Cove Guest Home’sSpecial Care Team

Over 14,000 seniors in Nova scotia suffer from various types of dementia (Nova scotia Department of health, 2004). Behavioural symptoms such as agitation and physical aggression occur in the late stages of dementia in up to 70-80% of cases.

Aggression is a primary factor leading to institutionalization or hospitalization of demented seniors. Because of this, it is critical that challenging behaviours are identifi ed and managed in long-term care facilities (nursing homes) for the safety and well-being of the residents who live there and the safety of the staff that provide their care.

Family caregivers identify physically aggressive behaviour as a source of mental distress, depression, injury, and abuse (Hinchliffe, 2000). It is therefore predictable that nursing home workers identify physical aggression as a signifi cant occupational stressor.

Challenging behaviours have been identifi ed in the forms of verbal, physical, and sexual aggression towards self or others (Hamilton, Collins, Harris & LeClair, 2005). As these behaviours are usually exhibited on a daily basis they require immediate staff interventions. Lack of knowledge, skills and resources have been identifi ed as possible barriers to positive staff and resident outcomes, and needs immediate attention by the provincial governments.

With this need in mind, the Cove Guest Home, a 110 bed long-term care facility in Sydney, Nova Scotia took the initiative to develop a Special Care Team. This team individually addresses the unique needs of residents who struggle with challenging behaviours and the needs of staff that provide their care. These comprehensive management strategies often fall outside the traditional nursing home protocol. Attention is also given to educational components that create and maintain a safer home and workplace for both residents and staff.

Staff buy-in is crucial to this program’s success. Membership in this team is purely on a voluntary basis, and staff must exhibit a desire and enthusiasm to work with seniors who struggle with daily challenges. A multidisciplinary team is also extremely important, as every discipline brings a unique skill set, view and possible solutions to problems. Cove Guest Home gave the team a high level of autonomy, decision making capacity and encouraged creative and innovative ideas.

Care plans are driven exclusively by the unique needs of each resident instead of plans developed by traditional thoughts and values. The mission statement surrounding the Special Care Team is simple and basic, “seniors have the right to come to the Cove Guest Home and live, and not just exist.”

The Special Care Team works collaboratively with external stakeholders such as seniors’ mental health and geriatric medicine specialists. Meetings are formally held once per month within the nursing home, while informal referrals are made by staff that care for the particular resident on a daily basis, all staff input is encouraged and expected. The team then begins with a full, formal assessment including a comprehensive history (pre and post admission), family input and interviews, and medication review and rationalization. Based on the information obtained a new careplan is developed.

Once careplans are developed, the information is spread through the unit where the resident lives. Modifications usually occur over the next several days during the initial implementation phase of the careplans. Family members are kept completely informed on an ongoing basis, including any changes to medications. This type of disclosure helps to develop a trust between the nursing home staff and the family.

The Special Care Team has been in place at the Cove Guest Home for over four years. This team’s many successes have given a higher level quality of life to residents entrusted to their care. Some residents still experience challenges on a daily basis, but the frequency and severity has decreased significantly.

One of the biggest successes in the development of the Special Care Team is our unique approach to care as it relates to challenging behaviours and the fulfillment and satisfaction of teamwork that is created.

Those who work in long-term care have extremely demanding jobs, not just physically but emotionally and mentally. The Special Care Team has provided a support network for staff to discuss their concerns. We offer staff the courage to move forward, the education to assist their approach to care and the necessary tools to get their jobs done safely for both the resident and themselves.

A special thanks for the extraordinary efforts of the Special Care Team at the Cove Guest Home, they are truly making a significant difference in the lives of those who struggle with challenging behaviours.