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TRANSCRIPT
The Senior Friendly Care Framework
October 2017
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Contents 1. Introduction ............................................................................................................................ 3
How to use this document .................................................................................................. 3
Purpose and Scope of the Framework ................................................................................ 3
2. Background ............................................................................................................................. 4
Evolution from Senior Friendly Hospital to sfCare ............................................................. 4
Relevance to the World Health Organization’s Age-Friendly City Framework .................. 4
3. The Framework Development Process ................................................................................... 5
4. The Senior Friendly Care Framework ..................................................................................... 6
The 7 Guiding Principles at the Core of the Framework..................................................... 7
The 5 Domains and 31 Defining Statements of the Framework ........................................ 7
5. Next Phases of Work ............................................................................................................... 9
Appendix A – Glossary of Terms ................................................................................................... 10
Appendix B – SFH Provincial Strategy ........................................................................................... 11
Appendix C – SFH Framework ....................................................................................................... 12
Appendix D – Project Team .......................................................................................................... 13
Appendix E – Literature Review Process ...................................................................................... 14
Appendix F – Expert Delphi Panel ................................................................................................. 15
Appendix G – References .............................................................................................................. 17
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1. Introduction The Regional Geriatric Program (RGP) of Toronto, in collaboration with provincial stakeholders, has developed a Senior Friendly Care (sfCare) Framework. The Framework development began in April 2016, and culminated with its launch in October 2017. The development of the framework was guided by a Steering Committee and an Expert Panel, and benefited from the input of hundreds of older adults and their caregivers and care providers. The goal of senior friendly care is to achieve the best possible health outcomes for older adults. The sfCare Framework provides the foundation for achieving this goal through guiding principles and defining statements which are intended to foster improvements in care across the system and inspire greater collaboration between older adults and their caregivers, care providers, and organizations.
How to use this document This document introduces the sfCare Framework, and its context by providing highlights of the development process as well as a preview of the next phase of work which will facilitate implementation. Administrators and care providers in healthcare organizations across the continuum (hospitals, long term care, primary care, and community care) are encouraged to reflect on the current structures they have in place for the care of older adults, and how they align with the Framework. Older adults and their caregivers are encouraged to reflect on the care they receive, and how it aligns with the principles and statements in the Framework. While most readers will be familiar with the terminology used in the framework, a few select terms have been included in the glossary for those seeking clarification. See Appendix A – Glossary of Terms.
Purpose and Scope of the Framework The sfCare Framework comprises seven guiding principles, and five domains encompassing 31 defining statements. It is intended to serve as a blueprint for what senior friendly care should look like across the healthcare system. The principles and statements are intentionally broad. The framework will provide the foundation for the development of implementation tools and resources that will focus on providing collaborative senior friendly care, wherever care is needed. Use of the terms “older adult” and their “caregivers” in the Framework The framework applies to all older adults, especially those with frailty. For the purpose of this framework, an older adult is considered to be 65 years or older, with the understanding that adults with complex age-related conditions may be younger than this and also benefit from senior friendly care. Caregivers are people who are involved in an older adult’s care, but who are not paid, such as family or friends. Older adults are partners in care, as are their caregivers, when identified as such by the older adult. In the context of this Framework, caregivers and family are assumed to be included in all of the statements, where applicable.
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Use of the terms “care provider” and “care” in the Framework The framework applies to care providers, who are paid to provide healthcare as well as to volunteers. This includes clinical professionals and non-clinical service providers. Care includes care and services provided in all healthcare settings by care providers, caregivers, and those providing non-clinical services (for example, appointment scheduling or meal delivery). In the context of the Framework, it is assumed that the older adult is a partner in care, and that something is not being done to or for them, but rather with them.
2. Background Evolution from Senior Friendly Hospital to sfCare The sfCare Framework builds upon several years of work focused on senior friendly hospital (SFH) care. This work includes two province-wide environmental scans, the identification of clinical priorities and a complex knowledge-to-practice intervention and provincial collaborative – SFH ACTION (Accelerating Change together in Ontario) - involving 87 hospitals. The Senior Friendly Care (sfCare) Framework is an evolution of the Senior Friendly Hospital (SFH) Framework (2004), which has proven to be very valuable in stimulating change in hospitals to improve care for older adults. Building on this success, the framework has been re-envisioned as one that will be applicable wherever healthcare is delivered, not just in hospitals. See Appendix B – SFH Provincial Strategy and Appendix C – SFH Framework for more details. Relevance to the World Health Organization’s Age-Friendly City Framework Our vision for sfCare is aligned with the World Health Organization’s (WHO’s) Age-Friendly City Framework, with a focus on the “community support and health services” domain. This focus guided our literature review and qualitative data analysis.
