Common use of Performance Indicators Clause in Contracts

Performance Indicators. The HSP’s delivery of the Services will be measured by the following Indicators, Targets and where applicable Performance Standards. In the following table: n/a meanç ‘not-appIicabIe’, that there iç no defined Performance Standard for the indicator for the applicable year. tbd means a Target, and a Performance Standard, if applicable, will be determined during the applicable year. INDICATOR CATEGORY INDICATOR P = Performance Indicator E = Explanatory Indicator M = Monitoring Indicator 2019/20 PERFORMANCE TARGET STANDARD Organizational Health and Financial Indicators Debt Service Coverage Ratio (P) 1 c1 Total Margin (P) 0 cO Coordination and Access Indicators Percent Resident Days – Long Stay (E) n/a n/a Wait Time from LHIN Determination of Eligibility to LTC Home Response (M) n/a n/a Long-Term Care Home Refusal Rate (E) n/a n/a SCHEDULE D — PERFORMANCE 2/3 INDICATOR CATEGORY Quality and Resident Safety Indicators INDICATOR P = Performance Indicator E = Explanatory Indicator M = Monitoring Indicator Percentage of Residents Who Fell in the Last 30 days (M) 2019/20 PERFORMANCE TARGET STANDARD n/a n/a Percentage of Residents Whose Pressure Ulcer Worsened (M) n/a n/a Percentage of Residents on Antipsychotics Without a Diagnosis of Psychosis (M) n/a n/a Percentage of Residents in Daily Physical Restraints (M) n/a n/a SCHEDULE D — PERFORMANCE 2.0 LHIN-Specific Performance Obligations 3/3

Performance Indicators. The HSP’s delivery of the Services will be measured by the following Indicators, Targets and where applicable Performance Standards. In the following table: n/a meanç means ‘not-appIicabIeapplicable’, that there iç is no defined Performance Standard for the indicator for the applicable year. tbd means a Target, and a Performance Standard, if applicable, will be determined during the applicable year. INDICATOR CATEGORY INDICATOR P = P=Performance Indicator E = E=Explanatory Indicator M = M=Monitoring Indicator 2019/20 PERFORMANCE TARGET STANDARD Performance Target Standard Organizational Health and Financial Indicators Debt Service Coverage Ratio (P) 1 c1 ≥1 Total Margin (P) 0 cO ≥0 Coordination and Access Indicators Percent Resident Days – Long Stay (E) n/a n/a Wait Time from LHIN Determination of Eligibility to LTC Home Response (M) n/a n/a Long-Term Care Home Refusal Rate (E) n/a n/a SCHEDULE D — PERFORMANCE 2/3 INDICATOR CATEGORY Quality and Resident Safety Indicators INDICATOR P = Performance Indicator E = Explanatory Indicator M = Monitoring Indicator Percentage of Residents Who Fell in the Last 30 days (M) 2019/20 PERFORMANCE TARGET STANDARD n/a n/a Percentage of Residents Whose Pressure Ulcer Worsened (M) n/a n/a Percentage of Residents on Antipsychotics Without a Diagnosis of Psychosis (M) n/a n/a Percentage of Residents in Daily Physical Restraints (M) n/a n/a SCHEDULE D — PERFORMANCE 2.0 LHIN-Specific Performance Obligations 3/32.0 LHIN-Specific Performance Obligations Schedule E – Form of Compliance Declaration DECLARATION OF COMPLIANCE Issued pursuant to the Long Term Care Service Accountability Agreement

Performance Indicators. The HSP’s delivery of the Services will be measured by the following Indicators, Targets and where applicable Performance Standards. In the following table: n/a meanç means ‘not-appIicabIeapplicable’, that there iç is no defined Performance Standard for the indicator for the applicable year. tbd means a Target, and a Performance Standard, if applicable, will be determined during the applicable year. INDICATOR CATEGORY INDICATOR P = P=Performance Indicator E = E=Explanatory Indicator M = M=Monitoring Indicator 2019/20 PERFORMANCE TARGET STANDARD Performance Target Standard Organizational Health and Financial Indicators Debt Service Coverage Ratio (P) 1 c1 ≥1 Total Margin (P) 0 cO ≥0 Coordination and Access Indicators Percent Resident Days – Long Stay (E) n/a n/a Wait Time from LHIN Determination of Eligibility to LTC Home Response (M) n/a n/a Long-Term Care Home Refusal Rate (E) n/a n/a SCHEDULE D — PERFORMANCE 2/3 INDICATOR CATEGORY Quality and Resident Safety Indicators INDICATOR P = Performance Indicator E = Explanatory Indicator M = Monitoring Indicator Percentage of Residents Who Fell in the Last 30 days (M) 2019/20 PERFORMANCE TARGET STANDARD n/a n/a Percentage of Residents Whose Pressure Ulcer Worsened (M) n/a n/a Percentage of Residents on Antipsychotics Without a Diagnosis of Psychosis (M) n/a n/a Percentage of Residents in Daily Physical Restraints (M) n/a n/a SCHEDULE D — PERFORMANCE 2.0 LHIN-Specific Performance Obligations 3/3Not Applicable. 1/3 SCHEDULE E Form of Compliance Declaration Declaration of Compliance Issued pursuant to the Long Term Care Service Accountability Agreement‌ To: The Board of Directors of the [Insert Name of LHIN]

Performance Indicators. The HSP’s delivery of the Services will be measured by the following Indicators, Targets and where applicable Performance Standards. In the following table: n/a meanç means ‘not-appIicabIeapplicable’, that there iç is no defined Performance Standard for the indicator for the applicable year. tbd means a Target, and a Performance Standard, if applicable, will be determined during the applicable year. INDICATOR CATEGORY INDICATOR P = Performance Indicator E = Explanatory Indicator M = Monitoring Indicator 2019/20 PERFORMANCE TARGET STANDARD Organizational Health and Financial Indicators Debt Service Coverage Ratio (P) 1 c1 ≥1 Total Margin (P) 0 cO ≥0 Coordination and Access Indicators Percent Resident Days – Long Stay (E) n/a n/a Wait Time from LHIN Determination of Eligibility to LTC Home Response (M) n/a n/a Long-Term Care Home Refusal Rate (E) n/a n/a SCHEDULE D — PERFORMANCE 2/3 INDICATOR CATEGORY Quality and Resident Safety Indicators INDICATOR P = Performance Indicator E = Explanatory Indicator M = Monitoring Indicator Percentage of Residents Who Fell in the Last 30 days (M) 2019/20 PERFORMANCE TARGET STANDARD n/a n/a Percentage of Residents Whose Pressure Ulcer Worsened (M) n/a n/a Percentage of Residents on Antipsychotics Without a Diagnosis of Psychosis (M) n/a n/a Percentage of Residents in Daily Physical Restraints (M) n/a n/a SCHEDULE D — PERFORMANCE 2.0 LHIN-Specific Performance Obligations 3/3

Performance Indicators. The HSP’s delivery of the Services will be measured by the following Indicators, Targets and where applicable Performance Standards. In the following table: n/a meanç means ‘not-appIicabIeapplicable’, that there iç is no defined Performance Standard for the indicator for the applicable year. tbd means a Target, and a Performance Standard, if applicable, will be determined during the applicable year. INDICATOR CATEGORY INDICATOR P = P=Performance Indicator E = E=Explanatory Indicator M = Monitoring Indicator 2019/20 PERFORMANCE TARGET STANDARD 2016/17 Performance Target Standard Organizational Health and Financial Indicators Debt Service Coverage Ratio (P) 1 c1 n/a n/a Total Margin (P) 0 cO n/a n/a Coordination and Access Indicators Percent Resident Days – Long Average Long-Stay Occupancy / Average Long-Stay Utilization (E) n/a n/a Wait Time from LHIN CCAC Determination of Eligibility to LTC Home Response (ME) n/a n/a Long-Term Care Home Refusal Rate (E) n/a n/a SCHEDULE D — PERFORMANCE 2/3 INDICATOR CATEGORY Quality and Resident Safety Indicators INDICATOR P = Performance Indicator E = Explanatory Indicator M = Monitoring Indicator Percentage of Residents Who Fell in the Last 30 days (ME) 2019/20 PERFORMANCE TARGET STANDARD n/a n/a Percentage of Residents Whose Pressure Ulcer Worsened (ME) n/a n/a Percentage of Residents on Antipsychotics Without a Diagnosis of Psychosis (ME) n/a n/a Percentage of Residents in Daily Physical Restraints (ME) n/a n/a SCHEDULE D — PERFORMANCE 2.0 LHIN-Specific Performance Obligations 3/3Schedule E – Form of Compliance Declaration DECLARATION OF COMPLIANCE Issued pursuant to the Long Term Care Service Accountability Agreement

