Inside: Medication management | Smart wheelchairs | Nutrition news | Quality of life
January 2018 Edition
The cannabis conundrum Page 10
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contents January 2018
Cover story: The cannabis conundrum
4 6 8 12 14 18 24 29 30
Educating caregivers and patients
Quality of life for seniors
Wheelchair obstacle detection
Working daughters and sons
Editorâ€™s Note Walk with them Improving quality of life for seniors Nutrition news Medication management Respite care Bridging acute to home care Communicating with someone who canâ€™t Curb patient wait times
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Innovation starts on the front lines here has been much talk in recent years of the benefits of medical cannabis in palliative care and for patients undergoing chemotherapy, in addition to other chronic and debilitating conditions. With the entire country being in what experts are calling an ‘opioid crisis’ it’s not surprising that medical cannabis advocates are calling for much more widespread use of marihuana in medicine. But what about the use of medical cannabis in longterm care? This month’s cover story (p10) delves into some of the benefits and risks of this line of treatment and its application in long-term care facilities. It is a complex issue that warrants further investigation and study – it is our hope this article will get people talking. In this issue you will also find information on smart wheelchairs – a Canadian researcher has developed an obstacle detecting system that can be added on to both manual and electric wheelchairs. A common theme I am seeing in the articles we receive is that many of the innovations are coming from the front-lines. Who better to know what will enhance care in the home and long-term care sector than the health professionals who live it every single day? Doctor-created solutions to enhance care are featured on pages 14 and 30 – both of these solutions
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MARCH 2018 ISSUE borne out of a need experienced first-hand by doctors who are providing care on the front lines. This is our goal – to share these stories of triumph and success. With the start of a new year comes possibility – things are happening in both home and long-term care. Governments are recognizing the desperate need for these sectors to improve in both quality and efficiency. We look forward to sharing more innovations and triumph through-out this new year. Happy New Year! LC
Kristie Jones Editor, Home and Long Term Care News
4 Home and LongTerm Care News JANUARY 2018
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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: firstname.lastname@example.org 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.
A care home’s novel approach to advance quality of life By Rumana D’Souza aregivers at a Sidney care home are using an important tool to address the cognitive and emotional symptoms of dementia among residents – the power of music. The music therapy program at Sidney All Care Residence in British Columbia goes beyond playing music for residents in common living areas. Staff work with families of residents to com-
pile a list of songs or instrumental pieces they once enjoyed. They then create personalized playlists on iPods for the residents. Judy Peterson, Community Enrichment Manager at Sidney All Care Residence, says the program was inspired by the 2014 movie Alive Inside, which follows a social worker who brings music to seniors with dementia in care homes. Continued on page 7
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Walk with them By Joanne Dykeman his fall, Sienna Senior Living partnered with the Change Day Ontario and Change Day BC movements that have been adopted around the world to improve quality of care and health systems. Change Day empowers people to make positive changes through personal pledges, large or small, which improve quality of care for residents.
MY BELIEF HAS BEEN REAFFIRMED THAT WE NEED TO ALWAYS ENGAGE THOSE PEOPLE WHO WORK DIRECTLY WITH RESIDENTS IN POLICY DEVELOPMENT
When a PSW reached out to me recently from one of our long-term care communities, extending an invitation to “walk with her,” this turned into a personal pledge for me to shadow her on the job. It also became part of a wider initiative that I believe will create positive change throughout Sienna. I shared my Change Day Pledge internally within the organization, and other leaders from various departments made their own pledges. Many of these
were also to job-shadow frontline care workers with the intention of creating positive change. PSWs, cooks, recreation aides and RPNs came forward with invites for Sienna’s support services employees to walk with them in their roles. The sentiment behind this was to see the work they do firsthand, and better understand a day in the life of someone who cares for residents face to face, every day. Not often am I so awestruck and inspired that I struggle to find words. However, after following in the footsteps of personal support worker Angela Miller at Villa Leonardo Gambin in Woodbridge, Ontario, one Wednesday in October – that was exactly how I felt. I made beds, worked at meal service, walked the halls and entered the rooms of residents, and generally provided hands-on assistance wherever needed. My intention with this project was to deepen my understanding of the work a PSW does every day, and to express my deep appreciation and respect for them. Angela is one of thousands of care workers across Sienna’s 73 care communities and retirement residences in Canada, which make up the bulk of our workforce of more than 11,000 people. While I have always admired the contributions of all people who work compassionately each day caring for the needs of others, I underestimated the skill and grace required to do this job. Despite the extra helping hands I was
Joanne Dykeman job shadowing Angela Miller, a PSW at Villa Leonardo Gambin. providing to Angela, I can honestly say that the pace was non-stop. Angela taught me so much that day. My belief has been reaffirmed that we need to always engage those people who work directly with residents in policy development. Decisions about care equipment, processes and policies can only be developed in consultation with the people who are doing the frontline work. I look forward to creating a space for their active contributions within policy, procedure and process development at Sienna.
Spending a day in the life of a PSW does not make me an expert. But it has allowed me to continue to understand their role and the contribution we make as one of Canada’s largest owners and operators of seniors living. We need to continue to advocate for staffing levels in long-term care so that PSWs like Angela can not only do what they do, but sustain themselves as care providers and offer that extra attention to detail that enhances quality of life for residents. LC
Joanne Dykeman is an Executive Vice President of Operations at Sienna Senior Living. 6 Home and LongTerm Care News JANUARY 2018
Musical memories Continued from page 5 The program at Sidney All Care currently has 20 iPods in circulation which are mostly used on the residence’s advanced dementia floor. “The results have been phenomenal,” Peterson says. “We have a resident who is often agitated, and when we put the iPod on, she calms down and she starts singing.” Many recent studies can explain why seniors come back to life and feel like their former selves when they listen to music. Music reactivates areas of the brain associated with memory, reasoning, emotion, speech and language. A growing body of evidence shows music
BC CARE PROVIDERS ASSOCIATION WANTS TO HEAR FROM YOU! IF YOU WOULD LIKE TO SHARE A PROGRAM THAT’S IMPROVING QUALITY OF LIFE FOR SENIORS AT YOUR CARE HOME, PLEASE CONTACT RUMANA D’SOUZA AT RUMANA@BCCARE.CA helps retrieve stored memories, as well as create new ones. Peterson credits the program’s success to the collective efforts of residents, staff, family and the community. “The families love it! One family
member donated 10 new iPods for the program.” There is currently a waitlist for families who want to create personalized playlists for their loved ones, and Peterson says they’re working on getting
Rumana D’Souza is the Digital Media & Communications Coordinator, BC Care Providers Association.
more iPods to grow the program. “It’s a process to get it up and running because each iPod must be individualized. We’ve been working on it for a year now, and we’re not where we want to be yet, but what we have now is great!” In addition to music therapy, Sidney All Care Residence also has other quality of life programs for its residents. “The Buddy Bingo program pairs our more “cognitive” seniors with residents who have dementia. They help them play the game, and they get to know each other,” Peterson says. “The buddy system helps create bonds, and goes a long way in reducing loneliness among residents.” LC
Improving the quality of life of seniors one sense at a time By Dr. Chantal Backman, Michelle Crick, Danielle Cho-Young, Megan Scharf he world’s senior population is growing fast. In 2015, there were approximately 900 million people over the age of 60, according to the United Nations (UN). The UN projects that the global senior population will grow to 1.4 billion by 2030. With this growing population, the number of people impacted by an age-related disease or health condition will also skyrocket. In fact, according to the Journal of the American Geriatrics Society, more than 90 per cent of adults will live with a deficit in at least one of their five senses. As we age, the five senses – hearing, vision, taste, smell, and touch – become less acute. Age-related sensory changes may create difficulties in communicating, in enjoying activities and in staying connected to people. Sensory changes can affect day-to-day activities and can often lead to increased feelings of isolation and depression. Little awareness exists regarding the negative effects sensory impairments have on seniors living in long-term care communities. Without proper consideration of the five senses, seniors are at greater risk for lower quality of life and for poor health outcomes. Sensory impairment can mask an individual’s true level of competence; having more than
one impaired sense can further prevent seniors from participating in daily activities or in performing basic tasks. Through a research collaboration between the University of Ottawa LIFE Research Institute and Sodexo, we developed a sense-sensitive guide to raise awareness about the impact of sensory loss and its impact on the quality of life in residents living in long-term care homes. By sharing common practices and using our soon to be released audit tool, long-term care homes will be better equipped to offer better quality services to seniors by providing a “sense-sensitive” environment. The audit tool provides a step-by-step approach to determining how sense-sensitive a specific long-term care home is in reality. Following an initial review of the long-term care homes’ physical design and an assessment of its policies and procedures, the audit is divided into four parts: (1) Interviews of residents to determine perceptions of issues related to the senses, (2) Interviews of staff to determine perceptions of issues related to the senses, (3) Walkthrough of the environment with staff and residents to explore deficiencies in the physical environment, and (4) Food tasting with staff and residents to determine its level of taste/smell sense-sensitivity.
