$3.8M to help care for dementia patients

Published on January 08, 2012

Funding to pay for 48 health-care workers

By Pauline Tam, Ottawa Citizen

Eastern Ontario is get-ting $3.8 million in provincial funding to hire 48 more health-care workers as part of a program to provide better care for aggressive and "difficult" patients with dementia and other neurological disorders.

The region's acting health chief said the new hires are meant to improve dementia care at nursing homes. An-other goal is to keep more people at home and out of nursing homes for as long as possible, while cutting down on the revolving door of ex-pensive and ineffective hospital stays made by patients with behavioural problems.

"A lot of people who end up in hospital waiting for placement in long-term-care homes have those behaviours," said Chantale LeClerc, interim chief executive of the Champlain Local Health Integration Network. "Or a lot of people end up in hospital from a long-term-care home because the behaviours are no longer manageable."

By April, the first of these specially trained nurses, personal support workers and case managers are expected to be working in the com-munity and at some of the region's 62 nursing homes.

Also in the works is a new, specialized unit at an as yet undetermined nursing home. The secure unit would pro-vide short-term stays for people who need intensive medical help to stabilize be-fore they return home.

Such a unit is sorely needed as an alternative to hospitals, where many of these high-needs patients are quickly labelled as candidates for nursing homes and left to deteriorate, said Nicole Robert, executive director of Geriatric Psychiatry Community Services of Ottawa, one of the agencies expected to receive a share of the funding to hire more staff.

"There is no setting right now where we could send them other than an acute-care hospital, which doesn't have specialized units for patients with challenging behaviours," said Robert.

More than half of the 13,000 Eastern Ontarians who suffer from dementia and other neurological disorders develop symptoms such as aggression, delusions, irritability and wandering as their disease progresses.

Providing adequate care for such patients has been long been overlooked. In particular, a lack of preventive care means many land in hospitals when their behavioural problems escalate.

"Often when a crisis occurs, it means an emergency-room visit. And that's what we want to prevent," said Robert. "Behavioural issues can be man-aged if we have knowledge-able people and if they are ad-dressed earlier."

Other dementia sufferers struggle to remain in their own homes because neither family members nor home-care workers know how to handle them. Some nursing homes, even those designed to look after difficult cases, refuse to admit aggressive patients.

The Geriatric Psychiatry Community Services of Ottawa is one of the few agencies that attempts to intervene before problems escalate. Similar mobile outreach teams exist in Cornwall, Pembroke, Prescott-Russell and Lanark.

With a referral by a family doctor, patients are visited in their homes by a team of specialists (usually a geriatric psychiatrist, followed by a case manager) who assess behavioural problems, educate families on how to cope and identify community services that could support both the clients and caregivers.

Recently, the agency's five geriatric psychiatrists and 15 case managers started once-a-month visits to residents living in select retirement homes that have a secure unit for those with behavioural problems.

However, with a caseload of 1,300 clients at any given time and a two-month waiting list, demand for the service is pushing the agency to its limit. With more staff, the agency will see more clients and cut its waiting list, said Robert.

The region's top geriatrician, who has long pushed for better dementia care, said the new hires, particularly for community-based programs that make house calls, are a promising first step in helping more seniors with dementia remain at home.

"It is not only more efficient to treat persons with (challenging) behaviours where they live, it is more humane," said Dr. Frank Molnar, medical director of the Regional Geriatric Program of Eastern Ontario.

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