There are at least 4 different innovative models of LTC (Butterfly, Eden Alternative, Green House and Hogewey) but they all tend to have similarities:
• Person-centered and emotion-based care, emphasis on kindness and compassion
• Meaningful relationships between residents, their families, and staff
• Vision and leadership needed to implement change
• Staff education/training on culture change, empathy
• Emphasis on teamwork
• Environmental design aspects to support residents
• Small group homes or household units within larger facilities
• Strive to create a non-institutional, familiar, home-like environment
• Access to the outdoors
• Opportunity to participate in meaningful activities
• Autonomy of residents, flexible daily schedules
• Focus is on possibilities, not on disabilities
• Quality of life and Quality of care
• Increase in resident activity levels and social activity
• Happier residents, families, and staff
• Staff feel valued and part of a community with residents and families
• Residents take fewer medications, stay active, eat better, sleep better
• Reduced boredom, helplessness, and loneliness
• Decrease in agitation and behavioural issues
• Decrease in spread of disease, respiratory illness, viruses
• Decrease in staff sick days
• Decrease in antipsychotic medications and supplements
• Decrease in falls causing injury
• Decrease in trips to hospital
• Decrease in weight loss
• Decrease in food waste
On the following pages, lists of examples include Long-term Care Homes that have at least one unit accredited as a Butterfly/Eden/GHP/Hogewey Model Home as well as those that are in the process of implementation.
THE BUTTERFLY MODEL
The Butterfly approach was pioneered over 20 years ago in the United Kingdom by Dr. David Sheard of Dementia Care Matters, who later sold it resulting in a name change – Meaningful Care Matters. It is a social model of care that shifts care from a traditional medical care approach to:
- Prioritizing emotional care that is person centered.
- Creating busy, filled up, engaging places that feel like ‘home’.
- Providing relaxed, freed up and comfortable environments.
- Involving people in the running of their own home.
- Emphasizing a more informal, best friends and family like approach.
- Staff wear regular street clothes vs uniforms
The Butterfly model is a home-like setting that creates an environment that is familiar to people so they feel more comfortable, less agitated, less aggressive and more content.
Some of the cultural changes in the Butterfly model are enabling staff to connect emotionally with residents and families, less emphasis on task-orientation and an increased emphasis on people interacting in a relaxed, compassionate, understanding way. The home is welcoming and intimate and filled with the “stuff of life” that has meaning to residents so they can connect with colours, textures and things that reflect their past lives, work, and hobbies.
Examples where the Butterfly Model is being used*
- Malton Village, Peel, ON
- The Glebe Centre, Ottawa, ON
- Sheridan Villa, Mississauga, ON
- Miramichi Lodge, Renfrew County, ON
- Henley House, St, Catharines, ON
- Bonnechere Manor, Renfrew County, ON
- Henley Place, London , ON
- Sunnyside Home, Kitchener-Waterloo, ON
- Burton Manor, Brampton, ON
- Griffin Manor, Waterdown, ON
- UK: 6 in Wales, 5 in Ireland, 4 in England
THE EDEN ALTERNATIVE
Dr. Bill Thomas – a physician in a small nursing home in upstate New York in the early 1990’s – was taking a break from regular work as an ER doctor. He found he loved working with the elderly but hated the institution that was housing them. He wanted to abolish what he defined as the 3 plagues of old age: loneliness, boredom, and helplessness. He envisioned life in nursing homes that brought the calm of nature indoors, with green space and gardens.
The Eden Alternative was born. The Eden Alternative provides a re-interpretation of the environment elders live in, from an institution to a garden. As the philosophy grew, there was a focus on kindness, companionship, creativity, and ongoing personal development.
Regimented schedules and activities are replaced by residents having a say in how they will live there. They can sleep in, garden, have pets, visits from children, help with chores or other responsibilities, giving them purpose and alleviating feelings of helplessness. Residents live in “villages” even in an older building.
Examples where the Eden Alternative model is being used*
- Sherbrooke Village – Saskatoon, Sask.
- Sunnyside Adventist Care Centre – Saskatoon, Sask.
- Central Haven Special Care Home – Saskatoon, Sask.
- Points West Living – Red Deer, Alta
- Eden Gardens – Nanaimo BC
- New Vista Care Home – Burnaby BC
- Harbourview Lodge and Willow Lodge, Nova Scotia
- Dr. Thomas has helped to “Edenize” more than 300 facilities in the U.S.
THE GREEN HOUSE® PROJECT (GHP)
While the Eden Alternative focuses on partnering with nursing homes to help them change their culture, environment and approach to care, the Green House® Model, also developed by Dr. Bill Thomas, focuses on helping companies and individuals build or convert residential homes that can provide high levels of care for people who do not wish to be in a nursing home setting.
The Green House® Project is a not-for-profit organization founded on the belief that everyone has the right to age with dignity. GHP seeks to protect this right by de-stigmatizing aging and humanizing care for all people through the creation of radically non-institutional eldercare environments that empower the lives of people who live and work in them. A Green House Project community consists of clusters of smaller homes (or units) with 6-10 residents. Each resident has their own bedroom and bathroom, they are free from scheduling, and can access shared and social areas of the home/unit at any time, making it truly like home. They use smart technology such as adaptive devices, computers, and ceiling lifts.
While GHP’s core mission is to build new homes, not all providers have the land or capital to do so. To broaden the reach and deepen the impact of the movement to transform eldercare, the Green House 2.0 initiative was launched, and Cultural Transformation was created to help progressive-minded providers implement cultural transformation in traditional settings.
One of the core values is that there must be a warm living situation with a layout that encourages social activity, as well as décor and furnishings that provide comfort. The operation of each home is guided by the Green House core values of Real Home, Meaningful Life, and Empowered Staff.
Examples where the Green House model is being used*
- There are no Green House Models known to us in Canada but there are many Green House Models and Projects in the U.S.A.
THE HOGEWEY VILLAGE
The concept of an entire village for the care of the elderly came about in 1993 in a small town just outside of Amsterdam called Weesp. Two managers of a traditional nursing home called Hogewey realized they were providing meals and safety but little joy in an institution that looked and felt like a hospital. They wanted to focus on the human beings under their care and on what they were still able to do and wanted to do.
They gathered people with similar interests and allowed them to live together in small households with kitchens, laundry, and the feel of “normal living”. By 2002, they planned and designed a new home which, instead of being one building, became a neighbourhood called de Hogeweyk. The design included a long outdoor community square with a fountain and tables/chairs for café-style conversation. Inside the doors to the main building would be a pub, a grocery store, a hair salon, and club rooms for baking or other activities. It opened in 2008 and the town of Weesp expanded and revitalized around it.
By 2019, de Hogeweyk had 27 homes, all attached, each housing 6-7 people and their caregivers, with doors opening to the courtyard or the gardens. Residents can shop for groceries, visit the restaurant, the theatre, or one of the 25 available clubs. They can garden, enjoy a coffee outdoors with others – all under the watchful eye of caregivers.
Examples where the Hogeway Village model is being used*
- The Village Langley, Langley, B.C.: The village is made up of 6 single-story cottage-like homes set on 5 acres of park-like grounds with sensory gardens, accessible walking paths with benches a farmyard with veggie patch, outdoor activity terraces, a games lawn, natural meadows, a water garden and a community centre and village plaza. The goal of the Village is enriched living.
- Hogewey Village – Weesp, North Netherlands
- According to CADTH’s report (Canadian Agency for Drugs and Technologies in Health), in 2019 there were many innovative models based on the Hogewey Villages in the planning stages in other countries such as France, Germany, Switzerland, Denmark, Japan, and Australia.