Toronto now has a blueprint to transform its nursing homes through emotion-focused care, says Dr. Samir Sinha, co-chair of the city’s seniors’ accountability group.
Prompted by a Star series on Peel Region’s year-long pilot of a Butterfly Model home, city council voted unanimously last July to hire an independent researcher to evaluate the U.K.-based program and other similar models.
That 58-page report is now in the hands of councillors.
York University professor Pat Armstrong and her team examined Butterfly, U.S.-based Green House Project, the Eden Alternative and a group of Wellspring homes in Wisconsin, which joined the Eden Alternative in 2012. They are all emotion-focused programs that transform care.
All have significant benefits, Armstrong’s report concludes, and all emphasize the “importance of care relationships” that embrace the interests of each individual living in the home. Key to success, the report said, are extra staff and flexibility for them to develop those relationships with residents.
The pilot project in Peel’s Redstone dementia unit, the focus of the Star series, was a departure from traditional nursing home care dominated by schedules, routines and hourly documentation. A resident played songs from the 1940s on the piano, while others sang. A 94-year-old enjoyed making marmalade toast and tea whenever she wished. A retired lawyer stayed busy writing after staff gave him a notebook and collection of legal books.
Armstrong’s report said four smaller programs, including a Montessori-based approach, could also benefit residents in Toronto’s 10 city-run homes.
“This (report) will be a great enabler, now allowing us to take the next steps that all homes — in Ontario and beyond — are looking to do,” said Sinha, director of geriatrics at Mount Sinai Hospital. Sinha wrote the seniors’ strategies for Ontario and Canada.
Sinha and Councillor Josh Matlow co-chair the city’s seniors’ accountability group, which represents about 60 organizations and holds meetings attended by hundreds.
As part of her research, Armstrong, a professor of sociology known for her expertise in long-term care, consulted with Toronto’s long-term care leaders, seniors advocates and the companies and organizations that sell the programs.
The majority of those consulted said homes should be able to choose the care model and physical design of a home. In an interview, Armstrong said there was debate over the definition of a “home-like’ environment and its size and decor. The report said those interviewed agreed that Toronto must redevelop five of its homes with input from those who live, work and volunteer in those homes.
Sinha said Toronto might take parts of different models for a custom, made-in-Toronto program. “It’s about investing in R and D — rob and duplicate, and give credit,” he said.
Councillor Matlow, Toronto’s seniors’ advocate, introduced the motion that resulted in the report. Matlow says he will introduce a second motion that, if passed by council, will require the city’s long-term care staff to give a detailed plan for change in each of Toronto’s homes. Matlow said he wants this plan to include staffing levels and accountability guidelines to ensure improvements are sustained.
“I’ve seen a lot of these reports end up in the dusty archives and nothing changes. We have an opportunity to be leaders. If we don’t believe that one of those approaches is indeed the best approach then let’s create a model that other jurisdictions can learn from.”
The Star’s story on Peel’s Butterfly Project pilot showed that residents who previously spent their days staring at the floor or watching TV soon came back to life through music, conversation and laughter. Residents developed friendships with workers, practising golf swings, shooting hoops in a mini-basketball net, or dancing to 1950s tunes.
The Star also visited a Green House nursing home in suburban Penfield, N.Y. There were two separate units of 10 people each, with open-concept kitchens, long family-style tables and cosy living rooms, operated by St. John’s long-term care, a non-profit organization.
After seeing improvements in Penfield, St. John’s turned its traditional 400-bed nursing home in nearby Rochester into smaller homes. A St. John’s spokesperson recently said the staff turnover rate in its Green House homes is 10 per cent, compared to 35 per cent in the traditional style of care. Sick days are also down, reducing overtime costs, he said.
Dr. Bill Thomas, the geriatrician who created Green House and the Eden Alternative models told the Star last year that demand for change from the massive demographic of aging boomers will only grow as they discover these care options.
After the Star series ran, provincial and national seniors’ lobby groups have pushed governments for emotion-focused programs.
Canada’s largest seniors lobby group, CARP (formerly Canadian Association of Retired Persons) is pushing Ontario to support “transformative dementia care” programs such as Butterfly.
Seniors’ advocates have long lobbied for increased staffing in nursing homes, a key point in Armstrong’s report.
Peel Region said it hired additional workers during the Butterfly pilot, and this year it is hiring 14 new workers as the program expands to two additional dementia units.
The Canadian Union of Public Employees, Local 966 in Peel, says more workers are needed for the emotion-focused program to work. The union is also filing a grievance that asks for an increase to workers’ current clothing allowance. The Butterfly program asks staff to avoid uniforms, saying they are a symbol of authority over people living in the home.
The report, called Models for Long-Term Residential Care, is now in the hands of Vija Mallia, the city’s interim general manager of long-term care. Mallia told the Star her staff will prepare an analysis for a presentation they will give to the April 3 meeting of the Economic and Community Development Committee.