Supporting Residents Expressing Responsive Behaviours

at Home, Hospital, and LTC HNHB LHIN Behavioural Supports Ontario Strategy

Family Council Network Four (FCN-4) Regional Meeting June 29, 2017

Objectives • Background on BSO Strategy in HNHB LHIN and client

population • Discuss how BSO models support individuals across

care settings • Share case stories from the Team • Review how BSO Strategy is building LTC Champions • Share program data • Q & A

Source: BSO Kick off Presentation August 2011

BSO Provincial Framework

Goals: Quality of Care & Quality of Life

Older people (& their caregivers) with cognitive impairments due to

mental health problems, addictions, dementia, or other neurological conditions that

exhibit, or are at risk of exhibiting, responsive

behaviours

Seniors with dementia are intensive users of health-care resources

People with dementia are: – Twice as likely to be hospitalized compared to seniors without

the disease – Twice as likely to visit emergency departments for potentially

preventable conditions – More than twice as likely to have alternate level of care days

when hospitalized – Nearly three times more likely to experience fall-related

emergency room visits Gill, et al. (2011). Health System Use by Frail Ontario Seniors. Institute for Clinical Evaluative Sciences.

Dementia • Dementia is an umbrella term for many brain disorders. Changes in a

person’s behaviour can be an indicator. • Dementia affects everyone differently, but it commonly diminishes

these abilities: • Language • Recognition • Memory (including knowledge of the disease) • Purposeful movement • Sensory perception • Reasoning

The Dementia Experience • We cannot understand the experience of a

person with dementia, but what we do know is that it can cause changes in memory, judgement, attention, mood, communication and language, and can significantly interfere with the person’s ability to do the things that matter to them and bring their life meaning

Normal Aging

Dementia

Presence of

Responsive Behaviours

What do Responsive Behaviours look like?

Verbally Responsive

Verbal Mutterings Swearing

Sounds that are Disruptive to Others

Throwing Objects Hurting Others

Disrobing

Verbal Complaints Physically responsive

Hurting Self

Hitting

Repetitive Sentences

Repetitive Behaviour Constant Requests for Attention

Agitation

Pacing

Wandering

Behaviours Have Meaning

Hiding Objects

Accusing

What do Responsive Behaviours often indicate?

a) an unmet need in a person, whether cognitive, physical, emotional, social, environmental or other

b) a response to circumstances within the social or physical environment that may be frustrating, frightening or confusing to a person.

Behaviours Have Meaning

• The most common trigger for the onset of responsive behaviours in anyone with a cognitive impairment is change in environment, including staff changes.

• As such, how Transitions are managed is essential to the quality of care and outcomes for individuals with cognitive impairment.

Margallo-Lana, M., Swann, A., O'Brien, J., Fairbairn, A., Reichelt, K., Potkins, D., … & Ballard, C. (2001). Prevalence and pharmacological management of behavioural and psychological symptoms amongst dementia sufferers living in care environments. International Journal of Geriatric Psychiatry, 16, 39–44. doi: 10.1002/1099-1166(200101)16:1<39::AID-GPS269>3.0.CO;2-F

Dementia and its link to Responsive Behaviours

Journey across the BSO continuum of care

BSO Connect

Community Outreach

Transitional Leads

LTC Mobile

Hospital Clinical Leads

Background of Funding • MOHLTC news release on August

18, 2016 announcing $10 million in new annual funding for Behavioural Supports Ontario

• The HNHB LHIN allocation is ≈ $1.1 M: – Long-Term Care: 0.7 M – Community/Hospital Sector: $0.3 M – Stabilization Funding (existing

resources): $0.1 M

HNHB LHIN Geographical Region

2 COT workers

2 COT workers

4 COT workers

3 COT workers

1 COT worker

BSO Funded Positions: 55 LTC Mobile Staff and Managers

13 COT staff and Manager 1 RH Responsive Behaviour Specialist

1 Connect staff 4 Clinical Leaders (serving 17 hospital sites)

1 Coordinator 1 Strategic Lead 2 Clinical Leaders

1 Clinical Leader

1 Clinical Leader

1RH RB Specialist

BSO Connect – Program Objectives • To provide a singular point of

entry for clients, caregivers, and providers to access services

• To ‘warmly connect’ clients to services

• To complete the feedback loop so clients do not ‘fall through cracks’

• Within I&R Department at HNHB LHIN

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BSO Community Outreach Team – Program Objectives

• Provide ‘just in time’ care for clients and their families in community

• Educate caregivers (formal and informal) on triggers of behaviour and associated coping strategies

• Reduce inappropriate emergency visits

• Improve capacity within the host mental health mobile outreach teams

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BSO LTC Transitional Leads– Program Objectives

• Supports future residents on “crisis list” in community and at “high risk” for a challenging transition into LTC

• Work with Community, Primary & Specialty care providers to stabilize individual as they wait for LTC bed offer

• Pre-admission meetings with LTC Homes and provide a Transitional Care Plan

• Support resident and LTC home staff well past admission 17

Transitional Care Plan developed and shared

with LTC Homes

Transitional Lead works with community , primary care, and

specialist care providers

BSO LTC Transitional Leads– In action

• Case study example

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BSO LTC Mobile Team- Program Objectives Collaborating with LTC • Provide behaviour assessment • Identify triggers and strategies • Coach and model with staff Supporting Transitions & Episodic • Provision of transitional support to/from LTC for low to moderate risk transitions • Provision of episodic support as needed

