Intervention program reduces difficult behaviours in seniors with dementia


Lanore MacKenzie (right) and daughter Jayne Patrick set out for a walk at Wellington Terrace Long Term Care Home in Fergus. A new program is helping reduce troublesome behaviour by residents with cognitive impairment and MacKenzie was helped through the program.

This article concludes with a few resources for people living in the Waterloo/Tri-Cities area.  If you live in or around Waterloo Ontario and are interested in connecting you or someone under your care with support, please click here to read this article on the Waterloo Record website.

WATERLOO REGION — When Lanore MacKenzie sits down with a few books to read aloud, the 93-year-old and her audience at a Fergus long-term care home couldn’t be happier.

“She reads short stories and they love it and she loves it,” said her daughter Jayne Patrick. “They’re just so calm and they sit and listen.”

The activity is simple, but the calm it brings to her neighbourhood in Wellington Terrace is palpable.

This article was published by The Waterloo Record on August 6th, 2013.  To see this article and other related articles on The Waterloo Record website, please click here  


A specially trained staff member there came up with the idea to have MacKenzie read to a group because the senior is very social and wants to be the centre of attention, but doesn’t always realize when she bothers other residents by getting in their personal space.

With a book in hand, any of that discord disappeared.

“It was just so peaceful and calm,” said Joanne Badder, the personal support worker trained through Behavioural Supports Ontario who thought of the reading sessions.

Behavioural Supports Ontario is a provincial initiative aimed to help people with challenging and complex behaviours wherever they live to improve their well-being and safety, as well as their caregivers and peers.

The local implementation is unique from most other regional health networks in the province, training staff in long-term care homes along with a community team. The approach is seeing great success and now other regions are looking to adopt it.

According to a recent report to the Waterloo Wellington Local Health Integration Network board, the program helped 718 clients in the in the final quarter of the 2012 and 2013 fiscal year — ranking first in the province for clients served. Among them there was an 85 per cent reduction in responsive behaviours, which are challenging behaviours common among people with dementia that are triggered by something in their environment.

“It’s like a puzzle,” explained Jane McKinnon Wilson, Waterloo Wellington Geriatric systems co-ordinator.

Often the behaviour is connected to something the person experienced in life. Looking for patterns in the behaviour and then learning about the person’s history, often helped by family to fill in details, can reveal the trigger.

“Usually you can start to match the puzzle pieces together,” McKinnon Wilson said.

For example, a woman becomes agitated at a certain time of the day and it’s discovered that she had a large family and that’s when she would start preparing for her children to return home from school. Giving her a purposeful activity at that time cuts down on the agitation.

“It’s exciting because of the success that we’ve seen,” said Kathy Tschirhart, program lead and vice-president clinical services at St. Joseph’s Health Centre in Guelph. “You can really see such positive outcomes.”

There has also been a drop in transfers from long-term care to emergency departments for mental health concerns, often sparked by exhausted caregivers who didn’t know how to handle the difficult behaviours. Admissions were cut in half in a year — from 54 transfers in 2011/12 to 28 in 2012/13.

Most health networks hired people in the community to go into long-term care homes when needed, but here they decided to train staff in the homes because that’s what they recommended.

“The needs we have in long-term care, they’re immediate,” Tschirhart said.

Teams in the area’s 35 long-term care centres include a nurse or practical nurse and a personal support worker.

The community mobile team includes three social workers, recreation therapist and occupational therapist. They go into homes and hospitals as well as helping with the transition into long-term care or other programs.

They develop individual plans for a senior that can help families handle difficult behaviour or even prevent it, and avoid long stays in hospital or early move into long-term care — with the ultimate goal to keep people at home as long as possible.

Long-term care centres were eager to get their own specially trained staff since they felt best equipped because they know all the residents well and are there every day to spot the first signs of behaviour changes.

“We’re actually delighted that they took this approach,” Peg Muhlbauer, Wellington Terrace’s director of care. “We know our residents best.”

The centre’s trained people also share their expertise with staff in all departments, from nursing to housekeeping staff, to spot responsive behaviours and suggest ideas to relieve them.

“The whole team needs to know how to help our cognitive-impaired residents,” said nurse team leader Mary Lou Bolen. “All behaviour has meaning.”

Badder looks closely at the person and their behaviour for the clue to the cause. It could be linked to their younger life, boredom, pain or illness. Maybe even staff are unknowingly causing the distress.

Badder’s partner, a practical nurse, does a medical assessment to see if any health conditions are sparking the behaviours. Funding from the province that’s earmarked for Behavioural Supports Ontario gives them the time to devote to sleuthing causes and then coming up with a “tool box” for staff to avoid triggers with that resident.

“We try to prevent these before they happen,” Badder said.

Doing that avoids the need for medication and restraints. Not only is the individual resident helped, but also others in the home and staff because one responsive behaviour often incites others and creates a chaotic atmosphere.

“It’s rewarding for the staff,” McKinnon Wilson said. “I think they’ve always known if they had the time they could help with these responsive behaviours.”

Badder meets with new residents every day for two weeks to get them settled and look for any behaviours that could be minimized with the right intervention. That varies from person to person, even from day to day.

Sometimes a senior can only tolerate 10 minutes of activity a day and just needs a small task to make the day enjoyable. Others like to keep busy, helping out with chores around the home that they would have done at home, such as tidying the dining room or gardening.

Badder works closely with the recreation department to come up with activities, both for groups and individual pursuits.

“You’ve got to really know your resident to know what is meaningful,” she said.

The trained staff have a caseload of residents they’re working with, identified by staff as someone who would benefit. Tschirhart said in many cases the intervention is so successful that a resident can be discharged from the program because “they have the plan and the plan is working.”

Jayne Patrick thinks the reading idea is amazing and is pleased her mother, who is quite physically able but has dementia connected to a head injury from a car crash years ago, is being kept busy with various activities.

“Anything like that keeps her sharper,” Patrick said. “It’s nice to know that she’s got something to do.”

© The Waterloo Record