Kudos for the Ontario Long-Term Care Staffing Report!

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.

An Opportunity for Lasting Change?

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.

TIME, MONEY AND A WRECKING BALL?

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MoneyWrecking ball

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.

 

COVID-19: Hats Off to Long-Term Care Home Workers

Hats Off!

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!

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!

Blog Dec 11

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.