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INSIDE: Dementia | Medication safety | Innovation grants | De-stress bathing

September 2017 Edition

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Choosing wisely: Up to 30 per cent of healthcare offers no clinical value to patients

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September 2017

12

Cover story: Choosing wisely

Innovation grants

Medication review

6

Dementia: A challenge for all

8

26

De-stress bathing

18

4 Editor’s Note 11 Medication safety 14 Role of private sector 15 Early predictors of dementia 22 Overcoming clutter 24 Fall prevention 28 Depression and dementia 30 Infoway conference 31 The challenge of self-care

Music care

21

Cushioning the impact of dementia

20

Is Canada a caring society?

23


Welcome to your new Home and

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Long Term Care News! W hile some of the changes we have made are obvious (new larger size and a slight adjustment to our name), some of them aren’t. Beginning with this issue we have expanded distribution to include the more than 3000 long-term care facilities across Canada. Why? Canada’s demographics are rapidly changing. For the first time in census history, in 2016, there were more seniors living in Canada than children. That means our healthcare system is in the midst of a major transition to meet the needs of an aging population. This new format will include articles and information on issues that are relevant to anyone who provides care or works in home or long-term care. The unpaid family caregivers who are helping their loved ones to stay at home, the health professionals who provide care both in the home and in the long-term care facilities and managers and policy-makers will all find valuable information here. This month’s cover story focuses on wasted healthcare dollars and resources. A clinician-led campaign called Choosing Wisely is working with doctors, patients and health associations to reduce the 30 per cent of healthcare that offers no clinical value to patients. In this article you will find their six recommendations on how clinicians and the long-term community can ensure patients receive high quality care and avoid overuse. In an effort to ease the burden of an aging population on an already over-stretched health system, The Centre for Aging + Brain Health Innovation is offering grants of up to $50,000 for innovations that will allow older adults to age more comfortably in the setting of their choice. For more information on this grant program please see page six. In this issue, you will also find articles on the importance of medication safety/regular medication re-

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Kristie Jones

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Denise Hodgson

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distributionteam@mediaclassified.ca views and the integral role they play in patient safety in the home and long-term care setting. If you have experienced difficulty in bathing a patient living with dementia, there is an article highlighting what one facility has implemented to help resolve that issue. The articles you find in this magazine feature real-life solutions to issues and challenges that are experienced on the front-lines of home and long-term care. In Cushioning the impact of dementia on page 20 – a simple but highly effective solution was found when one of the residents living with dementia began removing everything from the walls. As we work to provide exceptional care to patients/ residents and loved ones, we need to celebrate the triumphs and learn from the setbacks. It is our goal that the pages of Home & Long Term Care will provide you with a forum to share your successes and innovations so that patients from all over the country can reap the benefits. If you have something to share please don’t hesitate H to email me at editor@longtermcarenews.ca ■

Kristie Jones Editor, Home and Long Term Care News

4 Home and LongTerm Care News September 2017

UPCOMING DEADLINES OCTOBER 2017 ISSUE

EDITORIAL: September 11 ADVERTISING: Booking and Material – September 19

NOVEMBER 2017 ISSUE EDITORIAL: October 9 ADVERTISING: Booking and Material – October 17 Home and Long Term Care News is published for consumers who are supporting and/or involved in home care or long term care. It is available free of charge from distribution racks in hospitals across Ontario. The statements, opinions and viewpoints made or expressed by the writers do not necessarily represent the opinions and views of Home and Long Term Care News, or the publishers. Home and Long Term Care News and Members of the Advisory Board assume no responsibility or liability for claims, statements, opinions or views, written or reported by its contributing writers, including product or service information that is advertised. Changes of address, notices, subscription orders and undeliverable address notifications, and inquiries can be sent to: info@longtermcarenews.ca Subscription rates in Canada for single copies is $35.00 per year. Canadian Publications mail sales product agreement number 40065412. From the publishers off Hospital News, reporting on health care news and best practices for over 30 years.

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NEWS

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As you get older, your immune response to influenza vaccines decreases. FLUZONE® High-Dose improves your immune response to influenza (also known as the flu) and has demonstrated better protection of adults over 65 against the flu than our standard dose flu vaccine. In fact, FLUZONE® High-Dose vaccine is significantly more effective than our standard dose vaccine in preventing the flu – 24.2% more effective.

For more information, visit www.fluhd.ca FLUZONE® High-Dose is a vaccine used to prevent influenza in adults 65 years of age and older. Influenza (or flu) is an infection caused by the influenza virus. Annual vaccination using the current vaccine is recommended for prevention against influenza as immunity declines in the year following vaccination. Persons with a history of severe allergic reaction to eggs or egg products or any component of FLUZONE® High-Dose should not receive the vaccine. FLUZONE® High-Dose will only protect against the strains of influenza virus contained in the vaccine or those that are closely related. FLUZONE® HighDose will not protect against any other strains of influenza virus. FLUZONE® High-Dose is not indicated for the prevention of hospitalization or death after the onset of disease. As with all vaccines, FLUZONE® High-Dose does not protect 100% of people immunized. Allergic reactions can occur. The most common side effects are pain at the injection site and muscle ache. Contact your healthcare provider to see if this vaccine is right for you. For more information, visit www.sanofipasteur.ca. FLUZONE® is a trademark of Sanofi Pasteur. Sanofi Pasteur 1755 Steeles Avenue West, Toronto, Ontario M2R 3T4 © 2016 Sanofi Pasteur Limited. All rights reserved. DIN : 02445646 372-012c E 09/16

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September 2017 Home and LongTerm Care News 5


NEWS

You can receive up to $50,000 to fund your healthcare innovation By David Stoller

I

t is no secret that the world’s population is getting older. According to Statistics Canada, seniors are projected to outnumber children by 2017 – a never before reached milestone for Canada. As the population ages, governments are struggling to balance the needs of the current generation of seniors, in addition to the demands of the up-and-coming senior’s generation and the impact of rising healthcare costs. According to the Conference Board of Canada, by 2026 an estimated 2.4 million Canadians

aged 65 years and older will need continuing care – a 71 per cent increase since 2011. As older adults age, it is understandable that they will want to maintain their ability to live independently, despite having healthcare conditions that need to be monitored by family members and clinicians. This situation creates an opportunity for innovative solutions that provide older adults with the ability to maintain their independence while remaining connected to their healthcare providers and caregivers.

THE CENTRE FOR AGING + BRAIN HEALTH INNOVATION

Enter the Centre for Aging + Brain Health Innovation (CABHI). Established in 2015, CABHI is the result of the largest investment in aging and brain health in Canadian history, with a total investment of approximately $123.5 million (CAD) from key funding groups, including: The Government of Canada’s Public Health Agency of Canada; the Government of Ontario’s Ministry of Research, Innovation and Science; the Baycrest Foundation; and other health system partners. CABHI represents a unique collaboration of more than 40 leading industry, academic, public sector and notfor-profit partners who are focused on bringing innovative products and solutions to the senior’s healthcare space. CABHI’s objective is to ease the burden of an aging population by supporting the development of innovations that will allow older adults to age more comfortably in the setting of their choice. In addition, these new innovations are also meant to support the efforts of healthcare workers and family members who often encounter the challenges of caring for older adults suffering from cognitive decline.

THE SPARK PROGRAM

Healthcare workers, particularly those who operate at the point-of-care, are often well-suited to contribute to the innovation process because they are the ones who witness many aging related challenges every day. Point-ofcare practitioners bear witness to the loss of independence that can accompany cognitive decline as older adults age, which is reflected through an individual’s inability to perform basic daily tasks, the development of responsive behaviours that make people more difficult to care for, or the development of social isolation.

CABHI recognizes that the exposure point-of-care workers have to aging and brain health issues enables them to develop some of the most impactful healthcare innovations that address leading challenges for today’s aging adults, and the caregivers who support them. As a result, CABHI introduced the Spark Program in 2016, which offers up to $50,000 (CAD) in per project funding to support the development of early-stage innovations with the potential to drive forward solutions in the field of aging and brain health. The innovations supported through the Spark Program have been conceptualized by point-of-care staff and/ or service delivery staff involved with healthcare delivery for older adults – precisely those individuals who have great ideas but need help moving them from the idea stage into working prototypes for testing and validation. September 2016 marked the first iteration of Spark, and CABHI will be accepting applications for the next Spark Program from Septemer 14-28, 2017. Below are some of the innovations currently being funded thanks to Spark funding by CABHI.

DEMENTIA TALK APP

With Canada’s aging population and increasing number of dementia cases, caregivers are in need of practical and effective solutions to help guide them in managing care. Many caregivers encounter difficulties with respect to tracking and communicating the challenges they face to care providers and /or their family doctor, contributing further to the sense of loneliness that is often associated with caregiving. Led by Einat Danieli, and hosted through the Sinai Health System in Toronto, Dementia Talk App is an award-winning smartphone application designed to empower dementia caregivers in tracking and managing challenging behaviours and in en-

Left: A senior uses virtual reality technology at CABHI’s innovation showcase in June. 6 Home and LongTerm Care News September 2017

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NEWS hancing their communication with other care providers in the circle of care. Thanks to Spark funding, this project will support the development of the technology through the addition of a new suite of features and format compatibilities, and eventually, involve beta testing of the application in a clinical setting.

VIRTUAL REALITY TRAINING PROGRAM: A HOME-BASED, INNOVATIVE SOLUTION FOR IMPROVING COGNITIVE AND PHYSICAL FUNCTION

In an effort to improve the experience of aging at home, an innovative home-based virtual reality (VR) exercise program has been developed and is now being supported by Spark funding from CABHI. Led by Dr. Hillel Finestone, and hosted at the Bruyère Continuing Care facility in Ottawa, this VR training uses computer software to track the user’s movements, allowing them to interact

with a game or activity presented on a TV screen. Activities will focus on balance, arm and leg exercises, gentle aerobic conditioning, and cognition. For example, many of the physical games have cognitive and perceptual components (e.g. attention, hand-eye coordination, reaction time). VR is an enjoyable and interactive experience, and it may encourage individuals with Mild Cognitive Impairment to exercise more consistently and at a higher intensity. This project will test the feasibility of the VR program and assess its potential for maintaining and improving the physical and cognitive function of users.

AVOIDING HOSPITALIZATIONS FOR LONG-TERM CARE RESIDENTS: ©THE PREVIEW-ED ETOOL

Care Aides and Personal Support Workers comprise more than 70 percent of the staffing in long-term care (LTC) homes and are ideally positioned to notice subtle nuances in the

health status of a resident. Catherine Kohm and the Fraser Health Authority in Surrey, BC, have introduced PREVIEW-ED© – a tool that helps staff in LTC detect early health decline among residents related to four conditions. These conditions include: pneumonia, urinary tract infections, dehydration and congestive heart failure. This innovative solution measures the signs, symptoms, and severity of nine indicators using a simple scale to score each indicator, generating an aggregate score to quantify changes that have occurred. The Spark funding from CABHI is supporting the design, development and beta testing of an electronic version of the PREVIEW-ED© tool.

APPLY FOR FUNDING!

The Spark Program will be accepting applications beginning on September 14, 2017 and all point-of-care staff and/or service delivery staff are invited to submit their innovative ideas for consideration to this program before the window for applications closes on

September 28. Special consideration will be given to those solutions that offer innovations aligned with CABHI’s targeted challenges sets: • Aging in Place: solutions that enable older adults with dementia to maximize their choice, independence, and quality of life to enable aging in the most appropriate setting • Caregiver Support: solutions that support caregivers (formal and informal) in providing care to older adults with dementia • Care Coordination and Navigation: solutions that help older adults, caregivers and healthcare providers coordinate care and transitions for older adults with dementia • Cognitive Health: solutions focus on health promotion, prevention, early diagnostics, and slow progression of cognitive impairment for aging adults Don’t miss this opportunity to move your innovation forward! Visit www. cabhi.com for more information, or email info@cabhi.com to connect with a member of their team! LC

David Stoller is the Sr. Marketing Specialist at the Centre for Aging + Brain Health Innovation.

Innovation to Impact The Centre for Aging + Brain Health Innovation (CABHI) provides funding to support solution validation testing in the seniors care sector. Apply for up to $500,000 (CAD) to accelerate your innovation and help shape the future of healthy aging. To apply or to learn more about CABHI funding programs, email info@cabhi.com or visit cabhi.com.

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September 2017 Home and LongTerm Care News 7


NEWS

Dementia:

A challenge for all By Yves Joanette and Flamine Alary ver the last decade, many countries, including Canada, have felt the rising tide of dementia. The number of Canadians that live with dementia will more than double by 2050, whereas it will more than triple elsewhere in the world (World Alzheimer Report 2015, The Global Impact of Dementia: An analysis of prevalence, incidence, cost and trends. Alzheimer’s Disease International). Such an increase is essentially due to the aging of the population since the main risk factor for most of the brain disease causing dementia – such as Alzheimer’s disease – is age, and this risk increases significantly for the oldest. Given that increase in numbers of older individuals is particularly important for the oldest among the older, the conditions for a dramatic increase in the number of cases of dementia are with us for the coming years, here and globally. And each time one person is diagnosed with dementia, there is at least another person whose health and wellness can be affected, namely that person’s caregiver(s). Consequently, for the human cost associated with dementia, as well as for the paramount health costs expected – more than a trillion dollars world-wide in 2018 – dementia represents an important public health challenge that is now recognized as such by the World Health Organization. The magnitude of the challenge requires a major response from the research community in order to understand the causes of dementia, its treatment and risk reduction strategies, as well as to ensure the best quality of life for those currently living with dementia as well as their caregivers. The Canadian Institutes of Health Research’s (CIHR) Dementia Research Strategy was introduced to foster this effort in Canada. But the rising tide is not limited to Canada. The creation by the World Health Organization

O

(WHO) of a Global Dementia Observatory (GDO), the constitution of a WHO-led working group to prioritize the required research to face the global challenge of dementia. Research priorities to reduce the global burden of dementia by 2025. The Lancet Neurology, 15(12), 1285–1294), as well as

8 Home and LongTerm Care News September 2017

the initiation of work towards the development of a WHO Global Action Plan, constitute concrete examples of the world working together to tackle the challenge of dementia. In acting in a coordinated and determined way, Canada will not only enhance health and wellness in our Canadian aging

population, but we will contribute to creating another source of pride for a country that is looked upon as a small but bold leader in the world of public health. As a matter of fact, the Canadian community-based approach to dementia has been the object of a very interesting chapter in one of the latest www.longtermcarenews.ca


NEWS Alzheimer’s Diseases Annual Report, Improving healthcare for people living with dementia: Coverage, quality and costs now and in the future). The report underlines the involvement of community-based family practitioners in the diagnosis and management of individuals living with dementia, frequently living also with other chronic diseases. This of course underlines the challenge of the training of all health professionals in the community, including general practitioners. This topic, as well as the training of personal workers in support of individuals with dementia at home or in long-term care facilities represents a major challenge. For that reason, the CIHR Institute of Aging is considering to eventually support educational research on this question in order to better prepare all health professionals to face the challenge of the aging population and the surge of health conditions such as dementia.

IMPROVING DEMENTIA CARE AND SUPPORT REMAINS A TOP PRIORITY FOR CARE PROVIDERS AND THOSE AFFECTED BY THE DISEASE, ESPECIALLY WHILE NO CURE OR DISEASE-MODIFYING THERAPY IS AVAILABLE We also need to ensure that the care for individuals living with dementia, and their carers, is the best possible. Recently launched by the World Dementia Council (WDC), there is now a global care statement that can be taken as a reference to achieve this goal. As underlined by the WDC Chair (YJ): “Improving dementia care and support remains a top priority for care providers and those affected by the disease, especially while no cure or disease-modifying therapy is available. That is why WDC’s Global Care Statement is so important in specifying what needs

to be done to offer person-centered, high-quality care and support to everyone affected by what is undoubtedly the biggest health care challenge facing the world today.” The WDC Global Care Statement includes eight important Principles of High-Quality Care and Support, including for individuals to receive a timely and accurate dementia diagnosis; for people living with dementia to be treated with dignity and respect; for communities to be inclusive of people living with dementia and encourage their engagement in the community; for dementia care to be person and

relationship-centered and based upon continuous assessment and individualized planning; and for people living with dementia and their care partners to be active participants in care planning and decision making. The challenge of dementia is, and will, create immense challenges for all health professionals, as well as for long-term care facilities. Apart from providing the necessary knowledge and training to all health professionals and workers, there will obviously be a need to work across disciplines to ensure an holistic approach to disease management; and for care coordination and collaboration to occur between all care providers, including in monitoring and evaluating the care and support provided. Only under such conditions, will we be able not only to face the challenge of dementia, but to ensure wellness in the trajectory of those living with dementia and their caregivers. LC

Yves Joanette is Scientific Director, CIHR Institute of Aging, Lead CIHR Dementia Research Strategy Chair, World Dementia Council. Flamine Alary is Project Manager, CIHR Institute of Aging.

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Medication safety in long-term care By Jim Kong and Certina Ho edication safety is an essential component of medication use and has become a great benchmark for quality care in all sectors of healthcare. While healthcare services in the community and acute care settings receive much attention and awareness, long-term care (LTC) is a steadily growing industry that cannot be ignored. The current landscape of healthcare shows that, of the approximate five million seniors in Canada, 4.5 per cent reside in care facilities such as nursing homes, long-term care, and chronic care institutions. Moreover, advanced healthcare practices that have led to extended lifespans, along with the ever-rising numbers of aging baby boomers will likely create a significant strain for the already inundated LTC facilities in the near-future. A typical LTC resident is a frail, older adult, with multiple co-morbidities, declining physiologic function, and a complex medication regimen. Further substantiating the risk for medications errors is the multidisciplinary care model that residents receive in LTC facilities, many of which are challenged with time and resource constraints. This article attempts to take a look at two key aspects of medication safety in LTC.