Left to right – Top: Michelle Crick PhD(c) (PhD Candidate, School of Nursing, University of Ottawa), Danielle ChoYoung RN (Master’s student, School of Nursing, University of Ottawa), Megan Scharf (4th year nursing student, School of Nursing, University of Ottawa) Bottom: Chantal Backman RN, MHA, PhD (Assistant Professor, University of Ottawa), Linda Garcia PhD (Director University of Ottawa LIFE Research Institute)
8 Home and LongTerm Care News JANUARY 2018
Our research aims to share knowledge that can be used by residents, families, care providers, leaders, and policy-makers to optimize the environment for residents with sensory impairments. Understanding the impact of sensory impairments within the context of longterm care homes, and knowing what to do about them will lead to better person – and family – centered care and ultimately, improve the quality of life for residents and their families. The results of our innovative research provides insight into the complexity of the interactions between the five senses, insight into the relationship between person and family-centered care and
MORE THAN 90 PER CENT OF ADULTS WILL LIVE WITH A DEFICIT IN AT LEAST OF THEIR 5 SENSES sensory decline, and awareness into the degree that sensory decline can “mask” a person’s competence making it appear that they suffer from cognitive or other physical deficits. Long-term care homes need to consider how individuals with sensory impairments interact with their environment. For instance, they may not respond to verbal instructions (hearing), they may not eat because they cannot see the food on their plate (vision), or they may fall
more frequently (vision and touch). There are many strategies that can be used to minimize the impact these sensory losses might have on the daily life of residents as well as on their families and care providers. For example, if a senior has a hearing problem, a simple strategy is to consider the competing noises in the facility and reduce them if possible. If an older adult has a vision problem, a long-term care community might consider whether the lighting lev-
els are suitable in the different areas of the facility; or to ensure that the floor covering doesn’t create glare and contribute to falls. We believe that everyone – residents, families, care providers and leaders – can contribute to changing environments and changing approaches so that those with sensory loss have the best possible chance of engaging with others, regardless of other health challenges. If you are interested in becoming involved in this research, we are seeking organizations interested in piloting the prototype audit tool. Please contact the principal investigator Dr. Chantal Backman at email@example.com.LC
The authors are members of the research team from the Quality and Safety in Healthcare Research Program.
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Cannabis is generally not a firstline agent. It is more commonly used after other treatments have proven unsuccessful.
By Roxanne Tang and Susan C. Jenkins
10 Home and LongTerm Care News JANUARY 2018
eet Jim, a 70-year-old resident of an assisted living home. He is in generally good health, but he has been plagued by chronic pain for over five years. Jim’s physician has been prescribing opioid medication for the pain, but Jim is not managing well, and his quality of life is suffering. His doctor is considering whether medical cannabis (also known as medical marihuana or marijuana) might be an appropriate addition to Jim’s therapy. There are many factors he will have to assess before he makes that decision.
Medical cannabis is not the same as the drug that can be bought on the street. It is subject to strict quality control, testing, and analysis to ensure a safe product, free of contamination from mold, bacteria, or pesticides. Medical cannabis should not be thought of as a single agent. Over 100 cannabinoids (chemical compounds that act on specific receptors in the brain and body) have been identified in cannabis. Two key cannabinoids are tetrahydrocannabinol (THC) and cannabidiol (CBD). THC is the principle psychoactive component of cannabis and is responsible for the euphoria or “high” from using cannabis and psychotropic effects. It is effective in relieving pain, muscle spasms, and controlling nausea. CBD is mainly non-psychoactive. It is thought to have anti-inflammatory, analgesic, anti-nausea, anti-emetic, and antipsychotic effects. The relative concentrations of THC and CBD vary widely among cannabis strains and significantly impact the pharmacological and therapeutic effects of the final cannabis product. In addition, plant chemicals called terpenes, terpenoids, and flavonoids play a key role in modulating the effects of cannabinoids. Cannabis is different from any other pharmacologic agent. At present, there is insufficient scientific evidence to establish the safety and efficacy of cannabis to the level required by Health Canada. There are no approved indica-
tions, no standardized format, no drug identification number (DIN), and no dosing guidelines. Cannabis is generally not a first-line agent. It is more commonly used after other treatments have proven unsuccessful.
POSSIBLE BENEFITS, POTENTIAL RISKS
There is strong evidence that cannabis can have therapeutic benefit as an antiemetic in chemotherapy-induced nausea or vomiting, as an analgesic in chronic pain patients, and to reduce spasticity in adults with multiple sclerosis. Cannabis is also commonly used for stress, anxiety, and certain sleep disorders, although efficacy is difficult to quantify and tends to be highly subjective. More clinical research is needed for the use of cannabis in these and other conditions. Cannabis can cause some significant adverse effects that must be taken into account when determining its appropriateness for an individual patient. Drowsiness and dizziness, two wellknown side effects, can increase the risk of falls, posing particular problems for elderly patients. Other potential adverse effects include fatigue, impairment of short-term memory and information processing, altered judgment, and decreased attention, which can be a concern in patients already suffering from cognitive decline. Care must be taken to minimize the risk of drug interactions. Residents taking other psychoactive drugs, antidepressants, or anti-anxiety medications must be carefully monitored, as cannabis can enhance the actions or side effects of these medications. How does all of this impact Jim, our chronic pain patient? Because he is in generally good physical and mental health aside from his chronic pain and he takes no medications other than analgesics, Jim’s doctor decides he’s a suitable candidate for medical cannabis.
ACCESS TO MEDICAL CANNABIS
The Access to Cannabis for Medical Purposes Regulation (ACMPR) provides the framework for patients to
legally acquire medical cannabis in Canada today. The channel of distribution differs from that of any other medication. The “prescription” must be written by a physician or nurse practitioner, ordered from a licensed producer, and delivered directly to the patient by mail order. At this time, it is not legal for the licensed producer to provide cannabis in any other format except seed (for patients to grow their own plants), dried or fresh cannabis, or as cannabis oil. Furthermore, the ACMPR does not allow pharmacists to play a role in the safe distribution of medical cannabis as they would do with other medications.
IMPLICATIONS FOR THE HEALTHCARE TEAM
Current legislation doesn’t address the use of medical cannabis in the retirement home or long-term care environment. For example, it is the responsibility of the client for ordering, registering with the licensed producer, receiving, storing, dosing, handling, and disposing properly of unused cannabis. Residents are often cognitively or physically challenged and incapable of taking on these responsibilities. Security is an important issue when dealing with cannabis. Steps must be taken to ensure that it is stored securely (under lock and key), so that unauthorized individuals do not have access to it. Excess cannabis must be destroyed safely prior to disposal. Nurses and other health professionals are struggling to develop protocols to deal with medical cannabis that are in keeping with the ACMPR, the Nursing Home Act, and other required regulations.
DOSING AND ADMINISTRATION
Because there is no standard dosing guidelines for cannabis, dosing is highly individualized. It relies to a great extent on experimentation to find the dose that provides maximum therapeutic value with a minimum of adverse effects. The general rule of thumb is to “start low and go slow.”
