Behaviour Supports for Seniors: Opening a digital window to behaviour supports for people with dementia and their caregivers during the COVID-19 pandemic.

March 05, 2021 The Behaviour Supports for Seniors program (BSSP) for TC-LHIN , housed at Baycrest, is a provincially funded program which recognizes that all behaviour has meaning and that responsive behaviours are often a form of communication of an unmet need.  

  









Linus Fan Ip - Clinician Leader (left) and Cara Macanuel - Occupational Therapist and Behavioural Specialist (right)

“Many clients with dementia have struggled with understanding the new changes and precautions due to the pandemic. Self-isolation and reduced access to programs present added risk for clients who may wander for various reasons. Communication became hard and at times frightening due to use of masks, and many people with dementia have had challenges comprehending the concept of physical distancing,” says Einat Danieli, clinical manager, TC-LHIN-BSSP at Baycrest.
 
Throughout the pandemic the Behaviour Support clinicians at TC-LHIN have continued to provide support virtually and physically within the community, in acute care and in nursing home environments for  clients with dementia and their families, as well as coaching staff in managing these challenging situations.
 
With attempts to minimize traffic and exposure during the pandemic, the Behaviour Support teams were called to assist patients with dementia and their caregivers, as well as their care teams in both community and long-term care settings.
 
Building on Baycrest’s pre-existing experience and capabilities for virtual engagement of patients and families, the Leadership Office of the Behaviour Support for Seniors Program (BSSP) for TC-LHIN, located at Baycrest, amplified and spread these capabilities to enhance behaviour support in the TC-LHIN region throughout the pandemic. The BSSP Coordination Office has provided all 36 nursing homes with iPads to enable access to behaviour support services, behaviour support education and even to be used internally for team behaviour rounds and access to other specialized care. The same capability was mirrored for the Community Behaviour Support Team (CBSOT) by bridging access to technology through loaner devices, as well as by providing access to Baycrest trained volunteers to help coach family caregivers on the use of the device and various platforms so that they could access the service along with other online tools to support their ability to care for someone with dementia.
 
The team was initially somewhat nervous about how this transition to the virtual care environment would unfold and impact the relationship with their clients. While this impact has yet to be more formally assessed, the team reports some successes and benefits to this new virtual access by being able to respond quickly and efficiently to client needs.
 
Such is the case of a client in the community who was referred to our Community Behaviour Support Outreach Team (CBSOT) by a retirement home for responsive behaviours that included hitting, yelling, delusions and hallucinations.
 
Cara Macanuel, CBSOT Clinician, received the referral. She initiated virtual contact with family members and members of the circle of care, including the retirement home staff, general physician, TC-LHIN community pharmacist and geriatric psychiatry. In her assessment she realized that the resident’s behaviours were mostly associated with heightened anxiety during meal time. The resident’s family  did not agree on the approach to care. Using the Ontario Telemedicine Platform, Macanuel was able to bring together the care team and the resident’s family to discuss non-pharmacological and pharmacological interventions to address the resident’s needs and provide education regarding the recommended pharmacological treatment prescribed by the physician.
 
This intervention, while virtual, was effective in helping the care team and family members get on the same page, successfully implement recommendations, and bring the case to a positive outcome with significant improvement in the client’s well being. 
 
Another case involved a 76-year-old client with vascular dementia with a dominant symptom of apathy and cognitive changes. One of his children became his primary caregiver after his wife passed away. His other children would visit to give the daughter a break from time to time. He was referred to the service due to his inability to accept assistance in his personal care. In order to minimize risk for exposure, Linus Ip, CBSOT Clinician, attempted a virtual connection as a first means of contact.
 
“Many families are not ’digitally ready’ for a variety of reasons (e.g., finance, education level, etc.).  Some caregivers have never learned how to use a tablet or computer before, and/or cannot afford internet service and a device. At the beginning of the pandemic, CBSOT clinicians could only connect with these families and clients by phone, limiting opportunities for direct observation and interaction,” says Ip.
 
By providing a tablet, volunteer support, and coaching through Baycrest, the family has become “virtual ready” to access behaviour support services. Using the Ontario Telemedicine Platform, Ip provided the caregiver with intensive psychoeducation and coaching on how to apply modified communication/approaches with her father and brought the whole family together for an education session on strategies and therapeutic engagement to address symptoms of apathy and resistance to care.
 
“You have been wonderful! You listen and really understand how to talk to caregivers. You… go out of your way to inform us about my dad’s conditions and how we can help him. The iPad is great. It allows us to meet with my two brothers and sister at the same time. This meeting has helped us a lot. Now my siblings can come to terms with the fact that our dad needs help and we have to all work together. I already see we are making changes. My brothers now try to get my dad to move and I try to use your strategies when I help him. Thank you!” said the caregiver.
 
With the initiative to support caregivers in adapting digital technologies, caregivers lacking means for virtual connection can now access iPads and receive volunteer coaching to set up and use it. 
 
While virtual care does have some limitations, clinicians can use virtual capabilities to interact with clients and caregivers, and conduct observation and assessments of behaviour. 
 
“This has helped tremendously with building working relationships, and for our behaviour assessment and intervention,” added Ip.