Nursing Home Without Walls

What is a Nursing Home Without Walls?

The Nursing Home Without Walls (NHWW) program aims to enhance the experience of aging by empowering older adults and their caregivers in New Brunswick to age in their homes. Created by researcher Dr. Suzanne Dupuis-Blanchard from the Université de Moncton, this program facilitates healthy aging at home by providing access to essential knowledge, support, and services. By enabling older adults to age in place, NHWW contributes to prolonged independence, minimizing the need for premature admission to long-term care (LTC) facilities and decreasing unnecessary emergency department visits.

NHWW aims to:

1. Ensure that older adults and their families have access to appropriate services and information related to aging in place
2. Provide social health initiatives to counter social isolation and loneliness to older adults and their caregivers
3. Increase knowledge on health-related issues important to aging in place and healthy aging for older adults and their caregivers
4. Empower the local community to respond to the needs of an aging population

Collaboration with Nursing Homes

NHWW programs are hosted by nursing homes. Nursing homes provide the physical space and administrative oversight to support NHWW staff and operations, as well as trusted knowledge of the local community, community resources and aging. In some NHWW programs, nursing homes provide direct support to older adults living in the community.  Nursing homes customize program components to meet the unique needs of older adults in their community and leverage the distinctive features of their nursing home.

The NHWW program is defined by three key elements:

1. Direct community service: Tailored to directly assist older adults residing in the community.
2. Nursing home infrastructure: Leveraging the established infrastructure and resources of nursing homes.
3. Addressing aging challenges: Focused on tackling issues related to aging in place, such as combating social isolation.

Expanding NHWW across New Brunswick

Four English and French-speaking rural communities began implementing the NHWW model in their local nursing homes in 2019 through the Healthy Seniors Pilot Project. Although somewhat different in their approaches, their goals were the same – to support aging in place in their local communities. Early results of the NHWW pilot programs include:

• Increased satisfaction with levels of social interactions and outings
• Increased knowledge on who to contact to get information on services for aging at home
• 69% of older adults have stated that the services received are accessible and help them stay in their home
• Increased feeling of security in their home and the community
• 100% of older adults are satisfied with the services offered by NHWW
• Prevented some non-urgent visits to Emergency Dept. or medical after-hours clinic

To advance the adoption of NHWW and support older adults living and aging in community, the New Brunswick Department of Social Development, Université de Moncton and Healthcare Excellence Canada partnered together to spread and scale the NHWW initiative beyond the four pilot sites. In 2023, a funding opportunity was announced for Nursing Homes in New Brunswick to establish a Nursing Home Without Walls program within their local communities.

Over the course of the next year, Social Development, Healthcare Excellence Canada and the Université de Moncton are providing support, coaching and resources to sites during the planning and implementation of their NHWW programs.  Learnings and impacts from the spread and scale of this innovation are currently being measured with the plan to share, so that other jurisdictions across Canada can learn from the work being done in New Brunswick.

Why this work matters

Most people in Canada – 85 percent of adults surveyed and 96 percent of those aged 65 years and older – want to avoid moving into a long-term care home and age at home for as long as they can.

Despite this desire, one in 10 people who enter long-term care could have potentially been cared for at home with formal support. Learn more about Enabling Aging in Place, an HEC collaborative focused on implementing promising practices that enable older adults to age safely in place.

About the pilot sites

Four nursing homes volunteered to pilot the NHWW program. These homes were in the rural communities of Port Elgin, Lamèque, Inkerman and Paquetville. Access to services is complex in rural communities -New Brunswick is composed of 49% rural communities. 

All four nursing homes implemented the program at the same time and offer services appropriate to the needs of their communities (based on previous consultations and a needs assessment), which would not duplicate existing resources or services.

Lamèque

In Lamèque, NHWW initially assisted frail older adults at home with personal care, meals, medication and socialization. Services expanded to include transportation, community activities, home maintenance and caregiver support, reflecting a community- and person-centered approach to holistically address the diverse needs of older adults and their caregivers.

Inkerman and Paquetville

In Inkerman and Paquetville, NHWW provides home maintenance, transportation, bathing, foot care, health clinics, and socialization for older adults. Paquetville collaborates with a local volunteer organization for meal services. Sharing a coordinator, the nursing homes maintain distinct service approaches while leveraging proximity and similar needs between the communities.

Port Elgin

In Port Elgin, NHWW prioritizes community service access. The program aids older adults in accessing federal, provincial, and local services by assessing their needs and assisting with applications. Addressing social isolation, weekly coffee chats are hosted, and transportation is coordinated for appointments and errands. Expanding services, Port Elgin lends equipment and supplies to support older adults in comfortable home living.

The following promising practice summary was prepared following interviews with Nursing Home Without Walls (NHWW) sites in New Brunswick during the summer of 2023. Healthcare Excellence Canada (HEC) would like to formally acknowledge the generosity of the New Brunswick Department of Social Development, Université de Moncton, Lamèque NHWW site, Inkerman NHWW site, Paquetville NHWW site, and Port Elgin NHWW site in sharing their skills, knowledge, expertise and experiences to form this promising practice.

Read the entire summary

NHWW in the community: What We’ve Heard

"I just wanted you to know how very much I look forward to and enjoy the exercise class. It may be a senior’s class, but I assure you we all get our heart rates up and we stretch every single part of our bodies including places that we didn’t know we had! Thank you for organizing such a lovely class to enrich our lives." – A note from a NHWW client

"My mother is a new person. She now smiles and has something to look forward too." – From a daughter about her mother who lives alone

"Thank you for the information and links, and for all the time and care you took with us yesterday. Your visit was a huge help to us, and we are grateful to be able to benefit from NHWW." – A couple receiving a home visit

"I am so happy, I can't stop crying. There is no way I could have spent another winter in that home. NHWW has literally saved my life and I cannot thank you enough, thank you very much." – An 85-year-old man who was housing challenged

Nursing Home Without Walls: In the News

• Le programme des foyers de soins sans murs continue de s’élargir au Nouveau-Brunswick | Radio-Canada
• Nursing Homes Without Walls program reaches milestone of 20 locations (gnb.ca)
• Nursing Home Without Walls project supported by ResearchNB - ResearchN
• Expansion of Nursing Homes Without Walls program (gnb.ca) 
• N.B. senior buddy program makes big difference | CTV News 
• Être au foyer, mais vivre chez soi : le succès des foyers de soins sans mur au N.-B. | Radio-Canada
• Nursing Home Without Walls Program expands again (gnb.ca) 
• Nursing Home Without Walls Paves the Way for Seniors to Flourish at Home | Shannex 

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