Health and Wellbeing

November 12-13, 2013

Brenda M. Elias, PhD

““Building Coalitions Through An Integrated Service Delivery Model”

AgendaCommunity CampusReena Community ResidencePartnerships and Collaboration Development of the modelCurrent snapshotEvaluationChallenges and Lessons learned

VisionA new housing model of apartment living with supports for adults and seniors with developmental, physical, cognitive and/or mental health needs, located on a community campus.

Lebovic Jewish Community Campus

Campus CommunityLocated on the Joseph and Wolf Lebovic

Jewish Community Campus in Vaughan Easy access to the Schwartz/Reisman CentreMt. Sinai Family Health Clinic on CampusOpportunity to be part of Campus “life”

through classes, activities and programsCommunity integration is key in enhancing

inclusion

Schwartz/Reisman Centre

Reena Community Residence80,000 square foot, 4-storey Apartment building60 apartments on upper three floors for 84

tenants1, 2 and 3 bedroom units, some of which are

accessibleMain floor offers two Day Programs for young

people with developmental disabilities Holocaust Remembrance Garden & Education

Centre honours the over 200,000 people with disabilities who were targeted and killed by the Nazi Regime

Reena Community Residence

Tenant ProfileFor 84 adults and seniors

with:developmental

disabilitiesmental health issuesdual diagnosisphysical disabilities

Tenants Experiencing Major Life Transitions Downsizing from the family home Moving out of their childhood home Independent, supportive living after

years of searching Developing personal independence

in their new apartment

Apartment Units

Intentional CommunityA planned residential community providing

services with a higher degree of teamwork than other settings

Members hold a common social vision, focusing on the benefits of living together

Residents will be asked to look out for their neighbours and can expect the same help from others

Life at the Residence Embodies InclusionInclusion is one of Reena’s core values and

practicesTenants with varied abilities come together to

live a meaningful life, interacting with their neighbours

Beyond providing a home and supports, this integrated model builds community where people can live, play and work

Partnership/CollaborationPartners

Reena, Circle of Care, and Ontario March of Dimes

In collaboration with: Kehilla Residential ProgrammeUJA Federation of Greater Toronto

CollaborationPlanning Began in 2005 with several

community partners to collaborate on a new housing model with supports

Funding from the Ontario Trillium Foundation supported the development of the Integrated Service Delivery Model

March of Dimes joined the collaborative in 2013

ReenaEstablished in 1973Innovative Housing: Group

homes, triplexes, condo clusters, clustered apartment models, residential/respite models, family partnership models

Elderhomes Opened first in North America,

2000Two others have since opened

Supporting over 1,500 in Day Programs, respite, outreach and residential services to children, adults, and seniors

Circle of CareCommunity-based, non-profit agency serving

Toronto area since 1974In 2011-12, supported approximately 7,000

clients (mainly seniors)Approximately 525 staff and 350 volunteersFull range of services to support individual

independence for clients to live healthier, happier and longer lives at home.

Development of the ModelEnvironmental Scan and interviews with key

informants to inform the development of the model

Program and Steering Committees (agency staff and community members) reviewed the progress

Protocol manual developed, including: financial model, coordinated intake and applications

Care plan team struck to fine-tune the modelAdaptations on-going as needed

Integrated Service Delivery

Joint application and intake with Circle of Care for community applications

Cross-training and peer support for seamless service delivery to support tenants and families

Enhanced client-centred approach, which links each tenant with residential staff on their floor

Inclusion Supervisor and Receptionist assist all tenants

Sharing resources and expertise among agencies

Central LHIN Cluster Care Model Community-based housing with supports for

young people with complex care needsIntake for these units through March of

DimesMarch of Dimes provides attendant care,

assisted by Reena staffInnovative integrated service delivery model

providing wrap-around care for people with disabilities

The Research Project 2012 to 2017The most important indicator of success will be to

examine the lived experience of the individuals who relocate to the new building

A longitudinal study will observe and capture both qualitative and quantitative data before and after the tenants move and monitor change over time.

