Sunnybrook researchers Sander Hitzig and Christine Sheppard.
Gerry Banks has built his life in the Toronto Community Housing Corporation (TCHC) building he’s called home for the past 30 years. But now, at age 72, Gerry worries about his future as an older person living in social housing.
“I think about things like falling in the bathtub, and no one hears me. Or what if I need to move some furniture around – how will I do that with my bad back?” says Gerry, who shares his apartment with a dog and a cat. “There are a lot of things I have a hard time doing now, because I’m old.”
Health and safety become greater concerns for most people as they get older. But for senior tenants of social housing – who tend to be especially disadvantaged by poverty, health problems, social isolation and mobility barriers – these concerns are often magnified and, in many cases, left untended.
Sunnybrook scientists are stepping up to build and implement solutions to these urgent problems, in order to help seniors like Gerry remain in their homes safely and comfortably.
In a joint project that started almost two years ago, TCHC, the City of Toronto and the Toronto Central Local Health Integration Network (LHIN) have launched an “integrated services model” that addresses the issues faced by older Canadians living in government-supported housing. Key features of this new model include greater engagement of tenants in building affairs, on-site staff dedicated to each building, access to social and wellness programs and care coordinators who connect tenants to support services.
While these features are novel for Toronto Community Housing, what’s especially unique about its development is the application of implementation science – a field of expertise at Sunnybrook that uses carefully designed frameworks to translate research into strategy, actions and, ultimately, success.
FROM ANALYSIS TO EXECUTION
“Basically, it’s the study of how to get research evidence into practice and on to the front lines,” says Sander Hitzig, PhD, a scientist at the St. John’s Rehab Research Program, a Sunnybrook Research Institute program focused on advancing rehabilitation sciences to improve patient recovery.
“We often see great ideas for a new intervention or model of care that works really well under a controlled setting, but that doesn’t work as well when you try to implement it in the real world,” Hitzig says. “By applying implementation science, you can create and put into action the best possible model based on real world evidence.”
Hitzig says the successful implementation of any project depends on five key factors: characteristics of the intervention, project setting, stakeholders’ needs, the people involved and the process for executing and evaluating the intervention.
“Without this framework, you risk looking at the trees and missing the forest,” says Hitzig, who has used implementation science to develop and launch new models of care at Sunnybrook. As an example, he cites the decision to expand the work of physiatrists (specialists in physical medicine and rehabilitation) at St John’s Rehab to include consultations in acute care.
“Everyone liked the idea, because we knew it would lead to better outcomes for patients, such as a lower need for pain medications, but there was confusion around what physiatrists should do, and whether they should be at various sites or dedicated sites,” recalls Hitzig. “We used implementation science to determine the best model and the best way to implement it.”
For the senior housing project, Hitzig and post-doctoral research fellow Christine Sheppard, PhD, worked with a team to analyze 34 social housing models in Canada, the United States and Europe. They then narrowed their investigation to five models that aligned most closely with what TCHC, the city and Toronto Central LHIN wanted to accomplish.
They also interviewed 58 senior-aged community housing residents (including Gerry Banks) and consulted with 132 diverse stakeholders who included health-care providers, social workers, geriatricians, city hall officials and community advocates.
“We learned a lot,” says Sheppard. “For instance, how [to] empower tenants by helping them improve their financial literacy in things like everyday banking, setting up direct deposits and filling out forms. Because when tenants are empowered, they feel more free to ask for help.”
A BOLD NEW MODEL OF CARE
Andrea Austen, head of seniors, services and long-term care for the City of Toronto, says that having access to Sunnybrook’s experts in implementation science has made a big difference. Their work has led to key findings that shaped the integrated services model for TCHC’s 83 seniors-designated buildings.
“Under this new model, we will have these integrated teams of care coordinators, dedicated building staff and service providers like social workers and personal support workers working together to coordinate their services and to flag any issues,” says Austen.
“We will also be upping training in many different areas related to seniors, including how to identify and support cases of elder abuse, and how to communicate with people who have mild cognitive impairment.”
In addition to conducting research and presenting their findings and recommendations, Hitzig and Sheppard created a “logic model” that outlines goals and how various actions would affect outcomes for the short, intermediate and long term. They also created a dashboard to present a visual overview of 26 indicators for a healthy building.
“We are lucky to have access to experts like Christine and Sander,” says Austen. “Through the framework they’ve created, we will be able to closely monitor this new integrated services model and see the intended impact and outcomes.”
COMMUNITY HOUSING THAT WORKS
Here are some of the elements identified by Sunnybrook researchers Christine Sheppard, PhD, and Sander Hitzig, PhD, that indicate a healthy building:
CLEANLINESS: Buildings are clean, free of pests and repairs are completed in a timely manner
ACCESS: Tenants have access to health services, social supports and community agencies right in their buildings
SAFETY: Tenants feel safe in their homes and community, resulting in reduced safety incidents and reduced calls to police and fire departments
COMMUNICATION: Frequent, proactive and respectful communication from housing staff to tenants