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2. Creation of a Twelve Bed
Behavioural Support Unit in the Bungalows of the Peter D. Clark Long Term
care Home CrÉation d’une unité de
soutien compORTEMENTal DE DOUZE LITS DANS LES PAVILLONS DU foyer de soins DE
longUE DURÉE Peter D. Clark |
COMMITTEE RECOMMENDATION
That
Council approve that staff work
with the Champlain Local Health Integration Network (LHIN), Champlain Community
Care Access Centre (CCAC), The Royal Ottawa Mental Health Centre (ROMHC), the
Alzheimer’s Society, and other community partners at the discretion
of the Manager, Operations Branch, to develop a proposal to the Champlain
LHIN to establish a 12 bed Behavioural Support Unit (BSU) in the Peter D. Clark Long Term Care
Home Bungalows as outlined in this report, and upon acceptance of the proposal
by the Champlain LHIN, to implement the proposal
subject to the requirements as outlined in this report.
Recommandation DU Comité
Que le Conseil
accepter que le personnel collabore avec le Réseau local d’intégration des
services de santé (RLISS) de Champlain, le Centre d’accès aux soins
communautaires (CASC) de Champlain, le Centre de santé mentale Royal Ottawa
(ROMHC), la Société Alzheimer et d’autres partenaires communautaires, à la
discrétion du gestionnaire de la Direction des opérations, afin de formuler une
proposition visant à créer une unité de soutien comportemental de douze lits
dans les pavillons du Foyer de soins de longue durée Peter D. Clark, comme
indiqué dans ce rapport, et une fois la proposition acceptée par le RLISS de Champlain,
de mettre en œuvre la proposition sous réserve comme indiqué dans ce rapport.
Documentation
1.
City Operations and Infrastructure Services and
Community Sustainability Deputy City Manager’s report dated 15 February 2012 (ACS2012-COS-CSS-0004).
Community and Protective Services Committee
Comité des services communautaires et de protection
15 February 2011 / le 15 février 2011
Submitted by/Soumis par :
Steve
Kanellakos, Deputy City Manager/Directeur municipal adjoint,
City
Operations/Opérations municipales
Contact
Person/Personne ressource:
Marlynne Ferguson; Manager, Operations
Branch/ Direction
des opérations
(613) 580-2424 x, 23630
SUBJECT:
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OBJET : |
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That the Community and Protective
Services Committee recommend that Council approve that staff work with the Champlain Local Health
Integration Network (LHIN), Champlain Community Care Access Centre (CCAC), The
Royal Ottawa Mental Health Centre (ROMHC), the Alzheimer’s Society, and other community
partners at the discretion of the Manager, Operations Branch, to develop a
proposal to the Champlain LHIN to establish a 12 bed Behavioural Support Unit (BSU) in the Peter D. Clark Long Term Care
Home Bungalows as outlined in this report, and upon acceptance of the proposal
by the Champlain LHIN, to implement the proposal subject to the requirements as
outlined in this report.
Le Comité des services
communautaires et de protection recommande au Conseil d’accepter que le
personnel collabore avec le Réseau local d’intégration des services de santé
(RLISS) de Champlain, le Centre d’accès aux soins communautaires (CASC) de
Champlain, le Centre de santé mentale Royal Ottawa (ROMHC), la Société
Alzheimer et d’autres partenaires communautaires, à la discrétion du
gestionnaire de la Direction des opérations, afin de formuler une proposition
visant à créer une unité de soutien comportemental de douze lits dans les
pavillons du Foyer de soins de longue durée Peter D. Clark, comme indiqué dans
ce rapport, et une fois la proposition acceptée par le RLISS de Champlain, de
mettre en œuvre la proposition sous réserve comme indiqué dans ce rapport.
