Senior friendly: Recognizing unique needs of seniors

Becoming a Senior Friendly Hospital requires an approach to health care that utilizes a multi-pronged framework and a corporate strategic focus to support senior friendly initiatives, education and training for staff. It also requires a shift in culture to recognize the unique needs of seniors and encourage adoption of new attitudes around the care of seniors across the organization.

To support their ongoing work towards becoming a Senior Friendly Hospital, St. Joseph’s has developed a Senior Friendly Hospital Steering Committee to ensure they provide quality care for seniors throughout their hospital experience to support their journey along the health-care continuum.

“Like many hospitals, this body of work was developed because we are very interested in how we are providing senior friendly-focused care to our patients and how we are working to teach each other about what senior friendly care really means,” says Catherine Cotton, Administrative Program Director, Medicine, Ambulatory and Seniors’ Health Program.

The prime objective of the new committee is to develop, implement and evaluate a framework that facilitates the evolution of senior friendly care at St. Joseph’s – and builds on the work they have done over the last several years to enhance how we provide care to meet the unique needs of elderly patients.

The first initiative that the committee undertook was to identify a pilot unit in the hospital where new, senior friendly ideas could be trialed, and develop what those ideas would look like. The committee asked for volunteers for the pilot, and ultimately chose the Emergency Department. “Since the Emergency Department (ED) is the first place many seniors in the community come through for care and because of the increasing number of elderly patients we see in the ED, it made sense to make it the pilot unit,” says Stella Cruz, the department’s Geriatric Emergency Management (GEM) nurse.

Last year, seniors 65 years of age and over accounted for 18 per cent of ED visits, with patients 65 years of age and over representing 28 per cent of inpatient admissions to the hospital.

Feedback from staff during other quality and safety projects within the Health Centre indicates that looking at the environment and making changes that staff, patients and families can see, often promote and support cultural changes that follow. The committee decided that the first step in the senior friendly journey was to conduct an environmental audit of the ED. “The audit looked at a variety of key elements, like flooring, lighting, equipment, signage, hand rails, and washroom access – actually describing the physical environment as it exists now, and just how accessible it is for our elderly patients,” says Cotton.

A validated tool (developed by Fraser Health, British Columbia) was used by a member of the committee and the department’s Clinical Care Leader to conduct the audit. It utilized a series of questions, such as, “Are all lights in the unit in working order?” or “Does the floor have a non-glare, matte finish?” or “Is signage at eye level and in large print?” in order to focus the audit on key environmental concerns.

“Through the audit we realized that there is a great opportunity to improve physical aspects of the environment,” says Cruz. The committee has now developed a framework to assess the degree of impact of each change relative to the cost of making the change. In addition, it is partnering with the Facilities and Redevelopment Departments, as well as the Accessibility Committee, to ensure that any changes implemented also meet accessibility legislative requirements.

The committee also wanted to trial education modules for staff in the pilot unit that would highlight physical, cognitive, and social issues they should be aware of when caring for elderly patients. The modules are meant to provide ED staff with information on issues such as falls, skin care, mobility, cognition, dementia and delirium, social supports and polypharmacy – all of which could have an impact on the care of seniors in the hospital setting.

“In order to accommodate the hectic pace within the ED, the format used was a brief, ten minute session or “huddle” with the staff on each issue, which included a pre and post test to see if the knowledge was captured,” says Cotton. Being aware of these issues is key to providing care that is senior focused.

Cruz leads the dementia and delirium modules, which have been successful with staff. Through the sessions, Cruz teaches what the difference is between delirium and dementia, and what staff should look for to identify these conditions in patients. She explains that 25 per cent of elderly patients coming to the Emergency Department are affected by delirium, so enhancing education for staff on this issue is critical.

Over the next few months, the committee will be rolling out environmental audits and education modules to all units across the hospital.

“Our focus on seniors’ care at SJHC is a priority in our strategy to Put Patients First and Enhance the Health of the Communities we Serve, with seniors being one of the largest populations for whom we provide care,” says Cotton. “The development of a senior friendly health-care centre goes beyond having large print signs and literature, non-glare lighting, and wheelchair accessible washrooms. It requires a cultural shift in the way that we think, act, train, and lead the development towards becoming a more senior friendly health-care system. Ultimately, we hope that the Senior Friendly Steering Committee helps us to continue to support our goal of becoming a leader in providing integrated care and services for the seniors in our community.”