Designing Long-Term Care Facilities

october 5, 2020 I by: Selena Chau for Shape products

Link to the published article

COVID-19’s impact on LTC Facilities

Even months into the COVID-19 pandemic, without proper documentation and tracking of national data on COVID-19 cases, it’s hard to get a comprehensive view of who, where, and how citizens are currently being affected. In one of the unfinished first passes of reporting to the Centers for Medicare & Medicaid Services (CMS), deaths caused by Covid-19 within Long-Term Care (LTC) facilities are reported to account for somewhere between 30-40% deaths in the US. As told by the former head of the CDC on CNN on March 8th, “One thing stands out as the virus spreads throughout the United States: nursing homes and other long-term care facilities are ground zero”. For those who are familiar with the LTC system in the US, no one is surprised by why so much of the Covid-19’s death count appears to occur in these spaces. It is not just a matter of who is compromised by age; it is a systemic issue that many experts saw coming years ago.

The hopeful prospect of this pandemic is that it shows us where our limitations are. As the numbers grow and we continue to fight through this pandemic, it will prompt us to take a long, hard look at how we treat our aging population in need of assisted living services. The Medicare and Medicaid system does not cover the cost of most if any of the skilled labor and facilities needed for assisted living or long-term care. Many seniors of the middle class are forced to impoverish themselves to simply qualify for Medicaid alone and this says nothing of out of pocket expenses that are incurred from paying for services as older adults. We are living in an aging nation and the number of older adults over 65 projected to increase from 15.2% to 23.4% by 2060. This rising demographic does not receive its primary care from hospitals or physicians. Rather, they rely on the work of nurses, personal support workers, home care, nursing homes, and assisted living facilities.

“While the aging of America’s population has been foreseen for decades, little has been done to prepare the health and long-term-care workforce for it’s arrival.” – National Academy of Medicine

Systematically speaking, America does not care for older adults and that is laid bare in facilities of care that are understaffed, undertrained, and undersupplied; all of which are exacerbated by the pandemic. This also feeds into the expansion of privatization in LTC facilities in the US which further widens the disparity between wealthy and poor older adults whose care is now jeopardized by their ability to pay.

With the government making emergency stop-gap solutions for the lack of staffing, supplies, and general support in such facilities, it raises the question of what will happen after COVID-19. When we have time to bounce back, what will we have learned from this pandemic and what can we do differently? With any hope, it means we will see an honest effort made to put more funding into the care of older adults and more creative ideas put into action for what we can do to improve the design of LTC facilities.

Redesigning long-term care

Residents in LTC facilities are currently feeling more trapped than ever. As self-isolation has become a mandatory requirement among the residents of these facilities, their routine has been stripped down to daily meals left at their door and minimal interactions with staff and other residents. While there are clear physical risks for older adults venturing outside their rooms, there are also psychological repercussions to being confined to small spaces. Depression and loneliness were issues among older adults long before COVID-19 and are only made worse in our present position. Amidst the pandemic, our team took to coming up with some ideas that, we hope, will be implemented into the design of future LTC facilities.

How can we bring back meaningful in-person connections while still practicing proper social distancing?

Re-Designing LTC Floor Plans

Reorganizing LTC floor plans to cluster resident rooms into smaller pods and have their doors facing each other means that residents can still maintain daily in-person interactions with each other even through the confines of their rooms. Residents would be able to stay within a reasonable distance of each other while still being able to interact with one another in the pod-like layout of the floor, rather than having floor plans with straight and narrow halls with successive rooms one after the other.

Safer Doorway Interactions

We will not always be in a state of pandemic, but it will be important to prepare for those situations. Interactions have become more limited to the space surrounding resident doorways. How can we improve upon that space for interaction and make it a more lasting and enjoyable space for interaction? Introducing Dutch doors will help encourage more interaction from the confines of their rooms, but still offer a physical barrier that helps residents keep a safe distance towards others. Including additions like a folding table can help transform the space into a more enjoyable place for sustained periods of time. For times of more heightened safety precautions, a protective screen can be added to help safeguard other residents and workers while still helping encourage interaction.

Purposeful Wandering

Video chats have become a vital part of how we interact now and are critical for those living in LTC facilities. We should find ways of encouraging movement with these virtual visits to add a more physical element to them. This type of activity is typically conducted while sitting in place and it would be an interesting idea if we could flesh out this experience to be more dynamic for those involved. This would help encourage physical activity and help with the simulation of in-person interactions with loved ones. Using the familiar design of an IV drip stand, we can repurpose this to carry tablet displays while users can travel and walk alongside their virtual visitors with assisted stability. We can also design a tablet mounting system that attaches to an assistive walker, so users are able to use their walkers during a virtual visit. While this has implications for possible points of distraction and injury if users are not careful, with the right safety measures, this could have the potential to provide a new dimension to physical activity, virtual interactions, and personal independence for older adults that can perform these activities on their own.

The design and improvement of LTC facilities is not a new proposition, but we are currently living in a time of radical change and it offers the opportunity to look at the problem in new ways. Ageism is an issue in the US and so is the undervaluing of aging services. Policy development and lack of funding reflects our cultural attitudes. There is nothing glamorous about well-designed, pandemic-resistant nursing homes and there is no political or social price to pay for pushing long-term care down the priority list, but with the number of fatalities climbing among older adults we can’t ignore these issues. As designers we have the responsibility as innovators to make the distinction between what is exciting and what is important to talk about, because there is room for innovation in both.  There is not enough media attention in the design sphere for LTC facilities to pull focus into these less glamorous subjects. We have the power as designers to help draw attention and bring excitement to these kinds of subjects if we would take the time. So I offer the question: What could Covid-19 mean for LTC facilities?

How can we learn from the weaknesses we have seen over the past months?
•What is missing and can be improved?
•How do we look at these issues as opportunities for innovation?
•How can we help older adults be more active, social, provide necessary, or be more independent, without the spread of disease?