Designing the future of long-term care and retirement homes

Photo: An example of IPAC design by Trudel’s student Eric Cross. Of the many IPAC features considered, the supply cart has a touchless foot-activated removeable waste bin; and seamless surfaces, removeable shelving and bins and colour-coded high-touch areas (handles and bins) to support zoning, cleaning, disinfection and sterilization if needed.

By: Dr. Amy Hsu, Bruyère Research Institute, University of Ottawa Department of Family Medicine, Ottawa Hospital Research Institute & Professor Chantal Trudel, Carleton School of Industrial Design

Habits and routines drive the majority of our actions every day. In my first week back at the hospital after the COVID-19 outbreak, I was acutely aware of every surface I touched, the locations of wall-mounted hand sanitizer dispensers around me, and the number of times I have wiped the keyboard of a shared computer in my lab. This has now become routine.

High-touch surfaces – such as doorknobs, light switches, countertops, handles, phones, keyboards, faucets, pens – have always been a focal point in infection prevention and control. Our awareness of their cleanliness is heightened in times of an outbreak, but they often fall by the wayside once the outbreak has been resolved.

If steps to minimize the spread of pathogens in our environment can become routine – better yet, become part of our built environment – chances are we would have much fewer outbreaks of infectious diseases. Let's start designing our environments to keep healthy routines at top of mind.

Infection prevention and control is particularly challenging in healthcare settings. Daily activities and care involving the circulation of people among equipment, supplies, furniture, and shared spaces create opportunities for the transmission of microorganisms between healthcare workers, patients, and visitors.

Long-term care and congregate living environments (like retirement homes) have their own unique infection prevention and control considerations. Not only are their resident populations typically frail and at greater risk of experiencing severe outcomes from an infection, there is a high proportion of shared workers who could transmit the virus from home to home (including specialty care providers). Those factors are amplified by the prevalence of common spaces in these facilities, including shared resident accommodation and bathrooms, large dining rooms, and the design of shared home-like spaces for residents to socialize and receive family and friends.

Good design can and should balance infection prevention and control needs with residents' quality of life and care needs. No resident wants to see their living space transform from the feeling of home to hospital.

We now recognise how little is known of the impact of long-term care work and environment design on infection prevention and control. Through design, we can strategically place and integrate cueing or prompts at hand hygiene stations to promote hand hygiene at the right time, design high touch surfaces to be clearly defined and noticeable to support cleaning and disinfection;  and support socializing through novel interior/exterior layouts and easy-to-use communication technologies.

To address this gap and support the redevelopment of Canada's aging long-term care infrastructure the Bruyère Research Institute, Carleton's School of Industrial Design, and an interdisciplinary team of Ottawa-based researchers, are engaging long-term care homes in a first-of-its-kind 'remote' participatory design process. Building on the data and observations from long-term care during COVID-19, the focus will now be on developing a preliminary understanding how healthcare workers are experiencing the design of their work and these homes (e.g., the design of the physical environment, equipment, supplies, and technology) as they manage through the COVID-19 pandemic.

While perspectives from healthcare workers is vital, understanding the needs and wants of residents in these spaces is just as important. The research team will be engaging residents and their families to get their perspectives on their particular homes' design for a truly rich picture. Our study will also be capturing the overall perspectives from key stakeholders, including Family Councils Ontario, the Ontario Association of Residents' Councils, and Ontario Centres for Learning, Research and Innovation in Long-Term Care for a comprehensive understanding of all facets of long-term care design.

COVID-19 has revealed countless ways for us to re-evaluate our healthcare systems. Places like Bruyère are looking to apply the best evidence and innovation in built environments to guide the future redevelopment of these spaces. If we can support infection prevention and control through routine and habit created through environmental design, there's a chance to overcome some of the heavy-hitting challenges faced during the pandemic.