Rebuilding long-term care from the ground up

By Dr. Paula Rochon, Dr. Nathan Stall and Barbara Miszkiel

This article originally appeared in the fall 2020 issue of the RTOERO Foundation newsletter.

Long-term care (LTC) homes have borne the brunt of COVID-19, putting them at the forefront of public attention and discourse. As such, we have an unprecedented opportunity to think creatively about how to provide LTC residents with the best medical and social care. One area that has not been fully considered is how the design of long-term care homes impacts the care of its residents.

So how do we change LTC homes for the better? Most LTC home residents live there because they need to and the majority are women of advanced age, often with dementia, who can no longer be cared for in their own homes. On average their life expectancy is short and for most, it will be their last place of residence. Providing a home that balances health and wellness is essential to giving these residents the quality of life they deserve.

First, homes should be designed so that residents have private rooms. Evidence shows that private rooms reduce anxiety, improve sleep and are overwhelmingly preferred. Private rooms are also one way to mitigate the spread of infectious diseases.

Second, we should work to cluster residents into smaller groupings of only 10 to 12 residents per floor – this is particularly important for those with dementia who do better in smaller social groupings.

Third, spaces must be designed to increase social interaction and stimulation, which are important factors in maintaining cognition and promoting well-being. Connecting with nature also has great value in this regard. For example, inner courtyards allow residents with dementia to wander in gardens without getting lost and create spaces where family can be welcomed.

While these examples were not created to address current challenges resulting from COVID-19, private rooms, smaller clusters of residents and access to outdoor space all lead to better infection prevention and control. In homes where these design elements are already in place, residents have had better outcomes during COVID-19.

We must apply an interdisciplinary lens that brings together geriatricians, architects, families and our provincial authorities to rebuild long-term care – creating homes where older adults not only live, but where they can thrive.

Paula Rochon is a geriatrician, vice-president of research at Women’s College Hospital and the RTOERO Chair in Geriatric Medicine at the University of Toronto. Nathan Stall is a geriatrician and research fellow at Women’s College Research Institute and the University of Toronto. Barbara Miszkiel is a director of HDR’s healthcare practice and an award-winning architect.