ANNUAL REPORT – 2006–2007
PRESENTATION OF THE ESTABLISHMENT
Statement
Affiliated with McGillUniversity, Maimonides Geriatric Centre delivers a continuum of quality care to our aging population. Maimonides continues to respond to generations who have entrusted us with the care of their loved ones through a unique range of integrated services, at the heart of which are the values of home and family.
Our integrated network includes the Helen and SamSteinbergDayHospital, short-term respite stays, community-based homes and various long-term care accommodations.
Philosophy
Maimonides Geriatric Centre is founded on the Jewish tradition of caring for our elders.
We believe that everyone should be treated with dignity and respect.
We believe in promoting self-determination and autonomy.
We believe in an interdisciplinary approach to care, taking into account individualized needs.
We believe that the family must be involved in all aspects of care.
We believe in promoting a caring approach through the development of our staff.
We believe in research and education in order to ensure the highest quality of care.
We believe in being an active participant in the Jewish community and with our partner organizations.
Organizational Structure
During the year 2006-2007, no organizational changes took place at the senior management level. As we reported last year, we are very fortunate to have a team that works so well together, has been relatively stable for the past number of years and wehad the opportunity over the past year to be challenged by the additional work we are doing on behalf of Maimonides for the Jewish Eldercare Centre. This stability has also allowed us to function very smoothly as a team in reference to the accreditation process and strategic planning process both which took place during the year 2006-2007.
Visitors, whether they are the surveyors from the Canadian Council on Health Services Accreditation, professionals from other establishments or visiting family members, often comment on the good feeling one gets upon entering the building. This feeling is in part generated from the management staff and all our employees. Thank you to everyone.
CADRESFull time22
Part time 4
Availability 2
EMPLOYEESFull time 286
Part time 223
Availability 104
641
MAJOR ACTIVITIES AND PRINCIPAL MODIFICATIONS OF THE ESTABLISHMENT
The Board of Directors, during the year 2006-2007, was very active and met frequently along with its committees to ensure that Maimonides kept abreast of the changing political climate and standards in long-term care. Many activities took place during the past year which will be presented in this report.
Board of Directors
Merger Discussions and Election
In the annual report from 2005-2006 we noted that Board elections were scheduled to take place for the province in the fall of 2006 and we fully expected that our potential merger with Jewish Eldercare and Mount Sinaiwould be settled by that time. It was proposed and agreed that the three individual establishments would bring forward to their Boards, during the month of August, a proposal for a tri-partite merger subject to several conditions surrounding a transitional Board, a supraregional mandate, the assets of the new establishment and the regulation of the financial situation of the Jewish Eldercare Centre. With a letter in hand to this effect from the Agence, we anticipated that a new Board of Directors would be appointed for the three establishments in the fall of 2006.
After a brief consultation with a lawyer specializing in this area, we were advised, rather suddenly, in September of 2006, that the conditions being offered to us for a unified board no longer fell within the realm of the health care law. As a result we had to very quickly prepare and move forward with an election only for the Maimonides Geriatric Centre Board of Directors. Since discussions with Jewish Eldercare Centre are still ongoing and the senior management team is now managing Jewish Eldercare on an operational level, we were at least able to ensure some cross representation on the two Boards of Directors being elected and/or appointed during the fall and winter of 2006-2007. Since that time, with the Board of Directors finalized during the month of February 2007, there has been no further movement on the merger front.
From a practical point of view, this has not really had an affect on the operations since we are moving closer together gradually, and starting to share some services. In addition, at the Board level, with some shared Board members and several shared committees such as the Clinical Ethics Committee, the Building and Maintenance Committee, and beginning in 2007-2008 the Audit and Finance Committee, we are, in effect, achieving our goal in a slightly less dramatic fashion.
The main concern of all the Boards at this time is to ensure that we maintain ongoing links with our founders and our community and that each of the institutions continues to get the individual attention and recognition that they deserve.
Accreditation
The accreditation process took place between November 26 and November 30, 2006. Two surveyors from the Canadian Council of Health Services Accreditation evaluated the services and programs at Maimonides to ensure that we continue to meet national standards of quality. During the month of February, Maimonides received a glowing accreditation report from the CCHSA and is fully accredited for another three years. The centre garnered high praise for the quality of care given to its residents as well as its home-like environment, innovative approach to community services, excellent collaboration among departments and its award winning restraint-free program was recognized as a leading practice in the country. The surveyors emphasized that people are the biggest strength at Maimonides.
No formal recommendations were made by the Canadian Council of Health Services Accreditation.
Outstanding Service Award
At the annual meeting held in November of 2006, Murray Goodz, chairman of the Building and Maintenance Committee was awarded the outstanding service award. Over the past fourteen years, the last three as chairman, Murray has demonstrated outstanding leadership and has brought a level of professionalism and expertise to all projects underway both at Maimonides Geriatric Centre and now at the Jewish Eldercare Centre as well.
Strategic Plan – 2007-2012
December 2006 saw the end of our current strategic plan which was adopted in 2001. As we review the three major goals – Delivery of Care, Integrated Geriatric Care and Community Leadership – we realize how successfully we have achieved most of our goals.
A new strategic planning committee, under the co-chairmanship of Len Lewkowict and Diana Schweitzer started work in the fall of 2005 and finished its work during the winter of 2007. A new strategic plan was adopted by the Board of Directors during the winter of 2007 and reflects the direction that Maimonides has been moving towards for the last several years.
Over the next five years the centre will face both strategic and operational challenges. Strategic initiatives of the past five years, strengthened and consolidated, will now move into the operational arena. New strategic directions will strengthen our position as a leader in long term care.
Implementation of the plan will take place between 2007 and 2012. The progress will be reflected in the annual report starting in 2007-2008. This annual report of 2006-2007 will outline some of the major activities which took place during the past year in support of the goals set out in the five year plan which ended in December 2006.
GOAL
Delivery of Care
- Continue to excel in delivering personalized care
- Develop additional programs for specific groups
- Increase Sephardic involvement
- Continue to promote training and educational opportunities
- Expand research program
- Promote established leadership in clinical programming
Security and Safety
It is not possible to discuss the delivery of care any more without discussing the security and safety of residents. Almost everything that takes place these days has to be viewed from both points of view - whether it is the risk management program, the prevention and/or treatment of pressure sores, the prevention of falls, infection control, pandemic planning, maintenance of equipment – it all comes back to the security and safety in relation to the resident. Almost every program can be viewed from this light, including our Milieu de Vie which emphasizes the individuality and safety of everybody in this centre.
Risk Management and Quality Improvement
The Quality Improvement and Risk Management Committee met on a regular basis during 2006-2007. With the adoption of new legislation in the fall of 2006 this committee will be disbanded at the end of 2006-2007 and two new committees will be in place. The quality improvement portion of the committee will be replaced by the Comité de Vigilance and the risk management portion will be separated into the Risk Management Committee.
As stated previously, tracking incidents and accidents, ensuring that those which are significant are being disclosed to family members and examining the types of injuries have become a major focus of all establishments. A disclosure policy was adopted during the year. Disclosure occurs when the injury resulting from an accident is severe. However, improvement in communication is required with the more minimal injuries. A disclosure information pamphlet is currently being developed and will be circulated to all staff and families in order to educate everybody about their rights and responsibilities. The three most common types of incidents and accidents have remained the same during 2006-2007: 56.6% were falls; 11.4% were medication errors; and 12.4% were unknown causes. More than half of all the incidents and accidents did not cause any injury to the residents and a very small percentage of serious injuries, such as fractures, were reported.
Infection Control Program
This program is a good example of the collaboration that is occurring between Maimonides and the Jewish Eldercare Centre. The two infection control nurses worked together in order to produce one pandemic plan as required by the Agence for both institutions. This collaboration allowed us to make more efficient use of our resources in addition to being recognized for submitting a high quality plan which met all the criteria that were defined by the Agence. Protocols continue to be developed as new bugs work their way into our system. We were very fortunate not to have any outbreaks at the centre during 2006-2007, however, there was a major episode of gastro-interitis at Maison Paternelle during February 2007. With proper controls in place the outbreak lasted only 14 days and all residents were returned to their previous health status.
Fall Prevention Program
During the year 2006-2007 the implementation phase of the fall prevention program on pavilion 7 was completed. The final statistics demonstrated that the program was a great success. The results demonstrated that one year after implementation the number of falls dropped from 253 to 164; a 35% reduction in falls. Prior to implementation, the number of moderate to severe injuries resulting from a fall was 13%; post implementation, moderate to severe injuries decreased to 7%. As a result of this program, there was an increased awareness of falls, improved communication, an overall decrease in the number of falls and a decrease in the severity of injuries resulting from a fall.
