Reimagining long-term care with lessons from the pandemic

CSA Group outlines a new standard to enhance quality of life and protect residents, staff, and visitors



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By Diana Swift

Nothing revealed the need for enhanced infection prevention and control, and other safety measures, in Canada’s long-term care (LTC) homes than the tragic events caused by the SARS-Co2-V pandemic. Hospital News spoke with CSA Group about its vision for a new, safer generation of LTC settings that would help prevent pandemic history from repeating itself, while contributing to the creation of a more home-like environment for residents.

“During the pandemic about 70% of deaths were in long-term care homes” says Doug Morton, CSA Group’s Vice President, Government Relations. The residents’ physical proximity in sometimes crowded quarters and advanced age were key drivers of the virus’s terrible toll.

Conformity to CSA Group’s new standard will help ensure safe, adequately supported, and high-quality homes for more than 250,000 Canadians and their caregivers and visitors.

In its role, CSA Group, which already has published some standards addressing different aspects of LTC homes, will focus on infrastructure and environmental design, including operating systems, design and layout elements, and technology, that will help ensure a more nimble response to future crises.

“Whether a future pandemic or the annual flu season, we can be ready to make and lay out a more rapid and organized response,” says Dr. Alex Mihailidis, Scientific Director & CEO, AGE-WELL & Chair of CSA Group Technical Subcommittee on Long-Term Care Homes.


Front and Centre: Infection Control

With lessons learned from the pandemic, preventing and controlling infection is paramount. Comprehensive new operating practices and infection management will build on existing standards across a broad front: ventilation and air quality, heating and cooling, plumbing and water management, and medical gas systems. Another element will be waste disposal, including the dignified disposal of human waste. Flooring will be safer and senior-friendly; room design will diminish the crowded conditions that spurred transmission of COVID-19.

The new blueprint will address the advantages of installing microbe-resistant surfaces for furniture, food preparation and eating areas, bathrooms, and other high-touch areas. But if some homes lack the resources to achieve the ideal, says Dr. Mihailidis, the recommendations will offer practical alternatives for getting as close to the optimum as possible. For instance, although the ideal would be to change all surfaces to antibacterial materials, they would outline effective, but less costly cleaning procedures to make surfaces safe.

New technologies, some already being piloted in facilities, will also play a role. “These include systems that collect health data and vital signs from residents with less physical contact,” says Dr. Mihailidis.

Advanced technology will improve room cleaning, while other new tools will keep residents safely connected with their loved ones and communities, he adds.


Voluntary and Inclusive

“As thorough as CSA Group’s new standard will be, its adoption will be voluntary unless it’s incorporated by governments, regulators, or best-practice guidelines,” says Morton. “But we’re having discussions with federal and provincial governments, and we have members from government on the technical committee, so we’re very hopeful.”

A first draft of the standard will be available in February 2022 for public review and comment, and will be followed by the final standard being published in fall 2022. CSA Group’s inclusive approach has engaged LTC residents, families, caregivers, and administration and addresses the concerns of Indigenous and other racial/ethnic groups as well as the LGBTQ2S+ community.


Improving the Living Experience

Apart from physical safety, the new CSA standard will aim to provide residents with a more home-like living space – with, for example, furnishings that go beyond being antimicrobial to attractive, comfortable, and non-institutional. “This is their home,” says Dr. Mihailidis. “Yes, healthcare is being provided, but the environment should not look like a hospital.”

And given the negative impact of social isolation on residents’ mental wellness highlighted all too starkly by the pandemic, the new designs would encourage safe visiting during normal times and outbreaks.

The standard takes into account cultural differences. “In our consultations with Indigenous leaders we’ve learned a lot about the cultural and spiritual importance of food preparation and sharing of meals,” says Dr. Mihailidis.

In Canada’s recent federal election campaign, fixing LTC emerged as top of political mind. Conceivably, the new CSA standard will help ensure that this remains a priority of our political will.



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