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Ontario’s Centres for Learning, Research and
Innovation (CLRI) in Long-Term Care:
OANHSS 2015 | April 15, 2015
Ontario’s Centres for Learning, Research and Innovation
in Long-Term Care
Teaching LTC Homes:
Current and Future
Opportunities
Melissa Donskov, Bruyère CLRI
Raquel Meyer, Baycrest CLRI
Mary-Lou Van der Horst, Schlegel CLRI
BAYCREST
BRUYÈRE
SCHLEGEL
Ontario’s Centres for Learning, Research and Innovation in Long-Term Care | www.clri-ltc.ca
Outline
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Introduction
Origins and examples from other countries
The Ontario experience
Baycrest, Bruyère and Schlegel CLRIs
Lessons and experiences
The next generation of Ontario CLRIs
Discussion – what does this mean?
BAYCREST
BRUYÈRE
SCHLEGEL
Ontario’s Centres for Learning, Research and Innovation in Long-Term Care | www.clri-ltc.ca
Ontario’s Three CLRIs
Supported with funding from the Government of Ontario
The views expressed in this publication are the views of the author(s)/presenter(s)
and do not necessarily reflect those of the Province.
BAYCREST
BRUYÈRE
SCHLEGEL
Ontario’s Centres for Learning, Research and Innovation in Long-Term Care | www.clri-ltc.ca
Who are we?
Baycrest
Centre for Learning, Research and Innovation
in Long-Term Care
Bruyère
Centre for Learning, Research and Innovation
in Long-Term Care
Schlegel
Centre for Learning, Research and Innovation
in Long-Term Care
Ontario’s Centres for Learning, Research and Innovation in Long-Term Care are
supported with funding from the Government of Ontario (2011 – 2016)
BAYCREST
BRUYÈRE
SCHLEGEL
Ontario’s Centres for Learning, Research and Innovation in Long-Term Care | www.clri-ltc.ca
What do we do?
Ontario’s Centres for Learning, Research and Innovation in Long-Term Care
contribute toward enhancing the quality of care in the LTC sector through:
Education, research, innovation,
evidence-based service delivery and
knowledge transfer
BAYCREST
Facilitating collaboration between
researchers, educators, LTC home
personnel and other practitioners in
the development, adoption and
continuous improvement of evidencebased best practices that increase
efficiency, effectiveness, sustainability
and quality of care
BRUYÈRE
SCHLEGEL
Ontario’s Centres for Learning, Research and Innovation in Long-Term Care | www.clri-ltc.ca
What is a Teaching LTC Home?
• Fundamental concepts: linking and creating synergy
between the separate spheres of research, clinical
care and education and training
• Typical outcomes
–
–
–
–
Research to improve care
Increase knowledge of the workforce
Quality education and clinical experiences for students
Enhanced quality of care
Source: Chilvers & Jones 1997; Barnett 2014
BAYCREST
BRUYÈRE
SCHLEGEL
Ontario’s Centres for Learning, Research and Innovation in Long-Term Care | www.clri-ltc.ca
Why Teaching LTC Homes?
• Aging population
• Increasing complexity of residents and chronic
illnesses
• Challenges with recruitment to and retention in LTC
• Improve training and skills of interdisciplinary care
teams
• Social devaluing of LTC and lack of prestige with
geriatric care
• Competition for HHR from other providers/sectors
• Lack of collaboration among educational/research
institutions and LTC
Source: Early Leaders Forum Report 2011
BAYCREST
BRUYÈRE
SCHLEGEL
Ontario’s Centres for Learning, Research and Innovation in Long-Term Care | www.clri-ltc.ca
Why Teaching LTC Homes?
“Good health care is a combination of good systems and
processes; good clinical practice; and good
resident/patient engagement. With a reputation for
scoring highly in all three areas, long term care homes
are well positioned to offer quality on-the-job educational
opportunities to Canada’s future health care
professionals. Every-one – long term care homes,
colleges and universities, Canada’s health care system
and, most importantly, residents – will reap the benefits.”
