Inside: National senior strategy | Music care | Family councils | Food is medicine
November 2017 Edition
An in-depth look at innovations in senior care Page 14
Innovation to Impact Visit cabhi.com to learn how you can accelerate your aging and brain health innovation.
Take your medicine:
can technology help? By Tim Pauley t is estimated that half of us don’t take our medications properly. The consequences for individuals, and the healthcare system are significant. “Medication non-adherence” is responsible for an astonishing one quarter of emergency department visits and nursing home admissions, and is estimated to cost the Canadian healthcare system $7 billion annually. The most common issue in non-adherence is missed doses (39%). These difficulties are compounded for people taking many medications for multiple chronic conditions, and for those with cognitive impairment. For individuals living at home, family members and caregivers can help with reminders, but this can still leave gaps during the day when they may forget. In recent years, new technologies have hit the market to address this challenge, and an upcoming study involving clients of Toronto Central Local Health Integration Network (LHIN) is set to evaluate one of them, Circura + Reminder Rosie from LifeAssist Technologies. The multisite, randomized controlled trial is being supported by the Centre for Aging and Brain Health Innovation (CABHI) at Baycrest Health Sciences, through one of the largest research grants Toronto Central LHIN has ever been awarded. The relationship between Toronto Central LHIN and LifeAssist Technologies began last year during a test pilot conducted by LHIN home care pharmacists Andrea Calvert and Kate Walsh, and Rapid Response Nurse Majid Valerio, in which different medication reminder devices were tested with 10 clients. “We wanted to find a way to help clients who were struggling to take their medications as directed. Rosie stood out for ease of use,” reports Calvert.
Circura + Reminder Rosie from LifeAssist Technologies. Reminder Rosie looks like a tablet-based alarm clock, but instead of beeping, it plays voice recordings left by family members or the patient themselves. Reminder Rosie looks like a tablet-based alarm clock, but instead of beeping, it plays voice recordings left by family members or the patient themselves. “Dad, take one blue pill after lunch,” it might say at 1pm. Simple voice-activated prompts allow messages to be recorded easily. Reminders to test blood glucose or for medical or other appointments can also be added. For patients, the device can promote self-management and independence. The reminder component of Circura + Reminder Rosie is being evaluated for this trial, but it can also be linked to a secure virtual communications environment, in which patient information and health data can be viewed
on a mobile phone application by an individual’s circle of care (home care staff, primary care, family members or others), and members of that circle can communicate with each other. Additional biometric data (e.g. blood pressure, blood glucose levels, walking activity, weight) can be collected using Bluetooth-enabled technology, to provide comprehensive remote monitoring of patient health. In home care, the reach of health professionals is extended: a nurse driving to monitor patients in their home may only reach 3-4 in a day; but using virtual monitoring, 2025 clients could be monitored in the same time period, reducing costs while increasing monitoring intervals.
The research trial demonstrates Toronto Central LHIN’s unique ability to drive innovation in home care, and will evaluate medication adherence, resource utilization, patient satisfaction and patient participation in health management. Sixty people receiving home care from Toronto Central LHIN who have mild to moderate cognitive impairment and are struggling to take their medications as prescribed by their doctor will be selected to participate in the study, which will randomly assign half to receive standard community care and half to receive standard community care plus Circura + Reminder Rosie. The one-year study runs until fall 2018. LC
Tim Pauley is Manager, Research & Knowledge Mobilization at Toronto Central LHIN and Principal Investigator for the study. Healthcare professionals with questions can reach him at Tim.Pauley@tc.lhins.on.ca 2 Home and LongTerm Care News NOVEMBER 2017
contents November 2017
Cover story: An in-depth look at innovation in the senior sector
Why we need a national senior strategy
Dementia and sleep
2 4 8 10 11 12 18 21 22
Shift to culturally appropriate care
Family councils in long-term care
The brain and music
Life-saving stroke treatment
Technology and medicine Editorâ€™s Note Starting the palliative care conversation Alzheimer Society research grants Home care heroes Helping long-term care homes provide quality care Eldercare costs Assessing the diabetic foot Caregiver SOS
30 Food is
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Technology is the key s the demographics in Canada undergo a dramatic shift (more seniors than children), our healthcare system is struggling to keep up with the increased care demands of this new normal. Unfortunately, healthcare systems are slow to adapt and we are already falling behind as many seniors are living in hospitals, instead of at home (with assistance) or in long-term care facilities. As we try to provide more and better quality care to an increasing number of seniors, it’s clear that we need to find more efficient and cost effective ways to service this growing population. This is where technology has a huge role to play. This month’s cover story takes an in-depth look at three innovations that could enhance senior care. From helping people with Alzheimer’s Disease remember important events that happen on a day-to-day basis to an e-learning program that helps seniors deal with changes in memory, to a new app improving communication amongst long-term care staff, technology is not only enhancing care it is improving patient safety. Reminder Rosie is an alarm clock type device that plays voice recordings for seniors to remind them to take their medication or eat dinner (pg.2). The possibilities technology presents are endless. It wasn’t that long ago we were celebrating the arrival of a medical alert device to enable seniors to alert a loved one if they had fallen (see fall prevention month info on pg.24). Today, we have virtual reality that can calm agitated patients, apps that can monitor blood pressure, sensors on fridges to let us know if our loved one has been eating, just to name a few.
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JANUARY 2018 ISSUE Technology is the key to keeping seniors at home and finding efficiencies in our health system. Not only must we embrace technology and find a way to get it in the hands of health professionals and patients faster, we must continue to innovate. The home and long-term care sector is facing increasing pressure and many seniors are not able to access care in a timely manner. In this issue Canadian Medical Association President, Dr. Laurent Marcoux outlines why we need a national senior strategy and how it will improve access to care, not just for seniors but for all Canadians (pg.6). Through-out these pages you will find information on enhancing care for patients and loved ones requiring home or long-term care. If you have a story to share please email firstname.lastname@example.org LC
Kristie Jones Editor, Hospital News
4 Home and LongTerm Care News NOVEMBER 2017
EDITORIAL: December 8 ADVERTISING: Booking and Material – December 12 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: email@example.com Subscription rates in Canada for single copies is $35.00 per year. Canadian Publications mail sales product agreement number 40065412. From the publishers off Hospital News, reporting on health care news and best practices for over 30 years.
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National senior strategy needed to improve access to healthcare for all Canadians By Dr. Laurent Marcoux ealthcare in Canada has been a tremendous contributor to the success of our nation. From the people working in it and the research conducted within it to the medical advances coming at a pace like we’ve never seen before. This has combined to help Canadians live longer and healthier lives.
But – and there is always a ‘but’ isn’t there? We all know that our healthcare system is currently in a fragile state. While we celebrate living longer than ever, we must also recognize that our system is not well equipped to manage our aging population with its more complex and chronic diseases. How should our system operate to offer more efficiency, effectiveness and social equity?
6 Home and LongTerm Care News NOVEMBER 2017
Our system was built 50 years ago with a focus on an acute care delivery. Fast forward to today and we see that the system’s failure to evolve has become a major barrier to social equity in healthcare delivery, not to mention a serious cause of lengthy wait times. All too frequently patients languish in hospital when they could be getting more appropriate, high-quality care else-
where. Investments in residential care infrastructure and continuing care will improve care for seniors while significantly reducing surgical and emergency department wait times, benefiting all patients. CMA believes the ability of our country to meet the healthcare needs of seniors is not only necessary, it is also achievable.
