What is Transformative Culture Change Anyway?

What is transformative culture change and what does it mean?

The Independent Long-term Care (LTC) COVID-19 Commission has now been established. Terms of Reference have been posted. What can we hope for? The easiest solution for the Independent Commission is to make recommendations that should have been instituted long ago: more staff: full time staff versus casual staff; more direct hours of care; fair salaries; infection control education and practices, elimination of four bed rooms and availability of air conditioning. If this is the end result, then our government has failed. Long-term care is a broken system and if the Independent Commission wants to make any significant impact, then it needs to look at how to improve quality care in LTC homes with a transformative culture change.

This means revising rules and regulations, moving from institutional care to areas with small home-like environments, embracing the valuable contribution that families and volunteers make, hire staff who want to work with seniors, and look at delivery of person-centred care. All this happens now in a few LTC homes across Canada. We call them innovative models of care but they should be the norm not something unusual. CARP (Canadian Association of Retired Persons) Ottawa Chapter, along with collaborating organizations, is advocating for transformative culture change in long-term care homes.

Transformative culture change means the way of organizing, and giving care in long term care homes changes so that residents know and feel like they are living in a warm, caring environment that looks and feels like home. It enables staff to know who their residents and families are – and what their life was like before. It means schedules and routines are flexible to match the resident’s preferences and needs. Friendships develop between staff, residents, families and volunteers. It means residents are involved in many meaningful activities according to their abilities and what brings them joy. Transformative culture change means Relationships, Relationships, Relationships!

Excerpt from an article written by Sue McDonald, a member of CARP Ottawa Advocacy Working Group on Long-term Care

If you are interested in bringing transformative culture change to Ontario’s long-term care homes, please write directly to Ontario’s Independent Long-term Care COVID-19 Commission at info@LTCcommission-commissionSLD.ca


Why does it take an outbreak to put long-term care homes back in the news? The news of the latest outbreak in a long-term care home is a stark reminder that residents in long-term care homes have been, and still are, vulnerable to this terrible pandemic. The need for change in long-term care is patently obvious.

Although measures to deal with staffing are critical to fix the immediate problem, there is a greater need to fix the culture of long-term care homes for the longer term. This can be done. CARP Ottawa is working with other organizations in Ontario to bring about transformative culture change in Ontario’s long-term care homes through a grassroots movement.

An independent commission set up by the province to investigate how and why COVID-19 spread in long-term care homes, what was done to prevent the spread, and the impact of key elements of the existing system on the spread has begun its work. We should all follow the work of this commission with great interest. And we should all make our voices heard to make sure the changes recommended are truly transformative.

Elizabeth Spence, Letter to the Editor, Ottawa Citizen, September 26/20

If you are interested in helping to bring about transformative culture change to Ontario’s Long-Term Care Homes, please either write a letter to the editor in your local paper or write directly to the Commission. You can write to them at info@LTCcommission-commissionSLD.ca

Please share this post with your contacts or anyone else you know who might be interested.


Kudos for the Ontario Long-Term Care Staffing Report!

The Ontario Ministry of Long-Term Care Staffing Study Advisory Report, released on July 30, 2020, identified a number of challenges to the current staffing strategy for long-term care. Apart from workload and funding issues as well as increased acuity needs of residents, the Report also identified that “the culture of long-term care is one based heavily on compliance, which can create a punitive environment for staff.” 

Their recommendation states that, “The culture of long-term care needs to change both at the system and individual level.” The Report calls for a look at the philosophy of care within long-term care homes and specifically cited models of transformative culture change such as the Butterfly model and the Eden Alternative as models of care which focus on emotional care and relationship building. The Report’s findings indicate that “Operators reported that their staff frequently request working in homes that have implemented emotional models of care as they feel better supported, more collaboration within the team, and are able to spend more time with residents. (Region of Peel Long-Term Care, Submission to the Staffing Study Advisory Group 2020)

For more information about the Long-Term Care Staffing Advisory Report click here

Thank you for your support of transformative culture change. Your letters to your MPPs and City Councillors do make a difference! You can also help by sharing this post and others with at least one of your contacts.

