Person-directed living: honouring each person's lifestyle needs and preferences

Riverview Health Centre in Winnipeg, Manitoba is a vibrant, innovative, and inclusive community providing long-term care, palliative care, and neurological rehabilitation services through inpatient, outpatient, and outreach programs. 

We had a conversation with Kathleen Klassen, the Chief Executive Officer at Riverview. In this role, Kathleen is leading an organizational culture transformation towards person-directed living, a relationship-based, individualized approach where each person's lifestyle needs and preferences are honoured and respected. 

Learn more about Riverview: https://rhc.mb.ca/

Learn more about the Strengthening a Palliative Approach to Long-Term Care project at: https://spaltc.ca/

Transcript

SPEAKER_00 0:00

Welcome to the Strengthening a Palliative Approach in Long-Term Care Alliance podcast, exploring challenges and best practices and palliative care approaches for individuals in long-term care.

SPEAKER_01 0:15

Riverview Health Center in Winnipeg, Manitoba is a vibrant, innovative, and inclusive community providing long-term care, palliative care, and neurological rehabilitation services through inpatient, outpatient, and outreach programs. Today on the podcast, we're speaking with Kathleen Classen, the Chief Executive Officer at Riverview Health Center. In this role, Kathleen is leading an organizational culture transformation towards person-directed living, a relationship-based, individualized approach where each person's lifestyle, needs, and preferences are honored and respected. Welcome to the podcast, Kathleen. Thank you so much for having me. I'd like to begin by having you tell us a little bit more about Riverview Health Center and the services that you offer there.

SPEAKER_02 1:04

Absolutely. So Riverview Health Center is located in this wonderful park-like area of Winnipeg. So we have 23 acres of parkland. We're situated right on the river. We have those individuals that live with us who either they need long-term care or they need a specialized approach. They're living through dementia and need some supports in terms of that. We have individuals that are living with mechanical ventilation and individuals that are end-of-life in complex respiratory care needs. We also have Manitoba's only rehab for both stroke and for acquired brain injury. So we have 40 suites available for those that are recovering from strokes and acquired brain injuries. And we have 30 suites that are for those on the palliative care program in Winnipeg. Wow, that sounds like a huge place.

SPEAKER_01 1:58

It is. We have 387 suites. Wow, that's great. So I mentioned that you were leading this culture transformation towards what we've termed person-directed living. Can you tell me a little bit more about what that means and what it looks like?

SPEAKER_02 2:13

Absolutely. So person-directed living, a lot of organizations as we've grown and evolved, we really have focused on person-centered and trying to move away from staff-directed models or institutional models. And we've moved towards really having that person at the center of their care, their care plan. Person directed living takes that a little further. And what it changes or revises is it really further looks at removing institutional models or care practices. It puts the person being able to make their own decisions, having a say in what time they want to wake up, what time they want to eat, what their world looks like, how connected they are to communities. Person directed care is really focused on relationships. It's focused on the living environment, both our physical living environment and spaces at Riverview, but also the social and outdoors environment. Those are key aspects. Healthcare has been very much focused and designed institutionally for very good reasons. But when you're living somewhere and you want to live in a space that feels innovative and vibrant and part of a community and really strong relationships. And so that's where we're trying to shift pretty much all aspects of what we do here because it is really a transformation. For sure.

SPEAKER_01 3:27

More like home, though, right? Where you know you have the freedom to do what you want to do, right?

SPEAKER_02 3:33

Exactly. And even starting with our language, if you listen to those in healthcare, we often talk about frontline staff and units, which are very military-based, right? So we've shifted our culture. We've started with you know shifting our language, shifting the care and processes that we provide. And I guess even when you say it's like home, well, it really is home for individuals. This is their home. They live with us. So we try to make it a home, a community.

SPEAKER_01 4:04

I can imagine it takes some creativity if you have someone saying, I want to wake up and have my breakfast at this time versus another time, where I think in more traditional homes, you know, it's like breakfast rolls out at seven and you get it whether you're awake or not.

