Category Archives: CCAC

Stories we couldn’t let pass by this week

Posted on May 26, 2012 | 1 comment

CCACs hire 144 direct care nurses

This month the government announced 900 new nursing positions to come from their 2007 commitment to 9,000 new nurses for the health system. Among them are 144 nurses who will go into the schools to support early identification and intervention of students with potential mental health and/or addictions issues. The nurses will assess and develop plans of care, provide direct service for mild cases, and offer support and referral for more complex issues. What’s particularly interesting about this initiative is these nurses will be working directly for the Community Care Access Centres, the first new hires to provide direct care since Bob Rae was in the Premier’s seat. When Mike Harris changed the NDP’s multi-service agencies into the CCACs, he insisted that a strict purchaser-provider split exist, hoping to divest all direct care workers to private agencies. He never entirely succeeded – OPSEU still represents CCAC home care therapists that were supposed to be divested by 1998. The fact that the government has placed these nurses into the employ of the CCAC is a hopeful sign that the terrible Harris-era competitive bidding process may quietly be coming to an end. While Deb Matthews publicly said competitive bidding would return, OPSEU members are telling us the agency contracts are all being extended again.

Merging surgical departments in Windsor

A zero base budget for hospitals is forcing many administrators to look at novel ways to make ends meet. In Windsor much has been made about Finance Minister Dwight Duncan’s proposal for a very expensive mega-hospital, however, the two hospitals are looking at integration options that might save money in the meantime. Windsor Hotel Dieu is pushing for greater coordination of surgical departments with the Windsor Regional Hospital. Facing a $700,000 operating room budget deficit, Dieu is hoping costs could be saved by having the two hospitals move into even greater specialization than currently exists. Dieu presently specializes in trauma and neurosurgery while WRH does most of the pediatric surgeries. WRH CEO David Musyj told the Windsor Star he was cautious — concerned that Hotel Dieu’s financial problems could put more pressure on his 11 operating rooms.

Harper attacks Council of Canadians

Our friends at the Council of Canadians are under attack by the Harper government for encouraging Canadians to overturn elections of seven Tories elected in ridings involved in the so-called robocall scandal. According to the Ottawa Citizen, the Federal Tories hope to overturn lawsuits that seek new elections in the ridings. The Tories are basing their bid to throw out the lawsuits on an obscure and ancient legal prohibition against “champerty and maintenance,” which the Citizen describes as “meddling in another party’s lawsuit to share in the proceeds.” While the Council of Canadians would not stand to gain anything monetarily from the actions, the Tories highlight a Council fundraising campaign that notes the challenge among its work. Of course the Tories have no problems with right-wing organizations, many with American funding, helping to litigate against such left-wing institutions as Medicare. That includes the Canadian Constitution Foundation, an extreme right-wing group based in Alberta that supported Lindsay McCreith and Shona Holmes in their 2007 case intended to open up Ontario to two-tier private health insurance. While the CCF doesn’t say where their money comes from, they do specifically note on their website that they have charitable status with the U.S. Internal Revenue Service. Like the Council of Canadians, the CCF lists its McCreith/Holmes case as among the worthy activities it undertakes to solicit donations.

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A tale of two physiotherapists: Why professionals oppose competitive bidding in home care

Posted on February 16, 2012 | Leave a comment

Sharon and Jackie (not their real names) are experienced physiotherapists nearing retirement. Both do exactly the same public home care work within the region covered by the Champlain CCAC.

Sharon works in the Renfrew area. Jackie works within the City of Ottawa.

The two began their community physiotherapy work as municipal employees in 1992 and 1988 respectively.

When the CCACs were formed, the service transferred from the municipalities to the provincially-run centres. While that also meant transferring from an OMERS pension plan to a HOOP plan, the physiotherapists were told they would experience no actuarial loss. This turned out not to be true, and has been the subject of a lengthy court case about to enter its second decade.

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Drummond Report: Health care sectors get funding restraint… and a pony

Posted on February 15, 2012 | 2 comments

Don Drummond wants to provide every health care provider with their own pony while the system gets squeezed another notch tighter.

In his report released this week, the Commissioner on Public Sector reform wants to implement everything from increased salaries for the CEOs of the Local Health Integration Networks to triple the per capita spending on public health.

All this is to take place while restraining health care spending increases to 2.5 per cent per year – about half the funding increase from 2011.