Source: Chambers, 2010
BAYCREST
BRUYÈRE
SCHLEGEL
Ontario’s Centres for Learning, Research and Innovation in Long-Term Care | www.clri-ltc.ca
Origins of the Movement
• Early 1960s – veterans’ nursing homes and affiliated
veterans’ hospitals
– Improve knowledge about long term care of older people
– Increase number of qualified aged care providers
• 1980s – several TNH examples in the US
– Two most comprehensive and influential
• National Institute on Aging TNH Program
– Focus on multidisciplinary research to inform geriatric care (++ physicians)
• Robert Wood Johnson TNH Program
– Supported students and workforce education (++ nursing)
Source: Barnett 2014, Mezey & Lynaugh 1989
BAYCREST
BRUYÈRE
SCHLEGEL
Ontario’s Centres for Learning, Research and Innovation in Long-Term Care | www.clri-ltc.ca
Other Countries -Norway
– Started in 1996, emphasis on planning stage
– Piloted nationally with 5 TNH 1999-2003
– Permanent feature of aged care system as of 2004
– Main goals
• Improve competence of staff
• Enhance prestige of working in aged care (increase
recruitment/retention)
• Create a culture in NH conducive to developing
services informed by research
• Developing good learning environments for students
Source: Barnett 2014, Early Leaders Forum 2011, http://www.utviklingssenter.no
BAYCREST
BRUYÈRE
SCHLEGEL
Ontario’s Centres for Learning, Research and Innovation in Long-Term Care | www.clri-ltc.ca
Other Countries – Norway (cont’d)
– Network of TNH (one in each county) providing
leadership for the aged care sector
– Hub model – Role includes dissemination of
research findings and clinical expertise to impact
sector
– Recently expanded (2011) to include home and
community care; “Centre for Development of
Institutional and Home Care Services”
Source: Barnett 2014, Early Leaders Forum 2011, http://www.utviklingssenter.no
BAYCREST
BRUYÈRE
SCHLEGEL
Ontario’s Centres for Learning, Research and Innovation in Long-Term Care | www.clri-ltc.ca
Other Countries - Australia
• Teaching and Research Aged Care Services (TRACS)
• Combine teaching, research, clinical care and service
delivery in one location to operate as a learning
environment, to support clinical placements and
professional development activities in various
disciplines.
• 2011/12 to 2014/15
– 16 TRACS projects (spread across country) + national
evaluation
Source: https://www.dss.gov.au/our-responsibilities/ageing-and-aged-care/tools-and-resources/agedcare-workforce-fund/teaching-and-research-aged-care-services-tracs
BAYCREST
BRUYÈRE
SCHLEGEL
Ontario’s Centres for Learning, Research and Innovation in Long-Term Care | www.clri-ltc.ca
Other Countries – Australia (cont’d)
• Key Elements
– support training and professional development in a range of
disciplines (e.g., nursing, psychology, medicine, physiotherapy,
occupational therapy)
– aged care specific curriculum development
– clinical training in residential and community care settings
– inter-professional learning and participation by aged care employees
in teaching, learning and research
• Evaluation
– practical strategies and processes that help the aged care sector
operate as a learning environment to facilitate high quality clinical
training professional development opportunities; and deliver benefits
to industry, students, staff and care recipients.
Source: https://www.dss.gov.au/our-responsibilities/ageing-and-aged-care/tools-and-resources/agedcare-workforce-fund/teaching-and-research-aged-care-services-tracs
BAYCREST
BRUYÈRE
SCHLEGEL
Ontario’s Centres for Learning, Research and Innovation in Long-Term Care | www.clri-ltc.ca
The Ontario Experience
• Promoting Productive Partnerships
Community of Practice
– Members – Interdisciplinary Council on Aging and
Health within Ontario Council of Universities,
colleges, universities, government, hospitals,
research institutes, LTC homes, etc
• Early Leaders Forum – November 24, 2010
• Report and funding proposal – February, 2011
BAYCREST
BRUYÈRE
SCHLEGEL
Ontario’s Centres for Learning, Research and Innovation in Long-Term Care | www.clri-ltc.ca
The Ontario Experience
• RFP issued in summer 2011
• Three inaugural Ontario Centres for Learning,
Research and Innovation in Long-Term Care
funded in October 2011
– Baycrest
– Bruyère
– Schlegel
BAYCREST
BRUYÈRE
SCHLEGEL
Ontario’s Centres for Learning, Research and Innovation in Long-Term Care | www.clri-ltc.ca
Objectives – Ontario CLRIs
• The work of the Centres for Learning, Research and
Innovation in Long-Term Care (CLRI) will support LTC
homes to:
– deliver the right level of care, in the right place, and at the
right time across the continuum of care;
– contribute to the high quality of life and provide high
quality care for residents of LTC homes;
– promote a dynamic culture within the LTC sector, that is
responsive to client needs;
– develop and enhance the expertise of LTC home staff and
promote the LTC sector as an employer of choice; and
– provide efficient and effective care.
