Body: RULAC Type: Agenda Meeting: Committee Date: 2016 Collection: Council Agendas Municipality: Frontenac County
[View Document (PDF)](/docs/frontenac-county/Published Agendas/Rural Urban Liaison Advisory Committee (RULAC)/2015/Fairmount Business Plan 2016-2020.pdf)
Document Text
Business Plan 2016-2020 Department: Administrator: Version/Date:
Fairmount Home Steven Silver (Interim) September 2015
Department/Unit Strategic Goals Fairmount will provide a holistic lifestyle for all residents by responding to their unique needs and wishes related to their desired lifestyle in an effort to satisfy their physical, social, emotional, spiritual, mental and cultural needs resulting in being recognized as the “home of choice”. Key strategic directions
- To provide responsive and dignified care to the residents of Fairmount Home always seeking to improve their quality of life
- To provide an efficient, positive and safe work environment based upon best practices and mutual respect
- To see the involvement of the wider community by reaching out as a leader and participant to improve the lives of the elderly throughout the entire area as a positive voice for long term care. Alignment with Council Strategic Priorities: Goal #1 and #3 Meeting the Aging Tsunami Challenge and Respect for the Tax Payer: “Issues surrounding seniors is a common theme running through County of Frontenac Documents”. This plan addresses the needs of the seniors living in the County’s long term care facility while at the same time identifies the goal of community outreach to become a leader in the region as the population rapidly ages. This plan incorporates the regular monitoring of best practices for more efficient and improved ways of providing care to seniors respecting our residents, our employees and our ratepayers. Sustainability & Resilience We will endeavour to seek out opportunities and resources that will allow Fairmount to reduce our financial and environmental impact on our community. Also maintain a strategy for recruitment, training and employee retention to ensure an exceptional group of staff and volunteers.
Department/Unit Function Fairmount Home is governed by the Provincial Long Term Care Homes Act, 2007 (LTCHA) and licensed by the Ministry of Health and Long Term Care (MOHLTC). Fairmount is a 128 bed, long term care home serving adults whose needs can no longer be met within the community, whose medical conditions are relatively stable and who do not require intensive, ongoing intervention by physicians and other health professionals. Notwithstanding, residents may have a serious condition requiring intensive personal care or complex medical needs requiring nursing expertise. The waiting list for admission to Fairmount is long and often numbers in excess of 160 people at any one time.
Legislative Framework
Long-Term Care Homes Act, 2007 (LTCHA): http://www.ontario.ca/laws/regulation/r10079 Proclaimed July 1, 2010, the LTCHA, 2007 is the cornerstone of the Province’s strategy in improving and strengthening resident care in Ontario’s long term care homes. The Act emphasizes a resident focussed model of care, significant involvement of “resident & family councils” and greater public reporting and transparency. The MOHLTC continues to develop, refine and modify regulations contained within the LTCHA.
Long Term Care Service Accountability Agreement (L-SAA): Local Health Integration Networks (LHINs) assist in delivering the MOHLTC directives of regionally coordinated and integrated health care services. The LHINs have assumed responsibility for long term accountability and funding through “long term care service accountability agreements”.
As well as all other applicable employment, labour, and environmental legislation.
Clients Fairmount provides 24-hour nursing care which incorporates nursing restorative care through a team consisting of physicians, a full-time nurse practitioner, RNs, RPNs, and PSWs. Support services provided include: physiotherapy, occupational therapy and social work. Fairmount also provides recreational activities, dietary, housekeeping, laundry, maintenance and administrative services. Fairmount also enjoys the services of a dedicated and active team of volunteers. Internal: Fairmount Home residents External: Resident family members, Power of Attorneys, and volunteers.
