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ENOUGH IS ENOUGH!

According to a recent article in the Toronto Star, since January 15, 2021, 2721 residents of long-term care homes and 8 staff members have died from COVID-19. Read here. Thousands more are sickened, neglected and denied basic rights! Since the pandemic began, some 87% of all COVID deaths in Ontario have been among those over the age of 70 and about 61% of deaths have been in long-term care homes.

The long-term care system is broken and has been for many years!  We are slowly losing a generation of people to this pandemic. They are our elders, our grandparents, mentors, visionaries who paved the path for a better world for all of us. And when they need more care than they can receive in their home, we move them to a medical institutional warehouse, remove their ability to make choices, take away their individuality and stifle their creativity. We schedule their day from morning to night, medicate them when they resist, and when family members become upset, we wonder why. Then COVID-19 arrived and the inadequacies of how we care for and about our elders in long-term care homes have come to light!

As of October 2020, there were 11 long-term care homes in Ontario that had either adopted or were in the process of adopting the Butterfly model of care.  These homes along with the Green House Project homes in the U.S. that have embraced transformative culture change have reported better outcomes both pre and during the COVID-19 pandemic and have experienced fewer deaths than the institutional models of care that exist in most of our traditional long-term care homes. 

Please consider sending an email to your local MPP or City Councillor urging them to look at what these homes have done so that the Ontario government can bring an end to the inhumane treatment and needless deaths of our vulnerable elders.  Enough is enough!

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Will the Government bring change to Ontario’s Long-Term Care Homes?

Members of C.A.R.P. Ottawa’s Advocacy Working Group on Long-Term Care presented to the Independent Long-Term Care COVID-19 Commission on November 26th, 2020.  

The purpose was to explain how transformative culture change, an emotion-based model of care, would not only improve the quality of life for residents, families and staff in Ontario’s Long-Term Care Homes but would also help to mitigate the impact of future viruses.  

Key points presented were as follows:

-The fundamental principles of transformative culture change are consistent with the principles outlined in Ontario’s Long-Term Care Act which states:

“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.”

Despite many new regulations and many millions of dollars spent on education and new programs, it is obvious these principles have not been adequately met – for decades.

–Transformative culture change is a philosophy that uses an emotion-based approach to care where residents, staff and families feel part of a community and are all treated with dignity and respect: where there are small home-like environments; more direct hours of care for residents, where staff work full-time, are well-paid and are trained in empathy and culture change and where families and caregivers are recognized as an integral part of the team.  Staffing, inspections, design and family involvement are all critical elements of transformative culture change. 

-There are four innovative long-term care models that have successfully embraced transformative culture change.  These models have existed for years in the USA, Europe, the U.K. and more recently in parts of Canada and even Ontario:  The Butterfly Model, The Eden Alternative, The Green House Project and the Hogewey Villages. These homes have experienced better outcomes than our traditional homes both pre and during COVID-19. 

The “ask”: That the Commission recommend the Ontario Government commit to move towards transformative culture change in Ontario’s Long-Term Care homes.   This commitment could start by examining the long-term care homes that have already embraced this model of care to determine best practices and lessons learned, including how they have managed financially within current budgets and the current legislation.  This commitment could also include revisiting the new builds that are being fast-tracked to ensure Ontario does not end up with the same old institutional designs, that once built, will be with us for the next 3 decades.

We know this can be done since it is being done right here in Ontario, right now.  These innovative models are being led by a few who have taken the leap and the risk to improve the lives of residents, families and staff.  There are currently 11 long-term care homes in Ontario that have either implemented or launched the Butterfly Model of Care resulting in transformative culture change. 

Anyone wishing to support Transformative Culture Change in Ontario’s Long-Term Care Homes can send an email to info@LTCcommission-CommissionSLD.ca

For more information on the Commission www.ltccommission-commissionsld.ca

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Transformative Culture Change: C.A.R.P. Ottawa’s Brief

 

C.A.R.P Ottawa recently submitted its Brief to the Independent Long-term Care COVID-19 Commission and has requested an interview with the Commissioners. 

Its recommendation is that the Ontario Government bring about transformative culture change in its LTC homes by ensuring an incremental approach according to specific timelines and targets.  Accountability structures to be put in place for every long-term care home in order to adopt one of the existing innovative models of care. Staff and volunteers (working conditions; recruitment and retention), education/training, infrastructure, inspections, and families/caregivers are all critical elements of transformative culture change that need to be reformed.

The implementation of transformative culture change in Ontario’s LTC homes will require the Provincial Government to:

– Demonstrate the leadership and commitment necessary to implement transformative culture change in Ontario’s LTC home system by adopting one of the four innovative models of transformative culture change.

