Spotlight on the geriatric outreach behavioural supports program at The Royal


They say that one measure of a society is how we care for the most vulnerable in our community. 

The Dementia Society of Ottawa and Renfrew County estimate that over 24,000 people live with dementia in this region, a number that is expected to double by 2031.

“People say the tsunami is coming, but the tsunami is here,” says Nancy Lesiuk, manager of geriatric outreach at The Royal and regional lead of Behavioural Supports, Champlain, an initiative created to support health care services for older adults with dementia, mental health, substance use and/or other neurological conditions. 

Community-based mental health care support for older adults and their caregivers is essential for our aging population.  

The Royal’s geriatric outreach behavioural supports program focuses on the assessment, diagnosis, and treatment of complex mental health disorders in adults over the age of 65. Dedicated teams provide specialized geriatric care and share their knowledge and expertise to increase capacity at other organizations. 

“The Royal is a leader in this area and while we have a robust inpatient program, many people don’t realize how much of our work actually takes place out in the community, in hospitals across the entire Champlain region, long-term care homes, retirement homes, private dwellings, essentially anywhere the client and caregivers reside,” says Lesiuk.   

The geriatric outreach behavioural supports program consists of a team of specialized registered nurses, behaviour therapists, and geriatric psychiatrists who provide services within a 300km stretch of eastern Ontario from Hawkesbury to Deep River, which includes 7,500 beds in 61 long-term care homes. 

Their focus is older adults over the age of 65 with dementia, neurocognitive disorders with behavioural disturbance, or mental illness that interferes with their ability to function independently with cognitive impairments related to dementia, and adults under 65 with age-related cognitive disorders such as Alzheimer’s disease and Frontal Temporal Dementia. 

They work directly with long-term care staff to build capacity when caring for older adults with or at risk of responsive behaviours/personal expressions. (See sidebar.) 

Their goal is to improve residents’ quality of life using non- pharmacological methods whenever possible, reduce visits to the emergency department, and minimize the need for inpatient psychiatric care. 
A person who has dementia may experience memory loss, changes in mood or behavior, difficulties thinking and problem solving, and difficulties with language that are severe enough to reduce their ability to perform activities of daily living. 

The geriatric outreach behavioural supports program may be called to a long-term care home if a resident is experiencing behaviours with their daily care needs. 

While every resident’s care needs are unique, according to Lesiuk, it’s ultimately about “listening, understanding the need, and intervening to support the resident, caregivers and families.”

Building capacity

A key tenet of the geriatric outreach behavioural supports program is the building of partnerships and capacity in other organizations. This includes education and one-on-one consultation with staff at long-term care homes such as nurses and personal support workers, support staff, management, family and caregivers, and doctors, but also extends farther into the community to other groups who have regular encounters with older adults, such as nursing students, dental hygienists, police, and paramedics. 

“Our strength and our growth is truly our partnerships,” says Lesiuk. “We foster a culture of collaboration and work together across our systems.”

“We have a wonderful opportunity to support residents, caregivers, and staff in long-term care. Culture is an important part of that and I think the key lies in the collaborative models that we've built. There are people looking at all the angles, really working together to improve the quality of life for the clients we serve.”

For more information about The Royal’s Geriatric Psychiatry Program, go to

How language impacts care

Geriatric outreach teams at The Royal provide a range of services in the community, including 
support to long term care homes regarding responsive behaviours related to dementia and other neurological disorders. 

Responsive behaviours include but are not limited to pacing, wandering, hoarding, restlessness, risk to self or others, repetitious mannerisms, and cursing. 

While the term “challenging” or “problematic” behaviour is often also used, The Royal's Nancy Lesiuk and others in geriatric care prefer to use the term, “responsive” behaviour or “personal expressions.”

“All behaviour has meaning behind it,” says Lesiuk. 

By referring to the behaviour as responsive instead of “bad” or “challenging” it subtly encourages caregivers to focus more on what can be done to pay attention to triggers and make a change, rather than focus on the behaviour’s impact. 

Did you know?

Did you know The Royal has more geriatric psychiatrists than any other health centre in Canada?