M

ANTIMICROBIAL STEWARDSHIP

Suboptimal use of antimicrobials (including antibiotics) is a medication safety issue that is largely preventable. Infection outbreaks can be deadly in LTC settings due to both human and environmental-related factors. The

Hospital

Long-term Care

Conduct Medication Reviews

Conduct Medication Reconciliation

• E.g. Hospital pharmacists can perform a comprehensive medication review prior to discharging a patient so as to catch dosing errors or non-indicated medications.4

• E.g. A qualified healthcare professional (such as a nurse, pharmacist, or prescriber) should compare the discharge summary with the medications being ordered at the LTC facility and reconcile any discrepancies.4

Verify Accuracy of Discharge Plan and Discharge Prescription • E.g. Prescribers can co-sign discharge summaries to verify all information is correct.4 • E.g. Prescribers can provide complete orders for each medication; do not write “continue orders” on discharge summaries.4 Figure 1 combination of an aging, immunocompromised patient population with the staggered spacing of beds in healthcare facilities creates the perfect storm for opportunistic infections. Studies in LTC facilities have shown that common infections such as urinary tract, lower respiratory tract, and skin and soft tissue infections are responsible for 54 per cent of acute medical problems, 48 per cent of short-term hospitalizations, and 63 per cent of deaths. It becomes absolutely crucial for antibiotics to be appropriately prescribed, dispensed, and administered in order to mitigate collateral damage from compliance issues and potential adverse effects. A study conducted by Monette et al. demonstrated that an annual education campaign, even something as simple as an antibiotic guide, is an easy and cost-effective way to facilitate antimicrobial stewardship or improve antibiotic medication safety in LTC. Furthermore, clinical pharmacists can perform comprehensive medication

reviews (including the proper use of antibiotics), which will then add an extra layer of safety for LTC residents.

TRANSITION OF CARE

Transition of care is one of the three priority areas of the World Health Organization’s (WHO) third Global Patient Safety Challenge. The transition from hospital to LTC is a complex process fraught with potential medication errors. Erroneous continuation or omission of medications is common and can range from consequences of no harm to life-threatening. Further compounding this issue is the fact that hospital stays typically involve high-alert medications such as anticoagulants, opioids and injectables, and medical staff may not always be on-site at the LTC facility to conduct a comprehensive resident assessment immediately after admission of a new transfer. Statistics show that there is at least one medication discrepancy in 70 per cent of all hospital transfers to

LTC settings. The most common contributing factors to medication errors during this process are lack of communication across care settings, and mistakes during order transcription.4 The Institute for Safe Medication Practices (ISMP) recommends the strategies in figure 1 during transitions of care in order to reduce errors and mitigate patient harm.

CONCLUSION

Antimicrobial stewardship and transition of care are two common areas of concern in LTC patient/medication safety. Other vulnerabilities exist in different stages of the medication-use process, which includes prescribing, order entry or transcribing, dispensing, administration, and monitoring. It is through ongoing collaboration among healthcare professionals and mutual communication with patients and caregivers that a safer healthcare system and safe medication practices can be upheld and embraced. LC

Jim Kong is a Consultant Pharmacist at the Institute for Safe Medication Practices Canada (ISMP Canada); Certina Ho is a Project Lead at ISMP Canada. www.longtermcarenews.ca

September 2017 Home and LongTerm Care News 11


Up to 30 per cent of healthcare offers no clinical value to patients:

NEWS

The importance of choosing wisely By Karen Born & Patrick Quail linicians working in home and long-term care are at the front lines of a tide of change in healthcare. Seniors aged 85 and above are the fastest growing age group in Canada, and our hospital-centric healthcare system is not set up to meet the complex and ongoing health needs of seniors, and especially elderly seniors. Approximately 75-80 per cent of Canadian seniors have one or more chronic condition. We are faced daily with the challenge of providing high-quality, evidence-based and patient-centred health care. This can include demands from our colleagues, caregivers and patients for more – more medications, more testing, more procedures to try to improve our patients’ health. But sometimes in medicine, as in life, more is not always better. A recently-released report from the Canadian Institute of Health Information found that up to 30 per cent of all health care provided in Canada offers no clinical value to patients. Overuse and unnecessary care harms our patients, and is wasteful of healthcare system resources. For example, the report notes that one in 10 Canadian seniors are chronic users of benzodiazepines. Benzodiazepines are a powerful class of drugs intended for short-term use to manage insomnia or anxiety, but long-term use impairs thinking and mobility, leading to increased accidents and falls. While we prescribe drugs such as benzodiazepines to try to solve a medical problem, they can cause more problems and harm than good to our patients. A clinician-led campaign, Choosing Wisely Canada, is raising awareness among patients and the public

The list of recommendations highlights things that clinicians in longterm care and community can do to ensure that patients are receiving high quality care, and avoiding overuse.

C

RECOMMENDATION 1

Don’t send the frail resident of a nursing home to the hospital, unless their urgent comfort and medical needs cannot be met in their care home. This recommendation is based on research that many hospitalizations for seniors are avoidable and can harm more than heal. Hazards of hospitalization for frail elderly patients include delirium, hospital-acquired infections, lack of sleep and rapid deconditioning from being bedridden. If medical needs can be met in their care home, this is the best place for them to be. It is important for clinicians to respect patient and family choices, but also to have informed conversations with patients and caregivers about their goals, and the potential harms of hospitalization.

RECOMMENDATION 2

about the harms of unnecessary care and overuse. National clinician specialty societies have joined the campaign by releasing lists of recommendations of overused tests, treatments and procedures that are not supported by evidence. The campaign was launched in 2014 in Canada, and earlier this year the Long Term Care Medical Directors Association of Canada released their list of ‘Six Things Physicians and Patients Should Question’.

12 Home and LongTerm Care News September 2017

These recommendations are added to the over 230 recommendations released in Canada to date. Choosing Wisely is an international campaign, with over 20 countries worldwide having local campaigns and more are joining. The Long Term Care Medical Directors Association of Canada struck a small committee, which included a patient representative, and received feedback and approval of the list from association members and board.

Don’t use antipsychotics as a first choice to treat behavioral and psychological symptoms of dementia. Behavioral and psychological symptoms of dementia are often signs of an underlying problem for elderly patients. Rather than prescribing powerful medications to address the behaviors associated with dementia, treating the underlying cause can make these medications mostly unnecessary. Long-term use of antipsychotics can cause significant harm to patients.

RECOMMENDATION 3

Don’t do a urine dip or urine culture unless there are clear signs and symptoms of a urinary tract infection (UTI). www.longtermcarenews.ca


NEWS About one half of seniors residing in a nursing home will have bacteria in their urine. This is called colonization. But the presence of bacteria should not automatically mean they should take antibiotics. Antibiotics for patients who have no symptoms of a UTI increases risks of antibiotic associated diarrhea and C.difficile infections and contributes to the increases in antibiotic resistant bacteria which pose a significant harm to our current and future patients.

RECOMMENDATION 4

Donâ&#x20AC;&#x2122;t insert a feeding tube in individuals with advanced dementia. Instead, assist the resident to eat. Tube feeding in elderly patients has been shown to reduce rather than improve quality of life for elderly patients with advanced dementia. Tube feeding towards the end of life is associated with a host of harms, including risks of aspiration and aspiration pneumonia.

While assisted eating can be time consuming and more difficult, it is a safer way to feed patients than tube feeding.

RECOMMENDATION 5

Donâ&#x20AC;&#x2122;t continue or add long-term medications unless there is an appropriate indication and a reasonable expectation of benefit in the individual patient. The older Canadians are, the more medications they take. For seniors in long-term care facilities, the numbers continue to climb. But often multiple medications offer more harm than benefit as they can reduce quality of life and have harmful interactions. Before prescribing a medication to meet lab test targets that apply to adults living in the community, consider potential harms to the function, mobility and mortality of frail elderly seniors.

RECOMMENDATION 6

Donâ&#x20AC;&#x2122;t order screening or routine chronic disease testing just because

a blood draw is being done. Routine tests can cause more harm than good. If there is no treatment plan to enhance quality of life, routine tests in frail elderly patients are clinically useless. Especially as patients near the end of life, their care goals, quality of life and comfort are of paramount importance. The six items on this list reflect an overall message to clinicians who are dedicated to improving quality for elderly patients receiving care in the community and long-term care. As we continue to care for patients who have complex care needs, it is important to have conversations about the benefits, as well as harms of medical tests, treatments and interventions. Patients and caregivers do appreciate that more is not always better. Especially when clinicians take the time to have a conversation about expectations, hopes and fears during this time in their lives.

