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Transformative Culture Change: Key Messages

Keys

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.

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TIME, MONEY AND A WRECKING BALL?

Time

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.

 

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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

 

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#ChangeLTCNow

The residents, families, and staff of Ontario’s long-term care homes need your help.
An urgent update on our work re: Ontario’s Long-term Care Home System.

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We have joined the CARP Advocacy Project whose goal is to strengthen Ontario’s Long-term Care Home system through a transformative culture change.

The government has announced that an Independent Commission will be set up in July to review Ontario’s long-term care home system and propose improvements. CARP Ottawa has submitted a request to be involved in the Commission and has recommended a transformative culture change for long-term care homes.

A transformative culture change includes: a relationship-based approach to care; person and family-centred care; small home-like environments; higher staff to resident ratios; full time staff who are well-trained in empathy and culture change; and an environment where residents, staff and families feel a part of a community.  The Eden Alternative, Green House Project, Hogewey Villages and Butterfly Homes are examples that have been implemented in Europe, Australia, the U.S. and recently a few in Canada.

HELP US CREATE A GRASSROOTS MOVEMENT – #ChangeLTCNow

We want organizations and individuals to provide input that will encourage the Commission to consider recommendations for transformative culture change. Awareness of the need for major reforms in LTC has never been so evident. This is a unique opportunity.

We need to act – NOW.

Support this grassroots movement. Get involved.

Email – changeltcnow@gmail.com
Be a part of #ChangeLTCNow.

 

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Long-term care reform: what seniors need and deserve

 

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St. John’s Green House home in Penfield N.Y: residents eat together at a communal table. The Green House project focuses on residents’ emotional and social well-being.

“…….The COVID-19 crisis has highlighted that we need new ways of providing LTC to protect residents from plagues of communicable disease. But we also need to eradicate the noncommunicable plagues of old age identified by the architects of the Eden Alternative — loneliness, helplessness, and boredom.

We need new models of care that prioritize human relationships, dignity, and safety. That means a moratorium on new LTC facilities that don’t look like Sherbrooke Community Centre’s Poppy Lane…..” (a long-term care home featured on this blog site on November 16, 2017)  says Dr. Michael Rachlis, a public health physician and an Adjunct Professor at the University of Toronto Dalla Lana School of Public Health that appeared in The Star on May 8th, 2020.  Read more here

 

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Another innovative model – now in Waterloo

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“Sunnyside Home is adopting a new approach to make the Kitchener long-term care facility feel more like a home, and staff like family, for its residents with “dementia.”………

Sunnyside has been working for a few years to improve care by moving away from a medical model. The butterfly approach will take that to the next level to ensure residents have a full life” as reported in an article by Johanna Weidner in The Waterloo Chronicle.

This is another example of the increasing number of innovative long-term care home models that are striving for the transformative culture care we are hoping for in the future for Ontario. Unfortunately, the COVID-19 virus crisis has obviously put a damper on this kind of major change from moving forward at this time. We look forward to encouraging these homes in their quest for culture change once this crisis is over.

 

 

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COVID-19: Hats Off to Long-Term Care Home Workers

Hats Off!

Across Canada, there is a group of health care workers, those working in long term care homes, who are placing their own lives at risk while they do all that they can to care for and protect their residents. Residents living in long term care homes are particularly vulnerable to COVID-19 and long term care homes are one of the toughest places to contain an outbreak. This is because the people who live there are elderly, often have compromised immune systems, and they live and socialize in close quarters –in some of the older homes, even 4 per room.

Long term care homes are now prohibiting visitors, which adds more stress to both residents and staff. Residents, who look forward to visits from family and friends, may experience feelings of isolation and loneliness and staff are not only concerned about their own health but also those in their care. As one staff member has said, “You don’t know who’s going to still be there the next day.”

However, there are some amazing stories that are now coming out about the creative ways that long term care workers are promoting social connectedness while keeping residents physically distant from one another.  Read more here.

Our hats go off to these wonderful, caring, compassionate health care workers. Thank you very much for everything you are doing to try and keep your residents safe and healthy!

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Could Ontario’s long-term care home system be any more complicated?

There are 626 long-term care homes in Ontario (2019); of these, there are 3 categories:

For-Profit: 58%,   Not-for-Profit: 24%,   Municipal: 16%

What are the commonalities?

  • Funding: All 3 types are funded by the Ministry of Health and Long-Term Care through the Local Health Integration Network (LHIN) based on the same formula.
    In addition: Municipalities can opt to top up funding for their homes through tax payers’ dollars.  Some of the other homes have either foundations or fundraising programs that can top up their funding for capital expenditures or program enhancement.
  • Admission/wait lists: All 3 types are subject to a central admission/wait list process controlled by the LHIN
  • Resident costs: In all 3 types, residents are required to contribute a co-payment for accommodation of basic ($1848.73), semi-private ($2,228.63) or private ($2640.78).  These costs are as of 2018 and there is a cost of living increase each July.  
  • Legislation:  All 3 types are subject to the same standards, rules and regulations.    

