Healthy Living in the North

Learning to care for an aging population with dementia

Two female staff members play cards.

Left to right: Elizabeth Johnson, Activity Worker and Brenda Miller, Clinical Nurse Educator.

As the population ages, dementia with older adults is becoming more common. At Northern Health, staff are taking a proactive approach by taking education to learn more about caring for those with moderate to severe cognitive impairments.

Gentle Persuasive Approaches (GPA) teaches care teams how to use a person-centred, respectful, compassionate, and gentle persuasive approach to respond to the behaviours associated with dementia. GPA equips staff with real-life strategies, helping them remain safe and confident in how they respond to different situations.

Trainers across the region have noticed an overwhelmingly positive reaction from staff.

“The initial reaction from staff is that they love it,” says Erin Murdoch, Clinical Nurse Educator for Peace Villa in Fort St John. “It’s opened their eyes to recognize how important person-centered dementia care is, and to recognize why behaviors associated with dementia happen. The training has made staff more compassionate towards the residents and their families.”

Three staff members play cards with a Gateway Lodge resident.

Left to right: Brenda Miller, Clinical Nurse Educator, Myrtle, Gateway Resident, Keya Russell, Social Worker, and Elizabeth Johnson, Activity Worker enjoying a game of cards.

“The biggest change we’ve noticed as a result of GPA is staff attitude,” says Jennifer Miller, RAI Clinical Lead and a GPA trainer based in Burns Lake. “They’re more understanding and have empathy for people with dementia. Staff think about why the challenging behaviour is happening and come up with innovative solutions to manage the behaviour. The solutions are more dignified and respectful. Before, if someone had a challenging behaviour problem, sedation or restraints would be used to manage the behaviour. Now, staff are coming up with person-centred solutions to manage behaviour. It’s all about us modifying our approach. Every class I’ve taught has commented that the training is very helpful, it helps them understand dementia better, and that they didn’t know there were so many types of dementia. Overall it has brought a new awareness.”

GPA is only part of Northern Health’s strategy for caring for older adults.

“Our long term care homes are actively participating in DementiAbility Methods across the entire region,” says Brenda. “DementiAbility Methods is a practical, evidence-based dementia care program. The program teaches care staff how to support the changing memory and thinking skills a person with dementia presents. It also teaches how to create home-like environments that best engage residents in a variety of ways to participate in activities and responsibilities that match their different needs, interests, strengths, and abilities. DementiAblitiy Methods provides assessment and care planning tools for nursing staff when problem solving difficult situations often associated with dementia care.”

Both GPA and DementiAblity Methods work together like hand in glove to improve the environment, culture and, care approaches of staff so that a resident’s day is the best it can be.

Tamara Reichert

About Tamara Reichert

Tamara is the communications advisor for the innovation and development commons at Northern Health where she works on a number of projects with the research, quality improvement, clinical simulation, and education teams. Born and raised in Prince George, Tamara grew up on a ranch where she rode horses, played with farm animals, built forts, and raided the family garden. She enjoys spending time travelling, hiking, cooking, reading, and cheering for her favourite sports teams.

Share

Northern Table: Gardening at Gateway

A short sunflower in a wood raised garden.

This sunflower adds a pop of colour to the garden’s greens.

This summer, my two-year-old son excitedly watched the raspberry bush in our backyard grow as he waited for the berries to turn red. When he tasted our first raspberry, his eyes widened, he jumped up and down, and couldn’t wait to have another! Watching him, I felt a sense of satisfaction, pride, and joy because he’s getting to experience growing and harvesting his own food right in his backyard. Do you know the feeling I’m talking about? The feeling of picking that first berry of the season and enjoying its sweet and tangy taste?

Now, imagine losing that feeling – not being able to take the fresh raspberries from the bush you’ve harvested for years, not being able to enjoy the crisp texture of a freshly picked carrot, or not feeling the satisfaction and joy of growing food for your family.

A hydroponics tower is located in a corner. It has several young plants growing in it.

The hydroponics tower turns “growing season” into a year-round event.

