October 28, 2016
by Joanne Lam
Located in a suburb of Toronto, the Carefirst One-Stop Centre combines medical care and community services in a single location, offering a broad base of support for seniors who opt to continue living at home rather than in a dedicated care facility. Photo by Shai Gil
“No place like home!” In my grandmother’s early days of Alzheimer’s, this was my family’s battle cry as we struggled to care for her. We desperately wanted to keep her at home, but with little support, it was daunting and stressful.
The nonprofit organization Carefirst is guided by the exact same ethos. They have created a slew of services to encourage aging-in-place, recognizing the needs of seniors as well as their families. We would have been the perfect clients.
Carefirst’s humble beginnings were as a meal delivery service for seniors in Toronto’s Chinatown. Over the years, it gradually grew and adapted to the changing needs of its community, shedding its ethnic and geographical references in the process. With CEO Helen Leung at the helm for the last two decades, the organization has refined a healthcare model that combines home-based and centre-based services, putting it at the forefront of Ontario’s healthcare revolution.
Inspired by traditional Chinese houses, the building pivots around a central courtyard. Photo by Shai Gil
The approach is embodied in the Carefirst One-Stop Centre for Seniors and Community, a new facility designed by Montgomery Sisam Architects and located in the eastern suburb of Scarborough. A dream hatched by Leung (who is now supported by some 500 staff members), One-Stop’s innovation lies in providing medical care and community services under a single roof. On the face of it, the idea seems straight-forward. However, due to the provincial government’s fragmented funding model, the centre is an Ontario first in combining these resources.
Day program spaces enjoy views to the courtyard. Photo by Shai Gil
Located near the busy intersection of Kennedy and McNichol, One-Stop is tucked behind a nondescript banquet hall and surrounded by industrial buildings. Though accessible by two public transit bus lines, the immediate geography is a challenge—the site is bound by a hydro corridor on one side and a trans-Canada gas line on another, and situated at the end of a dead-end street. How do you draw people, the majority of whom are seniors, to a facility that feels out of the way, even by suburban standards? More importantly, how do you create a sense of place in the middle of nowhere?
Glazed interior walls bring daylight into a computer room, adjacent a corridor that doubles as a walking circuit. Photo by Shai Gil
Montgomery Sisam’s partner in charge of the project, Alice Liang, FRAIC, looked to the past and to the future for solutions. Though Carefirst serves people of all backgrounds, the majority of its clientele is Chinese. Liang drew on the typology of traditional Chinese courtyard houses, merging it with a contemporary Canadian suburban vernacular. The idea of the courtyard house as a model of integration captured the attention of Carefirst’s board, and won Montgomery Sisam the project. Liang also explored the future continuation of the dead-end road and took that as the de facto scenario—which, at present, makes for some curious siting conditions. However, it is possible to picture One-Stop’s front door becoming much more central and the retail component gaining prominence once the street becomes a throughfare.
The four-storey brick building is deceptively simple from afar—a series of elongated blocks with an exit stair tower adding verticality. The L-shaped plan is determined by the site’s setbacks and easements. A glass-enclosed stair projects from the building and acts as a giant lantern at night. Interior functions dictate the size and the stacking order of the volumes. It seems almost formulaic in composition.
The landscaped courtyard offers a space to connect with nature, and adds to the building’s open and welcoming character. In a post-occupancysurvey, 97 per cent of staff agreed that the building promoted a positive atmosphere for seniors that made it easier to inter act with them. Photo by Shai Gil
However, the mastery of the complex programming and the deft handling that makes sense of it all—even to first-time visitors—shines through as soon as the front door opens. Actually, there are two front doors—one fronting onto that current dead-end street, the other facing the parking lot. Both are visually connected to the exterior courtyard, so visitors are oriented from the moment they step in. The built-up volumes cleverly shelter the courtyard, allowing it to shine as the heart of the centre. The building is kept narrow to allow maximum exposure to natural light. This simple move has proved to be transformative, creating interiors that are refreshingly bright, in contrast to the dark, maze-like floorplates typical of institutional care buildings.
A transitional care unit on the third floor includes rooms where seniors can stay while moving between hospital and home, or spend a few days to give temporary relief to their at-home caregiver. Photo by Shai Gil
One-Stop organizes its base programming—wellness, daycare and transitional care—by floor. The wellness program, located on the very visible and public ground level, has a large menu of classes, much like any community centre. The offerings are geared towards able and independent seniors. On one end, this floor is anchored by an auditorium, and on the other, by a group of program rooms surrounded by a walking track. Because natural light streams in from every angle and there is always a view to the outside, the entire floor feels airy and accessible. In fact, the exterior courtyard and the walking track are well used by both the seniors as well as the staff.
On the second floor, a single waiting area allows for easy access to a range of healthcare services, including family physicians, physio-therapy, and specialized clinics for cardiology, endocrinology, nephrology, eye examination and allergies. Photo by Shai Gil
The second storey houses the medical centre and the daycare. The medical centre serves all seniors, while the daycare is designed for less able seniors, who require extra care. As soon as the elevator doors open, a spacious waiting area and set of reception counters come into view. There is no mistaking that this is where healthcare services are offered. Tucked behind the reception are examination rooms, offices and meeting rooms. The daycare occupies the balance of the floor, with secure access. Activities and meals take place in a large multipurpose room.
The third floor offers single and shared rooms for overnight stays and is fully staffed by nurses. Photo by Shai Gil
On the third floor is transitional care, a facility staffed around-the-clock by nurses, where seniors can stay for up to three months. It offers a bridge for seniors returning from hospital to home. This allows expensive hospital beds to be freed for others, and creates time for family to make necessary care arrangements at home. The program aligns well with the government’s need to control the ballooning healthcare budgets of our aging population. As the patient recovers, plans can be made for her to join the daycare and participate in other programs. Beds are also available for short stays to give relief to caregivers—a vital function for preventing burnout.
With all services in a single building, both medical and social needs are only an elevator ride away. Not only does this arrangement save time that might otherwise be spent shuttling between appointments, it also significantly reduces stress for seniors, as well as for family and caregivers. Like many healthcare institutions, One-Stop was bursting at the seams the day that Carefirst took occupancy. Expansion may be in the cards for this location. The ultimate dream, though, is to replicate the model across the country, and to serve people of all ages. To that end, both Leung and Liang are championing this paradigm of care in their own ways—one in providing integrated healthcare, and the other in housing it.
The ground-level canteen adjoins the courtyard garden. Photo by Shai Gil
My grandmother eventually went to YeeHong nursing home—a dedicated facility that stands at the opposite end of the seniors’ healthcare spectrum. While we could not wish for a better place of support with her advanced state of Alzheimer’s, I wish she had the chance to enjoy her last lucid days with Carefirst.
Joanne Lam is a Toronto-based architect and writer.
CLIENT CAREFIRST SENIORS & COMMUNITY SERVICES ASSOCIATION |ARCHITECT TEAM ALICE LIANG, BRAD COLLARD, WILLIAM HARISPURU |STRUCTURAL JABLONSKY AST & PARTNERS |MECHANICAL/ELECTRICALSHARMA & PARTNERS |CIVIL R.J. BURNSIDE & ASSOCIATES |LANDSCAPE JAMES MCWILLIAM LANDSCAPE ARCHITECT |INTERIORS MONTGOMERY SISAM ARCHITECTS |CONTRACTOR BROOKFIELD MULTIPLEX CONSTRUCTION CANADA |AREA 4,925 M2|BUDGET $12.7 M |COMPLETION JULY 2015