2015 Environmental Scan Summary by Waterloo Wellington LHIN

2015 Environmental Scan Summary

2015 ENVIRONMENTAL SCAN SUMMARY

2015 ENVIRONMENTAL SCAN SUMMARY: An environmental scan offers a review of information impacting a specific setting or situation. In 2015 all 14 LHINs collaborated to build an environmental scan of factors related to health care in support of developing the 2016-19 Integrated Health Service Plan. The following is a summary of information taken from the environmental scan related to the Waterloo Wellington LHIN area.

2015 Environmental Scan Summary

IN F/Y 2011-12 THERE WERE

7,973 BIRTHS

WATERLOO WELLINGTON LHIN IS HOME TO

778,700 PEOPLE

IN WATERLOO WELLINGTON LHIN HOSPITALS

5.6% OF THE POPULATION OF ONTARIO

In 2011:

IMMIGRANTS ACCOUNTED FOR 20.5% OF THE POPULATION

3.1% OF WOMEN WHO GAVE BIRTH WERE UNDER 20 YEARS OLD

NEARLY 14% OF THE PEOPLE LIVING IN THE LHIN WERE VISIBLE MINORITIES

17.9% WERE AGED 35 OR OLDER lower than the provincial average of 22.0%

similar to the provincial result

Demographics and Census: Births and Mortality: • Waterloo Wellington LHIN is home to 778,700 people, or 5.6% • In FY 2011/12, there were 7,973 births in Waterloo Wellington of the population of Ontario. LHIN hospitals. • Approximately 78% of LHIN residents lived in a large urban • 3.1% of women who gave birth were under 20 years of age population centre (100,000+), while 11% lived in a rural area. (similar to the provincial result) and 17.9% were aged 35 or • Just over 14% of LHIN residents were seniors aged 65 years older (lower than the provincial average of 22.0%). and over, higher than that in 2010 (11.6%). • The rate of caesarean deliveries was the third lowest in the • The population of the LHIN is projected to increase by 5.6% province (25.4%) and below the provincial rate of 28.4%. between 2015 and 2020 and 11.5% between 2015 and 2025. • 81.2% of hospital births were attended by obstetricians, 7.2% • Almost 2% of residents reported French as their mother tongue by family physicians, and 9.2% by midwives. The Waterloo in 2011. Wellington LHIN had the second highest proportion of • 1.4% of residents reported Aboriginal identity. midwife-attended hospital births in the province, which was • In 2011, immigrants accounted for 20.5% of the Waterloo almost twice the provincial average (5.2%). Wellington LHIN population. 2.6% of residents were recent • The rate of pre-term births (less than 37 weeks) was the immigrants, having arrived in Canada between 2006 and 2011. lowest in the province at 5.7%. • Nearly 14% of the people living in the LHIN were visible • The rate of exclusive breastfeeding (72.9%) was the second minorities. highest rate among all LHINs. • Waterloo Wellington LHIN had the highest labour force • 91.0% of the women were nonsmokers at time of admission participation rate among people age 15+ (69.8%) and the for birth. The rate has increased slightly since the first lowest unemployment rate of all LHINs. prenatal visit (increase of 1.7 percentage points). • Waterloo Wellington had the lowest proportion of residents • The women who reported drinking alcohol and using drugs living in low-income households (11.5%). The rate for Ontario during pregnancy were 1.6% and 1.5%, compared to 1.6% was 13.9%. and 2.0% for the province, respectively.