Where the savings come from with all this new investment is not clear, nor is there an explanation on how so much can be done with so little. In fact, there is very little costing associated with any of these recommendations.

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Posted in CCAC, Health System, Home Care, Hospitals, Local Health Integration Networks

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LHINs – Funding in a time of scarcity

Posted on August 24, 2011 | Leave a comment

This spring’s provincial budget set aside a three per cent base funding increase for community-based health care agencies this year. That doesn’t mean Community Care Access Centres, Canadian Mental Health Association branches or other local agencies will necessarily receive that amount.

The dilemma for the Local Health Integration Networks is whether to pass on an across–the-board increase that amounts to less than this spring’s Consumer Price Index, or whether to split that modest increase to address specific problems within the regional health care system? Do you make the situation worse for some agencies by slashing their funding increase to improve the situation for high-priority agencies faced with significant challenges? Either way, you know somebody is going to be unhappy. Worst still, does the absence of adequate funding for some agencies show up in new unforeseen challenges for next year?

The Central East LHIN passed a motion today that effectively cleaved the across-the-board funding increase in half – to 1.5 per cent – while using the remaining funds to address some serious problems within the LHIN. For those receiving only the 1.5 per cent, they will be in good company with the hospitals, most of whom will receive a similar base increase for a second year in a row.

 What is important to stress is that these are base increases, not total increases.

As we have seen with the hospitals, while the base was 1.5 per cent, many hospitals increased their bottom line by more than 4 per cent last year thanks to a variety of budget envelopes and increases in own-source revenues. For some agencies, particularly the very small ones, 1.5 per cent could turn out to be the total they do receive. James Meloche, a Senior Director with the CE LHIN, said 1.5 per cent could amount to as little as $900 for some agencies.

The 1.5 per cent the LHIN is reallocating is not a huge amount – about $5 million to support a population of 1.4 million, or about 11 per cent of Ontario’s population.  That’s about $3.50 per resident. This is on a provincial health budget of $47 billion.

While Don Drummond hammers away at unsustainable costs, there are no huge funding increases here at the health care coalface.

Clearly the region has a capacity problem, particularly when it comes to placing seniors into care following a hospital stay.

The LHIN has decided that it will address the problem by targeting the problem further upstream. By providing improved supports in the home, the LHIN hopes to avoid the arrival of seniors in the region’s already crowded emergency departments. Keeping people healthy is far more likely to be a winning strategy.

That does not necessarily mean more money for the CCAC – in fact, even with an allocation of almost half the available money, the CCAC will receive slightly less than the three per cent.

The LHIN is betting that more assisted living – including home making and falls prevention, among other services – will help keep seniors healthier in their homes and avoid hospital admissions.

The Oshawa/Whitby area will also be targeted, particularly for increased support for mental health and addictions. With a struggling economy, the communities have been hard hit by the recession, a situation that is putting pressure on health care providers.

“Clearly we have an issue at Lakeridge Health,” said Meloche. “People live in the park and they come to the emergency department for care.”

Fortunately one of the few mental health agencies in Ontario that will receive patients with concurrent addictions problems is already in the Oshawa community.  While several years ago Pinewood/Destiny Manor faced closure from a Ministry that wanted the hospital to cut unfunded mental health services, the service is now considered a major asset for the LHIN.

The LHIN is also trying to take some of the pressure off the Northeast part of its region by providing about $259,000 to establish a rural-based palliative care team.

While these are the priorities of the Central East LHIN, it does not necessarily mean that other LHINs will treat the funding in this manner.

* * *

The Central East LHIN used their “Urgent Priority Funding” to increase the volume of MRIs available in the region.  Senior Director Paul Barker pointed out that while the government was generously funding new MRI machines in the region, the actual funding for scans had gone down. The LHIN is tapping into this fund to provide $285,327 to buy 1,096 more MRI hours. Most hospitals can conduct about 1.5 scans per hour. The average wait for an MRI scan in the LHIN was 77 days as of July. One board member asked how it was Ontario hospitals could perform MRI scans for $260 an hour when they were charging $1600 for the same service in the United States. Barker pointed out that it may have something to do with the free market and profit-taking.