Health professionals do not condone smoking cannabis, as this releases the same toxins and carcinogens as smoking tobacco. Additionally, secondhand smoke and the distinctive aroma released by combusting cannabis are significant issues. The most common and accepted routes of administration for medical cannabis are inhalation by vaporization and oral consumption of the oil. Vaporization, or “vaping,” involves heating the dried cannabis to a lower temperature than smoking and inhaling the resultant vapour thru a special device. Cannabis in an oil format permits more precise dosing and standardization of strength. This is a highly concentrated product, so only a few drops need to be taken. The oil is typically swallowed or placed under the tongue. For medical purposes, baking or cooking with cannabis or making a tea out of cannabis leaves is not recommended. It is extremely difficult to control the potency and dosing of cannabis once the physical properties have been modified in this fashion. With inhalation (smoking or vaporizing), the effects are typically felt within a few minutes and peak within a half hour. Acute effects usually last between two and four hours. With oral ingestion of cannabis oil, the effects are much slower. Onset of action is generally 30 to 45 minutes but may be more than two hours, depending on the individual. It typically peaks three to four hours after dosing and lasts much longer than inhaled cannabis. Because of its longer duration of action, oral cannabis is more difficult to titrate, and patients should wait a minimum of four hours before taking more to avoid overdosing.
It has now been six months since Jim began his cannabis therapy. His pain is better controlled, he has been able to reduce his use of other pain medications, and he has been able to participate in more activities. He is happier and feels that the quality of his life has improved substantially. LC
Susan C. Jenkins is a freelance writer and editor specializing in medicine, pharmacy, and healthcare. She can be reached at firstname.lastname@example.org. Roxanne Tang, RPh, BSP is a pharmacist and Director of Pharmacy Practice with Medical Pharmacies Group Limited. She advocates for regulatory amendments to allow pharmacists to distribute cannabis for medical purposes. www.longtermcarenews.ca
JANUARY 2018 Home and LongTerm Care News 11
The importance of nutrition in long-term care By Dale Mayerson and Karen Thompson elcome to the inaugural article of the Nutrition News column for Home and LongTerm Care News. On a monthly basis, we will address a wide variety of topics related to nutrition, meal service and hydration as they apply in the long-term care (LTC) sector. Interest in nutrition is on the rise and much has been written in mainstream media about the importance of nutrition for all ages. ‘Good Nutrition’ can have a life altering impact for those in LTC and there are many facets of nutrition care and service to consider.
A CAREFULLY PLANNED MENU WILL PROVIDE MEALS THAT MEET NUTRITIONAL NEEDS AND PROVIDE A SOURCE OF ENJOYMENT FOR RESIDENTS
The overarching focus for providing nutrition care for older adults in LTC is on maintaining and enhancing health as well as optimizing quality of life. This requires full support of the entire healthcare team. A healthcare team that is well informed about nutrition-related issues is in a better position to help residents and to report specifics to the Registered Dietitian. This includes information about residents’ food intake, chewing and swallowing abilities, body positioning during meals, bowel activity, blood glucose levels, laboratory and test results etc., and in turn facilitates the whole team’s assistance into nutrition assessment and care planning.
Sound nutrition is central to maintaining and restoring optimal health. Nutrition related concerns that arise frequently in LTC include: unplanned weight loss, dysphagia or difficulty swallowing, skin breakdown, dementia, depression, constipation, dehydration, impact of multiple medications, and food allergies and intolerances. In addition, there are many residents with therapeutic complexities that require careful consideration by the Registered Dietitian such as diabetes, heart disease, kidney disease and other multiple comorbidities. A carefully planned menu will provide meals that meet nutritional needs and provide a source of enjoyment for
residents. To meet the nutrition requirements of a menu, consideration must be given to standards and guidelines such as Canada’s Food Guide and Dietary Reference intakes. In Ontario, the Long Term Care Homes Act and regulations provide direction to ensure that residents are receiving the meals and snacks that help to maintain their health and quality of life. This includes an organized program of nutrition care and dietary services that provides three meals per day, afternoon and evening snacks, beverages with and between meals, and availability of food 24 hours per day. Menus must be at least a 21-day rotation and must provide variety and alternative choices of entrees,
vegetables and desserts at lunch and dinner, along with choice of beverages. The regulations stipulate that menus must provide adequate nutrients, fibre and energy for residents, as well as a variety of foods, including fresh seasonal foods. Understanding the diverse cultural and religious requirements of residents as well as their personal preferences and choices are important for planning menus and for serving residents. It is critical that the food and nutrition team work closely in collaboration with residents and other stakeholders to develop menus that enhance the enjoyment of eating while providing the nutrients that optimize health, all within the framework of the available resources. Eating meals and snacks is a main activity that residents look forward to, providing opportunities for social interaction, sensory stimulation, and other pleasures related to dining. There is a great deal that can be done to support a positive meal time for residents. Significant care and planning must go into providing a pleasant and welcoming dining environment that is homelike but still supports residents with challenges such as reduced sight, hearing, mobility and cognition. Residents may require foods that are modified to a texture that makes food safe to eat, within a quality meal service. Residents must receive the appropriate and individualized meal time assistance so they can take enough food but not so that they lose their independence. Seating arrangements need to be considered so the social aspects of dining can be strengthened. Meals and snacks are crucially important for residents, and their health, weight, strength and quality of life are all impacted by nutritious meals that are a pleasure to eat. LC
Dale Mayerson B Sc RD CDE, and Karen Thompson, B A Sc RD are Registered Dietitians with extensive experience in long-term care. They are coauthors of “Menu Planning in Long Term Care and Retirement Homes: A Comprehensive Guide” and have participated for many years on the Ontario Long Term Care Action Group, an advocacy group of Dietitians of Canada. 12 Home and LongTerm Care News JANUARY 2018
NEWS NE EWS
One of the modules focuses on safety
A platform for educating caregivers and patients with dementia
By Ilan Mester eceiving a diagnosis like dementia is often overwhelming for patients and their families. It’s nearly impossible for healthcare professionals to provide all the information a patient would want to know in just one session. “As a clinician, it’s frustrating seeing patients for an hour or more, coming up with a diagnosis and then having only 20 minutes to teach them everything they possibly need to know about dementia,” says Dr. Richard Sztramko, a Hamilton-based geriatrician. Dr. Sztramko realized there was a sizeable gap when it comes to patient and caregiver education. According to
him, what’s provided to the patient during an initial diagnosis often isn’t enough. And while the web has a ton of information, it can be very misleading. “When patients go off into the internet, they’re exposed to so much information – a lot of it isn’t necessarily directly applicable to where they’re at in the current stage of the disease.”
COLLABORATION WITH CABHI
That’s the main reason the geriatrician and his team at the GERAS Centre are developing iGeriCare – an online platform for people who are newly diagnosed with dementia, along with
their families, to access relevant information at their own pace. The e-learning modules cater to the patient’s stage and type of dementia “There’s certainly a lot of educational material out there,” admits Dr. Sztramko. “But we did a needs assessment at our clinic and a big thing that the patients wanted was something that they knew they could trust. And so there might be lots of high-quality educational material out there, but how do you know you can trust it? And how do you know that it’s right?” Dr. Sztramko applied for Spark, a program launched by the Baycrest-led Centre for Aging + Brain Health In-
novation (CABHI), designed to nurture early-stage ideas from point-ofcare clinicians. CABHI provides up to $50,000 in financial support, plus guidance and feedback opportunities. “The Spark catalyst is really what started everything,” shares Dr. Sztramko. “Once we got that award, everybody else seemed to jump on board and get really excited about iGeriCare. We used the money to build out the project, but also acquire human resources – it’s been extremely helpful.” He adds that the ability to maintain academic freedom and intellectual property is another key benefit to collaborating with CABHI. Continued on page 23
Ilan Mester is a communications specialist at The Centre for Aging + Brain Health Innovation (CABHI). www.longtermcarenews.ca
JANUARY 2018 Home and LongTerm Care News 13
A collaborative approach to
medication management By Ilan Mester t’s safe to say Dr. Joanne Ho – an internist, geriatrician and clinical pharmacologist – wears many hats. But the one common thread in her professional life is an interest in medication. “I found it fascinating how the right combination of medication could make the difference between someone doing really well and not feeling so well and having poorly controlled diseases,” she says of the importance of understanding the impacts of medication when working with older adults. Dr. Ho completed a mandatory stint at the Ontario Poison Centre during her medical training. “That’s where I
saw an amazing interdisciplinary team make a huge difference by providing expertise in poisonings to a large population across a vast geographical area.” Although the centre housed physicians who specialized in toxicology, Dr. Ho says a majority of phone calls were manned by specialized pharmacists and nurses. Only a fraction required physician involvement. “Because of the Ontario Poison Centre’s infrastructure and that model of care, they’re able to serve the entire province of Ontario and a few other provinces as well,” explains Dr. Ho. “So it got me thinking, because from a geriatrics perspective, seniors are different.