Performance Indicators. The HSP’s delivery of the Services will be measured by the following Indicators, Targets and where applicable Performance Standards. In the following table: n/a meanç means ‘not-appIicabIeapplicable’, that there iç is no defined Performance Standard for the indicator for the applicable year. tbd means a Target, and a Performance Standard, if applicable, will be determined during the applicable year. INDICATOR CATEGORY INDICATOR P = Performance Indicator E = Explanatory Indicator M = Monitoring Indicator 2019/20 PERFORMANCE TARGET STANDARD Organizational Health and Financial Indicators Debt Service Coverage Ratio (P) 1 c1 ≥1 Total Margin (P) 0 cO ≥0 Coordination and Access Indicators Percent Resident Days – Long Stay (E) n/a n/a Wait Time from LHIN Determination of Eligibility to LTC Home Response (M) n/a n/a Long-Term Care Home Refusal Rate (E) n/a n/a SCHEDULE D — PERFORMANCE 2/3 INDICATOR CATEGORY Quality and Resident Safety Indicators INDICATOR P = Performance Indicator E = Explanatory Indicator M = Monitoring Indicator 2019/20 PERFORMANCE TARGET STANDARD Quality and Resident Safety Indicators Percentage of Residents Who Fell in the Last 30 days (M) 2019/20 PERFORMANCE TARGET STANDARD n/a n/a Percentage of Residents Whose Pressure Ulcer Worsened (M) n/a n/a Percentage of Residents on Antipsychotics Without a Diagnosis of Psychosis (M) n/a n/a Percentage of Residents in Daily Physical Restraints (M) n/a n/a SCHEDULE D — PERFORMANCE 2.0 LHIN-Specific Performance Obligations 3/3PERFORMANCE

Performance Indicators. The HSP’s delivery of the Services will be measured by the following Indicators, Targets and where applicable Performance Standards. In the following table: n/a meanç means ‘not-appIicabIeapplicable’, that there iç is no defined Performance Standard for the indicator for the applicable year. tbd means a Target, and a Performance Standard, if applicable, will be determined during the applicable year. INDICATOR CATEGORY INDICATOR P = Performance Indicator E = Explanatory Indicator M = Monitoring Indicator 2019/20 PERFORMANCE TARGET STANDARD Organizational Health and Financial Indicators Debt Service Coverage Ratio (P) 1 c1 ≥1 Total Margin (P) 0 cO ≥0 Coordination and Access Indicators Percent Resident Days – Long Stay (E) n/a n/a Wait Time from LHIN Determination of Eligibility to LTC Home Response (M) n/a n/a Long-Term Care Home Refusal Rate (E) n/a n/a SCHEDULE D — PERFORMANCE 2/3 INDICATOR CATEGORY Quality and Resident Safety Indicators INDICATOR P = Performance Indicator E = Explanatory Indicator M = Monitoring Indicator 2019/20 PERFORMANCE TARGET STANDARD Quality and Resident Safety Indicators Percentage of Residents Who Fell in the Last 30 days (M) 2019/20 PERFORMANCE TARGET STANDARD n/a n/a Percentage of Residents Whose Pressure Ulcer Worsened (M) n/a n/a Percentage of Residents on Antipsychotics Without a Diagnosis of Psychosis (M) n/a n/a Percentage of Residents in Daily Physical Restraints (M) n/a n/a SCHEDULE D — PERFORMANCE 2.0 LHIN-Specific Performance Obligations 3/3PERFORMANCE

Performance Indicators. The HSP’s delivery of the Services will be measured by the following Indicators, Targets and where applicable Performance Standards. In the following table: n/a meanç means ‘not-appIicabIeapplicable’, that there iç is no defined Performance Standard for the indicator for the applicable year. tbd means a Target, and a Performance Standard, if applicable, will be determined during the applicable year. INDICATOR CATEGORY INDICATOR P = Performance Indicator E = Explanatory Indicator M = Monitoring Indicator 2019/20 PERFORMANCE TARGET STANDARD Organizational Health and Financial Indicators Debt Service Coverage Ratio (P) 1 c1 ≥1 Total Margin (P) 0 cO ≥0 Coordination and Access Indicators Percent Resident Days – Long Stay (E) n/a n/a Wait Time from LHIN Determination of Eligibility to LTC Home Response (M) n/a n/a Long-Term Care Home Refusal Rate (E) n/a n/a SCHEDULE D — PERFORMANCE 2/3 INDICATOR CATEGORY Quality and Resident Safety Indicators INDICATOR P = Performance Indicator E = Explanatory Indicator M = Monitoring Indicator 2019/20 PERFORMANCE TARGET STANDARD Quality and Resident Safety Indicators Percentage of Residents Who Fell in the Last 30 days (M) 2019/20 PERFORMANCE TARGET STANDARD n/a n/a Percentage of Residents Whose Pressure Ulcer Worsened (M) n/a n/a Percentage of Residents on Antipsychotics Without a Diagnosis of Psychosis (M) n/a n/a Percentage of Residents in Daily Physical Restraints (M) n/a n/a SCHEDULE D — PERFORMANCE 2.0 LHIN-Specific Performance Obligations 3/3Obligations

Performance Indicators. The HSP’s delivery of the Services will be measured by the following Indicators, Targets and where applicable Performance Standards. In the following table: n/a meanç means ‘not-appIicabIeapplicable’, that there iç is no defined Performance Standard for the indicator for the applicable year. tbd means a Target, and a Performance Standard, if applicable, will be determined during the applicable year. INDICATOR CATEGORY INDICATOR P = Performance Indicator E = Explanatory Indicator M = Monitoring Indicator 2019/20 PERFORMANCE TARGET STANDARD Organizational Health and Financial Indicators Debt Service Coverage Ratio (P) 1 c1 ≥1 Total Margin (P) 0 cO ≥0 Coordination and Access Indicators Percent Resident Days – Long Stay (E) n/a n/a Wait Time from LHIN Determination of Eligibility to LTC Home Response (M) n/a n/a Long-Term Care Home Refusal Rate (E) n/a n/a SCHEDULE D — PERFORMANCE 2/3 INDICATOR CATEGORY Quality and Resident Safety Indicators INDICATOR P = Performance Indicator E = Explanatory Indicator M = Monitoring Indicator 2019/20 PERFORMANCE TARGET STANDARD Quality and Resident Safety Indicators Percentage of Residents Who Fell in the Last 30 days (M) 2019/20 PERFORMANCE TARGET STANDARD n/a n/a Percentage of Residents Whose Pressure Ulcer Worsened (M) n/a n/a Percentage of Residents on Antipsychotics Without a Diagnosis of Psychosis (M) n/a n/a Percentage of Residents in Daily Physical Restraints (M) n/a n/a SCHEDULE D — PERFORMANCE 2.0 LHIN-Specific Performance Obligations 3/3

