Category: Transformative Culture Change

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Get involved and demand change now in Ontario’s long-term care homes!

While change won’t happen overnight we need to start somewhere and there is no better time than now.   The upcoming provincial elections provide an excellent opportunity to demand change.   If we don’t demand change now in Ontario’s long-term care home system, the status quo is likely to be with us for decades to come.

Here are some questions  to consider asking the candidates who are running for office in your riding:

Small homelike environments and COVID

 Ontario’s Long-term Care COVID-19 Commission recommended that the Ontario government promote and provide funding for long-term care homes that change to recognized, emotion-based models of care – where residents, staff and families live in smaller, home-like environments which have shown fewer COVID cases and fewer deaths than in the current institutional models.

Do you agree with this and if so, would you commit to start this process in the first year of your term?

Emotion-based model of care and funding

 Ontario’s Long-term Care COVID-19 Commission recommended that the government promote and provide funding for long-term care homes that change to recognized, emotion-based models of care where staff know the residents, the residents are engaged and feel they are home and where compassion and respect are at the centre of everything.

Do you agree with this and if so, would you commit to including this in the budget process during the first year of your term?

 New Beds

 Ontario’s Long-term Care COVID-19 Commission recommended creating smaller self-contained home-like units within existing and new homes.

As Ontario looks at developing and rebuilding LTC homes in the future, do you agree with this and if so, what incentives would you put in place to make this happen during the first year of your term?

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C.A.R.P. asking for public support!

This article was published in the Ottawa Citizen, May 4, 2022

C.A.R.P. asking for public support to make transformation of Ontario’s long-term care home system a ballot box issue

 In a recent opinion piece Grace Welch and Brian Graham articulated well the major shortcomings of Ontario’s long-term care home system brought to light as a result of the pandemic and the type of changes needed.

Within the present system, it is very challenging for staff working in long-term care homes to address all the physical, social, psychological, spiritual, and cultural needs as described in the Long-Term Care Homes Residents’ Bill of Rights.  Ontario has one of the most risk adverse long-term care homes system in Canada where the overabundance of regulations contributes to objectifying residents according to tasks, not needs.

C.A.R.P. – a New Vision for Aging (Canadian Association of Retired Persons) wants to see a drastic transformative change in long-term care homes from a task-based to an emotion-based model of care.  Such models already exist: Eden Alternative, Green House, Butterfly and Hogewey in which the quality of care is understood as a relationship where residents, staff, families and volunteers are treated with dignity and respect in a homey environment, and kindness permeates the home.  These models have been implemented in Canada including Ontario, Saskatchewan, Alberta, and British Columbia, in the United States, and internationally.  No need to reinvent the wheel.

There are a growing number of both public and for-profit long-term care homes in Ontario that have successfully implemented an emotion-based model of care on one or more units in their homes.    Most of these homes did so within existing budgetary and regulatory constraints with plans to expand the model.

Even closer to home, kudos to the Glebe Centre (a non-profit charitable home in Ottawa) which is already in the second stage of implementing the Butterfly model, and to Bonnechere Manor and Miramichi Lodge in Renfrew County which have begun the process of implementing the model.

These homes also experienced better outcomes both pre and during COVID than the traditional homes with fever cases and fewer deaths. Other benefits include improved resident and family engagement; improved staff satisfaction; reduced use of anti-psychotropic drugs; reduced use of food supplements; reduced staff sick leave (huge cost savings for some); and the list goes on.

We recognize that home care services are also broken and need a major revamping. However, our aging population is increasing and so is the number of people with dementia   This means the need for long-term care homes is not going anywhere soon.   Circumstances are such that not every loved one when becoming frail, either physically and/or cognitively, can be cared for at home.  Approximately 85% of all residents in long-term care homes have either some kind of dementia or some complex chronic disease that requires 24/7 care.  It is unrealistic to expect these individuals to be cared for at home.

The action needed is to immediately begin change from task-based to emotion-based care in Ontario’s long-term care homes.  This can’t happen overnight but we need to start somewhere and the sooner we start the better.  There are many ways to do so, including a variety of pilot projects – one unit at a time, one floor at a time, one home at a time.  Residents in long-term care homes have been deprived for decades of the quality of care and quality of environment they so rightly deserve.  This change can’t come quickly enough!

