Patient quality of life often depends on smallest needs

Long-term health advocate, Michael Saunders, has discovered that often the simplest care can treat the most complicated of illnesses.

Saunders recalls a patient with dementia often became inexplicably agitated at night.

He learned from the man’s caregiver that the patient thoroughly enjoyed food and deduced that what he received as an evening snack was not enough to satisfy him. The care team gave him two sandwiches at night, as opposed to one; and his mood markedly improved.

“The behaviour (was) actually eliminated. He wasn’t getting agitated,” Saunders said. “Because we had this data, this information, and the discussions, we were able to improve his quality of life.”

Saunders calls this diagnostic technique a Quality of Life in Late-Stage Dementia (QUALID) tool.

A resident-client advocate, Saunders addressed the Advisory Committee on Long-Term Care Homes and Services during its last meeting of the year at the Seven Oaks facility at Neilson and Ellesmere roads in Scarborough. The committee also reflected on the rest of the year’s achievements when they gathered Friday morning.

Saunders said the QUALID tool – which assists in the assessment of satisfaction for residents with moderate to significant dementia – has proven increasingly successful.

“There are other tools out there but quite frankly you’ve got to be a PhD to be able to interpret them,” Saunders said. “I wanted to give the staff a tool that they can use to do the measurement. But even more importantly, have the discussion, ‘How do we make life better?’”

The QUALID application was first introduced Oct. 23, 2009. Wesburn Manor in Etobicoke ran a pilot project. Since May 1, 2010, the remaining nine city-run homes in Toronto have also used the tool to measure satisfaction and to update care and service plans accordingly.

The application measures the intensity with which 11 behaviours – ranging from smiling to crying – occur over the course of a week and the circumstances surrounding them.

Saunders reported that 352 residents have been assessed. Of them, 43 per cent are reasonably satisfied, 52 per cent moderately satisfied and 16 per cent less satisfied. While some staff members have reported that the QUALID tool takes up to eight days to administer, the division average is 12 minutes.

Care workers already collect the data required on a daily basis as part of their routine. Information collected over the course of a week is then used to determine quality of life.

Paul Gamble, chair of the division-wide advisory committee, said the implementation of QUALID goes above and beyond legislation that only requires staff to provide residents with a paper and pen survey.

“The vast majority of the clients that are in the homes here in the City of Toronto have a significant level of mental impairment,” Gamble said. “It is very different to ask, ‘Are you satisfied,’ when they may not be able to vocalize.”

Saunders said that the goal is to standardize the use of the QUALID tool to create a database of information regarding overall client satisfaction and to further improve care.

“I’ve already put into place some strategies with the staff across the 10 homes,” Saunders said. “I think in a year’s time we’re going to have much more valuable data.”