Crossing New Frontiers

Crossing New Frontiers Report to the Community 2013/14

ii

CIRCLE OF CARE REPORT TO THE COMMUNITY 2013/14 iii

Circle of Care has been serving the Greater Toronto Area for 40 years.

The city, which grew from 2.8 million people in 1976 to 5.9 million in

2013, has become increasingly diverse — 49.1% of Torontonians are

visible minorities.1 These demographic changes have occurred in

conjunction with a rapidly increasing senior’s population. The number

of Ontarians 65 and older is expected to more than double between

2010 and 2036, from 1.8 to 4.1 million people.2 Circle of Care’s largest

service area, North York, has one of the highest concentrations of

seniors in the province.

Circle of Care continues to meet community and home care needs

by demonstrating leadership and striving to be ahead of the

curve at every bend in the road. As Ontario’s fiscal constraints

mount, innovation and change are a must. Circle of Care plans to

lead the way.

The 2013/14 Annual Report to the Community will demonstrate how

Circle of Care is poised and ready to cross new frontiers in home and

community care which will transform the client/patient experience

in Ontario.

1 Statistics Canada Web Page

2 Central LHIN Integrated Health Service Plan 2013-14

Board of Directors

Officers:

Allan Rudolph,

Chairman

Michael F. Scheinert,

President & CEO

Howard Kaiman,

Treasurer

Harvey Bernstein,

Secretary

Other Directors:

Jessie M. Caryll

Gloria Clamen

Alan Dessau

Debby Kaplan

Dr. Les Richmond

Bernice Royce

Vision

To be the best community health care

organization in Ontario; the preferred choice!

Mission

To support individual independence and

to sustain and enhance quality of life in

the community

Values

Accountability

Safety

Diversity

Innovation

Client Centred Care

Ethical Behaviour

Learning and Growth

Teamwork & Collaboration Fiscal

Accountability

Table of Contents Message from the Chairman and President/CEO 2

Responding to Changing Care Needs 4

Service Highlights 8

Changing the Paradigm 10

New Frontiers in Service Excellence 14

New Frontiers in Service Offerings 18

New Frontiers in Technology 22

New Frontiers for the Future 26

2 MEssagE fROM THE CHaIR aNd PREsIdENT/CEO

We have 1140 staff and volunteers serving 8600

clients. In the last few years, home and community

care has become the preferred and necessary choice

for our ever expanding population. Older adults can

live at home longer, with multiple chronic conditions,

and more care requirements than ever before.

As Ontario confronts enormous fiscal challenges, the

status quo is no longer acceptable. The paradigm of

how we provide home and community care must be

changed so our system is sustainable and can meet

inevitable growing demands. As one of the largest

Community Support Service agencies in the Central

Local Health Integration Network, and a home health

care provider in 4 Community Care Access Centres,

Message from the Chairman and President/CEOIn 2014, Circle of Care celebrated 40 years of caring. as the city

has grown and changed, so has the agency. Circle of Care is now

one of the largest multi-service home and community care agencies

in Toronto.

Circle of Care has positioned itself to lead the way

in transformation.

Throughout 2013/14, Circle of Care’s focus has been

on preparing the organization to cross traditional

boundaries of siloed care. A cornerstone to this

approach is the proposed Mount Sinai Hospital/

Circle of Care partnership, announced in early 2014.

The vision is bold and exciting — to create a leading

system of integrated care that optimizes the patient,

client and caregiver experience and outcomes. The

Mount Sinai/Circle of Care partnership will connect

health sectors to create seamless care, improved

client outcomes and system efficiencies. New

models of care and exciting enhancements are

CIRCLE OF CARE REPORT TO THE COMMUNITY 2013/14 3

With a reputation for technological innovation,

Circle of Care implemented a number of initiatives

related to enhancing mobile care and security, and

automating client referrals in 2013/14. All of these

projects have been developed within the agency,

and have enhanced client and worker safety, service

quality and system efficiencies.

Given the extraordinary talents of our staff, volunteers

and Board of Directors, Circle of Care has had an

outstanding year. With our anticipated partnership

with Mount Sinai Hospital, we are positioned to lead

the way in developing a transformative and enriched

client/patient experience. We invite you to join us as

we step across a new threshold in care.

Allan Rudolph, Chairman

Michael F. Scheinert, President & CEO

already on the drawing board. We are eager to get

started on this important work with the support and

commitment of our many partners.

As we ready our organization for its next journey, we

have paved the way with proud accomplishments

this past year.

