Let’s Fix the Culture Around Long-Term Care Homes

Why does it take an outbreak to put long-term care homes back in the news? The news of the latest outbreak in a long-term care home is a stark reminder that residents in long-term care homes have been, and still are, vulnerable to this terrible pandemic. The need for change in long-term care is patently obvious.

Although measures to deal with staffing are critical to fix the immediate problem, there is a greater need to fix the culture of long-term care homes for the longer term. This can be done. CARP Ottawa is working with other organizations in Ontario to bring about transformative culture change in Ontario’s long-term care homes through a grassroots movement.

An independent commission set up by the province 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 has begun its work. We should all follow the work of this commission with great interest. And we should all make our voices heard to make sure the changes recommended are truly transformative.

Elizabeth Spence, Letter to the Editor, Ottawa Citizen, September 26/20

If you are interested in helping to bring about transformative culture change to Ontario’s Long-Term Care Homes, please either write a letter to the editor in your local paper or write directly to the Commission. You can write to them at info@LTCcommission-commissionSLD.ca

Please share this post with your contacts or anyone else you know who might be interested.

Please use #ChangeLTCNow when sharing on social media



As you know we are working with CARP Ottawa to bring about transformative culture change in Ontario’s long-term care homes through a grassroots movement.  To this end we have asked the members of CARP Ottawa and its collaborating organizations in Ontario to send an email to their own local MPP’s about this matter.  We would like to ask you, our blog followers, to do the same.

Thank you to all the blog followers and friends who responded to our last request by sending letters to Minister Fullerton to recommend that CARP Ottawa be appointed to the Independent Commission on Long-term Care.

In the end, only three individuals were appointed to the newly named Independent Long-term Care COVID-19 Commission – Associate Chief Justice Frank Marrocco, Angela Coke and Dr. Jack Kitts. Now it is even more imperative to bring awareness and influence regarding this change to not only the Commissioners but also to our local politicians. 

Here’s How YOU Can Help

Send the email below to your own local MPP (contact info here) and copy your local mayor or city councillor (contact info here). Personalize the email with your own words on the need for culture change in Ontario’s long-term care home system. Or if you and your family have been affected by the COVID-19 virus, describe the impact it had on you.     

Copy us at our email changeltcnow@gmail.com We’d like to know how many of you are still interested.

Subject line: CARP Ottawa calls for transformative culture change in Ontario’s long-term care homes.


As a member of your constituency and someone who is very concerned about the long-term care home system in Ontario, I would like to express my support for Ontario’s Independent Long-term Care COVID-19 Commission.  However, I believe strongly that a transformative culture change is needed to fix the systemic failings apparent in these homes. 

I agree with Minister Fullerton and Premier Ford who have said on many occasions, “We have been clear the long-term care home system in Ontario is broken.”  Now we must fix it.

There are new models of care that exist in the U.S., Europe and even in Ontario, which have embraced the same guiding principles: a relationship-based approach to care; person and family-centred care; small home-like environments; higher staff to resident ratio; full time, well-paid staff who are trained in empathy and culture change and an environment where residents, staff and families feel a part of a community.

These new models have all embraced transformative culture change and have achieved much better outcomes than our traditional homes in Ontario.  We don’t need to reinvent the wheel. 

These outcomes include a decrease in the use of medications, in the number of aggressive incidents, in the number of hospital visits, in the amount of food waste and staff sick time, all the while increasing positive interactions with staff, families and residents.

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

My request is that you bring this urgent need for a transformative culture change in Ontario’s long-term care homes to the attention of Minister Fullerton and Premier Ford. If you would like more details on the existing models or this kind of culture change, please contact CARP Ottawa at changeltcnow@gmail.com

I look forward to hearing from you.

Your name…

What does transformative culture change mean for: Infrastructure


Many LTC (Long-term Care) homes in Ontario are old and outdated with some residents living four to a room and sharing one bathroom.

  • Support shift from institutional to home-like environments.
  • Require facilities (existing and new) to create an environment that supports a culture of person-centred care, shared living spaces, and private bedrooms.
  • Shorten provincial timelines for requirement of homes to meet most recent standards for LTC building design.

What does transformative culture change mean for: Inspections

  • Use cumulative reports of LTC home inspections and data to guide timely improvements in Ontario’s provincial LTC system. Engage family councils, residents, families and front-line staff in this process.
  • Evolve the role of LTC inspectors to that of compliance advisors or resource persons who foster a partnership between government funders and providers of care.

What does transformative culture change mean for: Families/caregivers

  • Value, support, recognize and respect families and caregivers as part of the community in the home.
  • Activate timely and up-to-date communication protocols between families and LTC homes when a crisis occurs.
  • Support and help maintain family-resident relationships when a crisis occurs.

