The Toronto Star article on Crisis of Care printed Feb 7, 2021, focuses on the “inertia” of government that has led to a failure of the long-term care home system.
For more than four decades, a doctor working in the system has witnessed:
Poor business decisions that affected delivery of quality of care
Too much time spent on paperwork and not enough time on direct care of residents
Not enough adequately trained staff
Verbal, physical or sexual abuse of residents
And now more than 3000 residents have died from COVID-19. In April, Premier Doug Ford called “the widening cracks in the long-term care system a wake-up call to the world” and spoke of the need to form an “iron ring” around vulnerable seniors. Well, that has not happened. In fact since April, there have been many more deaths due to Covid-19 than there were in the first wave. When will the government stop promising and start doing? How many more deaths are needed before inertia turns to action. Our vulnerable seniors deserve nothing less than to live their remaining years in a safe, caring environment. Read more here.
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!
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.
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.
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.
There is no quick fix. It will take time, money and a wrecking ball — along with a new public attitude toward aging to fix Canada’s long-term care facilities.
The following is an excerpt from a CBC interview on June 27th, 2020 by Evan Dyer.
“Long-term care needs a long term solution. It’s not going to get fixed overnight. And our concern certainly now at the Canadian Nurses Association is it’ll be a sort of duct tape solution — throw a few more staff in and pay them a little bit more and it will be fine. And it won’t.
There are fundamental issues that need to be tackled in long-term care. So you have people in rooms of four or two, or you have a single room with a Jack and Jill bathroom — all kinds of places for disease to move.
It’s hard to imagine but many of those places don’t have air conditioning. So one of the things that staff do to make residents more comfortable is they will congregate them in a lounge or in a hallway and put large fans on them to help them cool off. Well, that’s a recipe for disaster right there. But pandemic measures on their own won’t lead to lasting change unless Canadians themselves change the way they think about aging and elder care.” See full article here.
Michael Villeneuve, Chief Executive Officer of the Canadian Nurses Association.
Across Canada, there is a group of health care workers, those working in long term care homes, who are placing their own lives at risk while they do all that they can to care for and protect their residents. Residents living in long term care homes are particularly vulnerable to COVID-19 and long term care homes are one of the toughest places to contain an outbreak. This is because the people who live there are elderly, often have compromised immune systems, and they live and socialize in close quarters –in some of the older homes, even 4 per room.
Long term care homes are now prohibiting visitors, which adds more stress to both residents and staff. Residents, who look forward to visits from family and friends, may experience feelings of isolation and loneliness and staff are not only concerned about their own health but also those in their care. As one staff member has said, “You don’t know who’s going to still be there the next day.”
However, there are some amazing stories that are now coming out about the creative ways that long term care workers are promoting social connectedness while keeping residents physically distant from one another. Read more here.
Our hats go off to these wonderful, caring, compassionate health care workers. Thank you very much for everything you are doing to try and keep your residents safe and healthy!
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.
Legislation: All 3 types are subject to the same standards, rules and regulations.
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.
The 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.
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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!
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.
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“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.
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