Time to Rethink Long Term Care Facilities

The COVID pandemic has laid bare the inadequacies in long-term care (LTC) facilities. It is time to rethink our approach to how these facilities are designed, operated and staffed.

According to the latest numbers from the Kaiser Family Foundation (KFF): 5% of all cases of COVID-19 in the US are residents of LTC facilities (approximately 1.2M cases) yet 37% of COVID related deaths are residents at LTC facilities. I have to admit this % is a lot higher than expected.

We have heard repeatedly how COVID-19 impacts the elderly and those with chronic conditions, so I knew the number of deaths from the LTC residents would be higher, but not 1/3 of all deaths in the US. Canada is even worse. During the first wave of the pandemic, LTC deaths accounted for 80% of Canada’s total due to COVID.

In addition to the high mortality rate, LTC facilities have also:

  • Lacked adequate PPE for staff
  • Had difficulty having enough staff to help with the daily care (toileting + bathing + eating)
  • Barred visitors which has led to loneliness and isolation for residents
  • Not communicated adequately with families about the conditions inside the facility

Things got so bad in some Canadian care homes that the military had to be called in to help bolster the staff. What they found were “horrific conditions” and abuse. Here is one of many articles that told of the horrors.

The pandemic didn’t cause the issues in Long Term Care facilities – it simply brought the issues that had been there for years into the spotlight. Chronic understaffing, lack of training, lack of empathy, slow pace of innovation…the list of challenges go on and on. There isn’t even any one party to blame. The issues are systemic.

In my opinion, it’s time to completely rethink the concept of LTC facilities. Given what’s happened over the past year, I don’t think there are many people who would choose to go to a facility. I have always wanted to age-in-place. COVID has convinced me 1000% that is the right decision.

But what innovative models and approaches might work for Long-Term Care?

The Hogewyk Dementia Village in the Netherlands was an innovative concept that was meant to help patients live in familiar surroundings. Entire areas of the facility were made to look like streetscapes from the 50s, 60s and 70s.

The Netherlands is also home to nursing homes that offer rent-free housing to students. In return for free rent, the students had to spend 30hrs a month acting as “good neighbors” – helping the residents with activities, cooking meals, watching sports, holding celebrations, etc. This hybrid living helped to mitigate the negative effects of aging.

Kaleigh Alkenbrack outlines several innovative approaches in this HealthyDebate article. She points to The Green House Project in the US as a sustainable example. Instead of a large, multi-unit facility, The Green House is a small residence with 10-12 private rooms, each with it’s own bathroom. Each room is centered on a communal open kitchen where residents have the opportunity to socialize and interact.

Join the #hcldr tweetchat on Tuesday February 2nd at 8:30pm EST (for your local time click here) when we will be discussing the following questions:

  • T1 What is the biggest failure in/challenge facing long-term care facilities today?
  • T2 Do you believe that the COVID experience will cause a significant shift away from long-term care facilities?
  • T3 What long-term care or aging-in-place innovations are you excited about?
  • T4 What can healthcare leaders do right now to improve how we care/treat the elderly?


Alkenbrack, Kaleigh. “Innovative models pave the way for safe, high-quality long-term care homes”, HealthyDebate, 13 January 2021, https://healthydebate.ca/2021/01/topic/innovative-models-long-term-care, accessed 1 February 2021

Reed, Carey. “Dutch nursing home offers rent-free housing to students”, PBS, 5 April 2015, https://www.pbs.org/newshour/world/dutch-retirement-home-offers-rent-free-housing-students-one-condition, accessed 1 February 2021

Brewster, Murray and Kapelos, Vassy. “Military alleges horrific conditions, abuse in pandemic-hit Ontario nursing homes”, CBC, 26 May 2020, https://www.cbc.ca/news/politics/long-term-care-pandemic-covid-coronavirus-trudeau-1.5584960, accessed 1 February 2021

Mulligan, Cynthia. “Horror and heartbreak in the wake of Whitby long-term care outbreak”, CityNews, 13 January 2021, https://toronto.citynews.ca/2021/01/13/horror-and-heartbreak-in-the-wake-of-whitby-long-term-care-outbreak/, accessed 1 February 2021

McBride, Jason. “Houses of Horror”, Toronto Life, 11 November 2020, https://torontolife.com/city/how-ontarios-long-term-care-homes-became-houses-of-horror/, accessed 1 February 2021

Gebeloff, Robert et al. “The Striking Racial Divide in How Covid-19 Has Hit Nursing Homes”, New York Times, 10 September 2020, https://www.nytimes.com/article/coronavirus-nursing-homes-racial-disparity.html, accessed 1 February 2021

Banerjee, Sidhartha. “Long-term care deaths surged in COVID-19 first wave, Tam hopeful it won’t repeat”, CP24, 28 October 2020, https://www.cp24.com/news/long-term-care-deaths-surged-in-covid-19-first-wave-tam-hopeful-it-won-t-repeat-1.5165069, accessed 1 February 2021

McGilton, Katherine S et al. “Uncovering the Devaluation of Nursing Home Staff During COVID-19: Are We Fuelling the Next Health Care Crisis?”, The Journal of Post-Acute and Long-Term Care Medicine, 2020, https://www.jamda.com/article/S1525-8610(20)30492-8/pdf, accessed 1 February 2021

Brown KA, Jones A, Daneman N, et al. “Association Between Nursing Home Crowding and COVID-19 Infection and Mortality in Ontario, Canada” JAMA Intern Med, 9 November 2020, https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2772335, accessed 1 February 2021

Chidambaram, Priya. “Key Questions About the Impact of Coronavirus on Long-Term Care Facilities Over Time”, KFF, 1 September 2020, https://www.kff.org/coronavirus-covid-19/issue-brief/key-questions-about-the-impact-of-coronavirus-on-long-term-care-facilities-over-time/, accessed 1 February 2021

Image Credit

Photo by Georg Arthur Pflueger on Unsplash

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