Jan 08, 2019

The Butterfly model of care: “This is how aged care should be”

When Helen Blayden was asked to run a pilot program for the Butterfly model of care, she wondered where she’d find the time to focus on residents’ emotions, while also doing all the other important work she had to do.

A nurse for nearly 40 years, Ms Blayden was used to routines, rosters – and getting jobs done.

But The Salvation Army had agreed to introduce the Butterfly model of care in a pilot program in one of its nursing homes, and Ms Blayden was running the trial.

The Butterfly model of care was developed by Dr David Sheard in the United Kingdom 23 years ago, and provides a complete programme and strategy for caring for vulnerable people, both in nursing homes and at home.

Ms Blayden went on to become National Director of Dementia Care Matters, which owns the Butterfly model of care and is now owned by the Salvation Army.

Ms Blayden said she had “no idea” what she was getting herself in for with the pilot, but the experience has been “life changing”.

Prior audit’s mixed results

Just prior to the butterfly pilot starting, Mountain View nursing home, where the pilot was taking place, was audited.

“We didn’t score particularly highly,” Ms Blayden said.

“We’d ticked the boxes for everything, but as far as people’s happiness and wellbeing, we weren’t doing that well,” she said.

People were sitting in chairs, asleep, and there wasn’t a sense of engagement. The nursing home was clean and tidy, but there was very little emotional connection between the residents and staff.

Staff must understand their own emotions before they can empathise with residents

The first step of the Butterfly pilot was to ensure that all the staff had the right types of personality to work in aged care. Staff needed to be able to “wear their hearts on their sleeves”, they needed to care about other people, and they needed to have emotional intelligence.

A comprehensive review of all staff was conducted.

Once the team was finalised, the programme’s purpose was to understand “the core” of each staff member.

Staff has to share their life stories, and their vulnerabilities, so that their authentic selves were revealed, not only to themselves, but to the team. And there was no escape for Ms Blayden, despite the fact she was the team leader.

“I had to step down from my position as manager and be part of the team, and show my own vulnerability so the staff could see that I was real and authentic, so they themselves could be real and authentic.”

Though the process was challenging for Ms Blayden, and certainly something different for her, she decided, “I’m just going to open my mind and heart to this and go with it.”  She knew the model had been successful many times overseas, so she just decided to trust the process.

The first four weeks of training also held another surprise for Ms Blayden.

“For the first four weeks, there was no talk of dementia. I was like, ‘When are we going to talk about dementia?’, but it was all about us. It was incredible,” she said.

Empathy at the heart of the Butterfly model

Staff understanding themselves and each other is the key to being more empathetic towards residents under the Butterfly model of care.

“We really bonded as a team and truly started to understand each other and ourselves more. By understanding our own vulnerabilities, our own feelings and emotions, we were able to bring that into the workplace to truly empathise with the people we were caring for,” Ms Blayden said.

If you know you’ve felt an emotion yourself before, it’s easier to relate to the residents, she said.

“I’ve felt lonely and isolated, I’ve felt scared not knowing what’s going on around me. So if I’ve been through that, what must this person going through – and they can’t even tell me.

“I can understand what that person’s going through, because I’ve felt something similar.”

The process was “life changing”, Ms Blayden said. “It had such a powerful impact.”

Understanding each resident, and their unique stories

Often, people living with dementia are not able to articulate why they are feeling a certain way, and an important part of the Butterfly program is understanding the history of each resident.

When staff began to look at the residents’ life histories, they quickly realised that some contained errors, so, in consultation with families and residents, the life stories were rewritten.

“We found out really amazing stuff about people,” Ms Blayden said, and the information they gained through the process helped them understand the residents better.

“One lady had been in Poland in the Second World War, and her family had been violated by the German soldiers. You can imagine when someone approaches her in a uniform, standing over her, how fearful she is,” Ms Blayden said.

Before the Butterfly training, the woman was said to have ‘behaviours’, but after the training, and understanding her history, staff were able to appreciate that she actually felt unsafe, and staff hadn’t been understanding her unmet needs.

“When you get to know and understand that person, you know what the fear is about and you can understand those behaviours,” Ms Blayden said.

Learning how to prioritise time

As for the matter of getting everything done, Ms Blayden said she is often asked how staff get everything done, while at the same time focussing so much on the residents.

“How do you ever get the time to do your job? This is just giving staff the resources and skills they need to be able to do the job better,” she said.

Staff are empowered to better prioritise their time, but with the focus on the resident, rather than tasks.

“The task gets done, but it’s in the background and it’s totally inclusive in the life of that person,” Ms Blayden said.

For example, Ms Blayden said if a resident is in a corner calling out for help, then spending time with that person has to be prioritised ahead of doing paperwork or work on the computer.

More innovation is needed in Australian aged care

Aged care in Australia is often focussed on meeting accreditation standards and ensuring compliance with the Commonwealth guidelines. Though these requirements are, of course, essential, they can also mean aged care operators lose sight of people – the residents – and their emotions, their wellbeing, their happiness, and their sense of safety.

The Butterfly model of care is about putting the focus back on people and their emotions. It is about helping staff access the interior world of the person the person they are caring for.

“It’s really letting them (the care receiver) be the person who controls the day, controls what’s going on, and staff being the facilitator and trying to enhance the quality of life that that person has in the moment,” Ms Blayden said.

The response from staff and families

Implementing the Butterfly model has been “life changing” for Ms Blayden, in particular for seeing how it has made staff feel so valued.

The programme has also had an “incredibly positive” response from families, who are always keep abreast of what is happening at their facility.

Families “loved it, they absolutely loved it,” Ms Blayden said.

“They said this is the best thing that’s ever happened.”

“Some of them (the residents) have had a quality of life at the end of their lives that they didn’t even know was possible.”

Residents “woke up” under the Butterfly model

Ms Blayden said the overwhelming reaction of residents under the Butterfly model was that they appeared to “wake up” when the model was brought in.

Residents who hadn’t spoken at all, began to talk again and find activities they enjoyed.

Ms Blayden told the story of one lady who had formerly mainly sat in a chair and never spoke.

“I’ll never forget when we started really connecting with her, talking to her, not brushing her off thinking we’ve got to shower her and dress her, and then leave her in a corner because she’s quiet.

“But when we started to really get in touch with her, she started talking. She had the deepest voice, and she loved dancing, and her personality came out,” Ms Blayden said.

Another gentleman had previously been at another nursing home and had been heavily medicated and spent most of his time in a floatation chair. He was heavily dependent on his carers.

Soon after he moved into the Butterfly home, he said he wanted to walk. So, with the help of OTs, physios and even the cleaners on duty, he began to walk.

His medications were reviewed and cut back, and within a few months he was walking with a walking frame, with supervision.

“He was chatty, he was the wittiest, lovely man you’re ever met. He was so full of character,” Ms Blayden said.

He also returned to sign at his local choir with his wife.

“His wife had had no relationship with her husband because he’d just sit there and be blank, but now they have a beautiful relationship again,” Ms Blayden said.

The first accreditation – hugging, kissing and crying

Twelve months into the pilot program, the accreditors arrived “with pursed lips” for an unannounced visit. Considering the mixed results of the previous audit, they began going about the audit in a businesslike way.

Ms Blayden said the home welcomed the audit, because they want the auditors to see what they’d been doing, and to see how they interpreted it.

“Well, half way through the day they were blown away, but by the end of the day they were hugging us, kissing us and crying, saying this is how it should be. We had beautiful feedback from them,” Ms Blayden said.

Ms Blayden said she’d like to see more operators try innovative approaches to care, rather than simply relying on the government’s guidelines for direction.

“I think the government is really under pressure to set a standard, but it’s up to aged care providers to show that innovation, and providing something better than just the basics,” she said.

Image: iStock.

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  1. Hurray! Well yes caring relationships built on our capacity to relate to and understand one another have been the foundation of real ‘care’ for a couple of thousand years and many hundreds even thousands of articles were written about it over the centuries. To imagine the life of the other we need to understand and reflect on our own.

    The ‘Neoliberal’ ideology and the management thinking it introduced in the 1980s and spread in the 1990s turned that on its head and replaced it with competition, efficiency and choice; all to be delivered through a market selling choices. As Professor Michael Fine has indicated in many articles this commodification of care makes it almost impossible to form caring relationships.

    This is something that we as citizens should all be insisting on and as family and community we should be there on site contributing to those caring relationships and insisting that it happens.

    Unless we all get involved and exert strong social pressures, the prevailing management structure and the patterns of thinking that lie behind it will not be changed.

    1. Yes, government and business models of the 1980s have a lot to answer for. There have been lasting effects on ethics across society.

  2. Such a wonderful concept. An aged care facility in my childhood hometown used to instinctively provide this level of care to its residents. Unfortunately, despite the overarching governing body not changing, new management staff were installed who have systematically destroyed the sense of loving community once enjoyed by the residents and staff at the facility. It breaks my heart to hear about these changes, brought about because management said that this facility was not allowed to be special, but had to be just like everywhere else.

    1. Yes this is a wonderful concept , and I too was familiar with this as a natural occurrence in my childhood where we were owner / operators of a small ‘Nursing Home’ in a Melbourne suburb.
      It is a shame we have to refer to ‘Models’ such as this and the ‘Montessori’ as a basis of identifying care.

  3. Wonderful work.

    With the current state of care in Now is time for models like this, that certainly are headed in tbe direction we need to go, is not owned by Any large corporation.

    It needs to be freely available with all its resources.

    I don’t believe it needs to be a buffer for the greedy admin engine of large organisations, no matter how worthy and precious their work.

    The fix for care should not rest with one group, but with us Al to find those wonderful compassionate emotionally intelligent Care Warrior Earth Angels.

    1. wonderful to hear new ways of thinking actually in place and working. As an aged care worker with knowledge of much relied on government funding I would like to ask about how the hurdles of staff time to get required documentation completed and the fact that residents show less behaviours to be documented have affected the facilities funding?

  4. what a no-brainer concept!! Kindness, compassion often have to be taught; while many of us dont have to be “taught” what we think of as part of our core value system! My sister is in an assisted care facility with 30 patients; and, some staff do interract with her; but, some just do their job!!! I wish this “Butterfly ” concept could be implemented in every facility! A smile, a touch, and a hug go a long way!

  5. What a fabulous, heartening story! And very important to spread the word to other residential homes. Valuing carers and cared-for is obviously a win-win result for all.

  6. This is such a lovely innovative approach to caring for elderly people. I saw so many shut down people when my father was in a Nursing Home. It is definitely time for thinking outside the box and approaching caring for the residents differently. Paperwork is important but so is the mental health and happiness of the residents.

  7. So wonderful to hear after spending nearly 7 years caring for my mother in a Nursing Home, I too encouraged emotional connection to all the staff so they would care emotionally for my mother not just toilet & distract her . . . .
    Nursing homes are bereft of emotional intelligence & is the biggest problem for understaffed & under skilled staff when so much more could be done & staff be satisfied they have really served & cared for in a wholistic way rather than “just physical” needs. Such a VOID in most nursing homes!!

  8. This story is so touching caring and loving. They got something like this in Holland and it makes a huge difference to Residents their families and Staff. Australia is full of Baby Boomers who helped make this Country what it is today. Don’t shove the Elderly in a Corner, show love and Compassion and you will be richly rewarded.
    I congratulate you for what you have and are achieving.


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