This panel presentation will take a closer look at three key areas of seniors health in residential care (falls, pressure sores, and meaningful engagement in everyday activities) and how collaborating with occupational therapy can lead to reducing injury, hospitalization and associated costs in residential care. Presentation will share best practices for mobility assessment and prescription, pressure sore management and prevention. It will also share experience of a BC residential care providers and OT provider to highlight a successful collaboration in action to improve health & well-being of residents/staff. Speakers: - Michelle Whitehouse, Director of Care, Zion Park Manor - Amit Kumar, Occupational Therapist and Director - Giovanna Boniface, National Director of Professional Affairs, CAOT

1. BC Care Provider Association: 2017 Annual Conference: May 30, 2017
Whistler, British Columbia
Giovanna Boniface, OT (National Director of Professional Affairs, CAOT)
Amit Kumar, OT (Owner, Life Skills Therapy)
Michelle Whitehouse (Director of Care, Zion Park Manor)
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Enhancing & Improving Health
Outcomes of Your Residents:
A Collaborative Approach to
Support Quality Care

2. Learning Objectives
1. Understand how collaboration between a
residential care provider and occupational therapy
can ↓ injury rates and hospitalization (residents
and staff)
2. Understand how the application of best practices in
mobility assessment and prescription, pressure sore
management and prevention and meaningful
activity engagement impact health and well being
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3. Learning Objectives
3. Understand how collaboration between a
residential care provider and occupational therapy
can assist the provincial government to meet health
care priorities related to residential care
4. Be familiar with the 'triple aim' framework and how
collaboration with health professionals can assist
residential care providers to pursue the three
dimensions: improving patient experience,
improving health, reducing costs of health care
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4. A little about us…
Michelle Whitehouse
Amit Kumar, OT
Giovanna Boniface, OT, CCLCP
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5. Life Skills Therapy @ Care Homes
What we offer to residents, staff, and management:
• Rehab services: OT, PT, RA/Kinesiology
• Support to staff:
-Staff training
-In-services
-Care conferences
• Return On Investment (ROI):
↑ quality of life for residents
↑ productivity
↓cost of doing business
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6. OT Role & Collaboration @ Zion Park
• ADL Assessments & Restorative Care
• Eating, Feeding & Swallowing
• Cognitive and perceptual assessment and intervention
• Adaptive equipment
• Mobility & seating
• Individual and group exercise program
• Restraint reduction
• Falls prevention
• Staff education for injury prevention (patient handling; lift
equipment selection & training; ongoing evaluation)
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7. Occupational Therapy: Enabling British
Columbians for the Occupations of Life
“Occupations” = all everyday activities that someone
needs & wants to do:
✓ Getting dressed
✓ Going to the bathroom
✓ Eating
✓ Getting around the environment
✓ Socializing
Occupations impact health and well being
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8. www.kahoot.it
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Pop Quiz

9. Setting Priorities for BC Health
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(Government of BC, 2014)

10. Setting Priorities for BC Health
➢ Broad strategy document
➢ Guides future direction
➢ Improvements to meet short & long term needs of
BC population
✓ Staying healthy
✓ Getting better
✓ Living with illness and/or disability
✓ Coping with end of life
(Government of BC, 2014)
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11. Policy Papers: Key Health Priorities
1. Delivering a patient-centred, high performing
and sustainable health system
2. Primary and Community Care (including
residential care)
3. Surgical Services
4. Rural Health Services
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12. Backdrop: Triple Aim
Simultaneous pursuit of:
1. Better care for individuals (improving patient experience e.g.
quality, satisfaction)
2. Better health for populations
3. Lower per capita costs
(Berwick, Nolan & Whttington, 2008)

13. So What?
Working collaboratively, we can improve & transform the
system of health delivery & performance to achieve goals:
➢ Supporting health & well-being of BC citizens
➢ Deliver responsive & effective health services
➢ Ensure value for money

14. Meaningful Activity Engagement:
Best Practice
✓ Lifestyle interventions (e.g. home & community safety, social
relationships, goal setting, changing routines & habits)
-Cost-effective
-Wide-scale applicability
Outcomes
↓depressive symptoms
↓pain symptoms
↑vitality
↑social functioning
↑mental health
↑life satisfaction
(Clark et al, 2011)
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15. Mobility Assessment & Prescription:
Best Practice
✓ Matching patients with most appropriate wheeled
mobility device & seating surface
✓ Avoid under-prescribing
✓ Avoid over-prescribing
Outcomes
↑functional ability
↑engagement in daily occupations
↑quality of life
(Greer et al, 2012)
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16. Mobility Assessment & Prescription:
Evidence Based Guidelines
✓ Individualized seating assessment (patient
evaluation)
✓ Individualized prescription
✓ Trained professionals with specialty in seating, off-
loading
✓ Inter-professional team approach (patient, OT,
vendor, family, residence staff)
✓ Long-term goal to preserve function
(CADTH, 2015; Requejo et al, 2015)
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17. Mobility Assessment & Prescription:
Process
✓ Patient evaluation
✓ Equipment selection & trial
✓ Equipment delivery
✓ Post-delivery training
✓ Follow-up
❖ Wheelchair skills are important predictors of life space mobility
and frequency of participation
❖ Depression is associated with poor wheelchair skills, mobility
and participation
❖ Customized wheelchairs improve wheelchair skills
(European Pressure Ulcer Advisory, 2014; Greer et al, 2012; Mortenson et al, 2012; Requejo et al, 2015)
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18. Collaborative practice:
Zion Park Manor & Occupational Therapy
• Zion Park Manor teamed up with Life Skills Therapy in June of
2016 as they offer a diverse skillset that includes occupational
therapy and a rehab assistant who is a kinesiologist.
• Elder outcomes so far?
– pressure sore reduction
– falls reduction
– improved functional mobility
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19. Nursing Assessment
MOBILITY/GAIT OBSERVATION
• How does the elder mobilize?
• Does the elder ambulate independently?
• Do they display poor balance?
• Do they require assistive devices?
• What is the history? Nurse to discuss with elder if
able, or family to identify what factors are involved
that lead to decline of function

20. Nursing assessment – Fall risk
• Identify if there is a history of falls. Factors contributed to
falling in the past? Speak with elder and their family
• Current diagnosis and medication list?
• Assess balance while seated and standing if applicable
• How does elder mobilize from one surface to the next
• Complete a fall risk assessment; note risk factors involved
• Assessment findings are also presented at care
conferences yearly and discussed with the
multidisciplinary team to create a resident specific plan

21. FH Fall Risk Assessment tool:
Adapted to Point Click Care

22. FH Fall Risk Assessment:
Adapted to Point Click Care

23. Fall Risk: Assessment Findings
• Referral are made to the OT if interventions
are required
• There are several methods of communication
for both staff and families: Communication
book at each neighborhood of Zion, email and
voicemail.

24. Mobility Assessment & Prescription
CASE STUDY
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25. Discussion
What processes do you use to address/prevent falls?
What processes do you use for mobility assessments ?
How do residents obtain wheelchairs?
(assessment?; borrow? other?)
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26. Pressure Sore Management &
Prevention: Best Practice
✓ Risk Assessment
✓ Skin Assessment
✓ Monitoring
✓ Specialty surfaces (wheelchair, bed, shower/bath)
✓ Trained professionals w/ expertise in positioning & support surfaces
✓ Inter-professional care
Outcomes
↑functional ability & engagement
↑quality of life
(Houghton et al, 2013; WOCN, 2016)
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27. Pressure Sore Reduction & Management:
Prevention
✓ Minimize/eliminate pressure, friction & shear
✓ Minimize/eliminate pressure from medical devices
✓ Head of bed elevation below 30°
✓ Repositioning for bed/chair-bound
✓ Attention to anatomy, postural alignment, weight distribution &
support of the feet
✓ Prophylactic dressings (sacral & heel) for those at-risk
✓ Support surfaces (beds, chairs) & other equipment
✓ Avoid rings, donuts & cutouts
(National Clinical Guideline Centre, 2014;WOCN, 2016)
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28. Pressure Sore Reduction & Management:
Process
✓ Comprehensive pressure management assessment
✓ Understand lifestyle & pressure ulcer risk
✓ Equipment selection
✓ Equipment trial
✓ Equipment delivery
✓ Post-delivery training
✓ Ongoing monitoring
(European Pressure Ulcer Advisory, 2014)
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29. Nursing Assessment – Skin
SKIN ASSESSMENT/OBSERVATION
Nurse assesses the integrity of the elders skin from
head to toe:
➢ Is the skin intact and free of pressure areas?
➢ Is the skin moist or dry?
➢ Any abnormalities are noted.
➢ Braden scale is completed in order to assess pressure
ulcer risk and determine interventions.
➢ The Braden scale is research tested and validated for
its ability to determine pressure ulcer risk.

30. Braden Scale adapted to Point Click Care

31. Pressure Ulcer Risk:
Assessment findings
• Referral are made to the OT if interventions
are required
• There are several methods of communication
for both staff and families: Communication
book at each neighborhood of Zion, email and
voicemail.

32. O.T. Intervention
• Zion Park Manor carries a variety of equipment
including fall mattresses, fall alarms (bed and chair),
specialty mattresses and surfaces, and wheelchairs
both basic and tilt.
• Walking programs and potential physio involvement
may be included to reduce risk factors.
• OT will assist and provide direction to the nursing team
based on the data collected through the various
assessment findings which includes the MDS RAI data.
• In-services are available to the care team by Life Skills
to address elder fall risk, safe transfers of residents by
staff and

33. Pressure Ulcer Management & Prescription
CASE STUDY
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34. Collaboration:
Positive Outcomes for Residents & Staff
• Some residents who were wheelchair bound
walking again with assistance
• Pressure sores improved/stopped progressing
further after collaborative intervention
• Improved wheelchair seating and positioning for
residents
• Improved participation in daily activities
• Staff education on posture and body mechanics
to avoid injuries
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35. Positive Outcomes for Management
↓Cost reduction
↑ROI
↑health care savings
↓education and training cost of staff
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36. OT Enhanced Surface Program
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Purpose:
• To utilize evidence based practice for optimizing wound care and
specialty surfaces (mattress only)
• To have the right surface under the right patient at the right time
• To reduce costs of specialty surface rentals in acute care
• To improve outcomes in patient care
• # of Patients Seen: 15-25 patients are seen per day by OT and/or
with rehabilitation assistant

37. OT Enhanced Surface Program: Outcomes
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TOTAL COST
Average Annual Cost (pre-implementation) $400,000
Year 1 implementation $121,000
2015/2016
-and funds 1.5 FTE staff (0.5 OT; 1.0 RA)
$72,000
Program has expanded to best bed frame safety selection, and
other wound care interventions with heels, elbows, ears and toes.

38. 38
✓ Better patient outcomes (↓ wounds; ↑healing)
✓ Patient satisfaction
✓ Quality of Life
✓ Earlier discharges (acute care)
✓ Equipment monitoring & centralization

39. Reducing Staff Injury
CASE STUDY
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40. Strategic Investments to Build
Integrated, Team-Based Infrastructure
• Dedicated health human resources
-IP team includes physician, nurse, OT, allied health
• Ongoing education of health care staff
– Best practices for prevention & treatment
• Appropriate equipment
-Specialty redistribution surfaces (VAC, mattresses-air loss, gel,
pulsation)
• Annual monitoring
Builds Capacity & Collaboration
↓Prevalence
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41. Discussion
Challenges with mobility prescription?
Opportunities?
Challenges with pressure management?
Opportunities?
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42. Questions?
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43. Thank you
mwhitehouse@zionparkmanor.com
amit@lifeskillstherapy.ca
gboniface@caot.ca
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44. References
Berwick DM, Nolan TW, & Whittington J. (2008). The Triple Aim: Care, health,
and cost. Health Affairs 27(3):759-769.
Canadian Agency for Drugs and Technologies in Health (2015). Custom versus
Off-the-Shelf Seating for Patients Requiring Wheelchairs: Clinical
Effectiveness, Cost-Effectiveness, and Guidelines.
Clark, F., Jackson, J., Carlson, M., Chou, C.P., Cherry, B.J., Jordan-Marsh, M.,
Knight, B.G., Mandel, D., Blanchard, J., Granger, D.A. and Wilcox, R.R.,
2012. Effectiveness of a lifestyle intervention in promoting the well-
being of independently living older people: results of the Well Elderly 2
Randomised Controlled Trial. Journal of Epidemiology and Community
Health, 66(9), pp.782-790.
European Pressure Ulcer Advisory Panel, National Pressure Ulcer Advisory Panel
& Pan Pacific Pressure Injury Alliance (2014). Special Populations. In:
Prevention and treatment of pressure ulcers: clinical practice
guidelines.
Government of BC (2014). Setting Priorities for B.C. Health.
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45. References
Houghton PE, Campbell KE, and CPG Panel. Canadian best practice guidelines for the
prevention and management of pressure ulcers in people with spinal cord
injury [Internet]. Toronto (ON): Ontario Neurotrauma Foundation; 2013.
Greer N, Brasure M, Wilt TJ. Wheeled mobility (wheelchair) service delivery [Internet].
Rockville (MD): Agency for Healthcare Research and Quality; 2012 Jan.
(Technical Brief No. 9). AHRQ Publication No. 11(12)- EHC065-EF. Prepared
by the University of Minnesota Evidence-based Practice Center under Contract
No. 290-07-10064-I.
Mortenson, W. B., Miller, W. C., Backman, C. L., & Oliffe, J. L. (2012). Association
Between Mobility, Participation, and Wheelchair‐Related Factors in Long‐Term
Care Residents Who Use Wheelchairs as Their Primary Means of Mobility.
Journal of the American Geriatrics Society, 60(7), 1310-1315.
National Clinical Guideline Centre. Pressure ulcers: prevention and management of pressure
ulcers. London (UK): National Institute for Health and Care Excellence; 2014 Apr.
37 p. (Clinical guideline; no. 179).
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46. References
Requejo, P. S., Furumasu, J., & Mulroy, S. J. (2015). Evidence-based strategies for
preserving mobility for elderly and aging manual wheelchair users. Topics in
geriatric rehabilitation, 31(1), 26.
Trefler E, Fitzgerald SG, Hobson DA et al. Outcomes of wheelchair systems intervention with
residents of long-term care facilities. Assist Technol 2004;16:18–27.
Wound, Ostomy and Continence Nurses Society (2016). Guideline for prevention and
management of pressure ulcers (injuries). Mt. Laurel (NJ): Wound, Ostomy and
Continence Nurses Society (WOCN); 2016. 164 p. (WOCN clinical practice
guideline; no. 2).
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