homes with mobile BSO teams. While other factors may be
affecting these findings, we believe there is a potential correlation between the contributions of in-home BSO teams
and overall improvements in these areas.
icy and funding should focus on supporting the development of in-home BSO teams. LTCT
The ability of the in-home BSO teams to provide a consistent presence and timely and individualized interventions is
a major advantage. Wait times of more than 10 days were
reported by one-quarter of homes that rely on BSO mobile
teams. As in-home BSO teams work on-site, they know
the staff, residents, and families, and are able to vary the
timing of their shifts to meet the needs of residents. They
also build capacity and support culture change within the
home, so that other staff have the knowledge and skill to
manage responsive behaviours.
About the authors: Michelle Grouchy is the
former Senior Knowledge Broker at the Ontario
Long Term Care Association (OLTCA); Nancy
Cooper is Director of Quality and Performance,
OLTCA; and Tommy Wong is Manager of
Planning and Analytics, OLTCA. Details of the
survey, data analysis, findings, and discussion
can be found in Implementation of Behavioural
Supports Ontario (BSO): An Evaluation of Three
Models of Care, published in Healthcare Quarterly, February 2017.
There is a role for mobile teams to provide expertise and
sharing of best practices across the regions, but future pol-
Seeing results with an in-home BSO team
Just three years ago, in the advanced dementia unit of one long-term care home, more than 45% of
residents were on antipsychotic medications, well above the provincial average. Many people were
agitated and restless, and there was some between residents as a result. Most had advanced to
a stage of dementia where they were hard to reach.
When a Behavioural Supports Ontario (BSO) team was funded in the home, they created four different
with activities that residents can explore throughout the day to provide more stimulation and
the dining hall, a selection of Montessori items such as books, sorting items, and lacing cards
helps to keep hands and minds occupied while waiting for their food. This waiting period
at mealtimes was previously a for agitated behaviour and between residents. The
BSO team taught personal support workers how to recognize which activities appealed to each
resident, and to ensure they have a personalized selection of Montessori items at every meal.
the lounge area, a dresser and mirror with hats, bracelets, and scarves, which provide tactile
stimulation and familiar activity (the population on this unit is largely female).
he station hosts a music area, decorated with framed album covers from decades past.
small lounge has been converted into a doll nursery, complete with soothing decor and a selection
of dolls and clothes donated by families. Residents are welcome to visit the nursery at
any time. Several times a week, they can participate in a formal doll therapy program of bathing and
dressing the dolls with the BSO team. The activity provides a sense of purpose, connection, and
pleasure; many are at a stage of dementia where they are not engaging with anything else. Families
that were initially uncertain about a doll therapy program have embraced it and the home now hosts
events that involve families, residents, and the dolls.
In addition to these home-wide activities, the BSO team develops behavioural management strategies
for individual residents. They watch happening when challenging behaviour occurs, and often
interview the family for clues. The team then pieces together triggering the behaviour
and helps staff to develop an approach that reduces or eliminates the distress.
The result: Within a year of the BSO arrival on the unit, staff were able to reduce antipsychotic
medications by almost 50%, and residents have much lower rates of agitation, restlessness, and
According to the managers, the BSO team has had a positive ripple effect throughout
the entire home and its culture.
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