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CareTO is improving care and quality of life for residents in the City’s long-term care homes.

This social model of care is a made-in-Toronto approach and is currently being piloted at Lakeshore Lodge.

  • CareTO is a made-in-Toronto, flexible, person-centered and emotion-based approach to long-term care
  • It is a timely and radical cultural change in how we deliver care in the City’s 10 LTC homes – rather than task-based care, the focus is on emotional needs and care preferences of each individual resident, and takes into account the diversity of residents and staff
  • Rather than a medical model, we are creating a social model of care that reflects the social and physical environments of home and puts focus on emotional needs and care preferences, consistent with the lifestyle of the individual resident
  • It focuses on the emotional well-being of residents and giving residents an active voice in the direction of their care (e.g., culturally diverse foods, what types of activities and when to participate, and more)
  • In December 2019, City Council (EC10.8) approved a made-in Toronto emotion-centred approach to care for long-term care residents, adding staff and educational support to guide transition to a social model of living
  • A 12-month pilot at Lakeshore Lodge was in the early stages when COVID-19 hit, causing delays as resources focused on the pandemic response
  • Toronto City Council has made a historic investment in Seniors Services and Long-Term Care, approving a significant 15 per cent increase to the 2022 budget
  • Funding of $18.6 million gross ($6.6 million) net will help prepare us to move forward and become a centre of excellence in senior’s services and long-term care
  • On June 6, 2022 Mayor Tory launched the CareTO pilot at Lakeshore Lodge, a new social model for long-term care.

CareTO is a new approach that puts emphasis on the emotional needs of residents and encourages the development of positive relationships amongst residents, families, staff, and community partners. The key components are:

  • More, and differently trained, staff: hiring additional direct care staff to meet the complex and diverse needs of residents, with the aim to achieve 4 hours of direct care per resident per day; also  education of staff in diversity equity and inclusion, emotional literacy, collaborative teamwork, and relational care
  • Comfortable living environment: living spaces that are more intimate, cozy and reminiscent of home, re-designing and decorating the physical space to be less institutional, more home-like and comfortable, with input on fabrics and finishes from the residents who live there, and providing improved access to the outdoors and safe places to wander, relax, visit and entertain.
  • Meaningful engagement and outdoor activity: attention to relationships, personal preferences, and previously enjoyed life routines
  • Flexible and pleasurable dining: promoting resident-centred menus that accommodate culturally diverse and evolving preferences; giving residents an opportunity to enjoy meals on their own terms; using a mobile food-cart, and more
  • Staff-Resident relationships: Consistent caregivers for residents to enable relationships to develop and thrive
  • More resident autonomy: efforts underway to create a home-like environment in which residents can have more autonomy of when to participate in therapy and self-care (e.g. when to shower)
  • Evaluation and research: independent evaluation conducted by University of Toronto Factor-Inwentash Faculty of Social Work, for continuous improvement of the new model.

In this video residents at Lakeshore Lodge describe, in their own words, how the hallmarks of CareTO play out in their day to day lives:

  • Tamara and George are able to preserve their family connection
  • Margaret speaks to the importance of a welcoming and safe environment
  • Louis discusses his care team’s high standards
  • Caroline welcomes access to the outdoors and connecting to the community
  • James tells how caring staff support him with interesting programs
  • Elizabeth appreciates consistent staff, excellent care and food choices
  • Sharon loves the resident programs, opportunity to volunteer and meet new people.
  • Toronto has a diverse population; residents residing in the City’s long-term care homes come from 55 different countries, speak 50 languages or dialects, and practice 34 different faiths.
  • Toronto’s aging population is culturally and ethnically diverse so care providers need to meet language, dietary, religious needs.
  • Although there are other models available for transforming long-term care (e.g. the Butterfly Model, the Eden Alternative), the City and an independent research team found that given Toronto’s LTC resident population, the City should develop its own model of care – one that combines best practices of existing models and incorporates a strong equity and diversity lens
  • CareTO is built on participatory implementation with residents, staff and stakeholders
  • CareTO is seen as being unique in that it:
    • is informed by research, evaluation and implementation science (bringing evidence into action)
    • has the potential to be applicable to more diverse populations, in terms of culture and ethnicity as well as different levels of dementia or cognitive impairment.
  • CareTO is flexible and person-centered, it enhances resident autonomy when it comes to their habits and preferences. CareTO attends to social and emotional needs, through an equity, diversity and inclusion lens
  • The residents in City-operated LTC homes are more diverse and require more “culturally-aware” care. CareTO is an opportunity to bring a “forward thinking” philosophy to LTC and may bring a more inclusive and home-like experience for residents living in LTC.

