Lloydminster Integrated Health Services and ... - City of Lloydminster

2013

Lloydminster Integrated Health Services and Facility Infrastructure Needs Assessment December 12, 2013

Final Report By:

Western Management Consultants and Management Consultants Ltd.

Lloydminster Health Services Needs RMCAssessment Resources

LLOYDMINSTER INTEGRATED HEALTH SERVICES AND FACILITY INFRASTRUCTURE NEEDS ASSESSMENT December 12, 2013

Lloydminster Health Services Needs Assessment – Executive Summary

Page 1

EXECUTIVE SUMMARY Study Purpose The purpose of the planning project was to develop a comprehensive integrated health assessment including facility infrastructure recommendations for Lloydminster and surrounding region. The plan spans fifteen years with major initiatives grouped in five year increments.

Major Findings The major findings and conclusions of the study are summarized below.  The demographic composition of Lloydminster continues to defy provincial averages, including continuing strong growth trends, a younger population and lower population health scores.  The population in the Lloydminster Hospital acute care catchment area (72,498) is 2.6 times the population in the city (27,804). The proportion of residents using the Lloydminster Hospital for acute care residing outside of the City is the highest of any of the comparator communities used in the study.  Some progress has been made in attracting family physicians to the area and this headway is reflected in a significant reduction in the number of CTAS 4 and 5 patients presenting at the Hospital Emergency Department.  The Lloydminster area is underserved when compared to provincial average health services capacity and the services provided in communities with similar catchment populations.  Health service planning and capacity building must be adequate to address current service deficits as well as accommodate growth projections that will bring the city’s population to over 50,000 people and the service catchment area to over 100,000 by 2030.  Significant challenges associated with Lloydminster’s status as a boarder city with two provincial governments accountable for providing health services need to be addressed to ensure integrated seamless service delivery for citizens regardless of their province of residence.


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P a g e | ii

Overview of Recommendations  The Assessment recommends that Lloydminster be developed as a secondary referral center that offers community hospital, specialist and support services appropriate for the size and the needs of the catchment area population.  Specific health service capacity building priorities for primary and community care, continuing care and acute care are identified. Key results to be achieved, strategies and related performance measures for each of these program areas are recommended. In addition the facility development implications for each major program area are detailed. Emphasis is also placed on identifying opportunities to streamline and improve work processes and implement proven innovative approaches to service delivery that improve service quality and cost-effectiveness.  The Assessment includes specific recommendations to build or re-develop the facilities required to support program capacity building priorities. Key projects recommended include: redevelopment and expansion of the Lloydminster Hospital; development of a primary health care center; opening of the new Lloydminster Extended Care Centre; building supported living capacity in the community and redevelopment of Jubilee Home.  A strong focus is placed on attracting and retaining the health service provider work force required to deliver services. Strategies to address the systemic shortage in trained health care service providers across many disciplines are included.  Lloydminster is well-positioned both geographically and demographically, to become a teaching centre for family physicians and other primary health care providers. The Assessment recommends positioning Lloydminster as a teaching center, which will also support recruitment efforts for the region.  The Assessment also includes a number of recommendations focused on resolving interprovincial policy and governance issues that are major inhibitors to cost-effective service delivery. Areas of focus include common information and reporting systems, funding, decisionmaking structures, certification of health care professionals and communications.


TABLE OF CONTENTS Title

Page No.

1.0 BACKGROUND .......................................................................................................................... 1 1.1 Imperatives for Change .............................................................................................................. 1 1.1.1 What is Expected from this Project? ................................................................................. 2 1.2 Project Context ........................................................................................................................... 2 1.2.1 Project Purpose and Objectives ......................................................................................... 2 1.2.2 Health Services Planning Principles ................................................................................. 3 1.3 Project Methodology .................................................................................................................. 4 1.3.1 Current Situation Review................................................................................................... 4 1.3.2 Projection of Future Health Service Needs ...................................................................... 4 1.3.3 Health Services Priorities and Service Needs Assessment ............................................ 5 1.3.4 Integrated Health Services and Capital Infrastructure Needs Assessment ................ 5 2.0

MAJOR FINDINGS..................................................................................................................... 7 2.0.1 Demographic Trends .......................................................................................................... 7 2.0.2 Patterns of Population Growth ......................................................................................... 7 2.0.3 Aboriginal Population ...................................................................................................... 10 2.0.4 Catchment Area ................................................................................................................. 11 2.0.5 Shadow Population ........................................................................................................... 15 2.1 Health Status............................................................................................................................. 15 2.1.1 Scores are Lower than Provincial Comparators ........................................................... 16 2.1.2 Lower Participation Rates for Preventative Health Practices ..................................... 16 2.2 Economic Development Data ................................................................................................. 16 2.3 Health Utilization Data and Service Capacity ................................................................... 17 2.3.1 Comparative Bed and Operating Room Capacity Numbers ...................................... 17 2.3.2 Comparative Physician Resources - ............................................................................... 17 2.3.3 General Medicine .............................................................................................................. 21 2.3.4 Mental Health Services ..................................................................................................... 21 2.3.5 Surgical Services ................................................................................................................ 21 2.3.6 Emergency Services .......................................................................................................... 22 2.3.7 Ambulatory Care............................................................................................................... 22 2.3.8 Women and Children’s Health ....................................................................................... 22 2.3.9 Clinical Support Services ................................................................................................. 23 2.3.10 Continuing Care Services ................................................................................................. 23 2.3.11 Child Preventative Health ............................................................................................... 24 2.4 Conclusion ................................................................................................................................. 24

Lloydminster Health Services Needs Assessment – Table of Contents

3.0 CURRENT FACILITY INFRASTRUCTURE ASSESSMENT ........................................... 26 3.1 Lloydminster Community Health Services (CHS) Building............................................... 26 3.1.1 Primary Function/Use ..................................................................................................... 26 3.1.2 Location .............................................................................................................................. 27 3.1.3 Age ...................................................................................................................................... 27 3.1.4 Size ...................................................................................................................................... 27 3.1.5 Description / Construction.............................................................................................. 27 3.1.6 Physical Assessment ......................................................................................................... 28 3.1.7 Functional Assessment ..................................................................................................... 28 3.1.8 Alternative Uses ................................................................................................................ 28 3.1.9 Planned Changes / Recommendations.......................................................................... 29 3.2 Jubilee Home .............................................................................................................................. 29 3.2.1 Primary Function/Use ..................................................................................................... 29 3.2.2 Location .............................................................................................................................. 30 3.2.3 Age ...................................................................................................................................... 30 3.2.4 Size ...................................................................................................................................... 30 3.2.5 Description / Construction.............................................................................................. 30 3.2.6 Physical Assessment ......................................................................................................... 31 3.2.7 Functional Assessment ..................................................................................................... 31 3.2.8 Alternative Uses ................................................................................................................ 31 3.2.9 Planned Changes / Recommendations.......................................................................... 32 3.3 Dr. Cooke Extended Care Centre (DCECC) - Original Facility ......................................... 32 3.3.1 Primary Function/Use ..................................................................................................... 32 3.3.2 Location .............................................................................................................................. 33 3.3.3 Age ...................................................................................................................................... 33 3.3.4 Size ...................................................................................................................................... 33 3.3.5 Description / Construction.............................................................................................. 33 3.3.6 Physical Assessment ......................................................................................................... 34 3.3.7 Functional Assessment ..................................................................................................... 34 3.3.8 Alternative Uses ................................................................................................................ 35 3.3.9 Planned Changes / Recommendations.......................................................................... 36 3.4 Lloydminster Long Term Care (LLTC) Facility – New Facility ........................................ 37 3.4.1 Primary Function/Use ..................................................................................................... 37 3.4.2 Location .............................................................................................................................. 37 3.4.3 Size ...................................................................................................................................... 37 3.4.4 Description / Construction.............................................................................................. 38 3.4.5 Physical Assessment ......................................................................................................... 38 3.4.6 Functional Assessment ..................................................................................................... 38 3.4.7 Alternative Uses ................................................................................................................ 38 3.4.8 Planned Changes / Recommendations.......................................................................... 38


3.5 Co-op Plaza ............................................................................................................................... 38 3.5.1 Primary Function/Use ..................................................................................................... 38 3.5.2 Location .............................................................................................................................. 39 3.5.3 Age ...................................................................................................................................... 39 3.5.4 Size ...................................................................................................................................... 39 3.5.5 Description / Construction.............................................................................................. 39 3.5.6 Physical Assessment ......................................................................................................... 40 3.5.7 Functional Assessment ..................................................................................................... 40 3.5.8 Alternative Uses ................................................................................................................ 40 3.5.9 Planned Changes / Recommendations.......................................................................... 41 3.6 Lloydminster Hospital............................................................................................................. 41 3.6.1 Primary Function/Use ..................................................................................................... 41 3.6.2 Location .............................................................................................................................. 42 3.6.3 Age ...................................................................................................................................... 42 3.6.4 Size ...................................................................................................................................... 43 3.6.5 Description / Construction.............................................................................................. 43 3.6.6 Physical Assessment ......................................................................................................... 43 3.6.7 Functional Assessment ..................................................................................................... 44 3.6.8 Alternative Uses ................................................................................................................ 45 3.6.9 Planned Changes / Recommendations.......................................................................... 46 3.7 Other Non-PNHRA Facilities ................................................................................................ 47 3.7.1 Pioneer Lodge .................................................................................................................... 47 3.7.2 Points West Living ............................................................................................................ 47 3.7.3 Dr. James W. Hemstock Assisted Living Residence .................................................... 47 3.7.4 Hearthstone Place - Independent Living ....................................................................... 48 4.0

HEALTH SERVICES NEEDS ASSESSMENT ..................................................................... 50 4.0.1 Triple Aim Framework ..................................................................................................... 50 4.0.2 Organization of the Assessment ..................................................................................... 50

A. PRIMARY AND COMMUNITY HEALTH SERVICES NEEDS ASSESSMENT .......... 52 4.1 Primary and Community Care Service Priorities ................................................................ 53 4.1.1 Priority 1: Improve Access to 24/7 Primary Health Care .......................................... 53 4.1.2 Priority 2: Mental Health and Addiction ...................................................................... 57 4.1.3 Priority 3: Chronic Disease .............................................................................................. 60 4.1.4 Priority 4: Rehabilitation: Improve Access to Rehabilitation Services....................... 62 4.1.5 Priority 5: Sexual Health and Harm Reduction ............................................................ 63 4.1.6 Priority 6: Maternal and Early Childhood Development ............................................ 64 4.1.7 Priority 7: Health Promotion, Disease and Injury Prevention .................................... 65 4.1.8 Priority 8: Education: Develop Lloydminster as a Teaching Centre .......................... 67 4.1.9 Facility Implications – Primary and Community Health Services ............................. 72


B.

CONTINUING CARE HEALTH SERVICES NEEDS ASSESSMENT ............................ 76 4.2 Continuing Care Service Priorities ........................................................................................ 77 4.2.1 Priority 1: Community of Care ........................................................................................ 79 4.2.2 Priority 2: Build Supportive Living Capacity................................................................ 81 4.2.3 Priority 3: Enhance Home Care ....................................................................................... 82 4.2.4 Priority 4: Health Service Provider Resources .............................................................. 84 4.2.5 Priority 5: Transition Unit ................................................................................................ 85 4.2.6 Priority 6: Palliative Care Service.................................................................................... 87 4.2.7 Priority 7: Respite Care Service ....................................................................................... 88 4.2.8 Priority 8: Specialty Continuing Care Services ............................................................. 89 4.2.9 Facility Implications – Continuing Care Services ......................................................... 90

C.

ACUTE CARE SERVICES NEEDS ASSESSMENT ............................................................ 96 4.3 Acute Care Services .................................................................................................................. 97 4.3.1 Priority 1: Medicine......................................................................................................... 100 4.3.2 Priority 2: Mental Health and Addiction Services ...................................................... 104 4.3.3 Priority 3: Surgery ........................................................................................................... 106 4.2.4 Priority 4: Intensive Care - Enhance ICU Capacity and Capability ......................... 110 4.3.5 Priority 5: Women and Children’s Health ................................................................... 111 4.3.6 Priority 6: Emergency Department ............................................................................... 114 4.3.7 Priority 7: Clinical and Logistical Support Services ................................................... 116 4.3.8 Priority 8: Ambulatory Care Services ........................................................................... 119 4.3.9 Facility Implications – Acute Care Services................................................................. 121

5.0

IMPLEMENTATION SCHEDULE AND PRELIMINARY FACILITY CAPITAL COST ESTIMATES.............................................................................................................................. 133 5.1 Phased Implementation Schedule ........................................................................................ 133 5.2 Facility Development Plan Including Order of Magnitude Costing............................... 133 5.3 Implementation Schedule ...................................................................................................... 134 5.3.1 Primary and Community Care Services ...................................................................... 134 5.3.2 Continuing Care Services ............................................................................................... 139 5.3.3 Acute Care Services ........................................................................................................ 143 5.4 Facility Development Plan - Capital Cost Estimates ...................................................... 149

6.0 GOVERNANCE ....................................................................................................................... 152 6.1 Bi-Provincial Ministerial Working Group ......................................................................... 152 6.2 Operations Committee........................................................................................................... 153 6.3 Operating Parameters ............................................................................................................ 155 6.4 Policy Issues, Barriers and Opportunities.......................................................................... 155 6.4.1 Policy Issues and Barriers .............................................................................................. 155 6.4.2 Opportunity for Innovative Funding Model............................................................... 156


APPENDIX I: ENCLOSURES Enclosure A: Catchment Area Calculation Methodology Enclosure B: Comparator Communities Description Enclosure C: Catchment Area Definition and Demographics


TABLE OF FIGURES Title

Page No.

Figure 1: Alberta Population, Historical and Projected .....................................................................................7 Figure 2: Lloydminster Population Growth Projections ....................................................................................8 Figure 3: Projected Population Growth of the Saskatchewan and Alberta Portions of Lloydminster ........9 Figure 4: Comparator Cities and Catchment Areas as a Percentage of City Populations...........................11 Figure 5: Percent Commuting to Lloydminster CA - 2006 ..............................................................................12 Figure 6: Percent Commuting to Wood Buffalo CA - 2006..............................................................................13 Figure 7: Percent Community to Medicine Hat CA - 2006 ..............................................................................13 Figure 8: Percent Commuting to Prince Albert CA - 2006 ...............................................................................14 Figure 9: Percent Commuting to Moose Jaw CA - 2006 ...................................................................................14 Figure 10: Physician Ratio/100,000 Population ...............................................................................................18 Figure 11: Comparison of Bed and Operating Room Capacity of Selected Jurisdictions ...........................19 Figure 12: Comparison of FTE Capacity of Selected Jurisdictions .................................................................20 Figure 13: Improve Access to 24/7 Primary Health Care ................................................................................54 Figure 14: Improve Access to Mental Health and Addictions Services .........................................................58 Figure 15: Enhance Chronic Disease Prevention and Management Services ...............................................60 Figure 16: Improve Access to Rehabilitation Services ......................................................................................62 Figure 17: Sexual Health and Hard Reduction ..................................................................................................63 Figure 18: Maternal and Early Childhood Development ................................................................................64 Figure 19: Health Promotion, Disease and Injury Prevention ........................................................................66 Figure 20: Develop Lloydminster as a Teaching Centre ..................................................................................68 Figure 21: Continuing Care Service Priorities ...................................................................................................77 Figure 22: Community of Care - Recommended Strategies ............................................................................80 Figure 23: Build Supportive Living Capacity - Recommended Strategies ....................................................82 Figure 24: Enhanced Home Care Service Options - Recommended Strategies ............................................83 Figure 25: Health Service Provider Resources - Recommended Strategies...................................................85 Figure 26: Transition Unit - Recommended Strategies ....................................................................................86 Figure 27: Palliative Care - Recommended Strategies ......................................................................................87 Figure 28: Respite Care - Recommended Strategies .........................................................................................88 Figure 29: Specialty Continuing Care Services - Recommended Strategies..................................................90 Figure 30: Key Results and Performance Measures..........................................................................................99 Figure 31: Comparison of Medicine Inpatient Bed Capacity ........................................................................101 Figure 32: Medicine - Recommended Strategies .............................................................................................102 Figure 33: Comparison of Mental Health/Addictions Inpatient Bed Capacity .........................................104 Figure 34: Mental Health and Addiction Service - Recommended Strategies ............................................105 Figure 35: Surgical Services - Recommended Strategies ................................................................................107 Figure 36: Comparison of Critical Care Capacity ...........................................................................................110

Lloydminster Health Services Needs Assessment – Table of Figures

Figure 37: Intensive Care Unit - Recommended Strategies ...........................................................................110 Figure 38: Comparison of Obstetrics Capacity ................................................................................................112 Figure 39: Women's and Children's Health - Recommended Strategies .....................................................112 Figure 40: Comparison of ED Capacity ............................................................................................................114 Figure 41: Emergency Department - Recommended Strategies ...................................................................115 Figure 42: Clinical and Logistical Support Services - Recommended Strategies .......................................117 Figure 43: Ambulatory Care Services - Recommended Strategies ...............................................................119 Figure 44: Implementation Schedule - Primary and Community Care Services........................................134 Figure 45: Implementation Schedule - Continuing Care Services ................................................................139 Figure 46: Implementation Schedule - Acute Care Services ..........................................................................143 Figure 47: Facility Development Plan - Capital Cost Estimates....................................................................149 Figure 48: Bi-provincial Working Group Composition and Structure ........................................................153 Figure 49: Operations Committee Composition and Structure ....................................................................154 Figure 50: Population Age ..................................................................................................................................163 Figure 51: Percentage of Total Population Over 65 ........................................................................................164 Figure 52: Persons 65 Years and over Residing in Private Households ......................................................164 Figure 53: Aboriginal Population ......................................................................................................................165 Figure 54: Median Income ..................................................................................................................................165 Figure 55: Percentage of People at a New Address Compared to 5 Years Ago .........................................166 Figure 56: Post-Secondary Certificate, Diploma or Degree - Education Rates (15 Years and over) ........166 Figure 57: Percentage of Immigrants ................................................................................................................167

Lloydminster Health Services Needs Assessment – Table of Figures

SECTION 1: BACKGROUND

Lloydminster Health Services Needs Assessment - Background

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1.0

BACKGROUND

The citizens of Lloydminster trace their roots to an enterprising group of settlers who chose to locate on the 4th meridian, little knowing that this would become the dividing point of two provinces in the new Dominion of Canada. That decision has had far-reaching impacts which still are visible in the health care practices of this growing community. The residents of Lloydminster have been creative in finding ways to coordinate essential public services, but significant barriers remain. This review establishes clear health service priorities for the Lloydminster area and seeks to address outstanding interjurisdictional issues that negatively impact the ability to provide residents the services they need.

1.1

Imperatives for Change

The effect of that historic decision is felt both by service providers and patients and families today. Lloydminster is a unique environment straddling the Alberta and Saskatchewan border that has and will continue to wrestle with policy and regulatory differences. The fundamental challenges associated with providing timely and affordable health care are compounded by differences in the funding, reporting and service protocols of two provincial health systems. This added degree of complexity has an ongoing negative impact on both residents and health care workers. For example, significant staff shortages are reported, impacting service workload and staff morale. Care models differ between the two provinces; and this can take focus and resource away from effectively integrating patients back into their communities. Decision-making processes are not clear, and often the decisions made are not effectively communicated to all interested staff members. Other issues and concerns include: the lack of timely access to health services; differences in resources, access criteria and accessibility of facilities and amenities between the two provinces; and the limited availability of specialist medical services within the Lloydminster health region. There is a need to address significant policy issues and questions related to Lloydminster’s unique status as a border city if residents are to receive timely, equitable access to the health care services they need regardless of their province of residency. These issues include:  Addressing funding alignment issues that are impairing the development of a single integrated health delivery system;  Removing policy and regulatory barriers to ensure clinical information flows efficiently and effectively;  Aligning bi-provincial credentialing and certification processes to enable the recruitment and retention of the scarce health care resources including primary care physicians;


Page |2  Developing bi-provincial care protocols and pathways to support continuity and consistent approaches;  Building the capacity necessary to provide the health care services appropriate to the Lloydminster catchment area; and  Addressing the heath care needs of the residents of Onion Lake in an efficient and effective manner.

1.1.1

What is Expected from this Project?

The Lloydminster Service and Facility Planning Project addresses these challenges in a number of ways.  A single health and wellness service area is being proposed that includes both Saskatchewan and Alberta residents, and would be developed and managed as an integrated service delivery vehicle for both provincial health ministries.  The services provided within the Lloydminster service area would be comparable to the mix and level of health services provided in any service area of similar size in Alberta or Saskatchewan.  Most importantly, health services in the Lloydminster service area would be delivered in a seamless fashion to patients and families, regardless of province of residence.  This new commitment to integrated and appropriate health services would be captured and illustrated through a Memorandum of Understanding (MOU) between the two health ministries. The MOU will address service delivery and funding arrangements, and establish all health facilities in Lloydminster as having bi-provincial status.

1.2

Project Context

1.2.1

Project Purpose and Objectives

The purpose of the project was to complete a comprehensive integrated health service assessment and capital infrastructure recommendations for Lloydminster and surrounding region. The plan spans fifteen years, is developed and presented in five year increments and:  Details current and projected demands for health services;  Recommends service priorities based upon demonstrated need;


Page |3  Recommends the service delivery approach, including potential innovative health services delivery options; and  Recommends the facility infrastructure to deliver the required health services.

1.2.2

Health Services Planning Principles

Health service planning decisions should be informed by clearly articulated principles. The following principles were developed by the working groups and guided the development of service planning recommendations.  Programs and services will be focused on meeting the needs of individuals and families in a seamless and integrated manner.  Providing appropriate access to safe, quality programs and services that are responsive to demonstrated and projected community needs will be a primary consideration.  Removal of unnecessary duplication, redundancy and other barriers to effective and efficient service delivery will be a high priority.  Programs and services will be planned and implemented with due regard to sustainability, and include assessment of feasibility with regard to program/service quality, required human resources, economic impacts and community acceptance.  Low volume, high end services will be consolidated where appropriate to ensure adequate critical mass to deliver the service safely, effectively and efficiently.  Program/service planning will include consideration of best practice research and innovative or alternate service delivery models, including partnerships with other regions and agencies.  Program/service planning will reflect all elements of the care continuum, including health promotion, chronic disease management, and disease and illness prevention and management.  Programs and services will be supported by adequate human resources and the required program delivery infrastructure.  Programs and services will be provided at the right time and place, and by the right service provider.  Program performance will be monitored against established performance measures and relevant benchmarks and include feedback from residents and key stakeholders. Lloydminster Health Services Needs Assessment - Background

Page |4  High priority will be placed on maintaining a regional culture that is focused on safe quality care, service integration, cooperation, customer service and continuity of care.

1.3

Project Methodology

The project methodology was designed to build upon significant community consultation and service and facility planning work that had already been completed by the PNRHA and included the following key steps.

1.3.1

Current Situation Review

Data collection and analysis was a key part of the strategy preparation. The consultants and employee teams reviewed existing health services capacity and gaps across the service continuum - primary care, community care, continuing care and acute care. Service activity and utilization levels for all major service areas were studied, relying heavily on data supplied by PHRHA and AHS. Using this material, patient flow and referral patterns for Lloydminster and areas residents were documented and major barriers identified. Recent work on LEAN, AIM/CPR and other process improvement initiatives was reviewed as well as the potential opportunities for increased operational effectiveness. Key community, provincial and national partnerships were noted and their role in coordinated service delivery confirmed. As final steps, existing facility infrastructure assets were inventoried and assessed, and potential governance models were developed for review by the bi-provincial working group.

1.3.2

Projection of Future Health Service Needs

Having developed a thorough understanding of the capacity and challenges of the Lloydminster health system, attention turned to envisioning the future demands that would be placed upon the organization. The demographic review done originally for the Primary Care Health Services Needs Assessment in 2011 was updated, and trends identified. Health profiles were developed likening the Lloydminster area to its provincial comparators; social and economic trend information was also gathered and analyzed. The consulting team reviewed innovative practices and approaches to health care, as well as the health policy directions emerging from the Alberta and Saskatchewan governments, and the Federal First Nations. Finally, health services utilizations rates were examined and correlated to the findings of the preceding assessment work.


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1.3.3

Health Services Priorities and Service Needs Assessment

Three working groups were structured to provide input and support to service planning. Each group had a specific focus area: acute care, primary and community care and continuing care. Building upon previous work done in the Prairie North Health Authority (PNRHA) and the Central Zone (CZ) of Alberta Health Services, inventories were prepared of major existing health services, capacities and gaps. The inventories addressed a broad continuum of activity including acute care, continuing care, mental health and addictions, primary care, public health and community programs. Service levels and utilization rates for each of these areas were also identified. The three working groups were instrumental in reviewing the data collected earlier in the project, assessing it, and developing service priorities for their respective areas. Once the priorities were identified, key results, strategies, timelines and performance measures were established for each. This was followed by a review of existing service delivery approaches, and a consideration of recommended enhancements or new approaches to improve outcomes and service metrics. Policy issues and potential barriers to service plan implementation were also acknowledged.

1.3.4

Integrated Health Services and Capital Infrastructure Recommendations

Concurrent with program development activities, a review commenced of facility space and other related infrastructure. Existing infrastructure was inventoried and assessed, the needs of new services were identified, and priorities were established. As part of this process, the impact on the Lloydminster Hospital Master Plan was identified. The results have been documented in a new 15 year facilities development plan organized in five year increments.


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SECTION 2: DEMOGRAPHIC, HEALTH SERVICES UTILIZATION AND SERVICE CAPACITY DATA

Lloydminster Health Services Needs Assessment – Demographic, Health Services Utilization and Service Capacity Data

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2.0

MAJOR FINDINGS

2.0.1

Demographic Trends

The design of a functional health system is grounded in the needs of the population it serves. An understanding of the population characteristics is especially important in the Lloydminster regional area which contains a number of demographic fluctuations that make it unique in Canada. Rapid growth, the dynamics of differing provincial populations, and the demands of a resource-based economy are all well known in Lloydminster. Designing a system to meet the needs of these residents, however, presents continuing challenges that require thoughtful consideration.

2.0.2

Patterns of Population Growth

 Strong Population Growth The 2013 population of Lloydminster is 31,483. The City’s Comprehensive Growth Strategy (2013) estimates that the population of Lloydminster could be 48,315 by 2030, and as high as 58,983 by 2041. These projections were based on Alberta data only but give a useful indication of expected population growth. Figure 1: Alberta Population, Historical and Projected

Source: City of Lloydminster Comprehensive Growth Strategy

The most recent Municipal Development Plan (2013) presented slightly varied growth scenarios since it used different base data and included both Alberta and Saskatchewan figures. The results of the MDP analysis are illustrated in the chart below, and provide an even more Lloydminster Health Services Needs Assessment – Demographic, Health Services Utilization and Service Capacity Data

Page |8 aggressive projection of the growth rate in Lloydminster showing anticipated expansion to between 51,148 and 65,320 by 2031. Figure 2: Lloydminster Population Growth Projections

Source: Lloydminster Municipal Development Plan (2013)

Whatever the figures used, it is clear that Lloydminster’s population growth is expected to continue and the health needs of its population will continue to increase.  Continued Disparity between the Saskatchewan and Alberta Portions of Lloydminster The table below demonstrates one of the key differences between the Saskatchewan and Alberta portions of Lloydminster. In the 40 year study period, the Alberta portion of Lloydminster is anticipated to grow substantially faster than the Saskatchewan side: the Alberta population is projected to increase almost 4-fold, while the number of Saskatchewan residents is expected to slightly more than double. This differential growth rate will exacerbate the existing differences between the two components of Lloydminster.


Page |9 Figure 3: Projected Population Growth of the Saskatchewan and Alberta Portions of Lloydminster

Source: Lloydminster Municipal Development Plan, 2013

There are other differences between the two provinces. Saskatchewan residents are younger (e.g. Population aged 20 – 44: 37% Alberta; 48 % Saskatchewan); more likely to be renters (31.4% Alberta; 39.3% Saskatchewan); have a higher percentage of children living in low income families (10.2% Alberta; 20.2% Saskatchewan), and have higher self-injury hospitalizations (per 10000 population: 68 Alberta; 174 Saskatchewan). The challenge to the preparation of the Service and Facility Needs Assessment is to understand these differences, since looking at the Lloydminster service area statistics as a whole, masks the dramatic differences between the two provinces.  Characteristics of Resident Populations They are younger: The population of Lloydminster is younger than the average provincial populations. For example, the median age in Lloydminster SK is 27.9, while the median in Saskatchewan as a whole is 38.2. The Lloydminster AB figures are 34.5 versus 36.5 for the province. In general, the population living in Lloydminster SK is noticeably younger than the Alberta side. 77.4% of the residents of Lloydminster SK are 44 years of age or younger; in Lloydminster AB, the figure is 65.5%. Most families have higher incomes: As reflects its status as a resource development centre, the average Lloydminster family income is higher than the provincial comparators (Lloydminster AB is 6% higher than the provincial average; Lloydminster, SK is 4%). The income for male lone parents is in line with this trend; in Lloydminster, AB for example, the average lone male parent family income is over 75% higher than the overall Alberta amount. (The Lloydminster, SK amount is 24% higher than the provincial average.)


P a g e | 10 Female lone parent families do not enjoy this advantage: the Lloydminster, AB incomes are, on average, 9% lower than the provincial comparable, while the Lloydminster, SK figures follow that province’s average almost exactly. They move more often: Lloydminster citizens are more mobile than their provincial counterparts. When compared to the provincial average, almost ten percent (9.6%) fewer Lloydminster, AB residents live at the same address they did five years ago. The Lloydminster, SK percentage is 21.5%. Immigration is on the increase: The number of immigrants has increased substantially since the 2006 census, especially in the Saskatchewan side of Lloydminster. The 2011 census showed that, 8.2% of the population in Lloydminster, SK was foreign-born, which is higher than the proportion in Saskatchewan as a whole (6.8%). However, the percentage of foreign born immigrants in Lloydminster, AB (6.6%) is still about a third of the rate in Alberta (18.1%). 36.7% of the immigrants living in Lloydminster are from the Philippines. Education rates are increasing. While Lloydminster education attainment levels still lag behind national averages, the number of residents with some form of postsecondary education has increased over the last five years. In 2011, 55.3% of the over-25 population had a university certificate or degree, a college diploma or a trade certificate. This is up from the 51.9% recorded in 2006. Growth is also noted in the apprenticeship and trades diploma categories.

2.0.3

Aboriginal Population

The aboriginal population in the PNRHA is almost double the Saskatchewan average (29%, PNHR; 14.9%, Saskatchewan). However, the percentage of aboriginal population in the Central Health Zone is very similar to the Alberta average (6%, CZ; 5.8%, Alberta).* The percentage of aboriginal people in Lloydminster is higher than the percentage in either Alberta or Saskatchewan, while Lloydminster, SK has a consistently higher percentage of aboriginal residents than Lloydminster, AB. In both cases, this population is younger than the remainder. For example in Lloydminster, SK, aboriginal children 14 years of age and under represented 34% of the total aboriginal population. For the remainder of the residents, 15.1% were 14 years of age and younger. In Lloydminster AB, the aboriginal children population was 28.8% of the total aboriginal population, while 14 year olds and younger represented only 8.1% of the remaining population. * In the data above, Prairie North Regional Health (PNRH) reflects the Saskatchewan portion of the population; Central Zone (CZ) is the Alberta portion.