 

  • Management:
  • The for-profit long-term care homes are managed by their corporate office through their Chief Executive Officers (CEO’s)
  • The not-for-profit long-term care homes are managed by a Board of Directors through their CEO’s
  • The municipal or city-run long-term care homes have a formal mechanism in place for their management through a committee of City Council and a staff director.   

Please note that unlike long-term care homes, retirement homes are not publicly funded and operate outside the domain of the long-term care home system.   More details here.  

Please comment on the blog if further clarifications are required. 

 

 

 

 

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Will this ever end?

blog feb2020The recent CBC news article regarding a female resident in an Alberta nursing home who was abused before she died from dehydration and a urinary tract infection is appalling and should never happen in our health care system in Canada. Unfortunately, abusive incidents do occur and indicate yet again that traditional medical models of care in long-term care homes need to be changed.  Read more here.

Yes, our long-term care homes need to keep residents safe and comply with regulations but if person centered care was provided where residents matter and are considered to be a member of the family rather than a person to be “cared for”, then abuse would not occur.

The CBC news report says that the nursing home reported that “there was a shortage of staff and experience” and that “employees needed better education about nutrition, hydration and monitoring infections”. Yes, staff need to have that knowledge but surely it is more than that! Staff education and training is required in order to change the culture of care from one of “giving” care to a relationship based approach with the residents.

Innovative models of long-term care that are featured in this blog will do just that.

Please forward this post to your friends and colleagues and if you are on social media, please share with your followers.

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Butterfly Approach takes flight!

Butterfly Approach launch at Miramichi Lodge

Here is an update on the exciting journey that Bonnechere Manor and Miramichi Lodge have begun in the implementation of the Butterfly model.

The Butterfly approach was pioneered over 20 years ago in the United Kingdom by Dementia Care Matters and over the past year or so has been adopted or emulated in a few long-term care homes in Ontario. It is a social model of care that shifts care from a traditional medical care approach to:
• Prioritising emotional care that is person centered
• Creating busy, filled up, engaging places that feel like ‘home’
• Providing relaxed, freed up comfortable environments
• Involving people in the running of their own home
• Emphasizing a more informal, best friends and family like approach.

Miramichi will start by focusing on a unit of 27 people and at Bonnechere Manor, a unit of 20 people. Eventually the Butterfly approach will be used throughout both homes.

“Long-term care homes are not a place where people go to stay; they are places where people go to live and that at the heart of long-term care must be family, friends, and community”.  Read more here.

Kudos to Renfrew County! Let’s hope that more long-term care homes will see the benefits of adopting an innovative approach to care.

Please forward this to others who may be interested and if you are on social media, share on your Facebook, Instagram or Twitter accounts.

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An Insider’s Perspective in Verse

 

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Paul, who wrote this poem, has been residing in a long-term care home for two years due to a degenerative physical condition.  He has been waiting all this time for a transfer to his first choice of a long-term care home so that his husband of 38 years, who doesn’t drive, can visit him without having to travel by bus for several hours each time.  Paul now believes that, at this rate, it will take another 5 years or so before he can move to the home of his choice.   This is just heartbreaking.

IN LONG-TERM CARE   (in the style of John McCrae’s “In Flanders Fields”)
By Paul Gregory Leroux

The wait lists longer daily grow
And move excruciating slow;
We seniors have no place to go
For long-term care.

We only ask for our fair share;
But the resources aren’t there,
No room for seniors anywhere
In long-term care.

Our parents fought the war and won;
Our battle’s only just begun,
As Baby Boomers now they shun
From long-term care.

We, it seems, no longer matter.
Politicians just get fatter,
As our dreams they blithely shatter
While we despair.

Bereft of dignity and pride,
We have no hope left deep inside,
As if already we had died.
The only thing we haven’t tried
Is mass assisted suicide.
But do we dare?

More about Paul’s journey to appear in a future blog post.

Please forward this post to your contacts OR share on your Facebook, Twitter or Instagram page.

 

 

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Meaningful Care Matters: Free To Be Me

Making Moments Matter at The Glebe Centre:    20GlebephotoJan7blogpost

No More Beige! 

An update from the Glebe Centre (Ottawa) :  Although the team from Meaningful Care Matters (formerly Dementia Care Matters) observed many exceptional moments of care, there were indeed areas that needed improvement and did not follow a person-centered model of care.

This will be our journey over the next year, to transform and re-think care on Bankwood (one of the care units at the Center) from a neutral/task based model of care to a person-centered, house-hold model of care.

Meaningful Care Matters has sent an extensive, formal report with recommendations on making meaningful change.

An audit was completed on the physical space on Bankwood and recommendations for change and transformation.  Over the last few months we have started to create a relaxed home-like feel to the day with less task orientated activities and more emphasis on the people living and working on Bankwood.

We have begun the process to re-design Bankwood to be more welcoming and intimate, filling the house with the “stuff of life” so that residents can connect with a variety of colours and objects that reflect their past lives, work and hobbies.  And staff training begins this month!

Person-centered care is front and foremost as Bankwood undergoes change and transformation!  Please forward this blog post to at least one other contact you know who may be interested.

And please encourage others to become followers by clicking on the button on the right hand side of this post.