– Implement the recommendations of the Ontario Ministry’s Long-term Care Staffing Study including the allocation of necessary resources to providers of LTC homes.

–Revise the Design Manual for LTC homes to achieve transformative culture change – small, home-like environments, single and double rooms with private bathrooms, and shorten the timeline for the requirement for homes to meet the most recent design standards.

–Utilize reports from LTC home inspections and data to guide timely improvements to the Ontario LTC home system and to support providers of LTC homes in utilization of data.

–Assert the role and value of families and caregivers as part of the community in the home through timely and up-to-date communication protocols, particularly when a crisis such as the current pandemic occurs and require the same of LTC home providers.

If you support C.A.R.P. Ottawa’s recommendation for a transformative culture change in Ontario’s long-term care homes, please contact your local MPP and make your view known or write directly to Ontario’s Independent Long-term Care COVID-19 Commission at info@LTCcommission-commissionSLD.ca.

#ChangeLTCNow!

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The clock is ticking!

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Increasing the number of direct care hours for residents in long-term care homes has been in the news! On Oct. 28, the Time to Care bill passed the second reading in the Ontario legislature. If the bill passes third reading, it will amend Ontario’s Long-Term Care Homes Act to put in place a minimum staffing level sufficient to provide four hours of personal support and nursing care per resident per day.  Then on November 2nd,  Premier Doug Ford announced that “thousands and thousands” of nurses and personal support workers will be hired as Ontario moves to an average of four hours of hands-on care daily for nursing-home residents. However, the Premier said, it will take four years to reach that level for hiring and training to occur.

While four years is a long time, this is a first big step in addressing the need for more staff who provide hands on care!   Providing more hours of direct care and more staff is a no brainer and experts have been advocating for this for some time. But should long-term care homes just focus on filling new staff positions or is it time to look at how care is delivered and then look at hiring appropriate staff?

Transformative culture care means, supporting a shift from institutional to home-like environments. It means requiring facilities, old and new, to create an environment that supports a culture of person-centred care, having shared living spaces and private bathrooms. It also means recruiting staff and volunteers who exhibit emotional intelligence, empathy, compassion, have a willingness and ability to learn new approaches and work as a team. Then a training program, that supports person-centered care, needs to be available, not as a streamed video learning program but as an in-person, mentored learning approach. The approach needs to be embraced by the leadership team and then modeled for all staff and volunteers!

If you are interested in bringing transformative culture change to Ontario’s long-term care homes, please write directly to Ontario’s Independent Long-term Care COVID-19 Commission at info@LTCcommission-commissionSLD.ca

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What is Transformative Culture Change Anyway?

What is transformative culture change and what does it mean?

The Independent Long-term Care (LTC) COVID-19 Commission has now been established. Terms of Reference have been posted. What can we hope for? The easiest solution for the Independent Commission is to make recommendations that should have been instituted long ago: more staff: full time staff versus casual staff; more direct hours of care; fair salaries; infection control education and practices, elimination of four bed rooms and availability of air conditioning. If this is the end result, then our government has failed. Long-term care is a broken system and if the Independent Commission wants to make any significant impact, then it needs to look at how to improve quality care in LTC homes with a transformative culture change.

This means revising rules and regulations, moving from institutional care to areas with small home-like environments, embracing the valuable contribution that families and volunteers make, hire staff who want to work with seniors, and look at delivery of person-centred care. All this happens now in a few LTC homes across Canada. We call them innovative models of care but they should be the norm not something unusual. CARP (Canadian Association of Retired Persons) Ottawa Chapter, along with collaborating organizations, is advocating for transformative culture change in long-term care homes.

Transformative culture change means the way of organizing, and giving care in long term care homes changes so that residents know and feel like they are living in a warm, caring environment that looks and feels like home. It enables staff to know who their residents and families are – and what their life was like before. It means schedules and routines are flexible to match the resident’s preferences and needs. Friendships develop between staff, residents, families and volunteers. It means residents are involved in many meaningful activities according to their abilities and what brings them joy. Transformative culture change means Relationships, Relationships, Relationships!

Excerpt from an article written by Sue McDonald, a member of CARP Ottawa Advocacy Working Group on Long-term Care

If you are interested in bringing transformative culture change to Ontario’s long-term care homes, please write directly to Ontario’s Independent Long-term Care COVID-19 Commission at info@LTCcommission-commissionSLD.ca

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Let’s Fix the Culture Around Long-Term Care Homes

Why does it take an outbreak to put long-term care homes back in the news? The news of the latest outbreak in a long-term care home is a stark reminder that residents in long-term care homes have been, and still are, vulnerable to this terrible pandemic. The need for change in long-term care is patently obvious.