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2.0.4

Catchment Area

As part of the environmental scanning process, the consultants did an analysis of the catchment area for the Lloydminster Hospital and compared it to similar centres in both Saskatchewan and Alberta. The methodology used was an analysis of approximate driving times and distances, based on data from the 2011 Canada Census and Google Maps. The same methodology was applied to all regions, and a detailed discussion of the methodology is attached as Enclosure A. The results of this review are displayed in the chart below. It clearly demonstrates that Lloydminster has a much larger catchment population than comparable centres, and that the demands on the Lloydminster health system are therefore, disproportionately greater. Figure 4: Comparator Cities and Catchment Areas as a Percentage of City Populations

2011 Population

2011 Catchment Population

2011 Total Hospital Population

Catchment As Percentage of City population

Moose Jaw

33,274

8,029

41,303

24.1%

Prince Albert

35,129

33,509

68,638

95.4%

Medicine Hat

60,005

23,219

83,224

38.7%

Wood Buffalo

67,516

contiguous

67,516

100%

Lloydminster

27,804

44,694

72,498

160.7%

City

The content results of this methodology are very similar to the results of similar studies undertaken by PNRHA. PNRHA defined the catchment area for Lloydminster health services “as the geographical area and the population within that area that access health services in Lloydminster.” This analysis was based on all activity performed at the Lloydminster Hospital and a subsequent determination of whether these visits were significant both for the Hospital and for the generating community. The PNRHA study determined the 2011 catchment area for the Lloydminster hospital to be 72,622* – a very similar figure to the calculation described above, determined by different methodology. *Source of data: PNHR, Lloydminster Data Report, Lloydminster Geographical Area, Community Assessment and Service Response, 2011 – 2012.

Also of interest is a pictorial representation of the commuting radius for the five communities referenced in Figure 4. The Lloydminster map below illustrates the commuting radius surrounding Lloydminster, and is an indication of the draw on health services with PNRHA.


P a g e | 12 Figure 5: Percent Commuting to Lloydminster CA - 2006

Source: Lloydminster Economic Development

Similar maps for the four comparator municipalities are shown below. The Wood Buffalo map makes no distinction between urban and rural areas, and is therefore not as useful for comparison. Medicine Hat shows a large commuting area (i.e. a high percentage of commuters in the 50 – 100km radius), but the populations in its commuting areas are substantially lower than in Lloydminster. Both Prince Albert and Moose Jaw record a high percentage of commuters only within a 50 km radius, and the numbers (as demonstrated in the chart above) are relatively small.


P a g e | 13 Figure 6: Percent Commuting to Wood Buffalo CA - 2006

Figure 7: Percent Community to Medicine Hat CA - 2006


P a g e | 14 Figure 8: Percent Commuting to Prince Albert CA - 2006

Figure 9: Percent Commuting to Moose Jaw CA - 2006

Special thanks and credit to Professor M. Rose Olfert of the University of Saskatchewan for providing the above information.


P a g e | 15 The demographics of the catchment area are of significant interest to this study, since they will impact migration trends. A detailed assessment of the catchment area characteristics is attached as Enclosure C. As expected from the analysis of provincial differences, the catchment area population (when compared to Lloydminster as a whole) shows the following features:       

It is older, displaying a greater proportion of population that is 65 years of age and above. Slightly more of the over 65 population in the catchment areas reside in private households. The aboriginal population is higher. The median income of the catchment population is almost $10,000 lower than that of Lloydminster. Catchment area residents move less often than their Lloydminster peers. Education rates are lower. Immigration is significantly lower.

* The analysis conducted of the Lloydminster catchment compares the City of Lloydminster (both AB and SK parts) with the surrounding catchment area and does not include the City itself in that catchment area in order to capture urban and rural differences.

2.0.5

Shadow Population

The existence of a shadow population in Lloydminster is an issue that impacts planning for all service providers in the region. The PNRHA 2011 – 2012 Lloydminster Data Report identifies residents living in ten communities outside the catchment area, who access emergency medical services in Lloydminster. In addition, another 7.6% of visitors to the ER are unidentified in terms of knowing where they live (PNRHA p. 6.). This is a significant portion of the work of the ER and further study might suggest strategies for dealing with it more effectively.

2.1

Health Status

Table 2 of the Prairie North Health Region (PNRHA) 2011 – 2012 provides a full review of the health status indicators of the residents of PNRHA (SK) and the Central Zone (AB)**. These indicators provide useful predictive information regarding the type and volume of medical services that may be accessed by residents of the area. While the full detail is available in the PNRHA report, the following is a brief summary of the most salient data. **In the data below, Prairie North Regional Health (PNRH) reflects the Saskatchewan portion of the population; Central Zone (CZ) is the Alberta portion.


P a g e | 16

2.1.1

Scores are Lower than Provincial Comparators

Residents of the PNRHA (SK) and the CZ (AB) have higher scores than provincial comparators in the rates of:  Overweight or obesity: (PNRHA, 68.3%; Saskatchewan, 58.7%. CZ, 57%; Alberta, 53.3%)  Arthritis: (PNRHA, 23.6%; Saskatchewan, 18.8%. CZ, 17.4%; Alberta, 15.1%)  Diabetes: (PNRHA, 8.6%; Saskatchewan, 6.4%. CZ, 6.9%; Alberta, 5.1%)  Smoking: (both daily and occasional): (PNRHA, 32.4%; Saskatchewan, 22.2%. CZ, 28%; Alberta, 23%)  Self-Injury hospitalizations (per 100,000 people): (PNRHA, 174; Saskatchewan, 85. CZ, 68; Alberta, 60)  Avoidable mortality from preventable causes (per 100,000 people): (PNRHA, 184; Saskatchewan, 142.3. CZ, 146.2; Alberta, 130.8) Compared to the provincial average, fewer PNRHA residents report having a regular medical doctor (76.3%, PNRHA; 83.9%, Saskatchewan); the CZ rates are very similar to the Alberta-wide figure (80.2%, CZ; 79.7%, Alberta).

2.1.2

Lower Participation Rates for Preventative Health Practices

Residents of the health region score lower on activities, which would improve their health status:  Leisure time physical activity: (PNRHA, 47.4%; Saskatchewan, 51.2%. CZ, 51.5%; Alberta, 56.2%)  Bike helmet use: (PNRHA, 19.8%; Saskatchewan, 23.4%. CZ, 31.7%; Alberta, 47.5%)  Influenza immunization: (PNRHA, 21%; Saskatchewan, 29%. CZ, 23.6%; Alberta, 30%)

2.2

Economic Development Data*

Lloydminster has become an important player in the energy development industry in both Alberta and Saskatchewan, serving as a centre for Husky Energy’s Canadian operations. As a result, the City is developing rapidly and has recorded impressive rates of growth.


P a g e | 17 The construction values in 2011 were in excess of $180 million, a 38% increase from 2010; and the 2012 value was almost $190 million. For the three years ending in 2012, Lloydminster’s construction values increased by 74.9%. Household incomes are high. The 2012 average household income of $109,842 is 20% above the Canadian National Average. As might be expected, the employment rates for both Alberta (70.1%) and Saskatchewan (65.7%) exceed Canada’s average rate of 61.6%. *Source: Lloydminster Economic Development – February 2013

2.3

Health Utilization Data and Service Capacity

Like the growth in population numbers, health utilization rates have also increased in Lloydminster. This section of the report summarizes key trends in health service utilization and compares the service capacity of the Lloydminster area with six other service regions in Alberta and Saskatchewan. While it is recognized that no two communities are completely the same, external comparisons are an important part of understanding the complexities, issues and challenges faced by the Lloydminster health region. More detailed information on the communities chosen as comparators, and some of the rationale as to why they were chosen, is attached as Enclosure B.

2.3.1

Comparative Bed and Operating Room Capacity Numbers

Lloydminster’s bed and operating room capacity was analyzed in relation to six comparator service areas – Fort McMurray, Grande Prairie, Prince Albert, Moose Jaw, Red Deer, and Medicine Hat. Long term care capacity, surgical, medicine, mental health inpatient beds and a number of other bed types are examined in relation to these peer hospitals. This information was assembled through the help of the two health authorities (Alberta Health Services and Prairie North Regional Health Region) and Saskatchewan Health. Figure 11 on page 19 details the results.

2.3.2

Comparative Physician Resources -

The number of family physicians serving the PHRHA/100,000 population has increased somewhat over the last two years, as a result of targeted recruitment efforts to replace retiring physicians and attract additional ones. The ratio of GP/100,000 population remains below the provincial average for both AHS Central Zone and the PNRHA. The number of specialist physicians serving AHS Central Zone and the PNRHA /100,000 population has increased more significantly over the past two years, although the ratio is still substantially lower that the provincial averages.


P a g e | 18 Figure 10: Physician Ratio/100,000 Population

AHS-CZ 2011 2013 General/Family Physicians (per 100,000 population) Specialist Physicians (per 100,000 population)

AB 2011

2013

PHRHA SK 2011 2013 2011 2013

89

90

112

109

80

84

93

95

14

33

91

103

10

18

70

75

Source of data: PNHR Lloydminster Data Report, May 2013.

A detailed comparison of the number of family and specialist physicians serving the Lloydminster area juxtaposed with the comparator municipalities is outlined in Figure 12 on page 20. The FTE analysis was completed in the same way as the bed capacity study referenced in section 2.3.1 above.


P a g e | 19 Comparison of Bed and Operating Room Capacity of Selected Jurisdictions This chart demonstrates that the bed capacity of the Lloydminster region compares unfavourably with similar jurisdictions. Figure 11: Comparison of Bed and Operating Room Capacity of Selected Jurisdictions


P a g e | 20 Comparison of FTE Capacity** of Selected Jurisdictions Figure 12: Comparison of FTE Capacity of Selected Jurisdictions


P a g e | 21

2.3.3

General Medicine

The General Medicine statistics show a significant discrepancy between the expected length of stays (ELOS) in hospital and the number of days that the individuals actually spend (ALOS). In 2011 – 2012, this accounted for 5,000 extra days of care, which is the operational equivalent of taking 14 beds out of the system. No one factor explains this excess utilization. Some of this demand is generated by patients waiting for transfer to alternate care; but delays in diagnostic tests and results, rehabilitation therapy staff vacancies, handoffs among medical staff, continuing care resource availability and other factors all contribute.

2.3.4

Mental Health Services

Utilization rates for mental health services have greatly increased, placing greater emphasis on the need to expand service capacity. The statistics are compelling:  The number of mental health visits/contacts by Lloydminster residents to the Battleford Mental Health Centre has grown by 52% over the past four years. (4,181 in 2009/10; 6,356 in 2012/13).  Individual mental health clients’ numbers have risen by 45% over the same period. (1,123 in 2009/10; 1,630 in 2012/13).  The number of new mental clients registered in the past four years is up by 100%, most of them adults. (272 in 2009/10; 542 in 2012/13).  Addiction Services has become a significant new service in the past two years with nearly 600 adult clients and 30 children accessing services. These client populations account for 1,500 direct service hours. An overview of mental health inpatient capacity in similar communities (e.g. Prince Albert, Medicine Hat, Grande Prairie and Moose Jaw) suggests that Lloydminster is short at least 10 mental health beds.

2.3.5

Surgical Services

Surgery cases have grown by 40%in the last three years, from just over 2,000 cases in 2009/10 to nearly 3,000 cases in 2012/13. At the same time, day surgery cases have reached 75% of total surgeries, reflecting effective use of a limited resource. All surgical specialties have increased except for General Surgery which declined by 27% during the study period (from 3,300 cases 2009/10, to 2,400 in 2012/13). This reflects additions of ENT and orthopedics to the service mix and limits in current OR and inpatient bed capacity. Lloydminster Health Services Needs Assessment – Demographic, Health Services Utilization and Service Capacity Data

P a g e | 22 Endoscopy service has seen more modest growth over the past few years at approximately 12% increase (from 1,463 procedures to 1,637).

2.3.6

Emergency Services

The number of visits to the Emergency Department of the Lloydminster Hospital has increased to 40,000, compared to the 35,000 recorded in 2007/08. More importantly, as access to primary care physicians in the community has improved, there has been an encouraging downward trend in number of CTAS 4 and 5 patients. In 2007/08 CTAS 4 and 5 clients represented over 80% of Emergency Department activity. In the most recent fiscal year, this percentage has been reduced to 65%.

2.3.7

Ambulatory Care

It is evident from the usage data that Lloydminster residents are making greater use of ambulatory care services and clinics. Ambulatory Clinic visits are up by 23% over the past four years, most notably the cast clinic (106%) and the orthopedic clinic (83%). This likely reflects the addition of an orthopedic surgeon to the hospital’s service mix, and the availability of more orthopedic services over the past 4 years. The Respiratory Care clinic has also experienced large positive growth over the past several years despite limited staff capacity. From start-up in 2009/10, the service most recently had 671 service visits. In addition Telehealth usage has increase by 69% and has become a well-utilized extension of clinical services.

2.3.8

Women and Children’s Health

Lloydminster is a young and growing community, but deliveries at the Lloydminster Hospital have remained stable over the past several years, at about 900 births annually. This is in contrast to the activity level in child health clinics which has grown substantially over the review period. The relative stability in obstetrics activity cannot be attributed to any one factor but may be due to the previously small number of OB/GYN specialists in the community, and other medical or social considerations. There is opportunity for growth in obstetrics services within existing infrastructure since the current LOS rates are at, or lower than ELOS; inpatient occupancy rates are less than 50%; and current C-Section and epidural rates are at reasonable levels.


P a g e | 23

2.3.9

Clinical Support Services

Clinical support service levels have either been largely stable or in decline over the past four to five years. This does not reflect a lack of demand or need for diagnostic services but a shortage of personnel to provide service. This is most easily seen in the shortage of ultrasound technicians and insufficient on-site access to Radiologist services. The personnel shortage appears to account for a nearly 14% decline in general radiography exams compared to 2009/10 (down 2,524 exams) and a 13.5% drop in ultrasound exams over the same timeframe (decrease of 597 exams). By comparison, CT exams have remained relatively stable having grown by 229 exams or 6% over the past four years. Despite the youthful demographics of Lloydminster, mammography is a new and relatively small service with only 397 exams having been performed in the most recent fiscal year. Inpatient Therapy activity at the hospital has grown by 34% in all areas (e.g., physical therapy, occupational therapy, speech language pathology, etc.) for a total increase of 3,763 visits. While this appears to be substantial growth, a truer assessment is possible when the Lloydminster figures are considered in the context of growth rates in neighbouring municipalities. For example, there was over 100% growth (5,899 visits) in inpatient activity in North Battleford over the same time period. As noted in section 3.4.2 above, access to therapies has been identified as one of the major barriers to appropriate and timely discharge from the Lloydminster hospital. This comparison to North Battleford inpatient activity growth over the same time period would seem to bear out the staffing challenge concern for Lloydminster.

2.3.10 Continuing Care Services Homemaking workload units have increased by 23% (nearly 4,000) since 2009/10 while Meals on Wheels units are up by 77% or 2,338 visits. On the other hand, the number of Home Care client visits has decreased by 13% between 2010/11 and 2012/13, and nursing workload units are down by 4% (824 units). This result is in sharp contrast to the increases in nursing workload units for other major PNHR communities. North Battleford experienced a 58% growth in that same time frame (7,500 units) and 124% in Meadow Lake (3,686 units). Client numbers in Lloydminster have been relatively stable through the review period (534 to 538) which also is in sharp contrast to other PNHRA communities. Some of this difference may be explained by the younger demographics in Lloydminster as contrasted with other PNHRA communities; however, part of this service record likely relates to challenges in maintaining adequate Home Care staffing.


P a g e | 24

2.3.11 Child Preventative Health The past several years have seen a sizeable increase in the number of children participating in preventative health activities. School immunizations are up by 160% in the past six years, and the number of children seen in Child Health Clinics has grown by 30%. These rates far exceed any growth anticipated by population increase alone.

2.4

Conclusion

Lloydminster is by almost any definition, a dynamic community experiencing dramatic growth and change. The challenge to its health system is to expand to deal with growth and evolve to meet the needs of its younger, more diverse population.


P a g e | 25

SECTION 3: CURRENT FACILITY INFRASTRUCTURE ASSESSMENT

Lloydminster Health Services Needs Assessment – Current Facility Infrastructure Assessment

P a g e | 26

3.0

CURRENT FACILITY INFRASTRUCTURE ASSESSMENT

The purpose of the Current Facility Assessment is to provide an inventory and current state of the existing PNRHA facilities in Lloydminster as part of the current situation review for the Lloydminster Health Service Needs Assessment. The assessment concentrated on those health care facilities that currently accommodate PNRHA programs and services in the City of Lloydminster and for which the PNRHA is responsible for their operation, i.e.: 1. 2. 3. 4. 5. 6.

Lloydminster Community Health Services (CHS) building Jubilee Home Dr. Cooke Extended Care Centre (DCECC) Lloydminster Long Term Care (LLTC) facility Co-op Plaza Lloydminster Hospital

The assessment involved building and site tours, along with discussions with PNRHA service providers and staff responsible for the building operations. For certain facilities, the assessment also drew from previous work completed by RMC for the Lloydminster Hospital Master Plan & Functional Program (2007) and the Dr. Cooke Extended Care Centre Functional Program (2007). For all six facilities, another key source of information was the 2013 Facility Condition Assessments completed by VFA. Inc., a US firm that specializes in facilities asset management. For each facility, the assessment provides information on its current function/use, location, age, size, construction, physical assessment including Facility Condition Index (FCI), functional assessment, its potential to accommodate alternative uses, and initial considerations for planned changes and recommendations. In addition, a number of non-PNRHA facilities in Lloydminster are captured in the inventory. There was a meeting held with representatives of these facilities, although we did not visit or assess them. They include: Pioneer Lodge, Point West Living, Dr. James W. Hemstock Assisted Living Residence and Hearthstone Place – Independent Living facility.

3.1

Lloydminster Community Health Services (CHS) Building

3.1.1

Primary Function/Use

 The CHS building (also referred to as the Home Care building) currently houses Home Care and Mental Health. The main functions include outpatient exam and counselling services, administrative services and staff services. It presently accommodates approximately 60 staff.


P a g e | 27  When Public Health moved to Co-op Plaza, Mental Health was able to consolidate all of its services in the CHS building including Child & Youth services.  Types of building spaces comprise: reception and waiting areas, exam and counselling rooms, offices and staff workstations, meeting rooms, home care equipment and supply rooms, and general support areas.  The building includes a large multipurpose education room that is reported to be well utilized.

3.1.2

Location

 3830 - 43rd Avenue, Lloydminster, Saskatchewan.  The CHS building is sited adjacent to the Lloydminster Hospital and Jubilee Home.

3.1.3

Age

 Originally constructed in 1987 and expanded and renovated in 2005, the building is now 26 years old.

3.1.4

Size

 1,012 total square metres (~10,900 square feet).  The original 1987 building was 715 square metres (~7,700 square feet); the 2005 addition was 297 square metres (~3,200 square feet).

3.1.5

Description / Construction

 Group D, Business/Personal Services Occupancy classification (National Building Code).  Single-floor building with no basement; the building generally reflects a ‘strip' retail quality of construction.  Concrete, slab-on-grade structure with supporting steel columns and beams on concrete foundations; wood-framed exterior walls and roof deck.  Exterior walls are a combination of brick and E.I.F.S. panels with aluminum windows and doors.


P a g e | 28  Standard retail/office grade interiors, i.e. resilient vinyl sheet flooring with small areas of ceramic tile flooring, painted gyproc walls, acoustic tile ceilings, and wood and metal doors.

3.1.6

Physical Assessment

 Current replacement value is reported to be approximately $2.75 million (VFA 2013).  The building is reported to have a Facility Condition Index (FCI) of 0.10 (VFA 2013), which represents a relatively acceptable level of condition and generally signifies that the building has a reasonable life expectancy.  Notable upgrading requirements include a number of elements categorized as “beyond their useful life” such as: rooftop air conditioning equipment, telephone system, some of the exterior wall panels, exterior lighting and uneven exterior concrete paving.  The building has individual battery-powered smoke alarms, but no central fire alarm system; emergency power is limited to battery packs for life-safety systems lighting.  The building does not fully meet accessibility requirements for persons with disabilities, e.g. signage.  Staff reported issues regarding water penetration and mold.

3.1.7

Functional Assessment

 Building is fully occupied, with some areas identified as being over-crowded. For example, portions of the open workstation areas are congested and lack privacy and confidentiality, especially where other staff are walking through them.  The Home Care equipment and supply area is of particular concern in failing to meet infection prevention and control standards, i.e. lack of separation of clean and soiled functions, and a shortage of space for Home Care equipment that is increasing in volume to meet the needs of expanding programs such as Orthopedics.

3.1.8

Alternative Uses

 Due to its overall size, type of construction, and layout/configuration, the CHS building is limited in its flexibility to accommodate alternative uses, i.e. it is suitable for medical/outpatient services and clinics, other community services, administrative and office functions, and perhaps some types of commercial/retail activities.


P a g e | 29  Building is not suitable for any type of inpatient or resident care service that entails overnight stays.

3.1.9

Planned Changes / Recommendations

 PNHRA has a tentative plan to move Mental Health to the Co-op Plaza and leave Home Care in the building, where it could expand into a portion of the space vacated by Mental Health.  However, an alternative short-term plan that merits consideration is to move both Mental Health and Home Care to the Co-op Plaza and use the vacated CHS building to decant nonacute and administrative type functions out of Lloydminster Hospital. This would create much needed space in the Hospital for immediate priority needs such as surgical and Medical Device Reprocessing (MDR) services, mental health beds, etc. This alternative is subject to the availability of vacant space in Co-op Plaza.  5, 10 and 15 Year Recommendation – It is recommended that the CHS building serves as administrative and support space for the adjacent Lloydminster Hospital.

3.2

Jubilee Home

3.2.1


 The Jubilee Home currently houses 50 continuing care residential beds, which includes 4 beds used for short term respite care, convalescent care and palliative care.  Building spaces comprise: 

50 single bedrooms with en-suite washrooms (without showers) located in four wings radiating out from a central core containing the nursing station;



Central resident lounge, dining room, craft and activity rooms, and other shared resident facilities such as bathing rooms, hair salon and therapies area;



A main entry and administration area; and



Common staff and support areas including kitchen, laundry, storage, mechanical rooms, etc.

 The facility currently is self-supporting with respect to in-house food services, laundry, etc.


P a g e | 30

3.2.2

Location

 3902 - 43rd Avenue, Lloydminster, Saskatchewan.  Jubilee Home is sited adjacent to the CHS building, approximately one block west of the Lloydminster Hospital.

3.2.3

Age

 Originally constructed in 1985, a small dining room addition (80 square metres) was completed in 1993 and an enclosed screen porch (unheated) added in 2007; the building is now 28 years old.  Renovations have been done over the years including: installation of lifts in all resident rooms, removal of skylight above the nursing station, replacement of the roof, refinishing interiors, etc.

3.2.4

Size

 3,320 total square metres (~34,800 square feet).  A small separate outbuilding contains an emergency generator.

3.2.5


 Group B-2, Care Occupancy classification (National Building Code).  Single-floor building with partial basement accessible only by stair; crawlspace below remainder.  Concrete sub-structure with supporting steel joists and a concrete on steel floor deck; woodframed exterior walls with brick veneer and cementitious hardboard panels; and wood frame roof deck with a new roof installed in 2007.  Aluminum windows and doors; the resident rooms have operable windows.  Interior finishes include: resilient vinyl sheet flooring with areas of ceramic tile, quarry tile and concrete flooring; painted gyproc walls with handrails and vinyl protection, and decorative stonework and wood screens in selected areas; acoustic tile ceilings, and wood and metal doors.  The building is sprinklered, with a central addressable alarm system with smoke and heat detectors. Lloydminster Health Services Needs Assessment – Current Facility Infrastructure Assessment

P a g e | 31  Other systems include: nurse call system, patient wander guard system, public address system, basic telephone and data systems, and an emergency generator.

3.2.6

Physical Assessment

 Current replacement value is reported to be approximately $11.45 million (VFA 2013).  The building is reported to have a Facility Condition Index (FCI) of 0.40 (VFA 2013), which is a relatively high ratio generally indicating that the building has significant deferred maintenance and upgrading needs.  Notable upgrading requirements include numerous elements categorized as “beyond their useful life”, i.e. major mechanical equipment such as boiler, chillers, pneumatic controls and ventilation ducts; low tension electrical system; various exhaust systems; emergency generator; nurse call and telephone systems; plumbing fixtures; and the interior floor and wall finishes.  The building does not fully meet accessibility requirements for persons with disabilities, e.g. signage.

3.2.7


 Building is fully occupied.  Design and layout reflect a dated concept of continuing care, e.g. long wings of double-loaded corridors with all of the resident social spaces and amenities clustered in the centre.  Facility was designed for a resident population that was more mobile and had a lower level of care needs. There are now many more residents in wheelchairs and a growing number of residents with special needs, e.g. residents with dementia who are prone to wandering.  Resident rooms are approximately 19.5 square metres (210 square feet) including the ensuite washroom. This is about 25% below current standards, i.e. the resident rooms in the new Lloydminster Long Term Care facility are approximately 26 square metres (280 square feet). The resident washrooms in the Jubilee Home do not meet accessibility standards and do not contain showers.

3.2.8

Alternative Uses

 Given its unique layout and configuration, without a major renovation and costly re-purposing, the Jubilee Home is limited mainly to its current use, i.e. accommodating residential services such as a lodge or continuing care facility.


P a g e | 32

3.2.9


 The PNRHA has examined a preliminary plan to add an 8-10 bed unit at the end of one wing designed to accommodate residents with special needs such as dementia. There is adequate space on the site to accommodate the plan, although it is not known if the existing mechanical and hot water systems have adequate capacity to support such an expansion.  Given the age, outdated layout and deteriorated condition of Jubilee Home as reflected in its relatively high FCI, its replacement should be planned in the 15 year time frame. This should be factored into the decision of whether to invest in adding the 8-10 bed special needs unit.  5 and 10 Year Recommendation - Jubilee Home continues with its current use; identify and procure a replacement site.  15 Year Plan - Replace Jubilee Home, locating it within a larger Community of Care concept.

3.3

Dr. Cooke Extended Care Centre (DCECC) - Original Facility

3.3.1


 The building currently houses 105 continuing care residential beds. 50 residents are located in the North Wing and 55 residents in the Central/South Wing; both resident wings are relatively self-sufficient in terms of their day-to-day living and care spaces. A Service Wing accommodates functions that support all 105 beds.  Building spaces comprise: 

49 single bedrooms with the remaining 56 beds in double occupancy rooms, all with ensuite washrooms (without showers);



Resident lounges, dining rooms, recreation/activity rooms, therapies area, hair salon, treatment room and chapel;



Other shared resident and staff facilities such as nursing stations, bathing rooms, utility and storage rooms, etc.;



A Service Wing containing shared staff and support areas including kitchen and cafeteria, supplies receiving area, laundry, maintenance, housekeeping, general storage, staff facilities, mechanical rooms, etc.; and



A main entry and administrative offices area that is part of the Service Wing.


P a g e | 33  Currently, the facility is self-supporting with respect to in-house food services, laundry, etc. The plan is to provide the laundry services for the new Lloydminster Long Term Care facility at this site.

3.3.2

Location

 3915 - 56th Avenue, Lloydminster, Alberta.  Building is sited adjacent to the Dr. James W. Hemstock Assisted Living Residence, the Hearthstone Adult Living facility and the Points West Living facility.

3.3.3

Age

 The Central/South Wing was constructed in 1968 and is now 45 years old; the North Wing and Service Wing were constructed in 1992 and are now 21 years old.  Various renovations have been done, predominantly in the newer North Wing and Service Wing, including for example: the installation of lifts in all resident rooms, new nurse call system, assisted tub replacement, new bed pan washers, new wander guard system, new dishwashing room, upgrades to the resident dining and lounge areas, etc.  Minimal renovations have occurred in the older Central/South Wing (at least in recent years) given that it is so outdated and slated for demolition once its replacement facility, the new Lloydminster Long Term Care facility opens.

3.3.4

Size

 7,645 total square metres (~82,300 square feet).  Based on a rough, not-to-scale floor plan, it is estimated that the North and Service Wings comprise approximately three-fifths and the Central/South Wing approximately two-fifths of the total building area.

3.3.5


 Group B-2, Care Occupancy classification (National Building Code).  Single-floor building with partial basement.


P a g e | 34  Concrete sub-structure with supporting steel joists and a concrete on steel floor deck; wood/ metal-framed exterior walls with brick veneer and stucco siding; wood frame roof structure; and aluminum windows and doors.  Interior finishes include: vinyl sheet flooring with areas of composite tile and ceramic tile; painted gyproc walls with handrails; acoustic tile ceilings, and wood and metal doors.  The newer North and Service Wings have a central cooling system and an automatic wet sprinkler system; all wings have a central addressable alarm system with smoke and heat detectors.  Other systems include: nurse call systems, patient wander guard systems, public address system, basic telephone and data systems, and a diesel-powered emergency generator.

3.3.6

Physical Assessment

 Current replacement value is reported to be approximately $22.13 million (VFA 2013) for the entire facility.  The entire building is reported to have a Facility Condition Index (FCI) of 0.31-0.33 (VFA 2013), with a majority of the deferred maintenance and upgrading issues specific to the older 1968 Central/South Wing. Note: Although a separate FCI for each wing was not provided, an approximate calculation estimates that the 1968 Central/South Wing has a FCI of approximately 0.53 while the North and Service Wings are approximately 0.20.  Notable upgrading requirements in the Central/South Wing include numerous elements categorized as “beyond their useful life”, i.e. heating system, distribution ductwork, water distribution system, sanitary waste system, electrical wiring, all flooring, roofing, lighting fixtures, washroom fixtures, nurse call system, television system, fire alarm system, installation of a sprinkler system and replacement of the emergency generator (serves all wings).  Notable upgrading requirements in the North and Service Wings include: replacement of the chiller, fire alarm system renewal, LAN system renewal, telephone system renewal, some flooring.  The building does not fully meet accessibility requirements for persons with disabilities, e.g. signage, barrier free public washrooms.

3.3.7


 All wings are fully occupied.


P a g e | 35  Design and layout of both the 1968 and 1992 wings reflect a dated concept of continuing care, e.g. long wings of double-loaded corridors with most of the resident social spaces and amenities clustered in the centre or at the ends.  Both the 1968 and 1992 wings were designed for a resident population that was more mobile and had a lower level of care needs. There are now many more residents in wheelchairs and in need of mechanical supports such as patient lifts, which have been installed only in the North Wing. The higher patient acuity has also had an impact on equipment and supply needs such as medical and IV supplies, pumps, etc.  Residents with dementia that are poorly accommodated in the outdated Central/South Wing will be relocating to appropriately designed facilities in the new Lloydminster Long Term Care facility.  In the 1968 Central/South Wing, the majority of residents are in multiple occupancy rooms, which significantly contravenes the current benchmark of 100% private bedrooms. The resident washrooms are very undersized and not even close to meeting accessibility requirements. Many of the other support spaces such as the resident amenities, medication rooms, utility rooms, storage, etc. are significantly smaller than acceptable standards, which can compromise resident comfort, staff functions and infection prevention and control practices.  In the 1992 North Wing, 26 of the 50 residents are in single bedrooms, which also contravene the current benchmark of 100% private bedrooms. The installation of the X-Y ceiling lifts in every bedroom/washroom has made a significant improvement in the ability of staff to provide assistance and care. Other renovations to the resident common areas have also improved the living and care environment in the North Wing, particularly addressing resident mobility and higher level of care needs.