An Opportunity for Lasting Change?

At the end of July 2020, the Ontario Government announced the creation of the Independent Long-term Care COVID 19 Commission.

The three commissioners appointed to the Commission are:

Angela Coke, former senior executive with the Ontario Public Service; and
Associate Chief Justice Frank N. Marrocco (Chair), member of the Superior Court of Justice since 2005;
Dr. Jack Kitts, recipient of the Order of Canada and recently retired as President and Chief Executive Officer of the Ottawa Hospital.

“The Commissioners of Ontario’s Long-Term Care COVID-19 Commission have a mandate to investigate how and why COVID-19 spread in long-term care homes, what was done to prevent the spread, and the impact of key elements of the existing system on the spread.”  The Commission will have a secretariat of 12 FTEs (full-time equivalents) and will submit its report by April 30, 2021.  For more information about the Commission including its Terms of Reference and guiding principles, go to: http://www.ltccommission-commissionsld.ca/about/index.html

Many thanks to those of you who sent letters to your MPP’s and City Councillors as a result of our last post.  Your help makes a difference! CARP Ottawa, with whom we continue to work, subsequently sent letters to both Minister Fullerton and the Commissioners requesting that recommendations for transformative culture change be developed.


As you know we are working with CARP Ottawa to bring about transformative culture change in Ontario’s long-term care homes through a grassroots movement.  To this end we have asked the members of CARP Ottawa and its collaborating organizations in Ontario to send an email to their own local MPP’s about this matter.  We would like to ask you, our blog followers, to do the same.

Thank you to all the blog followers and friends who responded to our last request by sending letters to Minister Fullerton to recommend that CARP Ottawa be appointed to the Independent Commission on Long-term Care.

In the end, only three individuals were appointed to the newly named Independent Long-term Care COVID-19 Commission – Associate Chief Justice Frank Marrocco, Angela Coke and Dr. Jack Kitts. Now it is even more imperative to bring awareness and influence regarding this change to not only the Commissioners but also to our local politicians. 

Here’s How YOU Can Help

Send the email below to your own local MPP (contact info here) and copy your local mayor or city councillor (contact info here). Personalize the email with your own words on the need for culture change in Ontario’s long-term care home system. Or if you and your family have been affected by the COVID-19 virus, describe the impact it had on you.     

Copy us at our email changeltcnow@gmail.com We’d like to know how many of you are still interested.

Subject line: CARP Ottawa calls for transformative culture change in Ontario’s long-term care homes.


As a member of your constituency and someone who is very concerned about the long-term care home system in Ontario, I would like to express my support for Ontario’s Independent Long-term Care COVID-19 Commission.  However, I believe strongly that a transformative culture change is needed to fix the systemic failings apparent in these homes. 

I agree with Minister Fullerton and Premier Ford who have said on many occasions, “We have been clear the long-term care home system in Ontario is broken.”  Now we must fix it.

There are new models of care that exist in the U.S., Europe and even in Ontario, which have embraced the same guiding principles: a relationship-based approach to care; person and family-centred care; small home-like environments; higher staff to resident ratio; full time, well-paid staff who are trained in empathy and culture change and an environment where residents, staff and families feel a part of a community.

These new models have all embraced transformative culture change and have achieved much better outcomes than our traditional homes in Ontario.  We don’t need to reinvent the wheel. 

These outcomes include a decrease in the use of medications, in the number of aggressive incidents, in the number of hospital visits, in the amount of food waste and staff sick time, all the while increasing positive interactions with staff, families and residents.

“You never change things by fighting the existing reality.  To change something, build a new model that makes the existing model obsolete”.  Buckminster Fuller. 

My request is that you bring this urgent need for a transformative culture change in Ontario’s long-term care homes to the attention of Minister Fullerton and Premier Ford. If you would like more details on the existing models or this kind of culture change, please contact CARP Ottawa at changeltcnow@gmail.com

I look forward to hearing from you.

Your name…

Transformative Culture Change



What does transformative culture change mean for: Infrastructure

Many LTC (Long-term Care) 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.

What does transformative culture change mean for: Inspections

  • 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.

What does transformative culture change mean for: Families/caregivers

  • 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.

If you have any questions, email us at ChangeLTCNow@gmail.com



Transformative Culture Change




What does transformative culture change mean for: 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
  • 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.

If you have any questions, email us at:  ChangeLTCNow@gmail.com





Transformative Culture Change


CARP Ottawa, as noted in previous blog posts, is advocating for transformative culture change.  This post will be the first of three that describes what this actually means along with the key messages detailing what elements are necessary to bring this change to fruition and improve quality care and quality of life for residents in long-term care homes in Ontario.    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;
  • Providing more hours of direct care for residents;
  • Employing full time, well-paid staff, who are trained in empathy and culture change;
  • Recognizing families and caregivers as integral members of the team:
  • Engaging volunteers who are trained in empathy and culture change.

Key messages have been developed for staff and volunteers, infrastructure, inspections, and families/caregivers. All the key messages need to be operationalized within a transformative culture change approach in which quality care is understood within a relationship-based environment where residents, staff, volunteers, and families are treated with dignity and respect and feel part of a community.  The key messages will appear in the next two blog posts.







MoneyWrecking ball

There is no quick fix. It will take time, money and a wrecking ball — along with a new public attitude toward aging to fix Canada’s long-term care facilities.

The following is an excerpt from a CBC interview on June 27th, 2020 by Evan Dyer.

“Long-term care needs a long term solution. It’s not going to get fixed overnight. And our concern certainly now at the Canadian Nurses Association is it’ll be a sort of duct tape solution — throw a few more staff in and pay them a little bit more and it will be fine. And it won’t.
There are fundamental issues that need to be tackled in long-term care. So you have people in rooms of four or two, or you have a single room with a Jack and Jill bathroom — all kinds of places for disease to move.

It’s hard to imagine but many of those places don’t have air conditioning. So one of the things that staff do to make residents more comfortable is they will congregate them in a lounge or in a hallway and put large fans on them to help them cool off. Well, that’s a recipe for disaster right there. But pandemic measures on their own won’t lead to lasting change unless Canadians themselves change the way they think about aging and elder care.”  See full article here.

Michael Villeneuve, Chief Executive Officer of the Canadian Nurses Association.


Help us change Long-term Care NOW!

Please join our grassroots movement to bring transformative culture change to Ontario’s long-term care homes.  You can do this by sending the following letter, or something similar in your own words, to the Minister of Long-term Care, Merrilee Fullerton. Please copy your own MPP (MPP names and emails are here) and CARP Ottawa at changeltcnow@gmail.com to help us evaluate the interest in this campaign.

“Dear Minister Fullerton, (Merrilee.fullerton@ontario.ca)

Thank you for setting up the Independent Commission to look at what changes need to be made regarding our long-term care home system in Ontario.

As a concerned citizen of Ontario, I would like to strongly recommend that you invite CARP Ottawa to have representation on this Commission.  CARP is Canada’s largest non-partisan advocacy association for older Canadians, with more than 320,000 members, most of whom are in Ontario.  In the past, CARP has successfully advocated for more federal funding for homecare, a reduction in the senior’s drug co-pay in Ontario, free high-dose influenza vaccine to adults over 65 in Ontario and an inquiry into safety and staffing in Ontario long-term care homes.

With seniors in Canada outnumbering the number of children, policy making in Canada that affects other Canadians is more important now than it has ever been.  CARP past successes in healthcare, combined with the strength in their membership uniquely positions them to represent the interests of older Ontarians.  CARP is advocating for a transformative culture change within the long-term care home system.

I believe, as you have stated many times, that Ontario’s Long-term Care Home system is broken.  CARP has a vision for transforming our long-term care home system.

As a society we all want a long-term care home system that affords our family members a better quality of life.  Please act now to bring transformative culture change to Ontario’s long-term care home system.

Thank you for your consideration.

I look forward to hearing from you.”

Your name