Nursing home chain starts big shift toward new care model
Long-term care leaders say the industry is welcoming change that offers people with dementia and staff warmth, friendship and purpose
The floors are clean, the walls are an inoffensive shade of beige and the staff work to keep the elderly people who live here safe from harm.
By Ontario government standards, the dementia unit inside the Henley House long-term care home in St. Catharines gives good care, its managing director says.
And now, she can’t wait to see it dismantled.
“There’s going to be a very, very big shift in the way we provide care,” said Jill Knowlton, of Primacare Living.
Instead of one big unit of 25 people, the home will be broken into two small, cozier living spaces for people with moderate and severe dementia. Workers will be trained to express empathy and spend time chatting, playing cards or dancing with people living in the home, rather than rushing from one task to the next. Walls will be painted in fuchsia, tangerine or neon green to help people navigate the hallways.
Inspired by the changes at Peel Region’s Malton Village, which used the British-based Butterfly program to turn a drab dementia unit into a place of warmth, energy and friendship, Primacare will also add the program to its homes in Brampton and London and a new home to be built near Hamilton.
“The scourge of dementia is old news — now is the time to do something about it,” Primacare president Matthew Melchior said at the launch of the Butterfly program in St. Catharines last week. “Standing still is stagnation. The status quo is not the answer.”
Peel’s Malton Village was the first in Ontario to implement the full Butterfly program, which focuses on social and emotional happiness for people with dementia. In Alberta, the program is used in six seniors’ homes (five assisted living and one longterm care.) It is used in 23 homes in the U.K., three in Australia and one in the United States.
Peel’s year-long pilot ended last spring and after seeing the results, Peel Regional councillors voted in favour of adding it to its four other long-term care homes.
Candace Chartier, CEO of the Ontario Long Term Care Association, which represents mostly for-profit long-term care homes like Primacare, told the St. Catharines crowd, “This is something that is going to change the lives of every person in this room and the staff members, volunteers and every resident and every family member that come through the doors.
“I’ve had the chance to look at the Butterfly Model … it truly is what the future of long-term care is, what senior care is,” Chartier said. She later told the Star that Ontario’s plans for 30,000 additional nursing home beds should follow new care models instead of replicating the current designs that place large groups of people in one living space.
The Butterfly program is one of several models that focus on sweeping culture change, easing workers out of a traditional style of care that, in Ontario, is dominated by schedules, routines and hourly documentation. The Green House Project and Eden Alternative — both created by American geriatrician Dr. Bill Thomas — share similar philosophies that favour small homes, social interaction and friendships between staff and people in their care.
Knowlton, of Primacare, said the company spent two years researching ways to improve, despite already adding extra staff and training programs. Primacare signed a contract last spring with Dementia Care Matters, the Butterfly model owner, after seeing the program’s impact on people living in Peel’s Malton Village.
Peel’s experiment with the program was documented in a 12-month Star investigation called The Fix. Starting in March of 2017, the process began slowly, but people who previously spent their days staring at the floor or watching TV came back to life. Workers spoke about falling in love with jobs that provided a sense of purpose. Peel said staff sick days have dropped by 75 per cent.
Critics say the program does not have peer-reviewed academic research to back its claims. Peter Bewert, CEO of Dementia Care Matters (owned by the Salvation Army Australia), said he welcomes independent research. Peel Region is in talks with the Centre for Elder Research at Sheridan College to begin a detailed evaluation.
The story of Peel’s experience showed the highly regulated and regimented nursing-home industry that change is possible, said Lisa Levin, CEO of Advantage Ontario, which represents non-profit and municipal homes.
“It created such a buzz,” Levin said. “Almost everywhere I went, people were asking me about this. It really has had quite an effect. A number of our members are looking at transformative care — I wouldn’t be surprised if all of them are looking at it.”
There’s a widespread belief in the industry that the Ontario Health Ministry could help homes improve care with a staffing boost and changes to ease some regulatory requirements. Officials have not said if they intend to do so. Levin said she believes the new government knows the system needs innovation.
For now, Levin said Peel’s experience shows that homes can begin moving forward with changes to create a relaxed, homier setting.
“What’s happening now is that people are realizing they can make a difference. They can change — I call it a transformation. That it is within the means of our homes, and our government.”
In the City of Toronto, which operates 10 long-term care homes, general manager Reg Paul is examining a variety of emotion-centred care programs. Last summer, city council voted unanimously to ask city officials to report back in early 2019 on recommendations for a pilot project.
Toronto’s Paul said city homes have fewer than average incidents (like falls, use of restraints or antipsychotic medication) but added, “I believe that we have to continue to evolve.” Dr. Samir Sinha, co-chair of Toronto’s seniors’ accountability group, said Toronto homes are improving but he’s still advocating for changes created by programs like the Green House Project or Butterfly.
The changes at Peel, for example, showed that staff and residents benefited, he said. “It allows people to blossom,” said Sinha, director of geriatrics at Mount Sinai and the University Health Network Hospitals.
Last year, the Star visited a Green House nursing home in a suburban neighbourhood in Penfield, N.Y. There were two separate units of 10 people each, with open-concept kitchens, long family-style tables and cozy living rooms, operated by St. John’s long-term care, a non-profit organization.
After seeing improvements in Penfield, St. John’s decided to turn its traditional 400-bed nursing home in nearby Rochester into smaller homes. St. John’s spokesperson, Nate Sweeney, 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 75 per cent fewer than in traditional units, reducing overtime costs, he said.
Peel is reporting the same drop in staff sick days. It also found an increase in resident and staff satisfaction and a decrease in anti-psychotic medication and falls, but a spokesperson said Peel wants to do an indepth evaluation and measure numerous outcomes, with Sheridan College.
“I believe it will stand up to the rigour of research,” said Mary Connell, Peel’s Butterfly project manager and a registered nurse who will oversee the program’s rollout in Peel’s five homes.