Many residents living in long-term care don’t get to experience these feelings anymore, and may not be able to participate in activities they used to love and found meaning in, like gardening. Backyard gardening or living on a rural agricultural property in Northern BC, and the experience of gardening and growing food for sustenance and pleasure, is a meaningful activity that some people greatly miss. Losing this connection to nature can affect their mental wellbeing. As a dietitian who loves the connection to food, this breaks my heart. At Gateway Lodge (Gateway) in Prince George, we’re helping create an environment where residents can experience growing, preparing, and eating homegrown fruit and vegetables again.

A team of people from the University of Northern BC (UNBC), BC Cancer, and Northern Health received a seed grant to grow vegetables and other edible produce in raised garden beds and a hydroponics tower at Gateway. With the help of residents, our team co-designed a gardening program that includes a shared gardening space between staff and residents, gardening time, and meaningful food and nutrition activities that support the nutritional and mental wellness of residents.

A hand holds a styrofoam cup filled with green smoothie.

A green smoothie, made from veggies from Gateway’s garden and sweetened with store-bought fruit, was a favourite of residents!

One activity that residents loved was making green smoothies from our harvest. We created delicious smoothies with greens from our gardens and added store-bought fruit to sweeten them up and make a vibrant, refreshing green drink.

Residents’ favourite recipe was a combination of greens (kale, Swiss chard, lettuce, spinach), banana, pineapple, vanilla almond milk, and ground flax seed – yum!

I’m thrilled with the opportunity to engage residents in meaningful and nourishing activities through gardening, and we hope to build on the success of 2019 for our next growing year!

Erin Branco

About Erin Branco

Erin is a dietitian who works with residents in long term care homes in Prince George. She is passionate about supporting residents’ quality of life as well as fostering their reconnection to food. In her spare time, you can find her with her family and friends, enjoying a meal, playing in the garden, camping or supporting clients in her private practice. She loves being a part of making positive change in healthcare, and is an advocate for providing best practice nutrition support to our northern communities.

Share

Cruisin’ Classics bring their car show to the residents at Gateway Lodge

Classic cars are parked in stalls. A group of elderly men admire another car as it drives past them.

The Cruisin’ Classics Auto Club brought memories, stories, and beautiful cars to the residents of Gateway Lodge in Prince George.

On June 14, members of the Cruisin’ Classics Auto Club brought their prized vehicles and many smiles to Gateway Lodge, a long-term care facility in Prince George.

Lynn AuCoin, Recreational Therapist in Complex Care shared how the event impacted the residents living at Gateway:

“This is something that the Cruisin’ Classic Auto Club has been doing for many, many years and is so well received by our residents and their families. Often, many of our residents are unable to attend the actual Father’s Day Show and Shine in the park and the generosity of the club to bring the cars out to the seniors and visit the various long-term care facilities is just amazing and so thoughtful!

A man stands in front of of four classic automobiles.

The classic cars, which ranged in year, model, and make, needed both sides of the parking lot.

“Our residents so look forward to making their way out into the parking lot to see the cars pull into the lot and visit with the owners. Often, there is much reminiscing during the event, as well as the lead up to the cars’ arrival and after they leave! Conversations can be heard about residents’ past vehicles that they owned, what they paid for it, what colour, where they bought it, road trips and so on.

“This year, I was overwhelmed with the number of cars that showed up and how the drivers and owners were thanking me for allowing them to bring their cars to Gateway. I was continuously saying, ‘No, thank you! You have no idea how special this is to our residents to have you bring your prized possession to us and share it with our residents!’”

Thank you to Cruisin’ Classics for bringing so much joy to the residents at our long-term care facilities!

Sanja Knezevic

About Sanja Knezevic

Sanja is a communications advisor with Northern Health’s medical affairs department and is based in Prince George. She moved to Canada in 1995 from former Yugoslavia to Fort Nelson where she lived for a few years before moving to Prince George in 2000. Sanja enjoys photography, curling up with a good book, cooking and spending time with her friends and family.

Share

The St. John Hospital acute care garden: improving quality of life for people waiting for long-term care

The acute care garden gives seniors waiting for long-term opportunities for engagement, socialization, and mobility.

