Transformation to Butterfly model of care coming to long-term care home in Orangeville

Photo courtesy of Jarlette Health Services
Photo courtesy of Jarlette Health Services

On July 6, 2022, Jarlette Health Services announced that it has begun a transformation to the Butterfly Approach to care at its Avalon long-term care home in Orangeville, Ontario.

It is embracing “the Butterfly Approach” to help create a more natural home and community setting. This includes fostering stronger interpersonal relationships between residents and team members, building daily routines around peoples’ needs and interests, and creating a living environment which more strongly resembles a private dwelling.

The care model, which has already been implemented in parts of Ontario, elsewhere in Canada, the United Kingdom, Ireland and Australia, has a proven record of positive outcomes for residents, including improved physical and emotional health and well-being, reduced use of medication, and greater engagement by residents in daily life.

The Butterfly Approach will be implemented at other Jarlette Health Services communities in the months ahead.”   Read more here  Butterfly Approach to care in Avalon Care Centre

 

Municipalities can make an important difference!

Redstone, Malton Village, Region of Peel

Most municipalities in Ontario manage at least one long-term care home.  In larger cities like Toronto and Ottawa, they manage several homes.

Here is a brief recap of Ontario’s long-term care home system: (from a previous blog post – March 16, 2020)

There are 626 long-term care homes in Ontario (as of 2019); of these, there are 3 categories:

For-Profit: 58%,   Not-for-Profit: 24%,   Municipal: 16%

What are the commonalities?

  • Funding: All 3 types are funded by the Ministry of Health and Long-Term Care through the Local Health Integration Network (LHIN) based on the same formula.
    In addition: Municipalities can opt to top up funding for their homes through tax payers’ dollars.  Some of the other homes have either foundations or fundraising programs that can top up their funding for capital expenditures or program enhancement.
  • Resident costs: In all 3 types, residents are required to contribute a co-payment for accommodation of basic ($1848.73), semi-private ($2,228.63) or private ($2640.78).  These costs are as of 2018 and there is a cost of living increase each July.
  • Legislation:  All 3 types are subject to the same standards, rules and regulations.

How are the homes managed?

  • The for-profit long-term care homes are managed by their corporate office through their Chief Executive Officers (CEO’s)
  • The not-for-profit long-term care homes are managed by a Board of Directors through their CEO’s
  • The municipal or city-run long-term care homes have a formal mechanism in place for their management through a committee of City Council and a staff director.

In our last blog post, we featured the innovation in city-run homes in Toronto including a joint model of funding.  The Region of Peel led the way a few years when it adopted an innovative model for its homes.  Homes in other municipalities like the Glebe Centre in Ottawa have also shown similar leadership.  Please make this an election issue in the upcoming municipal elections.

Transformation is coming to Toronto city-run LTC homes!

A Green House Dining Room (copied with permission)

Toronto City Council is embarking on a new venture called CareTO, transforming their city-run LTC homes into social models of living from the traditional task-and-schedule driven model. This $16.1 million program is a jointly funded effort over a five-year period, with $12 million from the province and $4.1 million from the city.

A 12-month pilot program has been launched at Lakeshore Lodge Long-Term Care Home in Toronto and if it meets city council’s expectations, the transformation will be undertaken in all 10 city-run homes.

The pilot program will be evaluated by researchers from Sunnybrook Health Sciences Centre and the University of Toronto and evaluation will focus on resident falls, staff absenteeism and satisfaction reports from residents or their families. Read more here.

The CareTO approach redesigns living spaces to be more intimate and less institutional and care focuses on an emotion-centred approach to meet the needs of residents.  Existing staff receive additional training and education to transition to the new model of care.

Just think what could be accomplished in other city-run LTC homes across Ontario if this joint model of funding was adopted!  Let’s make this an election issue in the upcoming municipal elections!

 

Leadership Matters: How to make a LTC Home a “home”

On June 8th, Rebecca Priest presented a webinar on the importance of leadership in emotion-based models of care. A leader herself, Rebecca has spent 20+ years working with seniors, serving as a social worker, Green House Guide, and Licensed Nursing Home Administrator and Chief Operating Officer for a large non-for-profit serving elders in upstate New York. 

Rebecca said that a leader is one who:

  • really listens to elders in the home as well as the staff who support them.
  • Wants to hear views from all involved.
  • Values people and partnerships.
  • Fosters relationships between elders, staff and families.
  • Believes all staff are good and want to do a good job.
  • Is not necessarily the person with the title.