3.3.8

Alternative Uses

 Given its unique layout and configuration, without a major renovation and costly re-purposing, the 1992 North Wing is limited mainly to its current use, i.e. a continuing care facility.  The 1968 Central/South Wing will soon be vacated when the new Lloydminster Long Term Care facility opens. Due to its 45-year old age, non-functional layout, and deteriorated condition (as reflected in the high FCI), the consideration of alternative uses is not warranted. Given the upgrading costs of all of the aforementioned building components and systems as well as bringing it up to current codes and standards, there is little if any residual value in the building. The costs of upgrading will not be much less than the cost of replacement and in the end, one is still left with an outdated design and layout that doesn’t come close to meeting best practices in continuing care.


P a g e | 36  However, the Central/South Wing occupies almost 50% of the existing DCECC site. Once the Central/South Wing is removed, the land it sits on has significant potential value given its adjacency to the remainder of the DCECC and the Dr. James W. Hemstock Assisted Living Residence, the Hearthstone Adult Living facility and the Points West Living facility. There is an opportunity to leverage the land to develop additional Community of Care beds and resources that complement what is already there.

3.3.9


 The PNRHA has committed to retaining the 50 extended care beds in the 1992 North Wing and Service Wing. Given that these wings are 21 years old and have already received substantial investment in upgrading, their continued use as a continuing care facility is warranted.  As a general observation, although the North Wing reflects a dated layout, the overall environment and interiors including the resident rooms are generally pleasant and welcoming and relatively non-institutional. Unfortunately, the same cannot be said for the much older Central/South Wing.  Also, as a longer term option, there appears to be the potential opportunity, over time, to undertake a phased redevelopment of the North Wing utilizing the vacant portion of land on the north end of the site between the two existing arms of the North Wing. The viability of this option would be confirmed in a future site development/master plan study.  The construction of the new 60-bed Lloydminster Long Term Care facility (opening in 2014) will replace the 55-bed 1968 Central/South Wing at the current DCECC site.  It is recommended that the Central/South Wing be demolished and that the PNHRA develop a plan that considers the best use of the vacated portions of the existing DCECC site, which represents a valuable opportunity even in the immediate/short term. For example, one potential option envisions the development of functions/uses (such as other levels of continuing care-supportive living beds) that complement the existing North and Service Wings, as well as the adjacent properties that include the Dr. James W. Hemstock Assisted Living Residence, the Hearthstone Adult Living facility and the Points West Living facility.  When the Central/south Wing is demolished, there is a need to relocate a small number of areas that currently also support the North and Central Wings, e.g. family space, staff amenities, conference/education space and storage.  5 Year Recommendation - Demolish the 1968 Central/South Wing and utilize the land it sits on to expand/ complement the existing surrounding Community of Care uses.


P a g e | 37  15 Year Recommendation - Examine options to redevelop and/or replace the 1992 North Wing, potentially on the existing site.

3.4

Lloydminster Long Term Care (LLTC) Facility – New Facility

3.4.1


 The new Lloydminster Long Term Care facility will be opening in early 2014 with 60 continuing care residential beds that replace the 55 beds in the 1968 Central/South Wing on the existing DCECC site and provide 5 additional beds.  The new facility also includes an Adult Day Care program planned to accommodate 10 clients.  Building spaces will comprise: 

60 single bedrooms sized to current standards and all with ensuite washrooms with showers, and state-of-the-art furnishings and equipment including ceiling-mounted lifts; and



All other required shared resident and staff facilities that make up the entire facility.

 The programming and design of the new LLTC facility is based on the Eden (Green House) concept with 10 residents per house. Each house is relatively self-sufficient with food preparation, dining and lounge facilities. Shared common facilities are located in a central ‘community services’ area such as therapies, large social/recreation space, reception and administration, etc.

3.4.2

Location

 Building is located in the more recently developed southwest sector of Lloydminster, Alberta in proximity to the Lakeland College campus.

3.4.3

Size

 Building is approximately 6,000 total square metres (~65,000 square feet).  The Lloydminster Long Term Care site is understood to include approximately 4 hectares (10 acres) of land for future building development/expansion.


P a g e | 38

3.4.4


 Group B-2, Care Occupancy classification (National Building Code).  Single-floor building with no basement.

3.4.5

Physical Assessment

 N/A

3.4.6


 N/A

3.4.7

Alternative Uses

 Given its unique layout and configuration, the new facility is limited mainly to its intended use, i.e. a continuing care facility.

3.4.8


 5, 10 and 15 Year Recommendation - No changes planned; there may be potential to increase the number of Adult Day Care clients within the planned space, i.e. up to approximately 12 or more.  At any point within the 15 year time frame (or later), there is the potential to utilize the available land to develop additional supportive living capacity adjacent to the new Lloydminster Long Term Care facility that would build upon the Community of Care concept.

3.5

Co-op Plaza

3.5.1


 The Co-op Plaza currently houses a Family Health Clinic, Specialist Clinic and a number of PNHRA functions including Public Health, Foundation, Human Resources, IT, Quality & Safety, Finance & Payroll, and other administrative services.  In addition there are a number of non-PNRHA tenants including Social Services, Child & Family Services, Mid-West Family Connections, Canadian Cancer Society and two retail outlets (hair salon and barber shop).


P a g e | 39

 In addition to the occupied clinic and office areas, the building includes a large loading dock and storage area, an unused cafeteria and portions of unoccupied space, most of which are in unfinished condition. Also, being a former retail mall, the building contains wide internal circulation spaces connecting the various entrances and tenant areas.  The building includes a partial basement (occupied by Mid-West Family Connections) and a multi-floor parking garage above.

3.5.2

Location

 4910 - 50th Street, Lloydminster, Saskatchewan.  The building is located in the downtown core of Lloydminster.

3.5.3

Age

 Estimated date of the original construction is 1979, with a complete renovation in 1987; selected portions of the building have been renovated in recent years by the PNHRA.  Public Health has been in the building for 5 years.  The Co-op Plaza is made up of multiple former retail buildings that have been combined and integrated into one facility. Construction dates of the original individual buildings are unknown.

3.5.4

Size

 8,823 total square metres (~ 95,000 square feet).  In addition there is a multi-floor parking garage above the building that totals approximately 12,000 square metres (~ 129,200 square feet).

3.5.5


 Group D - Business/Personal Services occupancy classification (National Building Code).  Single-floor building with partial basement, generally of a commercial/retail quality of construction. Much of the main floor space has a relatively high ceiling height.  Structure is concrete foundations, beams, columns and floor systems; exterior walls are stucco with aluminum windows and doors. Lloydminster Health Services Needs Assessment – Current Facility Infrastructure Assessment

P a g e | 40

 Standard retail/office grade interiors, i.e. carpet, vinyl sheet flooring, quarry tile in the open circulation areas, painted gyproc walls, acoustic tile ceilings, and wood and metal doors.  Building is sprinklered with central addressable alarm system with smoke and heat detectors.  Building contains two hydraulic passenger elevators that access the parking garage, one hydraulic passenger elevator to the basement, one freight elevator to the basement, and a wheelchair lift in Suite 101.  Since it originally was a number of separate individual buildings, the main floor levels vary throughout the facility and are connected by stairs and accessible ramps.

3.5.6

Physical Assessment

 Current replacement value is reported to be approximately $23.58 million (VFA 2013).  The building is reported to have a Facility Condition Index (FCI) of 0.17 (VFA 2013), which represents a relatively acceptable level of condition and generally signifies that the building has a reasonable life expectancy.  Notable upgrading requirements include a number of elements categorized as “beyond their useful life” such as: electrical distribution system, fluorescent lighting fixtures, 2 of the hydraulic elevators, cooling units, telephone system, and the concrete floor finish in the parking garage.

3.5.7


 The building is partially occupied, with large portions of unfinished space.  As a general observation, the areas occupied by PNRHA are functional and well developed with up-to-date services and finishes.  One observation is the lack of natural light in many of the internal office areas.

3.5.8

Alternative Uses

 The building is suitable for primary care medical/outpatient services and clinics, other community services, related education/teaching functions, administrative and office functions, certain types of commercial/retail activities, as well as a parking facility on the upper floors.


P a g e | 41  Also of note, the large loading dock and adjacent unfinished/storage areas could potentially accommodate PNRHA logistical/material handling/storage functions, some of which are currently housed in the Lloydminster Hospital.  Building is not suitable for any type of inpatient or resident care service that entails overnight stays.

3.5.9


 The current plan is to locate the Primary Health Care Clinic (PHCC) and Community Mental Health Services into portions of the unfinished space; should also consider moving Home Care, as well as other non-acute/administrative/support functions that are occupying much-needed Hospital space.  The PNRHA recommends that no additional retail functions/tenants be allowed in the building.  5, 10 and 15 Year Recommendation - Utilize the Co-op Plaza as a central downtown location for PNHRA and related primary care and community health services and other educational, administrative and support functions that do not need to be located at the acute care Hospital site.

3.6

Lloydminster Hospital

3.6.1


 The Lloydminster Hospital currently has approximately 66 acute care beds in operation, together with a range of medical, surgical, administrative and support services including diagnostic and treatment facilities.  The major program/service elements in the Hospital currently include: 

38 medical beds including 3 palliative care beds (increasing to 4).



12 surgical beds and a surgical suite containing 2 ORs.



3 special care beds (expanding to 4 ICU beds).



13 obstetrical beds with 3 LDRs and a C-Section room.


P a g e | 42  

3.6.2

Emergency services with 18 stretchers (4 are currently used by Ambulatory Care/Medical Day Care). A broad range of ambulatory care services including: day surgery (8 stretchers), endoscopy (1 procedure room), dialysis (6 stations), chemotherapy (5 spaces), medical day care, preand post-surgical clinics, cast clinic, minor outpatient procedures, etc.



Diagnostic Imaging services including: digital radiography, fluoroscopy, ultrasound, mammography, CT, and mobile MRI (on-site 1 week out of 5).



Laboratory services including: phlebotomy, specimen procurement, ECG, hematology, chemistry, transfusion medicine, microbiology and referral histology; most high volume tests are now done on site.



Other clinical support services including: therapies (physiotherapy and occupational therapy), speech language pathology, respiratory therapy, social work, pharmacy, health information services, admitting, medical devices reprocessing (MDR/CSR), and morgue/body holding.



Logistical support services including: facilities & maintenance, food & nutrition services, housekeeping and laundry (linen is processed off site), and materials management.



Other on-site services including: hospital administration, medical staff services & facilities, staff services & facilities, meeting & education services & facilities (including Telehealth), public services & facilities (including gift shop), etc.



In addition, a number of service elements that support not only the Hospital but other PNHRA programs, are located at the Co-op Plaza including: Foundation, Human Resources, IT, Quality & Safety, Finance & Payroll, etc.

Location

 3820 - 43rd Avenue, Lloydminster, Saskatchewan.  Building is sited adjacent to the CHS building.

3.6.3

Age

 The Lloydminster Hospital was constructed in 1987 and is now 26 years old; it has undergone various renovations, including most recent renovations and expansion of the main entrance, Emergency and DI areas in 2010-2012. A docking station was developed for the mobile MRI.


P a g e | 43  The site includes a number of out-buildings that generally house maintenance, emergency generator and storage functions, as well as portable unit recently added to accommodate health information services staff.

3.6.4

Size

 Approximately 10,500 total square metres (~113,000 square feet).  Total site area is 6.3 hectares (15.6 acres), with the Hospital, outbuildings and parking occupying approximately the northern half of the site and the remainder being used as playing fields.

3.6.5


 Major Occupancy is Group B-2, Care Occupancy classification, Medical-Hospital; Secondary Occupancy is Group D, Business/Professional Services (National Building Code).  The site is zoned I-Institutional, which allows uses such as extended medical treatment services and protective and emergency services.  Of particular note, the undeveloped land across 43rd Avenue is owned by Husky Oil and could provide long range future expansion opportunities for the Hospital and related services/ functions, including for example, the eventual replacement of the Jubilee Home and additional parking for the Hospital.  The Hospital is a three-floor building with partial basement and mechanical penthouse. There is an open internal courtyard on the 2nd floor.  The building has a concrete sub-structure and super-structure, utilizing concrete waffle slabs for both the floor and roof structures. Exterior walls are a masonry rain screen with insulated, steel stud internal wall.  Interior finishes and internal building systems are typical of those in an acute care hospital built in the 1980s, i.e. of a durable, institutional quality.

3.6.6

Physical Assessment

 Current replacement value is reported to be approximately $45.45 million (VFA 2013).  The building is reported to have a Facility Condition Index (FCI) of 0.26 (VFA 2013), which indicates that the building has some significant deferred maintenance and upgrading issues, Lloydminster Health Services Needs Assessment – Current Facility Infrastructure Assessment

P a g e | 44 although not necessarily at the point of replacing the building, i.e. it continues to have a reasonable life expectancy assuming the deferred maintenance needs are addressed.  One of the most critical upgrading requirements is the exterior envelope that is deteriorating and failing resulting in moisture penetration problems. This alone accounts for close to 30% of the FCI costs.  Other notable upgrading requirements in the Hospital building include the following elements categorized “beyond their useful life”, i.e. renewal of cabinets and counters, 200 Ton chiller, pneumatic DDC systems, heat exchanger and heat recovery pumps, isolation room distribution systems, emergency generator, exhaust systems, vinyl sheet flooring, and the telephone system.  Another item from the 2007 Master Plan - Building Condition Review is the finding that the structure can potentially accommodate the development of a new 4th floor for inpatient purposes noting however, that the elevators would need to be extended and upgraded and expansion of some of the building services would likely be required.

3.6.7


 The building is fully occupied with a number of areas having undergone re-purposing, e.g. former inpatient areas re-assigned to functions such as chemotherapy, day surgery, dialysis, endoscopy, IT, pharmacy, etc.; in most cases with minimal ‘make do’ renovations.  Many of the findings and priorities identified in the 2007 Master Plan - Functional Evaluation continue to be applicable, i.e.: 

No dedicated, purpose-planned Ambulatory Care space, i.e. occupying Emergency stretchers, inpatient space, etc.), which also includes undersized and poorly located chemotherapy, day surgery, dialysis space and endoscopy space.



Undersized and inadequate Surgical Suite facilities, i.e. insufficient ORs, no proper patient preparation/holding and recovery space, inadequate space for equipment and supplies, etc.



Undersized and inadequate MDR facilities, which is being compounded by the significant growth in surgical activity.



Severe shortage of single and isolation bedrooms and space for bariatric patients on the two inpatient floors, as well as space for therapy services on the inpatient units.



Lack of Psychiatry beds.


P a g e | 45 

Inappropriate use of Emergency facilities for non-Emergency functions such as Ambulatory Care, which results in space pressures in Emergency.



Shortage of space for Material Management functions, with the increasing pressure to provide on-site storage as the Hospital’s activity volumes continue to increase.



Shortage of space for clinical support services such as health information services, respiratory therapy, Telehealth, education and meetings/conferences.



Lack of space for future growth in inpatient beds, especially if they are planned to meet current best practice guidelines such as 100% single bedrooms.

 The PNRHA has explored a number of options and plans to address some of the current highest priority needs in the Hospital including, for example:

3.6.8



Expansion of the Special Care unit to a 4-bed ICU with 2 adjacent step-down beds.



Renovation of the Palliative Care beds and supporting areas (underway).



Interim redevelopment of a minor OR and Day Surgery beds on the 2nd floor, possibly expanding into the courtyard.



Conversion of 3 Obstetric bedrooms into 2 additional LDRs.



Relocation of Health Information Services and conversion of its existing space into Endoscopy.



Potential expansion of the OR’s, Recovery Room and MDR into adjacent Health Records space and former Laundry space (obviously Health Records would first need to be relocated, which may be possible if other non-essential functions can be decanted out of the Hospital).



Re-use of the old morgue.

Alternative Uses

 Given its unique layout, configuration, high level of servicing, types of finishes, etc. the Hospital is currently being put to its best use, that being an acute care hospital.


P a g e | 46  Re-purposing the Hospital for alternative uses would require costly reconfiguration and renovations. Furthermore, it should be noted that the design and layout are not conducive to potential re-use as a continuing care facility.

3.6.9


 1-5 Year Recommendation – It is suggested that the Stage 1 development proposed in the 2007 Master Plan continues to reflect what should be included in the 5 year plan. It proposes a 3-4 floor expansion of the Hospital to east-southeast (rear of the site) to accommodate the highest priority functional needs including: ambulatory care, chemotherapy, day surgery, dialysis, endoscopy, surgical suite, MDR, pharmacy, emergency and possibly other related functions.  5-10 Year Recommendation - Once the Stage 1 expansion is complete and occupied, the vacated space on floors 2 and 3 of the existing building can be renovated and re-claimed as inpatient space, both to address current deficiencies such as the shortage of single and isolation bedrooms, and to provide additional inpatient beds as recommended in the Service Plan. The vacated main floor space can also be renovated and re-assigned to meet future growth needs in DI, laboratory, allied health services, etc.  10-15 Year Recommendation- The 2007 Master Plan identified options for further expansion depending upon how future needs evolve. Options are to design the Stage 1 expansion with shell space, the ability to expand upwards, or to expand outwards. Regardless, prudent, sustainable and flexible planning suggests that the Stage 1 expansion be planned and designed to incorporate the eventual replacement of the Hospital in subsequent phase(s).  Adding a 4th floor to the existing building is not recommended for reasons such as: adding a new floor to a 26 year old building is generally not cost effective; the layout would be constrained by the existing structural dimensions; it would require costly changes to existing elements such as elevators, stairs and building services; it would cause major noise, vibration and disruptions to ongoing operations, e.g. it would likely be necessary to close the 3rd floor for an extended period of time.  It should be noted that given the significant costs entailed in expanding and upgrading the existing facility, the 2007 Master Plan considered the option of fully replacing the Hospital. At that time, it was assumed that the replacement facility could be constructed on the existing site. The full replacement option may continue to warrant consideration, estimating that it could entail a capital cost in the order of $350-$400 million.


P a g e | 47

3.7

Other Non-PNHRA Facilities

3.7.1

Pioneer Lodge

Primary Function/Use  The building currently houses 139 residents in 138 private room accommodations. The most recent expansion occurred three years ago.  The Pioneer Lodge operates under the Housing Act and has no on-site nursing staff. The Lodge mandate is to serve low to medium income residents.  Currently, the facility is self-supporting with respect to in-house food services, laundry, etc. Location  5722 - 50th Street, Lloydminster, Alberta.

3.7.2

Points West Living

Primary Function/Use  Opened in 2008, the building provides independent and supportive living with 60 apartments that can house up to 65 residents, i.e. 55 studios (33 suites with kitchenette facilities and 22 suites without) and 5 one-bedroom suites for couples. It also includes one guest suite.  The facility is based on the Eden Model of Seniors Care with cottages containing 12 apartments.  The facility is described as being barrier free, easy to navigate, and equipped with state-of-theart technology and safety features, including accessible showers in each resident en-suite bathroom. Location  4025 - 56th Avenue, Lloydminster, Alberta.

3.7.3

Dr. James W. Hemstock Assisted Living Residence

Primary Function/Use  Opened in 2000, the building contains 62 assisted living apartments ranging in size from smaller bachelor units up to two bedroom suites. Community amenity space makes up 40% of the Lloydminster Health Services Needs Assessment – Current Facility Infrastructure Assessment

P a g e | 48 ground floor and includes a large community dining hall, an activity room, social lounge with library, a country kitchen and a chapel.  Each apartment has a personalized entrance with apartment number and name. All apartments have a kitchenette. Each bathroom has either a bathtub with shower or walk in shower with seat. Location  4202 - 54th Avenue, Lloydminster, Alberta.

3.7.4

Hearthstone Place - Independent Living

Primary Function/Use  The building contains 67 independent living apartments ranging in size from 650 square feet to 1850 square feet (16 different floor plans). All apartments include a full kitchen with dining area.  The service package includes bi-weekly light housekeeping, ten meals per month in the dining room and unlimited use of all common amenities.  On-site amenities include a chapel, a beauty salon with hairdresser, manicures and pedicures, tuck shop, a games room and library, a fitness centre and a café. Location  4202 - 54th Avenue, Lloydminster, Alberta.


P a g e | 49

SECTION 4: HEALTH SERVICES ASSESSMENT A. Primary and Community Care Services B. Continuing Care Services C. Acute Care Services

Lloydminster Health Services Needs Assessment

P a g e | 50

4.0

HEALTH SERVICES ASSESSMENT

4.0.1

Triple Aim Framework

In developing the service plan a strong focus was maintained throughout on optimizing health system performance and improving the client/patient journey through the application of the Triple Aim Framework, an approach which is embraced by both provincial ministries. The three key dimensions of the Framework include:  Improving the patient experience of care (including quality and satisfaction);  Improving the health of populations; and  Reducing the per capita cost of health care.

4.0.2

Organization of the Assessment

The Health Services Assessment is organized under three main inter-related program groupings to reflect the current program leadership structure in the PNRHA. These groupings are:  Primary and Community Care Services – including primary health care, community mental health and addiction services, public health, community rehabilitation services and population health.  Continuing Care Services – including long term care, supportive living, palliative, respite, senior’s health, convalescent care and home care services.  Acute Care Services – including community hospital services, specialty medicine and surgical services, emergency services, in-patient mental health services, ambulatory services and clinical support services. Specific health service capacity building priorities for each of these areas - primary and community care, continuing care and acute care - are identified. Key results to be achieved, strategies and related performance measures for each of these program areas are recommended. In addition, the facility development implications for each major program area are detailed. Emphasis is also placed on identifying opportunities to streamline and improve work processes and implement proven innovative approaches to service delivery that improve service quality and costeffectiveness. It is recognized that there are strong inter-dependencies across all of three service groupings. In addition there are some strategies that apply to all three areas that are identified in each of the areas.


P a g e | 51 However, it was felt that the document would be more useful to management and staff if priorities, results to be achieved and strategies were aligned with PNRHA’s program leadership structure and each could be used as a stand-alone planning document.


P a g e | 52

A.

PRIMARY AND COMMUNITY HEALTH SERVICES ASSESSMENT

Lloydminster Health Services Needs Assessment – Primary and Community Health Services

P a g e | 53

4.1

Primary and Community Care Service Priorities

The PNRHA Primary and Community Health Services portfolio includes primary health care, mental health and addictions services, public health, and population health. The highest capacity building priorities identified included the following:  24/7 Primary Care Access: Improve access to 24/7 primary health care services.  Mental Health and Addiction: Improve access to mental health and addiction services.  Chronic Disease: Enhance chronic disease prevention and management services.  Rehabilitation: Improve access to rehabilitation services.  Maternal-Child Health: Enhance maternal and early childhood development services.  Health Promotion and Prevention: Increase focus on health promotion, disease and injury prevention.  Sexual Health and Harm Reduction: Increase focus on sexual health and harm reduction.  Education: Develop Lloydminster as a teaching centre for family physicians and other primary health care providers. The next section of the plan provides context and rational, details the key results, performance measures and recommended strategies for each of these priorities.

4.1.1

Priority 1: Improve Access to 24/7 Primary Health Care

Context and Rationale Family Physicians: Over the past two years substantial progress has been made in the Lloydminster service area to improve access to family physicians and reduce the pressure on the Emergency Department (ED). In 2011, 40% of all patients presenting at the ED did not have a family physician and 80% of all cases were Canadian Triage and Acuity Scale (CTAS) 4 or 5. Focused recruitment efforts and the provision of a turn-key clinic and other supports required to attract and retain physicians have resulted in the number of family physicians increasing from 19.38 to 27.0. As a result, the most recent data report shows that 20% to 25% of residents did not have a regular medical doctor, a reduction from the 2011 figure. This increased access to regular medical care is reflected in a decline in the percentage of people presenting at the ED with CTAS 4 or 5 scores from 80% to 60%.


P a g e | 54 While substantial progress has been made, the number of family physicians is still below the provincial averages for both Alberta and Saskatchewan. There remains an immediate need to recruit 6 FTE additional family physicians to bring these numbers in line with provincial norms. In addition future recruitment efforts will need to address increased demands as a result of the rapidly growing population and the retirement of family physicians. Other Health Care Professionals: In addition to challenges recruiting family physicians, the PNRHA has experienced significant recruitment challenges for a range of other primary health care professionals – the most significant being physiotherapy, occupational therapy, speech and audiology, respiratory therapy, mental health and addictions professionals, and specialized nursing. These recruitment challenges are compounded by jurisdictional differences between Alberta and Saskatchewan relating to certification, compensation and professional standards. In several instances funded positions have gone unfilled. Primary Health Care: Significant opportunity exists to build upon work being done in Alberta and Saskatchewan to develop primary care centres, primary care and family care clinics. These structures represent significant opportunities to transform the way primary health care services are delivered, improve access and service coordination, and optimize the use of human and fiscal resources. The development of a primary health care centre that would provide seamless services to both Alberta and Saskatchewan residents should be a high priority. Figure 13: Improve Access to 24/7 Primary Health Care

Improve Access to 24/7 Primary Health Care Key Result 

Primary health care services will be integrated and seamlessly delivered across the Lloydminster service area.

Performance Measures  Client levels of satisfaction with access to primary care service. 







Residents will have timely access to the primary health care services they need, including after-hours care. The service area will attract and retain the family physicians and other health care professionals required to deliver quality primary health care services. Residents will be better informed about how and where to access primary health care services.

Levels of staff satisfaction levels with service coordination and inter-disciplinary team effectiveness.

 Physician and other health care professional recruitment targets met. 

Percent of clinic cancellations and wait times for selected services (targets 5% annual improvement).

 Levels of service provider awareness and use of HealthLine Online, HealthLine or HealthLink.


P a g e | 55 Improve Access to 24/7 Primary Health Care Key Result

Performance Measures



Residents will have 24/7 access to consistent and accurate health information and advice.



Percent increase in the number of persons receiving services from HealthLine or HealthLink.



Physicians and health care staff will have improved access to required clinical information.



Year over year changes in ED CTAS scores



There will be improved coordination of Onion Lake and PNRHA primary care services.

Recommended Strategies A.1 Primary Health Care Service Integration: Organize and deliver primary health care services for the Lloydminster service area in a seamless integrated manner for both Alberta and Saskatchewan residents. This will involve working in partnership with residents, the PCN, AHS and PNRHA to enable the provision of contemporary, interdisciplinary care focused on improving access and quality of service for local residents within the context of provincial health priorities. This should include: 1.1 Client Voice: Ensuring effective processes and mechanisms are in place to engage patients and their families in service planning and providing feedback on the effectiveness of services. 1.2 Vision: Reviewing and confirming the vision for primary care for the Lloydminster area. 1.3 Operating Principles: Establishing the operating principles and major objectives for the program consistent with Alberta and Saskatchewan primary health care policy directions. 1.4 Service Focus: Establishing the service focus/priorities. 1.5 Management Structure: Establishing the management and decision-making structures required to support integrated service delivery. 1.6 Innovative Service Delivery Options: Utilizing a range of innovative service delivery options including: 1.6.1

Primary Health Care Centre: Developing a primary health care centre to capitalize on opportunities presented by Alberta and Saskatchewan government primary care initiatives.

1.6.2

TeleHealth: Expanding Tele-Health services.


P a g e | 56 Improve Access to 24/7 Primary Health Care Key Result 1.6.3

1.6.4


Remote Monitoring: Implementing remote monitoring services for chronic disease management; e.g. My Health Point. Collaborative Practice: Further developing and implementing the Collaborative Practice Model as an integral part of the primary health care service delivery framework.

1.7 Staffing Plans: Developing and implementing the staffing plan to support required service delivery in response to residents’ service needs. 1.8 Facility Development: Establish facility and space requirements based upon proposed programs and service delivery framework. A.2 Expand After-hours Care Options: Improve access to after-hours primary health care services. 2.1 Expanded Hours of Operation: Continue efforts to improve access to after-hours care; e.g., expanded clinic hours of operation, staggered clinic hours of operation, etc. 2.2 HealthLine, HealthLine Online and HealthLink: Continue to educate clients and health service providers about Saskatchewan’s HealthLine and HealthLine Online, and Alberta’s HealthLink. A.3 Primary Care Recruitment and Retention: Continue to implement the family physician and other health professions recruitment and retention strategy including both short-term and longer-term objectives. 3.1 Physician Resources Plan: Continue efforts to recruit family physicians to the Lloydminster area to address immediate as well as longer term requirements. (Immediate needs - 6-8 additional family physicians; longer term needs – additional 10-12 family physicians). 3.2 Other Health Care Staff: Implement recruitment and redeployment strategies for other required health care professionals. (Focus initially on filling vacant positions in high priority areas – PT, OT, RT, specialized nursing, mental health and addictions workers. A.4 Onion Lake Primary Health Care Collaboration: Work closely with Onion Lake to harmonize and coordinate the delivery of primary care services through enhanced sharing of resources and expertise while recognizing and respecting that control of health services delivered on reserve resides with the Band. Areas where service harmonization and coordination would add significant value for both Onion Lake and the PNRHA include:


P a g e | 57 Improve Access to 24/7 Primary Health Care Key Result


4.1 Short-term Support: Collaborate with the Onion Lake Primary Health Care Centre to support short-term strategies to mitigate challenges associated with the recent retirement of their family physician and maintain primary care centre operations at Onion Lake. 4.2 Technology and Information Sharing: Improve access to information technology and data management – Med Access. 4.3 Tele-health Consultation Support: Develop tele-health infrastructure and capacity, including improved ability for Onion Lake PHCC health professionals to access consultation support from Lloydminster Regional Hospital (LRH) Emergency Department and other specialists. 4.4 Hour Observation Beds: Support 24-hour observation beds at the Onion Lake Centre and use linkages to LRH Emergency Department to support effective triage; i.e., Onion Lake should be able to deal effectively with 4 and 5 CTAS scores and transport 1, 2, and 3 CTAS scores to LRH. 4.5 Discharge Planning: Improve discharge planning to enhance transitions and early discharge from LRH back to the PHCC at Onion Lake. 4.6 EMS: Provide LRH Emergency Department support to the Onion Lake EMS service with a view to ensuring treat and release and/or appropriate triage. 4.7 Education and Training: Develop training and educational opportunities/programs for AHS, PNRHA and Onion lake staff.

4.1.2

Priority 2: Mental Health and Addiction: Improve Access to Mental Health and Addiction Services

Context and Rationale Access to mental health and addictions services was identified by community and internal stakeholders as one of the most significant service gaps for residents in the Lloydminster area. This is evidenced by limited service capacity, escalating service demands, limited hours of access and a shortage of appropriately trained mental health professionals. Currently there are no inpatient psychiatric beds or 24 hour holding beds at the Lloydminster Hospital for mental health clients. Four psychiatrists operate private clinics in Lloydminster, one of whom has a strong focus on providing services for children. All psychiatrists reported very heavy caseloads – in excess of 3000 clients each.


P a g e | 58 On-call psychiatric consultation services are not available to the hospital. Given this lack of access to psychiatry call services, family physicians rely heavily on personnel from the Community Counseling Centre to provide mental health support and advice when clients present at the emergency room with serious mental health issues. Some access to addictions and detox services is provided for residents through a contract with Slim Thrope; however the cost of these contracted services has placed significant restraints on access. Both Alberta and Saskatchewan have identified addictions and mental health services as a high priority, and both governments have clearly articulated policy positions in this area. These provincial policies informed the development of this section of the report, and the key results and strategies proposed are closely aligned with these policy directions. Figure 14: Improve Access to Mental Health and Addictions Services

Improve Access to Mental Health and Addictions Services Key Results




Residents of Lloydminster and surrounding area will have improved access to emergency and acute mental health services.



