Project Details
About the Project
In light of a growing population in Greater Victoria, hospital beds have become an increasingly precious resource. This is particularly the case in specialized inpatient units, such as the Geriatric Psychiatry unit (also known as 2 South) at Royal Jubilee Hospital. This 27-bed unit is the only one of its kind on Vancouver Island, providing specialized care for geriatric patients with complex psychiatric challenges. The very limited number of these beds can generate a lengthy wait list for patients experiencing various forms of behavioural and psychiatric challenges across the region, including those who live in Long Term Care (LTC).
While some LTC residents require a transfer to 2 South to manage their behaviours and stabilize their medications, others can be well-supported within the LTC context. Indeed, caring for LTC residents in the home for as long as possible is a key component of delivering resident – and family-centered care. To support more LTC home-based approaches, the Island Health LTC program launched several new resources to help LTC staff and clinicians navigate complex, behavioural challenges. The Quality Resource Team (QRT) are a team of nurses deployed to provide individualized complex behaviour care planning and person-centred non-pharmacological recommendations to LTC direct care teams when caring for a resident experiencing behavioural and psychiatric challenges. Another added resource is the Complex Behavioural Support Team (BeST), a regional team of RN/RPNs with experience in mental health and substance use and complex behaviours. They provide additional support to LTC direct care teams virtually. In coordination with the QRT, the BeST work with the LTC home to work on more in depth behaviour care planning, non-pharmacological interventions, and other resources e.g. Trauma Informed Practice education.
The key drivers for this infrastructure is to optimize care in place in the LTC home, avoid transfer to the Emergency Department and to reduce referrals to 2S from LTC homes. The primary goal is to reduce wait times for patients needing care on 2S.
This ambitious undertaking could only be possible with the collaboration of leaders in both LTC and acute care; Dr. Margaret Manville and Jae Yon Jones, the LTC Medical Director for LTC and the LTC Regional Director for Quality, Education and Research respectively, collaborated with Linda Holmes, Manager of the 2 South Geriatric Psychiatry unit at Royal Jubilee Hospital. The goal was to socialize the new teams to Geriatric Psychiatrists and GPs working in LTC settings and track the proportion of 2 South referrals that had utilized one or both of these services prior to the referral.
This project culminated in an event in February 2025 which drew together numerous geriatric psychiatrists, GPs working in LTC settings, LTC and 2 South nurses and managers and senior Island Health leadership from the LTC, Seniors’ Health, and Mental Health and Substance Use programs. The project team shared initial data introducing the issue, descriptions of both the QRT and the BeST roles and responsibilities. The engagement process included breakout groups at each table to discuss potential next steps and how to coordinate with both the QRT and BeST. A key takeaway from the discussions was the lack of familiarity within the physician community about these resources. One physician remarked, “They [the QRT and BeST support teams] have been around for the last 2 years, but none of the referrals I’ve had in the last 2 years have gone thorough the QRT.” Another reflected on the value of bringing people together to share resources and dispel myths, given that “acute care and LTC don’t always speak the same language”.
Since the completion of the SIFEI-funded initiative, the project team has continued to meet, share data points, and refine the projects’ actions by piloting the resources in a focused manner at 4 LTC homes, all with an aim of reducing unnecessary transfers to the emergency department and 2S, and supporting LTC residents to remain in their homes whenever it is safe and evidence-informed to do so. For more information on these resources, please email LTCCoach@islandhealth.ca or access the resources directly at: https://vicsi-ltci.ca/resource/ltc-complex-behaviours/