Their bodies change over time and how they process drugs is different.” That’s why she created GeriMedRisk, a network of geriatric medication specialists that support clinicians involved in the primary care of older adults. “We’re not an extra prescriber,” Dr. Ho clarifies. “We empower the clinicians that are already involved in the patient’s care.” GeriMedRisk is currently being tested in long-term care facilities across the Kitchener-Waterloo region, where Dr. Ho and her team are based. The team uses a secure telemedicine platform to connect with clinicians interacting first-hand with older adults.
THE CABHI DIFFERENCE
Dr. Ho received financial support from the Baycrest-led Centre for Aging + Brain Health Innovation (CABHI). Our Spark program, which is designed to nurture early stage ideas from point-of-care clinicians, provides up to $50,000 in financial support plus guidance. “CABHI’s support through the Spark program helped us take off,” says the geriatrician. She adds that CABHI fosters a culture of innovation where clinicians such as herself can engage with other innovators. “The innovation showcase
Dr. Joanne Ho (left) attends CABHI’s Innovation Showcase.
14 Home and LongTerm Care News JANUARY 2018
that CABHI organized was amazing,” says Dr. Ho. “For me, it was truly quite a showcase. It was a great experience just having exposure to so many in dividuals as well as fellow CABHI projects. From this showcase, I learned to engage with the public, stakeholders, and other groups on a scale that I had never even considered.” According to Dr. Ho, CABHI has also helped her team think from a business perspective. “It’s important, even as a clinician, for me to be able to speak a different language – the language that administrators and policy makers are speaking. What is a key performance indicator? What are milestones? As a physician, those are unfamiliar concepts. So to be able to learn how to communicate in the same language was a wonderful learning experience.” The geriatrician is grateful CABHI has maintained and respected her academic freedom and intellectual proper-
GERIMEDRISK, IS A NETWORK OF GERIATRIC MEDICATION SPECIALISTS THAT SUPPORT CLINICIANS INVOLVED IN THE PRIMARY CARE OF OLDER ADULTS. ty. “To receive financial support from an organization like CABHI and to know that they support our research and respect that it’s still our research carries weight. We are very appreciative of CABHI’s support.”
CABHI’s support is helping Dr. Ho conduct a feasibility trial for GeriMedRisk. The team conducted a needs assessment with more than 70 clinicians in the Waterloo-Wellington region and is currently trialling its service in four long-term care facilities. “What we do is we randomize the order that four long-term care sites would start to get access to GeriMedRisk.”
Dr. Ho and her team are midway through the trial and so far the results are quite positive. “It also validates the fact that we are empowering the existing circle of care, the existing team members, as opposed to inserting ourselves as additional prescribers. There are a lot of excellent well-staffed, high functioning clinicians and teams who provide great care to their seniors. And we want to support them if they would like additional support managing their older adult patient’s medications, chronic diseases and/or mental health.” One primary care physician who works in a long-term care setting said the following: “[GeriMedRisk] is an ex-
cellent example of collaborative care. It is extremely valuable in my eyes – totally helpful! [The] family [was] happy with the care and outcome.” In addition to positive feedback from clinicians, her team has also received reassuring comments from older adults. One long-term care resident shared that “without the [GeriMedRisk] recommendation I would still be on too many medications … It’s a great service and I would recommend it highly to anybody”. Dr. Ho adds that her innovation was conceived in a relatively small city as opposed to a large urban centre. CABHI has been instrumental in helping her team move the project forward. “It’s the support from large organizations, like CABHI, that allowed this project to become what it is now. We’re at an exciting time of growth and it’s happened quickly, and with the right team. I have to say a big thank you to CABHI.” LC
Ilan Mester is a communications specialist at The Centre for Aging + Brain Health Innovation (CABHI).
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JANUARY 2018 Home and LongTerm Care News 15
The controller for a new add-on feature that can transform a regular wheelchair into a â€œsmartâ€? wheelchair.
16 Home and LongTerm Care News JANUARY 2018
An obstacle-detection system for wheelchairs By Margaret Polanyi and Annie Atkinson Toronto team has created an add-on system that can transform a regular wheelchair into a “smart” wheelchair able to help prevent collisions. The novel system uses sensors to detect obstacles and provides visual, audio or vibration feedback to drivers. It can be added to any powered or manual wheelchair. “Rear visibility and manoeuvering in tight spaces are real issues with mobility devices and collisions can result,” says Dr. Pooja Viswanathan, CEO of Braze Mobility Inc., the startup that commercialized the system. “Our obstacle-detection system is designed to increase safety, independence and quality of life for people living with mobility impairment.” Two versions of the product – the Braze Hydra and Braze Sentina debuted recently at the AGE-WELL Annual Conference in Winnipeg, Manitoba. AGE-WELL, Canada’s Technology and Aging Network, has supported Braze through its Strategic Investment Program. Incorporated in 2016, Braze has also received support from the Ontario Brain Institute through their ONtrepreneurs program, the Ontario Centres of Excellence, the National Research Council of Canada Industrial Research Assistance Program (NRC IRAP), the Impact Centre at the University of Toronto (U of T) and Semaphore Research Cluster at U of T. Herman Witlox, a powered wheelchair user who helped to Beta test the obstacle-detection system, calls it
Dr. Pooja Viswanathan, CEO of Braze Mobility Inc., displays the obstacledetection sensors that can transform a regular wheelchair into a “smart” wheelchair. “a lifesaver” that helps him avoid collisions with people and property that can happen when changing directions or backing up, for example. “It gives you an awareness and a sense of security,” says Witlox, who has continued to use the system and is involved with a company that will be one of its distributors. The system can now be ordered at www.brazemobility.com by institutions such as hospitals, long-term care facili-
ties and seating clinics, and by individual consumers, across North America. For Dr. Viswanathan, a postdoctoral fellow in computer science at the University of Toronto and an AGE-WELL highly qualified personnel (HQP), the launch of the new system is a personal milestone. She has worked for over a decade on collision-avoidance systems for wheelchairs. “Anyone who uses a wheelchair can benefit from this system, which will be
particularly useful for people with low peripheral vision and limited neck and upper body flexibility” she says. “One of our testers says he feels like he has eyes on the back of his head with this technology. He says that it’s ‘got his back.’ “And for people who are excluded from using powered wheelchairs, including some older adults with dementia, the system will widen access to mobility devices, giving new opportunities for independent mobility,” says Dr. Viswanathan, who co-founded Braze Mobility with Dr. Alex Mihailidis, a Toronto Rehab/University of Toronto scientist and scientific director at AGEWELL. Braze is generating jobs as well as products. Nine people are involved with the company, including contractors and interns. Graham Browning, a recent engineering graduate from Ontario’s University of Waterloo, is now a product manager. He took the position at Braze over other offers. “A big motivating factor was wanting to make a positive impact in people’s lives,” he says. Braze has earned recognition at several recent pitch competitions. The company captured cash prizes after coming first in the POWER PLAY pitch competition (hosted by Toronto Rehab Foundation, in partnership with the iDAPT Centre for Rehabilitation Research and AGE-WELL), the CNE Innovation Garage, and a competition hosted by the Ontario Bioscience Innovation Organization (OBIO). LC
Margaret Polanyi is Senior Communications Manager at AGE-WELL. 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 end-users to develop solutions for healthy aging. For more information, visit http:// agewell-nce.ca/ www.longtermcarenews.ca
JANUARY 2018 Home and LongTerm Care News 17
Respite care: A lifeline for many families By: Michaela Berniquez eing a caregiver for a loved one can be taxing, especially when caring for someone with dementia or any medically complex condition. Many caregivers find it difficult to maintain their own health and personal obligations, which may lead to strain and burnout. Luckily there are different ways to give these dedicated caregivers a break. This is where respite care comes in. Respite care can take several forms, one of which is most familiar to longterm care (LTC) homes: short-stay respite programs (SSR). Currently, there are approximately 350 ministry-approved SSR beds across Ontario. Frequently, only one or two beds are dedicated to respite in a home. Operators – including the Bruyère Centre for Learning, Research and Innovation (CLRI) – who participated in a recent scoping review of SSR beds in LTC, unanimously agreed that these beds provide a much needed service to the community. This review also highlighted several challenges operators face while facilitating these programs. It is recognized that there is a need for more integrated respite care programs, especially for those living with dementia. These families have few options, particularly for overnight respite. This type of respite is necessary as there are many incidents that may hinder a caregiver’s ability to care for their loved one for short periods of time. They may also simply need a break. The Bruyère CLRI and the Champlain Dementia Network (CDN) are working together, guided by the CDN’s multi-year strategy, to enhance respite care options available to those living with dementia in the Champlain region. Consistent with these efforts, the