Mental health and addictions services will be client and family focused and delivered in a coordinated and seamless manner.



Patients, clients and those defined as family will be partners in meeting their addiction and mental health care needs.



New mothers receiving pre and post-natal services are screened for mental health and/or addiction issues.



CDM, post-natal and addictions screening.



Levels of staff satisfaction with the quality and timeliness of training.





Screening processes in high-risk and targeted groups for addiction and mental health will be implemented within the primary care environment.



There will be improved access to mental health services in the Emergency Department.



Access to addiction and mental health care in the primary care setting will be enabled by partners, such as nutritionists, pharmacists and school staff and delivered by primary care providers including, physicians, other



Evidence of effective management of mental health clients in crisis.



Referral wait times from first visit for patients presenting in ER with a mental health issue. Measures of client/family satisfaction with access to mental health and addictions services.


P a g e | 59 Improve Access to Mental Health and Addictions Services professionals, and in some cases peer support groups.

Strategies A.5 In-patient Mental Health Beds: Establish a 12 in-patient psychiatric bed unit at the Lloydminster hospital supported by the required professional staff. A.6 Emergency Services: Improve access to psychiatric on-call services to support the Emergency Department; and continue to include mental health responders as part of the emergency room team at the Lloydminster Hospital. A.7 Screening, Detection and Intervention: Enhance early screening, detection and intervention mechanisms and processes with a specific focus on depression and maternal mental health needs. Complete pilot of the David Brown Model. A.8 Client Self-Management: Enhance the ability for client self-management by: building on resource lists available through Access Addiction, Mental Health Calgary, and Healthlink; increasing public awareness of addiction and mental health issues and services available; and creating a selfmanagement care Web portal for clients and patients. A.9 Shared Care Model: Effectively implement a Shared Care Model for mental health that combines the efforts of family physicians, psychiatrists, and mental health clinicians, working together to support patients as they move towards improved mental health. Key elements should include: 

A strong focus on meeting the needs of clients and their families as the primary purpose of the program;



Effective implementation and utilization of an integrated inter-disciplinary case management team model;



Active participation and engagement of psychiatrists and family physicians as part of the care team;



Engagement of clients and families as part of the case planning and management team; and



Utilization of available Primary Health Care Centre resources and processes to support care delivery.

A.10 Care Pathways: Acquire and implement care pathways to provide a more coordinated approach to detection and management of mental health services. A.11 Awareness and Understanding: Improve the level of understanding of addiction and mental health and illness amongst primary care providers and other providers within the primary healthcare environment. Address stigma issues amongst providers and increase their knowledge of how, when and where to access services appropriately.


P a g e | 60 Improve Access to Mental Health and Addictions Services A.12 Addictions Services: Work collaboratively with key partners to develop and implement a comprehensive addictions services plan designed to proactively address the following priorities: 12.1 Crisis management/intervention service; 12.2 Improved assessment and triage services – ED, Police, EMS, etc.; 12.3 Improved access to acute detox and treatment services; e.g., adequate funding to access services from Slim Thorpe; 12.4 Improved access to outpatient addictions services; and 12.5 Addictions education and prevention services. A.13 Communication: Ensure effective public and provider education and communications; e.g., consistent messaging; established clinical pathways; family supports and education; etc.

4.1.3

Priority 3: Chronic Disease: Enhance Chronic Disease Prevention and Management Services

Context and Rationale Chronic conditions are a major cause of health care utilization. For example, 30% of patients with chronic conditions are responsible for approximately 60% of costs to the health system. With appropriate support, the majority of chronic diseases can be managed effectively at a primary care level; and primary care, through health promotion, disease prevention, screening, and other upstream activities, can prevent or minimize the impact of chronic disease. Figure 15: Enhance Chronic Disease Prevention and Management Services

Enhance Chronic Disease Prevention and Management Services Key Results 

The life experience will be enhanced for patients/families living with and managing a chronic disease/condition.



Clients/patients will have a greater sense of influence and involvement in their care.

Performance Measures 

Population health statistics related to Chronic Disease (CD).



AIM and CPR performance metrics relating to chronic disease management.



Percent of clients with a CD that are being appropriately referred to specialist resources.


P a g e | 61 Enhance Chronic Disease Prevention and Management Services 



Effective prevention and management of chronic disease will reduce the pressure on the acute care system and help constrain health care costs. An integrated approach to service delivery supported by the collaborative practice model will be utilized.



Referral and feedback mechanism in place to support client interaction with the system, specifically in relation to flow of clients between providers and flow of information between providers.



Percent of clients diagnosed with a CD that are effectively managing their condition.



Demands on acute care and unscheduled primary care visits for CD clients.

Strategies A.14 Health Promotion: Maintain a strong focus on programs and initiatives that contribute to improved population health; e.g., providing public and provider education programs; influencing/advocating to support enlightened legislation and policy, joint planning with the City to encourage healthy lifestyles, and other initiatives that positively impact the determinants of health. A.15 Prevention: Enhance health promotion and injury prevention activities; e.g., workplace safety, accident prevention, farm safety, etc. A.16 Self-Management: Continue the strong focus on supporting and enhancing self-managed care for clients with chronic diseases. A.17 Education and Communication: Continue the strong focus on enhancing provider and patient education concerning the treatment and management of chronic diseases. A.18 CDM Focus: Maintain a strong focus on meeting the needs of clients with the following chronic conditions: diabetes, obesity, hypertension and COPD including pulmonary rehabilitation and cardiovascular disease/stroke rehabilitation. A.19 Innovative Practices: Utilize a range of innovative practices to improve the quality and cost effectiveness of service delivery - shared medical appointments, web based education and Point of Care services; e.g. MyHealthpoint.


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4.1.4

Priority 4: Rehabilitation: Improve Access to Rehabilitation Services

Context and Rationale There is significant unmet demand for rehabilitation services in the Lloydminster area. The major factor contributing to this capacity issue is the inability to recruit professional staff in a range of therapy areas (OT, PT, RT, Speech and Audiology). Access to rehabilitation services is required to effectively prevent and/or manage chronic conditions and maintain quality of life. These services help to prevent or delay the need to access acute care, and take pressure off the acute care system by enabling early discharge into the community for those in an acute care setting. Figure 16: Improve Access to Rehabilitation Services

Improve Access to Rehabilitation Services Key Results


Rehabilitation support for core programs (CDM, stroke rehab, orthopaedics) will reduce acute care wait times and improve outcomes for clients.



Evidence of successful recruitment of professional resources.



Time from client referral to service.



Clients will have prompt access to required rehabilitation services in primary care settings.



Reductions in admissions to acute care services.

 

The hospital will have access to adequate rehabilitation capacity to facilitate timely discharge into community settings.

Increased number of people accessing rehabilitation services.



Strategies A.20 Enhance Community Rehabilitation Services: Increase the capacity to access rehabilitation services in primary health care centres/settings to prevent and/or effectively manage injuries and CD. A.21 Acute Care: Build capacity within acute care settings to better support transition to community settings. A.22 Rehabilitation Resources: Recruit and retain rehabilitation services professionals required to support chronic disease prevention and management and early discharge from acute care settings. Areas of focus should be Physiotherapy, Occupational Therapy, Speech and Audiology Therapy, Respiratory Therapy, and Early Childhood Psychology.


P a g e | 63 Improve Access to Rehabilitation Services Key Results


A.23 Service Alignment: Partner with private providers and other agencies to make available a more comprehensive range of rehabilitation services. A.24 Early Intervention: Provide early access to rehabilitation services to prevent or delay the need for more acute or chronic services.

4.1.5

Priority 5: Sexual Health and Harm Reduction

Context and Rationale Lloydminster is a young and rapidly growing community with a fairly significant transient workforce. The annual number of births at the hospital is approximately 1,000; there are significant levels of teen pregnancy; and there is a growing incidence of STIs and HIV in the service area. There is a need to provide residents with the tools to build and support family planning and healthy relationships and lifestyles. Figure 17: Sexual Health and Hard Reduction

Sexual Health and Harm Reduction Key Results 

Junior and senior high school aged students will demonstrate increased awareness and knowledge regarding sexual health.



There will be a reduction in the rate of sexually transmitted infections.



There will be increased access to STI screening, detection and effective treatment.


Year over year percent changes in the rate of STIs in the targeted populations.



Evaluation results of the Needle Exchange Program.



Evidence of effective industry/health authority partnerships contributing to workforce health.



Year over year changes in teen pregnancy rates.


P a g e | 64 Strategies A.25 School and Community-based Programs: Enhance school and community-based sex education and prevention programs focusing on junior and senior high school students. Ensure public health nurses and other sexual health professionals have direct linkage with schools to support sexual health programs. A.26 Communications: Explore and develop the means to more effectively use social media as education and communication vehicles. A.27 Screening, Detection, Treatment and Follow-up: Enhance early screening, detection, treatment and follow-up to address issues related to increased levels of HIV and STIs. This should include developing outreach services to reach “hard to serve” clients, and integrating services into the PHCC environment to reduce stigma and help ensure continuity of care. A.28 Industry Partnerships: Explore opportunities to partner with community agencies, industry and business to improve the health of the workforce. This could include drug screening programs, educational programs, health and wellness forums; provision of information in local bars, etc. A.29 Harm Reduction Programs: Develop and implement harm reduction programs and services consistent with PNRHA priorities.

4.1.6

Priority 6: Maternal and Early Childhood Development

Context and Rationale Early identification and remediation of developmental issues and delays has a very positive impact on the quality of life and reduces costs to the health system. Coordinating the work of physicians, nutritionists, public health nurses and others in support of maternal-child health is fundamental to optimizing resources and results. Figure 18: Maternal and Early Childhood Development

Maternal and Early Childhood Development Key Results 



Effective screening processes will result in timely identification and remediation of developmental challenges. There will be reduced numbers of children identified with developmental delays during the initial pre-kindergarten assessment conducted by the schools.


Immunization rates.



Changes in the number of pre-kindergarten children with developmental delays.



Evidence of effective alignment of public health nursing and PHCC services.


P a g e | 65 Maternal and Early Childhood Development Key Results 


Residents will have access to timely high quality maternal/child education and support services.

 Client satisfaction with access to and quality of services.

Strategies A.30 Prenatal and Post-natal Screening: Standardize prenatal and post-natal screening based on informed practice, including the timing, assessment tools, responsibilities, and timelines to ensure timely identification and remediation of developmental issues, and to provide surveillance. A.31 Pre-school Partnerships: Work in partnership with the pre-school system and other community stakeholders to identify students entering kindergarten with developmental delays and develop and implement remediation plans targeted to individual children’s needs. (e.g., Early Childhood Development Mapping Strategy, etc.). A.32 Service Alignment: Align public health nursing with other primary care services to support more effective screening, early intervention and timely referral. A.33 Immunization: Improve children’s immunization rates. A.34 Onion Lake: Work with Onion Lake PHCC to support maternal and early childhood screening, identification, intervention and ongoing support programs/services on and off reserve. A.35 Maternal /Child Education: Enhance access to information and education through the use of a range of appropriate vehicles/channels. A.35 Targeted Support for Mothers/Children: Provide targeted supports for mothers and children based on identified needs; e.g., lactation support, parent support program, therapies, mental health, etc. A.36 Child Friendly Communities: Support the development of child friendly/healthy communities; e.g., child care facility reviews, training for staff, etc.

4.1.7

Priority 7: Health Promotion, Disease and Injury Prevention

Context and Rationale Timely investments in health promotion and disease and injury prevention reduce the pressure on the health care system and contribute to improved population health and quality of life. Aligning the


P a g e | 66 health region’s health promotion and disease and injury prevention programs with the PHCC should help focus energy and resources to the optimal benefit of residents. Figure 19: Health Promotion, Disease and Injury Prevention

Health Promotion, Disease and Injury Prevention Key Results 






High priority population health issues will be identified and targeted programs to address these needs will be developed and implemented.



Year over year changes in health status indicators for the region.



Injury rate statistics.

The PHCC will include a strong focus on health promotion and disease and injury prevention.



Evidence of successful industry partnerships to promote workplace safety.



Percent of 65+ population immunized against influenza/public health data.



Routine screening for maternal depression (pre and post natal), elderly and those with chronic disease/clinic data, chart review, CDM data.



% of clients who smoke and who received a “brief intervention”/chart reviews.

Effective screening processes will facilitate early detection and treatment

Strategies A.37 Health Status Improvement Priorities: Develop and implement evidence-informed strategies to address the priority health issues and social determinants of health using insights from the most recent Health Status Report. Data suggests the following as potential areas of focus: 37.1 Children’s Nutrition: Nutritional status of children, especially in populations most at risk for ill health; 37.2 Active Lifestyles: Programs to encourage physical activity and active life styles; 37.3 CDM Prevention: Chronic disease prevention; and 37.3 Mental Health: Mental health and well-being; 37.4 Addictions: Substance abuse prevention;


P a g e | 67 Health Promotion, Disease and Injury Prevention 37.6 Injury Prevention: Injury prevention including falls prevention, workplace safety, car seat and bike safety, and farm safety. Specific health status improvement tactics could include activities such as: 

Mapping assets/resources currently available in the community to support coordinated service delivery;



Partnering with the community to promote active lifestyles; e.g., the Lloydminster In-motion Initiative;



Implementing The Lloydminster Drug Strategy Committee initiatives;



Developing and implementing Youth programming relating to substance abuse;



Partnering with industry on workplace safety initiatives; and



Developing and implementing a Fall Prevention Strategy targeted at senior members of the community and their families; and farm safety programs.

A.38 Screening and Early Detection: Improve the percentage of the population who are screened and who receive appropriate follow-up: pap tests, breast exams, colorectal screening, smoking cessation support, obesity screening (based upon risk factors), and others as identified.

4.1.8

Priority 8: Education: Develop Lloydminster as a Teaching Centre for Family Physicians and other Primary Health Care Providers

Context and Rationale There is a recognized shortage of family physicians in both Alberta and Saskatchewan. This has resulted in significantly increased numbers of spaces dedicated to training family physicians; and a concurrent need for faculties of medicine to have increased access to field placements. These factors, combined with the focus that both provinces are placing on using a distributed learning approach, which includes increased opportunities to train in smaller urban and rural communities, provides a unique opportunity for Lloydminster to actively participate in servicing this demand. In addition, establishing Lloydminster as a teaching centre for other health care professionals with specialized skills will support more effective recruitment and retention in key areas such as the


P a g e | 68 therapies, mental health and addictions, diagnostic imaging technicians, nurse practitioners, specialized nursing, etc. Lloydminster would be an ideal training site to provide the volume and scope of clinical teaching experiences required to support high quality education programs; e.g., a large number of deliveries (over 1,000 annually), specialist support in the ED, Obs. & Gyn., G.S., G.I.M. Psychiatry; and a primary health care delivery model that is focused providing contemporary, inter-disciplinary care. In addition, the proximity of the Onion Lake Primary Health Care Centre provides a First Nations and cross-cultural training environment that reflects the current and growing needs of both provinces. There are also opportunities to link, align and integrate with existing colleges such as Lakeland College which has existing health sciences programs, significant learning infrastructure and is located in Lloydminster. Figure 20: Develop Lloydminster as a Teaching Centre

Develop Lloydminster as a Teaching Centre Key Results 






Community Services will maintain a culture where continuous learning and improvement are high priorities. The mechanisms, processes and infrastructure required to support the teaching mission will be in place. The range and quality of programs and services will contribute positively to ability to recruit and retain physicians and other health care professionals.



Levels of staff satisfaction with positioning as a learning organization.



Demonstrated success at providing residency rotations for family physicians.



Demonstrated success at providing field placements for other health care disciplines.



Evidence of successful operation of the “Grow Your Own” program.

Strategies A.39 Learning Culture: Create and maintain a learning culture where value is placed on continuous learning and improvement. This should include: 

Processes to ensure priorities are clearly defined and used to focus energy and resources;



Expectations for people joining the organization are clearly articulated and communicated as part of the recruitment process;



A strong focus on achieving clear outcomes and willingness to build on strengths and deal effectively with issues and problems;


P a g e | 69

Strategies 

Mechanisms to ensure achievements and contributions are recognized;



Effective use of clinical guidelines and care pathways to ensure best practices are being employed;



Information and knowledge sharing; including sharing of results and outcomes with a view to learning from each other’s practice areas;



Emphasis on implementing best practices as cited in professional literature;



Use of peer reviews/professional development rounds as teaching tools;



Ensuring the infrastructure is in place to support teaching, research and continuous improvement;



Encouraging applied research and pilot projects;



Ensuring access to technology required to support quality care; e.g., EMR (Med Access);



Maintaining a strong focus on quality assurance and improvement; and



Maintaining a strong focus on professional development aligned with program priorities; e.g., professional growth plans, practice development communities, etc.

A.40 Family Physician Education: Establish Lloydminster as a location that takes on family practice residents and medical students on both longer-term and shorter-term rotations. This will include: 

Building partnerships with educational institutions;



Attracting physicians with the ability and desire to teach;



Researching program requirements from the Faculties of Medicine;



Building support from our family physician community;



Providing locations at the other primary health care centres/clinics in Lloydminster for clinical rotations;



Providing supports for students – housing, vehicle access, and other supports; and



Accessing RPAP supports.


P a g e | 70

Strategies A.41 Establish Family Medicine Training Focus and Required Supports: The opportunity exists for Lloydminster to provide a range of family practice placement needs including: 

Family Medicine residents who need exposure to specialist rotations; e.g., Obstetrics, General Surgery;



Family Medicine first and second years rotations; clerkships/JURSI nine month rotations; and



First Nations trainees. This will require the following supports and infrastructure:



Accreditation requirements such as CCFP preceptor must be met;



Clinical facilities to see patients must be available. (Similar space requirements as for a family physician for second year residents; and half the space requirements for first year; and expanded clinic/exam rooms for other learners);



Access to electronic health records;



In-examination room video capacity for teaching;



Web-based capacity to support distance learning;



Simulation lab (potential exists to share with Lakeland College); and



A strong program coordination function to enable joint programming while recognizing that different students may be sponsored by different universities.

A.42 Other Health Care Workers Education Priorities: Provide practicums/learning opportunities for selected high priority areas where we have staff with the appropriate credentials by building upon existing relationships and creating new relationships with educational institutions. Areas of specific focus should include: 

Nurse Practitioners, Registered Nurses, Licensed Practical Nurses, Emergency Medical Technicians and Health Care Aides in partnerships with Lakeland College and other post-secondary institutions;



All therapies – design program so a student can get the full range of placements they require at PNRHA;



Mental Health Professionals and Social Workers;



Laboratory and Diagnostic Imaging Technologists; and


P a g e | 71

Strategies 

Medical Office Assistants.

A.43 Supports and Incentives: Provide supports and incentives for students doing field placements and practicums; e.g., 

Develop a mentorship program;



Provide Web-based learning supports for students and staff;



Provide summer jobs for senior assists – between third and fourth year with the promise of fulltime employment upon graduation;



Provide housing and other supports for students ( e.g. utilize Lakeland College residence facilities);



Provide a collaborative team environment that is attractive to students and employees;



Provide inter-professional learning opportunities that include both employees and staff; and



Develop networks and partnerships that facilitate collaboration in school and other settings.

A.44 Grow Your Own Program: Develop home grown solutions to support the training of health care workers, ensuring alignment with the human resources plan. This could be patterned after the Careers the Next Generation model and include: 

Industry sponsorship – business support for program development or bursaries;



Health career awareness in schools and online (NextGen Online);



Partnerships with public and post-secondary educational institutions – Camrose model/Lakeland College;



Bringing in a cohort of people into the organization at a young age – similar to the “Raise Your Own Program” in Alaska;



Support from Health Foundation – bursaries and scholarship program.


P a g e | 72

4.1.9

Facility Implications – Primary and Community Health Services

Existing Situation The PNRHA Community Health Services in Lloydminster are presently situated in two main locations:  Lloydminster Community Health Services (CHS) Building - Mental Health and Addictions Services (and Home Care).  Co-op Plaza Building - Public Health, Population Health, Primary Health. A number of other community and primary health care services are also located in Co-op Plaza including: Family Health Clinic, Specialist Clinic, Social Services, and Child and Family Services. In addition, there is the Prairie North Health Centre After-Hours Clinic (opened in April 2012) that houses a number of Lloydminster family physicians and operates 4-8 p.m. Monday to Thursday. It is located at 4806 50th Street in Lloydminster. Facility Development Requirements The facility implications of the Program Priorities and Recommended Strategies identified for Primary and Community Health Services earlier in this section are as follows (numbered according to the Recommended Strategies). All estimated capital costs are in current dollars. Phase 1 – Years 0 – 5 A.1

Develop the Primary Health Care Centre (PHCC): Complete the planning, design and construction of a new primary health care centre located in the Co-op Plaza building. The planning and design work on this capital project is already underway. Pending funding and approvals, the new PHCC could be completed and open within approximately one year. Key aspects of this project include:  Vacant unfinished space is currently available in Co-op Plaza to accommodate the PHCC.  The scope of the interdisciplinary PHCC, which continues to be developed, is expected initially to include 5-6 family physicians plus other health care professionals, with the ability to expand to 10.  A major service goal is to improve access to after-hours primary health care services.  The PHCC will co-locate primary health care services and providers in a patient-focused service model that ‘brings the services to the patient’, i.e. the concept of the patient at the


P a g e | 73 centre of an interdisciplinary and collaborative team. Furthermore, the service model also extends outwards into the community and region with the PHCC serving as a platform for enhanced outreach services.  In addition to housing the ‘typical’ day-to-day clinical activities, the PHCC should also focus on providing facilities to accommodate both a collaborative practice model as well as the teaching of family physicians and other primary health care providers. This includes for example, larger clinic rooms to include multiple providers and/or learners, breakout spaces for collaboration and for ‘teaching moments’, touch down workstations for visiting health care providers and for learners, conference space for consultations, group teaching and rounds, use of video and web technology for both on-site and distance learning, and access to electronic health records.  These same education and meeting spaces will also support other community health priorities such as health promotion, chronic disease prevention and management, public health service alignment, and professional development.  Based on the planning work completed to date by the PNRHA, the proposed size of the PHCC is approximately 800 square metres (including its internal growth space) and the preliminary order of magnitude capital cost is about $1 million.  The PHCC project will utilize a significant portion of the unfinished vacant space in Co-op Plaza.  It is anticipated that the Prairie North Health Centre After-Hours Clinic will close when the new PHCC opens. A.2

Relocate Mental Health and Addictions (and potentially Home Care) from the CHS Building to Co-op Plaza: This project potentially meets two important objectives: 1) it consolidates community-based health services in one central location in Lloydminster, and 2) it provides growth space for Mental Health and Addictions and possibly Home Care. A further benefit is that it provides space in the CHS building to accommodate non-acute and administrative type functions out of the Hospital thereby providing much needed space for immediate acute care needs, such as surgery and mental health beds. Key aspects of this project include:  A preliminary estimate indicates that Mental Health and Addictions will require approximately 400-500 square metres and Home Care will require approximately 500-600 square metres of space.


P a g e | 74  The amount of available vacant space in Co-op Plaza after the PHCC has been accommodated needs to be confirmed, as well as the potential to reconfigure and/or relocate other tenants to create additional space if necessary.  Pending funding and approvals (and the availability of space), these moves, including the decanting of Hospital functions into the vacated CHS space, could be completed within 1-2 years.  Depending on the specific functions moved into the CHS building from the Hospital, portions of the space could be used ‘as is’ with minimal time and budget required for renovations, e.g. administrative and other non-acute functions.  As a very preliminary estimate, the capital cost of relocating Mental Health and Addictions and/or Home Care is likely in the order of magnitude of $0.5 to $1.5 million. This depends in part whether they are moving into vacant unfinished space or finished space. A.3

Identify Facilities to Recruit and Retain Physicians and Other Health Care Staff: While this strategy should not have any direct capital cost impacts on the PNRHA, the facility implications could be two-fold:  Assisting in ensuring there are clinical facilities available in Lloydminster to support the growth in physicians and other health care providers.  Assisting in securing the availability of housing to be able to attract additional personnel.

A.5

Develop 2-3 Inpatient Mental Health Beds: As a short-term interim strategy, it is proposed to develop 2-3 mental health beds at the Lloydminster Hospital, utilizing existing space on an inpatient unit that currently houses ambulatory care services. This forms part of a broader short-term strategy to decant non-acute functions out of prime Hospital space in order to address priority acute care needs such as the mental health beds. It is described in more detail in the Acute Care Services section. This development should be completed within the next 1-2 years. There will likely be some capital cost implications in renovating the bedrooms to meet the safety and security needs of acute mental health patients.

A.20

Enhance Rehabilitative Services Capacity in the PHCC: The space being planned in the new PHCC in Co-op Plaza should include the capacity to accommodate rehabilitative services as part of the interdisciplinary health services model and the consolidation of community-based health services in one central location. Most important would be to ensure there is space to examine and consult with patients, i.e. access to exam and consultation rooms, as well as space to conduct ‘basic’ physical assessments such as gait, strength, flexibility, etc., i.e. access to a larger, multipurpose, flexible space and equipment


P a g e | 75 storage. However, it is assumed that rehabilitation treatments would not occur in the PHCC space, but rather in existing rehab treatment facilities already available in Lloydminster – both in PHRHA facilities such as the DCECC (that will have additional capacity with the reduction from 105 to 50 residents on the DCECC site) and private facilities. A.21

Enhance Inpatient Rehabilitative Services Capacity at the Lloydminster Hospital: While this strategy focuses primarily on recruiting and retaining rehabilitative professional resources, the facility implication is to ensure there is adequate space on the Hospital inpatient units to support rehabilitation services, i.e. satellite rehabilitation treatment space. This also ties into the broader short-term strategy of decanting non-acute functions out of prime/inpatient Hospital space in order to address priority acute care needs.

Phase 2 – Years 6 – 10 A.39-43 Provide Facilities to Support Education: The inclusion of education space in the PHCC is discussed under A.1 above, and forms part of the Phase 1 development requirements. In addition, technologically enhanced and expanded education facilities will be required at the Lloydminster Hospital to support continuing education, professional development and the teaching of family physicians and other health care providers. This also includes the ability to access teaching space and technologies within the clinical settings, as well as the remote viewing of clinical activities by learners, e.g. in the OR’s. An outcome of the Hospital expansion, described in the Acute Care Services section, will be improved education capacity, including both facilities and technology.


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B.

CONTINUING CARE HEALTH SERVICES ASSESSMENT

Lloydminster Health Services Needs Assessment – Continuing Care Services

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4.2

Continuing Care Service Priorities  Community of Care: Establish a model for “aging in place” for continuing care clients in the Lloydminster area that maximizes client independence and quality of life; minimizes service transitions; and provides access to an appropriate continuum of service options.  Supportive Living Capacity: Develop and maintain a continuum of supportive living options for the Lloydminster area.  Enhanced Home Care Options: Develop and implement enhanced Home Care service options in the Lloydminster area.  Health Service Provider Resources: Recruit, retain and utilize the required range of health care provider resources to full scope of practice in continuing care.  Transition Unit: Establish a transition unit, with comprehensive admission criteria and case management, which supports the delivery of the right care, at the right time, and in the right place.  Palliative Care Service: Enhance palliative care service options in the Lloydminster area.  Respite Service: Enhance respite care service options in the Lloydminster area.  Specialty Continuing Care Services: Establish appropriate service options for those with specialized/unique continuing care requirements (e.g., ABI, FASD, ALS). Figure 21: Continuing Care Service Priorities

Continuing Care Service Priorities Key Results  A well-defined Community of Care philosophy will guide continuing care service planning and development.  The quality of life experience will be enhanced for continuing care clients/ residents and their families.

Strategies  Evidence the Community of Care concept has been developed and is being utilized to guide continuing care service planning and delivery.  An effective referral and feedback mechanism is in place to assess client/resident and family interaction with the system.


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Continuing Care Service Priorities Key Results

Strategies

 Clients/residents and their families will have improved access to an appropriate range of continuing care service options; and will be better informed on how to access these services.

 Successful expansion of supportive living capacity in Lloydminster.

 Wait times for all levels of service in the continuing care sector will be improved through ensuring right service option is accessed at the appropriate stage of care.

 Successful commissioning of the new Dr. Cooke Extended Care Centre.

 Appropriate access to the continuing care services will reduce emergency department wait times and reduce the number of acute care beds occupied by Alternate Length of Stay patients.  Clients/residents will be able to establish and maintain a “home-like” environment where services adapt and flex to their changing health care requirements.

 Successful redevelopment of the Jubilee Home.

 Wait list and wait times for continuing care services (Target 1 month maximum wait time for service).  Rate of transfer between continuing care service sites/programs.  Utilization rates of each continuing care program/service.  Time between client assessment completed by Home Care and time services are delivered.

 Clients/residents and families will have a greater ability to influence and be involved in their care.

 CMI or other workload/acuity metrics for long term care facilities are at or above benchmarks.

 Clients/residents and their families will be consistently satisfied with access to services and involvement in their care.

 Number of persons occupying acute care beds while deemed ALC.

 Continuing care services, primary care, and acute care providers and staff will have clear understanding of roles, responsibilities and accountabilities of components of the continuing care sector.

 Levels of client/resident and family satisfaction with quality of care/quality of life.  Levels of staff satisfaction with service coordination and inter-disciplinary team effectiveness.


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Continuing Care Service Priorities Key Results

Strategies  Recruitment and retention targets for health human resources met.

4.2.1

Priority 1: Community of Care

Establish a model for “aging in place” for continuing care clients in the Lloydminster area that maximizes client independence and quality of life; minimizes service transitions; and provides access to an appropriate continuum of service options. Context and Rationale A high functioning continuing care system focused on delivering the highest quality of service is characterized by a number of key variables including: commitment to maximizing client/resident independence; a strong focus on minimizing number of transition points and disruptions in routine for clients/residents; support for family and caregiver interaction and involvement in the care journey; and effective coordination of the efforts of all healthcare providers. Historically, Lloydminster has managed continuing care in a segmented fashion often with multiple transfers of clients between community, hospital, lodge or assisted living and continuing care facilities. It is well understood that changes in physical location, care providers and patterns of activity can result in dramatic impacts to client/resident wellbeing. A more progressive and appropriate approach to managing changing care requirements is to establish a “aging in place” model in which a client/resident could transition from service to service with minimal change in environment and caregivers. In the short-term, Lloydminster will have to manage and develop a community of care philosophy within the constraints of its existing facilities. Opportunities may be available to advance a community of care concept by integrating lodge and supportive living services within the same building or site. Alternatively, similar efforts may be possible working with existing long term care sites to integrate supportive living arrangements into or adjacent to those sites. Long-term, facility and program/service developments should explicitly take into account and support a community of care concept allowing for side-by-side development of seniors housing, supportive living and long-term care within the same physical structure or within the same tract of land.


