The power of innovation

A letter from the Winnipeg Health Region

Winnipeg Health Region President & CEO
Wave, January / February 2012

Arlene Wilgosh

It is, without a doubt, a heartbreaking scenario.

Someone in the family, perhaps a mother or a father, is diagnosed with Alzheimer's disease or dementia. At first, an effort is made to care for them at home, the hope being that they might be more comfortable in familiar surroundings.

Eventually, though, it becomes clear that the family member in question needs the kind of care that is often only available in a personal care home.

This story is playing out with growing frequency within the Winnipeg Health Region. At any given time, there are about 6,000 people living in 39 personal care homes throughout the city. A good number of the residents in these homes will have Alzheimer's or dementia.

The families of these residents depend on staff working in these homes, whether they are owned and operated by the Region or by our partners in the private sector, to take good care of their loved ones. Of course, taking care of someone so vulnerable is a tremendous responsibility, one that comes with challenges as well as rewards.

I had an opportunity to learn about some of these challenges years ago while serving as Director of Patient Care Services at Kildonan Personal Care Home. At the time, we had a number of residents who required special attention as a result of having Alzheimer's or dementia.

As our story on page 24 of this issue of Wave explains, providing care for these residents is not always easy. Many residents exhibit what healthcare providers refer to as "challenging behaviours." As the story notes, "They're often confused, disoriented and anxious. Some of these residents may even act aggressively, putting themselves, staff and others at risk."

Personal care home staff throughout North America will use different approaches in caring for residents like these. Occasionally, they may turn to antipsychotic drugs, such as risperidone and quetiapine, to calm an agitated resident. This is not the preferred approach. Although medication is only used in personal care homes on doctor's orders, health-care professionals know it poses problems. For one thing, antipsychotic drugs can have side-effects, such as increased risk for heart attack and stroke. Clearly, this may not be good for the resident.

Of course, this still leaves us with a pretty fundamental question: If medication is not the answer, what is? How can we as a Region help those working in personal care homes provide better care to residents suffering from Alzheimer's or dementia?

Fortunately, I think we may have at least part of the answer to that question here in Winnipeg, thanks to some research done by Cynthia Sinclair and Joe Puchniak.

As senior administrators in the Region's Personal Care Home Program, Sinclair and Puchniak have long been interested in finding ways to enhance care for personal care home residents. And so, just over a year ago, they embarked on a research project designed to examine the use of medication at personal care homes and whether it could be reduced.

Key to the project was their ability to mine the Region's Minimum Data Set, or MDS. Updated four times a year, this database provides information about residents ranging from the type of medication they are on to their level of cognitive function.

In reviewing the data, Sinclair and Puchniak found that some personal care homes in the Region had a higher percentage of residents on medication than others. Their research also revealed that some programs, including one called P.I.E.C.E.S, were useful in helping to reduce the use of medication among personal care home residents.

P.I.E.C.E.S is a relatively new model of care, one that it is being implemented throughout the Region. It doesn't eliminate the need for medication, but it does empower caregivers to be more creative in caring for residents, thereby increasing the likelihood that medication will be used only as a last resort.

As our story explains, Sinclair and Puchniak put their research to the test at Middlechurch Home, which was interested in reducing medication usage among its residents. Working with senior staff members, Sinclair and Puchniak developed a variation of the P.I.E.C.E.S model for Middlechurch and organized training workshops for staff at the home.

The results have been very positive. Over a six-month period, antipsychotic drug use dropped by more than 20 per cent among Middlechurch residents who were on the medication when the project began. The work done by Sinclair and Puchniak has important implications for the delivery of care to residents in personal care homes, in Winnipeg and throughout the country. As Canada's population ages, the number of people who have Alzheimer's or dementia will continue to grow. It is incumbent upon all of us working within the health-care system to make sure we do everything we can to provide quality care as efficiently as possible.

Achieving that goal will not be easy; it will depend in large measure on approaches of the kind taken by Sinclair and Puchniak. By crunching the numbers, they were able to come up with a new formula to deliver better care. That is the power of innovation - something we must harness in all areas of health care.

As a result of the work done by Sinclair and Puchniak, staff at Middlechurch were empowered to develop a new approach to caring for those with degenerative illnesses such as Alzheimer's and dementia, one that has led to a better quality of life for residents. In doing so, they have lived up to the expectations of families who have placed loved ones in their care. For those working on the front lines of health care, there is nothing more rewarding than that.

Wave: January / February 2012

About Wave

Wave is published six times a year by the Winnipeg Health Region in cooperation with the Winnipeg Free Press. It is available at newsstands, hospitals and clinics throughout Winnipeg, as well as McNally Robinson Books.

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