PHC has embarked on a monumental culture shift, moving away from an institutionalised residential care model towards a social model through a process named "Megamorphosis."

The Tale of the Iron (and other learnings in long-term care)

September 28th, 2017

How an ironing board in Switzerland impacts elder care in BC

“When we saw that iron, in this long-term care home that was supporting a population with dementia, we saw an accident waiting to happen,” says Jo-Ann Tait. “This was a supervised area, of course, but our immediate thoughts were, someone could burn themselves—or burn the place down—or it might be used as a weapon. In our North American system of risk aversion, this is how we had been trained to think.”

At this moment, however, Jo-Ann Tait, Program Director for Elder Care and Palliative Services at Providence Health Care, was not in BC. She was in Switzerland.

Jo-Ann was touring long-term care homes in Europe with her colleague, Robena Sirett, Clinical Planner and Site Leader for Honoria Conway, a PHC assisted living home. Jo-Ann and Robena were in the information-gathering stage of a grand plan, the objective of which is to change how PHC provides long-term care.

“It was refreshing to see heaps of actual laundry, a clothes drying rack, a real iron in use, all in the residents’ space,” Jo-Ann says today. “Residents with moderate to severe dementia participated in the regular puttering around with chores: ironing, folding clothes, hanging clothes to dry. We’d be hard pressed to see this in our long-term care homes. Instead, we see staff provide residents a bag of hand towels to fold—but this is an exercise designed to keep people ‘busy’ rather than contribute to real life, actual household chores.”

Bringing “normal life” to long-term care

Jo-Ann and Robena learned that the iron and the laundry were part of what their Swiss counterparts called “bringing back normal life.”

“They were going back to remote memories,” says Jo-Ann, “back to things that you did at home, things you were familiar with. And like the laundry room, with its clothes casually strewn about, all of the rooms looked like this. They had this lived-in look and feel. Like a real home. Like the homes these residents would have spent their entire lives in up to the point of entering long-term care.”

The European tour was a whirlwind, to say the least. It was a trip that saw Jo-Ann and Robena visit 16 elder care homes in five countries over two weeks. The insights gleaned proved invaluable, however—and indelible.

But the knowledge gathering process had actually begun many months before, in PHC’s long-term care homes—and with the people who lived, visited and worked in these homes.

“Megamorphosis”—putting lessons learned into action

This plan to change long-term care across Providence Health Care has been aptly named “Megamorphosis” for the large, evolutionary shift that needs to happen as we move from a traditional institutional model of care to a social model.

But the evolutionary change that is Megamorphosis is but one part of an even larger plan called Residential Care for Me, the creation of which Jo-Ann attributes to Providence Health Care Quality Improvement Specialist Sonia Hardern.

“Sonia is invaluable to all of this,” says Jo-Ann. “She thinks in these large, visionary ways, yet is also on the ground with us, implementing trial program elements at the actual homes. Sonia brought us the ‘human-centred design’ approach, too, which led to the profound findings that have guided everything.”

The process approach known as “human-centred design” involves the human perspective at every step and, in this case, began with staff, volunteers, residents and families.

“First, we challenged our staff to think of what they would want long-term care to be if they had to live in one of our homes,” says Jo Ann. “Independence, choice and autonomy surfaced immediately.”

Next came input from residents and their families and it was with this process that the project truly took shape. The sentiments of the residents reflected those of staff, and all of this information was distilled into themes. As Jo-Ann, Sonia and Robena all agree, it is these words from the residents themselves that created the foundation of the program—and continue to guide it today:

“We want an environment of comfort and empowerment…” “Loosen up the rigid structure that is based on mealtimes, bedtimes, the dispensing of medication…” “We want to feel that we are part of the community…” “We want our lives to extend beyond these walls…” “We want every individual to feel significant…” “We want experiences that touch body, mind and spirit…”

With themes in place, staff undertook additional projects to better understand residents and their needs. Many of these projects proved a positive and often joyful experience for both parties, even creating and strengthening bonds, like when residents took a turn feeding staff in order to generate staff empathy.

Supporting the evolution of long-term care

Today, many elements of the Megamorphosis project are being tested in two PHC long-term homes at Youville and Brock Fahrni, with the ultimate goal of Residential Care for Me always in sight: to improve life for residents on a holistic level by learning about the individual experiences of the people who live in, work at, and visit PHC’s long-term care homes.

Says Jo-Ann: “Without normal life experiences, isolation and loneliness begin to creep in. And normal life experience is about more than bingo and bowling and keeping residents busy. It is about feeling empowered and engaged with the world around you, it’s about feeling you have community and you belong, and it’s about helping people find connection and meaning in their lives.”

St. Paul’s Foundation is a proud supporter of elder care across Providence Health Care and will continue to share updates and stories on these and other innovative programs. We also hope you will help our residents, and the tireless and passionate advocates like Jo-Ann, Sonia and Robena who do so much for them.

To support PHC elder care programs, give to St. Paul’s Foundation now.


Want to read more about the innovative work in elder care at Providence Health Care?

Volunteer residents provide spiritual support for their neighbours

The role of music, humour and human touch in long-term care

“I don’t call it elder care, I call it living”

A fall prevention program at Holy Family Hospital may be the first of its kind in the world