Supporting Residents Expressing Responsive Behaviours at Home, Hospital, and LTC HNHB LHIN Behavioural Supports Ontario Strategy Family Council Network Four (FCN-4) Regional Meeting June 29, 2017
Objectives Background on BSO Strategy in HNHB LHIN and client population Discuss how BSO models support individuals across care settings Share case stories from the Team Review how BSO Strategy is building LTC Champions Share program data Q & A
BSO Provincial Framework Older people (& their caregivers) with cognitive impairments due to mental health problems, addictions, dementia, or other neurological conditions that exhibit, or are at risk of exhibiting, responsive behaviours Goals: Quality of Care & Quality of Life Source: BSO Kick off Presentation August 2011
Seniors with dementia are intensive users of health-care resources People with dementia are: Twice as likely to be hospitalized compared to seniors without the disease Twice as likely to visit emergency departments for potentially preventable conditions More than twice as likely to have alternate level of care days when hospitalized Nearly three times more likely to experience fall-related emergency room visits Gill, et al. (2011). Health System Use by Frail Ontario Seniors. Institute for Clinical Evaluative Sciences.
Dementia Dementia is an umbrella term for many brain disorders. Changes in a person s behaviour can be an indicator. Dementia affects everyone differently, but it commonly diminishes these abilities: Language Recognition Memory (including knowledge of the disease) Purposeful movement Sensory perception Reasoning
The Dementia Experience We cannot understand the experience of a person with dementia, but what we do know is that it can cause changes in memory, judgement, attention, mood, communication and language, and can significantly interfere with the person s ability to do the things that matter to them and bring their life meaning
Normal Aging Dementia Presence of Responsive Behaviours
What do Responsive Behaviours look like? Verbally Responsive Repetitive Sentences Sounds that are Disruptive to Others Verbal Mutterings Wandering Disrobing Agitation Pacing Verbal Complaints Physically responsive Hurting Self Swearing Throwing Objects Hurting Others Repetitive Behaviour Constant Requests for Attention Hitting Accusing Hiding Objects Behaviours Have Meaning
What do Responsive Behaviours often indicate? a) an unmet need in a person, whether cognitive, physical, emotional, social, environmental or other b) a response to circumstances within the social or physical environment that may be frustrating, frightening or confusing to a person. Behaviours Have Meaning
Dementia and its link to Responsive Behaviours The most common trigger for the onset of responsive behaviours in anyone with a cognitive impairment is change in environment, including staff changes. As such, how Transitions are managed is essential to the quality of care and outcomes for individuals with cognitive impairment. Margallo-Lana, M., Swann, A., O'Brien, J., Fairbairn, A., Reichelt, K., Potkins, D., & Ballard, C. (2001). Prevalence and pharmacological management of behavioural and psychological symptoms amongst dementia sufferers living in care environments. International Journal of Geriatric Psychiatry, 16, 39 44. doi: 10.1002/1099-1166(200101)16:1<39::AID- GPS269>3.0.CO;2-F
Journey across the BSO continuum of care BSO Connect Hospital Clinical Leads Community Outreach LTC Mobile Transitional Leads
Background of Funding MOHLTC news release on August 18, 2016 announcing $10 million in new annual funding for Behavioural Supports Ontario The HNHB LHIN allocation is $1.1 M: Long-Term Care: 0.7 M Community/Hospital Sector: $0.3 M Stabilization Funding (existing resources): $0.1 M
HNHB LHIN Geographical Region 4 COT workers 2 COT workers 2 Clinical Leaders BSO Funded Positions: 55 LTC Mobile Staff and Managers 13 COT staff and Manager 1 RH Responsive Behaviour Specialist 1 Connect staff 4 Clinical Leaders (serving 17 hospital sites) 1 Coordinator 1 Strategic Lead 2 COT workers 1RH RB Specialist 1 Clinical Leader 1 COT worker 3 COT workers 1 Clinical Leader
BSO Connect Program Objectives To provide a singular point of entry for clients, caregivers, and providers to access services To warmly connect clients to services To complete the feedback loop so clients do not fall through cracks Within I&R Department at HNHB LHIN 15
BSO Community Outreach Team Program Objectives Provide just in time care for clients and their families in community Educate caregivers (formal and informal) on triggers of behaviour and associated coping strategies Reduce inappropriate emergency visits Improve capacity within the host mental health mobile outreach teams 16
BSO LTC Transitional Leads Program Objectives Supports future residents on crisis list in community and at high risk for a challenging transition into LTC Work with Community, Primary & Specialty care providers to stabilize individual as they wait for LTC bed offer Transitional Lead works with community, primary care, and specialist care providers Pre-admission meetings with LTC Homes and provide a Transitional Care Plan Support resident and LTC home staff well past admission Transitional Care Plan developed and shared with LTC Homes 17
BSO LTC Transitional Leads In action Case study example 18
BSO LTC Mobile Team- Program Objectives Collaborating with LTC Provide behaviour assessment Identify triggers and strategies Coach and model with staff Supporting Transitions & Episodic Provision of transitional support to/from LTC for low to moderate risk transitions Provision of episodic support as needed
BSO LTC Mobile Team In action Case study example 20
