Innovation

Are you ready for PRIME time?

Innovative centre delivers full-service care for seniors with complex illnesses

Innovative centre delivers full-service care for seniors with complex illnesses
Read more

Is PRIME for you?

The PRIME care team

Want to consider PRIME?

Other support services for seniors

BY JOEL SCHLESINGER
Winnipeg Health Region
Wave, September / October 2010

It's a bright, beautiful morning, and about 40 seniors are assembled in a room located inside the Deer Lodge Centre getting ready for their daily workout.

Recreation facilitator Karen Hart begins the specially designed, 40-minute routine with a warm-up to help loosen the joints and muscles. The seniors roll their heads around slowly, then their shoulders and arms before stretching their legs. After about 15 minutes, they're ready to hit the weights.

"Grab your dumbbells," Hart calls out enthusiastically. Some seniors are pumping one-pound weights, but a few are lifting eight-pounders as Hart carefully demonstrates how to execute each move.

There's no music, but the group has been known to sing or march on the spot during the workout. And there's often the sound of laughter as Hart creatively encourages them to finish each two-arm row or chest press.

"Hands in front of your shoulders, palms facing out. Now put it on the top shelf - like you're putting a bag of sugar away," she says, as the group lifts the dumbbells from their waists over their heads, stretching their arms as high as they can. "You're doing great," she says encouragingly to one of the participants.

It's the kind of scene one might expect to find at any number of seniors' centres across the province. But this is not your typical seniors' centre, and those participating in the workout are not your typical seniors.

This is PRIME - a relatively new program designed for seniors with complex health issues, such as dementia or Parkinson's disease. Available to seniors over the age of 65, PRIME offers a range of services under one roof. Part doctor's office, part rehabilitation clinic, part pharmacy, part recreation centre, part personal counselling service - PRIME is all these things and more.

"PRIME truly represents a unique approach to care within the Winnipeg Health Region," says program manager Judy Ahrens-Townsend, a social worker with 30 years of experience in geriatrics. "Our goal is to serve every aspect of a person's needs. We provide primary care, yes. But we're not just here to provide medical care. We're here to provide all sorts of services, ranging from medical care to personal counselling, and rehabilitation services to nutritional advice. Do you have to alter your home environment to accommodate a wheelchair? We can help with that, too."

Those enrolled in PRIME generally have serious health issues, but still live in their own home or with family. Without PRIME, many participants would have no alternative but to live in long-term care, says Sue Lotocki, a case manager and occupational therapist at the centre. "Essentially, (PRIME) is an out-patient program that supports complex seniors who are living in the community, so our goal is to provide an alternative to institutionalization (placement in a personal care home)," she says.

The program is modelled after a similar one called PACE, which started in San Francisco in the 1970s and has now been duplicated across the United States. It is the second program of its kind in Canada. The first - called CHOICE - started in one location in Edmonton in 1996, and quickly expanded to four locations, including two specialized satellite centres for individuals with mental health and dementia issues.

PRIME, too, has quickly gained popularity. The program, opened in 2009, is based in a beautifully renovated wing of Deer Lodge Centre. The total capital cost of the facility was $3.8 million, including a community contribution of $500,000 from the Deer Lodge Foundation. The program reached its capacity of 90 clients in July, and has received more than 400 referrals in the last year.

PRIME's unique approach to care starts as soon as one is enrolled in the program. Each participant is assigned a case manager, who serves as a single point of contact. Among other things, the case manager co-ordinates all facets of the participant's care, including Home Care needs and referrals to other PRIME service providers, such as the pharmacist, social worker, nurse, occupational therapist, physiotherapist, or dietitian.

"These are just examples of the variety of things we do," says Ahrens- Townsend. "The team meets daily to discuss the multi-dimensional needs of the participants and to problem-solve with each other and the participant and family with a goal of keeping that individual safe and in their own home."

Open Monday through Friday, from 10 a.m. to 3 p.m., seniors can attend PRIME as often as they like, though they are required to show up at least once a week for health monitoring and to pick up their medications. In addition, PRIME operates an afterhours service. By calling one number, a participant or family member can discuss a range of health issues or have someone visit to provide an assessment or assistance.

Part of what makes PRIME so attractive to participants is that so many services can be found in one place. And while waiting to see one of the service providers at the centre, participants can exercise, chat with other seniors or learn a new hobby.

"There are things to do, and they come and get you when they're ready to see you," says Eugene Burchill, a 78-year-old retired University of Manitoba chemistry professor who has advanced Parkinson's disease.

A typical day at PRIME might include a workout for those who are interested, followed by some social time - a chance for friends to catch up or play a game of checkers.

A highlight of any day at PRIME is the four-course lunch. On this day, the menu included a choice of cream of broccoli or beef vegetable soup and house salad, accompanied with a choice of veal steakette or cheese pizza, mashed potatoes and mixed vegetables, or salmon salad and cheese sandwiches. Fresh fruit was for dessert.

After lunch, participants can enjoy any number of activities, such as learning to paint watercolours or listening to a lecture from a guest speaker. Recently, Josephine Cox, daughter of PRIME member Michael Cox, spoke to the group about the six weeks she spent in Afghanistan training school teachers.

In addition to taking classes, participants can also lead them. Burchill, for example, is an accomplished artist who has created more than 100 intricately sewn and pieced quilts incorporating numerous themes. He is now leading a quilt-making class at the centre.

A key feature of PRIME is the primary-care service. The 22-person health-care team includes Dr. Russ Albak, a family physician, and Janna Kingdon, a nurse practitioner. Case managers, such as Lotocki, work with participants to co-ordinate visits with the medical team. For the majority of PRIME's participants, this kind of care was spotty at best before coming to the program. "A lot of our participants haven't had any primary or preventative care for a long time," says Lotocki, one of five case managers, all of whom come from diverse backgrounds in geriatric care, such as physiotherapy, occupational therapy, social work or nursing.

Trained to diagnose and treat disease, Kingdon is the "quarterback" of the medical team and reviews all aspects of the comprehensive primary care for patients at PRIME, says Albak. "Janna sees the patients on a daily basis, unless she's away. We consult extensively on medical issues and the team work really serves to enhance the overall care of our patients."

Albak says PRIME's multi-faceted approach to delivering care is a huge benefit to patients. "There are just so many issues with trying to investigate the participants' problems and formulate treatment plans, and then, of course, to implement the treatment plan," Albak says. "It really takes a team approach and that's one of the strengths of PRIME."

Of course, participants aren't the only ones benefiting from PRIME. Caregivers also get a much-needed respite when their loved ones are at the centre.

"A lot of times, the caregivers are exhausted, so part of our program is to provide support for them here," explains Lotocki.

Burchill has been attending PRIME twice a week for eight months. While he values the enhanced medical care he receives in the program, he says the best thing about PRIME is it provides a break for his wife, Margaret, who is his primary caregiver. "It gives her a chance to go shopping," he says.

Carol Vandale's husband, Dennis, was diagnosed three years ago with Multiple System Atrophy, a rare degenerative disease similar to ALS (Amyotrophic Lateral Sclerosis, often referred to as Lou Gehrig's disease).

"Pretty much every system in the body basically shuts down," says Carol, explaining the impact of the disease.

Unable to walk, Dennis has difficulty speaking and can no longer perform the daily tasks many people take for granted. He needs help getting dressed, using the washroom, and bathing. He is dependent on the care of his wife, Home Care visits, and their adult son, Trevor, who lives with them and is able to help during the day because he works evenings.

Dennis is unable to take a bath at home, and only receives a sponge bath from Home Care staff while in his bed. But the facilities at PRIME allow Dennis to take a full bath in a comfortable tub. Not only is this important for his health, it's also a quality-of-life issue.

Ahrens-Townsend says many PRIME participants require a great deal of handson personal care while they are attending the centre, similar to the care provided in a personal care home. "Our team of health-care aides are able to help with personal care needs, such as bathing, feeding, bathroom assistance, walking and transfers. This level of care is a unique feature that does not exist at any other outpatient program for seniors."

Carol Vandale appreciates PRIME's unique offerings. "What PRIME has done for me is it has taken a huge weight off my shoulders because I'm not the only one responsible for monitoring his condition," says Carol, who works full-time as constituency assistant at an MLA's office.

Like many clients, Dennis attends once or twice a week. Vital Transit picks him up in the morning and drops him off at home in the afternoon.

But even when he is not attending the program, Carol says PRIME has proven an indispensable resource when she is concerned his health has taken a turn for the worst. "I can phone or e-mail Sue, who is his case manager, and say, 'He seems really weak today' and they'll take a look right away," she says. "That's so nice, instead of having to go to work and thinking, 'Gosh he didn't seem right this morning. I should go home and check on him.'"

Carol recalls one morning when Dennis was lethargic and weaker than usual. She had a meeting to attend and felt uneasy about leaving him at home. She called PRIME, and left a message for his case manager about her concerns. "When I came back home, the case manager and the nurse practitioner were both there at the house," she says. "Within the hour, they were there just checking on him."

Medical needs aside, PRIME also provides a social component often lacking in participants' lives because the nature of their illness is often isolating.

"He's a real people person," Carol says of her husband. "As an optician, he always loved working with people, and his store used to be a real gathering place for all the people who worked in the building downtown."

And while clients make acquaintances to chat with over coffee when they arrive at 10 a.m., often the most important relationship they develop is with the staff.

"Some of our very elderly clients haven't left the house, unless it's for a doctor's appointment, for years, so there is a sense of community and a level of social support in addition to the medical care the program provides," Lotocki says.

And that rapport is a pivotal component in providing preventive care.

"Through bringing people in one to five times per week, we are able to notice subtle changes in them," Ahrens- Townsend says. "An illness may not be obvious, but often we can catch it in the early stages before it becomes a more serious problem."

Dennis, for instance, is prone to urinary tract infections, which can occur quickly, Carol says. Having good access to primary care at PRIME means an infection often gets diagnosed early and is treated with antibiotics before it festers into a serious illness requiring hospitalization.

In fact, prior to coming to PRIME, many participants were "frequent flyers" at hospital Emergency Departments. "These are clients who are medically frail, having many hospitalizations, and they typically are using a multitude of health resources," says Lotocki. "Often they sought care only when it became a crisis."

The need for the kind of care provided by PRIME is high within the Winnipeg Health Region, and it will only grow in the years ahead as the population ages. Indeed, a study produced by the Canadian Alzheimer Society says the number of Canadians suffering from dementia could more than double in the next 20 years.

PRIME is still in its pilot stage and will be evaluated later this fall. "But I think we know without even doing the evaluation that it's in demand and has been successful," Ahrens-Townsend says.

Michael Cox, 76, certainly believes PRIME needs to be emulated. "It is a fantastic program," says Cox, who attends PRIME four days a week.

Having trained as a chef in England and Switzerland, and served as Maitre d' at Stockholm's Royal Opera House in Sweden, Cox knows a thing or two about providing exceptional care and service. "I have never been in a hospital where the staff is so friendly," says the retired general manager of the Manitoba Club. "It is amazing."

Cox, who is confined to a wheelchair, receives visits from Home Care staff four times a day and his wife, Ingrid, provides much of his care in the evenings and on the weekends. "She's Swedish. She's fantastic! I'm so lucky, and she's an RN (registered nurse)," he says.

But caring for him all the time is a difficult task, even for a retired nurse. Cox is dependent on the help of others to get out of his chair or in and out of bed. "My wife can't handle me," says Cox. "I'm too heavy. Just a simple thing like getting me on a toilet requires two people."

Albak says many of PRIME's participants face similar mobility issues that prevent them from receiving optimal medical care at a typical family doctor's practice.

"They're the kind of patients that are really difficult to look after in your average doctor's office because of many factors: the physical layout, their mobility, time," says Albak, who also has a private practice as a family physician. "For your average doctor's office, a lot of these people couldn't get up on the table to be examined, so we have in this facility beds and examining tables that can be lowered."

Still, Albak says, PRIME is more than the sum of its parts. "It all comes down to listening to what people's issues are," he says. It sounds elementary, but many clients have conditions that are anything but. The only way to get a firm grasp on how to help them is by listening to them and their caregivers carefully. It's for this reason Albak believes that PRIME has had many success stories.

"As I say, when you see a population like we have here - they're all basically octogenarians and have multiple system problems - you have to be realistic that you're not the fountain of youth," he says.

But at the end of the day, PRIME is making a difference for the better in its participants' lives because it does more than just solve medical problems.

"It's not just medical care, it's 'care' as in caring for people," Albak says. "And I truly believe that at PRIME that's what they receive."

Joel Schlesinger is a Winnipeg writer.

Wave

About Wave

Wave is published six times a year by the Winnipeg Health Region in cooperation with the Winnipeg Free Press. It is available at newsstands, hospitals and clinics throughout Winnipeg, as well as McNally Robinson Books.

Bookmark Email Print Share this on Facebook SHARE Share this on Twitter Tweet RSS Feeds RSS
Make text smaller Make text bigger
WRHA Accessibility Plan Icon
Wait Times
View the Winnipeg Health Region's current approximate Emergency Department and Urgent Care wait times.

View wait times
Find Services
Looking for health services in Winnipeg?

Call Health Links-Info Sante at 788-8200

Search 211 Manitoba

Explore alternatives to emergency departments at MyRightCare.ca

Find a Doctor
Mobile App
Use your phone to find information about wait times and health services in Winnipeg. Download the Connected Care mobile app for iPhone today!

Learn more
Wave Magazine
The September / October 2017 issue of Wave, Winnipeg's health and wellness magazine, is now available online.

Read more
Contact Us
Do you have any comments or concerns?

Click here to contact us
Careers
The Winnipeg Health Region has a variety of career opportunities to suit your unique goals and needs.

Visit our Careers site
WRHA Logo Help| Terms of Use | Contact Us | En français