An Innovative Canadian Program Helps Reduce Social Isolation in Residential Care

 

The Power of Peer Support: Reducing Social Isolation in Residential Care is a collaborative project between the Bruyère Centre for Learning, Research and Innovation in Long-Term Care (CLRI), Java Group Programs, Carleton University’s Department of Health Sciences, and Bruyère Continuing Care. It is funded by the Centre for Aging + Brain Health Innovation, Carleton University and the Government of Ontario through the Bruyère CLRI.

 

THE ISSUE

It is well established that people who have meaningful social relationships experience better well-being. However, some in society have circumstances that limit opportunities for such interactions, and older adults in residential care are particularly vulnerable. Social isolation and loneliness are common in this population and better strategies are needed to counter its negative health outcomes, including depression, dementia, increased mortality and higher health care costs[i]. Studies show that 55% of residents in care homes experience loneliness.[ii]

 

When someone moves into residential care, it is often prompted by a health crisis. There can be a number of other issues that compound the complexity of said crisis. For many new residents, this transition is a very painful and lonely time. These challenges are exacerbated for those living with dementia.

 

These settings have proven beneficial for people who require physical care, however, research highlights concerns about resident psychosocial well-being.[iii],[iv] An American study found evidence that programs provided tend to be inaccessible or inappropriate for many residents, leading to low participation rates.ii Another study explained that 45% of residents with dementia participated in few or no activities, 20% participated only occasionally, and 12% participated in activities that were inappropriate for their needs.vi

 

These numbers show the need for meaningful engagement opportunities, allowing residents to deepen social connections and re-establish a sense of purpose. There is a growing body of research that documents the effectiveness of peer support in alleviating loneliness and depression. Peer support enables individuals to learn new ways of coping through identification with others in a similar position. The Java Group Programs offer a unique model to combat these issues.

 

THE SOLUTION

Peer support groups are known to benefit individuals with chronic illnesses, yet they are rarely used within senior living. Founded by Kristine Theurer (MA, Gerontology, MTA, PhD(c)), Java Group Programs are the first standardized peer support interventions designed to address the critical rates of depression and loneliness in senior living. Java Music Club is a weekly peer support group for older adults, including those living with mild to moderate dementia. The program is based on the altruistic concept that people are happiest when they are helping one another. It also draws on social psychology and gerontology research findings. Java Memory Care is a vital adaptation for those living with moderate to advanced dementia. These groups are designed to be facilitated by staff, volunteers and/or family members.

 

Homes that offer Java programs purchase a license and ensure that their staff or volunteers are trained to facilitate Java sessions. Facilitators provide opportunities for residents to unload burdens, learn coping skills, reminisce and increase their sense of belonging. This is done using a standardized facilitation manual which includes themes, questions, photographs, songs, quotes, and an Aboriginal talking stick.

 

 

Residents are encouraged to support one another through discussion and to reach out to members who are lonely or isolated. These groups provide opportunities for emotional expression/release, allowing residents to talk in a safe, public setting about complicated topics. There are 52 topics in total covered in the facilitator manual – some other topics include weddings, gratitude and boredom. These topics were originally chosen by residents in long-term care who were consulted as the program was developed. Both programs aim to reduce stigma associated with support groups by reflecting a warm social setting, incorporating coffee and music.

 

In an effort the enhance residents’ quality of life, many Canadian care homes have introduced Java Music and Java Memory. They have seen residents regain their love of life and sense of purpose, build new relationships and develop increased respect for their peers.

 

In recent months, a generous grant from the Centre for Aging + Brain Health Innovation has added 35 new locations (see map below) across Ontario where residents now benefit from this evidence-based peer support program. Committed to knowledge mobilization, interactive training workshops, coaching sessions and public webinars are woven together to elevate facilitators’ skills.

 

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Additionally, a portion of the grant advances the overall understanding of the benefits of Java programs through rigorous research. Both Java Music Club and Java Memory Care have shown success in alleviating loneliness and depression. This project will advance our understanding of the benefits to the individual residents (psychosocial and cognitive health outcomes). Dr. Renate Ysseldyk from Carleton University’s Department of Health Sciences is working with residents and staff at Riverstone Retirement Communities and Élisabeth Bruyère Residence to understand their experiences. The team is delighted to explore the benefits of these programs through the partnerships with Riverstone Retirement Communities and Bruyère Continuing Care.

