Story by Joanne Neilsen
More than simply an Alberta Health Services (AHS) value, compassion is an essential tool to battle delirium for at-risk elderly hospital patients.
The Hospital Elder Life Program (HELP) at Foothills Hospital in Calgary brings together more than 50 dedicated volunteers, supported by a small but robust leadership team, to make a meaningful difference in the lives of elderly hospital patients at risk of delirium.
Delirium is marked by a sudden onset of confusion or change in mental state and a loss of functioning. If unresolved, it can lead to cognitive and functional decline, and an increased risk of depression and premature death.
Through customized care plans, HELP aims to prevent delirium and help patients over the age of 65 retain their cognitive and physical capability while in hospital. Our AHS CARES values lie at the heart of this program. Volunteers build trust through compassion, hold themselves accountable, respect everyone they meet, strive for excellence and value safety.
“In 2017, we enrolled 314 at-risk elderly inpatients into our program,” says elder life specialist Vonda Chester. “When they were discharged, only five had become delirious. This is significant in terms of their quality of life, because patients who do become delirious are more susceptible to subsequent incidents.”
When an elderly patient returns home in a state of delirium, the burden on caregivers increases sharply, placing them at greater risk of burnout. More home-health supports are needed, the costs of care escalate and the elder is likely to face more frequent hospitalizations.
“Our program culture puts the patient and family front and centre,” says Lynnette Fritzke, Specialized Geriatric Services program manager at FMC. “Families appreciate knowing that a trained volunteer visitor will help keep their family member purposely focused and as well as possible. It provides a bit of relief and respite to family care givers, and education about what they can do to support their family member at home.
“The baseline for elderly patients developing delirium in hospital is more than 12 per cent. For HELP program participants it’s less than two per cent overall — with only one in 45 elders developing the condition,” says Fritzke. “By improving outcomes, this evidence-based program has a positive impact on the experiences of patients, their families and health providers — as well as the health system.”
Through planned visits, HELP volunteers give elders the opportunity to interact with others and participate in therapeutic activities like storytelling, and motion exercises which help them retain physical capabilities and promote cognitive wellness. Timely assistance with meals also ensures proper nutrition.
“A flexible approach to problem-solving is important,” says clinical nurse specialist Wendy DeBoer. “Each patient has different challenges and preferences that are potential barriers to successful interventions.”
Chester works with volunteer resources to find volunteers who are a fit for their clients and who will also gain from the experience.
“We like to match volunteers with their interests so they get what they need out of their volunteer experience,” says Chester. “We have many volunteers who have been with us from the start of the program and they help us mentor new recruits.”
HELP volunteers join in weekly shifts, come in all ages from every walk of life — from university students with an interest in healthcare to more career-minded folks and retirees.
“Our HELP volunteers demonstrate a desire to work with others. They have a patient focus and true interest in the care of our elderly patients,” says Chester. “Each year, 10 to 15 per cent of our student volunteers get accepted into post-secondary medicine or healthcare programs, so it’s a great volunteer opportunity for them.”
To participate in the program volunteers take specialized training led by clinical leaders Chester and DeBoer. DeBoer also works directly with patients living with more complications.
“The training we receive is really helpful,” says longtime HELP volunteer Saveen Sidhoo. “Besides the classroom- and experience-based learning, new volunteers hear from current volunteers about their approach, experiences and how we bring in our personalities to make visits more fun and engaging, while keeping in mind our responsibilities — they gain a different perspective from each of us and observe the diversity in our program.”
With many student volunteers, Chester says it’s challenging to figure out how to accommodate everyone’s schedules, find the right mix of patients and volunteers, and fill three shifts a day, seven days a week. Volunteers typically visit 12 to 18 patients over a four-hour shift.
The time volunteers share with patients brings a level of comfort that staff can be hard-pressed to provide on a busy shift.
“A lot of our seniors can feel isolated, so when unit staff sees a HELP volunteer, they know a patient’s day just got better,” says Chester. “They notice a positive change as a result of this friendly visit, and also note that the call-bell use reduces.”
With every interaction, HELP volunteers work towards a common goal — to improve the patient’s experience and outcomes during their hospital stay. They bring newspapers, play trivia, crosswords and word searches. They reminisce with patients about the past, share stories about their own lives and often take them on a wheelchair tour for a change of scenery or fresh air.
“We experience how the warmth shared between individuals can sometimes do much more than painkillers,” says volunteer Jung (Jane) Han Lee. “I think that’s what makes our program unique. We are not just people that offer help. Both the patients and volunteers benefit from this interaction.”
Elders enrolled in the program say they appreciate the opportunity to meet new people and engage in fascinating conversations. As volunteers get to know a patient over repeated visits, interactions become more personalized in response to differing needs, interests and personalities.
“Being able to hear and share that intergenerational piece where seniors can engage with others and share their life experiences and wisdom is invaluable for them, and for the volunteers who are also positively impacted by these interactions,” adds Fritzke.
“One fellow enrolled in our program said ‘I forgot how interesting I was!’,” says Chester.
Many volunteers have been with HELP from the start — and have come to genuinely appreciate the patients they care for.