CareTO is the City’s brand for the culture change we are investing throughout Seniors Services and Long-Term Care. Informed by evidence-based research, our goal is to enhance the experiences of those who live, work and visit by applying the CareTO approach to everything we do.
CareTO is a made-in Toronto person-centred approach to care that shapes how we think, act, and deliver care and services to residents/clients.
By building on the incredible work that is already happening in our homes, we are creating more responsive person-centred homes that continually adapt practices to meet the unique needs of residents/clients and teams.
Although there are other approaches for transforming long-term care, the City and an independent research team found that, given Toronto’s population, we should develop our own approach – one that combines the best practices of existing approaches and incorporates a strong equity and diversity lens.
The CareTO culture change requires an “all hands on deck” effort and active participation from all partners — residents, clients, loved ones, friends, staff, visitors, volunteers, and community partners — involved.
We put CareTO into action by:
CareTO is transforming person-centered care in our long-term care homes.
Family members have noticed the positive impact of CareTO, particularly in how it improves communication and builds better relationships:
As the Chair of Bendale Acres Family Council, I’ve seen firsthand the enthusiasm and commitment to CareTO. The motivation to improve is evident in the way staff interact with residents every day.
Family Council Volunteer
I truly appreciate the level of care my mom receives. Staff keep us informed, involve us in decisions, and show great compassion. The communication and attentiveness is excellent.
Family Member
Care Coaches are peer-nominated individuals who lead by example, with a passion for teaching and continuous learning, they are motivated and willing to share their knowledge with others.
From the beginning, CareTO has been about support. The Care Coaches have done an outstanding job training staff, and I’ve seen real progress.
RPN
At TDA, the introduction of “All About Me” individualized biographies has improved our person-centered care approach and assisted staff and volunteers in developing a deep rapport with residents.
Since the bios were introduced, I’ve made a point to read every one. It’s been interesting to see a different side of our residents—things I never would have known without this initiative.
Nursing Staff
Having my bio displayed allows people to learn a little more about me, beyond what they see every day. It’s nice to share my story without having to be asked.
Resident
Our person-centered care approach and teamwork within the home has improved with the implementation of Care Coaches utilizing the PCCOT (Person-Centered Care Observation Tool) to provide constructive and positive feedback to staff.
I’ve seen a huge improvement in teamwork since Care Coaches started using the PCCOT tool. Staff are even stepping in to help with activities and escorting residents to events.
Recreation Staff
At Wesburn Manor, the inter-professional team has embraced CareTO, noting improvement in all areas from operational efficiencies to the overall well-being of residents.
Spending time talking with and getting to know residents on a deeper level has been incredibly rewarding.
Staff
Thank you so much for taking the time to keep me company.
Resident
Staff members have become more engaged and invested in the program, showing ownership, and incorporating CareTO hallmarks into their daily routines.
The education sessions were so engaging! Learning about my colleagues’ different cultures and experiences helped me better understand them as individuals.
Staff
As a facilitator, I’ve become much more comfortable leading peer-to-peer training. The staff have been receptive and respectful, making the process rewarding.
Care Coach
Families and residents have also expressed satisfaction with the personalized care and attention they receive.
The staff go above and beyond. The PSWs who care for my husband are exceptional, and the team on his floor are helpful and kind. The recreation staff and volunteers do a fantastic job—I’ve recommended this home several times.
Family Member
Lakeshore Lodge is renowned for its commitment to resident-focused care, with an atmosphere that has been described as friendly and welcoming. This environment made it an ideal choice for the CareTO pilot in 2022.
Through participatory engagement, Lakeshore Lodge created these CareTO priorities:
Watch this video to learn more.
By 2023, Lakeshore Lodge saw the following changes as a result of the CareTO program:
Each City-run LTC home will make CareTO their own, defining priorities based on the distinct needs and preferences of resident demographics.
Residents share how the CareTO pilot has impacted them:
The recreation committee is always asking us, ‘What would you like to do?’ They will switch from things we dislike—for example, we have a Scholar’s Society. We didn’t want to talk about that topic that day, and they changed it. We have volunteers for bingo. One resident is mostly blind, and he gets assistance from the volunteers to participate.
Recreation staff understand the needs and requirements of residents. Even if residents aren’t actively participating in activities, staff still bring them. Because you are there, you don’t feel alone. You feel that you are involved.
We are old and thin. We come out of the shower, and it’s freezing. We asked for hot towels, and administration got a heater the size of a mini fridge. A PSW came up with the idea of heating our bed sheet. They now cover you with a warm sheet after a shower. So, you know the administration is listening.
In the hospital, they see you once a week. Here, staff check on you once a day. We have a 1-8 ratio, which is much better staffing than before.
Family members share thoughts on the CareTO pilot and its effect on their loved ones:
My dad has Alzheimer’s. The more stimulation there is for him, the better. In the assisted living facility, I had to pay for every interaction. His default was to decline when staff asked him to join activities, and they did not encourage him again. At Lakeshore Lodge, they actively promote engagement, even if it’s only for five minutes. There is way more time spent with residents here. There is more care and more individualization now that I pay less.
I was impressed with the variety of services. At other places, most people are up at 7 a.m., but here, if you’re not a morning person, you can take your time and wake up after 7 a.m. or have breakfast in bed if that’s what you choose.
Some of the PSWs are so amazing. When my mom is wandering, they put her behind the nursing desk and make her the secretary to engage her curiosity and make her feel included and special.
We’ve conducted an internal evaluation of the pilot to determine CareTO’s impact on resident quality of care and quality of life, staff satisfaction and retention.
Indicators selected to evaluate the pilot directly relate to goals and are commonly used as evidence-informed culture change indicators.
Review of Dementia Care Models (EC3.4 
) including Models for Long-term Residential Care: A Summary of the Consultants’ Report 
to Long-Term Care Homes and Services, by Dr. Pat Armstrong, Project Lead
Seniors Services and Long-Term Care Implementation Plan (EC10.8) includes recommendations to increase hours of care for LTC residents, add staff and educational support to guide transition to a social model of living. Appendix B , Models for Long-term Residential Care compares 7 different approaches reviewed by an expert panel.
CareTO Implementation Initiative Consultation Reports by St. John’s Rehab Research Program – Sunnybrook Research Institute to support implementation of CareTO pilot at Lakeshore Lodge and develop recommendations to support adoption in all of the City’s directly-operated LTC homes:
Health Equity Evaluation of CareTO conducted by Wellesley Institute:
CBC The National, November 22, 2022
Adrienne Arsenault’s documentary looks in depth at the CareTO pilot program at Lakeshore Lodge, as the City of Toronto transforms long-term care with a new person-centred and emotion-based approach to care for all residents.
The Toronto Star, Moira Welsh, June 14, 2022
At this Toronto long-term-care home, a little extra money has paid off handsomely — with time, respect and attention for residents. A bit of extra funding via a pilot project has let Lakeshore Lodge shed some of its institutional habits and be more flexible and responsive to the people it cares for. Staff there say it’s made all the difference.
If you are passionate about leading-edge senior care, the City is hiring – check out toronto.ca/jobs for current opportunities and join the CareTO team.