- Gouvernance
- Lieu de service de type « communautaire »
- Cohérence et liaison avec la promotion de la santé
- Capacité d’aiguillage
- Cadre/contexte politique
- Ancrage communautaire
- Données significatives, probantes et accessibles
De manière globale, nous croyons que le RLISS du Nord-Est devra procéder à une importante
réorganisation des services de santé primaire pour mieux répondre aux besoins de la population
francophone de Timmins. Bien que le RLISS ne puisse agir qu’à l’intérieur des paramètres régissant
son mandat, il devra, en collaboration et en concertation avec le Ministère de la santé et des soins de
longue durée (MSSLD) et autres ministères concernés, assumer un réel leadership dans la résolution
des nombreux défis reliés à l’offre de services de santé adéquats pour les francophones de Timmins.
Pour guider les actions qui contribueront à l’amélioration des services destinés aux francophones de
Timmins, nous proposons la vision suivante :
« Des services de soins primaires de qualité, sensibles à la culture et
accessibles en français à Timmins »
La mise sur pied d’un Centre de santé communautaire francophone a clairement été identifiée comme
étant la solution la plus susceptible de répondre aux lacunes dans l’offre de services en français par les
personnes rencontrées lors de la consultation avec la communauté. Notre analyse nous porte à croire
qu’un tel centre pourrait définitivement combler plusieurs des lacunes identifiées, mais ne les
comblerait pas toutes. Cela ne devrait donc pas constituer la seule stratégie pour améliorer l’offre de
services de soins primaires et de prévention et promotion de la santé en français à Timmins.
Ainsi, les recommandations émises dans ce rapport vont dans le sens de la mise sur pied d’un Centre
de santé communautaire, mais nous proposons également un ensemble de mesures additionnelles afin
de rehausser la prestation de services en français dans l’ensemble du système à Timmins. Ces autres
mesures devraient être mises en place indépendamment de la mise sur pied d’un Centre de santé
communautaire, et pourraient à elles seules constituer une nette amélioration dans l’offre de services
de soins primaires à la population francophone de la ville de Timmins.
Voici donc les recommandations que nous proposons, constituant ainsi le plan à long terme qui
permettra d’améliorer la prestation de services de soins primaires destinés aux francophones de
Timmins.
Recommandation no 1
Que le RLISS, en collaboration avec le Réseau du mieux-être francophone du Nord de l’Ontario
(RMEFNO), mette sur pied un Comité (du RLISS) permanent de coordination et d’intégration des
services de santé en français à Timmins qui veillera notamment à la mise en œuvre des
recommandations contenues dans le présent rapport. Le comité devra être représentatif de la
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communauté et des fournisseurs de services et de soins, et partenaires impliqués dans la prestation de
services de santé destinés à la population francophone.
Recommandation no 2
Que le MSSLD et le RLISS collaborent dans le but de mettre sur pied un Centre de santé
communautaire à gouvernance francophone, destiné à servir la population francophone de la ville de
Timmins.
Recommandation no 3
Que le RLISS, par le biais de son Comité permanent, entame dès que possible des dialogues
bilatéraux avec les principaux fournisseurs de services et de soins de santé désignés et identifiés afin
de leur exposer la problématique de l'insuffisance de services de santé en français et d'explorer des
pistes ou initiatives d'amélioration réalistes pouvant avoir des impacts à court terme.
Recommandation no 4
Que le RLISS, par le biais de son Comité permanent, développe une stratégie de promotion des
services de santé disponibles en français, de concert avec les fournisseurs de services et de soins
ainsi que le RMEFNO. De plus, le RLISS se doit de collaborer avec les fournisseurs et partenaires de
la santé publique pour que les informations sur les services en français partagées avec le grand public
soient à jour. Une fois la programmation du Centre de santé communautaire définie, le RLISS et le
Comité permanent devraient ajouter ces informations à la promotion effectuée auprès de la
communauté.
Recommandation no 5
Que le RLISS soutienne de manière active le Centre de santé communautaire francophone dans la
détermination de la programmation initiale du Centre de santé communautaire en collaboration avec
les fournisseurs de services et de soins de Timmins ainsi que le Comité permanent. Le leadership du
RLISS sera essentiel afin d’optimiser l’offre de services en français et de compléter l’offre de services
actuelle et dans l’objectif d’accroître les synergies au profit de la population francophone, tout en
considérant la revue documentaire de cette étude, ainsi que les orientations relevant de la
transformation en cours du système de santé.
Recommandation no 6
Que le RLISS assure la surveillance de la mise en place et du maintien de la représentation
francophone au sein de la gouvernance des fournisseurs de services et de soins désignés et identifiés,
et que le RMEFNO, en collaboration avec la communauté francophone de Timmins, identifie des
moyens par lesquels accroître la participation des francophones à la gouvernance des fournisseurs de
services et de soins identifiés et désignés.
Recommandation no 7
Que le RLISS, considérant la transformation actuelle du système de santé, et en collaboration avec le
Bureau de santé de Porcupine, le RMEFNO, les autres fournisseurs de services et de soins et les
autres acteurs sectoriels appropriés, révise les stratégies de promotion de la santé et de prévention
des maladies destinées à la population francophone de Timmins afin de mieux intégrer et coordonner
les différentes composantes du système et ainsi mieux desservir cette population.
Recommandation no 8
Que le RLISS, en collaboration avec les médecins en santé primaire et les organisations pour
lesquelles ils livrent des services, mette en place des mécanismes de coordination afin de faciliter le
maillage entre les patients francophones et les médecins étant en mesure de les servir en français.
Ces mécanismes pourraient s’intégrer aux efforts d’appariement des patients orphelins de Timmins. Le
RLISS pourrait éventuellement suggérer au MSSLD que cette problématique ainsi que celles reliées à
l’amélioration de l’offre de services de santé en français à Timmins soient soulevées au Comité
consultatif du ministre de la santé pour discussion.
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Recommandation no 9
Que le RLISS crée ou désigne un poste voué à l’aiguillage et à la navigation du système de santé en
français pour la population francophone de Timmins. La personne occupant ce poste pourrait par le fait
même faire de la sensibilisation auprès des fournisseurs de services et de soins sur l’importance de
l’offre active de services en français.
Recommandation no 10
Que le Comité permanent du RLISS travaille de concert avec Professions Santé Ontario afin de
développer, pour les postes cliniques et médicaux jugés les plus critiques (et en lien avec les
prévalences dominantes), une stratégie d’attraction et de rétention de ressources humaines
francophones en santé, conjointement avec les principaux fournisseurs de services et de soins dans la
ville, incluant l’hôpital de Timmins, ainsi que les établissements d’enseignement du nord de l’Ontario.
Cette stratégie devrait s’inspirer du Plan d’action sur les ressources humaines en santé en français en
Ontario à l’étude par le MSSLD.
Afin que puissent être livrés des soins primaires sécuritaires et de qualité, que le RLISS appuis
l'élaboration d’ententes particulières avec des établissements francophones, bilingues ou ayant les
ressources recherchées (au niveau des spécialités), pour augmenter la disponibilité de spécialistes
francophone par le biais de technologies modernes afin de combler l’offre de services n’étant pas
disponibles à Timmins et mieux structurer la visite de spécialistes externes dans la ville. Cette
programmation de services externes pourrait ensuite faire partie intégrante des efforts de promotion du
RLISS auprès de la population francophone.
Que le RLISS développe une stratégie afin d’améliorer la collecte de données sur les francophones par
les fournisseurs de services et de soins et qu’il révise son approche de planification des services pour
les francophones de la ville de Timmins, afin qu’elle soit davantage axée sur les données, en :
- Dressant un inventaire des données disponibles (incluant la variable linguistique des sites
pouvant en faire la collecte)
- Systématisant le suivi auprès des fournisseurs devant capter la variable linguistique à la fois sur
la langue maternelle ainsi que la langue de choix du patient
- Utilisant le résultat de l’analyse de ces données afin de planifier le déploiement de l’offre de
services en français à Timmins
- Partageant ces données avec le RMEFNO afin de mieux informer les conseils qu’il offrira au
RLISS sur la planification des services aux francophones
Que le RLISS révise ses exigences de reddition de compte envers les fournisseurs de services et de
soins désignés et insère dans les ententes de responsabilisation de ces établissements une clause
reliée à l’atteinte et au respect des critères de désignation en vertu de la Loi sur les services en
français.
Que le RLISS, par l’entremise des ententes de responsabilisation, exige des fournisseurs de services
et de soins identifiés, incluant les équipes de santé familiale, qu’ils adoptent des politiques
linguistiques, des stratégies reliées à l’offre active et des documents promotionnels dans les deux
langues officielles. De plus, le RLISS devrait exiger que ces politiques soient rendues publiques ou qu’il
y ait un mécanisme prévu en ce sens, pour que la population sache ainsi à quoi s’attendre en termes
de services en français.
Que la communauté francophone, en partenariat avec le RMEFNO, mette en place des mécanismes
formels et informels de valorisation de l’offre de services proactifs de santé en français à Timmins,
créant ainsi des modèles accessibles et inspirants pour toute la communauté.
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1. INTRODUCTION
En guise d’introduction, nous décrivons dans cette section le contexte dans lequel cette étude s’inscrit,
le mandat qui a été donné à PGF Consultants ainsi que les différentes étapes qui ont guidé l’examen et
mené à l'élaboration de recommandations et à la finalisation du présent rapport.
1.1 MISE EN CONTEXTE
À Timmins, la communauté francophone représente près de 40% de la population totale. Une telle
population vivant en situation minoritaire est souvent confrontée, comme démontré par des études, à
des obstacles systémiques qui limitent l’accès à des ressources et à des services de santé dans la
langue de la minorité. Ces barrières linguistiques ont un effet sur l'accès aux services de santé et
interfèrent avec la compréhension et l'adhésion aux plans de traitement, la qualité des soins, la
satisfaction des fournisseurs de services et de soins ainsi que celle des patients.
D’autres études ont également analysé l'accès différentiel et les déterminants de la santé qui résultent
des disparités de santé entre les populations de langue officielle en situation minoritaire et majoritaire.
De façon générale, la population vivant en situation minoritaire est davantage âgée que la majorité, est
moins éduquée et a un revenu inférieur. En lien avec ceci, les diverses données sur la santé
démontrent que la population au sein de ces communautés est confrontée à des défis liés au mode de
vie (embonpoint, tabagisme, etc.) et à la santé (santé perçue, prévalence de maladies chroniques,
etc.).
Il est impératif de tenir compte des déterminants de la santé dans l'analyse des besoins en matière de
services destinés à une communauté en situation linguistique minoritaire, ainsi que des obstacles à
l'accès à des services dans la langue de cette minorité. Ces disparités et obstacles à l'accès aux
services, ainsi que les différences dans les déterminants de la santé entre majorité et minorité
semblent être au cœur de préoccupations importantes pour la communauté francophone de Timmins.
Depuis plus d'une décennie, l'Ontario a apporté des changements importants à son système de soins
primaires afin d’en améliorer la qualité et l'accès, tout en améliorant le recrutement et la rétention des
médecins de famille. Alors que par le passé, les médecins de famille pratiquaient souvent seuls ou
évoluaient en très petits groupes, la plupart d'entre eux font maintenant partie d’un des modèles
rassemblant plusieurs médecins et autres professionnels de la santé.
Un secteur des soins primaires fort est désormais considéré comme une base solide pour un système
de santé performant alors que les besoins de la population évoluent. C’est la raison pour laquelle
l'Ontario a mis l'accent sur le renforcement de la prestation de soins primaires dans la province au
cours des dernières années.
Les modèles de soins primaires sont de formes variées, et se sont implantés progressivement au cours
des années. Notons par exemple les Équipes de santé familiale, les Centres de santé communautaire,
les Réseaux de santé familiale, les Groupes de santé familiale et les Cliniques dirigées par des
infirmières-praticiennes. En outre, les services de promotion et de prévention de la santé sont fournis
par un éventail d'organismes communautaires et de santé publique, de même que par plusieurs des
modèles cités plus haut.
Un système en transformation, une population vieillissante, des besoins en évolution et une population
en situation minoritaire confrontée à des défis de santé et d’accès aux soins sont tous des éléments
contextuels qui viennent appuyer le besoin de mieux comprendre la situation dans son ensemble, ainsi
que les particularités propres à une communauté comme la communauté francophone de Timmins.
C’est avec ce contexte en toile de fond que nous avons entrepris le présent mandat.
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1.2 COMPRÉHENSION DU MANDAT
Ce mandat consistait à rassembler des informations pour dresser le profil démographique et socioéconomique de la communauté francophone de Timmins, et rassembler des informations sur les
services de soins primaires actuellement offerts dans la ville de Timmins selon la langue. Dans le cas
de la présente étude, les soins primaires incluaient les services de promotion et de prévention de la
santé. Cette information devait par la suite servir à informer le RLISS du Nord-Est et la communauté
francophone sur l'état des services fournis, et devait aider à évaluer les besoins et les lacunes, surtout
en ce qui a trait à la capacité actuelle de fournir des services de soins primaires en français. L’accent
devait être mis sur la façon dont les services pouvaient être ajustés pour améliorer la santé de cette
population, ainsi que la performance du système.
L’Alliance de la francophonie de Timmins plaide depuis plusieurs années pour la mise sur pied d’un
Centre de santé communautaire. Or, aucune étude exhaustive n’avait été faite, permettant de bien
comprendre les lacunes dans l’offre de services, et les façons de les combler, que ce soit par la mise
sur pied d’une Centre de santé communautaire, par l’entremise d’autres initiatives, ou par une
combinaison des deux. Des considérations pour l’offre active étaient très importantes dans l'analyse
des besoins en matière de services de soins primaires pour la communauté francophone, en particulier
dans l'estimation des besoins non satisfaits.
Le RLISS du Nord-Est souhaitait engager la communauté francophone dans ce processus, en
collaboration avec le Comité consultatif mis sur pieds par le RLISS pour guider le présent examen.
C’est ainsi qu’une phase de consultation avec la communauté était prévue dans la réalisation de ce
mandat.
L'objectif global de l'examen était de définir une vision, étayée par des données et des
recommandations, d'élaborer un plan à court et à long terme pour améliorer la prestation de services
de soins primaires à cette population. De façon plus précise, les objectifs suivants étaient visés :
-
-
Dresser le profil socioéconomique et démographique des francophones habitant la Ville de
Timmins, qui fournira des renseignements permettant de guider l’examen
Entreprendre une revue de la littérature portant sur les pratiques se fondant sur les données
probantes et les pratiques exemplaires, y compris les modèles de soins. Cette revue de la
littérature permettra de guider l’examen
Rassembler des informations sur les services de soins primaires offerts dans la Ville de
Timmins afin d’élaborer une analyse de l’état actuel et de guider l’analyse des besoins non
satisfaits et des lacunes dans cette communauté
Mobiliser la communauté francophone pour qu’elle participe à la validation de l’analyse de l’état
actuel, à la détermination des besoins non satisfaits et des lacunes et à la formulation de
recommandations visant l’amélioration du continuum des services de soins primaires dans la
communauté
Présenter une vision, appuyée par les données, et un plan à long terme qui permettra
d’améliorer la prestation de services de soins primaires destinés aux francophones de Timmins
1.3 APPROCHE
L’approche qui a été prise pour la réalisation de ce mandat reposait sur des facteurs de succès tels
qu’une bonne collaboration entre le RLISS du Nord-Est, le Comité consultatif et le consultant, ainsi que
l’accès à des données pertinentes en temps opportun. Tout au long du processus, PGF Consultants a
eu des interactions avec le Comité, le RLISS, les membres du Comité de façon individuelle, ainsi
qu’avec divers acteurs clés dans le système, que ce soit au niveau provincial, ou auprès des
fournisseurs de services et de soins.
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Au total, quatre rencontres se sont tenues entre le Comité consultatif et PGF Consultants, permettant
de valider et de renforcer le processus à chacune des étapes-clés, et permettant l’avancement du
projet jusqu’à sa finalisation.
Les étapes suivantes ont permis la réalisation du projet.
Étape 1 : Coup d'envoi
Une rencontre de démarrage entre le consultant et le client visait à lancer le projet et à s’assurer que
toutes les exigences organisationnelles étaient en place pour la livraison en temps opportun du
mandat.
Étape 2 : Collecte et analyse des données
La deuxième étape consistait à recueillir et analyser des données pertinentes qui permettraient de
dresser un profil de la population francophone de Timmins ainsi qu’un inventaire des services
actuellement offerts pour cette population. Cette étape a été divisée en trois parties :
-
Profil démographique et socio-économique de la population francophone de la ville de Timmins
Profil de santé de la population francophone de la ville de Timmins
Inventaire des services de soins primaires actuellement offerts dans la ville de Timmins
Dans la mesure du possible, les sources de données primaires ont été utilisées. Dans le cas de
l’inventaire des services de soins primaires, les données ont été recueillies auprès des divers
fournisseurs de services et de soins.
Étape 3 : Revue de littérature
Une revue de littérature a été réalisée, s’attardant aux facteurs de changement dans l’environnement
des soins primaires, aux défis particuliers de la santé en situation minoritaire, aux divers modèles de
soins ainsi qu’aux meilleures pratiques en la matière.
Étape 4 : Validation auprès de professionnels de la santé
Suite à l’analyse de données réalisée à l’étape 2, nous avons voulu valider certains des constats avec
des professionnels de la santé sur le terrain, et augmenter le tout avec des questions ciblées
concernant les défis particuliers pour la population francophone de Timmins ainsi que les façons d’y
remédier. Ainsi, 11 entrevues dirigées ont été réalisées.
Étape 5 : Consultation auprès de la communauté
Une étape importante de ce projet était d’engager la communauté francophone de Timmins dans la
discussion pour ainsi mieux cerner sa façon de considérer les lacunes dans le système de soins
primaires, et obtenir de celle-ci des pistes de solution. Ainsi, une consultation ciblée a été réalisée,
rassemblant une quarantaine de participants.
Étape 6 : Rédaction d’un rapport préliminaire
Un rapport préliminaire a été soumis au RLISS du Nord-Est le 31 mai 2016, rassemblant l’essentiel de
l’information recueillie et permettant de présenter les principaux constats qui se dégageaient de
l’analyse. À la lumière des résultats obtenus, ce rapport préliminaire comportait aussi une liste de
recommandations visant l’amélioration des services destinés aux francophones de Timmins. Suite à
des échanges entre le RLISS et le consultant, un rapport préliminaire révisé a été partagé avec les
membres du Comité pour leurs rétroactions.
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Étape 7 : Finalisation du rapport
Le RLISS du Nord-Est et le Comité ayant pu réagir au rapport préliminaire, PGF Consultants a fait les
changements nécessaires en vue de sa finalisation, constituant la dernière étape de ce mandat, et dont
le présent document en est le fruit.
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2. REVUE DE LITTÉRATURE
Une revue de littérature, rehaussée d’informations disponibles sur le site Web du MSSLD entre autres,
nous a permis de nous attarder aux modèles de soins primaires actuellement en place en Ontario ainsi
qu’aux meilleures pratiques en contexte minoritaire. Ainsi, la revue de littérature commence par le
contexte évolutif des services de soins primaires en Ontario puis brosse un portrait des modèles en
place dans la province, incluant les divers modèles de rémunération de la médecine familiale. Par la
suite, d’autres modèles de soins en milieu minoritaire sont considérés, de même que les nouvelles
tendances en la matière.
2.1 UN SYSTÈME EN ÉVOLUTION
Les services de soins primaires sont essentiels au bon fonctionnement d’un système de santé
performant. L’augmentation de l’incidence de maladies chroniques et le vieillissement de la population
exigent de plus en plus de soins de santé primaire accessibles et bien intégrés à l’ensemble du
système. Des soins de santé primaire efficaces et efficients se traduisent de meilleurs résultats de
santé pour une population et réduisent les coûts reliés à la santé dans son ensemble (Starfield et al,
2005; Atun, 2004). De plus, des études récentes ont démontré que des soins de santé primaire
performants réduisent les admissions évitables dans les hôpitaux et les années potentielles de vie
perdues (KPMG, 2014).
Les soins de santé primaires font partie d’un ensemble de services s’inscrivant dans un continuum
allant de la promotion de la santé et prévention des maladies, jusqu’aux soins de longue durée.
Autrefois, l’offre de services était limitée à un nombre restreint d’acteurs qui travaillaient souvent de
façon isolée…
…comparativement à aujourd’hui où un grand nombre d’acteurs sont à l’œuvre dans un système de
plus en plus centré sur les besoins du patient et où l’intégration s’impose.
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Le modèle traditionnel de soins de santé primaire au Canada a été celui du médecin de famille
pratiquant seul ou en groupe et étant rémunéré à l’acte. Au cours de la dernière décennie, les
provinces et territoires ont tenté d’améliorer la performance de leur système de santé en apportant des
améliorations aux soins de santé primaire. Ces améliorations ont porté sur des modifications aux
systèmes de paiement des médecins, l’introduction du travail en équipe interdisciplinaire et sur des
efforts pour mieux coordonner les services.
2.2 MODÈLES DE SOINS ET MODÈLES DE RÉMUNÉRATION
L’Ontario, à l’instar des autres juridictions canadiennes, est passée au cours des dernières années d’un
modèle de soins de santé primaire axé surtout sur des médecins pratiquant seuls à une variété de
modèles de soins et de rémunération. En voici les principales composantes :
Les Équipes de santé familiale
Depuis 2005, 184 équipes de santé familiale ont été mises en place desservant la population dans plus
de 200 collectivités de la province. Les équipes de santé familiale sont des organismes de soins de
santé primaires, chacune comprenant une équipe de médecins de famille, d'infirmières praticiennes,
d'infirmières autorisées, de travailleurs sociaux, de diététistes, d'agents de promotion de la santé et
d'autres professionnels travaillant de concert pour offrir des soins de santé plus complets.
Ces équipes veillent à ce que les personnes reçoivent les soins dont elles ont besoin dans leurs
collectivités, car chaque équipe est créée en fonction de la collectivité et des besoins locaux en matière
de santé. Les équipes de santé familiale ont été mises sur pieds pour offrir un plus large accès à des
services complets de soins de santé familiale dans l'ensemble de l'Ontario. Les équipes de santé
familiale relèvent d’un conseil d’administration dont la composition varie grandement d’une équipe à
l’autre, de faible à forte représentation communautaire.
Les Centres de santé communautaire
Les centres de santé communautaire sont des organismes de soins de santé primaire gérés par la
communauté dans laquelle ils sont implantés. Ils existent depuis plus de quarante ans. Il y en a 73 au
total, dont six francophones. Les Centres de santé communautaire regroupent, sous un même toit, des
services de soins de santé primaires et une vaste gamme de services de promotion de la santé et de
développement communautaire, incluant des programmes et des services visant à atténuer les
problèmes d’ordre social et environnemental qui nuisent à la santé des communautés qu’ils
desservent.
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Chacun des CSC est géré par un conseil d’administration composé de clients, de membres de la
communauté, de fournisseurs de services et de soins ainsi que de chefs de file communautaires. Cette
gouvernance communautaire permet d’orienter plus facilement les services de santé en fonction des
besoins que les membres de la communauté identifient comme étant les plus importants pour eux. Le
conseil d’administration est redevable devant le RLISS, et doit s’assurer que ses activités soient
alignées avec les priorités du RLISS et des divers paliers de gouvernements.
Il existe quatre types de Centres de santé communautaire desservant la communauté francophone.
