Maimonides Geriatric Centre: Barbara Gold, CEO

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There are many things that are unique about Maimonides Geriatric Centre: its Jewish heritage, its history and its inclusion in the Quebec heath care system to name a few, but what really makes Maimonides stand out from other long-term care facilities of its kind is its progressive approach to elder care and the patient comfort and safety initiatives that have been introduced thanks to this perspective.

A Tradition of Long-Term Care

Like many of the faith-based health organizations in Quebec that were organized by small communities, Maimonides goes back many years. In 2010 Maimonides will be celebrating its 100th birthday. Established in 1910, by the Jewish community in Montreal, Maimonides began on a very small scale, in fact, in the beginning there were only about six beds in the entire facility, as Maimonides’s CEO Barbara Gold explains. “Part of the community’s responsibilities was to take care of their own indigent, frail, elderly population. From this small beginning, Maimonides has grown. The community involvement from our board members in the past and present is really one of the key factors that has made Maimonides a fabulous organization.”

Working Within and Beyond a Public System

Maimonides is located in the province of Quebec, and since the public health care system in Quebec is a provincial jurisdiction, all the facilities in Quebec are funded on an operational basis by the Quebec government. “In Quebec the board of directors is dictated by the health care law so you have to be able to work within these guidelines to get the right  people committed to working with the organization,” explains Gold. But she also adds that one of the keys to Maimonides’s success is the organization’s very active Foundation, which fundraises for capital, not operating expenses.

Overall Maimonides is comprised of several sites. There is a long-term care centre which houses 387 residents including eight respite beds. These respite beds offer clients and caregivers a unique flexible care opportunity. Families can reserve these beds for people who typically live at home with a caregiver for when the caregiver needs a break or is going away. There are another 150 intermediate resource beds located outside in two other facilities. Gold categorizes this arrangement like a private/public partnership with a lower level of care. Maimonides supplies the professional staff and the owner operators provide the day-to-day care. Another 80-90 clients are served in smaller homes scattered over seven to eight locations. “These are almost like foster homes for older people, at these homes the lowest level of care is required.”  There is also an outpatient Day Hospital. For all these care options, Maimonides employs 700 staff members.

An Innovative Philosophy that Caters to the Person and the Resident

As CEO for nearly 18 years, Gold is very proud of Maimonides’s improvements and consistency in care. She cites the numerous awards the organization has been honored with for it’s long-term care philosophies and the recognition the group has received. “When the Quebec government has visitors from all over the world, they come here to see how we treat long-term care. We are the best, not only from a physical standpoint, but from a program point of view and philosophy.” Gold says three basic indicators can judge a long-term care facility: fall prevention, use of restraints and quality of life measures. She feels that Maimonides is at the forefront of progressive initiatives on each of these fronts.

Although the building is an older facility, thanks to the organization’s foundation, it has been renovated and Gold describes it as “a very nice physical setting.” But Maimonides doesn’t attract patients just because of its looks. There is significant substance behind the Centre’s pleasant appearance. Patient safety initiatives include fall prevention programs. “We want to make sure we identify the frequent fallers and put in place systems to minimize their risk of injury.”  To reduce the chance of injury, special types of hip protectors that offer padding can be given to residents at particularly high risk. Another addition is a bed monitor that alerts staff to patient activity, particularly during the night and GPS-like monitoring for Alzheimer’s clients.

One of the most significant aspects of Maimonides’s client-care philosophy is the restraint-free environment that has been implemented throughout the organization’s facilities. “This is both a quality of life issue and a safety issue.” Beyond the safety concerns, families find this protocol reassuring because it helps to maintain dignity and help with emotional or psychological issues that might also be a problem for a client.

Besides creating a safe environment, Maimonides has created several programs to address quality of life issues for their long-term care clients. “We have created a life biography project where we collect information about a new client. A lot of residents can’t tell us about themselves, so we find out specifics from their families, their likes and dislikes and their history and we put it all into a slideshow that the staff views. This program allows the staff, to not only personalize care, but also allows them to see the person they are caring for, not just the resident.”

Maimonides encourages family involvement by allowing for 24-hour visiting hours. This schedule has had a very positive impact on the number of visitors the sites see. “We have about a thousand visitors coming each day to our building where we have 387 clients. So many times you will find a long-term care center to be a very quiet, empty place, but our facility is a welcoming, positive environment that really seems to draw families.”

A Clear and Consistent Culture

Two qualities can summarize the administrative culture of Maimonides: transparency and mission-centered. The first quality, transparency is particularly important in the long-term care industry. By having a very transparent organization that deals with issues and complaints head-on, Maimonides has been able to protect itself from accusations that are so often leveled against long-term care facilities. “We have a lot of systems in place so when something happens everything is put on the table, there are really no surprises and no secrets and I think that’s the key in a lot of cases to health care. We can address any issue; we are not perfect, things are going to happen, but when something happens we want to learn from it to reduce the risk and learn from it so it doesn’t happen again.”

The other part of the cultural equation is Maimonides’s strong mission focus on resident care. “Any decision we make comes down to what is best for the client. Since we all know this is our top priority, it’s very easy to make a decision thinking that way.” To help support the patient-focused initiative, Maimonides has become the first long-term care facility in Canada to work with Planetree (, a U.S.-based group that offers voluntary accreditation for client-focused organizations. “Planetree puts client-care standards into writing, basically these are common sense, practical steps that just point out you should treat people the way you want to be treated.” Incidently, using Planetree has also worked as an effective marketing tool in staff recruitment.

Investments Unique to Long-Term Care

“Long-term care is very different than acute care, its not as sexy; there’s not all the fancy equipment that we need, so there becomes a different type of focus for our investments.”  Gold points out that instead of investing in high-tech equipment, long-term care facilities need to focus on the actual physical environment in terms of rooms and living conditions. “There’s been a big push that we’ve implemented in the last few years to try to make some of our rooms feel as home-like as possible and yet still be safe.” Improvements have included upgraded electric beds, lighting, beds that go down low to the ground, specialized mattresses, specialized lifts and pressure sore maintenance. The Suite Dreams Capital Renovation Campaign, an ambitious undertaking that is nearly complete, involved completely refurbishing all resident rooms to add dramatic changes to the aesthetics and functionality of the rooms. To support this endeavor, the Foundation organizes many fundraising activities, from golf tournaments and concerts to a 100th anniversary kosher cookbook.

Maimonides has also focused on helping staff, creating a large bursary program funded by the Foundation for furthering education and offering training sessions for staff in everything from customer service to technical support. “The staff is the key; if you don’t have good people taking care of your clients, it doesn’t matter what the place looks like. We take pride in having a team that is not only competent, but also compassionate”

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