 As part of its planned to establish an umbrella organization to coordinate specialized geriatric services, the LHIN named the Northumberland Hills Hospital the “host agency.” A small secretariat will be set up at the hospital to work on a strategy to better deliver services to frail seniors. The immediate task will be to hire a project manager, recruit staff, establish office space and work on governance issues. The LHIN had found service providers, seniors and their families were largely unaware of what services were available in the LHIN. 2,100 seniors account for a third of all acute spending on seniors in the LHIN.  By focusing on the needs of this population, it could have a substantial impact on the overall use of acute care services in the LHIN.

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Cuts to outpatient rehab costly — Stroke report

Posted on June 22, 2011 | 1 comment

Cuts to outpatient rehab services are short sighted says Dr. Mark Bayley, author of a report on stroke services released this week by the Institute for Clinical Evaluative Sciences and theOntarioand Canadian Stroke Networks.

The lack of outpatient and CCAC rehab services mean many patients who would normally be able to go home end up in more expensive long term care facilities Bayley recently told the Toronto Star.

According to the 2011 Ontario Stroke Evaluation Report, patients are receiving far less visits than recommended from physiotherapists, occupational therapists and speech language pathologists.

Best practices suggest two visits per week from each of these professions. Instead over a two month period patients are averaging between three and four visits in total from each.

The report also notices considerable differences between the LHINs, calling for a more standardized approach for access to, and outcomes for, the rehabilitation sector.

InOntario only one in three stroke victims arrive at hospital in time to be considered for therapy that would dramatically improve outcomes.

While there was a reduction in overall wait times to stroke services, the report says there was also a reduction in access to inpatient rehabilitation among severly disable stroke patients.

The report also recommends the Ministry of Health Promotion continue to fund the warning signs of stroke television campaign.

The report did note that those taken to specialized stroke centers were more likely to receive care based on stroke best practices.

Between 2003/04 and 2009/10 there was also a reduced rate of emergency department visits and hospital stays for stroke or transient ischemic attack (TIA). TIAs are usually involve short term stroke-like symptoms and are considered to be a warning sign of a stroke.

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PC Platform: Tim Hudak wants you to compete for the job you have

Posted on June 7, 2011 | 3 comments

Tim Hudak is no longer the mystery man. The question is, now that his Ontario Progressive Conservative (PC) platform is out there, will it matter?

Hudak has made it clear that he intends to make public sector workers a target, including workers in health care.

“We will introduce initiatives requiring public sector unions to compete for government contracts, where appropriate,” the Tory Changebook states. “If another organization – whether a non-profit group or private business – can provide better value for money, taxpayers deserve to benefit.”

The platform goes on to suggest support services “like food preparation or laundry” in our “public institutions” are a prime example where he expects these competitions to take place.

If you are spared the competition, you may not have your next contract fairly arbitrated. Hudak plans to challenge the independence of the arbitrators, claiming recent awards have been “excessive.”

“We will require arbitrators to respect the ability of taxpayers to pay and take into account local circumstances,” the document states.

Changebook claims the Tories will “bring public sector paycheques in line with private sector standards.”

Specific to health care, Changebook makes the same promise as the McGuinty Liberals when it comes to funding – reduce increases to three per cent per year.

Hudak promises a review of all agencies and commissions, but would axe the LHINs before that even takes place. He would not replace the LHINs, which raises questions about how health care planning, local funding, and community engagement will take place. He says he will redirect the $70 million per year from closing the LHINs into front line care. At present Ontario spends $47 billion on public health care.

The Tories say they will add 5,000 new long term care beds and increase investments in home care to “give families more control over services.” That includes the ability to stay with the provider they have now, or pick a new government-funded home care provider who better meets their individual needs. Given the Tories have supported competitive bidding in home care, it is unclear whether an individual will be able to maintain their provider after they have lost the CCAC contract. While the Tories promise to increase investments in home care, they also promise to find savings at the CCACs.

Hudak says he will clamp down on fraud, but the only specific promise is to demand that people using the old red and white health cards also present another form of government-issued identification, such as a driver’s license or passport.

Unlike the Federal NDP, which promised more doctors and nurses, the Tories only claim to add to the number of doctors by increasing residency placements for medical students from Ontario who have pursued their education outside Canada. They call upon doctors, nurses, nurse practitioners, and physician assistants to work collaboratively, particularly in underserviced areas. There is no mention of the other health professions integral to the public health system.

