Dementia Care In RQHR

Transcription

1 Dementia Care In RQHR Presentation to the Board Regina Qu Appelle Health Region Presented by Gretta Lynn Ell, Executive Director Continuing Care/Family Medicine/Programming and Utilization Regina Qu Appelle Health Region Presentation to the Board, RQHR Overview of Presentation: Dementia Care in RQHR Summary of information provided at previous committee meeting Community supports: SWADD Home Care LTC Community-based Program supports: Adult Day Support Respite Care Quick Response LTC Institutional support Initiatives to equip staff in the provision of dementia care Staff education and training

2 Summary of Study for Alzheimer s Society Impact of Dementia Impact of Dementia on Canadian Society Personal Burden (chronic disease) on persons with disease and caregivers More years with disability than any other chronic disease Severe financial burden for people living with the disease Eroded health of caregivers (28-hour day) Systemic For the past decade, dementia and its impact on national economies have been the subject of increasing focus around the globe. Summary of Study for Alzheimer s Society Impact of Dementia Incidence/Prevalence of Dementia In Canada: Today: 500,000 Canadians with Alzheimer s disease/related dementia Within a generation (25 yr.) by 2038: million In Saskatchewan: Today: 17,506 are living with Alzheimer s disease/related dementia; Within a generation (25 yr.) by 2038: 28,099 persons (2.3% population) In Saskatchewan: Today: new cases of dementia each year: 3,920 By 2038: expected new cases each year: 8,140

3 Summary of Study for Alzheimer s Society Impact of Dementia Shift toward home/community-based care in Canada: It is anticipated that: The projected growth in long term care beds will not keep pace with the increasing numbers of persons with dementia who require care. In the future, the number of persons (65+) living at home with dementia will increase. In Saskatchewan Care by family/friends for persons with dementia is expected to rise. In 2012: approximately 9 million hours By 2038: approximately 30.5 million hours Summary of Study for Alzheimer s Society Impact of Dementia Interventions according to the Impact of Dementia Study: Four factors can potentially intervene in onset of dementia: Prevention: increased physical activity Prevention: diet and lifestyle program Support: caregiver training and support Support: system navigation All four factors showed potential for dramatic reductions in the number of cases and/or economic impact over the next 30 years.

4 Regina Qu Appelle Health Region Availability of care/services Availability of Care/Services in RQHR Community Supports: SWADD: Professional assessments of care needs Development/implementation of individualized service packages Home Care Services: Professional nursing care Professional therapy (e.g.: Physiotherapy) Home assessments (e.g.: Occupational Therapist) Personal care (Home Health Aides) Adult Day Support Program Availability of Care/Services in RQHR (continued) Long Term Care Community-based Programs: ADSP (Adult Day Support Program): for client: day-time programming and socialization1 for caregiver: day-time relief from care-giving responsibilities Regina: 2 facilities: total of 400 ADSP spaces per week William Booth Special Care Home: 230 spaces for various care needs (including some dementia) Regina Pioneer Village: 170 spaces for dementia care (clients requiring a secured unit ) Rural: 13 facilities: total of 180 ADSP spaces per week all 180 spaces for various needs (including some dementia)

5 Respite Care Program Availability of Care/Services in RQHR (continued) Long Term Care Community-based Programs: (continued) Respite Care Program: relief, for caregiver, from care giving responsibilities routine approval - up to 4 weeks per year (2 weeks at any one time) emergency respite if caregiver needs to recover from illness/injury Regina: 7 beds for clients with regular long term care needs/some dementia 2 beds for clients with complex care needs 2 beds for clients who require dementia care in a secured unit Rural RQHR: Short stay beds: 1 or 2 flex beds in each facility (multi-use) Regular LTC and dementia care private room; alarms on exit doors Quick Response Availability of Care/Services in RQHR (continued) Long Term Care Community-based Programs: (continued) Quick Response Unit (QRU): For non-acute patients who cannot immediately return to community supports appropriate use of ERs Staff assess care needs and develops service plans of care Clients with dementia present additional challenges, e.g: QRU beds are not in a secured unit Regina: 12 QRU beds in Extendicare Elmview Rural: Short stay beds in the rural facilities may be used to complete assessments and determine appropriate care plans

6 Institutional Dementia Care Availability of Care/Services in RQHR (continued) Institutional Dementia Care: Dementia Care Units: provide a secured environment for residents who are at risk for wandering, may exhibit disruptive behavior, e.g.: rummaging, may be destructive/aggressive, benefit from a low-stimulus environment Regina: Pioneer Village: 52 beds (16 P; 18 SP) Santa Maria: 49 beds (45 P; 2 SP) Rural facilities: Clients are accommodated in any of the facilities (all rooms are single-occupancy rooms, exit doors are alarmed) Improvement Initiatives Initiatives to improve care to clients with dementia: Continuing Care Consultants (2): clinical expertise in the delivery of a quality service to clients identified as difficult to serve. Charter Project: Mental Health/SWADD/RR&CC/LTCFs RQHR Policy of Least Restraint Capacity Conferences: 2004, 2007, 2012 RR&CC Clinical Nurse Educators (6 positions) educate staff in long term care facilities re: dementias and dementia care MDS Project Manager/Consultant provide reports from MDS data re: care practices, e.g: psychotropic medications in absence of psychiatric diagnosis P.I.E.C.E.S. Training: A $75,000 grant from Sask. Ministry of Health in 2009 to train staff on the dementia care units.

7 P.I.E.C.E.S. Training P.I.E.C.E.S Model to change staff practice, promote team dialogue/problem solving Systematic approach to understanding reasons for behaviors P.I.E.C.E.S. Framework: Staff assess possible causes of behaviors related to: P physical strengths and limitations I Intellectual capacity E emotional/psychiatric needs C capabilities (focus on maximizing client s abilities) E environment (how the client interacts with environmental factors) S social/cultural norms for the client Staff Education/Training Staff Education/Training RR&CC is meeting with educators and facilities to discuss: P.I.E.C.E.S. : comprehensive approach to understanding behaviors and individualizing the delivery of care (training is expensive) Gentle Persuasive Approach: an approach that is intended to prevent behaviors to escalate Non Violent Crisis Intervention: safety techniques staff can utilize when behaviors have escalated. PART: Provincial program for managing aggressive behaviors physical techniques may not be appropriate for the elderly. Various training programs focus on different aspects of the delivery of care to clients who present with challenging behaviors. No one program totally equips staff to manage all situations.

8 QUESTIONS? Dementia Care