New Brunswick

Saint Andrews nursing home wants to rebuild in 'Green House' style

A group that runs the non-profit Passamaquoddy Lodge in Saint Andrews is looking for provincial approval to build a newer, less institutional type of nursing home.

Smaller units would be more homelike, say proponents

An image from a recent presentation to Saint Andrews town council showing the inner courtyard of a Green House-type nursing home. (Town of Saint Andrews)

A group that runs the non-profit Passamaquoddy Lodge in Saint Andrews is looking for provincial approval to build a newer, less institutional type of nursing home.

The Green House model is made up of relatively small units that are more like houses than hospital wings, according to Caroline Davies, president of the Passamaquoddy Lodge board of directors.

Passamaquoddy Lodge is 50 years old, said Davies, and doesn't have enough room for mobility aids such as walkers, wheelchairs and lifts in patient rooms. 

Proponents of a replacement facility say there's not much room to manoeuvre inside the rooms at Passamaquoddy Lodge. (Town of Saint Andrews)

The board would like to build a 60-bed replacement facility, she said, split into five houses with 12 beds each.

Davies said her group put a year into studying how Green House project nursing homes have worked out in the United States, where some have operated for the past 17 years.

The non-profit group's mission is "humanizing care through the creation of radically non-institutional eldercare environments." 

Evidence points to them providing a better quality of life, she said.

Residents have their own open-concept living room, dining room and kitchen, said Davies. 

They wake up and eat breakfast when they want. 

And everyone has their own bathroom. 

Bathroom doors have been replaced with curtains to improved access in the cramped quarters. (Town of Saint Andrews)

"The pandemic, if nothing else, has shown us that we shouldn't share accommodations," Davies said. "We shouldn't share bathrooms."

All the people in one house require the same level of care, up to and including Level 3.

There are a couple of workers dedicated to each house during the day and extra dietary staff in a main kitchen.

Residents help with cooking to the extent they are able.

The Green House concept is well-known, according to gerontologist Janice Keefe.

"People recognize smaller neighbourhoods are the way to go," said Keefe.

"One of the biggest takeaways is they are more home-like," she said.

"It's not going to replace a person's own home," said Keefe, but with smaller groupings there can be better relationships among residents and between residents and staff.

New nursing homes built in Nova Scotia have taken this approach since 2008, she said.

Keefe is chair of family studies and gerontology at Mount Saint Vincent University and director of the Nova Scotia Centre on Aging. She's also taking part in the development of national standards for nursing homes. 

During the pandemic, she said, Green House-type homes have had an easier time with infection control, and fewer restrictions have been required on visitation.

Canada has been one of the worst countries in the world in terms of the number of COVID deaths in nursing homes, said Keefe.

Many of the country's nursing homes were built in the 1960s and '70s through federal programs, and they don't meet modern-day needs, she said.

Congestion in the hallways at Passamaquoddy Lodge. (Town of Saint Andrews)

Keefe said that when she started working in 1986, nursing homes had many residents who were still relatively independent.

That has evolved over the past few decades, she said, to accommodate an increased number of people needing Level 3 care.

The average age of a nursing home resident is now in the late 80s, she said, and their needs are a lot more intense.

But a "cultural change" is happening in long-term care, she said, away from heroic interventions and increased medical treatment and toward quality of life and a homelike setting.

The Saint Andrews group would like to incorporate a centre at their new nursing home that could house services fitting into a nursing homes without walls program, said Davies, such as foot care, cooking classes and shared meals.

Suzanne Dupuis-Blanchard is a professor at the School of Nursing at l'Université de Moncton and the research chair in population aging.

They've also proposed including a daycare in their project.

There's one in town looking for a new space, said Davies, and the nursing home residents and children could both benefit from each other's company.

The town has allocated a 13-acre parcel of land at the corner of Bar Road and Champlain Subdivision. It's a four-minute walk from the Algonquin Resort, and there are services nearby. (Town of Saint Andrews)

Passamaquoddy Lodge is not looking for provincial funding for construction, said Davies, but needs the province to agree to transfer the nursing home licence and to agree to negotiate new per diems down the road — like the arrangement Shannex has.

Per diems are based on square footage, so they'll have to be higher, she said, in order to meet modern standards.

The town has allocated 12 acres for the project.

The land has been set aside for a year in hopes a deal can be worked out, said Mayor Brad Henderson, and council would likely sell it to the non-profit group for $1.

Saint Andrews Mayor Brad Henderson says council supports the project. (Submitted by Brad Henderson)

Council supports the project, he said, because housing is its top priority.

The town wants to be "age-friendly," and the old nursing home could possibly be converted to "dormitory-style" accommodations for young workers, he said.

Some charitable foundations have pledged support, said Davies. 

If the lodge gets a green light from the government, an architect is ready to start designs, she said, and they might get shovels in the ground by 2023.

Proponents of a nursing home to replace the existing Passamaquoddy Lodge in St. Andrews want to change the culture of nursing home care in town. Host Julia Wright speaks with Caroline Davies, president of the board for Passamaquoddy Lodge. They hope to build a greenhouse model of long-term care. Then to learn more about this model of care we hear from Janice Keefe a Professor and Chair of Family Studies and Gerontology at Mount Saint Vincent University and Director of the NS Centre on Aging.

Asked where things stand with the project, the Social Development Department said the government continues to look for "innovative ways" to provide services to seniors.

"We want people to have access to the services and support they need when the time comes."

Asked whether the province has received any other proposals for new nursing homes, a spokesperson for the department replied that several new nursing homes would be announced in the coming months, as part of a multi-year plan set out in 2018.

With files from Information Morning Saint John


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