By Melissa Edwards | Photography by Jeff Topham
It starts with pausing to ask someone what would bring them comfort and joy. Inside the total rethink of seniors’ residential care taking place at PHC sites
A quiet revolution is underway at Providence Health Care (PHC), and it’s transforming how we care for elders in British Columbia. The revolution is called Residential Care for Me, and it has arisen out of the very frontlines of care, using innovation, research and compassion to change seniors’ lives through a thousand small but very meaningful moments. Residential Care for Me is already in phase two, being put into action on the ground through a process called Megamorphosis: a series of rapid, idea-to- action initiatives occurring in stages at PHC’s five residential care homes. Each cycle begins with a month of pre-work, in which staff of all types break from routine to slow down and connect with each other, residents and families – taking in their experience, learning what truly engages them. Next, the ideas and insights gained, small or large, are put into practice over an intense, two-week testing period, with extra support from leaders and allowing the usual months of planning to be tossed out the window.
“You think you know a person very well,” says Heather Mak, a clinical nurse specialist who has been with the initiative from the start. “But we knew residents from a clinical perspective: their care needs, their medical condition, how we need to support them in their daily lives. What’s different was asking the question, “What would bring you comfort and joy?”
During the first cycle, which started at Youville Residence in February 2017, the answer from one resident’s family was surprising: a particular shade of bright red lipstick. “If you had asked me about this lady, I could have talked about where she was in her stage of dementia, and how we were trying to be responsive to her needs,” says Mak. But by changing the priority to the emotional, the Youville staff can now provide the things that really matter to her: singing her favourite songs with her, and putting on her lipstick every day. One resident has become much more active and engaged after he took on the task of ironing the vestments for the weekly church service, while a retired physician finds comfort in always having a clipboard on hand for drawing charts. For another, staff prototyped a specialized poncho to help her feel less exposed and more dignified as she gets wheeled through the halls to the shower. Two new lighting systems help residents locate nurses and move around more safely at night, and the spaces have been redecorated to be warmer and more welcoming.
“You might say at the end of the two weeks that the residents were different,” says Mak. “But really, what was most different was us.”
A place you should want to live in
So far Youville and Brock Fahrni residences have undergone Megamorphosis, and Langara, Holy Family and Mount Saint Joseph Hospital are eager to get started. There is genuine excitement in seeing such immediate real-world progress arise to match the future envisioned in the Residential Care for Me initiative, which was first launched by Jo-Ann Tait, corporate director, seniors care and palliative services, along with other residential care leaders in March 2014. As with many big ideas, the initiative was born out of frustration: faced with tight funding, aging buildings and the pressure of supporting people with increasingly complex care needs, Tait and her team knew something had to change.
“We had been waiting, I think, for some kind of funding miracle, or for someone to say, ‘OK, we’re going to support residential care in a different way,’” she says. “But we very quickly realized that there was no magic answer. Instead, the answer lay within us.”
The team turned to Sonia Hardern, a specialist in human-centred design at PHC, who said the process must begin with “the people who are on the extremes,” says Tait. For one week in each care home, PHC executives came to sit with the most vulnerable residents – those who can no longer speak in a way that is understood – and experience the sounds and environments as they do. Meanwhile, residents who were able to speak for themselves were given cameras to document what was most meaningful to them.
Ultimately, two themes arose from this work. “We have a flow of the day that is very routinized. It’s based on running an institution – not on people and what they want,” says Tait. Those routines needed to be “blown out of the water” – along with unstimulating environments that felt more like a hospital than a home.
It was a challenging process, one that forced the entire leadership team to ask a hard question: If we had to live in residential care, would we be OK with how things are? Would we want to live here?
“We put ourselves in the shoes of a resident moving into care,” says Tait. “I think I had forgotten what it was like to have that first-time experience: walking into a home and being overwhelmed by the sights, sounds and smells. It brought me back to that very first time, thinking, ‘Oh my goodness. Why am I here?’”
A holistic approach
It’s a moment Kathleen Hamilton remembers all too well. She helped her mother, Beatrice, enter into the (now closed) Heather facility in Vancouver in 2002. “That first night, I almost took her home,” says Hamilton. “I remember going in; it was quite chaotic. My mother is a very gentle soul, but I could see that she was upset.”
Beatrice soon moved to St. Vincent’s: Langara, where care improved. But Hamilton was still frustrated by staff who were too focused on routine to listen to what she knew was best for her mother. Beatrice passed away in 2006, but Hamilton continued to fight for change through an association called Advocates for Care Reform. PHC reached out to her in the early stages of Residential Care for Me, and she became an important voice in its design.
“I’m just so impressed with what they’re doing, and I think they’re the right people to do it,” says Hamilton. She loved seeing PHC connect with other care agencies across the world so they could build on what was already working, and reach out to universities like Emily Carr to learn how better design can improve care. “They are looking at this from a very holistic, big-picture approach,” she says.
And the impact of Megamorphosis is already reaching further. The learnings will be applied to a $2-million improvement project at the Holy Family Residence, made possible by two generous legacy gifts, and there are plans for a new, community-style residence at the former Heather site that will be the first of its kind in Canada. The underlying vision for each step, from a favourite lipstick to a major construction project, is to create a space that supports each resident’s own sense of security, comfort and joy – just like home. “I feel very hopeful. This is a group of folks that was given short shrift for years, because they are hidden,” says Hamilton. “Other residences have tweaked things, but they don’t make the fundamental changes. PHC is standing up, and they’re looking around, and they’re getting to the root of it.”
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What makes home feel like home?
Three principles guide every step of the Megamorphosis process:
- Emotional connections matter most
The design of spaces and routines needs to support compassionate, human-to-human connection.
- Residents can direct their moments
Make room for what is meaningful to each resident in each moment, so that their souls are supported as much as their bodies.
- Home is not just a place; it’s a feeling
Residential care must foster safety, comfort, purpose and joy, so that people can feel at home and relax into their space.