Honouring residents with choice

Editor's note: This story was updated in November 2020

When you walk into the dining area on Unit 5AB at the Edmonton General Continuing Care Centre, the brightly painted walls quickly stand out. Each one features a different colour: orange, green and yellow — not the tones you might expect in a healthcare setting.

“Each wall is a different colour. It’s kind of wild,” says Sue Stein, whose husband, Dick, lived on the unit until he passed away on Nov. 3, 2020. “An interior designer didn’t do it, but it’s charming, really. I’m kind of traditional, so it was out of my experience, but it turned out really well.”

The eye-catching decor is the result of consultation with residents, along with input from staff and family members like Sue. It’s one example of an approach adopted by Covenant continuing care sites across Alberta that aims to offer residents more personal choice. And in the case of the multicoloured dining room, there’s evidence to back up the residents’ choice, too.

“As our eyes age, we need higher degrees of saturation in colour and more contrast,” says Living Our Values project coordinator Daphne Quigley.

Daphne says the Living Our Values approach to care focuses on cherishing the uniqueness of the individual within their continuing care community. This is done in collaboration with residents, family members and staff.

“Continuing care has a long-standing history of providing a good quality of care that often is embedded in routines. So when we’re looking at Living Our Values, we still have some routines. But we also look at the individual and find ways to meet individual needs within the context of community.”

Theodora Agoawike, unit manager for 5AB, says they’ve applied this approach to care a variety of ways. Before COVID-19, they would connect with a local kindergarten class that regularly sent gifts of socks and toiletries for residents. In August, staff arranged an outdoor visit for a woman turning 100 who hadn’t seen her two sons in five months. They also celebrate individual birthdays. When a resident dies, they light a candle and put up a hallway display to honour their memory.

These practices align with the four pillars of Living Our Values: honouring residents, building relationships, maintaining community connections and creating a “home-friendly” living environment. Every piece has an impact, even if it’s not as immediately noticeable as the walls.

“Those colours, they pop. And it made a big difference because bright colours lift your mood,” says Theodora. “The families love it. And even some of my colleagues initially thought it was too bright, but then it started to grow on them.”

• Read more: Transforming dementia care with a can of paint

Residents like the colours too, according to feedback gathered after the new paint went on. One suggested it “feels like summer,” and another described the space as “bright and cheery. On a dull day, it makes a difference.”

Individual sites find their own ways to include residents in choices about their care and their environment. Daphne says most continuing care sites have a set time for meals that may work well for most residents. At St. Martha’s Place in Banff, residents asked for more choice about what time they eat in the morning, and staff adapted.

“They found a way to have more flexibility in their breakfasts. So they keep some things handy earlier in the day like muffins or fruit, different options that are readily available for those early birds but also for those who wake up later, too.”

• Read more: Residents help plan menu

The Living Our Values approach was first adopted in October 2018 at all Covenant Health continuing care sites. Killam Health Centre and the Edmonton General were chosen as two demonstration units to explore ways of applying the approach. They created design teams made up of residents, family members, volunteers and staff from nursing to food services to spiritual care.  

In Killam, the team looked at ways to learn more about resident preferences. They changed their move-in resident questionnaire and developed personalized place mats to visually represent each resident’s likes, hobbies or values. At the Edmonton General, much of the work focused on improving the dining experience. They held town halls where residents voted on paint colours, shared ideas for wall decorations and offered other suggestions based on what was important to them.

“They improved the decor and made it more homey,” says Sue. “It has made the atmosphere more homelike, rather than just have beige walls and nothing on them but a clock.”

Residents have more choice when it comes to food as well. At breakfast, they can select from a range of consistent options, including porridge, eggs, bacon, cereal and toast. And at lunch and supper, they can pick between two different meal options.

“We are asking them to make a choice instead of assuming this is what they like,” says Theodora. “We bring out two plates and show them. Even if they can’t talk, they can point and make a visual connection with a particular plate.”

Sue and Dick both sat on the design team, representing family members and residents. Sue says they arranged for a comfort cart to be brought into a resident’s room when loved ones came to be with them for the final hours. It offers tea and coffee as well as helpful literature to guide them through what’s next. Led by spiritual care, the team also came up with Getting to Know Me signs that share interesting facts about each resident, such as their profession and hobbies.

“They printed that on a page and put it up outside every room so the nurses could see it before they came in, or whoever was walking down the hall. They would read this and have an idea of a resident’s background,” says Sue. “It was very interesting, actually. Because you see them in one respect, and this way you know what they were like in another time.”

Dick, a neuroscientist, was proud to share that he worked, studied and lived in four countries and that he liked to golf, ski, ballroom dance and photograph wildflowers. Read more: Couple's dance performance captures a lifetime of love Sue says she was thankful to be involved in the project and see the ideas become reality.

“I was very impressed with the commitment, the ownership, the care that each individual put into this. It was really remarkable,” says Sue. “And they did it cheerfully.”