Soon after her father was diagnosed with dementia, Carole Green decided she wanted to better understand how to support teams that focus on dementia care. This decision eventually led her to join an organization called Carefor, where she is, among other things, the program manager of Richmond Care Home (RCH), in Richmond, Ont. 

Carefor is a not-for-profit home health care and community support service for all-aged clients and their caregivers, providing nursing, assisted-living options, rehabilitation, respite and adult day programs for those living with dementia. RCH is one of the five residential facilities that Carefor operates in Ontario.

Establishing a vision for RCH

It was married couple John and Lillian Bosco who founded RCH in 2000. Prior to that, both had spent many years working in the long-term care sector: John held a senior management position in Ottawa’s St. Patrick’s Home, and Lillian worked as a care aide in a retirement home in Bells Corner, Ont. 

After researching the benefits of smaller, community-focused care homes for people living with dementia, the pair decided to open one of their own.  

“Our initial philosophy was to be the exact opposite from an ordinary retirement or nursing home — so, all the care would be resident-centred, not institution-centred,” John explains. “That meant that residents who were able and wanted to help with various household duties — like folding laundry or helping to clear the table after meals — could do that, and they could also wake up and retire as they would naturally. It also meant that staff (who did not have to wear uniforms) had their meals at the table with the residents, so that they would be privy to ordinary conversation about their families, daily life, etc.”  

On September 4, 2000, RCH opened as eastern Ontario’s first women’s-only care home for individuals living with dementia. At first there were just two residents, along with two registered practical nurses to split shifts, a cook, and Lillian as a care aide for the first six months.

“We make [residents] as comfortable as possible because that’s what they deserve; they’re our elders.”

– Carole Green

The choice of a female-only home felt like a logical one.

Photo Courtesy of Richmond Care Home.

“[Back then] in retirement or nursing homes, females outnumbered males eight to one, so if we had 14 or 15 females, we would have one or two males, which would mean that we would have to have both female and male personal support workers,” explains John, adding that was just not financially possible, so they decided the home would be for women only. 

RCH came under Carefor’s umbrella of care in 2008, after John and Lillian decided to retire completely. Today, the care home continues to be for a women’s only facility for residents living with early stages of dementia.

“There’s a higher population of women with dementia entering care settings sooner than males,” says Green, who goes on to explain that women and men often require different styles of care, and that since RCH is for women only, activities can be geared more easily toward women’s likes, and the environment can provide a sense of comfort, privacy and discretion.

“In some situations, being in the presence of men might be triggering for some women,” Green says. “We have a great reputation in the community. Families feel comfortable with the thought that it’s like the Golden Girls — ‘Mom is with all these other ladies, she’s going to have a great old time.’”

Intentional design 

Built in the shape of a “T,” RCH is a barrier-free bungalow containing 16 single-unit bedrooms, each with two-piece bathrooms. The bedrooms are small, so maintaining them feels manageable but also encourages residents to join others for activities in the larger, shared spaces. 

The arrangement works well; residents readily use the common areas, which include a large, open-concept kitchen, dining room, and living room, as well as a main bathroom that has a walk-in tub. There’s also an enclosed garden with gazebos.

Just as John and Lillian Bosco had hoped, each day, residents wake up when they choose to. In the mornings, staff assist them in whatever way they need, and breakfast is made when they’re ready for it. In the afternoon, recreation staff lead a daily component of exercise and music.

The staff of 18 — which includes RPNs, personal support workers, a recreation team and cooks — focus on getting to know the women. Where did they come from? Are they married? Do they have children?

“We make [residents] as comfortable as possible because that’s what they deserve; they’re our elders,” Green says. “There’s so much value in these ladies whether or not they have dementia.”

If a resident likes to knit, play cards, bake, walk or garden, staff will join her, assist her, or facilitate her activity. According to Green, it can be a bit of a mind-shift for new staff members who come from more traditional long-term care environments to understand their job is to be a friend and sometimes play board games.

“This is [our residents’] retirement, whether or not they may remember or understand it as such, they’re retired,” Green says. “They’re entitled to this level of care.”