NEWS What is required is a strategic approach – a national strategy for senior care. Creating such a strategy would also help build on the tremendous success stories that already exist across Canada: • The Acute Care for Elders Collaborative is a partnership between the Canadian Foundation for Healthcare Improvement and the Canadian Frailty Network where as improvement teams across the country accepted into the collaborative receive funding, coaching, education material and tools to support the adaptation of Toronto’s Mount Sinai Hospital’s Acute Care for Elders (ACE) Strategy. The initiative has enabled teams to become experts in healthcare practices benefitting older patients in the communities where they reside, improving patients’ experience of care, coordination of care and system outcomes. (http:// www.cfhi-fcass.ca/WhatWeDo/ace) • The Nova Scotia Health Authority Care by Design Program provides
INVESTMENTS IN RESIDENTIAL CARE INFRASTRUCTURE AND CONTINUING CARE WILL IMPROVE CARE FOR SENIORS WHILE SIGNIFICANTLY REDUCING SURGICAL AND EMERGENCY DEPARTMENT WAIT TIMES, BENEFITING ALL PATIENTS. residents of long-term care facilities access to high quality and consistent primary healthcare. The goal? Provide high quality of life to the most frail seniors and appropriate healthcare approach to meet their needs by teaming up family physicians with families and members of an interdisciplinary team to a single floor of a long-term care home to deliver the best care. • Northwest Territories Aven Cottages is an initiative funded by the Government of the NWT and the Department of Health Social Services. The facility dedicated to help-
ing seniors dealing with Alzheimer’s and related dementia consists of two cottages, each having 14 private rooms situated around a central core with a dining room, kitchen and living room area. These examples show the way forward. They show that we can offer the right type of care the patients need. Imagine if we applied these and the countless other examples that exist across Canada to drive systemic change at the national level? We could reduce the acute care burden and deliver timely access to the highest quality care for our seniors – and for all Canadians.
At the CMA, we have been vocal about the need to have a national vision on seniors care. We believe that addressing this issue would go a long way in helping stabilize our healthcare system. This is why in 2015 we launched our award-winning patient engagement platform – www.demandaplan.ca. Since then more than 51,000 Canadians have joined the movement to press the federal government to create a national strategy on seniors care. This fall, we submitted five recommendations to the government in its pre-budget consultation. From targeted funding to support development of a pan-Canadian strategy to capital investments in residential care infrastructure, our recommendations aim to build a roadmap for the healthcare system of the future. The time is now to act and enable the changes that will help build an efficient, effective and equitable healthcare system that will address the needs of our seniors andultimately – all Canadians. LC
Dr. Laurent Marcoux is President of The Canadian Medical Association.
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Starting the palliative conversation on
quality of life By Drew Tapley aintaining quality of life for residents is a daily consideration for Kim Lattimore. When people are admitted to either of the two long-term care communities where she divides her time as a resident relations coordinator, she starts a conversation that evolves as each resident’s health declines. “As people move in, we start the conversation about their quality of life, values, beliefs and wishes,” says Kim, who keeps that conversation alive even when a resident is dying. She does so to ensure families are not surprised by the disease process and inevitable decline, and are better prepared to make decisions. “You have to work with families on this because some of them are not there yet. We have care conferences once a year and each time there is a significant change in a resident’s condition.” A lot of people come to Kim at the Owen Hill and Creemore care communities – both in Simcoe County and owned by Sienna Senior Living – with an advanced care directive that talks to some of their wishes. She recently had a lady admitted with lung cancer. “I asked the family if she has talked about her goals of care, and how much she wanted to fight this disease. They had already had these conversations, and she had written things out in her advanced care directive.” But Kim says that some people are in denial, and she continually introduces the conversation so they can get more comfortable with it over time. During care conferences, there’s a discussion about some of the challenges the resident will experience at the end-of-life, or after a sudden decline in health, and what these changes mean.
Left: Kim Lattimore 8 Home and LongTerm Care News NOVEMBER 2017
“If someone went to hospital and comes back, or they had a stroke, we have conversations about how they need more help with this or that, and how some things are probably not going to get better. With dementia, I talk about how it’s progressive, that there is no cure, and how this person is going to lose mobility and memory.” And this conversation is unique to every individual within the homes. “As a disease progresses, we alter care plans so there continues to be some quality of life. Maybe they are going to have breathing or pain challenges, so we need to look at how we can make them more comfortable. What we always want to be doing is having a palliative approach to care from admission. It shouldn’t just be happening at end-oflife. It’s a conversation we should be having all the way along.” Not every resident Kim deals with is a senior. She believes that the palliative conversation should start with much younger generations too, and
“SOMEONE IS PALLIATIVE IF THEY HAVE ANY KIND OF LIFE-LIMITING ILLNESS. MOST PEOPLE COMING INTO LONG-TERM CARE WOULD BE PALLIATIVE. WE LOOK AT END OF LIFE AS THOSE LAST DAYS WHERE THERE ARE A LOT OF CHANGES, AND THEY ARE PROBABLY BEDBOUND.” says that we should all have our advanced care directives together in case of an accident. She manages care for younger people with palliative illnesses at the homes, and draws a distinction between palliative and endof-life care. “Someone is palliative if they have any kind of life-limiting illness. Most people coming into long-term care would be palliative. We look at end of life as those last days where there are a lot of changes, and they are probably bedbound.”
And even at this stage, Kim and her team are considering quality of life with recreational activities and pain management. When a resident passes away, she recognizes this within the two communities by doing certain things to honour them. But she also believes it is important to recognize other people who have been directly affected. “In passing, we strive to meet the needs of the resident and their family. But are we meeting the needs of the staff who looked after them for years,
or supporting the residents who may have lived with this person for years?” It’s this kind of forethought and leadership, along with considerable heart, which won her the Brenda Smith Award for Palliative Care earlier this year. Brenda Smith was a palliative care leader in the Simcoe region, who worked tirelessly to promote the highest standards of palliative care for healthcare providers. She died in 2008, and this award reflects her professional characteristics. On any given month, Kim sits on one palliative care board or another, and says that her attraction to working in longterm care was strongly influenced by a great relationship with her grandparents. “Long-term care is very interesting, and you have such a variety of personalities. Some people like to be private, and others like to have their family around them. It’s always about them having a voice in a home filled with all kinds of people with all kinds of needs.” LC
Drew Tapley is a Writer for Sienna Senior Living.
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Alzheimer Society Research Program provides $3.4 million boost to dementia research
he Alzheimer Society Research Program (ASRP) is pleased to announce it has awarded $3.4 million to Canadian researchers through this year’s research competition to help create a brighter future for Canadians who are impacted by or at risk of Alzheimer’s disease and other forms of dementia. This year’s awards and grants support 24 applicants from across the country
who are working towards finding new prevention and treatment strategies, enhancing patient care, and finding a cure. “Research funding is critical for advancing scientific discoveries and producing breakthroughs that enable people with dementia to live well and bring us closer to a cure,” says Nalini Sen, Program Director. “We’re proud of our Program and to be able to provide opportunities to many of
Canada’s bright and talented minds.” The Alzheimer Society Research Program (ASRP) is a national leader in dementia research aimed at supporting and developing capacity in the areas of biomedical, clinical and health services research. Funding applications undergo an extensive peer-review process led by respected researchers as well as people with lived experience of dementia. The ASRP is a collaborative initiative of Alzheimer Societies across
Canada, key partners and generous individual and corporate donors. Since its inception 30 years ago, the Program has invested $53 million in dementia research. For an inside look at the ASRP and to hear directly from some of our researchers about their discoveries, watch our video at https://youtu.be/ rqfQnFHOZk8. More information is also available at www.alzheimer.ca/research. LC
Alzheimer Society Research Program recipients
JENNIFER WALKER Laurentian University, Sudbury: Jennifer is collaborating with local researchers to study the increasing rate of dementia among First Nations in Saskatchewan. Her work will help inform and improve dementia care services in Indigenous communities.
HEATHER COOKE University of British Columbia: Heather seeks to better understand how incivility and bullying among long-term care workers influences dementia care. The results will help improve staffing practices and policies and enhance the quality of life for both residents and staff.
JANNIC BOEHM Université de Montréal: Jannic’s goal is to develop a “peptide” that will penetrate the blood-brain barrier and access neurons in the brain. If successful, this tool could be used to help maintain and promote brain function in people with Alzheimer’s disease.
MATTHEW PARSONS Memorial University, St. John’s: Matthew’s research will investigate when and where toxic proteins in the brain, the hallmarks of Alzheimer’s disease, begin to impair brain cells and disrupt the formation of memories. He hopes these findings will ultimately lead to new treatments.