Like the McGuinty Liberals, the Tories vow to be as obsessive about measuring health outcomes and “introducing a rigorous system of patient satisfaction.” Do we read that as even more patient satisfaction forms to fill out? And how does this square with the promise to reduce bureaucracy?

The Tories say they will make it law that the province cannot raise taxes without a clear mandate. Unfortunately, it is silent on needing the same to cut taxes, particularly for corporations.

They also promise to expand the scope of Freedom of Information, but it is not clear how.

The Tories have already come under fire for their spending commitments and tax cuts. The normally conservative Ottawa Citizen called it the “common nonsense revolution,” comparing Hudak’s plans to reckless debt run up by U.S. President George Bush. “Unlike Bush,” writes Citizen editorial board member Ken Gray, “Premier Dalton McGuinty has required Ontarians to pay for the services they receive for which his government has been dubbed ‘tax and spend’ by people who would rather spend, borrow and pay interest.”

“Hudak’s election platform is the kind of document that made Greece the model of fiscal prudence it is today,” writes Gray.

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Tell us your home care story

Posted on January 25, 2011 | Leave a comment

Tell us your home care story. Stories have been circulating about the difficulties Ontarians are having accessing home care. And when they finally do, quality care is challenged by the lack of resources front line nurses, therapists and support workers are given to get the job done.  OPSEU has set up a web site to collect these stories. We’ll publish the best comments and eventually forward it all on to the Health Minister. Whether you are a patient, a family member of a patient, or a worker in the system, please help us tell an important story. You can do so anonymously — we will confirm your comments by e-mail.

Go to www.whatwillyoudo.ca and click on Tell Your Story.

Some recent stories that we have received:

“I am a CCAC Case Manager.  I have been doing this job for over 15 years and only recently am concerned for the community I serve.  The CCAC funding is not adequate.  We are having to turn away seniors for simple things like bathing because we are nearing our budget for the year.  I have never seen anything like this in the 15 years I’ve worked here.  I feel we are leaving seniors at risk just because they don’t reach a certain ‘score’ determined solely by my CCAC. I think everyone has a right to have a bath regardless of age, or whether the disability is acute or chronic.  This is not happening and the Ministry needs to look at what is really happening as there is great disparity within Ontario.”

— CCAC Case Manager (name withheld by request)

“My mother is 70 years old and had hip surgery last summer. She had complications and was in the hospital almost six weeks. She required some care afterwards and VON had to take samples of her blood. My mother who was unable to drive at this time was told by the VON she had to transport the blood to the hospital lab herself. How was she going to do this? I was working out of town and so was my spouse the days her blood was drawn. I returned to town after the lab closed so my mom who is financially challenged had to pay a taxi to take her blood to the hospital. This wasn’t an issue before Mr. McGuinty took over and made all the cuts to Health Care.”

– Stella Morgan

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Healy & Juravich work with OPSEU to release home care music video

Posted on January 20, 2011 | Leave a comment

HAMILTON – Who says labour songs are dead? The Ontario Public Service Employees Union has produced a music video with recording artists Teresa Healy and Tom Juravich to highlight the exodus of Ontario’s home care professionals from an unstable work environment.

The song, “What Will You Do When I’m Gone?” was written by Healy and Juravich for a 2008 rally in Hamilton following news that the Victorian Order of Nurses and St. Joseph’s Home Care were dropped from a competition to provide visiting nursing services in the city. Both agencies had close to a century of history in Hamilton.

Healy & Juravich on the Hamilton waterfront in August.

As a result of the rally, a new moratorium was begun and the Hamilton competition cancelled.

Last spring Health Minister Deb Matthews said competitive bidding would return to home care despite the history of protest in many Ontario communities.

The union has argued that competitive bidding drives costs up and workers out as contracts change hands and jobs are lost. Patients in turn lose their long-time care providers, and waits increase as the sector is increasingly abandoned by health professionals who are frustrated by the unstable work environment.

“Unlike the sale of a business, when a home care contract changes hands, workers lose their jobs and are often forced to seek employment with new provider agencies at reduced wages and benefits,” says Warren (Smokey) Thomas, president of the 130,000-member union. “They also start again with minimum vacation and no union representation.”

The video is being distributed to media outlets this week and on-line.

OPSEU has produced a web site to host the video which includes a “making of” documentary, background information, a free download of the song, links to the artists’ sites and a form where patients, families and workers can leave their own stories behind.

