Learning from Long-Term Care
Author: Brendan Cole Buchanan Dee
Course: Thesis - Master of Advanced Studies in Architecture
Committee: Dr. Adam Rysanek, Dr. Sara Stevens, Prof. Blair Satterfield
UBC SALA / 2021-2022
COVID-19 & Architecture for Ageing
This research project investigates long-term care homes (LCTHs) as major sites of disease outbreak during the COVID-19 pandemic and as unique architectural manifestations that resemble aspects of home, hospital, and workplace in service of institutional eldercare. The research unfolds in two parts, scrutinizing LTCHs as a matter of public health in response to the disproportionate impact of COVID-19 on LTCHs, and through examination of the historical trends embedded in the design of LTCHs. First through a regional cohort analysis of British Columbia’s LTCHs (BCLTCHs), building design factors including resident population size and bedroom occupancy were assessed as potential factors influencing outbreak occurrence and severity. To visualize outbreak data across the province’s 355 BCLTCHs, graphs depicting the time and intensity of COVID-19 outbreaks were generated by synthesizing datasets from British Columbia’s Office of the Seniors Advocate (BCOSA) and British Columbia’s Centre for Disease Control (BCCDC). Secondly, an exploratory study was undertaken using satellite imagery and Google Streetview to identify and catalogue BCLTCHs based on building footprint and massing. Satellite images were categorized into distinct typologies for the photographic series, THREE HUNDRED FIFTYFIVE LONGTERM CAREHOMES, an assemblage that reveals patterns in form and spatial organization that have been repeated and elaborated in the construction of BCLTCHs. The analysis turns to architectural history to inspect the prevalence of certain typologies and aesthetics that surfaced in the cataloging of BCLTCHs, probing the dichotomy of modernism and postmodernism to explain the rationale behind the low-rise, suburban, vernacular, and ordinary character of buildings that now dominate the field of LTCH design.
Across Canada, LTCHs are known by a variety of names that reflect regional vernacular and healthcare traditions, including long-term care homes, nursing homes, and residential care facilities to name a few.1 Additional forms of eldercare communities exist including assisted living (AL) and independent living (IL) which cater to residents who need occasional on-call support or help with household chores, but crucially, LTCHs provides essential housing and healthcare for those who can no longer live independently and require the availability of 24-hour assistance. Long-term care (LTC) is a distinct form of healthcare typically provided in residential facilities with the aid of healthcare workers or through ‘home care’ with the support of family members, friends, or hired assistance. Recipients of LTC are mostly elderly individuals who are experiencing physical or cognitive decline due to the process of ageing, thereby requiring everyday assistance with mobility, personal hygiene, nutrition, medication, recreation, and socialization. Although the communities of LTCHs vary across countries, regions, and buildings—such as the age, ethnicity, or gender of residents, severity of health conditions, or by cultural or religious affiliation—the typical recipient of LTC is an elderly individual with chronic health issues requiring daily aid.
In Canada, provinces are responsible for the provision of healthcare services, an arrangement that has generated a patchwork of LTCH systems consisting of public, private non-profit, and private for-profit sectors.2 In BC, healthcare administration and operations including LTCHs are coordinated by five Regional Health Authorities (RHAs) with varying compositions of public and private sites that reflect the diversity of urban, suburban, and rural communities throughout the province. BCLTCHs are further stratified by adherence to either the Hospital Act (1996) or the Community Care and Assisted Living Act (2002)—or in some cases both—that establish the basic requirements and standards of care expected in the facility. What constitutes a BCLTCH must therefore encompass a multitude of facility and operational conditions, limiting capacity for generalization due to differences in scale, jurisdiction, and physical settings. Canada’s system of provincial LTCH management has come under scrutiny due to speculation that systemic regional differences between LTCH systems may be partly responsible for increased risk of outbreak exposure.
1 Amy T Hsu et al., “Impact of COVID-19 on Residents of Canada’s Long-Term Care Homes – Ongoing Challenges and Policy Responses” (International Long Term Care Policy Network, May 10, 2020), 3, LTCcovid.org.
2 Hsu et al. 2020, 3.
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