Strengthening the circle of geriatric care

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Hilary Lee realized the value of good training and volunteer-patient engagement when she was attending to a distraught patient whom everyone thought was babbling in a state of delirium. After she spent some time with him she realized it was not gibberish — the elderly man was speaking French.

“My French is not excellent but I did manage to communicate with him. He ended up giving me French lessons. Together we went through French magazines and he even helped me with my pronunciation,” says Lee, a volunteer in Mount Sinai’s Geriatrics Unit

This is the story Lee loves to recount to the geriatric–unit volunteers she also helps train. Her key message: “You may have special abilities that connect you with a patient and contribute something to what we all know about that patient, and how we care for him or her.”

This belief is also at the heart of Mount Sinai’s recently established MAUVE program — Maximizing Aging Using Volunteer Engagement — a unique model of care focused on one-on-one engagement. MAUVE is designed to prevent functional and cognitive decline among older patients by improving their quality of life during their stay in hospital.

What is MAUVE?

A program specially tailored to Mount Sinai Hospital’s Geriatrics Department, MAUVE is modelled loosely on the principles of HELP (Hospital Elder Life Program), which originated at Yale University and has been implemented at various hospital sites across the United States and Canada.

Part of a strengthened strategic emphasis on enhancing the clinical geriatric programs at Mount Sinai Hospital, MAUVE was developed by Occupational Therapist Jenny Carr and Social Worker Raynia Sauvageau, who were exploring effective ways to meet some of the non-clinical needs of their patients and help them maintain function. “Volunteer Services was also looking for more concrete activities that volunteers could be involved with in the Nursing Units, since volunteers enjoy working within a defined structure with increased direction from clinical staff,” says Joanne Fine-Schwebel, Volunteer Services Director.

The primary purpose of MAUVE is to offer an integrated continuum of care to elderly patients with the help of trained volunteers who work closely with hospital staff. “MAUVE also provides volunteers with training, structure and support, which in turn makes their experience a lot more fulfilling and satisfying,” Fine-Schwebel adds. Sixty volunteers have already received the MAUVE training.

Volunteers are screened for their interest in spending time with senior patients, and their social ability and desire to connect with people. “Our geriatric volunteers all share that longing to really personalize their work and get to connect with people at a deeper level than just routine interactions. They are also seeking guidance on how to make these often-challenging connections.” Fine-Schwebel says.

Training entails a three-hour session that acquaints volunteers with the myths and realities of aging. It also provides tips on communicating with patients unable or unwilling to communicate. The second stage is comprised of hands-on training.

Starting in September, the University of Toronto will provide an opportunity for volunteers to learn from skilled actors who simulate real-life geriatric situations, through the Standardized Patient Program.

Lee, who teaches volunteers how to unobtrusively encourage aging patients to keep up with simple routines such as brushing their teeth, combing their hair or washing their face, says the key lies in helping patients maintain a degree of independence and a sense of dignity.

In addition to grooming, nutrition and hydration training, volunteers are also trained on how to encourage patients to reminisce about past experiences, and determine their levels of orientation with space and time. Pet Therapy visitors and their dogs are an important part in breaking down communication barriers and helping with engagement.

Adding the Personal Touch

The importance of reminiscence for older patients hit home for Lee when she encountered a patient susceptible to uncontrolled bouts of anger. Lee gently steered the patient away from the present and engaged her with questions about her family and her past. “Within an hour, the patient transitioned from yelling at everybody to showing me pictures of her grandchildren and sharing her sadness over the death of her husband.”

MAUVE also encourages volunteers to be creative and to tailor their services around the individual passions and interests of their senior charges. For example, one volunteer hung a map of the world in the room of a patient who used to be an avid world traveler. At every visit the volunteer would point at an area on the map and the patient would fondly relive stories, experiences and memories from that part of the world. Another volunteer brought in gardening books and videos for a patient with a penchant for gardening.

To enable such one-on-one engagement, volunteers keep a log book in which they diligently record patients’ hobbies, likes, dislikes and specific needs. The book also maintains volunteer experiences with different patients so as to offer continuity of care when a patient gets assigned to another volunteer.

This personalized service extends even to the final goodbyes as volunteers present hand-knit shrugs and lap blankets to patients that they can keep upon discharge.

MAUVE was made possible through a generous five-year pledge by a donor who set it up in honour of his mother’s (also a Mount Sinai volunteer) 80th birthday.