BAYCREST
BRUYÈRE
SCHLEGEL
Ontario’s Centres for Learning, Research and Innovation in Long-Term Care | www.clri-ltc.ca
Goals of the Ontario CLRI Program
•
Provide educational opportunities and promote career opportunities within LTC settings to
develop a workforce with the knowledge and skills to provide quality care to LTCH residents.
•
Foster interdisciplinary/inter-professional learning and development of all health care
providers and disciplines.
•
Contribute to the development of learning curriculum that prepares health care workers for
the provision of quality care based on evolving best practices.
•
Create opportunities for evidence-based research to be conducted and validated within an
operating LTCH and enable providers to influence the research agenda. This includes finding
new ways to deliver care and services, and the development of new products.
•
Create opportunities to design, test and disseminate innovative approaches to providing
high quality care within LTC settings.
•
Facilitate knowledge transfer from applied and clinical research to practice and promote
healthcare integration and innovation across the continuum.
•
Enhance the profile of the LTC sector within the broader healthcare system.
•
Foster collaboration and partnerships within the LTC community and between the LTC
sector, colleges and universities, research institutions, government, the broader healthcare
sector and subject matter expert organizations.
BAYCREST
BRUYÈRE
SCHLEGEL
Ontario’s Centres for Learning, Research and Innovation in Long-Term Care | www.clri-ltc.ca
Key Elements – Ontario CLRIs
• Three inaugural Centres
• Coordinating Committee that meets quarterly
• Unique and complementary implementation
plans and foci
• Provincial reach
• Implementation plans with quarterly reporting
BAYCREST
BRUYÈRE
SCHLEGEL
Ontario’s Centres for Learning, Research and Innovation in Long-Term Care | www.clri-ltc.ca
Synergies with Dr. Sinha’s Report
• Overall, many linkages to the recommendations
• Each CLRI project links with:
– Enhancing Ontario’s LTC Home Environments
– Addressing the Specialized Care Needs of Older
Ontarians
• “The ministry should also look to leverage its
newly established Centres for Learning, Research,
and Innovation (CLRI) to support and advance
quality improvement and staff education and
training efforts that further advance the overall
sector.” pages 138-139
BAYCREST
BRUYÈRE
SCHLEGEL
Ontario’s Centres for Learning, Research and Innovation in Long-Term Care | www.clri-ltc.ca
The Baycrest CLRI
Focus: Developing and evaluating innovative educational approaches to enhance
interprofessional geriatric competencies in the LTC home workforce.
Team Approaches to:
• Acute Changes in Resident Condition
• Responsive Behaviours
• Engaging Families in Care
InterProvider
Learning
Units
•
•
Experiential Learning for LTC Home Students
Smart Classroom
Summer
Student
Internships
Team
Learning
Series
•
•
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Geriatric Training Program
Job Shadowing
Program Evaluation
•
Career Development in LTC
Baycrest CLRI
•
•
•
Experiential Learning
Simulation, Gamification & eLearning
Interprofessional, Arts-Based &
Team-Based Learning
•
•
•
•
BAYCREST
Educational
Research &
Innovation
Telehealth Rounds
Annual Conference
Interprofessional Linkages
Translating Knowledge to Practice
Virtual
Mentorships
Knowledge
Exchange
BRUYÈRE
SCHLEGEL
Ontario’s Centres for Learning, Research and Innovation in Long-Term Care | www.clri-ltc.ca
Fostering Cultures of Learning
LTC Learning
Network
Telehealth
Rounds
Follow-Up
Consultations
Team Learning
Series:
Acute Changes
Responsive Behaviours
Families
BAYCREST
BRUYÈRE
SCHLEGEL