Having conversations with patients and using the recommendations from the Choosing Wisely Canada list for long-term care can help to guide expectations and ensure that quality of life, comfort, safety and dignity are prioritized. Choosing Wisely Canada has developed a list of 4 Questions for patients and caregivers to help get the conversation started. 1. Do I really need this test, treatment or procedure? 2. What are the downsides? 3. Are there simpler, safer options? 4. What happens if I do nothing? Long-term care physicians and medical directors are having the conversation with our colleagues and with patients about how more is not always better. We encourage you to join the conversation and help to improve quality and reduce harm for your patients. LC

Karen Born, PhD, is Knowledge Translation Lead, Choosing Wisely Canada, and Assistant Professor, Institute of Health Policy, Management & Evaluation. Paddy Quail, MD is President of the Long-Term Care Medical Directors Association of Canada, Medical Lead Supportive Living Alberta Health Services Calgary Zone and Medical Director Intercare Corporate Group Inc.

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Private sector must play key role to meet demands of our aging population By Michael Kary tatistics Canada census figures for 2016 revealed the country saw its greatest increase in the proportion of older adults. There are now 5.9 million seniors in Canada, compared to 5.8 million children 14 and under. As the latest Statistics Canada data suggests, if current trends continue, demand for residential care will only increase significantly in the future because the proportion of seniors living in care homes increases with age, and the number of elderly seniors will grow as the aging of the population accelerates. The latest census data shows over 770,000 Canadians were aged 85 or older in 2016, with this cohort growing almost four times as fast as the overall population between 2011 and 2016. One per cent of people between the age of 65 and 69 live in residential care homes in Canada, while the largest age group living in care homes is 85 and older at 29.6 per cent. In a 2015 report, entitled Future Care for Canadian Seniors: A Status Quo Forecast, the Conference Board of Canada estimated that by 2026 over 2.4 million Canadians age 65 and over will require continuing care support – up 71 per cent from 2011. By 2046, this number will reach nearly 3.3 million. According to the report, “total spending on continuing care supports for seniors in Canada is projected to increase from $28.3 billion in 2011 to $177.3 billion in 2046. With nearly two-thirds of this spending likely to continue to be provided by governments, spending growth will significantly exceed the pace of revenue growth in most provinces.” The same report also highlights that the number of seniors living in retirement homes, supportive housing, or long-term care homes will grow to over 610,000, and that Canada will need an additional 131,000 spaces for Canadi-

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an seniors, growing to an additional 240,000 spaces by 2046. It is for these reasons, particularly with demand growing more rapidly than supply, that the Conference Board of Canada report advocates significant public and private sector investment in building the infrastructure that is necessary. With this increasing demand, as well as governments and stakeholders advocating for moving resources away from acute to home and community care (HCC) to reduce costs and improve quality care, it is somewhat troublesome to see other reports recommending that the role of the private sector in the delivery of senior care be significantly diminished or reduced. This, for example, is seen most recently in a report released in March 2017 by the Canadian Centre for Policy Alternatives (CCPA) titled Privatization and Declining Access to BC Seniors Care. While the BC Care Providers Association (BCCPA) is in general agree-

ment with two of the three recommendations from this report, particularly relating to improving access to publicly funded HCC and developing a framework and action plan to improve access and service integration, the recommendation to significantly reduce the role of the private sector in HCC is entirely misguided. In making this recommendation, the CCPA report argues that the quality of care provided in private care homes is largely inferior to that provided by non-profit and government run care homes. It also notes that staffing levels, including direct care hours (DCH), are lower—as highlighted in a recent report from the BC Office of the Seniors Advocate (OSA). While the DCH levels may be lower in some private care homes, this assertion is somewhat disingenuous without also noting the DCH levels, whether private, non-profit or government run, are determined by the regional Health Authority, which provides funding for different DCH levels to care homes.

The number of daily care hours provided to seniors is mandated and closely monitored through a contractual agreement between the care provider and the health authority. Likewise, along with failing to mention different DCH funding levels, the CCPA report also does not mention that all care providers, whether public, private or non-profit, are held to high-quality standards and regulations. There is little evidence in the B.C. health system to show that private care homes provide inferior quality of care. In fact, a recent report from Alberta which highlights results of a 2014/2015 Long Term Care Family Experience Survey largely debunks this notion indicating that in general, no one model type (government, private or non-profit) was better or worse than the others across all key measures of family experience measured. Like the Alberta study, the OSA is currently undertaking a comprehensive survey of residential care homes

Michael Kary is Director of Policy & Research at the BC Care Providers Association. 14 Home and LongTerm Care News September 2017

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across BC to get a better understanding on the overall resident experience, so only then may it be clearer whether significant differences do indeed exist. Not only is the CCPA report’s recommendation to diminish the role of the private sector in HCC misguided if it were adopted, it would have a very detrimental effect on access to seniors’ care across the province. This would be particularly problematic as private sector investment is critical to meet the needs of a rapidly growing and aging population. In summary, the private sector has and continues to play a crucial and important role in the delivery of senior care. Removing these private providers out of our mix of care options is not only impractical, it would be costly and counterproductive. Rather than pushing out private operators, the responsible position would be to embrace and encourage the types of innovation they have introduced into the system while upholding high standards for quality care. Such innovations include, for example, the introduction of new technologies but also development of large campuses of care which include a variety of amenities such as daycare centres or restaurants. The BCCPA hopes to continue to discuss and highlight the important role the private sector plays in the delivery of seniors’ care, particularly as a leader in innovation and improving choice in all areas of the continuing care sector. The BCCPA also continues to support and uphold appropriate oversight and regulations so that care providers, regardless of ownership type, are held to the highest possible standards when it comes to caring for the elderly. Along with communicating this to government and other stakeholders, the BCCPA hopes to have further dialogue on the role of the private sector in seniors’ care including possibly as a future topic area at one of our regular Care to Chat events. LC

Study participant Roy Bratty, 82, demonstrates the walking and talking gait test with Dr. Manuel Montero-Odasso, a Lawson scientist, geriatrician at St. Joseph’s Health Care London, and associate professor in the Division of Geriatric Medicine at Western University’s Schulich School of Medicine & Dentistry.

Walking and talking

can be an early predictor of dementia By Marek Kubow n a new study, researchers at Lawson Health Research Institute and Western University are demonstrating that gait, or motion testing, while simultaneously performing a cognitively demanding task can be an effective predictor of progression to dementia and eventually help with earlier diagnosis. To date, there is no definitive way for healthcare professionals to forecast the onset of dementia in a patient with memory complaints. Dr. Manuel Montero-Odasso, a Lawson scientist, geriatrician at St. Joseph’s Health Care London, and associate professor in the Division of Geriatric Medicine at Western University’s Schulich School of Medicine & Dentistry, is leading the “Gait and Brain Study.” His team is assessing up to 150 seniors with mild cognitive impairment (MCI), a slight decline of memory and other mental functions which is considered a pre-dementia syndrome, in order to detect an early predictor of cognitive and mobility decline and progression to dementia. “Finding methods to detect dementia early is vital to our ability to slow or halt the progression of the disease,” says Dr. Montero-Odasso. The study,

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“WHILE WALKING HAS LONG BEEN CONSIDERED AN AUTOMATIC MOTOR TASK, EMERGING EVIDENCE SUGGESTS COGNITIVE FUNCTION PLAYS A KEY ROLE IN THE CONTROL OF WALKING, AVOIDANCE OF OBSTACLES AND MAINTENANCE OF NAVIGATION,” SAYS DR. MONTERO-ODASSO. “WE BELIEVE THAT GAIT, AS A COMPLEX BRAIN-MOTOR TASK, PROVIDES A GOLDEN WINDOW OF OPPORTUNITY TO SEE BRAIN FUNCTION funded by the Canadian Institutes of Health Research, followed participants for six years and included bi-annual visits. Researchers asked participants to walk while simultaneously performing a cognitively demanding task, such as counting backwards or naming animals. Those individuals with MCI that slow down more than 20 per cent while performing a cognitively demanding task are at a higher risk of progressing to dementia. The “gait cost,” or speed at which participants completed a single task (walking) versus a dual-task, was higher in those MCI individuals with worse episodic memory and who struggle

with executive functions such as attention keeping and time management. “Our results reveal a ‘motor signature’ of cognitive impairment that can be used to predict dementia,” adds Dr. Montero-Odasso. “It is conceivable that we will be able to diagnose Alzheimer’s disease and other dementias before people even have significant memory loss. Our hope is to combine these methods with promising new medications to slow or halt the progression of MCI to dementia.” The study, “Association of Dual-Task Gait with Incident Dementia in Mild Cognitive Impairment”, was published in the journal, Jama Neurology. LC

Marek Kubow is Lead, Communications & External Relations, Lawson Health Research Institute. www.longtermcarenews.ca

September 2017 Home and LongTerm Care News 15


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Taking the stress out of bathing for patients with dementia How staff at the North Bay Regional Health Centre took the stress out of bathing for patients living with dementia. By Lindsay Smylie Smith or many of us, taking a bath is a relaxing experience. Some people use it as an opportunity to unwind at the end of a long day, and parents are often encouraged to bathe children to help them relax before bedtime. For patients living with dementia, the experience can often be the opposite – frightening and stressful for the patient, their families and the staff caring for them. “When you are living with dementia, you are trying to make sense of the world around you,” explains Debbie Hewitt Colborne, RN and Coordinator of Seniors’ Services at the North Bay Regional Health Centre. “This

