A new evidence review by the Care Collaboratory, a group based at St. Thomas More College in Saskatoon, claims the government should be looking into house-like long term care homes rather than institutional models.
“In small house design models, people are living and working together in a place that feels more like home. Everyone benefits from this change — the quality of life and care improves, family is more satisfied, and staff are more motivated to work there,” said research assistant Elizabeth Pywell at the University of Saskatchewan.
The small-scale, home-like models were defined in the report as housing approximately eight to 12 residents each with private bedrooms and bathrooms, but with shared living, kitchen and dining areas.
Pywell worked in a personal care home during the pandemic before beginning her research.
“I saw a lot of isolation. It was during the pandemic and during quite strict restrictions, so people were really struggling to adapt to that situation and not being able to see their families.
“If the environments were different during long-term care, we likely would have seen different outcome,” Pywell said, referring to the mass COVID-19 outbreaks in Saskatchewan long-term care homes.
Long-term care researcher Vivian Stamatopoulous said that long term-care models have been moving toward hospital-like facilities with over 15 residents each to promote efficiency, but the care isn’t the same.
“When you have smaller facilities, you tend to have a better care standard and you tend to have more of staff that are working with smaller numbers of people,” said Stamatopoulous.
“Unfortunately, a lot of these very large facilities, often for-profit facilities, you hear these stories and, you know, one to two workers for 50 to 60 residents. I mean, and then you wonder why you have neglect, and you have problems of preventable errors.”
“Staff can be more attuned when family can’t be there,” added Pywell. “It can be in a more personal way than a larger scale model who don’t really have that opportunity or time to make those deeper connections.”
While the report didn’t show any significant improvement on mental health, the benefits of home-like long-term care designs were identified as better quality of life, family satisfaction, and staff engagement.
“Residents in small-scale homelike facilities reported feeling more at home, and valued the privacy provided by individual bedrooms, seeing this as a positive change,” read the report. “They also had a greater sense of freedom, even though some reported still lacking the freedom to participate in preferred activates- such as cooking or walking without a walker.
“Overall, very few interventions in long-term care have been associated with such a wide range of positive outcomes for residents, families, staff, and organizations. Environmental design is a critical consideration for the future improvement of long-term care services.”
Shan Landry, contributor to the Saskatoon Council of Aging said long-term care homes have been hyper focused on the medical needs of residents.
“It’s at the expense of everything else that makes us human,” said Landry. “We need to look at it being not so focused in on that clinical aspect, and more about what makes us tick as human beings.”
Pywell said that the most notable area to achieve this successfully was the Netherlands.
“A lot of the original small-scale home-like models even from the 1980s came from that area and they have contributed a lot to literature on small-scale home-like models.”
It would be a huge provincial project to switch all of the care homes to smaller models.
“You’re going to need a massive public investment in this. There are no questions about it, and it should be done in the public sector,”
$39 million was announced by the Saskatchewan government for additional long-term care beds and assistants in the province as part of the health care budget for 2023-24. However, there were no details for how the beds will be distributed or how more assistants would be hired.
Several Saskatchewan cities are also to receive funding for redevelopment and expansion projects to individual long-term care centres.
Pywell and her group have reached out the Ministry of Health and are having discussions with continuing care in Saskatchewan about the smaller models.
“We want to help give them the evidence that they need to help them move forward with improving the environment of long-term care, especially with the funding that we have received from the government recently. It’s a great time for this to happen.”
In an email statement to Global News, the Minister of Health said they “ensure the quality of LTC homes through regular inspections, senior leadership tours, resident and family surveys and quality monitoring. In the past, the ministry has undertaken a number of regulatory amendments to ensure safety and quality care of residents. Our officials remain open to receiving any new information in regards to future care of LTC residents.”
They did not comment on the information presented in Pywell’s research.
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