A monthly summary of activities and announcements relating to personal care in Winnipeg Volume 3, Number 1

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1 Personal Care Home A monthly summary of activities and announcements relating to personal care in Winnipeg Volume 3, Number 1 Personal Care Home Program Summary Transfers to Emergency Data Collection In the fall of 2004, the WRHA Emergency Task Force had a number of findings related to the use of Emergency Rooms by Residents of Personal Care Homes. One of the difficulties in addressing these findings was the lack of information about these transfers to emergency. All of the Personal Care Homes in the region agree to collect information about when residents were transferred for a six-month period. This information has been very valuable in addressing the Task Force findings and has given us all a better understanding of the use of emergency services by residents of personal care homes. April to September 2005 January, 2006 OUTCOMES: Implementation of the Nurse Practitioner role at two more PCH sites recruitment is currently underway. Information about the services available in PCH s has been shared with the Emergency Program. Guidelines for communication from PCH to Emergency and Emergency to PCH are currently being developed. The study demonstrated that the Emergency Room is not being used to access specialty consults, tests or treatments. SUMMARY OF FINDINGS: There were a total of 1,424 reported transfers to Emergency from the PCH Program. On average, 237 transfers occurred monthly, representing 4.0 % of the total number of PCH beds (5,917). The most common reasons for transferring residents to Emergency were: o Suspected fracture 44.0 average o Respiratory distress 29.5 average o Deterioration of general condition 26.7 average o Acute abdomen/suspected GI bleed 24.2 average o Unresponsiveness/decreased level of consciousness 23.0 average o Infection/sepsis 16.5 average o Other 16.0 o Family insistence 13.3 average o Chest pain 11.0 average o Nausea or vomiting 10.3 average o Major laceration 10.1 average (PCHs were able to choose several reasons for each transfer) Other findings o The majority of residents were transferred during the day shift; o Very few were seen by physician or nurse practitioner prior to transfer. o Friday was the day that had the highest number of transfers. o The majority of residents were transferred and returned to the PCH within 24 hours. Changes at the Personal Care Homes Tony Fraser, Executive Director of The Convalescent Home of Winnipeg has retired as of December Rhonda Crane who is the Director of Care will be filling in as Acting Executive Director/Director of Care for the time. Pam Lavoie has returned to Poseidon Care Centre as the Director of Resident Services as of January Kerron Kidd as returned to her old position as Clinical Resource Nurse. Lisa Martens has taken on the role of Executive Director/ Director of Care at River East Personal Care Home as of January Kathleen Klaasen, Clinical Nurse Specialist has resigned from her position with the Personal Care Home Program, effective February 10, She has accepted a position as a Resident Care Manager at Misericordia Health Centre. The Long Term Care Association of Manitoba is now accepting nominations for the 2005 Award for Excellence To read more on the Award for Excellence and obtain a nomination form please visit our website at or contact us at

2 RAI/MDS 2.0 Related Measures of Care and Care Needs in the Personal Care Homes MDS reports such as RAPs, Outcome Scales, and Quality Indicators are available for use in decision making for resident care, clinical practice and operational decisions. The following is a short overview of three MDS reports that are available at the participating Personal Care Homes. RAPs (Resident Assessment Protocols) are being used to determine the need for further assessment of resident condition and to help guide the individual care plans. Assessment items coded in the MDS are calculated into the RAPs and either validate an already care planned resident need or suggest further assessment to determine a care plan for meeting a residents needs. Successful care planning can be ensured by the review of the RAPs. Outcomes Scales or Outcome Measures include: Cognitive performance is indicated in a way that is comparable to the MMSE (Mini Mental Status Exam). The Cognitive Performance Scale (CPS) is based on several indicators including; short-term memory, cognitive skills for daily decision-making, expressive communication and the ability to self-perform the task of eating. Clinical indication of depression is determined using a Depression Rating Scale that may be compared to both the Hamilton Depression Rating Scale and the Cornell Scale for Depression. This scale considers assessed behaviours such as persistent anger, unrealistic fears, negative statements, facial expressions, tearfulness, health complaints and anxious complaints. It is a successful screening instrument. Index of Social Engagement scale is a summation of items that predict how involved a resident is in the everyday goings of their life in the personal care home community. This scale includes the ability to establish ones own goals in even the simplest of daily tasks and other items that indicate involvement in daily life of the PCH. Three Activity of Daily Living, or ADL Scales, are offered. The ADL Scales take into consideration how much a person may actually do for themselves and how much they actually have done for them. They include not only a dependence rating but also include levels of independence. Quality Indicators related to individual residents as well as for entire facilities are available. Quality Indicators serve as a mechanism for identifying potential problems; the indicators will indicate a need for follow-up and further investigation for care decisions. Once established, Quality Indicators can help a resident, family or facility track and measure the change in care needs and help to make decisions on how to best accommodate these needs. Using available information sources such as these MDS reports allows for constructive interaction about care. Regular review of care can improve and preserve a high quality of life for all residents. WRHA implementation of the RAI supports this principle and endorses the use of MDS reports to make sound, valid, evidenced based decisions for resident care. Information and training on MDS report access is currently being offered through the RAI education sessions. PCH sites that are currently implementing the RAI/MDS 2.0 have the opportunity to request a site training session for these reports and more. Sessions may be booked by contacting Caroline Boyd, RAI Coordinator, PCH Program, cwboyd@wrha.mb.ca or call Let it Snow, Let it Snow, Let it Snow! Finding fun ways to enjoy the winter is a challenge. This year our particularly creative recreation staff along with a group of grade seven students from St. Emile School brought winter fun indoors to our residents. The students partner with Golden Links Lodge as a part of a Grandparenting program twice a month. Boxes of snow were brought into the facility and together with the residents snowmen were made.. For many of the residents it had been a long time since they had even felt snow. The memories and the stories that were shared were also a part of the experience. After the snowmen were made they were carried outside and placed in our front courtyard for all to see. Another activity involving our residents in winter fun was the making of ice candles. Over a period of a few weeks, residents and recreation staff made ice candleholders from ice cream pails and decorated them with evergreens and pinecones. On the night of our Christmas Candlelight service the two-dozen ice candles with tea lights inside lit the driveway and entranceway to our building. 2

