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Inside: A primer on stroke | Security in long-term care facilities | Product spotlight

December 2017 Edition


The next frontier in seniors’ independence Page 8

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Declines in plasticity – the brain’s ability to adapt – may underlie memory problems

Study participant undergoing EEG brain scan (CNW Group/Centre for Addiction and Mental Health)

Promising new avenue to explore treatments for Alzheimer’s disease I n an innovative study, researchers at the Centre for Addiction and Mental Health (CAMH) have discovered brain changes linked to memory loss in people with Alzheimer’s disease. The discovery provides a new focus for exploring ways to treat or prevent dementia, which currently affects more than 560,000 Canadians. Published in JAMA Psychiatry, the study shows that the brain’s ability to adapt or change – called brain plasticity – is significantly lower in people with early Alzheimer’s disease than in healthy individuals of the same age.

The research focuses on plasticity in the frontal lobes, the brain region involved in higher thinking activities, such as planning and working memory. Working memory is the type of memory used to store and manipulate information to complete tasks over a short time period, such as doing mental calculations. The findings also reveal that people with reduced plasticity in the frontal lobes also experienced poorer working memory. “What’s exciting is that we clearly demonstrated impairments in brain plasticity in the frontal lobes in people with early Alzheimer’s disease, and we

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showed that impaired brain plasticity is related to impaired function of the frontal lobes, specifically working memory,” says Dr. Tarek Rajji, senior author of the study and Chief of the Adult Neurodevelopment and Geriatric Psychiatry Division at CAMH. “This may indicate that impairments in brain plasticity underlie impairments in memory.” The findings are promising because “impaired brain plasticity may be a future target for treatment or prevention of dementia, for which no great treatments exist at present,” says Dr. Sanjeev Kumar, lead author of the study

and Medical Head of Geriatric Mental Health Inpatient Services at CAMH. Dr. Kumar and Dr. Rajji are both Clinician Scientists in CAMH’s Campbell Family Mental Health Research Institute. Healthy plasticity in the frontal lobes is important because researchers believe this brain region supports the brain’s “cognitive reserve,” or protection, that offsets poorer functioning in other brain areas that may contribute to the development of dementia. “Individuals with a higher reserve have been shown to develop dementia later in life than those with a lower reserve,” says Dr. Kumar. Continued on page 5

contents December 2017

8 Bringing play to dementia care

A primer on stroke

2 4 16 18 22 24 26 28 29 30



New avenue for Alzheimer’s Editor’s Note Security basics Improving falls detection Patient-centered care Holiday caregiving Caregiver SOS Women Leaders Digital health leaders Product spotlight

Cover story: Robots: The next frontier in seniors’ independence

Senior safety

Eldercare transitions


Music care



Diabetes and foot care


Preventing medical errors during a transfer of care


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technology ost of us have been or will be in the role of caregiver for a loved one at some point. I assisted my dad in providing care for my grandfather in 2001. One of the biggest challenges my father faced in caring for his dad was getting him to and from doctor appointments, ensuring he remembered to eat and that he was taking his medication. Living two hours away made it impossible for my grandfather to remain independent in his home and he was forced to move back to the city into my father’s house. His deterioration after that was rapid – he had lost his independence and became depressed and agitated. It was a situation borne out of necessity that wasn’t in his best interest but the only option available to him at the time. If we were faced with these same challenges now, we may have had a solution – a robot. This month’s cover story features the work being done to develop social robots that can remind seniors to eat, take medication, turn off the stove, and that is just the beginning. These robots can even provide virtual meetings with the patient’s healthcare team. In addition to the challenges of everyday living, many seniors face loneliness and isolation and the social robots can even assist in providing company to ward off the loneliness (see page 8). Robots aren’t the only way technology is enhancing senior care. At a residence in Ottawa, a team is working on improving falls detection with the assistance of artificial intelligence. One of the problems with falls is that the senior/resident has to call for help after-


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FEBRUARY 2018 ISSUE EDITORIAL: January 12 ADVERTISING: Booking and Material – January 23 wards – with this new technology (using the camera of a smart phone), falls can be detected without any input from the person who has fallen (p. 18). In this issue you will also find stories on security basics for long-term care facilities and how play and singing can be used to help with dementia; in addition to a primer on stroke, and how you can prevent medical errors during transfers of care. Our goal is provide you with information that will assist you in providing the best care possible to your patients or loved one. If you have a story you would like to share please email me. I would love to hear from you. LC

Kristie Jones Editor, Home and Long Term Care News

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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: Subscription rates in Canada for single copies is $35.00 per year. Canadian Publications mail sales product agreement number 42578518. From the publishers off Hospital News, reporting on health care news and best practices for over 30 years.


Exploring treatments for Alzheimer’s Continued from page 2 The research team used an innovative approach, developed by Dr. Rajji and his colleagues in earlier research, to study brain plasticity in the frontal lobes. In the CAMH-developed approach, the researchers use scalp electroencephalography (EEG), which measures electrical output generated directly by the frontal lobes in response to twopronged brain stimulation, referred to as paired associative stimulation (PAS). The participant wears a 64node cap that transmits the EEG signal, and researchers measure a person’s EEG signal before and after stimulation. Changes in this signal are an indicator of brain plasticity in the frontal lobes.

THE FINDINGS ARE PROMISING BECAUSE “IMPAIRED BRAIN PLASTICITY MAY BE A FUTURE TARGET FOR TREATMENT OR PREVENTION OF DEMENTIA The study included 32 people with Alzheimer’s disease and 16 healthy individuals, aged 65 or older. “In both healthy individuals and people with early Alzheimer’s disease, we were able to illicit a plasticity response from the frontal lobes, which is positive in that it shows that the brain circuits are still working in people with early Alzheimer’s disease,” says Dr. Kumar. “But plasticity was

significantly lower in people with Alzheimer’s disease.” Prior to the PAS arm of the study, each participant completed a memory test to assess the ability to recall alphabetic letter sequences. Individuals with impaired plasticity also had poorer recall ability. As next steps, the researchers are investigating approaches to enhance plasticity in the frontal lobes. This includes

research on brain stimulation alone or combined with brain-training exercises. Says Dr. Rajji, “Our goals now are: In people with early Alzheimer’s disease, can we recover plasticity in the frontal lobes, and will this lead to an improvement in memory? And, can we take this one step earlier – in people at risk of developing Alzheimer’s disease, can we enhance plasticity to prevent the progression toward illness?” The study was mainly supported by a grant from the Weston Brain Institute, and in part by the Canada Research Chairs program, the Canada Foundation for Innovation, a CAMH fellowship award and in-kind support from CAMH’s Temerty Centre for Therapeutic Brain Intervention. LC


Bringing the power of play to dementia care

By llan Mester B ho says playing is just for children? Adults can benefit from a dose of creativity and fun as well. That’s the philosophy behind Play Intervention ph p for fo Dementia (PID), a strategy developed by University of Toronto proop fessor Ka Tat Tsang in collaboration fes with wit the Yee Hong Centre for Geriatric Care in Toronto to engage seniors living with cognitive decline. With liv support from the Baycrest-led Centre sup for Aging + Brain Health Innovation (CABHI), ((C ), Yee Hongg is expanding the intervention’s reach and intervent delivering training deliv sessions to those ses that see the effects tha of dementia everyday: caregivers. c “The play process is very verpr many different ways ssatile; there’s so man you u can use play to engage seniors,” says William Leung, a social worker and senior coordinator coordinato at Yee Hong, adding that PID builds buil on professor Tsang’s Strategies & Skills Learning Development interven intervention (SSLD). “All human behavio behaviour in the SSLD system is seen as driven drive by an unmet need,” William explains. explain “So regardless if this behaviour is appropriate or not ap to our eyes, the person exhibiting this behaviour must have some form of uns met need, which is behind what’s motibeh vating the behaviour.” He uses the example of a senior with dementia sleeping during a day produ gram. “That person might be sleeping m because they’re feeling bored.”


