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‘A matter of being open-minded’:
Working together to meet dementia patients at a place they can call home

Chase Cromwell

Chase Cromwell was able to successfully transition to long-term care with the help of Karen Bennett, continuing care behavioural resource consultant, and others

By Jaimee Dobson

When Chase Cromwell was diagnosed with dementia, his wife chose to care for him in their home.

Despite her care and efforts to keep him safe, Cromwell’s disease progressed and his distress and change in behaviour led them to reach out to the local emergency department for support.

A visit to the emergency department can be stressful for anyone. The loud, stimulating environment caused added stress for Cromwell, which he expressed through behaviour.

During his hospital stay, the care team assessed Cromwell. They determined that staying home was no longer an option for him and that long-term care would provide the most appropriate environment.

Initially, the long-term care facility, Mountain Lea Lodge, declined placement for Cromwell due to his behaviour in hospital. Matthew Pothier, placement coordinator, contacted Karen Bennett, the continuing care behavioural resource consultant, to help develop a successful transition plan.

“I suggested to Karen that we work with the hospital and nursing home to develop the plan and to set up a trial stay at Mountain Lea Lodge for a week,” Pothier said.

“When you bring in the behaviourial health team, they can help you to better understand the person. It’s great to have Karen assist in making a care plan, identifying triggers and promoting safety and appropriate care for everyone.”

“Continuing care behavioural resource consultants (BRCs) are in a unique role where they have great background and understanding of the person,” said Tracy Bezanson, team lead of care coordination at Soldiers Memorial Hospital. “They take that step back and say this isn’t working; how about we try it this way?”

She added, “they provide feedback and support to staff, education and support for families, and advocate for the client.”

Mountain Lea Lodge agreed to a trial stay, but within the first couple of days Joyce d’Entremont, CEO and administrator of the facility reached out to Bob Jenkins, continuing care director for Annapolis Valley, South Shore and South West Nova Scotia.

“We thought we would have to send him back to hospital. It took three people to assist with care due to his behaviours,” d’Entremont said. “He resisted care, and was basically nonverbal and unable to eat.”

Jenkins brought together everyone involved in Cromwell’s care and committed to support Mountain Lea Lodge with additional staffing while they worked with Bennett to adjust Cromwell’s care plan.

“This showed Bob’s commitment to us, the commitment to Chase and his family and that our concerns were being heard. I knew that if concerns arose there would be support to help maintain Chase here,” d’Entremont said.

With new faces and no routine yet in place, Cromwell’s behaviours grew more intense and frequent. “At first I was worried that they would send him back to hospital,” said Latanya Cromwell, his granddaughter. “But it didn’t take long to get him into a good routine.”

Bennett coordinated discussion with the family to understand his interests, likes and dislikes. She supported the team and family to identify Cromwell’s life story, preferences and abilities to help identify strategies that might inform the approach to his care.

“We learned from his family that he’s a very private person and prefers a male nurse do his personal care,” Bennett said.

“As a result, the nursing home team made sure his care team involved a more consistent and smaller group of male staff. They dimmed the lights and played music to create a comfortable care environment for him. If he was not responding well to the care routine they would stop and give him space and time.”

The music has been “very soothing” for Cromwell because “he used to play guitar,” Latanya explained.

“The new routine works for him and he enjoys the music, of course,” she said. “When you see his hand or his foot going, you know he’s enjoying himself.”

“After many gospel songs, and earning his trust, we were able to reduce to additional staffing,” d’Entremont added.

“As we fall more in love with Chase we learn more about him, including his love for animals and gospel music. Chase was fearful initially; now he feels safe and secure here. He even visits the hairdresser for haircuts.”

Chase also uses Skype at Mountain Lea Lodge to connect with his wife and daughter, who now live in Ontario.

“When my grandmother gets to see him it lights up her face. The first time they used Skype it was on my birthday,” Latanya said. “It was the best birthday gift ever.”

“Needless to say we are so proud of the work my staff and NSHA continuing care staff accomplished with this sweet man and we are in tears most days to see how well he is doing,” d’Entremont said.

“I was panicking when staff asked to take him off site to a Halloween dance; I thought it was too soon. But he had a blast! It shows that when everyone comes to the table with the person at the centre anything is possible.”

Bennett continues to set up regular behavioural support meetings with staff at Mountain Lea Lodge, as well as other long-term care facilities in the Annapolis Valley.

Melissa Gosse, site manager at Orchard Court Shannex, shared how the sessions allow her team to implement creative solutions to improve the quality of life for the residents at her facility.

“We now use Velcro fireplaces across door frames to monitor and deter wanderers from other resident’s doorways. Residents who wander just walk right on by. We even take black tape and create the appearance of holes so residents don’t wander in those areas. We never would’ve come up with that on our own. There are other things you can do.

“You don’t need to jump straight to medication. It’s a matter of being open-minded,” Gosse said.

NSHA’s 11 continuing care behavioural resource consultants work with the continuing care coordination team, home care agencies and long-term care facilities across the province. They help teams and organizations understand responsive behaviours related to dementia and assist them with providing appropriate and safe care that leads to improved quality of life.

Mobilizing teams to work collaboratively and find shared solutions – building on the knowledge of all partners including and especially the person and care partner – enhances capacity at the team, organization and system levels while supporting the person through transitions to wherever they call home.