IT IS RECOGNIZED THAT THERE IS A NEED FOR MORE INTEGRATED RESPITE CARE PROGRAMS, ESPECIALLY FOR THOSE LIVING WITH DEMENTIA. CLRI and CDN organized a webinar on December 6, 2017 to explore ways to move forward with strengthening an integrated respite system in the Champlain region. The discussion featured the two reports written by the CLRI and CDN, as well as representatives from Mind the Gap to provide a care giver’s perspective. Mind the Gap is a grassroots group made up of families of individuals with dementia. The webinar opened with remarks from Gweneth Gowanlock and Rose Ann Hoffenberg of Mind the Gap. They were both the primary caregivers of their husbands, both of whom developed advanced dementia. They shared stories from their personal experiences, outlining the many challenges that come along with providing care for someone with dementia. They view respite care as a necessity for caregivers, and acknowledged that the
respite care systems currently in place need improvement. In the webinar they discussed that more often than not, SSR programs were unable to accommodate their husbands’ needs for various reasons, and that there were simply too few options available for families. Another issue with current respite care programs is the cost. Sometimes care partners have to sell their home in order to afford various forms of respite. The moving anecdotes from Gweneth and Rose Ann put into perspective why there is a need for a stronger respite system in Ontario. Following these remarks, Natasha Poushinsky joined the discussion. Natasha is a project manager at the CDN. She summarized a report about a joint initiative between the CDN and the Champlain Community Support Network which is designed to create a more person-centred strategy for respite op-
tions in the Champlain Region. She explained that the objectives of the strategy are to capture the existing continuum of respite approaches; develop principles that guide respite options through consultation with caregivers; gather information on innovative and best practices in the provision of reb spite; identify barriers to access respite options, potential mitigating approaches, and opportunities to enhance servvice; and developing short, medium and long-term recommendations on a respite strategy for the Champlain Region. Natasha elaborated on the focus, barriers, recommendations, and other b factors of this strategy, highlighting its importance and significance. Following Natasha, the webinar welcomed Andrew Rodrigues, a project manager in healthcare, who previously worked at the Bruyère Research Institute. Andrew summarized a report put out by the Bruyère CLRI about the realities of short-stay respite programs in LTC homes. Through scoping reviews, environmental scans, and stakeholder consultation, Andrew and the research team found that the current SSR program has both strengths and weaknesses with many opportunities for growth. Several examples of promising practices in SSR care in different community settings in Ontario have shown to be effective means of respite. The Bruyère CLRI and the CDN are committed to continuing to work together to enhance respite options for people living with dementia and their families living in the Champlain Region and across the province. Discussions about useful tools and resources, as well as innovative collaborations will continue, linking more closely with the region’s community-care providers and LTC homes. A recording of the webinar is available at www.clri-ltc.ca. LC
By: Michaela Berniquez, Bruyère Centre for Learning, Research and Innovation (CLRI) in Long-term Care 18 Home and LongTerm Care News JANUARY 2018
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Making sure our
prescription medications are safe and worth taking
It’s time we stepped up our system of drug surveillance By Jenna Wong and Robyn Tamblyn f you take prescription medications, what conditions do you take them for? Are they working for you? Have you experienced any negative side-effects from them? It may surprise you to know that answers to these critical health questions aren’t well documented for most Canadians. Yet the answers would provide the crucial information needed to ensure our medications are safe and worth taking after they’ve been approved for use. Before prescription drugs are approved in Canada, they are tested under controlled conditions on relatively small numbers of patients (several hun-
dred to several thousand) with selective characteristics (patients of certain ages, races, ethnic groups or genders). But once medications are approved, they aren’t monitored as closely as they should be. We need to significantly improve our system of post-market surveillance for prescription drugs in Canada to make sure we are continually monitoring their safety and effectiveness in real-world settings. Why? First, adverse drug reactions may surface that were not previously detected in smaller pre-regulatory trials. Recall the unfortunate case of 15-year-old Vanessa Young who was taking cisapride
20 Home and LongTerm Care News JANUARY 2018
for her gastrointestinal symptoms and died after suffering a heart arrhythmia – a life-threatening side-effect of the drug that surfaced only after it was released onto the market. Second, the use of a drug may broaden over time to include milder forms of the disease or even different medical conditions that were not assessed during the drug’s pre-market trials. Take antidepressants, for example. These medications are being increasingly used for conditions other than depression. New research has found that nearly one in three antidepressant prescriptions are written for unapproved (“off-label”) conditions – most of which are not backed by sufficient evidence.
To adequately monitor the safety and effectiveness of medications in real-world settings, we need a timely post-market drug surveillance system that can identify the reasons why patients are taking their medications and follow patients to detect adverse drug reactions and determine if their medications are working. How are we doing so far? Not great.
IDENTIFYING THE REASON FOR DRUG USE
The medical reasons for prescriptions are not often explicitly documented in patient charts, nor is this information required for patients to www.longtermcarenews.ca
fill prescriptions or receive reimbursement for drugs. So, when it comes to drugs like antidepressants that can be prescribed for different medical conditions, not knowing why a patient is taking a drug creates major challenges for assessing the drug’s effectiveness and appropriateness of use (i.e., whether the use is backed by regulatory approval or scientific evidence).
DETECTING ADVERSE DRUG REACTIONS
Canada’s Adverse Drug Reaction Reporting System has many flaws, including the fact that it relies upon voluntary reporting by physicians via a reporting process that is time-consuming and outside of routine procedures.
In fact, it’s estimated that less than five per cent of all adverse drug reactions are reported to Health Canada.
TRACKING MEDICATION EFFECTIVENESS
Once drugs are released onto the market, their real-world effectiveness is not systematically monitored. It’s troubling to know that we currently have no large-scale mechanisms in place to track whether patients are experiencing the anticipated benefits from their medications. So, what’s the solution? We need a national post-market drug surveillance system that mandates the systematic collection of data on the reasons for drug use, adverse drug reac-
tions and effectiveness, and governs the use of health information technologies to collect these data. Health information technologies offer the opportunity to seamlessly collect such data as part of the care process and even enhance patient care. For example, electronic prescribing systems could prompt physicians to record the reason for treatment when drugs are prescribed and alert physicians to potential prescribing errors or present alternative treatment options when prescriptions are not evidence-based. When prescriptions are cancelled, renewed or modified, electronic medical record systems could prompt physicians to record details about adverse drug reactions and effectiveness,
which would also ensure that details about a patient’s treatment history and experiences with past therapies are documented. Many Canadian provinces have implemented centralized drug information systems to track all medications that patients are receiving. If these systems are to contribute towards an effective post-market drug surveillance system, they need to additionally collect information on the reasons why medications are being prescribed and the outcomes that they produce. Medications can be life-saving. But they are only as good as our knowledge about them. It’s time we stepped up our game and kept better track of our experiences with medications. LC
Jenna Wong recently received her PhD from the Department of Epidemiology, Biostatistics and Occupational Health at McGill University and will begin a post-doctoral research fellowship in the Department of Population Medicine at Harvard Medical School beginning in 2018. Robyn Tamblyn is an expert advisor with EvidenceNetwork.ca and James McGill professor in the Departments of Medicine and Epidemiology, Biostatistics, and Occupational Health at McGill University.
