The importance of Centres of Learning, Research and Innovation in LTC
By Larry W. Chambers, PhD FACE HonFFPH(UK) FCAHS
To ensure a return investment in education, research and new innovations in long-term care homes, it is essential for the Ontario Ministry of Health and Long-Term Care to continue funding Centres of Learning, Research and Innovation (CLRI) in the Ontario Long-Term Care Program. The Program is designed to address the learning, research and innovation needs of the 630 long-term care homes financed by the Ministry, serving 75,000 residents, 70 percent of whom have cognitive impairment as well as virtually all residents having multiple complex long-term health conditions. The aging of the Ontario population over the next 30 years requires innovative programs such as the CLRI.
The first three Centres funded in 2011 are Baycrest Health Services, Bruyère Continuing Care and Schlegel Villages who created three distinct initiatives that share the same goal and are innovators in the field.
The Ontario Ministry of Health and Long-Term Care funded this new and innovative program from mid- 2011 to the end of March 2016. As outlined in the proposal entitled “CLRI 2.0 The Future of Long-term Care in Ontario: An Integrated Program – Ontario Centres for Learning, Research and Innovation in Long-Term Care (CLRI) January 2, 2016” (available from LWC), the Ontario Ministry of Health and Long-Term Care was urged to commit to funding the CLRI Program for the next five years. The document proposes three funding options that include a centre in northern Ontario plus additional affiliated long-term care homes (see attachment outlining ‘magnet’ long-term care homes in Ontario that should be recruited as affiliated CLRIs for example, Shalom Village (Hamilton), McCormick Home (London), Yee Hong Centre for Geriatric Care (Scarborough), St. Joseph’s Health Care (Thunder Bay), St. Joseph at Fleming (Peterborough), Providence Care (Kingston) and St. Joseph’s Villa (Sudbury).
The continued success of the CLRI Program will respond to the:
• Need to triple the long-term care workforce by 2050
• Need sufficiently skilled workforce to provide high quality care and meet the demands set by provincial reform
• Funding for at least three long-term care/community college, university partnerships across the province that combine learning, research and innovation.
The rationale for the CLRI Program is:
• Clinical placement in a teaching hospital with a focus on emergency needs occurs only over a brief timeframe
• Clinical placement in CLRI long-term care homes with a focus on complex and chronic care needs where students can work with older people over longer periods of time
• Clinical placement in a CLRI long-term care homes provides more effective preparation than only teaching hospital education for learning about care for older people which is an important CLRI outcome
Perceptions in Ontario are changing as reflected in recent reports on dementia care, gerontological/geriatric education, and, services for older adults. The CLRI Program includes the following goals: building and legitimising education and research in long- term care homes. A significant shift in perception of role is required because research is associated with universities, and health workforce training is associated with teaching hospitals. In reality, long-term care home providers are often involved in both roles, but typically receive neither resourcing nor recognition to do so. The CLRI Program’s innovative education and research projects are showcasing the long-term care home sector’s research and workforce training roles and capturing lessons about how to build these system-wide for the 630 long-term care homes throughout Ontario.
Important features of the CLRI Program include:
• Purpose designed research plus knowledge translation
• Current workforce education
• Enhanced quality of care
• Future (student) workforce education
The challenges in long-term care in Ontario are well documented and include: establishing partnerships between long-term care homes and community colleges/universities; the different expectations and cultures; investment of time and work; turnover and loss of champions; long-term staff not trained or resourced to supervise; competing priorities for long-term care staff, heavy workloads; ageism and lack of basic and continuing education infrastructure in long-term care homes.
The CLRI Program is comprised of a purpose-built Infrastructure that includes:
• Focus on working relationships and person-centred care
• Design for learning, research and innovation
• Technology, such as distance learning as a key feature
The three CLRIs in their first few years have already demonstrated excellent practice. Learning initiatives led by the CLRIs have included: structured preparation involving students and long-term care home staff; mentoring of students by nominated long-term care home staff and back-up; structured support of mentors by education and training partners (colleges and universities); appropriate physical infrastructure; evaluation of clinical placements by students, long-term care home staff and education/training staff; plus structured learning programs such as, learning labs and interaction with staff providing care.
The CLRIs also report impressive learning in terms of students acquiring skills in meeting the care needs of older people. Students are learning about specific conditions associated with aging. They also understand long-term care home services and how they operate as well as caring for older people. Changes in student attitudes have been documented. These outcomes demonstrate that long-term care homes should have a recognized role in student training.
CLRIs are having a positive impact on students by changing their attitudes toward working with older people and future employment in long-term care homes. They are demonstrating that long-term care homes can provide a high quality learning environment and have produced new education and/or training materials for staff in long-term care homes.
There is also an increase in participation from long-term care home staff in CLRI driven education or training and their parent organizations are better able to provide high quality educational environments. These long-term care homes are also increasingly operating as educational centres.
Long-term care home staff are excited about the workforce educational opportunities offered by CLRIs. Their staff are eager to participate in every educational opportunity that is offered by the CLRIs. CLRIs are just beginning to address the unmet need for continuing education by healthcare professionals who need to build their understanding of care for older people. For example, trained graduates from the array of existing Personal Support Worker certificate programs find their prior training does not match the responsibilities they encounter when providing care.
In four years, the CLRIs have begun to operate in three new centres and are designed to focus on specific clinical care needs, research and education. Long-term care staff recognize the relevance of CLRIs. The CLRIs are delivering education, research and innovation as an ongoing learning series. The CLRIs bring together different work groups and disciplines. Education is offered in work environment settings, online formats including websites, remote participation by videoconferencing and other internet resources. In future, they plan to include professional accreditation points for more disciplines that work in long-term care homes as an incentive to participate. Finally, CLRIs are committed to evaluation to ensure continuous improvement.
Exciting advances in research have included co-designed projects by researchers working with long-term care managers and staff to address key care issues. The CLRIs are learning that their affiliation with universities and colleges ensure support and this is an important part of capacity building. New research frontiers are being crossed with a range of strategies to build long-term care capacity in undertaking research and translating evidence into practice.
The Ministry of Health and Long-Term Care was urged to carefully consider the three options presented in the CLRI proposal for 2016 to 2021 (available from LWC). It is reassuring too that a number of long-term care homes and academic institutions are keen to be affiliated with the CLRI Program to advance further their commitment to improving long-term care homes in Ontario.
Larry W. Chambers is the scientific advisor to the Alzheimer Society of Canada and a scientist with the Bruyère Research Institute. His research, education, consultation and administrative responsibilities focus on epidemiology and program evaluation issues related to healthy aging, community health and local-level health policy development.