Support for Residents with Complex and Challenging Behaviours

September 2010- The Behavioral Support Systems Project is nearing the end of Phase 1. This three phase project began in January 2010 with the goal of improving the lives of people with behaviours associated with complex and challenging mental health, dementia or other neurological conditions, living in long-term care homes or in independent living settings in Ontario. The Project has 7 objectives:

1. Improve the care of persons with complex behaviours.
2. Develop policy congruence across the system – community, long-term care, acute care, and mental health and addictions.
3. Improve the integration, alignment, and availability of care across the system, including not-for-profit, for-profit and private partnership models.
4. Improve the efficiency, effectiveness and accountability of the existing resources and programs.
5. Ensure people are served in the least restrictive and least intrusive environment with the most efficient use of resources required for appropriate care.
6. Engage health service providers and other stakeholders in the project.
7. Enable the Local Health Integration Networks to assume a leadership role in developing a system plan and performance measures.

The first phase (January to October 2010) involved laying the foundation. This included defining the target population, collecting information on and building an inventory of behavioural support initiatives across the province, and proposing a system model based on best practices. The priority target population has been identified as "older adults with complex and responsive behaviours associated with cognitive impairments due to mental health, addictions, dementia, or other neurological conditions and their caregivers."

The Project has proposed guiding principles for the Behavioural Support Systems model. A key guiding principle proposed is that of person and caregiver directed care. All persons must be treated with respect and acceptance. The older person and the caregiver have a central voice and are the driving partners in care and life goal decisions.

Phase 2 is to begin in November and will involve demonstrating and testing the potential of specific interventions to improve outcomes. The final phase of the Project will examine how to implement these interventions throughout the system.

The BSS Project is much-needed and long-overdue. We hear many sad stories from people who are living with, caring for, or just trying to find an appropriate resource for, someone with challenging behaviours. We know that long-term care homes struggle to meet the needs of residents with behavioural issues while keeping other residents and staff safe. We are not sure that a long-term care home is the most appropriate placement for applicants with severe mental health issues and behaviours, but we see few other options at the moment. Concerned Friends strongly supports this initiative and we urge the Ministry of Health and Long-term Care to continue to support Phase 2 and Phase 3 as planned.

We know of at least one long-term care home that has recently opened a behavioural support unit where long-term care residents with behavioural difficulties can be assessed for the "triggers" that lead to difficulties and with this identification appropriate care can be given.

The BSS Project is being led by North Simcoe Muskoka LHIN, the Alzheimer Society of Ontario , the Alzheimer Knowledge Exchange, and the Ministry of Health and Long-term Care. Concerned Friends has been involved in consultations and workshops sponsored by the Project. To learn more about this important initiative see www.bssproject.ca

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