He Broke the Law to Build a Better Nursing Home

may blogIs growing older a good thing? Or is the idea of aging something to be feared leading to isolation, loneliness and a lack of autonomy?

In 1991, Dr. Bill Thomas became the medical director of a nursing home in upstate New York. He found the place, as the Washington Post put it, “depressing, and a repository for old people whose minds and bodies seemed dull and dispirited.”  Read article here.

So, what did Thomas do? He decided to transform the nursing home. Based on a hunch, he persuaded his staff to stock the facility with two dogs, four cats, several hens and rabbits, and 100 parakeets, along with hundreds of plants, a vegetable and flower garden, and a day-care site for staffers’ kids.

All those animals in a nursing home broke state law, but for Thomas and his staff, it was a revelation. Caring for the plants and animals restored residents’ spirits and autonomy; many started dressing themselves, leaving their rooms and eating again. The number of prescriptions fell to half of that of a control nursing home, particularly for drugs that treat agitation. Medication costs plummeted, and so did the death rate. “He named the approach the Eden Alternative.”

What do you think? Do our beliefs about aging affect our expectations about quality of life? Are our expectations about aging one of the reasons it is so difficult to implement innovative models within long term care homes? Please share your comments.

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Are inspectors the answer?

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In January, the Ontario Ministry of Health and Long-Term Care reported it would be hiring 100 more inspectors.  Is this really the answer to our ailing long-term care home systems?  Read more here.

Not so, according to this family member’s perspective:

“More inspectors are not the answer.  Deming and other quality improvement experts have shown time and time again that you can’t just ‘inspect’ quality into a system or workplace.  Inspection needs to be partnered with giving workers the tools and resources to do their work.  Trying to balance residents’ individual wants and needs with too few staff to meet them is an unwinnable state.  The long-term care system needs serious reform that includes feedback from residents, families, staff and the provincial government” – Pat Piaskowsk.  Read more here.

The number of inspectors continues to rise – from 102 (2013/14)  to 148 (2016/17).  And now, 100 more?  The cost of 248 inspectors, at an average of $85,000/yr (not including benefits and pensions) is approximately $21 million/year!

The outcry for additional personal support workers in long-term care isn’t new and isn’t the only part of the system that’s broken; perhaps the system would be better served by re-directing some of these dollars into transforming the long-term care home systems with a total culture change that provides a supportive community for staff, family and friends where relationships matter most.

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Where are our Champions?

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Why aren’t our leaders on the stage?

“We have an opportunity to be leaders” Toronto City Councillor Matlow says.  Where are the champions of long-term care homes in our other Canadian cities?

Recently the Region of Peel in Ontario bought into a transformational model of care for long-term care homes from the U.K. called the Butterfly Model.  Following Peel’s lead, Toronto City Council commissioned a report to review the various innovative models in existence in Canada, the U.S., the Netherlands and elsewhere. See the link to the article here.

Time will tell whether or not this leadership from Peel and Toronto will result in the sweeping changes needed for a sustainable culture change in our long-term care home systems.

Tell us what you think by commenting on our blog site. If you are on Facebook, Twitter or LinkedIn, please share with your followers or pass along to your contacts.

Abuse in long term care – when will it end?

marketplaceheadline1Meyer Sadoway, 84, on the floor, was attacked by another resident at his Toronto nursing home in 2013. (Security camera footage) reported by CBC news.

On Friday, February 1st, 2019, Marketplace featured an episode, ‘Crying out for care’, on long-term care homes.  Watch it here.

Here we are 6 years after the above photo was taken and very little has changed.  In fact, according to CBC Marketplace, the incidence of reported abuse between residents or by caregivers between 2011 and 2016 has more than doubled in long-term care facilities.  Even though the government has poured lots of dollars into a wide array of education programs for long-term care staff, facilities have spent money on re-designing dementia care units, and multi-sensory rooms and snoezelen carts are incorporated into daily care, the results have been minimal at best.  While education, re-designed environments and specific therapies can be helpful, they need to be delivered within a person-centred environment.

