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2017

Artistic Rendering

REKAI CENTRES ANNUAL REPORT

“Using an evidence-based decision-making process” Overview of our Resident Profile, Quality Indicators and approach to Long-Term Care


GREETINGS FROM HUGH INNES CHAIR, REKAI CHARITABLE FOUNDATION I am very pleased to present the 2017 Annual Report to our current and prospective donors. The Strategic Plan which guides the Rekai Centres, provides that a key Strategic Priority is Resident-Centred care. Embodied within this Strategic Priority is the imperative that our healthcare is of the highest quality. While we are very focused on building the new Rekai Centre at Cherry Place, we are very mindful that our top priority is the provision of the highest possible quality of care. As you can see from the data outlined in the Annual Report, the acuity level for our residents is growing. People come to the Rekai Centres only after they or their families, realize they cannot live in the community any longer. We take this responsibility very seriously and by monitoring our healthcare data, ensure our residents enjoy the highest quality of life from a holistic perspective.

GREETINGS FROM SUE GRAHAM-NUTTER CEO, REKAI CHARITABLE FOUNDATION The Rekai Centres employs an evidence-based decision-making model. To achieve this goal, we had to undertake a number of critical steps. We had to remain accredited by a recognized accreditation-granting body. A three-year accreditation was conferred by CARF in 2016. The healthcare team pushed itself to meet the rigorous standards of Providigm’s ABAQIS Advanced Accreditation—becoming the only Long-Term Care Home in Canada to be granted Advanced Accreditation. And we carefully crafted a Quality Indicator Scorecard monitoring the nine key indicators as required by Health Quality Ontario and the Canadian Institute for Health Information (CIHI). Each quarter, we upload the newest version of our Quality Indicator Scorecard for all to view. This tool assists us greatly in ensuring our residents receive the highest possible care. This evidence-based decision-making model has also enabled us to determine that the majority of our residents have cognitive or mobility impairment issues. This realization will help drive healthcare, program planning and evaluation. Donors can be certain that their much appreciated funds support the provision of the highest quality of care.

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2017 Annual Report


TABLE OF CONTENTS

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THE REKAI CENTRES CAMPUS Rekai Centre at Sherbourne Place Rekai Centre at Wellesley Central Place Rekai Centre at Cherry Place

DEMOGRAPHIC BACKGROUND

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Average Demographics Length of Stay

PROFILE OF THE HEALTH OF REKAI CENTRE RESIDENTS

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Key Findings

HEALTHCARE & DIETARY SERVICES AT THE REKAI CENTRES

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Specialized Dementia Care Unit Responsive Behaviours Palliative Care Program Nursing Restorative Healthcare Program Dialysis Program Dining Experience: Bridge Program

ACADEMIC & COMMUNITY PARTNERSHIPS

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College and University Partnerships LGBTQ2S+

MAINTAINING OUR STANDARDS

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CARF ABAQIS Quality Improvement Score Card

THE REKAI CENTRES CONDENSED FINANCIAL STATEMENTS

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Summary Statement of Operations Summary Balance Sheet

PHOTO GALLERY

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THE REKAI CENTRES CAMPUS

REKAI CENTRE AT SHERBOURNE PLACE The Rekai Centre at Sherbourne Place was Canada’s first multicultural nursing home when it opened in 1988. Sherbourne Place has a total of 126 beds. The home has private, semi-private and four-person basic rooms. At the time the building was designed with state-of-the-art standards. There are twenty-three Cantonese and Mandarin speaking residents and four staff members who speak those languages. These residents are purposefully placed together for a sense of community and socializing in one’s first language. Many of our residents have been previously marginalized due to low income, mental health challenges and inadequate housing. A number of them are also dependent on the Public Guardian & Trustee (PGT) to manage their finance and to make treatment decisions. The Rekai Centres person-centred approach addresses the individualized needs of each resident, and provides a safe and caring environment.

REKAI CENTRE AT WELLESLEY CENTRAL PLACE Wellesley Central Place was built in 2005 and has 150 beds, which includes a selection of private and basic rooms. This was the last long-term care home built in Toronto. The population at Wellesley Central Place reflects the unique diversity of Toronto.