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Professor Tsang and Adult Day Program staff at Yee Hong had an inkling that integrating the play process would stimulate the seniors in the day program, addressing some of those unmet needs. They initiated a ‘Toy Day,’ where they brought in a number of toys and games (everything from stress balls to Jenga blocks) for the seniors to engage with. “When we said toys they thought, ‘Oh, this is for children. Are you treating our seniors like children?’ No – anyone can have fun. The first step was actually to get caregivers and the seniors to understand that playfulness is not exclusive to children – each of us should be able to have fun when we’re doing things.” Initially, the play time was completely unstructured; there were no rules or instructions. “It’s not like you put a Monopoly board game and they follow the rules. It was a very freestyle way where we provided different objects and seniors actually had to eventually create their own rules and they started to interact with people beside them.” ‘Toy Day’ provided a lot of insight and further confirmed the potential of PID. Yee Hong decided to run PID for one year during its adult day program and received overwhelmingly positive feedback from clients and caregivers alike. “Some of the things we witnessed and observed were spectacular. It was very minute.” For example, Adult Day Program staff started noticing an increase in

NEWS talking amongst the seniors and a significant drop in washroom calls. “A lot of our evidence is anecdotal – it’s all reported from the family members that we’re seeing,” he adds. So where do caregivers come into this story? “Our wish is to postpone the seniors’ need to move into longterm care as much as we can,” William explains. “We want them to stay in the community and live the life they live. But the caregivers are crucial because if the caregivers fall apart, then there’s often no choice.” William applied for CABHI’s Spark program, which is designed to nurture early-stage ideas from point-of-care clinicians. CABHI provides up to $50,000 in financial support, plus guidance and feedback opportunities. “The whole CABHI team has been very supportive and responsive in every way,” says William. “Thanks to the financial support from CABHI, we’re able to expand this intervention to care-



Wendy Wu, who cared for a family member with dementia, has benefited from this first hand. The caregiver says the PID training was “eye-opening,” offering her a valuable strategy she could use to engage her family member. “All of us went home and felt the impact of the training,” she adds. “We sort of lost track of the person that

was buried inside the body that they don’t necessarily know how to express anymore. We have to sort of go back to the way we knew the person; we know what they like and what they didn’t like. So we kind of use that to engage them.” Wendy says PID also helped address physical issues. “I started using some of the PID principles with my family member after dinner. It was helpful because with dementia patients, their physical abilities can recede. So I learned to pay attention to that as well.

And how to bring something simple and fun that stimulates engagement. So that was very beneficial in the sense that we were now able to have a little more fun rather than being stressed all the time,” shares Wendy, adding the technique has reminded her of the importance of mental health and engagement as well. CABHI’s support is helping William deliver PID training sessions to caregivers in different languages (English, Cantonese and Mandarin). With the feedback from participants, William and his team are making adjustments to a PID workbook for caregivers that will have an even wider reach. “The beauty of PID is we are training people to look at play not as a set of rules,” William says. “We’re training caregivers that they can take any item in their home – it could be as simple as an elastic band that’s right in front of them – and make it into a play aspect that’s used to engage the senior.” LC

Ilan Mester is a Communications Content Specialist at the Centre for Aging + Brain Health Innovation Baycrest Health Sciences.

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The objective is to develop robotic assistance to help promote independence, quality of life and assist older people with activities of daily living


Dr. Nejat co-leads an AGE-WELL project to create social robots for older people with cognitive challenges. The aim is to help promote independence of the older adult, enhance their quality of life and assist with activities of daily living.

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Robots: The next frontier in seniors’ independence By Annie Atkinson ithin a few years, older Canadians could have their own affordable, mobile, intelligent robots specifically designed to help them stay healthy, independent and living at home. Dr. Goldie Nejat, director of the Institute for Robotics and Mechatronics at the University of Toronto, who holds the Canada Research Chair in Robots for Society, and Dr. François Michaud, founding director of the Interdisciplinary Institute for Technological Innovation (3IT) at Université de Sherbrooke, are leading a project to create assistive robots that can be used at home, as well as in hospitals, seniors’ residences and long-term care. The project is funded by AGE-WELL, Canada’s Technology and Aging Network. The robots will help with daily tasks by prompting seniors with cognitive impairment to do everything from brushing their teeth and getting dressed, to preparing and eating meals, doing exercises and remembering to take their medications. “The objective is to develop robotic assistance to help promote independence, quality of life and assist older people with activities of daily living,” says Dr. Nejat. “We focus on cognitive impairment, so what we really want the robot to do is prompt the person and remind them of the steps involved in a task. The robot doesn’t pick up the object or do the task, it helps provide encouragement and prompting for the older person to complete the task themselves.” The robots will also be able to assist with “brain training” through memory games that can help the older person retain their cognitive abilities. Telepresence will make “virtual” medical visits possible—without the older adult leaving the home. “The robot is used as a remote and mobile exten-


Photos courtesy of AGE-WELL Dr. Goldie Nejat with former graduate student Jacob Li and Casper the robot. sion of clinicians and caregivers,” says Dr. Michaud. It will also monitor the person’s well-being and signal for help in an emergency. Don’t imagine a tin box on wheels that goes beep. These are robots with a human-like face and arms, and a video screen at chest level. They will be capable of social interaction including natural two-way conversation, greeting and pointing gestures, facial expressions, and video and text instructions. The robots will also have the ability to move safely around the home, seniors’ residence and care facility environments. Dr. Nejat and her team are focusing on the human-robot social interactions and activities of daily living assistance aspects of the project while Dr. Michaud and his group are developing the telepresence, video, mapping and navigation capabilities. The project team also includes researchers at Western University and the Université du Quebec à Montréal.

Partners include CrossWing Inc., Vigilent Telesystems Inc. and Chartwell Retirement Residences. Members of the research team continue work on a large-scale needs assessment with seniors, using focus groups and questionnaires. Dr. Nejat is using a robot named Casper, created by her and her team, to interact with older adults in seniors’ residences and long-term care. Her group has gathered feedback about social, physical and behavioural features that will make the robots helpful and engaging for users. The results from all of these studies have been used to inform the creation of an AGE-WELL prototype robot, which is in the final stages of design. The prototype will be unveiled in 2018 for testing with users. “The users’ needs and wants are part of the process from the very beginning,” says Dr. Nejat, whose earlier work with robots has been featured in Time magazine.

Ultimately, this technology, which will be available on the market in two to five years, will “promote the independence of seniors with cognitive impairment, promote aging in place, minimize social isolation and provide cognitive intervention.” Mobile social robots will not only help older adults, they will also assist professional and family caregivers with elder care by “minimizing their burden of care and allowing caregivers to focus on high-level interactions and tasks with people,” says Dr. Nejat. “We’ve had a lot of input from caregivers about how they see the robot helping them. It’s included anything from reminders to reposition a resident in bed to serving as a translator since not all seniors and professional caregivers speak the same language.” People are looking at robotics as “the next big technology,” adds Dr. Nejat. “I think it will have one of the biggest impacts in our lifetime.” Jennifer Lee, who lives with her 96-year-old mother-in-law, can instantly see the benefits of a socially-assistive robot. “I think it’s a great idea,” says Lee. “And it’s needed.” A robot would bring her peace of mind when she is at work and her mother-in-law is at home, she says. Lee particularly likes the idea of someone watching out for problems, such as a fall, and ensuring that the stove is not left on. Another feature that excites her: virtual medical appointments. Getting to the doctor and sitting in waiting rooms can be a big deal for an elderly person and their family member. Doing it virtually would mean “freedom.” “I think this is amazing,” Lee says. “I want this for myself in the future.” LC

Annie Atkinson is a freelance writer. AGE-WELL is a federally funded Network of Centres of Excellence that is harnessing the power of new technologies to benefit older adults and caregivers. The pan-Canadian network brings together researchers, industry, non-profits, government, care providers and endusers to develop solutions for healthy aging. For more information, visit

DECEMBER 2017 Home and LongTerm Care News 9


Seniors safety in continuing care and the need for a holistic approach By Lara Croll he issue of seniors’ safety in continuing care has gained significant media attention across Canada over the past few years, in part due to high profile events such as fires at seniors’ care residences, and incidents of elder abuse. Yet issues pertaining to seniors’ safety are not just restricted to unusual and extreme events, but also include challenges such as the risk of falls, as well as adverse drug events (ADEs) caused by the use of multiple medications. While these everyday risks may not be highlighted regularly by the news media, they do adversely affect the health of seniors and impose significant costs to the health system. For these reasons, improving seniors’ safety must be seen


as a critical opportunity to ensure that our aging population remains healthy for as long as possible. Falls, for example, are overwhelmingly the most common cause of injury among BC’s seniors, as each year one in three seniors in BC experiences at least one fall. Moreover, injuries from falls account for 85 per cent of all injuries to seniors, costing the provincial government over $155 million annually in healthcare expenses. Frail seniors, particularly those in residential care, are at increased risk for falls, with the Office of the Seniors Advocate reporting that in 2015/16 there were over 3,000 reported incidents of a resident falling and being injured or experiencing another adverse event.