 

Social isolation of vulnerable populations is a universal issue in our society. The Java Group Programs aim to reduce this problem among residents who live in long-term care or in retirement settings. When it comes to Java, improving residents’ quality of life will always drive program implementation, research and the design of learning and skill building opportunities.

 


Tools and learning opportunities for recreation therapy professionals and volunteers in residential care settings:


 

References:

[i]  Victor, C. R. (2012). Loneliness in care homes: A neglected area of research? Aging Health, 8(6), 637-649. doi: 10.2217/ahe.12.65

[ii] Theurer K, Mortenson WB, Stone R, Suto M, Timonen V, & Rozanova J. (2015). The need for a social revolution in residential care. Journal of Aging Studies, 35, 201-210.

[iii] Kemp, C. L., Ball, M. M., Hollingsworth, C., & Perkins, M. M. (2012). Strangers and friends: Residents’ social careers in assisted living. Journals of Gerontology: Series B, Psychological Sciences and Social Sciences, 67(4). doi: 10.1093/geronb/gbs043

[iv] Moon, H. (2012). Risk factors for depression among the oldest-old in urban congregate housing: Contribution of grief. International Social Work, 56(4), 516-533. doi: 10.1177/0020872811429954

vi L.L. Buettner, S. Fitzsimmons. (2003).  Activity calendars for older adults with dementia: What you see is not what you get. American Journal of Alzheimer’s Disease and Other Dementias, 18 (4) pp. 215-226

 

Since October 2017, long-term care (LTC) homes across Ontario have participated in the Personal Support Worker (PSW) Education Fund for LTC. The Ministry of Health and Long-Term Care has worked with the Ontario Centres for Learning, Research and Innovation in LTC (CLRI) to coordinate continuing education and training for PSWs through the delivery of Excellence in Resident-Centred Care (ERCC). The ERCC program is delivered in partnership with Conestoga College. Élisabeth Bruyère Residence (ÉBR) is one of the homes benefitting. The Bruyère CLRI recently visited one of the training workshops at ÉBR. It was evident why the ERCC training is important for this small home in downtown Ottawa.

Who is at the centre of attention?PSWs engaged in learning.

PSWs who work in LTC spend most of their time caring for and interacting with residents. Many residents and their families depend on PSWs to provide necessary assistance with daily activities. This results in a lot of one-on-one time and strong caring relationships. Since PSWs work on the front line and impact the lives of so many residents, they need support. Part of this support is providing best practice-based resources and learning opportunities they can use to continue fine-tuning their skills.

 

ERCC promotes best practices in senior’s care environments. The program aims to help teams achieve better care and better outcomes. These goals are achieved using a person-centred, train-the-trainer approach to advance practice development.

 

ÉBR is running several workshops this winter. “These workshops have been a really big eye opener for everyone involved. Sometimes it’s easy to forget to look at situations through a resident’s eyes. The exercises and activities give the PSWs a chance to experience what challenges residents may experience daily,” explains Suzanne Doré. Suzanne is one of the PSW-trainers at ÉBR. “The workshops provide refreshers to remind PSWs of what’s most important in this field – the residents.”

 

Laying the groundwork, two PSWs from ÉBR participated in an ERCC train-the-trainer workshop in December. As reported at the time, the train-the-trainer workshop brought Conestoga faculty, affectionately known as “super-trainers,” to Ottawa. The super-trainers shared dynamic facilitation skills and tools, all aimed to reinforce teamwork. ÉBR sent PSW team members who were recognised by their peers as champions and role models for resident-centred care.

 

Advancing practice change at ÉBR

ÉBR’s PSW-trainers returned to their homes empowered by the train-the-trainer workshops. They were eager to share their knowledge with their fellow PSWs with whom they work every day.

 

Following this, in early 2018, the ÉBR PSW-trainers ran several in-house ERCC workshops for groups of PSWs. Using a module-based approach, the workshops cover a variety of topics essential for PSWs: person-centred care, oral and skin integrity, continence, nutrition and hydration, working with others, end-of-life care, observational assessment, and more. Each module delves into relevant principles, the importance, factors to consider, techniques, and strategies for optimization of care delivery.

