Toronto council is moving forward with detailed plans to give emotion-focused care to the 2,600 residents of its city-run nursing homes.
The plan may choose from many options including the Eden Alternative, the Green House Project and the Butterfly Model, which has already transformed the dementia unit in a Peel Region nursing home. The one-year Peel pilot project elevated the lives of residents through friendships with staff and a cosier home-like atmosphere.
Councillors and Mayor John Tory voted unanimously to support Councillor Josh Matlow’s motion for a plan to develop the “implementation strategy” with accountability measures to ensure change. Staff must report back with the detailed plan for culture change next fall.
If the plan is approved at that point, any part of it that seeks extra money would face the competing interests of Toronto’s 2020 budget. If no extra money is needed for some improvements, quick changes could be made based on the individual needs of each home.
“We have a choice, either to warehouse our seniors and under-resource, under-staff and really just manage them as patients or, to provide the kind of care that really addresses their needs and improves their quality of life,” said Matlow of the April 16 vote.
Matlow called the strategy a “giant step forward” for the city’s 10 long-term care homes, saying he wants Toronto to inspire other cities to improve care.
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Change is already happening in Ottawa, Brampton, Kitchener, St. Catharines and London, where operators are moving ahead with the U.K.-based Butterfly Model.
Toronto council’s demand for the implementation strategy follows an independent consultant’s report on options for culture change. The hiring of that consultant was prompted by a Star investigation into Peel Region’s year-long pilot of the Butterfly Model. The consultant’s report found that all programs studied provide significant benefits. It also said four smaller programs, including a Montessori-based approach, could also improve care.
In the Redstone dementia unit at Peel’s Malton Village, administrators and workers were trained to express empathy and spend time chatting with people who live in the home, holding hands, dancing or singing instead of racing from one job to the next. Peel Regional Council has since voted to expand the program to a second dementia unit in Malton Village and to its four other long-term care homes. It is hiring extra workers for each home, although the Canadian Union of Public Employees is pushing for more staff to support the program.
In his recent speech to Toronto council, Matlow cited improvements in Peel and in Wesburn Manor, a City of Toronto home where, he said, leaders transformed the home’s appearance and activities.
“It is remarkable,” he said. “They’ve changed the colour of the walls from the white, institutional hospital setting to warmer colours. They have dolls and robotic animals, things to provide comfort and security to those who need it. And, they’ve been reconfiguring the size and dimensions of their space.
“I want people to come (to Toronto homes) and say, ‘Wow.’ ”
In Ottawa, The Glebe Centre, a not-for-profit home, is adding the Butterfly program to its dementia unit, with training beginning in the early fall.
Susan Zorz, Glebe’s director of resident services, said the home offers many activities to the 32 people living in the dementia unit but after those scheduled events, there is little to do.
“The number one reason for doing this is to be able to provide the most homelike environment for the residents who live here,” she said. “This is their last place ... so we want people to be comfortable and have a quality of life.”
It costs $100,000 for the one-year training program. Zorz said Glebe’s board of directors, along with its family and resident councils all supported the plan to move forward with the program.
Zorz said she does not plan to hire more workers. Each frontline worker has seven or eight residents in their care during the day and evening shifts, she said.
Personal support workers and nursing staff have told management they want deeper connections with people in their care, she said.
“They feel their job is just so task-focused. They want that quality time to get to know residents,” she said. Zorz expects the program will help The Glebe Centre attract workers and keep them. Ontario, like many regions across North America, is struggling with a shortage of personal support workers.
The Region of Waterloo plans to begin Butterfly training at its one municipal home, called Sunnyside Home. It has 49 residents living with dementia.
Connie Lacy, Waterloo’s seniors’ services director, said she asked council and Sunnywide’s fundraising foundation for the money to pay for Butterfly after seeing Peel’s outcomes — reductions in falls, troubling resident behaviour and weight loss, along with improvements in resident satisfaction.
Lacy said the home developed its own program over the last three years. Workers painted walls in blocks of colour, turned one sitting room into a “man cave” with tools and another into a nursery with dolls. Still, she wanted outside help.
“We’ve made some good progress, some good outcomes, but we are not where I want us to be,” Lacy said. “We can’t wait. There is a great urgency here. We are working with people with advanced dementia right now and I want to move forward as quickly as I can.”
Last fall, Primacare Living, a private long-term care operator, began the year-long Butterfly training in its St. Catharines home. At the end of May, the program will begin in its London location. Primacare plans to bring Butterfly to its home in Brampton in September and will add it to a new nursing home that will be built outside of Hamilton.
Dr. Samir Sinha, who co-chairs Toronto’s seniors’ accountability group with Matlow, said Toronto homes have been trying to improve but the implementation strategy offers “a great opportunity” to make recommendations on specific changes.
“We may be able to identify some quick wins that we can achieve with existing resources over the coming year,” Sinha said. “But, we can also get greater clarity about what additional resources and investments we need to ultimately get where we want to be.”
Moira Welsh is a Toronto-based investigative reporter. Follow her on Twitter: @moirawelsh
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