By Catalina Guran

For seniors living with dementia, a hospital stay to treat an illness or injury can be difficult, resulting in responsive behaviours that can impact their care experience. Five years ago, William Osler Health System (Osler) set out to change that, blazing a new trail for dementia care within an acute care hospital environment.

In February 2023, Osler’s Acute Care for the Elderly (ACE) Unit at Brampton Civic Hospital was Accredited with Level 1 Distinction by the United Kingdom-based consultancy, Meaningful Care Matters (MCM) – its highest designation. Osler’s ACE unit is the first acute care health system in the world to successfully implement The Butterfly Approach^TM in a hospital setting.

Developed by MCM, The Butterfly Approach is an emotion-based, person-centred model of care for patients living with dementia that recognizes a patient’s emotional needs are just as important as their physical needs. While the ground-breaking program has been implemented in a number of Long-Term Care (LTC) homes across the UK, Ireland, US, Australia and Canada, Osler believed it could also greatly benefit patients in acute care after seeing it in action at a Region of Peel LTC home.

“Since implementing this approach on our ACE Unit, we have seen an increase in patient and family satisfaction, staff and physician engagement and also staff retention,” said Patricia Geerlinks, Osler’s Director, Women’s, Children’s & Seniors’ Programs. “Over the past couple of years, the team has observed fewer patient falls, an improvement in patients’ dementia-associated behaviours (such as agitation, pacing), and a reduction in their functional decline.”

Stepping into Osler’s ACE Unit, one can’t help but notice how vastly different the environment is from a typical hospital unit. This unit feels like home, even though patients are admitted for an acute care episode. Stark beige walls have been replaced by vibrant colours of purple, yellow, pink and green. Large vinyl wall decals convey the experiences of everyday life and provide orientation, navigation, way-finding and stimulation to patients living with dementia– a scenic rolling countryside beyond a backyard fence, a Farmers Market fruit and vegetable stand, a laundry room, a child’s room filled with toys and nursery rhymes, and a window box filled with flowers, to name a few. The doors to each patient room are also unique, each one looking like the front door into someone’s home.

“Dementia can affect a person’s ability to judge the spatial relationship between objects or to see colour differences – deficits that can lead to expressive behaviours,” said Dr. Sudip Saha, Osler’s Medical Director of Seniors’ Health and Division Head of Geriatric Medicine. “The bright colours and wall decals help patients navigate through the corridors and to their own rooms, creating a setting that is more appropriate, accessible and enjoyable for people living with dementia,”

What’s even more unique is that many of the wall decals are also interactive. Patients can pick apples or pears from a tree and drop them into a basket, pick and transplant flowers from a window box, grab a laundry basket full of clothes, or play with toys similar to those remembered from their childhood.

“A person who cannot cognitively recall because their memory is declining relies on their emotional brain, which is one of the last parts of the brain to be affected by dementia,” said Geerlinks. “All the wall designs in our unit are very reminiscent of a senior’s memories from an emotional perspective, and serve to engage and stimulate the patient’s mind.”

While environmental transformation is a key element of The Butterfly Approach, an equally important aspect of the model is the relationship between the patient and the health care team.

“The ACE Unit staff have received extensive training in emotion-based, person-centred care, and every interaction between staff and patient is seen as an opportunity for positive, meaningful care that takes into account who the patient was before they developed dementia,” said Chanese Lambert, Osler’s Clinical Services Manager, Seniors’ Health. “It’s a purposeful approach that really emphasizes the human touch as much as the clinical side of care. Team members are recruited with as strong a focus on emotional intelligence as well as their qualifications and years of experience.”

Unlike other clinical units, patients admitted to Osler’s ACE Unit are assessed for both their medical history and personal history, allowing the care team to better understand who they were before they became a person living with dementia. Meeting the patient’s emotional and clinical needs affords a person living with dementia quality of life while in hospital. And quality of life is quality of care.

“If we are able to recognize what a patient needs and anticipate it in advance, then we’ll greatly minimize them feeling emotionally distressed, reducing the onset of responsive behaviours, as well as the use of pharmacological interventions,” noted Geerlinks.

In Osler’s catchment area spanning Brampton, North Etobicoke and beyond, the population growth rate is three times the provincial average. Projections indicate that there will be an 83 per cent rise in the seniors’ population nationally in the next eight years.

“Dementia is one of the biggest health care challenges of our time and, in the absence of any curative or disease-modifying treatment, we must think of other ways that we can best help patients with dementia by incorporating new methodologies like The Butterfly Approach to ensure we continue to provide excellent care,” said Dr. Saha.

Osler will be closely monitoring the type of impact The Butterfly Approach has on patients within an acute care hospital environment with the hope to expand to other areas.

“This entire experience has been transformative, not only for the patients in our care and their families, but also for the staff and physicians who care for them,” said Geerlinks. “Osler and the ACE Unit are trail blazers and I hope that we can be the spark that ignites the flame of a necessary paradigm shift in dementia care, not just here in Canada, but around the world.”

Catalina Guran is Senior Manager, Public Relations | Strategic Communications at William Osler Health Centre.