Certains centres offrent un service presque exclusivement aux familles francophones ou exogames (p.
ex., Centre de santé communautaire de l’Estrie et Centre francophone de Toronto); d’autres offrent des
services aux francophones et aux anglophones en tant que fournisseurs de services et de soins en
français désignés par le gouvernement de l’Ontario (p. ex., Centre de santé communautaire du centreville d’Ottawa); des organismes anglophones non désignés offrent un nombre limité de programmes
ciblés en français par l'entremise de personnel francophone (p. ex., Centre de santé communautaire
TAIBU à Scarborough); et d’autres desservent à la fois les francophones, les anglophones et les
Autochtones (p. ex., Centre de santé communautaire CHIGAMIK à Midland et Lafontaine).
Les Cliniques dirigées par des infirmières praticiennes
En 2007, le gouvernement provincial annonçait la création de cliniques dirigées par des infirmières
praticiennes. Ces cliniques visent une approche interprofessionnelle comprenant un médecin-conseil,
en vue de fournir des services de santé familiale complets, accessibles et coordonnés. Les cliniques
offrent toutes une gamme de services incluant les soins de base ainsi que la promotion de la santé, la
prise en charge de maladies chroniques, le soutien aux personnes atteintes de maladies mentales, la
coordination et l’intégration des soins. Ces cliniques sont dirigées par un conseil d’administration qui
peut inclure une représentation de la communauté, et reçoivent du financement par l’entremise
d’ententes avec la Direction des soins primaires du MSSLD.
Les Organismes de santé familiale et Réseaux de santé familiale
Ces organismes et réseaux sont des groupes de trois médecins ou plus offrant un large éventail de
soins (24/7) à une clientèle inscrite. Ces services incluent la gestion de maladies chroniques, la
prévention ainsi que la promotion de saines habitudes de vie. La principale différence entre ces deux
modèles est la gamme de services offerts qui est plus grande dans le cas des Organismes de santé
familiale. La compensation se fait selon le modèle fondé sur le nombre d’effectifs pondérés plus primes
et incitatifs.
Les Groupes de santé familiale
Les Groupes de santé familiale sont des regroupements de 3 médecins ou plus offrant un large
éventail de soins (24/7) à une clientèle inscrite. La différence avec les Organismes et les Réseaux est
le modèle de compensation qui, dans ce cas-ci, tend vers le paiement à l’acte.
Les Maillons santé
Annoncée en 2012, cette initiative vise à mieux coordonner et de façon plus rapide les soins pour les
patients ayant des besoins importants. Les Maillons santé encouragent une collaboration accrue entre
les fournisseurs de soins au niveau local, incluant les fournisseurs de soins de santé familiale, les
spécialistes, les hôpitaux ainsi que les organismes offrant des soins de longue durée, des soins à
domicile et d'autres services de soutien communautaire.
Grâce à une coordination améliorée et au partage d'information, les patients obtiennent des soins plus
rapidement, attendent moins longtemps pour des services et sont soutenus par une équipe de
fournisseurs de soins de santé à tous les échelons du système. Les fournisseurs conçoivent un plan de
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soins personnalisé pour chaque patient visé et travaillent ensemble auprès des patients et de leur
famille pour s'assurer que ces derniers reçoivent les soins dont ils ont besoin.
Afin d'établir un Maillon santé, une forte représentation de fournisseurs de soins primaires locaux et du
centre d'accès aux soins communautaires est nécessaire. Il existe 69 Maillons santé communautaires
en Ontario et d'autres sont en cours de planification.
Autres modèles
Certains médecins exercent seuls, offrant un large éventail de soins à une clientèle inscrite, et offrant
parfois des services en dehors des heures régulières. Certains de ces médecins ont une pratique
médicale plus ciblée. Ils sont compensés selon le modèle de paiement à l’acte.
Il existe aussi des cliniques spécialisées qui habituellement font souvent partie des services
ambulatoires d’un hôpital. Ces cliniques offrent des services en médecine spécialisée et travaillent en
collaboration avec des équipes interdisciplinaires. Certains médecins spécialistes offrent aussi des
services spécialisés dans la communauté à partir de bureaux privés.
Enfin, les services d’urgences des hôpitaux sont aussi considérés comme des soins de santé primaire,
entre autres parce qu’ils se substituent souvent à ce qui est offert sous d’autres modèles.
Les modèles de rémunération de la médecine familiale en Ontario
La rémunération des médecins en Ontario a grandement évolué au cours de la dernière décennie dans
un effort gouvernemental pour améliorer l’accès aux services médicaux de première ligne et pour en
augmenter sa productivité. Les différents modes de rémunération peuvent être résumés ainsi :
Tableau 1 : Modèles de rémunération de la médecine familiale en Ontario
Modèle
Paiement à l’acte plus certains
incitatifs et primes pour les services
fournis aux patients inscrits
Modèle fondé sur la capitation
pondérée
Modèle fondé sur le nombre
d’effectifs pondérés plus primes et
incitatifs
Modèle fondé sur les salaires
S’applique aux…
-
Modèle de soins complets (médecins exerçant seuls)
Groupe de santé familiale
-
Réseaux de santé familiale
Organismes de santé familiale
Équipes de santé familiale
Groupes de médecins (souvent dans le Nord et les régions
rurales)
-
Centres de santé communautaire
Cliniques dirigées par des infirmières praticiennes
Source : Site Web du MSSLD
Plusieurs études ont été menées tentant de comparer les différents modèles de santé primaire en
Ontario ou ailleurs, mais peu de ces études s’attardent de façon précise sur la différentiation des coûts
pour les divers modèles1. Quoi qu’il en soit, la recension des écrits offre quelques pistes à cet effet.
Une étude de 2012 de l’Institute for Clinical Evaluative Sciences compare les modèles de soins
primaires en Ontario en fonction des données démographiques, de la casuistique et de l’utilisation des
salles d’urgence. Cette étude stipule que sur une population totale de près de 12 millions d’habitants,
près de 3 970 000 fréquentent les Groupes de santé familiale (33,3% du total) suivi des Organismes de
1
Une comparaison de certains coûts pour une Équipe de santé familiale ainsi qu’un Centre de santé
communautaire est présentée à l’annexe 1.
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santé familiale avec une clientèle avoisinant 2 250 000 (18,9% du total). Les Équipes de santé familiale
quant à elles sont fréquentées par près de 1 900 000 clients (15,7% du total), alors que les Centres de
santé communautaire attirent 0,9% du total avec 110 000 clients, et moins de 100 000 pour les
Réseaux de santé familiale (0,8% du total). Le reste fréquente soit un autre modèle (530 000 clients ou
4,5% du total) ou n’ont pas de fournisseur de soins primaires (plus de 3 millions de personnes ou
25,8% du total).
Cette étude a démontré que différents modèles de soins primaires desservent différentes populations
de patients et s’assortissent de différents résultats. Les Centres de santé communautaire se sont
démarqués parce qu’ils procuraient des soins à des populations défavorisées et en moins bonne santé,
et comptaient un nombre de visites des services d’urgence par cette population inférieur à celui prévu.
Les raisons de ces résultats ne sont pas connues et exigent, selon les auteurs, un examen plus
poussé.
Les modèles de paiements par capitation desservent des populations plus défavorisées et présentent
des taux de fréquentation des services d’urgence supérieurs aux prévisions. Le profil de fréquentation
des Réseaux de santé familiale et des Équipes de santé familiale est essentiellement rural tandis que
celui des Organismes de santé familiale est semblable à celui de l’Ontario dans son ensemble.
Comparativement à la moyenne, les patients de ces 3 modèles provenaient de quartiers à revenu
supérieur, avaient beaucoup moins tendance à être de nouveaux arrivants et avaient moins tendance à
recourir au système santé ou à avoir un fort taux de comorbidité. Le nombre de visites des services
d’urgence dans les 3 modèles était supérieur aux prévisions.
Enfin, il est à noter que les auteurs affirment, à la lumière de leurs constatations, qu’il convient de
réexaminer les structures de paiement et d’incitatifs qui sous-tendent les modèles de santé primaire en
Ontario.
Une étude de Kralj et Kantarevic publiée dans le Ontario Medical Review (2012) affirme ce qui suit en
décrivant l’évolution du système de santé primaire en Ontario :
…the physician shortage problem has been considerably reduced, the problem of
unattached patients has improved significantly, access to physicians in after-hour
periods has been enlarged, physician productivity has increased and the switch to
capitation models has improved chronic disease management, especially diabetes care.
2.3 NOUVELLES TENDANCES
Dans les pays développés, les défis en ce qui a trait à la santé primaire ainsi que l’organisation des
soins se ressemblent à plusieurs égards (KPMG, 2014), quoiqu’avec leur contexte spécifique. La
recension des écrits a fait ressortir des défis similaires d’un pays à l’autre :
-
Une population vieillissante nécessitant davantage de soins
Une augmentation de la prévalence de maladies chroniques et de morbidité
L’accès à de nouvelles technologies et traitements
Un accès limité à des services sociaux
Des attentes de plus en plus grandes de la part des patients avec, entre autres, la possibilité
pour ceux-ci de s’informer eux-mêmes sur leur santé (Web)
Au-delà de ces défis, mais aussi pour mieux répondre à ceux-ci, l’organisation des soins tend vers des
modèles davantage intégrés (des pratiques regroupées dans de grands centres de santé
communautaire avec des équipes interdisciplinaires), un peu à l’image de ce qui se fait de plus en plus
ici, et de moins en moins vers des modèles de cliniques avec médecins pratiquant en solo. Ainsi,
plusieurs tendances émergent, visant toujours l’amélioration du système et l’expérience pour le patient.
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La coordination et l’intégration des soins
Certains chercheurs comme Saltman et autres (2006) ont observé que dans certains systèmes de
santé on avait tendance à confier des rôles de plus en plus grands au système de santé primaire dans
la coordination et l’intégration de l’ensemble des soins prodigués par plusieurs fournisseurs de services
et de soins. Ces nouveaux rôles en lien avec les services spécialisés maintenant fournis en milieu de
santé primaire peuvent être considérés comme constituant ce que certains ont appelé « extended
primary care ». Plusieurs pays européens ont expérimenté cette approche afin de mieux arrimer les
services du médecin généraliste qui est souvent le premier contact entre le patient et le système, les
services de médecine spécialisée et de réadaptation ainsi que les soins à domicile.
Au Canada, cette approche retrouve aussi de plus en plus de preneurs. Pensons au récent Rapport
Price Groupes de soins : Un nouveau modèle de soins primaires à la population de l’Ontario (2015) qui
préconise une restructuration importante des soins primaires articulée autour de groupes de soins qui
seraient des organismes détenteurs de fonds tenus de rendre des comptes au MSSLD par
l’intermédiaire des RLISS. Il s’agirait de groupes créés sur une base géographique, un peu à l’image de
ce qui se fait dans le système scolaire. Les citoyens au sein de chacun de ces groupes seraient
rattachés à un groupe de soins, puis intégrés à la liste de patients d’un fournisseur de soins primaires
dont les services seraient retenus par le groupe de soins. Chaque groupe de soins conclurait des
contrats avec des modèles de prestation de services actuellement en place (Centres de santé
communautaires, Groupes de santé familiale, Organismes de santé familiale et Cliniques dirigées par
des infirmières praticiennes) ou d’autres fournisseurs comme les bureaux de santé publique et les
hôpitaux, selon le mode d’organisation, qui seraient tenus de lui rendre des comptes.
Plusieurs autres modèles d’intégration et de coordination de soins de santé primaire qui mettent à
contribution à la fois les prestataires de soins primaires et les établissements de services spécialisés
tels que les hôpitaux, sont en phase d’expérimentation au Canada et ailleurs dans le monde.
Prenons pour exemple la Stratégie ACE (Acute Care for Elders) de l’Hôpital Mount Sinai à Toronto.
Cette stratégie constitue un modèle de prestation de soins continus offerts aux personnes âgées dans
les services d’urgence, aux patients hospitalisés, en clinique externe et au sein de la collectivité. Des
équipes regroupant des médecins spécialisés, des infirmières en pratique avancée, des travailleurs
sociaux, des thérapeutes, des pharmaciens, des diététistes et des bénévoles travaillent ensemble pour
offrir aux patients de meilleurs soins, mieux coordonnés. Cette initiative a produit des améliorations
significatives dans la qualité globale des soins, la réduction des durées de séjours, le nombre
d’hospitalisations et de réadmissions et l’utilisation inopportune de ressources.
D’autres exemples d’initiatives pour une meilleure intégration et coordination de services ont été
répertoriés pour les soins aux personnes vivant avec une maladie respiratoire. La Régie régionale
Capital Health de la Nouvelle-Écosse a développé et mis en œuvre le modèle de soins INSPIRED
(Implementing a Novel and Supportive Program of Individualized care for patients and families living
with REspiratory Disease). Ce programme adopte une nouvelle approche proactive des soins et de la
maladie pulmonaire obstructive chronique avancée. En répondant aux besoins sous-jacents non
satisfaits de ces patients et de leur famille, le programme permet d’offrir aux personnes des soins plus
holistiques, de soutenir les aidants naturels et de réduire le recours aux soins hospitaliers. Les patients
et les familles reçoivent de la formation sur l’auto-prise en charge, du soutien psychosocial et spirituel,
ainsi que de l’information en vue de la planification préalable des soins de santé en fin de vie. Cette
initiative a amélioré l’expérience des soins des patients et de leur famille ainsi que diminué de 62% les
visites à l’urgence, de 64% les hospitalisations et de 63% les jours passés à l’hôpital.
À un haut niveau, et toujours dans cet élan d’intégration et de coordination des soins, la plupart des
guides de pratiques développés par les associations professionnelles mettent beaucoup d’accent sur la
nécessité de bien intégrer et coordonner les pratiques professionnelles entre différentes composantes
du système.
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La participation du patient et de la famille
Une autre tendance significative qui a des impacts sur l’ensemble du système et de manière très
importante sur les soins de santé primaire est celle de se concentrer davantage sur les objectifs du
patient que sur les processus de soins et les indicateurs biomédicaux. Quels sont les besoins du
patient pour améliorer sa qualité de vie? Cette approche est d’autant plus importante pour des patients
atteints de plusieurs conditions médicales, car les guides de pratique sont souvent développés pour
une maladie spécifique. Une approche concentrée uniquement sur l’application de ces guides serait
mal alignée sur cette nouvelle tendance qui replace le patient au cœur des soins.
Cette vision des soins augmente le pouvoir du patient comme participant actif dans ses propres soins.
À titre d’exemple, notons le professeur Bas Bloem des Pays Bas qui a développé un modèle intitulé
ParkinsonNet (KPMG, 2014). Son objectif était de créer un modèle qui satisferait les besoins du patient
tout en réglant plusieurs problèmes de nature institutionnels tels que des références inappropriées à
certains spécialistes, le sur-traitement, le sous-traitement, les traitements inappropriés et la mauvaise
communication entre les intervenants concernant les soins aux patients. Ses travaux de recherche lui
ont permis d’identifier cinq conditions de succès dans le design des services :
-
Créer un environnement de soins permettant au patient d’être actif dans la gestion de ses soins
et dans la prise de décisions le concernant
Déterminer la valeur ajoutée des soins à partir de la perspective du patient
Changer l’approche normative des professionnels en ce qui a trait aux soins requis à une
approche de partenariat avec le patient pour déterminer ce qui fonctionne le mieux pour lui
Créer un réseau d’experts
Relier le tout avec les nouvelles technologies d’information
Les organisations de santé canadiennes se concentrent de plus en plus sur l’expérience du patient, sur
les soins de santé centrés sur le patient et sa famille et sur l’engagement du patient. Cet engagement
du patient apportera un changement de culture et des changements significatifs dans les pratiques
professionnelles. Ce sera le cas surtout dans les soins de santé primaire, car elle exigera de nouveaux
types de support aux patients et à leur famille qui seront de nature plus sociale et qui feront appel à
d’autres secteurs d’activités ainsi qu’à une plus grande coordination avec ces derniers (Saltman, 2006).
Les nouvelles technologies
Les nouvelles technologies de l’information, les nouveaux médicaments et les nouvelles thérapies qui
permettent plus de soins à domicile et dans la communauté ainsi que des changements importants
dans les attentes des patients et leur famille à l’égard des soins qu’ils sont en droit de recevoir vont
avoir un impact considérable sur les soins de santé primaire dans un futur rapproché. Les
changements dans le domaine des technologies de l’information remettent en cause le concept même
de soins de santé primaire. Par exemple, les nouvelles approches technologiques incluant internet et la
télésanté nous incitent à réévaluer quel est le premier contact du patient avec les soins de santé et
comment le système de santé peut mieux optimiser cette technologie pour améliorer les soins aux
patients.
L’évolution des rôles professionnels
Enfin, des changements dans les rôles des différents intervenants dans le domaine de soins de santé
primaire apportent des approches différentes de soins et crée des opportunités nouvelles pour
améliorer les soins. Par exemple, les rôles élargis des infirmières dans les soins aux patients vivant
avec des maladies chroniques, les interventions des pharmaciens pour ajuster les médicaments
prescrits ainsi que les conseils qu’ils fournissent aux patients, les efforts de plus en plus coordonnés de
la santé publique dans la prévention de l’obésité et l'arrêt du tabagisme, sans compter un nombre
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accru d'intervenants ayant une formation de base en santé sans que ce ne soit une formation
professionnelle auront un impact sur la prestation des soins de santé primaire.
Ainsi, toujours selon KPMG (2014), beaucoup d’avancements ont été observés au cours des dernières
années, mais beaucoup d’efforts sont encore requis pour arriver à un système de santé primaire
davantage performant et adapté aux nouvelles réalités, notamment :
-
Il existe toujours des mécanismes de paiements qui favorisent des comportements inappropriés
chez les cliniciens
Les soins ne sont pas structurés et déterminés avec et pour les patients vivant avec des
maladies chroniques
La santé primaire est souvent centrée uniquement sur les besoins immédiats du patient et
n’utilise pas suffisamment les données de santé du patient pour du travail proactif avec des
patients à risque
La santé primaire n’utilise pas le plein potentiel des nouvelles technologies
Le rôle élargi de la santé primaire pour mieux coordonner un ensemble de soins et services
n’est pas encore une réalité dans la majorité des systèmes
Les intervenants en santé primaire ont encore souvent des difficultés importantes d’accès à des
consultations et services spécialisés
Les liens des soins de santé primaire avec les autres services dans la communauté (logement,
services sociaux, bénévoles, etc.) sont insuffisamment développés
2.4 SOINS PRIMAIRES ET STATUT LINGUISTIQUE MINORITAIRE
Une population vieillissante nécessitant plus de soins reliés à des maladies chroniques oblige le
système de santé à s’adapter, notamment en ce qui a trait aux soins de santé primaire. En Ontario,
comme ailleurs dans les pays développés, les maladies chroniques sont les causes prédominantes de
mort et d’incapacités. Selon l’Enquête de la santé dans les collectivités canadiennes (Statistique
Canada), près de 80% des Ontariens ayant plus de 45 ans souffrent d’une condition chronique. De
ceux-là, approximativement 70% doivent vivre avec 2 conditions chroniques ou plus. Si ces patients ne
sont pas traités adéquatement, Ils s’exposent à développer davantage de problèmes de santé. En
Ontario, il est estimé que les maladies chroniques génèrent 55% des coûts totaux directs et indirects
des soins de santé.
En plus de ces défis, le système de santé primaire au Canada et notamment en Ontario doit prendre en
considération les complexités d’offrir des services de santé dans la langue officielle de choix du patient.
Timmins est aux prises avec un tel défi avec 37% de sa population se disant francophone.
Au Canada, les communautés de langue officielle vivant en situation minoritaire représentent une
population de plus de 2 millions d’habitants, dispersée sur tout le territoire. Malgré l’égalité de statut
constitutionnel des deux langues officielles du pays, les francophones vivant dans les provinces
anglophones et les anglophones vivant au Québec, seule province francophone du pays, sont
confrontés à des barrières systémiques d’accès aux ressources et services dans leur langue officielle
première.
Cette situation linguistique minoritaire est à la source d’iniquités entre majorité et minorité de langue
officielle qui sont dénoncées par les communautés elles-mêmes et de plus en plus mises en évidence
par la recherche sous forme de rapports et d’enquêtes faites en Ontario et au Nouveau-Brunswick,
notamment. Selon un rapport de Santé Canada produit par Bowen (2001), les barrières linguistiques
ont un effet néfaste sur l’accès aux services de santé, interférant avec la compréhension et l’adhérence
aux traitements, la qualité des soins et la satisfaction des fournisseurs de services et de soins ainsi que
celle des utilisateurs. Ces constats sont d’ailleurs corroborés par des recherches similaires aux ÉtatsUnis, en Australie et en Europe.
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De plus, les organismes d’agrément, comme Agrément Canada et le Centre canadien de l’agrément,
reconnaissent de plus en plus que l’accessibilité linguistique constitue un facteur important de la qualité
des services de santé, et ils travaillent à établir des normes pour assurer une communication efficace
et sécuritaire centrée sur le patient.
Plusieurs études ont aussi mis en relief l’attitude selon laquelle lorsqu’un patient francophone peut
parler anglais, il n’est pas nécessaire de lui fournir des services en français. Selon une étude réalisée
en 2010 par l’Atlantic Evaluation Group, cette attitude semble généralisé à l’ensemble du système de
santé.
Les relations de force parfois utilisées inconsciemment par la majorité anglophone amplifient le
sentiment de vulnérabilité des patients et de leur famille. Le concept de la violence symbolique a été
étudié par Pierre Bourdieu et Jean-Claude Passeron dans les années 70. Il s’agit d’un concept général
qui s’applique aux relations de force qui existent dans la société entre les classes ou groupes
dominants et les classes ou groupes dominés. Lorsqu’un groupe dominant privilégie une norme au
détriment d’une autre, il en résulte une violence symbolique.
Dans un contexte de minorités
Exemple de modèle de soins primaires en francophonie canadienne
linguistiques,
la
violence
Le Centre Albert-Galliot, centre de bien-être (Manitoba)
symbolique consiste à forcer la
minorité linguistique à parler la
La communauté de Notre-Dame-de-Lourdes au Manitoba a souligné en
langue dominante. Lorsque ces
2007 l’ouverture du Centre Albert-Galliot, centre de bien-être. Distinctif
de la programmation de ce Centre est son emplacement au cœur d’une
épisodes
de
violence
population francophone, ce qui permet l’offre de services de santé en
symbolique se répètent sur une
français et en anglais. Le Centre a comme but l’amélioration de l’accès
longue période, voir même sur
aux soins primaires et aux services sociaux en français pour les
plus d’une génération, les
francophones à l’intérieur des frontières de l’Office régionale de santé
francophones, dans ce cas-ci,
Southern Health-Santé Sud. Ce centre a deux volets : la ressource
viennent à développer des
humaine et le local physique, nécessaire pour répondre à la ressource
comportements
empreints
humaine.
d’oppression intériorisée. Le
concept
de
l’oppression
La Corporation de développement communautaire Lourdéon inc. (CDC
intériorisée part de l’hypothèse
Lourdéon inc.) gère les opérations du Centre en partenariat avec
Southern Health-Santé Sud. Les services offerts sont les suivants :
selon laquelle les conditions
clinique, pharmacie, physiothérapeute, chiropraticien, masseuse
sociales
ont
un
impact
thérapeute, dentiste, santé publique, soins à domicile, santé mentale,
significatif sur la structure
diététicienne, salle d’exercices, bibliothèque/centre de ressources,
psychique des individus. Le
bureaux administratifs.
docteur Claude Steiner la
définit comme étant « la force
qui fait que nous avons des jugements de valeur nuisibles, inexacts — à propos de nous-mêmes et du
monde en général. Ces idées et sentiments se manifestent sous forme de comportements ou
d'attitudes constamment renforcés par la culture qui nous entoure. »
Dans un document intitulé Collaborer avec les francophones en Ontario, le Réseau communauté en
Santé identifie une série de manifestations de l’oppression intériorisée : malaise d’être francophone,
désir de ne plus appartenir à cette communauté, difficulté à afficher sa différence, crainte de soulever
la colère des autres, peur de ne pas obtenir de services, peur de perdre ses acquis et sa crédibilité,
crainte d’être perçue comme un insatisfait, peur de ne pas être écouté si on parle en français,
acceptation passive de l’assimilation, faire semblant d’appartenir au groupe majoritaire pour en avoir
les privilèges, considérer que les services en anglais sont meilleurs que les services en français.