REKAI CENTRE AT CHERRY PLACE In June 2017, the Rekai Centres announced the opening of a new home, Rekai Centre at Cherry Place located on the Waterfront lands at Front Street East and Cherry Street. Cherry Place is expected to have a minimum of 220 beds available, both private and basic rooms. The Rekai Centres is reaching out to the community through focus groups to discuss how to best support the community needs and the Rekai residents. Services expected to be available at Cherry Place include: • • • • •

Healthcare and dietary services provided to the local community to support “aging in place” An eight bed in-house peritoneal dialysis and hemodialysis Two floors specializing in dementia care An education centre for students and staff A green roof

160 Wellesley St East, Toronto, ON M4Y 1J2

345 Sherbourne St, Toronto, ON M5A 2S3

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2017 Annual Report

55 Eastern Ave, Toronto, ON M5A 1H5


DEMOGRAPHIC BACKGROUND

AVERAGE AGE OF:

76

for Male Residents at Wellesley Central Place

74

for Male Residents at Sherbourne Place

83

for Female Residents at Wellesley Central Place

80

for Female Residents at Sherbourne Place

LENGTH OF STAY The length of stay, on average, has declined at Sherbourne Place while the average length of stay at Wellesley Central Place has increased. Average Length of Stay per Resident Wellesley Central Place 5

4.08

Years

4 3

2.77

Sherbourne Place

3.42 2.53

2 1 0

2015

2016

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PROFILE OF THE HEALTH OF REKAI CENTRES RESIDENTS

MEDICAL METRIC DESCRIPTIONS Activities of Daily Living (ADL): measures the level of assistance a resident needs including toileting, personal hygiene, locomotion, and eating. Cognitive Performance Scale (CPS): measures a resident’s cognitive status. The CPS metric measures comatose, short-term memory, cognition skills for daily decision making, expressive communication and eating. Method for Assigning Priority Levels (MAPle): is a decision-support tool that can be used during the application process to prioritize clients needing community- or facility-based services and to help plan allocation of resources.

The vast majority of residents at the Rekai Centres have multiple chronic conditions affecting their health. Although most are seniors, we also provide care to younger adults who are experiencing health conditions that require 24/7 care. One in every three residents is highly or completely dependent on staff.

Key Findings

The Rekai Centres follows an evidence-based decision-making process. Our evidence indicates that there are two key populations needing our care:

Percentage of Residents with High CPS Scores Percentage of Residents

• 50% of our residents have cognitive impairment • Over 80% of residents have impaired mobility • Over 60% need help with Activities of Daily Living (ADL) • Over 75% of applicants have a high MAPle score

80%

63%

60% 49%

40%

48%

53% 56%

46% 45%

47% 55%

20% 0%

2012

• Those with cognitive impairment • Those who have impaired mobility

52%

2013

2014

Wellesley Central Place

2015

2016

Sherbourne Place

Both of these conditions are challenging to address within the community.

Number of Residents

Residents with Impaired Mobility 2017 100% 80%

82%

60% 40% 20% 0%

Wellesley Central Place

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2017 Annual Report

87%

Sherbourne Place


Over 75% of seniors that are applying to the Rekai Centres have high MAPle scores indicating a need for long-term care. Unfortunately with the growing need for long-term care beds, the Rekai Centres has a waitlist. This list is likely to grow due to the following factors: • The aging baby boomer population • The growing numbers of people with dementia All individuals who enter into a long-term care home come through the Local Health Integration Network (LHIN) Home and Community Care Services. As of April 13, 2018, we have 284 at Wellesley Central Place and 55 at Sherbourne Place waiting for long-term care beds.

Percentage of Residents

WAITLIST PROFILE

Percentage of Residents with High ADL Scores 80% 60%

63% 61%

70%

68%

64%

62%

2013

2014

65% 53%

61% 64%

40% 20% 0%

2012

Wellesley Central Place

2015

2016

Sherbourne Place

Maple Score on Waitlist Applicants Number of Residents

Both homes have over 60% of residents with cognition issues. The ADL scores at both homes show that our residents are in declining health and are in need of more nursing support. In 2017, over 80% of residents from both homes need mobility support; this includes gaits, walkers, wheel chairs and scooters.

350 300

295

250 200 150 100 50 0

51 Waitlist

73 12 Moderate

Wellesley Central Place

141 19 High

80 20 Very High

Sherbourne Place

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The Rekai Centres offers healthcare and dietary services to provide individuals the best quality of life possible. To meet specific needs, we offer the following sevices:

Sherbourne Place Percentage of Residents with Dementia

ALZHEIMER’S AND DEMENTIA CARE UNIT

Percentage of Residents

HEALTHCARE & DIETARY SERVICES AT THE REKAI CENTRES

• Over 50% of all residents being admitted have a form of dementia The Alzheimer’s Society expects the number of individuals in the GTA with dementia to increase from 30,000 to 70,000 by 2030, a mere 12 years away.

SPECIALIZED DEMENTIA CARE UNIT At Wellesley Central Place, 25 beds are dedicated to residents who have forms of dementia which may cause exit-weeking or wandering behaviours. These residents may have a diagnosis of Alzheimer’s, advanced Parkinson’s disease or acquired brain injury. The floor was designed specifically for these residents, with minimal clutter to prevent confusion and falls. The unit has a dedicated space called the Snoezelen Room. The Snoezelen Room is a multi-sensory therapy room that has different materials mounted on the wall so residents can touch them to re-educate and train the mind. Additionally, the multi-sensory room has had a positive impact on the residents’ behaviour. There are games, lights, and aromatherapy to help keep their minds active and engaged. The unit at Wellesley Central Place has a significant waitlist due to the high numbers of seniors with some form of dementia.

60% 40%

43%

53%

42%

2013

2014

49%

55%

20% 0%

2012

2015

2016

Wellesley Central Place Percentage of Residents with Dementia Percentage of Residents

Key Findings

80%

80% 60%

60% 40%

56%

37%

45%

48%

2015

2016

20% 0%

2012

2013

2014

RESPONSIVE BEHAVIOURS

What are Responsive Behaviours? Responsive behaviours is a term that is often preferred by persons with dementia, mental health, substance use and/or other neurological disorders to describe how their actions, words and gestures are a response to something important in their personal, social or physical environment.

(Alzheimer Society of Ontario, 2014)

The Toronto Central (TC) LHIN has graciously provided funding to allow for the hiring of a dedicated Behavioural Support Lead (BSL) for each home. As the evidence illustrates, over 60% of the residents live with cognitive impairment issues. For some residents, this can translate into behavioural issues. Each BSL holds an RPN diploma and can facilitate and resolve behavioural issues that arise in the Home. 7

2017 Annual Report


The BSL creates care plans based on successful interventions. They provide coaching, based on GPA, to staff and collaborate with external partners. The Rekai Centres’ BSL team has support from the Behavioural Support Team from UHN, Baycrest and a Psychogeriatric Resource Consultant from St. Michael’s Hospital. The hiring of the BSLs greatly aids in creating a safe environment.

Percentage of Residents with Responsive Behaviours

Percentage of Residents

The goal of the BSL is to help provide and implement strategies to reduce and manage responsive behaviours. This includes working with staff to build capacity in responsive behaviours within a Gentle Persuasive Approach (GPA) and PIECES (physical, intellectual, emotional, capabilities, environmental, and social) context.

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

Wellesley Central Place

Sherbourne Place

PALLIATIVE CARE PROGRAM

The Rekai Centres prides itself in providing care and support through life’s journey including palliative care and end of life. This is the residents’ home and many would choose to spend their final days in their own home. We try to facilitate this request.

Key Findings • Total residents who passed away in their home rather than hospital ◦ 84% of Wellesley Central Place residents ◦ 52% of Sherbourne Place residents Our care teams at the Rekai Centres have committed themselves to promoting a Palliative Care philosophy. This philosophy starts from admission to the ‘end of life stage’. Our homes ensure compassionate support for residents, family members and loved ones from the moment they enter the building. A team at the Rekai Centres is specifically trained to offer end-of-life support for our residents and families. A blue butterfly is placed on the door of a resident who is at the end-of-life stage so that staff and other individuals can treat the resident and their family with the respect and care they deserve during this difficult time. The Palliative Care Program includes: • • • •

Provides relief from pain and other distressing symptoms; Affirms life and regards dying as a normal process; Intends neither to hasten or postpone death; Integrates the psychological and spiritual aspects of resident-centred care; • Offers a support system to help residents live as actively as possible until death • Offers a support system to help the family cope during the resident’s illness and in their own bereavement; • Will enhance quality of life, and may also positively influence the course of illness. - World Health Organization The TC LHIN has accepted our proposal for more educational support in Palliative Care – End of Life approach. This initiative provides our homes with a clinical coach from the TC LHIN who will build on our existing approach, develop assessments and facilitate training for our staff.

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NURSING RESTORATIVE HEALTHCARE PROGRAM As an increasing number of applicants have higher ADL scores, our homes provide a Nursing Restorative program to assist residents in maintaining and regaining their independence. The uniquely designed exercises are geared to enhance: • • • • • •

Range of Motion Ambulation Dressing or Grooming Eating or Swallowing Transfers and Bed Mobility Communication

DIALYSIS PROGRAM Sherbourne Place was the second long-term care home in downtown Toronto to provide peritoneal dialysis in partnership with St. Michael’s Hospital. The St Michael’s team provides support from a nephrologist, home dialysis peritoneal dialysis nurse, social worker, dietitian and clinical managers. There is on-call support from a peritoneal dialysis nurse who offers clinical support which may reduce unnecessary emergency transfers. Peritoneal Dialysis Clinics are held quarterly on-site at the Home for the convenience of the residents so that they do not have to travel for follow-up appointments.

DINING EXPERIENCE: BRIDGE PROGRAM The Rekai Centres’ dietary partners, Compass Group, based on a pilot project at Wellesley Central Place has implemented tablets into each of our serveries. Each tablet is set up to provide the menu option or ‘show plate’ to the residents. As well, the tablets are linked to the kitchen’s menu planner that can flag any resident that has a restriction, allergies or preference on the day’s menu. Cost savings have been considerable with the implementation of the Bridge Program. With these cost savings, the residents at Wellesley Central Place will receive a special monthly meal.

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In partnership with our Compass Digital Labs team, Marquise Hospitality developed the Bridge solution as a centralized system to store all resident dining information as well as a digital means to showcase our daily menu offerings. With the Bridge innovation, Marquise is reducing food waste and costs while creating and investing in a more efficient, consistent, and enhanced resident dining experience. Compass Group

2017 Annual Report


ACADEMIC & COMMUNITY PARTNERSHIPS

COLLEGE AND UNIVERSITY PARTNERSHIPS

The Rekai Centres firmly believe that current students are future employees. The organization welcomes and encourages student placements from many disciplines in the Faculty of Community Services. The Rekai Centres have provided a great deal of valuable preceptor support, for example to our third and fourth year Nursing students, which foster student learning, mentoring, and development. The Rekai Centres is enthusiastic about searching for ways to foster creative projects and innovate when it comes to incorporating student experiential learning. Pamela Robinson, Associate Dean Faculty of Community Services, Ryerson University

Number of Students Completing their Placement at the Rekai Centres Number of Students

Our academic partnerships increased both in terms of the number of academic institutions and number of students from 2016 to 2017. Indeed, the increase in the number of students was an amazing 1,292% over the previous year. Students in our homes increase interaction with the residents, encourage participation in resident activities, and generally enhance the “joie de vivre” for everyone! Staff enjoy mentoring and assisting the younger generation with their careers.

250

195

200 150 100 50 0

14 2016

2017

Academic Partners • • • • • • • • •

Boreal College Centennial College George Brown College Guelph/Humber University Humber College (new) Ryerson University Seneca College University of Toronto (new) York University

Student Disciplines

The Rekai Centres partnered with Humber College to create the first preceptor-training program for our staff. Seventeen staff members participated in this program and were awarded a Humber College certificate.

