We Weren’t Prepared – Rethinking the Design of Long-Term Care Homes for Infectious Outbreaks

Canada’s Long-Term Care (LTC) sector was severely burdened by the coronavirus disease (COVID-19) pandemic, accounting for 81% of COVID-19 deaths nationwide as of June 2020, and 43% of deaths at the end of 2021 despite widespread vaccination. Ontario’s Science Table on COVID-19 identified 5 priorities moving forward which included improving staffing, essential caregiver access, timely/ high-quality palliative care, building/ maintaining infection prevention and control (IPC) expertise in homes, and rethinking the design of LTC homes. Given the frequent contact among residents, staff, and caregivers/ family members in homes, supporting IPC through design is an important strategy to ensure the quality of life (QoL) and care of residents, and the occupational health and safety (OHS) of healthcare workers. To support the ‘design priority’ from Ontario’s Science Table, we studied how the design of 8 LTC homes in Ontario influenced IPC, QoL, and OHS during the pandemic through photo diaries and interviews/ focus groups (N=38). We then developed alternative home concepts through co-design sessions with participants. We found deficiencies in the design of entrances/ exits, resident rooms, shared resident areas, outdoor areas, staff work areas, storage/ supply areas, soiled/ clean areas, design to support the donning/ doffing of personal protective equipment, among other issues. From this we developed design recommendations and concepts that may help inform how we can better respond to infectious outbreaks while balancing the QoL of residents, staff members, and caregivers/ family members.