Un rapport sur les modèles de soins de santé primaires offerts aux francophones vivant en situation
minoritaire au Canada (2016) réalisé pour l’Association canadienne des centres de santé
communautaire et la Société Santé en français met aussi en relief l’importance de la gouvernance
comme élément important pour assurer le maintien des services en français et le développement de
modèles qui favorisent la collaboration, l’intégration des soins, l’engagement et la participation de la
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communauté
francophone.
Selon les répondants de
cette
étude,
une
gouvernance
francophone
est essentielle pour assurer
le maintien des services en
français.
En
effet,
les
services ont tendance à
disparaître
lorsque
l’implication
des
francophones diminue au
sein
des
établissements
anglophones ou bilingues.
Exemple de modèle de soins primaires en francophonie canadienne
Le Centre de santé communautaire Saint-Thomas (Alberta)
Le Centre Saint-Thomas est le premier centre de santé communautaire
francophone en Alberta. Il offre un service personnalisé à guichet unique,
un accès facile à toute une gamme de professionnels de soins de santé et
de services, ainsi qu'une éducation en santé communautaire et en
promotion de la santé. Ce Centre a été développé dans le cadre du
développement de réseaux de santé primaires (Primary Care Networks)
par le gouvernement de l’Alberta en 2003. Ces réseaux regroupent des
médecins de famille qui travaillent avec Alberta Health Services et autres
professionnels pour mieux coordonner les services de santé primaire à
leurs patients. Un tel réseau peut être composé d’une clinique avec
plusieurs médecins ou de plusieurs cliniques sur un territoire donné. Ces
réseaux sont subventionnés par Alberta Health Services.
Plusieurs
recherches
Le Centre Saint-Thomas a profité de cette opportunité pour mettre en
récentes au Canada et
place un ensemble de services destinés aux francophones dans cette
notamment
en
Ontario
communauté. En plus du réseau, le centre regroupe plusieurs autres
confirment les inégalités en
partenaires francophones tel le Centre de santé Saint-Thomas, résidence
matière de santé pour les
pour personnes âgées, pour ainsi être en mesure d’offrir des services
communautés francophones
communs.
en situation minoritaire. Tout
récemment, le Ministère de la
santé et des soins de longue durée de l’Ontario a reconnu cet état de fait dans son document de
discussion Priorité aux patients (2015). On y parle de la situation des francophones en ces termes :
Les Franco-Ontariens éprouvent des difficultés à accéder à des services de santé en
français. Afin de satisfaire leurs besoins et d’améliorer leur expérience en tant que
patients et les résultats en matière de santé, nous devons nous assurer que le système
de soins est sensible à la culture et facilement accessible en français.
Un système de soins de santé primaire efficace et efficient est considéré comme étant essentiel afin de
bien satisfaire les besoins grandissants et évolutifs de la population. C’est la raison pour laquelle
l’Ontario a mis tant d’efforts et continue de le faire pour améliorer les soins de santé primaire. En
parallèle, des efforts doivent continuer à être mis pour que ce système réponde bien aux besoins d’une
population vivant en situation minoritaire.
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3. PROFIL DÉMOGRAPHIQUE, SOCIO-ÉCONOMIQUE ET DE SANTÉ
Dresser le profil démographique, socio-économique et de santé d’une population donnée peut très
certainement aider à mieux comprendre les besoins de santé d’une telle population. Considérant les
éléments qu’il est possible d’aller chercher avec de tels profils, et en les liant avec les principaux
déterminants de la santé, ils peuvent fournir une indication de l’état de santé probable d’une population,
ainsi que sur les facteurs de risque.
Les déterminants de la santé sont des éléments ou caractéristiques d’une population qui permettent de
déterminer la santé probable de cette même population. Bien que la relation entre ces éléments et la
santé ne soit pas directe et automatique, les déterminants agissent à titre d’indicateurs de la santé et
sont beaucoup utilisés en matière de santé publique.
Beaucoup de recherche a été faite au cours des dernières années visant à mieux comprendre ces
déterminants. Voici la liste des principaux déterminants de la santé tels que développés par l’Agence
de la santé publique du Canada :
-
Le niveau de revenu et le statut social
Les réseaux de soutien social
L'éducation et l'alphabétisme
L'emploi et les conditions de travail
Les environnements sociaux
Les environnements physiques
Les habitudes de santé et la capacité d'adaptation personnelles
Le développement de la petite enfance
Le patrimoine biologique et génétique
Les services de santé
Le sexe
La culture
La recherche tend à démontrer que le niveau de revenu et le statut social sont les éléments les plus
susceptibles de déterminer la santé d’une population. Cela étant dit, il n’existe pas de ligne claire entre
chacun des déterminants et ceux-ci sont souvent inter-reliés entre eux, l’un étant le résultat ou la
conséquence l’autre, etc.
Bien que la langue ne soit pas un déterminant figurant sur cette liste, la recherche penche de plus en
plus sur le fait qu’elle pourrait jusqu’à un certain point déterminer la santé. Dans le cas d’une population
en situation minoritaire, le statut minoritaire en tant que tel, démontré par les données, semble vouloir
déterminer la santé.
Nous avons voulu présenter les déterminants de la santé, car à travers les diverses analyses
présentées tout au long des prochaines pages, nous serons en mesure de faire des liens avec
plusieurs de ces déterminants de la santé, et ainsi mieux comprendre et situer les données liées à la
santé de la population de Timmins, et en particulier celles des francophones.
3.1 PROFIL DÉMOGRAPHIQUE DE LA POPULATION FRANCOPHONE DE TIMMINS
Selon les données du Recensement de 2011 de Statistique Canada, la ville de Timmins comptait cette
même année 43 165 habitants. De ce total, 15 895 personnes disaient avoir le français comme langue
maternelle, représentant 37,2% de la population totale, tel que présenté au Tableau 2. Une proportion
similaire de la population disait avoir le français comme première langue parlée. En considérant le
français comme langue la plus souvent utilisée à la maison, cette proportion baisse à 21,4% du total ou
9 150 personnes.
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Concernant l’unilinguisme et le bilinguisme à Timmins, plus de la moitié de la population disait
connaître les deux langues officielles, alors qu’environ 1000 personnes ou 2.4% de la population totale,
disaient ne connaître que le français. Bien que les données analysées ne puissent spécifier l’âge de
cette population unilingue francophone, on peut très bien s’imaginer qu’elle est majoritairement âgée.
Tableau 2: Profil linguistique de la population de Timmins, 2011
Français
% du
total
15 895
37,2%
15 710
36,8%
Anglais
% du
total
23 770
55,7%
26 340
61,7%
#
Langue maternelle
Première langue
parlée
Langue la plus
9 150
souvent parlée à la
maison
Connaissances des
1 040
langues officielles
Source : Statistique Canada
#
#
Les deux
% du total
875
265
2,1%
0,6%
21,4%
31 705
74,3%
985
2,3%
2,4%
19 950
46,7%
21 615
50,7%
Bien que nous ne soyons pas en mesure de connaître l’âge de la population se disant unilingue
francophone, il est possible de connaître l’âge de la population selon la langue maternelle. Ainsi,
comme présenté à la Figure 1, nous avons construit une pyramide des âges pour la population
francophone de même que pour la population anglophone de la ville de Timmins, et avons superposé
le tout.
Au premier coup d’œil, on constate qu’une plus grande proportion de la population francophone est
âgée de 45 ans et plus, alors qu’une plus petite proportion de celle-ci est âgée de 45 et moins,
comparativement à la population anglophone. Ceci est vrai pour pratiquement toutes les catégories
d’âge. L’autre élément qui ressort de façon flagrante est l’importance des écarts entre francophones et
anglophones pour chacun des groupes d’âge. On peut donc d’emblée affirmer que la population
francophone de Timmins est plus âgée que la population anglophone.
Figure 1: Pyramide des âges pour la population francophone et la population anglophone
de Timmins, 2011
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En considérant les chiffres de façon plus précise et comme relaté dans le Tableau 3, on voit que 18,7%
de la population anglophone est âgée de moins de 15 ans alors que cette proportion est de 15% pour
la population francophone. Inversement, 11,2% de la population anglophone est âgée de 65 ans et plus
alors que cette proportion est de 15,7% pour la population francophone. L’écart entre l’âge médian de
la population francophone et celui de la population anglophone est important : un peu plus de sept ans.
La population francophone est donc significativement plus âgée que la population anglophone dans la
ville de Timmins.
Tableau 3: Langue maternelle selon le groupe d’âge, 2011
% du total
Moins de 15 ans
15 à 44 ans
45 à 64 ans
65 ans et plus
Français
15,0%
35,1%
34,3%
15,7%
Âge médian
45,7
Anglais
18,7%
42,0%
28,1%
11,2%
38,6
L’autre élément qui ressort de ces données est le fait que l’écart entre l’âge médian de la population
francophone et celui de la population anglophone risque d’aller en s’accentuant au cours des
prochaines années étant donné la structure de la pyramide. En effet, une forte proportion de
francophones âgés de 45 et 65 ans viendra nourrir la cohorte des 65 ans et plus au cours des deux
prochaines décennies alors que la magnitude de cette tendance sera moindre pour la population
anglophone. La plus petite proportion de francophones moins âgés risque aussi de nourrir cette
tendance.
L’âge ne figure pas sur la liste des déterminants de la santé, mais il est certain qu’à mesure que l’âge
d’une personne avance, les risques de rencontrer des défis au niveau de la santé, et conséquemment,
la possibilité de faire appel au système de santé, sont accentués.
3.2 PROFIL SOCIO-ÉCONOMIQUE DE LA POPULATION FRANCOPHONE DE TIMMINS
Au-delà de l’âge, d’autres caractéristiques d’une population davantage liées aux aspects sociaux et
économiques de celle-ci viendront jeter un regard sur son état de santé possible.
Les données les plus récentes permettant de dresser le profil socio-économique d’une communauté
proviennent de l’Enquête nationale auprès des ménages de 2011, conduite par Statistique Canada.
Dans le cas de la ville de Timmins, les données disponibles sont limitées étant donné les défis liés au
fait qu’une enquête se fait par échantillonnage de la population, que la population de la ville de
Timmins est de petite taille et parce que nous voulions comparer francophones et anglophones. Quoi
qu’il en soit, les pages qui suivent présentent tout de même quelques données desquelles ressortent
des constats intéressants.
Statut matrimonial
Les francophones de Timmins ont un statut matrimonial plus « traditionnel » que la majorité
anglophone. Tel que le démontre la Figure 2, les francophones de Timmins sont, dans une plus grande
proportion, marié(e)s, divorcé(e)s ou veuf(ve)s. En ce qui a trait aux anglophones, une plus grande part
d’entre eux sont célibataires ou vivent en union libre. Bien que ces données ne soient pas d’un intérêt
marqué pour la présente étude, elles surprennent de par l’importance de certains des écarts.
Cependant, en considérant les déterminants de la santé, peu de liens sont à faire.
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Figure 2 : Statut matrimonial, Timmins, 2011
Éducation
L’éducation en tant que déterminant de la santé est importante puisqu’elle aura une incidence sur
d’autres déterminants : revenus, emploi et conditions de travail, etc.
La Figure 3 démontre que les francophones de Timmins sont moins éduqués que la majorité
anglophone, ou ont une éducation davantage axée sur les métiers. Ils ont dans une moindre proportion
une éducation universitaire ou une éducation collégiale. Inversement, une plus grande proportion
d’entre eux ont des certificats d’apprentis ou de métiers, ou n’ont tout simplement pas de certificat,
diplôme ou grade. Il pourrait y avoir un lien à faire entre ces données et l’âge de la population
francophone de Timmins. Quoi qu’il en soit, il y aura aussi des liens à faire avec les données
présentées ci-après.
Figure 3 : Plus haut niveau d'éducation atteint, Timmins, 2011
Source ; Statistique Canada
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Activités économiques
En ce qui a trait aux activités économiques, il y a peu de différences entre francophones et
anglophones de Timmins, ou du moins aucune différence notable, tel que le démontre le Tableau 4.
Tableau 4 : Quelques indicateurs sur l’activité économique, Timmins, 2011
% du total
Taux d’activité
Personnes au chômage
Personnes occupées
Personnes employées
Travailleurs autonomes
Francophones
63,9%
6,5%
59,7%
93,8%
5,6%
Anglophones
65,9%
7,7%
60,8%
93,3%
5,3%
Professions
En lien avec l’activité économique, attardons-nous maintenant aux types de professions qu’occupent
francophones et anglophones à Timmins. Tel que le démontre la Figure 4, les francophones de
Timmins occupent dans une grande proportion des professions davantage liés aux métiers, transport,
machinerie et domaines connexes. C’est le domaine où la différence est la plus marquée. On peut
d’ailleurs faire un lien entre les différences entre francophones et anglophones et les niveaux
d’éducation entre ces deux mêmes populations. On constate ainsi que les domaines où les
anglophones comptent pour une plus grande proportion sont généralement ceux où un niveau
d’éducation supérieur est requis.
Figure 4 : Emploi par type de profession, Timmins, 2010
Industries
Nous allons maintenant jeter un coup d’œil aux types d’industries pour lesquelles francophones et
anglophones de Timmins travaillent. En lien avec les professions dont on vient de parler, on constate à
la Figure 5 que les francophones ont plus de poids dans certaines industries : transport et entreposage,
construction, commerce de gros, fabrication, agriculture, foresterie, chasse, pêche. Encore une fois,
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ces catégories sont rattachées à des niveaux d’éducation moins élevés. De plus, tant pour les
professions que pour les industries, les francophones se retrouvent davantage dans des
environnements de travail plus difficile physiquement. En réfléchissant aux déterminants de la santé, il
serait donc tout à fait approprié de s’imaginer que cet état de fait se traduit par davantage de défis au
niveau de la santé.
Figure 5 : Emploi par type d'industrie, Timmins, 2010
Revenu
Nous avons mentionné précédemment que le niveau de revenu était le déterminant de la santé le plus
important. En considérant les données sur le revenu présentées à la Figure 6, on constate que des
différences existent entre francophones et anglophones selon la tranche de revenu. En effet, dans les
catégories extrêmes où les salaires sont de plus de 100 000 $ ou de moins de 20 000 $, ce sont les
anglophones qui prédominent, alors que pour les catégories situées entre celles-ci, ce sont les
francophones qui font le poids.
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Figure 6 : Revenu total en 2010, population de 15 ans et plus, Timmins
Par contre, en ce qui a trait aux revenus médians et moyens, francophones et anglophones se
retrouvent plutôt sur un même pied d’égalité, avec des revenus médians et moyens qui s’apparentent,
ou du moins où il n’y a pas de différences marquées. Il est intéressant de noter que de façon générale,
des niveaux d’éducation différents se traduisent par des niveaux de revenu différents, ce qui ne semble
pas être le cas ici. Il semblerait donc qu’indépendamment de l’éducation, les industries primaires où
francophones travaillent dans une plus grande proportion offrent des salaires semblables à ce qui est
offert ailleurs, ce qui n’est pas toujours le cas.
Revenu médian $
Revenu moyen $
Anglophones
31 287
42 302
Francophones
32 124
40 604
En regardant le profil de santé de la population de Timmins au long des prochaines pages, on pourrait
faire davantage des liens intéressants avec certaines de ces caractéristiques socio-économiques.
3.3 PROFIL DE SANTÉ DE LA POPULATION FRANCOPHONE DE TIMMINS
Dresser le profil de santé d’une population représente un défi de taille pour une multitude de raisons.
Premièrement, il n’existe pas de données publiques qui permettraient de dresser un portrait précis de
l’état de santé d’une population, surtout dans le cas d’une population de petite taille comme celle de la
ville de Timmins, et davantage dans le cas où on voudrait se concentrer sur les francophones. Un des
défis réside dans le fait que dans la plupart des données recueillies par les instances en santé, au
niveau provincial, régional, par établissement, etc., le statut linguistique n’est pas demandé.
Les enquêtes nationales comme l’Enquête sur la santé dans les collectivités canadiennes de
Statistique Canada offrent des données à certains niveaux géographiques dont le plus précis est la
région socio-sanitaire (région de Porcupine dans ce cas-ci). Cela étant dit, étant donné
l’échantillonnage, ce n’est qu’un nombre restreint de données qui soient statistiquement significatives
et donc rendues publiques, et la variable linguistique y est absente.
Au niveau de la province, davantage de données sont disponibles étant donné l’échantillon plus grand,
et il est possible de considérer en parallèle la situation des francophones versus celle des
anglophones. Pour arriver à dresser le profil de santé de la population francophone de Timmins, nous
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avons donc dû procéder par extrapolation de même qu’à partir de bribes d’information diverses ou
anecdotiques qui, prises collectivement, ont permis de tirer quelques constats.
Au niveau provincial et de la région socio-sanitaire
Nous sommes en mesure, avec les données disponibles, de comparer les francophones ainsi que les
anglophones (variable « première langue parlée ») au niveau de la province. Puis, la même série de
données existe au niveau de la région socio-sanitaire de Porcupine, mais sans pouvoir différencier la
langue. Timmins fait partie de la région socio-sanitaire de Porcupine et y compte pour plus de 50% de
sa population, donc y a un fort poids. Quarante-cinq pour cent des habitants de la région sociosanitaire de Porcupine se dit francophone de par la langue maternelle. Il importe aussi de noter
qu’environ 12% de la population a une identité autochtone, indépendamment de la langue
parlée.
La Figure 7 nous présente quelques indicateurs liés au bien-être. On peut voir que pour plusieurs
indicateurs, les francophones font moins bonne figure que les anglophones, quoique les différences ne
soient pas marquées (santé perçue, santé mentale perçue, stress perçu). Il existe aussi des différences
au niveau de la satisfaction à l’égard de la vie ainsi que la santé fonctionnelle, mais cette fois-ci à
l’avantage des francophones. Lorsqu’on considère les mêmes données pour le territoire de Porcupine,
on voit que sur la plupart des indicateurs, les chiffres sont beaucoup moins éloquents quand on les
compare tant aux francophones qu’aux anglophones dans la province.
Figure 7 : Indicateurs liés au bien-être, 2009-10
En % du total
Santé perçue, très bonne ou excellente
Santé perçue, passable ou mauvaise
Santé mentale perçue, très bonne ou excellente
Santé mentale perçue, passable ou mauvaise
Satisfaction à l'égard de la vie, satisfait(e) ou très
satisfait(e)
Stress perçu dans la vie, assez intense (15 ans et plus)
Trouble de l'humeur
Santé fonctionnelle, bonne à pleine
Légende :
Total
61,0
11,9
74,3
5,7
Ontario
Première langue parlée
Porcupine
Anglais
Français
61,6
61,8
53,3
11,4
12,1
17,6
74,6
72,5
71,9
5,6
5,5
6,5
91,5
24,0
6,8
79,9
Résulats positifs
91,8
24,1
6,8
80,2
92,7
25,5
6,7
80,6
88,1
24,7
6,9
76,6
Résultats négatifs
Plusieurs comportements ont une incidence importante sur l’état de la santé. Fumer, être exposé à la
fumée, consommer de l’alcool, consommer des fruits et légumes ainsi que faire de l’activité physique
peuvent faire une différence sur l’état de la santé d’une population. On voit à la Figure 8 que pour
certains indicateurs liés au tabagisme et à la consommation d’alcool, les francophones ont de moins
bons comportements que les anglophones. On voit aussi que la situation dans la région de Porcupine
est particulièrement préoccupante si on la compare tant aux francophones qu’aux anglophones au
niveau de la province.
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Figure 8 : Indicateurs liés aux comportements ayant une incidence sur la santé, 2009-10
En % du total
Fume actuellement, tous les jours
Fume actuellement, tous les jours ou à l'occasion
Exposition à la fumée secondaire au domicile
Exposition à la fumée secondaire au cours du dernier
mois, véhicules et/ou des lieux publics
5 verres ou + d'alcool en une même occasion, au
moins une fois par mois, dernière année
Consommation de fruits et légumes, 5 fois ou plus par
jour
Activité physique durant les loisirs, modérément actif
ou actif
Activité physique durant les loisirs, inactif
Légende :
Total
14,5
18,9
5,2
Ontario
Porcupine
Anglais
Français
14,7
16,4
18,1
19,2
20,9
25,9
5,3
5,1
7,4
15,8
15,9
16,8
15,9
15,9
16,3
17,7
21,0
43,2
43,3
44,3
44,1
50,5
49,5
51,0
49,0
53,7
46,3
55,5
44,5
Résulats positifs
D’autres indicateurs viennent jeter un certain regard sur la santé de la population, tel que présentés à
la Figure 9. Par exemple, le sentiment d’appartenance à la communauté, que l’on pourrait lier avec
certains déterminants de la santé, est significativement moins élevé pour les francophones de la
province, ce qui surprend peu en pensant au fait que les francophones sont parsemés dans la province
parmi de fortes communautés anglophones. Pas étonnant non plus qu’il soit fort dans le secteur de
Porcupine où ce sentiment dans de petites communautés risque d’être particulièrement élevé. Si on
pouvait départager les francophones des anglophones dans le secteur de Porcupine, on observerait
sûrement un haut sentiment d’appartenance chez les francophones comparativement à l’ensemble de
la province.
Concernant le fait d’avoir un médecin régulier, les francophones de la province en ont un dans une
moins grande proportion. Cet écart est accentué dans Porcupine. Inversement, les francophones ont
consulté dans une proportion un peu plus grande un médecin au cours des 12 derniers mois alors
qu’ils semblent davantage se faire vacciner contre la grippe. La population de Porcupine fait moins
bonne figure que les francophones de la province pour ce qui est de ces deux derniers indicateurs.
Figure 9 : Autres indicateurs liés à la santé, 2009-10
Ontario
En % du total
Sentiment d'appartenance à la communauté locale,
plutôt fort ou très fort
A un médecin régulier
Consultation d'un médecin au cours des 12 derniers
mois
Vaccination contre la grippe, il y a moins d'un an
Légende :
Total
Anglais
Français
Porcupine
67,4
91,1
68,0
91,4
62,4
89,0
74,5
83,5
82,2
31,2
82,1
30,6
82,7
37,3
81,3
33,9
Résulats positifs
Ces résultats où les francophones font généralement moins bonne figure que les anglophones, et où la
population de secteur de Porcupine se retrouve plus souvent dans une situation pire se traduisent-ils
par des problèmes de santé concrets pour cette population? Il semblerait que oui puisque tel que
présenté à la Figure 10, lorsque des problèmes de santé spécifiques sont considérés, les francophones
font moins bonne figure, et parfois de façon importante, que les anglophones sur l’ensemble des
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indicateurs au niveau provincial. Puis la population de la région de Porcupine fait moins bien que les
francophones et anglophones au niveau provincial, avec des écarts significatifs pour plusieurs
indicateurs.