This article was submitted by the Alzheimer Society of Canada. 10 Home and LongTerm Care News NOVEMBER 2017
Home Care Support Services
behind the scenes heroes By Elaine O’Connor
veryone has a story about a home healthcare hero. Home healthcare professionals are so intimately involved in their clients’ daily lives that they often form bonds and go above and beyond their job descriptions to ensure their clients receive the highest quality of care. The foundation of this kind of patient-centered quality community home care system depends upon a similar kind of dedication from behind the scenes heroes working in home care administration. Fraser Health’s Bryce Walker, the B.C. Health Authority’s Home Support Services Regional Coordinator, has that dedication and he’s dedicated his entire career to the field. He joined the Home Support Team in 2004, soon after high school, and has since filled nearly every position in his field – from scheduler to clerk to IT administrator to program coordinator – except for providing direct patient care. It was this diverse knowledge of the system that enabled him to take the reins during the incredibly complex centralization of Home Support Services in 2015. Bryce led efforts to standardize service delivery, protocols, and administration of home care support between regions with the ultimate goal of improving care delivery and patient experience. Bryce put in hundreds of hours of his own time on evenings and weekends to establish the new workplace and support employees with the transition. The Abbotsford-based coordinator collaborated with teams across New Westminster, Tri-Cities, Maple Ridge, Burnaby, Chilliwack, Abbotsford and Mission to ease their experience of reorganization and mentored new schedulers and clerks. His goal, Bryce says, was to “ensure we are not doing things differently in
Bryce Walker is he B.C. Health Authority’s Home Support Services Regional Coordinator. one community to another in terms of support structures for community health workers, which really just speaks to the quality of our care. The end result is more consistent services for clients. I kind of looked at it as bringing all the blood to the internal organs – bringing everything into one place to keep those critical systems going.” His team of 35 home support scheduling employees now organize care for approximately 2,600 patients, connecting them with care from 850 community health workers who provide an average of 109,000 visits every month. “It’s a lot of work,” Bryce explains. We’re supporting Fraser Health initiatives like Home is Best, Home First and as well, we’re doing a new initiative called ER to Home, all of which are helping with our shift to community care.” Colleagues praise him for motivating and inspiring others, leading by example and supporting team development initiatives which have resulted in reduced sick time, and increased employee retention, morale and productivity.
As a result of his efforts, Bryce was recognized by the health authority with a Fraser Health Above and Beyond Award for Service Delivery Excellence in September.
Learn more about Bryce’s work in this video and article: http://news.fraserhealth.ca/News/September-2017/ Bryce-Walker-Service-Delivery-Excellence-Award.aspx LC
Elaine O’Connor works in communications at Fraser Health.
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(left) Ann McIntyre with her husband, Larry. (right) Jim Singleton moved to Cassellholme a few months ago.
Helping long-term care homes provide quality care to residents By Sacha Novack he North East Local Health Integration Network (NE LHIN) is committed to providing the right health care at the right time to people across Northeastern Ontario. For some, that care is found in a longterm care home. Thousands of seniors across the region are thriving in this setting; meet two of them, who reside at Cassellholme in North Bay. Jim Singleton moved to Cassellholme a few months ago, following his wife’s death. The past president of Laurentian Ski Hill and former director of the YMCA has always been very involved in the community – and he was happy to take on another guiding role at Cassellholme. He joined the Family Council, a group of residents, family members, and friends that
THE NORTH EAST LHIN FUNDS CASSELLHOLME AND 39 OTHER LONGTERM CARE HOMES ACROSS THE REGION provides assistance, information, and advice – as well as supports and plans activities. “I like the people here. They’ve been very good to me,” says Singleton. “The service they provide is excellent.” Ann McIntyre’s husband, Larry, has been a resident at Cassellholme for two years. She visits him several times a day and appreciates the work longterm care homes do to help ensure
Sacha Novack is a Communications Officer with the North East LHIN 12 Home and LongTerm Care News NOVEMBER 2017
residents’ needs are met. “The staff at Cassellholme are wonderful, caring people who work hard to make the lives of their residents as safe, pleasant and meaningful as they can,” says McIntyre. “The NE LHIN is extremely pleased to support the health care needs of Northerners wherever they call home,” says Kate Fyfe, Interim CEO of the North East LHIN. “Long-term care offers a broad range of services in a friendly, safe environment, helping to ensure people receive the around-theclock care they need from a dedicated team of health care professionals.” The North East LHIN funds Cassellholme and 39 other long-term care homes across the region – facilities that work hard to improve the quality of life for the people they serve. LC
Facts: • The North East LHIN funds 40 long-term care homes across the region, which operate nearly 4,900 licensed beds. In October 2014, the Ministry of Health and Long-term Care announced its commitment to Enhanced Long-Term Care Home Renewal Strategy (Enhanced Strategy). • The Enhanced Strategy supports the redevelopment of more than 30,000 LTC beds in more than 300 LTC homes to current design standards by 2025, eliminating all four-bed wards in Ontario’s long-term care homes. • Through the Enhanced Strategy, residents will benefit from redeveloped LTC homes, which facilitate the provision of quality care and service in an environment that is comfortable, aesthetically pleasing and as home-like as possible. • 1 in 10 residents of the NE LHIN aged 75 and older live in long-term care. • Cassellholme has been in operation since 1925. It currently provides care to 240 residents. www.longtermcarenews.ca
Better care starts here. For seniors and their families, the shortage of long-term care isn’t just a story in the news. It’s a difﬁcult reality. Long waiting lists are a serious problem. And low stafﬁng levels mean seniors aren’t getting enough hours of specialized care from skilled and compassionate professionals. There are solutions.
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NEWS Users engaging with the SOS Checklist app, which gives care providers a common language.
An in-depth look at
innovations in the senior sector By Ilan Mester icture this: a person living with the early stages of Alzheimer’s Disease (AD) attends their grandchild’s seventh birthday party. They want to remember that moment, but realize the memory will likely escape them. So with a simple click of a button, they capture part of this precious moment on a device that will play it back to them later in a similar way to the hippocampus – the part of the brain that’s strongly linked to memory and is affected in people experiencing AD. This is the type of innovation the Centre for Aging + Brain Health Innovation (CABHI), led by Baycrest Health Sciences, is helping to nurture. Established in 2015, CABHI is a solution accelerator that collaborates with researchers, point-of-care clinicians and entrepreneurs across Canada and globally. The organization provides support to innovations (technologies, interventions, knowledge translation initiatives) that directly impact seniors living with dementia and other conditions associated with aging, along with projects that affect their caregivers and providers. Here is an in-depth look at a trio of unique senior-sector innovations that are in the pipeline:
Project Lead: Dr. Morgan Barense, cognitive neuroscientist Site: University of Toronto’s Memory & Perception Lab The sci-fi-esque Hippocamera is a digital memory augmentation device that acts like an external hippocampus. “The memories that are lost in people with Alzheimer’s Disease are the events of one’s life that are happening on a day-to-day basis,” explains neuroscientist and project lead Morgan Barense. “Recent events, they slip away as quickly as they occur. So what we want to do with a digital device is to capture those events and store them in a memory that saves on these smartphones. We don’t want the memories to only be on the phones; we need to get them into the user’s brain somehow.” The “trick,” according to Barense, is mimicking the hippocampus. “The hippocampus takes a memory and essentially broadcasts it to the rest of the brain through a process called hippocampal replay. It basically teaches the rest of the brain these memories. And the students of the hippocampus are the parts of the brain that are still intact in Alzheimer’s Disease, so it’s like our phone is the hippocampus and we’re trying to teach the rest of the brain those memories.”
