There are at least 4 different innovative models of LTC (Butterfly, Eden Alternative, Green House and Hogeweyk) but they all tend to have similar philosophies and similar outcomes.
Common Elements
• Person-centered and person-directed care, emphasis on kindness and compassion
• Meaningful relationships between residents, their families, and staff
• Vision and leadership needed to implement change
• Staff education/training on culture change, empathy
• Emphasis on teamwork
• Environmental design aspects to support residents
• Small group homes or household units within larger facilities
• Strive to create a non-institutional, familiar, home-like environment
• Access to the outdoors
• Opportunity to participate in meaningful activities
• Autonomy of residents, flexible daily schedules
• Focus is on possibilities, not on disabilities
Common Benefits
• Quality of life and Quality of care
• Increase in resident activity levels and social activity
• Happier residents, families, and staff
• Staff feel valued and part of a community with residents and families
• Residents take fewer medications, stay active, eat better, sleep better
• Reduced boredom, helplessness, and loneliness
• Decrease in agitation and behavioural issues
• Decrease in spread of disease, respiratory illness, viruses
• Decrease in staff sick days
• Decrease in antipsychotic medications and supplements
• Decrease in falls causing injury
• Decrease in trips to hospital
• Decrease in weight loss
• Decrease in food waste
THE BUTTERFLY APPROACH
The Butterfly model was pioneered over 20 years in the United Kingdom and is now known as the Butterfly Approach under the umbrella of Meaningful Care Matters. It is a social model of care that shifts care from a traditional medical care approach to:
- Prioritizing emotional care that is person centered.
- Creating busy, filled up, engaging places that feel like ‘home’.
- Providing relaxed, freed up and comfortable environments.
- Involving people in the running of their own home.
- Emphasizing a more informal, best friends and family like approach.
- Staff wear regular street clothes vs uniforms
The Butterfly Approach is a home-like setting that creates an environment that is familiar to people so they feel more comfortable, less agitated, less aggressive and more content.
Some of the cultural changes in the Butterfly Approach are enabling staff to connect emotionally with residents and families, less emphasis on task-orientation and an increased emphasis on people interacting in a relaxed, compassionate, understanding way. The home is welcoming and intimate and filled with the “stuff of life” that has meaning to residents so they can connect with colours, textures and things that reflect their past lives, work, and hobbies.
As of July 2023, there were 26 long-term care homes in Canada either fully accredited or in the process of being accredited in the Butterfly Approach. There are many more homes elsewhere including the United States and Europe.
THE EDEN ALTERNATIVE
The Eden Alternative was born in the 1990’s. It provides a re-interpretation of the environment elders live in, from an institution to a garden. As the philosophy grew, there was a focus on kindness, companionship, creativity, and ongoing personal development.
Regimented schedules and activities are replaced by residents having a say in how they will live there. They can sleep in, garden, have pets, visits from children, help with chores or other responsibilities, giving them purpose and alleviating feelings of helplessness. Residents live in “villages” even in an older building.
As of September 2023, there were approximately 300 Eden Alternative long-term care homes in the United State and several in western Canada.
THE GREEN HOUSE® PROJECT (GHP)
While the Eden Alternative focuses on partnering with nursing homes to help them change their culture, environment and approach to care, the Green House® Model focuses on helping companies and individuals build or convert residential homes that can provide high levels of care for people who do not wish to be in a nursing home setting.
The Green House® Project is a not-for-profit organization founded on the belief that everyone has the right to age with dignity. GHP seeks to protect this right by de-stigmatizing aging and humanizing care for all people through the creation of radically non-institutional eldercare environments that empower the lives of people who live and work in them. A Green House Project community consists of clusters of smaller homes (or units) with 6–10 residents. Each resident has their own bedroom and bathroom, they are free from scheduling, and can access shared and social areas of the home/unit at any time, making it truly like home. They use smart technology such as adaptive devices, computers, and ceiling lifts.
While GHP’s core mission is to build new homes, not all providers have the land or capital to do so. To broaden the reach and deepen the impact of the movement to transform eldercare, the Green House 2.0 initiative was launched, and Cultural Transformation was created to help progressive-minded providers implement cultural transformation in traditional settings.
As of September 2023, there were approximately 370 Green House Project long-term care homes in the United States. In Canada, the province of Quebec is now transitioning its long-term care homes based on the Green House Project philosophy.
THE HOGEWEYK VILLAGE
The concept of an entire village for the care of the elderly came about in 1993 in a small town just outside of Amsterdam called Weesp. Two managers of a traditional nursing home called Hogeweyk realized they were providing meals and safety but little joy in an institution that looked and felt like a hospital. They wanted to focus on the human beings under their care and on what they were still able to do and wanted to do.
They gathered people with similar interests and allowed them to live together in small households with kitchens, laundry, and the feel of “normal living”. By 2002, they planned and designed a new home which, instead of being one building, became a neighbourhood called de Hogeweyk. The design included a long outdoor community square with a fountain and tables/chairs for café-style conversation. Inside the doors to the main building would be a pub, a grocery store, a hair salon, and club rooms for baking or other activities. It opened in 2008 and the town of Weesp expanded and revitalized around it.
As of September 2023, there were 2 long-term care homes using the Hogeweyk Village model in Canada, and many other homes in Europe.
New emerging models:
There are new models of care emerging which incorporate one or more aspects of the models mentioned above. These changes in long-term care homes are taking place across Ontario and also within Quebec.