Long-term care home system: a ray of hope on the horizon

The Ontario government is currently reviewing and revising the LTC Act.  Now is the time to ensure that the Residents’ Bill of Rights is no longer violated.

This new legislation ‘will look fundamentally at what the foundation of long-term care needs to be in Ontario” and respond to recommendations from Ontario’s Long-Term Care COVID-19 Commission and others.

While all the recommendations in the Commission’s Report merit implementation, the following two recommendations are critical and need to be included in the revised LTC Act:

  • Ensure that family members are never denied access to their loved ones in long-term care homes (recommendation #31), and
  • Recognize the need for a transformative culture change using an emotion-based approach to care where residents, staff and families feel part of a community and are treated with dignity and respect; where there are small home home-like environments, where there is adequate, full-time, well-paid staff, who are trained in empathy and culture change and where family members are integral members of the team (recommendation #58)

Please encourage the Ontario Government to do the right thing and bring transformative culture change to long-term care homes in Ontario.  Write to your MPP or to your City Councillor, or write a letter to the editor, or any other action that you think will help to promote a quality, dignified life for our seniors living in long-term care homes.

 

A Life Worth Living

On Sept 15th, C.A.R.P. Ottawa provided a webinar on The Eden Alternative with speaker Suellen Beatty, CEO Sherbrooke Community Centre and Co-Regional Coordinator for Eden Alternative in Western Canada. Nearly 100 persons registered for this event and those that did attend were very pleased with the speaker and content.

The Eden Alternative is a philosophy of care that focuses on relationships. The philosophy has seven domains of well-being which residents and staff focus on to create a home. Their goal is to create a human habitat where people thrive and grow. They care for the human spirit as well as the human body. The staff know that people need to have a reason to get out of bed each morning, so they spend time focusing on what brings pleasure to each person and then they try to provide that program or activity at Sherbrooke.

Within Sherbooke Village, they welcome intergenerational communities: a Day Care Centre of 36 children on site who bring joy and pleasure to the residents: an Igen (Intergenerational) Program where a class of Grade 6 students use space at Sherbrooke for their classroom studies. In between, they build relationships with the residents.

To see a video recording of the webinar, click here.

What is needed to change an institutional model LTC home into Eden Alternative home? It requires a change in attitudes, beliefs, and behaviours. It requires a culture change which allows the resident to direct the type of life they wish to live and staff who are fully engaged and valued.  It requires leaders who become coaches and empower others.

Wouldn’t it be wonderful to be able to spend our later years in a home where there is identity, growth, autonomy ,security, connectedness, meaning , and joy. It would be “A Life Worth Living”.

Please do your part to bring transformative culture change to long-term care homes in Ontario.  Write to your MPP or to your City Councillor, or write a letter to the editor, or any other action that you think will help to promote a quality, dignified life for our seniors living in long-term care homes.

Will the Ontario government finally clean up its Act! continued…..

 

As noted in the previous blog post, the Ontario Government has long fallen short in meeting the existing Residents’ Bill of Rights (which falls within the Act).   Here are several more aspects of the Bill where expectations aren’t being met and where implementing an emotion-based model of care would meet those expectations:

  • Every resident has the right to live in a safe and clean environment. Transformative culture change to an emotion-based model of care would make this happen.
  • Every resident who is dying or who is very ill has the right to have family and friends present 24 hours per day. A culture change to an emotion-based model of care would ensure this happens.
  • Every resident has the right to receive personal care that accommodates physical, medical, emotional, and social needs. To succeed, we need a culture change to a resident-centered, emotion-based model of care.
  • Every resident has the right to receive assistance towards independence based on a restorative care philosophy to maximize independence to the greatest extent possible. An emotion-based model of care is needed.
  • Every resident has the right to have his or her lifestyle choices respected. Transformative culture change is needed to ensure this happens.

The urgent need for this transformative culture change cannot be repeated enough!  Already this issue seems to be disappearing from the Ontario Government’s radar.

We urge you to do your part to bring an emotion-based model of care to long-term care homes in Ontario. Write to your MPP or to your City Councillor, or write a letter to the editor, or any other action that you think will help to promote a quality, dignified life for our seniors living in long-term care homes.

If we don’t speak up for our seniors who will?

 

Will the Ontario Government finally clean up its “Act”!

 

It has been decades since any stripe of government has paid heed to or lived by the fundamental principle in the Ontario Long-Term Care Homes Act, 2007 and Regulation 79/10 (which came into force in July 2010):  i.e. “[A] long-term care home is primarily the home of its residents and is to be operated so that it is a place where they may live with dignity and security, safety and comfort and have their physical, psychological, social, spiritual and cultural needs adequately met.”

 Supposedly the Ontario Government is in the process of proposing changes to the Act by the fall 2021.