Performance Indicators. The HSP’s delivery of the Services will be measured by the following Indicators, Targets and where applicable Performance Standards. In the following table: n/a meanç means ‘not-appIicabIeapplicable’, that there iç is no defined Performance Standard for the indicator for the applicable year. tbd means a Target, and a Performance Standard, if applicable, will be determined during the applicable year. INDICATOR CATEGORY INDICATOR P = P=Performance Indicator E = E=Explanatory Indicator M = Monitoring Indicator 2019/20 PERFORMANCE TARGET STANDARD 2016/17 Performance Target Standard Organizational Health and Financial Indicators Debt Service Coverage Ratio (P) 1 c1 ≥1 Total Margin (P) 0 cO ≥0 Please indicate here if you wish to have your DSCR calculated at a corporate level Coordination and Access Indicators Percent Resident Days – Long Average Long-Stay Occupancy / Average Long-Stay Utilization (E) n/a n/a Wait Time from LHIN CCAC Determination of Eligibility to LTC Home Response (ME) n/a n/a Long-Term Care Home Refusal Rate (E) n/a n/a SCHEDULE D — PERFORMANCE 2/3 INDICATOR CATEGORY Quality and Resident Safety Indicators INDICATOR P = Performance Indicator E = Explanatory Indicator M = Monitoring Indicator Percentage of Residents Who Fell in the Last 30 days (ME) 2019/20 PERFORMANCE TARGET STANDARD n/a n/a Percentage of Residents Whose Pressure Ulcer Worsened (ME) n/a n/a Percentage of Residents on Antipsychotics Without a Diagnosis of Psychosis (ME) n/a n/a Percentage of Residents in Daily Physical Restraints (ME) n/a n/a SCHEDULE D — PERFORMANCE 2.0 LHIN-Specific Performance Obligations 3/3Name Objective to be achieved/ demonstrated Measure Reporting Protocol Reporting Requirements In-home BSO Liaison To assist in the development and sustainability of capacity in each LTC home, each home will be required to designate at least one (1) LTC staff member to act as a liaison with the BSO team. This staff member will work with the BSO team (MRT, PRC, GOC, psychiatry) to help develop capacity in each home. This liaison will work to establish a team/group within their home who deals specifically with complex residents with challenging behaviours. This does not have to be a new/separate team – we recognize that many LTC homes have groups/teams that deal specifically with complex residents with palliative care or high-intensity needs  Identification of Liaison  Progress made in the development of behavioral support capacity within the LTCH home Template to be provided by the LHIN Reporting requirements will be of an explanatory nature.  Q2 & Q4 – Narrative report outlining the progress that has been made to date in the development of behavioral support capacity within the LTCH home. Name Objective to be achieved/ demonstrated Measure Reporting Protocol Reporting Requirements Achievement of Provincial HQO Targets To ensure consistency of care in each LTC home, each home will be required to meet Provincial HQO targets over the course of three years. The LHIN will work with each home to develop goals and target setting to achieve each of the HQO indicators. · Recent Fall % · Worsening Bladder Control % · Pressure Ulcer % · Physically Restrained % Added in 2017-18 - Chemical Restraint %  2016/2017 – evaluation and target achievement goal setting for the first year  2017/2018 – evaluation of progression towards achievement of goals (meeting or above the Provincial Average)  2018/2019 – achievement of goals (meeting or above the Provincial Average) Template to be provided by the LHIN Reporting requirements in 2016/2017. • If existing LTC home is not meeting Provincial Averages, a plan with goals will be put in place to achieve the provincial minimum standards over a three year time period. • If existing LTC home is not meeting the Provincial targets – a review of utilized resources will be conducted, including utilization of NLOT teams, the BSO MRT teams and other resources • LTC homes will be required to fill out the template indicating the plan for achievement of targets over a three year period. Reporting requirements in 2017/2018 • An evaluation of progression towards the achievement of Provincial Averages will be conducted utilizing template. • Submission of template will be required in Q2 and Q4 • A review of the utilization of current resources will be conducted including NLOT teams, BSO MRT and other resources. Reporting requirements in 2018/2019 • LTC homes required to achieve Provincial HQO Averages in year three. • An evaluation of achievement utilizing the submitted templates in Q2 and Q4 will be conducted A review of the utilization of current resources will be conducted including NLOT teams, BSO MRT and other resources. Name Objective to be achieved/ demonstrated Measure Reporting Protocol Reporting Requirements In-home Palliative End- of-Life Care Liaison To assist in the development and sustainability of quality palliative end-of-life care in each LTC home, each home will be required to designate at least one (1) LTC staff member to act as a liaison with the Hospice Palliative Care Planner at the South East LHIN. This does not have to be a member of a new/separate team – we recognize that many LTC homes have groups/teams that deal specifically wih palliative end-of-life care.  Identification of Liaison.  Progress made in the development and sustainability of quality palliative end-of-life care within the LTCH home. Template provided by the LHIN Template to be provided by the LHIN Reporting requirements will be of an explanatory nature. Q2 and Q4 – Narrative report outlining the progress that has been made to date in the development of quality palliative end-of-life care within the LTCH home. Schedule E – Form of Compliance Declaration DECLARATION OF COMPLIANCE Issued pursuant to the Long Term Care Service Accountability Agreement

Performance Indicators. The HSP’s delivery of the Services will be measured by the following Indicators, Targets and where applicable Performance Standards. In the following table: n/a meanç means ‘not-appIicabIeapplicable’, that there iç is no defined Performance Standard for the indicator for the applicable year. tbd means a Target, and a Performance Standard, if applicable, will be determined during the applicable year. INDICATOR CATEGORY INDICATOR P = P=Performance Indicator E = E=Explanatory Indicator M = Monitoring Indicator 2019/20 PERFORMANCE TARGET STANDARD 2016/17 Performance Target Standard Organizational Health and Financial Indicators Debt Service Coverage Ratio (P) 1 c1 ≥1 Total Margin (P) 0 cO ≥0 Please indicate here if you wish to have your DSCR calculated at a corporate level Coordination and Access Indicators Percent Resident Days – Long Average Long-Stay Occupancy / Average Long-Stay Utilization (E) n/a n/a Wait Time from LHIN CCAC Determination of Eligibility to LTC Home Response (ME) n/a n/a Long-Term Care Home Refusal Rate (E) n/a n/a SCHEDULE D — PERFORMANCE 2/3 INDICATOR CATEGORY Quality and Resident Safety Indicators INDICATOR P = Performance Indicator E = Explanatory Indicator M = Monitoring Indicator Percentage of Residents Who Fell in the Last 30 days (ME) 2019/20 PERFORMANCE TARGET STANDARD n/a n/a Percentage of Residents Whose Pressure Ulcer Worsened (ME) n/a n/a Percentage of Residents on Antipsychotics Without a Diagnosis of Psychosis (ME) n/a n/a Percentage of Residents in Daily Physical Restraints (ME) n/a n/a SCHEDULE D — PERFORMANCE 2.0 LHIN-Specific Performance Obligations 3/3Name Objective to be achieved/ demonstrated Measure Reporting Protocol Reporting Requirements In-home BSO Liaison To assist in the development and sustainability of capacity in each LTC home, each home will be required to designate at least one (1) LTC staff member to act as a liaison with the BSO team. This staff member will work with the BSO team (MRT, PRC, GOC, psychiatry) to help develop capacity in each home. This liaison will work to establish a team/group within their home who deals specifically with complex residents with challenging behaviours. This does not have to be a new/separate team – we recognize that many LTC homes have groups/teams that deal specifically with complex residents with palliative care or high-intensity needs ▪ Identification of Liaison ▪ Progress made in the development of behavioral support capacity within the LTCH home Template to be provided by the LHIN Reporting requirements will be of an explanatory nature. ▪ Q2 & Q4 – Narrative report outlining the progress that has been made to date in the development of behavioral support capacity within the LTCH home. Name Objective to be achieved/ demonstrated Measure Reporting Protocol Reporting Requirements Achievement of Provincial HQO Targets To ensure consistency of care in each LTC home, each home will be required to meet Provincial HQO targets over the course of three years. The LHIN will work with each home to develop goals and target setting to achieve each of the HQO indicators. · Recent Fall % · Worsening Bladder Control % · Pressure Ulcer % · Physically Restrained % Added in 2017-18 - Chemical Restraint % ▪ 2016/2017 – evaluation and target achievement goal setting for the first year ▪ 2017/2018 – evaluation of progression towards achievement of goals (meeting or above the Provincial Average) ▪ 2018/2019 – achievement of goals (meeting or above the Provincial Average) Template to be provided by the LHIN Reporting requirements in 2016/2017. • If existing LTC home is not meeting Provincial Averages, a plan with goals will be put in place to achieve the provincial minimum standards over a three year time period. • If existing LTC home is not meeting the Provincial targets – a review of utilized resources will be conducted, including utilization of NLOT teams, the BSO MRT teams and other resources • LTC homes will be required to fill out the template indicating the plan for achievement of targets over a three year period. Reporting requirements in 2017/2018 • An evaluation of progression towards the achievement of Provincial Averages will be conducted utilizing template. • Submission of template will be required in Q2 and Q4 • A review of the utilization of current resources will be conducted including NLOT teams, BSO MRT and other resources. Reporting requirements in 2018/2019 • LTC homes required to achieve Provincial HQO Averages in year three. • An evaluation of achievement utilizing the submitted templates in Q2 and Q4 will be conducted A review of the utilization of current resources will be conducted including NLOT teams, BSO MRT and other resources. Name Objective to be achieved/ demonstrated Measure Reporting Protocol Reporting Requirements In-home Palliative End- of-Life Care Liaison To assist in the development and sustainability of quality palliative end-of-life care in each LTC home, each home will be required to designate at least one (1) LTC staff member to act as a liaison with the Hospice Palliative Care Planner at the South East LHIN. This does not have to be a member of a new/separate team – we recognize that many LTC homes have groups/teams that deal specifically wih palliative end-of-life care. ▪ Identification of Liaison. ▪ Progress made in the development and sustainability of quality palliative end-of-life care within the LTCH home. Template provided by the LHIN Template to be provided by the LHIN Reporting requirements will be of an explanatory nature. Q2 and Q4 – Narrative report outlining the progress that has been made to date in the development of quality palliative end-of-life care within the LTCH home. Schedule E – Form of Compliance Declaration DECLARATION OF COMPLIANCE Issued pursuant to the Long Term Care Service Accountability Agreement

Performance Indicators. The HSP’s delivery of the Services will be measured by the following Indicators, Targets and where applicable Performance Standards. In the following table: n/a meanç means ‘not-appIicabIeapplicable’, that there iç is no defined Performance Standard for the indicator for the applicable year. tbd means a Target, and a Performance Standard, if applicable, will be determined during the applicable year. INDICATOR CATEGORY INDICATOR P = P=Performance Indicator E = E=Explanatory Indicator M = Monitoring Indicator 2019/20 PERFORMANCE TARGET STANDARD 2018/19 Performance Target Standard Organizational Health and Financial Indicators Debt Service Coverage Ratio (P) 1 c1 n/a n/a Total Margin (P) 0 cO n/a n/a Coordination and Access Indicators Percent Resident Days – Long Stay (E) n/a n/a Wait Time from LHIN Determination of Eligibility to LTC Home Response (ME) n/a n/a Long-Term Care Home Refusal Rate (E) n/a n/a SCHEDULE D — PERFORMANCE 2/3 INDICATOR CATEGORY Quality and Resident Safety Indicators INDICATOR P = Performance Indicator E = Explanatory Indicator M = Monitoring Indicator Percentage of Residents Who Fell in the Last 30 days (ME) 2019/20 PERFORMANCE TARGET STANDARD n/a n/a Percentage of Residents Whose Pressure Ulcer Worsened (ME) n/a n/a Percentage of Residents on Antipsychotics Without a Diagnosis of Psychosis (ME) n/a n/a Percentage of Residents in Daily Physical Restraints (ME) n/a n/a SCHEDULE Schedule D — PERFORMANCE – Performance 2.0 LHIN-Specific Performance Obligations 3/3TORONTO CENTRAL LHIN’S STRATEGIC PLAN: Support the implementation of Toronto Central LHIN’s 2018-2022 Strategic Plan including a commitment to the specific initiatives outlined below: Toronto Central LHIN Sub Regions: Participate in the Toronto Central LHIN Local Collaborative as outlined in the Collaboration Agreement(s) and advance the work of the Integrated Health Service Delivery Network (IHSDN) within each sub region. Promoting Integration: Actively participate in the Toronto Central LHIN Integration Strategy. Health Equity: Continue to actively support Toronto Central LHIN Health Equity initiatives through:  Supporting approaches to service planning and delivery that: a) identify health inequities, b) actively seek new opportunities to address health inequities, and c) reduce existing health inequities.  Apply the Health Equity Impact Assessment (HEIA) tool and its supplement(s) in program and service planning.  Participation in appropriate Toronto Central LHIN Indigenous and Francophone Cultural Competency Initiatives.  As part of the Indigenous Health strategy HSPs are expected to: o Identify the Indigenous population as a priority in strategic / program plans, o Ensure all health care spaces are welcoming, accessible and inclusive of Indigenous people.  Participate in French Language Service (FLS) planning: o For identified HSPs that provide services in French, develop a FLS plan and demonstrate yearly progress towards meeting designation criteria. o HSPs that are not identified for the provision of FLS, the expectation is to identify their French-speaking clients. This information is to be used by the HSP to help with the establishment of an environment where people’s linguistic backgrounds are collected, linked with existing health services data and utilized in health services and health system planning to ensure services are culturally and linguistically sensitive. o All funded HSPs to support ministry and LHIN initiatives to deploy the OZi tool designed to collect quantitative data regarding the active offer of French Language Health Services. Digital Health: Adopt Digital Health and Information Management initiatives that encompass both provincial and local level priorities as identified by Toronto Central LHIN. This specifically includes, where applicable:  Adherence to operational privacy and security policies related to the use of all regional and provincial health technologies. Schedule D – Performance System Level & Quality Improvement: HSPs will work towards implementing Health Quality Ontario’s quality standards to applicable programs. These standards include but are not limited to:  Schizophrenia  Major Depression  Palliative Care  Dementia  Opioid Prescribing for Chronic Pain HSPs will participate in the planning and implementation of regional palliative care quality improvement initiatives as endorsed by Toronto Central Palliative Care Network (TCPCN) and the Toronto Central LHIN. HSPs will participate in the work of the Toronto Central LHIN Regional Quality Table. MINISTRY/LHIN ACCOUNTABILITY AGREEMENT PERFORMANCE (MLAA): Toronto Central LHIN is developing a system-wide plan to improve performance on its MLAA indicators including embedding performance targets in the Service Accountability Agreements. HSPs will be expected to contribute to the achievement of the Toronto Central LHIN MLAA Performance Indicators through the following specific initiative.

Performance Indicators. The HSP’s delivery of the Services will be measured by the following Indicators, Targets and where applicable Performance Standards. In the following table: n/a meanç means ‘not-appIicabIeapplicable’, that there iç is no defined Performance Standard for the indicator for the applicable year. tbd means a Target, and a Performance Standard, if applicable, will be determined during the applicable year. INDICATOR CATEGORY INDICATOR P = P=Performance Indicator E = E=Explanatory Indicator M = Monitoring Indicator 2019/20 PERFORMANCE TARGET STANDARD 2018/19 Performance Target Standard Organizational Health and Financial Indicators Debt Service Coverage Ratio (P) 1 c1 ≥1 Total Margin (P) 0 cO ≥0 Coordination and Access Indicators Percent Resident Days – Long Stay (E) n/a n/a Wait Time from LHIN Determination of Eligibility to LTC Home Response (ME) n/a n/a Long-Term Care Home Refusal Rate (E) n/a n/a SCHEDULE D — PERFORMANCE 2/3 INDICATOR CATEGORY Quality and Resident Safety Indicators INDICATOR P = Performance Indicator E = Explanatory Indicator M = Monitoring Indicator Percentage of Residents Who Fell in the Last 30 days (ME) 2019/20 PERFORMANCE TARGET STANDARD n/a n/a Percentage of Residents Whose Pressure Ulcer Worsened (ME) n/a n/a Percentage of Residents on Antipsychotics Without a Diagnosis of Psychosis (ME) n/a n/a Percentage of Residents in Daily Physical Restraints (ME) n/a n/a SCHEDULE D — PERFORMANCE 2.0 LHIN-Specific Performance Obligations 3/3Schedule E – Form of Compliance Declaration DECLARATION OF COMPLIANCE Issued pursuant to the Long Term Care Service Accountability Agreement To: The Board of Directors of the North East Local Health Integration Network (the “LHIN”). Attn: Board Chair. From: The Board of Directors (the “Board”) of the Lady Minto Hospital (the “HSP”) For: Villa Minto (the “Home”) Date: February 28th, 2018 Re: January 1, 2018 – December 31, 2018 (the “Applicable Period”) The Board has authorized me, by resolution dated February 28th 2018, to declare to you as follows: After making inquiries of the Chief Executive Office, Xxxx Xxxxxxxxx and other appropriate officers of the HSP and subject to any exceptions identified on Appendix 1 to this Declaration of Compliance, to the best of the Board’s knowledge and belief, the HSP has fulfilled its obligations under the long-term care service accountability agreement (the “Agreement”) in effect during the Applicable Period. Without limiting the generality of the foregoing, the HSP confirms that

