This Toronto long-term care home is being redesigned after learning from the COVID-19 pandemic

A long-term care home in downtown Toronto is rebuilding with a new design that goes beyond the province’s standards, taking into account lessons learned from the COVID-19 pandemic — but some say those standards are outdated.

Right down to where the trash cans are placed, the new design of Rekai Center’s Cherry Place aims to prevent the spread of the virus and prioritize residents’ emotional and social needs, according to center CEO Sue Graham-Nutter.

“We never wanted our residents to have to go through this again,” he said.

Traditional long-term care homes saw three times as many COVID-19 deaths and more than twice as many cases in 2020 than shorter care homes, according to the data. A study by the National Institute on Aging (NIA) to 2025.

Graham-Nutter said many of the planned updates to the 13-story facility on Cherry Street were brainstormed during the pandemic as shortcomings came to light.

“I would go up in the stairwell in my full PPE, and I would text (the architect), ‘We need to think about this, we need to think about this,’ because I didn’t want to forget the little things,” she said.

The redesigned facility will have sealed doors, better oxygen access and infection control areas with 348 beds.

According to the latest Ontario Long-Term Care Home Design Manual from 2015, Ontario requires facilities to have a maximum of two residents per room and patients must be divided into self-contained groups of a maximum of 32 people, called “resident home areas”.

According to Dr. Sameer Sinha, geriatrician, physician scientist and director of health policy research at the NIA, the changes made by the Rekai Center are a good start.

But Ontario’s standards for long-term care homes are falling behind the latest best practice research, he said.

“If you think about palliative care hospices, if you think about group homes for young people… we don’t often put them in large institutional settings,” Sinha said. “So why is it that in North America we only do this with frail, elderly people?”

Sinha said long-term care should move toward a “small care homes” model of 10 to 12 people, each with their own private bedroom and bathroom. Large buildings can be divided into multiple 12-person households and still follow the model, he said.

Smaller groups, more privacy

Some resident home areas at Cherry Place are being built for 14 or 18 beds to provide a more home-like feel, said project architect Dustin Hooper of the Montgomery Sisam firm.

According to the project’s architect, it also will have suites for families visiting a loved one, and several terraces with sandboxes with green spaces, Hooper said.

“An important aspect of long-term care is providing community outdoor spaces where residents can gather with other residents, but also with their loved ones when they come to visit,” Hooper said.

Residents will each have their own bedroom, and where possible, their own bathroom to reduce the spread of the disease in the event of an outbreak, Graham-Nutter said.

Graham-Nutter said when assigning rooms with shared bathrooms, residents who are able to use the bathroom will be paired with someone who does not have mobility. “So, actually, the toilet is private,” she said.

Best practice for ‘small care homes’, says expert

According to the NIA study, the smaller-scale model increases the emotional well-being of residents and staff retention and better prevents the spread of the disease.

It recommends that health care and other services such as housekeeping, laundry and cooking be performed by a continuous team of people who continue to work in that household community.

“Not only is it a good thing to do, it literally saves lives,” Sinha said. “People are less likely to go to hospitals, emergency departments in these models.”

Sinha said care homes in Ontario need more support from the government to make a difference.

According to a statement from the Ministry of Long-Term Care, the province is allowing facilities to implement smaller-scale models.

Although not updated, the 2015 design requirement standards ensure that the province is “supporting the demands of Ontario’s growing population,” the statement said.

More than 49,000 people were aboard Waiting List for Long Term Care Beds in ontario, in early 2023.

The province aims to build or renovate 58,000 long term care by 2028 and so far 6,700 beds have been constructed and 18,000 are in the works.

Cherry Place is expected to open in June 2028, Graham-Nutter said, and a waiting list will open in January of that year.