If you have any questions, please contact us


What does transformative culture change mean for: Staff and Volunteers?


Working Conditions

  • Value, support, recognize and respect all staff and volunteers for their work.
  • Provide fair compensation with fitting salaries and benefits including sick leave.
  • Ensure staff positions are full-time wherever possible with staff dedicated to working only in one long-term care home and with realistic
  • Provide more hours for direct care.

 Recruitment and Retention

  • Recruit staff and volunteers who exhibit emotional intelligence, empathy, compassion, have a willingness and ability to learn new approaches, and work as a team.
  • Actively involve staff and volunteers in decision-making that is integral to better resident care.

Education / Training

  • Educate staff and volunteers on relationship-based approaches.
  • Strengthen staff and volunteer skills in empathy, social interaction and team work.
  • Provide timely, on-the-job continuing education for staff and volunteers that is responsive to changing residents’ needs.

If you have any questions, email us at:  ChangeLTCNow@gmail.com





Transformative Culture Change: Key Messages


CARP Ottawa, as noted in previous blog posts, is advocating for transformative culture change.  This post will be the first of three that describes what this actually means along with the key messages detailing what elements are necessary to bring this change to fruition and improve quality care and quality of life for residents in long-term care homes in Ontario.

Transformative culture change means:
  • Using a relationship-based approach to care where residents, staff and families feel part of a community and are treated with dignity and respect;
  • Setting up small home-like environments;
  • Providing more hours of direct care for residents;
  • Employing full time, well-paid staff, who are trained in empathy and culture change;
  • Recognizing families and caregivers as integral members of the team:
  • Engaging volunteers who are trained in empathy and culture change.

Key messages have been developed for staff and volunteers, infrastructure, inspections, and families/caregivers. All the key messages need to be operationalized within a transformative culture change approach in which quality care is understood within a relationship-based environment where residents, staff, volunteers, and families are treated with dignity and respect and feel part of a community.  The key messages will appear in the next two blog posts.


The residents, families, and staff of Ontario’s long-term care homes need your help.
An urgent update on our work re: Ontario’s Long-term Care Home System.


Taken from WordPress.com

We have joined the CARP Advocacy Project whose goal is to strengthen Ontario’s Long-term Care Home system through a transformative culture change.

The government has announced that an Independent Commission will be set up in July to review Ontario’s long-term care home system and propose improvements. CARP Ottawa has submitted a request to be involved in the Commission and has recommended a transformative culture change for long-term care homes.

A transformative culture change includes: a relationship-based approach to care; person and family-centred care; small home-like environments; higher staff to resident ratios; full time staff who are well-trained in empathy and culture change; and an environment where residents, staff and families feel a part of a community.  The Eden Alternative, Green House Project, Hogewey Villages and Butterfly Homes are examples that have been implemented in Europe, Australia, the U.S. and recently a few in Canada.


We want organizations and individuals to provide input that will encourage the Commission to consider recommendations for transformative culture change. Awareness of the need for major reforms in LTC has never been so evident. This is a unique opportunity.

We need to act – NOW.

Support this grassroots movement. Get involved.

Email – changeltcnow@gmail.com
Be a part of #ChangeLTCNow.


Better ways to run long-term care homes


Sherbrooke Village Long-term Care Home, Saskatoon, Saskatchewan

Below is the letter published in the The Ottawa Citizen in response to the article re “funding cuts jeopardize care homes”.   Read the July 22/19 article here.

“Once again, the vulnerable older adults living in our long-term care homes will be penalized by funding cuts.  Many residents continue to be frustrated and bored, which often results in aggressive incidents.  Staff continue to be exhausted, frustrated and overworked.  Funding cuts aren’t the answer.  Transforming the way care is delivered and creating a new culture of care with innovative models that already exist is a solution.  These innovative models are being used in several communities in the province.

Yes, there is upfront investment but there are projections that the result is cost-neutral.  The result?  Fewer aggressive incidents, decreased medication use, and a decrease in staff sick days.

These models create an atmosphere that is more homelike and provide a sense of community for residents, staff and families.  Wouldn’t you want this kind of transformative care for your family member?

The new Minister of Long-term Care, Merrilee Fullerton, has said that ‘long-term care is a priority for this government.’   CARP Ottawa urges her to include a study of these innovative models of care before making any future decisions regarding cuts.

Rick Baker, President, CARP Ottawa”

If you belong to another branch of CARP or any other organization, please take some action and send letters to your local papers.   We need your help!

Just Imagine the Possibilities!

“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

Just imagine if politicians understood what quality of life looks like for persons living in long-term care homes!  Well, now you can see this for yourself.

Click on the video below and view between the 3:04 and 5:30 minute mark.