3 EDUCATION OPPORTUNITY Charting and the Nurse: What it means to You Carla Shapiro Faculty of Nursing, University of Manitoba Tuesday, February 7, hrs Friendship Room Golden Links Lodge 2280 St. Mary s Road Winnipeg, Mb. No charge to attend. To participate in this educational session please contact Golden Links Lodge by Fax or Telephone. Registration is limited to 25 participants. Telephone: ext: 255 (Lise) Fax: Golden Links Lodge wishes to thank the WRHA Continuing Education Fund for its financial support for this educational session. THE CNS CLINICAL CORNER Question: I have heard rumors that pressure mapping is now available for residents of personal care homes. Is this true? Answer: The rumors are true! Skilled assessment using pressure mapping technology is now available to residents in Winnipeg personal care homes. This type of assessment allows a skilled therapist to assess pressures when a resident is seated in their wheelchair, lying in bed, etc. Remember, in order to heal a pressure ulcer, we need to ensure adequate pressure offloading TREAT THE UNDERLYING CAUSE! Who should I refer? Any resident with a chronic, non-healing pressure ulcer(s) over his/her sacrum, ischial tuberosities or buttocks. How can I make a referral? The first step is to ensure the occupational therapist in your personal care home has assessed the resident. If based on his/her assessment findings, the occupational therapist feels pressure mapping is appropriate, he/she can contact Gord Neufeld, Community Therapy Services, at (extension 500), to make a referral. If you have any other questions you wish to see answered in this column, please them to either Deanne O Rourke, CNS, at dorourke@wrha.mb.ca or Kathleen Klaasen, CNS, at kklaasen@wrha.mb.ca 3

4 The 14th National Conference of the Canadian Gerontological Nursing Association will be hosted by the Manitoba Gerontological Nursing Association on May 2-5, 2007 in Winnipeg, Manitoba, Canada. The Canadian Gerontological Nursing Association is a national organization that represents registered nurses who work with the elderly in a wide variety of settings. The 14th National Conference theme The Vitality of Aging: Embracing the Spirit will be supported by a variety of excellent presentations provided by such notable keynote speakers as Sue Johansson, well known activist, lecturer and Canadian TV personality, Lynne Mitchell- Pedersen, local author, teacher and psychotherapist who has been actively involved in improving care to older adults and Lorraine Mion, Director of Nursing for Geriatrics and Nursing Research at Metro health Medical Center in Cleveland Ohio who has been extensively involved in establishing a geriatric nursing standards and education program as well as evidence-based approach to nursing practice. Please promote this conference to your members as an opportunity for sharing knowledge and networking with colleagues. If you require further information please contact Strauss at (204) or visit our website 4 We want your stories! Do you have news stories, resident profiles or successes in the services you deliver? There are many great things happening in Personal Care Homes in Winnipeg, and we want to share stories from PCH s with others through the PCH View. If you have questions about submitting articles, please contact Leanne Drad at or ldrad@wrha.mb.ca.