Implementation of the fall prevention program took place in October 2006 throughout the centre. In addition, Maimonides Geriatric Centre was recognized for its fall prevention program by winning the 2006 3M Health Care Quality Team Award which was presented at the annual meeting of the Canadian College of Health Service Executives in Victoria, BC. This award, which we have won for the second time in five years, recognizes teams in health care organizations who are devising innovative ways to improve the delivery of programs and services.
Restraint-free Program
The Restraint-free program, which has been in existence at Maimonides for a number of years, continues to grow especially with the support of the Foundation. With a donation of $20,000 from the Foundation, restraint alternatives such as alarms, safety pads, etc. were purchased in order to allow our residents to remain restraint free. Our main focus in this area these days is our response to many requests for information from other institutions who are now putting this program in place. We are also regularly contacted to speak on this topic. It was also cited by the Canadian Council of Health Services Accreditation as a leading practice for the country.
Pressure Ulcer Awareness Program – PUAP
Maimonides was chosen by the Canadian Association of Wound Care as one of the five pilot sites for the development of the pressure ulcer awareness program. The educational component of this program raised the profile of pressure ulcer risk assessment in prevention strategies among front line health professionals and the organization as a whole.
Maimonides also received the You Make a Difference award from the Canadian Association of Wound Care and had the opportunity to publish this experience in this area in Wound Care Canada. This award was given in recognition of an exceptional initiative in wound care.
At this time, a decreased prevalence of pressure ulcers and an increased reporting of skin redness and colour change are some of the results.
Milieu de Vie Approach
Every year more and more programs are added to the facility in support of the Milieu de Vie Approach. Most recently, some of the outstanding programs include the Art for Healing partnership, the Life Bio project and the implementation of concerts in our front lobby. Our partnership with the Art for Healing Foundation is bringing art work to the hallways of Maimonides. Donations from various collections are made through the Art for Healing Foundation, which then works with us to establish galleries on the different nursing units. Walking through hallways filled with art has significantly changed the feeling one gets on the units.
The Life Biography project, which was implemented a few years ago, continues to be an innovative and creative approach to personalizing care. This project, which results in a DVD put together about a resident’s life history, including old photos, their likes and dislikes, help the staff get to know the residents and assist them in personalizing the care. To date,fifteen life biographies have been completed and the objective is to do at least five a month. Again, this is a collaboration of the volunteer department (since it is a volunteer who is working with our families) and staff members to put these life biographies together.
Finally, we currently have seven volunteers who play the piano, violin and guitar in the lobby at various times of the week on a regular basis. These lobby concerts create a wonderful atmosphere in our lobby coffee shop area.
Establishments from around the province continue to visit Maimonides in order to see what we are doing to put this Milieu de Vie approach into action.
Staff Retention and Recruitment
As we have done for the last several years, Maimonides has directed a lot of attention to attracting, retaining and training competent staff. For the fifth year in a row, with the generous contribution of our Foundation, we have been able to offer scholarships to many of our staff who are in the process of upgrading their skills. In addition to a nursing bursary being offered to a graduate student at the McGill School of Nursing who has a special interest in geriatrics, many of our own staff members received bursaries to assist them in upgrading their education over the past year. This commitment by our Foundation, through the funding of educational opportunities, has allowed us to retain many of our staff, who otherwise go elsewhere.
In reference to recruitment, this has been a particularly difficult year for recruitment at Maimonides. Shortages exist in all the health care professions and it is not expected that there will be any improvement in the near future. New strategies will have to be developed over the next year in order to address this ongoing problem.
Capital and Environmental Improvements
With the input of our very active Building & Maintenance Committee, the Chief of Technical Services and the Nursing and Clinical Services Departments, all funds, received from the Foundation and the government during the past year, were directed towards improving the quality of life of the residents at Maimonides.
Specialized Wheelchairs
Once again, our Foundation donated approximately $30,000 which allowed us to purchase a variety of geriatric and light weight wheelchairs.
Restraint Alternatives
Rather than purchase restraints, the Centre was fortunate to receive a donation of $20,000 from the Foundation again which was used for specialized alarms, safety pads and other systems which allow us to monitor our residents’ movement.
Specialized Mattresses
More specialized mattresses werepurchased with funds from the Foundation this year, bringing our inventory of these kinds of mattresses, which were all paid for by the Foundation, to eleven. At an average cost of $10,000 a mattress, the Foundation has invested approximately $110,000 over the past five years into this program.