Over 200 staff at Actionmarguerite – from custodians to nurses to the CEO – are the first in Manitoba to be trained to help dementia patients deal with the side effects of their condition, like uncharacteristic verbal or physical outbursts, in a way that reduces the need to rely on sedation or physical restraints.
The staff at the Actionmarguerite personal care homes are all being trained in a new Canadian approach to reduce and respond to behaviours where some advanced dementia patients shout, swear and try to hit staff, says Charles Gagné, the CEO of Actionmarguerite, which houses 611 elderly and complex care residents in five locations in Winnipeg.
The program, created by Advanced Gerontological Education (AGE), based in Hamilton, ON, teaches staff practical ways to understand, avoid and defuse situations, using a compassionate and gentle approach – rather than responding automatically with physical restraint or sedation. Since introducing the Gentle Persuasive Approaches (GPA) training six months ago, Actionmarguerite has already reduced the need for physical restraints and medication for residents across the facility, including in its special needs behavioural units.
“By implementing GPA we are moving closer to changing the culture around residents who suffer with advanced dementia. It is making us a more dementia-friendly organization and enhancing our approach to managing a very complex illness,” said Gagné. Gagné, who, has been trained in GPA, has already helped successfully neutralize a situation with a resident who was shouting, swearing and lashing out at staff.
The key to GPA, Gagné said, includes understanding a resident’s behaviour is not his or her fault – and may often be in response to actions of the staff member in the room (known in the healthcare field as responsive behaviour), who can help prevent the behaviour by being more aware of how the resident is feeling.
“People with dementia may not have the neurological ability to reason why, but they still respond to their feelings. By helping our staff focus and monitor their own emotions it helps them recognize that their approach may feel threatening. We also need to consciously recognize it’s not the person reacting, it’s the illness. If we are invading their personal space, and that leads to a certain behaviour, we have to reconsider our actions and how we may intervene in a given situation. We are working on changing our culture and looking at responsive behaviours differently,” said Josée Fournier, Actionmarguerite’s Director of Dementia Care.
Actionmarguerite has certified 17 GPA coaches, continues to train more staff and has also held informational sessions for families to explain and answer questions about this new approach.
“We are approaching it in a more holistic way, and teaching staff to be more confident in their abilities to handle a situation. Most of the time it’s not a medical issue, it’s behavioural, and doesn’t need to be solved with medication,” said Fournier.
“Healthcare workers in Manitoba are all trained in the Provincial Healthcare Violence Prevention Program, but the way you would react to a person in a hospital ER who is becoming violent is very different from how you need to treat someone who is 85-years-old and isn’t trying to hurt you on purpose,” Fournier added.
“Their behaviour is a form of communication – they’re trying to tell you something,” Fournier added. “The GPA training gives staff the confidence and tools to handle a situation while not putting a patient at risk of falling and breaking a hip, or of bruising themselves.”
“Our goal is to keep people safe. We’re really delivering a message of hope with this way of looking at people with dementia and their behaviours – for our staff and for families,” Gagné added.
Embracing GPA is part of Actionmarguerite’s strategy to care for this higher-needs population and get ready as the baby boomer generation enter their eighties.

To view or listen to the various media interviews, please click on links below.

Winnipeg Free Press
https://www.winnipegfreepress.com/local/training-focuses-on-new-ways-of-dealing-with-dementia-509240252.html
(You will need a subscription to view the whole story.)

Winnipeg Sun
https://winnipegsun.com/news/news-news/personal-care-home-staff-first-in-mba-trained-for-dementia-care

CityTV
https://winnipeg.citynews.ca/video/2019/04/29/reduced-sedation-and-physical-restraints/

CTV
https://winnipeg.ctvnews.ca/care-home-staff-learn-gentle-persuasive-approach-to-outbursts-1.4401135

CJOB (indicate May 1, 2019 @ 5:39 PM)

https://globalnews.ca/pages/audio-vault-cjaudio-vault-cjobob/

ICI Radio-Canada
https://ici.radio-canada.ca/nouvelle/1166980/demence-soins-traitement-formation-employe-fournier

Less sedation and physical restraints for dementia patients … By the numbers

23,000+ – Manitobans with Alzheimer’s disease or another dementia*
40,700+ – Manitobans estimated to have some form of dementia by 2038*
564,000 – Canadians currently living with dementia**
25,000 – new cases of dementia diagnosed every year in Canada**
$1 billion – annual cost to Manitobans to care for those living with dementia, expected to grow to $28B by 2038*
4 – facilities in Winnipeg that will accept residents with responsive dementia behaviors – Actionmarguerite, Deer Lodge Centre, Riverview Health Centre and Holy Family Nursing Home (forthcoming)
86 – number of residents in high-needs units in Actionmarguerite’s three facilities
17 – Gentle Persuasive Approaches (GPA) coaches Actionmarguerite has trained
4 – stages of Gentle Persuasive Approach training:
1. Recognizing the need to respect each resident’s “personhood” and how to interact in a way that responds to the individual’s needs, diagnosis and background, and getting to know them and their “triggers” in order to avoid responsive behaviours in the first place
2. Translating what the resident is trying to communicate with those around him or her, to avoid turning agitation into a challenging behaviour.
3. De-escalating challenging behaviours if they do happen, with gentle approaches and techniques like distraction or offering recreational opportunities.
4. Only if necessary, using physical techniques specific to working with elderly people, to prevent them from hurting themselves or someone else.
200 – Actionmarguerite staff that have been trained in GPA
60 – family members attended an informational meeting about GPA
288,000+ – participants across Canada in the GPA program***
* Alzheimer Society of Manitoba – https://alzheimer.mb.ca/about-dementia/disease-stats/
** Alzheimer Society of Canada – https://alzheimer.ca/en/Home/About-dementia/What-is-dementia/Dementia-numbers
*** Advanced Gerontological Education (AGE) – https://ageinc.com