Ontario’s Centres for Learning, Research and Innovation in Long-Term Care | www.clri-ltc.ca
Integration of Education
• Shifting from a culture of compliance & mandatory
education … towards a culture of learning & inquiry
• Unique workforce mix
• Educational goals, frameworks & methods
• Home readiness & leadership stability
• Practice change realities
• Student placements: structures/policies, resources
• Developing, testing & disseminating innovations
• Local & provincial reach
BAYCREST
BRUYÈRE
SCHLEGEL
Ontario’s Centres for Learning, Research and Innovation in Long-Term Care | www.clri-ltc.ca
Baycrest CLRI
Collaborations & Networks
• Participating LTC Homes
• George Brown College, Michener Institute
• University of Toronto’s Centre for Interprofessional Education
•
•
•
•
•
Toronto-Central LHIN Behaviour Supports for Seniors Program
Psychogeriatric Resource Consultants
Ontario Telehealth Network
SIM-one
Rotman Research Institute
• Ontario Long Term Care Physicians
• OAHNSS, OLTCA
• Internal Baycrest Committees
BAYCREST
BRUYÈRE
SCHLEGEL
Ontario’s Centres for Learning, Research and Innovation in Long-Term Care | www.clri-ltc.ca
Baycrest CLRI – Current Structure
External Advisory Board
Internal Steering Committee
Executive
Implementation
Group
Work Groups
Ad Hoc Work Groups
CLRI Programs
Knowledge Exchange Events
BAYCREST
BRUYÈRE
Internal & External
Committees & Partnerships
SCHLEGEL
Ontario’s Centres for Learning, Research and Innovation in Long-Term Care | www.clri-ltc.ca
The Schlegel CLRI- Structure
Research Institute
for Aging (RIA)
Board of Directors
Schlegel CLRI
RIA-University of
Waterloo Liaison
Committee
BAYCREST
RIA-Schlegel Villages
Research to Practice
Integration
Committee
BRUYÈRE
RIA-Conestoga
College Liaison
Committee
SCHLEGEL
Ontario’s Centres for Learning, Research and Innovation in Long-Term Care | www.clri-ltc.ca
The Schlegel CLRI- Model
BAYCREST
BRUYÈRE
SCHLEGEL
Ontario’s Centres for Learning, Research and Innovation in Long-Term Care | www.clri-ltc.ca
The Schlegel CLRI- Logic
BAYCREST
BRUYÈRE
SCHLEGEL
Ontario’s Centres for Learning, Research and Innovation in Long-Term Care | www.clri-ltc.ca
The Schlegel CLRI- Incubation
BAYCREST
BRUYÈRE
SCHLEGEL
Ontario’s Centres for Learning, Research and Innovation in Long-Term Care | www.clri-ltc.ca
The Schlegel CLRI- Acceleration
BAYCREST
BRUYÈRE
SCHLEGEL
Ontario’s Centres for Learning, Research and Innovation in Long-Term Care | www.clri-ltc.ca
The Schlegel CLRI- Dissemination
Long-Term Care
• Workforce
Development
• Knowledge Transfer
• Research and
Living Labs
• Partnerships and
Networks
BAYCREST
•
•
•
•
•
•
•
•
•
•
•
•
PSW Certificate Course in Seniors Care
Enhanced PSW-PN Bridging Program
PSW & PN Living Classroom-based
programs
PN Living Classroom Program
Leadership Program for LTC
Excellence in Resident-Centre Care
(Trainer & PSW) Courses
Living Classrooms Implementation
Living Classroom Resources
Living Labs Partnership Development
Culture Change Toolkit
Neighbourhood Team Development
More
BRUYÈRE
SCHLEGEL
Ontario’s Centres for Learning, Research and Innovation in Long-Term Care | www.clri-ltc.ca
The Bruyère CLRI
• Focus
– Capacity Building – increase the knowledge and
skills of the workforce
– Capacity Planning – assist in shaping the LTC
system of the future
– Quality – enhance the quality of care
• Tangible outcomes/materials that can be
shared provincially to reach all stakeholders
– LTC Homes (ie: residents, workforce, etc),
MOH/LHIN, Workforce, Community
• Bilingualism
BAYCREST
BRUYÈRE
SCHLEGEL
Ontario’s Centres for Learning, Research and Innovation in Long-Term Care | www.clri-ltc.ca
INNOVATION
•HHR forecasting
BRUYERE
CLRI
Bruyère CLRI
•Transitions in care
and wait times
•Specialized units
