By Chris Jones/The Oshawa Express
A year-in-review shows long-term care homes in Durham had some successes and also face some challenges.
In all, the homes had 251 admissions and 257 discharges in 2017, and wait lists remain high as hundreds of applicants have selected one of the Durham’s four homes as their first choice in 2018.
In all, over the wait list is approximately 4,700 in Durham, and occupancy rates remained over 98 per cent.
Laura MacDermaid, Durham’s director of long term care services for seniors, said the province will hopefully be alleviating the waitlist as the Ford government has promised to add 30,000 long-term care beds within the next 10 years.
Of the residents in Durham homes, approximately 72 per cent have been diagnosed with dementia according to the report, which is higher than the provincial average of 62 per cent.
According to the review, the number of patients who have taken antipsychotics without a diagnosis of psychosis has dropped throughout the region.
In 2015, Durham’s rate sat at 23 per cent, but by 2018, was down to 17 per cent.
This is attributed to the implementation of an antipsychotic evaluation tool four years ago.
MacDermaid says the there is a reason some residents might be given antipsychotic medication, despite having not received a diagnosis calling for it.
“Some antipsychotics are given for aggression and agitation,” she explains. “So if a resident is experiencing behaviours or psychological symptoms of dementia, and they pose a risk of harm to themselves or to others, or if they’re in severe distress, they might sometimes get prescribed an antipsychotic.”
While living in long-term care homes, there are numerous risks to residents, such as falls.
In 2018, the fall in Durham homes increased by 5.4 per cent to 21.6 per cent, which is higher than the provincial rate of 16.5 per cent.
“As we continue to reduce restraints, encourage mobility, and decrease bed rails, all those types of things, as well as the increase in the complexity of residents has a potential impact on falls,” says MacDermaid.
She says every time patients around Durham do have a fall, staff discuss the possible reasons and what they can do to prevent it from happening again.
MacDermaid attributes the rise in falls to the “increased complexity of our residents.”
According to MacDermaid this means, “Our residents are coming to us … in greater level of frailty.”
She says there has been a lot of emphasis from the province on home and community care, which means residents have lived independently longer than they once would have.
“When they come into long term care they’re much more frail and much more compromised,” she says.
MacDermaid also notes the total number of falls is different from the total number of harmful falls, which she says have been going down.
The year-in-review notes in May of last year, the homes in Durham participated in a multi-sited external peer review that looked at quality, risk and safety programs.
The four long-term care homes received exemplary status from Accreditation Canada, which is considered “highest award” in the industry.
Within Durham’s four long-term care homes include there are 845 long-stay and two respite beds.
The homes are Hillsdale Estates and Hillsdale Terraces in Oshawa, Lakeview Manor in Beaverton, and Fairview Lodge in Whitby.
In 2018, facilities around Durham continued to use the National Research Corporation Health survey in order to measure resident and family satisfaction.
“This research-based survey allows LTC homes across Canada to measure and review the needs of the home from the client’s experience and perspective and to benchmark against other similar homes,” reads the report.
LTCHs around Durham received a rate of 89 per cent in resident satisfaction, and 92.2 per cent in family satisfaction.
The respective averages around Canada were 83.7 per cent, and 91.1 per cent.
However, only 33 per cent of families with residents in care responded to the survey.
The region focused on their model of a person-centred care program last year.
“The purpose of this priority area is to engage all stakeholders in a reflective and exploratory process to identify existing strengths of innovative person-centred care and identify means of growth and opportunities for change,” reads the review.
According to the review, the priority for 2018 was to “focus on engaging and collecting as much [person-centred care] feedback directly from the resident and family stakeholders” as possible.
The review says this feedback was achieved by providing residents and families with a qualitative survey in addition to the yearly satisfaction survey.
Durham’s LTCHs worked with the social services and innovation and research team in order to analyze the data, and came up with four major themes –
relationships, teamwork, empowerment and meaning.
The information provided by residents and their families will be used in the development of the new strategic plan, which will be put together in early 2019.
Senior management at the homes continued their work with Behaviour Supports Ontario, an organization which “helps older people with responsive behaviours associated with cognitive impairments due to complex health, addictions, dementia, or other neurological conditions and their caregivers.”
According to the review, almost 60 per cent of the 845 long stay residents living in LTCHs exhibited responsive behaviours in 2018.
Staff at Hillsdale Terraces and Fairview Lodge developed a program called “Dancing in the Moment.”
This eight-week program focuses on helping residents to understand what anxiety is, how it can affect a person physically, as well as how to manage symptoms by identifying “cognitive distortions.”
Hillsdale Terraces also continued a project which was started by Fairview Lodge in 2017, which aims to reduce the amount of time it takes for a new resident to be admitted, and to increase resident satisfaction in the process.
The project resulted in an increase of resident and family satisfaction from 85 per cent to 91 per cent.
Work also continued on the bed rail minimization program started in 2016, which has reportedly resulted in the use of bed rails dropping by 50 per cent.
In January 2016, bed rail usage was at 83 per cent, but rests at 41 per cent as of the end of 2018.
For 2019, the four LTCHs in Durham plan to implement new software to manage employee scheduling. which will also be used by the region’s finance and human resources departments, and Durham Paramedic Services.
Key features of the software include its capability to manage all schedules in a 24-hour operation, automate basic attendance, call-in, vacation bidding and payroll functions, and improved reporting and tracking components, the review states.
This builds on previously implemented new software meant to track residents’ health records, and several other improvements to technology.