Transforming Dementia Care with the Butterfly Program

Ontario's Dementia Care Revolution: From St. Catharines to Hamilton

Read the following article and answer the questions below (on a separate file)

The Toronto Star By Moira Welsh

The floors are clean, the walls are an inoffensive shade of beige and the staff work to keep the elderly people who live here safe from harm. By Ontario government standards, the dementia unit inside the Henley House ong-term care home in St. Catharines gives good care, its managing director says.

And now, she can’t wait to see it dismantled.“There’s going to be a very, very big shift in the way we provide care,” said Jill Knowlton, of Primacare Living. Instead of one big unit of 25 people the home wil be broken into two small cosier living spaces for people with moderate and severe dementia.

Workers will be trained to express empathy and spend time chatting, playing cards or dancing with people living in the home, rather than rushing from one task to the next. Walls will be painted i n fuchsia, tangerine or neon green to help people navigate the hallways.

Inspired by the changes at Peel Region’s Malton Village, which used the British-based Butterfly Program to turn a drab dementia unit into a place of warmth, energy and friendship, Primacare will also add the program to its homes in Brampton and London and a new home to be built near Hamilton.

“The scourge of dementia is old news — now is the time to do something about it,” Primacare president Matthew Melchior said at the launch of the Butterfly program in St. Catharines last week. “Standing still is stagnation. The status quo is not the answer.”

Peel’s Malton Village was the first in Ontario to implement the full Butterfly program, which focuses on social and emotional happiness for people with dementia. In Alberta, the program is used in six seniors’ homes (five assisted living and one long-term care.)

It is used in 23 homes in the U.K. three in Australia and one in the United States. Peel’s year-long pilot ended last spring and after seeing the results, Peel Regional councillors voted in favour of adding it to its four other long-term care homes.

Candace Chartier, CEO of the Ontario Long Term Care Association, which represents mostly for-profit long-term care homes like Primacare, told the St. Catharines crowd, “This is something that is going to change the lives of every person in this room and the staff members, volunteers and every resident and every family member that come through the doors.

The Butterfly Program: Social and Emotional Care for People with Dementia

“I’ve had the chance to look at the Butterfly Model.it truly is what the future of long-term care is, what senior care is,” Chartier said. She later told the Star that Ontario’s plans for 30,000 additional nursing home beds should follow new care models instead of replicating the current designs that place large groups of people in one living space.

The Butterfly program is one of several models that focus on sweeping culture change, easing workers out of a traditional style of care that, in Ontario, is dominated by schedules, routines and hourly documentation. The Green House Project and Eden Alternative — both created by American geriatrician Dr. Bill Thomas — share similar philosophies that favour small homes, social interaction and friendships between staff and people in their care.

Knowlton, of Primacare, said the company spent two years researching ways to improve, despite already adding extra staff and training programs. Primacare signed a contract last spring with Dementia Care Matters, the Butterfly model owner, after seeing the program’s impact on people living in Peel’s Malton Village.

Peel’s experiment with the program was documented in a 12-month Star Investigation, called The Fix. Starting in March of 2017, the process began slowly, but people who previously spent their days staring at the floor or watching TV came back to life. Workers spoke about falling in love with jobs that provided a sense of purpose. Peel said staff sick days have dropped by 75 per cent.

Critics say the program does not have peer-reviewed academic research to back its claims. Peter Bewert, CEO of Dementia Care Matters owned by the Salvation Army Australia), said he welcomes ndependent research. Peel Region is in talks with the Centre for Elder Research at Sheridan College to begin a detailed evaluation.

The story of Peel’s experience showed the highly regulated and regimented nursing-home industry that change is possible, said Lisa Levin, CEO of Advantage Ontario, which represents non-profit and municipal homes.

“It created such a buzz,” Levin said. “Almost everywhere I went people were asking me about this I really has had quite an effect. A number of our members are looking at transformative care — I wouldn’t be surprised if all of them are looking at it.”

There’s a widespread belief in the industry that the Ontario health ministry could help homes improve care with a staffing boost and changes to ease some regulatory requirements. Officials have not said if they intend to do so. Levin said she believes the new government knows the system needs innovation.

Peel Region's Malton Village: Ontario's Pioneer in the Butterfly Program

For now, Levin said Peel’s experience shows that homes can begin moving forward with changes to create a relaxed homier setting. “What’s happening now is that people are realizing they can make a difference. They can change — I cal it a transformation. That it is within the means of our homes, and our government.”

Last year, the Star visited a Green House nursing home in a suburban neighbourhood in Penfield, N.Y. There were two separate units of 10 people each, with open-concept kitchens, long family-style tables and cosy living rooms, operated by St. John’s long-term care, a non-profit organization.

After seeing improvements in Penfield, St. John’s decided to turn its traditional 400-bed nursing home in nearby Rochester into smaller homes. St. John’s spokesperson, Nate Sweeney, said the staff turnover rate in its Green House homes is 10 per cent, compared to 35 per cent in the traditional -style of care. Sick days are 75 per cent fewer than in traditional units, reducing overtime costs, he said.

Peel is reporting the same drop in staff sick days. It also found an increase in resident and staff satisfaction and a decrease in antipsychotic medication and falls, but a spokesperson said Peel wants to do an in-depth evaluation and measure numerous outcomes.

Assignment Questions:

Primacare (at it’s Henley House location) is looking at embarking on a change in their service. As with any idea for change it is expected to be a positive and impactful. As a class we have talked about the fact that not everyone sees a change the same way or with the same intensity and therefore it can still be hard to implement. Using the information from the article and our class content answer the following questions in a professionally written report.

1. Indicate the internal and external stakeholders that will be impacted by this change in service. Pick 2-3 stakeholders and explain how this change may be partially negative for them. Using the strategies for resistance explain how you would suggest managing through some of their potential (10 marks)
   
   
2. Acting as a Change Consultant for M r. Melchoir (Primacare President) write a proposal on how he should apply the first 4 steps of the Kotter model to this change initiative. Assume he does not know who John Kotter is Make sure you clearly explain each of the steps and your suggestions for specific ways to apply the step to gain the support of his employees and stakeholders. For step 3 “Applying” would mean you should be creating a change vision for him. (12 marks)

Remember you are working to become an expert in Leading Change. Make sure your report to Mr. Melchoir shows understanding on why change s so difficult and what can be done. Your goal s not only to give him some processes and tools but to instill confidence that it will effectively lead this change initiative.

Your report should be:

? Well written in a professional manner

? Easy to understand and read

? Clear understanding of the situation.

? Clear understanding of material presented in class this semester

? Quality of your ideas and strategies and use of the first 4 of the Kotter’s Leading Change model