P a g e | 80 Figure 22: Community of Care - Recommended Strategies

Community of Care – Recommended Strategies B.1 Develop Lloydminster Community of Care Concept: Develop and implement the Community of Care Concept. This will involve: 1.1 Plan Development: Establish a clear philosophy, operating principles and implementation plan for the Community of Care model. This should include a case management approach that positions clients and their families at the centre of the service. 1.2 Short-term Implementation Plan: Evaluate current service offerings and sites to determine how the Community of Care concept can be implemented within the context of current facilities and other short-term constraints. 1.3 Longer-term Implementation Plan: Ensure all future service and facility planning supports the Community of Care concept. B.2 Education, Communication and Advocacy: Educate, communicate and advocate with key stakeholders about the goals, objectives and benefits of the Community of Care concept and approach. This should include: 2.1 External Stakeholder Engagement: Strong engagement with external stakeholders will be required to coordinate current and future service delivery options and opportunities. This recognizes the reality that Prairie North Health Region, Saskatchewan Health, Alberta Health and Alberta Health Services do not have direct control over all continuing care service delivery requirements. Rather, a partnership approach with local and provincial governments and other providers is required to achieve the benefits of the community of care model. 2.2 Internal Stakeholder Engagement, Education and Training: The Community of Care concept will require significant effort in reorienting health care providers with specific attention on minimizing transitions between sites and service offerings and otherwise supporting the principle of “aging in place”. This will require more flexibility working arrangements between service environments and a strengthened commitment to an interdisciplinary team approach. 2.3 Community-Focused Engagement and Education: The community as a whole will have to be apprised of the Community of Care concept, goals and objectives and benefits of the approach. This will include implications for short-term service delivery changes and longer term service developments. B.3 Engage Clients/Residents and their Families in their Care: A critical component of the Community of Care concept is effective engagement of clients/residents and families in their care. 3.1 PNRHA Staff Orientation and Training: Orientating PNRHA staff/teams to Charter of Patient Rights and Responsibilities and ensuring all staff attend training sessions.


P a g e | 81 Community of Care – Recommended Strategies 3.2 Training for External Service Providers: Providing required training to staff not employed by PNRHA (e.g., housing authorities, supportive living providers, other contracted resources).

4.2.2

Priority 2: Build Supportive Living Capacity

Develop and maintain a continuum of supportive living options for the Lloydminster area. Context and Rationale The February 2013 Alberta Health Services report analyzing continuing care capacity indicates that the Lloydminster area has significant unmet demand in continuing care capacity of 99 “spaces” over the 15-year planning timeframe. There is an immediate identified shortfall of 44 spaces. In addressing this service gap it is important to ensure that clients can access care options appropriate to their needs and consistent with Community of Care concept. The Dr. Cooke Extended Care Centre and Jubilee Home do not presently have excessive waitlists. In addition, measures of acuity indicate that many of the current clients do not require long term care placements. This is supported by the fact that clients with escalating needs have been able to access to a long term care beds within a quick time frame. The same cannot be said for waitlists for existing supportive living options. Waitlists for these service options have averaged 25 clients per month with wait times approaching six months and longer. This has placed significant pressure on seniors housing lodges and Home Care to manage clients whose care requirements would be better served in supportive living environments. This situation also exerts pressure on the Lloydminster Hospital as evidenced by excessive lengths of stay in Medicine and overall impact on occupancy of acute care beds. Long-term, as the population of Lloydminster grows, there will be increasing demand for a range of continuing care options. With an expectation that seniors will be living longer with an increased quality of life and heightened expectations for remaining independent for as long as possible, future continuing care developments should focus on enhancing supportive living capacity while monitoring future needs for traditional long term care beds.


P a g e | 82 Figure 23: Build Supportive Living Capacity - Recommended Strategies

Build Supportive Living Capacity – Recommended Strategies B.4 Short-Term Strategy: Based on current and immediate service pressures, address short-term capacity demands. This will require working in partnership with supportive living service providers to develop at least 55 beds of capacity (e.g., Points West, Pioneer Lodge, etc. B.5 Identify and Confirm Long-Term Supportive Living Requirements: Based on current projections of service demand over the next 15 years, plan for additional expansion to supportive living capacity with the goals of achieving a total 100 beds of capacity. B.6 Long-Term Care Facility Development/Redevelopment: Ensure that long-term care facilities are developed or redeveloped in accordance with the Community of Care concept. 6.1 Short-term Plan: Ensure that any site developments related to Lloydminster Long-Term Care Centre and Jubilee Home explicitly accounts for and supports the Community of Care concept. 6.1.1

Consider opportunities for creating supportive living environments adjacent to existing long-term care facilities.

6.1.2

Maintain and further develop respite, palliative, convalescent, transition and specialized continuing care services (e.g., Acquired Brain Injury) within or adjacent to existing and future long-term facilities.

6.1.3

South Wing Dr. Cooke Extended Care Centre is unsuited and uneconomical for further investments. The wing should be demolished and land made available for other continuing care service options (e.g., supportive living, transition unit).

6.2 Long-Term Plan: Jubilee Home will require replacement in the final 5 years of the 15-year plan. Facility planning and development must take into account not only demand for traditional long-term care beds but also for other service requirements/opportunities such as palliative care, respite, transition and supportive living options.

4.2.3

Priority 3: Enhance Home Care

Develop and implement enhanced Home Care service options in the Lloydminster area. Context and Rationale The Lloydminster area has significant opportunity through Home Care to reduce pressure on acute care, both in terms of individuals presenting in the Emergency Department and for patients occupying acute care inpatient beds. A similar opportunity exists to manage requirements for continuing care Lloydminster Health Services Needs Assessment – Continuing Care Services

P a g e | 83 services by appropriately and more economically supporting clients’ ability to live independently in their homes or community settings for as long as possible. There are a number of proven models in Alberta and Saskatchewan that support the provision of appropriate service at the right time, in the right place, by the right provider; (e.g., Home First, ED to Home, etc.) A significant challenge in delivering home care services in the Lloydminster area has been a shortage of the human resources to meet demand. Addressing this issue needs to be a priority. Figure 24: Enhanced Home Care Service Options - Recommended Strategies

Enhanced Home Care Service Options – Recommended Strategies B.7 Common Home Care Service Delivery Framework: Establish a common service delivery framework, across the two provincial jurisdictions, to ensure Home Care services are consistently and equitably delivered. 7.1 Establish standardized policies, protocols and service delivery standards for the Lloydminster area; i.e., services are the same regardless of province of residence. 7.2 Develop a community/client education plan to ensure that service recipients are aware of service standards for the Lloydminster area. B.8 Self-Managed Care/Individualized Care: Establish a common service delivery framework, across the two provincial jurisdictions, by which Self-Managed Care/Individualized Care services are offered. 8.1 Establish standardized policies, protocols and service delivery standards for the Lloydminster area; i.e., services are the same regardless of province of residence. 8.2 Develop a community/client education plan to ensure that service recipients are aware of service standards for the Lloydminster area. B.9 Minimum Data Set (MDS) Contact Assessment: Implementation of the MDS Contact Assessment tool for use in Lloydminster area. B.10 Home First/ED to Home Initiatives: Fully implement Home First/ED to Home initiatives. Commit necessary resources to ensure appropriate use of acute care and other facilities, maintain clients/ residents in their homes, and provide rapid and appropriate response to non-acute care needs. B.11 Tele-Home Care: Implement tele-home care options including remote monitoring capacity (as documented in Community Care service plan – Self Management). This will help extend Home Care human resources while ensuring effective support and management of client care needs.


P a g e | 84 Enhanced Home Care Service Options – Recommended Strategies B.12 Day Programs: Expand Day Programs in conjunction with supportive living providers and long term care facilities. Ultimately, day programs become a key component for the Community of Care concept noted above. B.13 Streamline Work Processes: Improve access and integration with acute care, continuing care service and primary care options through improved work flow and referral processes. Specifically, apply LEAN methodology on an ongoing basis to ensure work flow processes support effective and efficient delivery of Home Care services and integration with other continuing care, primary care and acute care service options. B.14 Redevelop Home Care Service Space: Relocate Home Care services to the Co-op Plaza to further support integration of a range of services and promote collaborative practice. Redevelop the vacated space at the Community Health Services building to support administrative functions which can be relocated from both the Lloydminster Hospital and the Co-op Plaza. These moves will ensure additional space for ambulatory care programs at the Lloydminster Hospital and expanded array of primary care and community care programs at the Co-op Plaza.

4.2.4

Priority 4: Health Service Provider Resources

Recruit, retain and utilize the required range of health care provider resources to full scope of practice in continuing care. Context and Rationale Increasingly continuing care clients have more complex care needs. Ready access to appropriately trained health care providers functioning as an interdisciplinary team is important to ensure effective handoffs and continuity of care. This model of service delivery does require the presence and support of family physicians, nursing and other allied and support professionals to be effective. The Lloydminster area continues to have a shortage of family physicians and other health care professionals. This ongoing shortage of personnel must be addressed to meet service demands. Within this context, the use of Nurse Practitioners to manage the majority of care requirements in the continuing care environment offers significant potential. Their training, service disposition and compensation framework, allow Nurse Practitioners to support a range of primary care and chronic care requirements of clients and residents.


P a g e | 85 Figure 25: Health Service Provider Resources - Recommended Strategies

Health Service Provider Resources – Recommended Strategies B.15 Targeted Recruitment and Retention for Continuing Care: Develop a recruitment and retention strategy designed to meet existing and future demands in continuing care. This strategy needs to address short-term and longer term objectives and should include: 15.1 Recruitment Targets: Establish clear recruitment targets for the range of health care professionals (e.g., Nurse Practitioners, Registered Nurses, Licensed Practical Nurses, Aides, Therapists) designed to support effective care delivery in the continuing care sector. Initial focus should be on filling funded positions that are currently vacant. 15.2 Immediate NP Recruitment: Immediately recruit NP’s to support delivery of appropriate, responsive and holistic continuing care services. B.16 Standards and Guidelines: Establish standards and guidelines for NP practice within continuing care concerning the types and levels of care that should be provided, including: 16.1 Roles and responsibilities (e.g., specialized services to support primary care, reduce necessity for referral out); 16.2 Assessment criteria and referral/reporting protocols; 16.3 Definition of what services are to be/can be provided within continuing care; and 16.4 Quality Assurance Framework including monitoring and reporting mechanisms and assurance. B.17 Communication: Ensure effective public and provider education and communications; e.g., consistent messaging; established clinical pathways; family supports and education; etc. B.18 Inter-disciplinary Teamwork: Develop and support inter-disciplinary work within the continuing care environment ensuring team members work to full scope of practice.

4.2.5

Priority 5: Transition Unit

Establish a transition unit, with comprehensive admission criteria and case management, which supports the delivery of the right care, at the right time, and in the right place. Context and Rationale As of 2012/13, there exists a significant population of predominately seniors requiring evaluation of their care requirements prior to making an appropriate determination of service location. Lloydminster Health Services Needs Assessment – Continuing Care Services

P a g e | 86 Historically, attempts to manage these clients and their care requirements has been dealt with in a variety of settings including acute care medicine beds, dedicated transition service located within the Lloydminster Hospital, or within a small and often constrained bed base at Jubilee Home. These options have not fulfilled expectations and demands for appropriate transition service in the area. The need for such a service has been demonstrated by the number of patients unnecessarily occupying inpatient acute care medical beds (upwards of 14 beds on average). This pressure on the acute care bed base often results in clients being prematurely admitted to a long term care setting, when they could be more appropriately managed in an alternate level of care setting. Similar pressures can also come from seniors’ lodges and supportive living facilities. This directly and immediately impacts CMI ratings at the receiving long-term care centre and implies a premature admission/loss of independence for the individual client; and has serious funding implications. Creating well planned dedicated transition unit would help to address these serious issues and potentially reduce the cost of service delivery while enhancing the appropriateness and quality of care. Figure 26: Transition Unit - Recommended Strategies

Transition Unit – Recommended Strategies B.19 Develop Transition Unit: Develop and operationalize a 6 to 10 bed transition unit in partnership with Central Zone/Alberta Health Services. This will require: 19.1 Transition Unit Vision: Establish the vision for a transition unit with a specific focus on clients to be served, services to be offered, targets to be achieved and connection to other health services in the Lloydminster area. 19.2 Staffing Plan: Consistent with the service objectives and mandate established, develop a staffing plan to support effective operation of the service. 19.3 Facility Requirements: Establish short-term and long-term infrastructure requirements to support achievement of Transition Service mandate. 19.3.1

Short-term – establish the Transition Service outside of the acute care environment within Central Zone/Alberta Health Services to support a non-acute care approach in favour of a rehabilitative/ evaluative approach to care.

19.3.2

Long-term – within context of service developments in Lloydminster create purposebuilt space for Transition Service on old Dr. Cooke Extended Care Centre site.

B.20 Inter-disciplinary Teamwork: Develop and support inter-disciplinary Transition Service team working to full scope of practice.


P a g e | 87 Transition Unit – Recommended Strategies B.21 Care Pathways: Adopt/adapt/develop and implement care pathways to support effective evaluation, support and transition to appropriate continuing care environments. B.22 Standards and Guidelines: Establish standards and guidelines for the Transition Service concerning the types and levels of service that are to be provided, including: 22.1 Roles and responsibilities 22.2 Assessment criteria and referral/reporting protocols; and 22.3 Quality Assurance Framework including monitoring and reporting mechanisms and assurance. B.23 Communication: Ensure effective public and provider education and communications; e.g., consistent messaging; established clinical pathways; family supports and education; and role/expectations of a transition unit.

4.2.6

Priority 6: Palliative Care Service

Enhance palliative care service options in the Lloydminster area. Context and Rationale Population demographics and growth for Lloydminster, coupled with disease prevalence (e.g., cancer rates, other terminal conditions) and other end-of-life circumstances, continue to require ongoing development and evolution of an integrated and seamless approach to providing palliative care services. A well-managed and coordinated service will include an ability to support and manage throughout the spectrum of care and service options from community, through to acute care, through to continuing care. A well-developed palliative care service not only supports individual patients, but also ensures support to caregivers and families through challenging times. Figure 27: Palliative Care - Recommended Strategies

Palliative Care – Recommended Strategies B.24 Develop Program: Establish program philosophy and plan for the palliative care service. This should include: 24.1 Establishing the philosophy and vision for the palliative care service. 24.2 Developing the operating principles, values and major objectives for the service.


P a g e | 88 Palliative Care – Recommended Strategies 24.3 Establishing an integrated and seamless Service Delivery Model, including care pathways and standards and guidelines. 24.4 Developing a staffing plan to support effective operation of the service. B.25 Inter-disciplinary Teamwork: Develop and support inter-disciplinary palliative care teams working to full scope of practice. A. 26 Education and Communication: Develop a plan of education and communication around palliative care services that addresses needs of health care providers, families and the public as to the nature and focus of end of life care.

4.2.7

Priority 7: Respite Care Service

Enhance respite care service options in the Lloydminster area. Context and Rationale Population demographics and growth for Lloydminster, coupled with increased incidence of chronic disease and intent to promote independence, quality of life and aging in place, places ongoing pressure and demands on families and other caregivers. To support and maintain quality of life for clients and caregivers (and to minimize caregiver burnout) there is a need to maintain adequate opportunity for respite care. Respite and convalescent care options currently exist in long-term care but current capacity is inadequate to meet current and projected demand. Figure 28: Respite Care - Recommended Strategies

Respite Care – Recommended Strategies B.27 Develop Program: Establish program philosophy and plan for the respite care service. This should include: 27.1 Establishing the vision, operating principles and objectives for the respite care service including emergency respite. 27.2 Expanding program service capacity to provide respite services 7 days a week from current 5 days per week.


P a g e | 89 Respite Care – Recommended Strategies 27.3 Establishing respite service in a range of continuing care settings to meet service demand.

27.4 Developing a staffing plan to support effective operation of the service.

4.2.8

Priority 8: Specialty Continuing Care Services

Establish appropriate service options for those with specialized/unique continuing care requirements (e.g., ABI, FASD, ALS). Context and Rationale Historically, many health regions including Lloydminster have been challenged as to how to appropriately address the service and care needs of unique populations - those that do not reflect the population that in general requires continuing care services. These atypical clients are often younger than the general continuing care population and present with unique challenges and health conditions. Included in this small but challenging population are those with Acquired Brain Injury, those suffering from ALS, those with diagnosis of FASD who are now adults, and a range of other clients with physical and or mental disabilities requiring continuing care support. In some circumstances, families have either attempted to manage the care needs of their loved ones at home with significant impacts to their own emotional, psychological and financial health; or they have struggled with the supports available in traditional continuing care settings. Organizationally-based alternatives are usually less than appropriate and in many cases have had these individuals housed and managed in long term care facilities where they often feel isolated from the general population and lacking in program opportunities to address their particular physical, mental, social and emotional needs. These clients can often be “one-of-a-kind” within an environment geared to managing a traditional continuing care clientele. Lloydminster by itself does not have enough critical mass to justify a purpose-built facility or program to address this population demographic. However, as a regional hub, working in concert with other communities in a broader catchment area encompassing both Alberta and Saskatchewan, a critical mass could be achieved which would allow for an economically efficient, quality service to be established to the needs of this clientele.


P a g e | 90 Figure 29: Specialty Continuing Care Services - Recommended Strategies

Specialty Continuing Care Services – Recommended Strategies B.28 Specialty Services: Explore the feasibility of developing specialty continuing care services for the following unique and challenging client groups: 28.1 Acquired Brain Injury (ABI) 28.2 Fetal Alcohol Spectrum Disorder (FASD) 28.3 Amyotrophic Lateral Sclerosis (ALS). This will include the following key process elements:      

4.2.9

Establishing the catchment area to be served; Establishing the demand for the services; Researching informed practice to identify the service delivery model; Establishing staff and facility requirements; Determining service partners; and Accessing required funding.

Facility Implications – Continuing Care Services

Existing Situation The current scope of Continuing Care Services in Lloydminster includes the following programs and facilities (note, this inventory is not intended to encompass all seniors housing facilities in Lloydminster):  Jubilee Home - 50 continuing care residential beds operated by the PNRHA, which includes 4 beds used for short term respite care, convalescent care and palliative care. The Jubilee Home is a 28 year old building with a total area of 3,320 square metres, i.e. 66.4 square metres per bed.  Dr. Cooke Extended Care Centre (DCECC) - 105 continuing care residential beds operated by the PNRHA, with 50 residents in the newer North Wing and 55 residents in the older Central/South Wing. The North Wing is 21 years old and the Central/South Wing is 45 years old. The overall building area is 7,645 square metres, i.e. 72.8 square metres per bed, with less area per bed in the Central/South Wing. With the replacement of the Central/South Wing in the new Lloydminster Long Term Care facility, the remaining DCECC will have a total of 50 beds with an estimated area of Lloydminster Health Services Needs Assessment – Continuing Care Services

P a g e | 91 approximately 85-90 square metres per bed. The DCECC includes services that support other facilities, such as laundry.  Pioneer Lodge - 139 residential spaces, which are operated under the Housing Act.  Dr. James W. Hemstock Assisted Living Residence - 62 assisted living apartments operated by a private service provider. A portion of the apartments are two bedroom suites.  Points West Living - up to 65 residents in independent and supportive living suites operated by a private service provider.  Hearthstone Place - 67 independent living apartments operated by a private service provider. A portion of the units are multiple bedroom apartments.  The new Lloydminster Long Term Care (LLTC) facility will open in early 2014 with 60 continuing care residential beds that replace the 55 beds in the Central/South Wing of the DCECC, which will be demolished. The new facility is based on a state-of-the-art Eden (Green House) concept with 10 residents per house. It will total close to 6,000 square metres (which includes the Adult Day Care program space), i.e. approximately 95 residential square metres per bed. Facility Development Requirements The facility implications of the Program Priorities and Recommended Strategies identified for Continuing Care Services earlier in this section are as follows, numbered according to the Recommended Strategies. All estimated capital costs are in current dollars. Phase 1 – Years 0 – 5 B4.

Develop the Immediate/Short Term Increase in Supportive Living Capacity: Work in partnership with supportive living service provider(s) to develop approximately 55 supportive living spaces. Depending upon the approach and option(s) pursued all or at least a portion of these spaces could be operational within approximately 2 years, or sooner. Options and key aspects of this development include:  One option is to partner with Pioneer Lodge to develop approximately supportive living spaces in the existing facility, including the potential for these spaces to be within a secure unit. The Lodge has developed a preliminary design that confirms the feasibility of this expansion with an estimated capital budget of approximately $3.1 million. The project includes both expansion and renovations and results in a reduction of 8 existing lodge spaces to 130, i.e. the overall impact is an increase of 20 spaces on the site. To implement the


P a g e | 92 project, Pioneer Lodge will require capital funding assistance and a contract to provide the additional 24-hour staffing required to support the supportive living residents, e.g. personal care aides.  Given the design work completed to date and pending the timing of funding and approvals, this project could be completed within about 2 years. A shortcoming of this option is that it only addresses about 50% of the short term deficiency in supportive living capacity. However, while it still does not provide the required ‘immediate’ solution for additional capacity, it is an option that appears can be implemented relatively quickly.  The second and preferred option, which better embraces the PNRHA’s Community of Care vision and provides a more complete solution, is to take advantage of the land that will be available when the Central/ South Wing of the DCECC is demolished. It provides the opportunity to expand and complement a Community of Care campus that already includes the North Wing of the DCECC, Points West Living, Dr. James W. Hemstock Assisted Living Residence and Hearthstone Place. In addition to accommodating the short term supportive living capacity demands, it could potentially address other priority needs such as Respite, Convalescent and/or Transition services in conjunction with the DCECC. It also takes advantage of the support services and facilities that are already available in the North and Services Wings of the DCECC, e.g. rehabilitative services, food services, laundry, etc. Given that time is of the essence, the project could be developed in partnership with a supportive living service provider already in place, who could have the capability to expedite the planning, design and construction. Depending upon how quickly an RFP can be developed and put out into the market, this project could also potentially be completed within about 2 years, although 3 years may be more realistic. One advantage of this option is that the PNRHA already has the land that is appropriately zoned, which avoids the potentially protracted period of land acquisition, re-zoning, etc. While the potential scope and scale of this development requires much further definition, assuming a project in the range of 50-60 supportive living spaces, the overall size of the facility would be approximately 5,000 square metres with an order of magnitude capital cost of $15 to $18 million.  A third option is to consider the preliminary plan developed by the PNRHA to add 8-10 supportive living spaces to the Jubilee Home, specifically designed to accommodate residents with special needs such as dementia. Given the design work completed to date and pending the timing of funding and approvals, this project could be completed within about 1-2 years - however, this option has shortcomings. It addresses less than 20% of the short term deficiency in supportive living capacity. Given the age and outdated condition of


P a g e | 93 the Jubilee Home, its replacement is recommended within the 10-15 year time frame, which questions the value of investing in its expansion at this time.  A fourth option that would provide the quickest solution is to increase the level of supportive services provided to residents in existing facilities such as Points West Living, Dr. James W. Hemstock Assisted Living Residence and/or the Pioneer Lodge, effectively increasing the number of supportive living spaces. However, the significant down-side of this option is that it doesn’t increase the overall bed capacity, which would effectively result in longer waitlists for both seniors housing and supportive living in Lloydminster. B12.

Expand Adult Day Programs: The immediately available opportunity that exists is to operationalize the proposed Adult Day Program and the new Lloydminster Long Term Care facility. The space has been programmed, designed and constructed to accommodate at least 10 clients. This should have no capital cost implications. Beyond this, there appear to be at least two potential opportunities and locations to further expand Adult Day Programs, which would have the following facility implications:

 One option is to increase the number of Adult Day Program spaces in the new Lloydminster Long Term Care facility. While it was originally planned to accommodate 10 clients, there appears to be the opportunity to expand this to at least 12 and perhaps more depending upon the utilization and availability of space. Initially, there would appear to be no capital cost implications for this option and it could be implemented as soon as the new facility is open, pending operational funding approval.  A second option is to develop an Adult Day Program at the existing DCECC site. This could be implemented in conjunction with the aforementioned Supportive Living/Community of Care development suggested on the land that will be available and could also take advantage of the potentially available rehabilitation/activity spaces in the North and Service Wings that were sized for 105 residents and will soon be serving only 50 residents. Alternatively, the Day Program space could be developed in conjunction with the space redevelopments that are required when the Central/South Wing is demolished, i.e. family space, conference/education space, etc. This option is estimated to have an order of magnitude capital cost of $1 to $1.5 million, depending in a large part upon what other facilities are developed in conjunction. B14.

Relocate Home Care from the CHS Building to Co-op Plaza: This suggested plan is already described in the Community Health Services section for both Mental Health and Addictions and Home Care. In summary, it supports the integration of community-based health services and promotes collaborative practice, and it provides growth space for Home Care. An additional outcome is that it provides space in the CHS building to accommodate non-acute and administrative type functions out of the Hospital, thereby providing much


P a g e | 94 needed space for immediate acute care needs such as surgery and mental health beds. This project could be completed within 1-2 years depending upon funding and approvals, and most importantly, the availability of space in Co-op Plaza). B19.

Develop a Transition Program with 6-10 Spaces within Central Zone/Alberta Health Services as a Short-Term Interim Solution: AHS has identified that there may be available space in one or more AHS facilities in nearby communities that will meet the Transition Unit program requirements. Pending further analysis and facility assessment, it is assumed that this project can be implemented without incurring significant, if any, capital costs.

B27.

Develop Respite Space Capacity: Until the service delivery model is further established, it is difficult to identify a preferred facility development solution, e.g. will Respite services/space be consolidated on one site or distributed across multiple sites, are there important programmatic linkages between Respite services and Adult Day Program, the number of spaces required, etc. The following facility implications are suggested as potential options:

 One option, which ties into the PNRHA’s Community of Care vision, is to develop Respite services and spaces as part of the Community of Care campus on the DCECC site. It takes advantage of the available PNRHA land and the support services and facilities that are already available in the North and Services Wings of the DCECC, e.g. rehabilitative services, food services, etc. The Respite spaces could either be part of the suggested Supportive Living development and/or combined with the suggested development of Transition spaces on that site. The order of magnitude capital cost for this option is estimated to be $1 to $1.5 million, again depending upon what other facilities are developed in conjunction.  A second option is to expand the Respite space capacity at the Jubilee Home in conjunction with the potential short-term plan to add 8-10 supportive living spaces described previously. Phase 2 – Years 6 – 10 B19.

Develop a Transition Program with 10-14 Spaces on the DCECC Site as a Longer Term Solution: Similar to the development of Supportive Living and Respite spaces described previously, this suggested project builds upon the PNRHA’s Community of Care vision and takes advantage of the land that will be available when the Central/South Wing of the DCECC is demolished. It also takes advantage of the support services and facilities that are already available in the North and Services Wings of the DCECC. While the scope of this project requires much further definition, assuming a range of 10-14 spaces, the size of the facility would be approximately 700-1,200 square metres with an order of magnitude capital cost of about $4 to $6 million.


P a g e | 95 B5.

Develop the Longer Term Increase in Supportive Living Capacity: Work in partnership with supportive living service provider(s) to develop approximately 45 additional supportive living spaces. The target should be to have these spaces operational within about a 9-10 year time frame. There are a number of options as to their location, most of which depend upon the service provider. One option is certainly the potential to develop supportive living spaces on the expansion land adjacent to the new Lloydminster Long Term Care facility that would further develop and enhance the Community of Care concept. Again, while the potential scope and scale of this development requires much further definition, assuming a project of about 45 spaces, the overall size of the facility would be approximately 4,000 square metres with an order of magnitude capital cost of $12 to $15 million.

Phase 3 – Years 11 – 15 B6.

Replace the Jubilee Home: As noted in the Facility Assessment section, the Jubilee Home is now 28 years old with a relatively high Facility Condition Index (FCI) of 0.40. The layout reflects an outdated concept of continuing care that was designed for a resident population that was less frail and more mobile and had a lower level of care needs. Accordingly, as the building approaches 40+ years of age it is recommended that it be replaced within the 15 year time frame. The following facility implications of this project are identified:  The number of resident spaces in the replacement facility will need to be confirmed, taking into account not only the demand for traditional long-term care spaces, but also for other service requirements such as Supportive Living, Transition, Respite, and Palliative Care options.  A major goal would be to ensure that the replacement facility is developed in accordance with the Community of Care concept.  Within the 5-10 year time frame (or sooner), a replacement site should be identified and procured. The existing Jubilee Home site is too small to accommodate its replacement without first demolishing the facility. One potential site recommended is the land directly across from the Hospital that is currently owned by Husky Oil.  Assuming a replacement facility in the range of 50-60 resident spaces, the overall size of the facility would be approximately 5,000-6,000 square metres (i.e. similar to the new Lloydminster Long Term Care project), with an order of magnitude capital cost of $30 to $40 million.


P a g e | 96

C.

ACUTE CARE SERVICES ASSESSMENT

Lloydminster Health Services Needs Assessment – Acute Care Services

P a g e | 97

4.3

Acute Care Services

Background The Lloydminster Hospital has been identified as serving an acute care catchment area of over 72,000 people.* An assessment of various specialty services (e.g., orthopedics, ENT, ambulatory services) and consideration of the economic draw of the community indicates that this catchment already extends beyond the 70,000 people noted above. Population projections for Lloydminster note that, even with moderate growth assumptions, the city could grow to more than 50,000 residents by 2030. More aggressive or optimistic assumptions push this total nearer to 60,000. The surrounding catchment area is not expected to grow at the same rate as the City; but modest growth is still anticipated. Even using modest growth projections for the Lloydminster hospital acute care service area, the Hospital will be providing acute care services to well over 100,000 people by 2030. The current and projected composition of the population of Lloydminster and area is also noteworthy. The service area population includes:  Substantially more young residents than comparable communities and Alberta and Saskatchewan provincial populations;  A fairly rapidly growing seniors population;  A relatively large and growing transient population;  A large and growing First Nations population; and  An increasing immigrant population. These factors, amongst others, will put increased strain on already overburdened acute care services. Conversely, with appropriate planning and action, there is great opportunity to respond in a proactive fashion to meet current and future service requirements. (Detailed demographic data are presented earlier in this report.) Considering comparator communities in both Alberta and Saskatchewan, it is clear that Lloydminster is underserved relative to its ability to fulfill its current community hospital mandate. In addition, given the current and projected population to be served, Lloydminster can and should be further developed as a secondary referral centre for defined and appropriate specialty services to the benefit of both provinces.


