Parents Are Hard To Raise® S03 Episode 125 Transcript
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[00:00:37] This week on Parents Are Hard To Raise Diane’s special guest expert, Jennifer Ridgway of the Sinai Health System in Ontario, Canada pulls back the curtain to reveal how a simple idea can result in so many benefits.
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Diane Berardi [00:01:12] Welcome to Parents Are Hard To Raise… Helping families grow older together without losing their minds. I’m elder care expert, Diane Berardi.
[00:01:21] Recognizing that families and caregivers are an integral part of the collaborative care team is a great idea. Implementing that idea in a system known for bureaucratic logjams and interdepartmental turf wars is another matter altogether. My guest this week is part of an innovative team who made it past all the obstacles and implemented a simple idea that is paying off big benefits for family caregivers, providers and patients alike. And she’s here to tell us how they are doing it. Jennifer Ridgeway has been working in the field of therapeutic recreation for the past 19 years in both hospital and community settings. She is currently the program co-lead for the cultivating Change project at Sinai Health System in partnership with Wood Green Community Services, which is funded by the Change Foundation in Ontario, Canada. Jennifer Ridgway welcome to Parents Are Hard To Raise.
Jennifer Ridgway [00:02:22] Thank you so much for having me. It’s my pleasure.
Diane Berardi [00:02:24] We’re so happy to have you here. But my first question is could you tell our listeners, What is therapeutic recreation?
Jennifer Ridgway [00:02:35] Certainly. Therapeutic Recreation is a field where recreation therapists assess patients to look at what strengths that they have, what’s meaningful to them and what brings them joy. So when someone’s had an illness or an accident and they’re no longer able to participate in leisure the way they used to a recreation therapist looks for ways to adapt, and through equipment or a different approach, for them to still be able to engage and have those social connections to others. And Therapeutic Recreation also has been instrumental in helping people transition back into the community after their rehab stay, because life could look very different for them. And not only for themselves but also their family, if they have other kind of care needs that they didn’t have previously. It’s an adjustment not just for the patients but for everyone who’s in their support system.
Diane Berardi [00:03:27] Is this a fairly new field?
Jennifer Ridgway [00:03:30] It’s not as common as occupational therapy and physiotherapy. But, yeah. So Therapeutic Recreation has probably been around since I’d say the 80s, when they started their first kind of formal education programs. So recreation therapists often work in both community settings and hospital settings.
Diane Berardi [00:03:50] That’s a great field and there’s a great need.
Jennifer Ridgway [00:03:54] Yes and there’s also some current work happening not only with our our senior population but also within the school board because it’s really a strengths based approach that looks at building skills in a variety of cognitive, emotional, physical and social capacities.
Diane Berardi [00:04:12] Right. I love that social capacity, because getting people back into social settings.
Jennifer Ridgway [00:04:21] Exactly. Social isolation is such a huge concern for especially our seniors population.
Diane Berardi [00:04:26] Right. Yeah. So tell us about the programs you’ve implemented.
Jennifer Ridgway [00:04:33] So we have implemented many programs across the Sinai site and also with our community partner, which is Woodgreen, which is a community service organization. And I know that we wanted today focus on our caregiver I.D. component. But just to let you know besides the caregiver I.D., We also really leverage technology such as we have in Ontario, a telemedicine network which we’re utilizing to allow family caregivers to, it’s like Skyping into family meetings or rounds, medical rounds. But it’s on a secured network.
Diane Berardi [00:05:08] Wow.
Jennifer Ridgway [00:05:08] Yes. Many people have barriers to being able to get to meetings whether it be distance or having to return to work or other care needs for other family members. So looking at how we can break down as many barriers as possible to have caregivers successfully integrate into the care teams.
Diane Berardi [00:05:29] Yeah, that’s a great idea.
Jennifer Ridgway [00:05:32] Yes. Oh there’s a lot of interest in scaling and spreading that idea to other areas as well. So this project is looking at support, education, recognizing caregivers, which is what we’re going to talk about today more and really about education and support as well.
Diane Berardi [00:05:49] Right. Right. I was just telling Jen before we came on air about my mom and dad. And I could use your program with this guy tomorrow. [laughing] Right?
Jennifer Ridgway [00:06:00] Right. [laughing]
Diane Berardi [00:06:01] Because my mom felt she couldn’t get to her chemo appointment and she wanted to talk to the doctor. And she’s just so tired, and she’s not able to walk or you know we’re having… It’s a struggle. And so the doctor said, Don’t worry about it. We can do a phone conference.
[00:06:22] So I thought OK. And you know I’m two hours away so it’d be like four hours for 10 minutes. And I thought, OK let me try to see if we can have a conference call. But, I just had my dad… You know I wanted to just get him to adjust the volume, that was just the first step, you know on my mom’s cell phone. Four hours go by, and then he finally calls me back. And then he’s like, I don’t know how to even turn on the phone. [laughing].
[00:06:53] I’m like, You don’t know what her password is?
[00:06:58] I’m like, Oh my gosh. So I don’t know. Yeah. It’s just… But this would be perfect.
Jennifer Ridgway [00:07:04] Yes, I think that definitely a lot of the other project teams are very interested in this particular initiative. And so I can really see it spreading to other organizations.
Diane Berardi [00:07:13] So now what is the caregiver I.D.?
Jennifer Ridgway [00:07:17] Yes. So the caregiver I.D. is actually a physical I.D. card. It looks very similar to a staff badge and it’s really about recognizing the caregiver as an important member of the patient’s care team. And what’s really important about the caregiver I.D. tag is it’s not just giving someone this tag, this card, but it’s actually linked to access. So there is utility with the card and it was really a part of launching our family policy here at the Bridge Point site. So that family presence policy replaced our previous visiting hours. So, before June 5th of 2018, we used to have an announcement that would come on at about 8 o’clock letting people know that visiting hours are now over.
Diane Berardi [00:07:59] Right.
Jennifer Ridgway [00:08:00] We no longer do that. So caregivers, which could be family, friends, the neighbor, anyone who supports that patient are always welcome in our facility. And what we’ve done is we developed a process where a patient identifies who they would like their caregiver to be.
Diane Berardi [00:08:17] OK.
Jennifer Ridgway [00:08:17] That information is entered into our electronic medical record where the caregiver then goes down to our security office, and the security checks the caregiver information in the computer in our system against a photo I.D. of the caregiver. And then the card is presented. And then the card itself allows them to scan-in the elevator. So at 10:00 o’clock in the evening till 7:00 in the morning our elevators are shut down to general access, and only someone with that card on staff or caregiver can scan and they can go to the unit where they are supporting someone.
Diane Berardi [00:08:53] Oh wow.
Jennifer Ridgway [00:08:54] Yeah. So it’s really taking away that barrier of tryingto get there at a certain time, and having to it permission to be there, if they want to be there past 10:00.
Diane Berardi [00:09:04] Right. Right. Yeah, I know. Because you get that announcement in all the hospitals here. Visiting hours are closed and you feel horrible leaving your parent.
Jennifer Ridgway [00:09:17] Yes. And sometimes you know different people’s working schedules, if someone works until 5:00 and gets home or just gets to the hospital you might only be able to have a very short visit before that 8:00 announcement. And people work different shifts as well. The world is moving all the time and not everyone has the same schedule.
Diane Berardi [00:09:34] Right. So this is great. You know really looking at the caregiver and saying, OK how can we help in that way? Because you’re right, everybody has different work schedules and by the time you find a parking space, sometimes [laughing] or something like that. Yeah.
[00:09:52] I do remember though having to go be a patient in Florida, at Celebration Hospital, which is a Disney hospital. And they, now that I think about it, they did give my husband a card and he had access to the whole hospital, could come come and go at any time with this card. Now that I think about it… But not many places took on that and thought about that.
Jennifer Ridgway [00:10:22] Yeah and hopefully more will. There’s been some work done in Ontario with Ontario Hospital Association. They really set out a document. They have the principles for the family present policies. And then the Canadian Foundation for Healthcare Improvement developed, “Better Together pledge,” which is all about partnering with family caregivers and recognizing that they help in care and they help support the patient and just that the quality of the experience is so much greater when we don’t put those barriers in place.
Diane Berardi [00:10:52] You know going through this whole experience with my mom, you really can appreciate all the frustrations you can feel and it’s not intentional by any means on the part of the hospital, whatever. It’s just that no one thinks about it. And, how do we make the lives easier?
Jennifer Ridgway [00:11:10] And another component of the back bench itself too was that when we first were doing the discussions and reviewing our policy in 2017 and we engaged with patients and staff and caregivers some of the concerns were regarding staff working in the evening and not wanting just kind of as open up and unlocked the hospital and not knowing who would be here in the hospital and a feeling of safety. So not only for staff but also patients and other family members really like the fact that caregivers are getting this card from security. So even if they’re not visiting themselves at night they know that the hospital is not just open and that their loved one is safe within are within our walls.
Diane Berardi [00:11:46] Right. Can you have more than one caregiver or is it…
Jennifer Ridgway [00:11:50] That’s a great question.
[00:11:51] So we allow people to identify. We ask them to identify two caregivers. And we ask just one stay overnight at a time with the exception of our palliative care and our palliative care unit, we don’t put any restrictions whatsoever.
Diane Berardi [00:12:06] OK. Yeah.
Jennifer Ridgway [00:12:08] And we’re really fortunate though our palliative of care is only single rooms. So we moved to a beautiful new building about five years ago. And so it would be difficult or maybe we may have more considerations that people were sharing rooms, but in palliative care it is one patient per room. So we’re not interrupting anyone else’s rest or sleep pattern.
Diane Berardi [00:12:28] Yeah. That is really good. Yeah. Because I was thinking if you have you know two siblings or if and they take turns could it be two different people but that’s… Yeah. And not having any barriers with palliative care is really important.
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[00:16:12] So Jenn… When you implemented this program, the caregiver I.D., did you face any challenges?
Jennifer Ridgway [00:16:21] Yeah I think we definitely had a lot of innocent people feel uncomfortable or had some concern and it was especially with the nurses back to work in the evening because in the evening there there’s no other health disciplines, there’s no physiotherapist or unit manager, so there’s just less traffic of other employees. So we really had a lot of conversations.
[00:16:41] We actually went to every unit, and did council meetings. We had a breakfast event held at shift change, so we could kind of catch the oncoming and exiting nurses. So through having the conversations and really talking about, OK what is your concern? What do you think may happen? And then talk about that, What would we do if… Kind of a conversation. And we had security present as well. And they were really wonderful at saying, Listen, if something happens and you’re uncomfortable with the situation, call in Security. Like, you’re not alone. So I think having those conversations is really helpful.
[00:17:15] One nurse in particular who I had actually worked on a unit with and have a lot of respect for her was really concerned about the policy. And she had worked at a different facility where they had a family presence policy and it hadn’t gone as well. And so she brought with her that experience and was very vocal. And so you know it’s good to sometimes have individuals who aren’t the early adopter, in order to understand where they’re coming from, and those concerns.
[00:17:42] And so when we went live or soon after that we got together with caregivers and providers to create an expectations document and I asked her to join that group and at the end of it she actually apologized to me, which she didn’t owe me an apology, but just saying, you know I was really concerned and though all these things could happen. And she said, You know what… Having the caregivers here in the evening has actually been so helpful. And having their knowledge and their skills and those contributions have really improved patient care.
[00:18:12] So I just think about that example. And you know it’s OK that they’re not everyone’s on board right away. It was the right thing to do. And you just really have to socialize the idea. And be open to feedback.
Diane Berardi [00:18:27] You know, and I would think for a mom having her daughter there, she would be calmer.
Jennifer Ridgway [00:18:33] Absolutely.
Diane Berardi [00:18:33] Right? Maybe not require the nurse to come in, or it would give the staff leeway to do their, you know, what else they have to do. I would imagine. But, I can kind of see where the staff would be hesitant at first.
Jennifer Ridgway [00:18:50] Another way that’s really been helpful, and you mentioned you know a child helping support a parent, is some of our patients sometimes English is not their first language. So having someone there who can also help interpret on the spot, you know when someone needs to receive care or you know they want to check vitals and things like that it can be frightening for someone who sure understand what’s going on.
Diane Berardi [00:19:11] Yeah. Yeah you’re right. I mean I didn’t even think about that. But absolutely.
Jennifer Ridgway [00:19:16] For sure. I was just going to say a couple of things kind of came out when you mentioned, What were the challenges. One of the things were we didn’t think about right away perhaps, was that once we took we control the access to the elevators we had to think about our patients who like to go out in the evenings. So some of our patients are quite early risers or stay out a bit later. So we had to actually provide them with cards as well so that they could get back to the unit.
[00:19:46] [laughing] So… Yeah.
[00:19:48] And the same consideration for agency staff. So once in a while when we don’t have enough of our own care team we need to invite in agency staff to work in the evening which would be when the elevators are not…
[00:20:01] Yeah, you’re locked.
[00:20:02] Yeah. So just a couple of things that did come up and you keep doing your PDSA cycles your, plan, do, study and act and you just keep the quality improvement going on.
Diane Berardi [00:20:13] Things are going to come up. Right? Yeah. You don’t know about. And so, OK. We do it. We go live and we try it.
Jennifer Ridgway [00:20:19] That’s right. And you know like for one of the other things we have to purchase, too were more recliner chairs, because people were saying and they obviously needed somewhere to sleep. Yeah. And we didn’t want to purchase them ahead of time because we weren’t sure how many individuals would be staying over so we kind of you know launch the family presence policy and then really closely monitored, Where were people staying over night? And, How many people were staying overnight? Before purchasing, making that large purchase for the facility.
Diane Berardi [00:20:45] And how did the caregivers react?
Jennifer Ridgway [00:20:48] The caregivers have been really really impressed by being identified and being included. And one of the caregiver stories that I really enjoy is that I had a caregiver come down and I was doing an information session about a resource center that we’re building for caregivers. But during the session she had come by and she brought her I.D. badge down to get her flu shot. So in our hospital in Toronto every staffer that gets a flu shot gets a sticker on their badge. And so I’m not sure if that’s a common practice but it just identifies that you’ve had your flu shot should there be an outbreak. Yeah. And so she brought her caregiver badge down and she wanted her sticker on her badge similar to an employee. And I thought that’s great, because we do want to be recognizing you. And also I was so impressed because it’s the first year we provided flu shots to caregivers. And I thought, you know why not do one thing that we can take it off their list and they don’t have to go to their doctor or make that appointment when they’re so busy trying with someone in hospital. So I feel like it’s that culture change to being more inclusive into recognizing caregivers.
Diane Berardi [00:21:53] Oh definitely. I’m sure you’ve seen huge benefits as a result of this.
Jennifer Ridgway [00:21:59] They have. And we’re really also part of the dashboard template that we’re using to evaluate is looking at 10 questions that are in the patient satisfaction survey, the patient family survey, which is sent out. So we’re really looking also to track satisfaction, content, to know has this change in how we’re inviting caregivers and partnering with caregivers, Is it changing their feeling towards how that is changing their experience in a positive way? And would it help. Would it make you want to recommend this hospital to your friends and family? And did you feel included? And did you feel that you were treated with courtesy and respect? So these are all numbers that we want to always be improving on and want to accomplish in close to 100 percent as possible. And I think this policy definitely is a driver for that change.
Diane Berardi [00:22:48] Oh definitely. There’s just so many positive reasons to do it.
Jennifer Ridgway [00:22:55] Yeah. And you know what was interesting or you know tracking some of the numbers is that not everyone who has the caregiver I.D. badge actually stays overnight which is OK. What we found was that some of the caregivers and patients just felt that it lessened their anxiety just to know. Yeah. That if they wanted to if I was feeling unwell one evening and I called somebody I know they could come and they could be there and it was just a reassurance for both the caregiver and the patient staying in hospital, that they have that welcoming connection to have the person at their bedside.
Diane Berardi [00:23:28] Right. They just know that they can if they need it.
Jennifer Ridgway [00:23:32] Exactly.
Diane Berardi [00:23:33] Or they could call them and say, Geez, you know, can you come back?
[00:23:38] Exactly. Like I’m having a difficult night. Yeah. Yeah.
Diane Berardi [00:23:44] Because a lot of our parents. They wake up at 2:00 a.m. You know and… And then you wake up and you’re in a, you know you’re in a hospital, you’re in a strange environment. And you get scared.
Jennifer Ridgway [00:23:57] Yeah. And you know we’ve heard from. Also we have a fantastic volunteer who actually is now on our steering committee for for the project who was a caregiver to an individual on our stroke unit. And you know she she said You know I’ve been I’ve been married for more than 40 years. And so being a part this is a long as I’ve ever been apart from my husband in this hospital. Yes. So having that card and that that again to remain at bedside was really important to them.
