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? Verbal Complaints Verbally Responsive Physically responsive Agitation Pacing Repetitive Sentences Accusing Hurting Self Sounds that are Disruptive to Others Swearing Verbal Mutterings Throwing Objects Hurting Others Wandering Repetitive Behaviour Constant Requests for Attention Disrobing Hiding Objects Hitting Be ha vio urs Ha ve Me a ning
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. Beh ehaviours Ha Have Mea 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 Community Clinical Outreach Leads LTC Transitional Leads Mobile
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 BSO Funded Positions: 55 LTC Mobile Staff and Managers 13 COT staff and Manager 1 RH Responsive Behaviour Specialist 1 Connect staff 2 COT workers 4 Clinical Leaders (serving 17 hospital sites) 1 Coordinator 4 COT workers 2 Clinical Leaders 1 Strategic Lead 1RH RB Specialist 3 COT workers 1 Clinical Leader 2 COT workers 1 Clinical Leader 1 COT worker
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 & Transitional Lead works with community , primary care, and Specialty care providers to stabilize specialist care providers individual as they wait for LTC bed offer • Pre-admission meetings with LTC Homes and provide a Transitional Care Plan • Support resident and LTC home staff well Transitional Care Plan developed and shared past admission 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 Stakeholder August 2016: January to March consultation, Enhanced BSO 2017: New positions development & funding announced filled recruitment 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 Long-Term Care Community Hospital CORE COMPETENCIES • Appointment of 1-2 Behavioural • Two full-day sessions targeted to • Four P.I.E.C.E.S. Champions within LTCHs front-line care providers sessions planned in • 5 days’ training offered to • Opportunities to send additional hospitals LHIN-wide Leads team members to training sessions • U-First available for • Training of Mental Health First Aid • Opportunities to send additional PSWs and Aides for Seniors Coaches team members to training sessions 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 •
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
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