SPEAKER_02 4:18

Well, absolutely. And as healthcare providers, we're socialized, we're educated in a certain approach to health care. And this is more focused on a community-based model, a social-based model. How do we build long-term care or palliative care communities? What do they look like? What does the room look like? How do we connect people to the outdoors? How do we staff so that people can choose when they get up, choose when the meals come? How do we actually do the meal service, right? Oftentimes it's like breakfast is eight, lunch is 12, supper is at five. But if I want to sleep into 10, what does that mean to me? And I should have the ability to eat when I wish to eat and sleep till when I want to sleep. For relationships, that's a one really big change I've seen here is oftentimes when people come into hospital, if you think of it, or an organization, they get omitted. We could say moving in, that's a change in language, but they move into one area and often feel like they have to sort of stay in that area versus make friendships across the organization and relationships across the organization. And just like you would in your home in the community, if you were living here at Riverview, you still should be connected to your church and your community and your friends and going out for dinner, going out to the movies or going shopping, like what you normally would do. And how do we do that for everybody? It may look a little bit different, but those types of normal, spontaneous events should still happen, and people deserve that.

SPEAKER_01 5:46

Yes, absolutely. What are some of the challenges as you go through this transformation? I would imagine this is quite a change for your teams.

SPEAKER_02 5:54

It is. One is just shifting our thinking, right? This is exactly what people deserve. This is what older adults deserve. This is the care they should have. There's a lot of work happening across the country in terms of particularly long-term care. Palliative would fit with that in terms of hospice, and having a small house model, having small groups of people, not having 40 people on a long hallway that you know looks almost like a bowling alley, but having small clusters of people living together, having less institutional designs. We just renovated all of our bathing and showering suites. When I first came here, you would walk in, it was white walls, right, with an institutional tub, it was cold. There was some individuals who felt very uncomfortable in that space and actually would decline. And we talked to people living here. What do you like to see? What's important to you? So we just opened all 13 of the suites. There's tile, there's warm colors, there's shelving with artwork, there's dome lighting, there's heat that radiates over that individual, whether they're having a shower, there's a lot of privacy considerations. We have a space for hair salon and styling after. We have warm towel racks, we have music that can be chosen. We have people who've declined having showers and baths for a long time, and now they're excited about it.

SPEAKER_01 7:14

Yeah. And that personal touch really makes such a difference to people, especially when they are moving in for the first time, I imagine. That's a scary experience when you have to leave your own home and move somewhere where you are socializing with many different people.

SPEAKER_02 7:30

There's so many losses associated with it too, right? You know, when you talk to people, none of us have on our bucket list. I want to move into a personal care home, I want to live in a long-term care facility. That is not on our bucket list. That's not how we envision our senior years. So, how do we support someone with that? How do we welcome them into our community? How do we provide orientation and supports? How do we have them involved and ensure their voice is being heard? So that's been a lot of our focus too in this transformation is ensuring that those that we provide care and service to, their voice drives change, right? They're directing change. We've added residents on our board committees. We have residents participating on our quality and safety committees, we have residents participating and leading our resident council. They lead that and have amazing ideas, and their voice is informing choices. We actually do engagement forums where we do focus group work with uh residents and families and ask what's working, what's not.

SPEAKER_01 8:35

Can you tell me a little bit about the outpatient and outreach?

SPEAKER_02 8:40

We do have an adult day program. It's called the Rendezvous Club. This is a program where individuals will come once or twice a week. It provides an opportunity for social relationships, exercise, there's some focused programming. It also gives an opportunity for their family or care partner at home to have the time they need for some respite and to get all the things they need to do or have relationships themselves. We have an EMG clinic here, which helps diagnose how your muscles and nerves are talking to each other. It's electro biographies. The other program we have is called the Geriatric Day Hospital, but it's an interprofessional team. This is a program for people living at home that are having falls, concerns about medication, maybe some new changes in memory, struggling a little bit within their current supports in the community. So physiotherapy, occupational therapy, recreation, physicians, a geriatric specialist, a nurse, a team together and trying to establish, you know, what's happening, what we can do to maximize success in the community. So generally, people they come once a week for up to about three months just to help keep them living at home as long as possible. Other programs we have is we have outpatient clinics for those individuals that have just completed their rehab stays, and we have clinics that support people that need medication injections to help with spasticity.

