Long-term Care

By Nicole Pacampara

It’s no secret that pointof-care staff and caregivers are aware of the wide range of challenges that older adults face – from loss of independence due to cognitive decline to the inability to do basic everyday tasks. As the country’s population ages, there’s a growing need for innovative ideas to improve the quality of life and care for an aging demographic. Who better to develop these innovative ideas than clinical staff, managers, researchers, and caregivers who hold extensive knowledge and key insights into what can be transformed in this sector?

Last month, the Centre for Aging + Brain Health Innovation (CABHI), powered by Baycrest, announced the return of the Spark program, CABHI’s funding program supporting the development of grassroots solutions solving real-world healthcare challenges. Project applications are now open to point-of-care staff (workers, managers, researchers) working at Canadian healthcare delivery organizations and informal caregivers. Successful applicants will receive up to $50,000 (CAD) in funding over 12 months to help develop, refine, and implement these innovations.

This year, the Spark program is accepting applications aimed at addressing one or more of the following innovation themes:

• Caregiver Support: Solutions that support caregivers (formal and informal) in their care for older adults living with dementia • Aging in Place: Solutions that enable older adults with dementia to maximize their independence so they can age in their desired setting

tion: Solutions that help older adults, caregivers, and healthcare providers to better coordinate and navigate care for older adults with dementia • Cognitive & Mental Health: Solutions that improve brain/cognitive

health for aging adults and/or support the identification and assessment of adults at risk for dementia/ cognitive impairment

Helping older adults remain financially independent, stay safe in the workforce longer, seek later-life employment, prepare for retirement, and prevent financial exploitation

Beyond financial support, the Spark program offers CABHI’s Acceleration Services including tailored coaching, mentorship, networking, and end-user validation through CABHI’s Leap community for older adults and caregivers.

Past Spark innovations include: • Advancing Reminiscence Therapy through Virtual Reality Application to Promote the Social

Dementia – An innovative frame-

work prototype that aims to improve the implementation of reminiscence therapy for persons with dementia through customizable, immersive virtual reality experiences. • LiveWell@Home: Virtual GERAS

DANCE to improve health and build the resilience of seniors in our community – A new model of care delivered virtually in a senior-friendly online community. It is built on the success of GERAS DANCE, an evidence-based, clinically proven mind and body health program for older adults.

Unregulated Care Providers – A 12-week part-time micro-credentialed certificate designed to teach the basics of geriatric care to unregulated healthcare providers and assess the benefits and educational outcomes of a virtual 12-week certificate program. The course is delivered through an established virtual learning platform (ALPHA/LIPHA), which uses a simulated educational environment to foster effective, interactive, and motivated learning.

Do you have an idea to improve seniors’ care? Take advantage of this opportunity to move your innovation forward! Submit your application by Friday, December 2, 2022. To learn more and to apply, visit www.cabhi.com/spark. ■ H

Nicole Pacampara is a Digital Marketing and Communications Specialist at the Centre for Aging + Brain Health Innovation (CABHI).

VHAHomeHealthCare'sTHRUisanursing-ledteamthat: transitionsclientcarebetweendifferentsettingsandproviders; collaborateswithpartnerstoco-designandprovideintegrated careforclients; vaccinates,conductsclinicaltesting,andassessesforCOVID-19, influenza,&schoolimmunizations; createsWellnessClinics; operatesRemotePatientMonitoringandprovidesvirtualcarefor clients;andmore!

By Vanessa Woznow

Dan Levitt is the CEO of KinVillage, a Fraser Health affiliate partner and non-profit society in Tsawassen. He and his team provide a combination of housing (long-term care, assisted living and independent living), health services and programs for older adults in the community.

“We work closely with Fraser Health and its leadership,” says Dan. “Together, we want to set a new narrative on what long-term care is, which includes creative and innovative new ways of doing great things for seniors.”

Part of this innovation includes the promotion of food equity – so that no matter a resident’s age, health or ability, they feel valued and seen when it comes to their nutrition and meals.

“Food is all about dignity,” says Dan. “We want to make sure that anyone sitting down to eat in our dining room feels equal to their fellow diners.”

To support this goal, KinVillage has implemented an initiative for individuals with dysphasia – a condition that causes swallowing difficulties, which can lead to coughing or choking when eating or drinking.

“It’s something that we see in individuals who have neurological conditions, such as dementia or Parkinson’s disease, or who maybe have suffered a stroke,” says Dan.

For these residents, food must be served liquefied or as purees, which makes it safe for consumption, but can also make it less palatable or visually appealing.

“We wanted to make pureed food more appetizing. So we’re now shaping and re-forming textured food into solid forms, so they resemble the different pieces the dish. Effectively, the steak looks like steak, carrots look like carrots, and potatoes look like potatoes.”

Dan and his team have seen immediate positive impacts.

“One staff member actually returned a plate saying ‘This is not for the person I’m feeding – they can’t eat solid food.’ That’s how good it looks like. Another person who couldn’t feed themselves, can now feed themselves. And others who used to struggle to eat, are clearing their plates.”

Janice Sorensen registered dietitian, PhD, is the clinical research leader with Fraser Health’s Integrated Long-Term Care and Assisted Living team and stresses the positive impact work like this has, especially on resident populations at higher risk of malnutrition.

“Evidence shows that individuals on a modified consistency diet typically experience reduced food intake and undernutrition, which can result in functional decline and poorer health status,” she says. “Allowing individuals to participate during mealtime in ways they were accustomed to can increase one’s motivation to eat, improve mealtime experience and impact quality of life in a big way. It brings back the joy of food.”

Janice encouraged and provided advice for Dan and the KinVillage team to apply for seed grant funds through the Healthcare Excellence Canada LTC+ program, to support their project.

The success of their application made the program possible, and they are now currently working on securing permanent funding.

“We want this to become the standard,” says Dan.

He believes that the momentum from projects like this one carry on into new, creative ways of delivering excellent seniors care.

“Our focus is, if we can change one thing in long-term care, it puts the spotlight on the next thing we can work on. It’s all part of re-thinking the long-term care home all together.” ■ H

With more than half a million Canadians living with Alzheimer’s disease or other forms of dementia and no cure on the horizon, research and care is focused on prevention and protective interventions to help slow cognitive decline. In a recent study published in the Lancet, hearing loss was reported as being the leading potentially modifiable risk factor, accounting for up to 8 per cent of new dementia cases. Baycrest has launched a new online screening tool to help detect hearing loss. The tool is available to the public at no cost and takes approximately 10 minutes to complete.

Supported by Baycrest’s Audiology Department and the Baycrest Innovation Office, the online tool asks questions to identify individual hearing concerns, such as difficulty with conversations over the phone or in noisy environments, as well as other questions which can help guide Baycrest’s Hearing Services to assess one’s hearing ability and offer individualized solutions for hearing loss. The tool can be accessed on the Baycrest website.

“Baycrest’s new screening tool has the potential to slow cognitive decline and prevent dementia by identifying early risk factors for hearing loss. Most importantly, it can help improve the management of hearing loss, allowing older adults to live a more fulfilling life,” says Deb Galet, Vice President, Long-Term Care, Ambulatory Clinical Services, and Chief Heritage Officer.

Although hearing loss is very common among older adults, affecting two out of three of those over 70 years of age, it remains largely undiagnosed and untreated. Early identification and management of hearing loss helps to improve communication, social participation, and quality of life, and may help slow cognitive decline and the onset of dementia. The World Health Organization (WHO) recommends that all adults aged 50 years and older be screened regularly for hearing loss to identify those who would benefit from hearing rehabilitation at the earliest possible stage.

Baycrest is a global leader in research, innovation, education and care for older adults, with a special focus on brain health and aging. Baycrest is home to a robust research and innovation network, including one of the world’s top research institutes in cognitive neuroscience, the Rotman Research Institute; the scientific headquarters of the Canadian Consortium on Neurodegeneration in Aging, Canada’s largest national dementia research initiative; and the Baycrest-powered Centre for Aging + Brain Health Innovation, a solution accelerator focused on driving innovation in the aging and brain health sector.

Baycrest helps aging adults assess, monitor, maintain and enhance cognition through an innovative portfolio of evidence-based products and services offered through its brain health company, Cogniciti.

Fully affiliated with the University of Toronto, Baycrest provides excellent care for older adults combined with an extensive clinical training program for the next generation of healthcare professionals.