In its current iteration, the Hippocamera is an app that users can download to their smartphone. “So the user takes the device out when it’s a memory they want to remember,” adds Barense. “They take a video of it and then the phone stores that video and it plays it back on a steady schedule and with certain parameters. We’ve changed the video in such a way that we think mimics what the hippocampus is doing.” The device is currently being trialled through Barense’s lab. Her team is using narratives and neuro-imaging to determine whether the Hippocamera improves memory retention and if it changes how the brain represents these memories. So far, the feedback from users has been overwhelmingly positive. One senior who chose to remain anonymous notes the experience was “very motivational.” “I started to have more confidence in myself and started to be more aware of things around me,” they added. Barense says CABHI has been instrumental in moving the project forward. Her team received support through the Research-Clinician Partnership Program (R2P2), which connects clinicians with university-based researchers to collaboratively design and test products or services in real-world settings.
“CABHI’s financial support is helping with machine learning advancements for the Hippocamera,” says Barense. “And it’s also giving us extra fire power in terms of validating the device in a larger-scale clinical trial.”
SOS CHECKLIST APP
Project Lead: Raquel Meyer and Jennifer Reguindin Site: Centre for Learning, Research & Innovation in Long-term Care Like many innovations in healthcare, the Sensory Observation System (SOS) Checklist App came about after a clinician noticed an issue in practice. “There is room to improve communication in long-term care,” says Jennifer Reguindin, a nurse and interprofessional educator for the Centre for Learning, Research & Innovation in Long-term Care. “I hear staff say, ‘I need your help with a patient’ and it isn’t specific enough. So a typical response would be, ‘I’ll help later.’ This sometimes results in in an unnecessary escalation or uncovers a concern that was already addressed.” The SOS Checklist App offers care providers a common language they can use with healthcare providers. “Communication accounts for 80 per cent of medical errors,” adds Reguindin. Continued on page 16
Ilan Mester is the Communications Content Specialist for the Centre for Aging + Brain Health Innovation (CABHI). www.longtermcarenews.ca
NOVEMBER 2017 Home and LongTerm Care News 15
Innovations in the senior sector Continued from page 15 “So here’s a resource that can support communication using a framework. Here’s an easy way if you take the time to pause and think about what you want to say and activate the team accordingly.” That data includes everything from incremental changes in appetite, selfcare abilities and mood changes, among other things. The goal is to offer care providers a common language, a secure space for observable changes to be stored and shared, and potentially reduce unnecessary hospital admissions for seniors. “I believe that this app can increase the accuracy of patient report in the clinical setting, as well as recognize any acute changes that the patient is experiencing,” shares Anthony Saceda, a newly graduated registered practical nurse who has used the app in practice. “As a new graduate, there will be signs and symptoms that I can possibly miss when assessing my patient, of which can be critical. This app also allows me to explore different possible outcomes that may arise as I assess my patient.” At first, the SOS app was meant solely for care providers such as nurses and PSWs. However, Reguindin realized its potential benefits to caregivers and is
now testing it among people caring for elderly family members. In addition to financial support, Reguindin says CABHI has provided guidance and feedback opportunities. For example, Reguindin participated in a focus group with CABHI’s Seniors Advisory Panel – a diverse group of seniors who meet bi-weekly to share their input on CABHI-related innovations. Reguindin adds that CABHI’s involvement has been crucial to access business support. “I’m a nurse – how do I learn how to get this app out to people? I don’t know how. With CABHI’s support, someone will be able to coach us on getting the app to market when the time is right.”
MEMORY AND AGING PROGRAM (MAP)
Project Lead: Dr. Angela Troyer, neuropsychologist Site: Baycrest’s Neuropsychology and Cognitive Health Program Transforming a clinically validated intervention into an e-learning tool takes a lot of work. Just ask Cindy Plunkett, a project manager for CABHI’s e-Learning and Educational Technologies division. Cindy and her team work in-house at CABHI to develop and
leverage e-learning opportunities for CABHI-supported projects. One of those is the Memory and Aging (MAP) program, an educational intervention for older adults dealing with age-related memory changes. The clinically validated, five-week program has been running onsite at Baycrest Health Sciences for 20 years. “It gives participants practical memory strategies that they practice during the different weeks to help them continue to have a very vibrant lifestyle,” Plunkett explains. CABHI saw an opportunity to bring this well-researched program outside of Baycrest’s walls through e-learning, expanding its reach well beyond Toronto and into national and even international territory. The key, however, is to ensure MAP continues to have the same feel as the original in-person intervention. “We wanted to recreate the feeling of that small, 15-person discussion in the classroom in the online environment,” adds Plunkett. To do this, Plunkett and her team have drawn on a number of interactive components, such as a polling system and a curated discussion to increase engagement. “The face-to-face version has been rigorously tested,” she adds. “And we
will be doing the same with the online version, and then doing some comparisons to see if we are getting the same gains as we were getting in the face-toface version.” So far, the online version of MAP has been piloted twice and a few more iterations are in the works. There has been cross-Canada representation and even some international users. “I think because you’re doing something interactive, it keeps you more connected and engaged,” shares Shirley Criscione, a senior who participated in one of the pilots. “You’re not just sitting and listening to someone.” She’s already recommended the program to a friend who’s starting to experience memory changes. “What I liked about it is you could do the program in your own time and your own space. You didn’t have to travel somewhere to participate in the workshop. That’s really important because as people age and want to take advantage of this program, it’s going to be easier if they can do it in their home rather than having to go somewhere in a car or take transit.” Criscione adds that she’s still using many of the strategies she learned in the online group. “The memory program teaches you about how important it is to stay physically active, stay social and of course, mentally active as well. The relaxation strategies that are part of the program to keep yourself calm and stress free – I think all of those units are really important for people to access and try and hone.” These are just three of more than 70 exciting projects currently underway at the Baycrest-led Centre for Aging + Brain Health Innovation. To learn more about CABHI and its programs, visit cabhi.com or email firstname.lastname@example.org. LC
Memory and aging program (MAP)
16 Home and LongTerm Care News NOVEMBER 2017
In April 2017, long-time BCCPA member New Vista Society announced the building of a new culturally sensitive care home dedicated to Korean-Canadian seniors.
The shift toward culturally appropriate care By Rumana D’Souza anada’s population of seniors is surging, as the 2016 census found seniors now outnumber children under 14 for the first time. By 2031, projections show, about 23 per cent of Canadians will be seniors. The population of older adults has also become more ethnically diverse. With one out of five people in Canada’s population being foreign-born, immigrants represent a considerably large group among seniors in Canada.
A CHANGING POPULATION CALLS FOR CHANGE IN CARE
Ethnic minority seniors often experience health inequities in Canada – conflicting family values, cultural practices, language barriers, and immigration status can all pose as barriers to health care. They may also have trouble understanding roles of a health authority or a care provider.
ETHNIC MINORITY SENIORS OFTEN EXPERIENCE HEALTH INEQUITIES IN CANADA – CONFLICTING FAMILY VALUES, CULTURAL PRACTICES, LANGUAGE BARRIERS, AND IMMIGRATION STATUS CAN ALL POSE AS BARRIERS TO HEALTH CARE. Immigrant seniors, particularly more recent immigrants, have different characteristics, backgrounds, and life experiences than seniors born in Canada. A lack of cultural competence in a care setting can make residents feel isolated and uncomfortable. By its definition, culturally appropriate care is supportive, meaningful and beneficial. It facilitates delivery of care to seniors that aligns with cultural values, beliefs, and ways of life.