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email@example.com www.rchcs.com JANUARY 2018 Home and LongTerm Care News 21
What do student housing and quality of life for seniors have in common? By Rumana D’Souza hen most of us think about student housing we think of crowded student dorms, basement suites or shared off-campus housing. For many of us, seniors housing is not the first thing that springs to mind when we think of where university and college students might choose to live. Yet, innovative models which invite music students to live in independent and assisted living homes
at free, or subsidized rates are becoming increasingly common. The catch? Students must commit to sharing their musical talents with their senior neighbors. Programs have been developed in London, Ontario and Cleveland, Ohio with similar programs which focus on other groups of students, like medical students, appearing everywhere – Edmonton, Los Angeles and the Netherlands.
While these living arrangements might sound like the start of a buddy comedy, BC Care Providers Association (BCCPA) CEO Daniel Fontaine says they are just the kind of innovation that the sector needs. “These models marry two needs, a need to provide students with affordable housing – a considerable challenge in cities such as Vancouver – with the need to increase quality of life
for seniors, through intergenerational programing and the integration of the arts into daily living.” “It is exciting to see these creative approaches emerging, as it is a reminder that seniors care can’t and shouldn’t remain static. There are endless opportunities to bring joy into seniors’ care by simply thinking outside of what has typically been done,” says Fontaine.
Rumana D’Souza is the Digital Media & Communications Coordinator, BC Care Providers Association. 22 Home and LongTerm Care News JANUARY 2018
THE SENIORS ALSO REPORTED BENEFITING FROM THEIR INTERGENERATIONAL LIVING SITUATIONS, BOTH BECAUSE OF THE MUSIC PROGRAMMING AND BECAUSE STUDENTS OFTEN SOCIALIZED WITH THE RESIDENTS BY SHARING MEALS, PLAYING GAMES, OR SIMPLY CHATTING WITH THEM
Educating caregivers and patients with dementia Continued from page 13 The project has been heavily supported by Dr. Alexandra Pappaioannou and the GERAS Centre, as well as Dr. Anthony Levinson and the Division of e Learning at McMaster.
HOW IGERICARE LOOKS
Despite skepticism, students speak to enjoying the time they spent living in seniors’ homes. The seniors also reported benefiting from their intergenerational living situations, both because of the music programming and because students often socialized with the residents by sharing meals, playing games, or simply chatting with them. This helps reduce the risk of isolation, a major challenge for seniors. Likewise, engagement in the arts has been found to generate other positive outcomes for seniors, including building self-confidence and creating a sense of community. “As BC’s population ages, we will need to look at more opportunities for improving quality of life for seniors, and programs like these are just one example of how the arts can be integrated into seniors’ care,” says Fontaine. www.longtermcarenews.ca
The Ontario government recently committed to creating a fund to support professional arts programming and art therapy for seniors in community settings (such as Seniors Active Living Centres), retirement homes, hospitals, and long-term care homes, as well as build capacity for seniors to engage in arts organizations in their communities. Recently, BCCPA wrapped up the “40 for 40” Concerts in Care program which brought professional music performances to seniors in long-term care homes and assisted living sites across BC. The concerts were organized by Health Arts Society, and sponsored through a grant from the BC Care Providers Association. The BCCPA’s support of Concerts in Care is part of its commitment to enhance the quality of life for seniors. LC
iGeriCare isn’t a one-size-fits all resource. There are different evidence-informed modules based on the patient and caregiver’s unique needs. “So if they’ve just been diagnosed, it might be, ‘What is dementia?’ Or if they’re really advanced, it might be dealing with behavioural and psychiatric issues.” Users are supported with instructions throughout the e-lerning modules The modules include a number of elements such as videos, diagrams and clinical vignettes. “This is a story; this is somebody’s narrative,” adds Dr. Sztramko. “It’s always bringing it back to clinical vignettes that we see everyday. When people read it they can relate to the person that’s experiencing these things.” Dr. Sztramko is developing iGeriCare with the input of other geriatricians, clinical staff and a group that he calls “super users” – people such as Ruth Simmons, who have experienced caregiving first hand. “If I were backing up several years and was in the middle of my family member’s crises with Alzheimer’s, I
would find this very helpful…” shares Ruth, a caregiver who has used some of the iGeriCare modules and provided feedback. “This program would be very useful as it is not stressful to use. I was very happy and satisfied because [the lesson] sort of reviewed what I had experienced.”
The team has recruited a group of 15 patients and caregivers who will trial the platform for up to six months. “The first goal is just to build these modules and make them useful to understand that we have a process right for building modules,” says Dr. Sztramko. The geriatrician hopes to follow up the initial project with one that focuses on fostering an online community. “So instead of just going to a chat room on the web, and again not being able to trust what people say, people will be able to communicate with one another. They’ll be able to find resources outside of the modules,” he says, adding that the team is building Facebook Live and YouTube Live capabilities into the iGeriCare platform. According to Dr. Sztramko, the information itself is only one piece of the puzzle. “It’s not just the information, it’s how it’s presented. iGeriCare focuses on narrative-based medicine and providing that personal touch and connection.” LC
JANUARY 2018 Home and LongTerm Care News 23
Low Tolerance Long Duration Rehab: A safe bridge to home from acute care By Michael Oreskovich truck by a severe case of double pneumonia, 90-year-old Doris Dunne felt for the first time that her health was at risk. Physically weakened following treatment of her acute symptoms and susceptible to potentially life-threatening falls, Doris was unable to be discharged back to the community. Instead, she was admitted to Runnymede Healthcare Centre’s Low Tolerance Long Duration Rehabilitation (LTLD Rehab) program to help her get the care she needed to safely transition back to the independent life she enjoyed at home. According to a 2010 report by the Public Health Agency of Canada, between 20 and 30 per cent of seniors fall each year, a figure that is influenced by risk factors such as persistent weakness. Runnymede’s LTLD Rehab program helps patients like Doris restore strength, mobility and the skills needed for day-to-day living through low-intensity rehabilitation. Since 2012, the program has provided a safe bridge to home from acute care for over 1,500 patients recovering from injury or surgery. Upon her admission to LTLD Rehab, Doris was able to feed and dress herself, but had limited mobility and was challenged by her new physical limitations. Runnymede’s interprofessional team assessed Doris and developed a personalized treatment plan to increase her strength and ease her back into daily activities. “We focused on restoring her strength, mobility and independence,” says Runnymede patient care manager, LaVerne Edwards. “Doris was committed to getting back home to resume her active life, so we set high goals with her to help her reach this target.” Once the physiotherapy team had addressed Doris’s strength and balance, they gradually introduced her to uneven walking surfaces that simulated what she would encounter upon returning to the community. Support
Runnymede’s LTLD program provided a safe bridge to home for Doris Dunne by restoring her strength and mobility after an acute care stay. from Runnymede’s occupational therapy team complemented these gains. “We helped Doris adapt to using a cane, and coached her to avoid falls and conserve her energy,” says Nicole Digout, occupational therapist. The team then focused on restoring Doris’s capability to safely perform dayto-day tasks – like preparing meals and bathing – in a simulated kitchen and bathroom. The occupational therapists continued helping Doris to safely practice her
routine activities by accompanying her on shopping trips. “We made each trip more challenging for Doris as she got stronger,” says Digout. “After she mastered taking the bus, we introduced a shopping bag for her to hold; once she got comfortable with that, we added extra weight to mimic a real-life shopping trip.” Less than a month after her admission, Doris was back on her feet, ready to go home and resume the active life she was used to. Had she been dis-
charged directly back to the community from acute care, her recovery likely would have been slower and she would have been at higher risk of falling. The level of rehabilitation Runnymede provided safely bridged the gap between acute care and her home. “I think it’s amazing to have been as sick as I was, and to be back at the level I’m at today,” Dunne says. “I’m sincerely grateful to the people at Runnymede for my recovery – it’s a blessing to have this hospital in the community.” LC
