Addressing the need for meaningful change in long-term care

By Alex Mihailidis

As the pandemic continues to evolve and become a regular part of our lives, there are searing memories that should never be erased and one powerful lesson we all must commit to learning from the experience of the last two years. Never again should people in long-term care suffer and die as they have during COVID-19.

One of the most important learnings of the pandemic was that many long-term care operators in Canada were woefully unprepared. They were simply not ready with appropriate personal protective equipment for staff, and they did not know how to safely and humanely isolate residents during an outbreak.

We saw the heartbreaking result – either firsthand, or on our television screens. We were shocked. We grieved. Now, we must do better and the only way forward is to further improve the quality of life of people living in long-term care—including safety, but in balance with other physical, social, mental, emotional, and spiritual considerations.

Establishing how to do that has been the work undertaken over the last several months by CSA Group’s Standard Development Organization, which is a not-for-profit leader in standards research, development, education, and advocacy.

A draft Standard, Operation and infection prevention and control of long-term care homes (CSA Z8004) is now available for public review. It is a roadmap for meaningful change in long-term care (LTC) homes, which balances safety and residents’ right to live with dignity and risk.

The Standard is the product of several months of work by a technical subcommittee I chair on behalf of CSA Group.  The subcommittee consulted widely and listened carefully to everyone from residents and caregivers, through front-line staff, engineers, architects, LTC operators and academics.

The Standard is broad and comprehensive, touching on not only the physical buildings, infection prevention and control and operations but on the well-being of the people within. It is a complement to the new proposed standard for LTC services, being developed by the Health Standards Organization (HSO), which was posted for public review last month.

CSA Group’s draft Standard gives new and practical guidance on how to properly set up quarantine rooms – ones that more effectively prevent the spread of infection, while also mitigating the real human impact of isolation. We can also make better use of technologies to help keep residents in touch with loved ones and to ease the burdens for overworked staff.

Throughout the process, the subcommittee has kept a singular focus on the residents, as well as a recognition that these facilities are their homes, often their final homes. In designing buildings that house LTC we must always remember this human factor. They must be welcoming, not institutional.  They must facilitate and support positive interactions among residents, caregivers and loved ones. Too often, existing homes do not.

Frankly, there is a tension between safety and quality of life. The fabrics and surfaces in a resident’s room should support cleaning and disinfection standards, but we also want them to be comfortable and welcoming. I believe we have found a reasonable balance.

Too often, the mental health aspect of LTC has been neglected. People want to live in places where they can feel happy, safe, appreciated and respected.  This Standard takes into account our nation’s vast geography and the broad array of different life experiences. For instance, technical requirements for kitchen and dining areas also incorporate an equity, diversity, and inclusion perspective.

We were shocked to hear in our consultations that many 2SLGBTQI+ residents did not feel safe, let alone respected when they entered LTC. This is a troubling reality that operators need to address.

When we spoke to Indigenous people, we learned there was little consideration for their cultural practices, such as the high value placed on collective meal preparation and sharing food with family and friends.

There are certain practicalities—not every LTC facility can undergo a massive retrofit, so the Standard offers suggestions for meaningful improvements that are attainable.  If single resident rooms cannot be accommodated, for instance, measures can be taken to help ensure resident privacy and safety such as accommodating no more than two residents per multi-resident bedroom. Infection control is much easier if each resident had their own room. That may not be realistic, so the Standard offers alternatives that can greatly improve current practices.

The Standard just posted is not the final word. Whether you are a caregiver, a resident, a front-line professional or an operator of a home, the subcommittee wants to hear what you have to say about it.  We will be reviewing all responses in the months to come and they will inform the final shape of the standard.

Even then, the work is not complete. To bring real change, this must be a bottom-up process.

I encourage all Canadians to keep up the pressure on both care home operators and political decision makers to act. We know what needs to be done, so let’s do it.

Alex Mihailidis chairs a technical subcommittee on behalf of CSA Group to develop a new standard for the buildings that house long-term care homes. He is also the CEO and Scientific Director of AGE-WELL, and Associate Vice-President – International Partnerships & Professor, University of Toronto