Our Philosophy: Collaborative Care Model

“Collaborative Care” is founded on the premise that all care starts with the resident and their family and that all persons associated with the delivery of that care are collaborators.  This model focuses on four key areas:

People: Residents’ and their families are recognized as partners in their own care, relying on care giver relationships to support them in their journey.  A team approach to care giving is viewed as being critical to a meaningful response to residents needs. This approach is supported by continuous quality improvement initiatives.  The Resident Care Team (consisting of RNs, LPNs, and CCAs/PCWs roles) are optimized in order to ensure the best possible care is received by our Residents.   Other house staff such as environmental services, food services and recreation will round out the house team.  Other allied health professionals will be viewed as visiting consultants and these roles will be strengthened within available resources.

Processes: Comprehensive Care Plans will be undertaken upon entry to the Elms and reviewed on regularly scheduled bases and as needed. Resident history, family relationships and normal activities of daily living will be gathered and with the support of family and guided by resident input where possible, will be transformed into an individualized care plan.

Process review, supported by Policy and Procedural amendment, will be undertaken to maximize this process, as well as best practices reviewed and implemented wherever possible. Accountability and responsibility will be understood for all participants.

Information: Collection of the right information at the right time will be ensured and form part of an integrated system within the continuum of care. Staff training is viewed as critical to the model’s success.

Technology: Improved technology will be accessed to support this important work and its design, while integrated into the overall continuum, will be specific to the Elms needs.  All staff will have the required training and be held accountability for its appropriate use.

Collaborative Care is about:

  • Focusing on residents needs
  • Being flexible
  • Relying on effective communication
  • Continual rehabilitative approach
  • Eden and its 10 principles as key focus
  • Using full scope of practice
  • Minimizing rules and regulations
  • Effectively using information and technology
  • Relationships
  • Staff autonomy and innovation
  • Replicating the real world outside of institutionalized settings
  • Resident mix reflecting a normal community
  • Allied health professionals are visiting consultants
  • Individual skill sets being maximized
  • Decision making by the resident and for the resident
  • Family and friends being active participants
  • Work schedules being based upon household needs.
  • Windsor Elms Village is a member of: