Toronto budget proposal moves ‘emotion-centred’ care for seniors closer to reality

Thestar.com
Jan. 14, 2022

A new focus on the well-being of residents in City of Toronto nursing homes is closer to reality now that the city’s 2022 proposed budget is seeking a “historic” investment in emotion-centred care.

“This is a remarkable shift that focuses on enhancing the quality of life for our seniors,” said Toronto’s budget chief, Coun. Gary Crawford.

If properly funded -- and implemented -- the innovative philosophy would put the individual needs of Toronto’s 2,619 long-term-care residents ahead of routine schedules, enabling people to live with greater friendship, freedom and activities that allow them to flourish at any age or ability.

It could see 272 new front-line staff hired to work directly with residents, although the new and 3,000 existing workers would need specific training in the philosophies that focus on individual interests of residents and the value of their relationships with staff.

Staff training, said Jennifer Dockery, Toronto’s general manager of seniors services and long-term care, would be part of a city-created model branded as “Care TO” that is being piloted in Etobicoke’s Lakeshore Lodge. The 2022 budget request asks for $4.1 million to begin expanding the program across Toronto’s 10 city-operated homes, starting next fall, Dockery said.

The ongoing costs from the pandemic mean the 2022 budget is “more challenging than we had hoped it would be,” Crawford told the Star. “But we are committed to long-term funding for the emotion-centred care model.”

The proposal still has to be passed by Toronto City Council when it votes on the budget Feb. 17, but he noted that emotion-centred care has the support of Mayor John Tory.

On Thursday, in a statement to the Star, Tory cited the newspaper’s ongoing stories on nursing-home transformation, saying they showed that emotion-centred care “is the right thing to do for long-term-care residents.”

After the Star’s 2018 story on changes in a Peel Region dementia unit, Toronto City Council, led by Tory and Seniors Advocate Josh Matlow, voted unanimously for the pilot project that will be evaluated next fall.

“In December 2019, I was proud to lead city council in approving a new emotion-centred approach for our city-run long-term-care homes,” Tory said. “Since then, we have gone through 22 months and counting of the COVID-19 pandemic that should make us all better understand the importance and need to keep investing in and improving all of our long-term-care homes.

“I was more determined than ever to make sure that despite our budget challenges due to the pandemic, we continue to move forward with this approach for our long-term-care homes.”

If Toronto succeeds with its plans to transform all city-operated nursing homes, it will become a North American municipal leader in long-term care, said Dr. Samir Sinha, co-chair of Toronto’s seniors’ accountability group and director of geriatrics at Sinai Health and University Health Network.

Sinha said the city has a seniors strategy that elevated community support for older adults and focused on long-term care. Still, he said, the possibility of extra staff in nursing homes does not immediately mean Toronto will succeed with high-quality emotion-centred care.

“Just having more bodies doesn’t equal better care,” he said.

“You need to not only have a well-staffed home, but you also need to have staff that have the knowledge and skills to be able to deliver exceptional care,” Sinha said. “This additional investment is not just going to be about having an adequate number of people to provide good care, but also making sure that people can be trained to provide more emotion-focused care.”

Another key point is the hiring of full-time staff who work in the same long-term-care households, so workers get to know and understand the residents. Dockery said new workers would have “consistent” placements.

Well-researched models such as the GreenHouse Project, for example, show the value of deep connections between staff and residents.

Operators who use GreenHouse say that staff know the emotional needs of residents but also recognize potential health issues, such as urinary tract infections, long before more serious problems set in and people need to be hospitalized. Research shows that residents of these homes make fewer trips to the emergency department, experience fewer pressure ulcers, are more mobile and have deeper emotional connections with staff.

Workers with proper training in emotion-centred care, Sinha said, lead to better outcomes for residents and staff.

“Frankly, when we have a system where it’s so hard to attract, recruit and retain staff that if staff aren’t happy, if staff are not being fulfilled, they’re less likely to stay in that role,” he said.

“So when we’re training them to provide emotion-centred care, where residents have a higher quality of life and are happier, then staff are likely to be happier as well. And everybody wins.”