We need a complete culture change in our long-term care homes.  This will only come about if there is the political will to bring about this change and if we can learn from the positive experiences of places like Sherbrooke Village that are leading the way to make this culture change a reality.  Sherbrooke is a long-term care home that embraced such a culture change and was featured on the CBC news the same evening as the episode mentioned above appeared.   See it here.

So here is another plea to you to act now.  Contact your local councillor, contact your MPP,  write to your local newspaper, etc to bring culture change to your community and to a long-term care home near you!

 

 

 

 

Have we struck a chord!

 

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Elizabeth Payne’s series of articles on long term care has struck a chord with The Citizen readers as evidenced by the many letters to the editor.

“Focusing attention on long term care issues like increasing the number of available beds and the discussion about more or less oversight by the province is important.  However, it is even more essential to emphasize a complete culture change, transforming long term care homes to provide loving, home-like environments for their residents.

There are a number of models for long term care that would accomplish this transformation which have been developed in the UK (Butterfly Model), Holland (Hogewey Village) and the USA (The Eden Alternative & the Green House Project).  Some of these are currently being piloted in Peel County, Hamilton and are under consideration in the City of Toronto.

Newly elected City of Ottawa counsellors must review the benefits of these models and include a pilot project at one of Ottawa’s four city-run long term care homes in their next budget…….”

Excerpt submitted by James Sonley whose wife, Linda, had frontotemporal dementia for 16 years and passed away in May 2018.  Linda lived in a long-term care home for 20 months.  Consequently, Jay experienced firsthand the uncertainties of providing appropriate care for a loved one at home and in long term care.

Many newly elected City Councils in Ontario will likely be determining their 4 year priorities over the next few months.   PLEASE take a few minutes to send messages to your local councillors urging them to put transformation of our long-term care home system on their priority agenda.  Residents and staff cannot wait another 4 years!

 

 

Are Rules and Regulations Preventing Quality of Life?

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Here’s what some are saying:

NDP Health Critic, France Gélinas (MPP Nickel Belt): Long-Term Care Home inspections fall short.  Gélinas, stated that “some homes are really not meeting quality care and need the government oversight to protect people.” Click here for January 10th article in the Ottawa Citizen by Elizabeth Payne.

Candace Chartier, CEO/Ontario Long-Term Care Association: “in long-term care, 95% of administration burden arises from meeting legislated obligations directly related to superfluous care planning documentation and responding to inspection requirements, both of which divert staff time and resources from the provision of direct care.”

Lisa Levin, CEO/AdvantAGE Ontario: “Long-term care is the most over regulated sector in Ontario with 600 regulations”.

Administrators:  trying to comply with all the regulations prohibits the implementation of innovative care that would benefit residents directly.

A family member: I saw a staff who was handing out medication. She stopped to help a resident who fell and was then chastised for leaving the medication tray unattended.

If these 600 regulations and the extra 100 inspectors have not managed to improve our long-term care home system by now, they never will.  Don’t you think it is time for a transformation – one that promotes a better quality of life for residents as opposed to more rules and regulations?

What do you say?  Please tell us what you think – we would love to hear from you.

And share this with your contacts or anyone you know who may be interested in improving the way care is delivered to the 70,000 residents now living in our long-term care homes in Ontario.

Canada’s first Dementia Village!

Dec 2018

Canada’s first community designed, specifically for people with dementia opens in June 2019 Langley B.C.

It’s called The Village. Comprised of six, single-story cottage-style homes and a community centre, The Village will be home to 78 people with dementia, an umbrella term that includes people suffering from Alzheimer’s and other degenerative brain diseases associated with aging. Care will be provided by 72 specially trained staff.

At The Village, residents are not seen as dementia patients; they see the person and their story first. They believe that every person’s fundamental desire to achieve well-being, purpose and fulfillment does not diminish with age or dementia.

The Village’s design was inspired by Hogewey, the world’s first dementia village, in The Netherlands. What makes The Village different from traditional nursing homes is that residents will be able to shop, have a coffee, walk their dog, get their hair cut and take part in activities such as gardening by themselves. Continue reading “Canada’s first Dementia Village!”