The Ontario Morocco Commission recommended ‘that the Government promote and provide funding for long-term care homes that change to recognized emotion-based models of care”.  Ask your MPPs if they would commit to including this in the budget process in the first year of their term, if elected.

If we don’t begin to fix the long-term care home system now, after two years of horrific tragedies, long-term care homes will be forgotten once again for decades or until another pandemic hits!

Claude Paul Boivin, President, C.A.R.P. Ottawa

Kathy Wright, Vice-President, C.A.R.P. Ottawa

C.A.R.P. – A New Vision for Aging (formerly known as the Canadian Association for Retired Persons) is Canada’s largest advocacy Continue reading “C.A.R.P. asking for public support!”

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“Let’s Fly With Butterfly”

 

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

 

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Long-term care home system: a ray of hope on the horizon

The Ontario government is currently reviewing and revising the LTC Act.  Now is the time to ensure that the Residents’ Bill of Rights is no longer violated.

This new legislation ‘will look fundamentally at what the foundation of long-term care needs to be in Ontario” and respond to recommendations from Ontario’s Long-Term Care COVID-19 Commission and others.

While all the recommendations in the Commission’s Report merit implementation, the following two recommendations are critical and need to be included in the revised LTC Act:

  • Ensure that family members are never denied access to their loved ones in long-term care homes (recommendation #31), and
  • Recognize the need for a transformative culture change using an emotion-based approach to care where residents, staff and families feel part of a community and are treated with dignity and respect; where there are small home home-like environments, where there is adequate, full-time, well-paid staff, who are trained in empathy and culture change and where family members are integral members of the team (recommendation #58)

Please encourage the Ontario Government to do the right thing and 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.

 

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Will the Ontario government finally clean up its Act! continued…..

 

As noted in the previous blog post, the Ontario Government has long fallen short in meeting the existing Residents’ Bill of Rights (which falls within the Act).   Here are several more aspects of the Bill where expectations aren’t being met and where implementing an emotion-based model of care would meet those expectations:

  • Every resident has the right to live in a safe and clean environment. Transformative culture change to an emotion-based model of care would make this happen.
  • Every resident who is dying or who is very ill has the right to have family and friends present 24 hours per day. A culture change to an emotion-based model of care would ensure this happens.
  • Every resident has the right to receive personal care that accommodates physical, medical, emotional, and social needs. To succeed, we need a culture change to a resident-centered, emotion-based model of care.
  • Every resident has the right to receive assistance towards independence based on a restorative care philosophy to maximize independence to the greatest extent possible. An emotion-based model of care is needed.
  • Every resident has the right to have his or her lifestyle choices respected. Transformative culture change is needed to ensure this happens.

The urgent need for this transformative culture change cannot be repeated enough!  Already this issue seems to be disappearing from the Ontario Government’s radar.

We urge you to do your part to bring an emotion-based model of care 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.

If we don’t speak up for our seniors who will?

 

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Will the Ontario Government finally clean up its “Act”!

 

It has been decades since any stripe of government has paid heed to or lived by the fundamental principle in the Ontario Long-Term Care Homes Act, 2007 and Regulation 79/10 (which came into force in July 2010):  i.e. “[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.”

 Supposedly the Ontario Government is in the process of proposing changes to the Act by the fall 2021.

The Government has long fallen short in meeting the existing Residents’ Bill of Rights (which falls within the Act).   Implementing an emotion-based model of care would meet those expectations:

Every resident has the right to be properly sheltered, fed, clothed, groomed and cared for in a manner consistent with his/her needs.  A culture change to an emotion-based model of care would make this happen.

  • Every LTC resident has the right to NOT be neglected by the licensee or by the staff. Transformative culture change to an emotion-based model of care would ensure no LTC resident is ever neglected.
  • Every LTC resident has the right to be protected from abuse. Transformative culture change to an emotion-based model of care would make sure no LTC resident is ever abused.
  • Every LTC resident has the right to be treated with courtesy and respect, in a way that recognizes their individuality and respects their dignity. A culture change to an emotion-based model of care is a MUST.

Please do your part to bring emotion-based model of care 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.

 

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The Ontario Government Needs to Take Action NOW!

