Better care for veterans living in long term care

The Challenge: Improve the assessment and treatment of pain

According to medical literature, older people often suffer unnecessarily due to under-assessment and under-treatment of their problems, including pain. In fact, the prevalence of pain among the elderly is the highest for those living in long term care (LTC) homes, often because they are unable to self-report their pain. Over several years, daily and ongoing care at the Camp Hill Veterans’ Memorial Building in Halifax, Nova Scotia has become increasingly complex as more people arrive with multiple, complex, multi-system chronic diseases, including dementia. A satisfaction survey completed with veterans and their families identified pain management as an area that required improvement. In addition, Accreditation Canada recommended during a recent accreditation survey that the facility implement tools to assess pain in individuals who are cognitively impaired.

The Improvement Project: Develop a pain assessment protocol and philosophy of care

Elsie Rolls, Director of Veterans Services at the facility, launched her EXTRA improvement project with the support of an interdisciplinary team— veterans, their families, staff and other experts—to develop and implement a formal pain assessment and management program and new approach for the elderly.

The Result: Daily Flow Records a key element of pain-management strategy

The team collected data about pain-management, the prevalence and intensity of pain experienced by veterans within the LTC facility, as well as pain management strategies. It also revised the “Daily Flow Record” used by nurses at the facility to include pain assessment and documentation, as a lack of pain assessment is the greatest obstacle to managing pain. Finally, Rolls and her team developed an education program for pain assessment and management as well as a new philosophy of care with input from Veterans Affairs Canada. The facility is now using formal tools to assess pain-management strategies and the effectiveness of pain treatment. 

Impact: Satisfaction unanimous among residents and program widely applicable 

Since introducing its pain management approach, satisfaction among residents and their families has improved; follow-up assessments show from 99 to 100 percent rates of satisfaction. The improvement team has continued to develop this pain-management program to include spiritual, emotional, social and psychological aspects of pain. It has also developed and implemented an interdisciplinary orientation program that incorporates the care and service delivery philosophy and the pain program. This work is highly applicable to other organizations caring for elderly individuals, particularly those who have cognitive challenges. Capital District Health Authority, where Roll’s facility is located, is using this work to broaden its pain-assessment strategies for individuals who cannot reliably self-report their pain.

Elsie Rolls image

Elsie Rolls
Director of Veterans Services
Camp Hill Veterans’ Memorial Building
Halifax, Nova Scotia


To learn more about this project or the EXTRA program, visit or email us at