Improving care and reducing hospitalizations for people with dementia and responsive behaviours
Location: Baycrest, Toronto, ON
A virtual program to assess and treat people with challenging behaviours caused by dementia and related cognitive disorders is helping long-term care homes, as well as hospitals and family caregivers, to provide better care for people living with dementia.
Launched in April 2020, the Virtual Behavioural Medicine (VBM) Program is a collaboration between the Sam and Ida Ross Memory Clinic at Baycrest and the Toronto Central Behavioural Support for Seniors Program housed at Baycrest, which sees patients through virtual visits over the secure Ontario Telemedicine Network rather than in person.
Individuals with challenging responsive behaviours, such as physical and verbal aggression, agitation, hallucinations and paranoia, receive pharmacological and nonpharmacological interventions to mitigate their behaviours.
Among the benefits of the VBM Program is that its team of specialists – including neurologists, a nurse, a social worker, a pharmacist and the BSO team – can provide a rapid response where and when they are needed. They work with care teams in long-term care homes, as well as with acute care hospitals and family members in the community, to help them develop and implement care plans, access behavioural and social supports, and provide follow-up.
Analysis shows that before a consult with the VBM program, 96% of people were in clear need of admission to a specialized neurobehavioural unit. After implementing the program, only 38% needed inpatient care.
Two stories from long-term care homes show the significant impact of the program.
The Apotex Centre, Jewish Home for the Aged, had a new admission with behavioural symptoms of extreme aggression, both verbal and physical. The individual needed security and extra staff 24 hours a day. A referral was made to Dr. Morris Freedman, Head, Division of Neurology, Baycrest, who explained that he could assess the resident without seeing them in person. There was no need to transfer them to an in-patient unit.
Behaviours improved with the VBM’s two-pronged intervention approach. “Dr. Freedman came on board along with the Long-Term Care Behavioural Support Outreach Team,” said Shitu Wang, the Behavioural Supports Resources Team Lead at the home. “It took two months of sustained work with our team using medications and nonpharmacological interventions identified by the Behaviour Support Team. The results were especially positive with conversations and activities all done virtually.”
When the Downsview Long-Term Care Centre in Toronto referred a resident with physical aggression to the VBM Program, there were similar results. The resident was quickly assessed, and the program worked collaboratively with their interdisciplinary team to develop and implement effective strategies to stabilize their condition. Following this, the resident no longer required one-to-one monitoring. “It’s like having a virtual Behavioural Neurology in-patient unit in each location,” says Dr. Freedman. “And just like on an in-patient unit, we have weekly rounds to review patients as a team.”
The VBM program has also implemented bi-weekly case review rounds involving the whole team to look at each case and ensure that any gaps are filled, all available resources are optimized, and a transitional plan and supports are in place for a person’s discharge from the program.
A physician referral is necessary to access the VBM program. Referrals are processed through the TC-LHIN Behaviour Support Hotline at Baycrest. Health care practitioners requiring support can contact the BSO Hotline seven days a week, from 8:30 a.m. to 4:30 p.m., including weekends and holidays, to be connected to support as well as to the VBM program as needed.
Read the Baycrest website to learn more.