The importance of providing excellence in seniors care has been highlighted during COVID-19, with older adults suffering from deconditioning and social isolation (Regional Geriatric Program of Toronto, 2020). Prioritizing senior friendly principles of care is necessary to help to prevent hospital-acquired harm through preventative and proactive care.
At Trillium Health Partners (THP), excellence begins with a focus on strengthening foundations of care across the organization to ensure an 'always' experience for patients. Prior to the pandemic, THP had developed senior-friendly standards of care – focusing on areas such as functional mobility, cognitive function, medication and pain management – embedded as foundational practice across its programs through THP's practice councils and local leadership. As well, over 900 point of care staff received education in Gentle Persuasive Approaches (GPA), further building capacity for person-centered dementia care.
When the pandemic hit, THP's ways of providing care changed; interactions with patients were shorter and mobilization outside of the room was discouraged due to infection prevention and control measures. However, the groundwork laid through foundational care helped to prepare staff for these changes.
"During COVID-19, the majority of our patients have been geriatric," highlights Karen Simpson, a geriatric psychiatry Nurse Practitioner (NP) with the Seniors Mental Health Outreach Team who was deployed as an internal medicine NP to support COVID-19 and alternate level of care (ALC) units during the first wave of the pandemic. "In the early weeks, our patients with dementia were highly disoriented from staff's Personal Protective Equipment (PPE) and functional decline was a major issue, given that they were isolated in their rooms. Over the past 8 months, we've focused on bringing evidence-based geriatric principles to our COVID-19 and ALC patient populations, ensuring that there was alignment in these unique contexts."
Weaving a seniors' focus into standards of care has helped ensure a holistic approach to supporting patients. For example, to help an elderly gentleman, Mr. J, celebrate his 88th birthday on one the COVID-19 units, staff in PPE gathered by his bedside to sing with his family over the phone. It was quite a poignant and emotional moment. Mr. J passed away the following day, and the family expressed deep gratitude to the staff for serving as their 'surrogate family' and considering all aspects of Mr. J's unique wishes and needs.
Specialized and advanced practitioners are committed to continue building upon senior friendly care through ongoing staff education, mentorship and leadership. "COVID-19 has enabled us to get more creative with how we engage staff in providing excellent care for older adults," says Ms. Simpson. "As a team, we've been using Zoom to keep patients connected with their families, working more closely with Spiritual Care to support patients' full mind-body-spirit, and engaging around goals of care the moment a patient arrives in the Emergency Department (ED). I've been able to build deeper connections with our Long-Term Care partners, and witnessed the growth in our staff around senior-friendly care."
THP continues to iterate and revise its approaches as the current landscape changes, knowing that its standards of care efforts have helped build a common understanding and focus on the needs of older adults during this pandemic.
REFERENCES
Regional Geriatric Program of Toronto (2020). Policy Brief: Guidance for hospital senior leaders as they redesign care in pandemic times and beyond. It's time to Change the way care is provided in hospital for older adults with frailty, Senior Friendly Care, 1-4.