The document discusses the challenges of finding appropriate residential care for seniors, highlighting the emotional difficulty faced by families in navigating an overloaded and underfunded system. It emphasizes the need for designing long-term care (LTC) environments based on seniors' needs, staff input, and community integration, advocating for less institutional settings and more choice and engagement in daily activities. The document outlines various architectural and design strategies to improve living conditions and foster interactions among residents, families, and the wider community.

1. Re-imagining Seniors’ Residential
Care
Dr. Tamara Daly, MA PhD
CIHR Research Chair in Gender, Work & Health
Associate Professor,
Director, York University Centre for Aging Research & Education
© 2018

3. Tomorrow, Nadine and I are going to start looking at places for mom. I've been bawling my
head off about it, but I know it's time to start moving forward. We are too remote out here in
Rocky View County, too far removed from everything. Save for the companion care women,
when I am away working, mom is alone here with them. My options have narrowed and I need
more help than I can provide. It sucks hell.
Mom is changing so quickly and I don't want to be caught in a place where she has deteriorated
to the point where it's too late to move her with any kind of grace. Nothing about this is good.
Nothing about this is easy, but having said that, it's life and you have to throw your shoulders
into change, pull yourself together and get on with it. I want mom to have a purposeful life,
engaged with other people, doing activities and being surrounded with movement and motion
and LIFE….We had a lovely woman come out here a few days ago to help us narrow down the
possibilities of places that would be a "good fit" for mom. It was 350 dollars, but I think worth
every cent as Nadine and I would have been on a wild goose chase to find something in our
general area and suitable for mom's needs. It's such a shit show out there. I'm finding out all
kinds of things that I didn't really want to know. The system is overloaded and underfunded and
at a critical point for a million reasons. I'm scared and uncomfortable about all of this. But life
will stumble along and I'm going to try to stay afloat for her, for my mom. What a completely
strange thing it is. To become a new version of yourself in the blink of an eye.

5. Healthy Ageing in Residential Places
Canadian Institutes of Health Research & European Research Area in Ageing
II international project
Social Sciences and Humanities Research Council Major Collaborative
Research Initiative
Institute of Gender & Health
www.reltc.ca
https://tamaradaly.ca/

6. How do communities re-design LTC for
living, visiting and working?
• Don’t assume that what you want now is what seniors want now
or in future
– Ask Seniors
• We live in a community
– Ask families and volunteers what makes them want to spend time.
• LTC is a workplace
– Ask staff in LTC what they need to provide good quality care that makes
them smile at the end of the day
• Don’t assume that MOHLTC design standards are good enough...
– Ask architects + seniors + work organization people +

7. Promising Places for Seniors
• Architecture of the building +
• Design of physical environment inside & out +
• High staffing levels =
• How residents, visitors and staff can engage
• It includes everything from the location, the structure and
maintenance of the gardens, the floor coverings, the seating, the
acoustics, the sight lines, and spaces for building and maintaining
relationships, how the space is oriented, how much time there is
to engage, time to chat, time for comforting, meaningful activity
….

8. Design for Dining
• Smaller dining rooms (no more than 9) with 1
table or multiple small tables.
– Encourage interaction + decrease noise and clatter

9. Design for Pleasure…
• Ability to cook on the unit…
– People could get up when they wanted and the calmness
was palpable
– Smells of food, coffee and baked goods wafted…..
• It was immediately inviting;
• Did not smell like “airplane food”
• Make food accessible...
– Fruit bowls out on the counters, jugs of water in dispensers,
kettles for tea....think about how people spend their time?

10. Design the Décor
• Aim for a non-institutional look in the furniture
– But be careful if choosing antique look, art and kitsch:
• may feel nostalgic /or/ remind people of past trauma, e.g. wartime
– Try furniture that allows residents to “put their feet up”
– Encourage spaces that allow for reading, sitting and chatting
• Handrails that look like moldings
– environment looks less institutional
• Real plants throughout the space
– imbue it with life

11. Design for Dignity
• There should be comfortable spaces to rest
– Avoid the wheelchair line-up in front of the TV
when people are sleeping
• Allow residents to use all spaces...
– Too many homes cordon off their dining spaces
when it is not meal time

12. Design for Individuals
• Let people get up when they want to and eat
breakfast at different times
• Think about different tastes in music, food,
entertainment…including gender preferences
– Activities need a re-think. Music and singing can
happen all of the time as it did in one Norwegian
home