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Along with being the focus on a recent editorial by the BC Care Providers Association (BCCPA), the issue of resident-on-resident aggression in long term care has also been highlighted by the BC Office of the Seniors Advocate. While fortunately such incidents are rare in the larger context, the OSA estimates that in 2015 there were anywhere between 425 and 550 reported incidents of resident-on-resident aggression that resulted in some level of harm to another resident. Along with physical harm, these incidents cause emotional and psychological distress for the victim and other residents of the care home. The causes of such incidents are diverse and include factors such as the resident’s own personal history, phys-

iological factors, situational triggers, physical environments, and biomedical factors. Due to the wide range of factors that contribute to these acts of aggression, any solutions in this area must also be holistic. A more prevalent, though less visible safety risk for older adults is the inappropriate use of multiple medications, known as polypharmacy. Polypharmacy is an issue that affects many older adults in Canada and can increase the risk of drug interactions and side effects, including ADEs such as falls, hospitalization and even death. Older adults living in residential care homes are at high risk for polypharmacy, since they are often frail and suffer from multiple illnesses. According to the

NEWS try of Health residents in long-term care in BC are prescribed an average of nine medications, ranging between one and 42. While deprescribing and polypharmacy related initiatives in British Columbia have made some progress towards addressing this issue, according to a 2015 report by the Office of the Seniors Advocate, 51 per cent of residents in BC care homes are taking nine or more different medications. The BC Government has acknowledged some of the challenges related to seniors’ safety recently, with the development of a $10 Million BC Seniors Quality and Safety Program for the long-term care sector. This program, announced in March 2017, will provide residential care homes in BC with funds to invest in seniors’ safety and mobility equipment, such as resident lifts and wheelchairs. This initiative is significant, as it should reduce falls for frail seniors, as well as resident handling injuries for continuing care workers. The fund is being managed by the BCCPA and overseen by an Advisory Committee, who will determine appropriate

IMPROVING SENIORS’ SAFETY MUST BE SEEN AS A CRITICAL OPPORTUNITY TO ENSURE THAT OUR AGING POPULATION REMAINS HEALTHY FOR AS LONG AS POSSIBLE. guidelines for the allocation of these investments over the coming months. While the BC Seniors Quality and Safety Program is a significant step in the right direction, it is still limited to residential care and is narrowly focused on investments in equipment. As a result, it will likely not address other risks to seniors’ safety, such as preventing falls, as well as reducing levels of ADEs and resident-on-resident aggression. In order to address these issues further, the BCCPA has recommended that the BC government create a Provincial Seniors Safety Strategy (PSSS). As outlined in the 2017 BCCPA report entitled Strengthening Seniors Care: A Madein-BC Roadmap, this strategy would take a comprehensive approach to seniors’ safety in the home and communi-

ty care sector, addressing issues such as the use of technology, falls prevention, resident-on-resident aggression, reducing ADEs and elder abuse, to name a few. The BCCPA has also recommended that any such strategy be undertaken collaboratively, including not only the BC Ministry of Health and the Health Authorities, but also care providers, universities, research institutes, NGOs, and other stakeholders. The development of a PSSS should take a holistic and multiple-pronged approach to improving the safety of seniors in the continuing care sector. While working with the Advisory Committee from the BC Seniors Quality and Safety Program on issues pertaining to equipment, the development of a PSSS could also examine other strate-

gies, including building retrofits and redesigns to prevent falls; safe deprescribing initiatives to reduce polypharmacy and ADEs; as well as expanding access to life-enhancing therapies to prevent aggressive and responsive behaviours. Likewise, along with looking at ways to reduce elder abuse, the PSSS could look at technological solutions, such as monitoring and alarm systems as well as improving reporting systems so that safety incidents can be properly tracked and the root cause addressed. With the aging population, it is imperative that the we work collaboratively to prevent serious injuries from occurring in the first place. Though the creation of the BC Seniors Quality and Safety Program is a significant step towards this goal, it should be part of a larger initiative, particularly a Provincial Seniors Safety Strategy (PSSS) to address the spectrum of seniors’ safety issues through a diversity of approaches. In this respect, the BCCPA will continue to seek innovative ways to address safety issues and risks faced by seniors in the continuing care sector. LC

Lara Croll is BCCPA’s Policy Analyst.

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Three ways singing can be used in long- term care By Sarah Pearson inging can play a valuable role in long-term care. A staple of basic wellbeing, singing is a human activity that enhances physical health, increases socialization, reduces stress, improves circulation, and releases feel-good hormones. If that weren’t enough, singing also happens to support brain health for people with dementia.


SINGING OR HUMMING CAN HELP SOMEONE WHO IS IN DISTRESS TO CALM, CAN ENGAGE THEM, AND CAN CREATE A FEELING OF CONNECTEDNESS. Contrary to popular belief, no one needs to be an expert singer to use singing as a tool in long term care. We just need to have the willingness to take a deep breath and try something new. Here are three ways that care providers in can use singing to create meaningful relationships with residents. 1) Hum with a person who is distressed: humming is a natural way to connect to the breath, and create a calmer environment. It can cue someone in distress to calm down. For people who are too shy or intimidated to sing, humming can feel like an easier place to start. It’s quiet and less exposed than regular singing, and there’s no risk of “getting the words wrong.” The next time a resident appears anxious or in distress, move alongside them, and start humming the melody to something you find consoling. Perhaps it’s the tune to “You Are My Sunshine,” or maybe it’s an old AC/DC melody. Try humming it slowly, and with the intention of letting the person know you’re there for them. Notice how the

Staff at long-term care homes can use singing, or even humming, to achieve specific outcomes with residents. space around you may change, how the resident may change, and how you may feel differently. 2) Sing familiar songs: singing involves both hemispheres of the brain, which is why people who have neurodegenerative conditions such as dementia may not be able to say their own name, but they can sing all the words to “Over The Rainbow.” Singing familiar songs with residents can connect them to their memories, and engage them in a social activity. For folks living with advanced dementia, singing familiar songs may be one of the few remaining gateways into their identities. 3) Encourage group sing-alongs: there’s nothing quite like group singing for improving quality of life, feeling connected to others, and boosting

overall morale. Encourage group singing whenever possible with residents. Many professional musicians and music therapists will offer customized singalong programs for older adults. Digital group singing programs for memory care, such as the Pathways Singing Program, can offer a group singing experience when a live facilitator isn’t available. One of the main reasons we don’t see as much singing as is needed in most nursing homes is because of staff shyness or insecurity. Cultural attitudes about singing have made many people afraid of “getting it wrong” or sounding bad. The fact is, singing is a natural human impulse. It’s something that infants do for self-soothing, and that other mammals use for communi-

cation. Singing is a whole-self, holistic action. When we sing, our body, breath and spirit all work together. The voice is a direct result of the breath, musculature and overall mental and emotional state of a person at any given moment. If we are feeling nervous or threatened, the muscles that respond to fear will constrict and so too will the voice. When we feel impulsively joyous, our breath will dance and our voices will sing free. Singing can and should be used as much as possible. It’s something any staff member can initiate. The next time you or someone around you says, “I can’t sing,” consider where that belief is coming from. And then challenge it. It’s a belief worth challenging. LC

Sarah Pearson is a music therapist working in end-of-life care, a songwriter and professional musician, and is program development coordinator for the Room 217 Foundation. 12 Home and LongTerm Care News DECEMBER 2017


All about me Like you, people with dementia have their own hobbies, likes and dislikes. Like you, they have their own stories to tell. All About Me is an easy way for people with dementia to share their life stories, interests and more. Using All About Me, caregivers and health-care providers such as yourself can learn more about the person in your care. Download All About Me at While there, check out All about me: A conversation starter, the same resource in a shorter form, for when all you need is a “snapshot” of the person in order to start a conversation.

All aboute m klet about This is a boo g with a person livin disease or r’s me Alzhei ia. other dement


___ Name:______

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DECEMBER 2017 Home and LongTerm Care News 13


In long-term care, 21.3% of residents have had a stroke

A primer on stroke troke is one of the leading causes of disability and death in Canada. Out of every 100 people who experience a stroke, 15 die, 10 recover completely, 25 recover with a minor impairment or disability, 40 are left with moderate to severe impairment and 10 are so severely impacted that they require long-term care. In longterm care (LTC), 21.3 per cent of residents have had a stroke and stroke is the third most common diagnosis in LTC residents. Stroke is a medical emergency caused by an interruption in blood flow to the


brain either due to a blood clot (ischemic stroke) or uncontrolled bleeding (hemorrhagic stroke). Knowing the signs of stroke and reacting quickly can significantly impact on stroke recovery. For every minute that stroke treatment is delayed, the average patient loses 1.9 million brain cells. Rapid and appropriate emergency management after a stroke can substantially improve health outcomes For eligible patients experiencing an ischemic stroke, emergency departments may give tissue plasminogen activator (tPA), a clot busting medication, or perform an Endovascular

14 Home and LongTerm Care News DECEMBER 2017

Thrombectomy (EVT) which is an image guided mechanical clot retrieval to remove the source of the blockage. These treatments can significantly lessen brain damage thereby reducing the severity of deficits that can result from a stroke. Not all hospitals can provide these treatments and there are time windows, so it is critical to call 911 as paramedics will transfer the patient to the appropriate location and alert the stroke team in advance. A rapid response to the onset of new stroke symptoms should be regarded as a medical emergency and, in LTC, should be treated according to individ-

ual resident care plans and in accordance with their advanced care directive. Remember, time is brain! Transient Ischemic Attack (TIA) is also known as a “mini-stroke�. It is caused by a temporary blockage to blood flow in the brain with transient symptoms lasting from minutes to up to 24 hours. TIAs are considered warning events and should be taken very seriously as the risk of a subsequent stroke within seven days can be as high as 36 per cent. As with stroke, emergency treatment is needed and a rapid referral to a stroke prevention clinic should be arranged for follow-up.