 

“At ÉBR, we’re training 36 PSWs to provide these excellent levels of care to residents. That number is just across one LTC home. This is a great initiative, and I’m excited to see how it will enhance the quality of care provided in LTC homes across the province,” reflects Suzanne on the ERCC experience.

 

 

Recognising the important role PSWs play in LTC teams, in 2017, the Ministry of Health and Long-Term Care launched the PSW Education Fund for LTC. The goal of the Fund is to help develop and enhance the PSW workforce in LTC to deliver high-quality and safe care that meets resident needs. The Fund supports LTC homes to train a critical mass of PSWs in elements of resident-centred care and to sustain ongoing learning that will continue to benefit residents. To make the training possible, the Ministry worked with the Ontario Centres for Learning, Research and Innovation (CLRI) in LTC to deliver “Excellence in Resident-Centred Care” (ERCC), in partnership with Conestoga College.

 
Ontario Long Term Care Association’s This Is Long Term Care
November 14-16, 2018
Westin Harbour Castle, Toronto

Call for Abstracts — The Ontario Long Term Care Association’s signature conference, This is Long Term Care 2018: Disrupting the Norm, profiles new and emerging research, innovation, and successful quality initiatives in a unique forum designed for learning, networking and information sharing. This year we are issuing a challenge to presenters to think out-of-the-box and challenge the status quo. In so many ways, our industry is headed for a shake-up. From our changing demographics and capacity challenges to keeping pace with the evolving needs of residents and families. As leaders, we must disrupt the norm and lead with a positive change in the sector.

Call for Content close date is Friday, April 20, 2018, at 12:00 noon.

To review application criteria or to apply click here.

 
People living in Ontario long-term care (LTC) homes are diverse in terms of their ethnicity, language, Indigenous identity, religion, gender identity and expression, sexual orientation, ability, and so on.

Information and resources regarding the following CLRI initiatives are now available:

 
For more information, contact:

Kate Ducak
Project Officer (Diversity of Culture)
Schlegel-UW Research Institute for Aging
kate.ducak@uwaterloo.ca
519-904-0660 ext. 4107

Kyla English Leis
Research Coordinator (Indigenous Culture)
Schlegel-UW Research Institute for Aging
kyla.englishleis@uwaterloo.ca
519-904-0660 ext. 4208

 

On March 2, 2018, Brian Pollard, Assistant Deputy Minister, Licensing and Policy Branch, Long-Term Care Division, Ministry of Health and Long-Term Care (MOHLTC) and two of his senior staff members visited Saint-Louis Residence. Hosted by the Bruyère Centre for Learning, Research and Innovation in Long-Term Care (CLRI), positive impressions were made through discussions and project demonstrations. The engaging visit covered a broad range of programming and collaboration.

 

The afternoon began with brief overviews from Guy Chartrand (CEO, Bruyère Continuing Care) and Heidi Sveistrup (President, Bruyère Research Institute). The introductory part of the meeting was rounded out by Zsofia Orosz (Manager, Bruyère CLRI), highlighting some exciting and innovative initiatives that are advancing with CLRI support.

 

One area Zsofia touched on was the CLRI’s collaboration with La Cité Collégiale and the Registered Nurses’ Association of Ontario that helps improve oral care delivery. Read more about the oral care partnership. Another initiative covered was deprescribing, an effort to safely reduce and/or optimize medication use to meet life’s changes. Visit deprescribing.org for more details.

 

Many other projects running at the Orléans campus impact residents’ lives positively. Dr. Clare Liddy (Clinician Investigator, Bruyère Research Institute) discussed the benefits of the Champlain BASE™ eConsult Service. As a joint initiative between the Bruyère Research Institute, the Champlain Local Health Integration Network and the Winchester Memorial District Hospital, this electronic consultation service connects primary care practitioners with specialists to reduce wait times. The participation of the CLRI ensures that the needs and realities of long-term care are fully considered as the Champlain BASE™ eConsult expands across the province. Dr. Liddy’s engaging presentation prompted an animated conversation with the MOHLTC representatives. Visit the CLRI website for a recent update and to watch a webinar by Dr. Liddy.

 

Volunteer and MOHLTC representative with CWA bike.

Bruyère is benefitting from the influx of new volunteer pilots like Rob, proudly wearing the Bruyère red volunteer t-shirt.

 

Projects-in-Action!

