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Ontario to expand help for aggressive dementia patients

Ontario's Health Ministry plans to hire 700 health-care workers as part of a new program to provide better care for aggressive and "difficult" patients with Alzheimer's disease, dementia and other neurological disorders.

Health Minister Deb Matthews said the Ontario Behavioural Support Systems Project – the first of its kind in Canada and only one of a handful in the world – is meant to keep more people at home and out of long-term care facilities for as long as possible, and to reduce the use of medication and restraints for patients who are already institutionalized. She said it would start with four pilot projects later this month and be in place across Ontario within a year.

"We know that with the right investments, patients can be managed with sensitive care," Ms. Matthews told The Globe and Mail.

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For about 60 per cent of Alzheimer's and dementia patients, symptoms such as aggression, delusions and wandering are an unavoidable reality as their disease progresses. Getting adequate care for those patients is one of the major problems facing modern health care as the population ages.

Patients often end up in acute-care hospitals when they should be at home or in a long-term care facility, because neither family members nor health-care workers know how to handle them. Long-term care facilities, even those designed to look after difficult cases, often refuse to admit aggressive patients, said David Harvey, chief of public policy for the Alzheimer Society of Ontario. If they are admitted, their condition often deteriorates rapidly because of a lack of adequate care, he added.

He said stories like that of Diana, a 64-year-old Whitby woman who asked not to be named because of concerns her husband would lose his spot in a nursing home, are not uncommon.

She said she cared for her husband at home alone for nearly eight years with just three hours of help from home-care workers each week. Last September, he became so aggressive that he started screaming all night. She said she asked for a "crisis" placement in a secure unit in a local long-term care facility, but that after three months on a waiting list, he was refused because of his behaviour and because he would have had trouble adjusting.

"My argument was that if he required too much care, how did they expect me to do all of it at home on my own," she said.

Experts believe that in many cases difficult behaviour could be avoided or more easily controlled if it is properly understood. The designers of the new Ontario program also believe that patients could stay at home longer if health-care services were better co-ordinated.

Although Health Ministry officials are still working out details of the program, one of its designers, geriatric psychiatrist Ken LeClair, said it takes a three-pronged approach: to better co-ordinate services that already exist, to deploy teams of specialists who can assess behavioural problems and help educate health-care workers already in the field, and to identify gaps in services and try to find "flexible" solutions.

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"We know we can reduce behavioural challenges significantly, and this strategy is trying to get that knowledge into the DNA of health-care practice," said Dr. LeClair, co-chairman of the Canadian Commission for Seniors Mental Health.

Alexandre Henri-Bhargava, a behavioural neurology fellow at the Baycrest Centre for Geriatric Care in Toronto, said the program was "a good initiative," but added that it is not a panacea to the multiple problems facing patients and health-care workers dealing with dementia.

"It will help when the problem is knowing how to approach a patient with the resources you have, but I have seen cases where the disease is such that even if you understand the behaviour, there's not much you can do about it," he said.

The program relies on being able to hire 700 new health-care workers specially trained in how to recognize and deal with behavioural issues in dementia patients, but Dr. Henri-Bhargava said that such training is rarely offered and that the province may be hard-pressed to find enough qualified people.

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