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Caring for my COPD program

Reena De Groot, RN, CRE

Caring for My COPD is a free community-based program that began in February 2014. The program was designed to enhance the quality of life for people with Chronic Obstructive Pulmonary Disease (COPD). The Hamilton Niagara Halton Brant Local Integrated Health Network (HNHBLHIN) funded program is offered in four locations: North Hamilton Community Health Centre in Hamilton, Grand River Community Health Centre in Brantford, Niagara Falls Community Health Centre in Niagara Falls, and Centre de santé communautaire in Welland.
The design of the program is to help clients learn to better self-manage their COPD. A secondary goal of the program is to decrease COPD-related emergency room visits, hospitalizations, and hospital readmissions within 30 days of discharge. Ultimately the goal of the program is to improve clients’ quality of life by providing them with the tools to self-manage, engage in meaningful peer support and participate in exercise and activities that will enable them to remain healthy for longer.
The original program model allowed only hospital physicians to refer to the program; the aim was to target those clients who had recently been hospitalized or were at risk of re-hospitalization. The program has evolved to meet the needs of the communities they serve and now also accepts referrals from primary care providers with clients who have a confirmed diagnosis of COPD. Clients who are medically unstable or live in long-term care facilities are not eligible for the program.
The Caring for My COPD program offers a bundle of services using the principles of the Chronic Disease Management Model. Caring for My COPD provides the following services:

  • Case Management by a Certified Respiratory Educator (CRE) trained coordinator who collaborates with clients’ primary care providers and respirologists
  • Spirometry and 6-minute walk testing
  • Review and assessment of personalized COPD Action Plans
  • Group and individual COPD education
  • Peer support
  • Supervised and personalized exercise programs
  • Individual counseling and spiritual support
  • Education sessions for families and caregivers to support individuals with COPD
  • Caregiver support

The Caring for My COPD program staff includes a Certified Respiratory Educator (CRE), kinesiologist, physiotherapist, occupational therapist, social worker, dietitian, psychologist and admin support. The team works together with participants to help improve their ability to not only manage their COPD but to live life fully.

The program is a 10-week intensive program that involves once-weekly education sessions and a minimum of twice-weekly exercise sessions. Education sessions cover topics such as breathing and coughing, medications, stress and anxiety, falls prevention, healthy eating and COPD exacerbations and action plans. The exercise part of the program is targeted to meet the individual’s needs and all sites offer group or 1:1 options.

The four program locations have evolved over the years to include graduate peer support groups. There is compelling evidence in the medical literature that peer support is key in assisting people to successfully self-manage a chronic health condition. Peers understand the physical, emotional, and spiritual challenges of living with an illness like COPD and can assist one another in continuing to find meaning and joy in daily living. Peer support groups can enrich programming and contribute greatly to helping people live longer and more satisfying lives despite their illness.

North Hamilton Community Health Centre’s Take a Breath (TAB) Club has been offered since 2014. This group was formed for graduates of the Caring for My COPD Program to provide participants with the opportunity to enhance self-management skills and participate in regular exercise in a supportive and caring environment. The group meets weekly for peer support and then has the opportunity to exercise with the kinesiologist and physiotherapist two times a week. The group typically welcomes between 25 and 30 members each week. Additionally, the TAB Choir was formed in 2015 as an innovative way to improve lung function while engaging in a joyful group activity. As well as TV and radio appearances, the choir has sung at a variety of venues, including Hamilton Town Hall and St. Joseph’s Hospital.

The Grand River Community Health Centre (GRCHC) offers a peer support group monthly called LUNGevity. This group is open to all program graduates and is an opportunity for graduates to be a part of a community of shared experiences and shared resources. At the LUNGevity group, participants typically engage in cooking with the program’s dietitian during the first half of the session. They then enjoy the food they have prepared while having an informal supportive dialogue with the program’s social worker, who helps facilitate the discussion as needed. Although the goals of the group are to provide supportive care and build a community for participants, the activities used to help attain these goals remain fluid and are driven by the needs and interests of those participating. In addition to the LUNGevity group, the Brantford Caring for My COPD program also has plans to offer a graduate exercise program for those that are medically cleared to participate. This will allow program grads who are cleared to exercise with another option to stay active post-program in an environment that they are already familiar with.

Centre de santé communautaire Hamilton Niagara offers a twice-monthly group that allows a time for past participants to enjoy coffee, games and socializing in a supportive environment. Graduates of the program have the opportunity to attend open gym times and exercise with the kinesiologist. Graduates are also invited to stay on as volunteers assisting staff and supporting new clients as they work through the program.

If you have a client with COPD, know someone who would benefit from the program or would like more information please contact the program coordinator.

Centre de santé communautaire Welland – 905-714-9935 ext. 2285

Grand River CHC Brantford – 519-754-0777 ext.235

Niagara Falls CHC – 905-356-6666

North Hamilton CHC – 905-523-1184

 

 

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