 

Following these rich discussions, the group moved to participate in project demonstrations. The first demonstration was of Cycling Without Age (CWA). CWA helps seniors stay active and connected with their communities, making it possible for those with mobility challenges to get back on bicycles and enjoy nature. CWA uses a special three-wheeled rickshaw bike, a “trishaw”. A two-seater passenger carriage is in the front, while a volunteer “pilot” sits on a bike in the back and propels the trishaw forward. Through collaboration with a community partner, Bruyère is now running the CWA program at both of its long-term care homes. The CLRI contributed to program evaluation and developed a brief brochure that homes can use to learn about v bsetting up their own CWA program. For more information, download the brochure or to watch a recent webinar.

 

 

Testing out MotiView Technology

The MOHLTC guests enjoyed testing the Motiview technology for themselves.

The second project demonstration was of Motiview, an innovation combining the benefits of cycling for physical and emotional well-being. The Motiview Solution brings together an audio and video library with a stationary, user-adapted bicycle. Adaptable to each user’s requests, virtual bicycle trip through familiar surroundings encourage reminiscence as the user pedals. Motiview reduces the perception of difficulty, monotony, and discomfort associated with cycling, while enhancing participation and the experience. Funding from the Centre for Aging + Brain Health Innovation enables the multi-institutional team to test this technology in an Ontario context, including at Saint-Louis Residence and the John and Jennifer Ruddy Geriatric Day Hospital at Élisabeth Bruyère Hospital. In the long-term care setting, the focus is on the social aspects and reminiscences.

 

All were wowed by the demonstrations and impressed by the initiatives built on collaboration, research, and willingness to test ideas. The Assistant Deputy Minister and his staff expressed great eagerness to return and tour Élisabeth Bruyère Residence next time. À bientôt!

 

 

On March 12, 2018, the Bruyère CLRI hosted a webinar called “Cycling Without Age: Enhancing the Lives of Seniors – The Right to Wind in your Hair.” It focuses primarily on the concept of Cycling Without Age, as well as the pilot project conducted in Bruyère Continuing Care’s long-term care homes.

 

Cycling Without Age (CWA) is an innovative program that has helped seniors stay active and stay connected with their communities. CWA is making it possible for seniors or those with mobility challenges to get back on their bicycles and enjoy their communities and nature.

 

Presented by Kim Durst-Mackenzie (Therapeutic Recreation and Volunteer Coordinator, Bruyère Continuing Care) and Gary Bradshaw (Community Partner), this webinar also discusses the purposes and goals of the program, as well as the benefits and challenges the Bruyère teams came across during implementation.

 

To learn more about Cycling Without Age, please watch the engaging webinar below. 

 

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Limited access to specialist care remains a major barrier to health care in Canada. The consultation-referral process is complex and involves many factors that can limit the effectiveness and efficiency of patient care. Patients, Primary Care Providers and specialists express high levels of frustration about poor access and too-long wait lists.  Patients often wait months to see specialists, facing frustration and sometimes worsening conditions, only to learn for example that all they needed was a medication change. The risks of delays only increase as a person ages and as they become frailer.

 

Access barriers fixed by eConsult

What barriers do LTC home residents face to access specialist care?

 

Long-term care residents face multiple barriers to accessing care, as a growing number of residents suffers from Alzheimer’s disease or other dementias, complex health issues, multimorbidity, and physical frailty. These conditions increase the need for specialist care and at the same time reduce the residents’ ability to easily go to see specialists. A recent report from the Canadian Institute for Health Information noted that 25% of elderly Canadian patients waited over 2 months for specialist care, and 37% went to hospital emergency departments for treatments their PCP could have provided. These figures place Canada last among the 11 countries surveyed.[1]

 

AN INTEGRATED SOLUTION:

Given that wait times are affected by multiple factors, Ontario needs an integrated solution. This is where the Champlain BASE™ eConsult Service comes into play.

 

Champlain BASE™ eConsult is a secure, online platform connecting primary care providers (PCP) to specialists. The PCPs are able to consult with specialists on any questions they may have about their patient and receive a response from the specialist in a timely manner, never longer than seven days. With over 100 specialties available, the PCP can submit their patient-specific questions along with any supporting documents or photographs. Experience shows that this connection often eliminates the need for the patient to visit the specialist at all, as now the PCP can provide the care that their patient needs.

 

eConsult process

A solution: eConsult

 

This service is highly successful in the Champlain region across the primary care community. In collaboration with the Bruyère Centre for Learning, Research and Innovation in Long-Term Care (CLRI), the Champlain BASE™ eConsult service is now implementing the service in 2-4 long-term care homes in the Ottawa and surrounding area.

 

I know eConsult works. Down the road maybe they will get it [to help] caregivers of [residents with] long running diseases like Alzheimers, M.S. and Parkinson’s whose caregivers [and…] for whom it is hard to move their loved ones [particularly] in the later stages.“

– Family member who attended the National eConsult Forum in Ottawa on December 11, 2017.

 

Most recently, eConsult’s primary care lead Dr. Clare Liddy was featured in a webinar series hosted by the Bruyère CLRI. On February 6, 2018, Dr. Liddy discussed the implementation of the Champlain BASE™ eConsult service in Ontario’s long-term care homes. The goal is to improve integration of care, patient safety, and quality of life for complex aging residents. Opening with an informative and engaging overview, Dr. Liddy explained the need for specialist access in LTC, the benefits of eConsult, the current project, and how homes can get involved.

 

Watch a recording of the webinar to learn more about the Champlain BASE™ eConsult Service and how it is being implemented in long-term care in Ontario.

 

A shorter version of this article first appeared in AdvantAge Ontario‘s Action Update, a monthly newsletter for AdvantAge Ontario members.

 


[1] Canadian Institute for Health Information. How Canada Compares: Results From The Commonwealth Fund’s 2016 International Health Policy Survey of Adults in 11 Countries — Accessible Report. Ottawa, ON: CIHI; 2017

 

The Ontario Association of Residents’ Councils (OARC) has received special project funding from the Ontario Ministry of Health and Long-Term Care. The funding allows them to provide one copy of the “Through Our Eyes” program to every long-term care (LTC) home in Ontario.

 

This unique program guides LTC home staff and residents to co-develop and co-facilitate education sessions about the Residents’ Bill of Rights (LTCHA 2007). Inside you will find step-by-step instructions, videos, exercises, and resources to develop the education. See the program video here.

 

All long-term care homes will have a copy of this program by March 31, 2018.

 

OARC will also hold live webinars to review the program and support long-term care homes as they work through the “Through Our Eyes” program. Sessions will be held on Wednesday, June 13, from 2:30 to 3:30 pm (session full) and Friday, June 15, from 2:30 to 3:30 pm (register here).

 

COURSE OVERVIEW:

 

This FREE two-day workshop is intended for RPNs and RNs who have high potential to excel in leadership and who currently work in Ontario long-term care (LTC) homes.

 

At the end of Day One, participants will:

 

At the end of Day Two, participants will:

 

 

DATES:

 

Day One: March 19, 2018 (8AM-4PM)

Day Two: March 20, 2018 (8AM-4PM)

 

Nurses are required to attend both workshop dates.  Nurses’ direct supervisors are required to attend Day Two from 12PM-4PM.

 

 

LOCATION:

 

Lanark Lodge, 115 Christie Lake Road, Perth, ON, K7H 3C6

 

 

COURSE APPLICATION FORM:

 

Please complete the online COURSE APPLICATION FORM to apply for this training opportunity.

 

Application Deadline: March 5, 2018

 

For more information, please contact Michelle Fleming at mfleming@bruyere.org.

 

CLICK ON IMAGE TO DOWNLOAD POSTER

 

On February 6, 2018, the Bruyère CLRI hosted the third webinar of their webinar series. The webinar is called “Champlain BASE™ eConsult Expansion into Long-Term Care in Ontario.” It focuses primarily on the implementation of the Champlain BASE™ eConsult service in Ontario’s long-term care homes in order to improve integration of care, patient safety, and quality of life for complex aging residents.

 

Presenting is Dr. Clare Liddy, a Clinical Investigator at the C.T. Lamont Primary Health Care Research Centre of the Bruyère Research Institute. Dr. Liddy is also an Associate Professor in the University of Ottawa’s Department of Family Medicine with a cross-appointment to the Department of Epidemiology and Community Medicine. She continues to practice family medicine within the Ottawa Hospital Academic Family Health Team.

 

In the webinar, Dr Liddy discusses the following topics:

 

To learn more, watch the full webinar here: