R.E.S.T. Philosophy



The R.E.S.T® philosophy of care stands for building:

R


elationships between residents, families and care providers



E


ngaging and enabling residents using specific proven



S


trategies and interventions in a



T


herapeutic team environment



These are the foundational concepts which are the framework of the philosophy at 147 Elder Street and drive the care there.

Relationships

Connections and activities support the basic human need for interaction and acceptance. Insuring socialization among and between the residents is crucial to our model of care and therapeutic recreation programs were specifically designed to achieve these goals.

The individual in care is viewed as a whole person, one who has led a life rich with experiences and relationships. Often older persons who are functionally impaired and treated as though their functional status is what is of greatest importance. This perspective places an emphasis on understanding the individual, and thus building a relationship with them given this information. The perspective employs a individualized approach, wherein the uniqueness of each person is considered and an empathic connection is made.

It is imperative to understand an individual's past in order to provide the best possible care. Obtaining a history from the client is not feasible, thus an exploration of their history through the lens of family and friends is considered. By understanding the individual, the caregiver can treat older persons with respect and dignity and provide them with the ability to maintain their integrity despite their condition.

During assessment and throughout treatment, the integral components of relationships are identified and strengthened. An understanding of how the client made connections, their attachments, their knowledge and resources in their lives before their illness and their current capacities are incorporated in tailoring their case.

Although person with A.D. and dementia have difficulty remembering details and finding the appropriate words to express themselves such as names and places, what stays with them are the emotional connections associated with relationships, and when reminded of the practical information, they can make the connection between emotions and data provided.

Engagement and Enablement

Engaging the residents requires knowing who they are, what is important to them and what make them unique. Each individual has his or her own reality which is shaped by the past and future to influence the now.

This model of care places an emphasis of engaging the individual with Dementia in daily life experiences and provides them the opportunity for autonomy and self worth and socialization with peers in a normalized family environment. Enabling the individual to do all that they can possibly accomplish (such as completing tasks of daily living) not only promotes the integrity of the individual, but also allows the individual to preserve the skills and strengths they have. It is integral to elevate self-esteem of the client, which is done by having a complete understanding of the psychological strengths and weaknesses of the individual and planning a comprehensive range of programs best suited to persons with A.D. and dementia. Caregivers address issues of resistance and agitation when they occur, managing the emotions of the resident by reframing and reorienting them, and thus enabling the client to function successfully.

Strategies

The strict admission criteria to 147 Elder ensures that all persons have dementia. Each lived experience of dementia is unique along with coping mechanisms and reactions to particular stimuli and events. These take into account the respective psychosocial histories and diverse strengths and weaknesses that characterize each person. A comprehensive assessment is performed by a social worker and R.N prior to a resident's moving in, including a detailed exploration of the person's lifelong personality and experiences and background as well as their current home/family life, daily routine, perception of abilities and socialization skills. This material is disseminated to all staff and it is obligatory for them to know this information and integrate it into the daily care of the residents. Residents' behaviours or reactions to stimuli becomes more expected and anticipated resulting in improved ability to target interventions and achieve realistic outcomes. Staff move from novices to experts by knowing each resident, noting subtle changes, recognizing patterns of behaviour and individualized care. Independence in action and decision making is promoted as well as choice and flexibility around how one's day unfolds.

The staff is comprised of registered nurses (24/7), social workers, in-house consulting geriatrician and general practitioner, personal support workers and recreationists. A high ratio of staff to residents, 1:3, is provided to carry out the model of care, and extensive staff mentoring on a 1:1 basis thorough regular three times weekly conferences as well as regular educational and team-building workshops.

The approach is based on a problem-based learning methodology. We identify a problem and study it; tracking the behaviour or other manifestation of the problem at hand and then coming up with potential solutions which are monitored for efficacy.

147 Elder Street is committed to an ongoing process of expanding the knowledge base of staff as well as integrating new skills. Leading edge research is transferred from journals and is integrated into daily care.

Therapeutic team environment

The therapeutic environment values the contribution of every staff person with a focus on wellness and team spirit. The team consists of:

  • R.N.
  • Social worker
  • Personal support workers
  • Physician
  • Geriatrician
  • Physiotherapist
  • Recreation/activation therapists
  • Nutritionist
  • Residents, and families

Families are an integral part of the therapeutic team and are involved in team conferences and educational seminars. All changes in care plans are brought to their attention. Families are welcome to visit at all times and often join their relatives for tea and special occasions.

The goals of the therapeutic activities are preventative, restorative and enabling. The therapeutic recreation activities have been designed to meet the specific needs of our residents and are very innovative. They include regular fitness programs, drama, music therapy, art therapy, travelogues, crafts and current events. They are all tailored to engage the residents and to boost their self-worth. Along with trained recreationists, we have attracted aspiring O.T, nursing, medical and social work students to carry out our programs.

It offers the individual with A.D with opportunities for meaningful involvement in goal-directed activities and a chance to recall memories of experiences they have had. As well, task completion and being part of an activity provide the individual with a sense of accomplishment. These feelings are invaluable for an older person with A.D., as they are constantly searching for fulfillment and being met with frustration in attempting to accomplish without success. Individuals who are cognitively impaired are in tune and intuitive emotionally. Appropriate therapeutic activities provide people with Alzheimer's disease and dementia with the opportunity to spend time how they please, combating feelings of loss of control.