The York Care Centre

Long Term Homes Across Canada Collaborate to Improve Care for Seniors

Across Canada, more than one-in-four long term care residents are on antipsychotic medication without a diagnosis of psychosis. These strong medications are often prescribed to reduce challenging behaviours and resistance to care by people with dementia, but have a sedating effect and can cause serious harms such as falls and unnecessary hospital visits. Rates of antipsychotic use in long term care homes vary greatly between jurisdictions, from just over 20 percent (in Alberta) to almost 40 percent (in Newfoundland and Labrador), pointing to the potentially inappropriate use of these medications.

In 2014, CFHI launched a pan-Canadian quality improvement collaborative to support the appropriate use of antipsychotic medication, working with 15 teams spanning 56 long term care (LTC) facilities in seven provinces and one territory. Participating teams of healthcare professionals used patientcentred, data-driven approaches to manage the disruptive behaviours that can be associated with dementia. Frontline staff tailored services, replacing these medications with approaches such as music, pet or recreation therapy. CFHI provided the teams with training, funding, expert coaching and a platform for peer to peer learning.

The collaborative had its roots in CFHI’s EXTRA: ExecutiveTraining Program. Joe Puchniak and Cynthia Sinclair – at the time both managers with the Winnipeg Regional Health Authority Personal Care Home Program – designed an initiative to help multi-disciplinary teams of healthcare providers better use data. Based on the success of the WRHA initiative, and with the help of Joe and Cynthia, CFHI set out to spread these person-centred approaches to the appropriate use of antipsychotic medication in residential care.

After only one year, more than half of residents in the pan- Canadian collaborative had their inappropriate antipsychotics discontinued or significantly reduced without any increase in abusive or inappropriate behaviours. Equally impressive among these residents, falls decreased by 20 percent. And many families of residents reported being grateful to have their relatives become “more like themselves.”

If the results of the CFHI initiative were scaled up nationally, over the first five years an estimated: 35,000 LTC residents per year would have their antipsychotics reduced or discontinued, 91,000 falls would be prevented and $194 million in direct healthcare costs would be saved.