The site is located at www.whatwillyoudo.ca. A French version of the site is also available atwww.queferezvous.ca .

The music video:

The short documentary about the video:

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Auditor’s report gives opening to finally leave Mike Harris’ failed home care system behind

Posted on December 6, 2010 | 1 comment

Earlier this spring the Health Minister extended the moratorium on competitive bidding for service contracts in home care. She did promise that the controversial system would eventually return.

Reading this week’s report by the office of the Auditor General of Ontario, one has to question why she is not looking at alternatives.

While there have been some providers itching to see a return to the bidding system, the Community Care Access Centres have cautioned that the return to competition for home care services will not necessarily save money nor narrow the gap between the costs of agencies providing identical services. The auditor notes that in some cases the rates paid for shift nursing services by one CCAC could be twice as high as those paid by another CCAC.

While proponents of the bidding system – including former Minister Elinor Caplan – have argued the competitions enhance quality, the auditor says we just don’t have the present oversight to even know if patients are receiving the care the province is paying for – let alone measure quality.

According to the Auditor, three-quarters of the service providers had limited ability to assess whether their staff had delivered the required services in the client’s home in a timely manner. Further, 60 per cent of service providers had inaccurate or unclear definitions of what constituted a missed visit.

More disturbing is the inconsistent data that was made available. At one CCAC a service provider reported that it had rejected about seven per cent of requests for service in that quarter – the auditor’s review of the CCAC data showed that the provider had in fact rejected 39 per cent of requests for its services.

The auditor noted that the number of service complaints was relatively small compared to the number of clients the agencies see. However, his office fails to acknowledge that many care recipients are reluctant to complain about their service less they be taken off care. The auditor notes the CCACs told his staff that some issues brought to case managers by clients or family members were not classified as formal complaints, while others were dealt with as “events.” It’s hard to boast about how few complaints there are when the system doesn’t even have a standardized description of what a complaint is.

The auditor writes that the service discrepancies may be based partially on historic funding patterns. While the auditor likes the idea of a funding formula that reflects real need, it may be difficult to implement when one agency can be charging double that of another agency to provide the same service.

The auditor also notes that lengthy waits for service are also due to a lack of both human and financial resources. With the return of competitive bidding it will only accelerate this problem as professional workers will continue to leave in the face of continued job insecurity.

There is enough in the auditor’s report to warrant a deeper look at the present home care system. Ontario is the only province to rely almost exclusively on contracted service providers.

Its time for the McGuinty government to finally deal with Mike Harris’ failed home care system – a system they too opposed while in opposition.

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Northumberland Hills dominates debate as CE LHIN approves $68 million in budget cuts to 10 hospitals

Posted on March 17, 2010 | Leave a comment

The Central East Local Health Integration Network (CE LHIN) approved the operating plans of 10 hospitals yesterday, including almost $68 million in budget cuts. That $68 million includes $12 million in cuts that will have a direct impact on patient services.

About 25 community members were present from the Cobourg area, many who had demonstrated at the Northumberland Hills Hospital the day before (see video link on this BLOG). NHH is cutting 26 beds, all outpatient rehab services, and closing is diabetes education and outreach clinic. The hospital is making more than $2 million in cuts despite being described by the LHIN as the most efficient in the province for its size and service.

Defining cuts as “realignment strategies,” it was clear from the NHH discussion that the LHIN had no plans to replace the services that were coming out of the hospital beyond vague promises. No indication was given during the meeting whether cuts to services at other hospitals were finding alternate replacements in the community.

The LHIN said they did not have jurisdiction over the diabetes program that was being cut at NHH. The diabetes program is funded directly by the province, although the hospital was contributing $150,000.  The LHIN said it would meet with the Ministry to look at local alternatives to delivering this service. Clearly nothing is yet in place despite the fact that these services are soon to end at NHH.

Much of the debate centered on the closure of outpatient rehab services. With an aging population, NHH has numerous patients transferred to the hospital after receiving hip and knee replacement surgery. Once these patients have completed their stay in the hospital, no publicly funded outpatient rehab will be available to them within the boundaries of Northumberland County.

LHIN Board member Dr. Alex Hukowich drew applause from the gallery when he said there was a difference between service availability and access, given private physiotherapy will be available only at a price to patients. Hukowich suggested that this issue was worth revisiting given the province has told the hospitals that outpatient rehab is not considered a core hospital service. The Scarborough Hospital is also ending outpatient rehab as part of its new operating plan.

