Trinity Village’s collaborative work sparks new vitality among residents, staff

A new vitality is emerging at Trinity Village as it participates in a year-long, national collaborative to reduce use of antipsychotic medication.

The Kitchener long-term care home, part of a Lutheran Homes Kitchener-Waterloo care community, has lowered its rate of antipsychotics use among a group of residents without a relevant diagnosis to 16 per cent from 28 per cent in just eight months.

“It’s come down quite a bit, with minimal behaviours coming from residents which is fantastic,” says Sharon Jackson, Trinity Village’s lead on the collaborative and the RN lead with the home’s Behavioural Supports Ontario (BSO) program.

Jackson describes how a reduction or even the discontinuance of antipsychotics is changing lives. 

One resident, for instance, is almost free of one medication for the first time in her adult life and her risk for depression has dropped drastically. Another resident, who came to Trinity Village from a neural-behavioural unit and was described by family as being “like a zombie,” is now engaging with people after the home was able to discontinue his antipsychotic medication.

“He has done so well . . . it’s truly amazing,” Jackson says. “The family keeps telling us that they wish he’d come here years ago.”

Other residents have begun to talk and respond to touch.

Staff members, meanwhile, are finding new meaning in their work as they build their capacity for providing resident-centred care that enhances quality of life.

Trinity Village is among 15 health-care organizations across Canada – one of three Ontario Long Term Care Association members – selected for the Canadian Foundation for Healthcare Improvement (CFHI) collaborative. Launched in September, it follows a Winnipeg Regional Health Authority project that reduced antipsychotics use among a group of long-term care residents by 27 per cent in six months.

The collaborative utilizes the same P.I.E.C.E.S. model as the health authority as well as other, non-pharmacological alternatives to care. At Trinity Village, for instance, Jackson and Ramona Sirbu, the personal support worker lead on the BSO program, work closely with care staff to carefully and consistently monitor residents in the cohort and adjust their support/approaches accordingly.

“We’ve put in place scheduled huddles now,” Jackson says, adding these regular conversations underline the importance of interdisciplinary teamwork in customizing care. “We’re huddling and teaching practical skills that they can use for all residents and that has made a huge difference,” Jackson says. 

“It’s making everyone aware of their approach,” she says, adding team members become more proactive as they notice differences in residents sooner and suggest new interventions.

The BSO team is also now involved in Trinity Village’s admissions process, aiming to address medication and behavioural challenges sooner.

Expanding the BSO program was possible with a grant from CFHI. Jackson and Sirbu expanded their hours to collaborate more with staff. “The extra time has really allowed us to focus on making this happen,” Jackson says. 

The collaborative’s participants are also learning from each other, sharing successes and ideas regularly.

This project also builds on other Trinity Village initiatives, such as its quality improvement work plan to reduce antipsychotics use, a pastoral counselling education unit, and program changes for residents who have cognitive challenges. All of these efforts support the home’s Eden Alternative philosophy of care to lessen loneliness, helplessness and boredom.

“Everything is interconnected,” Trinity Village Chief Operating Officer Debby Riepert says. “We’re always looking here not just at medicine but we’re also looking at people. Although medicine has had lots of great successes, sometimes there’s been unfavourable outcomes.

“In reducing the antipsychotics, we’re moving away from treating symptoms medically to working together to first address symptoms from a psychotherapy perspective, addressing what is important to residents now and providing purposeful opportunities to help them and others to feel they are valued community members,” Riepert says. “It’s all-encompassing. It involves staff and families, increasing education, lots of talking and one-on-one communication, and working with people individually.

“It’s being open to other ways of looking at situations and making sure you put a process in place that you look at all of these areas before you go to medication.  . . . It’s not to say that no one’s going to have medication but at least there are people providing care who you know have done everything – they’ve done the research and are making educated decisions on the next step to take.”

Jackson says this has been a key realization to date. “It’s to think upstream and prevent the behaviours and look at everything before it reaches the point where the resident needs antipsychotics.”

With the progress made to date with its initial cohort, Jackson says Trinity Village is expanding the work to other residents. The home is also looking at how to make the work sustainable. That means, Jackson says, ensuring antipsychotics and RAI-MDS medication reviews are done quarterly and that “nobody falls between the cracks and if (antipsychotic medication) can be decreased or discontinued, it will be.”