Fairmount Home Business Plan 2016-2020
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Employee Complement: 2015 2016 2017 2018 2019 Full Time (non-union) 4 5 5 5 5 Full Time (CUPE 72 72 72 72 72 2290) Part-time (non-union) 0 0 0 0 0 Part-time (CUPE 55 55 55 55 55 2290) Contract 3 2 2 2 2 Total Employees 134 134 134 134 134 Total FTE Total Salaries/FTE Note: contract employees include: Interim Administrator, Manager of Environmental Services and Manager of Food Services
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Existing Service Levels Mandatory services to be provided under the LTCHA include: Accommodation Lodging Provision of meals Environmental services; laundry, housekeeping and building maintenance Administration Hospitality Services: o General recreation o Activation programs o Spiritual programs o Social programming Health Services: o Clinical nursing care o Personal care o Case management – assessment care planning, scheduling, conferencing and documentation o Intermittent Health Professionals Services; therapeutic, social work and pharmaceutical o Physician services Residents pay for supplemental personal services such as: o Hairdressing, foot care, transportation, pharmacy (not covered by OHIP) supplemental recreation i.e. Diner’s Club, and day excursions Statistics Resident Population Statistics (May 2015):
Male Female Total % of Population
51-60 Years 3 1 4 3%
61-70 Years 2 4 6 4%
71-80 Years 5 17 22 17%
Fairmount Home Business Plan 2016-2020
81-90 Years 15 49 64 50%
91-100 Years 6 16 32 25%
Total Residents 31 97 128
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2015 Ministry of Health & Long Term Care Funding Funding Envelope
Nursing & Personal Care
Resident per diem funding as at July 1, 2015 $85.60 / diem
Program & Support Services
$9.23 / diem
Raw Food
$7.87 / diem
Other Accommodation
$53.12 / diem
Accreditation
$0.33 / diem
Total Resident Per Diem Provincial Funding
$156.15
Service Envelope Description Resident nursing and care requirements based upon assessed individual needs and adjusted to meet case mix Resident restorative and social programs inclusive of registered dietician services Resident meals and snacks inclusive of specialized dietary requirements Resident indirect needs: administration, housekeeping, laundry, dietary services and facility maintenance
Resident Accommodation Revenue The MOHLTC directs and sets fees for Resident accommodation costs are recovered through Resident payments remitted to Fairmount Home. Resident Room Accommodations Basic (28 beds)
Resident per diem fees as at July 1, 2015 $58.35 / diem ($1,774.81 monthly)
Semi-Private (36 beds)
$70.35 / diem ($2,139.81 monthly)
Preferred – (64 beds)
$83.35 / diem ($2,535.23 monthly)
Fairmount Home Business Plan 2016-2020
Accommodation Description Two residents; shared sleeping space and shared bathroom Two residents: separate sleeping space and shared bathroom One resident: private sleeping space and bathroom
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In 2014 Fairmount budgeted $10,802,813 in revenue to balance expenditures: Revenue Source Province
2014 Amount $5,288,698
Residents Municipal Contributions Other funding including transfer from reserve
$2,907,342 $2,432,431 $174,342
Comment See above noted envelopes See chart below Includes: one time funding and specific funding such as water testing, pay equity funding etc.
Operating Budget Revenue:
FUNDING
Province Residents Municipal Other
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Operating Budget Expenses:
Expenses Nursing Care
Nursing Admin Dietary Programming House/Laundry Maint/Facilities Administration
Department/Unit Objectives
Improve quality of care to our residents
To reduce the occurrence and effect of illness and injury on workforce productivity, to promote employee attachment and reduce/manage costs
Maximize the use of non-municipal funding resources
Maximize best practice reviews, information technology resources and time saving tools
Improve community outreach Major Initiatives to meet Unit Objectives
Development of
Accreditation Quality Improvement Indicators Plans Description: Description: Development of/and Striving to reach and keeping current quality maintain the highest level of improvement plans and accreditation to ensure that staff/resident surveys Fairmount maintains a long waiting list of potential residents with a variety of care levels Timelines: 2016 - 2020
Attendance/Availability Improvement Description: To decrease the number of sick days, replacement labour costs and reduce the number of overtime shifts.
Timelines: 2016 - 2020
Timelines: 2016
Responsibility: All staff
Responsibility: All staff
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Responsibility: Management and Quality Assurance Committee
Resources: Internal
Resources: Internal
Resources: Internal 4. Seek out alternative funding sources
Move to full electronic charting and documentation Description: Description: Work closely with Eliminate all paper and Corporate Services to seek manual reporting to out volunteers and improve accessibility to revenue sources. Propose documents and to that Fairmount be used as accurately reflect the time a model for pilot projects spent with each resident for CMI.
