12 - Opportunities for Care Flashcards
What are the healthcare trends?
- most prevalent diagnosis in LTC homes: hypertension, dementia, osteoarthritis
- more co-morbidities, more polypharmacy/prescription meds
Veneration of __________ VS Veneration of _________.
Family, independence
Ownership of LTC Homes
- more than 1/2 are private-for-profit homes in Ontario
- how much does it cost for LTC care in Ontario:
What systemic challenges in LTC did COVID-19 present?
- staffing
- infrastructure
- quality of care
- infection, prevention, and control
These systemic challenges lead to:
- decreased QOL
- changes in condition or functional decline
- avoidable hospital admissions
- gaps in end-of-life care
Innovations in LTC
- paramedics
- expand diagnostic services (ultrasounds, blood work)
What is the Eden Alternative?
- philosophy is to treat patients as humans, not objects
- Developed in USA in 1990s by Dr Bill Thomas
- Uses slogan “it can be different’
- Intended for residential, home, or community care for older adults, and for those with mental health, developmental or cognitive difficulty
3 Plagues of Suffering
- Boredom
- Helplessness
- Loneliness
Principles of the Eden Alternative
1) Institutional care using a medical model = suffering caused by the “three plagues”
2) A community is a human habitat and should include engagement with plants, animals & children
3) Human and animal companionship is an antidote to loneliness and must be readily available
4) Must not be focused on “staff tasks” but enable residents to “give care” not just receive it = relieves helplessness
5) Boredom is alleviated by spontaneous events and interaction
Home based Primary Care
- House Calls is a primary health care practice for home-bound seniors living in Toronto
- house calls were much more common back then
Benefits
- transportation
- assess client in home environment
- reduces risk of falls = reducing incidence of hospitalizations
- first hand assessment perspective
What is the Dementia Village?
- The Hogeweyk is a publicly funded village/ gated smaller community for seniors living with dementia.
- Residents choose own schedule for meals and activities or may dine at the village café or restaurant
- The village is secured and residents cannot leave the village unaccompanied
- Design features include no locked or disguised doors, elevators sense when people are waiting and run between ground and first floors without having to press buttons
- Safe outdoor features include circular paths, night lighting, seating areas, water features, gardens – all provide greater range of movement than traditional homes
- doors are unlocked by wristbands
- Potential for higher QOL
Benefits of the Dementia Village?
- Social groups are available, supported by trained volunteers and staff
- Staff are assigned to each residence on 3 shifts
- Almost NO bedridden residents - occasionally a resident may be in bed for a long period
- 40% of disabled ppl use wheelchairs to ensure access to all areas of the home and the outdoors
- Residents remain at the home until they die - supported by a palliative care team
What is the Greenhouse Project?
- Seek to humanize elder care
- emphasizes dignity and respect
- aims to de- stigmatize, de -institutionalize, and humanize
- Shared central living area with communal dining room and kitchen
- Does not include a village but are intended to be linked to their community in informal ways
- No nursing stations, medication carts or visible medical supplies
- Homes run by specially trained certified nursing assistants supported by clinical staff who visit the home (nurses, SW, OT, MD)
- Role description very broad…“jump in and work together”
- Ability to know residents (TNCR)
Telemedicine
- Many LTC home lack medical coverage on weekends, evenings, holidays
- On-call physicians may visit resident but usually refer to transfer resident to ER
- Telemedicine uses two-way video conferencing and direct consultation-may prevent hospital transfer
- Prior to COVID, telemedicine only covered for use in remote areas but during COVID also used in urban areas
- challenge with telemedicine: they can not bill/charge for remote appts
Nurses Transforming LTC?
- the need to transform LTC in Ontario gained support during COVID-19
The pandemic exposed:
- high mortality rate resulting from COVID-19 in LTC settings, representing a large majority of COVID-19-related deaths in Ontario
- a report of poor care from the Canadian Armed Forces
- devastating stories from families who were separated from loved ones