P a g e | 98 Specific program/service strategies are documented in the body of this report, but the following overarching requirements set the context for these initiatives within a framework of establishing the Lloydminster Hospital as a secondary referral centre. These overarching strategies include:  Confirm the service role/mandate for the Lloydminster Hospital in partnership with Alberta Health, Saskatchewan Health, Alberta Health Services, and the Prairie North Health Region. This entails engaging key decision-makers in Alberta and Saskatchewan to confirm the secondary referral service role and mandate for the hospital. A commitment to this vision then makes possible a focus on programs and services required to fulfill the mandate.  Establish and enhance the role of the Lloydminster Hospital as an academic and teaching centre relative to its role as a secondary referral centre and a hub for rural acute care service delivery. This may require solidifying and expanding a range of partnerships with educational institutions and professional organizations to confirm a mandate and infrastructure to train a range of medical, nursing, nurse practitioner and other health care professionals.  Develop and implement a recruitment and retention strategy consistent with the service mandate of the hospital and the needs of the population served. Specific human resource requirements are noted within each program/service area in the body of this report. A particular challenge and requirement is to recruit to all currently funded but vacant positions.  Building from the updated Lloydminster Master Capital Plan, an agreed upon service mandate, and required service enhancements identified, the Lloydminster Hospital redevelopment should proceed and be completed in the shortest possible timeframe. As a first step, functional upgrades to the Lloydminster Hospital should proceed immediately. Building deficiencies are currently impacting operational effectiveness (e.g., repairs to exterior envelope) and completion will extend the useful life of the facility. Thereafter, short-term redevelopment opportunities should proceed in conjunction with space availability at other PNHRA sites (e.g., Plaza, Community Health building). These steps will provide short-term capacity for inpatient units and Emergency Department (e.g., relocation of therapies space, relocation of renal dialysis, and relocation of chemotherapy). Finally, a phased approach to redevelopment should proceed as established in the Master Capital Plan, recognizing ongoing functionality of existing hospital structure for continued revised use, and the pressing need for additional capacity in some services in the short-term (e.g., surgery).  Identify resource requirements and funding model to support acute care service requirements on a long-term and sustainable basis.  Address the existing policy issues that currently impair the delivery of acute health care services for the local area. These policy issues include: addressing funding alignment issues that are impairing the development of appropriate level of acute care services for Lloydminster;


P a g e | 99 removing policy and regulatory barriers to ensure clinical information flows efficiently and effectively; aligning bi-provincial credentialing and certification processes to enable the recruitment and retention of the scarce health care resources; and, developing or adapting care protocols and pathways to support timely access and quality of care.  Developing joint venture(s) between Onion Lake and the Lloydminster Hospital to coordinate and support the delivery of primary and acute care services at Onion Lake. This could entail enhanced sharing of resources and expertise while recognizing and respecting that control of health services delivered on reserve resides with the Band. Areas where service harmonization and coordination would add significant value for both Onion Lake and the PNRHA include: shared manpower planning and recruitment efforts; professional support and integration; technology and information sharing; tele-health links and consultation; coordinated and improved discharge planning; joint education and training efforts; and joint advocacy for resources at a provincial and federal level. Figure 30: Key Results and Performance Measures

Key Results  Lloydminster Hospital will be established as a secondary referral centre serving both Alberta and Saskatchewan residents.  Residents of the Lloydminster and area will have timely access to an appropriate range of acute care services.  Patients and their families will be satisfied with access to services and involvement in their care.  Demand for health services within the total Lloydminster service area will be assessed and updated on an ongoing basis and used to inform adjustments to the acute care service plan.  There will be improved service coordination among the Lloydminster Hospital, Onion Lake PHCC and other service providers.  The service area will attract and retain the health care human resources required to meet service demands.  Physicians and health care staff will have improved access to required clinical information.  Medical staff and health care professionals will have access to and will be satisfied with quality and timeliness of resources available to provide appropriate patient care services.  Health care staff will have clear understanding of their roles, responsibilities and accountabilities.


P a g e | 100 Recommended Acute Care Performance Metrics Medicine:  Inpatient ALOS vs. ELOS (peer hospital)  ALC occupancy as % of inpatient medical beds  Morbidity/Mortality rates (peer hospital)

Surgery:  Waitlist targets met  Day Surgery as % of Surgical Activity  Surgical Cancellations  Inpatient ALOS vs. ELOS (peer hospital)  Readmission Rates

Mental Health:  Admission Wait Times from ED to inpatient  Inpatient ALOS vs. ELOS (peer hospital)

Intensive Care:  Morbidity/Mortality Rates  Utilization Rate

Women’s & Children’s Health:  C-Section Rate  Epidural Rate  Inpatient ALOS vs. ELOS (peer hospital)  Wait time for specialist consultation

Emergency Department:  Wait time to be seen by physician  Wait time for admission to inpatient bed  % of visits that are CTAS Level 4 &5  % of patients left without being seen

Clinical and Logistical Support Services:  CT scan wait-time/waitlist  MRI scan wait-time/waitlist  Turnaround time for laboratory tests  Turnaround time for radiology interpretation

Ambulatory Care Services  Wait times for access to clinical service

    

4.3.1

Hospital Wide Performance: Community’s primary and secondary acute care service needs are met. Community and Patient Satisfaction measures meet or exceed provincial targets Targeted clinical pathways acquired or developed to support consistent, quality of practice and care. Health human resource recruitment targets, vacancy and staff turnover rates. Levels of staff satisfaction levels with service coordination and inter-disciplinary team effectiveness.

Priority 1: Medicine: Enhance Capability and Improve Access, Appropriateness and Service Quality

Context and Rationale A current medicine bed base of 34 (and 4 palliative care beds) serves the Lloydminster and area. Beyond what might be considered typical in a medicine program supported by Internists and Family Lloydminster Health Services Needs Assessment – Acute Care Services

P a g e | 101 Physicians, utilization of available capacity covers cardiology, palliative care, mental health and addictions, respite care, convalescent, geriatric and rehab, transition and alternate level of care (ALC) requirements. Figure 31: Comparison of Medicine Inpatient Bed Capacity

Comparison of Medicine Inpatient Bed Capacity City Fort McMurray

Catchment Population1 67,516

Medicine Inpatient Beds2 43

Grande Prairie

55,032

121,895

48

Medicine Hat Red Deer

60,005 97,109

83,224 189,243

58 108

Moose Jaw

35,671

41,303

30

Prince Albert Lloydminster 1. 2.

City Population (2011) 65,565

45,000 27,804

68,638 72,498

66 38

Other Related Capacity Palliative Care: 6 Sub-Acute: 10 Auxiliary Hospital: 3 Palliative Care: 10 0 Special Needs: 14 Convalescent/Palliative/ Respite: 14 Geriatric Assessment: 14 0 0

Determined by Census Tract – WMC developed Reflect current status, not new builds pending for Moose Jaw, Medicine Hat and Grande Prairie

At the present time, existing Medicine bed capacity is fully utilized running at or beyond 100% occupancy. Of note, however, is that average length of stay (ALOS) in the program exceeds expected length of stay (ELOS) by over 5,000 days a year. This represents 14 beds, or nearly 40%, of capacity that is being lost to effective and appropriate use. In addition, there is additional alternate level of care days to be considered, of a far less significant nature, which also puts a strain on current inpatient medical beds. A variety of factors impacts on availability of inpatient medical beds. These factors include:  Delays in completing/receiving necessary diagnostic tests and information;  Shortage of rehabilitation therapies staff and resultant delays in assessment/short-term interventions;  Availability of supportive living and other continuing care options to support discharge; and


P a g e | 102  The current medical model of care particularly as it relates to number of admitting physicians and transition points in care journey. In the short-term, Medicine bed capacity could adequately address current population requirements if this range of factors was attended to. Progress on these factors would not only positively impact inpatient functioning but would similarly positively Emergency Department capacity. In addition, work-life of staff would be improved as would quality of care for medical inpatients. As the population of Lloydminster grows over the next 15 years, inpatient bed capacity will have to expand to accommodate growth. As noted by existing comparator communities, and consistent with the Lloydminster Hospital’s service role, Medicine bed base will need to grow and also expand to include appropriate capacity for other related services such as palliative care, sub-acute and geriatric assessment/rehabilitation. In addition, the capability of the service and the composition of the health services team will have to adjust to support a variety of acute and chronic care conditions that will be prevalent into the future. Current population health demographics already identify higher than provincial averages for health conditions or behaviours such as obesity, diabetes, stroke and cardiovascular health, cancer, tobacco use, and respiratory ailments that will require appropriate medical resources to support care. Figure 32: Medicine - Recommended Strategies

Medicine - Recommended Strategies C.1 Recruitment and Retention of Healthcare Human Resources: Develop and implement a recruitment and retention strategy to support and sustain the inpatient medical service. 1.1 Recruitment Targets: Establish clear recruitment targets for key personnel and in particular: 1.1.1

Internists (target 6 by 2030)

1.1.2

Nurse Practitioners (target 2 in the short-term)

1.1.3

Infectious Disease Specialist (1 to support full volume of hospital-based activity)

1.1.4

Geriatrician (target 1 in the short-term to support acute and physicians and other health care professionals designed to support effective implementation of the Primary Health Care Service Plan).

1.2 Other Health Care Staff: Implement recruitment and retention strategies for other required health care professionals. Current emphasis is required on rehabilitation therapy as a critical resource to support effective discharge planning efforts and coordination with non-acute care services.


P a g e | 103

Medicine - Recommended Strategies C.2 Streamline Work Processes: Improve access, capacity and integration in the Medicine service through improved work flow and patient flow processes. Specifically: 2.1 Internal Processes: Apply LEAN process to inpatient activity and other clinical process reviews to ensure effective/efficient delivery of services, reduce waste and unnecessary steps in the care process. 2.1.1

Make targeted investments in equipment (e.g., laboratory equipment) and infrastructure (e.g., therapies space) as required to ensure effective and efficient management of the patient care process.

2.1.2

Review, update and reinforce discharge planning protocols to ensure appropriate use of medical inpatient resources.

2.2 Care and Clinical Pathways: Update, develop, implement and enforce use of care and clinical pathways. This should involve: 2.2.1

Focusing development on high volume/high cost patient services

2.2.2

Reaching agreement on an initial list of priorities for pathway acquisition and/or development, ensuring alignment with provincial priorities

2.2.3

Clearly integrating and defining the roles and responsibilities of all members of the medicine team particularly as additional personnel are recruited and new professional groups are brought into play (e.g., Nurse Practitioners)

2.2.4

Clarifying and enforcing objectives and protocols related to care plans to ensure that transition points in care (e.g., physician handoffs) do not result in delays in discharge

2.3 Innovation and Informed Practice: Identify and implement new approaches and informed practices to delivering medicine services. This will require an ongoing monitoring capacity for identifying and adapting best practices from within Alberta, Saskatchewan and other relevant jurisdictions. C.3 Inter-disciplinary Teamwork: Develop and support inter-disciplinary teams working to full scope of practice and in support of service objectives. This is particularly important as new roles are introduced to the Medicine Team (e.g., Nurse Practitioner) C.4 Enhance Inpatient Bed Capacity: Based on population projections, demographic composition, and secondary referral centre role, inpatient bed base should expand over the next 15 years to achieve: 4.1 Inpatient Medical bed base of 48 beds (up from current 34).


P a g e | 104

Medicine - Recommended Strategies 4.2 Inpatient Palliative Care Service of 6 beds (up from current 4) – this bed base is focused on short stay requirements, is integrated with and supports the overall Palliative Care service for the area. 4.3 Geriatric Assessment/Rehab service of 6 beds – this bed base is focused on short stay requirements with clearly targeted goals for care and discharge.

4.3.2

Priority 2: Mental Health and Addiction Services: Establish an Inpatient Mental Health and Addiction Service

Context and Rationale Access to mental health and addictions services has been consistently identified by community and internal stakeholders as one of the most significant service gaps for residents in the Lloydminster area. This is evidenced by long wait-lists, limited service capacity, escalating service demands, limited hours of access and a shortage of appropriately trained mental health professionals. Mental health and addiction services in North Battleford support much of the demand for services in Lloydminster but this requires either phone contact or travel out of the community by patients and families. This latter circumstance certainly applies if there is requirement for inpatient admission with no formal inpatient or observation capacity at the Lloydminster Hospital. Figure 33: Comparison of Mental Health/Addictions Inpatient Bed Capacity

Comparison of Mental Health/Addictions Inpatient Bed Capacity City Fort McMurray Grande Prairie Medicine Hat Red Deer Moose Jaw Prince Albert Lloydminster 1. 2.

City Population (2011) 65,565 55,032 60,005 97,109 35,671 45,000 27,804

Catchment Population1 67,516 121,895 83,224 189,243 41,303 68,638 72,498

Mental Health Inpatient Beds2 10 14 40 40 12 39 (Incl. 10 Child) 0

Addictions Inpatient Beds 0 0 0 0 0 14 0


Four psychiatrists operate private clinics in Lloydminster, one of whom has a strong focus on providing services for children. All psychiatrists report very heavy caseloads – in excess of 3000 clients each.


P a g e | 105 Comparison communities are generally served by a base complement of 10 mental health inpatient beds and which can be complemented by additional capacity for addictions. It is further noted that access to addiction services at the Thorpe Recovery Centre in Lloydminster has diminished. This puts further strain on other services in the local community that are ill-suited to the purpose. Potential clients in the community are left to manage to the best of their ability or to seek services outside of Lloydminster. Figure 34: Mental Health and Addiction Service - Recommended Strategies

Mental Health and Addiction Service – Recommended Strategies C.5 In-Patient Mental Health Beds: Establish a 12 bed in-patient psychiatric service, including shortterm/observation capacity for Addictions, at the Lloydminster hospital supported by the required professional staff. C.6 Emergency Services: Maintain and strengthen psychiatric on-call services to support the Emergency Department and inpatient services. 6.1 Enhance psychiatrist resources and further supplement with other professional resources (e.g., social workers, addiction counsellors) to support service to Emergency Department and Inpatient services. 6.2 Continue to include mental health responders as part of the emergency room team at the Lloydminster Hospital. 6.3 Update and complete redevelopment of appropriate holding space for mental health and addictions with the Emergency Department. C.7 Recruitment and Retention of Healthcare Human Resources: Develop and implement a recruitment and retention strategy to support and sustain the inpatient Mental Health and Addiction service specifically targeting Psychiatrists, Registered Psychiatric Nurses, Social Workers and Addiction Counsellors. C.8 Inter-disciplinary Teamwork: As the inpatient mental health and addiction service is developed it will be critical to plan for and establish an effectively functioning inter-disciplinary team where all members work to their full scope of practice and in support of service objectives. C.9 Establish Effective and Efficient Work Processes: As the inpatient mental health and addiction service is developed it will be critical to identify and establish processes which ensure the most effective and efficient means of achieving service objectives, most notably to provide high quality and responsive services to patients. Specifically:


P a g e | 106 Mental Health and Addiction Service – Recommended Strategies 9.1 Internal Processes: Adapt best practices and processes from similar services in Alberta and Saskatchewan while ensuring applicability within context of available human resources, physical infrastructure and other relevant parameters. 9.2 Care and Clinical Pathways: Adapt, develop and implement care and clinical pathways with a particular focus on clearly integrating and defining the roles and responsibilities of all members of the team. This will be particularly important as the team develops and as additional personnel are recruited (e.g., social workers, addiction counsellors, registered psychiatric nurses). 9.3 Innovation and Informed Practice: Identify and implement new approaches and informed practices to delivering Mental Health and Addiction services on an ongoing basis. This will require an ongoing monitoring capacity for identifying and adapting best practices from within Alberta, Saskatchewan and other relevant jurisdictions.

4.3.3

Priority 3: Surgery: Increase Capacity and Improve Access, Appropriateness and Service Quality

Context and Rationale The Lloydminster Hospital supports a complement of General Surgery, Orthopedics, Ophthalmology, ENT and Gynecology surgery within the confines of two (2) operating theatres and twelve (12) surgery beds. The surgical service has seen modest growth in total surgical procedures performed over the past number of years and in particular has seen significant impact and growth with the addition of Orthopedic and ENT surgery to the mix of services. While being constrained by the physical parameters noted above, the service has performed well against a number of performance metrics including length of stay as measured against peer hospitals (meeting ELOS expectations), percentage of procedures done as day surgery (70+%), and overall inpatient occupancy (approximately 85%).


P a g e | 107 Comparison of Surgical Capacity City Fort McMurray Grande Prairie Medicine Hat Red Deer Moose Jaw Prince Albert Lloydminster 1. 2.

City Population (2011) 65,565 55,032 60,005 97,109 35,671 45,000 27,804

Catchment Population1 67,516 121,895 83,224 189,243 41,303 68,638 72,498

OR Capacity2

Inpatient Bed Capacity2

7 8 7 9 3 4 2

27 40 31 78 20 33 12


Being constrained by the current complement of OR’s and bed base, the service has started to manage waitlists and volumes on a month-to-month basis. At the present time, the surgical service is not meeting waitlist targets and is unlikely to do so within the current infrastructure, funding parameters or human resource availability. In fact as the community grows waitlist pressure will grow or patients will have to be referred to other sites in Alberta and Saskatchewan. Current attempts to manage waitlist growth include extending OR hours and consideration of weekend slates to keep pace with demand. As the population of Lloydminster and area grows the demand for surgical services will similarly increase. At a minimum, based on current projections of population growth to 2030, the demand for surgical services will require at least a doubling of OR capacity from the current 2 operating theatres. The existing theatres also do not meet current standards and those deficiencies will also have to be addressed including development of appropriate pre-operative and recovery space. It is expected that day surgery cases will continue to constitute the majority of cases done at the site but increase in demand will require an increase in surgery inpatient beds to at least 24 if not 32 in the planning timeframe. Short-term steps to expand capacity are already in order based on inability to meet current demand. Endoscopy capacity will also have to expand to deal with demand and expected increase in complement of General Surgeons requiring access to that service modality. Figure 35: Surgical Services - Recommended Strategies

Surgical Services – Recommended Strategies C.10 Expand/Enhance Physical Infrastructure: In order to meet current and future demands for surgical services in Lloydminster and fulfill opportunity as a secondary referral centre surgical services infrastructure will have to be enhanced: 10.1 Increase Operating Theatres Capacity: The existing OR theatres to be replaced to meet surgical services demand and meet surgical services standards.


P a g e | 108 Surgical Services – Recommended Strategies 10.1.1

Immediate Implementation: Proceed with establishment of third operating theatre on the main floor and adjacent to existing theatres and support functions. This will require relocation and redevelopment of other components of the main floor (e.g., Health Records, Ambulatory, etc.). In the same timeframe, and commensurate with anticipated increases in overall hospital activity, expansion and upgrade of the MDRD should commence immediately.

10.1.2

Short-term Implementation: Proceed with first phase of Lloydminster Hospital redevelopment in the shortest possible timeframe to increase OR capacity to four (4) theatres; develop appropriate pre-operative and recovery space at the same time.

10.1.3

Long-term implementation: Expand capacity to six (6) operating theatres to meet future surgical services demand. To be operationalized as population and service demands dictate (final phase of the 15-year service plan)

10.2 Increase Inpatient Surgery Beds: The existing bed base is well utilized but inadequate to meet any increase from current demand. Phase expansion of surgical inpatient bed capacity: 10.2.1

Short-term Implementation: Relocate ambulatory services (e.g., renal dialysis, chemotherapy, etc.) off of inpatient floors to provide additional bed capacity to surgery in the short-term (e.g., 6-8 inpatient beds).

10.2.2

Long-term Implementation: Considering expected growth in population and requisite growth in demand for surgical services, bed base should increase in a phased manner, achieving 24-bed capacity as the first phase of the Lloydminster Hospital redevelopment, and further expansion to 32 inpatient beds in the final five years of the planning timeframe.

10.2.3

Increase Day-Surgery Capacity: The existing capacity of 12 stretchers/spaces is inadequate to serve surgical service requirements particularly as the complement of surgeons is increased. Capacity should be redeveloped to accommodate 20 stretchers/ spaces within the planning timeframe. Immediate steps should be taken to expand capacity by at least 4 stretchers.

10.3 Redevelop Endoscopy Capacity: As the surgery program develops and complement of general surgeons increases, current endoscopy space should be expanded to two (2) suites. 10.4 Develop MDRD to meet Standards/Future Demand: As surgical services demand increases along with expected increases in other hospital-based services, MDRD will have to expand to support a larger volume of clinical services. As the major facility in the area, the Lloydminster Hospital should also be considered as a support to equipment/instrument processing for outlying communities.


P a g e | 109 Surgical Services – Recommended Strategies Redevelopment should commence immediately by expansion into adjacent space occupied by the now dormant laundry service. C.11 Recruitment and Retention of Healthcare Human Resources: Develop and implement a recruitment and retention strategy to support and sustain Surgical Services. 11.1 Recruitment Targets: Establish clear recruitment targets for key personnel. Recruitment should focus in General Surgery, ENT, Ophthalmology, OB/GYN, Orthopedics and Anesthesiology. As infrastructure redevelopment and the phased expansion of the Lloydminster Hospital permits (e.g.., Years 6-10), recruit: 11.1.1 11.1.2 11.1.3 11.1.4 11.1.5 11.1.6

Three (3) general surgeons, Two (2) orthopedic surgeons, Three (3) ENT specialists, One (1) ophthalmologist with a practice dedicated to the site, One (1) GI specialist, and Requisite Anaesthesia (from 4 to 8 physicians) support.

11.2 In the final phase of the 15-year planning timeframe consideration should also be given to recruitment in Urology and Plastics. 11.3 Targeted recruitment and retention efforts must also be undertaken to address current shortages and anticipated need for perioperative nurses. C.12 Streamline Work Processes: Improve access, capacity and integration through improved work flow and patient flow processes. This will serve to maintain the current excellent length of stay performance of the program and assist in meeting waitlist targets. Specifically: 12.1 Internal Processes: Continue current LEAN activity and other clinical process reviews to reduce waste and unnecessary steps in the care process. 12.2 Care and Clinical Pathways: Continue development and implementation of care and clinical pathways. This should involve: 12.2.1

Focusing development on high volume/high cost patient services

12.2.2

Reaching agreement on an initial list of priorities for pathway acquisition and/or development, ensuring alignment with provincial priorities; and

12.2.3

Clearly integrating and defining the roles and responsibilities of all members of the surgical services team particularly as additional personnel.


P a g e | 110 Surgical Services – Recommended Strategies 12.3 Innovation and Informed Practice: Identify and implement new approaches and informed practices to delivering surgical services. This will require an ongoing monitoring capacity for identifying and adapting best practices from within Alberta, Saskatchewan and other relevant jurisdictions.

4.2.4

Priority 4: Intensive Care - Enhance ICU Capacity and Capability

Context and Rationale As the service demands on and capacity of the Lloydminster Hospital grows there will be an increased requirement for specialized medical/surgical support. This will ensure appropriate ability to manage local area emergencies related to growing industrial base and Lloydminster’s critical location on the Yellowhead highway. In addition, increased inpatient medical and surgical activity will require increased backup as will demand in the emergency department. Figure 36: Comparison of Critical Care Capacity

Comparison of Critical Care Capacity City Fort McMurray Grande Prairie Medicine Hat Red Deer Moose Jaw Prince Albert Lloydminster

City Population (2011) 65,565 55,032 60,005 97,109 35,671 45,000 27,804

Catchment Population1

Critical Care Capacity2

67,516 121,895 83,224 189,243 41,303 68,638 72,498

7 6 10 18 5 8 3

1. Determined by Census Tract – WMC developed 2. Reflect current status, not new builds pending for Moose Jaw, Medicine Hat and Grande Prairie

Figure 37: Intensive Care Unit - Recommended Strategies

Intensive Care Unit – Recommended Strategies C.13 Expand/Enhance Physical Infrastructure: In order to meet current and future demands for critical care services, in support of medical, surgical and emergency department requirements in Lloydminster and in order to fulfill opportunity as a secondary referral centre, intensive care unit infrastructure will have to be enhanced: 13.1 Proceed with expansion and evolution of the current 3-bed Specialty Care Unit to a 4-bed Intensive Care Unit.


P a g e | 111 Intensive Care Unit – Recommended Strategies 13.2 Expand Intensive Care Unit physical capacity to 8 beds within the 15-year planning timeframe and in consideration of the phased replacement/upgrade of the Lloydminster Hospital contemplated in the updated master capital plan. 13.3 Establish a two-bed Step-Down unit to specifically support short-term observation, close monitoring requirements for post-surgical patients and medically unstable patients (e.g., not able to be maintained on regular inpatient medical ward). C.14 Confirm/Clarify Service Delivery Model: Identify the basis upon which intensive care services will be medically managed and supported, what relationships will have to be established with tertiary level facilities, and what protocols will have to be in place to support delivery of high quality of care in the environment. C.15 Inter-disciplinary Teamwork: Develop care team structure to ensure clear leadership and accountability for care in the ICU and Step Down units is well established. C.16 General Internal Medicine/Intensivist Recruitment and Retention: Develop a recruitment and retention strategy for General Internal Medicine and Intensivists (in conjunction with other health human resources). This strategy needs to address short-term and longer term objectives and should include: 16.1 Intensivist – establish a shared services/contracted relationship with tertiary/consultative service based out of tertiary centre in Alberta/Saskatchewan. 16.2 Recruitment Targets: Establish clear recruitment targets for physicians and other health care professionals (e.g., respiratory therapy, registered nurses with specialized training) designed to support effective implementation.

4.3.5

Priority 5: Women and Children’s Health: Improve Capacity, Access and Service Quality

Context and Rationale The Lloydminster area is characterized by its relative youth compared to many other jurisdictions not only in Alberta and Saskatchewan but throughout Canada. This has meant strong demand on Lloydminster Hospital obstetrical services. What is noteworthy, however, is that utilization of a variety of child health clinics through Public Health exceeds what can be directly related to Lloydminster Hospital obstetrics activity alone. There are a number of possible explanations for this reality including a small and fluctuating number of OB/GYN specialists in the community, patient/family selection of other sites for a variety of medical and social reasons, and recent arrivals to the community. Lloydminster Health Services Needs Assessment – Acute Care Services

P a g e | 112 The obstetrical service has maintained itself by focusing on normal, low-risk deliveries. Evidence for this can be found in the relatively small number of transfers out of the area in the past number of years (i.e., less than 30 in the past 2 years out of nearly 900 deliveries per year for a rate of 3%). Demographic projections only reinforce expectations that such demand will remain and accelerate over the 15-year planning timeframe. Service demand and opportunity will also be positively impacted by establishing and maintaining a strong complement of OB/GYN physicians within a modern facility geared to adhering to care standards and public expectations. Figure 38: Comparison of Obstetrics Capacity

Comparison of Obstetrics Capacity City Fort McMurray Grande Prairie Medicine Hat Red Deer Moose Jaw Prince Albert Lloydminster 1. 2.

City Population (2011) 65,565 55,032 60,005 97,109 35,671 45,000 27,804


Obstetrics Beds2

67,516 121,895 83,224 189,243 41,303 68,638 72,498

9 LDRP/2 PP/AP 16 TBD TBD 14 13 13


A clear gap for Lloydminster has been the shortage of Pediatrician services both for in-hospital consultation and for follow-up service in the community. Family Physicians have been playing this role in the community, but even this service has been under pressure with lower than desired numbers of general practitioners for the community. Figure 39: Women's and Children's Health - Recommended Strategies

Women’s and Children’s Health – Recommended Strategies C.17 Confirm/Clarify Collaborative Service Delivery Model: Establish and confirm focus on lowrisk deliveries with maintenance/enhancement of referral relationships with designated tertiary centres in Alberta and Saskatchewan. C.18 Recruitment and Retention: Develop a recruitment and retention strategy for Obstetrics/ Gynecology and Pediatrics that supports and sustains demand for service commensurate with population demographics (in conjunction with other health human resources). This strategy needs to address short-term and longer term objectives and should include:


P a g e | 113 Women’s and Children’s Health – Recommended Strategies 18.1 Recruitment Targets: Establish clear recruitment targets for physicians and other health care professionals designed to support effective service delivery for the program. For Women’s Health this requires 4-6 OB/GYN to support service demand presently and over the planning timeframe (average of 250-300 deliveries per obstetricians) 18.2 Recruitment Targets: Three (3) Pediatricians, focused on community practice but available for in-hospital/emergency consultations, to support current requirements and future demand. 18.3 Other health human resources (e.g., specialty nurses) to support current requirements and future demands. 18.4 Longer-Term Recruitment: Implement medium to longer term physician and other health human resource recruitment strategies to support achievement of the long-term service delivery plan. C.19 Ambulatory Clinics: Develop a range of Women’s Health and Children’s Health Clinics that complements in-hospital and public health service delivery. C.20 Develop/Establish/Enforce Care Protocols: Consistent with the service mandate of the program and a focus on low-risk deliveries, the service must establish, confirm and enforce program/service criteria and mechanisms for appropriate to tertiary services as required. C.21 Streamline Work Processes: Improve access, capacity and integration through improved work flow and patient flow processes. This will serve to maintain the current excellent length of stay performance and capacity management of the program and assist in meeting community demand. 21.1 Care and Clinical Pathways: Continue development and implementation of care and clinical pathways. 21.2 Innovation and Informed Practice: Identify and implement new approaches and informed practices to delivering Women and Children’s Services. This will require an ongoing monitoring capacity for identifying and adapting best practices from within Alberta, Saskatchewan and other relevant jurisdictions.


P a g e | 114

4.3.6

Priority 6: Emergency Department: Improve Capacity, Access, Appropriateness and Service Quality

Context and Rationale The Emergency Department serves a dynamic and growing population base. Combined with this reality is the vibrant economy – primarily focused on oil & gas, agriculture and other light industry – which results in relatively high rates of injury presenting to the Emergency Department. This activity is further impacted by Lloydminster’s key location on a major highway with the potential and reality of treating accident victims and being a key service provider for a large transient population. In the past several years, the Lloydminster Hospital Emergency Department has experienced 40,000 visits per year. This has been accomplished within ED stretcher capacity of 18. Emergency Department space has also been shared, particularly in respect of waiting and procedure rooms, with ambulatory care. This results in high congestion for both ED and ambulatory care patients. In addition, this shared space reality puts additional stress on staff trying to manage within a confined work environment. Compounding challenges for service delivery is the lack of ready access to inpatient beds arising from number of medical inpatients waiting placement for other more appropriate community care options. Emergency Department activity is highly impacted not only by increased activity in the ambulatory care environment, but also by fluctuations in access in the community to primary care physicians. This is best illustrated by considering that in 2007/08 fully 81% of all visits to the ED were classified as Level 4 or 5. Following on successful recruitment of a number of general practitioners to the community this has dropped significantly settling in as low as 60% in the past year. Figure 40: Comparison of ED Capacity

Comparison of ED Capacity (e.g., stretchers) City Fort McMurray Grande Prairie Medicine Hat Red Deer Moose Jaw Prince Albert Lloydminster 1. 2.

City Population 2011 65,565 55,032 60,005 97,109 35,671 45,000 27,804


ED Stretcher Capacity2

67,516 121,895 83,224 189,243 41,303 68,638 72,498

27 28 22 52 TBD 19 18



P a g e | 115 Figure 41: Emergency Department - Recommended Strategies

Emergency Department – Recommended Strategies C.22 Upgrade Physical Capacity: Redevelop existing emergency department space to meet current/future standards for emergency services and expand overall physical capacity to address current and future demand. 22.1 Redevelop/relocate ambulatory care space: Ambulatory care services and clinics (with potential inclusion of dialysis and cancer outreach) should be relocated and redeveloped on main floor of current Lloydminster Hospital. This should be designed to eliminate shared space arrangements with the Emergency Department. 22.2 Coordinate Service Delivery Options with Primary Care/Continuing Care: Current and proposed service delivery options in primary care and continuing care will positively impact Emergency Department activity (e.g., continue to lower CTAS Level 4 and 5 visits, reduction in inappropriate inpatient utilization) in both the short- and longterm.

22.3 Establish Appropriate Space for Specialty Services: A range of associated services are managed in the Emergency Department but need upgrades to be fully functional and of a quality necessary to provide appropriate service. This effort should include development/ completion of care space for trauma services and holding space for mental health and addictions. 22.4 Establish On-Site/To-Standard Helipad – Construct Helipad appropriate to needs of the hospital and to facilitate rapid transfer to tertiary centres in Alberta/Saskatchewan. This is an immediate/short-term priority. C.23 Streamline Work Processes: Improve access and integration through improved work flow and patient flow processes with specific attention to: 23.1 Consultative Services: Clear and consistent access to specialty consult services whether resident in Lloydminster or through arrangement with tertiary centres. 23.2 Primary Care and Continuing Care Support and Referral: Clear and consistent processes and protocols in place to support referral and transfer of patients more appropriately supported in non-acute care settings. 23.3 Diagnostic Services Access: Establish and consistently meet targets for access to necessary diagnostic modalities and reporting timelines in order to meet Emergency Department access/wait time targets. A key requirement in this regard is establishment of on-site radiologist support.


