B.C. group looks to build smaller, homelike long-term care units

Rows of rooms line a long, narrow hallway where a tall aluminum cart stacked with food trays is parked as staff at the front desk register visitors and offer surgical masks. At the other end, a large TV from the 1980s is being removed from the building, which could itself be replaced if a rezoning plan is approved.

The nearly 60-year-old Inglewood Care Centre, home to 230 residents, would be bulldozed, along with its hospital-like setting, as part of a "household of 12" model of private rooms based on lessons learned from the COVID-19 pandemic.

Chris Russell, administrator of the home, said between 43 and 51 people live on each floor of the centre. But a rezoning application expected to go before the District of West Vancouver in April calls for a pair of buildings to accommodate two units, or households, of a dozen residents per floor.

"The big thing is you won't have that large group dynamic," he said, passing a dining room, the type that would no longer exist as a mass gathering place in the new home where members of the same household would eat meals together.

Baptist Housing, a non-profit provider of seniors housing with 21 homes around B.C., bought Inglewood in February 2020 with an aim to redevelop it in line with trends toward fewer residents per unit.

However, the pandemic forced the organization to reduce the number of people in each household from 23 to 12 in order to slash the incidence of COVID-19 or other infectious illnesses like seasonal influenza in keeping with guidelines set by health authorities in B.C.

The Health Ministry said design guidelines call for 12 to 18 people per unit, with a washroom in each person's living space. Operators of owned and contracted homes may accommodate two people in a room for fewer than five per cent of residents if there's a plan to transfer them to separate rooms on request.

Inglewood largely escaped the ravages of the pandemic and had no deaths.

Over 15,000 people have died during the pandemic in care homes across the country, the highest proportion among all 38 member countries of the Organization for Economic Co-operation and Development.

Marc Kinna, CEO of Baptist Housing, said Inglewood's expansion would include some independent and supportive housing options for seniors, along with affordable accommodation for staff, the vast majority of whom commute from outside the West Vancouver area.

The new buildings would incorporate aspects of the so-called Green House model in the United States, where a homelike environment for a lower number of residents does away with large, institutional-type facilities.

"The value of a household of 12 isn't new. What's new is that places that employed a household of 12 model had much less spread of COVID-19 than places that had communities of 20, 30, 40 residents sharing a space," Kinna said.

"Not only did it have socialization benefits and the quality-of-life benefits to go through a pandemic, you also realized that it has extreme value in terms of saving people's lives and providing for better protection against COVID or other diseases that might be yet to come."

As part of the proposal, families could safely access Inglewood during an outbreak by taking an elevator to a loved one's floor, where a visitation room with a Plexiglas wall would help reduce the risk of infection.

A separate entrance and exit for staff and a room for putting on and removing personal protective equipment is also part of the 12-person model, which Kinna said won't be any more expensive for residents, who pay about 80 per cent of their annual income for long-term care.

Baptist Housing would negotiate a new agreement with Vancouver Coastal Health to help pay for the increased cost of the new building. The budget for the entire project is estimated at $583 million, with an expected contribution of about $15.5 million from BC Housing and $13 million from the Canada Mortgage and Housing Corp.

Pat Armstrong, a distinguished professor emeritus of sociology at York University in Toronto, joined international teams to tour long-term homes in Norway, Sweden, Germany, the United Kingdom and Canada between 2016 and 2018. Their one-week visits to at least two homes in each country were part of a 10-year study that was completed in 2020.

"The Swedish and Norwegian people were especially shocked to see our big units," Armstrong said of researchers from countries where eight to 12 seniors typically live in a long-term care unit, compared with B.C. and Ontario, for example, where up to 32 people are housed together in most homes.

There are no Green House models in Canada, but some aspects have been implemented in parts of the country, including at one known as Eden Home in Halifax and another dubbed the Butterfly Home in Ontario's Peel Region, she said.

Consistency in staffing is a major benefit for both staff and residents in the smaller homes where employees are offered full-time jobs while many of their counterparts elsewhere have part-time hours and work at multiple locations.

Dr. Samir Sinha, director of geriatrics at Sinai Health System and the University Health Network in Toronto, said that besides appropriate staffing, smaller living quarters need adequate government funding, beyond the traditional formula for the current, higher number of residents per unit.

The pandemic has shown that the Green House approach led to a significantly lower risk of COVID-19 transmission, that staff felt better supported and family involvement was valued, he said.

"They tend to deliver superior care, pandemic or no pandemic," said Sinha, who is also director of health policy research at the National Institute on Ageing at Ryerson University in Toronto.

He said that with baby boomers turning 85 within a decade, Canada will face an unprecedented demand for long-term care, so the work to reshape the system can't wait.

Prime Minister Justin Trudeau has promised to establish national long-term care standards and Armstrong, who is on a committee to develop them, said public consultations were expected to begin early next year.

"All provinces, territories and the federal government must work together and say, 'Enough is enough, that this was so deeply horrific that we can never let this happen again,'" Sinha said of the number of COVID-19 deaths in long-term care homes.

"While some incremental things have happened, I really am hoping that ultimately, given the fact that out of respect to the 15,000-plus Canadians who died, we will try to honour their legacy by getting it right for those who are left behind and for those who one day might actually need to be living in a long-term care home."

This report by The Canadian Press was first published Dec. 31, 2021.