•Case Costing
•Health care use
and cost in LTC
and EOL
LEARNING
RESEARCH
•Inservice
training and
education
•Palliative
Care/EOL
•Responsive
Behaviours
•RN/RPN
Clinical
Leadership
•Inappropriate
prescribing
•BScN Student
Placements
•Oral Care
•Knowledge
Translation
BAYCREST
BRUYÈRE
SCHLEGEL
Ontario’s Centres for Learning, Research and Innovation in Long-Term Care | www.clri-ltc.ca
Bruyère CLRI—Structure
Bruyère
Research
Institute
Bruyère CLRI
Management
Committee
Bruyère CLRI
Researchers
Group
BAYCREST
Bruyère External
Steering
Committee
BRUYÈRE
Education
Partners
SCHLEGEL
Ontario’s Centres for Learning, Research and Innovation in Long-Term Care | www.clri-ltc.ca
Bruyère CLRI—The People
BAYCREST
BRUYÈRE
SCHLEGEL
Ontario’s Centres for Learning, Research and Innovation in Long-Term Care | www.clri-ltc.ca
Bruyère CLRI – Steering Committee
•
•
•
•
•
•
•
•
•
•
•
Algonquin College
La Cité collégiale
University of Ottawa
Carleton University
Ontario LTC Physicians
Ontario HHR Research Network
Champlain CCAC
• 2 external LTCHs (for- and not-for profit)
Champlain LHIN
• Ontario Association of Residents’ Councils
OANHSS
• Champlain Region Family Councils
OLTCA
Network
Council on Aging
BAYCREST
BRUYÈRE
SCHLEGEL
Ontario’s Centres for Learning, Research and Innovation in Long-Term Care | www.clri-ltc.ca
Bruyère CLRI – Steering Committee
• Purpose: provide advice and guidance, identify
issues and opportunities, provide input on priorities,
participate in all aspects of the Bruyère CLRI
• Partnerships, resources and support
• Insight from the frontline,
families, clinical experience
• Project specific direction
• Integration of sector
stakeholders
BAYCREST
BRUYÈRE
SCHLEGEL
Ontario’s Centres for Learning, Research and Innovation in Long-Term Care | www.clri-ltc.ca
Bruyère CLRI – Capacity Planning
“Indeed, the establishment of a robust and evidenceinformed capacity planning framework that can allow
the ministry, the LHINs, and the sector to make
planning decisions related to service organization and
delivery that are equitable, while addressing local
needs, will be a critical first step in these efforts; one
that needs to start immediately.”
-Sinha, 2012, p. 135
BAYCREST
BRUYÈRE
SCHLEGEL
Ontario’s Centres for Learning, Research and Innovation in Long-Term Care | www.clri-ltc.ca
Bruyère CLRI – Capacity Planning
• End goal is improved care – right place and time – good
planning improves care at the bedside
• Study linkages with other parts of the system and
highlight care practices at system level
• A robust LTC sector impacts
other aspects of the system
(ie: hospitalization, ER
visits, etc)
• LTC Integration and
Innovation
BAYCREST
BRUYÈRE
SCHLEGEL
Ontario’s Centres for Learning, Research and Innovation in Long-Term Care | www.clri-ltc.ca
Ontario CLRI Website
www.clri-ltc.ca
BAYCREST
BRUYÈRE
SCHLEGEL
Ontario’s Centres for Learning, Research and Innovation in Long-Term Care | www.clri-ltc.ca
BAYCREST
BRUYÈRE
SCHLEGEL
Ontario’s Centres for Learning, Research and Innovation in Long-Term Care | www.clri-ltc.ca
Lessons – Internal Influences
• Internal partnerships and buy-in
• Internal resource requirements, supportive
infrastructure
• Resources and space
• Policies and job descriptions
• Inter-organizational agreements pre-existing
are really important to get out the gate sooner
• Openness to change
BAYCREST
BRUYÈRE
SCHLEGEL
Ontario’s Centres for Learning, Research and Innovation in Long-Term Care | www.clri-ltc.ca
Lessons – External Influences
• Small group exercise
What external influences do you think would
accelerate or restrain CLRI success?
OR
If innovation is your mandate, what external
influencers would be necessary for success, and
what might be barriers?
