16 minute read
Long-Term Care
Discover and Adopt (D+A) Program: Call for Innovations 2022
The Centre for Aging + Brain Health Innovation (CABHI) is seeking solutions on behalf of six Ontario-based healthcare organizations enrolled in the Discover and Adopt (D+A) program.
If you are an innovator with a solution that can address one or more of the organizations’ needs listed below, apply today. A virtual platform that healthcare professionals can use to easily manage patients and to support appropriate medication use by older adults receiving virtual geriatric care.
Problem Statement: This Ontario-based healthcare organization is seeking a virtual platform for healthcare professionals to easily manage patients and perform medication optimization (i.e., increase adherence and reduce errors) to improve the frequency and quality of care for at-risk older adults.
Desired Outcomes: • Increase staff satisfaction by 10-15 per cent in delivering virtual care for this population. • Expedite medication optimization (increase medication adherence and reduce errors) for patients while they are waiting to see a geriatrician. • Increase patient satisfaction by 10-15 per cent in receiving geriatric services faster and in the convenience of their own home, reducing patient and caregiver burden for transportation.
An automated system that enables the monitoring and replenishment of medical supplies on nursing units.
Problem Statement: This Ontario-based healthcare organization is seeking a supply room replenishment system that allows for real-time data on the medical supplies on the nursing units, that requires minimal intervention by clinical staff, and limits the movement and intervention of support staff responsible for this task.
Desired Outcomes: • Increase productivity of nurses and supply management team. • Reduce stock out events and time clinical staff spend on requesting supplies. • Eliminate supply management hours spent in the replenishment process. • Reduce inventory level and optimize mix of product on the nursing unit
A solution that increases the social participation and engagement of residents in senior care organizations.
Problem Statement: This Ontario-based healthcare organization is seeking a solution to improve the social experience of long-term care residents, with for declining cognitive abilities and/or differing communication abilities, through engagement and activation strategies that are tailored to their individual needs and interests.
Desired Outcomes: • Increase social participation and engagement of residents by 20 per cent from baseline. • Improve quality of life of residents (increase QoL survey score related to meaningful activities by 10 per cent). • Improve family satisfaction with engagement of residents through proposed solution (more than 60 per cent of families agree that the solution is beneficial to their loved one; 10 per cent increase on QoL survey score related to meaningful activities).
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A remote care monitoring solution that improves safety and reduces adverse events for those living in the community with responsive behaviours.
Problem Statement: This Ontario-based healthcare organization is seeking a Remote Care Monitoring (RCM) solution that will support people living in the community with responsive behaviours to stay safe and reduce adverse events (e.g. wandering, missed medications, falls) leading to poorer health outcomes and higher care utilization.
Desired Outcomes: • Reduce adverse events reported over time by 20 per cent (e.g. trends/trajectories of incidents of wandering, falls, and medication adherence). • Increase ability of clients/family to manage chronic medical conditions. • Increase ability of clients/family to access healthcare system. • Increase number of referrals to RCM program. • Decrease number of police interactions for wandering. • Decrease number of 911 calls, unnecessary emergency room visits and hospitalizations related to adverse events. • Enable clients to live in the community longer.
A solution that enhances risk assessment and monitoring of older patients so they can be safely discharged following an emergency department visit.
Problem Statement: This Ontario-based healthcare organization is seeking a solution to support older patients return to home safely following an emergency department visit, and in turn reducing unnecessary overnight admissions and return visits to the emergency department within 72 hours.
Desired Outcomes: • Increase patient satisfaction with the availability, accessibility, and use of the solution during care discussions. • Staff satisfaction as related to accessibility of the solution and integration into clinical workflow, including: (a) maintenance of the solution and (b) potential downtime. • Reduce unnecessary overnight admission to the ward of older patients. • Reduce the number of return visits by older patients to the emergency department within 72 hours. • Reduce the average length of stay in the Emergency Department for older patients who can be discharged safely to the community.
A solution to reduce the workload related to meal service in the dining room in senior care organizations.