P a g e | 116 Emergency Department – Recommended Strategies 23.4 Care and Clinical Pathways: Continue development and implementation of care and clinical pathways. This should include: 23.4.1

Coordination and integration with primary care services in the community to ensure proper referral/redirection of patients as appropriate.

23.4.2

Coordination and integration with community and continuing care options (e.g., Home First) to ensure proper referral/redirection as appropriate.

23.4.3

Coordination and confirmed access to appropriate specialized resources (e.g., Pediatrics, Mental Health, Addictions) that ensures timely and appropriate response to clients/patients presenting to the Emergency Department.

23.5 Innovation and Informed Practice: Identify and implement new approaches and informed practices to delivering Acute Care Services. This will require an ongoing monitoring capacity for identifying and adapting best practices from within Alberta, Saskatchewan and other relevant jurisdictions. C.24 Support/Advocate for ALS EMS Service: The Lloydminster area has been underserved by EMS and has relied on ALS services in other communities. This impacts both quality and timeliness of response both for Lloydminster and surrounding communities.

4.3.7

Priority 7: Clinical and Logistical Support Services: Ensure Access to Support Services Commensurate with Clinical Requirements

Context and Rationale To support effective and efficient delivery of acute care services at the Lloydminster Hospital, a range of clinical and logistical support services are required. At the present time, the lack of a complete complement of such services is already impacting services at the site. This is noted by existing vacancies in rehabilitation therapies, shortage of ultrasound technicians, and insufficient in-house radiologist support. As plans are developed and implemented to enhance the range of acute care services at the Lloydminster Hospital efforts will have to be ramped up to deal with existing gaps and prepare for service delivery into the future.


P a g e | 117 Figure 42: Clinical and Logistical Support Services - Recommended Strategies

Clinical and Logistical Support Services – Recommended Strategies C.25 Expand/Upgrade Physical Capacity: Redevelop existing clinical and logistical support space to meet current/future standards and expand overall physical capacity to address current and future demand. 25.1 Work Space for Clinical Support Services: In some circumstances appropriate space for undertaking and completing necessary work is inadequate to service demands (e.g., health records, respiratory therapy, rehabilitation therapy) either in the short-term or long-term and is to be addressed as part of physical redevelopment of the site as envisioned in the updated master capital plan. 25.2 Storage Space for Clinical Support Services: In some circumstances appropriate space for equipment or storage of materials/records is inadequate to meet service requirements. Solutions may require development of on-site storage, off-site storage, or in the case of health records an approach to electronic scanning/storage should be pursued. C.26 Coordinate Service Delivery Options with Community/External Providers: Current and proposed service delivery options will benefit from partnerships with a variety of existing partners (e.g., private providers, Onion Lake, adjacent facilities/health authorities) in both the short- and long-term. C.27 Capital Equipment Enhancements: Review and upgrade equipment capacity to ensure timely access to clinical support services either in terms of diagnostic information or reporting requirements to support quality and timely service delivery. This may include: 27.1 Identifying relatively low-cost investments in equipment that can establish high return on investment relative to reduced length of stay and other patient care services results. 27.2 Identifying point of care testing and remote monitoring opportunities to leverage scare human resources while still meeting service objectives and patient expectations. C.28 Recruitment and Retention: Develop an aggressive recruitment and retention strategy for clinical and other support service functions critical to supporting acute care service requirements in the short-term and ensure ability to meet mandate as population demand grows. The plan should include: 28.1 Recruitment Targets: Establish clear recruitment targets for all categories of clinical and other support staff designed to support effective service delivery for the program. In particular, ensure that all current vacancies can be filled while at the same time establish objectives for other professional staff required to fulfill current and future service mandate (e.g., respiratory therapy, clinical pharmacists, dietitians, occupational therapy, physical therapy, therapy aides).


P a g e | 118 Clinical and Logistical Support Services – Recommended Strategies 28.2 Recruitment and Retention Strategies: Partnerships with a variety of stakeholders (e.g., municipal governments, provincial governments, adjacent health authorities, Onion Lake, private providers) will have to be undertaken to develop innovative and creative means of attracting and maintaining necessary access to key personnel. 28.3 Private/Public Partnerships: As realities/circumstances dictate, there may be requirement to consider contracting out certain specialized services (e.g., access to radiologists, MRI access) to support acute care delivery. 28.4 Service Relationships with Tertiary Centres: As realities/circumstances dictate, there may be requirement to consider contracting with other centres to gain timely access to hard-to-recruit specialty services (e.g., radiologists, intensivists) to support acute care delivery. 28.5 Longer-Term Recruitment: Implement medium to longer term physician and other health human resource recruitment strategies to support achievement of the long-term service delivery plan. C.29 Streamline Work Processes: Improve access and integration through improved work flow and patient flow processes. Specifically: 29.1 Internal Processes: Continue current LEAN activity and other clinical process reviews to reduce waste and unnecessary steps in the care process. This will have relevance for all clinical support services from laboratory and diagnostics, to admitting and health records, to housekeeping and maintenance. All efforts will need to be focused on and support effective and efficient inpatient management and discharge planning. 29.2 Innovation and Informed Practice: Identify and implement new approaches and informed practices to delivering clinical and support services. This will require an ongoing monitoring capacity for identifying and adapting best practices from within Alberta, Saskatchewan and other relevant jurisdictions. C.30 Information Technology and Information Management: Enhance access to data and information required to optimize care. Specifically: 30.1 Establish a plan to fully implement an Electronic Medical Record for the hospital tied to primary care settings, other health authority operations and that effectively integrates and coordinates with systems in both Alberta and Saskatchewan. 30.2 Determine the data and informational elements required to support effective clinical support services management.


P a g e | 119 Clinical and Logistical Support Services – Recommended Strategies 30.3 Determine information technology resources required to support required data collection and management. 30.4 Acquire the required resources and provide supporting training and development for health care workers. 30.5 Ensure effective centralized data management and monitoring of results being achieved; and 30.6 Determine how information should be shared across providers and jurisdictions.

4.3.8

Priority 8: Ambulatory Care Services: Establish a Range of Ambulatory Care Services that Appropriately Support and Complement Inpatient Acute Care and Primary Care Programming

Context and Rationale Ambulatory Care services has seen strong growth particularly in the last three years and in particular in those services supporting changes in the surgical service at the site (e.g., cast clinic, orthopedic clinic). In some circumstances this growth has been constrained by physical limitations of space (e.g., shared space with Emergency Department, inadequate space for renal dialysis) and lack of availability of some key human resources (e.g., cardiac stress test, ultrasound tech). Ambulatory Care services can serve an important and critical function in the continuum of care ensuring appropriate support to both inpatient acute care services and primary care services in the community. Critically important in establishing and supporting this role is ensuring that such services do require the utilization of skills and infrastructure typically associated with ambulatory care and do not, in fact, address services that are more appropriately managed in a primary care setting. Figure 43: Ambulatory Care Services - Recommended Strategies

Ambulatory Care Services – Recommended Strategies C.31 Confirm/Clarify Collaborative Service Delivery Model: Establish and confirm the focus for ambulatory care services, specifically how the service will serve as an appropriate adjunct for inpatient care services, serve the specialized role in service delivery that it should, and act as a complement to primary care services available in the community.


P a g e | 120 Ambulatory Care Services – Recommended Strategies 31.1 Focus on and Develop Specialized Service Delivery Options: This will include Medical Day Clinics (e.g., remicade, blood transfusions, iron transfusions, phlebotomy, IV Therapy), Chemotherapy, Renal Dialysis, Pre-Admission Surgical Clinics, Surgery Clinics, Minor Surgery/ Procedures, Cast Clinic, cardiac stress test, and similar programming. C.32 Expand/Upgrade Physical Capacity: Redevelop existing ambulatory care space to ensure ability to meet service mandate (as defined above) and meet service demands in the short- and long-term. 32.1 Given pressures on existing hospital infrastructure and demands on inpatient services in particular, all efforts should be made in the short term to relocate ambulatory services off of inpatient units to main floor of the Lloydminster Hospital and/or to other PNRHA sites in the community (e.g., Co-op Plaza, Lloydminster Long-Term Care). 32.2 Redevelop/relocate ambulatory care space: Ambulatory care services and clinics (with potential inclusion of dialysis and cancer outreach) may not require hospital grade infrastructure. Inclusion in or proximity to the hospital (e.g., main floor of existing hospital) or development of other community locations (e.g., Co-op Plaza, Lloydminster Long-Term Care) may be desirable if suitable space can be developed and other operational considerations permit (e.g., staffing efficiency). C.33 Coordinate Service Delivery Options with Primary Care/Continuing Care: Ambulatory Care services must act as an appropriate adjunct and support to primary care and continuing care service options. C.34 Streamline Work Processes: Improve access and integration through improved work flow and patient flow processes. Specifically: 34.1 Internal Processes: Continue current LEAN activity and other clinical process reviews to reduce waste and unnecessary steps in the care process. 34.2 Care and Clinical Pathways: Continue development and implementation of care and clinical pathways. This should include: 34.3 Coordination and integration with primary care services in the community to ensure proper referral/redirection of patients as appropriate. 34.4 Innovation and Informed Practice: Identify and implement new approaches and informed practices to delivering ambulatory care services. This will require an ongoing monitoring capacity for identifying and adapting best practices from within Alberta, Saskatchewan and other relevant jurisdictions.


P a g e | 121 Ambulatory Care Services – Recommended Strategies C.35 Effective Use of Telehealth Services: Ambulatory Care services can benefit from an effective use of Telehealth services especially relating to management of scarce specialized human resources. Develop clear and specific goals and objectives for the service as part of an overall plan to support not only acute care services, but also community care and continuing care service delivery.

4.3.9

Facility Implications – Acute Care Services

Existing Situation Acute Care services for Lloydminster and the surrounding acute care catchment area are provided at the Lloydminster Hospital. It currently operates with approximately 66 acute care beds and a broad range of medical, surgical, diagnostic and treatment services, together with administrative and logistical support services. A summary description of the program/service elements presently in the hospital is provided in the Facilities Assessment Section of this report. Constructed in 1987, the Hospital is 26 years old. It was built to serve a population of approximately 15,500 residents in the City of Lloydminster and immediate surrounding area. It is estimated that it now serves an acute care catchment area of over 72,000 people, i.e. four to five times the number of people from when it opened. The Hospital is a three-floor building of approximately 10,500 square metres located on a 6.3 hectare site (15.6 acres). The Hospital building, outbuildings, and parking occupy only about 50% of the total site area; much of the remainder is playing fields. The Hospital has undergone various renovations and minor expansions in recent years and a number of Hospital administrative and support functions have been moved off site to provide space to maintain the delivery of acute care services, e.g. to the Co-op Plaza. Master Plan Update Overview The Lloydminster Hospital Functional Program & Master Plan prepared in 2007 provided a planning framework and strategy together with recommendations for the staged redevelopment of the Hospital facilities, intended to address both immediate/short term priority needs and longer term growth requirements. The intent in this report is to identify key high-level updates and changes to the Master Plan findings and recommendations based on the Service Priorities and Strategies identified in this 2013 Service Assessment.


P a g e | 122 As an overarching observation, Based on our assessment of the current situation and the priorities and strategies arising out of this 2013 Service Assessment, the general approach and staged expansion and redevelopment of the Hospital as proposed in the 2007 Master Plan continues to remain valid and reflect priority needs, albeit with appropriate refinements and updates in some of its details. For example, the current Service Assessment recommends a total acute care bed requirement of 117-125 beds within the 15 year time frame (i.e. 2027), which is generally consistent with the 102-116 beds projected for 2021 in the 2007 Master Plan. Differences of note in the current Service Assessment are the increased growth in surgical services, i.e. 6 vs. 4 OR’s, 20 vs. 12 day surgery beds and 24-32 vs. 21-25 inpatient surgical beds; and others such as 8 vs. 4-6 ICU beds; and 12 vs. 8-10 mental health beds. Projected bed numbers in the other services are generally consistent with the 2007 Master Plan. Other priorities such as Ambulatory Care and Emergency have changed little from the 2007 Master Plan. Building Evaluation The Hospital building has an FCI of 0.26 indicating that it has some significant deferred maintenance and upgrading issues, although not necessarily at the point of replacing the building, i.e. the building continues to have a reasonable life expectancy assuming the deferred maintenance needs are properly addressed. Consistent with the findings of the 2007 Master Plan and based on our observations and discussions with PNRHA staff the key highlights include:  The building envelope needs to be renewed to eliminate moisture penetration problems and provide appropriate environmental control and humidification (this accounts for close to 30% of the FCI costs). This is a critical requirement given the assumption that the Hospital building will continue to operate as an acute care facility for at least the next 15+ years.  Portions of the mechanical and electrical systems are near or beyond their useful life, as well as reconfirmation that the mechanical and electrical systems do not have the capacity to serve any major building expansion.  Elevators require upgrading and modernization.  While it was determined that the building structure is capable of accommodating an additional floor (of light-weight construction), this is not deemed advisable or cost effective for reasons such as: the age of the building; layout constraints; additional and costly changes to elevators, stairs and building services; and the major disruptions it would cause to ongoing operations.


P a g e | 123 It should be noted that the scope of this Service Assessment study did not include the engagement of engineering and architectural consultants to formally update the physical assessment of the Hospital buildings and systems that was done as part of the Master Plan work in 2007. Site Review The development of a Helipad to facilitate rapid transfers to tertiary centres in Alberta and Saskatchewan is an immediate/short-term priority. The proposed location on the southwest sector of the site is understood to meet flight path requirements and will be proximate to the proposed location of Emergency in the Stage 1 expansion. The site continues to have significant expansion capacity with approximately 50% of the site area available for development. However, the proposed scale of Hospital expansion and eventual phased replacement, the development of a Helipad, the need for additional parking, and likely a future road access from 36th Street could conceivably exceed the site’s capacity, even within the 15 year time frame. Accordingly, the recommendation to acquire a portion of the undeveloped land (owned by Husky Oil) is suggested to be even more urgent than it was in 2007 as a longer term strategy. A portion of the land could also serve as a location for the future replacement of the Jubilee Home. Functional Assessment Most of the findings and priorities identified in the 2007 Master Plan functional evaluation continue to be valid and in some cases have become exacerbated due to increasing workload demands, higher levels of patient acuity, and simply the passage of time. At the risk of repeating what is described in the Facilities Assessment section, a summary of the most critical functional issues that impact on program/service delivery include:  Ambulatory Care has no appropriate space and is currently occupying Emergency stretchers and inpatient areas. This includes ambulatory clinics, day medicine and the congested and poorly located outpatient chemotherapy, day surgery, renal dialysis and endoscopy program areas.  Surgical facilities are significantly inadequate and do not meet current standards. This includes undersized, outdated and insufficient OR’s, makeshift day surgery facilities, lack of proper patient preparation/holding and recovery spaces, inadequate equipment and supply areas and congested internal flow issues.  The MDR space is undersized and does not meet current standards, which challenges the ability of staff to maintain stringent infection control practices. The pressure on the MDR facilities is and will continue to be compounded by the significant growth in surgical activity.


P a g e | 124  There is a severe shortage of single and isolation bedrooms on the both inpatient floors, as well as facilities for bariatric patients, for on-unit rehabilitative therapy, for education and teaching, and for both family and staff support.  There are no in-patient rooms designated and appropriately designed for mental health patients (using medical beds).  The existing special care beds do not meet current standards or the requirements to enhance the service into a 4-bed intensive care unit.  Emergency facilities, although recently renovated in selected areas, fail to meet current standards in terms of the size and separation of treatment spaces, facilities for trauma, isolation and for acute mental health and addiction patients, ambulance bay capacity, etc. Equally critical is the inappropriate daily use of at least 4 of the 18 Emergency spaces for Ambulatory Care activities, which increases the space pressures in Emergency.  Certain clinical support services and functions also have significant space issues including of note respiratory therapy, health information services, education and conference space and Telehealth facilities.  Material Management functions are facing increasing space pressures due to the need to provide more on-site storage as the Hospital’s activity volumes continue to grow. Recognizing that current best practice guidelines suggest up to 100% single bedrooms in acute care, the 2007 Master Plan included an assessment of the potential ability of the two existing inpatient floors to accommodate more single bedrooms and the impact this would have on total bed capacity. The analysis indicated that:  The Hospital currently has less than 30% single bedroom accommodation.  At a ratio of approximately 50% single bedrooms, the two existing Hospital floors could accommodate a total of about 75-80 beds.  At a ratio of approximately 75-80% single bedrooms, the two existing Hospital floors could accommodate a total of about 60-65 beds. A key outcome of these findings is that it will be necessary to include a component of new inpatient facilities in the first phase of Hospital expansion in order to meet the Service Assessment bed targets.


P a g e | 125 Facility Development Requirements Priority Needs – Immediate and Short Term (i.e. 0-5 years) To summarize, based on the Service Assessment priorities and strategies and the current functional assessment, the highest priority requirements that need to be addressed in the immediate and shortterm phases of Hospital redevelopment and expansion are:  Ambulatory Care, including medical day care, ambulatory clinics, outpatient chemotherapy, renal dialysis, and endoscopy. While the short term plan is to provide new Ambulatory Care facilities in the Stage 1 expansion, there is an immediate need to relocate some Ambulatory Care services out of the Emergency and inpatient areas to reduce constraints on those services.  Surgical Services, including new and expanded surgical suite facilities with 4-6 OR’s and all requisite patient recovery and support areas, day surgery with up to 16-20 beds and expanded inpatient surgical beds. Again, while the short term plan is to provide new Surgical facilities in the Stage 1 expansion, there is an immediate need to add a 3rd OR and to add 6-8 surgical beds within existing building space, by decanting other ‘less essential’ functions.  Mental health beds and facilities - there is an immediate need to fully operationalize the mental health space in Emergency and eventually to add a 2nd space. There is also an immediate need to develop 2-3 mental health beds that is discussed in the Primary and Community Health Services section. It is assumed the subsequent development of up to 12 mental health beds will be completed as part of the Stage 1 redevelopment.  ICU - the immediate need is to expand the special care unit into a 4-bed ICU, while the development of an 8-bed ICU and 2 step-down beds will form part of the Stage 1 expansion.  Medical Services – the immediate need is to expand the Palliative Care service to 4 beds within existing space reclaimed on the 3rd floor (project is underway). Given the lack of available space within the Hospital, a second immediate need for geriatric assessment beds may be addressed in another facility in the region, such as Islay.  Emergency facilities - including the immediate reclamation of existing space (by decanting Ambulatory Care) and the development of a new Emergency department in the Stage 1 expansion.  Clinical supports - the immediate priority needs include expansion of the MDR space (in conjunction with the OR expansion), the provision of RT space to support both the ICU development and Ambulatory Care activities, and the relocation/expansion of Health Information Services.


P a g e | 126  Administrative services - while the provision of administrative space is not considered an immediate or short term priority, there is the opportunity to relocate administrative functions out of the Hospital in order to create space for some of the priority acute care needs identified above.  Development of a Helipad is an immediate requirement. Longer Term Needs (6-15 years) There are projected longer term needs, which should be re-assessed at 5-year check points, that will have to be addressed in subsequent phase(s) of development including:  Additional inpatient beds for medical and surgical services, and geriatric assessment.  Build out of the surgical facilities to the total projected need for 6 OR’s and 20 day surgery beds.  Potential expansion of other services including Ambulatory Care, clinical support services, patient/family and staff support services, and possibly certain logistical support services. Master Plan Parameters Reflecting this 2013 Service Assessment and updates to the 2007 Master Plan, the following are suggested as overarching parameters for the Master Plan:  Plan and provide the required facilities to support the secondary referral service role and mandate of the Hospital.  Plan and provide the required facilities to support the role of the Hospital as an academic and teaching centre within the context of its role as a secondary referral centre and a hub for rural acute service delivery.  Optimize the use of on-site Hospital facilities for acute care services and to enhance service delivery and patient access.  Because future service needs are subject to change and potential unanticipated growth: plan open-ended, flexible and adaptable space; provide options for future expansion; and consider the long term expansion needs of the site.  Ensure the immediate and short term (Stage 1) expansion plans fit into a comprehensive, long term redevelopment strategy that enables the rejuvenation and/or eventual replacement of the existing Hospital building.


P a g e | 127  Integrate and locate acute care-based, high volume/ambulatory services at the Hospital in ground level space, while at the same time reclaiming space originally intended for inpatient services.  Plan for a continual increase in the ratio of single bedrooms to address trends and needs related to higher patient acuity, infectious diseases, enhanced recovery times, family-centred care, etc. Phase 1 Development – Years 0 - 5 1. Decanting and Renovation Plans to Address Immediate Priority Needs: There are potential opportunities that could be implemented over the next 0-2 years in order to address immediate priority needs within the existing Hospital facilities. These would need to be coordinated with certain development options identified in both the Primary and Community Health Services and Continuing Care Sections, including the potential use of space in the CHS building, in Coop Plaza and in other PNRHA facilities. Options and key aspects of these potential developments include:  Relocation of Administrative Functions out of the Hospital - There are certain administrative functions that could potentially operate outside of the Hospital walls, which could even possibly include a portion of health information services staff such as transcriptionists. The preferred location that would retain a close proximity to the Hospital is the adjacent CHS building. The use of the CHS building as administrative support space for the Hospital could in fact represent a longer term strategy for the Hospital site. In addition to staff offices and workstations, it could accommodate meeting and conference space, education space, files/storage space, and the like. Of course, the precursor to this strategy is the need to move Mental Health and Addictions and/or Home Care out of the CHS building. The suggested location for both of these programs, pending space availability, is in Co-op Plaza together with most other community-based health services. The vacated administrative space in the Hospital could accommodate (partially) the relocation of health information services, which would free up space for the interim expansion of the surgical suite facilities and possibly the day surgery beds (which would free up surgical inpatient beds). In conjunction with the interim surgical suite expansion, the MDR could expand into the adjacent former laundry space.  Interim Relocation of Ambulatory Services out of Prime Hospital Space - There is the opportunity to create needed space within the Hospital related to the current ambulatory service components. It is proposed to look at those ambulatory services that could move off site for an interim period (or permanently if deemed appropriate). The suggested services to


P a g e | 128 consider relocating are: outpatient rehabilitative services (i.e. the main floor therapies space), renal dialysis (would need to retain at least one station for inpatient dialysis), and outpatient chemotherapy. Potential off-site locations for these services include: 

Co-op Plaza: Depending upon space availability, any of these three services could operate in the Co-op Plaza space, potentially in conjunction with other ambulatory health services located there. Given the pending growth needs of renal dialysis in particular, it should be located in a space that provides the opportunity for short term expansion.



DCECC: Once the new Lloydminster Long Term Care facility opens, the number of residents at the DCECC will reduce from 105 to 50, which it is anticipated will free up rehabilitative services space at the DCECC. Outpatient rehabilitative services could relocate to the DCECC, either as an interim move, or as a permanent move in conjunction with suggested the development of the DCECC site as an expanded Community of Care facility.



CHS Building: Only as an interim solution, it may be possible to accommodate outpatient chemotherapy (and/or renal dialysis) in the CHS building. This is suggested because the building has previously served as clinical outpatient space over the years for programs such as public health. Other Sites in the Region: Again, only as an interim solution, there may be the opportunity to accommodate the renal dialysis program at another AHS health care site in the region.



The immediate benefits of moving these services off the Hospital site are as follows:





Ambulatory clinics and services such as medical day care, cast clinic, etc. (that cannot move off site) could relocate into the vacated therapies space, which would provide improved and expanded facilities for these services and addresses the priority space issues in Emergency.



Inpatient space would be reclaimed from renal dialysis and outpatient chemotherapy to provide additional beds (e.g. mental health and surgical) as well as to address the need for improved inpatient facilities such as single and isolation bedrooms.

Until further plans and details are developed, it would be too speculative to estimate even an order of magnitude cost for these suggested moves and renovations.


P a g e | 129 

2.

From a time frame perspective, these immediate developments will take about 6 months to 2 years to implement, depending upon the scope of work, funding and approvals.

Stage 1a - Expansion of the Hospital: As noted previously, it is suggested that the Stage 1 expansion concept identified in the 2007 Master Plan continues to reflect what should be included in the 5 year plan. Key aspects and requirements of the Stage 1 expansion include:  Considering the updated Service Assessment requirements and projections, the scope and scale of the Stage 1 expansion has increased and initially will now likely require three full floors of developed space.  From the perspective of site availability, connections to the existing Hospital, internal and external access routes, the location of the proposed Helipad, and allowance for future horizontal growth, the preferred location of the Stage 1 expansion continues to be towards the south and southwest, i.e. ‘rear’ of the site.  As a very preliminary concept, which takes into consideration the Phase 1 priority needs as well as commonly recognized functional and program/service adjacencies, the ‘stacking’ of the three floor expansion generally could include the following services: 

Level 1: On-site Ambulatory Care/Outpatient services, Emergency services including ambulance bay, and possibly other services such as such as Pharmacy (to free up existing inpatient space).



Level 2: Surgical Suite, Day Surgery, and possibly other services such as Respiratory Therapy and MDR.



Level 3: Surgical Inpatient beds and ICU.

 For the other inpatient services, the existing two upper floors of the Hospital would potentially accommodate the growth needs of Medicine, Mental Health and Obstetrics.  As a very preliminary estimate, the scale of the Stage 1 expansion could be in the order of at least 10,000-12,000 square metres (or more) and an order of magnitude capital cost of approximately $150-$200 million in today’s dollars.  Depending upon factors such as funding commitments, approvals, etc. the Stage 1 project could be completed as soon as 4-5 years, which implies a relatively aggressive schedule. To meet the 4-5 year target, initial planning and programming work would need to commence immediately.


P a g e | 130  As noted previously, given the substantial scale of expanding and upgrading the existing facility, the option of replacing the Hospital at this time may continue to warrant consideration, albeit at a significantly higher capital cost. Assuming not, however, it is critical that the Stage 1 expansion be planned and designed to incorporate the eventual replacement of the existing Hospital building and subsequent phase(s). Phase 2 – Years 6 - 10 3.

Stage 1b - Redevelopment of the Existing Hospital: Once the Stage 1 expansion is complete and occupied, the vacated space on floors 2 and 3 of the existing building can be renovated and re-claimed as inpatient space, both to address current deficiencies such as the shortage of single and isolation bedrooms, and to provide additional inpatient beds as recommended in the Service Assessment. The vacated main floor space can also be renovated and re-assigned to meet future growth needs in potential areas such as ambulatory care, diagnostic imaging, , laboratory, allied health services, health information services, repatriation of site-based administrative services, logistical support services, etc. In the 2007 Master Plan, the preliminary estimated capital cost for the functional renovations and physical upgrading (including building envelope) to the existing Hospital was approximately $30 million in current dollars. This scale of investment in the existing facility assumes it will continue to serve for a minimum of another 15 years. Assuming the Stage 1a expansion is complete in 5 years, the Stage 1b renovation work could be completed in years 6 and 7.

Phase 3 – Years 11 - 15 4.

Potential Stage 2 Expansion: Based on the Service Assessment projections and updated Master Plan requirements, it would appear that a Stage 2 expansion will not be required until after the 15 year time frame. This assumes that the existing two upper floors of the Hospital will accommodate the 10-15 year inpatient growth needs of Medicine, Mental Health and Obstetrics. This is feasible, noting however, it means accepting certain compromises such as a lower ratio of single bedrooms. To accommodate longer term (i.e. 15+ year) growth needs, three master planning options could be considered: include a 4th floor of shelled space for future inpatient beds (has significant capital cost implications), design the building to accommodate vertical expansion (has less capital cost implications but can be very disruptive when implemented), or design for horizontal expansion (has minimal capital cost implications but may compromise functional adjacencies and circulation flows).


P a g e | 131 At this time, given that the 15 year needs appear to be met in the Stage 1a/b developments, investing capital dollars in either shell space or vertical expansion capability does not appear to be warranted. Nevertheless, it is recommended that at the 5 year check point, projected service growth and space requirements be reviewed to determine the impact on the Master Plan and the potential need for a Stage 2 development. At that time, it may be determined that the Stage 2 development will actually represent the required eventual replacement of the existing Hospital building.


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SECTION 5: IMPLEMENTATION SCHEDULE AND ORDER OF MAGNITUDE FACILITY COSTS

Lloydminster Health Services Needs Assessment – Implementation Schedule and Order of Magnitude Facility Costs

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5.0

IMPLEMENTATION SCHEDULE AND PRELIMINARY FACILITY CAPITAL COST ESTIMATES

5.1

Phased Implementation Schedule

Figures 44 to 46 provide a summary of the proposed phased implementation schedule in five year increments for all recommended strategies in each of the three program groupings. Figure 44 focuses on Primary and Community Care, Figure 45 on Continuing Care, and Figure 46 on Acute Care. Strategies that are ongoing or can be advanced fairly quickly within existing human and capital resource constraints tend to be front loaded in the implementation schedule. In addition strategies that represent “quick-wins” are scheduled for early implementation. The proposed facility development components for each of the program groupings and the interrelationships and inter-dependencies are outlined in more detail in Section 4 of this report. It is anticipated that once the plan is approved, lead role responsibilities for all strategies will be established; more detailed tactical plans will be developed; required resources will be identified and allocated; and strategy implementation will be monitored against established metrics. Progress on the plan should be tracked on an ongoing basis with annual reviews and updates completed each year. A major review, particularly of progress on facility development projects, is proposed at five year increments to ensure that the plan still reflects the evolving needs and circumstances within the Lloydminster service area.

