The growing senior population in Ontario poses unique challenges to the healthcare system. By 2046, the province will see 1.7 million more seniors, with a significant proportion affected by dementia. In anticipation of this demographic shift, Humber River Health (Humber) has taken proactive steps to innovate and implement patient-centered strategies that address the complex needs of aging adults. Central to these efforts is the comprehensive Dementia and Responsive Behaviours Capacity Building initiative, a program that has transformed care across the organization.
The Need for Change
At Humber, nearly 73 per cent of admitted patients are over the age of 65. This population is at an increased risk for comorbidities, including cognitive impairment such as dementia, with the risk of dementia doubling every five years between the ages of 65 to 84 years. Patients with dementia exhibit expressive behaviours – such as anxiety, agitation, wandering, or withdrawal – frequently creating barriers to discharge to the next care destination and extended hospital stays. These behaviours are manifestations of unmet needs, making early identification and intervention critical for improving outcomes.
Recognizing this, Humber launched the Dementia and Responsive Behaviours Capacity Building initiative. Over two years, this pioneering initiative focused on staff capacity building and achieving measurable resident-level outcomes, with the digitization of the paper-based tool Behavioural Supports Ontario – Dementia Observation System (BSO-DOS©), serving as one of its key enablers. Humber became the first acute care hospital in Ontario to do this, underscoring the hospital’s commitment to innovation and patient-centered care, even during the pressures of the COVID-19 pandemic.
Permission was obtained from the Behavioural Supports Ontario (BSO) head office, and the integration into Humber’s electronic medical record (EMR) was overseen by this office to ensure compliance with the intent of the tool.
Implementation of the Dementia and Responsive Behaviours Initiative
The initiative began with a pilot project on the Acute Care of the Elderly (ACE) inpatient unit in 2021, informed by stakeholder consultation and staff knowledge survey results. This immersive program combined advanced staff training with the rollout of the electronic BSO-DOS© (eBSO-DOS©), which was completed within one quarter of 2021/2022 and went live in March 2021. Nurse practitioners and clinical practice leaders partnered with LOFT’s Behavioural Support Transition Resource Team (BSTR), the Regional Geriatric Program (RGP) Toronto, and the Alzheimer Society to deliver in-depth education on dementia care and responsive behaviour management to clinical teams. Additionally, nurse champions across the hospital were supported to complete Gentle Persuasive Approach (GPA) training, led by LOFT, to further enhance their ability to care for this patient
population.
The digitization of the BSO-DOS© integrated the tool into Humber’s EMR system, Meditech. This enabled real-time documentation, data analysis, and the creation of individualized behavioural support plans. In addition, BSTR team was provided view access to support and expedite their assessment across clinical areas, thus increasing team’s capacity. Over two years, the initiative expanded to 15 medical and surgical units and two Reactivation Care Centre (RCC) units, eventually covering all medical, surgical and RCC units at Humber.
The program unfolded during the height of the pandemic, yet the Humber team remained steadfast in its mission. “Expanding our team’s skills and capacity during these unprecedented times showcased the resilience and dedication of our staff,” said Kathleen Kirk, Manager of Family Medicine Teaching Unit and Integrated Care Services. “Despite the difficulties, staff engagement and competency in managing dementia-related behaviours saw tremendous improvement.”
Between April 2022 and October 2024, daily compliance for completing the Behavioural Assessment and Care (BAC) Intervention, a crucial tool to support documentation, averaged 88 per cent. Within 24 hours of admission, these compliance rates reached 99 per cent. Feedback from over 300 trained staff indicated a significant increase in their knowledge and confidence in managing responsive behaviours.
A Model for the Future
Humber’s efforts align with the newly introduced Support for Seniors and Caregivers Act, 2024. This legislation dedicates $114 million to improving dementia care, caregiver support, and social connection opportunities for seniors. With $80 million earmarked specifically for dementia care over the next three years, Humber’s comprehensive program positions the hospital as a leader in addressing this growing crisis.
“This initiative reflects our dedication to safe, compassionate, and individualized care for seniors,” said Beatrise Edelstein, Vice President of Post-Acute Care and Health System Partnerships. “By combining technology, robust education, training, and interdisciplinary collaboration, we are creating a model to scale and spread.”
Humber’s approach has delivered several key outcomes. Enhanced staff capacity to assess and manage responsive behaviours has been a cornerstone of the initiative. This capability has led to the development of individualized behavioural support plans, which in turn have improved patient outcomes and facilitated smoother transitions to community or long-term care settings. Additionally, the reduction in restraint use and incidents related to responsive behaviours has demonstrated the effectiveness of Humber’s strategies. Positive feedback from patients and caregivers further underscores the program’s impact.
Leading Through Innovation
Looking ahead, Humber has already initiated the sustainability phase of the initiative through several targeted actions. Audits on BAC and eBSO-DOS© compliance will continue to ensure consistency and identify areas for improvement. Long-term indicators such as alternate level of care (ALC) days and post-discharge hospitalizations will be closely monitored to assess the broader impact of the program. Recognizing the importance of staff training, Humber, in partnership with LOFT, is refreshing its education initiatives to address turnover and maintain high levels of competency through a train-the-trainer and unit huddles approach. The integration of new resources from the Toronto Academic Health Science Network (TAHSN) and RGP into staff training will further enhance the program’s sustainability and
effectiveness.
At its core, Humber River Health’s Dementia and Responsive Behaviours Capacity Building initiative exemplifies the hospital’s identity as an innovator. In a society where the demands of aging populations are ever-growing, Humber demonstrates that innovation is not a choice but a necessity. By leveraging digital tools, fostering interdisciplinary collaboration, and prioritizing patient-centered care, Humber is lighting new ways in geriatric medicine.