Although measures to deal with staffing are critical to fix the immediate problem, there is a greater need to fix the culture of long-term care homes for the longer term. This can be done. CARP Ottawa is working with other organizations in Ontario to bring about transformative culture change in Ontario’s long-term care homes through a grassroots movement.

An independent commission set up by the province to investigate how and why COVID-19 spread in long-term care homes, what was done to prevent the spread, and the impact of key elements of the existing system on the spread has begun its work. We should all follow the work of this commission with great interest. And we should all make our voices heard to make sure the changes recommended are truly transformative.

Elizabeth Spence, Letter to the Editor, Ottawa Citizen, September 26/20

If you are interested in helping to bring about transformative culture change to Ontario’s Long-Term Care Homes, please either write a letter to the editor in your local paper or write directly to the Commission. You can write to them at info@LTCcommission-commissionSLD.ca

Please share this post with your contacts or anyone else you know who might be interested.

Please use #ChangeLTCNow when sharing on social media

 

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Kudos for the Ontario Long-Term Care Staffing Report!

The Ontario Ministry of Long-Term Care Staffing Study Advisory Report, released on July 30, 2020, identified a number of challenges to the current staffing strategy for long-term care. Apart from workload and funding issues as well as increased acuity needs of residents, the Report also identified that “the culture of long-term care is one based heavily on compliance, which can create a punitive environment for staff.” 

Their recommendation states that, “The culture of long-term care needs to change both at the system and individual level.” The Report calls for a look at the philosophy of care within long-term care homes and specifically cited models of transformative culture change such as the Butterfly model and the Eden Alternative as models of care which focus on emotional care and relationship building. The Report’s findings indicate that “Operators reported that their staff frequently request working in homes that have implemented emotional models of care as they feel better supported, more collaboration within the team, and are able to spend more time with residents. (Region of Peel Long-Term Care, Submission to the Staffing Study Advisory Group 2020)

For more information about the Long-Term Care Staffing Advisory Report click here

Thank you for your support of transformative culture change. Your letters to your MPPs and City Councillors do make a difference! You can also help by sharing this post and others with at least one of your contacts.

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An Opportunity for Lasting Change?

At the end of July 2020, the Ontario Government announced the creation of the Independent Long-term Care COVID 19 Commission.

The three commissioners appointed to the Commission are:

Angela Coke, former senior executive with the Ontario Public Service; and
Associate Chief Justice Frank N. Marrocco (Chair), member of the Superior Court of Justice since 2005;
Dr. Jack Kitts, recipient of the Order of Canada and recently retired as President and Chief Executive Officer of the Ottawa Hospital.

“The Commissioners of Ontario’s Long-Term Care COVID-19 Commission have a mandate to investigate how and why COVID-19 spread in long-term care homes, what was done to prevent the spread, and the impact of key elements of the existing system on the spread.”  The Commission will have a secretariat of 12 FTEs (full-time equivalents) and will submit its report by April 30, 2021.  For more information about the Commission including its Terms of Reference and guiding principles, go to: https://www.ltccommission-commissionsld.ca/about/index.html

Many thanks to those of you who sent letters to your MPP’s and City Councillors as a result of our last post.  Your help makes a difference! CARP Ottawa, with whom we continue to work, subsequently sent letters to both Minister Fullerton and the Commissioners requesting that recommendations for transformative culture change be developed.

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#CHANGELTCNOW!

As you know we are working with CARP Ottawa to bring about transformative culture change in Ontario’s long-term care homes through a grassroots movement.  To this end we have asked the members of CARP Ottawa and its collaborating organizations in Ontario to send an email to their own local MPP’s about this matter.  We would like to ask you, our blog followers, to do the same.

Thank you to all the blog followers and friends who responded to our last request by sending letters to Minister Fullerton to recommend that CARP Ottawa be appointed to the Independent Commission on Long-term Care.

In the end, only three individuals were appointed to the newly named Independent Long-term Care COVID-19 Commission – Associate Chief Justice Frank Marrocco, Angela Coke and Dr. Jack Kitts. Now it is even more imperative to bring awareness and influence regarding this change to not only the Commissioners but also to our local politicians. 

Here’s How YOU Can Help

Send the email below to your own local MPP (contact info here) and copy your local mayor or city councillor (contact info here). Personalize the email with your own words on the need for culture change in Ontario’s long-term care home system. Or if you and your family have been affected by the COVID-19 virus, describe the impact it had on you.     

