Teaching LTC Homes: Current and Future Opportunities

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1 Ontario s Centres for Learning, Research and Innovation (CLRI) in Long-Term Care: Ontario s Centres for Learning, Research and Innovation in Long-Term Care Teaching LTC Homes: Current and Future Opportunities OANHSS 2015 April 15, 2015 Melissa Donskov, Bruyère CLRI Raquel Meyer, Baycrest CLRI Mary-Lou Van der Horst, Schlegel CLRI

2 Outline 1. Introduction 2. Origins and examples from other countries 3. The Ontario experience 4. Baycrest, Bruyère and Schlegel CLRIs 5. Lessons and experiences 6. The next generation of Ontario CLRIs 7. Discussion what does this mean?

3 Ontario s Three CLRIs Supported with funding from the Government of Ontario The views expressed in this publication are the views of the author(s)/presenter(s) and do not necessarily reflect those of the Province.

4 Who are we? Baycrest Centre for Learning, Research and Innovation in Long-Term Care Bruyère Centre for Learning, Research and Innovation in Long-Term Care Schlegel Centre for Learning, Research and Innovation in Long-Term Care Ontario s Centres for Learning, Research and Innovation in Long-Term Care are supported with funding from the Government of Ontario ( )

5 What do we do? Ontario s Centres for Learning, Research and Innovation in Long-Term Care contribute toward enhancing the quality of care in the LTC sector through: Education, research, innovation, evidence-based service delivery and knowledge transfer Facilitating collaboration between researchers, educators, LTC home personnel and other practitioners in the development, adoption and continuous improvement of evidencebased best practices that increase efficiency, effectiveness, sustainability and quality of care

6 What is a Teaching LTC Home? Fundamental concepts: linking and creating synergy between the separate spheres of research, clinical care and education and training Typical outcomes Research to improve care Increase knowledge of the workforce Quality education and clinical experiences for students Enhanced quality of care Source: Chilvers & Jones 1997; Barnett 2014

7 Why Teaching LTC Homes? Aging population Increasing complexity of residents and chronic illnesses Challenges with recruitment to and retention in LTC Improve training and skills of interdisciplinary care teams Social devaluing of LTC and lack of prestige with geriatric care Competition for HHR from other providers/sectors Lack of collaboration among educational/research institutions and LTC Source: Early Leaders Forum Report 2011

8 Why Teaching LTC Homes? Good health care is a combination of good systems and processes; good clinical practice; and good resident/patient engagement. With a reputation for scoring highly in all three areas, long term care homes are well positioned to offer quality on-the-job educational opportunities to Canada s future health care professionals. Every-one long term care homes, colleges and universities, Canada s health care system and, most importantly, residents will reap the benefits. Source: Chambers, 2010

9 Origins of the Movement Early 1960s veterans nursing homes and affiliated veterans hospitals Improve knowledge about long term care of older people Increase number of qualified aged care providers 1980s several TNH examples in the US Two most comprehensive and influential National Institute on Aging TNH Program Focus on multidisciplinary research to inform geriatric care (++ physicians) Robert Wood Johnson TNH Program Supported students and workforce education (++ nursing) Source: Barnett 2014, Mezey & Lynaugh 1989

10 Other Countries -Norway Started in 1996, emphasis on planning stage Piloted nationally with 5 TNH Permanent feature of aged care system as of 2004 Main goals Improve competence of staff Enhance prestige of working in aged care (increase recruitment/retention) Create a culture in NH conducive to developing services informed by research Developing good learning environments for students Source: Barnett 2014, Early Leaders Forum 2011,

11 Other Countries Norway (cont d) Network of TNH (one in each county) providing leadership for the aged care sector Hub model Role includes dissemination of research findings and clinical expertise to impact sector Recently expanded (2011) to include home and community care; Centre for Development of Institutional and Home Care Services Source: Barnett 2014, Early Leaders Forum 2011,

12 Other Countries - Australia Teaching and Research Aged Care Services (TRACS) Combine teaching, research, clinical care and service delivery in one location to operate as a learning environment, to support clinical placements and professional development activities in various disciplines. 2011/12 to 2014/15 16 TRACS projects (spread across country) + national evaluation Source:

13 Other Countries Australia (cont d) Key Elements support training and professional development in a range of disciplines (e.g., nursing, psychology, medicine, physiotherapy, occupational therapy) aged care specific curriculum development clinical training in residential and community care settings inter-professional learning and participation by aged care employees in teaching, learning and research Evaluation practical strategies and processes that help the aged care sector operate as a learning environment to facilitate high quality clinical training professional development opportunities; and deliver benefits to industry, students, staff and care recipients. Source:

14 The Ontario Experience Promoting Productive Partnerships Community of Practice Members Interdisciplinary Council on Aging and Health within Ontario Council of Universities, colleges, universities, government, hospitals, research institutes, LTC homes, etc Early Leaders Forum November 24, 2010 Report and funding proposal February, 2011

15 The Ontario Experience RFP issued in summer 2011 Three inaugural Ontario Centres for Learning, Research and Innovation in Long-Term Care funded in October 2011 Baycrest Bruyère Schlegel

16 Objectives Ontario CLRIs The work of the Centres for Learning, Research and Innovation in Long-Term Care (CLRI) will support LTC homes to: deliver the right level of care, in the right place, and at the right time across the continuum of care; contribute to the high quality of life and provide high quality care for residents of LTC homes; promote a dynamic culture within the LTC sector, that is responsive to client needs; develop and enhance the expertise of LTC home staff and promote the LTC sector as an employer of choice; and provide efficient and effective care.

17 Goals of the Ontario CLRI Program Provide educational opportunities and promote career opportunities within LTC settings to develop a workforce with the knowledge and skills to provide quality care to LTCH residents. Foster interdisciplinary/inter-professional learning and development of all health care providers and disciplines. Contribute to the development of learning curriculum that prepares health care workers for the provision of quality care based on evolving best practices. Create opportunities for evidence-based research to be conducted and validated within an operating LTCH and enable providers to influence the research agenda. This includes finding new ways to deliver care and services, and the development of new products. Create opportunities to design, test and disseminate innovative approaches to providing high quality care within LTC settings. Facilitate knowledge transfer from applied and clinical research to practice and promote healthcare integration and innovation across the continuum. Enhance the profile of the LTC sector within the broader healthcare system. Foster collaboration and partnerships within the LTC community and between the LTC sector, colleges and universities, research institutions, government, the broader healthcare sector and subject matter expert organizations.

18 Key Elements Ontario CLRIs Three inaugural Centres Coordinating Committee that meets quarterly Unique and complementary implementation plans and foci Provincial reach Implementation plans with quarterly reporting

19 Synergies with Dr. Sinha s Report Overall, many linkages to the recommendations Each CLRI project links with: Enhancing Ontario s LTC Home Environments Addressing the Specialized Care Needs of Older Ontarians The ministry should also look to leverage its newly established Centres for Learning, Research, and Innovation (CLRI) to support and advance quality improvement and staff education and training efforts that further advance the overall sector. pages

20 The Baycrest CLRI Focus: Developing and evaluating innovative educational approaches to enhance interprofessional geriatric competencies in the LTC home workforce. Team Approaches to: Acute Changes in Resident Condition Responsive Behaviours Engaging Families in Care Team Learning Series Inter- Provider Learning Units Experiential Learning for LTC Home Students Smart Classroom Summer Student Internships Geriatric Training Program Job Shadowing Program Evaluation Baycrest CLRI Experiential Learning Simulation, Gamification & elearning Interprofessional, Arts-Based & Team-Based Learning Educational Research & Innovation Virtual Mentorships Career Development in LTC Telehealth Rounds Annual Conference Interprofessional Linkages Translating Knowledge to Practice Knowledge Exchange

21 Fostering Cultures of Learning LTC Learning Network Telehealth Rounds Follow-Up Consultations Team Learning Series: Acute Changes Responsive Behaviours Families

22 Integration of Education Shifting from a culture of compliance & mandatory education towards a culture of learning & inquiry Unique workforce mix Educational goals, frameworks & methods Home readiness & leadership stability Practice change realities Student placements: structures/policies, resources Developing, testing & disseminating innovations Local & provincial reach

23 Baycrest CLRI Collaborations & Networks Participating LTC Homes George Brown College, Michener Institute University of Toronto s Centre for Interprofessional Education Toronto-Central LHIN Behaviour Supports for Seniors Program Psychogeriatric Resource Consultants Ontario Telehealth Network SIM-one Rotman Research Institute Ontario Long Term Care Physicians OAHNSS, OLTCA Internal Baycrest Committees

24 Baycrest CLRI Current Structure External Advisory Board Internal Steering Committee Executive Implementation Group Work Groups CLRI Programs Ad Hoc Work Groups Knowledge Exchange Events Internal & External Committees & Partnerships

25 The Schlegel CLRI- Structure Research Institute for Aging (RIA) Board of Directors Schlegel CLRI RIA-University of Waterloo Liaison Committee RIA-Schlegel Villages Research to Practice Integration Committee RIA-Conestoga College Liaison Committee

26 The Schlegel CLRI- Model

27 The Schlegel CLRI- Logic

28 The Schlegel CLRI- Incubation

29 The Schlegel CLRI- Acceleration

30 The Schlegel CLRI- Dissemination Long-Term Care Workforce Development Knowledge Transfer Research and Living Labs Partnerships and Networks PSW Certificate Course in Seniors Care Enhanced PSW-PN Bridging Program PSW & PN Living Classroom-based programs PN Living Classroom Program Leadership Program for LTC Excellence in Resident-Centre Care (Trainer & PSW) Courses Living Classrooms Implementation Living Classroom Resources Living Labs Partnership Development Culture Change Toolkit Neighbourhood Team Development More

