In recent years, Community Care Access Centres (CCACs) in Ontario have not been able to provide home care services to all eligible clients and some CCACs have chosen to utilize wait lists to manage their resources. This article describes the development of an aid designed to help the Simcoe County CCAC manage the wait lists for occupational therapy, physiotherapy, speech language pathology, nutritional services and social work. The aid may be used to: 1) quantify waiting times; 2) determine the impact of budget changes on wait times; 3) predict the impact of changing the number of visits per client on waiting times; 4) produce quantitative data to support requests for additional funds from the provincial government; and 5) to estimate waiting times for clients. Similar aids may be useful to the new Local Health Integration Networks and the realigned CCACs in Ontario.

Background: Community Care Access Centres (CCAC) in Ontario employ case managers who determine the type and frequency of service required by individuals and then contract to independent agencies to provide these services. In recent years, CCACs have not been able to provide service to all eligible clients and some have chosen to use wait lists to manage their resources. This article describes the development of an aid designed to help the Simcoe County CCAC manage the wait lists for occupational therapy, physiotherapy, speech language pathology, nutritional services and social work.

Methods: The researchers designed an aid using queuing theory, which enabled calculation of expected wait times based on a set of inputs that represented demand for and capacity to provide services. More specifically, the aid was to be used to: 1) quantify waiting times; 2) determine the impact of budget changes on wait times; 3) predict the impact of changing the number of visits per client on waiting time; 4) produce quantitative data to support requests for additional funds from the provincial government; and 5) estimate waiting times for clients. For each type of therapy or provided care, the wait list was further controlled by age (adult vs. child) and geographical region (5 regions of Simcoe County).

Findings: The following pieces of information were required as inputs: 1) the average number of new referrals per week; 2) the average number of clients who receive service (the average number of visits budgeted per week/ the average visits per client per week); and 3) the average number of patients completing therapy per week per therapist. Historical data from the CCAC were used to account for missing data on these factors (default input). This aid was also able to accommodate the Simcoe County CCAC's system for prioritizing clients to receive service. The actual aid was designed using input and output screens on a computer, facilitating use of the aid by individuals unfamiliar with the mathematics. The default inputs could be replaced by the user in order to conduct "what if" analyses to estimate the impact of moving funding between waiting lists or obtaining new funding from the provincial government. Validation using historical data showed that the aid worked well for adult waiting lists but poorly predicted waiting times for children due to the fact that children spent significantly longer time on service than adults.

Conclusions: Aids similar to the one described here may be useful to the new Local Health Integration Networks and the realigned CCACs in Ontario. Clients can be informed of their expected waiting time for service and may be better able to decide whether to wait for public service or to purchase it privately. Furthermore, having accessible quantitative data may strengthen requests for additional funding from the provincial government and help operators understand the factors that lead to long wait times. Alternatively, the provincial government could hold CCACs accountable for achieving the waiting times predicted by such an aid.

Reference: Busby CR, Carter MW. A decision tool for negotiating home care funding levels in Ontario. Home Health Care Services Quarterly. 2006; 25: 91-106.

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