After a distinguished military and professional life, Joseph Clark needed a sanctuary that could deal patiently with his dementia.
He found it at Sunnybrook
Last November, the retirement home where Joseph Clark lived with his wife, Patricia, was no longer the right fit for him. He was losing his ability to verbally communicate with staff and his friends, leaving him feeling increasingly isolated, despondent and angry. Reluctantly, Joseph’s family – including daughter Carolyn Rabbior and sons Joseph and Tom – agreed with staff that alternate accommodations were needed urgently.
The family found those accommodations in Sunnybrook’s Dorothy Macham Home, the first and only facility in Canada designed to meet the needs of a special group of war veterans who display aggressive or disruptive behaviours due to dementia. The home opened in 2001 with funding from Veterans Affairs Canada. The 10-bed facility is usually full with a short waiting list.
Joseph volunteered at the age of 18 with the Royal Canadian Navy and served for five years as a gunnery officer on the HMCS Loch Achanalt and the HMCS Arrowhead in the Second World War. Now 91, he suffers from vascular dementia and has aphasia, damage in the area of the brain responsible for language, so he can no longer speak and writes only a few words.
“This is very frustrating for a man who built a career in communications,” says daughter Carolyn. “He founded Canada Newswire and served as president and chief executive officer there until he retired. He started the Ontario Nurses’ Association. Two years ago he was still writing family memoirs and stories about his ships.”
The Dorothy Macham Home is modelled after Tasmania’s Adards Nursing Home (Adards is an acronym for Alzheimer’s disease and related disorders), an internationally renowned facility pioneered by psychiatrist Dr. John Tooth. He advocated that dementia patients with difficult behaviour could benefit from specially designed facilities to address their needs, rather than placing them in psychiatric hospitals.
“As disruptive and aggressive behaviours are either a normal or an exaggerated response to an unmet need, our job is to find the unmet need and meet it,” says Dr. Jocelyn Charles, medical director of the Veterans Centre at Sunnybrook.
The Dorothy Macham Home looks and feels like a regular home, making it easier for residents to navigate their way around it. Natural light streams in through skylights over wide hallways where two people using wheelchairs or walkers can pass with ample space. Residents can stroll whenever they like on the interior walking path, separate from the bedroom areas.
A large fireplace graces the common living room where two doors lead to a beautifully landscaped outdoor garden where residents can wander freely. Fences are disguised by strategic landscaping to minimize any feelings of confinement. All locked doors inside the home are disguised and there is an unlocked door nearby which residents can use.
Each private bedroom has large windows with a garden view. Bedroom floors have sensors so staff can be alerted if someone is out of bed. In the bathroom, the light turns on automatically, the toilet is visible from the bed, and mirrors can be hidden if residents find it distressing to see their own reflection.
The interdisciplinary staff works with family members to design a care plan to help each resident achieve his or her best life experience. “What we realized from the very beginning was that it takes a very special person to work here,” says Dr. Charles. “The right fit is based more on a person’s values and attitude rather than just their training: it’s how they approach people with dementia.” The staff includes registered nurses, registered practical nurses, a patient care manager and patient service partners, an attending physician, a consulting psychiatrist, a pharmacist, and recreation and music therapists. The consulting team includes physiotherapy, occupational therapy, speech therapy, audiology, social work, and spiritual care.
Joseph Clark’s wife Patricia says "he is treated with respect here."
“I try to assess the family dynamics and the veteran’s situation before they arrive,” says Sylvia Buchanan, patient care manager. “Once we had a veteran who refused to wear anything except white boxer shorts. The family was embarrassed about admitting him through the front door, so we simply arranged for him to be received at the side door entrance.”
Individual care means there are no fixed schedules for eating or sleeping. “Once we had a retired policeman who had always worked nights. We didn’t try to change that. He had all his meals at night and slept all day,” says Dr. Charles. “Research shows that the smell of cooking increases appetite and calms behaviour, so we have a coffee maker, a bread maker and often bake cookies. If residents say they’re hungry, we just ask what they would like, even if they’ve just eaten.”
Consultation with family members is a continuing process. Residents stay at the home as long as necessary to diminish aggressive behaviours: the length of stay varies from two weeks to four years.
“When we evaluated the home after the first year of opening, we found that we reduced aggressive incidents by 55 per cent and staff incidents across all our cognitive units by 30 per cent because we moved the most aggressive residents to the Dorothy Macham Home,” says Dr. Charles.
Joseph’s family is relieved he is living peacefully. “We have seen a big difference. The whole place exudes calm and his behaviours have been smoothed out," says Carolyn.
"The staff is patient with his language difficulties and they discovered very quickly that he doesn’t like loud noises. He is in the best place he could be. They just truly know who he is as a person,” Carolyn says.
“He is treated with respect here,” adds Patricia, Joseph’s wife. “They have staff meetings once a week and a couple of times Joe turned up to join the meeting and they let him. I think that’s wonderful.”
Dorothy Macham was an accomplished nurse from Toronto who made significant contributions as a health care leader during World War II and in civilian life after the war. The naming of the Dorothy Macham Home celebrates her outstanding service and career.
Dorothy enlisted with the Royal Canadian Army Medical Corps in 1939 and served for five years.
Of the nearly 4,500 Canadian Nursing Sisters who served in the war, Dorothy was one of the few women to attain the rank of major. In recognition of her accomplishments, King George VI presented her with the Royal Red Cross Medal in July 1945.
When she returned to Canada, Dorothy was appointed superintendent of Women’s College Hospital and after 29 years of service, she retired in 1975. Four months later, she accepted the position of executive director at West Park Hospital where she worked until 1980.
The Nursing Sisters Association of Canada recommended Dorothy’s name for the home, in recognition of her many contributions to health care. At 92, Dorothy attended the grand opening.