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6 This month the J. W. Crane Memorial Library focuses on resources on nutrition and long term care Books, Documents and Videos: The following books are available at the J. W. Crane Memorial Library. To borrow any of the following, contact the Library at or Australia.Central Area Health Service. Best practice food and nutrition manual for aged care facilities. Strawberry Hills, NSW : ANHECA, QU 145 B Crawley, Helen; University of Stirling. Dementia Services Development Centre. Food, drink and dementia : how to help people with dementia eat and drink well. Stirling, Scotland : University of Stirling, WM 220 C Food for thought : care homes practice guide. Penzance, U.K. : Alzheimer s Society QCI, WM 220 F NHS Scotland (National Health Service, Scotland). Nursing and Midwifery Practice Development Unit (NMPDU). Nutrition for physically frail older people : best practice statement. Edinburgh : NHS Scotland, QU 145 N Nutrition care of the older adult : a handbook for dietetics professionals working throughout the continuum of care. 2nd ed. Chicago : American Dietetic Association, QU 145 N Riverdale Hospital. Menu for safe feeding : a video teaching safe feeding practices. Toronto : Riverdale Hospital, WB 410 R [video] Journal Articles: For copies of the above articles, contact the J. W. Crane Memorial Library at or by jwclib@deerlodge.mb.ca Bowman JJ, Keller HH. Assessing nutritional risk of longterm care residents. Canadian Journal of Dietetic Practice and Research Fall;66(3): Cowan DT, Roberts JD, Fitzpatrick JM, While AE, Baldwin J. Nutritional status of older people in long term care settings: current status and future directions. International Journal of Nursing Studies 2004 Mar;41(3): Hudgens J, Langkamp-Henken B. The Mini Nutritional Assessment as an assessment tool in elders in long-term care. Nutrition in Clinical Practice Oct;19(5): Thomas DR, Ashmen W, Morley JE, Evans WJ. Nutritional management in long-term care: development of a clinical guideline. Journals of Gerontology: A Dec;55(12):M Yen PK. Meeting nutrition needs in long-term care. Geriatric Nursing 2005 Jul-Aug;26(4): On the Web.. National Resource Center on Nutrition, Physical Activity and Aging: Long Term Care Resources about_long_materials.asp The mission of this Resource Center, funded by the US Administration on Aging, is to increase food and nutrition services in home and community-based social, health, and long-term care systems serving older adults. The Long Term Care Resources page provides downloadable examples of a variety of useful tools for those involved in nutrition provision in long term care facilities. Included are a snack menu to increase food and fluid intake, nutrition risk assessment tools, a chart for documentating food and fluid intake, posters, and many other items. Also at the Center site and of possible interest is a downloadable document entitled Older Americans Act: Nutrition Programs Toolkit index.asp. All staff at Winnipeg Personal Care Homes are invited to use the services of the J. W. Crane Memorial Library. For further information on these services, visit or contact Laurie Blanchard, Outreach Librarian, Long Term Care at or laurie_blanchard@umanitoba.ca

7 The Crane Library has a collection of over 800 videos, games and other audiovisual titles. To find out what other videos are available you can download our video catalogue in PDF at videocat.shtml. You can also search the Crane catalogue for specific video titles in the J.W. Crane Library, or call Laurie at To see what is available at other Winnipeg hospital libraries, search BISON, The UM Library Catalogue Videos may be borrowed for a period of 7 days. To arrange to borrow a video, call the J. W. Crane Memorial Library at And don t forget: If you re interested in this or any other healthcare related topic, the J. W. Crane Memorial Library at Deer Lodge Centre is now offering free literature search services and article delivery service for all Winnipeg personal care home staff. Library staff will perform literature searches on your topic of interest, and provide a list of references and abstracts to journal articles, books and websites. You may then identify and request any articles, books or videos on this listing from the Library. To request a literature search, , fax or phone Laurie Blanchard, Outreach Librarian at lblanchard@deerlodge.mb.ca, FX: (204) or by phone at (204) University of Manitoba Continuing Education We at the University of Manitoba, Extended Education, Continuing Education, are pleased and excited to announce the re-introduction of the Certificate in Gerontology, previously known as the Advanced Certificate in Gerontology. (See attached pages.) Through discussion with the community I advisory committee and health care professionals it has been decided that this is timely and necessary program to offer. As the population demographics indicate we are rapidly moving into a time where this 7 program, and the course within in, will be needed and in demand by professionals, paraprofessionals and those who work with older adults. We hope that you will be as excited about this new program as we are and encourage you to register early as we are confident the courses will fill up quickly. Please ensure that this information is given to your colleagues and others who would benefit from it. For further information call April Dunn, at or April Dunn@umanitoba.ca.