Figure 1 The WHO's Age-Friendly City Framework
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3. The Framework Development Process The framework development included a literature search, qualitative data analysis, and a modified Delphi process. Work was guided by a Steering Committee and an Expert Panel, and hundreds of stakeholders were engaged to provide input. See Appendix D – Project Team for details about the team who led this work. Literature Review Process A literature search was conducted for published articles and grey literature reports related to care frameworks or the organization of healthcare systems for older adults. The search was limited to articles published between 1990 and 2016, written in English, and those with an available abstract. Articles were excluded if they were not related to healthcare, or if they were randomized controlled trials of interventions, demographic studies, or an assessment of risk factors. Two team members independently reviewed the abstracts and articles, where necessary to reach consensus on the inclusion of 57 published articles and 25 reports from the grey literature. See Appendix E – Literature Review Process and Appendix G – References for more details. Qualitative Data Analysis Two reviewers used the five domains of the Senior Friendly Hospital (SFH) Framework as a priori framework to code the content of the articles for themes related to senior friendly care. The coded content was then sorted into themes. The thematic analysis validated existing themes in the original SFH framework, and identified 16 new ones. A coding key was used for clustering the themes into the domains. Statements were then drafted for each domain. A third reviewer participated in further clustering of themes for consistency as well as in the drafting of statements.
Figure 2 Qualitative Analysis Process
Expert Panel Delphi Consensus Defining statements and guiding principles were incorporated into a modified Delphi consensus process and underwent four rounds of review and revision by the Expert Panel. The 30-member Expert Panel was selected through the Steering Committee to represent the breadth and diversity of health care practice and geographic regions of Ontario. See Appendix F – Expert Panel Delphi for panel members.
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Stakeholder Engagement Older adults, their caregivers, and healthcare providers were engaged throughout the development process. Strategic opportunities for input were provided as follows: On the guiding principles at two seniors fairs, and at the SFH ACTION showcase event
(attended by over 400 people) On the draft framework and its implementation, through: email distribution, social
media, newsletters, and on the RGP of Toronto website, and through in person engagement with two community-based patient and family advisory councils.
4. The Senior Friendly Care Framework The sfCare Framework comprises seven guiding principles, and five domains encompassing 31 defining statements.
Figure 3 The Senior Friendly Care Framework
NOTE – A larger, printable version of the framework can be found on the last page of this document
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The 7 Guiding Principles at the Core of the Framework During the development process, it became clear that there were important overarching fundamentals which should be applied across the domains. As a result, seven guiding principles were identified.
Figure 4 The 7 Guiding Principles
The 5 Domains and 31 Defining Statements of the Framework The framework comprises 5 domains encompassing 31 defining statements.
Organizational Support
1. Senior friendly care is an organizational priority
2. At least one leader in the organization is responsible for senior friendly care
3. There is organizational commitment to recruit and develop human resources with the knowledge, skills, and attitude needed to care for older adults
4. The values and principles of senior friendly care are evident in all relevant organizational policies and procedures
5. The organization has a senior friendly policy that values and promotes older adults’ health, dignity and participation in care
6. The organization demonstrates commitment to all domains of the Senior Friendly Care Framework - organizational support, processes of care, emotional and behavioural environment, ethics in clinical care and research, and the physical environment
7. The organization collaborates with system partners to meet the needs of older adults
8. The organization implements standards and monitors indicators relevant to the care of older adults
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Processes of Care
9. Assessment is holistic and identifies opportunities to optimize the physical, psychological, functional, and social abilities of older adults
10. Care addresses the physical, psychological, functional, and social needs of older adults
11. Care is guided by evidence-informed practice
12. An interprofessional model of care is preferred especially when older adults are frail
13. Care is integrated and provides continuity especially during transitions
14. Goals of care may include recovery from illness, maintenance of functional ability and preservation of the highest quality of life as defined by the individual
15. Older adults are partners with the care team
16. Care is flexible and aligned with an individual's preferences
17. Communications and clinical and administrative processes are adapted to meet the needs of older adults
18. Older adults are provided information in a way that makes it easy to understand so that they can make informed decisions
Emotional and
Behavioural Environment
19. The care provided is free of ageism and respectful of the unique needs of older adults
20. Care providers are able to identify and address issues of elder abuse and older adults' safety
21. The care of older adults is planned and delivered in alignment with their personal goals
22. Care providers demonstrate competency providing care to an older population with diversity in all its many forms
23. Care providers respect each individuals' breadth of lived experience, relationships, unique values, preferences and capabilities
24. Care is provided in a way that enables the older adult to feel confident in their care providers
25. Care is compassionate and sensitive to the needs of older adults
26. Family and other caregivers are valued and supported as care partners
27. Social connections are recognized as an important contributor to the health and well-being of older adults
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Ethics in Clinical Care
and Research
28. Autonomy, choice and dignity of older adults are protected in care processes and research
29. Care is delivered in a way that protects the rights of older adults especially those who are vulnerable
30. An older adult will not be denied access to care or the opportunity to participate in research based solely on their age
Physical Environment
31. The structures, spaces, equipment, and furnishings provide an
environment that minimizes the vulnerabilities of older adults and promotes safety, comfort, functional independence, and well-being
5. Next Phases of Work In order for the sfCare Framework to be effectively applied as a holistic template for quality improvement and practice change, additional supporting work must be considered. As part of their mandate, the Steering Committee will be creating the sfCare Strategy, which will include the development of tools and resources for implementation. Work that is currently underway includes:
• Creation of the sfCare Strategy • Recruitment for expert panels to guide the development of:
o a self-assessment tool to determine areas of priority for an organization o an implementation kit for one priority area across the sectors o standards and indicators
• The development of the Senior Friendly 7 Toolkit. Research suggests that interventions in seven areas promise significant individual and often additive benefits in the lives of frail older adults. The SF7 Toolkit will comprise resources on Cognition/Delirium, Mobility, Nutrition, Polypharmacy, Continence, Pain, and Social Engagement. The toolkit would be tailored to the care provided across the healthcare system, and also include self and family-focused care.
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Appendix A – Glossary of Terms
Word or phrase Meaning and use in the framework Administrative processes
Includes the scheduling of appointments and the provision of written or verbal instructions (for example, for tests or medications).
Ageism “Ageism is the stereotyping and discrimination against individuals or groups on the basis of their age. Ageism can take many forms, including prejudicial attitudes, discriminatory practices, or institutional policies and practices that perpetuate stereotypical beliefs.” (The World Health Organization).
Evidence-informed practice
Evidence-informed practice brings together the best available evidence from research, with local experience and expertise, and takes into consideration the older adult’s preferences and values.
Integrated care Care providers work together across organizations, as partners in care with older adults and their caregivers, to coordinate and deliver services.
Interprofessional model of care
Different types of care providers actively working together to provide coordinated care for the older adult.
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Appendix B – SFH Provincial Strategy
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Appendix C – SFH Framework
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Appendix D – Project Team
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Appendix E – Literature Review Process
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Appendix F – Expert Delphi Panel
Marlene Awad Director of Operations, RGP of Toronto
Sarah Byrne Community Health Worker, North Lanark Community Health Centre
Michael Campo Senior Policy Advisor, Partnerships and Consultation Unit, Capacity Planning and Priorities Branch, Strategic Policy and Planning Division, Ontario Ministry of Health and Long-Term Care
James Chau Care of the Elderly Physician, North East Specialized Geriatric Centre
Blaise Clarkson Assistant Professor, Department of Family and Community Medicine, South East Toronto Family Health Team
Dan Clydesdale Manager, Toronto Central LHIN
Trish Corbett Clinical Nurse Specialist Geriatrics and HELP, Joseph Brant Hospital
Jayne Coyle Director of Health Services, Lanark Renfrew Health and Community Resources
Gail Dobell Director, Performance Measurement, Health Quality Ontario
Mark Edmonds Director, Health System Integration, Central West LHIN
Alan Ernst Manager, Policy, Accountability & Agency Relations, Ontario Seniors Secretariat
Jim Grieve Executive Director, Retired Teachers of Ontario
Vinita Haroun Director of Research and Knowledge Translation, Ontario Long Term Care Association
Carol Holmes Program Manager, LTC Best Practices Program, RNAO (Retired)
Linda Jackson Program Director, Inner City Health Program, St. Michael’s Hospital Executive Director, Family Health Team, St. Michael’s Hospital
Mélusine Klein Senior Consultant, Policy Development, Ontario Seniors Secretariat
Charissa Levy
Executive Director Rehabilitative Care Alliance / GTA Rehab Network / Toronto ABI Network
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Barbara Liu Executive Director, RGP of Toronto Program Director, Geriatric Medicine Postgraduate Residency Program, University of Toronto Geriatrician, Sunnybrook Health Sciences Centre
Beth McCarthy Director, Specialized Geriatric Services of South West Ontario
Kelly Milne Program Director, Regional Geriatric Program of Eastern Ontario
José A. Morais Associate Professor and Director, Division of Geriatric Medicine, McGill University Associate Director, Quebec Network for Research on Aging
John Puxty Clinical Lead, Specialized Geriatric Services South East Ontario Associate Professor, Division Chair, Service Chief, and Program Director, Geriatric Medicine, Providence Care Hospital
David Patrick Ryan Director of Education & Knowledge Processes, RGP of Toronto Assistant Professor, Faculty of Medicine, University of Toronto Consulting Psychologist
Valerie Scarfone Executive Director, North East Specialized Geriatric Centre
Mary Schulz Director, Information, Support Services and Education, Alzheimer Society of Canada
Rhonda Schwartz Director - System Planning, Implementation & Quality, Seniors Care Network
Dallas Seitz Division Head, Geriatric Psychiatry Associate Professor, Department of Psychiatry Queen's University Providence Care - Mental Health Services
Deborah Simon CEO, Ontario Community Support Association
Cathy Sturdy-Smith Manager, Specialized Geriatric Service, Canadian Mental Health Association
Ross Upshur Head, Division of Clinical Public Health at University of Toronto
Kevin Young Physician Lead, North Simcoe Muskoka Specialized Geriatric Services Program
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