Inspiring Impact with Moira Welsh

Inspiring Impact with Moira Welsh

For this special series, Inspiring Impact, HIROC is partnering with AdvantAge Ontario to highlight the work of several of the presenters at their online education and networking event in May.

Show Summary

Today we’re talking with one of the session presenters, reporter Moira Welsh, author of the recent book Happily Ever Older. For close to two decades Moira had been investigating the negative aspects of long-term care homes. On a tip from someone at AdvantAge Ontario, she started exploring one progressive model of care in Peel Region. The outpouring of excitement around that story made Moira start thinking, maybe there are other stories out there of seniors living with purpose and energy and love.

Mentioned in this Episode


Narrator (Intro): Imagine you could step inside the minds of Canada's healthcare leaders, glimpse their greatest fears, strongest drivers, and what makes them tick. Welcome to Healthcare Change Makers, a podcast where we talk to leaders about the joys and challenges of driving change and working with partners to create the safest healthcare system.

Ellen Gardner: Welcome to Inspiring Impact, a special series from HIROC. I'm Ellen Gardner with Philip De Souza. We're delighted to partner with AdvantAge Ontario and highlight the work of several of their presenters in advance of their online education and networking event in May.

Today, we're talking with one of those session presenters, reporter, Moira Welsh, author of the recent book, Happily Ever Older. For close to two decades, Moira had been investigating the negative aspects of long-term care homes. On a tip from someone at AdvantAge Ontario, she started exploring one progressive model of care in Peel Region. The outpouring of excitement around that story made Moira start thinking, maybe there are other stories out there of seniors living with purpose, and energy and love.

Ellen Gardner: So nice to meet you Moira and welcome to Healthcare Change Makers. Great to have you on.

Moira Welsh: Thank you so much for inviting me. I'm happy to be here.

Ellen Gardner: Can you tell us a little bit about yourself and why you wrote the book, Happily Ever Older?

Moira Welsh: I wrote the book Happily Ever Older because it was the culmination of almost two decades of investigative reporting into long-term care. And I generally reported on the negative aspects of nursing homes and did a lot of very in-depth work around that. And came to the point after probably 15 years or so, came to the realization that none of it was really making a difference. I mean, some of it led to new legislation and new rules and so on, but it really didn't change the system. So I actually got a tip from Debbie Humphreys from AdvantAge Ontario, who suggested that I look into the Butterfly model that was coming up at Peel Region. And so I did.

Moira Welsh: And the result of that story, it was a year-long investigation into the positive, we called it. That led to a really interesting outpouring from the public, from the readers who wanted to know more. They were so excited by the possibilities that long-term care could actually be a home of warmth and friendship and music and just deep social interaction. So that response made me say, okay, what else is out there? And as a result, I travelled across Canada and the United States and into the Netherlands to explore some really progressive homes and meet the leaders of those homes.

Ellen Gardner: I want to hear more about what you discovered on your travels, but congratulations on bringing the Butterfly model to light and really promoting it because it's such an interesting model. And I think it has attracted, some of it based on your work, it has attracted worldwide attention.

Moira Welsh: It really has. And it's so interesting how that came to be, because really it's just sort of an organic process. It wasn't as if governments jumped onside and said, we need to do this. In fact, it was simply leaders of individual homes who saw again, what was possible and saw that people could live in a way that in many ways eliminated the anxiety and aggression that people experience, especially those with cognitive decline in homes. And we refer to them as these so-called behaviours, but really a lot of experts in the field are now saying, and people who use Butterfly are now saying those behaviours don't really exist. 

Those are simply emotional responses to people being locked up and left to sit in the chair for the rest of their lives. So when you use a program like Butterfly, it eliminates a great deal of that, which just makes it so much better for the homes, the operators, the workers, the residents and their families.

Ellen Gardner: As you study the different seniors' residences in North America and Europe, what were some of the features that really stood out?