Figure 10 : Indicateurs liés aux problèmes de santé, 2009-10
En % du total
Arthrite
Diabète
Asthme
Hypertension
Maladie pulmonaire obstructive chronique (MPOC)
Douleurs ou malaises selon l'intensité, modérés ou
sévères
Douleurs ou malaises empêchant des activités
Limitations dans les activités, parfois ou souvent
Indice de masse corporelle autodéclaré, adulte (18
ans et plus), embonpoint ou obèse
Indice de masse corporelle autodéclaré, jeune (12 à 17
ans), embonpoint ou obèse
Légende :
Total
17,3
6,8
8,3
17,4
4,2
Ontario
Porcupine
Anglais
Français
16,8
21,5
24,0
6,6
7,0
7,1
8,4
9,5
11,8
17,1
19,1
23,2
4,2
4,9
8,9
11,8
13,5
28,2
11,5
13,2
28,0
12,6
13,5
33,0
17,4
18,0
33,5
52,0
52,3
54,0
62,7
20,5
20,5
23,5
28,8
Résulats positifs
Qualité des soins primaires
La Figure 11 nous présente des données qui ont été produites par Qualité des services de santé
Ontario. En effet, cette organisation recueille des données qui visent à évaluer la qualité des soins
primaires offerts dans la province. La variable linguistique est présente pour certains de ces
indicateurs, que nous présentons ici. À une échelle plus grande, la variable linguistique n’est pas
présente, mais chacun des RLISS est couvert par l’analyse.
La population francophone de la province a, dans une moins grande proportion, un fournisseur de
soins primaires. De plus, cette proportion est significativement plus basse sur le territoire du RLISS du
Nord-Est comparativement à l’ensemble de la province, représentant le deuxième plus bas taux.
En ce qui a trait à l’accès en temps voulu à un fournisseur de soins primaires, la différence entre
francophones et anglophones n’est pas significative, mais elle l’est de façon importante entre le
territoire du RLISS du Nord-Est et l’ensemble de la province. Il s’agit en fait du troisième plus bas taux
de la province.
Par ailleurs, la réponse le même jour à un appel constitue un autre indicateur de la qualité des soins
primaires. Quoique des différences existent entre francophones et anglophones, ainsi qu’entre le
territoire du RLISS du Nord-Est et l’ensemble de la province, elles ne sont pas considérables.
Alors que la tendance est de ramener le patient au cœur des soins et de le faire participer dans les
diverses décisions relatives à ses soins, il semble que les francophones de la province font moins
bonne figure que les anglophones à cet égard. Le territoire du RLISS fait aussi moins bonne figure que
l’ensemble de la province, mais dans une moindre mesure. Le territoire du RLISS du Nord-Est a le
quatrième plus bas taux dans la province.
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Figure 11 : Divers indicateurs liés à la qualité des soins primaires en Ontario
Source : Qualité des services de santé Ontario
Données sur la fréquentation des services de l’hôpital de Timmins
L’hôpital de Timmins a été en mesure de nous fournir des données sur la fréquentation des services de
l’hôpital et de ses diverses cliniques externes entre 2010 et 2015 par la population venant
spécifiquement de la ville de Timmins et ce, sous l’angle de la langue maternelle du patient. Le bas
taux de non-réponse (où la langue était « inconnue ») de cette série de données, avoisinant le 2%,
ainsi que sa taille (541 000 visites au total) renforce les constats et conclusions que l’on peut tirer de
son analyse.
Entre 2010 et 2015, ce sont 37,8% de francophones qui ont fait appel aux services de l’hôpital de
Timmins (tel que le démontre la ligne rouge sur les figures 12 à 14). Un élément très intéressant
que nous avons pu tirer de ces données est la fréquentation par les francophones selon le type de
services qui, elle, varie grandement par rapport à cette moyenne. En effet, tel que présenté aux
figures 12, 13 et 14, certains services sont nettement fréquentés par une plus grande proportion de
francophones alors que c’est le contraire pour d’autres services.
Sans les énumérer tous, notons-en quelques-uns qui nous donnent de l’information intéressante. On
peut voir à la Figure 12 que les services d’urologie, d’endoscopie ainsi que la clinique de neurologie
sont nettement plus fréquentés par les francophones, dans des proportions avoisinant 47-48%. C’est le
cas aussi pour les catégories « Integrated Medical – GEME ». Il s’agit de l’occupation de lits à l’hôpital,
toutes raisons confondues, ce qui veut dire qu’une proportion plus grande de francophones, bien audelà de son poids démographique, passe un séjour de plus d’une journée à l’hôpital. Bien qu’on ne
puisse tirer de conclusions claires, le lien avec les données présentées précédemment (population plus
âgée ayant davantage de défis de santé) est intéressant.
D’autres services dignes de mention où les francophones comptent pour une bonne proportion de la
fréquentation comprennent l’électromyographie, l’oncologie, les services cardio-pulmonaires, télésanté,
clinique d’angiographie ainsi que les électrochocs, tous des services qui laissent présager des
conditions de santé présentant des défis potentiellement importants pour une population.
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Rapport final
Figure 12 : Utilisation des services de l'hôpital par les francophones de Timmins, 2010 à 2015
(Figure 1 de 3)
Source : Hôpital de Timmins
À la Figure 13 se retrouvent les services qui semblent être fréquentés par des francophones dans une
proportion attendue; soit autour de 38% du total.
(Figure 2 de 3)
Dans le cas de services fréquentés par les francophones dans des proportions se situant en-deçà de la
moyenne (Figure 14), la plupart sont liés à des conditions de santé moins graves que dans le cas de
services hautement fréquentés par les francophones. Beaucoup de ces services sont liés à la pédiatrie
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Rapport final
par exemple. Une donnée importante ressort de cette dernière figure par contre. L’urgence est
fréquentée dans une proportion moindre qu’attendue par des francophones : 34,5%. Est-ce lié au fait
qu’ils sont mieux pris en charge ailleurs? Est-ce qu’ils hésitent davantage à se rendre à l’urgence?
Difficile à dire. Quoi qu’il en soit, cette donnée est fort intéressante.
(Figure 3 de 3)
Autres données
Pour ajouter à ces données, nous avons pensé relater ici les principales conclusions d’un rapport qui a
été produit par le Bureau de santé Porcupine en 2015 intitulé Rapport sur l’état de santé dans la
communauté 2014. Bien que certaines données soient similaires à ce qui a été présenté plus haut,
d’autres sont nouvelles. Voici les principales conclusions tirées de ce rapport.
Par rapport à la moyenne provinciale, la population du territoire de Porcupine a :
- Une espérance de vie inférieure : 4 ans de moins chez les hommes et 3,3 ans de moins chez
les femmes
- Un taux de mortalité potentiellement évitable 1,6 fois plus élevé (lié au mode de vie)
- Un taux de cancer 1,25 fois plus élevé
- Un taux de décès liés à l’alcool 2 fois plus élevé
- Un taux d’hospitalisation 3 fois plus élevé en raison d’une maladie mentale
- Un taux de suicide 3 fois plus élevé (et davantage pour certains groupes d’âge)
- Un taux de mortalité infantile plus élevé : 7,7 versus 4,9 pour 1 000 naissances
- Un taux de grossesse adolescente 2 plus élevé et taux de naissances vivantes chez les
adolescentes plus de 3 fois plus élevé
- Un taux de tabagisme 1,4 plus élevé et taux d’exposition environnementale à la consommation
du tabac 1,7 fois plus élevé
- Un taux de chlamydia et de gonorrhée nettement plus élevé
- Un taux plus élevé de consommation d’alcool à des niveaux associés à une incidence négative
sur les résultats pour la santé, 52,8% versus 41%
- Un taux plus élevé de décès résultant d’accidents de transport terrestre, 9,6 pour 100 000
versus 6,2 pour 100 000
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3.4 DISCUSSION
Que nous révèlent les données démographiques et socio-économiques de la population francophone
de Timmins? Quels liens peut-on faire entre ces données et les déterminants de la santé? Y a-t-il lieu
de lier les données démographiques et socio-économiques avec le profil de santé de cette population?
Que nous disent les données fournies par l’hôpital?
De façon générale, l’état de santé change avec l’âge. En vieillissant, les risques de devoir faire appel
au système de santé s’accentuent, la fréquence à laquelle on fait appel au système de santé
s’accentue aussi, de même que la complexité des interventions. Bien que l’âge ne soit pas un
déterminant de la santé proprement dit, puisque la corrélation entre âge et état de santé est évidente et
attendue, elle la détermine.
Les francophones de Timmins sont plus âgés que les anglophones et ce, de manière assez importante,
avec une différence d’âge moyen d’un peu plus de 7 ans. De plus, la pyramide des âges laisse croire
que l’écart pourrait aller en s’accentuant au cours des prochaines années.
Les éléments les plus importants qui sont ressortis du profil socio-économique sont le fait que les
francophones de Timmins sont moins éduqués que les anglophones et, dans une plus grande
proportion, occupent des professions ou sont dans des industries où les conditions de travail liées à
l’environnement physique ne sont pas des plus faciles (industries primaires par exemple).
Bien que nous ayons mentionné que le déterminant le plus important était le niveau de revenu, et qu’il
y avait peu de différences entre francophones et anglophones à ce chapitre, le niveau d’éducation en
est un autre. L’Agence de santé publique du Canada l’explique en ces mots :
Le niveau d'instruction contribue à la santé et à la prospérité en donnant aux gens les
connaissances et les capacités dont ils ont besoin pour résoudre des problèmes et le sentiment
d'influencer et de maîtriser leur vie. Le niveau d'instruction accroît également les possibilités
d'emploi, de sécurité du revenu et de satisfaction au travail. Il améliore enfin la capacité des
gens de se renseigner et de comprendre l'information pour soigner leur santé.
En ce qui a trait au déterminant lié à l’emploi et aux conditions de travail (ou l’environnement physique
au travail), L’Agence de santé publique du Canada en parle en ces termes :
On associe le chômage, le sous-emploi, un travail stressant ou dangereux avec une piètre
santé. Les gens qui disposent de plus de pouvoir sur leurs conditions de travail et qui sont
soumis à moins de stress au travail sont en meilleure santé et vivent souvent plus longtemps
que ceux qui sont exposés à davantage de stress ou de risques au travail.
Concernant l’emploi et les environnements physiques, on a vu que les francophones de Timmins se
retrouvent en plus grandes proportions dans des professions ou industries où, justement,
l’environnement physique présente un haut niveau de risques. Cela peut aussi avoir une incidence sur
l’état de santé.
Les données sur la santé présentées précédemment nous disent que de façon générale, les
francophones de la province font moins bonne figure que les anglophones sur la plupart des
indicateurs sur la santé : indicateurs liés au bien-être, indicateurs liés aux comportements ayant une
incidence sur la santé, indicateurs sur l’état de santé, et autres indicateurs. Les données nous disent
aussi que la situation est pire au niveau de la région socio-sanitaire de Porcupine où la population de
Timmins et les francophones ont un grand poids.
En considérant le profil démographique de la population francophone de Timmins, certaines
caractéristiques socio-économiques de cette population ainsi que ce qui ressort des données sur la
santé au niveau de la province et de la région socio-sanitaire de Porcupine, il est possible par
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extrapolation d’en conclure que les francophones de Timmins sont probablement confrontés à des
défis particuliers au niveau de la santé, et davantage que la population anglophone majoritaire. Les
données fournies par l’hôpital viennent d’ailleurs corroborer ce constat, du fait que les services liés aux
défis de santé les plus importants sont fréquentés dans une plus grande proportion qu’attendue par les
francophones.
Un des déterminants de la santé cité en introduction est lié aux services de santé. De bons services de
santé se traduisent par une meilleure santé. La section qui suit dresse l’inventaire des services offerts
aux francophones de Timmins. Elle permettra de mieux comprendre s’il y a lieu de s’imaginer que cette
offre de services ait un impact sur la santé des francophones de Timmins. Les sections qui suivent
devraient aussi venir valider cette analyse ainsi que l’augmenter d’autres éléments contextuels.
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4. INVENTAIRE DES SERVICES DE SOINS PRIMAIRES
Un inventaire des services de soins primaires offerts à Timmins a été réalisé, visant à mieux
comprendre la gamme de services de soins primaires ainsi que les services de promotion de la santé
et de prévention dispensés sur le territoire de la ville de Timmins sous l’angle linguistique. Quels
services sont offerts en français? Lesquels ne le sont pas? Quelles sont les politiques linguistiques? Y
a-t-il une offre active en français?
Il aurait été très intéressant pour rehausser cet inventaire d’avoir une idée précise du nombre de
francophones fréquentant les services, et de la langue dans laquelle ces services étaient demandés,
mais peu de fournisseurs de services et de soins colligent cette information. Pour certains, cette
information n’est pas jugée utile. Pour d’autres, ce sont les limites des systèmes informatiques qui ont
été évoquées comme raisons.
Il importe de noter ici que cet inventaire n’est pas exhaustif. Nous nous sommes concentrés sur les
fournisseurs de services et de soins les plus importants, tout en étant conscients qu’il y en a d’autres
sur le territoire de la ville de Timmins. L’inventaire ne dresse donc pas un portrait précis de la situation,
mais vise plutôt à fournir un portrait général de ce qui est offert comme services et soins aux
francophones de Timmins. De plus, le type d’information recueilli ainsi que le niveau de détail de celleci a été très différent d’un organisme à l’autre. Quoi qu’il en soit, cet exercice a été fort utile pour
réfléchir aux lacunes en ce qui a trait à l’offre de services, ainsi que les façons de les combler.
Il importe aussi de noter que l’information rapportée ici est principalement celle qui a été partagée par
les fournisseurs de services et de soins, ou celle trouvée sur les divers sites Web de ces organismes.
Qui offre des services de soins primaires à Timmins?
L’offre de services de soins primaires ainsi que de services de promotion de la santé et de prévention
est importante à Timmins par rapport à la taille de sa population, s’expliquant peut-être par le rôle que
la ville joue au niveau régional. Cette offre de services passe par divers organismes qui offrent soit des
services de soins primaires, soit des services de promotion de la santé et de prévention, ou les deux,
comme explicité dans le Tableau 5.
Tableau 5 : Fournisseurs de services et de soins couverts par cet inventaire
Équipe de santé familiale Timmins
Hôpital de Timmins
Centre d’accès aux soins
communautaires du Nord-Est
East-End Family Health Team
Bureau de santé Porcupine
Misiway Community Health Centre
Association canadienne de santé
mentale – Filiale Cochrane
Temiskaming
Victorian Order of Nurses,
Northeast District
Services de soins
primaires
√
√
√
Services de promotion de
la santé et de prévention
√
√
√
√
√
√
√
√
√
√
La définition de ce qui est compris comme étant des soins primaires n’en est pas une qui ait des limites
claires. Comme mentionné précédemment, dans le cadre de la présente étude, les soins primaires
devaient inclure les services de promotion de la santé et de prévention. Nous avons étendu cette
définition pour inclure les services offerts par l’hôpital. En effet, la fréquentation de l’urgence par
exemple pourrait très bien cadrer dans la définition de soins primaires, et la gamme de services
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spécialisés y étant offerts est un prolongement des soins primaires. Nous avons donc inclus l’hôpital
dans cet inventaire.
4.1 L’OFFRE DE SERVICES DE SOINS PRIMAIRES EN FRANÇAIS
Ressources humaines en santé (infirmières et médecins)
Avant de s’attarder à chacun des fournisseurs de services et de soins, attardons-nous aux ressources
humaines en santé à Timmins, et plus précisément aux médecins et infirmières.
Le Ontario Physcian Human Resources Data Centre recueille des données sur tous les médecins de
l’Ontario, incluant la langue dans laquelle ils peuvent pratiquer, ainsi que l’endroit où ils pratiquent. Bien
que ces données soient peu détaillées, elles nous révèlent qu’en 2014, 34% des 83 médecins
pratiquant sur le territoire de la ville de Timmins, incluant les médecins spécialistes, étaient en mesure
d’offrir des services en français. Ce chiffre va dans le même sens que les données obtenues de
l’hôpital (où pratiquement tous les médecins présents à Timmins ont un rôle à jouer) qui révèlent la
présence de 84 médecins, dont 37% pouvant offrir des services en français.
En ce qui a trait aux infirmières, tous types confondus, elles seraient, selon l’Ordre des infirmières et
des infirmiers de l’Ontario, entre 600 et 700 à pratiquer sur le territoire de la ville de Timmins. Au total,
c’était la moitié d’entre elles (49,3%) qui étaient en mesure d’offrir des services en français en 2015, tel
que le démontre le Tableau 6, et cette proportion semble avoir connu une hausse assez importante au
cours des dernières années. Ce sont les infirmières auxiliaires qui, dans une plus grande proportion
(56,2% du total en 2015), sont en mesure d’offrir de tels services, alors que dans le cas des infirmières
praticiennes, la proportion est la plus petite (28,6% en 2015).
Tableau 6 : Pourcentage d'infirmières pratiquant sur le territoire de la ville de Timmins étant en
mesure d'offrir des services dans les deux langues officielles
% du total
Infirmière
autorisée
Infirmière
auxiliaire
Infirmière
praticienne
Total
2011
40,6%
48,4%
27,8%
42,6%
2012
41,8%
49,2%
27,8%
43,6%
2013
44,3%
53,1%
27,8%
46,5%
2014
44,9%
54,4%
29,2%
47,6%
2015
46,4%
56,2%
28,6%
49,3%
Source : Ordre des infirmières et des infirmiers de l’Ontario
Équipe de santé familiale Timmins
L’équipe de santé familiale (ÉSF) Timmins est présente partout à Timmins avec plusieurs bureaux
répartis dans la ville. L’ÉSF dessert une clientèle provenant de la ville de Timmins, mais aussi d’un
territoire allant au-delà de la ville et s’étendant dans un rayon de 100 km. Au total, ce sont près de
24 000 patients qui sont inscrits à l’ÉSF. L’ÉSF n’est pas en mesure de fournir des chiffres sur le
nombre de patients francophones, mais les discussions ont révélé qu’une grande proportion de la
clientèle était francophone, et que plusieurs des médecins francophones de l’ÉSF avaient une clientèle
presque exclusivement francophone.
L’ÉSF Timmins compte 31 médecins dont 19, représentant 61,3% du total, étant en mesure d’offrir des
services à une clientèle francophone, tel que le démontre le Tableau 7. En ce qui a trait aux infirmières,
un peu plus de la moitié d’entre elles, 10 sur 19, sont en mesure d’offrir des services en français. Au
total, c’est 60,6% des 86 employés de l’ÉSF Timmins qui peuvent offrir des services en français.
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Tableau 7 : Capacité de l'Équipe de santé familiale Timmins à offrir des services en français
Type de professionnels
Nombre d'employés
Médecin
Infirmière praticienne
Infirmière
Infirmière auxiliaire télémédecine
Travailleur social
Diététicienne
Promotion de la santé /
kinésiologue
Psychologue clinique
Personnel de bureau
Personnel administratif
Total
Source : Équipe de santé familiale Timmins
Employés bilingues
31
5
13
1
3
2
1
19
2
7
1
3
1
0
% du total qui sont
bilingues
61,3%
40,0%
53,8%
100,0%
100,0%
50,0%
0,0%
1
4
5
66
1
4
2
40
100,0%
100,0%
40,0%
60,6%
L’ÉSF Timmins offre une vaste gamme de programmes et services de soins, de promotion de la santé
et de prévention :
-
Programme de diabète
Chirurgie mineure
Services de pharmacie
Physical Activity
Programme des anticoagulants
Dépistage du cancer du col de l'utérus / Test
de Pap
Les aliments et la nutrition
-
Soins en médecine générale
Programme gériatrique
Programme d'hypertension
Réseau Télémédecine Ontario
Programme de l'ostéoporose
Le travail social
Programme Bébés bien portant, enfants
bien portant
Ces services sont tous offerts en anglais, et la plupart, dans la mesure du possible, sont offerts en
français2. L’ÉSF offre aussi diverses séances de modes de vie sains (programme de marche, thérapie
de groupe sur l’anxiété, etc.) qui ne sont offertes qu’en anglais.
Services et offre active en français
En ce qui a trait aux services en français et à l’offre active, il importe de mentionner que l’ÉSF n’a pas
de politiques spécifiques sur le français mais qu’elle vise à assurer un service dans les deux langues
officielles. Lors de l’embauche de personnel, l’ÉSF vise aussi, dans la mesure du possible, pour des
ressources étant en mesure d’offrir des services en français. En ce qui a trait à l’offre active, l’accueil
sur place ou par téléphone se fait dans les deux langues officielles. Le site internet de l’ÉSF est
presque entièrement bilingue.
Hôpital de Timmins
Comme il l'est si bien expliqué sur son site Web, l’Hôpital de Timmins et du District (« l’hôpital ») est un
hôpital régional d'enseignement de niveau C servant la population de la ville de Timmins et du district
de Cochrane ainsi que celle des régions avoisinantes des districts de Temiskaming, de Sudbury et
d'Algoma. [L’hôpital] se fait un devoir de fournir des services de soins de santé qui répondent aux
besoins de la communauté et de la région desservie. Il offre une gamme complète de soins médicaux,
chirurgicaux, pédiatriques et intensifs, de soins à la mère et au nouveau-né ainsi que de soins de
longue durée. En outre, il assure à l'échelle du district la prestation d'un large éventail de services de
santé mentale et de services d'éducation, entre autres.
2
Au moment d’écrire ces lignes, seuls deux services n’étaient pas offerts en français.
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D’entrée de jeu, il importe de mentionner que cet hôpital est un organisme désigné en vertu de la Loi
sur les services en français de l’Ontario. Il est donc assujetti à cette Loi et est tenu d’offrir des services
en français. Les données sur la fréquentation de l’hôpital mettent d’ailleurs en perspective l’importance
de cette offre de services en français. En effet, les données linguistiques obtenues de l’hôpital
démontrent que de tous les résidents de Timmins s’étant présentés aux portes de l’hôpital entre 2010
et 2015, incluant à l’une de ses cliniques externes, 37,8% s’étaient identifiés comme étant francophone
(langue maternelle).
Sans retourner dans le détail de ce qui a été présenté précédemment, il importe de noter à nouveau le
fait que la proportion de francophones fréquentant les divers services de l’hôpital est assez variable
d’un service à l’autre.
En plus de la variable « langue maternelle », l’hôpital a pu nous fournir des données sur la langue dans
laquelle les divers services étaient demandés, mais le taux de non-réponse (lorsque la langue
demandée était « inconnue ») était beaucoup trop élevé pour que l’on puisse utiliser ces données dans
le cadre de la présente étude.
Nous avons mentionné précédemment que 36,9% des 84 médecins exerçant à l’hôpital étaient en
mesure de le faire en français. Dans le Tableau 8 qui fournit le détail à cet effet, on constate que les
médecins généralistes sont dans une plus grande proportion francophone alors que c’est le contraire
pour les médecins spécialistes. On constate aussi que pour certaines spécialités, la main-d’œuvre
médicale étant en mesure d’offrir des services en français est basse ou absente. On peut faire un lien
ici avec les défis particuliers qui se rattachent à l’attraction de spécialistes francophones dans les
communautés rurales et isolées de l’Ontario.
Tableau 8 : Médecins exerçant à l'Hôpital de Timmins selon leur capacité à offrir des services en français
Spécialité
Total
Pouvant travailler en
français
Généralistes
52
24
Anesthésie
7
1
Imagerie diagnostique
1
0
Chirurgie générale
3
2
Médecine interne
2
0
Obstétrique et gynécologie
3
1
Ophtalmologie
1
0
Orthopédie
4
1
Oto-rhino-laryngologie
1
1
Pathologie
3
0
Pédiatrie
2
0
Psychiatrie
3
0
Urologie
2
1
Total
84
31
Source : Hôpital de Timmins. Données révisées par Dr Raymond.
% du total pouvant
travailler en français
46,2%
14,3%
0,0%
66,7%
0,0%
33,3%
0,0%
25,0%
100,0%
0,0%
0,0%
0,0%
50,0%
36,9%
Nous n’avons obtenu aucune donnée sur les autres ressources humaines présentes à l’hôpital ainsi
que sur leur niveau de bilinguisme.
