About P.I.E.C.E.S. in Ontario
LTC Homes in Ontario provide care for the most complex elderly in the province. It is estimated that 80% of LTC Home residents have dementia, 60% have serious mental illness. In addition, it has estimated that 70% of older individuals in LTC homes have behavioural problems, 30% severe. In Ontario, a move from hospital-based care to community-based care is underway.
These realities demand very skilled, knowledgeable, and sensitive staff that understand, observe, interact, support, and collaborate with others to improve the quality of life and decrease the burden of illness of home residents. In response, a foundation for a common vision, a common language, and common approach to the care of older people in the long-term care sector was developed through a comprehensive, system-wide approach to education. The provincial learning strategy entitled "Putting the P.I.E.C.E.S. Together", was originally designed to enhance the ability of Long-Term Care (LTC) home staff to meet the care requirements of individuals with increasingly complex physical and cognitive/ mental health needs and associated behavioural issues. Experiences and evaluations with the P.I.E.C.E.S. education program over an eight-year period has informed the design of support structures for the ongoing development of the learners (participants) and complimentary programs for the LTC community and for acute care and emergency departments
Mid 2003 further P.I.E.C.E.S. program developments led to sessions for members of senior management teams in LTC homes. The goal of engaging this target group has been to create strategies to increase their success rates in implementing and sustaining P.I.E.C.E.S.
Over the years advancing technologies have had increasing impact on the P.I.E.C.E.S. program. Managers have access to an online senior management guide to help them understand the program scope, to help with appropriate candidate selection for the program, and to learn their responsibilities for enhancing transfer of knowledge. Learners now have access to online registration and assessments. Technology enhances timely exchange of information across the Educator Team and Design Team.
Each improvement of the P.I.E.C.E.S. education builds upon the positive aspects identified in the evaluations and also addresses any shortcomings. The improvements have focused on (1) applicability in the long-term care setting; (2) feasibility; and (3) addressing the time constraints and realities of that environment. Ongoing updates and revisions are designed to advance the development of six-core competences and to integrate within the six-question template rather than stand-alone concepts or ideas.
Since its inception, the P.I.E.C.E.S. education program has been built upon the premise that training alone could not solve all the problems associated with evolving care requirements of individuals with increasingly complex physical and cognitive/ mental health needs and associated behavioural issues. However, P.I.E.C.E.S. could be part of the solution. The program is grounded in the research of adult learning theory, human performance technology, and organization development.
