RAIC issues statement on long-term care and inadequate standards and codes

The RAIC recently issued a statement on long-term care and inadequate standards and codes.“The ongoing COVID-19 pandemic has revealed profound weaknesses in the way Canadians are accommodated as they age and require more support. It has become evident that the very design of the buildings in which they reside greatly affects the health and safety of residents and staff members,” reads the statement, adding that crowding of multiple residents can spread infections.

The statement noted that as of of July 2022, the National Institute on Aging (NIA) recorded COVID-19 outbreaks across 3,820, or 63 per cent of Canada’s long-term care (LTC) and retirement homes and identified 107,461 resident and 58,715 staff cases. Additionally, they recorded 17,177 resident and 32 staff deaths which account for 43 per cent of Canada’s overall deaths.

During the first wave, 81 per cent of COVID-19 deaths occurred in LTC and other congregate settings.  This was almost twice the international average of 38 per cent in member nations of the Organisation for Economic Co-operation and Development (OECD).

NIA researchers also identified that there were 74 times more deaths of elderly Canadians living in LTC and retirement homes than among their community-dwelling counterparts — three times greater than the OECD average

“The basic physical design of LTC homes is a significant contributing factor in the spread of COVID-19 and other infections. Shared bedrooms and bathrooms in LTC homes are clearly associated with larger and deadlier COVID-19 outbreaks.  A study of Ontario LTC Homes in 2021 used simulations to determine that converting all multiple-resident rooms to single-resident rooms would have prevented 1641 infections (31.4 per cent) and 437 deaths (30.1 per cent),” reads the statement.

The statement noted that two recently released key standards and the National Building Code of Canada (NBCC) fail to address the need, on the basis of fundamental health and safety, to eliminate shared bedrooms and bathrooms in Canada’s LTC homes.

The Health Standards Organization (HSO) has recently released a revised standard on Long-Term Care Services that focuses on care and the Canadian Standards Association (CSA) has released a complementary standard that focuses on infection prevention and control.

“The HSO standard fails to recognize that the design of LTC buildings significantly affects the delivery of care and that crowding of residents compromises their health.  The CSA standard does consider the building design, suggesting, but not mandating that all resident rooms be single occupancy.  It also suggests, but again, does not mandate, that each resident bedroom has its own bathroom,” reads the statement.

The statement also noted that the National Building Code of Canada (NBCC) is a model building code that is updated on a five-year cycle. It establishes technical requirements for the design and construction of new buildings and the alteration and change of use of existing buildings.

As a result, the RAIC believes that shared bedrooms and bathrooms must be prohibited in all new facilities and that over time must be eliminated in existing facilities. Beyond health and safety improvements, private rooms and bathrooms greatly improve the overall quality of life of residents.

The RAIC not only calls for revision of the HSO standard to address crowding, but also that the CSA standard mandate single occupancy bedrooms and bathrooms. Furthermore, once updated, both standards should be adopted by Provincial and Territorial governments as compulsory standards governing the design and operation of LTC homes.

“Architects have a responsibility to advocate for Canadians and to create spaces that meet their needs and advance the public interest. Architects advocate for a new vision: places to live and to call home, and where there is support to live one’s life to the fullest possible – to one’s last breath,” reads the statement.

Kipling Acres Long Term Care, an example of an innovative, superior model of long term care, is designed around separate ‘neighbourhoods’ of single-occupancy resident rooms, allowing for residents to form tighter-knit communities, and for improved infection control measures. The project was completed by Montgomery Sisam in 2015.

“Canadian architects know that sensitive design offers a range of greatly improved accommodation options that promote well-being. The RAIC’s position is that alternative approaches to the accommodation of aging Canadians needing support are essential, and are a human rights and social justice issue, and we are committed to collaborating with governments, regulators, owners, and operators of facilities, as well as aging Canadians and their families to develop dramatically improved supportive places to live.”

There are many instances in which architects’ designs have supported innovative and superior accommodation models, the RAIC concludes.