Development of an outreach plan Description: To provide educational and networking opportunities to the community with regards to long term care issues and the resources available. To investigate possibilities in playing a role in assisted living in the community by providing guidance and expertise. Timelines: 2016 - 2020
Timelines: 2016 - 2020
Timelines: 2016 - 2020
Responsibility: Fairmount Management and Programming staff and volunteers
Responsibility: Medical teams
Responsibility: Management
Resources: Internal
Resources: Internal
Resources: Internal
Service Level Changes Fairmount has been fortunate over the last several years to have completed capital projects including a full redevelopment of the home and replacement of the auditorium. In 2011 the number of personal service workers (PSW) per shift (day and afternoon shifts) was reduced from 4 per unit to 3 per unit (except for the secure unit which remains at 4). As care for the residents becomes heavier and more demanding, the reduction in frontline staff remains a stressor for the employees as they attempt to complete their assigned duties within their shift. Emily Shoniker, Director of Care, prepared a case study observing the evolving care needs and the challenges of providing long term care to today’s residents. The report is attached to this plan as Appendix “A”. Fairmount Home Business Plan 2016-2020
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2016
2017 2018 2019
Proposed Service Level Change Provide access to all staff for relevant annual on-line self-directed mandatory training N/A N/A N/A
Rationale/ Relative to Objectives To meet Provincial compliance staff must receive annual mandatory training to ensure awareness levels which must be documented for inspection purposes
Financial Projection: 2016
2017 PROJECTED BUDGET $
2018 PROJECTED BUDGET $
2019 PROJECTED BUDGET $
2020 PROJECTED BUDGET $
2,979,822
3,009,610
3,052,469
3,095,949
3,140,058
5,440,035
5,513,265
5,588,706
5,665,274
5,742,985
BUDGET $
Operating Revenue Taxation and User charges User charges
Grants Federal and Provincial
Other Other
94,077
95,187
96,317
97,463
98,629
Total
8,513,934
8,618,062
8,737,492
8,858,686
8,981,672
137,774
0
0
0
0
8,651,708
8,618,062
8,737,492
8,858,686
8,981,672
8,988,436 976,137 1,222,523 62,933 534,897
9,138,463 992,885 1,249,489 0 534,897
9,415,945 1,006,367 1,271,354 0 534,897
9,701,732 1,018,104 1,300,183 0 534,897
9,995,096 1,026,055 1,330,011 0 534,897
11,784,926
11,915,734
12,228,563
12,554,916
12,886,059
112,681
114,155
115,658
117,191
118,755
11,897,607
12,029,889
12,344,221
12,672,107
13,004,814
3,245,899
3,411,827
3,606,729
3,813,421
4,023,142
534,897
534,897
534,897
534,897
534,897
NET MUNICIPAL CONTRIBUTION less depreciation
2,711,002
2,876,930
3,071,832
3,278,524
3,488,245
Other Municipal Contribution
-1,802,082
-1,905,207
-2,036,718
-2,176,226
-2,317,774
908,920
971,723
1,035,114
1,102,298
1,170,471
Transfer from reserves
Total Operating Revenue and Reserve Transfer Operating Expense Salaries & benefits Materials Contracted Service Project Proposals Brought Forward Depreciation
Total Operating Expense Reserve Transfers
Total Operating Expense with Reserve transfers NET MUNICIPAL CONTRIBUTION less depreciation ( non-cash)
County Contribution
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NET CAPITAL EXPENSE
233,172
130,696
130,696
130,696
130,696
Other Municipal Contribution
-233,172
-130,696
-130,696
-130,696
-130,696
0
0
0
0
0
210,295
210,295
210,295
210,295
210,295
1,119,215
1,182,018
1,245,409
1,312,593
1,380,766
County Contribution NET CONTRIBUTION TO DEBENTURE Requisition
Risk Analysis: Level
Issue
Risk
- Infrastructure, Facility & Grounds Maintenance: potable water, septic, and heating/cooling infrastructure are historic concerns for the Fairmount location. Failure of one of these systems could result in an emergency situation and major financial expenditures.
