‘I’m trying to show what’s possible’
Star reporter’s new book examines resident-based, more humane senior care
It didn’t take a pandemic for Star investigative journalist Moira Welsh to wonder what could change in long-term care.
Her 2018 investigation into the Butterfly program, a longterm-care program that leaves behind the traditional and institutional model of care common in Canada’s facilities in exchange for a compassionate and forward-thinking model, led her to wonder: What if this were the norm?
Enter Welsh’s new book, “Happily Ever Older,” which examines long-term-care homes that have abandoned the institutional and placed an emphasis on residents’ needs for interactions with nature and normal routines.
COVID-19 has given us “a time of reckoning,” Welsh said. “This is now an opportunity for us to make a difference and to call for change.”
Welsh sat down with the Star to talk about her book and how long-term care can evolve for the better.
You’ve been covering longterm care with the Star for a long time. How did the book come to be?
The book came about as a result of an investigation that I did in 2017, 2018. It was published in June of 2018, and it was related to the transformation of a dementia unit in a Region of Peel nursing home using what was called the Butterfly program. And what was so interesting to me about the response to that story was
the reaction from readers, from families, children, people who are probably of an age where they might have to consider long-term care at some point as well, depending on their health. People were just so excited to see that there was a different approach and they wanted more.
I was really inspired by that and took this as an idea for a book to a publisher, Jack David at ECW Press, who was also interested in similar ideas.
Was there a particular approach to long-term care that you found which resonated with you?
I think they all did. They’re all very similar, the DNA is similar. Basically, in many ways it comes down to kindness and social connections, and giving people freedom of movement within their homes and access to the outdoors so they can walk in fresh air and feel sunshine on their skin — something many long-term-care residents simply do not get. I think they were all really interesting and I purposely am not pushing one over the other. I’m trying to show people what’s possible.
In your book you talk about how barriers to implementing these types of care can be brought on by cost. Is there a way to fast-track this so it can be the reality of elder care right now?
It’s a really good question and I’ve been having discussions with people about how this might happen. For example, there is discussion right now about national standards for long-term care. Those national standards could include language that talks about personhood and rights of individuals who are living in long-term care to have social connections, to have individualized purpose in their days, to have access to the outdoors and to live in comfortable familiar surroundings. You need leadership that buys into it. If you don’t have that, then you don’t have much. I do think that if we can enshrine these ideas in legislation or regulation, then that starts the movement toward looking for people who can actually lead in long-termcare homes and create these new philosophies and new programs within the homes.
Is there something that could be implemented sooner that might make life easier for residents of long-term care?
It is very possible to begin change by getting to know each individual resident and what their needs are and what their interests are before arriving in long-term care so that you can try to provide for these people in your care. The reality is that little bits and pieces will not change the system because the system is so entrenched with a focus on tasks and documentation every hour. Small changes can help, absolutely, but really the transformation is what’s needed.
What did you learn that surprised you most?
The freedom piece of it was really unique and the connection to nature. I was not thinking about that specifically when I started my research. The more homes I visited, the more it came up in conversation and I just found it so interesting. We don’t think about the fact that people in longterm care are mostly locked indoors for the remainder of their lives. Imagine how you or I would feel if we had to live that way?
People I spoke to have said that it is not rocket science to treat people kindly, to enable them to live in small households.
Was there a particular resident whose story stood out to you?
There are a couple of women I met that I really liked. One named Alice Cowell lived in the Sherbrooke Community Centre in Saskatoon. She moved into the home and couldn’t get a room other than an opening in a dementia household, and they said they’d move her when a room became available. Alice had a problem with her legs, she did not have cognitive decline. She actually befriended most of the people in the dementia household that she lived in and became great friends with some of the women. She no longer wanted to move to a unit that did not have people with cognitive decline. It was a happy place for her; she felt like she had purpose by helping to care for people when they might be having a rough moment.
It’s difficult to have conversations about long-term care now without talking about COVID-19. Do you think that some of the solutions that you found while researching the book would have had an impact on how the virus panned out?
Quite likely, yes. Smaller households are naturally more proficient at infection control, because there are fewer people in them. They’re contained; it’s not a big open space or a 32unit ward. That makes a big difference. Also, in these homes the same workers are dedicated to the same households, so you don’t have people coming and going. A recent study looking at homes across the United States concluded that small, non-traditional nursing homes have fewer COVID-19 cases and deaths.
Another bit of it is in COVID times, a lot of people have withered not from COVID but from social isolation. In the homes that have a strong focus on human connection and friendship, there was a real effort to continue with daily events or conversations. I think that helped in some ways with emotional support for people living in the homes.