This spring, the residents and staff at St. John Hospital (Vanderhoof) came together to start a garden for acute care patients who are on long-term care waitlists. Acute patients who are waiting for a long-term care spot can have limited access to activities and recreation. This project gives them opportunities for engagement, socialization, and mobility on the acute floor.

Many of the residents grew up in or around Vanderhoof, and were avid farmers and gardeners throughout their lives. Now, they can tend, water, weed, and enjoy this garden. Doing so reconnects them to their past, sparking old memories, and contributes to their sense of purpose.

This project was started by the Rehabilitation Department at the St. John Hospital, which includes occupational therapist Valerie Padgin, rehabilitation assistant Roxanne, and myself (also an occupational therapist). It’s part of a DementiAbility initiative.

Thanks to the generous donations and support from several family members, the acute care garden is now thriving, growing tomatoes and lettuce! This project wouldn’t be possible without:

  • Maya Sullivan from the Vanderhoof Community Garden for loaning the hospital a wheelchair accessible planter, which got the project started.
  • The Men’s Shed for building two additional planters.
  • The Co-op and Home Hardware in Vanderhoof for donating soil, potting mix, gloves, hand tools, and a watering can.
  • Eileen at Maxine’s Greenhouse for donating dozens of beautiful plants that are flourishing in the garden.
  • Allan Pagdin and Joanne Petrie, who put in several hours of time and labour to make the project a success.

We hope the garden continues to grow and improve the lives of our residents and acute care patients!

Laura Giroux

About Laura Giroux

Laura is an Occupational Therapist at the St. John Hospital in Vanderhoof. Originally from Vancouver Island, Laura has been in the North for nearly four years, and enjoys all of the recreation and outdoor activities that it has to offer. She recently joined the Rehabilitation Department at St. John Hospital and is excited to work on such a creative and compassionate team.

Share

Success in Smithers: How cross-training and staff education has led to a fully staffed, skilled primary health care team

Members of the Smithers primary health care team are lined up, smiling, in their office.

Members of the Smithers primary health care team. L-R: Mike Oaks, Primary Care Nurse; Heather Olsen, Primary Care Assistant; Sandra Stanley, Team Lead; Stacey Pederson, Primary Care Assistant; Sam Bosscher, Primary Care Nurse.

Over the last couple of years, the primary health care team in Smithers has been struggling to get to a point where they have a complete number of staff. Today, we’re happy to say that all primary care nurse (PCN) positions are full!

What is a primary health care team and what’s the latest on the Smithers team?

A primary health care team is composed of nurses, social workers, physiotherapists and occupational therapists, dietitians, a diabetes educator, and other professionals who work together to support patients in the community.

Out of the 11 full-time and part-time staff who make up the PCNs on the Smithers primary health care team, only three team members have worked on the team for more than 18 months. That means that 72% of the team are new staff. Right now, there are two casual employees that are in permanent positions, and only one of them has been in Smithers longer than 18 months. The team has hired nine casual PCNs over the last 18 months and nearly all of them have become permanent employees or are in temporary positions.

PCNs and primary health care are pretty new… what’s happening with training?

I spoke with Sandra Stanley, Team Lead for the Smithers primary health care team, to find out how she’s cross training the new staff.

“The ‘how we did it’ is partially the people that are here. They’re amazing people – intelligent, kind, compassionate, and motivated to give great care,” says Sandra.

When Sandra started as the Team Lead, many skilled staff had left and new staff members were struggling. They needed support to provide the full range of expected services. Smithers faced many challenges getting to this point, but they now have a stable team and good morale.

“I believe now, from talking with nurses, that the morale has improved, and they have become a tight and supportive team that work really well together, and genuinely like each other,” says Sandra. “They’ve picked up the education with enthusiasm and [they’ve] been keen learners. They’re intelligent, compassionate, and good critical thinkers. I count myself as fortunate to be leading such a team and the credit for what I see as success is due in very large part to them and their excellent qualities.”