“Culturally appropriate care promises better outcomes and well-being for seniors,” says Daniel Fontaine, CEO of BC Care Providers Association. “It is a pressing issue, particularly in B.C. which is becoming increasingly multicultural.” “The BCCPA is committed to working closely with our members to deliver culturally competent senior care that addresses the needs of this diverse population.” Care providers, particularly nurses, play a key role in providing culturally
appropriate care to ethnic minority seniors. For care providers to be successful in doing that, they need to be acquainted with various behaviours, cultural customs, and types of communication – it’s not a one-sizefits-all approach. Care providers need to know forms of address, taboo gestures, and whether eye contact or physical contact is acceptable or improper. Not knowing how to effectively communicate with the resident’s family poses another challenge. Care providers also need to be aware of holidays, rituals and events that are important to residents, as well as dietary restrictions and food pairings in different cultures and religions. This knowledge can help avoid misunderstandings, and make residents feel more comfortable. Cultural awareness, sensitivity, and competence can increase navigability and effective use of services for many seniors in care. LC
Rumana D’Souza works in communications at the BC Care Providers Association. www.longtermcarenews.ca
NOVEMBER 2017 Home and LongTerm Care News 17
are putting the squeeze on families
By Susan Hyatt have worked as a consultant to the healthcare industry in Canada and across the globe for over 40 years. When I was on assignment in the United Kingdom, my elderly parents both took ill at the same time, in different cities, in Ontario. Even with my expertise and connections, as I tried to steer elderly parents through major transitions, I wound up being at the mercy of fragmented, disjointed and, at times, non-responsive systems.
All of a sudden, neither of my parents could live independently and I wasn’t able to find adequate solutions in their communities. We found ourselves in crisis mode. Weeks turned into months, the bills piled up, and I took time off work. After finally getting my parents settled into new accommodations, I put my own retirement plans on hold and started a professional services company called Silver Sherpa that delivers crisis management for
18 Home and LongTerm Care News NOVEMBER 2017
the elderly, along with advice in estate planning and life planning. Now every day I see families in crisis with no plan in place. Unfortunately, we often get the call after the crisis happens. Indeed, Canadians are complacent when it comes to eldercare and tend to think the government looks after everything. It is a huge shock when people are thrown into an emergency with elderly parents and suddenly realize how little the public purse pro-
vides, and how much things actually cost once those people leave hospital. Earlier this year CIBC Capital Markets released a study called ‘Who Cares: The Economics of Caring For Aging Parents’ and it was a call to action for Canadians. It provided some ‘big-picture’ costs and trends: • Ten years ago Canadians 65 years and older represented about 14 per cent of the population, but now it is 17 per cent and in another 10 years it will be 22 per cent. www.longtermcarenews.ca
NEWS • Almost two million Canadians, or 14 per cent of those with parents over age 65, incur out-of-pocket costs involving care, and on average that is estimated at $3,300 a year per caregiver. (Based on our practice, we think this figure of $3,300 is too low.) • The human labour costs are high as 30 per cent of workers caring for elders over age 65 take off from work about 450 hours per year. • The sum of direct and indirect costs to care for aging parents is about $33 billion per year in Canada and we are only at the beginning of the aging wave. Over the next 10 years these costs will mushroom by more than 20 per cent due to changing demographics. The great irony with all this is that the brunt of eldercare is borne by women at a time when society is focused on getting more women into leadership and management positions. Today people live longer than ever, and families are smaller and often living in different communities. This means fewer family members share the
CANADIANS ARE COMPLACENT WHEN IT COMES TO ELDERCARE AND TEND TO THINK THE GOVERNMENT LOOKS AFTER EVERYTHING. load. What’s more, if you live in a city like Toronto or Vancouver, the cost of housing is high, and almost one-third of older children wind up staying at home longer. So households are busy and hectic, and then along comes an emergency with your elderly mother or father. What do you do? Caring for an elderly person at home can be very costly. Here are the facts. The cost of 24/7 home care support can be a staggering $23,000 per month. That is not a misprint. Maybe the family decides you only need care for 12 hours a day, five days per week, and then family members are expected to help out. That’s still $7,680 per month. Except for the proverbial one per cent, who can afford that? Clearly, this is not sustainable.
What’s more, in-home services such as visiting physiotherapists can cost $150 per hour for the first visit and $100 for the subsequent visits. A course of 10 visits costs $1,050 plus HST. In our business we often see daughters or sons just “trying to hang on” for another few weeks, hoping Mom or Dad will improve. The reality is that the average length of time caring for an elderly parent today is 6.3 years! The result is that caregivers will suffer from burnout and many of them look for other options such as a respite stay in a retirement facility. But even that can be upwards of $3,500 per month and more depending on the acuity of care required.
What about publicly subsidized longterm care facilities? That’s fine, but in Ontario today there are now 26,000 people waiting to get into them. The wait lists are long everywhere, and some people may not meet the required ‘care criteria’ so families are forced to look at more costly alternatives. If we are talking about an elderly person with dementia, specialized dementia care in the Greater Toronto Area will cost $7,000 per month for a basic level of care and for the administration of first-level medication. But that’s not all. Add in such incidentals as outings, getting one’s hair done, incontinence products, and spending money, and you could be well into $7,500 per month. Do this over five years and it will be half a million dollars. The bottom line is that eldercare costs are rising and often putting the squeeze on family budgets. This underlines the necessity of planning ahead. As we age, we want to live life on our own terms but it may come at a steep cost. Costing out possible scenarios and financial impacts is key if you want to age smartly! LC
Susan Hyatt BSc (PT) MBA, is the CEO of Silver Sherpa Inc.
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www.bayshore.ca NOVEMBER 2017 Home and LongTerm Care News 19
The brain on music: A dementia perspective his song brings me so many emotions,” said Sally*, a long-term care resident who was listening to one of her all-time favourite pieces. Sally has dementia, and musical moments like this one have become highlights within her day-to-day routine. I have witnessed Sally, among many other residents, find peace, joy, pain relief, happiness and love within their musical experiences. Music is an invaluable tool in long-term care. It connects people with memories, emotions, and with their loved ones. Out of all of our activities of daily living, music activates the most brain areas, which explains why music can have such powerful and diverse effects. The effects of music begin in the brain, and from there, they project to all parts of our body and soul. Our ears detect sound waves from the environment, and use an encoding system of neurons that is 100 times more powerful than the one our eyes use to encode colours and shapes. Our auditory system is extremely precise. Once our ear has collected and encoded all the information from the airwaves, the coded information travels into our brain through a bundle of neurons appropriately named the auditory nerve. Once the information reaches our brain, it projects to many different areas, which are responsible for the effects of music. The brain relies on neurons that connect and communicate with different areas in order to function properly. In dementia, neuronal communication is jeopardized, leading to symptoms such as memory and communication challenges. Interestingly, music is the last type of memory to deteriorate in dementia. Research shows that brains of individuals with dementia are able to respond to musical stimuli to a far greater degree than other brain networks, at the same stage of demen-
tia. For example, an individual with dementia who is not able to recognize their children or spouse, quite often can sing every word to many songs from their youth. In this way, music can provide a moment of peace and familiarity in an otherwise unfamiliar world. Even though we have not answered all the questions about music and the brain, we do have an opportunity to improve the quality of life of individuals living with dementia, through the use of music. When we listen to music we love, the memory centres of our brain are stimulated. If a song you hear has ever transported you through time to re-create a certain memory, it is because the
music triggered memory recall within your limbic system. This system is responsible for encoding our deepest and most primal memories. Playing familiar songs that are known to have positive associations can be a great way to engage individuals with dementia through memory recall, and subsequent discussions about that memory. Music can also be used in dementia care to re-direct attention. For example, a care partner can easily hum or sing a familiar tune while bathing, feeding, or simply being present with an individual with dementia. Music activates the frontal lobe of the brain, which is responsible for attention. Familiar music can re-focus a person’s attention leading to a sense of relief.
Music has both biological and psychosocial effects. Sally benefits from the music used by her nurses, PSWs, and family members. When music is shared with Sally, she in turn shares it with other residents and care providers. It is this ripple effect, where music connects people within a space, which will change the culture of care in the long-term care setting. Music is free, and accessible to all, and has profound impacts on quality of life. *Name has been changed LC
Chelsea Mackinnon, BHSc, MA, is Room 217’s research lead. She teaches two interdisciplinary undergraduate courses at McMaster University, and is the founder of the Hamilton Intergenerational Music Program. 20 Home and LongTerm Care News NOVEMBER 2017
Assessing the diabetic foot By Ellen Kirk-Macri and Susan C. Jenkins p to 80 per cent of diabetes-related amputations are avoidable. Prevention starts with proper assessment and care of the feet in patients with diabetes. A nurse begins the assessment by taking a history, examining the feet, testing for loss of sensation and reduced circulation, and classifying the risk.