SPEAKER_01 10:02

And does that culture transformation get integrated into the outreach and outpatient programs too?

SPEAKER_02 10:09

Every single area in terms of how we talk and community and how we set goals. Another change with Person Directed Living is around redefining risk and who's defining risk, and that there's a dignity of risk. And we all get to make decisions and choices, and we all can make choices that we feel aligns with our values. Sometimes as healthcare providers, we can be very protective or paternalistic and want the very best for someone, but we need to also support them and what their goals are. And if that means living with risk, then we support that. And how can we support that and look at harm reduction or other approaches? So that is in every area, and it's challenging us, right?

SPEAKER_01 10:48

Oh, for sure. I think about your teams and how they have to maybe check themselves and think a little bit differently and really be guided by some of that freedom of decision making and being able to be okay with it. That's right.

SPEAKER_02 11:02

One individual that really enjoys being very connected and busy outside. And is it a risk? Absolutely, it's a risk. But that is really important to their quality of life. So harm reduction was making sure there was a safety vest, just like all of our staff would wear when they're out doing that type of work outside, and the right tools may be modified to support that person. And just being okay with yes, there is a risk, the person may fall, and they're okay with that risk. So we got to support that as well. Yeah.

SPEAKER_01 11:40

You mentioned nature earlier. You have quite a large area, almost like a park.

SPEAKER_02 11:47

We do. We have 23 acres, beautiful lands, countless trees, we're on the river. Being outside is incredibly important. When we did our engagement forum this spring, one of the number one things people said is, I want to be outside more. I want to be in nature. We do have an outdoor rehab courtyard where we are able to have people actually doing rehab outside. And the benefits of being in nature, gardening, all of that contributes to your rehab, to your therapy goals and program. But it also lets us have different sidewalk textures and different types of curves that you're starting to practice. So you might be walking on gravel, cement, asphalt, cobblestone. So we have outdoor steps, and that's all about the rehab program and being outside there. We also have lots of animals that live around us, and that's a feature here. So we have foxes and deers. We just had a brand new deer that was born on our property about a week ago, which was amazing. Lots of birds, that's really important. We have two courtyards. We have a courtyard that's a main courtyard everybody can access it. It has seating areas for individuals, for couples, for families, or larger gatherings. We have a barbecue and families and residents can use it. We just added two additional garden planters that are accessible and dedicated to vegetable growing. We have a courtyard that's for those living in our communities for people with dementia. We have a campfire, uh, you can roast marshmallows. We're just the process of getting a water feature out there. And we've put in plants that have different scents and smells all year in all summer, spring, and fall, and that also attract butterflies and birds into that space. We have some soft chimes that are available for that sense with hearing. So it's all about engaging all the senses. We have portable gardening centers so we can garden together. And we also do during the winter, because we're in Winnipeg, we do indoor gardening and have um, I'm not sure what they're called. I don't know if you know Nancy, but it's like the indoor plants, they have the lighting systems, like hydropods. Yes, thank you. We have two communities here, one that is for people with end-stage respiratory or lung disease, and another community that has people living with mechanical ventilation, like ventilators. And those individuals, well, outdoors is equally important, but it can be more difficult to get outside because you've got oxygen tanks or you've got other equipment, or it could just be that your comfort in terms of being too far away if you're feeling a little bit shorter breath or a bit more anxious. So those communities asked us to consider outdoor rooftop patios. We're so excited that we'll be opening those up next year and having space right off their community that they can be outside and being designed again with gardening and nature and lots of sitting spaces.

SPEAKER_01 14:44

You mentioned partnering with local nursery. Do you partner with other community organizations as well in the community?

SPEAKER_02 14:51

1,000 percent. Our community partnerships contribute to quality of life here so significantly, whether that's through volunteers that are supporting us, but partnerships with local businesses. We can walk up the street and go for coffee or go shopping, having the opportunity to go to our Blue Bombers here in Winnipeg or Winnipeg Jets, Goldey's. We have this amazing partnership with Churchill High School. And so the high school students come, their hockey team has come, and we've done gym exercises and exercise programs together. They have a lot of individuals that are newer to Canada and they're learning English, and so they come and they're practicing their English skills with residents here. We have a lot of people with amazing talents that live here, so previous teachers, people that love books and really support and love to sit with students and help them with that skill. We also have a lot of artists here, so we have shared programs with student artists and then our resident artists, and they co-create art together. We just about to open a child care center. We very specifically designed it so that it was accessible for all, that we have intergenerational spaces available. So we have an intergenerational art space and a large foyer, and then we also put in, thanks to our foundation, a gazebo or a large covered gazebo that's accessible through wheelchairs. So we're really excited to bring the vibrancy and excitement, the spontaneity. So that's something else we're really building on.