BSO LTC Mobile Team– In action

• Case study example

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BSO Clinical Leaders – Program Objectives • Consult with hospital inpatients who have

cognitive impairment and responsive behaviours

• Collaborate with the patient/family and the hospital team to: • Understand the triggers of the responsive

behaviours and develop personalized strategies to manage

• Share information between hospital, LTC and community to develop plans

• Educate hospital staff on population and their unique care needs

BSO Hospital Clinical Leads– In action

• Case study example

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How BSO Teams work together • Community, LTC and Hospital teams coming together in

news ways • Educational opportunities for shared learning • Team meetings provide opportunity for creative problem

solving Goal is to ensure the BSO client’s ‘story’ and effective

behaviour strategies follow along with them on their healthcare journey

How do BSO Teams collaborate with LTC Homes • All BSO LTC programs collaborate regularly through

formal and informal ways – Coaching and modelling in peer to peer model – Shift Huddles on the unit – Responsive Behaviour (or similar) committees – Leadership/Management attend LHIN-LTC meetings – BSO Transitional lead program was developed with LTC

stakeholders – BSO Transitional Lead Oversight Committee

How is BSO Strategy building knowledgeable care teams?

• Unused BSO funds are directed toward education and training

• Since BSO began, LTC staff have been offered numerous education sessions to improve their knowledge and skills

BSO Enhanced Funding: Education Plan 2016-17

August 2016: Enhanced BSO

funding announced

January to March 2017: New positions

filled

Stakeholder consultation,

development & recruitment

Unspent staffing dollars allocated for education to support the BSO population.

Must be spent by March 31st, 2017

A multi-faceted approach to educating our teams and colleagues across sectors

Community Hospital Long-Term Care • Appointment of 1-2 Behavioural

Champions within LTCHs • 5 days’ training offered to

Leads • Opportunities to send additional

team members to training sessions

• Two full-day sessions targeted to front-line care providers

• Opportunities to send additional team members to training sessions

• Training of Mental Health First Aid for Seniors Coaches

• Four P.I.E.C.E.S. sessions planned in hospitals LHIN-wide

• U-First available for PSWs and Aides

BSO Staff • 5 day Mental Health Recovery Care Program • 1 day collaborative learning event for staff members from all BSO teams, PRCs and ICMs • Standardized patient experiential learning sessions

CORE

COM

PETE

NCIE

S

Report on Education Plan 2016-17 • A total of 63 education sessions delivered after funding announcement (a

total of 1150 participants: LTC and Community) • 773 LTC Sector RNs, RPNs, PSWs & Allied Health attended training (not unique number as some attended more than one training session) • 87% of LTCHs (75/86) assigned 1 to 2 Behavioural Leads/Champions for a

total of 120 unique staff • PIECES, Montessori Methods, Pain Assessment training, GPA, U-First, and

other sessions devoted to supporting residents with responsive behaviours

LTC Behavioural Leads/Champions

• A Community of Practice will be one method to keep the training alive for LTC Behavioural Champions

• 87% of LTCHs (75/86) assigned 1 to 2 Behavioural Leads/Champions for a total of 120 unique staff

Sustainability • LTCH leadership have been informed of their responsibilities re:

Behavioural Champions(s); Behavioural Champions are aware of the expectations in role

• A Community of Practice will be formed based upon the Provincial BSO Knowledge to Practice Process Framework. Members will include: – Behavioural Champions/Leads – PRCs – Geriatric Outreach Teams – BSO Transitional Leads – BSO LTC Mobile Team members – BSO Clinical Leaders – BSO Responsive Behaviour Specialist (Retirement Homes)

BSO Program Data: Long-Term Care Mobile Team

• # of family members supported: – July-September 2016 : 631 – October-December 2016: 471 – January-March 2017: 375

“The external team provides a great resource to the Home as the Mobile Team are dedicated to what they do, and are well trained and versed in managing and responding to behaviours.” – Laura, RN, Parkview Nursing Centre, Hamilton

BSO Program Data: Hospital Clinical Leader Program

“[The BSO Clinical Leader] worked to know Edward as a human being – his background, interests, and needs – the whole process was so well done. [Her] involvement has made a phenomenal difference.” - Beatrice, Spouse of patient served by BSO Clinical Leader

Between April 2016 – March 2017: • 21 patients were diverted from

more highly-resourced care settings and safely discharged to lesser resourced settings.

• 607 hospital staff received formal education about supporting patients who are BSO clients

BSO Program Data: Hospital Clinical Leader Program

Total of all HNHB LHIN Hospital Sites

2014-15 (Pre- BSO Clinical Leader Program)

2015-16 ( 1 Year Post-BSO

Clinical Leader Program

Implementation)

2016-17 (2 Years Post- BSO Clinical

Leader Program Implementation)

Average number of ALC days per patient with behaviours

46.2 days

31.2 days (↓32.5%)

22.8 days (↓26.9%)

Opportunities for Collaboration with Family Councils

• Residents and their families are at the centre of what we do!

• Let’s work together: – Education to Family Councils – Shared brainstorming on how to best

support residents and families

QUESTIONS

“ I am who I am, so help me continue to be me”

Feedback from LTC providers • “Over time I have seen BSO staff being increasingly collaborative offering

compliments and suggestions re: ways to enhance the brain storming and success of behaviour strategies.”

• “They are very supportive, flexible and they sit on some of our committees. They are a valuable part of our team.”

• “The RPN who attends our home is great and realistic”

• “Long term care mobile team is extremely helpful for the hospital. Communicate well with the team and give some great suggestions to manage behaviour”