L’hôpital a depuis février 2016 une politique sur l’offre active en français. Cette politique explique de
façon détaillée comment l’établissement offre des services en français lors de la communication orale
et écrite avec la population francophone. Cette politique touche entre autres au bilinguisme du site web
de l’établissement, la traduction de documents officiels, le bilinguisme dans la langue d’affichage à
l’intérieur et è l’extérieur de l’établissement, etc. Elle donne aussi un aperçu de la façon dont
l’établissement entend assurer la permanence des services en français par l’embauche de même que
par la formation.
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Par ailleurs, les règlements administratifs de l’hôpital, disponibles sur le site Web de celui-ci, font
référence au statut bilingue de l’établissement en ces termes :
ATTENDU QUE l’Hôpital de Timmins et du district/Timmins et District Hospital, conformément à
la disposition de la Loi de 1986 sur les services en français s’est engagé à fournir des services
dans les deux langues officielles afin de répondre aux besoins linguistiques de la population
desservie par l’hôpital
Ces mêmes règlements font aussi référence à un Comité consultatif sur les questions touchant le
français, lequel comité se rapporterait au Comité des ressources financières et humaines.
Centre d’accès aux soins communautaires
Les Centres d'accès aux soins communautaires (CASC) sont des organismes locaux qui fournissent
des renseignements sur les soins offerts dans la région où ils sont implantés. Les CASC ont comme
mandat d’aider la population à :
- Vivre à la maison de façon autonome
- Présenter une demande d'admission à un programme de jour, à un logement avec services de
soutien ou à un programme d'assistance, ou à certains établissements pour malade chroniques
ou de réadaptation
- Présenter une demande d'admission dans un foyer de soins de longue durée
Les CASC renseignent également le public au sujet des autres organismes et services
communautaires et orientent les personnes vers les services. Ils offrent des services à domicile ainsi
que dans les écoles.
Le CASC du Nord-Est a été en mesure de nous fournir des données détaillées sur la fréquentation de
ses services dans la ville de Timmins entre 2010 et 2015, selon la langue. Ainsi nous constatons au
Tableau 9 que 43% de la clientèle était francophone, mais que cette proportion était significativement
plus basse dans les écoles et plus élevée en ce qui a trait aux services à domicile. En considérant la
langue dans laquelle les francophones ont demandé à être servis, on constate que peu d’entre eux –
moins d’une personne sur cinq – ont demandé à être servis en français uniquement. Le quart a
demandé à être servi en français et en anglais alors que plus de la moitié a demandé à être servie en
anglais.
Tableau 9 : Utilisation des services du CASC selon le profil linguistique, 2010 à 2015
Nombre
total de
patients
#
Services à
domicile
Services
dans les
écoles
Total
Patients nonfrancophones
#
% du
total
Patients
francophones
#
Patients francophones ayant demande des services
en…
…français
…français et
…anglais
anglais
% du
total
#
4 808
2 611
54,3%
2 197
45,7%
369
% des
francophones
16,8%
#
590
% des
francophones
26,9%
#
1 238
% des
francophones
56,3%
812
595
73,3%
217
26,7%
82
37,8%
1
0,5%
134
61,8%
5 620
3 206
57,0%
2 414
43,0%
451
18,7%
591
24,5%
1 372
56,8%
Source : Centre d’accès aux soins communautaires du Nord-Est
En ce qui a trait aux ressources humaines présentes au CASC à Timmins, et comme démontré au
Tableau 10, plus de la moitié des postes (54%) ont la désignation bilingue. L’autre élément qui ressort
du tableau est le fait 9 des 32,5 postes désignés bilingues ne sont pas comblés, démontrant une fois
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de plus la difficulté à recruter du personnel bilingue (et tel que confirmé lors de nos discussions avec le
CASC).
Tableau 10 : Employés du CASC à Timmins selon la désignation bilingue des postes
Type de professionnels
Nombre de
postes
Postes
désignés
bilingues
Gestion des cas
36
Ergothérapie
7
Physiothérapie
2
Travail social
1
Orthophonie
1,5
Infirmière invitée
3
Gestion des services cliniques
1
Santé mentale et toxicomanie
4
Orthophonie
1
Infirmières en réponse rapide
2
Infirmière praticienne en soins
1
palliatifs
Initiative de réforme de la
1
physiothérapie
Total
60,5
Source : Centre d’accès aux soins communautaires du Nord-Est
19
5
1
1
1,5
0
0
1
1
2
0
% de postes
qui sont
désignés
bilingues
52,8%
71,4%
50,0%
100,0%
100,0%
0,0%
0,0%
25,0%
100,0%
100,0%
0,0%
Postes
désignés
bilingues noncomblés
2
1
1
0
1
0
0
0
1
2
0
1
100,0%
1
32,5
53,7%
9
La plupart des services offerts à Timmins le sont dans les deux langues officielles, à l’exception de
quelques-uns pour lesquels, nous a-t-on expliqué, il est difficile à trouver du personnel bilingue. Les
spécialistes tels que diététistes et orthophonistes étant en mesure d’offrir des services en français ont
été identifiés comme étant difficiles à trouver.
Services à domicile
Coordination de services
Infirmière praticienne pour soins palliatifs
Personnel infirmier d’intervention rapide
(anglais seulement)
Télésoins à domicile
Soins infirmiers
Personnel de soins auxiliaires
Ergothérapie avec l’aide d’assistants en
réadaptation
Physiothérapie avec l’aide d’assistants en
réadaptation
-
Orthophonie (anglais seulement)
Travail social
Diététiste (anglais seulement)
Services dans les écoles
Coordination de services
Service infirmiers
Ergothérapie
Physiothérapie
Orthophonie (anglais seulement)
- Diététiste (anglais seulement)
Le CASC du Nord-Est est un organisme désigné en vertu de la Loi sur les services en français de
l’Ontario. Il est donc assujetti à cette Loi et est dont tenu d’offrir des services en français, comme en
témoigne le tableau ci-dessus décrivant la désignation bilingue des postes.
Concernant l’offre active et les services en français, les politiques sont de façon telle que toute
personne communiquant avec le CASC du Nord-Est et demandant à être servie en français est
redirigée à la centrale de Timmins qui est en mesure de fournir de tels services, et qui dirigera le
patient vers des services en français ou en anglais aux étapes subséquentes, selon le désir de celui-ci.
Des pratiques semblables existent lorsque le patient est recommandé par un médecin. Durant les
heures normales de bureau, le CASC garantit de tels services en français, mais il se pourrait qu’en
dehors de ces heures (soirs et fins de semaine), une telle offre soit plus problématique.
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En plus des politiques en ressources humaines ainsi que celles liées à l’offre active, les organismes
fournissant des services au nom du CASC ont la responsabilité d’offrir le service dans la langue dans
laquelle il a été demandé. Il est aussi à noter que le site Web est entièrement offert dans les deux
langues officielles.
Bureau de santé Porcupine
Le Bureau de santé Porcupine est le bureau de santé publique qui dessert le district de Cochrane et la
Ville de Hornepayne, et dont le siège social se trouve à Timmins. Le Bureau offre toute une gamme de
programmes et services en promotion de la santé et en prévention, tous offerts dans les deux langues
officielles.
-
Cliniques de santé sexuelle
Le Programme d’échange du Nord
Cliniques de vaccinations
Cliniques des voyageurs
Services génétiques – counselling
génétique, cliniques avec génétiste
Services de nutrition – divers ateliers,
NutriSTEP, Programme canadien de
nutrition prénatale
Cliniques d’abandon de tabac
-
Programme de prévention des chutes
« Stand Up »
Bébé en santé, enfant en santé
Cliniques de parentage (Triple P)
Soutien à l’allaitement
Cours prénatales
Programme d’orthophonie
Programme de la santé bucco-dentaire
Cours de formation sur la manipulation des
aliments
Pour être en mesure d’offrir ses services et programmes en français, le Bureau a un grand nombre de
ses postes qui sont occupés par des personnes bilingues. Au total, ce sont 60% des employés qui sont
en mesure d’offrir des services dans les deux langues officielles, comme démontré dans le Tableau 11.
Tableau 11 : Profil linguistique du personnel au Bureau de santé Porcupine
Spécialité
Médecin-hygiéniste
Infirmière
Coordonnateur de programme
Orthophoniste
Hygiéniste dentaire
Dirigeant
Accueil
Total
Source : Bureau de santé Porcupine
Total
1
25
8
1
1
2
2
40
Pouvant travailler en
français
1
10
7
1
1
2
2
24
% du total pouvant
travailler en français
100,0%
40,0%
87,5%
100,0%
100,0%
100,0%
100,0%
60,0%
Le Bureau de santé Porcupine a mis en place des politiques sur les langues officielles incluant des
politiques sur :
- Réactivité aux différences linguistiques et culturelles
- Flexibilité linguistique dans la conception des programmes
- Surveillance et l’évaluation linguistique des programmes
- Formation linguistique
- Traduction
Le Bureau fait une offre active en français tant à l’accueil que par téléphone, et offre ses programmes
et services dans les deux langues officielles. Il s’assure aussi de faire la promotion de ses programmes
et services dans les deux langues et d’offrir des ressources (dépliants, etc.) tant en français qu’en
anglais. Le site Web du Bureau est entièrement offert dans les deux langues officielles.
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Misiway Community Health Centre
Le Centre de santé communautaire Misiway Milopemahtesewin est une organisation de services de
soins de santé primaires destinés aux Autochtones dans le nord de l'Ontario. Il est situé à Timmins et
fourni des services dans un rayon de 140 kilomètres. Bien que le Centre ait un nombre élevé de clients
autochtones, les services sont mis à disposition de tous. Il dessert un peu plus de 1 450 patients à
travers des services tels que : soins de santé primaire, éducation sur le diabète, santé mentale et
toxicomanie pour enfants et adolescents, guérison traditionnelle. Aucune donnée n’est disponible sur
l’utilisation des services par les francophones, mais ils sont peu selon ce qu’on nous a rapporté.
En ce qui a trait à l’offre de services en français, il y en a peu, et dans le cas de la clinique, il n’y en a
pas. Les services en français ne font pas partie du mandat du centre. Cela étant dit, certains des
employés sont en mesure d’offrir des services en français. L’option « français » a d’ailleurs été ajoutée
au message téléphonique du Centre, menant à un employé parlant français. Aucun politique
linguistique lié au français n’est en place, et le site Web est uniquement offert en anglais.
Association canadienne de santé mentale
La filiale Timmins-Timiskaming de l’Association canadienne de santé mentale dessert la ville de
Timmins. Cette filiale est un organisme désigné en vertu de la Loi sur les services en français de
l’Ontario. Une infirmière praticienne est présente sur le territoire de la ville de Tmmins et celle-ci est en
mesure d’offrir des services en santé mentale en français. En 2015, ce sont 164 patients anglophones
et 17 patients francophones qui ont fait appel à ces services, tous provenant de Timmins. L’ACSM
Cochrane-Timiskaming a une politique détaillée en place sur les ressources humaines francophones,
reconnaissant que c’est une région désignée pour les services en français. Cette politique couvre les
éléments suivants :
- Mise en place d’un comité sur les services en français
- Représentation francophone sur les comités et le Conseil d’administration
- Règles d’embauche
- Offre active en français
Cela étant dit, le site Web de l’ACSM Cochrane-Timiskaming est uniquement offert en anglais. Par
contre, le site Web au niveau national est offert dans les deux langues officielles.
Victorian Order of Nurses
La filiale Porcupine du Victorian Order of Nurses est présente sur le territoire de la ville de Timmins,
offrant une panoplie de services allant des soins aux services de promotion de la santé et de
prévention.
-
Programme d’immunisation
Programme d'infirmière praticienne
Programme d'éducation sur le diabète
Cliniques de bien-être et de promotion de la
santé
-
Programme d'éducation sur le diabète
Cliniques de diabète disciplinaires
Tests de paternité
À Timmins se trouvent deux infirmières-praticiennes, quatre éducateurs sur le diabète ainsi que six
employés en gestion et administration, tous en mesure de travailler dans les deux langues officielles.
En ce qui a trait à la clientèle, 55% de celle-ci est francophone. Le bureau de Timmins fait une offre
active en français, tant sur place qu’au téléphone. Certaines politiques sur les services en français
existent, mais elles ne nous ont pas été partagées. En ce qui a trait au site Web, il ne semble pas en
exister un concernant la filiale Porcupine spécifiquement. Au niveau national, le site Web est offert
dans les deux langues officielles.
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East-End Family Health Team
L’Équipe de santé familiale East-End est une petite équipe offrant divers services de soins, de
promotion de la santé et de prévention à une clientèle majoritairement anglophone. 1650 patients y
sont inscrits. Un seul médecin fait partie de l’ÉSF East-End, n’ayant pas la capacité d’offrir des services
en français. Autre que le médecin, certains de membres du personnel sont en mesure d’offrir des
services en français, mais aucune politique de ressource humaine ou d’offre active n’est en place pour
garantir de tels services. Le site Web est uniquement offert en anglais.
4.2 DISCUSSION
L’offre de services de soins primaires, de promotion de la santé et de prévention est abondante dans la
ville de Timmins. De par le rôle que la ville joue au niveau régional, une vaste gamme de services y est
offerte, par plusieurs types de fournisseurs de services et de soins primaires.
Cet inventaire révèle que la plupart des fournisseurs de services et de soins sont en mesure d’offrir un
grand nombre de services de soins primaires, de promotion de la santé et de prévention en français,
mais que cette offre n’est pas égale d’un organisme à l’autre, ni n’est constante, ni n’est gérée de la
même façon.
Certains organismes semblent avoir misé grandement sur l’offre de tels services, entre autres en
demandant la désignation sous la Loi sur les services en français de l’Ontario et/ou en ayant en place
des politiques à cet égard. D’autres organismes disent s’assurer de l’offre de tels services, mais sans la
présence de politiques claires à cet effet. Dans d’autres cas, l’offre n’est pas institutionnalisée, mais la
présence d’employés ayant la capacité de parler français constitue la façon de répondre à la demande
Donc, les services offerts le sont pratiquement tous en anglais, et le sont partiellement en français.
L’offre ne se fait donc pas systématiquement dans les deux langues officielles. Nos échanges avec les
fournisseurs de services et de soins ont révélé deux raisons pour cette différence : manque de
ressources humaines ayant la capacité de travailler en français, demande pour des services en
français ne justifiant pas l’offre.
Pour plusieurs des intervenants, il serait difficile d’imaginer que l’ensemble du système de santé à
Timmins puisse être en mesure de fonctionner dans les deux langues officielles. En effet, ce sont le
tiers des médecins et la moitié des infirmières qui sont bilingues. De plus, l’inventaire a révélé le fait
qu’il pouvait être difficile pour les fournisseurs de services et de soins de recruter du personnel ayant la
capacité d’offrir des services en français, et il semble que ce défi soit rehaussé lorsqu’il s’agit du
personnel davantage spécialisé. Ce défi est bien réel et est présent dans l’ensemble des communautés
linguistiques minoritaires en Ontario.
Au-delà des services offerts, l’offre active est aussi importante pour le patient francophone
interagissant avec le système. Selon ce que cet inventaire nous a révélé, l’offre active ne se fait pas
partout, et elle se fait dans certaines parties du système alors qu’elle ne se fait pas dans d’autres. De
façon générale, elle se fait lors de l’interaction initiale avec le fournisseur de services ou de soins, soit
par téléphone ou en personne. Par contre, il n’est pas clair si aux étapes subséquentes, cette offre
active soit toujours présente.
Nous avons constaté dans la réalisation de cet inventaire que les politiques en lien avec l’offre de
services en français n’étaient pas disponibles publiquement (sur le Web). En effet, nos recherches
n’ont pas permis de trouver de politiques ou de documentation explicitant comment un fournisseurs de
services et de soins comptait répondre aux besoins des francophones par l’offre active, l’offre de
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services en français, la garantie d’une telle offre, etc. Le patient francophone ne sait donc pas toujours
à quoi s’attendre.
En lien avec ce dernier point, certains des fournisseurs de services et de soins ont noté le fait que
l’offre de services en français n’était pas toujours présente puisque la demande ne l’était pas. Ce fait a
entre autres été noté pour les services de promotion de la santé et de prévention. Cela étant dit, le
manque de clarté concernant ce à quoi un patient francophone peut s’attendre concernant l’offre de
services en français ainsi que le fait que le patient en question ait à adopter l’anglais ici et là lors de ses
interactions avec le système pourrait en partie expliquer une demande moins forte. Les discussions
avec la communauté pourront nous éclairer à cet effet.
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5. COMPTE-RENDU DES DISCUSSIONS AVEC LES PROFESSIONNELS DE LA SANTÉ ET
AVEC LA COMMUNAUTÉ
Cette section présente un compte-rendu des discussions qui ont eu lieu avec les professionnels de la
santé, ainsi que de la consultation qui a eu lieu avec la communauté.
5.1 CE QUI A ÉTÉ ENTENDU LORS DES DISCUSSIONS AVEC LES PROFESSIONNELS
Suite à l’analyse des données démographiques, socio-économiques et de santé, nous avons voulu
tenir des discussions3 avec des professionnels de la santé présents sur le terrain pour ainsi valider
et/ou obtenir des précisions sur les informations recueillies jusqu’à maintenant. Ainsi, nous avons pu
discuter avec 11 professionnels : cinq omnipraticiens, deux infirmières, un médecin-spécialiste, une
infirmière, un professionnel en santé publique ainsi qu’un représentant de l’hôpital.
Sommaire des discussions
D’abord, il est important de préciser que les principaux problèmes en ce qui a trait aux soins de santé
primaire pour les francophones étaient parfois présentés comme étant des difficultés s’appliquant à
l’ensemble de la population, mais qui sont exacerbées par l’accès limité à des services offerts en
français. Les problèmes présentés étaient souvent reliés au manque de support spécialisé pour que les
soins de santé primaire soient plus efficaces. L’accès à des services de médecins spécialistes pour
appuyer les médecins de santé primaire a été souvent évoqué, notamment la disponibilité de médecins
spécialistes francophones.
Malgré la présence de plusieurs médecins francophones dans la communauté, l’accès à ces médecins
par la population francophone est quand même limité par le fait que ces médecins n’ont pas une
clientèle exclusive francophone et qu’ils pratiquent dans d’autres contextes que les soins de santé
primaire. De plus, le problème de patients francophones n’ayant pas de médecin de famille a été
soulevé à quelques reprises4.
Par ailleurs, les professionnels consultés ont souligné la très grande collaboration entre l’hôpital et les
équipes de soins primaires pour les services diagnostiques. Ils ont aussi indiqué que plusieurs services
de santé primaire semblaient bien répondre aux besoins de la population francophone. Ils ont noté par
exemple l’existence de partenariats entre fournisseurs de services et de soins qui favorisent une
meilleure complémentarité dans l’offre de services ainsi que le fait que plusieurs professionnels de la
santé sont bilingues.
Les problèmes de recrutement et de rétention de professionnels francophones ont été aussi présentés
dans le contexte plus large de recrutement et de rétention dans le Nord de la province. La nondisponibilité de professionnels francophones mène parfois à des compromis sur l’aspect linguistique au
détriment des services offerts en français à la population.
L’absence de demande pour des services en français a été présentée comme étant un problème. Les
professionnels consultés se questionnent sur l’offre active de ces services en français et sur la collecte
de données précises sur la langue maternelle et la langue de choix.
3
Le questionnaire utilisé lors des discussions avec les professionnels de la santé est présenté à l’annexe 2.
Il importe de mentionner que deux estimations du nombre de patients orphelins ont été fournies au consultant,
mais ces données ne différenciaient pas francophones et anglophones, et avaient été recueillies selon deux
méthodes différentes qui arrivaient à des constats forts différents. Il a donc été décidé de ne pas considérer ces
données dans l’analyse.
4
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Les habitudes de vie des francophones de Timmins ont souvent été abordées comme source de
problèmes reliés à l’utilisation des soins de santé primaire. Les programmes de promotion de la santé
et de prévention ne semblent pas toujours bien rejoindre la population francophone.
L’intégration et la coordination des diverses composantes des soins de santé primaire (incluant les
services sociaux et les soins à domicile) destinées à la population francophone ont été évoquées
comme n’étant pas optimales, ce qui pourrait partiellement expliquer une surutilisation de certains
services hospitaliers par les francophones, bien que l’âge soit probablement le facteur le plus important
de cette surutilisation.
Les améliorations suggérées par les professionnels consultés ont été variées : amélioration des
services existants (entre autre ceux offerts par l’Équipe de santé familiale) par une meilleure intégration
et coordination des services, mise sur pied d’un centre de santé communautaire à gouvernance
francophone avec une programmation de services bien intégrée aux services existants, augmentation
des programmes de promotion de la santé et prévention de la maladie, et continuum de services plus
complet pour le traitement des maladies chroniques.
Des suggestions ont été apportées à l’effet de repenser les stratégies de recrutement et de rétention de
professionnels francophones, d’assurer un meilleur appariement des médecins francophones aux
patients francophones et de mieux articuler l’offre active de services en français.
Discussions détaillées
Voici de façon détaillée l’information recueillie pour chacune des questions posées. Les chiffres entre
parenthèses représentent le nombre de professionnels ayant répondu ainsi.
Selon vous, quels sont les trois principaux problèmes en ce qui a trait aux soins de santé primaires
pour les francophones?
-
Il y a un manque de services spécialisés pour l’ensemble de la population, notamment des
services en français (5)
Il y a des manques entre autres en psychiatrie (4)
Les problèmes sont les mêmes pour les francophones et les anglophones (3)
Les problèmes s’appliquent à l’ensemble de la population, mais c’est pire pour les
francophones (2)
Le nombre de médecins francophones est assez élevé, mais l’accès à ces médecins n’est pas
optimal pour les francophones (2)
Plusieurs personnes n’ont pas de médecin de famille (2)
La plupart des organisations offrent des services en français, mais souvent la demande n’est
pas là (2)
La demande de services en français est plus forte chez les personnes âgées (2)
Il y a des problèmes de transport pour obtenir les services requis (2)
Il y a des problèmes de recrutement de professionnels bilingues (2)
Le leadership en Ontario ne considère pas l’accès à des services en français comme une
question prioritaire (1)
Les patients ne sont pas très motivés par leur santé, ce qui fait que les programmes de
sensibilisation ne sont pas souvent utilisés de manière optimale (1)
L’occupation des lits à l’Hôpital de Timmins est plus élevée que son poids dans la population. Croyezvous que cela est dû à des lacunes dans l’organisation des soins primaires pour les francophones? Si
oui, pouvez-vous nous dire quelles sont selon vous ces lacunes?
-
Cette surutilisation n’est pas reliée à un manque de soins de santé primaire (3)
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-
Plusieurs visites évitables à l’hôpital sont liées aux déterminants de la santé et à un manque
d’éducation (3)
Cela pourrait être lié au vieillissement de la population (2)
Le support à domicile et le support social sont insuffisants (exemple : pas de lits de transition)
(1)
L’intégration des services entre l’hôpital et les soins primaires n’est pas toujours optimale (1)
Difficile parfois de donner congé de l’hôpital dans certains cas (ex. maladies chroniques), car il
n’y a pas de services pour prendre en charge ces patients (1)
Selon vous, quels sont les principaux problèmes rencontrés par les médecins de santé primaire en lien
avec l’accès aux services spécialisés de l’hôpital, s’il y en a, notamment quand il s’agit de patients
francophones?