Problem Statement: This Ontario-based healthcare organization is seeking a solution to reduce the workload related to meal service in the dining room in senior care organizations.
Desired Outcomes: • Reduce walking distance and/or steps taken by dietary team members by at least 60 per cent during a single meal. • Reduce the amount of time dietary team members spend carrying trays of plates by at least 60 per cent. • Reduce the amount of time required to serve a seating in the dining room. • Reduce the amount of time required to clear the dining room per seating. • Increase resident mealtime satisfaction in at least 80 per cent of residents. • Increase team member mealtime satisfaction in at least 80 per cent of team members. ■ H
LONG-TERM CARE NEWS We need trauma-informed care in long-term care homes
By Carole Estabrooks
C
anada needs trauma-informed aged care, training and strategies in long-term care homes across the
country.
“Trauma” is a heavy word, but it’s the right word.
“Trauma” describes what has been happening in long-term care facilities across Canada during the pandemic, where the majority of COVID-19 deaths have occurred, and where highly restrictive visitor policies and short staffing have meant extreme isolation and deprivation for the residents who live there.
But there are often two layers of trauma in long-term care.
Overlooked in these discussions is how the pandemic can also trigger symptoms of post-traumatic stress disorder (PTSD) in seniors who have experienced psychological trauma earlier in their lives. Earlier trauma could have resulted from any number of events that caused deep psychological harm, such as a car accident, physical or sexual abuse or fleeing an armed conflict, for example.
In our recently published analysis and review, we highlight how PTSD in long-term care residents is significantly more common than previously understood, how the pandemic has exacerbated PTSD in some residents, and recommend ways that nursing homes can manage the effects of trauma.
While not everyone who has experienced trauma will develop PTSD, those who do are likely to see symptoms re-emerge as they age, develop dementia or are admitted to a long-term care home, which can also be a traumatic event in itself. For vulnerable seniors living in care, the spread of a deadly virus can also trigger intense PTSD symptoms including intrusive thoughts, nightmares and feelings of panic.
Well over two thirds of seniors living in long-term care have some form of dementia. PTSD symptoms can occur when practices or environmental sights and sounds in the home inadvertently trigger an individual. When this occurs on top of dementia, it may cause extreme behaviors.
What’s more, symptoms associated with PTSD are similar to behaviours exhibited by those living with dementia such as anger, aggression or agitation. Since long-term care homes do not routinely screen for a history of psychological trauma on admission, staff may have a difficult time identifying which behaviours stem from PTSD and which stem from dementia.
All of this points to an urgent need for more person-centered care and well-trained staff who are equipped to meet the needs of residents.
Through trauma-informed practices, ensuring the quality of life of residents becomes an achievable goal and individuals living with PTSD will receive the care they need.
With the proper resources and training, nursing homes can be transformed into places worth living.
So, what does trauma informed care look like?
It means creating a safe environment with adequate staffing, training the workforce, screening residents for trauma upon admission and taking a personal history to be used as the basis for future care. It means management consults residents, their loved ones, and staff in all aspects of care planning as well as providing staff with access to specialized services like mental health teams.
It means incorporating strategies to support residents that focus on bodily senses to address symptoms and behaviours associated with PTSD. This includes the use of weighted blankets, music, breathing exercises or animal-assisted therapy to increase sleep quality, improve mental health and decrease pain and agitation.
A trauma informed approach also means centering staff well-being.
When visitation from caregivers and companions became severely restricted, staff who already did not have time to provide residents with adequate care saw their workload increase. Additionally, staff dealt with the moral injury of watching residents suffer and die alone.
Burnout levels amongst staff are nearing catastrophic levels and supporting staff with trauma means introducing cognitively based processes that regulate attention and set intention or somatic-based processes such as modified yoga therapies and stress reduction strategies.
While policy makers develop important industry wide standards and practices, we need to work locally towards fully integrating trauma-informed methods into long-term care homes across the country.
