City Centre Care Society

THE REPORT OF THE PRESIDENT AND EXECUTIVE DIRECTORS

TO THE CITY CENTRE CARE SOCIETY (CCCS) AGM

JUNE 19, 2007

City Centre Care Society and its predecessor Central City Mission Society have provided care to the marginalized of Vancouver since 1907. City Centre Care Society was incorporated in 1997 to amalgamate Central City Lodge and Cooper Place. The Lodge started operations in 1910 as Central City Mission. Cooper Place, operated by the Wilberforce Cooper Care Society, opened its doors in 1983 as an intermediate care facility. The City Centre Care Society is licensed to provide services to 194 residents and tenants in three programs – 100 residents in Complex Care, 22 residents in the Addictions Recovery Program and 72 residents in Assisted Living. Cooper Place houses the Assisted Living Program while Central City Lodge built in 1993 is home to both the Complex Care and the Addiction Recovery Programs.

During the past year there was a change in leadership at both the Board and the Executive Director levels. In March 2006 Alex Reibin returned as the interim Executive Director for five months pending the hiring of a new Executive Director. At the Annual General Meeting in June 2006, Harley Harris, after leading the organization for several years as the Board Chair, resigned to become Past Board President. Deborah Kitson, a Board member for many years, was elected as the Society’s new President. Seamus O’Melinn started as the new Executive Director in August 2006. Previously Seamus had worked for fourteen years as the Executive Director for non-profit Societies that provided complex care and independent housing for seniors.

GOALS

Working together the Board and the management team initiated a thorough organizational review that will result in lasting beneficial changes. The ongoing review requires taking sufficient time to understand how the organization currently operates. The leadership team set the following long term goals:

1) To continue building an organization in which staff can live their values by providing care with dignity and respect in a resident-centred community that strives to provide meaning and hope in the lives of some of society’s most marginalized members.

2) To continue developing and utilizing staff talents to identify unmet resident and tenant needs in the physical, social, emotional and spiritual realms. To find innovative ways to meet these needs by setting challenging yet achievable goals in the areas of leadership, clinical skills, teamwork, collaborative decision making and interpersonal skills.

3) To strive to be good stewards by being financially prudent in a manner that creatively addresses increasingly more complex operational needs including increased resident acuity, financial challenges and expensive maintenance of aging buildings.

4) To explore external strategic opportunities that utilize our Society’s strengths, address unmet needs in the community, and serve as a source of renewal for the organization. This will require our Society to renew or build relationships with partners.

OUR RESIDENTS AND TENANTS

While our operations are part of a larger continuum of care offered by Vancouver Coastal Health (VCH), Central City Lodge and Cooper Place are not typical complex care and assisted living facilities. All of our programs serve residents from the Downtown East Side and at Cooper Place being close to Chinatown also provides assisted living for Chinese tenants. Staff have developed skills and expertise over the years in meeting the unique and very complex needs of the residents who may have substance abuse or dependence issues, HIV/AIDS, and/or mental illness.

Staff proudly care for residents whose needs are among the most challenging within the residential programs offered within Vancouver Coastal Health (VCH). The Complex Care Program at Central City Lodge serves 74 residents in the general population and 26 residents in the Special (dementia) Care Program. Approximately 50% of residents are under the age of 70 and approximately 75% are male. This contrasts with the typical complex care facility which tends to care for residents that are female with an average age of 85.

Along with other complex care facilities we have noted that, due to the changes in admission criteria, the newer residents who are moving in are more medically compromised and do not tend to live as long as some residents admitted in previous years. Given the compromised health condition of those being admitted to complex care, it is wonderful to see residents whose physical and mental health improve due to our care. Residents with simpler medical needs are now being cared for by other alternatives such as Assisted Living.

Cooper Place, the first non-profit assisted living facility in Vancouver, probably has the highest percentage of tenants (15%) who would be eligible for admission to complex care. The complexity of the tenants’ health status is illustrated by the fact that 42% of the tenants are followed by VCH’s Mental Health Teams. Tenants range in age from 43 to 98 with the average age being 74. Approximately 40% of the tenants are Chinese and 60 % of the tenants are male.