 

Malton Village, The Toronto Star June22, 2018

Ontario’s Long-term Care COVID-19 Commission made 85 recommendations that need to be enacted in order to keep residents and staff safe in future viral outbreaks. The recommendations were divided into five areas. Highlighted here are the remaining three areas of the Report.

Person-centred care: Human Rights Code, the Long-Term Care Act and Residents Bill of Rights: With years of neglect, sweeping reforms are needed in our long-term care homes to protect residents and provide a quality of life. The Report highlights person-centred care but In order to provide person centred care, all the residents’ needs should be assessed and respected including lifestyle choices, diversity and emotional needs. (Recommendations: #29, #37, #38)

Staffing issues:  A severe staffing shortage and a work force poorly trained with few infection control measures compounded the COVID-19 situation. All the staffing recommendations in the Report are important. There is an urgent need for skilled staff but recommendations are not explicit enough in what training is required. Person-centred care requires staff to have emotion-based training. Recruitment and hiring practices need to be addressed. Staff recruitment should assess the attributes of emotional intelligence, empathy, compassion. All staff and students should have experience in settings where new models of care are being provided. Most importantly, there needs to be commitment from leadership to promote person-centred care practices.  (Recommendations: #40, #41, #42, #49)

Design Standards: Poor facility design and resident overcrowding heightened sickness and death in long-term care homes, with nearly 4,000 residents and 11 staff dying of COVID-19. All the design manual recommendations are important but alternative person-centred models and provision of incentives in order to create smaller home-like units needs to be included.  (Recommendations #61 and #64)

Transformative culture change is needed in our long-term care homes. Please send a letter to your MPP encouraging the government to take action NOW on the recommendations in this Report.

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Will You Make a Difference?

Sherbrooke Village Long-Term Care Home

Ontario’s Long-term Care COVID-19 Commission made 85 recommendations that need to be enacted in order to keep residents and staff safe in future viral outbreaks. The recommendations were divided into five areas but the quote that sets the tone of their report and directs all leaders in government and LTC homes is this:

“Leaders at every level must put their hearts, as well as their minds into reimagining the care of the elderly in this province.  This will require a philosophy of care that is anchored in respect, compassion and kindness for the people who live and work in long-term care.  It is not just about building more homes.  There needs to be a transformation to a person-centred care model, which motivates different behaviours and rewards innovation that leads to better outcomes for residents and staff.” (Ontario’s Long-Term Care COVID-19 Commission Report p. 24)

In calling for Transformative Culture Change, the Independent Commission recognized that alternate models of care that had smaller home-like units had fewer viral outbreaks. (Recommendations #58 and #61) Currently, we have over 11 such models of care in Ontario in both profit and non-profit LTC homes that can provide information and guidance to the over 600 institutional LTC homes in Ontario!

All the recommendations regarding family/caregivers are important. Family members/caregivers need to be engaged in the process and have access to their loved ones. (Recommendations #5, #9, #30, #31, #75).Safe in-person access and regular remote visits during viral outbreaks, increased communication with families/caregivers during this time and anytime are very important. In transformative culture change environments, family members/caregivers are integral members of the team!

The Commissioners did their part and shone a light on the terrible circumstances in our LTC homes. Now you can play a role by contacting your MPP with the above information. You can make a difference! Please send a letter to your MPP encouraging the government to take action NOW on the recommendations in this Report.

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Transformative Culture Change: C.A.R.P. Ottawa’s Brief

 

C.A.R.P Ottawa recently submitted its Brief to the Independent Long-term Care COVID-19 Commission and has requested an interview with the Commissioners. 

Its recommendation is that the Ontario Government bring about transformative culture change in its LTC homes by ensuring an incremental approach according to specific timelines and targets.  Accountability structures to be put in place for every long-term care home in order to adopt one of the existing innovative models of care. Staff and volunteers (working conditions; recruitment and retention), education/training, infrastructure, inspections, and families/caregivers are all critical elements of transformative culture change that need to be reformed.

The implementation of transformative culture change in Ontario’s LTC homes will require the Provincial Government to:

– Demonstrate the leadership and commitment necessary to implement transformative culture change in Ontario’s LTC home system by adopting one of the four innovative models of transformative culture change.

– Implement the recommendations of the Ontario Ministry’s Long-term Care Staffing Study including the allocation of necessary resources to providers of LTC homes.