Executive
Summary
There are three significant requirements to establish the BSU:
The City of Ottawa Long Term Care Homes (LTC)
operates 717 long term care beds (15.3% of the long term care beds in the
Champlain LHIN). In 1998 the City of Ottawa and the Alzheimer’s Society of
Ottawa (ASO) joined forces to incorporate the footprint of the Alzheimer’s
Bungalows into the new Peter D. Clark Long Term Care Home. The Ministry of
Health Long Term Care (MoHLTC) had approved the additional beds for the
Bungalows with a vision of creating and evaluating a state-of-the-art design
and care programs for residents with persistent and severe behaviours due to
dementia as this was a significant gap in the care and housing continuum. However, it must be noted that there are
individuals who challenge this stating that the vision was for state of the art
care and design for individuals with dementia, but not necessarily for
individuals with persistent and severe behaviours related to advanced
dementia.
Recently, the MoHLTC
has initiated a province wide strategy to develop Behavioural Support Service
systems in each of the LHIN areas. The Strategy is framed around three pillars
and involves re-design of the current system services in conjunction with an
enhancement of resources. The three pillars are:
An integral part of the Strategy includes the
creation of a Behavioural Support Unit (BSU) for individuals with persistent
and severe behaviours due to dementia. The hope is to locate a unit in a Long
Term Care Home and the Peter D. Clark Bungalows is seen as the logical option.
A tentative concept proposal has been submitted to the Champlain LHIN on behalf
of the partners: the City of Ottawa, the Royal Ottawa Mental Health Centre, the
Champlain CCAC and the Alzheimer’s Society. The concept proposal is to jointly
develop, operationalize and evaluate a Behavioural Support Unit (BSU) in the
Peter D. Clark Long Term Care Home’s Alzheimer’s Bungalows. Currently
there are four (12 bed) units and the intent is to dedicate one unit or 12 beds
for the BSU.
The proposal
includes a request for $938,207 in additional funding. The BSU will require additional
funding for two main reasons -- to augment staffing and to support specialized
education and support for the staff on the BSU. Please note that the Champlain
LHIN is aware that the entire funding request must be supported in order to implement
the BSU.
It is well
understood that existing long term care staffing patterns are inadequate for
residents with persistent and severe behavioural problems due to dementia. As
such, additional funding is required to augment staffing to levels that will
foster the provision of quality care and meet the safety needs of this
population and staff.
The funding will
also be used to support appropriate specialized education for staff working on
the BSU. Advance and as required education are necessary to foster success for
staff caring for individuals with severe behavioural problems due to the
complexity of their needs. Given that there is a belief by many that the
Bungalows were purpose-built for this specialized type of care in 2001, there
is no capital investment required to provide this specialized therapeutic
environment. To date, operational dollars for the bungalows has not differed
from traditional long-term care home staffing. As such, although the physical
environment has care delivery advantages, the lack of human resource capacity
to care for residents with persistent, severe behaviours associated with
dementia has created a care/housing challenge for these residents across the
Champlain region.
RÉSUMÉ
Trois dispositions importantes
doivent être incluses dans l’entente écrite conclue entre les partenaires, en
l’occurrence :
Les foyers
de soins de longue durée de la Ville d’Ottawa gèrent 717 lits de soins de
longue durée (dont 15,3 p. 100 au RLISSC de Champlain). En 1998, la Ville d’Ottawa et la Société
d’Alzheimer d’Ottawa avaient conjugué leurs efforts pour incorporer les
installations des pavillons du service Alzheimer au nouveau Foyer de soins de
longue durée Peter D. Clark. Le ministère de la Santé et des Soins de longue
durée (MSSLD) avait alors approuvé l’installation de lits supplémentaires dans
les pavillons. Cette mesure visait à créer et à évaluer des programmes de mise
en forme et de soins d’avant-garde destinés aux résidents ayant des
comportements graves et chroniques imputables à la démence, et ce, afin de
combler l’écart important alors relevé dans le continuum de l’hébergement et
des soins proposés. D’aucuns affirment cependant que l’objectif était d’offrir
des programmes de mise en forme et de soins d’avant-garde aux personnes
atteintes de démence, mais pas nécessairement aux personnes présentant des
comportements chroniques et graves liés à un état de démence avancé.
