Older people with cognitive impairments due to mental health problems, addictions, dementia, or other neurological conditions often exhibit responsive or challenging behaviours such as aggression, wandering, physical resistance and agitation.  These behaviours are known as "responsive" because they are not unpredictable, meaningless aggression or agitation but, are due to circumstances related to the person’s condition or a situation in his or her environment.  Such behaviours, which occur whether the person is living at home, in acute care or in long-term care, are a major source of distress to the person with the behaviour, family, caregivers and others providing support. And, while the number of people with cognitive impairments is growing, placing further strain on individuals and the entire healthcare system, the levels of support needed for this population are often inadequate or even non-existent.  

In January 2010, the Ministry of Health and Long-Term Care (MOLTCH) funded a working group to undertake the first phase of the then Ontario Behavioural Supports System (BSS) Project and develop a principle based Framework for Care that would mitigate the strain and improve outcomes for persons with challenging behaviours, families, health providers and the healthcare system.

Based on a what we know and a confirmed case for action, the second phase of the now Behavioural Supports Ontario (BSO) project has applied the evidence-informed provincial framework and operational program model for a cross-sectoral system of supports and services designed to meet the needs of older adults with cognitive impairments and associated complex and challenging behaviours.
 

Case for Action

  • The numbers of people at risk for responsive behaviours is increasing
  • Challenges are experienced across all health sectors and services
  • The person and family required better quality experiences
  • There are significant costs associated with managing behaviours
  • There are recognized best practices that could be more systematically adopted
  • There is an opportunity to leverage existing initiatives in Ontario
  • There is a stakeholder readiness for change.

What We Know

  • The number of Ontarians with dementia is expected to increase 40% by 2020 and, in some areas of the province, by as much as 42% in half that time. 
  • 30% of home care clients with dementia exhibit some behavioural symptoms. 
  • Over 65% of long-term care residents have dementia or mental health issues.
  • 17% of long-term care home residents are physically restrained
  • 34% of nurses in hospitals or long-term care facilities in Canada reported incidents of physical assault over the past year and 47% reported emotional abuse. 
  • Acute care hospitals in Ontario reported that ALC patients occupied 17% of all acute care beds; half were waiting for long-term care; over 36% have moderate to severe cognitive impairment and 19% has demonstrated behaviours.
  • Acute care hospital inpatients in the BSO target population have, on average, a hospital length of stay almost eight times as long as non-behavioural patients and they are more than twice as likely to require home care at discharge.
  • Ontario spends approximately $1.2B/yr for inpatient hospital care of patients in the BSO target population.  
  • Almost half of long-term care home residents exhibit behaviours; resisting care 37%, disruptive behaviour 18% and verbal abuse 18% being the most frequently reported.
  • The average length of stay in an Ontario hospital inpatient psychiatric bed is 2 months for patients with aggressive behaviours; 27 days for patients without.