-
Il y a une très bonne collaboration avec les services diagnostiques (à l’exception des services
en psychiatrie) et l’accès aux services spécialisés en français à l’hôpital est en général très bon
(6)
Le problème est plutôt relié à l’accès aux services des spécialistes venant de l’extérieur qui ne
sont pas toujours bilingues (5)
Les données de santé publique nous indiquent une prévalence plus élevée que la moyenne provinciale
pour plusieurs maladies chroniques (MPOC, arthrite, asthme, maladies du cœur, etc.) dans le district
de Porcupine. Pouvez-vous nous identifier les principales lacunes, selon vous, dans le continuum des
services requis par ces patients, notamment les patients francophones, et surtout dans les soins de
santé primaire?
-
Cette prévalence plus élevée est plutôt reliée à des habitudes de vie qu’à des lacunes dans le
continuum de services (6)
Un bon système de santé primaire axé sur ces maladies est nécessaire, par exemple pour les
MPOC (2)
Il y a un manque de coordination entre les services (2)
Il faudrait développer une clinique interdisciplinaire en gériatrie, du support dans la communauté
pour las cas complexes de santé mentale et des soins palliatifs plus complets (1)
Certains services ne sont pas couverts par l’assurance maladie, notamment la physiothérapie
(1)
Selon vous, quels services de soins de santé primaires qui existent actuellement dans votre
communauté répondent bien aux priorités des francophones (par exemple, partenariats existants avec
la communauté, modèles de soins, services)?
-
L’équipe de santé familiale offre beaucoup de services bilingues : médecins, IP et programmes
pour diabète, hypertension, gériatrie, anticoagulation, rein, intestins, bébés, santé mentale, etc.
(6)
Bons partenariats avec santé publique (2), CASC, VON, CAMH, etc. (1)
Partenariat avec le YMCA pour programme d’exercice pour les personnes âgées (1)
Partenariat avec les écoles pour la santé mentale (2)
2 audiologistes bilingues à temps partiel (1)
Children’s Center, Early Years Center, Centre de diabète (1)
Selon vous, quelles améliorations sont nécessaires pour venir combler les vides existants en matière
des soins de santé primaires pour les francophones et quelles stratégies doivent être adoptées pour y
subvenir?
-
Étendre les services en français à l’ÉSF, miser sur les services existants (6)
Un Centre de santé communautaire francophone pourrait être intéressant s’il est bien intégré
aux services existants (4)
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-
Améliorer et mieux coordonner le recrutement de personnel bilingue (4)
Assurer une meilleure intégration des services dans le système (3)
Avoir des associations plus étroites avec les maisons d’enseignement pour qu’ils ciblent
davantage les étudiants francophones (par exemple, l’École de médecine du Nord) (2)
En lien avec le rapport Price, créer un Patient Care Group pour la population francophone (2)
Miser sur l’éducation en augmentant la promotion de la santé pour les francophones (2)
Trouver des moyens pour mieux apparier les patients francophones avec les médecins
francophones (2)
Recruter un psychiatre francophone (1) et améliorer les services de santé mentale en
français (2)
Changer le mode de rémunération des médecins en santé primaire pour une formule mixte
comme celui des spécialistes pour augmenter la productivité (1)
Octroyer un budget dédié au fait français dans l’ÉSF pour l’offre active de services (1)
5.2 CE QUI A ÉTÉ ENTENDU LORS DE LA CONSULTATION AVEC LA COMMUNAUTÉ
L’équipe de PGF Consultants s’est rendue à Timmins pour tenir des consultations5 avec la
communauté francophone. Ces consultations visaient à obtenir la perspective de la communauté
francophone sur les lacunes dans l’offre de services de soins primaires et de prévention/promotion de
la santé, ainsi que sur les façons de combler ces lacunes. Ainsi, trois séances ont été organisées,
rassemblant une quarantaine de personnes au total. De plus, trois personnes ont répondu aux
questions par écrit.
Bien que ces consultations aient pu rassembler des personnes de toutes les sphères de la
communauté francophone de Timmins, on ne peut affirmer qu’elles aient permis d’aller chercher des
éléments qui soient représentatifs de l’ensemble de la communauté francophone puisque l’échantillon
n’a pas été choisi de façon aléatoire. Dans une perspective méthodologique, il importe de tenir compte
du fait que les personnes présentes aux consultations semblaient engagées dans la francophonie,
constituant ainsi l’opinion de cette tranche de la population francophone. Cela étant dit, l’exercice s’est
avéré être utile pour le peaufinage de l’analyse et l’élaboration de recommandations.
Voici les éléments clés qui sont ressortis pour chacune des questions posées lors de cette
consultation.
Selon vous, quels sont les services de soins de santé primaires en français qui existent actuellement
dans votre communauté?
Les répondants ont tout d’abord indiqué que plusieurs médecins et infirmières offrent des services en
français. Ils ont également mentionné que très souvent, le premier contact à l’Hôpital de Timmins ou
chez divers fournisseurs de services et de soins peut se faire en français, mais que la langue de
service aux étapes subséquentes est la plupart du temps l’anglais.
Les participants ont mentionné que certains spécialistes sont en mesure d’offrir des services en
français, mais c’est l’exception. Les services du CASC et de l’organisme VON ont été mentionnés
comme étant les plus bilingues à Timmins.
En ce qui a trait au Bureau de santé Porcupine, il semble offrir des services en français. Les
documents promotionnels destinés aux écoles sont tous offerts en français puisque c’est une exigence
des conseils scolaires. Cependant, ceux destinés au grand public ne semblent pas toujours être
5
Le questionnaire utilisé lors de la consultation avec la communauté est présenté à l’annexe 3.
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disponibles en français. Plusieurs participants nous ont mentionné que la publicité pour la promotion de
la santé et l’information sur les services de santé est nettement à prédominance anglophone.
Les participants ont indiqué que certains fournisseurs de services et de soins visent spécifiquement les
francophones, citant notamment la Maison Renaissance. Ils ont également mentionné qu’un psychiatre
francophone se rendait à Timmins 3 jours par mois.
Selon vous, est-ce que ces services de santé primaires répondent aux besoins/priorités des
francophones?
De façon générale, et en lien avec l’inventaire des services de soins primaires que nous avons
effectué, les participants s’entendent pour dire que les services de soins primaires offerts en français
ne répondent pas aux besoins pour de tels services. Certains ont tout de même mentionné que pour
certains types de services, l’offre était au rendez-vous.
Pour la vaste majorité des répondants, les besoins en tant que patient sont comblés, mais les besoins
en tant que francophone semblent l’être beaucoup moins. Cela étant dit, bien que la gamme complète
de services en français ne soit pas offerte, les participants ont tout de même souligné le haut niveau de
la qualité des services offerts en anglais (et en français lorsque disponibles).
Les participants ont répété l’enjeu crucial de l’offre sporadique de services de santé en français qui
selon eux est une problématique compte tenu de la probabilité incertaine de recevoir de tels services.
Selon vous, quels sont les principaux problèmes auxquels font face les francophones de Timmins en
matière d’accès aux soins de santé primaires?
- Est-ce que les francophones ont accès à tous les mêmes services en soin de santé que les
anglophones?
- Est-ce que les services en français sont aussi accessibles que ceux offerts en anglais, (temps
d'attente, déplacements requis pour recevoir les services, variété de professionnels au sein de
divers services, etc.)?
- Est-ce que les soins de santé auxquels ont accès les francophones sont de même qualité que
ceux offerts aux anglophones?
Les répondants nous ont clairement exprimés que selon eux, les francophones n’ont pas accès à
autant de services que les anglophones. Ces différences ne sont pas uniformes et varient selon la
spécialité et le type de service. Certains services ne sont pas du tout offerts en français (surtout dans le
cas des spécialités), alors que dans d’autres cas (par exemple, promotion de la santé et prévention), ils
sont offerts dans une modeste mesure et non de manière active.
Au-delà du fait que moins de services sont offerts en français, le manque de coordination et par
extension les lacunes au niveau de l’aiguillage en ce qui a trait aux services en français ont été
identifiées comme étant problématiques.
Au niveau de l’accessibilité, étant donné que l’offre de services en français à Timmins n’est pas la
même que l’offre de services en anglais, l’accessibilité n’est pas la même. Les temps d’attente, surtout
dans le cas de spécialistes, sont souvent plus longs et les déplacements sont aussi plus longs et
davantage risqués si le patient veut un service spécifique qui n’est pas offert en français à Timmins, ou
s’il veut être servi plus rapidement en allant ailleurs qu’à Timmins.
En ce qui a trait à la qualité des soins, les répondants ont mentionné que lorsque comparés, les soins
offerts aux francophones sont d’aussi bonne qualité que ceux offerts aux anglophones. Cela étant dit,
la barrière linguistique peut avoir une incidence sur la qualité du service dans le cas où un patient
francophone ne maîtrisant pas parfaitement l’anglais doit interagir en anglais avec le professionnel de
la santé.
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Quels sont les impacts reliés aux problèmes d’accès à des services de santé en français? Quelles sont
les « conséquences » du manque d’accès aux services de santé?
Pour cette question, les répondants ont identifié trois types d’impacts potentiels en lien avec les
problèmes d’accès aux services de santé en français.
Le premier type d’impact portait sur les personnes mêmes. Pour la majorité des répondants, le manque
de services en français accentue le piètre état actuel de la santé des francophones, tel que nous
l’avons décrit précédemment. Les autres conséquences citées étaient l’isolement, la souffrance inutile
et la détresse psychologique. Plusieurs ont cité des exemples ou les écarts et incompréhensions
linguistiques ont mené à de mauvais diagnostics, et des incompréhensions sur les indications du
professionnel (pour le suivi du traitement ou la posologie).
Pour plusieurs, la conséquence la plus inquiétante est celle de la normalisation graduelle de la relation
avec le système de santé en anglais pour la plus jeune génération. L’impact à long terme en est donc
celui de l’assimilation à force d’abdiquer et d’accepter des services en anglais.
Le deuxième type d’impact portait sur le système de santé. Les participants ont mentionné que les
impacts reliés aux problèmes d’accès aux services en français, ajoutent des coûts additionnels au
système compte tenu des temps d’attente plus élevés, du fait que les francophones doivent plus
souvent recourir à des services en dehors de la ville et donc engorgent parfois l’urgence de l’hôpital
faute d’accès à un médecin francophone.
Le troisième type d’impact portait sur la santé de la population. Les participants ont indiqué que de ne
pas miser sur la promotion de la santé et la prévention en français, particulièrement importantes pour
une population vieillissante, se traduit par davantage d’utilisation du système. À force d’éviter d’utiliser
les services de santé en anglais, cela peut avoir de plus graves impacts et ultimement se traduire par
une détérioration de la santé.
Pourquoi pensez-vous que certains francophones choisissent/acceptent de se faire servir en anglais?
- Est-ce en raison des carences au niveau de la qualité ou de l'accessibilité?
- Est-ce par préférence personnelle?
- Est-ce par ce qu’il n’y a pas d’offre active de service en français?
- Autres raisons?
Les répondants ont fait la distinction entre choisir et accepter de se faire servir en anglais. Certains
préconisaient qu’il s’agissait d’un choix individuel alors que d’autres ont décidé de tout simplement
accepter la réalité comme elle est, pour eux, soit un contexte anglophone où le service en français
relève de la chance.
Plusieurs nous ont indiqué qu’après des années de lutte, ils se sentent épuisés face à la récurrence
des revendications qui ne sont pas comblées. Ils ont aussi mentionné que la rapidité du service en
anglais par rapport au français est un facteur non négligeable.
Certains répondants ont quant à eux indiqué qu’ils hésitent à demander un service en français par
crainte du refus de la personne unilingue anglophone, ou de la possibilité de recevoir un service de
moins bonne qualité.
Comme plusieurs points de services et fournisseurs ne font pas d’offre active en français, plusieurs ont
mentionné la facilité de demander un service en anglais compte tenu du haut niveau de bilinguisme de
la population francophone. Plusieurs ont fait référence à la question de la vulnérabilité et du désir de
recevoir le soin approprié dans les plus brefs délais malgré les conséquences possibles de ne pas être
servi dans sa langue.
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Quelles sont les pistes de solutions pour améliorer les services en français pour la population
francophone de Timmins?
- Est-ce qu'un centre de santé communautaire permettrait de combler les lacunes que vous avez
identifiées en matière de soins de santé primaire pour les francophones de Timmins?
- Avez-vous d’autres pistes de solutions pour améliorer l’accès pour francophones aux soins de
santé primaires à Timmins?
- Avez-vous des suggestions pour améliorer la navigation des francophones dans le système de
santé? C’est-à-dire pour aider une personne à trouver les services requis?
La majorité des répondants ont mentionné que la mise sur pied d’un Centre de santé communautaire
était la solution la plus susceptible de combler les lacunes au niveau de l’offre de services de soins
primaires et de promotion de la santé et de prévention en français.
Certains répondants ont suggéré la mise en œuvre graduelle de quelconques initiatives en indiquant
que la communauté ne pouvait pas s’attendre à ce que toutes leurs attentes se réalisent complètement
à courte échéance.
Plusieurs répondants ont fait référence au fait qu’un meilleur aiguillage était nécessaire afin de faciliter
l’identification des services et par extension la navigation du système. Le partage d’information de
qualité, en français, à la population, sur les endroits étant en mesure d’offrir des services en français
consisterait déjà une amélioration.
Les participants ont aussi souhaité que le RLISS améliore ses stratégies de recrutement et de rétention
de professionnels de santé étant en mesure d’offrir des services en français.
Certains ont mentionné que l’ordre selon lequel toute nouvelle initiative devait être mise en œuvre
devait être cohérent avec les besoins les plus pressants des francophones, tout en restant réaliste sur
ce qui pouvait être accompli. À cet effet, l’urgence de l’Hôpital de Timmins a notamment été citée en
exemple, de par son rôle clé de service à toute la population.
Certains ont suggéré que la liste centralisée de médecins devrait inclure la variable linguistique de
ceux-ci afin de mieux arrimer l’offre et la demande pour des services en français.
Le Bureau de santé publique pourrait améliorer son offre de services en français, en améliorant la
promotion de ces services en français.
Il a été mentionné à maintes reprises que le RLISS et les fournisseurs devraient examiner la possibilité
d’accroître les services de consultation à distance en français par l'entremise du système de
télémédecine provincial en partenariat avec des établissements étant en mesure de fournir des
professionnels ayant la capacité de travailler en français.
Les répondants ont aussi souligné l’importance de la sensibilisation auprès du personnel médical sur
l’offre de services dans sa langue et sur les impacts néfastes de ne pas le faire.
Au-delà des professionnels, les répondants ont aussi souhaité que soit améliorée la sensibilisation de
la population sur l’importance de la demande de services dans sa langue. La promotion doit clairement
démontrer le lien entre l’augmentation de la demande, la conscientisation des professionnels et
gestionnaires et finalement, l’augmentation de l’offre de services.
Plusieurs ont aussi mentionné l’importance d’une implication francophone rehaussée dans la
gouvernance des fournisseurs de services et de soins de santé de la région de Timmins.
Finalement, les participants ont aussi souhaité que le RLISS, soit davantage actif auprès des
fournisseurs afin de mieux suivre le respect des obligations des organismes désignés et identifiés en
vertu de la Loi sur les services en Ontario.
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5.3 DISCUSSION
Sur certains points, les opinions émises par les professionnels de la santé et par la population ayant
participé à la consultation se rejoignaient, alors que sur d’autres, ce n’était pas le cas. Tous
reconnaissent les mêmes lacunes : l’accès à des services de spécialistes, l’intégration et la
coordination des diverses composantes des soins de santé primaires ainsi qu’une incompréhension
vis-à-vis l’offre active sont quelques-unes des composantes du contexte actuel qui sont reconnues à la
fois par les deux types d’intervenants rencontrés.
Les professionnels et la communauté ont cependant exprimé des points de vue différents sur les
causes de la surutilisation des services hospitaliers ainsi que sur les principaux problèmes rencontrés
par les francophones. Voici ces principaux points.
Accès à des services spécialisés : Les professionnels ainsi que la communauté reconnaissent
l’importance d’un continuum de services en français ainsi que les lacunes actuelles en termes de
spécialistes ayant la capacité de communiquer en français.
Intégration et coordination : Alors que les professionnels reconnaissent les difficultés d’intégrer et de
bien coordonner les composantes des soins de santé primaires, la communauté, elle, le présente sous
un autre angle : elle suggère que le Bureau de santé intervient en français auprès des écoles, mais ne
fait pas le même effort auprès de la population francophone en général. L’intégration et la coordination
permettent une plus grande uniformité dans les secteurs à l'étude soit ceux de la prestation de soins
primaires, de la promotion et de la prévention.
Offre active : Alors que les professionnels soulèvent l’absence de demande de services en français, la
communauté souligne les manquements dans l’affichage. L’absence de demande et l’absence
d’affichage sont deux composantes importantes auxquelles doit s’attarder le RLISS pour répondre aux
déficits d’offre active à Timmins. Selon certains répondants, l’absence de demande est entre autres
causée par une offre sporadique de services. Les variations dans l’offre de services en français créent
de l’incertitude auprès des patients qui, par conséquent, hésitent à demander leurs services en
français.
Difficultés rencontrées par les francophones : Les professionnels ont souligné que les difficultés
que rencontrent les francophones sont peut-être exacerbées par le manque de services en français,
mais qu’en général elles sont les mêmes que celles rencontrées par la majorité anglophone. Or, les
entretiens menés révèlent que les francophones sont satisfaits de l’offre de services de soins primaires
et que leurs besoins en tant que patients sont comblés (en anglais). Selon eux, la lacune repose
principalement sur le manque et parfois l’absence de services en français. Selon la communauté les
services en toxicomanie et en oncologie sont quelques exemples d’absence complète ou partielle de
services en français. Une iniquité importante entre les services offerts en français et ceux offerts en
anglais est la principale source de frustration des francophones. D’affirmer que les principaux
problèmes rencontrés par les francophones sont les mêmes que ceux rencontrés par l’ensemble de la
population, est de minimiser l’importance du respect des droits des francophones. Il serait plus juste de
dire que : les francophones font face aux mêmes problèmes que ceux de l’ensemble de la population,
mais qu’ils le font contre leur gré dans une langue qui n’est pas leur langue de choix.
Surutilisation des services hospitaliers : Nous avons mentionné précédemment que les
professionnels prétendaient que la surutilisation des services hospitaliers par les francophones pourrait
être liée au manque de coordination des services. Or, les intervenants rencontrés dans la communauté
ont mentionné que les francophones souffrent en silence, qu’ils attendent plus longtemps pour
consulter, qu’ils demandent souvent d’être accompagnés par un membre de la famille qui peut leur
servir d’interprète, et tout ça à cause de l’incapacité du système à leur offrir des services en français.
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La surutilisation des services hospitaliers est peut-être liée à une cause beaucoup plus profonde que
celle d’un manque de coordination. Des instructions en anglais sur les médicaments, un manque de
compréhension dans les communications entre médecins et patients, des diagnostics erronés et une
documentation qui ne correspond pas à la réalité franco-ontarienne peuvent être d’autres facteurs qui
influencent la surutilisation des services hospitaliers. L’analyse des causes de la surutilisation des
services hospitaliers doit être approfondie.
Outre ces divers points où des différences d’opinions existaient entre professionnels de la santé et la
communauté, des enjeux importants ont été soulevés par la communauté francophone au fil des
discussions, et auxquels les professionnels de la santé n’ont pas fait illusion. Ceux-ci valent la peine
d’être renforcés ici étant donné leur importance à un haut niveau.
La communauté francophone doit fournir des efforts considérables pour protéger la survie de sa langue
et de sa communauté. De nombreux défis qu’elle rencontre portent atteinte à la pérennité et
l’épanouissement de sa communauté. Des demandes répétées et continues pour obtenir des services
de qualité égale en santé est un défi qui s’ajoute aux autres. Le RLISS du Nord-Est fait preuve
d’ouverture en lançant cette étude sur les soins primaires. Cependant, des éléments d’ordre culturel
doivent être pris en compte par le RLISS afin d’arriver à améliorer la prestation de services de soins
primaires en français.
Les personnes qui ont participé aux discussions ont exprimé une certaine lassitude devant les
difficultés rencontrées pour obtenir des services de santé en français. Cette lassitude, couplée aux
sentiments de vulnérabilité du malade, place les francophones dans une situation précaire. La
résistance qu’ils ressentent à la demande de services en français affecte leurs comportements. Dans
ces circonstances, il est important de comprendre les concepts de « violence symbolique » et
« d’oppressions intériorisées » dont il a été question précédemment. Qu’elle soit réelle ou illusoire, la
compréhension de cette réticence ressentie par les francophones est la base d’une transformation
réussie des soins de santé primaire.
Les différences culturelles, les relations de forces et l’histoire doivent être considérées dans la
transformation des services de soins primaires. L’apport de compétences culturelles est important dans
cette transition vers de meilleurs services aux francophones.
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6. CONCLUSIONS ET RECOMMANDATIONS
Cette section présente les conclusions de l’étude, incluant le cadre d’analyse ayant servi à la
formulation de recommandations. Les recommandations sont par la suite présentées, constituant le
Plan d’amélioration des services de santé en français pour les francophones de Timmins.
6.1 CONCLUSIONS
La revue de littérature, les analyses de données, les consultations avec les professionnels de la santé
et les représentants de la communauté effectuées dans le cadre de cet examen des services de soins
primaires destinés aux francophones à Timmins confirment la nécessité urgente d’améliorer la livraison
de services de soins de santé primaire en français de qualité pour cette population.
Malgré l’égalité de statut constitutionnel des deux langues officielles du pays, les francophones vivant
dans les provinces majoritairement anglophones demeurent confrontées à des barrières systémiques
d’accès aux ressources et services dans leur langue officielle première. Nos analyses ont démontré
que cela était bel et bien le cas pour la population francophone de Timmins.
Cette situation linguistique minoritaire est à la source d’inégalités importantes entre majorité et minorité
de langue officielle qui sont dénoncées par les communautés elles-mêmes et de plus en plus
démontrées par la recherche. Les barrières linguistiques ont un effet néfaste sur l’accès aux services
de santé, interférant avec la compréhension et l’adhérence aux traitements, la qualité des soins et la
satisfaction des fournisseurs de services et de soins ainsi que celle des utilisateurs.
Plusieurs recherches récentes au Canada et notamment en Ontario confirment les inégalités en
matière de santé pour les communautés francophones en situation minoritaire. Tout récemment, le
Ministère de la santé et des soins de longue durée de l’Ontario a d’ailleurs reconnu cet état de fait dans
son document de discussion « Priorité aux patients » publié en décembre 2015, la situation des
francophones y est ainsi décrite en ces termes :
Les Franco-Ontariens éprouvent des difficultés à accéder à des services de santé en français.
Afin de satisfaire leurs besoins et d’améliorer leur expérience en tant que patients et les
résultats en matière de santé, nous devons nous assurer que le système de soins est sensible à
la culture et facilement accessible en français.
À la lumière des diverses analyses réalisées dans le cadre de la présente étude, nous présentons dans
cette section un ensemble de recommandations qui, nous le croyons, contribueront à l’amélioration de
l’offre de services de soins primaires, de promotion de la santé et de prévention en français pour la
population francophone de Timmins.
De manière globale, nous croyons que le RLISS du Nord-Est devra procéder à une importante
réorganisation des services de santé primaire pour mieux répondre aux besoins de la population
francophone de Timmins. Bien que le RLISS ne puisse agir qu’à l’intérieur des paramètres régissant
son mandat, il devra dans ce cas, en collaboration et en concertation avec le MSSLD et autres
ministères concernés assumer un réel leadership dans la résolution des nombreux défis reliés à l’offre
de services de santé adéquats et sécuritaires pour les francophones de Timmins. Il s’agit d’un constat
qui devrait être reçu comme étant la lentille fondamentale avec laquelle le RLISS du Nord-Est devra
gérer la mise en œuvre de l’ensemble des recommandations lui étant destinées dans ce rapport, dans
un plus grand contexte de transformation du système de santé ontarien.