• Nursing Placements: ◦ Registered Nurse ◦ Registered Practical Nurse ◦ Community Nursing ◦ Personal Support Worker • Life Enrichment /Social Placement: ◦ Therapeutic Recreation ◦ Gerontology Activation • Psychology • Social Service Worker • Social Work • Food Service Placement: ◦ Registered Dietitian ◦ Dietary Aides ◦ Food and Nutrition Management • Occupational Therapy / Physiotherapy

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LGBTQ2S+ The Rekai Centre at Wellesley Central Place is located adjacent to Canada’s largest LGBTQ2S+ community. Over the past year, the Rekai Centres have undergone LGBTQ2S+ education and training for staff. With support from The 519, the Rekai Centres created an “Inclusiveness for Older LGBTQ2S+ Adults in long-term care” program. In 2018, as part of the Rekai Centres Strategic Plan process, focus groups will be held with members of the LGBTQ2S+ community. The purpose of these community consultations and focus groups is to assist the Rekai Centres in better understanding this valued and underserved community’s long-term care needs. With the future opening of our new Rekai Centre at Cherry Place, the Rekai Centres has a unique opportunity to improve this community’s long-term care services. This includes the option of a dedicated LGBTQ2S+ unit and/or specialized LGBTQ2S+ staff training at our Wellesley Central Place location.

MAINTAINING OUR STANDARDS Improving efficiency and maintaining our standards is vital to our home. We manage this by constantly testing ourselves and going above and beyond, by using three tools—CARF, ABAQIS and our in-home designed scorecard, to scrutinize our homes and evaluate our teams.

CARF CARF (Commission on Accreditation of Rehabilitation Facilities) is an independent, non-profit accreditor for health service that examines long term care homes, nursing techniques and corporate governance. The survey is completed every three years. In the fall of 2016,we were reviewed by two surveyors and were granted a 3 year accreditation including our corporate governance structure.

ABAQIS We are very proud that we are the only long-term care home in Canada that has received the Advanced Accreditation from ABAQIS. While receiving the ABAQIS designation doesn’t provide additional funding, it does provide ongoing reviews of our nursing practices. To maintain this standard of excellence, we have an in-house review every month to ensure that our practices are perfected. The ABAQIS team conducts interviews and observes the staff at each home as well as conducts in-depth audits. This helps ensure that our homes are in compliance with the Ministry of Health and Long-Term Care’s directives and guidelines.

QUALITY IMPROVEMENT SCORE CARDS We believe in being transparent to our residents, families and to our community about our performance indicators. The Ministry of Health and Long-Term Care provides targets and indicators for long-term care facilities to maintain standards. There are nine indicators (number of: falls, worsened pain, daily physical restraint and more) that record how each home is performing against the Ontario average and the target.

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2017 Annual Report


Sherbourne Place (SP) Quality Improvement Score Card

Wellesley Central Place Quality Improvement Score Card

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THE REKAI CENTRES CONDENSED FINANCIAL STATEMENTS

Summary Statement of Operations

Summary Statement of Operations

REVENUE

DEC 31, 2016

Ministry of H health funding

$

DEC 31, 2015

13,962,419

Resident co-payments

$

13,752,432

5,838,552

5,707,954

105,792

107,888

80,793

84,045

-

83

19,987,556

19,652,402

Other services and interest Amortization of deferred capital contributions Other grants

Summary Balance Sheet

Summary Balance Sheet DEC 31, 2016

ASSETS

$

CURRENT Cash and investments Accounts receivable Prepaid expenses

5,769,037

DEC 31, 2015 $

4,585,207

289,956

248,131

36,023

103,190

6,095,016

4,936,528

1,425,112

LIABILITIES AND EQUITY

21,541,109

CURRENT Accounts payable and accrued liabilities

$

Deferred revenue

2,076,531 135,586

Current portion of mortgage loans

530,153 2,742,270

Mortgage loans Deferred capital contributions NET ASSETS

2017 Annual Report

10,762,257

2,089,472

2,170,265

13,402,415 $

13

10,204,831

28,618,532

12,227,957 $

27,902749


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The Rekai Centre at Sherbourne Place

The Rekai Centre at Wellesley Central Place

345 Sherbourne St Toronto, ON, M5A 2S3

160 Wellesley St East Toronto, ON, M4Y 1J2

416-964-1599 reception@rekaicentres.com

416-929-9385 reception-wcp@rekaicentres.com

www.rekaicentres.com

2017 ANNUAL REPORT | The Rekai Centres  

www.rekaicentre.com

2017 ANNUAL REPORT | The Rekai Centres  

www.rekaicentre.com

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