Moira Welsh: So I would say they all share a DNA, but they all also do things a little bit differently. But what I saw consistently was the freedom to step outside, to dig in a garden, to go for a walk or just enjoy the sunshine. Many of them had small households of between 6 to 10 people with dedicated staff. And that gave them the ability to, for example, if you felt like baking chocolate chip cookies on a Tuesday afternoon, you could do so. And that would be built into part of your day. You could have a glass of wine before dinner and sit and chat before everyone sits down for their meal. And there's also a real focus on eradicating loneliness, which I think we've all seen during the pandemic. And many of us have a new appreciation for how detrimental that is because so many people have been isolating in their own homes.

Moira Welsh: So they can now empathize with what older people experience. But in these homes, they're really focused on removing loneliness as a consistent part of people's lives. And the other piece I found that was super interesting was the evolving attitudes of the leaders of homes. So they're always looking at new research, new ideas, never afraid to say, you know what? I could've done this better, I could have gone so much further, especially around the inclusion of people with cognitive decline in the greater community, within the home or outside of the home. And a real embrace of people of all ages living together or interacting in a natural way throughout the day.

Ellen Gardner: Just give me an idea, just maybe a hint of some of the places that you saw, where they were doing these interesting things in terms of increased socializing and letting people have a glass of wine in the middle of the day. How far afield that you have to go to find those things?

Moira Welsh: They're all evolving. And I will say that the inclusive piece of this is much newer. And so it's not really entrenched in a lot of homes yet, but people are moving forward with new designs to build homes in a different way that will change that. But for example, in the Netherlands, people have a glass of wine. They have a little shop at de Hogeweyk which is an enclosed village model in the town of Weesp just outside of Amsterdam. And so if I live there, I can step outside of my home and go for a walk and stop in the store and pick up a bottle of wine if that's what I choose, or I might go with my caregiver. And then before the meal or during the meal, it's a very natural part of the day, if you like wine to have a glass. And that was their point that Eloy van Hal of de Hogeweyk said, "We want people to have a normal existence." And so a glass of wine is perfectly normal. So let's enjoy.

Ellen Gardner: When you say the word normal, that's really interesting. And evokes some questions really around how we define normal and that to create that kind of existence for older people, it seems really difficult to do that.

Moira Welsh: Yes, it does. And then it's not really, because I think it's just a completely different perspective that we need to reach when we're caring for older people. Because I think for many of us, there's a real built-in ageism around how we view older people and it's as if they lose their humanity and they're quite content in our minds to sit with almost nothing to do during the day and have a very static existence and maybe live in a sealed unit where you rarely go outside and feel a breeze on your skin.

But in fact, people, as we all know, if we think about it, people are just people at any age. And so a normal life then for many of us would be living in a smaller household for example. How many of us ever lived for an extended period of time in a big bright unit of 32 people and with a lot of different personalities and needs and a lot of rushing around. And especially for those with cognitive decline who are dealing with loss and fear, and a fear of not understanding where they are in life.

Moira Welsh: So those big units can be terrifying and can actually induce some of the anxiety and aggression that we talk about. So giving people a smaller household where life seems a little bit more normal, you can do your own laundry there for example, you can sit at a table and bake. If people feel like having a barbecue, they can step outside and do that with the caregiver. And it just is a simpler existence, but it's more peaceful for people. It's more natural to the way that they normally live. And it just leads to a greater sense of calm.

Ellen Gardner: Moira, why do you think we need to have innovative thinking and programs to support safe and quality care for seniors?

Moira Welsh: We need innovation because right now, our system is based on very old-style institutional system. And yes, there are lovely homes out there that are making a difference and doing some wonderful things for the people in their care. But overall, our system has embraced the status quo, which is big, big units, noisy, the staff are in charge, the people who live there must follow the rules of the workers and they don't really have a say in their lives. And so there's a large group of people, the boomers who are turning 75 this year and are quite aware that they do not wish to live that way. And while many of us will never end up in long-term care, some of us will, for whatever reason, we'll become vulnerable enough that we need that extra help. And so why not make it a good place to live?

Ellen Gardner: We're looking forward to hearing more about the book at the AdvantAge Conference Moira, but I wanted to ask you, if you could implement one thing today from your book that would help make an impact, what would that be?

