A senior Ontario architect with decades of experience designing long-term-care (LTC) homes has raised the alarm that Ontario’s stock of housing in the sector has too many old residences that do not allow for the best care possible.
Ed Applebaum, director and principal at Montgomery Sisam Architects, offered built-environment reasons why Ontario LTC homes are the source of disproportionately high numbers of COVID-19 cases and deaths in the province in a recent interview. He argued that even the best operational standards developed through future reforms will be ineffective if the residences themselves are old and of unsuitable design.
And compounding the problem is the fact that Ontario’s LTC design standards were drawn up in 1998 and have barely been tweaked since then, he said.
“I think that is a national tragedy in terms of what is happening in long-term-care homes across the country but particularly in Ontario and Quebec,” Applebaum said.
LTC homes are funded and regulated by the provincial government with three sources of suppliers — municipalities, the charitable sector and private builders. Statistics from May indicated that 82 per cent of Canada’s COVID-19 deaths were in LTC homes.
A scathing report on conditions in select homes released May 20 by the Canadian Armed Forces further put a harsh spotlight on Ontario’s LTC system.
“Many of our long-term-care homes were redeveloped in the 2000s but many more of them weren’t,” said Applebaum of Ontario’s stock. “We are looking at buildings that are 30-, 40- or 50 years old and those are the buildings those people are living in,” he said.
Many of the older buildings have three-bed and four-bed rooms.
“They are hopelessly out of date and they are completely ill-equipped to deal with COVID-19.”
Applebaum has designed LTC homes in seven provinces, with Peel Manor, designed for the Region of Peel, his latest job. He was also involved in creating new guidelines for LTC design published by the Canadian Standards Association (CSA) two years ago.
He said Ontario’s Ministry of Health design guidelines are among the worst in the country.
“I think we are not in a good place in Ontario,” Applebaum commented.
“However, the problem is really more nuanced than that. The homes that got redeveloped to the 1998 design standards back from 1998 to 2005 or 2007…the statistics show that while they haven’t been perfect, they have fared much, much better than the older homes, which were never redeveloped, and never caught up to the standards that were created all those years ago.”
Even the guidelines recently published by the CSA might now be out a little of date, Applebaum said.
“When you take into account social distancing rules and others that we are now starting to see, they are stricter than what is in the CSA standard, so that needs to be revised as well,” he said. “I think there are all sorts of guidelines and standards that need to be updated, given what we are learning about how the disease spreads.”
The financing model for new LTC builds in the province also needs updating, Applebaum said, with low provincial support contributing to the paucity of private sector projects that are seen in recent times.
But even with funding constraints, he said, the current four-storey, 262,000-square-foot
Peel Manor project in Brampton represents a “watershed” moment for Montgomery Sisam and is probably the “most progressive” design the firm has ever done. For starters, the building was designed to reflect the Butterfly Principles for care of dementia patients created by U.K.-based Dr. David Sheard. Peel Manor’s high standards are supported, Applebaum said, by an enlightened owner that embraced such features as isolation rooms, clusters of households and future-proofing — all now seen as even more valuable given the COVID-19 pandemic.
“It provides for a whole environment that is based around the notion of smaller clusters of individuals,” Applebaum explained. “There are roughly 15 residences in a neighbourhood and it creates these small pods that are not reliant on crowded, double-loadas ed corridors in order to get at your rooms. There is more room to manoeuvre. There is better ability to create social distances.”
As well, it is easier to isolate a cluster of 15 rooms than a whole floor of 60 units, he pointed out.
Isolation rooms are very rare in LTC projects Applebaum said but the owner pushed for them despite the extra cost.
“From an infection-control perspective, that is excellent. It mean if there is someone with COVID you can protect the rest of the people in the facility because it has its own isolated air system and doesn’t spread the virus.”
Construction began on Peel Manor six months ago, with completion scheduled for 2022, but the benefits of future-proofing are already evident, Applebaum pointed out. The project partners are currently discussing whether the ground floor community hub, which has a series of smaller bedrooms, could be adapted to function independently with more isolation units.
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