“Leadership is not associated with role but with influence.” This person “knows” his/her staff and empowers them in their role. Rebecca’s presentation also compared the Green House model to traditional LTC homes in terms of staff turnover, satisfaction rates, and clinical outcomes. In all cases the Green House model was assessed at better levels. (See ppt here)22 Green House – Leadership and relational models of LTC ppt June 8

“Good relationships lead to good clinical outcomes.” The Green House model is one example of an emotion-based model of care that ensures that all elders live life!

Ontario Election Day, Thursday June 2nd

The CARP 5
This is what CARP heard in the campaign:

CARP members will be glad to know that their issues were indeed a major part of most party platforms! The Report Card above illustrates where each party came down on the CARP 5 issues. Whatever the result of the June 2nd election, this campaign for change does not end. THE CARP 5 issues will be the first topics of discussion with elected Ministers and MPPs. Your support and the collective voice of all people is needed to continue to press for needed investments and improvements in our long-term care home system!

 

 

Get involved and demand change now in Ontario’s long-term care homes!

While change won’t happen overnight we need to start somewhere and there is no better time than now.   The upcoming provincial elections provide an excellent opportunity to demand change.   If we don’t demand change now in Ontario’s long-term care home system, the status quo is likely to be with us for decades to come.

Here are some questions  to consider asking the candidates who are running for office in your riding:

Small homelike environments and COVID

 Ontario’s Long-term Care COVID-19 Commission recommended that the Ontario government promote and provide funding for long-term care homes that change to recognized, emotion-based models of care – where residents, staff and families live in smaller, home-like environments which have shown fewer COVID cases and fewer deaths than in the current institutional models.

Do you agree with this and if so, would you commit to start this process in the first year of your term?

Emotion-based model of care and funding

 Ontario’s Long-term Care COVID-19 Commission recommended that the government promote and provide funding for long-term care homes that change to recognized, emotion-based models of care where staff know the residents, the residents are engaged and feel they are home and where compassion and respect are at the centre of everything.

Do you agree with this and if so, would you commit to including this in the budget process during the first year of your term?

 New Beds

 Ontario’s Long-term Care COVID-19 Commission recommended creating smaller self-contained home-like units within existing and new homes.

As Ontario looks at developing and rebuilding LTC homes in the future, do you agree with this and if so, what incentives would you put in place to make this happen during the first year of your term?

A Tale of Two Long-term Care Homes – It Can Be Different!

 

Sherbrooke Village in Saskatoon where the Eden Alternative has been implemented

 Life for Linda is colorless and boring. The atmosphere feels cold and clinical – more like a hospital than a home. She gets up when she’s told to. Is provided with meals when she’s not hungry. Sits all day in a chair by herself staring at the TV, or gazing out of the window.

Linda feels as if she doesn’t matter. She thinks: “This isn’t my home. I don’t have a home anymore.” She feels hopeless and helpless – staff are too busy with a million tasks to have time for her.

One of the staff caring for Linda is Tammy. She works part-time, and holds down two other jobs to support her family. Every shift at work feels the same: she’s rushed to do all the tasks on her list and to record them. She’s stressed. She has too many residents to care for. She believes she’s a compassionate person, but she doesn’t have time to show it. Her job is far from rewarding.

Life is quite different for Sylvie. She too lives in an Ontario Long-Term Care (LTC) home but one which has embraced an innovative model of care.  It feels like home, sounds like home and looks like home, because the residents, staff and family members are all part of the same community. Sylvie feels loved and cared for – she feels that everyone understands who she is, and how she has lived her life.

Sylvie is content. She has meaningful activities each day. She chooses what she wants to do, when she wants to do it. Meals are enjoyed as family-style eating, where residents can select what they want.

 THE NEED FOR CHANGE

Nothing substantive has changed in the past 40 years in how LTC is provided in Ontario. For the most part LTC homes continue to be warehouses where our older, frail citizens are held until they die.

The prevailing attitude to change seems to be: “What’s the point? Nothing ever changes.”

Not true!

Change is happening. A growing number of Ontario LTC homes have embraced a new culture that puts love and respect at the centre of everything they do.

These are homes where family members know their loved ones are getting the best possible care.

A DIFFERENT, EMOTION-BASED, MODEL OF CARE

This innovative model of care replaces institutional, 32-bed units with smaller, homelike environments. Residents have private or two-person rooms and private bathrooms. Each home has a warm, central spot where people can gather and socialize. Family members are respected as a valued part of the care team.

