What the design of long-term care homes can and can't do
Modern layouts can prevent infections and make residents feel at home, but that's just part of it
The design of long-term care homes has come under scrutiny during the COVID-19 pandemic after shared rooms and an old blueprint helped spread the virus in Northwood Halifax.
But those who work in the field say it's only one of many factors involved in protecting residents.
It's also likely the province is stuck with the old buildings it has.
"When it comes to renovating one of those older facilities to make them match what is in the newer standards it can be very, very difficult," says Benjie Nycum, the CEO of Nycum and Associates.
Nycum's design firm has been working on long-term care buildings for more than 40 years. It helped to develop and test the design standards currently used in Nova Scotia long-term care homes.
Those standards got a huge revamp in 2007, and an update last year. The 2007 changes saw the end of long hotel-style hallways and shared rooms.
They put each resident in a single room with their own washroom and grouped resident rooms in a "household" around a central dining room or living room area.
Now, each group of rooms can have between 12 and 24 residents, and staff don't need to go through one household in order to get to the others.
Staff at one nursing home in Enfield believe the design of the building played a part in containing the virus.
The Magnolia was one of the first nursing homes in the province to have a positive case, beginning with a staff person on March 29.
On April 15, a second "pocket" developed when one staff person acquired COVID-19 through community spread. The outbreak was declared over on May 15.
Magnolia's outbreak never got bigger than three staff members and two residents.
The facility was built in 2011, and every one of its 70 rooms is a single with a private washroom.
The rooms are grouped in households — the home calls them cottages — with specific staff for each cottage, says communications co-ordinator Tracey Tulloch.
"I think it definitely helped limit infection exposure and it also just makes it a more homey feel, which was the intent of the design," she said.
Tulloch said the home decided to have all staff wear masks after the first infection on March 29, even though the Department of Health didn't mandate it until two weeks later.
When the masks ran critically low, Magnolia had to be resupplied by the province. Tulloch believes that also helped prevent the virus from getting a firmer hold.
The province announced the construction or conversion of 162 new long-term care beds last year. Most of those are in Cape Breton.
It's announced a further 23 for Halifax this year. None of those facilities are ready yet.
Nycum said renovating older facilities to modern standards is possible, but it means reducing the density of shared rooms.
"Usually it makes sense to just start new," he said. "The other problem is we really can't do construction in an environment where there are frail elderly. There's dust and noise and all kinds of other contaminants."
Nycum estimates the cost of bringing an older facility up to current standards would be the same or more as a new building.
He said there are also issues to fix that go beyond design, such as front-line worker pay, shifts, career progression and benefits.
"These are all considerations that are probably big factors to consider as much as the environment of a nursing home," he said.
A special case for Northwood
The Northwood Halifax campus led many to question nursing home design during the pandemic.
Out of hundreds of nursing homes in Canada where deaths have occurred, Northwood has one of the highest bed counts at 485.
It also has many shared rooms. The facility has been trying for three years to separate the residents in its Centre Building and give them all single rooms.
At a post-cabinet meeting June 4, Premier Stephen McNeil told reporters he's not certain the plan to build three additional floors on top of the facility was the right one, because large facilities have issues preventing the virus from getting in.
"I would say to you it impacted single rooms as well," he said. "Our real issue here is what is the appropriate size of the facility, the number of staff moving in and out."
Nycum's firm has done many renovations at Northwood, although it was not involved in the proposal for three extra floors.
He believes it may be possible to add floors without disturbing or moving out existing residents. He also thinks a renovation might be the right move in this case.
"I think a really big factor for Northwood is you're in an urban setting where property is at a very high value. And it would be very hard to find a new property to start fresh," he said, cautioning that he hasn't seen the specifics of the proposal.
"The economics may make sense."
With files from Dave Irish