Bien que notre étude ait uniquement porté sur les besoins des francophones de la Ville de Timmins,
nombreuses sont les communautés francophones réparties dans la province qui vivent des
problématiques similaires et qui pourraient s’intéresser au cas de la ville de Timmins.
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Ainsi, pour guider les actions à venir qui contribueront à l’amélioration des services destinés aux
francophones de Timmins, nous proposons la vision suivante :
« Des services de soins primaires de qualité, sensibles à la culture et
accessibles en français à Timmins »
La population francophone de Timmins est vieillissante, ce qui, en soit, vient grandement déterminer
l’état de santé d’une population. Dans le cas de la population francophone de Timmins, cette tendance
devrait aller en s’accentuant au cours des prochaines années. Le profil démographique et socioéconomique de la population francophone de Timmins nous a révélé qu’en lien avec plusieurs
déterminants de la santé, la population est davantage à risque que la majorité du fait de son bas taux
d’éducation, de professions qui sont davantage axées sur les industries primaires, dans des milieux de
travail à conditions physiques difficiles.
En parallèle, les données fournies par l’hôpital de Timmins révèlent que l’occupation de lits par la
population provenant de cette même ville est dans une plus large proportion, francophone. C’est la
même chose au niveau de l’utilisation de plusieurs autres services de l’hôpital que l’on pourrait associer
à des conditions de santé présentant des défis importants.
Bien qu’il demeure hasardeux de tirer des conclusions précises à partir de ces éléments, ces données,
combinées à celles que nous avons vues au niveau provincial et au niveau de la région socio-sanitaire
de Porcupine, portent à croire que la population francophone de Timmins connait des défis de santé
plus importants que la population anglophone.
À un haut niveau, avec plus du tiers des médecins et la moitié des infirmières étant en mesure d’offrir
des services en français à Timmins, il est possible d’affirmer que l’offre répond relativement bien, en
principe, à la demande de services en français. Cela étant dit, l’inventaire des services de soins
primaires a révélé des niveaux différents d’offres de services en français d’une organisation à l’autre, et
un manque de constance dans la prestation de tels services. Au-delà d’une certaine offre active en
français pouvant se faire à l’accueil d’un fournisseur de services et de soins par exemple, il semblerait
que la langue dans laquelle un patient pourrait se faire servir au-delà de l’accueil relèverait de la
chance plutôt que d’un bilinguisme du personnel et de solides politiques linguistiques. L’absence de
telles politiques a d’ailleurs été relevée au sein de plusieurs organisations. De plus, le manque de clarté
concernant les services offerts en français fait en sorte que la population francophone étant bilingue
adopte souvent l’anglais dans ses interactions avec le système de santé, à moins d’une offre active
claire et constante.
Toujours en lien avec l’offre de services en français, les pénuries de certains types de spécialistes ont
été notées et/ou soulevées à plusieurs reprises. De plus, le peu d’activités de promotion de la santé et
de prévention offerts en français a été soulevé par la population comme étant problématique, surtout
pour une population vieillissante et présentant des défis de santé importants.
L’autre élément dont il faut tenir en compte dans la mise en place de recommandations est le fait
qu’une partie de la population francophone de Timmins n’est pas en mesure de s’exprimer en anglais.
Bien qu’il ne s’agisse que d’une petite partie de la population, cet élément n’est pas à négliger. Il peut
être renforcé par le fait que de nombreuses études ont démontré qu’en vieillissant, et indépendamment
de toutes langues apprises au cours d’une vie, la langue maternelle redevient celle par laquelle un
individu se sent le plus à l’aise, et particulièrement lors d’interactions liées à sa santé.
L’amélioration de l’offre de services de santé en français aux francophones de Timmins nécessitera la
mise en place d’une série d’initiatives coordonnées et intégrées. Les recommandations ont ainsi été
formulées. Sans être explicitement interdépendantes, elles forment un ensemble de conditions qui
devraient, après leur mise en œuvre, améliorer significativement la satisfaction des francophones de la
Ville de Timmins à l’égard du système de santé ontarien.
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La mise sur pied d’un Centre de santé communautaire francophone a clairement été identifiée comme
étant la solution la plus susceptible de répondre aux lacunes dans l’offre de services en français par les
personnes rencontrées lors de la consultation avec la communauté. Cela étant dit, notre analyse nous
porte à souligner que de nombreuses stratégies complémentaires devront être envisagées afin de
combler un plus grand nombre de lacunes, et afin d’améliorer le plus rapidement possible les
nombreux enjeux d’accès aux services de santé en français à Timmins. Nous considérons donc que
plusieurs mesures et actions gagneraient à être implantées dans le but d’améliorer l’offre de services
en français en plus de la mise sur pied d’un Centre de santé communautaire.
Concernant les lacunes qui pourraient être comblées par la mise sur pied d’un Centre de santé
communautaire, citons par exemple l’offre garantie de services en français, la gouvernance
francophone, la prise en charge de cas complexes, l’offre augmentée de services de promotion de la
santé et de prévention en français ainsi que potentiellement, une plus grande gamme de services
communautaires connexes offerts en français.
Toutefois, plusieurs autres obstacles à l’accès à des services de santé en français devront être
abordés par l’ensemble des fournisseurs de services et de soins. Un de ces défis est lié à l’attraction et
à la rétention de professionnels de la santé étant en mesure d’offrir des services en français. Ce défi,
présent dans toutes les communautés francophones de l’Ontario, est davantage important pour
certaines spécialités. Dans le cas de la ville de Timmins, le facteur d’éloignement et de nordicité
rehausse de façon encore plus importante ce défi. Il était donc impératif, compte tenu des nombreuses
études sur la santé de la population francophone en milieu minoritaire de proposer des façons de
répondre aux besoins populationnels, indépendamment de la mise sur pied ou non d’un Centre de
santé communautaire.
Un autre de ces défis est lié à la difficulté pour un patient à se trouver un médecin, et pour celui en
ayant un, de changer de médecin. Certaines règles, en dehors du contrôle de la population,
demeureront. Ainsi, l’arrivée d’un Centre de santé communautaire à Timmins ne signifierait pas
nécessairement pour la population francophone une garantie d’accès à un médecin ou à un spécialiste
étant en mesure de les servir en français, ce qui avait été identifié par la population comme étant le
problème le plus important. Il faut donc continuer à réfléchir à divers moyens par lesquels il est
envisageable que les fournisseurs de services et de soins sur le territoire améliorent le service à la
clientèle francophone, au-delà de la mise sur pied d’un Centre de santé communautaire.
Une autre dimension soulignée à maintes reprises dans le cadre des consultations est liée à
l’importance d’un espace physique destiné aux francophones. Plusieurs représentants de la
communauté ont cité la conjoncture de la convergence d’intérêts pour la création d’un espace qui
pourrait abriter une variété de services aux francophones (centre culturel, services éducatifs, services
de santé, services municipaux et publics et autres). La principale motivation pour ce lieu est la certitude
pour qui le fréquente de pouvoir y recevoir des services en français. Ce carrefour de services en
français viendrait répondre à l’enjeu majeur de dispersion des services.
Tel que mentionné plus haut, la mise sur pied d’un Centre de santé communautaire viendrait combler
plusieurs lacunes. Reste que ce type de centre ne pourrait tout de même pas offrir la gamme complète
de services. Cela ne devrait donc pas constituer la seule stratégie pour améliorer l’offre de services de
santé et de promotion de la santé en français. Ainsi, les recommandations avancées vont donc dans le
sens de la mise sur pied d’un Centre de santé communautaire, en proposant également un ensemble
de mesures additionnelles afin de rehausser la prestation de services en français dans l’ensemble du
système, à Timmins. Ces autres mesures devraient être mises en place indépendamment de la mise
sur pied d’un Centre de santé communautaire et pourraient à elles seules constituer une nette
amélioration dans l’offre de services de soins primaires à la population francophone de la ville de
Timmins.
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Cadre d’analyse ayant conduit à la formulation des recommandations
L’analyse et la recherche effectuées dans le cadre de cette étude sur les besoins de santé des
francophones de Timmins nous ont conduits à l’identification de huit considérations essentielles. Ces
considérations ont ensuite servi de cadre d’analyse pour la formulation des recommandations.
Conduite de l'analyse et de
la recherche
(Littérature, données,
consultations)
Identification de 8
Considérations
essentielles
Développement
des
recommandations
Mise en oeuvre des
recommandations
afin d'améliorer
D’une part, ces considérations ont été retenues de par leur omniprésence dans la littérature sur l’accès
aux services de santé pour les populations minoritaires. D’autre part, elles ont été évoquées à maintes
reprises lors des entretiens avec les membres de la communauté ainsi que les professionnels de la
santé de Timmins. Ces considérations forment donc le cadre d’analyse ayant servi à la formulation des
recommandations.
1. Mission /
mandat
francophone
2. Gouvernance
3. Lieu de
service de
type
« communaut
aire »
La mission d’une organisation lui confère sa raison d’être et clarifie les
bénéficiaires de ses services. Les fournisseurs de services et de soins ayant à
même leur énoncé de mission et de mandat une orientation envers la prestation
de services pour les francophones seront plus enclins à développer des
stratégies et mécanismes d’offre de services pour cette population et à même de
comprendre les besoins pour assurer la prestation de soins correspondants aux
besoins.
Ainsi, il serait préférable de préconiser une ou des solutions où le ou les
organismes impliqués auraient une mission et un mandat clair par rapport à
l’offre de services de santé actifs et continus en français.
La gouvernance de toute organisation publique est fondamentale à plusieurs
égards. Celle-ci fournit normalement les orientations stratégiques, les priorités et
les grands paramètres d’opération afin que l’institution réponde aux attentes des
bénéficiaires. L’implication de francophones au sein de la gouvernance des
fournisseurs de services et de soins est davantage garante d’une offre de
services alignée sur les besoins de cette population.
Ainsi, il serait préférable de préconiser une ou des solutions où la gouvernance
de l’organisation serait réellement représentative de la population francophone
et qu’elle exercerait le plein contrôle.
Les lieux physiques et identifiés constituent le reflet de la présence d’une
communauté. Ils soutiennent l’avènement d’un cadre de vie propice à
l’épanouissement d’une culture. Les milieux éducatifs sont édifiants à cet égard.
À l’inverse, la perte d’un lieu physique symbolique peut constituer un frein aux
rassemblements et aux échanges entre les membres d’une communauté. Dans
le contexte du milieu de la santé, un lieu identitaire et sécuritaire pour recevoir
des services en français remplirait à la fois un besoin de service ainsi qu’un
besoin social.
Ainsi, il serait préférable de préconiser une ou des solutions où la prestation de
services pourrait se faire dans un site qui pourrait à la fois servir d’autres
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besoins communautaires.
4. Cohérence et
liaison avec la
promotion de
la santé
5. Capacité
d’aiguillage
6. Cadre /
contexte
politique
7. Ancrage
communautair
e
La promotion de la santé est reconnue comme pièce structurante et
fondamentale du continuum de la santé. Son déploiement vise à agir sur la
prévention des maladies et à limiter, dans la mesure du possible, les éventuels
impacts sur la santé des individus ainsi que sur le système santé. En ce sens,
pour une communauté de langue officielle minoritaire, la prestation de services
de promotion de la santé en français est aussi fondamentalement importante
que celle des services mêmes, de sorte que les messages soient captés et
intégrés par la population. Cette compréhension est aussi fondamentale pour la
détermination de la programmation pour la population francophone en fonction
des besoins particuliers.
Ainsi, il serait préférable de préconiser une ou des solutions où la prestation de
services améliorés aux francophones pourrait facilement être à la fois
coordonnée (ou mieux) avec les efforts de promotion de la santé publique qui
seront prochainement rapprochés des RLISS suite à l’adoption de la loi sur la
transformation du système de santé.
La complexité du système de santé a récemment fait apparaître le besoin de
services d’aiguillage ou de navigation. Ce type de service prenant de multiples
formes, vise à soutenir les personnes nécessitant un accompagnement afin de
trouver les soins dont ils ont besoin, particulièrement lorsque le service n’est pas
disponible dans la langue ou la localité de leur choix. Cette fonction de liaison et
de coordination entre les services devient d’autant plus importante pour les
patients requérant des services complexes dans une langue avec laquelle ils ne
sont pas à l’aise en étant en plus dans un état de vulnérabilité.
Ainsi, il serait préférable de préconiser une ou des solutions où il serait possible
d’intégrer une capacité d’aiguillage à l’offre de services de santé afin que les
patients nécessitant un aiguillage externe puissent bénéficier de ce service en
un même lieu et en langue française.
Le contexte politique demeure une condition essentielle pour la mise en place
de toute nouvelle initiative publique. L’alignement d’une requête communautaire
avec le programme politique d’un gouvernement facilite normalement la
réalisation de l’initiative attendue. En ce sens, la mention et reconnaissance
explicite de l’inégalité des services pour les francophones de l’Ontario dans la
stratégie ontarienne « Priorité aux patients » ouvre la porte aux requêtes
d’amélioration en prestation de services. L’appui financier du fédéral offert par le
biais du Bureau d’appui aux communautés de langue officielle de Santé Canada
en Alberta pour le centre de santé communautaire crée également un précédent
en matière de soutien à une communauté.
Ainsi, il serait préférable de préconiser une ou des solutions pouvant s’aligner
aux orientations provinciales et fédérales.
L’ancrage communautaire tire son sens dans l’enracinement et le sens
d’attachement résultant de l’idée d’un projet en lien direct avec les besoins et
attentes d’une population ou communauté. En milieu minoritaire, la vitalité d’une
communauté dépend notamment des relations et synergies crées entre les
divers services, forces vives et institutions d’une communauté, afin que puisse
réellement avenir un certain élargissement de l’espace francophone.
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Ainsi, il serait préférable de préconiser une ou des solutions où les francophones
de la ville de Timmins sentiraient un réel ancrage à la fois identitaire et
communautaire.
Les bons plans sont fondés d’abord et avant tout sur des données probantes.
Des données significatives et accessibles facilitent la prise de décisions
pertinentes pour l’amélioration de services.
8. Données
significatives,
probantes et
Ainsi, il serait préférable de préconiser une ou des solutions répondant aux
accessibles
conclusions de l’analyse des données qui a été effectuée dans le cadre de cette
analyse.
La section qui suit dresse donc la liste de recommandations que nous proposons, constituant le plan à
long terme qui permettra d’améliorer la prestation de services de soins primaires destinés aux
francophones de Timmins.
6.2 RECOMMANDATIONS
Plan d’amélioration des services de santé primaire en français pour les
francophones de Timmins
Mettre sur pied un Comité permanent de coordination et d’intégration des services de
santé en français à Timmins
La consultation avec les représentants de la communauté a clairement fait ressortir l’inquiétude de voir
le présent rapport rangé aux oubliettes, sans suivis ni actions concrètes. PGF propose donc comme
première recommandation la mise sur pied d’un Comité permanent du RLISS qui aurait comme mandat
de diriger la coordination et l’intégration des services de santé primaire en français à Timmins.
La première responsabilité de ce comité consisterait à étudier de façon approfondie la faisabilité de
mise en œuvre des recommandations contenues dans ce rapport. Celui-ci pourrait par la suite élaborer
un plan de mise en œuvre des recommandations, ainsi que participer à la mise en œuvre et faire les
suivis qui s’imposeront. Cette recommandation nous apparait comme étant extrêmement importante vu
le besoin de communication et de développement de liens de collaboration requis pour améliorer de
manière importante la prestation de services de santé en français à Timmins.
Recommandation no 1
Que le RLISS, en collaboration avec le RMEFNO, mette sur pied un Comité (du RLISS) permanent de
coordination et d’intégration des services de santé en français à Timmins qui veillera notamment à la
mise en œuvre des recommandations contenues dans le présent rapport. Le comité devra être
représentatif de la communauté et des fournisseurs de services et de soins, et partenaires impliqués
dans la prestation de services de santé destinés à la population francophone.
Mettre sur pied un Centre de santé communautaire francophone (CSCF)
Les francophones de Timmins, de par leur langue, se trouvent en situation d’inégalité en ce qui
concerne leur accès à des services de santé dans leur langue de choix.
Les organismes d’agrément, tels qu’Agrément Canada et le Centre canadien de l’agrément,
reconnaissent de plus en plus que l’accessibilité linguistique constitue un facteur important de la qualité
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des services de santé, et ils travaillent à établir des normes pour assurer une communication efficace
et sécuritaire centrée sur le patient.
Les consultations avec les membres de la communauté, les professionnels et les représentants des
institutions de santé ont confirmé que les fournisseurs de services et de soins de santé primaire
existants à Timmins n’offrent pas tous les services en français que requiert la population francophone.
Plusieurs études ont confirmé l’attitude selon laquelle lorsqu’un client francophone peut parler anglais,
il n’est pas nécessaire de lui fournir des services en français. Selon une étude réalisée en 2010 par
l’Atlantic Evaluation Group, ce problème semble généralisé à l’ensemble du système de santé.
En contrepartie, les francophones développent des comportements qui sous-tendent des peurs de ne
pas obtenir des services (ou peur d’être perçu comme des insatisfaits ou de ne pas être écoutés)
jusqu’à en venir à croire que les services en anglais sont meilleurs que les services en français. En
conséquence, certains ne demandent pas ou plus leurs services en français, ou demandent
directement des services en anglais.
Un rapport sur les modèles de soins de santé primaires offerts aux francophones vivant en situation
minoritaire au Canada (2016) réalisé pour l’Association canadienne des centres de santé
communautaire et la Société Santé en français met en relief l’importance de la gouvernance comme
élément important pour assurer le maintien des services en français et le développement de modèles
qui favorisent la collaboration, l’intégration des soins, l’engagement et la participation de la
communauté francophone. Selon les répondants de cette étude, une gouvernance francophone est
essentielle pour assurer le maintien des services en français. En effet, les services ont tendance à
disparaître lorsque l’implication des francophones diminue au sein des établissements anglophones ou
bilingues.
La création d’un espace visible et physique de services en français est un moyen efficace pour aider
les francophones à se diriger dans la recherche de services. Le modèle de carrefour communautaire
qui existe au Nouveau-Brunswick et qui est à l’étude en Ontario pourrait être développé autour du
nouveau CSCF.
Le CSCF pourrait servir de point central pour l’intégration des services de santé en français et la
navigation des services pour les francophones.
Si le gouvernement ontarien donne suite à la recommandation du rapport Price de créer des groupes
de soins pour des populations spécifiques, le MSSLD pourrait créer un groupe de soins pour la
population francophone sous la gouverne du nouveau CSCF, ou tout au moins confier au CSCF un rôle
de coordination des services de santé en français.
Le CSCF pourrait développer une programmation de services axée sur les besoins spécifiques de la
population francophone plus vulnérable en lien avec les prévalences de maladies chroniques
démontrées dans notre étude.
La consultation auprès des représentants de la communauté francophone de Timmins a clairement fait
ressortir son désir de voir s’implanter dans la ville un Centre de santé communautaire, pour accroitre la
qualité d’accès des francophones de Timmins aux services de santé.
Notre analyse démontre qu’un tel centre viendrait répondre à plusieurs des lacunes identifiées tout au
long de cette étude, mais sans répondre à toutes celles-ci. Un tel centre pourrait entre autres jouer un
rôle actif et continu d’offre de services en français, améliorer la promotion de la santé et la prévention
des maladies en français, ainsi que potentiellement accroître la gamme de services connexes offerts
en français.
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Qui plus est, la mise sur pied d’un CSCF viendrait rejoindre les trois principaux objectifs du plan
d’action 2016-19, conjoint entre le RLISS du Nord-Est et le RMEFNO soit : améliorer la coordination
des soins (et améliorer l’expérience des patients), améliorer l’accès et réduire les inégalités (renforcer
la durabilité/viabilité du système) et faire une meilleure utilisation de la technologie.
Un tel centre pourrait aussi agir à titre de pôle des services offerts à la communauté francophone de la
ville de Timmins. Il pourrait également offrir un service d’aiguillage vers les services en français.
Recommandation no 2
Que le MSSLD et le RLISS collaborent dans le but de mettre sur pied un Centre de santé
communautaire à gouvernance francophone, destiné à servir la population francophone de la ville de
Timmins.
Améliorer de façon proactive l’offre actuelle
Compte tenu de la complexité et de la panoplie des besoins de santé que nécessite une communauté,
la multiplication des pistes de solutions est probablement l'un des moyens les plus sûrs afin d'accroître
l'amélioration de services.
En ce sens, et reconnaissant que la mise en place éventuelle d'un centre de santé communautaire
francophone à Timmins ne constituera possiblement pas la panacée ni la réponse à tous les besoins
en matière d'offre de santé en français, il serait souhaitable que le RLISS prenne le leadership d'inviter
les fournisseurs de services et de soins désignés et identifiés à agir de manière proactive.
Ainsi, le Comité permanent du RLISS pourrait collaborer avec les fournisseurs afin d'identifier des
pistes de solutions envisageables à même leur champ de compétence et de décision, en misant sur
l'ouverture à l'amélioration, inhérente à chaque organisation.
Recommandation no 3
Que le RLISS, par le biais de son Comité permanent, entame dès que possible des dialogues
bilatéraux avec les principaux fournisseurs de services et de soins de santé désignés et identifiés afin
de leur exposer la problématique de l'insuffisance de services de santé en français et d'explorer des
pistes ou initiatives d'amélioration réalistes pouvant avoir des impacts à court terme.
Améliorer la promotion des services disponibles en français
L’analyse ainsi que les discussions ont fait ressortir le fait que peu de services de promotion et de
prévention de la santé étaient offerts en français à Timmins. La principale raison évoquée était que la
demande ne serait peut-être pas au rendez-vous. Il nous appert que l’offre de tels services en français
est particulièrement importante pour la communauté francophone de Timmins, étant donné que la
population est vieillissante et qu’elle est confrontée à des défis de santé particuliers comme démontré
par l’analyse.
La consultation auprès de la communauté a aussi fait ressortir le fait que les représentants de la
communauté ne semblaient pas tout à fait conscients des lacunes de services qui pourraient
éventuellement être comblées par un Centre de santé communautaire. C’est ainsi que nous croyons
qu’un exercice de communication et de promotion soit nécessaire auprès de la population pour que
celle-ci soit mieux informée notamment à cet égard. Le RLISS devrait aussi informer la population
quant aux développements et démarches amorcées devant aboutir à la mise sur pied d’un Centre de
santé communautaire.
Recommandation no 4
Que le RLISS, par le biais de son Comité permanent, développe une stratégie de promotion des
services de santé disponibles en français, de concert avec les fournisseurs de services et de soins
ainsi que le RMEFNO. De plus, le RLISS se doit de collaborer avec les fournisseurs et partenaires de
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la santé publique pour que les informations sur les services en français partagées avec le grand public
soient à jour. Une fois la programmation du Centre de santé communautaire définie, le RLISS et le
Comité permanent devraient ajouter ces informations à la promotion effectuée auprès de la
communauté.
Intégrer et coordonner les services
Les fournisseurs de services et de soins occupent un rôle de premier plan en ce qui a trait à la mise en
place, au maintien et à l’amélioration de services de soins primaires destinés à la communauté
francophone de Timmins. Force est de constater que les interactions entre ces diverses organisations
ne sont pas optimales et gagneraient à être systématisées pour améliorer l’expérience des patients
francophones.