CareTO coach using hand gesture to off screen resident to explain activityPeer nominated, these individuals are leading by example, have a passion for teaching and continuous learning, are motivated and willing to share their knowledge with others:

  • Migena (at left) has been a Personal Support Worker (PSW) at Lakeshore Lodge for 20 years. She is actively involved within the home and is also an IPAC Champion. Migena has a teaching background, is tech savvy, and loves to read books. Her favourite Africa proverb is “If you want to go fast, go alone; but if you want to go far, go together”. Migena is attracted to the coaching role because she would like be a part of the culture change that will make a difference in residents’ lives.
  • Hui has been a RPN at Lakeshore Lodge for 5 years. She is actively involved within the home and is passionate about enhancing resident experience. Hui believes that person- centered care is about offering flexibility, catering to individual needs, and valuing relationships. Her supervisors described her as “very resident-oriented, knowledgeable, and incredible personality”. Hui is attracted to the coaching role because it gives her an opportunity to show her leadership skills, be organized, pass essential messages to colleagues, and be a part of a culture change that will greatly benefit residents.
  • Inderjit values holistic care, delivered with passion, empathy, and kindness. She enjoys building relationships with residents and finding new activities that residents will enjoy. Inderjit is a team player and believes that person-centered care is about fulfilling individual needs. Inderjit was attracted to the CareTO coaching role because it gives her the opportunity to work in teams, to fulfill residents’ social and emotional needs.
  • Krystyna is an RPN who has been caring for residents for over 20 years. She believes that resident choice is very important and is passionate about enhancing their home, here at Lakeshore Lodge. Krystyna places an emphasis on listening to resident needs and individualizing care. Krystyna is confident in her ability to problem solve, engage with families, and make residents happy.
  • Adora is a PSW who is passionate about enhancing resident experience. She believes that person- centered care is about building relationships with residents, giving them optimal care, and interacting with families. Guiding peers, having responsibilities, being a team player, and taking on new challenges is what attracts Adora to the coaching role.
  • Ashley is an entrepreneur, youth programmer, and LSW who enjoys giving back to her community. She believes that all the staff and residents at Lakeshore Lodge are a family and values building relationships. Ashley is excited to bring her passion for community development to a person- centered at the home.
  • Rashmi is a PSW at Lakeshore Lodge, enthusiastic to promote resident-centred care, believing that to be successful, we must also address the care team experience. Using her calm approach, strong interpersonal and communication skills, she will leave no stone unturned to enhance quality of life for residents.
  • Susset is a PSW at Lakeshore Lodge, who enjoys helping others, working with elders and supporting the residents entrusted to her care as if they are her own family members.
  • Yeshi has been a PSW for almost 20 years and strongly believes in being kind and compassionate while making LTC residents feel at home.

If you are passionate about leading-edge senior care, the City is hiring – check out toronto.ca/jobs for current opportunities.

As we change the culture in long-term care, each resident and their loved ones are:

  • Witness to Compassion, Accountability, Respect and Excellence
  • Shown respect and value as a full member of society
  • Provided with emotional and physical spaces that can adapt to changing needs
  • Supported and presented with opportunities to help them experience well-being

To do this, the City will ensure:

  • Ongoing participatory consultation throughout development and implementation processes
  • Engagement with residents and families via Family and Resident Councils to communicate and create opportunities for shared decision-making
  • Ensuring communications and information about CareTO are easy to find, approachable and accessible (e.g., translated)

An expert team from Sunnybrook St. John’s Rehab are helping to support the implementation of CareTO and develop a set of recommendations to enable the adoption of CareTO at all of the other nine City LTCHs.

While still in development, current ideas and possible framework could consist of the following engagement groups:

  • Leadership Council including members from each of the City’s directly operated LTC homes and frontline staff from the pilot site (Lakeshore Lodge) to oversee CareTO transition.
  • Implementation Steering Committee including members from each site responsible for CareTO, who meet regularly with partners to share progress, problem solve and engage in shared decision making.
  • Field Teams are knowledge brokers, connecting with both the Leadership Council and Implementation Steering Committee to support the transition from traditional models to the CareTO model.
  • CareTO is being implemented at Lakeshore Lodge long-term care home as a pilot project. This process began just prior to the COVID-19 pandemic in December 2019 and is ongoing
  • To support this implementation, managers and staff are receiving education in diversity equity and inclusion, emotional literacy, collaborative teamwork, and relational care
  • The education will cover how to connect meaningfully with residents; how to interpret behaviours as feelings; how to provide flexible care; and how to provide person-centred care for dementia and our diverse populations
  • To further support this organizational culture change and new approach to care, specially trained peer support coaches are working with their fellow staff to support the translation of the new educational knowledge into their frontline care practices with residents and their families.
  • CareTO has been supported by research since its inception – in 2019 SSLTC Commissioned a York University research team of specialists in long-term residential care to review and recommend existing models of care
  • These specialists recommended that the City develop a unique model by drawing on identified best practices and incorporating a foundation of diversity, equity and inclusion to ensure integration of lived experience of all residents into the model
  • Currently, an evaluation team from University of Toronto Factor-Inwentash Faculty of Social Work wants to know “How does the new CareTO model impact resident care and the experience of staff, residents and families?”
  • These experts have created an evaluation framework and will carefully review and assess inputs, processes/activities, outputs, outcomes and impact on residents, care staff, families, and other stakeholders
  • We will know the CareTO model is working based on:
    • Feedback from Resident and Family Councils.
    • Feedback on residents’ levels of satisfaction (e.g., food quality)
    • Improvement in staff retention and satisfaction levels.
    • Residents’ non-verbal cues (e.g., smiles, activity levels)
    • Reduction in residents’ responsive behaviours
    • Changes in current LTC indicators over time.

The full impact of CareTO may not be seen in the short term, so capturing initial feedback about CareTO by staff, residents and family members will offer insights on what outcomes should be tracked over time to demonstrate long-term impact.

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.

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.