Toronto unveils plans to revamp long term care homes

Thestar.com
Nov. 28, 2019
Moira Welsh

The city of Toronto is recommending dramatic changes to the way people live in its 10 long-term care homes, with a proposal for more staff and a new style of care that focuses on empathy, friendship and purpose.

The plan released Wednesday calls for in-depth training that could change the lives of residents, allowing staff to connect with vulnerable people in their care by learning empathy, creating friendships and connecting an older person with activities that give their life purpose. In traditional homes, residents spend most of their days alone while staff focus on tasks.

The proposal calls for extra staff members, beginning with six new front line workers in a 2020 pilot project at Lakeshore Lodge in Etobicoke.

Starting in 2021, roughly 55 additional workers would be hired each year until 2025, when a total of 281 new staff members would be in place throughout the city’s 10 facilities.

“This is an evolution of the industry and the care of the people in our homes,” said Paul Raftis, interim general manager of Toronto’s department of seniors services and long-term care.

The plan was spurred by a unanimous council vote last April, after a motion by Coun. Josh Matlow asked city staff to find ways to offer residents a happier, less-isolated lifestyle.

Matlow, who serves as the city’s seniors’ advocate, said he was inspired by “The Fix,” a 2018 Star series on the transformation of care in a dementia unit in Peel Region’s Malton Village.

After reading the series, Mayor John Tory expressed interest in offering city-operated homes programs like the “Butterfly” model that Peel used.

The report, which estimates the annual cost for new workers at $24 million by 2025, already has the support of city budget chief Gary Crawford.

“City staff have come forward with a proposal that will help us start to implement the emotion focused care model in the city’s long-term care facilities,” Crawford said in a written statement.

“I believe this will help us plan how we can adopt this approach across our city for the benefit of our residents. I know Mayor Tory supports this approach and as budget chief, I will be working with the mayor to make sure this is supported through the 2020 budget process."

While Peel’s Malton Village has inspired change in nursing homes in Ottawa, Kitchener, St. Catharines, Brampton and London, many others remain locked in the institutional model.

Old-style homes focus on schedules, tasks and government-required documentation instead of the emotional needs of people living there. Residents are generally kept clean, fed and safe but few have any purpose in life. Many spend their days staring at a television or the floor.

Toronto’s report sets out the reasons why Raftis and his staff are pushing for change. “Long-term care homes are not exclusively medical and nursing care institutions,” it notes. “They are social organizations where people who need care can continue to live their lives to the fullest.

“For the resident to experience long-term care as their home, meeting only care and medical needs is not enough. Residents also have social, emotional and psychological needs that staff support.”

The report will go to the economic and community development committee on Dec. 4, before it arrives before council two weeks later. If passed, it will head to the budget committee in February.

Audrey Sinclair, personal support worker, with Maxwell McCoy, in the lounge for people on the advanced side of the Redstone dementia unit on February 26, 2018. Audrey is one of the workers who spends time with Maxwell, massaging his hands, quietly talking to him. She says he is now starting to talk in short sentences, after not speaking at all.

Under the proposal, Toronto will begin a 12-month pilot project next year at Lakeshore Lodge with “really structured training” for workers, Raftis said. The pilot project will include six new staff at a cost of $500,000 for the new hires and the program changes, including a cozier decor.

Toronto’s emotion-focused program will evolve over time but Raftis said it will immediately help staff find ways to connect with people, tapping into residents’ interests, perhaps based on a previous career or a love of music.

Leaders of the home will give staff the flexibility meet resident’s needs, instead of rushing to finish tasks, Raftis said. If a resident feels like going for a walk outdoors, for example, a worker will have the freedom to take that person out for some fresh air.

“When we feel connected,” the report says, “our emotional needs are met; when our emotional needs are met, we can face life and enjoy it. This is the essence of emotion-centred care.”

Under the traditional system, Toronto workers are told to focus on residents’ daily needs, such as eating, bathing and toileting, along with some recreation and therapy.

“What’s been lacking is time to form relationships and quality social interaction,” the report says.

The extra workers would allow Toronto to give an average of four hours of daily direct care instead of the current 3.5 hours. By changing the staffing plan, the report says, “care can be tailored to the individual, where staff have more time for quality of life care.

“In other words, more focus on people, rather than tasks, will be the norm.”

Toronto’s emotion-focused program will evolve over time, but Paul Raftis says it will immediately help staff find ways to connect with people, tapping into residents’ interests, perhaps based on a previous career or a love of music.

Raftis said that spreading the costs over six years makes the transformation more affordable. The report requests that city council ask the province for extra money to help pay for the emotion-focused programs and staff. The province currently pays 80 per cent of the $268,499 million long-term care operating budget and the city pays the remainder.

While the city examined programs like Butterfly, the Green House Project, Eden Alternative and Montessori, staff recommend a Toronto-created approach.

As the program unfolds, staff will work with families and residents, along with University of Toronto’s Lynn McDonald and Raza Mirza, who will evaluate the progress and, Raftis said, recommend ways to adapt if change is needed.

Lakeshore Lodge was chosen after the smaller city-run homes made presentations explaining why they should be the site for the pilot project, Raftis said.

“These homes are hungry for this change,” he said.