In a separate meeting with OPSEU the day before, local MPP Lou Rinaldi suggested patients could travel out of county to Trenton to access outpatient rehab. Rinaldi lives close to Trenton in nearby Brighton.

The LHIN also said that the badly underfunded CCAC could pick up some of this work for patients who faced financial hardship. The cash-strapped CCAC admitted in January that it could only serve the most acute patients in the LHIN. Hospital staff at NHH reports that the CCAC has not been accepting their rehab patients recently.

The only service being lost from NHH that had any committed resources for relocation was the alternate level of care beds. Sixteen ALC beds are being chopped in the new plan. However, the LHIN has only $1.4 million to provide beds in retirement homes to cover ALC patients looking for a place to go. Essentially privatizing these beds, CE LHIN Senior Director Paul Barker admitted that it was not enough money to compensate for the 16 beds being lost at NHH given the funds were needed for beds across the region.

The retirement home beds have been under scrutiny since a Coroner’s Report last year, which recommended the hospitals assess who was being discharged to these facilities given the lack of appropriate resources and regulation. Since then, the province has changed the rules, requiring retirement homes accepting ALC patients to live up to long term care standards and be subject to inspection. It is not known whether retirement homes in the LHIN will be capable of increasing their staffing and other resources to meet these demands. A tender has yet to be issued from the LHIN.

As the LHIN board faced one agreement after another, no detail was given on what was in the $55 million in efficiencies the hospitals were committing to.

Normally the hospitals would be entering into new two-year accountability agreement with the LHINs. Without knowing what their funding levels would be, new agreements became impossible to achieve. Instead, hospitals were asked to come up with a risk report that highlighted what they would do given a funding freeze, a one per cent increase, or a two per cent increase. All the approved plans were based on a funding freeze scenario.

The CE LHIN suggested that they would recommend the NHH revisit its cuts to outpatient rehab services if there were to be a funding increase.

In order to extend funding beginning April 1st, the LHINs had to approve amending agreements that extended the existing accountability agreements by another year. Three hospitals had yet to complete the planning process and the LHIN board directed the CEO and LHIN Chair to sign these three agreements on their behalf based on the reporting they had received. It is expected next year hospitals will sign new three-year accountability agreements with the LHINs.

Should the LHIN not approve any of these plans, there would only have been a two-week window to readjust them.

The LHIN Board took a leap of faith when it came to approving a plan for the Peterborough Regional Health Centre given the hospital is presently undergoing a peer review. With no plan in place, it is expected that the peer review will come up with $26 million in cuts to trim the budget over the coming year. The LHIN is assuming these will all come from “efficiencies.”

All hospitals are expected to balance their operating budgets by the end of the coming year, although the LHIN acknowledged that hospitals would need to run surpluses to cover their debt repayments and cost of restructuring – mostly in the form of severance payments to staff.

If an increase does arrive in next week’s provincial budget, some hospitals may decide to apply it against their accumulated debt rather than rescue any of the services on the chopping block.

The shortcomings of the LHIN legislation became evident during the meeting as Barker reported that all hospitals had conducted public consultations as required under legislation. However, neither staff nor the general public was consulted regarding the NHH plan. The hospital had instead relied on a small panel of appointees drawn randomly from the community. Anticipating criticism, Barker pointed out that the legislation does not define what these consultations are to look like.

Cost savings required of each hospital in the upcoming plan (realignment numbers directly impact on patient services):

Bellwood Health Services: $168, 604 – all from “efficiencies”
Campbellford Memorial Hospital: $204,000 – all from “efficiencies”
Haliburton Highlands Health Services: $237,000 – all from “efficiencies”
Lakeride Health Corporation: $11,102,126 / Realignment: $3,1000,000
Ontario Shores: $4,040,000 / Realignment: $1,700,000
Peterborough Regional Health Centre: $25,752,200 – all from “efficiencies”
Ross Memorial Hospital: $4,768,114 / Realignment: $1,330,000
Rouge Valley Health System: $8,656,250 / Realignment: $1,036,250
The Scarborough Hospital: $11,148,000 / Realignment: $3,421,000
Northumberland Hills Hospital: $2,013,800 / Realignment: $1,794,300

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