John was born and raised on a farm. For more than 50 years he enjoyed a cup of coffee and slice of toast at the first crow of the rooster. Mary was a college professor. She worked into the small hours of the morning marking papers and reading research materials. Her husband woke her up with a cup of coffee every morning for three decades.
People’s routines are as varied as people themselves. This is one of the underlying principles of Gentlecare™, a customer service-focused wellness approach to care embraced by Specialty Care Mississauga Road as part of its Enabling Choices® philosophy.
Gentlecare is organized around a flexible wake-up time and breakfast, and individual preferences around care and programming. The ‘Early Risers’ program was created two years ago to cater to the nutritional needs and habits of a handful of residents who were awake at the crack of dawn and enjoyed greeting the day with a light breakfast and cup of coffee.
Several of these early risers were agitated during the night, using the call bell repeatedly and engaging in other disruptive behaviours. Accustomed to getting up at five am, they would pace the halls, sometimes wandering into other rooms. Providing these residents with a nutritional boost early in the morning gives them enough energy to manage their agitation and anxiety upon rising.
Based on the 24-hour nutritional clock—“a program of strategic metabolic boosts that enhance performance, avoid nutritional low points and prevent catastrophic behaviour”—Gentlecare is “a social paradigm, a social model of care,” explains Ilona Turczyn, director of care at Specialty Care Mississauga Road. “It’s not a medical model or task oriented. Routines and structure do not always work well for people with dementia.Flexibility is the key.”
The Gentlecare philosophy recognizes people as individuals with different biological rhythms. “Before entering long term care, some of our residents were early risers. Some were shift workers,” says Ms. Turczyn. “Why should we force them to wait until 8 am for breakfast when they have always started their day at 5 am?”
A dietary aide and nourishment dietary aide stock a cart the evening before, and an Early Riser personal support worker (PSW) is on duty from midnight to 8 am. From 5 am to 8 am, seven days a week, this dedicated PSW travels throughout the 160-bed home, taking an early-bird breakfast of coffee or tea, mini-muffins, a Danish, hot and cold cereal, yogurts and fruit to about 16 residents who are up early—or who may not have gone to bed. As with any nourishment pass, supervision is a priority—but with just 10 per cent of the home’s residents participating, the task is manageable.
The results have been very positive— and surprising. Night-shift staff have noticed a significant decrease in disruptive behaviours. Residents are less agitated and less resistive to care, which has improved staff morale. Hydration has improved. And from July 2008 to July 2009, 12 out of 14 residents (86 percent) gained weight. Many of the early risers have their ‘starter’ breakfast, and then join the rest of the residents a few hours later for a full meal. “The program is so successful we now have a weight gain issue!” jokes Ms. Turczyn.
The residents look forward to the arrival of the Early Riser caregiver and socialize while they wait for the cart. Residents say the program “Kick-startstheir day.” They have more energy and like the fact that they no longer take their morning medications on an empty stomach. Some, who enjoy their coffee and toast before rising, report that “It’s like having room service in a hotel” or breakfast in bed at home.
“It’s all about enabling choices,” says Ms. Turczyn. “The Early Risers program gives residents flexibility and choice over their routines and their schedule, which makes them more comfortable. We want our residents to feel like they are at home because they are at home. Offering a flex breakfast is one way we can make Specialty Care Mississauga Road even more like home.”
REPRINTED FROM: LTC Magazine, Spring 2011 Edition