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can be more difficult when you need assistance with personal care – it’s an intimate experience and can be very stressful for our patients.” Knowing that personal care could cause some of the most intense responsive behaviours from patients, staff from the B1 Dementia Transition Unit came up with a plan. “We recognized an opportunity to make bathing a less stressful experience with some changes to our tub room,” Hewitt Colborne explains. Before the upgrade, the tub room likely wouldn’t have been appealing for anyone to bathe there, let alone a patient who may be feeling vulnerable and unsure of their surroundings. Vi-

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BATHING CAN BE FRIGHTENING AND STRESSFUL FOR THE PATIENT, THEIR FAMILIES AND THE STAFF CARING FOR THEM sually, the room was an institutional looking drab colour and looked very busy and messy – clothing was stacked in the corner, supplies out in the open and pieces of equipment being stored in there. The team, comprised of nursing, clerical and housekeeping staff, set to work to make the tub room a more calming environment. First the room

was painted blue – a shade specifically chosen for its well documented calming properties. Artwork was hung on the wall that could be seen from the bathtub, in an effort to create a more home-like environment. Finally new cupboards were installed with doors that could be closed to store supplies out of sight, and arrangements were made to remove most of the excess www.longtermcarenews.ca


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clutter and unnecessary items that had found a temporary home in the room. The biggest change, however, was the installation of a blanket/towel warmer. “This addition was key for the experience of the patient living with dementia,” Hewitt Colborne says. Katherine Gagnon, RN and Team Lead on B1, has seen first-hand the positive effect these changes have had on patient experience. Gagnon remembers one patient in particular had historically found the bathing experience very stressful – which sometimes resulted in both verbal and physical responsive behaviours. First staff brought him to the tub room and prepared him for the bath by getting him undressed. “As soon as we did,” she remembers, “we put a warm towel on him right away. Immediately you could feel him relax.” They continued that way during the entire bath – any area of the patient

PERSON AND FAMILY CENTRED CARE IS THE IDEA THAT HEALTHCARE SHOULD BE TAILORED TO A PATIENT’S INDIVIDUAL NEEDS AND GOALS, TOGETHER WITH THE INVOLVEMENT OF THE PATIENT AND THEIR FAMILIES that was exposed was covered with a warm towel, and they were able to provide his bath without the stress that the patient previously experienced. Making the tub room more homelike is part of a larger goal to make the environment on B1 more dementia friendly – and to better provide what is known as ‘person and family centered care’. Person and family centered care is the idea that health care should be tailored to a patient’s individual needs and goals, together with the involvement of the patient and their families.

Hewitt Colborne explains sometimes even if staff have received all the right training and are eager to put these elements into practice, sometimes the environment they are working with can be limiting. “We know that environment is only one piece of the care we provide in a healthcare setting,” she says. “Bathing in the tub room before the renovations is an example of where the institutional setting limited our staff’s ability to provide the person-centred care they had been trained on,” she says. “Staff

are already equipped with the knowledge and understanding of our philosophy of care, but this change enabled them to practise in a way that exercised these principles.” In this instance, the addition of the towel warmer helped make the experience of bathing more personalized, and helped keep the focus on the patient’s comfort rather than just about the task of bathing. Another example is once the room was cleared of the excess clutter, the CD player was more accessible allowing staff to play music to enhance the relaxation for patients during their care. The change to a more home like environment has also had a positive effect on the staff working on the unit. The warmer environment is more welcoming, and the transformation instills a sense of pride as staff can see firsthand the effects this change has had on their patients and families. LC

Lindsay Smylie Smith is a Communications Specialist at North Bay Regional Health Centre.

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September 2017 Home and LongTerm Care News 19


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Cushioning the impact of dementia By Drew Tapley ometimes the solution to a problem comes out of left field and has a mindboggling effect. At least this is what happened to Michele Mackenzie, executive director of Maple Grove Care Community in Brampton, Ontario, when she had a resident with dementia removing everything from the walls. “Simon slowly and methodically began removing things from the hallway walls,” says Michele. “He started with the interactive things, then removed a point of care screen, hand sanitizers, and all the wall hangings. Everything was screwed in place, and he just used his hands to jimmy the items left and right until they came off.” Sixty-six percent of residents at Maple Grove have some form of dementia, and the hallways contain a number of interactive objects for them to use, such as textured panels secured to the walls. The hallways soon became bare due to Simon’s activities, with screw holes all along them, and no point in putting anything back up as he would rip it down again. “My building services manager couldn’t keep anything on the walls. He didn’t know what to do,” says Michele. One day, Simon went into the dining room during meal service and started ripping down the curtains. But the problem really escalated when he began entering other residents’ rooms and removing things from their walls. This was very upsetting for residents and their families. “I had to do something immediately, and the idea just came to me. I was watching him and noticed that he looks upwards, and is drawn to anything in his specific line of sight. He needed something to interact with and keep him busy because he thinks he’s doing a useful task, and requires an activity that is not going to cause him or anybody else harm. Well, if he likes to rip things off the wall, I thought – why don’t we velcro a cushion to the wall?” And that was that. The idea went into production straight away, and Michele went on a mission to find

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Michele Mackenzie with a cushion she made.

THE THING ABOUT DEMENTIA IS THAT PEOPLE HAVE A NEED TO BE CONSTANTLY ON THE MOVE. WITH THE CUSHIONS ON THE WALLS, THEY CAN PULL THEM OFF AND KEEP WALKING, AND WE JUST PUT THEM BACK UP AGAIN objects that would draw his attention as eyesight is adversely affected with dementia. She got the brightest coloured cushions she could find, and bought textured haberdashery items at Walmart such as sequins, tassels, and a variety of buttons.

“I sewed them on the cushions myself, and my team was very involved in giving feedback and suggestions about what he liked, where to put the cushions, and other materials we could use on them, such as a zipper.” The team have been excited to help, and it has allowed them to get

on with their work without having to constantly redirect Simon or intervene if he goes into someone’s room. They currently have four cushions spread out down the hall, and the input from team members at the care community has been vital in making this initiative work. “They will say things like, ‘It’s a narrow space between these two doors, and he can go into either room. Can you get a smaller cushion and put it into that space?’” Once they discovered the answer in the cushions, they then had to decide where best to put them. “We had a lady who had lost her purse, and we were looking at the cameras to try and find it. At the same time, we happened to see Simon do his circuit, and realized that there are certain areas in the hallway that he is drawn to, which helped us place the cushions and determine how high up they should go. “The thing about dementia is that people have a need to be constantly on the move. With the cushions on the walls, they can pull them off and keep walking, and we just put them back up again. It’s ongoing therapy. But the interactive stationary objects that have been permanently secured to the wall, don’t hold the same appeal. “From what we can see, residents do not have the concentration level to stop, stand and interact with them. It’s not something they can take with them and continue to interact with – unless they are ripping them off the wall,” she adds with an ironic giggle. One of the objects she is referring to is a wooden board with multicolored beads, which, strangely enough, Simon completely ignores. Overall, Michele is confident that this initiative has solved the problem with Simon, and says he seems to enjoy it as well. “He doesn’t go into the rooms anymore. Instead he heads towards a room, sees the cushion on the wall, stops and takes it. It services his need, and he heads off down the hall with it.” LC

Drew Tapley is a Writer with Sienna Senior Living. 20 Home and LongTerm Care News September 2017

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MUSIC CARE

Music care:

A developing approach to care By Bev Foster grew up in a family where music was valued and performed. It was my grandmother, Nanny Gross, who would stand behind me when I practiced the piano and put her fingers on my shoulders. “Don’t slouch,” she would say. She would hop on the subway and come hear a concert or recital I was involved in as a student at the Faculty of Music in Toronto. We both loved music. So it was natural that music would become part of our visits during the last 14 years of her life at the long-term care home in Port Perry. I would sing or wheel her to the piano and play old and new songs. Or I’d put some recorded music on and sit at her bedside stroking her hand and face. In the last five years of her life, Nanny suffered from dementia and music was the means by which we connected.

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And it was music that accompanied her final breath. I was there. I bear witness to its beauty and power. Music is an intensely and inherently human activity, relational in nature, and can be used as a method of validating the whole person within healthcare systems. Music is a fascinating tool to use in care settings, because of its diverse applications. From a person-centred point of view, music impacts all human dimensions – biological, emotional, social, cognitive, and spiritual. Music can, therefore, be applied in care practices that address any of these dimensions. However, music interventions must be targeted and intentional, especially in longterm care (LTC). In this column, we will explore the dimension of music in care, specifically LTC, its impact in relational care, cur-

THE GOAL OF MUSIC CARE IS TO INTEGRATE AND ASSIMILATE MUSIC INTO THE CARE ENVIRONMENT AS A PRIMARY APPROACH TO WHOLE PERSON CARE rent research in music interventions and therapies pertaining to LTC, and resources, programs and strategies using music that focus on the challenges and opportunities within a LTC setting. We will also discuss how music care – a cost effective, non-pharmacological, and universal approach – is able to leverage culture change. Music care is an emerging approach being developed by the Room 217 Foundation. Music care is not a specific practice, rather a paradigm within which music is inherently understood to be part of life, playing an integral role in all aspects of caregiving and care settings. Music care is intended to be relational and to improve quality of life and care, thus contributing to overall culture change in healthcare. The music care approach is more than a “complementary” approach to care. Research is demonstrating the benefits of music as a therapeutic tool, including enhancing well-being, and helping to manage physical and psychological symptoms in individuals with a variety conditions. The goal of music care is to integrate and assimilate music into the care environment as a primary approach to whole person care.

Ensuring that music becomes a part of people’s lives in care settings can be a lofty goal, but can happen with a thoughtful approach. The music care integration model that is being developed in the context of long-term and continuing care, follows the following steps: informing and training care partners on the music care approach to give them confidence and skill; defining the intention of developing a music care plan; creating an implementation plan; and integrating this plan into the culture of the care setting. While there are professional designations in music care like accredited music therapists, or certified harp therapists, all of us can use music to some degree. All care partners need to be informed about the therapeutic capacities of music. A baseline understanding of sound and musical effects is essential because music can also have adverse effects. Education and training not only build caregiver confidence and skill for integration but a sense of responsible use of music in care. Intentions that are informed will more effectively plan for and meaningfully implement music care strategies and purposeful uses of music for use in programs, tasks and relational care. LC

Bev Foster, MA, ARCT, AMus, is the founder and executive director of the Room 217 Foundation, a social enterprise dedicated to caring for the whole person with music by producing and delivering therapeutic music products, providing skills and training for integrating music into care and supporting innovative research in music and care. For more information, visit www.room217.ca www.longtermcarenews.ca

September 2017 Home and LongTerm Care News 21


NEWS

Helping a loved one overcome

overwhelming clutter By Pamela Stoikopoulos tacks of books, dishes piled two feet high, “collections” of newspapers, plastic bags, clothes, unpacked remnants of shopping trips of months – maybe years – gone passed. To the average person, the scene may feel like a confining, even debilitating pile of useless things, but to a person with a tendency to hoard, these are precious items they feel overwhelmingly attached to. Sound familiar? Chances are you know someone with a tendency to

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ESTIMATES SUGGEST HOARDING AFFECTS AROUND FIVE PER CENT OF THE POPULATION collect clutter and hoard. Estimates suggest hoarding, now listed as a mental disorder in the Diagnostic and Statistical Manual of Mental Disorders, affects around five per cent of the population. One of the biggest challenges for their caregivers and other family members is getting the person with

hoarding tendencies to see the impact their behaviour has – including unhealthy living conditions, an increased risk for fire, and the falling hazards of cluttered pathways that limit the ability to move around. Hoarding often starts early in life and can increase in intensity after

stressful or traumatic life events like the death of a parent. The “collections” can offer a sense of security, or can form part of a person’s identity. Though we all collect stuff that we don’t necessarily need, those who hoard attach greater importance to these items than most people. Or they are convinced that “one day” they may find a use for the item. They often see themselves as collectors, resourceful, or highly respectful of the environment. Over time, however, the “collection” can lead to clashes. Continued on page 29

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Is canada a caring society? New report reveals progress and gaps in supporting family carers By Catherine Suridjan ver eight million carers (also referred to as family caregivers) impact the lives of Canadians every day. They provide care and support to loved ones, family members and friends; and contribute over $25 billion in unpaid care every year. Advancing Collective Priorities: A Canadian Carer Strategy, developed through a partnership between Carers Canada, the Canadian Home Care Association (CHCA) and the Canadian Cancer Action Network (CCAN), showcases the policies and practices that are in place to recognize and support these important individuals.

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involvement of governments, public and private corporations and individuals. In 2017, a significant milestone was achieved when the Prime Minister gave a public statement acknowledging the role, value and importance of carers. This statement was reinforced through targeted funding for financial programs in the 2017 federal budget. At a provincial and territorial level, home care programs are being expanded to include necessary support and respite for caregivers. Services for carers are part of provincial cancer support programs, including patient navigation assistance, counselling, support groups and resource centres.

family carers. The momentum is building and our goal of “a Canada that recognizes, respects, and values the integral role of carers in society” is in sight.

The partners look forward to working with governments and stakeholders across the country to make this happen. LC

Catherine Suridjan, Senior Policy Analyst Canadian Home Care Association/Public Policy and Stakeholder Relations Lead, Carers Canada.

BUILDING A CARING SOCIETY THAT SUPPORTS FAMILY CARERS REQUIRES THE ACTIVE INVOLVEMENT OF GOVERNMENTS, PUBLIC AND PRIVATE CORPORATIONS AND INDIVIDUALS As our population ages and the number of individuals diagnosed with cancer and other chronic conditions increases, nearly every Canadian will take on a caring role for someone they love. For many, this additional responsibility will mean juggling work expectations, personal needs and their caring duties; often at the cost of their emotional, physical and financial well-being. “Over the past five years, we have seen an increase in awareness and recognition of carers, the creation of financial programs for carers, and focus on developing supportive workplaces,” says Nadine Henningsen, CEO of the CHCA and President of Carers Canada. “We have made progress in supporting carers, however there is still much more to be done.” Building a caring society that supports family carers requires the active www.longtermcarenews.ca

“Through this report, we aim to further identify opportunities for broader pan-Canadian collaboration and build on each other’s efforts to achieve measurable outcomes and values for patients, caregivers and our society as a whole,” says Marjorie Morrison, CEO of CCAN. “The partners identified both pockets of excellence and gaps in supporting carers,” says Anthony Milonas, COO of CBI Health Group, a Signatory Partner of Carers Canada. “Recognizing and helping individuals plan for when they become a carer, increasing access to financial assistance and carer support programs, and building an employer community that values carers are a few of the advancements that still need to be done.” If Canada is to be a caring society, we must all work together to support

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September 2017 Home and LongTerm Care News 23


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“Now, I am not a passive patient. I am a person who can make decisions and take steps towards my recovery,” says Jean Bubba, of her participation in the Falls Prevention Program at St. John’s Rehab.

Taking steps towards recovery:

Fall prevention By Natalie Chung-Sayers

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eing in a hospital for a while… you start to yearn for home. Home is great. It is your safe place. You know where things are,” says Jean Bubba, 67. But home is also where most adults 65 years of age or older, will experience injuries from a fall. The World Health Organization has identified falls as a major public health issue. In Canada, falls cause 70 per cent of major injuries among seniors, with 80 per cent of these falls occurring in the home. Jean had surgery for a neurological condition. After recovering in acute care, she began rehabilitation at Sunnybrook St. John’s Rehab in the Stroke and Neurological Rehabilitation Program.

HOME IS WHERE MOST ADULTS 65 YEARS OF AGE OR OLDER, WILL EXPERIENCE INJURIES FROM A FALL When Jean was ready to go home, her therapy team referred her to the Falls Prevention Program, part of the St. John’s Rehab Outpatient Therapy Program. The Program provides free in-home assessments to individuals aged 65 or older who are physician-referred and live in the hospital’s neighbouring communities. “I assumed the assessment would just be about the bathroom,” recalls Jean. “I wasn’t thinking about the whole place or about managing my medication – but they were!”

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“Our in-home assessment team made up of an occupational therapist and a pharmacist go to an individual’s home. They visit to understand how the individual moves within the home to complete daily activities,” says Gary Siu, Project manager, Outpatient Therapy Services, St. John’s Rehab. “The occupational therapist identifies and provides education about falls risks and hazards within the home. They also observe a client’s functional mobility within the home and make recommendations about home

adaptive equipment and safe transfer techniques,” says Gary. “The Pharmacist observes the in-home organization and administration of medications, and makes recommendations to the client and family doctor to decrease falls risk.” “I was surprised by the team’s findings,” says Jean. “Their assessment gave me a different set of eyes to see how I live.” She had many scatter mats throughout her home. To her, they were always just pretty and decorative. “Even though they had a non-slip lining, they turned out to be a risk factor. The varying surfaces of the rugs, the likelihood that they could get ‘kicked up’ in the corners, or that I could trip over a fold in one of them – these were things I had never considered before. www.longtermcarenews.ca


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THE EDUCATION DIDN’T JUST APPLY TO MY HOME. IT MADE ME AWARE OF WHAT RISKS TO LOOK FOR, OUTSIDE OF MY HOME They also looked at my bathroom and approved what I had installed, but most importantly, my entire apartment was assessed.” “It was eye-opening and instructive. It’s like getting driving lessons and instead of instructions for ‘skid school’ on what to do when things go bad. To my delight, the experience was more of a preventive approach of what to do to ensure that things don’t go bad. The education didn’t just apply to my home. It made me aware of what risks to look for, outside of my home.” On the medications assessment, Jean describes it as a holistic approach. “Before I was in the hospital, I was limited to using antibiotics. Now, post-surgery and at home, I had to take new medications that were very foreign to me.”

