Report reimagines long-term care architecture from Ontario’s ‘minimum standard’

A newly released University of Toronto study says there is a direct correlation between how long-term care (LTC) homes are planned, designed and constructed and the health of residents in those homes.

Sponsored by the Ontario Association of Architects (OAA) and consulting firm Jacobs Canada, Reimagining Long-Term Care Architecture in Post-Pandemic Ontario — and Beyond calls on the provincial government to update its built environment standards and lays out a blueprint on how that can be achieved.

It identifies a number of case studies of design excellence in long-term residences around the world and suggests 50 considerations for use by design professionals, health care providers and government agencies.

Written by Stephen Verderber of U of T’s John H. Daniels Faculty of Architecture, Landscape and Design, with the help of his post graduate students, it underlines the urgency for re-examining Ontario’s approach to refurbishing existing homes and building new ones.

 A “triad of challenges” confront the current long-term care home system in Ontario. Those challenges include obsolete minimum design standards, flawed procurement funding mechanisms and unacceptably limited choice for consumers, the report says.

The for-profit sector has little incentive to build anything above and beyond the “minimum standard” because it has been disincentivized to do so, says the report, noting more than 38,000 individuals are currently on waiting lists in Ontario and are eager to get in anywhere as close to home as possible.

It also emphasizes that “too many LTC homes in Ontario are architecturally obsolete and that updated operational standards will be ineffective if the residences are functionally obsolescent and of unsuitable design quality.”

Despite recent government long-term funding announcements, steps need to be taken to update standards for residents in those newly built LTC homes, it warns.

“This research could not have come at a better time,” says OAA president Susan Speigel.

“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 intent of the study is “not to lay blame” on the crisis in LTC homes, but to “provide positive solutions,” says Jacobs Canada’s vice-president of government relations Ansar Ahmed.

“Any public investment is a good thing. But the number of beds (announced) shouldn’t alone be a measure of success.”

In January 2021 Jacobs organized a virtual roundtable titled Reimaging Elder Care in a Post-COVID Ontario, which eventually turned out to be the genesis for the University of Toronto study.

Sparked by the provincial government’s $1.75 billion commitment over five years to strengthen and modernize LTC in Ontario — driven in large part by the need to respond to the COVID-19 pandemic —the morning-long session attracted a number of multi-discipline participants and was intended to provide ideas on the best investment of that funding, he says.

A key driver in developing the roundtable’s format and content was Dr. Diana Anderson, a geriatrician and architect with Jacobs, who specializes in medical planning of inpatient units.

Emerging out of the forum were several recommendations including one advocating for a central long-term care home secretariat. Currently, responsibility for the planning, design and construction of LTC homes actually comes under the purview of the ministries of LTC and municipal affairs and housing, plus Infrastructure Ontario, he points out.

Subsequent to the roundtable, Ahmed and Anderson were invited to make presentations to the provincial government’s Long-Term Care Commission looking into why and how COVID-19 spread in LTC homes.

Jacobs and the OAA also held discussions on the need for an in-depth study on how the built environment impacts therapeutic and clinical approaches to elderly patients, especially those who are physically impaired.

Ultimately, it was decided the best person to lead that study was Verderber.

Director of the Daniels Faculty’s Centre for Design + Health Innovation and a registered architect, Verderber received no compensation and costs were kept down by using the services of his post-graduate students.

Work on the study, which involved analyzing the design excellence case studies and reviewing subject literature, began in the spring of 2021.

In their role as co-sponsors, Jacobs and the OAA provided some compensation for the study team’s out-of-pocket expenses, says Ahmed.

“The vulnerabilities within Ontario’s LTC homes that led to the rapid spread of COVID-19 developed over several decades and no single government or political party has sole-ownership of this failure,” says 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.”

In noting that the built environment must be considered as important a parameter of care as any other medical intervention, Anderson has called on the provincial government, “to move beyond bricks-and-mortar solutions to considering data-driven design ideas, such as those identified in the U of T study, to inform health-based solutions.”