Kiwanis Care Centre (‘KCC’)

Francoise Laity, KCC Resident Care Coordinator francoise.laity@vch.ca

Sara Gilbert, KCC Manager sara.gilbert@vch.ca

Designing and Implementing an

Effective Behavioral

Support Unit -

Special Care Unit (SCU) Plus

Kiwanis Care Centre

Background

2009:

“Vancouver Community Project: Model of Care Framework for Vancouver Coastal Health’s SCU’s”.

Pilot:

Fairhaven (Vancouver): Chronic Behavior Residential Unit (CBRU)

2010:

Need identified for North Vancouver and other Coastal regions.

What is the SCU Plus?

Purpose: To serve individuals with moderate to severe cognitive impairment and who face behavioral challenges

What is different?

Environment

Staffing

Approach

Project Overview

Project Initiation - November 2010

Planning/monitoring:

Research/Lit Review

Communication

Construction / equipment

Human Resources (Staff Changes)

Staff Education

Admission process/criteria

Resident Transition

Project Implementation –

March 31, 2011 (1st admission)

Education

Entire Facility

Lunch and Learn Dementia: what is it and what does it mean to me?

Personhood: Look at Me

Communication

Making a Difference:

Safe Work Practices when working with Individuals with dementia

2 Day Dementia Series

Non Violence Crisis Intervention Training

Referrals

In the beginning:

Admission Criteria/Checklist

Prioritization Score tool

Review Panel

Tracking – non-ambulatory

Current

Revised process - streamlined

Kiwanis Care Centre SCU Plus Admission Checklist All items on the checklist must be completed (). Incomplete submissions will be returned. Please fax to Sophie Cole, Priority Access: 604-984-5806.

Resident Name: _________________ Facility Name: ______________Type of Bed currently residing: ________________ Paris or MSP #: _________________ Date of Checklist Completion: _________________________ Name and Phone # of person completing the checklist: _________________________________________________

Questions YES

()

NO

()

General:

1 What is the resident’s current level of care □ EC □ SCU □ IC3 □ Other (specify): _____________________ Please note, only IC residents will be considered at this time.

2 The facility has exhausted all external resources available (e.g. Older Adult Mental Health (‘OAMT’), Geriatric Psychiatry Outreach Team (‘GPOT’), Seniors CNS/CNE) to determine that the present residential care setting is not suitable. Please indicate what resources have been used:

3 The needs of the client can no longer be effectively or appropriately met with the available resources within their present residential care facility.

4 The resident is currently or in the last 6 months been living in a residential care facility, which has not been a successful setting. If the facility was not a successful setting please indicate the reasons why:

5 The resident is stable (In the prior 7 days he/she has NOT required 2 or more PRNs per day). Current status:

6 The resident is 60 years of age of older (if not, please indicate current age: ___)

7 The resident has been diagnosed with moderate to severe dementia. Relevant test scores must be provided. MMSE Score: ________. Please include a copy. Residents will not be considered unless scores are provided or if they do not have moderate to severe dementia.

8 The resident is physically strong and may cause harm to others.

9 The resident has a chronic mental illness

10 The resident is currently acutely ill (medically or acute psychosis or suicidal ideation)

11 The resident has a brain injury

12 The resident has an ongoing problem of alcohol or drug addiction that is NOT manageable with the supportive interventions

13 The resident is medically complex. If yes, please describe:

14 Medication compliance. Describe:

15 Outings: Supervised/Unsupervised. Circle most appropriate. Describe:

Documentation:

16 The resident has had a recent (in the last 4 weeks) Geriatric Psychiatrist and/or Geriatrician assessment. If no, please indicate when the last assessment was completed:

17 The resident has a care plan that contains detailed descriptions of behavioral approaches that have been successful (key phrases, distractions, 24 hr routines, triggers to challenging behavior).

Behaviors: Please indicate if the resident has displayed the following behaviors in the last 3 months:

18 Socially inappropriate and/or offensive behavior (provide details):

19 Aggressive: Abusive or intimidating behavior. It may be verbal like yelling or swearing at people or it may be directed at physical things like hitting or breaking objects. It is not physically directed at a person[s]).

20 Violent: includes threatening to, attempting to, or actually physically harming someone (directed at a person[s])

21 Extreme resistance to personal care

22 Persistent exit seeking or history of elopement

23 Poor impulse control, and/or poor insight

24 The resident displays dangerously destructive or aggressive behavior which puts others at risk (provide details):

Environment/Care Planning

Social Worker/Resident Care Coordinator admission triage

RCC Visit

Care plan development

Partnerships:

Geripsychiatrist, OAMH, CNS, Priority Access, LGH (acute)

Medication review

Outcomes

Since initiation, only 1 hospital admit due to responsive behavior

Flow at KCC

Length of Stay

Affect on SCU (regular) wait time

Accreditation recognition (2011):

Kiwanis Care Centre staff and the seniors' team are commended for implementing a comprehensive new program including a secure yet home like environment for residents and extensive education and training for staff.

Lessons Learned

Project lessons

Communication, communication, communication

Staff implementation

Unit lessons:

Review panel

Staffing

Medication organization

Questions