Récemment,
le MSSLD a entrepris, à l’échelle de la province, une stratégie visant à doter
tous les secteurs du RLISS de systèmes de
Services de soutien comportemental. Cette stratégie, qui prévoit le réaménagement
des services des systèmes actuels et l’amélioration des ressources, repose sur
trois piliers :
Cette
stratégie prévoit entre autres la création d’une Unité de soutien
comportemental (USC) réservée aux personnes atteintes de comportements
chroniques et graves imputables à la démence. L’objectif visé consiste à
installer l’unité dans un foyer de soins de longue durée, les pavillons du
centre Peter D. Clark constituant une option logique. Les partenaires du
projet, à savoir, la Ville d’Ottawa, le Centre de santé mentale Royal Ottawa
(ROMHC), le CASCC de Champlain et la Société Alzheimer ont présenté un projet
de concept provisoire au RLISS de Champlain. Ce projet consiste à élaborer, à
mettre en service et à évaluer conjointement une Unité de soutien
comportemental dans les pavillons réservés aux patients atteints d’Alzheimer du
Centre de soins de longue durée Peter D. Clark. À l’heure actuelle, il y a quatre
unités (12 lits); le but visé consiste à réserver une unité soit 12 lits à
l’Unité de soutien comportemental.
Cette proposition prévoit le dépôt
d’une demande de fonds supplémentaires évaluée à 938 207 $. L’USC sollicitera ces fonds pour deux raisons
principales : augmenter la dotation en personnel; soutenir la formation
spécialisée et l’appui au personnel affecté à l’USC. Ceci dit, le RLISS de
Champlain sait fort bien que cette demande de fonds supplémentaires devra avoir
été approuvée avant de mettre en œuvre l’USC.
Il est entendu que les modes de
dotation en personnel pour les soins de longue durée actuellement proposés aux
résidents souffrant de troubles du comportement chroniques et graves imputables
à la démence sont inappropriés. Des fonds supplémentaires s’imposent donc si
l’on veut que la dotation en personnel atteigne des niveaux susceptibles de
garantir la prestation de soins de qualité et de répondre aux besoins de la population
et du personnel en matière de sécurité.
Ces fonds serviront également à
appuyer la formation spécialisée appropriée du personnel affecté à l’USC. Les
progrès et la formation dispensée selon les besoins sont nécessaires si l’on
veut assurer la réussite des employés qui sont affectés aux soins aux personnes
souffrant de graves troubles de comportement en raison de la complexité de
leurs besoins. Puisque l’on croyait souvent que les pavillons avaient été
construits tout particulièrement pour ce type de soins en 2001, ce milieu
thérapeutique spécialisé n’exigeait aucune dépense en immobilisations. Jusqu’à
présent, le budget de fonctionnement qui leur était réservé ne différait pas de
celui des foyers de soins de longue durée traditionnels. Bien que le milieu
physique présente des avantages en termes de prestation, le manque de capacités
en ressources humaines affectées aux soins des résidents souffrant de
comportements chroniques et graves imputables à la démence a créé des problèmes
sur le plan des soins et/ou de l’hébergement pour les résidents de toute la
région de Champlain.
IMPACT
Previously, a presentation was made by the ROMHC to
the Peter D. Clark LTC Home Family and Friends Council. In January 2012,
feedback regarding the creation of the BSU was sought by the Home’s
Administrator.
Background
The City of Ottawa Long Term Care Homes (LTC)
operate 717 long term care beds (15.3% of the long
term care beds in the Champlain LHIN). In 1998 the City of Ottawa and the
Alzheimer’s Society of Ottawa (ASO) joined forces to incorporate the footprint
of the Alzheimer’s Bungalows into the new Peter D. Clark Long Term Care Home.
The Ministry of Health Long Term Care (MoHLTC) had approved the additional beds
for the Bungalows with a vision of creating and evaluating a state-of-the-art
design and care programs for residents with persistent and severe behaviours
due to dementia as this was a significant gap in the care and housing
continuum. However, it must be noted
that there are individuals who challenge this stating that the vision was for
state of the art care and design for individuals with dementia, but not
necessarily for individuals with persistent and severe behaviours related to
advanced dementia.
Recently, the MoHLTC has initiated a province
wide strategy to develop Behavioural Support Service systems in each of the
LHIN areas. The Strategy is framed around three pillars and involves re-design
of the current system services in conjunction with an enhancement of resources.
The three pillars are:
DISCUSSION
The
creation of a BSU is an integral part of the Behavioural Support Plan for the
Champlain LHIN. It will be a specialized unit for individuals with persistent
and severe behaviours related to dementia. The Peter D. Clark Long Home is seen
as the logical location given its history and experience in caring for
individuals with dementia.
The
benefits are significant for the individuals, staff and for the health care
system as the BSU offers a care and housing opportunity for individuals with
persistent and severe behaviours related to dementia. The advance
and as required education, coupled with expert support, will enhance care
practices and the development of evidence informed programs. Additionally,
the unit staffing will be enhanced above the existing staffing model. These two
factors will foster improved care and safety.
Other
LTC Homes have not expressed interest and given the belief that the Peter D.
Clark Home was designed for individuals with these types of needs, the
expectation is that Peter D. Clark be the site for the BSU at no cost to the
City of Ottawa.
CHANGES REQUIRED to the
CHAMPLAIN LHIN and CCAC POLICIES REGARDING ADMISSION/DISCHARGE PROCEDURES
The residents who will be admitted to the BSU will likely come from the ROMHC Inpatient Psychiatry via another LTC Home. Some may come from acute care hospitals but all will have been assessed by the ROMHC team and have a care plan developed. The expectation is for residents to return to their LTC Home or, if that is not possible, to be admitted to the BSU for a period of likely 9-18 months. Thereafter, the intent would be for the resident to return to his/her original long term care home.
Currently the policy regarding admission and discharge procedures into LTC do not support the processes required for the establishment of this BSU. With over 600 people (in different priority categories) on the wait-list for Peter D. Clark, many people will have been waiting for some time yet residents who have not waited as long and require the care of the BSU, may be admitted before them. Similarly, in order to encourage throughput, discharge back to the LTC Home from which the resident came, will need to occur in a timely manner – someone will be waiting for that bed yet this resident will need to have priority access. Clearly there are issues for the Champlain LHIN and CCAC to sort through prior to implementation. City staff has made it clear that these issues will need to be addressed in written agreements or the BSU will not be supported in the Bungalows of the Peter D. Clark LTC Home.
Admission to the unit is based on eligibility criteria and it is open to all residents of the Champlain region.
Much feedback has been gathered via the Champlain LHIN. Should the City of Ottawa support the BSU at the Peter D. Clark Home, the decision will be shared with all families and residents living at the Bungalow via various mechanisms such as the Family and Friend’s Council, phone calls, face to face conversation and/or print material. The intent is to be transparent and open while understanding that the BSU is meeting a real need for residents with persistent and severe behaviour related to dementia. The admission process will necessitate some movement of residents who currently live at the Home from one room to another and it is important to ensure that families understand this as well.
The feedback received from the Family and Friends Council in January was
appreciative of the need to provide the best care possible for these
individuals with persistent and severe behavior associated with dementia;
however the following is a list of their concerns:
·
Other residents may not feel as safe given this population’s care needs.
·
There are concerns related to unpredictable aggressive behavior and the
impact on other residents.
·
They believe the Bungalows were not set up for this type of care in that
the common area is for all residents. A dedicated site is preferred versus a
unit in a LTC Home.
·
Staffing may not be adequate for resident care needs.
·
Much education and support from external partners will be required yet
it may not always be available.
The Champlain LHIN and health care partners are fully supportive of the
establishment of a BSU at the Peter D. Clark LTC Home as it is recognized as a
LTC leader in care of individuals with dementia in the Champlain region.
RESPONSE TO CONCERNS
The planning will include risk mitigation strategies and the additional
staffing and education should assist with the management of behavior. Furthermore,
some of the residents who would be appropriate for admission to the BSU are
current residents. As such, some of the resident population
will not likely change.
Each resident will have had an admission to the ROMHC Geriatric
Psychiatry Unit. The purpose of this is to ensure that behavior is manageable
and a care plan that can be followed in LTC is created. Furthermore, geriatric
psychiatry outreach will be available to assist with education and care plan
revision.
A dedicated site is not available and no other LTC Homes have expressed
an interest.
The staffing request must be fully funded by the Champlain LHIN or the
BSU will not be created in the Bungalows of the Peter D. Clark LTC Home.
All partners are committed to ensuring that the advance and as required
education is made available and staff is supported to attend.
Comments by the Ward Councillor
The Ward Councillor is aware of
the recommendation in this report.
LEGAL IMPLICATIONS
There are no legal impediments to the implementation of the
recommendation in this report.
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RISK |
TO WHOM |
MITIGATION |
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Admission and discharges will not occur in a timely manner. |
City of Ottawa Peter D. Clark LTC Home |
Request for process in writing prior to admissions starting. |
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Behaviour will not be effectively managed placing other residents at
higher risk than usual. |
Residents, Staff and City of Ottawa Peter D Clark LTC Home |
Commitment to advance education Commitment to in-time education including 24/7 support Admission to Inpatient Psychiatry and transfer to the BSU with a care
plan and outreach staff when required. Evaluation criteria are established, monitored and managed. |
FINANCIAL IMPLICATIONS
The Champlain LHIN is aware that full funding as
requested is required or the Peter D. Clark Home will not be able to proceed.
There should be no financial impact on the City’s financial resources. This is
seen as an excellent use of public dollars in that it addresses a gap in the
current system by targeting individuals who require a specialized care
environment in LTC.
ACCESSIBILITY IMPACTS
Residents with disabilities
may be admitted as per any other resident who meets the eligiblity criteria.
Technology
Implications
There are no technology implications associated with the recommendation in
this report.
Aligned with City of Ottawa
Long Term Care Homes mission to respond to the personal needs of residents to
deliver care and services in partnerhsip with families.
SUPPORTING
DOCUMENTATION
Document 1: Additional Resourcing for Peter D Clark: 12 bed BSU requiring $938,207 in funding from the Champlain LHIN.
DISPOSITION
Long Term Care is to take the
lead to implement the BSU pending confirmation of full funding from the
Champlain LHIN. Subject to successful
negotiation and implementation of the BSU, staff will report back to Committee
with a report to establish the 11 FTEs at the Peter D. Clark Long Term Care
Home. Operations Branch staff to
work with Legal Counsel in the City Clerk and Solicitor Department with respect to the preparation and execution of the two
agreements described in the report recommendation.
DOCUMENT 1
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Staffing
Requirements |
FTE Value |
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Funding |
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Registered Nurse - F/T |
1.00 |
98,557 |
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Registered Nurse - P/T (provides coveroff to
FT FTE) |
0.40 |
46,557 |
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RN Casual Pool |
0.18 |
18,352 |
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RPN (2 F/T) |
2.00 |
154,780 |
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RPN (2 P/T) @ .4 FTE |
0.80 |
68,388 |
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RPN Casual Pool |
0.36 |
33,449 |
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PSW (3 F/T) |
3.00 |
196,497 |
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PSW (3 P/T) @ .4 FTE |
1.20 |
85,779 |
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PSW Casual Pool |
0.54 |
35,323 |
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Activities Coordinator |
1.00 |
77,390 |
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Activities Coord Casual
Pool |
0.14 |
13,224 |
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Program Admin Clerk |
0.50 |
41,911 |
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Staffing Resourcing |
11.12 |
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870,207 |
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Non-Compensation Resourcing |
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Physician 8 Hrs Weekly |
48,000 |
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Supplies - Recreation |
20,000 |
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PROPOSAL TOTAL |
938,207 |
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