Residents in LTC who have experienced a stroke can require complex care. Common effects of stroke include: • Paralysis or weakness on one side of the body • Vision problems (e.g. blurry vision, double vision or loss of visual fields) • Communication problems (e.g. aphasia) • Fatigue • Incontinence • Changes in how the person perceives or interprets the world • Neglect or inattention (decreased or no awareness of the affected side of the body, or the environment) • Changes in the ability to perceive touch, temperature or pressure • Personality changes (e.g. loss of emotional control) • Depression • Cognitive difficulties that make it hard to remember things, solve problems, and handle everyday tasks

IF YOU WANT TO LEARN MORE ABOUT STROKE CARE, STROKE BEST PRACTICES OR EDUCATIONAL RESOURCES FOR RESIDENTS AND FAMILIES, THERE ARE SEVERAL OPTIONS AVAILABLE. • Difficulty with swallowing • Increased or decreased muscle tone on the affected side of the body • Pain (in the affected shoulder or on the weak side of the body) Depending on the type and severity of a resident’s stroke, one or more of these symptoms may be present requiring specific interventions, approaches and/or equipment to support the resident in their everyday tasks. If you want to learn more about stroke care, stroke best practices or educational resources for residents and families, there are several options available.

• Taking Action for Optimal Community and Long-Term Stroke Care: A Resource for Healthcare Providers (TACLS), provides direction for health care providers on the provision of safe, evidence-based care for persons with stroke residing in community and long-term care settings. • Complementing the TACLS resource are the Stroke Care Plans for LongTerm Care (available via the CorHealth Ontario website). The Stroke Care Plans for Long-Term Care cover 12 focus areas (for example cognition, communication, behaviour, mobility)

and are a free resource which can be incorporated into a resident’s existing care plan. • The Canadian Stroke Best Practice Recommendations ( provide an in-depth, evidence based review of stroke best practices for all elements of care, across the continuum. • Partnering with the Stroke Community and Long Term Care Coordinator within your region to discuss strategies to incorporate best practices within your facility. Visit the CorHealth Ontario website to locate your stroke network and further contact information. • Heart and Stroke ( provides an overview of stroke and recovery as well as associated resources that may assist residents and families. Future articles will provide additional information on stroke impacts and specific interventions. Stay tuned! LC

This article was submitted by CorHealth Ontario Stroke Community and LTC Coordinators.

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Security basics for long-term care facilities By Martin Green t seems as though hardly a week passes by without there being a story in the news about an elderly person with Dementia or Alzheimer’s disease wandering away from a retirement home, long-term care facility or family home. More often than not, these stories have tragic endings. The population is aging more rapidly now as the “baby boomer” or “Silver Tsunami” generation hits their 60’s and 70’s. Just as society had to prepare and respond to the boomer generation in the 50’s by building schools, it now has to respond by building long-term care facilities, (LTC’s). According to the World Health Organization, (WHO) approximately 35.6 million people around the globe are currently living with dementia. This number is expected to double by 2030 and more than triple by 2050. It is estimated that 80 per cent of LTC Home residents have dementia, 60 per cent have serious mental illness 70 per cent of older individuals in LTC homes have behavioural problems, 30 per cent have severe issues. Right now in Canada, there are now more people over the age of 65 than under 15. In addition to the problem of patient/resident elopement from LTC facilities is resident violence. There have been numerous incidents where residents have attacked and seriously injured or killed other residents. In most cases, charges are not laid against the attacker due to their Dementia. In response to an incident that occurred in Toronto in June 2001, the Office of the Chief Coroner in Ontario held an inquest into the death of two residents at the hands of a third resident. Both the residents were deceased from severe head injuries at the scene. The resident was arrested and charged


EVERY FACILITY SHOULD HAVE A SECURITY MANAGEMENT PLAN. with double homicide. At his arraignment hearing he was sent to a Psychiatric Hospital for assessment, but died from a stroke while being assessed. The jury heard evidence from 43 witnesses and had 85 exhibits submitted during an inquest of 34 days. The jury deliberated over nine days. The Coroner’s jury reviewed the gruesome details surrounding the deaths, and made 85 recommendations. Not one of those recommendations mentioned security. The “Guide to the Long-Term Care Homes Act, 2007” in Ontario does mention security. It states that it is a “Fundamental Principle” that a Home is ….to be operated so that it is a place where its residents may live with dignity and in security, safety and comfort and have their physical, psychological, social, spiritual and cultural needs adequately met. Unfortunately, the guide does not address how individual homes are to provide security.


Risk Management – A systematic reduction in the extent of exposure to a risk and/or the likelihood of its occurrence. Also called risk reduction. Risk Acceptance – understanding that there is a risk, but that the risks do not have a high possibility of occurring. On the other hand, it also means that you understand that there is a risk of occurrence, but that is the nature of the business you are in.

16 Home and LongTerm Care News DECEMBER 2017

Risk Avoidance – the action that avoids any exposure to the risk whatsoever. Risk avoidance is usually the most expensive of all risk mitigation options. It also means that we chose not to do or be in this type of business. Risk Limitation – This strategy limits a company’s exposure by taking some action. An example of risk limitation would be a company accepting that an event may occur and avoiding their exposure by having regular training, strong and robust policies – Patient lift devices is an example Risk Transference – is the involvement of handing risk off to a willing third party. However, that does not eliminate repercussions to your facility in the event of an incident. CPTED Principles – Crime Prevention Through Environment Design, (CPTED) is a proactive design philosophy built around a core set of principles that is based on the belief that the proper design and effective use of the built environment can lead to a reduction in the fear and incidence of crime as well as an improvement in the quality of life. How hard is it for someone to get into your facility and enter the room of a resident, and equally important, how hard is it for someone to get out? As we move closer to a secure area the harder it should be to get to it. The main entrance of a LTC is a danger zone as it is the primary entry exit point and is often unattended, unmonitored or unsupervised. There are three primary goals in protecting residents in a LTC; reduce incidents of violence; stop unauthorized entry, (theft); stop unauthorized exit, (elopement). The International Association for Healthcare Security and Safety, (IAHSS) has developed the IAHSS

Healthcare Security Industry Guidelines and the Design Guidelines. These guidelines are written for all levels of experience and for all types and sizes of healthcare facilities, (HCF’s). These are very valuable resources for those people that are responsible for security regardless of their level of experience in the industry. Additionally, the IAHSS has developed the Long Term Care Safety & Security Management Guide. The IAHSS guidelines are applicable to ALL Healthcare facilities regardless of their size, type, or location. These Guidelines are very useful for all levels of security management as well, from the seasoned Security Director in a large facility, to a person who wears many hats in a smaller facility.


By taking the necessary steps to ensure that your facility has a viable security plan, you lower the risk of resident elopement.

Recently, IAHSS conducted a survey of Long-Term Care facilities across North America. The survey identified four top areas of concern • Resident aggression/violence • Public aggression/violence • Theft from residents and staff • Elopement/wandering Looking specifically at applications for LTC’s the Industry Guidelines are divided into eight different categories, but the one category that is most applicable to LTC’s is the first section which focuses on “Program Administration” The Program Administration section is further divided into nine

sub-categories. Of the nine subcategories, the three most applicable are Security Management Plan; Security Administrator; Security Risk Assessments Every facility should have a Security Management Plan. This has to be based on a Risk Assessment. Current best practices recommend that a Threat Risk Assessment, (TRA) should be conducted annually by a qualified security professional. It is recommended that the initial or original TRA be conducted by an external person. This provides for a fresh perspective or new set of eyes to examine your facility and your program and to

help identify areas for improvement. Program Administration – there must be someone in your facility that has a clearly defined role and job responsibility for security. Many facilities may not have a security manager, security department or program, you still have a person that has over-all responsibility. If you don’t have the required specialized knowledge it is incumbent on you to engage security expertise. When you are seeking outside expertise, ensure that it is from a qualified professional who has specific training and experience in healthcare security. There are many companies and individuals that promote themselves as

healthcare security “experts”. When selecting a consultant look for a direct background in healthcare. Look closely at their background, their experience; their education and credentials. A “Certified Healthcare Protection Administrator”, (CHPA) designation is highly desirable. A CHPA will have the industry specific knowledge that is required to provide an accurate assessment. By taking the necessary steps to ensure that your facility has a viable security plan, you lower the risk of resident elopement, resident violence while at the same time providing a safer facility for your residents and staff. LC

Martin Green is the Manager, Security, Telecommunications & Emergency Preparedness at Baycrest Health Sciences in Toronto, Ontario. He is also the current President of the International Association for Healthcare Security & Safety, (IAHSS).

DECEMBER 2017 Home and LongTerm Care News 17


New technology for an age-old problem By Anthony Remaud and Michaela Berniquez team at Ottawa’s Saint-Louis Residence is working at improving falls detection systems in long-term care (LTC) homes. They’ve come up with a solution to receive alerts as soon as a fall occurs, while collecting accurate information of what happened. They have turned to Artificial Intelligence to help turn this idea into a reality.



In Canada, half of all LTC residents experience one or more falls annually. In addition, if a resident has fallen in the past, they are at high risk of falling again. According to the Public Health Agency of Canada, 40 per cent of thosee who fall once will fall again at leastt twice more that same year. Not only does falling have a seriouss physical and psychological impact on n an individual’s quality of life, it also o contributes to a significant burden on n health systems. Many resources and serrvices end up being directed to addresss the consequences of falls. In 2014, thee Canadian Institute for Health Inforrmation estimated the annual direct ct healthcare costs for falls in Canada at $2 billion.

The variety of factors that can contribute to a fall can make prevention strategies difficult to implement especially as homes strive to support the independence of residents. A key challenge is that most falls in LTC homes are unwitnessed, and that falls most often happen when care providers are less available due to peak care demands or shift changes. Current fall detection systems in LTC homes often require that the resident call for assistance after a fall occurs, which they may not be able to do. In these cases, the resident may remain on the floor until found by a staff member. As no witness exists and the residents themselves are often unable to communicate exactly what

18 Home and LongTerm Care N News DECEMBER 2017

occurred, it is challenging for front line staff to understand what happened and to put appropriate preventative measures in place.


The RemoCare TeleHealth System is an advanced remote care solution developed by Remotronic Inc. that uses the built-in camera in today’s smartphones/tablets to capture important health data for viewing by point-of-care staff. RemoCare then uses artificial intelligence to continuously analyze the videos to identify a fall.

When a fall is detected, an alert is sent to front line caregivers, who can then determine follow-up action. RemoCare has demonstrated its ability to accurately detect falls and to provide an alert when one occurs in community settings. However, falls in a LTC facility can look very different than those experienced by people who live in the community and are usually more mobile. Falls in LTC homes can occur with less motion, at slower speeds, may involve mobility aids (e.g. walkers and wheel chairs), and may be more difficult to distinguish from a normal range of motion within the room.

l t



Since the beginning of this year, the Saint-Louis Residence team of managers and front line nursing staff and supported by the Bruyère Centre for Learning, Research and Innovation, has been working on the project aimed at assessing the effectiveness of the RemoCare TeleHealth System in detecting falls in a LTC setting. This activity is funded by the Centre for Aging + Brain Health Innovation (CAHBI) Spark Program. After gath-

ering ethics approval, the team is now preparing to monitor and collect resident data. Feedback and comments were gathered from staff and families at meetings and through open houses. For this first field testing, data collection will only involve a small group of volunteer residents. Smartphones with the RemoCare application will be placed in rooms of LTC residents that are known or suspected to be at high risk for falls. Should a fall be detected in a resident’s room, a real time alert showing a video of the time

leading up to and following the event will be sent to point-of-care staff. Staff will be equipped with smartphones to receive the alarm and view the video of the event to determine follow-up actions, in addition to existing processes.


Falls Prevention and Management Program policies and procedures are

based on validated and reliable results collected on large data samples. As a result, more data will be needed at the Saint-Louis Residence before any change to existing evidence-based policies and processes can be made. Still, this technology has the long term potential to reduce the frequency of falls in LTC by allowing front line staff to learn from and adapt to the causes of falls. If successful, the RemoCare TeleHealth System could be implemented in other LTC homes across not only Ontario, but Canada as a whole. LC

Anthony Remaud and Michaela Berniquez, Bruyère Research Institute.


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Diabetes and foot care By Susan C. Jenkins oot problems can develop quickly in people with diabetes, making proper foot care vital. In addition to careful attention to daily foot care, people with diabetes should have their feet examined by a healthcare professional on a regular basis.



• Athlete’s foot: This fungal infection can cause the skin to become red and itchy and lead to cracking. A doctor, foot care specialist, or pharmacist can recommend an appropriate product to treat athlete’s foot. • Blisters: Do not break open blisters, because the top layer of skin helps protect against infection. Cover the area with an antibacterial cream and a soft, clean bandage. • Calluses and corns: After a bath or shower when the area has softened up a bit, use a pumice to remove excess tissue. Do not try to remove them with sharp tools or over-thecounter products. Persistent problems should be treated by a doctor or foot care specialist. • Foot ulcers: While anyone can develop a foot ulcer, people with diabetes are more prone to them. Some studies indicate that as many as 15 per cent of people with diabetes will develop a foot ulcer during their lifetime. These foot ulcers can lead to gangrene, amputation and, if appropriate care is not provided, even death. Foot ulcers usually start out as a cut or scrape that does not heal quickly. If a foot ulcer develops, it is imperative to seek medical attention right away to prevent infection. • Hammertoes: A hammertoe occurs when weak muscles lead to shortening of the tendon in the toe, causing the toe to curl under. This not only hampers mobility, it can lead to blisters, calluses, and sores. Splints and corrective footwear help in

some cases; other times surgery may be necessary. • Infected toenails: Nails that are yellowish-brown or opaque, are thick and brittle, or crumble or separate easily may have a fungal infection. Treating nail infections can be difficult, and anyone with diabetes should have an infected nail treated by a healthcare professional. • Ingrown toenails: This problem can usually be prevented by trimming nails straight across, not dipping down at the corners. If an ingrown toenail does develop, it must be treated by a doctor or foot care specialist. • Plantar warts: These growths, which appear on the soles of the feet and may form in clusters, are caused by

a virus. People with diabetes should not use OTC wart removers; they should see a doctor or foot specialist for treatment.


Fortunately, nurses are able to detect foot problems early and prevent them from becoming serious. They can: • Teach patients and caregivers how to follow a daily foot care program that will reduce the risk of problems • Explain how to select and use appropriate creams and lotions • Perform periodic foot examinations to identify problems early when they are most easily treated • Educate patients about proper wound care

• Encourage physical activity and/ or physical therapy to promote mobility • Evaluate each patient’s needs, physical status, and cognitive abilities and design an education program suitable for each patient and his/ her family • Select appropriate dressings according to the type of foot ulcer to help keep the wound clean and reduce the number of bacteria • Educate patients in the use of assistive devices such as canes, walkers, and aids for pulling on support hose • Maintain proper documentation Nurses are a crucial part of the healthcare team, and their knowledge and expertise can enhance the quality of life for patients with diabetes. LC

Susan C. Jenkins is a freelance writer and editor specializing in medicine, pharmacy, and healthcare. She can be reached at 20 Home and LongTerm Care News DECEMBER 2017


Eldercare transitions:

Appoint your own Power of Attorney before you need one

By Susan Hyatt saac Asimov, the prolific American writer of science fiction and popular science, coined many sayings. One of them was this: “Life is pleasant. Death is peaceful. It’s the transition that’s troublesome.” He could have been talking about healthcare in Canada, especially regarding the elderly. Today the elderly are living longer. Many of them have complex needs for health and personal care involving different providers, often in multiple locations. If a hospital stay is required, the number of healthcare providers goes up exponentially. The result is that people consistently report how disjointed and poorly coordinated care is as they transition from one setting to another. Serious gaps in care often occur when a person moves from one care setting to another. The Canadian Patient Safety Institute here was formed to address these gaps, and to offer education to patients and health providers. The purpose? To improve care during these handoffs or transitions. The reality today is that hospital budgets are stretched, too many patients try to get into the hospital, and not enough people are discharged. One would expect the focus to be on organizing care around the person, and their future needs and wants. But this remains an ongoing challenge, and only part of the equation involves healthcare providers, coordinators and discharge planners. There is also the family side to consider. Alzheimer’s Ontario reports that 70 per cent of Ontarians do not have a Power of Attorney for Personal Care.


This can have dire consequences for the elderly in transition. Why do you need a Power of Attorney for Personal Care? If a person can’t make decisions about their healthcare and personal care, or about where to live in order to get care in the future, the POA for Personal Care can be a substitute decision-maker. Picture this scenario. An elderly woman is medically well enough to be discharged from hospital, but confused and unable to make decisions about her own care. There is no POA. Her three adult children argue about where she should go. The oldest daughter wants the mother to live with her and have private home care around the clock, but this costs a lot of money and the family can’t afford it. The son wants her in a retirement home with assisted living care, which is less expensive. However, the waiting list for long-term care is four years and in the meantime someone must pay privately for living accommodations and care. The other daughter is caught in the middle and doesn’t know what to do. The three siblings are in constant battle, and every member of the family is stressed. Sometimes this is enough to fracture family relationships.

But an appointed POA for Personal Care can solve many of these problems. It provides a legal document with a designated, trusted person (or persons) appointed to take on such duties. This is someone whom the mother trusts and who knows her wishes if she can’t act for herself. It could be one of her children or someone else she trusts. Here are examples where a POA can ensure coordinated transitions: • The family G.P. doesn’t know about medications prescribed by the hospital or by the other doctors involved, and meanwhile, prescriptions must be filled and appointments made with specialists. The POA can organize these appointments and advocate for the mother, keep the records in order, and organize medications with the local pharmacist. • A nurse practitioner working with one of the specialists organizes follow-up appointments with four different doctors, but no family member can take time off work to take the elderly person. As a result, the appointments get cancelled. The POA can take the necessary steps to make sure these appointments are kept and delegate an advocate to attend.

• What with all the medical people, healthcare navigators, and care coordinators involved, the POA can be the quarterback for schedules and appointments, organize transportation to and from appointments, and organize the coordinators and all the required information and health records. Not having a POA for Personal Care can help trigger the ‘domino effect.’ Consider what happens when an elderly person has a sudden fall, a stroke, or a broken hip. It can lead to a cascading set of crises, involving financial issues, questions about accommodation, and who can make care decisions on behalf of the elderly person. The fact is most people will have to depend on private caregiving, at least short- term, and this can be expensive. You need a trusted person who has the time and expertise to search out the best providers, and sort out all the costs and options. The POA for Personal Care understands the elderly person’s wishes and can make these difficult transitions easier. Life happens, and we all need to appoint a POA for Personal Care while we can before it is too late. LC

Susan Hyatt is the CEO of Silver Sherpa Inc.

DECEMBER 2017 Home and LongTerm Care News 21


Addressing the person at the centre of the community based

homecare services model By Jane Teasdale s we age we may lose control over the physical and cognitive aspects of our being. We may develop a new set of relationships, ones that are primarily focused on our physical and mental incapacities, to varying degrees. Our reason for being may be increasingly viewed through the medical and personal support lens and many of our own interactions risk being limited to exchanges within these same relationships and viewpoints. Yet, we know that there are a great many dimensions to a person: there is the creative, the existential, the social, spiritual, emotional, cultural, the active and physical, the community engaged, and the ways in which these many dimensions interact with the place in which we live. Very few of these avenues end up being addressed by the task focused and increasingly cost constrained medical, nursing or personal support interventions. Should our frailty stop us from being seen as “beings of meaning”, still willing to contribute, to experience, to interact in meaningful ways, to create and to experience new moments of existence? No, and this is the heart and the essence of the wider dimensions of person-centered care models. The 2011 Joseph Rowntree Report “A Better Life – What Older People With High Support Needs Value” stated that “the focus of care has been on the older adults’ needs in relation to services, rather than their broader aspirations in relation to their lives” and we agree. More recently Skilbeck et al (October 2017) in “Making Sense of Frailty: An Ethnographic Study of the Experience of Older People Living with Complex Health Problems” pointed out the continuing


Martha Miller, Mosaic Client Liaison, and Janet Turnbull discuss interests and plan activities. “disconnection between frail older people’s experiences and current health policy” and the fact that they were still viewed in terms of their “impairment, problems and dependency”. The issue of the medical lens remains very much a here and now problem. So just what is person-centered care in the wider dimension of being? Well

it depends on a number of things: first and foremost, it depends on where you are in the chain of care and what your scope of service or role is; it will also depend on the interactions you have with the person and the range of interactions you have with others in the wider community. But, it will also depend on the gaps in care that you can

see and that you can address and this will also depend on your organization’s processes, rules, bureaucracy and financial priorities. A great many organizations say they are person centered, yet academic research in the matter has tended to find quite widespread weaknesses in communication, documentation, process

Jane Teasdale is Director Business Development & Community Relations, Mosaic Home Care Services Inc and Community Resource Centres, Toronto, Ontario, Canada. 22 Home and LongTerm Care News DECEMBER 2017


and implementation. So how deeply your person-centered care processes are embedded in your service structures, your awareness of the whole and the complexity of the wider dimensions of care are also clearly important. With respect to issues of physical and mental impairment, the physician, geriatrician, nurse and personal support functions would focus on developing empathetic structures facilitating joint decision making and inclusion, with respect to personal preference and culture, inter alia, in developing treatment and care plans. This is a fundamental building block of all person-centered care relationships, but it does not go far enough if we are to address the wider dimensions of mind and being of older adults. Empathy for the ailment alone is insufficient. Home care is one of the furthest points along the chain of care that you can get for the older adult. It occupies an important space in the care continuum, dominating essentially large parts of the person’s space and time. The home is especially relevant to aging in place dynamics and is much closer to the highly important dimensions of the mind and community interaction. It was this proximity to community and aging in place, engendered by our long standing belief in the importance of age friendly communities that helped focus our attention on developing our own person-centered care interface, “The Meaning of Me®”. This service component extends the notion of person-centered care to one that embraces the voice and the rich habitat of the mind and the being of the person, to be especially sensitive to the importance of community and the person’s place in the community. The service allows client/caregiver in-

AT A FUNDAMENTAL LEVEL, “THE MEANING OF ME®” IS A CONVERSATIONAL FRAMEWORK THAT BECOMES AN INTERACTIVE JOURNEY BETWEEN ALL THOSE INVOLVED IN THE CARE RELATIONSHIP. teractions to move out of dimensions that address physical and mental incapacity and into those dimensions that impact mental and physical habitats. The culture it supports helps focus our entire organization onto the specifics of person-centered care along all levels of interaction. When looking at the wider dimensions of the person and our interactions with the person, we did not specifically want another task, another document to fill in and file away. We wanted something that was outside of the home care process in the sense that no care based information would be recorded or discussed. The person would decide which issues he or she wanted to talk about and pursue, whenever they wanted to. We wanted interaction to be meaningful. Ultimately we wanted a creative space where the mind could grow and develop and experience new moments. The focus of the interface would take the client away from the needs and demands and restrictions of care and encourage interaction with community, where possible, with interests and activities and with others. At a fundamental level, “The Meaning of Me®” is a conversational framework that becomes an interactive journey between all those involved in the care relationship. It differs in many meaningful respects from other similarly framed interventions paying attention to, as Daniel Kahneman would say, the

remembering self and the experiencing self: to remember, to create to positive experience. It is therefore a framework very much aware of the dynamics of interaction and the processes required to provide the necessary creative space and loop back to the client. The actual model itself, the logistics behind delivering the service, staffing,

resources, supports and how we actively engage with the person are other important aspects of our model and we cover these in more detailed presentations on the subject matter. For the sake of brevity we have not expanded on our own community outreach and interactions that we also feel are integral to the development of the holistic person-centered care model at this end of the chain of care. Through a deeper assessment and exploration of the wider dimensions of being across the chain of care we should help develop a better understanding of identity and its sustenance within a model of care that addresses this wider vista, this symphony of personhood and being. LC

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DECEMBER 2017 Home and LongTerm Care News 23


Caregiving during the holidays:

less stress, more joy By Crystal Gondor hen a loved one needs around-the-clock care, the holiday season can trigger more stress and guilt than joy and peace. Even under the best circumstances, the holidays can be a complicated time. The day-to-day demands of caregiving combined with holiday expectations, can leave you feeling overwhelmed. The tips below can help ease seasonal stress as a caregiver. Adjust your expectations. From the get-go, try to be realistic about what you can and cannot do over the holidays (remembering to consider what you actually WANT to do). By setting limits and realistic expectations, you’ll be more likely to enjoy yourself. If you’re someone that loves to go all out, give yourself permission to scale back. Little


adjustments like a potluck instead of a five-course meal, asking another family member to host and just saying “no” to another holiday gathering can make a big difference. Ask for and accept help. Being open and honest with your friends and family about the demands of caregiving will make them more likely to reach out. Often people want to help but they don’t know how. Ask for an afternoon off to work on your holiday to-dos or try delegating tasks to willing family and friends. Say yes to prepared meals or a neighbour’s offer to decorate. If you’re struggling to manage the difficult emotions that come with the holidays, visit an online message board, find a local support group or seek professional help from a counsellor or therapist.

Mix new with the old. If you feel like your holiday traditions are being left behind, try making a few updates. Instead of baking cookies together, focus on the fun of decorating them. If trimming the tree has become a challenge, ask your loved one to pass you ornaments or start untangling the lights. Take a drive to see the holiday lights or watch festive films to include your loved one in the season. Focus on the holiday joys you can experience together and the lasting memories you’re creating. Make some modifications. Stick to a regular routine so things don’t get too disruptive for you or the person you’re caring for. If you’re planning on hosting family and friends, make sure there’s a room in your house for your loved one to rest and recharge. Smaller family gath-

erings may be less exhausting and more enjoyable and technology is always a nice way to visit the holiday parties you can’t make. Put yourself at the top of your list. Although this is always a challenge, when you’re busier than usual, self-care can start to slip. Try to prioritize getting exercise, eating healthy (with room for holiday cheats) and soaking up some Vitamin D outside. Take a break from the holiday hustle and do something you enjoy like reading, knitting or getting a massage. As always, taking good care of yourself will make you better at looking after others. By managing expectations and finding different ways to celebrate together, you’ll not only survive the holiday season, but also make new memories to cherish. LC

Crystal Gondor is a Communications Consultant for VHA Home HealthCare. 24 Home and LongTerm Care News DECEMBER 2017


Preventing medical errors during a transfer of care By Michael Wong and Stephen Routledge edical errors can occur when patients are transferred home or to a longterm care facility. Patients and their caregivers should ensure that prescribed medication regimens are understood and, in particular, that any regimen involving opioids is monitored appropriately.



Patients’ non-adherence to physician-recommended medical treatment remains a persistent problem. It is estimated that 50 per cent of patients do not take their medications as prescribed. Consequently, clinicians should take steps to actively engage patients and their families as partners in their health. Most importantly, before transfer and discharge clinicians should ensure that patients have the information they need to use their medications safely. According to the Safety at Home: A Pan-Canadian Home Care Study, one in six seniors receive home care services in Canada and it is estimated that the rate of adverse events that have the potential to cause harm is 10-13 per cent. Given that many home care recipients are taking multiple medications,

it is very important that patients and family members understand medication regimens to reduce the risk of preventable medication incidents. Patients and their caregivers should ask and understand the answers to the following questions about their medications – as well, prescribing clinicians should make sure that their patients understand the answers to the following five questions about their medications: 1. Have any medications been added, stopped, or changed, and why? 2. What medications do I need to keep taking, and why? 3. How do I take my medication, and for how long? 4. How will I know if my medication is working, and what side effects do I watch for? 5. Do I need any tests and when do I book my next visit? We encourage patients and their caregivers to download a PDF version of these five questions and share with their patients here. The tool was jointly developed by several organizations (including the Canadian Patient Safety Institute) aiming to improve communication between patients and their caregivers with prescribers. It is available in over 22 languages and can be customized with a logo for implementation in a healthcare facility.


Patients are often sent home with patient-controlled analgesia (PCA) pumps and opioids to manage pain. Although opioids may help to manage pain, patients and their caregivers should be aware their use could result in adverse events or even death. As The Joint Commission cautions: While opioid use is generally safe for most patients, opioid analgesics may be associated with adverse effects, the most serious effect being respiratory depression, which is generally preceded by sedation. The PCA Safety Checklist was developed by a panel of experts to reduce the risk of opioid-related adverse events occurring with the use of patient-controlled analgesia (PCA) pumps in-hospital. Patients and their caregivers should be aware of increased

risk factors for respiratory compromise as noted in the Checklist, which include: • Obesity • Low body weight • Concomitant medications (both opiates and non-opiates) • Pre-existing conditions, such as asthma, COPD, and sleep apnea • Advanced age Moreover, the PCA Safety Checklist recommends that patients be monitored with pulse oximetry for oxygenation and capnography for adequacy of ventilation. In hospital, these monitors may provide an early indication of patient deterioration and the onset of respiratory compromise. The patient, who is at home or in a long-term care facility, may want to consider such monitoring to ensure their safety. For more resources dedicated to patient safety, please visit the CPSI and PPAHS websites. LC

Michael Wong, JD, is Founder & Executive Director of the Physician-Patient Alliance for Health & Safety and Stephen Routledge, MPH is Patient Safety Improvement Lead, Canadian Patient Safety Institute.

DECEMBER 2017 Home and LongTerm Care News 25


My wife’s dementia has her rummaging through the house

How do I cope? My wife has had Alzheimer’s for a few years and I have coped with many issues. Lately, she has taken to going through all the drawers in the house. This is making me very upset. Signed, Looking for a solution hough this behaviour isn’t uncommon, it can pose dangers to a lot of individuals living with dementia. This is not a unique behaviour your wife is exhibiting. A lot of individuals with dementia start looking through different places in search of items. I have witnessed this searching in the fridge, closets, cabinets and many other household locations. It is critical to deal with the safety factor related to this behaviour. Rummaging, as it is often called, can end up with a person accessing things that are dangerous, such as: toxic products, household cleaning supplies or tools and equipment. Some people rummage and then taste the items that they open, so it is critical to look around and lock up areas that may pose a potential safety issue. Some individuals take valuable or important items like chequebooks, jewelry, keys or important personal papers and place them in other locations. Ideally, you should ensure that these items couldn’t be found if a person is rummaging. Mail is also often a rummaging target that is easy to find. If it were clear and evident why a person was rummaging it would be easier


to contend with this behaviour. People with dementia may rummage for a variety of reasons. Some people may have a logical reason for this behaviour, as they may be thinking of something specific or are in search of something that has been recently triggered in their memory. The person may or may not be able to tell you what it is that they are looking for. Sometimes, they may stumble across it, which will cease the behaviour. Other people keep searching and simply cannot express what they are looking for. If they can’t tell you, leave them be. It will be frustrating for both of you to try to figure it out. Another common time people rummage is when they are hungry or thirsty. They may not be able to convey their need, so they set off in search of food. It is easy enough to see if a snack or a drink may interrupt this behaviour. More often than not, it is hard to know exactly why a person with dementia rummages. Boredom is another factor. They may not be able to properly occupy themselves. Finding some activities that can distract or interest them is another potential solution. As with other issues in dementia, you may have to deal with the problem

without ever figuring out its source. I frequently suggest closing off unused rooms. Often, things are hidden in the same spot over and over again. Check these “favourite” spots and if possible, minimize them. Garbage cans — and other containers that look inviting — should be stored out of sight. Another possible solution is creating a designated rummage area. This can be set up in a place that is easy to monitor. Choose a location that can be seen easily and place items that are not dangerous to rummage through. Old mail, pictures and other household items are good options to keep in this space. Redirecting someone to look in an area may keep them busy and dis-

tracted. I know of other caregivers who have used a designated rummage box and they hand it to the person to look through. Once the danger and concern of losing items is minimized, rummaging is not as much of a problem, it becomes relegated to a nuisance. Like other difficult behaviours related to dementia, ensure that the person is in a safe environment and make sure to secure your things. Once that is done, hopefully this phase, like many other difficult phases, will pass. 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 Email questions to This article originally appeared in the Toronto Star. 26 Home and LongTerm Care News DECEMBER 2017

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Canadian Women Leaders in Digital Health for 2017 New award celebrates the top ten female visionaries who are harnessing the power of IT to transform health and healthcare in Canada today igital Health Canada announced the winners of the inaugural Women Leaders in Digital Health Awards. The winners are: • Dr. Elizabeth Borycki, a tenured Professor in the School of Health Information Science and an Adjunct Professor in the School of Nursing at the University of Victoria • Shelly Cory, Executive Director of Canadian Virtual Hospice • Dr. Kathryn Hannah, Health Informatics Advisor to the Canadian Nurses Association (CNA) and Exec-


utive Project Leader of the Canadian Health Outcomes for Better Information and Care project • Elizabeth Keller, Vice-President Product Strategy & Delivery for OntarioMD (OMD) • Shelagh Maloney, Vice President, Consumer Health, Communications and Evaluation Services, Canada Health Infoway • Dr. Lynn Nagle, Assistant Professor at the Lawrence S. Bloomberg Faculty of Nursing and the Institute of Health Policy, Management and Evaluation at the University of Toronto

• Dr. Maureen O’Donnell, Associate Professor, Department of Pediatrics, University of British Columbia (UBC) and Executive Director, Child Health BC • Diane Salois-Swallow, Chief Information Officer, MacKenzie Health • Shirlee Sharkey, President and CEO, Saint Elizabeth Health Care • Heather Sulkers, Director of Clinical Informatics, Centre for Addiction and Mental Health The Women Leaders in Digital Health Award was created to celebrate the top ten female vision-

aries who are harnessing the power of IT to transform health and healthcare in Canada today. The award is inclusive of all women of influence in health information technology, no matter what their specialty, and is open to all women in the digital health community in Canada. Finalists were selected from peer-nominated submissions by the 2017 Women Leaders in Digital Health Award Adjudication Committee, consisting of Canadian health industry professionals. Continued on page 30

28 Home and LongTerm Care News DECEMBER 2017


Caregiver worries less with digital health By Shelagh Maloney heryl Ford has less to worry about since her mother Nancy Huyck, who lives alone with Chronic Obstructive Pulmonary Disease (COPD), has been using digital tools to track her vitals. The information is made available securely to her care team, which includes Cheryl, who is her mother’s primary caregiver. “I spend less time wondering how my mom is doing now, because all I have to do is log on and see for myself whenever I want,” Cheryl says. “The peace of mind it gives me is great, but the real value is in the changes I’ve noticed in her health since she started using remote patient monitoring tools at home. Problems are noticed earlier and dealt with before they become more severe.” The South Central Community Development Corporation, the project’s sponsor, is working with Middlesex-London Emergency Medical Services (MLEMS) and 10 other community paramedic services across Ontario to provide the Community Paramedic Remote Patient Monitoring (CPRPM) program. The digital health tools they place in the homes of patients enable them to measure their vitals including blood pressure, weight and oxygen levels. Paramedics, who intervene proactively when they note a change in an


Cheryl Ford (L) and her mother Nancy Huyck take a break from volunteering at the Back to the Garden Music Festival at Jones Farm in Dorchester, Ontario on August 20, 2017. individual’s health status, monitor the information on an ongoing basis. The goal is to keep patients like Nancy as well as possible so they can remain in their homes, and out of the hospital. It is also an innovative way to provide real value to caregivers and loved ones. According to Rick Whittaker, CPRPM Project Lead, the goal is being achieved. Patients like Nancy are experiencing a decrease in the need to go to the emergency department or walk-in clinics. “The most expensive place to deliver healthcare is in the hospital, where few patients want to be, while the least costly place to provide care is in the home, where most patients want to be,” says Whittaker. “If the goal is to reduce health care expenses and improve the patient experience, I think investing in remote patient monitoring is a sure bet.” When Nancy enrolled in the program, a MLEMS paramedic came to her home to teach her how to use the

tools, and ever since, she has been measuring and transmitting her blood pressure, weight and oxygen levels every day. Readings that require follow-up are flagged, and a secure portal provides Cheryl and the rest of Nancy’s care team with up-to-date results. “One day, mom received a call from the paramedic when her blood pressure was higher than usual,” says Cheryl. “He made an in-home visit to see her, and decided to get in touch with her doctor and they worked together to resolve the issue before I even knew there was a problem.” “Avoiding a trip to the doctor was an obvious benefit,” adds Nancy. “But getting to know my own results has taught me to make changes early on in order to avoid complications down the road, and that has been an added bonus.” Michael Green, President and CEO, Canada Health Infoway, believes providing patients and caregivers like Nancy and Cheryl with digital health tools is key to improving access,

patient outcomes and health system efficiencies. “We can help reduce wait times in the emergency department for everyone by creating innovative ways to support patients like Nancy, so they can avoid going there in the first place,” says Green. “Canadians have been quick to adopt these and other digital health tools that are fueling improved outcomes and health system efficiencies,” he adds. “The vast majority of Canadians want access to digital health tools. Providing it to them and to their caregivers will enhance their health care experience, which leads to better outcomes.” For Cheryl, that means less time worrying about her mother, and more time spent on activities they both enjoy, such as volunteering. “Digital health is helping me be a more informed caregiver, and is supporting me so I can better balance my obligations with the time I spend enjoying my mother’s company,” she adds. LC

Shelagh Maloney is Vice President, Canada Health Infoway.

DECEMBER 2017 Home and LongTerm Care News 29


Canadian Women Leaders in Digital Health Continued from page 28 The selected finalists were acknowledged as having contributed to the advancement of digital health through leadership and influence in their jurisdiction or nationally; involvement with organizational change or transformation through technology; and impact on health outcomes or health system improvements. Digital Health Canada board member Susan Anderson, Managing Director at Orion Health, led the creation of the new award. Her vision was for an award one that would celebrate leadership in two specific groups: women in digital health, and everyday leaders whose achievements go unrecognized in the industry. In the context of the Women Leaders in Digital Health Award, leadership can be found in anyone willing

to challenge themselves by stretching their personal goals. Leadership behavior, regardless of position, includes mentoring, communicating with confidence, collaborating, and striving daily to provide a positive example and create a rewarding experience for others. “The beauty of the digital health industry is that it creates more opportunities for leadership,” said Ms. Anderson. “Not just within organizations, but across the entire digital health network. Development opportunities across the industry enable people with leadership initiative to break out of their traditional roles and participate. I think more and more organizations are encouraging employees to reach out, volunteer, connect, and engage.” LC

VK 102



30 Home and LongTerm Care News DECEMBER 2017

Product Spotlight: Hextio

New indoor air decontamination solution: R

adic8 Canada recently introduced an entire product line offering many advanced innovations in continuous indoor air purification and sterilization portable equipment. Advanced patented and powerful VirusKiller UVC/TiO2 technology is at the heart of every machine, including the new compact and stylish Hextio. Hextio was created for everyone, everywhere, and is perfect for long-term care facility occupants as well as offices, hotels and domestic use from the nursery to the basement. Hextio covers 30 sq. meters which is the average room size. Hextio does not attempt to catch airborne cold and flu viruses. It destroys them, keeping loved ones and their caregivers safe. Compact, stylish and fully automated for all home and work environments, multiple award winning Hextio is the biggest technology advancement in compact air purification and sterilization in a decade. HEPA filters are great for collecting dust and pollen but for more serious pollution you need more serious technology. Also, most allergies are triggered by more than simple dust and pollen. Hextio neutralizes allergy causing pollutants such as mould, VOC’s, chemicals & fungi. Odour is an air pollutant and Hextio reacts intelligently to all air pollutants, switching to full fan until the pollution has been neutralized – giving you an odour free environment. The award winning UVC/ Titanium Dioxide reactor module creates a powerful amplified Photo

Catalytic Oxidation (PCO) reaction providing unparalleled performance. PCO is an advanced process by which volatile organic compounds (VOCs), bacteria, viruses, mould, fungi and more are destroyed by incorporating photon and ultraviolet (UV) energy activating a catalyst creating hydroxyl radicals which then break the pollutant down into harmless carbon dioxide and water molecules. No ozone is emitted. Radic8s ‘honeycomb of death’ technology incorporates multiple TiO2 nano-coated reflecting filter tubes as the catalyst. Titanium dioxide accounts for 70 per cent of the total production volume of pigments worldwide, and is a common ingredient also found in sunscreen.


Surrounding the Super UV lamp with nine nano chrome titanium dioxide filters and creating a fully mirrored reactor chamber increases the photo-catalytic oxidation technology efficiency by 10 times while a TiO2 coated carbon final filter finishes the air.


Multiple sensors constantly sample the air for dust, germs and VOC’s and when pollution is detected – Hextio reacts intelligently by switching to full fan and glowing red until the pollution has been neutralized.


Hextio is compact yet powerful and able to destroy many more air


This technology starts at just $399 and is sold direct through Radic8 Canada, or under a retail agreement allowing home and long-term care facilities to sell Hextio through reception and gift shops. Volume discounts and leasing options available.

HEXTIO DOES NOT ATTEMPT TO CATCH AIRBORNE COLD AND FLU VIRUSES. IT DESTROYS THEM, KEEPING LOVED ONES AND THEIR CAREGIVERS SAFE. ants than a HEPA filter attempts to catch, and only uses 15W maximum at 12VDC. Small enough to move around the house or take with you when you travel means Hextio can protect you wherever you are. Hextio also offers the world’s first Natural Fragrance Menu. Imagine a subtle natural fragrance that your room will smell of whilst being confident in the fact that the air in the room is free from air pollution including bacteria, viruses and city smog. The Natural Fragrance menu uses only natural products and unlike harmful artificial fragrances – it improves the air quality, and offers additional dignity within areas that would benefit from a light natural fragrance. One or multiple Hextio units can fully protect you in many environments. Radic8 Canada also offers larger area tabletop/wall hung and contemporary styled pedestal mobile units, built to industry leading South Korean technology, innovation and quality standards. Well over 300,000 units are in service worldwide, and are now available in Canada. All VirusKiller

units are UL/CSA certified, cost efficient and easy to maintain. VK-Blue is the perfect air purifier and sterilizer for medium to large rooms. Combining an easy to rinse pre-filter, a HEPA filter, activated carbon and a reactor cell with eight super UVC lamps and 40 TiO2 hexagon filters makes it the ultimate solution for spaces up to 60 square meters. The line includes the large flagship VK-Medi, with dual intakes and the worlds thickest 150 mm HEPA filter in a machine suited for everything from operating rooms to schools. The VirusKiller product line, built to Canadian healthcare standards will reduce hospital acquired infections, and tackle overall poor IAQ issues everywhere head on, fast. With Radic8 technology installed, Radic8 provides a ‘We Share Clean Air’ advertising campaign to inform patients and staff alike that the air they breathe is clean and safe. Meet Hextio at and see the full product line at Contact for Full indoor air decontamination is now simple plug and play possible. LC

This content was provided by Radic8 Canada.

DECEMBER 2017 Home and LongTerm Care News 31

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LongTerm Care News Edition December 2017  
LongTerm Care News Edition December 2017