Transformative culture change in long-term care homes

What does it look like?

By Sue LeConte

The Independent Long-term Care (LTC) COVID-19 Commission has now been established, and its terms of reference have been posted. What can we hope for? The easiest solution for the independent commission is to make recommendations that should have been instituted long ago: more staff; more full-time staff versus casual staff; more direct hours of care; fair salaries; infection control education and practices, elimination of four-bed rooms; and availability of air conditioning. If this is the end result, then our government has failed. Long-term care is a broken system and if the Independent Commission wants to make any significant impact, then it needs to look at how to improve quality care in LTC homes with a transformative culture change.

This means revising rules and regulations, moving from institutional care to areas with small home-like environments, embracing the valuable contribution that families and volunteers make, hiring staff who want to work with seniors and looking at delivery of person-centred care. All this happens now in a few LTC homes across Canada. We call them innovative models of care – they should be the norm, not something unusual. CARP (Canadian Association of Retired Persons) Ottawa Chapter, along with collaborating organizations, is advocating for transformative culture change in long-term care homes. What does this mean and what does it look like? Here is a hypothetical scenario to consider:

Joyce lives in Sunny Side LTC home. It is a 200-bed home with units for 12 residents that include private and semi-private bedrooms, bathrooms, living area, dining area and small kitchen. When Joyce wakes up – and the time varies from day to day – she has a shower and gets dressed with help from her personal support worker. Then it is off to breakfast in the dining room where Joyce is offered a menu with choices. A staff member serves the breakfast and sits down with the residents in that unit to enjoy some conversation. When ready, Joyce is encouraged to join activities planned for the morning though she may choose not to. The activities are varied according to the abilities of the residents – singing, arts and crafts, listening to readings and more. Joyce is particularly looking forward to the “spa” hour as she would like to have her nails done. In the morning, residents are offered a coffee/tea break. Joyce’s daughter arrives to help bake cookies in the kitchen. Joyce pitches in to help. As the smell of chocolate chip cookies fills the air, Joyce remembers the many times she spent with her children in the kitchen.

Transformative culture change means the way of organizing and giving care in long-term care homes changes so that residents know and feel like they are living in a warm, caring environment that looks and feels like home. It enables staff to know who their residents and families are and what their life was like before. It means schedules and routines are flexible to match the residents’ preferences and needs. Friendships develop between staff, residents, families and volunteers. It means residents are involved in many meaningful activities according to their abilities and what brings them joy. Transformative culture change means relationships, relationships, relationships!

Sue LeConte is a member of the CARP Ottawa Advocacy Working Group on Long-term Care, and a former executive director of The Glebe Centre.