Moira Welsh: That is a tough question because there are so many different pieces that actually need to be implemented to create real transformation. But since you put me on the spot, it would be innovative leaders. Because that is really what it all comes down to. It won't work unless the people who are running the homes or the operators are on side, and perhaps that takes some different people in those positions. But those new ideas and people who are not afraid to innovate, they're pooled so they don't mind taking some risks, even though really if you look at it, the risks aren't as great as a lot of people believe they are. That can change everything. So for me, it always comes down to great leadership and great leaders can make all the difference.

Ellen Gardner: I could see how leaders would feel. They might have great ideas, they might want to take risks, but there are probably so many constraints out there preventing them from taking those kinds of chances. And maybe those constraints don't exist in other environments.

Moira Welsh: That's a really interesting question. And I've talked to a lot of people about that because I hear that consistently. And so we've talked about Ontario. I've learned from leaders of homes that are creating change that the regulations, for example, are not as restrictive as people assume that they are. And so really what they're doing. And I'll give you an example in Butterfly homes, outside of COVID time, people generally sit at a family-style table and pass around bowls of food. And so there would be concerns in a couple of different ways of perhaps even family-style eating, and the heat of the food, the warmth of the food, there are requirements around that. But what people say to me and what the leaders say to me is follow the spirit of the regulation. And the intent of the regulation is to ensure, for example, that food is warm.

So does it need to be served cafeteria-style from a steam table? No, in fact, it can be served on hot plates on the table and people can pass it around the bowls or the workers can serve from the bowls. So you're able to have that experience.

Moira Welsh: Another example that was given to me was the measurement of fluids that people have and some homes, the staff are measuring, watching every resident taking note of intake. And in other homes, they're following the same regulations by staff saying to the dietician, for example, Mrs. Smith is not drinking well today. And so the dietician will go over and monitor that and help her along instead of having workers, trying to take notes of everything and spending so much time focused on documentation. So it's really about sort of opening your mind to different ways of doing things and also ensuring that the inspectors and the lens are on side with that. And that's what other leaders have spoken to me about is that they reach out to the people in power, so to speak and say here's what we're doing and come along and see what we're trying to achieve, or what we have achieved and see how it can be done.

Ellen Gardner: You've been writing about these things for a while. I just wonder how writing this book changed you, Moira and maybe your feelings about the whole field of long-term care.

Moira Welsh: What I think I really learned from this, it has to deal with the concept of potential and not about our age or our vulnerabilities. We can actually live up to our potential at any stage in life. And I think that was what was so exciting for me to see among the residents that I met were people who were fully engaged and many of whom had cognitive decline, but they were still conversing with each other or caregivers. They were still having dance parties, for example. One who actually did not have cognitive decline, but lived in what we have called a dementia unit at the time, she learned to swim at the age of 91. She bought her first bathing suit when she was 91 years old.

Philip De Souza: Wow. That's fantastic.

Moira Welsh: So there were just so many different examples like that, where people were living well.

Philip De Souza: It would be great to think that as a result of some of the things you discovered or your book, that things could get better down the road, that we're in a process where things have to change.

Moira Welsh: They do have to change. And honestly, I think we have an opportunity now through a large group of older people who are aging, and who are accustomed to changing society around them. And I believe that they probably haven't turned their attention to seniors living in many ways until now. And the pandemic has really brought out the need for change as well. So if we don't do it now, we probably will never succeed in really implementing real transformative care in homes. And also just the knowledge that we can do this, not just in long-term care, but in other seniors homes, other ways of living and even within the community, within home care and workers who are trained to connect with people in different ways.

Philip De Souza: That was great. Excellent. My only follow-up question for you Moira would be as you've been on this journey of writing the book, and I'm sure you've talked to many, many people, who work in all corners of the healthcare system, what's kind of the feedback you've been getting?

Moira Welsh: The feedback that I personally have been getting is from people who actually want to create change. And perhaps there are different homes that have the opportunities to build now because of the funding from the government. And so they're looking at some of these smaller households and the ways that they can actually do that within these new builds. And so that's really interesting. I'm sure there are people out there who say, no, this is possible, but more and more, the conversation is around overcoming that kind of attitude and explaining why it is possible. And so that's really exciting.

