Author: ChangeLTCNow

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My husband said “please don’t put me in a home”

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Taking the time to care

In 2011 Brian was diagnosed with dementia.  Last summer he died after being in long-term care (LTC) for 4 1/2 years.  I tried my hardest to care for him at home but Lewy Body Dementia defeated us.

I will always feel guilty: nearly 20 years ago I retired from my working life as a therapist which included visiting residents in LTC. I knew how unhappy he would be there.

I was right. Little had changed in the quality of life of the residents: the way staff worked was still hierarchical, the medical model firmly in place.  Care plans barely took into account the life experience, interests and personality of the resident.  Front line staff did their very best but were dominated and constrained by “Ministry” regulations.

The time is rapidly approaching when I and thousands of “baby boomers” may need a place in LTC.

Culture change is needed now and is possible through putting each resident’s emotional and social needs at the core of their care.  Change: to make living spaces home like and comfortable; time filled with companionship and meaningful activity, change to give staff the time and satisfaction of taking care of a resident known for who they were and are now.

Should I need a place in LTC I don’t want to be in a home where I am kept alive: I want to be helped to live.

Submitted by Janet

 

 

 

 

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Renfrew County follows the lead from Peel’s Malton Village

Two years after we featured several blog posts on the Butterfly home initiative at Malton Village in the Peel Region, there are now some very exciting results:

  • A 75% decrease in staff sick time resulting in continuity of care and huge cost savings;
  • a decrease from 39%-10% of residents exhibiting symptoms of depression;
  • a decrease in antipsychotic use by those without a diagnosis of psychosis 40% (‘17) to 8% (‘19);
  • anticipation that the implementation will end up being cost neutral after 3 years.

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Merrilee Fullerton, Minister of Long-term Care, meets with resident in Renfrew County.

And now on October 9th, 2019, both Bonnechere Manor and Miramichi Lodge Long-term Care Homes in Renfrew County began a journey to turn a dementia unit into a Butterfly Home.  “The transition will include significant environmental changes such as smaller more home-like ‘neighbourhoods’ versus units. This would mean for example converting a dementia unit where currently 20 residents reside into two (2) smaller neighbourhoods of 10.  Other environmental changes will include redesigning the dementia units to be more welcoming and intimate, and filling the household with the ‘stuff of life’ so that residents can connect with a variety of colours, textures and objects that reflect their past lives, work and hobbies.”  For full media release, click here.

Way to go Renfrew County for being another champion for culture change!

Contact your MPPs and City Councilors to let them know about these new developments and that we need to invest in more innovation in our long-term care homes.  Let’s keep the momentum going!

 

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Tell your candidates that Canada needs a fully funded Dementia Strategy

On June 17, 2019, the Government of Canada released the country’s first-ever national dementia strategy: A Dementia Strategy for Canada: Together We Aspire

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  Relationship-based model of care

A fully-funded strategy will allow Canada to meet the challenges of dementia with a coordinated, focused approach to care and research. The strategy will address the overwhelming scale, impact and cost of dementia in Canada through three key objectives:

• Prevent dementia,
• Advance therapies and find a cure, and
• Improve the quality of life of people living with dementia and caregivers.

Within the report, it states that: “integrated, person-centered quality care based on best practices will be available across all care settings and people living with dementia will feel welcomed and well-cared for”. In this blog, you have read that we need to create person-centered, relationship-based long-term care homes. This is just one of the ways that we can improve quality care.

Today 90% of residents in long-term care homes have some form of cognitive impairment with over 65% having a diagnosis of dementia. The opportunities for change are now.

The federal election is October 21st, 2019. Attend All-Candidates Meetings in your Riding or write to your local MP candidates, and ask for a fully-funded national dementia strategy.

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The Glebe Centre – finally a champion for Ottawa!

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The Glebe Centre, a non-profit, charitable long-term care home, has partnered with Dementia Care Matters to become the first Butterfly Home in Ottawa. The Butterfly Model is a transformative model of care for long-term care homes that means:

  • Total culture change
  • More than addressing the clinical needs of the residents
  • A place where residents, families and staff form a community of care,
  • Relationships matter most and
  • Where residents’ preferences for daily activities are respected

“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

The Glebe Centre has done just that and seized the opportunity to be the leader for transformative change for our long-term care homes in Ottawa. They will start with one unit in the fall of 2019.  This is a bold and risky step and we offer our hearty congratulations!

Now to get other cities like Brantford, Kingston, Belleville to follow suit.

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Better ways to run long-term care homes

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Sherbrooke Village Long-term Care Home, Saskatoon, Saskatchewan

Below is the letter published in the The Ottawa Citizen in response to the article re “funding cuts jeopardize care homes”.   Read the July 22/19 article here.

“Once again, the vulnerable older adults living in our long-term care homes will be penalized by funding cuts.  Many residents continue to be frustrated and bored, which often results in aggressive incidents.  Staff continue to be exhausted, frustrated and overworked.  Funding cuts aren’t the answer.  Transforming the way care is delivered and creating a new culture of care with innovative models that already exist is a solution.  These innovative models are being used in several communities in the province.

Yes, there is upfront investment but there are projections that the result is cost-neutral.  The result?  Fewer aggressive incidents, decreased medication use, and a decrease in staff sick days.

These models create an atmosphere that is more homelike and provide a sense of community for residents, staff and families.  Wouldn’t you want this kind of transformative care for your family member?

The new Minister of Long-term Care, Merrilee Fullerton, has said that ‘long-term care is a priority for this government.’   CARP Ottawa urges her to include a study of these innovative models of care before making any future decisions regarding cuts.

Rick Baker, President, CARP Ottawa”

If you belong to another branch of CARP or any other organization, please take some action and send letters to your local papers.   We need your help!

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Dementia villages!

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The Hogewey Village concept, developed in the Netherlands in the 1990’s, was featured in this blog’s first post (September 22, 2017) describing its implementation at Georgian Bay Retirement Home in Ontario; it has also been implemented in Alberta, and is soon to become a reality as a long-term care home in Langley, B.C.

As reported in The Northern View article on June 20, 2019,  the Langley  complex includes squares, gardens and a park where the residents can safely roam, along with a grocery store, restaurant, bar and theatre streets.

“What we want is to create a space where people can live life to the best of their ability in their own way, ”  For the full article, click here.

Even though the Langley project is private and costly,  it is a model from which both public and private sectors can build on to improve long-term care homes in Canada.  For instance Providence Health Care, a non-profit organization, is now in the process of creating similar purpose-built facilities in Vancouver and Comox.

While change is happening, it is very sporadic in a  system devoid of a strategic plan to overhaul the long-term care home system.

We need a strong advocacy voice to pressure governments at all levels to ‘step up to the plate’ and begin a health revolution in bringing about total culture change in the long-term care home system in Canada.  Please reach out to friends, families, organizations, politicians, and the list goes on to lobby and advocate to make this long overdue change a reality.

 

 

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He Broke the Law to Build a Better Nursing Home

Is 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.

If you are on Facebook, Twitter or Linkedin, please share with your followers or pass along to your contacts.

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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.

If you are on Facebook, Twitter or LinkedIn, please share with your followers or pass along to your contacts.

 

 

 

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Where are our Champions?

“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.

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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!

 

 

 

 

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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!

 

 

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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.