Performance Indicators. The HSP’s delivery of the Services will be measured by the following Indicators, Targets and where applicable Performance Standards. In the following table: n/a meanç means ‘not-appIicabIeapplicable’, that there iç is no defined Performance Standard for the indicator for the applicable year. tbd means a Target, and a Performance Standard, if applicable, will be determined during the applicable year. INDICATOR CATEGORY INDICATOR P = P=Performance Indicator E = E=Explanatory Indicator M = Monitoring Indicator 2019/20 PERFORMANCE TARGET STANDARD 2018/19 Performance Target Standard Organizational Health and Financial Indicators Debt Service Coverage Ratio (P) 1 c1 ≥1 Total Margin (P) 0 cO ≥0 Coordination and Access Indicators Percent Resident Days – Long Stay (E) n/a n/a Wait Time from LHIN Determination of Eligibility to LTC Home Response (ME) n/a n/a Long-Term Care Home Refusal Rate (E) n/a n/a SCHEDULE D — PERFORMANCE 2/3 INDICATOR CATEGORY Quality and Resident Safety Indicators INDICATOR P = Performance Indicator E = Explanatory Indicator M = Monitoring Indicator Percentage of Residents Who Fell in the Last 30 days (ME) 2019/20 PERFORMANCE TARGET STANDARD n/a n/a Percentage of Residents Whose Pressure Ulcer Worsened (ME) n/a n/a Percentage of Residents on Antipsychotics Without a Diagnosis of Psychosis (ME) n/a n/a Percentage of Residents in Daily Physical Restraints (ME) n/a n/a SCHEDULE D — PERFORMANCE 2.0 LHIN-Specific Performance Obligations 3/3French Language Services As an HSP identified to provide services in French to serve the Francophone population, you will actively participate in activities designed to support the implementation and delivery of services in French and you will demonstrate progress towards meeting designation criteria. These activities will include, without being limited to: Developing/updating a French Language Services (FLS) Work Plan, identifying specific milestones and target dates to achieve improvements in the next two years (2017-2019), with full compliance expected by March 31, 2019. Submitting and/or re-submitting the FLS Work Plan to the LHIN French Language Services (FLS) Coordinator by June 30, 2017 for approval. Progress will be monitored quarterly. The LHIN will be moving to publish this information on its website. As per schedule C, the HSP will submit yearly a FLS report to the LHIN, using the template provided by the LHIN. BSO Long-Term Care Maintain Health Human Resources and report changes as well as utilization data as required for the quarterly BSO MoHLTC / LHIN template. Provide monthly occupancy statistics and the number of residents refused at the point of application for responsive behaviors as well as when the home is seeking HINF related to Behaviors. BSO Long-Term Care Lead Homes Maintain Health Human Resources and report changes as well as utilization data as required for the quarterly BSO MoHLTC / LHIN template. Provide monthly occupancy statistics and the number of residents refused at the point of application as per the ESC LHIN template Language and Indigenous Identity Report All HSPs will provide annually a report on the number of patients/clients by mother tongue, official language and Indigenous identity. HSPs will develop a mechanism to track the language characteristics of their patients/clients to understand opportunities for culturally sensitive services, using the following questions:

Performance Indicators. The HSP’s delivery of the Services will be measured by the following Indicators, Targets and where applicable Performance Standards. In the following table: n/a meanç means ‘not-appIicabIeapplicable’, that there iç is no defined Performance Standard for the indicator for the applicable year. tbd means a Target, and a Performance Standard, if applicable, will be determined during the applicable year. INDICATOR CATEGORY INDICATOR P = Performance Indicator E = Explanatory Indicator M = Monitoring Indicator 2019/20 PERFORMANCE TARGET STANDARD Organizational Health and Financial Indicators Debt Service Coverage Ratio (P) 1 c1 ≥1 Total Margin (P) 0 cO ≥0 Coordination and Access Indicators Percent Resident Days – Long Stay (E) n/a n/a Wait Time from LHIN Determination of Eligibility to LTC Home Response (M) n/a n/a Long-Term Care Home Refusal HomeRefusal Rate (E) n/a n/a SCHEDULE D — PERFORMANCE 2/3 INDICATOR CATEGORY Quality and Resident Safety Indicators INDICATOR P = Performance Indicator E = Explanatory Indicator M = Monitoring Indicator 2019/20 PERFORMANCE TARGET STANDARD Quality and Resident Safety Indicators Percentage of Residents Who ResidentsWho Fell in the Last 30 days (M) 2019/20 PERFORMANCE TARGET STANDARD n/a n/a Percentage of Residents Whose Pressure Ulcer Worsened (MWorsened(M) n/a n/a Percentage of Residents on Antipsychotics Without a Diagnosis of Psychosis (M) n/a n/a Percentage of Residents in Daily Physical Restraints (M) n/a n/a SCHEDULE D — PERFORMANCE 2.0 LHIN-Specific Performance Obligations 3/3Obligations

Performance Indicators. The HSP’s delivery of the Services will be measured by the following Indicators, Targets and where applicable Performance Standards. In the following table: n/a meanç means ‘not-appIicabIeapplicable’, that there iç is no defined Performance Standard for the indicator for the applicable year. tbd means a Target, and a Performance Standard, if applicable, will be determined during the applicable year. INDICATOR CATEGORY INDICATOR P = P=Performance Indicator E = E=Explanatory Indicator M = Monitoring Indicator 2019/20 PERFORMANCE TARGET STANDARD 2017/18 Performance Target Standard Organizational Health and Financial Indicators Debt Service Coverage Ratio (P) 1 c1 n/a n/a Total Margin (P) 0 cO n/a n/a Coordination and Access Indicators Percent Resident Days – Long Average Long-Stay Occupancy / Average Long-Stay Utilization (E) n/a n/a Wait Time from LHIN CCAC Determination of Eligibility to LTC Home Response (ME) n/a n/a Long-Term Care Home Refusal Rate (E) n/a n/a SCHEDULE D — PERFORMANCE 2/3 INDICATOR CATEGORY Quality and Resident Safety Indicators INDICATOR P = Performance Indicator E = Explanatory Indicator M = Monitoring Indicator Percentage of Residents Who Fell in the Last 30 days (ME) 2019/20 PERFORMANCE TARGET STANDARD n/a n/a Percentage of Residents Whose Pressure Ulcer Worsened (ME) n/a n/a Percentage of Residents on Antipsychotics Without a Diagnosis of Psychosis (ME) n/a n/a Percentage of Residents in Daily Physical Restraints (ME) n/a n/a SCHEDULE Schedule D — PERFORMANCE – Performance Cont’d 2.0 LHIN-Specific Performance Obligations 3/3System Collaboration on Health Systems Planning and Design Health Service Providers are required to collaborate with system partners to support the development of an integrated system of health services that provides person-centred, timely, equitable, accessible, high quality, and evidence-based services in an efficient, effective and sustainable manner. (Referred to as “Care Connections - Partnering for Healthy Communities” and “Care Connections Refresh”). To ensure optimal alignment across the region, the Health Service Provider agrees that the development and submission of organizational plans and proposals to the LHIN will incorporate, where applicable, the following considerations: • the needs of patients, clients and/or residents • NSM LHIN System priorities (as outlined in the NSM LHIN Integrated Health Service Plan (IHSP), NSM LHIN Annual Business Plans, and NSM LHIN Annual CEO deliverables as posted on the NSM LHIN website) • Feedback from LHIN Leadership Council and relevant Coordinating Councils • coordination and collaboration within NSM LHIN geographic sub-regions, where applicable. The Health Service Provider understands that as a partner in the local health system, it has an ongoing obligation to provide input, where requested, on the content of strategic directions and plans for the geographic sub-regions of the NSM LHIN. Further the Health Service Provider agrees to participate in the work and initiatives of all Coordinating Councils and Project Steering Committees, to the extent that it is able without impacting its capacity to meet its other obligations under this agreement. Such initiatives include, but are not limited to: • Participation and collaboration of a LHIN-approved senior executive of the Health Service Provider as a member of the oversight council (“referred to as the “Leadership Council”), a Coordinating Council and/or a Project Steering Committee to implement such recommendations as are agreed to by the Leadership Council and NSM LHIN Board of Directors; • Identification of Coordinating Council project leads and/or project champions; • Participation in regional/provincial planning and implementation groups; • Specific obligations as may be specified as a condition of participation in Council initiatives (outlined in the Project Charter for the initiative). Schedule D – Performance Cont’d Risk Management Reporting to the LHIN HSP Boards will ensure that: • The health service provider has an organization-specific policy related to the management of risks; • Significant and major risks are identified and reported promptly to the LHIN in the manner outlined in the “NSM LHIN Risk Management Reporting Guidelines and Manual” (available on the NSM LHIN website); • All significant and major risks are assigned action plans to mitigate likelihood and/or impact, and that status updates for unmitigated risks are provided to the LHIN periodically until the risk is no longer significant.