To help her organize the timing and doses of medications, the pharmacist advised her to get a dosette, and a friendly ‘quack’ alarm sound that she set on her phone reminds her of specific dosage times. The pharmacist also assessed for factors that affect women – Jean’s vitamin D and calcium levels, and advised her to build up calcium with more dairy in her diet, and reduced caffeinated beverages overall. They also advised her to cut her caffeine in the evenings. This would allow sleep to be more restful, which means less risk of falling if she was to get up at night. The pharmacist also got Jean’s permission to check with her family doctor about her bone density. “Findings from that conversation were commu-

nicated to me. It was full circle with regard to the family physician, and then with me,” she says. In addition to the in-home assessment, clients attend exercise and education classes at St. John’s Rehab as part of the Falls Prevention Program. “The class encourages long term self-maintenance by working in results of an individualized physical and balance assessment, into a prescribed home exercise program. Clients also receive education on nutrition and the benefits of exercise. Our goal is to keep seniors safely and independently living at home longer,” says Gary. “Now, I am not a passive patient. I am a person who can make decisions and take steps towards my recovery. The effect of the falls prevention service is self-empowerment. I am able to regain independent living very quickly without worry. It’s one of the biggest steps towards healing.” “I am safe in my home – and safer – when I go out.” LC

St. John’s Rehab Falls Prevention Program A five-year review of the St. John’s Rehab Falls Prevention Program reports over 60 per cent of the home safety recommendations made by the pharmacists (67 per cent) and OT’s (64 per cent) were implemented in the home to reduce falls risk. Clients were also demonstrating statistically significant improvements in balance, as demonstrated by improved 4-Stage Balance Test and the Berg Balance Scale scores. At 90 days postdischarge from the Program, 83 per cent of seniors reported they had not accessed emergency services due to a fall, and 73 per cent reported they are still exercising on their own.

Natalie Chung-Sayers is a Communications Advisor at Sunnybrook Health Sciences Centre.

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September 2017 Home and LongTerm Care News 25


NEWS

How a medication review

prevents health problems By Shawn Goodman and Susan C. Jenkins early three-quarters of Canadian seniors have at least one chronic condition, and about one quarter have three or more. Almost two-thirds of those with three or more health conditions take at least five prescription medications on a regular basis.

N

GOOD NEWS, BAD NEWS

The good news is that modern medicines help people live longer, healthier lives and help them maintain their independence. The bad news is that seniors are more likely to experience drug-related health problems due to factors such as: • Aging bodies react differently to medicines, even ones we’ve taken for a long time. • The more medications we take, the greater the likelihood of making a mistake. For each medicine we take, we need to remember how much to take, when to take it, whether to take it with food or on an empty stomach, what foods or other drugs to avoid while on the particular

drug. Taking five or more drugs can easily become confusing. • When seeing more than one doctor (such as a family physician plus specialists), one of them may prescribe a drug that interacts with something another doctor prescribed. Drug-related problems can range from uncomfortable to dangerous and may include oversedation, confusion, hallucinations, falls, and bleeding. Hospitalization rates due to adverse drug effects are four times higher in elderly patients than in younger people.

FINDING A SOLUTION

In an effort to reduce medication-related problems, the Government of Ontario launched the MedsCheck program in 2007 to help people taking three or more prescription drugs for chronic conditions to better manage their therapy. MedsCheck medication reviews give people the chance to meet one-on-one with a pharmacist to identify and resolve any issues that are preventing them from getting the best result from their medicines. Great news, right? Well, it would be if more people took advantage of this

free program, but fewer than half of eligible seniors do. There are several different types of MedsCheck reviews available. • MedsCheck Annual: People living in the community who are able to travel to their local pharmacy can make an appointment with the pharmacist for a personal consultation once each year. • MedsCheck Follow-up: Certain circumstances, such as major changes to medications taken, make a person eligible for additional consultations between annual reviews. • MedsCheck at Home: Those who can’t get to the pharmacy can arrange to have a pharmacist come to their home for the annual consultation. In addition to assessing medication use and answering any questions a person or caregiver may have, the pharmacist can also perform a medicine cabinet clean-up to get rid of any drugs that are outdated or no longer needed. • MedsCheck Long Term Care (LTC): This program is designed for people who reside in long-term care facilities. It includes a comprehen-

sive medication review once a year plus three more quarterly reviews. • MedsCheck for Diabetes: In addition to the annual MedsCheck review, people with diabetes are eligible for education consultations throughout the year to help them manage their diabetes.

GET THE MOST FROM YOUR REVIEW

The following tips to help you get the most benefit from your medication review. • Make sure the pharmacist knows about all medicines taken—prescription, over-the-counter, and supplements including vitamins/ minerals. • Include creams, lotions, inhalers, eye and ear drops, and patches, not just those medicines taken by mouth. • Don’t forget natural health products. Just because they’re “natural,” doesn’t mean they’re safe, and some can interact with other medicines. • Prepare a list of questions in advance, so you won’t forget to ask the pharmacist about anything you don’t understand. LC

Shawn Goodman, a doctor of pharmacy, is a clinical consultant pharmacist with Medical Pharmacies. Susan C. Jenkins is a freelance writer and editor specializing in medicine, pharmacy, and healthcare. She can be reached at susancjenkins@gmail.com. 26 Home and LongTerm Care News September 2017

www.longtermcarenews.ca


ONE DAY YOU COULD NEED AN MRI

AFTER AGE 65, THE LIKELIHOOD OF NEEDING AN MRI DOUBLES. THIS AGE GROUP IS ALSO MORE LIKELY TO NEED A PACEMAKER.1 PATIENTS WITH PACEMAKERS HAVE A 50-75% LIKELIHOOD OF NEEDING AN MRI OVER THE LIFETIME OF THEIR DEVICE.1 1. 2.

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CAREGIVER SOS

Depression

in dementia patients can be tackled

My dad was diagnosed with dementia a couple of years ago. Now I notice that he is restless and crying. Is this sadness a normal part of the disease? epression can indeed be part of dementia. Some research has shown that up to 78 per cent of people with Alzheimer’s disease suffer from symptoms of depression. It is also common that family members report depression more than clinicians do. Depression is most common in the early to middle phase of the disease. Since depression and dementia can exhibit similar symptoms, it is sometimes hard to differentiate what is actually occurring. If you suspect a problem, it is imperative that you see your doctor, since a proper mental-health examination is essential. To muddy the waters further, it is reported that there is a two-fold increase incidence of Alzheimer’s in depressed elderly in the community. Dr. Madan, psychiatrist-in-chief at Bay-

D

crest Health Sciences, explains: “One theory is, that depression that occurs right before Alzheimer’s disease is an early symptom or manifestation of the illness. Again, this points to the reason to seek treatment early.” Some studies report that symptoms of depression may be less severe when someone already has dementia. Two common symptoms of depression in dementia are irritability and social withdrawal. Other signs and symptoms to look for include crying, lack of appetite and a lack of interest in activities that the person previously enjoyed. A lack of interest in being with people and a general lack of desire to participate in social activity are also symptoms of depression. With dementia it is important to realize that more than one cause can create a behaviour change. Hearing

impairment, or an inability to understand an activity are two such causes; while some impaired individuals become easily overwhelmed in a given social situation. These are just some examples of why someone with dementia may withdraw and appear sullen or depressed. The two conditions share many overlapping symptoms and older adults who experience depression for the first time may also have signs of cognitive decline. The course of treatment can vary, but it is important to know that there are both pharmacological and alternative treatments to help with either or both depression and dementia. Doctors who specialize in this care can help determine which drug, if any, to try. Families often worry about interactions with other medications, but many of these drugs are safe and can be taken without issues. Medication is not the only way to treat mood issues. Some clinicians believe that the root of mood issues in certain individuals with dementia is an

absence of activity at the right level. This is key as it is important to find the balance between over and under-stimulating a brain that is changing. Finding activities that are purposeful and enjoyable is a must. Many day programs work on this premise and help to support the individual’s strengths. Mood issues may also be addressed by friends or family who can support the individual by providing them a sense of well-being and usefulness. It is not always easy to be an understanding and patient caregiver to someone who has dementia. This sense of involvement with family can help prevent depressive symptoms. The key element as a caregiver is to sort the symptoms out and to work on treating the right issue while engaging the person to the best of their – and your – abilities. LC

Nira Rittenberg is an occupational therapist who specializes in geriatrics and dementia care at Baycrest Health Sciences Centre and in private practice. She is co-author of Dementia A Caregiver’s Guide available at baycrest.org/dacg. Email questions to caregivingwithnira@baycrest.org. This article originally appeared in the Toronto Star. 28 Home and LongTerm Care News September 2017

www.longtermcarenews.ca


NEWS

Overwhelming clutter Continued from page 22 “Hoarding and clutter create distress for both those with the disorder and the family members/caregivers who support them,” says Catherine Chater, Occupational Therapist with VHA Home HealthCare and host of an upcoming free webinar for caregivers on supporting loved ones with hoarding challenges. “It’s a really complicated issue that can generate a lot of conflict within families. Caregivers often get stressed out trying to deal with hoarding and are often the first ones to seek support. In many cases though, the person who hoards doesn’t recognize it as a problem so tensions can build – both for the caregiver/ family member (whose own well-being may be affected) and the person that hoards and feels highly distressed by any attempt to remove the clutter.” If you’re a caregiver or family member trying to help someone who hoards, Chater suggests you:

