Changing LTC

 From the CBC:

“This long-term care home radically changed the way it operates. Residents say it's working”

(A personal support worker chats with Louis Capozzi, left, and James Armstrong in the dining room at Lakeshore Lodge, a City of Toronto-run long term care home, on Oct. 26, 2022.)

Like so many people contemplating long-term care, Louis Capozzi said he was nervous about what he would find when he started looking at homes. "I heard so many awful things about, you know, people getting not well taken care of, laying in bed, needing to be changed and people hitting them or whatever. You hear all the worst things," he said. But Capozzi, who is 70 and has amyotrophic lateral sclerosis, or ALS, said he was pleasantly surprised by what he found at Toronto's Lakeshore Lodge, where he's lived since June.

Lakeshore Lodge is part of a pilot project to improve care in long-term care facilities — the first of the city of Toronto's municipally-run long-term care homes to receive extra funding to make the care more resident-centred. This allows the people living there to have more choices: in what they eat, when they get up in the morning and even on the colour of the hallways. Capozzi worked for years as a builder, so he's been consulted on construction aspects of the project. He also loved to cook before his ALS diagnosis, so he's helping improve the menu. He and the other residents on the committee nixed the Salisbury steak, for instance. But the new program, called CareTO, isn't just about improvements to food and decor. Lakeshore Lodge is shifting away from a traditional model of long-term care homes focused on task-based care — where for example, everyone had to be up and fed at the same time for efficiency.

(Capozzi sits in his room at Lakeshore Lodge, a City of Toronto-run long term care home, on Oct. 26, 2022.)

The funding for the program, which started in June, is $16.1 million over five years. The money will translate into 272 new positions at the city's 10 municipally-run long-term care homes, as well as more training for staff and programming to keep residents stimulated and engaged. The province has provided $12 million, with the rest coming from the city. Each home will have the chance to make the model its own, molding it to residents' needs.

More staff. More personalized care

(Personal support worker Sussett Bartley is pictured outside a resident’s room at Lakeshore Lodge, a City of Toronto-run long term care home, on Oct. 26.)

There were 198,220 long-term care beds in Canada in 2021, according to the Canadian Institute for Health Information. And the number of seniors needing beds is expected to "greatly increase" in the coming decades as Canada's population ages and the baby-boomer generation nears retirement, the Conference Board of Canada notes. The goal of the new Toronto program is to improve care and quality of life for residents. CareTO started at just the right time for Sussett Bartley, who has worked at Lakeshore Lodge as a personal support worker for 18 years. The extra strain COVID-19 brought was wearing her down, she said. "I personally was getting burned out," she said.  She said she felt like she never had enough time for the residents she was supporting. Now, with more staff thanks to the new funding, she's gone from having 10 residents under her care during a shift to eight. It makes a big difference, she said. It means she gets to be with them more, chatting and figuring out what they need.

The City of Toronto has launched a pilot project to change the way its long-term care homes are run, giving residents in a say in how their care home operates to make sure those who live there have a high quality of life. Residents and staff say it's working. "Everybody is different, right? And this lets you get to know each person on a personal level."  Sometimes, what is remarkable about having more staff are the things that aren't seen or heard, she said. Call bells ring less frequently because staff can answer them faster.  On each floor, visitors are greeted by an empty nursing station. It's a sign the caregivers are working hard, said Bartley, who is a peer mentor for CareTO. They can do their documentation in a resident's room, for instance. "We don't sit here to do it. We sit with them, we can talk with them, we can multitask."

'Culture change'

(Staff at Lakeshore Lodge prepare to serve lunch on Oct. 26.)

The home has also hired more activity staff, which means there are more choices for how residents spend their days. For some, that can mean being a part of the musical entertainment, bingo and other traditional activities.  For others, a walk with a caregiver to a local coffee shop, or a special breakfast where a few residents eat something different than the regular menu in a smaller dining room, is more their speed. Giving people power over their days, and keeping them safe while maintaining dignity, is key to the program. And researchers are monitoring the program's progress, evaluating its effectiveness as it expands to other Toronto-run long-term care facilities. "CareTO is really this culture change, this whole ongoing process where the idea is that the staff will be responsive to the emerging needs of the residents," said Sander Hitzig, a senior scientist at Sunnybrook Health Sciences Centre, who has been working on the implementation of the program. "The residents are starting to feel like, you know what, 'I actually can say… I want to do this today' and have more autonomy and control in terms of what their home life experience will be in the long-term care setting.

(Bartley checks on a resident in Lakeshore Lodge on Oct. 26.)

The program will continue to evolve as other homes are incorporated into the model because each home is different, he said. "The residents are different. The staff and team dynamics may be different," he said. For instance, some people are early risers and others would rather spend the morning in bed. To accommodate the varying needs, the home has invested in a hot/cold cart for each section of the home. This way, those who want meals a little later or want to eat in their rooms will get food at the right temperature.  The hot/cold cart was an "easy win," said Christine Sheppard, a researcher at the Wellesley Institute, a non-profit healthcare research organization. Sheppard is handling evaluation of the program for the City of Toronto. Other components of the program are more involved, such as training and education. "I think there's a lot of really good evidence-based thinking that went into the creation of CareTO that will help create that home environment that everybody is striving for and hoping for," Sheppard said.

More care per day

(Long-Term Care Minister Paul Calandra is shown in Toronto on June 24, 2022.)

Increased staffing has allowed for a lot of the changes CareTO has made to improve life in Lakeshore Lodge. The Ontario government has promised an average of four hours of care per resident per day by 2024-2025. In 2021, the province's long-term care COVID-19 commission recommended this level of care be reached more urgently. At the time, the average was 2.75 hours per day per resident.  Minister of Long-Term Care Paul Calandra said it's not possible to bring in the 27,000 staff the province would need to meet that goal faster.  "You'd always like to go faster, right?" he told CBC's Chief Correspondent Adrienne Arsenault in an interview. "But you have to do it in the context of what you're able to do. I wouldn't want to go out there and say I'm going to have four hours of care tomorrow and not have the people to fulfil that mandate."  Residents are getting more care per day than they were when the commission's 2021 report was released, he said.

'I feel very happy'

(Emelia and Paul Murphy, who share a suite at Lakeshore Lodge, are pictured on Oct. 26, 2022.)

The transition into long-term care can be very difficult. COVID outbreaks have triggered continued lockdowns and isolation in long-term care even as rules have relaxed elsewhere in the community.  Health Quality Ontario — an agency created by the Ontario government — reports that 22 cent of long-term care home residents in 2020/2021 had worsened symptoms of depression since their last assessment, including sadness, anger and anxiety or tearfulness. Emelia Murphy, 87,  is the president of the residents council at Lakeshore Lodge, or as she describes herself, "everybody's advocate." She shares a room with her husband, Paul, who has memory issues. Murphy said one of the biggest changes she's experienced is that she has a regular caregiver now. Where previously it might be a different personal support worker helping her depending on who was on shift, the home now strives to keep care consistent. "They're all really good," Murphy said of the staff. "They give you a hug and everything. I wouldn't want to live anywhere else." And Capozzi said he is attempting to enjoy life, despite the difficulties of his diagnosis. "Two weeks ago, I told my wife, you know, 'Bonnie, I'm really happy. I feel very happy.' I'm dying. I have ALS. But, you know, I'm trying to enjoy my life the best I can.'

^ I hope this model works, because Long-Term Resident Care in Canada, the US and around the World desperately needs to be upgraded and modernized – Covid showed us that. Now we need to make those changes for the battlement of both the Residents and the Staff at these places. ^

https://www.cbc.ca/news/canada/toronto/long-term-care-resident-centred-1.6659458