COMPONENTS OF A DIABETES FOOT CHECK
• History: Ask the patient about any foot issues that have arisen since the last assessment and inquire about the daily foot care routine to ensure that the patient or caregiver is following the appropriate procedures. • Physical examination: Start with a visual inspection of the lower legs and feet. Check for dry, cracked skin, fissures, and any changes to the colour or texture of the skin. Examine the toenails for length, colour, thickness, debris, odour, pain, and separation from the nail bed. Record the location, size, and colour of calluses and any areas that appear to be the result of mechanical stress or pre-ulcer formation. Look for any structural abnormality such as hammer toes or bunions that may make ulceration more likely. • Testing sensation: Loss of protective sensation is the single most significant risk factor for foot ulcers, because the patient is unable to perceive the warning signs of ulcer development. One common method for testing sensation uses a 10g monofilament. Begin by showing the filament to the patient and placing it on his/her hand or arm to show that it will not hurt. Hold the monofilament perpendicular to the skin and press until it bends. Hold it in this position for one to three seconds. Ask the person to say “yes” when he/
UP TO 80 PER CENT OF DIABETES-RELATED AMPUTATIONS ARE AVOIDABLE. PREVENTION STARTS WITH PROPER ASSESSMENT AND CARE OF THE FEET IN PATIENTS WITH DIABETES. she feels the filament. Do not press the filament to the skin and then ask, “Did you feel that?” Touch the underside of the big toe and three equally-spaced points across the ball of the foot. When you complete the sequence, go back and retest the areas the patient did not respond to. Repeat the procedure on the other foot, testing the spots in a random pattern. • Checking circulation: Check the skin temperature on the patient’s leg and foot using the back of your hand. Normally, the leg is warmer at the tibia and cooler at the toes. Dilation of the capillaries in the toes
can cause the temperature to be the same in both areas. Also check for the presence of varicose veins, brown staining in the ankle area, edema, and scarring from previous ulceration. Check for capillary filling time by pressing on the distal pulp of the toe until it blanches; then release the pressure. Normal reperfusion takes up to five seconds. Delayed refilling is a sign of arterial ischemia.
CLASSIFYING THE RISK
• Low risk: If there are no problems noted, the patient should be reassessed annually.
• Moderate risk: A patient with one risk factor but without calluses or deformity should be referred to a foot care specialist for further assessment. • High risk: A patient with a history of ulceration or amputation or more than one risk factor should see a foot care specialist within the next three months • Urgent: A patient with any of the following should see a foot care specialist or physician for immediate assessment: – active ulceration – spreading infection – critical ischemia – gangrene – unexplained hot, red, swollen feet – painful peripheral neuropathy – acute Charcot foot (a weakening of the bones due to nerve damage) All patients, regardless of risk level, should have a foot care management plan tailored to their individual circumstances. LC
Ellen Kirk-Macri is a registered nurse and certified diabetes educator. Susan C. Jenkins is a freelance writer and editor specializing in medicine, pharmacy, and healthcare. She can be reached at email@example.com. www.longtermcarenews.ca
NOVEMBER 2017 Home and LongTerm Care News 21
Depression after loss of spouse My dad passed away five months ago and mom is not doing well. They were married for 50 years. Now, mom seems to be depressed. She says it is normal. I am unsure it is. Signed, Waiting for better tats Canada reports there are about 1.8 million widowed individuals living in Canada in 2016. The vast majority of them are women. Clearly the loss of a spouse is a very traumatic and difficult experience and mom’s sadness is natural. Loss of a loved one is also known as bereavement. The loss of a spouse, especially after so many years of marriage, can be extremely painful and disrupt normal living. It can set off a whole range of events and emotions.
This question often comes up when family or friends are concerned about whether the sadness or grief is going on too long. To understand the process, one must know that ordinary grief is a universal human experience. Some people believe there are stages to this grief process, but this has not been well supported in the literature. People seem to grieve on their own timetable and in their own way (or as some say, “two steps forward, one step back”). For some, it is a raw and difficult ex-
perience that devastates them, while others suffer it in silence and their grief is imperceptible to the people around them. Most individuals who grieve are preoccupied and often living in a state of disbelief. They have memories and thoughts of longing and sadness, and can also experience a range of emotions from guilt to shame to anger. Some people may have a renewed appreciation for life and begin to feel some personal enjoyment while coping with their loss. This type of grieving person often transitions to what is considered “integrated grief” — when the acute pangs of grief become more bearable. Dr. Cindy Grief, psychiatrist and grief specialist at Baycrest Health Sciences in Toronto explains: “People are incredibly resilient. Over time, it becomes easier to accept the loss and find ways to cope and even have rich
lives. They say grief is timeless, because there will always be birthdays, holidays, anniversaries, celebrations and special family events, which can sometimes trigger painful feelings or ‘bittersweet’ memories.” It is common to have rituals that can help individuals mourn and these can help manage the loss whilst ensuring that the loved one is not forgotten. Different cultures and religions usually prescribe these grieving rituals to mark the passage of time. Some individuals have a more difficult time healing and this is what has to be differentiated with respect to your mother. A process called “complicated grief” may mean an inability to accept the loss. Feelings of anger, avoidance or guilt can be pervasive and can mean that the person is not able
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. 22 Home and LongTerm Care News NOVEMBER 2017
The loss of a spouse, especially after many years of marriage, can be extremely painful and disrupt normal living.
to function day-to-day. This person may be stuck in this state and cannot move forward. They may not be able to manage to care for themselves properly or may be so preoccupied with feelings of sadness that they are severely depressed. Some people can become depressed in the aftermath of loss, so this is important to monitor. Researchers have found that grieving individuals are vulnerable to adverse health/medical outcomes. Much like other stressors, someone with an anxiety disorder is also more likely to become ill. It is no surprise that substance abuse can also be a risk for those suffering a loss, especially if the death was not expected.
As a family member, it is crucial to watch your mother carefully. Does she take on more activity over time? The difficult periods should become less intense and shorter as time goes by; but it may take mom time to work through the loss. If you are concerned that things aren’t progressing in the right direction, seek an assessment from a qualified therapist. Remember, most people do recoup and manage to move on with their lives, but for some it is a complicated process and they may need treatment and more formal supports to find their comfort. A good resource is bfotoronto.ca. LC
Helping people live with independence, dignity and in comfort since 1925. • Nursing • Physio and other therapies • Personal care and support • Homemaking
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NOVEMBER 2017 Home and LongTerm Care News 23
Fall Prevention Month encourages organizations [VJVVYKPUH[L[OLPYLɈVY[ZMVY a larger impact. Canadian organizations participate by planning initiatives and sharing evidence-based PUMVYTH[PVUVUMHSSWYL]LU[PVU Together, we can raise the WYVÄSLVMMHSSWYL]LU[PVUHUK help everyone see their role in keeping older adults active, independent and healthy as they age.
Ç-HSSZHYL[OLSLHKPUNJH\ZLVMPUQ\Y`HTVUNVSKLYHK\S[Z · The average Canadian older adult stays in hospital 10 days SVUNLYMVYMHSSZ[OHUMVYHU`V[OLYJH\ZL Ç-HSSZPUVSKLYHK\S[ZHJJV\U[MVYIPSSPVUPUKPYLJ[OLHS[OJHYL costs annually Ç6]LYVMVSKLYHK\S[Z^PSSILHKTP[[LK[VSVUN[LYTJHYL HM[LYOVZWP[HSPaH[PVUMVYHMHSS · Falls in older adults are predictable and preventable. There are many organizations and individuals working hard [VPUJYLHZLH^HYLULZZVM[OLPZZ\LHUKLUJV\YHNLHJ[PVU[V WYL]LU[MHSSZHUKPUQ\YPLZMYVTMHSSZ
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INFORMATION FOR OLDER ADULTS
Dementia and sleep By Pamela Stoikopoulos • Use a baby alarm with the microphone in their room and the receiver in your room so you can hear them if they get up. • Lock doors of rooms you don’t want them to go into. How to prevent falls out of bed: • Put the bed against a wall. • Use a lower bed. • Put a soft mat with non-slip backing beside the bed. • Use a double bed rather than a single bed. • Remove the bed frame and place the mattress on the floor. How you can help: • Keep calm even if you feel upset, a strong reaction will make the situation worse. • Reassure your loved one that they’re okay. • Distract your loved with something pleasant like calming music. • Try to understand that they may be afraid. •Try different things like quiet music or singing to them. • Don’t raise your voice. Talk calmly and slowly.
hose with dementia sometimes find it difficult to sleep well at night for different reasons. This can be challenging for everyone involved as it can affect your precious sleep too! Below are some of the common problems family caregivers face and some ideas to help you overcome them.
