Transformative Culture Change

Transformative culture change in long-term care homes is a relationship-based or emotion-based approach to organizing and delivering care. Eight to sixteen residents live in warm, caring environments that look and feel like home. These small-home like environments provide residents with the ‘stuff of life’ and meaningful activities; the residents are surrounded by staff who interact and care for them with empathy, kindness, love and laughter.

Transformative culture change in long-term care homes looks like:

  • A warm, caring environment that feels like home.
  • Staff truly know their residents and families, and understand their lived experiences.
  • Schedules and routines match residents’ preferences and needs.
  • Meaningful activities engage residents according to their abilities and what brings them joy.
  • Relationships thrive between and amongst staff, volunteers, residents and their families.

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 of 8-16 residents/unit with shared living spaces such as a living room, kitchen;
  • Leadership who are committed to a relationship-based approach to care;
  • Employing full time, well-paid staff, who are trained in empathy and culture change; Hiring staff based on emotional intelligence;
  • Recognizing families and caregivers as integral members of the team;
  • Engaging volunteers who are trained in empathy and culture change.

Transformative culture change can occur in our LTC homes if the following is addressed:

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 workloads.
  • 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.


  • Many LTC 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.


  • 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.


  • 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.

Innovative models

There are several innovative models of care that have embraced culture change and that already exist in other countries with a few in Canada and even Ontario. These are The Butterfly Model, The Eden Alternative, The Hogewey Villages, and the Green House Project. These models have shown better outcomes than our traditional homes by decreasing aggressive incidents, decreasing the use of antipsychotic drugs, decreasing the number of staff sick days (in one case up to 75%), and an increase in social interaction. Although these homes have their own unique features, they all subscribe to a transformative culture change model. In Ontario there are more than 11 LTC homes that have, or are in the process of developing a unit/units which are following the Butterfly model.

Explore the models here »