A major focus of the study will be to examine whether tenants embrace a common social vision that places importance on sharing life together and whether these activities impact their perceptions of their own health

The Research Project 2012 to 2017This study offers a rare opportunity to sample

health perceptions of up to 84 individuals ranging in age from 18 to 82 years of age

Theoretical models include biopsychosocial, life course theory and person-environment fit

It presumes that perceptions of health, as well as barriers in an individual’s social or cultural environment will influence the likelihood that they will engage in health-promoting behaviors, such as medication taking, proper diet and physical activity

Current SnapshotEarly findings have been generated over the first year

although the building is about 98% occupied and therefore the integrated service model is evolving gradually as each new tenant joins in the community

65 tenants have been interviewed pre and post move with a total sample size now of 60 since 4 tenants did not “ fit” and moved out in 2012 and 1 young woman died while attending camp prior to her move to Reena Community Residence

Only 42 interviews are included in this report since others did not move into the new building until 2013.

All comments, observations and quotes are strictly confidential

Early Findings November 2013 after 14 months of life in the new building

Six themes from the aggregated data are as follows: tenant experiences, the building, perceived health improvements, support services ,sports and recreation and pets:

Overwhelming majority can be described as “ ecstatic” with their new apartments and the experience of buying items such as toasters, big screen televisions and microwaves which is very exciting if you have never owned such items before

What the tenants are saying“ I love it here and want to stay forever and ever”“ it’s nice” “ very quiet and peaceful” “ I really like my new room and I am very happy”“ the building is beautiful” one young man said that he “hated it in the group home” and is trying very hard

to keep up with cleaning his apartment“ when I moved in I was so tired, very stressful and

I slept a lot at the beginning, feeling better now”

What the tenants are sayingFindings confirmed perceived health

improvements, better diet, increased participation in sports, fitness classes and recreation activities due to complex next door.

“ I check my blood sugar and its done amazing, I take meds 3x day, make my bed and learned how to take care of my apartment”

“I take care of my health now, like aquafit, yoga classes, feel as healthy as a horse”

What the tenants are sayingFor others tenants they say it is the freedom to

come and go as they please. They are independent and learning many new things about their surrounding neighborhood, about grocery shopping, cooking, keeping their units clean, and living on their own.

“ I have made a good new friend next door and we go out for lunch together”

“ everyone gets along”“at night we watch hockey games together in our

apartments”

Early FindingsSome have pets to care for and at last count

there are 11 cats and dogs living in the intentional community

sharing the experience of living with pets is new for many.

Tenants are learning what it is like to live with other people and share common space.

“ I have never lived by myself before and I am working on socializing at evening programs”

“ Don’t mind helping neighbor with overflowing toilet but should not have to feel obligated”

Early FindingsHowever, there are 4 (<10%) tenants that say

they hate the location of the building in York Region and want to move out as soon as possible to be closer to action in Toronto, only 2 tenants own cars and bus fares are costly

Some concerns have been raised regarding safety and security in the building and tenants have requested a Tenant Council be established as soon as everyone is settled.

Smoking and fire drills are other issues that have been identified as a worry to tenants

Challenges and Lessons LearnedBoth internal and external communication is

extremely important with so many stakeholders involved in this complex project

A newsletter/website would be a simple way to involve tenants, students, volunteers, friends, staff and family members to keep everyone informed about what is going on in the intentional community

Partners will come and go as each organization tests out appropriate services and costs for their clients

Training and support is essential as this onsite work is very demanding

We are still in startup modePatience is a true virtue as each individual

adapts to the new setting, this includes tenants, family members and friends, pets, volunteers, researchers, students and staff

It has been a 14 month learning experience for everyone involved and for the most part it has certainly been a positive one so far

We are still taking community applications.

For more information, please contact:

Ellen RajzmanReena Community Residence Manager erajzman@reena.org