Royal Ottawa Place is not an ordinary long-term care home, it is an extraordinary one.
ROP occupies a distinctive space in the healthcare continuum. Located on the grounds of the Royal Ottawa Mental Health Centre, it’s a long-term care home for people who are diagnosed with a mental illness, yet, the home lacks any special designation or funding to support the type of care it provides.
“There is no long-term care home that is designated as a mental health long-term care home in Ontario,” says Sarah Anderson, the director of care at ROP. “We want to be the first.”
At ROP, staff pride themselves in providing a unique mental health-focused model of care for a unique population. Unlike a typical LTC home with an exclusively geriatric population, at ROP, the majority of residents have a severe mental illness (SMI) and are under the age of 65.
Examples of SMI include major depression, schizophrenia, bipolar disorder, obsessive-compulsive disorder, and borderline personality disorder. (See sidebar for more information about the people who live at ROP.)
SMI can cause mood and behavioural changes, alter cognition, and impair an individual's ability to function in society. SMI can be chronic and involve flare-ups. People living with SMI often need supportive community or group housing to maintain their well-being. Unfortunately, the availability of such housing is limited and demand is high.
Long-term care (LTC) homes in Ontario – which are designed for a geriatric population – are seeing an influx in the number of resident applications for individuals with SMI. Many staff in LTC aren’t equipped to provide care for individuals with SMI or responsive behaviours, and as a result, residents are sometimes sent to the hospital and reside on alternate level of care (ALC) beds or are not accepted to live in a LTC home.
Frequent hospital readmissions for this population can have negative effects. Readmissions are disruptive and demoralizing to the individual and their family, and strain healthcare resources.
ROP nurses, personal care attendants, and recreation therapists work as a team to reduce hospital readmissions through timely and individualized interventions, crisis management, and continuity of care.
ROP is not specifically funded for this care but provides it as best it can within the regular LTC system funding calculations because it’s needed and it’s the right thing to do.
For its residents, ROP represents a life-changing opportunity.
“In many cases, these individuals simply have nowhere else to go,” says Debbie Pilon, administrator.
Pilon says a special mental health designation would help secure funding for more specialized programming and allow the organization to focus exclusively on adults with a primary diagnosis of a severe mental illness.
The people who call ROP home enjoy a high quality of life in a supportive community, with personalized care and engaging activities.
“Royal Ottawa Place is more than just a home, it is a family,” says Pilon.
ROP residents are, on average, younger than typical residents in long-term care.
Adults at ROP in their 40s, 50s, and even their 60s generally have different needs than a typical geriatric population in LTC. For example, they benefit from different types of therapeutic groups and tend to be interested in different activities – and even dinner menus. (Think mac n’ cheese instead of meat and potatoes.) A younger clientele is more likely to explore volunteer opportunities than their geriatric counterparts in LTC, and benefit from extra guidance around community integration and life skills such as money management and taking public transit.
Take Alice* for example. Alice has been a resident of ROP for the past ten years, just slightly longer than the average length of stay. She’s 50 years old and was diagnosed with a schizophrenia spectrum disorder in her mid-twenties. Alice hears voices that tell her things that are not true. Sometimes she sees things that are not there. She takes medications to help her cope with her symptoms but they also make her feel tired and numb. In the years before she came to ROP Alice was in and out of hospital care but when ROP became her home, her hospital stays came to an end. Alice is happy to have a safe and comfortable place to live where she can have privacy and dignity. She feels supported and understood, not stigmatized.
“Royal Ottawa Place is more than just a home, it is a family,” says Pilon.
Alice appreciates a clean living environment and delicious meals, as well as extra help with her medications. Staff make sure she gets to her appointments on time. Alice has friends – people around her who don't judge her for her condition, and enjoys activities that stimulate her mind and creativity, such as reading, writing, painting, and volunteering.
Alice didn’t have these things before moving to ROP, nor did she have goals and dreams.
“We all deserve to have goals and dreams,” says Anderson. “Often it’s the basics of life people like Alice are so happy to have, but then we go further by adding more enrichment through our knowledge of mental illness and community resources we work with.”
“It's their home and they’re successful here,” adds Pilon. “So many of our residents have been in and out of the system for years and years. We provide them with a life that's meaningful.”
Pilon and Anderson say it’s very likely that ROP has the largest population of people with SMI compared to any other LTC home in Ontario.
Not only would the designation and funding sought by ROP support specialized programming for people like Alice, but it would also contribute to the hiring of staff members who aren’t typically part of a LTC team, such as recreation therapists and behaviour therapists.
Pilon says ROP’s ultimate goal is to create a unique LTC model and share this knowledge with other homes in Ontario that care for this demographic.
“Ideally, in the future, we will see the creation of specialized mental health LTC homes that follow a model of care specifically designed with this clientele in mind,” says Anderson. “Until that time we will continue to advocate for our residents – and for proper funding – so we can keep doing what we’re doing.”
*Alice is an amalgam of several resident profiles at ROP.