Performance Indicators. The HSP’s delivery of the Services will be measured by the following Indicators, Targets and where applicable Performance Standards. In the following table: n/a meanç ‘not-appIicabIe’, that there iç no defined Performance Standard for the indicator for the applicable year. tbd means a Target, and a Performance Standard, if applicable, will be determined during the applicable year. INDICATOR CATEGORY INDICATOR P = Performance Indicator E = Explanatory Indicator M = Monitoring Indicator 2019/20 PERFORMANCE TARGET STANDARD Organizational Health and Financial Indicators Debt Service Coverage Ratio (P) 1 c1 Total Margin (P) 0 cO c0 Coordination and Access Indicators Percent Resident Days – Long Stay (E) n/a n/a Wait Time from LHIN Determination of Eligibility to LTC Home Response (M) n/a n/a Long-Term Care Home Refusal Rate (E) n/a n/a SCHEDULE D — PERFORMANCE 2/3 INDICATOR CATEGORY Quality and Resident Safety Indicators INDICATOR P = Performance Indicator E = Explanatory Indicator M = Monitoring Indicator Percentage of Residents Who Fell in the Last 30 days (M) 2019/20 PERFORMANCE TARGET STANDARD n/a n/a Percentage of Residents Whose Pressure Ulcer Worsened (M) n/a n/a Percentage of Residents on Antipsychotics Without a Diagnosis of Psychosis (M) n/a n/a Percentage of Residents in Daily Physical Restraints (M) n/a n/a SCHEDULE D — PERFORMANCE 2.0 LHIN-Specific Performance Obligations 3/33/3 Indigenous Cultural Awareness: The Health Service Provider (HSP) will report on the activities it has undertaken during the fiscal year to increase the Indigenous cultural awareness and sensitivity of its staff, physicians and volunteers (including Board members) throughout the organization. In order to support the LHIN’s goal of improving access to health services and health outcomes for Indigenous people, a minimum of 15 per cent of the HSP’s staff will receive Indigenous Cultural Safety training during this reporting period. Meeting this minimum requirement will serve a longer-term goal of involving all HSP staff in this educational initiative over time. HSPs will be provided with a list of training options (e.g. online and face-to-face sessions) and other educational resources for staff to choose from. The LHIN may provide one-time funding through a lead agency to support HSP staff participation in priority training offerings. The Indigenous Cultural Awareness Report, using a template to be provided by the LHIN, is due to the LHIN by April 30, 2020 and should be submitted using the subject line: 2019-20 Indigenous Cultural Awareness Report to xx.xxxxxxxxxxxxxxxxxx@xxxxx.xx.xx. An updated/revised reporting template will be forwarded to all HSPs at a later date. HSPs that have multiple accountability agreements with the LHIN should provide one aggregated report for the corporation. SCHEDULE D — PERFORMANCE 1/3 SCHEDULE E Form of Compliance Declaration Declaration of Compliance Issued pursuant to the Long Term Care Service Accountability Agreement‌ To: The Board of Directors of the [Insert Name of LHIN]

Performance Indicators. The HSP’s delivery of the Services will be measured by the following Indicators, Targets and where applicable Performance Standards. In the following table: n/a meanç means ‘not-appIicabIeapplicable’, that there iç is no defined Performance Standard for the indicator for the applicable year. tbd means a Target, and a Performance Standard, if applicable, will be determined during the applicable year. INDICATOR CATEGORY INDICATOR P = Performance Indicator E = Explanatory Indicator M = Monitoring Indicator 2019/20 PERFORMANCE TARGET STANDARD Organizational Health and Financial Indicators Debt Service Coverage Ratio (P) 1 c1 ≥1 Total Margin (P) 0 cO ≥0 Coordination and Access Indicators Percent Resident Days – Long Stay (E) n/a n/a Wait Time from LHIN Determination of Eligibility to LTC Home Response (M) n/a n/a Long-Term Care Home Refusal Rate (E) n/a n/a SCHEDULE D — PERFORMANCE 2/3 INDICATOR CATEGORY Quality and Resident Safety Indicators INDICATOR P = Performance Indicator E = Explanatory Indicator M = Monitoring Indicator 2019/20 PERFORMANCE TARGET STANDARD Quality and Resident Safety Indicators Percentage of Residents Who Fell in the Last 30 days (M) 2019/20 PERFORMANCE TARGET STANDARD n/a n/a Percentage of Residents Whose Pressure Ulcer Worsened (M) n/a n/a Percentage of Residents on Antipsychotics Without a Diagnosis of Psychosis (M) n/a n/a Percentage of Residents in Daily Physical Restraints (M) n/a n/a SCHEDULE D — PERFORMANCE 2.0 LHIN-Specific Performance Obligations 3/33/3 Priority Area: Patient Safety Obligation Type: Compliance Obligation Description, Indicators and Target: HSPs activate Coordinated Care Plans for patients with hospital discharges for: Mental Health and Additions; Chronic Disease - Congestive Heart Failure (CHF); Chronic Disease – Chronic Obstructive Pulmonary Disease (COPD); Behaviours of Dementia; Palliative. Performance indicator: Number of individuals living with multiple chronic conditions and/or complex needs who are identified by your organization and have a new coordinated care plan (CCP) developed through the Health Links approach to care. Reporting Requirements: Waterloo Wellington LHIN to provide template. 1/3 SCHEDULE E Form of Compliance Declaration Declaration of Compliance Issued pursuant to the Long Term Care Service Accountability Agreement‌ To: The Board of Directors of the [Insert Name of LHIN]

Performance Indicators. The HSP’s delivery of the Services will be measured by the following Indicators, Targets and where applicable Performance Standards. In the following table: n/a meanç means ‘not-appIicabIeapplicable’, that there iç is no defined Performance Standard for the indicator for the applicable year. tbd means a Target, and a Performance Standard, if applicable, will be determined during the applicable year. INDICATOR CATEGORY INDICATOR P = Performance Indicator E = Explanatory Indicator M = Monitoring Indicator 2019/20 PERFORMANCE TARGET STANDARD Organizational Health and Financial Indicators Debt Service Coverage Ratio (P) 1 c1 ≥1 Total Margin (P) 0 cO ≥0 Coordination and Access Indicators Percent Resident Days – Long Stay (E) n/a n/a Wait Time from LHIN Determination of Eligibility to LTC Home Response (M) n/a n/a Long-Term Care Home Refusal Rate (E) n/a n/a SCHEDULE D — PERFORMANCE 2/3 INDICATOR CATEGORY Quality and Resident Safety Indicators INDICATOR P = Performance Indicator E = Explanatory Indicator M = Monitoring Indicator Percentage of Residents Who Fell in the Last 30 days (M) 2019/20 PERFORMANCE TARGET STANDARD n/a n/a Percentage of Residents Whose Pressure Ulcer Worsened (M) n/a n/a Percentage of Residents on Antipsychotics Without a Diagnosis of Psychosis (M) n/a n/a Percentage of Residents in Daily Physical Restraints (M) n/a n/a SCHEDULE D — PERFORMANCE 2.0 LHIN-Specific Performance Obligations 3/3PERFORMANCE

Performance Indicators. The HSP’s delivery of the Services will be measured by the following Indicators, Targets and where applicable Performance Standards. In the following table: n/a meanç means ‘not-appIicabIeapplicable’, that there iç is no defined Performance Standard for the indicator for the applicable year. tbd means a Target, and a Performance Standard, if applicable, will be determined during the applicable year. INDICATOR CATEGORY INDICATOR P = P=Performance Indicator E = E=Explanatory Indicator M = M=Monitoring Indicator 2019/20 PERFORMANCE TARGET STANDARD Performance Target Standard Organizational Health and Financial Indicators Debt Service Coverage Ratio (P) 1 c1 n/a n/a Total Margin (P) 0 cO n/a n/a Coordination and Access Indicators Percent Resident Days – Long Stay (E) n/a n/a Wait Time from LHIN Determination of Eligibility to LTC Home Response (M) n/a n/a Long-Term Care Home Refusal Rate (E) n/a n/a SCHEDULE D — PERFORMANCE 2/3 INDICATOR CATEGORY Quality and Resident Safety Indicators INDICATOR P = Performance Indicator E = Explanatory Indicator M = Monitoring Indicator Percentage of Residents Who Fell in the Last 30 days (M) 2019/20 PERFORMANCE TARGET STANDARD n/a n/a Percentage of Residents Whose Pressure Ulcer Worsened (M) n/a n/a Percentage of Residents on Antipsychotics Without a Diagnosis of Psychosis (M) n/a n/a Percentage of Residents in Daily Physical Restraints (M) n/a n/a SCHEDULE D — PERFORMANCE 2.0 LHIN-Specific Performance Obligations 3/3LHIN SPECIFIC INDICATOR PERFORMANCE STANDARD DATA SOURCE REPORTING RESPONSIBILITY