–Revise the Design Manual for LTC homes to achieve transformative culture change – small, home-like environments, single and double rooms with private bathrooms, and shorten the timeline for the requirement for homes to meet the most recent design standards.

–Utilize reports from LTC home inspections and data to guide timely improvements to the Ontario LTC home system and to support providers of LTC homes in utilization of data.

–Assert the role and value of families and caregivers as part of the community in the home through timely and up-to-date communication protocols, particularly when a crisis such as the current pandemic occurs and require the same of LTC home providers.

If you support C.A.R.P. Ottawa’s recommendation for a transformative culture change in Ontario’s long-term care homes, please contact your local MPP and make your view known or write directly to Ontario’s Independent Long-term Care COVID-19 Commission at info@LTCcommission-commissionSLD.ca.

#ChangeLTCNow!

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The clock is ticking!

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Increasing the number of direct care hours for residents in long-term care homes has been in the news! On Oct. 28, the Time to Care bill passed the second reading in the Ontario legislature. If the bill passes third reading, it will amend Ontario’s Long-Term Care Homes Act to put in place a minimum staffing level sufficient to provide four hours of personal support and nursing care per resident per day.  Then on November 2nd,  Premier Doug Ford announced that “thousands and thousands” of nurses and personal support workers will be hired as Ontario moves to an average of four hours of hands-on care daily for nursing-home residents. However, the Premier said, it will take four years to reach that level for hiring and training to occur.

While four years is a long time, this is a first big step in addressing the need for more staff who provide hands on care!   Providing more hours of direct care and more staff is a no brainer and experts have been advocating for this for some time. But should long-term care homes just focus on filling new staff positions or is it time to look at how care is delivered and then look at hiring appropriate staff?

Transformative culture care means, supporting a shift from institutional to home-like environments. It means requiring facilities, old and new, to create an environment that supports a culture of person-centred care, having shared living spaces and private bathrooms. It also means recruiting staff and volunteers who exhibit emotional intelligence, empathy, compassion, have a willingness and ability to learn new approaches and work as a team. Then a training program, that supports person-centered care, needs to be available, not as a streamed video learning program but as an in-person, mentored learning approach. The approach needs to be embraced by the leadership team and then modeled for all staff and volunteers!

If you are interested in bringing transformative culture change to Ontario’s long-term care homes, please write directly to Ontario’s Independent Long-term Care COVID-19 Commission at info@LTCcommission-commissionSLD.ca

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What is Transformative Culture Change Anyway?

What is transformative culture change and what does it mean?

The Independent Long-term Care (LTC) COVID-19 Commission has now been established. Terms of Reference have been posted. What can we hope for? The easiest solution for the Independent Commission is to make recommendations that should have been instituted long ago: more staff: full time staff versus casual staff; more direct hours of care; fair salaries; infection control education and practices, elimination of four bed rooms and availability of air conditioning. If this is the end result, then our government has failed. Long-term care is a broken system and if the Independent Commission wants to make any significant impact, then it needs to look at how to improve quality care in LTC homes with a transformative culture change.

This means revising rules and regulations, moving from institutional care to areas with small home-like environments, embracing the valuable contribution that families and volunteers make, hire staff who want to work with seniors, and look at delivery of person-centred care. All this happens now in a few LTC homes across Canada. We call them innovative models of care but they should be the norm not something unusual. CARP (Canadian Association of Retired Persons) Ottawa Chapter, along with collaborating organizations, is advocating for transformative culture change in long-term care homes.

Transformative culture change means the way of organizing, and giving care in long term care homes changes so that residents know and feel like they are living in a warm, caring environment that looks and feels like home. It enables staff to know who their residents and families are – and what their life was like before. It means schedules and routines are flexible to match the resident’s preferences and needs. Friendships develop between staff, residents, families and volunteers. It means residents are involved in many meaningful activities according to their abilities and what brings them joy. Transformative culture change means Relationships, Relationships, Relationships!

Excerpt from an article written by Sue McDonald, a member of CARP Ottawa Advocacy Working Group on Long-term Care

If you are interested in bringing transformative culture change to Ontario’s long-term care homes, please write directly to Ontario’s Independent Long-term Care COVID-19 Commission at info@LTCcommission-commissionSLD.ca

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