35% OF RESIDENTS (AGED 12+) HAD A CHRONIC CONDITION

AND 12% HAD MULTIPLE CONDITIONS

61% OF RESIDENTS REPORTED

VERY GOOD OR EXCELLENT HEALTH

WATERLOO WELLINGTON LHIN HAD THE THIRD LOWEST RATE OF RESIDENTS WITH MULTIPLE CHRONIC CONDITIONS AMONG ALL LHINS

71% OF RESIDENTS REPORTED

VERY GOOD OR EXCELLENT MENTAL HEALTH

General Health, Risk Factors, and Prevention: Chronic Conditions: • Approximately 61% of Waterloo Wellington LHIN residents • In 2013, 35% of Waterloo Wellington residents (aged 12+) had reported very good or excellent health, and 71% reported a chronic condition and 12% had multiple conditions. Waterloo very good or excellent mental health. Wellington LHIN had the third lowest rate of residents with • Approximately 15% of LHIN residents usually experienced multiple chronic conditions among all LHINs. moderate or severe pain/discomfort, and 35% experienced • Waterloo Wellington LHIN had the lowest prevalence of high activity limitations because of long-term physical or mental blood pressure in the province and this rate was significantly health problems. lower than the provincial average. Since 2009-2010, the • Among Waterloo Wellington LHIN residents, the rate of smoking prevalence of arthritis and heart disease increased and the (19%) was similar to the provincial average. Approximately prevalence of high blood pressure and asthma decreased for 21% of LHIN residents were heavy drinkers and this proportion Waterloo Wellington LHIN residents. was slightly larger than the provincial average. • In Waterloo Wellington LHIN, 16% of residents had arthritis, • Compared with the province, Waterloo Wellington LHIN 5.1% had heart disease, 14.8% had high blood pressure and residents had slightly lower rates of overweight/obesity 7.1% had asthma. (52%) and physical inactivity (43%). • Chronic conditions such as cancer, heart disease and diabetes accounted for 61% of deaths, 20% of acute discharges from hospital, and 26% of total acute days for Waterloo Wellington LHIN residents. • Although the prevalence of cancer in Waterloo Wellington LHIN was only 1.5%, these conditions were a leading cause of mortality, acute change to discharges from separation and total acute days. Cancer accounted for 8% of all acute hospital days for LHIN residents.

2015 Environmental Scan Summary

IN 2013-14, THERE WERE:

259,429 ED VISITS TO WATERLOO WELLINGTON HOSPITALS IN 2013-14, WATERLOO WELLINGTON LHIN RESIDENTS HAD THE

5.4% of these visits were by residents outside of the LHIN

SHORTEST ALC LENGTH OF STAY IN THE PROVINCE WHICH WAS 7.9 DAYS SHORTER THAN THE AVERAGE FOR ONTARIO RESIDENTS

Health Care Utilization: • There were 45,465 acute discharges, 212,227 acute days and 241,364 total days from Waterloo Wellington LHIN hospitals in 2013/14. Residents from outside the LHIN accounted for 7.1% of the acute discharges from Waterloo Wellington LHIN hospitals in 2013/14. • 16.5% of acute discharges for Waterloo Wellington LHIN residents were from hospitals outside the Waterloo Wellington LHIN in 2013/14. • Between 2010/11 and 2013/14 acute discharges increased by 6.7% and acute days by 5.9% for Waterloo Wellington LHIN hospitals. During the same period, there was 4.9% growth in acute discharges and 3.2% growth in acute care days for Ontario hospitals overall and total days remained stable. • There were 3,486 ALC discharges from Waterloo Wellington LHIN hospitals, with an average ALC length of stay of 8.4 days in 2013/14. Between 2010/11 and 2013/14, ALC days decreased by 30.0% for Waterloo Wellington LHIN hospitals, while ALC discharges increased by 18.4%. • Waterloo Wellington LHIN hospitals had the 2nd lowest average acute and total lengths of stay and the lowest average ALC length of stay in the province in 2013/14. • In 2013/14, Waterloo Wellington LHIN residents had the shortest ALC length of stay in the province, which was 7.9 days shorter than the average for Ontario residents.

Emergency Department (ED) Visits: • In 2013/14, there were 259,429 ED visits to Waterloo Wellington LHIN hospitals and 5.4% of these visits were by residents from outside the LHIN. • Between 2010/11 and 2013/14 in Waterloo Wellington LHIN hospitals, the number of visits in the lower acuity levels declined while those in the higher acuity levels increased. • There were 277,151 ED visits by Waterloo Wellington LHIN residents in 2013/14 and 11.4% of these visits occurred in hospitals outside the LHIN. Both the number and rate of ED visits for LHIN residents increased between 2010/11 and 2013/14. • The ED visit rate for Waterloo Wellington LHIN residents was lower than the provincial average. • The rate of ED visits best treated in alternative primary care settings was lower for Waterloo Wellington LHIN residents compared to Ontario residents in 2013/14. • The leading conditions for ED visits in Waterloo Wellington LHIN hospitals were injuries and poisonings; symptoms, signs and abnormal clinical findings; respiratory system diseases; diseases of the musculoskeletal system; and factors influencing health status and contact with health services.