Diane Berardi [00:24:25] Yeah. You don’t think about you know they’ve been together for all these years.
[00:24:29] Sure. And they rely on each other.
Jennifer Ridgway [00:24:33] Absolutely.
Diane Berardi [00:24:35] We have a huge audience of family caregivers and health care professionals listening from around the world. What advice do you have for others who might want to implement something like this in their area?
Jennifer Ridgway [00:24:48] I think my advice would be to definitely give yourself time in your implementation. Plan to have the conversations and not just have them from a leadership lens but have frontline providers involved. Have caregivers involved, and security. And someone from your quality team. Because I think it’s really important that people who work on the floor are talking about this policy because sometimes in health care we have a tendency when we’re front line and someone kind of swoops in to make a change we get our backs up and we say things like, Well they don’t know what it’s like to be on the floor. So I think you definitely need leadership support but it can’t be a top down. There’s got to be conversations that happen where it’s meaningful engagement and people have an opportunity to express what their concerns are. And you have time to address them before your go-live date. So, I’m just gonna say a lot of support is necessary to have this shift in culture, the shift in how we include caregivers. So I think that was the main thing was having a lot of conversation. Having posters in the parking garage and the elevators. Spending the time to teach the staff how to implement the caregiver information into the electronic medical record. So we want to make sure everything works for that Go-live date. And we wanted to we actually registered caregivers ahead of time discerning sure that wouldn’t have this huge lineup that would be frustrating for caregivers.
Diane Berardi [00:26:15] Right.
Jennifer Ridgway [00:26:16] Yeah, just being really thoughtful in what will this looks like day one and how we’re going to support the team in implementing this change as well as educating the caregivers and patients that this opportunity is available.
Diane Berardi [00:26:27] And how did you let the caregivers know?
[00:26:31] We had some unit champions who actually went that were nursing staff on the unit that went room to room to speak to caregivers and patients to let them know and answer any questions that they might have.
Diane Berardi [00:26:44] Perfect. Thank you so much Jennifer. You’ve been here today.
Jennifer Ridgway [00:26:47] Thank you so much for having me.
Diane Berardi [00:26:50] And thank you for everything you’re doing.
Jennifer Ridgway [00:26:52] Oh you know what. This has been such a fantastic opportunity. And this project been so exciting to actually have the opportunity to work with the caregivers and frontline providers and truly partner. So it’s amazing instead of just like kind of that check box that you did engagement but to really have people at the table together, and working together.
[00:27:13] It’s been fantastic.
Diane Berardi [00:27:14] And it’s great because I’m so happy for the professionals that are listening to hear this.
Jennifer Ridgway [00:27:19] Yes.
Diane Berardi [00:27:19] Because we need to implement this everywhere.
Jennifer Ridgway [00:27:23] Yeah. And you know what you can do it. Like I think people think it’s overwhelming but really you know you can do it. Like you can change that… Don’t make that announcement at 8:00 anymore and you can you can either do a phased approach, or we did the whole hospital. We just went live one day, just like flicking a switch like, This is the way we’re doing business, now.
Diane Berardi [00:27:41] Right. Right. No, it’s fantastic. And I wish you all the luck in the world and your continued success.
Jennifer Ridgway [00:27:48] And I hope that your appointment goes well [laughing]
Diane Berardi [00:27:53] Oh, my gosh. I know. I have I have to call them back. I’m like, Oh no! I know but… It’s just part of it. Right? [laughing].
Jennifer Ridgway [00:28:04] Well, they’re lucky to have you.
Diane Berardi [00:28:06] Oh, thank you. Thank you and you take care.
[00:28:10] Parents Are Hard To Raise family I love getting your e-mails and questions so please keep sending them. You can reach me at Diane at Parents Are Hard To Raise dot org or just click the green button on our home page.
[00:28:20] Parents Are Hard To Raise is a CounterThink Media production. The music used in this broadcast was managed by Cosmo Music New York, New York. Our New York producers Joshua Green. Our broadcast engineer is Well Gambino. And from our London studios, the melodic voice of our announcer, “Miss Dolly D.”
[00:28:37] We love our parents, but parents sure our hard to raise.
[00:28:41] Thank you so much for listening.
[00:28:42] Till next time… May you forget everything you don’t want to remember and remember everything you don’t want to forget.
[00:28:47] See you again next week!