So there is a real enthusiasm among people to do it differently because the examples I give are examples that are happening in real-time. They're all in different regulatory environments, but there are also homes that are following the old status quo institutional style in those jurisdictions and these homes, these progressive ones are not. So it shows that no matter what the regulations are, the oversight is you can manage to be really progressive and give people a completely different life.

Moira Welsh: And if I can say one more thing. The staff benefit from this immensely. And so the homes, I'll give you an example of Sherbrooke Community Centre, which is in Saskatoon and it's a not-for-profit and they have a very high retention rate among their staff, their full-time staff, because when you work in that home, essentially, you're living there in a sense as well, you spend so much time there with people. But it becomes a family. And so people, leaders of these homes treat their staff very, very well because they believe that how you treat your workers is how the workers will treat the people who live in the homes. And that's a key point that seems to be universal.

Philip De Souza: Absolutely. I love that you brought that up. Ellen and I were just talking about that earlier today, as well about the fact of ensuring that you encourage your employees to bring their full self to work, and then so that they can be their true, authentic selves. And then of course help and support others all around them.

Ellen Gardner: Moira, I'm really struck with how you ... Your book seems really upbeat. You focus on really positive stories and examples of where the change is happening and that it's possible to make those changes in a way that benefits staff and residents and families. And you didn't just go down the road of here's what's wrong with our systems. So was that a conscious choice on your part?

Moira Welsh: Yes. 100% conscious choice because frankly I've been writing those negative stories for so many years and it doesn't lead to change. And there was actually a really interesting conversation that I had when I was doing the original Butterfly story with Peel Region. And I interviewed a US geriatrician named Dr. Bill Thomas. And he said something that was so profound to me, an investigative reporter, who is always expected to uncover the worst. But he said, "You could tell a negative nursing home story every day, and it wouldn't assist them because all it would do is prove that it can't be better and it would lower the bar. So everyone would say, see, we're doing the best we can. And that's it."

Moira Welsh: And so I sort of thought about that a while and I took that to heart. And when I went out, I looked for homes that had a track record of success and those who are really pushing forward constantly. So I wanted to focus on them, but the point is, if you can show what people are already doing, then there is no excuse to say we can't do it because it's happening out there. And it's happening in Ontario. It's happening in provinces across Canada and throughout the United States and into Europe.

Ellen Gardner: Great to hear that it's happening close to home, that we don't have to look to Europe, that we don't have to look too far away to see positive change can happen.

Moira Welsh: That's so true. And there are so many interesting leaders in Ontario who are so passionate about change in terms of the emotion-focussed care, or relationship-based programs, and also the design of homes, because that is considered very, very important as well, especially the smaller household design, the involvement of families, and also the workers. Because there is probably nothing more important than the leaders of the homes and frontline workers who actually care for people. And especially with the shortage that we saw before the pandemic and what we've seen throughout, and probably post-pandemic. It matters immensely that homes could attract good staff and keep them. And that's what these programs are finding. That people want to work there because they feel value in their work. They feel like they have a sense of purpose and they have autonomy in the way that they care for the emotional well-being of their residents.

Ellen Gardner: Well, congratulations on the book. I really look forward to reading it and I think it's been called a warm, inspiring blueprint for change. It does sound like that's the path you're on with it. So wonderful work. And we really look forward to hearing more at the AdvantAge Conference. Thank you so much, Moira.

Moira Welsh: Thank you so much. And I'm really looking forward to the AdvantAge Ontario Conference.

Ellen Gardner: You have just been listening to Inspiring Impact, a special series produced by HIROC and AdvantAge Ontario. Today our guest was Moira Welsh, an investigative reporter and author of Happily Ever Older. Stay tuned for more episodes of Inspiring Impact.

Thank you for listening. You can hear more episodes of Healthcare Change Makers on our website and on your favourite podcasting apps. If you like what you hear, please rate us or post a review. Healthcare Change Makers is recorded by HIROC's Communications and Marketing team and produced by Podfly Productions. Follow us on Twitter at @hirocgroup or email us at We'd love to hear from you.