IN 2013-14, THERE WERE 63,771 DAY SURGERY VISITS 8.5% of the visits were by residents outside of the LHIN

IN 2013-14, THERE WERE

10,667

UNSCHEDULED ED VISITS FOR WATERLOO WELLINGTON RESIDENTS WHERE THE MAIN PROBLEM WAS A MH/SA CONDITION

Day Surgery: Mental Health and Substance Abuse (MH/SA): • In 2013/14, there were 63,771 day surgery and ambulatory • In 2013/14, there were 10,667 unscheduled ED visits for cardiac catheterization visits to Waterloo Wellington LHIN Waterloo Wellington residents where the main problem was hospitals. Residents from outside the LHIN accounted for a MH/SA condition. 8.5% of the visits in 2013/14. • Between 2010/11 and 2013/14, there was 12.4% growth in • Between 2010/11 and 2013/14, day surgery visits to Waterloo visits with a MH/SA main problem diagnosis. Wellington LHIN hospitals declined by 1.7%. • The MH/SA ED visit rates for Waterloo Wellington LHIN residents were lower than the provincial average. • Visits to ED where MH/SA was the main problem diagnosis Inpatient Rehab: accounted for 3.8% of all ED visits for Waterloo Wellington • In 2013/14, there were 1,007 admissions to inpatient LHIN residents. rehabilitation units in Waterloo Wellington LHIN hospitals and • In 2013/14 and 2014/15, support within housing, residents from outside the LHIN accounted for 4.1% of those counselling/treatment, and case management had the admissions. longest median wait times among the community MH • In 2013/14, there were 1,107 rehabilitation admissions for services provided in Waterloo Wellington LHIN. Waterloo Wellington LHIN residents, and 12.7% were treated in hospitals outside the LHIN. While the number of admissions increased there was a slight decrease in the admission rate for LHIN residents between 2010/11 and 2013/14. • Waterloo Wellington LHIN residents had the lowest rehabilitation admission rate in the province in 2013/14.

2015 Environmental Scan Summary

IN 2013-14, THERE WERE:

BETWEEN 2010/11 AND 2013/14, THERE WAS A 3.0% INCREASE IN ALL HOME CARE VISITS AND A 30.1% INCREASE IN ALL SERVICE HOURS. THE SERVICE TYPES WITH THE LARGEST INCREASES IN VISITS/HOURS WERE:

1,352 CCC ACTIVE CASES TREATED IN WATERLOO WELLINGTON RESIDENTS FROM OUTSIDE THE LHIN HOSPITALS LHIN ACCOUNTED 1,119 FOR 5.1% ADMISSIONS 1,095 DISCHARGES

PERSONAL SUPPORT WORK AND HOMEMAKING (30.4%)

AVERAGE LENGTH OF STAY = 67.4 DAYS

NURSING SHIFT (25.7%)

PHYSIOTHERAPY (12.6%)

