The County Day Program

Long-term care homes are full of life experiences. Each resident is a unique individual with a rich personal history that does not disappear with age, including for those living with dementia.

This reality is what fuels one care home in Prince Edward County, Ont., to actively reject the common belief that all long-term care homes are depressing and lonely, and to instead focus on providing meaningful, person-centred care for its residents.

Like many care homes, H.J. McFarland Memorial works with limited resources. But its motivated staff has proven that through hard work, compassion and a little creativity, homes like these can become havens.

Accepting change

Danielle Preston

Danielle Preston oversees recreation and volunteer services at H.J. McFarland Memorial. She and its executive director, Kyle Cotton, were brainstorming about how to better manage and improve repeated behaviours of some residents when the idea of creating an innovative day program was born. Together, they envisioned a place, on-site, where residents would feel safe, warm and joyful while keeping busy doing activities they loved.

 “It’s not something that’s been used in long-term care that we were aware of,” says Preston. “A day program in the community is usually for people still living at home.” 

Preston reached out to Laura Elliot, a representative from DementiAbility, which is a global organization that focuses on person-centred care by recognizing the connections between a person’s brain, life story, environment and behaviour and working to uncover their abilities. 

Laura Elliot

A gerontologist and educator, Elliot has been the program coordinator for the DementiAbility team for six years, helping to provide education, resources and new approaches to dementia care. With a great deal of experience in finding innovative ways to improve care by listening to people impacted by dementia, she was immediately supportive of Preston’s idea to create a day program at H.J. McFarland Memorial.

“One of the things families find difficult when their loved one goes into long-term care is that they will miss their day program because they loved going,” Elliot says.

With Elliot’s guidance, based on DementiAbility methods, Preston, Cotton and other members of the care home staff spent the next two months building out the program.

"If we had someone that worked at a grocery store, for example, we would give them coupons that they could sort and clip."

– Danielle Preston

Shaping a vision

Of course, planning for a new day program with limited resources requires hard work and creativity, so the team took it step by step.

“It started with the care home staff coming to the [DementiAbility] workshop, getting inspired, going back and saying, ‘How can we do this here?’” says Elliot. “We had all the research and all the things we knew had worked with other DementiAbility organizations. But also, we had the knowledge that [Preston] had from working day to day with the people in her care.” 

Following the Dementiability workshop, six participants (residents) were picked to take part in the care home’s program. Selection was based on Elliot and Cotton looking at factors such as behaviours, falls, pain, continence, meals, medications and personal history, and deciding, from there, who might benefit most from the initiative. 

Then, program activities were shaped based on each participant’s identity, past roles and hobbies. “If we had someone that worked at a grocery store, for example, we would give them coupons that they could sort and clip,” says Preston. 

An underused family dining room was chosen as the program’s site. “We converted the space, changing the artwork, decor and flow of the room. We purchased cube shelves and created 60 to 80 kits filled with activities such as card sorting, cutlery sorting, jewellery making, glasses cleaning and Tupperware matching,” she says. 

Supplies, storage items and decorations were bought by redirecting funds from the operating budget, a move that was justified by the potential impact the program would have on the home overall. 

It was also determined that a member of the home’s activity staff would be tasked with running the program each day. Plus, one of the floor support workers would visit to provide personal care if needed, and a registered practical nurse would come to give medication.

And for program evaluation, Preston created a personalized plan for each participant and shared it with staff to monitor changes in behaviour and improvement. 

After this careful planning, the program welcomed participants on July 4, 2021, operating seven days a week from 8:30 a.m. to 3:00 p.m., with a one-hour break after lunch. It ran through to December 2021 before COVID-19 restrictions halted activities.

"There was a reduction in falls and responsive behaviours, and improvements in food and fluid intake."

– Danielle Preston

Seeing results

Despite its short operation time, Preston says the day program showed impressive results. “There was a reduction in falls and responsive behaviours, and improvements in food and fluid intake,” she says. 

She attributes a large part of this success to the person-centred approach. For example, before the program, one participant would not sleep anywhere — including in his own bed or chair. Within the first week of the program’s launch, staff found him sleeping on a couch in the room that hosts day-program activities.

“He’s settled here because we were able to take that dedicated time to allow him to feel that this is his home,” Preston says. 

Though participants spent all their time together, the person-centred activities tailored to each personality were a hit. Providing a former carpenter with different building materials to put together, for instance, made him feel like he had a goal and purpose each day. 

Preston notes that staff morale also improved as they saw results.

“When we started, there was a bit of hesitancy in giving all this one-on-one time. But within two weeks, the staff was like, ‘This is actually working.’ Then it became, ‘How can we as a team make it better for the resident?’” she says. 

Both Preston and Elliot also noticed that, as a whole, the care home started running more efficiently. 

“Staff had time to dedicate to the other people who weren't having those high-intensity needs and were getting more time allocated to them,” Elliot says.

"Think about how each of your residents is a person and focus on what they need. Take the risk and take that step."

– Danielle Preston

Preston, who has worked in long-term care for about a decade, says she has finally found a care model she knows will help to improve long-term care moving forward. By taking that extra time to investigate individual residents’ histories and needs, as DementiAbility recommends, Preston and the staff found ways to personalize care and ease boredom and loneliness, while giving purpose to each day. 

“I've finally been able to be a part of helping people see change,” she says. “Our goal now is to bring DementiAbility with us and make it our care model so that every home area, every staff member and every interaction we have is focused on DementiAbility methods.”

And, with the day program’s return slated for Spring 2022, Preston can again look forward to what the future holds for its participants living with dementia.

Calling for action

H.J. McFarland Memorial’s triumph in creating a day program shows how long-term care can be changed despite limited resources, through teamwork, dedication, innovation and person-centred care. 

Preston and Elliot hope their story encourages other care homes to take initiative and help change the face of long-term care.

“Not everyone is going to have the resources to establish a dedicated space, but you can implement the ideas and the principles,” says Preston. “Think about how each of your residents is a person and focus on what they need. Take the risk and take that step.”

In her role as a DementiAbility educator, Elliot is already helping others make these changes. 

“This field needs more education. Then we can translate knowledge to practice,” she says. “My goal is to create a world where people with dementia want to live, where staff want to work and where families want to visit — this is what the future of long-term care will be.”