There are benefits to thinking 'small' for Alberta continuing care facilities

The COVID-19 pandemic has shed light on the weaknesses of facility-based continuing care, such as nursing homes, in Canada and beyond.

• Photo above: Green House nursing homes house 10 to 12 residents who each have a private room and attached bath; share a central living space with an open kitchen, dining, and living area; and have access to outdoor space.

Massive outbreaks of the virus led to more than 80 per cent of Canadian COVID-19 deaths occurring in these facilities during the first wave of the pandemic, from March to August 2020.

On Dec. 9, the Brenda Strafford Centre on Aging, a program within the O’Brien Institute for Public Health at the Cumming School of Medicine (CSM), will convene a panel of international and local experts to discuss solutions to this challenge.

Improving the delivery of care at these facilities is now a necessity, says Susan Ryan, director of the non-profit Green House Project, who will speak at the event.

“We must fundamentally change the way we provide elder care because we absolutely cannot have a repeat of the illness and death that COVID-19 caused in nursing homes and other institutions,” says Ryan.

Comprised of a network of nearly 300 homes across the United States, which typically only serve 10 to 12 residents, the small size of Green House Project homes has played a key role in keeping COVID-19 outbreaks at bay, says Ryan. 

Through July 2020, the Green House Project reported its homes had just 32.5 positive cases per 1,000 residents, almost five times fewer than the United States average for continuing care facilities. Deaths from COVID-19 were also low — Green House homes saw fewer than three deaths per 1,000 residents, about 14 times fewer than the national average.

“The pandemic must be the wake-up call to finally take action,” says Ryan. 

A need for new care delivery models

Long-simmering issues in facility-based continuing care, such as resident isolation and mental health, staffing, oversight and ability to deal effectively with infectious disease outbreaks, point to the urgent need for new care delivery models.

As COVID-19 continues to impact society, many are advocating for the small homes continuing care concept, says Dr. David Hogan, MD, academic lead of the Centre on Aging.

A recent government review of facility-based continuing care in Alberta recommends a target of creating approximately 1,600 small home spaces in Alberta by 2030. Hogan says the next step is to unpack what this means and remove barriers.

“If it was easy, we would be there now and not at the starting line,” says Hogan, a professor in the departments of Medicine and Community Health Sciences, and a member of the O’Brien Institute and the Hotchkiss Brain Institute at the CSM.     

Learning about the Green House model, and the growing body of evidence that supports it, will help flesh out some of the challenges and opportunities Alberta faces as it moves to implement a small home approach, says Hogan.

“This is an opportunity to come together and explore the mounting evidence that small homes, where person-centred care can be provided to continuing care residents in a home-like environment, does in fact lead to better care and improved quality of life,” he says.

While there are some small home model continuing care facilities already in operation in Alberta and Canada, the pandemic has increased support for expanding what is currently available says Kim Brundrit, with Dementia Network Calgary, who will also take part in the Dec. 9 event.

After seeing what was unfolding in Canada’s traditional continuing care facilities, Dementia Network Calgary decided early in the pandemic to explore alternatives, such as the small home model.

In the new year, Dementia Network Calgary plans to meet with Alberta policy-makers to discuss what they’ve learned from meeting with current small home operators, and from families impacted by dementia whose loved ones would reside in the facilities.

“The benefits are clear, but there is a cost involved. Our hope is that policy-makers take action to reduce or remove the barriers to making this model sustainable,” says Brundrit.

Hogan says he is optimistic to see a swell of government and public interest in reimagining the care older adults receive.

Despite the barriers, Albertans have a stake in developing an equitable and sustainable continuing care system that will humanely meet the needs of those who use it, he says.  

“Facility-based continuing care is where many of our parents, other family members, friends, and neighbours now live, and ultimately this is where many of us will reside — we are all in this together,” says Hogan.

Register for Thinking “Small” for Facility-Based Continuing Care in Alberta, Dec. 9, 6:30 to 8 p.m.