OPINION: Transformative Culture Change in Long-Term Care Homes: What is it and what does it look like?

(COVID-19 has exposed several existing problems within long-term care homes in Ontario – The Canadian Association of Retired Persons (CARP) Ottawa chapter believe this is an opportunity to make necessary changes. Photo: Rawpixel)

The Independent Long-term Care (LTC) COVID-19 Commission has now been established. 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; 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, hire staff who want to work with seniors, and look at delivery of person centred care. All this happens now in a few LTC homes across Canada. We call them innovative models of care but 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 scenario to consider:

Joyce lives in Sunny Side LTC home. It is a 200 bed home with units for 12 residents which 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, with help from her personal support worker, she has a shower and gets dressed for the day. Then it is off to the dining room for breakfast where Joyce is offered a menu with choices The 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 into activities planned for the morning. She may choose not to join in but the activities are varied according to the abilities of the residents: singing, arts and crafts, listening to readings, etc. She 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 joins in. 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 resident’s 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 McDonald Member, CARP Ottawa Advocacy Working Group on Long-term Care


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