Behavioural Supports Ontario (BSO) Hamilton Niagara Haldimand Brant (HNHB) Local Health Integration Network (LHIN) Phase I Report Presentation to the HNHB LHIN Board of Directors May 30, 2012 1
Agenda • Overview of BSO Project • HNHB LHIN BSO Governance Structure • HNHB LHIN Phase 1 Report • Long-Term Care Home (LTCH) BSO Capacity Building • Next Steps 2
BSO Project Overall Goal: • To enhance services for older adults with complex behaviours, wherever they live, through the development and implementation of new models of care that focus on: • quality of care • quality of life. • Focus of the strategy is not on new or increased resources, but rather on determining how all resources - new and existing - can be realigned to better service our clients. 3
BSO Project - Framework • System Coordination and Management • Integrated Service Delivery – both intersectoral and interdisciplinary • Knowledgeable Care Teams and Capacity Building Better integration + collaboration = better care and outcomes + better value + lower risk 4 Source: Ontario BSS A Framework for Care. January 2011. Alzheimer Society of Ontario, Alzheimer Knowledge Exchange , Ontario LHINs
HNHB LHIN BSO Governance Structure 5
“ I AM WHO I AM, SO HELP ME CONTINUE TO BE ME” Older people with cognitive impairments due to mental health problems, addictions, dementia, or other neurological conditions that exhibit responsive or challenging behaviours. 6
HNHB LHIN Phase 1 Report 7
HNHB LHIN Improvement Plans – Actioned in Phase 1 BSO Connect • BSO Connect - single point of entry • Integrated Community Lead (ICL) ICL • BSO Community Mobile Team Community Mobile Team Primary Care • Primary Care Toolkit • LTCH BSO Mobile Team Long Term Care Home
HNHB LHIN Process April - June 2012 – Implementation & Continued Testing March 2012 - Models revised to guide implementation in phase 2 February 2012 - Models tested - QI PDSA cycles December 2011 – March 2012 Four Subcommittees Increased Project Management Resources Support three Buddy LHINs
Enablers • BSO Framework and principles – vision for change • Focused change for target population • Readiness for change and commitment among system partners • Timelines – created momentum and sense of urgency • BSO Implementation strategy – province-wide with processes that fostered collaboration • LHIN lead project management model – Internal and Provincially (Coordinating Reporting Office) • Expert support – Health Quality Ontario, Provincial Resource Team and Alzheimer’s Knowledge Exchange • Over 170 LHIN stakeholders with the vision and courage to think outside of the box and lead change.
HNHB LHIN BSO Community Model BSO Connect Three components: • BSO Connect Community Outreach Team • ICL Integrated • Community Mobile Team Community Lead
Impact for Frank BSO Connect Frank, a retired gentleman who is very self aware and articulate individual who knows his needs called BSO Connect. Model : • Single point of information & referral • Frank shared he had a couple of “ Warm ” connection changeable psychiatric conditions that had • No wrong door. gotten worse and prevented him from seeing his doctor (fear of public places and verbal aggression when in manic Current : state). Frank shared additional stressors his mother & spouse were in • Client/caregiver provided numbers of LTCH and his two adult children had clinical depression. services/agencies to connect with • Previously, Frank had called CCAC for support & was provided with Difficult to navigate services. numbers to call. Frank had difficulty getting to his doctor (fear of public places), had called his pharmacist but did not get any help. Shared his BSO Connect - New Approach : frustrations about the ‘system”. • Client/caregiver actively referred • Services ‘pulled’ toward client. With Frank’s permission, BSO Connect staff connected Frank with a community support agency - Supportive Independent Living program in Niagara. Outcome : BSO Connect pulled support to the client by calling agency on his behalf & making the referral . Frank will receive support to assist him manage his health care needs.
