By: Dr. Morris Freedman, Head, Baycrest's Division of Neurology and Scientist, Baycrest's Rotman Research Institute
A common challenge for individuals living with dementia, and the people who care for them, is the presence of neuropsychiatric symptoms. These include physical and verbal aggression, agitation, hallucinations and paranoia. They are a leading cause of hospitalization for dementia.
In early 2020, Deb Galet, then Vice President, Ambulatory Clinical Services, Long-Term Care and Chief Heritage Officer, and now Interim President and CEO at Baycrest Hospital, and I co-created Baycrest's Virtual Behavioural Medicine program (VBM) to help individuals living with dementia promptly access highly specialized care while remaining in their home. VBM works by ensuring patients who exhibit these behaviours receive appropriate pharmacological and non-pharmacological interventions. This program has not only proven to reduce pressure on acute care hospital beds, but has also avoided unnecessary and upsetting changes in patients' physical environments.
Over the next three decades, the number of people living with dementia in Canada is expected to grow by 187 per cent, reaching almost 1 million by 2030.[1] With neuropsychiatric symptoms of dementia being a main cause of hospitalizations and transitions from home to long-term care, they are one of the most costly and burdensome of the behavioural problems associated with Alzheimer's and related dementias.
As reported in the Ontario Health Coalition's 2023 report, there is no excess hospital capacity in Ontario, with vital health services being closed[2]. What's more, being uprooted and transferred to an emergency department, acute care hospital or specialized behavioural unit can exacerbate neuropsychiatric symptoms due to dementia[3], profoundly impacting the quality of care the patient receives and further encumbering Ontario's already over-burdened health care system.
VBM, a collaboration between the Sam and Ida Ross Memory Clinic at Baycrest's Pamela and Paul Austin Centre for Neurology and Behavioural Support, and the Toronto Central Behavioural Support for Seniors Program (TC-BSSP), helps reduce the pressure on acute care hospital beds by offering virtual assessment and management for individuals living with dementia in acute-care hospitals, long-term care homes or the community who are exhibiting severe responsive behaviours. The VBM team of specialists, which includes behavioural neurologists, a neuropsychologist with expertise in behavioural management, a nurse, pharmacists, other mental health professionals and the Behaviour Support Outreach team, provides a rapid response and works in collaboration with the patient's existing care team in their current location. It also extends its network to family members in the community to help them develop and implement care plans, access behavioural and social supports and provide follow-up.
VBM has been highly successful in reducing the need for admission to specialized behavioural units. We examined the first 95 patients referred to VBM and found that it successfully improved the severity of neuropsychiatric symptoms and reduced the proportion of patients who needed admission to a specialized inpatient unit by 60 per cent. This suggests that the VBM program is highly effective for managing the majority of patients living with severe neuropsychiatric symptoms of dementia without the need to physically transfer them to a specialized program, thus avoiding unnecessary and upsetting changes in their environment.
In addition, through improved patient flow, Baycrest saved an estimated $33 million from April 1, 2022 to March 31, 2023.
VBM is covered by OHIP and can be accessed from home Ontario-wide. A physician or nurse practitioner referral is required to access VBM. Referrals are processed through Toronto Central Region Home and Community Care Support Services, Behaviour Support team at Baycrest.
To learn more about VBM, please contact behaviouralsupport@baycrest.org
References
[1] https://alzheimer.ca/en/the-many-faces-of-dementia-in-canada-landmark-study-volume-2
[2] https://www.ontariohealthcoalition.ca/wp-content/uploads/final-report-hospital-closures-report.pdf
[3] https://pubmed.ncbi.nlm.nih.gov/35180119/