Staff work full-time with good salaries and benefits. They are empowered to care for the residents with compassion and that all-important ‘human touch’. There is less emphasis on the many tasks that must be done (and tracked), and much more on spending quality time with the residents.

This is the fundamental culture change that is so urgently needed!

WHAT DOES IT TAKE?

What does it take to make the change to this new model of care? LTC spaces need to be reimagined and recreated. It takes visionary leadership, and financial investment upfront. It takes commitment from all the players to make it work, education and training in emotion-based care, and a sustainable plan to ensure success.

IS IT WORTH IT?

The benefits are clear and proven. Homes employing this new model of care experience improved happiness for residents, staff and family members. There is more interaction and family engagement, and heightened satisfaction.

There is reduced staff sick time, use of antipsychotic drugs, incidence of falls, and cases of worsened depression. In the US, homes using this new model of care experienced 50% fewer COVID cases, and 30% fewer deaths due to COVID in 2020. Administrative costs per patient were 6% lower.

WHICH WOULD YOU CHOOSE?

Keep the status quo, where most of our elderly citizens will languish in LTC warehouses, leading meaningless lives and risking exposure to future pandemics and other crises.

Or embrace a different, innovative model of care where emotion and connectedness are at the centre.  And where residents thrive.

Which one would you choose for your future?

Get Involved Now!

Ontario’s Long-term Care COVID-19 Commission recommended that the government promote and provide funding for long-term care homes that change to recognized, emotion-based models of care where staff know the residents, the residents are engaged and feel they are home and where compassion and respect are at the centre of everything.

Please get involved and ask candidates in your riding in the upcoming provincial election if they agree with this and if so, would they commit to including this in the budget process during the first year of your term?

 

C.A.R.P. asking for public support!

This article was published in the Ottawa Citizen, May 4, 2022

C.A.R.P. asking for public support to make transformation of Ontario’s long-term care home system a ballot box issue

 In a recent opinion piece Grace Welch and Brian Graham articulated well the major shortcomings of Ontario’s long-term care home system brought to light as a result of the pandemic and the type of changes needed.

Within the present system, it is very challenging for staff working in long-term care homes to address all the physical, social, psychological, spiritual, and cultural needs as described in the Long-Term Care Homes Residents’ Bill of Rights.  Ontario has one of the most risk adverse long-term care homes system in Canada where the overabundance of regulations contributes to objectifying residents according to tasks, not needs.

C.A.R.P. – a New Vision for Aging (Canadian Association of Retired Persons) wants to see a drastic transformative change in long-term care homes from a task-based to an emotion-based model of care.  Such models already exist: Eden Alternative, Green House, Butterfly and Hogewey in which the quality of care is understood as a relationship where residents, staff, families and volunteers are treated with dignity and respect in a homey environment, and kindness permeates the home.  These models have been implemented in Canada including Ontario, Saskatchewan, Alberta, and British Columbia, in the United States, and internationally.  No need to reinvent the wheel.

There are a growing number of both public and for-profit long-term care homes in Ontario that have successfully implemented an emotion-based model of care on one or more units in their homes.    Most of these homes did so within existing budgetary and regulatory constraints with plans to expand the model.

Even closer to home, kudos to the Glebe Centre (a non-profit charitable home in Ottawa) which is already in the second stage of implementing the Butterfly model, and to Bonnechere Manor and Miramichi Lodge in Renfrew County which have begun the process of implementing the model.

These homes also experienced better outcomes both pre and during COVID than the traditional homes with fever cases and fewer deaths. Other benefits include improved resident and family engagement; improved staff satisfaction; reduced use of anti-psychotropic drugs; reduced use of food supplements; reduced staff sick leave (huge cost savings for some); and the list goes on.

We recognize that home care services are also broken and need a major revamping. However, our aging population is increasing and so is the number of people with dementia   This means the need for long-term care homes is not going anywhere soon.   Circumstances are such that not every loved one when becoming frail, either physically and/or cognitively, can be cared for at home.  Approximately 85% of all residents in long-term care homes have either some kind of dementia or some complex chronic disease that requires 24/7 care.  It is unrealistic to expect these individuals to be cared for at home.