Through these initiatives, Baycrest has remained at the forefront of the fight to defeat dementia as our organization works to help individuals Fear No AgeTM and create a world where every older adult enjoys a life of purpose, inspiration and fulfilment. ■ H

Home care is about trust. It is feeling comfortable with a provider coming into the home of someone you care for and, possibly, Bayshore’s home care services are extensive, tasks or round-the-clock care, Bayshore’s caregivers can help your loved ones to live

PERSONAL CARE | HOME SUPPORT | NURSING

t’s hard being in lockdown. Having endured multiple of them since March 2020, it’s something pretty much everyone can agree on. Being separated from family and friends, being restricted in our movement and experiencing complete isolation can prompt a wide range of emotions and physical reactions. For people living with dementia and their caregivers, lockdown is even harder.

There’s no doubt that the COVID-19 pandemic was catastrophic for Long-Term Care Homes (LTCH). Between March 1, 2020 and February 15, 2021, more than 2,500 care homes in Canada experienced a COVID-19 outbreak resulting in the deaths of over 14,000 residents and close to 30 staff, according to The Dementia Strategy for Canada 2021 Annual Report. The majority of those LTCH residents are living with dementia. This brutal reality, especially in the early days of the pandemic, underscored the need for some type of tool to help LTCH residents and staff.

Dr. Andrea Iaboni, a geriatric psychiatrist and clinical researcher based at the Toronto Rehabilitation Institute at UHN and the Medical Lead of the Specialized Dementia Unit, quickly put a plan into action to develop a Dementia Isolation Toolkit (DIT). She and a diverse team of both KITE resources and external partners got to work quickly on the first DIT as the pandemic was declared.

Within six weeks they had designed, built and launched DIT version 1.0. Since then, the DIT has been downloaded 9,000 times. When asked how they did it, Dr. Iaboni says, “the structure and support at KITE gives us the confidence to launch and ask people to use it.”

The DIT’s overall purpose is to provide ethical guidance on how to safely and effectively isolate people living with dementia in LTCH while supporting their personhood. WHY WAS A DIT NEEDED?

The DIT has two specific goals.

The first goal is to support the implementation of compassionate and effective infection control and prevention measures in LTCH, such as isolation and quarantine of LTCH residents.

The second goal is to help caregivers with any moral distress they feel by having to enforce isolation and quarantine of residents. Keeping residents in their rooms is necessary for the good of the whole LTCH, but is also in conflict with person-centred care principles used to guide LTCH settings. This ethical conflict can cause moral distress.

The DIT is a set of three tools: Ethical Decision-making, Person-Centred Isolation Care-Planning, and Isolation Communication tools. The tools can be used together or separately, and each tool can be downloaded from the website dementiaisolationtoolkit.com. Collectively, these three tools achieve the DIT’s purpose and goals.

The Ethical Decision-making tool sets out the principles of public health ethics in the context of LTCH and provides a structured approach for LTCH staff to discuss and apply these principles. The tool is a worksheet that facilitates discussion and documentation on how to isolate a resident for infection control and prevention. It covers the strategies to be considered, risks and benefits of these strategies, and the chosen plan of action. It includes input from many stakeholders, including the resident and the resident’s family.

The Person-Centred Isolation Care-Planning tool has been the most popular tool so far. This tool is also a worksheet that helps the LTCH staff identify and communicate practical steps that can be taken to support the resident in isolation. It prompts discussion on questions such as: why the person leaves their room and what brings them back, what they like to talk about, what kinds of reminders work for them and whether they understand why they need to stay in their room and can’t visit others?

The Isolation Communication tool. This tool has 13 signs that are remind-

Dementia Isolation Toolkit played pivotal role during pandemic I Dr. Andrea Iaboni is KITE scientist and the Medical Lead of the Specialized Dementia Unit. ers for people living with dementia to stay in their room, stay back from others, wear a mask and wash their hands. Dr. Iaboni and her team have their work cut out for them. Two evaluation studies are currently in progress. First, the team has a research paper currently under peer review which does a deeper dive on moral distress. Second, they’re doing an implementation study at three Ontario LTCH to look at barriers to applying the DIT and find ways around them. This study will inform future research on how to support person-centred care in LTCH. And, DIT version 2.0 is also in progress. It will reflect where we are now in the pandemic, as vaccinations have significantly reduced the risks in LTCH but those risks remain. It will also reflect feedback from users to be shorter and more geared for use in their huddle settings. DIT version 2.0 will also be translated into more languages than version 1.0. Short training videos are already available in seven languages. ■ H