31 The Bruyère CLRI Focus Capacity Building increase the knowledge and skills of the workforce Capacity Planning assist in shaping the LTC system of the future Quality enhance the quality of care Tangible outcomes/materials that can be shared provincially to reach all stakeholders LTC Homes (ie: residents, workforce, etc), MOH/LHIN, Workforce, Community Bilingualism

32 BRUYERE CLRI Bruyère CLRI INNOVATION HHR forecasting Transitions in care and wait times Specialized units Case Costing Health care use and cost in LTC and EOL RESEARCH Palliative Care/EOL Responsive Behaviours Inappropriate prescribing Oral Care LEARNING Inservice training and education RN/RPN Clinical Leadership BScN Student Placements Knowledge Translation

33 Bruyère CLRI Structure Bruyère Research Institute Bruyère CLRI Management Committee Bruyère CLRI Researchers Group Bruyère External Steering Committee Education Partners

34 Bruyère CLRI The People

35 Bruyère CLRI Steering Committee Algonquin College La Cité collégiale University of Ottawa Carleton University Ontario LTC Physicians Ontario HHR Research Network Champlain CCAC Champlain LHIN OANHSS OLTCA Council on Aging 2 external LTCHs (for- and not-for profit) Ontario Association of Residents Councils Champlain Region Family Councils Network

36 Bruyère CLRI Steering Committee Purpose: provide advice and guidance, identify issues and opportunities, provide input on priorities, participate in all aspects of the Bruyère CLRI Partnerships, resources and support Insight from the frontline, families, clinical experience Project specific direction Integration of sector stakeholders

37 Bruyère CLRI Capacity Planning Indeed, the establishment of a robust and evidenceinformed capacity planning framework that can allow the ministry, the LHINs, and the sector to make planning decisions related to service organization and delivery that are equitable, while addressing local needs, will be a critical first step in these efforts; one that needs to start immediately. -Sinha, 2012, p. 135

38 Bruyère CLRI Capacity Planning End goal is improved care right place and time good planning improves care at the bedside Study linkages with other parts of the system and highlight care practices at system level A robust LTC sector impacts other aspects of the system (ie: hospitalization, ER visits, etc) LTC Integration and Innovation

39 Ontario CLRI Website

40

41 Lessons Internal Influences Internal partnerships and buy-in Internal resource requirements, supportive infrastructure Resources and space Policies and job descriptions Inter-organizational agreements pre-existing are really important to get out the gate sooner Openness to change

42 Lessons External Influences Small group exercise What external influences do you think would accelerate or restrain CLRI success? OR If innovation is your mandate, what external influencers would be necessary for success, and what might be barriers?

43 Lessons - Partnerships A wide range of partnerships are essential to achieve CLRI objectives; collaboration is key Seek partners who have strengths/abilities you are missing for leverage Partnership building takes time Build on existing relationships and look for small wins Involve partners at the planning stages and through out Memorandums and agreements Common goals Engage residents, families, LTCHs

44 Lessons Research within LTC Small group exercise What are unique challenges associated with conducting research in LTC homes? OR How might LTC homes work with CLRIs to move research into practice?

45 Lessons Students Placements Lets discuss Colleges and Universities supporting LTC education First experience in LTC Improve recruitment to LTC Preparing workforce for LTC environment Roles and Responsibilities Timing of placement in program Curriculum enhancements Logistics Supporting preceptors Build capacity LTC academic trainees Supply of LTC-ready graduates

46 Evaluation of the Ontario CLRIs Phase 1 Planning Jan-March 2015 Phase 2 Evaluation of first 3.5 years April-August 2015 Phase 3 Evaluation of final year and full 4.5 years April-August 2016

47 Next generation of Ontario CLRIs Spread and sustainability Build on Momentum Build on successes and expand, lessons learned for the future LTC sector workforce development Excellence in care and services, resident-focused Culture of innovation, learning and research for the LTC sector Integration of LTC within larger healthcare system LTC profile Leadership and advocacy

48 What Does This Mean? For the LTC sector For you

49 Contact us! Raquel Meyer Manager Faith Boutcher Director, Academic Education Melissa Donskov Director Tracy Luciani Knowledge Broker Mary-Lou van der Horst Director

50 References Barnett K (2014). Exploring the Teaching Nursing Home Model: Literature Review to Inform the National Evaluation of the TRACS Program, Adelaide: Australian Workplace Innovation and Social Research Centre, The University of Adelaide Chilvers J & Jones D (1997). The Teaching Nursing Homes innovation: a literature review, Jl of Advanced Nursing, 26, Chambers L (2010). Long Term Care Homes as Centres of Learning, Long Term Care Early Leaders Forum Report (2011). Creating a Vision for Long Term Care Homes as Centres of Learning : Options and Opportunities for Ontario, prepared on behalf of the Seniors Health Research Transfer Network Promoting Productive Partnerships among Colleges, Universities and Long-term care homes Community of Practice Mezey M & Lynaugh J (1989). The Teaching Nursing Home Program: outcomes of care, Nursing Clinics of North America, 24(3)

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