Reimagining Canada’s long-term care facilities

Canada’s older adult population increased by nearly one million people over the last five years and is projected to grow exponentially more in the coming decades. This will leave support systems, and especially the long-term care sector, scrambling to keep up. Long-term care (LTC) facilities have faced extensive scrutiny following the pandemic, opening Canadians’ eyes to the importance of these spaces and the need to combat concerns including social isolation, physical accessibility and more. 

What can be done to make LTC facilities better suited to present and future needs? The following are some key considerations that designers should keep in mind when retrofitting existing spaces and creating new ones for aging Canadians.   

Age-appropriate biophilic elements 

Green space is often an after-thought in the development of LTC facilities, especially in urban contexts where designers feel pressure to maximize building heights and footprints, but the benefits of such spaces are immense. Even the ability to view a natural landscape from a roof terrace or smell fresh flowers in a communal garden can be therapeutic for residents. In a post-pandemic world, however, age-appropriate spaces must provide protection from the elements using canopied patios and cantilevers, while simultaneously ensuring proper social distancing. Consider spreading out seating and table areas to allow residents to meaningfully engage in social activity, as opposed to activity and programming space for games involving balls that could cause injuries to residents. 

Also consider exploring walkable zones. Walking is a preferred activity among the active elderly; it is a prime source of exercise, provides opportunities to socialize, and can be a psychological diversion—a positive distraction from daily routines. Model these spaces after preferred age-appropriate places for walking, such as parks, forests, neighborhoods with sidewalks, traditional town centres (such as Collingwood, Ontario) and suburban shopping malls in larger cities like Toronto. 

Horticultural therapy  

Landscaped gardens provide more benefits than simply beautification. They can include multipurpose elements that allow for stimulating programming for residents as well.  

Consider creating vegetable gardens to draw people together as a seasonal (or year-round, in greenhouses) activity. It can be part of an organized program, daily or less frequently, depending on the resident population. The act of gardening provides opportunity for purpose and teamwork, allowing residents and others to work together towards common goals.   

Create spaces both for mobile and immobile residents using raised platform beds for flower and vegetable gardening. Universally-designed raised platform gardens provide all residents with equal physical access and the ability to water plants from a stationary position. Remember to allocate storage space for equipment nearby, along with seating for periodic resting and interacting with others. 

Encourage building operators to get families and visitors involved with horticultural therapy as well. Intergenerational activities are few and far between in most eldercare facilities as it is, so it follows that friends and family should feel they are stakeholders. 

Family support spaces  

Residents should also feel comfortable spending lots of time with family and visitors in informal intermediary settings. Avoid creating excessive programming spaces – residents need room to interact with family and staff outside of their bedroom zones, in the semi-publicness of the dayroom, the main dining room and other places.

These support spacesshould straddle the line between the semi-private and semi-public realms. Alcoves, window seats, terraces, balconies, patios, and informal break-out rooms can provide a welcoming environment that promotes both social interactions and reflective moments. Provide a kitchenette for family-visitor use, a We-Work-type workspace shared by residents’ family/visitors, and a dedicated washroom.  

Consider long-term visitors as well, especially in remote communities. In Australia, for instance, family sleepover rooms are provided for the families of Indigenous residents who travel great distances to visit loved ones. This strategy is equally applicable in Canada’s Far North.  Controlled wandering  

Aside from memory loss, wandering is perhaps the most well-known behavior exhibited by persons with Alzheimer’s and other types of dementia, which can be distressing and dangerous. LTC design should encourage and support mobility and freedom of movement in a safe, semi-independent physical setting. Wandering gardens and paths, for instance, are popular and prominent features of the most well-known LTC residences internationally. 

LTC homes with a memory care unit or Special Care Unit (SCU) for residents with cognitive disorders should feature at least one controlled wandering space—one indoors and one outdoors. Create a secure, gated architectural and exterior environment with locked doors. Provide a multi-faceted security system including visual monitoring and unobtrusive warning sounds to alert staff of unwanted movements. Ensure areas are well-lit and avoid steps with abrupt level changes. 

Consider programmable space for both indoor and outdoor activities to enrich and occupy the individual’s time, that include physical exercise and freedom to self-choose the degree of immersion in nature and landscape.  Multi-sensory stimulation  

There is growing empirical support for the inclusion of multi-sensory rooms for non-pharmaceutical behavioral treatment for dementia. This treatment modality revolves around music, massage and aromatherapy. Doll-, animal- and toy-assisted therapy can also help reduce agitation levels depending on the individual resident’s stage of dementia.  

Locate these rooms centrally but not at the heart of the most public area. Avoid potentially distracting external noise sources, such as adjacent busy corridors and active spaces, i.e. kitchen/dining areas. Pair a non-descript exterior with a blank canvas interior that can become highly activated with flowing, vibrating, contrasting colors and imagery, as well as sounds and sensations.  

While these recommendations would greatly improve LTC homes in Canada, there is so much more to do. Read more about LTC design considerations here 

Stephen Verderber is a professor with the John H. Daniels Faculty of Architecture, Landscape, and Design, University of Toronto