Dana Vladescu, Director, Clinical Services Alzheimer Society of Brant, Haldimand Norfolk, Hamilton Halton May 29 th , 2017
For individuals and families at the time of diagnosis and throughout the course of the disease LEARN more about the disease and living well CONN NNEC ECT with others in similar situations ENGAGE AGE through meaningful activities
Intake and Referral Support and Counselling Education Psychogeriatric Resource Consultants BSO-Community Outreach Team
Phone: 905 529 7030 Fax: 905 529 3787 On line referral form: https://www.alzhn.ca/our-services/first-link- referral-form/
For people with dementia and/or carers Intake Coordinator Hamilton ◦ Dawn Claus ◦ intake@alzhh.ca
Developed to meet the needs of people whose lives have been affected by Alzheimer’s disease and related dementias. Our Counsellors provide telephone, in-office or in-home assessments and work with all those involved to develop an individualized response to their needs This program also offers: ◦ Dementia-related individual and family support ◦ Case conferencing ◦ Advocacy ◦ Information about and referrals to community resources
Next First Steps Steps (for the person newly diagnosed + carer) (early-mid stage) Disease Progression Care Essentials (middle stage) Options for Care (LTC) Care in the Later Stages (end of life)
Over 50 PRCs across Ontario, funded by the MOH & LTC Hosted by local hospitals/organizations In Hamilton, the employer is the Alzheimer Society; 2 PRCs located at the Hamilton office of the HNHB LHIN (next to Placement Services) Their focus is on persons with Alzheimer’s Disease or related dementias who exhibit responsive behaviours The clients are the Formal Care Providers of this population
The PRC provides education & consultation to formal care providers of the target population, including regulated & unregulated health care providers: ◦ Staff of Long-term Care homes ◦ Care Coordinators of HNHB LHIN & their contracted agencies ◦ Adult Day Programs ◦ Community Support Agencies e.g. Alzheimer Society, Good Shepherd, Wesley Urban Ministries etc. The PRC is not: ◦ A direct service provider ◦ A case manager ◦ An emergency response service
In-person or phone consultations Home visits with contracted agency staff/supervisor Follow-up education to agency staff as needed
This program is offered in collaboration with the local mental health crisis team The BSO COT staff are not only trained in person-centered care, gentle persuasive approaches but also have specialized training in the management of responsive behaviours. 13
HNHB BSO – Centra rali lize zed by Hub (Regions of HNHB LHIN)
BSO O Pop opulat ulation: ion: Older adults Cognitive impairments due to age-related dementia, mental health, addiction and other neurological conditions Responsive or challenging behaviour Crisis isis: A sudden increase in an individual’s behaviour Increased risk to self or others Distress due to refusal of services or treatment Sudden onset of responsive behaviour ie: wandering, verbally responsive, physically responsive etc. 15
Enhance existing community crisis systems BSO staff working together with the existing crisis teams Clients supported with strategies until transitioned from crisis to longer term supports Reduce escalation of crisis May be first intersection with health care system 16
◦ Respond to crisis situations in the community within 24 to 48 hours ◦ Consult with community partners around situations involving older adults with responsive behaviour ◦ Share information with client consent or within circle of care ◦ Support with transitions (community-hospital and vice- versa ). We do not transport client’s to LTC, there is a separate team for this. We will however support and educate family on approaches to try ◦ Bridge community support while client is on the LTCH wait list ◦ Ensure proactive, contingency planning to help reduce potential crises ◦ Advocate for client and navigate client care 17
For BSO clients who are displaying responsive behaviours staff makes a referral to BSO COT through COAST BSO COT will follow-up with family or friends to assess client and obtain background information Perform cognitive assessments Educate on interventions at home Facilitate referral to geriatrician/specialist Education provided to Caregiver Recommendations provided to referral source, GP, or other involved parties.
BSO Community Outreach Team (BSO COT): Accessing Crisis Services for Responsive Behaviours For Information and to Make a Referral Call: Hamilton (COAST) 905-972-8338 Niagara (COAST) 1-866-550-5205 Haldimand Norfolk (CAST) 1-866-487-2278 Brantford (St. Leonard’s ) 519-759-7188 or 1- 866-811-7188 Burlington (COAST Halton) 1-877-825-9011 19
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