Toronto council has voted unanimously to bring change to city-run nursing homes with new programming that promises to improve the lives of seniors with dementia.

The vote marks Toronto’s first step toward a possible transformation of care in its 10 homes, similar to the work recently done in a Peel Region-operated dementia unit where residents who once spent days staring at the floor came back to life through friendship with staff trained in empathy-focused care.

Peel’s Redstone dementia unit was the focus of a Star investigation called The Fix, detailing a yearlong experiment that tossed out Ontario’s traditional task-focused care, replacing it with laughter, friendship, energy and love. Called the Butterfly program, it is already used in five Alberta seniors homes and one nursing home.

One month after The Fix was published, Toronto has begun plotting its path forward.

“City council recognized that residents with dementia in Toronto’s long-term care homes deserve a far more creative, respectful and caring approach,” said Councillor Josh Matlow, the city’s seniors advocate, who presented the motion.

“We now have the opportunity to provide those in our care, and their loved ones, a much better quality of life.”

An earlier draft of the motion pushed for the full implementation of the Butterfly program in all Toronto homes but, as the city’s 2018 budget is already settled, a new version was filed calling for a more incremental approach. It passed on Wednesday afternoon.

Now council is telling its general manager of long-term care, Reg Paul, to “provide better supports” for seniors living with dementia “within existing resources.” It cites the Butterfly model, owned by Australia’s Salvation Army and the U.S.-based Green House Project, as inspiration for change. There are more than 245 Green House homes in 33 states.

Both programs focus on emotion-centred care in small units of roughly 10 residents, who eat together at a long communal table.

The Star visited a Green House nursing home outside Rochester, N.Y., operated by St. John’s Senior Living, a not-for-profit chain.

A resident named Elsie said the care was different from traditional nursing homes because staff had the time to chat with her, instead of rushing and “talking to each other over my head.” Green House projects are built around an open kitchen, where workers bake cookies or cook dinner, so the smell of food makes residents feel like they’re in a real “home” and entices people with diminished appetites to eat.

Smaller units are considered key to good care. In Ontario, typical units have as many as 32 residents in different stages of cognitive decline sharing a living space, which can lead to conflict and violence.

St. John’s also has a much larger nursing home, with 400 beds, in the city of Rochester and has begun renovating it into smaller units.

Toronto’s motion is also telling Paul to join Matlow on a tour of Peel’s Redstone unit. As well, Paul must report back to Toronto’s community development committee in early 2019 on the “potential for a full pilot project inspired by care-based programs,” such as the Green House or Butterfly models. Paul oversees the care of Toronto’s 2,641 nursing home residents.

The motion builds on momentum created a few weeks ago when Mayor John Tory sent a letter to Paul, asking him to look into the feasibility of the Butterfly program in Toronto homes. Tory said he was interested in the potential for savings.

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Peel’s data showed a decrease in falls and antipsychotic drug use. Peel’s data also showed a significant drop in staff absenteeism in the final quarter of the 12-month pilot. Any financial savings from this decrease in staff sick days does not flow back to the home because Peel’s employee benefits provider covers those costs as part of a prepaid benefits program. Over the last year, the value of this reduced absenteeism totalled $23,000.

The Star had earlier projected a possible savings of $50,000 a year for the dementia unit, but this was based on incorrect information from Peel Region. Any absentee savings flow to Peel’s insurance provider.

A decrease in resident falls and antipsychotic drug use could lead to some savings to the provincial health-care system.

A single hip fracture costs the public health-care system between $24,000 to $28,000 in direct costs, according to the Registered Nurses’ Association of Ontario. As well, the Ontario health ministry says antipsychotic drugs in long-term care cost the taxpayer-funded Ontario Drug Benefit program $17.4 million in 2017-2018.

With files from Jennifer Pagliaro