Performance Indicators. The HSP’s delivery of the Services will be measured by the following Indicators, Targets and where applicable Performance Standards. In the following table: n/a meanç means ‘not-appIicabIeapplicable’, that there iç is no defined Performance Standard for the indicator for the applicable year. tbd means a Target, and a Performance Standard, if applicable, will be determined during the applicable year. INDICATOR CATEGORY INDICATOR P = P=Performance Indicator E = E=Explanatory Indicator M = M=Monitoring Indicator 2019/20 PERFORMANCE TARGET STANDARD Performance Target Standard Organizational Health and Financial Indicators Debt Service Coverage Ratio (P) 1 c1 n/a n/a Total Margin (P) 0 cO n/a n/a Coordination and Access Indicators Percent Resident Days – Long Stay (E) n/a n/a Wait Time from LHIN Determination of Eligibility to LTC Home Response (M) n/a n/a Long-Term Care Home Refusal Rate (E) n/a n/a SCHEDULE D — PERFORMANCE 2/3 INDICATOR CATEGORY Quality and Resident Safety Indicators INDICATOR P = Performance Indicator E = Explanatory Indicator M = Monitoring Indicator Percentage of Residents Who Fell in the Last 30 days (M) 2019/20 PERFORMANCE TARGET STANDARD n/a n/a Percentage of Residents Whose Pressure Ulcer Worsened (M) n/a n/a Percentage of Residents on Antipsychotics Without a Diagnosis of Psychosis (M) n/a n/a Percentage of Residents in Daily Physical Restraints (M) n/a n/a SCHEDULE D — PERFORMANCE 2.0 LHIN-Specific Performance Obligations 3/3Not Applicable. 1/3 SCHEDULE E Form of Compliance Declaration Declaration of Compliance Issued pursuant to the Long Term Care Service Accountability Agreement‌ To: The Board of Directors of the [Insert Name of LHIN]

Performance Indicators. The HSP’s delivery of the Services will be measured by the following Indicators, Targets and where applicable Performance Standards. In the following table: n/a meanç means ‘not-appIicabIeapplicable’, that there iç is no defined Performance Standard for the indicator for the applicable year. tbd means a Target, and a Performance Standard, if applicable, will be determined during the applicable year. INDICATOR CATEGORY INDICATOR P = P=Performance Indicator E = E=Explanatory Indicator M = Monitoring Indicator 2019/20 PERFORMANCE TARGET STANDARD 2016/17 Performance Target Standard Organizational Health and Financial Indicators Debt Service Coverage Ratio (P) 1 c1 n/a n/a Total Margin (P) 0 cO n/a n/a Coordination and Access Indicators Percent Resident Days – Long Average Long-Stay Occupancy / Average Long-Stay Utilization (E) n/a n/a Wait Time from LHIN CCAC Determination of Eligibility to LTC Home Response (ME) n/a n/a Long-Term Care Home Refusal Rate (E) n/a n/a SCHEDULE D — PERFORMANCE 2/3 INDICATOR CATEGORY Quality and Resident Safety Indicators INDICATOR P = Performance Indicator E = Explanatory Indicator M = Monitoring Indicator Percentage of Residents Who Fell in the Last 30 days (ME) 2019/20 PERFORMANCE TARGET STANDARD n/a n/a Percentage of Residents Whose Pressure Ulcer Worsened (ME) n/a n/a Percentage of Residents on Antipsychotics Without a Diagnosis of Psychosis (ME) n/a n/a Percentage of Residents in Daily Physical Restraints (ME) n/a n/a SCHEDULE D — PERFORMANCE 2.0 LHIN-Specific Performance Obligations 3/3Not-applicable. Schedule E – Form of Compliance Declaration DECLARATION OF COMPLIANCE Issued pursuant to the Long Term Care Service Accountability Agreement To: The Board of Directors of the Central Local Health Integration Network (the “LHIN”).

Performance Indicators. The HSP’s delivery of the Services will be measured by the following Indicators, Targets and where applicable Performance Standards. In the following table: n/a meanç ‘not-appIicabIe’, that there iç no defined Performance Standard for the indicator for the applicable year. tbd means a Target, and a Performance Standard, if applicable, will be determined during the applicable year. INDICATOR CATEGORY INDICATOR P = Performance Indicator E = Explanatory Indicator M = Monitoring Indicator 2019/20 PERFORMANCE TARGET STANDARD Organizational Health and Financial Indicators Debt Service Coverage Ratio (P) 1 c1 Total Margin (P) 0 cO Coordination and Access Indicators Percent Resident Days – Long Stay (E) n/a n/a Wait Time from LHIN Determination of Eligibility to LTC Home Response (M) n/a n/a Long-Term Care Home Refusal Rate (E) n/a n/a SCHEDULE D — PERFORMANCE 2/3 INDICATOR CATEGORY Quality and Resident Safety Indicators INDICATOR P = Performance Indicator E = Explanatory Indicator M = Monitoring Indicator Percentage of Residents Who Fell in the Last 30 days (M) 2019/20 PERFORMANCE TARGET STANDARD n/a n/a Percentage of Residents Whose Pressure Ulcer Worsened (M) n/a n/a Percentage of Residents on Antipsychotics Without a Diagnosis of Psychosis (M) n/a n/a Percentage of Residents in Daily Physical Restraints (M) n/a n/a SCHEDULE D — PERFORMANCE 2.0 LHIN-Specific Performance Obligations 3/33/3 Indigenous Cultural Awareness: The Health Service Provider (HSP) will report on the activities it has undertaken during the fiscal year to increase the Indigenous cultural awareness and sensitivity of its staff, physicians and volunteers (including Board members) throughout the organization. In order to support the LHIN’s goal of improving access to health services and health outcomes for Indigenous people, a minimum of 15 per cent of the HSP’s staff will receive Indigenous Cultural Safety training during this reporting period. Meeting this minimum requirement will serve a longer-term goal of involving all HSP staff in this educational initiative over time. HSPs will be provided with a list of training options (e.g. online and face-to-face sessions) and other educational resources for staff to choose from. The LHIN may provide one-time funding through a lead agency to support HSP staff participation in priority training offerings. The Indigenous Cultural Awareness Report, using a template to be provided by the LHIN, is due to the LHIN by April 30, 2020 and should be submitted using the subject line: 2019-20 Indigenous Cultural Awareness Report to xx.xxxxxxxxxxxxxxxxxx@xxxxx.xx.xx. An updated/revised reporting template will be forwarded to all HSPs at a later date. HSPs that have multiple accountability agreements with the LHIN should provide one aggregated report for the corporation. SCHEDULE D — PERFORMANCE 1/3 SCHEDULE E Form of Compliance Declaration Declaration of Compliance Issued pursuant to the Long Term Care Service Accountability Agreement‌ To: The Board of Directors of the [Insert Name of LHIN]

Performance Indicators. The HSP’s delivery of the Services will be measured by the following Indicators, Targets and where applicable Performance Standards. In the following table: n/a meanç means ‘not-appIicabIeapplicable’, that there iç is no defined Performance Standard for the indicator for the applicable year. tbd means a Target, and a Performance Standard, if applicable, will be determined during the applicable year. INDICATOR CATEGORY INDICATOR P = P=Performance Indicator E = E=Explanatory Indicator M = M=Monitoring Indicator 2019/20 PERFORMANCE TARGET STANDARD Performance Target Standard Organizational Health and Financial Indicators Debt Service Coverage Ratio (P) 1 c1 n/a n/a Total Margin (P) 0 cO n/a n/a Coordination and Access Indicators Percent Resident Days – Long Stay (E) n/a n/a Wait Time from LHIN Determination of Eligibility to LTC Home Response (M) n/a n/a Long-Term Care Home Refusal Rate (E) n/a n/a SCHEDULE D — PERFORMANCE 2/3 INDICATOR CATEGORY Quality and Resident Safety Indicators INDICATOR P = Performance Indicator E = Explanatory Indicator M = Monitoring Indicator Percentage of Residents Who Fell in the Last 30 days (M) 2019/20 PERFORMANCE TARGET STANDARD n/a n/a Percentage of Residents Whose Pressure Ulcer Worsened (M) n/a n/a Percentage of Residents on Antipsychotics Without a Diagnosis of Psychosis (M) n/a n/a Percentage of Residents in Daily Physical Restraints (M) n/a n/a SCHEDULE D — PERFORMANCE 2.0 LHIN-Specific Performance Obligations 3/3Not Applicable. SCHEDULE E Form of Compliance Declaration Declaration of Compliance Issued pursuant to the Long Term Care Service Accountability Agreement‌ To: The Board of Directors of the (the “LHIN”). Attn: Board Chair.

