Sweet Home Alabama was booming from a cedar-shingled building on a rock in the Strait of Canso on Wednesday morning.
Inside the St. Anne Centre, licensed practical nurse Kelsey Matthews was dancing with an elderly woman.
Wendy Boudreau led those who couldn’t leave their chairs in clapping along to the gospel of southern rock.
The 27 residents of the community-run, long-term care home on Isle Madame were all moving.
And that’s important because if people don’t move they aren’t healthy.
One of the symptoms of not moving and being unhealthy is bedsores.
Known to the medical community as pressure injuries, they became a news item after an investigation for The Chronicle Herald by freelance journalist Jennifer Henderson into bedsore-related deaths at private special care homes.
As a result of that reporting, Halifax Regional Police are investigating the death of 40-year-old Christine Dunnington from a sore that developed while the disabled woman was residing at Shannex-owned Parkstone Enhanced Care as a case of potential criminal negligence.
The Department of Health then demanded a count of bedsores at nursing homes around the province and received back reports of 152 existing stage 3 and stage 4 sores among residents.
By the time a sore has reached that classification it is often oozing, the skin is broken and bone or muscle tissue may be visible.
A preliminary count found 439 bedsores in the less serious stage 1 and 2 categories.
What happens between the walls
Meanwhile, the St. Anne Centre hasn’t had a bedsore in years.
That’s despite being an old building — it was built in 1986.
And the fact that it is a 90-minute drive from the specialists at the regional hospital in Antigonish.
“There’s a lot of talk about building new facilities,” said Annette Fougere, chief executive officer at the St. Anne Centre.
“But it’s not about new buildings, it’s about the care that happens between the walls.”
That’s because the vast majority of bedsores are preventable if residents move or get moved often and get the nutrients their bodies need.
Beyond that, prevention is about how they are moved, what they sit and lay on, and whether their bodies are kept clean and dry.
Bedsores are caused by two types of forces on the body:
Pressure — if a patient is sitting or laying for a long period of time in a position or on a surface that puts too much pressure on one part of the body.
Shearing — When a body doesn’t have enough fat to act as padding between the hard bones rubbing against the skin.
And they are expensive. Each advanced bedsore costs the medical system, on average, $12,648 a month to treat, according to WoundsCanada’s 2018 publication Foundations of Best Practice for Skin and Wound Management.
- VIDEO: Nova Scotia releases bedsore numbers, promises fixes
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- Expert blames lack of training for bedsore problem
- Problems found at Shannex facility in Sydney
Going against a top-down model
For the small care facility in Arichat, the prevention of bedsores has been about making a study of best practices and playing to their strengths in a close-knit, isolated community.
“The movement of late in this province has been to centralize health care in a top-down model based out of Halifax,” said Dr. Bob Martell, who is based up the road in West Arichat.
“St. Anne is the antithesis to that and it’s working.”
The St. Anne Centre is an anomaly in this province.
It is both a long-term care facility and an outpatient facility complete with X-ray, trauma room, examining room, diabetes clinic and visits from travelling specialists. It’s also the only outpatient facility in the province not run by the newly minted Nova Scotia Health Authority.
While all the province’s hospitals are run from Halifax, St. Anne is funded by the Department of Health and Wellness but run by an eight-member board composed of representatives from each of Isle Madame’s five communities, the municipality and the province.
“We were never integrated into the Nova Scotia Health Authority and we don’t want to be,” said Fougere.
“We appreciate that they are always there to help when we need something.”
When a new resident moves into one of the St. Anne Centre’s 29 beds, one of the first people they meet is director of care Lynn LeBlanc.
She assesses their skin condition, nutrition, mobility, continence and general well-being.
If they’re not able to get up and move around much, then Wendy Boudreau — who was leading the chair dancing to Lynyrd Skynyrd on Wednesday morning — determines if they will need a mattress or seat cushion customized to their needs.
Five of the beds at the facility are funded through Veterans Affairs Canada for veterans of the Korean and Second World War. Those residents have been able to get funding for air-filled and circulating mattresses that can cost up to $7,000 each.
When those residents have died, the families have often donated the mattresses to the St. Anne Centre for reuse.
Sheets are doubled-up nylon to decrease friction on the body.
Each room has a hoist so residents are lifted up instead of slid across their beds when being transferred in and out of chairs.
A dietitian whose position is split between the long-term care home and the outpatient department develops customized meal plans for each resident.
“Nutrition is key to keeping a healthy body,” said LeBlanc.
So real food that people want to eat is important.
That means fish at least twice a week — haddock, salmon, lobster or mackerel, according to the season.
All these assessments are updated daily by staff who primarily live in the small communities the St. Anne Centre serves — who know the both residents and the people who love them and are loved by them.
“You’ll notice that when you walked in there you didn’t smell anything,” said Dr. Martell.
“If someone needs 20 diapers in a day, they get them. Residents aren’t put on a schedule for changing there. It’s on an as-need basis.”
Beyond caring for their bodies, the staff is also tasked with caring for minds.
So while Wednesday morning was dancing, in the afternoon it was to be bingo.
“That’s when it gets really serious,” said Boudreau.
Other days it is bocce ball, bowling or balloon tennis.
“For most, this is their last home,” said Fougere.
“So it’s about quality of life while they are here and keeping them in as good of health as you can considering their age.”