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There is lots happening on the long-term care home front since COVID -19 began. More and more people are taking notice and want their voices heard. To grow our grassroots movement and appeal to a broader audience, we are changing our logo and blog address and joining with C.A.R.P. Ottawa.
Our new and improved blog will continue to provide information about transformative culture change, innovative models and ways that you can get involved.
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“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
Redstone, Malton Village, Region of Peel
In February, 2021, The Toronto Star ran a Special Edition called “Crisis of Care” which focused on our broken long-term care home system and the decades of reporting on tragic failures in long-term care with little action to change the status quo. The last article in this special edition, written June 24, 2018, focused on Redstone at Malton Village, Region of Peel.
Redstone embraced the Butterfly model of care and after one year of data, they report that staff sick days are down, fewer residents are falling, antipsychotic drug use is lower and social engagement is higher, all of which saves money! The article, entitled The Fix: Part IV Butterfly’s future is full of wonderful stories about the changes in the people living there. Residents are smiling, engaged in activities, and people who were non-verbal or progressed back to their first language, are starting to speak English again. Redstone is now a place of engagement and love. More information can be found in “The Fix: Part 4”, The Toronto Star, June 23, 2018 which was republished in the Special Section: Crisis of Care, The Toronto Star, February 7, 2021.
When will the Ontario government take notice that good things are happening in Ontario and that there are models of care that are working and have been proven to save money! This is not a matter of profit versus non-profit long-term care homes. By the way, Malton Village is a Municipal Home! The issue is all about how care is delivered. COVID-19 has shone a light on so many atrocities in long-term care homes. These failings were there long before COVID-19 appeared. More staff, more direct care hours, better PPE, will help but will not fix our long-term care homes! We have an opportunity now to change the system. Let’s just do it!
Malton Village, Peel Region, the Toronto Star, June 23, 2018
Imagine living in a long-term care home with 8 to 12 people where the focus of care is on people and relies on emotional intelligence, the ability to understand another person’s feelings and respond with compassion. There are no task sheets such as the bath list, mobility list, or activity list. Activities are not scripted but rather there is a natural flow towards individual interests. People are helping to set the dining room table, peel potatoes, fold laundry, music is playing and laughter can be heard. Those with memory loss are allowed to live in their moments, which some may call humane dishonesty.
This is what is happening on the Redstone Dementia Unit at Malton Village. An elderly woman with dementia thinks she is 10 years old and is calling for her mother. The Butterfly Model approach is to try and understand what the woman is seeking. Is it comfort, love, or reassurance and if so the Butterfly program says give that to her instead of the truth. Another person, who doesn’t understand why the staff member wants to change his briefs, gets scared and defensive. His hand balls into a fist. With the emotion-based care approach, in this situation the staff member recognizes that the person is scared and decides to give him a big hug then says, let’s go to the toilet. They walk arm in arm down the hallway. More information can be found in “The Fix: Part 3”, The Toronto Star, June 23, 2018 which was republished in the Special Section: Crisis of Care, The Toronto Star, February 7, 2021.
The emotion-based approach to care is a learned approach and it takes time for staff to adapt to this new way of caring for and about those living in their home. Giving hugs, hand-holding, sitting down and spending time listening to those living in the home is the norm. And meeting the person where they are at becomes more important than telling the truth.
Over the past 15 years the Toronto Star and other Ontario newspapers have written many stories about life in long-term care homes. Yes there are good stories to be told, but what we remember are those stories about neglect, abuse, urine-soaked sheets, loneliness or angry, aggressive incidents.
There is no-one among us that doesn’t abhor reading these awful stories and wonder how we are letting these incidents happen; regrettably it has taken the pandemic to bring the seriousness of the long-term care home situation to the forefront.
Most of the staff are trying their very best to deliver care according to what is expected of them. But is this the problem? “Is keeping our elderly clean, fed and safely tucked away” the best way to provide a quality of life?
In a recent article in the Toronto Star, we read stories about residents who live in LTC homes which have undergone transformative culture change. There is Inga who asks for a piece of toast, butters it and shares it with another resident. Or the Professor who is known for his crankiness, who starts to cry when hymns and wartime songs are played on the piano. And then all of a sudden, begins singing the words to these songs! Read more here from a recent article called Crisis of Care, The Toronto Star, February 7, 2021: The Fix: Part 2: Republished from 2018).
The good news is that where there is a willingness to change, lives are transformed. There is no excuse not to now. We know how much we have dreaded the traditional model of nursing care. We know, now, how much better a different model can be, and how joy, respect and community can actually be experienced by residents, families and staff. If the word “care” in our system of healthcare means anything, we need to get on with it.
There are over 78,000 people living in one of 630 long-term care homes in Ontario. These homes are controlled by more than 300 regulations that keep staff focused on the tasks of feeding, scheduling, and cleaning, all documented for government collection. Every day, at least 60 minutes is spent by staff filing ministry updates. They tap icons for mood, mobility, meals, bowel movements but there are no icons for laughter, conversation, human touch or sense of purpose. It is a detached, antiseptic end to life which some have called a culture of malignancy.
A long-term care home in Peel has moved away from a traditional model of care and took a gamble on fun, kindness and affection. It is Malton Village in Mississauga and they are focusing on laughter, friendship, energy, tenderness, freedom and hope. That is not to say that they are not meeting the Ministry regulations. They are doing that but in a different model of care. In a recent article in the Toronto Star, we read about Bill, a resident, who has been kicked out of multiple long-term care homes because of violent tendencies, until he arrived in a Butterfly home. He became docile, enjoyed his days and staff came to know him as a “lovely man”. Or there is the dietary aide who helps Roger with his dessert. She talks to him about her childhood memories visiting peach groves and before you know it, Roger has eaten all of his dessert. Read more here from a recent article called Crisis of Care, The Toronto Star, February 7, 2021: The Fix: Part 1: Republished from 2018).
Do we want our seniors to live out their days in long-term care homes that dehumanize their existence? We can help to change this by transforming our long-term care homes into innovative models of care such as the Butterfly model of care. Please support Transformative Culture Change in Ontario’s Long-Term Care Homes by sending an email to info@LTCcommission-CommissionSLD.ca or to your local MPP https://www.ola.org/en/members/current.
The Toronto Star article on Crisis of Care printed Feb 7, 2021, focuses on the “inertia” of government that has led to a failure of the long-term care home system.
For more than four decades, a doctor working in the system has witnessed:
- Poor business decisions that affected delivery of quality of care
- Too much time spent on paperwork and not enough time on direct care of residents
- Not enough adequately trained staff
- Verbal, physical or sexual abuse of residents
And now more than 3000 residents have died from COVID-19. In April, Premier Doug Ford called “the widening cracks in the long-term care system a wake-up call to the world” and spoke of the need to form an “iron ring” around vulnerable seniors. Well, that has not happened. In fact since April, there have been many more deaths due to Covid-19 than there were in the first wave. When will the government stop promising and start doing? How many more deaths are needed before inertia turns to action. Our vulnerable seniors deserve nothing less than to live their remaining years in a safe, caring environment. Read more here.
Please support Transformative Culture Change in Ontario’s Long-Term Care Homes by sending an email to info@LTCcommission-CommissionSLD.ca
Congratulations to Henley Place Home in London, Ontario for receiving its Butterfly Model of Care accreditation in December 2020. It joins Henley House in St. Catharines, Ontario which received it accreditation in December 2019.
When will other long-term care home providers rise to the challenge and begin to implement innovative models?
Kudos to Primacare Living Solutions, the provider of these homes for their leadership in implementing transformative culture change in their homes. And yes, more to come – Primacare has a third home (Burton Manor in Brampton, ON) currently undergoing Butterfly accreditation that should be completed in the fall 2021.
Please advocate for change by contacting your local councillor, your MPP, or organizations urging them to bring this change to your community.
According to a recent article in the Toronto Star, since January 15, 2021, 2721 residents of long-term care homes and 8 staff members have died from COVID-19. Read here. Thousands more are sickened, neglected and denied basic rights! Since the pandemic began, some 87% of all COVID deaths in Ontario have been among those over the age of 70 and about 61% of deaths have been in long-term care homes.
The long-term care system is broken and has been for many years! We are slowly losing a generation of people to this pandemic. They are our elders, our grandparents, mentors, visionaries who paved the path for a better world for all of us. And when they need more care than they can receive in their home, we move them to a medical institutional warehouse, remove their ability to make choices, take away their individuality and stifle their creativity. We schedule their day from morning to night, medicate them when they resist, and when family members become upset, we wonder why. Then COVID-19 arrived and the inadequacies of how we care for and about our elders in long-term care homes have come to light!
As of October 2020, there were 11 long-term care homes in Ontario that had either adopted or were in the process of adopting the Butterfly model of care. These homes along with the Green House Project homes in the U.S. that have embraced transformative culture change have reported better outcomes both pre and during the COVID-19 pandemic and have experienced fewer deaths than the institutional models of care that exist in most of our traditional long-term care homes.
Please consider sending an email to your local MPP or City Councillor urging them to look at what these homes have done so that the Ontario government can bring an end to the inhumane treatment and needless deaths of our vulnerable elders. Enough is enough!
Members of C.A.R.P. Ottawa’s Advocacy Working Group on Long-Term Care presented to the Independent Long-Term Care COVID-19 Commission on November 26th, 2020.
The purpose was to explain how transformative culture change, an emotion-based model of care, would not only improve the quality of life for residents, families and staff in Ontario’s Long-Term Care Homes but would also help to mitigate the impact of future viruses.
Key points presented were as follows:
-The fundamental principles of transformative culture change are consistent with the principles outlined in Ontario’s Long-Term Care Act which states:
“A long-term care home is primarily the home of its residents and is to be operated so that it is a place where they may live with dignity and security, safety and comfort and have their physical, psychological, social, spiritual and cultural needs adequately met.”
Despite many new regulations and many millions of dollars spent on education and new programs, it is obvious these principles have not been adequately met – for decades.
–Transformative culture change is a philosophy that uses an emotion-based approach to care where residents, staff and families feel part of a community and are all treated with dignity and respect: where there are small home-like environments; more direct hours of care for residents, where staff work full-time, are well-paid and are trained in empathy and culture change and where families and caregivers are recognized as an integral part of the team. Staffing, inspections, design and family involvement are all critical elements of transformative culture change.
-There are four innovative long-term care models that have successfully embraced transformative culture change. These models have existed for years in the USA, Europe, the U.K. and more recently in parts of Canada and even Ontario: The Butterfly Model, The Eden Alternative, The Green House Project and the Hogewey Villages. These homes have experienced better outcomes than our traditional homes both pre and during COVID-19.
The “ask”: That the Commission recommend the Ontario Government commit to move towards transformative culture change in Ontario’s Long-Term Care homes. This commitment could start by examining the long-term care homes that have already embraced this model of care to determine best practices and lessons learned, including how they have managed financially within current budgets and the current legislation. This commitment could also include revisiting the new builds that are being fast-tracked to ensure Ontario does not end up with the same old institutional designs, that once built, will be with us for the next 3 decades.
We know this can be done since it is being done right here in Ontario, right now. These innovative models are being led by a few who have taken the leap and the risk to improve the lives of residents, families and staff. There are currently 11 long-term care homes in Ontario that have either implemented or launched the Butterfly Model of Care resulting in transformative culture change.
Anyone wishing to support Transformative Culture Change in Ontario’s Long-Term Care Homes can send an email to info@LTCcommission-CommissionSLD.ca
For more information on the Commission www.ltccommission-commissionsld.ca