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Behavioural Supports team cracks code on compassionate care

Posted Aug 31st, 2023

We are Niagara Health is a series of stories that celebrates the incredible people working and volunteering in our organization and how they make a difference in the lives of patients and coworkers every day.

Two women wearing black Niagara Health zip-up jackets stand arm in arm smiling for the camera in a hospital hallway

Registered Practical Nurse Lennie Epp (left) and Occupational Therapist Paige Cote are Niagara Health's Behavioural Supports Ontario team.

Geniuses cracking enigmatic codes to save the world have been the makings of countless Hollywood blockbusters. 

While they haven’t been depicted on the big screen yet, Lennie Epp and Paige Cote of Niagara Health’s Behavioural Supports Ontario team spend their days deciphering complex communication and behaviour, too. Much like the characters in those box office draws, they do it to make the world a better place, but for older adult patients adjusting to a hospital stay.

“It’s getting to know the person. Who was this person? Who is this person today and what can we bring from their past to improve quality of life for them?” says Epp, a registered practical nurse.

That might sound like Epp is talking in code herself. But the results of the work she and Cote, an occupational therapist, do are clear.

Behavioural Supports Ontario (BSO) is a provincial initiative created to enhance healthcare services for older adults with complex and responsive behaviours associated with dementia, mental health, substance use and other neurological conditions that can pose challenges for their care teams or put them at risk of injury.

BSO, which is part of Niagara Health’s Care for Older Adults Strategy, also provides enhanced family caregiver support in the community, long-term care or wherever the patient and caregiver live.

In short, Epp and Cote determine what can trigger challenging or confusing behaviours in a patient and how care teams can reduce or avoid them, making the everyday better – for all involved.

Take the patient who loves classical music and relaxes instantly at the sound of a concerto streamed by a nurse while helping them wash up in the morning. Or the former flight attendant whose demeanor instantly changes when someone on their care team talks about vacation plans.

“There’s nothing more satisfying than having one nurse say, ‘I didn’t know So-and-so was a flight attendant. We talked about flying to Portugal and her face lit up,’” Cote says. “You know then that they’ve read the care plan we’ve created. That’s the best endorsement of what we do.”

Celebrating the successes

Sometimes it’s as simple as keeping a patient busy at a certain time of day, like during a shift change when they become confused by hearing staff say good-bye and think they can leave the hospital, too. In other cases, it’s learning how to approach a patient, how to speak to them, increasing or decreasing stimulation, or setting them up with an activity to keep their hands and minds busy while receiving care.

One of Cote’s favourite success stories was tying sailor knots in a shoelace for a patient – a former sailor – who would grab at members of his care team while they tended to him. Having him work on knots in the shoelace tapped into positive memories and kept his hands occupied while reducing the number of people needed to help him in the moment.

“That’s incorporating someone’s past into their care, especially someone with dementia whose mind is often in the past,” Epp explains.

To achieve such wins requires a bit of sleuthing by Epp and Cote, however. That includes observing and spending time with a patient referred to BSO. Talking to members of the care team and family for clues about the patient’s story – their careers, what brings them joy and what doesn’t, how they cope with stress – are also keys to cracking the behaviour codes. They then use that information to create a “blueprint” for how best to care for that patient and help guide healthcare providers’ interactions with them.

Challenging behaviours might be rooted in cognitive impairments or dementia, they explain. Sometimes, they’re the result of boredom. Epp and Cote focus on non-pharmacological interventions and provide critical insights and tactics that can follow someone from the hospital to long-term care or another healthcare setting.

“We’re not superheroes. We really rely on the information provided by the people taking care of the patient,” Cote says. “A lot of times, they know the answers. They just don’t know the questions.”

A career calling

There was no question for Epp that she wanted to do this work. The desire to help older adults, especially those with dementia, comes from watching her grandmother’s cognitive decline when Epp was growing up.

“She had responsive behaviours. She called out in the night and was verbally responsive,” Epp recalls. “I can still hear my grandmother saying ‘Help me. Help me.” That was her call. That really distressed me.”

That didn’t improve when her grandmother moved to long-term care, where Epp started volunteering and stayed on after her grandmother’s death. She fell in love with working with seniors and found her way back to older adult care, doing behaviour assessments, after stints in emergency and oncology.

She joined Niagara Health six years ago with BSO after doing the same work in long-term care.  

“I feel like people aren’t behavioural. They want to be heard,” Epp says. “To be their advocate is a real honour. I am where I am because I feel it in my bones.”

Cote joined Epp on the BSO team earlier this year from St. Joseph’s Healthcare to help manage growing need for the service that both predict will only increase, particularly as Niagara Health continues to implement its Care for Older Persons Strategy to support the region’s aging population.

Older adults have always been Cote’s favourite patients. Being part of BSO lets Cote continue providing care while playing leadership, capacity-building and educator roles, including training Niagara Health staff to use gentle, persuasive approaches with patients.

“The face-to-face is the best part of the job, and being able to spend time with patients and engage them meaningfully to prevent responsive behaviours,” Cote says. “Those are the moments.”

So, too, are the shows of gratitude from other healthcare teams that happen when Epp and Cote crack those communication and behaviour codes. Cote and Epp often call each other to honour the successes.

 “Having staff see the transformation, we celebrate that,” Epp says.

Niagara Health System