The residential aged care sector may need to reconsider its design and resident capacity to ensure facilities maintain a home-like and COVID-safe environment, an aged care conference has heard.

A panel of aged and healthcare care chief executive officers from across the globe shared their experiences with how their nations and facilities are coping with COVID at the LASA Ten Days of Congress conference on Monday.

The panel were asked whether aged care facilities should continue to be built with a large number of beds in light of the current pandemic.

Vanda Laconese, CEO of Doutta Galla Aged Services in Victoria, said keeping aged care facilities home-like while adhering to infection control measures was the key issue.

“One of the things that we’ve had some issues over is the building design. It’s not built like a hospital. It’s built like a home, and in fact we’ve invested a lot of time, effort, energy and design into lifestyle and ways of operating, which are about making it as homelike and homely as possible,” Ms Laconese told the conference.

She said their aged care facilities were not designed with large corridors to store personal protective equipment.

Another one of the challenges is whether you have a laminated sign on everything that says ‘please wipe me after you’ve used me’ in residents rooms and all those sorts of things suited to an infection control environment, but not normally in a home-like environment, Ms Lanconese said.

Bruce Spurlock

Bruce Spurlock, CEO of Cynosure Health in the United States, said the US has seen a trend of larger facilities being at greater risk of COVID outbreaks.

“The larger size homes are higher risk, and part of that was once you get it in there, it spreads like crazy and that’s the risk. The outbreak spreads faster and harder and so the impact is bigger,” Mr Spurlock told the conference.

Aged care facilities may need to move towards smaller and other community settings, he said.

“So instead of home care or nursing home care in facilities, go back and provide other care environments that are smaller and more intimate settings,” Mr Spurlock said.

Tom Lyons

He said large aged care facilities will continue  exist, but the sector will see a trend towards more aged care provided in smaller and more intimate settings over the next four to five years.

Tom Lyons, CEO of Black Swan Care Group in the United Kingdom, said the facility’s size didn’t matter.

“COVID-19 does not discriminate against your care home. It can affect it whether it’s a new build, an old converters block, a 30 bed, or a 60 bed. It seems to have gotten everywhere,” Mr Lyons said.

Norah Barlow, CEO of Heritage Lifecare in New Zealand, said facilities of the future would need to move towards a more clinical setting due to the nature of aged care includingstaffoften working across more than one facility.

“[You] have those sick people in the home who will be dealt with by a carer who will be going from home to home to home, and there is no single carer for a single person available… So, I think we just need to learn to be more clinical,” Ms Barlow told the conference.

“I hate the idea of it, but I do think we do need to be more aware of our infection control processes.”

“I really rue the day we move away from a home environment as well,” she said.

The LASA Ten Days of Congress takes place from 12 – 23 October as a virtual event.

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  1. Design is not a stand alone issue, nor is just it a case of ‘small’ vs. ‘large’. The model of care, inducing the design of the physical environment, from the arrangement of bedrooms and communal areas, to the flow of foot traffic in, out and around); the nature of care staff roles ( think multi-skilled vs. role definition between cooks, cleaners, are staff etc); the way in which care staff are deployed (stable allocation to a small unit or moving between units); the number of residents living in a discrete unit; the management of visitors, including families and other workers (think plumbers, electricians) all need to be carefully thought through – not only for infection control but to create welcoming, homely environment where residents can feel safe and ‘at home’, especially if they have a cognitive impairment. Environmental design will dictate operations and movement of people – eg. a central kitchen vs. individual kitchens in small home like clusters, or the movement of of contaminated items. Corridors do not have to be ‘big’ to house storage for PPE, nor does storage need to look institutional. Design needs to consider the movement of fresh air flow too! Environmental design influences everything about how we live and work. It is thoroughly over due to consider moving away form the “hotel” model to small clustered homes, that are just that, home, NOT a ‘care facility’. There will be better outcomes for everyone.

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