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!
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.
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.
Here is an update on the exciting journey that Bonnechere Manor and Miramichi Lodge have begun in the implementation of the Butterfly model.
The Butterfly approach was pioneered over 20 years ago in the United Kingdom by Dementia Care Matters and over the past year or so has been adopted or emulated in a few long-term care homes in Ontario. It is a social model of care that shifts care from a traditional medical care approach to:
• Prioritising emotional care that is person centered
• Creating busy, filled up, engaging places that feel like ‘home’
• Providing relaxed, freed up comfortable environments
• Involving people in the running of their own home
• Emphasizing a more informal, best friends and family like approach.
Miramichi will start by focusing on a unit of 27 people and at Bonnechere Manor, a unit of 20 people. Eventually the Butterfly approach will be used throughout both homes.
“Long-term care homes are not a place where people go to stay; they are places where people go to live and that at the heart of long-term care must be family, friends, and community”. Read more here.
Kudos to Renfrew County! Let’s hope that more long-term care homes will see the benefits of adopting an innovative approach to care.
Please forward this to others who may be interested and if you are on social media, share on your Facebook, Instagram or Twitter accounts.
An update from the Glebe Centre (Ottawa) : Although the team from Meaningful Care Matters (formerly Dementia Care Matters) observed many exceptional moments of care, there were indeed areas that needed improvement and did not follow a person-centered model of care.
This will be our journey over the next year, to transform and re-think care on Bankwood (one of the care units at the Center) from a neutral/task based model of care to a person-centered, house-hold model of care.
Meaningful Care Matters has sent an extensive, formal report with recommendations on making meaningful change.
An audit was completed on the physical space on Bankwood and recommendations for change and transformation. Over the last few months we have started to create a relaxed home-like feel to the day with less task orientated activities and more emphasis on the people living and working on Bankwood.
We have begun the process to re-design Bankwood to be more welcoming and intimate, filling the house with the “stuff of life” so that residents can connect with a variety of colours and objects that reflect their past lives, work and hobbies. And staff training begins this month!
Person-centered care is front and foremost as Bankwood undergoes change and transformation! Please forward this blog post to at least one other contact you know who may be interested.
And please encourage others to become followers by clicking on the button on the right hand side of this post.
Instead of building homes in which people feel homeless, let’s build communities where people belong”. Sonya Barsness.
In June, 2019, Canada’s first Dementia Village opened. The Village’s design was inspired by Hogewey, the world’s first dementia village, in The Netherlands. Langley will become home to 78 people with dementia housed in six cottages. Care will be provided by 72 specially trained staff.
After 4 months, Langley has admitted 38 residents, one couple, and more residents are being added from its wait list every week.
Two cottages are full and two more are at 50% capacity.
The General Store is stocked and open for shoppers (pet food is popular).
Elroy’s Cafe & Bistro is open for baking, lunch, coffee or a cold beer.
The kitchen is the centre of activity and the smells permeate the house and stimulate the senses and appetite of the residents. Residents are involved in the daily food prep, plating and cleanup to the best of their abilities.
Residents have created their own Newspaper complete with real and imagined stories and clippings contributed by each household member.
Music is also important to the residents playing instruments when able to express their own particular interests.
The Village is about doing things differently. It is about putting the interests and needs of the residents first and making each house a home.
Although the Village Langley in British Columbia is privately owned and will not be affordable to all, we hope that this kind of innovation will influence others to bring culture change to their own long-term care homes.
Please forward this link to your friends, colleagues and your local city councillors, MPs or MPPs.