Sandra believes that, wherever possible, a key to training is modeling the skill for others. Along with “walking the talk,” here’s how the Smithers team is tackling training for different aspects of their roles:

Palliative care
Palliative care is a “way of being” with people. It requires nurses to have the ability to assess the state people are in emotionally and spiritually, as well as physically. It can’t all be taught in a classroom. The skills are learned through experience, and being with other nurses who can mentor those skills. It was important to Sandra to pair less experienced nurses with others who have strong palliative care skills. The team was fortunate to have a primary care nurse with strong palliative care skills come back and join the team after moving away to work elsewhere. This was a game changer in many respects and helped provide that knowledgeable, consistent presence the nurses needed.

Long-term care needs assessment
Sandra’s team is focused on training related to completing the resident assessment instrument (RAI), which a requirement for a patient to go on a wait list for long-term care. With more primary care nurses using the RAI, people are assessed as needing long-term care and put on a wait list earlier. The team’s health care aides supports community members until they are ready to transition to a long-term care home. Health care aides are an essential part of a community program and are critical to supporting patients who are at home, waiting to enter a long-term care home.

Diabetes education services
After the diabetes educator in Smithers had to decrease workload, waitlists for service were longer than usual. In response, two nurses are training to help educate new diabetics to give insulin, manage blood sugars, and decide what to do when the sugars are high or low. There’s been an incredible amount of training and cross-training done in general, as well as new diabetes work taken on by the nurses due to the back log of diabetes referrals.

Mental health services
To support mental health patients in Smithers, there are cognitive behavioural therapy groups that include members of the primary health care team. These teams teach people with mental health issues how to cook, shop, bank, take care of themselves, and more. The other team lead in Smithers, Cynthia Rondeau, works very hard to ensure there is quality mental health support for clients.

Cross-community support

When the team has struggled, they’ve received help from Hazelton and Houston, and they helped those communities in return. These three communities are working well together and being generous when it comes to helping wherever they can.

“The better connected we are with the people in the community, the better we can prevent admissions to the hospital and visits to the ER that are unnecessary,” says Sandra.

Sandra’s work, helping her team learn and grow as primary care nurses, has been instrumental to providing Smithers with skilled health care professionals.

Bailee Denicola

About Bailee Denicola

Bailee is a communications advisor in the Primary Care Department and was born and raised in Prince George. She graduated from UNBC with an anthropology degree and loves exploring cultures and learning about people. When not at work, Bailee can be found hanging out with her dogs, building her house with her husband, or travelling the world.

Share

A picture-perfect partnership: Prince George photographer donates photographs to reconnect long-term care residents with their community

Two female Gateway Lodge residents in motorized wheelchairs are in a hallway. They are admiring a picture hanging on the wall. The picture has a rusted bridge in the foreground and a river, trees, and sky in the background.

Gateway Lodge residents Ilse and Diana can admire photographs of places they know thanks to a partnership with local photographer Anna Michele McCue. Photo courtesy of Anna Michele McCue.

They say, “A picture is worth a thousand words.” Lynn AuCoin hopes the pictures hanging in Gateway Lodge bring more than words – even a thousand of them. She hopes each image helps residents reconnect with their community.

“We’ve been trying to make our facilities more home-like,” says Lynn, the Recreation Therapist Supervisor for Gateway Lodge’s complex care and Rainbow Lodge in Prince George. “Our residents enter a new stage in their lives. Suddenly, they’re getting regular care and help in a new place. We want to see our hallways filled with things that residents can relate to and talk about. Whether that’s milking the cow, riding the tractor, or enjoying the sunset or local places.”

In a beige hallway, a picture of a long haired, black and brown dachshund in a wagon hangs above a chair.

This image of a dog in a wagon is a favourite among Gateway Lodge residents. Photo courtesy of Anna Michele McCue.

Lynn is a member of a Prince George Facebook group that shares good news and local photography. In February 2019, she was scrolling through it and several stunning photos caught her eye. Lynn noticed they were all by a photographer named Anna Michele McCue, who goes by Michele. Lynn reached out to Michele right away.

“We didn’t have a big budget for this, so I was hoping we could work something out,” says Lynn. “Michele got back to me right away. She loved the idea of connecting residents with their communities. She offered her pictures at no cost!”

Thanks to Michele’s generosity, nine pictures are now hanging throughout Gateway Lodge.

A picture of a Prince George street in the fall hangs on a wall. The street is centred and continues for several blocks. It is covered in yellow leaves. On either side of the street there are tall trees with yellow leaves that have yet to fall, and houses.

Another example of a picture by Anna Michele McCue that is hanging in Gateway Lodge. Photo courtesy of Anna Michele McCue.

“I’m so pleased that my photography is bringing joy to people,” says Michele. “Seniors, who have contributed so much, are an important part of our community. It means the world to help remind them of how they lived, what they accomplished, and what they enjoyed.”

Michele isn’t the only one who’s pleased. These trips down memory lane are getting rave reviews from Gateway residents as well.

“They add beauty and colour to our empty walls,” says Margaret, a resident of Gateway Lodge. “We all enjoy finding out the location of where a photo was taken.”

Lynn notes that other Northern Health long-term care facilities may see local photography on their walls in the future.

Mike Erickson

About Mike Erickson

Mike Erickson is the Communications Specialist, Content Development and Engagement at Northern Health, and has been with the organization since 2013. He grew up in the Lower Mainland and has called Prince George home since 2007. In his spare time, Mike enjoys spending time with friends and family, sports, reading, movies, and generally nerding out. He loves the slower pace of life and lack of traffic in the North.

Share

Advance Care Planning in Long Term Care

Patti sitting on a boulder amongst rocks.

ACP Lead Patti reminds us to have a conversation about end of life care with our loved ones.

I started working with Advance Care Planning (ACP) about a year and a half ago. While my position includes promoting ACP, I’m also a nurse consultant with the palliative care team, which means I meet with clients who reside in Long Term Care (LTC) facilities.

When I did my Registered Nurse (RN) training many years ago, I did a portion of my practicum in a LTC facility; at the time it was seen by my classmates as a position that lacked excitement and offered limited experience. Twenty-seven years later, I see this experience differently! LTC is an area where there is more of a focus on comfort and normalcy within the resident’s care, because this is likely the last home they will reside in. In these kinds of situations, we must consider the individual’s needs and wants within the care that they receive, including cultural-based values and beliefs. As such, it’s even more important that there’s a focus on the individual, and whether they have thought about what’s important to them regarding their wishes for end-of-life care.

The last year in this position has led me to further see and understand the importance of ACP in LTC facilities, including: discussions that need to happen amongst family members; awareness regarding what the future looks like for the resident; and situations and circumstances that need to be explained. Not having these conversations may lead to misunderstandings and the failure to follow the dying person’s wishes.

As health care staff, we have to ensure that there are open lines of communication with the family members and loved ones, as well as the residents. As a family member, we need to be proactive, involved, and not afraid to ask questions, in order to be informed. ACP needs to be an ongoing process to keep everyone from questioning care choices. Sometimes the residents are at a stage where they can no longer have these conversations, or they may not have loved ones who are involved, and these topics don’t always get discussed. This makes it even more important to have these conversations with our patients before it’s too late, at a time when they are still able to express their wishes.

The extended length of stay creates relationships and bonds between staff and the residents, often closer ones than exist in regular hospital wards. So, sometimes it can be difficult for the staff to experience the decline in the residents and the care involved, and even harder if there is no ACP in place.

Advance Care Planning day was April 16, but ACP should be encouraged every day whether it’s with a loved one or a patient. Find out what’s important to them and get them thinking about what their beliefs and values are, and what would matter most to them at end-of-life. Let’s all work at promoting ACP and make an effort to have those conversations. For more information on ACP visit www.speakup.ca and www.advancecareplanning.ca.

Patti Doering

About Patti Doering

Patti was raised in Prince George and graduated from the CNC Nursing Program in 1991. She has been employed with Northern Health for 26 years and has worked in many different areas such as Med/Surg, Emergency, Mental Health and the Operating Room. Patti joined the Palliative Care Consultation team in October 2017, in a one year term position which is focusing on personal support worker palliative care education, advanced care planning, and other projects which support the work of the consultation team. Patti is presently working on her BScN through the UNBC’s online program. In her spare time, she enjoys the outdoors, sports, and spending time with her daughters and her schnauzer, Dexter.

Share

“DementiAbility” approach helps make Terraceview Lodge feel like home

Activity bins for people with dementia at the Terraceview Lodge in Terrace.

