Policy/environmental factors | Access to equipment and spaces | Social opportunity Physical opportunity | We don't have the equipment. You don't have the financial means There’s no space where we can use | I'm submitting something for you today to get you a wheelchair. It might not show up for the next six months. So what do we do with you in those six months? If you need it in the next six weeks while we’re trying to rehab you, we don't have a chair for you to go in, you're spending all that time in bed, even just to sit up and foot propel or mobilize or just have that hip bent at 90 degrees is going to benefit you. So if we don't have the equipment to appropriately do that, it just kind of puts us behind…..Rehabilitation Provider7 So all of these preventative measures to stop the need from the rehabilitation, which you know, we want to be proactive about it. There's just a big barrier there as well. Just because if people don't have it or you don't have family involved or you don't have the financial means to do it, then you just don't get it….Rehabilitation Provider8 there's no dedicated rehab space or, you know, space where we can use to bring somebody away from those distractions into an area where they can actually focus on what they're doing. So, I find that's a big challenge across all the homes. Umm, I work across four homes, um, and the setup is pretty similar in each of them…….. I would love, for example, a mechanical, a walking harness type system where you know, we can practice those, balance things, where they’re actually hooked up to something and they're not gonna fall. That's my biggest fear when we're trying to really, like, stretch the boundaries of that is having a safe area to be able to do that in….Rehabilitation Provider5 | Improve access to equipment and create rehabilitation spaces |
Complex admission processes | Social opportunity Physical opportunity | Getting that piece that takes up a lot of our time Their services in the hospital are really scaled back We're not receiving accurate reports from the hospital | So it's and getting that piece that takes up a lot of our time. Working on those admissions and trying to get equipment and trying to get, you know, things in place for them to even be successful on admission and to have, it's important to have that success within those first few days because you know their first impression is everything and they're, um, if they become agitated and anxious because we haven't got things in place, then we're yeah, it's difficult to come back from that…Rehabilitation Provider5 I find in hospital their services in the hospital are really scaled back because they're waiting for long term care and obviously the rehab departments in the hospital have all these other people that possibly are going home that they then focus their time on, which is a shame, because if they, if there was more focus then on those people coming to long term care by the time they get to us they would be in a better physical condition to be able to actually participate when they get here, but often we find they have spent many, many weeks in a Broda chair, restrained and medicated…..Rehabilitation Provider5 We're not receiving accurate reports from NSHA when we have somebody coming back, you know, we get discharge papers, they're spotty, they say. Ohh, mobilize this, this times two with physiotherapy, but then we get reports from the family that physiotherapy was never there and they never got out of bed. And then OK, so like, they're saying an assist times two at the hospital, they come back, they can't stand up and we're using mechanical lift and we're trying to rehab from that. that's definitely a barrier rehabilitation because they say, OK, well, they said at the hospital they should be doing this or they were able to do this and now they're not able to. So why can't they do it with you guys?...Rehabilitation Provider7 | Streamline admission process Improve hospital to LTC transition process |
| High resident turnover and low staff ratio | Physical opportunity Physical capability | Sometimes I was the only nurse We have to write those notes You have to start picking and choosing | I had 58 demented residents to look after. And I'm not talking early dementia. I'm talking about very advanced dementia that nobody else looked after because there was nowhere else in the building and sometimes I was the only nurse….Staff2 And then we have to write notes like chart notes and progress notes. So if we don't have to write those, then we have extra time to see more people. But then we have to write those so. Yeah, that makes sense too, yeah….Rehabilitation Provider8 So then it's like, what's priority, who do we have to see? Who's gonna get the max benefit from what we're offering? Because then you have to start picking and choosing like who you're going to see and why you're gonna see them and what's the benefit…..Rehabilitation Provider7 | Recruit more care providers |
Lack of volunteers due to COVID-19 | Social opportunity Reflective motivation | People do not want to come in here | I still think COVID is a big issue. People do not want to come in here. They think they're gonna catch something or they're gonna bring it. Yeah. I think that's still the issue, but and the barriers to volunteerism, like, I just don't know why we haven't moved forward….Staff1 | Attract more volunteers |
Location of the LTC facility | Physical opportunity | Where the homes are situated are often not ideal | This home here is in [location] and is at the top of a steep hill so you know we could go out onto the, but they'd be very quickly at the bottom so. It's yeah, the where the homes are situated are often not ideal. I often feel jealous when I see places like [LTC home] and that that are like right in the center where you could go and go to Tim’s or, you know, do a walk to the store or something like that would be would be nice. But yeah, we have very few like functional active outdoor activities where we could take them…Rehabilitation Provider5 | Site facilities in good locations |
Restraint policy | Physical and psychological capability Social opportunity | They're going to fall So they're not tearing at the chair | we're very risk-averse within long-term care. So I find that nursing staff don't want people falling. Like if somebody has a fall, we go home for the weekend, we come back and they're restrained in a wheelchair. And they've had that conversation with the families. And they said, you know, they're gonna, they're gonna fall. They're gonna break something. We need to have them restrained in this wheelchair for their safety Coming back from that is very difficult from a personal perspective, because if I'm then going to the families, do you know what? You know, quality of life versus quantity versus and you have that conversation and you they agree to then take the restraint away and then they fall and they break a hip. Then all of a sudden, you know the physio told me that…Rehabilitation Provider5 We give them medications to settle them down. So they're not tearing at the chair and trying to get him so, it's a balance….Staff2 | Reconsider mobility needs of residents |
Interpersonal factors | Family not available | Social opportunity | They provide tips and tricks That can be a big benefit if you have somebody Primary caregiver must be present My loved one is not being restored to where they should be | Family can be helpful sometimes if you can get a family member, a loved one to call and encourage them to participate in rehab….Rehabilitation Provider1 PT might put out some information for families, you know, basic range of motion if they're looking for something that they can do with mom or dad while they're visiting. Umm that can be a big benefit if you have somebody in there routinely that does it, but if you don't have a consistent family member, somebody willing to do that, that can kind of inhibit your recovery after an injury as well….Rehabilitation Provider7 I believe that the government should have a requirement that anyone who is listed as the primary caregiver must be present at the facility at least twice a month….Family member 1 there is an unrealistic expectation of care and almost an anger that my loved one is not being restored to where they should be. And I talked to half a dozen people that have a new person in and it's either about meds or this or that but they are also talking to that loved one….Family member 1 | Increase involvement of family support |
Noisy or busy environment | Social opportunity Physical opportunity | There's so much holiday stuff going on | And then there are some people I've been told basically won't leave their room for the next three weeks because there's so much holiday stuff going on. Umm, you know, I'm gonna try to hide some Christmas trees in closets and get people out anyway. But there's just so many different environmental factors that play into it, but a big one I find is like stimulation, so it's like. What's visually happening? What's happening? Auditory wise? Umm, who's around? I mean, my biggest facility has 60 people and if you put any human with 59 other humans, there's gonna be people they don't get along with or they just don't like….Rehabilitation Provider1 | Make the environment conducive |
Interdisciplinary practice | Physical opportunity | Communication is really kind of important | I think it makes it easier if, you know, you've got kind of sort of meeting such a risk meeting so we can actually discuss specific residents' needs and what interventions are needed. Obviously, we can't. We haven't got the same sort of communication between yourself and the resident. So you're relying very much on those around to actually glean the information So I think communication is really kind of important…Rehabilitation Provider3 | Adopt interdisciplinary practice |
Intrapersonal factors | Communication difficulties | Physical capability Psychological capability Social opportunity | They don't understand that we're trying to help Communicate clearly, concisely, and loudly | they're not overly understanding of why we're there or what the purpose of doing all of this is, they just feel the pain and they see us as the people that are coming to hurt them, essentially because they don't understand that we're trying to help them recover and get them back up on their feet, so that lack of understanding, difficulty with following directions, the compliance with going along with the program is a big barrier….Rehabilitation Provider7 being able to communicate clearly, concisely, and loudly, sometimes with pictures, sometimes with tools. Again like bringing the walker to somebody. If they've used a walker, then they're gonna know what they're doing to a certain degree. So that can be really helpful….Rehabilitation Provider1 | Improve communication strategies |
Comorbidities | Physical capability Psychological capability | It just doesn’t come back Mental health piece is often seen as less of a priority They have fear and they are like no, I cannot walk It is so important to do the GPA training | It can be as simple as a urinary tract infection that is that difference. So it's not just ’ fractured hip or a broken arm or anything. It can be as simple as delirium. That has set in it and then, oh, my goodness, it’s just another, it just doesn’t come back…..Staff 1 once somebody gets diagnosed with dementia, that mental health piece is often seen as less of a priority because of the they have dementia, so they the shift of focus changes into, OK, they have dementia, they have this progressive disorder. However, they have lived with a mental health disorder for many, many, many years, and now we’re not really dealing with that piece…Rehabilitation Provider5 They have ability, I know, but they have fear and they are like no, I cannot walk. I cannot. They will do all kinds of exercises, I feel sometimes they have more strength than me. But then they won't stand up. They will do all kinds of exercises in bed or in chair, but they won't stand….Rehabilitation Provider8 So I think that it is so important to do the GPA training. Because you can see strategies you can understand more about this condition and how you can do to improve your. Your treatment, your. Your time with this person….Rehabilitation Provider2 | Assess and manage mental health Staff should undergo GPA training |
Conflicting availability between residents and rehab providers | Physical capability Social opportunity | They're sleeping and there is no way I can get them up We have an option to try another time | A few residents sleep during the day and are up during the night, and I don't work during the night, so. It's so hard to get them to walk. They do have physical ability because during the night they are walking around the unit. But then the balance is not great and when I want them to walk, they're sleeping and there is no way I can get them up…..Rehabilitation Provider8 If I try during the morning and I think that is not possible to do the exercise at this time here working at a long term care. We have an option to try another time like in the afternoon and maybe the afternoon there is it it's better….Rehabilitation Provider2 | Adopt flexible schedule |
Lack of motivation | Reflective motivation | She's happy. Waiting. And sitting The end destination is going to be the dining room We start to talk about something that they like They might go for a walk to see the bird feeders | But she moved in the long into assisted living. She wasn't much interested in doing things unless they were just going somewhere and sitting, you know? But, you know, she wouldn't play like, a card game or bingo. No way. She'll be around people doing it. It's never been her thing anyway. Doesn't interest her. She's happy. Waiting. And sitting….Family member 1 I've been doing that all my life, you know…Resident 1 If somebody is food motivated, you know it's pretty easy to get them up for a walk if it's right before lunchtime because the last you know the end destination is going to be the dining room…. Rehabilitation Provider1 sometimes we start to talk about something that they like or talk about the family or don't talk about the family. Depends on. Yeah. If this you they you be sad talking about some person they don't. We don't do that. It's important to know more details about the resident before you start doing the treatment…..Rehabilitation Provider2 if you've got someone who's 80 and they haven't exercised intentionally, like, maybe they like hikes or what have you. But like, they would never were like I'm doing a leg workout today. They're not gonna do it now. They did 80 years without it. It's just not gonna happen. But they might go for a walk to see the bird feeders on the other side of the facility. Because they do like to see the birds and perfect. Well, you just got your leg workout in for them and they got to see the birds and. It's just different, different goals, the same activity…..Rehabilitation Provider1 | Adopt functional activities |