PROBLEMS WITH SLEEPING
Some of these things could be getting in the way of your loved one sleeping well at night. He or she may: • Frequently wake up throughout the night. • Not be able to sleep at bedtime. • Get very upset just before bedtime. • Wake up in the middle of the night and think it’s time to get dressed. • Fall out of bed. • See imaginary people and may talk to them. • Think they are someone else. • Believe this is not their bed. • Wander around the house at night. • Try to get out of the house at night.
There are many reasons why your loved one is having problems sleeping and it may take some detective work to determine the cause. Sleeplessness could simply be a symptom of the disease or it could be because he/she: • Isn’t physically active enough during the day to be tired at night. • Fears being left alone or is worried something bad is going to happen to them. • Feels hungry, thirsty, too hot or too cold. • Is in physical pain but cannot express it. • Doesn’t know if it’s day or night. • Needs to use the bathroom and/or can’t find the bathroom.
SEEK SUPPORT Night time tips There are a number of steps you can take to encourage your loved one to sleep easier and better at night. Daily routine: • Create a regular routine before bedtime. For example: Watch the news and then feed the cat. Then change into pyjamas and wash face, hands and brush teeth. Take bedtime pills and get into bed. Be sure to keep the schedule the same every night. • Don’t give big drinks near bedtime. • Discourage your loved one from napping during the day. • Try to encourage some exercise every day.
In the room: • Keep the room warm on cold days and cool on hot days. • Remove daytime clothes so they can’t see them. • Put a clock where they can see it. • Cover the mirror if seeing a face in it is upsetting. • Darken the room but avoid shadows. Home safety: • Have a night light in the washroom. • Keep walkways clear so your loved one doesn’t trip. • Put padding on furniture with sharp corners. • Hang a bell on the door so you can hear if they leave.
An occupational therapist can provide you with tools and tips to help you make your home safer and find solutions to improve sleep patterns. Remember also to seek support from your loved one’s doctor to help improve sleep quality and quantity. While sleeplessness can be frustrating for you as a caregiver remember that your loved one is not intentionally trying to be difficult. Take deep breaths to help stay calm and talk in a slow, gentle voice to reduce anxiety and fear and to reassure your loved one that he/she is okay. Your soothing and reassuring response can go a long way in ensuring a better night’s sleep for everyone. LC
Pamela Stoikopoulos is the Senior Communications and Public Relations Manager at VHA Home HealthCare. www.longtermcarenews.ca
NOVEMBER 2017 Home and LongTerm Care News 25
Exploring the potential benefits and constraints
of family councils in long-term care By Rumana Dâ€™Souza ur understanding of how care should be delivered to seniors depends greatly on applied research. Through research, we know that family plays an integral role in senior care. We also know how the involve-
ment of individual family members can determine quality of life for residents in care. What we need now is a greater understanding of how family councils function, and their impact on longterm residential care.
26 Home and LongTerm Care News NOVEMBER 2017
THE ROLE OF FAMILY COUNCILS
Composed of family and friends of long-term care home residents, a family council meets regularly to identify and resolve issues affecting all residents, plan activities, and support each other.
A family council must be organized, self-led, self-determining, and democratic. Family councils typically work with a staff liaison appointed by the care home to assist the council. Family councils aim to facilitate communication, and promote partnerships
between staff, residents, as well as families of residents not actively involved in the council. “Care providers work very closely each and every day with family councils and individual family members of residents in care facilities,” says Daniel Fontaine, CEO of the BC Care Providers Association. “Family members play a very critical role in helping maintain and improve the quality of life of seniors living in a care setting. A fully functional and effective family council has proven to make a difference in the lives of many of B.C.’s senior population.”
FAMILY COUNCILS IN BRITISH COLUMBIA
B.C.’s Residential Care Regulation supports family councils by stating that long-term care facilities must provide an opportunity for family members to form a council which promotes the individual and collective interests of
FACILITIES WITH SUCCESSFUL FAMILY COUNCILS REPORTED IMPROVED PEER SUPPORT, CONSTRUCTIVE ATTITUDES, AND LEARNING OPPORTUNITIES AT THEIR SITES.
residents in care, and involves them in decisions that affect their day-to-day. Gerontological Education, Research and Outreach (GERO) at the UBC School of Nursing released a province-wide report on family councils in the province. Out of the 222 long-term care sites surveyed across B.C., 151 had family councils. Most of these sites were privately-owned, and located in urban areas. Facilities with successful family councils reported improved peer support, constructive attitudes, and learning opportunities at their sites.
The report also highlighted challenges to initiating and sustaining a family council, including a lack of interest, poor understanding of a family council’s purpose, and an inconsistency in family attendance.
FINDINGS OVER THE YEARS
Previous research tackling the subject shows the benefits of family councils on long-term care significantly outweigh its drawbacks. A 2007 study that set out to determine the presence, characteristics and impact of family councils on long-term
care in U.S. found they “provide mutual support, empower its members, and advocate change to improve the residents’ quality of life.” The study, published in the journal Geriatric Nursing, also mentioned family councils contribute to a culture of mutual respect within a long-term care facility. One of the greatest challenges of maintaining an active council, researchers found, is the fluid nature of membership. Family members are busy with work and their personal lives. And when a resident in long-term care passes away, their family withdraws from the council in most cases. The study called for increased efforts to identify the role of the facility in supporting family councils, and stated that the involvement of family councils has the potential to improve relationships between family, residents and staff, reduce and address complaints, and improve quality of life for seniors. LC
Rumana D’Souza works in communications at the BC Care Providers Association.
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Kingston Health Sciences Centre offers new life-saving stroke treatment By John Pereira new stroke treatment is now available 24/7 at Kingston Health Sciences Centre (KHSC) and it’s already proving to be a game changer for some patients. KHSC has become one of a small number of hospitals in Ontario that is now able to offer this procedure, opening the door to treatment for the 500,000 people living in KHSC’s catchment area. The procedure is called an Endovascular Thrombectomy (EVT) and to qualify for it, the patient must be experiencing a severe stroke that is caused by a large clot near the base of the brain. During the procedure a multidisciplinary team of experts work together to delicately remove that clot. “This is one of the greatest advances in stroke care in the last 20 years,” says Cally Martin, Regional Director of the Stroke Network of Southeastern Ontario. “To be able to extract a large clot and thereby allow blood flow to return to the brain is very exciting. We have entered a new era of stroke care.” When a patient arrives in KHSC’s Emergency Department suffering from a suspected stroke, the clock starts ticking. The first step is to get the patient into a CT scanner in less than 10 minutes so experts can see images of the arteries in the brain and find the clot that is causing the stroke. The patient may quickly be given a clot-busting drug (known as tissue plasminogen activator or tPA). If the clot is large, in the right place, and there is enough time left, the person is then moved to an Interventional Radiology suite. When the treatment starts one of KHSC’s Interventional Radiologists inserts a catheter into the femoral artery (in the groin) and using image-guidance technology navigates to the brain. They then place a stent-like device, which is attached to a wire, across the clot in the brain so the two can mesh together. After a few minutes, the device is pulled
Teams can now remove blood clot from brain of a patient suffering severe stroke out along with the blood clot. If all goes well, the blood flow is re-established into the affected area of the brain immediately. “Our brains are extremely complex and sensitive,” says Dr. Albert Jin, stroke neurologist and Regional Stroke Medical Director. “An estimated two million neurons die every minute they are deprived of the oxygen and other nutrients that are delivered by our blood. It’s extremely important we have smooth processes in place to carry out the treatment as quickly as possible.” KHSC began piloting the treatment after a series of landmark clinical trials showed it can significantly improve the outcome and reduce the mortality rates for patients who might not respond well to other types of treatment. During the pilot KHSC teams treated a number of patients and the results were impressive.