The Government has long fallen short in meeting the existing Residents’ Bill of Rights (which falls within the Act).   Implementing an emotion-based model of care would meet those expectations:

Every resident has the right to be properly sheltered, fed, clothed, groomed and cared for in a manner consistent with his/her needs.  A culture change to an emotion-based model of care would make this happen.

  • Every LTC resident has the right to NOT be neglected by the licensee or by the staff. Transformative culture change to an emotion-based model of care would ensure no LTC resident is ever neglected.
  • Every LTC resident has the right to be protected from abuse. Transformative culture change to an emotion-based model of care would make sure no LTC resident is ever abused.
  • Every LTC resident has the right to be treated with courtesy and respect, in a way that recognizes their individuality and respects their dignity. A culture change to an emotion-based model of care is a MUST.

Please do your part to bring emotion-based model of care to long-term care homes in Ontario. Write to your MPP or to your City Councillor, or write a letter to the editor, or any other action that you think will help to promote a quality, dignified life for our seniors living in long-term care homes.

 

The Green House: Made for this Moment

Over 290 Green House model long-term care homes exist in the United States and their focus is to deinstitutionalize, destigmatize and humanize care.

The model can be built as stand- alone small homes often 12 to a “home”, or a cottage model having two floors with a Green House model on each floor, or in a vertical building of over 200 residents with elevator access and smaller “homes” inside. There is a separate kitchen, living room, dining room, private or semi-private rooms and bathrooms. Resident rooms have a front door with a door bell and it looks welcoming. Meals are cooked in their “home”, there is consistent staffing who carry out cooking, cleaning and assistance with personal care and each “home” has access to the outdoors. The point is, the environment and life within the home is “homelike”.

When the pandemic hit, it became apparent that the small homelike aspect of this model, fewer staff entering the home, as well as staff having a consistent assignment, all helped to save lives. The advantage of smaller units of elders is that there are fewer infections and there is more ability to control exposure to infections. This is not to say that there were no COVID-19 cases in Green House homes but there were significantly fewer cases and deaths than those housed in institutional settings. Take a look at this short video: Green House: Made for this Moment – YouTube

The pandemic was a terrible tragedy for those living in long-term care homes and we have no way of knowing whether another pandemic will occur. The Green House model provides a safe home for its residents.  There are other innovative models of care such as the Eden Alternative, Hogewey Village and the Butterfly models. All promote safe “homelike “environments. Please do your part to bring transformative culture change to long-term care homes in Ontario. Write to your MPP or to your City Councillor, or write a letter to the editor, or any other action that you think will help to promote a quality, dignified life for our seniors living in long-term care homes.

 

Leadership matters!

Sherbrooke Village in Saskatoon where the Eden Alternative has been implemented

Happily Ever Older: Revolutionary Approaches to Long-Term Care by author Moira Welsh was published and released in February 2021. It provides a welcomed breath of fresh air in illustrating the successes of various innovative models (such as the Butterfly effect, the Eden Alternative, the Greenhouse project, and the Dutch model – Hogewey) that bring transformative culture change to long-term care homes abroad, in the United States, and in Canada.

A common theme throughout the implementation of these models is leadership. “Nothing on the frontline changes without a cultural shift that is embraced, nourished, and demanded, starting at the top. Without that shift, and it’s a dramatic one, transformation will not succeed.”

What is long overdue is a government that has the political will and leadership ability to bring such change to Ontario’s long-term care home system. Even in light of the tragic consequences the pandemic has brought to the forefront, the Ontario Government still seems paralyzed and has yet to officially respond to the Independent Long-term care Covid-19 Commission’s recommendations. If it doesn’t seize the moment now to implement these recommendations, we risk yet another abyss of neglect in caring for the elderly in our long-term care homes. Already this issue seems to be falling off the radar of the Ontario Government.

The implementation of the Eden Alternative at Sherbrooke Village in Saskatoon was made possible due to the exemplary leadership of CEO, Suellen Beatty. “Beatty may be the face of Sherbrooke but she is adamant that its success relies on a team approach. ‘I never did anything by myself……It has to be a leadership style that is warm and inviting. That can inspire people, and you have to have a really compelling why. Why are we doing this?”

Happily Ever Older is an upbeat book offering hope that meaningful change in our long-term care home system is possible. The book should be compulsory reading for every politician (at any level) and every provider/operator of a long-term care home.

Examples of kind expressions of humanity towards residents in these innovative long-term care homes and other gems are woven throughout the book and are delightful. We will feature some of these in upcoming blog posts.

Please make the time now to write to your MPP and/or your city councillor to help make this meaningful change happen.

The Ontario Government Needs to Take Action NOW!

 

Malton Village, The Toronto Star June22, 2018

Ontario’s Long-term Care COVID-19 Commission made 85 recommendations that need to be enacted in order to keep residents and staff safe in future viral outbreaks. The recommendations were divided into five areas. Highlighted here are the remaining three areas of the Report.

