holistic approach to admission

Three Parts of the Equation

A holistic approach to admission in Long-Term Care

Disclosure Statement

• I am a Registered Clinical Counsellor in private practice.

• I was hired by Fraserview Care Lodge to design and implement the program.

• I currently have a contract with Fraserview. • Limitation to evaluation of the project: limited

number of control group participants.

Context

• An admission support program was developed at Fraserview Intermediate Care Lodge.

• The program was developed as a response to feedback from families.

• The program piloted in September 2012. • The program is now a regular part of every

admission at Fraserview.

Problem

What is Admission to Long-Term Care?

Family

Caregiver stress is not automatically relievedGrief and lossGuiltUnknownConflict

Resident

Relocation Stress SyndromeLoss of identity Loss of independenceFamily conflictPhysical decline Loss of life as they know it

Staff

StressFeeling of incompetenceInability to meet complex needs of families

and ResidentsLack of time and resourcesIncreased risk for errors and

miscommunication

Facility

Increased likelihood of complaints “Unreasonable” requests and complaints from

familiesTime away from direct care Staff stress and burnoutErrors and incidents

Intervention

Working with all three parts of equation. Counselling professional with long-term care background (LPN).

Intervention

Resident• Assessment of needs• Counselling to address relocation stress• Education to address unknown• Follow up• “Friendly face”

Intervention

Family • Utilize family as a “hidden workforce”. • Education to address unknown. • Counselling to address crisis.• Integration. • Follow-up

Intervention

Staff• Communication training• Admission support training• Collaboration and coaching • Support

Results

Outcome measures:Family surveyStaff survey Management survey

Results

• Truly person and family-centered care. • More time for direct care duties. • Families trust that facility provides the best care

for their loved ones. • No complaints from families. • Residents adjust faster. • Staff are prepared and confident about admissions. • Commandments from Accreditation Canada.

Comments from Residents and Families

• “Very understanding and helpful”

• “Initial orientation and regular updates were helpful”

• “Alleviating my stress with counselling sessions”

• “We did not have this program at the other facility. It makes a huge difference in how quickly and easily my mother

and my family are adjusting to this facility”

• “The contact with Karyna was helpful”

• “Karyna was a life savior for me in helping address mom’s questions”

Comments from Staff and Management

• “I believe the program is efficient, personal, and as problem-free as

possible.”

• “It makes my life much easier. Residents and families are much more

relaxed and supported through the process”.

• “It is very helpful for us to receive information about new Residents before

they come in. It helps us provide person-centered care.”

• “I never worry about new admissions anymore”.

Comments from Staff and Management

• “Hospital information is often outdated or incomplete. It really helps

for us to get up-to-date, complete information before admission”.

• “Family members appear a lot more calm and relaxed. They do not

come to the nurses’ station with endless questions”

• “Residents and families trust us more”

• “It is great to have someone to advocate for the residents”

Challenges

• It was challenging to convince medical staff that psychological needs are important.

• Establishing a new practice.

Challenges addressed by:

Staff education:- Communication Bootcamp- Transforming Admissions- Person-centered interventions for difficult behaviors3 Cs:- Communication- Collaboration- Compromise