Evaluating the Seniors Mental Health Policy Lens

1. Evaluating the Seniors Mental Health Policy Lens Newfoundland and Labrador

2. Context • One of 4 provincial health regions. • Merger of 3 former health boards governing health and community services. • Large geographical area with a low population density and many small coastal communities. • Rural areas are expected to age at faster rate due to out migration, migration to urban centers and lower birth rates.

3. HEALTH REGIONS

4. Long Term Care • Personal Care Homes: 890 beds in 26 facilities. • Facility Based Care: 517 beds in 11 facilities. • Admissions coordinated through a “Single Entry Process”.

5. First Available Options Policy • Status: Draft Form • Purpose: Facilitates client care in the most appropriate setting • Overview: Affects clients who are medically discharged or awaiting discharge and assessed as appropriate for LTC. When a first placement choice is not available an individual is required to “accept an alternative placement until the desired choice becomes available”.

6. First Available Options Policy Main Benefits: Client: Ensures clients receive the best possible care, in the most appropriate setting, in a timely fashion. System: Ensures efficient and effective utilization of resources and ensures acute care resources are available. Potential Costs: • Geographical separation from family and social networks and related adjustment factors. • Feelings of having lack of control in process/destiny.

7. Applying the Lens Exercise • Who was involved? • Provincial Mental Health Consultants (2) • Manager of Residential Services • Process: • Draft policy and SMHP lens circulated prior to exercise. • Round table review of policy using the lens • Feedback provided which will enable further revisions of the policy and the development accompanying practice guidelines and procedures.

8. What we learned: • Collaboration between MH consultants and LTC was very helpful. Different perspectives enriched the process. • Allowed for a thorough, client centered analysis of the policy. • Allowed for reconsideration of policy development process factors. • Identified the need to develop accompanying procedures to ensure a client centered and respectful approach.

9. What we learned • Importance of involving key stakeholders (i.e. seniors and caregivers) very early in the process of policy development. • Semantic presentation has a strong impact on how a policy is interpreted. • Need to explain the rationale for the policy and the benefits to the senior (very important as policy statement will be provided to clients, family members &/or substitute decision makers).

10. What We Learned, con’t: • Identified gaps in information and the need to provide more detail (i.e. special considerations, diversity issues). • In the case of this policy negative impacts on mental health are possible, however, measures can be taken to address how such impacts can be mitigated and lessened. • Overall, a very useful tool!

11. What happened as a result? • Will change the language. • Will give more consideration to implementation process and who needs to be involved (consumer, family member and health care team). • Will develop accompanying procedures and practice guidelines for implementation of policy (i.e. process for informing patient/family). • Will apply the lens to future LTC policy development and use to evaluate the policy over time.