As smaller nursing homes are cropping in Canada, experts say they are better for residents and staff
Across Canada provincial governments are building small nursing homes that offer a better quality of life, limit the spread of infections and help retain staff in an industry struggling to find new workers.
But Ontario seems to be taking a different route.
The province’s ongoing $6.4-billion long-term care expansion is focused on homes with multiple units, each with 32 beds, said a new report from the National Institute on Ageing.
While Quebec builds small households for 12 residents and Alberta has plans for homes with four to 14 beds, Ontario uses a construction funding formula that many operators and developers say leads to “large, institutional-style” buildings, the NIA report said.
Released today, the NIA report titled There’s No Place Like Home details the advantages of small homes or tiny households situated within a larger building, noting that many provinces are adding them after COVID-19 revealed how infections can easily spread in large, populated spaces.
Proponents also note that small household designs feature cosier living spaces that more closely resemble the homes that residents once lived in, with daily routines more centred around individual interests.
“Traditional LTC home models,” the report said, “were felt to encourage their residents to spend most of their time in bed within highly sterile environments that lack, most if not all, of the amenities they would otherwise be able to access at home.”
In Ontario, the biggest homes ‘we’ve ever seen’
Some Ontario operators are trying to be innovative within the large-home design, adding spaces for socializing or additional private rooms with washrooms.
While the smallest traditional Ontario nursing homes have roughly 128 residents (some have 125), Lisa Levin, CEO of Advantage Ontario, said the province has been approving homes housing 340 residents.
“We’re seeing bigger homes than we’ve ever seen, especially in large urban areas,” Levin said.
In response to questions from the Star, Ontario’s Ministry of Long-Term Care did not say how many small homes are being built as part of its expansion plan.
A spokesperson said there is “no minimum bed requirement” for new or redeveloped long-term care homes, adding that “all operators already have the flexibility to propose smaller scale projects if they conform to provincial standards.”
Levin, whose organization represents not-for-profit, municipal and charitable homes, said she knows of a member that has been approved for a small household.
Lambton Meadowview Villa, a 125-bed Lambton County nursing home in Petrolia, is adding a small household of 12 residents living with dementia to its existing nursing home. Lambton County said a “significant amount” of the cost, which is not yet finalized, will be recovered from the province.
Levin said the home, operated by the county, can afford construction because local funding will cover outstanding costs. Without that additional money, Levin said, “it’s very difficult to build small long-term care homes in Ontario.”
A few other Ontario homes are pushing for smaller households, according to Donna Duncan, CEO of the Ontario Long Term Care Association. In Northern Ontario, the Foyer des Pionniers long-term care home in Hearst is moving forward with 12 beds, bringing that home to 79, she said. The Wilson Memorial General Hospital is getting a new long-term care wing with 14 beds in private, one-resident, as well as basic, two resident rooms, she added.
Ontario’s construction funding guidelines make it cheaper to build larger units in big homes, said Dr. Samir Sinha, the NIA’s director of health policy research. Sinha added that in Ontario it is more cost-effective to staff a large group of residents in one setting.
Across Canada and stateside, small homes taking root
Quebec has built 30 small nursing homes or alternative care homes for people with different needs, as of March 30, 2024, the NIA report said. Nova Scotia requires new nursing homes to be small households with 14 to 16 bedrooms.
Saskatoon’s Sherbrooke Community Centre, a long-term care home, started focusing on small settings in 1999, when it added 11 small households — each with roughly 10 residents — to its traditional nursing home. Sherbrooke, which uses the Eden Alternative philosophy that aims to eliminate loneliness, boredom and helplessness among residents, has high staff satisfaction and retention, the report said.
“Instead of this traditional kind of format that emerged decades ago where you have dozens of people living on one unit, increasingly now we’re seeing a desire to create smaller groupings of individuals and create more of a household,” Sinha said.
In the United States, the Green House Project of small homes “significantly” outperformed traditional American long-term care homes in the reduction of COVID-19 infections and related deaths during the first two years of the pandemic, the report said.
The NIA report calls for a Canada-wide adoption of small home designs and more research for best practices in these homes. It also emphasized that home staff responsibilities should include a greater range of tasks for employees who work with a smaller number of residents, from hands-on care to cooking (often with residents). This is how Green House homes operate.
Emotion-focused care could flourish in smaller homes
While the majority of Canadians say they want to avoid nursing homes, Sinha said that some will eventually need high levels of care and do not have family to provide support at home.
In December, the Ontario government announced plans to fund training of home staff in the practice of emotion-focused care, which aims to create better understanding and connections with residents living with dementia.
Sinha said emotion-focused care would have greater success in small households that do not resemble hospitals. And, he added, it’s not just residents who prefer it: Workers do, too.
“The best way to achieve (the emotion-centered approach) is actually by building and appropriately staffing small home settings, because that’s where you really, really see this sort of care come alive.”
This article was first reported by The Star
