1. Three Parts of the Equation A holistic approach to admission in Long-Term Care

2. Disclosure Statement I am a Registered Clinical Counsellor in private practice. I was hired by Fraserview Care Lodge to design and implement the program. I am biased because I am passionate about patient and family centered care.

3. Context An admission support program was developed at Fraserview Intermediate Care Lodge. The program was developed as a response to feedback from families. The program piloted in September 2012. The program is now a regular part of every admission at Fraserview.

4. Problem What is Admission to Long-Term Care?

5. Family  Caregiver stress is not automatically relieved  Grief and loss  Guilt  Unknown  Conflict

6. Resident  Relocation Stress Syndrome  Loss of identity  Loss of independence  Family conflict  Physical decline  Loss of life as they know it

7. Staff  Stress  Feeling of incompetence  Inability to meet complex needs of families and Residents  Lack of time and resources  Increased risk for errors and miscommunication

8. Facility  Increased likelihood of complaints  “Unreasonable” requests and complaints from families  Time away from direct care  Staff stress and burnout  Errors and incidents

9. Intervention  Working with all three parts of equation.  Counselling professional with long-term care background (LPN).

10. Intervention Resident Assessment of needs Counselling to address relocation stress Education to address unknown Follow up “Friendly face”

11. Intervention Family Utilize family as a “hidden workforce”. Education to address unknown. Counselling to address crisis. Integration. Follow-up

12. Intervention Staff Communication training Admission support training Collaboration and coaching Support

13. Results Outcome measures:  Family survey  Staff survey  Management survey

14. Results Truly person and family-centered care. More time for direct care duties (100%) Families trust that facility provides the best care for their loved ones (100%) No complaints from new families. Residents adjust faster. Staff are prepared and confident about admissions (100%) Commendations from Accreditation Canada.

15. Comments from Residents and Families “Very understanding and helpful” “Alleviating my stress with counselling sessions” “We did not have this program at the other facility. It makes a huge difference in how quickly and easily my mother and my family are adjusting to this facility” “Karyna was a life savior for me in helping address mom’s questions”

16. Comments from Staff and Management “I believe the program is efficient, personal, and as problem-free as possible.” “It makes my life much easier. Residents and families are much more relaxed and supported through the process”. “It is very helpful for us to receive information about new Residents before they come in. It helps us provide person-centered care.” “I never worry about new admissions anymore”.

17. Comments from Staff and Management “Hospital information is often outdated or incomplete. It really helps for us to get up-to-date, complete information before admission”. “Family members appear a lot more calm and relaxed. They do not come to the nurses’ station with endless questions” “Residents and families trust us more” “It is great to have someone to advocate for the residents”

18. Challenges It was challenging to convince medical staff that psychological needs are important. Establishing a new practice.

19. Challenges addressed by: Staff education: -Communication Bootcamp -Transforming Admissions -Person-centered interventions for difficult behaviors 3 Cs: -Communication -Collaboration -Compromise