BAYCREST
BRUYÈRE
SCHLEGEL
Ontario’s Centres for Learning, Research and Innovation in Long-Term Care | www.clri-ltc.ca
Lessons - Partnerships
• A wide range of partnerships are essential to achieve
CLRI objectives; collaboration is key
• Seek partners who have strengths/abilities you are
missing for leverage
• Partnership building takes time
• Build on existing relationships and look for small wins
• Involve partners at the planning stages and through out
• Memorandums and agreements
• Common goals
• Engage residents, families, LTCHs
BAYCREST
BRUYÈRE
SCHLEGEL
Ontario’s Centres for Learning, Research and Innovation in Long-Term Care | www.clri-ltc.ca
Lessons – Research within LTC
• Small group exercise
What are unique challenges associated with
conducting research in LTC homes?
OR
How might LTC homes work with CLRIs to move
research into practice?
BAYCREST
BRUYÈRE
SCHLEGEL
Ontario’s Centres for Learning, Research and Innovation in Long-Term Care | www.clri-ltc.ca
Lessons – Students Placements
• Lets discuss…
Roles and
Responsibilities
First experience
in LTC
Colleges and
Universities –
supporting
LTC education
BAYCREST
Timing of
placement in
program
Improve
recruitment
to LTC
Preparing
workforce for
LTC
environment
Supporting
preceptors
Build capacity
LTC academic
trainees
Curriculum
enhancements
Logistics
BRUYÈRE
Supply of
LTC-ready
graduates
SCHLEGEL
Ontario’s Centres for Learning, Research and Innovation in Long-Term Care | www.clri-ltc.ca
Evaluation of the Ontario CLRIs
• Phase 1 – Planning
 Jan-March 2015
• Phase 2 – Evaluation of first 3.5 years
 April-August 2015
• Phase 3 – Evaluation of final year and full 4.5
years
 April-August 2016
BAYCREST
BRUYÈRE
SCHLEGEL
Ontario’s Centres for Learning, Research and Innovation in Long-Term Care | www.clri-ltc.ca
Next generation of Ontario CLRIs
•
•
•
•
•
•
•
•
Spread and sustainability – Build on Momentum
Build on successes and expand, lessons learned for the future
LTC sector workforce development
Excellence in care and services, resident-focused
Culture of innovation, learning and research for the LTC sector
Integration of LTC within larger healthcare system
LTC profile
Leadership and advocacy
BAYCREST
BRUYÈRE
SCHLEGEL
Ontario’s Centres for Learning, Research and Innovation in Long-Term Care | www.clri-ltc.ca
What Does This Mean?
• For the LTC sector
• For you
BAYCREST
BRUYÈRE
SCHLEGEL
Ontario’s Centres for Learning, Research and Innovation in Long-Term Care | www.clri-ltc.ca
Contact us!
www.clri-ltc.ca
Raquel Meyer | Manager
[email protected]
BAYCREST
Faith Boutcher | Director, Academic Education
[email protected]
Melissa Donskov | Director
BRUYÈRE
[email protected]
Tracy Luciani | Knowledge Broker
[email protected]
SCHLEGEL
BAYCREST
Mary-Lou van der Horst | Director
[email protected]
BRUYÈRE
SCHLEGEL
Ontario’s Centres for Learning, Research and Innovation in Long-Term Care | www.clri-ltc.ca
References
•
•
•
•
•
Barnett K (2014). Exploring the Teaching Nursing Home Model: Literature Review
to Inform the National Evaluation of the TRACS Program, Adelaide: Australian
Workplace Innovation and Social Research Centre, The University of Adelaide
Chilvers J & Jones D (1997). The Teaching Nursing Homes innovation: a literature
review, Jl of Advanced Nursing, 26, 463-469
Chambers L (2010). Long Term Care Homes as Centres of Learning, Long Term Care
Early Leaders Forum Report (2011). Creating a Vision for Long Term Care Homes as
Centres of Learning : Options and Opportunities for Ontario, prepared on behalf of
the Seniors Health Research Transfer Network Promoting Productive Partnerships
among Colleges, Universities and Long-term care homes Community of Practice
Mezey M & Lynaugh J (1989). The Teaching Nursing Home Program: outcomes of
care, Nursing Clinics of North America, 24(3) 769-780
BAYCREST
BRUYÈRE
SCHLEGEL
Ontario’s Centres for Learning, Research and Innovation in Long-Term Care | www.clri-ltc.ca