Michael Oreskovich is a Communications Specialist at Runnymede Healthcare Centre. 24 Home and LongTerm Care News JANUARY 2018
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The need to talk about
daughters and sons By Susan Hyatt
e have all heard the term ‘working mothers,’ but what about working daughters? Not long ago an article in The Atlantic – (‘The Crisis Facing America’s Working Daughters, February 9, 2016) – referred to the lack of resources available for adult women who are struggling to balance careers and the needs of their elderly parents. It was reported that there are 44 million unpaid eldercare providers in the United States, and their needs are notably absent from discussions and policies on work-life balance. The article also revealed that caregivers often need to switch to less demanding jobs, take time off, or quit work entirely. They suffer from loss of wages, loss of job-related benefits such as retirement savings, and may not be able to re-enter the workforce if they wish to return later. Most of these caregivers are women, and most are in their mid-40s. Their caregiving responsibilities often hit during the peak of their career, caus-
ing many of them to struggle under the dual pressures of work and having to support aging parents. Even those on a solid financial footing struggle. While the article in The Atlantic focused on the U.S., Canadians are also feeling the squeeze – especially those in the so-called ‘sandwich generation’ who are balancing careers, children, and eldercare all at the same time. This was illustrated in a study by Linda Duxbury, a professor at Carleton University, and Christopher Higgins at the University of Western Ontario, in partnership with Desjardins Insurance, called ‘Balancing Work, Childcare and Eldercare – A View from the Trenches’. It revealed that one out of five working Canadian professionals take cares of both kids and an older family member. This is only going to increase in the future. Healthcare workers, in particular, are under extreme pressure with this issue. Shift work requires negotiation around changes well in advance. This
puts these workers in the same boat as first responders such as police, firefighters and emergency-service professionals who, like all of us, have parents. And those parents are getting older. These sandwich-generation professionals are evenly split between Generation X’ers and Baby Boomers, and most of them are married, living in dual-income families, and parents to either adolescents or teenagers. A quick glance at the numbers in that report shows how much people have been struggling: •6 in 10 employed caregivers were working more than 45 hours a week •47 per cent of employees said they cared for an elderly dependent who lives more than an hour away from their home •60 per cent of employees interviewed said their caregiving situation negatively impacted their productivity and/or their career •Both women and men in the sandwich-generation group were missing
more days of work per year (an average of 19.4 days for women and 13.4 days for men) than employees who had no care responsibilities for a dependent. Add to all this the fact that elderly caregiving will last for an average of 6.3 years. And that is right now. As the population continues to age, this length of time will only increase. Clearly, we have to ask the question – Who can manage such a level of stress for so long? And if you are a nurse, a physician, or any type of healthcare worker in a hospital or LTC facility, no doubt you are already engaged in a stressful job. What if your own elderly parent suddenly needs care? In the future, as the population continues to age, we can expect more people will have to leave the workforce to act as unpaid caregivers for their elderly parents. This will come at a high cost to individuals, organizations, and society at large. In Canada the number of older Canadians requiring the support of unpaid caregivers is expected
Susan Hyatt is the CEO of Silver Sherpa Inc. 26 Home and LongTerm Care News JANUARY 2018
IN CANADA THE NUMBER OF OLDER CANADIANS REQUIRING THE SUPPORT OF UNPAID CAREGIVERS IS EXPECTED TO DOUBLE OVER THE NEXT TWO DECADES.
to double over the next two decades. There are many resources and workplace policies available for working mothers, and also fathers, but consider that in 2015 the number of Canadian seniors outnumbered children under the age of 14 for the first time ever. This means that we have to play catchup in supporting working daughters and sons. Caregiving for an elderly person can be overwhelming and stressful on its own, and especially so when one must also balance the demands of a career and family. When crisis strikes an elderly family member or friend, many people
feel torn between the need to care for their loved one and their responsibilities at work. If you are in that situation, you may have to take time off work, experience high levels of emotional and financial strain, or just feel ‘burnt out.’ That’s why we recommend that everyone think about their elderly family members and start with a plan. Before a crisis hits, you need to discuss healthcare concerns, personal care issues, and financial or legal preparedness with your family. Planning ahead will go a long way to helping ease the stress and demands of these inevitable life transitions. LC
Helping people live with independence, dignity and in comfort since 1925. • Nursing • Physio and other therapies • Personal care and support • Homemaking
Also specializing in:
• Palliative support needs • Dementia care • Respite • Wound care
JANUARY 2018 Home and LongTerm Care News 27
Specialist helps you
understand brain, nervous system Mom has multiple sclerosis and the family doctor sent her to a geriatrician because of her cognitive and physical changes. She was seen and then sent for another assessment by a neuropsychologist. I am not sure what this specialty adds. Signed, Feeling bounced will start off by saying that you are lucky. As an occupational therapist, I have had the privilege of working with this group of talented professionals. We often put our findings together to understand what is happening as the result of an illness that is diagnosed or one that is in need of clarification. To clarify for you, neuropsychologists are psychologists who specialize in the area of how the brain and nervous system affect daily function. These professionals often are referred to in order to help us gain a better understanding of how the brain is working in its different areas. Neuropsychologists study brain anatomy and how the different parts of the brain are used and how they interact.
This puts them in a particularly good position to help with diagnoses, as well as getting a better understanding of some of the cognitive, behavioural and other changes that are associated with particular neurological conditions. Examples of the kinds of patients seen by neuropsychologists are patients with Alzheimer’s disease, Parkinson’s disease, stroke, traumatic brain injuries and brain tumours. Patients with these conditions often are referred to neuropsychologists so that the referring physician can obtain a clearer picture of the specific effects of a given condition on a person’s cognitive functions and that person’s ability to function adaptively in everyday life. For example, the physician may see physical changes on an MRI or a CT scan, but the daily issues that may be
present are best assessed through neuropsychological testing. Neuropsychological testing is also valuable in other respects. For example, an initial assessment serves to establish a baseline of an individual’s cognitive functioning in the early stages of a disease. A reassessment can identify what specific changes have occurred with its progression. It also can provide information about how a different pharmacological (medication) treatment is affecting the individual. The types of tests neuropsychologists use are ones designed to assess such functions as attention, memory, learning and problem-solving skills. Some people wonder why these are necessary if the cognitive screening was already conducted by a family physician. Frontline screening tests are usually brief and
narrow in scope. They provide a general idea of an individual’s cognitive capacities and can help identify individuals in need of more comprehensive assessment. Dr. Dmytro Rewilak, a neuropsychologist at Baycrest Health Sciences, explains: “When it comes to dementias, two general patterns of neuropsychological impairment have been identified and have been named, according to what part of the brain is most involved. One pattern is called ‘cortical’ because it primarily involves the cortex (i.e., the outer layer of brain). The second pattern is called ‘subcortical’ because it primarily involves areas of the brain lying beneath the cortex.
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 firstname.lastname@example.org. This article originally appeared in the Toronto Star. 28 Home and LongTerm Care News JANUARY 2018
Communicating with someone who cannot speak By Pamela Stoikopoulos
Neuropsychologists are in a good position to help with diagnoses of patients who are suffering brain function changes.
