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.
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
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.
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.
A Green House Dining Room (copied with permission)
At a recent virtual workshop on the Green House model intended for a Canadian audience, people from Alberta, B.C., Ontario and the Maritimes participated. Hopefully this will translate into action on the Ontario scene where bringing transformative culture change is long overdue. Continue reading “Will the Green House model be coming to Ontario?”
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.
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.
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.
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.
Congratulations to Henley Place Home in London, Ontario for receiving its Butterfly Model of Care accreditation in December 2020. It joins Henley House in St. Catharines, Ontario which received it accreditation in December 2019.
When will other long-term care home providers rise to the challenge and begin to implement innovative models?
Kudos to Primacare Living Solutions, the provider of these homes for their leadership in implementing transformative culture change in their homes. And yes, more to come – Primacare has a third home (Burton Manor in Brampton, ON) currently undergoing Butterfly accreditation that should be completed in the fall 2021.
Please advocate for change by contacting your local councillor, your MPP, or organizations urging them to bring this change to your community.
St. John’s Green House home in Penfield N.Y: residents eat together at a communal table. The Green House project focuses on residents’ emotional and social well-being.
“…….The COVID-19 crisis has highlighted that we need new ways of providing LTC to protect residents from plagues of communicable disease. But we also need to eradicate the noncommunicable plagues of old age identified by the architects of the Eden Alternative — loneliness, helplessness, and boredom.
We need new models of care that prioritize human relationships, dignity, and safety. That means a moratorium on new LTC facilities that don’t look like Sherbrooke Community Centre’s Poppy Lane…..” (a long-term care home featured on this blog site on November 16, 2017) says Dr. Michael Rachlis, a public health physician and an Adjunct Professor at the University of Toronto Dalla Lana School of Public Health that appeared in The Star on May 8th, 2020. Read more here
“Sunnyside Home is adopting a new approach to make the Kitchener long-term care facility feel more like a home, and staff like family, for its residents with “dementia.”………
Sunnyside has been working for a few years to improve care by moving away from a medical model. The butterfly approach will take that to the next level to ensure residents have a full life” as reported in an article by Johanna Weidner in The Waterloo Chronicle.
This is another example of the increasing number of innovative long-term care home models that are striving for the transformative culture care we are hoping for in the future for Ontario. Unfortunately, the COVID-19 virus crisis has obviously put a damper on this kind of major change from moving forward at this time. We look forward to encouraging these homes in their quest for culture change once this crisis is over.
Leonard Florence Center for Living outside Boston, Massachusetts
