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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.

 

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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.

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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.

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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.

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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.

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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

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Why can’t all homes be like this?

Redstone, Malton Village, Region of Peel

In February, 2021, The Toronto Star ran a Special Edition called “Crisis of Care” which focused on our broken long-term care home system and the decades of reporting on tragic failures in long-term care with little action to change the status quo. The last article in this special edition, written June 24, 2018, focused on Redstone at Malton Village, Region of Peel.

Redstone embraced the Butterfly model of care and after one year of data, they report that staff sick days are down, fewer residents are falling, antipsychotic drug use is lower and social engagement is higher, all of which saves money! The article, entitled The Fix: Part IV Butterfly’s future is full of wonderful stories about the changes in the people living there. Residents are smiling, engaged in activities, and people who were non-verbal or progressed back to their first language, are starting to speak English again. Redstone is now a place of engagement and love. More information can be found in “The Fix: Part 4”, The Toronto Star, June 23, 2018 which was republished in the Special Section: Crisis of Care, The Toronto Star, February 7, 2021.

When will the Ontario government take notice that good things are happening in Ontario and that there are models of care that are working and have been proven to save money! This is not a matter of profit versus non-profit long-term care homes. By the way, Malton Village is a Municipal Home! The issue is all about how care is delivered. COVID-19 has shone a light on so many atrocities in long-term care homes. These failings were there long before COVID-19 appeared. More staff, more direct care hours, better PPE, will help but will not fix our long-term care homes! We have an opportunity now to change the system. Let’s just do it!

Please support Transformative Culture Change in Ontario’s Long-Term Care Homes by sending an email to info@LTCcommission-CommissionSLD.ca or to your local MPP  here.

#ChangeLTCNow!

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The Power of the Noble Lie

Malton Village, Peel Region, the Toronto Star, June 23, 2018

Imagine living in a long-term care home with 8 to 12 people where the focus of care is on people and relies on emotional intelligence, the ability to understand another person’s feelings and respond with compassion. There are no task sheets such as the bath list, mobility list, or activity list. Activities are not scripted but rather there is a natural flow towards individual interests. People are helping to set the dining room table, peel potatoes, fold laundry, music is playing and laughter can be heard. Those with memory loss are allowed to live in their moments, which some may call humane dishonesty.

This is what is happening on the Redstone Dementia Unit at Malton Village. An elderly woman with dementia thinks she is 10 years old and is calling for her mother.  The Butterfly Model approach is to try and understand what the woman is seeking. Is it comfort, love, or reassurance and if so the Butterfly program says give that to her instead of the truth. Another person, who doesn’t understand why the staff member wants to change his briefs, gets scared and defensive. His hand balls into a fist. With the emotion-based care approach, in this situation the staff member recognizes that the person is scared and decides to give him a big hug then says, let’s go to the toilet. They walk arm in arm down the hallway. More information can be found in “The Fix: Part 3”, The Toronto Star, June 23, 2018 which was republished in the Special Section: Crisis of Care, The Toronto Star, February 7, 2021.

The emotion-based approach to care is a learned approach and it takes time for staff to adapt to this new way of caring for and about those living in their home. Giving hugs, hand-holding, sitting down and spending time listening to those living in the home is the norm. And meeting the person where they are at becomes more important than telling the truth.

Please support Transformative Culture Change in Ontario’s Long-Term Care Homes by sending an email to info@LTCcommission-CommissionSLD.ca or to your local MPP  https://www.ola.org/en/members/current.

#ChangeLTCNow

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Let’s put the “care” in healthcare!

Malton Village, the Toronto Star, June 22, 2018

Over the past 15 years the Toronto Star and other Ontario newspapers have written many stories about life in long-term care homes. Yes there are good stories to be told, but what we remember are those stories about neglect, abuse, urine-soaked sheets, loneliness or angry, aggressive incidents.

There is no-one among us that doesn’t abhor reading these awful stories and wonder how we are letting these incidents happen; regrettably it has taken the pandemic to bring the seriousness of the long-term care home situation to the forefront.

Most of the staff are trying their very best to deliver care according to what is expected of them. But is this the problem? “Is keeping our elderly clean, fed and safely tucked away” the best way to provide a quality of life?

In a recent article in the Toronto Star, we read stories about residents who live in LTC homes which have undergone transformative culture change. There is Inga who asks for a piece of toast, butters it and shares it with another resident. Or the Professor who is known for his crankiness, who starts to cry when hymns and wartime songs are played on the piano. And then all of a sudden, begins singing the words to these songs! Read more here from a recent article called Crisis of Care, The Toronto Star, February 7, 2021: The Fix: Part 2: Republished from 2018).

The good news is that where there is a willingness to change, lives are transformed. There is no excuse not to now. We know how much we have dreaded the traditional model of nursing care. We know, now, how much better a different model can be, and how joy, respect and community can actually be experienced by residents, families and staff.  If the word “care” in our system of healthcare means anything, we need to get on with it.

Please support Transformative Culture Change in Ontario’s Long-Term Care Homes by sending an email to info@LTCcommission-CommissionSLD.ca or to your local MPP  https://www.ola.org/en/members/current.

#ChangeLTCNow

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The Butterfly Effect

The walls of the Redstone unit at Malton Village in Mississauga 

There are over 78,000 people living in one of 630 long-term care homes in Ontario. These homes are controlled by more than 300 regulations that keep staff focused on the tasks of feeding, scheduling, and cleaning, all documented for government collection. Every day, at least 60 minutes is spent by staff filing ministry updates. They tap icons for mood, mobility, meals, bowel movements but there are no icons for laughter, conversation, human touch or sense of purpose.  It is a detached, antiseptic end to life which some have called a culture of malignancy.

A long-term care home in Peel has moved away from a traditional model of care and took a gamble on fun, kindness and affection. It is Malton Village in Mississauga and they are focusing on laughter, friendship, energy, tenderness, freedom and hope. That is not to say that they are not meeting the Ministry regulations. They are doing that but in a different model of care. In a recent article in the Toronto Star, we read about Bill, a resident, who has been kicked out of multiple long-term care homes because of violent tendencies, until he arrived in a Butterfly home. He became docile, enjoyed his days and staff came to know him as a “lovely man”. Or there is the dietary aide who helps Roger with his dessert. She talks to him about her childhood memories visiting peach groves and before you know it, Roger has eaten all of his dessert. Read more here from a recent article called Crisis of Care, The Toronto Star, February 7, 2021: The Fix: Part 1: Republished from 2018).

Do we want our seniors to live out their days in long-term care homes that dehumanize their existence? We can help to change this by transforming our long-term care homes into innovative models of care such as the Butterfly model of care. Please support Transformative Culture Change in Ontario’s Long-Term Care Homes by sending an email to info@LTCcommission-CommissionSLD.ca or to your local MPP  https://www.ola.org/en/members/current.

#ChangeLTCNow!

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