THERE WERE

521,524 HOME CARE VISITS AND 1,457,452 SERVICE HOURS IN 2013-14

Complex Continuing Care: Home Care: • In 2013/14, there were 1,352 CCC active cases treated in • In 2013/14, there were 36,630 active home care clients in the Waterloo Wellington LHIN hospitals and residents from outside Waterloo Wellington LHIN. the LHIN accounted for 5.1% of these active cases. There • Waterloo Wellington LHIN had a higher rate of active clients were 1,119 admissions and 1,095 discharges from Waterloo than the provincial average in 2013/14. Wellington LHIN hospitals in 2013/14. The average CCC length • Between 2010/11 and 2013/14, the number of home care of stay (67.4 days) for Waterloo Wellington LHIN hospitals was clients in the LHIN increased by 14.7%. less than the provincial average in 2013/14. • In Waterloo Wellington LHIN, there were 521,524 home care • Between 2010/11 and 2013/14, active cases, admissions, visits and 1,457,452 service hours in 2013/14. discharges, and total days declined for Waterloo Wellington • Between 2010/11 and 2013/14, there was a 3.0% increase LHIN hospitals. in all home care visits and a 30.1% increase in all service • The active case rate for Waterloo Wellington LHIN residents hours in Waterloo Wellington LHIN. During this period, the was lower than the provincial rate. service types with the largest increases in visits/hours were personal support work and homemaking (30.4%), nursing shift (25.7%), and physiotherapy (12.6%), while there was a 19.8% reduction in case management visits.

96.5% OF WATERLOO WELLINGTON ADULTS (AGED 16 AND OLDER)

HAD A PRIMARY CARE PROVIDER

THIS WAS THE SECOND HIGHEST ATTACHMENT RATE AMONG THE LHINS IN 2014

42.6% OF ADULTS WERE ABLE TO SEE A PRIMARY CARE PROVIDER ON THE SAME DAY OR NEXT DAY WHEN THEY WERE SICK

IN 2013/14, THE LTC BED SUPPLY RATE

(81.4 PER 1,000 POPULATION AGE 75+) FOR WATERLOO WELLINGTON LHIN WAS SIMILAR TO THE PROVINCIAL AVERAGE

Long Term Care (LTC): • In 2013/14, the LTC bed supply rate (81.4 per 1,000 population age 75+) for Waterloo Wellington LHIN was similar to the provincial average (82.6 per 1,000 population age 75+). • While the LTC resident rate for Waterloo Wellington LHIN was comparable to that for the province the waitlist rate was slightly lower than the Ontario rate. The LTC demand rate in Waterloo Wellington LHIN, which includes residents and waitlist, was lower than the provincial average.

Primary Care: • In 2014, 96.5% of Waterloo Wellington adults (aged 16 and older) had a primary care provider – this was the second highest attachment rate among the LHINs. • 42.6% of adults in the Waterloo Wellington LHIN were able to see a primary care provider on the same day or next day when they were sick. • While 50.9% of Waterloo Wellington LHIN adults were aware that their provider offers an after-hours clinic (the highest proportion in the province), 54.1% had difficulty accessing after-hours care without going to an emergency department. • 86.7% of adults who were attached reported that their primary care provider always or often gives them the opportunity to ask questions, and 83.6% reported that their provider always or often spends enough time with them.

2015 Environmental Scan Summary

FROM 2010-2013, THE TOTAL NUMBER OF PHYSICIANS IN WATERLOO WELLINGTON LHIN

INCREASED BY 8.6% TO A TOTAL OF 1,169

OVER THE SAME TIME PERIOD

The Waterloo Wellington population grew by only 1.9% Health Human Resources • From 2010 to 2013, the total number of physicians in Waterloo Wellington LHIN increased by 8.6% to a total of 1,169. Over the same time period, the Waterloo Wellington population grew by only 1.9%. • The total rate of physicians (per 100,000 population) increased from 144.0 physicians in 2010 to 153.3 in 2013. • The rate of both family physicians and specialists per population in Waterloo Wellington was lower than the province in 2013. • From 2011 to 2014, the total number of nurses in Waterloo Wellington increased by 11.9% reaching a total of 7,865. • Compared to the province, Waterloo Wellington had similar RPNs and NPs rates per 100,000 population in 2014. • The number of NPs in Waterloo Wellington increased by 38% and RPNs by 21% between 2011 and 2014.

To read the full environmental scan, please go to wwlhin.on.ca under 2016/19 IHSP. 7

Waterloo Wellington Local Health Integration Network 50 Sportsworld Crossing Road, East Building, Suite 220, Kitchener, Ontario N2P 0A4 Local: 519-650-4472 • Toll-Free: 1-866-306-LHIN (5446) • Fax: 519-650-3155 Website: wwlhin.on.ca • Email: waterloowellington@lhins.on.ca