BSO Clinical Leaders Program Objectives Consult with hospital inpatients who have cognitive impairment and responsive behaviours Collaborate with the patient/family and the hospital team to: Understand the triggers of the responsive behaviours and develop personalized strategies to manage Share information between hospital, LTC and community to develop plans Educate hospital staff on population and their unique care needs
BSO Hospital Clinical Leads In action Case study example 22
How BSO Teams work together Community, LTC and Hospital teams coming together in news ways Educational opportunities for shared learning Team meetings provide opportunity for creative problem solving Goal is to ensure the BSO client s story and effective behaviour strategies follow along with them on their healthcare journey
How do BSO Teams collaborate with LTC Homes All BSO LTC programs collaborate regularly through formal and informal ways Coaching and modelling in peer to peer model Shift Huddles on the unit Responsive Behaviour (or similar) committees Leadership/Management attend LHIN-LTC meetings BSO Transitional lead program was developed with LTC stakeholders BSO Transitional Lead Oversight Committee
How is BSO Strategy building knowledgeable care teams? Unused BSO funds are directed toward education and training Since BSO began, LTC staff have been offered numerous education sessions to improve their knowledge and skills
BSO Enhanced Funding: Education Plan 2016-17 August 2016: Enhanced BSO funding announced Stakeholder consultation, development & recruitment January to March 2017: New positions filled Unspent staffing dollars allocated for education to support the BSO population. Must be spent by March 31 st, 2017
A multi-faceted approach to educating our teams and colleagues across sectors CORE COMPETENCIES Long-Term Care Appointment of 1-2 Behavioural Champions within LTCHs 5 days training offered to Leads Opportunities to send additional team members to training sessions Community Two full-day sessions targeted to front-line care providers Opportunities to send additional team members to training sessions Training of Mental Health First Aid for Seniors Coaches BSO Staff 5 day Mental Health Recovery Care Program 1 day collaborative learning event for staff members from all BSO teams, PRCs and ICMs Standardized patient experiential learning sessions Hospital Four P.I.E.C.E.S. sessions planned in hospitals LHIN-wide U-First available for PSWs and Aides
Report on Education Plan 2016-17 A total of 63 education sessions delivered after funding announcement (a total of 1150 participants: LTC and Community) 773 LTC Sector RNs, RPNs, PSWs & Allied Health attended training (not unique number as some attended more than one training session) 87% of LTCHs (75/86) assigned 1 to 2 Behavioural Leads/Champions for a total of 120 unique staff PIECES, Montessori Methods, Pain Assessment training, GPA, U-First, and other sessions devoted to supporting residents with responsive behaviours
LTC Behavioural Leads/Champions A Community of Practice will be one method to keep the training alive for LTC Behavioural Champions 87% of LTCHs (75/86) assigned 1 to 2 Behavioural Leads/Champions for a total of 120 unique staff
Sustainability LTCH leadership have been informed of their responsibilities re: Behavioural Champions(s); Behavioural Champions are aware of the expectations in role A Community of Practice will be formed based upon the Provincial BSO Knowledge to Practice Process Framework. Members will include: Behavioural Champions/Leads PRCs Geriatric Outreach Teams BSO Transitional Leads BSO LTC Mobile Team members BSO Clinical Leaders BSO Responsive Behaviour Specialist (Retirement Homes)
BSO Program Data: Long-Term Care Mobile Team # of family members supported: July-September 2016 : 631 October-December 2016: 471 January-March 2017: 375 The external team provides a great resource to the Home as the Mobile Team are dedicated to what they do, and are well trained and versed in managing and responding to behaviours. Laura, RN, Parkview Nursing Centre, Hamilton
BSO Program Data: Hospital Clinical Leader Program [The BSO Clinical Leader] worked to know Edward as a human being his background, interests, and needs the whole process was so well done. [Her] involvement has made a phenomenal difference. - Beatrice, Spouse of patient served by BSO Clinical Leader Between April 2016 March 2017: 21 patients were diverted from more highly-resourced care settings and safely discharged to lesser resourced settings. 607 hospital staff received formal education about supporting patients who are BSO clients
BSO Program Data: Hospital Clinical Leader Program Total of all HNHB LHIN Hospital Sites Average number of ALC days per patient with behaviours 2014-15 (Pre- BSO Clinical Leader Program) 2015-16 ( 1 Year Post-BSO Clinical Leader Program Implementation) 46.2 days 31.2 days ( 32.5%) 2016-17 (2 Years Post- BSO Clinical Leader Program Implementation) 22.8 days ( 26.9%)
Opportunities for Collaboration with Family Councils Residents and their families are at the centre of what we do! Let s work together: Education to Family Councils Shared brainstorming on how to best support residents and families
QUESTIONS I am who I am, so help me continue to be me
Feedback from LTC providers Over time I have seen BSO staff being increasingly collaborative offering compliments and suggestions re: ways to enhance the brain storming and success of behaviour strategies. They are very supportive, flexible and they sit on some of our committees. They are a valuable part of our team. The RPN who attends our home is great and realistic Long term care mobile team is extremely helpful for the hospital. Communicate well with the team and give some great suggestions to manage behaviour