Person-centred care: Human Rights Code, the Long-Term Care Act and Residents Bill of Rights: With years of neglect, sweeping reforms are needed in our long-term care homes to protect residents and provide a quality of life. The Report highlights person-centred care but In order to provide person centred care, all the residents’ needs should be assessed and respected including lifestyle choices, diversity and emotional needs. (Recommendations: #29, #37, #38)

Staffing issues:  A severe staffing shortage and a work force poorly trained with few infection control measures compounded the COVID-19 situation. All the staffing recommendations in the Report are important. There is an urgent need for skilled staff but recommendations are not explicit enough in what training is required. Person-centred care requires staff to have emotion-based training. Recruitment and hiring practices need to be addressed. Staff recruitment should assess the attributes of emotional intelligence, empathy, compassion. All staff and students should have experience in settings where new models of care are being provided. Most importantly, there needs to be commitment from leadership to promote person-centred care practices.  (Recommendations: #40, #41, #42, #49)

Design Standards: Poor facility design and resident overcrowding heightened sickness and death in long-term care homes, with nearly 4,000 residents and 11 staff dying of COVID-19. All the design manual recommendations are important but alternative person-centred models and provision of incentives in order to create smaller home-like units needs to be included.  (Recommendations #61 and #64)

Transformative culture change is needed in our long-term care homes. Please send a letter to your MPP encouraging the government to take action NOW on the recommendations in this Report.

Will You Make a Difference?

Sherbrooke Village Long-Term Care Home

Ontario’s Long-term Care COVID-19 Commission made 85 recommendations that need to be enacted in order to keep residents and staff safe in future viral outbreaks. The recommendations were divided into five areas but the quote that sets the tone of their report and directs all leaders in government and LTC homes is this:

“Leaders at every level must put their hearts, as well as their minds into reimagining the care of the elderly in this province.  This will require a philosophy of care that is anchored in respect, compassion and kindness for the people who live and work in long-term care.  It is not just about building more homes.  There needs to be a transformation to a person-centred care model, which motivates different behaviours and rewards innovation that leads to better outcomes for residents and staff.” (Ontario’s Long-Term Care COVID-19 Commission Report p. 24)

In calling for Transformative Culture Change, the Independent Commission recognized that alternate models of care that had smaller home-like units had fewer viral outbreaks. (Recommendations #58 and #61) Currently, we have over 11 such models of care in Ontario in both profit and non-profit LTC homes that can provide information and guidance to the over 600 institutional LTC homes in Ontario!

All the recommendations regarding family/caregivers are important. Family members/caregivers need to be engaged in the process and have access to their loved ones. (Recommendations #5, #9, #30, #31, #75).Safe in-person access and regular remote visits during viral outbreaks, increased communication with families/caregivers during this time and anytime are very important. In transformative culture change environments, family members/caregivers are integral members of the team!

The Commissioners did their part and shone a light on the terrible circumstances in our LTC homes. Now you can play a role by contacting your MPP with the above information. You can make a difference! Please send a letter to your MPP encouraging the government to take action NOW on the recommendations in this Report.

Will the Government Take Action?

The long awaited Report from the Independent Long-Term Care COVID-19 Commission is now available! Since COVID-19 began over a year ago, nearly 4000 residents in LTC homes have died as well as staff who worked in these homes. After the first wave, recommendations were made to the government regarding staff, PPE, and infection control measures but the government did not act. As a result, there were more deaths from the second wave of COVID-19 than the first!

We now have the Report from the Commissioners, who should be congratulated for listening to the more than 700 persons interviewed, because they got it! The problems in LTC homes have been years in the making. COVID-19 exacerbated all the failings that we knew were there! The commissioners made 85 recommendations covering all aspects of LTC but the quote that stands out is, “We need a philosophy of care that is anchored in respect, compassion and kindness for the people who live and work in long-term care. There needs to be a transformation toward a person-centred care model, which motivates different behaviours, and rewards innovation that leads to better outcomes for residents and staff.” Click here for the full report.

What is needed now is the government to act! Leaders at every level need to step up and make a commitment to make sure that the recommendations of this Report are carried out. Our residents, families and staff in long-term care homes deserve nothing less.

There is great danger that this Report will sit on a shelf along with other past Reports that have addressed the failings of LTC. Please send a letter to your MPP encouraging the government to take action NOW on the recommendations in this Report.

New Transformations

There is lots happening on the long-term care home front since COVID -19 began. More and more people are taking notice and want their voices heard. To grow our grassroots movement and appeal to a broader audience, we are changing our logo and blog address and joining with C.A.R.P. Ottawa.

Our new and improved blog will continue to provide information about transformative culture change, innovative models and ways that you can get involved.

In the coming days look for us on facebook, twitter, instagram and if you have not already done so, become a follower of our blog!

“You never change things by fighting the existing reality. To change something, build a new model that makes the existing model obsolete” R. Buckminster Fuller