Caution
- Staffing levels vs. Increased Care Levels: heavier care such as lifts, feeding and resident complex behaviors increases the time needed to complete duties and properly chart the activity. Lack of documentation could result in poor inspection results and decreased revenue. Fairmount reputation could also suffer negatively affecting the resident waiting list.
- Staff Attendance/Availability: poor attendance, the wellness of staff, and lack of availability not only results in additional costs it reduces available staffing levels
Advisement
- Staffing Retention: Fairmount will experience a larger staff turnover than the historical average due to retirements, a shrinking workforce, and heavier care requirements.
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Risk Mitigation Strategies: Issue
Mitigation Strategy
Risk:
Facility Infrastructure
Ensure that environmental services remain a high priority by working closely with the Ministry of the Environment and the Public Health Unit. The septic and water systems are constantly monitored and may require significant future capital investment. Provincial regulations change frequently regarding such systems which may require additional costs beyond available operational funds. Sufficient reserve funds need to be established.
Availability of experienced personnel may fluctuate due to external forces. The deployment of different strategies such as adjusting the number of years of experience required when posting positions may be necessary.
Maintaining a proper balance between resident care and administration (charting) is essential. Resident care should always be the first priority. Develop “Quality Improvement” Champions on each team.
A constant and consistent approach to monitoring and follow-up of employee attendance and overtime costs is required.
Propose to establish a Human Resources Committee comprised of both Management and front line staff to discuss solutions to current absentee issues.
Caution: Staffing Levels / Increased Care Levels / Charting & Revenue Staff Attendance/Availability
Advisement: Staffing Retention
- The financial reality, employee satisfaction, and the employment market will impact this strategy.
- Increased workload and Ministry regulation compliance will impact this strategy.
- An aging workforce will result in more frequent retirements.
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4. Cross training and internal leadership programs to “grow our own” dedicated, flexible and knowledgeable employees requires continued support
Key Success Factors:
- Meeting the care needs of our residents in a dignified and professional manner.
- Providing a safe and respectful work environment for our employees.
- Providing affordable long term care services.
- Engagement of the wider community to improve the lives of the elderly in the region.
Key Performance Indicators: Objective 1 – Improve quality of care to our residents and build on Fairmount’s excellent reputation by maintaining exemplary accreditation status and limited exposure to Ministry orders. Indicators: Reduction in the number of resident falls Reduction of the number of restraints used Resident Length of Stay
Resident/family satisfaction survey Accreditation level awarded Annual compliance audit
Goal: Below Provincial average Goal: Below Provincial average Goal: Monitor Resident length of stay as a level of care indicator Goal: Obtain 95% satisfaction level Goal: Maintain “Exemplary” level Goal: Receive no written orders
Objective 2 – To reduce the occurrence and effect of illness and injury on workforce productivity, to promote employee attachment and reduce/manage costs by continuing to encourage a safe and respectful work environment resulting in a reduction to sick time, overtime and labour administration costs (grievances, arbitrations etc.). Indicators: Reduce sick time costs
Fairmount Home Business Plan 2016-2020
Goal: 80% of employees meeting the target for absenteeism Nursing (CUPE 2290) – no more than 10 days in a 12 month period 12
Non-nursing/Non-Union - no more than 7 days in a 12 month period; Objective 3 & 4 – Continue to focus on charting resident care to improve the case mix index score generating additional non-municipal revenue. Indicators: Increased Case Mix Index revenue Increased other revenue sources resulting in municipal contributions increasing by less than the rate of inflation.
Goal: increase CMI revenue by 1% Goal: obtain special project funding Goal: coordinate the creation of a “Friends of Fairmount” fundraising community group
Objective 5 – Development and implementation of an outreach program regarding seniors issues. Indicator: Host a spring and fall community information session focussing on relevant seniors issues Invite the community to participate in future strategic planning sessions.
Provide and advertise community access to the tele-medicine equipment/system which is in place Offer advice, knowledge and support to community groups seeking to assist seniors through the sharing of information and coordinating communications
Goal: to reach 50 participants.
Goal: to increase community awareness and use of the telemedicine service Goal: reach out to 6 community groups annually.
Respectfully Submitted,
Steven Silver Interim Administrator
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