COVID-19 is a psychological wrecking ball and only trauma-informed practices and policies can build a sturdier system able to withstand the next pandemic or catastrophic event. This requires a commitment from those managing long-term care homes to work towards ensuring a trauma informed approach in their facilities.
Staff must be equipped with the basic knowledge of the effects of trauma and receive training on how to integrate this knowledge into their daily care routines. Additionally, supporting residents as well as staff means providing them with access to educators, nurse practitioners and those who have specialized knowledge of mental health.
Vulnerable seniors in LTC have suffered enough. It’s time for policymakers, funders and long-term care home managers to prioritize trauma-informed aged care. ■ H
Hôpital Montfort and Ottawa Paramedic Service pilot emergency department program
By Geneviève Picard
In June 2022, the Ottawa Paramedic Service and Hôpital Montfort launched a pilot program that integrates Primary Care Paramedics into the Montfort Emergency Department. The program aims to reduce paramedic offload delays, increase the availability of paramedic resources in the community, and improve patient flow within the hospital. “The challenges we face in healthcare are requiring us to rethink the way we do things and to challenge the status quo”, explains Martine Potvin, Vice-President, Patient Experience, Clinical Programs and Chief Nursing Executive at Hôpital Montfort.
The program includes four Primary Care Paramedics working 12-hour shifts in Montfort’s Emergency Department, providing 12-hour coverage, seven days a week. When an ambulance arrives, the patient’s care can be transferred from the transporting paramedic crew to the paramedic working in the Emergency Department. This allows the paramedic crew to return to the community so they can be available for the next call.
Ontario Health Team is connecting care
By Melissa Londono
As the Eastern York Region North Durham (EYRND) Ontario Health Team (OHT) wraps up its second year since the Ministry of Health officially announced its establishment, collectively, it has been able to provide the community, Markham, Stouffville, Uxbridge and beyond, with an integrated system of care.
“Over the past two years, the pandemic has challenged us in ways we never imagined,” says Dr. Cristina Popa, Co-Chair, Core Leadership Council, EYRND OHT. “However, we continued delivering on our strategic priorities and bridging recovery through innovation to enhance the experience of individuals, caregivers, primary care providers, worked to improve population health, health equity and implemented integrated care delivery models.”
The EYRND OHT is a partnership of a number of health and non-health partner organizations that share a rich history of collaboration and an exciting vision for the future of health care in our communities. The EYRND OHT includes: • 360 Kids • Addiction Services Central Ontario • Canadian Mental Health
Association York and South Simcoe • Care First • CHATS Community & Home
Assistance to Seniors • East Markham Family Health
Organization • Entité 4 • Health for All • Krasman centre • Markham Family Health
Organization • New Unionville Home Society • SE Health • SRT MedStaff • York Region • York Support Services Network • Oak Valley Health “This past year through community partnerships, and a perseverance to improve the lives of people and families in our communities, we rose to the challenge and are forging the road ahead,” says Dr. Popa. The following are a few of the many EYRND OHT current initiatives that are paving the way:
COVID-19 RESPONSE
In partnership with 12 community organizations, EYRND OHT supported the largest mass vaccination centre in York Region the COVID-19 Community Vaccination Centre at the Cornell Community Centre. In over 56 weeks, over 270,000 shots were given with an average of 600 shots per day, up to a max of 2,752 per day including the pop-up vaccination clinics. Volunteers, staff, community partners and health care providers in the community came together quickly. The centre was paired with outreach efforts to ensure vulnerable residents in congregate settings (long-term care, retirement homes, and group homes) were supported and protected. Popup swabbing clinics and vaccination clinics were set up in high-priority communities to improve access and increase uptake. A key element that set the vaccination centre apart was that it was one of the few centres in the GTA that provided additional monitoring in the Emergency Department for people with special needs such as severe allergies.
The COVID-19 Assessment Centre, supported by the EYRND OHT, has also helped the health care system over the last two years successfully in many regards, and as the pandemic is changing so are the COVID-19 related services. In partnership with Oak Valley Health, the COVID-19, Cold, and Flu Care Clinic (CCFCC) opened to address underserved and hard-toreach populations, find solutions for high volumes of patients without a primary care provider, provide access to primary care assessments, and divert Emergency Department visits.
SCOPE – NAVIGATION AND CARE INTEGRATION
Connecting primary care providers to hospital-based resources and specialty services (e.g., General Internal Medicine, mental health, diagnostic imaging, wound care, Medical Day Unit, etc.) through a nurse navigator based at Oak Valley Health, SCOPE aims to improve value and efficiency through reducing visits to the Emergency Department. In partnership with Oak Valley Health and Women’s College, the goal is to improve patient’s access to care, reduce admissions for investigation, improved primary care provider and patient experience, time and human resource efficiencies and effort, and improve service wait times. Since launching in April 2022, SCOPE has on-boarded 100 physicians and the number is growing. Additionally, primary care providers’ access to SCOPE increased by 66 per cent in the sixth month of operation. This means equitable and timelier access to specialty care while primary care providers remain in control of patient care.
STREAMLINED ACCESS PRIMARY CARE PATHWAY
Streamlined Access is York Region and South Simcoe’s advanced, localized solution to coordinated access to Mental Health and Addiction services. Streamlined Access provides access and navigation to 26 individualized community-based programs which can be categorized into three “baskets of services”: Mental Health Case Management, Mental Health Supportive Housing and Assertive Community Treatment Teams.
The goals of this initiative includes improved provider experience by reducing the burden on primary care providers (PCP) through establishing a single, integrated and coordinated point of access for community-based mental health and addictions referrals; improved patient experience by providing advocacy and follow up on behalf of patients and family caregivers during the referral process.
Together, the EYRND OHT is working to redesign care for residents of its communities in Markham, Stouffville, Thornhill, and Uxbridge as well as for clients and families who use services in the communities but live elsewhere. For more information about the EYRND OHT, visit our website EYRND.ca ■ H
While working in Montfort’s Emergency Department, each paramedic can monitor and care for up to four patients at once. The paramedics work within their professional scope of practice under the medical direction of an Emergency Department physician. The Emergency Department physician provides the paramedics with the authority to perform various medical procedures and diagnostic tests. This promotes improved patient offload, continuity of care, and patient flow within the hospital. Montfort is the first hospital in our city to implement this integrated approach.
Daily, Montfort is seeing a reduction in paramedic offload delay in the Emergency Department. For example, over the course of one day in September, one paramedic eliminated over 30 hours of offload delay by caring for seven patients during their shift.
Montfort covers the staffing costs of the Primary Care Paramedics working there. The program was initially piloted for a three-month period and owing to its success has been extended until September 30, 2023.
“The integration of paramedics into our emergency team is one example of how we are rethinking the way we work”, adds Ms. Potvin. “It is also a reflection of the resilience of our staff, who are dedicated to providing an exceptional experience, with you, for you.”
The partnership between the Ottawa Paramedic Service and Hôpital Montfort demonstrates the innovation and leadership of both organizations in responding to community needs, requests for service and an ever-changing healthcare landscape.
“This program is just one of the impressive efforts by the Ottawa Paramedic Service to continuously improve its services to our growing city”, said Jim Watson, speaking at one of his last event as Mayor of the City of Ottawa. “My thanks to Montfort for its leadership in this important initiative.”
“On behalf of the Ottawa Paramedic Service, I am proud to partner with the Montfort on this exciting initiative and remain committed to working with local hospitals to identify additional strategies for reducing offload delay and increasing our ability to respond to the needs of Ottawa’s communities”, added Pierre Poirier, Chief of the Ottawa Paramedic Service. ■ H
Geneviève Picard is the communications director at Montfort Academic Hospital.
UPCOMING EDITIONS
JANUARY FEBRUARY
Human resource programs implemented to manage
Gerontology/Alternate Level of Care/Rehab/ Wound Care/Procurement:
Geriatric medicine, aging-related health issues and
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MARCH
An update on the impact of technology , including
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