Innovative Models

There are at least 4 different innovative models of LTC (Butterfly, Eden Alternative, Green House and Hogeweyk) but they all tend to have similar philosophies and similar outcomes.

Common Elements

Person-centred and person-directed 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

Common Benefits

• Quality of life and 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

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The Butterfly model, developed over 20 years in the United Kingdom and now known as the Butterfly Approach under Meaningful Care Matters, is a social model of care that shifts from traditional medical care to:

  • Prioritizing person-centred emotional care
  • Creating engaging, busy home-like environments
  • Providing comfortable, relaxed spaces
  • Involving residents in the management of their own home.
  • Emphasizing a more informal, best friends and familial approach.
  • Staff wearing regular clothes instead of uniforms.

The Butterfly Approach aims to create a familiar environment that promotes comfort, reduces agitation and aggression, and increases contentment among residents.

Some of the cultural changes in the Butterfly Approach are enabling staff to connect emotionally with residents and families, less emphasis on task-orientation and a greater emphasis on relaxed, compassionate interactions. Homes following this approach are welcoming and intimate, filled with meaningful items that reflect residents’ past lives, work, and hobbies.

As of July 2023, 26 long-term care homes in Canada were either fully accredited or in the process of being accredited in the Butterfly Approach. Many more homes across the United States and Europe also adopt this model.


The Eden Alternative, established in the 1990s, reimagines the environment for elders, transforming it from an institution into a vibrant living space akin 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. Residents have a say in how they live, including the freedom to sleep in, garden, have pets, enjoy visits from children, and participate in chores or other responsibilities. These choices provide purpose and help alleviate feelings of helplessness. Residents live in “villages” even in an older building.

As of September 2023, there were approximately 300 Eden Alternative long-term care homes in the United State and several in western Canada.


While the Eden Alternative focuses on changing the culture and environment with partnership of nursing homes, the Green House® Model is dedicated to helping individuals and organizations create or convert residential homes to provide high levels of care for elders.

The Green House® Model transforms residential homes into high-care environments for those who prefer non-institutional settings. It emphasizes dignity in aging and humanized care through smaller home clusters with 6–10 residents, each having their own bedroom and bathroom. Residents enjoy flexible routines, smart technology, adaptive devices, and shared social areas creating a true sense of home.

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.

As of September 2023, The Green House® Project has approximately 370 long-term care homes in the United States. In Canada, Quebec is transitioning its long-term care homes based on the Green House Project philosophy.


The concept of an entire village for the care of the elderly originated in 1993 in Weesp, a small town outside of Amsterdam. The managers of Hogeweyk, a traditional nursing home, realized they were providing meals and safety but little joy in an institution that resembled a hospital. They aimed to focus on the residents as individuals and on what they could still do and wanted to do.

Residents with similar interests were gathered and allowed to live together in small households with kitchens, laundry facilities, and a sense of normalcy. By 2002, they had planned and designed a new home that became a neighbourhood called de Hogeweyk. It featured a long outdoor community square with a fountain and café-style seating. Inside, there were amenities like a pub, grocery store, hair salon, and club rooms for activities. The village opened in 2008, leading to the expansion and revitalization of Weesp.

As of September 2023, there were 2 long-term care homes using the Hogeweyk Village model in Canada, with many others in Europe.

New emerging models

There are new models of care emerging which incorporate one or more aspects of the models mentioned above. These changes in long-term care homes are taking place across Ontario and also within Quebec.


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