From hospital to home in 50 years

Operating in Edmonton and area since 1963, CapitalCare – Canada’s largest publicly-funded, continuing care organization – marked 50 years of caring in 2013. As if reaching this important milestone were not enough for an organization that grew from 72 beds in one auxiliary hospital to nearly 1,400 across 10 residential centres, CapitalCare also received recognition in its anniversary year as one of Alberta’s top employers, and one of Canada’s safest employers.

The most significant achievement this year was the completion of a dining room renovation project and the introduction of a new model of care – person-centred care – that positions CapitalCare to lead the way in providing quality continuing care into the future.

“Both the dining room renovation project and the implementation of person-centred care are linked by the same principle, which is, to make our centres less like the institutions we built 50 years ago, and more like home,” explains CapitalCare CEO Iris Neumann.

In the past, CapitalCare took the lead in building up its infrastructure to meet the growing demand for long-term care services in the Alberta capital. By 1981, CapitalCare operated 1,100 beds over four centres. These centres were each three to four stories high. Like hospitals, the central feature was the nursing station, where nursing staff monitored up to 50 people living on each unit, most in shared accommodations. Dining rooms were like cafeterias and food was dished up on trays and brought up on carts from the kitchens below. This was considered state-of-the art for the time.

By the 1990s, the number of people being admitted to long-term care with Alzheimer’s disease and other forms of dementia had increased drastically. New research had emerged showing people with dementia did better in smaller, more familiar spaces that evoked the comforts of home.

Between 1995 and 2005, CapitalCare constructed 10 new residential centres, purpose-built to accommodate this growing population.

McConnell Place North, Canada’s first residential centre for people with Alzheimer’s disease – opened in 1995 – laid the groundwork for a design that replaced institutional centres with a household model. This design also went along with a shift towards a more social model of care, where staff treats people less like patients needing medical care and more like people needing support to continue living as they did in their own homes and communities.

With the opening of the Kipnes Centre for Veterans in 2005, CapitalCare demonstrated how the small-scale residential design of the Alzheimer care centres – with 36 private rooms divided into three households – could be adapted on a larger, more efficient scale. The Kipnes Centre accommodates 120 residents in eight “houses” of 15 residents in private rooms. The houses – each with their own dining rooms – are part of a “neighbourhood” which features a pub, a chapel, a barbershop, a fitness area, a bistro, several gathering areas and many outdoor gardens and patios. The goal of this modern centre is to re-create life in the community but with all the care and services of a long-term care facility.

Across Canada, new long-term care centres are being built similar to this standard. But CapitalCare has taken on a new challenge: how to apply these modern standards to buildings nearly 50 years old? For Neumann the answer lies in implementing person-centred care.

“We decided that it’s time for paradigm shift. Our centers are often the last place where people live, and we want it to be a home, or as home-like as it can be,” says Neumann.

CapitalCare has defined person-centre care as a way to provide care in the resident’s home, rather than caring for the resident in a workplace.

Meal enhancement was chosen as the first step towards person-centred care because of aging buildings and equipment that needed replacing and renovating. The goal for this project was to ensure residents received nutritious, tasty meals in a pleasurable dining atmosphere assisted by staff who are caring and knowledgeable.

“In our original buildings we had dining rooms that could seat 60 or 70 people. Our research shows that whenever possible, smaller groupings of people in a dining situation, is more conducive to socialization, and that is an important part of person-centred care and our new meal enhancement program,” says Neumann.

In addition to improved lighting, flooring, furniture and décor, the central feature of the dining room renovations was the addition of serveries (kitchenettes) with steam tables, convection ovens and soup tureens right on the units where people live. Now residents enjoy the aroma of fresh baked bread and home-made chicken soup, as well as food that is plated and served hot, just like at home.

“It not only looks like home, it smells like home,” says Neumann.

Dining room renovations were made at three of CapitalCare’s oldest centres, but the changes in meal service applied to all CapitalCare centres.

“Being person-centred is not just about changing the physical environment, it means also changing the way we work in these environments,” says Neumann. “We’re training our staff to think of their workplace as a home, and that part of their job is to interact with the people who live there. It’s about building relationships with the people we care for.”

“Long-term care is truly about relationships. You hear directly from the people that you’ve made a difference in their life, because you’ve helped them live better,” says Neumann. “This is one of the reasons why we have such high job satisfaction and retention rates, despite the challenges of the work.”

Challenges are part and parcel of being a public health care provider. Neumann attributes CapitalCare’s success over 50 years in CapitalCare’s ability to respond to changing circumstances.

“As the public provider, expectations are high,” says Neumann. “We are expected to meet standards, to be innovative, and to balance quality care with a break even bottom line. Our challenge going forward is how do we balance these increasing demands with decreasing resources?”

CapitalCare, a wholly owned subsidiary of Alberta Health Services, receives government funding for the health care services it provides and to operate its buildings. Residents pay a fee to cover room and board. Funding for capital improvements must be weighted against all other capital priorities.

“Considering the importance of mealtimes in a person’s life, the dining room renovation project was a high priority among our residents, their families and our staff, but there wasn’t government funding available to move forward with this project at this time,” says Neumann.

CapitalCare was able to proceed with the dining room renovation project thanks to the CapitalCare Foundation. For nearly 25 years, the Foundation has been supporting CapitalCare by engaging donors, leaders, volunteers and friends to support projects that enhance the quality of life of CapitalCare residents.

Over the past three years, the CapitalCare Foundation raised the $4 million needed for the renovation of 19 dining rooms in three centres, which were completed in phases as funds became available.

“We are fortunate to have the Foundation,” says Neumann. “These business leaders volunteer their time to help us raise money for the projects we feel make a difference in the day to day lives of our residents.”

“We are equally fortunate that our donors support our goal to transform our public continuing care centres into places we ourselves would want to live when and if we need support to live.”

In the next 50 years, CapitalCare plans to continue modernizing its aging infrastructure. With the dining room project completed this fall, Neumann is focused on replacing CapitalCare’s oldest building, built in 1964, with a modern facility that brings long-term care, research and teaching activities together in one centre to improve continuing care and train the workforce of the future.

CapitalCare has been engaged in research and development in continuing care since 1996, when it joined with the University of Alberta in creating western Canada’s first embedded research unit in a continuing care centre.

“CapitalCare’s strength is in education, research and high quality complex continuing care,” says Neumann. “We envision this new center becoming a teaching, researching continuing care centre where we can develop new initiatives and share this knowledge with others to improve long-term care for the next 50 years,” visions Neumann.