The action needed is to immediately begin change from task-based to emotion-based care in Ontario’s long-term care homes.  This can’t happen overnight but we need to start somewhere and the sooner we start the better.  There are many ways to do so, including a variety of pilot projects – one unit at a time, one floor at a time, one home at a time.  Residents in long-term care homes have been deprived for decades of the quality of care and quality of environment they so rightly deserve.  This change can’t come quickly enough!

The Ontario Morocco Commission recommended ‘that the Government promote and provide funding for long-term care homes that change to recognized emotion-based models of care”.  Ask your MPPs if they would commit to including this in the budget process in the first year of their term, if elected.

If we don’t begin to fix the long-term care home system now, after two years of horrific tragedies, long-term care homes will be forgotten once again for decades or until another pandemic hits!

Claude Paul Boivin, President, C.A.R.P. Ottawa

Kathy Wright, Vice-President, C.A.R.P. Ottawa

C.A.R.P. – A New Vision for Aging (formerly known as the Canadian Association for Retired Persons) is Canada’s largest advocacy Continue reading “C.A.R.P. asking for public support!”

No matter which model is used, meaningful care matters!

266 people registered for the webinar led by Sally Knocker on “What does emotion-based care look like in practice?”  Sally, a consultant with Meaningful Care Matters, said that LTC homes need to create a sense of home, slow down the pace, and staff need to sit more with residents and share themselves.

The Butterfly model, an emotion-based model of care, is not just about the environment, but about creating a meaningful environment with pictures and memorabilia that is significant to the resident. The key is to find out what makes sense to the person’s well-being and allow them to express and be themselves.

Based on Kitwood’s flower of psychological needs, the Butterfly model embraces the following elements: a sense of identity, comfort, attachment, inclusion and occupation. Sally then added two more elements. The first was the need for freedom, being able to do the things that makes sense to the person. This requires staff to manage risk in a positive way so that the person feels both safe and free. The second was that fun needs to be foremost, as laughter enhances engagement with others.. Click on link to see more

 Participants rated the webinar very positively with a wish that all LTC homes could embrace this culture of care. Please make this a ballot box issue in the upcoming provincial election and ask the candidates if they will commit to including funding for emotion-based models of care in the budget process in the first year of their term if elected.

 

Providence Living: Leading the way in Canada

 

On March 30th CARP Ottawa held a webinar on Providence Living Place in Comox BC. Candace Chartier, CEO, presented the webinar and provided slides which can be accessed here.

Providence Living is building a Hogewey village which will have 156 beds. The home will be configured with groupings of 12 private rooms or households that will constitute a “village”.  This new publicly funded long-term care home will be ready in 2024. What is unique about this emotion-based model of care is that they will have an indigenous log house in the centre as well as a chapel. Comox elders are helping to make this space a First Nations spiritual space, a first in long-term care homes in Canada. In addition, they are using a “living lab” concept where staff are currently being trained for three months with 10 residents in this model of care. This means that once the home is built, staff will be ready to move forward with policies in place.  Providence Living is also working with the University of British Columbia to evaluate their progress and outcomes each step of the way.

We have been able to obtain a video which provides an inside look at what Providence Living is hoping to achieve. It will provide an emotion-based model of care which will provide a quality of living focusing on a social model of care, yet residents’ physical needs will be attended to. This video can be seen here.

Hats off to Providence Living for leading the way! This is a publicly funded long-term care home that will provide a model for other provinces to follow. We need other provinces to change to emotion-based care.  With provincial elections coming up in Ontario, please make this a ballot box issue in Ontario.

 

Another Innovative Model Coming to British Columbia

 

Daring steps forward are making their mark as Providence Living, a new non-profit health care organization established by Providence Health Care is set to redefine seniors’ care in British Columbia.

Construction of Providence Living Place, Together by the Sea, a 156-bed dementia village in Comox, B.C. will take place on the site of the existing The Views long-term care home and the former St. Joseph’s General Hospital. Construction will begin in 2022.

Candace Chartier, President and CEO of Providence Living, recently said “We are so very close to showing BC and the rest of Canada how publicly funded seniors’ care must be provided to create whole communities where people want to live.” Providence Living Place, Together by the Sea will change long-term care from an institutionalized medical model to one that fosters a home-like environment where staff and residents become friends in a culture where families, children, pets and visitors become interwoven into the fabric of life throughout the facility.  Click here

Other provinces ‘are doing it’.   We need a drastic transformative change to emotion-based care in Ontario too.  Please make this a ballot box issue in Ontario.

For more information on existing emotion-based models of care in long-term care homes go to www.changeltcnow.ca