The Next Generation

By Doug Rapelje
Published in October-November 2017 edition of The Seniors Review (Niagara Edition)

I want to begin this article by quoting from a piece I wrote 25 years ago: “Long-term care for the elderly is often viewed as a low technology service, slow to change, especially when compared to the advances in open-heart surgery or in vitro fertilization, and genetic engineering. Nevertheless, it is a field that is more affected by social change than are others, and it will need to change quickly to respond to changes in our society.”

Fast forward to the last provincial design standards that provide for single and double rooms with washrooms, units limited to 32 beds that included sitting rooms, dining rooms, nurses stations, activity rooms and tub rooms. Also central areas with tuck shops, hairdressing parlours, meeting rooms, chapel, administration and overall design features that provide a “homey” living environment.

From the 1950s to the present we have seen progress in the physical design of our Long-term care (LTC) homes. With the province’s announcement to replace 30,000 LTC beds by 2025, it’s an opportunity to design these new facilities to provide improved care and comfort for residents. They are older, frailer, and 60-70 per cent have some degree of dementia. In Niagara, it is reported that 17 LTC facilities will be redeveloped.

For many, it is not only their home, it’s their world. “This is my world now; it’s all I have left. You see, I am old and I’m not as healthy as I used to be. I’m not necessarily happy with it, but I accept it. Occasionally, a member of my family will stop in to see me. He or she will bring me some flowers or a little present, maybe a pair of slippers. I have 8 pairs. We’ll visit for a while and then they will return to the outside world and I’ll be alone.” A son found this note in his mother’s room after her death.

The question is, how can we provide improved living, environmental design and care programs to maximize quality of life for today’s residents? These are some of the considerations:


I believe all facilities should have all private rooms, even if some share a common washroom. With the number of residents with varying degrees of dementia, abnormal behaviour, different lifestyles, more needing end-of-life care and often living 4-5 years in a home, they need and deserve privacy to retain what dignity they have left. We all expect to live our life with the right to privacy. So why do we think when a person enters a LTC facility privacy is not important? A curtain drawn between two beds does not prevent odours, abnormal behaviour of a roommate, disturbance by inconsiderate visitors, or cross-infection, nor does it allow for different lifestyles.

Dementia Centres of Excellence

It’s time to have a discussion on providing within our LTC system Dementia Centres of Excellence, either free-standing or designed with the pending new facilities. We read about the aggressive behaviour of residents, with residents and staff being injured. Is it possible our homes are trying to provide too many types of care in one facility? Dementia Centres of Excellence exist and the models I have looked at are usually units of 8-10 beds that allow better staff supervision and care, more staff/resident interaction, and reduced opportunity for conflict, making it safer for everyone.

Hub or Campus Models

I believe these are models of the future that bring a number of different senior services to one site. It’s a model being supported by the Region as they redevelop three of their facilities. I recently had the opportunity to visit Georgian Village in Penetanguishene, which is a hub or campus model developed on 20 acres. It accommodates 17 single-story, two bedroom life lease garden homes, 40 life lease suites, 40 affordable housing units, 143 long-term care beds, and 42 retirement units. Its Adult Day Program and Community Centre are used by the public.

These are ideas that support the remarks made by Dipika Damerla, Associate Minister of Health and Long-Term Care. “Long-term care homes are not just facilities – they are people’s homes. It is vital that they remain up-to-date to provide residents with secure, safe and comfortable surroundings.”