Performance Indicators. The HSP’s delivery of the Services will be measured by the following Indicators, Targets and where applicable Performance Standards. In the following table: n/a meanç means ‘not-appIicabIeapplicable’, that there iç is no defined Performance Standard for the indicator for the applicable year. tbd means a Target, and a Performance Standard, if applicable, will be determined during the applicable year. INDICATOR CATEGORY INDICATOR P = P=Performance Indicator E = E=Explanatory Indicator M = M=Monitoring Indicator 2019/20 PERFORMANCE TARGET STANDARD Performance Target Standard Organizational Health and Financial Indicators Debt Service Coverage Ratio (P) 1 c1 ≥1 Total Margin (P) 0 cO ≥0 Coordination and Access Indicators Percent Resident Days – Long Stay (E) n/a n/a Wait Time from LHIN Determination of Eligibility to LTC Home Response (M) n/a n/a Long-Term Care Home Refusal Rate (E) n/a n/a SCHEDULE D — PERFORMANCE 2/3 INDICATOR CATEGORY Quality and Resident Safety Indicators INDICATOR P = Performance Indicator E = Explanatory Indicator M = Monitoring Indicator Percentage of Residents Who Fell in the Last 30 days (M) 2019/20 PERFORMANCE TARGET STANDARD n/a n/a Percentage of Residents Whose Pressure Ulcer Worsened (M) n/a n/a Percentage of Residents on Antipsychotics Without a Diagnosis of Psychosis (M) n/a n/a Percentage of Residents in Daily Physical Restraints (M) n/a n/a SCHEDULE D — PERFORMANCE 2.0 LHIN-Specific Performance Obligations 3/3Not Applicable. SCHEDULE E‌ Form of Compliance Declaration Declaration of Compliance Issued pursuant to the Long Term Care Service Accountability Agreement To: The Board of Directors of the (the “LHIN”). Attn: Board Chair.

Performance Indicators. The HSP’s delivery of the Services will be measured by the following Indicators, Targets and where applicable Performance Standards. In the following table: n/a meanç means ‘not-appIicabIeapplicable’, that there iç is no defined Performance Standard for the indicator for the applicable year. tbd means a Target, and a Performance Standard, if applicable, will be determined during the applicable year. INDICATOR CATEGORY INDICATOR P = P=Performance Indicator E = E=Explanatory Indicator M = M=Monitoring Indicator 2019/20 PERFORMANCE TARGET STANDARD Performance Target Standard Organizational Health and Financial Indicators Debt Service Coverage Ratio (P) 1 c1 ≥1 Total Margin (P) 0 cO ≥0 Coordination and Access Indicators Percent Resident Days – Long Stay (E) n/a n/a Wait Time from LHIN Determination of Eligibility to LTC Home Response (M) n/a n/a Long-Term Care Home Refusal Rate (E) n/a n/a SCHEDULE D — PERFORMANCE 2/3 INDICATOR CATEGORY Quality and Resident Safety Indicators INDICATOR P = Performance Indicator E = Explanatory Indicator M = Monitoring Indicator Percentage of Residents Who Fell in the Last 30 days (M) 2019/20 PERFORMANCE TARGET STANDARD n/a n/a Percentage of Residents Whose Pressure Ulcer Worsened (M) n/a n/a Percentage of Residents on Antipsychotics Without a Diagnosis of Psychosis (M) n/a n/a Percentage of Residents in Daily Physical Restraints (M) n/a n/a SCHEDULE D — PERFORMANCE 2.0 LHIN-Specific Performance Obligations 3/32.0 LHIN-Specific Performance Obligations Schedule E – Form of Compliance Declaration DECLARATION OF COMPLIANCE Issued pursuant to the Long Term Care Service Accountability Agreement To: The Board of Directors of the Central West Local Health Integration Network (the

Performance Indicators. The HSP’s delivery of the Services will be measured by the following Indicators, Targets and where applicable Performance Standards. In the following table: n/a meanç means ‘not-appIicabIeapplicable’, that there iç is no defined Performance Standard for the indicator for the applicable year. tbd means a Target, and a Performance Standard, if applicable, will be determined during the applicable year. INDICATOR CATEGORY INDICATOR P = P=Performance Indicator E = E=Explanatory Indicator M = Monitoring Indicator 2019/20 PERFORMANCE TARGET STANDARD 2018/19 Performance Target Standard Organizational Health and Financial Indicators Debt Service Coverage Ratio (P) 1 c1 ≥1 Total Margin (P) 0 cO ≥0 Coordination and Access Indicators Percent Resident Days – Long Stay (E) n/a n/a Wait Time from LHIN Determination of Eligibility to LTC Home Response (ME) n/a n/a Long-Term Care Home Refusal Rate (E) n/a n/a SCHEDULE D — PERFORMANCE 2/3 INDICATOR CATEGORY Quality and Resident Safety Indicators INDICATOR P = Performance Indicator E = Explanatory Indicator M = Monitoring Indicator Percentage of Residents Who Fell in the Last 30 days (ME) 2019/20 PERFORMANCE TARGET STANDARD n/a n/a Percentage of Residents Whose Pressure Ulcer Worsened (ME) n/a n/a Percentage of Residents on Antipsychotics Without a Diagnosis of Psychosis (ME) n/a n/a Percentage of Residents in Daily Physical Restraints (ME) n/a n/a SCHEDULE D — PERFORMANCE 2.0 LHIN-Specific Performance Obligations 3/3Not –applicable. Schedule E – Form of Compliance Declaration DECLARATION OF COMPLIANCE Issued pursuant to the Long Term Care Service Accountability Agreement

Performance Indicators. The HSP’s delivery of the Services will be measured by the following Indicators, Targets and where applicable Performance Standards. In the following table: n/a meanç means ‘not-appIicabIeapplicable’, that there iç is no defined Performance Standard for the indicator for the applicable year. tbd means a Target, and a Performance Standard, if applicable, will be determined during the applicable year. INDICATOR CATEGORY INDICATOR P = P=Performance Indicator E = E=Explanatory Indicator M = Monitoring Indicator 2019/20 PERFORMANCE TARGET STANDARD 2018/19 Performance Target Standard Organizational Health and Financial Indicators Debt Service Coverage Ratio (P) 1 c1 n/a n/a Total Margin (P) 0 cO n/a n/a Coordination and Access Indicators Percent Resident Days – Long Stay (E) n/a n/a Wait Time from LHIN Determination of Eligibility to LTC Home Response (ME) n/a n/a Long-Term Care Home Refusal Rate (E) n/a n/a SCHEDULE D — PERFORMANCE 2/3 INDICATOR CATEGORY Quality and Resident Safety Indicators INDICATOR P = Performance Indicator E = Explanatory Indicator M = Monitoring Indicator Percentage of Residents Who Fell in the Last 30 days (ME) 2019/20 PERFORMANCE TARGET STANDARD n/a n/a Percentage of Residents Whose Pressure Ulcer Worsened (ME) n/a n/a Percentage of Residents on Antipsychotics Without a Diagnosis of Psychosis (ME) n/a n/a Percentage of Residents in Daily Physical Restraints (ME) n/a n/a SCHEDULE D — PERFORMANCE 2.0 LHIN-Specific Performance Obligations 3/3Not –applicable. Schedule E – Form of Compliance Declaration DECLARATION OF COMPLIANCE Issued pursuant to the Long Term Care Service Accountability Agreement