A FREE WEBINAR THAT FOCUSES ON HOW FAMILY CAREGIVERS CAN SUPPORT LOVED ONES WHO HOARD IS ALSO HAPPENING ON SEPTEMBER 12, 2017, FROM 7:00PM-8:30PM • Ditch a quick-fix mentality. While it may be tempting just to “clear out” a home to start from scratch, doing so can not only traumatize the person who hoards, but can also cause a relapse that is often more extreme than the original problem. Chater recommends a harm reduction ap-

proach that focuses on removing hazards and gradually helping the person sort through the clutter. • Stay positive. Avoid blaming the loved one for the clutter and focus on supporting them through a gradual transition. Conflict or judgment can often harm, not help, the person who hoards and worsen the behaviour. If your loved one had cancer, you wouldn’t blame them for it, so reminding yourself that this is an illness can help you stay focused on support. • Get help. Hoarding is a complex mental health issue that isn’t easily solved. VHA offers hoarding support services. A free webinar that focuses on how family caregivers can support loved ones who hoard is also happening on September 12, 2017, from 7:00PM-8:30PM. You can register at https://thecaregivernetwork.ca/event/hoard-

Hoarding can often create conflict, especially since often the person who hoards does not see the behavior as a problem. ing-help-family/ or by calling 1-888314-6622 ext. 4780 toll-free. The recorded session will also be available at www.vha.ca/events after September 12. LC

Pamela Stoikopoulos is the Senior Communications and Public Relations Manager at VHA Home HealthCare.

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September 2017 Home and LongTerm Care News 29


NEWS

Infoway Partnership Conference to emphasize digital health for Canadians By Dan Strasbourg or the past 12 years, digital health advancement has been at the forefront of the annual Infoway Partnership Conference, which serves as a forum for knowledge exchange, debate and discussion. In the early years, the conference emphasized modernizing the healthcare system by moving from paper to digital as the medium to record and exchange patient information. Today, interoperable systems that securely store and may communicate data (lab test results, digital images, and medication history), among healthcare providers are widely in use. Patients and caregivers can play a crucial role in improving patient outcomes themselves, and they are at the forefront of the next wave of digital health innovation in Canada. This year’s Infoway Partnership Conference has been designed to align with the next wave of the digital health journey, with themes that include the

and lessons learned,” says Lynne Zucker, Vice-President at Infoway. “Included within the program will be a healthy amount of debate and discussion, as well as a showcase of emerging digital health solutions that will transform the healthcare experience for Canadians, from how care is accessed, to how apps are being used to manage health to how medication safety is optimized through electronic prescribing.” While Infoway has always collaborated with clinicians, patients, government and others, the organization continues to greatly value the participation of patients and caregivers for the unique perspective they bring to dialogue. Once again, the 2017 Infoway Partnership Conference is proudly Patients Included Certified. To learn more about the program or register for the conference, visit www. Infoway-inforoute.ca, or follow us @ Infoway #thinkdigitalhealth. LC

F

MENTAL HEALTH

Patients (second from the left, to right) Jillianne Code, Brian Penner and Sara Kearley share their experiences with digital health with Shelagh Maloney, an Infoway Vice-President, along with attendees of the 2016 Infoway Partnership Conference. ability for all Canadians to access and manage digital health records, in addition to interoperability (the ability for systems to exchange information securely). The conference, hosted by Canada Health Infoway, will be held November 14 and

Many Canadians living with mental health illness end up at the Emergency Department when they are in crisis, often because their regular support network is not available. Virtual mental health services, such as portals or chat lines, digitally connect patients with resources, peers and professionals whenever they need it. New Zealand recently converged several helplines into one multichannel virtual mental health service for the country, and Andrew Slater, Chief Executive Officer, Homecare Medical New Zealand, will deliver what promises to be an insightful and motivating keynote address at the 2017 Infoway Partnership Conference. He will share with attendees their experience rolling out this national service, which has connected with 20 per cent of New Zealand’s population in its first year and a half in operation.

15 in Calgary, Alberta, during Digital Health Week. “Those who attend may look forward to learning from, patients, national and international healthcare leaders who will share their digital health journeys, best practices

WELLNESS AND PREVENTION WITH DIGITAL HEALTH

Join Andreas Souvaliotis, Founder and CEO, Carrot Insights, will share how digital tools can help promote wellness. He will walk participants through a new, very Canadian way to reach and influence millions and end up with great evidence along the way. By replacing sticks with carrots and by positively harnessing two of our biggest national addictions, Souvaliotis will demonstrate how we can all be healthier.

PRESCRIBEIT™ AND MEDICATION SAFETY CANADA

With 39 per cent of Canadians, age 55+, taking four or more medications, and Canada ranking second in the consumption of opioid prescriptions globally, ensuring medication safety for Canadians has never been more important. An integral step toward medication safety includes the implementation of e-prescribing in Canada. Canada Health Infoway is well on its way to initiating PrescribeIT™, a single service e-prescribing service to enable prescribers to securely and electronically transmit a prescription to a patient’s pharmacy of choice. In this session, Dr. Mike Hamilton, (Institute of Safe Medication Practices Canada), will moderate a panel discussion on the progress made toward PrescribeIT and questions related to its role in medication safety.

Dan Strasbourg is Director, Media Relations at Canada Health Infoway. 30 Home and LongTerm Care News September 2017

www.longtermcarenews.ca


NEWS

self-care

The challenge of By Barbara Grant

Y

ou love your job and you are really good at it. You love the residents in your care and they love you. You always go the extra mile. Every day you show up to work and you give your all because you care; because that’s what your job means to you. That’s why you got into this work in the first place. But it’s hard. And it’s getting harder. You’re exhausted. You haven’t had a day off in over a week because you’ve had to cover some extra shifts. Your friends tell you, “Let someone else do it.” But you know there is not enough staff to take the shifts and besides you need the money. Your family complains you are irritable and you look tired. “You need to take better care of yourself,” they say. “You need to practice self-care.” And you wonder, “When am I supposed to have the time to do that?” Healthcare workers in long-term care facilities face some of the biggest work-place challenges in the industry. Caring for a broad and diverse population requires workers to navigate complex psycho-social relationships not just with those in their care but also with other family members. The work is physically and emotionally exhausting. Understaffing is sometimes chronic. Staff morale can be low and burn out rates are high. Many healthcare workers of course also perform care roles outside of their job, looking after children or sick or elderly parents of their own. Time, energy and money are often in short supply. The challenge with self-care is that it can feel like just another stressor; another addition on your to-do list. Stress comes at us from all angles. It is impossible to remove stress from our lives, but there is much we can do to change our reaction to it. Rather than looking at self-care as another stressor,

as something more you need to fit into your life, consider thinking of it as an opportunity to create time and space for yourself. Here are three important ways you can carve out space for yourself and start to create calm, care, and connection.

1. LEARN STRATEGIES TO HELP MANAGE STRESS

Stress is insidious and our reactions to it are usually automatic and full of tension, which usually incites more stress! One of the best ways to learn to manage stress is a Mindfulness Based Stress Reduction program (MBSR. Mindfulness can provide powerful skills which lead us to respond to stress rather than react on auto-pilot. But it is not as simple as taking deep breaths. It takes learning and practice. Most

MBSR programs are delivered in an 8-week series of weekly sessions.

2. MAKE EXERCISE A PRIORITY

Daily physical exercise has a profound impact not just on our physical but also our emotional well -being. Of course we know exercise makes us stronger and more agile. It also helps us sleep better and influences our choices around the food we eat and the way we spend our leisure time. Daily exercise does not have to mean a super sweaty high paced workout. It can be as simple as taking a walk over lunch -time or playing soccer with the kids after dinner. There are all sorts of gentle yoga or restorative Pilates classes you can follow online that require no special equipment. The goal is to build daily exercise into your life in a way that is manageable and fun.

3. STAY SOCIAL THE OLD FASHIONED WAY

Social media can be a great way to stay in touch, but even better is to spend time with friends and family. Humour and affection go a long way in restoring our sense of well-being and community. The good is better and the bad is easier to bare when it is shared. Some work places provide employee wellness programs that offer such initiatives as MBSR, yoga and exercise classes and/or organized sports teams or staff social events. Check with your employer to see if such programs could be right for your work environment. We all need help to keep calm and carry on! LC

Barbara Grant is the President and founder of Retrofit Pilates, a full-service health and fitness studio in Toronto. For more information, go to www.retrofit.ca and visit Retrofit on Youtube at www.Youtube.com/retrofitpilates www.longtermcarenews.ca

September 2017 Home and LongTerm Care News 31


LongTerm Care News Edition September 2017  
LongTerm Care News Edition September 2017