New Report Reimagines a Better Built-Environment for Long-Term Care

The University of Toronto (UofT) Centre for Design + Health Innovation has released a new, comprehensive study, “Reimagining Long-Term Care Architecture in Post-Pandemic Ontario—and Beyond.” The report, supported by the Ontario Association of Architects (OAA) and consulting firm Jacobs Canada, explores how the built environment can better support long-term care (LTC) communities.

The COVID-19 pandemic had disproportionate impacts within Ontario’s LTC sector, exposing many structural vulnerabilities within these congregate facilities. Unless steps are taken to update standards and modernize design guidelines to better align to current and emerging clinical approaches, such vulnerabilities will remain largely unresolved—even in newly built LTC homes.

The study’s author, Dr. Stephen Verderber of UofT’s John H. Daniels Faculty of Architecture, Landscape, and Design, emphasizes the urgency for re-examining Ontario’s approach to refurbishing existing homes and building new ones.

“We applaud the Government’s commitment to adding desperately needed capacity into the LTC sector, however, success cannot be measured solely by the number of additional beds being provided,” he says.

The scale of financial commitment announced by the provincial government has the potential to bring about the paradigm shift in the quality of care for which residents and their families have long advocated. However, this rush to build new facilities will be a missed opportunity if the government neglects to first update standards and design guidelines to support enhanced infection control. Best practices must align with modern clinical approaches to dealing with LTC residents, particularly those living with physical or cognitive impairments.

In the case of residents with cognitive impairments, traditional approaches have used the built environment as a means of keeping residents’ movements carefully controlled. However, the effort to solve one critical problem (resident safety) has unintentionally created new issues—increased isolation and reduced mobility.

“The built environment must be considered as important a parameter of care as any other medical intervention,” says Dr. Diana Anderson, an Architect and Geriatrician with Jacobs Canada. “I hope the Government of Ontario takes this opportunity to move beyond bricks-and-mortar solutions to considering data-driven design ideas, such as those identified in the UofT study, to inform health-based solutions.”

The report identifies a number of exemplary case studies that model design excellence in long-term care residences. It also suggests 50 design considerations for use by design professionals, healthcare providers, governments, and other decision-makers working in this sector.

“This research could not have come at a better time,” says Susan Speigel, president of the OAA, which regulates the province’s architecture profession to protect the public interest. “We’ve known for a long time there were issues of concern within Ontario’s LTC sector, but this is one of the first times we’ve been able to take such a comprehensive look at the situation and begin identifying practical, evidence-based solutions and next steps that the architecture profession can bring into its practices.”

“The vulnerabilities within Ontario’s LTC homes that led to the rapid spread of COVID-19 developed over several decades; no single government or political party has sole-ownership of this failure,” says Dr. Verderber. “However, the current government does have the financial tools, and the support of LTC residents, caregivers, their families, and Ontarians, to finally take decisive action to begin fixing this urgent problem.”

The full report can be read at the University of Toronto Daniels website.

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