The Addiction Recovery Program at Central City Lodge, is a support recovery program licensed by VCH for 22 males aged 19 and older. It provides an abstinence model of intervention for people with a substance use problem. The program also offers assistance with life skills development and securing suitable housing. Our staff’s clinical expertise allows the program to admit more complex residents than some other recovery programs.

OUR INITIATIVES

Several major initiatives occurred during the past year in the Complex Care Program. These included implementing a new medication system, starting a Family Council, introducing monthly staff presentations to share resident information with other staff, and adding Licensed Practical Nurses into the staffing mix of the Special Care Unit. Other initiatives included starting work on a resident rights and responsibilities document, increasing programming in the special care unit, and continuing fall management by our Activation Department.

The largest initiative in Complex Care for the upcoming year will be the implementation of the Minimum Data Set (MDS) system. MDS is an internationally used system that assists staff to conduct resident assessments and treatments. To date we have selected a Team Leader for planning and implementing the system and we have purchased a computer server and software. In May 2007, our Team Leader, as a representative from VCH, participated at an international MDS conference in Ottawa. Future work will involve a workflow redesign for all care processes and extensive education for leaders and staff who will learn the process along with a new computer program. With financial and consulting assistance from VCH, we expect to receive many benefits from this undertaking. By reviewing our practices and using the new software, we expect to experience a sense of organizational renewal as our multi-disciplinary team works together to improve care, team work, and the efficiency of our system.

Initiatives in Assisted Living at Cooper Place included changing the pharmacy services provider, providing more management support on site which required setting up offices for shared Society staff, sponsoring an LPN to obtain a mental health certificate, implementing consistent recreation programming, participating in an annual operational review with VCH, and being involved in inspections by WorkSafe and VCH’s Food Quality and Environmental Health Departments.

Initiatives in the Addiction Recovery Program (ARP) included admitting more residents with concurrent disorders; improving Group Programming, charting procedures and service plans for ARP residents; assisting in the development and implementation of the VCH managed Access Central referral system; and participating in the Ministry of Employment and Income Assistance Funding Initiative. The ARP team also participated in courses on “Planning for Concurrent Disorders”, “Team Building Tactics”, Non-violent Crisis Intervention, and benzodiazepines.

HUMAN RESOURCES

In order to provide care and services to the residents, we rely heavily on our human resources consisting of staff, the Board of Directors, volunteers, consultants, physicians, and organizations such as Vancouver Coastal Health. Our staff do an extraordinary job in fulfilling a special role in the lives of our residents in making a community where staff replace family members who may not be present in the residents’ lives. We strive to provide the love and hope that family can bring. Staff often build very meaningful relationships with residents, many of whom have very interesting life stories.

Our 170 staff, whose average age is 49, are skilled in caring and in dealing with the unique needs of residents residing in Complex Care, Addiction Recovery and Assisted Living. Vancouver Coastal Health staff and others who deal with our staff recognize the extraordinary skills, tolerance, and compassion that our staff exercise in meeting the residents’ needs.

In order to meet new challenges, our Society assists staff with employee programs such as Alive, Employee Assistance, Graduated Return to Work, education, a staff recognition dinner, and recognizing the contributions of all of our staff by organizing events such as National Nurses week. The Alive Program is a confidential health risk assessment for staff and includes one-to-one nurse coaching to assist employees to identify personal health issues and develop action plans. This innovative pilot project is a year long initiative of the Healthcare Benefit Trust.

A working group of employees planned and implemented the Alive program. The group held monthly health promotion events such as nutrition and arthritis education, setting goals, walking and participating in Run for the Cure for breast cancer. Staff participation exceeded our expectations with 39 % of regular employees completing the survey and 33% meeting with a registered nurse provided by the Healthcare Benefit Trust.

In order to help staff provide continually better care to residents and to help fulfill our commitment to continuous learning, we have supported our staff in completing courses covering a wide range of topics including mental health, first aid, infection control, health records documentation, dealing with verbal aggression, creating effective exercise programs for Older Adults, palliative care and building maintenance. Staff at Central City Lodge also assist Vancouver Community College students complete their practicum as either Care Aides or in counselling.

To be successful in meeting resident needs we have to maintain and recruit staff in all departments. This is proving to be challenging due to regional labour shortages and staff retiring. Since March 31, 2006 ten staff have retired. Four staff members with 24 or more years of service when they retired were William So, Rose Sziraky, Jean-Louis Brussac, and George Coombs. Another four staff members retiring with more than ten years of service were Ken Dick, Ed Birkenthal, Jacqueline Hofforth, and Claire Sauve. Retiring staff who had seven years of service were Franciso Maldonado and Young Schmidt.

