Behavioural Supports Ontario BSO Impact in Ontario and the CE LHIN

1. Behavioural Supports OntarioBSO Impact in Ontario and the CE LHIN Presented by: Linda Dacres, Program Director, Clinical Care Programs, CECCAC Katherine Jackson, Administrator, The Wynfield LTC 16th Annual Geriatric Mental Health Forum April 24, 2013

2. It’s nice to meet you! Let’s get to know each other • How many people here today have heard of BSO… • Are informed about BSO… • Are involved with BSO….

3. Agenda • BSO Overview • BSO Provincial Update • BSO in Central East • Strategy, Quality Improvement, Capacity Building, Sustainability, Evaluation, Lessons Learned • The Need for Change

4. Overview - Purpose and Target Population • Behavioural Supports Ontario (BSO) Project was created: • To enhance services for older people with complex behaviours wherever they live - at home, in long-term care or elsewhere • To develop and implement new models of care that focus on quality of care and quality of life • To promote new ways to manage behaviours • To provide standardized, consistent levels of care • BSO population: older people with responsive behaviours linked to cognitive impairments, people at risk of the same and their caregivers; providing them with the right care at the right time and in the right place.

5. Overview - BSO Framework • Pillar 1 – System Coordination and Management • Pillar 2 – Integrated Service Delivery: Intersectoral and Interdisciplinary • Pillar 3 – Knowledgeable care team and capacity building

6. BSO Provincial Update • LHINs are moving from implementation to sustainability • Sustainability Plans posted on all LHIN websites • Evidence that BSO is making a difference is accumulating • 14516people received comprehensive behaviours training • 59381 clients supported by BSO trained resources • 7018 clients assessed using common assessment toolkits • 601 tests of change (PDSAs) and service improvements • BSO is providing better care, better health and better value • Alzheimer Knowledge Exchange continues to provide the structure for support and communications

7. BSO in Central East - Strategy • Phased - start with LTC and then move to Community • LTCH Stream • Community Stream • Integrated Care Team to leverage current resources and expertise: • LTC Team – LTC staff and physicians; Psycho-Geriatric Resource Consultants (PRCs); NPSTAT (nurse practitioner led outreach to LTC); Geriatric Mental Health Outreach Teams (GMHOT), acute/tertiary care hospitals • Community Team – CCAC, Community Support Services; Primary Care, PRCs; GAIN (Geriatric Assessment and Implementation Network); Geriatric Mental Health Outreach Teams (GMHOT), acute/tertiary care hospitals

8. BSO in Central East – Quality Improvement • Quality Improvement philosophy: using small tests of change … • Focus Learn Spread Sustain • Benefits of Quality Improvement Approach: • client-focused • ensures stakeholder understanding • creates ‘buy-in’ • focused on quality of care and improved outcomes • excellent vehicle for knowledge exchange • provides value for money • guaranteed to work 

9. BSO in Central East – Quality Improvement • Developed multi-stakeholder value stream maps (VSM) for each of the five client streams Focus Learn

10. BSO in Central East – Capacity Building for LTCHs, Community Providers & Integrated Care Teams CE LHIN training February 2012 to March 2013 • Learn

11. BSO in Central East – LTC Commitment of LTC Early Adopter BSO Teams • Enhanced care for people living with behaviours (including evening hours) • Participation and leadership in quality improvement activities • 266 Plan-Do-Study-Act cycles completed • Knowledge transfer and spread to Phase 2 homes • Implementation Tables • Outreach visits with buddy homes • “Whatever is needed” to help Phase 2 homes implement BSO • Community of Practice events Spread Sustain

12. BSO Measures for Success • Reduced resident transfers from LTC to acute or specialized unit for behaviours • Delayed need for more intensive services, reducing admissions and risk of ALC • Reduced length of stay for persons in hospital who can be discharged to a Long Term Care Home with enhanced behavioural resources Learn

13. BSO in Central East - Highlights from EA LTC Metrics 2012-2013 • EA LTCHs have identified 1491 residents with a new or escalated behaviour through 2012/2013. • 886 Behavioral Assessments Tools (BAT) completed. Overall, a BAT has been completed for 59% of those residents with a new or escalated behaviour. • 905 residents with responsive behaviours received a change in treatment for a medical or physiological condition that triggered the behaviour. • 869 residents with a completed BAT received support from the Integrated Care Team; presumably, 98% of those with a completed BAT have received such support. • 50 transfers to ED for primary reason of responsive behaviours; this equals only 2% of population in CE LHIN EA Homes Learn

14. BSO in Central East – Early Successes Impact: • 886 residents assessed and served in 13 Early Adopter LTC homes in 2012-2013 • 1520 staff trained (2610 training days) • Behavioural Assessment Tool, Whiteboard, Client Care Process Flow utilized in 72% of Central East LTCHs • Community – draft design of Client Care Process Flow developed Client Stories: • Decrease of behavioural incidents in clients with responsive behaviours • Increased client cooperation with activities of daily care • Decrease in use of physical and pharmacological restraints to control behaviours • Admission of people with difficult behaviours from tertiary care settings and behavioural support units

15. Lessons Learned/Observations • Common tools, common training = common language for collaborative problem solving • Standard process and tools increase communication & collaboration • Defined Value Stream Process provides a context to utilize new knowledge • Visual process maps make it easy to learn the new process • Staff initiate interventions before behaviours escalate

16. Next Steps… • LTC Stream • Sustain gains in EA homes • Implementation Table teams will continue to provide leadership to spread BSO to all Central East LHIN LTCHs • Refinement of GMHOT engagement processes • Metrics collection and analysis for all CE LHIN LTCHs • Community Stream • Refinement of process, conducting small tests of change – PDSAs • Other Areas of Focus: • Refinement of transfer process to and from hospital for LTC and Community streams • Identify new leaders • Recruit and refresh membership of BSO Design Team and Evaluation Committee • Align with development and implementation of Regional Specialized Geriatric Service Entity

17. The Need for Change… • More and more people are at risk for responsive behaviours • Challenges are experienced across all health sectors and services • The patient and family require better quality experiences • There are significant costs associated with managing behaviours • Recognized best practices could be adopted more systematically • There is an opportunity to leverage existing initiatives in Ontario • Stakeholders are ready for change

18. For more information…. • http://www.centraleastlhin.on.ca/report_display.aspx?id=21366 BSO page on CE LHIN website • http://www.centraleastlhin.on.ca/page.aspx?id=23202 BSO hidden page on CE LHIN website • http://www.akeresourcecentre.org/BSO Alzheimer Knowledge Exchange BSO webpage