Copy us at our email changeltcnow@gmail.com We’d like to know how many of you are still interested.

Subject line: CARP Ottawa calls for transformative culture change in Ontario’s long-term care homes.

Email:

As a member of your constituency and someone who is very concerned about the long-term care home system in Ontario, I would like to express my support for Ontario’s Independent Long-term Care COVID-19 Commission.  However, I believe strongly that a transformative culture change is needed to fix the systemic failings apparent in these homes. 

I agree with Minister Fullerton and Premier Ford who have said on many occasions, “We have been clear the long-term care home system in Ontario is broken.”  Now we must fix it.

There are new models of care that exist in the U.S., Europe and even in Ontario, which have embraced the same guiding principles: a relationship-based approach to care; person and family-centred care; small home-like environments; higher staff to resident ratio; full time, well-paid staff who are trained in empathy and culture change and an environment where residents, staff and families feel a part of a community.

These new models have all embraced transformative culture change and have achieved much better outcomes than our traditional homes in Ontario.  We don’t need to reinvent the wheel. 

These outcomes include a decrease in the use of medications, in the number of aggressive incidents, in the number of hospital visits, in the amount of food waste and staff sick time, all the while increasing positive interactions with staff, families and residents.

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

My request is that you bring this urgent need for a transformative culture change in Ontario’s long-term care homes to the attention of Minister Fullerton and Premier Ford. If you would like more details on the existing models or this kind of culture change, please contact CARP Ottawa at changeltcnow@gmail.com

I look forward to hearing from you.

Your name…

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What does transformative culture change mean for: Infrastructure

Keys

Many LTC (Long-term Care) homes in Ontario are old and outdated with some residents living four to a room and sharing one bathroom.

  • Support shift from institutional to home-like environments.
  • Require facilities (existing and new) to create an environment that supports a culture of person-centred care, shared living spaces, and private bedrooms.
  • Shorten provincial timelines for requirement of homes to meet most recent standards for LTC building design.

What does transformative culture change mean for: Inspections

  • Use cumulative reports of LTC home inspections and data to guide timely improvements in Ontario’s provincial LTC system. Engage family councils, residents, families and front-line staff in this process.
  • Evolve the role of LTC inspectors to that of compliance advisors or resource persons who foster a partnership between government funders and providers of care.

What does transformative culture change mean for: Families/caregivers

  • Value, support, recognize and respect families and caregivers as part of the community in the home.
  • Activate timely and up-to-date communication protocols between families and LTC homes when a crisis occurs.
  • Support and help maintain family-resident relationships when a crisis occurs.

If you have any questions, please contact us

 

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What does transformative culture change mean for: Staff and Volunteers?

Keys

Working Conditions

  • Value, support, recognize and respect all staff and volunteers for their work.
  • Provide fair compensation with fitting salaries and benefits including sick leave.
  • Ensure staff positions are full-time wherever possible with staff dedicated to working only in one long-term care home and with realistic
  • Provide more hours for direct care.

 Recruitment and Retention

  • Recruit staff and volunteers who exhibit emotional intelligence, empathy, compassion, have a willingness and ability to learn new approaches, and work as a team.
  • Actively involve staff and volunteers in decision-making that is integral to better resident care.

Education / Training

  • Educate staff and volunteers on relationship-based approaches.
  • Strengthen staff and volunteer skills in empathy, social interaction and team work.
  • Provide timely, on-the-job continuing education for staff and volunteers that is responsive to changing residents’ needs.

If you have any questions, email us at:  ChangeLTCNow@gmail.com

 

 

 

 

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Transformative Culture Change: Key Messages

Keys

CARP Ottawa, as noted in previous blog posts, is advocating for transformative culture change.  This post will be the first of three that describes what this actually means along with the key messages detailing what elements are necessary to bring this change to fruition and improve quality care and quality of life for residents in long-term care homes in Ontario.

Transformative culture change means:
  • Using a relationship-based approach to care where residents, staff and families feel part of a community and are treated with dignity and respect;
  • Setting up small home-like environments;
  • Providing more hours of direct care for residents;
  • Employing full time, well-paid staff, who are trained in empathy and culture change;
  • Recognizing families and caregivers as integral members of the team:
  • Engaging volunteers who are trained in empathy and culture change.

Key messages have been developed for staff and volunteers, infrastructure, inspections, and families/caregivers. All the key messages need to be operationalized within a transformative culture change approach in which quality care is understood within a relationship-based environment where residents, staff, volunteers, and families are treated with dignity and respect and feel part of a community.  The key messages will appear in the next two blog posts.

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