In the spring of 2021, Ontario hospitals were experiencing a surge in admissions resulting from the fourth wave of COVID-19. The Ontario government appealed to long-term care homes to increase admissions of patients from hospital, particularly those who are classified as Alternate Level of Care (ALC).
Within the ALC patient population, there is a subset of patients who experience frequent or “severe” behavioural expressions as a result of dementia, brain injury and/or mental health diagnoses. It is historically difficult to find spaces for these complex patients in most conventional long-term care homes because of concerns about risk.
Recognizing that this subset of ALC patients does not thrive in a hospital setting, Schlegel Villages proposed a pilot project on a dedicated floor in the Erin Mills Lodge Long-Term Care Home in Mississauga. A 20-bed Enhanced Supportive Neighbourhood (ESN) pilot project was approved for referrals from local hospitals. The ESN was designed as a temporary home for an anticipated period of 30 to 180 days for residents, with a goal of ultimately helping them to transition safely into an appropriate admission within the conventional long-term care home system.
Model of care
The ESN is staffed by a team that believes relationships, consistency and a gentle, respectful tone can be more effective than restraints, confrontation and antipsychotic medications when it comes to people living with dementia. It’s a supportive environment that allows freedom of movement to combine with a supportive team approach, relationship-centred training, and increased staffing levels in 12-hour shifts alongside a collaborative clinical team.
Success also hinged upon the training and support the entire team has received. LIVING in MY Today is the dementia program and philosophy used at Schlegel Villages to support residents living with dementia. Team members from every discipline participated in the LIVING in MY Today training together to ensure all team members share the same understanding and use the same approaches to support residents. Each team member interacts with residents in different ways, and through this relational approach to care, residents are treated with empathy, kindness and respect as people first, and not as tasks to complete.
The fact that the same dedicated team members work on 12-hour shifts means the relationship between the team member and resident grow deeper and the days move by with fewer transitions and less pressure to accomplish “tasks” before a shift change.
Each team member is also allocated one hour per shift for no other purpose than resident interaction: they can chat over a cup of tea, read together, sing and dance or simply sit quietly in each other’s presence. The team members report they get as much out of this time as the residents.
The ESN’s model of care includes the following unique features:
- Relational care approach;
- Twelve-hour shifts;
- Dedicated support (consistent assignment);
- One hour of dedicated resident engagement time for each personal support worker (PSW) per shift;
- Intentional environmental design; and
- No high intensity needs funding (for one-on-one support).
Schlegel Villages repurposed an outdated, empty retirement wing within their campus of care to accommodate the ESN. The goal was to transform the space into a safe and supportive physical environment to promote resident independence, mobility, engagement and comfort. The decor is intentionally familiar and homey, in contrast to the clinical tones of a hospital environment.
Each resident has their own private room with bathroom and shower, as well as their own television with WiFi capability in order to access programs and music to suit their preferences. That space is considered their sanctuary, while the common areas are decorated with intentional artwork that uses single focus, real-life images to break the monotony of the view and create visual cues and landmarks to support residents in finding their way.
A multi-purpose room is used for dining as well as engagement throughout the day. There is a servery space attached where food and drinks are available to residents 24 hours a day, supporting team members to respond to residents’ hunger and thirst in the moment, not according to an imposed, institutional schedule.
The care provided to the residents who call the ESN home is made possible through collaboration with key partners within and outside of the Ontario health care system to ensure optimal quality of life for residents while they are living in the ESN and also a smooth transition into and out of the ESN. These partners include, but are not limited to, the partner hospitals, the Ministries of Health and Long-Term Care, Ontario Health Team (Central), Behaviour Supports Ontario, Alzheimer’s Society, Home and Community Care Support Services, Mind Forward Brain Injury Services, and the Nurse Practitioner Teams Averting Transfers. The Schlegel-UW Research Institute for Aging is partnering on the project to support the evaluation of the pilot.
Preliminary results show significant promise
Preliminary evaluation results show that the ESN helps people labelled “high risk” who risk languishing in a hospital with ALC designation for the rest of their lives. The majority of residents were able to meet their clinical goals within the targeted amount of time and many have transitioned successfully into conventional long-term care homes.
In the spring of 2022, at the time of writing, no residents had been transferred back to hospital or sent to the emergency department for anything that was potentially avoidable or related to their dementia or mental illness. The ESN was always designed to be transitional and those who have been stabilized and have transitioned to new long-term are homes continue to do well.
The ESN improves quality of life for these individuals, while also improving health care system flow and efficiency. Having more intensive and appropriate supports eases family anxiety and helps to restore their trust in the health care system, and provides team members meaningful and enjoyable work, which translates to lower absenteeism and turnover.
The ESN pilot received higher funding than traditional long-term care, which allowed them to provide enhanced care and support. This provided a better quality of life for individuals at substantially lower cost than staying in hospital with estimated cost savings to the health care system of $1.13 million per year.
Schlegel Villages is awaiting a renewal of funding for ESN for another year. While some further analysis still needs to be done, the pilot study has shown significant promise for an expanded Enhanced Supportive Neighbourhood approach in homes across the province.