En ce sens, une meilleure intégration et coordination des différentes composantes de services est
considérée comme étant essentielle afin d’assurer un accès et une qualité de services optimale. Il est
d’ailleurs ressorti de la consultation publique que l’intégration et la coordination des soins étaient
déficientes.
La revue de littérature a confirmé que certaines juridictions ont tendance à confier des rôles de plus en
plus grands au système de santé primaire dans la coordination et l’intégration de l’ensemble des soins
prodigués par plusieurs fournisseurs de services et de soins. Ces nouveaux rôles en lien avec les
services spécialisés maintenant fournis en milieu de santé primaire peuvent être considérés comme
constituant ce que certains ont appelé « extended primary care ». Plusieurs pays européens ont
expérimenté cette approche afin de mieux arrimer les services du médecin généraliste qui est souvent
le premier contact entre le patient et le système, les services de médecine spécialisée et de
réadaptation ainsi que les soins à domicile.
Ce modèle, suggéré dans le Rapport Price, Groupes de soins : Un nouveau modèle de soins primaires
à la population de l’Ontario, préconise une restructuration importante des soins primaires articulée
autour de groupes de soins qui seraient des organismes détenteurs de fonds tenus de rendre des
comptes au Ministère par l’intermédiaire des Réseaux locaux d’intégration des services de santé. Il
s’agirait de groupes créés sur une base géographique. Les citoyens au sein de chacun de ces groupes
seraient rattachés à un groupe de soins, puis intégrés à la liste de patients d’un fournisseur de soins
primaires dont les services sont retenus par le groupe de soins.
Chaque groupe de soins conclurait des contrats avec des modèles de prestation de services
actuellement en place ou d’autres fournisseurs comme les bureaux de santé publique et les hôpitaux,
selon le mode d’organisation, qui seraient tenus de lui rendre des comptes.
Ainsi, si le gouvernement ontarien donne suite à la recommandation du Rapport Price de créer des
groupes de soins pour des populations spécifiques, le RLISS devrait envisager la création d’un groupe
de soins pour la population francophone de Timmins, sous la gouvernance d’un groupe ayant en son
sein une représentation importante de la communauté francophone de Timmins.
Une meilleure intégration et coordination des services passent par une programmation planifiée de
l’ensemble des services à la population francophone. La création d’un nouveau centre de services doit
essentiellement prendre en considération les services existants afin d’éviter les duplications et combler
les lacunes identifiées.
Recommandation no 5
Que le RLISS soutienne de manière active le CSC francophone dans la détermination de la
programmation initiale du Centre de santé communautaire en collaboration avec les fournisseurs de
services et de soins de Timmins ainsi que le Comité permanent. Le leadership du RLISS sera essentiel
afin d’optimiser l’offre de services en français et de compléter l’offre de services actuelle et dans
l’objectif d’accroître les synergies au profit de la population francophone, tout en considérant la revue
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documentaire de cette étude, ainsi que les orientations relevant de la transformation en cours du
système de santé.
Améliorer la participation francophone aux instances de gouvernance
La revue de littérature ainsi que la consultation avec la communauté ont fait ressortir l’importance de la
présence accrue de représentants francophones au sein des mécanismes de gouvernance des
prestataires de service de santé de Timmins. Une telle présence rehaussée permettrait d’avoir une plus
grande influence sur le développement et le maintien des services en français et le développement de
modèles qui favorisent la collaboration, l’intégration des soins, l’engagement et la participation de la
communauté francophone.
Recommandation no 6
Que le RLISS assure la surveillance de la mise en place et du maintien de la représentation
francophone au sein de la gouvernance des fournisseurs de services et de soins désignés et identifiés,
et que le RMEFNO, en collaboration avec la communauté francophone de Timmins, identifie des
moyens par lesquels accroître la participation des francophones à la gouvernance des fournisseurs de
services et de soins identifiés et désignés.
Améliorer l’intégration des efforts de promotion de la santé
Le Rapport Price soulignait à quel point il y a déconnexion entre certaines composantes du système de
soins primaires dans la province, dont les services de santé publique. Le rapport recommandait des
améliorations afin de raffiner et de rendre plus efficaces les liens entre, notamment, la santé publique
et les autres parties du système ontarien de santé et de services sociaux.
Plus récemment, le rapport Priorité aux patients identifiait l’intégration de la santé publique au sein des
stratégies des RLISS pour ainsi mieux arrimer la promotion de la santé aux efforts d’orchestration de la
santé primaire.
Recommandation no 7
Que le RLISS, considérant la transformation actuelle du système de santé, et en collaboration avec le
Bureau de santé de Porcupine, le RMEFNO, les autres fournisseurs de services et de soins et les
autres acteurs sectoriels appropriés, révise les stratégies de promotion de la santé et de prévention
des maladies destinées à la population francophone de Timmins afin de mieux intégrer et coordonner
les différentes composantes du système et ainsi mieux desservir cette population.
Rapprocher les patients et les médecins francophones
L’inventaire des services de soins primaires offerts à Timmins ainsi que l’analyse de données ont
permis de constater que plus du tiers des médecins et plus de la moitié des infirmières présentes sur le
territoire étaient en mesure d’offrir des services en français. Si le patient était en mesure de choisir son
médecin en fonction de ses capacités linguistiques, et que celui-ci pouvait refuser des patients ne
parlant pas une certaine langue par exemple, tous les patients francophones pourraient avoir un
médecin s’exprimant en français. Le système n’étant pas ainsi fait, il importe de trouver des façons,
tout en suivant les règles établies par le système, de mieux lier patients francophones et médecins
étant en mesure de travailler en français. Ainsi :
Recommandation no 8
Que le RLISS, en collaboration avec les médecins en santé primaire et les organisations pour
lesquelles ils livrent des services, mette en place des mécanismes de coordination afin de faciliter le
maillage entre les patients francophones et les médecins étant en mesure de les servir en français.
Ces mécanismes pourraient s’intégrer aux efforts d’appariement des patients orphelins de Timmins. Le
RLISS pourrait éventuellement suggérer au MSSLD que cette problématique ainsi que celles reliées à
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l’amélioration de l’offre de services de santé en français à Timmins soit soulevé au Comité consultatif
du ministre de la santé pour discussion.
Aider la navigation vers les services de santé en français
La navigation du système de santé est généralement difficile pour toute population, indépendamment
de la langue, mais elle demeure plus difficile pour une population francophone plus âgée et davantage
éprise de problèmes de santé, ou une population francophone parlant peu ou pas anglais. De plus, la
navigation du système pour quelqu’un qui voudrait s’assurer de services en français tout au long de
ses interactions avec le système de santé est encore plus difficile.
Nous pensons donc qu’un poste spécifiquement voué à l’aiguillage et la navigation du système de
santé en français pourrait être mis en place. La personne occupant ce poste pourrait être logée dans
un espace identifié comme étant francophone, tel que le centre de santé communautaire, s’il était mis
sur pieds.
Recommandation no 9
Que le RLISS crée ou désigne un poste voué à l’aiguillage et à la navigation du système de santé en
français pour la population francophone de Timmins. La personne occupant ce poste pourrait par le fait
même faire de la sensibilisation auprès des fournisseurs de services et de soins sur l’importance de
l’offre active de services en français.
Attirer, embaucher et retenir des ressources humaines en santé
L’attraction et la rétention de professionnels de la santé étant en mesure d’offrir des services en
français n’est pas chose simple en Ontario. La tenue récente d’un sommet sur les ressources
humaines en santé à la demande du MSSLD confirme la complexité des enjeux en question et
l’importance critique d’y apporter des solutions créatives dans les meilleurs délais.
Cela étant dit, les défis sont encore plus grands pour les communautés isolées et/ou nordiques,
requérant la même panoplie de spécialités et de soins. C’est ainsi que certaines communautés ont mis
en place des initiatives novatrices pour attirer, retenir et reconnaître les ressources humaines en santé
tant en mesure d’offrir des services en français.
Cette réalité demeure un enjeu critique pour la prestation de soins à Timmins comme en témoignent
les documents consultés dans le cadre de cette étude, ainsi que les consultations avec les
professionnels et les représentants de la communauté.
Que le Comité permanent du RLISS travaille de concert avec Professions Santé Ontario afin de
développer, pour les postes cliniques et médicaux jugés les plus critiques (et en lien avec les
prévalences dominantes), une stratégie d’attraction et de rétention de ressources humaines
francophones en santé, conjointement avec les principaux fournisseurs de services et de soins dans la
ville, incluant l’hôpital de Timmins, ainsi que les établissements d’enseignement du nord de l’Ontario.
Cette stratégie devrait s’inspirer du Plan d’action sur les ressources humaines en santé en français en
Ontario à l’étude par le MSSLD.
Développer des ententes stratégiques pour pallier l’absence de services
Le développement d’une stratégie visant l’attraction et la rétention de ressources humaines en santé
constituerait un premier pas visant à assurer une meilleure offre de services en français. Par contre, il
serait illusoire d’espérer que les professionnels de la santé soient tous en mesure d’offrir des services
en français, surtout dans le cas de spécialités. Bien que la réalité soit que de telles pénuries existent
dans la plupart des communautés francophones en Ontario, il y aurait lieu de voir s’il serait possible de
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palier à certaines d’entre elles par l’entremise de technologies modernes et de stratégies novatrices en
matière de programmation de spécialistes externes.
Il importe de porter une attention considérable à l’apport des spécialistes externes en tant que
compléments fondamentaux à l’offre de services de soins primaires à Timmins, afin d’éviter le
développement de systèmes parallèles et de possibles dédoublements de services.
Afin que puissent être livrés des soins primaires sécuritaires et de qualité, que le RLISS appuis
l'élaboration d’ententes particulières avec des établissements francophones, bilingues ou ayant les
ressources recherchées (au niveau des spécialités), pour augmenter la disponibilité de spécialistes
francophone par le biais de technologies modernes afin de combler l’offre de services n’étant pas
disponibles à Timmins et mieux structurer la visite de spécialistes externes dans la ville. Cette
programmation de services externes pourrait ensuite faire partie intégrante des efforts de promotion du
RLISS auprès de la population francophone.
Obtenir de meilleures données pour mieux planifier
Le travail entourant la présente étude a clairement démontré la difficulté d’accès à des données
permettant de bien planifier les services de soins primaires pour la population francophone de Timmins.
Dans certains cas, les données n’étaient tout simplement pas disponibles, alors que dans d’autres cas,
c’était plutôt la qualité de celles-ci qui était remise en cause. L’accès à ces données en temps opportun
a aussi été noté comme étant problématique. Bien que ce soit toutes les communautés en Ontario, et
de façon plus importante les plus petites d’entre elles, qui sont confrontées à d’importants défis liés aux
données, nous considérons que certaines améliorations sont possibles.
Que le RLISS développe une stratégie afin d’améliorer la collecte de données sur les francophones par
les fournisseurs de services et de soins et qu’il révise son approche de planification des services pour
les francophones de la ville de Timmins, afin qu’elle soit davantage axée sur les données, en :
- Dressant un inventaire des données disponibles (incluant la variable linguistique des sites
pouvant en faire la collecte)
- Systématisant le suivi auprès des fournisseurs devant capter la variable linguistique à la fois sur
la langue maternelle ainsi que la langue de choix du patient
- Utilisant le résultat de l’analyse de ces données afin de planifier le déploiement de l’offre de
services en français à Timmins
- Partageant ces données avec le RMEFNO afin de mieux informer les conseils qu’il offrira au
RLISS sur la planification des services aux francophones
Améliorer la reddition de comptes
La reddition de compte constitue un outil de taille pour soutenir l’amélioration et la mise en œuvre de
toutes nouvelles pratiques, approches ou systèmes. Elle requiert des organisations publiques d’une
part, de rendre des comptes, et d’autre part, aux organismes qui reçoivent des fonds publics de
démontrer clairement l’impact des travaux ayant pu être réalisés avec les fonds publics déboursés.
Conséquemment, il en va donc de soi que cela soit attendu de la part du RLISS du Nord-Est envers les
fournisseurs de services et de soins identifiés et désignés. Les consultations et documents examinés
dans le cadre de cette étude portent à croire qu’il est possible de faire mieux en matière de rigueur en
reddition de compte.
Nous soulevons ici trois exemples qui bénéficieraient selon nous d’une reddition de comptes plus
serrée par le RLISS auprès des fournisseurs de services et de soins : l’adoption et la publication de
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politiques linguistiques, l’adoption et la mise en œuvre de politiques reliées à l’offre active, et la
diffusion de documentation en français.
En premier lieu, le travail entourant la présente étude a démontré que les organismes qui fournissent
des services et des soins n’affichaient nulle part sur le Web leurs politiques entourant l’offre de services
en français ou autres politiques apparentées (embauche de personnel, présence de comités sur
l’aspect francophone de l’organisme, etc.). La publication de ces politiques constituerait une preuve
d’engagement envers la communauté francophone.
En deuxième lieu, la consultation avec la communauté a fait ressortir le fait que les francophones (de
Timmins) vont souvent opter pour une communication en anglais s’il n’est pas évident que le service
soit offert en français. Cette « évidence » de service en français peut bien sûr équivaloir à une offre
active en français, mais peut aussi venir d’ailleurs tel que par l’entremise d’un affichage bilingue.
En troisième lieu, la communauté a relevé plusieurs exemples où la documentation fournie aux patients
et au public n’était disponible qu’en anglais – notamment en matière de promotion de la santé. Nous
croyons qu’il serait important que la documentation soit disponible en français et en anglais, et encore
davantage dans un contexte où ce ne sont pas tous les services qui soient offerts en français. Il en va
également pour toute campagne de promotion qui devrait également être lancée dans les deux
langues.
Que le RLISS, révise ses exigences de reddition de compte envers les fournisseurs de services et de
soins désignés et insère dans les ententes de responsabilisation de ces établissements une clause
reliée à l’atteinte et au respect des critères de désignation en vertu de la Loi sur les services en
français.
Que le RLISS, par l’entremise des ententes de responsabilisation, exige des fournisseurs de services
et de soins identifiés, incluant les équipes de santé familiale, qu’ils adoptent des politiques
linguistiques, des stratégies reliées à l’offre active et des documents promotionnels dans les deux
langues officielles. De plus, le RLISS devrait exiger que ces politiques soient rendues publiques ou qu’il
y ait un mécanisme prévu en ce sens, pour que la population sache ainsi à quoi s’attendre en termes
Valoriser l’offre de services en français
L’appréciation et la reconnaissance de l’offre active de services de santé en français constituent des
composantes importantes de l’amélioration des services. Sans pour autant déployer d’importantes
ressources humaines et financières à cet égard, il est possible de reconnaître, de manière créative et
respectueuse, la contribution de professionnels de la santé, de fournisseurs publics et/ou privés qui se
démarquent par leur volonté de servir la population en français.
Cette valorisation peut s’effectuer de manière simple en mettant en œuvre des moyens de reconnaître
publiquement les organismes et individus inspirant, de sorte à en inciter d’autres à s’en inspirer.
La communauté francophone, de par la pression qu’elle peut exercer sur la demande et l’offre pour des
services en français, pourrait donc jouer un rôle de premier plan à cet effet.
Que la communauté francophone, en partenariat avec le RMEFNO, mette en place des mécanismes
formels et informels de valorisation de l’offre de services proactifs de santé en français à Timmins,
créant ainsi des modèles accessibles et inspirants pour toute la communauté.
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BIBLIOGRAPHIE SÉLECTIVE
Auditor General of Ontario, Assessment of the Ministry of Health and Long-Term Care (2011).
Bouchard, Louise, Malek Batal, Pascal Imbeault, Isabelle Gagnon-Arpin, Ewa Makandi et Golnaz
Sedigh, La santé des francophones en Ontario (2012).
Bouchard, Louise, et autres, La santé des populations de langue officielle en situation minoritaire,
Revue canadienne de santé publique, supplément, volume 104 (6) (2013).
Bowen S., Barrières linguistiques dans l’accès aux soins de santé, Santé Canada (2001).
État de la situation et étude de modèles de soins de santé primaires offerts aux francophones vivant en
situation minoritaire au Canada, Rapport réalisé pour l’Association canadienne des centres de santé
communautaire (ACCSC) et la Société Santé en français (SSF), Février 2016.
Étude environnementale sur les soins palliatifs et les besoins des francophones sur le territoire de
l’Entité 4, Réalisée par PGF, Mai 2016. (non-publiée).
Flamain, Ariane, Les aîné(e)s francophones de Timmins et des environs et l’accès aux services
sociaux et de santé : L’âge, la langue et le contexte d’éloignement, Mémoire de maîtrise, Université
d’Ottawa, Décembre 2015.
Fondation canadienne pour l’amélioration des services de santé, Projet collaboratif de 12 mois sur
l’amélioration de la qualité ACE : Prospectus.
Fondation canadienne pour l’amélioration des services de santé, INSPIRED : Feuillet d’information.
Health Quality Ontario, Quality Improvement Guide (2012).
Howard, Michelle et autres, Emergency Department and Walk-in Clinic Use in Models of Primary Care
Practice with Different After-Hours Accessibility in Ontario (2008).
Institute for Clinical Evaluative Sciences, Comparison of Family Health Teams to Other Ontario Primary
Care Models, 2004/05 to 2011/12 (2015).
Institute for Clinical Evaluative Sciences, Comparaison des modèles de soins primaire en Ontario en
fonction des données démographiques, de la casuistique et de l’utilisation des salles d’urgence de
2008-2009 à 2009-2010 (2012).
Institute for Clinical Evaluative Sciences, Examining Community Health Centres According to
Geography and Priority Populations Served, 2011/12 to 2012/13 (2015).
Institute for Clinical Evaluative Sciences, The Impact of Not Having a Primary Care Physician Among
People with Chronic Conditions (2008).
Jaakkimainen, Liisa et al., Did changing primary care delivery models change performance? A
population based study using health administrative data (2011).
KPMG, The Primary Care Paradox: New Designs and Models, (2014).
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Kralj, Boris, Jasmin Kantarevic, Primary Care in Ontario: Reforms, Investments and Achievements,
Ontario Medical Review (2012).
Leblanc, Stéphanie, La gouvernance communautaire dans la fourniture de services de santé en milieu
minoritaire francophone en Ontario : Le cas du Centre de santé communautaire de Kapuskasing et
région, École d’études politiques Programmes d’administration publique Université d’Ottawa (2015).
Lévesque, Jean-Frédéric et al., Emerging organizational models of primary healthcare and unmet
needs for care: Insights from a population-based survey in Quebec (2012)
McDonald J et al., Emerging models of integrated primary health care centres: How they optimize
access and integration and the influence of characteristics and organizational factors (2015).
Ministère de la santé et des soins de longue durée, Priorité aux patients : Une proposition pour
renforcer les soins de santé axés sur les patients en Ontario (2015).
Price, David, Elizabeth Baker, Brian Golden and Rosemary Hannam, Patient Care Groups: A new
model of population based primary health care for Ontario, Report of the Primary Health Care Expert
Advisory Committee (2015).
Réseau francophone de santé du Nord de l’Ontario, Préparer le terrain : Soins de santé primaire en
français de l’Ontario, Rapport régional : Nord (2006).
Rosen, Rebecca et Helen Parker, New models of primary care: Practical lessons from early
implementers (2013).
Van Uden CJ, Giesen PH, Metsemakers JF, Grol RP., Development of out-of-hours primary care by
general practitioners (GPs) in The Netherlands: from small-call rotations to large-scale GP
cooperatives, Fam Med., 2006, 38(8), p. 565–569.
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ANNEXE 1 : COMPARAISON DE CERTAINS COÛTS POUR UNE ÉQUIPE DE SANTÉ
FAMILIALE ET UN CENTRE DE SANTÉ COMMUNAUTAIRE
Salaires selon le poste occupé
Source : RLISS du Nord-Est
Cette information ne permet pas de comprendre pleinement les coûts de chacun des modèles et ce qui
les différencient puisque plusieurs autres facteurs doivent être pris en compte pour pleinement
comprendre les coûts et/ou l’efficacité reliés à un modèle ou à un autre.
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ANNEXE 2 : QUESTIONNAIRE DESTINÉ AUX PROFESSIONNELS DE SANTÉ
Questionnaire utilisé pour les discussions avec les professionnels de santé
1. Selon vous, quels sont les trois principaux problèmes en ce qui a trait aux soins de santé
primaires pour les francophones?
2. L’occupation des lits à l’Hôpital de Timmins est plus élevée que son poids dans la population.
Croyez-vous que cela est dû à des lacunes dans l’organisation des soins primaires pour les
francophones? Si oui, pouvez-vous nous dire quelles sont selon vous ces lacunes?
3. Selon vous, quels sont les principaux problèmes rencontrés par les médecins de santé primaire
en lien avec l’accès aux services spécialisés de l’hôpital, s’il y en a, notamment quand il s’agit
de patients francophones?
4. Les données de santé publique nous indiquent une prévalence plus élevée que la moyenne
provinciale pour plusieurs maladies chroniques (MPOC, arthrite, asthme, maladies du cœur,
etc.) dans le district de Porcupine. Pouvez-vous nous identifier les principales lacunes, selon
vous, dans le continuum des services requis par ces patients, notamment les patients
francophones, et surtout dans les soins de santé primaire?
5. Selon vous, quels services de soins de santé primaires qui existent actuellement dans votre
communauté répondent bien aux priorités des francophones (par exemple, partenariats
existants avec la communauté, modèles de soins, services)?
6. Selon vous, quelles améliorations sont nécessaires pour venir combler les vides existants en
matière des soins de santé primaires pour les francophones et quelles stratégies doivent être
adoptées pour y subvenir?
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ANNEXE 3 : QUESTIONNAIRE DESTINÉ À LA POPULATION
Questionnaire utilisé lors des consultations avec la population
1. Selon vous, quels sont les services de soins de santé primaires en français qui existent
actuellement dans votre communauté?
2. Selon vous, est-ce que ces services de santé primaires répondent aux besoins/priorités des
francophones?
3. Selon vous, quels sont les principaux problèmes auxquels font face les francophones de
Timmins en matière d’accès aux soins de santé primaires?
 Est-ce que les francophones ont accès à tous les mêmes services en soin de santé que les
anglophones?
 Est-ce que les services en français sont aussi accessibles que ceux offerts en anglais,
(temps d'attente, déplacements requis pour recevoir les services, variété de professionnels
au sein de divers services, etc.)?
 Est-ce que les soins de santé auxquels ont accès les francophones sont de même qualité
que ceux offerts aux anglophones?
4. Quels sont les impacts reliés aux problèmes d’accès à des services de santé en français?
Quelles sont les « conséquences » du manque d’accès aux services de santé?
5. Pourquoi pensez-vous que certains francophones choisissent/acceptent de se faire servir en
anglais?
 Est-ce en raison des carences au niveau de la qualité ou de l'accessibilité?
 Est-ce par préférence personnelle?
 Est-ce par ce qu’il n’y a pas d’offre active de service en français?
 Autres raisons?
6. Quelles sont les pistes de solutions pour améliorer les services en français pour la population
francophone de Timmins?
 Est-ce qu'un centre de santé communautaire permettrait de combler les lacunes que vous
avez identifiées en matière de soins de santé primaire pour les francophones de Timmins?
 Avez-vous d’autres pistes de solutions pour améliorer l’accès pour francophones aux soins
de santé primaires à Timmins?
 Avez-vous des suggestions pour améliorer la navigation des francophones dans le système
de santé? C’est-à-dire pour aider une personne à trouver les services requis?
7. Avez-vous des suggestions ou commentaires à transmettre au Réseau local d’intégration des
soins de santé et / ou aux établissements de santé offrant des services de santé pour améliorer
l’offre de services de santé en français à Timmins?
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NORTH EAST LHIN BOARD PACKAGE BOARD OF DIRECTORS

Transcription

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