Chronic care needs are changing – Deer Lodge Centre is changing with them.
By Ryan McBride
Researchers and healthcare professionals like Daryl Dyck want to challenge the idea that patients in chronic care are “as good as they’re going to get.”
“We want to be known as more than your last option,” says Dyck, a clinical nurse specialist at Deer Lodge Centre, which is home to 132 chronic care beds across three units.
Most chronic care clients come to Deer Lodge from acute care facilities with health conditions too complex for community care or personal care homes to manage. They require round-the-clock, specialized care that may include intravenous fluids, oxygen, antibiotics, feeding tubes, bariatric support, or dialysis. Some have wounds or infections that demand frequent, intense medical intervention. Their stay in chronic care may be temporary or permanent.
Generally, chronic care clients are adults of any age. Deer Lodge’s youngest chronic care patient is 21 years old.
“Our model of care is based on nurturing potential,” says Dyck. “It’s about exploring possibilities in our patients and in our staff. What we’ve found, after working with our staff to look carefully at our patients, is that there are often ways to improve a patient’s quality of life. We don’t assume a patient’s quality of life was as good as it was going to get when they arrive here. For some, there can be significant improvement in their life experience, while for others, there may be limited improvement, but the emphasis is on not overlooking an opportunity.”
For instance, a closer look may reveal the possibility of getting a patient to the point where they no longer need a feeding tube or tracheostomy breathing tube, which could make a huge difference in a patient’s wellbeing.
A chronic care stay may provide that extra bit of time and support a patient needs to recover from an acute exacerbation of a chronic condition, or optimizes the management of a chronic condition. Occasionally, chronic care has resulted in patients transferring to a less intensive setting, such as a personal care home, or even back to the community.
“It doesn’t happen often, but sometimes we can do that much,” says Dyck. “Regardless, our aim is to keep our patients as functional as possible for long as possible, while acknowledging that sometimes it involves providing good end of life care.”
This is where compassion and communication come in, says Dyck. “We always endeavour to be honest with our clients and their families about what they can expect, and involve families as much as possible in decision making and care planning.”
The changing face of chronic care
Healthcare has advanced to the point where more people are aging in place longer, says Dyck. “When they do come to us, they’re less functional than the same patients that were being treated 20 or 30 years ago.”
That was how long ago the criteria for selecting patients appropriate for chronic care were first established. “Back then, chronic care was limited more to medically stable, long-term clients—for example, head injury patients—who required institutional care. The range of needs today is much more varied.”
The chronic care patients Deer Lodge sees today also come with increased care and resource requirements.
“Where do we take it from here?”
This was the question Dyck and fellow researchers found themselves asking last year.
The answers are the result of an eight-month research study that wrapped up in April 2018. Made possible thanks to a $15,800 donation from Deer Lodge Centre Foundation, the study’s results offer a completely up-to-date description of today’s chronic care patient, and provide a clearer picture of chronic care at Deer Lodge Centre and Riverview Health Centre. Based in part on staff feedback about what was working and what was not in the care they provided, the study points to ways both facilities can continue to be supported and evolve. It also compared Manitoba’s chronic care program with other jurisdictions in Canada.
Dyck looks forward to the study’s recommendations as a way to enhance the quality of care currently provided at Deer Lodge Centre and other chronic care sites. He says the final report will also help other healthcare facilities who transfer patients to the chronic care program understand what type of patient makes a good chronic care candidate.
“Deer Lodge has the capacity and the expertise to provide what few other long-term care centres can. If this is the best place for you to be, we want to make sure you end up here. We want Deer Lodge to be a place where families can say, I couldn’t have dreamed of my family member being in a better place.”