SPEAKER_01 16:18

So older people living in long-term care then can connect with these kids. Well, absolutely.

SPEAKER_02 16:25

There's really good research about even for children, right? Some children have grandparents, some may not have that experience, but getting rid of ageism, right? Understanding that getting older is is human and part of life, and not to be frightened by aging or to misinterpret what those of us that are older can and can't do. Also demystifies dementia. Just because you have dementia doesn't mean you have any less involvement in your community or have relationships or participate. So it's really important for the kids as well. There's some research also that shows just that intergenerational relationship has been shown to decrease falls in older adults, decrease loneliness, decrease feelings of depression, and within a few weeks. So we're excited about that.

SPEAKER_01 17:12

I love hearing about high school students as well, because you know, great for them to get into volunteering, but I think being able to connect with the older generation helps them hear stories that they might not hear otherwise.

SPEAKER_02 17:26

Like history lessons and talking about this person's stories and storytelling. Those living here have gone to sock ops down the street and art classes. We've gone to their productions of their musical theater. And equally they've done their musical theater dress rehearsals on site here at Riverview, took over our cafeteria and did dress rehearsals all day, and we got to visit and participate in that.

SPEAKER_01 17:49

So it sounds like Riverview is more like a community center and that residents just happen to live there in the middle of all of it.

SPEAKER_02 17:56

Yeah, absolutely. That's our goal. It's not about the health care. Yes, there may be health conditions that require some type of different approaches or care, but ultimately we focus on you as a person and how you can live to the fullest. And let's create a community all together. We have residents that have started their own support groups now, and they get together. We have a resident group that has noticed that some individuals struggle when they first move here, and it can be really challenging. And so they are doing peer support and touching base and visiting and being involved. You know, oftentimes in healthcare we do four people. This is not us doing four. We're there to facilitate and enable. They run it, they do all that on their own. Amazing. What are you excited about for the future? I'm really excited because I think that there is a real palpable shift in expectations and how long-term care, rehab, palliative, how health care should be. I feel that there's an energy and commitment across government, care providers, educators, higher expectations for all of us to provide care in a way that actually speaks to our values, our relationships, what really matters for quality of life. I feel like there's an energy, not just in Manitoba, but across Canada and other partner countries. So I know that amazing things are happening in Europe and in the UK and Australia and the United States, just really shifting. I feel like there's this critical mass that the timing is right to really make this happen. This should become the norm. Yes, let's hope so. What is the favorite part of your work? My favorite part of my work is when I have an opportunity to be out and about and visiting, talking to people, hearing their stories, finding out what they're hoping to see changed, and make it that happen. If the staff have the education tools they need, and if they don't, then that's my job to figure out how to help them get there. But also empower them. I mean, the ideas, suggestions, that's from everybody living here, staying here, working here. That's aren't my suggestions. They're bringing it all up. We're just helping them get to make it a reality. And I remember one of our key partners, a Sherbrooke Community Center in Saskatoon, they've done incredible work there and they've been really supportive to us. I remember in talking to their past CEO, and I said, When do you know you might have got there? And they said, When you have no idea what's going to happen next in your organization. And I thought, well, that's kind of a strange thing to say, but it's so true because things are happening every single day, and I'm finding out these things as I'm walking about, and I love that they don't feel they have to ask permission. That if it aligns with our values and it aligns with the person's values, that they can just do it. That's amazing.

SPEAKER_01 20:46

That's I think my favorite part. Thank you so much for speaking with me today, Kathleen. It was a real pleasure. Thank you so much.

SPEAKER_00 20:54

You've been listening to the strengthening a palliative approach in long-term care podcast. For more information about our project, visit spawnltc.ca