Older people with cognitive impairments due to mental health problems, addictions, dementia, or other neurological conditions often exhibit responsive or challenging behaviours such as aggression, wandering, physical resistance and agitation. These behaviours, which occur whether the person is living at home, in acute care or in long-term care are a major source of distress to the person with the behaviour, family caregivers and others providing support.
We call this behaviour “responsive,” because it is not unpredictable, meaningless aggression or agitation, but is due to circumstances related to the person’s condition or a situation in his or her environment. Although people with responsive behaviours and their caregivers need high levels of support, sadly it is often inadequate or even non-existent. The number of people with cognitive impairment is growing, which places further strain on individuals and the entire healthcare system.
• Everyone is treated with respect and accepted “as one is”
• Person and caregiver/family/social supports are the driving partners in care decisions
• Respect and trust characterize relationships between staff and clients and care providers.
Supporting principles bring these concepts to life for those making daily decisions about care:
1. Behaviour is communication: Behaviours are an attempt to express distress, solve problems or communicate unmet needs. They can be minimized through interventions based on understanding the person and adapting the environment or care to satisfy the individual’s needs.
2. Diversity: Practices value the language, ethnicity, race, religion, gender, beliefs/traditions, and life experiences.
3. Collaborative care: Accessible, comprehensive assessment/interventions include shared interdisciplinary plans of care that rely on input and direction from the client and family members.
4. Safety: A culture of safety and well-being is promoted where older adults and families live and visit and where staff work.
5. System coordination and integration: Systems are built upon existing resources and initiatives. Partners to enable access to the range of needed, integrated services and supports.
6. Accountability and sustainability: The accountability of the system, health and social service providers and funders to each other is defined and ensured
Pillar 1 - System Coordination and Management
Coordinated, cross-agency, cross-sectoral collaboration and/or partnerships based on clearly defined roles and processes are required to facilitate seamless care.
Establish system management through a coordinated network of service providers and regional coordinators with accountability to Local Health Integration Networks (LHINs)
Initiate integrated, collaborative intake, transitions and referrals.
Pillar 2 - Integrated Service Delivery
Integrated Service Delivery: Intersectoral & Interdisciplinary
Outreach and cross-sector interdisciplinary transitional teams across the continuum enable equitable and timely access and transitions to the right provider for the right service
Introduces collaborative/shared care service delivery through mobile interdisciplinary cross-sector and system support teams, case management and intersectoral frameworks and communication vehicles
Value the least restrictive / intrusive approach: enhanced approaches and services that promote early detection and health promotion; specialized residential treatment.
Pillar 3: Knowledgeable Care Team & Capacity
Knowledgeable Care Team & Capacity Building
Education and training strengthen the capacity of family caregivers and professionals. The goal is person-directed care, prevention and early detection; implementation of standardized best practices in behavioural health; and continuous quality improvement.
Help families make informed choices
Create supportive learning infrastructures and foster collaboration between individuals, teams, organizations, systems
Nurture cutting edge research and apply new technologies
Support efficient, effective use of human resources and evidence-based decisions.