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Riverview Health Centre’s shift towards person directed living is building a sense of community and support from residents, patients, staff, and families, many of whom are praising the transformative approach of shared decision-making and goal-setting.

There is something special about the rehab gym at Riverview Health Centre, and it’s not just the warmth of natural light streaming in from three sides of the long, rectangular room. There is a noticeable energy when you walk in.

Susanne Boyd, a physiotherapist from Riverview’s 10-bed acquired brain injury rehabilitation unit, certainly feels it. She beams as her eyes scan the room, pointing out the breadth of innovative rehab equipment the gym has acquired in recent years.

She saves her biggest smiles for the patients though. There are half a dozen of them in the gym today running through various exercises under the guidance of their therapists. From climbing stairs to honing fine motor skills to relearning to walk, the patients – all of whom have suffered brain injuries from strokes or accidents – are here to recover.

And it’s that collective road-to-recovery energy that you feel in the room.

“When you ask about why I’ve been here for as long as I have,” says the 20-year veteran staff member, “this is why. It’s the people, the patients, being part of their progress.”

Boyd isn’t alone in her dedication. She’s part of the rehabilitation unit’s dynamic interdisciplinary team of physicians, healthcare aids, physiotherapists, occupational therapists, speech pathologists, nutritionists and more.

“We don’t work in silos, we work together,” she says of the team whose goal is to provide patients with physical, cognitive, behavioural, emotional, social and community functioning support. The team’s synergy and holistic approach are important, but it’s their collaboration with patients on the creation of individualized care plans where the magic happens.

“Part of building those positive relationships (with patients) is figuring out what is most important to them,” says Boyd, “and then making sure that we, as best as we can, find a way to make that happen and get them home.”

Boyd, like anyone you talk to at Riverview, knows that recovery is a team effort.

People and teamwork are a running theme at Riverview. On the other side of the building in the institutional sounding but soon-to-be-renamed CD1, residents of the long-term care community are working directly with staff and administration towards a model of shared decision-making and goal setting.

The formal name of this new approach is ‘person directed living’, a concept that upends the traditional dynamic in healthcare facilities. No more rigid wake-up and meal times; no more one-size-fits-all wall colours and room furniture; no more institutional unit names like CD1. The new approach allows residents to have more of a say on their individualized care and the space they live in.

“It’s important to remember that we work in people’s homes; they don’t live in our workspace,” says Stacey Ross, manager of CD1, perfectly summarizing the culture shift that Riverview is aiming to achieve as the person directed living model continues its roll out.

It’s a big organizational change but, if you ask around, it’s not about tearing down and throwing out what was – which could potentially lead to heightened worry and confusion within Riverview’s community – but more about building on Riverview’s existing legacy of patient-centred healthcare. Taking it to the next level, as it were.

Jack Dalgliesh, a resident of CD1 since May 2023 due to a spinal cord injury that left him paralyzed, is a strong supporter of the new approach and, according to him, the foundational building blocks of person-directed living were already in place even before the pilot program began in 2023.

“I’ve enjoyed person directed living ever since I got here,” he says. “They’ve helped me establish a (customized) physiotherapy program, they’ve been very attentive to my ailments, they’ve listened to my symptoms and tried to remedy my ills. So I think (Riverview) is already a person direct living facility. This is just a continuum of what they’re already doing.”

Jack’s take on things is closely listened to at Riverview. Not only is he co-chair of the Resident Council and a member of the ‘Influencer Team’, a key part of the person directed living pilot program, but he also has a feisty spirit that makes him comfortable with challenging ideas.

“Jack is a former accountant so he likes to get it done, and get it done right,” smiles his wife Dorothy, who is also a member of the Influencer Team, providing real-time family perspective and feedback on the pilot program.

Ross agrees emphatically that Jack is the perfect resident voice when it comes to ensuring accountability for change. There’ll be no tolerance for lip service on his watch.

“Jack said to us, ‘If you’re committing to this, then I’m going to hold your feet to the fire,’” she recounts with a smile. “And are we scared of that? No, because we are committed to this. It’s not going to be perfect and we’re going to make mistakes along the way, but as long as we have that two-way street and that communication, we’ll learn from it and move forward.”

That can-do sentiment on the staff side goes all the way to the top. Kathleen Klaasen, Riverview’s Chief Executive Officer, bubbles with enthusiasm when talking about the shift to person directed living.

“I could talk forever about it,” she says.

Although she deflects credit for the new vision, noting that it’s been a community initiative all along, it’s nonetheless true that it was she who initiated the process after assuming her leadership position at Riverview two and a half years ago.

“My passion was to really make a difference in terms of deinstitutionalizing long-term care and moving to person directed living,” she says.

Support for the change within Riverview was high from the outset but the specifics and feasibility of the change were still uncertain. The process began with an extensive period of review and research to get a full understanding of the possibilities and requirements of transitioning to a new person directed living model.

“We looked at literature, research, we talked to experts in the world and we said, okay if we are going to truly do this and not just make small changes, then we are changing our strategic direction,” she explains. “We are changing our language. We are potentially changing our staffing model. We are changing our environment. We are changing how we organize care. It is fundamentally a culture shift. It’s a transformation.”

One of the key figures in the opening stages of the transformation, and one of the architects of the research behind it, is Dr. Genevieve Thompson, a Research Chair in Person Directed Living from the College of Nursing at the University of Manitoba.

Thompson’s initial research contributed to the framework of the person directed living initiative, but her work didn’t stop there. Currently, she spends two days per week at Riverview providing support to various areas and neighborhoods / communities, including assisting with research, creating processes and educational materials, and helping evolve new ideas related to person directed living.

“The challenge with research is making it relevant to people, and so my goal has always been to help people understand the ‘so what?’ in this. Like, why should I participate? Why does this matter?” she says.

So far, so good.

“I’ve been really impressed by how open and honest people have been,” says Thompson, noting that many in the Riverview community have shared their excitement as well as their concerns about the change. Bottom line, people get it. And they want to work together towards something great.

Although person directed living is still in the early stages of implementation at Riverview Health Centre – CD1’s pilot program ends in May 2024, after which there will be a period of feedback and evaluation before continuing the roll out – momentum is building. Administration, healthcare staff, patients, researchers, residents and families are coming together in new and different ways to explore the new model and its benefits.

And it’s not just an abstract concept or an academic exercise. It’s starting to influence day-to-day operational thinking.

“Everything that we do moving forward, we say to ourselves, is that person directed? If we’re talking about any kind of improvements or changes, (we ask) does that fit with our model of person directed living?” says Ross. “Because that’s the direction we’re going. That’s our long term vision.”

You can be part of Riverview’s transformation to person directed living! Find out how by contacting the Riverview Health Centre Foundation or visiting our Donation page and showing your support.