The importance of this distinction can be illustrated with reference to memory. When impaired, the nature of the memory impairment differs, depending on what brain areas are most affected. The memory problems associated with Alzheimer’s disease, a cortical dementia, are different than those associated with Parkinson’s disease, a subcortical dementia. In the former, the person cannot form new memories, while in the latter the person can form them but needs cues and prompts to retrieve them. A neuropsychological assessment helps to define the nature of the memory problem, and this has different implications for management.” Testing is lengthy (two to six hours) and sometimes needs to be broken down for people who cannot tolerate it
due to physical or other reasons. However, many individuals actually enjoy the testing. Some indicate that they liked the challenge, while others find it helpful to know what cognitive areas have been affected by their disease. Another useful outcome of neuropsychological testing is that it identifies strengths the person can utilize, even in the midst of other problems and issues. Families, other professionals and staff caring for someone can utilize this information to help the individual. Unfortunately, not every medical centre or health unit has access to this service, but if yours does, remember — you are not being bounced. Rather, I urge you to look at it as a welcome, additional resource in the tool kit of understanding, planning and caring for any neurological issue. LC
rain damage caused by an accident, stroke or disease that takes away a person’s ability to speak can be devastating for both the individual and family. You can feel like he or she is a million miles away unable to speak or hear you but this may actually not be the case. Through brain scans, experts have discovered that even people with no signs of awareness are often able to understand and absorb what people are saying. You can and should communicate with your loved one but your methods will depend on the person and their level of responsiveness. To help you better communicate with your non-verbal loved one make sure you:
Never assume that your loved one can’t understand what is being said. Include them in your conversations, even if they can’t speak or appear to not understand. Pay attention to your loved one in a group and, whenever possible, continue normal activities like dinner with family or visits from friends.
Start your conversations by introducing who you are and why you’re there. If someone comes to visit or care for your loved one you should also introduce them by name and explain what the person is there to do. This can do wonders for recognition and shows your loved one a level of respect they deserve.
Use everyday words and ensure you speak to your loved one like an adult and not a child. Watch your tone of
voice and try to sound natural. Actively show your loved one you believe in their inner competence.
WATCH YOUR MOOD
The person you’re caring for may be very sensitive to nonverbal cues like facial expressions, mood and tension so consider how you’re presenting yourself. If you make a point of being relaxed and smiling, your positivity may even rub off on your loved one.
During conversations try to minimize or get rid of background noise all together. Things like phones, television, radio, street traffic or other conversations will make your attempts to communicate less effective. Even moderately impaired people can ‘overload’ on background noise and wind up feeling overwhelmed and unresponsive.
TALKING WITHOUT WORDS
Try other, non-verbal ways of communicating. Don’t rule out speech but experiment with writing, pictures, hand motions, eye contact and facial expressions. Try to look for clues on how your loved one is feeling based on body language so you can recognize if they’re tired, frustrated or experiencing other uncomfortable emotions. Use these alternatives:
This tool displays the alphabet, common words or phrases and pictures to represent them. A therapist may be able to help use the board more effectively. Continued on page 31
JANUARY 2018 Home and LongTerm Care News 29
Doctor-created solution helps curb patient wait times By Shelagh Maloney athalie Achim recently attended an office visit with her family physician who needed to be in touch with a specialist. So when her doctor called her back, she assumed it was to tell her when and where to show up for her specialist appointment. “Instead, I was told that the specialist had already provided advice, and all I needed was a minor fix that could be taken care of by my GP,” says Achim, whose wait time was erased thanks to the visionary work of two Ottawa-area physicians. It all began in 2008 when Dr. Clare Liddy, Primary Care Lead for the Champlain BASE™ eConsult Service, was told her patient faced a nine-month wait to see an endocrinologist. “I was frustrated by the amount of time my patients were waiting to see a specialist for matters that could perhaps be resolved with a simple communication, and that nine month wait was the catalyst for me. I knew something had to be done.” she says. Meanwhile Dr. Erin Keely, Chief, Division of Endocrinology and Metabolism at The Ottawa Hospital, was also frustrated by the long waits patients endured for relatively simple consultations with her. “Our wait times are up to a year for non-urgent cases and my colleagues and
MORE THAN 31,000 PATIENTS HAVE RECEIVED FASTER ACCESS TO SPECIALIST ADVICE, AND MORE THAN 60 PER CENT OF CASES HAVE BEEN RESOLVED WITHOUT THE PATIENT REQUIRING A FACE-TO-FACE SPECIALIST VISIT I felt patients were waiting needlessly to come see us for something that could be addressed directly with their primary care doctor,” says Keely. Together, the doctors created the Champlain BASE™ eConsult Service, a secure, online platform that enables primary care providers to seek advice from 107 specialty services. Since it was created nine years ago, more than 1,300 primary care providers have signed up for it, more than 31,000 patients have received faster access to specialist advice, and more than 60 per cent of cases have been resolved without the patient requiring a face-to-face specialist visit. Dr. Annabelle Lévesque-Chouinard, a Gatineau family physician, credits the service with reducing the time patients wait to receive the care and treatment they need. “I had a patient come to me with a lesion that persisted, despite the use of a variety of ointments and creams,” she explains. “Rather than fax a referral and have the patient wait for an ap-
pointment, I sent a photo of the lesion to a dermatologist, who replied quickly and together we were able to resolve the issue without delay. I wish more of my colleagues had access.” So do doctors Liddy and Keely. Encouraged with the positive feedback they have received from physicians, their objective is to increase the number of doctors in Quebec who have access to the Champlain BASE™ eConsult Service, and to spread the service to rural, remote areas in Newfoundland and Labrador. They also plan to launch in Manitoba. In Ontario, eConsult continues to grow through the Ontario Telemedicine Network (OTN) hub. Offered in conjunction with OntarioMD, the OTN eConsult service is available in several Local Health Integrated Networks through two models: Direct to Specialist (OTN eConsult) or as a Managed Service (Champlain BASE™ eConsult). It is a solution whose time has come. While advocating for a single-payer
healthcare system at a U.S. Senate Committee hearing in 2014, Dr. Danielle Martin, Vice-President, Medical Affairs at Women’s College Hospital in Toronto, shared that she had been held up for 30 minutes at the entrance to clear the building’s security that morning, only to see a second security entrance with no queue. “Sometimes it’s not actually about the amount of resources that you have, but rather about how you organize people in order to use your queues most effectively,” she says. Michael Green, President and CEO of Canada Health Infoway, says the Champlain BASE™ eConsult Service exemplifies how disruption through digital health can improve the health care experience for patients. “Canadian healthcare providers have a unique understanding of the obstacles they and their patients face,” says Green. “I am impressed with the results of the Champlain BASE™ eConsult Service, and hope to see the use of e-consults continue to grow to improve the health care experience of more and more Canadians.” Achim hopes so too. “I’m a busy working mother, and attending a medical appointment requires a lot of juggling,” she says. “It’s reassuring to know digital health innovation is making access to care easier for families like mine.” LC
Shelagh Maloney is a blah blah 30 Home and LongTerm Care News JANUARY 2018
Although it’s not for everyone, your loved one may respond well to touch.
Communicating with someone who cannot speak Continued from page 29
YES OR NO QUESTIONS
If the person you’re caring for can understand questions but can’t answer verbally, try asking ‘yes’ or ‘no’ questions. Choose a gesture for yes (head nod, eye blink etc.) and a gesture for no (shake of the head, hand squeeze etc.). Keep your sentences really simple so they only have to focus on one thought at a time.
USE PICTURES, OBJECTS AND WRITING
Draw pictures to show what you’re trying to say. Refer to maps, calendars
and clocks when you’re explaining where or when and photographs when you’re talking about someone. Experiment with printing key words in large, clear letters as you’re having the conversation. Even if you’re loved one shows no sign of recognition or response, continue to communicate with them this way, showing familiar faces and places can trigger positive reactions.
OTHER WAYS TO CONNECT
You don’t need to fill every single moment with your own words. There are lots of other ways to communicate
and connect that don’t require words at all. Try these methods:
Listening to music can be very soothing, healing and comforting. Watch for reactions and see if it’s well received.
Reading with someone who can’t speak is a great way to spend time together, regardless of whether they respond to you.
Although it’s not for everyone, your loved one may respond well to touch.
Start by gently holding their hand and watch for body language. Although they may not be able to squeeze you back, see if they seem more relaxed, startled or withdrawn. If they respond well, a light massage may be a great way to connect. You don’t have to do or say anything to bond with your loved one. Just sitting and looking out the window together can communicate a thousand words. Be on the lookout for body language clues that tell you how your loved one is feeling or responding to your efforts. Figure out likes and dislikes and offer the pleasure of your company in any way you can. LC
Pamela Stoikopoulos is the Sr.Communications and Public Relations Manager at VHA Home HealthCare. www.longtermcarenews.ca
JANUARY 2018 Home and LongTerm Care News 31
I donâ€™t want to feel scared
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