Embracing a New Approach to Challenging Physical Expressions

Village at St. Clair and Layered Natured Framework

By Kristian Partington

When someone who is living with cognitive impairment, such as a brain injury or dementia, expresses themselves physcially with their caregiver, it’s not uncommon for the report to say something along the lines of, ‘It came out of the blue’ or ‘I never saw it coming.’

But did this act really come out of the blue, or are there layers that when peeled back reveal the compounding factors that led to that physical personal expression?

A tool called the Layered Natured Framework (LNF), which is found within Schlegel Villages’ unique, LIVING in my Today dementia education program, helps team members drill down to the root causes of difficult personal expressions and recently, the team at the Village at St. Clair in Windsor has found it to be extremely helpful.

See, in recent years tools have come into play that allow people to address some of the difficult personal expressions that can flare up in someone living with cognitive impairments. There is P.I.E.C.E.S., which is an effective root-cause analysis tool, but it is something that must be overseen by a nurse. In Ontario, the Ministry of Health and Long-Term care has funded Behavioural Supports Ontario (BSO), but these teams are only funded in some homes, with outreach teams accessing the others.

Schlegel Villages decided to create the Personal Expression Resource Team (PERT) to work within the homes that have no internal BSO team, and this is the team that discovered the Layered Natured Framework and began utilizing it at St. Clair. As neighbourhood coordinator and PERT team lead Candace Manwaring explains, several factors led to a high number of residents there experiencing physical expressions, making life challenging for both them and their caregivers while inducing a high number of referrals to a psycho-geriatrician.

“Everybody was moving and everyone was transitioning at the same time,” she says, speaking to the weeks and months after the village opened last summer and began welcoming new neighbours. “We were introducing new team members to our way of caregiving, which means being resident-centred and getting to know each person and how you can help them the way they want to be cared for.”

These transitions and new experiences were likely quite overwhelming for many new residents and for those living with cognition challenges, that sense of being overwhelmed sometimes revealed itself in challenging expressions. “I think having the internal PERT team and the layered natured framework has allowed us to get to know our residents and in return, it decreases the amount of physical expressions we’ve seen,” Candace says.

Within Schlegel Villages as a whole, the policy specifically related to Personal Expression and Reporting has been revised to suggest that either P.I.E.C.E.S. or the LNF be applied to any resident who is experiencing physical personal expressions.

Nurse Consultant Melanie Pereira works closely with both the PERT team and the BSO teams and says St. Clair’s success demonstrates that by bringing all team members into the discussion with LNF, a much more comprehensive examination of the root causes of difficult personal expressions can be found. It goes far beyond nursing and opens the door for every team member to contribute to the betterment of individual residents’ lives.

“We’re seeing a shift,” Melanie says. “We’re seeing a change right now and some really positive outcomes and it’s great that it’s happening within a neighbourhood, driven by team members and not from support office or leadership.”

St. Clair is showing that the Layered Natured Framework can be applied successfully in understanding all personal expressions, and both Melanie and Candace hope other villages will see the same value in it.