by Ed Applebaum, Director and Principal, Montgomery Sisam Architects
The undue share of deaths in long-term care homes across this country from COVID-19 have exposed several systemic issues that negatively affect the vulnerable (largely elderly), people who reside in these facilities.
While improvements in this sector are conceivably on the horizon, the Regional Municipality of Peel is well ahead of the curve. The Peel Manor Redevelopment has always been an ambitious project, striving to exceed provincial standards and advance the state of residential long-term care in Ontario. Considering the current pandemic, it is especially timely in its response.
Many of the questions asked here, both at the outset of redevelopment and throughout the design process, have fortuitously addressed those other providers will face in the months and years ahead. And the forward-thinking nature of the decisions made will allow the new Peel Manor and its patrons to thrive in the ‘new normal’ that will surface in the wake of this crisis. Among them, deciding to:
Deciding to develop community
The new Peel Manor is situated in an established residential neighbourhood. It forms part of a larger campus development plan spearheaded by the Region to create a new, fully integrated Seniors Health and Wellness Village. The Village will also include some existing seniors’ housing and several other proposed seniors supportive housing projects.
Peel Manor is, therefore, not designed to be an insular building but dedicates its ground level to a new Services Hub that will serve hundreds, maybe thousands, within walking distance, including Village residents, other local seniors and neighbours alike. The Hub is composed of a café / tuck shop, resource centre, physician’s office, integrated care team area, short-term respite suites, and an adult day services centre able to support up to 90 people each day.
As a collective, these community components support local seniors in their bid to remain active and independent longer, taking pressure off an already overburdened healthcare system, and contributing to a more sustainable financial model. They also figure prominently in an evolving outbreak response strategy being developed by the Region.
Most notably, the community components can operate safely and separately from the residence facilities above during an outbreak through the use of dedicated air-handling systems. They have also been designed with technology in mind to support more flexible service models, including e-healthcare options and virtual visits.
Deciding to enhance the Resident Home Area
The new Peel Manor is licenced for 177 beds. Levels 2 through 4 comprise two Resident Home Areas (‘RHAs’) each. These RHAs accommodate up to 30 people.
Several design strategies have been employed therein to create a comfortable, stimulating care environment with improved Infection Prevention and Control (‘IPAC’) and containment.
RHAs are designed to operate as more intimate 15-bed households without losing the efficiencies of a 30-bed care structure driven by government funding. Each household is equipped with its own lounge area and a homestyle kitchenthat allows residents to be more involved in the preparation of their meals. During flu season and or outbreaks, the self-sufficient 15-bed household model, and in particular the decentralization of eating facilities and higher ratio of amenity space per resident, will help staff implement physical distancing and limit transmission rates.
Each private bedroom has a shower, an atypical move that will help take pressure off communal tub rooms and potentially reduce the spread of germs during an outbreak. Semi-private rooms provide residents with their own sink to reduce cross-contamination.
The Region has also elected to include an additional room per floor at their own expense, a dedicated isolation room with anti-chamber to be occupied as needed.
Single loaded corridors allow daylight to filter in across the floorplate. They intersect to create a series of interconnected walking loops on each floor that encourage movement while helping to reduce pinch points and limit crowding.
Finally, a palette of bright colours together with a series of activity stations help break down larger spaces along these loops, increase sensory stimulus, and create a more uplifting living environment.
Deciding to invest in high-quality outdoor spaces
The new Peel Manor includes several high-quality outdoor spaces in its program. The value of these spaces cannot be understated, especially during an outbreak.
The drop-off, community hall, adult day centre dining room and support services all benefit from designated courtyards. These courtyards contribute to the daily life and liveliness of the building. They will also allow residents to have physically distant visits with family during an outbreak.
On the floors above, each of the 15-bed households has access to one of four semi-conditioned, glazed atria. These pioneering outdoor-like spaces topped with angled skylights are directly accessible to households on the second level. They are also accessible via raked terraces from the third and fourth levels respectively. These atria offer opportunities for leisure, recreation year-round in the Canadian climate. With especially high ventilation requirements, they also provide safe, secure access to the outdoors during a lock down.
Outdoor tiered horseshoe terraces supplement the glazed atria. They afford residents views of the surrounding neighbourhood and of activities occurring around the building. These visual connections are important for mental health and morale, particularly where mobility is limited and or physical distancing is required.
Finally, the project includes in its scope extensive, newly landscape parklands that will attract and appeal to an even greater number and diversity of citizens. The adjacency between the community hall, community courtyard and public park will serve large-scale, outdoor events. And when transmission rates are high, the park will help the broader community stay active and engaged in a safe, socially responsible way.
Deciding to rethink the service model
The Region has long acknowledged the important role its dedicated teams of front-line workers play in each of its long-term care homes and is investing heavily in piloting new service models centred around improving the staff-resident relationship.
Many design decisions were made to support these efforts while addressing staff vulnerabilities during an outbreak:
In addition, a newly decentralized system of provides staff with several options to work and rest, preventing them from congregating at a single location and reducing their risk of exposure. Dedicated staff spaces include conference rooms and kitchenettes on every level, a lower level ‘lounge’ and locker room as well as a staff garden intended to support their physical and mental wellbeing while on the job.
Lastly, the building is fitted with high-grade mechanical and electrical systems to help reduce the spread of infection and limit potential outbreaks.
So, where do we go from here?
The ongoing COVID-19 pandemic has exposed many failings in our society, perhaps none more so than in residential long-term care.
The Peel Manor Redevelopment project offers a progressive response to many of the concerns stressed today. In its design, it achieves a comfortable, enriching care environment consistent within a restrictive funding model. It addresses the need to create community and foster connection, to enrich the resident experience, to test new care delivery models and to improve caregiving conditions.
The project is slated for completion in 2022, a critical juncture in our healthcare history. But it is not just a beacon of change; it is a call to action to better the quality of lives lived in these spaces – in the best of times, and the worst.
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