The Chronicle Herald (Provincial)
Nursing home design could change
As the number of active COVID-19 cases in Nova Scotia decreases, the number of deaths continue to climb at Northwood long-term care home in Halifax.
To date, there have been 57 deaths related to COVID-19 in the province, about 90 per cent of which were recorded at Northwood.
The numbers reveal fundamental issues in the long-term care system in Nova Scotia, which has been understaffed and underfunded for years. One of those issues is the design of larger and older homes.
Northwood has about 500 people living in its Halifax long-term care facility in two separate buildings. Kenneth Rockwood, a geriatrician, and a professor of geriatric medicine at Dalhousie University, says large homes may have a more difficult time managing pandemics.
“The principle behind reducing the spread (of COVID19) is to isolate the people who have the illness and to quarantine those who get exposed. It's easier to do those things with a smaller group of people rather than a larger one.”
The ideal long-term care facility would be made up of several neighbourhood-style communities, with each community housing 12-15 people, he said. If the number of people within the community goes below 12, it becomes too small to provide care effectively and to allow people to socialize.
Each neighbourhood would be “walled off” and decorated in a way that differentiates it from other neighbourhoods. A neighbouhood includes a communal area that's easily supervised where people can come together to eat and socialize or watch movies and play games.
Individuals have private rooms within these neighbourhoods, which allows for physical distancing that is essential to protect from an infectious disease such as COVID-19. A separate area can be designated for infected patients, those who were exposed and those who are not infected.
“And we can restrict the movement of the staff so that people aren't having to go from an infected area to an uninfected one.”
Benjie Nycum, an architect whose firm has worked on several long-term care facility projects, says all facilities built within the last 15 years in Nova Scotia only have private rooms with private washrooms, with very few exceptions. Most of them also follow the neighbourhood-style community model, which allows for better containment of infectious diseases.
While renovating older homes to meet those standards is possible, Nycum says it's not always cost-effective. Renovating also means people will have to be moved out of the facility to reduce the
occupancy density, as the rooms in older homes are small and house more people compared to new ones.
Since Northwood is an older facility, many of the rooms are built for two or three people. The limited resources available to Northwood left them with no choice but to move recovered COVID-19 patients to a hotel.
When it comes to moving patients for isolation or quarantine, the size of the facility or type of room are not the only obstacles.
“It's not like in hospitals where people just have a suitcase with them,” says Rockwood. “People have their lives with them.”
For people living with dementia and other cognitive disorders, changing their surroundings could have adverse effects on their well-being. Designing some areas to look the same everywhere within a long-term care home can help these patients find some familiarity.
“(You can) have toilets clearly marked as such and have consistently one colour on the door so that people can be cued when they see the colour and know what it is.”
Enforcing public health measures, such as wearing masks, can get challenging in long-term care homes, especially for patients living with dementia.
“People with dementia may find it difficult to remember to wear a mask or may find it intrusive or frightening if their health-care provider was wearing one,” says Rockwood.
Rockwood suggests having a single ward for people with dementia. Such a ward should be staffed with enough care providers that can handle the heightened levels of stress dementia patients would have in response to personal protective equipment.
Small changes can make a big difference when trying to manage an outbreak.
For example, replacing the central kitchen, which is common within long-term care facilities, with a kitchen for each household or offering pre-packaged meals can provide better control over infection, according to Nycum.
Design solutions suggested by Nycum and Rockwood will take time to implement. For now, Rockwood and other physicians at the Nova Scotia Health Authority (NSHA) are looking into short-term solutions to prepare for a potential second wave of
COVID-19.
“We need to have a plan for what happens if we get the second wave coincide with the flu,” he says.
The NSHA may need to once more mobilize healthcare providers to work at Northwood. The NSHA had done that in April as part of its emergency plan in response to the outbreak at the facility.
“We can imagine a circumstance where we need more (doctors) than that. We can imagine a circumstance where we need to do more blood testing.”
In an emailed statement, the Department of Health and Wellness said “it's too early” to comment on how longterm care may change POSTCOVID-19. The department will review the system after the pandemic subsides.
MOVING AWAY FROM LONG-TERM CARE
Both Nycum and Rockwood say that changing the design of long-term care facilities is not the ultimate solution. What needs to be done is help people take care of their loved ones at home, rather than rely on long-term care facilities.
“We as a society need to change, particularly in the years to come because the baby boom generation starts to turn 75 next year and that is statistically a very big increase (of senior citizens,)” says Rockwood.
The Halifax regional council's centre plan, which regulates development in the municipality, could make caring for loved ones more affordable by allowing people to build secondary or backyard suites on their property.
While secondary suites will not be designated by law for family or relatives, Dist. 7 councillor Waye Mason said the suites might make it possible for people to age without moving away from home.
“The core issue for us comes down to housing affordability. These measures have been available in Vancouver for decades as a tool to help create more small, affordable housing,” said Mason.
This type of housing could contribute about 1,000 to 5,000 units in the central region.
Voting on the bylaw amendments related to permitting secondary and backyard suites was deferred in January to allow for the preparation of a staff report. Mason expects the report to be ready within the next couple of months.