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Senior Living and Long-Term Care in a Post-Pandemic World: Part 2

How can the design of long-term care and retirement communities protect the elderly from viral outbreaks, without neglecting residents' need of emotion-focused care?



June 16, 2020

Throughout the COVID-19 pandemic, the physical design of long-term care and retirement communities has come under fire as a key factor in the rapid spread of the pandemic among the elderly population. In particular, three- and four-bedroom units, each with a single shared washroom, have been found to contribute to the spread of this highly infectious virus. In addition, there is often an insufficient number of hygiene stations located at points-of-care and other critical areas, which could be used to support proper hand washing protocols. In some cases, these are missing altogether. The number of air changes throughout each facility, including the intake of outdoor air, along with the lack of isolation or containment zones, may also be contributing to the spread of the disease.

By comparison, hospital design standards are highly regulated to incorporate these, and many other, best practices, including evidence-based infection prevention and control measures. As a result, most hospitals treating COVID patients have experienced fewer outbreaks. What lessons can be learned from well-regulated healthcare design that can be applied to long-term care and other congregate-care settings? 

Considerations include:

  1. Incorporating private rooms with ensuite washrooms, wherever possible
  2. Incorporating hygiene stations in all resident rooms, dining rooms, activity areas, unit entrances, and wherever food or medication are handled, to ensure hand sanitizing is made easy and accessible
  3. Incorporating showers in all ensuite washrooms for assisted bathing, thereby reducing the risk of contamination within communal bathing facilities
  4. Designing HVAC systems for more frequent air changes, including increased levels of fresh air intake
  5. Designing facilities and HVAC systems to enable isolation and containment centres in the event of a viral outbreak
  6. Providing more storage for personal protective equipment (PPE), including at point-of-care
  7. Designing smaller resident units (e.g. eight-ten beds), served by dedicated or decentralized elevators and one-way flow circulation routes, whenever possible
  8. Creating strategies for families to safely visit with residents during pandemics and outbreaks
  9. Selecting materials, finishes and furnishings that can withstand frequent cleaning and disinfecting

 In Part 1, we identified emotion-focused care (EFC) care as an emerging trend gaining traction in long-term care, particularly for those with dementia. Where implemented, EFC has had a profound impact on space, due in part to the creation of smaller, self-contained resident units that may include residential-style kitchens, dining areas, lounge spaces and activity areas to support both individual and group activities. Since dementia patients may be easily agitated, the availability of quiet, secluded spaces can help staff to calm residents while redirecting them to another activity. Importantly, participation in activities such as helping to prepare snacks is encouraged, so kitchens must be designed for safety, including barrier-free considerations.

Given the trend towards home-like, residential-scale environments to support new models of care, coupled with the necessity to consider aggressive measures to address infectious outbreaks, how can these seemingly opposing needs be successfully integrated? ‘Invisible’ measures such as HVAC design are easily addressed, but hygiene stations that must be visible to encourage frequent use may appear obtrusive and institutional. It’s clear that, during a pandemic or viral outbreak, the facilities must be resilient and perform at a very high level in order to protect the health of residents, staff and visitors. Facility design must, therefore, balance the desired aesthetics of the ‘essence of home’ with the required health and safety protocols.

Joyce has over 38 years of design and management experience leading healthcare, laboratory, and commercial projects. She is a skilled Healthcare Planner having specialized expertise in developing functional, contemporary solutions for a broad range of care environments. With a focus on the patient experience, Joyce is a passionate advocate for designs that improve safety, enhance independence, and promote dignity for a broad range of users including children, seniors and the frail elderly. Her work with a variety of cultural groups and under-served communities has been particularly insightful and rewarding.

Joyce brings a wealth of knowledge and innovation to her planning solutions based on a solid understanding of future trends in healthcare service delivery. Through her involvement with complex projects in several jurisdictions, she has successfully led user groups and other stakeholders in consensus-building activities while managing conflicting priorities and expectations.

Headshot of Joyce Loney-Brenes

Written by Joyce Loney-Brenes

Associate | Manager, Healthcare Planning
Toronto, ON
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