5.2

Facility Development Plan Including Order of Magnitude Costing

Figure 47 provides a summary of the phased facility development plan that addresses the identifiable facility implications arising out of the recommended strategies in all three program groupings. The facility development plan identifies the potential capital projects, appreciating that in some cases the projects may overlap and/or could be combined into one larger project. A time frame is shown for each capital project that takes into consideration the normal steps of planning/programming, design, tendering, construction and commissioning and assuming a relatively continuous process of reviews and approvals along the way. Clearly, these time frames are contingent upon timely funding approvals. Preliminary, order of magnitude capital cost estimates are included for most of the capital projects. The estimates are in current dollars (i.e. they exclude escalation) and are based on an estimated facility size and average cost per square metre. Detailed cost estimates for each project will need to be completed by a qualified quantity surveyor/cost consultant before finalizing the facility projects budgets. Lloydminster Health Services Needs Assessment – Implementation Schedule and Order of Magnitude Facility Costs

P a g e | 134

5.3

Proposed Implementation Schedule

5.3.1

Primary and Community Care Services Figure 44: Implementation Schedule - Primary and Community Care Services

PRIMARY AND COMMUNITY SERVICES Phase 1 - Years 0 -5

Priorities and Strategies

YR 1

YR 2

YR 3

Phase 2 - Years 6 - 10 YR4

YR 5

YR 6

YR 7

YR 8

5 Yr Check Pt

YR 9

Phase 3 - Years 11-15 YR 10

YR 11

YR 12

YR 13

5 Yr Check Pt

Priority 1: Improve 24/7 Access to Primary Care A.1

Primary Care Service Integration 1.1 Client Voice

Plan, develop & implement

1.2 Vision for Primary Care 1.3 Operating Principles 1.4 Service Focus 1.5 Management Structure 1.6 Innovative Service Delivery Options 1.6.1 Primary Health Care Centre 1.6.2 TeleHealth 1.6.3 Remote Monitoring 1.6.4 Collaborative Practice 1.7 Staffing Plans 1.8 Facility Development - Plaza

A.2 A.3

Develop, train, implement

Ongoing implementation


Expanded After Hours Care Recruitment and Retention 3.1 Physician Resources 3.2 Other Health Care Staff

Short term strategy - 8-10 GPs

Ongoing recruitment to respond

to growth and retirements

Fill funded positions; AHS-PNRHA alignment

Ongoing recruitment to respond

to growth and retirements

Lloydminster Health Services Needs Assessment – Phased Implementation: Primary and Community Services

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YR 1

YR 2

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YR 5

YR 6

YR 7

YR 8

5 Yr Check Pt

A.4

YR 10

YR 11

YR 12

YR 13

5 Yr Check Pt

Onion Lake Primary Health Care Collaboration 4.1 Short-term Physician Support 4.2 Technology and Information Sharing 4.3 TeleHealth Consultation 4.4 24-hr Observation Beds 4.5 Discharge Planning 4.6 EMS 4.7 Education and Training

Implement plan


In-patient Mental Health Beds Emergency MH Services Screening, Detection and Intervention Client Self-Management Shared Care Model Care Pathways Awareness and Understanding Addictions Services Plan

ST - 2 Med Beds

New building -12

12.1 Crisis Management Services 12.2 Improved Community Triage

Develop plan

12.3 Access to Detox Services

Funding for Slim Thorpe beds

Priority 2 Mental Health and Addictions A.5 A.6 A.7 A.8 A.9 A.10 A.11 A.12

YR 9

Phase 3 - Years 11-15

12.4 Outpatient Addictions Services 12.5 Education and Prevention

Enhance Ongoing implementation Ongoing implementation Ongoing implementation

Develop plan

Enhance services Develop & Implement



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YR 1

YR 2

YR 3


YR 5

YR 6

5 Yr Check Pt

A.13

Communications

Priority 3: Chronic Disease Prevention and Management A.14 A.15 A.16 A.17 A.18 A.19

Health Promotion Prevention Self-management Education and Communication CDM Focus Innovative Practices

Ongoing implementation Ongoing implementation Ongoing implementation Ongoing implementation Ongoing implementation Ongoing implementation

Priority 4: Rehabilitation Services A.20 A.21 A.22 A.23 A.24

Community Rehabilitation Services Acute Care Rehabilitation Services Rehabilitation Human Resources Service Alignment Early Intervention

Access capacity excess staff capacity at Daysland and Two Hills Continue active recruitment strategies Continue active recruitment strategies Coordinate staffing with AHS-PNRHA Ongoing implementation

Priority 5: Sexual Health and Harm Reduction A.25

School and Community-based Programs

A.26

Communications

A.27

Screening, Detection, Treatment and Follow-up

A.28

Industry Partnerships

Ongoing implementation Ongoing implementation Ongoing implementation Ongoing implementation


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YR 11

5 Yr Check Pt

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YR 3


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YR 6

5 Yr Check Pt

A.29

Harm Reduction Programs


Priority 6: Maternal and Childhood Development A.30

Pre-natal Screening, Natal and Post Natal Screening

A.31

Pre-school Partnerships

A.32

Service Alignment

A.33

Immunization

A.34

Onion Lake Collaboration

A.35

Maternal/Child Education

A.36

Child Friendly Communities

Ongoing implementation Ongoing implementation Ongoing implementation Ongoing implementation Ongoing implementation Ongoing implementation

Priority 7: Health Promotion, Disease and Injury Prevention A.37

Health Status Improvement Priorities 37.1 Children's Nutrition 37.2 Active Lifestyles 37.3 CDM Prevention 37.4 Mental Health and well-being

Ongoing implementation Ongoing implementation Ongoing implementation

37.5 Addictions 37.6 Injury Prevention Lloydminster Health Services Needs Assessment – Phased Implementation: Primary and Community Services

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YR 11

5 Yr Check Pt

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5 Yr Check Pt

A.38

Screening and Early Detection

YR 9


YR 11

YR 12

YR 13

5 Yr Check Pt


Priority 8: Health Care Education and Teaching Centre A.39 A.40

Learning Culture Family Physician Education

Plan and implement

A.41

Family Medicine Training and Supports

Plan and incorporate into primary care and new hospital

A.42 A.43 A.44

Other Health Care Workers Education Priorities Supports and Incentives Grow Your Own Program

Plan and implement







Plan and Develop supports Plan and implement


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5.3.2

Continuing Care Services Figure 45: Implementation Schedule - Continuing Care Services

CONTINUING CARE SERVICES Phase 1 - Years 0 -5


YR 1

YR 2

YR 3

YR4

Phase 2 - Years 6 - 10 YR 5

YR 6

YR 7

5 Yr Check Pt

YR 8

YR 9


YR 11

YR 12

YR 13

5 Yr Check Pt

Community of Care B.1

Develop Lloydminster Community of Care Concept 1.1 Plan Development 1.2 Short-term Implementation Plan 1.3 Longer-term Implementation Plan

B.2

Ongoing

Education, Communication and Advocacy 2.1 External Stakeholder Engagement 2.2 Internal Stakeholder Engagement 2.3 Community Focused Engagement

B.3

Engage Clients and Families in their Care 3.1 PNRHA Staff Training 3.2 External Service Provide Training

Build Supportive Living Capacity B.4 B.5

Short-term Strategy Identify and Confirm Long-term Supportive Living Requirements

Plan

Build

Lloydminster Health Services Needs Assessment – Phased Implementation: Continuing Care Services

implementation


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YR 2

YR 3

YR4


YR 6

5 Yr Check Pt

B.6

YR 10

YR 11

YR 12

YR 13

5 Yr Check Pt

Jubilee Home redevelopment

Enhanced Home Care Services B.7 B.8

Common Home Care Service Delivery Model Self-managed care / Individualized Care

B.9

Minimum Data Set Contact Assessment

B.10 B.11 B.12 B.13

Home First / ED to Home Tele-Home Care Expand Day Programs Streamline Work Processes Redevelop Home Care Space

Relocate HC to Plaza; relocate admin functions to CS Build; dev main fl hosp. for ambulatory

Health Service Provider Resources Targeted Recruitment and Retention for Continuing Care 15.1 Recruitment Target 15.2 Immediate NP Recruitment

B.16

YR 9

Apply Comm of Care concept; Demolish old wing of DCECC; open new LLTC facility

6.2 Long-term Plan

B.15

YR 8

Long-term Care Facility Development 6.1 Short-term Plan

B.14

YR 7


Establish Standards and Guidelines


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YR4


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YR 7

5 Yr Check Pt

B.17 B.18

Communication- Public and Provider Inter-disciplinary Teamwork

Transition Unit B.19

Develop Transition Unit 19.1 Transition Unit Vision 19.2 Staffing Plan 19.3 Facility Requirements/Development

B.20 B.21 B.22 B.23

Use AHS surplus capacity

Develop unit on

Inter-disciplinary Teamwork Care Pathways Standards and Guidelines Communications Plan

Palliative Care Services B.24 B.25 B.26

Develop Palliative Care Program Inter-disciplinary Team Development Education and Communication

Respite Care B.27

Develop Respite Program

Specialty Continuing Care Services B.28

Explore Feasibility of Providing Specialty Services 28.1 Acquired Brain Injury


Old Dr. Cooke site

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YR 11

5 Yr Check Pt

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YR 13

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YR 3

YR4


YR 6

5 Yr Check Pt 28.2 Fetal Alcohol Spectrum Disorder 28.3 Amyotrophic Lateral Sclerosis


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5 Yr Check Pt

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YR 13

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5.3.3

Acute Care Services Figure 46: Implementation Schedule - Acute Care Services

ACUTE CARE SERVICES Phase 1 - Years 0 -5


YR 1

YR 2

YR 3

YR4


YR 6

YR 7

YR 8

5 Yr Check Pt

YR 9


YR 11

5 Yr Check Pt

Medicine C.1

C.2

Recruitment and Retention of Human Resources 1.1 Physician and NP Recruitment

NPS and geriatrician

1.2 Other Health care Staff Recruitment

PT/OT/RT/

Infectious Disease Specialist

6 Internists

Streamline Work Processes 2.1 Internal Processes

LEAN, discharge planning, clinical networks, etc.

2.2 Care and Clinical Pathways 2.3 Innovation and Informed Practice

C.3 C.4

Inter-disciplinary Teamwork Enhance Inpatient Bed Capacity 4.1 Inpatient Medical beds 4.2 Inpatient Palliative beds 4.3 Geriatric Assessment and Rehab Beds

Expand to 48 Expand to 4

Expand to 6 beds Expand to 6 beds

Mental Health and Addictions Services C.5 C.6

In-patient Mental Health Beds MH Services 2.1 Psychiatric Resources 2.2 Mental Health Responders

On call psych service

Lloydminster Health Services Needs Assessment – Phased Implementation: Acute Care Services

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YR 1

YR 2

YR 3

YR4


YR 6

YR 7

YR 8

YR 9

5 Yr Check Pt 2.3 Mental Health Holding Spaces in ER

C.7 C.8 C.9

1 space


YR 11

YR 12

5 Yr Check Pt

Expand to 2 spaces

Recruitment and Retention of HR Resources Inter-disciplinary Teamwork Establish Effective and Efficient Work Processes 9.1 Internal Processes 9.2 Care and Clinical Pathways 9.3 Innovation and Informed Practice

Surgery: Increase Capacity and Improve Access, Appropriateness and Service Quality C.10

Expand/Enhance Physical Infrastructure 10.1. Increase Operating Theatre Capacity

Add 3rd OR

10.2. Increase Inpatient Surgery Beds

Add 6 to 8 beds

Total of 4 ORs

Total of 6 ORs Increase to 24 beds

10.2.3 Increase Day Surgery Beds

Increase to 16

10.3 Relocate/redevelop Endoscopy

Endo 2 rooms + 6-8 beds

10.4 Develop MDRD

C.11

HR Recruitment and Retention Strategy 11.1 Recruitment Targets 11.2 Urology and Plastics 11.3 Perioperative Nursing Staff

C.12

Dependent on increased surgical capacity Meet short term needs as well as future

Streamline Work Processes 12.1 Internal Processes 12.2 Care and clinical Pathways


Demands as surgical capacity increases

Increase to 32 beds Increase to 20

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YR 1

YR 2

YR 3

YR4


YR 6

YR 7

5 Yr Check Pt

Intensive Care Unit Expand/Enhance Physical Infrastructure 13.1 Expand ICU Capacity

ICU- 4 beds

13.2 Establish Step Down Unit

C.14 C.15 C.16

Confirm/clarify Service Delivery Model Inter-disciplinary Teamwork GIM/Intensivist Recruitment 16.2 Recruitment - Other ICU Staff

Women's and Children’s Health C.17 C.18

Confirm/Clarify Service Delivery Model Recruitment and Retention 18.1 OB/GYN 18.2 Pediatricians 18.3 Other Health Care Resources

C.19 C.20 C.21

Ambulatory Clinics Develop/Enforce Care Protocols Streamline Work Processes 21.1Care and Clinical Pathways 21.2 Innovation and Informed Practice


YR 9

YR 10

YR 11

5 Yr Check Pt

12.3 Innovation and informed Practice

C.13

YR 8


ICU - 8 SD - 2

Intensivist resources

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YR 13

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YR 1

YR 2

YR 3

YR4


YR 6

YR 7

YR 8

YR 9

5 Yr Check Pt

Emergency Department C.22

Upgrade Physical Capacity 22.1 Redevelop ED Space

Decant ambul. out of ED

ED Space in new build

22.2 Coordinate Service Delivery Options 22.3 Establish Appropriate Space of Specialty Services

Improve existing space

Develop new space in the new building

22.4 Establish On-site Standard Helipad

C.23

Streamline Work Processes 23.1 Consultative Services 23.2 Primary Care and Continuing Care Support and Referral 23.3 Diagnostic Services Access 23.4 Care and Clinical Pathways 23.5 Innovation and Informed Practice

C.24

On-site radio

Support/advocated for ALS EMS Services

Clinical and Logistical Support Services C.25

C.26

Expand/Upgrade Physical Capacity 25.1 Work Space for Clinical Support Services

RT/HR/PT

25.2 Storage Space for Clinical Support Services

RT/HR/PT

Coordinate Service Delivery Options with Community/External Providers


Part of new building


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5 Yr Check Pt

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YR 1

YR 2

YR 3

YR4


YR 6

5 Yr Check Pt

C.27

Capital Equipment Enhancements 27.1 Low Cost High Return Investments 27.2Point of Testing Care and Remote Options

C.28

Recruitment and Retention 28.1 Recruitment Targets - Funded Vacancies, Therapies, Pharmacy, Dietitians 28.2 Recruitment and Retention Strategies 28.3 Private/Public Partnerships 28.4 Service Relationships with Tertiary Care Centres 28.5 Longer-term Recruitment

C.29

Streamline Work Processes 29.1 Internal Processes 29.2 Innovation and Informed Practice

C.30

Information Technology and Information Management 30.1 Electronic Medical Record 30.2 Clinical Support Data Management 30.3 Establish IT Resource Requirements 30.4 Hire IT Resources and Train Health Care Staff 30.5 Centralized Data Monitoring 30.6 Data Security and Access

C.31

Confirm/Clarify Collaborative Service Delivery Model


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YR 3

YR4


YR 6

5 Yr Check Pt

C.32

Expand/Upgrade Physical Capacity 32.1 Short-term Strategy 32.2 Redevelop/relocate Ambulatory Space

C.33

Coordinate Service Delivery Options

C.34

Streamline Work Processes 34.1 Internal Processes 34.2 Care and Clinical Pathways 34.3 Primary Care Coordination 34.4 Innovation and Informed Practice

C.35

Effective Use of Telehealth Services


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YR 11

5 Yr Check Pt

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5.4

Facility Development Plan - Capital Cost Estimates Figure 47: Facility Development Plan - Capital Cost Estimates

FACILITY DEVELOPMENT PLAN - CAPITAL COST ESTIMATES Projects

Phase 1 - Years 0 -5 Yr 1

Yr 2

Yr 3

Yr4

Phase 2 - Years 6 - 10 Yr 5

Yr 6

Yr 7

Yr 8

5 Yr Check Pt

Yr 9

Phase 3 - Years 11-15 Yr 10

Yr 11

Yr 12

Yr 13

5 Yr Check Pt

A. Community Health Services A.1

Develop the PHCC in Co-op Plaza

$1 million

A.-

Re-locate MH&A to Co-op Plaza

$0.5 million

A.3

Facilities to Recruit/Retain Phys/Staff

A.5

Develop 2-3 MH Inpatient beds

A.20

Enhance Rehab Capacity in the PHCC

A.21

Enhance Inpatient Rehab Capacity at the Hospital

A.39 -A.43

Provide Facilities to Support Education in the PHCC and Hospital

$0

$0

$0

$ TBD $ Included above $ Included below for Hospital $ Included above for PHCC

$ Included below for Hospital

B. Continuing Care Services B.4a or

Develop Immediate/Short Term Supportive Living Capacity at Pioneer Lodge, or

B.4b

Develop Immediate/Short Term Supportive Living Capacity at DCECC - 55 spaces

B.5

Develop Longer Term Supportive Living Capacity in Lloydminster - 45 spaces

B.12a

Operationalize Adult Day Program at new LLTC site

B.12b Expand Adult Day Programs at DECC Site

$3.1 million or $15-$18 million $12-$15 million $0 $1-$1.5 million

Lloydminster Health Services Needs Assessment – Facility Development Plan - Capital Cost Estimates

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FACILITY DEVELOPMENT PLAN - CAPITAL COST ESTIMATES Projects

Phase 1 - Years 0 -5 Yr 1

Yr 2

Yr 3

Yr4

Phase 2 - Years 6 - 10 Yr 5

Yr 6

Yr 7

Yr 8

Yr 9

5 Yr Check Pt

B.14

Re-locate Home Care to Co-op Plaza?

$0.5-$1 million

B.19a

Develop Interim Transition Unit with 6-10 Spaces at another AHS Facility

$ TBD

B.19b

Develop Permanent Transition Unit with 1014 Spaces at DECC Site

B.27

Develop Respite Space Capacity

B.6

Replace the Jubilee Home

$1-$2 million

Phase 3 - Years 11-15 Yr 10

Yr 11

Yr 12

Yr 13

Yr 14

5 Yr Check Pt

$3-$4 million

$1-$1.5 million Procure replacement site - $ TBD

$30-$40 million

C. Acute Care Services 1. 2.

Decant Non-Acute Functions, Renovate Space for Acute Care Priorities Stage 1a - Expand Hospital with approximately 10,000-12,000 square metres of new space

3.

Stage 1b - Redevelop Existing Hospital

4.

Potential Stage 2 Hospital Expansion

Total Preliminary Estimated Capital Facility Investment (in current dollars)

$ TBD Planning/Design

Construction

$10-$15 million

$140-$185 million Planning/Design

Renovations

$2-$3 million

$30 million Planning

$172-$228.5 million

Lloydminster Health Services Needs Assessment – Facility Development Plan - Capital Cost Estimates

$45-$49 million

Update

$30-$40 million

Yr 15

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SECTION 6: GOVERNANCE STRUCTURE

Lloydminster Health Services Needs Assessment – Governance

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6.0

GOVERNANCE

There was recognition by the project sponsors that effective governance and decision-making structures to effectively deal with provincial inter-jurisdictional issues were required to ensure residents in the Lloydminster service area had seamless access to the health services they needed, regardless of their province of residence. Accordingly a governance committee with representatives from Alberta Health Services, the Prairie North Regional Health Authority and four community representatives was established to make recommendations in this regard. The Committee has recommended the following governance and decision-making structures to facilitate effective implementation of the Health Services Assessment.

6.1

Bi-Provincial Ministerial Working Group

Role:  Decisions that cannot be reached at the Operational Committee table need to be solved in a timely and collaborative manner with the input of both the Saskatchewan and Alberta Ministries through this Working Group.  There needs to be a “separate” funding model for Lloydminster based on up-to-date utilization data.  The Bi-provincial Ministerial Working Group would be responsible for ensuring that funding is received through both Ministries. Membership: The membership would include representatives from:      

Saskatchewan Health; Alberta Health; The PNRHA Board The PNRHA CEO; Alberta Health Services Senior Leaders; and The AHS Central Zone Senior Leader.

The structure of the Bi-provincial Working Group is presented diagrammatically in Figure 48, following.


P a g e | 153 Figure 48: Bi-provincial Working Group Composition and Structure

6.2

Operations Committee

Role:  Provide a collaborative approach to joint planning and implementation of health services for the Lloydminster Bi-Provincial Health Service Area ensuring that the vision of Lloydminster as a regional health and wellness service area is met.  Be accountable for the implementation of the Health Services Assessment.  Make budget and spending recommendations.  Resolve operational concerns.  Elevate any concerns that they are unable to resolve to the Bi-Provincial Working Group for their input or resolution.  Be responsible for utilization data evaluation and reporting.


P a g e | 154 Membership: The proposed membership and structure for the Operations Committee is depicted in Figure 49. Figure 49: Operations Committee Composition and Structure


P a g e | 155

6.3

Operating Parameters

 PNRHA will continue to be the operational authority in Lloydminster as long as the Regional Health system in Saskatchewan remains as it is presently.  PNRHA Board has AB membership. These members’ needs to have a connection with AHS so to ensure that when required there is an AHS understanding and connection at the Board level.  Health Services will be developed based on up-to-date; evidence based demographic and best practice data. This will ensure that the compliment of services is meeting the needs of Lloydminster and area. Funding will also be determined based on this data to ensure the financial stability of the overall organization.  Communication from the operating organization will occur on a regular basis with community members to ensure they have an accurate understanding of what health services they can reasonably expect to receive on a day-to-day basis in Lloydminster Bi-Provincial Health Services area.

6.4

Policy Issues, Barriers and Opportunities

6.4.1 Policy Issues and Barriers There is a need to address significant policy issues and questions related to Lloydminster’s unique status as a border city if residents are to receive timely, equitable access to the health care services they need regardless of their province of residency. These policy issues include:  Addressing funding alignment issues that are impairing the development of a single integrated health delivery system;  Continuing to collaborate to remove policy and regulatory barriers to ensure clinical information flows efficiently and effectively;  Continuing to align bi-provincial credentialing and certification processes to enable the recruitment and retention of the scarce health care resources;  Developing bi-provincial care protocols and pathways to support continuity and consistent approaches regardless of their province of residence.


P a g e | 156  Resolving inter-provincial issues relating to information technology and data management, specifically access to information required to optimize care and monitor health system performance.

6.4.2 Opportunity for Innovative Funding Model  Through this governance structure there is an opportunity to develop a funding model that ensures equitable funding for the Lloydminster Bi-Provincial Health Service area.  The Working Group recommends that funding for the Lloydminster Bi-Provincial Service area is a separate funding envelope from both Ministries and will be submitted through the newly formed Bi-Provincial Working Group. This will support both operational and capital funding requirements. This will ensure services are equitable to other communities that provide health services to a similar catchment area and demographic.  The Operations Committee will utilize these targeted funds to manage the agreed upon health services and infrastructure needs for the Lloydminster Bi-Provincial Health Services area.


APPENDIX I: ENCLOSURES

Lloydminster Health Services Needs Assessment – Appendix I

Enclosure A: Catchment Area Calculation Methodology The following catchment areas were determined by Western Management Consultants using a combination of the 2011 Census of Canada and Google Maps to approximate driving distances. The catchment areas were calculated by the same individual, applying a similar set of rules and assumptions. In some regions (such as Fort McMurray and Grande Prairie), a longer driving distance was used due to the remote nature of the sites and lack of large competitor hospital facilities in the regions. In other regions with more immediate larger centres, a 1.25 hour driving buffer was largely adhered to. Whenever an area in question could potentially go to one of two hospitals, the larger centre was determined to be the catchment draw for the area (ex: Regina hospital determined to be a draw over Moose Jaw hospital for communities in buffer zone region between the two locations).  Medicine Hat catchment determined through immediate vicinity of census tracts. Saskatchewan border regions were included but have (mostly) negligible populations. Up to Maple Creek included (1.25 hour drive).  Fort McMurray’s catchment was determined to be Census Division 16. Other census tracts are an extremely long driving distance and would likely be transported by Stars to Edmonton, if necessary.  Grande Prairie has a large catchment draw due to its large, spread out northern population. All of Census Division 19 was included, plus additional connected regions south of Division 19. These regions are in close proximity to the City of Grande Prairie as the City is located at the southern edge of the Division. Regions in British Columbia were not included because of the close proximity of the Dawson Creek hospital. Peace River and High Prairie hospitals were not considered to be large enough health centres to draw catchment populations away from Grande Prairie’s Queen Elizabeth hospital. Up to a 2 hour driving distance was included north of Grande Prairie.  The catchment area of Red Deer has been extensively researched by Statistics Canada and Red Deer has a designated Economic Region that has been delineated by Stats Can. This was determined to be the best approximation of the catchment for Red Deer’s hospital.  Lloydminster’s catchment was determined by including the City and its immediate census tract vicinity. Saskatchewan and Alberta border regions have been included when within a reasonable driving distance from Lloydminster and not near other major hospital centres. A driving distance of approximately 1.25 hours was used.


 Prince Albert’s catchment was determined by using census tracts within close proximity to Prince Albert and excluded areas with a closer travel time to major centres such as Saskatoon, Humboldt and Melfort. A driving distance of approximately 1.25 hours was used.  The catchment area for Moose Jaw was determined by using census tracts in the immediate vicinity with closer driving distance to Moose Jaw rather than Swift Current or Regina. The catchment is skewed slightly west as Regina likely has a larger draw than Moose Jaw does.


Enclosure B: Comparator Communities Description Comparator Cities  Red Deer – Red Deer Regional Hospital Centre The City of Red Deer has over 90,000 people and is a potential future state comparison for Lloydminster. Red Deer was included as a comparator to anticipate what the future state for the Lloydminster region may look like. The Red Deer model was examined to determine the level and type of health care capacity that Lloydminster may need to mimic for its future state. Within Red Deer, the top occupations are industrial, electrical and construction trades as well as service support and other service occupations. Red Deer has a higher than average percentage of the employed labour force working with no fixed workplace address, indicating a more transitory workforce. The vast majority of Red Deer residents (over 96%) report being Canadian citizens and the majority were born within the province or other part of Canada. In 2011, 5.2% of the population identified themselves as Aboriginal. http://www12.statcan.gc.ca/nhs-enm/2011/as-sa/fogsspg/Pages/FOG.cfm?lang=E&level=3&GeoCode=830 http://www.reddeer.ca/NR/rdonlyres/B7841678-4151-4C83-B0F3985100E4E85C/0/DemographicandSocioEconomicTrends2008_COM.pdf  Grande Prairie – Queen Elizabeth II Hospital Like Lloydminster, Grande Prairie has a resource-based economy and has experienced exponential population growth. Labour shortages are prevalent in this area and an inmigration of a younger population is evident. In 2001, the population of Grande Prairie was 35, 000 and ten years later this had grown to over 55,000 in 2011. There are a number of significant towns surrounding Grande Prairie that contribute to their large catchment population including Beaverlodge, Fairview, Peace River, Grimshaw, Sexsmith as well as a number of sizable municipal districts and counties. Some materials taken from source: City of Grande Prairie: http://www.cityofgp.com/index.aspx?page=1081


 Fort McMurray – Northern Lights Regional Health Centre Fort McMurray is part of the Regional Municipality of Wood Buffalo and comprises the largest population centre within the municipality. Like Lloydminster, Fort McMurray is also a resource-based economy. There are a number of large multi-national oil and gas companies operating in the near vicinity and Fort McMurray is recognized as the residential and commercial focal point of Canada’s oilsands. According to Statistics Canada, 11,570 people from Wood Buffalo work in oil and gas extraction, another 2,765 are specialty trade contractors and 1,015 are involved in support activities for mining and oil and gas. Wood Buffalo has experienced growth rates much higher than the national average and has a much younger population than the provincial or national average. Some materials taken from source: Wood Buffalo: http://www.woodbuffalo.ab.ca/living_2227/Communities/Fort-McMurray.htm Stats Canada source: http://www12.statcan.gc.ca/nhs-enm/2011/dp-pd/dt-td/Rpeng.cfm?TABID=2&LANG=E&APATH=3&DETAIL=0&DIM=0&FL=A&FREE=0&GC=0 &GID=1118436&GK=0&GRP=0&PID=105617&PRID=0&PTYPE=105277&S=0&SHOWA LL=1&SUB=0&Temporal=2013&THEME=96&VID=0&VNAMEE=&VNAMEF=&D1=0& D2=0&D3=0&D4=0&D5=0&D6=0  Medicine Hat – Medicine Hat Regional Hospital Medicine Hat’s catchment area is a similar size to Lloydminster and includes a mix of Alberta and Saskatchewan based residents. Anecdotal evidence indicates that residents of border catchment areas like Maple Creek, SK would rather drive to Medicine Hat for services rather than Swift Current, largely due to the placement on the sun. Medicine Hat is below the Alberta average for employment rates however, like Lloydminster, it has a large section of residents employed in the industrial, electrical and construction trades. Medicine Hat also has lower levels of educational attainment when compared to the provincial and national averages, similar to Lloydminster. Some source material taken from Stats Canada: http://www12.statcan.gc.ca/nhs-enm/2011/as-sa/fogsspg/Pages/FOG.cfm?lang=E&level=4&GeoCode=4801006


 Moose Jaw – Moose Jaw Union Hospital Moose Jaw is the fourth largest metropolitan area in Saskatchewan, just ahead of Lloydminster. However, Moose Jaw is not experiencing the growth that Lloydminster is and had a 3.2% change versus Lloydminster’s 14.0% percentage change. Moose Jaw has a larger percentage of their population over 65 than the national average. The vast majority of the population speaks English as their mother tongue with only 1,175 residents stating that a language other than English was primarily spoken at home. The economic outlook for Moose Jaw is positive and sustainable due to the area’s potash resources and a number of mega projects expected to come on line in the near future. Some source material taken from Stats Canada: http://www12.statcan.gc.ca/census-recensement/2011/as-sa/fogs-spg/Facts-cmaeng.cfm?LANG=Eng&GK=CMA&GC=715 Some source material taken from City of Moose Jaw: http://www.moosejaw.ca/?service=population-demographics  Prince Albert – Victoria Hospital Prince Albert is Saskatchewan’s third largest city. Because of its close proximity, Prince Albert functions as the conduit to northern Saskatchewan’s resource industries in mining, forestry and agriculture. Educational levels are lower in Prince Albert than the rest of Saskatchewan and Canada with 21.5% of residents without a high school diploma, college certificate or university degree. The unemployment rate in Prince Albert is almost double the provincial average at 10.6%. The vast majority of residents are non-immigrants with Tagalog being the most prevalent non-official language spoken at home. Prince Albert also has one of the highest obesity rates in the country with 67.2% categorized as overweight or obese compared to the national average of 52%. http://www12.statcan.gc.ca/nhs-enm/2011/as-sa/fogsspg/Pages/FOG.cfm?lang=E&level=4&GeoCode=4715066 http://www.citypa.ca/ThingstoDo/AboutPrinceAlbert/tabid/61/Default.aspx http://www12.statcan.gc.ca/health-sante/82228/details/page.cfm?Lang=E&Tab=1&Geo1=HR&Code1=4709&Geo2=PR&Code2=01 &Data=Rate&SearchText=Canada&SearchType=Contains&SearchPR=01&B1=All&Cust om= Lloydminster Health Services Needs Assessment – Appendix I

Enclosure C: Catchment Area Definition and Demographics The analysis conducted of the Lloydminster catchment compares the City of Lloydminster (both AB and SK parts) with the surrounding catchment area and does not include the City itself in that catchment area in order to capture urban and rural differences. The weighted average was taken as a comparison so that all catchment census areas (especially those with small populations) are not treated equally; instead they are weighted using their population to ensure an accurate comparison. For some indicators no information was released by Statistics Canada as the data was deemed unreliable or the census area population too small to ensure the confidentiality of the information. When data was not available, it was not included in the summarized weighted average of the catchment area. The black range bars on each chart refer to the maximum and minimum reflected in the catchment area for that specific indicator. All data sourced from Statistics Canada 2011 Census and the Statistics Canada National Household Survey 2011. Figure 50: Population Age

Population Age Lloydminster (Total)

Catchment (Weighted Average)

18% 16% 14% 12% 10% 8% 6% 4% 2% 0%


Figure 51: Percentage of Total Population Over 65

Percentage of Total Population Over 65 Lloydminster (Total)


20%

15%

10%

5%

0%

Figure 52: Persons 65 Years and over Residing in Private Households

Persons 65 Years and over Residing in Private Households Lloydminster (Total)


100% 80% 60% 40% 20% 0%


Figure 53: Aboriginal Population

Aboriginal Population Lloydminster (Total)


100% 80% 60% 40% 20% 0%

Figure 54: Median Income

Median Income Lloydminster (Total)


$45,000 $40,000 $35,000 $30,000 $25,000 $20,000 $15,000 $10,000 $5,000 $0


Figure 55: Percentage of People at a New Address Compared to 5 Years Ago

% of People at a New Address Compared to 5 Years Ago Lloydminster (Total)


60% 50% 40% 30% 20% 10% 0%

Figure 56: Post-Secondary Certificate, Diploma or Degree - Education Rates (15 Years and over)

Post-Secondary Certificate, Diploma or Degree - Education Rates (15 years and over) Lloydminster (Total)


70% 60% 50% 40% 30% 20% 10% 0%


Figure 57: Percentage of Immigrants

% of Immigrants Lloydminster (Total)


12% 10% 8% 6% 4% 2% 0%
