Backgrounder Physiotherapy Changes
On April 18, 2013, the Ontario government announced that Community Care Access Centres (CCACs) will receive $33 million in new funding to provide in-home physiotherapy services for up to 60,000 more people. Starting August 1, 2013, CCACs will be the single points of access for all publicly funded in-home physiotherapy services. The new funding will be used to reduce waiting lists for physiotherapy and expand services that help seniors stay safe at home.
The expansion of in-home physiotherapy is one part of a broader strategy that also includes:
- $10 million for community falls prevention and exercise classes,
- $44.5 million to expand clinic-based services in community settings,
- $58.5 million to provide one-on-one physiotherapy and $10 million to provide exercise classes in long-term care homes, and
- $2 million to enable family health teams, community health centres and nurse practitioner-led clinics in include physiotherapists in interdisciplinary team care.
Overall, the changes to how physiotherapy services are delivered and funded will more than double the number of people who can access this care in the community and increase the number of places where these services are available.
The changes build on recommendations in Dr. Sinha's report "Living Longer, Living Well" that identify the need for better access to physiotherapy services, exercise classes and falls prevention to promote seniors' health and help them live safely in the community longer.
OHIP-funded Physiotherapy Services
In the current system, in addition to the physiotherapy services offered through CCACs, Designated Physiotherapy Clinics (DPCs) also provide in-home physiotherapy services that are funded by OHIP on a fee-for-service basis. OHIP pays per physiotherapy visit for up to 100 services per person per year, plus 50 additional services in cases of exceptional need. The in-home services provided through DPCs are primarily provided in retirement homes and other congregate living settings for seniors, such as assisted living programs and seniors' apartments. The services provided include a mix of one-on-one physiotherapy and exercise classes. Some DPCs may provide additional services, such as routine physiotherapy assessments for all new retirement home residents, equipment assessments and other services.
On August 1, 2013, regulatory amendments under the
Health Insurance Act are expected to come into force that will eliminate the OHIP billing mechanism for physiotherapy services. Patients currently receiving OHIP-funded services will be transitioned to appropriate services in one of the five streams included in the proposed changes. Patients who require in-home care will be transitioned to CCAC services.
Beginning August 1, CCACs will be the single points of access for in-home physiotherapy services. In 2011/12, Ontario's 14 CCACs provided in-home physiotherapy services to 91,530 people at a cost of $48 million. The new investment of $33 million will enable CCACs to expand access to up to 60,000 new patients. The initial focus will be on eliminating current wait lists for physiotherapy services and ensuring that seamless transition plans are in place for all people who currently receive in-home physiotherapy services through DPCs. Over the summer, CCACs will be engaging retirement homes, other seniors' living settings and their residents to identify what services are currently provided by DPCs and to plan transitions to the most appropriate care based on residents' individual needs.
CCACs already provide a wide-range of services to residents of retirement homes and in other congregate living settings. These services include:
- Comprehensive assessment and care coordination;
- Nursing, personal support services, social work and other therapy services including occupational therapy, speech language therapy and dietitian services, in addition to physiotherapy;
- Information about and referral to other community services, such as meals on wheels, adult day programs and many other services;
- Assistance in finding a family physician or other primary care provider through Health Care Connect;
- Rapid response nursing for people with complex needs to help them transition home from hospital;
- In-home hospice palliative care for people with life-limiting health conditions, including intensive in-home care at the end of life; and
- Support in planning for advanced care needs, including transitions to long-term care homes.
Streamlining access to physiotherapy services through CCACs will ensure that Ontarians have access to an integrated, coordinated basket of services based on their needs. A physician referral is not required for these services; anyone can make a referral to a CCAC. While a physician referral is not necessary, CCACs work closely with patients' physicians to ensure collaborative, integrated care.
To ensure positive patient outcomes and the best value for the public investment in physiotherapy services, CCACs will:
- Continue to work with service providers to develop and implement best practice outcome focused care pathways, including pathways that promote seniors' independence and safety,
- Evolve care models to better serve congregate care settings through group and cluster care models, and
- Integrate therapy aides and other paraprofessionals working under the supervision of Registered Physiotherapists in care models.
Exercise Classes and Falls Prevention
The Ministry is investing $10 million to provide 130,000 seniors with access to exercise classes and falls prevention. This investment will ensure that seniors that currently receive exercise classes and falls prevention through DPCs will continue to have access to these services, as well as adding more classes in communities that currently do not have access to services. These services will be fully funded and will be offered free of charge to seniors. Services will be offered in multiple locations at multiple times during the week all year around.
Ontario's 14 Local Health Integration Networks (LHINs) are working to identify settings where these services are now provided and ensure classes are in place across the province starting in August. LHINs are conducting requests for proposals (RFPs) to identify new not-for-profit service providers who will be funded to provide these services under the
Home Care and Community Services Act, 1994 and will be accountable to LHINs through a service accountability agreement. The new program sponsors will have the option of providing exercise classes and falls prevention directly or contracting with other not-for-profit or for-profit providers for the provision of these classes.
Since the in-home services currently provided by DPCs include a mix of one-on-one care and exercise classes, LHINs and CCACs are working together closely to ensure coordinated plans are in place for services after August 1.
Long-term Care Homes
In addition to providing in-home and clinic-based services, DPCs also bill OHIP to provide physiotherapy to residents of long-term care homes. These services include a mix of one-on-one care, activation and exercise classes. After August 1, long-term care homes will be funded directly at $750 per resident to provide this care. The new funding includes $58.5 million to provide one-on-one physiotherapy and $10 million to provide exercise classes in long-term care homes.
Family Health Care Settings
The Ministry will be amending funding agreements with family health care and investing $2 million to integrate physiotherapists into interdisciplinary care teams to provide program-based care for people with chronic health conditions.