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!

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?

 

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

 

 

Moving from Institutional to Emotion-based Care

 

Malton Village, Region of Peel

Over 125  persons attended a recent webinar on “Moving from Institutional to Emotion-based Care” co-hosted by Family Councils of Ontario (FCO) and C.A.R.P. (Canadian Association for Retired Persons) Ottawa Chapter.

The webinar featured Mary Connell who implemented the first Butterfly Model home in Ontario in Peel Region  and Gerry Kupferschmidt whose wife lives in a Butterfly Model unit at Sheridan Villa Long-term Care Home in Mississauga.

An emotion-based model of care is the heart of all the innovative models (Eden, Hogewey, Butterfly, and Green House) that have been implemented in some long-term care homes in Ontario and elsewhere in Canada.

To watch the webinar,  click here:

Life can be beautiful for residents and staff in long-term care homes!

Redstone, Malton Village, Region of Peel

‘Life can be beautiful’ is the name of the exhibit which opened recently at the Peel art Gallery Museum and Archives.

An emotion-based model of care makes a huge difference to an individual’s life.  That’s exactly what inspired Mary Connell (Dementia Advisor and Person-Centred Care Project Manager – March 2017 to November 2021) to lead the way with the implementation of the Butterfly Home in several long-term care homes in the Peel Region, and this gratifying exhibit is her brainchild.   For a virtual visit to the exhibit, click here 

Please do everything you can to convince your candidates in the upcoming provincial election and/or the incumbent MPP in your riding (click here for list)  that this is the route to go.  Make bringing ‘an emotion-based model of care’ to Ontario’s long-term care homes a ballot box issue this June.

Kudos to the CBC!

 

Kudos  to CBC for its recent encouraging report on the Green House – a successful initiative in long-term care homes in the United States.

The top two floors of this building just blocks from the Canadian border in Detroit, Michigan, house another Green House Project home. Advocates say the model is adaptable to larger cities as well as rural areas and smaller communities. (CBC News)

In her news article posted on December 12th, Melissa Mancini, a producer with The National, focuses on how smaller long-term care homes can help address big elder-care issues.

As noted in the previous blog post, the Green House model has been implemented extensively in long-term care homes in the United States with proven positive results both in for-profit and non-profit homes, including experiencing fewer number of cases and less deaths than traditional homes during COVID-19.

“It’s a model of nursing home care that allows people to live life in retirement as close as possible to the way they did in their adult lives. It starts with the building — small homes with just 10 or 12 seniors living in them — and extends throughout all aspects of life there”.

“There are 38,000 people waiting for a spot in long-term care homes in Ontario alone and the government is preparing to build hundreds of facilities to meet demand, but some say we should also be reshaping how elder care is offered.”

“I would really challenge those that are investing in this to look at alternatives that are out of the box,” said Tammy Allison, who runs a small long-term care home in Monclova, Ohio. “You can do long-term care differently and you can do it better. And we feel like we’re doing that.”

To read the full article and see related-videos (including interviews of residents with CBC’s David Common), click here

Before we know it Ontario’s provincial election will be here. You have a voice – make bringing an innovative model such as the Green House or the Butterfly Home to long-term care homes a priority and a ballot box issue!

 

 

The Green House Model: A Blueprint for Change

Leonard Florence Center for Living outside Boston, Massachusetts

On November 24th, around 200 people registered for the webinar, The Green House Model: A Blueprint for Change. Susan Ryan, Senior Director of The Green House Project gave a dynamic presentation on the model and its positive impact on the lives of elders in the United States. The Green House model is “revolutionizing care and empowering lives’’ Susan said.

Here are just a few key comments that Susan shared about this emotion-based model of care:

  • During COVID-19, every Green House home fared much better in number of cases and less deaths than traditional homes. Smaller is better!
  • A meaningful life is about relationships, autonomy and control, purposeful engagements, honouring natural rhythms, and social connectedness.
  • Transformative culture change is all about deinstitutionalizing long-term care
  • We all want/need to be seen, heard and known as unique individuals
  • Ongoing learning is required by all for sustainability of any culture change.

Please listen and share this inspiring presentation.   Click on the link here.

 

“Let’s Fly With Butterfly”

 

Nora, a PSW, and Lionel, a resident, in one of the many rooms with tranquil murals –  photo is courtesy of the Glebe Centre

There are lots of innovative models for long-term care homes to ‘fly with’ and make culture change a reality.  The Glebe Centre in Ottawa has chosen to ‘fly with Butterfly’ and the Centre is the first Home in Ottawa to implement this innovative model.

“Every resident comes into long-term care with a history of family, friends, work, passions, desires, likes and dislikes.  Each has individual wants, needs and expectations. Many come into care with reluctance and apprehension. Long term care is often a necessity because of their physical or mental fragility.

So, what does the Butterfly Model involve and why is it different from other forms of care?

  • It is all about BEING not DOING. It is about enabling and supporting those in care rather than passively caring for them. Doing things WITH the residents and NOT for them.
  • We don’t DO Person-Centred care, we need to BE “Person-Centred.”
  • The Butterfly Model is all about getting to know each resident. Understanding their previous life stories and connecting— using active listening skills and maintaining a positive view of the importance of everyone’s emotional life journey. It is about treating each resident more like a friend than a patient.
  • Staff must be enthusiastic, have positive energy and be able to look at the world from the resident’s perspective.
  • The physical space is different in this model. Who wants to live with grey, green or beige walls? Talk about institutional! The colours used on a Butterfly floor are bright, sunny, and happy. The walls are filled with murals and each resident door is a different colour and design.

Donna read about the Butterfly Model, watched the video and got excited thinking of how her 98-year old mother with dementia would flourish in this environment.

But when she saw a completed floor at The Glebe Centre and experienced the full impact of how this works, she was very impressed! It far exceeded her expectations. The sense of calm and soft music provides a peaceful setting. The place felt like home, safe and secure – a family atmosphere.  The staff were relaxed, flexible, smiling and affectionate towards each other and the residents.

Many of you reading this article are starting to think about future care. Person-Centred Care is the way of the future. We have to make long-term-care a place where seniors go happily and not with dread and reluctance.”*

Let’s hope that other long-term care homes in Ontario ‘fly’ with an innovative model and pave the way for a happier future for their residents.

Please encourage the Ontario Government to bring culture change to its long-term care homes.   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.

*Extract from the Glebe Centre Long-term Care Home and Abbotsford House 2020-2021 Donor Community Newsletter

 

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.