At a dinner in October 2006 we honoured many staff members with ten or more years of service. The respective managers spoke about each staff member’s background and contributions to the organization. Staff members received a certificate from the Board President in recognition of their service. The Executive Director asked the group to continue to provide leadership in the organization as well as serve as role models of excellent resident care. Currently, we have 12 staff members with more than 20 years of service. Tom Vasa and Donna Longpre are the longest serving staff members at Central City Lodge and Jo-anne Blais and Rosalinda Mack are the longest serving staff members at Cooper Place.

New provincial legislation is expected to bring an end to mandatory retirement and our Society will be monitoring this development and adjusting our Mandatory Retirement Policy accordingly. We will welcome this development which may assist us in maintaining valued employees who are willing and able to continue contributing beyond age 65.

We would also like to thank three Board members who resigned at or since the last Annual General Meeting in June 2006. They are Nicole Garton, Alice Owen, and Joanne Stephenson. We would like to welcome three Board members who joined the Society in the past year. They are Marie Whelan, Anne Murdock, and John Hood. They join the Governance team of Gordon Crozier, Linda Ruiz, Harley Harris, Deborah Kitson and Michael Sorochan.

Our Society thanks the following persons and organizations for their service or contributions:

Alex Reibin for coming out of retirement to act as the Interim Executive Director
Central City Foundation for donations that assist us in our work
St. James Parish Foundation for leasing us the land next to Cooper Place
Dr. John Sehmer who was our Medical Coordinator and family physician for 12 years.
Dr. Brendan Russell, a long serving physician at CCL complex care for accepting the role of Medical Coordinator and Dr. Dara Behroozi for assuming care for approximately half the residents in complex care. Dr. Batt for continuing as the family physician for ARP
Volunteers in pastoral care and recreation
Vancouver Coastal Health staff from many departments
BC Housing staff

BUILDING MAINTENANCE AND EQUIPMENT

Our Society made building maintenance an organizational priority as evidenced by re-structuring the department and hiring a Maintenance Manager. The manager assisted in the development of a capital plan and is coordinating the planning for the major capital projects, which hopefully will begin within the next few months. He is also responsible for preventive maintenance and repairs in our two aging buildings. Cooper Place is now 24 years old and Central City Lodge is 14 years old. As the buildings age we are incurring, as expected, higher maintenance costs. The Maintenance Manager now reports to the Executive Director.

In March 2007, the Board of Directors approved the Capital Plan for both sites. At Central City Lodge our major projects consist of a building security system, a resident wandering system, and a more comfortable outdoor patio for smoking year round since the indoor smoking room was closed. The resident wandering system will protect residents who are at risk of wandering from the Lodge and not being able to find their way back.

The Building Security Project at Central City Lodge will result in increased protection for the residents and staff in several ways. Firstly, the system will limit access to the parkade and to all stairwells throughout the building. This will prevent unauthorized access and delays in finding residents with limited mobility who may fall in these less travelled areas. Secondly, the security system will include video surveillance with recording capacity to assist in both monitoring areas and investigating any security incident. Finally, the alarms on parkade doors will alert staff if persons are attempting to gain unauthorized access.

Cooper Place will be upgraded this upcoming year with two very major projects - a new water piping system and a new Heating, Ventilation and Air Conditioning system. In addition there will be a major roof repair.

Staff and contractors dealt with several major problems at Central City Lodge this year involving the electrical, telephone, computer and nurse call systems. Twelve bathrooms on the Special Care unit were repaired. We made several significant improvements in the Addiction Recovery Program on the second floor of the Lodge. These included renovating the kitchen, repairing the bathing rooms, purchasing new chairs for the lounge and dining room and installing new carpet. Vancouver Coastal Health personnel inspected the building and found that the building and equipment were being well maintained.

Our Society made several major improvements to our computer network including replacing a server, purchasing many computers, and purchasing software for several uses including MDS, a medical records upgrade and project management. The number of computer users on our network has grown substantially. Several ergonomic workstations were purchased. In the future we will be creating a computer training lab for MDS, continuing to computerize our scheduling process, and training more staff to use programs such as MS Excel.