In 2014, the agency was successful in receiving

Exemplary Standing from Accreditation Canada,

the highest level of excellence for a home care

organization. Client satisfaction scores in 2013/14

have been outstanding, and Circle of Care has

led the way in innovative projects related to

client experience, emergency preparedness, falls

prevention, and hand hygiene. Last year the agency

won two United Way Bhayana Family Foundation

Community Partnership Awards for innovative

integration partnerships – one in Toronto for the

South Hospice Hub partnership spearheaded by

Circle of Care; and the other in York Region for the

One Open Door partnership.

There is no doubt that the future of home and

community care lies in the consolidated provision

of multiple services across sectors, and not in siloed

exclusivity. Circle of Care continued to broaden its

service offerings last year by adding rehabilitation

services including physiotherapy, falls prevention

and exercise classes. Our agency has also recently

been awarded the role of lead transportation

provider in south Central LHIN. Circle of Care

continues to explore additional service areas for

development in 2014/15.

4 REsPONdINg TO CHaNgINg CaRE NEEds

Responding to Changing Care Needs Circle of Care has been preparing for the needs of an aging

population for many years. Today’s elders are living at home longer,

and often have multiple chronic conditions including Alzheimer’s

disease, hypertension, congestive heart failure, diabetes, and cancer.

Increasingly, clients with life threatening conditions want to die at

home in peace and dignity. At the same time, our client base is as

diverse as the Greater Toronto Area has become — clients speak over

25 different languages including English, Russian, Italian, Yiddish,

Mandarin and Cantonese. Circle of Care’s staff speak 24 languages

to meet these needs.



Clients Requiring More CareWith more complex needs than ever before, clients

require more care and a broader array of supports.

For example, in the area of personal support, service

increased by 23% from 2012/3 to 2013/14, with a

requirement to hire 21% more staff to provide care.

Increasingly, our clients are requiring care multiple

times a day and 7 days a week.

Number of Personal Support WorkersHours of Personal Support

2012/132012/13

600600,000

800800,000

400400,000

200200,000

002013/142013/14

Enhancing Human Resources Capacity Circle of Care partnered with community agencies

such as YMCA, JVS, St. Christopher’s House, and

Career Foundations, as well as George Brown

College and the University of Toronto to grow our

Personal Support Worker (PSW) workforce. Circle

of Care has also linked with the City of Toronto

Investing in Neighborhoods, and the Toronto

District School Board — Enhanced Language

Training Program to hire internal support staff.

The agency has become a centre of learning for

student placement from universities and colleges

representing multiple professions including social

work, occupational therapy, gerontology, business

development, communications and digital marketing.

519

647,045 629

795,417

23% 21%Increase Increase


Addressing DiversityOur agency’s capacity to meet the needs of a

diverse client population is a constant strength.

Circle of Care staff and volunteers speak over 24

languages. In particular, we serve a large number of

individuals from the former Soviet Union. To enhance

access to clients, the agency undertook a number

of initiatives in 2013/14 to expand language options

available through our web site, phone system, and

printed material.

Our agency is now the largest provider of home

care and community support services for Holocaust

survivors in the GTA — serving 499 clients in

2013/14. Our holocaust program is funded through

the Conference on Jewish Material Claims Against

Germany, with matching dollars provided by UJA

Federation of Greater Toronto. Service provided

to this increasingly frail population rose by 20% in

2013/14. The Toronto survivor community is one of

the largest in North America, with a requirement for

enhanced services growing each and every day.


91,960

3908,600

7,020

19,456

21,975

kosher meals on wheels delivered by 180 volunteers

volunteersclients

day centre client days

counselling and support visits

assisted living client days

service Highlights

390 750

28,925

volunteers staff

rides for 855 seniors in 10 vehicles

180,481calls received by Call Centre

795,417hours of personal support


10 INTEgRaTINg CaRE — THE NExT fRONTIER

Integrating Care — The Next FrontierIt is acknowledged that our health care system is fragmented, with

limited integration. Transitions of care between hospital and home

can be challenging for clients/patients and their caregivers. Circle

of Care has been a leader in integration initiatives such as the south

Hospice Hub and One Open door. In late 2013, the Circle of Care

Board of directors decided that the time had come to pursue a bold

partnership with the potential to make a significant impact on the

client/patient experience through the development of new models

of care. accordingly, in early 2014, Circle of Care and Mount sinai

Hospital announced their proposed system level integration.


12 INTEgRaTINg CaRE — THE NExT fRONTIER

Changing the ParadigmThe vision for the Mount Sinai Hospital/Circle of Care partnership

is to create a leading system of integrated care that optimizes the

client/patient, and caregiver experience and outcomes. Goals include:

bridging health care sectors to develop seamless transitions so that

patients and clients receive the right care and services in the right

place at the right time; transforming the patient/client experience

in Ontario by developing innovative models of enhanced care and

services that optimize client/patient outcomes; and developing, testing

and disseminating these new approaches to care and service.

