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Nursing home managers look at new ways to care for residents

For seniors, leaving behind family and familiar surroundings to move into a care home can be a stressful time.
For seniors, leaving behind family and familiar surroundings to move into a care home can be a stressful time.

It could be the hardest, most wrenching transition in a long life – the physical and emotional move from being cared for by a family member in the familiar surroundings of your own home to being attended by strangers in a long-term care facility.

“People are coming into long-term care with the expectation of receiving one-on-one care,” Debra Boudreau says quietly. “With our current level of funding and staffing, that’s not possible.”

Boudreau, chief executive officer of Tideview Terrace in Digby, chairs the Nursing Homes of Nova Scotia Association, a group of 36 non-profit or community-governed homes that recently held its annual general meeting.

Boudreau says two of the biggest challenges facing operators of long-term care facilities are staffing and “managing expectations.”

She sees people frequently move into long-term care after being looked after by a single caregiver at home or after an extended stay in hospital waiting for a nursing home bed. Up to 80 per cent of the residents in the person’s new surroundings will have some form of dementia.

Boudreau says recommendations from a government-appointed expert panel that urged hiring more people are both welcome and overdue.

Debra Boudreau is chief executive officer of Tideview Terrace in Digby and chair of the Nursing Homes of Nova Scotia Association. Jennifer Delorey
Debra Boudreau is chief executive officer of Tideview Terrace in Digby and chair of the Nursing Homes of Nova Scotia Association. Jennifer Delorey

The panel recommended hiring temporary assistants to help continuing-care assistants, who provide the bulk of daily care and are in short supply.

Boudreau’s group would prefer the province give homes “flexibility” to hire nurses and licensed practical nurses as well, in order to cover whatever full- or part-time hours are needed.

As a consequence of the chronic shortage of staff, Boudreau says non-profit homes in her association face another challenge: finding an answer to the question, “How can we keep our caregivers healthy so they can provide care?”

She says even though Tideview has more people on the payroll than in the past, the home is more frequently short-staffed because continuing-care assistants are not always available to come to work. They, too, can have elderly family members to care for at home, or they are off work on disability, trying to repair their own physical and mental health.

These types of staffing concerns are more difficult to resolve, because while the nursing home may have no vacancies on paper, it doesn’t always have enough people on the floor to meet the more complex needs of today’s residents. That’s led several non-profit facilities to source personnel from outside Canada.

For more than two years, Grand View Manor in Berwick and Glen Haven Manor in New Glasgow have been bringing in and providing temporary housing to workers from the Philippines, India and West Africa.

A recent change to immigration regulations makes it easier for nursing homes to recruit continuing-care assistants from outside Canada. The change means internationally trained registered nurses and licensed practical nurses can now be hired to work as continuing-care assistants while they study to be certified as nurses here.

Nursing home operators hope this will help recruit more people to Nova Scotia to work in long-term care, where there are currently about 300 vacancies for continuing-care assistants, and where the 16 per cent of the population who are seniors today will continue to age into nursing homes over the next 15 years.

At the recent meeting, progressive nursing home managers described how they are actively looking at new ways to care for residents with the high levels of anxiety and depression associated with dementia. They are also trying to care for caregivers experiencing high levels of stress and burnout from dealing with difficult behaviours.

Lisa Smith, the chief executive officer at Glen Haven Manor, purchased four Nordic therapy chairs after participating last fall in a tour of Denmark, where “hygge” or “living in comfortable contentment” is regarded as the key to healthy aging.

The Danish recliners rock gently back and forth. The motion affects the inner ear and helps calm residents who pace or get particularly agitated during the night. A pillow plays soothing music and a weighted blanket holds the resident in place, avoiding the use of restraints.

Smith says three of the four padded leather chairs are used by Glen Haven’s 202 residents and the other chair has been installed for staff to use in its brand-new “Hygge Nook” for employees. Seaview Manor in Glace Bay is also testing the chair, which costs $14,000.

At Ocean View Continuing Care Home in Eastern Passage, a stationary bicycle hooked up to a laptop projects images on a curved screen in front of the cyclist. The pedalling tension can be adjusted to give the resident a physical as well as a social workout. The technology is easy to use; for example, people in wheelchairs just roll up to the handlebars, where they can steer the bike to take a virtual tour of whatever address is tapped into the laptop.

Ocean View recreation director Patti Lane described how seeing Google Streetview images of a childhood home or a European vacation evoked sharp and pleasant memories for people with dementia, who often have zero awareness of the present. These images often lead to much more stimulating conversations with family and volunteers than, “What was for lunch today?”

The “Bikearound,” with the projector and laptop application, cost $22,000 to install. The money was raised by Andrew Holland, a post-grad health administration student at Dalhousie University. If there’s a downside, it’s that the large piece of gear needs a tall ceiling and a fair-sized living room to accommodate it.

All these innovations require some money to get off the ground. One of the most expensive is the Butterfly Model of Care, although data exists to show the $100,000 cost can be recovered through the positive consequences: fewer falls, fewer prescription medications, and less staff absenteeism in homes where the Butterfly project has been successfully implemented in a nursing home.

The Peel Region of Ontario recently experimented with Butterfly. The trademarked program developed by a doctor began in the U.K. and focuses on helping residents with late-stage dementia who have lost their sense of where or who they are. The care model teaches staff and family to focus on feelings and help the resident “live in the moment.” It involves one-day-a month training sessions for staff and family members by a consultant over the course of one year.

In Berwick, where Grand View Manor had for years been operated by the town but is now being run as a not-for-profit, CEO Menna MacIsaac is researching different models of care, including the Butterfly and Eden models.

If it takes a village to raise a child, it’s reasonable to think it will take a similar commitment to improve care for a community’s frail, oldest citizens.

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