FINANCES

The Finance Department has completed several initiatives including changing banks to obtain better interest rates, streamlining accounting procedures and re-locating to Central City Lodge.

Our annual financial audit went very well and confirmed that despite increasing financial challenges all three programs operated within budget. The audited financial statements show that our combined revenue of almost $10,000,000 exceeded expenditures by $76,000 or less than 1%. This is significantly less of a surplus than the previous year as our operating costs have increased significantly. Below is a condensed version of the Combined Statement of Operations from the Audited Financial Statements for the Year ending March 31, 2007:

COMBINED STATEMENT OF OPERATIONS OF CCCS
FOR THE YEAR ENDING MARCH 31, 2007

REVENUE
VCH Grants	7,289,437
Resident User Fees	2,037,969
Amortization of Deferred Capital Contribution	373,447
Miscellaneous	142,468
BC Housing Mortgage Subsidy	77,110
Total Revenue	9,920,431

EXPENSES
Salaries and Benefits	7,217,687
Building and Property	1,026,494
Amortization	689,868
Supplies	640,908
Administration	243,439
Replacement Reserve	25,800
Total Expenses	9,844,196

EXCESS OF REVENUE OVER EXPENSES	76,235

Revenues increased from several sources such as Vancouver Coastal Health (VCH), user fees and interest income. However, approximately $500,000 from VCH was a one time payment for a provincially mandated incentive bonus. Next year’s interest income is expected to decrease as the Society’s reserves will be used to fund major capital projects. The largest percentage expense increases were for Building and Property and then for Salaries and Benefits. Building and Property expenses account for approximately 10% of all expenses. Salaries and Benefits account for 73% of all expenses and most are specified in provincial union contracts. We have temporarily added some additional care hours because of the increased needs of the residents and we will review our staffing needs and financial resources in the coming year.

While our Society is in sound financial shape, the major capital projects will seriously drain the Society’s reserves and will require our Society to fund raise for future projects. Expenditures on the Capital projects will cause a loss of interest income, which will make operating within budget more difficult. Consequently, we will need to find partners to finance future initiatives such as developing adjoining properties next to our buildings.

POTENTIAL FUTURE PROJECTS

In order to address unmet needs in the community and in order to continue to create operational efficiencies through building economies of scale, the Society has expressed interest in initiating two additional programs on properties adjoining our buildings. The first involves the vacant land next to Cooper Place. This land is leased from the St. James Parish Foundation. We will respond to a request for proposals to build and operate supportive housing on this property. Services such as meals or recreation could be provided from Cooper Place. We will be talking with potential partners to obtain financial and technical assistance as well as letters of support for the project.

We also plan to submit an expression of interest to BC Housing to operate the Park Hotel, which adjoins Central City Lodge. In April 2007, the Province purchased the Park Hotel as part of the Provincial Homelessness Initiative. Our proposal, if accepted, would use the hotel to provide alcohol and drug free supportive transitional housing and programming for adult males, 19 years of age and older who have substance abuse or dependence issues and may also have a concurrent mental illness. The treatment would provide structure and build effective life skills for males attempting to maintain abstinence from substance abuse.

Our application will emphasize three strengths of our organization. The first strength is that our addiction recovery staff have the clinical expertise in dealing with homelessness, addiction, HIV/AIDS and concurrent disorders. Secondly, our Society has the administrative and maintenance structure in place to quickly operationalize this program. Thirdly, Central City Lodge is adjacent to the hotel and hence our Addiction Recovery Staff could be involved in efficiently operating the new urgently needed program.

CLOSING

In summary, our staff continue to work diligently to meet the holistic needs of the residents and tenants in our community while being good stewards of our resources. We thank the staff, management team, Board members and other volunteers, consultants and contractors for their efforts and dedication for enhancing the quality of life for the residents and responding to many challenges. At the same time the Society has made significant progress toward achieving its long term goals. We also appreciate the efforts of the many individuals and organizations that help us, through financial support, time and talent to live our values by caring in a warm and compassionate manner for many marginalized residents and tenants. We look forward to continuing that progress in the coming year.

Deborah Kitson Seamus O’Melinn, CHE

President, Board of Directors Executive Director

Annual Report City Centre Care Society