The Best Possible Care

The Best Possible Care – Forest Dale Home Inc.

Forest Dale Home Inc

Forest Dale Home Inc. first opened in 1980 as a rural facility in Albert County over 50km from Moncton, New Brunswick. While the nursing home originally began as a 40-bed facility, over the last 30 years it has evolved to its current role as a valuable community-centred resource. It actively supports the community by offering dental and foot care services; the facility’s van is used by a ride-sharing non-profit; and more recently, Forest Dale joined Phase 2 of CFHI’s New Brunswick Appropriate Use of Antipsychotics (NB-AUA) Collaborative.

The NB-AUA collaborative is a fully bilingual program that brings together inter-professional teams from nursing homes across the province to improve appropriate prescribing, enhance the resident and family experience, and build capacity to lead healthcare quality improvement.

Vicki Caissie is Forest Dale Home Inc.’s administrator and a strong believer in keeping the rural facility highly involved in all provincial initiatives.

“It’s important that Forest Dale Home stay current on best practices. It’s important to ensure our residents receive the best possible care,” Caissie says.

Changing the culture

Currently, Forest Dale has 14 residents out of 50 taking antipsychotics without a diagnosis of psychosis. The nursing home hopes to reduce this number to seven with the help of the NB-AUA initiative.

The AUA approach focuses on person-centred strategies and relies on teamwork, data and communication.

Part of this means involving all nursing home staff in training and education related to the AUA approach. “We plan to train 100% of staff from all departments using the Dementia Practical Education for Teams (PET) modules,” Caissie reports.

The PET modules were originally developed as part of the pan-Canadian AUA collaborative to provide a clinical framework and education on person-centred approaches to dementia care for care aides.

Forest Dale also plans to host weekly “cup of knowledge” education sessions and have a Gentle Persuasive Approaches in Dementia Care (GPA) trained coach on staff. GPA is an evidence-based training program for people who care for older adults with dementia and their challenging responsive behaviours.

“We are looking at using GPA for addressing resident agitation,” Caissie explains. “This will help with our process for new admission medication review and reassessment within six weeks of arrival.”

The nursing home has focus on resident-centred approaches to care by increasing staffing to its activity department by 50%. The activity department will lead the programming while all departments will be used for diversional activities.

A network of many

In May 2017, 43 nursing home organizations across New Brunswick joined the second phase of a province-wide effort that began in 2016 with 16 homes adopting resident-centred, non-medication approaches to manage the challenging behaviours associated with dementia.

That idea of being a part of something bigger is a game-changer for Forest Dale. Caissie says that Forest Dale Home feels privileged to be part of this provincial and national movement, and that “despite being small and rural,” their nursing home is still able to provide a superior national level of care.

“The network [of the NB-AUA] is crucial for the success of the program,” Caissie says. “Alone we might become complacent, but as a community we will feed off each other’s successes.”

Coming together

Engaging inter-professional staff and families is playing a major role in Forest Dale’s improvement initiatives within the NB-AUA.

The team is structured in a way that sees direct care staff, management, clinicians and family members working together.

Caissie explains that while the project is supported by management, it is driven and led by a registered nurse, which will help get the necessary buy-in from the team.

Other members of the team include a nursing unit clerk as the data recorder and a local pharmacist who is involved in the NB-AUA at another nursing home – which will help Forest Dale benefit from experience elsewhere. A family member of a former resident has even decided to join the team.

“With the involvement from the pharmacists, nursing unit clerk and RN, we can identify and address medication needs, which will then be communicated during physician rounds.”

The initial kick-off for the NB-AUA at Forest Dale was held at the nursing home’s annual general meeting and included a presentation on AUA and what would be happening.

Caissie reports that the families of the residents identified for the project will meet with staff on a one-on-one basis, and the residents’ progress will be reported at resident and family meetings.

Overall, Caissie believes that Forest Dale can look forward to great communication between their inter-professional team, families and residents due to the small size of their facility.

With Phase 2 of the NB-AUA just beginning, Caissie is excited for the future of Forest Dale Home’s residents.

“Our residents already enjoy a high level of functioning and interaction. At our latest provincial inspection, the liaison officer stated ‘your residents are so alive’. This can only get better with the implementation of the AUA!”