Behavioural Supports Ontario (BSO) What does it mean for you? Laurie Fox HNHB BSO Project Implementation Lead Hamilton Health Sciences With I am who I am, so help me continue to be me Dana Vladescu, Manager, BSO Community Outreach Team Terri Glover, Manager, BSO LTCH Mobile Team Jocelyne Lebel, HNHB CCAC Information & Referral Presentation to: Family Council Network Four (FCN4) April 2 nd, 2013
Agenda Behavioural Supports Ontario Provincial Project New Services ( models ) for HNHB Share success stories Opportunity to ask Questions
What are responsive behaviours? Repetitive Sentences Verbally Aggressive Hurting Others Hiding Objects Verbal Complaints Agitation Sounds that are Disruptive to Others Physically Aggressive Verbal Mutterings Constant Requests for Attention Wandering Pacing Disrobing Hitting Swearing Throwing Objects Hurting Self Repetitive Behaviour Accusing Behaviours Have Meaning
Provincial BSO Project BSO Population: Older adults Cognitive impairments due to: age-related dementia mental health addiction other neurological conditions Responsive or challenging behaviour Collaboration Between: Ontario s LHINs Alzheimer Society of Ontario Health Quality Ontario (HQO) Ministry of Health and Long- Term Care (Ministry)
BSO Framework I am who I am, so help me continue to be me (Value Statement) Goals: Quality of Care & Quality of Life Focus: not on new resources but rather on determining how all resources new & existing can be realigned to better service our clients Source: BSO Kick off Presentation August 2011
Framework Principles Overarching principle: Person & Caregiver-directed Care Everyone is treated with respect & accepted as one is Person & caregiver/family/supports are driving partners in care decisions Respect & trust characterize relationships Supporting Principles: Behaviour is communication Diversity Collaborative care Safety System coordination & integration Accountability and sustainability
HNHB BSO Centralized by Hub (Regions of HNHB LHIN) BSO LTCH Mobile Team
HNHB BSO Improvement Plans 8
One Place to Call HNHB Community Care Access Centre (CCAC) 310-CCAC or 1-800-810-0000 Information & referral (clients, caregivers, providers) Warm Connection to supports (transition or hand-over) What does it mean for you? One place to call & No wrong door Easier navigation of the system Connected to service / support ( Lead agency) Risk assessment of your or the situation Reduce calls, frustration & stress 9
Lynn s Experience Lynn s friends at the Senior s Centre encouraged her to call CCAC She was upset, scared and worried about her husband (Lloyd) Lynn spoke with Tessa (CCAC staff) about Lloyd s needs during the day & recent changes in his behaviour, where he has been: showing some aggressive behaviour increasingly mixing up days and nights wandered out of the house in the middle of the night Lynn s worried about leaving Lloyd alone, recent changes and potential risks.
How CCAC Connected Lynn Lynn s Concerns: not knowing where/who she should be calling questioning herself about what support she may need what Lloyd will need now and later in the future how to go about getting assistance Assessing needs and Identifying potential community services: Tessa provided time for Lynn to express her feelings and concerns Lynn was happy and felt much better that she could discuss her situation with a live individual Lynn felt Tessa was confident and very knowledgeable in working through what she needed.
How CCAC Connected Lynn Tessa determined the couple could benefit from the BSO services She identified the Alzheimer Society as a Lead to coordinate care Tessa teleconferenced Tom (Alzheimer Society) into the call (active referral) Together, all three discussed Lloyd s needs, planning for education and caregiver relief (warm transfer) Outcome: After the call, Tessa developed a report for community resources tailored to Lloyd and Lynn s needs and mailed it to their home CCAC brochure was included should Lynn feel she needs services in the future
How does the Lead role improve the supports for BSO clients / caregivers? Agency A ICL Agency C Client Primary Care Agency C Client Primary Care Agency B Hospital s Hospitals Agency B 13
Lead Role to Support Clients in the Community Clients only need to call one person (Single Point of Contact) Lead person coordinates supports Reduce multiple assessments Sharing among agencies What does it mean for you? Help to navigate the system Early identification of issues Planning for potential problems You will know who to call Lead knows client s journey / history 14
Karen s Story Widowed female, living alone. Cognitive impairment / confusion Socially isolated except one friend Friend is the caregiver & burning out quickly Refused: Agency staff into home (hung up on them) Intervention by community agencies To attend family physician s office for appointment Agency manages to complete a home visit and finds significant risk: Hoarding Utilities cut off due to non-payment Karen not eating Weight loss Not completing hygiene tasks.
Karen s Story The agency becomes the Lead organization to coordinate the care for Karen One staff member is functioning as Karen s Lead (or ICL) Case conference with community agencies Previously unaware of Karen s dire situation Outcome: Plan to address risks & arrange appropriate community services The Lead staff member connects with family physician to discuss concerns Facilitates referral to geriatric outreach Decision made that LTC is required Team of services coordinated to support client safely in community while she waits for a bed offer Support to caregiver provided
BSO Community Outreach Team Just in Time Care (Crisis) (BSOCOT) Geriatric mental health expertise Care for clients in crisis What does it mean for you? What is a Crisis? Sudden increase in a behaviour Increased risk to self / others Distress where client refuses services / treatment The sudden start of responsive behaviour (like wandering) Support through crisis to link you or your family with longer-term supports (Lead) Transfer information Hands-on assessments & practical supports for you Reduce potential for future crisis (tips & planning) 17
The Story of Lucy & her Caregiver, Joanne Joanne is Lucy s caregiver, who is experiencing severe stress caring for Lucy Lucy s confusion and memory loss resulted in episodes of verbal aggression Lucy used to enjoy daily walks for many years, but in the last 6 months she would get lost weekly (strangers brought her home) Lucy had become fearful of showering independently and has stopped eating properly unless food was left on the table Lucy felt lonely, overwhelmed & frustrated by her inability to care for herself Joanne has also been balancing 12-hour shift work, attending school and raising a son with special needs
The Story of Lucy & her Caregiver, Joanne Joanne required: Community supports & knowledge of resources for both Lucy and herself Knowledge about dementia Understanding how to deal with Lucy s cognitive impairments as Joanne would show frustration towards Lucy at times Lucy requires: A professional for a complete cognitive assessment Coordination of supports to improve her quality of life
The Story of Lucy & her Caregiver, Joanne The BSO Community Team: Referral from CCAC (BSO Connect) Completes Lucy s cognitive assessment Assesses the needs for both Lucy & Joanne Interventions by the Team: Referral to CCAC for services Respite companion 2 times a week Education for the Joanne on resources, dementia, approaches for Lucy and information on the type of meals to prepare
The Story of Lucy & her Caregiver, Joanne Outcomes: Lucy has: been referred to CCAC and will be receiving assistance with bathing weekly arrangements for an Adult Day Program in her community twice a week. walked twice a week with the assistance of a Respite Companion eaten 3 meals a day has not been exhibiting any responsive behaviours due to frustration and loneliness in the last month Joanne has: been given the tools to communicate and guide Lucy, and uses them daily 2 days a week to do things for self reported 90% decrease in anxiety & stress been actively involved in practicing redirecting techniques with client (daily) reported no incidents in the last month
Scheduled & Episodic Care Escalating Behaviours Transitions LTCH BSO Mobile Team 41 staff (RPNs, PSWs, RN leads) 22 5 Hubs
Modeling & Hands-On Peer-to-Peer support Support LTCH staff with assessments or tools Work with LTCH staff to develop & implement care plans Increase knowledge & capacity Partner with LTCH & other outreach services What does it mean for you? New strategies & approaches to reduce your loved-one s behaviours You can share the resident s interests, likes, life-style, history You can learn along side of the PSWs or other LTCH staff You can bring items in to assist with meaningful activities You may have the key to help reduce the behaviours (You know your loved-one best) 23
Judy s Story: Transitioning from Acute Care to Long-Term Care BSO LTCH Mobile received referral a month prior to transition Potential for behavioural escalation regarding admission to LTC identified Retired school teacher Diagnosis of Alzehimer s disease Admitted to hospital due to changes in behaviour Increase falls, confusion / delirium Known history of wandering & exit seeking in late afternoon/evening Prior to seeing Judy, BSO LTCH mobile staff: Reviewed her chart Interviewed various staff (allied health, nursing, support staff) Observed Judy Learned more about Judy s social context
Judy s Story: Transitioning from Acute Care to Long-Term Care Interventions by BSO LTCH Mobile staff: Visited resident 2 times per week prior to admission to LTCH Music therapy Reading/marking school papers Newspaper reading Decorating front entrance to minimize visual cue of exit Signage to help her navigate the unit Impact on Judy pre-transition: Activities were successful Particularly noticeable improvements with music Singing along to music Instant change in behaviour More relaxed Efforts to exit seek diminished
Judy s Story: Transitioning from Acute Care to Long-Term Care Judy s transition day: PSW met Judy at front door of LTC with admissions co-ordinator Judy was happy to see a familiar face on arrival PSW spent the day, helping Judy adjust to the new environment Visited 3 times during first week Way-finding signage Reorientation letters Judy s background shared with staff Liaised with the social worker to share additional information Outcome: Successful transition to LTC Potentially averted increase in behaviours related to medications Although she still exit seeks, LTCH staff follow BSO interventions which settle Judy & she is more easily re-directed.
Betty s Story: Transitioning from Community to Long-Term Care BSO LTCH Mobile received referral January15 th, for admission on 16 th Request for BSO support from LTCH administrator Potential for behavioural escalation in transition to LTC, with history of: Not caring for self (failure to thrive) Wandering Unsafe practices in home (stove) Incapable of making shelter decisions Betty was moving from her assisted living environment to LTC No longer able to safely care for self at home Resistant to moving to LTC
Betty s Story: Transitioning from Community to Long-Term Care BSO LTC Mobile staff assisted with admission: Met Betty at front door of LTC with admissions co-ordinator Accompanied resident to home area Assisted resident with settling in Developed recommendations based on her routine at home (woke up at 9:30): Shower in evenings Woke up later in the morning Gradual process to get ready Tea when dressed Coached & modelled approaches to care to front line staff: Helping the LTCH to use resident-centred approaches To assist with activities of daily living softer interventions
Betty s Story: Transitioning from Community to Long-Term Care Outcome: Successful transition to LTC BSO involved in 11 visits post admission Interventions & recommendations effective No behavioural escalations post admission
HNHB BSO Improvement Plans 30
BSO Questions?