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.
| 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.
Emotion Focused Care prioritizes understanding resident and client emotions and preferences to improve relationships.
Relationship Based Care focuses on building and nurturing the relationships among residents, clients, loved ones, staff, visitors, volunteers, and community partners.
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 aligns all people, systems, processes, and functions to be person-centred and provide emotion and relationship-based care through:
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 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.
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.