NEW HOPE FOR RETHINKING JOURNEY OF GROWING OLD
Pandemic may spur efforts to reimagine nursing home concept, writes Dan Levitt.
This crisis may be a watershed moment to turn the tide on replacing outdated living environments with the reinvented small household model, a better life for older adults and their caregivers.
The COVID-19 pandemic has created an unprecedented public health crisis that alarmingly impacts older adults, particularly those with pre-existing conditions. Those residing in long-term care and assisted living settings are at even higher risk of COVID-19 infections.
At Tabor Village, where I am the executive director, 300-plus dedicated employees support nearly 300 seniors who reside in independent living, assisted living and long-term care. When the pandemic was declared a public health emergency in mid-march, the leadership team implemented a COVID-19 response plan comprised primarily of hand hygiene, physical distancing, screening and self-monitoring and the use of personal protective equipment, mainly masks, gloves, eye protection and, when necessary, gowns.
All visitors, including family members, were forbidden to enter and only essential staff were allowed on-site and upon entering the buildings, employees were subjected to temperature checks and asked a series of health screening questions that felt more like airport security. Residents and tenants spent most of their time in their rooms, receiving room service and limiting dining room meals to one person seated at a table. To combat loneliness and boredom, therapeutic recreation staff introduced new activities such as doorway bingo, where long hallways are converted into a games room, and offered video conferencing with family members. Housekeeping staff have ramped up disinfecting high-touch surfaces such as faucets, door handles and handrails multiple times a day and placed hand sanitizers throughout the residences. The plan to be COVID-19 free seemed to be effective.
Unfortunately, these infection control measures were not enough to stop COVID-19 from entering the Village. At the end of April, an outbreak occurred at Valhaven, home to 26 older adults, where two seniors and three staff members tested positive for COVID-19. The two infected seniors lived at opposite ends of long hallways and the possibility of further spread appeared likely. A week later, one nonagenarian died. Despite all of the employees being encouraged to shelter at home as much as possible when not at work and following best infection prevention practices within the aged care community, the virus somehow found a way through security.
The clinical lead nurse moved into a nearby hotel; other nursing staff transferred their work assignments to the outbreak site and Fraser Health Authority offered support to ensure the outbreak did not spread. The culture at Tabor Village is to care for each other, to put others’ interests ahead of your own. Both older adults and staff have risen to the challenge, following the safety guidelines so others’ health and safety is paramount. The challenges that each day presents have been solved through a team approach that has made a difference to control the outbreak.
During the pandemic, older adults and their families, as well as employees, have shown an astounding ability to support each other and quickly adopt new infection control practices. Where in the past influenza vaccination rates and mask wearing for those who did not take the vaccine were not 100 per cent compliant, there is a thorough commitment to following the new normal of prevention measures — the results will save lives of employees, their families and the older adults who have entrusted them with their care.
Before anyone had heard of COVID-19, a movement had swept through the seniors living sector. It was embraced by the Tabor Village community, which committed to rebuilding the hospital-style long-term care bed stock with a new centre for living based on the household model. Rather than a long double-loaded corridor with dozens of residents, 10 to 14 older adults live in one self-contained home, each with their own private room and ensuite. The homes have their own front door, living room with fireplace, den, open kitchen, dining space and activity space with access to outside gardens. This decentralized model allows staff to be assigned to one home, improving continuity of care as they provide personal care, prepare food, do housekeeping and laundry. While the design model was first created to ensure meaningful living, individual choice and lifelong learning, the small home environment may in fact help to control infections. Staff focusing on one self-contained home are less likely to introduce a virus to other residents living in different households.
Tabor Village is nearly half way to reach an $11-million capital campaign goal to raise enough funds to contribute to the costs associated with replacing the outdated physical infrastructure. Donors began to rethink the aging journey and reimagined what a transformed nursing home experience might do for their family members. The vision grabbed hold of generous supporters who desire a different lifestyle for seniors living in care. As the global news stories have depicted the impact on seniors living in nursing homes grappling with devastating outbreaks, public sentiment is shifting to create a new narrative where seniors thrive in a vibrant living environment.
Further disease-prevention architectural features will be undoubtedly considered when the next generation of nursing homes are designed, including configuration features that are antimicrobial and negative air pressure and filtration systems that remove airborne toxins. Wearables, sensors, artificial intelligence and voice-activated technology will help reduce the need for hightouch surfaces and will improve resident to staff communication, anticipating the care needs of seniors before a person-generated request is made.
The pandemic has put a spotlight on the senior living sector. The culture change movement has embraced a new normal and the institutional design has demonstrated the challenge in controlling infections. This crisis may be a watershed moment to turn the tide on replacing outdated living environments with the reinvented small household model, a better life for older adults and their caregivers. Now is the time for such a change; to honour our mothers and fathers!
Dan Levitt is executive director of the Tabor Village elder care community in Abbotsford. He is also an adjunct professor of gerontology at Simon Fraser University, an adjunct professor of nursing at the University of B.C., and a sessional health sciences instructor at the B.C. Institute of Technology.
The small home environment may in fact help to control infections. Dan Levitt, executive director, Tabor Village