March 05, 2021
The Behaviour Supports for Seniors program (BSSP) for TC-LHIN , housed at Baycrest, is a provincially funded program which recognizes that all behaviour has meaning and that responsive behaviours are often a form of communication of an unmet need.
Veronica Downer - Behaviour Support Personal Support Worker (left)
and Joan (Yucong) Cai - Behaviour Support (right)
“Our mission is supporting and enhancing system capacity for effective management and care for clients with dementia, who may present with responsive behaviours through system coordination; education and training to staff and caregivers, as well as outreach services by specialized clinicians to assess, develop care plans and coach on the implementation of specially tailored care plans for people with dementia,” says Deb Galet, Executive Director of Interprofessional practice and ambulatory care at Baycrest.
Throughout the pandemic the Behaviour Support clinicians at TC-LHIN have continued to provide support virtually and physically within the community, in acute care and in nursing home environments to support clients with dementia and their families, as well as coach staff in managing these challenging situations.
The BSSP supports all 36 nursing homes across the TC-LHIN. During the pandemic, the BSSP has provided behaviour outreach services through its specialised Behaviour Support Long Term Care Team including behaviour support for: nurses, PSWs, addictions specialists and caregiver specialists through the Alzheimer Society of Toronto.
The pandemic has presented many changes and challenges to the nursing environment, and the need to balance residents’ needs and best practices with Infection Control Precautions.
Residents with dementia often struggle to make sense of these changes and to comply with COVID-19 precautions, such as reduced visitations, physical distancing and masking. These changes and their impact on individuals with dementia often result in responsive behaviours such as confusion, agitation, restlessness, wandering and physical aggression, adding stress and risk to both the residents, their families and the staff at the home.
This happened in the case of a woman in her 70s who has Alzheimer’s disease and resides in one of the Toronto nursing homes. Over the course of the pandemic, the resident became increasingly agitated. She did not have any family members. She was confused and refused staff support in care. She presented with verbal and physical aggressive expressions, during personal care and had difficulty communicating her needs.
When Joan (Yucong) Cai, Behaviour Support RN, and Veronica Downer, Behaviour Support Personal Support Worker at Baycrest, received the referral, they initially assessed and observed the resident to understand what might be the trigger for these behaviours. They then developed strategies and recommendations accordingly. It was up to Downer to trial these strategies with the resident and coach staff on how to apply them.
“Upon meeting the resident the first day of my visit, I quickly started to build up a friendly and trusting relationship with her. I could tell that wearing masks was disturbing to her. She kept saying ’I can’t see you, I don’t like that’ in reference to masks and the face shield. I engaged her in conversation by introducing myself, looking at magazines together and talked about things she enjoyed to do in the past like teaching and the arts,” said Downer.
Through implementation of Gentle Persuasion strategies
and client-centred approach, Downer quickly established a trusting relationship with the resident and was able to calmly redirect her and support her in participating in her own care. “I could see that the resident was much calmer with fewer staff in the room,” said Downer. Working collaboratively with the nursing home in-house behaviour support lead and staff to implement these approaches, the resident is now able to participate calmly in her care with minimal support.
The nursing home staff members modified their approach, giving the resident more time to process the instructions. The Home Personal Support Worker was able to finish resident care alone safely. “I’m ok with her now,” she said, “I appreciate having access to the Behaviour Support Personal Support Worker for her help.” The resident‘s resistance and physical aggression to care reduced dramatically and the resident is much more settled in the unit.