13. Design for Living
• Spaces should be inspirational for residents
– NH in Germany had a bicycle repair space on the
unit for a resident and a carousel in the lobby for
children
– NH in Ontario has a dedicated creative arts room --
pottery, painting and other creative projects with
artists-in-residence. Resident’s pottery is sold in
the gift shop

14. Design for Relationships
• Many Nordic homes included a restaurant on
the main floor with affordable food options
– Staff, families and community members would
come to eat

15. Design to increase Interaction
• Leadership style can flow from space allocation
– Top-down, hierarchical?
– Distributed?
• Avoid sequestering manager’s offices off into one
wing
• Good sight lines for care workers helps

16. Smaller units
• In many European homes, there were no
more than 8 or 9 residents on a unit…there
are typically 25 – 30 in Ontario
• Smaller dining room spaces
• Less commotion; calmer; less agitation.

17. Light and Wayfinding
• Lots of natural light
• Decorative doors help wayfinding and create interest
• Automatic doors allow access to covered patios that
can be heated year round
– People with Dementia like to walk. Automatic doors leading
out to safe spaces encourages outdoor time. So many places
have outdoor spaces and no staff time to take people out.

18. Promoting Choice
• Real plants throughout the space imbue it
with life
• In one integrated facility, the residents’
community garden was a source of inspiration
for the chef

19. Social First, Medical next
• Hide medical aspects of care into living spaces
– Orients the home around living
• Open nurses’ stations or no stations
• Medicines and supplies locked and stored in each
resident’s room -- like Germany
• Placed in a kitchen island – like Nova Scotia

20. Designing for living, visiting and working
• Think about the floors….
– Carpets may give a home-like atmosphere
– Carpets soften noise and cushion falls…
– BUT they also
• Retain odours
• Make it harder to navigate for wheelchairs; walkers;
laundry, meal and housekeeping carts

21. Promoting Choice
• Residents’ community garden was a source of
inspiration for the chef at one integrated facility
• Ability to cook on the unit…
– People could get up when they wanted and the
calmness was palpable
– Smells of food, coffee and baked goods wafted…..
• It was immediately inviting;
• Did not smell like “airplane food”

22. Integrated Inter-generational Space
• Most often, seniors residences are cordoned
off from other places….
– In Norway we observed in a home that also
housed the local library, community centre, space
for childrens’ programming…
– In what ways could inter-generational space be
incorporated into your vision?

23. Learning space
• Make learning and evaluation part of the
space
– Think about ways to bring in schools for
volunteering and higher education for research &
learning
• Allow staff and others to see your world from the inside
– Space in residence….
» Artists, philosophers, athletes, researchers, poets......

24. Designing for Outdoors
• A community in
Copenhagen
“Big 8” is
designed for
using the
outdoors

25. Think BIG…8
Danish Architect: Bjarke Ingels: People can bike all the way from the street up to the 10th story

26. …the garden was developed 12 years ago when the facility was operated by the city. A
landscape gardener was hired and designed the garden based on a modern version of
an old monastery garden. Divided into four sections and 2,500 square meters, it is
centered around a fountain with fish…and an 18th century gazebo (heated all year and
including seats as well as a tablecloth covered round table) intended to emphasize
openness. The idea is to stimulate all the senses and bring people outside every day,
escaping from the inside harsh light, shiny floors and noisy halls of the nursing home.
The green house has a table and chairs, a great place to sit in the rain, have coffee,
and hear the rain on the roof. The manicured grass is intended for barefoot walking,
which should encourage balance (although we wondered if workers have time to help
put shoes on and off there). Meadows around the edges are designed to follow the
sun, the paths of fine gravel are intended to sound like roads and the wood chip ones
to encourage balance maintenance. The stone ones are easy to use with wheel chairs
and are cleared all winter. All are designed for safety. You can have a glass of wine
here and come to a peaceful end, he said. Candles can brighten the garden in winter.
-- Physical Environments for Long-term Care

27. Summary: Designing for Seniors
• Emphasize choice
• Integrate the space into the community…
– bring the community in
• Design around the key aspects of living
– Make food central....and unit specific
– Bring the arts in
– Allow for spaces to reflect the residents...the ”bike
workshop”

28. “
Connecting with York Research

29. “
http://yucare.info.yorku.ca/

30. www.policyalternatives.ca

31. CONTACT INFO:
DR. TAMARA DALY, PH.D.
CIHR RESEARCH CHAIR IN GENDER, WORK & HEALTH
DIRECTOR – YORK UNIVERSITY CENTRE FOR AGING RESEARCH & EDUCATION
ASSOCIATE PROFESSOR, FACULTY OF HEALTH
YORK UNIVERSITY
DALYT@YORKU.CA