Below are the innovative models highlighted on our blog.  While each model possesses unique features, the fundamental elements integral to all of them are the development of relationships between staff and residents and their families and the caring that embraces kindness and compassion.  For more details on any of the models below, please scroll down our blog site.

  • Hogeway Dementia Village, from Holland (this model has been implemented in Ontario, Alberta, and in progress in British Columbia)
  • Eden Alternative: Over 300 homes in the USA and globally, 7 in Eastern/Central Canada and 1 in Saskatchewan (Sherbrooke Village in Saskatoon).
  • Green House: 242 homes in 32 states in the USA with 150 more in various stages of development.
  • Schlegel Villages in Ontario, 19 villages in Ontario
  • Butterfly Care Home: Over 100 Butterfly Homes in the U.K., Ireland, Australia, and Canada – 7 in Alberta & 1 in Ontario with more promised.

All of us, whether we are family members, health care workers, or just interested citizens, can advocate for change in a system that needs to be changed.   With the Ontario municipal elections behind us, we have an opportunity to influence the 2019 priorities that will be set in the coming weeks in communities across the province.  You can start by contacting your local councillor and/or Mayor.  Please share your advocacy ideas under the comments section of this blog.


More Transformations Coming!



It looks like Peel Region’s initiative is continuing to have a positive influence.  First the City of Toronto followed suit and now Primacare Living has decided to bring the Butterfly Program to St Catherines, Brampton, London, and near Hamilton according to the October 24th Toronto Star article.

Could we be on a roll?  If so, why is nothing happening in Brantford, Ottawa, Kingston, North Bay and other cities in Ontario?

And as we have highlighted in previous posts, it does not necessarily have to be the Butterfly Model!  Moira Welsh, the Star reporter, did research on other innovative models and stated “The Green House Project and Eden Alternative – both created by American Geriatrician Dr. Bill Thomas – share similar philosophies that favour small homes, social interaction and friendships between staff and people in their care.”

Let’s get going folks!  Now that the Municipal Elections are over in some provinces, you can send letters asking Mayors and City Councillors to champion transformation in one of the long-term care homes in your region. 

You can help by sharing our blog with your contacts and encouraging them to be followers.   Also, please share on your Facebook/Twitter accounts if you have them.

If we do nothing, nothing will change.


Thanks to Betty for leading the way!

18PanelTTLTCHFullSizeRenderSept20 (3)
Betty is in the centre flanked by the moderator and panelists

Betty is a past caregiver whose husband lived in a long-term care home.  She decided to increase awareness for innovation in our long-term care home system by organizing a panel at her church through the JOY (just older youth) program.

When asked “Do you think transforming our long-term care home system should be a municipal election issue”, the overwhelming response was “yes” (75 people).

If you agree, here is a draft letter you can personalize and send to those running in your ward on October 22nd.   Names and emails of candidates in Ontario wards can be found by searching “certified candidates for 2018 municipal election in (insert city name)”. There are only a few weeks left to plant these seeds.

If you are new to our blog,  scroll down to learn about the Butterfly model that  transformed a unit in one of the Region of Peel’s long-term care homes.

Please share this with your contacts and/or on your  Facebook or Twitter accounts.











18svh_roof_top_garden_concept Providence Care B.C.

Concept drawing for proposed Dementia Village in Metro Vancouver

Do you know what the main difference is between Ontario’s institutional long-term care home system and the innovative social models like the one now being proposed by Providence Health Care in B.C.?

Relationships, relationships, relationships – between and amongst staff, residents, families and the community

What does this actually mean?

  • It means a “constructive culture of care” enabling staff to know who their residents and families are – and what their life was like before.
  • It means residents are involved in many meaningful activities according to their abilities and what brings them joy.
  • It means schedules and routines are flexible to match the residents’ preferences and needs.
  • It means the surrounding community is invited to actively participate.

Providence Health Care is developing a concept for Metro Vancouver, based on the Dutch Hogewey Village model (scroll down for our first blog post re Hogewey in September 2017), that incorporates the above philosophy.   Read more here.

Please contact your MPPs again to urge them to fund something similar, perhaps as a pilot project, in Ontario when approving the new 5,000 long-term care beds.

AND PLEASE – encourage 3 of your contacts to “follow” our blog.  If you agree with our stance,  we really need your help on this to increase our influence.


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

Did you know that over 300 long-term care homes are using the Eden Alternative Model of Care? 

In just 3 minutes see how the Eden Alternative model revolutionizes care and reduces the need for drugs.  And this is only one of several model options.

“How many of our MPPs, or those running to become one, have taken the time to study alternative models of elder care? Most provincial politicians seem stuck on a vision that teeters on the verge of failure.”  Continue reading the Citizen’s Editorial here.

We would really like to know what you think!  Please complete the 2 question survey here.  Your name and contact info will not appear on the blog.

Let us know you are interested by following us!