Some activities for people with dementia at the Terraceview Lodge in Terrace. As a part of the DementiAbility initiative, these activities are designed to focus on maximizing abilities, instead of focusing on disabilities.

How do you define “home”? One definition was suggested by Northern Health Occupational Therapist Cheryl Block: “It’s the place where you make a genuine contribution, where you’re a part of what’s going on. That’s what feels like home.”

Cheryl, who works in Terraceview Lodge, is helping implement the DementiAbility initiative, which she says has been positively received by residents and their families.

DementiAbility, which is based on the Montessori educational philosophy, is an approach to caring for people with dementia that focuses on maximizing abilities instead of focusing on disabilities.

“We really work to prepare the environment so people can be successful,” says Cheryl. An example is using signage on walls to tell residents how to find the dining room or the activity room. “This can really decrease anxiety and help people feel, ‘Hey, I can be independent, I know where I’m going’,” says Cheryl.

A senior sorting silverware at Terraceview Lodge.

Sorting silverware is an example of an activity available at Terraceview Lodge that gives residents the chance to carry out day-to-day activities to help care for their home. Other examples include arranging flowers, folding socks, reading books, and trying on jewelry.

Another aspect of the DementiAbility approach is giving residents the chance to carry out day-to-day activities to help care for their home, Terraceview Lodge.

“We already have some residents who love to fold the aprons we use at mealtimes, and others who tend our plants,” says Cheryl.  “You can ask them, ‘I have this load of laundry that needs folding, would you be willing to help me?’ – and someone who isn’t interested in a more formal workout can still get some of the same range of motion and strength benefits — and also with a sense of purpose.”

Cheryl has challenged other departments at Terraceview to come up with activities they could involve residents in on a regular basis. “It’s been really neat, the response we’ve got from the residents — the smiles that we get — it’s that sense of purpose and that sense of belonging,” she says.

Another type of activity that has been a success at Terraceview Lodge is reading groups, where residents take turns reading a large-print book aimed at their age group page by page.

“I have to say, this is something that gives me goosebumps,” says Cheryl. “We’ve seen residents who are generally nonverbal and don’t interact with others come to these reading groups, read everything clearly and concisely and then participate in discussion group. It’s really neat to see how allowing residents to use the abilities that they have, can brighten their day and the day of anyone who interacts with them.”

Cheryl notes that it’s been a team effort to make DementiAbility a success at Terraceview Lodge. “The team has come together to make this a success,” she says, “all the way from Quality Improvement at the regional level supporting us; Brad, the manager here, has been extremely supportive and enthusiastic; and all the departments, from Maintenance to Dietary, Housekeeping, and Nursing. Everyone is really wanting to be part of something that’s good for the residents — it’s ultimately all about the residents and what’s best for them.”

With the help of Northern Health’s Quality Improvement department, Block is working on spreading the DementiAbility approach throughout Terraceview Lodge. “It’s exciting to see where this will go,” she says.

Anne Scott

About Anne Scott

Anne is a communications officer at Northern Health; she lives in Prince George with her husband Andrew Watkinson. Her current health goals are to do a pull-up and more than one consecutive “real” push-up. She also dreams of becoming a master’s level competitive sprinter and finding a publisher for her children’s book on colourblindness. Anne enjoys cycling, cross-country skiing, reading, writing, sugar-free chocolate, and napping -- sometimes all on the same day!

Share

Fire infographic

A dramatic infographic presents Northern Health’s response to the 2017 wildfires. Greg Marr, NH’s Regional Director, Medical Affairs, and Jason Jaswal, Prince George Director of Long Term Care and Support Services, presented it at the BC Health Care Leaders Conference in Vancouver.

infographic showing statistics during 2017 wildfires

Sincere thanks to everyone involved in supporting the northern wildfire response both this year and last year, including NH Emergency Management and all NH staff members and physicians, and thank you to Jason and Greg for highlighting these details!

Greg and Jason side by side in suits.

Greg Marr (L), NH’s Regional Director, Medical Affairs, and Jason Jaswal, Prince George Director of Long Term Care and Support Services, at the BC Health Care Leaders Conference in Vancouver.

Share