2019-11-15 Examples of Montessori Methods for Dementia, - - PDF document

2019-11-15 1

Susan Braedley, MSW, PhD

Professor of Social Work Carleton University

KEYNOTE ADDRESS

Transforming Long-Term Residential Care: Finding Promising Practices

Susan Braedley MSW PhD School of Social Work, Carleton University For The Art of the Possible, Nov 12, 2019 Ottawa

Research projects

• Reimagining Long-term Residential Care: An International Study of

Promising Practices (SSHRCC) 2010-2018

• Dreams of Home: Comparing Nova Scotia and Ontario LTRC policies and

practices (SSHRC) 2012-13

• Healthy Aging in Residential Places (CIHR & ERA) 2013-16
• Seniors Adding Life to Years (CIHR) 2017-20
• Changing Places: Unpaid work in public spaces (SSHRC) 2015-19
• Models for Long-term Residential Care (City of Toronto) 2018-19
• Planning for Care? Saskatchewan Policy and its Consequences for Long-

Term Residential Care Security (CUPE Healthcare) 2019

Our methods

• International, Interdisciplinary

teams and partners

• Analytic mapping
• Document analysis
• Rapid, site switching ethnography
• Collective analysis
• Knowledge sharing

Transforming Care: Models?

How Models Developed

Began more than a quarter century ago Started with a critique of existing homes They were deemed too impersonal Too rigid Undermining dignity and respect Transformation models seek to alter values,

• rganization, practices, physical structures

2 3 4 5 6 7

2019-11-15 2

Examples of Models

• Butterfly the most recent,
• Earlier, Eden,
• Green House,
• Wellspring

There are also Approaches or Methods that are not as extensive as models

Montessori Methods for Dementia, Dementi/Ability The Gentle Care System The Gentle Persuasive Approach

A Market for Models

Long-term care home sector scandals, wait lists, continual critique Competition among and between for-profit, not- for - profit and municipal homes Concurrent with changing admissions criteria, wait lists, and developments within the retirement home sector that shape a two-tier system, ltrc intensity is growing in multiple ways

Common elements (1)

• Focus on care as a relationship and

residents as individuals

• Collaborative approaches
• Flexibility for residents and staff,

empowerment

• Preference for small, “homelike”

places, plants, outdoor access

Common elements (2)

• Focus on care processes rather

than on tasks

• Leadership committed to guiding

principles

• Vary in degree of flexibility in

application

• All require higher staffing levels,

training

A Promising Practice : Short Video 8 9 10 11 12 13

2019-11-15 3

WHAT MODELS AND APPROACHES OFTEN DO NOT ADDRESS

SIGNIFICANT DIFFERENCES AMONG RESIDENTS IN TERMS OF AGE, CULTURE, INCOME, CAPACITIES, LANGUAGE, FAMILY STATUS

ROLE OF FAMILIES AND VOLUNTEERS

Transitioning

This Photo by Unknown Author is licensed under CC BY-NC-ND

Costing and funding

Ontario health ministry spending ($ billions) Long-Term Care Homes 3.6 3.7 3.8 3.9 3.9 4.0 4.1 4.3 4.4 Growth 1.7% 3.2% 2.2% 2.1% 1.9% 2.6% 3.9% 1.5% 11-12 12-13 13-14 14-15 15-16 16-17 17-18 18-19 19-20 Source: FAO analysis of data from MOHLTC, the 2019 Ontario Budget and FAO.

STAFFING RECRUITMENT, RETENTION, PAY AND BENEFITS, UNION AGREEMENTS AND REGULATIONS

14 15 16 17 18 19

2019-11-15 4

FOOD, CLOTHES AND LAUNDRY

DESIGNATED UNITS

Assessing Models for Care

Difficult to assess using conventional methods Research limited, often contradictory, most of it from the US All models make a positive difference, at least initially Difficult to tell if the higher staffing levels and attention are the main factor in improvement

Conclusion

No magic formula. One size does not fit all Lots of good ideas worth trying “Facility specific social model of care” (see Caspar, S., O’Rourke, N., & Gutman, G. (2009). The differential influence of culture change models on long-term care staff empowerment and provision of individualized care. The Canadian Journal on Aging, 28(2), 165-175).

THANK YOU

• For more information on this research,

see

• http://reltc.apps01.yorku.ca/ and
• https://carleton.ca/carework/

20 21 22 23 24