Inside Extendicare’s Behavioural Support Transitional Units

Community Feel

The specialized units are located at Extendicare Rouge Valley, a long-term care home in Scarborough, Ontario, with a 32-bed BSTU, and a 28-bed BSTU at Extendicare McGarrell Place in London, Ontario.

The BSTU hallways are painted with calming colours. At Extendicare Rouge Valley, beautiful murals of nature landscapes and city scenes have been intentionally designed to make the unit feel less clinical and more like a neighbourhood or community.

For example. Toronto landmarks such as the CN Tower are painted on the walls and TTC “bus stops” serve as resting places for residents. Other murals in the BSTU include a dining room or 1950s-style kitchen, which may look familiar to residents. There are also interactive elements on the unit, such as sensory boards that offer sounds and textures to engage residents.

28-bed BSTU at Extendicare McGarrell Place in London, Ontario.

The BSTU hallways are painted with calming colours. At Extendicare Rouge Valley, beautiful murals of nature landscapes and city scenes have been intentionally designed to make the unit feel less clinical and more like a neighbourhood or community.

For example. Toronto landmarks such as the CN Tower are painted on the walls and TTC “bus stops” serve as resting places for residents. Other murals in the BSTU include a dining room or 1950s-style kitchen, which may look familiar to residents. There are also interactive elements on the unit, such as sensory boards that offer sounds and textures to engage residents.

Residents living with dementia who display complex behavioural needs are cared for by interdisciplinary teams of highly skilled health professionals, including a geriatric psychiatrist, geriatric mental health outreach clinicians, registered nurses, nurse practitioners, social workers, personal support workers, activity aides and physicians.

In partnership with each resident’s family and caregivers, the teams delve deep to learn about each resident’s story and their behavioural patterns.

They use this information to develop individualized care plans that recognize their personhood, help alleviate responsive behaviours and create a daily roadmap for quality of life.

“Residents in our units aren’t defined by their behaviours. We see them for everything that influences who they are – their rich life experiences, their cultural backgrounds, their families and their beliefs. We find ways to leverage these elements into their care plans so it’s more meaningful to them.” says Simpson.

New Actions

Extendicare’s work with the BSTUs has informed a suite of new actions to enable person-centred care. There are 10 tools utilized at the Rouge Valley BSTU, including a “WOW & Now Personhood Tool.”

Inspired by the educational resources of DementiAbility and Behavioural Supports Ontario’s (BSO) My Personhood Summary©, the WOW part of the tool encourages the caregiver to capture who the resident is and information about their lived experience, such as where they grew up, their cultural, religious and spiritual backgrounds and family history, their interests and other details that make them who they are. This information empowers team members to tailor their engagements with each resident to enhance their quality of interactions.

The “Now” part of the tool encourages team members to draw upon care interventions they can enact, – immediately, to provide comfort in the current moment for the resident. The “Now” interventions are based on Gentle Persuasive Approaches (GPA®) education provided to all team members in the BSTU to ensure person-centred care is at the core of all resident interactions.

BSTU teams use the tool to guide the care they provide throughout each resident’s stay with the unit from acceptance to discharge. They also provide the WOW & Now reports to the resident’s next destination to help inform future care teams on how to provide individualized care unique to the resident and their family.

“WOW & Now is a tool to enable us to better know the resident’s unique story and the individualized ways we can provide specific care for behaviours – right at our fingertips during the point of care,” says Zaynab Sheraly, Geriatric Mental Health

Outreach Team Nurse with the Scarborough Health Network, who supports residents at Extendicare Rouge Valley’s BSTU. Collaborations and partnerships across the health care system can help provide support from an interdisciplinary team with expertise in dementia care and mental health.

Examples of Care

In one example, the personalized care a resident received at Extendicare Rouge Valley’s BSTU enabled him to move back home with his family and reconnect with his wife. Prior to admission to the unit, the family were unable to care for him due to verbal and physical responsive behaviours related to dementia. The care plan developed by the BSTU team and WOW & Now tool delivered ways for the family to better manage these behaviours.

Practical adjustments to day-to-day life included structured daily routines, specific activities tailored to their loved one’s interests, and modifications to the home environment to help avoid responsive behaviours. For example, this included moving the individual from their wheelchair to another location when behavioural triggers were observed.

Providing personal care to the resident had previously been a challenge, but distractive techniques, such as holding the resident’s hand and speaking to them in their language from childhood, were a simple strategy that helped eliminate responsive behaviours during these times.

The family reported the resident returned home with improved mood, increased engagement in activities, better sleep patterns and reduced agitation. They now keep a copy of the “WOW & Now” tool on the wall beside their loved one’s bed to help visiting personal support workers individualize the home care they provide.

In another example, a resident was admitted to the BSTU because the team in the long-term care home were finding that escalating verbal and physical responsive behaviours made it challenging to deliver care.

After a comprehensive resident assessment in the BSTU, the team started a plan to provide more person- centred care and gradually reduce use of medications. This included conversation starters about the resident’s native country provided to staff in the resident’s WOW & Now,” which promoted a greater sense of calm. She also became less agitated when holding familiar objects that seemed to evoke memories of her own personal and cultural experiences.

Other person-centred activities for this resident included playing music that she enjoyed, in addition to sensory supports such as hand massages, aromatherapy, outdoor visits, and speaking in calming and reassuring tones.

Following implementation of these care interventions, the resident’s comfort levels stabilized, and medication use was able to be carefully tapered. With this new daily care roadmap, she was able transition back to a mainstream long-term care environment.

With person-centred care, residents are often comforted by engaging in actions that are related to past careers, activities or sports. By learning what is familiar and meaningful to residents. the BSTU teams at Extendicare unlock key elements in this specialized dementia care that can make a world of difference to residents and their loved ones.