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CareTO is our brand for the culture change we are investing in for the City’s directly operated long-term care homes. Based on evidence-informed research, our goal is to improve the experiences of all those who live, work, and visit.

  • CareTO is a made-in Toronto, flexible and person-centred approach to care that will shift the practices, attitudes and behaviours within Seniors Services and Long-Term Care.
  • Although there are other approaches to care available for transforming long-term care, the City and an independent research team found that, given Toronto’s  SSLTC resident and client population, the City should develop its own approach to care – one that combines the best practices of existing approaches and incorporates a strong equity and diversity lens.
    • Residents residing in the City’s LTC homes come from 60+ countries, speak 50+ languages and practice 30+ faiths.
    • Toronto’s aging population is culturally and ethnically diverse so care providers need to meet language, dietary, and religious needs.
What culture change IS about What culture change IS NOT about
Person-Centred Care Institutional Care
Innovative and Flexible Practices Taks and Schedule Driven Practices
Participatory Engagement in Decision Making A One-Size-Fits-All Approach
Building Nurturing Relationships Neglecting Emotional and Social Needs
Empowering Voices and Collaborative Teamwork Top-Down Decision Making

CareTO has five pillars:

Person-Centred Care puts the resident and client at the centre of their care and gives the resident an active voice in the direction of their care.

CareTO empowers residents and clients and focuses on their strengths and abilities.

Equitable, Diverse & Inclusive Care ensures everyone has fair access to opportunities and is treated according to their individualized needs.

  • CareTO is responsive to the diverse needs of residents and clients and demonstrates strong cultural competence through inclusion in care.

Emotion Focused Care prioritizes understanding resident and client emotions and preferences to improve relationships.

  • CareTO puts focus on understanding the emotional needs of residents and clients and provides them with emotion-driven interventions, empathetic communication, and compassionate care.

Relationship Based Care focuses on building and nurturing the relationships among residents, clients, loved ones, staff, visitors, volunteers, and community partners.

  • This foundation enables CareTO to be built on participatory engagement with residents, staff and stakeholders who are involved in collaborative decision-making and co-creating.

Collaborative Teamwork creates a workplace culture centred around respect, teamwork, and exemplary care and services. Everyone has a role to play in improving the experiences of all those who live, work, and visit our homes.

  • CareTO emphasizes coordination across all disciplines and departments to deliver quality care to residents.

CareTO aligns all people, systems, processes, and functions to be person-centred and provide emotion and relationship-based care through:

  • Unwavering commitment to culture change where leadership and team members apply the CareTO approach to all aspects of their professional life.
  • Identification of home specific CareTO priorities.
  • Providing flexible care & service delivery that puts the resident at the centre of their care.
  • Promotion of local innovation by encouraging staff to feel comfortable creating and trying new strategies for care.
  • Participatory engagement that empowers residents, families, and staff to co-create and adapt how care is provided.
  • Peer-led in-person CareTO training that promotes the importance of collaborative decision-making & teamwork.
  • Ongoing dedication to continuous quality improvement and education.
  • CareTO is a strategic priority for Seniors Services and Long-Term Care. To optimally support each long-term care home in its CareTO roll out, a staggered approach will be implemented with three long-term care homes going live each year.
  • The selection criteria were based on various factors and weightings such as: CareTO readiness self-assessment, staffing vacancy, leadership team stability, past change experience, home competing priorities and timeline preference for roll out.
  • The three homes that will be implementing CareTO this year are:

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:

  • Offering flexible and pleasurable dining
  • Providing meaningful engagement and outdoor activity
  • Envisioning an intimate, cozy, and resident-involved redesign of their facility to create a home-like environment.

Watch this video to learn more.

By 2023, Lakeshore Lodge saw the following changes as a result of the CareTO program:

  • High-quality dining: Lakeshore Lodge enhanced the quality and variety of their dining options, with added flexibility in dining times and the option to eat in residents’ rooms, with overwhelmingly positive feedback.
  • Increased recreational activities: Efforts have been made to increase the number of recreational activities and meaningful engagement. This is a continued focus for the home.
  • Homey atmosphere: Families and residents are satisfied with the homey atmosphere, noting its cleanliness, freshly painted walls, and expanded access to the outdoors, including a gazebo and barbeque area.

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 volunteer 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.

  • Quality of Care: Since the implementation of CareTO, residents have reported significant satisfaction with the quality of care they receive. Residents feel that they can communicate openly and freely regarding their care and service needs and their health outcomes exceed provincial averages in multiple areas, including reduced symptoms of delirium, decreased antipsychotic medication use, and better pain management.
  • Quality of Life: CareTO has positively impacted the quality of life of residents through their home environment, food experiences, and perceptions of being treated with respect by the Lakeshore Lodge team. Since the implementation of CareTO, the average number of person-centered care behaviours that represent quality of life have more than doubled in comparison to the 2022 monthly averages.
  • Staff Satisfaction: Overall scores for staff satisfaction and the rating of Lakeshore Lodge have remained comparable between 2019 to 2023. Staff turnover rates at Lakeshore Lodge have shown a significant decrease and are much lower than SSLTC and Toronto Public Service averages. This demonstrates that staff are choosing to work at Lakeshore Lodge and want to continue to work at Lakeshore Lodge.

Additional Research:

Review of Dementia Care Models (EC3.4 (opens in new window)) including Models for Long-term Residential Care: A Summary of the Consultants’ Report PDF 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 PDF, 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 for current opportunities and join the CareTO team.