When Mr. X. moved into Tofield Continuing Care in July 2009, the staff soon knew by his behaviour that he was not happy. He frequently resisted care, was weepy, sad, aggressive, and rarely took part in recreation therapy programs. He also had frequent falls and tried repeatedly to leave the facility.
Today it is a different story for this senior. He now participates in 50-60 recreation therapy programs a month, up dramatically from the 10-15 that was his usual last summer and fall. His falls have been reduced to almost none. He is much more alert, more settled and although he has occasional angry outbursts, staff know how to intervene so that behaviours do not escalate and they can readily calm him. For example, they know that often when he gets restless, a warm pack on his neck and some 1:1 time with a staff work wonders. Janice, the Recreation Therapist says that “the sensory stimulation program and yes, the individual visits, massages, and attention really help him feel less helpless and less depressed.” One RN, Lynn, said he greets visitors cheerily and often even when they thought he was dozing he surprises them with comments about what has been going on around him.
When Mr. X. had his second MDS-RAI 2.0 assessment, the team saw a jump from 3 at the initial assessment to 9 in the Depression Rating Scale (DRS) score. In February they saw he was also having daily pain and considerable aggressive behaviour. Antidepressant therapy and a regular pain management regimen were implemented. His pain improved; from a score of 2 in February 2010 it went to and stayed at 0 and over time, repeated assessments showed the DRS score declined (to 2 and 3 on the last two assessments). Gradually the antipsychotic medication he was on was reduced to a quarter what it had been. He still has some trouble getting a good night’s sleep and staff continue to look for ways to make his life better.
At the recent resident/family conference his daughters said they were thrilled to see such a change in their father. They believe he is very happy now. Never one for a lot of group activity, they expressed amazement at all of the activities he now does daily and are grateful to the staff for the impressive turn around in their dad’s behaviour. When told about how he seemed to like the heat around his neck, his daughters stated “Dad used to operate heavy equipment - he had bad neck pain for years.”
The Continuing Care Manager, Phyllis, attributes this success to teamwork. “The staff here is great! They really care about each resident, and they treat them like the individuals they are, with unique needs. Our staff are very caring people; they get to know the residents well and they work together.”
By using their excellent clinical skills and reviewing the MDS assessment information, the interdisciplinary team was able to “put the picture together” and respond. They found the appropriate combination of medication and other therapies and all the caregivers are involved, using a consistent approach. “It is a bonus to see the MDS results reflect so well what we as a team can see is a great improvement in Mr. X’s quality of life” stated Diane, the physiotherapist on the team.