Integrated Community Lead (ICL) Model: • Single point of contact for BSO clients Agency ICL • A Plan & coordinate supports & services • Memorandum of Understandings. Primary Agency Primary Agency C Current: C C Care Care • Multiple assessments Clie Client Clie Client • Overlapping services • Stress & frustration for client(s). ICL - New Approach: Hospitals Agency B • Agency Lead role to coordinate services Hospitals B • Collaborations reduce client frustrations • Client has one lead agency/person to call. 13
Impact for Josie Community Outreach Team Salim is an elderly man with a diagnosis of Alzheimer's. Josie is Salim’s partner and Model: primary caregiver and is • Enhance existing community crisis systems • getting burnt-out as Salim New BSO resources - Regulated Health Professionals wakes up frequently during the night, attempts to leave & Intensive Geriatric Service Workers. and does not recognize Josie. Current: Josie has been intentionally taking Salim for walks at • Crisis teams are not always aware of resources night but Salim does not always settle. available or approaches to deescalate behaviour • Limited follow-up capabilities BSO Outreach met with Josie to explore options to • Not expert in geriatric & mental health as it relates to assist in reducing her burnout: responsive behaviours. • Prevent Salim from wandering i.e. curtain over doors, light on in bathroom. BSO COT - New Approach: • • Arranged for Salim to attend Adult Day Program, Clients supported with strategies until transitioned from enabling Josie to get some rest from care-giving. crisis to longer term supports • Connect Josie with Alzeheimer Society for “Safely • Linked with longer-term supports to sustain client in Home”, telephone support, counseling & friendly community • visiting. Reduce escalation of crisis. Outcome : Josie is more rested, remains healthy & enjoys her husband’s company again.
HNHB LHIN LTCH Mobile Team Three Main Functions: • Protocols for Escalating Behaviours • Scheduled and Episodic Care • Transitional Pathways.
HNHB LHIN BSO LTCH Mobile Team Scheduled and Escalating Behaviours Transitional Pathways Episodic Care Resident specific assessments and assist in developing care plans Development of evidence-based Draft standardized protocols for pathways developed for management of Model care through transitions to and from escalating “hands on” LTC, for clients with demonstration behaviours for LTCH responsive (or history residents with of) behaviours responsive behaviours Capacity Building
HNHB LHIN BSO LTCH Mobile Team – Key Features Model: • Provides a “team” of resources to LHIN’s 86 LTCH (41 new LTCH staff) Coaching and Mentoring. Escalation protocols: • Provides evidence based standardized protocols that LTCHs may use to assist them manage the care of residents with responsive behaviours. Scheduled and Episodic Support: • Support staff with assessments/tools and collaborate with staff to develop and implement care plans. • BSO staff scheduled to be at a LTCH when behaviours are most challenging (i.e. morning care). • New peer to peer opportunities - BSO staff work side by side with peers to model approaches to de-escalate behaviours through daily activities. • Follow up with LTCH on effect of care plan on de-escalating behaviours. • Increase knowledge transition and capacity building. Transitions Scheduled and Episodic Support: • Support resident, LTCH and hospitals with transitions in care. • Schedule to be in the LTCH when residents transitioned.
BSO LTCH Mobile Teams Burlington -1 RN, 2 RPN, 2 PSW Brant - 1 RN, 2 RPN, 2 PSW Hamilton - 1 RN, 4 RPN, 8 PSW Niagara - 1 RN, 4 RPN, 8 PSW LTCH MOBILE • 41 interdisciplinary staff divided into 5 teams: • Mobile Team Lead (RN) • Clinical coach (RPN) Haldimand & Norfolk - 1 RN, 2 RPN, 2 PSW • Care Support Worker (PSW)
Primary Care Toolkit Model : • Create toolkit for primary care providers. • To improve early identification and management of clients with responsive behaviours. Current : • Variable use of treatment strategies based on Opportunities: setting and resources. • Allows view of client for future comparison. • Delay in identification and management. • May be used in regions/areas with less • Inconsistent referrals to specialized geriatrics. specialty geriatric services. • Many complex toolkits, not well utilized. • Pathway identifies a single link to community supports . • Primary Care Collaborative Lead.
Next Steps Primary Care: • Identify Family Health Teams and Community Health Centres to utilize Toolkit. • Specialized Geriatric Clinic. • Receive feedback from NSM LHIN. • Trial in retirement and LTCHs, geriatric outreach and new BSO teams. Community: • Implementation of all three Models from April to July. LTCH: Continued evaluation of all models • Involvement in existing outreach residents from through Summer 2012 April to May. • BSO staff accepting referrals - staged roll out in May and June. 20
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