What if safer care starts with knowing the person?

A behaviour can tell you that something is wrong. It can’t tell you who someone is. 

“I want to learn who this person is.” That was Victoria Marek’s response when a resident at Riverview Health Centre in Winnipeg, Manitoba, was having difficult interactions with others in a shared television lounge. Marek, Director of Resident Care and Allied Health, sat down with him. Their conversation gave her context the behaviour couldn’t: the life he had lived, the independence he was accustomed to and how much he valued his privacy. Staff found him a quieter place to watch television. Marek kept listening. Was there something he missed?

“Fresh fruit,” he said.

They began bringing him fresh fruit each week. Soon, staff noticed that he seemed happier, smiling and laughing more. She calls it a “little win,” the kind worth remembering because, however small, “it matters in someone’s life.”

Marek knows fresh fruit may not always be the answer. But she believes they owe every resident the due diligence of understanding what they may be communicating before deciding what comes next. “I’ll buy apples every day if that’s going to make a difference,” she says.

What more can we do?

Riverview is home to 257 people across its personal care and Dementia Care communities, each with their own histories, routines and ways of communicating. For the team, safer care starts with understanding those differences and creating the conditions for residents, families, care partners and staff to contribute to decisions about care. That thinking also shaped Riverview’s approach to the appropriate use of antipsychotics, work that began well before the organization joined Healthcare Excellence Canada’s Sparking Change in the Appropriate Use of Antipsychotics program.

From May 2023 to May 2024, Riverview trained nurses and healthcare aides in Gentle Persuasive Approaches (GPA®), introduced a deprescribing toolkit and used quarterly medication reviews. The experience showed them where change had been difficult to sustain and where they could go further.

Through Sparking Change, they deliberately focused on a community where they expected change might be challenging. They expanded education beyond nurses and healthcare aides, strengthened partnerships with residents, families and care partners, leveraged interdisciplinary safety huddles and took a team-based approach to antipsychotic medication reviews. The goal was to involve more of the people who knew residents well and give them a meaningful role in decisions about their care.

Safer care is shaped by many perspectives. The people who know a resident well often know them in different ways. As the eyes and ears of a home, healthcare aides can notice subtle changes in people’s behaviour. Families and care partners bring a lifetime of knowledge about the relationships, experiences and routines that shaped who someone is. Housekeeping, clerical and other support staff often come to know residents through conversations and interactions that happen outside formal care.

For Jenelle Masi, a Clinical Resource Nurse at Riverview, bringing those perspectives into the conversation has changed the question teams ask. Instead of “What medication can we use to manage this behaviour?” she says they are increasingly asking, “What is this resident trying to tell us?”

Over the course of Sparking Change, the team worked to ensure antipsychotics were used only when necessary and as safely as possible, with reductions, increases and discontinuations tailored to each resident. In total, 11 of 22 residents had their medication reduced or discontinued. Most experienced no change in behaviours or symptoms, while others showed improvements including less drowsiness and greater participation. When symptoms worsened, teams responded with individualized strategies.

By the end of Sparking Change, all staff in the participating community had completed Person Directed Living education. Among residents, families and care partners who participated in education, average self-reported knowledge increased from 1.8 to 4.2 out of five. The education covered dementia and responsive behaviours, antipsychotic medications, associated risks and supportive approaches. Riverview also observed families and care partners asking more questions about their loved ones’ antipsychotic medications, including questions about dose reductions.

What if we tried something different?

Riverview is now taking that commitment to knowing the person across the organization. The team is developing “Getting to Know Me” profiles for all 257 residents, capturing the preferences, routines and personal details that can help staff understand who someone is, how they communicate and what matters to them.

For Marek, knowing the person also changes what staff can do in the moment. That thinking is being embedded into a new safe work procedure for supporting people who may communicate with physical actions rather than verbally. Drawing on Gentle Persuasive Approaches and Person Directed Living training, it encourages staff to pause, consider the person’s needs and cues and think about how they communicate before deciding how to respond.

Marek wants that pause to create room for questions, too. “Why are we doing it this way? Is there a better way? Can we do something different?” she asks. “Just because we’ve done something a certain way doesn’t mean we need to keep doing it.”

Those everyday moments of curiosity — listening, questioning and feeling empowered to act — are part of what shapes safer care at Riverview, and are carrying Riverview into its next phase of improvement. The organization has joined the Manitoba Appropriate Use of Antipsychotics in Long-Term Care Collaborative to continue learning and spread successful practices across its communities.

 “There’s no finish line to this, ever,” says Marek. “It’s a culture. It’s not a project.”

During Canadian Patient Safety Week 2026, we’re exploring What Shapes Safer Care? At Riverview, it can start with something as simple — and important — as knowing the person.

Personal Care Homes across Manitoba can join Riverview and other participating homes to learn from each other and build on their work to improve the appropriate use of antipsychotics.