The Mount Sinai Hospital/Circle of Care integration will occur at a

governance level through a newly formed Mount Sinai Health System.

This will include collaboration in strategic planning and service models,

with the intention of enhancing access to services in the Toronto and

Central LHINs. Each organization will retain its unique culture, history

and identity, and contribute its respective strengths to collaboratively

improve care.

A full engagement was conducted in 2014 with key stakeholders

including funders, clients, family caregivers, volunteers, community

partners and staff. Circle of Care and Mount Sinai Hospital are working

with the Central LHIN to finalize the integration in late 2014.

What We Heard During Our Engagement

A Circle of Care/Mount

Sinai Hospital partnership

would present the

following opportunities:

• Foster seamless transitions

between care settings

• Develop new clinical

service models

• Integrate services for

palliative care patients

• Improve the patient/

client experience through

information sharing and

coordinated care

• Leverage the best clinical

and service practices of

the two organizations


14 NEw fRONTIERs IN sERvICE ExCEllENCE

New frontiers in Service Excellence Circle of Care has a relentless focus on quality and safety, and

ongoing attention is paid to risk identification and mitigation. In 2014,

the agency received Exemplary Standing from Accreditation Canada

in recognition for its superb work. Circle of Care goes above and

beyond to shape its own innovations in service excellence — never

settling with status quo and constantly seeking improvement.


16 NEw fRONTIERs IN sERvICE ExCEllENCE

Enhancing the Client ExperienceCircle of Care is implementing a pilot project for personal support

clients focusing on “Always Events”. Always Events are activities that

clients believe are essential to their care, and should be undertaken

by health care providers every time, consistently and reliably. They are

designed based on client desires and preferences for care, rather than

what professionals think or assume clients and their families need and

want. Implementation of this initiative promotes an optimal patient and

family experience, and improved health outcomes.

Personal Support Worker (PSW) Hand Hygiene StrategyCircle of Care has implemented a leading home support practice

for hand hygiene that is based on national and international best

practice. An organization wide strategy has been put in place that

includes enhanced staff education, policies, and measurement as well

as improved distribution of required supplies such as hand sanitizer,

gloves, gowns and masks. This initiative is being monitored by PSW

and client surveys, as well as PSW spot checks.

Hand Hygiene Performance Results 2013 (% compliance)

IndicatorClient

Phone SurveyPSW

Self ReportPSW

Phone SurveySpot

Checks

Use of gloves

in provision

of direct

client care

91.8% 98.6% 97% 100%

Highly Satisfied Clients

The results of the 2013

client satisfaction survey

were outstanding:

95%

97%

96%

Overall Service Rating

Would recommend

Circle of Care to others

Felt safe while

receiving service


Falls PreventionFalls are a leading cause of hospitalization for

seniors. Experiencing a fall can have devastating

physical and psychological impacts, resulting

in disability, chronic pain, loss of independence,

reduced quality of life, and even death. To enhance

client safety, Circle of Care has taken the initiative

to develop and implement an evidence based “Falls

Screener” for all clients. Clients who are flagged at

risk are referred to a Circle of Care regulated health

care professional to complete further assessments,

including the interRAI-Community Health

Assessment. A written safety plan is also established

in accordance with our Falls Prevention Strategy.

Emergency PreparednessIn response to the power outage from the December

2013 ice storm, Circle of Care and UJA Federation

of Greater Toronto rallied together on Christmas

Eve to help hundreds of North York seniors. Over

100 volunteers delivered water and energy bars

to seniors trapped in their apartments without

elevators, power, heat or water. As part of the

agency’s post storm assessment, Circle of Care

and Councillor James Pasternak initiated a Ward 10

Emergency Preparedness Roundtable comprised of

8 community agencies. The roundtable developed

a list of community needs and resources, and is

working on a plan for future emergencies.

18 NEw fRONTIERs IN sERvICE OffERINgs

New frontiers in Service Offerings Circle of Care is expanding its services to provide an even greater

spectrum of coordinated services for the aging population. A broader

service mix is critical to meet the increasingly complex needs of

the agency’s clients. In 2013/14, Circle of Care added a range of

rehabilitation services to its roster and significantly expanded its

assisted living program.


20 NEw fRONTIERs IN sERvICE OffERINgs

Rehabilitation ServicesWith the addition of physiotherapy services in our Toronto Central

CCAC contract in 2013, Circle of Care now offers a robust range of

home health care and community support services. In the fall of 2013,

Circle of Care was one of three community agencies awarded funding

by the Central LHIN to offer exercise and falls prevention classes. Our

agency now holds over 90 classes at multiple locations across North

York and south west York region.

Assisted LivingCircle of Care received Central LHIN funding in 2014 to implement a

new program — Hub and Spoke Assisted Living Services for High Risk

Seniors. This initiative prevents institutionalization by providing security

checks, as well scheduled and unscheduled personal support and

homemaking service to clients 24 hours a day. Assisted Living operates

in two hubs in North York and their surrounding neighborhoods —

4455 Bathurst Street and 485 Patricia Avenue. Over 235 clients are now

part of this program.

Exercise and Falls Prevention Classes

Circle of Care’s new

exercise and falls prevention

classes help seniors

increase mobility, relieve

pain, build strength and

improve balance. They are

led by Physiotherapists,

Physiotherapy Assistants

and specially trained

Personal Support Workers.

Classes are located

throughout the Central

LHIN and are free of charge.


22 NEw fRONTIERs IN TECHNOlOgY

New frontiers in TechnologyRecognizing the incredible power of technology to improve the client

experience, and enhance efficiencies, Circle of Care develops and

implements technological solutions wherever possible. In 2013/14 the

agency focused on initiatives that enhanced mobile care and security,

and automated client referrals.


24 NEw fRONTIERs IN TECHNOlOgY

Mobile CareCircle of Care has close to 700 field staff comprised

of Personal Support Workers, Social Workers, Client

Service Supervisors, Physiotherapists, Drivers, and

Exercise/Falls Prevention Class Instructors. Managing

a large mobile work force is demanding. That is

why Circle of Care is transforming mobile care for

its staff and clients in the community to establish

a more efficient and consistent way of linking field

staff, office staff and partners. The agency goals

for technology are to improve the client and staff

experience directly at the point of care to enhance

client outcomes and increase efficiency.

Projects implemented in 2013/14 included

the following:

Visit connection

Through upgrades to the agency’s Easy Care E

charting system, Service Coordinators can easily

filter and select PSWs based on client care needs,

staff availability and staff skills to match the right

staff, to the right client, at the right time, in the

right location.

Mobile Care Planning

This new system enables PSWs to access client

schedules at the point of care, on PSW mobile

devices. The agency’s ALC (Acts, Looks, Copes)

client risk identification process is now available

on mobile devices for PSWs. This enables real time

reporting of changes in client status and helps

mobilize a response and safety plan.

VOIP/Mobile Device Dashboard

This dashboard allows for real-time viewing of

PSW activity, such as possible missed visits and

quality control.

Mobile Scan

Circle of Care Client Service Supervisors can now

securely scan client documents, such as consent

forms, on their cell phone, and send them to the

office, where the system automatically attaches

them to the appropriate client in Easy Care.


Enhancing SecurityTwo programs were put in place this year to

improve data security:

Mobile Device Management (MDM) Airwatch

If an agency cell phone is lost, all data is

immediately wiped remotely, thereby protecting

client confidentiality.

Intrusion Prevention System (IPS) and Web filtering

These provide increased data protection and

improved spam control for the agency.

Improving EfficiencyA technology solution was developed in house

at Circle of Care that automates the process of

receiving referral information from the CCACs so

that is automatically uploaded to the Easy Care E

charting system. This eliminates funding entry errors

for CCAC clients and automatically notifies Circle

of Care Service Coordinators of new referrals or

changes to existing client funding.

26 REadY TO CROss NEw fRONTIERs fOR THE fUTURE

Funders

Central Local Health

Integration Network

Community Care Access

Centres: Central;

Toronto Central; Central East;

Central West

Ministry of Citizenship

and Immigration

Conference on

Jewish Material Claims

Against Germany

UJA Federation of

Greater Toronto

United Way Toronto

City of Toronto

Ontario Trillium Foundation

Affiliates

Circle of Care Foundation

Association of Jewish Seniors

Habayit Shelanu Seniors

Residences Corporation

Reena Residence

Ready to Cross New Frontiers for the FutureIn 2013/14, Circle of Care put in place the building blocks for major

change. Our next year will be transformational. The Mount Sinai

Hospital/Circle of Care partnership will be implemented alongside the

development of new models of care.

By assuming the position of one of the lead providers for

transportation in the Central LHIN, Circle of Care looks forward to

unfolding a new era of improved coordination and integration of

transportation services. Circle of Care will continue to work with the

North York General, South West and North York West Health Links to

address needs of the highest health care users. We are investigating

the development of additional professional home health care services.

In addition, we are developing new client engagement initiatives to

provide for a stronger client/patient voice. Our future looks promising

and exciting. Stay tuned!

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28 REadY TO CROss NEw fRONTIERs fOR THE fUTURE

An agency of the Government of Ontario.Un organisme du gouvernement de l’Ontario.

Documents

Crossing New Frontiers