We must ‘rethink’ design of LTC homes
Creating smaller wings and more outdoor areas boosts safety, experts say
A “total rethink” of the design and function of long-term-care facilities and nursing homes in Ontario is urgently needed to fight the spread of diseases like COVID-19, says a Toronto expert in the industry.
Irka Dyczok, whose firm DesignFarm creates designs for retirement homes and longterm-care facilities, says the price tag to make the changes involves capital funding — such as the creation of wings that house fewer residents — but staffing and operations are also key.
“It’s obvious things aren’t working right now,” says Dyczok, referring to the shocking daily death rates in seniors homes across Ontario.
About 40 per cent of nursing homes across the province are in outbreak, a situation that has resulted in 3,000 deaths since the coronavirus began last March.
One such facility, Tendercare, a 254-bed nursing home on McNicoll Avenue in Scarborough, has seen a coronavirus outbreak that has killed more than 70 people, forcing North York General Hospital to take over temporary management of the facility.
Dyczok, who has been designing seniors residences in the province since 1991, says the standard LTC home model that is funded by the province has 27 to 32 beds per “wing” or retirement home area (RHA).
Each wing typically has one tub and shower shared by everyone in the wing, shared amenities such as a dining room and lounge, in addition to a nursing station and housekeeping storage space.
But even new facilities built to this standard are cramming and “warehousing” seniors in wings with double-loaded corridors (units facing each other in a hallway), Dyczok says.
She believes that eight to 10 beds in a wing (one bed per room) would be far better in terms of controlling the spread of infections like COVID-19.
If we’re moving to “a more humane and respectful elder care model we need to reconsider how we’re designing (senior care facilities),” Dyczok adds.
She adds that “every existing home should be examined for areas of infection control weaknesses and addressed appropriately. Are there finishes and furnishings that are worn and/or inappropriate?” Dyczok says.
“These are complex issues that need to be addressed by a team of people with experience. Professionals — designers, architects, engineers — along with front-line staff, and residents and their respective families.”
But Dyczok feels no one is listening to architects or designers when it comes to addressing these issues.
“The current (provincial) funding policies are limited and they directly affect how we are able to design and build,” she adds.
Bruce McKenzie, an architect in Calgary who is vice-president of Toronto-based Norr Architects, which designs affordable seniors facilities and higher-end centres, says no more than 16 to 20 beds per wing should be the target for LTCs.
“There’s a necessity to create neighbourhoods (wings) within these seniors facilities, where people can still socialize but you can control the spread of disease of any kind and isolate it,” McKenzie says.
“I can control the health of that neighbourhood, as opposed to 60 beds,” he says, later adding “architecturally, you can design (LTCs) so they are broken up into smaller units. That has definitely come to pass in new projects.”
Separate entrances to residents’ wings seem to help cut down the spread of viruses like COVID-19, McKenzie argues.
One 225-bed facility Norr designed that opened just before Christmas has had no outbreaks. It features a separate memory care wing, with its own enclosed, secure courtyard for residents and a separate entrance from the main facility.
“The pandemic has taught us that some of the physical constraints of existing buildings need to be looked at and that we need to find ways to protect people more with the architecture,” McKenzie says.
There are 626 long-term-care homes licensed to operate in the province, offering about 78,000 permanent, long-stay beds for frail seniors.
In November, the Ministry of Long Term Care announced it is allocating funds to build nearly 3,000 modern long-term spaces, 1,970 of them new and about 1,020 upgraded. That involves 23 new buildings.
The move comes in addition to the provincial announcement in July of a new funding model that has boosted support for 74 projects, representing 10,753 long-term-care spaces: 3,960 of them new.
Of the 74 projects, 49 involve the construction of new buildings.
“These new spaces will increase access to long-term care, reduce wait lists, and ease hospital capacity pressures,” says Tanya Blazina, a ministry spokesperson.
Dyczok remains skeptical about suggestions the wait list will be reduced.
“There are 38,000 seniors on a wait list. This has been the case for years,” she says.
Retirement homes are different from long-term-care facilities, with the latter providing medical and personal service care for people who can’t live independently. Nursing homes provide the highest level of care for seniors outside of a hospital setting.
Dyczok and other experts in the area say operational measures to control the spread of disease must be considered.
For example, staff change rooms — rooms typically stuffed in the basement of seniors residences as an afterthought according to Dyczok — should be prioritized.
Secure rooms for the storage of personal protective equipment such as masks and gloves should also be incorporated into new and refurbished LTC homes, experts argue.
Bradford Perkins, a licensed architect and co-founder and chair of Perkins Eastman, a U.S.-based firm specializing in international architecture, interior and urban design, planning and other disciplines, has extensive experience designing seniors care facilities around the world, including Canada and the U.S.
He and a colleague recently wrote a magazine article that proposed several recommendations to improve senior living design to reduce the spread of the coronavirus.
Some suggestions: Buildings should be designed to permit facilities to steer staff to one location “sized and equipped” for effective screening. In addition, all service deliveries should be limited to a separate point of entry, where packages can be disinfected.
Furniture and interior finishes should be chosen based on whether they can withstand frequent and harsh cleaning needed for disinfection.
Facilities should have a dedicated room that serves as a small health centre where residents can be examined or cared for during an outbreak.
But Perkins, who is well versed on Ontario’s rules and regulations for seniors care, told the Star alternatives that don’t involve retrofits or new buildings also need to be explored in any conversation about safe spaces for seniors.
“Money can go to home health care … and with telemedicine, more and more people can be safely and appropriately supported at home — that’s one less bed to build.”
He added there are “much less-expensive options like assisted living, or independent living with some support services. They are cheaper, yet not generally supported with public funds.
“It’s finding the right mix of options, most of which are less expensive than well-done, skilled nursing facilities,” Perkins says.
“The pandemic has taught us that some of the physical constraints of existing buildings need to be looked at.”
BRUCE MCKENZIE CARE-HOME ARCHITECT