Person-centred dementia care brings Newfoundland woman out of the fog

Donna Clothier has been a hardworking perfectionist for most of her life. From the western Newfoundland community of Codroy Valley, where she knew virtually everyone, Donna worked as an x-ray technician, a telephone operator and the area’s postmaster.

“She raised our two daughters, worked hard, dug in the yard and gardened, and made sure everything was just so,” said David Clothier, her husband of 52 years. “There was nothing Donna wouldn’t do – or at least try.”

In 2012, Donna and David’s ordered world began to change as Donna showed signs of dementia. “Doctors told me I should find a residence for her, but I didn’t want to,” said David. “I wanted to keep her at home for as long as possible.” In early 2018, David was so challenged by Donna’s responsive behaviours that he worried for her safety. Donna was admitted to an acute care facility where an antipsychotic medication was started due to here responsive behaviours. She was later transferred to a Bay St. George Long Term Care Centre where she became a participant in the AUA Collaborative.

Responsive behaviour is a term that describes behaviours of people with dementia when they represent how their actions, words, or gestures are a response and expression of something important about their personal, social and physical environment 1. This behaviour includes agitation and severe verbal or physical reactions that can be in response to pain.

By September 2018, Donna had been assessed, placed on antipsychotic medication and moved into the Protective Care Unit at Bay St. George Long Term Care Center in Stephenville Crossing, Newfoundland. But she wasn’t happy in her new home. Staff noticed physical and verbal responsive behaviours that led them to increase Donna’s dose of antipsychotics.

“At that point, we had to send four staff members into her room to do her daily care,” said Kathleen McCourt, Resident Care Coordinator at Bay St. George. “Her responsive behaviours were putting her and the staff at risk.”

With the increased dose, Donna was in a fog, said David. “It was like she was in a trance. She didn’t know me and she didn’t interact with anyone.”

In June 2018, Bay St. George became one of 39 long term care homes in the province to join an 18-month Appropriate Use of Antipsychotics (AUA) collaborative between CFHI and the Government of Newfoundland and Labrador. The goal was to improve dementia care by reducing the inappropriate use of antipsychotics and the risks associated with their use such as worsening cognitive functioning, confusion, dizziness, sleepiness, stroke and increase risk of falls.

McCourt said Bay St. George identified six residents who may benefit from a lower dose. After participating in a CFHI-led conference call and major kick-off campaign in the region, Bay St. George began to educate staff about AUA.

“We educated staff on what was causing the residents’ responsive behaviours so we could develop a system for managing them,” said McCourt. Staff were shown how to use the Dementia Observation System tool, which tracks a resident’s behaviour 24 hours a day over one week to determine their behaviour patterns. The tool’s system of colour-coded and numeric entries helps identify specific triggers as well as periods when care strategies are most helpful.

“Maybe somebody doesn’t like to be washed at 8 o’clock in the morning. Or perhaps they don’t feel like talking at the moment you’re trying to get them to answer a question. They may not want to eat a specific food type or are used to listening to a radio before settling to sleep” said McCourt. “We need to get to the source of the responsive behaviour and see if we can work around it before we resort to medication use.”

The goal at the Bay St George was to reduce the dose of medication by 25% every three weeks if there were no concerns noted with the resident following the review of the electronic chart and discussion with staff members. As we began tapering the medication dosage for Donna we noted she became more mobile and was able to move about the unit safely with a steady gait. Staff became aware that she responded better to one perhaps two staff members to provide care and that the overcrowding of staff were perhaps the cause of responsive behaviours.

As Donna became more alert, she was able to feed herself and was receptive to assistance from staff when needed.

“We have seen a success with the reduction of medication with Donna. We no longer see her biting, hitting staff, refusing assistance with personal care or not eating. Through a person-centered approach” staff were able to develop a plan of care with the assistance of the Care Coordinator that was best suited for this particular resident,” said McCourt.

“Once we reduced the meds, Donna got up and started to wander, but she’s safe on our ward, so we let her do it,” said McCourt. “She’s able to feed herself now. And when her husband is here, she’s more vocal.” Donna is also eating more and putting on weight. She’s more receptive to staff helping her in her daily care and she’s not getting into as much trouble with other residents as she did when she was exhibiting responsive behaviours.

McCourt said that since Bay St. George embraced the AUA approach, and physicians are working with the team to explore non-pharmacological approaches to care, as a way help manage responsive behaviours.

David feels buoyed by the outcome. “When Donna’s medication was reduced, she came out of that fog. She now recognizes me as someone she knows and she is more alive. She’ll even put out her hand for me to take and come for a walk. I feel like I have her back in my life.”  

Resident Mrs Madonna Clothier and her husband Mr David Clothier,

Coming out of the fog
Resident Mrs Madonna Clothier and her husband Mr David Clothier, Bay St. George Long Term Care Centre, Newfoundland & Labrador

Mr David Clothier  with Resident Care Coordinator, RN, Kathleen McCourt  and resident Mrs Madonna Clothier

Enjoying activities that are meaningful and help create a safe and supportive environment.
Mr David Clothier (left) with Resident Care Coordinator, RN, Kathleen McCourt (centre) and resident Mrs Madonna Clothier (right), Bay St. George Long Term Care, Newfoundland & Labrador

Alzheimer Society of Canada, 2019, Accessed via: