Building a Butterfly Home at Malton Village

Region of Peel - Long Term Care

This dashboard provides data related to the Region of Peel's Butterfly Model pilot project at Redstone House at Malton Village Long Term Care Centre.

Learn more about the Region of Peel's Butterfly pilot .

Overview

We measure progress towards the Butterfly Care Approach by tracking quality performance indicators on the health outcomes of the people who live there, levels of engagement, and family and staff experiences.

Review the indicators below to learn more about how Redstone is measuring up across the key indicators in comparison to Malton Village and the rest of the Region's four long term care centres.


Click on an indicator to view more detailed information and data.

= Measure is trending in the desired direction
= Measure is not trending in the desired direction
= Not enough historical data at this time
= Measure is trending the same as baseline

Unit Profiles

Select Long Term Care Centres

Using this Tool

Select the centres and houses for which you would like to see statistics, press the Update Charts button, and the graphs and charts will update below. Use the tabs below to view charts and information on each of the indicators.

Social Engagement

Index of Social Engagement score.

Quarterly

Indicator Description

This index describes the sense of initiative and social involvement of the people in the home. The scale includes six domains:

  1. At ease interacting with others
  2. At ease doing planned or structured activities
  3. At ease doing self-initiated activities
  4. Establishes own goals
  5. Pursues involvement in the life of the facility
  6. Accepts invitations into most group activities
Experience

People in the advanced stages of dementia have come 'alive' again due to focussed and concerted efforts to connect with them. For example, a gentleman who has been uncommunicative for a couple of years has started to listen to music and sing the words to songs. He is also using single words such as 'no' to advocate for himself.

Contributing Factors (What's causing this?)
  • Observation time periods are time sensitive and accurate results are not always captured during the time periods a person is assessed.
  • People have been more involved in 1:1 meaningful and purposeful activities with staff.
  • Additional nursing staff and activation staff have been provided skills and training to apply person-centred engagement strategies.
  • Staff have also focused on providing activities based on peoples' personal interests and stages of dementia.
Interpretation of the Results (What do the results mean?)
  • Higher results are favourable.
  • Performance on engagement has slightly improved as a result of increased 1:1 activities with staff, within a more home-like environment, and enhanced training to meet the needs of people at their specific stage of dementia.
Collection Information

Source of Data: RAI-MDS 2.0

Data Collection Schedule
  • Baseline: January 1 - March 31, 2017
  • Quarter 1: April 1 - June 30, 2017
  • Quarter 2: July 1 - September 30, 2017
  • Quarter 3: October 1 - December 31, 2017
  • Quarter 4: January 1 - March 31, 2018

Family Satisfaction

Herth Hope Index.

Annually

Indicator Description

This index describes an person's level of hope and is designed for use within a clinical setting for older adults. The multidimensional scale includes domains of:

  1. Temporality and future
  2. Positive readiness and expectancy
  3. Interconnectedness
Experience

Families express happiness about the changes brought about by the adoption of the Butterfly model.

"I love this, it's fantastic!"

Some families have started to visit more.

"He's come alive again."

Contributing Factors (What's causing this?)

Families have been engaged and actively involved throughout the year, including regular education sessions to learn more about the stages of dementia, person-centred care and how to best support their loved ones. There are always ongoing opportunities for families to provide feedback to improve the home environment, programming and activities, and overall aspects of care.

Interpretation of the Results (What do the results mean?)
  • The highest score to achieve on the Herth Hope Index scale is 48.
  • The higher the score, the higher the level of hope.
Collection Information

Source of Data: Herth Hope Index

Collection Schedule
  • Pre: June/July 2017
  • Post: March 2018

Staff Satisfaction

Number of staff incidental sick time hours.

Quarterly

Incidental Sick Time
Indicator Description

This indicator measures the average number of incidental sick time hours per full-time staff.

Experience

Many staff now say that they would not want to work anywhere else, "When I go to other floors I feel I can't work there because they don't support people the same way. It makes me feel sad."

Contributing Factors (What's causing this?)
  • Staff incidental sick time includes staff on short-term or long-term disability.
  • Within this quarter, increased staffing from the Nursing and Activation departments were added to the home.
Interpretation of the Results (What do the results mean?)
  • Lower results are favourable.
  • Staff sick time has slightly decreased compared to the previous quarter, most likely due to increased staffing levels in the home.
  • There has been an overwhelming sense of happiness among staff and people who live there that can be observed upon entry into Redstone House.
Collection Information

Source of Data: Performance Indicator Report

Data Collection Schedule
  • Baseline: January 1 - March 31, 2017
  • Quarter 1: April 1 - June 30, 2017
  • Quarter 2: July 1 - September 30, 2017
  • Quarter 3: October 1 - December 31, 2017
  • Quarter 4: January 1 - March 31, 2018

Responsive Behaviour

Number of incidents people who live on Redstone and people who live and work there.

Quarterly

Incidents between People Who Live in the Home
Indicator Description

This indicator measures the number of incidents between people who live in the home. Incident types include: verbal aggression, sexually inappropriate behaviour, physical aggression and/or alleged abuse.

Incidents between People Who Live in the Home and People Who Work There
Indicator Description

This indicator measures the number of incidents between people who live in the home and people who work there. Incident types include: verbal aggression, sexually inappropriate behaviour, physical aggression and/or alleged abuse.

Experience

One gentleman became fearful when receiving personal care and often had responsive behaviours towards staff. This often included hitting. This was very distressful for him as well as staff. One personal support worker decided to offer him a hug prior to providing care. This gentleman was a very loving and affectionate person when not receiving direct care. The hug worked wonderfully and this gentleman continues to respond well to hugs prior to care.

Contributing Factors (What's causing this?)
  • During each quarter, a majority of people assessed experienced a moderate to severe level of cognitive impairment. Expressive behaviours may be a persons' way of communicating or responding to their personal, physical or social environment that may be important, frustrating, or confusing to them.
  • Expressive behaviours may also be contributed to exacerbations in other chronic medical conditions people are experiencing.
Interpretation of the Results (What do the results mean?)
  • Lower results are favourable.
  • This is a priority area for the Region of Peel. Investments in enhancing our complex care model will strengthen performance in this area, such as person-centred approaches to help staff identify triggers related to responsive behaviours and strategies for behaviour management and de-escalation techniques.
Collection Information

Source of Data: Risk Management Report

Data Collection Schedule
  • Baseline: January 1 - March 31, 2017
  • Quarter 1: April 1 - June 30, 2017
  • Quarter 2: July 1 - September 30, 2017
  • Quarter 3: October 1 - December 31, 2017
  • Quarter 4: January 1 - March 31, 2018

Antipsychotic Drugs

Percentage of people living on Redstone prescribed antipsychotic drugs without a diagnosis of psychosis.

Quarterly

Indicator Description

This indicator looks at how many people living in the home are prescribed anti-psychotic drugs without a diagnosis of psychosis. These drugs are sometimes used to manage behaviours in people who have dementia.

Experience

A gentleman on medication to modify his behaviour has been weaned off the medication entirely with no occurrences of responsive behaviours. When this was attempted in the past, it was not successful as the Butterfly strategies to engage this person were not in place previously. Engagement strategies in addition to increased staff awareness around causes of behaviour have supported this person in a successful transition.

Contributing Factors (What's causing this?)
  • Some people assessed during this quarter were admitted to the home receiving anti-psychotic medications.
  • Some people have a long standing history of a severe mental health disorder (e.g., major depressive disorder or organic psychosis as a result of a traumatic head injury).
  • Consults with psychiatry will often recommend treatment with an anti-psychotic medication.
  • When people return from the hospital they are often receiving anti-psychotic medication.
  • Increased support across the interdisciplinary team (i.e. Geriatrician, specialized geriatric Nurse Practitioners, etc.) have contributed to better performance.
Interpretation of the Results (What do the results mean?)
  • Lower results are favourable.
  • Redstone House's performance in this area has strengthened since the previous quarter.
  • Peel's performance is slightly higher than the provincial average of 22.9% (as reported for the 2015/16 year). Quality improvement initiatives undertaken to reduce the potentially inappropriate use of antipsychotics have included strengthening quarterly medication reviews with the interdisciplinary care team, staff and family education, and staff training on non-pharmacological strategies, such as person-centred approaches to care.
Collection Information

Source of Data: RAI-MDS 2.0

Data Collection Schedule
  • Baseline: January 1 - March 31, 2017
  • Quarter 1: April 1 - June 30, 2017
  • Quarter 2: July 1 - September 30, 2017
  • Quarter 3: October 1 - December 31, 2017
  • Quarter 4: January 1 - March 31, 2018

Pain

Percentage of people living on Redstone experiencing worsening pain.

Quarterly

Indicator Description

The percentage of people living on Redstone who experienced moderate pain daily, or any severe pain, in seven days preceding their assessment.

Pain is any type of physical pain or discomfort in any part of the body. Pain may be localized to one area, or may be more generalized. It may be acute, chronic, continuous or intermittent (comes and goes), or occur at rest or with movement. The pain experience is very subjective; pain is whatever the person says it is.

Experience

A gentleman who frequently described pain throughout the day is now assessed for pain and then if no source of pain is detected, he is engaged in meaningful activity. Staff have noticed his expression of pain has decreased to almost nil.

Contributing Factors (What's causing this?)
  • Majority of people assessed during this quarter were experiencing changes in their health status and sustained a recent fall that resulted in an injury.
  • Majority of people assessed during this quarter were undergoing recent changes to their pain medications, which may contribute to better future performance.
  • Results are expected to further improve over the next few months as Malton Village embarks on increased pain education for staff and a new pain initiative.
Interpretation of the Results (What do the results mean?)
  • Lower results are favourable.
  • Pain has remained consistently low for people living on Redstone compared to the rest of the home and the other homes.
Collection Information

Source of Data: RAI-MDS 2.0

Data Collection Schedule
  • Baseline: January 1 - March 31, 2017
  • Quarter 1: April 1 - June 30, 2017
  • Quarter 2: July 1 - September 30, 2017
  • Quarter 3: October 1 - December 31, 2017
  • Quarter 4: January 1 - March 31, 2018

Falls

Percentage of people living on Redstone who fell in the last 30 days.

Quarterly

Number of Falls
Indicator Description

This indicator measures the percentage of people living on Redstone who fell in the last 30 days. A fall is any unintentional change in position where the person ends up on the floor, ground, or other lower level.

Experience

People who 'paced' throughout the day, to the point of fatigue, are now redirected and engaged in activity and socialization. Their 'pacing' has decreased significantly and thus reduced their potential for falls.

Contributing Factors (What's causing this?)
  • More than half of the people assessed during this quarter required a mobility aid and were limited in their ability to walk independently.
  • Several people have had multiple falls during this quarter which has had an impact on the overall number of falls in this period.
Interpretation of the Results (What do the results mean?)
  • Lower results are favourable.
  • This is a priority area for the Region of Peel. Staff continue to support and use evidence-based practices to help restore the physical abilities of people living in our homes and promote strategies to reduce the risk of a fall.
Collection Information

Source of Data: Risk Management Report

Data Collection Schedule
  • Baseline: January 1 - March 31, 2017
  • Quarter 1: April 1 - June 30, 2017
  • Quarter 2: July 1 - September 30, 2017
  • Quarter 3: October 1 - December 31, 2017
  • Quarter 4: January 1 - March 31, 2018

Weight Loss

Percentage of people living on Redstone with unplanned weight loss 5% or more in the last 30 days.

Quarterly

Indicator Description

Measures the percentage of people living on Redstone who experienced a change of 5% of body weight, or more, in the last 30 days.

Experience

People living on Redstone are now about to access snacks on their own and eat their meals at a time of their preference. One person who was not eating as well at meals has started to make toast and tea for herself and describes feeling empowered when making her own snacks.

Contributing Factors (What's causing this?)
  • Peoples' food and fluid intake is adequate, however underlying health conditions may be a contributing factor to unplanned weight loss (e.g., fluid retention resulting in congestive heart failure).
  • By applying the Butterfly approach, staff are encouraged to sit with people live on Redstone and share a drink or snack, as part of an enjoyable dining experience to promote food intake.
Interpretation of the Results (What do the results mean?)
  • Lower results are favourable.
  • The performance on unplanned weight loss for people living on Redstone has significantly improved since Q1.
Collection Information

Source of Data: RAI-MDS 2.0

Data Collection Schedule
  • Baseline: January 1 - March 31, 2017
  • Quarter 1: April 1 - June 30, 2017
  • Quarter 2: July 1 - September 30, 2017
  • Quarter 3: October 1 - December 31, 2017
  • Quarter 4: January 1 - March 31, 2018
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