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Behavioural Supports Ontario BSO Impact in Ontario and the CE LHIN Presented by: Joy L. Husak – BSO Design Team July 24, 2013.

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Presentation on theme: "Behavioural Supports Ontario BSO Impact in Ontario and the CE LHIN Presented by: Joy L. Husak – BSO Design Team July 24, 2013."— Presentation transcript:

1 Behavioural Supports Ontario BSO Impact in Ontario and the CE LHIN Presented by: Joy L. Husak – BSO Design Team July 24, 2013

2 BSO Project Background BSO project is a $40 million Ontario wide project in partnership with: All Ontario Local Health Integration Networks(LHINS) Alzheimer Society of Ontario Health Quality Ontario Ministry of Health and Long Term Care Central East LHIN is one of 4 early Adopter LHINS $1.6 million investment in 2011/2012 $ 4.06 million on an annual basis 2

3 Overview - Purpose and Target Population Behavioural Supports Ontario (BSO) Project was created:  To enhance services for older people with complex behaviours wherever they live - at home, in long-term care or elsewhere  To develop and implement new models of care that focus on quality of care and quality of life  To promote new ways to manage behaviours  To provide standardized, consistent levels of care BSO population: older people with responsive behaviours linked to cognitive impairments, people at risk of the same and their caregivers; providing them with the right care at the right time and in the right place. 3

4 Composition of the Integrated Care Team 1.Acute and Tertiary Care Team: includes psycho-geriatricians, behavioural nurses, Occupational Therapists, Physical Therapists and Behaviour Therapists. outreach to long-term care in-hospital care when required 2.NPSTAT (Nurse Practitioner Outreach Team): timely response to LTC to conduct advanced medical assessments for residents with escalated behaviours and medical care as appropriate 3.LTCH Behavioural support nurses and Personal Support Workers (PSW): Hands-on care - allowing evening and weekend coverage (when possible) Participate in and lead quality improvement activities Lead knowledge exchange activities within LTC and across CE LHIN 4.Psycho-geriatric resource consultants (PRC): expert input to quality improvement activities develop improved processes of care provide staff education. 4

5 Overview - BSO Framework Pillar 1 – System Coordination and Management Pillar 2 – Integrated Service Delivery: Intersectoral and Interdisciplinary Pillar 3 – Knowledgeable care team and capacity building 5

6 BSO Provincial Update LHINs are moving from implementation to sustainability  Sustainability Plans posted on all LHIN websites Evidence that BSO is making a difference is accumulating  people received comprehensive behaviours training  clients supported by BSO trained resources  7018 clients assessed using common assessment toolkits  601 tests of change (PDSAs) and service improvements BSO is providing better care, better health and better value Alzheimer Knowledge Exchange continues to provide the structure for support and communications 6

7 BSO in Central East - Strategy Phased - start with LTC and then move to Community 1.LTCH Stream 2.Community Stream Integrated Care Team to leverage current resources and expertise: 1.LTC Team – LTC staff and physicians; Psycho-Geriatric Resource Consultants (PRCs); NPSTAT (nurse practitioner led outreach to LTC); Geriatric Mental Health Outreach Teams (GMHOT), acute/tertiary care hospitals 2.Community Team – CCAC, Community Support Services; Primary Care, PRCs; GAIN (Geriatric Assessment and Implementation Network); Geriatric Mental Health Outreach Teams (GMHOT), acute/tertiary care hospitals 7

8 BSO in Central East – Quality Improvement Quality Improvement philosophy: using small tests of change … Focus Learn Spread Sustain Benefits of Quality Improvement Approach: client-focused ensures stakeholder understanding creates ‘buy-in’ excellent vehicle for knowledge exchange provides value for money focused on quality of care and improved outcomes guaranteed to work 8

9 BSO in Central East – Quality Improvement Developed multi-stakeholder value stream maps (VSM) for each of the five client streams Long-Term Care I. Support provided by LTCH staff II. Integrated Care Team support Community III. Prevention and Early Stage Support IV. Support from time of LTC application Acute and Tertiary Care V. Transition to acute care, tertiary and specialized care Focus Learn 9

10 BSO in Central East – Capacity Building for LTCHs, Community Providers & Integrated Care Teams CE LHIN training February 2012 to March 2013 CourseParticipants PIECES416 UFirst328 Montessori542 Gentle Persuasive Approaches (Train the trainer) 44 Sub-total1330 Quality Improvement Facilitation Training ( day, day training) 190 Total1520 Learn 10

11 BSO in Central East – LTC Commitment of LTC Early Adopter BSO Teams 1. Enhanced care for people living with behaviours (including evening hours) 2.Participation and leadership in quality improvement activities  266 Plan-Do-Study-Act cycles completed 3.Knowledge transfer and spread to Phase 2 homes Implementation Tables Outreach visits with buddy homes “Whatever is needed” to help Phase 2 homes implement BSO Community of Practice events Spread Sustain 11

