Could Ontario’s long-term care home system be any more complicated?

There are 626 long-term care homes in Ontario (2019); of these, there are 3 categories:

For-Profit: 58%,   Not-for-Profit: 24%,   Municipal: 16%

What are the commonalities?

  • Funding: All 3 types are funded by the Ministry of Health and Long-Term Care through the Local Health Integration Network (LHIN) based on the same formula.
    In addition: Municipalities can opt to top up funding for their homes through tax payers’ dollars.  Some of the other homes have either foundations or fundraising programs that can top up their funding for capital expenditures or program enhancement.
  • Admission/wait lists: All 3 types are subject to a central admission/wait list process controlled by the LHIN
  • Resident costs: In all 3 types, residents are required to contribute a co-payment for accommodation of basic ($1848.73), semi-private ($2,228.63) or private ($2640.78).  These costs are as of 2018 and there is a cost of living increase each July.  
  • LegislationAll 3 types are subject to the same standards, rules and regulations.    

 

  • Management:
  • The for-profit long-term care homes are managed by their corporate office through their Chief Executive Officers (CEO’s)
  • The not-for-profit long-term care homes are managed by a Board of Directors through their CEO’s
  • The municipal or city-run long-term care homes have a formal mechanism in place for their management through a committee of City Council and a staff director.   

Please note that unlike long-term care homes, retirement homes are not publicly funded and operate outside the domain of the long-term care home system.   More details here.  

Please comment on the blog if further clarifications are required. 

 

 

 

 

Will this ever end?

blog feb2020The recent CBC news article regarding a female resident in an Alberta nursing home who was abused before she died from dehydration and a urinary tract infection is appalling and should never happen in our health care system in Canada. Unfortunately, abusive incidents do occur and indicate yet again that traditional medical models of care in long-term care homes need to be changed.  Read more here.

Yes, our long-term care homes need to keep residents safe and comply with regulations but if person centered care was provided where residents matter and are considered to be a member of the family rather than a person to be “cared for”, then abuse would not occur.

The CBC news report says that the nursing home reported that “there was a shortage of staff and experience” and that “employees needed better education about nutrition, hydration and monitoring infections”. Yes, staff need to have that knowledge but surely it is more than that! Staff education and training is required in order to change the culture of care from one of “giving” care to a relationship based approach with the residents.

Innovative models of long-term care that are featured in this blog will do just that.

Please forward this post to your friends and colleagues and if you are on social media, please share with your followers.

Toronto to revamp long term care homes!

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The city of Toronto is planning to revamp their long term care homes! Their plan will include the implementation of an “emotion focused care model”. All staff will receive in-depth training on this model which focuses on empathy, creating friendships and engagement of activities that give life purpose.

The city of Toronto examined innovative models of care such as: the Butterfly model, the Green House Project, and the Eden Alternative and decided to use a Toronto-created approach.

“The proposal calls for extra staff members, beginning with six new front line workers in a 2020 pilot project at Lakeshore Lodge in Etobicoke. Starting in 2021, roughly 55 additional workers would be hired each year until 2025, when a total of 281 new staff members would be in place throughout the city’s 10 facilities.” An evaluation component, conducted by the University of Toronto, will be built into the pilot project at Lakeshore Lodge. Read more here.

Way to go Toronto! Let’s hope other cities will follow suit.

Please consider forwarding this link to one of your contacts and ask them to be a follower!

Are inspectors the answer?

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In January, the Ontario Ministry of Health and Long-Term Care reported it would be hiring 100 more inspectors.  Is this really the answer to our ailing long-term care home systems?  Read more here.

Not so, according to this family member’s perspective:

“More inspectors are not the answer.  Deming and other quality improvement experts have shown time and time again that you can’t just ‘inspect’ quality into a system or workplace.  Inspection needs to be partnered with giving workers the tools and resources to do their work.  Trying to balance residents’ individual wants and needs with too few staff to meet them is an unwinnable state.  The long-term care system needs serious reform that includes feedback from residents, families, staff and the provincial government” – Pat Piaskowsk.  Read more here.

The number of inspectors continues to rise – from 102 (2013/14)  to 148 (2016/17).  And now, 100 more?  The cost of 248 inspectors, at an average of $85,000/yr (not including benefits and pensions) is approximately $21 million/year!

The outcry for additional personal support workers in long-term care isn’t new and isn’t the only part of the system that’s broken; perhaps the system would be better served by re-directing some of these dollars into transforming the long-term care home systems with a total culture change that provides a supportive community for staff, family and friends where relationships matter most.

If you are on Facebook, Twitter or LinkedIn, please share with your followers or pass along to your contacts.

 

 

 

Where are our Champions?

“We have an opportunity to be leaders” Toronto City Councillor Matlow says.  Where are the champions of long-term care homes in our other Canadian cities?

Recently the Region of Peel in Ontario bought into a transformational model of care for long-term care homes from the U.K. called the Butterfly Model.  Following Peel’s lead, Toronto City Council commissioned a report to review the various innovative models in existence in Canada, the U.S., the Netherlands and elsewhere. See the link to the article here.

Time will tell whether or not this leadership from Peel and Toronto will result in the sweeping changes needed for a sustainable culture change in our long-term care home systems.

Tell us what you think by commenting on our blog site. If you are on Facebook, Twitter or LinkedIn, please share with your followers or pass along to your contacts.

Abuse in long term care – when will it end?

marketplaceheadline1Meyer Sadoway, 84, on the floor, was attacked by another resident at his Toronto nursing home in 2013. (Security camera footage) reported by CBC news.

On Friday, February 1st, 2019, Marketplace featured an episode, ‘Crying out for care’, on long-term care homes.  Watch it here.

Here we are 6 years after the above photo was taken and very little has changed.  In fact, according to CBC Marketplace, the incidence of reported abuse between residents or by caregivers between 2011 and 2016 has more than doubled in long-term care facilities.  Even though the government has poured lots of dollars into a wide array of education programs for long-term care staff, facilities have spent money on re-designing dementia care units, and multi-sensory rooms and snoezelen carts are incorporated into daily care, the results have been minimal at best.  While education, re-designed environments and specific therapies can be helpful, they need to be delivered within a person-centred environment.

We need a complete culture change in our long-term care homes.  This will only come about if there is the political will to bring about this change and if we can learn from the positive experiences of places like Sherbrooke Village that are leading the way to make this culture change a reality.  Sherbrooke is a long-term care home that embraced such a culture change and was featured on the CBC news the same evening as the episode mentioned above appeared.   See it here.

So here is another plea to you to act now.  Contact your local councillor, contact your MPP,  write to your local newspaper, etc to bring culture change to your community and to a long-term care home near you!

 

 

 

 

Are Rules and Regulations Preventing Quality of Life?

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Here’s what some are saying:

NDP Health Critic, France Gélinas (MPP Nickel Belt): Long-Term Care Home inspections fall short.  Gélinas, stated that “some homes are really not meeting quality care and need the government oversight to protect people.” Click here for January 10th article in the Ottawa Citizen by Elizabeth Payne.

Candace Chartier, CEO/Ontario Long-Term Care Association: “in long-term care, 95% of administration burden arises from meeting legislated obligations directly related to superfluous care planning documentation and responding to inspection requirements, both of which divert staff time and resources from the provision of direct care.”

Lisa Levin, CEO/AdvantAGE Ontario: “Long-term care is the most over regulated sector in Ontario with 600 regulations”.

Administrators:  trying to comply with all the regulations prohibits the implementation of innovative care that would benefit residents directly.

A family member: I saw a staff who was handing out medication. She stopped to help a resident who fell and was then chastised for leaving the medication tray unattended.

If these 600 regulations and the extra 100 inspectors have not managed to improve our long-term care home system by now, they never will.  Don’t you think it is time for a transformation – one that promotes a better quality of life for residents as opposed to more rules and regulations?

What do you say?  Please tell us what you think – we would love to hear from you.

And share this with your contacts or anyone you know who may be interested in improving the way care is delivered to the 70,000 residents now living in our long-term care homes in Ontario.

Kudos to Toronto for spreading innovation in long-term care homes

Toronto council has voted unanimously to bring change to city-run nursing homes with new programming that promises to improve the lives of seniors with dementia.  This change is similar to the work recently done in a Peel Region-operated dementia unit where residents, who once spent days staring at the floor, came back to life through friendship with staff trained in empathy-focused care.  Read more here.

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At the 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.

If you want to see innovative models of long-term care homes introduced in your community:  One of the followers of our blog sent us some ideas on how we can influence our own local politicians, especially in light of the upcoming October 22nd Ontario municipal elections.  See below for her suggestions:

We are not talking about high tech solutions
We are talking about low tech, low cost solutions
Solutions to what?
Solutions to our broken institutional long-term care homes.

If you want our vote
You must not be afraid to change the culture in these homes
You must allow residents to engage in meaningful activities
If you want our vote.

Thousands more beds are being allocated to long-term care
Now is the time to lead others in an innovative social model
A model in which you and your family would be happy to live
If you want our vote.

Residents with dementia living in our long-term care homes deserve a better quality of life.  Please take just a few minutes to help these residents by sending an email or making a phone call to your local councillors or mayors.

And please click on the “follow” our blog button to provide more support to our cause and share with your own contacts.

 

 

 

Does This Look Like Home To You?

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Does this photo show the kind of “home” in which you would like to live?

If you have had a relative in a long term care home in Ontario, you will understand. It’s about the choice between a medical model vs a “relationship” / social model of care.

Would you want to live out your final years in one of our existing long term care homes?  If so, please tell us. We would love to hear from you.

If not, please contact your MPP to tell them our system is broken and we need to consider replicating the innovative homes that already exist – some of which are referenced in our previous blog posts. Now is the time since the government is funding 5,000 new beds over the next 4 years.   Don’t have your MPP contact info?  Click here.

Help spread the word by sharing this with at least 5 of your contacts.

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You Can Bring Joy to Life in Long-Term Care

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

 R. Buckminster Fuller.  

Blog post #6

Barely a week goes by, when we hear yet another bad news story about our long-term care homes in Ontario. (See recent articles in the Ottawa Citizen and Toronto Star).

Despite the many millions of dollars injected into the system over the last 30 years, we seem to have fallen into an abyss from which we cannot escape.  Throwing good money after bad has not worked.  We need to transform our system!

The Ontario government has promised 5,000 new long-term care beds by 2021/22.  Models exist now such as Hogewey Villages (Netherlands), Eden Alternative models (in Canada and U.S.) and other innovative models which help to reduce aggressive incidents and promote quality of life.  Currently Langley, B.C. and Tasmania are building new homes designed after Hogewey Villages – 25 years after this model was created.

We cannot wait another 25 years for progress in Ontario. We need a willingness to act for significant change to our long-term care home system.  With new beds coming on stream, now is our opportunity to demand our government consider a new model of care!  Our residents deserve it.

The Ontario election is in June.  Please personalize the information in this post and send to your MPP urging them to address this situation!  Click here for MPP information.

And you can help to promote change by sharing this with all your contacts, posting on your Facebook page or on your Twitter account.  And FOLLOW US!

 

90% of Ontario’s long-term care home residents have some form of dementia

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Why don’t we have more innovative dementia-friendly long-term care homes?  Ron Schlegel and his family started the ball rolling years ago when they developed Schlegel Villages in Ontario which included Memory Care Neighbourhoods.

Emma, Ron’s mom, was the catalyst for their innovative homes.   Her experience in a long-term care home “robbed her of her personhood”,  and “no effort was made to get to know who she was as a person and what gave her joy in life or caused her frustration.”  Ron wanted “to change the way those with dementia would be cared for in their final years” and created a new social model of care.

You can probably relate to Emma’s story – just take 2 minutes  and click here:    https://schlegelvillages.com/living/memory-care

Meet, email, send a letter or phone your MPPs to ask for their commitment to ensure that the 5,000 new beds will be awarded only to those organizations/companies who propose to build innovative, dementia-friendly environments.   See our previous posts which have highlighted many such models already in existence.   Your MPP info is here.

Please leave us a comment as we would love to know what YOU think.  You can help to promote change by sharing this with all your contacts, posting on your Facebook page or on your Twitter account.  And FOLLOW US!