“We’ve seen instances where patients have gone from being completely unable to move or speak and within minutes of the procedure being completed, they are talking and shaking hands with our doctors and nurses,” says Dr. Jin. “These are patients who are experiencing the most severe types of strokes and in the past likely would have been left with severe paralysis if they survived. We’ve never seen patients recover this quickly.” The treatment requires that a number of departments from across the hospital, particularly the Emergency Department, Diagnostic Imaging, Interventional Radiology, Critical Care and Neurosciences, along with the five paramedic services and partner hospitals in our region, work together to quickly offer the service to patients. “This has required extensive cooperation between clinical programs in
the hospital, as well as our external partners and is a great example of how KHSC can achieve great things for our community through teamwork and commitment,” says Jin. “This partnership is allowing us to revolutionize stroke care across our region.” Of course it’s also vitally important that patients get to the hospital as quickly as possible so that treatment can begin. “A Stroke is a medical emergency and you can use the acronym F.A.S.T. to check for the signs of a stroke,” says Martin. “If you experience any of these signs, call 9-1-1. Do not drive to the hospital. An ambulance will get you to the right hospital for stroke care.” • Face – is it drooping? • Arms – can you raise both? • Speech – is it slurred or jumbled? • Time – to call 911 right away LC
John Pereira is the Strategic Communications Advisor at Kingston Health Sciences Centre. www.longtermcarenews.ca
NOVEMBER 2017 Home and LongTerm Care News 29
Food is medicine where malnutrition and frailty are concerned By Heather Keller and Leah Gramlich
Malnutrition is a common problem for patients entering healthcare facilities in Canada – costing the system $2 billion annually
30 Home and LongTerm Care News NOVEMBER 2017
ou are what you eat,” or so the saying goes. We use this axiom in our developed country, where obesity is often top of mind, to remind ourselves that overeating will lead to a less healthy physique. However, this saying is also true for undereating or malnutrition – and that happens in Canada too. It may be surprising to many Canadians that malnutrition is very common in our hospitals, our health care institutions and in certain patient populations. Malnutrition begins in the community and can be perpetuated by a hospital admission. Estimates suggest 30 to 45 per cent of medical patients at an average age of 65 years of age are malnourished at admission, costing our hospital system approximately two billion dollars per year. Malnutrition, whether due to inadequate intake of protein or energy, or vitamins and minerals, is a known contributor to many conditions, including frailty. Frailty is a growing concern in Canada with our aging population; although frailty can happen at any age, it is most common in older adults and estimated to occur in approximately 25 per cent of persons over the age of 65 years. What does frailty look like? Common symptoms of frailty include weight loss, weakness and exhaustion, often exhibited as falls, delirium and failure to thrive. The Canadian Frailty Network is raising awareness of this condition and how it can be prevented, delayed, potentially treated and better managed – and save the health system money in the process. Nutrition is one of the key areas where treatment for frailty is promising, especially if the person is also malnourished. Recent evidence demonstrates an overlap between frailty and malnutrition in Canadian hospital patients with 70 per cent of malnourished patients being screened as frail. A variety of physiological, social and economic factors, such as living alone or low income, and disease-related factors are the root causes of malnutrition for these Canadians. It is also likely that frailty and malnutrition impact each other. Many frail older adults living in the community are challenged with accessing the grocery store, getting the groceries home and preparing and eating food.
Appetite and interest in cooking may be poor, especially for those who live alone. After discharge from hospital, 25 per cent of patients will unintentionally lose weight in the first month, with poor appetite being a primary factor. Low protein intake or inadequate intake of key nutrients such as vitamin D can also result in muscle and bone changes that can lead to a fall and consequent disability. The public is generally unaware that as we age, we need the same or greater amounts of many vitamin and minerals than younger segments of the population need – particularly vitamin D and calcium. Due to a constellation of factors, older adults also need up to 50 per cent more high-quality protein in their diet than is currently recommended, to retain the muscle they have, with further increases required if they are
IT MAY BE SURPRISING TO MANY CANADIANS THAT MALNUTRITION IS VERY COMMON IN OUR HOSPITALS, OUR HEALTH CARE INSTITUTIONS AND IN CERTAIN PATIENT POPULATIONS.
frail, subjected to prolonged bed rest or surgery. So, “you are what you eat,” holds true as well for malnutrition. With caloric needs of older adults and those with frailty often low due to lack of activity and loss of muscle mass, this means that every bite needs to count nutrition-wise. In the case of malnutrition and frailty, food is medicine. So, what are we to do?
First, the medical profession and those who are routinely in contact with potentially frail and malnourished patients need to recognize these conditions and their importance in the overall health, well-being and recovery of patients. Screening for malnutrition and frailty should be done in all healthcare encounters for those over the age of 70 years, including at the doctor’s
office, home care visits and at every medical or surgical patient admission to hospital. Public health agencies across the country should work with primary care physicians to identify early nutritional habits that can be improved and promote self-screening tools targeted to the frail and senior populations. When those at risk for malnutrition are identified, referral to a dietitian to provide counseling, education and connection to community supports and services is needed. Malnutrition can be treated. Families and friends can support their loved ones who are frail by helping with groceries, cooking and eating together. Watch for unintentional weight loss and poor appetite and seek help early to prevent malnutrition and frailty. LC
Professor Heather Keller is the Schlegel-University of Waterloo Research Chair in Nutrition and Aging and an expert advisor with EvidenceNetwork.ca. Dr. Leah Gramlich is a gastroenterologist and professor in the Faculty of Medicine at the University of Alberta and Provincial Medical Advisor for Nutrition Services with Alberta Health Services. They are co-Chairs of the Canadian Malnutrition Task Force and both are researchers with Canadian Frailty Network (CFN), a not-for-profit organization dedicated to improving care for older Canadians living with frailty.
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As you get older, your immune response to inﬂuenza vaccines decreases. FLUZONE® High-Dose improves your immune response to inﬂuenza (also known as the ﬂu) and has demonstrated better protection of adults over 65 against the ﬂu than our standard dose ﬂu vaccine. In fact, FLUZONE® High-Dose vaccine is signiﬁcantly more effective than our standard dose vaccine in preventing the ﬂu – 24.2% more effective.
For more information, visit www.fluhd.ca FLUZONE® High-Dose is a vaccine used to prevent influenza in adults 65 years of age and older. Influenza (or flu) is an infection caused by the influenza virus. Annual vaccination using the current vaccine is recommended for prevention against influenza as immunity declines in the year following vaccination. Persons with a history of severe allergic reaction to eggs or egg products or any component of FLUZONE® High-Dose should not receive the vaccine. FLUZONE® High-Dose will only protect against the strains of influenza virus contained in the vaccine or those that are closely related. FLUZONE® HighDose will not protect against any other strains of influenza virus. FLUZONE® High-Dose is not indicated for the prevention of hospitalization or death after the onset of disease. As with all vaccines, FLUZONE® High-Dose does not protect 100% of people immunized. Allergic reactions can occur. The most common side effects are pain at the injection site and muscle ache. Contact your healthcare provider to see if this vaccine is right for you. For more information, visit www.sanofipasteur.ca. FLUZONE® is a trademark of Sanofi Pasteur. Sanofi Pasteur 1755 Steeles Avenue West, Toronto, Ontario M2R 3T4 © 2016 Sanofi Pasteur Limited. All rights reserved. DIN : 02445646 372-012c E 09/16