12 BSO 13 Early Adopter LTC Homes (2012) Durham Wynfield LTC Ballycliffe Lodge Community Nursing Home Pickering North East Fairhaven Riverview Manor Caressant Care McLaughlin Victoria Manor Home for the Aged Streamway Villa, Cobourg Scarborough Shepherd Village Yee Hong Centre for Geriatric Care- Finch Trilogy LTC Residence Bendale Acres Seven Oaks LTC 12

13 BSO Phase 2 Homes (April 2013) Durham Hillsdale Estates North East St Joseph’s at Fleming Community Nursing Home Warkworth Lakefield Extendicare Scarborough Tendercare Living Centre 13

14 BSO Measures for Success Reduced resident transfers from LTC to acute or specialized unit for behaviours Delayed need for more intensive services, reducing admissions and risk of ALC Reduced length of stay for persons in hospital who can be discharged to a Long Term Care Home with enhanced behavioural resources Learn 14

15 BSO in Central East - Highlights from EA LTC Metrics EA LTCHs have identified 1491 residents with a new or escalated behaviour through 2012/ Behavioral Assessments Tools (BAT) completed. Overall, a BAT has been completed for 59% of those residents with a new or escalated behaviour. 905 residents received a change in treatment 869 residents received support from IC Team 50 transfers to ED for primary reason of responsive behaviours; this equals only 2% of population in CE LHIN EA Homes Learn 15

16 BSO in Central East – Early Successes Impact: 886 residents assessed and served in 13 Early Adopter LTC homes in staff trained (2610 training days) Behavioural Assessment Tool, Whiteboard, Client Care Process Flow utilized in 72% of Central East LTCHs Community – draft design of Client Care Process Flow developed Client Stories: Decrease of behavioural incidents in clients with responsive behaviours Increased client cooperation with activities of daily care Decrease in use of physical and pharmacological restraints to control behaviours Admission of people with difficult behaviours from tertiary care settings and behavioural support units 16

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18 Lessons Learned/Observations Common tools, common training = common language for collaborative problem solving Standard process and tools increase communication & collaboration (require OTN sessions – training) Defined Value Stream Process provides a context to utilize new knowledge Visual process maps make it easy to learn the new process Staff initiate interventions before behaviours escalate 18

19 Next Steps… LTC Stream Sustain gains in EA homes Implementation Table teams will continue to provide leadership to spread BSO to all Central East LHIN LTCHs Refinement of GMHOT engagement processes Metrics collection and analysis for all CE LHIN LTCHs Community Stream Refinement of process, conducting small tests of change – PDSAs Other Areas of Focus : Refinement of transfer process to and from hospital for LTC and Community streams Identify new leaders Recruit and refresh membership of BSO Design Team and Evaluation Committee Align with development and implementation of Regional Specialized Geriatric Service Entity 19

20 The Need for Change… More and more people are at risk for responsive behaviours Challenges are experienced across all health sectors and services The patient and family require better quality experiences There are significant costs associated with managing behaviours Recognized best practices could be adopted more systematically There is an opportunity to leverage existing initiatives in Ontario Stakeholders are ready for change 20

21 OTN AS A RESOURCE Collaborative events and In-services for all staff pertaining to delirium, person centred approach, healthy aging of people with developmental disability, palliative, mentoring and coaching Share knowledge and skills between all health and business sectors (build relationships) including physicians, mental health, paramedics, ambulance, emergency room staff, police, fire department, etc. Assessments (telemedicine), enhance delivery of service, and follow up 21

22 OTN AS A RESOURCE Transfer of knowledge to post-secondary education students to implement the BSO program within their course curriculum and integrate with student placement (capacity building)(hours for community service Co-op Students) Establish and expand OTN and teleconference availability (LTC/community); integrate family/SDM/POA for resident focused care Educate community, family members, residents, clients – proactive rather than reactive 22

23 OTN AS A RESOURCE How can we help each other? By bringing together diverse groups from traditional medicine, nursing, allied health professionals, academic institutions, technology and telecommunication organizations, e-health, physicians, hospitals, long term care homes, community agencies, government and others to overcome barriers to the advancement of telemedicine through the professional, ethical and equitable improvement in health care delivery. 23

24 OTN AS A RESOURCE Benefits: Widen our reach to individuals in a cost-effective manner Convenient for clients, healthcare providers,family members, students, other business professionals Increase in care, education, training with less travel Satisfaction due to improved equipment and change in people’s perception of technology 24

25 For more information…. BSO page on CE LHIN website BSO hidden page on CE LHIN website Alzheimer Knowledge Exchange BSO webpage Joy L. Husak – Executive Director, Fairhaven – , extension 231 – 25

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