In long-term care homes across Ontario, we are seeing a wonderful shift away from rigid, task-focused routines and towards a more emotion-based model of care. Care homes have transformed their spaces to focus on what matters most, which is how residents feel and how we can connect with them.

Two of the leading frameworks gaining momentum, both funded under Ontario’s Improving Dementia Care Program, are the Butterfly Approach (pioneered by Dr. David Sheard and Meaningful Care Matters) and the BSO 5STaR model (developed by Behavioural Supports Ontario).

While both models prioritize person-centered care over institutional routines, they approach daily care from different angles. Here is a look at how these two models compare, and how weighted therapy dolls serve as a versatile, meaningful tool within both frameworks

Butterfly Approach vs. BSO 5STaR Model: What’s the Difference?

While some long-term care facilities have implemented both models simultaneously, it helps to understand how their core philosophies differ. 

On one hand, the Butterfly Approach places its main emphasis on emotional well-being, connection, and feeling valued. Its focus centers on a transformation of the whole care-home culture, where residents’ feelings matter most. The core question staff ask themselves is, “How does this person feel, and how can we connect with them?” Within this model, a therapy doll serves as an effective avenue for nurturing, relationship-building, and purpose. 

BSO 5STaR, on the other hand, places its main emphasis on supporting abilities and reducing distress. Its care focus centers on strengthening staff skills to adapt environments and care. The core question staff ask themselves is, “What is this behaviour communicating, and how do we adapt?” Within this model, a therapy doll serves as an individualized, non-pharmacological tool to ease distress and soothe nerves.

Understanding the Butterfly Approach

Developed by Dr. David Sheard, the Butterfly Approach shifts the focus of a care home from completing tasks on a checklist to creating small, vibrant, home-like neighbourhoods where emotional needs come first. Its key principles include:

  • Feelings Over Facts: As cognitive processing changes, individuals experience the world primarily through emotions and physical senses rather than logic. This is why it is so important to focus on creating comforting sensory experiences and reassuring moments that ground them in feeling safe.
  • De-Institutionalizing Spaces: Replacing staff uniforms and nursing stations in favour of cozy, familiar spaces that feel like home, allowing staff and residents to connect more easily and naturally.
  • Meet Residents in their Reality: Caregivers join residents in their emotional truth rather than trying to force reorientation to present-day facts.
  • Filling Up the Environment: Creating a rich landscape of everyday domestic items, rummage drawers, and comfort objects to prevent boredom and isolation

How Weighted Therapy Dolls Support These Models

Because therapy dolls bridge sensory comfort and emotional memory, they adapt beautifully whether a care home follows Butterfly, BSO 5STaR, or a hybrid of both. It is the same doll, but with a different, thoughtful application.

Butterfly Homes: Fostering Connection and Agency

Within the Butterfly framework, a therapy doll is not viewed as an intervention for a symptom. Instead, it is used as a tool for developing emotional connections, restoring self-identity, and promoting joy.

  • Restoring Purpose: Holding, dressing, or rocking a doll allows a resident to step back into an active caregiving role, bringing a sense of dignity, usefulness, and attachment.
  • Deep Pressure Stimulation (DPS): The realistic, balanced weight of a therapy doll provides soothing proprioceptive input, offering grounding tactile comfort that feels both natural and safe.
  • Shared Moments: A doll gives staff, family members, and residents a gentle conversational focal point, encouraging natural storytelling and affection.

BSO 5STaR Homes: An Individualized, Non-Pharmacological Tool

Within a BSO 5STaR framework, care teams focus on understanding what a resident is communicating through their responsive behaviours such as wandering, agitation, or calling out.

  • Targeted Reassurance: A weighted doll can be introduced as an individualized tool for a resident who naturally calms down when holding or nurturing an object.
  • Easing Restlessness: The deep pressure comfort of a weighted doll helps anchor residents during stressful parts of the day, particularly during evening periods known as sundowning.
  • Sensory Engagement: Providing something familiar to hold and soothe can significantly reduce anxiety and help a resident feel secure.

Best Practices for Implementing Therapy Dolls

To ensure therapy dolls are used ethically and respectfully across any care models, care teams should follow a few core guidelines.

  • Offer, but Never Force: Introduce dolls naturally into the living space. Place a doll on a rocking chair, a cozy couch, or in a crib in a common area, letting residents discover it on
    their own terms.
  • Support Their Reality, but Stay Truthful: If a resident is already treating the doll like a real baby, you can validate their emotional experience with soft phrases like, “You are taking such lovely care of the baby today.” However, you should never try to trick or deceive a resident. If they directly ask if the doll is real, gently tell them the truth that it is a doll, while reassuring them of how well they are taking care of it.
  • Appropriate Sizing: Select weighted dolls based on the resident's physical comfort.
    • Preemie dolls under 18 inches are ideal for smaller residents or those who find heavy objects overwhelming.
    • Newborn dolls between 18 and 22 inches are the most versatile option, offering a balanced weight for most adults.
    • Toddler dolls over 22 inches provide fuller deep-pressure support for individuals seeking a more substantial hold.
  • Integrate with Daily Activities: Place baskets of soft baby blankets, brushes, or booties nearby so residents can groom, swaddle, or care for the doll as part of their daily routine.

Bringing Meaningful Care to Life

Whether your care home is transforming its culture with the Butterfly Approach, equipping staff with BSO 5STaR strategies, or blending both, every detail in the environment is an opportunity for connection.

Weighted therapy dolls offer a gentle, adaptable bridge, meeting residents exactly where they are with warmth, comfort, and purpose.

Explore our complete line of weighted therapy dolls to find the right fit for your home’s care journey.